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Sample records for non-randomized observational study

  1. Impact of specialist home-based palliative care services in a tertiary oncology set up: a prospective non-randomized observational study.

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    Dhiliwal, Sunil R; Muckaden, Maryann

    2015-01-01

    Home-based specialist palliative care services are developed to meet the needs of the patients in advanced stage of cancer at home with physical symptoms and distress. Specialist home care services are intended to improve symptom control and quality of life, enable patients to stay at home, and avoid unnecessary hospital admission. Total 690 new cases registered under home-based palliative care service in the year 2012 were prospectively studied to assess the impact of specialist home-based services using Edmonton symptom assessment scale (ESAS) and other parameters. Out of the 690 registered cases, 506 patients received home-based palliative care. 50.98% patients were cared for at home, 28.85% patients needed hospice referral and 20.15% patients needed brief period of hospitalization. All patients receiving specialist home care had good relief of physical symptoms (P care (OOH) through liaising with local general practitioners; 42.68% received home based bereavement care and 91.66% had good bereavement outcomes. Specialist home-based palliative care improved symptom control, health-related communication and psychosocial support. It promoted increased number of home-based death, appropriate and early hospice referral, and averted needless hospitalization. It improved bereavement outcomes, and caregiver satisfaction.

  2. Conservative/surgical treatment predictors of maternal hydronephrosis: results of a single-center retrospective non-randomized non-controlled observational study.

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    Ercil, Hakan; Arslan, Burak; Ortoglu, Ferhat; Alma, Ergun; Unal, Umut; Deniz, Mehmet Eflatun; Senturk, Aykut Bugra; Gurbuz, Zafer Gokhan

    2017-08-01

    To determine the parameters that may help the clinicians decide the best suitable treatment method for the pregnant women with symptomatic hydronephrosis which will be based on the easily accessible laboratory tests, monitoring methods and clinical symptoms. Digital data and documents of 246 pregnant women with symptomatic hydronephrosis who were hospitalized in our clinic between the dates of January 2011 and January 2016 were retrospectively evaluated. All patients were statistically evaluated in terms of age, symptomatic maximal anterior-posterior diameter of the renal pelvis (MADP), parity, C-reactive protein (CRP) level, white blood cell count (WBC), presence of pyuria, growth of urine culture, fever, serum urine and creatinine levels, visual analog scale (VAS) score of pre- and post-therapy and threatened preterm labor. The study includes a total of 211 pregnant women with symptomatic hydronephrosis. In the second and third trimester groups, the surgical treatment group statistically provided higher levels of CRP, WBC and VAS. Mean MADP in the second trimester of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.67 ± 4.67 and 28.68 ± 7.70 mm, respectively. Mean MADP in the third trimester group of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.96 ± 5.96 and 28.85 ± 7.64 mm, respectively. In patients with symptomatic pregnancy hydronephrosis, the likelihood of surgical treatment for CRP levels, WBC counts and VAS is high.

  3. Evaluating the Effectiveness of an Antimicrobial Stewardship Program on Reducing the Incidence Rate of Healthcare-Associated Clostridium difficile Infection: A Non-Randomized, Stepped Wedge, Single-Site, Observational Study.

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    DiDiodato, Giulio; McArthur, Leslie

    2016-01-01

    The incidence rate of healthcare-associated Clostridium difficile infection (HA-CDI) is estimated at 1 in 100 patients. Antibiotic exposure is the most consistently reported risk factor for HA-CDI. Strategies to reduce the risk of HA-CDI have focused on reducing antibiotic utilization. Prospective audit and feedback is a commonly used antimicrobial stewardship intervention (ASi). The impact of this ASi on risk of HA-CDI is equivocal. This study examines the effectiveness of a prospective audit and feedback ASi on reducing the risk of HA-CDI. Single-site, 339 bed community-hospital in Barrie, Ontario, Canada. Primary outcome is HA-CDI incidence rate. Daily prospective and audit ASi is the exposure variable. ASi implemented across 6 wards in a non-randomized, stepped wedge design. Criteria for ASi; any intravenous antibiotic use for ≥ 48 hrs, any oral fluoroquinolone or oral second generation cephalosporin use for ≥ 48 hrs, or any antimicrobial use for ≥ 5 days. HA-CDI cases and model covariates were aggregated by ward, year and month starting September 2008 and ending February 2016. Multi-level mixed effect negative binomial regression analysis was used to model the primary outcome, with intercept and slope coefficients for ward-level random effects estimated. Other covariates tested for inclusion in the final model were derived from previously published risk factors. Deviance residuals were used to assess the model's goodness-of-fit. The dataset included 486 observation periods, of which 350 were control periods and 136 were intervention periods. After accounting for all other model covariates, the estimated overall ASi incidence rate ratio (IRR) was 0.48 (95% 0.30, 0.79). The ASi effect was independent of antimicrobial utilization. The ASi did not seem to reduce the risk of Clostridium difficile infection on the surgery wards (IRR 0.87, 95% CI 0.45, 1.69) compared to the medicine wards (IRR 0.42, 95% CI 0.28, 0.63). The ward-level burden of Clostridium

  4. Evaluating the Effectiveness of an Antimicrobial Stewardship Program on Reducing the Incidence Rate of Healthcare-Associated Clostridium difficile Infection: A Non-Randomized, Stepped Wedge, Single-Site, Observational Study.

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    Giulio DiDiodato

    Full Text Available The incidence rate of healthcare-associated Clostridium difficile infection (HA-CDI is estimated at 1 in 100 patients. Antibiotic exposure is the most consistently reported risk factor for HA-CDI. Strategies to reduce the risk of HA-CDI have focused on reducing antibiotic utilization. Prospective audit and feedback is a commonly used antimicrobial stewardship intervention (ASi. The impact of this ASi on risk of HA-CDI is equivocal. This study examines the effectiveness of a prospective audit and feedback ASi on reducing the risk of HA-CDI.Single-site, 339 bed community-hospital in Barrie, Ontario, Canada. Primary outcome is HA-CDI incidence rate. Daily prospective and audit ASi is the exposure variable. ASi implemented across 6 wards in a non-randomized, stepped wedge design. Criteria for ASi; any intravenous antibiotic use for ≥ 48 hrs, any oral fluoroquinolone or oral second generation cephalosporin use for ≥ 48 hrs, or any antimicrobial use for ≥ 5 days. HA-CDI cases and model covariates were aggregated by ward, year and month starting September 2008 and ending February 2016. Multi-level mixed effect negative binomial regression analysis was used to model the primary outcome, with intercept and slope coefficients for ward-level random effects estimated. Other covariates tested for inclusion in the final model were derived from previously published risk factors. Deviance residuals were used to assess the model's goodness-of-fit.The dataset included 486 observation periods, of which 350 were control periods and 136 were intervention periods. After accounting for all other model covariates, the estimated overall ASi incidence rate ratio (IRR was 0.48 (95% 0.30, 0.79. The ASi effect was independent of antimicrobial utilization. The ASi did not seem to reduce the risk of Clostridium difficile infection on the surgery wards (IRR 0.87, 95% CI 0.45, 1.69 compared to the medicine wards (IRR 0.42, 95% CI 0.28, 0.63. The ward-level burden of

  5. Correction of confounding bias in non-randomized studies by appropriate weighting.

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    Schmoor, Claudia; Gall, Christine; Stampf, Susanne; Graf, Erika

    2011-03-01

    In non-randomized studies, the assessment of a causal effect of treatment or exposure on outcome is hampered by possible confounding. Applying multiple regression models including the effects of treatment and covariates on outcome is the well-known classical approach to adjust for confounding. In recent years other approaches have been promoted. One of them is based on the propensity score and considers the effect of possible confounders on treatment as a relevant criterion for adjustment. Another proposal is based on using an instrumental variable. Here inference relies on a factor, the instrument, which affects treatment but is thought to be otherwise unrelated to outcome, so that it mimics randomization. Each of these approaches can basically be interpreted as a simple reweighting scheme, designed to address confounding. The procedures will be compared with respect to their fundamental properties, namely, which bias they aim to eliminate, which effect they aim to estimate, and which parameter is modelled. We will expand our overview of methods for analysis of non-randomized studies to methods for analysis of randomized controlled trials and show that analyses of both study types may target different effects and different parameters. The considerations will be illustrated using a breast cancer study with a so-called Comprehensive Cohort Study design, including a randomized controlled trial and a non-randomized study in the same patient population as sub-cohorts. This design offers ideal opportunities to discuss and illustrate the properties of the different approaches. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  6. Multidisciplinary intervention reducing readmissions in medical inpatients: a prospective, non-randomized study

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    Torisson G

    2013-09-01

    Full Text Available Gustav Torisson,1 Lennart Minthon,1 Lars Stavenow,2 Elisabet Londos1 1Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, 2Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden Background: The purpose of this study was to examine whether a multidisciplinary intervention targeting drug-related problems, cognitive impairment, and discharge miscommunication could reduce readmissions in a general hospital population. Methods: This prospective, non-randomized intervention study was carried out at the department of general internal medicine at a tertiary university hospital. Two hundred medical inpatients living in the community and aged over 60 years were included. Ninety-nine patients received interventions and 101 received standard care. Control/intervention allocation was determined by geographic selection. Interventions consisted of a comprehensive medication review, improved discharge planning, post-discharge telephone follow-up, and liaison with the patient's general practitioner. The main outcome measures recorded were readmissions and hospital nights 12 months after discharge. Separate analyses were made for 12-month survivors and from an intention-to-treat perspective. Comparative analyses were made between groups as well as within groups over time. Results: After 12 months, survivors in the control group had 125 readmissions in total, compared with 58 in the intervention group (Mann–Whitney U test, P = 0.02. For hospital nights, the numbers were 1,228 and 492, respectively (P = 0.009. Yearly admissions had increased from the previous year in the control group from 77 to 125 (Wilcoxon signed-rank test, P = 0.002 and decreased from 75 to 58 in the intervention group (P = 0.25. From the intention-to-treat perspective, the same general pattern was observed but was not significant (1,827 versus 1,008 hospital nights, Mann–Whitney test, P = 0.054. Conclusion: A multidisciplinary approach

  7. Improving Sleep for Hospitalized Antepartum Patients: A Non-Randomized Controlled Pilot Study.

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    Lee, Kathryn A; Gay, Caryl L

    2017-12-15

    To evaluate feasibility and efficacy of a hospital-based protocol for improving sleep in high- risk antepartum patients. Sleep measures were compared during 1 week of hospitalization before and after implementing a Sleep Improvement Protocol for Antepartum Patients (SIP-AP). A non-randomized convenience sample of usual care controls was compared to a subsequent intervention sample after the protocol was implemented. Women were eligible if they spoke English, were medically stable, pregnant for at least 20 weeks, and hospitalized at least 24 hours; 25 pregnant women had sufficient data for analyses (11 controls, 14 intervention). Sleep was assessed in 3 ways: the Pittsburgh Sleep Quality Index was completed after obtaining consent to estimate sleep quality prior to hospital admission; sleep diary completed each hospital day; and General Sleep Disturbance Scale completed at 7 days or prior to hospital discharge. Symptoms that could affect sleep were assessed with the Memorial Symptom Assessment Scale. Both groups recorded similar sleep duration (7 hours) but the intervention group had fewer symptoms and significantly ( P = .015) lower sleep disturbance scores (53.1 ± 14.5) than controls (71.9 ± 18.8). Participant feedback about the intervention was positive, although adherence to components of the intervention protocol was variable. This pilot study provides evidence of the feasibility and preliminary efficacy of the SIP-AP intervention for reducing symptoms and improving sleep of antepartum patients during hospitalization. Further detailed evaluation of specific components of this protocol is warranted, and other types of hospitalized patients may benefit from unit-based modifications to this SIP-AP protocol. © 2017 American Academy of Sleep Medicine

  8. Home based telemedicine intervention for patients with uncontrolled hypertension: - a real life - non-randomized study

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    2014-01-01

    Background Control of blood pressure is frequently inadequate in spite of availability of several classes of well tolerated and effective antihypertensive drugs. Several factors, including the use of suboptimal doses of drugs, inadequate or ineffective treatments and poor drug compliance may be the reason for this phenomenon. The aim of the current non- randomized study was to evaluate the effectiveness of a Home-Based Telemedicine service in patients with uncontrolled hypertension. Methods 74 patients were enrolled in a Home Based Telemedicine group and 94 patients in the Usual Care group. At baseline and at the end of the study, patients in both groups were seen in a cardiology office. Patients in Home Based Telemedicine group additionally were followed by a physician-nurse, through scheduled and unscheduled telephone appointments. These patients also received a blood pressure measuring device that could transmit the readings to a central data monitor via secure data connection. Results During the study period (80 ± 25 days), a total of 17401 blood pressure measurements were taken in the Home Based Telemedicine group corresponding to 236 ± 136 readings per patient and a mean daily measurement of 3 ± 1.7. The scheduled telephone contacts (initiated by the nurse) equaled to 5.2 ± 4.3/patient (370 in total) and the unscheduled telephone contacts (initiated by the patients) were 0.4 ± 0.9/patient (30 in total). The mean systolic blood pressure values decreased from 153 ± 19 mmHg to 130 ± 15 mmHg (p < 0.0001) at the end of the study and diastolic blood pressure values decreased from 89 ± 10 mmHg to 76 ± 11 mmHg (p < 0.0001). In the Usual Care group, the mean systolic blood pressure values decreased from 156 ± 16 mmHg to 149 ± 17 mmHg (p < 0.05) at the end of the study and diastolic blood pressure values decreased from 90 ± 8 mmHg to 86 ± 9 mmHg (p < 0.05). The changes in drug

  9. Network meta-analysis incorporating randomized controlled trials and non-randomized comparative cohort studies for assessing the safety and effectiveness of medical treatments: challenges and opportunities

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    Cameron, Chris; Fireman, Bruce; Hutton, Brian; Clifford, Tammy; Coyle, Doug; Wells, George; Dormuth, Colin R.; Platt, Robert; Toh, Sengwee

    2015-01-01

    Network meta-analysis is increasingly used to allow comparison of multiple treatment alternatives simultaneously, some of which may not have been compared directly in primary research studies. The majority of network meta-analyses published to date have incorporated data from randomized controlled trials (RCTs) only; however, inclusion of non-randomized studies may sometimes be considered. Non-randomized studies can complement RCTs or address some of their limitations, such as short follow-up...

  10. Sucralfate gel as a radioprotector against radiation induced dermatitis in a hypo-fractionated schedule: a non-randomized study.

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    Kouloulias, V; Asimakopoulos, C; Tolia, M; Filippou, G; Platoni, K; Dilvoi, M; Beli, I; Georgakopoulos, J; Patatoukas, G; Kelekis, N

    2013-04-01

    External beam radiotherapy with high doses provokes many acute skin reactions, such as erythema and moist desquamation. Many topical preparations are used in radiation oncology departments in the skin care. Sucralfate humid gel, a colloidal physical form of the anti-ulcer drug sucralfate, promotes epithelial regeneration and activates cell proliferation. Based on this knowledge, we performed a non-randomized clinical trial to evaluate the efficacy of topical sucralfate gel in 30 breast cancer patients receiving postoperative accelerated hypofractionated photon beam therapy. The comparison was performed with 30 patients as historical controls. The acute reaction of the skin was significantly lower in the group receiving the sucralfate gel (p<0.05, Mann Whitney test), while 90% of the patients had no evidence of radiation induced skin toxicity. There was no sucralfate gel related toxicity reported by any patient in this study. More patients in a randomized way are needed for more definite results.

  11. Bias analysis applied to Agricultural Health Study publications to estimate non-random sources of uncertainty.

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    Lash, Timothy L

    2007-11-26

    The associations of pesticide exposure with disease outcomes are estimated without the benefit of a randomized design. For this reason and others, these studies are susceptible to systematic errors. I analyzed studies of the associations between alachlor and glyphosate exposure and cancer incidence, both derived from the Agricultural Health Study cohort, to quantify the bias and uncertainty potentially attributable to systematic error. For each study, I identified the prominent result and important sources of systematic error that might affect it. I assigned probability distributions to the bias parameters that allow quantification of the bias, drew a value at random from each assigned distribution, and calculated the estimate of effect adjusted for the biases. By repeating the draw and adjustment process over multiple iterations, I generated a frequency distribution of adjusted results, from which I obtained a point estimate and simulation interval. These methods were applied without access to the primary record-level dataset. The conventional estimates of effect associating alachlor and glyphosate exposure with cancer incidence were likely biased away from the null and understated the uncertainty by quantifying only random error. For example, the conventional p-value for a test of trend in the alachlor study equaled 0.02, whereas fewer than 20% of the bias analysis iterations yielded a p-value of 0.02 or lower. Similarly, the conventional fully-adjusted result associating glyphosate exposure with multiple myleoma equaled 2.6 with 95% confidence interval of 0.7 to 9.4. The frequency distribution generated by the bias analysis yielded a median hazard ratio equal to 1.5 with 95% simulation interval of 0.4 to 8.9, which was 66% wider than the conventional interval. Bias analysis provides a more complete picture of true uncertainty than conventional frequentist statistical analysis accompanied by a qualitative description of study limitations. The latter approach is

  12. Bias analysis applied to Agricultural Health Study publications to estimate non-random sources of uncertainty

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    Lash Timothy L

    2007-11-01

    Full Text Available Abstract Background The associations of pesticide exposure with disease outcomes are estimated without the benefit of a randomized design. For this reason and others, these studies are susceptible to systematic errors. I analyzed studies of the associations between alachlor and glyphosate exposure and cancer incidence, both derived from the Agricultural Health Study cohort, to quantify the bias and uncertainty potentially attributable to systematic error. Methods For each study, I identified the prominent result and important sources of systematic error that might affect it. I assigned probability distributions to the bias parameters that allow quantification of the bias, drew a value at random from each assigned distribution, and calculated the estimate of effect adjusted for the biases. By repeating the draw and adjustment process over multiple iterations, I generated a frequency distribution of adjusted results, from which I obtained a point estimate and simulation interval. These methods were applied without access to the primary record-level dataset. Results The conventional estimates of effect associating alachlor and glyphosate exposure with cancer incidence were likely biased away from the null and understated the uncertainty by quantifying only random error. For example, the conventional p-value for a test of trend in the alachlor study equaled 0.02, whereas fewer than 20% of the bias analysis iterations yielded a p-value of 0.02 or lower. Similarly, the conventional fully-adjusted result associating glyphosate exposure with multiple myleoma equaled 2.6 with 95% confidence interval of 0.7 to 9.4. The frequency distribution generated by the bias analysis yielded a median hazard ratio equal to 1.5 with 95% simulation interval of 0.4 to 8.9, which was 66% wider than the conventional interval. Conclusion Bias analysis provides a more complete picture of true uncertainty than conventional frequentist statistical analysis accompanied by a

  13. Randomly and Non-Randomly Missing Renal Function Data in the Strong Heart Study: A Comparison of Imputation Methods.

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    Nawar Shara

    Full Text Available Kidney and cardiovascular disease are widespread among populations with high prevalence of diabetes, such as American Indians participating in the Strong Heart Study (SHS. Studying these conditions simultaneously in longitudinal studies is challenging, because the morbidity and mortality associated with these diseases result in missing data, and these data are likely not missing at random. When such data are merely excluded, study findings may be compromised. In this article, a subset of 2264 participants with complete renal function data from Strong Heart Exams 1 (1989-1991, 2 (1993-1995, and 3 (1998-1999 was used to examine the performance of five methods used to impute missing data: listwise deletion, mean of serial measures, adjacent value, multiple imputation, and pattern-mixture. Three missing at random models and one non-missing at random model were used to compare the performance of the imputation techniques on randomly and non-randomly missing data. The pattern-mixture method was found to perform best for imputing renal function data that were not missing at random. Determining whether data are missing at random or not can help in choosing the imputation method that will provide the most accurate results.

  14. Does balneotherapy with low radon concentration in water influence the endocrine system? A controlled non-randomized pilot study.

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    Nagy, Katalin; Berhés, István; Kovács, Tibor; Kávási, Norbert; Somlai, János; Bender, Tamás

    2009-08-01

    Radon bath is a well-established modality of balneotherapy for the management of degenerative musculoskeletal disorders. The present study was conducted to ascertain whether baths of relatively low (80 Bq/l) radon concentration have any influence on the functioning of the endocrine system. In the study, a non-randomized pilot study, 27 patients with degenerative musculoskeletal disorders received 30-min radon baths (of 31-32 degrees C temperature and 80 Bq/l average radon concentration) daily, for 15 days. Twenty-five patients with matching pathologies were subjected to balneotherapy according to the same protocol, using thermal water with negligible radon content (6 Bq/l). Serum thyroid stimulating hormone, prolactin, cortisol, adrenocorticotropic hormone, and dehydroepiandrosterone levels were measured before and after a balneotherapy course of 15 sessions. Comparison of the accumulated data using the Wilcoxon test did not reveal any significant difference between pre- and post-treatment values or between the two patient groups. It is noted that while the beneficial effects of balneotherapy with radon-containing water on degenerative disorders is widely known, only few data have been published in the literature on its effect on endocrine functions. The present study failed to demonstrate any substantial effect of thermal water with relatively low radon content on the functioning of the endocrine system.

  15. Treatment of age-related subfoveal neovascular membranes by teletherapy. Results of a non-randomized study

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    Subasi, M.; Akmansu, M.; Or, M. [Gazi Univ., Ankara (Turkey). Medical Faculty

    1999-03-01

    This investigation was designed to determine whether low-dose radiation to the macular region could influence the natural course of age-related subfoveal neovascularization. Thirty-one patients with subfoveal membranes due to age-related macular degeneration (ARMD) were treated with 12 Gy of 6 MV X-rays, and 72 patients who were untreated served as a control group. Both groups were followed-up. At six months of follow-up visual acuity was maintained in 54.8% and improved 25.8% of patients treated by radiotherapy. In the control group, visual acuity showed deterioration in 55.5%. There was a significant difference between the treated and untreated groups (p<0.01). Significant neovascular membrane regression or stabilization was recorded in 61.3% of treated patients at six months post-radiation, whereas the membranes in all. 72 control patients showed progressive enlargement. This non-randomized study suggested that low doses of radiation may be an alternative treatment for ARMD without an immediate drop in visual acuity or significant radiation morbidity. (author)

  16. [Can venous iron and tranexamic acid reduce the transfusion need? Report on a non randomized, case control study].

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    Essola, L; Kouégnigan Rérambiah, L; Obame, R; Issembè, H; Sima Zué, A

    2017-06-01

    To evaluate if the association of injectable iron and tranexamic acid allows a significant saving in transfusion, in cases of myomectomies and hysterectomies. This is a prospective, non randomized study done over 8 months (from January 2013 to August 2013). Were included, patients undergoing hysterectomy or myomectomy who had a hemoglobin level greater than or equal to 8g/dl and less than 12g/dl. Two groups were compared: group A consisting of patients for whom a pack red cells was ordered and the group B which patients received intravenous iron preoperatively and tranexamic acid perioperatively. The level of hemoglobin, pre- and postoperative, the average number of blood units per patient and estimated blood loss was compared. The transfusion economy was evaluated. During this period, 87 patients with a mean age of 40±9 years (range: 23 and 70years) were included according to our criteria: 44 patients in group A and 43 patients in group B. Initial mean hemoglobin in both groups was 9.1±0.7g/dl. In group B, after iron administration, the mean hemoglobin was 11.3±0.7g/dl. The average number of red blood cells received intraoperative patient in group A was 1.54±0.51. The estimated blood loss was significant greater (P=0.0002) in group A (571.6±237.1ml) than in group B (213.7±131.7ml). No transfusion was performed in group B. The association intravenous iron and tranexamic acid resulted in the reduction of transfusion requirements in our setting. It could be integrated in the strategy for sparing blood transfusion in scheduled surgery with hemorrhagic risks. Copyright © 2017. Published by Elsevier SAS.

  17. Estimating the treatment effect from non-randomized studies: The example of reduced intensity conditioning allogeneic stem cell transplantation in hematological diseases

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    Resche-Rigon Matthieu

    2012-08-01

    Full Text Available Abstract Background In some clinical situations, for which RCT are rare or impossible, the majority of the evidence comes from observational studies, but standard estimations could be biased because they ignore covariates that confound treatment decisions and outcomes. Methods Three observational studies were conducted to assess the benefit of Allo-SCT in hematological malignancies of multiple myeloma, follicular lymphoma and Hodgkin’s disease. Two statistical analyses were performed: the propensity score (PS matching approach and the inverse probability weighting (IPW approach. Results Based on PS-matched samples, a survival benefit in MM patients treated by Allo-SCT, as compared to similar non-allo treated patients, was observed with an HR of death at 0.35 (95%CI: 0.14-0.88. Similar results were observed in HD, 0.23 (0.07-0.80 but not in FL, 1.28 (0.43-3.77. Estimated benefits of Allo-SCT for the original population using IPW were erased in HR for death at 0.72 (0.37-1.39 for MM patients, 0.60 (0.19-1.89 for HD patients, and 2.02 (0.88-4.66 for FL patients. Conclusion Differences in estimated benefits rely on whether the underlying population to which they apply is an ideal randomized experimental population (PS or the original population (IPW. These useful methods should be employed when assessing the effects of innovative treatment in non-randomized experiments.

  18. Overweight and obesity in Slovak high school students and body composition indicators: a non-randomized cross-sectional study

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    Bibiana Vadasova

    2016-08-01

    Full Text Available Abstract Background Physical development can be considered as an indicator of the overall health status of the youth population. Currently, it appears that the increasing trend of the prevalence of obesity among children and youths has stopped in a number of countries worldwide. Studies point to the fact that adolescence is a critical period for the development of obesity. Body mass index (BMI seems to be an orientation parameter in the assessment of prevalence of obesity which is not sufficient for more accurate identification of at risk individuals. The purpose of this study was to evaluate association between BMI percentile zones as health-risk for being overweight and obese and body composition indicators in high-school students from the Prešov (Slovakia region. Methods A non-randomized cross-sectional study in high school students from the Prešov (Slovakia region was conducted. The research sample consisted of 1014 participants (boys n = 466, girls n = 549. Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis (DSM-BIA. To examine the association between obesity and selected body composition indicators, Kruskal-Wallis ANOVA and Eta2 were used. The relationship between selected body composition indicators and percentile BMI zones was determined using the Kendall tau correlation. Results In groups with different BMI percentile zones (normal weight, overweight, obese, ANOVA showed significant differences for girls and boys (p ˂.05 with high effect size (η2 ˂.26 in body weight, body fat mass index, body fat percentage, fat free mass index, fat-free mass percentage, visceral fat area, waist-to-hip ratio, waist circumference, protein mass and mineral mass. The highest degree of correlation among boys was between BMI values indicating overweight and obesity and fat free mass index and waist circumference, respectively (τ = .71, τ = .70, respectively. In girls, the highest

  19. Improvement of functional constipation with kiwifruit intake in a Mediterranean patient population: An open, non-randomized pilot study

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    Oriol Cunillera

    2015-07-01

    Full Text Available Introduction: Kiwifruit consumption has shown to improve functional constipation in healthy elderly population, according to studies in New Zealand and China. The aim of this study was to evaluate the effect of kiwifruit intake on functional constipation in a Mediterranean patient population characterized by its distinctive nutritional habits.Material and Methods: An open, non-controlled and non-randomized longitudinal study was conducted in 46 patients with constipation (Rome III criteria. Patients monitored for five weeks: weeks 1 and 2 no kiwifruit and weeks 3-5 three kiwifruit per day (Green kiwifruit, Actinidia deliciosa var Hayward. Bristol Scale, volume of stools, and ease of defecation was self- reported daily. The evolution of the categorical variables was tested using the Bhapkar test; functional data methodology was used for continuous variables, and Generalized Estimating Equation (GEE models were adjusted.Results: The percentage of patients with ≥3 stools per week increased from 82.61% (95% CI: 69–91.2 at week 1 to 97.78% (95% CI: 87.4–99.9 at week 2 of kiwifruit intake, with 76.09% (95% CI: 61.9–86.2 responding during the first week. The reporting of stable ideal stools increased from 17.39% (95% CI: 8.8–31 at week 2 to 33.33% (95% CI: 21.3–48 at week 5. According to GEE models, the number of depositions increased significantly (p-values<0.001 in 0.398 daily units at week 1 the first week of intake, up to 0.593 daily units at week 5; significant improvements on facility in evacuation and volume of evacuation were found from the firstweek of intake (all p-values<0.001.Conclusions: The intake of three kiwifruits per day significantly improves the quality of evacuation (number of depositions, volume, consistency and ease in a Mediterranean patient population suffering from functional constipation.

  20. Run charts revisited: a simulation study of run chart rules for detection of non-random variation in health care processes.

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    Anhøj, Jacob; Olesen, Anne Vingaard

    2014-01-01

    A run chart is a line graph of a measure plotted over time with the median as a horizontal line. The main purpose of the run chart is to identify process improvement or degradation, which may be detected by statistical tests for non-random patterns in the data sequence. We studied the sensitivity to shifts and linear drifts in simulated processes using the shift, crossings and trend rules for detecting non-random variation in run charts. The shift and crossings rules are effective in detecting shifts and drifts in process centre over time while keeping the false signal rate constant around 5% and independent of the number of data points in the chart. The trend rule is virtually useless for detection of linear drift over time, the purpose it was intended for.

  1. Non-random mating and convergence over time for alcohol consumption, smoking, and exercise: the Nord-Trøndelag Health Study.

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    Ask, Helga; Rognmo, Kamilla; Torvik, Fartein Ask; Røysamb, Espen; Tambs, Kristian

    2012-05-01

    Spouses tend to have similar lifestyles. We explored the degree to which spouse similarity in alcohol use, smoking, and physical exercise is caused by non-random mating or convergence. We used data collected for the Nord-Trøndelag Health Study from 1984 to 1986 and prospective registry information about when and with whom people entered marriage/cohabitation between 1970 and 2000. Our sample included 19,599 married/cohabitating couples and 1,551 future couples that were to marry/cohabitate in the 14-16 years following data collection. All couples were grouped according to the duration between data collection and entering into marriage/cohabitation. Age-adjusted polychoric spouse correlations were used as the dependent variables in non-linear segmented regression analysis; the independent variable was time. The results indicate that spouse concordance in lifestyle is due to both non-random mating and convergence. Non-random mating appeared to be strongest for smoking. Convergence in alcohol use and smoking was evident during the period prior to marriage/cohabitation, whereas convergence in exercise was evident throughout life. Reduced spouse similarity in smoking with relationship duration may reflect secular trends.

  2. An open-label, non-randomized study of the pharmacokinetics of the nutritional supplement nicotinamide riboside (NR and its effects on blood NAD+ levels in healthy volunteers.

    Directory of Open Access Journals (Sweden)

    Sophia E Airhart

    Full Text Available The co-primary objectives of this study were to determine the human pharmacokinetics (PK of oral NR and the effect of NR on whole blood nicotinamide adenine dinucleotide (NAD+ levels.Though mitochondrial dysfunction plays a critical role in the development and progression of heart failure, no mitochondria-targeted therapies have been translated into clinical practice. Recent murine studies have reported associations between imbalances in the NADH/NAD+ ratio with mitochondrial dysfunction in multiple tissues, including myocardium. Moreover, an NAD+ precursor, nicotinamide mononucleotide, improved cardiac function, while another NAD+ precursor, nicotinamide riboside (NR, improved mitochondrial function in muscle, liver and brown adipose. Thus, PK studies of NR in humans is critical for future clinical trials.In this non-randomized, open-label PK study of 8 healthy volunteers, 250 mg NR was orally administered on Days 1 and 2, then uptitrated to peak dose of 1000 mg twice daily on Days 7 and 8. On the morning of Day 9, subjects completed a 24-hour PK study after receiving 1000 mg NR at t = 0. Whole-blood levels of NR, clinical blood chemistry, and NAD+ levels were analyzed.Oral NR was well tolerated with no adverse events. Significant increases comparing baseline to mean concentrations at steady state (Cave,ss were observed for both NR (p = 0.03 and NAD+ (p = 0.001; the latter increased by 100%. Absolute changes from baseline to Day 9 in NR and NAD+ levels correlated highly (R2 = 0.72, p = 0.008.Because NR increases circulating NAD+ in humans, NR may have potential as a therapy in patients with mitochondrial dysfunction due to genetic and/or acquired diseases.

  3. An open-label, non-randomized study of the pharmacokinetics of the nutritional supplement nicotinamide riboside (NR) and its effects on blood NAD+ levels in healthy volunteers.

    Science.gov (United States)

    Airhart, Sophia E; Shireman, Laura M; Risler, Linda J; Anderson, Gail D; Nagana Gowda, G A; Raftery, Daniel; Tian, Rong; Shen, Danny D; O'Brien, Kevin D

    2017-01-01

    The co-primary objectives of this study were to determine the human pharmacokinetics (PK) of oral NR and the effect of NR on whole blood nicotinamide adenine dinucleotide (NAD+) levels. Though mitochondrial dysfunction plays a critical role in the development and progression of heart failure, no mitochondria-targeted therapies have been translated into clinical practice. Recent murine studies have reported associations between imbalances in the NADH/NAD+ ratio with mitochondrial dysfunction in multiple tissues, including myocardium. Moreover, an NAD+ precursor, nicotinamide mononucleotide, improved cardiac function, while another NAD+ precursor, nicotinamide riboside (NR), improved mitochondrial function in muscle, liver and brown adipose. Thus, PK studies of NR in humans is critical for future clinical trials. In this non-randomized, open-label PK study of 8 healthy volunteers, 250 mg NR was orally administered on Days 1 and 2, then uptitrated to peak dose of 1000 mg twice daily on Days 7 and 8. On the morning of Day 9, subjects completed a 24-hour PK study after receiving 1000 mg NR at t = 0. Whole-blood levels of NR, clinical blood chemistry, and NAD+ levels were analyzed. Oral NR was well tolerated with no adverse events. Significant increases comparing baseline to mean concentrations at steady state (Cave,ss) were observed for both NR (p = 0.03) and NAD+ (p = 0.001); the latter increased by 100%. Absolute changes from baseline to Day 9 in NR and NAD+ levels correlated highly (R2 = 0.72, p = 0.008). Because NR increases circulating NAD+ in humans, NR may have potential as a therapy in patients with mitochondrial dysfunction due to genetic and/or acquired diseases.

  4. Natalizumab stabilizes physical, cognitive, MRI, and OCT markers of disease activity: A prospective, non-randomized pilot study.

    Directory of Open Access Journals (Sweden)

    Garrick D Talmage

    Full Text Available Natalizumab is an effective therapy for multiple sclerosis (MS. Its effectiveness has been demonstrated in several clinical and imaging studies. The objective of this study was to further demonstrate the efficacy of natalizumab using a comprehensive battery of clinical and imaging markers in the same cohort of patients followed longitudinally, hence capturing the multi-faceted nature of the MS disease process. A prospective, open-label, pilot study of 20 MS patients treated with natalizumab was conducted. High resolution MRI, Symbol-Digit Modalities Test (SDMT, and Optical Coherence Tomography (OCT scans were obtained at baseline, 48, and 96 weeks. 15 patients completed the study. Natalizumab treatment decreased Expanded Disability Status Scale score (EDSS and no change in SDMT, Brain Parenchymal Fraction (BPF, or any of the OCT markers of retinal degeneration was observed. Thalamic and whole brain volume as assessed by Percentage Brain Volume Change (PBVC showed continuous deterioration. Higher baseline T2 lesion load correlated with increased rate of PBVC at 96-weeks (r = 0.566, R2 = 0.320, p = 0.035 and thalamic volume loss (r = -0.586, R2 = 0.344, p = 0.027. Most patients, 93%, achieved no evidence of disease activity (NEDA at 2 years, likely due to early disease duration and lower initial baseline lesion load. This study further demonstrates stabilization of clinical and imaging markers of disease activity during natalizumab treatment.

  5. TP53 status and taxane-platinum versus platinum-based therapy in ovarian cancer patients: A non-randomized retrospective study

    Directory of Open Access Journals (Sweden)

    Markowska Janina

    2008-01-01

    Full Text Available Abstract Background Taxane-platinum therapy (TP has replaced platinum-based therapy (PC or PAC, DNA damaging chemotherapy in the postoperative treatment of ovarian cancer patients; however, it is not always effective. TP53 protein plays a differential role in response to DNA-damaging agents and taxanes. We sought to define profiles of patients who benefit the most from TP and also of those who can be treated with PC. Methods We compared the effectiveness of PC/PAC (n = 253 and TP (n = 199 with respect to tumor TP53 accumulation in ovarian cancer patients with FIGO stage IIB-IV disease; this was a non-randomized retrospective study. Immunohistochemical analysis was performed on 452 archival tumors; univariate and multivariate analysis by the Cox's and logistic regression models was performed in all patients and in subgroups with [TP53(+] and without TP53 accumulation [TP53(-]. Results The advantage of taxane-platinum therapy over platinum-based therapy was seen in the TP53(+, and not in the TP53(- group. In the TP53(+ group taxane-platinum therapy enhanced the probability of complete remission (p = .018, platinum sensitivity (p = .014, platinum highly sensitive response (p = .038 and longer survival (OS, p = .008. Poor tumor differentiation diminished the advantage from taxane-platinum therapy in the TP53(+ group. In the TP53(- group PC/PAC was at least equally efficient as taxane-platinum therapy and it enhanced the chance of platinum highly sensitive response (p = .010. However, in the TP53(- group taxane-platinum therapy possibly diminished the risk of death in patients over 53 yrs (p = .077. Among factors that positively interacted with taxane-platinum therapy in some analyses were endometrioid and clear cell type, FIGO III stage, bulky residual tumor, more advanced age of patient and moderate tumor differentiation. Conclusion Our results suggest that taxane-platinum therapy is particularly justified in patients with TP53(+ tumors or older

  6. Efficacy of metformin in improving glycaemic control & perinatal outcome in gestational diabetes mellitus: A non-randomized study

    Directory of Open Access Journals (Sweden)

    Neeta Singh

    2017-01-01

    Interpretation & conclusions: Our findings indicate that metformin may be used as a safe and effective oral hypoglycaemic agent in GDM, especially in low-resource settings where cost, storage and compliance are logistic issues. However, long-term follow up studies are needed to solve issues related to its safety in pregnancy.

  7. Prevalence of burnout in Polish anesthesiologists and anesthetist nursing professionals: A comparative non-randomized cross-sectional study.

    Science.gov (United States)

    Misiołek, Aleksandra; Gil-Monte, Pedro R; Misiołek, Hanna

    2017-03-01

    The purpose of the study was to assess the burnout levels in nurses ( N = 161) versus physicians ( N = 373). The levels of burnout were evaluated by the Polish adaptation of the Spanish Burnout Inventory (Cronbach's alpha > .70). High burnout level was found in 18.63 percent nurses and 12.06 percent anesthesiologists, and critical level in 3.74 percent nurses and 5.90 percent anesthetists. There were statistically significant differences in Burnout global score, Enthusiasm toward the job, Psychological exhaustion, and Indolence subscales between nurses and physicians. No significant differences were found between sexes in any variable.

  8. Non-randomized clinical study comparing chemotherapy plus radiotherapy with radiotherapy alone in neoadjuvant therapy for oral cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kayahara, Hiroaki; Okuda, Mamiko; Terakado, Nagaaki; Shintani, Satoru; Hamakawa, Hiroyuki [Ehime Univ., Shigenobu (Japan). School of Medicine

    2002-06-01

    Neoadjuvant therapy plays an important role for organ preservation and survival rate in the treatment of oral cancer. We clinically compared the effect of neoadjuvant radiotherapy and chemoradiotherapy in patients with oral cancer. We retrospectively examined 47 patients diagnosed with oral squamous cell carcinoma who underwent neoadjuvant therapy followed by curative surgery in the oral and maxillofacial surgery department of Ehime University Hospital. We divided them into two groups: radiotherapy alone (24 cases) and chemoradiotherapy (23 cases). The patients in the radiotherapy group underwent irradiation of 32.6{+-}5.0 Gy (mean {+-}SD). The patients in the chemoradiotherapy group received a low-dose fraction of cisplatin (8 mg/mm{sup 2}/day, 5 days a week; total dose: 139.4{+-}67.1 mg) and 5-fluorouracil (300 mg/mm{sup 2}/day, 5 days a week; total dose: 5,900{+-}1,839.8 mg) combined with simultaneous irradiation of 31.0{+-}3.2 Gy. None of the 24 patients had a complete response to radiotherapy alone and 12 (50%) had a partial response. Six (26%) of the 23 patients had a complete response to chemoradiotherapy and 12 (52%) had a partial response. The primary control rate (82.6%) to chemoradiotherapy was higher than that (67.5%) to radiotherapy alone although no significant difference was found. The 5-year survival rate was 64.3% in the radiotherapy group and 62.8% in the chemoradiotherapy group. The findings of the present study suggest that while the combination of radiation and cisplatin/5-fluorouracil in neoadjuvant therapy for oral cancer may not bring a significant benefit to improve survival rate, the primary local control rate is improved in comparison with radiotherapy alone. (author)

  9. Laparoscopic Complete Mesocolic Excision versus Open Complete Mesocolic Excision for Transverse Colon Cancer: Long-Term Survival Results of a Prospective Single Centre Non-Randomized Study.

    Science.gov (United States)

    Storli, Kristian Eeg; Eide, Geir Egil

    2016-01-01

    Laparoscopic complete mesocolic excision (CME) used in the treatment of transverse colon cancer has been questioned on the basis of the technical challenges. The aim of this study was to evaluate the medium- and long-term clinical and survival outcomes after laparoscopic and open CME for transverse colon cancer and to compare the 2 approaches. This study was a retrospective non-randomized study of patients with prospectively registered data on open and laparoscopic CME for transverse colon cancer tumour-node-metastasis stages I-III operated on between 2007 and 2014. This was a single-centre study in a community teaching hospital. A total of 56 patients with transverse colon cancer were included, excluding those with tumours in the colonic flexures. The outcome aims were 4-year time to recurrence (TTR) and cancer-specific survival (CSS). Morbidity was also measured. The 4-year TTR was 93.9% in the laparoscopic group and 91.3% in the open group (p = 0.71). The 4-year CSS was 97.0% in the laparoscopic group and 91.3% in the open group (p = 0.42). This was a prospective single-institution study with a small sample size. Results of the study suggest that the laparoscopic CME approach might be the preferred approach for transverse colon cancer, especially regarding its benefits in terms of short-term morbidity, length of stay and oncological outcome. © 2016 S. Karger AG, Basel.

  10. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

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    Logoluso Nicola

    2011-05-01

    Full Text Available Abstract Background Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol. Methods Nineteen patients (20 hips were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS] and hip joint function (Harris Hip score. Results The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104 months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84 pre-operatively to 18 (range, 0 - 38 prior to spacer removal and to 8 (range, 0 - 15 at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment. Conclusions Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.

  11. A psycho-educational HIV/STI prevention intervention for internally displaced women in Leogane, Haiti: results from a non-randomized cohort pilot study.

    Directory of Open Access Journals (Sweden)

    Carmen H Logie

    Full Text Available Little evidence exists regarding efficacious HIV and sexually transmitted infections (STI prevention interventions with internally displaced populations. Internally displaced women are at elevated risk for HIV/STI due to limited access to health services, heightened poverty and social network breakdown. The FASY (Famn an Aksyon Pou Sante' Yo (Women Taking Action For Their Health study examined the effectiveness of a peer health worker (PHW delivered psycho-educational HIV/STI pilot study with internally displaced women in Leogane, Haiti.This was a non-randomized cohort pilot study. Participants completed a computer-assisted pre-test programmed on Android tablet PCs followed by an HIV/STI educational video-based session and a 6-week psycho-educational group program of weekly meetings. Participants completed a post-test upon completion of group sessions. The primary outcome was HIV knowledge; our pre-specified index of clinically significant change was an effect size of 0.30. Secondary outcomes included: STI knowledge, condom use, social support, resilient coping, depression and relationship control. We used mixed-effects regression to calculate mean outcome pre-post score change. This study was registered (clinicaltrials.gov, NCT01492829.Between January 1-April 30, 2012 we assigned 200 participants to the study. The majority of participants (n = 176, 88% completed the study and were followed up at 8 weeks, finishing April 30, 2012. Adjusted for socio-demographic characteristics, HIV knowledge (β = 4.81; 95% CI 4.36-5.26, STI knowledge (β = 0.84; 95% CI 0.70-0.99, condom use (AOR = 4.05, 95% CI 1.86-8.83, and depression (β = -0.63, 95% CI -0.88--0.39 scores showed statistically significant change post-intervention (p<0.05.This pilot study evaluated a PHW psycho-educational HIV/STI prevention intervention among internally displaced women in post-earthquake Haiti. Pilot studies are an important approach to understand feasibility and scientific

  12. A psycho-educational HIV/STI prevention intervention for internally displaced women in Leogane, Haiti: results from a non-randomized cohort pilot study.

    Science.gov (United States)

    Logie, Carmen H; Daniel, CarolAnn; Newman, Peter A; Weaver, James; Loutfy, Mona R

    2014-01-01

    Little evidence exists regarding efficacious HIV and sexually transmitted infections (STI) prevention interventions with internally displaced populations. Internally displaced women are at elevated risk for HIV/STI due to limited access to health services, heightened poverty and social network breakdown. The FASY (Famn an Aksyon Pou Sante' Yo) (Women Taking Action For Their Health) study examined the effectiveness of a peer health worker (PHW) delivered psycho-educational HIV/STI pilot study with internally displaced women in Leogane, Haiti. This was a non-randomized cohort pilot study. Participants completed a computer-assisted pre-test programmed on Android tablet PCs followed by an HIV/STI educational video-based session and a 6-week psycho-educational group program of weekly meetings. Participants completed a post-test upon completion of group sessions. The primary outcome was HIV knowledge; our pre-specified index of clinically significant change was an effect size of 0.30. Secondary outcomes included: STI knowledge, condom use, social support, resilient coping, depression and relationship control. We used mixed-effects regression to calculate mean outcome pre-post score change. This study was registered (clinicaltrials.gov, NCT01492829). Between January 1-April 30, 2012 we assigned 200 participants to the study. The majority of participants (n = 176, 88%) completed the study and were followed up at 8 weeks, finishing April 30, 2012. Adjusted for socio-demographic characteristics, HIV knowledge (β = 4.81; 95% CI 4.36-5.26), STI knowledge (β = 0.84; 95% CI 0.70-0.99), condom use (AOR = 4.05, 95% CI 1.86-8.83), and depression (β = -0.63, 95% CI -0.88--0.39) scores showed statistically significant change post-intervention (pHaiti. Pilot studies are an important approach to understand feasibility and scientific impacts of HIV prevention strategies in disaster contexts. Study results may inform HIV prevention interventions among internally displaced women in

  13. Benefit of carbohydrate deficient transferrin in detecting chronic alcohol abuse in the elderly: study protocol for a multicentre, non-randomized, open-label study

    Directory of Open Access Journals (Sweden)

    Cécile Schnell

    2016-01-01

    Ethics: The Committee for the Protection of Persons located in Strasbourg, France, delivered a favourable opinion on the study project. Informed consent: The physician or the health network′s care coordinator informs the patient about the study protocol and obtains the patient′s assent. The investigator completes a non-opposition file and a copy is given to the patient and to his/her relative or helper.

  14. Heat rate variability and dyssomnia and their correlations to neurological defects in cerebral infarction patients complicated by insomnia A concurrent non-randomized case-control study

    Institute of Scientific and Technical Information of China (English)

    Jianping Chu; Xueli Shen; Jun Fan; Changhai Chen; Shuyang Lin

    2008-01-01

    BACKGROUND: Heart rate variability refers to the beat-to-beat alteration in heart rate. It is usually a slight periodic variation of R-R intervals. Much information of autonomic nerve system balance can be obtained by measuring the heart rate variability of patients. It remains to be shown whether heart rate variability can be used as an index for determining the severity of insomnia and cerebral infarction. OBJECTIVE: This study aimed to analyze the correlation for each frequency spectrum parameter of heart rate variability with an insomnia index, as well as the degree of neurological defects in patients with simple cerebral infarction and cerebral infarction complicated by insomnia. The goal was to verify the feasibility of frequency spectrum parameters for heart rate variability as a marker for insomnia and cerebral infarction. DESIGN: A case-control observation. SETTING: Department of Neurology, First Hospital Affiliated to China Medical University. PARTICIPANTS: Sixty inpatients, and/or outpatients, with cerebral infarction were admitted to the 202 Hospital of Chinese PLA between December 2005 and October 2006, confirmed by CT, and recruited to the study. According to the insomnia condition (insomnia is defined by a Pittsburgh Sleep Quality Index score > 7), the patients were assigned to a simple cerebral infarction group and a cerebral infarction complicated by insomnia group, with 30 subjects in each group. Thirty additional subjects, who concurrently received ex-aminations and were confirmed to not suffer from cerebral infarction and insomnia, were recruited into the control group. Written informed consent was obtained from each subject for laboratory specimens. The pro-tocol was approved by the Hospital's Ethics Committee. METHODS: Following admission, each subject's neurological impairment was assessed with the National Institutes of Health Stroke Scale and Pittsburgh Sleep Quality Index. Heart rate variability of each subject was measured with an

  15. A systematic review and meta-analysis of randomized and non-randomized studies comparing laparoscopic and open abdominoperineal resection for rectal cancer.

    LENUS (Irish Health Repository)

    Ahmad, N Z

    2013-03-01

    Evidence supporting the role of laparoscopy in abdominoperineal resection (APR) is limited. This study compared the short-term and long-term outcomes and complications associated with open and laparoscopic APR.

  16. Treated Hypertension has No Influence on the Efficacy of Alendronate in the Therapy of Postmenopausal Osteoporosis: A Non-Randomized, Non-Blind, Controlled Prospective Study

    OpenAIRE

    Matziolis, Doerte; Drewke, Monika; Matziolis, Georg; Perka, Carsten

    2011-01-01

    Changes in hormone metabolism during menopause are involved in the development of osteoporosis and arterial hypertension. A mutual influence of these two clinical pictures is evident on the basis of pathophysiological factors. In this study, we investigated whether a drug therapy of hypertension influences the efficacy of a bisphosphonate (alendronate) in the treatment of postmenopausal osteoporosis. For this purpose, 60 female patients were enrolled in the study, 30 of them on drug treatment...

  17. Low-dose tacrolimus combined with donor-derived mesenchymal stem cells after renal transplantation: a prospective, non-randomized study

    OpenAIRE

    Pan, Guang-hui; Chen, Zheng; Xu, Lu; Zhu, Jing-hui; Xiang, Peng; Ma, Jun-jie; Peng, Yan-wen; Li, Guang-hui; Chen, Xiao-yong; Fang, Jia-li; Guo, Yu-he; Zhang, Lei; Liu, Long-shan

    2016-01-01

    Calcineurin inhibitors, including tacrolimus, are largely responsible for advances in allotransplantation. However, the nephrotoxicity associated with these immunosuppressants impairs patients' long-term survival after renal allograft. Therefore, novel regimens that minimize or even eliminate calcineurin inhibitors could improve transplantation outcomes. In this pilot study, we investigated the use of low-dose tacrolimus in combination with mesenchymal stem cells (MSCs), which are immunosuppr...

  18. Choosing an Appropriate Physical Exercise to Reduce Stereotypic Behavior in Children with Autism Spectrum Disorders: A Non-Randomized Crossover Study

    Science.gov (United States)

    Tse, C. Y. Andy; Pang, C. L.; Lee, Paul H.

    2018-01-01

    Considerable evidence has shown that physical exercise could be an effective treatment in reducing stereotypical autism spectrum disorder (ASD) behaviors in children. The present study seeks to examine the underlying mechanism by considering the theoretical operant nature of stereotypy. Children with ASD (n = 30) who exhibited hand-flapping and…

  19. A phase I/II, non-randomized, feasibility/safety and efficacy study of the combination of everolimus, cetuximab and capecitabine in patients with advanced pancreatic cancer

    NARCIS (Netherlands)

    Kordes, Sil; Richel, Dick J.; Klümpen, Heinz-Josef; Weterman, Mariëtte J.; Stevens, Arnoldus J. W. M.; Wilmink, Johanna W.

    2013-01-01

    Improvements in knowledge of molecular mechanisms in cancer are the basis for new studies combining chemotherapy with targeted drugs. Inhibition of the epidermal growth factor receptor (EGFR) by erlotinib or cetuximab has limited or no activity, respectively, in pancreatic cancer. The crosstalk

  20. Impact of vacuum-assisted closure (VAC) therapy on clinical outcomes of patients with sternal wound infections: a meta-analysis of non-randomized studies.

    Science.gov (United States)

    Falagas, Matthew E; Tansarli, Giannoula S; Kapaskelis, Anastasios; Vardakas, Konstantinos Z

    2013-01-01

    To examine the impact of VAC therapy on mortality of patients with sternal wound infections after cardiothoracic surgery. Controversial results regarding mortality of patients with sternal wound infections were published. We performed a systematic search in PubMed and Scopus. Mortality was the primary outcome of the meta-analysis. Recurrences, complications and length of stay were secondary outcomes. Twenty-two retrospective studies including 2467 patients were eligible for inclusion. Patients treated with VAC had significantly lower mortality compared to those treated without VAC [2233 patients, RR = 0.40, (95% CI 0.28, 0.57)]. This finding was consistent regardless of the study design, the exclusion of studies with positive findings, the criteria for establishment of the compared groups, the time of mortality assessment or the type of infections under study, provided that adequate data was available. VAC therapy was associated with fewer recurrences (RR = 0.34, 95% CI: 0.19-0.59). The meta-analysis did not show any difference in the length of stay (RR = -2.25, 95% CI: -7.52-3.02). VAC therapy was associated with lower mortality than other surgical techniques in retrospective cohorts of patients with DSWIs following cardiothoracic surgery.

  1. The study protocol for a non-randomized controlled clinical trial using a genotype-guided strategy in a dataset of patients who undergone percutaneous coronary intervention with stent

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    Cristina Lucía Dávila-Fajardo

    2017-02-01

    Full Text Available This article contains data related to the research article entitled “Results of genotype–guided antiplatelet therapy in patients undergone percutaneous coronary intervention with stent” (J. Sánchez-Ramos, C.L. Dávila-Fajardo, P. Toledo Frías, X. Díaz Villamarín, L.J. Martínez-González, S. Martínez Huertas, F. Burillo Gómez, J. Caballero Borrego, A. Bautista Pavés, M.C. Marín Guzmán, J.A. Ramirez Hernández, C. Correa Vilches, J. Cabeza Barrera, 2016 (1. This data article reports, for the first time, about the non-randomized clinical trial protocol that check if CYP2C19/ABCB1 genotype–guided strategy in which the choice of antiplatelet therapy is based on the genetic test, reduces the rates of cardiovascular events and bleeding compared to a non-tailored strategy in patients undergone percutaneous coronary intervention (PCI with stent. The data included in this article are: design and setting of the study, study population, inclusion and exclusion criteria, definition of the intervention, objectives, variables (baseline characteristics and during the follow-up, study procedures, collection and treatment of the biological sample, genotyping, withdrawal criteria, sample size, statistic analysis, ethical aspects, information sheet and consent form. The authors confirm that this study has been registered in Eudra CT (Eudra CT: 2016-001294-33.

  2. Impact of a Multifaceted and Clinically Integrated Training Program in Evidence-Based Practice on Knowledge, Skills, Beliefs and Behaviour among Clinical Instructors in Physiotherapy: A Non-Randomized Controlled Study.

    Science.gov (United States)

    Olsen, Nina Rydland; Bradley, Peter; Espehaug, Birgitte; Nortvedt, Monica Wammen; Lygren, Hildegunn; Frisk, Bente; Bjordal, Jan Magnus

    2015-01-01

    Physiotherapists practicing at clinical placement sites assigned the role as clinical instructors (CIs), are responsible for supervising physiotherapy students. For CIs to role model evidence-based practice (EBP) they need EBP competence. The aim of this study was to assess the short and long term impact of a six-month multifaceted and clinically integrated training program in EBP on the knowledge, skills, beliefs and behaviour of CIs supervising physiotherapy students. We invited 37 CIs to participate in this non-randomized controlled study. Three self-administered questionnaires were used pre- and post-intervention, and at six-month follow-up: 1) The Adapted Fresno test (AFT), 2) the EBP Belief Scale and 3) the EBP Implementation Scale. The analysis approach was linear regression modeling using Generalized Estimating Equations. In total, 29 CIs agreed to participate in the study: 14 were invited to participate in the intervention group and 15 were invited to participate in the control group. One in the intervention group and five in the control group were lost to follow-up. At follow-up, the group difference was statistically significant for the AFT (mean difference = 37, 95% CI (15.9 -58.1), p students.

  3. Non-random distribution of instability-associated chromosomal rearrangement breakpoints in human lymphoblastoid cells

    International Nuclear Information System (INIS)

    Moore, Stephen R.; Papworth, David; Grosovsky, Andrew J.

    2006-01-01

    Genomic instability is observed in tumors and in a large fraction of the progeny surviving irradiation. One of the best-characterized phenotypic manifestations of genomic instability is delayed chromosome aberrations. Our working hypothesis for the current study was that if genomic instability is in part attributable to cis mechanisms, we should observe a non-random distribution of chromosomes or sites involved in instability-associated rearrangements, regardless of radiation quality, dose, or trans factor expression. We report here the karyotypic examination of 296 instability-associated chromosomal rearrangement breaksites (IACRB) from 118 unstable TK6 human B lymphoblast, and isogenic derivative, clones. When we tested whether IACRB were distributed across the chromosomes based on target size, a significant non-random distribution was evident (p < 0.00001), and three IACRB hotspots (chromosomes 11, 12, and 22) and one IACRB coldspot (chromosome 2) were identified. Statistical analysis at the chromosomal band-level identified four IACRB hotspots accounting for 20% of all instability-associated breaks, two of which account for over 14% of all IACRB. Further, analysis of independent clones provided evidence within 14 individual clones of IACRB clustering at the chromosomal band level, suggesting a predisposition for further breaks after an initial break at some chromosomal bands. All of these events, independently, or when taken together, were highly unlikely to have occurred by chance (p < 0.000001). These IACRB band-level cluster hotspots were observed independent of radiation quality, dose, or cellular p53 status. The non-random distribution of instability-associated chromosomal rearrangements described here significantly differs from the distribution that was observed in a first-division post-irradiation metaphase analysis (p = 0.0004). Taken together, these results suggest that genomic instability may be in part driven by chromosomal cis mechanisms

  4. EFFICACY AND SAFETY OF INHALED NITRIC OXIDE USE IN PATIENTS WITH PULMONARY HYPERTENSION AND CHRONIC HEART FAILURE III-IV FUNCTIONAL CLASS, SURVIVED LEFT VENTRICULAR MYOCARDIAL INFARCTION: RESULTS OF NON-RANDOMIZED COMAPARIVE STUDY

    Directory of Open Access Journals (Sweden)

    P. N. Pavlenko

    2011-01-01

    Full Text Available Aim – assessment of the influence of inhaled nitric oxide (NO on the course of pulmonary hypertension (PH in patients with chronic heartfailure (CHF III–IV functional class (FC, myocardial infarction (MI.Materials and methods. Results of comparative non-randomized study that included 45 patients (26 men and 19 women aged 51 to 98 years with PH III–IV functional class, left ventricular myocardial infarction. In the study, patients underwent physical examination and Doppler echocardiography, and assessed FC LH (carried out with six-minute walking test, to determine the degree of dyspnea by Borg.Results. Symptoms of CHF and PH regressed in both groups of patients against the background of the therapy. Conclusion. It is established that the use of inhaled NO is a safe therapy and helps to reduce mean pulmonary arterial pressure (PAPmean in patients with PH and CHF III–IV FC, myocardial infarction. The method of inhaled NO is simple and easy to use.

