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Sample records for neumonia intersticial usual

  1. Conferencia clinico patologica (CPC): paciente previamente sana con insuficiencia respiratoria debida a neumonia intersticial

    National Research Council Canada - National Science Library

    Catano Correa, Juan Carlos; Serna Ortiz, Carlos Andres; Arias Restrepo, Luis Fernando; Munoz Ortiz, Edison

    2013-01-01

    .... Se diagnostico sida de novo y neumonia intersticial asociada, todo lo cual progreso hasta la falla ventilatoria, que fue refractaria al tratamiento dirigido hacia los oportunistas identificados...

  2. Interstitial neumonia and cytomegalovirus: and immunopathological process Neumonía intersticial y citomegalovirus: un proceso inmunopatológico

    Directory of Open Access Journals (Sweden)

    Ana Isabel Toro

    1995-03-01

    Full Text Available

    Cytomegalovirus (CMV infection is a frequent cause of morbidity and mortality in immunocompromised individuals. including renal and bone marrow transplant recipients and patients with the acquired immunodeficiency syndrome (AIDS. CMV infection often affects the lung producing a fatal interstitial pneumonitis (IP. The pathogenesis of CMV IP is not well understood, but clinical observations in humans and laboratory studies with murine models, offer possibilities for explaining CMV-induced IP as an immunopathological disease.

    La infección activa por Citomegalovirus (CMV es causa frecuente de morbi-mortalidad en individuos inmunocomprometidos, particularmente entre receptores de trasplante renal y médula ósea y en personas afectadas por el virus de la inmunodeficiencia adquirida (HIV, en las cuales, a menudo, se presenta neumonía intersticial (NI fatal (1,2. La patogénesis de la NI causada por CMV no es clara aún, pero las observaciones clínicas en el hombre y los estudios con modelos murinos permiten pensar en ella como una alteración inmunopatológica. El análisis de tales conceptos es el objetivo de esta revisión.

  3. Enfermedad pulmonar intersticial asociada a rituximab

    Directory of Open Access Journals (Sweden)

    Marcelo Fernández Casares

    2013-08-01

    Full Text Available La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evidencia de infección. Presentamos un caso de enfermedad pulmonar intersticial asociada a rituximab.

  4. Enfermedad pulmonar intersticial asociada a rituximab

    OpenAIRE

    Marcelo Fernández Casares; Gisela Espósito; Alejandra González; Jaime Segovia; María de los Ángeles Galperín; Eduardo Del Valle

    2013-01-01

    La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evid...

  5. Cistite Intersticial. Etiopatogenia e Atitudes Terapêuticas

    OpenAIRE

    Coelho, MF; Rebola, J

    2003-01-01

    Introdução: A Cistite Intersticial é uma síndroma crónica e debilitante, onde surpreendentemente se sabe pouco acerca da epidemiologia, fisiopatologia e consequentemente do tratamento. Objectivos: Sugerir formas de actuação e terapêutica na cistite intersticial. Analisaram-se os artigos publicados nos últimos anos, com recurso ao medline. Resultados: Apresenta-se Fluxograma Terapêutico adaptado à realidade portuguesa

  6. Frecuencia, características clínicas, serológicas, patrón radiológico y severidad del compromiso pulmonar intersticial en enfermedades del tejido conectivo en una cohorte de pacientes colombianos

    OpenAIRE

    Pertuz Charris, Neil Smith

    2014-01-01

    Introducción: La enfermedad pulmonar intersticial (EPI) asociada a Enfermedades del Tejido Conectivo (ETC) es una complicación asociada por el papel autoinmune inflamatorio característico de este tipo de patologías. La frecuencia de EPI en ETC es variable, siendo más frecuente como complicación en Esclerosis sistémica con patrón de Neumonía Intersticial No específica, en Artritis Reumatoide patrón de Neumonía Intersticial Usual, en Sindrome de Sjögren la Neumonía Intersticial No específica, e...

  7. Neumonia por Legionella en pacientes con leucemia. presentacion de dos casos.(Reporte de caso)(Perspectiva general de la enfermedad/trastorno)

    National Research Council Canada - National Science Library

    Arcila, Giovanna; Betancur-Jimenez, Carlos Alberto; Lema, Mauricio

    2011-01-01

    .... Con tratamiento especifico con claritromicina resolvieron sus sintomas. PALABRAS CLAVE Neumonia Bacterias atipicas Legionella Leucemia Neutropenia We present two cases of patients with lymphoblastic leukemia...

  8. Micosis Fungoide Intersticial: Diagnóstico diferencial con el Granuloma Anular Intersticial Interstitial Mycosis Fungoides: Differential diagnosis with Interstitial Granuloma Annulare

    OpenAIRE

    RE Achenbach; LJA Lococo; GF Sánchez; S Monroy; MI Jorge; EH Pittaro

    2011-01-01

    La micosis fungoide en su variante histopatológica intersticial, puede ser confundida con el granuloma anular intersticial. Se ejemplifican dos casos de micosis fungoide intersticial y se subrayan los criterios histopatológicos para el diagnóstico diferencial, entre estas dos entidades.The interstitial type of mycosis fungoides and the interstitial type of granuloma annulare have several findings in common, in some cases may be difficult to differentiate them. Two cases of interstitial mycosi...

  9. [Intersticial lung disease as the sole manifestation of antisynthetase syndrome].

    Science.gov (United States)

    Monteiro, Paulo; Coutinho, Margarida; Machado, Pedro; Garcia, Jorge; Salvador, Maria João; Inês, Luís; Silva, Jorge; Malcata, Armando

    2009-01-01

    The authors report a clinical case of a woman who had a 3 years diagnosis of hipersensitivity pneumonitis based on intersticial lung disease without other manifestations. The diagnosis of antisynthetase syndrome was made three years after the initial symptoms upon the onset of systemic manifestations with articular involvement, myositis and determination of anti-PL 7 antibodies. In this syndrome, the isolated pulmonary involvement is rare.

  10. COEFICIENTES DE PRESIÓN INTERSTICIAL EN EL APARATO DE CORTE SIMPLE

    Directory of Open Access Journals (Sweden)

    Galindo-Aires, Rubén Ángel

    2013-06-01

    Full Text Available La actuación de cargas sobre un suelo saturado, produce, en función de la naturaleza de la solicitación, del tipo de suelo y de las condiciones de drenaje del terreno, un incremento de la presión sobre el agua de los intersticios. Se ha abordado el estudio de la generación de dicha presión intersticial a partir de muestras de suelo blando, normalmente consolidadas, procedentes del subsuelo del Puerto de Barcelona; para ello, se han utilizado los datos de una completa campaña experimental utilizando la máquina de ensayo de corte simple, y tras la adecuada interpretación del ensayo, se identifican los aspectos que se consideran clave para el proceso de generación de presión intersticial en el suelo, según las diferentes situaciones de carga actuante. Como conclusión, se plantea la generalización de la clásica ecuación que Skempton formuló hace casi 60 años y que permite interpretar la generación de presión intersticial para el aparato de ensayo triaxial.

  11. Neumonía intersticial linfoidea asociada a inmunodeficiencia común variable

    Directory of Open Access Journals (Sweden)

    Gonzalo Peralta

    2011-10-01

    Full Text Available La neumonía intersticial linfoidea (NIL es una rara entidad, descripta como hiperplasia no neoplásica del tejido linfoide pulmonar y clasificada dentro de las enfermedades intersticiales idiopáticas. Se la ha descripto asociada a infección por HIV, fenómenos autoinmunes, hipergamaglobulinemia policlonal o menos frecuentemente a hipogammaglobulinemia. Presentamos una paciente de 66 años de edad con diabetes mellitus, síndrome de Sjögren e hipertensión arterial, derivada a nuestro centro por tos seca y disnea clase funcional II-III. En el examen físico presentaba rales tipo “velcro” bibasales y esplenomegalia. Los estudios de laboratorio evidenciaron plaquetopenia (50 000/mm³ e hipogammaglobulinemia; la tomografía axial computarizada (TAC de tórax mostró compromiso intersticial bibasal, con nódulos peribroncovasculares menores a un centímetro. Se realizó una videotoracoscopia con biopsia pulmonar, la anatomía patológica mostró hallazgos compatibles con neumonía intersticial linfoidea. Se inició tratamiento con metilprednisona 40 mg/día vía oral e infusión endovenosa de gammaglobulina 500 mg/kg, mensual, evolucionando con mejoría clínico-radiológica. Por persistencia de plaquetopenia, asociada a hiperesplenismo, se realizó esplenectomía con buena respuesta. En la anatomía patológica no se observo clonalidad linfoide.

  12. Cistitis intersticial o vejiga dolorosa: Un desafío para el clínico

    OpenAIRE

    Pablo Young; Bárbara C. Finn; Martín González; Laura P. Comercio; Mariano Quezel; Julio E. Bruetman

    2010-01-01

    La cistitis intersticial se define como un síndrome clínico caracterizado por un incremento de la frecuencia urinaria, urgencia miccional y/o dolor abdominal o perineal en ausencia de infección urinaria o enfermedad conocida del aparato urinario. Se divide de acuerdo a los hallazgos citoscópicos en ulcerativa o no. La base del diagnóstico es clínica apoyada en scores de probabilidad y pruebas invasivas. Con la comprensión de la fisiopatología se ha desarrollado un abanico de posibilidades ter...

  13. Cistitis intersticial o vejiga dolorosa: Un desafío para el clínico

    Directory of Open Access Journals (Sweden)

    Pablo Young

    2010-08-01

    Full Text Available La cistitis intersticial se define como un síndrome clínico caracterizado por un incremento de la frecuencia urinaria, urgencia miccional y/o dolor abdominal o perineal en ausencia de infección urinaria o enfermedad conocida del aparato urinario. Se divide de acuerdo a los hallazgos citoscópicos en ulcerativa o no. La base del diagnóstico es clínica apoyada en scores de probabilidad y pruebas invasivas. Con la comprensión de la fisiopatología se ha desarrollado un abanico de posibilidades terapéuticas. Comunicamos el caso de una paciente sintomática por cuatro años con diagnóstico de cistitis intersticial con úlcera de Hunner por cistoscopia y excelente respuesta a la amitriptilina. Es una enfermedad que produce considerable alteración de la calidad de vida, por lo que es importante que los médicos estén familiarizados con este cuadro.

  14. Neurite hipertrófica intersticial: estudo de três casos

    Directory of Open Access Journals (Sweden)

    Lineu Cesar Werneck

    1978-09-01

    Full Text Available São relatados 3 casos de neuropatia hipertrófica intersticial que apresentam conduções nervosas motoras bastante reduzidas; no estudo anatomopatológico foram encontradas estruturas em forma de "casca de cebola", com proliferação de tecido conjuntivo. São abordadas as teorias sobre a formação das "cascas de cebola" e a correlação com a diminuição da velocidade de condução nervosa. Os autores concluem que somente um dos casos corresponde a descrição original de Dejerine-Sottas, sendo que os outros são provavelmente doença de Charcot-Marie-Tooth.

  15. Pneumonite intersticial em paciente sob tratamento com leflunomide: toxicidade da droga?

    Directory of Open Access Journals (Sweden)

    Reichert Jonatas

    2003-01-01

    Full Text Available O leflunomide é uma droga anti-reumática com ação imunomoduladora. Pneumonia intersticial granulomatosa nunca foi descrita com o uso de leflunomide. Relata-se o caso de uma mulher de 33 anos que apresentou dor torácica, emagrecimento e síndrome infecciosa respiratória no quinto mês de monoterapia com leflunomide para artrite reumatóide, progredindo para insuficiência respiratória no sexto mês. A radiografia de tórax revelou infiltrado pulmonar intersticial e alveolar bilateral predominando em lobos superior e médio, micronódulos esparsos e ausência de alterações mediastinais. Suspendeu-se o leflunomide. Após a resolução da infecção persistiram lesões intersticiais retículo-nodulares predominantemente na periferia dos terços superiores do pulmão direito e terço médio do pulmão esquerdo, entremeadas por padrão de vidro fosco em lobos superiores. Biópsia pulmonar a céu aberto revelou granulomas tuberculóides sem necrose central. Foi realizada extensa investigação etiológica, que resultou negativa. Ocorreu resolução espontânea do quadro após quatro meses. O quadro sugere que as manifestações pulmonares neste caso foram causadas pelo leflunomide.

  16. Enfisema Intersticial Unilateral — Resolução através da intubação brônquica selectiva e posicionamento

    OpenAIRE

    de Miguel, Cristina; Ferreira, Manuela; Araújo, Filomena; Ferreira, Paula; Vilarinho, António

    2014-01-01

    O enfisema intersticial pulmonar é uma complicação grave que surge em recém-nascidos ventilados, ocorrendo com maiorfrequência no prematuro. Geralmente afecta ambos os campos pulmonares e mais raramente pode ser localizado.Os autores apresentam um caso clínico de um recém-nascido de termo com diagnóstico de enfisema intersticial unilateral àesquerda, na sequência de quadro de hipertensão pulmonar, que evoluiu favoravelmente após intubação selectiva do brônquio direitoe posicionamento....

  17. Biopsia en enfermedad intersticial pulmonar Lung biopsy for the diagnosis of interstitial lung disease

    Directory of Open Access Journals (Sweden)

    Silvia Quadrelli

    2007-12-01

    Full Text Available El objetivo del presente estudio fue determinar el rédito diagnóstico y los factores asociados a mayor morbimortalidad en la biopsia quirúrgica de pulmón en pacientes con enfermedad intersticial difusa. Se analizaron en forma retrospectiva los registros clínicos de 71 pacientes. Se registraron complicaciones en 16 pacientes (22.5%. La mortalidad operatoria fue 11.2%. Los pacientes en quienes la biopsia se realizó por videotoracoscopia (n = 52 y por toracotomía (n = 17 tuvieron la misma duración de estadía en terapia intensiva y de estadía hospitalaria. La tasa de complicaciones (22.2% vs. 21.0%, p = 1.0000 y la mortalidad (9.2 vs. 15.7%, p = 0.2738 no fueron diferentes. Ocho pacientes murieron dentro de los 30 días. La prevalencia de inmunosupresión (4/8 vs. 9/63, p = 0.0325 fue significativamente superior en el grupo de pacientes fallecidos. Estos pacientes tuvieron valores preoperatorios más elevados de urea (50 ± 20.1 mg/dl vs. 31.2 ± 10.3 mg/ dl, p = 0.0013 y menores valores de saturación de O2: 82.7 ± 14.8% vs. 92.8 ± 3.4%, p = 0.0009. En los 11 pacientes con iniciación aguda la mortalidad fue significativamente más elevada (36.3% vs. 7.1%, p = 0.0223. La biopsia aportó un diagnóstico específico en 100% de los pacientes y cambió la estrategia terapéutica en 66.7%. En conclusión, la biopsia de pulmón por vía toracoscópica es un procedimiento útil y seguro en los pacientes con enfermedad intersticial difusa del pulmón. Sin embargo, en el grupo de pacientes inmunocomprometidos, con cuadros de presentación aguda y con insuficiencia respiratoria preoperatoria, la mortalidad es elevada y deben balancearse muy críticamente los riesgos contra los beneficios en ese grupo de enfermos.The objective of this study was to determine the morbidity, mortality and diagnostic yield of video assisted thoracoscopy (VATS and thoracotomy lung biopsy in interstitial lung disease (ILD. Clinical records of 71 patients were

  18. Tratamiento del enfisema intersticial pulmonar unilateral con ventilación monopulmonar contralateral: Presentación de 1 caso

    Directory of Open Access Journals (Sweden)

    María Victoria González Alonso

    1998-06-01

    Full Text Available Se presenta el caso de un recién nacido de 750 g de peso y 27 semanas de edad gestacional, que durante su evolución en la asistencia respiratoria mecánica, presentó enfisema intersticial pulmonar a tensión en el pulmón derecho, el cual producía desplazamiento mediastinal y pobre aereación del pulmón izquierdo. La subsecuente hipercapnia hizo fracasar todos los intentos de disminuir la presión inspiratoria en la vía aérea proximal y el enfisema intersticial fue empeorando. A los 6 días de vida se decide realizar intubación selectiva del bronquiotronco izquierdo y mantener al paciente con ventilación monopulmonar izquierda durante 36 horas. Al recolocar el tubo en la tráquea y reexpandirse el pulmón derecho, se observó una disminución notable del enfisema intersticial pulmonar y una mejoría gasométrica importante que permitió reducir la intensidad del apoyo ventilatorio. El paciente falleció posteriormente durante una enteritis necrosante.It is presented a case of a newborn of 750 g of weight and 27 weeks of gestational age that during his evolution in the mechanical respiratory assistance had a pulmonary interstitial emphysema on stress in the right lung, which produced mediastinal displacement and poor airing of the left lung. The subsequent hypercapsia made all the attempts to reduce the inspiratory pressure in the proximal air passage fail and therefore, the interstitial emphysema got worse. After the 6th day of life, it was decided to carry out selective intubation of the left bronchial trunk and to mantain the patient with left monopulmonary ventilation during 36 hours. On placing the tube into the trachea again, the right lung reexpanded and it was observed a remarkable decrease of the pulmonary interstitial emphysema and an important gasometric improvement that allowed to reduce that intensity of the ventilatory support. The patient died later due to a necrotizing enteritis.

  19. Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis Dermatite intersticial granulomatosa como apresentação de tireoidite autoimune

    Directory of Open Access Journals (Sweden)

    Joana Antunes

    2012-10-01

    Full Text Available A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions.Uma doente de 54 anos foi avaliada por placas eritematosas, dolorosas, disseminadas, recorrentes, com 3 meses de evolução. A biopsia cutânea foi compatível com dermatite intersticial granulomatosa. Os restantes exames laboratoriais revelaram hipotiroidismo e anticorpos anti-tiroideus positivos. Apesar da normalização da função tiroideia e de tratamento com corticóide tópico de alta potência, a dermatose melhorou apenas parcialmente. Dermatite intersticial inflamatória é um diagnóstico histopatológico, com expressão clínica variável. Tem sido associada a vários fármacos, doenças linfoproliferativas e autoimunes, nomeadamente artrite reumatóide, lupus eritematoso sistémico e vasculites, mas a associação com tireoidite autoimune é rara. Até ao momento, não foi definido nenhum tratamento específico, mas os corticóides tópicos são dos fármacos mais utilizados. A doença caracteriza-se por períodos de agravamento e remissão.

  20. Análise de 39 casos de pneumonia intersticial crônica idiopática Analysis of 39 cases of idiopathic chronic interstitial pneumonia

    Directory of Open Access Journals (Sweden)

    Rogério Rufino

    2006-12-01

    Full Text Available OBJETIVO: Analisar de forma retrospectiva fragmentos de biópsias pulmonares que receberam o diagnóstico de pneumonia intersticial crônica idiopática, à luz da classificação da American Thoracic Society e European Respiratory Society, de 2000. MÉTODOS: A partir da revisão de 252 fragmentos de biópsias pulmonares a céu aberto de pacientes com doença intersticial pulmonar, no período de 1977 a 1999, 39 casos de doença pulmonar intersticial idiopática foram selecionados e reavaliados por dois patologistas, segundo a classificação da American Thoracic Society e European Respiratory Society, de 2000. RESULTADOS: Vinte e oito dos 39 diagnósticos foram mantidos (71,8%. Uma nova entidade patológica, a pneumonia intersticial não específica, foi incluída na reclassificação e houve superposição de padrões em seis casos. Mantiveram o mesmo diagnóstico 28 casos, 4 casos apresentaram associação entre fibrose pulmonar idiopática e organização pneumônica criptogênica, 1 entre organização pneumônica criptogênica e pneumonia intersticial não específica, e 1 entre pneumonia intersticial descamativa e pneumonia intersticial não específica. Todos os casos de fibrose pulmonar idiopática foram confirmados, embora 3 deles estivessem associados a organização pneumônica criptogênica. Os diagnósticos anteriores foram quase todos mantidos na revisão dos espécimes (p > 0,05. CONCLUSÃO: A classificação das doenças pulmonares intersticiais da American Thoracic Society e European Respiratory Society é uma ferramenta útil aos patologistas que lidam com biópsias pulmonares.OBJECTIVE: To make a retrospective analysis of lung biopsy samples obtained from patients diagnosed with chronic idiopathic interstitial pneumonia, as defined in the American Thoracic Society/European Respiratory Society classification system made public in 2000. METHODS: Samples from 252 open-lung biopsies of patients with interstitial lung disease, all

  1. VASCULITIS DE CHURG-STRAUSS: PRESENTACIÓN CLÍNICA COMO GLOMERULONEFRITIS EXTRACAPILAR NECROTIZANTE PAUCI-INMUNE CON NEFRITIS TUBULO-INTERSTICIAL EOSINOFÍLICA.

    OpenAIRE

    Fernanda da Cunha; Edgar Lorga; Tânia Sousa; Jesús Garrido.

    2004-01-01

    RESUMEN: Se presenta el caso clínico de una mujer de 81 años con antecedentes patología pulmonar obstructiva crónica "idiopática" que desarrolló un cuadro de insuficiencia renal aguda aparentemente prerrenal, con posterior oliguria y eosinofilia simulando una nefropatía túbulo-intersticial alérgica. La evolución atípica y la presencia de p-ANCA, sugerían una vasculitis, patología que se confirmó con la biopsia renal. Los resultados anatomopatológicos revelaron la existencia de una glomerulone...

  2. Importância do diagnóstico de cistite intersticial na dor pélvica crônica = Importance of interstitial cystitis diagnosis in chronic pelvic pain

    Directory of Open Access Journals (Sweden)

    Zimmer, Michael Geraldo

    2005-01-01

    Conclusão: A cistite intersticial é um distúrbio crônico do trato urinário inferior. Não há medicação curativa para essa patologia, porém um tratamento de alívio dos sintomas pode proporcionar uma melhora na qualidade de vida

  3. Neumonía intersticial linfoidea asociada a inmunodeficiencia común variable Interstitial lymphoid pneumonia associated with common variable immunodeficiency

    Directory of Open Access Journals (Sweden)

    Gonzalo Peralta

    2011-10-01

    Full Text Available La neumonía intersticial linfoidea (NIL es una rara entidad, descripta como hiperplasia no neoplásica del tejido linfoide pulmonar y clasificada dentro de las enfermedades intersticiales idiopáticas. Se la ha descripto asociada a infección por HIV, fenómenos autoinmunes, hipergamaglobulinemia policlonal o menos frecuentemente a hipogammaglobulinemia. Presentamos una paciente de 66 años de edad con diabetes mellitus, síndrome de Sjögren e hipertensión arterial, derivada a nuestro centro por tos seca y disnea clase funcional II-III. En el examen físico presentaba rales tipo “velcro” bibasales y esplenomegalia. Los estudios de laboratorio evidenciaron plaquetopenia (50 000/mm³ e hipogammaglobulinemia; la tomografía axial computarizada (TAC de tórax mostró compromiso intersticial bibasal, con nódulos peribroncovasculares menores a un centímetro. Se realizó una videotoracoscopia con biopsia pulmonar, la anatomía patológica mostró hallazgos compatibles con neumonía intersticial linfoidea. Se inició tratamiento con metilprednisona 40 mg/día vía oral e infusión endovenosa de gammaglobulina 500 mg/kg, mensual, evolucionando con mejoría clínico-radiológica. Por persistencia de plaquetopenia, asociada a hiperesplenismo, se realizó esplenectomía con buena respuesta. En la anatomía patológica no se observo clonalidad linfoide.The interstitial lymphoid pneumonia (LIP is an uncommon disorder, described as non-neoplastic lung lymphoid tissue hyperplasia and classified as an interstitial lung disease. It has been described in association with HIV infection, autoimmune disorders, policlonal hypergammaglobulinemia and less frequently, with hypogammaglobulinemia. We report the case of a 66 year old female patient with a history of diabetes, Sjögren syndrome and hypertension. She was referred to our hospital due to a dry cough and dyspnea (FC II-III. The physical examination showed bilateral dry crackles and splenomegaly

  4. Semelhanças entre a doença idiopática do trato urinário inferior dos felinos e a cistite intersticial humana

    OpenAIRE

    Reche Junior Archivaldo; Hagiwara Mitika Kuribayashi

    2004-01-01

    A doença idiopática do trato urinário inferior dos felinos (DITUIF) continua sendo um grande desafio para o clínico veterinário uma vez que, apesar dos avanços nas técnicas diagnósticas, sua etiologia continua por ser determinada. O objetivo do presente trabalho é demonstrar as principais semelhanças entre a doença urinária felina e a cistite intersticial humana (CI), principalmente no que se refere à comprovação do caráter neurogênico da inflamação vesical, o papel do estresse na gênese e/ou...

  5. Insuficiência renal aguda e febre prolongada – um caso de nefrite intersticial aguda induzida por fármacos

    OpenAIRE

    Melo, Cláudia; Santos Silva, Rita; Tomé, Soraia; Carvalho, Sónia; Teixeira, Paulo

    2013-01-01

    A nefrite intersticial aguda (NIA) é uma causa de insuficiência renal aguda em idade pediátrica. A etiologia medicamentosa é a mais frequente e o tratamento primário da NIA consiste na eliminação do agente etiológico suspeito. Descreve-se o caso de uma adolescente, de 15 anos, com uma síndrome febril com 24 dias de evolução, acompanhado de exantema maculopapular e insuficiência renal aguda (IRA). Após exclusão de etiologias mais frequentes, foi diagnosticada NIA induzida por fármacos e após d...

  6. Cistitis intersticial o vejiga dolorosa: Un desafío para el clínico Interstitial cystitis: A challenge for the clinician

    Directory of Open Access Journals (Sweden)

    Pablo Young

    2010-08-01

    Full Text Available La cistitis intersticial se define como un síndrome clínico caracterizado por un incremento de la frecuencia urinaria, urgencia miccional y/o dolor abdominal o perineal en ausencia de infección urinaria o enfermedad conocida del aparato urinario. Se divide de acuerdo a los hallazgos citoscópicos en ulcerativa o no. La base del diagnóstico es clínica apoyada en scores de probabilidad y pruebas invasivas. Con la comprensión de la fisiopatología se ha desarrollado un abanico de posibilidades terapéuticas. Comunicamos el caso de una paciente sintomática por cuatro años con diagnóstico de cistitis intersticial con úlcera de Hunner por cistoscopia y excelente respuesta a la amitriptilina. Es una enfermedad que produce considerable alteración de la calidad de vida, por lo que es importante que los médicos estén familiarizados con este cuadro.Interstitial cystitis is characterized by over 6 months of chronic pain, pressure and discomfort felt in the lower pelvis or bladder. It is often relieved with voiding, along with daytime frequency and nocturia in the absence of an urinary tract infection. The disorder can be divided clinically into two groups -ulcerative and non-ulcerative- based on cystoscopic findings and response to treatment. Management follows an approach of applying the least invasive therapy that affords sufficient relief of symptoms. We report a case of a patient with interstitial cystitis. The diagnosis was performed by symptoms and lesion in the cystoscopy and excellent response to amitriptyline.

  7. Doença pulmonar intersticial crônica na criança Chronic interstitial lung disease in children

    Directory of Open Access Journals (Sweden)

    Maria Aparecida S. S. Paiva

    2007-06-01

    Full Text Available OBJETIVOS: Descrever aspectos clínicos, diagnósticos e resultados de conduta terapêutica em um grupo de pacientes pediátricos com doença pulmonar intersticial crônica.Métodos: Estudo retrospectivo de 25 pacientes imunocompetentes, de 2 meses a 17 anos, com doença pulmonar intersticial crônica, internados no Setor de Pneumologia, Serviço de Pediatria do Hospital dos Servidores do Estado, por um período de 20 anos (1984-2004. Seguiu-se protocolo para pneumopatias crônicas persistentes e selecionaram-se os casos de doença intersticial. Foram avaliados aspectos clínicos, laboratoriais e de imagem, diagnóstico final e tratamento. RESULTADOS: Vinte e cinco pacientes tiveram diagnóstico de doença pulmonar intersticial crônica, 13 menores de 2 anos e 17 do sexo masculino. O diagnóstico foi realizado pela história, exame físico e exames de rotina em um paciente, por exames mais complexos em três pacientes e por exames invasivos em 21 pacientes (20 por biópsia e um por lavado broncoalveolar. Com exceção do paciente com linfangiectasia pulmonar, o tratamento consistiu de corticoterapia, em seis casos associada à hidroxicloroquina e foi prolongado (1 a 7 anos. Quatro pacientes necessitaram oxigenoterapia domiciliar. Foram realizadas de seis a oito consultas de acompanhamento/ano pelas autoras. Evolução dos pacientes: boa (15; regular, com seqüela leve (4; ruim, com seqüela grave (3; dois óbitos e um perdido. CONCLUSÃO: As doenças pulmonares intersticiais crônicas constituem um grupo raro, porém relevante dentre as pneumopatias crônicas na criança, em razão da possível evolução para fibrose pulmonar. São importantes para a evolução o diagnóstico oportuno e o acompanhamento especializado e prolongado do paciente. Os pediatras devem ser alertados, pois certamente muitos casos não são diagnosticados nem tratados adequadamente.OBJECTIVES: To describe clinical and diagnostic features and the results of therapeutic

  8. Adaptação à cultura brasileira dos questionários The O'Leary-Sant e PUF, usados para cistite intersticial

    Directory of Open Access Journals (Sweden)

    Marcella Lima Victal

    2013-04-01

    Full Text Available O objetivo deste estudo foi traduzir e adaptar à cultura brasileira os instrumentos The O'Leary-Sant e PUF, utilizados no diagnóstico de cistite intersticial. Foram realizadas as etapas metodológicas recomendadas pela literatura internacional para a adaptação cultural. As etapas de tradução, síntese das traduções e retrotradução foram realizadas satisfatoriamente, e a avaliação das versões sintéticas pelo comitê de especialistas resultou em algumas alterações, assegurando as equivalências entre as versões originais e traduzidas. O PUF foi pré-testado entre 40 sujeitos e The O'Leary-Sant em uma amostra de 50 indivíduos, devido à necessidade de ajustes em decorrência da baixa escolaridade da população. O processo de tradução e adaptação foi realizado com sucesso e os instrumentos, após as modificações, demonstraram ser de fácil compreensão e rápido preenchimento. Entretanto, este é um estudo que antecede o processo de validação e será premente o emprego do instrumento em novas pesquisas para que sejam avaliadas suas propriedades psicométricas.

  9. Usual Dietary Intakes: SAS Macros for Fitting Multivariate Measurement Error Models & Estimating Multivariate Usual Intake Distributions

    Science.gov (United States)

    The following SAS macros can be used to create a multivariate usual intake distribution for multiple dietary components that are consumed nearly every day or episodically. A SAS macro for performing balanced repeated replication (BRR) variance estimation is also included.

  10. VASCULITIS DE CHURG-STRAUSS: PRESENTACIÓN CLÍNICA COMO GLOMERULONEFRITIS EXTRACAPILAR NECROTIZANTE PAUCI-INMUNE CON NEFRITIS TUBULO-INTERSTICIAL EOSINOFÍLICA.

    Directory of Open Access Journals (Sweden)

    Fernanda da Cunha

    2004-01-01

    Full Text Available RESUMEN: Se presenta el caso clínico de una mujer de 81 años con antecedentes patología pulmonar obstructiva crónica "idiopática" que desarrolló un cuadro de insuficiencia renal aguda aparentemente prerrenal, con posterior oliguria y eosinofilia simulando una nefropatía túbulo-intersticial alérgica. La evolución atípica y la presencia de p-ANCA, sugerían una vasculitis, patología que se confirmó con la biopsia renal. Los resultados anatomopatológicos revelaron la existencia de una glomerulonefritis necrotizante con semilunas e infiltrado eosinófilo. Estos datos y el historial de la paciente llevaron al diagnóstico de vasculitis de Churg-Strauss. El tratamiento inicial con corticoides y ciclofosfamida y posteriormente con Azatioprina mostró excelentes resultados con mejoría de la función renal, de los parámetros inflamatorios y de la clínica sistémica, que la paciente mantuvo posteriormente. ABSTRACT: We report a case of a 81 year-old woman with idiopathic chronic obstructive pulmonary disease, who developed a functional acute renal failure with delayed oliguria and eosinophily, simulating an acute interstitial nephropathy. The unusual clinical course and the presence of antimyeloperoxidase antibodies (p-ANCA suggested a vasculitis; the renal biopsy confirmed this diagnosis. The histology revealed a crescentic glomerulonephritis with eosinophilic infiltration. With these data and the pulmonary history of the patient, a diagnosis of Churg-Struss Vasculitis was made. The initial treatment with steroids and ciclophosphamide switched later to azatioprine, was succeeded with a sustained improvement in renal function, inflammatory markers and clinical course.

  11. Pegylated interferon induced interstitial pneumonitis in a patient with hepatitis C infection Neumonitis intersticial secundaria a tratamiento con interferón pegilado

    Directory of Open Access Journals (Sweden)

    J. Torres Macho

    2010-10-01

    Full Text Available Pegylated interferon and ribavirin is the treatment of choice in patients with chronic hepatitis C infection. The most common side effects of interferon therapy are flu-like symptoms and psychiatric disorders. Pneumonitis is a less frequent complication associated with non-negligible mortality. We herein report a case of interferon associated pneumonitis in a patient with non-severe clinical symptoms and a normal chest radiography. Physicians should be aware of this entity during the differential diagnosis of respiratory symptoms in patients receiving treatment with interferon due to its high morbimortality and good resolution and outcome after drug withdrawal.El interferón pegilado asociado a ribavirina es el tratamiento de elección en los pacientes con infección por hepatitis C crónica. Los efectos secundarios más comunes son los síntomas gripales y las alteraciones psiquiátricas. La neumonitis es una complicación poco frecuente, pero se asocia con una mortalidad no despreciable. Presentamos el caso clínico de un paciente con neumonitis intersticial asociada a interferón que presentaba signos y síntomas clínicos sutiles y una radiografía de tórax sin alteraciones. Se debe de tener presente esta entidad en el diagnóstico diferencial de los síntomas respiratorios en pacientes que reciben tratamiento con interferón debido a su elevada morbi-mortalidad y a su evolución favorable tras la retirada del fármaco.

  12. Doença pulmonar intersticial relacionada a miosite e a síndrome antissintetase Myositis-related interstitial lung disease and antisynthetase syndrome

    Directory of Open Access Journals (Sweden)

    Joshua Solomon

    2011-02-01

    Full Text Available Em pacientes com miosite, é comum o comprometimento pulmonar, e a presença de anticorpos anti-aminoacil-RNAt sintetase (anti-ARS é preditora da presença ou do desenvolvimento de doença pulmonar intersticial (DPI. Uma entidade clínica distinta - a síndrome antissintetase - é caracterizada pela presença de anticorpos anti-ARS, miosite, DPI, artrite, fenômeno de Raynaud e "mãos de mecânico". O mais comum anticorpo anti-ARS é o anti-Jo-1. Anticorpos anti-ARS mais recentemente descritos podem conferir um fenótipo que é distinto daquele de pacientes com positividade para anti-Jo-1, sendo caracterizado por uma menor incidência de miosite e uma maior incidência de DPI. Nos pacientes com DPI relacionada à síndrome antissintetase, a resposta a medicações imunossupressoras é em geral favorável.In patients with myositis, the lung is commonly involved, and the presence of anti-aminoacyl-tRNA synthetase (anti-ARS antibodies marks the presence or predicts the development of interstitial lung disease (ILD. A distinct clinical entity-antisynthetase syndrome-is characterized by the presence of anti-ARS antibodies, myositis, ILD, fever, arthritis, Raynaud's phenomenon, and mechanic's hands. The most common anti-ARS antibody is anti-Jo-1. More recently described anti-ARS antibodies might confer a phenotype that is distinct from that of anti-Jo-1-positive patients and is characterized by a lower incidence of myositis and a higher incidence of ILD. Among patients with antisynthetase syndrome-related ILD, the response to immunosuppressive medications is generally, but not universally, favorable.

  13. Geoengineering, Climate Harm, and Business as Usual

    Science.gov (United States)

    Jankunis, F. J.; Peacock, K.

    2014-12-01

    We define geoengineering (GE) as the intentional use of technology to change the planet's climate. Many people believe GE is different in kind rather than degree from any other organized activity in human history. In fact, humans caused changes in the planet's climate long before the industrial age, and all organisms engineer their environments directly or indirectly. The relevant difference between this cumulative and generally inadvertent activity and GE is the presence of intention. Now that science has revealed the extent to which humans can change the climate, however, even the continuance of Business as Usual (BAU) is, in effect, a form of intentional GE, albeit one that will cause significant climate harm, defined as effects such as sea level rise that will impact human well-being. But as with all forms of engineering, the devil is in the details: what forms of GE should be tried first? Some methods, such as large-scale afforestation, are low risk but have long-term payoffs; others, such as aerosol injection into the stratosphere, could help buy time in a warming crisis but have unknown side-effects and little long-term future. Climate change is a world-wide, inter-generational tragedy of the commons. Rational choice theory, the spatial and temporal extension of the problem, poorly fitted moral frameworks, and political maneuvering are all factors that inhibit solutions to the climate tragedy of the commons. The longer that such factors are allowed to dominate decision-making (or the lack thereof) the more likely it is that humanity will be forced to resort to riskier and more drastic forms of GE. We argue that this fact brings an additional measure of urgency to the search for ways to engineer the climate differently so as to avoid climate harm in the most lasting and least risky way.

  14. Estudio de nuevas técnicas de imagen en la evaluación y seguimiento de la neumopatía intersticial en las enfermedades autoinmunes sistémicas

    OpenAIRE

    Pinal Fernández, Iago

    2014-01-01

    La tomografía computarizada de alta resolución (TCAR) es la prueba de referencia para la valoración de las alteraciones estructurales del parénquima pulmonar en la enfermedad pulmonar intersticial (EPI) de las enfermedades autoinmunes sistémicas, también denominadas enfermedades del tejido conectivo (ETC). Junto con las pruebas de función respiratoria (PFRs), esenciales para el estudio del funcionalismo pulmonar de estos pacientes, la TCAR es la herramienta más útil para el diagnóstico y segu...

  15. Pneumonia intersticial em bovinos associada à ingestão de batata-doce (Ipomoea batatas mofada Interstitial pneumonia in cattle fed moldy sweet potatoes (Ipomoea batatas

    Directory of Open Access Journals (Sweden)

    Rafael A. Fighera

    2003-12-01

    Full Text Available Uma doença respiratória foi diagnosticada em cinco dentre 23 bovinos (21,7% após terem sido alimentados com batata-doce (Ipomoea batatas mofada em uma pequena propriedade rural em São Vicente do Sul, Rio Grande do Sul, Brasil. Três dos cinco bovinos afetados morreram espontaneamente, e o quarto foi sacrificado para necropsia quando mostrava sinais clínicos respiratórios avançados. A manifestação clínica iniciara cerca de 24 horas após a ingestão das batatas-doces e a evolução clínica foi de 1 a 4 dias. Os sinais clínicos incluíam dispnéia (respiração laboriosa e abdominal, taquipnéia, pescoço estendido com cabeça baixa e dilatação ritmada das narinas. Dois bovinos foram necropsiados. Os achados de necropsia incluíam pulmões distendidos, pálidos e de consistência borrachenta, que não colapsavam quando o tórax era aberto; enfisema e edema acentuados eram evidentes no pulmão. Os linfonodos e o baço apresentavam alterações características de hiperplasia linfóide. Histologica-mente, as lesões eram típicas de pneumonia intersticial. Os septos alveolares estavam espessados por fibroblastos e células inflamatórias, havia hipertrofia e hiperplasia de pneumócitos tipo II; os septos interlobulares estavam distendidos por edema e enfisema. A cultura de amostras das batatas-doces mofadas produziu Fusarium solani e F. oxysporum.Cases of respiratory disease were diagnosed in five out of 23 cattle (21.7% after they were fed moldy damaged sweet potatoes (Ipomoea batatas on a small farm in the county of São Vicente do Sul, state of Rio Grande do Sul, Brazil. Of those five cattle, three died spontaneously and another one was euthanatized for necropsy while showing advanced respiratory clinical signs. The disease manifested itself approximately 24 hours after the ingestion of the sweet potatoes and lasted from 1 to 4 days. Clinical signs included dyspnea (labored breathing and abdominal respiration, tachypnea, extended

  16. Uma breve contextualização sobre a nefrite tubulo-intersticial por IgG4 com base em um relato de caso no sul do Brasil

    Directory of Open Access Journals (Sweden)

    Karla Lais Pêgas

    2016-06-01

    Full Text Available Resumo A Doença relacionada a IgG4 (IgG4RD é um processo inflamatório recente de etiologia supostamente autoimune, que se caracteriza por níveis séricos elevados de IgG4, um denso infiltrado mononuclear rico em plasmócitos IgG4 positivos e fibrose estoriforme. A nefrite túbulo-intersticial é a manifestação renal mais comum, com diferentes graus de disfunção renal e achados clínicos variáveis. Aqui, os autores descrevem um novo caso de nefrite túbulo-intersticial associada a IgG4 (NTIgG4, e discutem critérios clínicos e patológicos. Paciente masculino, 72 anos, foi admitido no serviço hospitalar com queixa clínica de astenia, perda de força, emagrecimento e anosmia. A história prévia incluía Diabetes mellitus tipo 2. Os dados laboratoriais incluíam anemia normocrômica, proteinúria e elevação da creatinina. A ultrassonografia/tomografia computadorizada renal bilateral revelou um parênquima heterogêneo, com zonas densas e difusas irregulares, áreas de fibrose nos polos superiores e hidronefrose. A biópsia renal mostrou um infiltrado mononuclear intersticial denso, com mais de 50 plasmócitos por campo de grande aumento, áreas irregulares de fibrose fibroblástica e colagênica, tubulite focal e glomérulos normais. A imunofluorescência revelou deposição granular leve de IgG e C3c na membrana basal tubular. A imuno-histoquímica foi positiva para CD138, cadeias leves Kappa e lambda, e IgG4 (cerca de quarenta e cinco plasmócitos IgG4 positivos por campo de grande aumento. O nível sérico de IgG4 estava aumentado. O diagnóstico de NTIgG4 foi então estabelecido. O paciente recebeu corticoterapia e controle rigoroso da glicemia com insulina, com melhoria significativa dos sintomas e dos níveis de creatinina.

  17. Should You Put Sunscreen on Infants? Not Usually

    Science.gov (United States)

    ... Consumers Home For Consumers Consumer Updates Should You Put Sunscreen on Infants? Not Usually Share Tweet Linkedin ... month-old baby is there, too. Should you put sunscreen on her? Not usually, according to Hari ...

  18. Autopsy-proven causes of death in lungs of patients immunocompromised by secondary interstitial pneumonia Causas de óbito por pneumonia intersticial secundária em autópsias pulmonares de pacientes imunocomprometidos

    Directory of Open Access Journals (Sweden)

    Alberto Antonio Terrabuio Junior

    2007-02-01

    thromboembolism was associated with an appreciable risk of death (OR = 2.4 in patients with arterial hypertension. The risk of death was also high in patients presenting hepatic cancer (OR = 2.5 or steroid therapy (OR = 2.4 who developed pulmonary hemorrhage as the histological pattern of secondary interstitial pneumonia . The risk of death by lung metastasis was also elevated (OR = 1.6 for patients that were immunosuppressed after radiotherapy. CONCLUSION: Patients with secondary immunosuppression who developed secondary interstitial pneumonia during treatment in hospital should be evaluated to avoid death by diffuse alveolar damage, pulmonary edema, bronchopneumonia, lung hemorrhage, pulmonary thromboembolism, or lung metastasis. The high-risk patients are those immunosuppressed by hematologic disease; those under steroid treatment; or those with colon or hepatic carcinoma, cachexia, or arterial hypertension.OBJETIVO: Apresentar as associações mais freqüentes encontradas em autópsias de pacientes imunossuprimidos que desenvolveram pneumonia intersticial secundária bem como o risco de óbito (Odds Ratio de desenvolver PIS associada à causa da imunossupressão. MÉTODO: De janeiro de 1994 a março de 2004, 17000 autópsias foram realizadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A partir da revisão dos laudos patológicos foram selecionados 558 destas autópsias (3,28% de pacientes com 15 anos de idade ou mais, com alguma doença de base que desenvolveu um infiltrado pulmonar radiologicamente difuso durante o curso da hospitalização e que depois foi para óbito com pneumonia intersticial secundária (broncopneumonia, pneumonia lobar, pneumonia intersticial, dano alveolar difuso, doença pulmonar recorrente, doença pulmonar induzida por drogas, edema pulmonar cardiogênico e embolismo pulmonar. As lâminas histológicas foram revisadas por patologistas experientes para confirmar ou não a presença de pneumonia intersticial

  19. 19 CFR 134.14 - Articles usually combined.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Articles usually combined. 134.14 Section 134.14... TREASURY COUNTRY OF ORIGIN MARKING Articles Subject to Marking § 134.14 Articles usually combined. (a) Articles combined before delivery to purchaser. When an imported article is of a kind which is...

  20. Statistical modelling of usual intake. Scientific report submitted to EFSA

    NARCIS (Netherlands)

    Voet, van der H.; Klaveren, van J.D.; Arcella, D.; Bakker, M.; Boeing, H.; Boon, P.E.; Crépét, A.; Dekkers, A.; Boer, de W.; Dodd, K.W.; Ferrari, P.; Goedhart, P.W.; Hart, A.; Heijden, van der G.W.A.M.; Kennedy, M.; Kipnis, V.; Knüppel, S.; Merten, C.; Ocké, M.; Slob, W.

    2010-01-01

    Within the EFSA Article 36 project “European Tool Usual Intake” (ETUI) a workshop was organised in May 2010 where the different available models to calculate usual intake were presented and discussed. This report integrates the workshop background document, the presentations given by experts, and th

  1. From the braided to the usual Yang-Baxter relation

    CERN Document Server

    Fioravanti, D; Fioravanti, Davide; Rossi, Marco

    2001-01-01

    Quantum monodromy matrices coming from a theory of two coupled (m)KdV equations are modified in order to satisfy the usual Yang-Baxter relation. As a consequence, a general connection between braided and {\\it unbraided} (usual) Yang-Baxter algebras is derived and also analysed.

  2. Malandro, malandra, malandrinha e malandrógino: o espaço intersticial de identidade e gênero na ópera de Chico Buarque de Hollanda

    Directory of Open Access Journals (Sweden)

    Lúcia Helena de Azevedo Vilela

    2008-04-01

    Full Text Available Em De mendigos e malandros, Solange Ribeiro de Oliveira percorre os caminhos das articulações intertextuais e intersemióticas, da tradução lato sensu e das transposições histórico-culturais em sua análise das ambivalências e conflitos presentes na imagem que nós brasileiros construímos de nós mesmos – sintetizada na figura emblemática do malandro e sua escorregadia localização em um espaço intersticial entre o bandido e o herói, entre a censura e a admiração. A ambigüidade proporcionada pela própria definição do termo gera uma série de articulações dentre as quais encontram-se as representações da mulher e do homossexual – a malandra, a malandrinha e o malandrógino.

  3. Fibroadenoma with "immature-like" type of usual ductal hyperplasia.

    Science.gov (United States)

    Bezić, Joško; Karaman, Ivana; Kunac, Nenad

    2016-01-01

    We herein report a case of the breast fibroadenoma with foci of so-called immature variant of the conventional ductal hyperplasia. This type of usual ductal hyperplasia is histologically characterised by encircling intraductal proliferation of large cells with pale to amphophilic cytoplasm and large nuclei which vary in shape and in staining quality of the chromatin. We showed here, using the cytokeratin immunohistochemistry, that the proliferating cells were not of immature but rather mature immunohistochemical phenotype. Because of the presented discordance between immature histology and mature immunohistological profile we suggest that this rare type of usual ductal hyperplasia should be called "immature-like".

  4. Integrating palliative care with usual care of diabetic foot wounds.

    Science.gov (United States)

    Dunning, Trisha

    2016-01-01

    Palliative care is a philosophy and a system for deciding care and can be used alone or integrated with usual chronic disease care. Palliative care encompasses end-of-life care. Palliative care aims to enhance quality of life, optimize function and manage symptoms including early in the course of chronic diseases. The purposes of this article are to outline palliative care and discuss how it can be integrated with usual care of diabetic foot wounds. Many people with diabetes who have foot wounds also have other comorbidities and diabetes complications such as cardiovascular and renal disease and depression, which affect medicine and other treatment choices, functional status, surgical risk and quality of life. Two broad of diabetic foot disease exist: those likely to heal but who could still benefit from integrated palliative care such as managing pain and those where healing is unlikely where palliation can be the primary focus. People with diabetes can die suddenly, although the life course is usually long with periods of stable and unstable disease. Many health professionals are reluctant to discuss palliative care or suggest people to document their end-of-life care preferences. If such preferences are not documented, the person might not achieve their desired death or place of death and health professionals and families can be confronted with difficult decisions. Palliative care can be integrated with usual foot care and is associated with improved function, better quality of life and greater patient and family satisfaction.

  5. Cognitive-behavioural therapy v. usual care in recurrent depression

    NARCIS (Netherlands)

    H.J. Conradi; P. de Jonge; J. Ormel

    2008-01-01

    We examined in a primary care sample whether acute-phase cognitive-behavioural therapy (CBT) would be more effective than usual care for patients with multiple prior episodes of depression. Depression outcome was based on a 3-monthly administered Beck Depression Inventory (BDI) during a 2-year follo

  6. Recirculation usually precedes malignant edema in middle cerebral artery infarcts

    DEFF Research Database (Denmark)

    Nielsen, T H; Ståhl, N; Schalén, W;

    2012-01-01

    In patients with large middle cerebral artery (MCA) infarcts, maximum brain swelling leading to cerebral herniation and death usually occurs 2-5 days after onset of stroke. The study aimed at exploring the pattern of compounds related to cerebral energy metabolism in infarcted brain tissue....

  7. Cognitive behavioural therapies versus treatment as usual for depression.

    Science.gov (United States)

    Hunot, Vivien; Moore, Theresa Hm; Caldwell, Deborah; Davies, Philippa; Jones, Hannah; Furukawa, Toshi A; Lewis, Glyn; Churchill, Rachel

    2010-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all cognitive behavioural therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different cognitive behavioural therapy models (cognitive therapy, rational emotive behaviour therapy, problem-solving therapy, self-control therapy and the Coping with Depression course) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all cognitive behavioural therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression.

  8. Mortality estimation based on Business as Usual Scenario

    Science.gov (United States)

    Pozzer, Andrea; Lelieveld, Jos; Barlas, Ceren

    2013-04-01

    Air pollution by fine particulate matter (PM2.5) and ozone (O3) has increased strongly with industrialization and urbanization. Epidemiological studies have shown that these pollutants increase lung cancer, cardiopulmonary and respiratory mortality. The atmospheric chemistry general circulation model EMAC has been used to estimate the concentration of such pollutants in recent and future years (2005, 2010, 2025 and 2050), based on a Business as Usual scenario. The emission scenario assumes that population and economic growth largely determine energy consumption and consequent pollution sources ("business as usual"). Based on the modeled pollutants concentrations and the UN estimates of population growth in the future, we assessed the premature mortality and the years of human life lost (YLL) caused by anthropogenic PM2.5 and O3 for epidemiological regions defined by the World Health Organization. The premature mortality for people of 30 years and older were estimated using a health impact function using parameters derived from epidemiological studies. Our results suggest that with a Business as Usual scenario, the ratio between mortality and population would increase of ~ 50% by 2050. This ratio, together with the increase of world population, would lead by the year 2050 to 8.9 millions premature deaths, equivalent to 79 millions of YYL.

  9. [The usual diet of a group of adolescents from Valencia].

    Science.gov (United States)

    Farré Rovira, R; Frasquet Pons, I; Martínez Martínez, I; Romá Sánchez, R

    1999-01-01

    Adolescents are considered a high nutritional risk group because their nutritional needs are increased with respect to other age groups, and because this period of life coincides with changes in life style that affect, often negatively, their eating habits. Our overall goal is to study the usual eating pattern of Valencian adolescents together with their drink and tobacco consumption, but the first stage focuses on setting up, validating and correcting methods to be applied. The present study was therefore carried out in a sample composed of 64 adolescents, ranging from 16 to 20 years of age. A self administered survey developed in our Department was used to explore their food preferences, eating habits, smoking habits and alcohol and coffee intake. The following results were obtained: The number of daily meals was of 3.7 +/- 0.9. The 91% takes the breakfast daily (milk with cereals or sweet rolls) and the majority of the students eat a second mid-morning breakfast. Lunch is of the traditional type, consisting of two courses. The first is rice or pasta, followed by meat, fish or eggs usually accompanied by a side dish or salad. Fresh fruit is the dessert eaten, almost daily by the majority of the sample. The most usual drink is water. The 70% of the sample have one supplementary afternoon intake "merienda". All of the surveyed people like fruits, pasta and chicken meat. While, liver and legumes are disliked by the majority. The intakes of soft drinks, snacks, alcohol, coffee and tobacco are moderate, being, all these products mainly consumed during the weekend. The mean diet offers an excess of proteins and saturated fat, while complex carbohydrates and dietetic fiber are scarce. Nutritional intakes of iron, magnesium and zinc in girls, and magnesium, folates and vitamin A in boys are estimated insufficient to fulfil their needs.

  10. Adaptação à cultura brasileira dos questionários The O'Leary-Sant e PUF, usados para cistite intersticial Adaptación a la cultura brasileña de los cuestionarios The O'Leary-Sant y Puf, usados para cistitis intersticial Adaptation of the O'Leary-Sant and the PUF for the diagnosis of interstitial cystitis for the Brazilian culture

    Directory of Open Access Journals (Sweden)

    Marcella Lima Victal

    2013-04-01

    Full Text Available O objetivo deste estudo foi traduzir e adaptar à cultura brasileira os instrumentos The O'Leary-Sant e PUF, utilizados no diagnóstico de cistite intersticial. Foram realizadas as etapas metodológicas recomendadas pela literatura internacional para a adaptação cultural. As etapas de tradução, síntese das traduções e retrotradução foram realizadas satisfatoriamente, e a avaliação das versões sintéticas pelo comitê de especialistas resultou em algumas alterações, assegurando as equivalências entre as versões originais e traduzidas. O PUF foi pré-testado entre 40 sujeitos e The O'Leary-Sant em uma amostra de 50 indivíduos, devido à necessidade de ajustes em decorrência da baixa escolaridade da população. O processo de tradução e adaptação foi realizado com sucesso e os instrumentos, após as modificações, demonstraram ser de fácil compreensão e rápido preenchimento. Entretanto, este é um estudo que antecede o processo de validação e será premente o emprego do instrumento em novas pesquisas para que sejam avaliadas suas propriedades psicométricas.Se objetivó traducir y adaptar a la cultura brasileña los instrumentos The O'Leary-Sant y PUF, utilizados para diagnosticar cistitis intersticial. Fueron efectuadas las etapas metodológicas recomendadas por la literatura internacional para adaptación cultural. Las etapas de traducción, síntesis de traducciones y retrotraducción se realizaron satisfactoriamente, la evaluación de las versiones sintetizadas por parte del comité de especialistas derivó en algunas alteraciones, asegurando las equivalencias entre versiones originales y traducidas. El PUF fue pre-testeado con 40 sujetos y The O'Leary-Sant en muestra de 50 individuos, por la necesidad de ajustes derivados de la baja escolarización de la población. El proceso de traducción y adaptación se efectuó con suceso y los instrumentos luego de las modificaciones demostraron ser de sencilla comprensión y

  11. Salivary Composition Is Associated with Liking and Usual Nutrient Intake.

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    Caroline Méjean

    Full Text Available Salivary flow and composition have an impact on flavor perception. However, very few studies have explored the relationship between saliva, individual liking and usual dietary intake. The aim of our study was to evaluate the association of salivary flow and composition with both a liking for fat, saltiness and sweetness and the usual nutrient intake in an adult French population. Liking for fat, saltiness, and sweetness were inferred from liking scores obtained during hedonic tests on 32 food products among 282 French adults participating in the Nutrinet-Santé Study. Before assessing liking, resting saliva was collected. Standard biochemical analyses were performed to assess specific component concentrations and enzymatic activities. Dietary data were collected using three web-based 24 h records. Relationships between salivary flow and composition, sensory liking and nutrient intake were assessed using linear regression. Total antioxidant capacity was positively associated with simple carbohydrate intake (β = 31.3, 95% CI = 1.58; 60.99 and inversely related to complex carbohydrate consumption (β = -52.4, 95% CI = -87.51; -19.71. Amylolysis was positively associated with both total (β = 0.20, 95% CI = 0.01; 0.38 and simple carbohydrate intake (β = 0.21, 95% CI = 0.01; 0.39. Salivary flow was positively associated with liking for fat (β = 0.14, 95% CI = 0.03; 0.25. Proteolysis was positively associated with liking for saltiness and for fat (β = 0.31, 95% CI = 0.02; 0.59; β = 0.28, 95% CI = 0.01; 0.56, respectively. Amylolysis was inversely associated with liking for sweetness (β = -10.13, 95% CI = -19.51; -0.75. Carbonic anhydrase 6 was inversely associated with liking for saltiness (β = -46.77, 95% CI = -86.24; -7.30. Saliva does not substantially vary according to a usual diet, except for carbohydrate intake, whereas the specific association between salivary flow/composition and sensory liking suggests the influence of saliva

  12. Enfermedad pulmonar intersticial en Esclerosis Sistémica : diferencia en la presentación clínica y evolución clínica y evolución entre pacientes con anticuerpos Scl-70 frente PM-Scl

    OpenAIRE

    Guillén del Castillo, Alfredo

    2013-01-01

    La esclerosis sistémica (ES) es una enfermedad autoinmune multisistémica que afecta de forma variable a diferentes órganos. En el pulmón produce la enfermedad pulmonar intersticial difusa (EPID), cuyo pronóstico difiere según el autoanticuerpo asociado. Se estudiaron las características clínicas y espirométricas de 63 pacientes diagnosticados de ES y EPID, con positividad para anti-Scl-70 o anti-PM-Scl. En el grupo anti-Scl-70 se documentó mayor prevalencia de úlceras digitales y afección gas...

  13. Evolving MultiAlgebras unify all usual sequential computation models

    CERN Document Server

    Grigorieff, Serge

    2010-01-01

    It is well-known that Abstract State Machines (ASMs) can simulate "step-by-step" any type of machines (Turing machines, RAMs, etc.). We aim to overcome two facts: 1) simulation is not identification, 2) the ASMs simulating machines of some type do not constitute a natural class among all ASMs. We modify Gurevich's notion of ASM to that of EMA ("Evolving MultiAlgebra") by replacing the program (which is a syntactic object) by a semantic object: a functional which has to be very simply definable over the static part of the ASM. We prove that very natural classes of EMAs correspond via "literal identifications" to slight extensions of the usual machine models and also to grammar models. Though we modify these models, we keep their computation approach: only some contingencies are modified. Thus, EMAs appear as the mathematical model unifying all kinds of sequential computation paradigms.

  14. Consolidity: Moving opposite to built-as-usual systems practices

    Directory of Open Access Journals (Sweden)

    Hassen Taher Dorrah

    2013-06-01

    Full Text Available With the recent uncovering of the mystery of consolidity as an inner property of systems, it is demonstrated that this notion is an indispensable pillar of systems modeling, analysis, design and building. Based on the opposite mathematical relation between consolidity versus stability and controllability, a new conceptual life cycle (change pathway graph for natural and man-made built-as-usual systems is presented and thoroughly discussed. For the conceptual cycle development progress, it is logically conceived that system behavior changes rate has not accidentally happened, but is relatively influenced at the point of progress by the associated direct system consolidity index corresponding to the acting on-the-spot varying environments or effects. Such conceptual graph represents a real research advancement indicating that we have to move opposite to current systems building practices for solving many real life enigmatic problems. It is illustrated using stabilization of inverted pendulum problem that it is amenable by cleverly manipulating systems structure and parameters to attain new designed systems with aggregates of superiority of consolidity, stability and controllability principle. It is recommended that we have to seek new generation of innovative non-conventional systems structures moving opposite to conventional built-as-usual system practices that can enable providing directly such three aggregates of superiority requirements as their built-in self property. This will open the door towards solving many real life challenging dilemmas in various sciences and disciplines, such as engineering, space sciences, medicine, pharmacology, biology, ecology, life sciences, economy, operations research, humanities and social sciences that are believed to be attributed due to their systems inferior consolidity.

  15. Braquiterapia intersticial de alta tasa de rescate en cáncer cabeza cuello previamente radiado High-dose-rate (HDR brachytherapy in previously irradiated recurrent head and neck cancer

    Directory of Open Access Journals (Sweden)

    Lucía Gutiérrez-Bayard

    2011-09-01

    Full Text Available A pesar de los avances en el tratamiento de cáncer de cabeza y cuello (CCC, el 15-50% de los pacientes presentan recurrencia locorregional. Para los pacientes que presentan enfermedad localmente recurrente o un segundo tumor primario en un campo previamente irradiado, las opciones terapéuticas de rescate son limitadas, siendo la resección quirúrgica con intención curativa la opción de elección para los pacientes con enfermedad limitada. Reirradiación con o sin la adición de quimioterapia puede ser una buena opción, obteniendo en pacientes seleccionados supervivencia a largo plazo. La braquiterapia de alta tasa de dosis (HDRBT puede jugar un papel importante en el tratamiento de rescate en tumores de cabeza y cuello recurrentes. Presentamos un paciente de 56 años diagnosticado de cáncer de lengua sometido a cirugía y radioterapia externa adyuvante, y recurrencia metastásica ganglionar cervical contralateral a los 18 meses. Recibió tratamiento multidisciplinar con quimioterapia, cirugía y braquiterapia intersticial.Despite advances in the treatment of head and neck cancer (HNC, 15-50% of patients present locoregional disease recurrence. The therapeutic options are limited for patients who present locally recurrent disease or a second primary tumor in a previously irradiated field. Surgical salvage with curative intent is the preferred option for patients with limited-volume disease. Re-irradiation with or without the addition of chemotherapy may hold promise for long-term survival for selected patients. High-dose-rate (HDR brachytherapy can play an important role in the salvage treatment of previously irradiated recurrent head and neck cancer. The case reported was a 56-year old man diagnosed of tongue cancer who presented recurrent metastatic contralateral cervical node 1.5 years after radical treatment with surgery and adjuvant external radiotherapy. He received multidisciplinary treatment with chemotherapy, surgery and HDR

  16. The Glycoprofile Patterns of Endothelial Cells in Usual Interstitial Pneumonia

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    A Barkhordari

    2014-09-01

    Full Text Available [THIS ARTICLE HAS BEEN RETRACTED FOR DUPLICATE PUBLICATION] Background: The pathological classification of cryptogenic fibrosing alveolitis has been a matter of debate and controversy for histopathologists. Objective: To identify and specify the glycotypes of capillary endothelial cells in usual interstitial pneumonia (UIP compared to those found in normal tissue. Methods: Sections of formalin-fixed, paraffin-embedded blocks from 16 cases of UIP were studied by lectin histochemistry with a panel of 27 biotinylated lectins and an avidin-peroxidase revealing system. Results: High expression of several classes of glycan was seen de novo in capillary endothelial cells from patients with UIP including small complex and bi/tri-antennary bisected complex N-linked sequences bolund by Concanavalin A and erythro-phytohemagglutinin, respectively, GalNAca1 residues bound by Helix pomatia and Maclura pomifera agglutinins, and L-fucosylated derivatives of type II glycan chains recognized by Ulex europaeus agglutinin-I. Glycans bound by agglutinins from Lycopersicon esculentum (β1,4GlcNAc and Wisteria floribunda (GalNAc as well as GlcNAc oligomers bound by Phytolacca americana and succinylated Wheat Germ agglutinin were also seen in the capillary endothelial cells of UIP. In contrast, L-fucosylated derivatives of type I glycan chains were absent in cells from cases of UIP when Anguilla anguilla agglutinin was applied, unlike the situation in normal tissue. Conclusion: These results may indicate existence of two distinct populations of endothelial cell in UIP with markedly different patterns of glycosylation, reflecting a pattern of differentiation and angiogenesis, which is not detectable morphologically.

  17. El territorio intersticial de lo cotidiano

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    Leonardo Seguel Briones

    2015-04-01

    Full Text Available Quizás la palabra urbano sea una de las más escritas y recurrentes en el extenso análisis sociológico e histórico de la cultura gregaria universal. Junto con ella, el concepto de espacio, que aun estando preferentemente presente, e indiscutiblemente ligado a todas las disciplinas del saber, donde va tomando diversas connotaciones, su neutralidad elemental no alcanza a atrapar ni a registrar la complejidad de la vida en la ciudad.

  18. Usual coffee intake in Brazil: results from the National Dietary Survey 2008-9.

    Science.gov (United States)

    Sousa, Alessandra Gaspar; da Costa, Teresa Helena Macedo

    2015-05-28

    Coffee is central to the economy of many developing countries, as well as to the world economy. However, despite the widespread consumption of coffee, there are very few available data showing the usual intake of this beverage. Surveying usual coffee intake is a way of monitoring one aspect of a population's usual dietary intake. Thus, the present study aimed to characterise the usual daily coffee intake in the Brazilian population. We used data from the National Dietary Survey collected in 2008-9 from a probabilistic sample of 34,003 Brazilians aged 10 years and older. The National Cancer Institute method was applied to obtain the usual intake based on two nonconsecutive food diaries, and descriptive statistical analyses were performed by age and sex for Brazil and its regions. The estimated average usual daily coffee intake of the Brazilian population was 163 (SE 2.8) ml. The comparison by sex showed that males had a 12% greater usual coffee intake than females. In addition, the highest intake was recorded among older males. Among the five regions surveyed, the North-East had the highest usual coffee intake (175 ml). The most common method of brewing coffee was filtered/instant coffee (71%), and the main method of sweetening beverages was with sugar (87%). In Brazil, the mean usual coffee intake corresponds to 163 ml, or 1.5 cups/d. Differences in usual coffee intake according to sex and age differed among the five Brazilian regions.

  19. Manejo hospitalario de la meningoencefalitis bacteriana por S. Neumoniae

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    Roberto Álvarez Fumero

    2003-12-01

    Full Text Available La actitud terapéutica ante la meningitis bacteriana (MEB es uno de los retos más importantes a los que se enfrenta el pediatra, pues de su oportuno y adecuado manejo depende el pronóstico. Los cambios en la epidemiología de los síndromes neurológicos infecciosos bacterianos observados en Cuba a partir del año 2000, promovieron la implementación de modificaciones al régimen terapéutico antibiótico convencional. En este artículo, sin olvidar que el tratamiento ideal es el preventivo, se expone una revisión actualizada del manejo hospitalario de las MEB por S.pneumoniae, que incluye: adopción de medidas generales, instauración temprana de acciones dirigidas a atenuar los efectos perjudiciales de la respuesta inflamatoria sistémica, conducta específica contra el agente (antibioticoterapia y finalmente la identificación precoz e inicio de la rehabilitación de secuelas. Se hace énfasis en las modificaciones al esquema antibiótico adoptadas recientemente por la Comisión Nacional de SNI. Se exponen consideraciones sobre la introducción de la vancomicina en esquema antimicrobiano de las MEB por S.pneumoniae.The therapeutic attitude to face bacterial meningitis (BME is one of the most important challenges for pediatricians, since the prognosis depends on its timely and adequate management The changes in the epidemiology of the bacterial infectious neurological syndromes ocurred in Cuba from 2000 on, promoted the implementation of modifications in the conventional therapeutical antibiotic regimen. In this article, without forgetting that the ideal treatment is the preventive one, it is exposed an updated review of the hospital management of BME due to S.Pneumoniae that includes: adoption of general measures, early establishment of actions directed to alleviate the harmful effects of the systemic inflammatory reponse, specific conduct against the agent (antibiotic therapy and, finally, the identification and beginning of the rehabilitation of sequelae. Emphasis is made on the modifications of the antibiotic scheme recently adopted by the National Commission of the National System of Information. Considerations are made on the introduction of vancomycin in the antimicrobial scheme of the BME caused by S. pneumnoniae.

  20. Novel loci associated with usual sleep duration: The CHARGE Consortium Genome-Wide Association Study

    NARCIS (Netherlands)

    Gottlieb, D.J.; Hek, K.; Chen, T.H.; Watson, N.F.; Eiriksdottir, G.; Byrne, E.M.; Cornelis, M.; Warby, S.C.; Bandinelli, S.; Cherkas, L.; Evans, D.S.; Grabe, H.J.; Lahti, J.; Li, M.; Lehtimaki, T.; Lumley, T.; Marciante, K.D.; Pérusse, L.; Psaty, B.M.; Robbins, J.; Tranah, G.J.; Vink, J.M.; Wilk, J.B.; Stafford, J.M.; Bellis, C.; Biffar, R.; Bouchard, C.; Cade, B.; Curhan, G.C.; Eriksson, J.G.; Ewert, R.; Ferrucci, L.; Fulop, T.; Gehrman, P.R.; Goodloe, R.; Harris, T.B.; Heath, A.C.; Hernandez, D.G.; Hofman, A.; Hottenga, J.J.; Hunter, D.J.; Jensen, M.K.; Johnson, A.D.; Kahonen, M.; Kao, L.; Kraft, P.; Larkin, E.K.; Lauderdale, D.S.; Luik, A.I.; Medici, M.; Montgomery, G.W.; Palotie, A.; Patel, S.R.; Pistis, G.; Porcu, E.; Quaye, L.; Raitakari, O.; Redline, S.; Rimm, E.B.; Rotter, J.I.; Smith, A.V.; Spector, T.D.; Teumer, A.; Uitterlinden, A.G.; Vohl, M.C.; Widen, E.; Willemsen, G.; Young, T.; Zhang, X.; Liu, Y.; Blangero, J.; Boomsma, D.I.; Gudnason, V.; Hu, F.; Mangino, M.; Martin, N.G.; O'Connor, G.T.; Stone, K.L.; Tanaka, T.; Viikari, J.; Gharib, S.A.; Punjabi, N.M.; Raikkonen, K.; Völzke, H.; Mignot, E.; Tiemeier, H.

    2015-01-01

    Usual sleep duration is a heritable trait correlated with psychiatric morbidity, cardiometabolic disease and mortality, although little is known about the genetic variants influencing this trait. A genome-wide association study (GWAS) of usual sleep duration was conducted using 18 population-based

  1. Novel loci associated with usual sleep duration: The CHARGE Consortium Genome-Wide Association Study

    NARCIS (Netherlands)

    Gottlieb, D.J.; Hek, K.; Chen, T.H.; Watson, N.F.; Eiriksdottir, G.; Byrne, E.M.; Cornelis, M.; Warby, S.C.; Bandinelli, S.; Cherkas, L.; Evans, D.S.; Grabe, H.J.; Lahti, J.; Li, M.; Lehtimaki, T.; Lumley, T.; Marciante, K.D.; Pérusse, L.; Psaty, B.M.; Robbins, J.; Tranah, G.J.; Vink, J.M.; Wilk, J.B.; Stafford, J.M.; Bellis, C.; Biffar, R.; Bouchard, C.; Cade, B.; Curhan, G.C.; Eriksson, J.G.; Ewert, R.; Ferrucci, L.; Fulop, T.; Gehrman, P.R.; Goodloe, R.; Harris, T.B.; Heath, A.C.; Hernandez, D.G.; Hofman, A.; Hottenga, J.J.; Hunter, D.J.; Jensen, M.K.; Johnson, A.D.; Kahonen, M.; Kao, L.; Kraft, P.; Larkin, E.K.; Lauderdale, D.S.; Luik, A.I.; Medici, M.; Montgomery, G.W.; Palotie, A.; Patel, S.R.; Pistis, G.; Porcu, E.; Quaye, L.; Raitakari, O.; Redline, S.; Rimm, E.B.; Rotter, J.I.; Smith, A.V.; Spector, T.D.; Teumer, A.; Uitterlinden, A.G.; Vohl, M.C.; Widen, E.; Willemsen, G.; Young, T.; Zhang, X.; Liu, Y.; Blangero, J.; Boomsma, D.I.; Gudnason, V.; Hu, F.; Mangino, M.; Martin, N.G.; O'Connor, G.T.; Stone, K.L.; Tanaka, T.; Viikari, J.; Gharib, S.A.; Punjabi, N.M.; Raikkonen, K.; Völzke, H.; Mignot, E.; Tiemeier, H.

