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Sample records for multiple jet-droplet impacts

  1. Multiple impacts in dissipative granular chains

    Nguyen, Ngoc Son

    2014-01-01

    The extension of collision models for single impacts between two bodies, to the case of multiple impacts (which take place when several collisions occur at the same time in a multibody system) is a challenge in Solid Mechanics, due to the complexity of such phenomena, even in the frictionless case. This monograph aims at presenting the main multiple collision rules proposed in the literature. Such collisions typically occur in granular materials, the simplest of which are made of chains of aligned balls. These chains are used throughout the book to analyze various multiple impact rules which extend the classical Newton (kinematic restitution), Poisson (kinetic restitution) and Darboux-Keller (energetic or kinetic restitution) approaches for impact modelling. The shock dynamics in various types of chains of aligned balls (monodisperse, tapered, decorated, stepped chains) is carefully studied and shown to depend on several parameters: restitution coefficients, contact stiffness ratios, elasticity coefficients (...

  2. Multiplicity distributions in impact parameter space

    Wakano, Masami

    1976-01-01

    A definition for the average multiplicity of pions as a function of momentum transfer and total energy in the high energy proton-proton collisions is proposed by using the n-pion production differential cross section with the given momentum transfer from a proton to other final products and the given energy of the latter. Contributions from nondiffractive and diffractive processes are formulated in a multi-Regge model. We define a relationship between impact parameter and momentum transfer in the sense of classical theory for inelastic processes and we obtain the average multiplicity of pions as a function of impact parameter and total energy from the corresponding quantity afore-mentioned. By comparing this quantity with the square root of the opaqueness at given impact parameter, we conclude that the overlap of localized constituents is important in determining the opaqueness at given impact parameter in a collision of two hadrons. (auth.)

  3. Survivability of systems under multiple factor impact

    Korczak, Edward; Levitin, Gregory

    2007-01-01

    The paper considers vulnerable multi-state series-parallel systems operating under influence of external impacts. Both the external impacts and internal failures affect system survivability, which is determined as the probability of meeting a given demand. The external impacts are characterized by several destructive factors affecting the system or its parts simultaneously. In order to increase the system's survivability a multilevel protection against the destructive factors can be applied to its subsystems. In such systems, the protected subsystems can be destroyed only if all of the levels of their protection are destroyed. The paper presents an algorithm for evaluating the survivability of series-parallel systems with arbitrary configuration of multilevel protection against multiple destructive factor impacts. The algorithm is based on a composition of Boolean and the Universal Generating Function techniques. Illustrative examples are presented

  4. Patterned Armor Performance Evaluation for Multiple Impacts

    De

    2003-01-01

    .... Performance characteristics of an ideal patterned armor with respect to multiple hits are discussed, and the types of single-shot ballistic data needed to quantify that performance are presented...

  5. Rasch analysis of the Multiple Sclerosis Impact Scale (MSIS-29)

    Ramp, Melina; Khan, Fary; Misajon, Rose Anne; Pallant, Julie F

    2009-01-01

    Abstract Background Multiple Sclerosis (MS) is a degenerative neurological disease that causes impairments, including spasticity, pain, fatigue, and bladder dysfunction, which negatively impact on quality of life. The Multiple Sclerosis Impact Scale (MSIS-29) is a disease-specific health-related quality of life (HRQoL) instrument, developed using the patient's perspective on disease impact. It consists of two subscales assessing the physical (MSIS-29-PHYS) and psychological (MSIS-29-PSYCH) im...

  6. Multiple ionization of atoms by ion impact

    DuBois, R.D.

    1988-01-01

    In order to model the energy deposition of fast ions as they slow down in gaseous media, information about the ionization occurring in collisions between ions and target atoms/molecules is required. Our measurements of doubly differential electron emission cross sections provide detailed information about the ionization process but do not provide any information about the final states of the target. They also do not distinguish between the emission of one or more target electrons in a single collision. It is important to know the relative importance of multiple-, with respect to single-, target ionization in order to accurately model the energy deposition. To date, multiple ionization of He, Ne, Ar, Kr, and Xe targets has been studied. Primarily, H and He ions were used, although some data for heavier ions (C,N and O) have also been obtained

  7. Assessing the Impacts of Multiple Breadbasket Failures

    Casellas Connors, J. P.; Janetos, A.

    2016-12-01

    A relatively small area of the world accounts for a large proportion of total global cereal production, with most of the area devoted to the production of the world's three major cereal crops, rice, wheat and maize. An extensive literature of the sensitivity of agricultural productivity of these crops, and many others, has arisen over the past 25 years, with a general consensus that continued change in the physical climate system will very likely increase the difficulty of agricultural production in areas of the world that are already marginal with respect to production. But what this research only rarely does is assess the influence of extreme events in shocking agricultural production, and how the rest of the agricultural system reacts, in terms of prices, food insecurity, subsequent land-use change, and terrestrial carbon emissions, among many other possible responses. Because the agricultural system is interlinked with energy systems, food distribution and transportation systems, and economic systems, models that focus only on agricultural productivity can only provide a unidimensional view of the magnitude of potential impacts. We know such impacts can occur as a consequence of extreme climatic events, because they have - the impact of the severe regional drought and heat wave on the Russian and Ukrainian wheat harvests in 2010 had global consequences for food prices, just as one example. In this paper, we use an Integrated Assessment Model, the Global Change Assessment Model (GCAM), to investigate the potential outcomes of both moderate and severe shocks to agricultural productivity in the major breadbaskets of the world - both singly and in combination. The results demonstrate clearly that there are likely to be multidimensional consequences from the kinds of shocks that are possible from a rapidly changing climate system, especially when combined with other demographic and economic trends in the coming decades. These results are only one aspect of

  8. Impact of Pilates Exercise in Multiple Sclerosis

    Duff, Whitney R.D.; Andrushko, Justin W.; Renshaw, Doug W.; Chilibeck, Philip D.; Farthing, Jonathan P.; Danielson, Jana

    2018-01-01

    Abstract Background: Pilates is a series of exercises based on whole-body movement and may improve mobility in people with multiple sclerosis (MS). The purpose of this study was to determine the effect of Pilates on walking performance in people with MS. Methods: 30 individuals with MS who were not restricted to a wheelchair or scooter (Patient-Determined Disease Steps scale score Pilates (twice weekly) and massage therapy (once weekly) or once-weekly massage therapy only (control group). The Pilates was delivered in a group setting (five to ten participants per session). The primary outcome was change in walking performance (6-Minute Walk Test) after 12 weeks. Secondary outcomes included functional ability (Timed Up and Go test), balance (Fullerton Advanced Balance Scale), flexibility (sit and reach test), body composition (dual-energy X-ray absorptiometry), core endurance (plank-hold test), and muscle strength and voluntary activation (quadriceps). Intention-to-treat analysis was performed using a two-factor repeated-measures analysis of variance. Results: Walking distance increased by a mean (SD) of 52.4 (40.2) m in the Pilates group versus 15.0 (34.1) m in the control group (group × time, P = .01). Mean (SD) time to complete the Timed Up and Go test decreased by 1.5 (2.8) seconds in the Pilates group versus an increase of 0.3 (0.9) seconds in the control group (group × time, P = .03). There were no other significant differences between groups over time. Conclusions: Pilates improved walking performance and functional ability in persons with MS and is a viable exercise option to help manage the disease. PMID:29670495

  9. Impact strength of small icy bodies that experienced multiple collisions

    Yasui, Minami; Hayama, Ryo; Arakawa, Masahiko

    2014-05-01

    Frequent collisions are common for small bodies in the Solar System, and the cumulative damage to these bodies is thought to significantly affect their evolution. It is important to study the effects of multiple impacts such as the number of impacts on the impact strength and the ejection velocity of impact fragments. Here we conducted multiple-impact experiments using a polycrystalline water ice target, varying the number of impacts from 1 to 10 times. An ice cylindrical projectile was impacted at 84-502 m s-1 by using a single-stage gas gun in a cold room between -10 and -15 °C. The impact strength of the ice target that experienced a single impact and multiple impacts is expressed by the total energy density applied to the same target, ΣQ, and this value was observed to be 77.6 J kg-1. The number of fine impact fragments at a fragment mass normalized by an initial target mass, m/Mt0 ∼ 10-6, nm, had a good correlation with the single energy density at each shot, Qj, and the relationship was shown to be nm=10·Qj1.31±0.12. We also estimated the cumulative damage of icy bodies as a total energy density accumulated by past impacts, according to the crater scaling laws proposed by Housen et al. (Housen, K.R., Schmidt, R.M., Holsapple, K.A. [1983]. J. Geophys. Res. 88, 2485-2499) of ice and the crater size distributions observed on Phoebe, a saturnian icy satellite. We found that the cumulative damage of Phoebe depended significantly on the impact speed of the impactor that formed the craters on Phoebe; and the cumulative damage was about one-third of the impact strength ΣQ* at 500 m s-1 whereas it was almost zero at 3.2 km s-1.

  10. The impact of comorbidity on mortality in multiple myeloma

    Gregersen, Henrik; Vangsted, Annette Juul; Abildgaard, Niels

    2017-01-01

    To describe the prevalence of comorbidity and its impact on survival in newly diagnosed multiple myeloma patients compared with population controls. Cases of newly diagnosed symptomatic multiple myeloma during the 2005-2012 period were identified in the Danish National Multiple Myeloma Registry....... For each myeloma patient, 10 members of the general population matched by age and sex were chosen from the national Civil Registration System. Data on comorbidity in the myeloma patients and the general population comparison cohort were collected by linkage to the Danish National Patient Registry (DNPR......). Cox proportional hazards regression models were used to evaluate the prognostic significance of comorbidity. The study included 2190 cases of multiple myeloma and 21,900 population controls. The comorbidity was increased in multiple myeloma patients compared with population controls, odds ratio (OR) 1...

  11. Successful treatment of multiple bilateral impactions - a case report

    Schubert, Michael; Proff, Peter; Kirschneck, Christian

    2016-01-01

    Background Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. Case presentation In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of th...

  12. Multiple electron processes of He and Ne by proton impact

    Terekhin, Pavel Nikolaevich; Montenegro, Pablo; Quinto, Michele; Monti, Juan; Fojon, Omar; Rivarola, Roberto

    2016-05-01

    A detailed investigation of multiple electron processes (single and multiple ionization, single capture, transfer-ionization) of He and Ne is presented for proton impact at intermediate and high collision energies. Exclusive absolute cross sections for these processes have been obtained by calculation of transition probabilities in the independent electron and independent event models as a function of impact parameter in the framework of the continuum distorted wave-eikonal initial state theory. A binomial analysis is employed to calculate exclusive probabilities. The comparison with available theoretical and experimental results shows that exclusive probabilities are needed for a reliable description of the experimental data. The developed approach can be used for obtaining the input database for modeling multiple electron processes of charged particles passing through the matter.

  13. Successful treatment of multiple bilateral impactions - a case report.

    Schubert, Michael; Proff, Peter; Kirschneck, Christian

    2016-07-25

    Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of the deciduous and surgical exposure of the impacted permanent teeth, the Easy-Way-Coil™ system was used in conjunction with a skeletal anchorage (maxilla, BENEfit™ system) to guide the eruption of all impacted teeth. After a total treatment time of only 22.8 months all impacted teeth could be aligned successfully and a stable and functional class I occlusion was achieved. In addition, there were no adverse treatment effects such as anchorage loss, root resorptions or periodontal problems and an esthetic result could be achieved. The presented treatment approach thus proved to be highly effective in cases with multiple bilateral impactions with minimal side effects and considerably reduced treatment time.

  14. Mucoid impaction presenting as multiple pulmonary nodules in cystic fibrosis

    Carpenter, L.D.; Lambie, N.K.; Wilsher, M.L.

    1996-01-01

    Mucoid impaction has been described as a complication of asthma and more commonly in patients with allergic bronchopulmonary aspergillosis. In such cases, the impacted pools of mucus may present as discrete nodules on chest X-ray and hence simulate the appearance of metastatic malignancy. A case of mucoid impaction presenting as multiple pulmonary nodules in a patient with cystic fibrosis is described. The chest X-ray showed hyperinfiltration and scattered changes consistent with bronchiectasis. Computed tomography scan confirmed these and additional intra-pulmonary nodular densities. This report illustrates that mucus impaction as a cause of pulmonary nodules should be considered in any patient with chronic lung disease characterised by excess mucus production. 6 refs., 3 figs

  15. Numerical study of impact erosion of multiple solid particle

    Zheng, Chao; Liu, Yonghong; Chen, Cheng; Qin, Jie; Ji, Renjie; Cai, Baoping

    2017-11-01

    Material erosion caused by continuous particle impingement during hydraulic fracturing results in significant economic loss and increased production risks. The erosion process is complex and has not been clearly explained through physical experiments. To address this problem, a multiple particle model in a 3D configuration was proposed to investigate the dynamic erosion process. This approach can significantly reduce experiment costs. The numerical model considered material damping and elastic-plastic material behavior of target material. The effects of impact parameters on erosion characteristics, such as plastic deformation, contact time, and energy loss rate, were investigated. Based on comprehensive studies, the dynamic erosion mechanism and geometry evolution of eroded crater was obtained. These findings can provide a detailed erosion process of target material and insights into the material erosion caused by multiple particle impingement.

  16. Single and multiple ionization of sulfur atoms by electron impact

    Ziegler, D.L.

    1982-01-01

    Laboratory measurements of the cross sections for single, double, triple, and quadruple ionization of sulfur atoms by electron impact are presented for collision energies from threshold to 500 eV. The cross sections for single ionization of sulfur are measured relative to those of several elements whose absolute cross sections for single ionization are known. Cross sections for each multiple ionization process are then measured relative to those for single ionization. The configuration and operation of the apparatus for these measurements are described. The possible effects of excited sulfur reactants are examined, and the reported cross sections are felt to be characteristic of ground state sulfur atoms

  17. Improved patient-reported health impact of multiple sclerosis

    Macdonell, Richard; Nagels, Guy; Laplaud, David-Axel

    2016-01-01

    BACKGROUND: Multiple sclerosis (MS) is a debilitating disease that negatively impacts patients' lives. OBJECTIVE: ENABLE assessed the effect of long-term prolonged-release (PR) fampridine (dalfampridine extended release in the United States) treatment on patient-perceived health impact in patients...... with MS with walking impairment. METHODS: ENABLE was a 48-week, open-label, Phase 4 study of PR-fampridine 10 mg twice daily. Patients who showed any improvement in Timed 25-Foot Walk walking speed at weeks 2 and 4 and any improvement in 12-item MS Walking Scale score at week 4 remained on treatment....... The primary endpoint was change from baseline in 36-Item Short-Form Health Survey (SF-36) physical component summary (PCS) score. RESULTS: At week 4, 707/901 (78.5%) patients met the criteria to remain on treatment. Patients on treatment demonstrated significant and clinically meaningful improvements in SF-36...

  18. Rasch analysis of the Multiple Sclerosis Impact Scale (MSIS-29

    Misajon Rose

    2009-06-01

    Full Text Available Abstract Background Multiple Sclerosis (MS is a degenerative neurological disease that causes impairments, including spasticity, pain, fatigue, and bladder dysfunction, which negatively impact on quality of life. The Multiple Sclerosis Impact Scale (MSIS-29 is a disease-specific health-related quality of life (HRQoL instrument, developed using the patient's perspective on disease impact. It consists of two subscales assessing the physical (MSIS-29-PHYS and psychological (MSIS-29-PSYCH impact of MS. Although previous studies have found support for the psychometric properties of the MSIS-29 using traditional methods of scale evaluation, the scale has not been subjected to a detailed Rasch analysis. Therefore, the objective of this study was to use Rasch analysis to assess the internal validity of the scale, and its response format, item fit, targeting, internal consistency and dimensionality. Methods Ninety-two persons with definite MS residing in the community were recruited from a tertiary hospital database. Patients completed the MSIS-29 as part of a larger study. Rasch analysis was undertaken to assess the psychometric properties of the MSIS-29. Results Rasch analysis showed overall support for the psychometric properties of the two MSIS-29 subscales, however it was necessary to reduce the response format of the MSIS-29-PHYS to a 3-point response scale. Both subscales were unidimensional, had good internal consistency, and were free from item bias for sex and age. Dimensionality testing indicated it was not appropriate to combine the two subscales to form a total MSIS score. Conclusion In this first study to use Rasch analysis to fully assess the psychometric properties of the MSIS-29 support was found for the two subscales but not for the use of the total scale. Further use of Rasch analysis on the MSIS-29 in larger and broader samples is recommended to confirm these findings.

  19. Rasch analysis of the Multiple Sclerosis Impact Scale (MSIS-29)

    Ramp, Melina; Khan, Fary; Misajon, Rose Anne; Pallant, Julie F

    2009-01-01

    Background Multiple Sclerosis (MS) is a degenerative neurological disease that causes impairments, including spasticity, pain, fatigue, and bladder dysfunction, which negatively impact on quality of life. The Multiple Sclerosis Impact Scale (MSIS-29) is a disease-specific health-related quality of life (HRQoL) instrument, developed using the patient's perspective on disease impact. It consists of two subscales assessing the physical (MSIS-29-PHYS) and psychological (MSIS-29-PSYCH) impact of MS. Although previous studies have found support for the psychometric properties of the MSIS-29 using traditional methods of scale evaluation, the scale has not been subjected to a detailed Rasch analysis. Therefore, the objective of this study was to use Rasch analysis to assess the internal validity of the scale, and its response format, item fit, targeting, internal consistency and dimensionality. Methods Ninety-two persons with definite MS residing in the community were recruited from a tertiary hospital database. Patients completed the MSIS-29 as part of a larger study. Rasch analysis was undertaken to assess the psychometric properties of the MSIS-29. Results Rasch analysis showed overall support for the psychometric properties of the two MSIS-29 subscales, however it was necessary to reduce the response format of the MSIS-29-PHYS to a 3-point response scale. Both subscales were unidimensional, had good internal consistency, and were free from item bias for sex and age. Dimensionality testing indicated it was not appropriate to combine the two subscales to form a total MSIS score. Conclusion In this first study to use Rasch analysis to fully assess the psychometric properties of the MSIS-29 support was found for the two subscales but not for the use of the total scale. Further use of Rasch analysis on the MSIS-29 in larger and broader samples is recommended to confirm these findings. PMID:19545445

  20. Multiple Transcoding Impact on Speech Quality in Ideal Network Conditions

    Martin Mikulec

    2015-01-01

    Full Text Available This paper deals with the impact of transcoding on the speech quality. We have focused mainly on the transcoding between codecs without the negative influence of the network parameters such as packet loss and delay. It has ensured objective and repeatable results from our measurement. The measurement was performed on the Transcoding Measuring System developed especially for this purpose. The system is based on the open source projects and is useful as a design tool for VoIP system administrators. The paper compares the most used codecs from the transcoding perspective. The multiple transcoding between G711, GSM and G729 codecs were performed and the speech quality of these calls was evaluated. The speech quality was measured by Perceptual Evaluation of Speech Quality method, which provides results in Mean Opinion Score used to describe the speech quality on a scale from 1 to 5. The obtained results indicate periodical speech quality degradation on every transcoding between two codecs.

  1. Impact on healthcare resource utilization of multiple sclerosis in Spain.

    Sicras-Mainar, Antoni; Ruíz-Beato, Elena; Navarro-Artieda, Ruth; Maurino, Jorge

    2017-12-29

    Multiple sclerosis (MS) is a chronic disease with a high socioeconomic impact. The aim of this study was to assess healthcare resources utilization and costs in a sample of patients with MS. A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Asturias and Catalonia, Spain. Adult patients diagnosed with MS were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0-3.5 (no-moderate disability) and 4-9.5 (severe disability). Healthcare (direct cost) and non-healthcare costs (work productivity losses) were analysed. An analysis of covariance (ANCOVA) was used for correction, p < 0.05. A multiple regression model was performed to obtain the variables associated with costs. A total of 222 patients were analyzed; mean (SD) age: 45.5 (12.5) years, 64.4% female, and 62.2% presented a diagnosis of relapsing-remitting MS. Median EDSS score was 2.5, with 68.5% of the patients with no to moderate disability. The mean annual cost per MS patient was €25,103. For no-moderate and severe disability, the ANCOVA-adjusted mean annual cost was €23,157 and €29,242, respectively (p = 0.013). Direct costs and MS disease-modifying therapy accounted for 39.4% and 31.7% of the total costs, respectively. The total costs were associated with number of relapses (β = 0.135, p = 0.001), time since diagnosis (β = 0.281, p = 0.023), and age (β = 0.198, p = 0.037). Multiple sclerosis imposes a substantial economic burden on the Spanish National Health System, patients and society as a whole. Costs significantly correlated with disease progression.

  2. Economic impact of the new oral treatments for multiple sclerosis.

    Álvarez Ayuso, L; Rodríguez Marrodán, B; Blasco Quílez, M R; García-Merino, J A; Sánchez Guerrero, A

    2018-01-11

    Multiple sclerosis (MS) is a chronic disease affecting the central nervous system and is characterised by inflammation, demyelination, gliosis, and axonal damage. The introduction of dimethyl fumarate and teriflunomide has led to an increase in the number of alternative first-line therapies for MS. The objective of this study was to evaluate the economic impact of the incorporation of new oral therapies at the reference unit (CSUR) at Hospital Universitario Puerta de Hierro Majadahonda. We performed a retrospective observational study including patients diagnosed with MS, who underwent treatment with disease-modifying drugs in 2015 and were followed up for a minimum mean time of one year. Data were collected from patients' electronic clinical histories and the pharmacy service's programme for dispensing drugs to outpatients. Evaluating the cost of changing 125 patients' treatment from other drugs to dimethyl fumarate and teriflunomide, and comparing this with the cost that would have resulted from maintaining their previous treatment, demonstrated a total saving of €169,107.31 over the study period. In addition to contributing new therapeutic alternatives, dimethyl fumarate and teriflunomide produced an economic saving in MS treatment at our hospital. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. [Multiple sclerosis: socioeconomic effects and impact on quality of life].

    Ayuso, Guillermo Izquierdo

    2014-12-01

    Multiple sclerosis (MS) is a disease of the central nervous system (CNS) that affects young adults. Survival is long, more than 35 years, and consequently the disease has a huge socioeconomic impact. The present article discusses the enormous difficulties of carrying out economic assessments in this field but also describes the advances made in research on this topic and the advantages of performing socioeconomic evaluations with increasingly sophisticated tools. We also discuss the need to quantify indirect and intangible costs to translate them into quality of life and subsequently into economic cost, expressed in euros in the case of Spain. The available data indicate that the enormous cost of the disease (1200 million euros per year) is due more to disability-related expenditure than to treatment, which-although expensive-does not represent more than 16-18% of the total expenditure (approximately 200 million euros per year). The increase represented by the cost of MS is not based on higher treatment expenditure but on an increase in the incidence and-especially-the prevalence of the disease. Above all, in the last few years, there has been a considerable rise in the percentage of patients with an indication for treatment. Reflection is therefore needed on the use of drug therapy in MS, since a saving in the most effective products seems to increase the overall cost of MS, while expenditure on these drugs represents a saving in the long-term. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  4. Economic and clinical impact of multiple myeloma to managed care.

    Cook, Richard

    2008-09-01

    Because of the development of novel agents such as immunomodulators, proteasome inhibitors, and bisphosphonates, the standards of care for the multiple myeloma (MM) patient have changed. The costs associated with current and emerging therapies, as well as supportive care, are significant and pose a tremendous financial burden to both patients and managed care. To review the economic impact of MM and to weigh the advantages and disadvantages of current treatments in bringing value for prolonged life versus the cost of treatment. This chapter will also discuss the need for thorough data review and pharmacoeconomic analyses to determine the most cost-effective therapies. Although MM accounts for only a small percentage of all cancer types, the costs associated with treating and managing it are among the highest. Recent developments in diagnosing, treating, and managing myeloma have led to novel treatment strategies. Immunomodulators, proteasome inhibitors, and bisphosphonates are improving response rates and preserving quality of life. However, these agents are not replacing older treatment modalities, but being used in addition to them. Intensive chemotherapy, stem cell transplantation, and supportive care are all important components in achieving treatment goals. Costs associated with stem cell transplants and complications of the disease add to the economic burden of myeloma. Additional costs for routine diagnostics to measure the progression of the disease or response to treatment need to be considered. Complications (e.g., lytic bone disease, infection, anemia, and renal failure) also add to morbidity and mortality, thus increasing the burden to the patient and the health care system as a whole. Financial and time constraints of caregivers must also be considered, as well as the added administrative burdens to health care providers. New standards of care in the treatment and management of myeloma are likely to lead to significant increases in costs. Although

  5. Experimental and Analytical Investigations on Multiple Liquid Impact Erosion

    Thiruvengadam, A

    1969-01-01

    .... High speed motion pictures as well as conventional movie films with stroboscopic illumination were taken to show the phenomenon of liquid jet impact with the test material in a qualitative manner...

  6. Multiple Sclerosis: associated cardiometabolic risks and impact of exercise therapy

    Jacobs, Jasper

    2016-01-01

    Multiple sclerosis (MS) is characterized by complex heterogeneous symptoms, which often leads to a more sedentary lifestyle. This lifestyle increases the likelihood to develop secondary health problems, like cardiometabolic risk (CMR) profile. However, in other population these secondary health problems can be, partly, reversed by exercise therapy. We hypothesized that MS affects the CMR profile, but the outcome can be reversed following exercise therapy. Persons with MS and matched healthy c...

  7. Impact if hyperprolific line of litter size in multiplication herd

    Zdeněk Tvrdoň

    2009-01-01

    Full Text Available The hyperprolific line is considered to be maximally effective in pursuit of progress in sow’s reproduction. Hyperprolific line efficiency is commonly evaluated in regard of breeding herd progress. We decided to study how effective it is with respect to increasing of litter size in multiplication herd. Our study is specific by using the data from practice, concretely it is based on the information about the ancestor of sows in multiplication herd. The ancestors could be the member either hyperprolific line or normal line. The information about performances of sows breed in multiplication herd was known. The mixed linear models in SAS for Windows 9.1.2. were conducted to statistical analysis. Our results indicated that no significant effect on litter size was achieved by selection criteria used in the hyperprolific line creation. In studied population no differences between TNB, NBA or NW were found on the 1st as well as on the 1st–5th litters. As we have mentioned above, the study is specific by using the data from practice. Therefore the studied population size is limited. It is necessary to take into consideration when the results are applied. Nevertheless, the results shown that other studies with larger population should be done to reevaluate the selection criteria.

  8. Brain atrophy in multiple sclerosis: therapeutic, cognitive and clinical impact

    Juan Ignacio Rojas

    2016-03-01

    Full Text Available ABSTRACT Multiple sclerosis (MS was always considered as a white matter inflammatory disease. Today, there is an important body of evidence that supports the hypothesis that gray matter involvement and the neurodegenerative mechanism are at least partially independent from inflammation. Gray matter atrophy develops faster than white matter atrophy, and predominates in the initial stages of the disease. The neurodegenerative mechanism creates permanent damage and correlates with physical and cognitive disability. In this review we describe the current available evidence regarding brain atrophy and its consequence in MS patients.

  9. Variations in multiple birth rates and impact on perinatal outcomes in Europe

    Heino, A.; Gissler, M.; Hindori-Mohangoo, A.D.; Blondel, B.; Klungsøyr, K.; Verdenik, I.; Mierzejewska, E.; Velebil, P.; Sól Ólafsdóttir, H.; Macfarlane, A.; Zeitlin, J.; et al.

    2016-01-01

    Objective. Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse

  10. The impacts of multiple stressors to model ecological structures

    Landis, W.G.; Kelly, S.A.; Markiewicz, A.J.; Matthews, R.A.; Matthews, G.B.

    1995-01-01

    The basis of the community conditioning hypothesis is that ecological structures are the result of their unique etiology. Systems that have been exposed to a variety of stressors should reflect this history. The authors how conducted a series of microcosm experiments that can compare the effects of multiple stressors upon community dynamics. The microcosm protocols are derived from the Standardized Aquatic Microcosm (SAM) and have Lemma and additional protozoan species. Two multiple stressor experiments have been conducted. In an extended length SAM (ELSAM), two of four treatments were dosed with the turbine fuel JP-8 one week into the experiment. Two treatments were later exposed to the heat stress, one that had received jet fuel and one that had not. Similarly, an ELSAM was conducted with the second stressor being the further addition of JP-8 replacing the heat shock. Biological, physical and chemical data were analyzed with multivariate techniques including nonmetric clustering and association analysis. Space-time worms and phase diagrams were also employed to ascertain the dynamic relationships of variables identified as important by the multivariate techniques. The experiments do not result in a simple additive linear response to the additional stressor. Examination of the relative population dynamics reveal alterations in trajectories that suggest treatment related effects. As in previous single stressor experiments, recovery does not occur even after extended experimental periods. The authors are now attempting to measure the resulting trajectories, changes in similarity vectors and overall dynamics. However, community conditioning does appear to be an important framework in understanding systems with a heterogeneous array of stressors

  11. Multiple Sclerosis impact on employment and income in New Zealand.

    Pearson, J F; Alla, S; Clarke, G; Mason, D F; Anderson, T; Richardson, A; Miller, D H; Sabel, C E; Abernethy, D A; Willoughby, E W; Taylor, B V

    2017-09-01

    We investigated the demographic, social and clinical characteristics associated with employment status and income for people with multiple sclerosis (MS) in New Zealand (NZ). The NZ National MS Prevalence study included all persons resident in NZ on census day 2006 diagnosed with MS (96.7% coverage). Factors associated with employment and income status among the working age population (25-64 years) were identified by linear regression. Over 90% of working age people with MS (n=1727) had a work history, but 54% were not working. Work loss occurred early in the disease course, and at low disability (Pincome than the NZ population (Pincome for MS females and about half the additional income for MS males (Pincome early in the disease course, and at low levels of disability, however, unemployment is not entirely accounted for by clinical, social and demographic factors. These findings suggest social supports should be explored early in the disease course to reduce loss of income and unemployment for people with MS. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. The Normative Impact of Consumer Price Expectations for Multiple Brands on Consumer Purchase Behavior

    Aradhna Krishna

    1992-01-01

    Empirical research indicates that some consumers form price expectations which may impact their purchase behavior. While literature in operations research has built purchase policy models incorporating uncertain price expectations, these models have been built for commodities. Consumers face an environment with multiple brands. In this paper, we develop a model that incorporates consumer preferences and price expectations for multiple brands as determinants of normative consumer purchase beha...

  13. Multiple ionization produced in Yb due to N-,Si- and Ti-ion impact

    Verma, P.

    2000-01-01

    Heavy ion induced inner shell ionization produces multiple vacancies in the outer shells (M, N etc.) simultaneous to vacancies in the inner-shells (viz. L-shell), which in turn create a very complicated electronic configuration. Three projectiles N 2+,3+ , Si 7+,8+ and Ti 10+,11+ ion beams having a range of 0.3 to 3.5 MeV/u were bombarded on a thin rare earth target of Yb. The recorded L X-ray spectra of Yb have been analyzed in the light of multiple ionization produced due to the heavy ion impact. The outer-shell vacancies acting as spectator vacancies cause a shift in the energy of the various L X-ray diagram lines. A comparison of the shifts in the energies of the various L X-ray transitions of Yb due to the impact of these projectiles, from standard values and that due to proton impact along with the deviation of the intensity ratios from single hole branching ratios, reveal a dependence of multiple ionization on the projectile atomic number (Z) and energy. A further comparison of the degree of multiple ionization produced in Yb, evident by the number of spectator vacancies produced due to the impact of projectiles with 7≤Z≤22 and overlapping MeV/u range lead to explicit conclusions regarding the probability of multiple vacancy production in outer shells simultaneous to a single L-shell vacancy for such projectile target combinations. (orig.)

  14. The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study.

    Hoonakker, Peter L T; Carayon, Pascale; Cartmill, Randi S

    2017-04-01

    Secure messaging is a relatively new addition to health information technology (IT). Several studies have examined the impact of secure messaging on (clinical) outcomes but very few studies have examined the impact on workflow in primary care clinics. In this study we examined the impact of secure messaging on workflow of clinicians, staff and patients. We used a multiple case study design with multiple data collections methods (observation, interviews and survey). Results show that secure messaging has the potential to improve communication and information flow and the organization of work in primary care clinics, partly due to the possibility of asynchronous communication. However, secure messaging can also have a negative effect on communication and increase workload, especially if patients send messages that are not appropriate for the secure messaging medium (for example, messages that are too long, complex, ambiguous, or inappropriate). Results show that clinicians are ambivalent about secure messaging. Secure messaging can add to their workload, especially if there is high message volume, and currently they are not compensated for these activities. Staff is -especially compared to clinicians- relatively positive about secure messaging and patients are overall very satisfied with secure messaging. Finally, clinicians, staff and patients think that secure messaging can have a positive effect on quality of care and patient safety. Secure messaging is a tool that has the potential to improve communication and information flow. However, the potential of secure messaging to improve workflow is dependent on the way it is implemented and used. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Impact of the 'non-destructive' multiple-readout on the Lorentzian noise

    Guazzoni, C.; Gatti, E.; Geraci, A.

    2006-01-01

    In this paper, we discuss the effect of 'non-destructive' multiple-readout on the Lorentzian noise. To our knowledge, it is the first time that such interaction is investigated. We have studied the peculiarities of the shape of the optimum weighting function for the multiple-readout technique in the presence of Lorentzian noise and other noise sources. The impact of the Lorentzian noise on the resolution achievable with the multiple-readout technique is analyzed in detail with respect to the interaction between the oscillation time and the characteristic time constant of the Lorentzian noise

  16. Multiple Representation Instruction First versus Traditional Algorithmic Instruction First: Impact in Middle School Mathematics Classrooms

    Flores, Raymond; Koontz, Esther; Inan, Fethi A.; Alagic, Mara

    2015-01-01

    This study examined the impact of the order of two teaching approaches on students' abilities and on-task behaviors while learning how to solve percentage problems. Two treatment groups were compared. MR first received multiple representation instruction followed by traditional algorithmic instruction and TA first received these teaching…

  17. Orthodontic Management with Traction and Asymmetric Extraction for Multiple Impacted Permanent Maxillary Teeth - A Case Report.

    Niu, Qiannan; Zhang, Liang; Dai, Juan; Li, Feifei; Feng, Xue

    2016-01-01

    Multiple impacted teeth are a rare eruption disturbance that increases the case complexity. In this article, we described a 13-year-old boy whose 5 permanent maxillary teeth were not erupted although their root formation was complete. The orthodontic treatment with traction and asymmetric extraction was performed to achieve a significantly improved functional and esthetic result.

  18. Nonsyndromic Bilateral Multiple Impacted Supernumerary Mandibular Third Molars: A Rare and Unusual Case Report

    G. Siva Prasad Reddy

    2013-01-01

    Full Text Available A supernumerary tooth is that which is present additionally to the normal series and can be found in any region of the dental arch. An impacted tooth is defined as the one which is embedded in the alveolus, so that its eruption is prevented, or the tooth is locked in position by bone or the adjacent teeth. The occurrence of multiple supernumerary teeth in only one patient in the absence of an associated systemic condition or syndrome is considered as a rare phenomenon. The occurrence of supernumerary teeth in the lower molar region is rare. A prevalence of less than 2% of cases occurring in this region has been estimated. Their occurrence presents a clinical problem for orthodontists and oral surgeons. The cause, frequency, complications, and surgical operation of impacted teeth are always interesting subjects for study and research. An impacted tooth can result in caries, pulp disease, periapical and periodontal disease, temporomandibular joint disorder, infection of the fascial space, root resorption of the adjacent tooth, and even oral and maxillofacial tumours. The management of impacted wisdom teeth has changed over the past 20 years from removal of nonsymptomatic third molars to simple observation. The aim of this paper is to present a rare case of bilateral multiple impacted supernumerary mandibular third molars.

  19. Accounting for multiple sources of uncertainty in impact assessments: The example of the BRACE study

    O'Neill, B. C.

    2015-12-01

    Assessing climate change impacts often requires the use of multiple scenarios, types of models, and data sources, leading to a large number of potential sources of uncertainty. For example, a single study might require a choice of a forcing scenario, climate model, bias correction and/or downscaling method, societal development scenario, model (typically several) for quantifying elements of societal development such as economic and population growth, biophysical model (such as for crop yields or hydrology), and societal impact model (e.g. economic or health model). Some sources of uncertainty are reduced or eliminated by the framing of the question. For example, it may be useful to ask what an impact outcome would be conditional on a given societal development pathway, forcing scenario, or policy. However many sources of uncertainty remain, and it is rare for all or even most of these sources to be accounted for. I use the example of a recent integrated project on the Benefits of Reduced Anthropogenic Climate changE (BRACE) to explore useful approaches to uncertainty across multiple components of an impact assessment. BRACE comprises 23 papers that assess the differences in impacts between two alternative climate futures: those associated with Representative Concentration Pathways (RCPs) 4.5 and 8.5. It quantifies difference in impacts in terms of extreme events, health, agriculture, tropical cyclones, and sea level rise. Methodologically, it includes climate modeling, statistical analysis, integrated assessment modeling, and sector-specific impact modeling. It employs alternative scenarios of both radiative forcing and societal development, but generally uses a single climate model (CESM), partially accounting for climate uncertainty by drawing heavily on large initial condition ensembles. Strengths and weaknesses of the approach to uncertainty in BRACE are assessed. Options under consideration for improving the approach include the use of perturbed physics

  20. Analysing the impact of multiple stressors in aquatic biomonitoring data: A 'cookbook' with applications in R.

    Feld, Christian K; Segurado, Pedro; Gutiérrez-Cánovas, Cayetano

    2016-12-15

    Multiple stressors threaten biodiversity and ecosystem integrity, imposing new challenges to ecosystem management and restoration. Ecosystem managers are required to address and mitigate the impact of multiple stressors, yet the knowledge required to disentangle multiple-stressor effects is still incomplete. Experimental studies have advanced the understanding of single and combined stressor effects, but there is a lack of a robust analytical framework, to address the impact of multiple stressors based on monitoring data. Since 2000, the monitoring of Europe's waters has resulted in a vast amount of biological and environmental (stressor) data of about 120,000 water bodies. For many reasons, this data is rarely exploited in the multiple-stressor context, probably because of its rather heterogeneous nature: stressors vary and are mixed with broad-scale proxies of environmental stress (e.g. land cover), missing values and zero-inflated data limit the application of statistical methods and biological indicators are often aggregated (e.g. taxon richness) and do not respond stressor-specific. Here, we present a 'cookbook' to analyse the biological response to multiple stressors using data from biomonitoring schemes. Our 'cookbook' includes guidance for the analytical process and the interpretation of results. The 'cookbook' is accompanied by scripts, which allow the user to run a stepwise analysis based on his/her own data in R, an open-source language and environment for statistical computing and graphics. Using simulated and real data, we show that the recommended procedure is capable of identifying stressor hierarchy (importance) and interaction in large datasets. We recommend a minimum number of 150 independent observations and a minimum stressor gradient length of 75% (of the most relevant stressor's gradient in nature), to be able to reliably rank the stressor's importance, detect relevant interactions and estimate their standardised effect size. We conclude with

  1. The clinical impact of cerebellar grey matter pathology in multiple sclerosis.

    Alfredo Damasceno

    Full Text Available BACKGROUND: The cerebellum is an important site for cortical demyelination in multiple sclerosis, but the functional significance of this finding is not fully understood. OBJECTIVE: To evaluate the clinical and cognitive impact of cerebellar grey-matter pathology in multiple sclerosis patients. METHODS: Forty-two relapsing-remitting multiple sclerosis patients and 30 controls underwent clinical assessment including the Multiple Sclerosis Functional Composite, Expanded Disability Status Scale (EDSS and cerebellar functional system (FS score, and cognitive evaluation, including the Paced Auditory Serial Addition Test (PASAT and the Symbol-Digit Modalities Test (SDMT. Magnetic resonance imaging was performed with a 3T scanner and variables of interest were: brain white-matter and cortical lesion load, cerebellar intracortical and leukocortical lesion volumes, and brain cortical and cerebellar white-matter and grey-matter volumes. RESULTS: After multivariate analysis high burden of cerebellar intracortical lesions was the only predictor for the EDSS (p<0.001, cerebellar FS (p = 0.002, arm function (p = 0.049, and for leg function (p<0.001. Patients with high burden of cerebellar leukocortical lesions had lower PASAT scores (p = 0.013, while patients with greater volumes of cerebellar intracortical lesions had worse SDMT scores (p = 0.015. CONCLUSIONS: Cerebellar grey-matter pathology is widely present and contributes to clinical dysfunction in relapsing-remitting multiple sclerosis patients, independently of brain grey-matter damage.

  2. The impact of embedding multiple modes of representation on student construction of chemistry knowledge

    McDermott, Mark Andrew

    2009-12-01

    This study was designed to examine the impact of embedding multiple modes of representing science information on student conceptual understanding in science. Multiple representations refer to utilizing charts, graphs, diagrams, and other types of representations to communicate scientific information. This study investigated the impact of encouraging students to embed or integrate the multiple modes with text in end of unit writing-to-learn activities. A quasi-experimental design with four separate sites consisting of intact chemistry classes taught by different teachers at each site was utilized. At each site, approximately half of the classes were designated treatment classes and students in these classes participated in activities designed to encourage strategies to embed multiple modes within text in student writing. The control classes did not participate in these activities. All classes participated in identical end of unit writing tasks in which they were required to use at least one mode other than text, followed by identical end of unit assessments. This progression was then repeated for a second consecutive unit of study. Analysis of quantitative data indicated that in several cases, treatment classes significantly outperformed control classes both on measures of embeddedness in writing and on end of unit assessment measures. In addition, analysis at the level of individual students indicated significant positive correlations in many cases between measures of student embeddedness in writing and student performance on end of unit assessments. Three factors emerged as critical in increasing the likelihood of benefit for students from these types of activities. First, the level of teacher implementation and emphasis on the embeddedness lessons was linked to the possibility of conceptual benefit. Secondly, students participating in two consecutive lessons appeared to receive greater benefit during the second unit, inferring a cumulative benefit. Finally

  3. Doubly differential single and multiple ionization of krypton by electron impact

    Lucio, O. G. de; Gavin, J.; DuBois, R. D.

    2007-01-01

    Differential measurements for single and multiple ionization of Kr by 240 and 500 eV electron impact are presented. Using a pulsed extraction field, Kr + , Kr 2+ , and Kr 3+ ions were measured in coincidence with scattered electrons for energy losses up to 120 eV and scattering angles between 16 degree sign and 90 degree sign . Scaling properties of the doubly differential cross sections (DDCS) are investigated as a function of energy loss, scattering angle, and momentum transfer. It is shown that scaling the DDCS as outlined by Kim and Inokuti and plotting them versus a parameter consisting of the momentum transfer divided by the square root of the impact energy times 1-cos(θ), where θ is the scattering angle, yielded similar curves, but with different magnitudes, for single and multiple ionization. Normalizing these curves together produced two universal curves, one appropriate for single and multiple electron emission at larger scattering angles (θ≥30 degree sign ) and one appropriate for small scattering angles (θ<30 degree sign )

  4. Meteorite impacts on ancient oceans opened up multiple NH3 production pathways.

    Shimamura, Kohei; Shimojo, Fuyuki; Nakano, Aiichiro; Tanaka, Shigenori

    2017-05-10

    A recent series of shock experiments by Nakazawa et al. starting in 2005 (e.g. [Nakazawa et al., Earth Planet. Sci. Lett., 2005, 235, 356]) suggested that meteorite impacts on ancient oceans would have yielded a considerable amount of NH 3 to the early Earth from atmospheric N 2 and oceanic H 2 O through reduction by meteoritic iron. To clarify the mechanisms, we imitated the impact events by performing multi-scale shock technique-based ab initio molecular dynamics in the framework of density functional theory in combination with multi-scale shock technique (MSST) simulations. Our previous simulations with impact energies close to that of the experiments revealed picosecond-order rapid NH 3 production during shock compression [Shimamura et al., Sci. Rep., 2016, 6, 38952]. It was also shown that the reduction of N 2 took place with an associative mechanism as seen in the catalysis of nitrogenase enzymes. In this study, we performed an MSST-AIMD simulation to investigate the production by meteorite impacts with higher energies, which are closer to the expected values on the early Earth. It was found that the amount of NH 3 produced further increased. We also found that the increased NH 3 production is due to the emergence of multiple reaction mechanisms at increased impact energies. We elucidated that the reduction of N 2 was not only attributed to the associative mechanism but also to a dissociative mechanism as seen in the Haber-Bosch process and to a mechanism through a hydrazinium ion. The emergence of these multiple production mechanisms capable of providing a large amount of NH 3 would support the suggestions from recent experiments much more strongly than was previously believed, i.e., shock-induced NH 3 production played a key role in the origin of life on Earth.

  5. All roads lead to Rome: the impact of multiple attainment means on motivation.

    Huang, Szu-Chi; Zhang, Ying

    2013-02-01

    Individuals have different concerns before and after they become relatively certain about a goal's attainability; hence, we propose that the presence of alternative means of goal attainment will have a distinctive impact on motivation, depending on their stage of goal pursuit. In the initial stage of goal pursuit, people are concerned about whether the goal is attainable. The presence of multiple attainment means (vs. a single means) makes the goal seem more easily attainable and thus leads to greater motivation. Conversely, when people have made substantial progress on the goal and its attainment is relatively secured, they focus more on how they can race to the end and complete the pursuit. At these times, a single means (vs. multiple means) provides a more straightforward action plan and in turn leads to greater motivation. Two field studies and 3 lab experiments support this theorizing. (c) 2013 APA, all rights reserved.

  6. Impacts of education level and employment status on healthrelated quality of life in multiple sclerosis patients

    Selma Šabanagić-Hajrić

    2015-02-01

    Full Text Available Aim To evaluate the impacts of education level and employment status on health-related quality of life (HRQoL in multiple sclerosis patients. Methods This study included 100 multiple sclerosis patients treated at the Department of Neurology, Clinical Center of the University of Sarajevo. Inclusion criteria were the Expanded Disability Status Scale (EDSS score between 1.0 and 6.5, age between 18 and 65 years, stable disease on enrollment. Quality of life (QoL was evaluated by the Multiple Sclerosis Quality of Life-54 questionnaire (MSQoL-54. Mann-Whitney and Kruskal-Wallis test were used for comparisons. Linear regression analyses were performed to evaluate prediction value of educational level and employment status in predicting MSQOL-54 physical and mental composite scores. Results Full employment status had positive impact on physical health (54.85 vs. 37.90; p<0.001 and mental health (59.55 vs. 45.90; p<0.001 composite scores. Employment status retained its independent predictability for both physical (r2=0.105 and mental (r2=0.076 composite scores in linear regression analysis. Patients with college degree had slightly higher median value of physical (49.36 vs. 45.30 and mental health composite score (66.74 vs. 55.62 comparing to others, without statistically significant difference. Conclusion Employment proved to be an important factor in predicting quality of life in multiple sclerosis patients. Higher education level may determine better QOL but without significant predictive value. Sustained employment and development of vocational rehabilitation programs for MS patients living in the country with high unemployment level is an important factor in improving both physical and mental health outcomes in MS patients.

  7. Progression of a fracture site impaction as a prognostic indicator of impacted femoral neck fracture treated with multiple pinning.

    Yoon, Pil Whan; Shin, Young Ho; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

    2012-03-01

    We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p articulo-trochanteric distance index between 6 weeks and 3 months (p articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.

  8. Time dependent response of low velocity impact induced composite conical shells under multiple delamination

    Dey, Sudip; Karmakar, Amit

    2014-02-01

    This paper presents the time dependent response of multiple delaminated angle-ply composite pretwisted conical shells subjected to low velocity normal impact. The finite element formulation is based on Mindlin's theory incorporating rotary inertia and effects of transverse shear deformation. An eight-noded isoparametric plate bending element is employed to satisfy the compatibility of deformation and equilibrium of resultant forces and moments at the delamination crack front. A multipoint constraint algorithm is incorporated which leads to asymmetric stiffness matrices. The modified Hertzian contact law which accounts for permanent indentation is utilized to compute the contact force, and the time dependent equations are solved by Newmark's time integration algorithm. Parametric studies are conducted with respect to triggering parameters like laminate configuration, location of delamination, angle of twist, velocity of impactor, and impactor's displacement for centrally impacted shells.

  9. Dynamic studies of multiple configurations of CERN's Antiproton Decelerator Target core under proton beam impact

    AUTHOR|(CDS)2248381

    Antiprotons, like many other exotic particles, are produced by impacting high energy proton beams onto fixed targets. At the European Organization for Nuclear Research (CERN), this is done in the Antiproton Decelerator (AD) Facility. The engineering challenges related to the design of an optimal configuration of the AD-Target system derive from the extremely high energy depositions reached in the very thin target core as a consequence of each proton beam impact. A new target design is foreseen for operation after 2021, triggering multiple R&D activities since 2013 for this purpose. The goal of the present Master Thesis is to complement these activities with analytical and numerical calculations, delving into the phenomena associated to the dynamic response of the target core. In this context, two main studies have been carried out. First, the experimental data observed in targets subjected to low intensity proton pulses was cross-checked with analytical and computational methods for modal analysis, applie...

  10. Comparison of Personal Resources in Patients Who Differently Estimate the Impact of Multiple Sclerosis.

    Wilski, Maciej; Tomczak, Maciej

    2017-04-01

    Discrepancies between physicians' assessment and patients' subjective representations of the disease severity may influence physician-patient communication and management of a chronic illness, such as multiple sclerosis (MS). For these reasons, it is important to recognize factors that distinguish patients who differently estimate the impact of MS. The purpose of this study was to verify if the patients who overestimate or underestimate the impact of MS differ in their perception of personal resources from individuals presenting with a realistic appraisal of their physical condition. A total of 172 women and 92 men diagnosed with MS completed Multiple Sclerosis Impact Scale, University of Washington Self Efficacy Scale, Rosenberg Self-Esteem Scale, Body Esteem Scale, Brief Illness Perception Questionnaire, Treatment Beliefs Scale, Actually Received Support Scale, and Socioeconomic resources scale. Physician's assessment of health status was determined with Expanded Disability Status Scale. Linear regression analysis was conducted to identify the subsets of patients with various patterns of subjective health and Expanded Disability Status Scale (EDSS) scores. Patients overestimating the impact of their disease presented with significantly lower levels of self-esteem, self-efficacy in MS, and body esteem; furthermore, they perceived their condition more threatening than did realists and underestimators. They also assessed anti-MS treatment worse, had less socioeconomic resources, and received less support than underestimators. Additionally, underestimators presented with significantly better perception of their disease, self, and body than did realists. Self-assessment of MS-related symptoms is associated with specific perception of personal resources in coping with the disease. These findings may facilitate communication with patients and point to new directions for future research on adaptation to MS.

  11. Multiple-Criteria Decision-Making in the Design of Innovative Lock Walls for Barge Impact; Phase 1

    Lambert, James

    2001-01-01

    .... This research project consists of two phases: Phase 1, which culminates with this report, investigated the use of multiple-criteria decision-making in the design process of lock approach walls to consider barge impact and earthquake loads...

  12. The assessment of problems in functioning and the subjective perception of these problems in people with Multiple Sclerosis : the Multiple Sclerosis Impact Profile (MSIP)

    Wynia, Klaske; Roodbol, Petrie F.; Middel, Berry

    People with Multiple Sclerosis (MS) perceive consequences of this chronic condition that are not limited to impairments in physical functioning but also have their impact on limitations in activities and restrictions in participation in life situations. There is a growing awareness among healthcare

  13. Multiple Threats to Child Health from Fossil Fuel Combustion: Impacts of Air Pollution and Climate Change

    Perera, Frederica P.

    2016-01-01

    Background: Approaches to estimating and addressing the risk to children from fossil fuel combustion have been fragmented, tending to focus either on the toxic air emissions or on climate change. Yet developing children, and especially poor children, now bear a disproportionate burden of disease from both environmental pollution and climate change due to fossil fuel combustion. Objective: This commentary summarizes the robust scientific evidence regarding the multiple current and projected health impacts of fossil fuel combustion on the young to make the case for a holistic, child-centered energy and climate policy that addresses the full array of physical and psychosocial stressors resulting from fossil fuel pollution. Discussion: The data summarized here show that by sharply reducing our dependence on fossil fuels we would achieve highly significant health and economic benefits for our children and their future. These benefits would occur immediately and also play out over the life course and potentially across generations. Conclusion: Going beyond the powerful scientific and economic arguments for urgent action to reduce the burning of fossil fuels is the strong moral imperative to protect our most vulnerable populations. Citation: Perera FP. 2017. Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change. Environ Health Perspect 125:141–148; http://dx.doi.org/10.1289/EHP299 PMID:27323709

  14. Multiple Threats to Child Health from Fossil Fuel Combustion: Impacts of Air Pollution and Climate Change.

    Perera, Frederica P

    2017-02-01

    Approaches to estimating and addressing the risk to children from fossil fuel combustion have been fragmented, tending to focus either on the toxic air emissions or on climate change. Yet developing children, and especially poor children, now bear a disproportionate burden of disease from both environmental pollution and climate change due to fossil fuel combustion. This commentary summarizes the robust scientific evidence regarding the multiple current and projected health impacts of fossil fuel combustion on the young to make the case for a holistic, child-centered energy and climate policy that addresses the full array of physical and psychosocial stressors resulting from fossil fuel pollution. The data summarized here show that by sharply reducing our dependence on fossil fuels we would achieve highly significant health and economic benefits for our children and their future. These benefits would occur immediately and also play out over the life course and potentially across generations. Going beyond the powerful scientific and economic arguments for urgent action to reduce the burning of fossil fuels is the strong moral imperative to protect our most vulnerable populations. Citation: Perera FP. 2017. Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change. Environ Health Perspect 125:141-148; http://dx.doi.org/10.1289/EHP299.

  15. Variations in Multiple Birth Rates and Impact on Perinatal Outcomes in Europe.

    Anna Heino

    Full Text Available Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level.We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA, stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births. We also used European Society of Human Reproduction and Embryology (ESHRE data on assisted conception and single embryo transfer (SET. The impact of MBR on outcomes was studied using meta-analysis techniques with random-effects models to derive pooled risk ratios (pRR overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR for these groups.In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania to 26.5 (Cyprus. Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1-9.8 of preterm birth (<37 weeks GA, an almost 12-fold increased risk (pRR 11.7, 95% CI 11.0-12.4 of very preterm birth (<32 weeks GA. Pooled RR were 2.4 (95% Cl 1.5-3.6 for fetal mortality at or after 28 weeks GA and 7.0 (95% Cl 6.1-8.0 for neonatal mortality. PAR of neonatal death and very preterm birth were higher in countries with high MBR compared to low MBR (17.1% (95% CI 13.8-20.2 versus 9.8% (95% Cl 9.6-11.0 for neonatal death and 29.6% (96% CI 28.5-30.6 versus 17.5% (95% CI 15.7-18.3 for very preterm births, respectively.Wide variations in MBR and their impact on population outcomes imply that efforts by countries to reduce MBR could improve perinatal outcomes, enabling better long-term child health.

  16. Impact of natalizumab on ambulatory improvement in secondary progressive and disabled relapsing-remitting multiple sclerosis.

    Diego Cadavid

    Full Text Available There is an unmet need for disease-modifying therapies to improve ambulatory function in disabled subjects with multiple sclerosis.Assess the effects of natalizumab on ambulatory function in disabled subjects with relapsing-remitting multiple sclerosis (RRMS or secondary progressive multiple sclerosis (SPMS.We retrospectively reviewed ambulatory function as measured by timed 25-foot walk (T25FW in clinical trial subjects with an Expanded Disability Status Scale score ≥3.5, including RRMS subjects from the phase 3 AFFIRM and SENTINEL trials, relapsing SPMS subjects from the phase 2 MS231 study, and nonrelapsing SPMS subjects from the phase 1b DELIVER study. For comparison, SPMS subjects from the intramuscular interferon beta-1a (IM IFNβ-1a IMPACT study were also analyzed. Improvement in ambulation was measured using T25FW responder status; response was defined as faster walking times over shorter (6-9-month or longer (24-30-month treatment periods relative to subjects' best predose walking times.There were two to four times more T25FW responders among disabled MS subjects in the natalizumab arms than in the placebo or IM IFNβ-1a arms. Responders walked 25 feet an average of 24%-45% faster than nonresponders.Natalizumab improves ambulatory function in disabled RRMS subjects and may have efficacy in disabled SPMS subjects. Confirmation of the latter finding in a prospective SPMS study is warranted.

  17. Multiple Sclerosis Impact Profile (MSIP). An ICF-based outcome measure for Disability and Disability Perception in MS. A manual.

    Wynia, K.; Middel, B.; Reijneveld, S.A.

    2009-01-01

    The aim of this manual is to support working with the Multiple Sclerosis Impact Profile (MSIP), a self-report measure for people with Multiple Sclerosis (MS) to assess disability and disability perception in research and clinical practice. On individual level the MSIP reflects a persons disease

  18. Impact of Vertical Canopy Position on Leaf Spectral Properties and Traits across Multiple Species

    Tawanda W. Gara

    2018-02-01

    Full Text Available Understanding the vertical pattern of leaf traits across plant canopies provide critical information on plant physiology, ecosystem functioning and structure and vegetation response to climate change. However, the impact of vertical canopy position on leaf spectral properties and subsequently leaf traits across the entire spectrum for multiple species is poorly understood. In this study, we examined the ability of leaf optical properties to track variability in leaf traits across the vertical canopy profile using Partial Least Square Discriminatory Analysis (PLS-DA. Leaf spectral measurements together with leaf traits (nitrogen, carbon, chlorophyll, equivalent water thickness and specific leaf area were studied at three vertical canopy positions along the plant stem: lower, middle and upper. We observed that foliar nitrogen (N, chlorophyll (Cab, carbon (C, and equivalent water thickness (EWT were higher in the upper canopy leaves compared with lower shaded leaves, while specific leaf area (SLA increased from upper to lower canopy leaves. We found that leaf spectral reflectance significantly (P ≤ 0.05 shifted to longer wavelengths in the ‘red edge’ spectrum (685–701 nm in the order of lower > middle > upper for the pooled dataset. We report that spectral bands that are influential in the discrimination of leaf samples into the three groups of canopy position, based on the PLS-DA variable importance projection (VIP score, match with wavelength regions of foliar traits observed to vary across the canopy vertical profile. This observation demonstrated that both leaf traits and leaf reflectance co-vary across the vertical canopy profile in multiple species. We conclude that canopy vertical position has a significant impact on leaf spectral properties of an individual plant’s traits, and this finding holds for multiple species. These findings have important implications on field sampling protocols, upscaling leaf traits to canopy level

  19. Impact of multiple stressors on juvenile fish in estuaries of the northeast Pacific.

    Toft, Jason D; Munsch, Stuart H; Cordell, Jeffery R; Siitari, Kiira; Hare, Van C; Holycross, Brett M; DeBruyckere, Lisa A; Greene, Correigh M; Hughes, Brent B

    2018-05-01

    A key step in identifying global change impacts on species and ecosystems is to quantify effects of multiple stressors. To date, the science of global change has been dominated by regional field studies, experimental manipulation, meta-analyses, conceptual models, reviews, and studies focusing on a single stressor or species over broad spatial and temporal scales. Here, we provide one of the first studies for coastal systems examining multiple stressor effects across broad scales, focused on the nursery function of 20 estuaries spanning 1,600 km of coastline, 25 years of monitoring, and seven fish and invertebrate species along the northeast Pacific coast. We hypothesized those species most estuarine dependent and negatively impacted by human activities would have lower presence and abundances in estuaries with greater anthropogenic land cover, pollution, and water flow stress. We found significant negative relationships between juveniles of two of seven species (Chinook salmon and English sole) and estuarine stressors. Chinook salmon were less likely to occur and were less abundant in estuaries with greater pollution stress. They were also less abundant in estuaries with greater flow stress, although this relationship was marginally insignificant. English sole were less abundant in estuaries with greater land cover stress. Together, we provide new empirical evidence that effects of stressors on two fish species culminate in detectable trends along the northeast Pacific coast, elevating the need for protection from pollution, land cover, and flow stressors to their habitats. Lack of response among the other five species could be related to differing resistance to specific stressors, type and precision of the stressor metrics, and limitations in catch data across estuaries and habitats. Acquiring improved measurements of impacts to species will guide future management actions, and help predict how estuarine nursery functions can be optimized given anthropogenic

  20. Climate change impact on available water resources obtained using multiple global climate and hydrology models

    S. Hagemann

    2013-05-01

    Full Text Available Climate change is expected to alter the hydrological cycle resulting in large-scale impacts on water availability. However, future climate change impact assessments are highly uncertain. For the first time, multiple global climate (three and hydrological models (eight were used to systematically assess the hydrological response to climate change and project the future state of global water resources. This multi-model ensemble allows us to investigate how the hydrology models contribute to the uncertainty in projected hydrological changes compared to the climate models. Due to their systematic biases, GCM outputs cannot be used directly in hydrological impact studies, so a statistical bias correction has been applied. The results show a large spread in projected changes in water resources within the climate–hydrology modelling chain for some regions. They clearly demonstrate that climate models are not the only source of uncertainty for hydrological change, and that the spread resulting from the choice of the hydrology model is larger than the spread originating from the climate models over many areas. But there are also areas showing a robust change signal, such as at high latitudes and in some midlatitude regions, where the models agree on the sign of projected hydrological changes, indicative of higher confidence in this ensemble mean signal. In many catchments an increase of available water resources is expected but there are some severe decreases in Central and Southern Europe, the Middle East, the Mississippi River basin, southern Africa, southern China and south-eastern Australia.

  1. Fisetin Acts on Multiple Pathways to Reduce the Impact of Age and Disease on CNS Function

    Maher, Pamela

    2017-01-01

    It is becoming increasingly clear that neurological diseases are multi-factorial involving disruptions in multiple cellular systems. Thus, while each disease has its own initiating mechanisms and pathologies, certain common pathways appear to be involved in most, if not all, neurological diseases described to date. Thus, it is unlikely that modulating only a single factor will be effective at either preventing disease development or slowing disease progression. A better approach is to identify small (fisetin. Fisetin not only has direct antioxidant activity but it can also increase the intracellular levels of glutathione, the major intracellular antioxidant. Fisetin can also activate key neurotrophic factor signaling pathways. In addition, it has anti-inflammatory activity against microglial cells and inhibits the activity of lipoxygenases, thereby reducing the production of pro-inflammatory eicosanoids and their by-products. This wide range of actions suggests that fisetin has the ability to reduce the impact of age-related neurological diseases on brain function. PMID:25961687

  2. Spatio-temporal analyses of impacts of multiple climatic hazards in a savannah ecosystem of Ghana

    Gerald A.B. Yiran, PhD

    2016-01-01

    Full Text Available Ghana’s savannah ecosystem has been subjected to a number of climatic hazards of varying severity. This paper presents a spatial, time-series analysis of the impacts of multiple hazards on the ecosystem and human livelihoods over the period 1983–2012, using the Upper East Region of Ghana as a case study. Our aim is to understand the nature of hazards (their frequency, magnitude and duration and how they cumulatively affect humans. Primary data were collected using questionnaires, focus group discussions, in-depth interviews and personal observations. Secondary data were collected from documents and reports. Calculations of the standard precipitation index (SPI and crop failure index used rainfall data from 4 weather stations (Manga, Binduri, Vea and Navrongo and crop yield data of 5 major crops (maize, sorghum, millet, rice and groundnuts respectively. Temperature and windstorms were analysed from the observed weather data. We found that temperatures were consistently high and increasing. From the SPI, drought frequency varied spatially from 9 at Binduri to 13 occurrences at Vea; dry spells occurred at least twice every year and floods occurred about 6 times on average, with slight spatial variations, during 1988–2012, a period with consistent data from all stations. Impacts from each hazard varied spatio-temporally. Within the study period, more 70% of years recorded severe crop losses with greater impacts when droughts and floods occur in the same year, especially in low lying areas. The effects of crop losses were higher in districts with no/little irrigation (Talensi, Nabdam, Garu-Tempane, Kassena-Nankana East. Frequency and severity of diseases and sicknesses such as cerebrospinal meningitis, heat rashes, headaches and malaria related to both dry and wet conditions have increased steadily over time. Other impacts recorded with spatio-temporal variations included destruction to housing, displacement, injury and death of people. These

  3. [User Associations and Multiple Sclerosis: Impact of Neoliberalism in France on the trajectory of life].

    Colinet, Séverine

    Multiple sclerosis is a neurological disease that induces limitation of bodily performance. It has a major impact on the work and social life of affected persons because the patient's disability, often in the absence of visible symptoms, is o source of incomprehension in a society marked by the neoliberal dogma of performance. Patient associations often provide support for patients in their trajectory. The aim of this research was to identify how the principles of neoliberalism manifest themselves in the discourse of multiple sclerosis subjects, to understand the effects of neoliberal integration, and to clarify the role played by the association involvement in the trajectories of life. This qualitative study was based on 30 individual interviews and 4 group interviews with patients, as well as 23 observations of patient group meetings and focus groups. Ten people met in interviews also kept a mini-diary, in order to record their daily involvement in a patient association. Data were analysed thematically, initially independently then by cross-linked AtlasTi software. The association constitutes two forms, practical and ideological, an illustration of the resistance to neoliberalism, particularly in the form of individual and collective responsibilities. However, to a certain extent, it also recreates performance spaces. From a practical point of view, this research re-affirms the need to create collective activities to accompany people with chronic illness.