  5. EFFICACY AND SAFETY OF INHALED NITRIC OXIDE USE IN PATIENTS WITH PULMONARY HYPERTENSION AND CHRONIC HEART FAILURE III-IV FUNCTIONAL CLASS, SURVIVED LEFT VENTRICULAR MYOCARDIAL INFARCTION: RESULTS OF NON-RANDOMIZED COMAPARIVE STUDY

    Directory of Open Access Journals (Sweden)

    P. N. Pavlenko

    2014-07-01

    Full Text Available Aim – assessment of the influence of inhaled nitric oxide (NO on the course of pulmonary hypertension (PH in patients with chronic heartfailure (CHF III–IV functional class (FC, myocardial infarction (MI.Materials and methods. Results of comparative non-randomized study that included 45 patients (26 men and 19 women aged 51 to 98 years with PH III–IV functional class, left ventricular myocardial infarction. In the study, patients underwent physical examination and Doppler echocardiography, and assessed FC LH (carried out with six-minute walking test, to determine the degree of dyspnea by Borg.Results. Symptoms of CHF and PH regressed in both groups of patients against the background of the therapy. Conclusion. It is established that the use of inhaled NO is a safe therapy and helps to reduce mean pulmonary arterial pressure (PAPmean in patients with PH and CHF III–IV FC, myocardial infarction. The method of inhaled NO is simple and easy to use.

  6. Impact of a Multifaceted and Clinically Integrated Training Program in Evidence-Based Practice on Knowledge, Skills, Beliefs and Behaviour among Clinical Instructors in Physiotherapy: A Non-Randomized Controlled Study.

    Directory of Open Access Journals (Sweden)

    Nina Rydland Olsen

    Full Text Available Physiotherapists practicing at clinical placement sites assigned the role as clinical instructors (CIs, are responsible for supervising physiotherapy students. For CIs to role model evidence-based practice (EBP they need EBP competence. The aim of this study was to assess the short and long term impact of a six-month multifaceted and clinically integrated training program in EBP on the knowledge, skills, beliefs and behaviour of CIs supervising physiotherapy students.We invited 37 CIs to participate in this non-randomized controlled study. Three self-administered questionnaires were used pre- and post-intervention, and at six-month follow-up: 1 The Adapted Fresno test (AFT, 2 the EBP Belief Scale and 3 the EBP Implementation Scale. The analysis approach was linear regression modeling using Generalized Estimating Equations.In total, 29 CIs agreed to participate in the study: 14 were invited to participate in the intervention group and 15 were invited to participate in the control group. One in the intervention group and five in the control group were lost to follow-up. At follow-up, the group difference was statistically significant for the AFT (mean difference = 37, 95% CI (15.9 -58.1, p < 0.001 and the EBP Beliefs scale (mean difference = 8.1, 95% CI (3.1 -13.2, p = 0.002, but not for the EBP Implementation scale (mean difference = 1.8. 95% CI (-4.5-8.1, p = 0.574. Comparing measurements over time, we found a statistically significant increase in mean scores related to all outcome measures for the intervention group only.A multifaceted and clinically integrated training program in EBP was successful in improving EBP knowledge, skills and beliefs among CIs. Future studies need to ensure long-term EBP behaviour change, in addition to assessing CIs' abilities to apply EBP knowledge and skills when supervising students.

  7. A 4-year non-randomized comparative phase-IV study of early rheumatoid arthritis: integrative anthroposophic medicine for patients with preference against DMARDs versus conventional therapy including DMARDs for patients without preference

    Directory of Open Access Journals (Sweden)

    Hamre HJ

    2018-03-01

    Full Text Available Harald J Hamre,1 Van N Pham,2 Christian Kern,3 Rolf Rau,4 Jörn Klasen,3 Ute Schendel,5 Lars Gerlach,6 Attyla Drabik,2 Ludger Simon6,† 1Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Freiburg, Germany; 2Institute of Statistics in Medicine, Universitätsklinikum Düsseldorf, Düsseldorf, Germany; 3Department of Integrative Medicine, Asklepios Westklinikum, Hamburg, Germany; 4Department of Rheumatology, Evangelisches Fachkrankenhaus Ratingen, Ratingen, Germany; 5Department of Rheumatology, m&i-Fachklinik Bad Pyrmont, Bad Pyrmont, Germany; 6Department of Internal Medicine and Gastroenterology, Filderklinik, Filderstadt, Germany †Dr Ludger Simon passed away on June 10, 2016 Background: While disease-modifying antirheumatic drugs (DMARDs are a mainstay of therapy for rheumatoid arthritis (RA, some patients with early RA refuse DMARDs. In anthroposophic medicine (AM, a treatment strategy for early RA without DMARDs has been developed. Preliminary data suggest that RA symptoms and inflammatory markers can be reduced under AM, without DMARDs. Patients and methods: Two hundred and fifty-one self-selected patients aged 16–70 years, starting treatment for RA of <3 years duration, without prior DMARD therapy, participated in a prospective, non-randomized, comparative Phase IV study. C-patients were treated in clinics offering conventional therapy including DMARDs, while A-patients had chosen treatment in anthroposophic clinics, without DMARDs. Both groups received corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs. Primary outcomes were intensity of RA symptoms measured by self-rating on visual analog scales, C-reactive protein, radiological progression, study withdrawals, serious adverse events (SAE, and adverse drug reactions in months 0–48. Results: The groups were similar in most baseline characteristics, while A-patients had longer disease duration (mean 15.1 vs 10.8 months, p<0

  8. A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos).

    Science.gov (United States)

    Canena, Jorge; Liberato, Manuel; Meireles, Liliane; Marques, Inês; Romão, Carlos; Coutinho, António Pereira; Neves, Beatriz Costa; Veiga, Pedro Mota

    2015-07-01

    Endoscopic management of postcholecystectomy biliary leaks is widely accepted as the treatment of choice. However, refractory biliary leaks after a combination of biliary sphincterotomy and the placement of a large-bore (10F) plastic stent can occur, and the optimal rescue endotherapy for this situation is unclear. To compare the clinical effectiveness of the use of a fully covered self-expandable metal stent (FCSEMS) with the placement of multiple plastic stents (MPS) for the treatment of postcholecystectomy refractory biliary leaks. Prospective study. Two tertiary-care referral academic centers and one general district hospital. Forty consecutive patients with refractory biliary leaks who underwent endoscopic management. Temporary placement of MPS (n = 20) or FCSEMSs (n = 20). Clinical outcomes of endotherapy as well as the technical success, adverse events, need for reinterventions, and prognostic factors for clinical success. Endotherapy was possible in all patients. After endotherapy, closure of the leak was accomplished in 13 patients (65%) who received MPS and in 20 patients (100%) who received FCSEMSs (P = .004). The Kaplan-Meier (log-rank) leak-free survival analysis showed a statistically significant difference between the 2 patient populations (χ(2) [1] = 8.30; P stents (P = .024), a plastic stent diameter <20F (P = .006), and a high-grade biliary leak (P = .015) were shown to be significant predictors of treatment failure with MPS. The 7 patients in whom placement of MPS failed were retreated with FCSEMSs, resulting in closure of the leaks in all cases. Non-randomized design. In our series, the results of the temporary placement of FCSEMSs for postcholecystectomy refractory biliary leaks were superior to those from the use of MPS. A randomized study is needed to confirm our results before further recommendations. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  9. A Prospective Observational Study

    African Journals Online (AJOL)

    Methods: This was a prospective, questionnaire-based observational study. Printed questionnaires were distributed to the visitors of medical, surgical and neurosurgical ICU patients to determine awareness of basic infection control practices among visitors to an ICU. All the ICU staff, including nurses, doctors, consultant ...

  10. Change in organizational justice as a predictor of insomnia symptoms: longitudinal study analysing observational data as a non-randomized pseudo-trial.

    Science.gov (United States)

    Lallukka, Tea; Halonen, Jaana I; Sivertsen, Børge; Pentti, Jaana; Stenholm, Sari; Virtanen, Marianna; Salo, Paula; Oksanen, Tuula; Elovainio, Marko; Vahtera, Jussi; Kivimäki, Mika

    2017-08-01

    Despite injustice at the workplace being a potential source of sleep problems, longitudinal evidence remains scarce. We examined whether changes in perceived organizational justice predicted changes in insomnia symptoms. Data on 24 287 Finnish public sector employees (82% women), from three consecutive survey waves between 2000 and 2012, were treated as 'pseudo-trials'. Thus, the analysis of unfavourable changes in organizational justice included participants without insomnia symptoms in Waves 1 and 2, with high organizational justice in Wave 1 and high or low justice in Wave 2 (N = 6307). In the analyses of favourable changes in justice, participants had insomnia symptoms in Waves 1 and 2, low justice in Wave 1 and high or low justice in Wave 2 (N = 2903). In both analyses, the outcome was insomnia symptoms in Wave 3. We used generalized estimating equation models to analyse the data. After adjusting for social and health-related covariates in Wave 1, unfavourable changes in relational organizational justice (i.e. fairness of managerial behaviours) were associated with increased odds of developing insomnia symptoms [odds ratio = 1.15; 95% confidence interval (CI) 1.02-1.30]. A favourable change in relational organizational justice was associated with lower odds of persistent insomnia symptoms (odds ratio = 0.83; 95% CI 0.71-0.96). Changes in procedural justice (i.e. the fairness of decision-making procedures) were not associated with insomnia symptoms. These data suggest that changes in perceived relational justice may affect employees' sleep quality. Decreases in the fairness of managerial behaviours were linked to increases in insomnia symptoms, whereas rises in fairness were associated with reduced insomnia symptoms. © The Author 2017. Published by Oxford University Press on behalf of the International Epidemiological Association.

  11. Relationship of nocturnal concentrations of melatonin, gamma-aminobutyric acid and total antioxidants in peripheral blood with insomnia after stroke: study protocol for a prospective non-randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Wei Zhang; Fang Li; Tong Zhang

    2017-01-01

    Melatonin and gamma-aminobutyric acid (GABA) have been shown to regulate sleep. The nocturnal concentrations of melatonin, GABA and total antioxidants may relate to insomnia in stroke patients. In this prospective single-center non-randomized controlled clinical trial performed in the China Rehabilitation Research Center, we analyzed the relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke. Patients during rehabilitation of stroke were recruited and assigned to the insomnia group or non-insomnia group. Simultaneously, persons without stroke or insomnia served as normal controls. Each group contained 25 cases. The primary outcome was nocturnal concentrations of melatonin, GABA and total antioxidants in peripheral blood. The secondary outcomes were Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Morningness-Eveningness Questionnaire (Chinese version), and National Institute of Health Stroke Scale. The relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke was analyzed and showed that they were lower in the insomnia group than in the non-insomnia group. The severity of stroke was higher in the insomnia group than in the non-insomnia group. Correlation analysis demonstrated that the nocturnal concentrations of melatonin and GABA were associated with insomnia after stroke. This trial was regis-tered at ClinicalTrials.gov, identifier: NCT03202121.

  12. Colonic stem cell data are consistent with the immortal model of stem cell division under non-random strand segregation.

    Science.gov (United States)

    Walters, K

    2009-06-01

    Colonic stem cells are thought to reside towards the base of crypts of the colon, but their numbers and proliferation mechanisms are not well characterized. A defining property of stem cells is that they are able to divide asymmetrically, but it is not known whether they always divide asymmetrically (immortal model) or whether there are occasional symmetrical divisions (stochastic model). By measuring diversity of methylation patterns in colon crypt samples, a recent study found evidence in favour of the stochastic model, assuming random segregation of stem cell DNA strands during cell division. Here, the effect of preferential segregation of the template strand is considered to be consistent with the 'immortal strand hypothesis', and explore the effect on conclusions of previously published results. For a sample of crypts, it is shown how, under the immortal model, to calculate mean and variance of the number of unique methylation patterns allowing for non-random strand segregation and compare them with those observed. The calculated mean and variance are consistent with an immortal model that incorporates non-random strand segregation for a range of stem cell numbers and levels of preferential strand segregation. Allowing for preferential strand segregation considerably alters previously published conclusions relating to stem cell numbers and turnover mechanisms. Evidence in favour of the stochastic model may not be as strong as previously thought.

  13. Effect of a multidisciplinary stress treatment programme on the return to work rate for persons with work-related stress. A non-randomized controlled study from a stress clinic

    Directory of Open Access Journals (Sweden)

    Bech Per

    2010-11-01

    Full Text Available Abstract Background In recent years an increasing number of patients have been referred to the medical sector with stress symptoms. Moreover, these conditions imply increased sickness absence. This indicates a need for treatment programmes in general medical practice. The aim of this study was to test the effect of a multidisciplinary stress treatment programme on the return to work (RTW rate in persons with work-related stress and establish predictive factors for this outcome. Methods During a two-year period 63 out of 73 referrals to the Stress Clinic (a section of a Clinic of Occupational Medicine completed a stress treatment programme consisted of the following: 1 Identification of relevant stressors. 2. Changing the coping strategies of the participants. 3. Evaluating/changes in participant workload and tasks. 4. Relaxation techniques. 5. Physical exercise. 6. Psychiatric evaluation when indicated by depression test score. On average each patient attended six one-hour sessions over the course of four months. A group of 34 employees referred to the Clinic of Occupational Medicine by their general practitioners served as a control group. Each participant had a one-hour consultation at baseline and after four months. A specialist in occupational medicine carried out all sessions. Return To Work (RTW, defined as having a job and not being on sick leave at the census, was used as outcome measure four months after baseline, and after one and two years. Results The level of sick leave in the stress treatment group dropped from 52% to 16% during the first four months of follow-up and remained stable. In the control group, the reduction in sick leave was significantly smaller, ranging from 48% at baseline to 27% after four months and 24% after one year. No statistically significant difference between the two groups was observed after one and two years. Age below 50 years and being a manager increased the odds ratio for RTW after one and two years

  14. A multicenter, non-randomized, phase II study of docetaxel and carboplatin administered every 3 weeks as second line chemotherapy in patients with first relapse of platinum sensitive epithelial ovarian, peritoneal or fallopian tube cancer

    DEFF Research Database (Denmark)

    Wang, Yun; Herrstedt, Jørn; Havsteen, Hanne

    2014-01-01

    of 398 cycles were given. Grade 3/4 neutropenia was seen in 80% (59 of 74) patients with an incidence of febrile neutropenia of 16%. Grade 2/3 sensory peripheral neuropathy occurred in 7% of patients, but no grade 4 sensory peripheral neuropathy was observed. Sixty patients were evaluable for response...... of platinum-sensitive ovarian, peritoneal and Fallopian tube cancer. The major toxicity was neutropenia, while the frequency of peripheral neuropathy was low.......BACKGROUND: In patients with ovarian cancer relapsing at least 6 months after end of primary treatment, the addition of paclitaxel to platinum treatment has been shown to improve survival but at the cost of significant neuropathy. In the first line setting, the carboplatin-docetaxel combination...

  15. Effect of a multidisciplinary stress treatment programme on the return to work rate for persons with work-related stress. A non-randomized controlled study from a stress clinic

    DEFF Research Database (Denmark)

    Netterstrøm, Bo; Bech, Per

    2010-01-01

    was to test the effect of a multidisciplinary stress treatment programme on the return to work (RTW) rate in persons with work-related stress and establish predictive factors for this outcome. METHODS: During a two-year period 63 out of 73 referrals to the Stress Clinic (a section of a Clinic of Occupational...... and after four months. A specialist in occupational medicine carried out all sessions.Return To Work (RTW), defined as having a job and not being on sick leave at the census, was used as outcome measure four months after baseline, and after one and two years. RESULTS: The level of sick leave in the stress...... the two groups was observed after one and two years. Age below 50 years and being a manager increased the odds ratio for RTW after one and two years, while gender and depression had no predictive value. CONCLUSIONS: The stress treatment programme showed a significant effect on the return to work rate...

  16. A 12-Month Prospective, Observational Study of Treatment Regimen and Quality of Life Associated with ADHD in Central and Eastern Europe and Eastern Asia

    Science.gov (United States)

    Goetz, Michal; Yeh, Chin-Bin; Ondrejka, Igor; Akay, Aynur; Herczeg, Ilona; Dobrescu, Iuliana; Kim, Boong Nyun; Jin, Xingming; Riley, Anne W.; Martenyi, Ferenc; Harrison, Gavan; Treuer, Tamas

    2012-01-01

    Objectives: This prospective, observational, non-randomized study aimed to describe the relationship between treatment regimen prescribed and the quality of life (QoL) of ADHD patients in countries of Central and Eastern Europe (CEE) and Eastern Asia over 12 months. Methods: 977 Male and female patients aged 6-17 years seeking treatment for…

  17. Non-randomized study on the effects of preoperative radiotherapy and daily administration of low-dose cisplatin against those of radiotherapy alone for oral cancer. Effects on local control, control of metastases, and overall survival

    International Nuclear Information System (INIS)

    Kurita, Hiroshi; Ohtsuka, Akiko; Kobayashi, Hiroichi; Kurashina, Kenji; Shikama, Naoto; Oguchi, Masahiko

    2000-01-01

    Cisplatin is a known radiation modifier. Our previous study suggested that daily administration of low-dose cisplatin enhanced the efficacy of radiotherapy against primary oral squamous carcinoma. In this paper, we follow the patients who participated in the previous study and survey the benefit of combination low-dose cisplatin in improving local control, prevention of metastases, and overall survival. This study included patients with surgically resectable advanced oral tumors. Ten patients underwent preoperative radiotherapy of 30-40 Gy/15-20 days with concomitant daily administration of low-dose cisplatin (5 mg/body or 5 mg/m 2 ). Ten other patients received external radiotherapy alone. All patients then underwent a planned radical tumor resection. No significant difference was see in loco-regional control rates (primary: 86 vs. 88%, neck: 83 vs. 78% at 48 months) or incidence of metastasis (70 vs. 64%) between the two groups. Nor was there a significant difference in the overall survival rate (60 vs. 66%). The results of this study suggest that the concomitant use of daily administration of low-dose cisplatin with preoperative radiation brings no statistically significant benefit in improving local control and survival rate in patients with advanced resectable oral cancer. (author)

  18. Effect of a multidisciplinary stress treatment programme on the return to work rate for persons with work-related stress. A non-randomized controlled study from a stress clinic

    DEFF Research Database (Denmark)

    Netterstrøm, Bo; Bech, Per

    2010-01-01

    ABSTRACT: BACKGROUND: In recent years an increasing number of patients have been referred to the medical sector with stress symptoms. Moreover, these conditions imply increased sickness absence. This indicates a need for treatment programmes in general medical practice. The aim of this study...... was to test the effect of a multidisciplinary stress treatment programme on the return to work (RTW) rate in persons with work-related stress and establish predictive factors for this outcome. METHODS: During a two-year period 63 out of 73 referrals to the Stress Clinic (a section of a Clinic of Occupational...... indicated by depression test score.On average each patient attended six one-hour sessions over the course of four months.A group of 34 employees referred to the Clinic of Occupational Medicine by their general practitioners served as a control group. Each participant had a one-hour consultation at baseline...

  19. Evaluating the effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care in a network of community-based mental health services: a study protocol of a non-randomized, multiple baseline trial.

    Science.gov (United States)

    Bartlem, Kate; Bowman, Jennifer; Freund, Megan; Wye, Paula; McElwaine, Kathleen; Knight, Jenny; McElduff, Patrick; Gillham, Karen; Wiggers, John

    2013-08-06

    People with a mental illness experience substantial disparities in health, including increased rates of morbidity and mortality caused by potentially preventable chronic diseases. One contributing factor to such disparity is a higher prevalence of modifiable health risk behaviors, such as smoking, inadequate fruit and vegetable intake, harmful alcohol consumption, and inadequate physical activity. Evidence supports the effectiveness of preventive care in reducing such risks, and guidelines recommend that preventive care addressing such risks be incorporated into routine clinical care. Although community-based mental health services represent an important potential setting for ensuring that people with a mental illness receive such care, research suggests its delivery is currently sub-optimal. A study will be undertaken to evaluate the effectiveness of a clinical practice change intervention in increasing the routine provision of preventive care by clinicians in community mental health settings. A two-group multiple baseline design will be utilized to assess the effectiveness of a multi-strategic intervention implemented over 12 months in increasing clinician provision of preventive care. The intervention will be implemented sequentially across the two groups of community mental health services to increase provision of client assessment, brief advice, and referral for four health risk behaviors (smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Outcome measures of interest will be collected via repeated cross-sectional computer-assisted telephone interviews undertaken on a weekly basis for 36 months with community mental health clients. This study is the first to assess the effectiveness of a multi-strategic clinical practice change intervention in increasing routine clinician provision of preventive care for chronic disease behavioral risk factors within a network of community mental health services

  20. Efficacy and safety of combination therapy with latanoprost after a change in therapeutic regimen from timolol to brinzolamide in Japanese adult patients with primary open-angle glaucoma and ocular hypertension: open, non-randomized 12-week study

    Directory of Open Access Journals (Sweden)

    Shusaku Ishikawa

    2008-09-01

    Full Text Available Shusaku Ishikawa1, Yoshimi Nakamura1, Yuko Nakamura1, Hiroshi Sakai1, Shoichi Sawaguchi1, Kazuo Terashima2, Makoto Kanno2, Hidetoshi Yamashita21Department of Ophthalmology, University of the Ryukyus Faculty of Medicine, Okinawa, Japan; 2Department of Ophthalmology and Visual Science, Yamagata University Faculty of Medicine, Yamagata, JapanPurpose: To compare the efficacy of brinzolamide in Japanese patients with primary open-angle glaucoma (POAG or ocular hypertension (OH after a change from timolol in combination therapy with latanoprost.Methods: A 12-week, prospective, open-label, comparative study was performed in 20 patients [11 males and 9 females, mean age of 64.5 ± 11.0 (SDy] with POAG or OH treated with both latanoprost once daily and timolol 0.5% twice daily. During the study brinzolamide was substituted for timolol. Intraocular pressure (IOP was measured at baseline, 4, 8, and 12 weeks. Blood pressure (BP, pulse rate (PR, and adverse events were also recorded.Results: IOPs at baseline, 4, 8, and 12 weeks were 18.6 ± 2.1 mmHg, 17.8 ± 2.6 mmHg, 17.4 ± 2.5 mmHg, and 17.3 ± 3.5 mmHg, respectively. IOP reduction at 4 and 8 weeks was statistically significant (p < 0.05. The PR was significantly increased at 12 weeks (p < 0.01, but BP was not significantly affected. Four ocular adverse events were noted, but all were mild and transient.Conclusions: Substituting brinzolamide 1% for timolol 0.5% in combination therapy with latanoprost 0.005% demonstrated significant IOP reduction with improvement in PR with POAG or OH. Combination therapy using latanoprost and brinzolamide may be recommended for better IOP control with fewer systemic adverse events.Keywords: open-angle glaucoma, brinzolamide/latanprost combination therapy, timolol/latanoprost combination therapy, intraocular pressure

  1. Stereotactic body radiotherapy for medically inoperable patients with stage I non-small cell lung cancer - A first report of toxicity related to COPD/CVD in a non-randomized prospective phase II study

    International Nuclear Information System (INIS)

    Baumann, Pia; Nyman, Jan; Hoyer, Morten; Gagliardi, Giovanna; Lax, Ingmar; Wennberg, Berit; Drugge, Ninni; Ekberg, Lars; Friesland, Signe; Johansson, Karl-Axel; Lund, Jo-Asmund; Morhed, Elisabeth; Nilsson, Kristina; Levin, Nina; Paludan, Merete; Sederholm, Christer; Traberg, Anders; Wittgren, Lena; Lewensohn, Rolf

    2008-01-01

    Background and Aims: In a retrospective study using stereotactic body radiotherapy (SBRT) in medically inoperable patients with stage I NSCLC we previously reported a local control rate of 88% utilizing a median dose of 15 Gy x 3. This report records the toxicity encountered in a prospective phase II trial, and its relation to coexisting chronic obstructive pulmonary disease (COPD) and cardio vascular disease (CVD). Material and methods: Sixty patients were entered in the study between August 2003 and September 2005. Fifty-seven patients (T1 65%, T2 35%) with a median age of 75 years (59-87 years) were evaluable. The baseline mean FEV1% was 64% and median Karnofsky index was 80. A total dose of 45 Gy was delivered in three fractions at the 67% isodose of the PTV. Clinical, pulmonary and radiological evaluations were made at 6 weeks, 3, 6, 9, 12, 18, and 36 months post-SBRT. Toxicity was graded according to CTC v2.0 and performance status was graded according to the Karnofsky scale. Results: At a median follow-up of 23 months, 2 patients had relapsed locally. No grade 4 or 5 toxicity was reported. Grade 3 toxicity was seen in 12 patients (21%). There was no significant decline of FEV1% during follow-up. Low grade pneumonitis developed to the same extent in the CVD 3/17 (18%) and COPD 7/40 (18%) groups. The incidence of fibrosis was 9/17 (53%) and pleural effusions was 8/17 (47%) in the CVD group compared with 13/40 (33%) and 5/40 (13%) in the COPD group. Conclusion: SBRT for stage I NSCLC patients who are medically inoperable because of COPD and CVD results in a favourable local control rate with a low incidence of grade 3 and no grade 4 or 5 toxicity

  2. The nucleoid protein Dps binds genomic DNA of Escherichia coli in a non-random manner

    Science.gov (United States)

    Kondrashov, F. A.; Toshchakov, S. V.; Dominova, I.; Shvyreva, U. S.; Vrublevskaya, V. V.; Morenkov, O. S.; Panyukov, V. V.

    2017-01-01

    Dps is a multifunctional homododecameric protein that oxidizes Fe2+ ions accumulating them in the form of Fe2O3 within its protein cavity, interacts with DNA tightly condensing bacterial nucleoid upon starvation and performs some other functions. During the last two decades from discovery of this protein, its ferroxidase activity became rather well studied, but the mechanism of Dps interaction with DNA still remains enigmatic. The crucial role of lysine residues in the unstructured N-terminal tails led to the conventional point of view that Dps binds DNA without sequence or structural specificity. However, deletion of dps changed the profile of proteins in starved cells, SELEX screen revealed genomic regions preferentially bound in vitro and certain affinity of Dps for artificial branched molecules was detected by atomic force microscopy. Here we report a non-random distribution of Dps binding sites across the bacterial chromosome in exponentially growing cells and show their enrichment with inverted repeats prone to form secondary structures. We found that the Dps-bound regions overlap with sites occupied by other nucleoid proteins, and contain overrepresented motifs typical for their consensus sequences. Of the two types of genomic domains with extensive protein occupancy, which can be highly expressed or transcriptionally silent only those that are enriched with RNA polymerase molecules were preferentially occupied by Dps. In the dps-null mutant we, therefore, observed a differentially altered expression of several targeted genes and found suppressed transcription from the dps promoter. In most cases this can be explained by the relieved interference with Dps for nucleoid proteins exploiting sequence-specific modes of DNA binding. Thus, protecting bacterial cells from different stresses during exponential growth, Dps can modulate transcriptional integrity of the bacterial chromosome hampering RNA biosynthesis from some genes via competition with RNA polymerase

  3. Distracted Biking: An Observational Study.

    Science.gov (United States)

    Wolfe, Elizabeth Suzanne; Arabian, Sandra Strack; Breeze, Janis L; Salzler, Matthew J

    2016-01-01

    Commuting via bicycle is a very popular mode of transportation in the Northeastern United States. Boston, MA, has seen a rapid increase in bicycle ridership over the past decade, which has raised concerns and awareness about bicycle safety. An emerging topic in this field is distracted bicycle riding. This study was conducted to provide descriptive data on the prevalence and type of distracted bicycling in Boston at different times of day. This was a cross-sectional study in which observers tallied bicyclists at 4 high traffic intersections in Boston during various peak commuting hours for 2 types of distractions: auditory (earbuds/phones in or on ears), and visual/tactile (electronic device or other object in hand). Nineteen hundred seventy-four bicyclists were observed and 615 (31.2%), 95% CI [29, 33%], were distracted. Of those observed, auditory distractions were the most common (N = 349; 17.7%), 95% CI [16, 19], p = .0003, followed by visual/tactile distractions (N = 266; 13.5%), 95% CI [12, 15]. The highest proportion (40.7%), 95% CI [35, 46], of distracted bicyclists was observed during the midday commute (between 13:30 and 15:00). Distracted bicycling is a prevalent safety concern in the city of Boston, as almost a third of all bicyclists exhibited distracted behavior. Education and public awareness campaigns should be designed to decrease distracted bicycling behaviors and promote bicycle safety in Boston. An awareness of the prevalence of distracted biking can be utilized to promote bicycle safety campaigns dedicated to decreasing distracted bicycling and to provide a baseline against which improvements can be measured.

  4. Non-Random Chromosome Segregation in Stem Cells

    OpenAIRE

    Conboy, Michael J; Karasov, Ariela O; Rando, Thomas A

    2007-01-01

    Decades ago, the "immortal strand hypothesis" was proposed as a means by which stem cells might limit acquiring mutations that could give rise to cancer, while continuing to proliferate for the life of an organism. Originally based on observations in embryonic cells, and later studied in terms of stem cell self-renewal, this hypothesis has remained largely unaccepted because of few additional reports, the rarity of the cells displaying template strand segregation, and alternative interpretati...

  5. Non-random intrachromosomal distribution of radiation-induced chromatid aberrations in Vicia faba. [Aberration clustering

    Energy Technology Data Exchange (ETDEWEB)

    Schubert, I; Rieger, R [Akademie der Wissenschaften der DDR, Gatersleben. Zentralinst. fuer Genetik und Kulturpflanzenforschung

    1976-04-01

    A reconstructed karyotype of Vicia faba, with all chromosomes individually distinguishable, was treated with X-rays, fast neutrons, (/sup 3/H) uridine (/sup 3/HU). The distribution within metaphase chromosomes of induced chromatid aberrations was non-random for all agents used. Aberration clustering, in part agent specific, occurred in chromosome segments containing heterochromatin as defined by the presence of G bands. The pattern of aberration clustering found after treatment with /sup 3/HU did not allow the recognition of chromosome regions active in transcription during treatment. Furthermore, it was impossible to obtain unambiguous indications of the presence of AT- and GC-base clusters from the patterns of /sup 3/HT- and /sup 3/HC-induced chromatid aberrations, respectively. Possible reasons underlying these observations are discussed.

  6. Observational Study of Travelers' Diarrhea.

    Science.gov (United States)

    Meuris

    1995-03-01

    Background: European air travelers returning from Algeria, Egypt, Mexico, Morocco, and Tunisia were interviewed about their experience of travelers' diseases upon arrival in Brussels. Diarrhea was mentioned by 37% of the adults and 27% of the children. These subjects were questioned about the types of measures taken, type and duration of drug treatment (if any), and about duration of diarrhea and side effects experienced. Methods: Final analysis was performed based on 2160 interviews. The largest proportion of diarrhea was reported in the age group 15-24 years (46%). Results: The majority of the 2160 subjects had opted for drug treatment (81%): 927 subjects for loperamide alone, 235 for loperamide in combination with nifuroxazide, and 178 for nifuroxazide alone. Other drugs had been used less frequently. The median time to recovery was 2.4 days with loperamide compared to 3.2 days with nifuroxazide and to 3.4 days for the no-treatment group. Conclusions: A stratification of the results by severity of the diarrhea suggests a rank of antidiarrheal potency as follows: loperamide > nifuroxazide > no-drug treatment. The side effect with the highest incidence was constipation (2.4% with loperamide). (J Travel Med 2:11-15, 1995) Travelers' diarrhea is usually defined as the passage of at least three unformed stools per day or any number of such stools when accompanied by fever, abdominal cramping, or vomiting. The definition may be broadened to include more trivial bowel disturbance.1,2 The duration of this self-limited disease generally is 3 to 5 days. Medical intervention aims at shortening the duration of disease, thus allowing the sufferer to resume his or her usual activities at an early stage. A shortened period of recovery to physical well-being has obvious favorable economic implications if the traveler is on business and may help the maintenance of a desired level of quality of life while a traveler is on holiday. An observational study of various medical

  7. Science Studies from Archived Observations

    Science.gov (United States)

    Armstrong, T. P.; Manweiler, J. W.; Patterson, J. D.

    2008-12-01

    Goals for spaceflight investigations include the discovery and characterization of physical features of the in- situ and remote environment. Abundant successes of flight investigations are easily documented. Prudent scientific practice dictates that to the maximum extent possible, observations should be well-characterized, reliably catalogued, and knowledgeably interpreted. This is especially true of data sets used in the publication of results in the reviewed literature. Typical scientific standards include making primary data numbers available to other investigators for replicated study. While NASA's contracts with investigators have required that data be submitted to agency official archives, the details, completeness (especially of ancillary and metadata) and forms differ from investigation to investigation and project to project. After several generations of improvements and refinements, modern computing and communications technology makes it possible to link multiple data sets at multiple locations through a unified data model. Virtual Observatories provide the overall organizational structures and SPASE-compliant XML defines the data granules that can be located. Proofs of the feasibility and value of this latest approach remain to be seen, but its ultimate goal of improving archival research using flight-derived data sets appears to depend on user acceptance and efficient use of the VxO resources. Criteria based on the authors experience in science derived from archival sources follow: 1. Interfaces and tools must be easy to learn, easy to use, and reliable. 2. Data numbers must be promptly downloadable in plain text. 3. Data must be available in or readily converted to physical units using calibrations and algorithms easily traceable as part of the search. Knowledge about (or heritage of) specific data items present in the science literature must be associated with the search for that item. 4. Data items must be trustworthy, having quoted uncertainties and

  8. UFOs: Observations, Studies and Extrapolations

    CERN Document Server

    Baer, T; Barnes, M J; Bartmann, W; Bracco, C; Carlier, E; Cerutti, F; Dehning, B; Ducimetière, L; Ferrari, A; Ferro-Luzzi, M; Garrel, N; Gerardin, A; Goddard, B; Holzer, E B; Jackson, S; Jimenez, J M; Kain, V; Zimmermann, F; Lechner, A; Mertens, V; Misiowiec, M; Nebot Del Busto, E; Morón Ballester, R; Norderhaug Drosdal, L; Nordt, A; Papotti, G; Redaelli, S; Uythoven, J; Velghe, B; Vlachoudis, V; Wenninger, J; Zamantzas, C; Zerlauth, M; Fuster Martinez, N

    2012-01-01

    UFOs (“ Unidentified Falling Objects”) could be one of the major performance limitations for nominal LHC operation. Therefore, in 2011, the diagnostics for UFO events were significantly improved, dedicated experiments and measurements in the LHC and in the laboratory were made and complemented by FLUKA simulations and theoretical studies. The state of knowledge is summarized and extrapolations for LHC operation in 2012 and beyond are presented. Mitigation strategies are proposed and related tests and measures for 2012 are specified.

  9. Non-random alkylation of DNA sequences induced in vivo by chemical mutagens

    Energy Technology Data Exchange (ETDEWEB)

    Durante, M.; Geri, C.; Bonatti, S.; Parenti, R. (Universita di Pisa (Italy))

    1989-08-01

    Previous studies of the interaction of alkylating agents on the eukaryotic genome support the idea that induction of DNA adducts is at specific genomic sites. Here we show molecular and cytological evidence that alkylation is rather specific. Mammalian cell cultures were exposed to different doses of mutagens and the DNA was analyzed by density gradient ultracentrifugation, hydroxylapatite fractionation, and by restriction enzyme analysis. Studies with the labelled mutagens N-ethyl-N-nitrosourea and N-methyl-N'-nitro-N-nitrosoguanidine show that there is a non-random distribution of the adducts. The adducts are found more frequently in A-T, G-C rich satellite DNA and highly repetitive sequences. Analysis with restriction enzymes shows that both methyl and ethyl groups influence the restriction patterns of the enzymes HpaII and MspI that recognize specific endogenous DNA methylation. These data suggest, as a subsequent mechanism, a modification in the pattern of the normal endogenous methylation of 5-methylcytosine.

  10. Real-time definition of non-randomness in the distribution of genomic events.

    Directory of Open Access Journals (Sweden)

    Ulrich Abel

    Full Text Available Features such as mutations or structural characteristics can be non-randomly or non-uniformly distributed within a genome. So far, computer simulations were required for statistical inferences on the distribution of sequence motifs. Here, we show that these analyses are possible using an analytical, mathematical approach. For the assessment of non-randomness, our calculations only require information including genome size, number of (sampled sequence motifs and distance parameters. We have developed computer programs evaluating our analytical formulas for the real-time determination of expected values and p-values. This approach permits a flexible cluster definition that can be applied to most effectively identify non-random or non-uniform sequence motif distribution. As an example, we show the effectivity and reliability of our mathematical approach in clinical retroviral vector integration site distribution.

  11. Microstructural descriptors and cellular automata simulation of the effects of non-random nuclei location on recrystallization in two dimensions

    Directory of Open Access Journals (Sweden)

    Paulo Rangel Rios

    2006-06-01

    Full Text Available The effect of non-random nuclei location and the efficiency of microstructural descriptors in assessing such a situation are studied. Cellular automata simulation of recrystallization in two dimensions is carried out to simulate microstrutural evolution for nuclei distribution ranging from a periodic arrangement to clusters of nuclei. The simulation results are compared in detail with microstrutural descriptors normally used to follow transformation evolution. It is shown that the contiguity is particularly relevant to detect microstructural deviations from randomness. This work focuses on recrystallization but its results are applicable to any nucleation and growth transformation.

  12. Potential use of the non-random distribution of N2 and N2O mole masses in the atmosphere as a tool for tracing atmospheric mixing and isotope fractionation processes

    International Nuclear Information System (INIS)

    Well, R.; Langel, R.; Reineking, A.

    2002-01-01

    The variation in the natural abundance of 15 N in atmospheric gas species is often used to determine the mixing of trace gases from different sources. With conventional budget calculations one unknown quantity can be determined if the remaining quantities are known. From 15 N tracer studies in soils with highly enriched 15 N-nitrate a procedure is known to calculate the mixing of atmospheric and soil derived N 2 based on the measurement of the 30/28 and 29/28 ratios in gas samples collected from soil covers. Because of the non-random distribution of the mole masses 30 N 2 , 29 N 2 and 28 N 2 in the mixing gas it is possible to calculate two quantities simultaneously, i.e. the mixing ratio of atmospheric and soil derived N 2 , and the isotopic signature of the soil derived N 2 . Routine standard measurements of laboratory air had suggested a non-random distribution of N 2 -mole masses. The objective of this study was to investigate and explain the existence of non-random distributions of 15 N 15 N, 14 N 15 N and 14 N 14 N in N 2 and N 2 O in environmental samples. The calculation of theoretical isotope data resulting from hypothetical mixing of two sources differing in 15 N natural abundance demonstrated, that the deviation from an ideal random distribution of mole masses is not detectable with the current precision of mass spectrometry. 15 N-analysis of N 2 or N 2 O was conducted with randomised and non-randomised replicate samples of different origin. 15 N abundance as calculated from 29/28 ratios were generally higher in randomised samples. The differences between the treatments ranged between 0.05 and 0.17 δper mille 15 N. It was concluded that the observed randomisation effect is probably caused by 15 N 15 N fractionation during environmental processes. (author)

  13. Observing Protein & Energy Nutrition (OPEN) Study

    Science.gov (United States)

    The Observing Protein and Energy Nutrition (OPEN) Study was designed to assess dietary measurement error by comparing results from self-reported dietary intake data with four dietary biomarkers: doubly labeled water and urinary nitrogen, sodium, and potassium.

  14. STRengthening analytical thinking for observational studies

    DEFF Research Database (Denmark)

    Sauerbrei, Willi; Abrahamowicz, Michal; Altman, Douglas G.

    2014-01-01

    The validity and practical utility of observational medical research depends critically on good study design, excellent data quality, appropriate statistical methods and accurate interpretation of results. Statistical methodology has seen substantial development in recent times. Unfortunately, ma...

  15. The Alberta smoke plume observation study

    Directory of Open Access Journals (Sweden)

    K. Anderson

    2018-02-01

    Full Text Available A field project was conducted to observe and measure smoke plumes from wildland fires in Alberta. This study used handheld inclinometer measurements and photos taken at lookout towers in the province. Observations of 222 plumes were collected from 21 lookout towers over a 6-year period from 2010 to 2015. Observers reported the equilibrium and maximum plume heights based on the plumes' final levelling heights and the maximum lofting heights, respectively. Observations were tabulated at the end of each year and matched to reported fires. Fire sizes at assessment times and forest fuel types were reported by the province. Fire weather conditions were obtained from the Canadian Wildland Fire Information System (CWFIS. Assessed fire sizes were adjusted to the appropriate size at plume observation time using elliptical fire-growth projections. Though a logical method to collect plume observations in principle, many unanticipated issues were uncovered as the project developed. Instrument limitations and environmental conditions presented challenges to the investigators, whereas human error and the subjectivity of observations affected data quality. Despite these problems, the data set showed that responses to fire behaviour conditions were consistent with the physical processes leading to plume rise. The Alberta smoke plume observation study data can be found on the Canadian Wildland Fire Information System datamart (Natural Resources Canada, 2018 at http://cwfis.cfs.nrcan.gc.ca/datamart.

  16. The Alberta smoke plume observation study

    Science.gov (United States)

    Anderson, Kerry; Pankratz, Al; Mooney, Curtis; Fleetham, Kelly

    2018-02-01

    A field project was conducted to observe and measure smoke plumes from wildland fires in Alberta. This study used handheld inclinometer measurements and photos taken at lookout towers in the province. Observations of 222 plumes were collected from 21 lookout towers over a 6-year period from 2010 to 2015. Observers reported the equilibrium and maximum plume heights based on the plumes' final levelling heights and the maximum lofting heights, respectively. Observations were tabulated at the end of each year and matched to reported fires. Fire sizes at assessment times and forest fuel types were reported by the province. Fire weather conditions were obtained from the Canadian Wildland Fire Information System (CWFIS). Assessed fire sizes were adjusted to the appropriate size at plume observation time using elliptical fire-growth projections. Though a logical method to collect plume observations in principle, many unanticipated issues were uncovered as the project developed. Instrument limitations and environmental conditions presented challenges to the investigators, whereas human error and the subjectivity of observations affected data quality. Despite these problems, the data set showed that responses to fire behaviour conditions were consistent with the physical processes leading to plume rise. The Alberta smoke plume observation study data can be found on the Canadian Wildland Fire Information System datamart (Natural Resources Canada, 2018) at http://cwfis.cfs.nrcan.gc.ca/datamart.

  17. A Non-randomized Controlled Trial of EMDR on Affective Symptoms in Patients With Glioblastoma Multiforme

    Directory of Open Access Journals (Sweden)

    Monika Szpringer

    2018-05-01

    Full Text Available Glioblastoma multiforme (GBM is a highly aggressive brain cancer and its survival after diagnosis is less than 2 years. Therefore, GBM patients are especially prone to co-occurring psychological conditions such as anxiety and depressive disorders. Furthermore, aggressive medical therapies affect patients’ lives, undermining their sense of meaning and coherence. The main aim of this study was to determine the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR therapy on anxiety, depression and sense of coherence in patients with GBM. Thirty-seven GBM-diagnosed women were included in this trial and received standard medical care. Of those, 18 patients were treated during 4 months with 10–12 individual EMDR sessions (60–90 minutes each. Nineteen GBM patients were used as a non-randomized control group as they consented to psychological evaluations but not to a psychotherapeutic intervention. The groups were homogeneous in terms of gender, age, educational level and treatment, but not in anxiety and depressive levels at baseline. All patients were evaluated at baseline, after treatment (4 months and at follow-up (further 4 months by the Hospital Anxiety and Depression Scale (HADS-M and the Sense of Coherence Scale (SOC-29. Caregivers in both groups were interviewed by the Patient Caregiver Questionnaire after 4 months follow-up. Statistical analyses were conducted using ANOVA statistics, correlation and regression analysis. Results showed a statistically significant decrease in the EMDR group in anxiety, depression and anger, when compared to the experimental group. EMDR therapy also had a positive impact upon the sense of coherence level in the experimental group, whereas in the control group this declined. Finally, the caregivers reported beneficial outcomes of the EMDR therapy with less anxiety- and anger-related behaviors in patients in the experimental group compared to the control group. This study is the first to show

  18. Functional redundancy patterns reveal non-random assembly rules in a species-rich marine assemblage.

    Directory of Open Access Journals (Sweden)

    Nicolas Guillemot

    Full Text Available The relationship between species and the functional diversity of assemblages is fundamental in ecology because it contains key information on functional redundancy, and functionally redundant ecosystems are thought to be more resilient, resistant and stable. However, this relationship is poorly understood and undocumented for species-rich coastal marine ecosystems. Here, we used underwater visual censuses to examine the patterns of functional redundancy for one of the most diverse vertebrate assemblages, the coral reef fishes of New Caledonia, South Pacific. First, we found that the relationship between functional and species diversity displayed a non-asymptotic power-shaped curve, implying that rare functions and species mainly occur in highly diverse assemblages. Second, we showed that the distribution of species amongst possible functions was significantly different from a random distribution up to a threshold of ∼90 species/transect. Redundancy patterns for each function further revealed that some functions displayed fast rates of increase in redundancy at low species diversity, whereas others were only becoming redundant past a certain threshold. This suggested non-random assembly rules and the existence of some primordial functions that would need to be fulfilled in priority so that coral reef fish assemblages can gain a basic ecological structure. Last, we found little effect of habitat on the shape of the functional-species diversity relationship and on the redundancy of functions, although habitat is known to largely determine assemblage characteristics such as species composition, biomass, and abundance. Our study shows that low functional redundancy is characteristic of this highly diverse fish assemblage, and, therefore, that even species-rich ecosystems such as coral reefs may be vulnerable to the removal of a few keystone species.

  19. An observational study on oesophageal variceal endoscopic ...

    African Journals Online (AJOL)

    An observational study on oesophageal variceal endoscopic injection sclerotherapy in patients with portal hypertension seen at the Centre for Clinical Research, ... The report concludes that variceal injection sclerotherapy is a useful method of treating oesophageal varices and can be performed on an out patient basis.

  20. An Approach to Distinguish between Plasticity and Non-random Distributions of Behavioral Types Along Urban Gradients in a Wild Passerine Bird

    Directory of Open Access Journals (Sweden)

    Philipp Sprau

    2017-08-01

    Full Text Available The impact of urbanization has been widely studied in the context of species diversity and life history evolution. Behavioral adaptation, by contrast, remains poorly understood because empirical studies rarely investigate the relative importance of two key mechanisms: plastic responses vs. non-random distributions of behavioral types. We propose here an approach that enables the simultaneous estimation of the respective roles of these distinct mechanisms. We investigated why risky behaviors are often associated with urbanization, using an urban nest box population of great tits (Parus major as a study system. We simultaneously and repeatedly quantified individual behavior (aggression and flight initiation distance as well as environmental factors characterizing level of urbanization (numbers of pedestrians, cars and cyclists. This enabled us to statistically distinguish plastic responses from patterns of non-random distributions of behavioral types. Data analyses revealed that individuals did not plastically adjust their behavior to the level of urbanization. Behavioral types were instead non-randomly distributed: bold birds occurred more frequently in areas with more cars and fewer pedestrians while shy individuals were predominantly found in areas with fewer cars and more pedestrians. These novel findings imply a major role for behavioral types in the evolutionary ecology of urban environments and call for the full integration of among- and within-individual variation in urban ecological studies.

  1. The NOAA Satellite Observing System Architecture Study

    Science.gov (United States)

    Volz, Stephen; Maier, Mark; Di Pietro, David

    2016-01-01

    NOAA is beginning a study, the NOAA Satellite Observing System Architecture (NSOSA) study, to plan for the future operational environmental satellite system that will follow GOES and JPSS, beginning about 2030. This is an opportunity to design a modern architecture with no pre-conceived notions regarding instruments, platforms, orbits, etc. The NSOSA study will develop and evaluate architecture alternatives to include partner and commercial alternatives that are likely to become available. The objectives will include both functional needs and strategic characteristics (e.g., flexibility, responsiveness, sustainability). Part of this study is the Space Platform Requirements Working Group (SPRWG), which is being commissioned by NESDIS. The SPRWG is charged to assess new or existing user needs and to provide relative priorities for observational needs in the context of the future architecture. SPRWG results will serve as input to the process for new foundational (Level 0 and Level 1) requirements for the next generation of NOAA satellites that follow the GOES-R, JPSS, DSCOVR, Jason-3, and COSMIC-2 missions.

  2. Effectiveness of an Internet-based preparation for psychosomatic treatment: Results of a controlled observational study.

    Science.gov (United States)

    Zimmer, Benjamin; Moessner, Markus; Wolf, Markus; Minarik, Carla; Kindermann, Sally; Bauer, Stephanie

    2015-11-01

    Patients often have to sustain long waiting periods between the time they first apply for psychotherapy and the actual uptake of the treatment. To support patients who are on a wait-list for inpatient psychosomatic treatment an Internet-based preparatory treatment (VORSTAT) was developed. In a randomized controlled trial, VORSTAT proved to increase treatment motivation prior to intake and to accelerate the accommodation phase at the beginning of inpatient treatment. No impact of VORSTAT on inpatient treatment outcome was found. The aim of the present study was to investigate the effectiveness of VORSTAT after implementing the service into routine care. A large naturalistic observational study comparing VORSTAT participants (N=911) against non-participants (N=1721) was conducted. Propensity scores were used to control for potential confounding variables due to the non-randomized group allocation. Reliable improvement of self-reported impairment achieved during inpatient treatment was used as outcome measure. VORSTAT participants showed higher rates of reliable improvement in physical impairment (50.8% vs. 44.9%), psychological impairment (41.2% vs. 29.9%), and social problems (22.3% vs. 15.2%). An Internet-based preparation for psychotherapy is an effective approach to improve outcome of inpatient psychosomatic treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. AECL's excavation stability study - summary of observations

    International Nuclear Information System (INIS)

    Read, R.S.; Chandler, N.A.

    1996-05-01

    The Excavation Stability Study (ESS) was conducted at the 420 Level of the Underground Research Laboratory (URL) to evaluate stability and the extent of excavation damage in tunnels as a function of tunnel geometry and orientation, geology, and excavation method. A series of ovaloid and circular openings were used to achieve different boundary stress levels and near-field stress distributions to assess the effect of tunnel geometry on damage development. Several of these openings had sections in both granite and granodiorite lithology, providing a comparison of damage in rock types with different strength characteristics. Damage around circular tunnels (one excavated by drill-and-blast, the other by mechanical means) was also investigated. The study.showed that mechanically stable openings can be excavated in the most adverse stress conditions at the 420 Level of the URL. In addition, it was shown that tunnel stability is sensitive to tunnel shape, variations in geology, and to some extent, the excavation method. Findings of the study are relevant in developing design criteria, and in assessing the feasibility of constructing large ovaloid openings in adverse stress conditions. This report summarizes the preliminary observations related to tunnel stability and excavation damage. (author). 8 refs., 7 tabs., 23 figs

  4. [The Strengthening the Reporting of Observational Studies in Epidemiology [STROBE] statement: guidelines for reporting observational studies

    DEFF Research Database (Denmark)

    Elm, E. von; Altman, D.G.; Egger, M.

    2008-01-01

    Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed...... recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists...... and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case...

  5. Theoretical and observational studies of stellar activity

    International Nuclear Information System (INIS)

    Schmitt, J.H.M.M.

    1984-01-01

    In the theoretical part of this thesis, doubly-diffusive MHD instabilities are studied as a means of breaking up a diffuse magnetic field at the bottom of the solar convection zone. The analysis is linear and local, and assumes short meridional wavelengths; the effects of rotation and diffusion of vorticity, magnetic fields and heat are included. Results show that the instability depends sensitively on the temperature stratification, but rather insensitively on the assumed magnetic field configuration; instability time scales considerably less than the solar cycle period can be easily obtained. In the observational part of the thesis, results are reported of a survey of the x-ray emission of stars with shallow connection zones to study the onset of convection and dynamo activity along the main sequence. Complications arising from stellar multiplicity are discussed extensively; it is demonstrated that binaries have statistically higher x-ray luminosities; and it is shown that physical parameters can only be deduced from single stars. It is further shown that the x-ray luminosities of stars with spectral type in the color range 0.1 less than or equal to B. V less than or equal to 0.5 increase rapidly, whereas stars with B. V approx. 0.0 appear to have no intrinsic x-ray emission at presently detectable levels

  6. Aneuploidy in immortalized human mesenchymal stem cells with non-random loss of chromosome 13 in culture.

    Science.gov (United States)

    Takeuchi, Masao; Takeuchi, Kikuko; Ozawa, Yutaka; Kohara, Akihiro; Mizusawa, Hiroshi

    2009-01-01

    Aneuploidy (an abnormal number of chromosomes) is commonly observed in most human cancer cells, highlighting the need to examine chromosomal instability in tumorigenesis. Previously, the immortalized human mesenchymal stem cell line UE6E7T-3 was shown to undergo a preferential loss of one copy of chromosome 13 after prolonged culture. Here, the loss of chromosome 13 was found to be caused by chromosome missegregation during mitosis, which involved unequal segregation, exclusion of the misaligned chromosome 13 on the metaphase plate, and trapping of chromosome 13 in the midbody region, as observed by fluorescence in situ hybridization. Near-diploid aneuploidy, not tetraploidy, was the direct result. The loss of chromosome 13 was non-random, and was detected by analysis of microsatellites and single nucleotide polymorphism-based loss of heterozygosity (LOH). Of the five microsatellite loci on chromosome 13, four loci showed microsatellite instability at an early stage in culture, and LOH was apparent at a late stage in culture. These results suggest that the microsatellite mutations cause changes in centromere integrity provoking loss of this chromosome in the UE6E7T-3 cell line. Thus, these results support the use of this cell line as a useful model for understanding the mechanism of aneuploid formation in cell cultures.

  7. Late onset rheumatoid arthritis an observational study.

    Science.gov (United States)

    Rexhepi, Sylejman; Rexhepi, Mjellma; Sahatçiu-Meka, Vjollca; Rexhepi, Blerta; Bahtiri, Elton; Mahmutaj, Vigan

    Rheumatoid arthritis (RA) may have an onset at older age. The onset of the disease at the age of 60 and over is called late-onset rheumatoid arthritis (LORA). The aim of this study was to analyze the clinical, laboratory, radiological, and treatment characteristics of patients with LORA compared to those with early-onset RA (EaORA), provided that all the patients had an approximately equal duration of the disease. This is an observational single-center study, which involved 120 patients with an established diagnosis of RA, of which 60 patients had LORA, and 60 patients EaORA. The disease activity, measured by the Disease Activity Score 28 (DAS28-ESR), was significantly higher in the LORA group compared to the EaORA group (p0.05), while the number of patients positive for anti-citrullinated protein antibody (ACPA) was signifi cantly greater in the EaORA group (p<0.05). The values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were significantly higher in the LORA than in the EaORA group. Hemoglobin levels were lower in the LORA group (11.96±1.64 g/dL) than in the EaORA group (12.18±1.56 g/dL). The most used disease-modifying antirheumatic drugs (DMARDs) were methotrexate and sulfasalazine, while biological drugs were not used. In conclusion, based on the results of our study, LORA has some features that distinguish it from EaORA, such as higher disease activity, more frequent involvement of large joints, and more pronounced structural damage. This should be taken in account in clinical practice, especially regarding treatment choices.

  8. Empirically Driven Variable Selection for the Estimation of Causal Effects with Observational Data

    Science.gov (United States)

    Keller, Bryan; Chen, Jianshen

    2016-01-01

    Observational studies are common in educational research, where subjects self-select or are otherwise non-randomly assigned to different interventions (e.g., educational programs, grade retention, special education). Unbiased estimation of a causal effect with observational data depends crucially on the assumption of ignorability, which specifies…

  9. Multicenter observational prehospital resuscitation on helicopter study.

    Science.gov (United States)

    Holcomb, John B; Swartz, Michael D; DeSantis, Stacia M; Greene, Thomas J; Fox, Erin E; Stein, Deborah M; Bulger, Eileen M; Kerby, Jeffrey D; Goodman, Michael; Schreiber, Martin A; Zielinski, Martin D; O'Keeffe, Terence; Inaba, Kenji; Tomasek, Jeffrey S; Podbielski, Jeanette M; Appana, Savitri N; Yi, Misung; Wade, Charles E

    2017-07-01

    Earlier use of in-hospital plasma, platelets, and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from January to November 2015. Five helicopter systems had plasma and/or RBCs, whereas the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high-risk criteria were analyzed. Patients receiving PHT were compared with patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. Twenty-five thousand one hundred eighteen trauma patients were admitted, 2,341 (9%) were transported by helicopter, of which 1,058 (45%) met the highest-risk criteria. Five hundred eighty-five of 1,058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and Glasgow Coma Scale (7 vs 14) was significantly lower, whereas median Injury Severity Score was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 hours (8.4% vs 3.6%), 24 hours (12.6% vs 8.9%), and 30 days (19.3% vs 13.3%). Twenty-four percent of eligible patients received a PHT. A median of 1 unit of RBCs and plasma were transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs, and 69% received both. In the propensity score matching analysis (n = 109), PHT was not significantly associated with mortality

  10. Consent for pediatric anesthesia: an observational study.

    Science.gov (United States)

    Lagana, Zoe; Foster, Andrew; Bibbo, Adriana; Dowling, Kate; Cyna, Allan M

    2012-08-01

    Informed consent prior to anesthesia is an important part of the pediatric pre-anesthetic consultation. This study aimed to observe and identify the number and nature of the anesthesia risks considered and communicated to parents/guardians and children during the pediatric informed consent process on the day of elective surgery. A convenience sample of anesthetists had their pre-anesthesia consultations voice recorded, prior to elective surgery, during a 4-month period at the largest tertiary referral centre for pediatric care in South Australia. A data collection form was used to note baseline demographic data, and voice recording transcripts were independently documented by two researchers and subsequently compared for accuracy regarding the number and nature of risks discussed. Of the 96 voice recordings, 91 (92%) were suitable for the analysis. The five most commonly discussed risks were as follows: nausea and vomiting (36%); sore throat (35%); allergy (29%); hypoxia (25%); and emergence delirium (19%). Twenty-seven pre-anesthetic consultations (30%) were found to have had no discussion of anesthetic risk at all while a further 23 consultations (26%) incorporated general statements inferring that anesthesia carried risks, but with no elaboration about their nature, ramifications or incidence. The median number of risks (IQR) specifically mentioned per consultation was higher, 3 (1) vs 1 (1), P anesthesia experience odds ratio 0.34, 95% CI [0.13, 0.87], P = 0.025. The pediatric anesthesia risk discussion is very variable. Trainees tend to discuss more specific risks than consultants and a patient's previous experience of anesthesia was associated with a more limited discussion of anesthesia risk. © 2011 Blackwell Publishing Ltd.