    2015-01-01

    Usual sleep duration is a heritable trait correlated with psychiatric morbidity, cardiometabolic disease and mortality, although little is known about the genetic variants influencing this trait. A genome-wide association study (GWAS) of usual sleep duration was conducted using 18 population-based c

  2. Novel loci associated with usual sleep duration: The CHARGE Consortium Genome-Wide Association Study

    NARCIS (Netherlands)

    D.J. Gottlieb (Daniel J); K. Hek (Karin); T.-H. Chen; N.F. Watson; G. Eiriksdottir (Gudny); E.M. Byrne; M. Cornelis (Marilyn); S.C. Warby; S. Bandinelli; L. Cherkas (Lynn); D.S. Evans (Daniel); H.J. Grabe (Hans Jörgen); J. Lahti (Jari); M. Li (Man); T. Lehtimäki (Terho); T. Lumley (Thomas); K. Marciante (Kristin); L. Perusse (Louis); B.M. Psaty (Bruce); J. Robbins; G.J. Tranah (Gregory); J.M. Vink; J.B. Wilk; J.M. Stafford; C. Bellis (Claire); R. Biffar; C. Bouchard (Claude); B. Cade; G.C. Curhan (Gary); J. Eriksson; R. Ewert; L. Ferrucci (Luigi); T. Fülöp; P.R. Gehrman (Philip); R. Goodloe (Robert); T.B. Harris (Tamara B.); A.C. Heath (Andrew C.); D.G. Hernandez (Dena); A. Hofman (Albert); J.J. Hottenga (Jouke Jan); D. Hunter (David); M.K. Jensen (Majken K.); A.D. Johnson (Andrew); M. Kähönen (Mika); W.H.L. Kao (Wen); P. Kraft (Peter); E.K. Larkin; D.S. Lauderdale; A.I. Luik (Annemarie I); M. Medici; G.W. Montgomery (Grant W.); A. Palotie; S.R. Patel (Sanjay); G. Pistis (Giorgio); E. Porcu; L. Quaye (Lydia); O. Raitakari (Olli); S. Redline (Susan); E.B. Rimm (Eric B.); J.I. Rotter; A.V. Smith; T.D. Spector (Timothy); A. Teumer (Alexander); A.G. Uitterlinden (André); M.-C. Vohl (Marie-Claude); E. Widen; G.A.H.M. Willemsen (Gonneke); T.L. Young (Terri L.); X. Zhang; Y. Liu; J. Blangero (John); D.I. Boomsma (Dorret); V. Gudnason (Vilmundur); F. Hu; M. Mangino; N.G. Martin (Nicholas); G.T. O'Connor (George); K.L. Stone (Katie L); T. Tanaka; J. Viikari (Jorma); S.A. Gharib (Sina); N.M. Punjabi (Naresh); K. Räikkönen (Katri); H. Völzke (Henry); E. Mignot; H.W. Tiemeier (Henning)

    2015-01-01

    textabstractUsual sleep duration is a heritable trait correlated with psychiatric morbidity, cardiometabolic disease and mortality, although little is known about the genetic variants influencing this trait. A genome-wide association study (GWAS) of usual sleep duration was conducted using 18 popula

  3. Marlboro and Other Usual Brand Choices by Youth Smokers in Middle Eastern Countries

    Science.gov (United States)

    Page, Randy M.

    2012-01-01

    This study analyzed data from 118,743 adolescents completing 30 different Global Youth Tobacco Surveys conducted in 15 different Middle Eastern countries between 1999 and 2007 to determine the proportion of young smokers who usually smoked Marlboro, other cigarette brands, or no usual brand smoked in these countries. Marlboro was the most…

  4. Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Risom, Signe S; Zwisler, Ann-Dorthe; Rasmussen, Trine Bernholdt

    2016-01-01

    fibrillation and sex to cardiac rehabilitation consisting of 12 weeks physical exercise and four psycho-educational consultations plus usual care (cardiac rehabilitation group) versus usual care. The primary outcome was Vo2 peak. The secondary outcome was self-rated mental health measured by the Short Form-36......BACKGROUND: To assess the effects of comprehensive cardiac rehabilitation compared with usual care on physical activity and mental health for patients treated with catheter ablation for atrial fibrillation. METHODS: The patients were randomized 1:1 stratified by paroxysmal or persistent atrial...... questionnaire. Exploratory outcomes were collected. RESULTS: 210 patients were included (mean age: 59 years, 74% men), 72% had paroxysmal atrial fibrillation prior to ablation. Compared with usual care, the cardiac rehabilitation group had a beneficial effect on Vo2 peak at four months (24.3mL kg(-1) min(-1...

  5. Supervised exercise therapy versus usual care for patellofemoral pain syndrome : an open label randomised controlled trial

    NARCIS (Netherlands)

    van Linschoten, R.; van Middelkoop, M.; Berger, M. Y.; Heintjes, E. M.; Verhaar, J. A. N.; Willemsen, S. P.; Koes, B. W.; Bierma-Zeinstra, S. M.

    2009-01-01

    Objective To assess the effectiveness of supervised exercise therapy compared with usual care with respect to recovery, pain, and function in patients with patellofemoral pain syndrome. Design Open label randomised controlled trial. Setting General practice and sport physician practice. Participants

  6. Supervised exercise therapy versus usual care for patellofemoral pain syndrome : an open label randomised controlled trial

    NARCIS (Netherlands)

    van Linschoten, R.; van Middelkoop, M.; Berger, M. Y.; Heintjes, E. M.; Verhaar, J. A. N.; Willemsen, S. P.; Koes, B. W.; Bierma-Zeinstra, S. M.

    2009-01-01

    Objective To assess the effectiveness of supervised exercise therapy compared with usual care with respect to recovery, pain, and function in patients with patellofemoral pain syndrome. Design Open label randomised controlled trial. Setting General practice and sport physician practice. Participants

  7. Treatment-Based Classification versus Usual Care for Management of Low Back Pain

    Science.gov (United States)

    2015-08-01

    Back Pain PRINCIPAL INVESTIGATOR: Dr. Daniel Rhon RECIPIENT: The Geneva Foundation Tacoma, WA 98402-4437 REPORT DATE: August 2015 TYPE OF...DATES COVERED 1Aug2014 - 31Jul2015 4. TITLE AND SUBTITLE Treatment-Based Classification versus Usual Care for Management of Low Back Pain 5a. CONTRACT...the effectiveness of two management strategies for patients with a recent onset of low back pain . One is based on usual care and the other is based on

  8. Removing Specification Errors from the Usual Formulation of Binary Choice Models

    Directory of Open Access Journals (Sweden)

    P.A.V.B. Swamy

    2016-06-01

    Full Text Available We develop a procedure for removing four major specification errors from the usual formulation of binary choice models. The model that results from this procedure is different from the conventional probit and logit models. This difference arises as a direct consequence of our relaxation of the usual assumption that omitted regressors constituting the error term of a latent linear regression model do not introduce omitted regressor biases into the coefficients of the included regressors.

  9. Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease.

    Science.gov (United States)

    Kim, E J; Elicker, B M; Maldonado, F; Webb, W R; Ryu, J H; Van Uden, J H; Lee, J S; King, T E; Collard, H R

    2010-06-01

    Interstitial lung disease is a common manifestation of rheumatoid arthritis; however, little is known about factors that influence its prognosis. The aim of the present study was to determine whether or not the usual interstitial pneumonia pattern found on high-resolution computed tomography (HRCT) is of prognostic significance in rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Patients with RA-ILD were identified retrospectively (n = 82). The relationship of a definite usual interstitial pneumonia pattern on HRCT to survival was determined and compared to that in a cohort of patients with radiologically diagnosed idiopathic pulmonary fibrosis (n = 51). A definite usual interstitial pneumonia pattern was seen in 20 (24%) out of 82 patients with RA-ILD. These patients showed worse survival than those without this pattern (median survival 3.2 versus 6.6 yrs), and a similar survival to those with idiopathic pulmonary fibrosis. On multivariate analysis, a definite usual interstitial pneumonia pattern on HRCT was associated with worse survival (hazard ratio of 2.3). Analysis of specific HRCT features demonstrated that traction bronchiectasis and honeycomb fibrosis were associated with worse survival (hazard ratio of 2.6 and 2.1, respectively). Female sex (hazard ratio of 0.30) and a higher baseline diffusing capacity of the lung for carbon monoxide (hazard ratio of 0.96) were associated with better survival. A definite usual interstitial pneumonia pattern on HRCT has important prognostic implications in RA-ILD.

  10. Usual gait speed assessment in middle-aged and elderly Brazilian subjects Velocidade usual da marcha em brasileiros de meia idade e idosos

    Directory of Open Access Journals (Sweden)

    Rômulo D. Novaes

    2011-04-01

    Full Text Available OBJECTIVES: To evaluate the usual gait speed of asymptomatic adult and elderly Brazilians with a 10-meter walk test and to compare the results with foreign reference values. METHODS: Seventy-nine asymptomatic volunteers >40 years old of both genders were assessed. After anamnesis, anthropometry and the application of a habitual physical activity questionnaire, the volunteers were submitted to a 10-meter walk test at usual speed by means of which gait speed, the number of steps and length of stride were calculated. RESULTS: Except for age, all study variables were significantly lower in women. Subjects >70 years old presented a significantly lower gait speed than subjects between 40 and 49 years old and between 50 and 59 in both men (1.09±0.18 m/s, 1.35±0.11 m/s and 1.34±0.22 m/s, respectively and women (1.02±0,10 m/s, 1.27±0.20 m/s and 1.27±0,15 m/s, respectively. Gait speed showed moderate correlations with age (r=-0.41, pOBJETIVOS: Avaliar a velocidade usual da marcha (VM por meio de teste de caminhada de 10 m (TC10m em adultos e idosos assintomáticos brasileiros e compará-la com os valores de referência estrangeiros. MÉTODOS: Setenta e nove voluntários assintomáticos com idade >40 anos, de ambos os gêneros, foram avaliados. Após anamnese, antropometria e questionário de atividade física habitual, os voluntários foram submetidos ao TC10m em velocidade usual. Por meio do tempo de teste, a VM, o número e comprimento dos passos e das passadas foram calculados. RESULTADOS: Com exceção da idade, todas as variáveis estudadas foram significativamente inferiores para as mulheres. Os indivíduos com idade >70 anos apresentaram VM significativamente inferior aos indivíduos entre 40 e 49 anos e entre 50 e 59 anos nos homens (1,09±0,18 m/s, 1,35±0,11 m/s e 1,34±0,22 m/s, respectivamente e nas mulheres (1,02±0,10 m/s, 1,27±0,20 m/s e 1,27±0,15 m/s, respectivamente. A VM apresentou correlações moderadas com a idade (r=-0,41, p

  11. Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality

    DEFF Research Database (Denmark)

    Graudal, Niels; Jürgens, Gesche; Baslund, Bo

    2014-01-01

    BACKGROUND: The effect of sodium intake on population health remains controversial. The objective was to investigate the incidence of all-cause mortality (ACM) and cardiovascular disease events (CVDEs) in populations exposed to dietary intakes of low sodium (sodium (low usual...... sodium: 115-165 mmol; high usual sodium: 166-215 mmol), and high sodium (>215 mmol). METHODS: The relationship between individual measures of dietary sodium intake vs. outcome in cohort studies and randomized controlled trials (RCTs) measured as hazard ratios (HRs) were integrated in meta......-analyses. RESULTS: No RCTs in healthy population samples were identified. Data from 23 cohort studies and 2 follow-up studies of RCTs (n = 274,683) showed that the risks of ACM and CVDEs were decreased in usual sodium vs. low sodium intake (ACM: HR = 0.91, 95% confidence interval (CI) = 0.82-0.99; CVDEs: HR = 0...

  12. Pneumonia intersticial associada à esclerose sistêmica: avaliação da função pulmonar no período de cinco anos Systemic sclerosis-associated interstitial pneumonia: evaluation of pulmonary function over a five-year period

    Directory of Open Access Journals (Sweden)

    Agnaldo José Lopes

    2011-04-01

    Full Text Available OBJETIVO: Avaliar as alterações da função pulmonar em portadores de pneumonia intersticial associada à esclerose sistêmica no intervalo de cinco anos. MÉTODOS: Foi realizado um estudo longitudinal no qual foram avaliados 35 pacientes não tabagistas com esclerose sistêmica e sem história de doença pulmonar prévia. Na primeira avaliação, realizada na época do diagnóstico da pneumonia intersticial, os pacientes foram submetidos à TCAR, espirometria e medida de DLCO. Os pacientes foram subdivididos em dois grupos de acordo com a presença ou não de faveolamento na TCAR. Aproximadamente cinco anos após a primeira avaliação, os pacientes foram submetidos a espirometria e medida da DLCO apenas. RESULTADOS: Dos 35 pacientes, 34 eram mulheres, com média de idade de 47,6 anos. A média de tempo entre as duas avaliações foi de 60,9 meses. O faveolamento foi demonstrado por TCAR em 17 pacientes. Na amostra total, após cinco anos do diagnóstico, CVF, VEF1 e DLCO reduziram significativamente (81,3 ± 18,2% vs. 72,1 ± 22,2%; 79,9 ± 17,8% vs. 72,5 ± 20,6%; e 74,0 ± 20,5% vs. 60,7 ± 26,8%, respectivamente; p = 0.0001 para todos, enquanto a relação VEF1/CVF aumentou significativamente (98,5 ± 7,2% vs. 101,9 ± 7,8%; p = 0,008. No mesmo período, os valores de CVF, VEF1 e DLCO foram significativamente menores nos pacientes com faveolamento do que naqueles sem faveolamento na TCAR (p = 0,0001. CONCLUSÕES: Na esclerose sistêmica com doença pulmonar intersticial associada, a detecção de faveolamento na TCAR é determinante para predizer uma deterioração acelerada da função pulmonar.OBJECTIVE: To evaluate alterations in pulmonary function in patients with systemic sclerosis-associated interstitial pneumonia over a five-year period. METHODS: This was a longitudinal study involving 35 nonsmoking patients with systemic sclerosis and without a history of lung disease. At the first evaluation, performed at the time of the

  13. Doing "Business as Usual": Dynamics of Voice in Community Organizing Talk

    Science.gov (United States)

    O'Connor, Kevin; Hanny, Courtney; Lewis, Cameron

    2011-01-01

    This article examines discourse in a community change project committed to undoing "business as usual"--attempts to "fix" problems within the community without involvement of residents in the process. We show how, despite commitments to recognizing community "voice," participants' orientation to powerful "centering institutions" (Jan Blommaert…

  14. Effectiveness of Mindfulness-Based Group Therapy Compared to the Usual Opioid Dependence Treatment

    Directory of Open Access Journals (Sweden)

    Saeed Imani

    2015-11-01

    Full Text Available  Objective: This study investigated the effectiveness of mindfulness-based group therapy (MBGT compared to the usual opioid dependence treatment (TAU.Thirty outpatients meeting the DSM-IV-TR criteria for opioid dependence from Iranian National Center for Addiction Studies (INCAS were randomly assigned into experimental (Mindfulness-Based Group Therapy and control groups (the Usual Treatment.The experimental group undertook eight weeks of intervention, but the control group received the usual treatment according to the INCAS program.  Methods:The Five Factor Mindfulness Questionnaire (FFMQ and the Addiction Sevier Index (ASI were administered at pre-treatment and post-treatment assessment periods. Thirteen patients from the experimental group and 15 from the control group completed post-test assessments. Results:The results of MANCOVA revealed an increase in mean scores in observing, describing, acting with awareness, non-judging, non-reacting, and decrease in mean scores of alcohol and opium in MBGT patient group. Conclusion:The effectiveness of MBGT, compared to the usual treatment, was discussed in this paper as a selective protocol in the health care setting for substance use disorders.

  15. Case Management as a Significant Component of Usual Care Psychotherapy for Youth with Disruptive Behavior Problems

    Science.gov (United States)

    Zoffness, Rachel; Garland, Ann; Brookman-Frazee, Lauren; Roesch, Scott

    2009-01-01

    Youth with disruptive behavior problems (DBPs) represent the majority of youth served in usual care (UC) psychotherapy, and are at high risk for maladaptive outcomes. Little is known about UC psychotherapeutic strategies utilized with this population. Researchers and clinicians suggest that case management (CM) is a major activity occurring in…

  16. Case Management as a Significant Component of Usual Care Psychotherapy for Youth with Disruptive Behavior Problems

    Science.gov (United States)

    Zoffness, Rachel; Garland, Ann; Brookman-Frazee, Lauren; Roesch, Scott

    2009-01-01

    Youth with disruptive behavior problems (DBPs) represent the majority of youth served in usual care (UC) psychotherapy, and are at high risk for maladaptive outcomes. Little is known about UC psychotherapeutic strategies utilized with this population. Researchers and clinicians suggest that case management (CM) is a major activity occurring in…

  17. Mandometer treatment not superior to treatment as usual for anorexia nervosa

    NARCIS (Netherlands)

    van Elburg, Annemarie A; Hillebrand, Jacquelien J G; Huyser, Chaim; Snoek, Maartje; Kas, Martien J H; Hoek, Hans W; Adan, Roger A H

    2012-01-01

    OBJECTIVE: A comparison of the efficacy of a novel treatment method for anorexia nervosa (AN), the Mandometer treatment (MT), with treatment as usual (TAU). METHOD: During treatment data were collected to determine weight recovery and outcome as assessed by the Morgan Russell Outcome Assessment Sche

  18. Mandometer Treatment Not Superior to Treatment as Usual for Anorexia Nervosa

    NARCIS (Netherlands)

    van Elburg, Annemarie A.; Hillebrand, Jacquelien J. G.; Huyser, Chaim; Snoek, Maartje; Kas, Martien; Hoek, Hans W.; Adan, Roger A. H.

    2012-01-01

    Objective: A comparison of the efficacy of a novel treatment method for anorexia nervosa (AN), the Mandometer treatment (MT), with treatment as usual (TAU). Method: During treatment data were collected to determine weight recovery and outcome as assessed by the Morgan Russell Outcome Assessment Sche

  19. Usual energy intake mediated the relationship between food reinforcement and BMI

    Science.gov (United States)

    The relative reinforcing value of food (RRVfood) is correlated with overweight status and energy consumed, as those who find food more reinforcing are heavier and consume more energy. One hypothesis relating these variables is that food reinforcement is related to BMI through usual energy intake. ...

  20. 76 FR 44855 - Common or Usual Name for Raw Meat and Poultry Products Containing Added Solutions

    Science.gov (United States)

    2011-07-27

    ... a common or usual name for raw meat and poultry products that do not meet standard of identity... into the raw meat or poultry product, and the individual ingredients or multi-ingredient components in... Products Inspection Act (PPIA) (21 U.S.C. 451-470) (``the Acts'') provide that the labels of meat and...

  1. Usual Dietary Intakes: Food Intakes, U.S. Population, 2007-10

    Science.gov (United States)

    We have applied the NCI Method for estimating distributions of usual intake to data from two recent cycles of the NHANES to estimate means and percentiles of the distributions of food intake and the percentage of persons meeting recommendations for a range of sex-age groups in the US population.

  2. Usual Dietary Intakes: Food Intakes, U.S. Population, 2001-04

    Science.gov (United States)

    The NCI Method provides the capability to estimate the distribution of usual food intakes in the U.S. population to greatly enhance the ability to monitor diets relative to recommendations and to assess the scope of dietary deficiencies and excesses.

  3. The Competition of Autistic Stereotyped Behavior with Usual and Specially Assessed Reinforcers.

    Science.gov (United States)

    Dyer, Kathleen

    1987-01-01

    The study evaluated a reinforcement theory of stereotyped behavior with six autistic students (ages 9-16). Three students evidenced decreases in stereotypy and increases in responding in the presence of usual reinforcers, while the other three students required external suppression of stereotypy before increases in responding were shown.…

  4. Yarrowia lipolytica as a biotechnological chassis to produce usual and unusual fatty acids.

    Science.gov (United States)

    Ledesma-Amaro, Rodrigo; Nicaud, Jean-Marc

    2016-01-01

    One of the most promising alternatives to petroleum for the production of fuels and chemicals is bio-oil based chemistry. Microbial oils are gaining importance because they can be engineered to accumulate lipids enriched in desired fatty acids. These specific lipids are closer to the commercialized product, therefore reducing pollutants and costly chemical steps. Yarrowia lipolytica is the most widely studied and engineered oleaginous yeast. Different molecular and bioinformatics tools permit systems metabolic engineering strategies in this yeast, which can produce usual and unusual fatty acids. Usual fatty acids, those usually found in triacylglycerol, accumulate through the action of several pathways, such as fatty acid/triacylglycerol synthesis, transport and degradation. Unusual fatty acids are enzymatic modifications of usual fatty acids to produce compounds that are not naturally synthetized in the host. Recently, the metabolic engineering of microorganisms has produced different unusual fatty acids, such as building block ricinoleic acid and nutraceuticals such as conjugated linoleic acid or polyunsaturated fatty acids. Additionally, microbial sources are preferred hosts for the production of fatty acid-derived compounds such as γ-decalactone, hexanal and dicarboxylic acids. The variety of lipids produced by oleaginous microorganisms is expected to rise in the coming years to cope with the increasing demand. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial.

    NARCIS (Netherlands)

    R. van Linschoten (Robbart); M. van Middelkoop (Marienke); M.Y. Berger (Marjolein); E.M. Heintjes (Edith); J.A.N. Verhaar (Jan); S.P. Willemsen (Sten); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)

    2009-01-01

    textabstractOBJECTIVE: To assess the effectiveness of supervised exercise therapy compared with usual care with respect to recovery, pain, and function in patients with patellofemoral pain syndrome. DESIGN: Open label randomised controlled trial. SETTING: General practice and sport physician practic

  6. Optimal Transportation-entropy Inequalities for Several Usual Distributions on R

    Institute of Scientific and Technical Information of China (English)

    Wei LIU

    2011-01-01

    In this paper,based on the recent results of Gozlan and Léonard we give optimal transportationentropy inequalities for several usual distributions on R,such as Bernoulli,Binomial,Poisson,Gamma distributions and infinitely divisible distributions with positive or negative jumps.

  7. Costs of terminal patients who receive palliative care or usual care in different hospital wards.

    Science.gov (United States)

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2010-11-01

    In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

  8. Secondary prevention after minor stroke and TIA - usual care and development of a support program.

    Directory of Open Access Journals (Sweden)

    Stefanie Leistner

    Full Text Available BACKGROUND: Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program. METHODS: Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU. Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed. RESULTS: 168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP: 155/84 mmHg and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01. LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12. Proportions of patients who stopped smoking were 50 versus 79% (p<0.01. 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09. CONCLUSIONS: Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-vascular recurrence rates are going to be assessed in a multicenter randomized trial.

  9. Randomized trial of DVD, telephone, and usual care for increasing mammography adherence.

    Science.gov (United States)

    Champion, Victoria L; Rawl, Susan M; Bourff, Sara A; Champion, Kristen M; Smith, Lisa G; Buchanan, Adam H; Fish, Laura J; Monahan, Patrick O; Stump, Timothy E; Springston, Jeffery K; Gathirua-Mwangi, Wambui G; Skinner, Celette Sugg

    2016-06-01

    The purpose of this study was to test an intervention to increase mammography screening in women 51-75 years of age who had not received a mammogram in the last 15 months. A total of 1681 women were randomized to (1) a mailed tailored interactive DVD, (2) a computer-tailored telephone counseling, or (3) usual care. Women with income below US$75,000 who were in the interactive DVD group had significantly more mammograms than women in usual care. Women with income above US$75,000 had significantly fewer mammograms than women with income less than US$75,000 regardless of group. Further investigation is needed to understand why women with income above US$75,000 did not show the same benefit of the intervention.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    Objective: To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Design: Randomised, observer blinded parallel group superiority clinical trial. Setting: Three hospitals...... in Denmark. Participants: 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Interventions: Education in skin care...... and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual. Main outcome measures: The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index...

  11. Mindfulness-based 'third wave' cognitive and behavioural therapies versus treatment as usual for depression.

    Science.gov (United States)

    Churchill, Rachel; Moore, Theresa Hm; Davies, Philippa; Caldwell, Deborah; Jones, Hannah; Lewis, Glyn; Hunot, Vivien

    2010-09-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all third wave CBT approaches compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different third wave CBT approaches (ACT, compassionate mind training, functional analytic psychotherapy, meta-cognitive therapy, dialectical behaviour therapy, MBCT, extended behavioural activation and meta-cognitive therapy) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all third wave CBT approaches compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression.

  12. Syllogistic reasoning in fuzzy logic and its application to usuality and reasoning with dispositions

    Science.gov (United States)

    Zadeh, L. A.

    1985-01-01

    A fuzzy syllogism in fuzzy logic is defined to be an inference schema in which the major premise, the minor premise and the conclusion are propositions containing fuzzy quantifiers. A basic fuzzy syllogism in fuzzy logic is the intersection/product syllogism. Several other basic syllogisms are developed that may be employed as rules of combination of evidence in expert systems. Among these is the consequent conjunction syllogism. Furthermore, it is shown that syllogistic reasoning in fuzzy logic provides a basis for reasoning with dispositions; that is, with propositions that are preponderantly but not necessarily always true. It is also shown that the concept of dispositionality is closely related to the notion of usuality and serves as a basis for what might be called a theory of usuality - a theory which may eventually provide a computational framework for commonsense reasoning.

  13. Mindfulness based cognitive therapy versus treatment as usual in adults with attention deficit hyperactivity disorder (ADHD)

    OpenAIRE

    Janssen, L.; Kan, C C; Carpentier, P.J.; Sizoo, B.B.; Hepark, S.; Grutters, J.P.; Donders, R.; Buitelaar, J; Speckens, A.E.M.

    2015-01-01

    BACKGROUND: Adults with attention deficit hyperactivity disorder (ADHD) often present with a lifelong pattern of core symptoms that is associated with impairments of functioning in daily life. This has a substantial personal and economic impact. In clinical practice there is a high need for additional or alternative interventions for existing treatments, usually consisting of pharmacotherapy and/or psycho-education. Although previous studies show preliminary evidence for the effectiveness of ...

  14. Do you really know precise radiologic–pathologic correlation of usual interstitial pneumonia?

    Energy Technology Data Exchange (ETDEWEB)

    Johkoh, Takeshi, E-mail: johkoht@aol.com [Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami (Japan); Sumikawa, Hiromotsu [Department of Radiology, Osaka University Graduate School of Medicine, Suita (Japan); Fukuoka, Junya; Tanaka, Tomonori [Department of Pathology, Nagasaki University Graduate School of Medicine, Toyama (Japan); Fujimoto, Kiminori [Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume (Japan); Takahashi, Masashi [Department of Radiology, Shiga Medical University, Otsu (Japan); Tomiyama, Noriyuki [Department of Radiology, Osaka University Graduate School of Medicine, Suita (Japan); Kondo, Yasuhiro; Taniguchi, Hiroyuki [Department of Respiratory and Allergic Medicine, Tosei General Hospital, Seto (Japan)

    2014-01-15

    Although usual interstitial pneumonia (UIP) is the most common chronic interstitial pneumonia, understanding of pathologic backgrounds of CT findings has still not been enough. Since honeycombing on either scanning microgram or CT is essential for diagnosis of UIP in 2010 ATS-ERS-JRS-ALAT guide line, the role of radiologists has become much more important. We will summarize common and uncommon CT findings with radiologic–pathological correlation.

  15. Outcomes of usual chiropractic, harm & efficacy, the ouch study: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Walker Bruce F

    2011-10-01

    Full Text Available Abstract Background Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, because of these studies design we do not know the frequency and extent of these events when compared to sham treatment. The principal aims of this study are to establish the frequency and severity of adverse effects from short term usual chiropractic treatment of the spine when compared to a sham treatment group. The secondary aim of this study is to establish the efficacy of usual short term chiropractic care for spinal pain when compared to a sham intervention. Methods One hundred and eighty participants will be randomly allocated to either usual chiropractic care or a sham intervention group. To be considered for inclusion the participants must have experienced non-specific spinal pain for at least one week. The study will be conducted at the clinics of registered chiropractors in Western Australia. Participants in each group will receive two treatments at intervals no less than one week. For the usual chiropractic care group, the selection of therapeutic techniques will be left to the chiropractors' discretion. For the sham intervention group, de-tuned ultrasound and de-tuned activator treatment will be applied by the chiropractors to the regions where spinal pain is experienced. Adverse events will be assessed two days after each appointment using a questionnaire developed for this study. The efficacy of short term chiropractic care for spinal pain will be examined at two week follow-up by assessing pain, physical function, minimum acceptable outcome, and satisfaction with care, with the use of the following outcome measures: Numerical Rating Scale, Functional Rating Index, Neck Disability Index, Minimum Acceptable Outcome Questionnaire, Oswestry Disability Index, and a global measure of treatment satisfaction. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Trial

  16. The Kramers-Kronig relations for usual and anomalous Poisson-Nernst-Planck models.

    Science.gov (United States)

    Evangelista, Luiz Roberto; Lenzi, Ervin Kaminski; Barbero, Giovanni

    2013-11-20

    The consistency of the frequency response predicted by a class of electrochemical impedance expressions is analytically checked by invoking the Kramers-Kronig (KK) relations. These expressions are obtained in the context of Poisson-Nernst-Planck usual or anomalous diffusional models that satisfy Poisson's equation in a finite length situation. The theoretical results, besides being successful in interpreting experimental data, are also shown to obey the KK relations when these relations are modified accordingly.

  17. Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review.

    Science.gov (United States)

    Schneider, Emma J; Lannin, Natasha A; Ada, Louise; Schmidt, Julia

    2016-10-01

    In people receiving rehabilitation aimed at reducing activity limitations of the lower and/or upper limb after stroke, does adding extra rehabilitation (of the same content as the usual rehabilitation) improve activity? What is the amount of extra rehabilitation that needs to be provided to achieve a beneficial effect? Systematic review with meta-analysis of randomised trials. Adults aged 18 years or older that had a diagnosis of stroke. Extra rehabilitation with the same content as usual rehabilitation aimed at reducing activity limitations of the lower and/or upper limb. Activity measured as lower or upper limb ability. A total of 14 studies, comprising 15 comparisons, met the inclusion criteria. Pooling data from all the included studies showed that extra rehabilitation improved activity immediately after the intervention period (SMD=0.39, 95% CI 0.07 to 0.71, I(2)=66%). When only studies with a large increase in rehabilitation (> 100%) were included, the effect was greater (SMD 0.59, 95% CI 0.23 to 0.94, I(2)=44%). There was a trend towards a positive relationship (r=0.53, p=0.09) between extra rehabilitation and improved activity. The turning point on the ROC curve of false versus true benefit (AUC=0.88, p=0.04) indicated that at least an extra 240% of rehabilitation was needed for significant likelihood that extra rehabilitation would improve activity. Increasing the amount of usual rehabilitation aimed at reducing activity limitations improves activity in people after stroke. The amount of extra rehabilitation that needs to be provided to achieve a beneficial effect is large. PROSPERO CRD42012003221. [Schneider EJ, Lannin NA, Ada L, Schmidt J (2016) Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review.Journal of Physiotherapy62: 182-187]. Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

  18. Adequacy of Usual Vitamin and Mineral Intake in Spanish Children and Adolescents: ENALIA Study

    Directory of Open Access Journals (Sweden)

    Ana M. López-Sobaler

    2017-02-01

    Full Text Available Background: The National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA provides data to assess the usual micronutrient intake among Spanish infants, children, and adolescents. Methods: Cross-sectional survey (November 2012–July 2014 of a representative sample of Spanish children and adolescents (six months–17 years (n = 1862. Dietary information was collected using two non-consecutive one-day food diaries (six months–10 years old or two 24 h dietary recalls (11 years and older separated by at least 14 days. Estimates were calculated using the Iowa State University method and PC-SIDE software (version 1.0, department of statistics, center for agricultural and rural development, Ames, IA, USA to account for within- and between-person variation. Results: Usual intake of vitamin D was insufficient in practically all individuals. Vitamin E, folate, and calcium were insufficient, especially from nine years of age, and magnesium and iodine from 14 years of age. The percentage of subjects with insufficient intakes was higher among females. Sodium intake was excessive in a considerable percentage of the population, especially in males, and it increased with age. Finally, over half of children under four years of age had zinc usual intakes that exceeded the Tolerable Upper Level. Conclusion: Vitamin and mineral intake in Spain should be improved, especially in late childhood and adolescence. Nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies in Spanish children and adolescents.

  19. Cercarial productivity of Fasciola hepatica in Lymnaea truncatula during usual and unusual development of redial generations.

    Science.gov (United States)

    Augot, D; Rondelaud, D

    2001-08-01

    Single-miracidium infections of Lymnaea truncatula by Fasciola hepatica were carried out to determine the cercarial productivity of each redial generation when the first-appearing mother redia (R1a redia) normally developed (usual development of redial generations) or quickly died (unusual development). In both developmental patterns of infection, the number of morulae was significantly higher in the second-appearing mother rediae (R1b group) than in either the daughter rediae from R1a rediae (R2a group) or the rediae from subsequent groups (R2b/R3a). The live R1a group did not produce cercariae. The percentages of cercariae produced by the R1b, R2a, and R2b/R3a groups were 28.2%, 62.8%, and 8.9% when the development of redial generations was usual. In contrast, in an unusual development, they were 69.3%, 20.3%, and 10.2%, respectively. Cercarial production until day 63 post-exposure was essentially provided by the R2a rediae, when the development of redial generations was usual, and by the R1b rediae when it was unusual.

  20. Acupuncture, Counseling, and Usual care for Depression (ACUDep: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    MacPherson Hugh

    2012-11-01

    Full Text Available Abstract Background The evidence on the effect of acupuncture or counseling for depression is not conclusive yet is sufficient to warrant further research. Our aim is to conduct a full-scale RCT to determine the clinical and cost effectiveness of acupuncture and counseling compared to usual care alone. We will explore the experiences and perspectives of patients and practitioners. Methods/Design Randomized controlled trial with three parallel arms: acupuncture plus usual care, counseling plus usual care, and usual care alone, in conjunction with a nested qualitative study using in-depth interviews with purposive samples of trial participants. Participants: Patients aged over 18 years diagnosed with depression or mood disorder by their GP and with a score of 20 or above on the Beck Depression Inventory (BDI-II. Randomization: Computer randomization by York Trials Unit to acupuncture, counseling, and usual care alone in proportions of 2:2:1, respectively, with secure allocation concealment. Interventions: Patients allocated to acupuncture and counseling groups receive the offer of up to 12 weekly sessions. Both interventions allow flexibility to address patient variation, yet are constrained within defined protocols. Acupuncture is based on traditional Chinese medicine and counseling is non-directive within the humanistic tradition. Outcome: The PHQ-9 is the primary outcome measure, collected at baseline, 3, 6, 9, and 12 months. Also measured is BDI-II, SF-36 Bodily pain subscale, and EQ-5D. Texted mood scores are collected weekly over the first 15 weeks. Health-related resource use is collected over 12 months. Analysis: The sample size target was for 640 participants, calculated for an effect size of 0.32 on the PHQ-9 when comparing acupuncture with counseling given 90% power, 5% significance, and 20% loss to follow-up. Analysis of covariance will be used on an intention-to-treat basis. Thematic analysis will be used for qualitative data. We will

  1. Usual Dietary Intakes: SAS Macros for Estimating Ratios of Two Dietary Components that are Consumed Nearly Every Day

    Science.gov (United States)

    The following SAS macros can be used to create a bivariate distribution of usual intake of two dietary components that are consumed nearly every day and to calculate percentiles of the population distribution of the ratio of usual intakes.

  2. Usual interstitial pneumonia end-stage features from explants with radiologic and pathological correlations.

    Science.gov (United States)

    Rabeyrin, Maud; Thivolet, Françoise; Ferretti, Gilbert R; Chalabreysse, Lara; Jankowski, Adrien; Cottin, Vincent; Pison, Christophe; Cordier, Jean-François; Lantuejoul, Sylvie

    2015-08-01

    Idiopathic pulmonary fibrosis (IPF) is the most frequent and severe idiopathic interstitial pneumonia, with typical high-resolution computed tomography (HRCT) features and histologic pattern of usual interstitial pneumonia (UIP); its main differential diagnosis is fibrotic nonspecific interstitial pneumonia (F-NSIP). Usual interstitial pneumonia was mainly described from lung biopsies, and little is known on explants. Twenty-two UIP/IPF explants were analyzed histologically and compared with previous open lung biopsies (OLBs; n = 11) and HRCT (n = 19), when available. Temporospatial heterogeneity and subpleural and paraseptal fibrosis were similarly found in UIP/IPF explants and OLB (91%-95%). Fibroblastic foci were found in 82% of OLBs and 100% of explants, with a higher mean score in explants (P = .023). Honeycombing was present in 64% of OLBs and 95% of explants, with a higher mean score in explants (P = .005). Almost 60% of UIP/IPF explants showed NSIP areas and 41% peribronchiolar fibrosis; inflammation, bronchiolar metaplasia, and vascular changes were more frequent in UIP/IPF explants; and Desquamative Interstitial Pneumonia (DIP)-like areas were not common (18%-27%). Numerous large airspace enlargements with fibrosis were frequent in UIP/IPF explants (59%). On HRCT, honeycombing was observed in 95% of the cases and ground-glass opacities in 53%, correlating with NSIP areas or acute exacerbation at histology. Six patients had combined IPF and emphysema. Lesions were more severe in UIP/IPF explants, reflecting the worsening of the disease. Usual interstitial pneumonia/IPF explants more frequently presented with confounding lesions such as NSIP areas, peribronchiolar fibrosis, and airspace enlargements with fibrosis sometimes associated with emphysema.

  3. Association Between Usual Vitamin K Intake and Anticoagulation in Patients Under Warfarin Therapy.

    Science.gov (United States)

    Park, Ji Na; Lee, Ji Sun; Noh, Min Young; Sung, Mi-Kyung

    2015-10-01

    This study aimed to explore the correlation between usual vitamin K intake and response to anticoagulant therapy among patients under warfarin therapy. We conducted a retrospective survey of patients (n = 50) on continuous warfarin therapy. Clinical information and laboratory parameters were sourced from medical records. Anticoagulant effect was evaluated by using the percent time in therapeutic range (TTR) and the coefficient of variation (CV) of International normalized ratio (INR). Dietary vitamin K intake was assessed using a semi-quantitative food frequency questionnaire that has been developed for the purpose of assessing dietary intake of vitamin K. A total of 50 patients aged between 21 and 87 years were included in the study. The mean vitamin K intake was 262.8 ± 165.2 µg/day. Study subjects were divided into tertiles according to their usual vitamin K intake. The proportion of men was significantly higher in second and third tertile than first tertile (p = 0.028). The mean percent TTR was 38.4 ± 28.4% and CV of INR was 31.8 ± 11.8%. Long-term warfarin therapy group (≥ 3 years) had a higher percentage of TTR as compared to the control group (vitamin K intake and percent TTR (p > 0.05). In conclusion, no significant association was observed between usual vitamin K intake and anticoagulant effects. Further studies are required to consider inter-individual variability of vitamin K intake. Development of assessment tools to measure inter-individual variability of vitamin K intake might be helpful.

  4. Acanthosis nigricans – a common significant disorder usually unassociated with malignancy

    Directory of Open Access Journals (Sweden)

    Edmund J. Janniger

    2011-03-01

    Full Text Available Acanthosis nigricans (AN can be a highly significant cutaneous findingand is usually unrelated to cancer. It is most often evident as velvetythickening of axillae, posterior neck fold, flexor skin surfaces andumbilicus. It is common in obesity, which is seen increasing in childrenand adolescents, and can serve as a cutaneous marker of insulin resistance.It is most often associated with hyperinsulinemia, which mayresult from insulin receptor gene defects causing insulin resistance, andless frequently due to mutations in fibroblast growth factor receptors.In this work non malignancy-associated AN types will be emphasized,particularly the association of AN with insulin-resistance, itself a potentialthreat to life.

  5. Terrestrial bitumen analogue of orgueil organic material demonstrates high sensitivity to usual HF-HCl treatment

    Science.gov (United States)

    Korochantsev, A. V.; Nikolaeva, O. V.

    1993-01-01

    The relationship between the chemical composition and the interlayer spacing (d002) of organic materials (OM's) is known for various terrestrial OM's. We improved this general trend by correlation with corresponding trend of natural solid bitumens (asphaltite-kerite-anthraxolite) up to graphite. Using the improved trend we identified bitumen analogs of carbonaceous chondrite OM's residued after HF-HCl treatment. Our laboratory experiment revealed that these analogs and, hence, structure and chemical composition of carbonaceous chondrite OM's are very sensitive to the HF-HCl treatment. So, usual extraction of OM from carbonaceous chondrites may change significantly structural and chemical composition of extracted OM.

  6. Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review

    Directory of Open Access Journals (Sweden)

    Emma J Schneider

    2016-10-01

    Full Text Available Questions: In people receiving rehabilitation aimed at reducing activity limitations of the lower and/or upper limb after stroke, does adding extra rehabilitation (of the same content as the usual rehabilitation improve activity? What is the amount of extra rehabilitation that needs to be provided to achieve a beneficial effect? Design: Systematic review with meta-analysis of randomised trials. Participants: Adults aged 18 years or older that had a diagnosis of stroke. Intervention: Extra rehabilitation with the same content as usual rehabilitation aimed at reducing activity limitations of the lower and/or upper limb. Outcome measures: Activity measured as lower or upper limb ability. Results: A total of 14 studies, comprising 15 comparisons, met the inclusion criteria. Pooling data from all the included studies showed that extra rehabilitation improved activity immediately after the intervention period (SMD = 0.39, 95% CI 0.07 to 0.71, I2 = 66%. When only studies with a large increase in rehabilitation (> 100% were included, the effect was greater (SMD 0.59, 95% CI 0.23 to 0.94, I2 = 44%. There was a trend towards a positive relationship (r = 0.53, p = 0.09 between extra rehabilitation and improved activity. The turning point on the ROC curve of false versus true benefit (AUC = 0.88, p = 0.04 indicated that at least an extra 240% of rehabilitation was needed for significant likelihood that extra rehabilitation would improve activity. Conclusion: Increasing the amount of usual rehabilitation aimed at reducing activity limitations improves activity in people after stroke. The amount of extra rehabilitation that needs to be provided to achieve a beneficial effect is large. Trial registration: PROSPERO CRD42012003221. [Schneider EJ, Lannin NA, Ada L, Schmidt J (2016 Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review. Journal of Physiotherapy 62: 182–187

  7. Electronic Health Record for Intensive Care based on Usual Windows Based Software.

    Science.gov (United States)

    Reper, Arnaud; Reper, Pascal

    2015-08-01

    In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed an EHR based on usual software and components. The software was designed as a client-server architecture running on the Windows operating system and powered by the access data base system. The client software was developed using Visual Basic interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in September 2004, the EHR was used to care more than five thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of basic functionalities communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on usual software components was able to respond to the medical needs of the local ICU environment. The use of Windows for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

  8. The Quality of Colonoscopy Reporting in Usual Practice: Are Endoscopists Reporting Key Data Elements?

    Directory of Open Access Journals (Sweden)

    S. D. Hadlock

    2016-01-01

    Full Text Available Background. High quality reporting of endoscopic procedures is critical to the implementation of colonoscopy quality assurance programs. Objective. The aim of our research was to (1 determine the quality of colonoscopy (CS reporting in “usual practice,” (2 identify factors associated with good quality reporting, and (3 compare CS reporting in open-access and non-open-access procedures. Methods. 557 CS reports were randomly selected and assigned a score based on the number of mandatory data elements included in the report. Reports documenting greater than 70% of the mandatory data elements were considered to be of good quality. Physician and procedure factors associated with good quality CS reporting were identified. Results. Variables that were consistently well documented included date of the procedure (99.6%, procedure indication (88.9%, a description of the most proximal anatomical segment reached (98.6%, and documentation of polyp location (97.8%. Approximately 79.4% of the reports were considered to be of good quality. Gastroenterology specialty, lower annual CS volume, and fewer years in practice were associated with good quality reporting. Discussion. CS reporting in usual practice in Ontario lacks quality in several areas. Almost 1 in 5 reports was of poor quality in our study. Conclusions. Targeted interventions and/or use of mandatory fields in synoptic reports should be considered to improve CS reporting.

  9. Therapy recommendation "act as usual" in patients with whiplash injuries QTF I°.

    Science.gov (United States)

    Dehner, Christoph; Kraus, Michael; Schöll, Hendrik; Schneider, Florian; Richter, Peter; Kramer, Michael

    2012-08-20

    Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation "act as usual" has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation "act as usual" and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values After injury, the median pain disability index (PDI) was 3.9 (min = 1.9; max = 7.7). After six months 3 of the 162 patients stated persisting disability during sporting and physical activities (VAS values whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes.

  10. Medical teleconferencing with high-definition video presentation on the 'usual' Internet.

    Science.gov (United States)

    Obuchi, Toshiro; Shima, Hiroji; Iwasaki, Akinori

    2013-06-01

    Although medical teleconferences on advanced academic networks have been common (Telemed J E Health 15:112-117, 1; Asian J Endosc Surg 3:185-188, 2; Surg Today 41:1579-1581, 3; Telemedicine development center of Asia. http://www.aqua.med.kyushu-u.ac.jp/eg/index.html . Accessed 6 March 2013, 4), reports regarding 'usual' Internet teleconferences or tele-lectures employing a telecommunication system for business use are very rare. Medical teleconferences and tele-lectures on the Internet were held three times between our institutions and other institutions, using the 'HD Com' made by Panasonic (HD Com. http://panasonic.biz/com/visual/ . Accessed 6 March 2013, 5), which is a high-definition telecommunication system for business tele-meeting. All of our medical telecommunications were successfully completed without any troubles. This system allows for all kinds of presentations using personal computers to be made from each station, so that discussions with high-definition surgical video presentation, which has recently been developed, could be effortlessly established despite the distance between institutions. Unlike telecommunication using advanced academic networks, this system can run without any need for specific engineering support, on the usual Internet. Medical telecommunication employing this system is likely to become common among ordinary hospitals in the near future.

  11. Integrating telehealth in to 'business as usual': Is it really possible?

    Science.gov (United States)

    Jury, Susan C; Kornberg, Andrew J

    2016-12-01

    The Royal Children's Hospital, Melbourne, began offering web-based telehealth video consultation in 2011, with the principle being that telehealth should be integrated into 'business as usual'. In telehealth literature, key differences between telehealth and in-person consultations can make this hard to achieve, so an audit was performed that revealed many small gaps in the process.A total of 125 telehealth appointments were booked during the study period. Of these, 13% (n = 16) were rescheduled, cancelled or changed to face-to-face appointments, and up to two main issues were identified for the remaining appointments. Some 69% of the remaining 108 appointments (n = 75) were completed successfully, with 23% (n = 25) completely seamless end to end. Overall, 39 issues were administrative (40%), 34 technical (35%) and 24 scheduling (25%); nine (8%) required some minor troubleshooting.For long-term sustainability, integrating telehealth into business as usual needs to remain the target. Scheduling and technical glitches were the main barriers to seamless telehealth. Several issues have now been addressed with the introduction of an electronic medical record, and the development of standardised processes and staff training.

  12. A phase 3 randomized trial comparing inolimomab vs usual care in steroid-resistant acute GVHD.

    Science.gov (United States)

    Socié, Gérard; Vigouroux, Stéphane; Yakoub-Agha, Ibrahim; Bay, Jacques-Olivier; Fürst, Sabine; Bilger, Karin; Suarez, Felipe; Michallet, Mauricette; Bron, Dominique; Gard, Philippe; Medeghri, Zakaria; Lehert, Philippe; Lai, Chinglin; Corn, Tim; Vernant, Jean-Paul

    2017-02-02

    Treatment of steroid-resistant acute graft-versus-host disease (GVHD) remains an unmet clinical need. Inolimomab, a monoclonal antibody to CD25, has shown encouraging results in phase 2 trials. This phase 3 randomized, open-label, multicenter trial compared inolimomab vs usual care in adult patients with steroid-refractory acute GVHD. Patients were randomly selected to receive treatment with inolimomab or usual care (the control group was treated with antithymocyte globulin [ATG]). The primary objective was to evaluate overall survival at 1 year without changing baseline allocated therapy. A total of 100 patients were randomly placed: 49 patients in the inolimomab arm and 51 patients in the ATG arm. The primary criteria were reached by 14 patients (28.5%) in the inolimomab and 11 patients (21.5%) in the ATG arms, with a hazard ratio of 0.874 (P = .28). With a minimum follow-up of 1 year, 26 (53%) and 31 (60%) patients died in the inolimomab and ATG arms, respectively. Adverse events were similar in the 2 arms, with fewer viral infections in the inolimomab arm compared with the ATG arm. The primary end point of this randomized phase 3 trial was not achieved. The lack of a statistically significant effect confirms the need for development of more effective treatments for acute GVHD. This trial is registered to https://www.clinicaltrialsregister.eu/ctr-search/search as EUDRACT 2007-005009-24.

  13. Novel Loci Associated with Usual Sleep Duration: The CHARGE Consortium Genome-Wide Association Study

    Science.gov (United States)

    Gottlieb, Daniel J.; Hek, Karin; Chen, Ting-hsu; Watson, Nathaniel F.; Eiriksdottir, Gudny; Byrne, Enda M.; Cornelis, Marilyn; Warby, Simon C.; Bandinelli, Stefania; Cherkas, Lynn; Evans, Daniel S.; Grabe, Hans J.; Lahti, Jari; Li, Man; Lehtimäki, Terho; Lumley, Thomas; Marciante, Kristin D.; Pérusse, Louis; Psaty, Bruce M.; Robbins, John; Tranah, Gregory J.; Vink, Jacqueline M.; Wilk, Jemma B.; Stafford, Jeanette M.; Bellis, Claire; Biffar, Reiner; Bouchard, Claude; Cade, Brian; Curhan, Gary C.; Eriksson, Johan G.; Ewert, Ralf; Ferrucci, Luigi; Fülöp, Tibor; Gehrman, Philip R.; Goodloe, Robert; Harris, Tamara B.; Heath, Andrew C.; Hernandez, Dena; Hofman, Albert; Hottenga, Jouke-Jan; Hunter, David J.; Jensen, Majken K.; Johnson, Andrew D.; Kähönen, Mika; Kao, Linda; Kraft, Peter; Larkin, Emma K.; Lauderdale, Diane S.; Luik, Annemarie I.; Medici, Marco; Montgomery, Grant W.; Palotie, Aarno; Patel, Sanjay R.; Pistis, Giorgio; Porcu, Eleonora; Quaye, Lydia; Raitakari, Olli; Redline, Susan; Rimm, Eric B.; Rotter, Jerome I.; Smith, Albert V.; Spector, Tim D.; Teumer, Alexander; Uitterlinden, André G.; Vohl, Marie-Claude; Widen, Elisabeth; Willemsen, Gonneke; Young, Terry; Zhang, Xiaoling; Liu, Yongmei; Blangero, John; Boomsma, Dorret I.; Gudnason, Vilmundur; Hu, Frank; Mangino, Massimo; Martin, Nicholas G.; O’Connor, George T.; Stone, Katie L.; Tanaka, Toshiko; Viikari, Jorma; Gharib, Sina A.; Punjabi, Naresh M.; Räikkönen, Katri; Völzke, Henry; Mignot, Emmanuel; Tiemeier, Henning

    2015-01-01

    Usual sleep duration is a heritable trait correlated with psychiatric morbidity, cardiometabolic disease and mortality, although little is known about the genetic variants influencing this trait. A genome-wide association study of usual sleep duration was conducted using 18 population-based cohorts totaling 47,180 individuals of European ancestry. Genome-wide significant association was identified at two loci. The strongest is located on chromosome 2, in an intergenic region 35–80 kb upstream from the thyroid-specific transcription factor PAX8 (lowest p=1.1 ×10−9). This finding was replicated in an African-American sample of 4771 individuals (lowest p=9.3 × 10−4). The strongest combined association was at rs1823125 (p=1.5 × 10−10, minor allele frequency 0.26 in the discovery sample, 0.12 in the replication sample), with each copy of the minor allele associated with a sleep duration 3.1 minutes longer per night. The alleles associated with longer sleep duration were associated in previous genome-wide association studies with a more favorable metabolic profile and a lower risk of attention deficit hyperactivity disorder. Understanding the mechanisms underlying these associations may help elucidate biological mechanisms influencing sleep duration and its association with psychiatric, metabolic and cardiovascular disease. PMID:25469926

  14. Total Usual Intake of Shortfall Nutrients Varies With Poverty Among US Adults.

    Science.gov (United States)

    Bailey, Regan L; Akabas, Sharon R; Paxson, Erin E; Thuppal, Sowmyanarayanan V; Saklani, Shilpa; Tucker, Katherine L

    2017-09-01

    To examine shortfall nutrient intakes (ie, calcium, folate, potassium, magnesium, and vitamins A, C, D, and E) by poverty-to-income ratio (PIR). National Health and Nutrition Examination Survey 2011-2012, a nationally representative, cross-sectional survey. US adults with complete data on poverty status and diet were included (n = 4,524). The National Cancer Institute method was used to estimate total usual micronutrient intakes from foods, beverages, medications, and dietary supplements reported on 2 24-hour dietary recalls using measurement error correction. Calcium, folate, potassium, magnesium, and vitamins A, C, D, and E across 3 PIR categories: <130%, 130% to 350%, and ≥350%. Mean intakes of folate, vitamin C, and vitamin D were significantly greater in men, and magnesium in women, across all PIR categories. Except for calcium in men and vitamin C in women, the highest PIR category had significantly higher mean total usual intakes of all remaining shortfall micronutrients. Importantly, men and women in the highest PIR category (≥350%) were significantly less likely to have intakes below the Estimated Average Requirement across all micronutrients compared with those in the lower PIR categories. Even with dietary supplements, large proportions of US adults have micronutrient intakes below the Estimated Average Requirement. Adults at the highest adjusted income have higher micronutrient intakes and lower risk of inadequacy than those with lower incomes. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  15. Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: two-year outcome.

    Science.gov (United States)

    Rosenbaum, Bent; Harder, Susanne; Knudsen, Per; Køster, Anne; Lindhardt, Anne; Lajer, Matilde; Valbak, Kristian; Winther, Gerda

    2012-01-01

    During recent decades, the field of treatment of schizophrenia has lacked empirical, systematic outcome studies that support psychodynamic psychotherapy as an evidence-based intervention for patients with schizophrenia. The Danish schizophrenia project (DNS) compared psychodynamic psychotherapy for psychosis with standard treatment in patients with a first-episode schizophrenia spectrum disorder. The study was designed as a prospective, comparative, longitudinal multi-site investigation of consecutively referred patients who were included during two years. The patients were treated with either manualized individual supportive psychodynamic psychotherapy (SPP) in addition to treatment as usual or with treatment as usual alone (TaU). Symptoms and functional outcomes were measured using the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning scale (GAF). The study included 269 consecutively admitted patients, age 18-35, of whom 79% remained in the study after two years. The intervention group improved significantly on measures of both PANSS and GAF scores, with large effect sizes at two years follow-up after inclusion. Further, improvement on GAF(function) (p = 0.000) and GAF(symptom) (p = 0.010) significantly favored SPP in combination with TaU over TaU alone. In spite of limitations, this study speaks in favor of including supportive psychodynamic psychotherapy in the treatment for patients with schizophrenic first-episode psychoses.

  16. Assessing usual dietary intake in complex sample design surveys: the National Dietary Survey

    Directory of Open Access Journals (Sweden)

    Flávia dos Santos Barbosa

    2013-02-01

    Full Text Available The National Cancer Institute (NCI method allows the distributions of usual intake of nutrients and foods to be estimated. This method can be used in complex surveys. However, the user must perform additional calculations, such as balanced repeated replication (BRR, in order to obtain standard errors and confidence intervals for the percentiles and mean from the distribution of usual intake. The objective is to highlight adaptations of the NCI method using data from the National Dietary Survey. The application of the NCI method was exemplified analyzing the total energy (kcal and fruit (g intake, comparing estimations of mean and standard deviation that were based on the complex design of the Brazilian survey with those assuming simple random sample. Although means point estimates were similar, estimates of standard error using the complex design increased by up to 60% compared to simple random sample. Thus, for valid estimates of food and energy intake for the population, all of the sampling characteristics of the surveys should be taken into account because when these characteristics are neglected, statistical analysis may produce underestimated standard errors that would compromise the results and the conclusions of the survey.

  17. Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial.

    Science.gov (United States)

    van de Port, Ingrid G L; Wevers, Lotte E G; Lindeman, Eline; Kwakkel, Gert

    2012-05-10

    To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home. Randomised controlled trial with follow-up to 24 weeks. Multicentre trial in nine outpatient rehabilitation centres in the Netherlands Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic. Patients were randomly allocated to circuit training or usual physiotherapy, after stratification by rehabilitation centre, with an online randomisation procedure. Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks. The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency. The control group received usual outpatient physiotherapy. The primary outcome was the mobility domain of the stroke impact scale (SIS, version 3.0). Secondary outcomes were standing balance, self reported abilities, gait speed, walking distance, stair climbing, instrumental activities of daily living, fatigue, anxiety, and depression. Differences between groups were analysed according to the intention to treat principle. All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks. 126 patients were included in the circuit training group and 124 in the usual care group (control), with data from 125 and 117, respectively, available for analysis. One patient from the circuit training group and seven from the control group dropped out. Circuit training was a safe intervention, and no serious adverse events were reported. There were no significant differences between groups for the stroke impact scale mobility domain (β=0.05 (SE 0.68), P=0.943) at 12 weeks. Circuit training was associated with

  18. 'Third wave' cognitive and behavioural therapies versus treatment as usual for depression.

    Science.gov (United States)

    Churchill, Rachel; Moore, Theresa H M; Furukawa, Toshi A; Caldwell, Deborah M; Davies, Philippa; Jones, Hannah; Shinohara, Kiyomi; Imai, Hissei; Lewis, Glyn; Hunot, Vivien

    2013-10-18

    So-called 'third wave' cognitive and behavioural therapies represent a new generation of psychological therapies that are increasingly being used in the treatment of psychological problems. However, the effectiveness and acceptability of third-wave cognitive and behavioural therapy (CBT) approaches as treatment for acute depression remain unclear. 1. To examine the effects of all third wave CBT approaches compared with treatment as usual/waiting list/attention placebo/psychological placebo control conditions for acute depression.2. To examine the effects of different third wave CBT approaches (ACT, compassionate mind training, functional analytic psychotherapy, dialectical behaviour therapy, MBCT, extended behavioural activation and metacognitive therapy) compared with treatment as usual/waiting list/attention placebo/psychological placebo control conditions for acute depression.3. To examine the effects of all third wave CBT approaches compared with different types of comparators (treatment as usual, no treatment, waiting list, attention placebo, psychological placebo) for acute depression. We searched the Cochrane Depression Anxiety and Neurosis Group Trials Specialised Register (CCDANCTR to 01/01/12), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE, (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies. An updated search of CCDANCTR restricted to search terms relevant to third wave CBT therapies was conducted in March 2013 (CCDANCTR to 01/02/13). Randomised controlled trials that compared third wave CBT therapies with control conditions for acute depression in adults. Two review authors independently identified studies, assessed trial quality and extracted data. Study authors were contacted for additional information when required. We rated the

  19. Can the Cardiopulmonary 6-Minute Walk Test Reproduce the Usual Activities of Patients with Heart Failure?

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    Guimarães Guilherme Veiga

    2002-01-01

    Full Text Available OBJECTIVE: The 6-minute walk test is an way of assessing exercise capacity and predicting survival in heart failure. The 6-minute walk test was suggested to be similar to that of daily activities. We investigated the effect of motivation during the 6-minute walk test in heart failure. METHODS: We studied 12 males, age 45±12 years, ejection fraction 23±7%, and functional class III. Patients underwent the following tests: maximal cardiopulmonary exercise test on the treadmill (max, cardiopulmonary 6-minute walk test with the walking rhythm maintained between relatively easy and slightly tiring (levels 11 and 13 on the Borg scale (6EB, and cardiopulmonary 6-minute walk test using the usual recommendations (6RU. The 6EB and 6RU tests were performed on a treadmill with zero inclination and control of the velocity by the patient. RESULTS: The values obtained in the max, 6EB, and 6RU tests were, respectively, as follows: O2 consumption (ml.kg-1.min-1 15.4±1.8, 9.8±1.9 (60±10%, and 13.3±2.2 (90±10%; heart rate (bpm 142±12, 110±13 (77±9%, and 126±11 (89±7%; distance walked (m 733±147, 332±66, and 470±48; and respiratory exchange ratio (R 1.13±0.06, 0.9±0.06, and 1.06±0.12. Significant differences were observed in the values of the variables cited between the max and 6EB tests, the max and 6RU tests, and the 6EB and 6RU tests (p<0.05. CONCLUSION: Patients, who undergo the cardiopulmonary 6-minute walk test and are motivated to walk as much as they possibly can, usually walk almost to their maximum capacity, which may not correspond to that of their daily activities. The use of the Borg scale during the cardiopulmonary 6-minute walk test seems to better correspond to the metabolic demand of the usual activities in this group of patients.

  20. Allocation of energy resources for power generation in India. Business as usual and energy efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Mallah, Subhash; Bansal, N.K. [Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir 182320 (India)

    2010-02-15

    This paper deals with MARKAL allocations for various energy sources, in India, for Business As Usual (BAU) scenario and for the case of exploitation of energy saving potential in various sectors of economy. In the BAU scenario, the electrical energy requirement will raise up to 5000 bKwh units per year or 752 GW of installed capacity with major consumers being in the industry, domestic and service sectors. This demand can be met by a mix of coal, hydro, nuclear and wind technologies. Other renewables i.e. solar and biomass will start contributing from the year 2040 onwards. By full exploitation of energy saving potential, the annual electrical energy demand gets reduced to 3061 bKwh (or 458 GW), a reduction of 38.9%.The green house gas emissions reduce correspondingly. In this scenario, market allocations for coal, gas and large hydro become stagnant after the year 2015. (author)

  1. What to do when people with Parkinson's disease cannot take their usual oral medications.

    Science.gov (United States)

    Alty, Jane; Robson, Jeremy; Duggan-Carter, Philippa; Jamieson, Stuart

    2016-04-01

    People with Parkinson's disease have limited brain reserves of endogenous dopamine; thus, their medications must not be omitted or delayed as this may lead to a significant drop in brain dopamine levels. This has two main clinical consequences: first, a deterioration in disease control, with distressing symptoms such as tremor, pain, rigidity, dysphagia and immobility, and second, an increased risk of developing the life-threatening complication of neuroleptic malignant-like syndrome. Common reasons for people with Parkinson's disease being unable to take their oral medications are neurogenic dysphagia from progressive disease or concurrent illness, gastroenteritis, iatrogenic 'nil by mouth' status especially perioperatively, and impaired consciousness level. Here we outline alternative methods to give dopaminergic drugs in the acute setting to people with Parkinson's disease who cannot take their usual oral treatment, namely using dispersible preparations in thickened fluids, an enteral tube, a transdermal patch or subcutaneous injections.

  2. Mong La: Business as Usual in the China-Myanmar Borderlands

    Directory of Open Access Journals (Sweden)

    Alessandro Rippa

    2016-06-01

    Full Text Available The aim of this project is to lay the conceptual groundwork for a new understanding of the positionality of remote areas around the globe. It rests on the hypothesis that remoteness and connectivity are not independent features but co-constitute each other in particular ways. In the context of this project, Rippa and Saxer conducted exploratory fieldwork together in 2015 along the China-Myanmar border. This collaborative photo essay is one result of their research. They aim to convey an image of Mong La that goes beyond its usual depiction as a place of vice and unruliness, presenting it, instead, as the outcome of a particular China-inspired vision of development.

  3. Survey of Usual Practice: Dysphagia Therapy in Head & Neck Cancer Patients

    Science.gov (United States)

    Krisciunas, Gintas P.; Sokoloff, William; Stepas, Katherine; Langmore, Susan E.

    2012-01-01

    There is no standardized dysphagia therapy for head and neck cancer patients and scant evidence to support any particular protocol, leaving institutions and individual speech language pathologists (SLPs) to determine their own protocols based on “typical” practices or anecdotal evidence. To gain an understanding of current usual practices, a national internet-based survey was developed and disseminated to SLPs who treat HNC patients. From a random sample of 4,000 ASHA SID 13 members, 1,931 fit the inclusion criteria, and 759 complete responses were recorded for a 39.3% response rate. Results were analyzed by institution type as well as by individual clinical experience. While some interesting trends emerged from the data, a lack of uniformity and consensus regarding best practices was apparent. This is undoubtedly due to a paucity of research adequately addressing the efficacy of any one therapy for dysphagia in the HNC population. PMID:22456699

  4. From Sustainability-as-usual to Sustainability Excellence in Local Bioenergy Business

    Directory of Open Access Journals (Sweden)

    Heli Kasurinen

    2017-06-01

    Full Text Available Bioenergy business operators can significantly contribute to the sustainability of bioenergy systems. While research has addressed the maturity of corporate responsibility for sustainability, the maturity levels of bioenergy business have not been determined. The objectives of this research were to characterise the maturity levels of bioenergy corporate responsibility for sustainability and outline an approach by which companies can operate at the most mature sustainability excellence level. Literature, three workshops attended by bioenergy experts and a case study on biobutanol production in Brazil were used to develop the maturity model and approach. The results characterise the profitability, acceptability, and sustainability orientation maturity levels through sustainability questions and methods, and list the components of a systemic, holistic approach. Although the shift of business mindset from sustainability-as-usual to sustainability excellence is challenging, a systemic approach is necessary to broadly identify sustainability questions and a multitude of methods by which they can be answered.

  5. How to distinguish between 'business as usual' and 'significant business disruptions' and plan accordingly.

    Science.gov (United States)

    Halliwell, Peter

    2008-01-01

    This paper seeks to provide an insight into Air New Zealand and how business continuity is managed in an industry with inherent disruptions. The differences between 'business as usual' and 'significant business disruptions' are outlined along with their associated criteria, response and escalation processes. The paper describes why the company incorporates the four 'R's of the Civil Defence Emergency Management Act within its BCM framework and how this aids resilience. A case study is provided that details a 'significant disruption' that occurred in November 2006. This event resulted in the total loss of a sales office and cargo shed after unrest in the Kingdom of Tonga escalated to widespread rioting, looting and destruction of their central business district. The lessons from this event have been captured and provide some essential mitigation measures that will assist in future events.

  6. Non-interventional research and usual care: definition, regulatory aspects, difficulties and recommendations.

    Science.gov (United States)

    Lemaire, François; Ravoire, Sophie; Golinelli, Danielle

    2008-01-01

    Non-interventional research is an essential approach to gathering data in different situations and it often complements other research methodologies, such as biomedical research and research aimed at evaluating usual care. Yet the legislative framework for this type of research is nonexistent, and this void poses a number of problems for non-interventional researchers, including an absence of any guarantee of quality and therefore of reliability, a limited recognition of the research beyond our borders, cumbersome administrative procedures, and a lack of visibility. In light of the growing demand for data, particularly in post marketing authorisation for drugs, which largely relies on non-interventional methods, the Round Table participants have issued a set of proposals for a future legislative framework for this type of research.

  7. Effectiveness of community-based football compared to usual care in men with prostate cancer

    DEFF Research Database (Denmark)

    Bjerre, Eik; Bruun, Ditte Marie; Tolver, Anders;

    2016-01-01

    . The intervention period will be six months. The primary outcome is quality of life assessed after 12 weeks based on the change from baseline in the Functional Assessment of Cancer Therapy-Prostate questionnaire. Secondary outcomes are change from baseline to six months in quality of life, lean body mass, fat mass...... has been suggested and previously studies have shown improvements of disease specific quality of life and a reduction in treatment-related toxicity. Cohort studies with long term follow up have suggested that physical activity is associated with improved survival in prostate cancer patients....... Previously one randomised controlled trial has examined the efficacy of football in prostate cancer patients undergoing androgen deprivation therapy to usual care and reported positive effects on lean body mass and bone markers. Against this background, we wish to examine the effectiveness of community...

  8. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

    DEFF Research Database (Denmark)

    Hansen, Tina Birgitte; Zwisler, Ann Dorthe; Berg, Selina Kikkenborg

    2017-01-01

    and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs...... and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality......Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following...

  9. Supervised progressive cross-continuum strength training compared with usual care in older medical patients

    DEFF Research Database (Denmark)

    Pedersen, Mette Merete; Petersen, Janne; Beyer, Nina;

    2016-01-01

    on the model), combined with post-training protein supplementation initiated during hospitalization and continued at home for 4 weeks, is superior to usual care on change in mobility 4 weeks after discharge in older medical patients. Methods: Eighty older medical patients (65 years or older) acutely admitted...... hospitalization and continued after discharge. We conducted a feasibility study prior to this trial and found a progression model for loaded sit-to-stands feasible in older medical patients. This study aims to determine whether a simple supervised strength training program for the lower extremities (based...... hospitalization and three times per week for 4 weeks after discharge. Both exercises follow pre-defined models for progression and will be performed for three sets of 8–12 repetitions maximum in each training session. Thereafter, the patient will be asked to consume a protein supplement given orally containing 18...

  10. EULAR recommendations for neuropsychiatric systemic lupus erythematosus vs usual care: results from two European centres.

    Science.gov (United States)

    Pamfil, Cristina; Fanouriakis, Antonis; Damian, Laura; Rinzis, Mirela; Sidiropoulos, Prodromos; Tsivgoulis, Georgios; Rednic, Simona; Bertsias, George; Boumpas, Dimitrios T

    2015-07-01

    To compare the European League Against Rheumatism (EULAR) recommendations for the management of NPSLE with usual care in two tertiary centres and to detect potential pitfalls in their use for diagnosis and treatment. A chart-based review of NPSLE manifestations was conducted in two European centres. Diagnostic and treatment decisions were compared against the EULAR recommendations for general NPSLE and specific manifestations. We studied a total of 94 patients who experienced 123 lupus-related neuropsychiatric events over 10 years. In 80% of the events, at least one EULAR-defined risk factor (previous NPSLE, generalized disease activity or aPL positivity) was present. Overall, there was good concordance between clinical care and recommendations for diagnosis and treatment (68.7% and 62.7% of events, respectively). Brain MRI was performed in the absence of a clear EULAR recommendation in 42.9% of events; therein, it was more frequently normal compared with imaging performed according to the recommendations (52.4% vs 18.5%, P = 0.008), and it did not influence management. Among patients reporting cognitive dysfunction, only 27.8% underwent the recommended neuropsychological assessment. In line with the recommendations, immunosuppressants were more frequently given in events suggestive of an inflammatory process (80.5% vs 47.6% in non-inflammatory events, P EULAR recommendations for NPSLE and usual clinical practice, we identified a number of issues (such as overutilization of brain MRI, suboptimal evaluation of cognitive dysfunction, and frequent use of immunosuppressives in cerebrovascular disease) that need to be investigated further. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

    OpenAIRE

    Jones, AL; Cochran, SD; Leibowitz, A.; Wells, KB; Kominski, G; Mays, VM

    2015-01-01

    © 2015 Society of General Internal Medicine BACKGROUND: The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. OBJECTIVE: To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services...

  12. Effects of business-as-usual anthropogenic emissions on air quality

    Science.gov (United States)

    Pozzer, A.; Zimmermann, P.; Doering, U. M.; van Aardenne, J.; Tost, H.; Dentener, F.; Janssens-Maenhout, G.; Lelieveld, J.

    2012-08-01

    The atmospheric chemistry general circulation model EMAC has been used to estimate the impact of anthropogenic emission changes on global and regional air quality in recent and future years (2005, 2010, 2025 and 2050). The emission scenario assumes that population and economic growth largely determine energy and food consumption and consequent pollution sources with the current technologies ("business as usual"). This scenario is chosen to show the effects of not implementing legislation to prevent additional climate change and growing air pollution, other than what is in place for the base year 2005, representing a pessimistic (but plausible) future. By comparing with recent observations, it is shown that the model reproduces the main features of regional air pollution distributions though with some imprecisions inherent to the coarse horizontal resolution (~100 km) and simplified bottom-up emission input. To identify possible future hot spots of poor air quality, a multi pollutant index (MPI), suited for global model output, has been applied. It appears that East and South Asia and the Middle East represent such hotspots due to very high pollutant concentrations, while a general increase of MPIs is observed in all populated regions in the Northern Hemisphere. In East Asia a range of pollutant gases and fine particulate matter (PM2.5) is projected to reach very high levels from 2005 onward, while in South Asia air pollution, including ozone, will grow rapidly towards the middle of the century. Around the Persian Gulf, where natural PM2.5 concentrations are already high (desert dust), ozone levels are expected to increase strongly. The population weighted MPI (PW-MPI), which combines demographic and pollutant concentration projections, shows that a rapidly increasing number of people worldwide will experience reduced air quality during the first half of the 21st century. Following this business as usual scenario, it is projected that air quality for the global

  13. Usual sleep duration and cognitive function in older adults in Spain.

    Science.gov (United States)

    Faubel, Raquel; López-García, Esther; Guallar-Castillón, Pilar; Graciani, Auxiliadora; Banegas, José R; Rodríguez-Artalejo, Fernando

    2009-12-01

    The few studies that have examined the association between usual sleep duration and cognitive function have shown conflicting results. This cross-sectional study examined the association between sleep duration and cognitive function among 3212 people, representative of the non-institutionalized population aged 60 years and over in Spain. Sleep duration was self-reported, and cognitive function was measured with the Mini-Examen Cognoscitivo (MEC), a version of the Mini-Mental State Examination that has been validated in Spain. Linear regression, with adjustment for the main confounders, was used to obtain mean differences in the MEC between the categories of sleep duration (or=11 h day(-1)). The MEC score decreased progressively (became worse) across sleep categories from 7 to >or=11 h (P for linear trend or=11 h had a significantly lower MEC score than those who slept for 7 h (mean difference -1.48; 95% confidence interval -2.12 to -0.85). This difference in the MEC was similar to that observed for a 10-year increase in age. The results did not vary significantly by sex (P for interaction >0.05). No association was observed between short sleep duration (<7 h) and cognitive function. We conclude that long sleep duration is associated with poorer cognitive function in older adults from the general population.

  14. Pancreatic mucinous noncystic (colloid) carcinomas and intraductal papillary mucinous carcinomas are usually microsatellite stable.