  4. Exercising Impacts on Fatigue, Depression, and Paresthesia in Female Patients with Multiple Sclerosis.

    Razazian, Nazanin; Yavari, Zeinab; Farnia, Vahid; Azizi, Akram; Kordavani, Laleh; Bahmani, Dena Sadeghi; Holsboer-Trachsler, Edith; Brand, Serge

    2016-05-01

    Multiple sclerosis (MS) is a chronic progressive autoimmune disease impacting both body and mind. Typically, patients with MS report fatigue, depression, and paresthesia. Standard treatment consists of immune modulatory medication, though there is growing evidence that exercising programs have a positive influence on fatigue and psychological symptoms such as depression. We tested the hypothesis that, in addition to the standard immune regulatory medication, either yoga or aquatic exercise can ameliorate both fatigue and depression, and we examined whether these interventions also influence paresthesia compared with a nonexercise control condition. Fifty-four women with MS (mean age: M = 33.94 yr, SD = 6.92) were randomly assigned to one of the following conditions: yoga, aquatic exercise, or nonexercise control. Their existing immune modulatory therapy remained unchanged. Participants completed questionnaires covering symptoms of fatigue, depression, and paresthesia, both at baseline and on completion of the study 8 wk later. Compared with the nonexercise control condition and over time, fatigue, depression, and paresthesia decreased significantly in the yoga and aquatic exercise groups. On study completion, the likelihood of reporting moderate to severe depression was 35-fold higher in the nonexercise control condition than in the intervention conditions (yoga and aquatic exercising values collapsed). The pattern of results suggests that for females with MS and treated with standard immune regulatory medication, exercise training programs such as yoga and aquatic exercising positively impact on core symptoms of MS, namely, fatigue, depression, and paresthesia. Exercise training programs should be considered in the future as possible complements to standard treatments.

  5. Evaluation of the Impact of Alveolar Nitrogen Excretion on Indices Derived from Multiple Breath Nitrogen Washout

    Nielsen, Niklas; Nielsen, Jorgen G.; Horsley, Alex R.

    2013-01-01

    Background A large body of evidence has now accumulated describing the advantages of multiple breath washout tests over conventional spirometry in cystic fibrosis (CF). Although the majority of studies have used exogenous sulphur hexafluoride (SF6) as the tracer gas this has also led to an increased interest in nitrogen washout tests, despite the differences between these methods. The impact of body nitrogen excreted across the alveoli has previously been ignored. Methods A two-compartment lung model was developed that included ventilation heterogeneity and dead space (DS) effects, but also incorporated experimental data on nitrogen excretion. The model was used to assess the impact of nitrogen excretion on washout progress and accuracy of functional residual capacity (FRC) and lung clearance index (LCI) measurements. Results Excreted nitrogen had a small effect on accuracy of FRC (1.8%) in the healthy adult model. The error in LCI calculated with true FRC was greater (6.3%), and excreted nitrogen contributed 21% of the total nitrogen concentration at the end of the washout. Increasing DS and ventilation heterogeneity both caused further increase in measurement error. LCI was increased by 6–13% in a CF child model, and excreted nitrogen increased the end of washout nitrogen concentration by 24–49%. Conclusions Excreted nitrogen appears to have complex but clinically significant effects on washout progress, particularly in the presence of abnormal gas mixing. This may explain much of the previously described differences in washout outcomes between SF6 and nitrogen. PMID:24039916

  6. Multiple imputation for estimating the risk of developing dementia and its impact on survival.

    Yu, Binbing; Saczynski, Jane S; Launer, Lenore

    2010-10-01

    Dementia, Alzheimer's disease in particular, is one of the major causes of disability and decreased quality of life among the elderly and a leading obstacle to successful aging. Given the profound impact on public health, much research has focused on the age-specific risk of developing dementia and the impact on survival. Early work has discussed various methods of estimating age-specific incidence of dementia, among which the illness-death model is popular for modeling disease progression. In this article we use multiple imputation to fit multi-state models for survival data with interval censoring and left truncation. This approach allows semi-Markov models in which survival after dementia depends on onset age. Such models can be used to estimate the cumulative risk of developing dementia in the presence of the competing risk of dementia-free death. Simulations are carried out to examine the performance of the proposed method. Data from the Honolulu Asia Aging Study are analyzed to estimate the age-specific and cumulative risks of dementia and to examine the effect of major risk factors on dementia onset and death.

  7. In situ impact of multiple pulses of metal and herbicide on the seagrass, Zostera capricorni.

    Macinnis-Ng, Catriona M O; Ralph, Peter J

    2004-04-28

    Tides and freshwater inflow which influence water movement in estuarine areas govern the exposure-regime of pollutants. In this experiment, we examined the in situ impact of double pulses of copper and the herbicide Irgarol 1051 on the photosynthesis of the seagrass, Zostera capricorni. Despite a 4-day recovery period between the two 10h pulses of toxicant, the effective quantum yield of photosystem II (DeltaF/Fm') and total chlorophyll concentrations indicated that multiple-pulses had a greater impact than a single pulse. During the first exposure period, samples exposed to Irgarol 1051 had DeltaF/Fm' values as low as zero while controls remained around 0.6 relative units. After the second exposure period, treated samples recovered to only 0.4 relative units. Samples exposed to copper had DeltaF/Fm' values around 0.3 relative units during the first exposure period and while these samples recovered before the second dose, they remained below 0.2 relative units after the second exposure period. Alternate samples were also exposed to one toxicant, allowed to recover and then exposed to the other toxicant. DeltaF/Fm' values indicated that copper exposure followed by Irgarol 1051 exposure was more toxic than Irgarol 1051 exposure followed by copper exposure.

  8. In situ impact of multiple pulses of metal and herbicide on the seagrass, Zostera capricorni

    Macinnis-Ng, Catriona M.O.; Ralph, Peter J.

    2004-01-01

    Tides and freshwater inflow which influence water movement in estuarine areas govern the exposure-regime of pollutants. In this experiment, we examined the in situ impact of double pulses of copper and the herbicide Irgarol 1051 on the photosynthesis of the seagrass, Zostera capricorni. Despite a 4-day recovery period between the two 10 h pulses of toxicant, the effective quantum yield of photosystem II (ΔF/Fm') and total chlorophyll concentrations indicated that multiple-pulses had a greater impact than a single pulse. During the first exposure period, samples exposed to Irgarol 1051 had ΔF/Fm' values as low as zero while controls remained around 0.6 relative units. After the second exposure period, treated samples recovered to only 0.4 relative units. Samples exposed to copper had ΔF/Fm' values around 0.3 relative units during the first exposure period and while these samples recovered before the second dose, they remained below 0.2 relative units after the second exposure period. Alternate samples were also exposed to one toxicant, allowed to recover and then exposed to the other toxicant. ΔF/Fm' values indicated that copper exposure followed by Irgarol 1051 exposure was more toxic than Irgarol 1051 exposure followed by copper exposure

  9. In situ impact of multiple pulses of metal and herbicide on the seagrass, Zostera capricorni

    Macinnis-Ng, Catriona M.O.; Ralph, Peter J

    2004-04-28

    Tides and freshwater inflow which influence water movement in estuarine areas govern the exposure-regime of pollutants. In this experiment, we examined the in situ impact of double pulses of copper and the herbicide Irgarol 1051 on the photosynthesis of the seagrass, Zostera capricorni. Despite a 4-day recovery period between the two 10 h pulses of toxicant, the effective quantum yield of photosystem II ({delta}F/Fm') and total chlorophyll concentrations indicated that multiple-pulses had a greater impact than a single pulse. During the first exposure period, samples exposed to Irgarol 1051 had {delta}F/Fm' values as low as zero while controls remained around 0.6 relative units. After the second exposure period, treated samples recovered to only 0.4 relative units. Samples exposed to copper had {delta}F/Fm' values around 0.3 relative units during the first exposure period and while these samples recovered before the second dose, they remained below 0.2 relative units after the second exposure period. Alternate samples were also exposed to one toxicant, allowed to recover and then exposed to the other toxicant. {delta}F/Fm' values indicated that copper exposure followed by Irgarol 1051 exposure was more toxic than Irgarol 1051 exposure followed by copper exposure.

  10. Sensitivity of Microstructural Factors Influencing the Impact Toughness of Hypoeutectoid Steels with Ferrite-Pearlite Structure using Multiple Regression Analysis

    Lee, Seung-Yong; Lee, Sang-In; Hwang, Byoung-chul

    2016-01-01

    In this study, the effect of microstructural factors on the impact toughness of hypoeutectoid steels with ferrite-pearlite structure was quantitatively investigated using multiple regression analysis. Microstructural analysis results showed that the pearlite fraction increased with increasing austenitizing temperature and decreasing transformation temperature which substantially decreased the pearlite interlamellar spacing and cementite thickness depending on carbon content. The impact toughness of hypoeutectoid steels usually increased as interlamellar spacing or cementite thickness decreased, although the impact toughness was largely associated with pearlite fraction. Based on these results, multiple regression analysis was performed to understand the individual effect of pearlite fraction, interlamellar spacing, and cementite thickness on the impact toughness. The regression analysis results revealed that pearlite fraction significantly affected impact toughness at room temperature, while cementite thickness did at low temperature.

  11. The impacts of multiple rest-break periods on commercial truck driver's crash risk.

    Chen, Chen; Xie, Yuanchang

    2014-02-01

    Driver fatigue has been a major contributing factor to fatal commercial truck crashes, which accounted for about 10% of all fatal motor vehicle crashes that happened between 2009 and 2011. Commercial truck drivers' safety performance can deteriorate easily due to fatigue caused by long driving hours and irregular working schedules. To ensure safety, truck drivers often use off-duty time and short rest breaks during a trip to recover from fatigue. This study thoroughly investigates the impacts of off-duty time prior to a trip and short rest breaks on commercial truck safety by using Cox proportional hazards model and Andersen-Gill model. It is found that increasing total rest-break duration can consistently reduce fatigue-related crash risk. Similarly, taking more rest breaks can help to reduce crash risk. The results suggest that two rest breaks are generally considered enough for a 10-hour trip, as three or more rest breaks may not further reduce crash risk substantially. Also, the length of each rest break does not need to be very long and 30min is usually adequate. In addition, this study investigates the safety impacts of when to take rest breaks. It is found that taking rest breaks too soon after a trip starts will cause the rest breaks to be less effective. The findings of this research can help policy makers and trucking companies better understand the impacts of multiple rest-break periods and develop more effective rules to improve the safety of truck drivers. Copyright © 2014 Elsevier Ltd and National Safety Council. All rights reserved.

  12. Impact of Autologous Stem Cell Transplantation on Blood Pressure and Renal Function in Multiple Myeloma Patients.

    Balsam, Leah; Saad, Chadi; Arsene, Camelia; Fogel, Joshua

    2017-01-01

    Autologous stem cell transplantation (ASCT) reverses kidney failure in one-third of multiple myeloma (MM) patients, which may lead to blood pressure (BP) improvement. We evaluate the long term impact of ASCT on BP and renal function in MM patients. We studied 192 MM patients that underwent ASCT. We compared BP readings and glomerular filtration rate (GFR) at 4 weeks before ASCT, on day of ASCT and post-ASCT at 30, 100 and 180 days. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) on day of ASCT and at both 30 and 100 days post-ASCT was significantly lower as compared to pre-ASCT SBP and DBP. There was a significantly higher mean GFR at day of ASCT and 30 days post-ASCT and significantly lower mean GFR at 180 days post-ASCT as compared to pre-ASCT. White patients had similar patterns to the total group for SBP, DBP, and GFR except for SBP which was still significantly lower and GFR which was not significantly different at 180 days. African-American patients showed no significant reductions in the mean values of SBP and DBP and no significant increases for GFR in follow-up after day of ASCT. Furthermore, the mean value of GFR was significantly lower at 180 days post-ASCT. ASCT in MM patients had a positive impact on SBP and DBP and GFR but the impact was minimal for African-American patients. We recommend that clinicians consider closer follow-up of BP and kidney function and more intense therapy in African-Americans with MM. Copyright © 2017 National Medical Association. Published by Elsevier Inc. All rights reserved.

  13. Impact of multiple sclerosis on employment and use of job-retention strategies: The situation in France in 2015.

    Fantoni-Quinton, Sophie; Kwiatkowski, Arnaud; Vermersch, Patrick; Roux, Bastien; Hautecoeur, Patrick; Leroyer, Ariane

    2016-06-13

    The main objective of this survey of persons with multiple sclerosis was to describe their employment situation. Secondary objectives were to ascertain when and how multiple sclerosis symptoms first impact employment per se and what strategies persons with multiple sclerosis use to cope with their employment problems. A retrospective survey was conducted to collect data from persons with multiple sclerosis aged 18 years and over, using a computer-assisted web tool. A total of 941 respondents were working at the time of multiple sclerosis diagnosis or had worked subsequently. Median time since diagnosis was 10 years. Multiple sclerosis had an impact on employment for 74.3% of respondents. The overall employment rate at the time of the survey was 68.1%; 27.2% had discontinued their occupational activity for a multiple sclerosis-related reason. Median time from diagnosis to multiple sclerosis-related cessation of occupational activity was 24.0 years (95% confidence interval (CI) 21.7-26.3 years). Respondents were poorly aware of available tools designed to assist them in retaining employment. This study highlights the importance of early intervention by the occupational medicine physician in order to favour job retention and use of available tools by all workers with MS and not only those with a recognized status as a disabled worker.

  14. Impact of optical hard limiter on the performance of an optical overlapped-code division multiple access system

    Inaty, Elie; Raad, Robert; Tablieh, Nicole

    2011-08-01

    Throughout this paper, a closed form expression of the multiple access interference (MAI) limited bit error rate (BER) is provided for the multiwavelength optical code-division multiple-access system when the system is working above the nominal transmission rate limit imposed by the passive encoding-decoding operation. This system is known in literature as the optical overlapped code division multiple access (OV-CDMA) system. A unified analytical framework is presented emphasizing the impact of optical hard limiter (OHL) on the BER performance of such a system. Results show that the performance of the OV-CDMA system may be highly improved when using OHL preprocessing at the receiver side.

  15. Microstructural response and grain refinement mechanism of commercially pure titanium subjected to multiple laser shock peening impacts

    Lu, J.Z.; Wu, L.J.; Sun, G.F.; Luo, K.Y.; Zhang, Y.K.; Cai, J.; Cui, C.Y.; Luo, X.M.

    2017-01-01

    The microstructural response and grain subdivision process in commercially pure (CP) titanium subjected to multiple laser shock peening (LSP) impacts were investigated by means of optical microscopy (OM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM) observations. The micro-hardness curves as a function of the impact time were also determined. The deformation-induced grain refinement mechanism of the close-packed hexagonal (hcp) material by laser shock wave was subsequently analyzed. Experimental results showed that uniform equiaxed grains with an average size of less than 50 nm were generated due to the ultra-high plastic strain induced by multiple LSP impacts. Special attention was paid to four types of novel deformation-induced microstructural features, including a layered slip band in the tension deformation zone, and inverse-transformation martensite, micro-twin grating and micro-twin collision in the compression deformation zone. Furthermore, the grain refinement mechanism in the near-surface layer of CP titanium subjected to multiple LSP impacts contains two types of simultaneous subdivision modes: multi-directional mechanical twin (MT)-MT intersections at (sub)micrometer scale, and the intersection between longitudinal secondary MTs and transverse dislocation walls at nanometer scale. In addition, both grain refinement (nanocrystallization) and the existence of a small amount of inverse-transformation martensite induced by multiple LSP impacts contribute to an increase in the micro-hardness of the near-surface layer.

  16. Impact of Co-Channel Interference on the Outage Performance Under Multiple Type II Relay Environments

    Choi, Seyeong; Alouini, Mohamed-Slim; Nam, Sung Sik

    2017-01-01

    In this paper, through an exact analysis of the outage probability, we investigate the impact of co-channel interference (CCI) on the outage performance of type II (or user equipment) relay under multiple-relay environments considering the selection combining-based relay selection scheme with the decode-and-forward protocol. We consider the signal to interference plus noise ratio (SINR) over both independent and identically distributed and independent but non-identically distributed fading channels. To fully take into account the effect of CCI, we adopt a more practical parameter such as the CCI coefficient. The major difficulty in the analysis resides in the determination of the statistics of the output SINR. To settle this problem, we first present the general but relatively simplified expressions for the statistics and then the related outage probability in closed-form. Furthermore, to consider more practical scenario, based on the fact that the number of participating relays can be random, we investigate the average outage probability by averaging the number of participating relays.

  17. Analysis of multiple scattering contributions in electron-impact ionization of molecular hydrogen

    Ren, Xueguang; Hossen, Khokon; Wang, Enliang; Pindzola, M. S.; Dorn, Alexander; Colgan, James

    2017-10-01

    We report a combined experimental and theoretical study on the low-energy (E 0 = 31.5 eV) electron-impact ionization of molecular hydrogen (H2). Triple differential cross sections are measured for a range of fixed emission angles of one outgoing electron between {θ }1=-70^\\circ and -130° covering the full 4π solid angle of the second electron. The energy sharing of the outgoing electrons varies from symmetric ({E}1={E}2=8 eV) to highly asymmetric (E 1 = 1 eV and E 2 = 15 eV). In addition to the binary and recoil lobes, a structure is observed perpendicular to the incoming beam direction which is due to multiple scattering of the projectile inside the molecular potential. The absolutely normalized experimental cross sections are compared with results from the time-dependent close-coupling (TDCC) calculations. Molecular alignment dependent TDCC results demonstrate that these structures are only present if the molecule axis is lying in the scattering plane.

  18. The impact of subjective cognitive fatigue and depression on cognitive function in patients with multiple sclerosis.

    Golan, Daniel; Doniger, Glen M; Wissemann, Karl; Zarif, Myassar; Bumstead, Barbara; Buhse, Marijean; Fafard, Lori; Lavi, Idit; Wilken, Jeffrey; Gudesblatt, Mark

    2018-02-01

    The association between subjective cognitive fatigue and objective cognitive dysfunction in patients with multiple sclerosis (PwMS) has been studied, with conflicting results. To explore the impact of fatigue on cognitive function, while controlling for the influence of depression, disability, comorbidities, and psychotropic medications. PwMS completed a computerized cognitive testing battery with age- and education-adjusted cognitive domain scores. Disability (Expanded Disability Status Scale (EDSS)), cognitive fatigue, and depression were concurrently evaluated. In all, 699 PwMS were included. Both cognitive fatigue and depression were significantly and negatively correlated with the same cognitive domains: information processing speed, executive function, attention, motor function, and memory (-0.15 ⩽ r ⩽ -0.14 for cognitive fatigue; -0.24 ⩽ r ⩽ -0.19 for depression). Multivariate analysis revealed significant but small independent correlations only between depression and neuropsychological test results, while cognitive fatigue had no independent correlation with objective cognitive function except for a trend toward impaired motor function in highly fatigued PwMS. Depression and cognitive fatigue accounted for no more than 6% of the variance in objective cognitive domain scores. Cognitive fatigue is not independently related to objective cognitive impairment. Depression may influence cognitive function of PwMS primarily when it is severe. Cognitive impairment in PwMS should not be ascribed to fatigue or mild depression.

  19. The impact of science teachers' epistemological beliefs on authentic inquiry: A multiple-case study

    Jackson, Dionne Bennett

    The purpose of this study was to examine how science teachers' epistemological beliefs impacted their use of authentic inquiry in science instruction. Participants in this multiple-case study included a total of four teachers who represented the middle, secondary and post-secondary levels. Based on the results of the pilot study conducted with a secondary science teacher, adjustments were made to the interview questions and observation protocol. Data collection for the study included semi-structured interviews, direct observations of instructional techniques, and the collection of artifacts. The cross case analysis revealed that the cases epistemological beliefs were mostly Transitional and the method of instruction used most was Discussion. Two of the cases exhibited consistent beliefs and instructional practices, whereas the other two exhibited beliefs beyond their instruction. The findings of this study support the literature on the influence of contextual factors and professional development on teacher beliefs and practice. The findings support and contradict literature relevant to the consistency of teacher beliefs with instruction. This study's findings revealed that the use of reform-based instruction, or Authentic Inquiry, does not occur when science teachers do not have the beliefs and experiences necessary to implement this form of instruction.

  20. Something from (almost) nothing: the impact of multiple displacement amplification on microbial ecology.

    Binga, Erik K; Lasken, Roger S; Neufeld, Josh D

    2008-03-01

    Microbial ecology is a field that applies molecular techniques to analyze genes and communities associated with a plethora of unique environments on this planet. In the past, low biomass and the predominance of a few abundant community members have impeded the application of techniques such as PCR, microarray analysis and metagenomics to complex microbial populations. In the absence of suitable cultivation methods, it was not possible to obtain DNA samples from individual microorganisms. Recently, a method called multiple displacement amplification (MDA) has been used to circumvent these limitations by amplifying DNA from microbial communities in low-biomass environments, individual cells from uncultivated microbial species and active organisms obtained through stable isotope probing incubations. This review describes the development and applications of MDA, discusses its strengths and limitations and highlights the impact of MDA on the field of microbial ecology. Whole genome amplification via MDA has increased access to the genomic DNA of uncultivated microorganisms and low-biomass environments and represents a 'power tool' in the molecular toolbox of microbial ecologists.

  1. Impact of Co-Channel Interference on the Outage Performance Under Multiple Type II Relay Environments

    Choi, Seyeong

    2017-11-15

    In this paper, through an exact analysis of the outage probability, we investigate the impact of co-channel interference (CCI) on the outage performance of type II (or user equipment) relay under multiple-relay environments considering the selection combining-based relay selection scheme with the decode-and-forward protocol. We consider the signal to interference plus noise ratio (SINR) over both independent and identically distributed and independent but non-identically distributed fading channels. To fully take into account the effect of CCI, we adopt a more practical parameter such as the CCI coefficient. The major difficulty in the analysis resides in the determination of the statistics of the output SINR. To settle this problem, we first present the general but relatively simplified expressions for the statistics and then the related outage probability in closed-form. Furthermore, to consider more practical scenario, based on the fact that the number of participating relays can be random, we investigate the average outage probability by averaging the number of participating relays.

  2. Prospective memory in multiple sclerosis: The impact of cue distinctiveness and executive functioning.

    Dagenais, Emmanuelle; Rouleau, Isabelle; Tremblay, Alexandra; Demers, Mélanie; Roger, Élaine; Jobin, Céline; Duquette, Pierre

    2016-11-01

    Prospective memory (PM), the ability to remember to do something at the appropriate time in the future, is crucial in everyday life. One way to improve PM performance is to increase the salience of a cue announcing that it is time to act. Multiple sclerosis (MS) patients often report PM failures and there is growing evidence of PM deficits among this population. However, such deficits are poorly characterized and their relation to cognitive status remains unclear. To better understand PM deficits in MS patients, this study investigated the impact of cue salience on PM, and its relation to retrospective memory (RM) and executive deficits. Thirty-nine (39) MS patients were compared to 18 healthy controls on a PM task modulating cue salience during an ongoing general knowledge test. MS patients performed worse than controls on the PM task, regardless of cue salience. MS patients' executive functions contributed significantly to the variance in PM performance, whereas age, education and RM did not. Interestingly, low- and high-executive patients' performance differed when the cue was not salient, but not when it was, suggesting that low-executive MS patients benefited more from cue salience. These findings add to the growing evidence of PM deficits in MS and highlight the contribution of executive functions to certain aspects of PM. In low-executive MS patients, high cue salience improves PM performance by reducing the detection threshold and need for environmental monitoring. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Modified Moliere's screening parameter and its impact on multiple coulomb scattering

    Striganov, Sergei

    2015-01-01

    The Moliere approximation of elastic Coulomb scattering cross-sections plays an important role in accurate description of multiple scattering, non-ionisation energy, DPA radiation damage etc. The cross-section depends only on a single parameter that describes the atomic screening. Moliere calculated the screening angle for the Tomas-Fermi distribution of electrons in atoms. In this paper, the screening parameter was recalculated using a more accurate atomic form-factor obtained from the self-consistent Dirac-Hartree-Fock-Slater computations. For relativistic particles, the new screening angle can differ from the Moliere approximation by up to 50%. At the same time, it is rather close to other independent calculations. At low energies, the new screening angle is different for positrons and electrons. The positron screening parameter is much larger than the electron one for heavy nuclei at energies of ∼Z keV. The impact of the screening angle on particle transport and calculated quantities is discussed. (authors)

  4. The Impact of the Required Reserve on the Monetary Multiplication in the Republic of Macedonias

    Aleksandar Dejanovski

    2014-11-01

    Full Text Available One of the primary and most important tasks of any central bank is conducting monetary policy in the state. In Macedonia the only central and issuing bank is the National Bank of Macedonia, which is responsible for the monetary and financial stability in the country, while performing important functions, without which the overall economic and financial system could not exist. In exercising its functions, the National Bank of Macedonia uses a set of economic instruments and policies, from which in RM the most efective is the required resserve. This monetary tool is showing the best results in developing countries where the financial markets are not developed and where there is a high concentration of the banking sector (in RM banks occupy a good 98% of total financial institutions. The role of the reserve will be analyzed through the prism of its effects on the process of multiplication the money supply in the country and its contribution to generating or withdrawal of money by the central bank. The main goal of the paper is to research the required reserve, as a monetary instrument, and to qualify its impact on the monetary creation in the Republic of Macedonia. The basic methods, used in this paper are the positive analysis, comparative analysis and deductive approach.

  5. The impact of disability, fatigue and sleep quality on the quality of life in multiple sclerosis

    Ghaem Haleh

    2008-01-01

    Full Text Available Background: Only few papers have investigated the impact of multiple sclerosis (MS, especially MS-related fatigue and the impact of the quality of sleep on the quality of life (QoL in MS patients. Objective: The objective of this study was to measure the quality of life in MS patients and the impact of disability, fatigue and sleep quality, using statistical modeling. Materials and Methods: A cross-sectional study was conducted and data was collected from 141 MS patients, who were referred to the Mottahari Clinic, Shiraz, Iran, in 2005. Data on health-related quality of life (MSQoL-54, fatigue severity scale (FSS, and Pittsburgh sleep quality Index (PSQI were obtained in the case of all the patients. Epidemiology data concerning MS type, MS functional system score, expanded disability status scale (EDSS etc. were also provided by a qualified neurologist. Spearman a coefficient, Mann-Whitney U test, and linear regression model were used to analyze the data. Results : The mean ±SD age of 141 MS patients was 32.6±9.6 year. Thirty five (24.8% of them were male and the others were female. Eighty two (58.1% of the patients had EDSS score of ≤ 2, 36 (25.5% between 2.5 and 4.5, and 23 (16.3% ≥ 5. As per PSQI scores, two (1.4% of the patients had good sleep, 16 (11.3% had moderate sleep and 123 (87.2% had poor sleep. There was a significant high positive correlation between the quality of mental and physical health composite scores (r = 0.791, P < 0.001. There was a significant negative correlation between the quality of physical score and age (r = -0.88, P < 0.001, fatigue score (r = -0.640, P < 0.001, EDSS score (r = -0.476, P < 0.001 and PSQI (sleep quality r = -0.514, P < 0.000. Linear regression analysis showed that PSQI score, EDSS, and fatigue score were predictors in the model between the quality of physical score and covariates ( P < 0.001. Linear regression model showed that fatigue score and PSQI were predictors in the model between the

  6. The impact of self-perceived limitations, stigma and sense of coherence on quality of life in multiple sclerosis patients : results of a cross-sectional study

    Broersma, Feddrik; Oeseburg, Barth; Dijkstra, Jacob; Wynia, Klaske

    2018-01-01

    OBJECTIVE: To examine the impact of perceived limitations, stigma and sense of coherence on quality of life in multiple sclerosis patients. DESIGN: Cross-sectional survey. SETTING: Department of Neurology, University Medical Center Groningen, the Netherlands. SUBJECTS: Multiple sclerosis patients.

  7. When things don't add up: quantifying impacts of multiple stressors from individual metabolism to ecosystem processing.

    Galic, Nika; Sullivan, Lauren L; Grimm, Volker; Forbes, Valery E

    2018-04-01

    Ecosystems are exposed to multiple stressors which can compromise functioning and service delivery. These stressors often co-occur and interact in different ways which are not yet fully understood. Here, we applied a population model representing a freshwater amphipod feeding on leaf litter in forested streams. We simulated impacts of hypothetical stressors, individually and in pairwise combinations that target the individuals' feeding, maintenance, growth and reproduction. Impacts were quantified by examining responses at three levels of biological organisation: individual-level body sizes and cumulative reproduction, population-level abundance and biomass and ecosystem-level leaf litter decomposition. Interactive effects of multiple stressors at the individual level were mostly antagonistic, that is, less negative than expected. Most population- and ecosystem-level responses to multiple stressors were stronger than expected from an additive model, that is, synergistic. Our results suggest that across levels of biological organisation responses to multiple stressors are rarely only additive. We suggest methods for efficiently quantifying impacts of multiple stressors at different levels of biological organisation. © 2018 John Wiley & Sons Ltd/CNRS.

  8. Multiple ionization of noble gases by 2.0 MeV proton impact: comparison with equi-velocity electron impact ionization

    Melo, W.S.; Santos, A.C.F.; Sant'Anna, M.M.; Sigaud, G.M.; Montenegro, E.C.

    2002-01-01

    Absolute single- and multiple-ionization cross sections of rare gases (He, Ne, Ar, Kr and Xe) have been measured for collisions with 2.0 MeV p + . A comparison is made with equi-velocity electron impact ionization cross sections as well as with the available proton impact data. For the light rare gases the single-ionization cross sections are essentially the same for both proton and electron impacts, but increasing differences appear for the heavier targets. (author). Letter-to-the-editor

  9. The Impact of Multiple Intelligences-Based Instruction on Developing Speaking Skills of the Pre-Service Teachers of English

    Salem, Ashraf Atta M. S.

    2013-01-01

    The current study investigates the impact of multiple intelligences-based Instruction on developing speaking skills of the pre-service teachers of English. Therefore, the problem of the current study can be stated in the lack of speaking skills of the pre-service teachers of English in Hurgada faculty of Education, South Valley University. To…

  10. The impact of conservation management on the community composition of multiple organism groups in eutrophic interconnected man-made ponds

    Lemmens, P.; Mergeay, J.; Van Wichelen, J.; De Meester, Luc; Declerck, S.A.J.

    2015-01-01

    Ponds throughout the world are subjected to a variety of management measures for purposes of biodiversity conservation. Current conservation efforts typically comprise a combination of multiple measures that directly and indirectly impact a wide range of organism groups. Knowledge of the relative

  11. Health-Related Quality of Life in Patients with Multiple Sclerosis : Impact of Disease-Modifying Drugs

    Jongen, Peter Joseph

    Multiple sclerosis (MS) has a profound impact on health-related quality of life (HRQoL), a comprehensive subjective measure of the patient's health status. Assessment of HRQoL informs on the potential advantages and disadvantages of disease-modifying drugs (DMDs) beyond their effects on

  12. The Impact of Multiple Endpoint Dependency on "Q" and "I"[superscript 2] in Meta-Analysis

    Thompson, Christopher Glen; Becker, Betsy Jane

    2014-01-01

    A common assumption in meta-analysis is that effect sizes are independent. When correlated effect sizes are analyzed using traditional univariate techniques, this assumption is violated. This research assesses the impact of dependence arising from treatment-control studies with multiple endpoints on homogeneity measures "Q" and…

  13. Single and multiple objective biomass-to-biofuel supply chain optimization considering environmental impacts

    Valles Sosa, Claudia Evangelina

    respond to these new challenges, the Modified Multiple Objective Evolutionary Algorithm for the design optimization of a biomass to bio-refinery logistic system that considers the simultaneous maximization of the total profit and the minimization of three environmental impacts is presented. Sustainability balances economic, social and environmental goals and objectives. There exist several works in the literature that have considered economic and environmental objectives for the presented supply chain problem. However, there is a lack of research performed in the social aspect of a sustainable logistics system. This work proposes a methodology to integrate social aspect assessment, based on employment creation. Finally, most of the assessment methodologies considered in the literature only contemplate deterministic values, when in realistic situations uncertainties in the supply chain are present. In this work, Value-at-Risk, an advanced risk measure commonly used in portfolio optimization is included to consider the uncertainties in biofuel prices, among the others.

  14. The impact of wildland fires on calcareous Mediterranean pedosystems (Sardinia, Italy) - An integrated multiple approach.

    Capra, Gian Franco; Tidu, Simona; Lovreglio, Raffaella; Certini, Giacomo; Salis, Michele; Bacciu, Valentina; Ganga, Antonio; Filzmoser, Peter

    2018-05-15

    Sardinia (Italy), the second largest island of the Mediterranean Sea, is a fire-prone land. Most Sardinian environments over time were shaped by fire, but some of them are too intrinsically fragile to withstand the currently increasing fire frequency. Calcareous pedoenvironments represent a significant part of Mediterranean areas, and require important efforts to prevent long-lasting degradation from fire. The aim of this study was to assess through an integrated multiple approach the impact of a single and highly severe wildland fire on limestone-derived soils. For this purpose, we selected two recently burned sites, Sant'Antioco and Laconi. Soil was sampled from 80 points on a 100×100m grid - 40 in the burned area and 40 in unburned one - and analyzed for particle size fractions, pH, electrical conductivity, organic carbon, total N, total P, and water repellency (WR). Fire behavior (surface rate of spread (ROS), fireline intensity (FLI), flame length (FL)) was simulated by BehavePlus 5.0.5 software. Comparisons between burned and unburned areas were done through ANOVA as well as deterministic and stochastic interpolation techniques; multiple correlations among parameters were evaluated by principal factor analysis (PFA) and differences/similarities between areas by principal component analysis (PCA). In both sites, fires were characterized by high severity and determined significant changes to some soil properties. The PFA confirmed the key ecological role played by fire in both sites, with the variability of a four-modeled components mainly explained by fire parameters, although the induced changes on soils were mainly site-specific. The PCA revealed the presence of two main "driving factors": slope (in Sant'Antioco), which increased the magnitude of ROS and FLI; and soil properties (in Laconi), which mostly affected FL. In both sites, such factors played a direct role in differentiating fire behavior and sites, while they played an indirect role in determining

  15. Damage to Preheated Tungsten Targets after Multiple Plasma Impacts Simulating ITER ELMs

    Garkusha, I.E.; Bandura, A.N.; Byrka, O.V.; Chebotarev, V.V.; Makhlay, V.A.; Tereshin, V.I. [Kharkov Inst. of Physics and Technology, Inst. of Plasma Physics of National Science Center, Akademicheskaya street, 1, 61108 Kharkov (Ukraine); Landman, I.; Pestchanyi, S. [FZK-Forschungszentrum Karlsruhe, Association Euratom-FZK, Technik und Umwelt, Postfach 3640, D-7602 1 Karlsruhe (Germany)

    2007-07-01

    surface with increased number of impacts. Degradation of thermophysical properties of tungsten under multiple plasma exposures is analyzed. (authors)

  16. SU-E-T-428: Dosimetric Impact of Multileaf Collimator Leaf Width On Single and multiple Isocenter Stereotactic IMRT Treatment Plans for multiple Brain Tumors

    Giem, J; Algan, O; Ahmad, S; Ali, I; Young, J; Hossain, S

    2014-01-01

    Purpose: To assess the impacts that multileaf collimator (MLC) leaf width has on the dose conformity and normal brain tissue doses of single and multiple isocenter stereotactic IMRT (SRT) plans for multiple intracranial tumors. Methods: Fourteen patients with 2–3 targets were studied retrospectively. Patients treated with multiple isocenter treatment plans using 9 to 12 non-coplanar beams per lesion underwent repeat planning using single isocenter and 10 to 12 non-coplanar beams with 2.5mm, 3mm and 5mm MLC leaf widths. Brainlab iPlan treatment planning system for delivery with the 2.5mm MLC served as reference. Identical contour sets and dose-volume constraints were applied. The prescribed dose to each target was 25 Gy to be delivered over 5 fractions with a minimum of 99% dose to cover ≥ 95% of the target volume. Results: The lesions and normal brains ranged in size from 0.11 to 51.67cc (median, 2.75cc) and 1090 to 1641cc (median, 1401cc), respectively. The Paddick conformity index for single and multiple isocenter (2.5mm vs. 3mm and 5mm MLCs) was (0.79±0.08 vs. 0.79±0.07 and 0.77±0.08) and (0.79±0.09 vs. 0.77±0.09 and 0.76±0.08), respectively. The average normal brain volumes receiving 15 Gy for single and multiple isocenter (2.5mm vs. 3mm and 5mm MLCs) were (3.65% vs. 3.95% and 4.09%) and (2.89% vs. 2.91% and 2.92%), respectively. Conclusion: The average dose conformity observed for the different leaf width for single and multiple isocenter plans were similar, throughout. However, the average normal brain volumes receiving 2.5 to 15 Gy were consistently lower for the 2.5mm MLC leaf width, especially for single isocenter plans. The clinical consequences of these integral normal brain tissue doses are still unknown, but employing the use of the 2.5mm MLC option is desirable at sparing normal brain tissue for both single and multiple isocenter cases

  17. Fuel Mix Impacts from Transportation Fuel Carbon Intensity Standards in Multiple Jurisdictions

    Witcover, J.

    2017-12-01

    Fuel carbon intensity standards have emerged as an important policy in jurisdictions looking to target transportation greenhouse gas (GHG) emissions for reduction. A carbon intensity standard rates transportation fuels based on analysis of lifecycle GHG emissions, and uses a system of deficits and tradable, bankable credits to reward increased use of fuels with lower carbon intensity ratings while disincentivizing use of fuels with higher carbon intensity ratings such as conventional fossil fuels. Jurisdictions with carbon intensity standards now in effect include California, Oregon, and British Columbia, all requiring 10% reductions in carbon intensity of the transport fuel pool over a 10-year period. The states and province have committed to grow demand for low carbon fuels in the region as part of collaboration on climate change policies. Canada is developing a carbon intensity standard with broader coverage, for fuels used in transport, industry, and buildings. This study shows a changing fuel mix in affected jurisdictions under the policy in terms of shifting contribution of transportation energy from alternative fuels and trends in shares of particular fuel pathways. It contrasts program designs across the jurisdictions with the policy, highlights the opportunities and challenges these pose for the alternative fuel market, and discusses the impact of having multiple policies alongside federal renewable fuel standards and sometimes local carbon pricing regimes. The results show how the market has responded thus far to a policy that incentivizes carbon saving anywhere along the supply chain at lowest cost, in ways that diverged from a priori policy expectations. Lessons for the policies moving forward are discussed.

  18. The Impact of Multiple Roles on Psychological Distress among Japanese Workers.

    Honda, Ayumi; Abe, Yasuyo; Date, Yutaka; Honda, Sumihisa

    2015-06-01

    There has been considerable interest in Japanese society in the problem of work-related stress leading to depressive symptoms, and an increasing number of primary houseworkers maintain paid employment. The purpose of this study was to examine the differential impact of multiple roles associated with psychological distress among Japanese workers. We studied 722 men and women aged 18-83 years in a cross-sectional study. The K10 questionnaire was used to examine psychological distress. The proportion of participants with psychological distress was higher in women (17.8%) compared with men (11.5%). Having three roles significantly decreased the risk of psychological distress [women: odds ratio (OR), 0.37-fold; men: OR, 0.41] compared with only one role. In working married women, there was significantly less psychological distress (OR, 0.27), and those with childrearing or caregiving responsibilities for elderly parents had significantly less psychological distress (OR, 0.38) than those with only an employment role. Similarly, working married men who had childrearing or caregiving responsibilities for elderly parents had significantly less psychological distress (OR, 0.41) than those who had only an employment role. The present study demonstrated that participants who had only an employment role had an increased risk of psychological distress. The degree of psychological distress was not determined solely by the number of roles. It is important to have balance between work and family life to reduce role conflict and/or role submersion, which in turn may reduce the risk of psychological distress.

  19. Severe injury in multiple impacts: Analysis of 1997-2015 NASS-CDS.

    Viano, David C; Parenteau, Chantal S

    2018-07-04

    This is a descriptive study of the incidence and risk for severe injury in single-impact and multi-impact crashes by belt use and crash type using NASS-CDS. 1997-2015 NASS-CDS data were used to determine the distribution of crashes by the number of impacts and severe injury (Maximum Abbreviated Injury Score [MAIS] 4+F) to >15-year-old nonejected drivers by seat belt use in 1997+ MY vehicles. It compares the risk for severe injury in a single impact and in crashes involving 2, 3, or 4+ impacts in the collision with a focus on a frontal crash followed by other impacts. Most vehicle crashes involve a single impact (75.4% of 44,889,518 vehicles), followed by 2-impact crashes (19.6%), 3-impact crashes (5.0%) and 4+ impacts (2.6%). For lap-shoulder-belted drivers, the distribution of severe injury was 42.1% in a single impact, 29.3% in 2 impacts, 13.4% in 3 impacts, and 15.1% in 4+ impact crashes. The risk for a belted driver was 0.256 ± 0.031% in a single impact, 0.564 ± 0.079% in 2 impacts, 0.880 ± 0.125% in 3 impacts, and 2.121 ± 0.646% in 4+ impact. The increase in risk from a single crash to multi-impact collisions was statistically significant (P impact, 53.8% of belted drivers were in a frontal crashes, 22.4% in side crashes, 20% in rear crashes, and 1.7% in rollover crashes. The risk for severe injury was highest in a rollover at 0.677 ± 0.250%, followed by near-side impact at 0.467 ± 0.084% and far-side impact at 0.237 ± 0.071%. Seat belt use was 82.4% effective in preventing severe injury (MAIS 4+F) in a rollover, 47.9% in a near-side impact, and 74.8% in a far-side impact. In 2-impact crashes with a belted driver, the most common sequence was a rear impact followed by a frontal crash at 1,843,506 (21.5%) with a risk for severe injury of 0.100 ± 0.058%. The second most common was a frontal impact followed by another frontal crash at 1,257,264 (14.7%) with a risk of 0.401 ± 0.057%. The risk was 0.658 ± 0.271% in a frontal impact followed by a rear

  20. Single and multiple ionization of noble gas atoms by H0 impact

    Sarkadi, L.; Gulyas, L.; Herczku, P.; Kovacs, S.T.S.; Koever, A.

    2012-01-01

    Complete text of publication follows. The understanding of the mechanisms of collisions between energetic charged particles and neutral atoms is of fundamental significance, and it has large importance in many research fields (plasma physics, astrophysics, materials science, etc.), as well as in number of practical applications. In the present work we measured total direct ionization and electron loss cross sections for the collisions of H 0 atoms with noble gas atoms (He, Ne, Ar, Kr) in the energy range 75-300 keV. The experiment was carried out at the 1.5 MV Van de Graaff accelerator of Atomki by coincident detection of the recoil target ions and the charge-state analyzed scattered projectiles. With this study we wished to obtain information about the role played by the electron of the H 0 projectile in the process of the single and multiple vacancy production induced by the collision. For this purpose we repeated the measurements also with proton projectile under the same experimental conditions. For calibration of the measuring system and normalization of our data we used the cross section values of Ref. [1]. The experimental results were analysed with using the classical trajectory Monte Carlo (CTMC) method. CTMC describes well the experimental data for both projectiles for the single vacancy creation, however we observed increasing deviation between the theory and experiment with increasing number of the created vacancies, as well as with decreasing atomic number of the target atoms. Fig. 1 shows our results obtained for the single, double and triple ionization (q = 1, 2, 3) of Kr at H 0 impact for the two cases when the outgoing projectile is H 0 (a) and H + (b), i.e., for pure ionization of the target, and ionization of the target with simultaneous electron loss of the projectile. The curves in the figure were obtained by two versions of the three-body CTMC theory: a conventional model (dashed curves); and a model taking partially account of the many

  1. Cost effectiveness and budget impact of natalizumab in patients with relapsing multiple sclerosis.

    Chiao, Evelyn; Meyer, Kellie

    2009-06-01

    Disease-modifying therapy (DMT) is the largest single-cost item that contributes to the total per-patient cost of multiple sclerosis (MS), a disabling disorder of the central nervous system. Natalizumab is the most recent DMT to be approved for the treatment of relapsing MS and may be an attractive alternative to interferon beta and glatiramer acetate (GA). To determine from the perspective of a United States payer (1) the incremental cost effectiveness of natalizumab compared with other DMTs and (2) the budgetary impact of utilization of natalizumab for the treatment of relapsing MS. A combined cost effectiveness and budget impact model was developed. Model inputs were drug acquisition costs (wholesale acquisition cost), costs of drug administration and monitoring, costs of treating relapses, anticipated reduction in relapse rates after 2 years of therapy, and estimated market utilization of natalizumab. Outcomes included total 2-year costs of therapy per patient, costs per relapse avoided for each treatment, and overall 2-year costs to the health plan and per member per month (PMPM) costs. Drug acquisition costs are in 2008 US dollars, and all other costs were inflated to 2008 US dollars when necessary. Univariate sensitivity analyses were performed to determine the model inputs with the greatest influence on the cost per relapse avoided for natalizumab. The overall 2-year cost of therapy per patient was $72,120 for natalizumab, $56,790 for intramuscular (IM) interferon beta-1a (IFNbeta-1a), $56,773 for IFNbeta-1b, $57,180 for GA, and $58,538 for subcutaneous (SC) IFNbeta-1a. The cost per relapse avoided was lowest for natalizumab at $56,594, followed by $87,791 for IFNbeta-1b, $93,306 for IM IFNbeta-1a, $96,178 for SC IFNbeta-1a, and $103,665 for GA. The incremental cost-effectiveness ratios of natalizumab relative to IM IFNbeta-1a, IFNbeta-1b, GA, and SC IFNbeta-1a were $23,029, $24,452, $20,671, and $20,403 per additional relapse avoided, respectively. An

  2. Recovery of multiple impacted maxillary teeth in a hyperdivergent Class I patient using Temporary Skeletal Anchorage Devices and augmented corticotomy.

    Kim, Kyung A; Hwang, Hyeon-Shik; Chung, Kyu-Rhim; Kim, Seong-Hun; Nelson, Gerald

    2018-01-01

    Treatment of multiple impacted teeth is challenging. Three-dimensional treatment planning can help in delivering a better outcome. This case report presents a patient with an incomplete dental transposition between the canine and lateral incisor of the maxillary right side associated with the impaction of a dilacerated right central incisor. Using a two-stage surgical exposure and augmented corticotomy, the patient's occlusion and smile esthetics were significantly improved, and Class I occlusal relationships with optimal overjet and overbite were achieved after 50 months of orthodontic treatment. Thirty-month posttreatment records revealed a stable result.

  3. Impact of genetic risk loci for multiple sclerosis on expression of proximal genes in patients

    James, Tojo; Lindé n, Magdalena; Morikawa, Hiromasa; Fernandes, Sunjay Jude; Ruhrmann, Sabrina; Huss, Mikael; Brandi, Maya; Piehl, Fredrik; Jagodic, Maja; Tegner, Jesper; Khademi, Mohsen; Olsson, Tomas; Gomez-Cabrero, David; Kockum, Ingrid

    2018-01-01

    Despite advancements in genetic studies, it is difficult to understand and characterize the functional relevance of disease-associated genetic variants, especially in the context of a complex multifactorial disease such as Multiple Sclerosis (MS

  4. Disability impact and coping in mothers of children with intellectual disabilities and multiple disabilities.

    Kishore, M Thomas

    2011-12-01

    Understanding the disability impact on parenting and caregiving is important for intervention. The present study was designed to understand the differences in perceived disability impact and related coping in mothers having children with intellectual disabilities alone compared to those having children with intellectual disabilities and additional disabilities. Accordingly, 30 mothers of children with intellectual disabilities and 30 mothers of children with intellectual and additional disabilities were assessed for disability impact and coping. Group differences for disability impact were present in specific domains but not overall. Despite variations in coping pattern, both positive and negative coping strategies were observed in both groups. The results may imply that the impact of intellectual disability is so pervasive that except in certain domains mothers may not perceive the further impact of additional disabilities. Positive coping does not rule out negative coping strategies. These findings have specific relevance to service delivery in a cultural context.

  5. Impact of high-intensity concurrent training on cardiovascular risk factors in persons with multiple sclerosis - pilot study.

    Keytsman, Charly; Hansen, Dominique; Wens, Inez; O Eijnde, Bert

    2017-10-27

    High-intensity concurrent training positively affects cardiovascular risk factors. Because this was never investigated in multiple sclerosis, the present pilot study explored the impact of this training on cardiovascular risk factors in this population. Before and after 12 weeks of high-intense concurrent training (interval and strength training, 5 sessions per 2 weeks, n = 16) body composition, resting blood pressure and heart rate, 2-h oral glucose tolerance (insulin sensitivity, glycosylated hemoglobin, blood glucose and insulin concentrations), blood lipids (high- and low-density lipoprotein, total cholesterol, triglyceride levels) and C-reactive protein were analyzed. Twelve weeks of high-intense concurrent training significantly improved resting heart rate (-6%), 2-h blood glucose concentrations (-13%) and insulin sensitivity (-24%). Blood pressure, body composition, blood lipids and C-reactive protein did not seem to be affected. Under the conditions of this pilot study, 12 weeks of concurrent high-intense interval and strength training improved resting heart rate, 2-h glucose and insulin sensitivity in multiple sclerosis but did not affect blood C-reactive protein levels, blood pressure, body composition and blood lipid profiles. Further, larger and controlled research investigating the effects of high-intense concurrent training on cardiovascular risk factors in multiple sclerosis is warranted. Implications for rehabilitation High-intensity concurrent training improves cardiovascular fitness. This pilot study explores the impact of this training on cardiovascular risk factors in multiple sclerosis. Despite the lack of a control group, high-intense concurrent training does not seem to improve cardiovascular risk factors in multiple sclerosis.

  6. Exploring the Impact of Sports Participation on Multiple Intelligence Development of High School Female Students

    Kul, Marat

    2015-01-01

    After Gardner had introduced the Multiple Intelligence (MI) theory, many researchers tried to find out the possibilities of applying this theory in the education domain. Moreover, the effects of different kinds of athletic applications on intelligence development within the framework of this theory have also been under investigation. This study…

  7. Impact of assisted reproductive technology on the incidence of multiple-gestation infants: a population perspective

    Scholten, Irma; Chambers, Georgina M.; van Loendersloot, Laura; van der Veen, Fulco; Repping, Sjoerd; Gianotten, Judith; Hompes, Peter G. A.; Ledger, William; Mol, Ben W. J.

    2015-01-01

    To study the value of a population view in assessing assisted reproductive technology (ART) multiple-gestation infants. Descriptive comparison of ART treatment and population statistics in seven developed countries (United States [U.S.], South Korea, United Kingdom, the Netherlands, Australia,

  8. Continuous subcutaneous insulin infusion versus multiple daily injections: the impact of baseline A1c

    Retnakaran, Ravi; Hochman, Jackie; DeVries, J. Hans; Hanaire-Broutin, Helene; Heine, Robert J.; Melki, Vincent; Zinman, Bernard

    2004-01-01

    Rapid-acting insulin analogs (insulin lispro and insulin aspart) have emerged as the meal insulin of choice in both multiple daily insulin injection (MDII) therapy and continuous subcutaneous insulin infusion (CSII) for type 1 diabetes. Thus, a comparison of efficacy between CSII and MDII should be

  9. Impact of Answer-Switching Behavior on Multiple-Choice Test Scores in Higher Education

    Ramazan BAŞTÜRK

    2011-06-01

    Full Text Available The multiple- choice format is one of the most popular selected-response item formats used in educational testing. Researchers have shown that Multiple-choice type test is a useful vehicle for student assessment in core university subjects that usually have large student numbers. Even though the educators, test experts and different test recourses maintain the idea that the first answer should be retained, many researchers argued that this argument is not dependent with empirical findings. The main question of this study is to examine how the answer switching behavior affects the multiple-choice test score. Additionally, gender differences and relationship between number of answer switching behavior and item parameters (item difficulty and item discrimination were investigated. The participants in this study consisted of 207 upper-level College of Education students from mid-sized universities. A Midterm exam consisted of 20 multiple-choice questions was used. According to the result of this study, answer switching behavior statistically increase test scores. On the other hand, there is no significant gender difference in answer-switching behavior. Additionally, there is a significant negative relationship between answer switching behavior and item difficulties.

  10. Results of a diesel multiple unit fuel tank blunt impact test

    2017-04-04

    The Federal Railroad Administrations Office of Research and Development is conducting research into passenger locomotive fuel tank crashworthiness. A series of impact tests is being conducted to measure fuel tank deformation under two types of dyn...

  11. Multiple Imputation for Estimating the Risk of Developing Dementia and Its Impact on Survival

    Yu, Binbing; Saczynski, Jane S.; Launer, Lenore J.

    2010-01-01

    Dementia, Alzheimer’s disease in particular, is one of the major causes of disability and decreased quality of life among the elderly and a leading obstacle to successful aging. Given the profound impact on public health, much research has focused on the age-specific risk of developing dementia and the impact on survival. Early work has discussed various methods of estimating age-specific incidence of dementia, among which the illness-death model is popular for modeling disease progression. I...

  12. Prognostic impact of circulating plasma cells in patients with multiple myeloma: implications for plasma cell leukemia definition.

    Granell, Miquel; Calvo, Xavier; Garcia-Guiñón, Antoni; Escoda, Lourdes; Abella, Eugènia; Martínez, Clara Mª; Teixidó, Montserrat; Gimenez, Mª Teresa; Senín, Alicia; Sanz, Patricia; Campoy, Desirée; Vicent, Ana; Arenillas, Leonor; Rosiñol, Laura; Sierra, Jorge; Bladé, Joan; de Larrea, Carlos Fernández

    2017-06-01

    The presence of circulating plasma cells in patients with multiple myeloma is considered a marker for highly proliferative disease. In the study herein, the impact of circulating plasma cells assessed by cytology on survival of patients with multiple myeloma was analyzed. Wright-Giemsa stained peripheral blood smears of 482 patients with newly diagnosed myeloma or plasma cell leukemia were reviewed and patients were classified into 4 categories according to the percentage of circulating plasma cells: 0%, 1-4%, 5-20%, and plasma cell leukemia with the following frequencies: 382 (79.2%), 83 (17.2%), 12 (2.5%) and 5 (1.0%), respectively. Median overall survival according to the circulating plasma cells group was 47, 50, 6 and 14 months, respectively. At multivariate analysis, the presence of 5 to 20% circulating plasma cells was associated with a worse overall survival (relative risk 4.9, 95% CI 2.6-9.3) independently of age, creatinine, the Durie-Salmon system stage and the International Staging System (ISS) stage. Patients with ≥5% circulating plasma cells had lower platelet counts (median 86×10 9 /L vs 214×10 9 /L, P <0.0001) and higher bone marrow plasma cells (median 53% vs 36%, P =0.004). The presence of ≥5% circulating plasma cells in patients with multiple myeloma has a similar adverse prognostic impact as plasma cell leukemia. Copyright© Ferrata Storti Foundation.

  13. Configuration of multiple human stressors and their impacts on fish assemblages in Alpine river basins of Austria.

    Schinegger, Rafaela; Pucher, Matthias; Aschauer, Christiane; Schmutz, Stefan

    2018-03-01

    This work addresses multiple human stressors and their impacts on fish assemblages of the Drava and Mura rivers in southern Austria. The impacts of single and multiple human stressors on riverine fish assemblages in these basins were disentangled, based on an extensive dataset. Stressor configuration, i.e. various metrics of multiple stressors belonging to stressor groups hydrology, morphology, connectivity and water quality were investigated for the first time at river basin scale in Austria. As biological response variables, the Fish Index Austria (FIA) and its related single as well as the WFD biological- and total state were investigated. Stressor-response analysis shows divergent results, but a general trend of decreasing ecological integrity with increasing number of stressors and maximum stressor is observed. Fish metrics based on age structure, fish region index and biological status responded best to single stressors and/or their combinations. The knowledge gained in this work provides a basis for advanced investigations in Alpine river basins and beyond, supports WFD implementation and helps prioritizing further actions towards multi-stressor restoration- and management. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  14. Can resistance training impact MRI outcomes in relapsing-remitting multiple sclerosis?

    Kjølhede, Tue; Siemonsen, Susanne; Wenzel, Damian

    2017-01-01

    BACKGROUND: Multiple sclerosis (MS) is characterised by accelerated brain atrophy, which relates to disease progression. Previous research shows that progressive resistance training (PRT) can counteract brain atrophy in other populations. OBJECTIVE: To evaluate the effects of PRT by magnetic...... lifestyle followed by PRT). Assessments included disability measures and MRI (lesion load, global brain volume, percentage brain volume change (PBVC) and cortical thickness). RESULTS: While the MS Functional Composite score improved, Expanded Disability Status Scale, lesion load and global brain volumes did...

  15. Digestible information: The impact of Multiple Traffic Light nutritional labeling in a developing country

    Defago, Daniel; Geng, José F.; Molina, Oswaldo; Santa María, Diego

    2017-01-01

    Bad dietary habits are among the main causes of increasing obesity and other health problems. According to the literature, information asymmetry and cognitive biases may lead to suboptimal decisions by individuals regarding food consumption. Many countries have implemented different forms of nutritional labelling in order to provide individuals with better information when making choices. We assess the Multiple Traffic Light (MTL) system, an alternative and simplified labelling format impleme...

  16. Work ability in multiple sclerosis : the impact of immunomodulating treatments and adjusted working conditions

    Wickström, Anne

    2015-01-01

    Background Multiple sclerosis (MS) is a chronic inflammatory, demyelinating disease affecting the central nervous system (CNS) and is considered to be of autoimmune origin. The prevalence in Sweden is estimated to be about 1 in 500. The inflammation leads to demyelination as well as neurodegeneration and with time the patients often suffer from increasing neurological disability. The young age of onset makes MS one of the major causes of reduced ability to work in the Western society. Several...

  17. Management of a rare case of idiopathic multiple unerupted impacted permanent teeth in an adult female patient

    Karunakar Shetty

    2016-01-01

    Full Text Available This clinical case report describes the multi-disciplinary approach in the management of an unusual presentation of idiopathic multiple unerupted impacted permanent teeth in a 20-year-old female patient. The case was unique in that, not only were there multiple missing permanent teeth, but also over retained deciduous teeth and attrited existing permanent teeth with loss of vertical dimension of occlusion. Since the patient was young, it was decided to retain all the erupted permanent teeth and extract the infected deciduous teeth with the objective of fabricating overlay complete dentures. This is a simple, reversible and an economical treatment modality, which satisfies both the esthetic and functional demands where the extraction of teeth is not generally indicated and, in addition, provides a stable occlusion.

  18. [Impact of TDZ and NAA on adventitious bud induction and cluster bud multiplication in Tulipa edulis].

    Zhu, Li-Fang; Xu, Chao; Zhu, Zai-Biao; Yang, He-Tong; Guo, Qiao-Sheng; Xu, Hong-jian; Ma, Hong-Jian; Zhao, Gui-Hua

    2014-08-01

    To explore the method of explants directly induced bud and establish the tissue culture system of mutiple shoot by means of direct organogenesis, core bud and daughter bulbs (the top of bud stem expanded to form daughter bulb) of T. edulis were used as explants and treated with thidiazuron (TDZ) and 1-naphthlcetic acid (NAA). The results showed that the optimal medium for bud inducted form core bud and daughter bulb were MS + TDZ 2.0 mg x L(-1) + NAA 4.0 mg x L(-1) and MS +TDZ 2.0 mg x L(-1) + NAA 2.0 mg x L(-1) respectively, both of them had a bud induction rate of 72.92%, 79.22%. The optimal medium for cluster buds multiplication was MS + TDZ 0.2 mg x L(-1) + NAA 0.2 mg x L(-1), and proliferation coefficient was 2.23. After proliferation, cluster buds rooting occurred on MS medium with IBA 1.0 mg x L(-1) and the rooting rate was 52.6%, three to five seedlings in each plant. Using core bud and daughter bulb of T. edulis, the optimum medium for adventitious bud directly inducted from daughter bulb, core bud and cluster bud multiplication were screened out and the tissue culture system of multiple shoot by means of direct organogenesis was established.

  19. Partial Interference and Its Performance Impact on Wireless Multiple Access Networks

    Lau WingCheong

    2010-01-01

    Full Text Available To determine the capacity of wireless multiple access networks, the interference among the wireless links must be accurately modeled. In this paper, we formalize the notion of the partial interference phenomenon observed in many recent wireless measurement studies and establish analytical models with tractable solutions for various types of wireless multiple access networks. In particular, we characterize the stability region of IEEE 802.11 networks under partial interference with two potentially unsaturated links numerically. We also provide a closed-form solution for the stability region of slotted ALOHA networks under partial interference with two potentially unsaturated links and obtain a partial characterization of the boundary of the stability region for the general M-link case. Finally, we derive a closed-form approximated solution for the stability region for general M-link slotted ALOHA system under partial interference effects. Based on our results, we demonstrate that it is important to model the partial interference effects while analyzing wireless multiple access networks. This is because such considerations can result in not only significant quantitative differences in the predicted system capacity but also fundamental qualitative changes in the shape of the stability region of the systems.

  20. Impacts of education level and employment status on health-related quality of life in multiple sclerosis patients.

    Šabanagić-Hajrić, Selma; Alajbegović, Azra

    2015-02-01

    To evaluate the impacts of education level and employment status on health-related quality of life (HRQoL) in multiple sclerosis patients. This study included 100 multiple sclerosis patients treated at the Department of Neurology, Clinical Center of the University of Sarajevo. Inclusion criteria were the Expanded Disability Status Scale (EDSS) score between 1.0 and 6.5, age between 18 and 65 years, stable disease on enrollment. Quality of life (QoL) was evaluated by the Multiple Sclerosis Quality of Life-54 questionnaire (MSQoL-54). Mann-Whitney and Kruskal-Wallis test were used for comparisons. Linear regression analyses were performed to evaluate prediction value of educational level and employment status in predicting MSQOL-54 physical and mental composite scores. Full employment status had positive impact on physical health (54.85 vs. 37.90; p les than 0.001) and mental health (59.55 vs. 45.90; p les than 0.001) composite scores. Employment status retained its independent predictability for both physical (r(2)=0.105) and mental (r(2)=0.076) composite scores in linear regression analysis. Patients with college degree had slightly higher median value of physical (49.36 vs. 45.30) and mental health composite score (66.74 vs. 55.62) comparing to others, without statistically significant difference. Employment proved to be an important factor in predicting quality of life in multiple sclerosis patients. Higher education level may determine better QOL but without significant predictive value. Sustained employment and development of vocational rehabilitation programs for MS patients living in the country with high unemployment level is an important factor in improving both physical and mental health outcomes in MS patients.

  1. A One-Day Dental Faculty Workshop in Writing Multiple-Choice Questions: An Impact Evaluation

    AlFaris, E.; Naeem, N; Irfan, F.; Qureshi, R.; Saad, H.; Sadhan, R. Al; Abdulghani, H.M.; Vleuten, C. van der

    2015-01-01

    Long training workshops on the writing of exam questions have been shown to be effective; however, the effectiveness of short workshops needs to be demonstrated. The aim of this study was to evaluate the impact of a one-day, seven-hour faculty development workshop at the College of Dentistry, King

  2. Impact of self-reported multiple chemical sensitivity on everyday life: a qualitative study

    Skovbjerg, Sine; Brorson, Stig; Rasmussen, Alice

    2009-01-01

    on everyday life are limited. OBJECTIVE: To describe the impact of MCS on everyday life, strategies for managing the condition, and experiences with healthcare management. METHODS: A focus group study was conducted, including two interviews with a sample of six women and six men between 27 and 78 years of age...

  3. Impacts of multiple stresses on water demand and supply across the southeastern United States

    Ge Sun; Steven G. McNulty; Jennifer A. Moore Myers; Erika C. Cohen

    2008-01-01

    Assessment of long-term impacts of projected changes in climate, population, and land use and land cover on regional water resource is critical to the sustainable development of the southeastern United States. The objective of this study was to fully budget annual water availability for water supply (precipitation ) evapotranspiration + groundwater supply + return flow...

  4. Single Parents and the Work Setting: The Impact of Multiple Job and Homelife Responsibilities.

    Burden, Dianne S.

    1986-01-01

    Examines the impact of combined work/family responsibilities on single-parent employees. Results indicated that parent employees, but particularly single female parents, were at risk for high job-family role strain and reduced levels of well-being. In spite of increased strain, however, single parents exhibited high levels of job satisfaction and…

  5. Youth crowds and substance use: The impact of perceived group norm and multiple group identification

    Verkooijen, K.T.; Vries, de N.K.; Nielsen, G.A.