  11. Century Scale Evaporation Trend: An Observational Study

    Science.gov (United States)

    Bounoui, Lahouari

    2012-01-01

    Several climate models with different complexity indicate that under increased CO2 forcing, runoff would increase faster than precipitation overland. However, observations over large U.S watersheds indicate otherwise. This inconsistency between models and observations suggests that there may be important feedbacks between climate and land surface unaccounted for in the present generation of models. We have analyzed century-scale observed annual runoff and precipitation time-series over several United States Geological Survey hydrological units covering large forested regions of the Eastern United States not affected by irrigation. Both time-series exhibit a positive long-term trend; however, in contrast to model results, these historic data records show that the rate of precipitation increases at roughly double the rate of runoff increase. We considered several hydrological processes to close the water budget and found that none of these processes acting alone could account for the total water excess generated by the observed difference between precipitation and runoff. We conclude that evaporation has increased over the period of observations and show that the increasing trend in precipitation minus runoff is correlated to observed increase in vegetation density based on the longest available global satellite record. The increase in vegetation density has important implications for climate; it slows but does not alleviate the projected warming associated with greenhouse gases emission.

  12. The BraveNet prospective observational study on integrative medicine treatment approaches for pain.

    Science.gov (United States)

    Abrams, Donald I; Dolor, Rowena; Roberts, Rhonda; Pechura, Constance; Dusek, Jeffery; Amoils, Sandi; Amoils, Steven; Barrows, Kevin; Edman, Joel S; Frye, Joyce; Guarneri, Erminia; Kligler, Ben; Monti, Daniel; Spar, Myles; Wolever, Ruth Q

    2013-06-24

    Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (-23%) and interference (-28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. ClinicalTrials.gov, NCT01186341.

  13. Observational study of Herbig-Haro nebulae

    International Nuclear Information System (INIS)

    Brugel, E.W.

    1981-01-01

    Spectrophotometric data have been obtained for twelve Herbig-Haro nebulae with the multichannel spectrometer on the Mt. Palomar 5.08 meter telescope and with the image intensified dissector scanner on the Kitt Peak 2.13 meter telescope. Energy distributions of the continuous spectra of the Herbig-Haro objects H-H 1 (NW), H-H 2A, H-H 2G, H-H 2H, H-H 24A and H-H 32 have been determined in the wavelength range 3300 to 8000A. The signal-to-noise ratio has been improved in comparison to an earlier attempt to measure the continuum in H-H 1 and H-H 2H. Reddening corrections are based on Miller's [SII] method. The [FeII] emission line spectra have also been utilized as a secondary method for determining the interstellar reddening. In all continua the flux F/sub lambda/ increases rapidly with decreasing wavelength after the small scale structure has been averaged out. A power law interpolation F/sub lambda/ proportional lambda/sup -n/ demonstrates that for all observed H-H objects n lies in the range between 2.04 (H-H 2A, H-H 2H) and 2.92 (H-H 32). The relation of these results to recent I.U.E. observations of H-H 1 is discussed. It is also found that the ratio of the total optical continuum flux to Hβ flux is almost the same for all observed H-H objects with the sole exception of H-H 24A in which the continuum is considerably stronger than in other objects. This fact leads to difficulties in the usual dust scattering hypothesis for the interpretation of H-H continua. It is argued, if these energy distributions are really due to dust scattering in stellar continua as has been usually assumed, the original source must be a hot object and cannot be a T Tauri star.An interpretation in terms of transition radiation (as suggested by Gurzadyan) does not seem to be possible because the observed rise of F/sub lambda/ towards the ultraviolet is too steep

  14. Geomagnetic Observations for Main Field Studies

    DEFF Research Database (Denmark)

    Matzka, Jürgen; Chulliat, A.; Mandea, M.

    2010-01-01

    Direct measurements of the geomagnetic field have been made for more than 400 years, beginning with individual determinations of the angle between geographic and magnetic North. This was followed by the start of continuous time series of full vector measurements at geomagnetic observatories...... and the beginning of geomagnetic repeat stations surveys in the 19th century. In the second half of the 20th century, true global coverage with geomagnetic field measurements was accomplished by magnetometer payloads on low-Earth-orbiting satellites. This article describes the procedures and instruments...... for magnetic field measurements on ground and in space and covers geomagnetic observatories, repeat stations, automatic observatories, satellites and historic observations. Special emphasis is laid on the global network of geomagnetic observatories....

  15. Growth-induced strong pinning sites in laser ablated YBa2Cu3O7-δ films with a non-random distribution

    International Nuclear Information System (INIS)

    Huijbregtse, J.M.; Klaassen, F.C.; Geest, R.C.F. van der; Dam, B.; Griessen, R.

    1999-01-01

    Recently, the authors showed that natural linear defects are the origin of the high critical currents in laser ablated YGBa 2 Cu 3 O 7-δ films. Combining wet-chemical etching and Atomic Force Microscopy, they find that these dislocations are created by island coalescence during growth. Consequently, the defect density can be reproducibly varied by manipulating the density of growth islands, which in turn depends on the substrate temperature. Interestingly, the radial defect distribution function approaches zero at small distances, indicating short range order. Therefore, they are now able to study vortex matter in films with a tailored non-random distribution of natural strong pinning sites

  16. Effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda: results from a non-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Michielsen Kristien

    2012-09-01

    Full Text Available Abstract Background While the HIV epidemic is levelling off in sub-Saharan Africa, it remains at an unacceptably high level. Young people aged 15-24 years remain particularly vulnerable, resulting in a regional HIV prevalence of 1.4% in young men and 3.3% in young women. This study assesses the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda on young people’s sexual behavior, HIV knowledge and attitudes. Methods In a non-randomized longitudinal controlled trial, fourteen schools were selected in two neighboring districts in Rwanda Bugesera (intervention and Rwamagana (control. Students (n = 1950 in eight intervention and six control schools participated in three surveys (baseline, six and twelve months in the intervention. Analysis was done using linear and logistic regression using generalized estimation equations adjusted for propensity score. Results The overall retention rate was 72%. Time trends in sexual risk behavior (being sexually active, sex in last six months, condom use at last sex were not significantly different in students from intervention and control schools, nor was the intervention associated with increased knowledge, perceived severity or perceived susceptibility. It did significantly reduce reported stigma. Conclusions Analyzing this and other interventions, we identified several reasons for the observed limited effectiveness of peer education: 1 intervention activities (spreading information are not tuned to objectives (changing behavior; 2 young people prefer receiving HIV information from other sources than peers; 3 outcome indicators are not adequate and the context of the relationship in which sex occurs and the context in which sex occurs is ignored. Effectiveness of peer education may increase through integration in holistic interventions and redefining peer educators’ role as focal points for sensitization and referral to experts and services. Finally, we argue that a

  17. Assessment of Safety and Effectiveness of the Extracorporeal Continuous-Flow Ventricular Assist Device (BR16010) Use as a Bridge-to-Decision Therapy for Severe Heart Failure or Refractory Cardiogenic Shock: Study Protocol for Single-Arm Non-randomized, Uncontrolled, and Investigator-Initiated Clinical Trial.

    Science.gov (United States)

    Fukushima, Norihide; Tatsumi, Eisuke; Seguchi, Osamu; Takewa, Yoshiaki; Hamasaki, Toshimitsu; Onda, Kaori; Yamamoto, Haruko; Hayashi, Teruyuki; Fujita, Tomoyuki; Kobayashi, Junjiro

    2018-06-08

    The management of heart failure patients presenting in a moribund state remains challenging, despite significant advances in the field of ventricular assist systems. Bridge to decision involves using temporary devices to stabilize the hemodynamic state of such patients while further assessment is performed and a decision can be made regarding patient management. The purpose of this study (NCVC-BTD_01, National Cerebral and Cardiovascular Center-Bridge to Dicision_01) is to assess the safety and effectiveness of the newly developed extracorporeal continuous-flow ventricular assist system employing a disposable centrifugal pump with a hydrodynamically levitated bearing (BR16010) use as a bridge-to-decision therapy for patients with severe heart failure or refractory cardiogenic shock. NCVC-BTD_01 is a single-center, single-arm, open-label, exploratory, medical device, investigator-initiated clinical study. It is conducted at the National Cerebral and Cardiovascular Center in Japan. A total of nine patients will be enrolled in the study. The study was planned using Simon's minimax two-stage phase design. The primary endpoint is a composite of survival free of device-related serious adverse events and complications during device support. For left ventricular assistance, withdrawal of a trial device due to cardiac function recovery or exchange to other ventricular assist devices (VADs) for the purpose of bridge to transplantation (BTT) during 30 days after implantation will be considered study successes. For right ventricular assistance, withdrawal of tal device due to right ventricular function recovery within 30 days after implantation will be considered a study success. Secondary objectives include changes in brain natriuretic peptide levels (7 days after implantation of a trial device and the day of withdrawal of a trial device), period of mechanical ventricular support, changes in left ventricular ejection fraction (7 days after implantation of a trial device

  18. The Results of Open-Label, Multicenter, Non-Randomized Study on the Efficacy and Safety of Insulins: Insuman Basal®, Insuman Comb 25®, Insuman Rapid® in Patients with Diabetes Mellitus Type 2 Who Underwent Basic Training in Diabetes Schools (SPIRIT

    Directory of Open Access Journals (Sweden)

    A.S. Larin

    2015-04-01

    Conclusions. Treatment with Insuman® insulins of patients with DM-2, who were not compensated while taking OADs, was associated with improved glycemic control without an increase in the incidence of severe hypoglycemia. There was no statistically significant increase in the effectiveness of therapy in patients, who have successfully completed a training program at diabetes school, compared with evaluation of overall efficiency. The state of young studied population of patients with inadequate control at baseline, and those who had developed cardiovascular complications associated with DM, improved in most cases in terms of glycemic control, and, at that, episodes of severe hypoglycemia were not detected. This may be due to the positive influence of training in diabetes school.

  19. Random and non-random mating populations: Evolutionary dynamics in meiotic drive.

    Science.gov (United States)

    Sarkar, Bijan

    2016-01-01

    Game theoretic tools are utilized to analyze a one-locus continuous selection model of sex-specific meiotic drive by considering nonequivalence of the viabilities of reciprocal heterozygotes that might be noticed at an imprinted locus. The model draws attention to the role of viability selections of different types to examine the stable nature of polymorphic equilibrium. A bridge between population genetics and evolutionary game theory has been built up by applying the concept of the Fundamental Theorem of Natural Selection. In addition to pointing out the influences of male and female segregation ratios on selection, configuration structure reveals some noted results, e.g., Hardy-Weinberg frequencies hold in replicator dynamics, occurrence of faster evolution at the maximized variance fitness, existence of mixed Evolutionarily Stable Strategy (ESS) in asymmetric games, the tending evolution to follow not only a 1:1 sex ratio but also a 1:1 different alleles ratio at particular gene locus. Through construction of replicator dynamics in the group selection framework, our selection model introduces a redefining bases of game theory to incorporate non-random mating where a mating parameter associated with population structure is dependent on the social structure. Also, the model exposes the fact that the number of polymorphic equilibria will depend on the algebraic expression of population structure. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Complicated Intra-Abdominal Infections Observational European study (CIAO Study

    Directory of Open Access Journals (Sweden)

    Sartelli Massimo

    2011-12-01

    Full Text Available Abstract Complicated intra-abdominal infections are frequently associated with poor prognoses and high morbidity and mortality rates. Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. In order to describe the clinical, microbiological, and management-related profiles of both community-acquired and healthcare-acquired complicated intra-abdominal infections (IAIs, the World Society of Emergency Surgery (WSES, in collaboration with the Surgical Infections Society of Europe (SIS-E and other prominent European surgical societies, has designed the CIAO study. The CIAO study is a multicenter, observational study and will be carried out in various surgical departments throughout Europe. The study will include patients undergoing surgery or interventional drainage for complicated IAI.

  1. Management of rheumatic chorea: an observational study

    Directory of Open Access Journals (Sweden)

    Araújo Alexandra Prufer de Queiroz Campos

    2002-01-01

    Full Text Available BACKGROUND: Rheumatic chorea (RC has recently been linked to an antibody-mediated immune mechanism. OBJECTIVE/METHOD: To verify if this knowledge reflected in management changes we conceived a descriptive study. RESULTS: The medical charts of 20 children (13 females aged 6 to 12 years (mean 8 years, diagnosed as RC from June 1996 to June 1999, were reviewed. All patients received some medical treatment. Haloperidol was the most prescribed medication (15 patients - 75 %. Sulpiride, diazepam and valproate were also used as symptomatic treatment. Imune-modulating therapy with prednisone was prescribed for seven children. The shortest course of chorea (16 days occurred in a patient treated with prednisone. CONCLUSION: Prednisone has been prescribed for rheumatic chorea besides the traditional symptomatic approach. A great variety of antichoreic drugs are being employed.

  2. Exceptional diversity, non-random distribution, and rapid evolution of retroelements in the B73 maize genome.

    Directory of Open Access Journals (Sweden)

    Regina S Baucom

    2009-11-01

    Full Text Available Recent comprehensive sequence analysis of the maize genome now permits detailed discovery and description of all transposable elements (TEs in this complex nuclear environment. Reiteratively optimized structural and homology criteria were used in the computer-assisted search for retroelements, TEs that transpose by reverse transcription of an RNA intermediate, with the final results verified by manual inspection. Retroelements were found to occupy the majority (>75% of the nuclear genome in maize inbred B73. Unprecedented genetic diversity was discovered in the long terminal repeat (LTR retrotransposon class of retroelements, with >400 families (>350 newly discovered contributing >31,000 intact elements. The two other classes of retroelements, SINEs (four families and LINEs (at least 30 families, were observed to contribute 1,991 and approximately 35,000 copies, respectively, or a combined approximately 1% of the B73 nuclear genome. With regard to fully intact elements, median copy numbers for all retroelement families in maize was 2 because >250 LTR retrotransposon families contained only one or two intact members that could be detected in the B73 draft sequence. The majority, perhaps all, of the investigated retroelement families exhibited non-random dispersal across the maize genome, with LINEs, SINEs, and many low-copy-number LTR retrotransposons exhibiting a bias for accumulation in gene-rich regions. In contrast, most (but not all medium- and high-copy-number LTR retrotransposons were found to preferentially accumulate in gene-poor regions like pericentromeric heterochromatin, while a few high-copy-number families exhibited the opposite bias. Regions of the genome with the highest LTR retrotransposon density contained the lowest LTR retrotransposon diversity. These results indicate that the maize genome provides a great number of different niches for the survival and procreation of a great variety of retroelements that have evolved to

  3. [Therapeutic failure in scabies: An observational study].

    Science.gov (United States)

    De Sainte Marie, B; Mallet, S; Gaudy-Marqueste, C; Baumstarck, K; Bentaleb, N; Loundou, A; Hesse, S; Monestier, S; Grob, J-J; Richard, M-A

    2016-01-01

    Several sources suggest an escalation of scabies in France. To describe a population of patients continuing to present with scabies despite multiple treatments in order to identify factors associated with persistence of infection. A descriptive cross-sectional study in adults and children consulting for persistent scabies despite at least one previous treatment. A standardized questionnaire explored potential sources of treatment failure. Thirty-one patients were analyzed. Initial symptoms were noted to have started between two and 52 weeks earlier (mean: 19 weeks). The mean number of prior consultations with a general practitioner was 3.1 (0-10) and 1.7 with a dermatologist (0-7). The mean number of patients per household was 3.5 (1-9). At least one dose of oral ivermectin (maximum of 6 doses per household) was prescribed for 84 % of patients (29 % of whom were not fasted at the time). Further, 74 % of patients received at least one local application of esdepallethrin and piperonyl butoxide (maximum: 5 courses), four received benzyl benzoate and two received permethrin; however, 58 % did not reapply the substance after hand washing. All households bought the prescribed treatments despite the costs. Close contacts of patients were treated in 58 % of households. Decontamination of bedding and clothing was carried out properly in 90 % of households. Persistence of infection appears to be linked to: (1) insufficient treatment of close contacts; (2) absence of a second treatment between days 7 and 14; (3) insufficient efficacy of the available treatments, doubtless due to multiple factors (intrinsic resistance of Sarcoptes, failure to repeat treatment, poor explanation of methods for dosing and application, and oral intake of treatments). Access to non-reimbursed treatments was not identified as a problem and decontamination of bedding and clothing was correctly performed in most cases. Though certain fundamental aspects of scabies treatment must be better

  4. Reduced Suprathreshold Odor Identification in Patients with Pseudotumor Cerebri: A Non-Randomized Prospective Study.

    Science.gov (United States)

    Dotan, Gad; Cohen, Eyal; Klein, Ainat; Kesler, Anat

    2018-01-01

    Recent evidence suggests that olfaction is impaired in patients with pseudotumor cerebri (PTC). To measure suprathreshold olfactory function by using the University of Pennsylvania Smell Identification Test (UPSIT), assessing its usefulness for routine clinical use. Forty PTC patients underwent USPIT olfactory testing. Twenty-nine out of 40 (73%) PTC patients (36 women, 4 men; mean age 34 years) had reduced suprathreshold smell sensation according to UPSIT scores: 19 (47%) had mild microsmia, 9 (23%) had moderate microsmia, and one (3%) was classified as having severe microsmia. The mean UPSIT score of all patients was 32.4 (95% confidence interval 31.4-33.4). Multivariate regression analysis found that UPSIT scores were not related to disease activity, disease duration, initial intracranial pressure (ICP), or visual function. Many PTC patients have reduced suprathreshold olfactory dysfunction that can be discovered by UPSIT, a rapidly administered smell test, which is suitable for clinical office use.

  5. Laparoscopic distal pancreatectomy: results of a prospective non-randomized study from a tertiary center.

    Science.gov (United States)

    Palanivelu, C; Shetty, R; Jani, K; Sendhilkumar, K; Rajan, P S; Maheshkumar, G S

    2007-03-01

    Though laparoscopic distal pancreatectomy for benign conditions was first described in the early 1990s, it has not become as popular as other laparoscopic surgeries. Published literature on this topic consists of several case reports and a handful of small series. We present our experience, which, to the best of our knowledge, is the largest series reported to date. Since 1998, 22 patients have undergone distal pancreatectomy at our institute. The technique of distal pancreatosplenectomy, as well as spleen-preserving distal pancreatectomy, is described. Four males and 18 females in the age range of 12-69 years underwent operation. Splenic preservation was possible in 7 patients. The tumor diameter ranged from 2.1 cm to 7.4 cm. The mean operating time was 215 min. The mean length of incision required for specimen retrieval was 3.4 cm. All patients were started on a liquid diet on the first postoperative day. The median hospital stay was 4 days. One patient developed a pancreatic fistula that was managed conservatively. At the end of an average follow-up of 4.6 years, no recurrence has been reported. Laparoscopic distal pancreatectomy is a safe procedure, with minimal morbidity, rapid recovery, and short hospital stay. In appropriate cases, splenic preservation is feasible.

  6. Risk of bias and confounding of observational studies of Zika virus infection: A scoping review of research protocols.

    Science.gov (United States)

    Reveiz, Ludovic; Haby, Michelle M; Martínez-Vega, Ruth; Pinzón-Flores, Carlos E; Elias, Vanessa; Smith, Emma; Pinart, Mariona; Broutet, Nathalie; Becerra-Posada, Francisco; Aldighieri, Sylvain; Van Kerkhove, Maria D

    2017-01-01

    Given the severity and impact of the current Zika virus (ZIKV) outbreak in the Americas, numerous countries have rushed to develop research studies to assess ZIKV and its potential health consequences. In an effort to ensure that studies are comprehensive, both internally and externally valid, and with reliable results, the World Health Organization, the Pan American Health Organization, Institut Pasteur, the networks of Fiocruz, the Consortia for the Standardization of Influenza Seroepidemiology (CONSISE) and the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) have generated six standardized clinical and epidemiological research protocols and questionnaires to address key public health questions on ZIKV. We conducted a systematic search of ongoing study protocols related to ZIKV research. We analyzed the content of protocols of 32 cohort studies and 13 case control studies for systematic bias that could produce erroneous results. Additionally we aimed to characterize the risks of bias and confounding in observational studies related to ZIKV and to propose ways to minimize them, including the use of six newly standardized research protocols. Observational studies of ZIKV face an array of challenges, including measurement of exposure and outcomes (microcephaly and Guillain-Barré Syndrome). Potential confounders need to be measured where known and controlled for in the analysis. Selection bias due to non-random selection is a significant issue, particularly in the case-control design, and losses to follow-up is equally important for the cohort design. Observational research seeking to answer key questions on the ZIKV should consider these restrictions and take precautions to minimize bias in an effort to provide reliable and valid results. Utilization of the standardized research protocols developed by the WHO, PAHO, Institut Pasteur, and CONSISE will harmonize the key methodological aspects of each study design to minimize bias at

  7. Risk of bias and confounding of observational studies of Zika virus infection: A scoping review of research protocols.

    Directory of Open Access Journals (Sweden)

    Ludovic Reveiz

    Full Text Available Given the severity and impact of the current Zika virus (ZIKV outbreak in the Americas, numerous countries have rushed to develop research studies to assess ZIKV and its potential health consequences. In an effort to ensure that studies are comprehensive, both internally and externally valid, and with reliable results, the World Health Organization, the Pan American Health Organization, Institut Pasteur, the networks of Fiocruz, the Consortia for the Standardization of Influenza Seroepidemiology (CONSISE and the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC have generated six standardized clinical and epidemiological research protocols and questionnaires to address key public health questions on ZIKV.We conducted a systematic search of ongoing study protocols related to ZIKV research. We analyzed the content of protocols of 32 cohort studies and 13 case control studies for systematic bias that could produce erroneous results. Additionally we aimed to characterize the risks of bias and confounding in observational studies related to ZIKV and to propose ways to minimize them, including the use of six newly standardized research protocols.Observational studies of ZIKV face an array of challenges, including measurement of exposure and outcomes (microcephaly and Guillain-Barré Syndrome. Potential confounders need to be measured where known and controlled for in the analysis. Selection bias due to non-random selection is a significant issue, particularly in the case-control design, and losses to follow-up is equally important for the cohort design.Observational research seeking to answer key questions on the ZIKV should consider these restrictions and take precautions to minimize bias in an effort to provide reliable and valid results. Utilization of the standardized research protocols developed by the WHO, PAHO, Institut Pasteur, and CONSISE will harmonize the key methodological aspects of each study design to

  8. On Estimation of the Survivor Average Causal Effect in Observational Studies when Important Confounders are Missing Due to Death

    Science.gov (United States)

    Egleston, Brian L.; Scharfstein, Daniel O.; MacKenzie, Ellen

    2008-01-01

    We focus on estimation of the causal effect of treatment on the functional status of individuals at a fixed point in time t* after they have experienced a catastrophic event, from observational data with the following features: (1) treatment is imposed shortly after the event and is non-randomized, (2) individuals who survive to t* are scheduled to be interviewed, (3) there is interview non-response, (4) individuals who die prior to t* are missing information on pre-event confounders, (5) medical records are abstracted on all individuals to obtain information on post-event, pre-treatment confounding factors. To address the issue of survivor bias, we seek to estimate the survivor average causal effect (SACE), the effect of treatment on functional status among the cohort of individuals who would survive to t* regardless of whether or not assigned to treatment. To estimate this effect from observational data, we need to impose untestable assumptions, which depend on the collection of all confounding factors. Since pre-event information is missing on those who die prior to t*, it is unlikely that these data are missing at random (MAR). We introduce a sensitivity analysis methodology to evaluate the robustness of SACE inferences to deviations from the MAR assumption. We apply our methodology to the evaluation of the effect of trauma center care on vitality outcomes using data from the National Study on Costs and Outcomes of Trauma Care. PMID:18759833

  9. Observational study of outpatients with schizophrenia in the Middle ...

    African Journals Online (AJOL)

    Observational study of outpatients with schizophrenia in the Middle East and Africa — 3- and 6-month efficacy and safety results. The Intercontinental Schizophrenia Outpatient Health Outcomes Study.

  10. Variation of mutational burden in healthy human tissues suggests non-random strand segregation and allows measuring somatic mutation rates.

    Science.gov (United States)

    Werner, Benjamin; Sottoriva, Andrea

    2018-06-01

    The immortal strand hypothesis poses that stem cells could produce differentiated progeny while conserving the original template strand, thus avoiding accumulating somatic mutations. However, quantitating the extent of non-random DNA strand segregation in human stem cells remains difficult in vivo. Here we show that the change of the mean and variance of the mutational burden with age in healthy human tissues allows estimating strand segregation probabilities and somatic mutation rates. We analysed deep sequencing data from healthy human colon, small intestine, liver, skin and brain. We found highly effective non-random DNA strand segregation in all adult tissues (mean strand segregation probability: 0.98, standard error bounds (0.97,0.99)). In contrast, non-random strand segregation efficiency is reduced to 0.87 (0.78,0.88) in neural tissue during early development, suggesting stem cell pool expansions due to symmetric self-renewal. Healthy somatic mutation rates differed across tissue types, ranging from 3.5 × 10-9/bp/division in small intestine to 1.6 × 10-7/bp/division in skin.

  11. Variation of mutational burden in healthy human tissues suggests non-random strand segregation and allows measuring somatic mutation rates.

    Directory of Open Access Journals (Sweden)

    Benjamin Werner

    2018-06-01

    Full Text Available The immortal strand hypothesis poses that stem cells could produce differentiated progeny while conserving the original template strand, thus avoiding accumulating somatic mutations. However, quantitating the extent of non-random DNA strand segregation in human stem cells remains difficult in vivo. Here we show that the change of the mean and variance of the mutational burden with age in healthy human tissues allows estimating strand segregation probabilities and somatic mutation rates. We analysed deep sequencing data from healthy human colon, small intestine, liver, skin and brain. We found highly effective non-random DNA strand segregation in all adult tissues (mean strand segregation probability: 0.98, standard error bounds (0.97,0.99. In contrast, non-random strand segregation efficiency is reduced to 0.87 (0.78,0.88 in neural tissue during early development, suggesting stem cell pool expansions due to symmetric self-renewal. Healthy somatic mutation rates differed across tissue types, ranging from 3.5 × 10-9/bp/division in small intestine to 1.6 × 10-7/bp/division in skin.

  12. Effectiveness of a 'Global Postural Reeducation' program for persistent Low Back Pain: a non-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Violante Francesco S

    2010-12-01

    Full Text Available Abstract Background The aim of this non-randomized controlled trial was to evaluate the effectiveness of a Global Postural Reeducation (GPR program as compared to a Stabilization Exercise (SE program in subjects with persistent low back pain (LBP at short- and mid-term follow-up (ie. 3 and 6 months. Methods According to inclusion and exclusion criteria, 100 patients with a primary complaint of persistent LBP were enrolled in the study: 50 were allocated to the GPR group and 50 to the SE group. Primary outcome measures were Roland and Morris Disability Questionnaire (RMDQ and Oswestry Disability Index (ODI. Secondary outcome measures were lumbar Visual Analogue Scale (VAS and Fingertip-to-floor test (FFT. Data were collected at baseline and at 3/6 months by health care professionals unaware of the study. An intention to treat approach was used to analyze participants according to the group to which they were originally assigned. Results Of the 100 patients initially included in the study, 78 patients completed the study: 42 in the GPR group and 36 in the SE group. At baseline, the two groups did not differ significantly with respect to gender, age, BMI and outcome measures. Comparing the differences between groups at short- and mid-term follow-up, the GPR group revealed a significant reduction (from baseline in all outcome measures with respect to the SE group. The ordered logistic regression model showed an increased likelihood of definitive improvement (reduction from baseline of at least 30% in RMDQ and VAS scores for the GPR group compared to the SE group (OR 3.9, 95% CI 2.7 to 5.7. Conclusions Our findings suggest that a GPR intervention in subjects with persistent LBP induces a greater improvement on pain and disability as compared to a SE program. These results must be confirmed by further studies with higher methodological standards, including randomization, larger sample size, longer follow-up and subgrouping of the LBP subjects. Trial

  13. Concatenation of observed grasp phases with observer's distal movements: a behavioural and TMS study.

    Directory of Open Access Journals (Sweden)

    Elisa De Stefani

    Full Text Available The present study aimed at determining how actions executed by two conspecifics can be coordinated with each other, or more specifically, how the observation of different phases of a reaching-grasping action is temporary related to the execution of a movement of the observer. Participants observed postures of initial finger opening, maximal finger aperture, and final finger closing of grasp after observation of an initial hand posture. Then, they opened or closed their right thumb and index finger (experiments 1, 2 and 3. Response times decreased, whereas acceleration and velocity of actual finger movements increased when observing the two late phases of grasp. In addition, the results ruled out the possibility that this effect was due to salience of the visual stimulus when the hand was close to the target and confirmed an effect of even hand postures in addition to hand apparent motion due to the succession of initial hand posture and grasp phase. In experiments 4 and 5, the observation of grasp phases modulated even foot movements and pronunciation of syllables. Finally, in experiment 6, transcranial magnetic stimulation applied to primary motor cortex 300 ms post-stimulus induced an increase in hand motor evoked potentials of opponens pollicis muscle when observing the two late phases of grasp. These data suggest that the observation of grasp phases induced simulation which was stronger during observation of finger closing. This produced shorter response times, greater acceleration and velocity of the successive movement. In general, our data suggest best concatenation between two movements (one observed and the other executed when the observed (and simulated movement was to be accomplished. The mechanism joining the observation of a conspecific's action with our own movement may be precursor of social functions. It may be at the basis for interactions between conspecifics, and related to communication between individuals.

  14. Concatenation of observed grasp phases with observer's distal movements: a behavioural and TMS study.

    Science.gov (United States)

    De Stefani, Elisa; Innocenti, Alessandro; De Marco, Doriana; Gentilucci, Maurizio

    2013-01-01

    The present study aimed at determining how actions executed by two conspecifics can be coordinated with each other, or more specifically, how the observation of different phases of a reaching-grasping action is temporary related to the execution of a movement of the observer. Participants observed postures of initial finger opening, maximal finger aperture, and final finger closing of grasp after observation of an initial hand posture. Then, they opened or closed their right thumb and index finger (experiments 1, 2 and 3). Response times decreased, whereas acceleration and velocity of actual finger movements increased when observing the two late phases of grasp. In addition, the results ruled out the possibility that this effect was due to salience of the visual stimulus when the hand was close to the target and confirmed an effect of even hand postures in addition to hand apparent motion due to the succession of initial hand posture and grasp phase. In experiments 4 and 5, the observation of grasp phases modulated even foot movements and pronunciation of syllables. Finally, in experiment 6, transcranial magnetic stimulation applied to primary motor cortex 300 ms post-stimulus induced an increase in hand motor evoked potentials of opponens pollicis muscle when observing the two late phases of grasp. These data suggest that the observation of grasp phases induced simulation which was stronger during observation of finger closing. This produced shorter response times, greater acceleration and velocity of the successive movement. In general, our data suggest best concatenation between two movements (one observed and the other executed) when the observed (and simulated) movement was to be accomplished. The mechanism joining the observation of a conspecific's action with our own movement may be precursor of social functions. It may be at the basis for interactions between conspecifics, and related to communication between individuals.

  15. Evaluation of Multiclass Model Observers in PET LROC Studies

    Science.gov (United States)

    Gifford, H. C.; Kinahan, P. E.; Lartizien, C.; King, M. A.

    2007-02-01

    A localization ROC (LROC) study was conducted to evaluate nonprewhitening matched-filter (NPW) and channelized NPW (CNPW) versions of a multiclass model observer as predictors of human tumor-detection performance with PET images. Target localization is explicitly performed by these model observers. Tumors were placed in the liver, lungs, and background soft tissue of a mathematical phantom, and the data simulation modeled a full-3D acquisition mode. Reconstructions were performed with the FORE+AWOSEM algorithm. The LROC study measured observer performance with 2D images consisting of either coronal, sagittal, or transverse views of the same set of cases. Versions of the CNPW observer based on two previously published difference-of-Gaussian channel models demonstrated good quantitative agreement with human observers. One interpretation of these results treats the CNPW observer as a channelized Hotelling observer with implicit internal noise

  16. Stroke risk and NSAIDs: A systematic review of observational studies

    NARCIS (Netherlands)

    C. Varas-Lorenzo (Cristina); N. Riera-Guardia (Nuria); B. Calingaert (Brian); J. Castellsague (Jordi); A. Pariente (Antoine); L. Scotti (Lorenza); M.C.J.M. Sturkenboom (Miriam); S. Perez-Gutthann (Susana)

    2011-01-01

    textabstractAims: To perform a quantitative systematic review of observational studies on the risk of stroke associated with the use of individual NSAIDs. Methods and results: Searches were conducted using the Medline database within PubMed (1990-2008). Observational cohort or case-control studies

  17. Learning to observe mathematical learning in lesson studies

    DEFF Research Database (Denmark)

    Rasmussen, Klaus; Østergaard, Camilla Hellsten; Foss, Kristian Kildemoes

    2016-01-01

    This poster deals with lesson study (LS) in pre-service teacher education. In particular how to prepare for, carry out, and reflect upon, observations of pupil learning. Observation is of crucial importance to the lesson study process, and here we present a study of observation features which ena...... enable or hinder fruitful lesson study. While substantial research has been carried out in the general field of bserving pupils’ learning processes and teachers’ pedagogical practice, little is known about this in the particular setting of lesson study....

  18. An observational study on the relationship between plasma vitamin ...

    African Journals Online (AJOL)

    ARTICLE. An observational study on the relationship between plasma ... To study plasma vitamin C, oxidative stress, hyperglycaemia, endothelial dysfunction and outcome in septic shock. ..... with critical illness,[6,7,16] and excess losses of.

  19. High-resolution characterization of sequence signatures due to non-random cleavage of cell-free DNA.

    Science.gov (United States)

    Chandrananda, Dineika; Thorne, Natalie P; Bahlo, Melanie

    2015-06-17

    High-throughput sequencing of cell-free DNA fragments found in human plasma has been used to non-invasively detect fetal aneuploidy, monitor organ transplants and investigate tumor DNA. However, many biological properties of this extracellular genetic material remain unknown. Research that further characterizes circulating DNA could substantially increase its diagnostic value by allowing the application of more sophisticated bioinformatics tools that lead to an improved signal to noise ratio in the sequencing data. In this study, we investigate various features of cell-free DNA in plasma using deep-sequencing data from two pregnant women (>70X, >50X) and compare them with matched cellular DNA. We utilize a descriptive approach to examine how the biological cleavage of cell-free DNA affects different sequence signatures such as fragment lengths, sequence motifs at fragment ends and the distribution of cleavage sites along the genome. We show that the size distributions of these cell-free DNA molecules are dependent on their autosomal and mitochondrial origin as well as the genomic location within chromosomes. DNA mapping to particular microsatellites and alpha repeat elements display unique size signatures. We show how cell-free fragments occur in clusters along the genome, localizing to nucleosomal arrays and are preferentially cleaved at linker regions by correlating the mapping locations of these fragments with ENCODE annotation of chromatin organization. Our work further demonstrates that cell-free autosomal DNA cleavage is sequence dependent. The region spanning up to 10 positions on either side of the DNA cleavage site show a consistent pattern of preference for specific nucleotides. This sequence motif is present in cleavage sites localized to nucleosomal cores and linker regions but is absent in nucleosome-free mitochondrial DNA. These background signals in cell-free DNA sequencing data stem from the non-random biological cleavage of these fragments. This

  20. Case Study Observational Research: A Framework for Conducting Case Study Research Where Observation Data Are the Focus.

    Science.gov (United States)

    Morgan, Sonya J; Pullon, Susan R H; Macdonald, Lindsay M; McKinlay, Eileen M; Gray, Ben V

    2017-06-01

    Case study research is a comprehensive method that incorporates multiple sources of data to provide detailed accounts of complex research phenomena in real-life contexts. However, current models of case study research do not particularly distinguish the unique contribution observation data can make. Observation methods have the potential to reach beyond other methods that rely largely or solely on self-report. This article describes the distinctive characteristics of case study observational research, a modified form of Yin's 2014 model of case study research the authors used in a study exploring interprofessional collaboration in primary care. In this approach, observation data are positioned as the central component of the research design. Case study observational research offers a promising approach for researchers in a wide range of health care settings seeking more complete understandings of complex topics, where contextual influences are of primary concern. Future research is needed to refine and evaluate the approach.

  1. Case-Control Studies - An Efficient Observational Study Design

    NARCIS (Netherlands)

    van Stralen, Karlijn J.; Dekker, Friedo W.; Zoccali, Carmine; Jager, Kitty J.

    2010-01-01

    Case-control studies are an efficient research method for investigating risk factors of a disease. The method involves the comparison of the odds of exposure in a patient group with that of the odds of exposure in a control group. As only a minority of the population is included in the study, less

  2. An observational study of road safety around selected primary ...

    African Journals Online (AJOL)

    Materials and Methods: A multistage sampling technique was used to select 46 of the 74 schools in the study area. Some (11) of the selected schools were sited within the same premises and shared a common entrance; thus a total of 35 school premises were eventually observed. Trained research assistants observed the ...

  3. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)

    DEFF Research Database (Denmark)

    Vandenbroucke, Jan P; von Elm, Erik; Altman, Douglas G

    2014-01-01

    Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical...... to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how...

  4. Assessing validity of observational intervention studies - the Benchmarking Controlled Trials.

    Science.gov (United States)

    Malmivaara, Antti

    2016-09-01

    Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations. To create and pilot test a checklist for appraising methodological validity of a BCT. The checklist was created by extracting the most essential elements from the comprehensive set of criteria in the previous paper on BCTs. Also checklists and scientific papers on observational studies and respective systematic reviews were utilized. Ten BCTs published in the Lancet and in the New England Journal of Medicine were used to assess feasibility of the created checklist. The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies. The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies. However, the piloted checklist should be validated in further studies. Key messages Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations. This paper presents a checklist for appraising methodological validity of BCTs and pilot-tests the checklist with ten BCTs published in leading medical journals. The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies. The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies.

  5. Observational studies and the difficult quest for causality

    DEFF Research Database (Denmark)

    Lipsitch, Marc; Jha, Ayan; Simonsen, Lone

    2016-01-01

    be answered once the vaccine is in use, from observational studies. However, such studies are inherently at risk for bias. Using a causal framework and illustrating with examples, we review newer approaches to detecting and avoiding confounding and selection bias in three major classes of observational study...... design: cohort, case-control and ecological studies. Studies of influenza VE, especially in seniors, are an excellent demonstration of the challenges of detecting and reducing such bias, and so we use influenza VE as a running example. We take a fresh look at the time-trend studies often dismissed...... as 'ecological'. Such designs are the only observational study design that can measure the overall effect of a vaccination programme [indirect (herd) as well as direct effects], and are in fact already an important part of the evidence base for several vaccines currently in use. Despite the great strides towards...

  6. Pain in neurosurgically treated patients: A prospective observational study

    NARCIS (Netherlands)

    M. Klimek (Markus); J.F. Ubben (Johannes); J. Ammann (Jan); K. Borner (Katy); J. Klein (Jan); S.J.C. Verbrugge (Serge)

    2006-01-01

    textabstractObject. This is the first observational study to compare perioperative pain character and intensity in patients undergoing different types of elective neurosurgical procedures. Methods. A structured questionnaire was used to inquire about pain intensity, character, and management during

  7. Discontinuation of tofacitinib after achieving low disease activity in patients with rheumatoid arthritis: a multicentre, observational study.

    Science.gov (United States)

    Kubo, Satoshi; Yamaoka, Kunihiro; Amano, Koichi; Nagano, Shuji; Tohma, Shigeto; Suematsu, Eiichi; Nagasawa, Hayato; Iwata, Kanako; Tanaka, Yoshiya

    2017-08-01

    To determine whether tofacitinib can be discontinued in patients with RA who achieve low disease activity (LDA). RA patients with LDA after tofacitinib treatment in a phase III and long-term extension study were enrolled in this multicentre, non-randomized, open, prospective, observational study. The decision of discontinuation or continuation of tofacitinib was determined based on patient-physician decision making with informed consent. The primary endpoint was the proportion of patients who remained tofacitinib-free at post-treatment week 52. Clinical outcome was compared between those who continued and those who discontinued tofacitinib. The last observation carried forward method was used for patients who could not discontinue tofacitinib before week 52. Of 64 patients, 54 discontinued and 10 continued tofacitinib therapy. At post-treatment week 52, 20 of the 54 patients (37%) of the discontinuation group remained tofacitinib-free without disease flare. Disease activity at post-treatment week 52 was higher in the discontinuation group than the continuation group. Among the discontinuation group, the RF titre at baseline was significantly lower in patients who remained tofacitinib-free than those who did not (40 vs 113 U/ml). In fact, a higher proportion of patients with lower RF remained tofacitinib-free at week 52 compared with those with higher RF at baseline. In patients who could not achieve tofacitinib-free status, re-initiation of tofacitinib or other biologics improved disease activity. It is possible to discontinue tofacitinib without flare in about a third of patients with RA. A low RF predicts maintenance of LDA after discontinuation of tofacitinib. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  8. On sensitivity value of pair-matched observational studies

    OpenAIRE

    Zhao, Qingyuan

    2017-01-01

    An observational study may be biased for estimating causal effects by failing to control for unmeasured confounders. This paper proposes a new quantity called the "sensitivity value", which is defined as the minimum strength of unmeasured confounders needed to change the qualitative conclusions of a naive analysis assuming no unmeasured confounder. We establish the asymptotic normality of the sensitivity value in pair-matched observational studies. The theoretical results are then used to app...

  9. Examining Clandestine Social Networks for the Presence of Non-Random Structure

    National Research Council Canada - National Science Library

    Seder, Joshua S

    2007-01-01

    .... The proposed hypothesis testing framework is employed to statistically quantify a given partition's relativity in explaining the variability in the observed adjacency matrix relative to what can be explained by chance...

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

    DEFF Research Database (Denmark)

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

    2018-01-01

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

  11. Discovering non-random segregation of sister chromatids: The naïve treatment of a premature discovery

    Directory of Open Access Journals (Sweden)

    Karl G. Lark

    2013-02-01

    Full Text Available The discovery of non-random chromosome segregation is discussed from the perspective of what was known in1965 and1966. The distinction between daughter, parent or grandparent strands of DNA was developed in a bacterial system and led to the discovery that multiple copies of DNA elements of bacteria are not distributed randomly with respect to the age of the template strand. Experiments with higher eukaryotic cells demonstrated that during mitosis Mendel’s laws were violated; and the initial serendipitous choice of eukaryotic cell system led to the striking example of non-random segregation of parent and grand-parent DNA template strands in primary cultures of cells derived from mouse embryos. Attempts to extrapolate these findings to established TC lines demonstrated that the property could be lost. Experiments using plant root tips demonstrated that the phenomenon exists in plants and that it was, at some level, under genetic control. Despite publication in major journals and symposia (Lark et al. (1966a; Lark (1967a; 1967b; 1969, 1969a; 1969b the potential implications of these findings were ignored for several decades. Here we explore possible reasons for the pre-maturity (Stent, 1972 of this discovery.

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

    NARCIS (Netherlands)

    Madsen, M.B.; Skrede, S.; Bruun, T.; Arnell, P.; Rosén, A.; Nekludov, M.; Karlsson, Y.; Bergey, F.; Saccenti, E.; Martins dos Santos, V.A.P.; Perner, A.; Norrby-Teglund, A.; Hyldegaard, O.

    2018-01-01

    Background: The INFECT project aims to advance our understanding of the pathophysiological mechanisms in necrotizing soft tissue infections (NSTIs). The INFECT observational study is part of the INFECT project with the aim of studying the clinical profile of patients with NSTIs and correlating

  13. Contribution of infrared observations to the study of supernovae remnants

    International Nuclear Information System (INIS)

    Douvion, Thomas

    2000-01-01

    This research thesis addresses the study of dust in young supernovae remnants observed in middle infrared, mainly by means of the ISOCAM instrument installed on the ISO satellite. The author first presents the supernovae physics and the studied young remnants, describes dusts and the main sites of formation and destruction, and outlines the difficulties and benefits of observations performed in the middle infrared. Then, the author reports acquired evidences related to the formation of dusts in supernovae, and the search for a millimetre emission by cold dust contained in regions which are not yet excited by the shock, in order to better assess the overall quantities created by supernovae. He reports the use of observations of dust and neon in Cassiopeia A to perform a diagnosis on the mixture of elements during the supernovae explosion [fr

  14. Space observations for global and regional studies of the biosphere

    Science.gov (United States)

    Cihlar, J.; Li, Z.; Chen, J.; Sellers, P.; Hall, F.

    1994-01-01

    The capability to make space-based measurements of Earth at high spatial and temporal resolutions, which would not otherwise be economically or practically feasible, became available just in time to contribute to scientific understanding of the interactive processes governing the total Earth system. Such understanding has now become essential in order to take practical steps which would counteract or mitigate the pervasive impact of the growing human population on the future habitability of the Earth. The paper reviews the rationale for using space observations for studies of climate and terrestrial ecosystems at global and regional scales, as well as the requirements for such observations for studies of climate and ecosystem dynamics. The present status of these developments is reported along with initiatives under way to advance the use of satellite observations for Earth system studies. The most important contribution of space observations is the provision of physical or biophysical parameters for models representing various components of the Earth system. Examples of such parameters are given for climatic and ecosystem studies.

  15. An observational study of defensible space in the neighbourhood park

    Science.gov (United States)

    Marzukhi, M. A.; Afiq, M. A.; Zaki, S. Ahmad; Ling, O. H. L.

    2018-02-01

    The planning of neighborhood park is important to provide space for interaction, leisure, and recreation among residents in any neighbourhood area. However, on an almost daily basis, newspapers report inappropriate incidents such as snatch theft, robbery and street attack that occurred in the neighborhood park. These cases reflect the significance of physical planning and design of neighborhood park that directly affect the safety and comfort of the users. Thus, this study attempts to engage with the defensible space concept in ensuring the security elements be applied in the planning of the recreational area. This study adopts a qualitative method form of research that is retrofitted to an observational study. The observational study is significant for revealing the condition of a neighbourhood park in the ‘real-world,’ in which direct observation is conducted on Taman Tasik Puchong Perdana. The observer focused on four elements or variables of defensible space concept including the provision of facilities in the neighborhood park, territoriality, surveillance, image and milieu. The findings revealed that the planning of Taman Tasik Puchong Perdana does not deliberate the defensible space elements, which may contribute to the crime activities in the park. In these circumstances, the planning of neighbourhood park needs to include proposals for the implementation of defensible space in response to the challenges underpinned by crime problems. Besides, the awareness among the residents needs to be emphasized with the support from local authorities and other organizations to manage and sustain the safety environment in the neighborhood park.

  16. Observing position and movements in hydrotherapy: a pilot study.

    Science.gov (United States)

    Stark, Mary Ann; Rudell, Barb; Haus, George

    2008-01-01

    To observe and describe the positions and movements women choose while immersed in water during the first stage of labor. Descriptive, observational pilot study. A rural community hospital that provided hydrotherapy in labor. Women (N = 7) who intended to use hydrotherapy in labor were recruited prenatally from a midwife-managed practice. For 15 minutes of each hour during the first stage of labor, position and movements of the participants were observed and recorded on a laptop computer. The observational tool was developed for this study from a review of the literature and interviews with nursing experts; 435 observations were recorded. Women were free to choose when and how long to use hydrotherapy and had no restriction on their positions and movements. Only 3 of the 7 participants labored in the tub. Women demonstrated a greater range of positions and movements in the tub than in bed, both throughout labor and during late first-stage labor (7-10 cm of dilatation). Women had more contractions and made more rhythmic movements while in the tub than in bed. Hydrotherapy may encourage upright positions and movements that facilitate labor progress and coping, helping women avoid unnecessary interventions.

  17. Validation of the k-filtering technique for a signal composed of random-phase plane waves and non-random coherent structures

    Directory of Open Access Journals (Sweden)

    O. W. Roberts

    2014-12-01

    Full Text Available Recent observations of astrophysical magnetic fields have shown the presence of fluctuations being wave-like (propagating in the plasma frame and those described as being structure-like (advected by the plasma bulk velocity. Typically with single-spacecraft missions it is impossible to differentiate between these two fluctuations, due to the inherent spatio-temporal ambiguity associated with a single point measurement. However missions such as Cluster which contain multiple spacecraft have allowed for temporal and spatial changes to be resolved, using techniques such as k filtering. While this technique does not assume Taylor's hypothesis it requires both weak stationarity of the time series and that the fluctuations can be described by a superposition of plane waves with random phases. In this paper we test whether the method can cope with a synthetic signal which is composed of a combination of non-random-phase coherent structures with a mean radius d and a mean separation λ, as well as plane waves with random phase.

  18. Non-Random Sibling Cannibalism in the Marine Gastropod Crepidula coquimbensis.

    Directory of Open Access Journals (Sweden)

    Antonio Brante

    Full Text Available Sibling cannibalism is commonly observed in marine species. For instance, intrabrood cannibalism has been documented in marine gastropods with direct development, suggesting a relationship between embryo behavior and the evolution of life history strategies. However, there has been little effort to document the factors driving sibling cannibalism in marine species. The kin selection theory suggests that the level of relatedness plays an important role in cannibalism patterns. We examined Crepidula coquimbensis, a marine gastropod that broods and encloses its brooded offspring in capsules. Encapsulated embryos show sibling cannibalism and high levels of intracapsular multiple paternity. Given these features, cannibalistic behavior may be driven by kin-relatedness. To test this hypothesis, we constructed artificial aggregations of embryos to mimic three levels of relatedness: high, medium and low. For each category of aggregation, the cannibalism rate and benefits (i.e. size at hatching of surviving offspring were estimated. In addition, at the end of embryo development, we performed parentage analyses to determine if cannibalism was associated with the relatedness between cannibal and victim embryos. Our results show that the intensity of sibling cannibalism increased in aggregations characterized by the lowest level of relatedness. There were important benefits of cannibalism in terms of hatching cannibal size. In addition, cannibalism between embryos was not random: the variation in reproductive success between males increased over the course of the experiment and the effective number of fathers decreased. Altogether, these results suggest that polyandry may play an important role in the evolution of sibling cannibalism in C. coquimbensis and that kin selection may operate during early embryonic stages in this species.

  19. Non-random species loss in bacterial communities reduces antifungal volatile production

    NARCIS (Netherlands)

    Hol, G.; Garbeva, P.; Hordijk, C.; Hundscheid, M.P.J.; Klein Gunnewiek, P.J.A.; Agtmaal, van M.; Boer, de W.

    2015-01-01

    The contribution of low-abundance microbial species to soil ecosystems is easily overlooked because there is considerable overlap between metabolic abilities (functional redundancy) of dominant and subordinate microbial species. Here we studied how loss of less abundant soil bacteria affected the

  20. Folic Acid Supplementation and Preterm Birth: Results from Observational Studies

    Directory of Open Access Journals (Sweden)

    Elena Mantovani

    2014-01-01

    Full Text Available Introduction. Folic acid (FA supplementation is recommended worldwide in the periconceptional period for the prevention of neural tube defects. Due to its involvement in a number of cellular processes, its role in other pregnancy outcomes such as miscarriage, recurrent miscarriage, low birth weight, preterm birth (PTB, preeclampsia, abruptio placentae, and stillbirth has been investigated. PTB is a leading cause of perinatal mortality and morbidity; therefore its association with FA supplementation is of major interest. The analysis of a small number of randomized clinical trials (RCTs has not found a beneficial role of FA in reducing the rate of PTBs. Aim of the Study. The aim of this review was to examine the results from recent observational studies about the effect of FA supplementation on PTB. Materials and Methods. We carried out a search on Medline and by manual search of the observational studies from 2009 onwards that analyzed the rate of PTB in patients who received supplementation with FA before and/or throughout pregnancy. Results. The results from recent observational studies suggest a slight reduction of PTBs that is not consistent with the results from RCTs. Further research is needed to better understand the role of FA supplementation before and during pregnancy in PTB.

  1. An open-label, non-randomized comparison of venlafaxine and gabapentin as monotherapy or adjuvant therapy in the management of neuropathic pain in patients with peripheral neuropathy

    Directory of Open Access Journals (Sweden)

    William Eardley

    2010-04-01

    Full Text Available William Eardley, Cory TothDepartment of Clinical Neurosciences and the University of Calgary, Calgary, AB, CanadaAbstract: Although many therapies are used in the management of neuropathic pain (NeP due to polyneuropathy (PN, few comparison studies exist. We performed a prospective, non-randomized, unblended, efficacy comparison of the serotonin-norepinephrine reuptake inhibitor venlafaxine, as either monotherapy or adjuvant therapy, with a first-line medication for NeP, gabapentin, in patients with PN-related NeP. VAS pain scores were assessed after 3 and 6 months in intervention groups and in a cohort of patients receiving no pharmacotherapy. In a total of 223 patients, we analyzed pain quantity and quality (visual analogue scale [VAS] score, Brief Pain Inventory [BPI], quality of life and health status measures [EuroQol 5 Domains, EQ-5D], Medical Outcomes Sleep Study Scale [MOSSS], Hospital Anxiety and Depression Scale [HADS] and Short Form 36 Health Survey [SF-36] after 6 months of therapy. Significant improvements in VAS pain scores occurred for all treatment groups after 6 months. Improvements in aspects of daily life and anxiety were identified in all treatment groups. Our data suggest that monotherapy or adjuvant therapy with venlafaxine is comparable to gabapentin for NeP management. We advocate for head-to-head, randomized, double-blinded studies of current NeP therapies.Keywords: peripheral neuropathy, neuropathic pain, pharmacotherapy, venlafaxine, gabapentin

  2. Manometric Biofeedback Effectiveness on Urinary Incontinence and Quality of Life: A Non-Randomized Control Trial

    Directory of Open Access Journals (Sweden)

    Marcos E Fernandez-Cuadros

    2017-04-01

    Full Text Available Objectives This study aimed at examining if a 6-session protocol of tonic-phasic exercises using manometric biofeedback (BFB is capable of improving quality of life (QoL and muscular strength in patients with urinary incontinence (UI. Methods A prospective quasi-experimental before-after study was performed on 31 patients with Urinary Incontinence (UI referred to the rehabilitation department of Santa Cristina’s University hospital, Madrid, Spain. The study was performed from January to December 2016. At initial evaluation, affiliation of data, predisposing factors, and type of UI were recorded. Patients were given lifestyle recommendations and international consultation on incontinence questionnaire short form (ICIQ-SF/ incontinence quality-of-life measure (I-QOL questionnaires/scales to be fulfilled at the beginning/end of treatment. Manometric evaluation was recorded at initial/final evaluation by MYOMED ® 932. Manometric-BFB protocol consisted of a 30-minute session of tonic/phasic exercises (15 minutes each, 2 times a week for up to 6 sessions, supervised by a physiotherapist. Results Mean age was 52 ± 12.1 years. Overall, 96.7% (n = 31 of the participants were females. Maximum and mean strength of pelvic floor contraction was 24 ± 17.72 and 4.9 ± 4.1 mmHg, and increased significantly after treatment to 35 ± 20.85 and 7.45 ± 4.92 mmHg (P < 0.01. The mean ICIQ-SF score was 9.13 ± 5.18 and decreased significantly to 6.13 ± 4.75 (P = 0.003. The mean I-QoL score increased significantly from 70.33 ± 22.12 to 81.25 ± 16.72 (P = 0.0017. The I-QoL Limiting Behaviour (LB-subscale raised from 68.38 ± 23.33 to 80 ± 16.56 (P = 0.0015; I-QoL Psychosocial Impact (PI-subscale increased from 77.43 ± 24.51 to 80 ± 17.47 (p = 0.0152; and I-QoL social embarrassment (SE-subscale incremented from 60.72 ± 22.37 to 74.37 ± 20.86 (P = 0.0007. Conclusions Manometric-BFB protocol is capable of decreasing UI and to improve QoL and manometric values

  3. Observed Orbit Effects during Long Range Beam-Beam Studies

    CERN Document Server

    Alemany, R; Buffat, X; Calaga, R; Fitterer, M; Giachino, R; Hemelsoet, GH; Herr, W; Papotti, G; Pieloni, T; Poyer, M; Schaumann, M; Trad, G; Wollmann, D

    2012-01-01

    Possible limitations due to long range beam-beam effects at the LHC have been studied and are presented in this note. With a larger number of bunches and collisions in all interaction points, the crossing angles were reduced to enhance long range beam-beam effects. The analysis of the effects on the dynamic aperture and losses are documented in [1]. This note concentrates on the bunch-by-bunch orbit effects observed during the experiment.