    Science.gov (United States)

    Lüttges, Jutta; Beyser, Kurt; Pust, Susanne; Paulus, Anja; Rüschoff, Josef; Klöppel, Günter

    2003-06-01

    Pancreatic mucinous noncystic (colloid) carcinomas (MNCC) differ from the usual ductal adenocarcinomas in their mucin expression profile and share with many extrapancreatic mucinous carcinomas the expression of MUC2. Because mucinous carcinomas are frequently associated with mutations of the DNA mismatch repair genes, causing them to exhibit the so-called mutator phenotype, we decided to investigate whether MNCCs of the pancreas are characterized by microsatellite instability (MSI). Twelve carcinomas with a mucinous phenotype (8 mucinous noncystic carcinomas, 3 intraductal papillary-mucinous carcinomas with an invasive muconodular component, and 1 ductal adenocarcinoma with an extensive mucinous noncystic component) and 11 ductal adenocarcinomas were immunostained with monoclonal antibodies to the mismatch repair gene products hMLH1, hMSH2, and hMSH6. For MSI analysis, DNA was isolated from microdissected tissue, and five primary microsatellites (BAT 25, BAT 26, D5S346, D17S250, and D2S123) were analyzed. MSI was diagnosed in case a novel allele was found, compared with the normal tissue. The criterion for LOH was a 75% signal reduction. All carcinomas tested exhibited nuclear expression of mismatch repair gene products, except for one MNCC that also showed MSI at the molecular level. The data suggest that pancreatic carcinomas with a mucinous phenotype (MUC2+/MUC1-) do not appear to normally exhibit mutations in the mismatch repair genes and therefore differ in their carcinogenesis from those in other organs.

  15. Usual source of health care among Hispanic children: the implications of immigration.

    Science.gov (United States)

    Durden, T Elizabeth

    2007-08-01

    Deep inequities continue to exist in the access to and sources of care across racial and ethnic groups in the United States. This research examines differences in the regular source of usual health care for children among Hispanic subgroups of the United States. The immigration status of the mother -- including nativity, duration in the United States, and citizenship status -- as well as sociodemographic factors are considered as significant influences on the type of regular sources of care. Using the National Health Interview Survey from 1999 to 2001, multinomial logistic regression models are estimated to compare Mexican American and other Hispanic children with non-Hispanic whites and blacks. Both Mexican Americans and other Hispanics were more likely to report the use of clinic or the emergency room over private doctor's office as their regular source of health care compared with non-Hispanic whites. Together, the impact of the mother's nativity, duration, and citizenship status explains much of the differentials in the sources of care among Mexican American and other Hispanic children compared with non-Hispanic whites.

  16. Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Mayumi; Matsuzaki, Kenji; Yoshida, Shusaku; Nishitani, Hiromu [University of Tokushima, Department of Radiology, Tokushima (Japan); Uehara, Hisanori [University of Tokushima, Department of Molecular and Environmental Pathology, Tokushima (Japan); Shimazu, Hideki [Oe Kyoudo Hospital, Department of Radiology (Japan)

    2005-11-01

    The endometrial cavity may demonstrate various imaging manifestations such as normal, reactive, inflammatory, and benign and malignant neoplasms. We evaluated usual and unusual magnetic resonance imaging (MRI) findings of the uterine endometrial cavity, and described the diagnostic clues to differential diagnoses. Surgically proven pathologies of the uterine endometrial cavity were evaluated retrospectively with pathologic correlation. The pathologies included benign endometrial neoplasms such as endometrial hyperplasia and polyp, malignant endometrial neoplasms such as endometrial carcinoma and carcinosarcoma, endometrial-myometrial neoplasm such as endometrial stromal sarcoma, pregnancy-related lesions in the endometrial cavity such as gestational trophoblastic diseases (hydatidiform mole, invasive mole and choriocarcinoma) and placental polyp, myometrial lesions simulating endometrial lesions such as submucosal leiomyoma and some adenomyosis, endometrial neoplasms simulating myometrial lesions such as adenomyomatous polyp and endometrial lesions arising in the hemicavity of a septate/bicornate uterus, and fluid collections in the uterine cavity (hydro/hemato/pyometra). It is important to recognize various imaging findings in these diseases, in order to make a correct preoperative diagnosis. (orig.)

  17. Berlin prehospital or usual delivery of acute stroke care - Study protocol.

    Science.gov (United States)

    Ebinger, Martin; Harmel, Peter; Nolte, Christian H; Grittner, Ulrike; Siegerink, Bob; Audebert, Heinrich J

    2017-08-01

    Rationale Prehospital stroke care in specialized ambulances increases thrombolysis rates, reduces alarm-to-treatment times, and improves the prehospital triage. Preliminary analyses suggest cost-effectiveness. However, scientific proof of better functional outcome compared to usual care is still lacking. Aim To prove better functional outcomes after deployment of the Stroke Emergency Mobile compared to regular ambulances. Sample size estimates A sample size of 686 patients will be required in each arm (Stroke Emergency Mobile group vs. regular care) to detect a difference regarding the primary outcome with 80% power at a two-sided significance level of 0.05. Methods and design This is a pragmatic, prospective study with blinded outcome assessment. Primary outcome will be functional status as defined by modified Rankin Scale score three months after the incident event. We will include cerebral ischemia patients within a predefined catchment area in Berlin, Germany. The study population consists of patients who might be candidates for acute recanalizing treatments, with onset-to-alarm time ≤4 h, symptoms not resolved at time of ambulance arrival, and able to walk without assistance prior to the qualifying incident. About 45% of Stroke Emergency Mobile dispatches are expected to be handled by regular ambulances, since Stroke Emergency Mobile will be already in operation creating the control group. Primary outcome Functional outcome after three months measured by the modified Rankin Scale over the entire range. Discussion The results will inform decision makers on the effectiveness of Stroke Emergency Mobile.

  18. P63 marker Expression in Usual Skin Cancers Compared With Non Tumoral Skin Lesions

    Directory of Open Access Journals (Sweden)

    Abdolhamid Esmaili

    2017-07-01

    Full Text Available Background: Non-melanoma skin cancers including basal cell carcinoma and squamous cell carcinoma are the most common cancers in human. The aim of this study was to determine the expression of P63 marker in usual skin cancers compared with non-tomoral skin lesions. Materials and Methods: In this cross-sectional study, sampling was performed from archival blocks of Shahid Mohammadi hospital patients during 2010-2011. 60 samples (including 30 samples of non tumoral skin lesions and 30 samples of basal cell carcinoma and squamous cell carcinoma were studied and evaluation of p63 gene expression was done with Immunohistochemistry method. T-test and Chi-square were used for analysis of data. Results: P63 gene were expressed in 4 cases (13.33 % of non tumoral lesions and all tumoral lesions (100 %. In tumoral lesions, 5 cases (16.66 % showed 1+ severity experssion, 11 cases (36.66% 2 + severity experssion and 14 cases (46.66 % 3+severity experssion. All 4 non tumoral lesions shoed 1+ severity experssion of P63gene. Conclusion: The results of this study indicated that the incidence and severity of gene expression of P63 can be use for differentiation between basal cell carcinoma and squamous cell carcinoma as well as non-tumoral skin lesions. 

  19. Isolated dysarthria-facial paresis syndrome: A rare clinical entity which is usually overlooked

    Directory of Open Access Journals (Sweden)

    Celebisoy Mehmet

    2005-01-01

    Full Text Available Background and Aims: The aim of the study is to search the lesion localization of the pure isolated facial paresis-dysarthria syndrome in patients who were admitted to our neurology clinic in a prospective study. Methods: Over a period of six years, the patients who had no prominent sensorimotor dysfunction were examined by neurologists and underwent computerized tomography (CT and/or magnetic resonance imaging (MRI. Results: Eleven patients out of more than 2000 had the aforementioned clinical picture. Lacunar infarctions were identified at the corona radiata in nine patients, and at the internal capsule in two patients. As reported previously, facial paresis was usually mild and temporary. Six of our eleven patients were seen at the outpatient clinic one month later. Four of them had completely recovered and the other two had mild dsyarthria without any facial paresis. The other five could not be reached after leaving the hospital. Conclusions: Dysarthria-facial paresis is a rare clinical entity and possibly a variation of dysarthria-clumsy hand syndrome, and we suggest that pure facial paresis (FP and pure dysarthria should be considered as very extreme examples of this syndrome.

  20. European Gas in the Next Century. Fundamental Changes or Business as Usual?

    Energy Technology Data Exchange (ETDEWEB)

    Norvik, Harald [Statoil, Stavanger (Norway)

    1999-07-01

    The oil price development is surprising. As soon as a consensus has been formed, it moves in some direction opposite of what was expected. Producers should be prepared to meet a future with declining rather than increasing prices in real terms. In this presentation, the President and Chief Executive Officer of Statoil focuses on some aspects he believes to be important for the evolution of current and future natural gas trade: Demand, supply and prices, Innovation, Geopolitical environment. The European gas industry is moving into the next century after a remarkable development with extensive infrastructure and solid trade patterns established. The future will bring new challenges. The market will be more transparent and more competitive. Cost efficiency and capacity utilization of existing infrastructure will be key factors in order to exploit production at competitive costs. Big reserves are available, although at more remote locations which call for strong commercial players and strong relations between the producers and the distributors if new big supply projects shall be lifted. Norway has gained a competitive position, but new measures will be needed in order to ensure a competitive position for the commercial companies also in the future. The shape of the gas business has developed continuously and market changes will keep it doing so. Therefore, Business as usual will never be a winning strategy in a world of change.

  1. Managing Nature–Business as Usual: Resource Extraction Companies and Their Representations of Natural Landscapes

    Directory of Open Access Journals (Sweden)

    Mark Brown

    2015-11-01

    Full Text Available This article contributes to knowledge of how one category of business organization, very large, British-based, natural resource extraction corporations, has begun to manage its operations for sustainability. The object of study is a large volume of texts that make representations of the managing-for-sustainability practices of these multinational corporations (MNCs. The macro-level textual analysis identifies patterns in the wording of the representations of practice. Hajer’s understanding of discourse, in which ideas are contextualized within social processes of practice, provides the theoretical approach for discourse analysis that gives an insight into how they understand and practice sustainability. Through this large-scale discourse analysis, illustrated in the article with specific textual examples, one can see that these natural resource MNCs are developing a vocabulary and a “grammar” which enables them to manage natural spaces in the same way that they are able to manage their own far-flung business operations. They make simplified representations of the much more complex natural landscapes in which their operations are sited and these models of nature can then be incorporated into the corporations’ operational management processes. Their journey towards sustainability delivers, in practice, the management of nature as business continues as usual.

  2. Epidural Steroids for Lumbosacral Radicular Syndrome Compared to Usual Care : Quality of Life and Cost Utility in General Practice

    NARCIS (Netherlands)

    Spijker-Huiges, Antje; Vermeulen, Karin; Winters, Jan C.; van Wijhe, Marten; van der Meer, Klaas

    Objective: To investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome (LRS) in general practice. Design: A pragmatic randomized controlled trial. Results were

  3. Laryngeal chondrosarcoma: a very unusual pathology CONDROSARCOMA LARÍNGEO: UNA PATOLOGÍA POCO USUAL

    Directory of Open Access Journals (Sweden)

    Enrique Cadena-Piñeros

    2011-06-01

    Full Text Available Chondrosarcoma is the third most frequently occurring bone tumor, following myeloma and osteosarcoma; it accounts for around 20% of all malign bone tumors. They are usually localized in the long bones and the bones of the pelvis; only 2% to 5% are located in the head and neck, mainly in the maxillary bone. Initial symptoms are usually very bizarre and sometimes only a sensation of having a neck mass means that a patient goes to see a doctor. Due to the larynx's intimate relationship with the thyroid gland, this tumor may give a false diagnostic impression. As happened in this case, a patient consulted due to level 4 mass (central neck area, echography of the thyroid nodule and fine needle aspiration (FNA having proved positive for thyroid goiter. The presence of an invasive thyroid carcinoma was suspected in the TAC due to infiltration of the cricoid cartilage; a well-differentiated diagnosis of chondrosarcoma (grade 1 was only made during surgical intervention orientated by biopsy following intraoperation exposure and the definitive study of the pathology. This case has been reported and the topic reviewed as it was difficult case to diagnose and involved a very infrequently occurring pathology.El condrosarcoma es el tercer tumor más frecuente de los huesos, luego del mieloma y el osteosarcoma, y constituye aproximadamente el 20% de todos los tumores óseos malignos. Generalmente se localiza en los huesos largos y de la pelvis y tan sólo 2 a 5% se ubican en la cabeza y el cuello, principalmente en el maxilar. Los síntomas iniciales suelen ser muy bizarros y en ocasiones sólo la sensación de masa del cuello hace que el paciente acuda al médico. Por la íntima relación de la laringe y de la glándula tiroides, este tumor puede llevar a una falsa impresión diagnóstica. Como ocurrió en este caso, una paciente que consultó por masa del nivel VI (zona central del cuello, con ecografía de nódulo tiroideo y aspiración con aguja fina (ACAF

  4. Patients who do not respond to the "usual" dose: why Terry fell off the dose-response curve.

    Science.gov (United States)

    Preskorn, Sheldon H

    2009-11-01

    Clinical trials are aimed at determining what happens in the "usual" patient; however, clinicians are interested in what happens in their patients even if they are not usual. The usual dose-response relationship is determined as part of the drug development process required for approval of a new drug. However, clinicians are likely to encounter patients who "fall off" the usual dose-response curve because they are either sensitive or resistant to the beneficial (efficacy) or adverse effects of a drug. This column is the first in a series that will examine why specific patients fall off the usual dose-response curve and how clinicians can manage such patients when they encounter them. This column discusses what a dose-response curve is, how it is determined, and why it is clinically important.

  5. [Spanish collaborative study: Description of usual clinical practice in infant obesity].

    Science.gov (United States)

    Lechuga Sancho, Alfonso; Palomo Atance, Enrique; Rivero Martin, María José; Gil-Campos, Mercedes; Leis Trabazo, Rosaura; Bahíllo Curieses, María Pilar; Bueno Lozano, Gloria

    2017-09-21

    Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines. An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of "Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity" issued by the Spanish Ministry of Health. A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used. There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  6. Fatty Acid and Cholesterol Concentrations in Usually Consumed Fish in Brazil

    Directory of Open Access Journals (Sweden)

    Carlos Scherr

    2015-02-01

    Full Text Available Background: Several studies have demonstrated clinical benefits of fish consumption for the cardiovascular system. These effects are attributed to the increased amounts of polyunsaturated fatty acids in these foods. However, the concentrations of fatty acids may vary according to region. Objective: The goal of this study was to determine the amount of,cholesterol and fatty acids in 10 Brazilian fishes and in a non-native farmed salmon usually consumed in Brazil. Methods: The concentrations of cholesterol and fatty acids, especially omega-3, were determined in grilled fishes. Each fish sample was divided in 3 sub-samples (chops and each one was extracted from the fish to minimize possible differences in muscle and fat contents. Results: The largest cholesterol amount was found in white grouper (107.6 mg/100 g of fish and the smallest in badejo (70 mg/100 g. Omega-3 amount varied from 0.01 g/100 g in badejo to 0.900 g/100 g in weakfish. Saturated fat varied from 0.687 g/100 g in seabass to 4.530 g/100 g in filhote. The salmon had the greatest concentration of polyunsaturated fats (3.29 g/100 g and the highest content of monounsaturated was found in pescadinha (5.98 g/100 g. Whiting and boyfriend had the best omega-6/omega 3 ratios respectively 2.22 and 1.19, however these species showed very little amounts of omega-3. Conclusion: All studied Brazilian fishes and imported salmon have low amounts of saturated fat and most of them also have low amounts of omega-3.

  7. Neuronal and microglial regulators of cortical wiring: usual and novel guideposts

    Directory of Open Access Journals (Sweden)

    Paola eSquarzoni

    2015-07-01

    Full Text Available Neocortex functioning relies on the formation of complex networks that begins to be assembled during embryogenesis by highly stereotyped processes of cell migration and axonal navigation. The guidance of cells and axons is driven by extracellular cues, released along by final targets or intermediate targets located along specific pathways. In particular, guidepost cells, originally described in the grasshopper, are considered discrete, specialized cell populations located at crucial decision points along axonal trajectories that regulate tract formation. These cells are usually early-born, transient and act at short-range or via cell-cell contact. The vast majority of guidepost cells initially identified were glial cells, which play a role in the formation of important axonal tracts in the forebrain, such as the corpus callosum, anterior and post-optic commissures as well as optic chiasm. In the last decades, tangential migrating neurons have also been found to participate in the guidance of principal axonal tracts in the forebrain. This is the case for several examples such as guideposts for the lateral olfactory tract (LOT, corridor cells, which open an internal path for thalamo-cortical axons and Cajal-Retzius cells that have been involved in the formation of the entorhino-hippocampal connections. More recently, microglia, the resident macrophages of the brain, were specifically observed at the crossroads of important neuronal migratory routes and axonal tract pathways during forebrain development. We furthermore found that microglia participate to the shaping of prenatal forebrain circuits, thereby opening novel perspectives on forebrain development and wiring. Here we will review the last findings on already known guidepost cells populations and will discuss the role of microglia as a potentially new class of atypical guidepost cells.

  8. Diagnostic accuracy of computed tomography and histopathology in the diagnosis of usual interstitial pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Aaloekken, Trond Mogens; Mynarek, Georg; Kolbenstvedt, Alf (Dept. of Radiology, Oslo Univ. Hospital Rikshospitalet, Oslo (Norway)), Email: trond.mogens.aalokken@rikshospitalet.no; Naalsund, Anne (Dept. of Pulmonology, Oslo Univ. Hospital Rikshospitalet (Norway)); Elnaes Berstad, Audun (Dept. of Radiology, Oslo Univ. Hospital Rikshospitalet, Oslo (Norway); Univ. of Oslo (Norway)); Solberg, Steinar (Dept. of Thoracic Surgery, Oslo Univ. Hospital Rikshospitalet (Norway)); Stroem, Erik H.; Scott, Helge (Dept. of Pathology, Oslo Univ. Hospital Rikshospitalet (Norway)); Soeyseth, Vidar (Univ. of Oslo (Norway); Depts. of Pulmonology, Akershus Univ. Hospital, Loerenskog (Norway))

    2012-04-15

    Background: The relative clinical benefit of histopathology and computed tomography (CT) in patients with idiopathic interstitial pneumonia (IIP) is under debate. Purpose: To analyze thin-section CT features and histopathologic findings in patients with usual interstitial pneumonia (UIP) in the clinical context of idiopathic pulmonary fibrosis (IPF), and to evaluate and compare diagnostic accuracy of the two methods among patients with an appropriate spectrum of IIP. Material and Methods: The study included 91 patients (49 men; mean age 53.2 years; median follow-up 7.2 years) with clinically suspected interstitial lung disease. All underwent surgical lung biopsy and thin-section CT. Two independent readers retrospectively assessed the CT images for the extent and pattern of abnormality and made a first-choice diagnosis. Two pathologists retrospectively assessed the histopathologic slides. In 64 patients with IIP, a retrospective composite reference standard identified 41 patients with UIP. CT characteristics of UIP and IIPs other than UIP were compared with univariate and multivariate analyses. Results: There was good agreement between the readers for the correct first-choice CT diagnosis of UIP (kappa = 0.79). The sensitivity, specificity, and positive predictive value of the CT diagnosis of UIP were 63%, 96%, and 96%, respectively. The sensitivity, specificity, and positive predictive value of the histological diagnosis of UIP were 73%, 74%, and 83%, respectively. The CT feature that best differentiated UIP from IIPs other than UIP was the extent of reticular pattern (odds ratio, 5.1). Conclusion: Surgical lung biopsy may not be warranted in patients with thin-section CT diagnosis of UIP

  9. Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Seonah; Suh, Sang-Il; Ha, Su Min; Seol, Hae-Young [Korea University Guro Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Byeon, Jung Hye; Eun, Baik-Lin [Korea University Guro Hospital, Korea University College of Medicine, Department of Pediatrics, Seoul (Korea, Republic of); Lee, Young Hen; Seo, Hyung Suk [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan (Korea, Republic of); Eun, So-Hee [Korea University Ansan Hospital, Korea University College of Medicine, Department of Pediatrics, Ansan (Korea, Republic of)

    2012-03-15

    Most enterovirus (EV) 71 infections manifest as mild cases of hand-foot-mouth disease (HFMD)/herpangina with seasonal variations, having peak incidence during the summer. Meanwhile, EV 71 may involve the central nervous system (CNS), causing severe neurologic disease. In many cases, enteroviral encephalomyelitis involves the central midbrain, posterior portion of the medulla oblongata and pons, bilateral dentate nuclei of the cerebellum, and the ventral roots of the cervical spinal cord, and the lesions show hyperintensity on T2-weighted and fluid-attenuation inversion recovery (FLAIR) images. Our goal was to review usual and unusual magnetic resonance (MR) findings in CNS involvement of enteroviral infection. Among consecutive patients who had HFMD and clinically suspected encephalitis or myelitis and who underwent brain or spinal MR imaging, five patients revealed abnormal MR findings. Diffusion-weighted and conventional MR and follow-up MR images were obtained. From cerebrospinal fluid, stool, or nasopharyngeal swabs, EV 71 was confirmed in all patients. MR imaging studies of two patients showed hyperintensity in the posterior portion of the brainstem on T2-weighted and FLAIR images, which is the well-known MR finding of EV 71 encephalitis. The remaining three cases revealed unusual manifestations: leptomeningeal enhancement, abnormal enhancement along the ventral roots at the conus medullaris level without brain involvement, and hyperintensity in the left hippocampus on T2/FLAIR images. EV 71 encephalomyelitis shows relatively characteristic MR findings; therefore, imaging can be helpful in radiologic diagnosis. However, physicians should also be aware of unusual radiologic manifestations of EV 71. (orig.)

  10. BIO-CHARACTERISTICS OF INTESTINAL METAPLASIA IN THE STOMACH: HYPERPROLIFERATIVE AND USUAL TYPE

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yang; ZHANG Lian; PAN Kai-feng; YOU Wei-cheng; LI Ji-you

    2006-01-01

    Background: In Padova and Vienna International Classification, the usual intestinal metaplasia (UIM) of the stomach,including complete and incomplete type, is defined as negative for dysplasia, and hyperproliferative intestinal metaplasia (HIM) as indefinite for dysplasia, but the biological characteristics of these two types of intestinal metaplasia (IM)remain to be studied. Objective: To investigate the biological differences between UIM, HIM and intestinal type gastric cancer (IGC), apanel of biomarkers were detected. Methods: A total of 38 cases of IGC, 41 HIM and 56 UIM adjacent to gastric cancer were studied. Immunohistochemistry was used to detect the expressions of pS2, MUC2, MUC5AC, MUC6, Ki-67, EGFR, p53 and sulfo-Lewisa in UIM, HIM and IGC. Microsatellite instability (MSI) in UIM, HIM and IGC was detected by using Denaturing High Performance Liquid Chromatography (DHPLC). Results: The pS2 antigen expression in UIM (78.6%) was significantly higher than in HIM and IGC (9.8%, 10.5%), p<0.01. The MUC6, sulfo-Lewisa and EGFR protein expressions were significant increased in HIM (24.4%, 82.9%, 48.7%) and IGC (34.2%, 75.0%, 42.1%) than in UIM (3.6%, 25.5%, 17.9%), p<0.01. Areversed pattern of expressions of MUC2 and MUC5AC was observed in UIM (96.4%, 50.0%) and HIM (82.9%, 36.6%)compared with IGC (52.6%, 13.2%), p<0.05; and the p53 gene expression was increased from UIM (1.8%) to HIM (19.5%) to IGC (57.9%), p<0.01. The Ki-67 labeling index was significantly different among three lesions (UIM: 16%±6%, HIM:45%±9%, IGC: 63%±10%, p<0.01). Conclusion: These findings suggest that there are different bio-characteristics among UIM, HIM and IGC, and HIM may have higher potential to progress to more advanced lesions in comparison with UIM.

  11. Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual.

    Science.gov (United States)

    Soares, William E; Wilson, Donna; Rathlev, Niels; Lee, Joshua D; Gordon, Michael; Nunes, Edward V; O'Brien, Charles P; Friedmann, Peter D

    2017-05-12

    Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up. This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Of the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63-1.23, p=0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32-2.16, p=0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p=0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30-1.00, p=0.05) during the course of the entire study. XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders. Copyright © 2017

  12. Cost-Effectiveness of Physical Therapy Only and of Usual Care for Various Health Conditions: Systematic Review.

    Science.gov (United States)

    Bürge, Elisabeth; Monnin, Dominique; Berchtold, André; Allet, Lara

    2016-06-01

    Given continually rising health care costs, interventions of health care providers should be cost-effective. This review aimed to summarize current cost-effectiveness of physical therapy. Specific aims were: (1) to analyze cost-effectiveness of physical therapy only compared with usual care only, (2) to analyze cost-effectiveness of physical therapy added to usual care compared with usual care only, and (3) to specify in which health conditions physical therapy only or physical therapy added to usual care was cost-effective. Topic-related systematic reviews were searched in MEDLINE, CINAHL, PEDro, and Cochrane Library and manually. Studies published between 1998 and 2014 that investigated the cost-effectiveness of interventions carried out by physical therapists were reviewed. The methodological quality was assessed with the Cochrane risk of bias assessment for intervention studies and with the Quality of Health Economic Analyses Scale. Effectiveness and cost data for calculating incremental cost-effectiveness ratios (ICERs) and the original authors' conclusions were extracted. The 18 included studies presented low risk of bias and contained 8 comparisons of physical therapy only with usual care only and 11 comparisons of physical therapy added to usual care with usual care only. Based on ICERs, physical therapy only or added to usual care was cost-effective in 9 out of the 19 comparisons and in 10 comparisons according to the original authors' conclusions. Physical therapy only or added to usual care implies improved health in almost all studies. The cost-effectiveness of such interventions was demonstrated in half of the studies. This result might have been influenced by the fact that different definitions of the notion of "cost-effectiveness" exist. © 2016 American Physical Therapy Association.

  13. Supplement to “Consolidity: Moving opposite to built-as-usual systems practices”

    Directory of Open Access Journals (Sweden)

    Hassen Taher Dorrah

    2013-12-01

    Full Text Available A new updated conceptual systems change pathway graph for natural and man-made built-as-usual physical systems is developed following a joint two-level event-driven (or activity-driven and time-driven framework. The events and activities “on and above” the normal systems operations are recognized in the form of high influencing level (referred to as the “event-driven or upper system layer(s” acting over the ordinary systems state equations denoted as the “time-driven or the basic system layer(s.” This is envisaged through the existence of some sort of an “Event clocklike register” that runs alongside with the ordinary “time clock”. Different than the ordinary continued operation of the time clock, the event clocklike register begins its operation with the original (or initial system state, steps forward only with the occurrence of any coming event affecting the system, and stops at the final (or end system state. The pathway graph reveals also the important finding that each system (including their parts and components has autonomous self-recording consolidity-based scaled intelligent mechanisms (with infinite stacking of their actions through continuously storing parameters changes internally with the occurrences of their varying environments or events. Conversely, it is envisioned that it is amenable under the existence of the reversibility conditions of the change functions to perform backtracking procedure (reversing direction of event clocklike register at the event-driven or upper system layer(s of the history of affected events through sequentially disclosing the internal overlaid stacking arrangements of systems parameters changes corresponding to such effects. The various stack-based system change classifications and categorizations are also scrutinized. The case study of the change pathway of the stabilized inverted pendulum is provided to thoroughly demonstrate the applicability of the suggested theory. Moreover

  14. A Randomized Clinical Trial of the Collaborative Assessment and Management of Suicidality vs. Enhanced Care as Usual for Suicidal Soldiers

    Science.gov (United States)

    2016-04-01

    Award Number: W81XWH-11-1-0164 TITLE: “A Randomized Clinical Trial of the Collaborative Assessment and Management of Suicidality vs. Enhanced...Care as Usual for Suicidal Soldiers” PRINCIPAL INVESTIGATOR: David A. Jobes, Ph.D., ABPP CONTRACTING ORGANIZATION: Catholic University Washington, DC...5a. CONTRACT NUMBER W23RYX0279N601 Management of Suicidality vs. Enhanced Care as Usual for Suicidal Soldiers Soldiers 5b. GRANT NUMBER W81XWH-11

  15. Patient-reported benefits of rizatriptan compared with usual non-triptan therapy for migraine in a primary care setting.

    Science.gov (United States)

    Baos, V; Serrano, A; Torrecilla, M; Bertral, C; Caloto, M T; Nocea, G; Gerth, W C

    2003-11-01

    The purpose of this open-label study was to compare rizatriptan with usual non-triptan therapy for migraine in patients who had never received a triptan. Patient-reported outcomes were examined for a prestudy migraine attack and after three consecutive study attacks, the first and third treated with rizatriptan 10 mg wafer and the second with usual non-triptan therapy. A total of 97 patients (83% women; mean age 39 years) completed the study. Two-thirds of patients reported severe or total disability during migraine attacks. All comparisons between rizatriptan therapy and usual non-triptan therapy significantly favoured rizatriptan (p rizatriptan and by 46-48% of patients after usual therapy; 41-47% and 12-18%, respectively, were pain free at 2 hours. Patient satisfaction and migraine-specific quality-of-life scores were also significantly better for attacks treated with rizatriptan. At study end, 62% and 17% of patients were very or completely satisfied with rizatriptan and usual non-triptan therapy, respectively. Among those patients who worked for pay, therapy with rizatriptan significantly reduced absenteeism and improved the amount and quality of time at work compared with usual non-triptan therapy. Allowing patients to have experience with rizatriptan may improve the level of medical care for migraine attacks.

  16. Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial Evaluation of the use of transbronchial biopsy in patients with clinical suspicion of interstitial lung disease

    Directory of Open Access Journals (Sweden)

    Cristiano Claudino Oliveira

    2011-04-01

    Full Text Available OBJETIVO: Estudar os padrões clínicos, radiológicos e histopatológicos da biópsia transbrônquica (BTB utilizados para a confirmação diagnóstica em pacientes com suspeita clinica de doença pulmonar intersticial (DPI atendidos em um hospital universitário de nível terciário. MÉTODOS: Os prontuários, laudos radiológicos e de biópsias transbrônquicas de todos os pacientes com suspeita de DPI submetidos a BTB entre janeiro de 1999 e dezembro de 2006 no Hospital das Clínicas de Botucatu, localizado na cidade de Botucatu (SP, foram revisados. RESULTADOS: Foram incluídos no estudo 56 pacientes. Desses, 11 (19,6% apresentaram o diagnóstico definitivo de fibrose pulmonar idiopática (FPI, que foi significativamente maior nos casos nos quais DPI era uma possibilidade diagnóstica em comparação com aqueles nos quais DPI era a principal suspeita (p = 0,011, demonstrando a contribuição da BTB para a definição diagnóstica dessas doenças. O exame histopatológico dessas biópsias revelou que 27,3% dos pacientes com FPI apresentavam o padrão de pneumonia organizante, o que pode sugerir doença mais avançada. O padrão histológico indeterminado foi o mais frequente, refletindo a característica periférica da FPI. Entretanto, o padrão fibrose apresentou alta especificidade e alto valor preditivo negativo. Para os padrões sugestivos de FPI em TC, a curva ROC indicou que a melhor relação entre sensibilidade e especificidade ocorreu com a presença de cinco alterações radiológicas, sendo o aspecto de favo de mel fortemente sugestivo de FPI (p = 0,01. CONCLUSÕES: Nas DPIs, a TC de tórax deve ser sempre realizada e a BTB usada em situações individualizadas, conforme a suspeita e distribuição das lesões.OBJECTIVE: To study the clinical, radiological, and histopathological patterns of transbronchial biopsy (TBB used in order to confirm the diagnosis in patients with clinical suspicion of interstitial lung disease (ILD

  17. Fatores preditores da qualidade de vida relacionada à saúde física e mental em pacientes com doença pulmonar intersticial: uma análise multifatorial Predictors of physical and mental health-related quality of life in patients with interstitial lung disease: a multifactorial analysis

    Directory of Open Access Journals (Sweden)

    Ana Cláudia Coelho

    2010-10-01

    Full Text Available OBJETIVO: Avaliar fatores preditores da qualidade de vida relacionada à saúde (QVRS em pacientes com doença pulmonar intersticial (DPI. MÉTODOS: Estudo transversal com 63 pacientes, submetidos a provas de função pulmonar e teste de caminhada de seis minutos. Foram aplicados os seguintes instrumentos: Medical Outcomes Study 36-item Short-form Survey (SF-36, Saint George's Respiratory Questionnaire (SGRQ, os inventários de ansiedade e depressão de Beck e Modified Medical Research Council Dyspnea Scale. A análise de componentes principais foi utilizada para reduzir as variáveis em fatores preditivos, e a análise de regressão linear múltipla foi utilizada como um modelo explicativo. RESULTADOS: Dos 63 pacientes, 34 eram mulheres. A média de idade foi de 60,1 ± 13,3 anos, média de CVF = 64,17 ± 15,54% do previsto e média de DLCO = 44,21 ± 14,47% do previsto. Todos os pacientes avaliados tinham sua QVRS prejudicada, e os piores escores foram observados nos domínios capacidade funcional do SF-36 e atividade do SGRQ. Dos pacientes avaliados 60,3% e 57,1% apresentaram sintomas de ansiedade e depressão, respectivamente. A análise de componentes principais identificou um fator preditor para QVRS física e um fator preditor para QVRS mental. A depressão apresentou uma forte influência sobre o fator preditor de QVRS mental, e o grau de dispneia apresentou uma influência significativa sobre os dois fatores preditores de QVRS nos pacientes avaliados. Variáveis relacionadas à função pulmonar, capacidade de exercício e ansiedade não apresentaram impactos sobre esses fatores preditores. CONCLUSÕES: Em nossa amostra de pacientes com DPI, o grau de dispneia teve um impacto importante sobre a QVRS física e mental, e a depressão teve um impacto sobre a QVRS mental nos pacientes com DPI.OBJECTIVE: To determine predictors of health-related quality of life (HRQoL in patients with interstitial lung disease (ILD. METHODS: A cross

  18. Effectiveness of Standardized Physiotherapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

    2016-01-01

    : The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. PATIENTS: One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow...... was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. DESIGN: A multicenter randomized controlled trial was conducted. SETTING...... outcome measures. LIMITATIONS: The nature of the exercise intervention did not allow blinding of patients and care providers. CONCLUSION: The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12...

  19. Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Sabina Sanghera

    Full Text Available OBJECTIVE: To undertake an economic evaluation alongside the largest randomised controlled trial comparing Levonorgestrel-releasing intrauterine device ('LNG-IUS' and usual medical treatment for women with menorrhagia in primary care; and compare the cost-effectiveness findings using two alternative measures of quality of life. METHODS: 571 women with menorrhagia from 63 UK centres were randomised between February 2005 and July 2009. Women were randomised to having a LNG-IUS fitted, or usual medical treatment, after discussing with their general practitioner their contraceptive needs or desire to avoid hormonal treatment. The treatment was specified prior to randomisation. For the economic evaluation we developed a state transition (Markov model with a 24 month follow-up. The model structure was informed by the trial women's pathway and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per Quality Adjusted Life Year (QALY estimated using both EQ-5D and SF-6D. RESULTS: Using EQ-5D, LNG-IUS was the most cost-effective treatment for menorrhagia. LNG-IUS costs £100 more than usual medical treatment but generated 0.07 more QALYs. The incremental cost-effectiveness ratio for LNG-IUS compared to usual medical treatment was £1600 per additional QALY. Using SF-6D, usual medical treatment was the most cost-effective treatment. Usual medical treatment was both less costly (£100 and generated 0.002 more QALYs. CONCLUSION: Impact on quality of life is the primary indicator of treatment success in menorrhagia. However, the most cost-effective treatment differs depending on the quality of life measure used to estimate the QALY. Under UK guidelines LNG-IUS would be the recommended treatment for menorrhagia. This study demonstrates that the appropriate valuation of outcomes in menorrhagia is crucial.

  20. How the psychosocial context of clinical trials differs from usual care: A qualitative study of acupuncture patients

    Directory of Open Access Journals (Sweden)

    White Peter

    2011-05-01

    Full Text Available Abstract Background Qualitative studies of participants' experiences in randomised clinical trials (RCTs suggest that the psychosocial context of treatment in RCTs may be quite different to the psychosocial context of treatment in usual practice. This is important, as the psychosocial context of treatment is known to influence patient outcomes in chronic illness. Few studies have directly compared the psychosocial context of treatment across RCTs and usual practice. In this study, we explored differences in psychosocial context between RCT and usual practice settings, using acupuncture as our model. Methods We undertook a secondary analysis of existing qualitative interviews with 54 patients. 27 were drawn from a study of western and traditional acupuncture in usual practice (for a range of painful conditions. 27 were drawn from a qualitative study nested in an RCT of western acupuncture for osteoarthritis of the hip or knee. We used qualitative analysis software to facilitate an inductive thematic analysis in which we identified three main themes. Results In usual practice, starting acupuncture was more likely to be embedded in an active and ongoing search for pain relief, whereas in the RCT starting acupuncture was opportunistic. Usual practice patients reported few uncertainties and these had minimal consequences for them. In the RCT, patients experienced considerable uncertainties about their treatment and its effectiveness, and were particularly concerned about whether they were receiving real (or fake acupuncture. Patients stopped acupuncture only at the end of the fixed course of treatment in the RCT, which was similar to those receiving acupuncture in the public sector National Health Service (NHS. In comparison, private sector patients re-evaluated and re-negotiated treatments particularly when starting to use acupuncture. Conclusions Differences in psychosocial context between RCTs and usual practice could reduce the impact of

  1. The CHANGE trial: no superiority of lifestyle coaching plus care coordination plus treatment as usual compared to treatment as usual alone in reducing risk of cardiovascular disease in adults with schizophrenia spectrum disorders and abdominal obesity.

    Science.gov (United States)

    Speyer, Helene; Christian Brix Nørgaard, Hans; Birk, Merete; Karlsen, Mette; Storch Jakobsen, Ane; Pedersen, Kamilla; Hjorthøj, Carsten; Pisinger, Charlotta; Gluud, Christian; Mors, Ole; Krogh, Jesper; Nordentoft, Merete

    2016-06-01

    Life expectancy in patients with schizophrenia is reduced by 20 years for men and 15 years for women compared to the general population. About 60% of the excess mortality is due to physical illnesses, with cardiovascular disease being dominant. CHANGE was a randomized, parallel-group, superiority, multi-centre trial with blinded outcome assessment, testing the efficacy of an intervention aimed to improve cardiovascular risk profile and hereby potentially reduce mortality. A total of 428 patients with schizophrenia spectrum disorders and abdominal obesity were recruited and centrally randomized 1:1:1 to 12 months of lifestyle coaching plus care coordination plus treatment as usual (N=138), or care coordination plus treatment as usual (N=142), or treatment as usual alone (N=148). The primary outcome was 10-year risk of cardiovascular disease assessed post-treatment and standardized to age 60. At follow-up, the mean 10-year risk of cardiovascular disease was 8.4 ± 6.7% in the group receiving lifestyle coaching, 8.5 ± 7.5% in the care coordination group, and 8.0 ± 6.5% in the treatment as usual group (p=0.41). We found no intervention effects for any secondary or exploratory outcomes, including cardiorespiratory fitness, physical activity, weight, diet and smoking. In conclusion, the CHANGE trial did not support superiority of individual lifestyle coaching or care coordination compared to treatment as usual in reducing cardiovascular risk in patients with schizophrenia spectrum disorders and abdominal obesity.

  2. Brief Strategic Family Therapy versus Treatment as Usual: Results of a Multisite Randomized Trial for Substance Using Adolescents

    Science.gov (United States)

    Robbins, Michael S.; Feaster, Daniel J.; Horigian, Viviana E.; Rohrbaugh, Michael; Shoham, Varda; Bachrach, Ken; Miller, Michael; Burlew, Kathleen A.; Hodgkins, Candy; Carrion, Ibis; Vandermark, Nancy; Schindler, Eric; Werstlein, Robert; Szapocznik, Jose

    2011-01-01

    Objective: To determine the effectiveness of brief strategic family therapy (BSFT; an evidence-based family therapy) compared to treatment as usual (TAU) as provided in community-based adolescent outpatient drug abuse programs. Method: A randomized effectiveness trial in the National Drug Abuse Treatment Clinical Trials Network compared BSFT to…

  3. 76 FR 69146 - Common or Usual Name for Raw Meat and Poultry Products Containing Added Solutions-Reopening of...

    Science.gov (United States)

    2011-11-08

    ... Meat and Poultry Products Containing Added Solutions--Reopening of Comment Period AGENCY: Food Safety..., ``Common or Usual Name for Raw Meat and Poultry Products Containing Added Solutions.'' It is also providing... Meat and Poultry Products Containing Added Solutions'' (76 FR 44855) to amend its regulations to...

  4. Does Cognitive Behavioral Therapy for Youth Anxiety Outperform Usual Care in Community Clinics? An Initial Effectiveness Test

    Science.gov (United States)

    Southam-Gerow, Michael A.; Weisz, John R.; Chu, Brian C.; McLeod, Bryce D.; Gordis, Elana B.; Connor-Smith, Jennifer K.

    2010-01-01

    Objective: Most tests of cognitive behavioral therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The present study used…

  5. Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

    NARCIS (Netherlands)

    Hendriks, Jeroen; Tomini, Florian; van Asselt, Thea; Crijns, Harry; Vrijhoef, Hubertus

    2013-01-01

    AIMS: A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess cost-effectiven

  6. When yesterday's consumption strikes back: Deviation from usual consumption inversely predicts amounts consumed the next weekend evening

    NARCIS (Netherlands)

    Labhart, F.; Kuntsche, E.N.

    2014-01-01

    Introduction and Aims. Young adults' weekend alcohol consumption is characterised by heavy episodic drinking (HED) with low alcohol use in between. This study investigates whether consuming a lower or higher number of drinks than usual on a given evening predicts consumption the following evening. D

  7. [Psychosocial vulnerability and substance use screening during pregnancy: Evaluation of a composite auto-questionnaire versus usual medical questioning].

    Science.gov (United States)

    Fline-Barthes, M-H; Vandendriessche, D; Gaugue, J; Urso, L; Therby, D; Subtil, D

    2015-05-01

    To evaluate auto-questionnaire use for psychosocial vulnerability and substance use (smoking, alcohol consumption, depression, intimate violence) screening during pregnancy versus usual medical report. An auto-questionnaire based on validated tests (Fagerström/HSI, T-ACE, EPDS, SSQ6) was proposed to 1977 pregnant patients at their first obstetrical consultation. We compared results of auto-questionnaire and usual medical questioning. The auto-questionnaire was filled by 1676 pregnant patients (89.4 %). The two Fagerström/HIS questions showed that 20.7 % smoked during pregnancy. T-ACE score was better than usual medical questioning to detect excessive alcohol consumption (4.0 % vs 0.1 %, Pauto-questionnaire, but was only found in 4.9 % of medical files (Pauto-questionnaire. Intimate violence, physical or psychological, was reported in 9.4 %. All of these vulnerability factors were linked together, in auto-questionnaire or in usual medical reports. Using auto-questionnaire based on standardized screening tests could help medical practioneers to detect psychosocial vulnerability and/or substance use during pregnancy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  8. Treating Anxiety Disorders in Inner City Schools: Results from a Pilot Randomized Controlled Trial Comparing CBT and Usual Care

    Science.gov (United States)

    Ginsburg, Golda S.; Becker, Kimberly D.; Drazdowski, Tess K.; Tein, Jenn-Yun

    2012-01-01

    Background: The effectiveness of cognitive-behavioral treatment (CBT) in inner city schools, when delivered by novice CBT clinicians, and compared to usual care (UC), is unknown. Objective: This pilot study addressed this issue by comparing a modular CBT for anxiety disorders to UC in a sample of 32 volunteer youth (mean age 10.28 years, 63%…

  9. The effect and expense of redemption reintegration services versus usual reintegration care for young African Canadians discharged from incarceration.

    Science.gov (United States)

    Beausoleil, Victor; Renner, Chenowa; Dunn, Jody; Hinnewaah, Priscilla; Morris, Kofi; Hamilton, Akilah; Braithewaite, Star; Hunter, Nigel; Browne, Gina; Browne, Dillon T

    2017-03-01

    African Canadians comprise 2.5% of the population, but represent 9.5% of federal inmates - an increase of 80% since 2003-2004. Recidivism among federal inmates is high (about 40%). This paper outlines the findings, at 9 months after enrolment during 2011-2012, of a randomised controlled trial testing the effectiveness and cost of Redemption Reintegration Services (RRS), a culturally specific, multi-level intervention for young African Canadian former inmates. Retention at 9 months was 95% of those randomised (n = 115 per group) to RRS (n = 114) or usual reintegration services (n = 105) offered by the municipality. The primary outcomes were recidivism and service costs. Mediating and moderating measures were Personality Strengths, Developmental Assets, Meaning in Life, the Structured Assessment of Violence Risk in Youth, the Youth Behaviour Checklist and Neighbourhood Vitality. Compared with the usual care group, the RRS group showed significant improvements in: self-reported Personality Strengths, Developmental Assets, the presence and search for Meaning in Life, social and individual risk factors, behaviour, and life events such as obtaining stable housing and enrolling in school. At 9 months, RRS participants generated significantly lower per person per annum expenditures for law enforcement services, housing services and total direct costs. Among RRS participants, 3.5% reported being re-charged for offences in the previous 9 months compared with 45.7% of the usual care group. The 2010-2011 average annual cost per person for incarceration was $114,364. The 48 individuals in the usual care group and 4 in RRS would generate costs of $5,489,472 and $457,456, respectively - a $5 million difference. We conclude that, at 9 months, RRS is more effective and less expensive than usual reintegration services for young African Canadians.

  10. Business as Usual

    Institute of Scientific and Technical Information of China (English)

    Wang Wenfeng; Da Wei

    2008-01-01

    In the years since 9/11, there is no doubt that the emphasis of U.S. global strategy has been on counter-terrorism and the war in Iraq. During this period of time, the U.S. investment in strategic, political and military resources in the Middle East, Iraq, and the war on terror, which are the top priorities on the list of Bush's foreign policy, has been far greater than in any other fields. However, there are some in the U.S. who believe that China's rise has been much ignored by the U.S., due to the global war on terror (GWOT), and that America should, in fact, be focusing more on China, not the Middle East. However, as we see it, China has by no means been ignored by the U.S., neither has China's rise been the result of U.S. ignorance.

  11. Disasters as Usual

    DEFF Research Database (Denmark)

    Albris, Kristoffer

    floods entail gradually faded as a result of a long period without a major event. Then, in August 2002, heavy rain for weeks on end caused the biggest flood on record in Dresden and across Central Europe. Thousands of homes were flooded, and damages in the city amounted to over 1 billion euros...

  12. About estimation of fitted parameters' statistical uncertainties in EXAFS. Critical approach on usual and Monte Carlo methods.

    Science.gov (United States)

    Curis, Emmanuel; Bénazeth, Simone

    2005-05-01

    An important step in X-ray absorption spectroscopy (XAS) analysis is the fitting of a model to the experimental spectra, with a view to obtaining structural parameters. It is important to estimate the errors on these parameters, and three methods are used for this purpose. This article presents the conditions for applying these methods. It is shown that the usual equation Sigma = 2H(-1) is not applicable for fitting in R space or on filtered XAS data; a formula is established to treat these cases, and the equivalence between the usual formula and the brute-force method is evidenced. Lastly, the problem of the nonlinearity of the XAS models and a comparison with Monte Carlo methods are addressed.

  13. A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van der Meer Klaas

    2007-02-01

    Full Text Available Abstract Background Subacromial impingement syndrome (SIS is the most frequently recorded shoulder disorder. When conservative treatment of SIS fails, a subacromial decompression is warranted. However, the best moment of referral for surgery is not well defined. Both early and late referrals have disadvantages – unnecessary operations and smaller improvements in shoulder function, respectively. This paper describes the design of a new interdisciplinary treatment strategy for SIS (TRANSIT, which comprises rules to treat SIS in primary care and a well-defined moment of referral for surgery. Methods/Design The effectiveness of an arthroscopic subacromial decompression versus usual medical care will be evaluated in a randomized controlled trial (RCT. Patients are eligible for inclusion when experiencing a recurrence of SIS within one year after a first episode of SIS which was successfully treated with a subacromial corticosteroid injection. After inclusion they will receive injection treatment again by their general practitioner. When, after this treatment, there is a second recurrence within a year post-injection, the participants will be randomized to either an arthroscopic subacromial decompression (intervention group or continuation of usual medical care (control group. The latter will be performed by a general practitioner according to the Dutch National Guidelines for Shoulder Problems. At inclusion, at randomization and three, six and 12 months post-randomization an outcome assessment will take place. The primary outcome measure is the patient-reported Shoulder Disability Questionnaire. The secondary outcome measures include both disease-specific and generic measures, and an economic evaluation. Treatment effects will be compared for all measurement points by using a GLM repeated measures analyses. Discussion The rationale and design of an RCT comparing arthroscopic subacromial decompression with usual medical care for subacromial

  14. Cognitive-reminiscence therapy and usual care for depression in young adults: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Hallford, David J; Mellor, David

    2013-10-21

    Depression is a common affliction for young adults, and is associated with a range of adverse outcomes. Cognitive-reminiscence therapy is a brief, structured intervention that has been shown to be highly effective for reducing depressive symptoms, yet to date has not been evaluated in young adult populations. Given its basis in theory-guided reminiscence-based therapy, and incorporation of effective therapeutic techniques drawn from cognitive therapy and problem-solving frameworks, it is hypothesized to be effective in treating depression in this age group. This article presents the design of a randomized controlled trial implemented in a community-based youth mental health service to compare cognitive-reminiscence therapy with usual care for the treatment of depressive symptoms in young adults. Participants in the cognitive-reminiscence group will receive six sessions of weekly, individual psychotherapy, whilst participants in the usual-care group will receive support from the youth mental health service according to usual procedures. A between-within repeated-measures design will be used to evaluate changes in self-reported outcome measures of depressive symptoms, psychological wellbeing and anxiety across baseline, three weeks into the intervention, post-intervention, one month post-intervention and three months post-intervention. Interviews will also be conducted with participants from the cognitive-reminiscence group to collect information about their experience receiving the intervention, and the process underlying any changes that occur. This study will determine whether a therapeutic approach to depression that has been shown to be effective in older adult populations is also effective for young adults. The expected outcome of this study is the validation of a brief, evidence-based, manualized treatment for young adults with depressive symptoms. Australian New Zealand Clinical Trials Registry ACTRN12613000084785.

  15. The effects of immunotherapy with intravenous immunoglobulins versus no intervention, placebo, or usual care in patients with recurrent miscarriages

    DEFF Research Database (Denmark)

    Egerup, Pia; Lindschou, Jane; Gluud, Christian

    2014-01-01

    , and publication status investigating infusions with immunoglobulins in relation to pregnancy compared to placebo, no intervention, or treatment as usual for assessments of benefits and harms. The relevant published literature will be searched using the following databases: Cochrane Central Register of Controlled...... Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, and Ovid Medline In-Process and Other Non-Indexed Citations databases. Two review authors will independently extract data and assess risk of bias. We will undertake meta-analyses according to the recommendations stated...

  16. Changes in executive functions and self-efficacy are independently associated with improved usual gait speed in older women

    Directory of Open Access Journals (Sweden)

    Hsu Chun

    2010-05-01

    Full Text Available Abstract Background Improved usual gait speed predicts substantial reduction in mortality. A better understanding of the modifiable factors that are independently associated with improved gait speed would ensure that intervention strategies are developed based on a valid theoretical framework. Thus, we examined the independent association of change in executive functions and change in falls-related self-efficacy with improved gait speed among community-dwelling senior women. Methods A secondary analysis of the 135 senior women aged 65 to 75 years old who completed a 12-month randomized controlled trial of resistance training. Usual gait speed was assessed using a 4-meter walk. Three executive processes were assessed by standard neuropsychological tests: 1 set shifting; 2 working memory; and 3 selective attention and response inhibition. A linear regression model was constructed to determine the independent association of change in executive functions and falls-related self-efficacy with change in gait speed. Results Improved selective attention and conflict resolution, and falls-related self-efficacy, were independently associated with improved gait speed after accounting for age, global cognition, baseline gait speed, and change in quadriceps strength. The total variance explained was 24%. Conclusions Interventions that target executive functions and falls-related self-efficacy, in addition to physical functions, to improve gait speed may be more efficacious than those that do not. Trial Registration ClinicalTrials.gov Identifier: NCT00426881

  17. Evaluation of the Relative Validity of the Short Diet Questionnaire for Assessing Usual Consumption Frequencies of Selected Nutrients and Foods

    Directory of Open Access Journals (Sweden)

    Bryna Shatenstein

    2015-08-01

    Full Text Available A 36-item Short Diet Questionnaire (SDQ was developed to assess usual consumption frequencies of foods providing fats, fibre, calcium, vitamin D, in addition to fruits and vegetables. It was pretested among 30 community-dwelling participants from the Québec Longitudinal Study on Nutrition and Successful Aging, “NuAge” (n = 1793, 52.4% women, recruited in three age groups (70 ± 2 years; 75 ± 2 years; 80 ± 2 years. Following revision, the SDQ was administered to 527 NuAge participants (55% female, distributed among the three age groups, both sexes and languages (French, English prior to the second of three non-consecutive 24 h diet recalls (24HR and validated relative to the mean of three 24HR. Full data were available for 396 participants. Most SDQ nutrients and fruit and vegetable servings were lower than 24HR estimates (p < 0.05 except calcium, vitamin D, and saturated and trans fats. Spearman correlations between the SDQ and 24HR were modest and significant (p < 0.01, ranging from 0.19 (cholesterol to 0.45 (fruits and vegetables. Cross-classification into quartiles showed 33% of items were jointly classified into identical quartiles of the distribution, 73% into identical and contiguous quartiles, and only 7% were frankly misclassified. The SDQ is a reasonably accurate, rapid approach for ranking usual frequencies of selected nutrients and foods. Further testing is needed in a broader age range.

  18. Study protocol: Cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care

    Directory of Open Access Journals (Sweden)

    van Bokhorst-de van der Schueren Marian AE

    2010-02-01

    Full Text Available Abstract Background Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness and cost-effectiveness of transmural nutritional support in malnourished elderly patients, starting at hospital admission until three months after discharge. Methods This study is a randomized controlled trial. Patients are included at hospital admission and followed until three months after discharge. Patients are eligible to be included when they are ≥ 60 years old and malnourished according to the following objective standards: Body Mass Index (BMI in kg/m2 Conclusion In this randomized controlled trial we will evaluate the effect of transmural nutritional support in malnourished elderly patients after hospital discharge, compared to usual care. Primary endpoints of the study are changes in activities of daily living, body weight, body composition, quality of life, and muscle strength. An economic evaluation will be performed to evaluate the cost-effectiveness of the intervention in comparison with usual care. Trial registration Netherlands Trial Register (ISRCTN29617677, registered 14-Sep-2005

  19. Does environmental certification in coffee promote "business as usual"? A case study from the Western Ghats, India.

    Science.gov (United States)

    Bose, Arshiya; Vira, Bhaskar; Garcia, Claude

    2016-12-01

    Conservation initiatives are designed to address threats to forests and biodiversity, often through partnerships with natural-resource users who are incentivized to change their land-use and livelihood practices to avoid further biodiversity loss. In particular, direct incentives programmes that provide monetary benefits are commended for being effective in achieving conservation across short timescales. In biodiversity-rich areas, outside protected areas, such as coffee agroforestry systems, direct incentives, such as certification schemes, are used to motivate coffee producers to maintain native tree species, natural vegetation, restrict wildlife hunting, and conserve soil and water, in addition to encouraging welfare of workers. However, despite these claims, there is a lack of strong evidence of the on-ground impact of such schemes. To assess the conservation importance of certification, we describe a case study in the Western Ghats biodiversity hotspot of India, in which coffee growers are provided price incentives to adopt Rainforest Alliance certification standards. We analyse the conservation and social outcomes of this programme by studying peoples' experiences of participating in certification. Despite high compliance and effective implementation, we find a strong case for the endorsement of 'business as usual' with no changes in farm management as a result of certification. We find that such 'business as usual' participation in certification creates grounds for diminishing credibility and local support for conservation efforts. Working towards locally relevant conservation interventions, rather than implementing global blueprints, may lead to more meaningful biodiversity conservation and increased community support for conservation initiatives in coffee landscapes.

  20. Conocimientos usuales de los pacientes diabéticos en los estudiantes de medicina del occidente de México Usual knowledge of medical students form Western Mexico on diabetic patients

    Directory of Open Access Journals (Sweden)

    Rafael Bustos Saldaña

    2007-12-01

    Full Text Available Objetivo: Identificar el conocimiento que presentan los estudiantes de Medicina acerca de los conceptos usuales de los pacientes diabéticos sobre su enfermedad. Material y métodos: Estudio descriptivo en 275 estudiantes de Medicina del Centro Universitario del Sur de la Universidad de Guadalajara. Se seleccionó la muestra en forma aleatoria a los alumnos inscritos en el calendario 2006 A, para aplicarles el instrumento Diabetes Knowledge Questionnaire (24. Se utilizó el programa de estadística EPI INFO 2000, se tomó una significancia estadística Objective: To identify the knowledge that presents Medicine students about the usual concepts of the diabetic patients on their disease. Material and Methods: Cross sectional study in 275 Medicine alumni of the University Center of the South of the University of Guadalajara. Sample was selected in randomized form in the students enrolled in calendar 2006 A, in order to apply them instrument Diabetes Knowledge Questionnaire (24. The statistic program was used EPI INFO 2000, a statistical significance was taken <0.05. Results: Students age: 20.03±1.9 years. The total average of guessed right answers was: 17.56± 3.24, students of 7º and 8º. cycle presented 19.53 ±2.15 and 19.75±1.92 right answers. As far as Basic knowledge of the disease 75,82% answered the reagents suitably, in glycemic control 70.7% and prevention measures and complications 71.9%. Conclusions: knowledge in Medicine students as far as the concepts that must have the diabetic patients on their disease increases in significant form as soon as it increases the semesters of study, the first scholastic cycles have the tendency to be similar to the population in regional diabetic patients.

  1. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul Dlpm; Frith, Peter A; Zwerink, Marlies; Monninkhof, Evelyn M; van der Palen, Job; Effing, Tanja W

    2017-08-04

    Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary

  2. Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial

    DEFF Research Database (Denmark)

    Kongsted, Alice; Montvilas, Erisela Qerama; Kasch, Helge

    2007-01-01

    Study Design. Randomized, parallel-group trial. Objective. To compare the effect of 3 early intervention strategies following whiplash injury. Summary of Background Data. Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion......-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. Methods. Participants were recruited from emergency units and general...... practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12...

  3. Evaluation of the Relative Validity of the Short Diet Questionnaire for Assessing Usual Consumption Frequencies of Selected Nutrients and Foods.

    Science.gov (United States)

    Shatenstein, Bryna; Payette, Hélène

    2015-08-04

    A 36-item Short Diet Questionnaire (SDQ) was developed to assess usual consumption frequencies of foods providing fats, fibre, calcium, vitamin D, in addition to fruits and vegetables. It was pretested among 30 community-dwelling participants from the Québec Longitudinal Study on Nutrition and Successful Aging, "NuAge" (n = 1793, 52.4% women), recruited in three age groups (70 ± 2 years; 75 ± 2 years; 80 ± 2 years). Following revision, the SDQ was administered to 527 NuAge participants (55% female), distributed among the three age groups, both sexes and languages (French, English) prior to the second of three non-consecutive 24 h diet recalls (24HR) and validated relative to the mean of three 24HR. Full data were available for 396 participants. Most SDQ nutrients and fruit and vegetable servings were lower than 24HR estimates (p nutrients and foods. Further testing is needed in a broader age range.

  4. Measurement of the space charge tune spread with a quadrupolar pick-up: New (general) formula VS. "Usual" one

    CERN Document Server

    Metral, Elias

    2015-01-01

    In 1966, W. Hardt derived the oscillation frequencies obtained in the presence of space charge forces and gradients errors for elliptical beams. Since then, a simple formula is usually used to relate the shift of the quadrupolar mode (obtained from the quadrupolar pick-up) and the space charge tune spread, depending only on the ratio between the two transverse equilibrium beam sizes. However, this formula is not always valid, in particular for machines running close to the coupling resonance Qx = Qy with almost round beams. A new general formula is presented, giving the space charge tune spread as a function of i) the measured shift of the quadrupolar mode, ii) the ratio between the two transverse equilibrium beam sizes and iii) the distance between the two transverse tunes.

  5. Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial

    DEFF Research Database (Denmark)

    Kongsted, Alice; Montvilas, Erisela Qerama; Kasch, Helge

    2007-01-01

    practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12......-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. Methods. Participants were recruited from emergency units and general......Study Design. Randomized, parallel-group trial. Objective. To compare the effect of 3 early intervention strategies following whiplash injury. Summary of Background Data. Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion...

  6. Specialized psychosocial treatment plus treatment as usual (TAU) versus TAU for patients with cannabis use disorder and psychosis

    DEFF Research Database (Denmark)

    Hjorthøj, C R; Fohlmann, A; Larsen, Anne-Mette

    2013-01-01

    of motivational interviewing and cognitive behaviour therapy (CBT). TAU was targeted primarily at the psychotic disorder. The primary outcome was self-reported days with cannabis use in the preceding month. RESULTS: Pre-randomization cannabis use frequency was 14.9 [95% confidence interval (CI) 12.7-17.1] days......BACKGROUND: Cannabis abuse in psychotic patients is associated with rehospitalizations, reduced adherence and increased symptom severity. Previous psychosocial interventions have been ineffective in cannabis use, possibly because of low sample sizes and short interventions. We investigated whether...... adding CapOpus to treatment as usual (TAU) reduces cannabis use in patients with cannabis use disorder and psychosis. Method A total of 103 patients with psychosis and cannabis use disorder were centrally randomized to 6 months of CapOpus plus TAU (n = 52) or TAU (n = 51). CapOpus consisted mainly...

  7. Absence of the predisposing factors and signs and symptoms usually associated with overreaching and overtraining in physical fitness centers

    Directory of Open Access Journals (Sweden)

    Carolina Ackel-D'Elia

    2010-01-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the occurrence of the well-known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil. METHOD: A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1-7 or signs and symptoms (8-13 was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching. A mean score was calculated ranging from 1 (completely absent to 5 (severe for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups. RESULTS: The psychological evaluation by POMS Mood State Questionnaire indicated a normal non-inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60. CONCLUSION: According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60.

  8. Cost-effectiveness of cognitive behaviour therapy versus talking and usual care for depressed older people in primary care

    Directory of Open Access Journals (Sweden)

    Leurent Baptiste E

    2011-02-01

    Full Text Available Abstract Background Whilst evidence suggests cognitive behaviour therapy (CBT may be effective for depressed older people in a primary care setting, few studies have examined its cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cognitive behaviour therapy (CBT, a talking control (TC and treatment as usual (TAU, delivered in a primary care setting, for older people with depression. Methods Cost data generated from a single blind randomised controlled trial of 204 people aged 65 years or more were offered only Treatment as Usual, or TAU plus up to twelve sessions of CBT or a talking control is presented. The Beck Depression Inventory II (BDI-II was the main outcome measure for depression. Direct treatment costs were compared with reductions in depression scores. Cost-effectiveness analysis was conducted using non-parametric bootstrapping. The primary analysis focussed on the cost-effectiveness of CBT compared with TAU at 10 months follow up. Results Complete cost data were available for 198 patients at 4 and 10 month follow up. There were no significant differences between groups in baseline costs. The majority of health service contacts at follow up were made with general practitioners. Fewer contacts with mental health services were recorded in patients allocated to CBT, though these differences were not significant. Overall total per patient costs (including intervention costs were significantly higher in the CBT group compared with the TAU group at 10 month follow up (difference £427, 95% CI: £56 - £787, p Conclusions CBT is significantly more costly than TAU alone or TAU plus TC, but more clinically effective. Based on current estimates, CBT is likely to be recommended as a cost-effective treatment option for this patient group if the value placed on a unit reduction in BDI-II is greater than £115. Trial Registration isrctn.org Identifier: ISRCTN18271323

  9. Greenhouse gas emissions from the waste sector in Argentina in business-as-usual and mitigation scenarios.

    Science.gov (United States)

    Santalla, Estela; Córdoba, Verónica; Blanco, Gabriel

    2013-08-01

    The objective of this work was the application of 2006 Intergovernmental Panel on Climate Change (IPCC) Guidelines for the estimation of methane and nitrous oxide emissions from the waste sector in Argentina as a preliminary exercise for greenhouse gas (GHG) inventory development and to compare with previous inventories based on 1996 IPCC Guidelines. Emissions projections to 2030 were evaluated under two scenarios--business as usual (BAU), and mitigation--and the calculations were done by using the ad hoc developed IPCC software. According to local activity data, in the business-as-usual scenario, methane emissions from solid waste disposal will increase by 73% by 2030 with respect to the emissions of year 2000. In the mitigation scenario, based on the recorded trend of methane captured in landfills, a decrease of 50% from the BAU scenario should be achieved by 2030. In the BAU scenario, GHG emissions from domestic wastewater will increase 63% from 2000 to 2030. Methane emissions from industrial wastewater, calculated from activity data of dairy, swine, slaughterhouse, citric, sugar, and wine sectors, will increase by 58% from 2000 to 2030 while methane emissions from domestic will increase 74% in the same period. Results show that GHG emissions calculated from 2006 IPCC Guidelines resulted in lower levels than those reported in previous national inventories for solid waste disposal and domestic wastewater categories, while levels were 18% higher for industrial wastewater. The implementation of the 2006 IPCC Guidelines for National Greenhouse Inventories is now considering by the UNFCCC for non-Annex I countries in order to enhance the compilation of inventories based on comparable good practice methods. This work constitutes the first GHG emissions estimation from the waste sector of Argentina applying the 2006 IPCC Guidelines and the ad doc developed software. It will contribute to identifying the main differences between the models applied in the estimation of

  10. Adequacy of usual dietary intake and nutritional status among pregnant women in the context of nutrition transition: the DEPOSIT Study.

    Science.gov (United States)

    Abu-Saad, Kathleen; Shahar, Danit R; Fraser, Drora; Vardi, Hillel; Friger, Michael; Bolotin, Arkardy; Freedman, Laurence S

    2012-11-28

    Bedouin Arabs in southern Israel are a traditionally semi-nomadic population undergoing the nutrition transition in a context of urbanisation. The effect of these changes on the nutritional status of pregnant women is unknown. The Dietary Exposures and Pregnancy Outcomes in a Society In Transition (DEPOSIT) study evaluated the adequacy of pregnant Bedouin women's usual dietary intake and their nutritional status. Dietary intake was assessed in a cross-sectional study design using repeat 24 h recall (24HR) questionnaires. The National Cancer Institute method was used to estimate the usual intake of selected nutrients. The Estimated Average Requirement (EAR) was used to evaluate nutrient intake adequacy. Measured weight and height data were used to calculate the participants' BMI. A total of 1109 24HR were obtained from 683 participants, of which 8 % contained no animal-source protein and an additional 43 % contained no haeme-Fe. Animal-source protein intake reached less than half of the EAR for most participants (71 %). Over 90 % had inadequate intakes of Ca, Fe, animal-source Zn, vitamin A and folate. The probability of consuming haeme-source Fe was higher among urban than rural participants (OR 1·68, 95 % CI 1·17, 2·41), and among those with employed v. unemployed husbands (OR 1·81, 95 % CI 1·27, 2·58). Only 14 % reported consuming home-produced animal products. According to pre-pregnancy BMI, 42 % were overweight or obese. The DEPOSIT study findings suggest that Bedouin Arab women are in need of interventions that address the co-existing problems of inadequate nutrient intakes and increased risk of obesity.

  11. [Combined pulmonary fibrosis and emphysema (CPFE)--limitation of usual lung function test and challenge at practice].

    Science.gov (United States)

    Takai, Daiya

    2014-12-01

    Spirometry and the flow-volume curve test are commonly performed lung function tests. However, a unique clinical entity occasionally shows almost normal data in these tests, and is therefore missed on screening tests. The clinical entity of combined pulmonary emphysema and pulmdoary fibrosis was recognized and documented in the 90's in Japan, the USA, and Europe. Typical emphysema shows obstructive disorders, and pulmonary fibrosis shows restrictive disorders. Thus, the combination of both should lead to a combined disorder pattern in lung function tests, but this is not the case. In 2005, Cottin reported and redefined this combination of emphysema and fibrosis of the lung as "Combined Pulmonary Fibrosis and Emphysema" (CPFE). The patients are typically heavily smoking males who show an almost normal lung function. The upper lobe of these patients usually shows severe emphysema, which contributes to a static volume and a late phase in the forced volume test. On the other hand their lower lobe shows fibrotic change. The fibrotic portion contributes to early phase flow in the flow-volume curve. These mechanisms are a reason for the normal pattern appearance in lung function tests in CPFE patients. As a matter of course, these patients have damaged upper and lower lobes: their diffusing capacity of the lung shows a low performance, their saturation of blood hemoglobin decreases soon after light exercise, and their KL-6 (a blood marker of pulmonary fibrosis) usually shows a high value. They are considered a high risk group regarding complications of post-surgical treatment. Thus, when medical technologists identify suspicious cases, they should advise doctors to add diffusing capacity and KL-6 tests. (Review).

  12. Cell cycle related proteins in hyperplasia of usual type in breast specimens of patients with and without breast cancer

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    Gobbi Helenice

    2006-07-01

    Full Text Available Abstract Background Hyperplasia of usual type (HUT is a common proliferative lesion associated with a slight elevated risk for subsequent development of breast cancer. Cell cycle-related proteins would be helpful to determine the putative role of these markers in the process of mammary carcinogenesis. The aim of this study was to analyze the expression of cell cycle related proteins in HUT of breast specimens of patients with and without breast cancer, and compare this expression with areas of invasive carcinomas. Results Immunohistochemical evaluation was performed using antibodies against cell cycle related proteins ER, PR, p53, p21, p63, and Ki-67 in hyperplasia of usual type (HUT in specimens of aesthetic reduction mammaplasty (ARM, in specimens of mammaplasty contralateral to breast cancer (MCC, and in specimens of invasive mammary carcinomas (IMC presenting HUT in the adjacent parenchyma. The results showed that the immunoexpression of ER, PR, p21, p53, p63, and KI-67 was similar in HUT from the three different groups. The p63 expression in myoepithelial cells showed discontinuous pattern in the majority of HUT, different from continuous expression in normal lobules. Nuclear expression of p53 and p21 was frequently higher expressed in IMC and very rare in HUT. We also found cytoplasmic expression of p21 in benign hyperplastic lesions and in neoplastic cells of IMC. Conclusion Our data failed to demonstrate different expression of cell cycle related proteins in HUT from patients with and without breast cancer. However, we found discontinuous expression of p63 in myoepithelial cells around HUT adjacent to carcinomas and cytoplasmic expression of p21 in epithelial cells of hyperplastic foci. Further studies are needed to determine how these subgroups relate to molecular abnormalities and cancer risk.

  13. Associations between usual school lunch attendance and eating habits and sedentary behaviour in French children and adolescents.

    Science.gov (United States)

    Dubuisson, C; Lioret, S; Dufour, A; Volatier, J L; Lafay, L; Turck, D

    2012-12-01

    Our objective was to investigate whether school lunch attendance was associated with overall eating habits and sedentary behaviour in a French sample of children and adolescents. Data for the study were taken from the second French cross-sectional dietary survey (INCA2-2006-07). In total, 1413 school children aged 3-17 years old were classified according to their school type and their usual school lunch attendance. Eating habits included meal regularity, dietary diversity, purchase in vending machine, snacking habits and frequency of eating in fast-foods. Two composite indices of eating habits were derived from multiple correspondence analyses. Sedentary behaviour was assessed by the average daily screen times for TV and computer. The association between school lunch attendance and each variable was tested. Multivariate association between school lunch attendance and the composite indices of eating habits and sedentary behaviours was studied. In all, 69.0% (CI(95%): 64.2-73.9) of secondary school children and 63.0% (CI(95%): 58.5-67.5) of pre- and elementary school children usually attended school lunch at least once a week. Pre- and elementary school children attending school lunches showed a higher dietary diversity score (P=0.02) and ate morning snacks more frequently (P=0.02). In secondary school children, attending school canteen was related to a lower rate of skipping breakfast (P=0.04) and main meals (P=0.01). In all school children, school lunch attendance was simultaneously associated with healthier overall eating habits and less sedentary behaviour. In France, children attending school canteens seem to have healthier eating habits and display less sedentary behaviour, independently of their socio-economic and demographic background.

  14. Neumonia adquirida en la comunidad: guia practica elaborada por un comite intersociedades

    OpenAIRE

    C. M Luna; A. Calmaggi; O. Caberloto; J Gentile; R. Valentín; J. Ciruzzi; L. Clara; Rizzo, O.; S. Lasdica; Blumenfeld, M; Benchetrit, G; A. Famiglietti; C. Apezteguia; A. Monteverde

    2003-01-01

    Las guías para neumonía adquirida en la comunidad (NAC) contribuyen a ordenar el manejo de los pacientes. La NAC presenta cambios en su etiología, epidemiología y sensibilidad a antibióticos que obligan a la revisión periódica de las guías. Un comité intersociedades elaboró esta guía dividida en tópicos y basada en guías y estudios clínicos recientes. La NAC afecta anualmente al 1% de la población; la mayoría de los pacientes requiere atención ambulatoria, en otros reviste gravedad (represent...