    2007-01-01

    The impact of group identity on adolescent tobacco, alcohol, and marijuana use was examined through a postal survey. The study included adolescents who identified with 1 subgroup (n = 1425) as well as adolescents who identified with 2 (n = 895) or 3 (n = 339) subgroups. The results showed that

  6. Sexual Therapy for Women with Multiple Sclerosis and Its Impact on Quality of Life

    Maryam Zamani

    2017-02-01

    Full Text Available Objective: Multiple Sclerosis (MS is a disease with a detrimental effect on functional status. The present study investigated the effect of a sexual therapy program on the quality of life (QOL of women with multiple sclerosis.Method: Women with multiple sclerosis and sexual dysfunction (n = 30 were selected, and were randomly assigned into the treatment (n = 15, or the control groups (n = 15. Participants of the treatment group (n = 15 received 12 weekly sessions of sexual therapy. Participants in both groups completed the Female Sexual Function Inventory (FSFI and the MS Quality of Life- 54 (MSQOL-54 in the onset of the program and at the end of the program.Results: ANCOVA(s using pre-test scores as covariate(s revealed that in comparison to the control condition, MS patients within the treatment group showed a significant improvement in their sexual desire (0.0001, arousal (0.022, lubrication (0.001, orgasm (0.001, satisfaction (0.0001, overall quality of life (0.001, energy (0.023, cognitive function (0.005, and social function (0.001 at the end of the program. In addition, they were less limited in their roles due to the emotional and health problems.Conclusion: The present study revealed that addressing sexual dysfunction in MS patients could improve their quality of life. In the future, this research can extend its results, and apply the same method to men with MS to find whether sexual therapy enhances their quality of life.

  7. Multiple goals and time constraints: perceived impact on physicians' performance of evidence-based behaviours

    Francis Jillian J

    2009-11-01

    Full Text Available Abstract Background Behavioural approaches to knowledge translation inform interventions to improve healthcare. However, such approaches often focus on a single behaviour without considering that health professionals perform multiple behaviours in pursuit of multiple goals in a given clinical context. In resource-limited consultations, performing these other goal-directed behaviours may influence optimal performance of a particular evidence-based behaviour. This study aimed to investigate whether a multiple goal-directed behaviour perspective might inform implementation research beyond single-behaviour approaches. Methods We conducted theory-based semi-structured interviews with 12 general medical practitioners (GPs in Scotland on their views regarding two focal clinical behaviours--providing physical activity (PA advice and prescribing to reduce blood pressure (BP to Results Most GPs reported strong intention to prescribe to reduce BP but expressed reasons why they would not. Intention to provide PA advice was variable. Most GPs reported that time constraints and patient preference detrimentally affected their control over providing PA advice and prescribing to reduce BP, respectively. Most GPs perceived many of their other goal-directed behaviours as interfering with providing PA advice, while fewer GPs reported goal-directed behaviours that interfere with prescribing to reduce BP. Providing PA advice and prescribing to reduce BP were perceived to be facilitated by similar diabetes-related behaviours (e.g., discussing cholesterol. While providing PA advice was perceived to be mainly facilitated by providing other lifestyle-related clinical advice (e.g., talking about weight, BP prescribing was reported as facilitated by pursuing ongoing standard consultation-related goals (e.g., clearly structuring the consultation. Conclusion GPs readily relate their other goal-directed behaviours with having a facilitating and interfering influence on their

  8. Impact of airway gas exchange on the multiple inert gas elimination technique: theory.

    Anderson, Joseph C; Hlastala, Michael P

    2010-03-01

    The multiple inert gas elimination technique (MIGET) provides a method for estimating alveolar gas exchange efficiency. Six soluble inert gases are infused into a peripheral vein. Measurements of these gases in breath, arterial blood, and venous blood are interpreted using a mathematical model of alveolar gas exchange (MIGET model) that neglects airway gas exchange. A mathematical model describing airway and alveolar gas exchange predicts that two of these gases, ether and acetone, exchange primarily within the airways. To determine the effect of airway gas exchange on the MIGET, we selected two additional gases, toluene and m-dichlorobenzene, that have the same blood solubility as ether and acetone and minimize airway gas exchange via their low water solubility. The airway-alveolar gas exchange model simulated the exchange of toluene, m-dichlorobenzene, and the six MIGET gases under multiple conditions of alveolar ventilation-to-perfusion, VA/Q, heterogeneity. We increased the importance of airway gas exchange by changing bronchial blood flow, Qbr. From these simulations, we calculated the excretion and retention of the eight inert gases and divided the results into two groups: (1) the standard MIGET gases which included acetone and ether and (2) the modified MIGET gases which included toluene and m-dichlorobenzene. The MIGET mathematical model predicted distributions of ventilation and perfusion for each grouping of gases and multiple perturbations of VA/Q and Qbr. Using the modified MIGET gases, MIGET predicted a smaller dead space fraction, greater mean VA, greater log(SDVA), and more closely matched the imposed VA distribution than that using the standard MIGET gases. Perfusion distributions were relatively unaffected.

  9. Is the impact of fatigue related to walking capacity and perceived ability in persons with multiple sclerosis? A multicenter study.

    Dalgas, U; Langeskov-Christensen, M; Skjerbæk, A; Jensen, E; Baert, I; Romberg, A; Santoyo Medina, C; Gebara, B; Maertens de Noordhout, B; Knuts, K; Béthoux, F; Rasova, K; Severijns, D; Bibby, B M; Kalron, A; Norman, B; Van Geel, F; Wens, I; Feys, P

    2018-04-15

    The relationship between fatigue impact and walking capacity and perceived ability in patients with multiple sclerosis (MS) is inconclusive in the existing literature. A better understanding might guide new treatment avenues for fatigue and/or walking capacity in patients with MS. To investigate the relationship between the subjective impact of fatigue and objective walking capacity as well as subjective walking ability in MS patients. A cross-sectional multicenter study design was applied. Ambulatory MS patients (n = 189, age: 47.6 ± 10.5 years; gender: 115/74 women/men; Expanded Disability Status Scale (EDSS): 4.1 ± 1.8 [range: 0-6.5]) were tested at 11 sites. Objective tests of walking capacity included short walking tests (Timed 25-Foot Walk (T25FW), 10-Metre Walk Test (10mWT) at usual and fastest speed and the timed up and go (TUG)), and long walking tests (2- and 6-Minute Walk Tests (MWT). Subjective walking ability was tested applying the Multiple Sclerosis Walking Scale-12 (MSWS-12). Fatigue impact was measured by the self-reported modified fatigue impact scale (MFIS) consisting of a total score (MFIS total ) and three subscales (MFIS physical , MFIS cognitive and MFIS psychosocial ). Uni- and multivariate regression analysis were performed to evaluate the relation between walking and fatigue impact. MFIS total was negatively related with long (6MWT, r = -0.14, p = 0.05) and short composite (TUG, r = -0.22, p = 0.003) walking measures. MFIS physical showed a significant albeit weak relationship to walking speed in all walking capacity tests (r = -0.22 to -0.33, p < .0001), which persisted in the multivariate linear regression analysis. Subjective walking ability (MSWS-12) was related to MFIS total (r = 0.49, p < 0.0001), as well as to all other subscales of MFIS (r = 0.24-0.63, p < 0.001), showing stronger relationships than objective measures of walking. The physical impact of fatigue is weakly

  10. The impact of multiple show-ups on eyewitness decision-making and innocence risk.

    Smith, Andrew M; Bertrand, Michelle; Lindsay, R C L; Kalmet, Natalie; Grossman, Deborah; Provenzano, Daniel

    2014-09-01

    If an eyewitness rejects a show-up, police may respond by finding a new suspect and conducting a second show-up with the same eyewitness. Police may continue finding suspects and conducting show-ups until the eyewitness makes an identification (Study 1). Relatively low criterion-setting eyewitnesses filter themselves out of the multiple show-ups procedure by choosing the first suspect with whom they are presented (Studies 2 and 3). Accordingly, response bias was more stringent on the second show-up when compared with the first, but became no more stringent with additional show-ups. Despite this stringent shift in response bias, innocence risk increased with additional show-ups, as false alarms cumulate (Studies 2 and 3). Although unbiased show-up instructions decreased innocent suspect identifications, the numbers were still discouraging (Study 4). Given the high number of innocent suspects who would be mistakenly identified through the use of multiple show-up procedures, using such identifications as evidence of guilt is questionable. Although evidence of guilt is limited to identifications from a single show-up, practical constraints might sometimes require police to use additional show-ups. Accordingly, we propose a stronger partition between evidentiary and investigative procedures. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  11. Analyzing the Impacts of Alternated Number of Iterations in Multiple Imputation Method on Explanatory Factor Analysis

    Duygu KOÇAK

    2017-11-01

    Full Text Available The study aims to identify the effects of iteration numbers used in multiple iteration method, one of the methods used to cope with missing values, on the results of factor analysis. With this aim, artificial datasets of different sample sizes were created. Missing values at random and missing values at complete random were created in various ratios by deleting data. For the data in random missing values, a second variable was iterated at ordinal scale level and datasets with different ratios of missing values were obtained based on the levels of this variable. The data were generated using “psych” program in R software, while “dplyr” program was used to create codes that would delete values according to predetermined conditions of missing value mechanism. Different datasets were generated by applying different iteration numbers. Explanatory factor analysis was conducted on the datasets completed and the factors and total explained variances are presented. These values were first evaluated based on the number of factors and total variance explained of the complete datasets. The results indicate that multiple iteration method yields a better performance in cases of missing values at random compared to datasets with missing values at complete random. Also, it was found that increasing the number of iterations in both missing value datasets decreases the difference in the results obtained from complete datasets.

  12. The impact of napping on memory for future-relevant stimuli: Prioritization among multiple salience cues.

    Bennion, Kelly A; Payne, Jessica D; Kensinger, Elizabeth A

    2016-06-01

    Prior research has demonstrated that sleep enhances memory for future-relevant information, including memory for information that is salient due to emotion, reward, or knowledge of a later memory test. Although sleep has been shown to prioritize information with any of these characteristics, the present study investigates the novel question of how sleep prioritizes information when multiple salience cues exist. Participants encoded scenes that were future-relevant based on emotion (emotional vs. neutral), reward (rewarded vs. unrewarded), and instructed learning (intentionally vs. incidentally encoded), preceding a delay consisting of a nap, an equivalent time period spent awake, or a nap followed by wakefulness (to control for effects of interference). Recognition testing revealed that when multiple dimensions of future relevance co-occur, sleep prioritizes top-down, goal-directed cues (instructed learning, and to a lesser degree, reward) over bottom-up, stimulus-driven characteristics (emotion). Further, results showed that these factors interact; the effect of a nap on intentionally encoded information was especially strong for neutral (relative to emotional) information, suggesting that once one cue for future relevance is present, there are diminishing returns with additional cues. Sleep may binarize information based on whether it is future-relevant or not, preferentially consolidating memory for the former category. Potential neural mechanisms underlying these selective effects and the implications of this research for educational and vocational domains are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  13. Ozone impact minimization through coordinated scheduling of turnaround operations from multiple olefin plants in an ozone nonattainment area

    Ge, Sijie; Wang, Sujing; Xu, Qiang; Ho, Thomas

    2018-03-01

    Turnaround operations (start-up and shutdown) are critical operations in olefin plants, which emit large quantities of VOCs, NOx and CO. The emission has great potentials to impact the ozone level in ozone nonattainment areas. This study demonstrates a novel practice to minimize the ozone impact through coordinated scheduling of turnaround operations from multiple olefin plants located in Houston, Texas, an ozone nonattainment area. The study considered two olefin plants scheduled to conduct turnaround operations: one start-up and one shutdown, simultaneously on the same day within a five-hour window. Through dynamic simulations of the turnaround operations using ASPEN Plus Dynamics and air quality simulations using CAMx, the study predicts the ozone impact from the combined effect of the two turnaround operations under different starting-time scenarios. The simulations predict that the ozone impact from planned turnaround operations ranges from a maximum of 11.4 ppb to a minimum of 1.4 ppb. Hence, a reduction of up to 10.0 ppb can be achieved on a single day based on the selected two simulation days. This study demonstrates a cost-effective and environmentally benign ozone control practice for relevant stakeholders, including environmental agencies, regional plant operators, and local communities.

  14. Norway spruce crown structure changes under long-term multiple stress impact in Central European Mts

    Moravec, Ivo; Cudlín, Pavel; Polák, T.

    2003-01-01

    Roč. 22, Suppl. 1 (2003), s. 252-255 ISSN 1335-342X. [Long Term Air Pollution Effect on Forest Ecosystems (International Meeting for Specialists in Air Pollution Effects on Forest Ecosystems)/20./. Zvolen, 30.08.2002-01.09.2002] R&D Projects: GA MŠk OK 355 Institutional research plan: CEZ:AV0Z6087904 Keywords : Norway spruce * crown transformation * tree status Subject RIV: EH - Ecology, Behaviour Impact factor: 0.100, year: 2003

  15. Invasive herb Impatiens glandulifera has minimal impact on multiple components of temperate forest ecosystem function

    Čuda, Jan; Vítková, Michaela; Albrechtová, Marie; Guo, Wen-Yong; Barney, J. N.; Pyšek, Petr

    2017-01-01

    Roč. 19, č. 10 (2017), s. 3051-3066 ISSN 1387-3547 R&D Projects: GA ČR GB14-36079G Grant - others:AV ČR(CZ) AP1002 Program:Akademická prémie - Praemium Academiae Institutional support: RVO:67985939 Keywords : field study * himalayan basam * soil characteristic Subject RIV: EH - Ecology, Behaviour OBOR OECD: Ecology Impact factor: 2.473, year: 2016

  16. Impact of food choice on sodium intake patterns from multiple NHANES surveys.

    Dong, Zefeng; Gao, Zhifeng; McFadden, Brandon

    2017-02-01

    To examine how the food consumption from various food groups would impact American adults' sodium intake and whether this impact structurally changes over time, data were obtained from six-cycle National Health and Nutrition Examination Survey (NHANES) 1999-2010. Foods were categorized by the first two digits of the USDA food code. Regression models were employed to investigate the associations between the consumption of each food group and sodium intake, and whether there were changes in the associations in consecutive six cycles. Results show that the calorie consumption of oils, beverages and water, fruit juices, fruits, lamb, fruit products, and sugars and sweets had no significant impact on individuals' sodium intake, while calorie consumption of tomatoes, fish, dark-green vegetables, and crackers contributes the most to sodium intake. The contribution to sodium intake of most food groups does not change significantly over time, with the exception of salad dressing whose contribution to sodium intake increased in four consecutive years when compared to that of 1999-2000. The sodium amount contributed by one calorie consumption (sodium density) of most food was above the daily recommendation level, 1.2 mg per calorie per day. Lowering individuals' sodium intake involves either guiding individuals to consume more fruit related products or decreasing the amount of sodium in most food groups at the production or food preparation stages. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Impact of a Pelvic Floor Training Program Among Women with Multiple Sclerosis: A Controlled Clinical Trial.

    Ferreira, Ana Paula Silva; Pegorare, Ana Beatriz Gomes de Souza; Salgado, Pedro Rippel; Casafus, Filemón Silva; Christofoletti, Gustavo

    2016-01-01

    The objective of this study was to investigate the effects of two programs for strengthening the pelvic floor on the urinary incontinence of patients with multiple sclerosis (MS). This is a prospective study of the clinical trial type, monitored for 6 mos, in which 24 women in the moderate stage of MS participated in a program of exercises for strengthening the pelvic floor-associated (experimental group) or not (control group) with electrotherapy. The variables analyzed were as follows: quality-of-life, overactivity of the bladder, perineal contraction, and level of anxiety and depression. The statistical procedures involved multivariate analyses of repeated measurements, with a significance of 5%. Initial homogeneity being observed in the anthropometric and clinical variables, both protocols resulted in improvements in quality-of-life (P = 0.001), overactive bladder (P = 0.001), perineal contraction (P = 0.004), and level of anxiety (P = 0.001) and depression (P = 0.001), in relation to the initial comparison. The association of electrotherapy with strengthening exercises increased the improvement of the patients regarding overactive bladder (P = 0.039) and perineal contraction (P = 0.001), in comparison with the control group. The results reinforce the benefit of exercises for strengthening the musculature of the pelvic floor in women with overactive bladder in MS and demonstrate a potential of the action when associated with electrotherapy. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Identify common dysfunctions of the lower urinary tract in women with multiple sclerosis; (2) Discuss the relationship between quality-of-life, level of anxiety and depression, degree of perineal contraction, and overactive bladder; and (3) Recognize the benefits promoted by physical therapy for strengthening the pelvic floor in patients with

  18. Bioanalytical characterisation of multiple endocrine- and dioxin-like activities in sediments from reference and impacted small rivers

    Kinani, Said, E-mail: said@dcmr.polytechnique.f [Unite d' Ecotoxicologie, Institut National de l' Environnement Industriel et des Risques (INERIS), BP2, F-60550 Verneuil en Halatte (France); Departement de Chimie des Mecanismes Reactionnels, Ecole Polytechnique, 91128 Palaiseau Cedex (France); Bouchonnet, Stephane, E-mail: stephane.bouchonnet@dcmr.polytechnique.f [Departement de Chimie des Mecanismes Reactionnels, Ecole Polytechnique, 91128 Palaiseau Cedex (France); Creusot, Nicolas [Unite d' Ecotoxicologie, Institut National de l' Environnement Industriel et des Risques (INERIS), BP2, F-60550 Verneuil en Halatte (France); Bourcier, Sophie [Departement de Chimie des Mecanismes Reactionnels, Ecole Polytechnique, 91128 Palaiseau Cedex (France); Balaguer, Patrick [Institut National de la Sante et de la Recherche Medicale (INSERM), U896, Montpellier, F-34298 (France); Porcher, Jean-Marc [Unite d' Ecotoxicologie, Institut National de l' Environnement Industriel et des Risques (INERIS), BP2, F-60550 Verneuil en Halatte (France); Ait-Aissa, Selim, E-mail: selim.ait-aissa@ineris.f [Unite d' Ecotoxicologie, Institut National de l' Environnement Industriel et des Risques (INERIS), BP2, F-60550 Verneuil en Halatte (France)

    2010-01-15

    A comprehensive evaluation of organic contamination was performed in sediments sampled in two reference and three impacted small streams where endocrine disruptive (ED) effects in fish have been evidenced. The approach combined quantitative chemical analyses of more than 50 ED chemicals (EDCs) and a battery of in vitro bioassays allowing the quantification of receptor-mediated activities, namely estrogen (ER), androgen (AR), dioxin (AhR) and pregnane X (PXR) receptors. At the most impacted sites, chemical analyses showed the presence of natural estrogens, organochlorine pesticides, parabens, polycyclic aromatic hydrocarbons (16 PAHs), bisphenol A and alkylphenols, while synthetic steroids, myco-estrogens and phyto-estrogens were not detected. Determination of toxic-equivalent amounts showed that 28-96% of estrogenic activities in bioassays (0.2-6.3 ng/g 17beta-estradiol equivalents) were explained by 17beta-estradiol and estrone. PAHs were major contributors (20-60%) to the total dioxin-like activities. Interestingly, high PXR and (anti)AR activities were detected; however, the targeted analysed compounds could not explain the measured biological activities. This study highlighted the presence of multiple organic EDCs in French river sediments subjected to mixed diffuse pollution, and argues for the need to further identify AR and PXR active compounds in the aquatic environment. - Multiple endocrine disrupting chemicals (ER, AR, AhR and PXR ligands) are detected in French river sediments using a panel of in vitro bioassays and analytical methods.

  19. Impact of emotional competence on supportive care needs, anxiety and depression symptoms of cancer patients: a multiple mediation model.

    Baudry, A-S; Lelorain, S; Mahieuxe, M; Christophe, V

    2018-01-01

    The aim of this study was to test the effect of intrapersonal and interpersonal emotional competence on cancer patients' supportive care needs, as mediated by anxiety and depression symptoms. Cross-sectional design: 137 cancer patients (42% breast or ovarian cancer, 58% gastrointestinal cancer) in 4 French hospitals completed the Profile of Emotional Competence (PEC), the Hospital Anxiety and Depression Scale (HADS), and the Supportive Care Needs Survey Short Form (SCNS-SF). Bootstrap methods with PROCESS Macro were used to test multiple mediation models. Emotional competence presented a direct or indirect beneficial effect on the satisfaction of supportive care needs, anxiety and depression symptoms. As expected, anxiety and depression symptoms had also strong positive correlations with unmet needs. All multiple mediation models were significant, except for physical needs: intrapersonal and interpersonal emotional competence impacted anxiety and depression symptoms, which in turn impacted psychological, sexual, care/support, and information needs. These innovative results show the important effect of patients' emotional competence on their supportive care need satisfaction, as mediated by anxiety and depression. Consequently, patients with high emotional competence may require less psychosocial input from medical clinicians. Thus, emotional competence may be integrated into health models and psychosocial interventions to improve patient adjustment. Further investigation is, however, needed to know which are the most beneficial specific emotional competences and at what point of the cancer pathway.

  20. The impact of two multiple-choice question formats on the problem-solving strategies used by novices and experts.

    Coderre, Sylvain P; Harasym, Peter; Mandin, Henry; Fick, Gordon

    2004-11-05

    Pencil-and-paper examination formats, and specifically the standard, five-option multiple-choice question, have often been questioned as a means for assessing higher-order clinical reasoning or problem solving. This study firstly investigated whether two paper formats with differing number of alternatives (standard five-option and extended-matching questions) can test problem-solving abilities. Secondly, the impact of the alternatives number on psychometrics and problem-solving strategies was examined. Think-aloud protocols were collected to determine the problem-solving strategy used by experts and non-experts in answering Gastroenterology questions, across the two pencil-and-paper formats. The two formats demonstrated equal ability in testing problem-solving abilities, while the number of alternatives did not significantly impact psychometrics or problem-solving strategies utilized. These results support the notion that well-constructed multiple-choice questions can in fact test higher order clinical reasoning. Furthermore, it can be concluded that in testing clinical reasoning, the question stem, or content, remains more important than the number of alternatives.

  1. Preliminary Investigation of Impact on Multiple-Sheet Structures and an Evaluation of the Meteoroid Hazard to Space Vehicles

    Nysmith, C. Robert; Summers, James L.

    1961-01-01

    Small pyrex glass spheres, representative of stoney meteoroids, were fired into 2024-T3 aluminum alclad multiple-sheet structures at velocities to 11,000 feet per second to evaluate the effectiveness of multisheet hull construction as a means of increasing the resistance of a spacecraft to meteoroid penetrations. The results of these tests indicate that increasing the number of sheets in a structure while keeping the total sheet thickness constant and increasing the spacing between sheets both tend to increase the penetration resistance of a structure of constant weight per unit area. In addition, filling the space between the sheets with a light filler material was found to substantially increase structure penetration resistance with a small increase in weight. An evaluation of the meteoroid hazard to space vehicles is presented in the form of an illustrative-example for two specific lunar mission vehicles, a single-sheet, monocoque hull vehicle and a glass-wool filled, double-sheet hull vehicle. The evaluation is presented in terms of the "best" and the "worst" conditions that might be expected as determined from astronomical and satellite measurements, high-speed impact data, and hypothesized meteoroid structures and compositions. It was observed that the vehicle flight time without penetration can be increased significantly by use of multiple-sheet rather than single-sheet hull construction with no increase in hull weight. Nevertheless, it is evident that a meteoroid hazard exists, even for the vehicle with the selected multiple-sheet hull.

  2. Multiple-electron removal and molecular fragmentation of CO by fast F4+ impact

    Ben-Itzhak, I.; Ginther, S.G.; Carnes, K.D.

    1993-01-01

    Multiple-electron removal from and molecular fragmentation of carbon monoxide molecules caused by collisions with 1-MeV/amu F 4+ ions were studied using the coincidence time-of-flight technique. In these collisions, multiple-electron removal of the target molecule is a dominant process. Cross sections for the different levels of ionization of the CO molecule during the collision were determined. The relative cross sections of ionization decrease with increasing number of electrons removed in a similar way as seen in atomic targets. This behavior is in agreement with a two-step mechanism, where first the molecule is ionized by a Franck-Condon ionization and then the molecular ion dissociates. Most of the highly charged intermediate states of the molecule dissociate rapidly. Only CO + and CO 2+ molecular ions have been seen to survive long enough to be detected as molecular ions. The relative cross sections for the different breakup channels were evaluated for collisions in which the molecule broke into two charged fragments as well as for collisions where only a single charged molecular ion or fragment were produced. The average charge state of each fragment resulting from CO Q+ →C i+ +O j+ breakup increases with the number of electrons removed from the molecule approximately following the relationship bar i=bar j=Q/2 as long as K-shell electrons are not removed. This does not mean that the charge-state distribution is exactly symmetric, as, in general, removing electrons from the carbon fragment is slightly more likely than removing electrons from the oxygen due to the difference in binding energy. The cross sections for molecular breakup into a charged fragment and a neutral fragment drop rapidly with an increasing number of electrons removed

  3. Multiple Changes in the Hydrologic Regime of the Yangtze River and the Possible Impact of Reservoirs

    Feng Huang

    2016-09-01

    Full Text Available This paper investigates hydrologic changes in the Yangtze River using long-term daily stream flow records (1955–2013 collected from four flow gauging stations located from the upper to the lower reaches of the river. The hydrologic regime is quantified using the Indicators of Hydrologic Alteration, which statistically characterize hydrologic variation within each year. Scanning t-test is applied to analyze multiple changes in the hydrologic regime at different time scales. Then, coherency analysis is applied to identify common changes among different hydrologic indicators and across different reaches of the Yangtze River. The results point to various change patterns in the five components of hydrologic regime, including the magnitude of monthly water conditions, magnitude and duration of annual extreme water conditions, timing of annual extreme water conditions, frequency and duration of high and low pulses, and rate and frequency of water condition changes. The 32 hydrologic indicators feature multiple temporal-scale changes. Spatial variations can be observed in the hydrologic changes of the upper, middle, and lower reaches of the river. Common changes in different reaches consist of hydrologic indicators including the monthly flow in October and the low-flow indicators. The monthly flow in October is dominated by decreasing trends, while the monthly flows between January and March, the annual minimum 1/3/7/30/90-day flows, and the base flow index are characterized by increasing trends. Low pulse duration and total days of low pulses feature downward trends. The coherency analysis reveals significant relationships between the monthly flow in October and the low-flow indicators, indicating that reservoir regulation is an important factor behind the hydrologic changes.

  4. Impact of low vision care on reading performance in children with multiple disabilities and visual impairment

    Krishna Kumar Ramani

    2014-01-01

    Full Text Available Background: Lack of evidence in literature to show low vision care enhances the reading performance in children with Multiple Disabilities and Visual Impairment (MDVI. Aim: To evaluate the effectiveness of Low Vision Care intervention on the reading performance of children with MDVI. Materials and Methods: Three subjects who were diagnosed to have cerebral palsy and visual impairment, studying in a special school were recruited for the study. All of them underwent detailed eye examination and low vision care evaluation at a tertiary eye care hospital. A single subject multiple baseline (study design was adopted and the study period was 16 weeks. The reading performance (reading speed, reading accuracy, reading fluency was evaluated during the baseline phase and the intervention phase. The median of all the reading parameters for each week was noted. The trend of the reading performance was graphically represented in both the phases. Results: Reading speed increased by 37 Word per minute, 37 Letters per minute and 5 letters per minute for the subject 1, 2 and 3 respectively after the intervention. Reading accuracy was 84%, 91% and 86.4% at the end of the baseline period and 98.7%, 98.4% and 99% at the end of 16 weeks for subject 1, 2 and 3 respectively. Average reading fluency score was 8.3, 7.1 and 5.5 in the baseline period and 10.2, 10.2 and 8.7 in the intervention period. Conclusion: This study shows evidence of noticeable improvement in reading performance of children with MDVI using a novel study design.

  5. Untangling the effects of multiple human stressors and their impacts on fish assemblages in European running waters.

    Schinegger, Rafaela; Palt, Martin; Segurado, Pedro; Schmutz, Stefan

    2016-12-15

    This work addresses human stressors and their impacts on fish assemblages at pan-European scale by analysing single and multiple stressors and their interactions. Based on an extensive dataset with 3105 fish sampling sites, patterns of stressors, their combination and nature of interactions, i.e. synergistic, antagonistic and additive were investigated. Geographical distribution and patterns of seven human stressor variables, belonging to four stressor groups (hydrological-, morphological-, water quality- and connectivity stressors), were examined, considering both single and multiple stressor combinations. To quantify the stressors' ecological impact, a set of 22 fish metrics for various fish assemblage types (headwaters, medium gradient rivers, lowland rivers and Mediterranean streams) was analysed by comparing their observed and expected response to different stressors, both acting individually and in combination. Overall, investigated fish sampling sites are affected by 15 different stressor combinations, including 4 stressors acting individually and 11 combinations of two or more stressors; up to 4 stressor groups per fish sampling site occur. Stressor-response analysis shows divergent results among different stressor categories, even though a general trend of decreasing ecological integrity with increasing stressor quantity can be observed. Fish metrics based on density of species 'intolerant to water quality degradation' and 'intolerant to oxygen depletion" responded best to single and multiple stressors and their interactions. Interactions of stressors were additive (40%), synergistic (30%) or antagonistic (30%), emphasizing the importance to consider interactions in multi-stressor analyses. While antagonistic effects are only observed in headwaters and medium-gradient rivers, synergistic effects increase from headwaters over medium gradient rivers and Mediterranean streams to large lowland rivers. The knowledge gained in this work provides a basis for

  6. Analytical and experimental investigation on a multiple-mass-element pendulum impact damper for vibration mitigation

    Egger, Philipp; Caracoglia, Luca

    2015-09-01

    Impact dampers are often used in the field of civil, mechanical and aerospace engineering for reducing structural vibrations. The behavior of this type of passive control device has been investigated for several decades. In this research a distributed-mass impact damper, similar to the "chain damper" used in wind engineering, has been examined and applied to the vibration reduction on a slender line-like structural element (stay-cable). This study is motivated by a practical problem and describes the derivation of a reduced-order model for explaining the behavior, observed during a field experiment on a prototype system. In its simplest form, the dynamics of the apparatus is modeled as a "resilient damper", composed of mass-spring-dashpot secondary elements, attached to the primary structure. Various sources of excitation are analyzed: free vibration, external harmonic force and random excitation. The proposed model is general and potentially applicable to the analysis of several structural systems. The study also shows that the model can adequately describe and explain the experimentally observed behavior.

  7. Impacts of multiple stressors on ecosystem function: Leaf decomposition in constructed urban wetlands

    Mackintosh, Teresa J.; Davis, Jenny A.; Thompson, Ross M.

    2016-01-01

    The impact of stormwater on stream biota is well documented, but less is known about the impacts on ecosystem processes, such as the breakdown of organic matter. This study sought to establish whether the degree of urbanisation affected rates of leaf-litter breakdown within constructed wetlands. A litter bag method was used to ascertain rate of decomposition along a gradient of urbanisation (total imperviousness, TI), in constructed wetlands in western and south-eastern Melbourne. A significant positive relationship between TI and breakdown rate was found in the south-eastern wetlands. The significant reduction in rate of invertebrate-mediated breakdown with increasing concentration of certain metals was consistent with other studies. However, overall there was an increase in rate of breakdown. Studies have shown that the effects of heavy metals can be negated if nutrient levels are high. Our results suggest that other parameters besides exposure to contaminants are likely to affect leaf litter breakdown. - Highlights: • There have been few studies on the effect of urbanisation on ecosystem function. • Rate of leaf litter breakdown increased moving along a gradient of urbanisation. • There was a reduction in invertebrate mediated breakdown with certain metals. • Results suggest other parameters besides contaminants affect leaf litter breakdown. - Certain heavy metals led to a decrease in leaf litter breakdown; however overall, there was a positive relationship between breakdown and increasing urbanisation.

  8. Impacts of multiple stressors on ecosystem function: Leaf decomposition in constructed urban wetlands.

    Mackintosh, Teresa J; Davis, Jenny A; Thompson, Ross M

    2016-01-01

    The impact of stormwater on stream biota is well documented, but less is known about the impacts on ecosystem processes, such as the breakdown of organic matter. This study sought to establish whether the degree of urbanisation affected rates of leaf-litter breakdown within constructed wetlands. A litter bag method was used to ascertain rate of decomposition along a gradient of urbanisation (total imperviousness, TI), in constructed wetlands in western and south-eastern Melbourne. A significant positive relationship between TI and breakdown rate was found in the south-eastern wetlands. The significant reduction in rate of invertebrate-mediated breakdown with increasing concentration of certain metals was consistent with other studies. However, overall there was an increase in rate of breakdown. Studies have shown that the effects of heavy metals can be negated if nutrient levels are high. Our results suggest that other parameters besides exposure to contaminants are likely to affect leaf litter breakdown. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Measuring the impact of multiple sclerosis on psychosocial functioning: the development of a new self-efficacy scale.

    Airlie, J; Baker, G A; Smith, S J; Young, C A

    2001-06-01

    To develop a scale to measure self-efficacy in neurologically impaired patients with multiple sclerosis and to assess the scale's psychometric properties. Cross-sectional questionnaire study in a clinical setting, the retest questionnaire returned by mail after completion at home. Regional multiple sclerosis (MS) outpatient clinic or the Clinical Trials Unit (CTU) at a large neuroscience centre in the UK. One hundred persons with MS attending the Walton Centre for Neurology and Neurosurgery and Clatterbridge Hospital, Wirral, as outpatients. Cognitively impaired patients were excluded at an initial clinic assessment. Patients were asked to provide demographic data and complete the self-efficacy scale along with the following validated scales: Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, Impact, Stigma and Mastery and Rankin Scales. The Rankin Scale and Barthel Index were also assessed by the physician. A new 11-item self-efficacy scale was constructed consisting of two domains of control and personal agency. The validity of the scale was confirmed using Cronbach's alpha analysis of internal consistency (alpha = 0.81). The test-retest reliability of the scale over two weeks was acceptable with an intraclass correlation coefficient of 0.79. Construct validity was investigated using Pearson's product moment correlation coefficient resulting in significant correlations with depression (r= -0.52) anxiety (r =-0.50) and mastery (r= 0.73). Multiple regression analysis demonstrated that these factors accounted for 70% of the variance of scores on the self-efficacy scale, with scores on mastery, anxiety and perceived disability being independently significant. Assessment of the psychometric properties of this new self-efficacy scale suggest that it possesses good validity and reliability in patients with multiple sclerosis.

  10. The impact of lower urinary tract symptoms on health-related quality of life among patients with multiple sclerosis.

    Khalaf, Kristin M; Coyne, Karin S; Globe, Denise R; Malone, Daniel C; Armstrong, Edward P; Patel, Vaishali; Burks, Jack

    2016-01-01

    Lower urinary tract symptoms are commonly experienced among patients with multiple sclerosis (MS), however, their impact on health-related quality of life (HRQOL) has not been well characterized. Herein the incremental impact of lower urinary tract symptoms on HRQOL among patients with MS has been evaluated. A cross-sectional online survey was administered to US residents with a self-reported MS diagnosis. Data pertaining to demographics, disease history, urinary symptoms, and HRQOL, including the Short Form 36, version 2 (SF-36v2), were collected. Patients were stratified into four urinary symptom groups: no/minimal urinary symptoms, urinary urgency (UU), urinary urgency incontinence (UUI), and other lower urinary tract symptoms. Multiple linear regression models evaluated the impact of these symptoms. Out of the 1,052 respondents, mean age was 47.8 ± 10.6 years; mean time since MS diagnosis was 8.5 ± 7.8 years. UUI and UU subgroups showed the greatest adjusted HRQOL decrement compared with the no/minimal urinary symptoms group, scoring 2.8 (SE ± 0.7, UUI) and 3.5 (SE ± 0.8, UU) points lower on SF-36v2 Physical Component Summary, respectively, and 3.7 (SE ± 1.0, UUI) and 5.0 (SE ± 1.2, UU) points lower on SF-36v2 Mental Component Summary (P decrement in HRQOL among patients with MS. The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.

  11. THE PHYSICS OF PROTOPLANETESIMAL DUST AGGLOMERATES. V. MULTIPLE IMPACTS OF DUSTY AGGLOMERATES AT VELOCITIES ABOVE THE FRAGMENTATION THRESHOLD

    Kothe, Stefan; Guettler, Carsten; Blum, Juergen

    2010-01-01

    In recent years, a number of new experiments have advanced our knowledge on the early growth phases of protoplanetary dust aggregates. Some of these experiments have shown that collisions between porous and compacted agglomerates at velocities above the fragmentation threshold velocity can lead to growth of the compact body, when the porous collision partner fragments upon impact and transfers mass to the compact agglomerate. To obtain a deeper understanding of this potentially important growth process, we performed laboratory and drop tower experiments to study multiple impacts of small, highly porous dust-aggregate projectiles onto sintered dust targets. The projectile and target consisted of 1.5 μm monodisperse, spherical SiO 2 monomers with volume filling factors of 0.15 ± 0.01 and 0.45 ± 0.05, respectively. The fragile projectiles were accelerated by a solenoid magnet and combined with a projectile magazine with which 25 impacts onto the same spot on the target could be performed in vacuum. We measured the mass-accretion efficiency and the volume filling factor for different impact velocities between 1.5 and 6.0 m s -1 . The experiments at the lowest impact speeds were performed in the Bremen drop tower under microgravity conditions to allow partial mass transfer also for the lowest adhesion case. Within this velocity range, we found a linear increase of the accretion efficiency with increasing velocity. In the laboratory experiments, the accretion efficiency increases from 0.12 to 0.21 in units of the projectile mass. The recorded images of the impacts showed that the mass transfer from the projectile to the target leads to the growth of a conical structure on the target after less than 100 impacts. From the images, we also measured the volume filling factors of the grown structures, which ranged from 0.15 (uncompacted) to 0.40 (significantly compacted) with increasing impact speed. The velocity dependency of the mass-transfer efficiency and the packing

  12. Impact of sole cropping and multiple cropping on soil humified carbon fractions

    Radhakrishnan, R.; Lee, I.J.

    2014-01-01

    The present study was planned to improve our understanding how crop rotation can enhance humified C fractions. A long term experiment was conducted on Vanmeter farm of the Ohio State University South Centers at Piketon Ohio, USA from 2002 to 2007. Crop rotation treatments included were continuous corn (CC), corn-soybean (CS) and corn-soybean-wheat-cowpea (CSW) rotations. Randomized complete block design with 6 replications was used under natural field conditions. The findings of this long-term study revealed that multiple cropping had significantly improved humified carbon fractions compared to mono-cropping system. Although total humified carbon (THOC), sugar free humified carbon (HOC) concentration were non-significant however, humin (NH) contents, humic (HA), fulvic acids (FA), humic and fulvic acid associated glucose (HA-NH and FA-NH) were significantly affected by various crop rotations within five years. The soil under CC had 22-52% significantly greater NH concentration than CSW and CS rotations respectively. Similarly all crop rotations had shown 5-16 increase in HA and 5-17% decreased in FA over time. Likewise soil under CC had 16 and 54% greater HA-NH concentration as compared to CSW and CS rotations. The FA-NH concentration increased significantly by 27- 51% in soil under all treatments over time. The soil under CSW had greater HA/FA (1.6) fallowed by CC (1.4) and CS (1.1). Soils under CSW had significantly greater HA/HOC (12-18%) as compare to CC and CS respectively. Conversely, the value of FA/HOC decreased (1-23%) in soil under all crop rotation treatments within five years. Degree of humification (DH) had shown a significant increase (7-12%) in soil under all treatments as compared to 2002. Irrespective of crop rotation THOC, HOC, NH, humin, HA, HR and FA/HOC concentration decreased significantly with increase in soil depth. While fulvic acid concentration HA/HOC in all crop rotation increased with increase in soil depth. The effect of crop rotation

  13. Non-syndromic multiple impacted supernumerary teeth with peripheral giant cell granuloma

    Pankaj Bansal

    2011-01-01

    Full Text Available Peripheral giant cell granuloma (PGCG is a relatively frequent benign reactive lesion of the gingiva, originating from the periosteum or periodontal membrane following local irritation or chronic trauma. PGCG manifests as a red-purple nodule located in the region of the gingiva or edentulous alveolar margins. The lesion can develop at any age, although it is more common between the second and third decades of life, and shows a slight female predilection. PGCG is a soft tissue lesion that very rarely affects the underlying bone, although the latter may suffer superficial erosion. A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. These teeth may be single, multiple, erupted or unerupted and may or may not be associated with syndrome. Usually, they cause one or the other problem in eruption or alignment of teeth, but may also present without disturbing the normal occlusion or eruption pattern. Management of these teeth depends on the symptoms. Presented here is a case of PGCG in relation to the lower left permanent first molar with three supernumerary teeth in the mandibular arch but no associated syndrome.

  14. Fertility, pregnancy and childbirth in patients with multiple sclerosis: impact of disease-modifying drugs.

    Amato, Maria Pia; Portaccio, Emilio

    2015-03-01

    In recent decades, pregnancy-related issues in multiple sclerosis (MS) have received growing interest. MS is more frequent in women than in men and typically starts during child-bearing age. An increasing number of disease-modifying drugs (DMDs) for the treatment of MS are becoming available. Gathering information on their influences on pregnancy-related issues is of crucial importance for the counselling of MS patients. As for the immunomodulatory drugs (interferons and glatiramer acetate), accumulating evidence points to the relative safety of pregnancy exposure in terms of maternal and foetal outcomes. In case of higher clinical disease activity before pregnancy, these drugs could be continued until conception. As for the 'newer' drugs (fingolimod, natalizumab, teriflunomide, dimethyl fumarate and alemtuzumab), the information is more limited. Whereas fingolimod and teriflunomide are likely associated with an increased risk of foetal malformations, the effects of natalizumab, dimethyl fumarate and alemtuzumab still need to be ascertained. This article provides a review of the available information on the use of DMDs during pregnancy, with a specific focus on fertility, foetal development, delivery and breast-feeding.

  15. Inactivating UBE2M impacts the DNA damage response and genome integrity involving multiple cullin ligases.

    Scott Cukras

    Full Text Available Protein neddylation is involved in a wide variety of cellular processes. Here we show that the DNA damage response is perturbed in cells inactivated with an E2 Nedd8 conjugating enzyme UBE2M, measured by RAD51 foci formation kinetics and cell based DNA repair assays. UBE2M knockdown increases DNA breakages and cellular sensitivity to DNA damaging agents, further suggesting heightened genomic instability and defective DNA repair activity. Investigating the downstream Cullin targets of UBE2M revealed that silencing of Cullin 1, 2, and 4 ligases incurred significant DNA damage. In particular, UBE2M knockdown, or defective neddylation of Cullin 2, leads to a blockade in the G1 to S progression and is associated with delayed S-phase dependent DNA damage response. Cullin 4 inactivation leads to an aberrantly high DNA damage response that is associated with increased DNA breakages and sensitivity of cells to DNA damaging agents, suggesting a DNA repair defect is associated. siRNA interrogation of key Cullin substrates show that CDT1, p21, and Claspin are involved in elevated DNA damage in the UBE2M knockdown cells. Therefore, UBE2M is required to maintain genome integrity by activating multiple Cullin ligases throughout the cell cycle.

  16. Inactivating UBE2M impacts the DNA damage response and genome integrity involving multiple cullin ligases.

    Cukras, Scott; Morffy, Nicholas; Ohn, Takbum; Kee, Younghoon

    2014-01-01

    Protein neddylation is involved in a wide variety of cellular processes. Here we show that the DNA damage response is perturbed in cells inactivated with an E2 Nedd8 conjugating enzyme UBE2M, measured by RAD51 foci formation kinetics and cell based DNA repair assays. UBE2M knockdown increases DNA breakages and cellular sensitivity to DNA damaging agents, further suggesting heightened genomic instability and defective DNA repair activity. Investigating the downstream Cullin targets of UBE2M revealed that silencing of Cullin 1, 2, and 4 ligases incurred significant DNA damage. In particular, UBE2M knockdown, or defective neddylation of Cullin 2, leads to a blockade in the G1 to S progression and is associated with delayed S-phase dependent DNA damage response. Cullin 4 inactivation leads to an aberrantly high DNA damage response that is associated with increased DNA breakages and sensitivity of cells to DNA damaging agents, suggesting a DNA repair defect is associated. siRNA interrogation of key Cullin substrates show that CDT1, p21, and Claspin are involved in elevated DNA damage in the UBE2M knockdown cells. Therefore, UBE2M is required to maintain genome integrity by activating multiple Cullin ligases throughout the cell cycle.

  17. Factor structure of the Disability and Impact Profile in patients with multiple sclerosis

    Cohen, J. L.; Pouwer, F; Pfennings, L E

    1999-01-01

    and their complementary weighted scores share common variance? What is the factor structure of the weighted scores? To what extent do disease-related information and information from psychological questionnaires offer concurrent validity for the factors? Correlations between impairment ratings and the weighted item...... scores were high; for most items the complementary ratings of impact do not supplement information provided by impairment ratings. The DIP weighted scores can be represented to some extent by three independent dimensions: a motor (skeletal movement) or displacement ability factor, a factor relating...... to sensory-cognitive intactness and a psychological well-being factor. A two-factor solution provides a first factor identical to that of the three-factor solution and a second factor representing psychological well-being. The two factors correlate well with instruments measuring disability...

  18. K/T boundary stratigraphy: Evidence for multiple impacts and a possible comet stream

    Shoemaker, E. M.; Izett, G. A.

    1992-01-01

    A critical set of observations bearing on the K/T boundary events were obtained from several dozen sites in western North America. Thin strata at and adjacent to the K/T boundary are locally preserved in association with coal beds at these sites. The strata were laid down in local shallow basins that were either intermittently flooded or occupied by very shallow ponds. Detailed examination of the stratigraphy at numerous sites led to the recognition of two distinct strata at the boundary. From the time that the two strata were first recognized, E.M. Shoemaker has maintained that they record two impact events. We report some of the evidence that supports this conclusion.

  19. Addressing Complex Societal Problems: Enabling Multiple Dimensions of Proximity to Sustain Partnerships for Collective Impact in Quebec

    Nii A. Addy

    2018-03-01

    Full Text Available Sustainable solutions for complex societal problems, like poverty, require informing stakeholders about progress and changes needed as they collaborate. Yet, inter-organizational collaboration researchers highlight monumental challenges in measuring seemingly intangible factors during collective impact processes. We grapple with the question: How can decision-makers coherently conceptualize and measure seemingly intangible factors to sustain partnerships for the emergence of collective impact? We conducted an inductive process case study to address this question, analyzing data from documents, observations, and interviews of 24 philanthropy leaders and multiple stakeholders in a decades-long partnership involving Canada’s largest private family foundation, government and community networks, and during which a “collective impact project” emerged in Quebec Province, Canada. The multidimensional proximity framework provided an analytical lens. During the first phase of the partnership studied, there was a lack of baseline measurement of largely qualitative factors—conceptualized as cognitive, social, and institutional proximity between stakeholders—which evaluations suggested were important for explaining which community networks successfully brought about desired outcomes. Non-measurement of these factors was a problem in providing evidence for sustained engagement of stakeholders, such as government and local businesses. We develop a multidimensional proximity model that coherently conceptualizes qualitative proximity factors, for measuring their change over time.

  20. Quantification of Multiple Climate Change and Human Activity Impact Factors on Flood Regimes in the Pearl River Delta of China

    Yihan Tang

    2016-01-01

    Full Text Available Coastal flood regimes have been irreversibly altered by both climate change and human activities. This paper aims to quantify the impacts of multiple factors on delta flood. The Pearl River Delta (PRD, with dense river network and population, is one of the most developed coastal areas in China. The recorded extreme water level (m.s.l. in flood season has been heavily interfered with by varied income flood flow, sea-level rise, and dredged riverbeds. A methodology, composed of a numerical model and the index R, has been developed to quantify the impacts of these driving factors in the the PRD. Results show that the flood level varied 4.29%–53.49% from the change of fluvial discharge, 3.35%–38.73% from riverbed dredging, and 0.12%–16.81% from sea-level rise. The variation of flood flow apparently takes the most effect and sea-level rise the least. In particular, dense river network intensifies the impact of income flood change and sea-level rise. Findings from this study help understand the causes of the the PRD flood regimes and provide theoretical support for flood protection in the delta region.

  1. Analysis of Resource and Emission Impacts: An Emergy-Based Multiple Spatial Scale Framework for Urban Ecological and Economic Evaluation

    Lixiao Zhang

    2011-03-01

    Full Text Available The development of the complex and multi-dimensional urban socio-economic system creates impacts on natural capital and human capital, which range from a local to a global scale. An emergy-based multiple spatial scale analysis framework and a rigorous accounting method that can quantify the values of human-made and natural capital losses were proposed in this study. With the intent of comparing the trajectory of Beijing over time, the characteristics of the interface between different scales are considered to explain the resource trade and the impacts of emissions. In addition, our improved determination of emergy analysis and acceptable management options that are in agreement with Beijing’s overall sustainability strategy were examined. The results showed that Beijing’s economy was closely correlated with the consumption of nonrenewable resources and exerted rising pressure on the environment. Of the total emergy use by the economic system, the imported nonrenewable resources from other provinces contribute the most, and the multi‑scale environmental impacts of waterborne and airborne pollution continued to increase from 1999 to 2006. Given the inputs structure, Beijing was chiefly making greater profits by shifting resources from other provinces in China and transferring the emissions outside. The results of our study should enable urban policy planners to better understand the multi-scale policy planning and development design of an urban ecological economic system.

  2. Management Control in Major Brazilian Multiple Banks: the Impact of Internationalization and Convergence of Accounting Standards on the Control Systems

    João Carlos Damasceno Reis

    2014-08-01

    Full Text Available This study verifies the impact caused by the processes of globalization and convergence to international accounting standards on the managerial control systems of the largest multiple banks that operate in Brazil. The study was exploratory in nature, with the use of the case study method and the application of questionnaires containing mostly open questions to upper tier executives of four major Brazilian banks. The analysis showed that globalization has resulted in improved control systems and widespread use of information technology. It was also found that the convergence to international accounting standards occurred properly, thanks to the steps taken by the Central Bank that aimed at an agile updating of the Brazilian accounting standards laid down for banks operating in Brazil, in line with international standards. In general, the researched banks did not report a significant impact of convergence to the IFRS on their management control systems; adherence to the international accounting standards has had more significant impacts on information systems, especially regarding the new reporting and transparency standards, rather than on management controls. This result signals that the management control systems of the four banks in the sample are in line with Anthony (1965’s vision, that is, that flexibility to adapt to every change in the external environment might actually increase risks of failure.

  3. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs

    Yin, Hao; Pizzol, Massimo; Xu, Linyu

    2017-01-01

    Multiple PM2.5 related health impacts and external costs were estimated. • ICD-10 report was utilized to avoid double counting of PM2.5 health impacts. • Both AHC and VSL methods were applied for external costs comparison. • Variables uncertainties were considered to quantify the external cost distribution. • The external costs of PM2.5 ranged from 0.3% to 0.9% of regional GDP in Beijing.

  4. Impact of Pilates Exercise in Multiple Sclerosis: A Randomized Controlled Trial.

    Duff, Whitney R D; Andrushko, Justin W; Renshaw, Doug W; Chilibeck, Philip D; Farthing, Jonathan P; Danielson, Jana; Evans, Charity D

    2018-01-01

    Pilates is a series of exercises based on whole-body movement and may improve mobility in people with multiple sclerosis (MS). The purpose of this study was to determine the effect of Pilates on walking performance in people with MS. 30 individuals with MS who were not restricted to a wheelchair or scooter (Patient-Determined Disease Steps scale score Pilates (twice weekly) and massage therapy (once weekly) or once-weekly massage therapy only (control group). The Pilates was delivered in a group setting (five to ten participants per session). The primary outcome was change in walking performance (6-Minute Walk Test) after 12 weeks. Secondary outcomes included functional ability (Timed Up and Go test), balance (Fullerton Advanced Balance Scale), flexibility (sit and reach test), body composition (dual-energy X-ray absorptiometry), core endurance (plank-hold test), and muscle strength and voluntary activation (quadriceps). Intention-to-treat analysis was performed using a two-factor repeated-measures analysis of variance. Walking distance increased by a mean (SD) of 52.4 (40.2) m in the Pilates group versus 15.0 (34.1) m in the control group (group × time, P = .01). Mean (SD) time to complete the Timed Up and Go test decreased by 1.5 (2.8) seconds in the Pilates group versus an increase of 0.3 (0.9) seconds in the control group (group × time, P = .03). There were no other significant differences between groups over time. Pilates improved walking performance and functional ability in persons with MS and is a viable exercise option to help manage the disease.

  5. Multiple stressors and amphibian declines: dual impacts of pesticides and fish on yellow-legged frogs.

    Davidson, Carlos; Knapp, Roland A

    2007-03-01

    More than 40% of Earth's 5700+ amphibian species have undergone recent declines. Despite the likely involvement of multiple factors in driving these declines, most studies continue to focus on single stressors. In California (USA), separate studies have implicated either introduced fish or pesticides as causal agents. To date, however, no study has simultaneously evaluated the respective roles of these two potential stressors nor attempted to assess their relative importance, information critical for the development of effective conservation efforts and environmental policies. We examined the role and relative effect of fish and pesticides on the mountain yellow-legged frog (Rana muscosa) using unusually detailed data sets for a large portion of R. muscosa's historic range in California's Sierra Nevada. Habitat characteristics and presence/absence of R. muscosa and fish were quantified at each of 6831 sites during field surveys. Pesticide use upwind of each site was calculated from pesticide application records and predominant wind directions. Using generalized additive models, we found that, after accounting for habitat effects, the probability of R. muscosa presence was significantly reduced by both fish and pesticides, with the landscape-scale effect of pesticides much stronger than that of fish. The degree to which a site was sheltered from the predominant wind (and associated pesticides) was also a significant predictor of R. muscosa presence. Taken together, these results represent the strongest evidence to date that windborne pesticides are contributing to amphibian declines in pristine locations. Our results suggest that amphibian declines may have complex multi-factorial causes, and caution that single-factor studies that demonstrate the importance of one factor should not be used as evidence against the importance of other factors.

  6. The impact of hereditary multiple exostoses on quality of life, satisfaction, global health status, and pain.

    D'Ambrosi, Riccardo; Ragone, Vincenza; Caldarini, Camilla; Serra, Nicola; Usuelli, Federico Giuseppe; Facchini, Renato Mario

    2017-02-01

    The aim of the study was to evaluate quality of life (QOL), global health status, pain, and level of satisfaction in patients with hereditary multiple exostoses (HME), and to correlate the association between the severity of diseases and age, sex, number of surgical procedures, and number of exostoses. The data of 50 patients with HME were retrospectively evaluated and recorded. QOL was evaluated with the Short-Form Health Survey (SF-12) questionnaire, the 12-Item General Health Questionnaire (GHQ-12), and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF); intensity of pain was measured using the visual analogue scale (VAS). The association of age, gender, pain, quality of life, number of exostoses, and number of surgical procedures were evaluated and correlated. Mean number of exostoses in our patient's cohort resulted 18.12 ± 8.60, and every patient underwent to a mean of 5.62 ± 5.74 surgical procedures for the exostoses. Mean VAS resulted 5.16 ± 2.90. Considering SF-12, mental (MCS) and physical (PCS) component resulted, respectively, 45.36 ± 10.76 and 38.73 ± 11.09, while GHQ-12 and Q-LES-Q-SF were 15.48 ± 4.70 and 45.28 ± 9.55, respectively. We found a significant positive correlation between the number of exostoses and the number of surgical procedures (p life as measured by the MCS and PCS scores similar to the disability associated with osteoarthritis in the mental component and tumors or diabetes as regards the physical component. Moreover, we found no difference in patients' quality of life as regards number of exostoses, age, and surgical procedure, but we found that women have a worse response as regards the psychological side than men.

  7. Impact of genetic risk loci for multiple sclerosis on expression of proximal genes in patients

    James, Tojo

    2018-01-06

    Despite advancements in genetic studies, it is difficult to understand and characterize the functional relevance of disease-associated genetic variants, especially in the context of a complex multifactorial disease such as Multiple Sclerosis (MS). Since a large proportion of expression quantitative trait loci (eQTLs) are context-specific, we performed RNA-Seq in peripheral blood mononuclear cells (PBMCs) from MS patients (n=145) to identify eQTLs in regions centered on 109 MS risk SNPs and seven associated HLA variants. We identified 77 statistically significant eQTL associations, including pseudogenes and non-coding RNAs. Thirty-eight out of 40 testable eQTL effects were colocalised with the disease association signal. Since many eQTLs are tissue specific, we aimed to detail their significance in different cell types. Approximately 70% of the eQTLs were replicated and characterized in at least one major PBMC derived cell type. Furthermore, 40% of eQTLs were found to be more pronounced in MS patients compared to noninflammatory neurological diseases patients. In addition, we found two SNPs to be significantly associated with the proportions of three different cell types. Mapping to enhancer histone marks and predicted transcription factor binding sites added additional functional evidence for eight eQTL regions. As an example, we found that rs71624119, shared with three other autoimmune diseases and located in a primed enhancer (H3K4me1) with potential binding for STAT transcription factors, significantly associates with ANKRD55 expression. This study provides many novel and validated targets for future functional characterization of MS and other diseases.

  8. The economic impact of multiple sclerosis to the patients and their families in Norway.

    Svendsen, B; Grytten, N; Bø, L; Aarseth, H; Smedal, T; Myhr, K-M

    2018-04-21

    Multiple sclerosis (MS) imposes high economic costs on society, but the patients and their families have to bear some of these costs. We aimed to estimate the magnitude of these economic costs in Norway. We collected data through a postal questionnaire survey targeting 922 MS patients in Hordaland County, western Norway, in 2013-2014; 546 agreed to participate and were included. The questionnaire included clinical and demographic characteristics, volume and cost of MS-related resource use, work participation, income, government financial support, and disability status. The mean annual total economic costs for the patients and their families were €11,603. Indirect costs accounted for 66% and were lower for women than for men. The direct costs were nearly identical for men and women. The costs increased up to Expanded Disability Status Scale score 6 except for steps between 3 and 4 where it remained nearly constant. The costs reduced from EDSS 6 to 8, and increased from 8 to 9. Lifetime costs ranged from €24,897 to €70,021 for patients with late disease onset and slow progression, and between €441,934 and €574,860 for patients with early onset and rapid progression. The economic costs of MS impose a heavy burden on the patients and their families. Supplementing the information on the cost of MS to society, our finding should be included as background information in decisions on reimbursing and allocating public resources for the well-being of MS patients and their families.

  9. Fingolimod's Impact on MRI Brain Volume Measures in Multiple Sclerosis: Results from MS-MRIUS.

    Zivadinov, Robert; Medin, Jennie; Khan, Nasreen; Korn, Jonathan R; Bergsland, Niels; Dwyer, Michael G; Chitnis, Tanuja; Naismith, Robert T; Alvarez, Enrique; Kinkel, Peter; Cohan, Stanley; Hunter, Samuel F; Silva, Diego; Weinstock-Guttman, Bianca

    2018-05-11

    Evidence is needed to understand the effect of fingolimod on slowing down brain atrophy progression in multiple sclerosis (MS) patients in clinical practice. We investigated the effect of fingolimod on brain atrophy in MS patients with active disease (clinically and/or magnetic resonance imaging [MRI]) versus no evidence of active disease (NEAD). MS and clinical outcome and MRI in the United States (MS-MRIUS) is a multicenter, retrospective study that included 590 relapsing-remitting MS patients, who initiated fingolimod, and were followed for a median of 16 months. Patients with active disease at baseline (245, 41.5%) were defined as those who had one or more relapses in the year previous starting fingolimod, and/or displayed gadolinium enhancing lesions(s) at baseline MRI scan, whereas patients with NEAD at baseline (345, 58.5%) did not fulfill these criteria. Annualized percentage brain volume change (PBVC) and percentage lateral ventricle volume change (PLVVC) over the follow-up were analyzed in both groups. Over the follow-up, the rate of PBVC was -.38% in active disease and -.25% in NEAD patients (P = .076), whereas PLLVC was 1.76% in active disease and .28% in NEAD patients (P = .046). No changes in timed 25-foot walk (P = .619) and Expanded Disability Status Scale (P = .275) scores or MRI lesion accumulation (P > 0.08) were detected, although the active disease group had a higher proportion of relapses during the follow-up period (P = .02). The study provides real-world evidence that rate of brain atrophy in MS patients with underlying active disease and NEAD in fingolimod treated patients is below the established pathological cutoff for loss of whole brain volume (>-.4%) or expansion of lateral ventricles (> 3.5%). Copyright © 2018 by the American Society of Neuroimaging.

  10. Multiple approaches to valuation of conservation design and low-impact development features in residential subdivisions.

    Bowman, Troy; Tyndall, John C; Thompson, Janette; Kliebenstein, James; Colletti, Joe P

    2012-08-15

    Residents, developers and civic officials are often faced with difficult decisions about appropriate land uses in and around metropolitan boundaries. Urban expansion brings with it the potential for negative environmental impacts, but there are alternatives, such as conservation subdivision design (CSD) or low-impact development (LID), which offer the possibility of mitigating some of these effects at the development site. Many urban planning jurisdictions across the Midwest do not currently have any examples of these designs and lack information to identify public support or barriers to use of these methods. This is a case study examining consumer value for conservation and low-impact design features in one housing market by using four different valuation techniques to estimate residents' willingness to pay for CSD and LID features in residential subdivisions. A contingent valuation survey of 1804 residents in Ames, IA assessed familiarity with and perceptions of subdivision development and used an ordered value approach to estimate willingness to pay for CSD and LID features. A majority of residents were not familiar with CSD or LID practices. Residents indicated a willingness to pay for most CSD and LID features with the exception of clustered housing. Gender, age, income, familiarity with LID practices, perceptions of attractiveness of features and the perceived effect of CSD and LID features on ease of future home sales were important factors influencing residents' willingness to pay. A hypothetical referendum measured willingness to pay for tax-funded conservation land purchases and estimated that a property tax of around $50 would be the maximum increase that would pass. Twenty-seven survey respondents participated in a subsequent series of experimental real estate negotiations that used an experimental auction mechanism to estimate willingness to pay for CSD and LID features. Participants indicated that clustered housing (with interspersed preserved forest

  11. Evaluating the impacts of climate change on diurnal wind power cycles using multiple regional climate models

    Goddard, Scott D.

    2015-05-01

    Electrical utility system operators must plan resources so that electricity supply matches demand throughout the day. As the proportion of wind-generated electricity in the US grows, changes in daily wind patterns have the potential either to disrupt the utility or increase the value of wind to the system over time. Wind power projects are designed to last many years, so at this timescale, climate change may become an influential factor on wind patterns. We examine the potential effects of climate change on the average diurnal power production cycles at 12 locations in North America by analyzing averaged and individual output from nine high-resolution regional climate models comprising historical (1971–1999) and future (2041–2069) periods. A semi-parametric mixed model is fit using cubic B-splines, and model diagnostics are checked. Then, a likelihood ratio test is applied to test for differences between the time periods in the seasonal daily averaged cycles, and agreement among the individual regional climate models is assessed. We investigate the significant changes by combining boxplots with a differencing approach and identify broad categories of changes in the amplitude, shape, and position of the average daily cycles. We then discuss the potential impact of these changes on wind power production.

  12. The impact of multiple information on coupled awareness-epidemic dynamics in multiplex networks

    Pan, Yaohui; Yan, Zhijun

    2018-02-01

    Growing interest has emerged in the study of the interplay between awareness and epidemics in multiplex networks. However, previous studies on this issue usually assume that all aware individuals take the same level of precautions, ignoring individual heterogeneity. In this paper, we investigate the coupled awareness-epidemic dynamics in multiplex networks considering individual heterogeneity. Here, the precaution levels are heterogeneous and depend on three types of information: contact information and local and global prevalence information. The results show that contact-based precautions can decrease the epidemic prevalence and augment the epidemic threshold, but prevalence-based precautions, regardless of local or global information, can only decrease the epidemic prevalence. Moreover, unlike previous studies in single-layer networks, we do not find a greater impact of local prevalence information on the epidemic prevalence compared to global prevalence information. In addition, we find that the altruistic behaviors of infected individuals can effectively suppress epidemic spreading, especially when the level of contact-based precaution is high.

  13. The impact of quality of life on treatment preferences in multiple sclerosis patients

    Lee Mortensen G

    2017-10-01

    Full Text Available Gitte Lee Mortensen,1 Peter V Rasmussen2 1Medical Anthropology Department, AnthroConsult, 2Department of Neurology, University Hospital of Aarhus, Aarhus C, Denmark Introduction: Multiple sclerosis (MS is a demyelinating disorder with an unpredictable and often disabling course. MS symptoms are very heterogeneous and may lead to reduced physical, cognitive, and psychosocial functioning decreasing patients’ quality of life (QoL. Today, various disease-modifying treatments (DMTs may prevent disease progression. However, it is increasingly complex to select the right therapy for a given patient and patient preferences should be considered when making treatment decisions. This study aimed to explore the main factors affecting patients’ preferences regarding MS treatment and health care.Methods: Five qualitative focus group interviews were carried out with a total of 40 participants from across Denmark. A semistructured question guide included questions that were identified in a systematic literature study about QoL and treatment preferences in patients with MS. The participants were asked to describe their disease experiences, their health-related QoL, and reasons behind their preferences with regard to treatment and care. The data were analyzed using content analysis and a constructivist approach.Results: The participants’ physical, cognitive, and psychosocial QoL and functioning were reduced by disease symptoms, treatment side effects, and mode of administration. Their ability to uphold meaningful role functioning was crucial to their treatment priorities. The preeminence of anticipated efficacy, ie, the patients’ hope that DMT might prevent disease deterioration in the future, was modified by their present QoL and functioning when ultimately framing their treatment preferences. There was an unmet information and support need from neurology clinics, particularly at the time of diagnosis.Conclusion: The participants’ treatment preferences

  14. The Relational Impact of Multiple Sclerosis: An Integrative Review of the Literature Using a Cognitive Analytic Framework.