  4. Strategies GeoCape Intelligent Observation Studies @ GSFC

    Science.gov (United States)

    Cappelaere, Pat; Frye, Stu; Moe, Karen; Mandl, Dan; LeMoigne, Jacqueline; Flatley, Tom; Geist, Alessandro

    2015-01-01

    This presentation provides information a summary of the tradeoff studies conducted for GeoCape by the GSFC team in terms of how to optimize GeoCape observation efficiency. Tradeoffs include total ground scheduling with simple priorities, ground scheduling with cloud forecast, ground scheduling with sub-area forecast, onboard scheduling with onboard cloud detection and smart onboard scheduling and onboard image processing. The tradeoffs considered optimzing cost, downlink bandwidth and total number of images acquired.

  5. The new worlds observer: The astrophysics strategic mission concept study

    Directory of Open Access Journals (Sweden)

    Cash W.

    2011-07-01

    Full Text Available We present some results of the Astrophysics Strategic Mission Concept Study for the New Worlds Observer (NWO. We show that the use of starshades is the most effective and affordable path to mapping and understanding our neighboring planetary systems, to opening the search for life outside our solar system, while serving the needs of the greater astronomy community. A starshade-based mission can be implemented immediately with a near term program of technology demonstration.

  6. Folic acid supplementation and preterm birth: results from observational studies.

    Science.gov (United States)

    Mantovani, Elena; Filippini, Francesca; Bortolus, Renata; Franchi, Massimo

    2014-01-01

    Folic acid (FA) supplementation is recommended worldwide in the periconceptional period for the prevention of neural tube defects. Due to its involvement in a number of cellular processes, its role in other pregnancy outcomes such as miscarriage, recurrent miscarriage, low birth weight, preterm birth (PTB), preeclampsia, abruptio placentae, and stillbirth has been investigated. PTB is a leading cause of perinatal mortality and morbidity; therefore its association with FA supplementation is of major interest. The analysis of a small number of randomized clinical trials (RCTs) has not found a beneficial role of FA in reducing the rate of PTBs. The aim of this review was to examine the results from recent observational studies about the effect of FA supplementation on PTB. We carried out a search on Medline and by manual search of the observational studies from 2009 onwards that analyzed the rate of PTB in patients who received supplementation with FA before and/or throughout pregnancy. The results from recent observational studies suggest a slight reduction of PTBs that is not consistent with the results from RCTs. Further research is needed to better understand the role of FA supplementation before and during pregnancy in PTB.

  7. Routine delivery of artemisinin-based combination treatment at fixed health facilities reduces malaria prevalence in Tanzania: an observational study

    Directory of Open Access Journals (Sweden)

    Khatib Rashid A

    2012-04-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT has been promoted as a means to reduce malaria transmission due to their ability to kill both asexual blood stages of malaria parasites, which sustain infections over long periods and the immature derived sexual stages responsible for infecting mosquitoes and onward transmission. Early studies reported a temporal association between ACT introduction and reduced malaria transmission in a number of ecological settings. However, these reports have come from areas with low to moderate malaria transmission, been confounded by the presence of other interventions or environmental changes that may have reduced malaria transmission, and have not included a comparison group without ACT. This report presents results from the first large-scale observational study to assess the impact of case management with ACT on population-level measures of malaria endemicity in an area with intense transmission where the benefits of effective infection clearance might be compromised by frequent and repeated re-infection. Methods A pre-post observational study with a non-randomized comparison group was conducted at two sites in Tanzania. Both sites used sulphadoxine-pyrimethamine (SP monotherapy as a first-line anti-malarial from mid-2001 through 2002. In 2003, the ACT, artesunate (AS co-administered with SP (AS + SP, was introduced in all fixed health facilities in the intervention site, including both public and registered non-governmental facilities. Population-level prevalence of Plasmodium falciparum asexual parasitaemia and gametocytaemia were assessed using light microscopy from samples collected during representative household surveys in 2001, 2002, 2004, 2005 and 2006. Findings Among 37,309 observations included in the analysis, annual asexual parasitaemia prevalence in persons of all ages ranged from 11% to 28% and gametocytaemia prevalence ranged from Interpretation The introduction of ACT at

  8. A foundational observation method for studying design situations

    DEFF Research Database (Denmark)

    Cash, Philip; Hicks, Ben; Culley, Steve

    2015-01-01

    Observational studies of designers play an important role in engineering design research, yet there is currently no accepted standard approach for comparing, combining, or contrasting studies. Consequentially, reuse, reanalysis, replication, and aggregation of data are limited and the potential...... that covers capture, coding, and analysis. The capture step defines overall and situational context as well as multiple capture streams, generating a broad data-set that can be examined from multiple perspectives. The coding step employs a multi-level approach that seeks to minimise workload while describing...

  9. Using data mining techniques to characterize participation in observational studies.

    Science.gov (United States)

    Linden, Ariel; Yarnold, Paul R

    2016-12-01

    Data mining techniques are gaining in popularity among health researchers for an array of purposes, such as improving diagnostic accuracy, identifying high-risk patients and extracting concepts from unstructured data. In this paper, we describe how these techniques can be applied to another area in the health research domain: identifying characteristics of individuals who do and do not choose to participate in observational studies. In contrast to randomized studies where individuals have no control over their treatment assignment, participants in observational studies self-select into the treatment arm and therefore have the potential to differ in their characteristics from those who elect not to participate. These differences may explain part, or all, of the difference in the observed outcome, making it crucial to assess whether there is differential participation based on observed characteristics. As compared to traditional approaches to this assessment, data mining offers a more precise understanding of these differences. To describe and illustrate the application of data mining in this domain, we use data from a primary care-based medical home pilot programme and compare the performance of commonly used classification approaches - logistic regression, support vector machines, random forests and classification tree analysis (CTA) - in correctly classifying participants and non-participants. We find that CTA is substantially more accurate than the other models. Moreover, unlike the other models, CTA offers transparency in its computational approach, ease of interpretation via the decision rules produced and provides statistical results familiar to health researchers. Beyond their application to research, data mining techniques could help administrators to identify new candidates for participation who may most benefit from the intervention. © 2016 John Wiley & Sons, Ltd.

  10. Parental behaviour in paediatric chronic pain: a qualitative observational study.

    Science.gov (United States)

    Dunford, Emma; Thompson, Miles; Gauntlett-Gilbert, Jeremy

    2014-10-01

    Parental behaviour appears to influence the adjustment of children with chronic pain. However, research in this area has failed to produce consistent evidence. Studies have tended to rely on self-report measures derived from adult pain populations. This qualitative, observational research provides descriptive data of parental behaviour in a clinical environment. A qualitative observational study was made of parents and adolescents in a physically stressful setting. Modified grounded theory was used to analyse verbal and non-verbal behaviours. Eight parent-adolescent dyads seeking treatment for chronic pain were videoed during physical exercise sessions. Verbal and non-verbal behaviours were recorded and transcribed. Four overarching categories emerged: 'monitoring', 'protecting', 'encouraging' and 'instructing'. These often had both verbal and non-verbal aspects. Within these categories, more precise behavioural groups were also identified. This research identifies categories of parental behaviour that were derived directly from observation, rather than imposed on the basis of results from different populations. Four categories of behaviour were derived, which clarify and extend dimensions used in existing self-report instruments. Careful description of parental behaviours showed features that past research has neglected, and highlighted potential drawbacks of apparently positive parental actions. © The Author(s) 2013.

  11. Observations of radiographer communication: An exploratory study using Transactional Analysis

    International Nuclear Information System (INIS)

    Booth, Lisa A.; Manning, David J.

    2006-01-01

    Purpose: Communication in medical imaging is a neglected area of research, despite the necessity for good communication if optimum diagnostic images are to be achieved. Methods: The present study has investigated the styles of communication used in medical imaging, using an approach known as Transactional Analysis. This approach has been demonstrated previously as having reliability and validity, using observations and supporting interviews with medical imaging staff, along with inter-rater observations of radiographer-patient interactions. Results: The results indicate that Transactional Analysis can be used effectively for identifying and naming interaction events in diagnostic radiography, with diagnostic radiographers using five styles of communication. Conclusion: Radiographers tend to use Parental styles of communicating; these styles are commonly associated with a practitioner-centred approach to dealing with patients which often result in non-adherence

  12. An observational study of sea breeze characteristics over Kalpakkam Coast

    International Nuclear Information System (INIS)

    Mohan, Manju; Mishra, M.K.

    2005-01-01

    An observational study of the sea breeze characteristics has been carried out at Kalpakkam, India which lies on the East coast of Southern Indian peninsula about 700 m inland from the sea, the Bay of Bengal. There are clear and significant changes in the surface meteorological parameters at the onset and during sea-breeze phenomenon in the coastal areas. Hourly averaged measurements from a 30 m tall micrometeorological tower were used to study the sea-breeze characteristics at the above site. In this study, based on detailed analysis of the data on-set criteria of the sea breeze is characterized by increase in relative humidity at least by 5%, fall in temperature by equal or greater than 0.5 K and increase in wind speed with respect to previous hour record. The present study is also compared with the earlier studies in relation to sea breeze carried out at Chennai located approximately 80 km North from Kalpakkam and the differences between these studies are discussed. The comparison of sea breeze characteristics of the present study with those from earlier studies that were carried out more than half a century back also reflects the changes due to urbanization and other development activities as well as resulting climatic impacts. (author)

  13. A conceptual framework for evaluating data suitability for observational studies.

    Science.gov (United States)

    Shang, Ning; Weng, Chunhua; Hripcsak, George

    2017-09-08

    To contribute a conceptual framework for evaluating data suitability to satisfy the research needs of observational studies. Suitability considerations were derived from a systematic literature review on researchers' common data needs in observational studies and a scoping review on frequent clinical database design considerations, and were harmonized to construct a suitability conceptual framework using a bottom-up approach. The relationships among the suitability categories are explored from the perspective of 4 facets of data: intrinsic, contextual, representational, and accessible. A web-based national survey of domain experts was conducted to validate the framework. Data suitability for observational studies hinges on the following key categories: Explicitness of Policy and Data Governance, Relevance, Availability of Descriptive Metadata and Provenance Documentation, Usability, and Quality. We describe 16 measures and 33 sub-measures. The survey uncovered the relevance of all categories, with a 5-point Likert importance score of 3.9 ± 1.0 for Explicitness of Policy and Data Governance, 4.1 ± 1.0 for Relevance, 3.9 ± 0.9 for Availability of Descriptive Metadata and Provenance Documentation, 4.2 ± 1.0 for Usability, and 4.0 ± 0.9 for Quality. The suitability framework evaluates a clinical data source's fitness for research use. Its construction reflects both researchers' points of view and data custodians' design features. The feedback from domain experts rated Usability, Relevance, and Quality categories as the most important considerations. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  14. How safe do teenagers behave on Facebook? An observational study.

    Science.gov (United States)

    Vanderhoven, Ellen; Schellens, Tammy; Valcke, Martin; Raes, Annelies

    2014-01-01

    The substantial use of social network sites by teenagers has raised concerns about privacy and security. Previous research about behavior on social network sites was mostly based on surveys and interviews. Observational research overcomes problems inherent to this research method, for example social desirability. However, existing observational research mostly focuses on public profiles of young adults. Therefore, the current observation-study includes 1050 public and non-public Facebook-profiles of teenagers (13-18) to investigate (1) what kind of information teenagers post on their profile, (2) to what extent they protect this information using privacy-settings and (3) how much risky information they have on their profile. It was found that young people mostly post pictures, interests and some basic personal information on their profile. Some of them manage their privacy-settings as such that this information is reserved for friends' eyes only, but a lot of information is accessible on the friends-of-friends' pages. Although general risk scores are rather low, more detailed analyses show that teenagers nevertheless post a significant amount of risky information. Moreover, older teenagers and girls post more (risky) information while there are no differences in applying privacy settings. We found no differences in the Facebook behavior of teenagers enrolled in different education forms. Implications of these results are discussed.

  15. How safe do teenagers behave on Facebook? An observational study.

    Directory of Open Access Journals (Sweden)

    Ellen Vanderhoven

    Full Text Available The substantial use of social network sites by teenagers has raised concerns about privacy and security. Previous research about behavior on social network sites was mostly based on surveys and interviews. Observational research overcomes problems inherent to this research method, for example social desirability. However, existing observational research mostly focuses on public profiles of young adults. Therefore, the current observation-study includes 1050 public and non-public Facebook-profiles of teenagers (13-18 to investigate (1 what kind of information teenagers post on their profile, (2 to what extent they protect this information using privacy-settings and (3 how much risky information they have on their profile. It was found that young people mostly post pictures, interests and some basic personal information on their profile. Some of them manage their privacy-settings as such that this information is reserved for friends' eyes only, but a lot of information is accessible on the friends-of-friends' pages. Although general risk scores are rather low, more detailed analyses show that teenagers nevertheless post a significant amount of risky information. Moreover, older teenagers and girls post more (risky information while there are no differences in applying privacy settings. We found no differences in the Facebook behavior of teenagers enrolled in different education forms. Implications of these results are discussed.

  16. A Statistical Study of Interplanetary Type II Bursts: STEREO Observations

    Science.gov (United States)

    Krupar, V.; Eastwood, J. P.; Magdalenic, J.; Gopalswamy, N.; Kruparova, O.; Szabo, A.

    2017-12-01

    Coronal mass ejections (CMEs) are the primary cause of the most severe and disruptive space weather events such as solar energetic particle (SEP) events and geomagnetic storms at Earth. Interplanetary type II bursts are generated via the plasma emission mechanism by energetic electrons accelerated at CME-driven shock waves and hence identify CMEs that potentially cause space weather impact. As CMEs propagate outward from the Sun, radio emissions are generated at progressively at lower frequencies corresponding to a decreasing ambient solar wind plasma density. We have performed a statistical study of 153 interplanetary type II bursts observed by the two STEREO spacecraft between March 2008 and August 2014. These events have been correlated with manually-identified CMEs contained in the Heliospheric Cataloguing, Analysis and Techniques Service (HELCATS) catalogue. Our results confirm that faster CMEs are more likely to produce interplanetary type II radio bursts. We have compared observed frequency drifts with white-light observations to estimate angular deviations of type II burst propagation directions from radial. We have found that interplanetary type II bursts preferably arise from CME flanks. Finally, we discuss a visibility of radio emissions in relation to the CME propagation direction.

  17. Palliative care team visits. Qualitative study through participant observation.

    Science.gov (United States)

    Alfaya Góngora, Maria Del Mar; Bueno Pernias, Maria José; Hueso Montoro, César; Guardia Mancilla, Plácido; Montoya Juárez, Rafael; García Caro, Maria Paz

    2016-03-30

    To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants. A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room) were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed. The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources. Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources.

  18. Serum YKL-40 and gestational diabetes - an observational cohort study

    DEFF Research Database (Denmark)

    Gybel-Brask, Dorte; Johansen, Julia S; Christiansen, Ib J

    2016-01-01

    To examine serum YKL-40 in women developing gestational diabetes mellitus (GDM). In the present large observational cohort study of 1179 pregnant women, we determined serum YKL-40 four times during pregnancy (at gestational age 12, 20, 25, and 32 weeks). Pregnancy outcome was obtained from medical...... records. Sixty-eight women (5.8%) developed GDM. Serum YKL-40 increased from gestational age (GA) 12 weeks and the following weeks in the women who developed GDM and was independent of BMI, parity, and maternal age (OR = 2.69, 95% CI: 1.45-5.00, p = 0.002). No association was found between serum YKL-40...

  19. Nursing praxis, compassionate caring and interpersonal relations: an observational study.

    Science.gov (United States)

    Fry, Margaret; MacGregor, Casimir; Ruperto, Kate; Jarrett, Kate; Wheeler, Janet; Fong, Jacqueline; Fetchet, Wendy

    2013-05-01

    The Clinical Initiative Nurse (CIN) is a role that requires experienced emergency nurses to assess, initiate diagnostic tests, treat and manage a range of patient conditions. The CIN role is focused on the waiting room and to 'communicate the wait', initiate diagnostics or treatment and follow-up for waiting room patients. We aim to explore what emergency nurses' do in their extended practice role in observable everyday life in the emergency department (ED). The paper argues that compassionate caring is a core nursing skill that supports CIN interpersonal relations, despite the role's highly clinical nature. Sixteen non-participant observations were undertaken in three EDs in New South Wales, Australia. Nurses were eligible for inclusion if they had two years of emergency experience and had worked in the CIN role for more than one year. All CIN's that were observed were highly experienced with a minimum three year ED experience. The CIN observations revealed how compassionate caring was utilised by CIN's to quickly build a therapeutic relationship with patients and colleagues, and helped to facilitate core communication and interpersonal skills. While the CIN role was viewed as extended practice, the role relied heavily on compassionate care to support interpersonal relationships and to actualise extended practice care. The study supports the contribution made by emergency nurses and demonstrates how compassionate caring is central to nursing praxis. This paper also demonstrates that the CIN role utilises a complex mix between advanced clinical skills and compassion that supports interpersonal and therapeutic relationships. Further research is needed to understand how compassionate care can be optimised within nursing praxis and the duty of care between nurses and patients, nurses and other health care professionals so that future healthcare goals can be realised. Copyright © 2013 College of Emergency Nursing Australasia Ltd. All rights reserved.

  20. Technological aspects of hospital communication challenges: an observational study.

    Science.gov (United States)

    Popovici, Ilinca; Morita, Plinio P; Doran, Diane; Lapinsky, Stephen; Morra, Dante; Shier, Ashleigh; Wu, Robert; Cafazzo, Joseph A

    2015-06-01

    To gain insights into how technological communication tools impact effective communication among clinicians, which is critical for patient safety. This multi-site observational study analyzes inter-clinician communication and interaction with information technology, with a focus on the critical process of patient transfer from the Emergency Department to General Internal Medicine. Mount Sinai Hospital, Sunnybrook Health Sciences Centre and Toronto General Hospital. At least five ED and general internal medicine nurses and physicians directly involved in patient transfers were observed on separate occasions at each institution. N/A. N/A. The study provides insight into clinician workflow, evaluates current hospital communication systems and identifies key issues affecting communication: interruptions, issues with numeric pagers, lack of integrated communication tools, lack of awareness of consultation status, inefficiencies related to the paper chart, unintuitive user interfaces, mixed use of electronic and paper systems and lack of up-to-date contact information. It also identifies design trade-offs to be negotiated: synchronous communication vs. reducing interruptions, notification of patient status vs. reducing interruptions and speed vs. quality of handovers. The issues listed should be considered in the design of new technology for hospital communications. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  1. Treatment of Crohn's disease with cannabis: an observational study.

    Science.gov (United States)

    Naftali, Timna; Lev, Lihi Bar; Yablecovitch, Doron; Yablekovitz, Doron; Half, Elisabeth; Konikoff, Fred M

    2011-08-01

    The marijuana plant cannabis is known to have therapeutic effects, including improvement of inflammatory processes. However, no report of patients using cannabis for Crohn's disease (CD) was ever published. To describe the effects of cannabis use in patients suffering from CD. In this retrospective observational study we examined disease activity, use of medication, need for surgery, and hospitalization before and after cannabis use in 30 patients (26 males) with CD. Disease activity was assessed by the Harvey Bradshaw index for Crohn's disease. Of the 30 patients 21 improved significantly after treatment with cannabis. The average Harvey Bradshaw index improved from 14 +/- 6.7 to 7 +/- 4.7 (P disease in humans. The results indicate that cannabis may have a positive effect on disease activity, as reflected by reduction in disease activity index and in the need for other drugs and surgery. Prospective placebo-controlled studies are warranted to fully evaluate the efficacy and side effects of cannabis in CD.

  2. Assessing the completeness of reporting of observational studies in Colombian Journal of Anesthesiology. Cross sectional study

    NARCIS (Netherlands)

    Bravo-Peña, M. (Mary); Barona-Fong, L. (Luis); Campo-López, J. (Julio); Arroyave, Y. (Yeni); J.A. Calvache (Jose Andres)

    2017-01-01

    textabstractIntroduction The STROBE statement (Strengthening the Reporting of Observational Studies in Epidemiology), consisting of 22 points, was published in 2007 with the aim of improving the reporting of observational research. Objective To determine the completeness of reporting of

  3. Prospective Observational Study on acute Appendicitis Worldwide (POSAW).

    Science.gov (United States)

    Sartelli, Massimo; Baiocchi, Gian L; Di Saverio, Salomone; Ferrara, Francesco; Labricciosa, Francesco M; Ansaloni, Luca; Coccolini, Federico; Vijayan, Deepak; Abbas, Ashraf; Abongwa, Hariscine K; Agboola, John; Ahmed, Adamu; Akhmeteli, Lali; Akkapulu, Nezih; Akkucuk, Seckin; Altintoprak, Fatih; Andreiev, Aurelia L; Anyfantakis, Dimitrios; Atanasov, Boiko; Bala, Miklosh; Balalis, Dimitrios; Baraket, Oussama; Bellanova, Giovanni; Beltran, Marcelo; Melo, Renato Bessa; Bini, Roberto; Bouliaris, Konstantinos; Brunelli, Daniele; Castillo, Adrian; Catani, Marco; Che Jusoh, Asri; Chichom-Mefire, Alain; Cocorullo, Gianfranco; Coimbra, Raul; Colak, Elif; Costa, Silvia; Das, Koray; Delibegovic, Samir; Demetrashvili, Zaza; Di Carlo, Isidoro; Kiseleva, Nadezda; El Zalabany, Tamer; Faro, Mario; Ferreira, Margarida; Fraga, Gustavo P; Gachabayov, Mahir; Ghnnam, Wagih M; Giménez Maurel, Teresa; Gkiokas, Georgios; Gomes, Carlos A; Griffiths, Ewen; Guner, Ali; Gupta, Sanjay; Hecker, Andreas; Hirano, Elcio S; Hodonou, Adrien; Hutan, Martin; Ioannidis, Orestis; Isik, Arda; Ivakhov, Georgy; Jain, Sumita; Jokubauskas, Mantas; Karamarkovic, Aleksandar; Kauhanen, Saila; Kaushik, Robin; Kavalakat, Alfie; Kenig, Jakub; Khokha, Vladimir; Khor, Desmond; Kim, Dennis; Kim, Jae I; Kong, Victor; Lasithiotakis, Konstantinos; Leão, Pedro; Leon, Miguel; Litvin, Andrey; Lohsiriwat, Varut; López-Tomassetti Fernandez, Eudaldo; Lostoridis, Eftychios; Maciel, James; Major, Piotr; Dimova, Ana; Manatakis, Dimitrios; Marinis, Athanasio; Martinez-Perez, Aleix; Marwah, Sanjay; McFarlane, Michael; Mesina, Cristian; Pędziwiatr, Michał; Michalopoulos, Nickos; Misiakos, Evangelos; Mohamedahmed, Ali; Moldovanu, Radu; Montori, Giulia; Mysore Narayana, Raghuveer; Negoi, Ionut; Nikolopoulos, Ioannis; Novelli, Giuseppe; Novikovs, Viktors; Olaoye, Iyiade; Omari, Abdelkarim; Ordoñez, Carlos A; Ouadii, Mouaqit; Ozkan, Zeynep; Pal, Ajay; Palini, Gian M; Partecke, Lars I; Pata, Francesco; Pędziwiatr, Michał; Pereira Júnior, Gerson A; Pintar, Tadeja; Pisarska, Magdalena; Ploneda-Valencia, Cesar F; Pouggouras, Konstantinos; Prabhu, Vinod; Ramakrishnapillai, Padmakumar; Regimbeau, Jean-Marc; Reitz, Marianne; Rios-Cruz, Daniel; Saar, Sten; Sakakushev, Boris; Seretis, Charalampos; Sazhin, Alexander; Shelat, Vishal; Skrovina, Matej; Smirnov, Dmitry; Spyropoulos, Charalampos; Strzałka, Marcin; Talving, Peep; Teixeira Gonsaga, Ricardo A; Theobald, George; Tomadze, Gia; Torba, Myftar; Tranà, Cristian; Ulrych, Jan; Uzunoğlu, Mustafa Y; Vasilescu, Alin; Occhionorelli, Savino; Venara, Aurélien; Vereczkei, Andras; Vettoretto, Nereo; Vlad, Nutu; Walędziak, Maciej; Yilmaz, Tonguç U; Yuan, Kuo-Ching; Yunfeng, Cui; Zilinskas, Justas; Grelpois, Gérard; Catena, Fausto

    2018-01-01

    Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.

  4. Beyond the traditional definition of breakthrough pain: an observational study.

    Science.gov (United States)

    Gatti, Antonio; Gentili, Marta; Iorno, Vittorio; Mammucari, Massimo; Tufaro, Giuseppe; Lazzari, Marzia; Sabato, Alessandro Fabrizio

    2013-03-01

    Breakthrough pain (BTP) is traditionally defined as a transitory pain flare in opioid-treated patients with chronic background pain. This definition has, however, been challenged in recent years. This study aimed to analyze BTP prevalence in different pain conditions. This was a prospective, non-interventional, observational study conducted from June to September 2011 in two Italian pain treatment reference centres. Consecutive patients aged >18 years with oncological or non-oncological pain were eligible for this study; background pain was acute/ subacute (3 months). The characteristics of pain were evaluated by means of a structured interview by physicians, and patients were asked to complete a dedicated clinical study form. The following outcomes were assessed: chronic pain duration (in patients with chronic pain), BTP prevalence, and number and severity of daily BTP episodes. All outcomes were assessed in four populations of patients with: (a) chronic oncological pain; (b) chronic non-oncological pain; (c) non-chronic oncological pain; (d) non-chronic non-oncological pain. The correlation between BTP and gender was also investigated. Of 1,270 patients with chronic pain, 1,086 had non-oncological pain (85.5%). Most patients (68.6%) with non-oncological pain were female (P = 0.001). Pain duration was significantly longer in non-oncological pain versus oncological pain groups (P = 0.002). BTP prevalence was lower in non-oncological patients (P definition. BTP frequency and severity is similar in oncological and non-oncological pain.

  5. Yogurt and Diabetes: Overview of Recent Observational Studies.

    Science.gov (United States)

    Salas-Salvadó, Jordi; Guasch-Ferré, Marta; Díaz-López, Andrés; Babio, Nancy

    2017-07-01

    The effects of dairy consumption on the prevention of type 2 diabetes remain controversial and depend on the dairy subtype. Yogurt intake has received special attention because its association with health benefits is more consistent than that of other types of dairy products. In the present article, we review those observational studies that evaluated the association between yogurt consumption and type 2 diabetes. We also discuss the possible mechanisms involved in these associations. We found that 13 prospective studies evaluated the association between yogurt intake and type 2 diabetes, most of which showed an inverse association between the frequency of yogurt consumption and the risk of diabetes. In addition to the scientific evidence accumulated from individual prospective studies, several meta-analyses have shown that yogurt consumption has a potential role in diabetes prevention. The most recent analysis shows a 14% lower risk of type 2 diabetes when yogurt consumption was 80-125 g/d compared with no yogurt consumption. The intake of fermented dairy products, especially yogurt, has been inversely associated with variables of glucose metabolism. Yogurt may have probiotic effects that could modulate glucose metabolism. We conclude that yogurt consumption, in the context of a healthy dietary pattern, may reduce the risk of type 2 diabetes in healthy and older adults at high cardiovascular risk. Large-scale intervention studies and randomized clinical trials are warranted to determine if yogurt consumption has beneficial effects on insulin sensitivity and reduces the risk of type 2 diabetes. © 2017 American Society for Nutrition.

  6. Warfarin and fibrinolysis - a challenging combination: an observational cohort study

    Directory of Open Access Journals (Sweden)

    Luurila Harri

    2011-04-01

    Full Text Available Abstract Background Patients presenting with ST-segment elevation myocardial infarction (STEMI frequently use warfarin. Fibrinolytic agents and warfarin both increase bleeding risk, but only a few studies have been published concerning the bleeding risk of warfarin-prescribed patients receiving fibrinolysis. The objective of this study was to define the prevalence for intracranial haemorrhage (ICH or major bleeding in patients on warfarin treatment receiving pre-hospital fibrinolysis. Methods This was an observational cohort study. Data for this retrospective case series were collected in Helsinki Emergency Medical Service catchment area from 1.1.1997 to 30.6.2010. All warfarin patients with suspected ST-segment elevation myocardial infarction (STEMI, who received pre-hospital fibrinolysis, were included. Bleeding complications were detected from Medical Records and classified as ICH, major or minor bleeding. Results Thirty-six warfarin patients received fibrinolysis during the study period. Fourteen patients had bleeding complications. One (3%, 95% CI 0-15% patient had ICH, six (17%, 95% CI 7-32% had major and seven (19%, 95% CI 9-35% had minor bleeding. The only fatal bleeding occurred in a patient with ICH. Patients' age, fibrinolytic agent used or aspirin use did not predispose to bleeding complications. High International Normalized Ratio (INR seemed to predispose to bleedings with values over 3, but no statistically significant difference was found. Conclusions Bleedings occur frequently in warfarin patients treated with fibrinolysis in the real world setting, but they are rarely fatal.

  7. An observational study of foot lifts asymmetry during obstacle avoidance

    Directory of Open Access Journals (Sweden)

    Ujjawal Singh Tomar

    2012-01-01

    Full Text Available Background: Specific information regarding obstacle-clearance strategies used by community-dwelling young and elderly is scant in the literature, and physical barriers encountered in real-life situations have not been used in most of the studies. Aim: The aim of this study is to determine foot lift asymmetry during obstacle avoidance in young and elderly subjects. Settings and Design: This was an observational study. Materials and Methods: Thirty elderly and 30 young individuals were taken for the study. All the subjects were evaluated using different scales and foot lift asymmetry was measured on a walkway using three obstacles of different heights. Results: The mean and standard deviation (SD value of the asymmetric index of the young was 3.25±0.28 and the mean and SD value of the asymmetric index of the elderly was 3.53±0.47. The asymmetric index of the elderly population was found to be higher than that of the younger population. Conclusion: The asymmetric index of the elderly population was found to be higher than that of the younger population, though it is not clinically significant.

  8. Increasing capacity to deliver diabetes self-management education: results of the DESMOND lay educator non-randomized controlled equivalence trial.

    Science.gov (United States)

    Carey, M E; Mandalia, P K; Daly, H; Gray, L J; Hale, R; Martin Stacey, L; Taub, N; Skinner, T C; Stone, M; Heller, S; Khunti, K; Davies, M J

    2014-11-01

    To develop and test a format of delivery of diabetes self-management education by paired professional and lay educators. We conducted an equivalence trial with non-randomized participant allocation to a Diabetes Education and Self Management for Ongoing and Newly Diagnosed Type 2 diabetes (DESMOND) course, delivered in the standard format by two trained healthcare professional educators (to the control group) or by one trained lay educator and one professional educator (to the intervention group). A total of 260 people with Type 2 diabetes diagnosed within the previous 12 months were referred for self-management education as part of routine care and attended either a control or intervention format DESMOND course. The primary outcome measure was change in illness coherence score (derived from the Diabetes Illness Perception Questionnaire-Revised) between baseline and 4 months after attending education sessions. Secondary outcome measures included change in HbA1c level. The trial was conducted in four primary care organizations across England and Scotland. The 95% CI for the between-group difference in positive change in coherence scores was within the pre-set limits of equivalence (difference = 0.22, 95% CI 1.07 to 1.52). Equivalent changes related to secondary outcome measures were also observed, including equivalent reductions in HbA1c levels. Diabetes education delivered jointly by a trained lay person and a healthcare professional educator with the same educator role can provide equivalent patient benefits. This could provide a method that increases capacity, maintains quality and is cost-effective, while increasing access to self-management education. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

  9. Intrauterine temperature during intrapartum amnioinfusion: a prospective observational study.

    Science.gov (United States)

    Tomlinson, T M; Schaecher, C; Sadovsky, Y; Gross, G

    2012-07-01

    To determine the influence of routine intrapartum amnioinfusion (AI) on intrauterine temperature. Prospective observational study. Maternity unit, Barnes Jewish Hospital, St Louis, MO, USA. Forty women with singleton gestations and an indication for intrapartum intrauterine pressure catheter placement. Using a temperature probe, we digitally recorded intrauterine temperature every 10 minutes during labour. Amnioinfusion was administered according to a standard protocol using saline equilibrated to the ambient temperature. Mean intrauterine temperature during labour. Participants were monitored for a mean of 280 minutes (range 20-820). A total of 164 intrauterine temperature readings in the AI cohort were compared with 797 control measurements. When compared with controls, we observed a lower intrauterine temperature in the AI cohort (36.4 versus 37.4°C, P<0.01). More measurements in the AI cohort were recorded in the presence of intrapartum fever (40% versus 30%). A subgroup analysis of measurements recorded in afebrile parturients revealed an even greater effect of AI (1.5°C decrease, 37.3 versus 35.8°C, P<0.01). Routine intrapartum AI using saline equilibrated to a mean ambient temperature of 25.0°C reduces intrauterine temperature and may thereby affect fetal core temperature. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  10. [Assessment of Urinary Incontinence in Pregnancy and Postpartum: Observational Study].

    Science.gov (United States)

    Rocha, Juliana; Brandão, Pedro; Melo, Anabela; Torres, Silvia; Mota, Lurdes; Costa, Fernanda

    2017-08-31

    The urinary incontinence can affect up to 50% of women at some stage of their lives, particularly during pregnancy and postpartum. This study was designed in order to identify and assess the prevalence and risk factors for urinary incontinence during the third trimester of pregnancy and three months postpartum. Observational and cross-sectional study. The population of the study was composed of 268 women who delivered and were admitted to the Centro Hospitalar Tâmega e Sousa in the years 2013 and 2014, and who agreed to participate in this study. Postpartum women were asked to fill out a questionnaire adapted from the International Consultation on Incontinence Questionnaire - Short Form, for urinary incontinence research in the third trimester of pregnancy. Three months after delivery, they were contacted by telephone and asked to answer the same questions about the urinary incontinence postpartum. Of the 268 women interviewed, 31 were excluded from the study, taking into account the defined inclusion and exclusion criteria. In total (n = 237), 51.89% of women included in the study, reported the occurrence of urinary incontinence during pregnancy. The prevalence of urinary incontinence in pregnancy by parity (primiparous versus multiparous) was statistically significant (p = 0.006). At postpartum (n = 237), 28.69% of women with urinary incontinence had vaginal delivery and 5.91% of women underwent cesarean delivery (p = 0.001). In these group of women with postpartum urinary incontinence (n = 82), 31.69% have had urinary incontinence only in the postpartum and 68.31% of women have had symptoms during pregnancy (p urinary incontinence in pregnancy and the respective decrease in postpartum. Multiparity and occurrence of urinary incontinence in pregnancy appear as potential risk factors in the emergence of the urinary incontinence.

  11. Nursing diagnoses in patients with chronic venous ulcer: observational study

    Directory of Open Access Journals (Sweden)

    Glycia de Almeida Nogueira

    2015-06-01

    Full Text Available This study aimed to analyze nursing diagnoses in people with chronic venous ulcer. An observational, descriptive, quantitative research conducted in an ambulatory specialized in wound treatment, with a non-probabilistic sample of 20 patients.  Data collection was performed in an institutional form denominated Assessment Protocol for Clients with Tissue Lesions. Diagnoses were established by consensus among four researchers with experience in nursing diagnoses and wound treatments. From data analysis, 16 diagnoses were identified, with 100% of participants presenting: Impaired tissue integrity, Ineffective peripheral tissue perfusion, Risk of infection, Impaired physical mobility and Ineffective health self-control. These diagnoses are found in Safety/Protection, Activity/Rest and Health promotion domains, which from the clinical practice stand point should be priority focuses in nursing intervention and assessment.

  12. Splenic lesions observed in 71 splenectomized dogs: a retrospective study

    Directory of Open Access Journals (Sweden)

    Elisângela Olegário da Silva

    2016-10-01

    Full Text Available The spleen of dogs is frequently affected by disorders that vary from local and systemic origin. The difficulty in associating clinical and gross findings contributes for the choice of total splenectomy as the main treatment, leading to an impairment of the immune and hematopoietic functions. The aim of this study was to evaluate the pathological findings in the spleen of splenectomized dogs during 2008 to 2014 at a Veterinary Teaching Hospital. From the 71 cases analyzed, 97% (69/71 of the dogs were submitted to total splenectomy and 3% (2/71 to partial splenectomy. In 45 (63.4% of these cases, the histopathological diagnosis was non-neoplastic alterations; only 36.6% (26/71 had a splenic neoplasia. The main non-neoplastic lesions observed were nodular hyperplasia 24.4% (11/45, infarction 22.3% (10/45, and hematoma 20% (9/45. The most frequent tumors were hemangiosarcoma 50% (13/26, histiocytic sarcoma 23% (6/26, and lymphoma 11.5% (3/26. The clinical methods used to diagnose splenic lesions were ultrasonography 88% (63/71, radiography 2.8% (2/71 and exploratory laparotomy 4.2% (3/71. In 4.2% (3/71 the spleen changes were observed during the therapeutic ovariohysterectomy. The results of the present study showed a prevalence of benign disorders in the spleen of splenectomized dogs associated with a high incidence of total splenectomy performed, indicating a difficulty in recognizing the different lesions that can affect the spleen by the veterinarian medical.

  13. Radiology workstation for mammography: preliminary observations, eyetracker studies, and design

    Science.gov (United States)

    Beard, David V.; Johnston, Richard E.; Pisano, Etta D.; Hemminger, Bradley M.; Pizer, Stephen M.

    1991-07-01

    For the last four years, the UNC FilmPlane project has focused on constructing a radiology workstation facilitating CT interpretations equivalent to those with film and viewbox. Interpretation of multiple CT studies was originally chosen because handling such large numbers of images was considered to be one of the most difficult tasks that could be performed with a workstation. The authors extend the FilmPlane design to address mammography. The high resolution and contrast demands coupled with the number of images often cross- compared make mammography a difficult challenge for the workstation designer. This paper presents the results of preliminary work with workstation interpretation of mammography. Background material is presented to justify why the authors believe electronic mammographic workstations could improve health care delivery. The results of several observation sessions and a preliminary eyetracker study of multiple-study mammography interpretations are described. Finally, tentative conclusions of what a mammographic workstation might look like and how it would meet clinical demand to be effective are presented.

  14. Observational studies of X-ray binary systems

    International Nuclear Information System (INIS)

    Klis, M. van der.

    1983-01-01

    The subject of Chapter 1 is theoretical. The other chapters, Ch. 2 to 6, contain original observational data and efforts towards their interpretation. Of these, Ch. 3, 4 and 5 deal with massive X-ray binaries, Ch. 6 with low-mass systems and Ch. 2 with Cygnus X-3, which we have not yet been able to assign to any of these two classes. The X-ray observations described were made with the COS-B satellite. Work based on UV and optical observations is described in Ch. 5. The UV observations were made with the IUE satellite, the optical observations at several ground-based observatories. (Auth.)

  15. Satellite Observation Systems for Polar Climate Change Studies

    Science.gov (United States)

    Comiso, Josefino C.

    2012-01-01

    The key observational tools for detecting large scale changes of various parameters in the polar regions have been satellite sensors. The sensors include passive and active satellite systems in the visible, infrared and microwave frequencies. The monitoring started with Tiros and Nimbus research satellites series in the 1970s but during the period, not much data was stored digitally because of limitations and cost of the needed storage systems. Continuous global data came about starting with the launch of ocean color, passive microwave, and thermal infrared sensors on board Nimbus-7 and Synthetic Aperture Radar, Radar Altimeter and Scatterometer on board SeaSat satellite both launched in 1978. The Nimbus-7 lasted longer than expected and provided about 9 years of useful data while SeaSat quit working after 3 months but provided very useful data that became the baseline for follow-up systems with similar capabilities. Over the years, many new sensors were launched, some from Japan Aeronautics and Space Agency (JAXA), some from the European Space Agency (ESA) and more recently, from RuSSia, China, Korea, Canada and India. For polar studies, among the most useful sensors has been the passive microwave sensor which provides day/night and almost all weather observation of the surface. The sensor provide sea surface temperature, precipitation, wind, water vapor and sea ice concentration data that have been very useful in monitoring the climate of the region. More than 30 years of such data are now available, starting with the Scanning Multichannel Microwave Radiometer (SMMR) on board the Nimbus-7, the Special Scanning Microwave/Imager (SSM/I) on board a Defense Meteorological Satellite Program (DMSP) and the Advanced Microwave Scanning Radiometer on board the EOS/ Aqua satellite. The techniques that have been developed to derive geophysical parameters from data provided by these and other sensors and associated instrumental and algorithm errors and validation techniques

  16. Oral implications of the vegan diet: observational study.

    Science.gov (United States)

    Laffranchi, L; Zotti, F; Bonetti, S; Dalessandri, D; Fontana, P

    2010-01-01

    The aim of this study was to investigate oral changes in subjects who have assumed a vegan diet for a long time (at least 18 months), that is to say, a diet completely lacking in meat and animal derivatives. A sample of 15 subjects was analyzed, all from northern Italy and aged 24 to 60 year, composed of 11 men and 4 women who had been following a vegan diet for a minimum of 18 months to a maximum of 20 years. In parallel with the study sample, a control group (15 subjects) with the same criteria of age, sex, and place of origin all following an omnivorous diet was chosen. The sample answered a questionnaire that investigated their eating habits, the frequency with which they eat meals, the main foodstuffs assumed, oral hygiene habits, and any painful symptomatology of the teeth or more general problems in the oral cavity. The sample was then subject to objective examination in which the saliva pH was measured and the teeth were checked for demineralization of the enamel, white spots, and caries (using KaVo DIAGNOdent) with particular attention being paid to the localization of these lesions, and lastly, sounding was carried out to detect any osseous defects and periodontal pockets. The study revealed greater incidence of demineralization and white spots in the vegan subjects compared to the omnivorous ones localized at the neck of the teeth and on the vestibular surfaces of dental elements (with the exception of the lower anterior group). The saliva pH, more acid in the omnivorous patients, ranged between four and six. Changes in oral conditions in both groups of subjects were observed. In order to research into the cause-effect relationship of the vegan diet on the oral cavity effectively, the sample needs to be studied for a longer period of time and the results re-evaluated.

  17. Estimation of Skin to Subarachnoid Space Depth: An Observational Study.

    Science.gov (United States)

    Hazarika, Rajib; Choudhury, Dipika; Nath, Sangeeta; Parua, Samit

    2016-10-01

    In a patient, the skin to Subarachnoid Space Depth (SSD) varies considerably at different levels of the spinal cord. It also varies from patient to patient at the same vertebral level as per age, sex and Body Mass Index (BMI). Estimation of the skin to SSD reduces complications related to spinal anaesthesia. To measure the skin to SSD in the Indian population and to find a formula for predicting this depth. Three hundred adult patients belonging to American Society of Anaesthesiologist class I and II, undergoing surgery using spinal anaesthesia in various surgical specialities of Gauhati Medical College were selected by systemic sampling for this prospective, observational study. Patients were divided into three groups: Group M containing male patients, Group F containing non-pregnant female patients, and Group PF containing pregnant female's patients. SSD was measured after performing lumbar puncture. The relationship between SSD and patient characteristics were studied, correlated and statistical analysis was used to find a formula for predicting the skin to SSD. Statistical analysis was done using Statistical Package for Social Sciences (SPSS 21.0, Chicago, IL, USA). One-way ANOVA with post-hoc(Bonferroni correction factor) analysis was applied to compare the three groups. Multivariate analysis was done for the covariates followed by a multivariate regression analysis to evaluate the covariates influencing SSD for each group separately. Mean SSD was 4.37±0.31cm in the overall population. SSD in adult males was 4.49±0.19cm which was significantly longer than that observed in female's 4.18±0.39cm which was comparable with SSD in parturient 4.43±0.19 cm. The formula for predicting the skin to SSD in the male population was 1.718+0.077×BMI+0.632×Height, in nonpregnant female population was 1.828+0.077×BMI+0.018×Height+0.007×Age and 0.748+0.209×BMI+4.703×Height-0.054×weight in parturient females, respectively. Skin to SSD correlated with the BMI in all

  18. Observational Study on Safety of Prehospital BLS CPAP in Dyspnea.

    Science.gov (United States)

    Sahu, Novneet; Matthews, Patrick; Groner, Kathryn; Papas, Mia A; Megargel, Ross

    2017-12-01

    Introduction Continuous positive airway pressure (CPAP) improves outcomes in patients with respiratory distress. Additional benefits are seen with CPAP application in the prehospital setting. Theoretical safety concerns regarding Basic Life Support (BLS) providers using CPAP exist. In Delaware's (USA) two-tiered Emergency Medical Service (EMS) system, BLS often arrives before Advanced Life Support (ALS). Hypothesis This study fills a gap in literature by evaluating the safety of CPAP applied by BLS prior to ALS arrival. This was a retrospective, observational study using Quality Assurance (QA) data collected from October 2009 through December 2012 throughout a state BLS CPAP pilot program; CPAP training was provided to BLS providers prior to participation. Collected data include pulse-oximetry (spO2), respiratory rate (RR), heart rate (HR), skin color, and Glasgow Coma Score (GCS) before and after CPAP application. Pre-CPAP and post-CPAP values were compared using McNemar's and t-tests. Advanced practitioners evaluated whether CPAP was correctly applied and monitored and whether the patient condition was "improved," "unchanged," or "worsened." Seventy-four patients received CPAP by BLS; CPAP was correctly indicated and applied for all 74 patients. Respiratory status and CPAP were appropriately monitored and documented in the majority of cases (98.6%). A total of 89.2% of patients improved and 4.1% worsened; CPAP significantly reduced the proportion of patients with SpO224, and cyanosis (PCPAP (mean difference [MD]=0.17; 95% CI, -0.49 to 0.83; P=.59). The HR decreased from 115.7 (SD=53) to 105.1 (SD=37) after CPAP (MD=-10.9; 95% CI, -3.2 to -18.6; PCPAP (MD=17.8; 95% CI, 14.2-21.5; PCPAP was indicated, to apply it correctly, and to appropriately monitor the status of these patients. The majority of patients who received CPAP by BLS providers had improvement in their clinical status and vital signs. The findings suggest that CPAP can be safely used by BLS providers

  19. Southeast Atmosphere Studies: learning from model-observation syntheses

    Directory of Open Access Journals (Sweden)

    J. Mao

    2018-02-01

    Full Text Available Concentrations of atmospheric trace species in the United States have changed dramatically over the past several decades in response to pollution control strategies, shifts in domestic energy policy and economics, and economic development (and resulting emission changes elsewhere in the world. Reliable projections of the future atmosphere require models to not only accurately describe current atmospheric concentrations, but to do so by representing chemical, physical and biological processes with conceptual and quantitative fidelity. Only through incorporation of the processes controlling emissions and chemical mechanisms that represent the key transformations among reactive molecules can models reliably project the impacts of future policy, energy and climate scenarios. Efforts to properly identify and implement the fundamental and controlling mechanisms in atmospheric models benefit from intensive observation periods, during which collocated measurements of diverse, speciated chemicals in both the gas and condensed phases are obtained. The Southeast Atmosphere Studies (SAS, including SENEX, SOAS, NOMADSS and SEAC4RS conducted during the summer of 2013 provided an unprecedented opportunity for the atmospheric modeling community to come together to evaluate, diagnose and improve the representation of fundamental climate and air quality processes in models of varying temporal and spatial scales.This paper is aimed at discussing progress in evaluating, diagnosing and improving air quality and climate modeling using comparisons to SAS observations as a guide to thinking about improvements to mechanisms and parameterizations in models. The effort focused primarily on model representation of fundamental atmospheric processes that are essential to the formation of ozone, secondary organic aerosol (SOA and other trace species in the troposphere, with the ultimate goal of understanding the radiative impacts of these species in the southeast and

  20. [Pregnancy-Associated Breast Cancer: An analytical observational study].

    Science.gov (United States)

    Baulies, Sonia; Cusidó, Maite; Tresserra, Francisco; Rodríguez, Ignacio; Ubeda, Belén; Ara, Carmen; Fábregas, Rafael

    2014-03-04

    Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum. A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared. The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P < .05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P < .05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively. The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade iii, as well as a delay in diagnosis with a higher rate of advanced stages. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  1. Southeast Atmosphere Studies: learning from model-observation syntheses

    Science.gov (United States)

    Mao, Jingqiu; Carlton, Annmarie; Cohen, Ronald C.; Brune, William H.; Brown, Steven S.; Wolfe, Glenn M.; Jimenez, Jose L.; Pye, Havala O. T.; Ng, Nga Lee; Xu, Lu; McNeill, V. Faye; Tsigaridis, Kostas; McDonald, Brian C.; Warneke, Carsten; Guenther, Alex; Alvarado, Matthew J.; de Gouw, Joost; Mickley, Loretta J.; Leibensperger, Eric M.; Mathur, Rohit; Nolte, Christopher G.; Portmann, Robert W.; Unger, Nadine; Tosca, Mika; Horowitz, Larry W.

    2018-02-01

    Concentrations of atmospheric trace species in the United States have changed dramatically over the past several decades in response to pollution control strategies, shifts in domestic energy policy and economics, and economic development (and resulting emission changes) elsewhere in the world. Reliable projections of the future atmosphere require models to not only accurately describe current atmospheric concentrations, but to do so by representing chemical, physical and biological processes with conceptual and quantitative fidelity. Only through incorporation of the processes controlling emissions and chemical mechanisms that represent the key transformations among reactive molecules can models reliably project the impacts of future policy, energy and climate scenarios. Efforts to properly identify and implement the fundamental and controlling mechanisms in atmospheric models benefit from intensive observation periods, during which collocated measurements of diverse, speciated chemicals in both the gas and condensed phases are obtained. The Southeast Atmosphere Studies (SAS, including SENEX, SOAS, NOMADSS and SEAC4RS) conducted during the summer of 2013 provided an unprecedented opportunity for the atmospheric modeling community to come together to evaluate, diagnose and improve the representation of fundamental climate and air quality processes in models of varying temporal and spatial scales.This paper is aimed at discussing progress in evaluating, diagnosing and improving air quality and climate modeling using comparisons to SAS observations as a guide to thinking about improvements to mechanisms and parameterizations in models. The effort focused primarily on model representation of fundamental atmospheric processes that are essential to the formation of ozone, secondary organic aerosol (SOA) and other trace species in the troposphere, with the ultimate goal of understanding the radiative impacts of these species in the southeast and elsewhere. Here we

  2. Study of Rayleigh-Love coupling from Spatial Gradient Observation

    Science.gov (United States)

    Lin, C. J.; Hosseini, K.; Donner, S.; Vernon, F.; Wassermann, J. M.; Igel, H.

    2017-12-01

    We present a new method to study Rayleigh-Love coupling. Instead of using seismograms solely, where ground motion is recorded as function of time, we incorporate with rotation and strain, also called spatial gradient where ground is represented as function of distance. Seismic rotation and strain are intrinsic different observable wavefield so are helpful to indentify wave type and wave propagation. A Mw 7.5 earthquake on 29 March 2015 occurred in Kokopo, Papua New Guinea recorded by a dense seismic array at PFO, California are used to obtaint seismic spatial gradient. We firstly estimate time series of azimuthal direction and phase velocity of SH wave and Rayleigh wave by analyzing collocated seismograms and rotations. This result also compares with frequency wavenumber methods using a nearby ANZA seismic array. We find the direction of Rayleigh wave fits well with great-circle back azimuth during wave propagation, while the direction of Love wave deviates from that, especially when main energy of Rayleigh wave arrives. From the analysis of cross-correlation between areal strain and vertical rotation, it reveals that high coherence, either positive or negative, happens at the same time when Love wave deparate from great-circle path. We also find the observed azimuth of Love wave and polarized particle motion of Rayleigh wave fits well with the fast direction of Rayleigh wave, for the period of 50 secs. We conclude the cause of deviated azimuth of Love wave is due to Rayleigh-Love coupling, as surface wave propagates through the area with anisotropic structure.

  3. Evaluation of an educational "toolbox" for improving nursing staff competence and psychosocial work environment in elderly care: results of a prospective, non-randomized controlled intervention.

    Science.gov (United States)

    Arnetz, J E; Hasson, H

    2007-07-01

    Lack of professional development opportunities among nursing staff is a major concern in elderly care and has been associated with work dissatisfaction and staff turnover. There is a lack of prospective, controlled studies evaluating the effects of educational interventions on nursing competence and work satisfaction. The aim of this study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of their competence, psychosocial work environment and overall work satisfaction. The study was a prospective, non-randomized, controlled intervention. Nursing staff in two municipal elderly care organizations in western Sweden. In an initial questionnaire survey, nursing staff in the intervention municipality described several areas in which they felt a need for competence development. Measurement instruments and educational materials for improving staff knowledge and work practices were then collated by researchers and managers in a "toolbox." Nursing staff ratings of their competence and work were measured pre and post-intervention by questionnaire. Staff ratings in the intervention municipality were compared to staff ratings in the reference municipality, where no toolbox was introduced. Nursing staff ratings of their competence and psychosocial work environment, including overall work satisfaction, improved significantly over time in the intervention municipality, compared to the reference group. Both competence and work environment ratings were largely unchanged among reference municipality staff. Multivariate analysis revealed a significant interaction effect between municipalities over time for nursing staff ratings of participation, leadership, performance feedback and skills' development. Staff ratings for these four scales improved significantly in the intervention municipality as compared to the reference municipality. Compared to a reference municipality, nursing staff ratings of their competence and the

  4. Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach

    Directory of Open Access Journals (Sweden)

    Dirks Maaike

    2010-11-01

    Full Text Available Abstract Background Economic evaluation of stroke services indicates that such services may lead to improved quality of life at affordable cost. The present study assesses lifetime health impact and cost consequences of stroke in an integrated service setting. Methods The EDISSE study is a prospective non-randomized controlled cluster trial that compared stroke services (n = 151 patients to usual care (n = 187 patients. Health status and cost trial-data were entered in multi-dimensional stroke life-tables. The tables distinguish four levels of disability which are defined by the modified Rankin scale. Quality-of-life scores (EuroQoL-5D, transition and survival probabilities are based on concurrent Dutch follow-up studies. Outcomes are quality-adjusted life years lived and lifetime medical cost by disability category. An economic analysis compares outcomes from a successful stroke service to usual care, by bootstrapping individual costs and effects data from patients in each arm. Results Lifetime costs and QALYs after stroke depend on age-of-onset of first-ever stroke. Lifetime QALYs after stroke are 2.42 (90% CI - 0.49 - 2.75 for male patients in usual care and 2.75 (-0.61; 6.26 for females. Lifetime costs for men in the usual care setting are €39,335 (15,951; 79,837 and €42,944 (14,081; 95,944 for women. A comparison with the stroke service results in an ICER of €11,685 saved per QALY gained (€14,211 and €7,745 for men and women respectively. This stroke service is with 90% certainty cost-effective. Conclusions Our analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.

  5. A prospective, non-randomized phase II trial of Trastuzumab and Capecitabine in patients with HER2 expressing metastasized pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Endlicher Esther

    2009-01-01

    Full Text Available Abstract Background Pancreatic cancer is the fourth most common cause of cancer related death in Western countries. Advantages in surgical techniques, radiation and chemotherapy had almost no impact on the long term survival of affected patients. Therefore, the need for better treatment strategies is urgent. HER2, a receptor tyrosine kinase of the EGFR family, involved in signal transduction pathways leading to cell growth and differentiation is overexpressed in a number of cancers, including breast and pancreatic cancer. While in breast cancer HER2 has already been successfully used as a treatment target, there are only limited data evaluating the effects of inhibiting HER2 tyrosine kinases in patients with pancreatic cancer. Methods Here we report the design of a prospective, non-randomized multi-centered Phase II clinical study evaluating the effects of the Fluoropyrimidine-carbamate Capecitabine (Xeloda ® and the monoclonal anti-HER2 antibody Trastuzumab (Herceptin® in patients with non-resectable, HER2 overexpressing pancreatic cancer. Patients eligible for the study will receive Trastuzumab infusions on day 1, 8 and 15 concomitant to the oral intake of Capecitabine from day 1 to day 14 of each three week cylce. Cycles will be repeated until tumor progression. A total of 37 patients will be enrolled with an interim analysis after 23 patients. Discussion Primary end point of the study is to determine the progression free survival after 12 weeks of bimodal treatment with the chemotherapeutic agent Capecitabine and the anti-HER2 antibody Trastuzumab. Secondary end points include patient's survival, toxicity analysis, quality of life, the correlation of HER2 overexpression and clinical response to Trastuzumab treatment and, finally, the correlation of CA19-9 plasma levels and progression free intervals.

  6. Safe medication management in specialized home healthcare - an observational study.

    Science.gov (United States)

    Lindblad, Marléne; Flink, Maria; Ekstedt, Mirjam

    2017-08-24

    Medication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering. Data were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory. The MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients' active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies. To manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals' strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients' and family caregivers' as active partners in the MMP may be an underestimated resource for a resilient home healthcare.

  7. A school intervention for mental health literacy in adolescents: effects of a non-randomized cluster controlled trial

    Science.gov (United States)

    2013-01-01

    Background “Mental health for everyone” is a school program for mental health literacy and prevention aimed at secondary schools (13–15 yrs). The main aim was to investigate whether mental health literacy, could be improved by a 3-days universal education programme by: a) improving naming of symptom profiles of mental disorder, b) reducing prejudiced beliefs, and c) improving knowledge about where to seek help for mental health problems. A secondary aim was to investigate whether adolescent sex and age influenced the above mentioned variables. A third aim was to investigate whether prejudiced beliefs influenced knowledge about available help. Method This non-randomized cluster controlled trial included 1070 adolescents (53.9% boys, M age14 yrs) from three schools in a Norwegian town. One school (n = 520) received the intervention, and two schools (n = 550) formed the control group. Pre-test and follow-up were three months apart. Linear mixed models and generalized estimating equations models were employed for analysis. Results Mental health literacy improved contingent on the intervention, and there was a shift towards suggesting primary health care as a place to seek help. Those with more prejudiced beleifs did not suggest places to seek help for mental health problems. Generally, girls and older adolescents recognized symptom profiles better and had lower levels of prejudiced beliefs. Conclusions A low cost general school program may improve mental health literacy in adolescents. Gender specific programs and attention to the age and maturity of the students should be considered when mental health literacy programmes are designed and tried out. Prejudice should be addressed before imparting information about mental health issues. PMID:24053381

  8. Telomere disruption results in non-random formation of de novo dicentric chromosomes involving acrocentric human chromosomes.