  15. Neumonia adquirida en la comunidad: guia practica elaborada por un comite intersociedades

    Directory of Open Access Journals (Sweden)

    C. M. Luna

    2003-08-01

    Full Text Available Las guías para neumonía adquirida en la comunidad (NAC contribuyen a ordenar el manejo de los pacientes. La NAC presenta cambios en su etiología, epidemiología y sensibilidad a antibióticos que obligan a la revisión periódica de las guías. Un comité intersociedades elaboró esta guía dividida en tópicos y basada en guías y estudios clínicos recientes. La NAC afecta anualmente al 1% de la población; la mayoría de los pacientes requiere atención ambulatoria, en otros reviste gravedad (representa la 6ª causa de muerte en Argentina. La etiología es diferente si el paciente es ambulatorio, requiere internación en sala general o en terapia intensiva, pero no hay forma segura de predecirla clínicamente. Los predictores de mala evolución son: edad, antecedentes personales y comorbilidades y hallazgos del examen físico, del laboratorio y de la radiografía de tórax. Entre 10 y 25% de los pacientes que se internan deben hacerlo en terapia intensiva para ventilación mecánica o soporte hemodinámico (NAC grave, tanto inicialmente como durante su evolución. Estos pacientes presentan alta mortalidad; algunos criterios ayudan a reconocerlos. Embarazo, EPOC e internación en institutos geriátricos requieren consideraciones especiales. El diagnóstico es clínico, los métodos complementarios ayudan a determinar la etiología y la gravedad: la radiografía de tórax debe practicarse en todos los pacientes; el resto de los estudios están indicados en internados. El tratamiento inicial es empírico y debe iniciarse precozmente usando antibióticos activos frente a los gérmenes blanco, evitando el uso inapropiado que induce el desarrollo de resistencias. El tratamiento no debe prolongarse innecesariamente. Hidratación, nutrición, oxígeno y el manejo de las complicaciones complementan al tratamiento antibiótico. La prevención se basa en la profilaxis antinfluenza y antineumocóccica, evitar la aspiración y medidas generales.Clinical practice guidelines for community-acquired pneumonia (CAP contribute to improve patient's management. CAP undergoes continuous changes in etiology, epidemiology and antimicrobial sensitivity, requiring periodic guidelines revisions. An inter-society committee designed this guidelines dividing it into several topics based on prior guidelines and recent clinical studies. CAP compromises annually more than 1% of the population; most of the cases only require outpatient care but others are severe cases, reaching the 6th cause of death in Argentina. The cases are distributed unevenly into ambulatory, admitted in the general ward or in the intensive care unit. There is no way to predict the etiology. Unfavorable outcome predictors include age, antecedents and physical, laboratory and radiography findings. Ten to 25% of inpatients need to be admitted to the intensive care unit at the onset or during the follow-up, for mechanical ventilation or hemodynamic support (severe CAP. Severe CAP is associated with high mortality and requires adequate and urgent therapy. Pregnant, COPD and nursing home patients require special recommendations. Diagnosis is clinical, while complementary methods are useful to define etiology and severity; chest X-ray is the only one universally recommended. Other studies, including microbiologic evaluation are particularly appropriate in the hospitalized patients. The initial therapy is empiric, it must begin early, using antimicrobials active against the target microorganisms, avoiding their inappropriate use which can lead to the development of resistance. Length of therapy must not be unnecessarily prolonged. Hydratation, nutrition, oxygen and therapy of complications must complement antibiotic treatment. Prevention is based on influenza prophylaxis, anti-pneumococcal vaccine, aspiration prevention and other general measures.

  16. DURACION DE LA ESTADIA HOSPITALARIA POR NEUMONIA COMUNITARIA CON LA APLICACION RIGUROSA DEL CONSENSO CHILENO 2005.

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    Dr Luis Sanhueza A.

    2007-12-01

    Full Text Available INTRODUCTION: Community adquired pneumonia (CAP isan acute respiratory infection prevalent in our country. Ourgoal is to evaluate impact of national guideline implementation(Chilean CAP consensus 2005, in patients diagnosed with CAPGroup 3 (G3, in terms of the clinical evolution and hospitalizationtime among others variables assessed. For this purposeclinical records from the Medicine Service of the Yumbel Hospitalwere reviewed, between January 2006 and March 2007.

  17. Neumonia adquirida en la comunidad: guia practica elaborada por un comite intersociedades

    OpenAIRE

    C. M. Luna; A. Calmaggi; O. Caberloto; J Gentile; R. Valentín; J. Ciruzzi; L. Clara; Rizzo, O.; S. Lasdica; Blumenfeld, M; Benchetrit, G; Famiglietti, A.; C. Apezteguia; Monteverde, A

    2003-01-01

    Las guías para neumonía adquirida en la comunidad (NAC) contribuyen a ordenar el manejo de los pacientes. La NAC presenta cambios en su etiología, epidemiología y sensibilidad a antibióticos que obligan a la revisión periódica de las guías. Un comité intersociedades elaboró esta guía dividida en tópicos y basada en guías y estudios clínicos recientes. La NAC afecta anualmente al 1% de la población; la mayoría de los pacientes requiere atención ambulatoria, en otros reviste gravedad (represent...

  18. Chickenpox pneumonia. Case presentation. Dora Ngiza hospital, Port Elizabeth, South Africa. Neumonia varicelosa. Presentacion de caso.

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    Ilen Ochoa Tamayo

    2009-03-01

    Full Text Available Chickenpox is an exanthematic highly infectious disease produced by the Varicella zoster virus (VZV, commonly occurs in childhood, 90% of cases occurred in children under 12 years of age, 10% of the population over 15 years is susceptible to suffer it. It is an airborne illness, the inhale virus cause an infection in the initial respiratory epithelium, the virus spreads to distant cells of the reticuloendothelial system, finally, there is a state of viremia with skin lesions, although the spread can also be extended to the viscera. The deterioration of the cell-mediated immunity caused by coexisting diseases, HIV infection, cancer, hemato-oncology illnesses, steroid use, as well as advanced age, smoking, chronic obstructive pulmonary disease and hemorrhagic nature of the Skin lesions, are risk factors for developing Varicella-Zoster pneumonia. In this article we describe a case of chickenpox in a young HIV positive patient complicated with Varicella-Zoster pneumonia. Despite of the treatment with acyclovir, prednisone and supportive measures had a fatal outcome.La varicela es una infección exantemática producida por el virus Varicela zoster (VZV que comúnmente ocurre en la infancia. Se reporta el 90 % de los casos en niños menores de 12 años, el 10 % de la población mayor de 15 años es susceptible a padecerla. La enfermedad se adquiere por inhalación de partículas que contienen el virus y que son expulsadas por la nasofaringe de individuos infectados. Esto causa una infección inicial en el epitelio respiratorio. El virus se disemina a células distantes del sistema retículo endotelial y, finalmente, se produce un estado de viremia con manifestaciones en la piel, aunque la diseminación también se puede extender a las vísceras. El deterioro de la inmunidad celular ocasionado por enfermedades coexistentes, infección por VIH, cáncer, enfermedad hemato-oncológica, uso de esteroides, así como, la edad avanzada, el hábito de fumar, la enfermedad pulmonar obstructiva crónica y el carácter hemorrágico de las lesiones cutáneas son factores de riesgo para desarrollar neumonías varicelosas. En este articulo describimos un caso de varicela en una paciente joven VIH positiva complicada con Neumonía Varicelosa, que a pesar de recibir tratamiento con Aciclovir, Prednisona y tratamiento de soporte tuvo un desenlace fatal.

  19. Assessing usual dietary intake in complex sample design surveys: the National Dietary Survey Evaluación del consumo alimentario usual en investigaciones con muestras complejas: pesquisa nacional de alimentación Avaliação do consumo alimentar usual em pesquisas com amostras complexas: Inquérito Nacional de Alimentação

    Directory of Open Access Journals (Sweden)

    Washington Leite Junger

    2013-02-01

    Full Text Available The National Cancer Institute (NCI method allows the distributions of usual intake of nutrients and foods to be estimated. This method can be used in complex surveys. However, the user must perform additional calculations, such as balanced repeated replication (BRR, in order to obtain standard errors and confidence intervals for the percentiles and mean from the distribution of usual intake. The objective is to highlight adaptations of the NCI method using data from the National Dietary Survey. The application of the NCI method was exemplified analyzing the total energy (kcal and fruit (g intake, comparing estimations of mean and standard deviation that were based on the complex design of the Brazilian survey with those assuming simple random sample. Although means point estimates were similar, estimates of standard error using the complex design increased by up to 60% compared to simple random sample. Thus, for valid estimates of food and energy intake for the population, all of the sampling characteristics of the surveys should be taken into account because when these characteristics are neglected, statistical analysis may produce underestimated standard errors that would compromise the results and the conclusions of the survey.El objetivo del estudio fue indicar una adaptación del método del Instituto Nacional del Cáncer (NCI, utilizándose datos de la pesquisa nacional de alimentación. Ese método estima la distribución del consumo usual de nutrientes y alimentos y puede ser aplicado en estudios con muestra compleja. Mientras, son necesarios cálculos adicionales, tales como la replicación repetida balanceada, a fin de obtener los errores estándar e intervalos de confianza para los percentiles y el promedio de la distribución de consumo usual. La aplicación de este método fue ejemplificado analizando el total de energía (Kcal y frutas (gr, comparando las estimaciones de los promedios y sus respectivos errores estándar obtenidos

  20. An open-label study of algorithm-based treatment versus treatment-as-usual for patients with schizophrenia

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    Hirano J

    2013-10-01

    Full Text Available Jinichi Hirano,1,2 Koichiro Watanabe,3 Takefumi Suzuki,1,4 Hiroyuki Uchida,1 Ryosuke Den,5 Taishiro Kishimoto,1 Takashi Nagasawa,5 Yusuke Tomita,4 Koichiro Hara,6 Hiromi Ochi,7 Yoshimi Kobayashi,1 Mutsuko Ishii,1 Akane Fujita,1 Yoshihiko Kanai,1 Megumi Goto,1 Hiromi Hayashi,1 Kanako Inamura,1 Fumiko Ooshima,1 Mariko Sumida,1 Tomoko Ozawa,1 Kayoko Sekigawa,1 Maki Nagaoka,1 Kae Yoshimura,1 Mika Konishi,1 Ataru Inagaki,1 Takuya Saito,8 Nobutaka Motohashi,9 Masaru Mimura,1 Yoshiro Okubo,8 Motoichiro Kato,11Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; 2Ohizumi Hospital, Tokyo, Japan; 3Department of Psychiatry School of Medicine, Kyorin University, Tokyo, Japan; 4Inokashira Hospital, Tokyo, Japan; 5Komagino Hospital, Tokyo, Japan; 6Asai Hospital, Chiba, Japan; 7Kurumegaoka Hospital, Tokyo, Japan; 8Department of Psychiatry School of Medicine, Nippon Medical School, Tokyo, Japan; 9Department of Psychiatry, School of Medicine, University of Yamanashi, Yamanashi, JapanObjective: The use of an algorithm may facilitate measurement-based treatment and result in more rational therapy. We conducted a 1-year, open-label study to compare various outcomes of algorithm-based treatment (ALGO for schizophrenia versus treatment-as-usual (TAU, for which evidence has been very scarce.Methods: In ALGO, patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, fourth edition were treated with an algorithm consisting of a series of antipsychotic monotherapies that was guided by the total scores in the positive and negative syndrome scale (PANSS. When posttreatment PANSS total scores were above 70% of those at baseline in the first and second stages, or above 80% in the 3rd stage, patients proceeded to the next treatment stage with different antipsychotics. In contrast, TAU represented the best clinical judgment by treating psychiatrists.Results: Forty-two patients (21 females, 39.0 ± 10.9 years

  1. Reverse process of usual optical analysis of boson-exchange superconductors: impurity effects on s- and d-wave superconductors.

    Science.gov (United States)

    Hwang, Jungseek

    2015-03-04

    We performed a reverse process of the usual optical data analysis of boson-exchange superconductors. We calculated the optical self-energy from two (MMP and MMP+peak) input model electron-boson spectral density functions using Allen's formula for one normal and two (s- and d-wave) superconducting cases. We obtained the optical constants including the optical conductivity and the dynamic dielectric function from the optical self-energy using an extended Drude model, and finally calculated the reflectance spectrum. Furthermore, to investigate impurity effects on optical quantities we added various levels of impurities (from the clean to the dirty limit) in the optical self-energy and performed the same reverse process to obtain the optical conductivity, the dielectric function, and reflectance. From these optical constants obtained from the reverse process we extracted the impurity-dependent superfluid densities for two superconducting cases using two independent methods (the Ferrel-Glover-Tinkham sum rule and the extrapolation to zero frequency of -ϵ1(ω)ω(2)); we found that a certain level of impurities is necessary to get a good agreement on results obtained by the two methods. We observed that impurities give similar effects on various optical constants of s- and d-wave superconductors; the greater the impurities the more distinct the gap feature and the lower the superfluid density. However, the s-wave superconductor gives the superconducting gap feature more clearly than the d-wave superconductor because in the d-wave superconductors the optical quantities are averaged over the anisotropic Fermi surface. Our results supply helpful information to see how characteristic features of the electron-boson spectral function and the s- and d-wave superconducting gaps appear in various optical constants including raw reflectance spectrum. Our study may help with a thorough understanding of the usual optical analysis process. Further systematic study of experimental

  2. Secondary prevention in patients with coronary heart diseases: what factors are associated with health status in usual primary care?

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    Dominik Ose

    Full Text Available BACKGROUND: For patients with coronary heart diseases a substantial part of secondary prevention is delivered in primary care. Along with the growing importance of prevention, health-related quality of life (HRQoL is an indicator of patient-centered care that has gained increased attention. Different approaches for reorganization in primary care have been associated with improvements in HRQoL. However, these are often results of complex interventions. Evidence on aspects concerning usual primary care that actually have an impact on HRQoL remains scarce. Therefore, this observational study aimed to identify factors which are associated with HRQoL in usual primary care at practice and patient-level. METHODS: This observational study was conducted in eight European countries. We were able to match data from survey instruments for 3505 patients with coronary heart disease (CHD in 228 practices. A multilevel analysis was performed to identify associations of EQ-5D scores at patient and practice-level. RESULTS: After dropping patients with missing information, our cohort consisted of 2656 patients. In this sample, 30.5% were female and the mean age was 67.5 years (SD 10.1. The final model included a total set of 14 potential explanatory variables. At practice-level no variable was associated with EQ-5D. At patient-level, lower education (r = -0.0381, p<0.0001, female gender (r = -0.0543, p<0.0001 and a higher number of other conditions (r = -0.0340, p<0.0001, had a strong negative effect on HRQoL. Strong positive associations with HRQoL were found for a good medication adherence (Morisky (r = 0.0195, p<0.0001 and more positive evaluations of physicians' clinical behavior (r = 0.0282, p = 0.002. In terms of HRQoL no differences between single-handed and group practices exist. CONCLUSION: The results of our study suggest that a better patient-physician relationship rather than organization of CHD care is associated with higher HRQOL in the primary

  3. Proactive cardiovascular risk management versus usual care in patients with and without diabetes mellitus: CRUCIAL trial subanalysis.

    Science.gov (United States)

    Kim, Jae-Hyung; Zamorano, José; Erdine, Serap; Pavia, Abel; Al-Khadra, Ayman; Sutradhar, Santosh; Yunis, Carla

    2012-07-01

    Patients with diabetes mellitus (DM) and additional cardiovascular (CV) risk factors are at very high risk for future CV events. This study investigated the efficacy and safety of a proactive, multifactorial CV risk factor-management strategy based on single-pill amlodipine/atorvastatin (SPAA) versus continuing physicians' usual care (UC) over 52 weeks in patients with and without DM. Patients with hypertension and ≥ 3 additional CV risk factors from the Cluster Randomized Usual Care vs Caduet Investigation Assessing Long-Term-Risk (CRUCIAL) trial--an open-label, cluster-randomized trial conducted in 19 countries--were enrolled and randomized to receive proactive intervention (based on SPAA 5/10 to 10/20 mg) or UC (based on investigators' best clinical judgment). Patients were analyzed according to baseline DM status. Six hundred patients had DM. Patients with DM in the SPAA and UC arms had mean ages of 61.8 and 61.5 years, respectively, and an absolute coronary heart disease (CHD) risk of 25.2% and 21.5%, respectively. Among non-DM patients, mean ages were 58.6 and 59.5 years, respectively, and CHD risk was 16.0% vs 15.7%, respectively. Least-squares mean treatment differences in percentage change from baseline in calculated 10-year Framingham CHD risk were -26.3% vs -27.3% among DM and non-DM patients (adjusted for respective baseline values) (both P risk-management approach, simultaneously targeting blood pressure and lipids, was more effective for reducing calculated 10-year Framingham CHD risk than UC in patients with DM. While blood pressure changes were of smaller magnitude among patients with DM, this strategy reduced overall risk to an extent comparable with that observed in non-DM patients. Further studies are thus warranted to study this proactive risk factor intervention on CV or mortality endpoints in patients with and without DM. www.ClinicalTrials.gov identifier NCT00407537.

  4. Energy-containing nutritional supplements can affect usual energy intake postsupplementation in institutionalized seniors with probable Alzheimer's disease.

    Science.gov (United States)

    Parrott, Matthew D; Young, Karen W H; Greenwood, Carol E

    2006-09-01

    To determine whether increases in caloric intake associated with consumption of a mid-morning nutritional supplement for 3 weeks were maintained in the week after stopping the supplement and to investigate the effects of body mass index (BMI) and cognitive and behavioral measures on this response. Secondary analysis of a previously published randomized, crossover, nonblinded clinical trial. A fully accredited geriatric care facility affiliated with the University of Toronto. Thirty institutionalized seniors with probable Alzheimer's disease (AD) who ate independently. Investigator-weighed food intake, body weight, cognitive (Severe Impairment Battery; Global Deterioration Scale) and behavioral (Neuropsychiatric Inventory--Nursing Home version; London Psychogeriatric Rating Scale) assessments. Individuals who responded successfully to supplementation as indicated by increases in daily energy intake were likely to maintain 58.8% of that increase postsupplementation, although stopping the supplement was associated with decreased habitual energy intake in low-BMI individuals who reduced their daily intakes during supplementation in response to the extra calories. Cognitive/behavioral tests were not reliable predictors of postsupplement intake. Institutionalized seniors with probable AD are likely to alter their usual energy intakes to maintain changes resulting from 3 weeks of supplementation. This effect may allow for rotating supplementation schedules in nursing homes that could reduce staff burden, but only for those individuals who are most likely to respond favorably. These data indicate that nutritional supplements and diet plans should be carefully prescribed in low-BMI individuals to limit variability in total energy provided and thus prevent lower-than-normal intake.

  5. Trends in the Types of Usual Sources of Care: A Shift from People to Places or Nothing at All.

    Science.gov (United States)

    Liaw, Winston; Jetty, Anuradha; Petterson, Stephen; Bazemore, Andrew; Green, Larry

    2017-08-31

    (1) To examine usual source of care (USC) trends across four categories (No USC, Person USC, Person, in Facility USC, and Facility USC), and (2) to determine whether USC types are associated with emergency department (ED) visits and hospital admissions. 1996-2014 Medical Expenditure Panel Surveys. We stratified each USC category, by age, region, gender, poverty, insurance, race/ethnicity, and education and used regression to determine the characteristics associated with USC types, ED visits, and hospital admissions. Those with No USC and Facility USCs increased 10 and 18 percent, respectively, while those with Person USCs decreased by 43 percent. Compared to those in the lowest income bracket, those in the highest income bracket were less likely to have a Facility USC. Among those with low incomes, individuals with No USC, Person, in Facility, and Facility USCs were more likely to have ED visits than those with Person USCs. A growing number are reporting facilities as their USCs or none at all. The impact of these trends is uncertain, although we found that some USC types are associated with ED visits and hospital admissions. Tracking USCs will be crucial to measuring progress toward enhanced care efficiency. © Health Research and Educational Trust.

  6. Circulating immune complexes in patients with usual interstitial pulmonary fibrosis: partial characterization and relationship with Thermoactinomyces vulgaris.

    Science.gov (United States)

    Cocchiara, R; Giallongo, A; Amoroso, S; Spina, G; Stancampiano, R; Geraci, D

    1981-01-01

    Sixty-six sera were analysed by solid-phase conglutinin binding assay, to detect the levels of circulating immune complexes (CIC), and by enzyme-linked immunosorbent assay (ELISA) to show a correlation with antibodies to Thermoactinomyces vulgaris. Sixty per cent of patients with usual interstitial pulmonary fibrosis (UIP), were positive for CIC; and T. vulgaris antibodies were detected in 60% of the same patients. In comparison, there was a low frequency of positive results in bronchitis patients (5% for CIC and 35% for T. vulgaris), and in normal blood donors (0% for CIC and 30% for T. vulgaris). Furthermore 31% of patients with lung cancer were found positive for CIC, but not for T. vulgaris. Immune complexes purified on Protein A-Sepharose and by sucrose density gradient from patients with UIP, showed a sedimentation coefficient higher than 19 S. The purified material was found to contain IgG and IgM as antibodies. Binding of immune complexes, purified by sedimentation on sucrose gradient, to conglutinin was inhibited by the presence of T. vulgaris antigen; thus suggesting that this antigen might be present in the complexes. Images Figure 7 PMID:7319561

  7. Drinking to have fun and to get drunk: motives as predictors of weekend drinking over and above usual drinking habits.

    Science.gov (United States)

    Kuntsche, Emmanuel; Cooper, M Lynne

    2010-08-01

    Most evidence on the motives-alcohol use link has come from cross-sectional research using retrospective assessments. It remains also to be demonstrated whether motives predict drinking in particular circumstances. In the present study, drinking motives assessed 2 weeks prior to a diary study were used to predict the number of drinks on weekend days as reported via short message service (SMS). Multilevel regression models were estimated based on 391 reports from 55 participants (mean age 22.7). The results revealed that enhancement motives but not gender, age, or social, coping, or conformity motives predicted weekend drinking over and above usual consumption. Consumption and motives together explained more than three-quarters of the inter-individual variance in weekend drinking. To conclude, this study points to a heavy episodic weekend drinking culture of young people who drink large quantities on Friday and Saturday nights apparently because they are seeking fun and excitement. Preventive measures should aim to counteract young people's drinking at peak times and in high-risk situations. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  8. Single v. multiple measures of skin carotenoids by resonance Raman spectroscopy as a biomarker of usual carotenoid status

    Science.gov (United States)

    Scarmo, Stephanie; Cartmel, Brenda; Lin, Haiqun; Leffell, David J.; Ermakov, Igor V.; Gellermann, Werner; Bernstein, Paul S.; Mayne, Susan T.

    2013-01-01

    Resonance Raman spectroscopy (RRS) is a non-invasive method of assessing carotenoid status in the skin, which has been suggested as an objective indicator of fruit/vegetable intake. The present study assessed agreement and identified predictors of single v. multiple RRS measures of skin carotenoid status. A total of seventy-four participants had their skin carotenoid status measured in the palm of the hand by RRS at six time points over 6 months. Questionnaires were administered to collect information on demographic, lifestyle and dietary data. Mean age of the participants was 36.6 years, 62.2% were female, 83.8% Caucasian and 85.1% were non-smoking at baseline. There was a good agreement between a single measure of skin carotenoids by RRS and multiple measures (weighted κ = 0.80; 95% CI 0.72, 0.88). The same variables were significantly associated with carotenoid status based on single or multiple measures, including a positive association with intake of total carotenoids (Pseason of measurement (P≤0.05). The exception was recent sun exposure, which emerged as a significant predictor of lower carotenoid status only when using multiple RRS measures (P≤0.01). A single RRS measure was reasonably accurate at classifying usual skin carotenoid status. Researchers using RRS may want to take into account other factors that are associated with the biomarker, including season of measurement and recent sun exposure. PMID:23351238

  9. A randomised feasibility trial of a new lifestyle referral assessment versus usual assessment in an acute cardiology setting

    Science.gov (United States)

    Hill, Kate; Walwyn, Rebecca; Camidge, Diana; Murray, Jenni; Meads, David; Reynolds, Greg; Farrin, Amanda; House, Allan

    2015-01-01

    Background A healthy diet, taking exercise and not smoking or consuming alcohol in excess are important to reduce the risk of cardiovascular disease either alone or in combination with statin medication. Health education, including providing information to patients on healthy living and guidance on how to achieve it, is a key nursing function. Objectives This study aims firstly to assess the feasibility of conducting a full-scale trial of lifestyle referral assessment as shown by recruitment rate, data collection and follow-up; and secondly to assess proof of concept and explore possible mechanisms of change. Methods A single-centre, randomised two-arm parallel-group, unblinded feasibility trial conducted in an acute teaching hospital trust. Participants followed up at 3 and 6 months post-randomisation. Results 887 patients screened for eligibility of whom 132 (15%) were randomised into the trial. Of the patients allocated to the individualised assessment: 27% accepted referral or self-referred by 3 months in comparison to 5% allocated to the usual assessment. Conclusions We demonstrated that a full-scale trial is feasible, and that an individualised approach increased the number of patients accepting referral to a formal programme and initiating lifestyle change. However, we should consider the aim of the assessment and ways in which the process of change can be optimised in order to produce long-term benefit for patients. Trial registration: Current Controlled Trials ISRCTN41781196. PMID:26422640

  10. A Randomized Feasibility Trial of a New Lifestyle Referral Assessment Versus Usual Assessment in an Acute Cardiology Setting.

    Science.gov (United States)

    Hill, Kate; Walwyn, Rebecca; Camidge, Diana; Murray, Jenni; Meads, David; Reynolds, Greg; Farrin, Amanda; House, Allan

    A healthy diet, taking exercise, and not smoking or consuming alcohol in excess are important to reduce the risk of cardiovascular disease either alone or in combination with statin medication. Health education, including providing information to patients on healthy living and guidance on how to achieve it, is a key nursing function. This study aims first to assess the feasibility of conducting a full-scale trial of lifestyle referral assessment as shown by recruitment rate, data collection, and follow-up and second to assess proof of concept and explore possible mechanisms of change. This was a single-center, randomized, 2-arm, parallel-group, unblinded feasibility trial conducted in an acute teaching hospital trust. Participants were followed up at 3 and 6 months after randomization. Eight hundred eighty-seven patients were screened for eligibility, of whom 132 (15%) were randomized into the trial. Of the patients allocated to the individualized assessment, 27% accepted referral or self-referred by 3 months in comparison to 5% allocated to the usual assessment. We demonstrated that a full-scale trial is feasible and that an individualized approach increased the number of patients accepting referral to a formal program and initiating lifestyle change. However, we should consider the aim of the assessment and ways in which the process of change can be optimized in order to produce long-term benefit for patients. current controlled trials ISRCTN41781196.

  11. Prolonged exposure therapy for combat- and terror-related posttraumatic stress disorder: a randomized control comparison with treatment as usual.

    Science.gov (United States)

    Nacasch, Nitzah; Foa, Edna B; Huppert, Jonathan D; Tzur, Dana; Fostick, Leah; Dinstein, Yula; Polliack, Michael; Zohar, Joseph

    2011-09-01

    Empirically based studies have demonstrated that prolonged exposure therapy effectively reduces posttraumatic stress disorder (PTSD) symptoms in a vast range of traumas, yet reports of the efficacy of such therapies in combat- and terror-related PTSD are scarce. In this article, we examine the efficacy of prolonged exposure therapy in combat- and terror-related PTSD in comparison to treatment as usual (TAU). Between July 2002 and October 2005, 30 patients of a trauma unit within a psychiatric outpatient clinic were recruited and randomized into prolonged exposure versus TAU therapies. Patients were diagnosed with chronic PTSD (Mini-International Neuropsychiatric Interview criteria) related to combat- (n = 19) or terror-related (n = 11) trauma. Main outcome measures included symptoms of PTSD and depression, as measured by the PTSD Symptom Scale-Interview Version and the Beck Depression Inventory. Posttraumatic stress disorder symptom severity was significantly lower in patients who received prolonged exposure therapy in comparison to patients who received TAU (F(1,24) = 35.3, P terror-related PTSD symptoms. In addition, prolonged exposure was superior to TAU in the short- and long-term reduction of PTSD and depression symptoms. clinicaltrials.gov Identifier: NCT00229372. © Copyright 2011 Physicians Postgraduate Press, Inc.

  12. Single v. multiple measures of skin carotenoids by resonance Raman spectroscopy as a biomarker of usual carotenoid status.

    Science.gov (United States)

    Scarmo, Stephanie; Cartmel, Brenda; Lin, Haiqun; Leffell, David J; Ermakov, Igor V; Gellermann, Werner; Bernstein, Paul S; Mayne, Susan T

    2013-09-14

    Resonance Raman spectroscopy (RRS) is a non-invasive method of assessing carotenoid status in the skin, which has been suggested as an objective indicator of fruit/vegetable intake. The present study assessed agreement and identified predictors of single v. multiple RRS measures of skin carotenoid status. A total of seventy-four participants had their skin carotenoid status measured in the palm of the hand by RRS at six time points over 6 months. Questionnaires were administered to collect information on demographic, lifestyle and dietary data. Mean age of the participants was 36.6 years, 62.2% were female, 83.8% Caucasian and 85.1% were non-smoking at baseline. There was a good agreement between a single measure of skin carotenoids by RRS and multiple measures (weighted κ = 0.80; 95% CI 0.72, 0.88). The same variables were significantly associated with carotenoid status based on single or multiple measures, including a positive association with intake of total carotenoids (Pcarotenoid status only when using multiple RRS measures (P≤ 0.01). A single RRS measure was reasonably accurate at classifying usual skin carotenoid status. Researchers using RRS may want to take into account other factors that are associated with the biomarker, including season of measurement and recent sun exposure.

  13. Comparison of the ISU, NCI, MSM, and SPADE Methods for Estimating Usual Intake: A Simulation Study of Nutrients Consumed Daily

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    Greice H. C. Laureano

    2016-03-01

    Full Text Available Various methods are available for estimating usual dietary intake distributions. Hence, there is a need for simulation studies to compare them. The methods Iowa State University (ISU, National Cancer Institute (NCI, Multiple Source Method (MSM and Statistical Program to Assess Dietary Exposure (SPADE were previously compared in another study, but some results were inconclusive due to the small number of replications used in the simulation. Seeking to overcome this limitation, the present study used 1000 simulated samples for 12 different scenarios to compare the accuracy of estimates yielded by the aforementioned methods. The focus is on scenarios that exhibited the most uncertainty in the conclusions of the mentioned study above, i.e., scenarios with small sample sizes, skewed intake distributions, and large ratios of the between- and within-person variances. Bias was used as a measure of accuracy. For scenarios with small sample sizes (n = 150, the ISU, MSM and SPADE methods generally achieved more accurate estimates than the NCI method, particularly for the 10th and 90th percentiles. The differences between methods became smaller with larger sample sizes (n = 300 and n = 500. With few exceptions, the methods were found to perform similarly.

  14. [STUDY OF LIPIDS OF THE FRUITS OF USUAL HAZEL-NUT CORYLUS AVELLANA L., GROWING IN GEORGIA].

    Science.gov (United States)

    Kikalishvili, B; Gorgaslidze, N; Zurabashvili, D; Sulakvelidze, Ts; Malania, M; Turabelidze, D

    2017-05-01

    The aim of this investigation was the study of lipids from the fruits of usual hazel-nut Corylus avellana L, growing in Georgia. Ripe fruits was collected in the West Georgia, just in Imereti. From the powdered fruits was obtained the sums of neutral and pollar lipids. Qualitatively there were established classes entered in them. By using High performance liquid chromatography qualitatively and quantitatively were identified ten fatty acids, which time of deduction hesitate from 4,01 min to 13,00 min. By the analyses there were determined unsaturated fatty acids C12:0 to C24:0. The content of unsaturated fatty acids considerably is distinquished from the content of the oil from the hazel-nut, growing in the other eco-geographical conditions. In the oil of the hazel-nut growing in Georgia content of hexadecanoic acid is by far exceled (surpassed) than of the oil from the nut growing in the other natural conditions. In the other matters dominant acid is octadecanoic acid. The oil from the fruits of hazel-nut content physiologically active compounds, which desirably correlation is interesting not only for receiving (obtaining) cosmetic means, not is important for usage in practical medicine.

  15. Conflicting results of robot-assisted versus usual gait training during postacute rehabilitation of stroke patients: a randomized clinical trial

    Science.gov (United States)

    Taveggia, Giovanni; Borboni, Alberto; Mulé, Chiara; Negrini, Stefano

    2016-01-01

    Robot gait training has the potential to increase the effectiveness of walking therapy. Clinical outcomes after robotic training are often not superior to conventional therapy. We evaluated the effectiveness of a robot training compared with a usual gait training physiotherapy during a standardized rehabilitation protocol in inpatient participants with poststroke hemiparesis. This was a randomized double-blind clinical trial in a postacute physical and rehabilitation medicine hospital. Twenty-eight patients, 39.3% women (72±6 years), with hemiparesis (Bobath approach were assigned randomly to an experimental or a control intervention of robot gait training to improve walking (five sessions a week for 5 weeks). Outcome measures included the 6-min walk test, the 10 m walk test, Functional Independence Measure, SF-36 physical functioning and the Tinetti scale. Outcomes were collected at baseline, immediately following the intervention period and 3 months following the end of the intervention. The experimental group showed a significant increase in functional independence and gait speed (10 m walk test) at the end of the treatment and follow-up, higher than the minimal detectable change. The control group showed a significant increase in the gait endurance (6-min walk test) at the follow-up, higher than the minimal detectable change. Both treatments were effective in the improvement of gait performances, although the statistical analysis of functional independence showed a significant improvement in the experimental group, indicating possible advantages during generic activities of daily living compared with overground treatment. PMID:26512928

  16. Treatment of vertigo with a homeopathic complex remedy compared with usual treatments: a meta-analysis of clinical trials.

    Science.gov (United States)

    Schneider, Berthold; Klein, Peter; Weiser, Michael

    2005-01-01

    The increasing interest in alternative medical practices has led to a number of controlled studies on herbal and homeopathic agents. This paper presents the results of a meta-analysis of four recent clinical trials evaluating the homeopathic preparation Vertigoheel (VH) compared with usual therapies (betahistine, Ginkgo biloba extract, dimenhydrinate) for vertigo in a total of 1388 patients. Two trials were observational studies and the other two were randomised double-blind controlled trials. The duration of treatment (6-8 weeks) and dosage were comparable in all studies. Treatments were evaluated for the variables "number of vertigo episodes", "intensity of episodes" and "duration of episodes". As the studies differed in the age of patients and in the baseline values of vertigo, the individual reductions of number, intensity and duration of episodes were adjusted on equal age and baseline values (total means). An analysis of variance (with studies as random effects) showed no relevant influence of studies on the adjusted reductions and no relevant interaction between studies and treatment effects. The meta-analysis of all four trials showed equivalent reductions with VH and with control treatment: mean reduction of the number of daily episodes 4.0 for VH and 3.9 for control (standard error 0.11 for both groups); mean reduction of the duration (on a scale 0-4) for VH 1.1 and for the control 1.0 (standard error 0.03 for both groups); mean reduction of the intensity (on a scale 0-4) for VH 1.18 and for the control 1.8 (standard error 0.03 for both groups). In the non-inferiority analysis from all trials, VH was non-inferior in all variables. The results show the applicability of meta-analyses on the data from studies with homeopathicdrugs and support the results from the individual studies indicating good efficacy and tolerability of VH in patients with vertigo.

  17. Summary of comparison between FFT-CW(®) and Usual Care sample from Administration for Children's Services.

    Science.gov (United States)

    Turner, Charles W; Robbins, Michael S; Rowlands, Sylvia; Weaver, Lisa R

    2017-07-01

    This evaluation compared the efficiency and effectiveness of Functional Family Therapy-Child Welfare (FFT-CW(®), n=1625) to Usual Care (UC: n=2250) in reducing child maltreatment. FFT-CW(®) is a continuum of care model based on the family's risk status. In a child welfare setting, families received either UC or FFT-CW(®) in a quasi-experimental, stepped wedge design across all five boroughs of New York City. The families were matched using stratified propensity scoring on their pre-service risk status and followed for 16 months. The ethnically diverse sample included African American (36%), Asian (4%); Hispanic (49%), and Non-Hispanic White (6%) or Other (6%) participants. Referral reasons included abuse or neglect (57.4%), child service needs (56.9%) or child health and safety concerns (42.8%). Clinical process variables included staff fidelity, service duration, and number of contacts. Positive outcomes included whether all clinical goals were met and negative outcomes included transfers, outplacement, recurring allegations and service participation within 16 months of the case open date. Families receiving FFT-CW(®) completed treatment more quickly than UC and they were significantly more likely to meet all of the planned service goals. Higher treatment fidelity was associated with more favorable outcomes. Fewer FFT-CW(®) families were transferred to another program at closing, and they had fewer recurring allegations. FFT-CW(®) had fewer out-of-home placements in families with higher levels of risk factors. The FFT-CW(®) program was more efficient in completing service, and more effective than UC in meeting treatment goals while also avoiding adverse outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Usual choline and betaine dietary intake and incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC Study

    Directory of Open Access Journals (Sweden)

    Zeisel Steven H

    2007-07-01

    Full Text Available Abstract Background Low dietary intake of the essential nutrient choline and its metabolite betaine may increase atherogenesis both through effects on homocysteine methylation pathways as well as through choline's antioxidants properties. Nutrient values for many common foods for choline and betaine have recently become available in the U.S. nutrient composition database. Our objective was to assess the association of dietary intake of choline and betaine with incident coronary heart disease (CHD, adjusting for dietary intake measurement error. Methods We conducted a prospective investigation of the relation between usual intake of choline and betaine with the risk of CHD in 14,430 middle-aged men and women of the biethnic Atherosclerosis Risk in Communities study. A semi-quantitative food frequency questionnaire was used to assess nutrient intake. Proportional hazard regression models were used to calculate the risk of incident CHD. A regression calibration method was used to adjust for measurement error. Results During an average 14 years of follow-up (1987–2002, 1,072 incident CHD events were documented. Compared with the lowest quartile of intake, incident CHD risk was slightly and non-significantly higher in the highest quartile of choline and choline plus betaine, HR = 1.22 (0.91, 1.64 and HR = 1.14 (0.85, 1.53, controlling for age, sex, education, total energy intake, dietary intakes of folate, methionine and vitamin B6. No association was found between dietary choline intake and incident CHD when correcting for measurement error. Conclusion Higher intakes of choline and betaine were not protective for incident CHD. Similar investigations in other populations are of interest.

  19. Conocimientos usuales de los pacientes diabéticos en los estudiantes de medicina del occidente de México

    Directory of Open Access Journals (Sweden)

    Rafael Bustos Saldaña

    Full Text Available Objetivo: Identificar el conocimiento que presentan los estudiantes de Medicina acerca de los conceptos usuales de los pacientes diabéticos sobre su enfermedad. Material y métodos: Estudio descriptivo en 275 estudiantes de Medicina del Centro Universitario del Sur de la Universidad de Guadalajara. Se seleccionó la muestra en forma aleatoria a los alumnos inscritos en el calendario 2006 A, para aplicarles el instrumento Diabetes Knowledge Questionnaire (24. Se utilizó el programa de estadística EPI INFO 2000, se tomó una significancia estadística <0.05. Resultados: Edad en los estudiantes: 20.03±1.9 años. El promedio total de contestaciones acertadas fue: estudiantes 17.56± 3.24, los alumnos de 7º y 8º. Ciclo presentaron 19.53 ±2.15 y 19.75±1.92 aciertos. En cuanto a conocimientos básicos de la enfermedad solo el 75.82% contesto adecuadamente los reactivos, en el control glucémico 70.7% y en medidas de prevención y complicaciones 71.9% de los estudiantes. Conclusiones: El conocimiento de los estudiantes de Medicina en cuanto a los conceptos que deben de tener los pacientes diabéticos sobre su enfermedad se incrementa en forma significativa en cuanto aumenta los semestres de estudio, los primeros ciclos escolares tienen la tendencia a ser semejantes a la población de pacientes diabéticos de la región.

  20. Association of heart rate and blood pressure among European adolescents with usual food consumption: The HELENA study.

    Science.gov (United States)

    Julián-Almárcegui, C; Vandevijvere, S; Gottrand, F; Beghin, L; Dallongeville, J; Sjöstrom, M; Leclercq, C; Manios, Y; Widhalm, K; Ferreira De Morares, A C; Gónzalez-Gross, M; Stehle, P; Castillo, M J; Moreno, L A; Kersting, M; Vyncke, K; De Henauw, S; Huybrechts, I

    2016-06-01

    In adults, there is some evidence that improving diet reduces blood pressure (BP) and the subsequent risk of cardiovascular diseases (CVDs). However, studies that analyse this association in adolescents are still scarce. The objective of the present study was to examine the associations between heart rate, systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP) among European adolescents and usual intake of vegetables, fruits, dairy products, meat, fish, high-sugar foods and savoury snacks. In total, 2283 adolescents from the HELENA-study (12.5-17.5 years old; 1253 girls) were included. Dietary intake was assessed using two computerized 24-hour dietary recalls. Age, sex, body mass index, maternal educational level, physical activity and Tanner stage were considered as confounders. Associations were examined by mixed model analysis stratified by sex. Tests for trend were assessed by tertiles of intake while controlling for the aforementioned confounders. Dairy products and fish intake were negatively associated with BP and heart rate. Significant decreasing trends were observed for heart rate and BP across tertiles of dairy products, fish intake and high-sugar foods intake (p trends were observed for SBP and MAP across tertiles of savoury snack intake (p products consumption with blood pressure and heart rate have been found in European adolescents. Dietary intervention studies are needed to explore these associations in the context of the modification of several risk factors for the prevention of cardiovascular diseases. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  1. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland.

    Science.gov (United States)

    Retèl, Valesca P; van den Boer, Cindy; Steuten, Lotte M G; Okła, Sławomir; Hilgers, Frans J; van den Brekel, Michiel W

    2015-09-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.

  2. Modeling pulmonary fibrosis by abnormal expression of telomerase/apoptosis/collagen V in experimental usual interstitial pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Parra, E.R.; Pincelli, M.S. [Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Teodoro, W.R.; Velosa, A.P.P. [Disciplina de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Martins, V.; Rangel, M.P.; Barbas-Filho, J.V.; Capelozzi, V.L. [Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil)

    2014-06-04

    Limitations on tissue proliferation capacity determined by telomerase/apoptosis balance have been implicated in pathogenesis of idiopathic pulmonary fibrosis. In addition, collagen V shows promise as an inductor of apoptosis. We evaluated the quantitative relationship between the telomerase/apoptosis index, collagen V synthesis, and epithelial/fibroblast replication in mice exposed to butylated hydroxytoluene (BHT) at high oxygen concentration. Two groups of mice were analyzed: 20 mice received BHT, and 10 control mice received corn oil. Telomerase expression, apoptosis, collagen I, III, and V fibers, and hydroxyproline were evaluated by immunohistochemistry, in situ detection of apoptosis, electron microscopy, immunofluorescence, and histomorphometry. Electron microscopy confirmed the presence of increased alveolar epithelial cells type 1 (AEC1) in apoptosis. Immunostaining showed increased nuclear expression of telomerase in AEC type 2 (AEC2) between normal and chronic scarring areas of usual interstitial pneumonia (UIP). Control lungs and normal areas from UIP lungs showed weak green birefringence of type I and III collagens in the alveolar wall and type V collagen in the basement membrane of alveolar capillaries. The increase in collagen V was greater than collagens I and III in scarring areas of UIP. A significant direct association was found between collagen V and AEC2 apoptosis. We concluded that telomerase, collagen V fiber density, and apoptosis evaluation in experimental UIP offers the potential to control reepithelization of alveolar septa and fibroblast proliferation. Strategies aimed at preventing high rates of collagen V synthesis, or local responses to high rates of cell apoptosis, may have a significant impact in pulmonary fibrosis.

  3. Characteristics of U.S. Adults with Usual Daily Folic Acid Intake above the Tolerable Upper Intake Level: National Health and Nutrition Examination Survey, 2003-2010.

    Science.gov (United States)

    Orozco, Angela M; Yeung, Lorraine F; Guo, Jing; Carriquiry, Alicia; Berry, Robert J

    2016-04-01

    The Food and Drug Administration mandated that by 1998, all enriched cereal grain products (ECGP) be fortified with folic acid in order to prevent the occurrence of neural tube defects. The Institute of Medicine established the tolerable upper intake level (UL) for folic acid (1000 µg/day for adults) in 1998. We characterized U.S. adults with usual daily folic acid intake exceeding the UL. Using NHANES 2003-2010 data, we estimated the percentage of 18,321 non-pregnant adults with usual daily folic acid intake exceeding the UL, and among them, we calculated the weighted percentage by sex, age, race/ethnicity, sources of folic acid intake, supplement use and median usual daily folic acid intakes. Overall, 2.7% (standard error 0.6%) of participants had usual daily intake exceeding the UL for folic acid; 62.2% were women; 86.3% were non-Hispanic whites; and 98.5% took supplements containing folic acid. When stratified by sex and age groups among those with usual daily folic acid intake exceeding the UL, 20.8% were women aged 19-39 years. Those with usual daily intake exceeding the folic acid UL were more likely to be female, non-Hispanic white, supplement users or to have at least one chronic medical condition compared to those not exceeding the folic acid UL. Among those with usual daily folic acid intake exceeding the UL who also took supplements, 86.6% took on average >400 µg of folic acid/day from supplements. Everyone with usual daily folic acid intake exceeding the UL consumed folic acid from multiple sources. No one in our study population had usual daily folic acid intake exceeding the UL through consumption of mandatorily-fortified enriched cereal grain products alone. Voluntary consumption of supplements containing folic acid is the main factor associated with usual daily intake exceeding the folic acid UL.

  4. Eccentric exercise versus Usual-care with older cancer survivors: The impact on muscle and mobility- an exploratory pilot study

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    Smith Sheldon B

    2011-01-01

    Full Text Available Abstract Background Resistance exercise programs with high compliance are needed to counter impaired muscle and mobility in older cancer survivors. To date outcomes have focused on older prostate cancer survivors, though more heterogeneous groups of older survivors are in-need. The purpose of this exploratory pilot study is to examine whether resistance exercise via negative eccentrically-induced work (RENEW improves muscle and mobility in a diverse sample of older cancer survivors. Methods A total of 40 individuals (25 female, 15 male with a mean age of 74 (± 6 years who have survived (8.4 ± 8 years since their cancer diagnosis (breast, prostate, colorectal and lymphoma were assigned to a RENEW group or a non-exercise Usual-care group. RENEW was performed for 12 weeks and measures of muscle size, strength, power and mobility were made pre and post training. Results RENEW induced increases in quadriceps lean tissue average cross sectional area (Pre: 43.2 ± 10.8 cm2; Post: 44.9 ± 10.9 cm2, knee extension peak strength (Pre: 248.3 ± 10.8 N; Post: 275.4 ± 10.9 N, leg extension muscle power (Pre: 198.2 ± 74.7 W; Post 255.5 ± 87.3 W, six minute walk distance (Pre: 417.2 ± 127.1 m; Post 466.9 ± 125.1 m and a decrease on the time to safely descend stairs (Pre: 6.8 ± 4.5 s; Post 5.4 ± 2.5 s. A significant (P Conclusions This exploration of RENEW in a heterogeneous cohort of older cancer survivors demonstrates increases in muscle size, strength and power along with improved mobility. The efficacy of a high-force, low perceived exertion exercise suggests RENEW may be suited to older individuals who are survivors of cancer. Trial Registration ClinicalTrials.gov Identifier: NCT00335491

  5. Improved health outcomes with etanercept versus usual DMARD therapy in an Asian population with established rheumatoid arthritis.

    Science.gov (United States)

    Bae, Sang-Cheol; Gun, Suk Chyn; Mok, Chi Chiu; Khandker, Rezaul; Nab, Henk W; Koenig, Andrew S; Vlahos, Bonnie; Pedersen, Ron; Singh, Amitabh

    2013-01-08

    combination therapy with usual standard of care DMARDs plus MTX in patients with established rheumatoid arthritis from the Asia-Pacific region. clintrials.gov # NCT00422227.

  6. An economic analysis of usual care and acupuncture collaborative treatment on chronic low back pain: A Markov model decision analysis

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    Lee Taejin

    2010-11-01

    , the probability for cost-effectiveness of a collaborative practice would exceed 50%. At 20,000,000 KRW per QALY, which is recommended using per capita gross domestic product (GDP as the threshold, the probability would be 72.3%. Conclusions On the basis of our findings, acupuncture collaborative therapy for patients with chronic LBP may be cost-effective if the usual threshold is applied. Further empirical studies are required to overcome the limitations of uncertainties and improve the precision of the results.

  7. INCANT: a transnational randomized trial of Multidimensional Family Therapy versus treatment as usual for adolescents with cannabis use disorder

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    Grichting Esther

    2010-04-01

    Full Text Available Abstract Background In 2003, the governments of Belgium, France, Germany, the Netherlands and Switzerland agreed that there was a need in Europe for a treatment programme for adolescents with cannabis use disorders and other behavioural problems. Based on an exhaustive literature review of evidence-based treatments and an international experts meeting, Multidimensional Family Therapy (MDFT was selected for a pilot study first, which was successful, and then for a joint, transnational randomized controlled trial named INCANT (INternational CAnnabis Need for Treatment. Methods/design INCANT is a randomized controlled trial (RCT with an open-label, parallel group design. This study compares MDFT with treatment as usual (TAU at and across sites in Brussels, Berlin, Paris, The Hague and Geneva. Assessments are at baseline and at 3, 6, 9 and 12 months after randomization. A minimum of 450 cases in total is required; sites will recruit 60 cases each in Belgium and Switzerland, and a maximum of 120 each in France, Germany and the Netherlands. Eligible for INCANT are adolescents from 13 through 18 years of age with a cannabis use disorder (dependence or abuse, with at least one parent willing to take part in the treatment. Randomization is concealed to, and therefore beyond control by, the researcher/site requesting it. Randomization is stratified as to gender, age and level of cannabis consumption. Assessments focus on substance use; mental function; behavioural problems; and functioning regarding family, school, peers and leisure time. For outcome analyses, the study will use state of the art latent growth curve modelling techniques, including all randomized participants according to the intention-to-treat principle. INCANT has been approved by the appropriate ethical boards in Belgium, France, Germany, the Netherlands, Switzerland, and the University of Miami Miller School of Medicine. INCANT is funded by the (federal Ministries of Health of Belgium

  8. A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth.

    Science.gov (United States)

    Jensen, Tine K; Holt, Tonje; Ormhaug, Silje M; Egeland, Karina; Granly, Lene; Hoaas, Live C; Hukkelberg, Silje S; Indregard, Tore; Stormyren, Shirley D; Wentzel-Larsen, Tore

    2014-01-01

    The efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) has been shown in several randomized controlled trials. However, few trials have been conducted in community clinics, few have used therapy as usual (TAU) as a comparison group, and none have been conducted outside of the United States. The objective of this study was to evaluate the effectiveness of TF-CBT in regular community settings compared with TAU. One hundred fifty-six traumatized youth (M age = 15.1 years, range = 10-18; 79.5% girls) were randomly assigned to TF-CBT or TAU. Intent-to-treat analysis using mixed effects models showed that youth receiving TF-CBT reported significantly lower levels of posttraumatic stress symptoms (est. = 5.78, d = 0.51), 95% CI [2.32, 9.23]; depression (est. = 7.00, d = 0.54), 95% CI [2.04, 11.96]; and general mental health symptoms (est. = 2.54, d = 0.45), 95% CI [0.50, 4.58], compared with youth in the TAU group. Youth assigned to TF-CBT showed significantly greater improvements in functional impairment (est. = -1.05, d = -0.55), 95% CI [-1.67, -0.42]. Although the same trend was found for anxiety reduction, this difference was not statistically significant (est. = 4.34, d = 0.30), 95% CI [-1.50, 10.19]. Significantly fewer youths in the TF-CBT condition were diagnosed with posttraumatic stress disorder compared to youths in the TAU condition, χ(2)(1, N = 116) = 4.61, p = .031, Phi = .20). Findings indicate that TF-CBT is effective in treating traumatized youth in community mental health clinics and that the program may also be successfully implemented in countries outside the United States.

  9. Comparing Smoking Topography and Subjective Measures of Usual Brand Cigarettes Between Pregnant and Non-Pregnant Smokers.

    Science.gov (United States)

    Bergeria, Cecilia L; Heil, Sarah H; Bunn, Janice Y; Sigmon, Stacey C; Higgins, Stephen T

    2017-06-27

    Most pregnant smokers report abruptly reducing their cigarettes per day (CPD) by ~50% after learning of pregnancy and making further smaller reductions over the remainder of their pregnancy. Laboratory and naturalistic studies with non-pregnant smokers have found that these types of reductions often lead to changes in smoking topography (i.e., changes in smoking intensity to maintain a desired blood-nicotine level). If pregnant women smoke more intensely, they may expose themselves and their offspring to similar levels of toxicants despite reporting reductions in CPD. Pregnant and non-pregnant female smokers (n = 20 and 89, respectively) participated. At the experimental session, after biochemical confirmation of acute abstinence, participants smoked one usual brand cigarette ad lib through a Borgwaldt CReSS Desktop Smoking Topography device. Carbon monoxide (CO) and measures of nicotine withdrawal, craving, and reinforcement derived from smoking were also collected. The two groups did not differ on demographic or smoking characteristics at screening, except nicotine metabolism rate, which as expected, was faster in pregnant smokers. Analyses suggest that none of the smoking topography parameters differed between pregnant and non-pregnant smokers, although pregnant smokers had a significantly smaller CO boost. Both groups reported similar levels of relief of withdrawal and craving after smoking, but other subjective effects suggest that pregnant smokers find smoking less reinforcing than non-pregnant smokers. Pregnant smokers do not smoke cigarettes differently than non-pregnant women, but appear to find smoking comparatively less pleasurable. This is the first study to assess smoking topography in pregnant women. Pregnant women appear to be at increased risk for smoking cigarettes with more intensity because of (1) their tendency to make significant abrupt reductions in the number of cigarettes they smoke each day after learning of pregnancy and (2) an increase in

  10. Evaluation of Penicillium expansum isolates for aggressiveness, growth and patulin accumulation in usual and less common fruit hosts.

    Science.gov (United States)

    Neri, Fiorella; Donati, Irene; Veronesi, Francesca; Mazzoni, David; Mari, Marta

    2010-10-15

    Experiments were carried out in vivo and in vitro with four isolates of Penicillium expansum (I 1, E 11, C 28 and I 12) to evaluate their aggressiveness, growth and patulin accumulation in both usual (pears and apples) and less common hosts (apricots, peaches, strawberries and kiwifruits) of the pathogen. The 75% of isolates showed the ability to cause blue mould in all tested hosts. In particular, C 28 and I 1 were the most and the least aggressive isolates, respectively (52.9 and 10.6% infection and 20.7 and 15.4 mm lesion diameters). 'Candonga' strawberries and 'Pinkcot' apricots showed the largest lesion diameters (29.8 and 25.3 mm), followed by 'Conference' pears, 'Spring Crest' peaches and 'Abate Fetel' pears. With the exception of 'Candonga' strawberries, the formation of colonies and mycelial growth of P. expansum isolates on fruit puree agar media (PAMs) was stimulated in comparison to a standard growth medium (malt extract agar, MEA). Two of the most aggressive isolates in our assays (I 12 and C 28) showed the greatest accumulation of patulin both in vitro and in vivo, while the least aggressive isolate (I 1) produced patulin only in a few growth media and cvs. Patulin concentration on fruit PAMs was higher than patulin detected in infected fruit tissues. Apple PAMs were the more favorable substrates for patulin accumulation in vitro (maximum concentration 173.1 and 74.1 μg/mL in 'Pink Lady and 'Golden Delicious' PAMs, respectively) and 'Pink Lady' apples inoculated with the isolate E 11 showed the greatest accumulation of patulin in the whole in vivo assay (33.9 μg/mL). However, infected tissue of cv Golden Delicious showed lower average accumulation of patulin (1.7 μg/mL) than that of cv Pink Lady (19.1 μg/mL), and no significant differences in patulin concentrations were found among 'Golden Delicious' apples and tested cvs of pears, kiwifruits and strawberries. Peaches were highly susceptible to patulin accumulation, showing average concentrations

  11. Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Favela J

    2013-01-01

    Full Text Available Jesús Favela,1 Luis A Castro,2 Francisco Franco-Marina,3 Sergio Sánchez-García,4 Teresa Juárez-Cedillo,4 Claudia Espinel Bermudez,4 Julia Mora-Altamirano,4 Marcela D Rodriguez,5 Carmen García-Peña41Center for Scientific Research and Higher Education of Ensenada, Ensenada, Baja California, Mexico; 2Sonora Institute of Technology, Ciudad Obregon, Mexico; 3National Institute of Respiratory Diseases, Mexican Ministry of Health, Mexico City, Mexico; 4Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico; 5School of Engineering, MyDCI, Autonomous University of Baja California, Mexicali, MexicoObjective: To assess whether an intervention based on nurse home visits including alert buttons (NV+AB is effective in reducing frailty compared to nurse home visits alone (NV-only and usual care (control group for older adults.Design: Unblinded, randomized, controlled trial.Setting: Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico.Participants: Patients were aged over 60 years with a frailty index score higher than 0.14.Intervention: After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups.Measurements: The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered.Results: The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients, they had died (107, they were ill (50, or they were not currently living in the city (28. A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete

  12. Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care.

    Science.gov (United States)

    Chiarelli, Anna M; Muradali, Derek; Blackmore, Kristina M; Smith, Courtney R; Mirea, Lucia; Majpruz, Vicky; O'Malley, Frances P; Quan, May Lynn; Holloway, Claire Mb

    2017-05-09

    Timely coordinated diagnostic assessment following an abnormal screening mammogram reduces patient anxiety and may optimise breast cancer prognosis. Since 1998, the Ontario Breast Screening Program (OBSP) has offered organised assessment through Breast Assessment Centres (BACs). For OBSP women seen at a BAC, an abnormal mammogram is followed by coordinated referrals through the use of navigators for further imaging, biopsy, and surgical consultation as indicated. For OBSP women seen through usual care (UC), further diagnostic imaging is arranged directly from the screening centre and/or through their physician; results must be communicated to the physician who is then responsible for arranging any necessary biopsy and/or surgical consultation. This study aims to evaluate factors associated with diagnostic wait times for women undergoing assessment through BAC and UC. Of the 2 147 257 women aged 50-69 years screened in the OBSP between 1 January 2002 and 31 December 2009, 155 866 (7.3%) had an abnormal mammogram. A retrospective design identified two concurrent cohorts of women diagnosed with screen-detected breast cancer at a BAC (n=4217; 47%) and UC (n=4827; 53%). Multivariable logistic regression analyses examined associations between wait times and assessment and prognostic characteristics by pathway. A two-sided 5% significance level was used. Screened women with breast cancer were two times more likely to be diagnosed within 7 weeks when assessed through a BAC vs UC (OR=1.91, 95% CI=1.73-2.10). In addition, compared with UC, women assessed through a BAC were significantly more likely to have their first assessment procedure within 3 weeks of their abnormal mammogram (OR=1.25, 95% CI=1.12-1.39), ⩽3 assessment procedures (OR=1.54, 95% CI=1.41-1.69), ⩽2 assessment visits (OR=1.86, 95% CI=1.70-2.05), and ⩾2 procedures per visit (OR=1.41, 95% CI=1.28-1.55). Women diagnosed through a BAC were also more likely than those in UC to have imaging (OR=1.99, 95

  13. Comparison of clinicoradiologic manifestation of nonspecific interstitial pneumonia and usual interstitial pneumonia/idiopathic pulmonary fibrosis: A report from NRITLD

    Directory of Open Access Journals (Sweden)

    Tafti Saeid

    2008-01-01

    Full Text Available Background: Ever since Katzenstein and Fiorelli introduced the term nonspecific interstitial pneumonia (NSIP to denote those cases of interstitial pneumonia that cannot be categorized as any of the other types of idiopathic interstitial pneumonias (IIP, there has been continuing debate on whether it is a real clinical entity or not. The American Thoracic Society/European Respiratory Symposium task group tried to identify idiopathic NSIP as a separate disease and exclude it from the category of IIP. However, it appears that the clinical presentation of NSIP and usual interstitial pneumonia (UIP are the same. Objective : To show that the radiologic features of NSIP and UIP should be relied upon, instead of clinical presentation and pathologic findings, to differentiate between the two. Materials and Methods: Consecutive patients who had received a diagnosis of either NSIP or UIP on the basis of open lung biopsy between January 2001 and December 2007 were identified for inclusion in this retrospective review. The study included 61 subjects: 32 men and 29 women with a mean age of 59.39 ± 14.5 years. Chest computed tomography images of all the cases were collected for a review. High resolution computed tomography (HRCT and all pathologic specimens were also evaluated. A weighted kappa coefficient was used to evaluate whether radiology can be used instead of biopsy for the diagnosis of NSIP and UIP. Comparison of the mean ages and the time intervals (i.e., interval between symptom onset and the time of diagnosis in the UIP and NSIP groups was done using the Mann-Whitney U test. Association between gender and biopsy result was evaluated by the Fisher exact test. Data were evaluated using SPSS, v.13. Results : Sixty-one patients were included in this study, 32 were male and 29 were female. On the basis of biopsy findings, 50 (82% patients had UIP and 11 (18% had NSIP. Thirty (60% of the 50 patients who had UIP were male and 20 (40% were female; 2 (18

  14. Deep venous thrombosis and pulmonary embolism. Part 1. Initial treatment: usually a low-molecular-weight heparin.

    Science.gov (United States)

    2013-04-01

    anticoagulant therapy reduced mortality or recurrences after pulmonary embolism. In the 5 trials that included patients with massive pulmonary embolism, thrombolytic therapy appeared to reduce mortality by about one-half (6% versus 13%). This difference is noteworthy, even if it did not reach the usual threshold of statistical significance. The results of the 6 trials involving patients with deep venous thrombosis, and those of 2 trials and 8 cohort studies in patients with pulmonary embolism at low risk of complications, suggest that outpatient management is acceptable in some cases. Clinical practice guidelines largely agree on the use of LMWH or fondaparinux as initial therapy for most patients with deep venous thrombosis or pulmonary embolism. Unfractionated heparin is generally recommended for patients with renal failure. Thrombolysis is recommended for massive pulmonary embolism and, in some guidelines, for iliofemoral venous thrombosis. In practice, initial treatment of deep venous thrombosis and pulmonary embolism should be based on LMWH in patients without renal failure. Thrombolytic agents may be useful in case of massive pulmonary embolism, but more evaluation is needed. Bleeding and heparin thrombocytopenia are the main adverse effects of these treatments.

  15. Management of coronary risk factors by registered nurses versus usual care in patients with unstable angina pectoris (a chest pain evaluation in the emergency room [CHEER] substudy).

    Science.gov (United States)

    Allison, T G; Farkouh, M E; Smars, P A; Evans, R W; Squires, R W; Gabriel, S E; Kopecky, S L; Gibbons, R J; Reeder, G S

    2000-07-15

    This study examined whether nurses could manage coronary risk factors in patients with unstable angina more effectively than physicians practicing usual care. Three hundred twenty-six patients were randomized in the emergency room to a 6-month program of risk factor management by a registered nurse versus participation in usual care. The nurse intervention consisted of a 30-minute counseling visit at 6 to 10 days after the chest pain episode and a second 30-minute session 1 month later. Multiple risk factors were assessed and addressed: smoking, blood lipids, blood pressure, blood glucose, physical inactivity, weight, psychological stress, and social isolation. Compared with usual care, nurse intervention patients significantly reduced both triglycerides (-29 +/- 8 vs 5 +/- 6 mg/dl; p chest pain is feasible and more effective than usual care in terms of fostering lifestyle changes that may lower coronary risk.

  16. A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes.

    NARCIS (Netherlands)

    Blanc-Bisson, C.; Dechamps, A.A.; Gouspillou, G.; Dehail, P.; Bourdel-Marchasson, I.

    2008-01-01

    OBJECTIVE: To evaluate effects of early intensive physiotherapy during acute illness on post hospitalization activity daily living autonomy (ADL). DESIGN: Prospective randomized controlled trial of intensive physiotherapy rehabilitation on day 1 to 2 after admission until clinical stability or usual

  17. Race, Medical Mistrust, and Segregation in Primary Care as Usual Source of Care: Findings from the Exploring Health Disparities in Integrated Communities Study.

    Science.gov (United States)

    Arnett, M J; Thorpe, R J; Gaskin, D J; Bowie, J V; LaVeist, T A

    2016-06-01

    Compared to White Americans, African-Americans are less likely to use primary care (PC) as their usual source of care. This is generally attributed to race differences in socioeconomic status and in access to primary care services. Little is known about the relationship between race differences in medical mistrust and the usual source of care disparity. Using data from the Exploring Health Disparities in Integrated Communities (EHDIC) study, we examined the role of medical mistrust in choosing usual source of care in 1408 black and white adults who were exposed to the same healthcare facilities and low-income racially integrated community. Multinomial logistic regression models were estimated to examine the relationship between race, medical mistrust, and usual source of care. After adjusting for demographic and health-related factors, African-Americans were more likely than whites to use the emergency department (ED) (relative risk ratio [RRR] = 1.43 (95 % confidence interval (CI) [1.06-1.94])) and hospital outpatient department (RRR1.50 (95 %CI [1.10-2.05])) versus primary care as a usual source of care. When medical mistrust was added to the model, the gap between African-Americans' and whites' risk of using the ED versus primary care as a usual source of care closed (RRR = 1.29; 95 % CI [0.91-1.83]). However, race differences in the use of the hospital outpatient department remained even after accounting for medical mistrust (RRR = 1.67; 95 % CI [1.16-2.40]). Accounting for medical mistrust eliminated the ED-as-usual-source of care disparity. This study highlights the importance of medical mistrust as an intervention point for decreasing ED use as a usual source of care by low-income, urban African-Americans.

  18. A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial).

    OpenAIRE

    2013-01-01

    Evidence supports exercise-based interventions for the management of neck pain, however there is little evidence of its superiority over usual physiotherapy. This study investigated the effectiveness of a group neck and upper limb exercise programme (GET) compared with usual physiotherapy (UP) for patients with non-specific neck pain. A total of 151 adult patients were randomised to either GET or UP. The primary measure was the Northwick Park Neck pain Questionnaire (NPQ) score at six weeks, ...

  19. Features of localization coronary arterial orifices and angles of origin their proximal segments in usually formed hearts and with transposition of the great vessels

    OpenAIRE

    Malov A.E.

    2011-01-01

    The work purpose was revealing of features of localization coronary arterial orifices, angles of origin and acourse of their proximal segments in usually formed hearts and with transposition of the great vessels. Research is executedon 31 specimens of usually formed hearts and 31 specimens with transposition of the great vessels. For the estimation ofposition the orifices in aortic sinuses and orientation of a course of proximal segments of coronary arteries the morphologicalresearches was ca...

  20. A Public Health Nursing Model Assists Women Receiving Temporary Assistance for Needy Families Benefits to Identify a Usual Source of Primary Care.

    Science.gov (United States)

    Cook, Christa L; Hall, Allyson G; Garvan, Cynthia S; Kneipp, Shawn M

    2015-01-01

    Women enrolled in Florida's Temporary Assistance for Needy Families (TANF) program experience high rates of chronic health problems and often lack a usual source of care. Thus, in this study, we aimed to identify variables related to being in a usual source of care at time of study enrollment and determine whether a public health nursing case management intervention affected the obtainment of a usual source of care. To achieve these aims, we conducted a secondary analysis of a randomized controlled trial of a public health nursing case management intervention, which included women with chronic health conditions enrolled in TANF (n = 432). Results indicated 35% of the women did not identify a usual source of care at time of study enrollment, and the public health nursing intervention was effective in helping women obtain a usual source of care (OR = 2.5, 95% CI 1.004-6.491). Thus, a public health nursing case management intervention is an effective way to connect TANF participants to a usual source of care, which may lead to improved health outcomes in this vulnerable population of women.

  1. Use and impact of usual intake models on dietary exposure estimate and risk assessment of chemical substances: a practical example for cadmium, acrylamide and sulphites.

    Science.gov (United States)

    Mancini, Francesca Romana; Sirot, Véronique; Busani, Luca; Volatier, Jean-Luc; Hulin, Marion

    2015-01-01

    To estimate of food and nutrient intakes, 24-h recalls are frequently used in dietary assessment. However intake data collected for a short period are a limited estimator of long-term usual intake. An important limitation of such data is that the within-person variability tends to inflate the intake distribution leading to a biased estimation of extreme percentiles. Statistical models, named usual-intake models, that separate the within-person variability from the between-persons variability, have lately been implemented. The main objectives of this study were to highlight the potential impact that usual-intake models can have on exposure estimate and risk assessment and to point out which are the key aspects to be considered in order to run these models properly and be sure to interpret the output correctly. To achieve the goal we used the consumption data obtained by the French dietary survey INCA2 and the concentration data collected during the French TDS2, using Monte Carlo Risk Assessment (MCRA) software, release 8.0. For the three substances included in this study (cadmium, acrylamide and sulphites), the exposure of the upper percentiles was significantly reduced when using usual-intake models in comparison with the results obtained in the observed individual mean models, even if in terms of risk assessment the impact of using usual-intake models was limited. From the results it appears that the key aspects to consider when using usual-intake models are: (1) the normality of the log-transformed intake distribution, (2) the contribution per single food group to the total exposure, and (3) the independency of food consumption data on multiple days. In conclusion, usual-intake models may have an impact on exposure estimates although, referring to the results, it did not bring any changes in terms of risk assessment, but further investigations are needed.

  2. Effect of reversal of neuromuscular blockade with sugammadex versus usual care on bleeding risk in a randomized study of surgical patients.

    Science.gov (United States)

    Rahe-Meyer, Niels; Fennema, Hein; Schulman, Sam; Klimscha, Walter; Przemeck, Michael; Blobner, Manfred; Wulf, Hinnerk; Speek, Marcel; McCrary Sisk, Christine; Williams-Herman, Debora; Woo, Tiffany; Szegedi, Armin

    2014-11-01

    Previous studies show a prolongation of activated partial thromboplastin time and prothrombin time in healthy volunteers after treatment with sugammadex. The authors investigated the effect of sugammadex on postsurgical bleeding and coagulation variables. This randomized, double-blind trial enrolled patients receiving thromboprophylaxis and undergoing hip or knee joint replacement or hip fracture surgery. Patients received sugammadex 4 mg/kg or usual care (neostigmine or spontaneous recovery) for reversal of rocuronium- or vecuronium-induced neuromuscular blockade. The Cochran-Mantel-Haenszel method, stratified by thromboprophylaxis and renal status, was used to estimate relative risk and 95% confidence interval (CI) of bleeding events with sugammadex versus usual care. Safety was further evaluated by prespecified endpoints and adverse event reporting. Of 1,198 patients randomized, 1,184 were treated (sugammadex n = 596, usual care n = 588). Bleeding events within 24 h (classified by an independent, blinded Adjudication Committee) were reported in 17 (2.9%) sugammadex and 24 (4.1%) usual care patients (relative risk [95% CI], 0.70 [0.38 to 1.29]). Compared with usual care, increases of 5.5% in activated partial thromboplastin time (P sugammadex occurred 10 min after administration and resolved within 60 min. There were no significant differences between sugammadex and usual care for other blood loss measures (transfusion, 24-h drain volume, drop in hemoglobin, and anemia), or risk of venous thromboembolism, and no cases of anaphylaxis. Sugammadex produced limited, transient (<1 h) increases in activated partial thromboplastin time and prothrombin time but was not associated with increased risk of bleeding versus usual care.

  3. Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

    DEFF Research Database (Denmark)

    Nørskov, A K; Wetterslev, J; Rosenstock, C V

    2016-01-01

    ' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible......BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI...... with usual airway assessment. METHODS: From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists...

  4. Change in interpersonal problems after cognitive agoraphobia and schema-focused therapy versus psychodynamic treatment as usual of inpatients with agoraphobia and Cluster C personality disorders.

    Science.gov (United States)

    Gude, Tore; Hoffart, Asle

    2008-04-01

    The aim was to study whether patients with panic disorder with agoraphobia and co-occurring Cluster C traits would respond differently regarding change in interpersonal problems as part of their personality functioning when receiving two different treatment modalities. Two cohorts of patients were followed through three months' in-patient treatment programs and assessed at follow-up one year after end of treatment. The one cohort comprised 18 patients treated with "treatment as usual" according to psychodynamic principles, the second comprised 24 patients treated in a cognitive agoraphobia and schema-focused therapy program. Patients in the cognitive condition showed greater improvement in interpersonal problems than patients in the treatment as usual condition. Although this quasi-experimental study has serious limitations, the results may indicate that agoraphobic patients with Cluster C traits should be treated in cognitive agoraphobia and schema-focused programs rather than in psychodynamic treatment as usual programs in order to reduce their level of interpersonal problems.

  5. Features of localization coronary arterial orifices and angles of origin their proximal segments in usually formed hearts and with transposition of the great vessels

    Directory of Open Access Journals (Sweden)

    Malov A.E.

    2011-01-01

    Full Text Available The work purpose was revealing of features of localization coronary arterial orifices, angles of origin and acourse of their proximal segments in usually formed hearts and with transposition of the great vessels. Research is executedon 31 specimens of usually formed hearts and 31 specimens with transposition of the great vessels. For the estimation ofposition the orifices in aortic sinuses and orientation of a course of proximal segments of coronary arteries the morphologicalresearches was carried out. For the purpose of carrying out of the statistical processing, the obtained data has been presentedon schematic images. As a result of research statistically authentic differences in localization distribution coronary arterialorifices on a vertical axis are established at a transposition of the great vessels, in comparison with usually formed hearts.Peculiarities of an arrangement orifices with acute angles of origin their proximal segments of coronary arteries and themintramural course are established.

  6. A cost-effectiveness analysis comparing a clinical decision rule versus usual care to risk stratify children for intraabdominal injury after blunt torso trauma.