    Blundell Jones, Joanna; Walsh, Sue; Isaac, Claire

    2017-12-01

    This integrative literature review uses cognitive analytic therapy (CAT) theory to examine the impact of a chronic illness, multiple sclerosis (MS), on relationships and mental health. Electronic searches were conducted in six medical and social science databases. Thirty-eight articles met inclusion criteria, and also satisfied quality criteria. Articles revealed that MS-related demands change care needs and alter relationships. Using a CAT framework, the MS literature was analysed, and five key patterns of relating to oneself and to others were identified. A diagrammatic formulation is proposed that interconnects these patterns with wellbeing and suggests potential "exits" to improve mental health, for example, assisting families to minimise overprotection. Application of CAT analysis to the literature clarifies relational processes that may affect mental health among individuals with MS, which hopefully will inform how services assist in reducing unhelpful patterns and improve coping. Further investigation of the identified patterns is needed.

  15. The impact of the cycle counting in the inventory accuracy: multiple cases in industries of Paraná

    Everton Drohomeretski

    2013-05-01

    Full Text Available This article aims to identify the impact of cycle counting on inventory accuracy. Multiple case studies were used as research method; these include seven case studies of companies in Paraná. A research protocol was used as the basis for collecting the data. For the data analysis, the content analysis method was used with the triangulation of collected data. For the main results, the study demonstrates the relationship between cycle counting, the level of importance attributed by the organization, the number of items and the rate of accuracy obtained. The high level of control of inventory processes, together with the use of cycle counting made it possible to eliminate the main cause of failure in inventory accuracy – errors in recording the movement of material – and with this, improve the operational efficiency of the companies.

  16. Ionization of liquid water by fast electron impact: multiple differential cross sections for the 1B1 orbital

    Fojon, O A; De Sanctis, M L; Stia, C R; Vuilleumier, R; Politis, M-F

    2011-01-01

    We present a theoretical study of single ionization of water molecules in liquid phase by impact of fast electrons in a coplanar geometry. Multiple differential cross sections are obtained through a first order model obtained within the framework of an independent electron approximation in which relaxation of the target is not taken into account. The wavefunctions for a single water molecule in the liquid phase are obtained through a Wannier orbital formalism and the ejected electron is described by means of Coulomb functions. We also present averaged calculations over all molecular orientations. A comparison with previous theoretical and experimental results, the latter corresponding to water in gaz phase, shows a good agreement. The main physical features of the reaction (such as binary and recoil peaks) present in measurements for vapor are also observed in the present theoretical predictions.

  17. Impact of light on Hypocrea jecorina and the multiple cellular roles of ENVOY in this process

    Druzhinina Irina S

    2007-12-01

    Full Text Available Abstract Background In fungi, light is primarily known to influence general morphogenesis and both sexual and asexual sporulation. In order to expand the knowledge on the effect of light in fungi and to determine the role of the light regulatory protein ENVOY in the implementation of this effect, we performed a global screen for genes, which are specifically effected by light in the fungus Hypocrea jecorina (anamorph Trichoderma reesei using Rapid Subtraction Hybridization (RaSH. Based on these data, we analyzed whether these genes are influenced by ENVOY and if overexpression of ENVOY in darkness would be sufficient to execute its function. Results The cellular functions of the detected light responsive genes comprised a variety of roles in transcription, translation, signal transduction, metabolism, and transport. Their response to light with respect to the involvement of ENVOY could be classified as follows: (i ENVOY-mediated upregulation by light; (ii ENVOY-independent upregulation by light; (iii ENVOY-antagonized upregulation by light; ENVOY-dependent repression by light; (iv ENVOY-independent repression by light; and (v both positive and negative regulation by ENVOY of genes not responsive to light in the wild-type. ENVOY was found to be crucial for normal growth in light on various carbon sources and is not able to execute its regulatory function if overexpressed in the darkness. Conclusion The different responses indicate that light impacts fungi like H. jecorina at several cellular processes, and that it has both positive and negative effects. The data also emphasize that ENVOY has an apparently more widespread cellular role in this process than only in modulating the response to light.

  18. Impact of consensus contours from multiple PET segmentation methods on the accuracy of functional volume delineation

    Schaefer, A. [Saarland University Medical Centre, Department of Nuclear Medicine, Homburg (Germany); Vermandel, M. [U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille, Inserm, CHU Lille, Lille (France); CHU Lille, Nuclear Medicine Department, Lille (France); Baillet, C. [CHU Lille, Nuclear Medicine Department, Lille (France); Dewalle-Vignion, A.S. [U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, University of Lille, Inserm, CHU Lille, Lille (France); Modzelewski, R.; Vera, P.; Gardin, I. [Centre Henri-Becquerel and LITIS EA4108, Rouen (France); Massoptier, L.; Parcq, C.; Gibon, D. [AQUILAB, Research and Innovation Department, Loos Les Lille (France); Fechter, T.; Nestle, U. [University Medical Center Freiburg, Department for Radiation Oncology, Freiburg (Germany); German Cancer Consortium (DKTK) Freiburg and German Cancer Research Center (DKFZ), Heidelberg (Germany); Nemer, U. [University Medical Center Freiburg, Department of Nuclear Medicine, Freiburg (Germany)

    2016-05-15

    The aim of this study was to evaluate the impact of consensus algorithms on segmentation results when applied to clinical PET images. In particular, whether the use of the majority vote or STAPLE algorithm could improve the accuracy and reproducibility of the segmentation provided by the combination of three semiautomatic segmentation algorithms was investigated. Three published segmentation methods (contrast-oriented, possibility theory and adaptive thresholding) and two consensus algorithms (majority vote and STAPLE) were implemented in a single software platform (Artiview registered). Four clinical datasets including different locations (thorax, breast, abdomen) or pathologies (primary NSCLC tumours, metastasis, lymphoma) were used to evaluate accuracy and reproducibility of the consensus approach in comparison with pathology as the ground truth or CT as a ground truth surrogate. Variability in the performance of the individual segmentation algorithms for lesions of different tumour entities reflected the variability in PET images in terms of resolution, contrast and noise. Independent of location and pathology of the lesion, however, the consensus method resulted in improved accuracy in volume segmentation compared with the worst-performing individual method in the majority of cases and was close to the best-performing method in many cases. In addition, the implementation revealed high reproducibility in the segmentation results with small changes in the respective starting conditions. There were no significant differences in the results with the STAPLE algorithm and the majority vote algorithm. This study showed that combining different PET segmentation methods by the use of a consensus algorithm offers robustness against the variable performance of individual segmentation methods and this approach would therefore be useful in radiation oncology. It might also be relevant for other scenarios such as the merging of expert recommendations in clinical routine and

  19. Impact of elimination diets on growth and nutritional status in children with multiple food allergies.

    Berry, Melissa J; Adams, Jennifer; Voutilainen, Helena; Feustel, Paul J; Celestin, Jocelyn; Järvinen, Kirsi M

    2015-03-01

    Impairment of growth has been reported in food-allergic children. It is not known whether this is related to the extent of food allergies. We sought to compare growth, nutritional status, and nutrient intake in children with food allergy either avoiding cow's milk or avoiding cow's milk and wheat, which are staples of the diet in young children. Infants and young children with challenge-proven allergy were recruited to this prospective study. They were strictly avoiding their allergic food triggers, either cow's milk, or cow's milk and wheat. They were counseled by a dietitian specialized in food allergies on food avoidance diets and nutritionally adequate supplementation at regular intervals. A 3-day food diary was kept. Children's height, weight, and laboratory data for nutritional parameters were monitored at 8-month intervals. A total of 18 patients avoiding milk and 28 patients avoiding milk and wheat were evaluated at an average of 12, 21, and 28 months of age. During the follow-up, the markers of nutritional status, nutrient intake or height for age, and weight for height were comparable between the two groups, although the means for anthropometric measures were below the average for age in both groups. The extent of food elimination diet has no impact on growth or nutritional status of food-allergic children, when diet is adequately supplemented. Close physician and dietitian follow-up are essential for food-allergic children when avoiding one or more foods, which are staples of the diet. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Modelling multiple hospital outcomes: the impact of small area and primary care practice variation

    Congdon Peter

    2006-11-01

    Full Text Available Abstract Background: Appropriate management of care – for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care – is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need and primary care factors (e.g. referral thresholds, that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. Results: A fixed effects model shows variations in attendances and admissions are significantly related (positively to area and practice need, and nursing home patients, and related (negatively to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. Conclusion: The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In

  1. Impact of neighbourhood land-cover in epiphytic lichen diversity: Analysis of multiple factors working at different spatial scales

    Pinho, P.; Augusto, S.; Maguas, C.; Pereira, M.J.; Soares, A.; Branquinho, C.

    2008-01-01

    The objective of this work was to determine the impact of neighbourhood land-cover in epiphytic lichen diversity. We used geostatistics to analyse the spatial structure of lichen-indicators (number of lichen species and Lichen Diversity Value) and correlate them to land-cover considering different distances from the observed data. The results showed that lichen diversity was influenced by different environmental factors that act in the same territory but impact lichens at different distances from the source. The differences in the distance of influence of the several land-cover types seem to be related to the size of pollutants/particles that predominantly are dispersed by each land-cover type. We also showed that a local scale of analysis gives a deeper insight into the understanding of lichen richness and abundance in the region. This work highlighted the importance of a multiple spatial scale of analysis to deeply interpret the relation between lichen diversity and the underling environmental factors. - The interpretation of lichen-biodiversity data was improved by using analysis at different scales

  2. Impact of neighbourhood land-cover in epiphytic lichen diversity: Analysis of multiple factors working at different spatial scales

    Pinho, P.; Augusto, S.; Maguas, C. [Universidade de Lisboa, Faculdade de Ciencias, Centro de Ecologia e Biologia Vegetal (CEBV), 1749-016 Lisbon (Portugal); Pereira, M.J.; Soares, A. [Universidade Tecnica de Lisboa, Instituto Superior Tecnico, Centro de Recursos Naturais e Ambiente (CERENA) Av. Rovisco Pais, 1049-001 Lisbon (Portugal); Branquinho, C. [Universidade de Lisboa, Faculdade de Ciencias, Centro de Ecologia e Biologia Vegetal (CEBV), 1749-016 Lisbon (Portugal); Universidade Atlantica, Antiga Fabrica da Polvora de Barcarena, 2745-615 Barcarena (Portugal)], E-mail: cmbranquinho@fc.ul.pt

    2008-01-15

    The objective of this work was to determine the impact of neighbourhood land-cover in epiphytic lichen diversity. We used geostatistics to analyse the spatial structure of lichen-indicators (number of lichen species and Lichen Diversity Value) and correlate them to land-cover considering different distances from the observed data. The results showed that lichen diversity was influenced by different environmental factors that act in the same territory but impact lichens at different distances from the source. The differences in the distance of influence of the several land-cover types seem to be related to the size of pollutants/particles that predominantly are dispersed by each land-cover type. We also showed that a local scale of analysis gives a deeper insight into the understanding of lichen richness and abundance in the region. This work highlighted the importance of a multiple spatial scale of analysis to deeply interpret the relation between lichen diversity and the underling environmental factors. - The interpretation of lichen-biodiversity data was improved by using analysis at different scales.

  3. Assessing the impact of multiple altimeter missions and Argo in a global eddy-permitting data assimilation system

    Verrier, Simon; Le Traon, Pierre-Yves; Remy, Elisabeth

    2017-12-01

    A series of observing system simulation experiments (OSSEs) is carried out with a global data assimilation system at 1/4° resolution using simulated data derived from a 1/12° resolution free-run simulation. The objective is to not only quantify how well multiple altimeter missions and Argo profiling floats can constrain the global ocean analysis and 7-day forecast at 1/4° resolution but also to better understand the sensitivity of results to data assimilation techniques used in Mercator Ocean operational systems. The impact of multiple altimeter data is clearly evidenced even at a 1/4° resolution. Seven-day forecasts of sea level and ocean currents are significantly improved when moving from one altimeter to two altimeters not only on the sea level, but also on the 3-D thermohaline structure and currents. In high-eddy-energy regions, sea level and surface current 7-day forecast errors when assimilating one altimeter data set are respectively 20 and 45 % of the error of the simulation without assimilation. Seven-day forecasts of sea level and ocean currents continue to be improved when moving from one altimeter to two altimeters with a relative error reduction of almost 30 %. The addition of a third altimeter still improves the 7-day forecasts even at this medium 1/4° resolution and brings an additional relative error reduction of about 10 %. The error level of the analysis with one altimeter is close to the 7-day forecast error level when two or three altimeter data sets are assimilated. Assimilating altimeter data also improves the representation of the 3-D ocean fields. The addition of Argo has a major impact on improving temperature and demonstrates the essential role of Argo together with altimetry in constraining a global data assimilation system. Salinity fields are only marginally improved. Results derived from these OSSEs are consistent with those derived from experiments with real data (observing system evaluations, OSEs) but they allow for more

  4. Using Water Quality Models in Management - A Multiple Model Assessment, Analysis of Confidence, and Evaluation of Climate Change Impacts

    Irby, Isaac David

    pollution diet in light of future projections for air temperature, sea level, and precipitation was examined. While a changing climate will reduce the ability of the nutrient reduction to improve oxygen concentrations, that effect is trumped by the improvements in dissolved oxygen stemming from the pollution diet itself. However, climate change still has the potential to cause the current level of nutrient reduction to be inadequate. This is primarily due to the fact that low-oxygen conditions are predicted to start one week earlier, on average, in the future, with the primary changes resulting from the increase in temperature. Overall, this research lends an increased degree of confidence in the water quality modeling of the potential impact of the Chesapeake Bay pollution diet. This research also establishes the efficacy of utilizing a multiple model approach to examining projected changes in water quality while establishing that the pollution diet trumps the impact from climate change. This work will lead directly to advances in scientific understanding of the response of water quality, ecosystem health, and ecological resilience to the impacts of nutrient reduction and climate change.

  5. Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts

    Nana Amankwah

    2017-02-01

    Full Text Available Introduction: The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of multiple sclerosis (MS in Canada over a 20-year time horizon (2011–2031. Methods: Using Statistics Canada’s Population Health Microsimulation Model (POHEM framework, specifically the population-based longitudinal, microsimulation model named, we identified people with MS from health administrative data sources and derived incidence and mortality rate parameters from a British Columbia population-based cohort for future MS incidence and mortality projections. We also included a utility-based measure (Health Utilities Index Mark 3 reflecting states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of the neurological conditions. Results: The number of incident MS cases is expected to rise slightly from 4 051 cases in 2011 to 4 794 cases per 100,000 population in 2031, and the number of Canadians affected by MS will increase from 98 385 in 2011 to 133 635 in 2031. The total per capita health care cost (excluding out-of-pocket expenses for adults aged 20 and older in 2011 was about $16 800 for individuals with MS, and approximately $2 500 for individuals without a neurological condition. Thus, after accounting for additional expenditures due to MS (excluding out-of-pocket expenses, total annual health sector costs for MS are expected to reach $2.0 billion by 2031. As well, the average out-of-pocket expenditure for people with MS was around $1 300 annually throughout the projection period. Conclusion: MS is associated with a significant economic burden on society, since it usually affects young adults during prime career- and family-building years. Canada has a

  6. Role of executive functions in prospective memory in multiple sclerosis: Impact of the strength of cue-action association.

    Dagenais, Emmanuelle; Rouleau, Isabelle; Tremblay, Alexandra; Demers, Mélanie; Roger, Élaine; Jobin, Céline; Duquette, Pierre

    2016-01-01

    Patients diagnosed with multiple sclerosis (MS) often report prospective memory (PM) deficits. Although PM is important for daily functioning, it is not formally assessed in clinical practice. The aim of this study was to examine the role of executive functions in MS patients' PM revealed by the effect of strength of cue-action association on PM performance. Thirty-nine MS patients were compared to 18 healthy controls matched for age, gender, and education on a PM task modulating the strength of association between the cue and the intended action. Deficits in MS patients affecting both prospective and retrospective components of PM were confirmed using 2 × 2 × 2 mixed analyses of variance (ANOVAs). Among patients, multiple regression analyses revealed that the impairment was modulated by the efficiency of executive functions, whereas retrospective memory seemed to have little impact on PM performance, contrary to expectation. More specifically, results of 2 × 2 × 2 mixed-model analyses of covariance (ANCOVAs) showed that low-executive patients had more difficulty detecting and, especially, retrieving the appropriate action when the cue and the action were unrelated, whereas high-executive patients' performance seemed to be virtually unaffected by the cue-action association. Using an objective measure, these findings confirm the presence of PM deficits in MS. They also suggest that such deficits depend on executive functioning and can be reduced when automatic PM processes are engaged through semantic cue-action association. They underscore the importance of assessing PM in clinical settings through a cognitive evaluation and offer an interesting avenue for rehabilitation.

  7. Multiple Gene-Environment Interactions on the Angiogenesis Gene-Pathway Impact Rectal Cancer Risk and Survival

    Noha Sharafeldin

    2017-09-01

    Full Text Available Characterization of gene-environment interactions (GEIs in cancer is limited. We aimed at identifying GEIs in rectal cancer focusing on a relevant biologic process involving the angiogenesis pathway and relevant environmental exposures: cigarette smoking, alcohol consumption, and animal protein intake. We analyzed data from 747 rectal cancer cases and 956 controls from the Diet, Activity and Lifestyle as a Risk Factor for Rectal Cancer study. We applied a 3-step analysis approach: first, we searched for interactions among single nucleotide polymorphisms on the pathway genes; second, we searched for interactions among the genes, both steps using Logic regression; third, we examined the GEIs significant at the 5% level using logistic regression for cancer risk and Cox proportional hazards models for survival. Permutation-based test was used for multiple testing adjustment. We identified 8 significant GEIs associated with risk among 6 genes adjusting for multiple testing: TNF (OR = 1.85, 95% CI: 1.10, 3.11, TLR4 (OR = 2.34, 95% CI: 1.38, 3.98, and EGR2 (OR = 2.23, 95% CI: 1.04, 4.78 with smoking; IGF1R (OR = 1.69, 95% CI: 1.04, 2.72, TLR4 (OR = 2.10, 95% CI: 1.22, 3.60 and EGR2 (OR = 2.12, 95% CI: 1.01, 4.46 with alcohol; and PDGFB (OR = 1.75, 95% CI: 1.04, 2.92 and MMP1 (OR = 2.44, 95% CI: 1.24, 4.81 with protein. Five GEIs were associated with survival at the 5% significance level but not after multiple testing adjustment: CXCR1 (HR = 2.06, 95% CI: 1.13, 3.75 with smoking; and KDR (HR = 4.36, 95% CI: 1.62, 11.73, TLR2 (HR = 9.06, 95% CI: 1.14, 72.11, EGR2 (HR = 2.45, 95% CI: 1.42, 4.22, and EGFR (HR = 6.33, 95% CI: 1.95, 20.54 with protein. GEIs between angiogenesis genes and smoking, alcohol, and animal protein impact rectal cancer risk. Our results support the importance of considering the biologic hypothesis to characterize GEIs associated with cancer outcomes.

  8. The impact of a patient support program for multiple sclerosis on patient satisfaction and subjective health status.

    Kohlmann, Thomas; Wang, Cheng; Lipinski, Jens; Hadker, Nandini; Caffrey, Elizabeth; Epstein, Michael; Sadasivan, Ravi; Gondek, Kathleen

    2013-06-01

    Leading multiple sclerosis (MS) therapies have patient support programs (PSPs) aimed at improving patients' lives. There is limited knowledge about what drives patient satisfaction with PSPs and little evidence about its impact on patient-reported health status or health-related quality of life. The aims of this study were to evaluate patient needs and the PSP's role in meeting those needs; understand the drivers of PSP satisfaction and loyalty; and assess whether a MS PSP provides quantifiable, incremental benefit to patients, as measured by patient-reported health status, health state utility, and/or health-related quality of life. An Internet survey was conducted among 1,123 adult German MS patients currently enrolled in Bayer's German BETAPLUS PSP. Health status, health state utility, and health-related quality of life were measured using the EQ-5D Visual Analog Scale, the EQ-5D Index, and Short Form-12 Health Survey, respectively. MS patient needs vary by disease severity, duration of disease, and gender. Patients with greater self-reported needs and lower health status, health state utility, and health-related quality of life value and use the PSP more than other patients. Drivers of PSP satisfaction include use of patient hotline, nurse telephone calls, and mail education. Patients estimate that their health status would be 15 points lower if the PSP ceased to exist (translating to 0.15 on the time trade-off utility scale). This impact is significant, as it is nearly two times the minimally important difference. MS patients place inherent value on PSPs. From a patient's viewpoint, PSPs provide real incremental benefit in patient-reported health status at all stages of MS.

  9. Combining vibrational linear-by-part dynamics and kinetic-based decoupling of the dynamics for multiple elastoplastic smooth impacts

    Barjau, Ana, E-mail: ana.barjau@upc.edu; Batlle, Joaquim A., E-mail: agullo.batlle@upc.edu; Font-Llagunes, Josep M., E-mail: josep.m.font@upc.edu [Universitat Politècnica de Catalunya, Department of Mechanical Engineering and Biomedical Engineering Research Centre (Spain)

    2015-11-15

    This article proposes a linear-by-part approach for elastoplastic 3D multiple-point smooth impacts in multibody systems with perfect constraints. The model is an extension of a previous version, restricted to the perfectly elastic case, able to account for the high sensitivity to initial conditions and for redundancy without assuming any particular collision sequence (Barjau et al., Multibody Syst. Dyn. 31:497–517, 2014). Energy losses associated with compression and expansion in percussive analysis is a matter as complex as the physical phenomena involved, at the nanoscale level, for different materials. Simplified models can be developed for specific purposes, which can retain the most relevant trends of internal damping and at the same time be suitable for a particular analytical approach of impact mechanics. In the context of this article, energy dissipation due to material deformation is introduced through a linear-by-part elastoplastic model consisting on two elementary sets of springs and dry-friction dampers. The first set accounts for inelastic behavior (energy loss without permanent indentation), whereas the second one introduces plasticity (that is, permanent indentation). In inelastic and plastic collisions, instantaneous unilateral constraints may appear, thus reducing the number of degrees of freedom (DOF) of the system. The calculation of the corresponding normal contact force at the constrained points is then necessary in order to detect whether the constraint holds or disappears (either because a new compression or an expansion phase starts, or because contact is lost). Different simulated application examples are presented and thoroughly discussed.

  10. The budget impact of introducing delayed-release dimethyl fumarate for treatment of relapse-remitting multiple sclerosis in Canada.

    Dorman, Emily; Kansal, Anuraag R; Sarda, Sujata

    2015-01-01

    Multiple sclerosis (MS) causes significant disability globally and is especially prevalent in Canada. Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) is an orally administered disease-modifying treatment (DMT) for patients with relapsing-remitting MS (RRMS) that is currently on the market in the US, Australia, Canada, and Europe. A budget impact model (BIM) was developed to assess the financial consequences of introducing DMF for treatment of RRMS in Canada. A BIM calculated the financial consequences of introducing DMF in Canada over 3 years based on RRMS prevalence, treatment market share, and clinical effects. RRMS prevalence in Canada was derived from published literature and natural relapse rates, and disease state distribution from clinical trial data. It was conservatively assumed that 100% of RRMS patients were treated with a DMT. DMF was assumed to absorb market share proportionally from the following current treatments: interferon beta-1a-IM, interferon beta-1a-SC, interferon beta-1b, and glatiramer acetate. Treatment efficacy, in terms of relapse rate reductions and treatment discontinuation rates, was determined from mixed treatment comparison. Treatment costs (including costs of acquisition, monitoring, and administration) and cost of relapse were considered. Deterministic one-way sensitivity analyses were conducted to assess the most sensitive input parameters. Over 3 years, the introduction of DMF resulted in an average annual increase of CAD417 per treated patient per year, with reductions in costs associated with relapses (CAD192/patient/year) partially offsetting increased drug acquisition costs (CAD602/patient/year). On a population level, the average annual cost increase was CAD24,654,237, a CAD 0.68 increase per population covered by the Canadian healthcare system. The main drivers of budget impact were drop-out rates, proportion of RRMS patients treated, and market share assumptions. The acquisition costs of DMF for

  11. Pharmacoeconomic impact of up-front use of plerixafor for autologous stem cell mobilization in patients with multiple myeloma.

    Kim, Sara S; Renteria, Anne S; Steinberg, Amir; Banoff, Karen; Isola, Luis

    2014-11-01

    Stem cell collection can be a major component of overall cost of autologous stem cell transplantation (ASCT). Plerixafor is an effective agent for mobilization; however, it is often reserved for salvage therapy because of its high cost. We present data on the pharmacoeconomic impact of the use of plerixafor as an up-front mobilization in patients with multiple myeloma (MM). Patients with MM who underwent ASCT between January 2008 and April 2011 at the Mount Sinai Medical Center were reviewed retrospectively. In April 2010, practice changes were instituted for patients with MM to delay initiation of granulocyte-colony-stimulating factor (G-CSF) support from day 0 to day +5 and to add plerixafor to G-CSF as an up-front autologous mobilization. Targets of collection were 5-10 × 10(6) CD34(+) cells/kg. Of 50 adults with MM who underwent ASCT, 25 received plerixafor/filgrastim and 25 received G-CSF alone as an up-front mobilization. Compared with the control, plerixafor mobilization yielded higher CD34(+) cell content (16.1 versus 8.4 × 10(6) CD34(+) cells/kg; P = 0.0007) and required fewer sessions of apheresis (1.9 versus 3.1; P = 0.0001). In the plerixafor group, the mean number of plerixafor doses required per patient was 1.8. Although the overall cost of medications was higher in the plerixafor group, the cost for blood products and overall cost of hospitalization were similar between the two groups. Up-front use of plerixafor is an effective mobilization strategy in patients with MM and does not have a substantial pharmacoeconomic impact in overall cost of hospitalization combined with the apheresis procedure. Copyright © 2014 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  12. Double ionization of the hydrogen sulfide molecule by electron impact: Influence of the target orientation on multiple differential cross sections

    Imadouchene, N. [Laboratoire de Mécanique, Structures et Energétique Université Mouloud Mammeri de Tizi-Ouzou, B.P. 17, Tizi-Ouzou 15000 (Algeria); Aouchiche, H., E-mail: h_aouchiche@yahoo.fr [Laboratoire de Mécanique, Structures et Energétique Université Mouloud Mammeri de Tizi-Ouzou, B.P. 17, Tizi-Ouzou 15000 (Algeria); Champion, C. [Centre d’Etudes Nucléaires de Bordeaux Gradignan, Université Bordeaux, CNRS/IN2P3, Boîte Postale 120, Gradignan 33175 (France)

    2016-07-15

    Highlights: • The double ionization of the H{sub 2}S molecule is here theoretically studied. • The orientation dependence of the differential cross sections is scrutinized. • The specific double ionizing mechanisms are clearly identified. - Abstract: Multiple differential cross sections of double ionization of hydrogen sulfide molecule impacted by electrons are here investigated within the first Born approximation. In the initial state, the incident electron is represented by a plane wave function whereas the target is described by means of a single-center molecular wave function. In the final state, the two ejected electrons are described by Coulomb wave functions coupled by the Gamow factor, whereas the scattered electron is described by a plane wave. In this work, we analyze the role played by the molecular target orientation in the double ionization of the four outermost orbitals, namely 2b{sub 1}, 5a{sub 1}, 2b{sub 2} and 4a{sub 1} in considering the particular case of two electrons ejected from the same orbital. The contribution of each final state to the double ionization process is studied in terms of shape and magnitude for specific molecular orientations and for each molecular orbital we identified the mechanisms involved in the double ionization process, namely, the Shake-Off and the Two-Step 1.

  13. The impact of adjusted work conditions and disease-modifying drugs on work ability in multiple sclerosis.

    Wickström, Anne; Fagerström, Maria; Wickström, Lucas; Granåsen, Gabriel; Dahle, Charlotte; Vrethem, Magnus; Sundström, Peter

    2017-07-01

    Multiple sclerosis (MS) is a neurological disorder that causes significantly reduced ability to work, and the Expanded Disability Status Scale (EDSS) is one of the main predictors for reduced work ability. To investigate how work requirements, flexible work conditions and disease-modifying drugs (DMDs) influence the work ability in relation to different EDSS grades in two MS populations. Work ability was studied in two MS populations: one in the southern and one in the northern part of Sweden, both demographically similar. In the latter population, more active work-promoting interventions have been practised and second-generation DMDs have been widely used from the onset of disease for several years. The proportion of MS patients who participated in the workforce or studied was significantly higher in the northern compared with the southern population ( p work conditions and were able to work more hours per week. Higher EDSS was associated with lower reduction in number of worked hours per week in the northern population ( p = 0.042). Our data indicated that treatment strategy and adjusted work conditions have impact on work ability in MS.

  14. A case matched study examining the reliability of using ImPACT to assess effects of multiple concussions.

    Barker, Trevor; Russo, Stephen A; Barker, Gaytri; Rice, Mark A; Jeffrey, Mary G; Broderick, Gordon; Craddock, Travis J A

    2017-04-28

    Approximately 3.8 million sport and recreational concussions occur per year, creating a need for accurate diagnosis and management of concussions. Researchers and clinicians are exploring the potential dose-response cumulative effects of concussive injuries using computerized neuropsychological exams, however, results have been mixed and/or contradictory. This study starts with a large adolescent population and applies strict inclusion criteria to examine how previous mild traumatic brain injuries affect symptom reports and neurocognitive performance on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) computerized tool. After applying exclusion criteria and case matching, 204 male and 99 female participants remained. These participants were grouped according to sex and the number of previous self-reported concussions and examined for overall differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. In an effort to further reduce confounding factors due to the varying group sizes, participants were then case matched on age, sex, and body mass index and analyzed for differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. Case matched analysis demonstrated males with concussions experience significantly higher rates of dizziness (p = .027, η 2  = .035), fogginess (p = .038, η 2  = .032), memory problems (p = .003, η 2  = .055), and concentration problems (p = .009, η 2  = .046) than males with no reported previous concussions. No significant effects were found for females, although females reporting two concussions demonstrated a slight trend for experiencing higher numbers of symptoms than females reporting no previous concussions. The results suggest that male adolescent athletes reporting multiple concussions have lingering concussive symptoms well after the last concussive event; however, these symptoms were found to

  15. Cumulative impacts from multiple human activities on seagrass meadows in eastern Mediterranean waters: the case of Saronikos Gulf (Aegean Sea, Greece).

    Brodersen, Maren Myrto; Pantazi, Maria; Kokkali, Athina; Panayotidis, Panayotis; Gerakaris, Vasilis; Maina, Irida; Kavadas, Stefanos; Kaberi, Helen; Vassilopoulou, Vassiliki

    2017-12-05

    Ecosystem-based management (EBM) addresses the fundamental need to account for cumulative impacts of human activities with the aim of sustainably delivering ecosystem services. The Saronikos Gulf, a large embayment of the Aegean Sea, provides a wide range of ecosystem services that are impacted by multiple human activities, deriving from the metropolitan area of Athens (situated at the northeast part of the Gulf). The anthropogenic impacts affect the status of several marine ecosystem components, e.g., seagrass meadows. Cymodocea nodosa meadows are only present at the most confined western part of the Gulf, whereas Posidonia oceanica meadows are mainly distributed in the inner and outer part of the Gulf. The aim of this study is to assess the cumulative impacts from multiple human activities on the seagrass meadows in the Gulf. The main results indicated that most impacted meadows are P. oceanica in the inner part of the Gulf, adjacent to the most urbanized coastal areas, and near port infrastructures. Land-based pollution, as well as physical damage and loss seem to be the main pressures exerted on the meadows. Understanding cumulative impacts is crucial for informing policy decisions under an EBM approach.

  16. The impact of farmers’ participation in field trials in creating awareness and stimulating compliance with the World Health Organization’s farm-based multiple-barrier approach

    Amponsah, Owusu; Vigre, Håkan; Schou, Torben Wilde

    2016-01-01

    -barrier approach field trials. The results of the study show that participation in the field trials has statistically significant effects on farmers’ awareness of the farm-based multiple-barrier approach. Compliance has, however, been undermined by the farmers’ perception that the cost of compliance is more......The results of a study aimed as assessing the extent to which urban vegetable farmers’ participation in field trials can impact on their awareness and engender compliance with the World Health Organization’s farm-based multiple-barrier approach are presented in this paper. Both qualitative...... and quantitative approaches have been used in this paper. One hundred vegetable farmers and four vegetable farmers’ associations in the Kumasi Metropolis in Ghana were covered. The individual farmers were grouped into two, namely: (1) participants and (2) non-participants of the farm-based multiple...

  17. A practical theoretical formalism for atomic multielectron processes: direct multiple ionization by a single auger decay or by impact of a single electron or photon

    Liu, Pengfei; Zeng, Jiaolong; Yuan, Jianmin

    2018-04-01

    Multiple electron processes occur widely in atoms, molecules, clusters, and condensed matters when they are interacting with energetic particles or intense laser fields. Direct multielectron processes (DMEP) are the most complicated among the general multiple electron processes and are the most difficult to describe theoretically. In this work, a unified and accurate theoretical formalism is proposed on the DMEP of atoms including the multiple auger decay and multiple ionization by an impact of a single electron or a single photon based on the atomic collision theory described by a correlated many-body Green's function. Such a practical treatment is made possible by taking consideration of the different coherence features of the atoms (matter waves) in the initial and final states. We first explain how the coherence characteristics of the ejected continuum electrons is largely destructed, by taking the electron impact direct double ionization process as an example. The direct double ionization process is completely different from the single ionization where the complete interference can be maintained. The detailed expressions are obtained for the energy correlations among the continuum electrons and energy resolved differential and integral cross sections according to the separation of knock-out (KO) and shake-off (SO) mechanisms for the electron impact direct double ionization, direct double and triple auger decay, and double and triple photoionization (TPI) processes. Extension to higher order DMEP than triple ionization is straight forward by adding contributions of the following KO and SO processes. The approach is applied to investigate the electron impact double ionization processes of C+, N+, and O+, the direct double and triple auger decay of the K-shell excited states of C+ 1s2{s}22{p}2{}2D and {}2P, and the double and TPI of lithium. Comparisons with the experimental and other theoretical investigations wherever available in the literature show that our

  18. Temporal Assessment of the Impact of Exposure to Cow Feces in Two Watersheds by Multiple Host-Specific PCR Assays

    Exposure to feces in two watersheds with different management histories was assessed by tracking cattle feces bacterial populations using multiple host-specific PCR assays. In addition, environmental factors affecting the occurrence of these markers were identified. Each assay wa...

  19. The Impact of Multiple Malignancies on Patients with Bladder Carcinoma: A Population-Based Study Using the SEER Database

    Joshua R. Ehrlich

    2009-01-01

    Results. Analyses demonstrated diminished survival among AB and ABS cohorts. However, when cohorts were substratified by stage, patients in the high-stage BS cohort appeared to have a survival advantage over high-stage BO patients. Conclusions. Bladder cancer patients with multiple malignancies have diminished survival. The survival advantage of high-stage BS patients is likely a statistical phenomenon. Such findings are important to shape future research and to improve our understanding of patients with multiple malignancies.

  20. Retrieval practice after multiple context changes, but not long retention intervals, reduces the impact of a final context change on instrumental behavior.

    Trask, Sydney; Bouton, Mark E

    2018-06-01

    Recent evidence from this laboratory suggests that a context switch after operant learning consistently results in a decrement in responding. One way to reduce this decrement is to train the response in multiple contexts. One interpretation of this result, rooted in stimulus sampling theory, is that conditioning of a greater number of common stimulus elements arising from more contexts causes better generalization to new contexts. An alternative explanation is that each change of context causes more effortful retrieval, and practice involving effortful retrieval results in learning that is better able to transfer to new situations. The current experiments were designed to differentiate between these two explanations for the first time in an animal learning and memory task. Experiment 1 demonstrated that the detrimental impact of a context change on an instrumental nose-poking response can be reduced by training the response in multiple contexts. Experiment 2 then found that a training procedure which inserted extended retention intervals between successive training sessions did not reduce the detrimental impact of a final context change. This occurred even though the inserted retention intervals had a detrimental impact on responding (and, thus, presumably retrieval) similar to the effect that context switches had in Experiment 1. Together, the results suggest that effortful retrieval practice may not be sufficient to reduce the negative impact of a context change on instrumental behavior. A common elements explanation which supposes that physical and temporal contextual cues do not overlap may account for the findings more readily.

  1. A point-wise fiber Bragg grating displacement sensing system and its application for active vibration suppression of a smart cantilever beam subjected to multiple impact loadings

    Chuang, Kuo-Chih; Ma, Chien-Ching; Liao, Heng-Tseng

    2012-01-01

    In this work, active vibration suppression of a smart cantilever beam subjected to disturbances from multiple impact loadings is investigated with a point-wise fiber Bragg grating (FBG) displacement sensing system. An FBG demodulator is employed in the proposed fiber sensing system to dynamically demodulate the responses obtained by the FBG displacement sensor with high sensitivity. To investigate the ability of the proposed FBG displacement sensor as a feedback sensor, velocity feedback control and delay control are employed to suppress the vibrations of the first three bending modes of the smart cantilever beam. To improve the control performance for the first bending mode when the cantilever beam is subjected to an impact loading, we improve the conventional velocity feedback controller by tuning the control gain online with the aid of information from a higher vibration mode. Finally, active control of vibrations induced by multiple impact loadings due to a plastic ball is performed with the improved velocity feedback control. The experimental results show that active vibration control of smart structures subjected to disturbances such as impact loadings can be achieved by employing the proposed FBG sensing system to feed back out-of-plane point-wise displacement responses with high sensitivity. (paper)

  2. Neonatal outcomes among multiple births ≤ 32 weeks gestational age: Does mode of conception have an impact? A Cohort Study

    Yoon Woojin

    2011-06-01

    Full Text Available Abstract Background Studies comparing perinatal outcomes in multiples conceived following the use of artificial reproductive technologies (ART vs. spontaneous conception (SC have reported conflicting results in terms of mortality and morbidity. Therefore, the objective of our study was to compare composite outcome of mortality and severe neonatal morbidities amongst preterm multiple births ≤ 32 weeks gestation infant born following ART vs. SC. Methods We conducted a single center cohort study at Mount Sinai Hospital, Toronto, Ontario, Canada. Data on all preterm multiple births (≤ 32 weeks GA discharged between July 2005 and June 2008 were retrospectively collected from a prospective database at our centre. Details regarding mode of conception were collected retrospectively from maternal health records. Preterm multiple births were categorized into those born following ART vs. SC. Composite outcome was defined as combination of death or any of the three neonatal morbidities (grade 3/4 intraventricular hemorrhage or periventricular leukomalacia; retinopathy of prematurity > stage 2 or chronic lung disease. Univariate and multivariate regression analysis were preformed after adjustment of confounders (maternal age, parity, triplets, gestational age, sex, and small for gestational age. Results One hundred and thirty seven neonates were born following use of ART and 233 following SC. The unadjusted composite outcome rate was significantly higher in preterm multiples born following ART vs. SC [43.1% vs. 26.6%, p = 0.001; OR 1.98 (95% CI 1.13, 3.45]; however, when adjusted for confounders the difference between groups was not statistically significant [OR 1.39, 95% CI 0.67, 2.89]. Conclusion In our population of preterm multiple births, the mode of conception had no detectable effect on the adjusted composite neonatal outcome of mortality and/or three neonatal morbidities.

  3. Impact of multiple-dose versus single-dose inhaler devices on COPD patients’ persistence with long-acting β2-agonists: a dispensing database analysis

    van Boven, Job FM; van Raaij, Joost J; van der Galiën, Ruben; Postma, Maarten J; van der Molen, Thys; Dekhuijzen, PN Richard; Vegter, Stefan

    2014-01-01

    Background: With a growing availability of different devices and types of medication, additional evidence is required to assist clinicians in prescribing the optimal medication in relation to chronic obstructive pulmonary disease (COPD) patients’ persistence with long-acting β2-agonists (LABAs). Aims: To assess the impact of the type of inhaler device (multiple-dose versus single-dose inhalers) on 1-year persistence and switching patterns with LABAs. Methods: A retrospective observational cohort study was performed comparing a cohort of patients initiating multiple-dose inhalers and a cohort initiating single-dose inhalers. The study population consisted of long-acting bronchodilator naive COPD patients, initiating inhalation therapy with mono-LABAs (formoterol, indacaterol or salmeterol). Analyses were performed using pharmacy dispensing data from 1994 to 2012, obtained from the IADB.nl database. Study outcomes were 1-year persistence and switching patterns. Results were adjusted for initial prescriber, initial medication, dosing regimen and relevant comorbidities. Results: In all, 575 patients initiating LABAs were included in the final study cohort. Among them, 475 (83%) initiated a multiple-dose inhaler and 100 (17%) a single-dose inhaler. Further, 269 (47%) initiated formoterol, 9 (2%) indacaterol and 297 (52%) salmeterol. There was no significant difference in persistence between users of multiple-dose or single-dose inhalers (hazard ratio: 0.98, 95% confidence interval: 0.76–1.26, P=0.99). Over 80% re-started or switched medication. Conclusions: There seems no impact of inhaler device (multiple-dose versus single-dose inhalers) on COPD patients’ persistence with LABAs. Over 80% of patients who initially seemed to discontinue LABAs, re-started their initial medication or switched inhalers or medication within 1 year. PMID:25274453

  4. Social Support for Changing Multiple Behaviors: Factors Associated with Seeking Support and the Impact of Offered Support

    Greaney, Mary L.; Puleo, Elaine; Sprunck-Harrild, Kim; Haines, Jess; Houghton, Serena C.; Emmons, Karen M.

    2018-01-01

    Introduction: Social support is important for behavior change, and it may be particularly important for the complexities of changing multiple risk behaviors (MRB). Research is needed to determine if participants in an MRB intervention can be encouraged to activate their social network to aid their change efforts. Methods: Healthy Directions 2, a…

  5. The Multiple Intelligence Based Enrichment Module on the Development of Human Potential: Examining Its Impact and the Views of Teachers

    Azid, Nurulwahida Hj; Yaacob, Aizan; Shaik-Abdullah, Sarimah

    2016-01-01

    Purpose: Howard Gardners' concept of multiple intelligence (MI) offers an alternative perspective on intelligence which highlights the importance of acknowledging learner diversity, individual talents and the development of human potentials. MI has been used as a basis for the construction of modular enrichment activities to facilitate the…

  6. Reactive transport impacts on recovered freshwater quality during multiple partially penetrating wells (MPPW-)ASR in a brackish heterogeneous aquifer

    Zuurbier, Koen G.; Hartog, Niels; Stuyfzand, Pieter J.

    The use of multiple partially penetrating wells (MPPW) during aquifer storage and recovery (ASR) in brackish aquifers can significantly improve the recovery efficiency (RE) of unmixed injected water. The water quality changes by reactive transport processes in a field MPPW-ASR system and their

  7. Impact of a comprehensive supportive care team on management of hopelessly ill patients with multiple organ failure.

    Field, B E; Devich, L E; Carlson, R W

    1989-08-01

    We developed a supportive care team for hopelessly ill patients in an urban emergency/trauma hospital. The team includes a clinical nurse specialist and a faculty physician as well as a chaplain and social worker. The supportive care team provides an alternative to intensive care or conventional ward management of hopelessly ill patients and concentrates on the physical and psychosocial comfort needs of patients and their families. We describe our experience with 20 hopelessly ill patients with multiple organ failure vs a similar group treated before the development of the supportive care team. Although there was no difference in mortality (100 percent), the length of stay in the medical ICU for patients with multiple organ failure decreased by 12 days to 6 days. Additionally, there were 50 percent fewer therapeutic interventions provided by the supportive care team vs intensive care or conventional ward treatment of multiple organ failure patients. We describe the methods that the supportive care team uses in an attempt to meet the physical and psychosocial comfort needs of hopelessly ill multiple organ failure patients and their families. This multidisciplinary approach to the care of the hopelessly ill may have applications in other institutions facing the ethical, medical, and administrative challenges raised by these patients.

  8. Single versus multiple enemies and the impact on biological control of spider mites in cassava fields in West-Africa

    Onzo, A.; Sabelis, M.W.; Hanna, R.

    2014-01-01

    To determine whether to use single or multiple predator species for biological pest control requires manipulative field experiments. We performed such tests in Benin (West Africa) in cassava fields infested by the cassava green mite Mononychellus tanajoa, and the cotton red mite Oligonychus

  9. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs

    Hao, Yin; Pizzol, Massimo; Xu, Linyu

    2017-01-01

    Some cities in China are facing serious air pollution problems including high concentrations of particles, SO2 and NOx. Exposure to PM2.5, one of the primary air pollutants in many cities in China, is highly correlated with various adverse health impacts and ultimately represents a cost for society....... The aim of this study is to assess health impacts and external costs related to PM2.5 pollution in Beijing, China with different baseline concentrations and valuation methods. The idea is to provide a reasonable estimate of the total health impacts and external cost due to PM2.5 pollution, as well...... as a quantification of the relevant uncertainty. PM2.5 concentrations were retrieved for the entire 2012 period in 16 districts of Beijing. The various PM2.5 related health impacts were identified and classified to avoid double counting. Exposure-response coefficients were then obtained from literature. Both...

  10. The impact of a multiple intelligences teaching approach drug education programme on drug refusal skills of Nigerian pupils.

    Nwagu, Evelyn N; Ezedum, Chuks E; Nwagu, Eric K N

    2015-09-01

    The rising incidence of drug abuse among youths in Nigeria is a source of concern for health educators. This study was carried out on primary six pupils to determine the effect of a Multiple Intelligences Teaching Approach Drug Education Programme (MITA-DEP) on pupils' acquisition of drug refusal skills. A programme of drug education based on the Multiple Intelligences Teaching Approach (MITA) was developed. An experimental group was taught using this programme while a control group was taught using the same programme but developed based on the Traditional Teaching Approach. Pupils taught with the MITA acquired more drug refusal skills than those taught with the Traditional Teaching Approach. Urban pupils taught with the MITA acquired more skills than rural pupils. There was no statistically significant difference in the mean refusal skills of male and female pupils taught with the MITA. © The Author(s) 2014.

  11. Treatments of Missing Values in Large National Data Affect Conclusions: The Impact of Multiple Imputation on Arthroplasty Research.

    Ondeck, Nathaniel T; Fu, Michael C; Skrip, Laura A; McLynn, Ryan P; Su, Edwin P; Grauer, Jonathan N

    2018-03-01

    Despite the advantages of large, national datasets, one continuing concern is missing data values. Complete case analysis, where only cases with complete data are analyzed, is commonly used rather than more statistically rigorous approaches such as multiple imputation. This study characterizes the potential selection bias introduced using complete case analysis and compares the results of common regressions using both techniques following unicompartmental knee arthroplasty. Patients undergoing unicompartmental knee arthroplasty were extracted from the 2005 to 2015 National Surgical Quality Improvement Program. As examples, the demographics of patients with and without missing preoperative albumin and hematocrit values were compared. Missing data were then treated with both complete case analysis and multiple imputation (an approach that reproduces the variation and associations that would have been present in a full dataset) and the conclusions of common regressions for adverse outcomes were compared. A total of 6117 patients were included, of which 56.7% were missing at least one value. Younger, female, and healthier patients were more likely to have missing preoperative albumin and hematocrit values. The use of complete case analysis removed 3467 patients from the study in comparison with multiple imputation which included all 6117 patients. The 2 methods of handling missing values led to differing associations of low preoperative laboratory values with commonly studied adverse outcomes. The use of complete case analysis can introduce selection bias and may lead to different conclusions in comparison with the statistically rigorous multiple imputation approach. Joint surgeons should consider the methods of handling missing values when interpreting arthroplasty research. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Gender as a prognostic factor and its impact on the incidence of multiple sclerosis in Lorraine, France.

    Debouverie, M

    2009-11-15

    We sought to identify (a) the change of incidence rates among gender from 1990 to 2002 from the LORSEP (Lorraine Multiple Sclerosis) population-based cohort, and (b) the role of gender as a predictive demographic factor of disability during the initial course of the disease among multiple sclerosis (MS) patients. The incidence rates of multiple sclerosis (MS) in Lorraine, France, have significantly increased in women, but not in men, from 1990 to 2002 but this increase in incidence of MS was not related to a better ascertainment of patients with mild disability. A total of 2871 MS patients were analyzed. For relapsing-remitting (RR) patients, a multivariate analysis showed that a shorter time to the assignment of an EDSS score of 3 and 4 was associated with the late onset MS, incomplete recovery from the first relapse and a high number of relapses during the first 5 years after the MS onset. Median times were not influenced by gender or by time between the first two relapses. The data were very different for the time between the assignment of scores of 4 and 6, since the median times were not influenced by any of the predicting variables.

  13. Combined Orthodontic-surgical Treatment for Skeletal Class III Malocclusion with Multiple Impacted Permanent and Supernumerary Teeth: Case Report.

    Xue, Dai Juan And Feng

    2014-01-01

    In this report we describe a combined orthodontic and surgical treatment for a 14-year-old boy with severe skeletal class III deformity and dental problem. His upper posterior primary teeth in the left side were over-retained and 6 maxillary teeth (bilateral central incisors and canines, left first and second premolars) were impacted, together with 5 supernumerary teeth in both arches. The treatment protocol involved extraction of all the supernumerary and deciduous teeth, surgical exposure and orthodontic traction of the impacted teeth, a bimaxillary orthognathic approach including Lefort I osteotomy. Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty was performed to correct skeletal problem. After treatment, all of the impacted teeth were brought to proper alignment in the maxillary arch. A satisfied profile and good posterior occlusion was achieved. Treatment mechanics and consideration during different stages are discussed.

  14. Multiple sclerosis patients' experiences in relation to the impact of the kinect virtual home-exercise programme: a qualitative study.

    Palacios-Ceña, Domingo; Ortiz-Gutierrez, Rosa M; Buesa-Estellez, Almudena; Galán-Del-Río, Fernando; Cachon Perez, José M; Martínez-Piedrola, Rosa; Velarde-Garcia, Juan F; Cano-DE-LA-Cuerda, Roberto

    2016-06-01

    Neurorehabilitation programs are among the most popular therapies aimed at reducing the disabilities that result from multiple sclerosis. Video games have recently gained importance in the rehabilitation of patients with motor neurological dysfunctions. Currently, the studies describing the perspective of patients with multiple sclerosis who have participated in rehabilitation programmes via home-based video games are almost inexistent. The aim of this paper was to explore the experiences of multiple sclerosis patients who performed a virtual home-exercise programme using Kinect. A qualitative research enquiry was conducted as part of a study that examined postural control and balance after a 10-week Kinect home-exercise programme in adults with multiple sclerosis. Patients were recruited from a Neurology Unit of a University Hospital. The inclusion criteria were: subjects aged between 20 and 60 years, diagnosed with multiple sclerosis for over 2 years based on the McDonald Criteria; with an EDSS score ranging from 3 to 5. Purposeful sampling method was implemented. The data collection consisted of unstructured interviews, using open questions, and thematic analysis was conducted. Guidelines for conducting qualitative studies established by the Consolidated Criteria for Reporting Qualitative Research were followed. Twenty-four patients with a mean age of 36.69 were included. Four main themes emerged from the data: 1) regaining previous capacity and abilities. The patients described how, after the treatment with Kinect they felt more independent; 2) sharing the disease. The patients sharing the experience of living with MS with their family, thanks to the use of Kinect; 3) adapting to the new treatment. This refers to how the use of the videogame console incorporated novelties to their rehabilitation programme; and 4) comparing oneself. This refers to the appearance of factors that motivate the patient during KVHEP. The patients' experiences gathered in this study

  15. Prolonged-release fampridine treatment improved subject-reported impact of multiple sclerosis: Item-level analysis of the MSIS-29.

    Gasperini, Claudio; Hupperts, Raymond; Lycke, Jan; Short, Christine; McNeill, Manjit; Zhong, John; Mehta, Lahar R

    2016-11-15

    Prolonged-release (PR) fampridine is approved to treat walking impairment in persons with multiple sclerosis (MS); however, treatment benefits may extend beyond walking. MOBILE was a phase 2, 24-week, double-blind, placebo-controlled exploratory study to assess the impact of 10mg PR-fampridine twice daily versus placebo on several subject-assessed measures. This analysis evaluated the physical and psychological health outcomes of subjects with progressing or relapsing MS from individual items of the Multiple Sclerosis Impact Scale (MSIS-29). PR-fampridine treatment (n=68) resulted in greater improvements from baseline in the MSIS-29 physical (PHYS) and psychological (PSYCH) impact subscales, with differences of 89% and 148% in mean score reduction from baseline (n=64) at week 24 versus placebo, respectively. MSIS-29 item analysis showed that a higher percentage of PR-fampridine subjects had mean improvements in 16/20 PHYS and 6/9 PSYCH items versus placebo after 24weeks. Post hoc analysis of the 12-item Multiple Sclerosis Walking Scale (MSWS-12) improver population (≥8-point mean improvement) demonstrated differences in mean reductions from baseline of 97% and 111% in PR-fampridine MSIS-29 PHYS and PSYCH subscales versus the overall placebo group over 24weeks. A higher percentage of MSWS-12 improvers treated with PR-fampridine showed mean improvements in 20/20 PHYS and 8/9 PSYCH items versus placebo at 24weeks. In conclusion, PR-fampridine resulted in physical and psychological benefits versus placebo, sustained over 24weeks. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  16. Modeling the impact of travel information on activity-travel rescheduling decisions under multiple uncertain events: distributed myopic decision heuristics

    Sun, Z.; Arentze, T.A.; Timmermans, H.J.P.

    2005-01-01

    Travel information is widely available in different forms through various sources. This wide availability of travel information is believed to influence travellers’ daily activity-travel patterns. To understand and model the impact of travel information on traveller’s decision processes, the authors

  17. Candidates for multiple impact craters?: Popigai and Chicxulub as seen by the global high resolution gravitational field model EGM2008

    Klokočník, Jaroslav; Kostelecký, J.; Pešek, I.; Novák, P.; Wagner, C. A.; Sebera, Josef

    2010-01-01

    Roč. 1, č. 1 (2010), s. 71-83 ISSN 1869-9510 Grant - others:ESA(XE) ESA- PECS project no. 98056 Institutional research plan: CEZ:AV0Z10030501 Keywords : impact craters * gravity field model EGM2008 * second radial derivatives Subject RIV: BN - Astronomy, Celestial Mechanics, Astrophysics

  18. Assessing climate change impacts, benefits of mitigation, and uncertainties on major global forest regions under multiple socioeconomic and emissions scenarios

    John B Kim; Erwan Monier; Brent Sohngen; G Stephen Pitts; Ray Drapek; James McFarland; Sara Ohrel; Jefferson Cole

    2016-01-01

    We analyze a set of simulations to assess the impact of climate change on global forests where MC2 dynamic global vegetation model (DGVM) was run with climate simulations from the MIT Integrated Global System Model-Community Atmosphere Model (IGSM-CAM) modeling framework. The core study relies on an ensemble of climate simulations under two emissions scenarios: a...

  19. Reproducibility of R-fMRI metrics on the impact of different strategies for multiple comparison correction and sample sizes.

    Chen, Xiao; Lu, Bin; Yan, Chao-Gan

    2018-01-01

    Concerns regarding reproducibility of resting-state functional magnetic resonance imaging (R-fMRI) findings have been raised. Little is known about how to operationally define R-fMRI reproducibility and to what extent it is affected by multiple comparison correction strategies and sample size. We comprehensively assessed two aspects of reproducibility, test-retest reliability and replicability, on widely used R-fMRI metrics in both between-subject contrasts of sex differences and within-subject comparisons of eyes-open and eyes-closed (EOEC) conditions. We noted permutation test with Threshold-Free Cluster Enhancement (TFCE), a strict multiple comparison correction strategy, reached the best balance between family-wise error rate (under 5%) and test-retest reliability/replicability (e.g., 0.68 for test-retest reliability and 0.25 for replicability of amplitude of low-frequency fluctuations (ALFF) for between-subject sex differences, 0.49 for replicability of ALFF for within-subject EOEC differences). Although R-fMRI indices attained moderate reliabilities, they replicated poorly in distinct datasets (replicability < 0.3 for between-subject sex differences, < 0.5 for within-subject EOEC differences). By randomly drawing different sample sizes from a single site, we found reliability, sensitivity and positive predictive value (PPV) rose as sample size increased. Small sample sizes (e.g., < 80 [40 per group]) not only minimized power (sensitivity < 2%), but also decreased the likelihood that significant results reflect "true" effects (PPV < 0.26) in sex differences. Our findings have implications for how to select multiple comparison correction strategies and highlight the importance of sufficiently large sample sizes in R-fMRI studies to enhance reproducibility. Hum Brain Mapp 39:300-318, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  20. Effects of daratumumab on natural killer cells and impact on clinical outcomes in relapsed or refractory multiple myeloma

    Casneuf, Tineke; Xu, Xu Steven; Adams, Homer C

    2017-01-01

    Daratumumab, a human CD38 imunoglobulin G 1κ monoclonal antibody, has demonstrated clinical activity and a manageable safety profile in monotherapy and combination therapy clinical trials in relapsed and/or refractory multiple myeloma. CD38 is expressed at high levels on myeloma cells and......, to a lesser extent, on immune effector cells, including natural killer (NK) cells, which are important for daratumumab-mediated antibody-dependent cellular cytotoxicity (ADCC). Here, the pharmacodynamic effects of daratumumab monotherapy on NK cells, and the effect of NK cell dynamics on daratumumab efficacy...

  1. The impact of self-transcendence on physical health status promotion in multiple sclerosis patients attending peer support groups.

    JadidMilani, Maryam; Ashktorab, Tahereh; AbedSaeedi, Zhila; AlaviMajd, Hamid

    2015-12-01

    This study aimed to investigate the effect of self-transcendence on the physical health of multiple sclerosis (MS) patients attending peer support groups. This study was a quasi-experimental before-and-after design including 33 MS patients in three groups: 10 men in the men-only group, 11 women in the women-only group, and 12 men and women in the mixed group. Participants were required to attend eight weekly sessions of 2 h each. Instruments included the physical health section of the Multiple Sclerosis Quality of Life Inventory and Reed's Self-Transcendence Scale. Peer support group attendance was found to have a significant positive effect on the physical health and self-transcendence of MS patients when comparing average scores before and after attendance. Regression analysis showed that improvement in self-transcendence predicted improvement in physical health. Results show the positive effects of peer support groups on self-transcendence and physical health in MS patients, and suggest that improvement in well-being can be gained by promoting self-transcendence and physical health. © 2015 Wiley Publishing Asia Pty Ltd.

  2. Impact of multiple soil nutrients on distribution patterns of shrubs in an arid valley, in southwest china

    Song, C.J.; Yishui, T.; Zao, L.X.

    2014-01-01

    Shrubs play key roles in arid regions and multiple interacting resources limit their distribution patterns. Identifying limiting resources and their coupling effects on shrubs is essential for developing restoration theory and practice. A survey of shrub composition, soil properties and topography was conducted in fifty-seven 15-m * 15-m plots in an arid valley of the upper Minjiang River, Southwest China. With quantitative classification method and ordination technique, 48 shrubs species were classified into four clusters and two categories along soil gradient. Cluster I and II composed Category I and had a significantly higher percentage of dominant legume shrubs than in Cluster III and Cluster IV, which made up Category II. Correlation analysis indicated that both multi-resource limitation and single resource limitation were coexisting simultaneously in this arid area, the extent of which was functional cluster-specific and also quantified hierarchical structure of multiple resource limitation: soil water played a primary limitation role, available nitrogen the next, and available phosphorus the third at community scale. Moreover, this study affirmed that both soil pH and soil texture could effectively regulate retention of soil moisture and available nutrients, respectively. Distinguishing critical limiting resources and their regulators is very meaningful to clarify couplings and controlling mechanisms in restoration practices. Therefore, decreasing soil pH and increasing soil clay content should be conducted thoroughly in plantation sites to remain abundant soil moisture and available nutrients in native restoration projects. (author)

  3. Step responses of a torsional system with multiple clearances: Study of vibro-impact phenomenon using experimental and computational methods

    Oruganti, Pradeep Sharma; Krak, Michael D.; Singh, Rajendra

    2018-01-01

    Recently Krak and Singh (2017) proposed a scientific experiment that examined vibro-impacts in a torsional system under a step down excitation and provided preliminary measurements and limited non-linear model studies. A major goal of this article is to extend the prior work with a focus on the examination of vibro-impact phenomena observed under step responses in a torsional system with one, two or three controlled clearances. First, new measurements are made at several locations with a higher sampling frequency. Measured angular accelerations are examined in both time and time-frequency domains. Minimal order non-linear models of the experiment are successfully constructed, using piecewise linear stiffness and Coulomb friction elements; eight cases of the generic system are examined though only three are experimentally studied. Measured and predicted responses for single and dual clearance configurations exhibit double sided impacts and time varying periods suggest softening trends under the step down torque. Non-linear models are experimentally validated by comparing results with new measurements and with those previously reported. Several metrics are utilized to quantify and compare the measured and predicted responses (including peak to peak accelerations). Eigensolutions and step responses of the corresponding linearized models are utilized to better understand the nature of the non-linear dynamic system. Finally, the effect of step amplitude on the non-linear responses is examined for several configurations, and hardening trends are observed in the torsional system with three clearances.

  4. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs.

    Yin, Hao; Pizzol, Massimo; Xu, Linyu

    2017-07-01

    Some cities in China are facing serious air pollution problems including high concentrations of particles, SO 2 and NO x . Exposure to PM2.5, one of the primary air pollutants in many cities in China, is highly correlated with various adverse health impacts and ultimately represents a cost for society. The aim of this study is to assess health impacts and external costs related to PM2.5 pollution in Beijing, China with different baseline concentrations and valuation methods. The idea is to provide a reasonable estimate of the total health impacts and external cost due to PM2.5 pollution, as well as a quantification of the relevant uncertainty. PM2.5 concentrations were retrieved for the entire 2012 period in 16 districts of Beijing. The various PM2.5 related health impacts were identified and classified to avoid double counting. Exposure-response coefficients were then obtained from literature. Both the value of statistical life (VSL) and the amended human capital (AHC) approach were applied for external costs estimation, which could provide the upper and lower bound of the external costs due to PM2.5. To fully understand the uncertainty levels, the external cost distribution was determined via Monte Carlo simulation based on the uncertainty of the parameters such as PM2.5 concentration, exposure-response coefficients, and economic cost per case. The results showed that the external costs were equivalent to around 0.3% (AHC, China's guideline: C 0  = 35 μg/m 3 ) to 0.9% (VSL, WHO guideline: C 0  = 10 μg/m 3 ) of regional GDP depending on the valuation method and on the assumed baseline PM2.5 concentration (C 0 ). Among all the health impacts, the economic loss due to premature deaths accounted for more than 80% of the overall external costs. The results of this study could help policymakers prioritizing the PM2.5 pollution control interventions and internalize the external costs through the application of economic policy instruments. Copyright © 2017

  5. Impact of multiple sub-melt laser scans on the activation and diffusion of shallow Boron junctions

    Rosseel, E.; Vandervorst, W.; Clarysse, T.

    2008-01-01

    , careful process optimization is required. While macroscopic variations can easily be addressed using the proper spatial power compensation it is more difficult to completely eliminate the micro scale non-uniformity which is intimately linked to the laser beam profile, the amount of overlaps and the scan...... pitch. In this work, we will present micro scale sheet resistance uniformity measurements for shallow 0.5 keV B junctions and zoom in on the underlying effect of multiple subsequent laser scans. A variety of characterization techniques are used to extract the relevant junction parameters and the role...... of different implantation and anneal parameters will be explored. It turns out that the observed sheet resistance decrease with increasing number of laser scans is caused on one hand by a temperature dependent increase of the activation level, and on the other hand, by a non-negligible temperature...