    Directory of Open Access Journals (Sweden)

    Kaitlin M Stimpson

    2010-08-01

    Full Text Available Genome rearrangement often produces chromosomes with two centromeres (dicentrics that are inherently unstable because of bridge formation and breakage during cell division. However, mammalian dicentrics, and particularly those in humans, can be quite stable, usually because one centromere is functionally silenced. Molecular mechanisms of centromere inactivation are poorly understood since there are few systems to experimentally create dicentric human chromosomes. Here, we describe a human cell culture model that enriches for de novo dicentrics. We demonstrate that transient disruption of human telomere structure non-randomly produces dicentric fusions involving acrocentric chromosomes. The induced dicentrics vary in structure near fusion breakpoints and like naturally-occurring dicentrics, exhibit various inter-centromeric distances. Many functional dicentrics persist for months after formation. Even those with distantly spaced centromeres remain functionally dicentric for 20 cell generations. Other dicentrics within the population reflect centromere inactivation. In some cases, centromere inactivation occurs by an apparently epigenetic mechanism. In other dicentrics, the size of the alpha-satellite DNA array associated with CENP-A is reduced compared to the same array before dicentric formation. Extra-chromosomal fragments that contained CENP-A often appear in the same cells as dicentrics. Some of these fragments are derived from the same alpha-satellite DNA array as inactivated centromeres. Our results indicate that dicentric human chromosomes undergo alternative fates after formation. Many retain two active centromeres and are stable through multiple cell divisions. Others undergo centromere inactivation. This event occurs within a broad temporal window and can involve deletion of chromatin that marks the locus as a site for CENP-A maintenance/replenishment.

  9. Large-area imaging reveals biologically driven non-random spatial patterns of corals at a remote reef

    Science.gov (United States)

    Edwards, Clinton B.; Eynaud, Yoan; Williams, Gareth J.; Pedersen, Nicole E.; Zgliczynski, Brian J.; Gleason, Arthur C. R.; Smith, Jennifer E.; Sandin, Stuart A.

    2017-12-01

    For sessile organisms such as reef-building corals, differences in the degree of dispersion of individuals across a landscape may result from important differences in life-history strategies or may reflect patterns of habitat availability. Descriptions of spatial patterns can thus be useful not only for the identification of key biological and physical mechanisms structuring an ecosystem, but also by providing the data necessary to generate and test ecological theory. Here, we used an in situ imaging technique to create large-area photomosaics of 16 plots at Palmyra Atoll, central Pacific, each covering 100 m2 of benthic habitat. We mapped the location of 44,008 coral colonies and identified each to the lowest taxonomic level possible. Using metrics of spatial dispersion, we tested for departures from spatial randomness. We also used targeted model fitting to explore candidate processes leading to differences in spatial patterns among taxa. Most taxa were clustered and the degree of clustering varied by taxon. A small number of taxa did not significantly depart from randomness and none revealed evidence of spatial uniformity. Importantly, taxa that readily fragment or tolerate stress through partial mortality were more clustered. With little exception, clustering patterns were consistent with models of fragmentation and dispersal limitation. In some taxa, dispersion was linearly related to abundance, suggesting density dependence of spatial patterning. The spatial patterns of stony corals are non-random and reflect fundamental life-history characteristics of the taxa, suggesting that the reef landscape may, in many cases, have important elements of spatial predictability.

  10. Exploring interprofessional, interagency multimorbidity care: case study based observational research

    Science.gov (United States)

    McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.

    2017-01-01

    Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID

  11. Coordinated Regional Benefit Studies of Coastal Ocean Observing Systems

    National Research Council Canada - National Science Library

    Kite-Powell, Hauke L; Colgan, Charles S; Luger, Michael; Wieand, Ken; Pulsipher, Allan; Pendleton, Linwood; Wellman, Katherine; Pelsoci, Tom

    2003-01-01

    .... The authors will first produce regional "inventories" of ocean observation user sectors, including information about the physical and economic scale of their activities, how products from improved...

  12. Corneal permeability changes in dry eye disease: an observational study.

    Science.gov (United States)

    Fujitani, Kenji; Gadaria, Neha; Lee, Kyu-In; Barry, Brendan; Asbell, Penny

    2016-05-13

    Diagnostic tests for dry eye disease (DED), including ocular surface disease index (OSDI), tear breakup time (TBUT), corneal fluorescein staining, and lissamine staining, have great deal of variability. We investigated whether fluorophotometry correlated with previously established DED diagnostic tests and whether it could serve as a novel objective metric to evaluate DED. Dry eye patients who have had established signs or symptoms for at least 6 months were included in this observational study. Normal subjects with no symptoms of dry eyes served as controls. Each eye had a baseline fluorescein scan prior to any fluorescein dye. Fluorescein dye was then placed into both eyes, rinsed with saline solution, and scanned at 5, 10, 15, and 30 min. Patients were administered the following diagnostic tests to correlate with fluorophotometry: OSDI, TBUT, fluorescein, and lissamine. Standard protocols were used. P eyes from 25 patients (DED = 22 eyes, 11 patients; Normal = 28 eyes, 14 patients) were included. Baseline scans of the dry eye and control groups did not show any statistical difference (p = 0.84). Fluorescein concentration of DED and normal patients showed statistical significance at all time intervals (p eyes up to 30 min after fluorescein dye instillation. There may be an aspect of DED that is missed in the current regimen of DED tests and only captured with fluorophotometry. Adding fluorophotometry may be useful in screening, diagnosing, and monitoring patients with DED.

  13. Observational study of drug-drug interactions in oncological inpatients

    Directory of Open Access Journals (Sweden)

    María Sacramento Díaz-Carrasco

    2018-01-01

    Full Text Available Objective: To determine the prevalence of potential clinically relevant drug- drug interactions in adult oncological inpatients, as well as to describe the most frequent interactions. A standard database was used. Method: An observational, transversal, and descriptive study including patients admitted to the Oncology Service of a reference hospital. All prescriptions were collected twice a week during a month. They were analysed using Lexicomp® database, recording all interactions classified with a level of risk: C, D or X. Results: A total of 1 850 drug-drug interactions were detected in 218 treatments. The prevalence of treatments with at least one clinically relevant interaction was 95%, being 94.5% for those at level C and 26.1% for levels D and X. The drugs most commonly involved in the interactions detected were opioid analgesics, antipsychotics (butyrophenones, benzodiazepines, pyrazolones, glucocorticoids and heparins, whereas interactions with antineoplastics were minimal, highlighting those related to paclitaxel and between metamizole and various antineoplastics. Conclusions: The prevalence of clinically relevant drug-drug interactions rate was very high, highlighting the high risk percentage of them related to level of risk X. Due to the frequency of onset and potential severity, highlighted the concomitant use of central nervous system depressants drugs with risk of respiratory depression, the risk of onset of anticholinergic symptoms when combining morphine or haloperidol with butylscopolamine, ipratropium bromide or dexchlorpheniramine and the multiple interactions involving metamizole.

  14. Young adult smoking in peer groups: an experimental observational study.

    Science.gov (United States)

    Harakeh, Zeena; Vollebergh, Wilma A M

    2013-03-01

    The aim of this experimental observational study is to examine whether, in a group setting (same-sex triads), passive peer influence (imitation) in the context of homogeneous and heterogeneous (contradictory) behavior of peer models affects young adults' smoking behavior. An experiment was conducted among 48 daily-smoking college and university students aged 17-25. Participants had to complete a 30-min music task with two same-sex confederates. We tested the following three conditions: (a) neither of the confederates is smoking, (b) one confederate is smoking and the other is not, and (c) both confederates are smoking. The primary outcome tested was the total number of cigarettes smoked during the task. Students in the condition with two smoking peer models and in the condition with one smoking peer model and one nonsmoking peer model smoked significantly more cigarettes than those in the condition with two nonsmoking peer models. However, results for the condition with two smoking peer models did not differ significantly from the condition with one smoking peer model and one nonsmoking peer model. Our findings show that in a group setting, the impact of the homogeneity of smoking peers on young adults' smoking behavior is not greater than the impact of the heterogeneity of smoking and nonsmoking peers. This would suggest that the smoking peer in the group has a greater impact on the daily-smoking young adult, thus reducing or even eliminating the protective effect of the nonsmoking peer model.

  15. External Validation of the HERNIAscore: An Observational Study.

    Science.gov (United States)

    Cherla, Deepa V; Moses, Maya L; Mueck, Krislynn M; Hannon, Craig; Ko, Tien C; Kao, Lillian S; Liang, Mike K

    2017-09-01

    The HERNIAscore is a ventral incisional hernia (VIH) risk assessment tool that uses only preoperative variables and predictable intraoperative variables. The aim of this study was to validate and modify, if needed, the HERNIAscore in an external dataset. This was a retrospective observational study of all patients undergoing resection for gastrointestinal malignancy from 2011 through 2015 at a safety-net hospital. The primary end point was clinical postoperative VIH. Patients were stratified into low-risk, medium-risk, and high-risk groups based on HERNIAscore. A revised HERNIAscore was calculated with the addition of earlier abdominal operation as a categorical variable. Cox regression of incisional hernia with stratification by risk class was performed. Incidence rates of clinical VIH formation within each risk class were also calculated. Two hundred and forty-seven patents were enrolled. On Cox regression, in addition to the 3 variables of the HERNIAscore (BMI, COPD, and incision length), earlier abdominal operation was also predictive of VIH. The revised HERNIAscore demonstrated improved predictive accuracy for clinical VIH. Although the original HERNIAscore effectively stratified the risk of an incisional radiographic VIH developing, the revised HERNIAscore provided a statistically significant stratification for both clinical and radiographic VIHs in this patient cohort. We have externally validated and improved the HERNIAscore. The revised HERNIAscore uses BMI, incision length, COPD, and earlier abdominal operation to predict risk of postoperative incisional hernia. Future research should assess methods to prevent incisional hernias in moderate-to-high risk patients. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  16. An observational study of disk-population globular clusters

    International Nuclear Information System (INIS)

    Armandroff, T.E.

    1988-01-01

    Integrated-light spectroscopy was obtained for twenty-seven globular clusters at the Ca II infrared triplet. Line strengths and radial velocities were measured from the spectra. For the well-studied clusters in the sample, the strength of the CA II lines is very well correlated with previous metallicity estimates obtained using a variety of techniques. The greatly reduced effect of interstellar extinction at these wavelengths compared to the blue region of the spectrum has permitted observations of some of the most heavily reddened clusters in the Galaxy. For several such clusters, the Ca II triplet metallicities are in poor agreement with metallicity estimates from infrared photometry by Malkan. Color-magnitude diagrams were constructed for six previously unstudied metal-rich globular clusters and for the well-studied cluster 47 Tuc. The V magnitudes of the horizontal branch stars in the six clusters are in poor agreement with previous estimates based on secondary methods. The horizontal branch morphologies and reddenings of the program clusters were also determined. Using the improved set of metallicities, radial velocities, and distance moduli, the spatial distribution, kinematics, and metallicity distribution of the Galactic globulars were analyzed. The revised data supports Zinn's conclusion that the metal-rich clusters form a highly flattened, rapidly rotating disk system, while the metal-poor clusters make up the familiar, spherically distributed, slowly rotating halo population. The scale height, metallicity distribution, and kinematics of the metal-rich globulars are in good agreement with those of the stellar thick disk. Luminosity functions were constructed, and no significant difference is found between disk and halo samples. Metallicity gradients seem to be present in the disk cluster system. The implications of these results for the formation and evol

  17. Sensitivity of dose-finding studies to observation errors.

    Science.gov (United States)

    Zohar, Sarah; O'Quigley, John

    2009-11-01

    The purpose of Phase I designs is to estimate the MTD (maximum tolerated dose, in practice a dose with some given acceptable rate of toxicity) while, at the same time, minimizing the number of patients treated at doses too far removed from the MTD. Our purpose here is to investigate the sensitivity of conclusions from dose-finding designs to recording or observation errors. Certain toxicities may go undetected and, conversely, certain non-toxicities may be incorrectly recorded as dose-limiting toxicities. Recording inaccuracies would be expected to have an influence on final and within trial recommendations and, in this paper, we study in greater depth this question. We focus, in particular on three designs used currently; the standard '3+3' design, the grouped up-and-down design [M. Gezmu, N. Flournoy, Group up-and-down designs for dose finding. Journal of Statistical Planning and Inference 2006; 136 (6): 1749-1764.] and the continual reassessment method (CRM, [J. O'Quigley, M. Pepe, L. Fisher, Continual reassessment method: a practical design for phase 1 clinical trials in cancer. Biometrics 1990; 46 (1): 33-48.]). A non-toxicity incorrectly recorded as a toxicity (error of first kind) has a greater influence in general than the converse (error of second kind). These results are illustrated via figures which suggest that the standard '3+3' design in particular is sensitive to errors of the second kind. Such errors can have a very important impact on drug development in that, if carried through to the Phase 2 and Phase 3 studies, we can significantly increase the probability of failure to detect efficacy as a result of having delivered an inadequate dose.

  18. Giant cell arteritis: a multicenter observational study in Brazil

    Directory of Open Access Journals (Sweden)

    Alexandre Wagner Silva de Souza

    2013-01-01

    Full Text Available OBJECTIVE: To describe demographic features, disease manifestations and therapy in patients with giant cell arteritis from referral centers in Brazil. METHODS: A retrospective cohort study was performed on 45 giant cell arteritis patients from three university hospitals in Brazil. Diagnoses were based on the American College of Rheumatology classification criteria for giant cell arteritis or temporal artery biopsy findings. RESULTS: Most patients were Caucasian, and females were slightly more predominant. The frequencies of disease manifestations were as follows: temporal headache in 82.2%, neuro-ophthalmologic manifestations in 68.9%, jaw claudication in 48.9%, systemic symptoms in 44.4%, polymyalgia rheumatica in 35.6% and extra-cranial vessel involvement in 17.8% of cases. Aortic aneurysms were observed in 6.6% of patients. A comparison between patients with biopsy-proven giant cell arteritis and those without temporal artery biopsies did not yield significant differences in disease manifestations. All patients were treated with oral prednisone, and intravenous methylprednisolone was administered to nearly half of the patients. Methotrexate was the most commonly used immunosuppressive agent, and low-dose aspirin was prescribed to the majority of patients. Relapses occurred in 28.9% of patients, and aspirin had a protective effect against relapses. Females had higher prevalences of polymyalgia rheumatica, systemic manifestations and jaw claudication, while permanent visual loss was more prevalent in men. CONCLUSIONS: Most of the clinical features of Brazilian giant cell arteritis patients were similar to those found in other studies, except for the high prevalence of neuro-ophthalmic manifestations and permanent blindness in the Brazilian patients. Aspirin had a protective effect on relapses.

  19. Active Bleeding after Cardiac Surgery: A Prospective Observational Multicenter Study.

    Directory of Open Access Journals (Sweden)

    Pascal H Colson

    Full Text Available To estimate the incidence of active bleeding after cardiac surgery (AB based on a definition directly related on blood flow from chest drainage; to describe the AB characteristics and its management; to identify factors of postoperative complications.AB was defined as a blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or in case of reoperation for hemostasis during the first 12 postoperative hours. The definition was applied in a prospective longitudinal observational study involving 29 French centers; all adult patients undergoing cardiac surgery with cardiopulmonary bypass were included over a 3-month period. Perioperative data (including blood product administration were collected. To study possible variation in clinical practice among centers, patients were classified into two groups according to the AB incidence of the center compared to the overall incidence: "Low incidence" if incidence is lower and "High incidence" if incidence is equal or greater than overall incidence. Logistic regression analysis was used to identify risk factors of postoperative complications.Among 4,904 patients, 129 experienced AB (2.6%, among them 52 reoperation. Postoperative bleeding loss was 1,000 [820;1,375] ml and 1,680 [1,280;2,300] ml at 6 and 24 hours respectively. Incidence of AB varied between centers (0 to 16% but was independent of in-centre cardiac surgical experience. Comparisons between groups according to AB incidence showed differences in postoperative management. Body surface area, preoperative creatinine, emergency surgery, postoperative acidosis and red blood cell transfusion were risk factors of postoperative complication.A blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or early reoperation for hemostasis seems a relevant definition of AB. This definition, independent of transfusion, adjusted to body weight, may assess real time bleeding occurring early after surgery.

  20. Active Bleeding after Cardiac Surgery: A Prospective Observational Multicenter Study.

    Science.gov (United States)

    Colson, Pascal H; Gaudard, Philippe; Fellahi, Jean-Luc; Bertet, Héléna; Faucanie, Marie; Amour, Julien; Blanloeil, Yvonnick; Lanquetot, Hervé; Ouattara, Alexandre; Picot, Marie Christine

    2016-01-01

    To estimate the incidence of active bleeding after cardiac surgery (AB) based on a definition directly related on blood flow from chest drainage; to describe the AB characteristics and its management; to identify factors of postoperative complications. AB was defined as a blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or in case of reoperation for hemostasis during the first 12 postoperative hours. The definition was applied in a prospective longitudinal observational study involving 29 French centers; all adult patients undergoing cardiac surgery with cardiopulmonary bypass were included over a 3-month period. Perioperative data (including blood product administration) were collected. To study possible variation in clinical practice among centers, patients were classified into two groups according to the AB incidence of the center compared to the overall incidence: "Low incidence" if incidence is lower and "High incidence" if incidence is equal or greater than overall incidence. Logistic regression analysis was used to identify risk factors of postoperative complications. Among 4,904 patients, 129 experienced AB (2.6%), among them 52 reoperation. Postoperative bleeding loss was 1,000 [820;1,375] ml and 1,680 [1,280;2,300] ml at 6 and 24 hours respectively. Incidence of AB varied between centers (0 to 16%) but was independent of in-centre cardiac surgical experience. Comparisons between groups according to AB incidence showed differences in postoperative management. Body surface area, preoperative creatinine, emergency surgery, postoperative acidosis and red blood cell transfusion were risk factors of postoperative complication. A blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or early reoperation for hemostasis seems a relevant definition of AB. This definition, independent of transfusion, adjusted to body weight, may assess real time bleeding occurring early after surgery.

  1. Endovascular control of haemorrhagic urological emergencies: an observational study

    Directory of Open Access Journals (Sweden)

    Thorpe Peter

    2006-09-01

    Full Text Available Abstract Background Transarterial embolisation (TAE is an effective method in control of haemorrhage irrespective of the nature of urological emergency. As the technique and technology have evolved, it is now possible to perform highly selective embolisation. The aim of this study was to critically appraise feasibility and efficacy of therapeutic TAE in control of haemorrhagic urological emergencies using selective and non-selective embolisation. Specifically, we aimed to assess the impact of timing of embolisation on the requirement of blood transfusion and long-term morphological and functional follow-up of embolised organs. Methods This is a single institutional observational study carried out between March 1992 and March 2006. Records of all patients who underwent selective and non-selective angioembolisation to control bleeding in urological emergencies were reviewed. Data on success rate, periprocedural complications, timing of embolisation, requirement of blood transfusion and the long-term morphological and functional outcomes of embolised organs was recorded. Results Fourteen patients underwent endovascular control of bleeding as a result of trauma, iatrogenic injury and spontaneous perinephric haemorrhage during a period of 14 years. All these patients would have required emergency open surgery without the option of embolisation procedure. The mean time between the first presentation and embolisation was 22 hours (range 30 minutes to 60 hours. Mean pre-embolisation transfusion requirement was 6.8 units (range 0–22 units. None of the patients with successful embolisation required post-procedural blood transfusion. Permanent haemostasis was achieved in all but one patient, who required emergency nephrectomy. There were no serious procedure related post-embolisation complications. Conclusion Endovascular control using transarterial angioembolisation is an effective method for managing haematuria or haemorrhage in urological emergencies

  2. [The aggression in SPDC: an observational study. Preliminary data].

    Science.gov (United States)

    Minutolo, Giuseppe; Cannavò, Dario; Petralia, Antonino; Gandolfo, Liliana; Palermo, Filippo; Aguglia, Eugenio

    2010-01-01

    In the different psychiatric disorders the aggression often leads to uncontrolled events, taking aspects of impulsiveness and irrationality. Our research proposes the assessment of socio-demographic and clinical characteristics of patients with a psychiatric disorder, who presented an aggressive event. The observational study was conducted on a sample of 50 patients (34 men and 16 women), hospitalized following the manifestation of an aggressive event. For each patient was provided an assessment of socio-demographic and clinical variables and a psychometric investigation through: the OAS, for the analysis of aggressive episodes; the BDHI, for the hostile behavior and attitudes; the BIS-11, for the impulsiveness and the BPRS for the psychopathological aspects. Among the socio-demographic features investigated, the highest correlation with aggressive behavior was related to the concomitant substance abuse, type of admission to psychiatric hospital and the male gender. The OAS has shown a greater propensity to directed-aggression in males with schizophrenia, and self-directed in females with major depression. The BPRS has shown a positive correlation between hetero-directed aggressive behavior and positive symptomatology, and between the self-directed and depression, risk of suicide, feelings of guilt and somatic concerns. The BDHI has indicated greater suspicion in women's group. The hypothesis that aggression is otherwise related to specific socio-demographic and clinical characteristics was confirmed by our study. The data suggest that early identification and assessment of potential risk factors involved in the genesis of aggressive episodes would allow the clinician to implement a better strategy for prevention and intervention.

  3. The G-spot: an observational MRI pilot study.

    Science.gov (United States)

    Maratos, Y K; Gombergh, R; Cornier, E; Minart, J P; Amoretti, N; Mpotsaris, A

    2016-08-01

    To identify a G-spot complex (GSC) in vivo in MRI examinations at 1.5 Tesla field strength. Observational study. Single centre. Twenty-one consecutive patients (January-March 2014). Imaging analysis of routine imaging protocols for usual medical indications with and without concomitant opacification of the vaginal cavity with inert ultrasound gel. The gel distends the otherwise collapsed vaginal walls, allowing for an improved discrimination of anatomic features. The macroscopic and histological results recently derived from the dissections of fresh cadavers by Ostrzenski et al. were translated into imaging characteristics to be expected in the respective MRI sequences (e.g. T1- and T2-weighted) in search of an in vivo correlate of the GSC. Age, menopause status, medical indication and diagnosis were co-variables. To analyse primarily whether MRI imaging is able to depict a distinct morphological entity in vivo matching the GSC, based on anatomical descriptions published recently. The elaboration of an appropriate MRI-imaging protocol was a secondary aim. A total of 21 studies were obtained. A GSC was identified within the anterior vaginal wall in 13/21 patients (62%). In all, 10/21 (48%) had vaginal gel opacification. We identified a GSC in 10/10 patients (100%) with opacification in all three planes of the T2 images. This was only true for 3/11 cases (27%) without opacification. There is evidence for an in vivo morphological correlate to the postmortem anatomical findings of a GSC described by Ostrzenski et al.; its visibility in MRI imaging can be significantly improved with vaginal opacification by ultrasound gel. Identification of G-spot by MRI with vaginal gel-opacification in 13/21 patients. © 2016 Royal College of Obstetricians and Gynaecologists.

  4. Fatal poisonings in Oslo: a one-year observational study.

    Science.gov (United States)

    Bjornaas, Mari A; Teige, Brita; Hovda, Knut E; Ekeberg, Oivind; Heyerdahl, Fridtjof; Jacobsen, Dag

    2010-06-06

    Acute poisonings are common and are treated at different levels of the health care system. Since most fatal poisonings occur outside hospital, these must be included when studying characteristics of such deaths. The pattern of toxic agents differs between fatal and non-fatal poisonings. By including all poisoning episodes, cause-fatality rates can be calculated. Fatal and non-fatal acute poisonings in subjects aged > or =16 years in Oslo (428 198 inhabitants) were included consecutively in an observational multi-centre study including the ambulance services, the Oslo Emergency Ward (outpatient clinic), and hospitals, as well as medico-legal autopsies from 1st April 2003 to 31st March 2004. Characteristics of fatal poisonings were examined, and a comparison of toxic agents was made between fatal and non-fatal acute poisoning. In Oslo, during the one-year period studied, 103 subjects aged > or =16 years died of acute poisoning. The annual mortality rate was 24 per 100 000. The male-female ratio was 2:1, and the mean age was 44 years (range 19-86 years). In 92 cases (89%), death occurred outside hospital. The main toxic agents were opiates or opioids (65% of cases), followed by ethanol (9%), tricyclic anti-depressants (TCAs) (4%), benzodiazepines (4%), and zopiclone (4%). Seventy-one (69%) were evaluated as accidental deaths and 32 (31%) as suicides. In 70% of all cases, and in 34% of suicides, the deceased was classified as drug or alcohol dependent. When compared with the 2981 non-fatal acute poisonings registered during the study period, the case fatality rate was 3% (95% C.I., 0.03-0.04). Methanol, TCAs, and antihistamines had the highest case fatality rates; 33% (95% C.I., 0.008-0.91), 14% (95% C.I., 0.04-0.33), and 10% (95% C.I., 0.02-0.27), respectively. Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental deaths. Although case fatality rates were

  5. Observation and Study of Proton Aurora by using Scanning Photometer

    Science.gov (United States)

    Mochizuki, T.; Ono, T.; Kadokura, A.; Sato, N.

    2009-12-01

    The proton auroras have significant differences from electron auroras in their spectral shape. They show Doppler-shifted and broadened spectra: the spectra have Doppler-shifted (~0.5 nm shorter) peak and both bluewing (~2-4 nm) and redwing (~1.5 nm) extending. Energy spectra of precipitating protons have been estimated from this shape. Recently it is found that the intensity in the extent of the blue wing reflects more effectively by the change of the mean energy of precipitating protons than the shift of peak wavelength [Lanchester et al., 2003]. Another character of the H-beta aurora is that it is diffuse form because a proton becomes hydrogen atom due to a charge-exchange reaction with atmospheric constituent and then possible to move across the magnetic field line. By using a scanning photometer, the movement of the proton auroral belt and change of a spectrum shape associated with the variation of proton source region due to storm and substorm were reported, however, not discussed in detail yet [Deehr and Lummerzheim, 2001]. The purpose of this study is to obtain the detail characteristics of H-beta aurora for understanding of source region of energetic protons in the magnetosphere. For this purpose, a new meridian-scanning photometer (SPM) was installed at Husafell station in Iceland in last summer season and Syowa Station, Antarctica. It will contribute to investigate the distribution of energetic protons and plasma waves which cause the pitch angle scattering in the magnetosphere. The meridian-scanning photometer is able to observe at five wavelengths for H-beta emission. One channel is to measure the background level. By analyzing the data obtained by the SPM, the H-beta spectrum can be estimated by fitting a model function with it. Then it is possible to obtain distribution of precipitating protons in north-south direction. It is also possible to estimate an energy spectrum of precipitating proton, simultaneously. The instrumental parameters of the SPM is

  6. Non-random temporary emigration and the robust design: Conditions for bias at the end of a time series: Section VIII

    Science.gov (United States)

    Langtimm, Catherine A.

    2008-01-01

    Deviations from model assumptions in the application of capture–recapture models to real life situations can introduce unknown bias. Understanding the type and magnitude of bias under these conditions is important to interpreting model results. In a robust design analysis of long-term photo-documented sighting histories of the endangered Florida manatee, I found high survival rates, high rates of non-random temporary emigration, significant time-dependence, and a diversity of factors affecting temporary emigration that made it difficult to model emigration in any meaningful fashion. Examination of the time-dependent survival estimates indicated a suspicious drop in survival rates near the end of the time series that persisted when the original capture histories were truncated and reanalyzed under a shorter time frame. Given the wide swings in manatee emigration estimates from year to year, a likely source of bias in survival was the convention to resolve confounding of the last survival probability in a time-dependent model with the last emigration probabilities by setting the last unmeasurable emigration probability equal to the previous year’s probability when the equality was actually false. Results of a series of simulations demonstrated that if the unmeasurable temporary emigration probabilities in the last time period were not accurately modeled, an estimation model with significant annual variation in survival probabilities and emigration probabilities produced bias in survival estimates at the end of the study or time series being explored. Furthermore, the bias propagated back in time beyond the last two time periods and the number of years affected varied positively with survival and emigration probabilities. Truncating the data to a shorter time frame and reanalyzing demonstrated that with additional years of data surviving temporary emigrants eventually return and are detected, thus in subsequent analysis unbiased estimates are eventually realized.

  7. Effect of cognitive behavioral group therapy for recovery of self-esteem on community-living individuals with mental illness: Non-randomized controlled trial.

    Science.gov (United States)

    Kunikata, Hiroko; Yoshinaga, Naoki; Nakajima, Kazuo

    2016-10-01

    The aim of this study was to examine over a 12-month post-intervention period whether the participation of community-living individuals with mental illness in cognitive behavioral group therapy for recovery of self-esteem (CBGTRS) resulted in improved outcomes. This was a non-randomized controlled trial. The participants were persons with mental illness who resided in communities in the Chugoku region of Japan. In total, 41 were assigned to an experimental group (CBGTRS intervention, 12 group sessions), and 21 to a control group. Outcome indices (self-esteem, moods, cognition, subjective well-being, psychiatric symptoms) were measured for the experimental group prior to intervention (T0), immediately post-intervention (T1), and at 3 (T2) and 12 (T3) months post-intervention. The control group was measured at the same intervals. For the experimental group, self-esteem scores at T1, T2, and T3 were significantly higher than at T0. Moods and cognition scores remained significantly low until T2. Scores for Inadequate Mental Mastery in the subjective well-being index had not decreased by T3. Confidence in Coping remained significantly high until T2. Psychiatric symptoms scores at T0, T1, T2, and T3 were significantly lower than at T0. The means and standard errors for self-esteem and Inadequate Mental Mastery increased until T3, and those for Tension-Anxiety, Depression-Dejection, and Confusion decreased until T2. From within-group trends and between-group differences in self-esteem, we conclude that CBGTRS may have a relatively long-term effect on self-esteem recovery. T2 is the turning point for moods and cognition; thus, follow-up is needed 3 months following the initial program. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

  8. Southeast Atmosphere Studies: learning from model-observation syntheses

    Data.gov (United States)

    U.S. Environmental Protection Agency — Observed and modeled data shown in figure 2b-c. This dataset is associated with the following publication: Mao, J., A. Carlton, R. Cohen, W. Brune, S. Brown, G....

  9. Pulp polyp - A periapical lesion: Radiographic observational study

    Directory of Open Access Journals (Sweden)

    Kandagal V Suresh

    2015-01-01

    Full Text Available Introduction: Pulp polyp (PP is a chronic hyperplastic condition resulting in formation of granulation tissue and proliferative mass. The radiographic appearance of PP has innumerable presentations. Diagnosing and treatment planning of periapical lesions, heavily relies on the radiographic changes surrounding the root structures. Objective: To evaluate different radiographic periapical changes in clinically detected PP patients. Materials and Methods: Patients reporting to Department of Oral Medicine and Radiology and who were clinically diagnosed with PP by an oral diagnostician were subjected to radiographic examination. Digital intraoral periapical radiographs of 50 patients with PP were taken. Various periapical changes in the digital radiographs were recorded by a skilled oral radiologist. The data obtained was subjected to statistical analysis using SPSS ver 17.0 and P-value was set at <0.05 as significant. Result: Periapical changes like periodontal space widening (PDLW, loss of lamina dura, periapical abscess, periapical granuloma, hypercementosis, condensing osteitis and root resorption were noted. Periodontal space widening was seen in all patients (100%, loss of lamina dura was noted in 72%, periapical rarefying osteitis in 56%, condensing osteitis in 8%, hypercementosis, periapical granuloma, and root resorption were seen in 4% of PP patients. Majority of PP were asymptomatic (66%. Pulp polyp was commonly seen in mandibular first molar followed by mandibular second molar and maxillary first molar. Statistically significant difference was noticed between periapical changes in PP patients (P value <0.0001. All PP patients showed definite periapical changes suggesting it to be a periapical lesion. Conclusion: Pulp polyp is confined to the pulpal portion of the tooth which, may or may not cause changes in periapical region. The results of the present study showed that majority of the PP patients were associated with definite periapical

  10. Outcomes from massive paracetamol overdose: a retrospective observational study.

    Science.gov (United States)

    Marks, Daniel J B; Dargan, Paul I; Archer, John R H; Davies, Charlotte L; Dines, Alison M; Wood, David M; Greene, Shaun L

    2017-06-01

    This article is commented on by Bateman DN and Dear JW. Should we treat very large paracetamol overdose differently? Br J Clin Pharmacol 2017; 83: 1163-5. https://doi.org/10.1111/bcp.13279 AIMS: Treatment of paracetamol (acetaminophen) overdose with acetylcysteine is standardized, with dose determined only by patient weight. The validity of this approach for massive overdoses has been questioned. We systematically compared outcomes in massive and non-massive overdoses, to guide whether alternative treatment strategies should be considered, and whether the ratio between measured timed paracetamol concentrations (APAP pl ) and treatment nomogram thresholds at those time points (APAP t ) provides a useful assessment tool. This is a retrospective observational study of all patients (n = 545) between 2005 and 2013 admitted to a tertiary care toxicology service with acute non-staggered paracetamol overdose. Massive overdoses were defined as extrapolated 4-h plasma paracetamol concentrations >250 mg l -1 , or reported ingestions ≥30 g. Outcomes (liver injury, coagulopathy and kidney injury) were assessed in relation to reported dose and APAP pl :APAP t ratio (based on a treatment line through 100 mg l -1 at 4 h), and time to acetylcysteine. Ingestions of ≥30 g paracetamol correlated with higher peak serum aminotransferase (r = 0.212, P paracetamol overdose are at higher risk of organ injury, even when acetylcysteine is administered early. Enhanced therapeutic strategies should be considered in those who have an APAP pl :APAP t  ≥ 3. Novel biomarkers of incipient liver injury and abbreviated acetylcysteine regimens require validation in this patient cohort. © 2016 The British Pharmacological Society.

  11. Effectiveness of the “What’s Up!” Intervention to Reduce Stigma and Psychometric Properties of the Youth Program Questionnaire (YPQ: Results from a Cluster Non-randomized Controlled Trial Conducted in Catalan High Schools

    Directory of Open Access Journals (Sweden)

    Laura Andrés-Rodríguez

    2017-09-01

    Full Text Available Mental disorders are highly prevalent in the general population, and people who experience them are frequently stigmatized. Stigma has a very negative impact on social, academic/professional, and personal life. Considering the high rates of mental disorders among children and adolescents (13.4% and how critical this age is in the formation of nuclear beliefs, many campaigns to combat stigma have been developed in the last decade, with mixed results. The OBERTAMENT initiative has produced various anti-stigma campaigns in Catalonia (Spain. In the present study, the main objective was to report on the effectiveness of the OBERTAMENT “What’s up!” intervention, a curricular intervention including education and social contact conducted by the teachers in the classroom with teenagers aged between 14 and 18. Prior to this, we examined the psychometric properties of the Youth Program Questionnaire (YPQ, our main outcome measure, in terms of dimensionality, reliability, and validity. A cluster non-randomized controlled trial was conducted to assess this intervention, which was tested in nine high schools situated in the Barcelona region. A convenience sample of 261 students formed the intervention group and 132 the control group (52% women, mean age = 14, SD = 0.47. The assignment to study conditions was conducted by Departament d’Ensenyament (Department of Education, Generalitat de Catalunya (Catalan Government. Participants were evaluated at baseline, post-intervention, and 9-month follow-up. The main outcome measure of this study was the YPQ. The Reported and Intended Behavior Scale (RIBS was used as secondary outcome measure. The statistical analysis indicated that the YPQ possesses a two-factor structure (stereotypical attitudes and intended behavior and sound psychometric properties. The multilevel mixed-effects models revealed statistically significant interactions for both study measures and post hoc intragroup analyses revealed a

  12. Classroom Observation Practice in Career Schools: A Multiple Case Study

    Science.gov (United States)

    Withers, Marya G.

    2017-01-01

    Post-secondary career school educational leaders are charged with formulating sufficient, ongoing, and effective faculty development programming to ensure the delivery of quality education in their unique trade-expert led institutions. Classroom observations, which include substantive feedback exchanges from trained personnel are well documented…

  13. Study of observed microearthquakes at Masada Deep Borehole

    Science.gov (United States)

    Hofstetter, A.; Malin, P. E.

    2017-12-01

    Seismological measurements, conducted at great depths of several hundred of meters or even a few km, can provide useful information that one cannot get while conducting the measurements on the surface. We take advantage of Masada Deep borehole (MDBI), an abandoned oil well, for the installation of a seismometer at a large depth of 1,256 m (1,516 bsl). The station is located in the near vicinity of the East Masada fault, part of the Western Boundary Fault of the Dead Sea basin. We present seismic observations of microearthquakes which occurred along the Dead Sea fault (DSF). Many of them were not recorded by the Israel Seismic Network (ISN). The quiet site of the station has an obvious advantage in detection and identification of earthquakes and explosions. For example, the station detects about 30% more quarry explosions as compared to observations of the ISN. We demonstrate that borehole seismograms are clearer than the on-surface observations of nearby seismometer. We lowered the magnitude scale of observed events down to about M≈-3. Many of the earthquakes, sometimes clusters, occurred underneath the MDBI at depths of 10-25 km, having special signature. Using the cross-correlation technique we present several series of seismic activity either underneath the station or along the DSF. Frequency-magnitude relationship, known also as Gutenberg-Richter relationship, is somewhat higher than the determined value for the whole Dead Sea Fault.

  14. Mother-Father-Infant Interaction: A Naturalistic Observational Study.

    Science.gov (United States)

    Belsky, Jay

    1979-01-01

    Investigates infant preferences for interaction with mother v father, similarities and differences in maternal and paternal behavior, and the influence of a second parent's presence on parent-infant interaction. Families with infants 15 months of age were observed in their own homes. (Author/SS)

  15. Design and Baseline Findings of a Multi-site Non-randomized Evaluation of the Effect of a Health Programme on Microfinance Clients in India

    OpenAIRE

    Saha, Somen

    2013-01-01

    Microfinance is the provision of financial services for the poor. Health program through microfinance has the potential to address several access barriers to health. We report the design and baseline findings of a multi-site non-randomized evaluation of the effect of a health program on the members of two microfinance organizations from Karnataka and Gujarat states of India. Villages identified for roll-out of health services with microfinance were pair-matched with microfinance only villages...

  16. Reliability of radiographic observations recorded on a proforma measured using inter- and intra-observer variation: a preliminary study.

    Science.gov (United States)

    Saunders, M B; Gulabivala, K; Holt, R; Kahan, R S

    2000-05-01

    The aim of this preliminary study was to test the reliability of radiographic evaluation of features of endodontic interest using a newly devised data collection system. Twelve endodontic MSc postgraduate students and one specialist endodontist examined sample radiographs derived from a random selection of 42 patients seen previously on an Endodontic New Patient Clinic (EDI). Each student examined a random selection of 8-9 roots on periapical radiographs of single- and multirooted teeth, with and without previous root canal therapy and 3-4 dental panoramic tomograms (DPTs). A total of 100 roots were examined. A proforma was used to record observations on 67 radiographic features using predefined criteria. Intra-observer agreement was tested by asking the students to re-examine the radiographs. The principle investigator and the specialist endodontist examined the same radiographs and devised a Gold Standard using the same criteria. This was compared with the student assessments to determine inter-observer variation. The postgraduates then attended a revision session on the use of the form. Each student subsequently examined 8-9 different roots from the pool of radiographs. A further assessment of inter-observer variation was made by comparing these observations with the Gold Standard. Of the 67 radiographic features, only 25 had sufficient response to allow statistical analysis. Kappa values for intra- and inter-observer variation were estimated. These varied depending on the particular radiographic feature being assessed. Fifteen out of 25 intra-observer recordings showed 'good' or 'very good' Kappa agreement, but only three out of 25 inter-observer observations achieved 'good' or 'very good' values. Inter-observer variation was improved following the revision session with 16 out of 25 observations achieving 'good' or 'very good' Kappa agreement. Modification to the proforma, the criteria used, and training for radiographic assessment were considered necessary to

  17. Evaluation of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses: a non-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kaitani T

    2015-02-01

    Full Text Available Toshiko Kaitani,1 Gojiro Nakagami,2 Junko Sugama,3 Masahiro Tachi,4 Yutaka Matsuyama,5 Yoshiki Miyachi,6 Takashi Nagase,2 Yukie Takemura,7 Hiromi Sanada2 1School of Nursing, Sapporo City University, Hokkaido, Japan; 2Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 3Department of Clinical Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan; 4Department of Plastic Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan; 5Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 6Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan; 7Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan Aims and objectives: We investigated the effectiveness and safety of an advanced pressure ulcer (PU management protocol comprising 1 ultrasonography to assess the deep tissue, 2 use of a non-contact thermometer to detect critical colonization, 3 conservative sharp debridement, 4 dressing selection, 5 negative pressure wound therapy, and 6 vibration therapy in comparison with those of a conventional approach. Each protocol was followed by trained wound, ostomy, and continence nurses (WOCNs. Background: At present, there is no systematic PU management protocol for nurses that includes appropriate assessment and intervention techniques for deep tissue injury and critical colonization. In Japan, there is no such protocol that the nurses can follow without a physician’s orders. Design and methods: This was a prospective non-randomized controlled trial. Over a 3-week period, we evaluated the effectiveness of an advanced protocol by comparing the PU severity and healing on the basis of the DESIGN-R scale and presence of patients' discomfort. We recruited ten WOCNs to follow

  18. Comprehensive study of observables in Compton scattering on the nucleon

    Science.gov (United States)

    Grießhammer, Harald W.; McGovern, Judith A.; Phillips, Daniel R.

    2018-03-01

    We present an analysis of 13 observables in Compton scattering on the proton. Cross sections, asymmetries with polarised beam and/or targets, and polarisation-transfer observables are investigated for energies up to the Δ(1232) resonance to determine their sensitivity to the proton's dipole scalar and spin polarisabilities. The Chiral Effective Field Theory Compton amplitude we use is complete at N4LO, O(e2δ4), for photon energies ω˜ m_{π}, and so has an accuracy of a few per cent there. At photon energies in the resonance region, it is complete at NLO, O(e2δ0), and so its accuracy there is about 20%. We find that for energies from pion-production threshold to about 250 MeV, multiple asymmetries have significant sensitivity to presently ill-determined combinations of proton spin polarisabilities. We also argue that the broad outcomes of this analysis will be replicated in complementary theoretical approaches, e.g., dispersion relations. Finally, we show that below the pion-production threshold, 6 observables suffice to reconstruct the Compton amplitude, and above it 11 are required. Although not necessary for polarisability extractions, this opens the possibility to perform "complete" Compton-scattering experiments. An interactive Mathematica notebook, including results for the neutron, is available from judith.mcgovern@manchester.ac.uk.

  19. Case Study of Ion Beams Observed By Cluster At Perigee

    Science.gov (United States)

    Sergeev, V.; Sauvaud, J.-A.; Perigee Beam Team

    During substorms the short beams of ions in the keV-to-tens keV energy range are injected into the auroral flux tubes from the magnetotail (sometimes extending up to >100 keV energy) carrying the information on the source distance, scale-size and temporal history of plasma acceleration. We present observations with the CLUSTER crossing inward the auroral zone flux tubes at ~4Re distance near its perigee during the substorm activity on February 14, 2001. The ion beams cover the same region (poleward half) of the auroral oval where the low-energy ions are extracted from the ionosphere, and where the small-scale transient transverse Alfven waves are observed which carry predominantly the downward parallel Poynting flux into the ionosphere. The multiple beams were basically confirmed to be the transient effects, although some effects including the (spatial) velocity filter and the parallel electric fields (im- posed by quasineutrality requirement) may complicate the interpretation. The gener- ation region of ion beams is not limited to most poleward, newly-reconnected flux tubes; the beam generation region could extend across magnetic field inward by as much as >100km (if mapped to the ionosphere). Surprising variety of injection dis- tances observed nearly simultaneously (ranging between >60 Re and ~10 Re) have been inferred when using the full available energy and time resolution, with shorter injection distances be possibly associated with the flow braking process. The beam multiplicity often displays the apparent ~3 min quasiperiodicity inherent to the basic dissipation process, it was not yet explained by any substorm theory.

  20. An Observational Study of the Mesoscale Mistral Dynamics

    Science.gov (United States)

    Guenard, Vincent; Drobinski, Philippe; Caccia, Jean-Luc; Campistron, Bernard; Bench, Bruno

    2005-05-01

    We investigate the mesoscale dynamics of the mistral through the wind profiler observations of the MAP (autumn 1999) and ESCOMPTE (summer 2001) field campaigns. We show that the mistral wind field can dramatically change on a time scale less than 3 hours. Transitions from a deep to a shallow mistral are often observed at any season when the lower layers are stable. The variability, mainly attributed in summer to the mistral/land-sea breeze interactions on a 10-km scale, is highlighted by observations from the wind profiler network set up during ESCOMPTE. The interpretations of the dynamical mistral structure are performed through comparisons with existing basic theories. The linear theory of R. B. Smith [ Advances in Geophysics, Vol. 31, 1989, Academic Press, 1-41] and the shallow water theory [Schär, C. and Smith, R. B.: 1993a, J. Atmos. Sci. 50, 1373-1400] give some complementary explanations for the deep-to-shallow transition especially for the MAP mistral event. The wave breaking process induces a low-level jet (LLJ) downstream of the Alps that degenerates into a mountain wake, which in turn provokes the cessation of the mistral downstream of the Alps. Both theories indicate that the flow splits around the Alps and results in a persistent LLJ at the exit of the Rhône valley. The LLJ is strengthened by the channelling effect of the Rhône valley that is more efficient for north-easterly than northerly upstream winds despite the north-south valley axis. Summer moderate and weak mistral episodes are influenced by land-sea breezes and convection over land that induce a very complex interaction that cannot be accurately described by the previous theories.

  1. Solar energetic particles: observational studies and magnetohydrodynamic simulation

    International Nuclear Information System (INIS)

    Masson, S.

    2010-10-01

    Solar activity manifests itself through highly dynamical events, such as flares and coronal mass ejections, which result in energy release by magnetic reconnection. This thesis focuses on two manifestations of this energy release: solar energetic particles and dynamics of magnetic reconnection. The first part of my work consists in the detailed temporal analysis of several electromagnetic signatures, produced by energetic particles in the solar atmosphere, with respect to the energetic particle flux at Earth. Using multi-instrument observations, I highlighted that particles can be accelerated by the flare to relativistic energies during a specific episode of acceleration in the impulsive phase. This showed that particles traveled a longer path length than the theoretical length generally assumed. Using in-situ measurements of magnetic field and plasma, I identified the interplanetary magnetic field for 10 particle events, and performing a velocity dispersion analysis I obtained the interplanetary length traveled by particles. I showed that the magnetic structure of the interplanetary medium play a crucial role in the association of the particle flux at Earth and the acceleration signatures of particles at the Sun. The second part of my work focuses on the dynamics of magnetic reconnection. Observationally, the best evidence for magnetic reconnection is the appearance of brightnesses at the solar surface. Performing the first data-driven 3 dimensional magneto-hydrodynamic (MHD) simulation of an observed event, I discovered that the evolution of brightnesses can be explained by the succession of two different reconnection regimes, induced by a new topological association where null-point separatrix lines are embedded in quasi-separatrix layers. This new topological association induces a change of field line connectivity, but also a continuous reconnection process, leading to an apparent slipping motion of reconnected field lines. From a MHD simulation I showed that

  2. Astronomical Observations Astronomy and the Study of Deep Space

    CERN Document Server

    2010-01-01

    Our Search for knowledge about the universe has been remarkable, heartbreaking, fantastical, and inspiring, and this search is just beginning. Astronomical Observations is part of a 7 book series that takes readers through a virtual time warp of our discovery. From the nascent space programs of the 1960's to today's space tourism and the promise of distant planet colonization, readers will be transfixed. Throughout this journey of the mind, Earth-bound explorers gain keen insight into the celestial phenomena that have fascinated humans for centuries. Thrilling narratives about indefatigable sc

  3. Temporal sequence in observational studies to establish causality

    Directory of Open Access Journals (Sweden)

    Luis Carlos Silva Ayçaguer, PhD

    2014-05-01

    Full Text Available The article includes a brief summary on the scope of the notions of causality and risk and considers some operational difficulties that arise when dealing with problems associated with them. It underscores the vital importance of timing and its link with the most commonly used observational research designs that address causal relationships. The article describes in detail the need to record the order in which the relevant events occur and how to consider this in the analysis. A detailed example of errors that are usually incurred in and their effect is provided.

  4. Direct observation, study and control of molecular super rotors

    Science.gov (United States)

    Korobenko, Aleksey; Milner, Alexander; Hepburn, John; Milner, Valery

    2014-05-01

    Extremely fast rotating molecules whose rotational energy is comparable with or exceeds the molecular bond strength are known as ``super rotors''. It has been speculated that super rotors may exhibit a number of unique properties, yet only indirect evidence of these molecular objects has been reported to date. We demonstrate the first direct observation of molecular super rotors by detecting coherent unidirectional molecular rotation with extreme frequencies exceeding 10 THz. The technique of an ``optical centrifuge'' is used to control the degree of rotational excitation in an ultra-broad range of rotational quantum numbers, reaching as high as N = 95 in oxygen and N = 60 in nitrogen. State-resolved detection enables us to determine the shape of the excited rotational wave packet and quantify the effect of centrifugal distortion on the rotational spectrum. Femtosecond time resolution reveals coherent rotational dynamics with increasing coherence times at higher angular momentum. We demonstrate that molecular super rotors can be created and observed in dense samples under normal conditions where the effects of ultrafast rotation on many-body interactions, inter-molecular collisions and chemical reactions can be readily explored.

  5. Observational study of food safety practices in retail deli departments.

    Science.gov (United States)

    Lubran, M B; Pouillot, R; Bohm, S; Calvey, E M; Meng, J; Dennis, S

    2010-10-01

    In order to improve the safety of refrigerated ready-to-eat food products prepared at retail deli departments, a better understanding of current practices in these establishments is needed. Food employees in deli departments at six chain and three independent retail establishments in Maryland and Virginia were observed, using notational analysis, as they prepared deli products for sale. The frequency of contact with objects and deli products before sale, hand washing and glove changing during preparation, and equipment, utensil, and surface cleaning and sanitizing was determined. Compliance with the U.S. Food and Drug Administration's 2005 model Food Code recommendations, which must be adopted by the individual state and local jurisdictions that are responsible for directly regulating retail establishments, was also assessed. Observations indicated there were a large number of actions for which hand washing was recommended at independent and chain stores (273 recommended of 1,098 total actions and 439 recommended of 3,073 total actions, respectively). Moreover, 67% (295 of 439) of the actions for which hand washing was recommended at the chain stores and 86% (235 of 273) of those at the independent stores resulted from employees touching non-food contact surfaces prior to handling ready-to-eat food. Compliance with hand washing recommendations was generally low and varied depending on store type with independent stores exhibiting lower compliance than chain stores (5 instances of compliance for 273 recommended actions and 73 instances of compliance for 439 recommended actions, respectively). Potential risk mitigation measures that may reduce the frequency of hand washing actions needed during ready-to-eat food preparation in retail deli departments are discussed. More research is needed to determine the impact of such measures on food safety.

  6. Communication Patterns and Stress in the Preschool: An Observational Study

    Science.gov (United States)

    Sjödin, Fredrik; Neely, Gregory

    2017-01-01

    The study included 12 preschool departments, with two teachers in six departments characterised by high levels of stress and burnout and two teachers in six departments characterised by low levels of stress and burnout. A total of 24 females with a mean age of 43.5 years participated in the study. The teachers rated stress, fatigue, work demands…

  7. Safety and efficacy of endovascular therapy and gamma knife surgery for brain arteriovenous malformations in China: Study protocol for an observational clinical trial.

    Science.gov (United States)

    Jin, Hengwei; Huo, Xiaochuan; Jiang, Yuhua; Li, Xiaolong; Li, Youxiang

    2017-09-01

    Brain arteriovenous malformations (BAVMs) are associated with high morbidity and mortality. The treatment of BAVM remains controversial. Microinvasive treatment, including endovascular therapy and gamma knife surgery, has been the first choice in many conditions. However, the overall clinical outcome of microinvasive treatment remains unknown and a prospective trial is needed. This is a prospective, non-randomized, and multicenter observational registry clinical trial to evaluate the safety and efficacy of microinvasive treatment for BAVMs. The study will require up to 400 patients in approximately 12 or more centers in China, followed for 2 years. Main subjects of this study are BAVM patients underwent endovascular therapy and/or gamma knife surgery. The trial will not affect the choice of treatment modality. The primary outcomes are perioperative complications (safety), and postoperative hemorrhage incidence rate and complete occlusion rate (efficacy). Secondary outcomes are elimination of hemorrhage risk factors (coexisting aneurysms and arteriovenous fistula), volume reduction and remission of symptoms. Safety and efficacy of endovascular therapy, gamma knife surgery, and various combination modes of the two modalities will be compared. Operative complications and outcomes at pretreatment, post-treatment, at discharge and at 3 months, 6 months and 2 years follow-up intervals will be analyzed using the modified Rankin Scale (mRS). The most confusion on BAVM treatment is whether to choose interventional therapy or medical therapy, and the choice of interventional therapy modes. This study will provide evidence for evaluating the safety and efficacy of microinvasive treatment in China, to characterize the microinvasive treatment strategy for BAVMs.

  8. Safety and efficacy of endovascular therapy and gamma knife surgery for brain arteriovenous malformations in China: Study protocol for an observational clinical trial

    Directory of Open Access Journals (Sweden)

    Hengwei Jin

    2017-09-01

    Full Text Available Introduction: Brain arteriovenous malformations (BAVMs are associated with high morbidity and mortality. The treatment of BAVM remains controversial. Microinvasive treatment, including endovascular therapy and gamma knife surgery, has been the first choice in many conditions. However, the overall clinical outcome of microinvasive treatment remains unknown and a prospective trial is needed. Methods: This is a prospective, non-randomized, and multicenter observational registry clinical trial to evaluate the safety and efficacy of microinvasive treatment for BAVMs. The study will require up to 400 patients in approximately 12 or more centers in China, followed for 2 years. Main subjects of this study are BAVM patients underwent endovascular therapy and/or gamma knife surgery. The trial will not affect the choice of treatment modality. The primary outcomes are perioperative complications (safety, and postoperative hemorrhage incidence rate and complete occlusion rate (efficacy. Secondary outcomes are elimination of hemorrhage risk factors (coexisting aneurysms and arteriovenous fistula, volume reduction and remission of symptoms. Safety and efficacy of endovascular therapy, gamma knife surgery, and various combination modes of the two modalities will be compared. Operative complications and outcomes at pretreatment, post-treatment, at discharge and at 3 months, 6 months and 2 years follow-up intervals will be analyzed using the modified Rankin Scale (mRS. Discussion: The most confusion on BAVM treatment is whether to choose interventional therapy or medical therapy, and the choice of interventional therapy modes. This study will provide evidence for evaluating the safety and efficacy of microinvasive treatment in China, to characterize the microinvasive treatment strategy for BAVMs. Keywords: Brain arteriovenous malformation, Clinical trial, Endovascular therapy, Gamma knife, Safety, Efficacy

  9. High incidence of non-random template strand segregation and asymmetric fate determination in dividing stem cells and their progeny.

    Science.gov (United States)

    Conboy, Michael J; Karasov, Ariela O; Rando, Thomas A

    2007-05-01

    Decades ago, the "immortal strand hypothesis" was proposed as a means by which stem cells might limit acquiring mutations that could give rise to cancer, while continuing to proliferate for the life of an organism. Originally based on observations in embryonic cells, and later studied in terms of stem cell self-renewal, this hypothesis has remained largely unaccepted because of few additional reports, the rarity of the cells displaying template strand segregation, and alternative interpretations of experiments involving single labels or different types of labels to follow template strands. Using sequential pulses of halogenated thymidine analogs (bromodeoxyuridine [BrdU], chlorodeoxyuridine [CldU], and iododeoxyuridine [IdU]), and analyzing stem cell progeny during induced regeneration in vivo, we observed extraordinarily high frequencies of segregation of older and younger template strands during a period of proliferative expansion of muscle stem cells. Furthermore, template strand co-segregation was strongly associated with asymmetric cell divisions yielding daughters with divergent fates. Daughter cells inheriting the older templates retained the more immature phenotype, whereas daughters inheriting the newer templates acquired a more differentiated phenotype. These data provide compelling evidence of template strand co-segregation based on template age and associated with cell fate determination, suggest that template strand age is monitored during stem cell lineage progression, and raise important caveats for the interpretation of label-retaining cells.

  10. High incidence of non-random template strand segregation and asymmetric fate determination in dividing stem cells and their progeny.

    Directory of Open Access Journals (Sweden)

    Michael J Conboy

    2007-05-01

    Full Text Available Decades ago, the "immortal strand hypothesis" was proposed as a means by which stem cells might limit acquiring mutations that could give rise to cancer, while continuing to proliferate for the life of an organism. Originally based on observations in embryonic cells, and later studied in terms of stem cell self-renewal, this hypothesis has remained largely unaccepted because of few additional reports, the rarity of the cells displaying template strand segregation, and alternative interpretations of experiments involving single labels or different types of labels to follow template strands. Using sequential pulses of halogenated thymidine analogs (bromodeoxyuridine [BrdU], chlorodeoxyuridine [CldU], and iododeoxyuridine [IdU], and analyzing stem cell progeny during induced regeneration in vivo, we observed extraordinarily high frequencies of segregation of older and younger template strands during a period of proliferative expansion of muscle stem cells. Furthermore, template strand co-segregation was strongly associated with asymmetric cell divisions yielding daughters with divergent fates. Daughter cells inheriting the older templates retained the more immature phenotype, whereas daughters inheriting the newer templates acquired a more differentiated phenotype. These data provide compelling evidence of template strand co-segregation based on template age and associated with cell fate determination, suggest that template strand age is monitored during stem cell lineage progression, and raise important caveats for the interpretation of label-retaining cells.

  11. Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification. Observational study.