    Science.gov (United States)

    Nishijima, Daniel K; Yang, Zhuo; Clark, John A; Kuppermann, Nathan; Holmes, James F; Melnikow, Joy

    2013-11-01

    Recently a clinical decision rule (CDR) to identify children at very low risk for intraabdominal injury needing acute intervention (IAI) following blunt torso trauma was developed. Potential benefits of a CDR include more appropriate abdominal computed tomography (CT) use and decreased hospital costs. The objective of this study was to compare the cost-effectiveness of implementing the CDR compared to usual care for the evaluation of children with blunt torso trauma. The hypothesis was that compared to usual care, implementation of the CDR would result in lower CT use and hospital costs. A cost-effectiveness decision analytic model was constructed comparing the costs and outcomes of implementation of the CDR to usual care in the evaluation of children with blunt torso trauma. Probabilities from a multicenter cohort study of children with blunt torso trauma were derived; estimated costs were based on those at the study coordinating site. Outcome measures included missed IAI, number of abdominal CT scans, total costs, and incremental cost-effectiveness ratios. Sensitivity analyses varying imputed probabilities, costs, and scenarios were conducted. Using a hypothetical cohort of 1,000 children with blunt torso trauma, the base case model projected that the implementation of the CDR would result in 0.50 additional missed IAIs, a total cost savings of $54,527, and 104 fewer abdominal CT scans compared to usual care. The usual care strategy would cost $108,110 to prevent missing one additional IAI. Findings were robust under multiple sensitivity analyses. Compared to usual care, implementation of the CDR in the evaluation of children with blunt torso trauma would reduce hospital costs and abdominal CT imaging, with a slight increase in the risk of missed intraabdominal IAI. © 2013 by the Society for Academic Emergency Medicine.

  7. Association of usual self-reported dietary intake with ecological momentary measures of affective and physical feeling states in children ☆

    Science.gov (United States)

    O’Reilly, Gillian A.; Huh, Jimi; Schembre, Susan M.; Tate, Eleanor B.; Pentz, Mary Ann; Dunton, Genevieve

    2016-01-01

    Background Little is known about the relationship between dietary intake and affective and physical feeling states in children. Purpose The current study used Ecological Momentary Assessment (EMA) to examine how usual dietary intake is cross-sectionally associated with both average affective and physical feeling state ratings and rating variability in children. Methods Children (N = 110, mean age = 11.0 ± 1.2 years, 52.5% male, 30.1% Hispanic/Latino) completed EMA measures of affective and physical feeling states 3–7 times per day for a full or partial day (weekday evenings and weekend days and evenings) over a 4-day period. Usual intake of pre-selected dietary components was measured prior to the EMA measurement period using the Block Kids Food Screener. Statistical analyses included mixed models and mixed-effects location scale models. Results Greater usual fiber intake was cross-sectionally associated with higher average positive affect (PA) ratings, lower variability of NA ratings, and higher variability of physical fatigue ratings. Lower usual glycemic load of diet was cross-sectionally associated with lower variability of NA ratings. Lower usual added sugar intake was cross-sectionally associated with higher average physical energy ratings and lower variability of NA ratings. Conclusions Although temporal precedence was not established by these findings, they indicate that characteristics of children’s usual dietary intake are cross-sectionally associated with both the average and variability of affective and physical feeling states. EMA offers a promising avenue through which to explore the associations between affective states and diet and has the potential to provide insight into nuances of this relationship. PMID:26032196

  8. Characteristics of U.S. Adults with Usual Daily Folic Acid Intake above the Tolerable Upper Intake Level: National Health and Nutrition Examination Survey, 2003–2010

    OpenAIRE

    Orozco, Angela M.; Yeung, Lorraine F.; Guo, Jing; Carriquiry, Alicia; Berry, Robert J.

    2016-01-01

    The Food and Drug Administration mandated that by 1998, all enriched cereal grain products (ECGP) be fortified with folic acid in order to prevent the occurrence of neural tube defects. The Institute of Medicine established the tolerable upper intake level (UL) for folic acid (1000 µg/day for adults) in 1998. We characterized U.S. adults with usual daily folic acid intake exceeding the UL. Using NHANES 2003–2010 data, we estimated the percentage of 18,321 non-pregnant adults with usual daily ...

  9. Effectiveness of rehabilitation after a total hip arthroplasty : a protocol for an observational study for the comparison of usual care in the Netherlands versus Germany

    NARCIS (Netherlands)

    Seeber, Gesine H; Wijnen, Annet; Lazovic, Djordje; Bulstra, Sjoerd K; Dietz, Günter; van Lingen, Christiaan P; Stevens, Martin

    2017-01-01

    INTRODUCTION: Osteoarthritis is the most common joint disorder worldwide. Total hip arthroplasty (THA) is considered one of the most effective treatments for end-stage hip osteoarthritis. The number of THAs is expected to increase dramatically in the coming decades. Usual postoperative

  10. Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB)

    DEFF Research Database (Denmark)

    Beck, Emma; Bo, Sune; Gondan, Matthias

    2016-01-01

    to Child and Adolescent Psychiatric Clinics in Region Zealand are randomized to 1 year of either mentalization-based treatment in groups or treatment as usual. Patients will be included if they meet at least four DSM-5 criteria for BPD. The primary outcome is self-reported borderline features at discharge...

  11. Cognitive-Behavioral Therapy versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians

    Science.gov (United States)

    Weisz, John R.; Southam-Gerow, Michael A.; Gordis, Elana B.; Connor-Smith, Jennifer K.; Chu, Brian C.; Langer, David A.; McLeod, Bryce D.; Jensen-Doss, Amanda; Updegraff, Alanna; Weiss, Bahr

    2009-01-01

    Community clinic therapists were randomized to (a) brief training and supervision in cognitive-behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8-15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families…

  12. The 'carry-over' effects of patient self-testing: positive effects on usual care management by an anticoagulation management service.

    LENUS (Irish Health Repository)

    Ryan, Fiona

    2010-11-01

    Patient self-testing (PST) of the international normalised ratio (INR) has a positive effect on anticoagulation control. This study investigated whether the benefits of PST (other than increased frequency of testing, e.g. patient education, empowerment, compliance etc.) could be \\'carried-over\\' into usual care management after a period of home-testing has ceased.

  13. Effect of nurse case management compared with usual care on controlling cardiovascular risk factors in patients with diabetes: a randomized controlled trial.

    Science.gov (United States)

    Ishani, Areef; Greer, Nancy; Taylor, Brent C; Kubes, Laurie; Cole, Paula; Atwood, Melissa; Clothier, Barbara; Ercan-Fang, Nacide

    2011-08-01

    To determine whether nurse case management with a therapeutic algorithm could effectively improve rates of control for hypertension, hyperglycemia, and hyperlipidemia compared with usual care among veterans with diabetes. A randomized controlled trial of diabetic patients that had blood pressure (BP) >140/90 mmHg, hemoglobin A(1c) (HbA(1c)) >9.0%, or LDL >100 mg/dL. Intervention patients received case management (n = 278) versus usual care (n = 278) over a 1-year period. The primary outcome was the percentage of patients achieving simultaneous control of all three parameters (defined by BP management achieved the primary study outcome of having all three outcome measures under control (61 [21.9%] compared with 28 [10.1%] in the usual care group [P < 0.01]). In addition, a greater number of individuals assigned to the intervention group achieved the individual treatment goals of HbA(1c) <8.0% (73.7 vs. 65.8%, P = 0.04) and BP <130/80 mmHg (45.0 vs. 25.4%, P < 0.01), but not for LDL <100 mg/dL (57.6 vs. 55.4%, P = 0.61), compared with those in the usual care group. In patients with diabetes, nurse case managers using a treatment algorithm can effectively improve the number of individuals with control of multiple cardiovascular risk factors at 1 year.

  14. Cost-effectiveness of cognitive-behavioral therapy versus treatment as usual for anxiety disorders in children with autism spectrum disorder

    NARCIS (Netherlands)

    van Steensel, F.J.A.; Dirksen, C.D.; Bögels, S.M.

    2014-01-01

    The study's aim was to evaluate the cost-effectiveness of CBT compared to treatment as usual (TAU). In total, 49 children aged 8-18 years with ASD and comorbid anxiety disorders, and their parents, participated; 24 were assigned to CBT and 25 were assigned to TAU. Outcome measures were the percentag

  15. Cost-effectiveness of non-invasive assessment in the Dutch breast cancer screening program versus usual care: A randomized controlled trial

    NARCIS (Netherlands)

    Timmers, J.M.H.; Damen, J.A.A.G.; Pijnappel, R.M.; Verbeek, A.L.M.; Heeten, GJ. den; Adang, E.M.M.; Broeders, M.J.M.

    2014-01-01

    OBJECTIVE: Increased recall rates in the Dutch breast cancer screening program call for a new assessment strategy aiming to reduce unnecessary costs and anxiety. Diagnostic work-up (usual care) includes multidisciplinary hospital assessment and is similar for all recalled women, regardless of the ra

  16. The Effect of Cognitive-Behavioral Therapy versus Treatment as Usual for Anxiety in Children with Autism Spectrum Disorders: A Randomized, Controlled Trial

    Science.gov (United States)

    Storch, Eric A.; Arnold, Elysse B.; Lewin, Adam B.; Nadeau, Josh M.; Jones, Anna M.; De Nadai, Alessandro S.; Mutch, P. Jane; Selles, Robert R.; Ung, Danielle; Murphy, Tanya K.

    2013-01-01

    Objective: To examine the efficacy of a modular cognitive-behavioral therapy (CBT) protocol relative to treatment as usual (TAU) among children with high-functioning autism spectrum disorders (ASD) and clinically significant anxiety. Method: A total of 45 children (7-11 years of age) with high-functioning ASD and clinically significant anxiety…

  17. Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: A pilot randomized controlled trial

    NARCIS (Netherlands)

    Oosting, E.; Jans, M.P.; Dronkers, J.J.; Naber, R.H.; Dronkers-Landman, C.M.; Appelman-De Vries, S.M.; Meeteren, N.L. van

    2012-01-01

    Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise

  18. Cognitive-Behavioral Therapy versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians

    Science.gov (United States)

    Weisz, John R.; Southam-Gerow, Michael A.; Gordis, Elana B.; Connor-Smith, Jennifer K.; Chu, Brian C.; Langer, David A.; McLeod, Bryce D.; Jensen-Doss, Amanda; Updegraff, Alanna; Weiss, Bahr

    2009-01-01

    Community clinic therapists were randomized to (a) brief training and supervision in cognitive-behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8-15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families…

  19. Sharp Lines Due to Cr3+ and Mn2+ Impurities in Insulators: Going Beyond the Usual Tanabe−Sugano Approach

    DEFF Research Database (Denmark)

    García Lastra, Juan Maria; García-Fernández, P.; Barriuso, M. T.

    2014-01-01

    This work is aimed at understanding the different behavior of optical sharp lines (corresponding to 10Dq-independent transitions) of Mn(2+) and Cr(3+) in normal and inverted perovskites that cannot be explained within the usual Tanabe-Sugano approach. In particular, we want to clarify why on pass...

  20. Assessing treatment-as-usual provided to control groups in adherence trials: Exploring the use of an open-ended questionnaire for identifying behaviour change techniques

    NARCIS (Netherlands)

    Oberjé, E.J.M.; Dima, A.L.; Pijnappel, F.J.; Prins, J.M.; Bruin, M. de

    2015-01-01

    OBJECTIVE: Reporting guidelines call for descriptions of control group support in equal detail as for interventions. However, how to assess the active content (behaviour change techniques (BCTs)) of treatment-as-usual (TAU) delivered to control groups in trials remains unclear. The objective of this

  1. An economic evaluation alongside a randomized controlled trial evaluating an individually tailored lifestyle intervention compared with usual care in people with Familial Hypercholesterolemia

    NARCIS (Netherlands)

    Broekhuizen, K.; Wier, M.F. van; Koppes, L.L.J.; Brug, J.; Mechelen, W. van; Bosmans, J.E.; Poppel, M.N.

    2015-01-01

    Background: Cost-effectiveness analyses provide insight in the use of lifestyle interventions. To evaluate the cost-effectiveness of a lifestyle intervention compared to usual care in people with Familial Hypercholesterolemia, 340 people with FH were randomized to the intervention or control group.

  2. Treating Low-Income and Minority Women with Posttraumatic Stress Disorder: A Pilot Study Comparing Prolonged Exposure and Treatment as Usual Conducted by Community Therapists

    Science.gov (United States)

    Feske, Ulrike

    2008-01-01

    Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominately low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community…

  3. Manipulative therapy in addition to usual care for patients with shoulder complaints : results of physical examination outcomes in a randomized controlled trial

    NARCIS (Netherlands)

    Bergman, Geert; Winters, Jan C.; Groenier, Klaas H.; Meyboom-de Jong, Betty; Postema, Klaas; van der Heijden, Geert J.

    2010-01-01

    Objective: The purpose of this study was to examine the effect of manipulative therapy on the shoulder girdle, in addition to usual care provided by the general practitioner, on the Outcomes of physical examination tests for the treatment of shoulder complaints. Methods: This was a randomized contro

  4. An economic evaluation alongside a randomized controlled trial evaluating an individually tailored lifestyle intervention compared with usual care in people with Familial Hypercholesterolemia.

    NARCIS (Netherlands)

    Broekhuizen, K.; Wier, M.F. van; Koppes, L.L.J.; Brug, J.; Mechelen, W. van; Bosmans, J.E.; Poppel, M.N.M. van

    2015-01-01

    Background: Cost-effectiveness analyses provide insight in the use of lifestyle interventions. To evaluate the cost-effectiveness of a lifestyle intervention compared to usual care in people with Familial Hypercholesterolemia, 340 people with FH were randomized to the intervention or control group.

  5. An economic evaluation alongside a randomized controlled trial evaluating an individually tailored lifestyle intervention compared with usual care in people with Familial Hypercholesterolemia

    NARCIS (Netherlands)

    Broekhuizen, K.; Wier, M.F. van; Koppes, L.L.J.; Brug, J.; Mechelen, W. van; Bosmans, J.E.; Poppel, M.N.

    2015-01-01

    Background: Cost-effectiveness analyses provide insight in the use of lifestyle interventions. To evaluate the cost-effectiveness of a lifestyle intervention compared to usual care in people with Familial Hypercholesterolemia, 340 people with FH were randomized to the intervention or control group.

  6. Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial.

    Science.gov (United States)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah; Haahr, Jens Peder; Frich, Lars Henrik; Andrea, Linda Christie; Svendsen, Susanne Wulff

    2016-06-01

    Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. A multicenter randomized controlled trial was conducted. The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. A standardized exercise program consisting of physical therapist-supervised individual training sessions and home training was used. The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=-0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. The nature of the exercise intervention did not allow blinding of patients and care providers. The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and

  7. Comparison of psychometric properties between usual-week and past-week self-reported physical activity questionnaires: a systematic review.

    Science.gov (United States)

    Doma, Kenji; Speyer, Renée; Leicht, Anthony S; Cordier, Reinie

    2017-01-31

    The aim was to critically appraise the methodological quality of studies and determine the psychometric qualities of Past-week and Usual-week Physical Activity Questionnaires (PAQs). Data sources were obtained from Pubmed and Embase. The eligibility criteria for selecting studies included: 1) at least one psychometric property of PAQs was examined in adults; 2) the PAQs either had a recall period of usual 7-days (Usual-week PAQs) within the past 12 months or during the past 7-days (Past-week PAQs); and 3) PAQs were self-administered. Study quality was evaluated using the COSMIN taxonomy and the overall psychometric qualities evaluated using pre-established psychometric criteria. Overall, 45 studies were reviewed to assess the psychometric properties of 21 PAQs with the methodological quality of most studies showing good to excellent ratings. When the relationship between PAQs and other instruments (i.e., convergent validity) were compared between recall methods, Past-week PAQs appeared to have stronger correlations than Usual-week PAQs. For the overall psychometric quality, the Incidental and Planned Exercise Questionnaire for the Usual-week (IPEQ-WA) and for the Past-week (IPEQ-W) had the greatest number of positive ratings. For all included PAQs, very few psychometric properties were assessed with poor ratings for the majority of the overall qualities of psychometric properties indicating the limitation of current PAQs. More research that covers a greater spectrum of psychometric properties is required to gain a better understanding of the qualities of current PAQs.

  8. Pluto: The Farthest Planet (Usually).

    Science.gov (United States)

    Universe in the Classroom, 1988

    1988-01-01

    Provides background information about the planet Pluto. Includes the history of Pluto and discusses some of the common misconceptions about the planets. Addresses some of the recent discoveries about Pluto and contains a resource list of books, articles, and a videotape. (TW)

  9. Safeway, CNG - business as usual

    Energy Technology Data Exchange (ETDEWEB)

    Attree, R. [Safeway Stores plc, Aylesford (United Kingdom)

    2000-07-01

    Safeway describes how it makes use of Compressed Natural Gas (CNG) as part of its environmental policy in its Logistics activities. After one year's experience, the Company expresses concern that other businesses are hesitant to do the same. The paper discusses why CNG was chosen, how the fleet has developed, performance of the vehicles, financial benefits, environmental benefits and the way forward. Environmental best practice features strongly in the Company's culture. Safeway has ten tractor units (32-38 tonnes) powered by modern Perkins Eagle TXSi gas engines developed specifically to run on CNG.

  10. Effect of guided self-determination youth intervention integrated into outpatient visits versus treatment as usual on glycemic control and life skills

    DEFF Research Database (Denmark)

    Husted, Gitte R; Thorsteinsson, Birger; Esbensen, Bente Appel

    2014-01-01

    BACKGROUND: Providing care for adolescents with type 1 diabetes is complex, demanding, and often unsuccessful. Guided self-determination (GSD) is a life skills approach that has been proven effective in caring for adults with type 1 diabetes. To improve care, GSD was revised for adolescents...... of the adolescents' visits (P = 0.05) compared with control parents. CONCLUSIONS: Compared with treatment-as-usual, GSD-Y did not improve HbA1c levels, but it did decrease adolescents' amotivation for diabetes self-management.Trial registration: ISRCTN 54243636, registered on 10 January 2010. Life skills......, their parents, and interdisciplinary healthcare providers (HCP) to create GSD-Youth (GSD-Y). We evaluated the impact of GSD-Y after it was integrated into pediatric outpatient visits versus treatment-as-usual, focusing on glycemic control and the development of life skills in adolescents with type 1 diabetes...

  11. Urban homelessness and poverty during economic prosperity and welfare reform: changes in self-reported comorbidities, insurance, and sources for usual care, 1995-1997.

    Science.gov (United States)

    O'Toole, Thomas P; Gibbon, Jeanette L; Seltzer, Deborah; Hanusa, Barbara H; Fine, Michael J

    2002-06-01

    Little is known of how homeless and other urban poor populations have fared during the robust economy and within structural changes in health care delivery and entitlement programs of the 1990s. This is important in determining the need for population-specific services during a vigorous economy with low unemployment and increasing Medicaid managed-care penetration. This study compared health insurance status and availability of a source for usual medical care, psychiatric and substance abuse comorbidities, and perceived causes of homelessness in homeless adults surveyed in 1995 and 1997. Cross-sectional, community-based surveys were conducted in 1995 and 1997 at sites frequented by urban homeless adults residing in Pittsburgh, Pennsylvania. Self-reported medical, mental health, and substance abuse comorbidities, health insurance, and source for usual care were measured. Compared to the 388 individuals surveyed in 1995, the 267 homeless adults surveyed in 1997 had more medical comorbidity (56.6% vs. 30.2%, P <.001) and mental health comorbidity (44.9% vs. 36.9%, P =.04) and required more chronic medication (52.1% vs. 30.3%, P <.001). More respondents in 1997 than 1995 reported having no health insurance (41.4% vs. 29.4%, P <.001). While there was no difference in the overall proportion reporting a source for usual care (78.3% in 1997 vs. 80.2% in 1995, P =.55), fewer persons reported use of the emergency department and more persons reported using a shelterbased clinic for usual care in 1997 compared with 1995. These findings suggest more need for medical care among homeless and urban poor persons in 1997 compared with 1995 and support the continued need for outreach and support services despite a vigorous economy.

  12. Nutrient intakes among children and adolescents eating usual pizza products in school lunch compared with pizza meeting HealthierUS School Challenge criteria.

    Science.gov (United States)

    Hur, In Young; Marquart, Len; Reicks, Marla

    2014-05-01

    Pizza is a popular food that can contribute to high intakes of saturated fat and sodium among children and adolescents. The objective of this study was to compare daily nutrient intakes when a pizza product meeting the US Department of Agriculture's criteria for competitive food entrées under the HealthierUS School Challenge (HUSSC) was substituted for usual pizza products consumed during foodservice-prepared school lunch. The study used National Health and Nutrition Examination Survey (2005-2008) dietary recall data from a cross-sectional sample of US children and adolescents (age 5 to 18 years, n=337) who ate pizza during school lunch on 1 day of dietary recall. Daily nutrient intakes based on the consumption of usual pizza products for school lunch (pre-modeled) were compared with intakes modeled by substituting nutrient values from an HUSSC whole-grain pizza product (post-modeled). Paired t tests were used to make the comparison. Post-modeled intakes were lower in daily energy, carbohydrate, total fat, saturated fat, cholesterol, and sodium compared with pre-modeled intakes among children and adolescents (Ppizza product for usual pizza products may significantly improve dietary quality of children and adolescents eating pizza for school lunch, indicating that it could be an effective approach to improve the nutritional quality of school lunch programs.

  13. Nefritis tubulo intersticial asociada a parvovirus b19 Tubulointerstitial nephritis associated with parvovirus b19 infection

    Directory of Open Access Journals (Sweden)

    José A. Ramírez

    2005-08-01

    Full Text Available Paciente de 9 años, previamente sana, que ingresa en anasarca con síndrome nefrótico clínico y humoral, asociado a hipertensión arterial y microhematuria, con función renal normal y se comporta como corticorresistente. Se realiza 1° biopsia renal que informa glomerulonefritis proliferativa mesangial difusa con esclerosis focal y segmentaria. En tratamiento con ciclofosfamida y corticoides, presenta síndrome febril prolongado con anemia secundaria a crisis aplásica de la serie roja, asociada con una infección aguda por parvovirus B19, e insuficiencia renal aguda secundaria a nefritis tubulointersticial severa. La PCR para parvovirus B19 DNA fue positiva en tejido renal y médula ósea. La paciente evoluciona a insuficiencia renal crónica terminal. No se puede descartar que desde su inicio, el síndrome nefrótico estuviera asociado al daño glomerular por la infección viral, que comenzó como síndrome nefrótico con componentes nefríticos y que evoluciona inesperadamente a una nefritis tubulointersticial. Este sería el primer caso en el que se documenta como causa de insuficiencia renal crónica terminal, un daño tubulointersticial secundario a parvovirus B19.A previously healthy 9 year old girl developed nephrotic syndrome with hypertension, microhematuria and normal renal function. The patient evolved as steroid resistant nephrotic syndrome whose initial renal biopsy was consistent with diffuse proliferative mesangial glomerulonephritis with focal segmental glomerulosclerosis. At the time of cyclophosphamide and prednisone treatment, she developed a prolonged febrile syndrome. She also had severe anemia following an aplastic crisis induced by human parvovirus B19 infection and acute renal failure secondary to a severe tubulointersticial disease. Bone marrow and renal tissue, tested by polimerase chain reaction were positive for parvovirus, while the patient’s blood was negative. The renal involvement did not improve requiring chronic dialysis support. We believe that the initial glomerular disease could have been due to a parvovirus infection followed by un unexpected acute tubular interstitial nephritis, rapidly progressing to chronic renal disease. This case represents, to our knowledge, the first time that a direct relationship between parvovirus infection and acute tubulointerstitial disease has been demonstrated.

  14. [Combination of intersticial cystitis and adenomyosis in females suffering from chronic pelvic pain syndrome].

    Science.gov (United States)

    Neĭmark, A I; Shelkovnikova, N V

    2011-01-01

    General and endoscopic examinations of 25 patients aged 40-48 years with chronic pelvic pain syndrome (CPPS) revealed combination of two urogenital diseases: interstitial cystitis and adenomyosis of the second-third degree. The complex treatment including a course of lavomax immunocorrection relieved CPPS in 72% (18) patients, reduced the number of recurrences of chronic pelvic diseases in 16% (4) patients. The therapeutic complex proposed may serve an alternative to surgical treatment of adenomyosis of the second-third degree which is uncomplicated with posthemorrhagic iron-deficiency anemia, manifests with pain only and associated with interstitial cystitis.

  15. Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial

    Directory of Open Access Journals (Sweden)

    Duffy Sonia A

    2012-08-01

    Full Text Available Abstract Background The objectives of this smoking cessation study among hospitalized smokers are to: 1 determine provider and patient receptivity, barriers, and facilitators to implementing the nurse-administered, inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys; 2 compare the effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus usual care across hospitals, units, and patient characteristics using thirty-day point prevalence abstinence at thirty days and six months (primary outcome post-recruitment; and 3 determine the cost-effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention relative to usual care including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. Methods/Design This effectiveness study will be a quasi-experimental design of six Michigan community hospitals of which three will get the nurse-administered Tobacco Tactics intervention and three will provide their usual care. In both the intervention and usual care sites, research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at thirty days and six months post-recruitment. The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site. The Master Trainers, in turn, will teach the intervention to all staff nurses. Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination. Descriptive statistics will be used to summarize the results of surveys administered to nurses, nurses’ participation rates, smokers’ receipt of specific cessation services, and satisfaction with services. General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates, respectively, with

  16. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial.

    Science.gov (United States)

    Zipfel, Stephan; Wild, Beate; Groß, Gaby; Friederich, Hans-Christoph; Teufel, Martin; Schellberg, Dieter; Giel, Katrin E; de Zwaan, Martina; Dinkel, Andreas; Herpertz, Stephan; Burgmer, Markus; Löwe, Bernd; Tagay, Sefik; von Wietersheim, Jörn; Zeeck, Almut; Schade-Brittinger, Carmen; Schauenburg, Henning; Herzog, Wolfgang

    2014-01-11

    Psychotherapy is the treatment of choice for patients with anorexia nervosa, although evidence of efficacy is weak. The Anorexia Nervosa Treatment of OutPatients (ANTOP) study aimed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa--focal psychodynamic therapy and enhanced cognitive behaviour therapy--versus optimised treatment as usual. The ANTOP study is a multicentre, randomised controlled efficacy trial in adults with anorexia nervosa. We recruited patients from ten university hospitals in Germany. Participants were randomly allocated to 10 months of treatment with either focal psychodynamic therapy, enhanced cognitive behaviour therapy, or optimised treatment as usual (including outpatient psychotherapy and structured care from a family doctor). The primary outcome was weight gain, measured as increased body-mass index (BMI) at the end of treatment. A key secondary outcome was rate of recovery (based on a combination of weight gain and eating disorder-specific psychopathology). Analysis was by intention to treat. This trial is registered at http://isrctn.org, number ISRCTN72809357. Of 727 adults screened for inclusion, 242 underwent randomisation: 80 to focal psychodynamic therapy, 80 to enhanced cognitive behaviour therapy, and 82 to optimised treatment as usual. At the end of treatment, 54 patients (22%) were lost to follow-up, and at 12-month follow-up a total of 73 (30%) had dropped out. At the end of treatment, BMI had increased in all study groups (focal psychodynamic therapy 0·73 kg/m(2), enhanced cognitive behaviour therapy 0·93 kg/m(2), optimised treatment as usual 0·69 kg/m(2)); no differences were noted between groups (mean difference between focal psychodynamic therapy and enhanced cognitive behaviour therapy -0·45, 95% CI -0·96 to 0·07; focal psychodynamic therapy vs optimised treatment as usual -0·14, -0·68 to 0·39; enhanced cognitive behaviour therapy vs optimised treatment as usual -0·30

  17. Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding: long-term randomised pragmatic trial in primary care.

    Science.gov (United States)

    Kai, Joe; Middleton, Lee; Daniels, Jane; Pattison, Helen; Tryposkiadis, Konstantinos; Gupta, Janesh

    2016-12-01

    Heavy menstrual bleeding (HMB) is a common, chronic problem affecting women and health services. However, long-term evidence on treatment in primary care is lacking. To assess the effectiveness of commencing the levonorgestrel-releasing intrauterine system (LNG-IUS) or usual medical treatments for women presenting with HMB in general practice. A pragmatic, multicentre, parallel, open-label, long term, randomised controlled trial in 63 primary care practices across the English Midlands. In total, 571 women aged 25-50 years, with HMB were randomised to LNG-IUS or usual medical treatment (tranexamic/mefenamic acid, combined oestrogen-progestogen, or progesterone alone). The primary outcome was the patient reported Menorrhagia Multi-Attribute Scale (MMAS, measuring effect of HMB on practical difficulties, social life, psychological and physical health, and work and family life; scores from 0 to 100). Secondary outcomes included surgical intervention (endometrial ablation/hysterectomy), general quality of life, sexual activity, and safety. At 5 years post-randomisation, 424 (74%) women provided data. While the difference between LNG-IUS and usual treatment groups was not significant (3.9 points; 95% confidence interval = -0.6 to 8.3; P = 0.09), MMAS scores improved significantly in both groups from baseline (mean increase, 44.9 and 43.4 points, respectively; P<0.001 for both comparisons). Rates of surgical intervention were low in both groups (surgery-free survival was 80% and 77%; hazard ratio 0.90; 95% CI = 0.62 to 1.31; P = 0.6). There was no difference in generic quality of life, sexual activity scores, or serious adverse events. Large improvements in symptom relief across both groups show treatment for HMB can be successfully initiated with long-term benefit and with only modest need for surgery. © British Journal of General Practice 2016.

  18. Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II.

    Directory of Open Access Journals (Sweden)

    Annie LeBlanc

    Full Text Available Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown.Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01, improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively, had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001. Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer. There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07; medication adherence at 6 months was no different across arms.Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.clinical trials.gov NCT00949611.

  19. Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Beurskens Anna J

    2007-10-01

    Full Text Available Abstract Background Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation. A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain. This trial investigates whether mental practice can contribute to a quicker and/or better recovery of stroke in two Dutch nursing homes. The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual. In addition, we will investigate prognostic variables and feasibility (process evaluation. Methods A randomised, controlled, observer masked prospective trial will be conducted with adult stroke patients in the (subacute phase of stroke recovery. Over a six weeks intervention period the control group will receive multi professional therapy as usual. Patients in the experimental group will be instructed how to perform mental practice, and will receive care as usual in which mental practice is embedded in physical, occupation and speech therapy sessions. Outcome will be assessed at six weeks and six months. The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale. Secondary outcomes are: Motricity Index, Nine Hole Peg Test, Barthel Index, Timed up and Go, 10 metres walking test, Rivermead Mobility Index. A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility. All patients are asked to keep a log to determine unguided training intensity. Discussion Advantages and disadvantages of several aspects of the chosen design are discussed. Trial registration ISRCTN27582267

  20. Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding: long-term randomised pragmatic trial in primary care

    Science.gov (United States)

    Kai, Joe; Middleton, Lee; Daniels, Jane; Pattison, Helen; Tryposkiadis, Konstantinos; Gupta, Janesh

    2016-01-01

    Background Heavy menstrual bleeding (HMB) is a common, chronic problem affecting women and health services. However, long-term evidence on treatment in primary care is lacking. Aim To assess the effectiveness of commencing the levonorgestrel-releasing intrauterine system (LNG-IUS) or usual medical treatments for women presenting with HMB in general practice. Design and setting A pragmatic, multicentre, parallel, open-label, long term, randomised controlled trial in 63 primary care practices across the English Midlands. Method In total, 571 women aged 25–50 years, with HMB were randomised to LNG-IUS or usual medical treatment (tranexamic/mefenamic acid, combined oestrogen–progestogen, or progesterone alone). The primary outcome was the patient reported Menorrhagia Multi-Attribute Scale (MMAS, measuring effect of HMB on practical difficulties, social life, psychological and physical health, and work and family life; scores from 0 to 100). Secondary outcomes included surgical intervention (endometrial ablation/hysterectomy), general quality of life, sexual activity, and safety. Results At 5 years post-randomisation, 424 (74%) women provided data. While the difference between LNG-IUS and usual treatment groups was not significant (3.9 points; 95% confidence interval = −0.6 to 8.3; P = 0.09), MMAS scores improved significantly in both groups from baseline (mean increase, 44.9 and 43.4 points, respectively; P<0.001 for both comparisons). Rates of surgical intervention were low in both groups (surgery-free survival was 80% and 77%; hazard ratio 0.90; 95% CI = 0.62 to 1.31; P = 0.6). There was no difference in generic quality of life, sexual activity scores, or serious adverse events. Conclusion Large improvements in symptom relief across both groups show treatment for HMB can be successfully initiated with long-term benefit and with only modest need for surgery. PMID:27884916

  1. Efficacy of an adjunctive brief psychodynamic psychotherapy to usual inpatient treatment of depression: rationale and design of a randomized controlled trial

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    Ambresin Gilles

    2012-10-01

    Full Text Available Abstract Background A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. Methods/Design The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions. Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention–to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. Discussion Despite the large number of studies

  2. Clinical effectiveness of usual care with or without antidepressant medication for primary care patients with minor or mild-major depression: a randomized equivalence trial

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    van Dyck Richard

    2007-12-01

    Full Text Available Abstract Background Minor and mild-major depression are highly prevalent in primary care. There is insufficient evidence for the effectiveness of antidepressants in the treatment of minor and mild-major depression. We compared the effectiveness of usual primary care treatment, with or without antidepressants, in minor and mild-major depression. Methods A pragmatic patient-randomized equivalence trial with 52 weeks follow-up was conducted in The Netherlands. In total, 59 primary care physicians (PCPs recruited and treated 181 adult patients with minor or mild-major depression. Patients were randomized to four consultations within 3 months of usual care plus antidepressants (UCandAD or usual care alone (UCnoAD. The Montgomery Åsberg Depression Rating Scale (MADRS was used to assess changes in severity of depressive symptoms. The predefined equivalence margin was set at five points. Multilevel analysis was used to analyze the data. Secondary outcome measures were the Short-Form 36 (SF-36, and the Client Satisfaction Questionnaire (CSQ-8. Results Patients received on average 3.0 (SD 1.4 15-min consultations within 3 months with (n = 85 or without paroxetine (n = 96. Equivalence of UCandAD and UCnoAD was demonstrated in the intention-to-treat analyses as well as the per-protocol analysis after 6 weeks, but not at 13, 26 and 52 weeks follow-up. No statistical differences in effectiveness between treatment groups were found in the intention-to-treat analysis. No differences in the physical and mental functioning (SF-36 were found between the treatment groups. Patients allocated to UCandAD were slightly more satisfied with their treatment at 13 weeks follow-up (but not at 52 weeks follow-up than patients allocated to UCnoAD. Preliminary analyses suggested that subgroups such as patients with mild-major (instead of a minor depression might benefit from antidepressant treatment. Patients who were assigned to their preferred treatment (in particular to

  3. The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial

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    IJzelenberg Wilhelmina

    2012-09-01

    Full Text Available Abstract Background The additional benefit of lifestyle interventions in patients receiving cardioprotective drug treatment to improve cardiovascular risk profile is not fully established. The objective was to evaluate the effectiveness of a target-driven multidisciplinary structured lifestyle intervention programme of 6 months duration aimed at maximum reduction of cardiovascular risk factors in patients with cardiovascular disease (CVD compared with usual care. Methods A single centre, two arm, parallel group randomised controlled trial was performed. Patients with stable established CVD and at least one lifestyle-related risk factor were recruited from the vascular and cardiology outpatient departments of the university hospital. Blocked randomisation was used to allocate patients to the intervention (n = 71 or control group (n = 75 using an on-site computer system combined with allocations in computer-generated tables of random numbers kept in a locked computer file. The intervention group received the comprehensive lifestyle intervention offered in a specialised outpatient clinic in addition to usual care. The control group continued to receive usual care. Outcome measures were the lifestyle-related cardiovascular risk factors: smoking, physical activity, physical fitness, diet, blood pressure, plasma total/HDL/LDL cholesterol concentrations, BMI, waist circumference, and changes in medication. Results The intervention led to increased physical activity/fitness levels and an improved cardiovascular risk factor profile (reduced BMI and waist circumference. In this setting, cardiovascular risk management for blood pressure and lipid levels by prophylactic treatment for CVD in usual care was already close to optimal as reflected in baseline levels. There was no significant improvement in any other risk factor. Conclusions Even in CVD patients receiving good clinical care and using cardioprotective drug treatment, a comprehensive

  4. Comparison on aerobic stability between silage and usual TMRs%普通与发酵全混合日粮的好气安定性比较

    Institute of Scientific and Technical Information of China (English)

    王福金; 西野直树; 王靖宇

    2011-01-01

    This experiment was designed to investigate advantages of aerobic stability between usual TMR and TMR silages. Four TMR were prepared with 3, 4, 5 and 6 ingredients in experiment 1 , and two TMR were prepared with 50% brewers grains or soybean curd residue in experiment 2 and four ensiling materials were prepared with brewers grains and soybean curd residue alone or in comhination with other feeds as TMR in experiment 3. The aerobic stabilities were compared between usual TMR ( stored for 0 day) and TMR silage ( stored for 14 or 56 days). The results indicated that the aerobic stability of TMR silage was higher than that of usual TMR, and the aerobic stabilities of TMR silages with ensiled for long ( stored for 56 days) were higher than that for short ( stored for 14 days) . The finding of our experiment suggested that the aerobic stability of TMR silages were better than usual TMR. In particular, the TMR silages were not easy to deteriorate above ensiled 56 days after exposure to air. This expcnment provided a basis for solving TMR deterioration prohlems in the production.%本试验旨在比较普通与发酵全混合日粮(TMR)的好气安定性的优劣.选用3~6种不同材料与啤酒糟调制成的4种TMR、含50%的啤酒糟和豆腐渣与其他材料调制的2种TMR、啤酒糟和豆腐渣的单独贮存及与其他材料调制的TMR等进行了3个试验,对普通TMR(贮存0 d)与发酵TMR(贮存14和56 d)的好气安定性进行了比较.结果显示:发酵TMR的好气安定性高于普通TMR,而且贮存时间长(56 d)的发酵TMR的好气安定性高于贮存时间短(14 d)的发酵TMR.提示发酵TMR的好气安定性较好,尤其发酵56 d以上的发酵TMR,开封后不易变坏,为实际生产中解决TMR变败问题提供了依据.

  5. A sensitivity analysis of the Children's Treatment Network trial: a randomized controlled trial of integrated services versus usual care for children with special health care needs

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    Ye C

    2013-09-01

    Full Text Available Chenglin Ye,1,2 Gina Browne,1,3 Joseph Beyene,1 Lehana Thabane1,2 1Department of Clinical Epidemiology and Biostatistics, McMaster University, 2Biostatistcs Unit, St Joseph's Healthcare Hamilton, 3School of Nursing, McMaster University, Hamilton, ON, Canada Background: The value of integrated care through comprehensive, coordinated, and family-centered services has been increasingly recognized for improving health outcomes of children with special health care needs (CSHCN. In a randomized controlled trial (RCT, the integrated care provided through the Children's Treatment Network (CTN was compared with usual care in improving the psychosocial health of target CSHCN. In this paper, we aimed to estimate the effect of CTN care by conducting multiple analyses to handle noncompliance in the trial. Methods: The trial recruited target children in Simcoe County and York Region, ON, Canada. Children were randomized to receive CTN or usual care and were followed for 2 years. The CTN group received integrated services through multiple providers to address their specific needs while the usual care group continued to receive care directed by their parents. The outcome was change in psychosocial quality of life at 2 years. We conducted intention-to-treat, as-treated, per-protocol, and instrumental variable analyses to analyze the outcome. Results: The trial randomized 445 children, with 229 in the intervention group and 216 in the control group. During follow-up, 52% of children in the intervention group did not receive complete CTN care for various reasons. At 2 years, we did not find a significant improvement in psychosocial quality of life among the children receiving CTN care compared with usual care (intention-to-treat mean difference 1.50, 95% confidence interval −1.49 to 4.50; P = 0.32. Other methods of analysis yielded similar results. Conclusion: Although the effect of CTN care was not significant, there was evidence showing benefits of integrated

  6. Number of days required for assessing usual nutrient and antioxidant intakes in a sample from a U.S. healthy college population.

    Science.gov (United States)

    Ouellette, Catherine D; Yang, Meng; Wang, Ying; Vance, Terrence; Fernandez, Maria Luz; Rodriguez, Nancy; Chun, Ock K

    2014-01-01

    The primary aim of this study was to determine the number of days required to assess usual antioxidant intake with a defined level of accuracy in a sample of healthy college students. The secondary aim of this study was to increase the validity of the calculation of days by first determining the prevalence of misreporting energy intake in 30-d food records (FRs). We examined the percentage of misreporting, the within- and between-person variations of nutrient intake, and the minimum days required to estimate a person's true intake with a correlation coefficient r ≥ 0.9. Sixty students from the University of Connecticut completed a 30-d FR, which was analyzed using the Nutrition Data System for Research software combined with Flavonoid and Proanthocyanidin Provisional Table. Twenty-seven percent (44 average reporters) included in the dietary analysis misreported after applying the Goldberg cutoff equation. The within-person variation was greater than the between-person variation with the variance ratios ranging from 1.10 to 10.51. After adjusting for energy and sex, a 7-d FR was adequate to achieve r ≥ 0.9 for fat, carbohydrate, protein, lycopene, and proanthocyanidin, whereas α-tocopherol, total carotenoids, and flavonoids required 8 d. The remaining antioxidants required between 10 and 45 d. Overall, micronutrients and antioxidants had a greater daily variation than macronutrients and the majority required more than 7 d to assess usual intakes for this population. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. La «historia de vida» periodística, un género poco usual en la prensa española

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    Dr. Antonio López Hidalgo

    2002-01-01

    Full Text Available En los últimos años, el periodismo ha recurrido con asiduidad a los géneros periodísticos biográficos. Lo ha hecho no sólo el periodismo escrito, sino también el periodismo radiofónico y el televisivo. Los manuales sobre géneros periodísticos, sin embargo, le han dedicado hasta el momento muy poca atención. Uno de estos géneros es la historia de vida periodística, poco usual en la prensa española, aunque cada día más presente en los suplementos dominicales de los diarios nacionales.ABSTRACTIn the last years the media has resorted frequently to the biographic journalistic genres. This has been done not only by the written media, also the radiofonic and Tv. The manuals about media genres, nevertheless, have dedicated until the moment very little attention to him. One of these kinds is the history of the journalist life, not usual in the Spanish press, although is present every day more in sunday supplements of national newspapers.

  8. Future climate trends from a first-difference atmospheric carbon dioxide regression model involving emissions scenarios for business as usual and for peak fossil fuel

    CERN Document Server

    Leggett, L M W

    2014-01-01

    This paper investigates the implications of the future continuation of the demonstrated past (1960-2012) strong correlation between first-difference atmospheric CO2 and global surface temperature. It does this, for the period from the present to 2050, for a comprehensive range of future global fossil fuel energy use scenarios. The results show that even for a business-as-usual (the mid-level IPCC) fossil fuel use estimate, global surface temperature will rise at a slower rate than for the recent period 1960-2000. Concerning peak fossil fuel, for the most common scenario the currently observed (1998-2013)temperature plateau will turn into a decrease. The observed trend to date for temperature is compared with that for global climate disasters: these peaked in 2005 and are notably decreasing. The temperature and disaster results taken together are consistent with either a reduced business-as-usual fossil fuel use scenario into the future, or a peak fossil fuel scenario, but not with the standard business-as-usu...

  9. A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial).

    Science.gov (United States)

    McLean, Sionnadh M; Klaber Moffett, Jennifer A; Sharp, Donald M; Gardiner, Eric

    2013-06-01

    Evidence supports exercise-based interventions for the management of neck pain, however there is little evidence of its superiority over usual physiotherapy. This study investigated the effectiveness of a group neck and upper limb exercise programme (GET) compared with usual physiotherapy (UP) for patients with non-specific neck pain. A total of 151 adult patients were randomised to either GET or UP. The primary measure was the Northwick Park Neck pain Questionnaire (NPQ) score at six weeks, six months and 12 months. Mixed modelling identified no difference in neck pain and function between patients receiving GET and those receiving UP at any follow-up time point. Both interventions resulted in modest significant and clinically important improvements on the NPQ score with a change score of around 9% between baseline and 12 months. Both GET and UP are appropriate clinical interventions for patients with non-specific neck pain, however preferences for treatment and targeted strategies to address barriers to adherence may need to be considered in order to maximise the effectiveness of these approaches.

  10. A comparison of usual care, a patient-centred education intervention and motivational interviewing to improve medication adherence and readmissions of adults in an acute-care setting.

    Science.gov (United States)

    Hyrkas, Kristiina; Wiggins, Marjorie

    2014-04-01

    To compare medication adherence and readmissions in patients who received usual care vs. patient-centred interventions. Medication adherence is a complex behaviour that may be improved with patient-centred strategies. A non-concurrent convenience sample of 303 hospitalised patients received either usual care (n = 98) or patient-centred interventions (n = 205). Intervention patients received teach-back and medication tools (n = 137) or motivational interviewing (n = 68). Data were collected at discharge (T1), at 48-72 hours (T2) and 30 days after discharge (T3). No significant differences were found in medication adherence, therapeutic alliance, patients' experience and readmissions between groups. Patients in the motivational interview group reported lower confidence with medication adherence at T1 (P = 0.01) and T2 (P = 0.00) than the patient-centred intervention group. Motivational interviewing was a significant predictor (β = -1.55, P = 0.01, OR 0.21, 95% CI 0.06, 0.72) of fewer readmissions. Overall, patients reported very low levels of non-adherence and very high levels of confidence and importance of medication adherence. Medication adherence continues to be an important area for clinical inquiry. For those patients who lack confidence for medication adherence, comprehensive patient-centred strategies such as motivational interviewing may improve treatment outcomes. © 2014 John Wiley & Sons Ltd.

  11. Centrifugal forces within usually-used magnitude elicited a transitory and reversible change in proliferation and gene expression of osteoblastic cells UMR-106.

    Science.gov (United States)

    Li, Juan; Jiang, Lingyong; Liao, Ga; Chen, Guoping; Liu, Ying; Wang, Jun; Zheng, Yi; Luo, Songjiao; Zhao, Zhihe

    2009-02-01

    Centrifugation is an important step in biochemical and molecular biological researches. But the effects of centrifugal stress on cells are still unclear. In this study, osteoblastic cells UMR-106 were subjected to a moderate centrifugal stress at 209 x g for 10 min. Then the cell proliferation and gene transcription after centrifugation were analyzed with flow cytometry and Real-time RT-PCR techniques, respectively. The result showed that the cell proliferation and mRNA expression of Runx2/Cbfa1, Collagen I and osteocalcin changed shortly after centrifugal loading, but recovered to pre-load levels within 24 h. A dose-response study of exposure cells to centrifugal force at 209, 253 and 301 x g showed that the centrifugal forces within usually-used range can rapidly influenced the mRNA expression of the osteoblast-specific genes, but no statistical differences were found among the three centrifugal magnitudes. And the fast regulation in the investigated genes was proved to be related to increased c-fos mRNA levels and subsequent activation of RTK and integrity of cytoskeleton construction. The result showed that the osteoblastic cells displayed a fast auto-regulation to usually-used centrifugal stress through multiple signal pathways.

  12. Food intake during the previous 24 h as a percentage of usual intake: a marker of hypoxia in infants with bronchiolitis: an observational, prospective, multicenter study

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    Corrard François

    2013-01-01

    Full Text Available Abstract Background Hypoxia associated with bronchiolitis is not always easy to assess on clinical grounds alone. The aim of this study was to determine the value of food intake during the previous 24 hours (bottle and spoon feeding, as a percentage of usual intake (24h FI, as a marker of hypoxia, and to compare its diagnostic value with that of usual clinical signs. Methods In this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants, aged from 0 to 6 months, with bronchiolitis (rhinorrhea + dyspnea + cough + expiratory sounds. Infants with risk factors (history of prematurity, chronic heart or lung disorders, breast-fed infants, and infants having previously been treated for bronchial disorders were excluded. The 24h FI, subcostal, intercostal, supracostal retractions, nasal flaring, respiratory rate, pauses, cyanosis, rectal temperature and respiratory syncytial virus test results were noted. The highest stable value of transcutaneous oxygen saturation (SpO2 was recorded. Hypoxia was noted if SpO2 was below 95% and verified. Results 24h FI ≥ 50% was associated with a 96% likelihood of SpO2 ≥ 95% [95% CI, 91–99]. In univariate analysis, 24h FI  Conclusion In practice, the measure of 24 h FI may be useful in identifying hypoxia and deserves further study.

  13. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3: a randomised trial to determine the efficacy of adding a complex intervention for major depressive disorder (Depression Care for People with Lung Cancer to usual care, compared to usual care alone in patients with lung cancer

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    Sharpe Michael

    2009-09-01

    Full Text Available Abstract Background Depression Care for People with Lung Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3 Trial will test its efficacy when compared to usual care alone. Design A two arm parallel group multi-centre randomised controlled trial. 200 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of lung cancer; an estimated life expectancy of three months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Lung Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is average depression severity. This will be assessed using scores on the 20-item Symptom Hopkins Checklist (SCL-20D, collected every four weeks over 32 weeks. Secondary outcomes include severity of anxiety, pain and fatigue; self-rated improvement of depression; quality of life and satisfaction with depression care. Trial Registration Current controlled trials ISRCTN75905964

  14. Outcome predictors in autism spectrum disorders preschoolers undergoing treatment as usual: insights from an observational study using artificial neural networks

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    Narzisi A

    2015-06-01

    Full Text Available Antonio Narzisi,1 Filippo Muratori,1,2 Massimo Buscema,3,4 Sara Calderoni,1 Enzo Grossi3,5 1Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 2Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 3Semeion Research Centre of Sciences of Communication, Rome, Italy; 4Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, USA; 5Autism Research Unit, Villa Santa Maria Institute, Tavernerio, Italy Background: Treatment as usual (TAU for autism spectrum disorders (ASDs includes eclectic treatments usually available in the community and school inclusion with an individual support teacher. Artificial neural networks (ANNs have never been used to study the effects of treatment in ASDs. The Auto Contractive Map (Auto-CM is a kind of ANN able to discover trends and associations among variables creating a semantic connectivity map. The matrix of connections, visualized through a minimum spanning tree filter, takes into account nonlinear associations among variables and captures connection schemes among clusters. Our aim is to use Auto-CM to recognize variables to discriminate between responders versus no responders at TAU.Methods: A total of 56 preschoolers with ASDs were recruited at different sites in Italy. They were evaluated at T0 and after 6 months of treatment (T1. The children were referred to community providers for usual treatments. Results: At T1, the severity of autism measured through the Autism Diagnostic Observation Schedule decreased in 62% of involved children (Response, whereas it was the same or worse in 37% of the children (No Response. The application of the Semeion ANNs overcomes the 85% of global accuracy (Sine Net almost reaching 90%. Consequently, some of the tested algorithms were able to find a good correlation between some variables and TAU outcome. The semantic connectivity map obtained with the application of the Auto-CM system showed

  15. Does treatment of subsyndromal depression improve depression and diabetes related outcomes: protocol for a randomised controlled comparison of psycho-education, physical exercise and treatment as usual

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    Lovrenčić Marijana

    2011-01-01

    Full Text Available Abstract Background The prevalence of mood difficulties in persons with diabetes is approximately twice that in the general population, affecting the health outcomes and patients' quality of life in an undesirable way. Although subsyndromal depression is an important predictor of a more serious clinical depression, it is often overlooked. This study aims to compare the effects of two non-pharmacological interventions for subsyndromal depression, psychoeducation and physical exercise, with diabetes treatment as usual on mood- and diabetes-related outcomes. Methods and Design Type 2 diabetic patients aged 18-65 yrs. who report mood difficulties and the related need for help in a mail survey will be potential participants. After giving informed consent, they will be randomly assigned to one of the three groups (psychoeducation, physical activity, treatment as usual. Depressive symptoms, diabetes distress, health-related quality of life and diabetes self-care activities will be assessed at baseline, at 6 weeks, 6 months and 12 months. A structured clinical interview for DSM-IV Axis I Disorders (SCID-I will be performed at baseline and at one-year follow-up in order to determine the clinical significance of the patients' depressive symptoms. Disease-related data will be collected from patients' files and from additional physical examinations and laboratory tests. The two interventions will be comparable in terms of format (small group work, duration (six sessions and approach (interactive learning; supporting the participants' active roles. The group treated as usual will be informed about their screening results and about the importance of treating depression. They will be provided with brief re-education on diabetes and written self-help instructions to cope with mood difficulties. Primary outcomes will be depressive symptoms. Secondary outcomes will be glycaemic control, diabetes-related distress, self-management of diabetes and health

  16. Patient directed self management of pain (PaDSMaP compared to treatment as usual following total knee replacement: study protocol for a randomized controlled trial

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    Donell Simon

    2012-11-01

    Full Text Available Abstract Background In 2009, 665 patients underwent total knee replacements (TKRs at the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH, representing nearly 1% of the national total. Pain control following the operation can be poor, and this can cause poor mobilization and potential long-term adverse events. Although high levels of pain are not associated with patient dissatisfaction, brief periods of pain may lead to neuronal remodeling and sensitization. Patient controlled oral analgesia (PCOA may improve pain relief; however, the evidence to date has been inconclusive. Patient directed self management of pain (PaDSMaP is a single center randomized controlled trial, which aims to establish if patient self-medication improves, or is equivalent to, treatment as usual and to create an educational package to allow implementation elsewhere. Methods/design Patients eligible for a TKR will be recruited and randomized in the outpatient clinic. All patients will undergo their operations according to normal clinical practice but will be randomized into two groups. Once oral medication has commenced, one group will have pain relief administered by nursing staff in the usual way (treatment as usual; TAU, whilst the second group will self manage their pain medication (patient directed self management of pain; PaDSMaP. Those recruited for self-medication will undergo a training program to teach the use of oral analgesics according to the World Health Organization (WHO pain cascade and how to complete the study documentation. The primary endpoint of the trial is the visual analogue scale (VAS pain score at 3 days or discharge, whichever is sooner. The follow-up time is 6 weeks with a planned trial period of 3 years. The secondary objectives are satisfaction with the management of patient pain post-operatively whilst an inpatient after primary TKR; overall pain levels and pain on mobilization; satisfaction with pain management information

  17. Effect of nurse home visits vs. usual care on reducing intimate partner violence in young high-risk pregnant women: a randomized controlled trial.

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    Jamila Mejdoubi

    Full Text Available BACKGROUND: Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV. The nurse-family partnership (NFP is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect of nurse home visiting on IPV is inconsistent. This study aims to study the effect of VoorZorg, the Dutch NFP, on IPV. METHODS: A random sample of 460 eligible disadvantaged women <26 years, with no previous live births, was randomized. Women in the control group (C; n=223 received usual care; women in the intervention group (I; n=237 received usual care plus nurse home visits periodically during pregnancy and until the child's second birthday. RESULTS: At 32 weeks of pregnancy, women in the intervention group self-reported significantly less IPV victimization than women in the control group in: level 2 psychological aggression (C: 56% vs. I: 39%, physical assault level 1 (C: 58% vs. I: 40% and level 2 (C: 31% vs. I: 20%, and level 1 sexual coercion (C: 16% vs. I: 8%. Furthermore, women in the intervention group reported significantly less IPV perpetration in: level 2 psychological aggression (C: 60% vs. I: 46%, level 1 physical assault (C: 65% vs. I: 52%, and level 1 injury (C: 27% vs. I: 17%. At 24 months after birth, IPV victimization was significantly lower in the intervention group for level 1 physical assault (C: 44% vs. I: 26%, and IPV perpetration was significantly lower for level 1 sexual assault (C: 18% vs. I: 3%. Multilevel analyses showed a significant improvement in IPV victimization and perpetration among women in the intervention group at 24 months after birth. CONCLUSION: VoorZorg, compared with the usual care, is effective in reducing IPV during pregnancy and in the two years after birth among young high-risk women. TRIAL REGISTRATION: Dutch Trial Register NTR854 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=854.

  18. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial.

    Science.gov (United States)

    van der Meij, Eva; Huirne, Judith Af; Bouwsma, Esther Va; van Dongen, Johanna M; Terwee, Caroline B; van de Ven, Peter M; den Bakker, Chantal M; van der Meij, Suzan; van Baal, W Marchien; Leclercq, Wouter Kg; Geomini, Peggy Maj; Consten, Esther Cj; Schraffordt Koops, Steven E; van Kesteren, Paul Jm; Stockmann, Hein Bac; Ten Cate, A Dorien; Davids, Paul Hp; Scholten, Petrus C; van den Heuvel, Baukje; Schaafsma, Frederieke G; Meijerink, Wilhelmus Jhj; Bonjer, H Jaap; Anema, Johannes R

    2016-12-21

    Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social participation, self-rated health

  19. Regional assessment of urban impacts on landcover and open space finds a smart urban growth policy performs little better than business as usual.

    Science.gov (United States)

    Thorne, James H; Santos, Maria J; Bjorkman, Jacquelyn H

    2013-01-01

    Assessment of landscape change is critical for attainment of regional sustainability goals. Urban growth assessments are needed because over half the global population now lives in cities, which impact biodiversity, ecosystem structure and ecological processes. Open space protection is needed to preserve these attributes, and provide the resources humans need. The San Francisco Bay Area, California, is challenged to accommodate a population increase of 3.07 million while maintaining the region's ecosystems and biodiversity. Our analysis of 9275 km² in the Bay Area links historic trends for three measures: urban growth, protected open space, and landcover types over the last 70 years to future 2050 projections of urban growth and open space. Protected open space totaled 348 km² (3.7% of the area) in 1940, and expanded to 2221 km² (20.2%) currently. An additional 1038 km² of protected open space is targeted (35.1%). Urban area historically increased from 396.5 km² to 2239 km² (24.1% of the area). Urban growth during this time mostly occurred at the expense of agricultural landscapes (62.9%) rather than natural vegetation. Smart Growth development has been advanced as a preferred alternative in many planning circles, but we found that it conserved only marginally more open space than Business-as-usual when using an urban growth model to portray policies for future urban growth. Scenarios to 2050 suggest urban development on non-urban lands of 1091, 956, or 179 km², under Business-as-usual, Smart Growth and Infill policy growth scenarios, respectively. The Smart Growth policy converts 88% of natural lands and agriculture used by Business-as-usual, while Infill used only 40% of those lands. Given the historic rate of urban growth, 0.25%/year, and limited space available, the Infill scenario is recommended. While the data may differ, the use of an historic and future framework to track these three variables can be easily applied to other metropolitan areas.

  20. Regional assessment of urban impacts on landcover and open space finds a smart urban growth policy performs little better than business as usual.

    Directory of Open Access Journals (Sweden)

    James H Thorne

    Full Text Available Assessment of landscape change is critical for attainment of regional sustainability goals. Urban growth assessments are needed because over half the global population now lives in cities, which impact biodiversity, ecosystem structure and ecological processes. Open space protection is needed to preserve these attributes, and provide the resources humans need. The San Francisco Bay Area, California, is challenged to accommodate a population increase of 3.07 million while maintaining the region's ecosystems and biodiversity. Our analysis of 9275 km² in the Bay Area links historic trends for three measures: urban growth, protected open space, and landcover types over the last 70 years to future 2050 projections of urban growth and open space. Protected open space totaled 348 km² (3.7% of the area in 1940, and expanded to 2221 km² (20.2% currently. An additional 1038 km² of protected open space is targeted (35.1%. Urban area historically increased from 396.5 km² to 2239 km² (24.1% of the area. Urban growth during this time mostly occurred at the expense of agricultural landscapes (62.9% rather than natural vegetation. Smart Growth development has been advanced as a preferred alternative in many planning circles, but we found that it conserved only marginally more open space than Business-as-usual when using an urban growth model to portray policies for future urban growth. Scenarios to 2050 suggest urban development on non-urban lands of 1091, 956, or 179 km², under Business-as-usual, Smart Growth and Infill policy growth scenarios, respectively. The Smart Growth policy converts 88% of natural lands and agriculture used by Business-as-usual, while Infill used only 40% of those lands. Given the historic rate of urban growth, 0.25%/year, and limited space available, the Infill scenario is recommended. While the data may differ, the use of an historic and future framework to track these three variables can be easily applied to other

  1. Modificacion de conductas de riesgo biologico y profesional para la neumonia nosocomial en las unidades de cuidados intensivos

    Directory of Open Access Journals (Sweden)

    Rhina Maria Ramos Mejía

    2013-12-01

    Full Text Available Uno de los problemas que actualmente se está presentando en el ámbito hospitalario, especialmente en las Unidades de Cuidados Intensivos (UCI es la neumonía nosocomial, entendida como una infección aguda del tracto respiratorio bajo, que aparece en los enfermos que ingresan al hospital. Una de las causas de estas infecciones es atribuida a conductas inadecuadas que realiza el personal de salud al atender pacientes infectados sin los elementos adecuados. Estudios epidemiológicos realizados en las UCI indican que uno de los principales mecanismos de transmisión de los agentes patógenos es el contacto, ya sea a través de las manos o de gotitas que se forman en el aire al comunicarse, por estornudo o por la tos; otro mecanismo es a través del aire, el cual tiene especial importancia en la contaminación de elementos y aparatos de uso exclusivo para pacientes. En los programas de prevención de infecciones nosocomiales se hace necesaria la intervención del psicólogo especializado en salud, cuyo objetivo primordial es la promoción de conductas tendientes a disminuir el riesgo de infección intrahospitalaria, por medio de la modificación comportamental de los profesionales de la salud y del paciente mismo. 

  2. Neumonia adquirida en la comunidad en dos poblaciones hospitalarias Community-acquired pneumonia in patients from two different hospitals

    Directory of Open Access Journals (Sweden)

    O. J. Caberlotto

    2003-01-01

    Full Text Available Se estudiaron en forma prospectiva pacientes con diagnóstico de neumonía adquirida en la comunidad que acudieron a la consulta en un hospital general y en un centro especializado en medicina respiratoria ubicados en la provincia de Buenos Aires, y que requirieron internación. Se evaluaron la distribución por sexo y edad, las comorbilidades asociadas, los agentes etiológicos, su incidencia y la mortalidad. Se incluyeron 52 pacientes (marzo 1998-febrero 1999 del Hospital General de Agudos Manuel Belgrano (HMB y 23 pacientes (junio 2000-mayo 2001 del Hospital del Tórax Dr. Antonio A. Cetrángolo (HCET. Se excluyeron pacientes con tuberculosis o micosis pulmonar, neoplasia de pulmón y diagnóstico serológico para HIV. Se completó una historia clínica y se realizaron estudios microbiológicos para gérmenes comunes, virus respiratorios y micobacterias. Para el estudio de los agentes productores de neumonías atípicas (Chlamydia spp, Coxiella burnetii, Mycoplasma pneumoniae y Legionella spp. y como complemento del estudio virológico, se utilizaron pruebas serológicas. No se observaron diferencias por sexo y edad en los dos grupos. En el HMB las comorbilidades más frecuentes fueron EPOC, diabetes e insuficiencia cardíaca, en tanto que en el HCET fueron EPOC, asma y fibrosis pulmonar. Se obtuvo un diagnóstico microbiológico en el 48% y 65.2% de los pacientes para ambos grupos. Los agentes hallados más frecuentemente fueron Mycoplasma pneumoniae, Streptococcus pneumoniae, influenza A y Legionella spp, este último germen con una incidencia del 12% en pacientes que evolucionaron favorablemente y que en su mayoría pertenecían al HMB. La mortalidad fue similar para ambos grupos (13.3%. En el HMB estuvo relacionada con la existencia de comorbilidades en 7 de 8 casos y en el HCET con el agravamiento de la insuficiencia respiratoria crónica.Patients hospitalized with community acquired pneumonia were studied prospectively in two hospitals located in the surroundings of Buenos Aires city. Fifty two patients from General Hospital Manuel Belgrano (HMB were included from March 1998 to February 1999 and 23 patients from Hospital Dr A. Cetrangolo (HCET for respiratory disease, were included from June 2000 to May 2001. Patients with lung tuberculosis, lung neoplasia and HIV infection were excluded. Clinical background, signs and symptoms were recorded. Microbiological examinations performed included bacteria, respiratory viruses and mycobacteria. Studies for «atypical» bacteria (Chlamydia spp., Coxiella burnetii, Mycoplasma pneumoniae and Legionella spp. were carried out by serological methods. No differences in age and gender were observed between both groups. Most frequently observed comorbidities in the HMB group included COPD, diabetes and cardiac failure while in the HCET group these were COPD, asthma and lung fibrosis. Etiology was established in 48% and 65.2% of the patients in the first and second group, respectively. Most frequent agents were Mycoplasma pneumoniae, Streptococcus pneumoniae, influenza A and Legionella spp.; the last one was detected in 12% of the patients. Most of these patients were from HMB and presented a good outcome. Mortality was similar in both groups (13.3%. In the HMB group it was related to the presence of comorbidities in 7 out of 8 cases, and in the HCET group it was a consequence of the worsening of their chronic respiratory failure.

  3. Modificacion de conductas de riesgo biologico y profesional para la neumonia nosocomial en las unidades de cuidados intensivos

    OpenAIRE

    Rhina Maria Ramos Mejía; Dary Luz Mendoza Meza

    2013-01-01

    Uno de los problemas que actualmente se está presentando en el ámbito hospitalario, especialmente en las Unidades de Cuidados Intensivos (UCI) es la neumonía nosocomial, entendida como una infección aguda del tracto respiratorio bajo, que aparece en los enfermos que ingresan al hospital. Una de las causas de estas infecciones es atribuida a conductas inadecuadas que realiza el personal de salud al atender pacientes infectados sin los elementos adecuados. Estudios epidemiológicos realizados en...

  4. The ExStroke Pilot Trial: rationale, design, and baseline data of a randomized multicenter trial comparing physical training versus usual care after an ischemic stroke

    DEFF Research Database (Denmark)

    Krarup, L.H.; Gluud, C.; Truelsen, T.

    2008-01-01

    : Patients with ischemic stroke above 39 years were randomized to intervention or control group. The intervention group will, over a 2-year period, receive information on and verbal instruction to exercise by a physiotherapist or a physician. The control group will receive the department's usual care......INTRODUCTION: A high level of physical activity is associated with a decreased risk of first stroke and physical activity modifies recognized stroke risk factors and is recommended for stroke survivors. Available research shows that stroke patients can increase their level of physical performance...... over a short period. When the intervention period is over, physical performance often declines towards baseline level. Currently, there is no evidence on the association between physical activity and the risk of recurrent stroke. The ExStroke Pilot Trial is a randomized clinical trial with the aim...

  5. A d-statistic for single-case designs that is equivalent to the usual between-groups d-statistic.

    Science.gov (United States)

    Shadish, William R; Hedges, Larry V; Pustejovsky, James E; Boyajian, Jonathan G; Sullivan, Kristynn J; Andrade, Alma; Barrientos, Jeannette L

    2014-01-01

    We describe a standardised mean difference statistic (d) for single-case designs that is equivalent to the usual d in between-groups experiments. We show how it can be used to summarise treatment effects over cases within a study, to do power analyses in planning new studies and grant proposals, and to meta-analyse effects across studies of the same question. We discuss limitations of this d-statistic, and possible remedies to them. Even so, this d-statistic is better founded statistically than other effect size measures for single-case design, and unlike many general linear model approaches such as multilevel modelling or generalised additive models, it produces a standardised effect size that can be integrated over studies with different outcome measures. SPSS macros for both effect size computation and power analysis are available.

  6. The "Business-As-Usual" growth of global primary energy use and carbon dioxide emissions - historical trends and near-term forecasts

    Science.gov (United States)

    Jarvis, A.; Hewitt, C. N.

    2014-09-01

    We analyse the global primary energy use and total CO2 emissions time series since 1850 and show that their relative growth rates appear to exhibit periodicity with a fundamental timescale of ~60 years and with significant harmonic behaviour. Quantifying the inertia inherent in these dynamics allows forecasting of future "business as usual" energy needs and their associated CO2 emissions. Our best estimates for 2020 are 800 EJ yr-1 for global energy use and 14 Gt yr-1 for global CO2 emissions, with both being above almost all other published forecasts. This suggests the energy and total CO2 emissions landscape in 2020 may be significantly more challenging than currently envisaged.

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

    LENUS (Irish Health Repository)

    Flynn, Daniel

    2017-01-01

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

  8. Learning psychology as a challenging process towards development as well as "studies as usual": a thematic analysis of medical students' reflective writing.

    Science.gov (United States)

    Semb, Olof; Kaiser, Niclas; Andersson, Sven-Olof; Sundbom, Elisabet

    2014-01-01

    Reflective writing in medical training has been shown to be most effective when combined with some form of personal meeting or dialog. During a course in medical psychology for medical students, reflective texts were followed up by an individual personal talk with a teacher from the course. Thematic analysis of the texts revealed four separate sub-themes: 1) the course has enabled me and the class to develop, which is good albeit arduous; 2) understanding myself is a resource in understanding people as well as knowing psychology; 3) the course provided me with new, purely intellectual skills as well as eye-openers; and 4) the receiving teacher is an integral part of my reflective writing. The main theme, capturing the students' writing process, concluded that students perceive the course as "Learning psychology as a challenging process towards development" as well as "studies as usual". Ethical, psychological, and pedagogical aspects are discussed in the paper.

  9. Effectiveness of manual therapy compared to usual care by the general practitioner for chronic tension-type headache: design of a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Dekker Joost

    2009-02-01

    Full Text Available Abstract Background Patients with Chronic Tension Type Headache (CTTH report functional and emotional impairments (loss of workdays, sleep disturbances, emotional well-being and are at risk for overuse of medication. Manual therapy may improve symptoms through mobilisation of the spine, correction of posture, and training of cervical muscles. We present the design of a randomised clinical trial (RCT evaluating the effectiveness of manual therapy (MT compared to usual care by the general practitioner (GP in patients with CTTH. Methods and design Patients are eligible for participation if they present in general practice with CTTH according to the classification of the International Headache Society (IHS. Participants are randomised to either usual GP care according to the national Dutch general practice guidelines for headache, or manual therapy, consisting of mobilisations (high- and low velocity techniques, exercise therapy for the cervical and thoracic spine and postural correction. The primary outcome measures are the number of headache days and use of medication. Secondary outcome measures are severity of headache, functional status, sickness absence, use of other healthcare resources, active cervical range of motion, algometry, endurance of the neckflexor muscles and head posture. Follow-up assessments are conducted after 8 and 26 weeks. Discussion This is a pragmatic trial in which interventions are offered as they are carried out in everyday practice. This increases generalisability of results, but blinding of patients, GPs and therapists is not possible. The results of this trial will contribute to clinical decision making of the GP regarding referral to manual therapy in patients with chronic tension headache.

  10. Quantitative data for care of patients with systemic lupus erythematosus in usual clinical settings: a patient Multidimensional Health Assessment Questionnaire and physician estimate of noninflammatory symptoms.

    Science.gov (United States)

    Askanase, Anca Dinu; Castrejón, Isabel; Pincus, Theodore

    2011-07-01

    To analyze quantitative data in patients with systemic lupus erythematosus (SLE), seen in usual care, from a patient Multidimensional Health Assessment Questionnaire (MDHAQ) with routine assessment of patient index data (RAPID3) scores and from a physician global estimate of noninflammatory symptoms; and to compare results to self-report Systemic Lupus Activity Questionnaire (SLAQ) scores and 4 SLE indices: SLE Disease Activity Index-2K (SLEDAI-2K), British Isles Lupus Assessment Group (BILAG), Systemic Lupus Activity Measure (SLAM), and European Consensus Lupus Activity Measurement (ECLAM). Fifty consecutive patients with SLE were studied in usual care of one rheumatologist. All patients completed an MDHAQ/RAPID3 in this setting. Each patient also completed a SLAQ. The rheumatologist scored SLEDAI-2K, BILAG, SLAM, ECLAM, and 2 physician global estimates, one for overall status and one for noninflammatory symptoms. Patients were classified into 2 groups: "few" or "many" noninflammatory symptoms. Scores and indices were compared using correlations, cross-tabulations and t tests. The patients included 45 women and 5 men. MDHAQ/RAPID3 and SLAQ scores were significantly correlated. RAPID3 scores were significantly higher in patients with SLE index scores above median levels, and in 34 patients scored by the rheumatologist as having "few" noninflammatory symptoms. MDHAQ/RAPID3 and SLAQ were significantly higher in 16 patients scored as having many noninflammatory symptoms. MDHAQ/RAPID3 and SLAQ subscale scores appear to reflect disease activity in patients with SLE, but not in patients with many noninflammatory symptoms. A physician scale for noninflammatory symptoms is useful to interpret MDHAQ/RAPID3, SLAQ, and SLE index scores.

  11. Full disclosure of financial costs and options to patients: the roles of race, age, health insurance, and usual source for care.

    Science.gov (United States)

    O'Toole, Thomas P; Arbelaez, Jose J; Dixon, Bruce W

    2004-02-01

    The objective was to identify factors associated with financial discussions and financial disclosure of medical costs within a low-income urban community. The method used was a cross-sectional community-based survey in Allegheny County, Pennsylvania. The survey was conducted door-to-door and at area food pantries. Two hundred and twenty six adults were interviewed. Overall, 76.1% reported having a usual source for care and 73.0% had health insurance. Thirty nine and four tenths percent reported having been asked about their ability to pay for health services; this was more common among African Americans (OR 5.2; 95% CI 1.73-15.84), those with no health insurance (OR 4.3; 95% CI 1.01-17.89), and those less than 45 years old (OR:2.9; 95% CI 1.03-8.28). Only 10.6% reported being told how much a health visit would cost. Overall, 30.1% reported their provider made payment allowances for medical bills, with white respondents 2.5 times more likely and those persons identifying an ambulatory site for care 2.6 times more likely to report this. Overall, 30.5% reported being referred to a collection agency for unpaid medical bills; this was 2.4 times more common among those individuals identifying a non-ambulatory usual site for care. Significant race and socio-economic disparities exist in discussions about and access to financial resources to pay for medical care. Expanding the availability of financial assistance is critical to improving access to health care.