  6. Impact of Age and Antibody Type on Progression From Single to Multiple Autoantibodies in Type 1 Diabetes Relatives.

    Bosi, Emanuele; Boulware, David C; Becker, Dorothy J; Buckner, Jane H; Geyer, Susan; Gottlieb, Peter A; Henderson, Courtney; Kinderman, Amanda; Sosenko, Jay M; Steck, Andrea K; Bingley, Polly J

    2017-08-01

    Islet autoantibodies are markers of type 1 diabetes, and an increase in number of autoantibodies detected during the preclinical phase predicts progression to overt disease. To refine the effect of age in relation to islet antibody type on progression from single to multiple autoantibodies in relatives of people with type 1 diabetes. We examined 994 relatives with normal glucose tolerance who were positive for a single autoantibody, followed prospectively in the TrialNet Pathway to Prevention. Antibodies to glutamic acid decarboxylase (GADA), insulin (IAA), insulinoma-associated antigen 2, and zinc transporter 8 and islet cell antibodies were tested every 6 to 12 months. The primary outcome was confirmed development of multiple autoantibodies. Age was categorized as <8 years, 8 to 11 years, 12 to 17 years, and ≥18 years, and optimal age breakpoints were identified by recursive partitioning analysis. After median follow-up of 2 years, 141 relatives had developed at least one additional autoantibodies. Five-year risk was inversely related to age, but the pattern differed by antibody type: Relatives with GADA showed a gradual decrease in risk over the four age groups, whereas relatives with IAA showed a sharp decrease above age 8 years. Recursive partitioning analysis identified age breakpoints at 14 years in relatives with GADA and at 4 years in relatives with IAA. In relatives with IAA, spread of islet autoimmunity is largely limited to early childhood, whereas immune responses initially directed at glutamic acid decarboxylase can mature over a longer period. These differences have important implications for monitoring these patients and for designing prevention trials. Copyright © 2017 Endocrine Society

  7. Impact on creatinine renal clearance by the interplay of multiple renal transporters: a case study with INCB039110.

    Zhang, Yan; Warren, Mark S; Zhang, Xuexiang; Diamond, Sharon; Williams, Bill; Punwani, Naresh; Huang, Jane; Huang, Yong; Yeleswaram, Swamy

    2015-04-01

    Serum creatinine is commonly used as a marker of renal function, but increases in serum creatinine might not represent changes in glomerular filtration rate (GFR). INCB039110 (2-(3-(4-(7H-pyrrolo[2,3-day]pyrimidin-4-yl)-1H-pyrazol-1-yl)-1-(1-(3-fluoro-2-(trifluoromethyl)isonicotinoyl)piperidin-4-yl)azetidin-3-yl)acetonitrile) is an inhibitor of the Janus kinases (JAKs) with selectivity for JAK1. In a phase 1 study, a modest and reversible increase in serum creatinine was observed after treatment with INCB039110. However, a dedicated renal function study with INCB039110, assessed by iohexol plasma clearance, conducted in healthy volunteers indicated no change in GFR. In vitro studies were therefore conducted to investigate the interaction of INCB039110 with five transporters that are likely involved in the renal clearance of creatinine. Cell systems expressing individual or multiple transporters were used, including a novel quintuple-transporter model OAT2/OCT2/OCT3/MATE1/MATE2-K. INCB039110 potently inhibited OCT2-mediated uptake of creatinine as well as MATE1-/MATE2-K-mediated efflux of creatinine. Given the interactions of INCB039110 with multiple transporters affecting creatinine uptake and efflux, an integrated system expressing all five transporters was sought; in that system, INCB039110 caused a dose-dependent decrease in transcellular transport of creatinine with weaker net inhibition compared with the effects on individual transporters. In summary, a molecular mechanism for the increase in serum creatinine by INCB039110 has been established. These studies also underline the limitations of using serum creatinine as a marker of renal function. Copyright © 2015 by The American Society for Pharmacology and Experimental Therapeutics.

  8. Assessing climate change impacts, benefits of mitigation, and uncertainties on major global forest regions under multiple socioeconomic and emissions scenarios

    Kim, John B.; Monier, Erwan; Sohngen, Brent; Pitts, G. Stephen; Drapek, Ray; McFarland, James; Ohrel, Sara; Cole, Jefferson

    2017-04-01

    We analyze a set of simulations to assess the impact of climate change on global forests where MC2 dynamic global vegetation model (DGVM) was run with climate simulations from the MIT Integrated Global System Model-Community Atmosphere Model (IGSM-CAM) modeling framework. The core study relies on an ensemble of climate simulations under two emissions scenarios: a business-as-usual reference scenario (REF) analogous to the IPCC RCP8.5 scenario, and a greenhouse gas mitigation scenario, called POL3.7, which is in between the IPCC RCP2.6 and RCP4.5 scenarios, and is consistent with a 2 °C global mean warming from pre-industrial by 2100. Evaluating the outcomes of both climate change scenarios in the MC2 model shows that the carbon stocks of most forests around the world increased, with the greatest gains in tropical forest regions. Temperate forest regions are projected to see strong increases in productivity offset by carbon loss to fire. The greatest cost of mitigation in terms of effects on forest carbon stocks are projected to be borne by regions in the southern hemisphere. We compare three sources of uncertainty in climate change impacts on the world’s forests: emissions scenarios, the global system climate response (i.e. climate sensitivity), and natural variability. The role of natural variability on changes in forest carbon and net primary productivity (NPP) is small, but it is substantial for impacts of wildfire. Forest productivity under the REF scenario benefits substantially from the CO2 fertilization effect and that higher warming alone does not necessarily increase global forest carbon levels. Our analysis underlines why using an ensemble of climate simulations is necessary to derive robust estimates of the benefits of greenhouse gas mitigation. It also demonstrates that constraining estimates of climate sensitivity and advancing our understanding of CO2 fertilization effects may considerably reduce the range of projections.

  9. Evaluation of the impact of multiple micronutrient powders on children anemia in three andean regiones in Peru

    Munayco, César V.; Dirección General de Epidemiología, Ministerio de Salud. Lima, Perú. Médico, magister en Epidemiologia y Salud Pública.; Ulloa-Rea, María E.; Dirección General de Epidemiología, Ministerio de Salud. Lima, Perú. técnico en informática.; Medina-Osis, José; Dirección General de Epidemiología, Ministerio de Salud. Lima, Perú. médico.; Lozano-Revollar, Carmen R.; Oficina de Epidemiología, Dirección Regional de Ayacucho. Ayacucho, Perú. licenciada en enfermería.; Tejada, Violeta; Oficina de Epidemiología, Dirección Regional de Andahuaylas. Andahuaylas, Perú. licenciada en enfermería.; Castro-Salazar, Consuelo; Oficina de Epidemiología, Dirección Regional de Huancavelica. Huancavelica, Perú. licenciada en enfermería.; Munarriz-Villafuerte, José; Oficina de Epidemiología, Dirección Regional de Huancavelica. Huancavelica, Perú. bachiller en Ingeniería de Sistemas y Computación.; de Bustos, Cecilia; Programa Mundial de Alimentos de las Naciones Unidas, Sede Perú. Lima, Perú. PhD en Patología experimental.; Arias, Lena; Fondo de Naciones Unidas para la Infancia (UNICEF), Sede Perú. Lima, Perú. licenciada en Nutrición.

    2014-01-01

    The aim of this research was to determine the impact of the strategy of multi-micronutrient supplementation (MMN) on the childhood anemia in three Andean regions of Peru. A sentinel surveillance system was established in 29 health centers of Andahuaylas, Ayacucho and Huancavelica (Peru) to monitor a cohort of children of 6 to 35 months of age whom been received MMM for a period of 12 months. Data regarding hemoglobin levels were gathered at the beginning and at the end of the research; th...

  10. Assessment of the Impact of Stochastic Day-Ahead SCUC on Economic and Reliability Metrics at Multiple Timescales: Preprint

    Wu, H.; Ela, E.; Krad, I.; Florita, A.; Zhang, J.; Hodge, B. M.; Ibanez, E.; Gao, W.

    2015-03-01

    This paper incorporates the stochastic day-ahead security-constrained unit commitment (DASCUC) within a multi-timescale, multi-scheduling application with commitment, dispatch, and automatic generation control. The stochastic DASCUC is solved using a progressive hedging algorithm with constrained ordinal optimization to accelerate the individual scenario solution. Sensitivity studies are performed in the RTS-96 system, and the results show how this new scheduling application would impact costs and reliability with a closer representation of timescales of system operations in practice.

  11. Analgesic efficacy of lysine clonixinate plus tramadol versus tramadol in multiple doses following impacted third molar surgery.

    Perez-Urizar, J; Martínez-Rider, R; Torres-Roque, I; Garrocho-Rangel, A; Pozos-Guillen, A

    2014-03-01

    This study compared the analgesic and anti-inflammatory efficacy, trismus control, and tolerability of the combination of lysine clonixinate and tramadol (LCT) versus tramadol (T) alone after surgical removal of impacted mandibular third molars. This study was a double-blind, randomized clinical trial, including two study groups of 20 patients each, who exhibited acute pain subsequent to surgical extraction of two mandibular third molars. Pain intensity was quantified over a 96-h period using a visual analogue scale and a 5-point verbal rating scale. Secondary indicators of analgesic and anti-inflammatory efficacy, trismus control, and tolerability were determined. Patients administered LCT exhibited better therapeutic effects that those administered T. Fifty percent of patients in the LCT group rated this therapy as 'excellent analgesia' compared with only 10% in the T group. The onset of the analgesic effect of LCT was significantly faster, without any therapeutic failures. There were no significant differences between the groups with regard to anti-inflammatory effect or trismus. The results of this study suggest that the postsurgical analgesic efficacy of LCT in combination (LC 125 mg + T 25 mg) is superior to that obtained with T alone, administered at the standard dose of 50 mg, for up to 96 h after the extraction of both impacted mandibular third molars. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  12. Impact of multiple radar reflectivity data assimilation on the numerical simulation of a flash flood event during the HyMeX campaign

    Maiello, Ida; Gentile, Sabrina; Ferretti, Rossella; Baldini, Luca; Roberto, Nicoletta; Picciotti, Errico; Alberoni, Pier Paolo; Silvio Marzano, Frank

    2017-11-01

    An analysis to evaluate the impact of multiple radar reflectivity data with a three-dimensional variational (3-D-Var) assimilation system on a heavy precipitation event is presented. The main goal is to build a regionally tuned numerical prediction model and a decision-support system for environmental civil protection services and demonstrate it in the central Italian regions, distinguishing which type of observations, conventional and not (or a combination of them), is more effective in improving the accuracy of the forecasted rainfall. In that respect, during the first special observation period (SOP1) of HyMeX (Hydrological cycle in the Mediterranean Experiment) campaign several intensive observing periods (IOPs) were launched and nine of which occurred in Italy. Among them, IOP4 is chosen for this study because of its low predictability regarding the exact location and amount of precipitation. This event hit central Italy on 14 September 2012 producing heavy precipitation and causing several cases of damage to buildings, infrastructure, and roads. Reflectivity data taken from three C-band Doppler radars running operationally during the event are assimilated using the 3-D-Var technique to improve high-resolution initial conditions. In order to evaluate the impact of the assimilation procedure at different horizontal resolutions and to assess the impact of assimilating reflectivity data from multiple radars, several experiments using the Weather Research and Forecasting (WRF) model are performed. Finally, traditional verification scores such as accuracy, equitable threat score, false alarm ratio, and frequency bias - interpreted by analysing their uncertainty through bootstrap confidence intervals (CIs) - are used to objectively compare the experiments, using rain gauge data as a benchmark.

  13. Consequences of climate change, eutrophication, and other anthropogenic impacts to coastal salt marshes: multiple stressors reduce resiliency and sustainability

    Watson, E. B.; Wigand, C.; Nelson, J.; Davey, E.; Van Dyke, E.; Wasson, K.

    2011-12-01

    Coastal salt marshes provide a wide variety of ecosystem services, including habitat for protected vertebrates and ecologically valuable invertebrate fauna, flood protection, and improvements in water quality for adjacent marine and estuarine environments. Here, we consider the impacts of future sea level rise combined with other anthropogenic stressors to salt marsh sustainability through the implementation of field and laboratory mesocosms, manipulative experiments, correlative studies, and predictive modeling conducted in central California and southern New England salt marshes. We report on measurements of soil respiration, decomposition, sediment accumulation, and marsh elevation, which considered jointly suggest an association between nitrate input and marsh elevation loss resulting from mineralization of soil organic matter. Furthermore, use of imaging techniques (CT scans) has shown differences in belowground root and rhizome structure associated with fertilization, resulting in a loss of sediment cohesion promoted by fine root structure. Additionally, field and greenhouse mesocosm experiments have provided insight into the specific biogeochemical processes responsible for plant mortality at high immersion or salinity levels. In conclusion, we have found that poor water quality (i.e. eutrophication) leads to enhanced respiration and decomposition of soil organic matter, which ultimately contributes to a loss of salt marsh sustainability. However, marsh deterioration studied at field sites (Jamaica Bay, NY and Elkhorn Slough, CA) is associated not only with enhanced nutrient loads, but also increased immersion due to tidal range increases resulting from dredging. To ensure the continuation of the ecosystem services provided by tidal wetlands and to develop sustainable management strategies that provide favorable outcomes under a variety of future sea level rise and land use scenarios, we need to develop a better understanding of the relative impacts of the

  14. Impact of Grain Shape and Multiple Black Carbon Internal Mixing on Snow Albedo: Parameterization and Radiative Effect Analysis

    He, Cenlin; Liou, Kuo-Nan; Takano, Yoshi; Yang, Ping; Qi, Ling; Chen, Fei

    2018-01-01

    We quantify the effects of grain shape and multiple black carbon (BC)-snow internal mixing on snow albedo by explicitly resolving shape and mixing structures. Nonspherical snow grains tend to have higher albedos than spheres with the same effective sizes, while the albedo difference due to shape effects increases with grain size, with up to 0.013 and 0.055 for effective radii of 1,000 μm at visible and near-infrared bands, respectively. BC-snow internal mixing reduces snow albedo at wavelengths external mixing, internal mixing enhances snow albedo reduction by a factor of 1.2-2.0 at visible wavelengths depending on BC concentration and snow shape. The opposite effects on albedo reductions due to snow grain nonsphericity and BC-snow internal mixing point toward a careful investigation of these two factors simultaneously in climate modeling. We further develop parameterizations for snow albedo and its reduction by accounting for grain shape and BC-snow internal/external mixing. Combining the parameterizations with BC-in-snow measurements in China, North America, and the Arctic, we estimate that nonspherical snow grains reduce BC-induced albedo radiative effects by up to 50% compared with spherical grains. Moreover, BC-snow internal mixing enhances the albedo effects by up to 30% (130%) for spherical (nonspherical) grains relative to external mixing. The overall uncertainty induced by snow shape and BC-snow mixing state is about 21-32%.

  15. No relevant impact of ambient temperature on disability measurements in a large cohort of patients with multiple sclerosis.

    Stellmann, J-P; Young, K L; Vettorazzi, E; Pöttgen, J; Heesen, C

    2017-06-01

    Many patients with multiple sclerosis (MS) report a worsening of symptoms due to high ambient temperatures, but objective data about this association are rare and contradictory. The aim of this study was to investigate the influence of ambient temperature on standard clinical tests. We extracted the Symbol Digit Modality Test, Nine Hole Peg Test, Timed 25 Foot Walk (T25FW), Timed Tandem Walk, Expanded Disability Status Scale (EDSS) and quality-of-life items on cognition, fatigue and depression from our clinical database and matched them to historical temperatures. We used linear mixed-effect models to investigate the association between temperature and outcomes. A total of 1254 patients with MS (mean age, 42.7 years; 69.9% females; 52.1% relapsing-remitting MS, mean EDSS, 3.8) had 5751 assessments between 1996 and 2012. We observed a worsening in the T25FW with higher ambient temperatures in moderately disabled patients (EDSS ≥ 4) but not in less disabled patients. However, an increase of 10°C prolonged the T25FW by just 0.4 s. Other outcomes were not associated with ambient temperatures. Higher ambient temperature might compromise walking capabilities in patients with MS with a manifest walking impairment. However, effects are small and not detectable in mildly disabled patients. Hand function, cognition, mood and fatigue do not appear to be correlated with ambient temperature. © 2017 EAN.

  16. Regional resources buffer the impact of functional limitations on perceived autonomy in older adults with multiple illnesses.

    Schüz, Benjamin; Westland, Josh N; Wurm, Susanne; Tesch-Römer, Clemens; Wolff, Julia K; Warner, Lisa M; Schwarzer, Ralf

    2016-03-01

    Retaining perceptions of autonomy is a key component of successful aging. Perceived autonomy refers to the capacity to make and enact self-directed decisions. These perceptions are often threatened in older adults with multiple illnesses, when functional limitations resulting from these illnesses impede the enactment of self-directed decisions. Regional resources (in Germany specifically at the level of administrative districts) might counteract these impediments of autonomy. Economically stronger districts can provide more-concrete support resources for older adults, buffering the negative effect of functional limitations on self-perceived autonomy. This study assessed participants aged over 65 with 2 or more chronic conditions. In total, N = 287 provided data (Mage = 73.3, SD = 5.07), and n = 97 were women. Gross domestic product (GDP) per capita was used as a proxy measure of administrative district wealth in Germany. Hierarchical multilevel regression analyses with cross-level interactions were conducted. Results suggest that the detrimental effect of functional limitations on perceived autonomy is less pronounced for participants residing in higher GDP districts. Conversely, for participants in lower GDP districts, the effect is exacerbated. This finding suggests that districts with greater financial resources might be better able to invest in supports that promote and facilitate autonomy and, thus, provide a buffer against threats to individual perceived autonomy. (c) 2016 APA, all rights reserved).

  17. Corpus callosum atrophy as a marker of clinically meaningful cognitive decline in secondary progressive multiple sclerosis. Impact on employment status.

    Papathanasiou, Athanasios; Messinis, Lambros; Zampakis, Petros; Papathanasopoulos, Panagiotis

    2017-09-01

    Cognitive impairment in Multiple Sclerosis (MS) is more frequent and pronounced in secondary progressive MS (SPMS). Cognitive decline is an important predictor of employment status in patients with MS. Magnetic Resonance Imaging (MRI) markers have been used to associate tissue damage with cognitive dysfunction. The aim of the study was to designate the MRI marker that predicts cognitive decline in SPMS and explore its effect on employment status. 30 SPMS patients and 30 healthy participants underwent neuropsychological assessment using the Trail Making Test (TMT) parts A and B, semantic and phonological verbal fluency task and a computerized cognitive screening battery (Central Nervous System Vital Signs). Employment status was obtained as a quality of life measure. Brain MRI was performed in all participants. We measured total lesion volume, third ventricle width, thalamic and corpus callosum atrophy. The frequency of cognitive decline for our SPMS patients was 80%. SPMS patients differed significantly from controls in all neuropsychological measures. Corpus callosum area was correlated with cognitive flexibility, processing speed, composite memory, executive functions, psychomotor speed, reaction time and phonological verbal fluency task. Processing speed and composite memory were the most sensitive markers for predicting employment status. Corpus callosum area was the most sensitive MRI marker for memory and processing speed. Corpus callosum atrophy predicts a clinically meaningful cognitive decline, affecting employment status in our SPMS patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. The adipose organ and multiple myeloma: Impact of adipokines on tumor growth and potential sites for therapeutic intervention.

    Allegra, Alessandro; Innao, Vanessa; Gerace, Demetrio; Allegra, Andrea Gaetano; Vaddinelli, Doriana; Bianco, Oriana; Musolino, Caterina

    2018-07-01

    In addition to its capacity to store lipids the adipose tissue is now identified as a real organ with both endocrine and metabolic roles. Preclinical results indicate that modifying adipose tissue and bone marrow adipose tissue (BMAT) could be a successful multiple myeloma (MM) therapy. BMAT interrelates with bone marrow cells and other immune cells, and may influence MM disease progression. The BM adipocytes may have a role in MM progression, bone homing, chemoresistance, and relapse, due to local endocrine, paracrine, or metabolic factors. BM adipocytes isolated from MM subjects have been shown to increase myeloma growth in vitro and may preserve cells from chemotherapy-induced apoptosis. By producing free fatty acids and emitting signaling molecules such as growth factors and adipokines, BM adipocytes are both an energy font and an endocrine signaling factory. This review should suggest future research approaches toward developing novel treatments to target MM by targeting BMAT and its products. Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  19. Personality in multiple sclerosis (MS): impact on health, psychological well-being, coping, and overall quality of life.

    Strober, L B

    2017-02-01

    Personality has long been considered a factor that can account for differences in health, well-being, and overall quality of life (QOL). A 'Distressed or Type D Personality' has been studied in medical populations as a predictor of several outcomes. The purpose of the present investigation was to determine the presence of Type D Personality in multiple sclerosis (MS) and its role on disease symptoms, disease management, health-related behaviors, coping, psychological well-being, and overall QOL and functioning. Two hundred and thirty (230) individuals with MS completed a survey assessing personality, disease symptoms, disease management, coping, self-efficacy, locus of control (LOC), psychological well-being, and QOL. Thirty-seven (16%) individuals were found to be 'Type D+.' Such individuals reported greater fatigue, pain, depression, and anxiety and worse disease management and adherence. They also reported engaging in maladaptive means of coping. Compared to 'Type D-' they reported lower self-efficacy, LOC, QOL and greater perceived stress. Finally, 'Type D+' individuals were more likely to be considering leaving the workforce. Findings suggest that 'Type D' Personality is associated with various negative outcomes in MS. Consideration of the routine assessment of personality in MS seems warranted and may better inform interventions and ward off poor outcomes.

  20. PER3 VNTR polymorphism in Multiple Sclerosis: A new insight to impact of sleep disturbances in MS.

    Golalipour, Masoud; Maleki, Zahra; Farazmandfar, Touraj; Shahbazi, Majid

    2017-10-01

    Multiple Sclerosis (MS) is a degenerative disease of central nervous system caused by an immune response against the myelin. About half of MS patients suffers from sleep disturbances. The circadian clock genes such as PER3 controls circadian rhythm and sleep. Due to the role of PER3 in sleep disturbances and regulation of immune response, it is possible that PER3 dysregulation increase risk of MS disease. Study groups included 160 MS patients and 160 healthy volunteers. PER3 VNTR polymorphism was evaluated by PCR method. The genotypic and allelic distribution analyzed by chi square test. There was a significant association between genotype PER3 4/4 , and 4-repeat allele with MS disease (p = 0.014 and p MS group, and MS onset showed that there was a significant correlation between PER3 4/4 genotype with female gender and early onset of MS disease (p = 0.033 and p = 0.028 respectively). Our data suggest that, PER3 4/4 genotype may accelerate the course of disease in MS susceptible individuals. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. [Evaluation of the impact of multiple micronutrient powders on children anemia in three Andean regiones in Peru].

    Munayco, César V; Ulloa-Rea, María E; Medina-Osis, José; Lozano-Revollar, Carmen R; Tejada, Violeta; Castro-Salazar, Consuelo; Munarriz-Villafuerte, José; de Bustos, Cecilia; Arias, Lena

    2013-04-01

    The aim of this research was to determine the impact of the strategy of multi-micronutrient supplementation (MMN) on the childhood anemia in three Andean regions of Peru. A sentinel surveillance system was established in 29 health centers of Andahuaylas, Ayacucho and Huancavelica (Peru) to monitor a cohort of children of 6 to 35 months of age whom been received MMM for a period of 12 months. Data regarding hemoglobin levels were gathered at the beginning and at the end of the research; they included consumption of MMN, and other data from clinical records and from growth and development charts. Between the child who completed the supplementation, the prevalence of anemia decreased from 70.2% to 36.6% (p value anemia at the beginning of the supplementation got cured. This research shows that supplementation with MMN could be a valuable strategy to fight anemia.

  2. Impact of metal cations on the electrocatalytic properties of Pt/C nanoparticles at multiple phase interfaces.

    Durst, Julien; Chatenet, Marian; Maillard, Frédéric

    2012-10-05

    Proton-exchange membrane fuel cells (PEMFCs) use carbon-supported nanoparticles based on platinum and its alloys to accelerate the rate of the sluggish oxygen-reduction reaction (ORR). The most common metals alloyed to Pt include Co, Ni and Cu, and are thermodynamically unstable in the PEMFC environment. Their dissolution yields the formation and redistribution of metal cations (M(y+)) within the membrane electrode assembly (MEA). Metal cations can also contaminate the MEA when metallic bipolar plates are used as current collectors. In each case, the electrical performance of the PEMFC severely decreases, an effect that is commonly attributed to the poisoning of the sulfonic acid groups of the perfluorosulfonated membrane (PEM) and the resulting decrease of the proton transport properties. However, the impact of metal cations on the kinetics of electrochemical reactions involving adsorption/desorption and bond-breaking processes remains poorly understood. In this paper, we use model electrodes to highlight the effect of metal cations on Pt/C nanoparticles coated or not with a perfluorosulfonated ionomer for the CO electrooxidation reaction and the oxygen reduction reaction. We show that metal cations negatively impact the ORR kinetics and the mass-transport resistance of molecular oxygen. However, the specific adsorption of sulfonate groups of the Nafion® ionomer locally modifies the double layer structure and increases the tolerance to metal cations, even in the presence of sulphate ions in the electrolyte. The survey is extended by using an ultramicroelectrode with cavity and a solid state cell (SSC) specifically developed for this study.

  3. An Integrated Modeling Framework Forecasting Ecosystem Exposure-- A Systems Approach to the Cumulative Impacts of Multiple Stressors

    Johnston, J. M.

    2013-12-01

    Freshwater habitats provide fishable, swimmable and drinkable resources and are a nexus of geophysical and biological processes. These processes in turn influence the persistence and sustainability of populations, communities and ecosystems. Climate change and landuse change encompass numerous stressors of potential exposure, including the introduction of toxic contaminants, invasive species, and disease in addition to physical drivers such as temperature and hydrologic regime. A systems approach that includes the scientific and technologic basis of assessing the health of ecosystems is needed to effectively protect human health and the environment. The Integrated Environmental Modeling Framework 'iemWatersheds' has been developed as a consistent and coherent means of forecasting the cumulative impact of co-occurring stressors. The Framework consists of three facilitating technologies: Data for Environmental Modeling (D4EM) that automates the collection and standardization of input data; the Framework for Risk Assessment of Multimedia Environmental Systems (FRAMES) that manages the flow of information between linked models; and the Supercomputer for Model Uncertainty and Sensitivity Evaluation (SuperMUSE) that provides post-processing and analysis of model outputs, including uncertainty and sensitivity analysis. Five models are linked within the Framework to provide multimedia simulation capabilities for hydrology and water quality processes: the Soil Water Assessment Tool (SWAT) predicts surface water and sediment runoff and associated contaminants; the Watershed Mercury Model (WMM) predicts mercury runoff and loading to streams; the Water quality Analysis and Simulation Program (WASP) predicts water quality within the stream channel; the Habitat Suitability Index (HSI) model scores physicochemical habitat quality for individual fish species; and the Bioaccumulation and Aquatic System Simulator (BASS) predicts fish growth, population dynamics and bioaccumulation

  4. [Actual medical care situation and therapeutic needs in multiple sclerosis: Impact of the Pharmaceutical Market Restructuring Act (AMNOG)].

    Bittner, S; Meuth, S G

    2016-04-01

    The treatment of patients with multiple sclerosis (MS) is associated with constantly rising costs for the healthcare system and pharmaceuticals constitute 60 % of the direct medical costs. The Pharmaceutical Market Restructuring Act (Arzneimittelmarkt-Neuordnungsgesetz, AMNOG) came into force on 1 January 2011 with the aim of limiting the costs of pharmaceuticals by obligating newly approved products to be subjected to an early evaluation of the additional benefits by the Federal Joint Committee (FJC, Gemeinsamer Bundesausschuss, G‑BA). The majority of products evaluated up to October 2015 in neurology (5 out of 8) were approved for treatment of MS. Has the AMNOG been able to fulfill the original aims? Analysis of available information on MS therapies evaluated by the FJC between December 2010 and October 2015. For various reasons an additional benefit could be shown in only 2 out of 5 assessment procedures for MS drugs. It is obvious that some methodological shortcomings of the process have to be improved. Additionally requirements for pivotal clinical trials have to be harmonized with AMNOG requirements taking the best available evidence and real-life data into consideration (e.g. non-interventional studies) and a closer collaboration between the FJC, healthcare providers and the neurological societies is necessary. The AMNOG procedure currently only partially fulfills the original aims, which could be the reason why guidelines play a more important role for therapy decision-making than FJC decisions. As the early evaluation procedure is an adaptive process methodological shortcomings might be overcome in the future; however, this requires a much closer collaboration between the FJC and neurological societies.

  5. Impact of natalizumab treatment on fatigue, mood and aspects of cognition in relapsing-remitting multiple sclerosis

    Annett eKunkel

    2015-05-01

    Full Text Available Background/ObjectiveFatigue, cognitive and affective disorders are relevant symptoms in Multiple Sclerosis (MS. The treatment with Natalizumab has a positive effect on physical disabilities in patients with RRMS. Some studies describe improvements in cognition and fatigue over one year of treatment. Only little is known about longer treatment effects especially on fatigue, but also on cognition and mood. Therefore the present retrospective open label observational study investigates the effect of Natalizumab on fatigue, attention and depression over a treatment period of two years. Methods 51 RRMS patients that were treated with Natalizumab (male = 11, female = 40; mean age: 33,9+9,1 years were included. The neuropsychological assessment consisted of different tests of attention (TAP: alertness, divided attention, flexibility, SDMT, PASAT, fatigue (WEIMUS, FSMC and depression (CES-D. The assessments occurred immediately before the first administration of Natalizumab, after one and two years of treatment. ResultsSignificant improvements were found in aspects of attention and depression from baseline to follow-up 1 (alertness: reaction time (RT cued, p < 0.05; divided attention: visual RT, p < 0.05; SDMT: p = 0.05; CES-D: p < 0.05 and from baseline to follow-up 2 (divided attention: visual RT: p < 0.001; errors: p < 0.01, omissions: p < 0.05; flexibility: RT, p < 0.05; SDMT: p < 0.01; CES-D: p < 0.05. No significant changes were detected in fatigue probably because of the small sample size especially in the second year of treatment (WEIMUS: N = 16, FSMC: N = 8. Conclusion The results show a positive effect of Natalizumab on attention in patients with RRMS and for the first time also in depression after two years of observation and support the efficacy of the treatment over two years. More research is needed for fatigue.

  6. Multiple scattering in grazing-incidence X-ray diffraction: impact on lattice-constant determination in thin films

    Resel, Roland, E-mail: roland.resel@tugraz.at; Bainschab, Markus; Pichler, Alexander [Graz University of Technology, Graz (Austria); Dingemans, Theo [Delft University of Technology, Delft (Netherlands); Simbrunner, Clemens [Johannes Kepler University, Linz (Austria); University of Bremen, Bremen (Germany); Stangl, Julian [Johannes Kepler University, Linz (Austria); Salzmann, Ingo [Humboldt University, Berlin (Germany)

    2016-04-20

    The use of grazing-incidence X-ray diffraction to determine the crystal structure from thin films requires accurate positions of Bragg peaks. Refraction effects and multiple scattering events have to be corrected or minimized. Dynamical scattering effects are observed in grazing-incidence X-ray diffraction experiments using an organic thin film of 2,2′:6′,2′′-ternaphthalene grown on oxidized silicon as substrate. Here, a splitting of all Bragg peaks in the out-of-plane direction (z-direction) has been observed, the magnitude of which depends both on the incidence angle of the primary beam and the out-of-plane angle of the scattered beam. The incident angle was varied between 0.09° and 0.25° for synchrotron radiation of 10.5 keV. This study reveals comparable intensities of the split peaks with a maximum for incidence angles close to the critical angle of total external reflection of the substrate. This observation is rationalized by two different scattering pathways resulting in diffraction peaks at different positions at the detector. In order to minimize the splitting, the data suggest either using incident angles well below the critical angle of total reflection or angles well above, which sufficiently attenuates the contributions from the second scattering path. This study highlights that the refraction of X-rays in (organic) thin films has to be corrected accordingly to allow for the determination of peak positions with sufficient accuracy. Based thereon, a reliable determination of the lattice constants becomes feasible, which is required for crystallographic structure solutions from thin films.

  7. Interactions between aerosol absorption, thermodynamics, dynamics, and microphysics and their impacts on a multiple-cloud system

    Lee, Seoung Soo; Li, Zhanqing; Mok, Jungbin; Ahn, Myoung-Hwan; Kim, Byung-Gon; Choi, Yong-Sang; Jung, Chang-Hoon; Yoo, Hye Lim

    2017-12-01

    This study investigates how the increasing concentration of black carbon aerosols, which act as radiation absorbers as well as agents for the cloud-particle nucleation, affects stability, dynamics and microphysics in a multiple-cloud system using simulations. Simulations show that despite increases in stability due to increasing concentrations of black carbon aerosols, there are increases in the averaged updraft mass fluxes (over the whole simulation domain and period). This is because aerosol-enhanced evaporative cooling intensifies convergence near the surface. This increase in the intensity of convergence induces an increase in the frequency of updrafts with the low range of speeds, leading to the increase in the averaged updraft mass fluxes. The increase in the frequency of updrafts induces that in the number of condensation entities and this leads to more condensation and cloud liquid that acts to be a source of the accretion of cloud liquid by precipitation. Hence, eventually, there is more accretion that offsets suppressed autoconversion, which results in negligible changes in cumulative precipitation as aerosol concentrations increase. The increase in the frequency of updrafts with the low range of speeds alters the cloud-system organization (represented by cloud-depth spatiotemporal distributions and cloud-cell population) by supporting more low-depth clouds. The altered organization in turn alters precipitation spatiotemporal distributions by generating more weak precipitation events. Aerosol-induced reduction in solar radiation that reaches the surface induces more occurrences of small-value surface heat fluxes, which in turn supports the more low-depth clouds and weak precipitation together with the greater occurrence of low-speed updrafts.

  8. A qualitative study of Filipina immigrants' stress, distress and coping: the impact of their multiple, transnational roles as women.

    Straiton, Melanie L; Ledesma, Heloise Marie L; Donnelly, Tam T

    2017-09-05

    Migration is associated with a number of stress factors which can affect mental health. Ethnicity, gender and socioeconomic status can intertwine with and influence the process of migration and mental health. Philippine migration to Europe has increased in recent years and has become more feminised. Knowing more about the factors that influence immigrants' mental health and coping can help aid health care delivery and policy planning. The purpose of this qualitative study was to explore the contextual factors that influence the mental health of Filipinas living in Norway and their coping strategies. Individual in-depth interviews were conducted with fourteen Filipinas 24-49 years, living in Norway. The analysis was informed by the post-colonial feminist perspective in order to examine the process by which gender, ethnicity and socioeconomic status interact with contextual factors in these women's lives and influence their wellbeing. Data analysis revealed that all informants experienced some level of stress or distress. Two main factors: Sense of belonging and Securing a future contributed to the women's level of distress associated with living abroad as an immigrant woman. Distress was heighted by the women's multiple, transnational roles they occupied; roles as workers, breadwinners, daughters, wives and mothers. None of the women had sought professional help for their distress. Religion and informal support from friends and family appear to help these women cope with many of the challenges they face as immigrant women living and working abroad. Filipinas face a number of challenges related to their status as immigrant women and the juggling of their transnational lives. Understanding the context of these women's lives may aid the identification of mental health problems. Although the women show resilience and appear to cope successfully, some may benefit from professional help.

  9. The impact of an online Facebook support group for people with multiple sclerosis on non-active users.

    Steadman, Jacqui; Pretorius, Chrisma

    2014-01-01

    Multiple sclerosis (MS) is a debilitating disease and there is little research on support networks for people with MS (PwMS). More specifically, most studies on online support groups focus on those who actively participate in the group, whereas the majority of those who utilise online support groups do so in a passive way. This study therefore aimed to explore the experiences of non-active users of an online Facebook support group for PwMS. Emphasis was placed on the facilitators and the barriers that were associated with membership to this group. An exploratory qualitative research design was implemented, whereby thematic analysis was utilised to examine the ten semi-structured interviews that were conducted. Several facilitators were acquired through the online support group; namely emotional support (constant source of support, exposure to negative aspects of the disease), informational support (group as a source of knowledge, quality of information) and social companionship (place of belonging). Some barriers were also identified; namely emotional support (emotions lost online, response to messages, exposure to negative aspects of the disease), informational support (information posted on the group, misuse of group) and social companionship (non-active status). These findings demonstrate that the non-active members of the online support group for PwMS have valid reasons for their non-active membership status. More important, the findings suggest that the online Facebook support group provided the group members with an important support network in the form of emotional support, informational support and social companionship, despite their non-active membership status or the barriers that have been identified.

  10. Chase the direct impact of rainfall into groundwater in Mt. Fuji from multiple analyses including microbial DNA

    Kato, Kenji; Sugiyama, Ayumi; Nagaosa, Kazuyo; Tsujimura, Maki

    2016-04-01

    A huge amount of groundwater is stored in subsurface environment of Mt. Fuji, the largest volcanic mountain in Japan. Based on the concept of piston flow transport of groundwater an apparent residence time was estimated to ca. 30 years by 36Cl/Cl ratio (Tosaki et al., 2011). However, this number represents an averaged value of the residence time of groundwater which had been mixed before it flushes out. We chased signatures of direct impact of rainfall into groundwater to elucidate the routes of groundwater, employing three different tracers; stable isotopic analysis (delta 18O), chemical analysis (concentration of silica) and microbial DNA analysis. Though chemical analysis of groundwater shows an averaged value of the examined water which was blended by various water with different sources and routes in subsurface environment, microbial DNA analysis may suggest the place where they originated, which may give information of the source and transport routes of the water examined. Throughout the in situ observation of four rainfall events showed that stable oxygen isotopic ratio of spring water and shallow groundwater obtained from 726m a.s.l. where the average recharge height of rainfall was between 1500 and 1800 m became higher than the values before a torrential rainfall, and the concentration of silica decreased after this event when rainfall exceeded 300 mm in precipitation of an event. In addition, the density of Prokaryotes in spring water apparently increased. Those changes did not appear when rainfall did not exceed 100 mm per event. Thus, findings shown above indicated a direct impact of rainfall into shallow groundwater, which appeared within a few weeks of torrential rainfall in the studied geological setting. In addition, increase in the density of Archaea observed at deep groundwater after the torrential rainfall suggested an enlargement of the strength of piston flow transport through the penetration of rainfall into deep groundwater. This finding was

  11. Psychometric Properties of the Persian Version of the Fatigue Impact Scale (FIS-P in Patients with Multiple Sclerosis

    Marzieh Heidari

    2015-09-01

    Full Text Available Objectives: This study was designed to evaluate the psychometric features of the Persian version of the Fatigue Impact Scale (FIS-P tool when used in Iranian MS patients. Methods: 140 MS patients and the equivalent number of healthy controls completed the following assessments: FIS-P, Fatigue Severity Scale (FSS, SF-36 questionnaire and  the Mini-Mental State Examination (MMSE.  Results: A significant inverse correlation between FIS and the quality of life (SF-36 assessment tool, as well as a positive and significant correlation with the FSS were noted. The Intraclass Correlation Coefficient (ICC values for the inter-rater reliability for the physical, cognitive, and social sections and the whole questionnaire were 0.89, 0.86, 0.95 and 0.98, respectively. The FIS Persian version was shown to possess a high reliability (with a Cronbach’s alpha  of 0.953. Likewise, the ICC values for the test-retest reliability were 0.86, 0.87, 0.92 and 0.93 for the physical, cognitive, social subscales and the whole questionnaire, respectively. This suggested a high reliability for the FIS-P. Discussion: With a proper validity and reliability, the Persian-version of FIS retains the capability for being used in the assessment of fatigue and evaluation of the treatment and rehabilitation effects on fatigue-related symptoms among Persian-speaking patients with MS. 

  12. The Multiple Impacts of Tropical Forest Fragmentation on Arthropod Biodiversity and on their Patterns of Interactions with Host Plants

    Benítez-Malvido, Julieta; Dáttilo, Wesley; Martínez-Falcón, Ana Paola; Durán-Barrón, César; Valenzuela, Jorge; López, Sara; Lombera, Rafael

    2016-01-01

    Tropical rain forest fragmentation affects biotic interactions in distinct ways. Little is known, however, about how fragmentation affects animal trophic guilds and their patterns of interactions with host plants. In this study, we analyzed changes in biotic interactions in forest fragments by using a multitrophic approach. For this, we classified arthropods associated with Heliconia aurantiaca herbs into broad trophic guilds (omnivores, herbivores and predators) and assessed the topological structure of intrapopulation plant-arthropod networks in fragments and continuous forests. Habitat type influenced arthropod species abundance, diversity and composition with greater abundance in fragments but greater diversity in continuous forest. According to trophic guilds, coleopteran herbivores were more abundant in continuous forest and overall omnivores in fragments. Continuous forest showed a greater diversity of interactions than fragments. Only in fragments, however, did the arthropod community associated with H aurantiaca show a nested structure, suggesting novel and/or opportunistic host-arthropod associations. Plants, omnivores and predators contributed more to nestedness than herbivores. Therefore, Heliconia-arthropod network properties do not appear to be maintained in fragments mainly caused by the decrease of herbivores. Our study contributes to the understanding of the impact of fragmentation on the structure and dynamics of multitrophic arthropod communities associated with a particular plant species of the highly biodiverse tropical forests. Nevertheless, further replication of study sites is needed to strengthen the conclusion that forest fragmentation negatively affects arthropod assemblages. PMID:26731271

  13. The Multiple Impacts of Tropical Forest Fragmentation on Arthropod Biodiversity and on their Patterns of Interactions with Host Plants.

    Benítez-Malvido, Julieta; Dáttilo, Wesley; Martínez-Falcón, Ana Paola; Durán-Barrón, César; Valenzuela, Jorge; López, Sara; Lombera, Rafael

    2016-01-01

    Tropical rain forest fragmentation affects biotic interactions in distinct ways. Little is known, however, about how fragmentation affects animal trophic guilds and their patterns of interactions with host plants. In this study, we analyzed changes in biotic interactions in forest fragments by using a multitrophic approach. For this, we classified arthropods associated with Heliconia aurantiaca herbs into broad trophic guilds (omnivores, herbivores and predators) and assessed the topological structure of intrapopulation plant-arthropod networks in fragments and continuous forests. Habitat type influenced arthropod species abundance, diversity and composition with greater abundance in fragments but greater diversity in continuous forest. According to trophic guilds, coleopteran herbivores were more abundant in continuous forest and overall omnivores in fragments. Continuous forest showed a greater diversity of interactions than fragments. Only in fragments, however, did the arthropod community associated with H aurantiaca show a nested structure, suggesting novel and/or opportunistic host-arthropod associations. Plants, omnivores and predators contributed more to nestedness than herbivores. Therefore, Heliconia-arthropod network properties do not appear to be maintained in fragments mainly caused by the decrease of herbivores. Our study contributes to the understanding of the impact of fragmentation on the structure and dynamics of multitrophic arthropod communities associated with a particular plant species of the highly biodiverse tropical forests. Nevertheless, further replication of study sites is needed to strengthen the conclusion that forest fragmentation negatively affects arthropod assemblages.

  14. Economic impact of new active substance status on EU payers' budgets: example of dimethyl fumarate (Tecfidera(®)) for multiple sclerosis.

    Toumi, Mondher; Jadot, Guy

    2014-01-01

    Recently, collaboration between regulators and payers was set up and was mainly focused on evidence generation along product clinical development. However, neither the regulatory path nor the new active substance status (NASs) was considered. Granting NASs will provide the product with 8 years of data protection and 2 years of market exclusivity during which no generic could enter the market. To review the economic impact (for payers) of NASs granted by the European Medicines Agency (EMA) for dimethyl fumarate (DMF), developed by Biogen and approved for multiple sclerosis (MS) as Tecfidera(®) on 3 February 2014. We reviewed the available DMF-containing products and identified their indication and price through relevant databases and official Web sites. The economic impact of Tecfidera(®) on payers' budgets was calculated assuming NASs was or was not granted. The forecast was identified in Datamonitor. Results identified four products already containing DMF as the main or unique active substance. This would have potentially prevented Tecfidera(®) from being granted NASs. The EMA Committee for Medicinal Products for Human Use (CHMP) denied Tecfidera(®) NASs and, following a company appeal, reversed its position opening as polemic. The impact of that decision has been evaluated at €7 to €10 billion over a 10-year period. NASs is a critical decision because it does have a major budget impact for payers, and it prevents generic competition. Current European Union (EU) regulations on that topic are unclear and open up too many interpretations thus distorting fair trade and affecting payers' bills. Greater clarity and more stringent rules are required to prevent mistrust of this EMA decision.

  15. Ratio of involved/uninvolved immunoglobulin quantification by Hevylite™ assay: clinical and prognostic impact in multiple myeloma

    Koulieris Efstathios

    2012-04-01

    Full Text Available Abstract Background HevyLite™ is a new, recently developed method that facilitates separate quantification of the kappa- and lambda-bounded amounts of a given immunoglobulin (Ig. Using this method, we measured intact immunoglobulin (heavy/light chain; HLC IgG-kappa, IgG-lambda, IgA-kappa, IgA-lambda individually, as well as their deriving ratios (HLCR in a series of IgG or IgA multiple myeloma (MM patients, to investigate and assess the contribution of these tests to disease evaluation. Patients and methods HevyLite™ assays were used in sera from 130 healthy individuals (HI and 103 MM patients, at time of diagnosis. In patients, the level of paraprotein was IgG in 78 (52 IgG-kappa, 26 IgG-lambda and IgΑ in 25 (13 IgΑ-kappa, 12 IgΑ-lambda. Durie-Salmon and International Staging System stages were evenly distributed. Symptomatic patients (n = 77 received treatment while asymptomatic ones (n = 26 were followed. Patients' median follow-up was at 32.6 months. HLCR was calculated with the involved Ig (either G or A as numerator. Results In HI, median IgG-kappa was 6.85, IgG-lambda 3.81, IgA-kappa 1.19 and IgA-lambda 0.98 g/L. The corresponding median involving HLC values in MM patients were 25.8, 23.45, 28.9 and 36.4 g/L. HLC-IgG related to anemia, high serum free light chain ratio and extensive bone marrow infiltration, while high HLCR correlated with the same plus increased β2-microglobulin. In addition, increased HLCR and the presence of immunoparesis correlated with time to treatment. Patients with high HLCR had a significantly shorter survival (p = 0.022; HLCR retained its prognostic value in multivariate analysis. Conclusions HLC and HLCR quantify the precise amount of the involved immunoglobulin more accurately than other methods; moreover, they carry prognostic information regarding survival in MM patients.

  16. Impacts of multiple global environmental changes on African crop yield and water use efficiency: Implications to food and water security

    Pan, S.; Yang, J.; Zhang, J.; Xu, R.; Dangal, S. R. S.; Zhang, B.; Tian, H.

    2016-12-01

    Africa is one of the most vulnerable regions in the world to climate change and climate variability. Much concern has been raised about the impacts of climate and other environmental factors on water resource and food security through the climate-water-food nexus. Understanding the responses of crop yield and water use efficiency to environmental changes is particularly important because Africa is well known for widespread poverty, slow economic growth and agricultural systems particularly sensitive to frequent and persistent droughts. However, the lack of integrated understanding has limited our ability to quantify and predict the potential of Africa's agricultural sustainability and freshwater supply, and to better manage the system for meeting an increasing food demand in a way that is socially and environmentally or ecologically sustainable. By using the Dynamic Land Ecosystem Model (DLEM-AG2) driven by spatially-explicit information on land use, climate and other environmental changes, we have assessed the spatial and temporal patterns of crop yield, evapotranspiration (ET) and water use efficiency across entire Africa in the past 35 years (1980-2015) and the rest of the 21st century (2016-2099). Our preliminary results indicate that African crop yield in the past three decades shows an increasing trend primarily due to cropland expansion (about 50%), elevated atmospheric CO2 concentration, and nitrogen deposition. However, crop yield shows substantially spatial and temporal variation due to inter-annual and inter-decadal climate variability and spatial heterogeneity of environmental drivers. Climate extremes especially droughts and heat wave have largely reduced crop yield in the most vulnerable regions. Our results indicate that N fertilizer could be a major driver to improve food security in Africa. Future climate warming could reduce crop yield and shift cropland distribution. Our study further suggests that improving water use efficiency through land

  17. A comparative study of pelvic floor muscle training in women with multiple sclerosis: its impact on lower urinary tract symptoms and quality of life

    Adélia Correia Lúcio

    2011-01-01

    Full Text Available OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18 and a sham group (n = 17. The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.

  18. Tracking the direct impact of rainfall on groundwater at Mt. Fuji by multiple analyses including microbial DNA

    Sugiyama, Ayumi; Masuda, Suguru; Nagaosa, Kazuyo; Tsujimura, Maki; Kato, Kenji

    2018-02-01

    A total of 2 to 3 million tons of spring water flushes out from the foot of Mt. Fuji, the largest volcanic mountain in Japan. Based on the concept of piston flow transport, residence time of stored groundwater at Mt. Fuji was estimated at ˜ 15-30 years by the 36Cl / Cl ratio (Tosaki et al., 2011). This range, however, represents the average residence time of groundwater that was mixed before it flushed out. To elucidate the route of groundwater in a given system, we determined signatures of direct impacts of rainfall on groundwater, using microbial, stable isotopic (δ18O), and chemical analyses (concentration of silica). Chemical analysis of the groundwater gave an average value of the water, which was already mixed with waters from various sources and routes in the subsurface environment. The microbial analysis suggested locations of water origin and paths. In situ observation during four rainfall events revealed that the stable oxygen isotopic signature obtained from spring water (at 726 m a.s.l., site SP-0 m) and shallow groundwater (at 150 m a.s.l., site GW-42 m), where the average recharge height from rainfall was 1700-1800 m, became greater than values observed prior to a torrential rain producing more than 300 mm of precipitation. The concentration of silica decreased after this event. In addition, the abundance of Bacteria in spring water increased, suggesting the influence of heavy rain. Such changes did not appear when rainfall was less than 100 mm per event. The above findings indicate a rapid flow of rain through the shallow part of the aquifer, which appeared within a few weeks of torrential rain extracting abundant microbes from soil in the studied geologic setting. Interestingly, we found that after the torrential rain, the abundance of Archaea increased in the deep groundwater at site GW-550 m, ˜ 12 km downstream of SP-0 m. However, chemical parameters did not show any change after the event. This suggests that strengthened piston flow caused by

  19. Tracking the direct impact of rainfall on groundwater at Mt. Fuji by multiple analyses including microbial DNA

    A. Sugiyama

    2018-02-01

    Full Text Available A total of 2 to 3 million tons of spring water flushes out from the foot of Mt. Fuji, the largest volcanic mountain in Japan. Based on the concept of piston flow transport, residence time of stored groundwater at Mt. Fuji was estimated at  ∼  15–30 years by the 36Cl ∕ Cl ratio (Tosaki et al., 2011. This range, however, represents the average residence time of groundwater that was mixed before it flushed out. To elucidate the route of groundwater in a given system, we determined signatures of direct impacts of rainfall on groundwater, using microbial, stable isotopic (δ18O, and chemical analyses (concentration of silica. Chemical analysis of the groundwater gave an average value of the water, which was already mixed with waters from various sources and routes in the subsurface environment. The microbial analysis suggested locations of water origin and paths. In situ observation during four rainfall events revealed that the stable oxygen isotopic signature obtained from spring water (at 726 m a.s.l., site SP-0 m and shallow groundwater (at 150 m a.s.l., site GW-42 m, where the average recharge height from rainfall was 1700–1800 m, became greater than values observed prior to a torrential rain producing more than 300 mm of precipitation. The concentration of silica decreased after this event. In addition, the abundance of Bacteria in spring water increased, suggesting the influence of heavy rain. Such changes did not appear when rainfall was less than 100 mm per event. The above findings indicate a rapid flow of rain through the shallow part of the aquifer, which appeared within a few weeks of torrential rain extracting abundant microbes from soil in the studied geologic setting. Interestingly, we found that after the torrential rain, the abundance of Archaea increased in the deep groundwater at site GW-550 m,  ∼  12 km downstream of SP-0 m. However, chemical parameters did not show any change

  20. When Natural Disaster Follows Economic Downturn: The Incremental Impact of Multiple Stressor Events on Trajectories of Depression and Posttraumatic Stress Disorder.

    Mandavia, Amar D; Bonanno, George A

    2018-04-29

    To determine whether there were incremental mental health impacts, specifically on depression trajectories, as a result of the 2008 economic crisis (the Great Recession) and subsequent Hurricane Sandy. Using latent growth mixture modeling and the ORANJ BOWL dataset, we examined prospective trajectories of depression among older adults (mean age, 60.67; SD, 6.86) who were exposed to the 2 events. We also collected community economic and criminal justice data to examine their impact upon depression trajectories. Participants (N=1172) were assessed at 3 times for affect, successful aging, and symptoms of depression. We additionally assessed posttraumatic stress disorder (PTSD) symptomology after Hurricane Sandy. We identified 3 prospective trajectories of depression. The majority (83.6%) had no significant change in depression from before to after these events (resilience), while 7.2% of the sample increased in depression incrementally after each event (incremental depression). A third group (9.2%) went from high to low depression symptomology following the 2 events (depressive-improving). Only those in the incremental depression group had significant PTSD symptoms following Hurricane Sandy. We identified a small group of individuals for whom the experience of multiple stressful events had an incremental negative effect on mental health outcomes. These results highlight the importance of understanding the perseveration of depression symptomology from one event to another. (Disaster Med Public Health Preparedness. 2018;page 1 of 10).

  1. Source apportionment of PM2.5 at multiple Northwest U.S. sites: Assessing regional winter wood smoke impacts from residential wood combustion

    Kotchenruther, Robert A.

    2016-10-01

    Wood smoke from residential wood combustion is a significant source of elevated PM2.5 in many communities across the Northwest U.S. Accurate representation of residential wood combustion in source-oriented regional scale air quality models is challenging because of multiple uncertainties. As an alternative to source-oriented source apportionment, this work provides, through receptor-oriented source apportionment, an assessment of winter residential wood combustion impacts at multiple Northwest U.S. locations. Source apportionment was performed on chemically speciated PM2.5 from 19 monitoring sites using the Positive Matrix Factorization (PMF) receptor model. Each site was modeled independently, but a common data preparation and modeling protocol was used so that results were as comparable as possible across sites. Model solutions had from 4 to 8 PMF factors, depending on the site. PMF factors at each site were associated with a source classification (e.g., primary wood smoke), a dominant chemical composition (e.g., ammonium nitrate), or were some mixture. 15 different sources or chemical compositions were identified as contributing to PM2.5 across the 19 sites. The 6 most common were; aged wood smoke and secondary organic carbon, motor vehicles, primary wood smoke, ammonium nitrate, ammonium sulfate, and fugitive dust. Wood smoke was identified at every site, with both aged and primary wood smoke identified at most sites. Wood smoke contributions to PM2.5 were averaged for the two winter months of December and January, the months when wood smoke in the Northwest U.S. is mainly from residential wood combustion. The total contribution of residential wood combustion, that from primary plus aged smoke, ranged from 11.4% to 92.7% of average December and January PM2.5 depending on the site, with the highest percent contributions occurring in smaller towns that have fewer expected sources of winter PM2.5. Receptor modeling at multiple sites, such as that conducted in this

  2. Multiple educational programs improves glycemic control, quality of life with diminishing the impact of diabetes in poorly controlled type 1 diabetics.

    Vyas, Chintan; Dalal, Lopa; Talaviya, Praful; Saboo, Banshi

    2017-12-01

    The aim of present study was to assess the outcomes of multiple educational programs on glycemic control, quality of life and impact of diabetes in poorly controlled Type 1 Diabetic patients. A 12 months diabetes education programs were conducted every week for first one month then followed by every 3 months with follow up on improvement of HbA1c and QOL in T1D patients (n=54). Clinical characteristics were recorded at baseline visit. The QOL was evaluated by 15 set DQOL questionnaires in 40 consecutive patients at baseline, 3, 6 and 12 months after education programs. The HbA1c level (%) was evaluated at same time point. Decrease in DQOL score was reported as improvement in QOL. The rate of patients response to educational programs was noted 74.07% (n=40) at end of the study (12 months). The prevalence of T1D was reported higher in men than in women. The overall DQOL score and HbA1c% level was significantly (Peducational programs. Patients exhibited greater satisfaction and diminished impact of diabetes after educational programs was observed after 3 months and it was continue up to end of study. The frequencies of self-monitoring of blood glucose were increased. Numbers of hypoglycemic and DKA events were decreased after educational programs when compared to baseline. Results of study revealed that the appropriate education and counseling diminish impact of diabetes, improve QOL and help to achieve desired glycemic (HbA1c) level in poorly control T1D patients. Copyright © 2017. Published by Elsevier Ltd.

  3. Multiple inflation

    Murphy, P.J.

    1987-01-01

    The Theory of Inflation, namely, that at some point the entropy content of the universe was greatly increased, has much promise. It may solve the puzzles of homogeneity and the creation of structure. However, no particle physics model has yet been found that can successfully drive inflation. The difficulty in satisfying the constraint that the isotropy of the microwave background places on the effective potential of prospective models is immense. In this work we have codified the requirements of such models in a most general form. We have carefully calculated the amounts of inflation the various problems of the Standard Model need for their solution. We have derived a completely model independent upper bond on the inflationary Hubble parameter. We have developed a general notation with which to probe the possibilities of Multiple Inflation. We have shown that only in very unlikely circumstances will any evidence of an earlier inflation, survive the de Sitter period of its successor. In particular, it is demonstrated that it is most unlikely that two bouts of inflation will yield high amplitudes of density perturbations on small scales and low amplitudes on large. We conclude that, while multiple inflation will be of great theoretical interest, it is unlikely to have any observational impact

  4. Formation of multiple networks

    Magnani, Matteo; Rossi, Luca

    2013-01-01

    we introduce the first network formation model for multiple networks. Network formation models are among the most popular tools in traditional network studies, because of both their practical and theoretical impact. However, existing models are not sufficient to describe the generation of multiple...

  5. Impact on malaria parasite multiplication rates in infected volunteers of the protein-in-adjuvant vaccine AMA1-C1/Alhydrogel+CPG 7909.

    Christopher J A Duncan

    Full Text Available Inhibition of parasite growth is a major objective of blood-stage malaria vaccines. The in vitro assay of parasite growth inhibitory activity (GIA is widely used as a surrogate marker for malaria vaccine efficacy in the down-selection of candidate blood-stage vaccines. Here we report the first study to examine the relationship between in vivo Plasmodium falciparum growth rates and in vitro GIA in humans experimentally infected with blood-stage malaria.In this phase I/IIa open-label clinical trial five healthy malaria-naive volunteers were immunised with AMA1/C1-Alhydrogel+CPG 7909, and together with three unvaccinated controls were challenged by intravenous inoculation of P. falciparum infected erythrocytes.A significant correlation was observed between parasite multiplication rate in 48 hours (PMR and both vaccine-induced growth-inhibitory activity (Pearson r = -0.93 [95% CI: -1.0, -0.27] P = 0.02 and AMA1 antibody titres in the vaccine group (Pearson r = -0.93 [95% CI: -0.99, -0.25] P = 0.02. However immunisation failed to reduce overall mean PMR in the vaccine group in comparison to the controls (vaccinee 16 fold [95% CI: 12, 22], control 17 fold [CI: 0, 65] P = 0.70. Therefore no impact on pre-patent period was observed (vaccine group median 8.5 days [range 7.5-9], control group median 9 days [range 7-9].Despite the first observation in human experimental malaria infection of a significant association between vaccine-induced in vitro growth inhibitory activity and in vivo parasite multiplication rate, this did not translate into any observable clinically relevant vaccine effect in this small group of volunteers.ClinicalTrials.gov [NCT00984763].

  6. Longitudinal proxy measurements in multiple sclerosis: patient-proxy agreement on the impact of MS on daily life over a period of two years

    Thompson Alan J

    2008-02-01

    Full Text Available Abstract Background The use of self-report measurements in clinical settings is increasing. However, in patients with limitations that interfere with reliable self-assessment such as cognitive impairment or mood disturbances, as may be the case in multiple sclerosis (MS, data collection might be problematic. In these situations, information obtained from proxy respondents (e.g. partners may replace self-ratings. The aim of this study was to examine the value of proxy ratings at separate points in time and to assess patient-proxy agreement on possible changes in disease impact of MS. Methods Fifty-six MS patients and their partners completed the Multiple Sclerosis Impact Scale (MSIS-29 at baseline and follow-up, two years later. Patient-proxy agreement was assessed at both time points by calculating intraclass correlation coefficients (ICCs, exact and global agreement and the mean directional differences between groups. Agreement of change over time was assessed by calculating ICCs between change scores. In parallel, global ratings of both patients and proxy respondents of the extent to which the patient had improved or deteriorated over the past two years were collected to validate possible changes on the MSIS-29. Results At both time points, agreement on the physical scale was higher than agreement on the psychological scale (ICCs at baseline were 0.81 for the physical scale and 0.72 for the psychological scale; at follow-up, the ICC values were 0.86 and 0.65 respectively. At follow-up, statistically significant mean differences between patients and proxies were noted for the physical scale (-4.8 ± 12.7, p = 0.006 and the psychological scale (-8.9 ± 18.8, p = 0.001. Agreement between change scores on the MSIS-29 was fair (ICC Conclusion Proxy respondents could act as a reliable source of information in cross-sectional studies. Moreover, results suggested that agreement on change over time might be better for proxy respondents compared to

  7. Multiple Perspectives / Multiple Readings

    Simon Biggs

    2005-01-01

    Full Text Available People experience things from their own physical point of view. What they see is usually a function of where they are and what physical attitude they adopt relative to the subject. With augmented vision (periscopes, mirrors, remote cameras, etc we are able to see things from places where we are not present. With time-shifting technologies, such as the video recorder, we can also see things from the past; a time and a place we may never have visited.In recent artistic work I have been exploring the implications of digital technology, interactivity and internet connectivity that allow people to not so much space/time-shift their visual experience of things but rather see what happens when everybody is simultaneously able to see what everybody else can see. This is extrapolated through the remote networking of sites that are actual installation spaces; where the physical movements of viewers in the space generate multiple perspectives, linked to other similar sites at remote locations or to other viewers entering the shared data-space through a web based version of the work.This text explores the processes involved in such a practice and reflects on related questions regarding the non-singularity of being and the sense of self as linked to time and place.

  8. "Cross-Cultural Adaptation Of The Multiple Sclerosis Impact Scale (MSIS-29 For Iranian MS Patients, Evaluation Of Reliability And Validity "

    P. Ayatollahi

    2006-05-01

    Full Text Available Background and Aim: Measuring the outcome of chronic diseases such as multiple sclerosis is an important factor in assessment of disease impact on different dimensions of quality of life and in evaluation of therapeutic interventions. The aim of this study was to perform the cross-cultural adaptation of the MSIS-29 which is a MS-specific outcome measure for Iranian patients. Materials and Methods: The Iranian adaptation process of the MSIS-29 included 5 steps. To evaluate psychometric properties of the translated version, the questionnaire was administered to a consecutive sample of 96 patients with clinically definite MS referred to our out-patient clinic. Test-retest reliability was assessed in a sub-sample consisted of 30 patients. These patients completed the questionnaire on two occasions separated by a 7-day interval. The Iranian version of the SF-36 was also administered to this sub-sample in order to evaluate the validity of translated MSIS-29. Results: Statistical analysis indicated that the Persian version of the MSIS-29 had high internal consistency (cronbach’s alpha coefficients > 0.70 and test-retest reliability (intra-class correlation coefficients >0.70 and a good validity. Conclusion: The Persian version of the MSIS-29 is a reliable and valid instrument for measuring MS outcome in Iranian patients. It can be used in clinical trials and cross-sectional studies.

  9. Impact of induction treatment before autologous stem cell transplantation on long-term outcome in patients with newly diagnosed multiple myeloma.

    Gassiot, Susanna; Motlló, Cristina; Llombart, Inuska; Morgades, Mireia; González, Yolanda; Garcia-Caro, Montse; Ribera, Josep-Maria; Oriol, Albert

    2017-06-01

    Clinical trials for patients with multiple myeloma (MM) using novel agent (NA)-based regimens before autologous stem cell transplantation (SCT) have shown improvement in response rates and progression-free survival (PFS); however they have failed to identify a significant overall survival (OS) benefit. The aim of this study was to analyze the potential impact of initial induction on the feasibility and outcome of subsequent treatment lines in a real clinical practice setting. Patients with consecutive MM <70 years of age diagnosed between 1999 and 2009 were prospectively registered and classified as having received conventional chemotherapy induction regimens with new agents available at relapse (CC cohort, 89 patients) or as treated with NAs upfront (NA cohort, 65 patients). Patients in the NA cohort demonstrated a superior median PFS (2.8 years vs 1.6 years, P=.03) and also a median PFS from diagnosis to second progression (5.2 years vs 2.7 years, P=.003). After a median follow-up of 7 years, clear differences in OS were observed (7.97 years in NA cohort compared to 3.35 years in CC cohort, P<.001). New agent-based first-line induction treatments provide benefits in both PFS and beyond that point, contributing to a significant improvement in OS. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Parsing multiple processes of high temperature impacts on corn/soybean yield using a newly developed CLM-APSIM modeling framework

    Peng, B.; Guan, K.; Chen, M.