    Science.gov (United States)

    Vasavada, Viraj; Vasavada, Vaishali; Raj, Shetal M; Vasavada, Abhay R

    2007-06-01

    To evaluate the intraoperative performance and postoperative outcomes after microcoaxial phacoemulsification. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. A prospective observational case series comprised 84 eyes with age-related uncomplicated cataract having microcoaxial phacoemulsification through a 2.2 mm clear corneal incision by a standard surgical technique. Phacoemulsification parameters (Infiniti Vision System, Alcon) were microburst width, 30 ms; preset power, 50%; vacuum, 650 mm Hg; aspiration flow rate, 25 cc/minute. A single-piece Alcon AcrySof intraocular lens was implanted with the C cartridge (Alcon) cartridge. The incision was measured at the end of surgery. Observations included surgical time (from commencement of sculpting to end of epinucleus removal), cumulative dissipated energy (CDE), wound burns, intraoperative complications, postoperative increase in mean central corneal thickness (CCT) at 1 day and 1 month, mean % decrease in endothelial cell density (ECD), absolute mean change in coefficient of variation (cv) 3 months, and uncorrected visual acuity (UCVA) at 1 day. Data were analyzed using a 1-sample t test with 95% confidence intervals (CIs). The mean follow up was 3 months +/- 0.3 (SD). The mean incision size at the end of surgery was 2.3 +/- .09 mm; mean surgical time, 4.5 +/- 1.5 minutes; and mean CDE, 2.3 +/- 2.2 seconds. No wound burns or other intraoperative complications occurred. The postoperative CCT increased by a mean of 16 microm at 1 day (95% CI, 8-25; P = .66;) and by a mean of 3.14 microm at 1 month (95% CI, 2.26-4.05; P = .92). The ECD decreased by a mean of 5.8% (95% CI, 6.8-3.5; P = .82) and the mean coefficient of variation, by 3.3 (95% CI, 4.5-2.0; P = .65). At 1 day, the UCVA was 20/20 in 29% of cases, 20/20 to 20/40 in 58%, and 20/40 to 20/50 in 12%. Microcoaxial phacoemulsification was safely and effectively performed, achieving consistent and satisfactory postoperative outcomes.

  12. ADVERSE REACTIONS OF BLOOD DONATION: A PROSPECTIVE OBSERVATIONAL STUDY

    OpenAIRE

    Kandukuri Mahesh; Ravikanth; Chinthakindi; Shashi Kiran; Sudhir Kuma

    2014-01-01

    BACKGROUND: Voluntary donors normally tolerate blood donation very well as the history and preliminary examination is clear without any hidden history or facts related to the health status of the donor, occasionally, adverse reactions of variable severity may occur during or at the end of the collection. AIM: Aim of this study is to estimate and possibly avoid the cause of unwanted reactions. MATERIALS AND METHODS: This study is conducted over a period of three years, from ...

  13. [Observational study of craniofacial growth and development in Mexican children].

    Science.gov (United States)

    Fijikami, T K; Cedeño Pacheco, E

    1991-01-01

    The election of a investigation about craniofacial growing and development in Mexican children, was done due to a lack of national information in this rubric and as a fundamental part of the "growing and development in the scholastic" module of the Universidad Autónoma Metropolitana-Xochimilco, which work hypothesis was that "craniofacial growing and development in Mexican, 6 to 12 children in Xochimilco area are due to nutritional deficiency, second dentition eruption delay and dental maloclution "which was totality confirmed in a 100 Mexican facial characteristic children field work study, with cephalometric studies which permit to determine the craniofacial growing standard. This study was corroborated with a 40 children, 4 years later follow up.

  14. Subclinical Hypothyroidism: A Prospective Observational Study from Southern India.

    Science.gov (United States)

    Sridhar, Mathrubootham; Mahadevan, Shriraam; Vishwanathan, Latha; Subbarayan, Anbezhil

    2018-03-15

    To assess the natural history and progression of subclinical hypothyroidism and to study factors which help predict evolution of subclinical hypothyroidism into overt hypothyroidism. Longitudinal study in 40 children (2-16 yrs) presenting with subclinical hypothyroidism in a tertiary care unit in Chennai, India. Patients showing evidence of overt hypothyroidism or thyroid stimulating hormone ≥15 mIU/mL during follow-up were started on thyroxine. Others were followed up with 3-monthly thyroid function tests up to one year. At the end of our study period 3 (7.5%) were overtly hypothyroid, 16 (40%) remained as subclinical hypothyroid, and 21 (52.5%) became euthyroid. Evidence of auto- immunity at baseline was a significant (Phypothyroidism. Subclinical hypothyroidism in children, with thyroid stimulating hormone upto 15 mIU/L and irrespective of thyroid autoimmunity, needs only periodic clinical and biochemical follow up. Thyroid autoimmunity may point to an increased probability of progression to overt hypothyroidism.

  15. Musical Expression: An Observational Study of Instrumental Teaching

    Science.gov (United States)

    Karlsson, Jessika; Juslin, Patrik N.

    2008-01-01

    Research has shown that both music students and teachers think that expression is important. Yet, we know little about how expression is taught to students. Such knowledge is needed in order to enhance teaching of expression. The aim of this study was thus to explore the nature of instrumental music teaching in its natural context, with a focus on…

  16. Diversity of Pneumocystis jirovecii Across Europe: A Multicentre Observational Study

    Directory of Open Access Journals (Sweden)

    Alexandre Alanio

    2017-08-01

    Our study showed the wide population diversity across Europe, with evidence of local clusters of patients harbouring a given genotype. These data suggest a specific association between genotype and underlying disease, with evidence of a different natural history of PCP in HIV patients and renal transplant recipients.

  17. Observing power blackouts from space - A disaster related study

    Science.gov (United States)

    Aubrecht, C.; Elvidge, C. D.; Ziskin, D.; Baugh, K. E.; Tuttle, B.; Erwin, E.; Kerle, N.

    2009-04-01

    In case of emergency disaster managers worldwide require immediate information on affected areas and estimations of the number of affected people. Natural disasters such as earthquakes, hurricanes, tornados, wind and ice storms often involve failures in the electrical power generation system and grid. Near real time identification of power blackouts gives a first impression of the area affected by the event (Elvidge et al. 2007), which can subsequently be linked to population estimations. Power blackouts disrupt societal activities and compound the difficulties associated with search and rescue, clean up, and the provision of food and other supplies following a disastrous event. Locations and spatial extents of power blackouts are key considerations in planning and execution of the primary disaster missions of emergency management organizations. To date only one satellite data source has been used successfully for the detection of power blackouts. Operated by NOAA's National Geophysical Data Center (NGDC) the U.S. Air Force Defense Meteorological Satellite Program (DMSP) Operational Linescan System (OLS) offers a unique capability to observe lights present at the Earth's surface at night. Including a pair of visible and thermal spectral bands and originally designed to detect moonlit clouds, this sensor enables mapping of lights from cities and towns, gas flares and offshore platforms, fires, and heavily lit fishing boats. The low light imaging of the OLS is accomplished using a photomultiplier tube (PMT) which intensifies the visible band signal at night. With 14 orbits collected per day and a 3.000 km swath width, each OLS is capable of collecting a complete set of images of the Earth every 24 hours. NGDC runs the long-term archive for OLS data with the digital version extending back to 1992. OLS data is received by NGDC in near real time (1-2 hours from acquisition) and subscription based services for the near real time data are provided for users all over the

  18. Harvesting Collective Trend Observations from Large Scale Study Trips

    DEFF Research Database (Denmark)

    Eriksen, Kaare; Ovesen, Nis

    2014-01-01

    To enhance industrial design students’ decoding and understanding of the technological possibilities and the diversity of needs and preferences in different cultures it is not unusual to arrange study trips where such students acquire a broader view to strengthen their professional skills and app...... numbers of students to the annual Milan Design Week and the Milan fair ‘I Saloni’ in Italy. The present paper describes and evaluates the method, the theory behind it, the practical execution of the trend registration, the results from the activities and future perspectives....... and approach, hence linking the design education and the design culture of the surrounding world. To improve the professional learning it is useful, though, to facilitate and organize the trips in a way that involves systematic data collection and reporting. This paper presents a method for facilitating study...

  19. Splenic lesions observed in 71 splenectomized dogs: a retrospective study

    OpenAIRE

    Elisângela Olegário da Silva; Giovana Wingeter Di Santis; Selwyn Arlington Headley; Ana Paula Frederico Rodrigues Loureiro Bracarense

    2016-01-01

    The spleen of dogs is frequently affected by disorders that vary from local and systemic origin. The difficulty in associating clinical and gross findings contributes for the choice of total splenectomy as the main treatment, leading to an impairment of the immune and hematopoietic functions. The aim of this study was to evaluate the pathological findings in the spleen of splenectomized dogs during 2008 to 2014 at a Veterinary Teaching Hospital. From the 71 cases analyzed, 97% (69/71) of the ...

  20. COLORECTAL CANCER IN YOUNG INDIVIDUALS: AN OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Mukesh Shanthilal

    2016-07-01

    Full Text Available INTRODUCTION Colorectal cancer is the third most common cancer which can be detected early by implementation of cancer screening. This has led to decline in colorectal cancer related morbidity and mortality in elderly patients. However, there is increase in the incidence of this cancer in young individuals. This study was undertaken to study the characteristics of young colorectal cancer patients. METHODS AND MATERIALS The study was conducted from 2014 to 2016. All colorectal cancer patients attending the Department of Oncology, who were less than or equal to 50 years of age were included. Patients’ demographic data as well as data regarding the colorectal cancer was collected. The data was entered into MS Excel worksheet and analysed using descriptive statistics. RESULTS This study included 28 patients with a median age of 40 years and equal sex distribution. History of smoking in 85.7% (12/14 and alcohol (moderate consumption in 64% (9/14 was present in male patients. There was no history of alcohol or smoking was present among female patients. However, tobacco chewing habit was present in 28% (4/14 of female patients. History of multiple sexual partners in 14% (4/28 of cases and 78% (22/28 were non-vegetarians. Nearly 85% (24/28 of patients presented with an advanced stage disease. The analysis showed involvement of left side of colon in 50% (14/28, rectum in 39% (11/28 and right side of colon in 11%(3/28. Except for two patients who were in stage - 1, all other patients received chemotherapy. CONCLUSION The incidence of colorectal cancer in young individuals is constantly rising. The reason for this increase is unclear and the relative contributions of genetic versus environmental factors remain relatively unexplored.

  1. Quality of Life after Stapled Hemorrhoidopexy: A Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Pankaj Kumar Garg

    2013-01-01

    Full Text Available Objective. The objective of the study was to assess the change in quality of life (QOL of patients undergoing stapled hemorrhoidopexy (SH using WHO Quality of Life-BREF (WHOQOL-BREF questionnaire. Methods. The study sample comprised patients with symptomatic II, III, and IV degree hemorrhoids, undergoing SH. The patients were asked to complete WHOQOL-BREF questionnaire before and one month following the surgery. Result. There were 20 patients in the study group. The postoperative pain score measured by visual analogue scale at six hours postoperatively was at 24 hours. The items in the WHOQOL-BREF had high-internal consistency or reliability as shown by high Cronbach's alpha coefficient which was 0.82 and 0.90 for pre- and postoperative questionnaires. There was significant improvement in the overall perception of QOL and health, and in physical and psychological domains. There was modest improvement in environmental domain, while no change was noted in social domain. Conclusion. SH improved the quality of life of patients treated for hemorrhoids.

  2. VY Canis Majoris: Observational Studies of the Outflow

    Science.gov (United States)

    Harwit, M.

    2001-12-01

    A number of recent studies carried out with the Infrared Space Observatory, ISO, and the Submillimeter Wave Astronomy Satellite, SWAS, provide new information on the chemical composition of the dust and the geometry of the outflow. With ISO, we have obtained a near-, mid-, and far-infrared spectrum of VY CMa that shows the strong preponderance of amorphous, as contrasted to crystalline, silicates. The sharp spectral slope in the near-infrared suggests the presence also of iron grains. While an excellent theoretical fit to the data is obtained, we emphasize that this is far from unique. A resolution of ambiguities will require a self-consistent model that considers not only radiative transfer, but also plausible elemental abundances, laboratory studies of chemical condensation sequences, and gas dynamics. With SWAS we have obtained a high-resolution spectrum of the 557GHz ground state transition of ortho-water. The spectral profile enables us to rule out a number of outflow geometries proposed in the literature. With ISO we also obtained the intensities and velocity structure of several other spectral lines of water. Most of these lines must be optically thick but effectively thin, a circumstance that permits us to make use of recent gas-dynamic models to locate the radial position in the outflow where individual lines are emitted.

  3. Thermoacoustic CT of the breast: pilot study observations

    Science.gov (United States)

    Kruger, Robert A.; Kiser, William L., Jr.; Romilly, A. P.; Scmidt, Phyllis

    2001-06-01

    In order to assess the potential clinical utility of using thermoacoustic computer tomography (TCT) to image the breast, we conducted a retrospective pilot study of 78 patients. We recruited patients in three age groups (50 years). The study population was further segregated into normal and suspicious based on the results of the previous x-ray mammography and ultrasound. Image quality was evaluated qualitatively by consensus of two trained mammographers using a 4-point scale. The appearance of normal anatomy, cysts, benign disease and cancer was noted. Patients were also asked to rate the comfort of the TCT exam and to indicate a personal preference for x-ray mammography or TCT. Analysis of the data indicated that TCT image quality was dependent upon both patient age and breast density, improving with both increasing breast density and decreasing patient age. Fibrocystic disease was well seen, cysts appearing as areas of low RF absorption. Fibroadenomas did not demonstrate contrast enhancement with the exception of one patient with associated atypical hyperplasia. Cancer displayed higher RF absorption than surrounding tissues in 4/7 patients in whom cancer was confirmed, including one patient with a 7-mm ductal carcinoma in situ (DCIS).

  4. Ambulatory laparoscopic minor hepatic surgery: Retrospective observational study.

    Science.gov (United States)

    Gaillard, M; Tranchart, H; Lainas, P; Tzanis, D; Franco, D; Dagher, I

    2015-11-01

    Over the last decade, laparoscopic hepatic surgery (LHS) has been increasingly performed throughout the world. Meanwhile, ambulatory surgery has been developed and implemented with the aims of improving patient satisfaction and reducing health care costs. The objective of this study was to report our preliminary experience with ambulatory minimally invasive LHS. Between 1999 and 2014, 172 patients underwent LHS at our institution, including 151 liver resections and 21 fenestrations of hepatic cysts. The consecutive series of highly selected patients who underwent ambulatory LHS were included in this study. Twenty patients underwent ambulatory LHS. Indications were liver cysts in 10 cases, liver angioma in 3 cases, focal nodular hyperplasia in 3 cases, and colorectal hepatic metastasis in 4 cases. The median operative time was 92 minutes (range: 50-240 minutes). The median blood loss was 35 mL (range: 20-150 mL). There were no postoperative complications or re-hospitalizations. All patients were hospitalized after surgery in our ambulatory surgery unit, and were discharged 5-7 hours after surgery. The median postoperative pain score at the time of discharge was 3 (visual analogue scale: 0-10; range: 0-4). The median quality-of-life score at the first postoperative visit was 8 (range: 6-10) and the median cosmetic satisfaction score was 8 (range: 7-10). This series shows that, in selected patients, ambulatory LHS is feasible and safe for minor hepatic procedures. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Gait Analysis of Symptomatic Flatfoot in Children: An Observational Study.

    Science.gov (United States)

    Kim, Ha Yong; Shin, Hyuck Soo; Ko, Jun Hyuck; Cha, Yong Han; Ahn, Jae Hoon; Hwang, Jae Yeon

    2017-09-01

    Flatfoot deformity is a lever arm disease that incurs kinetic inefficiency during gait. The purpose of this study was to measure the degree of kinetic inefficiency by comparing the gait analysis data of a flatfoot group with a normal control group. The patient group consisted of 26 children (21 males and 5 females) with symptomatic flatfoot. They were examined with gait analysis between May 2005 and February 2014. Exclusion criteria were patients with secondary flatfoot caused by neuromuscular disorders, tarsal coalition, vertical talus, or others. Patients' mean age was 9.5 years (range, 7 to 13 years). The gait analysis data of the study group and the normal control group were compared. The mean vertical ground reaction force (GRF) in the push-off phase was 0.99 for the patient group and 1.15 for the control group ( p push-off phase was 0.89 for the patient group and 1.27 for the control group ( p push-off phase was 1.38 for the patient group and 2.52 for the control group ( p push-off phase during gait. Symptomatic flatfeet had a moment inefficiency of 30% and power inefficiency of 45% during gait compared to feet with preserved medial longitudinal arches.

  6. Change in neck circumference after shoulder arthroscopy: An observational study

    Directory of Open Access Journals (Sweden)

    Shrividya Chellam

    2015-01-01

    Full Text Available Background and Aims: Shoulder arthroscopy requires fluid irrigation, which causes soft-tissue oedema around chest, neck, and arm intraoperatively, leading to postoperative airway complications. We decided to study the incidence of increase in the neck circumference in shoulder arthroscopy and its effects on the airway. Methods: We studied 32 cases of shoulder arthroscopies over a period of 1-year, performed under general anaesthesia with interscalene block. The neck circumference of patients before and after the procedure was measured along with other parameters. The endotracheal tube cuff was deflated at the end of surgery to determine air leak around the tube. The negative leak test suggested airway oedema. Results: Thirty out of 32 patients showed positive air leak test. The average change in neck circumference was 1.17 ± 1.16 cm and all could be extubated uneventfully. Two showed negative leak test with an increase in neck circumference by 4.5 and 6.4 cm and were not extubated. Multiple regression analysis for risk factors showed intraoperative hypertension as a single predictor for an increase in neck circumference. Conclusion: Change in the neck circumference beyond 4 cm may suggest airway compromise and below 4 cm, airway compromise is unlikely even in the presence of extensive soft-tissue oedema around the shoulder, upper arm and chest.

  7. Brucellosis in pregnant women from Pakistan: an observational study.

    Science.gov (United States)

    Ali, Shahzad; Akhter, Shamim; Neubauer, Heinrich; Scherag, André; Kesselmeier, Miriam; Melzer, Falk; Khan, Iahtasham; El-Adawy, Hosny; Azam, Asima; Qadeer, Saima; Ali, Qurban

    2016-09-02

    Brucella species occasionally cause spontaneous human abortion. Brucella can be transmitted commonly through the ingestion of raw milk or milk products. The objective of this study was to determine the sero-prevalence of and to identify potential risk factors for brucellosis in pregnant women from Rawalpindi, Pakistan. We conducted a cross-sectional study at the Gynecology Outdoor Patient department of the Benazir Bhutto Hospital, Rawalpindi, Pakistan from March to June 2013. Data related to potential risk factors and clinical history was collected by individual interviews on the blood sampling day. The 429 serum samples collected were initially screened by Rose Bengal Plate Agglutination test for the detection of Brucella antibodies. We applied standard descriptive statistics and logistic regression analyses. Twenty five (5.8 %; 95 % confidence interval (CI): 3.8 % -8.5 %) serum samples were found to be seropositive. Brucellosis-related clinical symptoms were recorded in various seropositive cases. Animal contact, raw milk consumption, having an abortion history and the experience of an intrauterine fetal death were associated with seropositivity for brucellosis in univariate analyses (all p Brucellosis is a serious threat for pregnant women and their unborn children in Pakistan. Pregnant women having brucellosis-related symptoms or previous history of abortions, miscarriages, intrauterine fetal death and other brucellosis-related manifestations should be screened for brucellosis - especially those exposed to animals given the increased risk - and medication should be administered according to state of the art.

  8. ENZYMATIC CHANGES IN SNAKE ENVENOMATION- AN OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Sidharth Kapoor

    2017-06-01

    Full Text Available BACKGROUND Snakes are the most feared and the most worshipped living creatures on the earth. Snakes are called venomous when envenomation or human fatalities after their bite are known. Snakebite is an acute medical emergency faced by temperate and tropical regions with heavy rainfall and humid climate. The specific therapy for snakebite in India is still polyvalent ASV and clinical practice ASV is not recommended until the victim of snakebite presents either with the evidence of bite by a poisonous snake such as definite fang marks, swelling or pain at the bite site or with clinical or laboratory evidence of envenomation such as local and systemic bleeding. In some cases, institution of ASV may also be initiated on the identification of offending snake brought by the patient or attendants, but most of these are subjective matters and subject to fallacies. Also, that out of polyvalent and monovalent ASV available, since it is monovalent ASV, which is desirable due to its less side effects and more effectiveness, but its use warrants the identification of snake, which is practically not possible in every case and/or on the objective evidence of peripheral neurological signs and symptoms and haematological alterations, which may not be dependable in many cases. MATERIALS AND METHODS Snake envenomation is in fact a multifactorial stress phenomenon, which produces altered physiological states including death and one of the consequences of the stress phenomenon is generation of several lysosomal enzymes and formation of free radicals. Extensive data search on Medline has failed to show study of this type in any part of the world, so this study being taken up as a preliminary attempt to evaluate the pattern of enzymatic changes in snake envenomation. RESULTS The patients included in the study were be those coming to the Emergency Department of Government Medical College, Jammu, bitten by poisonous snakes during the period May 2003 to April 2004. The

  9. Can headache impair intellectual abilities in children? An observational study

    Directory of Open Access Journals (Sweden)

    Esposito M

    2012-11-01

    Full Text Available Maria Esposito,1 Antonio Pascotto,1 Beatrice Gallai,3 Lucia Parisi,2 Michele Roccella,2 Rosa Marotta,4 Serena Marianna Lavano,4 Antonella Gritti,5 Giovanni Mazzotta,6 Marco Carotenuto11Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Second University of Naples, Naples, 2Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, 3Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, 4Department of Psychiatry, “Magna Graecia” University of Catanzaro, Catanzaro, 5Suor Orsola Benincasa University, Napoli, 6Unit of Child and Adolescent Neuropsychiatry, Azienda Sanitaria Locale 4, Terni, ItalyBackground: The purpose of this study was to assess the cognitive functioning of children affected by headache, pinpointing the differences in intelligence style between subjects affected by migraine without aura and subjects with tension-type headache.Methods: The study population consisted of 147 children (mean age 10.82 ± 2.17 years with headache, recruited from the Headache Center for Developmental Age, Child and Adolescent Neuropsychiatry Clinic, Second University of Naples. Cognitive profiling was performed using Weschler Intelligence Scale for Children Third Edition throughout the sample. According to the International Classification of Headache Disorders II criteria for pediatric age, subjects were divided into a migraine without aura group (n = 75; 43 boys, 32 girls and a tension-type headache group (n = 72; 49 boys, 23 girls. The results were compared with the findings obtained from a sample of 137 healthy control subjects recruited from schools in the Campania region, matched for age and gender.Results: No difference in full intelligence quotient was found between the groups, but the children with tension-type headache had a lower verbal intelligence quotient and a higher performance intelligence quotient than the healthy controls and children with migraine. Factor

  10. THE MANY FACES OF PNEUMOMEDIASTINUM: AN OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Narendra Kumar Narahari

    2016-06-01

    Full Text Available Pneumomediastinum is an uncommon condition which is defined by the presence of air in the mediastinum. It may result from a number of causes, but at times the underlying aetiology remains obscure. The present study aims to review the clinical and imaging features in patients who presented with pneumomediastinum alone or in association with other findings in order to establish the aetiological diagnosis. We report here, a series of cases with pneumomediastinum of various unusual aetiologies and also the clinical profile, predisposing factors and outcome of these patients along with the associated complications. METHODS We retrospectively reviewed the records of all patients who presented to the respiratory unit of our hospital with the diagnosis of pneumomediastinum over a period of 2 years from 2013-2015. The cases of pneumomediastinum resulting from trauma and iatrogenic causes were excluded from the study. RESULTS A total of six patients (4 males and 2 females with pneumomediastinum were identified during the study period after applying the exclusion criteria. The most common presenting symptom in these cases was shortness of breath followed by dry cough, chest pain and fever. Subcutaneous emphysema and Hamman sign was identified in one patient each. Of the six cases, preexisting lung disease was identified in 3 patients and these included connective tissue disease related interstitial lung disease in two cases and combined pulmonary fibrosis and emphysema in one case. In the remaining three cases, the causes of pneumomediastinum were Pneumocystis carinii pneumonia (PCP in HIV positive patient, pulmonary tuberculosis in another and spontaneous oesophageal perforation in the third. Coexisting pneumothorax was present in 3 out of 6 cases. The mean duration of hospital stay in these six patients was 8 days. No recurrence of pneumomediastinum was seen in any of the six patients during six months of followup. CONCLUSIONS Pneumomediastinum is a

  11. Psychological harassment in the nursing workplace: an observational study.

    Science.gov (United States)

    Fornés, Joana; Cardoso, Meiremar; Castelló, Joana Maria; Gili, Margalida

    2011-06-01

    Psychological harassment in the workplace involves disrespectful or humiliating behavior to workers. Nurses make up one of the groups that are most exposed to these behaviors. This descriptive study investigated the most common types of psychological harassment in the nursing workplace and their relationship with sociodemographic variables among 285 nurses in Spain. Findings indicate differences in the prevalence of psychological harassment depending on the criterion that was used. Psychological harassment is positively correlated with a desire to abandon the profession and negatively with participation in decision making. The results suggest combining different measures to evaluate psychological harassment in the workplace and zero-tolerance polices for psychological abuse. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. UFOs in the LHC: Observations, studies and extrapolations

    CERN Document Server

    Baer, T; Cerutti, F; Ferrari, A; Garrel, N; Goddard, B; Holzer, EB; Jackson, S; Lechner, A; Mertens, V; Misiowiec, M; Nebot del Busto, E; Nordt, A; Uythoven, J; Vlachoudis, V; Wenninger, J; Zamantzas, C; Zimmermann, F; Fuster, N

    2012-01-01

    Unidentified falling objects (UFOs) are potentially a major luminosity limitation for nominal LHC operation. They are presumably micrometer sized dust particles which lead to fast beam losses when they interact with the beam. With large-scale increases and optimizations of the beam loss monitor (BLM) thresholds, their impact on LHC availability was mitigated from mid 2011 onwards. For higher beam energy and lower magnet quench limits, the problem is expected to be considerably worse, though. In 2011/12, the diagnostics for UFO events were significantly improved: dedicated experiments and measurements in the LHC and in the laboratory were made and complemented by FLUKA simulations and theoretical studies. The state of knowledge, extrapolations for nominal LHC operation and mitigation strategies are presented

  13. [Using consumer panels in public health observational studies].

    Science.gov (United States)

    Matilla-Santander, Nuria; Fu, Marcela; Ballbè, Montse; Lidón-Moyano, Cristina; Martín-Sánchez, Juan Carlos; Fernández, Esteve; Martínez-Sánchez, José M

    Consumer panels are a market research method useful for gathering information about low-frequency or difficult-access customers. The objective of this field-note is to explain our experience using this method in a cross-sectional public health study on the use of electronic cigarettes. After taking into account other non-probabilistic sampling techniques to obtain a huge sample of electronic-cigarette users (n=600), in the end we decided to use consumer panels (recruiters) because of the relative short duration of the field work and the high representativeness of the sample. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Aetiology of arthritis in hospitalised children: an observational study.

    Science.gov (United States)

    Aupiais, Camille; Ilharreborde, Brice; Doit, Catherine; Blachier, Audrey; Desmarest, Marie; Job-Deslandre, Chantal; Mazda, Keyvan; Faye, Albert; Bonacorsi, Stéphane; Alberti, Corinne; Lorrot, Mathie

    2015-08-01

    Arthritis in children has many causes and includes septic and viral arthritis, reactive arthritis and juvenile idiopathic arthritis (JIA). We aimed to describe the different types of arthritis among children hospitalised for a first episode of arthritis. Retrospective, descriptive case series study. A French tertiary care centre. Children under 16 years of age hospitalised for an arthritis episode between 1 January 2008 and 31 December 2009. Demographic and clinical features were compared with χ(2) or Fisher's exact tests and non-parametric tests. 173 children were hospitalised for a first episode of arthritis during the study period, with a male/female ratio of 1.14. The most frequent cause of hospitalisation was septic arthritis (43.4% of cases, 69.3% of which were due to Kingella kingae and 10.7% to Staphylococcus aureus). JIA was responsible for 8.1% of cases and arthritis without any definitive diagnosis for 40.4%. Median age at diagnosis was 2.7 years (IQR 0.3-14.6) and was lower in the septic arthritis group (1.5 years; 1.1-3.4) than in the JIA group (4.7 years; 2.5-10.9) (p<0.01). Septic arthritis involved a single joint in 97.3% of cases, while JIA involved four joints in 14.3% of cases and two to four joints in 28.6% of cases (p<0.01). Septic arthritis was the most frequent cause of arthritis in hospitalised children. Despite the increasing application of microbiological molecular methods to synovial fluid analysis, further measures are required to improve the diagnosis of arthritis of unknown cause. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Overnight switching from oxcarbazepine to eslicarbazepine acetate: an observational study.

    Science.gov (United States)

    Schmid, E; Kuchukhidze, G; Kirschner, M; Leitinger, M; Höfler, J; Rohracher, A; Kalss, G; Wendling, A-S; Steinhoff, B J; Trinka, E

    2017-04-01

    There are clinical situations where it might be appropriate to switch patients from immediate-release oxcarbazepine (OXC) to eslicarbazepine acetate (ESL). We investigated the effects of transitioning patients overnight from OXC to ESL. A retrospective, single-center study was conducted in which patients with drug-resistant focal epilepsy on a stable dose of immediate-release OXC for at least 4 weeks were switched overnight to ESL. Patients were switched because they experienced persistent seizures with OXC but were unable to tolerate increased OXC dosing due to adverse events. Tolerability was assessed using the Adverse Events Profile (AEP), quality of life was assessed using the Quality of Life in Epilepsy Inventory 10 (QOLIE-10), and alertness was assessed as reaction time using a subtest of the Test Battery for Attention Performance version 2.3. Assessments were performed immediately prior to and 5 days after switching from OXC to ESL (days 0 and 5, respectively). The analysis included 21 patients (12 women, 9 men; mean age 36 years). After switching from OXC to ESL, there were significant improvements in mean scores for AEP (Peffects, quality of life, and alertness. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Temporomandibular disorders in burning mouth syndrome patients: an observational study.

    Science.gov (United States)

    Corsalini, Massimo; Di Venere, Daniela; Pettini, Francesco; Lauritano, Dorina; Petruzzi, Massimo

    2013-01-01

    Burning Mouth Syndrome (BMS) is a chronic disease characterized by absence of any lesions and burning of the oral mucosa associated to a sensation of dry mouth and/or taste alterations. The purpose of our study is to estimate signs and symptoms of Temporomandibular Disorders (TMD) in patients with BMS and to investigate for the existence of an association between BMS and TMD. Forty-four BMS patients were enrolled; BMS subtype was established according to the classification of Lamey. After a gnathological evaluation, according to the protocol of the European Academy of Craniomandibular Disorders, patients were classified by RDC/TMD criteria. The data were compared and analyzed using a chi-square test to describe the existence of an association between BMS and TMD. 65.9% the BMS patients showed disorders classified as primary signs and symptoms of TMD according to RDC / TMD criteria, and 72.7% showed parafunctional habits. The chi-square test revealed a statistically significant association (p = 0.035) between BMS and TMD. The data suggest that there is a possible relationship not yet well understood between BMS and TMD, may be for neurophatic alterations assumed for BMS that could be also engaged in TMD pathogenesis.

  17. Study of melt produced bodies observed at Henbury crater region

    International Nuclear Information System (INIS)

    Hopper, V.D.; Sewell, D.K.B.; Aitken, D.K.

    1989-01-01

    Spherical and non spherical bodies derived from target rock and meteorite components have been found in samples of soil in the Henbury crater region. From a study of the composition of these bodies, the compositions of the meteorite and the target rock, it has been possible to separate the bodies into three groups showing differing degrees of volatilization of various oxides. The composition of a number of the soil samples were measured using X-ray fluorescence. A selected number were then examined by a scanning electron microscope fitted with an energy dispersive X-ray analyzer. Where Ni was definitely identified, it was examined by an electron microprobe X-ray analyzer. A major finding was the depletion of SiO 2 in the production of both Group 1 and Group 3 bodies. Group 3 bodies are not volatilized to the same extent as Group 1. With no reference to the target rock , the general order of volatility appears to be Na 2 O>MgO>K 2 O>TiO 2 , SiO 2 and Al 2 O 3 , the significant change being the place of SiO2. 13 refs., 7 figs., 5 tabs

  18. The Reporting of Observational Research Studies in Dermatology Journals A Literature-Based Study

    NARCIS (Netherlands)

    Langan, Sinead; Schmitt, Jochen; Coenraads, Pieter-Jan; Svensson, Ake; von Elm, Erik; Williams, Hywel

    Objective: To assess the quality of reporting in observational studies in dermatology. Data Sources: Five dermatology journals-the Archives of Dermatology, the British Journal of Dermatology, the Journal of the American Academy of Dermatology, the Journal of Investigative Dermatology, and Acta

  19. Characterizing Suicide in Toronto: An Observational Study and Cluster Analysis

    Science.gov (United States)

    Sinyor, Mark; Schaffer, Ayal; Streiner, David L

    2014-01-01

    Objective: To determine whether people who have died from suicide in a large epidemiologic sample form clusters based on demographic, clinical, and psychosocial factors. Method: We conducted a coroner’s chart review for 2886 people who died in Toronto, Ontario, from 1998 to 2010, and whose death was ruled as suicide by the Office of the Chief Coroner of Ontario. A cluster analysis using known suicide risk factors was performed to determine whether suicide deaths separate into distinct groups. Clusters were compared according to person- and suicide-specific factors. Results: Five clusters emerged. Cluster 1 had the highest proportion of females and nonviolent methods, and all had depression and a past suicide attempt. Cluster 2 had the highest proportion of people with a recent stressor and violent suicide methods, and all were married. Cluster 3 had mostly males between the ages of 20 and 64, and all had either experienced recent stressors, suffered from mental illness, or had a history of substance abuse. Cluster 4 had the youngest people and the highest proportion of deaths by jumping from height, few were married, and nearly one-half had bipolar disorder or schizophrenia. Cluster 5 had all unmarried people with no prior suicide attempts, and were the least likely to have an identified mental illness and most likely to leave a suicide note. Conclusions: People who die from suicide assort into different patterns of demographic, clinical, and death-specific characteristics. Identifying and studying subgroups of suicides may advance our understanding of the heterogeneous nature of suicide and help to inform development of more targeted suicide prevention strategies. PMID:24444321

  20. Aortic replacement in aorto-occlusive disease: an observational study

    Directory of Open Access Journals (Sweden)

    Winter Richard K

    2008-10-01

    Full Text Available Abstract Background For many patients with aorto-occlusive disease, where stent deployment is not possible, surgery remains the only treatment option available. The aim of this study was to assess the results of aortic reconstruction surgery performed in patients with critical ischaemia. Methods All patients with critical ischaemia undergoing surgery during 1991–2004 were identified from a prospectively maintained database. Mortality data was verified against death certificate data. Demographic and clinical data were obtained from the clinical notes and the radiology database. Disease was classified as: type I – limited to aorta and common iliac arteries; type II – external iliac disease and type III combined aortic, iliac and infra-inguinal disease. Results 86 patients underwent aortic replacement surgery all of whom had critical ischaemia consisting of: type I (n = 16; type II (n = 37 and type III (n = 33. The 30-day mortality rate was 10.4%, the one-year patient survival was 80%, and the 1-year graft survival was 80%. At 2 years the actual patient survival was 73% and no additional graft losses were identified. All patients surviving 30 days reported excellent symptomatic relief. Early, complications occurred in 6 (7% patients: thrombosis within diseased superficial femoral arteries (n = 4; haemorrhage and subsequent death (n = 2. Ten (14% late complications (> 12 months occurred in the 69 surviving patients and included: anastomotic stenosis (n = 3; graft thrombosis (n = 4, graft infection (n = 3. Four patients developed claudication as a result of more distal disease in the presence of a patent graft, and 1 patient who continued smoking required an amputation for progressive distal disease. Conclusion Aortic reconstruction for patients with extensive aorto-occlussive disease provides long-standing symptomatic relief for the majority of patients. After the first year, there is continued patient attrition due to co

  1. Returning to work after laparoscopic myomectomy: a prospective observational study.

    Science.gov (United States)

    Huff, Keren O; Aref-Adib, Mehrnoosh; Magama, Zwelihle; Vlachodimitropoulou, Evangelia K; Oliver, Reeba; Odejinmi, Funlayo

    2018-01-01

    Laparoscopic myomectomy offers women many benefits over conventional open surgery, including an expedited recovery and return to employment. Our study evaluates the time taken for women to return to work after laparoscopic myomectomy and identifies factors prolonging recovery to > 8 weeks. We prospectively evaluated 94 women undergoing laparoscopic myomectomy by a single surgeon between January 2012 and March 2015. Women had standardized preoperative counseling and completed a validated return to work questionnaire 3 months postoperatively via telephone, post or in clinic. In all, 71/94 (75.5%) women completed the questionnaire. Results were analyzed comparing women who returned to work in ≤ 8 weeks [43/71 (60.6%)] with those who returned > 8 weeks postoperatively [28/71 (39.4%)]. A higher proportion of Asian and Caucasian women returned to work in ≤ 8 weeks (24/29) compared with black African and Caribbean women (19/42) (p = 0.003). Mean number of fibroids removed (2.59 and 5.75, respectively) was the only significantly differing factor between the two groups (p = 0.004). There was a significant difference in body mass index (BMI) and time to return to normal activity between the ≤ 8-week and > 8-week groups (p = 0.027, p = 0.011, respectively). Logistic regression analysis demonstrated that BMI and time to return to normal activity were the only factors prolonging recovery to > 8 weeks (p = 0.039, p = 0.015, respectively). Time to return to normal activity and BMI significantly influenced the time taken for women to work after laparoscopic myomectomy. Further data would support clinicians in counseling women appropriately and optimizing their postoperative return to employment. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  2. Effects of caffeine on the preterm brain: An observational study.

    Science.gov (United States)

    Dix, Laura M L; van Bel, Frank; Baerts, Willem; Lemmers, Petra M A

    2018-05-01

    Caffeine improves neurodevelopmental outcome of preterm infants. This study analyses the effects of caffeine on the neonatal brain. We hypothesized that caffeine has a neuroprotective effect through an increase in oxygen metabolism; reflected by increased cerebral oxygen extraction, electrical function, and perfusion. Preterm infants <32 weeks gestation (GA) receiving their primary dose caffeine-base (10 mg/kg) were included. Ten minutes of stable monitoring were selected before, during, and every hour up to 6 h after caffeine. Near-infrared spectroscopy monitored regional cerebral oxygenation (rScO 2 ) and extraction (FTOE). Amplitude-integrated electroencephalogram (aEEG) monitored minimum, mean and maximum amplitudes. Spontaneous activity transients (SAT) rate and the interval between SATs (ISI) were calculated. Mean arterial blood pressure (MABP), heart rate (HR) and arterial oxygen saturation (SaO 2 ) were monitored. Arterial pCO 2 's were collected before and 4 h after caffeine. Brain perfusion was assessed 1 h before and 3 h after caffeine by Doppler-measured resistance-index (RI), peak systolic velocity (PSV) and end-diastolic velocity (EDV), in the anterior cerebral artery (ACA) and internal carotid artery (ICA). Results were presented in mean ± SD. 34 infants, mean GA 28.8 ± 2.1 wk, were included. rScO 2 significantly decreased from 69 ± 11 to 63 ± 12 1 h after caffeine, and recovered at 6 h (66 ± 10). FTOE increased correspondingly. MABP and HR increased significantly. PSV in the ACA decreased slightly. Other Doppler variables, aEEG parameters, and SaO 2 were unaffected. Caffeine increases oxygen extraction, suggesting a (transient) stimulating effect on brain metabolism. However, no substantial changes were found in brain perfusion and in electrical brain activity. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Physical activity among hospitalized older adults - an observational study.

    Science.gov (United States)

    Evensen, Sigurd; Sletvold, Olav; Lydersen, Stian; Taraldsen, Kristin

    2017-05-16

    Low level of physical activity is common among hospitalized older adults and is associated with worse prognosis. The aim of this paper is to describe the pattern and level of physical activity in a group of hospitalized older adults and to identify factors associated with physical activity. We measured physical activity on day three after admission using accelerometer based activity monitors and time in upright position as outcome measure. We collected data of physical function (Short Physical Performance Battery, SPPB. 0-12), cognitive function (Mini Mental Status Examination, MMSE, 0-30 and diagnosis of cognitive impairment at discharge, yes/no), personal Activities of Daily Living (p-ADL, Barthel Index, BI, 0-20) and burden of disease (Cumulative Illness Rating Scale, CIRS, 0-56). We analyzed data using univariable and multivariable linear regression models, with time in upright position as dependent variable. We recorded physical activity in a consecutive sample of thirty-eight geriatric patients. Their (mean age 82.9 years, SD 6.3) mean time in upright position one day early after admission was 117.1 min (SD 90.1, n = 38). Mean SPPB score was 4.3 (SD 3.3, n = 34). Mean MMSE score was 19.3 (SD 5.3, n = 30), 73% had a diagnosis of cognitive impairment (n = 38). Mean BI score was 16.4 (SD 4.4, n = 36). Mean CIRS score was 17.0 (SD 4.2, n = 38). There was a significant association between SPPB score and time in upright position (p = 0.048): For each one unit increase in SPPB, the expected increase in upright time was 11.7 min. There was no significant association between age (p = 0.608), diagnosis of cognitive impairment (p = 0.794), p-ADL status (p = 0.127), CIRS score (p = 0.218) and time in upright position. The overall model fit was R 2 0.431. Participants' mean time in upright position one day early after admission was almost two hours, indicating a high level of physical activity compared to results from similar studies. Physical

  4. International Halley watch amateur observers' manual for scientific comet studies. Part 1: Methods

    Science.gov (United States)

    Edberg, S. J.

    1983-01-01

    The International Halley Watch is described as well as comets and observing techniques. Information on periodic Comet Halley's apparition for its 1986 perihelion passage is provided. Instructions are given for observation projects valuable to the International Halley Watch in six areas of study: (1) visual observations; (2) photography; (3) astrometry; (4) spectroscopic observations; (5) photoelectric photometry; and (6) meteor observations.

  5. An observational study of the initial management of hypothyroidism in France: the ORCHIDÉE study

    OpenAIRE

    Delemer, Brigitte; Aubert, Jean-Pierre; Nys, Pierre; Landron, Frédéric; Bouée, Stéphane

    2012-01-01

    Objective To document the initial management of hypothyroidism in France with respect to diagnostic setting, investigations, and therapeutic approach. Design Observational study of the management by primary care practitioners (PCPs) and endocrinologists of patients diagnosed with, and treated for, hypothyroidism during the enrollment period or the previous 6 months. Methods A representative sample of PCPs and endocrinologists enrolled up to five consecutive patients and reported sociodemograp...

  6. The taxation of unhealthy energy-dense foods (EDFs) and sugar-sweetened beverages (SSBs): An overview of patterns observed in the policy content and policy context of 13 case studies.

    Science.gov (United States)

    Hagenaars, Luc Louis; Jeurissen, Patrick Paulus Theodoor; Klazinga, Niek Sieds

    2017-08-01

    Taxation of energy-dense foods (EDFs) and sugar-sweetened beverages (SSBs) is increasingly of interest as a novel public health and fiscal policy instrument. However academic interest in policy determinants has remained limited. We address this paucity by comparing the policy content and policy context of EDF/SSB taxes witnessed in 13 case studies, of which we assume the tax is sufficiently high to induce behavioural change. The observational and non-randomized studies published on our case studies seem to indicate that the EDF/SSB taxes under investigation generally had the desired effects on prices and consumption of targeted products. The revenue collection of EDF/SSB taxes is minimal yet significant. Administrative practicalities in tax levying are important, possibly explaining why a drift towards solely taxing SSBs can be noted, as these can be demarcated more easily, with levies seemingly increasing in more recent case studies. Despite the growing body of evidence suggesting that EDF/SSB taxes have the potential to improve health, fiscal needs more often seem to lay their policy foundation rather than public health advocacy. A remarkable amount of conservative/liberal governments have adopted these taxes, although in many cases revenues are earmarked for benefits compensating regressive income effects. Governments voice diverse policy rationales, ranging from explicitly describing the tax as a public health instrument, to solely explicating revenue raising. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Is the alpha-beta ratio of prostate cancer really low? A prospective, non-randomized trial comparing standard and hyperfractionated conformal radiation therapy

    International Nuclear Information System (INIS)

    Valdagni, Riccardo; Italia, Corrado; Montanaro, Paolo; Lanceni, Angelo; Lattuada, Paola; Magnani, Tiziana; Fiorino, Claudio; Nahum, Alan

    2005-01-01

    Background and purpose: The objectives of the current study were to compare genito-urinary (GU) and gastro-intestinal (GI) toxicities as well as biochemical control (bRFS) in prostate cancer, utilizing conventional (2.0 Gy daily) (STD) or hyperfractionated (HFX) conformal irradiation (CRT). HFX (1.2 Gy BID) was chosen as a radiobiological method to try to reduce long term sequelae without compromising local control. Patients and methods: Three-hundred-and-seventy consecutive patients (pts) entered this prospective, non-randomized trial in the period January 1993-January 2003; 209 were treated with STD and 161 with HFX CRT. All were evaluable for acute toxicity analysis, 179 (STD) and 151 pts (HFX) being evaluable for late sequelae and bRFS analyses. Pt characteristics were not statistically different in the two groups. CRT consisted of a 4-field technique for prostate and/or pelvic nodes and a 5-field boost with rectal shielding. Median doses were 74 and 79.2 Gy for STD and HFX patients respectively, the latter dose being isoeffective for tumour control assuming α/β=10 (EQD 2 =73.9 Gy). Median follow-up was 29.4 months (25.2 mos for STD; 37.7 mos for HFX; P<0.01). The two regimens were compared in terms of acute and late GU and GI toxicities and 5-year bRFS by univariate and multivariate analyses. Results: Acute grade≥2 GU toxicity was higher in the STD group (48.6% versus 37.3% in HFX, P=0.03), while no significant difference was found for acute GI toxicity. Late grade≥2 GU and GI toxicities were lower in the HFX group (5-year actuarial rate: GU: 10.1% versus 20.3%, P=0.05; GI: 6.0% versus 10.6%, P=0.18). Five-year bRFS were 70% (±13.8%, 95% CI) and 82.6% (±7.2%) for STD and HFX, respectively (P=0.44); a trend favouring HFX was found in the subgroup of pts who did not receive hormonal therapy (5-year bRFS: 85.9%±12.4% versus 63.9%±23.8%, P=0.15). Multivariate analysis revealed only risk groups and age statistically related to bRFS but not fractionation

  8. Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: protocol for an observational study.

    Science.gov (United States)

    Malla, Lucas; Perera-Salazar, Rafael; McFadden, Emily; English, Mike

    2017-09-18

    WHO treatment guidelines are widely recommended for guiding treatment for millions of children with pneumonia every year across multiple low-income and middle-income countries. Guidelines are based on synthesis of available evidence that provides moderate certainty in evidence of effects for forms of pneumonia that can result in hospitalisation. However, trials have included fewer children from Africa than other settings, and it is suggested that African children with pneumonia have higher mortality. Thus, despite improving access to recommended treatments and deployment with high coverage of childhood vaccines, pneumonia remains one of the top causes of mortality for children in Kenya. Establishing whether there are benefits of alternative treatment regimens to help reduce mortality would require pragmatic clinical trials. However, these remain relatively expensive and time consuming. This protocol describes an approach to using secondary analysis of a new, large observational dataset as a potentially cheaper and quicker way to examine the comparative effectiveness of penicillin versus penicillin plus gentamicin in treatment of indrawing pneumonia. Addressing this question is important, as although it is now recommended that this form of pneumonia is treated with oral medication as an outpatient, it remains associated with non-trivial mortality that may be higher outside trial populations. We will use a large observational dataset that captures data on all admissions to 13 Kenyan county hospitals. These data represent the findings of clinicians in practice and, because the system was developed for large observational research, pose challenges of non-random treatment allocation and missing data. To overcome these challenges, this analysis will use a rigorous approach to study design, propensity score methods and multiple imputation to minimise bias. The primary data are held by hospitals participating in the Kenyan Clinical Information Network project with de

  9. A comparative study of kalman filtering based observer and sliding mode observer for state of charge estimation

    Science.gov (United States)

    Ben Sassi, Hicham; Errahimi, Fatima; Es-Sbai, Najia; Alaoui, Chakib

    2018-05-01

    Nowadays, electric mobility is starting to define society and is becoming more and more irreplaceable and essential to daily activities. Safe and durable battery is of a great significance for this type of mobility, hence the increasing interest of research activity oriented to battery studies, in order to assure safe operating mode and to control the battery in case of any abnormal functioning conditions that could damage the battery if not properly managed. Lithium-ion technology is considered the most suitable existing technology for electrical storage, because of their interesting features such as their relatively long cycle life, lighter weight, their high energy density, However, there is a lot of work that is still needed to be done in order to assure safe operating lithium-ion batteries, starting with their internal status monitoring, cell balancing within a battery pack, and thermal management. Tasks that are accomplished by the battery management system (BMS) which uses the state of charge (SOC) as an indicator of the internal charge level of the battery, in order to avoid unpredicted system interruption. Since the state of charge is an inner state of a the battery which cannot be directly measured, a powerful estimation technique is inevitable, in this paper we investigate the performances of tow estimation strategies; kalman filtering based observers and sliding mode observers, both strategies are compared in terms of accuracy, design requirement, and overall performances.

  10. Probability calculus of fractional order and fractional Taylor's series application to Fokker-Planck equation and information of non-random functions

    International Nuclear Information System (INIS)

    Jumarie, Guy

    2009-01-01

    A probability distribution of fractional (or fractal) order is defined by the measure μ{dx} = p(x)(dx) α , 0 α (D x α h α )f(x) provided by the modified Riemann Liouville definition, one can expand a probability calculus parallel to the standard one. A Fourier's transform of fractional order using the Mittag-Leffler function is introduced, together with its inversion formula; and it provides a suitable generalization of the characteristic function of fractal random variables. It appears that the state moments of fractional order are more especially relevant. The main properties of this fractional probability calculus are outlined, it is shown that it provides a sound approach to Fokker-Planck equation which are fractional in both space and time, and it provides new results in the information theory of non-random functions.

  11. Task Equivalence for Model and Human-Observer Comparisons in SPECT Localization Studies

    Science.gov (United States)

    Sen, Anando; Kalantari, Faraz; Gifford, Howard C.

    2016-06-01

    While mathematical model observers are intended for efficient assessment of medical imaging systems, their findings should be relevant for human observers as the primary clinical end users. We have investigated whether pursuing equivalence between the model and human-observer tasks can help ensure this goal. A localization receiver operating characteristic (LROC) study tested prostate lesion detection in simulated In-111 SPECT imaging with anthropomorphic phantoms. The test images were 2D slices extracted from reconstructed volumes. The iterative ordered sets expectation-maximization (OSEM) reconstruction algorithm was used with Gaussian postsmoothing. Variations in the number of iterations and the level of postfiltering defined the test strategies in the study. Human-observer performance was compared with that of a visual-search (VS) observer, a scanning channelized Hotelling observer, and a scanning channelized nonprewhitening (CNPW) observer. These model observers were applied with precise information about the target regions of interest (ROIs). ROI knowledge was a study variable for the human observers. In one study format, the humans read the SPECT image alone. With a dual-modality format, the SPECT image was presented alongside an anatomical image slice extracted from the density map of the phantom. Performance was scored by area under the LROC curve. The human observers performed significantly better with the dual-modality format, and correlation with the model observers was also improved. Given the human-observer data from the SPECT study format, the Pearson correlation coefficients for the model observers were 0.58 (VS), -0.12 (CH), and -0.23 (CNPW). The respective coefficients based on the human-observer data from the dual-modality study were 0.72, 0.27, and -0.11. These results point towards the continued development of the VS observer for enhancing task equivalence in model-observer studies.

  12. An observational study of the initial management of hypothyroidism in France: the ORCHIDÉE study

    Science.gov (United States)

    Delemer, Brigitte; Aubert, Jean-Pierre; Nys, Pierre; Landron, Frédéric; Bouée, Stéphane

    2012-01-01

    Objective To document the initial management of hypothyroidism in France with respect to diagnostic setting, investigations, and therapeutic approach. Design Observational study of the management by primary care practitioners (PCPs) and endocrinologists of patients diagnosed with, and treated for, hypothyroidism during the enrollment period or the previous 6 months. Methods A representative sample of PCPs and endocrinologists enrolled up to five consecutive patients and reported sociodemographic, clinical, therapeutic, and laboratory data. Data were submitted at baseline and at the first measurement of TSH after starting the treatment. Results The analysis population comprised 1255 patients (mean (s.d.) age 52.8 (16.3) years; 84% female). Hypothyroidism was suspected on clinical grounds in 77% of patients, with goiter in 16%. Autoimmune thyroiditis, supported by positive anti-thyroid antibodies, was the most frequent diagnosis (59%), followed by iatrogenic causes (28%), of which thyroidectomy was the most common. The median baseline TSH was 8.6 mIU/l, suggesting a high incidence of subclinical hypothyroidism. Imaging studies were requested in over 75% of patients, with ultrasound performed in 98% and scintigraphy performed in 19% of these patients. Both groups of physicians treated their patients almost exclusively with levothyroxine. Endocrinologists were more likely than PCPs to provide counseling on how to take medication correctly. Conclusions This observational study of a large cohort of patients with newly diagnosed hypothyroidism in France illustrates current practice and indicates some areas where physician education may be required to optimize adherence to guidelines and cost-effectiveness. PMID:23034782

  13. Study of Application for Excursion Observation Method in Primary School 2nd Grade Social Studies

    Directory of Open Access Journals (Sweden)

    Ahmet Ali GAZEL

    2014-04-01

    Full Text Available This study aims to investigate how field trips are conducted at 2nd grade of primary schools as a part of social studies course. Data for this research is compiled from 143 permanent Social Studies teachers working throughout 2011–2012 Education Year in the primary schools of central Kütahya and its districts. Data is compiled by using descriptive search model. In the research, after taking expert opinions, a measuring tool developed by the researcher is used. Data obtained from the research were transferred to computer, and analyses were made. In the analysis of the data, frequency and percentage values have been used to determine the distribution. Also a single factor variance analysis and t-test for independent samples have been used to determine the significance of difference between the variables. As a result of the research, it has been realized that insufficient importance is given to field trip method in Social Studies lessons. Most of the teachers using this method apply it in spring months. Teachers usually make use of field trips independent from unit/topic to increase the students’ motivation, and they generally use verbal expression in the class after tours. The biggest difficulty teachers encounter while using tour-observation method is the students’ undisciplined behavior.

  14. A fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial

    Directory of Open Access Journals (Sweden)

    Tahsin Gorgulu

    2016-02-01

    Full Text Available ABSTRACT Background Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. Materials and Methods : Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6–9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. Results No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33% occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6–9 minutes. The conventional guillotine group comprised one hematoma (1.3%, two wound dehiscences (2.6%, and two hemorrhages (2.6%, and the median operating time was 22 (range 20–26 minutes. The difference in surgical time was significant (p<0.001, with no significant difference in the rate of complications between the two groups. Conclusion The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone.

  15. Effectiveness of Vildagliptin in Clinical Practice: Pooled Analysis of Three Korean Observational Studies (the VICTORY Study

    Directory of Open Access Journals (Sweden)

    Sunghwan Suh

    2017-01-01

    Full Text Available The present observational study aimed to evaluate the clinical effectiveness of vildagliptin with metformin in Korean patients with type 2 diabetes mellitus (T2DM. Data were pooled from the vildagliptin postmarketing survey (PMS, the vildagliptin/metformin fixed drug combination (DC PMS, and a retrospective observational study of vildagliptin/metformin (fixed DC or free DC. The effectiveness endpoint was the proportion of patients who achieved a glycemic target (HbA1c of ≤7.0% at 24 weeks. In total, 4303 patients were included in the analysis; of these, 2087 patients were eligible. The mean patient age was 56.99 ± 11.25 years. Overall, 58.94% patients achieved an HbA1c target of ≤7.0% at 24 weeks. The glycemic target achievement rate was significantly greater in patients with baseline HbA1c < 7.5% versus ≥7.5% (84.64% versus 43.97%, receiving care at the hospital versus clinic (67.95% versus 52.33%, and receiving vildagliptin/metformin fixed DC versus free DC (70.69% versus 55.42%. Multivariate logistic regression analysis indicated that disease duration (P<0.0001, baseline HbA1c (P<0.0001, and DC type (P=0.0103 had significant effects on drug effectiveness. Vildagliptin plus metformin appeared as an effective treatment option for patients with T2DM in clinical practice settings in Korea.

  16. Comparative Evaluation of Liposomal Albendazole and Tablet-Albendazole Against Hepatic Cystic Echinococcosis: A Non-Randomized Clinical Trial.

    Science.gov (United States)

    Li, Haitao; Song, Tao; Shao, Yingmei; Aili, Tuergan; Ahan, Ayifuhan; Wen, Hao

    2016-01-01

    In this study, we aimed to compare the clinical efficacy of liposomal albendazole (L-ABZ) and tablet-albendazole (T-ABZ) for the treatment of human hepatic cystic echinococcosis (CE). Sixty patients with single cyst (CE1) or daughter cyst (CE2) were included in this study and were nonrandomly divided into the L-ABZ group (n = 30, 10  mg/kg per day, p.o., b.i.d.) and T-ABZ group (n = 30, 12-20 mg/kg per day, p.o., b.i.d.), respectively. The treatment duration lasted for 6 months, during which dynamic follow-up was carried out to evaluate the clinical efficacy through calculating the total effective rates (TERs). Measurement data and numerous data were analyzed by the chi-square test. Two-sided tests were performed for all the statistical tests. In our study, 2 patients were lost in the follow-up in the L-ABZ group. One patient was lost in the follow-up in the T-ABZ group, and 1 patient was withdrawal from the study due to receiving surgery. Significant difference was identified in the 3-month TERs of L-ABZ group and T-ABZ group (33.3% vs 76.7%, P  0.05). Based on our study, both T-ABZ and L-ABZ are effective for treating human CE. The TER in the L-ABZ group is superior to that of T-ABZ.

  17. Treatment of periocular hyperpigmentation due to lead of kohl (surma by penicillamine: A single group non-randomized clinical trial

    Directory of Open Access Journals (Sweden)

    El Safoury Omar

    2009-01-01

    Full Text Available Background: Periocular hyperpigmentation is a condition in which skin of eyelids become darker in color than the normal surrounding skin. Lead and other heavy metals produce increased pigmentation because of deposition of metal particles in the dermis and increased epidermal melanin production. Aims: This study was conducted to evaluate the dual effect of chelation therapy in treating periocular hyperpigmentation and lead toxicity. Methods: The study population consisted of nine females complaining from dark coloration of their eyelids. The nine females were continuously using kohl as eyeliner. Lead levels in conjunctiva and serum before and after D-penicillamine (D-PCN oral administration were estimated in relation to vertical, horizontal length, and degree of hyperpigmentation score. Results: Highly significant P values (0.000 were obtained as regard to the conjunctival lead levels, serum lead levels, horizontal length, and degree of darkness score before and after D-PCN therapy. A less significant P value (0.040 was recorded as regard to the vertical length. Conclusion: Regardless other causes, this study spots the light on a new concept for periocular hyperpigmentation from lead toxicity in adult females using kohl and suggests D-PCN in a low divided dose (750 mg/day for its treatment.