  12. To Screen or not to Screen: Low Dose Computed Tomography in Comparison to Chest Radiography or Usual Care in Reducing Morbidity and Mortality from Lung Cancer

    Science.gov (United States)

    Kamdar, Jay; Moats, Austin; Nguyen, Brenda

    2016-01-01

    Lung cancer has the highest mortality rate of all cancers. This paper seeks to address the question: Can the mortality of lung cancer be decreased by screening with low-dose computerized tomography (LDCT) in higher risk patients compared to chest X-rays (CXR) or regular patient care? Currently, CXR screening is recommended for certain high-risk patients. Several recent trials have examined the effectiveness of LDCT versus chest radiography or usual care as a control. These trials include National Lung Screening Trial (NLST), Detection And screening of early lung cancer with Novel imaging TEchnology (DANTE), Lung Screening Study (LSS), Depiscan, Italian Lung (ITALUNG), and Dutch-Belgian Randomized Lung Cancer Screening Trial (Dutch acronym: NELSON study). NLST, the largest trial (n=53, 454), demonstrated a decrease in mortality from lung cancer in the LDCT group (RRR=20%, P=0.004). LSS demonstrated a greater sensitivity in detecting both early stage and any stage of lung cancer in comparison to traditional CXR. Although the DANTE trial yielded data consistent with findings in LSS, it also showed that via LDCT screening a greater proportion of patients were placed under unnecessary surgical procedures. The Depiscan trial yielded a high nodule detection rate at the cost of a high false-positive rate compared to CXR screening. The ITALUNG and NELSON trials demonstrated the early detection capabilities of LDCT for lung cancers compared to usual care without surveillance imaging. False-positive findings with unnecessary workup, intervention, and radiation exposure remain significant concerns for routine LDCT screening. However, current data suggests LDCT may provide a highly sensitive and specific means for detecting lung cancers and reducing mortality. PMID:27375974

  13. 'Pragmatic randomized controlled trial of individually prescribed exercise versus usual care in a heterogeneous cancer survivor population': A feasibility study PEACH Trial: Prescribed exercise after chemotherapy

    Directory of Open Access Journals (Sweden)

    Guinan Emer

    2010-02-01

    Full Text Available Abstract Background Many cancer survivors suffer a range of physical and psychological symptoms which may persist for months or years after cessation of treatment. Despite the known benefits of exercise and its potential to address many of the adverse effects of treatment, the role of exercise as well as optimum duration, frequency, and intensity in this population has yet to be fully elucidated. Many cancer rehabilitation programmes presented in the literature are very long and have tight eligibility criteria which make them non-applicable to the majority of cancer survivors. This paper presents the protocol of a novel 8-week intervention which aims to increase fitness, and address other physical symptoms in a heterogeneous cancer survivor population. Methods/design The aim is to recruit 64 cancer survivors 2-6 months after completion of chemotherapy, usually adjuvant, with curative intent. Subjects will be recruited through oncology clinics in a single institution and randomised to usual care or an exercise intervention. The exercise intervention consists of two specifically tailored supervised moderate intensity aerobic exercise sessions weekly over 8-weeks. All participants will be assessed at baseline (0 weeks, at the end of the intervention (8 weeks, and at 3-month follow-up. The primary outcome measure is fitness, and secondary patient-related outcome measures include fatigue, quality of life, and morphological outcomes. A further secondary outcome is process evaluation including adherence to and compliance with the exercise program. Discussion This study will provide valuable information about the physical outcomes of this 8-week supervised aerobic programme. Additionally, process information and economic evaluation will inform the feasibility of implementing this program in a heterogeneous population post cessation of chemotherapy. Trial Registration NCT01030887

  14. A randomised clinical trial of comprehensive cardiac rehabilitation versus usual care for patients treated for infective endocarditis—the CopenHeartIE trial protocol

    Science.gov (United States)

    Rasmussen, Trine Bernholdt; Zwisler, Ann-Dorthe; Sibilitz, Kirstine Lærum; Risom, Signe Stelling; Bundgaard, Henning; Gluud, Christian; Moons, Philip; Winkel, Per; Thygesen, Lau Caspar; Hansen, Jane Lindschou; Norekvål, Tone Merete; Berg, Selina Kikkenborg

    2012-01-01

    Introduction Infective endocarditis (IE) is among the most serious infectious diseases in the western world. Treatment requires lengthy hospitalisation, high-dosage antibiotic therapy and possible valve replacement surgery. Despite advances in treatment, the 1-year mortality remains at 20–40%. Studies indicate that patients experience persisting physical symptoms, diminished quality of life and difficulties returning to work up to a year postdischarge. No studies investigating the effects of rehabilitation have been published. We present the rationale and design of the CopenHeartIE trial, which investigates the effect of comprehensive cardiac rehabilitation versus usual care for patients treated for IE. Methods and analysis We will conduct a randomised clinical trial to investigate the effects of comprehensive cardiac rehabilitation versus usual care on the physical and psychosocial functioning of patients treated for IE. The trial is a multicentre, parallel design trial with 1 : 1 individual randomisation to either the intervention or control group. The intervention consists of five psychoeducational consultations provided by specialised nurses and a 12-week exercise training programme. The primary outcome is mental health (MH) measured by the standardised Short Form 36 (SF-36). The secondary outcome is peak oxygen uptake measured by the bicycle ergospirometry test. Furthermore, a number of exploratory analyses will be performed. Based on sample size calculation, 150 patients treated for left-sided (native or prosthetic valve) or cardiac device endocarditis will be included in the trial. A qualitative and a survey-based complementary study will be undertaken, to investigate postdischarge experiences of the patients. A qualitative postintervention study will explore rehabilitation participation experiences. Ethics and dissemination The study complies with the Declaration of Helsinki and was approved by the regional research ethics committee (no H-1

  15. A Structured, Manual-Based Low-Level Intervention vs. Treatment as Usual Evaluated in a Randomized Controlled Trial for Adolescents with Extreme Obesity - the STEREO Trial

    Directory of Open Access Journals (Sweden)

    Yvonne Mühlig

    2017-08-01

    Full Text Available Background: To compare efficacy and safety of a manual-based low-level psychological intervention with treatment as usual (weight loss treatment. Methods: A two-armed randomized controlled trial without blinding and computer-based stratified block randomization included adolescents and young adults (14.0-24.9 years with a BMI ≥ 30 kg/m2 at five German university hospitals. Primary outcomes were adherence (participation rate ≥ 5/6 sessions and quality of life (DISABKIDS-37 6 months after randomization. Secondary outcomes included depression, self-esteem, and perceived stress scores. Results: Of 397 screened adolescents, 119 (mean BMI 40.4 ± 7.0 kg/m2, 49.6% female were randomized to the manual-based low-level intervention (n = 59 or treatment as usual (n = 60. We observed no group difference for adherence (absolute risk reduction 0.4%, 95% CI -14.7% to 15.5%; p = 1.0 or health-related quality of life (score difference 8.1, 95% CI -2.1 to 18.3; p = 0.11. Among all secondary outcomes, we detected explorative evidence for an effect on the DISABKIDS-37 ‘social exclusion' subscale (score difference 15.5; 95% CI 1.6-29.4; p = 0.03. 18/19 adverse events occurred in 26 participants, none were classified as serious. Conclusion: Adherence to a coping-oriented intervention was comparable to weight loss treatment, although it was weak in both interventions. Psychological interventions may help to overcome social isolation; further confirmation is required.

  16. El concepto de corrección idiomática : lo "recto", lo usual y lo ejemplar en la práctica del idioma

    Directory of Open Access Journals (Sweden)

    José Javier Mangado Martínez

    2013-05-01

    Full Text Available La polisemia de los términos correcto/incorrecto, referidos al uso del idioma, induce a confusiones indeseables. En consecuencia, hay que distinguir los conceptos diferentes subsumidos en ellos. A esa distinción dedica el autor este trabajo: parte de la concepción de Coseriu, incorpora las ideas recientes sobre el tema y aporta un nuevo concepto muy útil al respecto, al que llama lo “recto”, oponiéndolo a lo usual y a lo ejemplar ya fijados. En el uso del idioma lo correcto es lo normal. Una realización idiomática puede pertenecer a lo normal por dos motivos: por estar construida de acuerdo con los cánones del sistema de la lengua correspondiente (es decir, por ser recta, o por ser usual en la comunidad lingüística donde se emite. Puesto que las comunidades lingüísticas presentan entre sí diferencias evidentes, se necesita una norma estándar, la ejemplar, que, dentro de la misma lengua, facilite la comunicación intercomunitaria. Dado que la variedad lingüística que se adquiere de forma natural no es la intercomunitaria, sino la intracomunitaria, se hace imprescindible estudiar la norma ejemplar para conocerla y fijarla. La lingüística normativa, la encargada del estudio de la lengua estándar, cobra así razón de ser y justificación científica.

  17. A Structured, Manual-Based Low-Level Intervention vs. Treatment as Usual Evaluated in a Randomized Controlled Trial for Adolescents with Extreme Obesity - the STEREO Trial.

    Science.gov (United States)

    Mühlig, Yvonne; Scherag, André; Bickenbach, Annika; Giesen, Ulrike; Holl, Reinhard; Holle, Rolf; Kiess, Wieland; Lennerz, Belinda; Lütke Brintrup, Diana; Moss, Anja; Neef, Madlen; Ose, Claudia; Reinehr, Thomas; Teuner, Christina M; Wiegand, Susanna; Wolters, Barbara; Wabitsch, Martin; Hebebrand, Johannes

    2017-01-01

    To compare efficacy and safety of a manual-based low-level psychological intervention with treatment as usual (weight loss treatment). A two-armed randomized controlled trial without blinding and computer-based stratified block randomization included adolescents and young adults (14.0-24.9 years) with a BMI ≥ 30 kg/m2 at five German university hospitals. Primary outcomes were adherence (participation rate ≥ 5/6 sessions) and quality of life (DISABKIDS-37) 6 months after randomization. Secondary outcomes included depression, self-esteem, and perceived stress scores. Of 397 screened adolescents, 119 (mean BMI 40.4 ± 7.0 kg/m2, 49.6% female) were randomized to the manual-based low-level intervention (n = 59) or treatment as usual (n = 60). We observed no group difference for adherence (absolute risk reduction 0.4%, 95% CI -14.7% to 15.5%; p = 1.0) or health-related quality of life (score difference 8.1, 95% CI -2.1 to 18.3; p = 0.11). Among all secondary outcomes, we detected explorative evidence for an effect on the DISABKIDS-37 'social exclusion' subscale (score difference 15.5; 95% CI 1.6-29.4; p = 0.03). 18/19 adverse events occurred in 26 participants, none were classified as serious. Adherence to a coping-oriented intervention was comparable to weight loss treatment, although it was weak in both interventions. Psychological interventions may help to overcome social isolation; further confirmation is required. © 2017 The Author(s) Published by S. Karger GmbH, Freiburg.

  18. 'Pragmatic randomized controlled trial of individually prescribed exercise versus usual care in a heterogeneous cancer survivor population': a feasibility study PEACH trial: prescribed exercise after chemotherapy.

    LENUS (Irish Health Repository)

    Walsh, Julie M

    2010-01-01

    BACKGROUND: Many cancer survivors suffer a range of physical and psychological symptoms which may persist for months or years after cessation of treatment. Despite the known benefits of exercise and its potential to address many of the adverse effects of treatment, the role of exercise as well as optimum duration, frequency, and intensity in this population has yet to be fully elucidated. Many cancer rehabilitation programmes presented in the literature are very long and have tight eligibility criteria which make them non-applicable to the majority of cancer survivors. This paper presents the protocol of a novel 8-week intervention which aims to increase fitness, and address other physical symptoms in a heterogeneous cancer survivor population. METHODS\\/DESIGN: The aim is to recruit 64 cancer survivors 2-6 months after completion of chemotherapy, usually adjuvant, with curative intent. Subjects will be recruited through oncology clinics in a single institution and randomised to usual care or an exercise intervention. The exercise intervention consists of two specifically tailored supervised moderate intensity aerobic exercise sessions weekly over 8-weeks. All participants will be assessed at baseline (0 weeks), at the end of the intervention (8 weeks), and at 3-month follow-up. The primary outcome measure is fitness, and secondary patient-related outcome measures include fatigue, quality of life, and morphological outcomes. A further secondary outcome is process evaluation including adherence to and compliance with the exercise program. DISCUSSION: This study will provide valuable information about the physical outcomes of this 8-week supervised aerobic programme. Additionally, process information and economic evaluation will inform the feasibility of implementing this program in a heterogeneous population post cessation of chemotherapy.

  19. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial

    Science.gov (United States)

    Huirne, Judith AF; Bouwsma, Esther VA; van Dongen, Johanna M; Terwee, Caroline B; van de Ven, Peter M; den Bakker, Chantal M; van der Meij, Suzan; van Baal, W Marchien; Leclercq, Wouter KG; Geomini, Peggy MAJ; Consten, Esther CJ; Schraffordt Koops, Steven E; van Kesteren, Paul JM; Stockmann, Hein BAC; ten Cate, A Dorien; Davids, Paul HP; Scholten, Petrus C; van den Heuvel, Baukje; Schaafsma, Frederieke G; Meijerink, Wilhelmus JHJ; Bonjer, H Jaap; Anema, Johannes R

    2016-01-01

    Background Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. Objective With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. Methods This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social

  20. Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol

    Directory of Open Access Journals (Sweden)

    Orrell Martin

    2009-07-01

    Full Text Available Abstract Background The growing number of people with dementia, and the increasing cost of care, provides a major incentive to develop and test methods of supporting them in the community for longer. Most attention has been given to pharmacological interventions, but there is increasing recognition that psychosocial interventions may be equally effective, even preferable where medication has negative side-effects. Reminiscence groups, run by professionals and volunteers, which use photographs, recordings and other objects to trigger personal memories are probably the most popular therapeutic approach to working with people with dementia, but there is little evidence for their effectiveness and cost-effectiveness. The recent inclusion of family carers in groups with people with dementia, notably in our own pilot studies, has generated informal evidence that this joint approach improves relationships between people with dementia and their carers, and benefits both. Design and methods This multi-centre, pragmatic randomised controlled trial (RCT to assess the effectiveness and cost-effectiveness of joint reminiscence groups for people with dementia and their family care-givers has two parallel arms – an intervention group and a control group who receive care as usual. The intervention consists of joint reminiscence groups held weekly for twelve consecutive weeks, followed by monthly maintenance sessions for a further seven months. The primary outcome measures are the quality of life of people with dementia, as assessed by QoL-AD, and their care-givers' mental health as assessed by the GHQ-28. Secondary outcomes include: the autobiographical memories of people with dementia; the quality of the relationship between them and their care-givers; and the levels of depression and anxiety felt by them and their care-giver. Using a 5% significance level, comparison of 200 pairs attending joint reminiscence groups with 200 pairs receiving usual treatment

  1. Eye Movement Desensitization and Reprocessing (EMDR Versus Treatment as Usual for Non-Specific Chronic Back Pain Patients with Psychological Trauma: A Randomized Controlled Pilot Study

    Directory of Open Access Journals (Sweden)

    Andreas Gerhardt

    2016-12-01

    Full Text Available Objective: Eye-Movement-Desensitization and Reprocessing (EMDR – an evidence-based approach to eliminate emotional distress from traumatic experiences – was recently suggested for the treatment of chronic pain. Aim of this study was to estimate preliminary efficacy of a pain-focused EMDR intervention for the treatment of non-specific chronic back pain.Design: Randomized controlled pilot study.Methods: Forty non-specific chronic back pain patients reporting previous experiences of psychological trauma were consecutively recruited from outpatient tertiary-care pain centers. After baseline assessment, patients were randomized to intervention or control group (1:1. The intervention group received ten sessions standardized pain-focused EMDR in addition to treatment-as-usual. The control group received treatment-as-usual alone.The primary outcome was preliminary efficacy, measured by pain intensity, disability, and treatment satisfaction from the patients' perspective. Clinical relevance of changes was determined according to established recommendations. Assessments were conducted at the baseline, post-treatment, and at a 6-month follow-up. Intention-to-treat-analysis with last-observation-carried-forward method was used. Registered with ClinicalTrials.gov (NCT01850875.Results: Estimated effect sizes (between-group, pooled standard deviation for pain intensity and disability were d=0.79 (CI95%: 0.13, 1.42 and d=0.39 (CI95%: -0.24, 1.01 post-treatment, and d=0.50 (CI95%: 0.14, 1.12 and d=0.14 (CI95%: -0.48, 0.76 at 6-month follow-up. Evaluation on individual patient basis showed that about 50% of the patients in the intervention group improved clinically relevant and also rated their situation as clinically satisfactory improved, compared to zero patients in the control group.Conclusions: There is preliminary evidence that pain-focused EMDR might be useful for non-specific chronic back pain patients with previous experiences of psychological trauma

  2. Effect of aqua-cycling on pain and physical functioning compared with usual care in patients with knee osteoarthritis: study protocol of a randomised controlled trial.

    Science.gov (United States)

    Rewald, Stefanie; Mesters, Ilse; Lenssen, A F; Emans, Pieter J; Wijnen, Wiel; de Bie, Rob A

    2016-02-18

    Over the last decade aquatic exercise has become more and more popular. One of the latest trends is aqua-cycling, where participants sit on a water-resistant stationary bike and, while immersed chest deep in the water, combine continuous cycling with upper body exercises that utilise water resistance. Since stationary cycling and aquatic exercises are frequently recommended to patients with knee osteoarthritis, combining both would seem an obvious step, and an aqua-cycling exercise programme for patients with knee osteoarthritis has indeed been developed. This study protocol gives a detailed description of the exercise programme and the methodology of a study to compare this programme with treatment involving usual care only. The study is a single-blind, parallel-group, randomised controlled trial of Maastricht University Medical Centre+, the Netherlands. knee pain of four to seven on a 10-point pain rating scale; a Kellgren/Lawrence score between one to three; ability to cycle; good mental health; sufficient language skills; indication for physical therapy in conjunction with impairments due to OA. any contra-indication for aquatic exercise; planned total knee replacement; corticosteroid injection physical therapist. Participants will be assessed at baseline, and at 12 and 24 weeks after baseline. The primary outcome is self-reported knee pain and physical functioning. Secondary outcomes are lower limb muscle strength, functional capacity, self-reported disease severity, physical activity level, quality of life, self-efficacy and fear of movement. Daily diaries will collect information on knee pain, physical functioning, level of physical activity, pain medication routine and physical therapy (control group only) or exercise participation over two 30-day periods (during the intervention period). To our knowledge the present study is the first randomised controlled trial evaluating the effects of aqua-cycling in the pre-surgical stage of knee osteoarthritis. This

  3. The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Schauenburg Henning

    2009-04-01

    Full Text Available Abstract Background Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide. The seriousness of the disorder requires extensive knowledge of effective treatment options. However, evidence for treatment efficacy in this area is remarkably weak. A recent Cochrane review states that there is an urgent need for large, well-designed treatment studies for patients with anorexia nervosa. The aim of this particular multi-centre study is to evaluate the efficacy of two standardized outpatient treatments for patients with anorexia nervosa: focal psychodynamic (FPT and cognitive behavioural therapy (CBT. Each therapeutic approach is compared to a "treatment-as-usual" control group. Methods/Design 237 patients meeting eligibility criteria are randomly and evenly assigned to the three groups – two intervention groups (CBT and FPT and one control group. The treatment period for each intervention group is 10 months, consisting of 40 sessions respectively. Body weight, eating disorder related symptoms, and variables of therapeutic alliance are measured during the course of treatment. Psychotherapy sessions are audiotaped for adherence monitoring. The treatment in the control group, both the dosage and type of therapy, is not regulated in the study protocol, but rather reflects the current practice of established outpatient care. The primary outcome measure is the body mass index (BMI at the end of the treatment (10 months after randomization. Discussion The study design surmounts the disadvantages of previous studies in that it provides a randomized controlled design, a large sample size, adequate inclusion criteria, an adequate treatment protocol, and a clear separation of the treatment conditions in order to avoid contamination. Nevertheless, the study has to deal with difficulties specific to the psychopathology of anorexia nervosa. The treatment protocol allows for dealing with the

  4. Revascularization and cardioprotective drug treatment in myocardial infarction patients: how do they impact on patients' survival when delivered as usual care

    Directory of Open Access Journals (Sweden)

    Courteau Josiane

    2006-05-01

    Full Text Available Abstract Background Randomized clinical trials showed the benefit of pharmacological and revascularization treatments in secondary prevention of myocardial infarction (MI, in selected population with highly controlled interventions. The objective of this study is to measure these treatments' impact on the cardiovascular (CV mortality rate among patients receiving usual care in the province of Quebec. Methods The study population consisted of a "naturalistic" cohort of all patients ≥ 65 years old living in the Quebec province, who survived a MI (ICD-9: 410 in 1998. The studied dependant variable was time to death from a CV disease. Independent variables were revascularization procedure and cardioprotective drugs. Death from a non CV disease was also studied for comparison. Revascularization procedure was defined as percutaneous transluminal coronary angioplasty (PTCA or coronary artery bypass graft (CABG. The exposure to cardioprotective drugs was defined as the number of cardioprotective drug classes (Acetylsalicylic Acid (ASA, Beta-Blockers, Angiotensin-Converting Enzyme (ACE Inhibitors, Statins claimed within the index period (first 30 days after the index hospitalization. Age, gender and a comorbidity index were used as covariates. Kaplan-Meier survival curves, Cox proportional hazard models, logistic regressions and regression trees were used. Results The study population totaled 5596 patients (3206 men; 2390 women. We observed 1128 deaths (20% within two years following index hospitalization, of them 603 from CV disease. The CV survival rate at two years is much greater for patients with revascularization, regardless of pharmacological treatments. For patients without revascularization, the CV survival rate increases with the number of cardioprotective drug classes claimed. Finally, Cox proportional hazard models, regression tree and logistic regression analyses all revealed that the absence of revascularization and, to a lower extent

  5. The addition of a goal-based motivational interview to standardised treatment as usual to reduce dropouts in a service for patients with personality disorder: a feasibility study

    Directory of Open Access Journals (Sweden)

    Whitham Diane

    2010-10-01

    Full Text Available Abstract Background Rates of non-completion of treatments for personality disorder are high and there are indications that those who do not complete treatment have worse outcomes than those who do. Improving both cost-efficiency and client welfare require attention to engaging people with personality disorder in treatment. A motivational interview, based on the Personal Concerns Inventory, may have the ability to enhance engagement and retention in therapy. Here, we report the protocol for a feasibility study for a randomised controlled trial (RCT. Methods All referrals accepted to the psychological service of Nottinghamshire Healthcare NHS Trust's outpatient service for people with personality disorder are eligible for inclusion. Consenting participants are randomised to receive the Personal Concerns Inventory interview plus treatment as usual or treatment as usual only. We aim to recruit 100 participants over 11/2 years. A randomised controlled trial will be considered feasible if 1 the recruitment rate to the project is 54% of all referrals (95% CI 54-64, 2 80% of clients find the intervention acceptable in terms of its practicability and usefulness (95% CI 80-91, and 3 80% of therapists report finding the intervention helpful (95% CI 80-100. In a full-scale randomised controlled trial, the primary outcome measure will be completion of treatment i.e., entry into and completion of ≥ 75% of sessions offered. Therefore, information will be collected on recruitment rates, attendance at therapy sessions, and completion of treatment. The feasibility of examining the processes of engagement will be tested by assessing the value, coherence, and attainability of goals pre-treatment, and engagement in treatment. The costs associated with the intervention will be calculated, and the feasibility of calculating the cost-benefits of the intervention will be tested. The views of clients and therapists on the intervention, collected using semi

  6. Case study of the 9 April 2009 ‘brown’ cloud: Observations of usually high cloud droplet concentrations in Saudi Arabia

    Science.gov (United States)

    Delene, D. J.

    2009-12-01

    Cloud droplets nucleate on aerosol particles termed cloud condensation nuclei (CCN). It is well known that a larger number concentration of CCN results in a larger number concentration of droplets in developing cumulus clouds. However, the conditions where dust particles can serve as cloud condensation nuclei (CCN) and hence change cloud droplet concentration and precipitation formation processes is uncertain. Aircraft measurements of cloud droplet concentration between 13:20 and 13:30 UTC during the 9 April 2009 flight near Riyadh, Saudi Arabia, show total cloud droplet concentration (3-50 µm in diameter) of 800 to 1200 #/cm-3 at a altitude of 18000 ft. Typical cloud droplet concentration for this type of cloud in the Riyadh region is approximately 400 #/cm-3 and is typical of observation made between 13:00 and 13:20 UTC during the 9 April 2009 flight at 18,000 ft. Photographs of ice accumulation on the unprotected leading edge of the aircraft’s wing due to the freezing of super cooled droplets show a color changed from white during the time of low droplet number condensation to brown during the high droplet number concentration. It is hypothesized that high droplet number concentration observations were the result of ingestion of a large about of dust particles by the cloud. : Case Study of the 9 April 2009 ‘Brown’ Cloud: Observations of Usually High Cloud Droplet Concentrations in Saudi Arabia.

  7. Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study.

    Science.gov (United States)

    Mayoux-Benhamou, M A; Roux, C; Perraud, A; Fermanian, J; Rahali-Kachlouf, H; Revel, M

    2005-03-01

    This prospective 18-month study was designed to assess long-term compliance with a program of exercise aimed to prevent osteoporosis after an educational intervention and to uncover determinants of compliance. A total of 135 postmenopausal women were recruited by flyers or instructed by their physicians to participate in an educational session added to usual medical care. After a baseline visit and dual-energy X-ray absorptiometry, volunteers participated in a 1-day educational session consisting of a lecture and discussion on guidelines for appropriate physical activity and training in a home-based exercise program taught by a physical therapist. Scheduled follow-up visits were 1, 6, and 18 months after the educational session. Compliance with the exercise program was defined as an exercise practice rate 50% or greater than the prescribed training. The 18-month compliance rate was 17.8% (24/135). The main reason for withdrawal from the program was lack of motivation. Two variables predicted compliance: contraindication for hormone replacement therapy (odds ratio [OR] = 0.13; 95% confidence interval [95% CI], 0.04 to 0.46) and general physical function scores from an SF-36 questionnaire (OR=1.26; 95% CI, 1.03 to 1.5). To a lesser extent, osteoporosis risk, defined as a femoral T-score exercise, only a minority of postmenopausal women adhered to a home-based exercise program after 18 months.

  8. The clinical effectiveness of a brief consultation and advisory approach compared to treatment as usual in child and adolescent mental health services.

    LENUS (Irish Health Repository)

    McGarry, Joan

    2008-07-01

    A brief consultation and advice (BCA) approach to dealing with routine referrals was introduced into a child and adolescent mental health service (CAMHS) over an 18-month period. This is a time-limited, client-centred and solution-focused approach to dealing with common non-complex referrals. The model proposes that all families are seen for an initial \\'consultation\\' appointment followed by a maximum of two further appointments. A randomized controlled study compared the clinical effectiveness of BCA treatment with treatment as usual (TAU) over a 6-month period. The parents of children referred to CAMHS were eligible to participate if their child was deemed \\'non-complex\\'. Ethical approval was granted by the relevant ethics committee. Families who consented to participate in the study were randomly allocated to either the BCA or TAU group. Sixty children enrolled in the study. Both groups showed improvements on a number of variables at 3 months post treatment, but only those receiving BCA showed continued improvement at 6 months. Participants in both groups showed high levels of satisfaction with the treatment received. Participants in the TAU group expressed dissatisfaction with long waiting times and had a higher drop out rate than the BCA treatment group. During the time frame studied, the introduction of the BCA approach did not lead to a decrease in overall mean waiting time. These results and the usefulness of a BCA model are discussed.

  9. Association between treatment or usual care region and hospitalization for fall-related traumatic brain injury in the Connecticut Collaboration for Fall Prevention.

    Science.gov (United States)

    Murphy, Terrence E; Baker, Dorothy I; Leo-Summers, Linda S; Allore, Heather G; Tinetti, Mary E

    2013-10-01

    To evaluate the association between the treatment region (TR) or usual care region (UCR) of the Connecticut Collaboration for Fall Prevention (CCFP), a clinical intervention for prevention of falls, and the rate of hospitalization for fall-related traumatic brain injury (FR-TBI) in persons aged 70 and older and to describe the Medicare charges for FR-TBI hospitalizations. Using a quasi-experimental design, rates of hospitalization for FR-TBI were recorded over an 8-year period (2000-2007) in two distinct geographic regions (TR and UCR) chosen for their similarity in characteristics associated with occurrence of falls. Two geographical regions in Connecticut. More than 200,000 persons aged 70 and older. Clinicians in the TR translated research protocols from the Yale Frailty and Injuries: Cooperative Studies of Intervention Techniques, a successful fall-prevention randomized clinical trial, into discipline- and site-specific fall-prevention procedures for integration into their clinical practices. Rate of hospitalization for FR-TBI in persons aged 70 and older. Connecticut Collaboration for Fall Prevention's TR exhibited lower rates of hospitalization for FR-TBI than the UCR (risk ratio = 0.84, 95% credible interval = 0.72-0.99). The significantly lower rate of hospitalization for FR-TBI in CCFP's TR suggests that the engagement of practicing clinicians in the implementation of evidence-based fall-prevention practices may reduce hospitalizations for FR-TBI. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  10. A Randomized Controlled Trial of Cognitive-Behavioral Therapy versus Treatment as Usual for Adolescents with Autism Spectrum Disorders and Comorbid Anxiety

    Science.gov (United States)

    Storch, Eric A.; Lewin, Adam B.; Collier, Amanda B.; Arnold, Elysse; De Nadai, Alessandro S.; Dane, Brittney F.; Nadeau, Joshua M.; Mutch, P. Jane; Murphy, Tanya K.

    2014-01-01

    Objective Examine the efficacy of a personalized, modular cognitive-behavioral therapy (CBT) protocol among early adolescents with high-functioning autism spectrum disorders (ASD) and co-occurring anxiety relative to treatment as usual (TAU). Method Thirty-one children (11–16 years) with ASD and clinically significant anxiety were randomly assigned to receive 16 weekly CBT sessions or an equivalent duration of TAU. Participants were assessed by blinded raters at screening, post-treatment, and 1-month follow-up. Results Youth randomized to CBT demonstrated superior improvement across primary outcomes relative to those receiving TAU. Eleven of 16 adolescents randomized to CBT were treatment responders, versus 4/15 in the TAU condition. Gains were maintained at 1-month follow-up for CBT responders. Conclusions These data extend findings of the promising effects of CBT in anxious youth with ASD to early adolescents. Clinicaltrials.gov trial reference number NCT01563003. Internet links: http://clinicaltrials.gov/show/NCT01563003 PMID:25424398

  11. Studying a denition for a boosted W/Z/H jet tagger at the FCChh, employing modern Machine Learning algorithms and customised features (beyond the usual substructure variables)

    CERN Document Server

    Brzhechko, Danyyl

    2016-01-01

    A jet is a spray of particles, usually produced by the hadronization of a quark or gluon in a particle physics or heavy ion experiment. Reconstructed particles are clustered into jets using one of the available jet clustering algorithms (kT, anti-kT etc.), which adopt dierent metrics to decide if two given particles belong to the same jet or not. Jets can also originate from the decay of high-momenta heavy particles, such as boosted vector boson. When these particles decay to quarks, the overlap of the hadronization products of each quark result into a single massive jet, dierent than the ordinary jets from quarks and gluons. These special jets can be identied using substructure algorithms. In this study, we consider the performances of a commonly used substructure variable, N-subjettiness, with two variants of an alternative approach, based on the momentum ow around the jet axis. I focused on high-energy collision in a hypothetical future circular collider (FCC) colliding protons at a center-of-mass energy 1...

  12. Which subgroups of patients with non-specific neck pain are more likely to benefit from spinal manipulation therapy, physiotherapy, or usual care?

    Science.gov (United States)

    Schellingerhout, Jasper Mattijs; Verhagen, Arianne Petra; Heymans, Martinus Wilhelmus; Pool, Jan Jacobus Maria; Vonk, Frieke; Koes, Bart Willem; Wilhelmina de Vet, Henrica Cornelia

    2008-10-31

    The objective of this study is to identify subgroups of patients with non-specific neck pain who are more likely to benefit from either physiotherapy, spinal manipulation therapy, or usual care, on the short- and long-term. Data of three recently finished randomised controlled trials, with similar design and setting, were combined. The combined study population consisted of 329 patients with non-specific neck pain in an adult (18-70years) primary care population in the Netherlands. The primary outcome measure was global perceived recovery and was measured at the end of the treatment period and after 52 weeks of follow-up. Fourteen candidate variables were selected for the analysis. Predictors were identified by multivariable logistic regression analysis and were tested for interaction with treatment. Based on the multivariable models with interaction terms a decision model for treatment choice was developed. The analysis revealed three predictors for recovery of which the effect is modified by treatment: pain intensity (0-10 scale) in the short-term model, age and (no) accompanying low back pain in the long-term model. With these predictors a clinically relevant improvement in recovery rate (up to 25% improvement) can be established in patients receiving a tailored instead of a non-advised treatment. In conclusion we identified three characteristics that facilitate a deliberate treatment choice, to optimise benefit of treatment in patients with non-specific neck pain: age, pain intensity, and (no) accompanying low back pain.

  13. Comparing mindfulness based cognitive therapy and traditional cognitive behavior therapy with treatments as usual on reduction of major depressive disorder symptoms.

    Science.gov (United States)

    Omidi, Abdollah; Mohammadkhani, Parvaneh; Mohammadi, Abolfazl; Zargar, Fatemeh

    2013-02-01

    In this studyMindfulness and CBT were combined to investigate the enhance of psychotropic work. Both therapies have integrated acceptance-based mindfulness approaches with change-based cognitive behavioral therapies to create efficacious treatments. That is, introduce use of MBCT in active phase of treatment and chronic depression. This study was done to evaluate efficacy of Mindfulness Based Cognitive Therapy (MBCT) and traditional Cognitive Behavior Therapy (CBT) with Treatments as usual (TAU) to reduce psychiatric symptoms in a sample of patients with Major Depressive Disorder (MDD). 90 patients who were referred to clinics of university of Social Welfare and Rehabilitation Sciences and Tehran University Counseling Centre and met DSM-IV criteria for MDD were selected. They were randomly assigned to MBCT (n = 30), CBT (n = 30), or TAU (n = 30). They were aged between 18 and 45 years (M = 28, SD = 8), with an average of two previous depression episodes. They were interviewed through the Structured Clinical Interview for DSM-IV and self-report by Brief Symptom Inventory, pre and post treatment. Patients in MBCT and CBT group received the treatment, while TAU group continued therapy (anti-depressant). The results indicated that MBCT and CBT groups have significant efficacy on reduction of MDD symptoms. MBCT appears to be as effective as CBT in the treatment of current depression.

  14. Determinants of Usual Source of Care Disparities among African American and Caribbean Black Men: Findings from the national Survey of american life

    Science.gov (United States)

    Hammond, Wizdom Powell; Mohottige, Dinushika; Chantala, Kim; Hastings, Julia F.; Neighbors, Harold W.; Snowden, Lonnie

    2011-01-01

    Purpose The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n5551) and Caribbean Black men (n51,217). Methods We used the 2001–2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses. Results Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men. Conclusions Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men. PMID:21317513

  15. Effectiveness of fixed dose combination medication ('polypills') compared with usual care in patients with cardiovascular disease or at high risk : A prospective, individual patient data meta-analysis of 3140 patients in six countries

    NARCIS (Netherlands)

    Webster, Ruth; Patel, Anushka; Selak, Vanessa; Billot, Laurent; Bots, Michiel L.; Brown, Alex; Bullen, Chris; Cass, Alan; Crengle, Sue; Raina Elley, C.; Grobbee, Diederick E.; Neal, Bruce; Peiris, David; Poulter, Neil; Prabhakaran, Dorairaj; Rafter, Natasha; Stanton, Alice; Stepien, Sandrine; Thom, Simon; Usherwood, Tim; Wadham, Angela; Rodgers, Anthony

    2016-01-01

    Aims To conduct a prospective, individual participant data (IPD) meta-analysis of randomised controlled trials comparing a polypill-based approach with usual care in high risk individuals. Methods and results Three trials comparing polypill-based care with usual care in individuals with CVD or high

  16. No Austrians in South Tyrol? Why the German-speaking community in Italy’s South Tyrol (Alto Adige province is not usually called an Austrian minority

    Directory of Open Access Journals (Sweden)

    Michael Julian Emanuel Volkmer

    2016-08-01

    Full Text Available No Austrians in South Tyrol? Why the German-speaking community in Italy’s South Tyrol (Alto Adige province is not usually called an Austrian minority The article discusses the question why the German-speakers in Northern Italy’s South Tyrol province are only very rarely referred to as an Austrian minority, in spite of the fact that they were split off from Austria, and not Germany, in the aftermath of World War I. An analysis of the naming of German-speaking South Tyroleans in German, Austrian, Italian and English-speaking news media, which demonstrates a preference for terms such as “German-speaking minority” or “German minority” over “Austrian minority and equivalents, is followed by a discussion of three hypotheses to account for the situation. The author shows how the question of how to name the German-speaking South Tyroleans is closely intertwined with the issue of Austrian national identity and its re-orientation away from Germany in the aftermath of the Second World War. The author comes to the conclusion that the minority is not usually referred to as Austrian both due to the fact that it is difficult to include them in the young (civic Austrian nation in a logically consistent manner, and due to the German-speaking South Tyroleans’ own inconsistent self-identification as Austrians.   Nie ma Austriaków w Tyrolu Południowym? Dlaczego niemieckojęzyczna wspólnota we włoskiej prowincji Tyrol Południowy (Alto Adige zwykle nie jest nazywana mniejszością austriacką Artykuł podejmuje kwestię, dlaczego niemieckojęzyczna ludność północnowłoskiej prowincji Tyrol Południowy rzadko bywa nazywana mniejszością austriacką, pomimo tego że w efekcie I wojny światowej odłączona została ona od Austrii, a nie od Niemiec. Analiza nazewnictwa odnoszonego do niemieckojęzycznej ludności Tyrolu Południowego, które występuje w informacyjnych środkach przekazu: niemiecko-, austriacko-, włosko- i angloj

  17. Effectiveness of Caregiver Training in Mindfulness-Based Positive Behavior Support (MBPBS) vs. Training-as-Usual (TAU): A Randomized Controlled Trial

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    Singh, Nirbhay N.; Lancioni, Giulio E.; Karazsia, Bryan T.; Chan, Jeffrey; Winton, Alan S. W.

    2016-01-01

    Caregivers of individuals with intellectual and developmental disabilities (IDD) often end up having their medical and psychological well-being compromised due to the stressful nature of caregiving, especially when those in their care engage in aggressive behavior. In this study, we provided caregivers with mindfulness-based training to enable them to better manage their psychological well-being and, through this, to also enhance specific indices of quality of life of the individuals in their care. Thus, the aim of the present study was to evaluate in a randomized controlled trial (RCT) the comparative effectiveness of Mindfulness-Based Positive Behavior Support (MBPBS) and Training-as-Usual (TAU) for caregivers in a congregate care facility for individuals with severe and profound IDD. The comparative effects of the two training conditions were assessed in terms of caregiver variables care recipient variable (number of aggressive events), and agency variables Results showed that MBPBS was significantly more effective than TAU in enabling the caregivers to manage their perceived psychological stress, and to reduce the use of physical restraints and stat medications for aggressive behavior of the individuals in their care. In addition, there were significant reductions in aggressive events by the individuals in their care, 1:1 staffing of individuals with aggressive behavior, and staff turnover. Furthermore, the MBPBS training was significantly more cost-effective than the TAU training. If replicated in future RCT studies, MBPBS may provide an effective means of enhancing socially acceptable bidirectional engagement of caregivers and care recipients within a person-centered context. PMID:27766088

  18. Comparative effectiveness of homoeopathic vs. conventional therapy in usual care of atopic eczema in children: long-term medical and economic outcomes.

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    Stephanie Roll

    Full Text Available BACKGROUND: One in five children visiting a homeopathic physician suffers from atopic eczema. OBJECTIVES: We aimed to examine the long-term effectiveness, safety and costs of homoeopathic vs. conventional treatment in usual medical care of children with atopic eczema. METHODS: In this prospective multi-centre comparative observational non-randomized rater-blinded study, 135 children (48 homoeopathy, 87 conventional with mild to moderate atopic eczema were included by their respective physicians. Depending on the specialisation of the physician, the primary treatment was either standard conventional treatment or individualized homeopathy as delivered in routine medical care. The main outcome was the SCORAD (SCORing Atopic Dermatitis at 36 months by a blinded rater. Further outcomes included quality of life, conventional medicine consumption, safety and disease related costs at six, 12 and 36 months after baseline. A multilevel ANCOVA was used, with physician as random effect and the following fixed effects: age, gender, baseline value, severity score, social class and parents' expectation. RESULTS: The adjusted mean SCORAD showed no significant differences between the groups at 36 months (13.7 95% CI [7.9-19.5] vs. 14.9 [10.4-19.4], p = 0.741. The SCORAD response rates at 36 months were similar in both groups (33% response: homoeopathic 63.9% vs. conventional 64.5%, p = 0.94; 50% response: 52.0% vs. 52.3%, p = 0.974. Total costs were higher in the homoeopathic versus the conventional group (months 31-36 200.54 Euro [132.33-268.76] vs. 68.86 Euro [9.13-128.58], p = 0.005. CONCLUSIONS: Taking patient preferences into account, while being unable to rule out residual confounding, in this long-term observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs.

  19. An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing.

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    Pinto, Daniel; Heleno, Bruno; Rodrigues, David S; Papoila, Ana Luísa; Santos, Isabel; Caetano, Pedro A

    2014-01-15

    The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown. The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies. A cost-benefit analysis will also be conducted. We will carry out a parallel, open, superiority, randomized trial directed to primary care physicians. Physicians will be recruited and allocated at a cluster-level (primary care unit) by minimization. Data will be analyzed at the physician level. Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate. Physicians in intervention units will be offered individual educational outreach visits (one for each guideline) at their workplace during a six-month period. Physicians in the control group will be offered a single unrelated group training session. Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class, and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database. We estimated a sample size of 110 physicians in each group, corresponding to 19 clusters with a mean size of 6 physicians. Outcome collection and data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and detailers cannot be blinded. This trial will attempt to address unresolved issues in the literature, namely, long term persistence of effect, the importance of sequential visits in an outreach program, and cost issues. If successful, this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese

  20. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial

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    Bergman Gert JD

    2010-09-01

    Full Text Available Abstract Background Shoulder complaints are common in primary care and have unfavourable long term prognosis. Our objective was to evaluate the clinical effectiveness of manipulative therapy of the cervicothoracic spine and the adjacent ribs in addition to usual medical care (UMC by the general practitioner in the treatment of shoulder complaints. Methods This economic evaluation was conducted alongside a randomized trial in primary care. Included were 150 patients with shoulder complaints and a dysfunction of the cervicothoracic spine and adjacent ribs. Patients were treated with UMC (NSAID's, corticosteroid injection or referral to physical therapy and were allocated at random (yes/no to manipulative therapy (manipulation and mobilization. Patient perceived recovery, severity of main complaint, shoulder pain, disability and general health were outcome measures. Data about direct and indirect costs were collected by means of a cost diary. Results Manipulative therapy as add-on to UMC accelerated recovery on all outcome measures included. At 26 weeks after randomization, both groups reported similar recovery rates (41% vs. 38%, but the difference between groups in improvement of severity of the main complaint, shoulder pain and disability sustained. Compared to the UMC group the total costs were higher in the manipulative group (€1167 vs. €555. This is explained mainly by the costs of the manipulative therapy itself and the higher costs due sick leave from work. The cost effectiveness ratio showed that additional manipulative treatment is more costly but also more effective than UMC alone. The cost-effectiveness acceptability curve shows that a 50%-probability of recovery with AMT within 6 months after initiation of treatment is achieved at €2876. Conclusion Manipulative therapy in addition to UMC accelerates recovery and is more effective than UMC alone on the long term, but is associated with higher costs. International Standard

  1. Physiotherapy informed by Acceptance and Commitment Therapy (PACT): protocol for a randomised controlled trial of PACT versus usual physiotherapy care for adults with chronic low back pain

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    Godfrey, Emma; Galea Holmes, Melissa; Wileman, Vari; McCracken, Lance; Moss-Morris, Rona; Pallet, John; Sanders, Duncan; Barcellona, Massimo; Critchley, Duncan

    2016-01-01

    Introduction Chronic low back pain (CLBP) is a common condition and source of significant suffering, disability and healthcare costs. Current physiotherapy treatment is moderately effective. Combining theory-based psychological methods with physiotherapy could improve outcomes for people with CLBP. The primary aim of this randomised controlled trial (RCT) is to evaluate the efficacy of Physiotherapy informed by Acceptance and Commitment Therapy (PACT) on functioning in patients with CLBP. Methods and analysis The PACT trial is a two-armed, parallel-group, multicentre RCT to assess the efficacy of PACT in comparison with usual physiotherapy care (UC). 240 patients referred to physiotherapy with CLBP will be recruited from three National Health Service (NHS) hospitals trusts. Inclusion criteria are: age ≥18 years, CLBP ≥12-week duration, scoring ≥3 points on the Roland-Morris Disability Questionnaire (RMDQ) and adequate understanding of spoken and written English to participate. Patients will be randomised to PACT or UC (120 per arm stratified by centre) by an independent randomisation service and followed up at 3 and 12 months post randomisation. The sample size of 240 will provide adequate power to detect a standardised mean difference of 0.40 in the primary outcome (RMDQ; 5% significance, 80% power) assuming attrition of 20%. Analysis will be by intention to treat conducted by the trial statistician, blind to treatment group, following a prespecified analysis plan. Estimates of treatment effect at the follow-up assessments will use an intention-to-treat framework, implemented using a linear mixed-effects model. Ethics and dissemination This trial has full ethical approval (14/SC/0277). It will be disseminated via peer-reviewed publications and conference presentations. The results will enable clinicians, patients and health service managers to make informed decisions regarding the efficacy of PACT for patients with CLBP. Trial registration number ISRCTN

  2. Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: a study protocol for a randomised trial

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    Kallesøe, Karen Hansen; Schröder, Andreas; Wicksell, Rikard K; Fink, Per; Ørnbøl, Eva; Rask, Charlotte Ulrikka

    2016-01-01

    Introduction Functional somatic syndromes (FSS) are common in adolescents, characterised by severe disability and reduced quality of life. Behavioural treatments such as acceptance and commitment therapy (ACT) has shown promising results in children and adolescents with FSS, but has focused on specific syndromes such as functional pain. The current study will compare the efficacy of group-based ACT with that of enhanced usual care (EUC) in adolescents with a range of FSS operationalised by the unifying construct of multiorgan bodily distress syndrome (BDS). Methods and analysis A total of 120 adolescents aged 15–19 and diagnosed with multiorgan BDS, of at least 12 months duration, will be assessed and randomised to either: (1) EUC: a manualised consultation with a child and adolescent psychiatrist and individualised treatment plan or (2) manualised ACT-based group therapy plus EUC. The ACT programme consists of 9 modules (ie, 27 hours) and 1 follow-up meeting (3 hours). The primary outcome is physical health, assessed by an Short Form Health Survey (SF-36) aggregate score 12 months after randomisation. Secondary outcomes include self-reported symptom severity, symptom interference, depression and anxiety, illness worry, perceived stress and global improvement; as well as objective physical activity and bodily stress response measured by heart rate variability, hair cortisol and inflammatory biomarkers. Process measures are illness perception, illness-related behaviour and psychological flexibility. Ethics and dissemination The study is conducted in accordance with Helsinki Declaration II. Approval has been obtained from the Science Ethics Committee of the Central Denmark Region and the Danish Data Protection. The results will be sought to be published according to the CONSORT statement in peer-reviewed journals. Discussion This is one of the first larger randomised clinical trials evaluating the effect of a group-based intervention for adolescents with a

  3. Investigating Impacts of Incorporating an Adjuvant Mind–Body Intervention Method Into Treatment as Usual at a Community-Based Substance Abuse Treatment Facility

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    Yoshio Nakamura

    2015-02-01

    Full Text Available Treatment of substance use/misuse (SUM continues to pose a difficult challenge. This exploratory pilot study evaluated whether a novel mind–body intervention program called “Mind–Body Bridging” (MBB could be an effective short-term adjuvant intervention for managing SUM and coexisting symptoms in women undergoing residential and outpatient substance use treatment in a community setting. Thirty-eight women attending a local substance abuse (SA facility were recruited and randomly assigned to either (a treatment as usual (TAU or (b MBB and TAU. The MBB program consisted of 20 sessions and lasted for 10 weeks. Participants were asked to complete a set of self-report questionnaires designed to assess drug/alcohol cravings, impact of past trauma, depression, sleep disturbance, mindfulness, self-compassion, and well-being. They completed the questionnaires at three time points: preintervention, midintervention (after the fifth week, and postintervention. MBB + TAU significantly reduced drug/alcohol cravings, trauma-related thinking, and disturbed sleep in comparison with TAU. Furthermore, MBB + TAU significantly increased mindfulness, self-compassion, and well-being in comparison with TAU. MBB for SUM appears promising as a complementary adjuvant intervention, warranting future larger scale randomized controlled trials of MBB for SUM populations. SUM is a difficult condition to treat and manage clinically, especially given the multiple comorbid conditions that frequently affect those with SUM. In the search to develop effective adjuvant interventions for SUM, the present pilot study suggested that adding MBB to standard SUM treatment in community-based settings could enhance therapeutic efficacy and quality of care.

  4. Proactive multiple cardiovascular risk factor management compared with usual care in patients with hypertension and additional risk factors: the CRUCIAL trial.

    Science.gov (United States)

    Zamorano, José; Erdine, Serap; Pavia, Abel; Kim, Jae-Hyung; Al-Khadra, Ayman; Westergaard, Mogens; Sutradhar, Santosh; Yunis, Carla

    2011-04-01

    To investigate whether a proactive multifactorial risk factor intervention strategy using single-pill amlodipine/atorvastatin (5/10, 10/10 mg) in addition to other antihypertensive and lipid-lowering therapy, as required, resulted in greater reduction in calculated Framingham 10-year coronary heart disease (CHD) risk compared with usual care (UC) after 52-weeks treatment. Prospective, multinational, open-label, cluster randomized trial, with the investigator as the unit of randomization. Eligible hypertensive patients were 35-79 years of age, with ≥3 additional cardiovascular risk factors, but no history of CHD and baseline total cholesterol (TC) ≤6.5 mmol/l. www.ClinicalTrials.gov ; trial identifier NCT00407537. The primary endpoint was calculated Framingham 10-year CHD risk at 52 weeks. Of the 140 randomized sites, 136 sites contributed 1461 patients. Mean baseline age and low-density lipoprotein cholesterol (LDL-C) were comparable between treatment arms. Mean baseline BP (150.3/89.7 vs. 144.3/86.5 mmHg) and Framingham CHD risk (20.0 vs. 18.1%) were higher in the proactive intervention versus the UC arm (p risk was 12.5% in the proactive intervention arm and 16.3% in the UC arm (p safety experience for this medication. A proactive multifactorial risk factor intervention strategy that simultaneously treated both BP and cholesterol regardless of individual risk factors per se, is more effective in reducing calculated Framingham 10-year CHD risk than UC in patients with hypertension and additional risk factors.

  5. Treatment of chronically depressed patients: a multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) for chronic depressions versus usual secondary care.

    Science.gov (United States)

    Wiersma, Jenneke E; van Schaik, Digna J F; van Oppen, Patricia; McCullough, James P; Schoevers, Robert A; Dekker, Jack J; Blom, Marc B J; Maas, Kristel; Smit, Johannes H; Penninx, Brenda W J H; Beekman, Aartjan T F

    2008-03-25

    'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) is a form of psychotherapy specifically developed for patients with chronic depression. In a study in the U.S., remarkable favorable effects of CBASP have been demonstrated. However, no other studies have as yet replicated these findings and CBASP has not been tested outside the United States. This protocol describes a randomized controlled trial on the effectiveness of CBASP in the Netherlands. The purpose of the present paper is to report the study protocol of a multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP) for chronic depression in the Netherlands. In this study, CBASP in combination with medication, will be tested versus usual secondary care in combination with medication. The aim is to recruit 160 patients from three mental health care organizations. Depressive symptoms will be assessed at baseline, after 8 weeks, 16 weeks, 32 weeks and 52 weeks, using the 28-item Inventory for Depressive Symptomatology (IDS). Effect modification by co morbid anxiety, alcohol consumption, general and social functioning and working alliance will be tested. GEE analyses of covariance, controlling for baseline value and center will be used to estimate the overall treatment effectiveness (difference in IDS score) at post-treatment and follow up. The primary analysis will be by 'intention to treat' using double sided tests. An economic analysis will compare the two groups in terms of mean costs and cost-effectiveness from a societal perspective. The study will provide an answer to the question whether the favorable effects of CBASP can be replicated outside the US. The Dutch Cochrane Center, NTR1090.

  6. Cost-effectiveness of counselling, graded-exercise and usual care for chronic fatigue: evidence from a randomised trial in primary care

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    Sabes-Figuera Ramon

    2012-08-01

    Full Text Available Abstract Background Fatigue is common and has been shown to result in high economic costs to society. The aim of this study is to compare the cost-effectiveness of two active therapies, graded-exercise (GET and counselling (COUN with usual care plus a self-help booklet (BUC for people presenting with chronic fatigue. Methods A randomised controlled trial was conducted with participants consulting for fatigue of over three months’ duration recruited from 31 general practices in South East England and allocated to one of three arms. Outcomes and use of services were assessed at 6-month follow-up. The main outcome measure used in the economic evaluation was clinically significant improvements in fatigue, measured using the Chalder fatigue scale. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves. Results Full economic and outcome data at six months were available for 163 participants; GET = 51, COUN = 58 and BUC = 54. Those receiving the active therapies (GET and COUN had more contacts with care professionals and therefore higher costs, these differences being statistically significant. COUN was more expensive and less effective than the other two therapies. The incremental cost-effectiveness ratio of GET compared to BUC was equal to £987 per unit of clinically significant improvement. However, there was much uncertainty around this result. Conclusion This study does not provide a clear recommendation about which therapeutic option to adopt, based on efficiency, for patients with chronic fatigue. It suggests that COUN is not cost-effective, but it is unclear whether GET represents value for money compared to BUC. Clinical Trial Registration number at ISRCTN register: 72136156

  7. The effect of integrated cardiac rehabilitation versus treatment as usual for atrial fibrillation patients treated with ablation: the randomised CopenHeartRFA trial protocol

    Science.gov (United States)

    Risom, Signe Stelling; Zwisler, Ann-Dorth Olsen; Rasmussen, Trine Bernholdt; Sibilitz, Kirstine Lærum; Svendsen, Jesper Hastrup; Gluud, Christian; Hansen, Jane Lindschou; Winkel, Per; Thygesen, Lau Caspar; Perhonen, Merja; Hansen, Jim; Dunbar, Sandra B; Berg, Selina Kikkenborg

    2013-01-01

    Introduction Atrial fibrillation affects almost 2% of the population in the Western world. To preserve sinus rhythm, ablation is undertaken in symptomatic patients. Observational studies show that patients with atrial fibrillation often report a low quality of life and are less prone to be physically active due to fear of triggering fibrillation. Small trials indicate that exercise training has a positive effect on exercise capacity and mental health, and both patients with recurrent atrial fibrillation and in sinus rhythm may benefit from rehabilitation in managing life after ablation. No randomised trials have been published on cardiac rehabilitation for atrial fibrillation patients treated with ablation that includes exercise and psychoeducational components. Aim To test the effects of an integrated cardiac rehabilitation programme versus treatment as usual for patients with atrial fibrillation treated with ablation. Methods and analysis design The trial is a multicentre parallel arm design with 1:1 randomisation to the intervention and control group with blinded outcome assessment. 210 patients treated for atrial fibrillation with radiofrequency ablation will be included. The intervention consists of a rehabilitation programme including four psychoeducative consultations with a specially trained nurse and 12 weeks of individualised exercise training, plus the standard medical follow-up. Patients in the control group will receive the standard medical follow-up. The primary outcome measure is exercise capacity measured by the VO2 peak. The secondary outcome measure is self-rated mental health measured by the Short Form 36 questionnaire. Postintervention, qualitative interviews will be conducted in 10% of the intervention group. Ethics and dissemination The protocol is approved by the regional research ethics committee (number H-1-2011-135), the Danish Data Protection Agency (reg. nr. 2007-58-0015) and follows the latest version of the Declaration of Helsinki

  8. Selective sweep analysis in the genomes of the 91-R and 91-C Drosophila melanogaster strains reveals few of the 'usual suspects' in dichlorodiphenyltrichloroethane (DDT) resistance.

    Science.gov (United States)

    Steele, Laura D; Coates, Brad; Valero, M Carmen; Sun, Weilin; Seong, Keon Mook; Muir, William M; Clark, John M; Pittendrigh, Barry R

    2015-01-01

    Adaptation of insect phenotypes for survival after exposure to xenobiotics can result from selection at multiple loci with additive genetic effects. To the authors' knowledge, no selective sweep analysis has been performed to identify such loci in highly dichlorodiphenyltrichloroethane (DDT) resistant insects. Here we compared a highly DDT resistant phenotype in the Drosophila melanogaster (Drosophila) 91-R strain to the DDT susceptible 91-C strain, both of common origin. Whole genome re-sequencing data from pools of individuals was generated separately for 91-R and 91-C, and mapped to the reference Drosophila genome assembly (v. 5.72). Thirteen major and three minor effect chromosome intervals with reduced nucleotide diversity (π) were identified only in the 91-R population. Estimates of Tajima's D (D) showed corresponding evidence of directional selection in these same genome regions of 91-R, however, no similar reductions in π or D estimates were detected in 91-C. An overabundance of non-synonymous proteins coding to synonymous changes were identified in putative open reading frames associated with 91-R. Except for NinaC and Cyp4g1, none of the identified genes were the 'usual suspects' previously observed to be associated with DDT resistance. Additionally, up-regulated ATP-binding cassette transporters have been previously associated with DDT resistance; however, here we identified a structurally altered MDR49 candidate resistance gene. The remaining fourteen genes have not previously been shown to be associated with DDT resistance. These results suggest hitherto unknown mechanisms of DDT resistance, most of which have been overlooked in previous transcriptional studies, with some genes having orthologs in mammals.

  9. Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial

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    Debbie L. Cohen

    2011-01-01

    Full Text Available The prevalence of prehypertension and Stage 1 hypertension continues to increase despite being amenable to non-pharmacologic interventions. Iyengar yoga (IY has been purported to reduce blood pressure (BP though evidence from randomized trials is lacking. We conducted a randomized controlled trial to assess the effects of 12 weeks of IY versus enhanced usual care (EUC (based on individual dietary adjustment on 24-h ambulatory BP in yoga-naïve adults with untreated prehypertension or Stage 1 hypertension. In total, 26 and 31 subjects in the IY and EUC arms, respectively, completed the study. There were no differences in BP between the groups at 6 and 12 weeks. In the EUC group, 24-h systolic BP (SBP, diastolic BP (DBP and mean arterial pressure (MAP significantly decreased by 5, 3 and 3 mmHg, respectively, from baseline at 6 weeks (P < .05, but were no longer significant at 12 weeks. In the IY group, 24 h SBP was reduced by 6 mmHg at 12 weeks compared to baseline (P = .05. 24 h DBP (P < .01 and MAP (P < .05 decreased significantly each by 5 mmHg. No differences were observed in catecholamine or cortisol metabolism to explain the decrease in BP in the IY group at 12 weeks. Twelve weeks of IY produces clinically meaningful improvements in 24 h SBP and DBP. Larger studies are needed to establish the long term efficacy, acceptability, utility and potential mechanisms of IY to control BP.

  10. Short Physical Performance Battery, usual gait speed, grip strength and Vulnerable Elders Survey each predict functional decline among older women with breast cancer.

    Science.gov (United States)

    Owusu, Cynthia; Margevicius, Seunghee; Schluchter, Mark; Koroukian, Siran M; Berger, Nathan A

    2017-09-01

    To determine the ability of three performance-based measures [Short Physical Performance Battery (SPPB), gait speed, and Grip Strength] and a self-report measure [Vulnerable Elders Survey (VES-13)] to predict functional decline among older women with breast cancer. Longitudinal data from a study of women ≥65years, with newly diagnosed stages I-III breast cancer, recruited from ambulatory oncology clinics between July 2010 and April 2014, was used. The primary outcome was functional decline, Yes or No, defined as a decrease in ≥1-point from baseline to 12months, on Activities of Daily Living Scales. Multivariable logistic regression and receiver operator curve analyses were conducted. Among 123 participants 18 (15%) developed functional decline. The predictive abilities for measures were: SPPB [Adjusted odds ratio (AOR)=1.65 per unit decrease in scores, 95% confidence interval (CI)=1.33-2.05; area under the receiver operator curve (AUC)=0.93; sensitivity=94%, specificity=80%]; gait speed (AOR=1.76 per unit increase in usual walking time, CI=1.29-2.41; AUC=0.93; sensitivity=87%, specificity=79%); VES-13 (AOR=1.64 per unit increase in scores, CI=1.31-2.05; AUC=0.87; sensitivity=83%, specificity=84%); and grip strength: (AOR=1.18 per unit decrease in grip strength, CI=1.06-1.30; AUC=0.80; sensitivity=67%, specificity=77%). SPPB, gait speed, grip strength and VES-13 all demonstrated excellent predictive abilities for functional decline. Larger studies are warranted to confirm the utility of these measures for identifying older adults with cancer at increased risk for functional decline, who may then be targeted for studies to explore the effects of interventions to improve function. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Identification of early-stage usual interstitial pneumonia from low-dose chest CT scans using fractional high-density lung distribution

    Science.gov (United States)

    Xie, Yiting; Salvatore, Mary; Liu, Shuang; Jirapatnakul, Artit; Yankelevitz, David F.; Henschke, Claudia I.; Reeves, Anthony P.

    2017-03-01

    A fully-automated computer algorithm has been developed to identify early-stage Usual Interstitial Pneumonia (UIP) using features computed from low-dose CT scans. In each scan, the pre-segmented lung region is divided into N subsections (N = 1, 8, 27, 64) by separating the lung from anterior/posterior, left/right and superior/inferior in 3D space. Each subsection has approximately the same volume. In each subsection, a classic density measurement (fractional high-density volume h) is evaluated to characterize the disease severity in that subsection, resulting in a feature vector of length N for each lung. Features are then combined in two different ways: concatenation (2*N features) and taking the maximum in each of the two corresponding subsections in the two lungs (N features). The algorithm was evaluated on a dataset consisting of 51 UIP and 56 normal cases, a combined feature vector was computed for each case and an SVM classifier (RBF kernel) was used to classify them into UIP or normal using ten-fold cross validation. A receiver operating characteristic (ROC) area under the curve (AUC) was used for evaluation. The highest AUC of 0.95 was achieved by using concatenated features and an N of 27. Using lung partition (N = 27, 64) with concatenated features had significantly better result over not using partitions (N = 1) (p-value < 0.05). Therefore this equal-volume partition fractional high-density volume method is useful in distinguishing early-stage UIP from normal cases.

  12. A GP caregiver needs toolkit versus usual care in the management of the needs of caregivers of patients with advanced cancer: a randomized controlled trial

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    Sibbritt David

    2010-11-01

    Full Text Available Abstract Background Caring for a person with progressive cancer creates challenges for caregivers. However the needs of caregivers are often not assessed or recognised by health care providers. Research is also lacking in this area, with little knowledge relating to effective strategies to address the specific needs of caregivers. This paper outlines a study protocol aimed at developing and evaluating the effectiveness of a general practice-based intervention to better meet the needs of caregivers of patients with advanced cancer. Methods/Design Two hundred and sixty caregivers will be randomised into each of two arms of the intervention (520 participants in total through patients with advanced cancer attending medical and radiation oncology outpatient clinics at two tertiary hospital sites. Consenting caregivers will be followed up for six months, and telephone surveyed at baseline, 1, 3 and 6 months following their entry into the study or until the patient's death, whichever occurs first. Assessment and management of the unmet needs of caregivers in the intervention arm will be facilitated through a specifically developed general practice-based strategy; caregivers in the control group will receive usual care. Qualitative interviews will be conducted with a sample of up to 20 caregivers and 10 GPs at the conclusion of their participation, to explore their views regarding the usefulness of the intervention. Discussion This study will determine whether systematic assessment of caregiver needs supported by caregiver-specific information for General Practitioners is effective in alleviating the unmet needs experienced by caregivers caring for patients with advanced cancer. Trial registration number ISRCTN: ISRCTN43614355

  13. Texture analysis using proton density and T2 relaxation in patients with histological usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP).

    Science.gov (United States)

    Buzan, Maria T A; Wetscherek, Andreas; Heussel, Claus Peter; Kreuter, Michael; Herth, Felix J; Warth, Arne; Kauczor, Hans-Ulrich; Pop, Carmen Monica; Dinkel, Julien

    2017-01-01

    The purpose of our study was to assess proton density (PD) and T2 relaxation time of usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) and to evaluate their utility in differentiating the two patterns. Furthermore, we aim to investigate whether these two parameters could help differentiate active-inflammatory and stable-fibrotic lesions in NSIP. 32 patients (mean age: 69 years; M:F, 1:1) with pathologically proven disease (UIP:NSIP, 1:1), underwent thoracic thin-section multislice CT scan and 1.5T MRI. A total of 437 regions-of-interest (ROIs) were classified at CT as advanced, moderate or mild alterations. Based on multi-echo single-shot TSE sequence acquired at five echo times, with breath-holding at end-expiration and ECG-triggering, entire lung T2 and PD maps were generated from each subject. The T2 relaxation time and the respective signal intensity were quantified by performing a ROI measurement on the T2 and PD maps in the corresponding CT selected areas of the lung. UIP and NSIP regional patterns could not be differentiated by T2 relaxation times or PD values alone. Overall, a strong positive correlation was found between T2 relaxation and PD in NSIP, r = 0.64, prelaxation showed significant statistical difference between active-inflammatory and stable-fibrotic NSIP regions at all levels, p0.05. T2 relaxation times and PD values may provide helpful quantitative information for differentiating NSIP from UIP pattern. These parameters have the potential to differentiate active-inflammatory and stable-fibrotic lesions in NSIP.

  14. Colloquium paper: where does biodiversity go from here? A grim business-as-usual forecast and a hopeful portfolio of partial solutions.

    Science.gov (United States)

    Ehrlich, Paul R; Pringle, Robert M

    2008-08-12

    The threats to the future of biodiversity are many and well known. They include habitat conversion, environmental toxification, climate change, and direct exploitation of wildlife, among others. Moreover, the projected addition of 2.6 billion people by mid-century will almost certainly have a greater environmental impact than that of the last 2.6 billion. Collectively, these trends portend a grim future for biodiversity under a business-as-usual scenario. These threats and their interactions are formidable, but we review seven strategies that, if implemented soundly and scaled up dramatically, would preserve a substantial portion of global biodiversity. These are actions to stabilize the human population and reduce its material consumption, the deployment of endowment funds and other strategies to ensure the efficacy and permanence of conservation areas, steps to make human-dominated landscapes hospitable to biodiversity, measures to account for the economic costs of habitat degradation, the ecological reclamation of degraded lands and repatriation of extirpated species, the education and empowerment of people in the rural tropics, and the fundamental transformation of human attitudes about nature. Like the carbon "stabilization wedges" outlined by Pacala and Socolow [Pacala S, Socolow R (2004) Stabilization wedges: Solving the climate problem for the next 50 years with current technologies. Science 305:968-972] (1), the science and technologies needed to effect this vision already exist. The remaining challenges are largely social, political, and economic. Although academic conservation biology still has an important role to play in developing technical tools and knowledge, success at this juncture hinges more on a massive mobilization of effort to do things that have traditionally been outside the scope of the discipline.

  15. Effectiveness of Caregiver Training in Mindfulness-Based Positive Behavior Supports (MBPBS vs. Training-as-Usual (TAU: A Randomized Controlled trial

    Directory of Open Access Journals (Sweden)

    Nirbhay N. Singh

    2016-10-01

    Full Text Available Caregivers of individuals with intellectual and developmental disabilities (IDD often end up having their medical and psychological well-being compromised due to the stressful nature of caregiving, especially when those in their care engage in aggressive behavior. In this study, we provided caregivers with mindfulness-based training to enable them to better manage their psychological well-being and, through this, to also enhance specific indices of quality of life of the individuals in their care. Thus, the aim of the present study was to evaluate in a randomized controlled trial (RCT the comparative effectiveness of Mindfulness-Based Positive Behavior Support (MBPBS and Training-as-Usual (TAU for caregivers in a congregate care facility for individuals with severe and profound IDD. The comparative effects of the two training conditions were assessed in terms of caregiver variables care recipient variable (number of aggressive events, and agency variables Results showed that MBPBS was significantly more effective than TAU in enabling the caregivers to manage their perceived psychological stress, and to reduce the use of physical restraints and stat medications for aggressive behavior of the individuals in their care. In addition, there were significant reductions in aggressive events by the individuals in their care, 1:1 staffing of individuals with aggressive behavior, and staff turnover. Furthermore, the MBPBS training was significantly more cost-effective than the TAU training. If replicated in future RCT studies, MBPBS may provide an effective means of enhancing socially acceptable bidirectional engagement of caregivers and care recipients within a person-centered context.

  16. Future changes in climate, ocean circulation, ecosystems, and biogeochemical cycling simulated for a business-as-usual CO2 emission scenario until year 4000 AD

    Science.gov (United States)

    Schmittner, Andreas; Oschlies, Andreas; Matthews, H. Damon; Galbraith, Eric D.

    2008-03-01

    A new model of global climate, ocean circulation, ecosystems, and biogeochemical cycling, including a fully coupled carbon cycle, is presented and evaluated. The model is consistent with multiple observational data sets from the past 50 years as well as with the observed warming of global surface air and sea temperatures during the last 150 years. It is applied to a simulation of the coming two millennia following a business-as-usual scenario of anthropogenic CO2 emissions (SRES A2 until year 2100 and subsequent linear decrease to zero until year 2300, corresponding to a total release of 5100 GtC). Atmospheric CO2 increases to a peak of more than 2000 ppmv near year 2300 (that is an airborne fraction of 72% of the emissions) followed by a gradual decline to ˜1700 ppmv at year 4000 (airborne fraction of 56%). Forty-four percent of the additional atmospheric CO2 at year 4000 is due to positive carbon cycle-climate feedbacks. Global surface air warms by ˜10°C, sea ice melts back to 10% of its current area, and the circulation of the abyssal ocean collapses. Subsurface oxygen concentrations decrease, tripling the volume of suboxic water and quadrupling the global water column denitrification. We estimate 60 ppb increase in atmospheric N2O concentrations owing to doubling of its oceanic production, leading to a weak positive feedback and contributing about 0.24°C warming at year 4000. Global ocean primary production almost doubles by year 4000. Planktonic biomass increases at high latitudes and in the subtropics whereas it decreases at midlatitudes and in the tropics. In our model, which does not account for possible direct impacts of acidification on ocean biology, production of calcium carbonate in the surface ocean doubles, further increasing surface ocean and atmospheric pCO2. This represents a new positive feedback mechanism and leads to a strengthening of the positive interaction between climate change and the carbon cycle on a multicentennial to millennial

  17. Screening for distress, the 6th vital sign: common problems in cancer outpatients over one year in usual care: associations with marital status, sex, and age

    Directory of Open Access Journals (Sweden)

    Giese-Davis Janine

    2012-10-01

    Full Text Available Abstract Background Very few studies examine the longitudinal prevalence of problems and the awareness or use of clinical programs by patients who report these problems. Of the studies that examine age, gender and marital status as predictors of a range of patient outcomes, none examines the interactions between these demographic variables. This study examined the typical trajectory of common practical and psychosocial problems endorsed over 12 months in a usual-care sample of cancer outpatients. Specifically, we examined whether marital status, sex, age, and their interactions predicted these trajectories. We did not actively triage or refer patients in this study in order to examine the natural course of problem reports. Methods Patients completed baseline screening (N = 1196 of 1707 approached and the sample included more men (N = 696 than women (N = 498, average age 61.1 years. The most common diagnoses were gastrointestinal (27.1%, prostate (19.2%, skin (11.1% and gynecological (9.2%. Among other measures, patients completed a Common Problem Checklist and Psychosocial Resources Use questions at baseline, 3, 6, and 12 months using paper and pencil surveys. Results Results indicated that patients reported psychosocial problems more often than practical and both decreased significantly over time. Younger single patients reported more practical problems than those in committed relationships. Younger patients and women of all ages reported more psychosocial problems. Among a number of interesting interactions, for practical problems, single older patients improved more; whereas among married people, younger patients improved more. For psychosocial problems we found that older female patients improved more than younger females, but among males, it was younger patients who improved more. Young single men and women reported the most past-and future-use of services. Conclusions Younger women are particularly vulnerable to experiencing

  18. Comparison of usual podiatric care and early physical therapy intervention for plantar heel pain: study protocol for a parallel-group randomized clinical trial

    Science.gov (United States)

    2013-01-01

    Background A significant number of individuals suffer from plantar heel pain (PHP) and many go on to have chronic symptoms and continued disability. Persistence of symptoms adds to the economic burden of PHP and cost-effective solutions are needed. Currently, there is a wide variation in treatment, cost, and outcomes of care for PHP with limited information on the cost-effectiveness and comparisons of common treatment approaches. Two practice guidelines and recent evidence of effective physical therapy intervention are available to direct treatment but the timing and influence of physical therapy intervention in the multidisciplinary management of PHP is unclear. The purpose of this investigation is to compare the outcomes and costs associated with early physical therapy intervention (ePT) following initial presentation to podiatry versus usual podiatric care (uPOD) in individuals with PHP. Methods A parallel-group, block-randomized clinical trial will compare ePT and uPOD. Both groups will be seen initially by a podiatrist before allocation to a group that will receive physical therapy intervention consisting primarily of manual therapy, exercise, and modalities, or podiatric care consisting primarily of a stretching handout, medication, injections, and orthotics. Treatment in each group will be directed by practice guidelines and a procedural manual, yet the specific intervention for each participant will be selected by the treating provider. Between-group differences in the Foot and Ankle Ability Measure 6 months following the initial visit will be the primary outcome collected by an independent investigator. In addition, differences in the European Quality of Life – Five Dimensions, Numeric Pain Rating Scale, Global Rating of Change (GROC), health-related costs, and cost-effectiveness at 6 weeks, 6 months, and 1 year will be compared between groups. The association between successful outcomes based on GROC score and participant expectations of recovery

  19. DEGRADATION OF OXO-BIODEGRADABLE AND USUAL PLASTIC PACKAGING = DEGRADAÇÃO DE EMBALAGENS PLÁSTICAS OXI-BIODEGRADÁVEIS E COMUNS

    Directory of Open Access Journals (Sweden)

    Caio da Silva Miranda

    2015-11-01

    Full Text Available The mostly packaging Urban Solid Waste are bought or acquired in commercial establishments. This study was possible to analyze the degradation of packaging urban solid waste, checking which packages used by consumers cause for less impact on the environment. The experimental conditions adopted in this present study are due to the variation of temperature, time, amount of leachate and/ or rainwater. Therefore, with the experiments it can be seen that variation of nutrients matches the variation of microorganism in the filtrate of rainwater and leachate. The samples immersed in rainwater and leachate obtained opposite results among themselves. The samples have degraded more at the high temperatures. In a short exposure time have been shown to hardly relevant to the degradation. In general the oxo-biodegradable packaging get showed similar results with the usual packaging. = A maioria das embalagens plásticas é sacola comprada ou recebida gratuitamente de estabelecimentos comerciais. No presente trabalho foi possível analisar a degradação de embalagens plásticas oxi-biodegradáveis e as comuns, verificando quais delas utilizadas pelos consumidores causam menos impacto ao meio ambiente. As condições experimentais adotadas no presente trabalho foram em função da variação de temperatura, tempo, na presença de chorume e de água de chuva. Com a realização dos experimentos pode-se observar que uma variação de nutrientes condisse com a variação de micro-organismos nos filtrados de água da chuva e do chorume. As amostras imersas em água da chuva e no chorume obtiveram efeitos inversos entre si. As amostras degradaram mais em altas temperaturas. Em pequeno período de exposição, o tempo se mostrou pouco relevante para a degradação. De uma forma geral, as embalagens oxibiodegradáveis apresentaram resultados parecidos com as embalagens comuns.