    2016-12-01

    Future agricultural production faces a grand challenge of higher temperature under climate change. There are multiple physiological or metabolic processes of how high temperature affects crop yield. Specifically, we consider the following major processes: (1) direct temperature effects on photosynthesis and respiration; (2) speed-up growth rate and the shortening of growing season; (3) heat stress during reproductive stage (flowering and grain-filling); (4) high-temperature induced increase of atmospheric water demands. In this work, we use a newly developed modeling framework (CLM-APSIM) to simulate the corn and soybean growth and explicitly parse the above four processes. By combining the strength of CLM in modeling surface biophysical (e.g., hydrology and energy balance) and biogeochemical (e.g., photosynthesis and carbon-nitrogen interactions), as well as that of APSIM in modeling crop phenology and reproductive stress, the newly developed CLM-APSIM modeling framework enables us to diagnose the impacts of high temperature stress through different processes at various crop phenology stages. Ground measurements from the advanced SoyFACE facility at University of Illinois is used here to calibrate, validate, and improve the CLM-APSIM modeling framework at the site level. We finally use the CLM-APSIM modeling framework to project crop yield for the whole US Corn Belt under different climate scenarios.

  11. Randomized Controlled Trial to Examine the Impact of Aquatic Exercise Training on Functional Capacity, Balance, and Perceptions of Fatigue in Female Patients With Multiple Sclerosis.

    Kargarfard, Mehdi; Shariat, Ardalan; Ingle, Lee; Cleland, Joshua A; Kargarfard, Mina

    2018-02-01

    To assess the effects of an 8-week aquatic exercise training program on functional capacity, balance, and perceptions of fatigue in women with multiple sclerosis (MS). Randomized controlled design. Referral center of an MS society. Women (N=32; mean age ± SD, 36.4±8.2y) with diagnosed relapsing-remitting MS. After undergoing baseline testing by a neurologist, participants were allocated to either an intervention (aquatic training program, n=17) or a control group (n=15). The intervention consisted of an 8-week aquatic training program (3 supervised training sessions per week; session duration, 45-60min; 50%-75% estimated maximum heart rate). Six-minute walk test (6-MWT), balance (Berg Balance Scale [BBS]), and perceptions of fatigue (Modified Fatigue Impact Scale; [MFIS]) at baseline and after the 8-week intervention. Differences over time between the experimental and control groups were assessed by a 2×2 (group by time) repeated-measures analysis of variance. Thirty-two women completed the 8-week aquatic training intervention (experimental group, n=17; control group, n=15). All outcome measures improved in the experimental group: 6-MWT performance (pretest mean ± SD, 451±58m; posttest mean ± SD, 503±57m; Ptraining improved functional capacity, balance, and perceptions of fatigue in women with MS. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. Impacts

    Hellmuth, M.; Kabat, P.

    2003-01-01

    Even without the impacts of climate change, water managers face prodigious challenges in meeting sustainable development goals. Growing populations need affordable food, water and energy. Industrial development demands a growing share of water resources and contaminates those same resources with its

  13. IMPACTS !

    2008-01-01

    (Photo courtesy of Don Davis / NASA)The University of Geneva (UNIGE) and the Ecole Polytechnique Fédérale of Lausanne (EPFL) are organising the 4th series of public lectures on astronomy, on the theme of "Impacts". The schedule is as follows: Il y a 100 ans : une explosion dans la Tunguska – Dr. Frédéric COURBIN, EPFL Les impacts sur Terre – Prof. Didier Queloz, UNIGE La fin des dinosaures – Dr. Stéphane Paltani, UNIGE Wednesday 7 May 2008, from 7.00 p.m. to 9.00 p.m. Auditoire CO1, EPFL, Ecublens Thursday 08 May 2008, from 7.00 p.m. to 9.00 p.m. Auditoire Rouiller, Uni-Dufour, Genève All 3 lectures will be givent each evening! Admission free Information: 022 379 22 00

  14. Multiple sclerosis

    ... indwelling catheter Osteoporosis or thinning of the bones Pressure sores Side effects of medicines used to treat the ... Daily bowel care program Multiple sclerosis - discharge Preventing pressure ulcers Swallowing problems Images Multiple sclerosis MRI of the ...

  15. Investigation of Dysphagia After Antireflux Surgery by High-resolution Manometry: Impact of Multiple Water Swallows and a Solid Test Meal on Diagnosis, Management, and Clinical Outcome.

    Wang, Yu Tien; Tai, Ling Fung; Yazaki, Etsuro; Jafari, Jafar; Sweis, Rami; Tucker, Emily; Knowles, Kevin; Wright, Jeff; Ahmad, Saqib; Kasi, Madhavi; Hamlett, Katharine; Fox, Mark R; Sifrim, Daniel

    2015-09-01

    Management of patients with dysphagia, regurgitation, and related symptoms after antireflux surgery is challenging. This prospective, case-control study tested the hypothesis that compared with standard high-resolution manometry (HRM) with single water swallows (SWS), adding multiple water swallows (MWS) and a solid test meal increases diagnostic yield and clinical impact of physiological investigations. Fifty-seven symptomatic and 12 asymptomatic patients underwent HRM with SWS, MWS, and a solid test meal. Dysphagia and reflux were assessed by validated questionnaires. Diagnostic yield of standard and full HRM studies with 24-hour pH-impedance monitoring was compared. Pneumatic dilatation was performed for outlet obstruction on HRM studies. Clinical outcome was assessed by questionnaires and an analogue scale with "satisfactory" defined as at least 40% symptom improvement requiring no further treatment. Postoperative esophagogastric junction pressure was similar in all groups. Abnormal esophagogastric junction morphology (double high pressure band) was more common in symptomatic than in control patients (13 of 57 vs 0 of 12, P = .004). Diagnostic yield of HRM was 11 (19%), 11 (19%), and 33 of 57 (58%), with SWS, MWS, and solids, respectively (P dysphagia (19 of 27, 70%). Outlet obstruction was present in 4 (7%), 11 (19%), and 15 of 57 patients (26%) with SWS, MWS, and solids, respectively (P < .009). No asymptomatic control had clinically relevant dysfunction on solid swallows. Dilatation was performed in 12 of 15 patients with outlet obstruction during the test meal. Symptom response was satisfactory, good, or excellent in 7 of 12 (58%) with no serious complications. The addition of MWS and a solid test meal increases the diagnostic yield of HRM studies in patients with symptoms after fundoplication and identifies additional patients with outlet obstruction who benefit from endoscopic dilatation. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All

  16. Impact of initial FDG-PET/CT and serum-free light chain on transformation of conventionally defined solitary plasmacytoma to multiple myeloma.

    Fouquet, Guillemette; Guidez, Stéphanie; Herbaux, Charles; Van de Wyngaert, Zoé; Bonnet, Sarah; Beauvais, David; Demarquette, Hélène; Adib, Salim; Hivert, Bénédicte; Wemeau, Mathieu; Berthon, Céline; Terriou, Louis; Coiteux, Valérie; Macro, Margaret; Decaux, Olivier; Facon, Thierry; Huglo, Damien; Leleu, Xavier

    2014-06-15

    Solitary plasmacytoma (SP) is a localized proliferation of monoclonal plasma cells in either bone or soft tissue, without evidence of multiple myeloma (MM), and whose prognosis is marked by a high risk of transformation to MM. We studied the impact of FDG-PET/CT (2[18F]fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography) on the risk of transformation of SP to overt MM among other markers in a series of 43 patients diagnosed with SP. Median age was 57.5 years; 48% of patients had an abnormal involved serum-free light chain (sFLC) value, and 64% had an abnormal sFLC ratio at diagnosis. Thirty-three percent had two or more hypermetabolic lesions on initial PET/CT, and 20% had two or more focal lesions on initial MRI. With a median follow-up of 50 months, 14 patients transformed to MM with a median time (TTMM) of 71 months. The risk factors that significantly shortened TTMM at diagnosis were two or more hypermetabolic lesions on PET/CT, abnormal sFLC ratio and involved sFLC, and to a lesser extent at completion of treatment, absence of normalized involved sFLC and PET/CT or MRI. In a multivariate analysis, abnormal initial involved sFLC [OR = 10; 95% confidence interval (CI), 1-87; P = 0.008] and PET/CT (OR = 5; 95% CI, 0-9; P = 0.032) independently shortened TTMM. An abnormal involved sFLC value and the presence of at least two hypermetabolic lesions on PET/CT at diagnosis of SP were the two predictors of early evolution to myeloma in our series. This data analysis will need confirmation in a larger study, and the study of these two risk factors may lead to a different management of patients with SP in the future. . ©2014 American Association for Cancer Research.

  17. Potential impact of the implementation of multiple-criteria decision analysis (MCDA) on the Polish pricing and reimbursement process of orphan drugs.

    Kolasa, Katarzyna; Zwolinski, Krzysztof M; Kalo, Zoltan; Hermanowski, Tomasz

    2016-03-10

    The objective of this study was to assess the potential impact of the implementation of multiple-criteria decision analysis (MCDA) on the Polish pricing and reimbursement (P&R) process with regard to orphan drugs. A four step approach was designed. Firstly, a systematic literature review was conducted to select the MCDA criteria. Secondly, a database of orphan drugs was established. Thirdly, health technology appraisals (HTA recommendations) were categorized and an MCDA appraisal was conducted. Finally, a comparison of HTA and MCDA outcomes was carried out. An MCDA outcome was considered positive if more than 50% of the maximum number of points was reached (base case). In the sensitivity analysis, 25% and 75% thresholds were tested as well. Out of 2242 publications, 23 full-text articles were included. The final MCDA tool consisted of ten criteria. In total, 27 distinctive drug-indication pairs regarding 21 drugs were used for the study. Six negative and 21 positive HTA recommendations were issued. In the base case, there were 19 positive MCDA outcomes. Of the 27 cases, there were 12 disagreements between the HTA and MCDA outcomes, the majority of which related to positive HTA guidance for negative MCDA outcomes. All drug-indication pairs with negative HTA recommendations were appraised positively in the MCDA framework. Economic details were available for 12 cases, of which there were 9 positive MCDA outcomes. Amongst the 12 drug-indication pairs, two were negatively appraised in the HTA process, with positive MCDA guidance, and two were appraised in the opposite direction. An MCDA approach may lead to different P&R outcomes compared to a standard HTA process. On the one hand, enrichment of the list of decision making criteria means further scrutiny of a given health technology and as such increases the odds of a negative P&R outcome. On the other hand, it may uncover additional values and as such increase the odds of positive P&R outcomes.

  18. MULTIPLE OBJECTS

    A. A. Bosov

    2015-04-01

    Full Text Available Purpose. The development of complicated techniques of production and management processes, information systems, computer science, applied objects of systems theory and others requires improvement of mathematical methods, new approaches for researches of application systems. And the variety and diversity of subject systems makes necessary the development of a model that generalizes the classical sets and their development – sets of sets. Multiple objects unlike sets are constructed by multiple structures and represented by the structure and content. The aim of the work is the analysis of multiple structures, generating multiple objects, the further development of operations on these objects in application systems. Methodology. To achieve the objectives of the researches, the structure of multiple objects represents as constructive trio, consisting of media, signatures and axiomatic. Multiple object is determined by the structure and content, as well as represented by hybrid superposition, composed of sets, multi-sets, ordered sets (lists and heterogeneous sets (sequences, corteges. Findings. In this paper we study the properties and characteristics of the components of hybrid multiple objects of complex systems, proposed assessments of their complexity, shown the rules of internal and external operations on objects of implementation. We introduce the relation of arbitrary order over multiple objects, we define the description of functions and display on objects of multiple structures. Originality.In this paper we consider the development of multiple structures, generating multiple objects.Practical value. The transition from the abstract to the subject of multiple structures requires the transformation of the system and multiple objects. Transformation involves three successive stages: specification (binding to the domain, interpretation (multiple sites and particularization (goals. The proposed describe systems approach based on hybrid sets

  19. Estimating the Economic Impact of Adding Panobinostat to a U.S. Formulary for Relapsed and/or Refractory Multiple Myeloma: A Budget Impact and Cost-Benefit Model.

    Bloudek, Lisa; Roy, Anuja; Kish, Jonathan K; Siegel, David S; Jagannath, Sundar; Globe, Denise; Orloski, Laurie; Kuriakose, Emil T

    2016-08-01

    Multiple myeloma is an incurable B-cell malignancy with a natural history that involves alternating periods of remission and subsequent relapse. For relapsed and/or refractory multiple myeloma (RRMM), the typical patient currently receives more lines of therapy than has been feasible in the past, translating into longer progression-free survival (PFS). Consequently, cost issues have become more prominent because patients may be offered newer and more expensive therapies during a more prolonged overall treatment course. To estimate the economic impact of adding panobinostat to a U.S. health plan formulary as a treatment option with bortezomib and dexamethasone for patients with RRMM previously treated with a proteasome inhibitor (PI) and immunomodulatory drug (IMiD), using a budget impact and cost-benefit model. Total costs of commonly used salvage therapy regimens were combined with market share data and population prevalence estimates of RRMM to yield the total cost of treatment, from the perspective of a U.S. third-party payer (commercial or Medicare) with a time horizon of 1 year. Comparator treatment regimens included bortezomib-dexamethasone, lenalidomide-dexamethasone, lenalidomide-bortezomib-dexamethasone, carfilzomib monotherapy, carfilzomib-lenalidomide-dexamethasone, and pomalidomide-dexamethasone. Costs (2015 U.S. dollars) included drug costs for oral oncology agents, medical and administration costs for injectable oncology agents, costs of adverse event (AE) prophylaxis and monitoring, and costs of grade 3/4 AEs. In a hypothetical health plan with 1 million members, the annual number of RRMM patients with previous PI and IMiD treatments was estimated at 16 and 118 for a commercial and Medicare plan, respectively. Introduction of panobinostat as part of the panobinostat-bortezomib-dexamethasone regimen was not expected to result in a substantial budget impact to either commercial or Medicare plans, with an incremental cost money. Funding for this study

  20. The Impact of Science Integrated Curriculum Supplements on Early Childhood Teachers' Attitudes and Beliefs towards Science while In-Service: A Multiple Case

    Collins, Kellian L.

    Science at the early childhood level has been rarely taught as a single subject or integrated into the curriculum. One reason why early childhood educators avoid teaching science are their attitudes, beliefs, and lack of understanding scientific concepts as presented in traditional science curriculums. The intervention used by researchers for improving beliefs and attitudes in K-6 pre-service teachers towards teaching science in early childhood has been science method courses. For in service teachers, the intervention has been professional development workshops, seminars, and symposiums. Though these interventions have had a positive impact on teachers' attitudes and beliefs toward teaching science, the interventions have not necessarily guaranteed more science being taught in the preschool classroom. The specific problem investigated for this study was how to improve the interventions designed to improve preschool teachers' attitudes and beliefs so that they would feel more confident in teaching science to young children. The purpose of this study was to examine how implementing a one-week science integrated curriculum supplement could be an effective tool for improving preschool teachers' attitudes and beliefs toward teaching science. This study utilized the qualitative multiple case study research method. A logical model was created based on negative teacher attitudes and beliefs attributes that were the core components of the Preschool Teachers' Attitudes and Beliefs toward Science teaching (P-TABS) questionnaire. The negative attributes were paired with positive interventions and encapsulated in a one-week science integrated curriculum supplement based on the factors of teacher comfort, child benefit and challenges. The primary source of evidence for this study was the semi-structured interview. The researcher contacted 24 early childhood facilities, 44 emails were sent to preschool teachers, four teachers agreed to participate in the study. The results of the

  1. IMPACT OF PRETRANSPLANT DONOR AND RECIPIENT CYTOMEGALOVIRUS SEROSTATUS ON OUTCOME FOR MULTIPLE MYELOMA PATIENTS UNDERGOING REDUCED INTENSITY CONDITIONING ALLOGENEIC STEM CELL TRANSPLANTATION.

    Jean Elcheikh

    2013-04-01

    Full Text Available To investigate the impact of pre-transplant CMV serostatus of donor or recipient on outcome of patients undergoing allogeneic hematopoietic stem cell transplantation (Allo-SCT for Multiple Myeloma (MM. To our knowledge no data are available in the literature about this issue. We retrospectively followed 99 consecutive patients who underwent reduced-intensity conditioning (RIC Allo-SCT for MM in our cancer centre at Marseille between January 2000 and January 2012. Based upon CMV serostatus, patients were classified as low risk (donor [D]-/recipient [R]- 17 patients (17.1%, intermediate risk (D+/R 14 patients (14.1%, or high risk – either (D-/R+ 31 patients (31.3% or (D+/R+, 37 patients (37.3%. Cumulative incidence of CMV reactivation was 39% with a median time of 61 days (26–318. Three patients (3% developed CMV disease. Two factors were associated with CMV reactivation: CMV serostatus group (low: 0% vs intermediate: 29% vs high: 50%; p=0.001 and the presence of grade II–IV acute GvHD (Hazard Ratio: HR=2.1 [1.1–3.9]. Thirty-six of the 39 patients (92% with CMV reactivation did not present positive detection of CMV after a 21-day median duration preemptive treatment with ganciclovir. Cumulative incidence of day 100 grade II–IV acute GvHD, 1-year chronic GvHD and day 100 transplantation related mortality (TRM were 37%, 36% and 9%, respectively. CMV reactivation and serostatus were not associated with increased GvHD and TRM or short survival. Only the presence of acute GvHD as a time dependent variable was significantly associated with increased TRM (p=0.005. Two-year overall and progression free survival were 56% and 34%, respectively. Donor and recipient CMV serostatus and acute GvHD are independent factors for increased CMV reactivation in high-risk MM patients undergoing RIC Allo-SCT. However, we did not find any influence of CMV reactivation on post transplantation outcome. CMV monitoring and pre-emptive treatment strategy could in

  2. Impact of pretransplant donor and recipient cytomegalovirus serostatus on outcome for multiple myeloma patients undergoing reduced intensity conditioning allogeneic stem cell transplantation.

    El-Cheikh, Jean; Devillier, Raynier; Crocchiolo, Roberto; Fürst, Sabine; Calmels, Boris; Faucher, Catherine; Stoppa, Anne Marie; Granata, Angela; Castagna, Luca; Ladaique, Patrick; Lemarie, Claude; Bouabdallah, Reda; Zandotti, Christine; Merlin, Michele; Berger, Pierre; Chabannon, Christian; Blaise, Didier

    2013-01-01

    Scope of the study was to investigate the impact of pre-transplant CMV serostatus of the donor and/or recipient on the outcome of patients undergoing allogeneic hematopoietic stem cell transplantation (Allo-SCT) for Multiple Myeloma (MM). To our knowledge no data are available in the literature about this issue. We retrospectively followed 99 consecutive patients who underwent reduced-intensity conditioning (RIC) Allo-SCT for MM in our cancer center at Marseille between January 2000 and January 2012. Based upon CMV serostatus, patients were classified as low risk (donor [D]-/recipient [R] -) 17 patients (17.1%), intermediate risk (D+/R) 14 patients (14.1%), or high risk - either (D-/R+) 31 patients (31.3%) or (D+/R+), 37 patients (37.3%). Cumulative incidence of CMV reactivation was 39% with a median time of 61 days (26-318). Three patients (3%) developed CMV disease. Two factors were associated with CMV reactivation: CMV serostatus group (low: 0% vs. intermediate: 29% vs. high: 50%; p=0.001) and the presence of grade II-IV acute GvHD (Hazard Ratio: HR=2.1 [1.1-3.9]). Thirty-six of the 39 patients (92%) with CMV reactivation did not present positive detection of CMV after a 21-day median duration preemptive treatment with ganciclovir. Cumulative incidence of day 100 grade II-IV acute GvHD, 1-year chronic GvHD and day 100 transplantation related mortality (TRM) were 37%, 36% and 9%, respectively. CMV reactivation and serostatus were not associated with increased GvHD and TRM or short survival. Only the presence of acute GvHD as a time dependent variable was significantly associated with increased TRM (p=0.005). Two-year overall and progression free survival were 56% and 34%, respectively. Donor and recipient CMV serostatus and acute GvHD are independent factors for increased CMV reactivation in high-risk MM patients undergoing RIC Allo-SCT. However, we did not find any influence of CMV reactivation on post transplantation outcome. CMV monitoring and pre

  3. Impact of a population based intervention to increase the adoption of multiple physical activity practices in centre based childcare services: a quasi experimental, effectiveness study

    Finch Meghan

    2012-08-01

    Full Text Available Abstract Background There is considerable scope to improve the delivery of practices that increase the physical activity of children in centre based childcare services. Few studies have reported the effectiveness of interventions to address this, particularly at a population level. The primary aim of this study was to describe the impact of an intervention to increase the adoption of multiple policies and practices to promote physical activity in centre based childcare services. Methods A quasi experimental study was conducted in centre based childcare services (n =228 in New South Wales (NSW, Australia and involved a three month intervention to increase the adoption of eight practices within childcare services that have been suggested to promote child physical activity. Intervention strategies to support the adoption of practices included staff training, resources, incentives, follow-up support and performance monitoring and feedback. Randomly selected childcare services in the remainder of NSW acted as a comparison group (n = 164 and did not receive the intervention but may have been exposed to a concurrent NSW government healthy eating and physical activity initiative. Self reported information on physical activity policies, fundamental movement skills sessions, structured physical activity opportunities, staff involvement in active play and provision of verbal prompts to encourage physical activity, small screen recreation opportunities, sedentary time, and staff trained in physical activity were collected by telephone survey with childcare service managers at baseline and 18 months later. Results Compared with the comparison area, the study found significantly greater increases in the prevalence of intervention services with a written physical activity policy, with policy referring to placing limits on small screen recreation, and with staff trained in physical activity. In addition, non-significant trends towards a greater increase in the

  4. Análisis tridimensional del proceso de granallado utilizando un modelo de múltiples impactos. // 3d shot peening process analysis using multiple impacts model.

    M. A. Calle Gonzales

    2006-05-01

    son comparados con resultados experimentales disponibles en la literatura especializada ypresentados en forma de gráficos y tablas.Palabras claves: Granallado, tensión residual, elementos finitos, modelación.____________________________________________________________________________Abstract.The shot peening is one of the most used superficial treatments for, amongst other applications, providing a considerableincrease of the fatigue life elements of machines and structures submitted to cyclic loads. The control of parameters, suchas, the depth of the plastic zone, residual stresses level, among others, is of vital importance to guarantee the adequateapplication of the treatment. To simulate the shot peening process, using the Finite Elements Method, a three-dimensionalrepresentative cell model of the treated part surface is created and submitted to the multiple impact shots. The modelevaluates the compression residual stresses field in different regions of the cell surface, due to the impact shots, in order tofind the best representation through out the cell. The representative profile evaluation is important, since it is responsiblefor the improvement of the mechanical properties of the component. The results reveal additionally, in an implicit way, theeffect of the shot peening process covering, in the behavior of the residual stress profile, which is also commented in thework. The results are compared with experimental results available in the specialized literature and presented in form ofgraphs and tables.Keyword: Shot peening, residual stress, finite elements, modeling.

  5. Multiple sclerosis

    Grunwald, I.Q.; Kuehn, A.L.; Backens, M.; Papanagiotou, P.; Shariat, K.; Kostopoulos, P.

    2008-01-01

    Multiple sclerosis is the most common chronic inflammatory disease of myelin with interspersed lesions in the white matter of the central nervous system. Magnetic resonance imaging (MRI) plays a key role in the diagnosis and monitoring of white matter diseases. This article focuses on key findings in multiple sclerosis as detected by MRI. (orig.) [de

  6. Immunohistochemical Estimates of Angiogenesis, Proliferative Activity, p53 Expression, and Multiple Drug Resistance Have No Prognostic Impact in Osteosarcoma: A Comparative Clinicopathological Investigation

    Sørensen, Flemming Brandt; Jensen, Kenneth; Vaeth, Michael

    2008-01-01

    Purpose. To investigate angiogenesis, multiple drug resistance (MDR) and proliferative activity as prognostic variables in patients suffering from osteosarcoma. Methods. Histologic biopsies from 117 patients treated in the period from 1972 through 1999 were immunohistologically investigated...

  7. The Impact of Five VDR Polymorphisms on Multiple Sclerosis Risk and Progression: a Case-Control and Genotype-Phenotype Study.

    Křenek, Pavel; Benešová, Yvonne; Bienertová-Vašků, Julie; Vašků, Anna

    2018-04-01

    Vitamin D receptor polymorphisms have been the target of many studies focusing on multiple sclerosis. However, previously reported results have been inconclusive. The objective of this study was to investigate the association between five vitamin D receptor polymorphisms (EcoRV, FokI, ApaI, TaqI, and BsmI) and multiple sclerosis susceptibility and its course. The study was carried out as a case-control and genotype-phenotype study, consisted of 296 Czech multiple sclerosis patients and 135 healthy controls. Genotyping was carried out using polymerase chain reaction and restriction analysis. In multiple sclerosis men, allele and/or genotype distributions differed in EcoRV, TaqI, BsmI, and ApaI polymorphisms as compared to controls (EcoRV, p a = 0.02; Taq, p g = 0.02, p a = 0.02; BsmI, p g = 0.02, p a = 0.04; ApaI, p g = 0.008, p a = 0.005). In multiple sclerosis women, differences in the frequency of alleles and genotypes were found to be significant in ApaI (controls vs multiple sclerosis women: p g = 0.01, p a = 0.05). Conclusive results were observed between multiple sclerosis women in the case of EcoRV [differences in Expanded Disability Status Scale (p = 0.05); CT genotype was found to increase the risk of primary progressive multiple sclerosis 5.5 times (CT vs CC+TT p corr = 0.01, sensitivity 0.833, specificity 0.525, power test 0.823)] and FokI [borderline difference in Multiple Sclerosis Severity Score (p = 0.05)]. Our results indicate that the distribution of investigated vitamin D receptor polymorphisms is a risk factor for multiple sclerosis susceptibility and progression in the Czech population. The association between disease risk and polymorphisms was found to be stronger in men. The association of disease progression with polymorphisms was observed only in women.

  8. Multiple homicides.

    Copeland, A R

    1989-09-01

    A study of multiple homicides or multiple deaths involving a solitary incident of violence by another individual was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during 1983-1987. A total of 107 multiple homicides were studied: 88 double, 17 triple, one quadruple, and one quintuple. The 236 victims were analyzed regarding age, race, sex, cause of death, toxicologic data, perpetrator, locale of the incident, and reason for the incident. This article compares this type of slaying with other types of homicide including those perpetrated by serial killers. Suggestions for future research in this field are offered.

  9. Multiple Sclerosis

    Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down ...

  10. Multiple myeloma.

    Collins, Conor D

    2012-02-01

    Advances in the imaging and treatment of multiple myeloma have occurred over the past decade. This article summarises the current status and highlights how an understanding of both is necessary for optimum management.

  11. Multiple mononeuropathy

    ... with multiple mononeuropathy are prone to new nerve injuries at pressure points such as the knees and elbows. They should avoid putting pressure on these areas, for example, by not leaning on the elbows, crossing the knees, ...

  12. Impact of flash glucose monitoring on hypoglycaemia in adults with type 1 diabetes managed with multiple daily injection therapy: a pre-specified subgroup analysis of the IMPACT randomised controlled trial.

    Oskarsson, Per; Antuna, Ramiro; Geelhoed-Duijvestijn, Petronella; Krӧger, Jens; Weitgasser, Raimund; Bolinder, Jan

    2018-03-01

    Evidence for the effectiveness of interstitial glucose monitoring in individuals with type 1 diabetes using multiple daily injection (MDI) therapy is limited. In this pre-specified subgroup analysis of the Novel Glucose-Sensing Technology and Hypoglycemia in Type 1 Diabetes: a Multicentre, Non-masked, Randomised Controlled Trial' (IMPACT), we assessed the impact of flash glucose technology on hypoglycaemia compared with capillary glucose monitoring. This multicentre, prospective, non-masked, RCT enrolled adults from 23 European diabetes centres. Individuals were eligible to participate if they had well-controlled type 1 diabetes (diagnosed for ≥5 years), HbA 1c ≤ 58 mmol/mol [7.5%], were using MDI therapy and on their current insulin regimen for ≥3 months, reported self-monitoring of blood glucose on a regular basis (equivalent to ≥3 times/day) for ≥2 months and were deemed technically capable of using flash glucose technology. Individuals were excluded if they were diagnosed with hypoglycaemia unawareness, had diabetic ketoacidosis or myocardial infarction in the preceding 6 months, had a known allergy to medical-grade adhesives, used continuous glucose monitoring (CGM) within the previous 4 months or were currently using CGM or sensor-augmented pump therapy, were pregnant or planning pregnancy or were receiving steroid therapy for any disorders. Following 2 weeks of blinded (to participants and investigator) sensor wear by all participants, participants with sensor data for more than 50% of the blinded wear period (or ≥650 individual sensor results) were randomly assigned, in a 1:1 ratio by a central interactive web response system (IWRS) using the biased-coin minimisation method, to flash sensor-based glucose monitoring (intervention group) or self-monitoring of capillary blood glucose (control group). The control group had two further 14 day blinded sensor-wear periods at the 3 and 6 month time points. Participants, investigators and

  13. Stereotactic body radiotherapy (SBRT) for multiple pulmonary oligometastases: Analysis of number and timing of repeat SBRT as impact factors on treatment safety and efficacy.

    Klement, R J; Hoerner-Rieber, J; Adebahr, S; Andratschke, N; Blanck, O; Boda-Heggemann, J; Duma, M; Eble, M J; Eich, H C; Flentje, M; Gerum, S; Hass, P; Henkenberens, C; Hildebrandt, G; Imhoff, D; Kahl, K H; Klass, N D; Krempien, R; Lohaus, F; Petersen, C; Schrade, E; Wendt, T G; Wittig, A; Guckenberger, M

    2018-03-03

    Stereotactic body radiotherapy (SBRT) for oligometastatic disease is characterized by an excellent safety profile; however, experiences are mostly based on treatment of one single metastasis. It was the aim of this study to evaluate safety and efficacy of SBRT for multiple pulmonary metastases. This study is based on a retrospective database of the DEGRO stereotactic working group, consisting of 637 patients with 858 treatments. Cox regression and logistic regression were used to analyze the association between the number of SBRT treatments or the number and the timing of repeat SBRT courses with overall survival (OS) and the risk of early death. Out of 637 patients, 145 patients were treated for multiple pulmonary metastases; 88 patients received all SBRT treatments within one month whereas 57 patients were treated with repeat SBRT separated by at least one month. Median OS for the total patient population was 23.5 months and OS was not significantly influenced by the overall number of SBRT treatments or the number and timing of repeat SBRT courses. The risk of early death within 3 and 6 months was not increased in patients treated with multiple SBRT treatments, and no grade 4 or grade 5 toxicity was observed in these patients. In appropriately selected patients, synchronous SBRT for multiple pulmonary oligometastases and repeat SBRT may have a comparable safety and efficacy profile compared to SBRT for one single oligometastasis. Copyright © 2018 Elsevier B.V. All rights reserved.

  14. Longitudinal proxy measurements in multiple sclerosis: patient-proxy agreement on the impact of MS on daily life over a period of two years

    van der Linden, F.A.H.; Kragt, J.J.; van Bon, M.; Klein, M.; Thompson, A.J.; van der Ploeg, H.M.; Polman, C.H.; Uitdehaag, B.M.J.

    2008-01-01

    Background: The use of self-report measurements in clinical settings is increasing. However, in patients with limitations that interfere with reliable self-assessment such as cognitive impairment or mood disturbances, as may be the case in multiple sclerosis (MS), data collection might be

  15. Assessing the impact of groundwater contamination on stream water quality by multiple approaches at the groundwater-surface water interface (Invited Presentation)

    Bjerg, Poul Løgstrup; Rønde, Vinni Kampman; Balbarini, Nicola

    Contaminants such as chlorinated solvents and pesticides, as well as new classes of compounds or emerging micropollutants are extensively produced, utilized and then discarded in society and subsequently released to streams from multiple point and diffuse sources. Sustainable management of water...

  16. [Multiple meningiomas].

    Terrier, L-M; François, P

    2016-06-01

    Multiple meningiomas (MMs) or meningiomatosis are defined by the presence of at least 2 lesions that appear simultaneously or not, at different intracranial locations, without the association of neurofibromatosis. They present 1-9 % of meningiomas with a female predominance. The occurrence of multiple meningiomas is not clear. There are 2 main hypotheses for their development, one that supports the independent evolution of these tumors and the other, completely opposite, that suggests the propagation of tumor cells of a unique clone transformation, through cerebrospinal fluid. NF2 gene mutation is an important intrinsic risk factor in the etiology of multiple meningiomas and some exogenous risk factors have been suspected but only ionizing radiation exposure has been proven. These tumors can grow anywhere in the skull but they are more frequently observed in supratentorial locations. Their histologic types are similar to unique meningiomas of psammomatous, fibroblastic, meningothelial or transitional type and in most cases are benign tumors. The prognosis of these tumors is eventually good and does not differ from the unique tumors except for the cases of radiation-induced multiple meningiomas, in the context of NF2 or when diagnosed in children where the outcome is less favorable. Each meningioma lesion should be dealt with individually and their multiple character should not justify their resection at all costs. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. The impact of prevention and control of infectious disease law on diarrhoea control: a 5-year evaluation in multiple provinces in Vietnam.

    Phung, Dung; Tran, Phu Dac; Nguyen, Lien Huong; Do, Cuong Manh; Rutherford, Shannon; Chu, Cordia

    2017-12-01

    To address to burden of infectious diseases such as diarrhoea, the Vietnamese government has enacted the Law on Prevention and Control of Infectious Diseases (LPCIDs) since July 2008. However, no evaluation of the impact of the LPCID has been conducted. This study aims to evaluate the impact of the LPCID on diarrhoeal control for the 5 years following the implementation of LPCID in Vietnam. We used an interrupted time series design using a segmented regression analysis to estimate the 'province-level' impact of LPCID and then used random-effect meta-analysis to estimate the pooled effect sizes of the 'country-level' impact of LPCID on diarrhoeal control throughout Vietnam. The results show that the impacts varied by provinces. They were classified in four groups: 'positive impact, positive impact without sustainability, possibly positive impact, no or negative impact' of the LPCID. The meta-analysis indicated that the country-level impact of the LPCID became significant at 11 months after the LPCID took effect, with a decrease in level of diarrhoea of 9.7% (coefficient, -0.097; 95% CI: -19.1 to - 0.002) and a permanent downward trend of diarrhoea at a rate of 1.1% per month (coefficient, -0.011; 95% CI: -0.02 to - 0.003); whereas the trend in diarrhoea before the LPCID took effect was unchanging (coefficient, 0.002; 95% CI, 0-0.004). At 12, 24, 36, 48 and 60 months following the LPCID implementation date the levels of diarrhoea decreased by 10.9% (coefficient, -0.109; 95% CI: -0.203 to - 0.015), P < 0.01), 21.8% (coefficient, -0.218; 95% CI: -0.338 to - 0.098), P < 0.01), 31% (coefficient, -0.31; 95% CI: -0.474 to - 0.145), P < 0.01), 46.8% (coefficient, -0.468; 95% CI: -0.667 to - 0.27), P < 0.01), 48.2% (coefficient, -0.482; 95% CI: -0.708 to - 0.256), P < 0.01) respectively. The findings of this study reveal the effectiveness of the LPCID in reducing diarrhoea incidence in Vietnam. However, further studies should be conducted to

  18. Multiple sclerosis

    Stenager, Egon; Stenager, E N; Knudsen, Lone

    1994-01-01

    In a cross-sectional study of 117 randomly selected patients (52 men, 65 women) with definite multiple sclerosis, it was found that 76 percent were married or cohabitant, 8 percent divorced. Social contacts remained unchanged for 70 percent, but outgoing social contacts were reduced for 45 percent......, need for structural changes in home and need for pension became greater with increasing physical handicap. No significant differences between gender were found. It is concluded that patients and relatives are under increased social strain, when multiple sclerosis progresses to a moderate handicap...

  19. Impact of urban contamination of the La Paz River basin on thermotolerant coliform density and occurrence of multiple antibiotic resistant enteric pathogens in river water, irrigated soil and fresh vegetables.

    Poma, Violeta; Mamani, Nataniel; Iñiguez, Volga

    2016-01-01

    La Paz River in Andean highlands is heavily polluted with urban run-off and further contaminates agricultural lowlands and downstream waters at the Amazon watershed. Agricultural produce at this region is the main source of vegetables for the major Andean cities of La Paz and El Alto. We conducted a 1 year study, to evaluate microbial quality parameters and occurrence of multiple enteropathogenic bacteria (Enterohemorrhagic E. coli-EHEC, Enteroinvasive E. coli or Shigella-EIEC/Shigella, Enteroaggregative E. coli-EAEC, Enteropathogenic E. coli-EPEC Enterotoxigenic E. coli-ETEC and Salmonella) and its resistance to 11 antibiotics. Four sampling locations were selected: a fresh mountain water reservoir (un-impacted, site 1) and downstream sites receiving wastewater discharges (impacted, sites 2-4). River water (sites 1-4, N = 48), and soil and vegetable samples (site 3, N = 24) were collected during dry (April-September) and rainy seasons (October-March). Throughout the study, thermotolerant coliform density values at impacted sites greatly exceeded the guidelines for recreational and agricultural water uses. Seasonal differences were found for thermotolerant coliform density during dry season in water samples nearby a populated and hospital compound area. In contrast to the un-impacted site, where none of the tested enteropathogens were found, 100 % of surface water, 83 % of soil and 67 % of vegetable samples at impacted sites, were contaminated with at least one enteropathogen, being ETEC and Salmonella the most frequently found. ETEC isolates displayed different patterns of toxin genes among sites. The occurrence of enteropathogens was associated with the thermotolerant coliform density. At impacted sites, multiple enteropathogens were frequently found during rainy season. Among isolated enteropathogens, 50 % were resistant to at least two antibiotics, with resistance to ampicillin, nalidixic acid, trimethoprim-sulfamethoxazole and tetracycline commonly

  20. The impact of energy conservation in transport models on the π−/π+ multiplicity ratio in heavy-ion collisions and the symmetry energy

    M.D. Cozma

    2016-02-01

    Full Text Available The charged pion multiplicity ratio in intermediate energy central heavy-ion collisions has been proposed as a suitable observable to constrain the high density dependence of the isovector part of the equation of state. A comparison of various transport model predictions with existing experimental data has led, however, to contradictory results. Using an upgraded version of the Tübingen QMD transport model, which allows the conservation of energy at a local or global level by accounting for the potential energy of hadrons in two-body collisions and leading thus to particle production threshold shifts, we demonstrate that compatible constraints for the symmetry energy stiffness can be extracted from pion multiplicity and elliptic flow observables. However, pion multiplicities and ratios are proven to be highly sensitive to the yet unknown isovector part of the in-medium Δ(1232 potential which hinders, at present, the extraction of meaningful information on the high density dependence of the symmetry energy. A solution to this problem together with the inclusion of contributions presently neglected, such as in-medium pion potentials and retardation effects, are needed for a final verdict on this topic.

  1. Multiple myeloma

    Sohn, Jeong Ick; Ha, Choon Ho; Choi, Karp Shik

    1994-01-01

    Multiple myeloma is a malignant plasma cell tumor that is thought to originate proliferation of a single clone of abnormal plasma cell resulting production of a whole monoclonal paraprotein. The authors experienced a case of multiple myeloma with severe mandibular osteolytic lesions in 46-year-old female. As a result of careful analysis of clinical, radiological, histopathological features, and laboratory findings, we diagnosed it as multiple myeloma, and the following results were obtained. 1. Main clinical symptoms were intermittent dull pain on the mandibular body area, abnormal sensation of lip and pain due to the fracture on the right clavicle. 2. Laboratory findings revealed M-spike, reversed serum albumin-globulin ratio, markedly elevated ESR and hypercalcemia. 3. Radiographically, multiple osteolytic punched-out radiolucencies were evident on the skull, zygoma, jaw bones, ribs, clavicle and upper extremities. Enlarged liver and increased uptakes on the lesional sites in RN scan were also observed. 4. Histopathologically, markedly hypercellular marrow with sheets of plasmoblasts and megakaryocytes were also observed.

  2. Multiple sclerosis

    Stenager, E; Jensen, K

    1988-01-01

    Forty-two (12%) of a total of 366 patients with multiple sclerosis (MS) had psychiatric admissions. Of these, 34 (81%) had their first psychiatric admission in conjunction with or after the onset of MS. Classification by psychiatric diagnosis showed that there was a significant positive correlation...

  3. Multiple sclerosis

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    In a cross-sectional investigation of 116 patients with multiple sclerosis, the social and sparetime activities of the patient were assessed by both patient and his/her family. The assessments were correlated to physical disability which showed that particularly those who were moderately disabled...

  4. Multiple sclerosis

    Stenager, E; Jensen, K

    1990-01-01

    An investigation on the correlation between ability to read TV subtitles and the duration of visual evoked potential (VEP) latency in 14 patients with definite multiple sclerosis (MS), indicated that VEP latency in patients unable to read the TV subtitles was significantly delayed in comparison...

  5. Multiple sclerosis

    Stenager, E; Knudsen, L; Jensen, K

    1994-01-01

    In a cross-sectional study of 94 patients (42 males, 52 females) with definite multiple sclerosis (MS) in the age range 25-55 years, the correlation of neuropsychological tests with the ability to read TV-subtitles and with the use of sedatives is examined. A logistic regression analysis reveals...

  6. Multiple Sclerosis.

    Plummer, Nancy; Michael, Nancy, Ed.

    This module on multiple sclerosis is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then…

  7. Parenting Multiples

    ... when your babies do. Though it can be hard to let go of the thousand other things you need to do, remember that your well-being is key to your ability to take care of your babies. What Problems Can Happen? It may be hard to tell multiple babies apart when they first ...

  8. The use of multiple tracers to evaluate the impact of sewered and non-sewered development on coastal water quality in a rural area of Florida.

    Meeroff, Daniel E; Bloetscher, Frederick; Long, Sharon C; Bocca, Thais

    2014-05-01

    When onsite wastewater treatment and disposal systems (OSTDS) are not sited appropriately or installed properly, wastewater constituents can be a source of adverse environmental impacts to soil and groundwater, which can lead to potential public health risks. A paired monitoring design developed to compare water quality in sewered and non-sewered areas is presented here. It is suggested as a possible monitoring scheme for assessing the impact of sewer installation projects. As such, two sets of single-family, rural residential Florida neighborhoods were evaluated over a two-year period to gain insight into the effects of small-community use of OSTDS on coastal water quality. One set of two neighborhoods were connected to the sanitary sewer network and the other set of two were served exclusively by OSTDS. Water quality sampling was conducted at the paired sites during seasonal high water table (SHWT) and seasonal low water table (SLWT) events. Measured surface water quality during the SHWT showed indications of environmental impacts from OSTDS in terms of nutrients, microbial pathogen indicators, and other water quality measures, such as turbidity and conductivity. However, during the SLWT events, no obvious impacts attributable to OSTDS were detected. The water quality results indicate that OSTDS impacts may be measureable in rural areas. Other factors, such as microbial indicator survival and regrowth potential, may confound the understanding of water quality impacts of sewer projects. For example, the microbial indicators Escherichia coli and enterococci were found to persist over time and therefore did not always represent true comparisons of OSTDS and sewered areas between seasons. The timeframe for evaluating the effects of sewer projects may be longer than anticipated because of this survival and regrowth phenomenon.

  9. The Impact of Multiple Types of Child Maltreatment on Subsequent Risk Behaviors among Women during the Transition from Adolescence to Young Adulthood

    Hahm, Hyeouk Chris; Lee, Yoona; Ozonoff, Al; Van Wert, Michael J.

    2010-01-01

    The purpose of this study was to investigate how different types of child maltreatment, independently and collectively, impact a wide range of risk behaviors that fall into three domains: sexual risk behaviors, delinquency, and suicidality. Cumulative classification and Expanded Hierarchical Type (EHT) classification approaches were used to…

  10. Multiple sclerosis

    Sadashima, Hiromichi; Kusaka, Hirofumi; Imai, Terukuni; Takahashi, Ryosuke; Matsumoto, Sadayuki; Yamamoto, Toru; Yamasaki, Masahiro; Maya, Kiyomi

    1986-01-01

    Eleven patients with a definite diagnosis of multiple sclerosis were examined in terms of correlations between the clinical features and the results of cranial computed tomography (CT), and magnetic resonance imaging (MRI). Results: In 5 of the 11 patients, both CT and MRI demonstrated lesions consistent with a finding of multiple sclerosis. In 3 patients, only MRI demonstrated lesions. In the remaining 3 patients, neither CT nor MRI revealed any lesion in the brain. All 5 patients who showed abnormal findings on both CT and MRI had clinical signs either of cerebral or brainstem - cerebellar lesions. On the other hand, two of the 3 patients with normal CT and MRI findings had optic-nerve and spinal-cord signs. Therefore, our results suggested relatively good correlations between the clinical features, CT, and MRI. MRI revealed cerebral lesions in two of the four patients with clinical signs of only optic-nerve and spinal-cord lesions. MRI demonstrated sclerotic lesions in 3 of the 6 patients whose plaques were not detected by CT. In conclusion, MRI proved to be more helpful in the demonstration of lesions attributable to chronic multiple sclerosis. (author)

  11. Should I stay or should I go? A prospective investigation examining individual factors impacting employment status among individuals with multiple sclerosis (MS).

    Strober, Lauren B; Chiaravalloti, Nancy; DeLuca, John

    2018-01-01

    Rates of unemployment among individuals with multiple sclerosis (MS) are as high as 80%. While several factors for such high rates of unemployment have been identified, they do not account for the majority of the variance. This study examines person-specific factors such as personality and coping, which may better account for individuals leaving the workforce. Forty individuals with MS (20 considering reducing work hours or leaving the workforce and 20 remaining employed) were matched on age, gender, education, disease duration, and disease course, and administered a comprehensive survey of factors purported to be related to employment status. Based on multiple, logistic regression analyses certain disease factors and person-specific factors differentiate those who are considering leaving work or reducing work hours and those staying employed. In particular, those expressing the need to reduce work hours or leaving the workforce reported more fatigue, anxiety, depression, and use of behavioral disengagement as a means of coping. In contrast, those staying employed reported greater levels of extraversion, self-efficacy, and use of humor as a means of coping. Together, fatigue, use of humor, and use of behavioral disengagement as a means of coping were the most significant factors, accounting for 44% of the variance. Findings suggest that greater consideration be given to these factors and that interventions tailored to address these factors may assist individuals with MS staying employed and/or making appropriate accommodations.

  12. The Impact of Multiple Concussions on Emotional Distress, Post-Concussive Symptoms, and Neurocognitive Functioning in Active Duty United States Marines Independent of Combat Exposure or Emotional Distress

    Lathan, Corinna E.; Bleiberg, Joseph; Tsao, Jack W.

    2014-01-01

    Abstract Controversy exists as to whether the lingering effects of concussion on emotional, physical, and cognitive symptoms is because of the effects of brain trauma or purely to emotional factors such as post-traumatic stress disorder or depression. This study examines the independent effects of concussion on persistent symptoms. The Defense Automated Neurobehavioral Assessment, a clinical decision support tool, was used to assess neurobehavioral functioning in 646 United States Marines, all of whom were fit for duty. Marines were assessed for concussion history, post-concussive symptoms, emotional distress, neurocognitive functioning, and deployment history. Results showed that a recent concussion or ever having experienced a concussion was associated with an increase in emotional distress, but not with persistent post-concussive symptoms (PPCS) or neurocognitive functioning. Having had multiple lifetime concussions, however, was associated with greater emotional distress, PPCS, and reduced neurocognitive functioning that needs attention and rapid discrimination, but not for memory-based tasks. These results are independent of deployment history, combat exposure, and symptoms of post-traumatic stress disorder and depression. Results supported earlier findings that a previous concussion is not generally associated with post-concussive symptoms independent of covariates. In contrast with other studies that failed to find a unique contribution for concussion to PPCS, however, evidence of recent and multiple concussion was seen across a range of emotional distress, post-concussive symptoms, and neurocognitive functioning in this study population. Results are discussed in terms of implications for assessing concussion on return from combat. PMID:25003552

  13. Development and Validation of the Total HUman Model for Safety (THUMS) Version 5 Containing Multiple 1D Muscles for Estimating Occupant Motions with Muscle Activation During Side Impacts.

    Iwamoto, Masami; Nakahira, Yuko

    2015-11-01

    Accurate prediction of occupant head kinematics is critical for better understanding of head/face injury mechanisms in side impacts, especially far-side occupants. In light of the fact that researchers have demonstrated that muscle activations, especially in neck muscles, can affect occupant head kinematics, a human body finite element (FE) model that considers muscle activation is useful for predicting occupant head kinematics in real-world automotive accidents. In this study, we developed a human body FE model called the THUMS (Total HUman Model for Safety) Version 5 that contains 262 one-dimensional (1D) Hill-type muscle models over the entire body. The THUMS was validated against 36 series of PMHS (Post Mortem Human Surrogate) and volunteer test data in this study, and 16 series of PMHS and volunteer test data on side impacts are presented. Validation results with force-time curves were also evaluated quantitatively using the CORA (CORrelation and Analysis) method. The validation results suggest that the THUMS has good biofidelity in the responses of the regional or full body for side impacts, but relatively poor biofidelity in its local level of responses such as brain displacements. Occupant kinematics predicted by the THUMS with a muscle controller using 22 PID (Proportional-Integral- Derivative) controllers were compared with those of volunteer test data on low-speed lateral impacts. The THUMS with muscle controller reproduced the head kinematics of the volunteer data more accurately than that without muscle activation, although further studies on validation of torso kinematics are needed for more accurate predictions of occupant head kinematics.

  14. Multiple sclerosis

    Sørensen, Per Soelberg

    2016-01-01

    A randomized, double-blind, phase III trial of generic glatiramer acetate has shown equivalent efficacy and safety compared with the approved formulation, Copaxone. The impact of approval of generic glatiramer acetate, however, will mainly depend on the pricing of the drug....

  15. Significant geographic gradients in particulate sulfate over Japan determined from multiple-site measurements and a chemical transport model: Impacts of transboundary pollution from the Asian continent

    Aikawa, Masahide; Ohara, Toshimasa; Hiraki, Takatoshi; Oishi, Okihiro; Tsuji, Akihiro; Yamagami, Makiko; Murano, Kentaro; Mukai, Hitoshi

    2010-01-01

    We found a significant geographic gradient (longitudinal and latitudinal) in the sulfate (SO 42-) concentrations measured at multiple sites over the East Asian Pacific Rim region. Furthermore, the observed gradient was well reproduced by a regional chemical transport model. The observed and modeled SO 42- concentrations were higher at the sites closer to the Asian continent. The concentrations of SO 42- from China as calculated by the model also showed the fundamental features of the longitudinal/latitudinal gradient. The proportional contribution of Chinese SO 42- to the total in Japan throughout the year was above 50-70% in the control case, using data for Chinese sulfur dioxide (SO 2) emission from the Regional Emission Inventory in Asia (40-60% in the low Chinese emissions case, using Chinese SO 2 emissions data from the State Environmental Protection Administration of China), with a winter maximum of approximately 65-80%, although the actual concentrations of SO 42- from China were highest in summer. The multiple-site measurements and the model analysis strongly suggest that the SO 42- concentrations in Japan were influenced by the outflow from the Asian continent, and this influence was greatest in the areas closer to the Asian continent. In contrast, we found no longitudinal/latitudinal gradient in SO 2 concentrations; instead SO 2 concentrations were significantly correlated with local SO 2 emissions. Our results show that large amounts of particulate sulfate are transported over long distances from the East Asian Pacific Rim region, and consequently the SO 42- concentrations in Japan are controlled by the transboundary outflow from the Asian continent.

  16. Diffuse nitrogen loss simulation and impact assessment of stereoscopic agriculture pattern by integrated water system model and consideration of multiple existence forms

    Zhang, Yongyong; Gao, Yang; Yu, Qiang

    2017-09-01

    Agricultural nitrogen loss becomes an increasingly important source of water quality deterioration and eutrophication, even threatens water safety for humanity. Nitrogen dynamic mechanism is still too complicated to be well captured at watershed scale due to its multiple existence forms and instability, disturbance of agricultural management practices. Stereoscopic agriculture is a novel agricultural planting pattern to efficiently use local natural resources (e.g., water, land, sunshine, heat and fertilizer). It is widely promoted as a high yield system and can obtain considerable economic benefits, particularly in China. However, its environmental quality implication is not clear. In our study, Qianyanzhou station is famous for its stereoscopic agriculture pattern of Southern China, and an experimental watershed was selected as our study area. Regional characteristics of runoff and nitrogen losses were simulated by an integrated water system model (HEQM) with multi-objective calibration, and multiple agriculture practices were assessed to find the effective approach for the reduction of diffuse nitrogen losses. Results showed that daily variations of runoff and nitrogen forms were well reproduced throughout watershed, i.e., satisfactory performances for ammonium and nitrate nitrogen (NH4-N and NO3-N) loads, good performances for runoff and organic nitrogen (ON) load, and very good performance for total nitrogen (TN) load. The average loss coefficient was 62.74 kg/ha for NH4-N, 0.98 kg/ha for NO3-N, 0.0004 kg/ha for ON and 63.80 kg/ha for TN. The dominating form of nitrogen losses was NH4-N due to the applied fertilizers, and the most dramatic zones aggregated in the middle and downstream regions covered by paddy and orange orchard. In order to control diffuse nitrogen losses, the most effective practices for Qianyanzhou stereoscopic agriculture pattern were to reduce farmland planting scale in the valley by afforestation, particularly for orchard in the

  17. Impact of cladribine therapy on changes in circulating dendritic cell subsets, T cells and B cells in patients with multiple sclerosis.

    Mitosek-Szewczyk, Krystyna; Tabarkiewicz, Jacek; Wilczynska, Barbara; Lobejko, Katarzyna; Berbecki, Jerzy; Nastaj, Marcin; Dworzanska, Ewa; Kolodziejczyk, Beata; Stelmasiak, Zbigniew; Rolinski, Jacek

    2013-09-15

    Cladribine causes sustained reduction in peripheral T and B cell populations while sparing other immune cells. We determined two populations of dendritic cells (DCs): namely CD1c(+)/CD19(-) (myeloid DCs) and CD303(+)/CD123(+) (plasmacytoid DCs), CD19(+) B lymphocytes, CD3(+) T lymphocytes and CD4(+) or CD8(+) subpopulations in patients with multiple sclerosis after cladribine therapy. We examined 50 patients with secondary progressive multiple sclerosis (SP MS) according to McDonalds et al.'s criteria, 2001 [15]. Blood samples were collected before the initiation of cladribine therapy and after 1st, 2nd, 3th, 4th and 5th courses of treatment. DC subsets, T and B cells were analyzed by flow cytometry. During cladribine treatment the myeloid DCs CD1c(+)/CD19(-) did not change (p=0.73175), and the plasmacytoid DCs CD303(+)/CD123(+) significantly increased (p=0.00034) which resulted in significant changes in the ratio of myeloid DCs to plasmacytoid DCs (p=0.00273). During therapy, B lymphocyte CD19(+) significantly decreased (p=0.00005) and significant changes in CD4(+) cells (p=0.00191), changes in CD8(+) cells (p=0.05760) and significant changes in CD3(+) (p=0.01822) were found. We noticed significant trend to increase the CD303(+) circulating the dendritic cells. This population produces large amounts of IFN-alfa. We found significant and rapid decrease in B cells and CD4(+) Th cells. Our results suggest two possible ways of beneficial cladribine influence on immune system in MS. Induction of IFN-alfa producing cells and their predominance over BDCA-1(+) DCs, which are associated with cytotoxic response. Additionally, cladribine could influence two populations of lymphocytes: B cells and Th lymphocytes responsible for induction of immune response against myelin antigens. Copyright © 2013 Elsevier B.V. All rights reserved.

  18. Direct and indirect effects of multiple stressors on stream invertebrates across watershed, reach and site scales: A structural equation modelling better informing on hydromorphological impacts.

    Villeneuve, B; Piffady, J; Valette, L; Souchon, Y; Usseglio-Polatera, P

    2018-01-15

    The purpose of our approach was to take into account the nested spatial scales driving stream functioning in the description of pressures/ecological status links by analysing the results of a hierarchical model. The development of this model has allowed us to answer the following questions: Does the consideration of the indirect links between anthropogenic pressures and stream ecological status modify the hierarchy of pressure types impacting benthic invertebrates? Do the different nested scales play different roles in the anthropogenic pressures/ecological status relationship? Does this model lead to better understanding of the specific role of hydromorphology in the evaluation of stream ecological status? To achieve that goal, we used the Partial Least Square (PLS) path modelling method to develop a structural model linking variables describing (i) land use and hydromorphological alterations at the watershed scale, (ii) hydromorphological alterations at the reach scale, (iii) nutrients-organic matter contamination levels at the site scale, and (iv) substrate characteristics at the sampling site scale, to explain variation in values of a macroinvertebrate-based multimetric index: the French I 2 M 2 . We have highlighted the importance of land use effects exerted on both hydromorphological and chemical characteristics of streams observed at finer scales and their subsequent indirect impact on stream ecological status. Hydromorphological alterations have an effect on the substrate mosaic structure and on the concentrations of nutrients and organic matter at site scale. This result implies that stream hydromorphology can have a major indirect effect on macroinvertebrate assemblages and that the hierarchy of impacts of anthropogenic pressures on stream ecological status generally described in the literature - often determining strategic restoration priorities - has to be re-examined. Finally, the effects of nutrients and organic matter on macroinvertebrate assemblages

  19. ‘They Make Us Feel Like We’re a Virus’: The Multiple Impacts of Islamophobic Hostility Towards Veiled Muslim Women

    Irene Zempi

    2015-10-01

    Full Text Available Within the prevailing post-9/11 climate, veiled Muslim women are commonly portrayed as oppressed, ‘culturally dangerous’ and ‘threatening’ to the western way of life and to notions of public safety and security by virtue of being fully covered in the public sphere. It is in such a context that manifestations of Islamophobia often emerge as a means of responding to these ‘threats’. Drawing from qualitative data elicited through a UK-based study, this article reflects upon the lived experiences of veiled Muslim women as actual and potential victims of Islamophobia and examines the impacts of Islamophobic attacks upon victims, their families and wider Muslim communities. Among the central themes we explore are impacts upon their sense of vulnerability, the visibility of their Muslim identity, and the management of their safety in public. The individual and collective harms associated with this form of victimisation are considered through notions of a worldwide, transnational Muslim community, the ummah, which connects Muslims from all over world. We conclude by noting that the effects of this victimisation are not exclusively restricted to the global ummah; rather, the harm extends to society as a whole by exacerbating the polarisation which already exists between ‘us’ and ‘them’.

  20. Assessing the potential impact of non-proprietary drug copies on quality of medicine and treatment in patients with relapsing multiple sclerosis: the experience with fingolimod

    Correale J

    2014-06-01

    Full Text Available Jorge Correale,1 Erwin Chiquete,2 Snezana Milojevic,3 Nadina Frider,3 Imre Bajusz31Raúl Carrea Institute for Neurological Research, Foundation for the Fight against Infant Neurological Illnesses, Buenos Aires, Argentina; 2Department of Neurology and Psychiatry, Salvador Zubirán National Institute of Medical Science and Nutrition, Mexico City, Mexico; 3Novartis Pharma AG, Basel, SwitzerlandBackground: Fingolimod is a once-daily oral treatment for relapsing multiple sclerosis, the proprietary production processes of which are tightly controlled, owing to its susceptibility to contamination by impurities, including genotoxic impurities. Many markets produce nonproprietary medicines; assessing their efficacy and safety is difficult as regulators may approve nonproprietary drugs without bioequivalence data, genotoxic evaluation, or risk management plans (RMPs. This assessment is especially important for fingolimod given its solubility/bioavailability profile, genotoxicity risk, and low-dose final product (0.5 mg. This paper presents an evaluation of the quality of proprietary and nonproprietary fingolimod variants.Methods: Proprietary fingolimod was used as a reference substance against which eleven nonproprietary fingolimod copies were assessed. The microparticle size distribution of each compound was assessed by laser light diffraction, and inorganic impurity content by sulfated ash testing. Heavy metals content was quantified using inductively coupled plasma optical emission spectrometry, and levels of unspecified impurities by high-performance liquid chromatography. Solubility was assessed in a range of solvents at different pH values. Key information from the fingolimod RMP is also presented.Results: Nonproprietary fingolimod variants exhibited properties out of proprietary or internationally accepted specifications, including differences in particle size distribution and levels of impurities such as heavy metals. For microparticle size and

  1. The Impact Of Climate Change On Production Of Multiple Food Crops In The 21st Century- An Analysis Based On Two Land Surface Models

    Song, Y.; Jain, A. K.; Lawrence, P.; Kheshgi, H. S.

    2015-12-01

    Climate change presents potential risks to global food supply. To date, understanding of climate change effects on crop production remains uncertain due to (1) uncertainties in projected climate change trends and their spatial and temporal variability; (2) uncertainties in the physiological, genetic and molecular basis of crop adaptation to climate change and adaptive management practices and (3) uncertainties in current land surface models to estimate crop adaptation to climate change. We apply the process-based land surface model, the Integrated Science Assessment model (ISAM), to assess the impact of climate change on the production of row crops (corn, soybean, rice, cotton, sugarcane and wheat) at global and regional scales. The results are compared to the corresponding simulations performed with the crop model in the Community Land Model (CLM4.5). Three questions are addressed: (1) what is the impact of different climate change projections on global crop production; (2) what is the effect of crop adaptation and adaptive management practices on projected crop production; and (3) how do model differences in ISAM and CLM4.5 impact projected global crop production and adaptive management practices over the 21st century. ISAM and CLM4.5 have been included in the Agricultural Model Intercomparison and Improvement Project (AgMIP). Both models consider the effects of temperature, light and soil water and nitrogen availability on crop photosynthesis and temperature control on crop phenology and carbon allocation. ISAM also considers the adaptation of crop phenology, carbon allocation and structures growth to drought, light stress and N stress. The effects of model differences on projected crop production are evaluated by performing the following experiments. Each model is driven with historical atmospheric forcing data (1901-2005) and projected atmospheric forcing data (2006-2100) under RCP 4.5 or RCP 8.5 from CESM CMIP5 simulations to estimate the effects of different

  2. The clinical utility of lung clearance index in early cystic fibrosis lung disease is not impacted by the number of multiple-breath washout trials

    Rachel E. Foong

    2018-02-01

    Full Text Available The lung clearance index (LCI from the multiple-breath washout (MBW test is a promising surveillance tool for pre-school children with cystic fibrosis (CF. Current guidelines for MBW testing recommend that three acceptable trials are required. However, success rates to achieve these criteria are low in children aged <7 years and feasibility may improve with modified pre-school criteria that accepts tests with two acceptable trials. This study aimed to determine if relationships between LCI and clinical outcomes of CF lung disease differ when only two acceptable MBW trials are assessed. Healthy children and children with CF aged 3–6 years were recruited for MBW testing. Children with CF also underwent bronchoalveolar lavage fluid collection and a chest computed tomography scan. MBW feasibility increased from 46% to 75% when tests with two trials were deemed acceptable compared with tests where three acceptable trials were required. Relationships between MBW outcomes and markers of pulmonary inflammation, infection and structural lung disease were not different between tests with three acceptable trials compared with tests with two acceptable trials. This study indicates that pre-school MBW data from two acceptable trials may provide sufficient information on ventilation distribution if three acceptable trials are not possible.

  3. Impact of single versus multiple policy options on the economic feasibility of biogas energy production: Swine and dairy operations in Nova Scotia

    Brown, Bettina B.; Yiridoe, Emmanuel K.; Gordon, Robert

    2007-01-01

    The economic feasibility of on-farm biogas energy production was investigated for swine and dairy operations under Nova Scotia, Canada farming conditions, using net present value (NPV), internal rate of return (IRR), and payback period (PP) economic decision criteria. In addition, the effects of selected environmental and 'green' energy policy schemes on co-generation of on-farm biogas energy production and other co-benefits from anaerobic digestion of livestock manure were investigated. Cost-efficiencies arising from economies of scale for on-farm anaerobic biogas production were found for swine farms, and less so for dairy production systems. Without incentive schemes, on-farm biogas energy production was not economically feasible across the farm size ranges studied, except for 600- and 800-sow operations. Among single policy schemes investigated, green energy credit policy schemes generated the highest financial returns, compared to cost-share and low-interest loan schemes. Combinations of multiple policies that included cost-share and green energy credit incentive schemes generated the most improvement in financial feasibility of on-farm biogas energy production, for both swine and dairy operations

  4. The clinical utility of lung clearance index in early cystic fibrosis lung disease is not impacted by the number of multiple-breath washout trials

    Foong, Rachel E.; Harper, Alana J.; King, Louise; Turkovic, Lidija; Davis, Miriam; Clem, Charles C.; Davis, Stephanie D.; Ranganathan, Sarath; Hall, Graham L.

    2018-01-01

    The lung clearance index (LCI) from the multiple-breath washout (MBW) test is a promising surveillance tool for pre-school children with cystic fibrosis (CF). Current guidelines for MBW testing recommend that three acceptable trials are required. However, success rates to achieve these criteria are low in children aged tests with two acceptable trials. This study aimed to determine if relationships between LCI and clinical outcomes of CF lung disease differ when only two acceptable MBW trials are assessed. Healthy children and children with CF aged 3–6 years were recruited for MBW testing. Children with CF also underwent bronchoalveolar lavage fluid collection and a chest computed tomography scan. MBW feasibility increased from 46% to 75% when tests with two trials were deemed acceptable compared with tests where three acceptable trials were required. Relationships between MBW outcomes and markers of pulmonary inflammation, infection and structural lung disease were not different between tests with three acceptable trials compared with tests with two acceptable trials. This study indicates that pre-school MBW data from two acceptable trials may provide sufficient information on ventilation distribution if three acceptable trials are not possible.