  18. Interventions for Preventing Childhood Obesity with Smartphones and Wearable Device: A Protocol for a Non-Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Hye Jung Yang

    2017-02-01

    Full Text Available Background: Childhood obesity is a critical health issue, both currently and for the foreseeable future. To prevent obesity, behavior changes are essential. Smartphones can be a good tool, as the number of child smartphone users is rapidly increasing. We have developed a mobile platform system named “HAPPY ME,” which is a smartphone application coupled with a wearable device, designed to improve healthy behaviors to prevent childhood obesity. This study aimed to evaluate the effectiveness of obesity prevention among children 10–12 years of age using HAPPY ME. Methods: A total of 1000 participants, all fifth and sixth graders from four schools, were assigned to either control or intervention groups by school. Students in the intervention group used HAPPY ME. The study comprises a safety test, a 12-week efficacy test, and a six-month follow-up test to determine the long-term effects of preventive intervention via the integrated service platform. The integrated service platform aims to facilitate child-parent-school participation, involving the child-parent mobile application, a child-teacher mobile web, and a school website. Primary outcome measures are behavioral changes, including healthy eating, increased physical activity, and fitness. Secondary outcome measures are changes in anthropometric parameters (body weight, height, body mass index z-score, and waist circumference, body mass index (BMI percentiles (obesity rate, and psychological perceptions among participants. Conclusions: The results of this study will offer evidence of the effectiveness of a mobile platform service with a multi-component intervention program based on a comprehensive approach.

  19. A non-randomized [corrected] controlled trial of the active music engagement (AME) intervention on children with cancer.

    Science.gov (United States)

    Robb, Sheri L; Clair, Alicia A; Watanabe, Masayo; Monahan, Patrick O; Azzouz, Faouzi; Stouffer, Janice W; Ebberts, Allison; Darsie, Emily; Whitmer, Courtney; Walker, Joey; Nelson, Kirsten; Hanson-Abromeit, Deanna; Lane, Deforia; Hannan, Ann

    2008-07-01

    Coping theorists argue that environmental factors affect how children perceive and respond to stressful events such as cancer. However, few studies have investigated how particular interventions can change coping behaviors. The active music engagement (AME) intervention was designed to counter stressful qualities of the in-patient hospital environment by introducing three forms of environmental support. The purpose of this multi-site randomized controlled trial was to determine the efficacy of the AME intervention on three coping-related behaviors (i.e. positive facial affect, active engagement, and initiation). Eighty-three participants, ages 4-7, were randomly assigned to one of three conditions: AME (n = 27), music listening (ML; n = 28), or audio storybooks (ASB; n = 28). Conditions were videotaped to facilitate behavioral data collection using time-sampling procedures. After adjusting for baseline differences, repeated measure analyses indicated that AME participants had a significantly higher frequency of coping-related behaviors compared with ML or ASB. Positive facial affect and active engagement were significantly higher during AME compared with ML and ASB (p<0.0001). Initiation was significantly higher during AME than ASB (p<0.05). This study supports the use of the AME intervention to encourage coping-related behaviors in hospitalized children aged 4-7 receiving cancer treatment. (c) 2007 John Wiley & Sons, Ltd.

  20. Observational studies in systematic [corrected] reviews of comparative effectiveness: AHRQ and the Effective Health Care Program.

    Science.gov (United States)

    Norris, Susan L; Atkins, David; Bruening, Wendy; Fox, Steven; Johnson, Eric; Kane, Robert; Morton, Sally C; Oremus, Mark; Ospina, Maria; Randhawa, Gurvaneet; Schoelles, Karen; Shekelle, Paul; Viswanathan, Meera

    2011-11-01

    Systematic reviewers disagree about the ability of observational studies to answer questions about the benefits or intended effects of pharmacotherapeutic, device, or procedural interventions. This study provides a framework for decision making on the inclusion of observational studies to assess benefits and intended effects in comparative effectiveness reviews (CERs). The conceptual model and recommendations were developed using a consensus process by members of the methods workgroup of the Effective Health Care Program of the Agency for Healthcare Research and Quality. In considering whether to use observational studies in CERs for addressing beneficial effects, reviewers should answer two questions: (1) Are there gaps in the evidence from randomized controlled trials (RCTs)? (2) Will observational studies provide valid and useful information? The latter question involves the following: (a) refocusing the study questions on gaps in the evidence from RCTs, (b) assessing the risk of bias of the body of evidence of observational studies, and (c) assessing whether available observational studies address the gap review questions. Because it is unusual to find sufficient evidence from RCTs to answer all key questions concerning benefit or the balance of benefits and harms, comparative effectiveness reviewers should routinely assess the appropriateness of inclusion of observational studies for questions of benefit. Furthermore, reviewers should explicitly state the rationale for inclusion or exclusion of observational studies when conducting CERs. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Study of the Penetration Bias of ENVISAT Altimeter Observations over Antarctica in Comparison to ICESat Observations

    Directory of Open Access Journals (Sweden)

    Aurélie Michel

    2014-09-01

    Full Text Available The aim of this article is to characterize the penetration bias of the ENVIronmental SATellite (ENVISAT radar altimeter over the Antarctic ice sheet through comparison with the more accurate measurements of the Ice, Cloud and land Elevation Satellite (ICESat altimeter at crossover points. We studied the difference between ENVISAT and ICESat fluctuations over six years. We observed the same patterns between the leading edge width and the elevation difference. Both parameters are linked, and the major bias is due to the lengthening of the leading edge width due to the radar penetration. We show that the elevation difference between both altimeters and the leading edge width are linearly well-linked with a 0.8 Pearson correlation coefficient, whereas the slope effect over the coasts is difficult to analyze. When we analyze each crossover point temporal evolution locally, the linear correlation between the leading edge width and the elevation difference is between −0.6 and −1. Fitting a linear model between them, we find a reliability index greater than 0.7 for the Antarctic Plateau and Dronning Maud Land, which confirms that the penetration effect has a linear influence on the retrieved height. Moreover, we present results from SARAL/AltiKa (launched in February 2013 that confirm SARAL/AltiKa accuracy and the promising information it will provide.

  2. Evaluation of physical activity interventions in children via the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework: A systematic review of randomized and non-randomized trials.

    Science.gov (United States)

    McGoey, Tara; Root, Zach; Bruner, Mark W; Law, Barbi

    2016-01-01

    Existing reviews of physical activity (PA) interventions designed to increase PA behavior exclusively in children (ages 5 to 11years) focus primarily on the efficacy (e.g., internal validity) of the interventions without addressing the applicability of the results in terms of generalizability and translatability (e.g., external validity). This review used the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) framework to measure the degree to which randomized and non-randomized PA interventions in children report on internal and external validity factors. A systematic search for controlled interventions conducted within the past 12years identified 78 studies that met the inclusion criteria. Based on the RE-AIM criteria, most of the studies focused on elements of internal validity (e.g., sample size, intervention location and efficacy/effectiveness) with minimal reporting of external validity indicators (e.g., representativeness of participants, start-up costs, protocol fidelity and sustainability). Results of this RE-AIM review emphasize the need for future PA interventions in children to report on real-world challenges and limitations, and to highlight considerations for translating evidence-based results into health promotion practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Development of Creative Behavior Observation Form: A Study on Validity and Reliability

    Science.gov (United States)

    Dere, Zeynep; Ömeroglu, Esra

    2018-01-01

    This study, Creative Behavior Observation Form was developed to assess creativity of the children. While the study group on the reliability and validity of Creative Behavior Observation Form was being developed, 257 children in total who were at the ages of 5-6 were used as samples with stratified sampling method. Content Validity Index (CVI) and…

  4. Forest observational studies-an essential infrastructure for sustainable use of natural resources

    Directory of Open Access Journals (Sweden)

    XiuHai Zhao

    2014-04-01

    Full Text Available This contribution complements Forest Ecosystems’ Thematic Series on “Forest Observational Studies”. We provide essential clarification regarding the definition and purpose of long-term field studies, review some of the extensive literature and discuss different approaches to collecting field data. We also describe two newly established forest observational networks that serve to illustrate the scope and diversity of forest field studies. The first is a large-scale network of forest observational studies in prominent natural forest ecosystems in China. The second example demonstrates observational studies in mixed and uneven-aged pine-oak forests which are selectively managed by local communities in Mexico. We summarize the potential for analysing and modeling forest ecosystems within interdisciplinary projects and provide argumentation in favour of long-term institutional commitment to maintaining forest observational field studies.

  5. Inter-observer reliability assessments in time motion studies: the foundation for meaningful clinical workflow analysis.

    Science.gov (United States)

    Lopetegui, Marcelo A; Bai, Shasha; Yen, Po-Yin; Lai, Albert; Embi, Peter; Payne, Philip R O

    2013-01-01

    Understanding clinical workflow is critical for researchers and healthcare decision makers. Current workflow studies tend to oversimplify and underrepresent the complexity of clinical workflow. Continuous observation time motion studies (TMS) could enhance clinical workflow studies by providing rich quantitative data required for in-depth workflow analyses. However, methodological inconsistencies have been reported in continuous observation TMS, potentially reducing the validity of TMS' data and limiting their contribution to the general state of knowledge. We believe that a cornerstone in standardizing TMS is to ensure the reliability of the human observers. In this manuscript we review the approaches for inter-observer reliability assessment (IORA) in a representative sample of TMS focusing on clinical workflow. We found that IORA is an uncommon practice, inconsistently reported, and often uses methods that provide partial and overestimated measures of agreement. Since a comprehensive approach to IORA is yet to be proposed and validated, we provide initial recommendations for IORA reporting in continuous observation TMS.

  6. Observed Sensitivity during Family Interactions and Cumulative Risk: A Study of Multiple Dyads per Family

    Science.gov (United States)

    Browne, Dillon T.; Leckie, George; Prime, Heather; Perlman, Michal; Jenkins, Jennifer M.

    2016-01-01

    The present study sought to investigate the family, individual, and dyad-specific contributions to observed cognitive sensitivity during family interactions. Moreover, the influence of cumulative risk on sensitivity at the aforementioned levels of the family was examined. Mothers and 2 children per family were observed interacting in a round robin…

  7. Detailed Study of the Internal Structure of a Red-giant Star Observed with Kepler

    DEFF Research Database (Denmark)

    Di Mauro, M. P.; Ventura, R.; Cardini, D.

    2012-01-01

    We study the internal structure and evolutionary state of KIC 4351319, a red-giant star observed with the Kepler satellite. The use of 25 individual oscillation frequencies, together with the accurate atmospheric data provided by ground-based spectroscopic observations, allowed us to estimate the...

  8. A Classroom Observational Study of Qatar's Independent Schools: Instruction and School Reform

    Science.gov (United States)

    Palmer, Douglas J.; Sadiq, Hissa M.; Lynch, Patricia; Parker, Dawn; Viruru, Radhika; Knight, Stephanie; Waxman, Hersh; Alford, Beverly; Brown, Danielle Bairrington; Rollins, Kayla; Stillisano, Jacqueline; Abu-Tineh, Abdullah M. Hamdan; Nasser, Ramzi; Allen, Nancy; Al-Binali, Hessa; Ellili, Maha; Al-Kateeb, Haithem; Al-Kubaisi, Huda

    2016-01-01

    Qatar initiated a K-12 national educational reform in 2001. However, there is limited information on the instructional practices of the teachers in the reform schools. This project was an observational study of classrooms with a stratified random sample of the first six cohorts of reform schools. Specifically, 156 classrooms were observed in 29…

  9. An Observational Analysis of Coaching Behaviors for Career Development Event Teams: A Mixed Methods Study

    Science.gov (United States)

    Ball, Anna L.; Bowling, Amanda M.; Sharpless, Justin D.

    2016-01-01

    School Based Agricultural Education (SBAE) teachers can use coaching behaviors, along with their agricultural content knowledge to help their Career Development Event (CDE) teams succeed. This mixed methods, collective case study observed three SBAE teachers preparing multiple CDEs throughout the CDE season. The teachers observed had a previous…

  10. Long term observation on absolute lymphocyte counts in the adult health study sample, Hiroshima and Nagasaki

    International Nuclear Information System (INIS)

    Oesterle, S.N.; Norman, J.E. Jr.

    1980-01-01

    Total peripheral blood lymphocytes were evaluated by age and exposure status in the Adult Health Study population during three examination cycles between 1958 and 1972. No radiation effect was observed, but a significant drop in the absolute lymphocyte counts of those aged 70 years and over and a corresponding maximum for persons aged 50 - 59 was observed. (author)

  11. An Observation Capability Semantic-Associated Approach to the Selection of Remote Sensing Satellite Sensors: A Case Study of Flood Observations in the Jinsha River Basin.

    Science.gov (United States)

    Hu, Chuli; Li, Jie; Lin, Xin; Chen, Nengcheng; Yang, Chao

    2018-05-21

    Observation schedules depend upon the accurate understanding of a single sensor’s observation capability and the interrelated observation capability information on multiple sensors. The general ontologies for sensors and observations are abundant. However, few observation capability ontologies for satellite sensors are available, and no study has described the dynamic associations among the observation capabilities of multiple sensors used for integrated observational planning. This limitation results in a failure to realize effective sensor selection. This paper develops a sensor observation capability association (SOCA) ontology model that is resolved around the task-sensor-observation capability (TSOC) ontology pattern. The pattern is developed considering the stimulus-sensor-observation (SSO) ontology design pattern, which focuses on facilitating sensor selection for one observation task. The core aim of the SOCA ontology model is to achieve an observation capability semantic association. A prototype system called SemOCAssociation was developed, and an experiment was conducted for flood observations in the Jinsha River basin in China. The results of this experiment verified that the SOCA ontology based association method can help sensor planners intuitively and accurately make evidence-based sensor selection decisions for a given flood observation task, which facilitates efficient and effective observational planning for flood satellite sensors.

  12. An Observation Capability Semantic-Associated Approach to the Selection of Remote Sensing Satellite Sensors: A Case Study of Flood Observations in the Jinsha River Basin

    Directory of Open Access Journals (Sweden)

    Chuli Hu

    2018-05-01

    Full Text Available Observation schedules depend upon the accurate understanding of a single sensor’s observation capability and the interrelated observation capability information on multiple sensors. The general ontologies for sensors and observations are abundant. However, few observation capability ontologies for satellite sensors are available, and no study has described the dynamic associations among the observation capabilities of multiple sensors used for integrated observational planning. This limitation results in a failure to realize effective sensor selection. This paper develops a sensor observation capability association (SOCA ontology model that is resolved around the task-sensor-observation capability (TSOC ontology pattern. The pattern is developed considering the stimulus-sensor-observation (SSO ontology design pattern, which focuses on facilitating sensor selection for one observation task. The core aim of the SOCA ontology model is to achieve an observation capability semantic association. A prototype system called SemOCAssociation was developed, and an experiment was conducted for flood observations in the Jinsha River basin in China. The results of this experiment verified that the SOCA ontology based association method can help sensor planners intuitively and accurately make evidence-based sensor selection decisions for a given flood observation task, which facilitates efficient and effective observational planning for flood satellite sensors.

  13. Coronal structures and particle acceleration studies from radioelectric and optical observations

    International Nuclear Information System (INIS)

    Axisa, Francois.

    1974-01-01

    The problem of acceleration outside of and during eruptions is studied from the association of type III radioelectric jumps with the chromosphere activity observed in absorption and emission of the Hα line. In addition the mean corona structure is investigated from observation of the slowly variable metric wave component in connection with coronal filaments and jets, and by type III emission in relation to the eruptive sites of complex active regions. Most of the experimental material comes from observations made with the Nancay East-West radioheliograph, which works on 169 MHz and optical observations carried out at the Meudon Observatory on the chromosphere and on photosphere magnetic fields [fr

  14. Relationship between healthcare worker surface contacts, care type and hand hygiene: an observational study in a single-bed hospital ward.

    Science.gov (United States)

    King, M-F; Noakes, C J; Sleigh, P A; Bale, S; Waters, L

    2016-09-01

    This study quantifies the relationship between hand hygiene and the frequency with which healthcare workers (HCWs) touch surfaces in patient rooms. Surface contacts and hand hygiene were recorded in a single-bed UK hospital ward for six care types. Surface contacts often formed non-random patterns, but hygiene before or after patient contact depends significantly on care type (P=0.001). The likelihood of hygiene correlated with the number of surface contacts (95% confidence interval 1.1-5.8, P=0.002), but not with time spent in the room. This highlights that a potential subconscious need for hand hygiene may have developed in HCWs, which may support and help focus future hygiene education programmes. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. A concealed observational study of infection control and safe injection practices in Jordanian governmental hospitals.

    Science.gov (United States)

    Al-Rawajfah, Omar M; Tubaishat, Ahmad

    2017-10-01

    The recognized international organizations on infection prevention recommend using an observational method as the gold standard procedure for assessing health care professional's compliance with standard infection control practices. However, observational studies are rarely used in Jordanian infection control studies. This study aimed to evaluate injection practices among nurses working in Jordanian governmental hospitals. A cross-sectional concealed observational design is used for this study. A convenience sampling technique was used to recruit a sample of nurses working in governmental hospitals in Jordan. Participants were unaware of the time and observer during the observation episode. A total of 384 nurses from 9 different hospitals participated in the study. A total of 835 injections events were observed, of which 73.9% were performed without handwashing, 64.5% without gloving, and 27.5% were followed by needle recapping. Handwashing rate was the lowest (18.9%) when injections were performed by beginner nurses. Subcutaneous injections were associated with the lowest rate (26.7%) of postinjection handwashing compared with other routes. This study demonstrates the need for focused and effective infection control educational programs in Jordanian hospitals. Future studies should consider exploring the whole infection control practices related to waste disposal and the roles of the infection control nurse in this process in Jordanian hospitals. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Pre-LBA Anglo-Brazilian Amazonian Climate Observation Study (ABRACOS) Data

    Data.gov (United States)

    National Aeronautics and Space Administration — The data set presents the principal data from the Anglo-BRazilian Amazonian Climate Observation Study (ABRACOS) (Gash et al. 1996) and provides quality controlled...

  17. Pre-LBA Anglo-Brazilian Amazonian Climate Observation Study (ABRACOS) Data

    Data.gov (United States)

    National Aeronautics and Space Administration — ABSTRACT: The data set presents the principal data from the Anglo-BRazilian Amazonian Climate Observation Study (ABRACOS) (Gash et al. 1996) and provides quality...

  18. COGNOS : Care for People With Cognitive Dysfunction A National Observational Study

    NARCIS (Netherlands)

    Mets, Tony; De Deyn, Peter P.; Pals, Philippe; De Lepeleire, Jan; Vandewoude, Maurits; Ventura, Manfredi; Ivanoiu, Adrian; Albert, Adelin; Seghers, An-Katrien

    2013-01-01

    Care plans are intended to improve the independence and functioning of patients with cognitive dysfunction and support the caregivers involved. They are an integral part of the Belgian reimbursement procedure for cholinesterase inhibitors. This nationwide, multicenter, observational study examined

  19. Association Between the Mediterranean Diet and Cancer Risk: A Review of Observational Studies

    NARCIS (Netherlands)

    Verberne, L.D.M.; Bach-Faig, A.; Buckland, G.; Serra-Majem, L.

    2010-01-01

    The aim of this article was to summarize the evidence concerning the association between Mediterranean dietary pattern and cancer risk in observational epidemiological studies. All the studies that met the following criteria were reviewed: human cohort and case-control studies that examined the

  20. User-friendly tools on handheld devices for observer performance study

    Science.gov (United States)

    Matsumoto, Takuya; Hara, Takeshi; Shiraishi, Junji; Fukuoka, Daisuke; Abe, Hiroyuki; Matsusako, Masaki; Yamada, Akira; Zhou, Xiangrong; Fujita, Hiroshi

    2012-02-01

    ROC studies require complex procedures to select cases from many data samples, and to set confidence levels in each selected case to generate ROC curves. In some observer performance studies, researchers have to develop software with specific graphical user interface (GUI) to obtain confidence levels from readers. Because ROC studies could be designed for various clinical situations, it is difficult task for preparing software corresponding to every ROC studies. In this work, we have developed software for recording confidence levels during observer studies on tiny personal handheld devices such as iPhone, iPod touch, and iPad. To confirm the functions of our software, three radiologists performed observer studies to detect lung nodules by using public database of chest radiograms published by Japan Society of Radiological Technology. The output in text format conformed to the format for the famous ROC kit from the University of Chicago. Times required for the reading each case was recorded very precisely.

  1. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement

    DEFF Research Database (Denmark)

    von Elm, Erik; Altman, Douglas G; Egger, Matthias

    2014-01-01

    Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed...... recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists...... and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case...

  2. [Registration of observational studies: it is time to comply with the Declaration of Helsinki requirement].

    Science.gov (United States)

    Dal-Ré, Rafael; Delgado, Miguel; Bolumar, Francisco

    2015-01-01

    Publication bias is a serious deficiency in the current system of disseminating the results of human research studies. Clinical investigators know that, from an ethical standpoint, they should prospectively register clinical trials in a public registry before starting them. In addition, it is believed that this approach will help to reduce publication bias. However, most studies conducted in humans are observational rather than experimental. It is estimated that less than 2% out of 2 million concluded or ongoing observational studies have been registered. The 2013 revision of the Declaration of Helsinki requires registration of any type of research study involving humans or identifiable samples or data. It is proposed that funding agencies, such as the Fondo de Investigaciones Sanitarias, as well as private companies, require preregistration of observational studies before providing funding. It is also proposed that Research Ethics Committees which, following Spanish regulation, have been using the Declaration as the framework for assessing the ethics of clinical trials with medicines since 1990, should follow the same provisions for the assessment of health-related observational studies: therefore, they should require prospective registration of studies before granting their final approval. This would allow observational study investigators to be educated in complying with an ethical requirement recently introduced in the most important ethical code for research involving humans. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  3. Concatenation of Observed Grasp Phases with Observer’s Distal Movements: A Behavioural and TMS Study

    Science.gov (United States)

    De Stefani, Elisa; Innocenti, Alessandro; De Marco, Doriana; Gentilucci, Maurizio

    2013-01-01

    The present study aimed at determining how actions executed by two conspecifics can be coordinated with each other, or more specifically, how the observation of different phases of a reaching-grasping action is temporary related to the execution of a movement of the observer. Participants observed postures of initial finger opening, maximal finger aperture, and final finger closing of grasp after observation of an initial hand posture. Then, they opened or closed their right thumb and index finger (experiments 1, 2 and 3). Response times decreased, whereas acceleration and velocity of actual finger movements increased when observing the two late phases of grasp. In addition, the results ruled out the possibility that this effect was due to salience of the visual stimulus when the hand was close to the target and confirmed an effect of even hand postures in addition to hand apparent motion due to the succession of initial hand posture and grasp phase. In experiments 4 and 5, the observation of grasp phases modulated even foot movements and pronunciation of syllables. Finally, in experiment 6, transcranial magnetic stimulation applied to primary motor cortex 300 ms post-stimulus induced an increase in hand motor evoked potentials of opponens pollicis muscle when observing the two late phases of grasp. These data suggest that the observation of grasp phases induced simulation which was stronger during observation of finger closing. This produced shorter response times, greater acceleration and velocity of the successive movement. In general, our data suggest best concatenation between two movements (one observed and the other executed) when the observed (and simulated) movement was to be accomplished. The mechanism joining the observation of a conspecific’s action with our own movement may be precursor of social functions. It may be at the basis for interactions between conspecifics, and related to communication between individuals. PMID:24278395

  4. Seeing beyond monitors-Critical care nurses' multiple skills in patient observation: Descriptive qualitative study.

    Science.gov (United States)

    Alastalo, Mika; Salminen, Leena; Lakanmaa, Riitta-Liisa; Leino-Kilpi, Helena

    2017-10-01

    The aim of this study was to provide a comprehensive description of multiple skills in patient observation in critical care nursing. Data from semi-structured interviews were analysed using thematic analysis. Experienced critical care nurses (n=20) from three intensive care units in two university hospitals in Finland. Patient observation skills consist of: information gaining skills, information processing skills, decision-making skills and co-operation skills. The first three skills are integrated in the patient observation process, in which gaining information is a prerequisite for processing information that precedes making decisions. Co-operation has a special role as it occurs throughout the process. This study provided a comprehensive description of patient observation skills related to the three-phased patient observation process. The findings contribute to clarifying this part of the competence. The description of patient observation skills may be applied in both clinical practice and education as it may serve as a framework for orientation, ensuring clinical skills and designing learning environments. Based on this study, patient observation skills can be recommended to be included in critical care nursing education, orientation and as a part of critical care nurses' competence evaluation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. The utility of observational studies in clinical decision making: lessons learned from statin trials.

    Science.gov (United States)

    Foody, JoAnne M; Mendys, Phillip M; Liu, Larry Z; Simpson, Ross J

    2010-05-01

    Contemporary clinical decision making is well supported by a wide variety of information sources, including clinical practice guidelines, position papers, and insights from randomized controlled trials (RCTs). Much of our fundamental understanding of cardiovascular risk factors is based on multiple observations from major epidemiologic studies, such as The Seven Country Studies and the US-based Framingham Heart Study. These studies provided the framework for the development of clinical practice guidelines, including the National Cholesterol Education Program Adult Treatment Panel series. The objective of this article is to highlight the value of observational studies as a complement to clinical trial data for clinical decision making in real-world practice. Although RCTs are still the benchmark for assessing clinical efficacy and safety of a specific therapeutic approach, they may be of limited utility to practitioners who must then adapt the lessons learned from the trial into the patient care environment. The use of well-structured observational studies can improve our understanding of the translation of clinical trials into clinical practice, as demonstrated here with the example of statins. Although such studies have their own limitations, improved techniques for design and analysis have reduced the impact of bias and confounders. The introduction of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines has provided more uniformity for such studies. When used together with RCTs, observational studies can enhance our understanding of effectiveness and utility in real-world clinical practice. In the examples of statin observational studies, the results suggest that relative effectiveness of different statins and potential impact of switching statins should be carefully considered in treating individual patients by practicing physicians.

  6. An Observational Study of Score Study Practices among Undergraduate Instrumental Music Education Majors

    Science.gov (United States)

    Silvey, Brian A.; Montemayor, Mark; Baumgartner, Christopher M.

    2017-01-01

    The purpose of this study was to investigate undergraduate instrumental music education majors' score study practices as they related to the effectiveness of their simulated conducting. Participants (N = 30) were video recorded in two sessions in which they completed a 20-min score study session and a simulated conducting performance. In the first…

  7. Using direct clinical observation to assess the quality of cesarean delivery in Afghanistan: an exploratory study

    Science.gov (United States)

    2014-01-01

    Background As part of a National Emergency Obstetric and Newborn Care (EmONC) Needs Assessment, a special study was undertaken in July 2010 to examine the quality of cesarean deliveries in Afghanistan and examine the utility of direct clinical observation as an assessment method in low-resource settings. Methods This cross-sectional assessment of the quality of cesareans at 14 facilities in Afghanistan included a survey of surgeons regarding their routine cesarean practices, direct observation of 29 cesarean deliveries and comparison of observations with facility records for 34 additional cesareans conducted during the 3 days prior to the observation period at each facility. For both observed cases and record reviews, we assessed time intervals between specified points of care-arrival to the ward, first evaluation, detection of a complication, decision for cesarean, incision, and birth. Results All time intervals with the exception of “decision to skin incision” were longer in the record reviews than in observed cases. Prior cesarean was the most common primary indication for all cases. All mothers in both groups observed survived through one hour postpartum. Among newborns there were two stillbirths (7%) in observed births and seven (21%) record reviews. Although our sample is too small to show statistical significance, the difference is noteworthy. In six of the reviewed cesareans resulting in stillbirth, a fetal heart rate was recorded in the operating theater, although four were recorded as macerated. For the two fresh stillbirths, the cesarean surgeries were recorded as scheduled and not urgent. Conclusions Direct observation of cesarean deliveries enabled us to assess a number of preoperative, postoperative, and intraoperative procedures that are often not described in medical records in low resource settings. Comparison of observations with findings from provider interviews and facility records allowed us to infer whether observed practices were typical

  8. Many participants in inpatient rehabilitation can quantify their exercise dosage accurately: an observational study.

    Science.gov (United States)

    Scrivener, Katharine; Sherrington, Catherine; Schurr, Karl; Treacy, Daniel

    2011-01-01

    Are inpatients undergoing rehabilitation who appear able to count exercises able to quantify accurately the amount of exercise they undertake? Observational study. Inpatients in an aged care rehabilitation unit and a neurological rehabilitation unit, who appeared able to count their exercises during a 1-2 min observation by their treating physiotherapist. Participants were observed for 30 min by an external observer while they exercised in the physiotherapy gymnasium. Both the participants and the observer counted exercise repetitions with a hand-held tally counter and the two tallies were compared. Of the 60 people admitted for aged care rehabilitation during the study period, 49 (82%) were judged by their treating therapist to be able to count their own exercise repetitions accurately. Of the 30 people admitted for neurological rehabilitation during the study period, 20 (67%) were judged by their treating therapist to be able to count their repetitions accurately. Of the 69 people judged to be accurate, 40 underwent observation while exercising. There was excellent agreement between these participants' counts of their exercise repetitions and the observers' counts, ICC (3,1) of 0.99 (95% CI 0.98 to 0.99). Eleven participants (28%) were in complete agreement with the observer. A further 19 participants (48%) varied from the observer by less than 10%. Therapists were able to identify a group of rehabilitation participants who were accurate in counting their exercise repetitions. Counting of exercise repetitions by therapist-selected patients is a valid means of quantifying exercise dosage during inpatient rehabilitation. Copyright © 2011 Australian Physiotherapy Association. Published by .. All rights reserved.

  9. Challenges in translating end points from trials to observational cohort studies in oncology

    Directory of Open Access Journals (Sweden)

    Ording AG

    2016-06-01

    Full Text Available Anne Gulbech Ording,1 Deirdre Cronin-Fenton,1 Vera Ehrenstein,1 Timothy L Lash,1,2 John Acquavella,1 Mikael Rørth,1 Henrik Toft Sørensen1 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA Abstract: Clinical trials are considered the gold standard for examining drug efficacy and for approval of new drugs. Medical databases and population surveillance registries are valuable resources for post-approval observational research, which are increasingly used in studies of benefits and risk of new cancer drugs. Here, we address the challenges in translating endpoints from oncology trials to observational studies. Registry-based cohort studies can investigate real-world safety issues – including previously unrecognized concerns – by examining rare endpoints or multiple endpoints at once. In contrast to clinical trials, observational cohort studies typically do not exclude real-world patients from clinical practice, such as old and frail patients with comorbidity. The observational cohort study complements the clinical trial by examining the effectiveness of interventions applied in clinical practice and by providing evidence on long-term clinical outcomes, which are often not feasible to study in a clinical trial. Various endpoints can be included in clinical trials, such as hard endpoints, soft endpoints, surrogate endpoints, and patient-reported endpoints. Each endpoint has it strengths and limitations for use in research studies. Endpoints used in oncology trials are often not applicable in observational cohort studies which are limited by the setting of standard clinical practice and by non-standardized endpoint determination. Observational studies can be more helpful moving research forward if they restrict focus to appropriate and valid endpoints. Keywords: endpoint determination, medical oncology

  10. Observation of Online Communities: A Discussion of Online and Offline Observer Roles in Studying Development, Cooperation and Coordination in an Open Source Software Environment

    Directory of Open Access Journals (Sweden)

    Sladjana V. Nørskov

    2011-09-01

    Full Text Available This paper addresses the application of observation to online settings with a special focus on observer roles. It draws on a study of online observation of a virtual community, i.e. an open source software (OSS community. The paper examines general and specific advantages and disadvantages of the observer roles in online settings by relating these roles to the same roles assumed in offline settings. The study suggests that under the right circumstances online and offline observation may benefit from being combined as they complement each other well. Quality issues and factors important to elicit trustworthy observational data from online study settings, such as OSS communities, are discussed. A proposition is made concerning how threats to credibility and transferability in relation to online observation (i.e. lack of richness and detail, risk of misunderstandings can be diminished, while maintaining the level of dependability (which is potentially high due to a greater degree of anonymity and "isolation" in online settings. The paper thus suggests that the less participative the researcher's online observer role is, the more s/he should consider introducing offline data collection techniques rather than adopting a more participative role in the observed online setting. This methodological discussion forms the basis for making a well-considered choice of online observer role rather than passively sliding into a role assigned by the setting. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs110358

  11. Gamblers Anonymous in Israel: a participant observation study of a self-help group.

    Science.gov (United States)

    Cromer, G

    1978-10-01

    This participant observation study of the first Gamblers Anonymous group in Israel is designed to show (1) the ways in which the group helps it members rehabilitate themselves, (2) the three stages through which they must go in order to ensure success, and (3) the reason why some participants fail to do so. The article concludes with a number of observations concerning the extent of gambling in Israel and the different ways that should be developed for dealing with the problem.

  12. Service Failure and Recovery in a Public Setting: A Comparative Study of Target and Observing Customers

    OpenAIRE

    SEYED SHAHIN SHARIFI

    2017-01-01

    Previous research has examined the effect of service failure and recovery on target and the observing customers separately, with an emphasis on evaluations by target customers. It has been assumed that the reactions of those customers observing the recovery efforts would mirror those of target customers, or perhaps be even more favourable, given that they are not directly affected by the service failure. This research challenges this pre-conception. Through a series of experimental studies, t...

  13. 78 FR 8152 - Proposed Collection; Comment Request: Women's Health Initiative Observational Study

    Science.gov (United States)

    2013-02-05

    ... Health Initiative (WHI) Observational Study. Type of Information Collection Request: Revision OMB 0925... causes of frailty, disability and death for postmenopausal women, namely, coronary heart disease, breast... providers. Type of Respondents: Study participants, next-of-kin, and physician's office staff. The annual...

  14. Dietary patterns are associated with disease risk among participants in the women's health initiative observational study

    Science.gov (United States)

    Coronary heart disease (CHD) is the leading cause of death in women. A nested case-control study tested whether dietary patterns predicted CHD events among 1224 participants in the Women’s Health Initiative-Observational Study (WHI-OS) with centrally confirmed CHD, fatal or nonfatal myocardial infar...

  15. Coagulation Profile Dynamics in Pediatric Patients with Cushing Syndrome: A Prospective, Observational Comparative Study

    NARCIS (Netherlands)

    Birdwell, L. (Leah); M.B. Lodish (Maya Beth); Tirosh, A. (Amit); P. Chittiboina (Prashant); M. Keil (Mark); Lyssikatos, C. (Charlampos); Belyavskaya, E. (Elena); R.A. Feelders (Richard); C.A. Stratakis (Constantine)

    2016-01-01

    textabstractObjective To evaluate the association between Cushing syndrome and hypercoagulability in children. Study design A prospective, observational study was performed of 54 patients with Cushing syndrome, 15.1 ± 3.9 years, treated at the National Institutes of Health Clinical Center.

  16. The comparison of two analgesic regimes after ambulatory surgery: an observational study

    NARCIS (Netherlands)

    Worp, F. van der; Stapel, J.T.; Lako, S.J.; Hendriks, J.C.M.; Vissers, K.C.P.; Steegers, M.A.H.

    2014-01-01

    INTRODUCTION: Over the past 15 years, the number of ambulatory surgical procedures worldwide has increased continuously. Studies show that 30% to 40% of the patients experience moderate-to-severe pain in the first 48 hours. The objective of this observational study is to compare the percentage of

  17. Using and Experiencing the Academic Library: A Multisite Observational Study of Space and Place

    Science.gov (United States)

    May, Francine; Swabey, Alice

    2015-01-01

    This study examines how students are using academic library spaces and the role these spaces are playing in the campus community. Data were collected on five campuses (two community colleges, two undergraduate universities, and one technical institute) via observational seating sweeps and questionnaires. The study found remarkably similar usage…

  18. Falls in people with chronic obstructive pulmonary disease: An observational cohort study

    DEFF Research Database (Denmark)

    Roig, Marc; Eng, Janice J; MacIntyre, Donna L

    2011-01-01

    STUDY OBJECTIVE: To investigate incidence, risk factors and impact of falls on health related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Observational cohort study. METHODS: Patients completed these questionnaires at baseline and at 6-months...

  19. Vitamin D insufficiency, preterm delivery and preeclampsia in women with type 1 diabetes - an observational study

    DEFF Research Database (Denmark)

    Vestgaard, Marianne; Secher, Anna L; Ringholm, Lene

    2017-01-01

    INTRODUCTION: The aim of this study was to evaluate whether vitamin D insufficiency is associated with preterm delivery and preeclampsia in women with type 1 diabetes. MATERIAL AND METHODS: An observational study of 198 pregnant women with type 1 diabetes. 25-Hydroxy-Vitamin D and HbA1c were meas...

  20. Predictors of switching from mania to depression in a large observational study across Europe (EMBLEM)

    NARCIS (Netherlands)

    Vieta, Eduard; Angst, Jules; Reed, Catherine; Bertsch, Jordan; Maria Haro, Josep

    Background: The risk of switching from mania to depression in bipolar disorder has been poorly studied. Large observational studies may be useful in identifying variables that predict switch to depression after mania and provide data on medication use and outcomes in "real world" patients. Method:

  1. Predictors of switching from mania to depression in a large observational study across Europe (EMBLEM)

    NARCIS (Netherlands)

    Vieta, Eduard; Angst, Jules; Reed, Catherine; Bertsch, Jordan; Maria Haro, Josep

    2009-01-01

    Background: The risk of switching from mania to depression in bipolar disorder has been poorly studied. Large observational studies may be useful in identifying variables that predict switch to depression after mania and provide data on medication use and outcomes in "real world" patients. Method:

  2. Observational study of atmospheric surface layer and coastal weather in northern Qatar

    Science.gov (United States)

    Samanta, Dhrubajyoti; Sadr, Reza

    2016-04-01

    Atmospheric surface layer is the interaction medium between atmosphere and Earth's surface. Better understanding of its turbulence nature is essential in characterizing the local weather, climate variability and modeling of turbulent exchange processes. The importance of Middle East region, with its unique geographical, economical and weather condition is well recognized. However, high quality micrometeorological observational studies are rare in this region. Here we show experimental results from micrometeorological observations from an experimental site in the coastal region of Qatar during August-December 2015. Measurements of winds are obtained from three sonic anemometers installed on a 9 m tower placed at Al Ghariyah beach in northern Qatar (26.08 °N, 51.36 °E). Different surface layer characteristics is analyzed and compared with earlier studies in equivalent weather conditions. Monthly statistics of wind speed, wind direction, temperature, humidity and heat index are made from concurrent observations from sonic anemometer and weather station to explore variations with surface layer characteristics. The results also highlights potential impact of sea breeze circulation on local weather and atmospheric turbulence. The observed daily maximum temperature and heat index during morning period may be related to sea breeze circulations. Along with the operational micrometeorological observation system, a camera system and ultrasonic wave measurement system are installed recently in the site to study coastline development and nearshore wave dynamics. Overall, the complete observational set up is going to provide new insights about nearshore wind dynamics and wind-wave interaction in Qatar.

  3. Mindfulness Training for Health Profession Students-The Effect of Mindfulness Training on Psychological Well-Being, Learning and Clinical Performance of Health Professional Students: A Systematic Review of Randomized and Non-randomized Controlled Trials.

    Science.gov (United States)

    McConville, Janet; McAleer, Rachael; Hahne, Andrew

    High levels of stress have been identified in medical students and increasingly in other health profession student population groups. As stress can affect psychological well-being and interfere with learning and clinical performance, there is a clear argument for universities to include health professional student well-being as an outcome in core curriculum. Mindfulness training is a potential construct to manage stress and enhance academic success. The aims of this systematic review were to assess the effectiveness of mindfulness training in medical and other health professional student population groups and to compare the effectiveness of the different mindfulness-based programs. A literature search was completed using The Cochrane library, Medline, Cinahl, Embase, Psychinfo, and ERIC (proquest) electronic databases from inception to June 2016. Randomized and non-randomized controlled trials were included. Of the potential 5355 articles, 19 met the inclusion criteria. Studies focused on medical (n = 10), nursing (n = 4), social work (n = 1), psychology (n = 1), and medical plus other health (n = 3) students. Interventions were based on mindfulness. The 19 studies included 1815 participants. Meta-analysis was performed evaluating the effect of mindfulness training on mindfulness, anxiety, depression, stress, mood, self-efficacy, and empathy. The effect of mindfulness on academic performance was discussed. Mindfulness-based interventions decrease stress, anxiety, and depression and improve mindfulness, mood, self-efficacy, and empathy in health profession students. Due to the range of presentation options, mindfulness training can be relatively easily adapted and integrated into health professional training programs. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Immunogenicity and safety of an adjuvanted herpes zoster subunit candidate vaccine in adults ≥ 50 years of age with a prior history of herpes zoster: A phase III, non-randomized, open-label clinical trial.

    Science.gov (United States)

    Godeaux, Olivier; Kovac, Martina; Shu, Daniel; Grupping, Katrijn; Campora, Laura; Douha, Martine; Heineman, Thomas C; Lal, Himal

    2017-05-04

    This phase III, non-randomized, open-label, multi-center study (NCT01827839) evaluated the immunogenicity and safety of an adjuvanted recombinant subunit herpes zoster (HZ) vaccine (HZ/su) in adults aged ≥ 50 y with prior physician-documented history of HZ. Participants (stratified by age: 50-59, 60-69 and ≥ 70 y) received 2 doses of HZ/su 2 months apart and were followed-up for another 12 months. Anti-glycoprotein E (gE) antibodies were measured by enzyme-linked immunosorbent assay before vaccination and 1 month after the second dose (Month 3). Solicited local and general adverse events (AEs) were recorded for 7 d and unsolicited AEs for 30 d after each vaccination. Serious AEs were recorded until study end. The primary immunogenicity objective was met if the lower limit of the 95% confidence interval (CI) of the vaccine response rate (VRR), defined as a 4-fold increase in anti-gE over baseline, at Month 3 was ≥ 60%. 96 participants (32/age group) were enrolled. The primary immunogenicity objective was met, as the VRR at Month 3 was 90.2% (95% CI: 81.7-95.7). Geometric mean anti-gE antibody concentrations at Month 3 were similar across age groups. 77.9% and 71.6% of participants reported local and general solicited AEs, respectively. The most frequent solicited AEs were pain at injection site, fatigue, headache, myalgia and shivering. The HZ/su vaccine was immunogenic in adults aged ≥ 50 y with a physician-documented history of HZ, and no safety concerns were identified.

  5. The International Classification of Functioning, Disability and Health: a systematic review of observational studies.

    Science.gov (United States)

    Castaneda, Luciana; Bergmann, Anke; Bahia, Ligia

    2014-01-01

    To systematically review the use of the International Classification of Functioning, Disability and Health (ICF) in observational studies. This study is a systematic review of articles that use the ICF in observational studies. We took into account the observational design papers available in databases such as PubMed, Lilacs and SciELO, published in English and Portuguese from January 2001 to June 2011. We excluded those in which the samples did not comprise individuals, those about children and adolescents, and qualitative methodology articles. After reading the abstracts of 265 identified articles, 65 met the inclusion criteria. Of these, 18 were excluded. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) adapted Checklist, with 15 items needed for observational studies, was applied to the 47 remaining articles. Any paper that met 12 of these criteria was included in this systematic review. 29 articles were reviewed. Regarding the ICF application methodology, the checklist was used in 31% of the articles, the core set in 31% and the ICF categories in 31%. In the remaining 7%, it was not possible to define the applied methodology. In most papers (41%), qualifiers were used in their original format. As far as the area of knowledge is concerned, most of the studies were related to Rheumatology (24%) and Orthopedics (21%). Regarding the study design, 83% of the articles used cross-sectional studies. Results indicate a wide scientific production related to ICF over the past 10 years. Different areas of knowledge are involved in the debate on the improvement of information on morbidity. However, there are only a few quantitative epidemiological studies involving the use of ICF. Future studies are needed to improve data related to functioning and disability.

  6. Assessing validity of observational intervention studies – the Benchmarking Controlled Trials

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Abstract Background: Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations. Aims: To create and pilot test a checklist for appraising methodological validity of a BCT. Methods: The checklist was created by extracting the most essential elements from the comprehensive set of criteria in the previous paper on BCTs. Also checklists and scientific papers on observational studies and respective systematic reviews were utilized. Ten BCTs published in the Lancet and in the New England Journal of Medicine were used to assess feasibility of the created checklist. Results: The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies. Conclusions: The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies. However, the piloted checklist should be validated in further studies.Key messagesBenchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations.This paper presents a checklist for appraising methodological validity of BCTs and pilot-tests the checklist with ten BCTs published in leading medical journals. The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies.The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies. PMID:27238631

  7. Terminal illness and the increased mortality risk of conventional antipsychotics in observational studies: a systematic review.

    Science.gov (United States)

    Luijendijk, Hendrika J; de Bruin, Niels C; Hulshof, Tessa A; Koolman, Xander

    2016-02-01

    Numerous large observational studies have shown an increased risk of mortality in elderly users of conventional antipsychotics. Health authorities have warned against use of these drugs. However, terminal illness is a potentially strong confounder of the observational findings. So, the objective of this study was to systematically assess whether terminal illness may have biased the observational association between conventional antipsychotics and risk of mortality in elderly patients. Studies were searched in PubMed, CINAHL, Embase, the references of selected studies and articles referring to selected studies (Web of Science). Inclusion criteria were (i) observational studies that estimated (ii) the risk of all-cause mortality in (iii) new elderly users of (iv) conventional antipsychotics compared with atypical antipsychotics or no use. Two investigators assessed the characteristics of the exposure and reference groups, main results, measured confounders and methods used to adjust for unmeasured confounders. We identified 21 studies. All studies were based on administrative medical and pharmaceutical databases. Sicker and older patients received conventional antipsychotics more often than new antipsychotics. The risk of dying was especially high in the first month of use, and when haloperidol was administered per injection or in high doses. Terminal illness was not measured in any study. Instrumental variables that were used were also confounded by terminal illness. We conclude that terminal illness has not been adjusted for in observational studies that reported an increased risk of mortality risk in elderly users of conventional antipsychotics. As the validity of the evidence is questionable, so is the warning based on it. Copyright © 2015 John Wiley & Sons, Ltd.

  8. Vitamin D Intake and Risk of Type 1 Diabetes: A Meta-Analysis of Observational Studies

    Directory of Open Access Journals (Sweden)

    Li-Qiang Qin

    2013-09-01

    Full Text Available Vitamin D is suggested to have protective effects against type 1 diabetes. However, the results from observational studies have been inconsistent. We aimed to examine their association by conducting a meta-analysis of observational studies. Multiple databases were searched in June 2013 to identify relevant studies including both case-control and cohort studies. Either a fixed- or random-effects model was used to calculate the pooled risk estimate. We identified eight studies (two cohort studies and six case-control studies on vitamin D intake during early life and three studies (two cohort studies and one case-control study on maternal vitamin D intake during pregnancy. The pooled odds ratio for type 1 diabetes comparing vitamin D supplementation with non-supplementation during early life was 0.71 (95% confidence interval [CI], 0.51–0.98. Similar results were observed in the case-control subgroup analysis but not in the cohort subgroup analysis. The pooled odds ratio with maternal intake of vitamin D during pregnancy was 0.95 (95% CI, 0.66–1.36. In conclusion, vitamin D intake during early life may be associated with a reduced risk of type 1 diabetes. However, there was not enough evidence for an association between maternal intake of vitamin D and risk of type 1 diabetes in the offspring.

  9. Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies

    DEFF Research Database (Denmark)

    Brorson, Stig; Bagger, Jens; Sylvest, Annette

    2009-01-01

    Displaced four-part fractures comprise 2-10 % of all proximal humeral fractures. The optimal treatment is unclear and randomised trials are needed. The conduct and interpretation of such trials is facilitated by a reproducible fracture classification. We aimed at quantifying observer agreement...... on the classification of displaced four-part fractures according to the Neer system. Published and unpublished data from five observer studies were reviewed. Observers agreed less on displaced four-part fractures than on the overall Neer classification. Mean kappa values for interobserver agreement ranged from 0.......16 to 0.48. Specialists agreed slightly more than fellows and residents. Advanced imaging modalities (CT and 3D CT) seemed to contribute more to classification of displaced four-part patterns than in less complex fracture patterns. Low observer agreement may challenge the clinical approach to displaced...

  10. Simulation study on heterogeneous variance adjustment for observations with different measurement error variance

    DEFF Research Database (Denmark)

    Pitkänen, Timo; Mäntysaari, Esa A; Nielsen, Ulrik Sander

    2013-01-01

    of variance correction is developed for the same observations. As automated milking systems are becoming more popular the current evaluation model needs to be enhanced to account for the different measurement error variances of observations from automated milking systems. In this simulation study different...... models and different approaches to account for heterogeneous variance when observations have different measurement error variances were investigated. Based on the results we propose to upgrade the currently applied models and to calibrate the heterogeneous variance adjustment method to yield same genetic......The Nordic Holstein yield evaluation model describes all available milk, protein and fat test-day yields from Denmark, Finland and Sweden. In its current form all variance components are estimated from observations recorded under conventional milking systems. Also the model for heterogeneity...

  11. A Randomized Controlled Study of Art Observation Training to Improve Medical Student Ophthalmology Skills.

    Science.gov (United States)

    Gurwin, Jaclyn; Revere, Karen E; Niepold, Suzannah; Bassett, Barbara; Mitchell, Rebecca; Davidson, Stephanie; DeLisser, Horace; Binenbaum, Gil

    2018-01-01

    Observation and description are critical to the practice of medicine, and to ophthalmology in particular. However, medical education does not provide explicit training in these areas, and medical students are often criticized for deficiencies in these skills. We sought to evaluate the effects of formal observation training in the visual arts on the general and ophthalmologic observational skills of medical students. Randomized, single-masked, controlled trial. Thirty-six first-year medical students, randomized 1:1 into art-training and control groups. Students in the art-training group were taught by professional art educators at the Philadelphia Museum of Art, during 6 custom-designed, 1.5-hour art observation sessions over a 3-month period. All subjects completed pre- and posttesting, in which they described works of art, retinal pathology images, and external photographs of eye diseases. Grading of written descriptions for observational and descriptive abilities by reviewers using an a priori rubric and masked to group assignment and pretesting/posttesting status. Observational skills, as measured by description testing, improved significantly in the training group (mean change +19.1 points) compared with the control group (mean change -13.5 points), P = 0.001. There were significant improvements in the training vs. control group for each of the test subscores. In a poststudy questionnaire, students reported applying the skills they learned in the museum in clinically meaningful ways at medical school. Art observation training for first-year medical students can improve clinical ophthalmology observational skills. Principles from the field of visual arts, which is reputed to excel in teaching observation and descriptive abilities, can be successfully applied to medical training. Further studies can examine the impact of such training on clinical care. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  12. The brain study : Cognition, quality of life and social functioning following preeclampsia; An observational study

    NARCIS (Netherlands)

    Postma, I. R.; Groen, H.; Easterling, T. R.; Tsigas, E. Z.; Wilson, M. L.; Porcel, J.; Zeeman, G. G.

    2013-01-01

    Objectives: Previously preeclamptic women may express cognitive difficulties, which have largely been unappreciated or attributed to stresses of a complicated pregnancy. This study aimed to explore the scope of perceived neurocognitive and psychosocial problems as well as quality of life following

  13. Study of Seismic Activity Using Geophysical and Radio Physical Equipment for Observation

    Science.gov (United States)

    Kvavadze, N.; Tsereteli, N. S.

    2015-12-01

    One of the most dangerous and destructive natural hazards are earthquakes, which is confirmed by recent earthquakes such as Nepal 2015, Japan and Turkey 2011. Because of this, study of seismic activity is important. Studying any process, it is necessary to use different methods of observation, which allows us to increase accuracy of obtained data. Seismic activity is a complex problem and its study needs different types of observation methods. Two main problems of seismic activity study are: reliable instrumental observations and earthquake short-term predictions. In case of seismic risks it is necessary to have reliable accelerometer data. One of the most promising field in earthquake short-term prediction is very low frequency (VLF) electromagnetic wave propagation in ionosphere observation. To study Seismic activity of Caucasus region, was created observation complex using Accelerometer, Velocimeter and VLF electromagnetic waves received from communication stations (located in different area of the world) reflected from low ionosphere. System is created and operates at Tbilisi State University Ionosphere Observatory, near Tbilisi in Tabakhmela 42.41'70 N, 44.80'92 E, Georgia. Data obtained is sent to a local server located at M. Nodia Institute of Geophysics, TSU, for storage and processing. Diagram for complex is presented. Also data analysis methods were created and preliminary processing was done. In this paper we present some of the results: Earthquake data from ionosphere observations as well as local earthquakes recorded with accelerometer and velocimeter. Complex is first in 6 that will be placed around Georgia this year. We plan on widening network every year.

  14. DNA fingerprinting validates seed dispersal curves from observational studies in the neotropical legume parkia.

    Science.gov (United States)

    Heymann, Eckhard W; Lüttmann, Kathrin; Michalczyk, Inga M; Saboya, Pedro Pablo Pinedo; Ziegenhagen, Birgit; Bialozyt, Ronald

    2012-01-01

    Determining the distances over which seeds are dispersed is a crucial component for examining spatial patterns of seed dispersal and their consequences for plant reproductive success and population structure. However, following the fate of individual seeds after removal from the source tree till deposition at a distant place is generally extremely difficult. Here we provide a comparison of observationally and genetically determined seed dispersal distances and dispersal curves in a Neotropical animal-plant system. In a field study on the dispersal of seeds of three Parkia (Fabaceae) species by two Neotropical primate species, Saguinus fuscicollis and Saguinus mystax, in Peruvian Amazonia, we observationally determined dispersal distances. These dispersal distances were then validated through DNA fingerprinting, by matching DNA from the maternally derived seed coat to DNA from potential source trees. We found that dispersal distances are strongly right-skewed, and that distributions obtained through observational and genetic methods and fitted distributions do not differ significantly from each other. Our study showed that seed dispersal distances can be reliably estimated through observational methods when a strict criterion for inclusion of seeds is observed. Furthermore, dispersal distances produced by the two primate species indicated that these primates fulfil one of the criteria for efficient seed dispersers. Finally, our study demonstrated that DNA extraction methods so far employed for temperate plant species can be successfully used for hard-seeded tropical plants.

  15. DNA Fingerprinting Validates Seed Dispersal Curves from Observational Studies in the Neotropical Legume Parkia

    Science.gov (United States)

    Heymann, Eckhard W.; Lüttmann, Kathrin; Michalczyk, Inga M.; Saboya, Pedro Pablo Pinedo; Ziegenhagen, Birgit; Bialozyt, Ronald

    2012-01-01

    Background Determining the distances over which seeds are dispersed is a crucial component for examining spatial patterns of seed dispersal and their consequences for plant reproductive success and population structure. However, following the fate of individual seeds after removal from the source tree till deposition at a distant place is generally extremely difficult. Here we provide a comparison of observationally and genetically determined seed dispersal distances and dispersal curves in a Neotropical animal-plant system. Methodology/Principal Findings In a field study on the dispersal of seeds of three Parkia (Fabaceae) species by two Neotropical primate species, Saguinus fuscicollis and Saguinus mystax, in Peruvian Amazonia, we observationally determined dispersal distances. These dispersal distances were then validated through DNA fingerprinting, by matching DNA from the maternally derived seed coat to DNA from potential source trees. We found that dispersal distances are strongly right-skewed, and that distributions obtained through observational and genetic methods and fitted distributions do not differ significantly from each other. Conclusions/Significance Our study showed that seed dispersal distances can be reliably estimated through observational methods when a strict criterion for inclusion of seeds is observed. Furthermore, dispersal distances produced by the two primate species indicated that these primates fulfil one of the criteria for efficient seed dispersers. Finally, our study demonstrated that DNA extraction methods so far employed for temperate plant species can be successfully used for hard-seeded tropical plants. PMID:22514748

  16. Detection of lung cancer on the chest radiograph: a study on observer performance

    International Nuclear Information System (INIS)

    Quekel, Lorentz G.B.A.; Kessels, Alphons G.H.; Goei, Reginald; Engelshoven, Joseph M.A. van

    2001-01-01

    Study objectives: to study the validity and observers consistency in the detection of lung cancer on the chest radiograph. Materials and methods: the chest radiographs of 100 clinical cases were interpreted by 14 observers. The radiographs were obtained from 30 patients with initially missed but histopathologically proven non-small cell lung cancer (NSCLC), 35 patients with other cardiopulmonary diseases and 35 patients with no abnormalities. The observers consisted of ten experienced radiologists, two-experienced chest physicians and two residents in radiology. All observers were unaware of the study design. The validity and observer consistency was determined for each observer. Results: the mean sensitivity and specificity of the ten radiologists were 0.36 and 0.90. For the two chest physicians, the mean sensitivity and specificity were 0.29 and 0.96. For the two residents in radiology, mean sensitivity and specificity were 0.25 and 0.94. The mean interobserver kappa and mean intraobserver kappa for the radiologists were 0.38 and 0.54. For the two chest physicians, the mean interobserver kappa was 0.43, while the intraobserver kappa was 0.59. For the two residents in radiology, mean interobserver kappa was 0.35 and the intraobserver kappa was 0.42. There was no significant relation between the consistency parameters and validity parameters. The interobserver and intraobserver kappa values showed good correlation. Conclusion: the validity of the chest radiograph and observers consistency in the detection of nodular lung cancer varies widely. The level of experience is likely to influence the diagnostic performance

  17. Observational Studies on Evaluating the Safety and Adverse Effects of Traditional Chinese Medicine

    Science.gov (United States)

    Tang, Jin-Ling; Wang, Jung-Der

    2013-01-01

    Background. This study aims to share our experiences when carrying out observational studies of traditional Chinese medicine (TCM). Methods. We have proactively monitored the safety profiles of Duhuo Jisheng Tang (DJT), Suan Zao Ren Tang (SZRT), and TMN-1. A list of adverse events (AEs), complete blood counts, and liver and kidney function tests were obtained from the participants during their scheduled hospital visits. Retrospective observational studies were conducted based on the reimbursement database of the National Health Insurance system, Taiwan, to explore the relationship between the use of TCM that have been adulterated by aristolochic acid and the risk from both nephrotoxins and carcinogens. Results. A total of 221, 287, and 203 AEs were detected after SZRT, DJT, and TMN-1 had been taken, respectively. Dizziness, headache, stomach ache, and diarrhea were judged to be probably related to SZRT treatment. Retrospective observational studies found an association between the consumption of aristolochic acid-containing Chinese formulae such as Mu Tong and an increased risk of CKD, ESRD, and urinary tract cancer. Conclusion. Prospective and retrospective observational studies seem to have specific advantages when investigating the safety and adverse effects of TCM therapies, as well as possibly other alternative/complementary therapies. PMID:24159351

  18. Observational Studies on Evaluating the Safety and Adverse Effects of Traditional Chinese Medicine

    Directory of Open Access Journals (Sweden)

    Jung-Nein Lai

    2013-01-01

    Full Text Available Background. This study aims to share our experiences when carrying out observational studies of traditional Chinese medicine (TCM. Methods. We have proactively monitored the safety profiles of Duhuo Jisheng Tang (DJT, Suan Zao Ren Tang (SZRT, and TMN-1. A list of adverse events (AEs, complete blood counts, and liver and kidney function tests were obtained from the participants during their scheduled hospital visits. Retrospective observational studies were conducted based on the reimbursement database of the National Health Insurance system, Taiwan, to explore the relationship between the use of TCM that have been adulterated by aristolochic acid and the risk from both nephrotoxins and carcinogens. Results. A total of 221, 287, and 203 AEs were detected after SZRT, DJT, and TMN-1 had been taken, respectively. Dizziness, headache, stomach ache, and diarrhea were judged to be probably related to SZRT treatment. Retrospective observational studies found an association between the consumption of aristolochic acid-containing Chinese formulae such as Mu Tong and an increased risk of CKD, ESRD, and urinary tract cancer. Conclusion. Prospective and retrospective observational studies seem to have specific advantages when investigating the safety and adverse effects of TCM therapies, as well as possibly other alternative/complementary therapies.