  20. Exercise augmentation compared to usual care for Post Traumatic Stress Disorder: A Randomised Controlled Trial (The REAP study: Randomised Exercise Augmentation for PTSD

    Directory of Open Access Journals (Sweden)

    van der Ploeg Hidde P

    2011-07-01

    Full Text Available Abstract Background The physical wellbeing of people with mental health conditions can often be overlooked in order to treat the primary mental health condition as a priority. Exercise however, can potentially improve both the primary psychiatric condition as well as physical measures that indicate risk of other conditions such as diabetes mellitus and cardiovascular disease. Evidence supports the role of exercise as an important component of treatment for depression and anxiety, yet no randomised controlled trials (RCT's have been conducted to evaluate the use of exercise in the treatment of people with post traumatic stress disorder (PTSD. This RCT will investigate the effects of structured, progressive exercise on PTSD symptoms, functional ability, body composition, physical activity levels, sleep patterns and medication usage. Methods and design Eighty participants with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV diagnosis of PTSD will be recruited. Participants will have no contraindications to exercise and will be cognitively able to provide consent to participate in the study. The primary outcome measures will be PTSD symptoms, measured through the PTSD Checklist Civilian (PCL-C scale. Secondary outcome measures will assess depression and anxiety, mobility and strength, body composition, physical activity levels, sleep patterns and medication usage. All outcomes will be assessed by a health or exercise professional masked to group allocation at baseline and 12 weeks after randomisation. The intervention will be a 12 week individualised program, primarily involving resistance exercises with the use of exercise bands. A walking component will also be incorporated. Participants will complete one supervised session per week, and will be asked to perform at least two other non-supervised exercise sessions per week. Both intervention and control groups will receive all usual non-exercise interventions including psychotherapy

  1. Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: a study protocol for a randomised trial.

    Science.gov (United States)

    Kallesøe, Karen Hansen; Schröder, Andreas; Wicksell, Rikard K; Fink, Per; Ørnbøl, Eva; Rask, Charlotte Ulrikka

    2016-09-15

    Functional somatic syndromes (FSS) are common in adolescents, characterised by severe disability and reduced quality of life. Behavioural treatments such as acceptance and commitment therapy (ACT) has shown promising results in children and adolescents with FSS, but has focused on specific syndromes such as functional pain. The current study will compare the efficacy of group-based ACT with that of enhanced usual care (EUC) in adolescents with a range of FSS operationalised by the unifying construct of multiorgan bodily distress syndrome (BDS). A total of 120 adolescents aged 15-19 and diagnosed with multiorgan BDS, of at least 12 months duration, will be assessed and randomised to either: (1) EUC: a manualised consultation with a child and adolescent psychiatrist and individualised treatment plan or (2) manualised ACT-based group therapy plus EUC. The ACT programme consists of 9 modules (ie, 27 hours) and 1 follow-up meeting (3 hours). The primary outcome is physical health, assessed by an Short Form Health Survey (SF-36) aggregate score 12 months after randomisation. Secondary outcomes include self-reported symptom severity, symptom interference, depression and anxiety, illness worry, perceived stress and global improvement; as well as objective physical activity and bodily stress response measured by heart rate variability, hair cortisol and inflammatory biomarkers. Process measures are illness perception, illness-related behaviour and psychological flexibility. The study is conducted in accordance with Helsinki Declaration II. Approval has been obtained from the Science Ethics Committee of the Central Denmark Region and the Danish Data Protection. The results will be sought to be published according to the CONSORT statement in peer-reviewed journals. This is one of the first larger randomised clinical trials evaluating the effect of a group-based intervention for adolescents with a range of severe FSS. NCT02346071; Pre-results. Published by the BMJ

  2. Comparison of Usual Interstitial Pneumonia and Nonspecific Interstitial Pneumonia: Quantification of Disease Severity and Discrimination between Two Diseases on HRCT Using a Texture-Based Automated System

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sang Ok; Kim, Dong Soon [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Lee, Young Kyung [East-West Neo Medical Center of Kyung Hee University, Seoul (Korea, Republic of); Lee, Jeong Jin [The Catholic University of Korea, Seoul (Korea, Republic of)

    2011-06-15

    To evaluate the usefulness of an automated system for quantification and discrimination of usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). An automated system to quantify six regional high-resolution CT (HRCT) patterns: normal, NL; ground-glass opacity, GGO; reticular opacity, RO; honeycombing, HC; emphysema, EMPH; and consolidation, CONS, was developed using texture and shape features. Fifty-four patients with pathologically proven UIP (n = 26) and pathologically proven NSIP (n 28) were included as part of this study. Inter-observer agreement in measuring the extent of each HRCT pattern between the system and two thoracic radiologists were assessed in 26 randomly selected subsets using an interclass correlation coefficient (ICC). A linear regression analysis was used to assess the contribution of each disease pattern to the pulmonary function test parameters. The discriminating capacity of the system between UIP and NSIP was evaluated using a binomial logistic regression. The overall ICC showed acceptable agreement among the system and the two radiologists (r = 0.895 for the abnormal lung volume fraction, 0.706 for the fibrosis fraction, 0.895 for NL, 0.625 for GGO, 0.626 for RO, 0.893 for HC, 0.800 for EMPH, and 0.430 for CONS). The volumes of NL, GGO, RO, and EMPH contribute to forced expiratory volume during one second (FEV1) (r = 0.72, {beta} values, 0.84, 0.34, 0.34 and 0.24, respectively) and forced vital capacity (FVC) (r 0.76, {beta} values, 0.82, 0.28, 0.21 and 0.34, respectively). For diffusing capacity (DLco), the volumes of NL and HC were independent contributors in opposite directions (r = 0.65, {beta} values, 0.64, -0.21, respectively). The automated system can help discriminate between UIP and NSIP with an accuracy of 82%. The automated quantification system of regional HRCT patterns can be useful in the assessment of disease severity and may provide reliable agreement with the radiologists' results. In

  3. Cost-Effectiveness of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care among Adults with Chronic Low-Back Pain.

    Science.gov (United States)

    Herman, Patricia M; Anderson, Melissa L; Sherman, Karen J; Balderson, Benjamin H; Turner, Judith A; Cherkin, Daniel C

    2017-07-24

    Economic evaluation alongside a randomized trial of cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) versus usual care alone (UC) for chronic low-back pain (CLBP). Determine the one-year cost-effectiveness of CBT and MBSR compared to UC. CLBP is expensive in terms of healthcare costs and lost productivity. Mind-body interventions have been found effective for back pain, but their cost-effectiveness is unexplored. 342 adults in an integrated healthcare system with CLBP were randomized to receive MBSR (n = 116), CBT (n = 113), or UC (n = 113). CBT and MBSR were offered in 8 weekly 2-hour group sessions. Cost-effectiveness from the societal perspective was calculated as the incremental sum of healthcare costs and productivity losses over change in quality-adjusted life-years (QALYs). The payer perspective only included healthcare costs. This economic evaluation was limited to the 301 health plan members enrolled >=180 days in the years pre-and post-randomization. Compared to UC, the mean incremental cost per participant to society of CBT was $125 (95% CI: -4103, 4307) and of MBSR was -$724 (CI: -4386, 2778)-i.e., a net saving of $724. Incremental costs per participant to the health plan were $495 for CBT over UC and -$982 for MBSR, and incremental back-related costs per participant were $984 for CBT over UC and -$127 for MBSR. These costs (and cost savings) were associated with statistically significant gains in QALYs over UC: 0.041 (0.015, 0.067) for CBT and 0.034 (0.008, 0.060) for MBSR. In this setting CBT and MBSR have high probabilities of being cost-effective, and MBSR may be cost saving, as compared to UC for adults with CLBP. These findings suggest that MBSR, and to a lesser extent CBT, may provide cost-effective treatment for CLBP for payers and society. 2.

  4. Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain

    Directory of Open Access Journals (Sweden)

    De Salas-Cansado M

    2012-06-01

    identified, comprising 157 in a pregabalin group and 125 in an SSRI/SNRI group. Compared with SSRI/SNRI, pregabalin (average dose 163 mg/day was associated with higher quality-adjusted life years gained (0.1086 ± 0.0953 versus 0.0967 ± 0.1003, P = 0.334, but increased health care costs (€1014 ± 762 versus €846 ± 620, P = 0.166 and drug costs (€376 ± 252 versus 220 ± 140, P < 0.001, resulting in an incremental cost-effectiveness ratio of €25,304 (95% confidence interval dominant 149,430 per quality-adjusted life years gained for health care costs and €25,454 (dominant 124,562 when drug costs were considered alone. Eighty-six percent of resamples fell below the threshold of €30,000 per quality-adjusted life years.Conclusion: This evaluation suggests that pregabalin may be cost-effective in comparison with SSRIs/SNRIs in benzodiazepine-refractory outpatients with GAD treated in mental health care settings under usual medical practice in Spain.Keywords: cost-effectiveness, generalized anxiety disorder, benzodiazepine-refractory patients, pregabalin, quality-adjusted life years

  5. Comparison of the caries-protective effect of fluoride varnish with treatment as usual in nursery school attendees receiving preventive oral health support through the Childsmile oral health improvement programme - the Protecting Teeth@3 Study: a randomised controlled trial.

    Science.gov (United States)

    Wright, William; Turner, Stephen; Anopa, Yulia; McIntosh, Emma; Wu, Olivia; Conway, David I; Macpherson, Lorna M D; McMahon, Alex D

    2015-12-18

    The Scottish Government set out its policy on addressing the poor oral health of Scottish children in 2005. This led to the establishment of Childsmile, a national programme designed to improve the oral health of children in Scotland. One element of the programme promotes daily tooth brushing in all nurseries in Scotland (Childsmile Core). A second targeted component (Childsmile Nursery) offers twice-yearly application of fluoride varnish to children attending nurseries in deprived areas. Studies suggest that fluoride varnish application can reduce caries in both adult and child populations. This trial aims to explore the effectiveness and cost-effectiveness of additional preventive value fluoride varnish application compared to Childsmile Core. The Protecting Teeth@3 Study is an ongoing 2 year parallel group randomised treatment as usual controlled trial. Three-year-old children attending the ante pre-school year are randomised (1:1) to the intervention arm (fluoride varnish & treatment as usual) or the control arm (treatment as usual). Children in the intervention arm will have Duraphat® fluoride varnish painted on the primary tooth surfaces and will continue to receive treatment as usual: the core Childsmile Nursery intervention. Children in the treatment as usual arm will receive the same series of contacts, without the application of varnish and will also continue with the Childsmile Core intervention. Interventions are undertaken by Childsmile trained extended duty dental nurses at six-monthly intervals. Participants receive a baseline dental inspection in nursery and an endpoint inspection in Primary 1 at the age of 5 years old. We will use primary and secondary outcome measures to compare the effectiveness of Duraphat® fluoride varnish plus treatment as usual with treatment as usual only in preventing any further dental decay. We will also undertake a full economic evaluation of the trial. This study is registered at ClinicalTrials.gov. Number: NCT

  6. Clinico-pathological conference (CPC: a previously healthy patient with respiratory insuficiency due to intersticial pneumonia = Conferencia Clínico Patológica (CPC: paciente previamente sana con insuficiencia respiratoria debida a neumonía intersticial

    Directory of Open Access Journals (Sweden)

    Serna Ortiz, Carlos Andrés

    2013-01-01

    Full Text Available We present the case of a 40-year-old woman, with no remarkable past medical history, who was admitted to San Vicente Foundation University Hospital, in Medellín, Colombia; she complained of respiratory symptoms lasting 20 days. Interstitial pneumonia associated with AIDS was diagnosed, which progressed to respiratory failure that did not respond to therapy directed against the opportunistic infections that were identified. She finally developed multiorgan failure that caused death.

  7. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Rasmussen, Søren

    2008-01-01

    BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic ...

  8. Three-year follow-up of 3-year-old to 5-year-old children after participation in a multidisciplinary or a usual-care obesity treatment program

    NARCIS (Netherlands)

    Bocca, Gianni; Corpeleijn, Eva; van den Heuvel, Edwin R.; Stolk, Ronald P.; Sauer, Pieter J. J.

    2014-01-01

    Background & aims: Little is known on the long-term effects of obesity intervention programs in preschool-aged children. We compared the long-term effects of a multidisciplinary treatment program with a usual-care program in seventy-five 3- to 5-year-old overweight or obese children who had

  9. Cost-effectiveness of involving nurse specialists for adult patients with urinary incontinence in primary care compared to care-as-usual: an economic evaluation alongside a pragmatic randomized controlled trial.

    NARCIS (Netherlands)

    Albers-Heitner, C.P.; Joore, M.A.; Winkens, R.A.G.; Lagro-Janssen, A.L.M.; Severens, J.L.; Berghmans, L.C.M.

    2012-01-01

    AIMS: To determine the 12-month, societal cost-effectiveness of involving urinary incontinence (UI) nurse specialists in primary care compared to care-as-usual by general practitioners (GPs). METHODS: From 2005 until 2008 an economic evaluation was performed alongside a pragmatic multicenter randomi

  10. Three-year follow-up of 3-year-old to 5-year-old children after participation in a multidisciplinary or a usual-care obesity treatment program

    NARCIS (Netherlands)

    Bocca, Gianni; Corpeleijn, Eva; van den Heuvel, Edwin R.; Stolk, Ronald P.; Sauer, Pieter J. J.

    2014-01-01

    Background & aims: Little is known on the long-term effects of obesity intervention programs in preschool-aged children. We compared the long-term effects of a multidisciplinary treatment program with a usual-care program in seventy-five 3- to 5-year-old overweight or obese children who had particip

  11. Pulmonary interstitial emphysema in neonates -reporting of 11 cases; Enfisema pulmonar intersticial neonatal -descricao de uma serie de 11 casos

    Energy Technology Data Exchange (ETDEWEB)

    Alvares, Beatriz Regina; Santos Mezzacappa, Maria Aparecida dos; Marba, Sergio Tadeu Martins [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Ciencias Medicas

    1997-07-01

    The present paper relates the radiologic and clinical aspects of pulmonary interstitial emphysema in 11 infants submitted to assisted ventilation. The radiologic diagnosis was made using the classification of Boothroyd and Barson (levels I to III). A prevalence of pulmonary interstitial emphysema of levels II and III was observed in masculine premature infants with hyaline membrane disease and intrauterine pneumonia. Mortality was high and occurred in the infants with advanced levels of the disease. The authors emphasize the importance of early radiologic diagnosis of this condition during the treatment of premature infants submitted to assisted ventilation. (author) 9 refs., 5 figs., 1 tab.

  12. Especiación del carbono inorgánico en sistemas estuáricos y agua intersticial

    OpenAIRE

    Ortega, T,; J. M. Forja; Gómez-Parra, A.

    2001-01-01

    A calculation procedure to obtain pH, total alkalinity and concentration of inorganic carbon, based on the application of Gran functions, is described. An iterative program was used to optimise the electrode standard potential (E₀) and inorganic carbon concentration. Alkalinities higher than 15 mM were detected in interstitial waters from sediments collected in Cadiz Bay. A contribution of 20 % was associated with those acid-based species other than inorganic carbon. Speciation of inorganic c...

  13. Multicolor immunofluorescence reveals that p63- and/or K5-positive progenitor cells contribute to normal breast epithelium and usual ductal hyperplasia but not to low-grade intraepithelial neoplasia of the breast.

    Science.gov (United States)

    Boecker, Werner; Stenman, Göran; Schroeder, Tina; Schumacher, Udo; Loening, Thomas; Stahnke, Lisa; Löhnert, Catharina; Siering, Robert Michael; Kuper, Arthur; Samoilova, Vera; Tiemann, Markus; Korsching, Eberhard; Buchwalow, Igor

    2017-03-16

    We contend that knowledge about the cellular composition of normal breast epithelium is a prerequisite for understanding proliferative breast disease. Against this background, we used multicolor immunofluorescence to study normal breast epithelium and two types of intraepithelial proliferative breast lesion for expression of the p63, basal keratin K5, glandular keratin K8/18, SMA, ER-alpha, and Ki67. We studied eight normal breast epithelium samples, 12 cases of usual ductal hyperplasia, and 33 cases of low-grade intraepithelial neoplasia (9 flat epithelial atypia, 14 low-grade ductal carcinoma in situ and 10 cases of lobular neoplasia). Usual ductal hyperplasia showed striking similarity to normal luminal breast epithelium including p63+ and/or K5+ luminal progenitor cells and the full spectrum of luminal progeny cells. In normal breast epithelium and usual ductal hyperplasia, expression of ER-alpha was associated with lack of expression of the proliferation antigen Ki67. In contrast, we found in both types of low-grade intraepithelial neoplasia robust expression of keratin K8/18 and a positive association between ER-alpha and Ki67 expression. However, these lesions were consistently negative for p63 and/or K5. Our observational study supports the view that usual ductal hyperplasia and low-grade intraepithelial neoplasia are different entities rather than part of a spectrum of the same disease. We propose a new operational model of cell differentiation that may serve to better understand correlations between normal breast epithelium and proliferative breast diseases. From our data we conclude that p63+ and/or K5+ progenitor cells contribute to maintenance of normal epithelium and usual ductal hyperplasia, but not to low-grade intraepithelial neoplasia of the breast.

  14. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFRCT: outcome and resource impacts study

    Science.gov (United States)

    Douglas, Pamela S.; Pontone, Gianluca; Hlatky, Mark A.; Patel, Manesh R.; Norgaard, Bjarne L.; Byrne, Robert A.; Curzen, Nick; Purcell, Ian; Gutberlet, Matthias; Rioufol, Gilles; Hink, Ulrich; Schuchlenz, Herwig Walter; Feuchtner, Gudrun; Gilard, Martine; Andreini, Daniele; Jensen, Jesper M.; Hadamitzky, Martin; Chiswell, Karen; Cyr, Derek; Wilk, Alan; Wang, Furong; Rogers, Campbell; De Bruyne, Bernard

    2015-01-01

    Aims In symptomatic patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) improves patient selection for invasive coronary angiography (ICA) compared with functional testing. The impact of measuring fractional flow reserve by CTA (FFRCT) is unknown. Methods and results At 11 sites, 584 patients with new onset chest pain were prospectively assigned to receive either usual testing (n = 287) or CTA/FFRCT (n = 297). Test interpretation and care decisions were made by the clinical care team. The primary endpoint was the percentage of those with planned ICA in whom no significant obstructive CAD (no stenosis ≥50% by core laboratory quantitative analysis or invasive FFR < 0.80) was found at ICA within 90 days. Secondary endpoints including death, myocardial infarction, and unplanned revascularization were independently and blindly adjudicated. Subjects averaged 61 ± 11 years of age, 40% were female, and the mean pre-test probability of obstructive CAD was 49 ± 17%. Among those with intended ICA (FFRCT-guided = 193; usual care = 187), no obstructive CAD was found at ICA in 24 (12%) in the CTA/FFRCT arm and 137 (73%) in the usual care arm (risk difference 61%, 95% confidence interval 53–69, P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4 mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after receiving CTA/FFRCT results. Among those with intended non-invasive testing, the rates of finding no obstructive CAD at ICA were 13% (CTA/FFRCT) and 6% (usual care; P = 0.95). Clinical event rates within 90 days were low in usual care and CTA/FFRCT arms. Conclusions Computed tomographic angiography/fractional flow reserve by CTA was a feasible and safe alternative to ICA and was associated with a significantly lower rate of invasive angiography showing no obstructive CAD. PMID:26330417

  15. Ten (Usually Wrong) Ideas about ELLs

    Science.gov (United States)

    Gottschalk, Barbara

    2016-01-01

    ESOL teacher Barbara Gottshalk frequently hears well-intentioned but misinformed comments and questions about English language learners and her teaching field. In this article, she clarifies the misconceptions revealed by 10 common remarks--for example, "The students will never learn English if they don't speak it in their home,"…

  16. Addgene: making materials sharing "science as usual".

    Directory of Open Access Journals (Sweden)

    Joanne Kamens

    2014-11-01

    Full Text Available Addgene (www.addgene.org is a nonprofit organization that facilitates biomedical research and discovery by improving access to useful research materials and information. To fulfill this mission, Addgene works with hundreds of laboratories all over the world to collect high-quality published plasmids and data for the repository that can then be distributed to academic institutions and used to further research. Biological resource centers such as Addgene are an important part of the scientific infrastructure. They play a key role in helping scientists overcome logistical barriers to sharing, improving experimental reproducibility, and optimizing use of limited resources.

  17. The usual treatment of trigeminal autonomic cephalalgias.

    Science.gov (United States)

    Pareja, Juan A; Álvarez, Mónica

    2013-10-01

    Trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, and rhinorrhea (SUNCT). Conventional pharmacological therapy can be successful in the majority of trigeminal autonomic cephalalgias patients. Most cluster headache attacks respond to 100% oxygen inhalation, or 6 mg subcutaneous sumatriptan. Nasal spray of sumatriptan (20 mg) or zolmitriptan (5 mg) are recommended as second choice. The bouts can be brought under control by a short course of corticosteroids (oral prednisone: 60-100 mg/day, or intravenous methylprednisolone: 250-500 mg/day, for 5 days, followed by tapering off the dosage), or by long-term prophylaxis with verapamil (at least 240 mg/day). Alternative long-term preventive medications include lithium carbonate (800-1600 mg/day), methylergonovine (0.4-1.2 mg/day), and topiramate (100-200 mg/day). As a rule, paroxysmal hemicrania responds to preventive treatment with indomethacin (75-150 mg/day). A short course of intravenous lidocaine (1-4 mg/kg/hour) can reduce the flow of attacks during exacerbations of SUNCT. Lamotrigine (100-300 mg/day) is the preventive drug of choice for SUNCT. Gabapentin (800-2700 mg/day), topiramate (50-300 mg/day), and carbamazepine (200-1600 mg/day) may be of help. © 2013 American Headache Society.

  18. Security threats are usually an inside job.

    Science.gov (United States)

    Simpson, R L

    1996-12-01

    Although most health care providers fear the unnamed backer, the real risk of computer security danger lies in the hands of seemingly innocuous or harmless individuals within the institution. Creating information security from the inside out is the key to ensuring privacy and confidentiality.

  19. Engineer Works as Usual Despite Honors

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    HU Meijuan, 49, is a high-ranking engineer in charge of computer operations at the Qinshan Nuclear Power Station, the first nuclear power station built by China. Among more than 600 technicians, there are many women, but Hu is considered the most understanding of them. In 1987 the Qinshan Nuclear Power Station started operations in scenic Hangzhouwan. A large group of qualified personnel in

  20. Teaching Across Borders: Business as Usual?

    OpenAIRE

    Allen, Bobbe McGhie

    2011-01-01

    The quest to comprehend how cultural differences can impact learning is one of those intriguing challenges that continue to beguile some scholars and educational leaders even at a time that is characterized as globalized. This dissertation is a qualitative case study about teaching to culturally diverse populations and is primarily based on the interviews of seven accountants designated as instructors and the direct observation of those instructors while teaching accounting principles to othe...

  1. Antibiotic research and development: business as usual?

    NARCIS (Netherlands)

    Harbarth, S.; Theuretzbacher, U.; Hackett, J.; Hulscher, M.

    2015-01-01

    The global burden of antibiotic resistance is tremendous and, without new anti-infective strategies, will continue to increase in the coming decades. Despite the growing need for new antibiotics, few pharmaceutical companies today retain active antibacterial drug discovery programmes. One reason is

  2. Antibiotic research and development: business as usual?

    Science.gov (United States)

    Harbarth, S; Theuretzbacher, U; Hackett, J

    2015-01-01

    The global burden of antibiotic resistance is tremendous and, without new anti-infective strategies, will continue to increase in the coming decades. Despite the growing need for new antibiotics, few pharmaceutical companies today retain active antibacterial drug discovery programmes. One reason is that it is scientifically challenging to discover new antibiotics that are active against the antibiotic-resistant bacteria of current clinical concern. However, the main hurdle is diminishing economic incentives. Increased global calls to minimize the overuse of antibiotics, the cost of meeting regulatory requirements and the low prices of currently marketed antibiotics are strong deterrents to antibacterial drug development programmes. New economic models that create incentives for the discovery of new antibiotics and yet reconcile these incentives with responsible antibiotic use are long overdue. DRIVE-AB is a €9.4 million public-private consortium, funded by the EU Innovative Medicines Initiative, that aims to define a standard for the responsible use of antibiotics and to develop, test and recommend new economic models to incentivize investment in producing new anti-infective agents. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  3. Roadblocks to Reform: Beyond the Usual Suspects

    OpenAIRE

    Grignon Michel

    2012-01-01

    Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered for why such reforms are so difficult: institutional gridlock, path dependency and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that, as a result, public resistance to real reform may more accurately reflect citizensÕ personal convictions, self...

  4. The 2BFit study: is an unsupervised proprioceptive balance board training programme, given in addition to usual care, effective in preventing ankle sprain recurrences? Design of a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    van Mechelen Willem

    2008-05-01

    Full Text Available Abstract Background There is strong evidence that athletes have a twofold risk for re-injury after a previous ankle sprain, especially during the first year post-injury. These ankle sprain recurrences could result in disability and lead to chronic pain or instability in 20 to 50% of these cases. When looking at the high rate of ankle sprain recurrences and the associated chronic results, ankle sprain recurrence prevention is important. Objective To evaluate the effect of a proprioceptive balance board training programme on ankle sprain recurrences, that was applied to individual athletes after rehabilitation and treatment by usual care. Methods/Design This study was designed as a randomized controlled trial with a follow-up of one year. Healthy individuals between 12 and 70 years of age, who were actively participating in sports and who had sustained a lateral ankle sprain up to two months prior to inclusion, were eligible for inclusion in the study. The intervention programme was compared to usual care. The intervention programme consisted of an eight-week proprioceptive training, which started after finishing usual care and from the moment that sports participation was again possible. Outcomes were assessed at baseline and every month for 12 months. The primary outcome of this study was the incidence of recurrent ankle injuries in both groups within one year after the initial sprain. Secondary outcomes were severity and etiology of re-injury and medical care. Cost-effectiveness was evaluated from a societal perspective. A process evaluation was conducted for the intervention programme. Discussion The 2BFit trial is the first randomized controlled trial to study the effect of a non-supervised home-based proprioceptive balance board training programme in addition to usual care, on the recurrence of ankle sprains in sports. Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains. Results will

  5. Design paper: The CapOpus trial: a randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis

    DEFF Research Database (Denmark)

    Hjorthøj, Carsten; Fohlmann, Allan; Larsen, Anne-Mette

    2008-01-01

    trial. Patients are primarily recruited through early-psychosis detection teams, community mental health centers, and assertive community treatment teams. Patients are randomized to one of two treatment arms, both lasting six months: 1) specialized addiction treatment plus treatment as usual or 2...... of cannabis consumption over time. Other outcome measures will be psychosis symptoms, cognitive functioning, quality of life, social functioning, and cost-benefit analyses. TRIAL REGISTRATION: ClinicalTrials.gov NCT00484302....

  6. Usual Defects in Drawing Technics for Close-head and Reasons Analysis%封头拉伸工艺中常见缺陷及原因分析

    Institute of Scientific and Technical Information of China (English)

    朱淳喜; 吉春生; 杨勇民

    2001-01-01

    After analyzing usual defects of drawing technics for up -close-head and down-close-head of YSP-15 steel bottle, good views for reforming this technics are put forward.%对YSP-15型钢瓶上下封头拉伸工艺中常见的缺陷进行分析,提出了控制封头在拉伸中产生缺陷的主要措施.

  7. Design paper: The CapOpus trial: A randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis

    Directory of Open Access Journals (Sweden)

    Gluud Christian

    2008-07-01

    Full Text Available Abstract Background A number of studies indicate a link between cannabis-use and psychosis as well as more severe psychosis in those with existing psychotic disorders. There is currently insufficient evidence to decide the optimal way to treat cannabis abuse among patients with psychosis. Objectives The major objective for the CapOpus trial is to evaluate the additional effect on cannabis abuse of a specialized addiction treatment program adding group treatment and motivational interviewing to treatment as usual. Design The trial is designed as a randomized, parallel-group, observer-blinded clinical trial. Patients are primarily recruited through early-psychosis detection teams, community mental health centers, and assertive community treatment teams. Patients are randomized to one of two treatment arms, both lasting six months: 1 specialized addiction treatment plus treatment as usual or 2 treatment as usual. The specialized addiction treatment is manualized and consists of both individual and group-based motivational interviewing and cognitive behavioral therapy, and incorporates both the family and the case manager of the patient. The primary outcome measure will be changes in amount of cannabis consumption over time. Other outcome measures will be psychosis symptoms, cognitive functioning, quality of life, social functioning, and cost-benefit analyses. Trial registration ClinicalTrials.gov NCT00484302.

  8. Usual dietary intake among female breast cancer survivors is not significantly different from women with no cancer history: results of the National Health and Nutrition Examination Survey, 2003-2006.

    Science.gov (United States)

    Milliron, Brandy-Joe; Vitolins, Mara Z; Tooze, Janet A

    2014-06-01

    Dietary intake is a modifiable behavior that may reduce the risk of recurrence and death among breast cancer survivors. Cancer survivors are encouraged to consume a diet rich in fruit, vegetables, and whole grains and limit red meat, processed meat, and alcohol intake. Using data from the National Health and Nutrition Examination Survey (2003-2006), this study examined whether breast cancer survivors and women with no history of cancer differed in the distribution of usual intake of foods included in the dietary recommendations for preventing cancer and recurrences. Participants completed one or two 24-hour dietary recalls. The food groups included in this analysis were whole fruit; total vegetables; dark green and orange vegetables; whole grains; red meat; processed meat; alcohol; and calories from solid fat, alcohol, and added sugar. The National Cancer Institute Method was used to estimate the distribution of usual intake and to compare breast cancer survivors (n=102) to noncancer respondents (n=2,684). Using age and cancer survivor as covariates, subgroup estimates of usual intake were constructed. No significant group differences were found, except that survivors reported a greater intake of whole grains. More than 90% of both groups did not meet recommendations for fruits, vegetables, and whole grains; 75.4% and 70.2%, respectively, consumed less than the red meat recommendation; and cancer survivors was not significantly different from women with no history of cancer.

  9. EMG-triggered electrical stimulation is a feasible intervention to apply to multiple arm muscles in people early after stroke, but does not improve strength and activity more than usual therapy: a randomized feasibility trial.

    Science.gov (United States)

    Dorsch, Simone; Ada, Louise; Canning, Colleen G

    2014-05-01

    To determine whether EMG-triggered electrical stimulation applied to multiple muscles daily is a feasible intervention and to determine its effect on strength and activity in very weak stroke patients. A prospective, randomized trial with blinded assessment. Metropolitan mixed acute and rehabilitation units. Thirty-three people within four weeks of a stroke with less than Grade 3 strength in three out of four muscle groups (shoulder flexors, elbow extensors, wrist and finger extensors and thumb abductors) of the affected arm. Participants were randomly allocated to receive EMG-triggered electrical stimulation to the four muscle groups of the affected arm plus usual therapy five times a week for four weeks, or usual therapy only. Feasibility of the intervention was measured by examining compliance with the trial protocol. Strength was measured using manual muscle testing summed across muscle groups (0-20). Activity was measured using the Motor Assessment Scale, summed upper limb items (0-18). The experimental group received 87% of the intervention. Following the intervention period, there was no difference between the groups for strength (mean between-group difference, 0 out of 20, 95% confidence interval (CI) -3 to 3, p = 0.91) or activity (mean between-group difference 1 out of 18, 95% CI -2 to 4, p = 0.44). It is feasible to apply EMG-triggered electrical stimulation to multiple muscles of the upper limb in very weak people early after stroke. However, it does not appear to improve strength or activity beyond usual arm therapy that contains strengthening.

  10. Cost-effectiveness of recurrence risk guided care versus care as usual in women who suffered from early-onset preeclampsia including HELLP syndrome in their previous pregnancy (the PreCare study

    Directory of Open Access Journals (Sweden)

    de Wit-Zuurendonk Laura D

    2010-10-01

    Full Text Available Abstract Background Preeclampsia and HELLP syndrome may have serious consequences for both mother and fetus. Women who have suffered from preeclampsia or the HELLP syndrome, have an increased risk of developing preeclampsia in a subsequent pregnancy. However, most women will develop no or only minor complications. In this study, we intend to determine cost-effectiveness of recurrence risk guided care versus care as usual in pregnant women with a history of early-onset preeclampsia. Methods/design We developed a prediction model to estimate the individual risk of recurrence of early-onset preeclampsia and the HELLP syndrome. In a before-after study, pregnant women with preeclampsia or HELLP syndrome in their previous pregnancy receiving care as usual (before introduction of the prediction model will be compared with women receiving recurrence risk guided care (after introduction of the prediction model. Eligible and pregnant women will be recruited at six university hospitals and seven large non-university tertiary referral hospitals in the Netherlands. The primary outcome measure is the recurrence of early-onset preeclampsia or HELLP syndrome in women allocated to the regular monitoring group. For the economic evaluation, a modelling approach will be used. Costs and effects of recurrence risk guided care with those of care as usual will be compared by means of a decision model. Two incremental cost-effectiveness ratios will be calculated: 1 cost per Quality Adjusted Life Year (mother unit of analysis and 2 cost per live born child (child unit of analysis. Discussion This is, to our knowledge, the first study that evaluates prospectively the efficacy of a multivariable prediction rule for recurrent hypertensive disease in pregnancy. Results of this study could either be integrated into the current guideline on Hypertensive Disorders in Pregnancy, or be used to develop a new guideline.

  11. Early preventive exercises versus usual care does not seem to reduce trismus in patients treated with radiotherapy for cancer in the oral cavity or oropharynx: a randomised clinical trial.

    Science.gov (United States)

    Høgdal, Nina; Juhl, Carsten; Aadahl, Mette; Gluud, Christian

    2015-01-01

    In head and neck cancer patients undergoing curative radiotherapy, we investigated the benefits and harms of an early exercise regime on trismus. Patients with head and neck cancer undergoing radiotherapy were centrally randomised to exercises 5-6 times for 45 minutes during and after radiotherapy supervised by a physiotherapist in addition to usual care versus usual care alone. The primary outcome was change in maximal interincisor distance (MID) measured at 5 and 12 months. Secondary outcomes were change in cervical ranges of motion, tissue tightness, and health-related quality of life. Mixed model analysis of repeated measures adjusted for tumour size and operation was conducted to assess the effect of early preventive exercises across time periods. Of the 100 patients included, two patients withdrew and one died before the onset of radiotherapy. The unadjusted mean difference in MID at 12 months after having completed radiotherapy was 0.83 mm (95% confidence interval (CI) -3.64-5.29, p = 0.71) in the exercise intervention group compared with the control group. When adjusted for operation and tumour size, the effect of the exercise intervention on mean MID from baseline to 12-month follow-up was 5.92 mm (95% CI -0.48-12.33, p = 0.07). Of the secondary outcomes, cervical rotation showed a statistically significant deterioration in the exercise group compared with the control group (p = 0.01). No significant effects were observed on the other secondary outcomes. In patients with cancer in the oral cavity or oropharynx, early supervised exercises combined with self-care treatment focusing on mobility exercises to reduce trismus do not seem to provide additional beneficial effects compared with usual care during curative radiotherapy.

  12. Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial

    Science.gov (United States)

    Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

    2016-01-01

    Objectives To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). Setting 36 primary care general practices in North West England. Participants 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Intervention Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. Outcome measures As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). Results The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI −30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI −0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Conclusions Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated

  13. Diagnosis of the defectology wich usually arises when rolling high-performance pipes. Diagnosis de la defectologia que de forma accidental suele presentar la laminacion de tuberias de altas prestaciones

    Energy Technology Data Exchange (ETDEWEB)

    Gutierrez de Saiz-Solabarria, S. (Departamento de Ciencias de los Materiales e Ingenieria Metalurgica, UPV/EHU, Bilbao (Spain))

    1995-01-01

    The possible causes are studied which produce the defectology that, incidentally, is usually present at high-performing pipe rolling processes.d The steel qualities included in Specification 5CT(1) for grade C75-1 (C-Mn-Mo-alloyed steel) and grade J55 (C-Mn steel) as well as those qualities regarding Specification 5L (2) for grade A of Standard API (American Petroleum Institute) are studied herein. Both chemical and metallurgical characterizations of the pipe are provided. Defects are diagnosed and conclusions are set. (Author) 5 refs.

  14. Early intensive hand rehabilitation is not more effective than usual care plus one-to-one hand therapy in people with sub-acute spinal cord injury (‘Hands On’: a randomised trial

    Directory of Open Access Journals (Sweden)

    Lisa A Harvey

    2016-04-01

    Full Text Available Question: What is the effect of adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy in people with sub-acute tetraplegia? Design: A parallel group, randomised, controlled trial. Participants were randomly assigned (1:1 via a computer-generated concealed block randomisation procedure to either a control or experimental intervention. Participants: Seventy people with C2 to T1 motor complete or incomplete tetraplegia within 6 months of injury. Participants were recruited from seven spinal units in Australia and New Zealand. Intervention: Experimental participants received intensive training for one hand. Intensive training consisted of training with an instrumented exercise workstation in conjunction with functional electrical stimulation for 1 hour per day, 5 days per week for 8 weeks. Both groups received usual care and 15 minutes of one-to-one hand therapy three times per week without functional electrical stimulation. Outcome measures: The primary outcome was the modified Action Research Arm Test reflecting arm and hand function, which was assessed at the end of the intervention, that is, 11 weeks after randomisation. Secondary outcomes were measured at 11 and 26 weeks. Results: Sixty-six (94% participants completed the post-intervention assessment and were included in the primary intention-to-treat analysis. The mean modified Action Research Arm Test score for experimental and control participants at the post-intervention assessment was 36.5 points (SD 16.0 and 33.2 points (SD 17.5, respectively, with an adjusted mean between-group difference of 0.9 points (95% CI –4.1 to 5.9. Conclusion: Adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy does not improve

  15. Economic evaluation of Internet-based problem-solving guided self-help treatment in comparison with enhanced usual care for depressed outpatients waiting for face-to-face treatment

    DEFF Research Database (Denmark)

    Kolovos, Spyros; Kenter, Robin M F; Bosmans, Judith E

    2016-01-01

    at outpatient clinics. METHODS: An economic evaluation was performed alongside a randomized controlled trial with 12 months follow-up. Outcomes were improvement in depressive symptom severity (measured by CES-D), response to treatment and Quality-Adjusted Life-Years (QALYs). Statistical uncertainty around cost...... differences and incremental cost-effectiveness ratios were estimated using bootstrapping. RESULTS: Mean societal costs for the intervention group were €1579 higher than in usual care, but this was not statistically significant (95% CI - 1395 to 4382). Cost-effectiveness acceptability curves showed...

  16. Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial

    Science.gov (United States)

    2014-01-01

    Background Among the multiple conservative modalities, physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain. Despite the scientific progresses with regard to pain and motor control neuroscience, treatment of chronic spinal pain (CSP) often tends to stick to a peripheral biomechanical model, without targeting brain mechanisms. With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP, the development of clinical strategies targeted at ‘training the brain’ is to be pursued. Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care, but confirmation is required in a larger, multi-center trial with appropriate evidence-based control intervention and long-term follow-up. The aim of this study is to assess the effectiveness of a modern neuroscience approach, compared to usual care evidence-based physiotherapy, for reducing pain and improving functioning in patients with CSP. A secondary objective entails examining the effectiveness of the modern neuroscience approach versus usual care physiotherapy for normalizing brain gray matter in patients with CSP. Methods/Design The study is a multi-center, triple-blind, two-arm (1:1) randomized clinical trial with 1-year follow-up. 120 CSP patients will be randomly allocated to either the experimental (receiving pain neuroscience education followed by cognition-targeted motor control training) or the control group (receiving usual care physiotherapy), each comprising of 3 months treatment. The main outcome measures are pain (including symptoms and indices of central sensitization) and self-reported disability. Secondary outcome measures include brain gray matter structure, motor control, muscle properties, and psychosocial correlates. Clinical assessment and brain imaging will be performed at baseline, post-treatment and at 1-year follow-up. Web

  17. DIAGNOSTICO SEROLÓGICO DE NEUMONIA POR LEGIONELLA. INCIDENCIA EN UN PERIODO DE TRES AÑOS EN EL AREA SANITARIA OESTE DE VALLADOLID

    Directory of Open Access Journals (Sweden)

    M.A. Mazón

    2005-12-01

    Full Text Available ABSTRACT:Introduction: Legionella species are Gram-negative bacilli. There are described for the first time in 70's associated to the Legionnarie's disease. Presently, more than 34 species of Legionella have been identified, 20 of which have been found pathogenic for the man. The clinical manifestations of Legionella infections are primarily respiratory. The most common presentation is acute pneumonia, which varies in severity from mild illness that does not require hospitalization to fatal pneumonia.Material and Methods: The results corresponding to the determination of antibodies to L. pneumophila (Gull Laboratories by indirect inmunofluorescence (IFI have been analysed and reviewed. This conventional inmunofluorescent test measures antibodies versus a pool of 1, 2, 3, 4, 5, 6, 7 and 8 serogroups. During the 3 years of surveillance period 1249 determinations by IFI were performed in our Hospital. The determination of urinary antigen of Legionella for the qualitative detection of the antigen to L. pneumophila serogroup 1 was made in almost all studied samples by using a fast inmunochromatographical technique (Binax NOW.Results and Discussion: Of the 1249 cases of nosocomial pneumonia (diagnosed by a positive result of IFI Legionella test recorded during the period, 12 cases met the criteria for infection with L. pneumophila serogroup 1. Later, clinical histories were reviewed and it was observed that the ages of the confirmed cases oscillated between the 40 and 87 years, with an average of age of 40, of which 8 were men and 4 women. From the point of view of factors of risk, 6 patients were smokers. Clinically, the displayed symptoms were general malaise, fever high and pattern of pulmonary infiltration in all the cases, migraine in 3 cases, diarrhoea in 5 cases and arthralgias and muscle aches in 3 cases. The analytical parameters in common were high VSG and leukocytosis. Hyponatremia 1/1024, what it demonstrates a clear seroconversion. In other two cases the title of the first sample already was > 1/1024.Although in our casuistic the incidence of pneumonia by Legionella is low, we can observe the importance of the determination of the urinary Legionella antigen as well as the delayed appearance of antibodies. The clinical importance of this single observation carried us to practice a second determination of antibodies when the suspicion of pneumonia by Legionella is high. RESUMEN.Introducción: Las especies de Legionella son bacilos gram negativos. Fueron descritas por primera vez en los 70 asociados a la enfermedad de los legionarios (EL. Casi la mitad de las 34 especies conocidas son patógenas para el hombre. Las manifestaciones clínicas de infecciones por Legionella son fundamentalmente respiratorias. La forma más común es la neumonía aguda, que varía en severidad de enfermedad suave que no requiere hospitalización a neumonía fatal.Material y Métodos: Se han estudiado y revisado los resultados correspondientes a la medición de anticuerpos frente a L. pneumophila por inmunofluorescencia indirecta, IFI (Gull Laboratories, que determina anticuerpos frente a un pool de serogrupos 1, 2, 3, 4, 5, 6, 7 y 8. El número de resultados obtenidos por IFI, correspondientes al periodo 2000-2003, ha sido de 1249, procedentes de diferentes Servicios de nuestro Centro.La determinación de antígeno urinario de Legionella, se ha realizado, en casi todas muestras estudiadas, mediante una técnica inmunocromatográfica rápida para la detección cualitativa del antígeno serogrupo 1 de L. pneumophila (Binax NOW.Resultados y Discusión: De todas las determinaciones realizadas (1249, solo se han confirmado 12 casos de neumonía por Legionella. Posteriormente, se revisaron las historias clínicas y se observó que las edades de los casos confirmados oscilaban entre los 40 y 87 años, con un promedio de edad de 40, de los cuales 8 eran varones y 4 mujeres. Desde el punto de vista de factores de riesgo 6 eran fumadores.Clínicamente los síntomas presentados fueron: malestar general, fiebre alta y patrón de infiltración pulmonar en todos los casos, cefalea en 3 casos, diarrea en 5 casos y artralgias y mialgias en 3 casos. Como parámetros analíticos comunes a todos los casos se observaron VSG elevada y leucocitosis. La hiponatremia inferior a 130 sólo se observó en 1 caso.La determinación de antígeno de Legionella fue positiva en 9 casos. En los 3 casos en que resultó negativa ha de interpretarse que la enfermedad fue producida por un serogrupo diferente del 1 (que es el que se detecta en la muestras de orina.La determinación de anticuerpos frente a L. pneumophila por IFI se realizaron todas en el momento del ingreso. En 7 casos el título fue 1/1024, lo que nos demuestra una clara seroconversión. En otros dos casos el título de la primera muestra ya fue > 1/1024.Aunque en nuestra casuística la incidencia de neumonía por Legionella es baja, es posible observar la importancia de la determinación del antígeno urinario de Legionella así como la aparición tardía de anticuerpos. Estos hallazgos nos refuerzan el interés de practicar una segunda determinación de anticuerpos cuando la sospecha de neumonía por Legionella es alta.

  18. Chronic eosinophilic pneumonia involving with mediastinal lymph nodes: radiologic study of three cases. Neumonia eosinofila cronica asociada a adenopatias mediastinicas: estudio radiologico de tres casos

    Energy Technology Data Exchange (ETDEWEB)

    Calvo Garcia, A.; Gordillo Gutierrez, I.; Guembe Urtiaga, P. (Hospital Gregorio Maraon, Madrid (Spain))

    1994-01-01

    Chronic eosinophilic pneumonia (CEP) is an uncommon disorder in our setting. Chest x-ray is essential to diagnosis. To date, we have found only three reported cases in which mediastinal lymph nodes were involved. We present three additional cases with standard thoracic study. (Author)

  19. 川芎嗪对放射性肺炎的保护作用%Protective effect of Chuanxiongqin on radioactive neumonia

    Institute of Scientific and Technical Information of China (English)

    柴曼超; 肖悦娥

    2005-01-01

    目的:观察川芎嗪对放射性肺炎的保护作用.方法:65例放射性肺炎患者随机分为治疗组(34例)与对照组(31例).两组基本治疗相同.即应用激素、控制感染、对症处理.治疗组加用川芎嗪100mg加液体静脉滴注,每天1次,连用28天.全部病例疗程均为28天,治疗结束时进行组间疗效比较.结果:治疗组临床治愈率26.55.总有效率91.2%,对照组分别为16.1%和74.1%,经比较P<0.05;治疗组胸部X线治愈率29.4%,总有效率88.3%,对照组分别为19.4%和67.7%,P<0.05.结论:川芎嗪对放射性肺炎有明显的保护作用.

  20. Comparison of the costs of different treatments for child neumonia Estudio comparativo de los costos del tratamiento de las neumonías del niño

    Directory of Open Access Journals (Sweden)

    María de La Luz Valencia Chávez

    1998-02-01

    Full Text Available We compared the costs of treatment of severe.noncomplicated child pneumonia, in four different systems of hospital attention (private, prepaid, compulsory health plan and economic planwith those of ambulatory treatment with cefixime; also a comparison was made between the costs of treatment of moderate child pneumonia with ambulatoy cefixime and with the WHO-recommended scheme with trimetoprim sulfametoxazole. The costs of ambulatory cefixime treatment of severe pneumonia were significantly lower than those at hospital in private practice, prepaid medicine and compulsory health plan (pO.O5. This difference persisted even when the analysis was limited to the cost of drugs. On the other hand, treatment of moderate pneumonia with trimetoprim-sulfametoxazole was cheaper than ambulatory cefixime (p 0.05. Esta diferencia se mantuvo cuando se calculó, únicamente, el costo de los medicamentos. El manejo de la neumonía moderada con trimetoprim-sulfa es significativamente más barato que el que se efectúa con la cefixima (p<0.001. Se concluye que la cefixima constituye una alternativa económica para el tratamiento de las neumonías graves no complicadas del niño, pero que en las moderadas su costo es superior al esquema que recomienda la OMS para estos casos.

  1. “ESTRATEGIAS DIAGNOSTICO- TERAPEUTICAS EN LA NEUMONIA POR VIRUS INFLUENZA A H1N1 EN EL HOSPITAL INFANTIL DE MORELIA EVA SAMANO DE LOPEZ MATEOS”

    OpenAIRE

    Zirate Arzate, Gabriela Alejandra

    2012-01-01

    Los historiadores de la medicina afirman que la gripe ya era conocida en la antigüedad. Existe la posibilidad de que la epidemia descrita por Hipócrates en el año 412 a.C. fuera de gripe. Otra pestilencia de perfil similar fue la que afectó al ejército griego en el sitio de Siracusa, en el año 395 a.C. El primer registro de una gran pandemia de gripe se refiere a la que ocurrió en Europa en el año de 1170 d.C., a la que siguieron por lo menos 47 epidemias importantes en el viej...

  2. “ESTRATEGIAS DIAGNOSTICO- TERAPEUTICAS EN LA NEUMONIA POR VIRUS INFLUENZA A H1N1 EN EL HOSPITAL INFANTIL DE MORELIA EVA SAMANO DE LOPEZ MATEOS”

    OpenAIRE

    Zirate Arzate, Gabriela Alejandra

    2012-01-01

    Los historiadores de la medicina afirman que la gripe ya era conocida en la antigüedad. Existe la posibilidad de que la epidemia descrita por Hipócrates en el año 412 a.C. fuera de gripe. Otra pestilencia de perfil similar fue la que afectó al ejército griego en el sitio de Siracusa, en el año 395 a.C. El primer registro de una gran pandemia de gripe se refiere a la que ocurrió en Europa en el año de 1170 d.C., a la que siguieron por lo menos 47 epidemias importantes en el viej...

  3. Incidencia de las neumonias neumocócicas en el ámbito hospitalario en el Comunidad Valenciana durante el período 1995-2001

    Directory of Open Access Journals (Sweden)

    Ana María Comes Castellano

    2004-01-01

    Full Text Available Fundamento: Las neumonías neumocóccicas son un importante problema de salud. El objetivo del estudio es conocer la evolución en la Comunidad Valenciana de las neumonías neumocóccicas hospitalarias desde 1995 a 2001. Métodos: Del Conjunto Mínimo Básico de Datos se seleccionaron los casos de neumonías neumocócica en la Comunidad Valenciana. Se calculó el intervalo de confianza (95% y ANOVA con el programa SPSS, así como la incidencia y su evolución en el tiempo y las interacciones con las variables de sexo, edad, y provincia. Se calculó igualmente el promedio de estancia hospitalaria. Resultados: La incidencia del periodo fue de 29 casos por 100.000. Disminuye desde 1996 y se estabiliza en los últimos años del estudio. En personas mayores de 65 años la incidencia fue de 101 por 100.000, mientras que en menores de 5 años fue de 76 por 100.000. La incidencia en mujeres fue de 22 por 100.000 y de 37 por 100.000 en hombres. La incidencia por provincias fue de 31 para Valencia, 21 para Alicante y 24 para Castellón; en Valencia y Alicante tienden a estabilizarse, mientras que ascienden en Castellón. La estancia media fue de 10,6±9 días, siendo de 12,5 en el grupo de 45 a 64 años. Conclusiones: Las neumonías neumocócicas son más frecuentes en las edades extremas. Afectan más a hombres, especialmente en mayores de 65 años. Se observa una evolución diferente en la provincia de Castellón. El promedio de estancia varía según la edad, sin existir diferencias significativas entre sexo o grupo de edad.

  4. Incidencia de las neumonias neumocócicas en el ámbito hospitalario en el Comunidad Valenciana durante el período 1995-2001

    OpenAIRE

    Ana María Comes Castellano; José Antonio Lluch Rodrigo; Antonio Portero Alonso; Eliseo Pastor Villalba; Miguel Sanz Valero

    2004-01-01

    Fundamento: Las neumonías neumocóccicas son un importante problema de salud. El objetivo del estudio es conocer la evolución en la Comunidad Valenciana de las neumonías neumocóccicas hospitalarias desde 1995 a 2001. Métodos: Del Conjunto Mínimo Básico de Datos se seleccionaron los casos de neumonías neumocócica en la Comunidad Valenciana. Se calculó el intervalo de confianza (95%) y ANOVA con el programa SPSS, así como la incidencia y su evolución en el tiempo y las interacciones con las vari...

  5. A mixed methods study to evaluate the clinical and cost-effectiveness of a self-managed exercise programme versus usual physiotherapy for chronic rotator cuff disorders: protocol for the SELF study

    Directory of Open Access Journals (Sweden)

    Littlewood Chris

    2012-04-01

    Full Text Available Abstract Background Shoulder pain is the third most common reason for consultation with a physiotherapist and up to 26% of the general population might be expected to experience an episode at any one time. Disorders of the shoulder muscles and tendons (rotator cuff are thought to be the commonest cause of this pain. The long-term outcome is frequently poor despite treatment. This means that many patients are exposed to more invasive treatment, e.g. surgery, and/or long-term pain and disability. Patients with this disorder typically receive a course of physiotherapy which might include a range of treatments. Specifically the value of exercise against gravity or resistance (loaded exercise in the treatment of tendon disorders is promising but appears to be under-used. Loaded exercise in other areas of the body has been favourably evaluated but further investigation is needed to evaluate the impact of these exercises in the shoulder and particularly the role of home based or supervised exercise versus usual treatment requiring clinic attendance. Methods/Design A single-centre pragmatic unblinded parallel group randomised controlled trial will evaluate the effectiveness of a self-managed loaded exercise programme versus usual clinic based physiotherapy. A total of 210 study participants with a primary complaint of shoulder pain suggestive of a rotator cuff disorder will be recruited from NHS physiotherapy waiting lists and allocated to receive a programme of self-managed exercise or usual physiotherapy using a process of block randomisation with sealed opaque envelopes. Baseline assessment for shoulder pain, function and quality of life will be undertaken with the Shoulder Pain & Disability Index, the Patient Specific Functional Scale and the SF-36. Follow-up evaluations will be completed at 3, 6 and 12 months by postal questionnaire. Both interventions will be delivered by NHS Physiotherapist’s. An economic analysis will be conducted from an

  6. Avaliação da dieta habitual de crianças e adolescentes com sobrepeso e obesidade Evaluation of usual diet of obese and overweight children and adolescents

    Directory of Open Access Journals (Sweden)

    Severina Carla Vieira Cunha Lima

    2004-12-01

    Full Text Available OBJETIVO: Investigar a dieta habitual de crianças e adolescentes com sobrepeso e obesidade, atendidas no Ambulatório de Endocrinologia Pediátrica da Universidade Federal do Rio Grande do Norte. MÉTODOS: Foram constituídos os grupos sobrepeso (n=15, obesidade (n=30 e controle (n=21 de ambos os sexos. A avaliação antropométrica foi realizada utilizando-se o Índice de Massa Corporal e a dieta habitual por registro alimentar e analisada pelo Virtual Nutri 1.0. RESULTADOS: As calorias totais e fibra alimentar do grupo obesidade feminino foram inferiores e diferente significativamente do controle masculino. Observou-se elevada ingestão de proteínas nos grupos sobrepeso masculino e obesidade feminino. Uma correlação negativa foi verificada entre o Índice de Massa Corporal e a fibra alimentar no grupo obesidade feminino. CONCLUSÃO: As crianças e adolescentes com sobrepeso e obesidade da amostra estudada, possuem uma dieta habitual inadequada, com elevada ingestão de proteínas e lipídios e deficiente em fibras.OBJECTIVE: The aim of this study was to investigate the usual diet of obese and overweight children and adolescents, attended at the Pediatric Endocrinology Ambulatory of the Universidade Federal do Rio Grande do Norte, Natal, Brazil. METHODS: Overweight (n=15, obesity (n=30 and control (n=21 groups were constituted. The anthropometric evaluation was obtained by Body Mass Index and the usual diet was investigated by self-register. The diet was analysed using the Virtual Nutri 1.0 software. RESULTS: In the female obesity group the intake of total calories and fiber was significantly smaller than in the male control group. There was a high average of protein intake in male overweight and female obesity groups. Negative correlation between Body Mass Index and diet fiber was observed in female obesity group. CONCLUSIONS: In general, the usual diet of obese and overweight children and adolescents was inadequate in relation to protein

  7. The ACTonHEART study: rationale and design of a randomized controlled clinical trial comparing a brief intervention based on Acceptance and Commitment Therapy to usual secondary prevention care of coronary heart disease.

    Science.gov (United States)

    Spatola, Chiara A M; Manzoni, Gian Mauro; Castelnuovo, Gianluca; Malfatto, Gabriella; Facchini, Mario; Goodwin, Christina L; Baruffi, Matteo; Molinari, Enrico

    2014-02-19

    Modifiable risk factors, including life-style habits and psychological variables, have been increasingly demonstrated to have an important role in influencing morbidity and mortality in cardiovascular patients, and to account for approximately 90% of the population risk for cardiac events.Acceptance and Commitment Therapy (ACT) has shown effectiveness in promoting healthy behaviors, and improving psychological well-being in patients with chronic physical conditions. Moreover, a first application of an acceptance-based program in cardiac patients has revealed high treatment satisfaction and initial evidences of effectiveness in increasing heart-healthy behaviour. However, no clinical trial to date has evaluated the efficacy of an acceptance-based program for the modification of cardiovascular risk factors and the improvement of psychological well-being, compared to usual secondary prevention care. Approximately 168 patients will be recruited from an outpatient cardiac rehabilitation unit and randomly assigned to receive usual care or usual care + a brief ACT-based intervention. The ACT group will be administered five group therapy sessions integrating educational topics on heart-healthy behaviours with acceptance and mindfulness skills. Participants will be assessed at baseline, six weeks later (post treatment for the ACT condition), at six and twelve months follow-up.A partially-nested design will be used to balance effects due to clustering of participants into small therapy groups. Primary outcome measures will include biological indicators of cardiovascular risk and self-reported psychological well-being. Treatment effects will be tested via multilevel modeling after which the mediational role of psychological flexibility will be evaluated. The ACTonHEART study is the first randomized clinical trial designed to evaluate the efficacy of a brief group-administered, ACT-based program to promote health behavior change and psychological well-being among cardiac

  8. A comparison of specialist rehabilitation and care assistant support with specialist rehabilitation alone and usual care for people with Parkinson's living in the community: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Gage Heather

    2011-11-01

    Full Text Available Abstract Background Parkinson's Disease is a degenerative neurological condition that causes movement problems and other distressing symptoms. People with Parkinson's disease gradually lose their independence and strain is placed on family members. A multidisciplinary approach to rehabilitation for people with Parkinson's is recommended but has not been widely researched. Studies are needed that investigate cost-effective community-based service delivery models to reduce disability and dependency and admission to long term care, and improve quality of life. Methods A pragmatic three parallel group randomised controlled trial involving people with Parkinson's Disease and live-in carers (family friends or paid carers, and comparing: management by a specialist multidisciplinary team for six weeks, according to a care plan agreed between the professionals and the patient and carer (Group A; multidisciplinary team management and additional support for four months from a trained care assistant (Group B; usual care, no coordinated team care planning or ongoing support (Group C. Follow up will be for six months to determine the impact and relative cost-effectiveness of the two interventions, compared to usual care. The primary outcomes are disability (patients and strain (carers. Secondary outcomes include patient mobility, falls, speech, pain, self efficacy, health and social care use; carer general health; patient and carer social functioning, psychological wellbeing, health related quality of life. Semi structured interviews will be undertaken with providers (team members, care assistants, service commissioners, and patients and carers in groups A and B, to gain feedback about the acceptability of the interventions. A cost - effectiveness evaluation is embedded in the trial. Discussion The trial investigates components of recent national policy recommendations for people with long term conditions, and Parkinson's Disease in particular, and will

  9. Improved Medication Adherence and Frequency of Blood Glucose Self-Testing using an m-Health Platform Versus Usual Care in a Multisite Randomized Clinical Trial Among People with Type 2 Diabetes in India.

    Science.gov (United States)

    Kleinman, Nora J; Shah, Avani; Shah, Sanjiv; Phatak, Sanjeev; Viswanathan, Vijay

    2017-03-06

    In 2015, India had an estimated 69.2 million people with diabetes and a national prevalence of 8.7%. Evidence is mounting for the benefits of telemedicine in diabetes care, but remains limited on mobile-health (m-Health) interventions. This study assessed the impact of an m-Health diabetes platform on clinical outcomes, patient-reported outcomes, patient and provider satisfaction, and app usage. This open-label, two-arm parallel study enrolled 91 people at 3 sites in India, aged 18-65, with type 2 diabetes, and an A1c between 7.5% and 12.5% (58-113 mmol/mol). Participants were randomly assigned 1:1 to m-Health or usual care and observed for 6 months. All received free visits, laboratory tests, transportation fees, and strips and lancets. Intervention participants received the m-Health app and a mobile phone data stipend. A1c change was previously reported as statistically significant. Significantly more participants in intervention than control had improved medication adherence (39.0% vs. 12.8%; p = 0.03) and increased frequency of blood glucose (BG) self-testing (39.0% vs. 10.3%; p = 0.01) at 6 months from baseline. No other outcomes were significantly different. Among m-Health users, 75% of participants actively used the app at week 24. Participants entered 29,668 medications and 2,575 BG readings, sent 497 messages, and received 890 messages. Most participants (80%) were satisfied with all aspects of the app and all seven providers rated the software very acceptable. Participants assigned to m-Health had increased medication adherence and frequency of BG testing compared with usual care participants. This tool could be an effective way to expand access to quality chronic disease care and improve outcomes.

  10. Preliminary examination of metabolic syndrome response to motivational interviewing for weight loss as compared to an attentional control and usual care in primary care for individuals with and without binge-eating disorder.

    Science.gov (United States)

    Barnes, Rachel D; Barber, Jessica A

    2017-02-14

    Motivational interviewing (MI) treatment for weight loss is being studied in primary care. The effect of such interventions on metabolic syndrome or binge eating disorder (BED), both highly related to excess weight, has not been examined in primary care. This study conducted secondary analyses from a randomized controlled trial to test the impact of MI for weight loss in primary care on metabolic syndrome. 74 adult participants with overweight/obesity recruited through primary care were randomized to 12weeks of either MI, an attentional control, or usual care. Participants completed measurements for metabolic syndrome at pre- and post-treatment. There were no statistically significant differences in metabolic syndrome rates at pre-, X(2)(2)=0.16, p=0.921, or post-, X(2)(2)=0.852, p=0.653 treatment. The rates in metabolic syndrome, however, decreased for MI (10.2%) and attentional control (13.8%) participants, but not for usual care. At baseline, metabolic syndrome rates did not differ significantly between participants with BED or without BED across treatments. At post-treatment, participants with BED were significantly more likely to meet criteria for metabolic syndrome than participants without BED, X(2)(1)=5.145, p=0.023, phi=0.273. Across treatments, metabolic syndrome remitted for almost a quarter of participants without BED (23.1%) but for 0% of those with BED. These preliminary results are based on a small sample and should be interpreted with caution, but they are the first to suggest that relatively low intensity MI weight loss interventions in primary care may decrease metabolic syndrome rates but not for individuals with BED.

  11. An evaluation study of WRF-ARW model with observations during a usual low pressure system over eastern Mediterranean area (Greece) and comparison of the results with an extreme weather event

    Science.gov (United States)

    Emmanouil, George; Vlachogiannis, Diamanto; Sfetsos, Athanasios; Karozis, Stelios; Tasopoulou, Antonia

    2016-04-01

    The accurate simulation of weather conditions is becoming more and more an issue of increased research interest and public demand. Because of the uncertainty in forecasting such phenomena, the investigation of the choice of a proper model configuration to simulate in a satisfactory way usual weather conditions, as well as extreme events is of crucial importance. In the framework of providing reliable weather forecasting, the WRF atmospheric model was employed to simulate the weather conditions during a usual for the area low pressure system that passed over the Greek peninsula during 2015 (September, 18-24). NCEP FNL analysis data were used for model input. The model configuration was setup to include three nested domains with increasing horizontal resolution inwards (11km, 2km and 0.5km respectively), centered in Attica area. The model parameterization was concluded following a number of sensitivity tests, previously carried out for other weather events including extremes in the same area, such as the Cleopatra cyclone. The main meteorological variables were analyzed and evaluation of the results was performed against in-situ measurements by the network of the Hellenic National Meteorological Service stations. The comparison of the September low-pressure event and the Cleopatra case study model results in temperature showed good agreement with the observations in both cases. Study of the precipitation fields yielded significant improvement compared to the analysis data of the NCEP FNL and the comparison between the model results and observed values was found to be good locally at some stations. The overall conclusion was that the model parameterization and applied methodology proved to be an efficient and useful tool for studying and forecasting such events.

  12. The feasibility of determining the effectiveness and cost-effectiveness of medication organisation devices compared with usual care for older people in a community setting: systematic review, stakeholder focus groups and feasibility randomised controlled trial.

    Science.gov (United States)

    Bhattacharya, Debi; Aldus, Clare F; Barton, Garry; Bond, Christine M; Boonyaprapa, Sathon; Charles, Ian S; Fleetcroft, Robert; Holland, Richard; Jerosch-Herold, Christina; Salter, Charlotte; Shepstone, Lee; Walton, Christine; Watson, Steve; Wright, David J

    2016-07-01

    Medication organisation devices (MODs) provide compartments for a patient's medication to be organised into the days of the week and the recommended times the medication should be taken. To define the optimal trial design for testing the clinical effectiveness and cost-effectiveness of MODs. The feasibility study comprised a systematic review and focus groups to inform a randomised controlled trial (RCT) design. The resulting features were tested on a small scale, using a 2 × 2 factorial design to compare MODs with usual packaging and to compare weekly with monthly supply. The study design was then evaluated. Potential participants were identified by medical practices. Aged over 75 years, prescribed at least three solid oral dosage form medications, unintentionally non-adherent and self-medicating. Participants were excluded if deemed by their health-care team to be unsuitable. One of three MODs widely used in routine clinical practice supplied either weekly or monthly. To identify the most effective method of participant recruitment, to estimate the prevalence of intentional and unintentional non-adherence in an older population, to provide a point estimate of the effect size of MODs relative to usual care and to determine the feasibility and acceptability of trial participation. The systematic review included MOD studies of any design reporting medication adherence, health and social outcomes, resource utilisation or dispensing or administration errors. Focus groups with patients, carers and health-care professionals supplemented the systematic review to inform the RCT design. The resulting design was implemented and then evaluated through questionnaires and group discussions with participants and health-care professionals involved in trial delivery. Studies on MODs are largely of poor quality. The relationship between adherence and health outcomes is unclear. Of the limited studies reporting health outcomes, some reported a positive relationship while some

  13. A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial).

    LENUS (Irish Health Repository)

    Hurley, Deirdre A

    2009-01-01

    BACKGROUND: Chronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs. Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery. While international clinical guidelines and systematic reviews for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost, barriers to their delivery include space and time restrictions in healthcare settings and poor patient attendance. The European Clinical Guidelines have identified the need for research in the use of brief\\/minimal contact self-activation interventions that encourage participation in physical activity for CLBP. Walking may be an ideally suited form of individualized exercise prescription as it is easy to do, requires no special skills or facilities, and is achievable by virtually all ages with little risk of injury, but its effectiveness for LBP is unproven. METHODS AND DESIGN: This study will be an assessor-blinded randomized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy, which will act as the control group, in people with chronic low back pain. A sample of 246 patients will be recruited in Dublin, Ireland through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP. Patients will be randomly allocated to one of the three groups in a concealed manner. The main outcomes will be functional disability, pain, quality of life, fear avoidance, back beliefs, physical activity, satisfaction and costs, which will be evaluated at baseline, and 3, 6 and 12 months [follow-up by pre-paid postage]. Qualitative telephone interviews and focus groups will be embedded in the research

  14. ALDH1在乳腺UDH、ADH、IDC中的表达及意义%The Expression and Significance of ALDH1 in Usual Ductal Hyperplasia (UDH), Atypical Ductal Hyperplasia (ADH) and Infiltrative Ductal Carcino-ma (IDC)

    Institute of Scientific and Technical Information of China (English)

    郭钰; 卫建平

    2014-01-01

    Objective To investigate the expression of ALDH1 in usual ductal hyperplasia, atypical ductal hyperplasia and infiltra-tive ductal carcinoma and its clinical significance. Methods Immunohistochemistry method was used to detect the expression of ALDH1 in the normal mammary gland of 30 cases and mammary gland ductal disease of 90 cases of patients. Results The positive expression rate of ALDH1 in normal mammary gland, usual ductal hyperplasia, atypical ductal hyperplasia and infiltrative ductal carcinoma was 0%, 23.3%, 23.3%, 60%, respectively. Conclusion The positive rate of ALDH1 in patients with infiltrative ductal carcinoma was significantly higher than that in normal mammary gland and other mammary gland diseases, which suggests that the positive expression of ALDH1 has a certain relationship with the evolution of the mammary gland hyperplasia to mammary gland cancer and the prognosis of the disease.%目的:探讨ALDH1在乳腺普通导管增生、非典型导管上皮增生以及浸润性导管癌中表达及其临床意义。方法采用免疫组织化学方法对30例正常乳腺及90例乳腺导管疾病患者的ALDH1的表达进行测定。结果 ALDH1在正常、乳腺普通导管增生、不典型导管上皮增生以及浸润性导管癌中的阳性表达率为:0%、23.3%、23.3%、60%。结论乳腺浸润性导管癌患者的ALDH1的阳性率明显高于正常乳腺及其它乳腺导管疾病,提示ALDH1的阳性表达与乳腺增生至乳腺癌变的演进,且与疾病的预后有一定的关系。

  15. Higher usual alcohol consumption was associated with a lower 41-y mortality risk from coronary artery disease in men independent of genetic and common environmental factors: the prospective NHLBI Twin Study.