  5. The Impact of a Rigorous Multiple Work Shift Schedule and Day Versus Night Shift Work on Reaction Time and Balance Performance in Female Nurses: A Repeated Measures Study.

    Thompson, Brennan J; Stock, Matt S; Banuelas, Victoria K; Akalonu, Chibuzo C

    2016-07-01

    The aim of this study was to determine the impact of a demanding work schedule involving long, cumulative work shifts on response time and balance-related performance outcomes and to evaluate the prevalence of musculoskeletal disorders between day and night shift working nurses. A questionnaire was used to identify the prevalence of past (12-month) and current (7-day) musculoskeletal disorders. Nurses worked three 12-hour work shifts in a 4-day period. Reaction time and balance tests were conducted before and after the work period. The work period induced impairments for reaction time, errors on reaction time tasks, and balance performance, independent of shift type. Musculoskeletal symptom prevalence was high in workers of both work shifts. Compressed work shifts caused performance-based fatigue in nurses. Reaction time and balance tests may be sensitive fatigue identification markers in nurses.

  6. How the Pacific Islands Climate Education Partnership (PCEP) Has Collaboratively Increased Regional Collective Impacts on Climate Literacy Via Networks of Diverse Stakeholders Engaging in Multiple Reinforcing Activities

    Sussman, A.

    2016-12-01

    The Pacific Islands Climate Education Partnership (PCEP) serves the U.S. Affiliated Pacific Island (USAPI) Region. The international entities served by PCEP are the state of Hawai`i (USA); three Freely Associated States (the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau), and three Territories (Guam, Commonwealth of Northern Mariana Islands, and American Samoa). Funded by NSF, the PCEP aims to educate the region's students and citizens in ways that exemplify modern science and indigenous environmental knowledge, address the urgency of climate change impacts, and focus on adaptation strategies that can increase resiliency with respect to climate change impacts. PCEP partners include universities, education nonprofits, state or country offices/ministries of education, local ecological nonprofits, and a variety of community organizations. Partners contribute and share expertise in climate science, local ecological knowledge, K-12 education in the Pacific island region, science and environmental education, community college education, learning science, indigenous navigation, and oceanography. Over the past six years, PCEP has engaged with regional school systems and communities in a wide variety of ways that complement and reinforce each other. Highlighted activities include improving country and state climate science education standards; focusing on place-based local ecological knowledge and skills in working with schools and communities; developing and disseminating formal education resources such as books and web resources that focus on local contexts and skills rather than contextually inappropriate mainland the textbooks; developing and implementing professional development for teachers; and supporting local ways of knowing by gathering and sharing local stories of climate change; and promoting an emphasis on climate adaptation strategies that increase resilience of natural environments and community systems.

  7. Health impact assessments in hospital community benefit: A multiple case study of the use of HIAs at Children’s Hospital Colorado

    Gregory Jackson Tung

    2017-09-01

    Full Text Available Objective:  To explore the use of Health Impact Assessments (HIAs within non-profit hospital community benefit activities. Methods:  We constructed case studies of three HIAs that were conducted in collaboration with Children’s Hospital Colorado as part of the hospital’s community benefit portfolio. These HIAs were part of a pilot that was funded by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. Results:  HIAs provided Children’s Hospital Colorado with a transparent and systematic process for generating evidence-based recommendations with community and stakeholder feedback within the hospital’s community benefit activities. HIAs were used to generate recommendations to inform community benefit planning activities and to generate public policy recommendations to enhance child health. The case studies highlighted several issues that need to be addressed in order to further advance the use of HIA within hospital community benefit activities including: use of HIA on explicit health issues, hospital capacity for HIA, potentially broadening the scope of HIA recommendations, and the use of HIA to generate recommendations from broad priority areas. Conclusion: HIAs can help meet the need for established, evidence-based, and stakeholder responsive tools and processes to be used within non-profit hospital community benefit activities. In meeting this need, the non-profit hospital community benefit area can potentially serve as a major institutional home for the practice of HIA. There is a need for additional research and practice innovation to further explore and refine the use of HIA within non-profit hospital community benefit activities.

  8. Assessing the impact of local meteorological variables on surface ozone in Hong Kong during 2000-2015 using quantile and multiple line regression models

    Zhao, Wei; Fan, Shaojia; Guo, Hai; Gao, Bo; Sun, Jiaren; Chen, Laiguo

    2016-11-01

    The quantile regression (QR) method has been increasingly introduced to atmospheric environmental studies to explore the non-linear relationship between local meteorological conditions and ozone mixing ratios. In this study, we applied QR for the first time, together with multiple linear regression (MLR), to analyze the dominant meteorological parameters influencing the mean, 10th percentile, 90th percentile and 99th percentile of maximum daily 8-h average (MDA8) ozone concentrations in 2000-2015 in Hong Kong. The dominance analysis (DA) was used to assess the relative importance of meteorological variables in the regression models. Results showed that the MLR models worked better at suburban and rural sites than at urban sites, and worked better in winter than in summer. QR models performed better in summer for 99th and 90th percentiles and performed better in autumn and winter for 10th percentile. And QR models also performed better in suburban and rural areas for 10th percentile. The top 3 dominant variables associated with MDA8 ozone concentrations, changing with seasons and regions, were frequently associated with the six meteorological parameters: boundary layer height, humidity, wind direction, surface solar radiation, total cloud cover and sea level pressure. Temperature rarely became a significant variable in any season, which could partly explain the peak of monthly average ozone concentrations in October in Hong Kong. And we found the effect of solar radiation would be enhanced during extremely ozone pollution episodes (i.e., the 99th percentile). Finally, meteorological effects on MDA8 ozone had no significant changes before and after the 2010 Asian Games.

  9. Detection of multiple cocirculating wild poliovirus type 1 lineages through environmental surveillance: impact and progress during 2011-2013 in Pakistan.

    Alam, Muhammad Masroor; Shaukat, Shahzad; Sharif, Salmaan; Angez, Mehar; Khurshid, Adnan; Malik, Farzana; Rehman, Lubna; Zaidi, Syed Sohail Zahoor

    2014-11-01

    The environmental surveillance has proven to be a useful tool to identify poliovirus circulation in different countries and was started in Pakistan during July 2009 to support the acute flaccid paralysis (AFP) surveillance system. Sewage samples were collected from 27 environmental sampling (ENV) sites and processed for poliovirus isolation through 2-phase separation method. Poliovirus isolates were identified as Sabin-like or wild type through real-time polymerase chain reaction (PCR). Wild-type strains were subjected to VP1 gene sequencing and phylogenetic analysis performed using MEGA 5.0. During 2011-2013, a total of 668 samples were collected from 4 provinces that resulted in 40% of samples positive for wild poliovirus type-1 (WPV-1). None of the samples were positive for WPV-3. The areas with high frequency of WPV-1 detection were Karachi-Gadap (69%), Peshawar (82%), and Rawalpindi (65%), whereas the samples from Quetta and Sukkur remained negative for WPV during 2013. Phylogenetic analysis revealed 3 major clusters with multiple poliovirus lineages circulating across different country areas as well as in bordering areas of Afghanistan. Environmental surveillance in Pakistan has been proven to be a powerful tool to detect WPV circulation in the absence of poliomyelitis cases in many communities. Our findings emphasize the need to continue and expand such surveillance activities to other high-risk areas in the country. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  10. Impact of High-Cut-Off Dialysis on Renal Recovery in Dialysis-Dependent Multiple Myeloma Patients: Results from a Case-Control Study.

    Hans U Gerth

    Full Text Available High-cut-off hemodialysis (HCO-HD can effectively reduce high concentrations of circulating serum free light chains (sFLC in patients with dialysis-dependent acute kidney injury (AKI due to multiple myeloma (MM. Therefore, the aim of this study was to analyze renal recovery in a retrospective single-center cohort of dialysis-dependent MM patients treated with either conventional HD (conv. HD or HCO-HD.The final cohort consisted of 59 patients treated with HCO-HD (n = 42 or conv. HD (n = 17. A sustained sFLC response was detected in a significantly higher proportion of HCO-HD patients (83.3% compared with conv. HD patients (29.4%; p = 0.007. The median duration of sFLC required to reach values <1000 mg/l was 14.5 days in the HCO-HD group and 36 days in the conv. HD group. The corresponding rates of renal recovery were 64.3% and 29.4%, respectively (chi-squared test, p = 0.014. Multivariate regression and decision tree analysis (recursive partitioning revealed HCO-HD (adjusted odds ratio [OR] 6.1 [95% confidence interval (CI 1.5-24.5], p = 0.011 and low initial uric acid values (adjusted OR 1.3 [95%CI 1.0-1.7], p = 0.045 as independent and paramount variables associated with a favorable renal outcome.In summary, the results from this retrospective case-control study suggest in addition to novel agent-based chemotherapy a benefit of HCO-HD in sFLC removal and renal outcome in dialysis-dependent AKI secondary to MM. This finding was especially pertinent in patients with low initial uric acid values, resulting in a promising renal recovery rate of 71.9%. Further prospective studies are warranted.

  11. Impact of Leukocyte Function-Associated Antigen-1 Blockade on Endogenous Allospecific T Cells to Multiple Minor Histocompatibility Antigen Mismatched Cardiac Allograft.

    Kwun, Jean; Farris, Alton B; Song, Hyunjin; Mahle, William T; Burlingham, William J; Knechtle, Stuart J

    2015-12-01

    Blocking leukocyte function-associated antigen (LFA)-1 in organ transplant recipients prolongs allograft survival. However, the precise mechanisms underlying the therapeutic potential of LFA-1 blockade in preventing chronic rejection are not fully elucidated. Cardiac allograft vasculopathy (CAV) is the preeminent cause of late cardiac allograft failure characterized histologically by concentric intimal hyperplasia. Anti-LFA-1 monoclonal antibody was used in a multiple minor antigen-mismatched, BALB.B (H-2B) to C57BL/6 (H-2B), cardiac allograft model. Endogenous donor-specific CD8 T cells were tracked down using major histocompatibility complex multimers against the immunodominant H4, H7, H13, H28, and H60 minor Ags. The LFA-1 blockade prevented acute rejection and preserved palpable beating quality with reduced CD8 T-cell graft infiltration. Interestingly, less CD8 T cell infiltration was secondary to reduction of T-cell expansion rather than less trafficking. The LFA-1 blockade significantly suppressed the clonal expansion of minor histocompatibility antigen-specific CD8 T cells during the expansion and contraction phase. The CAV development was evaluated with morphometric analysis at postoperation day 100. The LFA-1 blockade profoundly attenuated neointimal hyperplasia (61.6 vs 23.8%; P < 0.05), CAV-affected vessel number (55.3 vs 15.9%; P < 0.05), and myocardial fibrosis (grade 3.29 vs 1.8; P < 0.05). Finally, short-term LFA-1 blockade promoted long-term donor-specific regulation, which resulted in attenuated transplant arteriosclerosis. Taken together, LFA-1 blockade inhibits initial endogenous alloreactive T-cell expansion and induces more regulation. Such a mechanism supports a pulse tolerance induction strategy with anti-LFA-1 rather than long-term treatment.

  12. Characterizing Microstructural Tissue Properties in Multiple Sclerosis with Diffusion MRI at 7 T and 3 T: The Impact of the Experimental Design.

    De Santis, Silvia; Bastiani, Matteo; Droby, Amgad; Kolber, Pierre; Zipp, Frauke; Pracht, Eberhard; Stoecker, Tony; Groppa, Sergiu; Roebroeck, Alard

    2018-04-07

    The recent introduction of advanced magnetic resonance (MR) imaging techniques to characterize focal and global degeneration in multiple sclerosis (MS), like the Composite Hindered and Restricted Model of Diffusion, or CHARMED, diffusional kurtosis imaging (DKI) and Neurite Orientation Dispersion and Density Imaging (NODDI) made available new tools to image axonal pathology non-invasively in vivo. These methods already showed greater sensitivity and specificity compared to conventional diffusion tensor-based metrics (e.g., fractional anisotropy), overcoming some of its limitations. While previous studies uncovered global and focal axonal degeneration in MS patients compared to healthy controls, here our aim is to investigate and compare different diffusion MRI acquisition protocols in their ability to highlight microstructural differences between MS and control tissue over several much used models. For comparison, we contrasted the ability of fractional anisotropy measurements to uncover differences between lesion, normal-appearing white matter (WM), gray matter and healthy tissue under the same imaging protocols. We show that: (1) focal and diffuse differences in several microstructural parameters are observed under clinical settings; (2) advanced models (CHARMED, DKI and NODDI) have increased specificity and sensitivity to neurodegeneration when compared to fractional anisotropy measurements; and (3) both high (3 T) and ultra-high fields (7 T) are viable options for imaging tissue change in MS lesions and normal appearing WM, while higher b-values are less beneficial under the tested short-time (10 min acquisition) conditions. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  13. Impact of Genomics Platform and Statistical Filtering on Transcriptional Benchmark Doses (BMD and Multiple Approaches for Selection of Chemical Point of Departure (PoD.

    A Francina Webster

    Full Text Available Many regulatory agencies are exploring ways to integrate toxicogenomic data into their chemical risk assessments. The major challenge lies in determining how to distill the complex data produced by high-content, multi-dose gene expression studies into quantitative information. It has been proposed that benchmark dose (BMD values derived from toxicogenomics data be used as point of departure (PoD values in chemical risk assessments. However, there is limited information regarding which genomics platforms are most suitable and how to select appropriate PoD values. In this study, we compared BMD values modeled from RNA sequencing-, microarray-, and qPCR-derived gene expression data from a single study, and explored multiple approaches for selecting a single PoD from these data. The strategies evaluated include several that do not require prior mechanistic knowledge of the compound for selection of the PoD, thus providing approaches for assessing data-poor chemicals. We used RNA extracted from the livers of female mice exposed to non-carcinogenic (0, 2 mg/kg/day, mkd and carcinogenic (4, 8 mkd doses of furan for 21 days. We show that transcriptional BMD values were consistent across technologies and highly predictive of the two-year cancer bioassay-based PoD. We also demonstrate that filtering data based on statistically significant changes in gene expression prior to BMD modeling creates more conservative BMD values. Taken together, this case study on mice exposed to furan demonstrates that high-content toxicogenomics studies produce robust data for BMD modelling that are minimally affected by inter-technology variability and highly predictive of cancer-based PoD doses.

  14. Development of new experimental platform 'MARS'-Multiple Artificial-gravity Research System-to elucidate the impacts of micro/partial gravity on mice.

    Shiba, Dai; Mizuno, Hiroyasu; Yumoto, Akane; Shimomura, Michihiko; Kobayashi, Hiroe; Morita, Hironobu; Shimbo, Miki; Hamada, Michito; Kudo, Takashi; Shinohara, Masahiro; Asahara, Hiroshi; Shirakawa, Masaki; Takahashi, Satoru

    2017-09-07

    This Japan Aerospace Exploration Agency project focused on elucidating the impacts of partial gravity (partial g) and microgravity (μg) on mice using newly developed mouse habitat cage units (HCU) that can be installed in the Centrifuge-equipped Biological Experiment Facility in the International Space Station. In the first mission, 12 C57BL/6 J male mice were housed under μg or artificial earth-gravity (1 g). Mouse activity was monitored daily via downlinked videos; μg mice floated inside the HCU, whereas artificial 1 g mice were on their feet on the floor. After 35 days of habitation, all mice were returned to the Earth and processed. Significant decreases were evident in femur bone density and the soleus/gastrocnemius muscle weights of μg mice, whereas artificial 1 g mice maintained the same bone density and muscle weight as mice in the ground control experiment, in which housing conditions in the flight experiment were replicated. These data indicate that these changes were particularly because of gravity. They also present the first evidence that the addition of gravity can prevent decreases in bone density and muscle mass, and that the new platform 'MARS' may provide novel insights on the molecular-mechanisms regulating biological processes controlled by partial g/μg.

  15. A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol.

    Geddie, Hannah; Dobrow, Mark J; Hoch, Jeffrey S; Rabeneck, Linda

    2012-06-01

    Health-policy decision making is a complex and dynamic process, for which strong evidentiary support is required. This includes scientifically produced research, as well as information that relates to the context in which the decision takes place. Unlike scientific evidence, this "contextual evidence" is highly variable and often includes information that is not scientifically produced, drawn from sources such as political judgement, program management experience and knowledge, or public values. As the policy decision-making process is variable and difficult to evaluate, it is often unclear how this heterogeneous evidence is identified and incorporated into "evidence-based policy" decisions. Population-based colorectal cancer screening poses an ideal context in which to examine these issues. In Canada, colorectal cancer screening programs have been established in several provinces over the past five years, based on the fecal occult blood test (FOBT) or the fecal immunochemical test. However, as these programs develop, new scientific evidence for screening continues to emerge. Recently published randomized controlled trials suggest that the use of flexible sigmoidoscopy for population-based screening may pose a greater reduction in mortality than the FOBT. This raises the important question of how policy makers will address this evidence, given that screening programs are being established or are already in place. This study will examine these issues prospectively and will focus on how policy makers monitor emerging scientific evidence and how both scientific and contextual evidence are identified and applied for decisions about health system improvement. This study will employ a prospective multiple case study design, involving participants from Ontario, Alberta, Manitoba, Nova Scotia, and Quebec. In each province, data will be collected via document analysis and key informant interviews. Documents will include policy briefs, reports, meeting minutes, media

  16. Multiplicity of secondary electrons emitted by carbon thin targets by impact of H0, H2+ and H3+ projectiles at MeV energies

    Vidovic, Zvonimir

    1997-01-01

    This work focuses on the study of the emission statistics of secondary electrons from thin carbon foils bombarded with H 0 , H 2 + and H 3 + projectiles in the 0.25 - 2.2 MeV energy range. The phenomenon of secondary electron emission from solids under the impact of swift ions is mainly due to inelastic interactions with target electrons. Phenomenological and theoretical descriptions as well as a summary of the main theoretical models are the subjects of the first chapter. The experimental set-up used to measure event by event the electron emission of the two faces of the thin carbon foils crossed by an energetic projectile is described in the chapter two. In this chapter there are also presented the method and the algorithms used to process experimental spectra in order to obtain the statistical distribution of the emitted electrons. Chapter three presents the measurements of secondary electron emission induced by H 0 atoms passing through thin carbon foils. The secondary electron yields are studied in correlation with emergent projectile charge state. We show the peculiar role of the projectile electron, whether it remains or not bound to the incident proton. The fourth chapter is dedicated to the secondary electron emission induced by H 2 + and H 3 + polyatomic ions. The results are interpreted in terms of collective effects in the interactions of the ions with solids. The role of the proximity of the protons, molecular ions fragments, upon the amplitude of these collected effects is evidenced from the study of the statistics of forward emission. The experiments allowed us to shed light on various aspects of atom and polyatomic ion interactions with solid surfaces. (author)

  17. SU-E-T-296: Single Field Per Day Vs. Multiple Fields Per Day and the Impact On BED in Proton Therapy Treatment

    Grantham, K; Wooten, H; Zhao, T; Klein, E

    2014-01-01

    Purpose: A common practice, in proton therapy, is to deliver a rotating subset of fields from the treatment plan for the daily fractions. This study compares the impact this practice has on the biological effective dose (BED) versus delivering all planned fields daily. Methods: For two scenarios (a phantom with a geometry approximating the anatomy of a prostate treatment with opposing lateral beams, and a clinical 3-field brain treatment), treatment plans were produced in Eclipse (Varian) to simulate delivery of one, two, and three fields per fraction. The RT-Dose file, structure set, and α/β ratios were processed using in-house MATLAB code to return a new RT-Dose file containing the BED (including a proton RBE of 1.1) which was imported back into Eclipse for analysis. Results: For targets and regions of field overlap in the treatment plan, BED is not affected by delivery regimen. In the phantom, BED in the femoral heads showed increased by 20% when a single field was used rather than two fields. In the brain treatment, the minimum BED to the left optic nerve and the pituitary gland increased by 13% and 10% respectively, for a one-field regime compared to three-fields per fraction. Comparing the two-field and threefield regimes, the optic nerve BED was not significantly affected and the minimum pituitary BED was 4% higher for two fields per day. Conclusion: Hypo-fractionation effects, in regions of non-overlap of fields, significantly increase the BED to the involved tissues by as much as 20%. Care should be taken to avoid inadvertently sacrificing plan effectiveness in the interest of reduced treatment time

  18. Ordering, materiality and multiplicity

    van der Duim, René; Ren, Carina Bregnholm; Jóhannesson, Gunnar Thór

    2013-01-01

    In this article we discuss how ANT has been translated into tourism research and show how it has impacted the field by presenting three concepts integral to the ANT approach: ordering, materiality and multiplicity. We first introduce ANT and draw attention to current ANT studies in tourism......, followed by a discussion of how newer approaches within post-ANT urge us to face the ontological politics, which we engage in when performing tourism research. In conclusion we argue that ANT enables a radical new way at looking at tourism, tourism destinations and objects and investigations...... into the ontological condition of tourism....

  19. The potential impact of green agendas on historic river landscapes: Numerical modelling of multiple weir removal in the Derwent Valley Mills world heritage site, UK

    Howard, A. J.; Coulthard, T. J.; Knight, D.

    2017-09-01

    The exploitation of river systems for power and navigation has commonly been achieved through the installation of a variety of in-channel obstacles of which weirs in Britain are amongst the most common. In the UK, the historic value of many of these features is recognised by planning designations and protection more commonly associated with historic buildings and other major monuments. Their construction, particularly in the north and west of Britain, has often been associated with industries such as textiles, chemicals, and mining, which have polluted waterways with heavy metals and other contaminants. The construction of weirs altered local channel gradients resulting in sedimentation upstream with the potential as well for elevated levels of contamination in sediments deposited there. For centuries these weirs have remained largely undisturbed, but as a result of the growth in hydropower and the drive to improve water quality under the European Union's Water Framework Directive, these structures are under increasing pressure to be modified or removed altogether. At present, weir modifications appear to be considered largely on an individual basis, with little focus on the wider impacts this might have on valley floor environments. Using a numerical modelling approach, this paper simulates the removal of major weirs along a 24-km stretch of the river Derwent, Derbyshire, UK, designated as a UNESCO World Heritage Site. The results suggest that although removal would not result in significant changes to the valley morphology, localised erosion would occur upstream of structures as the river readjusts its base level to new boundary conditions. Modelling indicates that sediment would also be evacuated away from the study area. In the context of the Derwent valley, this raises the potential for the remobilisation of contaminants (legacy sediments) within the wider floodplain system, which could have detrimental, long-term health and environmental implications for the

  20. The impact of multiple interventions to reduce household exposure to second-hand tobacco smoke among women: a cluster randomized controlled trial in Kalutara district, Sri Lanka

    A. M. A. A. P. Alagiyawanna

    2017-10-01

    Full Text Available Abstract Background Second-hand smoke (SHS in households remains a serious public health problem in Sri Lanka, partly due to a lack of voluntary prohibitions of tobacco smoking inside houses. Women are especially at risk of being exposed. Effective community based interventions to reduce the SHS in households targeting women is scarce. The objective of this study was to examine the impact of a multi-component intervention on household SHS exposure among Sri Lankan women. Methods Thirty clusters of 25 women (aged 18–65 from 750 households were randomized into the intervention and control groups. Women in the intervention group were exposed to activities which focused on improving knowledge on the health effects of SHS, attitudes towards SHS exposure, right to a smoke-free living and women empowerment against smoking. The duration of the intervention was six months. The comparison group received no intervention. The primary outcome of interest was self-reported SHS exposure in the household within 7 days prior to data collection. The secondary outcomes were exposure in the past 30 days, knowledge of the health risks of exposure, attitudes towards exposure, right to smoke-free living, women empowerment against smoking, and smoking inside the homes. Results Final assessment was in 329 (89.6% in the intervention group and 309 (85.8% in the comparison group. Following the intervention, significantly lower proportion of women in the intervention group as compared to the control group reported SHS exposure in their households within 7-days (9.2% vs. 15.3%, p = 0.02 and 30-days (13.6% vs. 21.6%, p = 0.008 prior to the post survey. As compared to the control group, significantly higher median scores were observed in the intervention group on the knowledge of the health risks of exposure to SHS (p < 0.001, attitudes on exposure to SHS (p = 0.004, right to smoke free living (p = 0.001 and women empowerment (p < 0.001. Conclusion Multi

  1. The Impacts of Multiple Simultaneous Climate Variations

    2016-12-01

    in the ITCZ and SPCZ, and between the subtropical high and subpolar lows where the extratropical storm tracks occur. Lower PR values tend to occur...especially over and near the maritime continent and Amazon, in the ITCZ and SPCZ, and in the extratropical storm tracks over the North Pacific and...gradient and low tropospheric winds are strong (cf. Figure 9)—for example, between the subtropical highs and subpolar lows where the extratropical storm

  2. Humanizing Outgroups Through Multiple Categorization

    Prati, Francesca; Crisp, Richard J.; Meleady, Rose; Rubini, Monica

    2016-01-01

    In three studies, we examined the impact of multiple categorization on intergroup dehumanization. Study 1 showed that perceiving members of a rival university along multiple versus simple categorical dimensions enhanced the tendency to attribute human traits to this group. Study 2 showed that multiple versus simple categorization of immigrants increased the attribution of uniquely human emotions to them. This effect was explained by the sequential mediation of increased individuation of the outgroup and reduced outgroup threat. Study 3 replicated this sequential mediation model and introduced a novel way of measuring humanization in which participants generated attributes corresponding to the outgroup in a free response format. Participants generated more uniquely human traits in the multiple versus simple categorization conditions. We discuss the theoretical implications of these findings and consider their role in informing and improving efforts to ameliorate contemporary forms of intergroup discrimination. PMID:26984016

  3. Multiple Input - Multiple Output (MIMO) SAR

    National Aeronautics and Space Administration — This effort will research and implement advanced Multiple-Input Multiple-Output (MIMO) Synthetic Aperture Radar (SAR) techniques which have the potential to improve...

  4. Multiple gas reduction strategy

    A. Kurosawa [Institute of Applied Energy, Tokyo (Japan)

    2003-07-01

    Future global warming has a close relationship with the abatement potential of six greenhouse gases (GHGs), including carbon dioxide (CO{sub 2}), methane (CH{sub 4}), nitrous oxide (N{sub 2}O), hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), and sulfur hexafluoride (SF6). Therefore, multiple gas reduction flexibility should be assessed. The emission of each non-CO{sub 2} GHG is calculated endogenously by the sum of the product of the emission factor and the endogenous activity index using an integrated assessment model, GRAPE (Global Relationship Assessment to Protect the Environment). The model consists of five modules dealing with issues on energy, climate, land use, macroeconomics and environmental impacts. The uncertainty in the non-CO{sub 2} GHG emission inventory and emission factors is discussed. 5 refs., 3 figs., 1 tab.

  5. Robust multiple frequency multiple power localization schemes in the presence of multiple jamming attacks.

    Ahmed Abdulqader Hussein

    Full Text Available Localization of the wireless sensor network is a vital area acquiring an impressive research concern and called upon to expand more with the rising of its applications. As localization is gaining prominence in wireless sensor network, it is vulnerable to jamming attacks. Jamming attacks disrupt communication opportunity among the sender and receiver and deeply impact the localization process, leading to a huge error of the estimated sensor node position. Therefore, detection and elimination of jamming influence are absolutely indispensable. Range-based techniques especially Received Signal Strength (RSS is facing severe impact of these attacks. This paper proposes algorithms based on Combination Multiple Frequency Multiple Power Localization (C-MFMPL and Step Function Multiple Frequency Multiple Power Localization (SF-MFMPL. The algorithms have been tested in the presence of multiple types of jamming attacks including capture and replay, random and constant jammers over a log normal shadow fading propagation model. In order to overcome the impact of random and constant jammers, the proposed method uses two sets of frequencies shared by the implemented anchor nodes to obtain the averaged RSS readings all over the transmitted frequencies successfully. In addition, three stages of filters have been used to cope with the replayed beacons caused by the capture and replay jammers. In this paper the localization performance of the proposed algorithms for the ideal case which is defined by without the existence of the jamming attack are compared with the case of jamming attacks. The main contribution of this paper is to achieve robust localization performance in the presence of multiple jamming attacks under log normal shadow fading environment with a different simulation conditions and scenarios.

  6. Methodology for the assessment of the impacts of climate change on land degradation at multiple scales: Use of high resolution satellite imagery, modelling, and ground measurements for the assessment in Ethiopia

    Ahmed, Oumer

    In this study, a new multi-scalar methodology for assessing land degradation response to climate change is presented by analyzing 22 years of both climatic data and satellite observations, together with future projections from modelling, for Ethiopia. A comprehensive analysis of the impacts of climate change on land degradation was performed as evidenced from the integration of a host of land degradation indicators, namely: normalized difference vegetation Index (NDVI), net primary productivity (NPP), crop yield, biomass, length of growing period (LGP), rainfall use efficiency (RUE), energy use efficiency (EUE) and aridity index (AI). The results from the national level assessment indicate that over the period of 1984-2006, NPP decreased overall. Degrading areas occupy 30% of the country and suffer an average loss of NPP 10.3 kg C ha-1 y-1. The crop yield prediction results indicate a wide range of outcomes is to be expected for the country, due to the heterogeneity of the agro-climatic resources as well as of projected climate change. The results of the sub-national level assessment show that about 29% of the Awash watershed is degrading, and these degrading areas experience an average loss of NPP 4.6 kg C ha-1 y-1. Further, about 33.8% of the degrading area in the watershed is associated with bare land and 25% with agricultural land. Finally, since remotely sensed estimates are frequently used to assess land degradation at multiple scales, scale transfer methods are evaluated in this study to provide a tool to rank both upscaling and downscaling procedures.

  7. Genetic variants and multiple myeloma risk

    Martino, Alessandro; Campa, Daniele; Jurczyszyn, Artur

    2014-01-01

    BACKGROUND: Genetic background plays a role in multiple myeloma susceptibility. Several single-nucleotide polymorphisms (SNP) associated with genetic susceptibility to multiple myeloma were identified in the last years, but only a few of them were validated in independent studies. METHODS...... with multiple myeloma risk (P value range, 0.055-0.981), possibly with the exception of the SNP rs2227667 (SERPINE1) in women. CONCLUSIONS: We can exclude that the selected polymorphisms are major multiple myeloma risk factors. IMPACT: Independent validation studies are crucial to identify true genetic risk...

  8. Multiple-Ring Digital Communication Network

    Kirkham, Harold

    1992-01-01

    Optical-fiber digital communication network to support data-acquisition and control functions of electric-power-distribution networks. Optical-fiber links of communication network follow power-distribution routes. Since fiber crosses open power switches, communication network includes multiple interconnected loops with occasional spurs. At each intersection node is needed. Nodes of communication network include power-distribution substations and power-controlling units. In addition to serving data acquisition and control functions, each node acts as repeater, passing on messages to next node(s). Multiple-ring communication network operates on new AbNET protocol and features fiber-optic communication.

  9. Viruses and Multiple Sclerosis

    Virtanen, Jussi Oskari; Jacobson, Steve

    2016-01-01

    Multiple sclerosis (MS) is a heterogeneous disease that develops as an interplay between the immune system and environmental stimuli in genetically susceptible individuals. There is increasing evidence that viruses may play a role in MS pathogenesis acting as these environmental triggers. However, it is not known if any single virus is causal, or rather several viruses can act as triggers in disease development. Here, we review the association of different viruses to MS with an emphasis on two herpesviruses, Epstein-Barr virus (EBV) and human herpesvirus 6 (HHV-6). These two agents have generated the most impact during recent years as possible co-factors in MS disease development. The strongest argument for association of EBV with MS comes from the link between symptomatic infectious mononucleosis and MS and from seroepidemiological studies. In contrast to EBV, HHV-6 has been found significantly more often in MS plaques than in MS normal appearing white matter or non-MS brains and HHV-6 re-activation has been reported during MS clinical relapses. In this review we also suggest new strategies, including the development of new infectious animal models of MS and antiviral MS clinical trials, to elucidate roles of different viruses in the pathogenesis of this disease. Furthermore, we introduce the idea of using unbiased sequence-independent pathogen discovery methodologies, such as next generation sequencing, to study MS brain tissue or body fluids for detection of known viral sequences or potential novel viral agents. PMID:22583435

  10. Generalized internal multiple imaging

    Zuberi, Mohammad Akbar Hosain

    2014-12-04

    Various examples are provided for generalized internal multiple imaging (GIMI). In one example, among others, a method includes generating a higher order internal multiple image using a background Green\\'s function and rendering the higher order internal multiple image for presentation. In another example, a system includes a computing device and a generalized internal multiple imaging (GIMI) application executable in the computing device. The GIMI application includes logic that generates a higher order internal multiple image using a background Green\\'s function and logic that renders the higher order internal multiple image for display on a display device. In another example, a non-transitory computer readable medium has a program executable by processing circuitry that generates a higher order internal multiple image using a background Green\\'s function and renders the higher order internal multiple image for display on a display device.

  11. MultipleColposcopyJCO

    Performing multiple biopsies during a procedure known as colposcopy—visual inspection of the cervix—is more effective than performing only a single biopsy of the worst-appearing area for detecting cervical cancer precursors. This multiple biopsy approach

  12. Salmonella Infections - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Salmonella Infections URL of this page: https://medlineplus.gov/ ... V W XYZ List of All Topics All Salmonella Infections - Multiple Languages To use the sharing features ...

  13. Health Literacy - Multiple Languages

    ... Here: Home → Multiple Languages → All Health Topics → Health Literacy URL of this page: https://medlineplus.gov/languages/ ... W XYZ List of All Topics All Health Literacy - Multiple Languages To use the sharing features on ...

  14. Cosmetic Dentistry - Multiple Languages

    ... Here: Home → Multiple Languages → All Health Topics → Cosmetic Dentistry URL of this page: https://medlineplus.gov/languages/ ... W XYZ List of All Topics All Cosmetic Dentistry - Multiple Languages To use the sharing features on ...

  15. Atrial Fibrillation - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Atrial Fibrillation URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Atrial Fibrillation - Multiple Languages To use the sharing features on ...

  16. Zika Virus - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Zika Virus URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Zika Virus - Multiple Languages To use the sharing features on ...

  17. Elder Abuse - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Elder Abuse URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Elder Abuse - Multiple Languages To use the sharing features on ...

  18. Herbal Medicine - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Herbal Medicine URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Herbal Medicine - Multiple Languages To use the sharing features on ...

  19. Generalized internal multiple imaging

    Zuberi, Mohammad Akbar Hosain; Alkhalifah, Tariq

    2014-01-01

    Various examples are provided for generalized internal multiple imaging (GIMI). In one example, among others, a method includes generating a higher order internal multiple image using a background Green's function and rendering the higher order internal multiple image for presentation. In another example, a system includes a computing device and a generalized internal multiple imaging (GIMI) application executable in the computing device. The GIMI application includes logic that generates a higher order internal multiple image using a background Green's function and logic that renders the higher order internal multiple image for display on a display device. In another example, a non-transitory computer readable medium has a program executable by processing circuitry that generates a higher order internal multiple image using a background Green's function and renders the higher order internal multiple image for display on a display device.

  20. Domestic Violence - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Domestic Violence URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Domestic Violence - Multiple Languages To use the sharing features on ...

  1. Multiple Primary Tumors

    2017-12-05

    Dec 5, 2017 ... Multiple primary tumors occur in clinical practice causing diagnostic dilemma. It is not very .... was estrogen receptor negative, progesterone receptor negative, and ... cervical, ovarian, and urinary bladder cancers. Multiple.

  2. Diabetic Foot - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Diabetic Foot URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Diabetic Foot - Multiple Languages To use the sharing features on ...

  3. Child Abuse - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Child Abuse URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Child Abuse - Multiple Languages To use the sharing features on ...

  4. Fatigue and Multiple Sclerosis

    ... to navigation Skip to content Menu Navigation National Multiple Sclerosis Society Sign In In Your Area Donate Donate ... of MS What Causes MS? Who Gets MS? Multiple Sclerosis FAQs Types of MS Related Conditions Symptoms & Diagnosis ...

  5. Rotavirus Infections - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Rotavirus Infections URL of this page: https://medlineplus.gov/ ... V W XYZ List of All Topics All Rotavirus Infections - Multiple Languages To use the sharing features ...

  6. Neutron Multiplicity Analysis

    Frame, Katherine Chiyoko [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-06-28

    Neutron multiplicity measurements are widely used for nondestructive assay (NDA) of special nuclear material (SNM). When combined with isotopic composition information, neutron multiplicity analysis can be used to estimate the spontaneous fission rate and leakage multiplication of SNM. When combined with isotopic information, the total mass of fissile material can also be determined. This presentation provides an overview of this technique.

  7. Neutron multiplication measurement instrument

    Nixon, K.V.; Dowdy, E.J.; France, S.W.; Millegan, D.R.; Robba, A.A.

    1983-01-01

    The Advanced Nuclear Technology Group of the Los Alamos National Laboratory is now using intelligent data-acquisition and analysis instrumentation for determining the multiplication of nuclear material. Earlier instrumentation, such as the large NIM-crate systems, depended on house power and required additional computation to determine multiplication or to estimate error. The portable, battery-powered multiplication measurement unit, with advanced computational power, acquires data, calculates multiplication, and completes error analysis automatically. Thus, the multiplication is determined easily and an available error estimate enables the user to judge the significance of results

  8. Multiplicity distributions for p-barp collisions

    Huang, D.W.; Yen, E.

    1988-01-01

    The multiplicity distribution for P-barP collisions at √s = 540 GeV is written as the sum of Poisson distributions at different impact parameter b. An energy independent relation between the variable z-bar and b is suggested. With this relation, the multiplicity distributions at √s = 200 and 900 GeV are described well. The distribution at √s = 1600 GeV is predicted

  9. Distributed video coding with multiple side information

    Huang, Xin; Brites, C.; Ascenso, J.

    2009-01-01

    Distributed Video Coding (DVC) is a new video coding paradigm which mainly exploits the source statistics at the decoder based on the availability of some decoder side information. The quality of the side information has a major impact on the DVC rate-distortion (RD) performance in the same way...... the quality of the predictions had a major impact in predictive video coding. In this paper, a DVC solution exploiting multiple side information is proposed; the multiple side information is generated by frame interpolation and frame extrapolation targeting to improve the side information of a single...

  10. Prenatal multiple micronutrient supplementation impact on biochemical indicators during pregnancy and postpartum Efecto de la suplementación prenatal con micronutrimentos múltiples en indicadores bioquímicos durante el embarazo y el posparto

    Armando García-Guerra

    2009-08-01

    Full Text Available OBJECTIVE: The objective of this analysis was to test the impact of daily supplementation with multiple micronutrients (MM during pregnancy on Zn, vitamin A and folate status compared to iron only (Fe. MATERIAL AND METHODS: The study was carried out during 1997-2000 in a semi-urban community in Morelos state, Mexico. Women were randomly assigned to MM (n= 249 or Fe (n= 258 and received supplements daily (6 d/wk under supervision by the field team from recruitment (approximately 9 weeks pregnancy until delivery. Blood samples were collected on a sub-sample of women at baseline, 32 weeks pregnancy and one month postpartum (1PP and assessed for serum zinc, retinol and whole blood folate (baseline and 1PP only. A breast milk sample was extracted at 1PP and assessed for retinol content. RESULT: At baseline there was no significant difference between supplementation groups in mean Zn, retinol or folate concentrations or the prevalence of deficiencies (Zn 12.2%, vitamin A 2.8%, folate 5.3%. Mean change in Zn and retinol concentrations from baseline to 32 weeks pregnancy did not differ between groups or between baseline and 1PP for Zn, retinol or folate. At 1PP, there was a tendency (p= 0.09 towards a lower prevalence of folate deficiency/depletion in the MM group (10.0% than the Fe group (18.5%. CONCLUSIONS: MM supplementation during pregnancy did not improve zinc or vitamin A status compared to Fe only. There is some indication that folate status may have improved with MM supplementation despite low prevalence of deficiency. While lack of response in serum retinol may be explained by generally adequate status, the lack of impact on zinc status requires further exploration.OBJETIVO: Evaluar el efecto de la suplementación diaria con múltiples micronutrimentos (MM durante el embarazo en el estado de zinc, vitamina A y folato comparado con la suplementación sólo con hierro (Fe. MATERIAL Y MÉTODOS: El estudio se realizó en una comunidad semiurbana en

  11. Accurate scaling on multiplicity

    Golokhvastov, A.I.

    1989-01-01

    The commonly used formula of KNO scaling P n =Ψ(n/ ) for descrete distributions (multiplicity distributions) is shown to contradict mathematically the condition ΣP n =1. The effect is essential even at ISR energies. A consistent generalization of the concept of similarity for multiplicity distributions is obtained. The multiplicity distributions of negative particles in PP and also e + e - inelastic interactions are similar over the whole studied energy range. Collider data are discussed. 14 refs.; 8 figs

  12. ALICE Photon Multiplicity Detector

    Nayak, T

    2013-01-01

    Photon Multiplicity Detector (PMD) measures the multiplicity and spatial distribution of photons in the forward region of ALICE on a event-by-event basis. PMD is a pre-shower detector having fine granularity and full azimuthal coverage in the pseudo-rapidity region 2.3 < η < 3.9.

  13. Body Weight - Multiple Languages

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Body Weight URL of this page: https://medlineplus.gov/ ... V W XYZ List of All Topics All Body Weight - Multiple Languages To use the sharing features on this page, ...

  14. Multiplicity in difference geometry

    Tomasic, Ivan

    2011-01-01

    We prove a first principle of preservation of multiplicity in difference geometry, paving the way for the development of a more general intersection theory. In particular, the fibres of a \\sigma-finite morphism between difference curves are all of the same size, when counted with correct multiplicities.

  15. Applying Multiple Intelligences

    Christodoulou, Joanna A.

    2009-01-01

    The ideas of multiple intelligences introduced by Howard Gardner of Harvard University more than 25 years ago have taken form in many ways, both in schools and in other sometimes-surprising settings. The silver anniversary of Gardner's learning theory provides an opportunity to reflect on the ways multiple intelligences theory has taken form and…

  16. Orchestrating Multiple Intelligences

    Moran, Seana; Kornhaber, Mindy; Gardner, Howard

    2006-01-01

    Education policymakers often go astray when they attempt to integrate multiple intelligences theory into schools, according to the originator of the theory, Howard Gardner, and his colleagues. The greatest potential of a multiple intelligences approach to education grows from the concept of a profile of intelligences. Each learner's intelligence…

  17. Assessing Children's Multiplicative Thinking

    Hurst, Chris; Hurrell, Derek

    2016-01-01

    Multiplicative thinking is a "big idea" of mathematics that underpins much of the mathematics learned beyond the early primary school years. This paper reports on a current study that utilises an interview tool and a written quiz to gather data about children's multiplicative thinking. The development of the tools and some of the…

  18. Guiding phosphorus stewardship for multiple ecosystem services

    Phosphorus is vital to agricultural production and water quality regulation. While the role of phosphorus in agriculture and water quality has been studied for decades, the benefits of sustainable phosphorus use and management for society due to its downstream impacts on multiple ecosystem services...

  19. Safe Dynamic Multiple Inheritance

    Ernst, Erik

    2002-01-01

    Multiple inheritance and similar mechanisms are usually only supported at compile time in statically typed languages. Nevertheless, dynamic multiple inheritance would be very useful in the development of complex systems, because it allows the creation of many related classes without an explosion...... in the size and level of redundancy in the source code. In fact, dynamic multiple inheritance is already available. The language gbeta is statically typed and has supported run-time combination of classes and methods since 1997, by means of the combination operator '&'. However, with certain combinations...

  20. A multiplicity logic unit

    Bialkowski, J.; Moszynski, M.; Zagorski, A.

    1981-01-01

    The logic diagram principle of operation and some details of the design of the multiplicity logic unit are presented. This unit was specially designed to fulfil the requirements of a multidetector arrangement for gamma-ray multiplicity measurements. The unit is equipped with 16 inputs controlled by a common coincidence gate. It delivers a linear output pulse with the height proportional to the multiplicity of coincidences and logic pulses corresponding to 0, 1, ... up to >= 5-fold coincidences. These last outputs are used to steer the routing unit working with the multichannel analyser. (orig.)

  1. Fission neutron multiplicity calculations

    Maerten, H.; Ruben, A.; Seeliger, D.

    1991-01-01

    A model for calculating neutron multiplicities in nuclear fission is presented. It is based on the solution of the energy partition problem as function of mass asymmetry within a phenomenological approach including temperature-dependent microscopic energies. Nuclear structure effects on fragment de-excitation, which influence neutron multiplicities, are discussed. Temperature effects on microscopic energy play an important role in induced fission reactions. Calculated results are presented for various fission reactions induced by neutrons. Data cover the incident energy range 0-20 MeV, i.e. multiple chance fission is considered. (author). 28 refs, 13 figs

  2. Multiple sclerosis research

    Battaglia, M.A.

    1990-01-01

    This volume proceedings contains four contributions which are in INIS scope, dealing with MRI and SPECT in the diagnosis of multiple sclerosis and assessment of disease activity. (H.W.). refs.; figs.; tabs

  3. Generalized internal multiple imaging

    Zuberi, M. A. H.; Alkhalifah, Tariq Ali

    2014-01-01

    Internal multiples deteriorate the image when the imaging procedure assumes only single scattering, especially if the velocity model does not have sharp contrasts to reproduce such scattering in the Green’s function through forward modeling

  4. Connecting the Production Multiple

    Lichen, Alex Yu; Mouritsen, Jan

    &OP process itself is a fluid object, but there is still possibility to organise the messy Production. There are connections between the Production multiple and the managerial technology fluid. The fluid enacted the multiplicity of Production thus making it more difficult to be organised because there were...... in opposite directions. They are all part of the fluid object. There is no single chain of circulating references that makes the object a matter of fact. Accounting fluidity means that references drift back and forth and enact new realities also connected to the chain. In this setting future research may......This paper is about objects. It follows post ANT trajectories and finds that objects are multiple and fluid. Extant classic ANT inspired accounting research largely sees accounting inscriptions as immutable mobiles. Although multiplicity of objects upon which accounting acts has been explored...

  5. Multiple sex partner

    User

    intercourse, about 60% reported having a single sexual partner and 40% reported having multiple ... masturbation, start having sex at a younger age, have sex with married people and/or .... sex were considered unacceptable by 89 vs.

  6. Multiple Stages 2

    Andreasen, John

    Multiple stages 2: theatrical futures, set design, community plays, cultural capitals, democracy & drama, WWII dramas, performance on adoption, promenade about emigration, qualities in political theatre, performance analysis, dramaturgical education, Toulmin Variations...

  7. Rehabilitation and multiple sclerosis

    Dalgas, Ulrik

    2011-01-01

    In a chronic and disabling disease like multiple sclerosis, rehabilitation becomes of major importance in the preservation of physical, psychological and social functioning. Approximately 80% of patients have multiple sclerosis for more than 35 years and most will develop disability at some point......, a paradigm shift is taking place and it is now increasingly acknowledged that exercise therapy is both safe and beneficial. Robot-assisted training is also attracting attention in multiple sclerosis rehabilitation. Several sophisticated commercial robots exist, but so far the number of scientific studies...... promising. This drug has been shown to improve walking ability in some patients with multiple sclerosis, associated with a reduction of patients' self-reported ambulatory disability. Rehabilitation strategies involving these different approaches, or combinations of them, may be of great use in improving...

  8. Impact of prior treatment status and reasons for discontinuation on the efficacy and safety of fingolimod: Subgroup analyses of the Fingolimod Research Evaluating Effects of Daily Oral Therapy in Multiple Sclerosis (FREEDOMS) study.

    Kremenchutzky, Marcelo; O'Connor, Paul; Hohlfeld, Reinhard; Zhang-Auberson, Lixin; von Rosenstiel, Philipp; Meng, Xiangyi; Grinspan, Augusto; Hashmonay, Ron; Kappos, Ludwig

    2014-05-01

    Fingolimod is a once-daily, oral sphingosine 1-phosphate receptor modulator approved for the treatment of relapsing multiple sclerosis. This post-hoc analysis of phase 3 FREEDOMS data assessed whether the effects of fingolimod are consistent among subgroups of patients defined by prior treatment history. Annualized relapse rate and safety profile of treatment with fingolimod 0.5mg, 1.25mg, or placebo once-daily for 24 months were analyzed in 1272 relapsing multiple sclerosis patients, by subgroups based on disease-modifying therapy history (treatment-naive; prior interferon-β or glatiramer acetate), reason for discontinuation of prior disease-modifying therapy (unsatisfactory therapeutic response or adverse events), and prior disease-modifying therapy duration. Both fingolimod doses significantly reduced annualized relapse rate in patients that received prior interferon-β or glatiramer acetate, discontinued prior disease-modifying therapy owing to unsatisfactory therapeutic effect, were treatment-naive, or had prior disease-modifying therapy duration of >1-3 years (P≤0.0301 for all comparisons vs placebo). Fingolimod 1.25mg resulted in greater reductions in annualized relapse rate in patients that discontinued prior disease-modifying therapy for adverse events or had prior disease-modifying therapy duration of ≤1 year or >3 years (P≤0.0194 vs placebo). Fingolimod demonstrated similar efficacy in relapsing multiple sclerosis patients regardless of prior treatment history. Clinicaltrials.gov identifier: NCT00289978. © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

  9. Generalized internal multiple imaging

    Zuberi, M. A. H.

    2014-08-05

    Internal multiples deteriorate the image when the imaging procedure assumes only single scattering, especially if the velocity model does not have sharp contrasts to reproduce such scattering in the Green’s function through forward modeling. If properly imaged, internal multiples (internally scattered energy) can enhance the seismic image. Conventionally, to image internal multiples, accurate, sharp contrasts in the velocity model are required to construct a Green’s function with all the scattered energy. As an alternative, we have developed a generalized internal multiple imaging procedure that images any order internal scattering using the background Green’s function (from the surface to each image point), constructed from a smooth velocity model, usually used for conventional imaging. For the first-order internal multiples, the approach consisted of three steps, in which we first back propagated the recorded surface seismic data using the background Green’s function, then crosscorrelated the back-propagated data with the recorded data, and finally crosscorrelated the result with the original background Green’s function. This procedure images the contribution of the recorded first-order internal multiples, and it is almost free of the single-scattering recorded energy. The cost includes one additional crosscorrelation over the conventional single-scattering imaging application. We generalized this method to image internal multiples of any order separately. The resulting images can be added to the conventional single-scattering image, obtained, e.g., from Kirchhoff or reverse-time migration, to enhance the image. Application to synthetic data with reflectors illuminated by multiple scattering (double scattering) demonstrated the effectiveness of the approach.

  10. Neutron source multiplication method

    Clayton, E.D.

    1985-01-01

    Extensive use has been made of neutron source multiplication in thousands of measurements of critical masses and configurations and in subcritical neutron-multiplication measurements in situ that provide data for criticality prevention and control in nuclear materials operations. There is continuing interest in developing reliable methods for monitoring the reactivity, or k/sub eff/, of plant operations, but the required measurements are difficult to carry out and interpret on the far subcritical configurations usually encountered. The relationship between neutron multiplication and reactivity is briefly discussed and data presented to illustrate problems associated with the absolute measurement of neutron multiplication and reactivity in subcritical systems. A number of curves of inverse multiplication have been selected from a variety of experiments showing variations observed in multiplication during the course of critical and subcritical experiments where different methods of reactivity addition were used, with different neutron source detector position locations. Concern is raised regarding the meaning and interpretation of k/sub eff/ as might be measured in a far subcritical system because of the modal effects and spectrum differences that exist between the subcritical and critical systems. Because of this, the calculation of k/sub eff/ identical with unity for the critical assembly, although necessary, may not be sufficient to assure safety margins in calculations pertaining to far subcritical systems. Further study is needed on the interpretation and meaning of k/sub eff/ in the far subcritical system

  11. MULTIPLE SPINAL CANAL MENINGIOMAS

    Nandigama Pratap Kumar

    2016-10-01

    Full Text Available BACKGROUND Meningiomas of the spinal canal are common tumours with the incidence of 25 percent of all spinal cord tumours. But multiple spinal canal meningiomas are rare in compare to solitary lesions and account for 2 to 3.5% of all spinal meningiomas. Most of the reported cases are both intra cranial and spinal. Exclusive involvement of the spinal canal by multiple meningiomas are very rare. We could find only sixteen cases in the literature to the best of our knowledge. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for single lesion. We analysed the literature, with illustration of our case. MATERIALS AND METHODS In September 2016, we performed a literature search for multiple spinal canal meningiomas involving exclusively the spinal canal with no limitation for language and publication date. The search was conducted through http://pubmed.com, a wellknown worldwide internet medical address. To the best of our knowledge, we could find only sixteen cases of multiple meningiomas exclusively confined to the spinal canal. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for solitary intradural extra medullary spinal canal meningioma at D4-D6 level, again presented with spastic quadriparesis of two years duration and MRI whole spine demonstrated multiple intradural extra medullary lesions, which were excised completely and the histopathological diagnosis was transitional meningioma. RESULTS Patient recovered from his weakness and sensory symptoms gradually and bladder and bowel symptoms improved gradually over a period of two to three weeks. CONCLUSION Multiple

  12. The Multiplicative Group Generated by the Lehmer Numbers

    Luca, F.; Porubský, Štefan

    2003-01-01

    Roč. 41, - (2003), s. 122-132 ISSN 0015-0517 Institutional research plan: AV0Z1030915 Keywords : Lehmer numbers * primitive prime divisor * multiplicative subgroup Subject RIV: BA - General Mathematics Impact factor: 0.180, year: 2003

  13. Multiple primary cancer

    Jung, Gyu Sik; Lee, Ouk; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duck

    1989-01-01

    It is rare for one human being to be afflicted with more than one cancer. However with further advances in therapeutic regimens, histopathologic observation, diagnostic modalities, and increased curiosity, there are increasing number of case reports of multiple primary cancer. The present study evaluates 25 histologically confirmed cases of multiple primary cancer from 1974 to 1988 at Kosin Medical Center. The most frequent site of the first primary cancer in male was stomach and in female, uterine cervix. The first primary cancer in female occurred in endocrine-related organs (breast, uterus and thyroid) in 63.6 percent. Synchronous cancers are diagnosed simultaneously or within an interval of about six months and synchronous cancers were 16 out of 25 cases. Metachronous cancers are diagnosed at interval of more than six months. There were 9 metachronous cancers and average interval between the first and second primary cancer was 22.8 months. The incidence of multiple primary cancer was 0.11 percent. The average age was 51.9 years at the time of the first primary cancer (53.1 years in male and 50.3 years in female). CT scan was most helpful in early detection of multiple primary cancers facilitating biopsy and surgery. Multiple primary cancers are beyond the medical curiosity. Early diagnosis of the disease and careful follow-up study, based on an awareness of the possibility of second cancers, will substantially increase the survival of these patients

  14. Impact of prior treatment and depth of response on survival in MM-003, a randomized phase 3 study comparing pomalidomide plus low-dose dexamethasone versus high-dose dexamethasone in relapsed/refractory multiple myeloma

    San Miguel, Jesus F.; Weisel, Katja C.; Song, Kevin W.; Delforge, Michel; Karlin, Lionel; Goldschmidt, Hartmut; Moreau, Philippe; Banos, Anne; Oriol, Albert; Garderet, Laurent; Cavo, Michele; Ivanova, Valentina; Alegre, Adrian; Martinez-Lopez, Joaquin; Chen, Christine; Renner, Christoph; Bahlis, Nizar Jacques; Yu, Xin; Teasdale, Terri; Sternas, Lars; Jacques, Christian; Zaki, Mohamed H.; Dimopoulos, Meletios A.

    2015-01-01

    Pomalidomide is a distinct oral IMiD® immunomodulatory agent with direct antimyeloma, stromal-support inhibitory, and immunomodulatory effects. The pivotal, multicenter, open-label, randomized phase 3 trial MM-003 compared pomalidomide + low-dose dexamethasone vs high-dose dexamethasone in 455 patients with refractory or relapsed and refractory multiple myeloma after failure of bortezomib and lenalidomide treatment. Initial results demonstrated significantly longer progression-free survival and overall survival with an acceptable tolerability profile for pomalidomide + low-dose dexamethasone vs high-dose dexamethasone. This secondary analysis describes patient outcomes by treatment history and depth of response. Pomalidomide + low-dose dexamethasone significantly prolonged progression-free survival and favored overall survival vs high-dose dexamethasone for all subgroups analyzed, regardless of prior treatments or refractory status. Both univariate and multivariate analyses showed that no variable relating to either the number (≤ or > 3) or type of prior treatment was a significant predictor of progression-free survival or overall survival. No cross-resistance with prior lenalidomide or thalidomide treatment was observed. Patients achieving a minimal response or better to pomalidomide + low-dose dexamethasone treatment experienced a survival benefit, which was even higher in those achieving at least a partial response (17.2 and 19.9 months, respectively, as compared with 7.5 months for patients with less than minimal response). These data suggest that pomalidomide + low-dose dexamethasone should be considered a standard of care in patients with refractory or relapsed and refractory multiple myeloma regardless of prior treatment. ClinicalTrials.gov: NCT01311687; EudraCT: 2010-019820-30. PMID:26160879

  15. Cognitive Impairment in Multiple Sclerosis

    Farnaz Etesam

    2014-01-01

    Full Text Available Cognitive impairment can emerge in the earliest phases of multiple sclerosis. It strongly impacts different aspects of Multiple Sclerosis (MS patients' lives, like employment, social relationships and the overall quality of life; thus, its on-time recognition and treatment is mandatory. This paper discusses issues, diagnostic methods and treatment options for cognitive dysfunctions in MS. This paper is a descriptive review of the related studies in the recent 10 years, performing a keyword search in the main databases4T. Cognitive impairment mostly involves aspects of information processing, memory and executive functioning in MS. Neuropsychological tests like MACFIMS and BRB-N are recommended for its assessment. Still, there is no fully efficient treatment for cognitive impairment. Researchers have shown some positive effects, using disease-modifying therapies and cognitive rehabilitation. Depression, pain, fatigue and other factors influencing cognitive functions must be paid attention to4T. Recognizing cognitive impairment as a major symptom for MS, makes studying this subject one of the priorities in dealing with the disease. Therefore, a consecutive research for identification and management of this part of quality of life in MS patients is obligatory4T.4T

  16. The Future Multiple

    Spaniol, Matthew Jon; Rowland, Nicholas James

    2015-01-01

    /value – The original contribution is in demonstrating how plural futures and the singular future co-exist in practice. Thus, an eclipse of the future by futures can only ever be partial. For “futures” to be conceptually potent, “the future” must be at least provisionally believable and occasionally useful. Otherwise......, if “the future” were so preposterous an idea, then “futures” would cease to be a critical alternative to it. Futures needs the future; they are relationally bound together in a multiplicity. This paper considers what such a logical reality implies for a field that distances itself from the future and self......). Multiplicity, as a post-ANT sensibility, helps one make sense of the empirical materials. This paper examines the possibility that rather than being alternatives to one another, plural futures and the singular future might co-exist in practice, and, thus, constitute a multiplicity. Design...

  17. Hadron multiplicities at COMPASS

    Du Fresne von Hohenesche, Nicolas [Institut fuer Kernphysik, Universitaet Mainz, Johann-Joachim-Becher-Weg 45, 55128 Mainz (Germany); Collaboration: COMPASS Collaboration

    2014-07-01

    Quark fragmentation functions (FF) D{sub q}{sup h}(z,Q{sup 2}) describe final-state hadronization of quarks q into hadrons h. The FFs can be extracted from hadron multiplicities produced in semi-inclusive deep inelastic scattering. The COMPASS collaboration has recently measured charged hadron multiplicities for identified pions and kaons using a 160 GeV/c muon beam impinging on an iso-scalar target. The data cover a large kinematical range and provide an important input for global QCD analyses of world data at NLO, aiming at the determination of FFs in particular in the strange quark sector. The newest results from COMPASS on pion and kaon multiplicities will be presented.

  18. Multiplicities and parton dynamics

    Knuteson, R.O.

    1987-01-01

    The production of strongly interacting particles from the annihilation of electrons and positrons at high energies is studied, with emphasis on the multiplicity, or number, of particles produced. A probabilistic branching model based on the leading log approximation in QCD is formulated to predict the evolution of particle number with the energy of collision. Direct integration of a master equation for the probabilities allows a comparison to the experimentally observed particle distribution. The production of strongly interacting particles from proton-antiproton collisions is also considered. A model for the production of particles from parton-parton collisions is presented and the growth in multiplicity with energy demonstrated

  19. Sentencing Multiple Crimes

    Most people assume that criminal offenders have only been convicted of a single crime. However, in reality almost half of offenders stand to be sentenced for more than one crime.The high proportion of multiple crime offenders poses a number of practical and theoretical challenges for the criminal......, and psychology offer their perspectives to the volume. A comprehensive examination of the dynamics involved with sentencing multiple offenders has the potential to be a powerful tool for legal scholars and professionals, particularly given the practical importance of the topic and the relative dearth of research...

  20. High-multiplicity processes

    Shelkov, G.; Sisakyan, A.; Mandzhavidze, I.

    1999-01-01

    We wish to demonstrate that investigation of asymptotically high multiplicity (AHM) hadron reactions may solve, or at least clear up, a number of problems unsolvable by other ways. We would lean upon the idea: (i) the reactions final state entropy is proportional to multiplicity and, by this reason, just in the AHM domain one may expect the equilibrium final state and (ii) the AHM final state is cold because of the energy-momentum conservation laws. This means that the collective phenomena may become important in the AHM domain. The possibility of hard processes dominance is considered also

  1. Rise of mean multiplicity depending on transverse momentum

    Troshin, S.M.

    1977-01-01

    Dependence of mean multiplicity on the transversal momentum transfer is studied. In framework of the model in view, based on possible probabilitic interpretation of the unitarity condition, and assuming a weak correlation between the recoil particle momenta in the intermediate n-particle state, it is shown that mean multiplicity increases linearly with rise of the transversal momentum. Behaviour of the mean multiplicity depending on the impact parameter is also studied

  2. The relationship between multiple intelligence profiles and reading ...

    This study is thereby built on the premise that EFL readers' metacognitive awareness of reading strategies was also influenced by their multiple intelligence profiles. The purpose of this study is to explore the integrated impact of multiple intelligences and reading strategies on EFL learners' reading performance. This was an ...

  3. Failure analysis of multiple delaminated composite plates due

    The present work aims at the first ply failure analysis of laminated composite plates with arbitrarily located multiple delaminations subjected to transverse static load as well as impact. The theoretical formulation is based on a simple multiple delamination model. Conventional first order shear deformation is assumed using ...

  4. Response of secondary production and its components to multiple stressors in nematode field populations.

    Doroszuk, A.; Brake, te E.; Crespo-Gonzalez, D.; Kammenga, J.E.

    2007-01-01

    Realistic measures of the impact of individual or multiple stressors are important for ecological risk assessment. Although multiple anthropogenic stressors are common in human-dominated environments, knowledge of their influence on functional population parameters such as secondary production (P)

  5. [Delivery in multiple pregnancies].

    Colla, F; D'Addato, F; Grio, R

    2001-04-01

    A knowledge of clinical physiognomy in pathologies related to multiple births is indispensable for improving maternal and feto-neonatal prognosis. This study is a contribution to the solution of this problem. A meta-analysis of data for multiple births at Department B of the Gynecology and Obstetrics Clinic at the University of Turi during the decade 1989-1998 was carried out, focusing on the arrangement and presentation of fetuses, the various types of birth, the gestational age at which birth occurred, the weight of neonates, neonatal mortality and maternal morbidity. Out of 11,523 births, there were a total of 194 (1.68%) multiple births, including 190 sets of twins and 4 triplets. 154 (79.38%) premature births were reported; 20 occurred 1500 g). The perinatal mortality rate was 3.82%. Maternal complications mainly occurred during the placental state, in the immediate postpartum and in puerperio. The authors feel that a more careful medical and social assistance, preventive hospitalisation, early recognition of the risk, constant monitoring for the optimal timing of birth, and lastly, qualified medical assistance during labour (expert gynecologist, trained obstetric staff) with other medical personnel (anesthetist, neonatal specialist) represent winning strategies to solve the problems arising during multiple pregnancies.

  6. Multiple Primary Tumors

    2018-02-07

    Feb 7, 2018 ... breast and ascending colon. KEYWORDS: Carcinoid, colorectal cancer, metachronous, synchronous. Multiple Primary Tumors. MA Adeyanju, AA Ilori. Address for correspondence: Dr. MA Adeyanju,. Department of Surgery, Federal Medical Centre, Ebute Metta,. Lagos, Nigeria. E-mail: mbadeyanju@yahoo.