    Science.gov (United States)

    Dai, Jun; Mukamal, Kenneth J; Krasnow, Ruth E; Swan, Gary E; Reed, Terry

    2015-07-01

    Evidence that alcohol consumption is inversely associated with long-term coronary artery disease (CAD) mortality independent of genetic and early life environmental factors is lacking. We evaluated whether alcohol consumption was prospectively associated with CAD mortality risk independent of familial factors. In total, 843 male twins (396 pairs and 51 unpaired twins) aged 42-55 y (mean: 48 y) without baseline CAD reported beer, wine, and spirits consumption at baseline (1969-1973) and were followed up to 2010 in the prospective National Heart, Lung, and Blood Institute Twin Study. Data on usual alcohol consumption over the past year were collected. Outcome was time to event, where the primary event was death from CAD and secondary events were death from cardiovascular disease and all causes. HRs were estimated by using frailty survival models, both overall and within-pair. There were 129 CAD deaths and 219 cardiovascular deaths during 41 y of follow-up. In the whole cohort, after adjustment for caloric intake and cardiovascular disease risk factors, overall HRs per 10-g increment in alcohol intake were 0.94 (95% CI: 0.89, 0.98) for CAD and 0.97 (95% CI: 0.93, 1.00) for cardiovascular mortality. The within-pair adjusted HRs for a twin with 10-g higher daily alcohol consumption than his co-twin were 0.90 (95% CI: 0.84, 0.97) for CAD and 0.95 (95% CI: 0.90, 1.00) for cardiovascular disease mortality in the cohort pooled by zygosity, which remained similar among monozygotic twins. All 3 beverage types tended to be associated with lower CAD mortality risk within-pair to a similar degree. Alcohol consumption was not associated with total mortality risk overall or within-pair. Higher usual alcohol consumption is associated with lower CAD mortality risk, independent of germline and early life environment and adulthood experience shared among twins, supporting a possible causal role of alcohol consumption in lowering CAD death risk. This trial was registered at

  16. Testing of Usually Used Valves Manufactured by API Standards of Piping Works for Watersupply and Drainage in Petrochemical Industry%石油化工给排水管道常用API标准制造阀门的试验

    Institute of Scientific and Technical Information of China (English)

    成义祥

    2014-01-01

    该文介绍了石油化工给排水管道常用API标准制造阀门—闸阀、截止阀、蝶阀的试验项目及试验比例,通过在某大型石油化工项目的成功实践,证明了严格执行该阀门试验项目及试验比例对保证石油化工给排水管道施工质量的必要性、合理性。%Testing items and proportion of Usually Used Valves namely gate valve,globe valve, butterfly valve manufactured by API standards of piping worksfor watersupply and drainage in petrochemical industry is introduced. It is proved that strictly performing the testing items and proportion is essential and reasonable to ensure construction quality of piping works for watersupply and drainage in petr- ochemical industry through practicing in some large petrochemical project.

  17. Validity and Reproducibility of a Self-Administered Semi-Quantitative Food-Frequency Questionnaire for Estimating Usual Daily Fat, Fibre, Alcohol, Caffeine and Theobromine Intakes among Belgian Post-Menopausal Women

    Directory of Open Access Journals (Sweden)

    Selin Bolca

    2009-01-01

    Full Text Available A novel food-frequency questionnaire (FFQ was developed and validated to assess the usual daily fat, saturated, mono-unsaturated and poly-unsaturated fatty acid, fibre, alcohol, caffeine, and theobromine intakes among Belgian post-menopausal women participating in dietary intervention trials with phyto-oestrogens. The relative validity of the FFQ was estimated by comparison with 7 day (d estimated diet records (EDR, n 64 and its reproducibility was evaluated by repeated administrations 6 weeks apart (n 79. Although the questionnaire underestimated significantly all intakes compared to the 7 d EDR, it had a good ranking ability (r 0.47-0.94; weighted κ 0.25-0.66 and it could reliably distinguish extreme intakes for all the estimated nutrients, except for saturated fatty acids. Furthermore, the correlation between repeated administrations was high (r 0.71-0.87 with a maximal misclassification of 7% (weighted κ 0.33-0.80. In conclusion, these results compare favourably with those reported by others and indicate that the FFQ is a satisfactorily reliable and valid instrument for ranking individuals within this study population.

  18. Validity and reproducibility of a self-administered semi-quantitative food-frequency questionnaire for estimating usual daily fat, fibre, alcohol, caffeine and theobromine intakes among Belgian post-menopausal women.

    Science.gov (United States)

    Bolca, Selin; Huybrechts, Inge; Verschraegen, Mia; De Henauw, Stefaan; Van de Wiele, Tom

    2009-01-01

    A novel food-frequency questionnaire (FFQ) was developed and validated to assess the usual daily fat, saturated, mono-unsaturated and poly-unsaturated fatty acid, fibre, alcohol, caffeine, and theobromine intakes among Belgian post-menopausal women participating in dietary intervention trials with phyto-oestrogens. The relative validity of the FFQ was estimated by comparison with 7 day (d) estimated diet records (EDR, n 64) and its reproducibility was evaluated by repeated administrations 6 weeks apart (n 79). Although the questionnaire underestimated significantly all intakes compared to the 7 d EDR, it had a good ranking ability (r 0.47-0.94; weighted kappa 0.25-0.66) and it could reliably distinguish extreme intakes for all the estimated nutrients, except for saturated fatty acids. Furthermore, the correlation between repeated administrations was high (r 0.71-0.87) with a maximal misclassification of 7% (weighted kappa 0.33-0.80). In conclusion, these results compare favourably with those reported by others and indicate that the FFQ is a satisfactorily reliable and valid instrument for ranking individuals within this study population.

  19. The Effects of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Analysis System of Psychotherapy added to Treatment as Usual on suicidal ideation in chronic depression: Results of a randomized-clinical trial.

    Science.gov (United States)

    Forkmann, Thomas; Brakemeier, Eva-Lotta; Teismann, Tobias; Schramm, Elisabeth; Michalak, Johannes

    2016-08-01

    Suicidal ideation (SI) is common in chronic depression, but only limited evidence exists for the assumption that psychological treatments for depression are effective for reducing SI. In the present study, the effects of Mindfulness-based Cognitive Therapy (MBCT; group version) plus treatment-as-usual (TAU: individual treatment by either a psychiatrist or a licensed psychotherapist, including medication when indicated) and Cognitive Behavioral Analysis System of Psychotherapy (CBASP; group version) plus TAU on SI was compared to TAU alone in a prospective, bi-center, randomized controlled trial. The sample consisted of 106 outpatients with chronic depression. Multivariate regression analyses revealed different results, depending on whether SI was assessed via self-report (Beck Depression Inventory suicide item) or via clinician rating (Hamilton Depression Rating Scale suicide item). Whereas significant reduction of SI emerged when assessed via clinician rating in the MBCT and CBASP group, but not in the TAU group while controlling for changes in depression, there was no significant effect of treatment on SI when assessed via self-report. SI was measured with only two single items. Because all effects were of small to medium size and were independent of effects from other depression symptoms, the present results warrant the application of such psychotherapeutical treatment strategies like MBCT and CBASP for SI in patients with chronic depression. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Understanding outliers on the usual dose-response curve: venlafaxine as a way to phenotype patients in terms of their CYP 2D6 status and why it matters.

    Science.gov (United States)

    Preskorn, Sheldon H

    2010-01-01

    Venlafaxine is a model substrate for the drug metabolizing cytochrome P450 (CYP) enzyme 2D6. The desvenlafaxine/venlafaxine ratio, either after a single dose or at steady state, can be used to determine whether a patient is functionally (i.e., phenotypically) a CYP 2D6 extensive or poor metabolizer (EM or PM). In turn, CYP 2D6 EM and PM status is important in determining the efficacy of venlafaxine as an antidepressant. Based on a secondary analysis of four of the venlafaxine registration trials, venlafaxine was effective in patients who were CYP 2D6 EMs versus a parallel placebo-treated control group, whereas it was not effective in patients who were CYP 2D6 PMs. Thus, venlafaxine is a useful example of how drugs can be used to quantify differences in drug metabolizing capacity among patients and how such differences can in turn affect the efficacy of a drug (i.e., make a patient an outlier on the usual dose-response curve).

  1. Effectiveness of a parenting programme in a public health setting: a randomised controlled trial of the positive parenting programme (Triple P level 3 versus care as usual provided by the preventive child healthcare (PCH

    Directory of Open Access Journals (Sweden)

    Jansen Daniëlle EMC

    2010-03-01

    Full Text Available Abstract Background Considering the high burden of disease of psychosocial problems in children and adolescents, early intervention regarding problem behaviour of young children is very important. The Preventive Child Healthcare (PCH offers a good setting to detect such problem behaviour and to provide parenting support to the parents concerned. This paper aims to describe the design of an effectiveness study of a parenting programme for parents of children with mild psychosocial problems after an initial, evidence based screening in routine PCH. Methods/Design The effects of the intervention will be studied in a randomised controlled trial. Prior to a routine PCH health examination, parents complete a screening questionnaire on psychosocial problems. Parents of children with increased but still subclinical levels of psychosocial problems will be assigned at random to the experimental group (Triple P, level 3 or to the control group (care as usual. Outcome measures, such as problem behaviour in the child and parenting behaviour, will be assessed before, directly after and 6 and 12 months after the intervention. Discussion Parenting support may be an effective intervention to reduce psychosocial problems in children but evidence-based parenting programmes that fit the needs of the PCH are not available as yet. Although the Triple P programme seems promising and suitable for a universal population approach, evidence on its effectiveness in routine PCH still lacks. Trial registration NTR1338

  2. Short-term effect on pain and function of neurophysiological education and sensorimotor retraining compared to usual physiotherapy in patients with chronic or recurrent non-specific low back pain, a pilot randomized controlled trial.

    Science.gov (United States)

    Wälti, Philipp; Kool, Jan; Luomajoki, Hannu

    2015-04-10

    Non-specific chronic low back pain (NSCLBP) is a major health problem. Identification of subgroups and appropriate treatment regimen was proposed as a key priority by the Cochrane Back Review Group. We developed a multimodal treatment (MMT) for patients with moderate to severe disability and medium risk of poor outcome. MMT includes a) neurophysiological education on the perception of pain to decrease self-limitation due to catastrophizing believes about the nature of NSCLBP, b) sensory training of the lower trunk because these patients predominantly show poor sensory acuity of the trunk, and c) motor training to regain definite movement control of the trunk. A pilot study was conducted to investigate the feasibility of MMT, prior to a larger RCT, with focus on patients' adherence and the evaluation of short-term effects on pain and disability of MMT when compared to usual physiotherapy. We conducted a randomised controlled trial (RCT) in a primary care physiotherapy centre in Switzerland. Outcome assessment was 12 weeks after baseline. Patients with NSCLBP, considerable disability (five or more points on the Roland and Morris Disability Questionnaire (RMDQ) and medium or high risk of poor outcome on the Keele Start Back Tool (KSBT) were randomly allocated to either MMT or usual physiotherapy treatment (UPT) by an independent research assistant. Treatment included up to 16 sessions over 8 to 12 weeks. Both groups were given additional home training of 10 to 30 minutes to be performed five times per week. Adherence to treatment was evaluated in order to assess the feasibility of the treatment. Assessments were conducted by an independent blinded person. The primary outcome was pain (NRS 0-10) and the secondary outcome was disability (RMDQ). Between-group effects with Student's t-test or the Mann-Whitney U test and the standardized mean difference of the primary outcome were calculated. Twenty-eight patients (46% male, mean age 41.5 years (SD 10.6)) were randomized

  3. High-Protein and High-Dietary Fiber Breakfasts Result in Equal Feelings of Fullness and Better Diet Quality in Low-Income Preschoolers Compared with Their Usual Breakfast.

    Science.gov (United States)

    Kranz, Sibylle; Brauchla, Mary; Campbell, Wayne W; Mattes, Rickard D; Schwichtenberg, Amy J

    2017-03-01

    Background: In the United States, 17% of children are currently obese. Increasing feelings of fullness may prevent excessive energy intake, lead to better diet quality, and promote long-term maintenance of healthy weight.Objective: The purpose of this study was to develop a fullness-rating tool (aim 1) and to determine whether a high-protein (HP), high-fiber (HF), and combined HP and HF (HPHF) breakfast increases preschoolers' feelings of fullness before (pre) and after (post) breakfast and pre-lunch, as well as their diet quality, as measured by using a composite diet quality assessment tool, the Revised Children's Diet Quality Index (aim 2).Methods: Children aged 4 and 5 y (n = 41; 22 girls and 19 boys) from local Head Start centers participated in this randomized intervention trial. Sixteen percent of boys and 32% of girls were overweight or obese. After the baseline week, children rotated through four 1-wk periods of consuming ad libitum HP (19-20 g protein), HF (10-11 g fiber), HPHF (19-21 g protein, 10-12 g fiber), or usual (control) breakfasts. Food intake at breakfast was estimated daily, and for breakfast, lunch, and snack on day 3 of each study week Student's t tests and ANOVA were used to determine statistical differences.Results: Children's post-breakfast and pre-lunch fullness ratings were ≥1 point higher than those of pre-breakfast (aim 1). Although children consumed, on average, 65 kcal less energy during the intervention breakfasts (P quality (12%) was calculated for the HP and HF breakfasts (P quality. Serving HP or HF breakfasts may be valuable in improving diet quality without lowering feelings of satiation or satiety. This trial was registered at clinicaltrials.gov as NCT02122224.

  4. The effect of daily self-measurement of pressure pain sensitivity followed by acupressure on depression and quality of life versus treatment as usual in ischemic heart disease: a randomized clinical trial.

    Directory of Open Access Journals (Sweden)

    Natasha Bergmann

    Full Text Available BACKGROUND: Depressive symptoms and reduced quality of life (QOL are parts of the chronic stress syndrome and predictive of adverse outcome in patients with ischemic heart disease (IHD. Chronic stress is associated with increased sensitivity for pain, which can be measured by algometry as Pressure Pain Sensitivity (PPS on the sternum. AIM: To evaluate if stress focus by self-measurement of PPS, followed by stress reducing actions including acupressure, can decrease depressive symptoms and increase psychological well-being in people with stable IHD. DESIGN: Observer blinded randomized clinical trial over 3 months of either intervention or treatment as usual (TAU. STATISTICAL ANALYSIS: Intention to treat. METHODS: Two hundred and thirteen participants with IHD were included: 106 to active treatment and 107 to TAU. Drop-out: 20 and 12, respectively. The active intervention included self-measurement of PPS twice daily followed by acupressure as mandatory action, aiming at a reduction in PPS. Primary endpoint: change in depressive symptoms as measured by Major depression inventory (MDI. Other endpoints: changes in PPS, Well-being (WHO-5 and mental and physical QOL (SF-36. RESULTS: At 3 months PPS decreased 28%, to 58, in active and 11%, to 72, in TAU, p<0.001. MDI decreased 22%, to 6.5, in active group vs. 12%, to 8.3 in TAU, p = 0.040. WHO-5 increased to 71.0 and 64.8, active group and TAU, p = 0.015. SF-36 mental score sum increased to 55.3 and 53.3, active and TAU, p = 0.08. CONCLUSIONS: PPS measurements followed by acupressure reduce PPS, depressive symptoms and increase QOL in patients with stable IHD. TRIAL REGISTRATION: ClinicalTrials.gov NCT01513824.

  5. Te Ira Tangata: A Zelen randomised controlled trial of a treatment package including problem solving therapy compared to treatment as usual in Maori who present to hospital after self harm

    Directory of Open Access Journals (Sweden)

    Wikiriwhi Karen

    2011-05-01

    Full Text Available Abstract Background Maori, the indigenous people of New Zealand, who present to hospital after intentionally harming themselves, do so at a higher rate than non-Maori. There have been no previous treatment trials in Maori who self harm and previous reviews of interventions in other populations have been inconclusive as existing trials have been under powered and done on unrepresentative populations. These reviews have however indicated that problem solving therapy and sending regular postcards after the self harm attempt may be an effective treatment. There is also a small literature on sense of belonging in self harm and the importance of culture. This protocol describes a pragmatic trial of a package of measures which include problem solving therapy, postcards, patient support, cultural assessment, improved access to primary care and a risk management strategy in Maori who present to hospital after self harm using a novel design. Methods We propose to use a double consent Zelen design where participants are randomised prior to giving consent to enrol a representative cohort of patients. The main outcome will be the number of Maori scoring below nine on the Beck Hopelessness Scale. Secondary outcomes will be hospital repetition at one year; self reported self harm; anxiety; depression; quality of life; social function; and hospital use at three months and one year. Discussion A strength of the study is that it is a pragmatic trial which aims to recruit Maori using a Maori clinical team and protocol. It does not exclude people if English is not their first language. A potential limitation is the analysis of the results which is complex and may underestimate any effect if a large number of people refuse their consent in the group randomised to problem solving therapy as they will effectively cross over to the treatment as usual group. This study is the first randomised control trial to explicitly use cultural assessment and management. Trial

  6. Guided and unguided internet-based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three-armed randomised trial

    Science.gov (United States)

    van der Wouden, Johannes C; Bosmans, Judith E; Smalbrugge, Martin; van Diest, Willianne; Essery, Rosie; Yardley, Lucy; van der Horst, Henriëtte E; Maarsingh, Otto R

    2017-01-01

    Introduction Dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages. Methods and analysis A single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support (‘blended care’) with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale—Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners. Ethics and dissemination The ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations. Trial registration number Pre

  7. Protocol for the effect evaluation of Individual Placement and Support (IPS): a randomized controlled multicenter trial of IPS versus treatment as usual for patients with moderate to severe mental illness in Norway.

    Science.gov (United States)

    Sveinsdottir, Vigdis; Løvvik, Camilla; Fyhn, Tonje; Monstad, Karin; Ludvigsen, Kari; Øverland, Simon; Reme, Silje Endresen

    2014-11-18

    Roughly one third of disability pensions in Norway are issued for mental and behavioral disorders, and vocational rehabilitation offered to this group has traditionally been dominated by train-and-place approaches with assisted or sheltered employment. Based on a more innovative place-and-train approach, Individual Placement and Support (IPS) involves supported employment in real-life competitive work settings, and has shown great promise for patients with severe mental illness. The study is a multicenter Randomized Controlled Trial (RCT) of IPS in a Norwegian context, involving an effect evaluation, a process evaluation, and a cost/benefit analysis. IPS will be compared to high quality treatment as usual (TAU), with labor market participation and educational activity at 12 months post inclusion as the primary outcome. The primary outcome will be measured using register data, and the project will also include complete follow-up up to 4 years after inclusion for long-term outcome data. Secondary outcomes include mental health status, disability and quality of life, collected through survey questionnaires at baseline, and after 6 and 12 months. Participants will include patients undergoing treatment for moderate to severe mental illness who are either unemployed or on sickness or social benefits. The estimated total sample size of 400-500 will be randomly assigned to the interventions. To be eligible, participants must have an expressed desire to work, and sufficient Norwegian reading and writing skills to fill out the questionnaires. The Effect Evaluation of Individual Placement and Support (IPS) will be one of the largest randomized controlled trials to date investigating the effectiveness of IPS on competitive employment, and the first study to evaluate the effectiveness of IPS for patients with moderate to severe mental illness within a Norwegian context. Clinicaltrials.gov: NCT01964092 . Registered October 16th, 2013.

  8. Definition of Business as Usual and Its Impact on Assessment of Mitigation Efforts%照常情景的定义及其对减缓努力评价的影响

    Institute of Scientific and Technical Information of China (English)

    腾飞

    2012-01-01

    Business as usual (BAU) scenario has been a debated issue during climate change negotiation. This paper introduces different definitions of BAU and points out that the major difference among different definitions is how to set the starting point of BAU projection, so called the "base year" of BAU. Some international institutions used "existing policy scenarios" to project the BAU trajectory of developing countries. Such a definition will lead to an underestimate of the BAU emissions of developing countries and thus an underestimate of mitigation efforts. This paper suggests to use the "without policy scenario" with a fixed base year as the definition of BAU, this definition will set an objective benchmark for assessing the mitigation efforts of developing countries.%发展中国家排放的“照常情景”是气候变化研究及谈判中的焦点问题.目前对“照常情景”有不同的定义,本文分析了这些定义的异同,并指出不同定义的主要区别在于如何确定排放预测的起始点,也即“照常情景”的“基年”问题.部分国际机构采取的“照常情景”定义低估了发展中国家在“照常情景”下的排放路径,进而低估了发展中国家的减缓努力.建议采用固定基年的“无措施情景”来定义“照常情景”,以设定客观的评价基准,公平地评价发展中国家的减缓努力.

  9. Effects of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy and Usual Care on Back Pain and Functional Limitations among Adults with Chronic Low Back Pain: A Randomized Clinical Trial

    Science.gov (United States)

    Cherkin, Daniel C.; Sherman, Karen J.; Balderson, Benjamin H.; Cook, Andrea J.; Anderson, Melissa L.; Hawkes, Rene J.; Hansen, Kelly E.; Turner, Judith A.

    2016-01-01

    Importance Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain. Objective To evaluate the effectiveness for chronic low back pain of MBSR versus usual care (UC) and cognitive-behavioral therapy (CBT). Design, Setting, and Participants Randomized, interviewer-blind, controlled trial in integrated healthcare system in Washington State of 342 adults aged 20–70 years with CLBP enrolled between September 2012 and April 2014 and randomly assigned to MBSR (n = 116), CBT (n = 113), or UC (n = 113). Interventions CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. UC included whatever care participants received. Main Outcomes and Measures Co-primary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range 0 to 23) and in self-reported back pain bothersomeness (0 to 10 scale) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks. Results Among 342 randomized participants (mean age, 49 (range, 20–70); 225 (66%) women; mean duration of back pain, 7.3 years (range 3 months to 50 years), low back pain, treatment with MBSR and CBT, compared with UC, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain. PMID:27002445

  10. Improvement in Depressive Symptoms Is Associated with Reduced Oxidative Damage and Inflammatory Response in Type 2 Diabetic Patients with Subsyndromal Depression: The Results of a Randomized Controlled Trial Comparing Psychoeducation, Physical Exercise, and Enhanced Treatment as Usual

    Science.gov (United States)

    Vučić Lovrenčić, Marijana; Pibernik-Okanović, Mirjana; Šekerija, Mario; Prašek, Manja; Ajduković, Dea; Kos, Jadranka; Hermanns, Norbert

    2015-01-01

    Aims. To examine one-year changes in oxidative damage and inflammation level in type 2 diabetic patients undergoing behavioral treatment for subsyndromal depression. Materials and Methods. A randomized controlled comparison of psychoeducation (A), physical exercise (B), and enhanced treatment as usual (C) was performed in 209 eligible subjects in a tertiary diabetes care setting. Depressive symptoms (primary outcome) and selected biomarkers of oxidative damage and inflammation (secondary outcomes) were assessed at baseline and six- and twelve-month follow-up. Results. Out of the 74, 67, and 68 patients randomised into groups A, B, and C, respectively, 201 completed the interventions, and 179 were analysed. Participants in all three groups equally improved in depressive symptoms from baseline to one-year follow-up (repeated measures ANOVA; F = 12.51, p < 0.0001, η2 = 0.07). Urinary 8-oxo-deoxyguanosine (u-8-oxodG) decreased (F = 10.66, p < 0.0001, η2 = 0.06), as did sialic acid and leukocytes (F = 84.57, η2 = 0.32 and F = 12.61, η2 = 0.07, resp.; p < 0.0001), while uric acid increased (F = 12.53, p < 0.0001, η2 = 0.07) in all subjects during one year. Improvement of depressive symptoms at 6 months significantly predicted one-year reduction in u-8-oxodG (β = 0.15, p = 0.044). Conclusion. Simple behavioral interventions are capable not only of alleviating depressive symptoms, but also of reducing the intensity of damaging oxidative/inflammatory processes in type 2 diabetic patients with subsyndromal depression. This trial is registered with ISRCTN05673017. PMID:26347775

  11. Improvement in Depressive Symptoms Is Associated with Reduced Oxidative Damage and Inflammatory Response in Type 2 Diabetic Patients with Subsyndromal Depression: The Results of a Randomized Controlled Trial Comparing Psychoeducation, Physical Exercise, and Enhanced Treatment as Usual

    Directory of Open Access Journals (Sweden)

    Marijana Vučić Lovrenčić

    2015-01-01

    Full Text Available Aims. To examine one-year changes in oxidative damage and inflammation level in type 2 diabetic patients undergoing behavioral treatment for subsyndromal depression. Materials and Methods. A randomized controlled comparison of psychoeducation (A, physical exercise (B, and enhanced treatment as usual (C was performed in 209 eligible subjects in a tertiary diabetes care setting. Depressive symptoms (primary outcome and selected biomarkers of oxidative damage and inflammation (secondary outcomes were assessed at baseline and six- and twelve-month follow-up. Results. Out of the 74, 67, and 68 patients randomised into groups A, B, and C, respectively, 201 completed the interventions, and 179 were analysed. Participants in all three groups equally improved in depressive symptoms from baseline to one-year follow-up (repeated measures ANOVA; F=12.51, p<0.0001, η2=0.07. Urinary 8-oxo-deoxyguanosine (u-8-oxodG decreased (F=10.66, p<0.0001, η2=0.06, as did sialic acid and leukocytes (F=84.57, η2=0.32 and F=12.61, η2=0.07, resp.; p<0.0001, while uric acid increased (F=12.53, p<0.0001, η2=0.07 in all subjects during one year. Improvement of depressive symptoms at 6 months significantly predicted one-year reduction in u-8-oxodG (β=0.15, p=0.044. Conclusion. Simple behavioral interventions are capable not only of alleviating depressive symptoms, but also of reducing the intensity of damaging oxidative/inflammatory processes in type 2 diabetic patients with subsyndromal depression. This trial is registered with ISRCTN05673017.

  12. The ACCESS study a Zelen randomised controlled trial of a treatment package including problem solving therapy compared to treatment as usual in people who present to hospital after self-harm: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Parag Varsha

    2011-05-01

    Full Text Available Abstract Background People who present to hospital after intentionally harming themselves pose a common and important problem. Previous reviews of interventions have been inconclusive as existing trials have been under powered and done on unrepresentative populations. These reviews have however indicated that problem solving therapy and regular written communications after the self-harm attempt may be an effective treatment. This protocol describes a large pragmatic trial of a package of measures which include problem solving therapy, regular written communication, patient support, cultural assessment, improved access to primary care and a risk management strategy in people who present to hospital after self-harm using a novel design. Methods We propose to use a double consent Zelen design where participants are randomised prior to giving consent to enrol a large representative cohort of patients. The main outcome will be hospital attendance following repetition of self-harm, in the 12 months after recruitment with secondary outcomes of self reported self-harm, hopelessness, anxiety, depression, quality of life, social function and hospital use at three months and one year. Discussion A strength of the study is that it is a pragmatic trial which aims to recruit large numbers and does not exclude people if English is not their first language. A potential limitation is the analysis of the results which is complex and may underestimate any effect if a large number of people refuse their consent in the group randomised to problem solving therapy as they will effectively cross over to the treatment as usual group. However the primary analysis is a true intention to treat analysis of everyone randomised which includes both those who consent and do not consent to participate in the study. This provides information about how the intervention will work in practice in a representative population which is a major advance in this study compared to what has

  13. A pilot cluster randomised controlled trial to investigate the addition of direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain: the STEMS pilot trial protocol (ISRCTN23378642).

    Science.gov (United States)

    Bishop, Annette; Tooth, Stephanie; Protheroe, Joanne; Salisbury, Chris; Ogollah, Reuben O; Jowett, Sue; Hay, Elaine M; Foster, Nadine E

    2015-01-01

    Musculoskeletal problems are common, accounting for up to 30 % of general practitioner (GP) consultations and are a major cause of chronic disability worldwide. Demand for health care for musculoskeletal conditions is likely to continue to rise given the ageing population and the increasing impact of these common painful conditions. Physiotherapists are well equipped to deliver evidence-based management for these conditions. Direct access allows patients to access physiotherapy without seeing their GP or another referring practitioner first; however, for most patients in the UK, access to National Health Service physiotherapy is controlled through GP referral. The aim of this pilot, pragmatic, cluster trial is to assess the feasibility of a future large trial to compare the clinical and cost-effectiveness of the additional offer of direct access to physiotherapy versus continuing with usual GP-led primary care alone for adults with common musculoskeletal problems. The pilot will focus on process outcomes to assess feasibility, although performance of the likely outcomes of a main trial will also be assessed. This is a two-arm parallel, cluster RCT where GP practices are the units of randomisation (the clusters), yet data are collected from individual patients with musculoskeletal problems (the participants). A direct access service will be set up in the participating physiotherapy service to provide the option of direct access to patients of the intervention arm practices. Inclusion criteria are broad to reflect the 'real-world' operation of an NHS physiotherapy direct access service for patients with musculoskeletal pain. Data collection will be through patient self-reported questionnaires at baseline, 2, 6 and 12 months and medical record review. No previous trials have been conducted into direct access to physiotherapy for patients with musculoskeletal problems. The strengths of the STEMS pilot trial are its size, the length of follow-up, and collection of

  14. TIGA-CUB - manualised psychoanalytic child psychotherapy versus treatment as usual for children aged 5-11 years with treatment-resistant conduct disorders and their primary carers: study protocol for a randomised controlled feasibility trial.

    Science.gov (United States)

    Edginton, Elizabeth; Walwyn, Rebecca; Burton, Kayleigh; Cicero, Robert; Graham, Liz; Reed, Sadie; Tubeuf, Sandy; Twiddy, Maureen; Wright-Hughes, Alex; Ellis, Lynda; Evans, Dot; Hughes, Tom; Midgley, Nick; Wallis, Paul; Cottrell, David

    2017-09-15

    The National Institute for Health and Care Excellence (NICE) recommends evidence-based parenting programmes as a first-line intervention for conduct disorders (CD) in children aged 5-11 years. As these are not effective in 25-33% of cases, NICE has requested research into second-line interventions. Child and Adolescent Psychotherapists (CAPTs) address highly complex problems where first-line treatments have failed and there have been small-scale studies of Psychoanalytic Child Psychotherapy (PCP) for CD. A feasibility trial is needed to determine whether a confirmatory trial of manualised PCP (mPCP) versus Treatment as Usual (TaU) for CD is practicable or needs refinement. The aim of this paper is to publish the abridged protocol of this feasibility trial. TIGA-CUB (Trial on improving Inter-Generational Attachment for Children Undergoing Behaviour problems) is a two-arm, pragmatic, parallel-group, multicentre, individually randomised (1:1) controlled feasibility trial (target n = 60) with blinded outcome assessment (at 4 and 8 months), which aims to develop an optimum practicable protocol for a confirmatory, pragmatic, randomised controlled trial (RCT) (primary outcome: child's behaviour; secondary outcomes: parental reflective functioning and mental health, child and parent quality of life), comparing mPCP and TaU as second-line treatments for children aged 5-11 years with treatment-resistant CD and inter-generational attachment difficulties, and for their primary carers. Child-primary carer dyads will be recruited following a referral to, or re-referral within, National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) after an unsuccessful first-line parenting intervention. PCP will be delivered by qualified CAPTs working in routine NHS clinical practice, using a trial-specific PCP manual (a brief version of established PCP clinical practice). Outcomes are: (1) feasibility of recruitment methods, (2) uptake and follow-up rates, (3

  15. Heat-Insulation Property Evaluation of thermal protective clothing and cold protective clothing usually used at workplaces%常用高、低温防护服隔热性能研究

    Institute of Scientific and Technical Information of China (English)

    张忠彬; 刘宝龙; 李俊; 王云仪; 周书林

    2011-01-01

    为评价常用类型高、低温防护服的防护性能,本研究应用热平板仪、人工气候室和暖体假人等研究设备,对高低温作业典型工种常用的耐高温防护服和低温防护服的隔热性能进行了研究.研究结果显示,不同类型高、低温防护服的服装面料、服装整体的隔热性表现出一定差异,模拟环境下的着装生理学测试结果也存在不同,防护服的面料、结构和工艺等均影响到其整体隔热性能.防护服装的全面评价通常涉及安全性、工效学特性等多个方面,有必要从服装的舒适性、工效学特性等方面进一步研究,并开展大规模的现场人体穿着实验,从而为高低温防护服的选用和设计改进等提供依据.%In order to elucidate heat-insulation property of thermal protective clothing and cold protective clothing usually used at typical workplaces existing heat stress or cold stress, heat resistance for tested clothes and their materials were determined with thermal plane-table and thermal manikin, physiological index changes for six healthy males wearing tested clothes in artificial climate cabin were also determined. The results suggest that there is significant difference in heat insulate property for different type thermal protective clothing and cold protective clothing, as well as physiological index of the six healthy males such as temperature under clothes and average skin temperature. Factors affecting heat insulation property include the material, design and concrete technology of tested protective clothing. Thus, to provide scientific data for selection and improving of tested protective clothing, further studies are needed to make comprehensive evaluation for these tested clothes, such as assessment on ergonomics and comfort of tested clothes, and so on.

  16. Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual in Adult Patients With Emotional Disorders in the Primary Care Setting (PsicAP Study): Protocol for a Randomized Controlled Trial.

    Science.gov (United States)

    Cano-Vindel, Antonio; Muñoz-Navarro, Roger; Wood, Cristina Mae; Limonero, Joaquín T; Medrano, Leonardo Adrián; Ruiz-Rodríguez, Paloma; Gracia-Gracia, Irene; Dongil-Collado, Esperanza; Iruarrizaga, Iciar; Chacón, Fernando; Santolaya, Francisco

    2016-12-23

    Demand for primary care (PC) services in Spain exceeds available resources. Part of this strong demand is due to the high prevalence of emotional disorders (EDs)-anxiety, depression, and somatic symptom disorders-and related comorbidities such as pain or chronic illnesses. EDs are often under- or misdiagnosed by general practitioners (GPs) and, consequently, treatment is frequently inadequate. We aim to compare the short- and long-term effectiveness of group-delivered transdiagnostic cognitive behavioral therapy (TD-CBT) versus treatment as usual (TAU) in the treatment of EDs in the PC setting in Spain. We also aim to compare the effect of these treatments on disability, quality of life, cognitive-emotional factors, and treatment satisfaction. Here we present the study design of a two-arm, single-blind, randomized controlled trial (N=1126) to compare TAU to TD-CBT for EDs. TAU will consist primarily of pharmacological treatment and practical advice from the GP while TD-CBT will be administered in seven 90-minute group sessions held over a period ranging from 12 to 14 weeks. Psychological assessments are carried out at baseline (ie, pretreatment); posttreatment; and at 3-, 6-, and 12-month follow-up. The study is conducted in approximately 26 PC centers from the National Health System in Spain. This study was initiated in December 2013 and will remain open to new participants until recruitment and follow-up has been completed. We expect all posttreatment evaluations to be completed by December 2017, and follow-up will end in December 2018. We expect the TD-CBT group to have better results compared to TAU on all posttreatment measures and that this improvement will be maintained during follow-up. This project could serve as a model for use in other areas or services of the National Health System in Spain and even in other countries. International Standard Randomized Controlled Trial Number (ISRCTN): 58437086; http://www.isrctn.com/ISRCTN58437086 (Archived by Web

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

    Science.gov (United States)

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

    2014-01-01

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

  18. Interstitial high-dose rate brachytherapy for recurrent cervical cancer after radiation therapy; Braquiterapia intersticial para recidivas de cancer de colo uterino pos-radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Antonio Carlos Zuliani de; Esteves, Sergio Carlos Barros; Feijo, Luiz Fernando Andrade; Tagawa, Eduardo Komai; Cunha, Maercio de Oliveira [Universidade Estadual de Campinas, SP (Brazil). Centro de Atencao Integral a Saude da Mulher (CAISM)]. E-mail: estevesrt@uol.com.br

    2005-04-01

    Objective: To evaluate the response and potential toxicity of fractionated interstitial high-dose rate (HDR) brachytherapy for post-radiation pelvic recurrence in cervical cancer. Materials And Methods: From 1998 to 2001, 11 patients aged 41 to 71 years with cervical carcinoma stages II to IV who presented pelvic recurrence after radiation therapy were treated wit interstitial HDR. Nine of these patients (82%) had squamous cell carcinoma and two had adenocarcinoma. Radiation consisted of 20 Gy to 30 Gy delivered in fractions of 4 Gy to 5 Gy over three days. The median follow-up was 22.5 months (2 to 54 months), with periodic physical examinations (three months interval). One patient died without evaluation of the response. Results: Ten patients (91%) presented complete clinical response, three patients (27%) were disease free, two were alive with disease, three (27%) died of cancer and three (27%) were lost in the follow-up after the second recurrence. Urinary tract toxicity grade III was 9% (one patient). Conclusion: Interstitial HDR brachytherapy is an alternative approach to selected patients with recurrent cervical carcinoma after radiation therapy. High response rates were achieved with low toxicity taking into account the studied group, time of follow-up and re-irradiation. (author)

  19. Computerized tomography of chest in emphysema and interstitial diseases diagnosis. Tomografia computerizada del torax de alta resolucion en el diagnostico de enfisema y enfermedad intersticial

    Energy Technology Data Exchange (ETDEWEB)

    Souto Bayarri, M.; Malagari, K.; Ibarburen, C.; Arenas, G.; Correa Pombo, J.; Garcia Tahoces, P.; Tucker, D.; Barnes, G.T.; Luna, R.; Zerhouni, E.A.; Fraser, R.G.; Vidal Carrerira, J.J. (Hospital General de Galicia, Santiago de Compostela (Spain))

    1994-01-01

    To study the effect of increasing the spatial resolution on thin section (1.5 mm) computed tomography (CT) of the chest, we compared images reconstructed with the standard algorithm (SA) to three other images obtained with (1) a high spatial frequency algorithm, (2) retrospective targeting to a small field of view (FOV) reconstructed with the high spatial frequency algorithm, and (3) the same high spatial frequency algorithm with images acquired with the small (0.6 mm) rather the large (0.9 mm) focal spot. Examinations were performed on a phantom, on normal subjects, and on patients with emphysema and other diffuse lung diseases. Modulation transfer function (MTF) calculations revealed that higher resolution was achieved on the small focal spot and high spatial frequency algorithm than on the standard algorithm. Evaluation of the four images from 25 normal subjects, 16 patients with emphysema and 9 with interstitial disease was performed by means of an ROC study. Results from the areas under the ROC curves, sensitivity and specificity have shown that images reconstructed with the high spatial frequency algorithm were preferred. We conclude that the use of a high spatial frequency algorithm increases spatial resolution and improves visibility of lung parenchyma. Although more evaluation is needed, the potential of increasing spatial resolution further by using a smaller focal spot is currently limited by the mas Available per slice and the associated increased level of quantum noise. (Author)

  20. Variabilidad glucémica y envejecimiento: Estudio de la monitorización continua de glucemia intersticial en Diabetes Mellitus tipo 2

    OpenAIRE

    Pazos Couselo, Marcos

    2014-01-01

    La variabilidad glucémica (VG) se define como la magnitud de las oscilaciones de glucosa en sangre por encima y por debajo del rango de normalidad. Este concepto ha adquirido gran importancia en los últimos años, no solo por ser un factor limitante del tratamiento de la diabetes (por riesgo de hipoglucemias), sino por su relación con la aparición de complicaciones micro/macrovasculares. Las herramientas utilizadas en la clínica habitual para el control de la diabetes mellitus son la hemogl...

  1. Lymphocytic interstitial pneumonia: correlation of high-resolution computed tomography findings with anatomopathology; Pneumonia intersticial linfocitica: correlacao da tomografia computadorizada de alta resolucao com a anatomopatologia

    Energy Technology Data Exchange (ETDEWEB)

    Marchiori, Edson; Damato, Simone [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia; Rodrigues, Rosana; Mendonca, Renato Goncalves de [Universidade Federal, Rio de Janeiro, RJ (Brazil). Hospital Universitario Clementino Fraga Filho. Servico de Radiodiagnostico; Valiante, Paulo Marcos [Universidade Federal, Rio de Janeiro, RJ (Brazil). Dept. de Patologia; Miyagui, Tizuko [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Patologia; Aide, Miguel Abidon [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Disciplina de Pneumologia]. E-mail: edmarchiori@zipmail.com.br

    2002-08-01

    The purpose of this study is to report the main high-resolution computed tomography findings of two patients with lymphocytic interstitial pneumonia. High-resolution computed tomography findings were correlated with pathology findings of material obtained from open biopsies. One patient had diffuse ground glass opacities seen on high-resolution computed tomography whereas the other patient had peribroncovascular thickening. Anatomopathology studies showed that the main pattern was polyclonal lymphocyte interstitial infiltration, particularly along alveolar septa. The current study demonstrated a close correlation between high-resolution computed tomography and anatomopathology findings. (author)

  2. Evaluation of testosterone serum levels in testicular interstitial fluid under thyroxine influence; Avaliacao da testosterona no fluido intersticial testicular sob influencia da tiroxina

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Isvania Maria S. da; Pereira, Simey de L.S.; Souza, Grace Mary L.; Carvalho, Elaine F.M.B.; Catanho, Maria Teresa J. de A. [Pernambuco Univ., Recife, PE (Brazil). Dept. de Biofisica e Radiobiologia; Silveira, Maria de Fatima G. da [Pernambuco Univ., Recife, PE (Brazil). Dept. de Anatomia; Lima Filho, Guilherme L. [Universidade de Pernambuco (UPE), Nazare da Mata, PE (Brazil). Faculdade de Formacao de Professores

    2000-07-01

    The thyroid hormones possibly exert a reciprocal action between testicular steroids and Sertoli's cells during the premature period. This work aims to evaluate thyroxine effect on testosterone serum levels and in the testicular interstitial fluid (TIF) in rats. Wistar males rats, 22 days old, 80g of body weight, were induced to hyperthyroidism with thyroxine (20{mu}g/kg) in periods of 5, 10, 15 and 20 consecutive days. After the treatment the animals were weighed and sacrificed for blood and testis collection. From the blood serum and from the TIF drained from the testis were performed testes in order to obtain testosterone attached to {sup 125} I with a specific activity of 36,86 MBq/ig. The results have shown a testosterone significant lineal increase in both - serum and TIF - in the group treated with thyroxine as a time function. In the control group, testosterone levels remained low in both serum and TIF dosages. As a result, we were able to verify that the testosterone levels could be modified by thyroxine in serum and TIF. And so, it could affect luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in hypophysis. (author)

  3. ISO Observations of Starless Bok Globules: Usually No Embedded Stars

    Science.gov (United States)

    Clemens, D.; Byrne, A.; Yun, J.; Kane, B.

    1996-01-01

    We have used ISOCAM to search the cores of a sample of small Bok globules previously classified to be mostly starless based on analysis of IRAS data. The ISO observations at 6.75microns (LW2 filter) and 14.5microns (LW3 filter) were sufficiently deep to enable detection of any low-mass hydrogen burning star or young stellar object (YSO) embedded in these globules. Of the 20 Bok globules observed by ISOCAM to date, we have reduced the data for 14. Of these, 13 show no evidence for faint red (S(sub v)(LW3) greater than S(sub v)(LW2)) stars missed by IRAS. One (CB68) does show the first mid-infrared detection of the very cool IRAS source toward this cloud, and may be a Class I or 0 YSO. We conclude, based on these new ISO observations, that Bok globules which have no IRAS sources are in general bona fide starless molecular clouds.

  4. Umbilical cord clamping. An analysis of a usual neonatological conduct.

    Science.gov (United States)

    Papagno, L

    1998-01-01

    Here we described a critical analysis of the neonatological procedure of early cord clamping, meaning this, within 40 seconds after birth. Fifty three cases are here analysed, in which this practice was not performed, but instead a late umbilical cord clamping was done after birth or after the cord had stopped beating. Variations in hematocrito values within 24 to 36 hours after birth were studied. A transitory polycithemia, with a maximum peak 12 hours post-delivery was observed. These values returned to normal levels between 24 and 36 hours after birth. K vitamin was not administered to any of the newborns. No pathology appeared related to this transitory polycithemia. In can be concluded that the late umbilical cord clamping represents no risk to the new-born and that the pathological phenomena described under these circumstances may be attributed to the increase in K vitamin dependent coagulation factors that are induced by the routinary administration of phitonadione to all normal newborns.

  5. Far Beyond the Usual Biomarkers in Breast Cancer: A Review

    Science.gov (United States)

    dos Anjos Pultz, Brunna; da Luz, Felipe Andrés Cordero; de Faria, Paulo Rogério; Oliveira, Ana Paula Lima; de Araújo, Rogério Agenor; Silva, Marcelo José Barbosa

    2014-01-01

    Research investigating biomarkers for early detection, prognosis and the prediction of treatment responses in breast cancer is rapidly expanding. However, no validated biomarker currently exists for use in routine clinical practice, and breast cancer detection and management remains dependent on invasive procedures. Histological examination remains the standard for diagnosis, whereas immunohistochemical and genetic tests are utilized for treatment decisions and prognosis determinations. Therefore, we conducted a comprehensive review of literature published in PubMed on breast cancer biomarkers between 2009 and 2013. The keywords that were used together were breast cancer, biomarkers, diagnosis, prognosis and drug response. The cited references of the manuscripts included in this review were also screened. We have comprehensively summarized the performance of several biomarkers for diagnosis, prognosis and predicted drug responses of breast cancer. Finally, we have identified 15 biomarkers that have demonstrated promise in initial studies and several miRNAs. At this point, such biomarkers must be rigorously validated in the clinical setting to be translated into clinically useful tests for the diagnosis, prognosis and prediction of drug responses of breast cancer. PMID:25057307

  6. Business as Usual: Business Students' Conceptions of Ethics

    Science.gov (United States)

    Reid, Anna; Taylor, Paul; Petocz, Peter

    2011-01-01

    There is continuing debate about how best to teach ethics to students in business, that is, how best to help them to develop the ethical aspects of their future profession. This debate has covered whether to teach ethics, what to teach and whether it has any effect on students' views or future behaviour. For the most part, the views of the…

  7. A Usual Schwannoma at an Unusual Site-The Mesorectum

    Directory of Open Access Journals (Sweden)

    Jaya Manchanda

    2016-07-01

    Full Text Available The aim of the article is to present a rare case of mesorectal schwannoma diagnosed by fine needle aspiration cytology in a 36 year old man. Schwannomas are benign encapsulated tumors arising from Schwann cells of motor and peripheral nerves. They commonly present on the head, neck and trunk and on rare occasion arise in the retroperitoneum and in the lumbosacral region. It is however quite uncommon for a schwanomma to originate in the mesorectum. In evaluating such cases, FNAC provides a safe and effective method to resolve the great diagnostic dilemma.

  8. Indicators for European Union Policies. Business as Usual?

    Science.gov (United States)

    Saltelli, Andrea; D'Hombres, Beatrice; Jesinghaus, Jochen; Manca, Anna Rita; Mascherini, Massimiliano; Nardo, Michela; Saisana, Michaela

    2011-01-01

    This paper looks at the role of "statistics-based knowledge" in the making of EU policy. We highlight "shortcomings" in the use of statistical indicators made in the course of the Lisbon strategy, ended in 2010. In our opinion the shortcomings are: (i) The paradox of the "coexistence" within the same European…

  9. The Learning Outcomes Project: Not Business as Usual

    Science.gov (United States)

    Heiland, Linda; Switzer-Kemper, Cathy

    2007-01-01

    Central Arizona College successfully defined student learning outcomes and is building a culture of evidence to support the Learning Paradigm. Recent data indicate great strides in the improvement of student learning. Qualitative research produced meaningful comparisons of leadership and faculty perceptions of the process of developing student…

  10. Why Third World Urban Employers Usually Prefer Men.

    Science.gov (United States)

    Anker, Richard; Hein, Catherine

    1985-01-01

    Case studies provide evidence as to why Third World employers generally prefer male workers and consider certain jobs to be more suitable for men, and other jobs, much less numerous, to be more suitable for women. The authors also draw a number of distinctions between stereotype and fact. (Author/CT)

  11. Regional Overview: Summits Galore, But (Mostly) Business as Usual

    National Research Council Canada - National Science Library

    Ralph A Cossa; Brad Glosserman

    2016-01-01

    ...) in Seoul and the "non-summit" between Mr. Xi Jinping and Mr. Ma Ying-Jeou who just happen to be the presidents, respectively, of the People's Republic of China and Republic of China, in Singapore. Chinese actions...

  12. The Netherlands and the Oil Crisis : Business as Usual

    NARCIS (Netherlands)

    Hellema, Duco; Wiebes, Cees; Witte, Toby

    2004-01-01

    Tijdens de Oktober-oorlog en de daarop volgende oliecrisis in 1973 speelde Nederland een opvallende rol. Al vóór Nixon een luchtbrug vormde naar Israël, had de Nederlandse regering in het geheim een aanzienlijke hoeveelheid wapentuig naar Israël gestuurd. Binnen de Europese Gemeenschap sprak Nederla

  13. Imaging Spectrum of Hydatid Disease: Usual and Unusual Locations

    Science.gov (United States)

    Srinivas, Maskal Revanna; Deepashri, Basavalingu; Lakshmeesha, Mogenahalli Thimmaiah

    2016-01-01

    Summary Hydatid disease is a parasitic infection caused by Echinococcus granulosus and Echinococcus multilocularis. It is common in endemic regions and can demonstrate a variety of imaging features that differ according to the affected organ and the stage of the disease. Liver and lungs are the most commonly affected organs. The classic features of hepatic hydatid disease are well known. However, diagnosing hydatid disease at unusual locations may be challenging because of myriad imaging features in each of these locations. Knowledge of the imaging spectrum in systemic hydatidoses in various organs is very valuable in improving the accuracy of radiological interpretation. The purpose of this article is to review the imaging features of hydatid disease at its varied locations. PMID:27231490

  14. Biology and Economics: Metaphors that Economists usually take from Biology

    Directory of Open Access Journals (Sweden)

    Danny García Callejas

    2007-10-01

    Full Text Available Adam Smith, Alfred Marshall, Stanley Jevons, Karl Marx, Francois Quesnay and Joseph Schumpeter all have at least one thing in common: they used biological metaphors when speaking about economics. Nonetheless, today, this relation subsists and biology and economics are viewed as complementary sciences that have a lot to gain from joint research in fields like: evolutionary economics, economic growth, cognitive economics and environmental and ecological economics, among others. This paper, divided in four sections, will show this conclusion and explain that biology and economics are more sisters than strangers

  15. Dyspnea in a nonagenarian: The usual suspects, an unexpected culprit.

    Science.gov (United States)

    Madeira, Sérgio; Raposo, Luís; David, Raquel; Marques, Alexandre; Andrade Gomes, José; Cardim, Nuno; Anjos, Rui

    2015-09-01

    Platypnea-orthodeoxia syndrome (POS) is an uncommon syndrome characterized by dyspnea and hypoxemia triggered by orthostatism and relieved by recumbency. It is often associated with an interatrial shunt through a patent foramen ovale (PFO). We report the case of a 92-year-old woman initially admitted in the setting of a traumatic femoral neck fracture (successfully treated with hip replacement surgery) in whom a reversible decline in transcutaneous oxygen saturation from 98% (in the supine position) to 84% (in the upright position) was noted early post-operatively. Thoracic multislice computed tomography excluded pulmonary embolism and severe parenchymal lung disease. The diagnosis of POS was confirmed by tilt-table contrast transesophageal echocardiography, which demonstrated a dynamic and position-dependent right-to-left shunt (torrential when semi-upright and minimal in the supine position) through a PFO. The patient underwent percutaneous closure of the PFO with an Amplatzer device, which led to prompt symptom relief and full functional recovery.

  16. Predictors of leadership: The usual suspects and the suspect traits

    OpenAIRE

    Antonakis, J.

    2011-01-01

    In this chapter, I review literature on traits (i.e., individual differences) and their links to leader outcomes. I present an integrated model, the ascription-actuality trait theory, to explain two routes to leader outcomes that stem from traits: the route that objectively matters and the route that appears to matter but objectively may not. I discuss the history of trait research and provide criteria by which we should judge the validity of trait models. Finally, I review trait models that ...

  17. Populisms and liberal democracy – business as usual?

    DEFF Research Database (Denmark)

    Thompson, Grahame Frederick

    2017-01-01

    Populism is often thought to mark a sharp break with liberal democracy. But to what extent is this the case? In this contribution the connections between populism and liberal democracy are sketched in the context of several areas where discussions about populisms have stressed their discontinuity...

  18. Business as Usual: Amazon.com and the Academic Library

    Science.gov (United States)

    Van Ullen, Mary K.; Germain, Carol Anne

    2002-01-01

    In 1999, Steve Coffman proposed that libraries form a single interlibrary loan based entity patterned after Amazon.com. This study examined the suitability of Amazon.com's Web interface and record enhancements for academic libraries. Amazon.com could not deliver circulating monographs in the University at Albany Libraries' collection quickly…

  19. Dictionaries in the Internet Era: Innovation or Business as Usual?

    DEFF Research Database (Denmark)

    Tarp, Sven

    2014-01-01

    This article is the written version of the Enrique Alcaraz Annual Memorial Lecture, given by the author at the University of Alicante on March 26, 2014. After a brief overview of the past and present of lexicography, it presents some of the challenges and paradoxes facing the discipline in the cu......This article is the written version of the Enrique Alcaraz Annual Memorial Lecture, given by the author at the University of Alicante on March 26, 2014. After a brief overview of the past and present of lexicography, it presents some of the challenges and paradoxes facing the discipline...... and techniques which can be applied to improve the quality of present and future online dictionaries. Finally, it presents the main concept of an online business dictionary under construction where some of these principles, methods and techniques are used in order to adapt the articles visualised on the screen...

  20. Dictionaries in the Internet Era: Innovation or Business as Usual?

    DEFF Research Database (Denmark)

    Tarp, Sven

    2014-01-01

    in the current transition to the digital media. Through examples from lexicographical practice it provides a vision of dictionaries as information tools and presents the core elements of a general theory covering all types of lexicographical work. Upon this basis, the article discusses principles, methods...... and techniques which can be applied to improve the quality of present and future online dictionaries. Finally, it presents the main concept of an online business dictionary under construction where some of these principles, methods and techniques are used in order to adapt the articles visualised on the screen...

  1. Protein purification and crystallization artifacts: The tale usually not told.

    Science.gov (United States)

    Niedzialkowska, Ewa; Gasiorowska, Olga; Handing, Katarzyna B; Majorek, Karolina A; Porebski, Przemyslaw J; Shabalin, Ivan G; Zasadzinska, Ewelina; Cymborowski, Marcin; Minor, Wladek

    2016-03-01

    The misidentification of a protein sample, or contamination of a sample with the wrong protein, may be a potential reason for the non-reproducibility of experiments. This problem may occur in the process of heterologous overexpression and purification of recombinant proteins, as well as purification of proteins from natural sources. If the contaminated or misidentified sample is used for crystallization, in many cases the problem may not be detected until structures are determined. In the case of functional studies, the problem may not be detected for years. Here several procedures that can be successfully used for the identification of crystallized protein contaminants, including: (i) a lattice parameter search against known structures, (ii) sequence or fold identification from partially built models, and (iii) molecular replacement with common contaminants as search templates have been presented. A list of common contaminant structures to be used as alternative search models was provided. These methods were used to identify four cases of purification and crystallization artifacts. This report provides troubleshooting pointers for researchers facing difficulties in phasing or model building.

  2. During the holidays, it was business as usual.

    CERN Multimedia

    2006-01-01

    On the eve of this long weekend for jeûne genevois, many of you are already back from your holidays. The Staff Association hopes you are in fine form for your return to work, which, no doubt, will not be easy. During the holidays, the Staff Association representatives, for their part, carried on with the work they had begun. We would like to inform you about this work by simply running through the list of subjects tackled. This information supplements the three previous editorials.

  3. Chemical Tracking Systems: Not Your Usual Global Positioning System!

    Science.gov (United States)

    Roy, Ken

    2007-01-01

    The haphazard storing and tracking of chemicals in the laboratory is a serious safety issue facing science teachers. To get control of your chemicals, try implementing a "chemical tracking system". A chemical tracking system (CTS) is a database of chemicals used in the laboratory. If implemented correctly, a CTS will reduce purchasing costs,…

  4. Simple algebraic groups are (usually) determined by an invariant

    CERN Document Server

    Garibaldi, Skip

    2013-01-01

    Let G be a simple algebraic group over an algebraically closed field k and V be a irreducible rational kG-module. We show that, for a typical G-invariant polynomial function f on V, the identity component of the stabilizer of f in GL(V) is G. As a specific example, we show that groups of type E8 are automorphism groups of certain degree 8 homogeneous forms on Lie(E8). We also classify all irreducible G-modules V such that the dimension of the invariant rings for G and H are the same with G < H < SL(V). We also show that for characteristic not 2, there almost always exists an irreducible tensor indecomposable kG-module so that G is the identity component of the stabilizer in SL(V) of a homogeneous polynomial that has degree at most 3.

  5. Physics that Textbook Writers Usually Get Wrong: III.

    Science.gov (United States)

    Bauman, Robert P.

    1992-01-01

    Examines inconsistencies in science textbook discussions of vector quantities and force. Provides illustrations of textbook inconsistencies related to Newton's laws of motion and the concepts of centrifugal and coriolis force. (MDH)

  6. Comparison of Centauro and usual {gamma}'s events

    Energy Technology Data Exchange (ETDEWEB)

    Barroso, S.L.C.; Beggio, P.C.; Carvalho, A.O. de; Marques, M.D.O.; Menon, M.J.; Navia, C.E.; Oliveira, R. de; Shibuya, E.H

    1999-03-01

    The B-J Collaboration experiments discovered high transverse momenta in hadronic interactions, through cosmic ray events. Among then, mean transverse momenta < P{sub T{sub h}} > of the order of 1 GeV/c events were found and such events were nicknamed Centauro events. As the high transverse momenta are of hadronic particles, naturally this is connected with the criteria of identification of secondaries. To have more confidence on the abnormal features of Centauro events, we used the Kolmogorov-Smirnov non parametric test, aiming to show the discrepancy with normal events.

  7. Why Third World urban employers usually prefer men.

    Science.gov (United States)

    Anker, R; Hein, C

    1985-01-01

    Males outnumber female employees by 3 to 1 in the modern sector of developing countries; moreover, women tend to be concentrated in a limited number of occupations. This underrepresentation of women in employment in Third World countries is generally attributed to the restricted supply of qualified women willing and able to work away from home in modern sector occupations. However, this approach pays insufficient attention to the demand for labor and the recruitment policy of employers. Employer concerns and perceptions that limit the overall demand for women workers and thereby reduce their employment opportunities include the need for pregnancy and maternity leave and protection, absenteeism, turnover, and cultural restrictions. Among the factors that contribute to the sexual segmentation of the labor market are protective legislation that excludes women from certain sectors of the labor market, sex-typing of jobs, and employer perceptions that women lack muscular strength, are not effective supervisors, and cannot work well with men. At the same time, women are preferred for certain jobs because of their greater docility, acceptance of lower wages, household-type skills, and sex appeal. The general factor limiting employment opportunities for women is the employer's perception that women are more costly and less productive than male employees. This perception is directly related to women's role in childbearing and rearing, and is reinforced by legislation that places the costs of maternity leave, nursing breaks, and child care directly on the employer. Thus, women's childbearing and family responsibilities not only limit their availability for work but also discourage employers from hiring them.

  8. LKB1 and lung cancer: more than the usual suspects.

    Science.gov (United States)

    Shah, Usman; Sharpless, Norman E; Hayes, D Neil

    2008-05-15

    Often, the problem in cancer research is figuring out how a gene or pathway works in regulating cellular transformation. The question of what RAS activates or PTEN inhibits have been classic dilemmas of modern cancer biology. In these cases, biochemical and genetic studies have provided us with a fairly clear picture of the cancer relevant functions of these genes. For LKB1, a more recently identified human tumor suppressor gene, however, the problem is different. This serine-threonine kinase that is conserved from yeast to mammals seems to play a role in many diverse cellular pathways. Therefore, although elegant functional and genetic approaches have established critical roles for LKB1 in the regulation of metabolism, motility, polarity, and the cell cycle, the role(s) responsible for its true tumor suppressor function(s) is unknown. One is reminded of an Agatha Christie murder mystery where nearly every character in the book has reason to be suspected of committing the crime-there are too many suspects for how LKB1 might repress lung cancer.

  9. Phenolic characterization of Northeast Portuguese propolis: usual and unusual compounds

    OpenAIRE

    Falcão, Soraia; Vilas-Boas, Miguel; Estevinho, Leticia M.; Barros, Cristina; Domingues, M. R. M.; Cardoso, Susana M.

    2010-01-01

    In this study, an ethanolic extract from Portuguese propolis was prepared, fractionated by highperformance liquid chromatography, and the identification of the phenolic compounds was done by electrospray mass spectrometry in the negative mode. This technical approach allowed the identification of 37 phenolic compounds, which included not only the typical phenolic acids and flavonoids found in propolis from temperate zones but also several compounds in which its occurre...

  10. Business Not as Usual: Developing Socially Conscious Entrepreneurs and Intrapreneurs

    Science.gov (United States)

    Parris, Denise Linda; McInnis-Bowers, Cecilia

    2017-01-01

    Our objective was to design an introductory business course to shape the mind-sets and skill sets of the next generation of socially conscious practitioners--to help students develop a sense of self-efficacy built on the confidence that they can make a positive impact on the world using entrepreneurial thinking and action. Essentially, the focus…

  11. The orange roughy Hoplostethus atlanticus is an un- usual fish ...

    African Journals Online (AJOL)

    denise

    stand several cycles of freezing and thawing (Merrett and Haedrich 1997); ... Deep-water habitat may be damaged by trawling operations and may take many years to recover, so ... tool for managing orange roughy fisheries, both old and new.

  12. Usual Dietary Intakes: SAS Macros for the NCI Method

    Science.gov (United States)

    SAS macros are currently available to facilitate modeling of a single dietary component, whether consumed daily or episodically; ratios of two dietary components that are consumed nearly every day; multiple dietary components, whether consumed daily or episodically.

  13. "There is usually just one Friday a week."

    DEFF Research Database (Denmark)

    Gram, Malene; Grønhøj, Alice

    2015-01-01

    . Drawing on the literature on family and food consumption, this study builds on interviews with 35 children and 13 families in Danish middle- and upper-middle-class areas and explores food categorization through the use of Greimas’ semiotic square. Findings show that while clear rules for consumption...

  14. Vinculación entre las prácticas usuales del proceso de gestión, preparación y evaluación de proyectos públicos y conocimientos académicos que las sustentan.

    OpenAIRE

    Ma. Victoria Yori; Francisco Sobrero

    2011-01-01

    El objetivo de este trabajo es determinar cuál es la relación entre los enfoques conceptuales correspondientes a las prácticas usuales de “Evaluación de Proyectos” y los conocimientos académicos que las sustentan. Para ello, se analizaron entrevistas realizadas a informantes calificados, formulaciones de Proyectos de Inversión Pública actuales, los programas de enseñanza de la disciplina, y la bibliografía más relevante. El resultado de este trabajo muestra que existen ciertos problemas en la...

  15. Neumonía por Legionella pneumophila: Experiencia en un Hospital Universitario de Buenos Aires Neumonia due to Legionella pneumophila. Experience gathered in a University Hospital in Buenos Aires

    Directory of Open Access Journals (Sweden)

    Carlos M. Luna

    2004-04-01

    Full Text Available La enfermedad de los legionarios es una causa de neumonía adquirida en la comunidad (NAC reconocida en todo el mundo. En Latinoamérica su incidencia es desconocida. En este estudio se analizó a 9 pacientes con NAC por Legionella pneumophila atendidos entre 1997 y 2001 en el Hospital de Clínicas José de San Martín de la Universidad de Buenos Aires. Se registraron datos de antecedentes, enfermedad actual, contactos, exposición laboral, examen físico, pruebas de laboratorio y uso previo de antibióticos, y se tomó en cuenta la presencia de criterios de gravedad. Nueve pacientes presentaron diagnóstico de NAC por Legionella, ninguno refirió antecedentes de viajes recientes; cuatro de ellos debieron ser internados en unidades de cuidado intensivo. Siete pacientes tenían antecedentes de tabaquismo, 4 tenían EPOC y un paciente linfoma no-Hodgkin. Nuestra casuística corrobora la baja especificidad de la clínica y estudios complementarios para predecir esta etiología. El aislamiento de Legionella es dificultoso, la seroconversión permite el diagnóstico retrospectivo y requiere plazos prolongados y el antígeno urinario aporta un diagnóstico inmediato. Cuando la legionelosis aparece en casos aislados, como ocurriría en Argentina, si no se piensa en esta etiología no se llegará al diagnóstico. Legionella pneumophila es un patógeno de NAC en nuestro medio, debe buscarse mejor, particularmente en pacientes graves, inmunodeprimidos y en fumadores con enfermedad pulmonar obstructiva crónica (EPOC.Legionnaires’ disease is a well recognized cause of community acquired pneumonia (CAP all around the world. In Latin America its incidence remains unknown. This study analyzed a cohort of 9 patients with CAP due to Legionella pneumophila observed from 1997 to 2001, in the Hospital de Clínicas José de San Martín, University of Buenos Aires. Clinical history included recent illnesses, work exposure, physical exam, prior antibiotic use and severity of illness criteria. None of the 9 patients had a history of recent travels, and 4 of them required admission in intensive care unit (ICU. Seven patients had a cigarette smoking history, four of them also had COPD, and one patient had a non-Hodgkin lymphoma. This study confirms the low specificity of clinical and general laboratory criteria to predict this etiology. Legionella isolation is difficult, and serological testing allows retrospective diagnosis but takes several weeks, while urinary antigen test gives a bed-side diagnosis. When Legionella appears in isolated cases, as happens in Argentina, it should be necessary to have a high index of suspicion to successfully arrive at an etiological diagnosis. Legionella pneumophila is a pathogen causing CAP in our area. A surveillance should be established preferably focused on selected populations including severe CAP, immunocompromised hosts and patients with chronic obstructive pulmonary disease.

  16. Cost-Effectiveness Analysis of Three Dosage Regimen in the Treatment of Pedo-Bronchop-neumonia%三种药物治疗方案治疗小儿支气管肺炎的成本-效果分析

    Institute of Scientific and Technical Information of China (English)

    张晓昊

    2007-01-01

    目的:评价治疗小儿支气管肺炎的三种药物治疗方案的成本-效果分析.方法:选择32例小儿支气管肺炎患者,分为A、B、C三组,进行药物经济学的成本-效果分析.结果:C组(注射用阿奇霉素即齐宏)治疗方案效率最高,成本最低.结论:大环内酯类抗生素阿奇霉素治疗支气管肺炎效果好,但不良反应也较多,有待于进一步研究.

  17. Drug resistance mechanisms of imipenem-resistant K lebsiella p neumoniae%耐亚胺培南肺炎克雷伯菌的耐药机制研究

    Institute of Scientific and Technical Information of China (English)

    豆清娅; 邹明祥; 李春辉; 李军; 胡咏梅; 王海晨; 吴安华

    2016-01-01

    目的:探讨耐亚胺培南肺炎克雷伯菌的流行病学特征和β‐内酰胺酶基因型,为临床合理用药和感染控制提供依据。方法收集2014年2-11月临床分离25株耐亚胺培南肺炎克雷伯菌,采用VIT EK‐2微生物系统检测菌株的药物敏感性;改良 Hodge试验检测碳青霉烯酶;PCR检测β‐内酰胺酶基因 KPC‐2、SHV、CTX‐M、IM P、VIM、NDM‐1、OXA‐48;采用肠杆菌科基因间一致重复序列聚合酶链技术(ERIC‐PCR)对菌株进行同源性分析。结果在检测的18种药物中,哌拉西林/他唑巴坦、氨苄西林/舒巴坦、头孢唑林、头孢曲松、氨苄西林、厄他培南、亚胺培南、氨曲南的耐药率均为100.0%,磺胺甲噁唑/甲氧苄啶的耐药率最低为32.0%,其次为阿米卡星和妥布要素均为(68.0%);改良H o dg e试验阳性20株(80.0%);25株菌均检测到 S H V基因,20株菌检测到CTX‐M基因,15株检测到KPC‐2基因,1株菌检测到 IMP‐4基因,3株菌检测到NDM‐1基因,未检测到 VIM、OXA‐48基因;25株菌分为6型,为A、B、C、D、E、F ,分别有15、5、2、1、1、1株。结论耐亚胺培南的肺炎克雷伯菌多药耐药严重,产生β‐内酰胺酶是菌株对多种药物耐药的主要机制,且菌株存在克隆性传播,3株菌检测到NDM‐1基因,应引起相关部门的重视。%OBJECTIVE To study the epidemiological characteristics and genotypes of β‐lactamase in imipenem‐re‐sistant K lebsiella pneumoniae so as to provide guidance for reasonable clinical use of antibiotics and control of in‐fections .METHODS A total of 25 strains of imipenem‐resistant K .pneumoniae were collected from Feb 2014 to Nov 2014 .The drug susceptibility was tested by microorganism analytical system VITEK‐2 ,the modified Hodge test was carried out to screen carbapenemases of the strains ,PCR was used to detect KPC‐2 ,SHV ,CTX‐M , IMP ,VIM ,NDM‐1 ,and OXA‐48 of β‐lactamase genes .The homology of the 25 strains was analyzed by mean of enterobacterial repetitive intergenic consensus‐PCR (ERIC‐PCR) .RESULTS Among the 18 antibiotics tested ,the drug resistance rates to piperacillin‐tazobactam ,ampicillin/sulbactam ,cefazolin ,ceftriaxone ,ampicillin ,ertapen‐em ,imipenem ,and aztreonam were 100 .0% ;the drug resistance rate to sulfamethoxazole‐trimethoprim was the lowest (32 .0% ) ,followed by amikacin and tobvamyin toth (68 .0% ) .The modified Hodge test showed that 20 strains(80 .0% ) were positive ;totally 25 strains were tested positive for SHV gene ,20 strains were tested posi‐tive for CTX‐M gene ,15 strains were tested positive for KPC‐2 gene ,1 strain was tested positive for IMP‐4 gene , 3 strains were tested positive for NDM‐1 gene ,and VIM and OXA‐48 genes were tested negative .The 25 strains were classified into 6 genotypes ,namely as the followsing :A (15 strains) ,B (5 strains) ,C (2 strains) ,D (1 strain) ,E(1 strain) ,and F (1 strain) .CONCLUSION The imipenem‐resistant K .pneumoniae strains are highly multidrug‐resistant ;the production of theβ‐lactamase is the leading mechanism for the resistance to multiple anti‐biotics ,and there is a clonal spread in the area ,and 3 strains carrying NDM‐1 gene ,to which great attention should be paid .

  18. Spot paste combined microwave for assistant teatment of neonatal neumonia%穴位贴结合微波辅助治疗新生儿肺炎临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    尹美辉

    2011-01-01

    目的:观察使用穴位敷贴结合微波辅助治疗新生儿肺炎临床疗效。方法:对40例新生儿肺炎随机分成治疗组和对照组,治疗组采用在常规抗感染、雾化化痰、拍背、吸痰、氧疗等基础上加用中药穴位贴结合微波治疗,对照组给予常规治疗。结果:采用中药穴位贴结合微波辅助治疗新生儿肺炎的治疗组治愈、好转率较常规治疗有显著提高,两组比较有差异(P<0.05)。结论:穴位贴结合微波辅助治疗新生儿肺炎效果较好,值得推广应用。

  19. Research progress of prevention and nursing on ventilator-associated neumonia%呼吸机相关性肺炎的预防及护理研究进展

    Institute of Scientific and Technical Information of China (English)

    李淑君; 陈娟; 孔瑞兰

    2010-01-01

    @@ 随着呼吸机在临床的广泛应用,机械通气(MV)技术已经成为抢救各种原因引起的呼吸衰竭的主要措施之一,并取得了显著的疗效[1],但也随之出现了呼吸机相关性肺炎(VAP).在重症监护(ICU)越来越引起关注.

  20. Identification of a strain of Mycoplasma ovipneumonia from the lung of a neumonia sheep%从湖羊肺脏中分离绵羊肺炎支原体的鉴定

    Institute of Scientific and Technical Information of China (English)

    李媛; 陶岳; 阿依吐拉·肉孜; 高玉龙; 尹训南; 李新萍; 张孝恩; 王砚范; 辛九庆

    2006-01-01

    从新疆湖羊肺脏病料中分离出一株支原体XJ-3f,用其培养物人工感染80日龄健康绵羊,28 d后剖杀,剖检可见肺表面肉粉色实变,显微病理变化为大灶性融合性肺炎.参考国际已知支原体16S rRNA序列,设计一对扩增700bp片段的通用引物,直接提取肺脏组织DNA进行PCR扩增并克隆、测序.将该序列与GenBank中33种支原体序列比较,结果证明该序列与绵羊肺炎支原体(M.ovipneumonia)标准株Y-98同源性为99.9%,而与山羊支原体山羊亚种(M.capricolum subsp.capricolum,Mcc)、丝状支原体山羊亚种(M.mycoides subsp.Capri,Mmc)、丝状支原体丝状亚种LC型(M.mycoides subsp.mycoides LC,M.mmLC)等同源率为81%.以感染羊血清和Y-98与从发病羊肺脏中分离出的三株支原体菌体蛋白进行Western blot,证明均与感染羊血清有特异性反应,且与Y-98相比无明显差异,故确定分离株为绵羊肺炎支原体(M.ovipneumonia).

  1. neumonia in the Hospitals in Different Levels in Chengdu%成都市属医院1,175例儿童支气管肺炎住院费用分析

    Institute of Scientific and Technical Information of China (English)

    杨建南; 辛珏; 尹代红; 庞宇; 刘勇华

    2007-01-01

    为探讨成都市不同级别医疗机构儿童支气管肺炎单病种费用水平以及不同收费项目占总费用的比例特点及控制医疗费用的有效途径,为患者自主选择就诊医疗机构提供参考指导,对成都市卫生局所属不同级别医院儿童支气管肺炎住院医疗费用分析如下。

  2. Neumonía adquirida en la comunidad en lactantes y preescolares del municipio de Turbo, Antioquia Community acquired neumonia in chil- children dren aged 2-60 months in Colombia

    Directory of Open Access Journals (Sweden)

    <