  7. Back Pain - Multiple Languages

    ... List of All Topics All Back Pain - Multiple Languages To use the sharing features on this page, please enable JavaScript. Arabic (العربية) ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated on 31 May 2018

  8. Anemia - Multiple Languages

    ... XYZ List of All Topics All Anemia - Multiple Languages To use the sharing features on this page, please enable JavaScript. Arabic (العربية) ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated on 30 April 2018

  9. Allergy - Multiple Languages

    ... XYZ List of All Topics All Allergy - Multiple Languages To use the sharing features on this page, please enable JavaScript. Arabic (العربية) ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated on 23 May 2018

  10. Alcohol - Multiple Languages

    ... XYZ List of All Topics All Alcohol - Multiple Languages To use the sharing features on this page, please enable JavaScript. Arabic (العربية) ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated on 16 April 2018

  11. Immunomodulation of multiple myeloma.

    Tohnya, Tanyifor M; Figg, William D

    2004-11-01

    Multiple myeloma is a multi-process disease, and these different processes are responsible for the reduced sensitivity to chemotherapy and radiotherapy, hence the relapse and refractory nature of multiple myeloma. Emphasis is now placed on the hypothesis that myeloma cell growth, inhibition of apoptosis and drug resistance are dependent on immunomodulatory cytokines such as IL-6 and pro-angiogenic factors such as VEGF. In addition to its anti-angiogenic effects, the immunomodulatory properties of thalidomide make it a possible therapy for patients with advanced multiple myeloma. This has lead to the clinical development of a number of immunomodulatory thalidomide analogues (IMiDs) which are more potent and have less side effects than the parent drug, thalidomide. In the August 15(th) issue of Journal of Clinical Oncology, Schey SA et al. suggested that an IMiD (CC-4047) maybe efficacious due to T-cell co-stimulation, and safe in patients with relapsed or refractory multiple myeloma. This article demonstrates a supporting role for IMiDs as immunomodulatory adjuvant therapy.

  12. Seizures in multiple sclerosis

    Koch, Marcus; Uyttenboogaart, Maarten; Polman, Susan; De Keyser, Jacques

    Seizures have long been recognized to be part of the disease spectrum of multiple sclerosis (MS). While they occur in only a minority of patients with MS, epileptic seizures can have serious consequences. The treatment of MS can be epileptogenic, and antiepileptic treatment can conversely worsen the

  13. Multiple Primary Cancer Monograph

    To identify groups of cancer survivors that are at increased risk for multiple primary cancers, investigators led an effort to provide the first comprehensive population-based analysis of the risk of subsequent cancer in the U.S., resulting in a monograph.

  14. Reduced multiplication modules

    if M is a von Neumann regular module (VNM); i.e., every principal submodule of M is a summand submodule. Also if M is an injective R-module, then M is a VNM. Keywords. Multiplication module; reduced module; minimal prime submodule;. Zariski topology; extremally disconnected. 1. Introduction. In this paper all rings are ...

  15. Zinc in multiple sclerosis

    Bredholt, Mikkel; Fredriksen, Jette Lautrup

    2016-01-01

    In the last 35 years, zinc (Zn) has been examined for its potential role in the disease multiple sclerosis (MS). This review gives an overview of the possible role of Zn in the pathogenesis of MS as well as a meta-analysis of studies having measured Zn in serum or plasma in patients with MS...

  16. Visualizing Matrix Multiplication

    Daugulis, Peteris; Sondore, Anita

    2018-01-01

    Efficient visualizations of computational algorithms are important tools for students, educators, and researchers. In this article, we point out an innovative visualization technique for matrix multiplication. This method differs from the standard, formal approach by using block matrices to make computations more visual. We find this method a…

  17. Multiple photon resonances

    Elliott, C.J.; Feldman, B.J.

    1979-02-01

    A detailed theoretical analysis is presented of the interaction of intense near-resonant monochromatic radiation with an N-level anharmonic oscillator. In particular, the phenomenon of multiple photon resonance, the process by which an N-level system resonantly absorbs two or more photons simultaneously, is investigated. Starting from the Schroedinger equation, diagrammatic techniques are developed that allow the resonant process to be analyzed quantitatively, in analogy with well-known two-level coherent phenomena. In addition, multiple photon Stark shifts of the resonances, shifts absent in two-level theory, are obtained from the diagrams. Insights into the nature of multiple photon resonances are gained by comparing the quantum mechanical system with classical coupled pendulums whose equations of motion possess identical eigenvalues and eigenvectors. In certain limiting cases, including that of the resonantly excited N-level harmonic oscillator and that of the equally spaced N-level system with equal matrix elements, analytic results are derived. The influence of population relaxation and phase-disrupting collisions on the multiple photon process are also analyzed, the latter by extension of the diagrammatic technique to the density matrix equations of motion. 11 figures

  18. Multiple plots in R

    Edwards, Stefan McKinnon

    2012-01-01

    In this chapter I will investigate how to combine multiple plots into a single. The scenario is a dataset of a series of measurements, on three samples in three situations. There are many ways we can display this, e.g. 3d graphs or faceting. 3d graphs are not good for displaying static data so we...

  19. Vaccines and multiple sclerosis

    Frederiksen, J. L.; Topsøe Mailand, M.

    2017-01-01

    An association between certain vaccinations and onset or relapse of multiple sclerosis (MS) has been debated. Based on PubMed, we made a thorough literature review and included all relevant studies, 51 on MS and 15 on optic neuritis (ON). Case studies were excluded. With the exception of a live...

  20. Vaccines and multiple sclerosis

    Mailand, Mia Topsøe; Frederiksen, Jette Lautrup

    2017-01-01

    on the database PubMed. The study found no change in risk of developing multiple sclerosis (MS) after vaccination against hepatitis B virus, human papillomavirus, seasonal influenza, measles–mumps–rubella, variola, tetanus, Bacillus Calmette-Guérin (BCG), polio, or diphtheria. No change in risk of relapse...

  1. Radiation Therapy - Multiple Languages

    ... W XYZ List of All Topics All Radiation Therapy - Multiple Languages To use the sharing features on this page, ... Information Translations Vietnamese (Tiếng Việt) Expand Section Radiation Therapy - Tiếng Việt (Vietnamese) ... Health Information Translations Characters not displaying correctly on this page? See language display issues . Return to the MedlinePlus Health Information ...

  2. Mastering the Multiplication Facts

    D'Ettorre, Jenna

    2009-01-01

    The purpose of this paper is to share the results of a six-week research project (after baseline data was collected) that focused on three different strategies (flashcards, interactive games, and music) and their effectiveness in helping fifth grade students memorize the basic multiplication facts. Many teachers face a serious problem when their…

  3. The Border Multiple

    of European borders by looking at border practices in the light of the mobility turn, and thus as dynamic, multiple, diverse and best expressed in everyday experiences of people living at and with borders, rather than focusing on static territorial divisions between states and regions at geopolitical level...

  4. Asthma - Multiple Languages

    ... XYZ List of All Topics All Asthma - Multiple Languages To use the sharing features on this page, please enable JavaScript. Arabic (العربية) ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated on 2 May 2018

  5. Multiple preequilibrium decay processes

    Blann, M.

    1987-11-01

    Several treatments of multiple preequilibrium decay are reviewed with emphasis on the exciton and hybrid models. We show the expected behavior of this decay mode as a function of incident nucleon energy. The algorithms used in the hybrid model treatment are reviewed, and comparisons are made between predictions of the hybrid model and a broad range of experimental results. 24 refs., 20 figs

  6. Multiple Access Communications

    This book constitutes the proceedings of the 9th International Workshop on Multiple Access Communications, MACOM 2016, held in Aalborg, Denmark, in November 2016. The 10 full papers presented in this volume were carefully reviewed and selected from 12 submissions. They were organized in topical...

  7. Multiple chemical sensitivity

    Tran, Marie Thi Dao; Arendt-Nielsen, Lars; Kupers, Ron

    2013-01-01

    BACKGROUND: Multiple Chemical Sensitivity (MCS) is a chronic condition characterized by recurrent, non-specific symptoms in response to chemically unrelated exposures in non-toxic concentrations. Although the pathophysiology of MCS remains unknown, central sensitization may be an important factor...

  8. Multiple Chemical Sensitivity

    Junge, Anne Gram

    Et voksende antal mennesker i Danmark oplever at være overfølsomme over for dufte og kemikalier. Imidlertid er den tilskrevne diagnose Multiple Chemical Sensitivity (MCS) ikke medicinsk anerkendt i Danmark pga. mangel på organiske og patofysiologisk basis for symptomerne. Dette speciale bygger på...

  9. Fast matrix multiplication and its algebraic neighbourhood

    Pan, V. Ya.

    2017-11-01

    Matrix multiplication is among the most fundamental operations of modern computations. By 1969 it was still commonly believed that the classical algorithm was optimal, although the experts already knew that this was not so. Worldwide interest in matrix multiplication instantly exploded in 1969, when Strassen decreased the exponent 3 of cubic time to 2.807. Then everyone expected to see matrix multiplication performed in quadratic or nearly quadratic time very soon. Further progress, however, turned out to be capricious. It was at stalemate for almost a decade, then a combination of surprising techniques (completely independent of Strassen's original ones and much more advanced) enabled a new decrease of the exponent in 1978-1981 and then again in 1986, to 2.376. By 2017 the exponent has still not passed through the barrier of 2.373, but most disturbing was the curse of recursion — even the decrease of exponents below 2.7733 required numerous recursive steps, and each of them squared the problem size. As a result, all algorithms supporting such exponents supersede the classical algorithm only for inputs of immense sizes, far beyond any potential interest for the user. We survey the long study of fast matrix multiplication, focusing on neglected algorithms for feasible matrix multiplication. We comment on their design, the techniques involved, implementation issues, the impact of their study on the modern theory and practice of Algebraic Computations, and perspectives for fast matrix multiplication. Bibliography: 163 titles.

  10. CDW-EIS calculations for multiple ionization of Ne, Ar, Kr and Xe by the impact of H{sup +} and He{sup +}, including post-collisional electron emission

    Montanari, C C; Miraglia, J E [Instituto de AstronomIa y FIsica del Espacio, casilla de correo 67, sucursal 28, C1428EGA, Buenos Aires (Argentina); Montenegro, E C, E-mail: mclaudia@iafe.uba.a [Instituto de FIsica, Universidade Federal de Rio de Janeiro, Caixa Postal 68528, Rio de Janeiro 21945-970, RJ (Brazil)

    2010-08-28

    We present theoretical single to quintuple ionization cross sections for Ne, Ar, Kr and Xe bombarded by H{sup +} and He{sup +}. Post-collisional contributions due to Auger-like processes are taken into account using recent photoionization data. The present continuum distorted wave-eikonal initial state (CDW-EIS) and first Born approximation results are compared with the experimental data available in the energy range of 50-10 000 keV amu{sup -1} for H{sup +} on Ne and Ar, and 50-1000 keV amu{sup -1} for the other cases. In general, the combination of the CDW-EIS with the post-collisional branching ratios describes well the multiple ionization data above 300 keV amu{sup -1}, showing a clear tendency to coalesce with the first Born approximation at high energies. The surprising result of this work is the good performance of the first Born approximation which describes rather well the experimental data of double and triple ionization, even in the intermediate energy range (50-300 keV amu{sup -1}), where direct ionization is the dominant contribution.

  11. The multiple Dirichlet product and the multiple Dirichlet series

    Onozuka, Tomokazu

    2016-01-01

    First, we define the multiple Dirichlet product and study the properties of it. From those properties, we obtain a zero-free region of a multiple Dirichlet series and a multiple Dirichlet series expression of the reciprocal of a multiple Dirichlet series.

  12. Computing multiple-output regression quantile regions

    Paindaveine, D.; Šiman, Miroslav

    2012-01-01

    Roč. 56, č. 4 (2012), s. 840-853 ISSN 0167-9473 R&D Projects: GA MŠk(CZ) 1M06047 Institutional research plan: CEZ:AV0Z10750506 Keywords : halfspace depth * multiple-output regression * parametric linear programming * quantile regression Subject RIV: BA - General Mathematics Impact factor: 1.304, year: 2012 http://library.utia.cas.cz/separaty/2012/SI/siman-0376413.pdf

  13. [Supporting parenting in families with multiple problems].

    Le Foll, Julie

    2015-01-01

    Supporting parenthood in families with multiple problems is a major early prevention challenge. Indeed, the factors of vulnerability, especially if they mount up, expose the child to an increased risk of a somatic pathology, developmental delays, learning difficulties and maltreatment. In order to limit the impact of these vulnerabilities on the health of mothers and infants, it is essential to act early, to adapt the working framework and to collaborate within a network. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Galois connection for multiple-output operations

    Jeřábek, Emil

    2018-01-01

    Roč. 79 (2018), č. článku 17. ISSN 0002-5240 EU Projects: European Commission(XE) 339691 - FEALORA Institutional support: RVO:67985840 Keywords : clones and coclones * Galois connection * multiple-output operations Subject RIV: BA - General Mathematics OBOR OECD: Pure mathematics Impact factor: 0.625, year: 2016 https://link.springer.com/ article /10.1007%2Fs00012-018-0499-7

  15. Galois connection for multiple-output operations

    Jeřábek, Emil

    2018-01-01

    Roč. 79, č. 2 (2018), č. článku 17. ISSN 0002-5240 EU Projects: European Commission(XE) 339691 - FEALORA Institutional support: RVO:67985840 Keywords : clones and coclones * Galois connection * multiple-output operations Subject RIV: BA - General Mathematics OBOR OECD: Pure mathematics Impact factor: 0.625, year: 2016 https://link.springer.com/article/10.1007%2Fs00012-018-0499-7

  16. Chronic progressive multiple sclerosis

    Buffoli, A.; Micheletti, E.; Capra, R.; Mattioli, F.; Marciano', N.

    1991-01-01

    A long-lasting immunological suppression action seems to be produced by total lymphoid irradiation; some authors emphasize the favorable effect of this treatment on chronic progressive multiple sclerosis. In order to evaluate the actual role of TLI, 6 patients affected with chronic progressive multiple sclerosis were submitted to TLI with shaped and personalized fields at the Istituto del Radio, University of Brescia, Italy. The total dose delivered was 19.8 Gy in 4 weeks, 1.8 Gy/day, 5d/w; a week elapsed between the first and the second irradiation course. Disability according to Kurtzke scale was evaluated, together with blood lymphocyte count and irradiation side-effects, over a mean follow-up period of 20.8 months (range: 13-24). Our findings indicate that: a) disease progression was not markedly reduced by TLI; b) steroid hormones responsivity was restored after irradiation, and c) side-effects were mild and tolerable

  17. Curability of Multiple Myeloma

    Raymond Alexanian

    2012-01-01

    Full Text Available Among 792 patients with multiple myeloma treated from 1987 to 2010 and assessed after 18 months, there were 167 patients with complete remission. For those 60 patients treated between 1987–1998 and with long followup, the latest relapse occurred after 11.8 years, so that 13 patients have remained in sustained complete remission for longer than 12 years (range 12–22 years. These results suggest that 3% of all patients treated during that period may be cured of multiple myeloma. In addition to immunofixation, more sensitive techniques for the detection of residual disease should be applied more consistently in patients with apparent complete remission in order to identify those with potential cure.

  18. Multiple time scale dynamics

    Kuehn, Christian

    2015-01-01

    This book provides an introduction to dynamical systems with multiple time scales. The approach it takes is to provide an overview of key areas, particularly topics that are less available in the introductory form.  The broad range of topics included makes it accessible for students and researchers new to the field to gain a quick and thorough overview. The first of its kind, this book merges a wide variety of different mathematical techniques into a more unified framework. The book is highly illustrated with many examples and exercises and an extensive bibliography. The target audience of this  book are senior undergraduates, graduate students as well as researchers interested in using the multiple time scale dynamics theory in nonlinear science, either from a theoretical or a mathematical modeling perspective. 

  19. Suicide and multiple sclerosis

    Stenager, E N; Stenager, Egon; Koch-Henriksen, N

    1992-01-01

    In a nationwide investigation the risk of death by suicide for patients with multiple sclerosis (MS) was assessed using records kept at the Danish Multiple Sclerosis Registry (DMSR) and the Danish National Register of Cause of Death. The investigation covers all MS patients registered with DSMR...... with an onset of the disease within the period 1953-85, or for whom MS was diagnosed in the same period. Fifty three of the 5525 cases in the onset cohort group committed suicide. Using the figures from the population death statistics by adjustment to number of subjects, duration of observation, sex, age......, and calendar year at the start of observation, the expected number of suicides was calculated to be nearly 29. The cumulative lifetime risk of suicide from onset of MS, using an actuarial method of calculation, was 1.95%. The standard mortality ratio (SMR) of suicide in MS was 1.83. It was highest for males...

  20. Multiple splenic abscesses

    Harish Kumar

    2015-01-01

    Full Text Available Splenic abscess is a rare clinical entity with poor prognosis. But owing to imaging technique, diagnosis and prognosis have improved nowadays. Most patients who are presented with splenic abscess are immunocompromised due to predisposing risk factors like diabetes mellitus, intravenous drug abuse, trauma, bacterial endocarditis, human immunodeficiency virus (HIV, chemotherapy, or steroids. Here, we are presenting a rarer case of multiple splenic abscesses with its complication in an immunocompetent healthy adult male without any risk factor.

  1. Multiple Employer Welfare Arrangements

    1992-01-01

    Sponsors in the Private Nonfarm Sector in the United States, 1978-79," Volume IV, Description and Analysis of Plans and Plan Sponsors, NTIS # PB81-180366...Labor finds to be collectively bargained plans, and those organized by rural electrical cooperatives and rural telephone cooperatives. Thus, except for...their existence and generally higher cost than uninsured plans no doubt contributed to the development of other types of multiple employer

  2. Treatment of Multiple Sclerosis

    Bošnjak-Pašić, Marija; Vidrih, Branka; Miškov, Snježana; Demarin, Vida

    2009-01-01

    Multiple sclerosis is an autoimmune inflammatory demyelinating disease of the central nervous system, characterized by multifocal inflammatory destruction of myelin, axonal damage and loss of oligodendrocytes. The disease is carried through two stages: inflammatory and degenerative. The most common form of disease in approximately 85% of the cases is RRMS (relapsing-remitting form). The treatment of MS is divided into: treatment of the acute phase of illness, prevention of new relapses and di...

  3. Multiple trichodiscomas: histogenetical observations.

    Requena, L; Schöendorff, C; López, M J; Yus, E S

    1991-02-01

    A 23-year-old man with multiple trichodiscomas on his face is described. Four papules were histologically examinated, and all of them showed similar findings, a dermal fibrovascular proliferation with abundant ground substance between collagen bundles and an absence of elastic fibers. We found no evidence to establish a relationship between trichodiscomas and hair disk, and, in our opinion, these lesions should be included into the spectrum of hyperplasia of the adventicial dermis.

  4. Multiple lymphatic cervical cysts

    Jordan, J.; Piotrowski, S.; Zalewska-Rzezniczak, I.

    1994-01-01

    Authors described a case of 60 year-old woman with multiple lateral neck cysts. 4 cysts were located in the supraclavicular region of lateral neck triangle. During histopathological studies of postoperative specimens a cystic hygroma diagnosis was established. The fact, that cystic lymphangioma occurred in an adult woman, was interesting. The authors stress the necessity of preoperative evaluation of tumor size in view of the possibility of its penetration into the thorax. The CT examination may be useful in these cases. (author)

  5. Midkine and multiple sclerosis

    Takeuchi, Hideyuki

    2014-01-01

    Multiple sclerosis (MS) is an autoimmune neurological disease characterized by inflammatory demyelination with subsequent neuronal damage in the CNS. MS and its animal model, experimental autoimmune encephalomyelitis (EAE), have been thought as autoreactive Th1 and Th17 cell-mediated diseases. CD4+CD25+FoxP3+ regulatory T-cell (Treg) plays a pivotal role in autoimmune tolerance, and tolerogenic dendritic cells (DCreg) drive the development of inducible Treg cells. Thus, a dysfunction in the d...

  6. Multiple myeloma: 45 cases

    Yang, Hee Chul; Suh, Jin Suck; Park, Chang Yun

    1990-01-01

    We evaluated 45 cases of multiple myelomas retrospectively confirmed in Severance Hospital from the period of 1983-1989. In order to assess the radiologic features of the multiple myeloma and to assist in possible early diagnosis and treatment. The result were as follows: 1. IgG(41%) was the most common immunoglobulin type secreted followed by light chain(36%). IgA(19%) and IgD(2%). Two percent of the patients had non-secretory type. 89% of patients were in their stage III of the disease. 2. Among the 45 patients, 96% had abnormal plain radiographic findings with average number of 4.5 lesions. Common sites were the spine, rib, skull, pelvis, and humerus in descending orders. The findings were localized or diffuse osteolytic bone destruction(85%). osteoporosis(49%), pathologic fracture and endosteal scalloping(55%). Osteoporosis was more prominent in stage III than stage II. 3. Both plain X-ray and radioisotope study was available for comparison in 28 patients. Concordance between the two studies were 44%, lesions detected only on plain X-ray film were 51%, and lesions detected only on the radioisotope were 5%. The plain radiography was able to detect only 54% of bone lesions confirmed by bone marrow biopsy. With the above results, accurate evaluation of bone lesions in multiple myeloma may be difficult with radiologic studies only. But familiarity with these radiologic findings of the this disease entity is necessary for early suspicion of the disease, thus for early diagnosis and treatment

  7. Falls in multiple sclerosis.

    Matsuda, Patricia N; Shumway-Cook, Anne; Bamer, Alyssa M; Johnson, Shana L; Amtmann, Dagmar; Kraft, George H

    2011-07-01

    To examine incidence, associated factors, and health care provider (HCP) response to falls in persons with multiple sclerosis (MS). Cross-sectional retrospective design. Community setting. Four hundred seventy-four persons with MS. Mailed survey questionnaire examined incidence, risk factors, and HCP response to falls in persons with MS who were dwelling in the community. Univariate and multiple ordinal regression analysis identified variables associated with single and multiple falls. Falls, causes and perceived reasons for falls, and HCP response. A total of 265 participants (58.2%) reported one or more falls in the previous 6 months, and 58.5% of falls were medically injurious. Trips/slips while walking accounted for 48% of falls. Factors associated with falls included use of a cane or walker (odds ratio [OR] 2.62; 95% confidence interval [CI] 1.66-4.14), income falls; recommended strategies included safety strategies (53.2%), use of gait assistive devices (42.1%), exercise/balance training (22.2%), and home modifications (16.6%). Factors associated with falls in persons with MS are similar to those in other populations with neurologic diseases. Despite the high incidence of falls, fewer than 50% of people with MS receive information about prevention of falls from an HCP. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  8. Rehabilitation in multiple sclerosis.

    Kubsik-Gidlewska, Anna M; Klimkiewicz, Paulina; Klimkiewicz, Robert; Janczewska, Katarzyna; Woldańska-Okońska, Marta

    2017-07-01

    The aim of the study is to present a strategy of rehabilitation in multiple sclerosis on the basis of the latest developments in the field of physiotherapy. The publications on the problem discuss a wide range of methods of physiotherapy that can be used in order to reduce the degree of disability and alleviate the symptoms associated with the disease. The complexity of the disease, the difficulty in determining the appropriate treatment and a wide range of symptoms require a comprehensive approach to the patient, which would include both pharmacology and neurorehabilitation. Rehabilitation, which includes psychotherapy and symptomatic therapy, is regarded nowadays as the best form of treatment for multiple sclerosis. An indepth diagnostic assessment of functional status and prognosis should be carried out before the start of the rehabilitation process. The prognosis should take into account the mental state, the neurological status and the awareness of the patient. The kinesiotherapy program in multiple sclerosis is based on a gradation of physiotherapy which assumes a gradual transition from basic movements to more complex ones till global functions are obtained. The most appropriate form of treatment is functional rehabilitation combined with physical procedures. Recent reports indicate the need for aerobic training to be included in the rehabilitation program. The introduction of physical activities, regardless of the severity of the disease, will reduce the negative effects of akinesia, and thus increase the functional capabilities of all body systems.

  9. Multiples waveform inversion

    Zhang, Dongliang

    2013-01-01

    To increase the illumination of the subsurface and to eliminate the dependency of FWI on the source wavelet, we propose multiples waveform inversion (MWI) that transforms each hydrophone into a virtual point source with a time history equal to that of the recorded data. These virtual sources are used to numerically generate downgoing wavefields that are correlated with the backprojected surface-related multiples to give the migration image. Since the recorded data are treated as the virtual sources, knowledge of the source wavelet is not required, and the subsurface illumination is greatly enhanced because the entire free surface acts as an extended source compared to the radiation pattern of a traditional point source. Numerical tests on the Marmousi2 model show that the convergence rate and the spatial resolution of MWI is, respectively, faster and more accurate then FWI. The potential pitfall with this method is that the multiples undergo more than one roundtrip to the surface, which increases attenuation and reduces spatial resolution. This can lead to less resolved tomograms compared to conventional FWI. The possible solution is to combine both FWI and MWI in inverting for the subsurface velocity distribution.

  10. Patients with multiple contact allergies

    Carlsen, Berit Christina; Andersen, Klaus Ejner; Menné, Torkil

    2008-01-01

    Patients with multiple contact allergies, also referred to as polysensitized, are more frequent than predicted from prevalence of single sensitivities. The understanding of why some people develop multiple contact allergies, and characterization of patients with multiple contact allergies...... of developing multiple contact allergies. Evidence of allergen clusters among polysensitized individuals is also reviewed. The literature supports the idea that patients with multiple contact allergies constitute a special entity within the field of contact allergy. There is no generally accepted definition...... of patients with multiple contact allergies. We suggest that contact allergy to 3 or more allergens are defined as multiple contact allergies....

  11. Impact of the Internet.

    Balajthy, Ernest

    1997-01-01

    Discusses the impact and the potential of the Internet on education. Suggests that educators and parents need to deal with the lack of quality assurance of the Internet. Addresses readability and appropriateness for children. Notes that successful use of the Internet by children requires that teachers provide instruction in multiple sources and…

  12. Multiple Entity Reconciliation

    Samoila, Lavinia Andreea

    2015-01-01

    Living in the age of "Big Data" is both a blessing and a curse. On he one hand, the raw data can be analysed and then used for weather redictions, user recommendations, targeted advertising and more. On he other hand, when data is aggregated from multiple sources, there is no guarantee that each source has stored the data in a standardized or even compatible format to what is required by the application. So there is a need to parse the available data and convert it to the desired form. Here i...

  13. The Border Multiple

    Addressing and conceptualizing the changing character of borders in contemporary Europe, this book examines developments occurring in the light of European integration processes and an on-going tightening of Europe's external borders. Moreover, the book suggests new ways of investigating the nature...... of European borders by looking at border practices in the light of the mobility turn, and thus as dynamic, multiple, diverse and best expressed in everyday experiences of people living at and with borders, rather than focusing on static territorial divisions between states and regions at geopolitical level...

  14. Multiple Chemical Sensitivity

    Dantoft, Thomas Meinertz

    Multiple chemical sensitivity (MCS) is a chronic disorder characterized by reports of symptoms from various organ systems attributed by the individuals to exposure to common odors and airborne chemicals in doses far below those known to induce toxic effects. There exists a general lack of knowledge......, significantly reduced levels of IL-13 in the MCS group and no group differences in the allergen specific IgE measures. The differences were independent of factors such as sex, age, Body Mass Index, asthma, smoking, depression, anxiety and allergen-specific IgE. In conclusion, the study identified a distinct...

  15. INDIA: Photon multiplicity detector

    Anon.

    1995-01-01

    Full text: The team of Indian scientists from Calcutta's Variable Energy Cyclotron Centre, Bhubaneswar Institute of Physics, Panjab (Chandigarh), Rajasthan (Jaipur) and Jammu in collaboration with GSI Darmstadt have contributed a large and highly granular preshower photon multiplicity detector (PMD) for the WA98 experiment at the CERN SPS proton synchrotron. This experiment studies high energy collisions of lead ions and will measure both charged particle and photon multiplicity in a large overlap region. The motivation for measuring photon multiplicity in ultra-relativistic heavy ion collisions stems from theoretical predictions of changes in the relative production of photons and charged particles in the phase transition of hadronic matter to quarkgluon plasma and its subsequent hadronization. The photon multiplicity detector consists of a matrix of scintillator pads placed in light-tight boxes and mounted behind the lead converter plates. The light from the scintillator pads is transported to the readout system using wavelength shifting (WLS) fibres. Developing on the team's earlier experience with a smaller version for the WA93 experiment (September 1991, page 16), several modifications were incorporated to improve light collection and transport. Use of improved WLS fibres, short WLS pieces to minimize self-absorption, and thermal splicing with long clear fibres were some of the important changes incorporated. Tests showed signficantly improved light collection. The scintillator pads were fabricated at all the five collaborating centres in India and the complicated assembly in the detector box modules carried out at the Variable Energy Cyclotron Centre, Calcutta. More than 400 lead converter plates were machined in Calcutta to rigorous tolerances of 0.2 mm. The assembled detector box modules and lead plates were shipped to CERN in spring 1994 for tests and installation. The WA98 PMD consists of over 50,000 scintillator pads of sizes varying from 15 to

  16. INDIA: Photon multiplicity detector

    Anon.

    1995-01-15

    Full text: The team of Indian scientists from Calcutta's Variable Energy Cyclotron Centre, Bhubaneswar Institute of Physics, Panjab (Chandigarh), Rajasthan (Jaipur) and Jammu in collaboration with GSI Darmstadt have contributed a large and highly granular preshower photon multiplicity detector (PMD) for the WA98 experiment at the CERN SPS proton synchrotron. This experiment studies high energy collisions of lead ions and will measure both charged particle and photon multiplicity in a large overlap region. The motivation for measuring photon multiplicity in ultra-relativistic heavy ion collisions stems from theoretical predictions of changes in the relative production of photons and charged particles in the phase transition of hadronic matter to quarkgluon plasma and its subsequent hadronization. The photon multiplicity detector consists of a matrix of scintillator pads placed in light-tight boxes and mounted behind the lead converter plates. The light from the scintillator pads is transported to the readout system using wavelength shifting (WLS) fibres. Developing on the team's earlier experience with a smaller version for the WA93 experiment (September 1991, page 16), several modifications were incorporated to improve light collection and transport. Use of improved WLS fibres, short WLS pieces to minimize self-absorption, and thermal splicing with long clear fibres were some of the important changes incorporated. Tests showed signficantly improved light collection. The scintillator pads were fabricated at all the five collaborating centres in India and the complicated assembly in the detector box modules carried out at the Variable Energy Cyclotron Centre, Calcutta. More than 400 lead converter plates were machined in Calcutta to rigorous tolerances of 0.2 mm. The assembled detector box modules and lead plates were shipped to CERN in spring 1994 for tests and installation. The WA98 PMD consists of over 50,000 scintillator pads of sizes varying from 15 to 25 mm

  17. Networks amid multiple logics

    Bergenholtz, Carsten; Bjerregaard, Toke

    The present study investigates how a high-tech-small-firm (HTSF) can carry out an inter-organizational search of actors located at universities. Responding to calls to study how firms navigate multiple institutional norms, this research examines the different strategies used by a HTSF to balance...... adopted academic norm-sets, commercial imperatives and formal regulations to support formation of networks and collaborations with universities. The findings show how the significance of weak and strong ties for the formation of collaborations and networks with universities is relative...

  18. Writing on Multiple Journeys

    Robbins, Sarah; Pullen, Ann Ellis

    2012-01-01

    In their beautifully researched study and critical edition, Nellie Arnott’s Writings on Angola, 1905–1913: Missionary Narratives Linking Africa and America (Parlor Press), authors Sarah Robbins and Ann Ellis Pullen examine in fine detail the historical record of the transnational network of literary work produced by Arnott. Tracing her legacy in the study’s third chapter, “Writing on Multiple Journeys,” the authors argue on behalf of Arnott’s capacity to create authority and celebrity as well...

  19. Multiple constant multiplication optimizations for field programmable gate arrays

    Kumm, Martin

    2016-01-01

    This work covers field programmable gate array (FPGA)-specific optimizations of circuits computing the multiplication of a variable by several constants, commonly denoted as multiple constant multiplication (MCM). These optimizations focus on low resource usage but high performance. They comprise the use of fast carry-chains in adder-based constant multiplications including ternary (3-input) adders as well as the integration of look-up table-based constant multipliers and embedded multipliers to get the optimal mapping to modern FPGAs. The proposed methods can be used for the efficient implementation of digital filters, discrete transforms and many other circuits in the domain of digital signal processing, communication and image processing. Contents Heuristic and ILP-Based Optimal Solutions for the Pipelined Multiple Constant Multiplication Problem Methods to Integrate Embedded Multipliers, LUT-Based Constant Multipliers and Ternary (3-Input) Adders An Optimized Multiple Constant Multiplication Architecture ...

  20. Multiple capillary biochemical analyzer

    Dovichi, N.J.; Zhang, J.Z.

    1995-08-08

    A multiple capillary analyzer allows detection of light from multiple capillaries with a reduced number of interfaces through which light must pass in detecting light emitted from a sample being analyzed, using a modified sheath flow cuvette. A linear or rectangular array of capillaries is introduced into a rectangular flow chamber. Sheath fluid draws individual sample streams through the cuvette. The capillaries are closely and evenly spaced and held by a transparent retainer in a fixed position in relation to an optical detection system. Collimated sample excitation radiation is applied simultaneously across the ends of the capillaries in the retainer. Light emitted from the excited sample is detected by the optical detection system. The retainer is provided by a transparent chamber having inward slanting end walls. The capillaries are wedged into the chamber. One sideways dimension of the chamber is equal to the diameter of the capillaries and one end to end dimension varies from, at the top of the chamber, slightly greater than the sum of the diameters of the capillaries to, at the bottom of the chamber, slightly smaller than the sum of the diameters of the capillaries. The optical system utilizes optic fibers to deliver light to individual photodetectors, one for each capillary tube. A filter or wavelength division demultiplexer may be used for isolating fluorescence at particular bands. 21 figs.

  1. Multiple symbol differential detection

    Divsalar, Dariush (Inventor); Simon, Marvin K. (Inventor)

    1991-01-01

    A differential detection technique for multiple phase shift keying (MPSK) signals is provided which uses a multiple symbol observation interval on the basis of which a joint decision is made regarding the phase of the received symbols. In accordance with the invention, a first difference phase is created between first and second received symbols. Next, the first difference phase is correlated with the possible values thereof to provide a first plurality of intermediate output signals. A second difference phase is next created between second and third received symbols. The second difference phase is correlated with plural possible values thereof to provide a second plurality of intermediate output signals. Next, a third difference phase is created between the first and third symbols. The third difference phase is correlated with plural possible values thereof to provide a third plurality of intermediate output signals. Each of the first plurality of intermediate outputs are combined with each of the second plurality of intermediate outputs and each of the third plurality of intermediate outputs to provide a plurality of possible output values. Finally, a joint decision is made by choosing from the plurality of possible output values the value which represents the best combined correlation of the first, second and third difference values with the possible values thereof.

  2. Albumin and multiple sclerosis.

    LeVine, Steven M

    2016-04-12

    Leakage of the blood-brain barrier (BBB) is a common pathological feature in multiple sclerosis (MS). Following a breach of the BBB, albumin, the most abundant protein in plasma, gains access to CNS tissue where it is exposed to an inflammatory milieu and tissue damage, e.g., demyelination. Once in the CNS, albumin can participate in protective mechanisms. For example, due to its high concentration and molecular properties, albumin becomes a target for oxidation and nitration reactions. Furthermore, albumin binds metals and heme thereby limiting their ability to produce reactive oxygen and reactive nitrogen species. Albumin also has the potential to worsen disease. Similar to pathogenic processes that occur during epilepsy, extravasated albumin could induce the expression of proinflammatory cytokines and affect the ability of astrocytes to maintain potassium homeostasis thereby possibly making neurons more vulnerable to glutamate exicitotoxicity, which is thought to be a pathogenic mechanism in MS. The albumin quotient, albumin in cerebrospinal fluid (CSF)/albumin in serum, is used as a measure of blood-CSF barrier dysfunction in MS, but it may be inaccurate since albumin levels in the CSF can be influenced by multiple factors including: 1) albumin becomes proteolytically cleaved during disease, 2) extravasated albumin is taken up by macrophages, microglia, and astrocytes, and 3) the location of BBB damage affects the entry of extravasated albumin into ventricular CSF. A discussion of the roles that albumin performs during MS is put forth.

  3. Rotator Cuff Injuries - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Rotator Cuff Injuries URL of this page: https://medlineplus.gov/ ... V W XYZ List of All Topics All Rotator Cuff Injuries - Multiple Languages To use the sharing features ...

  4. Multiple Sclerosis and Vitamin D

    ... Editors David C. Spencer, MD Steven Karceski, MD Multiple sclerosis and vitamin D Andrew J. Solomon, MD WHAT ... caused by improper immune responses (autoimmune diseases), including multiple sclerosis (MS). A recent Patient Page in Neurology provided ...

  5. Piercing and Tattoos - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Piercing and Tattoos URL of this page: https://medlineplus. ... V W XYZ List of All Topics All Piercing and Tattoos - Multiple Languages To use the sharing ...

  6. Asian American Health - Multiple Languages

    ... Are Here: Home → Multiple Languages → All Health Topics → Asian American Health URL of this page: https://medlineplus.gov/ ... V W XYZ List of All Topics All Asian American Health - Multiple Languages To use the sharing features ...

  7. Multiple Hierarchies and Organizational Control

    Evans, Peter B.

    1975-01-01

    Uses a control-loss model to explore the effects of multiple channels in formal organizations, and presents an argument for the superior control properties of dual hierarchies. Two variant forms of multiple hierarchies are considered. (Author)

  8. Multiple Intelligences and quotient spaces

    Malatesta, Mike; Quintana, Yamilet

    2006-01-01

    The Multiple Intelligence Theory (MI) is one of the models that study and describe the cognitive abilities of an individual. In [7] is presented a referential system which allows to identify the Multiple Intelligences of the students of a course and to classify the level of development of such Intelligences. Following this tendency, the purpose of this paper is to describe the model of Multiple Intelligences as a quotient space, and also to study the Multiple Intelligences of an individual in...

  9. MULTIPLE GALAXY COLLISIONS

    2002-01-01

    Here is a sampling of 15 ultraluminous infrared galaxies viewed by NASA's Hubble Space Telescope. Hubble's sharp vision reveals more complexity within these galaxies, which astronomers are interpreting as evidence of a multiple-galaxy pileup. These images, taken by the Wide Field and Planetary Camera 2, are part of a three-year study of 123 galaxies within 3 billion light-years of Earth. The study was conducted in 1996, 1997, and 1999. False colors were assigned to these photos to enhance fine details within these coalescing galaxies. Credits: NASA, Kirk Borne (Raytheon and NASA Goddard Space Flight Center, Greenbelt, Md.), Luis Colina (Instituto de Fisica de Cantabria, Spain), and Howard Bushouse and Ray Lucas (Space Telescope Science Institute, Baltimore, Md.)

  10. Multiple passage cells theory

    Riva, R.

    1983-01-01

    A review of the main concepts envolved in non astigmatic multiple passes cells is presented. It is shown that these concepts can be extended to ring cavities in which the analysis of the ray propagation (in the paraxial approaching) in two separated plans is accomplished. The concepts developed are applyed to a simple ring cavity (one curve mirror and two plane ones) showing that the acquired pattern of the rays on the mirrors is the one of a Lissajours figure which allows a better use of the mirror's area and consequently a larger number of passes. The cavity has applications in optical delay lines, measurements of mirrors reflectivities and possibly in passive optical gyroscopes. (Author) [pt

  11. Multiple stage railgun

    Aaland, K.; Hawke, R.S.; Scudder, J.K.

    1982-01-01

    A multiple stage magnetic railgun accelerator for accelerating a projectile by movement of a plasma arc along the rails. The railgun is divided into a plurality of successive rail stages which are sequentially energized by separate energy sources as the projectile moves through the bore of the railgun. Propagation of energy from an energized rail stage back towards the breech end of the railgun can be prevented by connection of the energy sources to the rails through isolation diodes. Propagation of energy from an energized rail stage back towards the breech end of the railgun can also be prevented by dividing the rails into electrically isolated rail sections. In such case means are used to extinguish the arc at the end of each energized stage and a fuse or laser device is used to initiate a new plasma arc in the next energized rail stage

  12. Strategizing in multiple ways

    Larsen, Mette Vinther; Madsen, Charlotte Øland; Rasmussen, Jørgen Gulddahl

    2013-01-01

    Strategy processes are kinds of wayfaring where different actors interpret a formally defined strat-egy differently. In the everyday practice of organizations strategizing takes place in multiple ways through narratives and sensible actions. This forms a meshwork of polyphonic ways to enact one...... and the same strategy. The paper focusses on such processes as they develop in a Danish service company. It is done on the basis of an empirical and longitudinal study of a strategy process in the Service Company where the strategic purpose was to implement value-based management. The theme to be developed...... based on this development paper is whether one can understand these diver-gent strategic wayfaring processes as constructive for organizations....

  13. Automated multiple failure FMEA

    Price, C.J.; Taylor, N.S.

    2002-01-01

    Failure mode and effects analysis (FMEA) is typically performed by a team of engineers working together. In general, they will only consider single point failures in a system. Consideration of all possible combinations of failures is impractical for all but the simplest example systems. Even if the task of producing the FMEA report for the full multiple failure scenario were automated, it would still be impractical for the engineers to read, understand and act on all of the results. This paper shows how approximate failure rates for components can be used to select the most likely combinations of failures for automated investigation using simulation. The important information can be automatically identified from the resulting report, making it practical for engineers to study and act on the results. The strategy described in the paper has been applied to a range of electrical subsystems, and the results have confirmed that the strategy described here works well for realistically complex systems

  14. Quantum Optical Multiple Scattering

    Ott, Johan Raunkjær

    . In the first part we use a scattering-matrix formalism combined with results from random-matrix theory to investigate the interference of quantum optical states on a multiple scattering medium. We investigate a single realization of a scattering medium thereby showing that it is possible to create entangled...... states by interference of squeezed beams. Mixing photon states on the single realization also shows that quantum interference naturally arises by interfering quantum states. We further investigate the ensemble averaged transmission properties of the quantized light and see that the induced quantum...... interference survives even after disorder averaging. The quantum interference manifests itself through increased photon correlations. Furthermore, the theoretical description of a measurement procedure is presented. In this work we relate the noise power spectrum of the total transmitted or reflected light...

  15. Anthropology and Multiple Modernities

    Thomassen, Bjørn

    “modernities” over the last 10 years, this paper wishes to address the analytical usefulness of this conceptual development. What is it about these concepts that make them useful as we try to capture the World today? Rather than providing any substantial definitions as to what those modernities are about (or...... what they are not about), anthropologists have used ethnographies to demonstrate how modernities are lived and constructed differently in different cultural contexts. To a very large extent, anthropologists intend these multiple modernities to refer to the interplay between local and global...... configurations. However, if the current pluralizing of modernity ultimately serves to describe the variety of cultural forms that co-exist in the World today, the analytical value of the concept risks being watered down, and little is gained in perspective. Arguably, other concepts would have served the purpose...

  16. Vaccines in Multiple Sclerosis.

    Williamson, Eric M L; Chahin, Salim; Berger, Joseph R

    2016-04-01

    Vaccinations help prevent communicable disease. To be valuable, a vaccine's ability to prevent disease must exceed the risk of adverse effects from administration. Many vaccines present no risk of infection as they are comprised of killed or non-infectious components while other vaccines consist of live attenuated microorganisms which carry a potential risk of infection-particularly, in patients with compromised immunity. There are several unique considerations with respect to vaccination in the multiple sclerosis (MS) population. First, there has been concern that vaccination may trigger or aggravate the disease. Second, disease-modifying therapies (DMTs) employed in the treatment of MS may increase the risk of infectious complications from vaccines or alter their efficacy. Lastly, in some cases, vaccination strategies may be part of the treatment paradigm in attempts to avoid complications of therapy.

  17. Multiple sclerosis and suicide.

    Feinstein, Anthony; Pavisian, Bennis

    2017-06-01

    Mortality rates are elevated in people with multiple sclerosis (MS) relative to the general population. There is, however, some uncertainty whether suicide contributes to this. Epidemiological data suggest that the standardized mortality ratio (SMR) for suicide in MS is approximately twice that of the general population with younger males in the first few years following diagnosis most at risk. Rates of suicidal intent, a potential harbinger of more self-destructive behavior, are also elevated, but the frequency with which intent is followed by suicide is not known. Depression, severity of depression, social isolation, and alcohol abuse are associated with thoughts of suicide. The variables linked with suicide and suicidal intent are therefore well defined and should be readily available from routine clinical inquiry. While vigilance on the part of clinicians is required, particularly in the context of high-risk patients, it is also recognized that prevention is dependent on full disclosure of intent.

  18. On Multiple Appearances

    Bork Petersen, Franziska

    2012-01-01

    reduction and epoché to focus on how dancing bodies appear in a stage context. To test these tools’ ability to explore dancing bodies from a third-person perspective, I analyse the Danish choreographer Kitt Johnson’s solo performance Drift (2011) - focussing on her shifting physical appearance. While...... phenomenology helps me to describe the multiple and radically different guises that Johnson assumes in her piece, my analysis, ultimately, does not aim to distil a truer, more real being from her appearances as is often the case in phenomenological philosophy. I complement my analytical approach...... with the Deleuzian notion of becoming animal and suggest that Johnson stages what could, in Judith Butler’s terms, be called a critical contingency of bodily appearance....

  19. Media and Multiplicity

    Blaagaard, Bolette

    2010-01-01

    In the past few years continental Europe has experienced a resurgence of right-wing party politics, nationalism and xenophobia. In this nationalist revival the media and advanced communications technologies have played a significant role, as evidenced by the debates following cases...... such as the Danish cartoon controversy, and Dutch politician Geert Wilders’s film, Fitna. Simultaneously, however, the media is more diverse and rhizomatic than ever and offers potential for cosmopolitanism, transnational ethical relations as well as radical anti-racist and anti-fascist interventions. This article...... explores the tensions within the relation between journalistic practice and the construction of the idea of the nation and the multiplicity of media and cultures which inhabit the spheres of journalism and nation....

  20. Multiple-port valve

    Doody, T.J.

    1978-01-01

    A multiple-port valve assembly is designed to direct flow from a primary conduit into any one of a plurality of secondary conduits as well as to direct a reverse flow. The valve includes two mating hemispherical sockets that rotatably receive a spherical valve plug. The valve plug is attached to the primary conduit and includes diverging passageways from that conduit to a plurality of ports. Each of the ports is alignable with one or more of a plurality of secondary conduits fitting into one of the hemispherical sockets. The other hemispherical socket includes a slot for the primary conduit such that the conduit's motion along that slot with rotation of the spherical plug about various axes will position the valve-plug ports in respect to the secondary conduits

  1. Multiple cerebral hydatid cysts

    Banzo, J.; Pina, J.I.; Abos, M.D.; Rios, G.; Garcia, D.; Marin, F.; Diaz, F.J.

    1984-12-01

    A 39-year-old woman was admitted to hospital with headaches, vomiting, psychic impairment and diplopia. Three hydatid cysts of the lung had been previously removed. An avascular mass in the left hemisphere with left-to-right displacement of the anterior cerebral arteries was noted during a brain angioscintigraphy. A cerebralthrombosis (CT) brain scan showed two cystic lesions situated in the left-frontal and occipital regions. A CT abdominal scan showed multiple cysts in the liver, spleen and both kidneys. At operation, two brain cysts were totally extirpated without rupture. The definite pathological diagnosis was secondry hydatid cysts. The headaches, vomiting and diplopia were persistent in the post-operative period. Seven days after the operation, a CT brain scan showed an infratenrorial cyst. The patient rejected any surgical intervention.

  2. Multiple Temporalities, Layered Histories

    Steven Pearson

    2017-11-01

    Full Text Available In Quotational Practices: Repeating the Future in Contemporary Art, Patrick Greaney asserts, “the past matters not only because of what actually happened but also because of the possibilities that were not realized and that still could be. Quotation evokes those possibilities. By repeating the past, artists and writers may be attempting to repeat that past’s unrealized futures.”[1]  In the information age, the Internet, for instance, provides us an expanded collection of visual information—quite literally available at our fingertips—summoning together aspects of the past and possibilities of the future into a boundless present. Sketchbook Revisions (2014–2015, a series of mixed-media paintings, represents my attempt to communicate the ways in which I experience my contemporary moment constructed from multiple temporalities excavated from my past. This body of work combines fragments of representational paintings created between 1995 and 2003 and nonrepresentational renderings produced between 2003 and 2014. Using traditional tracing paper and graphic color, I randomly select moments of my previous work to transfer and layer over selected areas of already-filled pages of a sketchbook I used from 2003 to 2004. These sketches depict objects I encountered in studio art classrooms and iconic architecture on the campus of McDaniel College, and often incorporate teaching notes. The final renditions of fragmented and layered histories enact the ways that we collectively experience multiple temporalities in the present. Quoting my various bodies of work, Sketchbook Revisions challenges both material and conceptual boundaries that determine fixed notions of artistic identity.

  3. Future directions of multiple behavior change research.

    Geller, Karly; Lippke, Sonia; Nigg, Claudio R

    2017-02-01

    Non-communicable diseases (i.e., chronic diseases including cardiovascular disease, cancer, chronic respiratory disease, diabetes and obesity) result in 36 million deaths each year. Individuals' habitual participation in a single health-risk behaviors substantially contribute to morbidity and mortality (e.g., tobacco use, daily fast food intake, etc.); however, more concerning is the impact of typically co-occurring or clustering of multiple health-risk behaviors. This burden can be minimized through successful cessation of health-risk behaviors and adoption of healthy behaviors; namely healthy lifestyle adoption or multiple health behavior change (MHBC). MHBC is a developing field and future research recommendations are provided to advance MHBC research. A valid measure of MHBC (i.e., lifestyle) is warranted to provide the needed basis for MHBC investigations and evaluations. MHBC is thought to occur through shared co-variation of underlying motivating mechanisms, but how these relationships influence behavior remains unclear. A better understanding of the relationship between behaviors and the related motivating mechanisms (and potential cross-relationship of influences) is needed. Future research should also aim to improve lifestyles through understanding how to change multiple health behaviors. Finally, MHBC research should target the development of sustainable interventions which result in lasting effects (e.g., capacity, systems, policy and environmental changes), with dissemination considered during development. Focusing MHBC research in these areas will increase our understanding and maximize the impact on the health of populations.

  4. Exploring Multiple Usability Perspectives

    Uldall-Espersen, Tobias

    2007-01-01

    Industrial usability work often fails to produce the expected impact on software products even though significant resources have been used on uncovering problems and suggesting improvements. So, it seems that feedback from industrial usability work lacks persuasiveness, i.e. it fails to convince...... the key stakeholders that actions need to be taken. This study reports from interviews with 26 stakeholders in software development projects. Our data suggests that the interviewees address usability using different perspectives and based on our observations we describe five such perspectives. Further, we...... discuss how applying different usability perspectives might inform the persuasiveness of usability work....

  5. Neutron-multiplication measurement instrument

    Nixon, K.V.; Dowdy, E.J.; France, S.W.; Millegan, D.R.; Robba, A.A.

    1982-01-01

    The Advanced Nuclear Technology Group of the Los Alamos National Laboratory is now using intelligent data-acquisition and analysis instrumentation for determining the multiplication of nuclear material. Earlier instrumentation, such as the large NIM-crate systems, depended on house power and required additional computation to determine multiplication or to estimate error. The portable, battery-powered multiplication measurement unit, with advanced computational power, acquires data, calculates multiplication, and completes error analysis automatically. Thus, the multiplication is determined easily and an available error estimate enables the user to judge the significance of results.

  6. Neutron-multiplication measurement instrument

    Nixon, K.V.; Dowdy, E.J.; France, S.W.; Millegan, D.R.; Robba, A.A.

    1982-01-01

    The Advanced Nuclear Technology Group of the Los Alamos National Laboratory is now using intelligent data-acquisition and analysis instrumentation for determining the multiplication of nuclear material. Earlier instrumentation, such as the large NIM-crate systems, depended on house power and required additional computation to determine multiplication or to estimate error. The portable, battery-powered multiplication measurement unit, with advanced computational power, acquires data, calculates multiplication, and completes error analysis automatically. Thus, the multiplication is determined easily and an available error estimate enables the user to judge the significance of results

  7. Application of Multiple Evaluation Models in Brazil

    Rafael Victal Saliba

    2008-07-01

    Full Text Available Based on two different samples, this article tests the performance of a number of Value Drivers commonly used for evaluating companies by finance practitioners, through simple regression models of cross-section type which estimate the parameters associated to each Value Driver, denominated Market Multiples. We are able to diagnose the behavior of several multiples in the period 1994-2004, with an outlook also on the particularities of the economic activities performed by the sample companies (and their impacts on the performance through a subsequent analysis with segregation of companies in the sample by sectors. Extrapolating simple multiples evaluation standards from analysts of the main financial institutions in Brazil, we find that adjusting the ratio formulation to allow for an intercept does not provide satisfactory results in terms of pricing errors reduction. Results found, in spite of evidencing certain relative and absolute superiority among the multiples, may not be generically representative, given samples limitation.

  8. Multiple chronic conditions and life expectancy

    DuGoff, Eva H; Canudas-Romo, Vladimir; Buttorff, Christine

    2014-01-01

    BACKGROUND: The number of people living with multiple chronic conditions is increasing, but we know little about the impact of multimorbidity on life expectancy. OBJECTIVE: We analyze life expectancy in Medicare beneficiaries by number of chronic conditions. RESEARCH DESIGN: A retrospective cohort...... study using single-decrement period life tables. SUBJECTS: Medicare fee-for-service beneficiaries (N=1,372,272) aged 67 and older as of January 1, 2008. MEASURES: Our primary outcome measure is life expectancy. We categorize study subjects by sex, race, selected chronic conditions (heart disease, cancer...... and increasing numbers of comorbid conditions. CONCLUSIONS: Social Security and Medicare actuaries should account for the growing number of beneficiaries with multiple chronic conditions when determining population projections and trust fund solvency....

  9. Evaluation of multiple emission point facilities

    Miltenberger, R.P.; Hull, A.P.; Strachan, S.; Tichler, J.

    1988-01-01

    In 1970, the New York State Department of Environmental Conservation (NYSDEC) assumed responsibility for the environmental aspect of the state's regulatory program for by-product, source, and special nuclear material. The major objective of this study was to provide consultation to NYSDEC and the US NRC to assist NYSDEC in determining if broad-based licensed facilities with multiple emission points were in compliance with NYCRR Part 380. Under this contract, BNL would evaluate a multiple emission point facility, identified by NYSDEC, as a case study. The review would be a nonbinding evaluation of the facility to determine likely dispersion characteristics, compliance with specified release limits, and implementation of the ALARA philosophy regarding effluent release practices. From the data collected, guidance as to areas of future investigation and the impact of new federal regulations were to be developed. Reported here is the case study for the University of Rochester, Strong Memorial Medical Center and Riverside Campus

  10. High rate multiplicity detector for relativistic heavy-ion collisions

    Beavis, D.; Bennett, M.J.; Carroll, J.B.; Chiba, J.; Chikanian, A.; Crawford, H.J.; Cronqvist, M.; Dardenne, Y.; Debbe, R.; Doke, T.; Engelage, J.; Flores, I.; Greiner, L.; Hayano, R.S.; Hallman, T.J.; Heckman, H.H.; Kashiwagi, T.; Kikuchi, J.; Kumar, B.S.; Kuo, C.; Lindstrom, P.J.; Mitchell, J.W.; Nagamiya, S.; Nagle, J.L.; Pope, J.K.; Stankus, P.; Tanaka, K.H.; Welsh, R.C.; Zhan, W.

    1995-01-01

    We have constructed and operated a detector to measure the multiplicity of secondary particles produced in nucleus-nucleus collisions in the E878 experiment at the Brookhaven National Laboratory AGS facility. We describe the operation and performance of the detector in a high rate Au beam environment, and interpret the multiplicity data in terms of the impact parameters of the nucleus-nucleus collisions. ((orig.))

  11. High rate multiplicity detector for relativistic heavy-ion collisions

    Beavis, D [Brookhaven National Lab., Upton, NY (United States); Bennett, M J [Yale University, A.W. Wright Nuclear Structure Laboratory, New Haven, CT 06511 (United States); Carroll, J B [University of California at Los Angeles, Los Angeles, CA (United States); Chiba, J [KEK National High Energy Physics, Tsukuba (Japan); Chikanian, A [Yale University, A.W. Wright Nuclear Structure Laboratory, New Haven, CT 06511 (United States); Crawford, H J [University of California Space Sciences Laboratory, Berkeley, CA (United States); Cronqvist, M [University of California Space Sciences Laboratory, Berkeley, CA (United States); Dardenne, Y [University of California Space Sciences Laboratory, Berkeley, CA (United States); Debbe, R [Brookhaven National Lab., Upton, NY (United States); Doke, T [Waseda University, Science and Engineering Research Institute, Waseda (Japan); Engelage, J [University of California Space Sciences Laboratory, Berkeley, CA (United States); Flores, I [University of California Space Sciences Laboratory, Berkeley, CA (United States); Greiner, L [University of California Space Sciences Laboratory, Berkeley, CA (United States); Hayano, R S [University of Tokyo, Tokyo (Japan); Hallman, T J [University of California at Los Angeles, Los Angeles, CA (United States); Heckman, H H [Lawrence Berkeley Lab., CA (United States); Kashiwagi, T [Waseda University, Science and Engineering Research Institute, Waseda (Japan); Kikuchi, J [Waseda University, Science and Engineering Research Institute, Waseda (Japan); Kumar, B S [Yale University, A.W. Wright Nuclear Structure Laboratory, New Haven, CT 06511 (United States); Kuo, C [University of California Space Sciences Laboratory, Berkeley, CA (United States); Lindstrom, P J [Lawrence Berkeley Lab., CA (United States); Mitchell, J W [Universities Space Research Association/Goddard Space Flight Center, Greenbelt, MD (United States); Nagamiya, S; E878 Collaboration

    1995-04-21

    We have constructed and operated a detector to measure the multiplicity of secondary particles produced in nucleus-nucleus collisions in the E878 experiment at the Brookhaven National Laboratory AGS facility. We describe the operation and performance of the detector in a high rate Au beam environment, and interpret the multiplicity data in terms of the impact parameters of the nucleus-nucleus collisions. ((orig.)).

  12. Multiple Levels of Suffering

    Kiley, Kasey B.; Haywood, Carlton; Bediako, Shawn M.; Lanzkron, Sophie; Carroll, C. Patrick; Buenaver, Luis F.; Pejsa, Megan; Edwards, Robert R.; Haythornthwaite, Jennifer A.; Campbell, Claudia M.

    2016-01-01

    Objective: People living with sickle cell disease (SCD) experience severe episodic and chronic pain and frequently report poor interpersonal treatment within health-care settings. In this particularly relevant context, we examined the relationship between perceived discrimination and both clinical and laboratory pain. Methods: Seventy-one individuals with SCD provided self-reports of experiences with discrimination in health-care settings and clinical pain severity, and completed a psychophysical pain testing battery in the laboratory. Results: Discrimination in health-care settings was correlated with greater clinical pain severity and enhanced sensitivity to multiple laboratory-induced pain measures, as well as stress, depression, and sleep. After controlling for relevant covariates, discrimination remained a significant predictor of mechanical temporal summation (a marker of central pain facilitation), but not clinical pain severity or suprathreshold heat pain response. Furthermore, a significant interaction between experience with discrimination and clinical pain severity was associated with mechanical temporal summation; increased experience with discrimination was associated with an increased correlation between clinical pain severity and temporal summation of pain. Discussion: Perceived discrimination within health-care settings was associated with pain facilitation. These findings suggest that discrimination may be related to increased central sensitization among SCD patients, and more broadly that health-care social environments may interact with pain pathophysiology. PMID:26889615

  13. High multiplicity events

    Wegener, D.

    1981-01-01

    In this talk I summarize the characteristic features of strong interactions investigated during the last decade at the CERN proton-proton intersecting storage rings (ISR) at CMS energies in the interval 23 GeV <= √s <= 63 GeV, which presently represent the highest energies accessible at accelerators. I will concentrate on a few topics being relevant for this workshop. In the first chapter a few remarks concerning detectors will be made. In the second part of the talk I want to discuss the properties of hadronic interactions at high energies in general terms avoiding special model assumptions. In the third chapter some results are described, which illustrate the impact of quantumchromodynamics (QCD) on the phenomenology of hadronic interactions. (orig.)

  14. Modeling Workload Impact in Multiple Unmanned Vehicle Supervisory Control

    2010-01-01

    task (e.g., replanning the path of a UV because of an emergent target). Compared to more common measures of workload (e.g., pupil dilation, NASA TLX ...utilization (p=.005). 0 5 10 15 20 25 30 35 40 45 50 W ai t t im es d ue t o at te nt io n in ef fic ie nc ie s (s ec ) Utilization (%) No

  15. Multiple-stressor impacts on Spartina alterniflora and Distichlis spicata

    Salt marshes are subject to an array of environmental changes that have the potential to alter community structure and function. Manipulative experiments often study environmental changes in isolation, although changes may interactively affect plant and ecosystem response. We rep...

  16. Multiple exostotic hypochondroplasia: Syndrome of combined hypochondroplasia and multiple exostoses

    Dominguez, R.; Young, L.W.; Girdany, B.R.; Steele, M.W.

    1984-01-01

    This is a report of a family with major focus on the daughter who had short stature. The mother had hypochondroplasia and the father had multiple exostoses. The daughter's skeletal roentgenograms show features of both hypochondroplasia and multiple exostoses. The roentgenographic, clinical and genetic aspects of these skeletal dysplasias are reviewed and hypochrondroplasia is contrasted with achondroplasia. The genetic and counseling implications of the association of hypochondroplasia and multiple exostoses are discussed. (orig.)

  17. Multiple exostotic hypochondroplasia: Syndrome of combined hypochondroplasia and multiple exostoses

    Dominguez, R.; Young, L.W.; Girdany, B.R.; Steele, M.W.

    1984-07-01

    This is a report of a family with major focus on the daughter who had short stature. The mother had hypochondroplasia and the father had multiple exostoses. The daughter's skeletal roentgenograms show features of both hypochondroplasia and multiple exostoses. The roentgenographic, clinical and genetic aspects of these skeletal dysplasias are reviewed and hypochrondroplasia is contrasted with achondroplasia. The genetic and counseling implications of the association of hypochondroplasia and multiple exostoses are discussed.

  18. On directional multiple-output quantile regression

    Paindaveine, D.; Šiman, Miroslav

    2011-01-01

    Roč. 102, č. 2 (2011), s. 193-212 ISSN 0047-259X R&D Projects: GA MŠk(CZ) 1M06047 Grant - others:Commision EC(BE) Fonds National de la Recherche Scientifique Institutional research plan: CEZ:AV0Z10750506 Keywords : multivariate quantile * quantile regression * multiple-output regression * halfspace depth * portfolio optimization * value-at risk Subject RIV: BA - General Mathematics Impact factor: 0.879, year: 2011 http://library.utia.cas.cz/separaty/2011/SI/siman-0364128.pdf

  19. Education for All: Gardner's Multiple Intelligences Theory

    Gisela Emst-Slavit

    2001-12-01

    Full Text Available In the last years the Theory of the Multiple Intelligences developed by Howard Gardner has had a tremendous impact in elementary and secondary classrooms in the United States. Gardner(1983 defines intelligence as the ability to solve a problem or fashion a product that is valued in one or more cultural settings. His definition expands our understanding of "intelligence" beyond the familiar linguistic and Logical-mathematical intelligences, to include the spatial, musical,bodily-kinesthetic, naturalist. interpersonal, and intrapersonal intelligences. This new wayof conceptualizing human intelligence has profound implications for educators whose task needs to include the identification and nourishment of the different talents brought by al students.

  20. Introduction: multiple myeloma.

    Cook, Richard

    2008-09-01

    Multiple myeloma (MM) is the most common type of primary bone tumor, affecting approximately 50,000 patients in the United States. Although it is currently not curable, recent advancements in treatment are bringing myeloma closer to becoming a chronic disease instead of a terminal illness. To better understand the prevalence of MM as well as provide an overview of the costs associated with treatment. The goals of treatment in MM include eradicating all evidence of disease, controlling disease to prevent damage to target organs, preserving normal function and quality of life, relieving pain, and managing myeloma that is in remission. To achieve these goals, treatment must be individually tailored for each patient based on the patient's age, overall health status, symptoms, and laboratory test results. Advancements in the understanding of the pathogenesis of myeloma and the role of genetic mutations are leading to a new standard of treatment. Advancements in diagnostic technology, such as cytogenetic testing, are also being used to tailor treatment for each individual to work toward achieving better response rates, longer periods of remission, and improved quality of life. Increased costs associated with the improved therapies being used to treat MM, and the comorbid conditions associated with the disease, present a challenge to managed care. Health plans and formulary decision makers need to better understand the complexity of therapy to best use resources. The economic burden to the patient must also be considered when developing treatment strategies. Better understanding of the pathophysiology of MM, including the role of cytogenetics, is leading to the development and use of novel agents and treatment options. Head-to-head studies comparing treatments must be performed to best balance the costs associated with treatment and the benefits of improved survival rates and maintaining quality of life.