  19. Public availability of results of observational studies evaluating an intervention registered at ClinicalTrials.gov.

    Science.gov (United States)

    Baudart, Marie; Ravaud, Philippe; Baron, Gabriel; Dechartres, Agnes; Haneef, Romana; Boutron, Isabelle

    2016-01-28

    Observational studies are essential for assessing safety. The aims of this study were to evaluate whether results of observational studies evaluating an intervention with safety outcome(s) registered at ClinicalTrials.gov were published and, if not, whether they were available through posting on ClinicalTrials.gov or the sponsor website. We identified a cohort of observational studies with safety outcome(s) registered on ClinicalTrials.gov after October 1, 2007, and completed between October 1, 2007, and December 31, 2011. We systematically searched PubMed for a publication, as well as ClinicalTrials.gov and the sponsor website for results. The main outcomes were the time to the first publication in journals and to the first public availability of the study results (i.e. published or posted on ClinicalTrials.gov or the sponsor website). For all studies with results publicly available, we evaluated the completeness of reporting (i.e. reported with the number of events per arm) of safety outcomes. We identified 489 studies; 334 (68%) were partially or completely funded by industry. Results for only 189 (39%, i.e. 65% of the total target number of participants) were published at least 30 months after the study completion. When searching other data sources, we obtained the results for 53% (n = 158; i.e. 93% of the total target number of participants) of unpublished studies; 31% (n = 94) were posted on ClinicalTrials.gov and 21% (n = 64) on the sponsor website. As compared with non-industry-funded studies, industry-funded study results were less likely to be published but not less likely to be publicly available. Of the 242 studies with a primary outcome recorded as a safety issue, all these outcomes were adequately reported in 86% (114/133) when available in a publication, 91% (62/68) when available on ClinicalTrials.gov, and 80% (33/41) when available on the sponsor website. Only 39% of observational studies evaluating an intervention with safety outcome

  20. Preliminary Checklist for Reporting Observational Studies in Sports Areas: Content Validity

    Science.gov (United States)

    Chacón-Moscoso, Salvador; Sanduvete-Chaves, Susana; Anguera, M. Teresa; Losada, José L.; Portell, Mariona; Lozano-Lozano, José A.

    2018-01-01

    Observational studies are based on systematic observation, understood as an organized recording and quantification of behavior in its natural context. Applied to the specific area of sports, observational studies present advantages when comparing studies based on other designs, such as the flexibility for adapting to different contexts and the possibility of using non-standardized instruments as well as a high degree of development in specific software and data analysis. Although the importance and usefulness of sports-related observational studies have been widely shown, there is no checklist to report these studies. Consequently, authors do not have a guide to follow in order to include all of the important elements in an observational study in sports areas, and reviewers do not have a reference tool for assessing this type of work. To resolve these issues, this article aims to develop a checklist to measure the quality of sports-related observational studies based on a content validity study. The participants were 22 judges with at least 3 years of experience in observational studies, sports areas, and methodology. They evaluated a list of 60 items systematically selected and classified into 12 dimensions. They were asked to score four aspects of each item on 5-point Likert scales to measure the following dimensions: representativeness, relevance, utility, and feasibility. The judges also had an open-format section for comments. The Osterlind index was calculated for each item and for each of the four aspects. Items were considered appropriate when obtaining a score of at least 0.5 in the four assessed aspects. After considering these inclusion criteria and all of the open-format comments, the resultant checklist consisted of 54 items grouped into the same initial 12 dimensions. Finally, we highlight the strengths of this work. We also present its main limitation: the need to apply the resultant checklist to obtain data and, thus, increase quality indicators of

  1. Preliminary Checklist for Reporting Observational Studies in Sports Areas: Content Validity

    Directory of Open Access Journals (Sweden)

    Salvador Chacón-Moscoso

    2018-03-01

    Full Text Available Observational studies are based on systematic observation, understood as an organized recording and quantification of behavior in its natural context. Applied to the specific area of sports, observational studies present advantages when comparing studies based on other designs, such as the flexibility for adapting to different contexts and the possibility of using non-standardized instruments as well as a high degree of development in specific software and data analysis. Although the importance and usefulness of sports-related observational studies have been widely shown, there is no checklist to report these studies. Consequently, authors do not have a guide to follow in order to include all of the important elements in an observational study in sports areas, and reviewers do not have a reference tool for assessing this type of work. To resolve these issues, this article aims to develop a checklist to measure the quality of sports-related observational studies based on a content validity study. The participants were 22 judges with at least 3 years of experience in observational studies, sports areas, and methodology. They evaluated a list of 60 items systematically selected and classified into 12 dimensions. They were asked to score four aspects of each item on 5-point Likert scales to measure the following dimensions: representativeness, relevance, utility, and feasibility. The judges also had an open-format section for comments. The Osterlind index was calculated for each item and for each of the four aspects. Items were considered appropriate when obtaining a score of at least 0.5 in the four assessed aspects. After considering these inclusion criteria and all of the open-format comments, the resultant checklist consisted of 54 items grouped into the same initial 12 dimensions. Finally, we highlight the strengths of this work. We also present its main limitation: the need to apply the resultant checklist to obtain data and, thus, increase

  2. Preliminary Checklist for Reporting Observational Studies in Sports Areas: Content Validity.

    Science.gov (United States)

    Chacón-Moscoso, Salvador; Sanduvete-Chaves, Susana; Anguera, M Teresa; Losada, José L; Portell, Mariona; Lozano-Lozano, José A

    2018-01-01

    Observational studies are based on systematic observation, understood as an organized recording and quantification of behavior in its natural context. Applied to the specific area of sports, observational studies present advantages when comparing studies based on other designs, such as the flexibility for adapting to different contexts and the possibility of using non-standardized instruments as well as a high degree of development in specific software and data analysis. Although the importance and usefulness of sports-related observational studies have been widely shown, there is no checklist to report these studies. Consequently, authors do not have a guide to follow in order to include all of the important elements in an observational study in sports areas, and reviewers do not have a reference tool for assessing this type of work. To resolve these issues, this article aims to develop a checklist to measure the quality of sports-related observational studies based on a content validity study. The participants were 22 judges with at least 3 years of experience in observational studies, sports areas, and methodology. They evaluated a list of 60 items systematically selected and classified into 12 dimensions. They were asked to score four aspects of each item on 5-point Likert scales to measure the following dimensions: representativeness, relevance, utility, and feasibility. The judges also had an open-format section for comments. The Osterlind index was calculated for each item and for each of the four aspects. Items were considered appropriate when obtaining a score of at least 0.5 in the four assessed aspects. After considering these inclusion criteria and all of the open-format comments, the resultant checklist consisted of 54 items grouped into the same initial 12 dimensions. Finally, we highlight the strengths of this work. We also present its main limitation: the need to apply the resultant checklist to obtain data and, thus, increase quality indicators of

  3. Is there a 'Scottish effect' for mortality? Prospective observational study of census linkage studies.

    Science.gov (United States)

    Popham, Frank; Boyle, Paul J

    2011-09-01

    Scotland's mortality rate is higher than England and Wales' and this difference cannot be explained by differences in area-level socio-economic deprivation. However, studies of this 'Scottish effect' have not adjusted for individual-level measures of socio-economic position nor accounted for country of birth; important as Scottish born living in England and Wales also have high mortality risk. Data sets (1991-2001 and 2001-2007) were obtained from the Scottish Longitudinal Study and the Office for National Statistics England and Wales Longitudinal Study that both link census records to subsequent mortality. Analysis was limited to those aged 35-74 at baseline with people followed to emigration, death or end of follow-up. Those born in Scotland living in either England and Wales or Scotland had a higher mortality rate than the English born living in England and Wales that was not fully attenuated by adjustment for car access and housing tenure. Adjusting for household-level differences in socio-economic deprivation does not fully explain the Scottish excess mortality that is seen for those born in Scotland whether living in England and Wales or Scotland. Taking a life course approach may reveal the cause of the 'Scottish effect'.

  4. Experimental and Observational Studies of Molecular Hydrogen in Interstellar and Circumstellar Environments

    Science.gov (United States)

    Hoadley, Keri

    2017-08-01

    Understanding the evolution of gas over the lifetime of protoplanetary disks provides us with important clues about how planet formation mechanisms drive the diversity of exoplanetary systems observed to date. In the first part of my thesis, I discuss how I use fluorescent emission observations of molecular hydrogen (H2) in the far-ultraviolet (far-UV) with the Hubble Space Telescope to study the warm molecular regions (a rocket experiment designed to probe the warm and cool atoms and molecules near sites of recent star formation in the local interstellar medium. I present the science goals, design, research and development components, and calibration of the CHESS instrument. I provide results on observations taken during both launches of CHESS, with detailed analysis of the epsilon Per sightline, as inferred from the flight data. I conclude by providing future works and simple estimates of the performance of an instrument like CHESS on LUVOIR to study planet-forming environments.

  5. Organisational culture in residential aged care facilities: a cross-sectional observational study.

    Science.gov (United States)

    Etherton-Beer, Christopher; Venturato, Lorraine; Horner, Barbara

    2013-01-01

    Organisational culture is increasingly recognised as important for provision of high-quality long-term care. We undertook this study to measure organisational culture in residential aged care facilities in two Australian states. Cross-sectional observational study in 21 residential aged care facilities in Western Australia (n = 14) and Queensland (n = 7), Australia. Staff and next-of-kin of residents participated. Measurement comprised surveys of facility staff and residents' next-of-kin, and structured observation of indicators of care quality. Staff tended to rate organisational culture positively. Some qualitative feedback from staff emphasised negative perceptions of communication, leadership and teamwork. Staffing levels were perceived as a dominant challenge, threatening care quality. Direct observation revealed variability within and between facilities but suggested that most facilities (n = 12) were in the typical range, or were quality facilities (n = 8). There was scope to strengthen organisational culture in participating aged care facilities.

  6. Relationships of multitasking, physicians' strain, and performance: an observational study in ward physicians.

    Science.gov (United States)

    Weigl, Matthias; Müller, Andreas; Sevdalis, Nick; Angerer, Peter

    2013-03-01

    Simultaneous task performance ("multitasking") is common in hospital physicians' work and is implicated as a major determinant for enhanced strain and detrimental performance. The aim was to determine the impact of multitasking by hospital physicians on their self reported strain and performance. A prospective observational time-and-motion study in a Community Hospital was conducted. Twenty-seven hospital physicians (surgical and internal specialties) were observed in 40 full-shift observations. Observed physicians reported twice on their self-monitored strain and performance during the observation time. Associations of observed multitasking events and subsequent strain and performance appraisals were calculated. About 21% of the working time physicians were engaged in simultaneous activities. The average time spent in multitasking activities correlated significantly with subsequently reported strain (r = 0.27, P = 0.018). The number of instances of multitasking activities correlated with self-monitored performance to a marginally significant level (r = 0.19, P = 0.098). Physicians who engage in multitasking activities tend to self-report better performance but at the cost of enhanced psychophysical strain. Hence, physicians do not perceive their own multitasking activities as a source for deficient performance, for example, medical errors. Readjustment of workload, improved organization of work for hospital physicians, and training programs to improve physicians' skills in dealing with multiple clinical demands, prioritization, and efficient task allocation may be useful avenues to explore to reduce the potentially negative impact of simultaneous task performance in clinical settings.

  7. A suggestion for quality assessment in systematic reviews of observational studies in nutritional epidemiology

    Directory of Open Access Journals (Sweden)

    Jong-Myon Bae

    2016-04-01

    Full Text Available OBJECTIVES: It is important to control the quality level of the observational studies in conducting meta-analyses. The Newcastle-Ottawa Scale (NOS is a representative tool used for this purpose. We investigated the relationship between high-quality (HQ defined using NOS and the results of subgroup analysis according to study design. METHODS: We selected systematic review studies with meta-analysis which performed a quality evaluation on observational studies of diet and cancer by NOS. HQ determinations and the distribution of study designs were examined. Subgroup analyses according to quality level as defined by the NOS were also extracted. Equivalence was evaluated based on the summary effect size (sES and 95% confidence intervals computed in the subgroup analysis. RESULTS: The meta-analysis results of the HQ and cohort groups were identical. The overall sES, which was obtained by combining the sES when equivalence was observed between the cohort and case-control groups, also showed equivalence. CONCLUSIONS: The results of this study suggest that it is more reasonable to control for quality level by performing subgroup analysis according to study design rather than by using HQ based on the NOS quality assessment tool.

  8. A Study of the Carbon Cycle Using NASA Observations and the GEOS Model

    Science.gov (United States)

    Pawson, Steven; Gelaro, Ron; Ott, Lesley; Putman, Bill; Chatterjee, Abhishek; Koster, Randy; Lee, Eunjee; Oda, Tom; Weir, Brad; Zeng, Fanwei

    2018-01-01

    The Goddard Earth Observing System (GEOS) model has been developed in the Global Modeling and Assimilation Office (GMAO) at NASA's Goddard Space Flight Center. From its roots in chemical transport and as a General Circulation Model, the GEOS model has been extended to an Earth System Model based on a modular construction using the Earth System Modeling Framework (ESMF), combining elements developed in house in the GMAO with others that are imported through collaborative research. It is used extensively for research and for product generation, both as a free-running model and as the core of the GMAO's data assimilation system. In recent years, the GMAO's modeling and assimilation efforts have been strongly supported by Piers Sellers, building on both his earlier legacy as an observationally oriented model developer and his post-astronaut career as a dynamic leader into new territory. Piers' long-standing interest in the carbon cycle and the combination of models with observations motivates this presentation, which will focus on the representation of the carbon cycle in the GEOS Earth System Model. Examples will include: (i) the progression from specified land-atmosphere surface fluxes to computations with an interactive model component (Catchment-CN), along with constraints on vegetation distributions using satellite observations; (ii) the use of high-resolution satellite observations to constrain human-generated inputs to the atmosphere; (iii) studies of the consistency of the observed atmospheric carbon dioxide concentrations with those in the model simulations. The presentation will focus on year-to-year variations in elements of the carbon cycle, specifically on how the observations can inform the representation of mechanisms in the model and lead to integrity in global carbon dioxide simulations. Further, applications of the GEOS model to the planning of new carbon-climate observations will be addressed, as an example of the work that was strongly supported by

  9. Evaluating effectiveness and safety toward electronic cigarette among Malaysian vapers: One-month observational study

    Directory of Open Access Journals (Sweden)

    Azizur Rahman

    2016-01-01

    Conclusion: A month follow-up showed a good smoking cessation rate among Malaysian vapers mainly in single users, whereas less number of quitters but the high reduction in tobacco cigarette consumption observed in dual users without any harmful effects. Furthermore, extended period studies are warranted to confirm its long-term safety and effectiveness among different Malaysian population.

  10. A mixed methods observational simulation-based study of interprofessional team communication

    DEFF Research Database (Denmark)

    Paltved, Charlotte; Nielsen, Kurt; Musaeus, Peter

    2013-01-01

    Interprofessional team communication has been identified as an important focus for safety in medical emergency care. However, in-depth insight into the complexity of team communication is limited. Video observational studies might fill a gap in terms of understanding the meaning of specific commu...

  11. Expanding the Evidence Base: Comparing Randomized Controlled Trials and Observational Studies of Statins

    NARCIS (Netherlands)

    Atar, Dan; Ong, Seleen; Lansberg, Peter J.

    2015-01-01

    It is widely accepted that randomized controlled trials (RCTs) are the gold standard for demonstrating the efficacy of a given therapy (results under ideal conditions). Observational studies, on the other hand, can complement this by demonstrating effectiveness (results under real-world conditions).

  12. Measuring disabilities in stroke patients with apraxia : A validation study of an observational method

    NARCIS (Netherlands)

    van Heugten, CM; Dekker, J; Deelman, BG; van Dijk, AJ; Stehmann-Saris, FC; Kinebanian, A

    The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a

  13. Measuring disabilities in stroke patients with apraxia: a validation study of an observational method.

    NARCIS (Netherlands)

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Dijk, A.J. van; Stehmann-Saris, F.C.; Kinebanian, A.

    2000-01-01

    The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a

  14. 75 FR 17411 - Submission for OMB Review; Comment Request; Women's Health Initiative Observational Study

    Science.gov (United States)

    2010-04-06

    ... Health Initiative (WHI) Observational Study. Type of Information Collection Request: REVISION: OMB No... additional information on the common causes of frailty, disability and death for postmenopausal women, namely...: Individuals and physicians. Type of Respondents: Women, next-of-kin, and physician's office staff. The annual...

  15. Measurement Error Correction Formula for Cluster-Level Group Differences in Cluster Randomized and Observational Studies

    Science.gov (United States)

    Cho, Sun-Joo; Preacher, Kristopher J.

    2016-01-01

    Multilevel modeling (MLM) is frequently used to detect cluster-level group differences in cluster randomized trial and observational studies. Group differences on the outcomes (posttest scores) are detected by controlling for the covariate (pretest scores) as a proxy variable for unobserved factors that predict future attributes. The pretest and…

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

    DEFF Research Database (Denmark)

    Mocroft, A; Kirk, O; Aldins, P

    2008-01-01

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

  17. Adaptive list sequential sampling method for population-based observational studies

    NARCIS (Netherlands)

    Hof, Michel H.; Ravelli, Anita C. J.; Zwinderman, Aeilko H.

    2014-01-01

    In population-based observational studies, non-participation and delayed response to the invitation to participate are complications that often arise during the recruitment of a sample. When both are not properly dealt with, the composition of the sample can be different from the desired

  18. Systematically missing confounders in individual participant data meta-analysis of observational cohort studies

    NARCIS (Netherlands)

    Jackson, D.; White, I.; Kostis, J.B.; Wilson, A.C.; Folsom, A.R.; Feskens, E.J.M.

    2009-01-01

    One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an

  19. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

    DEFF Research Database (Denmark)

    Johansson, Per Ingemar; Sorensen, Anne Marie; Perner, Anders

    2011-01-01

    the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. METHODS: Observational study at a single Level I Trauma Centre. Inclusion of 80 adult trauma patients ([greater than or equal to]18 years) who met criteria for full trauma team...

  20. Observer Role and Field Study Knowledge--An Essay Review of Usable Knowledge and SAFARI I.

    Science.gov (United States)

    Smith, Louis M.; And Others

    1981-01-01

    A synthesis is presented of the work of Lindblom and Cohen, MacDonald and Walker, and the current authors. The synthesis considers issues in the usefulness of social science theory and research, and how observer roles in qualitative field studies yield multiple kinds of usable knowledge to a variety of audiences. (Author/BW)

  1. Studying Children’s friendship activities ethically using the Interaction Based Observation Method

    DEFF Research Database (Denmark)

    Sørensen, Hanne Værum

    2018-01-01

    The aim of this chapter is to acknowledge the influence that the interaction based observation method developed by Mariane Hedegaard has had on my studies of young children’s friendship activities. Hedegaard has problematized how existing methods of evaluating children’s development were inadequate...

  2. An Observational Study of Intermediate Band Students' Self-Regulated Practice Behaviors

    Science.gov (United States)

    Miksza, Peter; Prichard, Stephanie; Sorbo, Diana

    2012-01-01

    The purpose of this study was to investigate intermediate musicians' self-regulated practice behaviors. Thirty sixth- through eighth-grade students were observed practicing band repertoire individually for 20 min. Practice sessions were coded according to practice frame frequency and duration, length of musical passage selected, most prominent…

  3. Systematically missing confounders in individual participant data meta-analysis of observational cohort studies

    DEFF Research Database (Denmark)

    Jackson, D.; White, I.; Kostis, J.B.

    2009-01-01

    One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an...

  4. The Effects of Music Genre on Young People's Alcohol Consumption: An Experimental Observational Study

    NARCIS (Netherlands)

    Engels, R.C.M.E.; Poelen, E.A.P.; Spijkerman, R.; Bogt, T.F.M. ter

    2012-01-01

    he aim of this study was to test whether exposure to specific music genres in a social drinking setting leads to differences in drinking levels. An observational experimental design was used in which we invited peer groups of young adults into a bar lab, a lab which is furnished like an ordinary,

  5. Treatment of convulsive status epilepticus in the UMCG: A retrospective, observational study

    NARCIS (Netherlands)

    Vlaskamp, D.R.M.; Brouwer, O.F.; Callenbach, P.M.C.

    2013-01-01

    Objectives: Little is known about clinical practice with respect to the application of guidelines in the treatment of Convulsive Status Epilepticus (CSE). This retrospective, observational study evaluated treatment of episodes of CSE in children at the University Medical Centre Groningen (UMCG).

  6. Self-Regulation of Practice Behavior Among Elite Youth Soccer Players : An Exploratory Observation Study

    NARCIS (Netherlands)

    Toering, Tynke; Elferink-Gemser, Marije; Jordet, Geir; Jorna, Casper; Pepping, Gert-Jan; Visscher, Chris

    2011-01-01

    This study aimed to measure behavioral correlates of self-regulation in elite youth soccer players. Behaviors regarded as indicative of self-regulated learning were identified by interviewing six expert youth soccer coaches. These behaviors were observed during practice of eight elite youth soccer

  7. Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: Observational study of mortality outcomes

    NARCIS (Netherlands)

    P. Sooriakumaran (Prasanna); T. Nyberg (Tommy); O. Akre (Olof); L. Haendler (Leif); I. Heus (Inge); M. Olsson (Marita); S. Carlsson (Sigrid); M.J. Roobol-Bouts (Monique); G. Steineck (Gunnar); P. Wiklund (Peter)

    2014-01-01

    textabstractObjective: To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer. Design: Observational study. Setting: Sweden, 1996-2010. Participants: 34 515 men primarily treated for prostate cancer with surgery (n=21 533) or radiotherapy (n=12 982).

  8. A prospective, comparative, observational study on optical coherence tomography of the anterior eye segment

    NARCIS (Netherlands)

    Theelen, T.; Hoyng, C.B.

    2013-01-01

    BACKGROUND: We compared two commercially available spectral-domain optical coherence tomography (OCT) devices according to their capacity of imaging the anterior segment of the eye with the same detail and quality. METHODS: A prospective, observational, single-visit study with individuals aged 18

  9. High salt meals in staff canteens of salt policy makers: observational study

    NARCIS (Netherlands)

    Brewster, L.M.; Berentzen, C.A.; van Montfrans, G.A.

    2011-01-01

    To assess the salt content of hot meals served at the institutions of salt policy makers in the Netherlands. Observational study. 18 canteens at the Department of Health, the Health Council, the Food and Consumer Product Safety Authority, university hospitals, and affiliated non-university

  10. Methods to assess intended effects of drug treatment in observational studies are reviewed

    NARCIS (Netherlands)

    Klungel, Olaf H|info:eu-repo/dai/nl/181447649; Martens, Edwin P|info:eu-repo/dai/nl/088859010; Psaty, Bruce M; Grobbee, Diederik E; Sullivan, Sean D; Stricker, Bruno H Ch; Leufkens, Hubert G M|info:eu-repo/dai/nl/075255049; de Boer, A|info:eu-repo/dai/nl/075097346

    2004-01-01

    BACKGROUND AND OBJECTIVE: To review methods that seek to adjust for confounding in observational studies when assessing intended drug effects. METHODS: We reviewed the statistical, economical and medical literature on the development, comparison and use of methods adjusting for confounding. RESULTS:

  11. Bedside practice of blood transfusion in a large teaching hospital in Uganda: An observational study

    Directory of Open Access Journals (Sweden)

    de Graaf J

    2009-01-01

    Full Text Available Background: Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients. Materials and Methods: An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG in Groningen, The Netherlands. Results: In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed. Conclusion: The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.

  12. Multi-Spacecraft Study of Kinetic scale Turbulence Using MMS Observations in the Solar Wind

    Science.gov (United States)

    Chasapis, A.; Matthaeus, W. H.; Parashar, T.; Fuselier, S. A.; Maruca, B.; Burch, J.; Moore, T. E.; Phan, T.; Pollock, C. J.; Gershman, D. J.; Torbert, R. B.; Russell, C. T.; Strangeway, R. J.

    2017-12-01

    We present a study investigating kinetic scale turbulence in the solar wind. Most previous studies relied on single spacecraft measurements, employing the Taylor hypothesis in order to probe different scales. The small separation of MMS spacecraft, well below the ion inertial scale, allow us for the first time to directly probe turbulent fluctuations at the kinetic range. Using multi-spacecraft measurements, we are able to measure the spatial characteristics of turbulent fluctuations and compare with the traditional Taylor-based single spacecraft approach. Meanwhile, combining observations from Cluster and MMS data we were able to cover a wide range of scales from the inertial range where the turbulent cascade takes place, down to the kinetic range where the energy is eventually dissipated. These observations present an important step in understanding the nature of solar wind turbulence and the processes through which turbulent energy is dissipated into particle heating and acceleration. We compute statistical quantities such as the second order structure function and the scale-dependent kurtosis, along with their dependence on the parameters such as the mean magnetic field direction. Overall, we observe an overall agreement between the single spacecraft and the multi-spacecraft approach. However, a small but significant deviation is observed at the smaller scales near the electron inertial scale. The high values of the scale dependent kurtosis at very small scales, observed via two-point measurements, open up a compelling avenue of investigation for theory and numerical modelling.

  13. Eating frequency and weight and body composition: a systematic review of observational studies.

    Science.gov (United States)

    Canuto, Raquel; da Silva Garcez, Anderson; Kac, Gilberto; de Lira, Pedro Israel Cabral; Olinto, Maria Teresa Anselmo

    2017-08-01

    The present review aimed to examine the association of eating frequency with body weight or body composition in adults of both sexes. PubMed, EMBASE and Scopus databases were searched. PRISMA and MOOSE protocols were followed. Observational studies published up to August 2016 were included. The methodological quality of the studies was assessed with the Downs and Black checklist. A systematic review of the literature. Adults (n 136 052); the majority of studies were developed in the USA and Europe. Thirty-one articles were included in the review: two prospective and twenty-nine cross-sectional studies. Thirteen per cent of the studies received quality scores above 80 %. The assessment of eating frequency and body composition or body weight varied widely across the studies. Potential confounders were included in 73 % of the studies. Fourteen studies reported an inverse association between eating frequency and body weight or body composition, and seven studies found a positive association. The majority of studies applied multiple analyses adjusted for potential confounders, such as sex, age, education, income, smoking, physical activity and alcohol intake. Six studies took into account under-reporting of eating frequency and/or energy intake in the analysis, and one investigated the mediation effect of energy intake. There is not sufficient evidence confirming the association between eating frequency and body weight or body composition when misreporting bias is taken into account. However, in men, a potential protective effect of high eating frequency was observed on BMI and visceral obesity.

  14. Measuring disabilities in stroke patients with apraxia: a validation study of an observational method.

    OpenAIRE

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Dijk, A.J. van; Stehmann-Saris, F.C.; Kinebanian, A.

    2000-01-01

    The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a blouse or shirt. The study was carried out at occupational therapy departments in general hospitals, rehabilitation centres, and nursing homes. Patients diagnosed to have had a stroke in the left h...

  15. Urea cycle disorders in Spain: an observational, cross-sectional and multicentric study of 104 cases

    OpenAIRE

    Martín-Hernández, Elena; Aldámiz-Echevarría, Luis; Castejón-Ponce, Esperanza; Pedrón-Giner, Consuelo; Couce, María Luz; Serrano-Nieto, Juliana; Pintos-Morell, Guillem; Bélanger-Quintana, Amaya; Martínez-Pardo, Mercedes; García-Silva, María Teresa; Quijada-Fraile, Pilar; Vitoria-Miñana, Isidro; Dalmau, Jaime; Lama-More, Rosa A; Bueno-Delgado, María Amor

    2014-01-01

    Background Advances in the diagnosis and treatment of urea cycle disorders (UCDs) have led to a higher survival rate. The purpose of this study is to describe the characteristics of patients with urea cycle disorders in Spain. Methods Observational, cross-sectional and multicenter study. Clinical, biochemical and genetic data were collected from patients with UCDs, treated in the metabolic diseases centers in Spain between February 2012 and February 2013, covering the entire Spanish populatio...

  16. Nursing practice in the prevention of pressure ulcers: an observational study of German Hospitals.

    Science.gov (United States)

    Hoviattalab, Khadijeh; Hashemizadeh, Haydeh; D'Cruz, Gibson; Halfens, Ruud J G; Dassen, Theo

    2015-06-01

    The study aimed to establish the range and extent of preventive interventions undertaken by nurses for patients who are at high risk of developing or currently have a pressure ulcer. Since 2000, the German National Expert Standard for the prevention of pressure ulcers has provided evidence-based recommendations, but limited studies have been published on its adherence in hospitals. There are also limited observational studies that investigated whether patients who are at risk of or have pressure ulcers are provided with appropriate preventative measures. A nonparticipant observational descriptive design was used. A sample of 32 adult patients who were at high risk of developing or currently had a pressure ulcer were observed during all shifts in medical and surgical wards in two general hospitals in Germany. A range of preventive interventions that were in line with the German National Expert Standard was observed. The most frequent preventive measures were 'cleaning the patients' skin' and 'minimizing exposure to moisture' that were undertaken in more than 90% of all patients. The least frequent measures were 'patient and relative education', 'assessment and recording of nutritional status'. This study demonstrates that the pressure ulcers preventive interventions as set out in the German National Expert Standard were not fully implemented. The study highlights the need for further studies on the barriers that impede the undertaking of the interventions that may prevent the development or deterioration of pressure ulcers and the delivery of evidence-based preventative care. This study provides an insight into the extent of pressure ulcers preventive practices used by nurses. The results may serve as a basis for developing an effective strategy to improve nursing practice in this area and the promotion of evidence-based practice. However, our results refer to two general hospitals and for a broader population, further studies with larger data samples are needed.

  17. The effect of liraglutide on weight loss in women with polycystic ovary syndrome: an observational study

    OpenAIRE

    Christina Bording Rasmussen; Svend eLindenberg

    2014-01-01

    AbstractObjective: The aim of the present study was to evaluate the effect of the glucagon-like peptide-1 analogue liraglutide on weight loss in overweight and obese women with polycystic ovary syndrome. Methods: In an observational study, 84 overweight or obese women with polycystic ovary syndrome were treated with liraglutide. Baseline characteristics and weight changes at clinical follow-up were recorded. Main outcome measures were absolute and relative weight loss.Results: In overweight o...

  18. South Carolina Coastal Erosion Study, Data Report for Observations, October 2003 - April 2004

    Science.gov (United States)

    Sullivan, Charlene M.; Warner, John C.; Martini, Marinna A.; Voulgaris, George; Work, Paul; Haas, Kevin A.; Hanes, Daniel

    2006-01-01

    Oceanographic observations have been made at nine locations in Long Bay, South Carolina from October 2003 through April 2004. These sites are centered around a shore-oblique sand feature that is approximately 10 km long, 2 km wide, and in excess of 3 m thick. The observations were collected through a collaborative effort with the U.S. Geological Survey, the University of South Carolina, and Georgia Institute of Technology Savannah Campus as part of a larger study to understand the physical processes that control the transport of sediments in Long Bay.

  19. The survival time of chocolates on hospital wards: covert observational study.

    Science.gov (United States)

    Gajendragadkar, Parag R; Moualed, Daniel J; Nicolson, Phillip L R; Adjei, Felicia D; Cakebread, Holly E; Duehmke, Rudolf M; Martin, Claire A

    2013-12-14

    To quantify the consumption of chocolates in a hospital ward environment. Multicentre, prospective, covert observational study. Four wards at three hospitals (where the authors worked) within the United Kingdom. Boxes of Quality Street (Nestlé) and Roses (Cadbury) on the ward and anyone eating these chocolates. Observers covertly placed two 350 g boxes of Quality Street and Roses chocolates on each ward (eight boxes were used in the study containing a total of 258 individual chocolates). These boxes were kept under continuous covert surveillance, with the time recorded when each chocolate was eaten. Median survival time of a chocolate. 191 out of 258 (74%) chocolates were observed being eaten. The mean total observation period was 254 minutes (95% confidence interval 179 to 329). The median survival time of a chocolate was 51 minutes (39 to 63). The model of chocolate consumption was non-linear, with an initial rapid rate of consumption that slowed with time. An exponential decay model best fitted these findings (model R(2)=0.844, P<0.001), with a survival half life (time taken for 50% of the chocolates to be eaten) of 99 minutes. The mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes (95% confidence interval 0 to 24). Quality Street chocolates survived longer than Roses chocolates (hazard ratio for survival of Roses v Quality Street 0.70, 95% confidence interval 0.53 to 0.93, P=0.014). The highest percentages of chocolates were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%). From our observational study, chocolate survival in a hospital ward was relatively short, and was modelled well by an exponential decay model. Roses chocolates were preferentially consumed to Quality Street chocolates in a ward setting. Chocolates were consumed primarily by healthcare assistants and nurses, followed by doctors. Further practical studies are needed.

  20. Midwives' experiences of performing maternal observations and escalating concerns: a focus group study.

    Science.gov (United States)

    Jeffery, Justine; Hewison, Alistair; Goodwin, Laura; Kenyon, Sara

    2017-09-02

    For the past decade, Maternal Mortality Reports, published in the United Kingdom every three years, have consistently raised concerns about maternal observations in maternity care. The reports identify that observations are not being done, not being completed fully, are not recorded on Early Warning Score systems, and/or are not escalated appropriately. This has resulted in delays in referral, intervention and increases the risk of maternal morbidity or mortality. However there has been little exploration of the possible reasons for non-completion of maternal observations. The aim of this study was to explore midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings in the West Midlands of England. A qualitative design involving a series of six focus groups with midwives and Supervisors of Midwives was employed to investigate the facilitators of, and barriers to the completion of maternal observations. Eighteen Midwives and 8 Supervisors of Midwives participated in a total of 6 focus groups. Three key themes emerged from the data: (1) Organisation of Maternal Observations (including delegation of tasks to Midwifery Support Workers, variation in their training, the care model used e.g. one to one care, and staffing issues); (2) Prioritisation of Maternal Observations (including the role of professional judgement and concerns expressed by midwives that they did not feel equipped to care for women with complex clinical needs; and (3) Negotiated Escalation (including the inappropriate response from senior staff to use of Modified Early Warning Score systems, and the emotional impact of escalation). A number of organisational and cultural barriers exist to the completion of maternal observations and the escalation of concerns. In order to address these the following actions are recommended: standardised training for Midwifery Support Workers, review of training of midwives to ensure it addresses the

  1. Danish Observational Study of Eldercare work and musculoskeletal disorderS (DOSES)

    DEFF Research Database (Denmark)

    Karstad, Kristina; Jørgensen, Anette F B; Greiner, Birgit A

    2018-01-01

    PURPOSE: Musculoskeletal disorders (MSDs), sickness absence and premature retirement are highly prevalent among eldercare workers. We conducted a prospective observational workplace study with the main purpose to investigate longitudinal associations between physical and psychosocial working cond...... and team factors for distribution of physical work demands and development of MSD among the workers. This will provide important knowledge for future workplace interventions to reduce MSD and sickness absence.......PURPOSE: Musculoskeletal disorders (MSDs), sickness absence and premature retirement are highly prevalent among eldercare workers. We conducted a prospective observational workplace study with the main purpose to investigate longitudinal associations between physical and psychosocial working...... conditions and occurrence of MSD and its consequences (pain-related interference with daily work activities and sickness absence) among Danish eldercare workers. PARTICIPANTS: At 20 Danish nursing homes, a total of 941 eldercare workers employed in day and evening shifts were invited to the study. Of those...

  2. Amateur boxing and risk of chronic traumatic brain injury: systematic review of observational studies.

    Science.gov (United States)

    Loosemore, Mike; Knowles, Charles H; Whyte, Greg P

    2007-10-20

    To evaluate the risk of chronic traumatic brain injury from amateur boxing. Secondary research performed by combination of sport physicians and clinical academics. DESIGN, DATA SOURCES, AND METHODS: Systematic review of observational studies in which chronic traumatic brain injury was defined as any abnormality on clinical neurological examination, psychometric testing, neuroimaging studies, and electroencephalography. Studies were identified through database (1950 to date) and bibliographic searches without language restrictions. Two reviewers extracted study characteristics, quality, and data, with adherence to a protocol developed from a widely recommended method for systematic review of observational studies (MOOSE). 36 papers had relevant extractable data (from a detailed evaluation of 93 studies of 943 identified from the initial search). Quality of evidence was generally poor. The best quality studies were those with a cohort design and those that used psychometric tests. These yielded the most negative results: only four of 17 (24%) better quality studies found any indication of chronic traumatic brain injury in a minority of boxers studied. There is no strong evidence to associate chronic traumatic brain injury with amateur boxing.

  3. Ethics and observational studies in medical research: various rules in a common framework

    Science.gov (United States)

    Claudot, Frédérique; Alla, François; Fresson, Jeanne; Calvez, Thierry; Coudane, Henry; Bonaïti-Pellié, Catherine

    2009-01-01

    Background Research ethics have become universal in their principles through international agreements. The standardization of regulations facilitates the internationalization of research concerning drugs. However, in so-called observational studies (i.e. from data collected retrospectively or prospectively, obtained without any additional therapy or monitoring procedure), the modalities used for applying the main principles vary from one country to the other. This situation may entail problems for the conduct of multi-centric international studies, as well as for the publication of results if the authors and editors come from countries governed by different regulations. In particular, several French observational studies were rejected or retracted by United States peer reviewed journals, because their protocols have not been submitted to an Institutional Review Board/Independent Ethics Committee (IRB/IEC). Methods national legislation case analysis Results In accordance with European regulation, French observational studies from data obtained without any additional therapy or monitoring procedure, do not need the approval of an IRB/IEC. Nevertheless, these researches are neither exempt from scientific opinion nor from ethical and legal authorization. Conclusion We wish to demonstrate through the study of this example that different bodies of law can provide equivalent levels of protection that respect the same ethical principles. Our purpose in writing this paper was to encourage public bodies, scientific journals, and researchers to gain a better understanding of the various sets of specific national regulations and to speak a common language. PMID:19336436

  4. The Effect of Pivotal Response Treatment in Children with Autism Spectrum Disorders: A Non-Randomized Study with a Blinded Outcome Measure

    Science.gov (United States)

    Duifhuis, E. A.; den Boer, J. C.; Doornbos, A.; Buitelaar, J. K.; Oosterling, I. J.; Klip, H.

    2017-01-01

    Purpose of this quasi-experimental trial was to investigate the effect of Pivotal response treatment (PRT) versus treatment as usual (TAU) on autism symptoms. Children with autism spectrum disorder (ASD), aged 3-8 years, received either PRT (n = 11) or TAU (n = 13). Primary outcome measure was the total score on the Autism Diagnostic Observation…

  5. The Effect of Pivotal Response Treatment in Children with Autism Spectrum Disorders: A Non-randomized Study with a Blinded Outcome Measure

    NARCIS (Netherlands)

    Duifhuis, E.A.; Boer, J.C. den; Doornbos, A.; Buitelaar, J.K.; Oosterling, I.J.; Klip, H.

    2017-01-01

    Purpose of this quasi-experimental trial was to investigate the effect of Pivotal response treatment (PRT) versus treatment as usual (TAU) on autism symptoms. Children with autism spectrum disorder (ASD), aged 3-8 years, received either PRT (n = 11) or TAU (n = 13). Primary outcome measure was the

  6. Observation of Clouds Using the CSIR Transportable LIDAR: A Case Study over Durban, South Africa

    Directory of Open Access Journals (Sweden)

    Lerato Shikwambana

    2016-01-01

    Full Text Available The Council for Scientific and Industrial Research (CSIR transportable Light Detection And Ranging (LIDAR was used to collect data over Durban (29.9°S, 30.9°E during 20–23 November 2012. Aerosol measurements have been carried out in the past over Durban; however, no cloud measurements using LIDAR have ever been performed. Therefore, this study further motivates the continuation of LIDAR for atmospheric research over Durban. Low level clouds were observed on 20–22 November 2012 and high level clouds were observed on 23 November 2012. The low level cloud could be classified as stratocumulus clouds, whereas the high level clouds could be classified as cirrus clouds. Low level cloud layers showed high extinction coefficients values ranging between 0.0009 and 0.0044 m−1, whereas low extinction coefficients for high level clouds were observed at values ranging between 0.000001 and 0.000002 m−1. Optical depth showed a high variability for 20 and 21 November 2012. This indicates a change in the composition and/or thickness of the cloud. For 22 and 23 November 2012, almost similar values of optical depth were observed. Cloud-Aerosol LIDAR and Infrared Pathfinder Satellite Observations (CALIPSO revealed high level clouds while the CSIR LIDAR could not. However, the two instruments complement each other well to describe the cloudy condition.

  7. Mars atmosphere studies with the SPICAM IR emission phase function observations

    Science.gov (United States)

    Trokhimovskiy, Alexander; Fedorova, Anna; Montmessin, Franck; Korablev, Oleg; Bertaux, Jean-Loup

    Emission Phase Function (EPF) observations is a powerful tool for characterization of atmosphere and surface. EPF sequence provides the extensive coverage of scattering angles above the targeted surface location which allow to separate the surface and aerosol scattering, study a vertical distribution of minor species and aerosol properties. SPICAM IR instrument on Mars Express mission provides continuous atmospheric observations in near IR (1-1.7 mu) in nadir and limb starting from 2004. For the first years of SPICAM operation only a very limited number of EPFs was performed. But from the mid 2013 (Ls=225, MY31) SPICAM EPF observations become rather regular. Based on the multiple-scattering radiative transfer model SHDOM, we analyze equivalent depths of carbon dioxide (1,43 mu) and water vapour (1,38 mu) absorption bands and their dependence on airmass during observation sequence to get aerosol optical depths and properties. The derived seasonal dust opacities from near IR can be used to retrieve the size distribution from comparison with simultaneous results of other instruments in different spectral ranges. Moreover, the EPF observations of water vapour band allow to access poorly known H2O vertical distribution for different season and locations.

  8. Study on individual stochastic model of GNSS observations for precise kinematic applications

    Science.gov (United States)

    Próchniewicz, Dominik; Szpunar, Ryszard

    2015-04-01

    The proper definition of mathematical positioning model, which is defined by functional and stochastic models, is a prerequisite to obtain the optimal estimation of unknown parameters. Especially important in this definition is realistic modelling of stochastic properties of observations, which are more receiver-dependent and time-varying than deterministic relationships. This is particularly true with respect to precise kinematic applications which are characterized by weakening model strength. In this case, incorrect or simplified definition of stochastic model causes that the performance of ambiguity resolution and accuracy of position estimation can be limited. In this study we investigate the methods of describing the measurement noise of GNSS observations and its impact to derive precise kinematic positioning model. In particular stochastic modelling of individual components of the variance-covariance matrix of observation noise performed using observations from a very short baseline and laboratory GNSS signal generator, is analyzed. Experimental test results indicate that the utilizing the individual stochastic model of observations including elevation dependency and cross-correlation instead of assumption that raw measurements are independent with the same variance improves the performance of ambiguity resolution as well as rover positioning accuracy. This shows that the proposed stochastic assessment method could be a important part in complex calibration procedure of GNSS equipment.

  9. Lower Risk of Death With SGLT2 Inhibitors in Observational Studies: Real or Bias?

    Science.gov (United States)

    Suissa, Samy

    2018-01-01

    Two recent observational studies reported a remarkably lower rate of all-cause death associated with sodium-glucose cotransporter 2 inhibitor (-SGLT2i) use in all patients with type 2 diabetes and not only those at increased cardiovascular risk. The >50% lower mortality rates reported in these studies are much greater than those found in the BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) and CANagliflozin cardioVascular Assessment Study (CANVAS) randomized trials. We show that these observational studies are affected by time-related biases, including immortal time bias and time-lag bias, which tend to exaggerate the benefits observed with a drug. The Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors (CVD-REAL) study, based on 166,033 users of SGLT2i and 1,226,221 users of other glucose-lowering drugs (oGLD) identified from health care databases of six countries, was affected by immortal time bias. Indeed, the immortal time between the first oGLD prescription and the first SGLT2i prescription was omitted from the analysis, which resulted in increasing the rate of death in the oGLD group and thus producing the appearance of a lower risk of death with SGLT2i use. The Swedish study compared 10,879 SGLT2i/dipeptidyl peptidase 4 inhibitor (DPP-4i) users with 10,879 matched insulin users. Such comparisons involving second-line therapies with a third-line therapy can introduce time-lag bias, as the patients may not be at the same stage of diabetes. This bias is compounded by the fact that the users of insulin had already started their insulin before cohort entry, unlike the new users of SGLT2i. Finally, the study also introduces immortal time bias with respect to the effects of SGLT2i relative to DPP-4i. In conclusion, the >50% lower rate of death with SGLT2i in type 2 diabetes reported by two recent observational studies is likely exaggerated by immortal time and time

  10. Prevalence of Recommendations Made Within Dental Research Articles Using Uncontrolled Intervention or Observational Study Designs.

    Science.gov (United States)

    Wilson, M K; Chestnutt, I G

    2016-03-01

    Evidence to inform clinical practice is reliant on research carried out using appropriate study design. The objectives of this work were to (i) identify the prevalence of articles reporting on human studies using uncontrolled intervention or observational research designs published in peer-reviewed dental journals and (ii) determine the nature of recommendations made by these articles. Six peer-reviewed dental journals were selected. Issues published in January to June 2013 were examined and the types of articles published categorized. Following pre-defined inclusion/exclusion criteria, human studies classified as using uncontrolled intervention or observational research designs were subject to detailed review by two independent investigators, to examine if they presented clinical, policy or research recommendations and if these recommendations were supported by the data presented. 52.9% (n = 156) of studies published during the time period met the inclusion criteria. Studies with uncontrolled intervention or observational research designs comprised a larger proportion of the primary research studies published in the journals with lower impact factors (73.3%; n = 107) compared to the high impact journals (38.9%; n = 49). Analysis showed that 60.9% (n = 95) of the included studies made recommendations for clinical practice/dental policy. In 28.2% (n = 44) of studies, the clinical/policy recommendations made were judged to not be fully supported by the data presented. Many studies published in the current dental literature, which are not considered to produce strong evidence, make recommendations for clinical practice or policy. There were some cases when the recommendations were not fully supported by the data presented. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Mobile phone use among female entertainment workers in Cambodia: an observation study.

    Science.gov (United States)

    Brody, Carinne; Tatomir, Brent; Sovannary, Tuot; Pal, Khuondyla; Mengsrun, Song; Dionosio, Jennifer; Luong, Minh-Anh; Yi, Siyan

    2017-01-01

    Text or voice messages containing health behavior change content may be an inexpensive, discreet, sustainable and scalable way to reach populations at high risk for HIV. In Cambodia, one of the important high-risk populations is female entertainment workers (FEWs). This ethnographic study aims to explore typical phone use, examining patterns and behaviors that may influence the design of future mHealth interventions. The study consisted of one 8-hour non-participant observation session for 15 randomly sampled FEWs. Observations focused on capturing normal daily use of mobile devices. Observation checklists were populated by observers during the observations and a post-observation survey was conducted. Findings were discussed with Cambodian HIV outreach workers and HIV research fellows and their interpretations are summarized below. In this ethnographic study, all 15 participants made calls, checked the time and received research-related texts. More than half (n=8) of the participants engaged in texting to a non-research recipient. About half (n=7) went on Facebook (FB) and some (n=5) listened to music and looked at their FB newsfeed. Fewer played a mobile game, posted a photo to FB, went on YouTube, used FB chat/messenger, watched a video on FB, played a game on FB, used FB call/voice chat, looked at their phone's background or used the LINE app. Fewer still shared their phones, left them unattended, added airtime or changed their SIM cards. When participants received a research text message, most did not share the text message with anyone, did not ask for help deciphering the message and did not receive help composing a response. Notable themes from observer notes, HIV outreach workers and researchers include reasons why phone calls were the most frequent mode of communication, examples of how cell phone company text messages are used as a form of behavior change, literacy as a persistent barrier for some FEWs, and FEWs' high interest in receiving health

  12. Night Shift Work and Risk of Depression: Meta-analysis of Observational Studies.

    Science.gov (United States)

    Lee, Aeyoung; Myung, Seung Kwon; Cho, Jung Jin; Jung, Yu Jin; Yoon, Jong Lull; Kim, Mee Young

    2017-07-01

    This study aimed to assess whether night shift work is associated with the risk of depression by using a meta-analysis of observational studies. We searched PubMed and EMBASE in August, 2016 to locate eligible studies and investigated the association between night shift work and the risk of depression, reporting outcome measures with adjusted odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs). In the meta-analysis of a total of 11 observational studies with 9 cross-sectional study, 1 longitudinal study, and 1 cohort study, night shift work was significantly associated with an increased risk of depression (OR/RR, 1.43; 95% CI, 1.24-1.64; I² = 78.0%). Also, subgroup meta-analyses by gender, night shift work duration, type of occupation, continent, and type of publication showed that night shift work was consistently associated with the increased risk of depression. The current meta-analysis suggests that night shift work is associated with the increased risk of depression. However, further large prospective cohort studies are needed to confirm this association. © 2017 The Korean Academy of Medical Sciences.

  13. A study of the inner parts of protoplanetary disks observed by interferometry

    International Nuclear Information System (INIS)

    Anthonioz, Fabien

    2015-01-01

    Observing gas and dusty disks around young stars are of utmost importance for our knowledge about planetary formation. Observations of these disks bring unprecedented details about their structure and composition, and provide stronger and stronger constrains on planetary formation models. However, the inner parts of these disk are still barely known. Indeed, a 100 m diameter telescope would be required in order to resolve these inner region, for the closest young stars; nowadays, the construction of such telescope is impossible technologically and financially. By combining the light of pairs of telescopes, the interferometry technique is able to reach the sufficient resolving power, and permits us to observe the inner parts of circumstellar disks. My thesis has been focused on the observation and study of the inner part of TTauri's circumstellar disks. I present in this manuscript a statistical study on the environment around these stars, along with its modeling by taking into account thermal emission and light scattering of the disk. Finally, I present a more complete modelling for some of these stars, done by constraining spectroscopic, interferometric and photometric datasets with a radiative transfer code. (author)

  14. An Observational Case Study of Near-peer Teaching in Medical and Pharmacy Experiential Training.

    Science.gov (United States)

    Sharif-Chan, Bayan; Tankala, Dipti; Leong, Christine; Austin, Zubin; Battistella, Marisa

    2016-09-25

    Objective. To compare peer teaching in a medical and a pharmacy clinical teaching unit and to provide suggestions for future research in pharmacy near-peer teaching. Methods. This exploratory observational study used principles of ethnographic methodology for data collection and analysis. Observations were collected in a large downtown teaching hospital. An average of 4-6 hours per day were spent observing a team of medical trainees from the Faculty (School) of Medicine in the general internal medicine (unit for two weeks, followed by a team of pharmacy trainees in an ambulatory hemodialysis (HD) unit for two weeks. Data was collected through field notes and informal interviews that were audiotaped and subsequently transcribed. Data was interpreted by the observer and reviewed weekly by two impartial pharmacists. Results. Five major themes emerged: (1) influence of peer teaching hierarchy; (2) educational distance between peer learners and teachers; (3) effect of the clinical teaching unit size on peer learning; (4) trainees' perception of their teaching role in the clinical teaching unit; and (5) influence of daily schedule and workload on peer teaching. As opposed to pharmacy, a hierarchy and pyramidal structure of peer teaching was observed in medical experiential training. There appeared to be no effect of educational distance on near peer teaching; however, perception of teaching role and influence of daily schedule affected near-peer teaching. Conclusion. Through initial comparisons of medical and pharmacy clinical teaching units, this study provides a reflection of elements that may be necessary to successfully implement near-peer teaching in pharmacy experiential training. Future studies in this area should assess learning outcomes and participant satisfaction, preceptor workload, and impact on patient care.

  15. Are Bank Employees Stressed? Job Perception and Positivity in the Banking Sector: An Italian Observational Study.

    Science.gov (United States)

    Mannocci, Alice; Marchini, Laura; Scognamiglio, Alfredo; Sinopoli, Alessandra; De Sio, Simone; Sernia, Sabina; La Torre, Giuseppe

    2018-04-10

    Background : The epidemiology of stress on bank workers in Europe is only at the introductory stages. This study investigated for the first time the association between occupational stress level in bank-employees using the BEST8, Karasek-Model and socio-demographic and working factors in Italy. Methods : The observational pilot study involved 384 employees. Three questionnaires were adopted to collect data: Karasek-Model, BEST8 ( p banking sector involves many aspects: gender, type of bank, role, personal morals, high job-demands, low level of decision-making. This study recommended that banks should implement strategic interventions for well-being of employees, and consequently for their productivity.

  16. A Prospective Observation Study of Medical Toxicology Consultation in a U.S. Combat Theater.

    Science.gov (United States)

    Maddry, Joseph K; Ng, Patrick C; Sessions, Daniel; Bebarta, Vikhyat S

    2016-11-01

    Since 2001, U.S. military personnel and active duty, uniformed physicians providing medical support have been deployed to Afghanistan. Medical toxicologists are among the physicians deployed. There is a paucity of information present in the literature that has documented cases treated by toxicologists in theater. This prospective observational study describes 15 male patients treated in theater by a military medical toxicologist. We performed a prospective observational study in which a medical toxicologist consulted and reported on deployed toxicology cases occurring during a 5-month deployment to Bagram, Afghanistan. Fifteen toxicology cases were collected during the 5-month period. The patients included three Afghan civilians, three U.S. civilians, and nine U.S. military personnel. Eight cases were attempts at recreational euphoria, two were self-harm attempts, two were from performance-enhancing supplements, two were accidental occupational exposures and one was alcohol withdrawal. Methanol was the most common exposure followed by dextromethorphan, supplements, opiates, and chlorine gas. In our study, we found that toxic alcohols and nonprescription medications were the most common exposures. In addition, this is the first study to describe bedside toxicology consults for U.S. combat forces in theater and the use of an observation unit for critically ill patients. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  17. Expanding the Evidence Base: Comparing Randomized Controlled Trials and Observational Studies of Statins.

    Science.gov (United States)

    Atar, Dan; Ong, Seleen; Lansberg, Peter J

    2015-01-01

    It is widely accepted that randomized controlled trials (RCTs) are the gold standard for demonstrating the efficacy of a given therapy (results under ideal conditions). Observational studies, on the other hand, can complement this by demonstrating effectiveness (results under real-world conditions). To examine the role that observational studies can play in complementing data from RCTs, we reviewed published studies for statins, a class of drugs that have been widely used to reduce the risk of cardiovascular (CV) events by lowering low-density lipoprotein cholesterol levels. RCTs have consistently demonstrated the benefits of statin treatment in terms of CV risk reduction and have demonstrated that more intensive statin therapy has incremental benefits over less intensive treatment. Observational studies of statin use in 'real-world' populations have served to augment the evidence base generated from statin RCTs in preselected populations of patients who are often at high CV risk and have led to similar safety and efficacy findings. They have also raised questions about factors affecting medication adherence, under-treatment, switching between statins, and failure to reach low-density lipoprotein cholesterol target levels, questions for which the answers could lead to improved patient care.

  18. Potential and limitations of multidecadal satellite soil moisture observations for selected climate model evaluation studies

    Directory of Open Access Journals (Sweden)

    A. Loew

    2013-09-01

    Full Text Available Soil moisture is an essential climate variable (ECV of major importance for land–atmosphere interactions and global hydrology. An appropriate representation of soil moisture dynamics in global climate models is therefore important. Recently, a first multidecadal, observation-based soil moisture dataset has become available that provides information on soil moisture dynamics from satellite observations (ECVSM, essential climate variable soil moisture. The present study investigates the potential and limitations of this new dataset for several applications in climate model evaluation. We compare soil moisture data from satellite observations, reanalysis and simulations from a state-of-the-art land surface model and analyze relationships between soil moisture and precipitation anomalies in the different dataset. Other potential applications like model parameter optimization or model initialization are not investigated in the present study. In a detailed regional study, we show that ECVSM is capable to capture well the interannual and intraannual soil moisture and precipitation dynamics in the Sahelian region. Current deficits of the new dataset are critically discussed and summarized at the end of the paper to provide guidance for an appropriate usage of the ECVSM dataset for climate studies.

  19. Predictors of switching from mania to depression in a large observational study across Europe (EMBLEM)

    DEFF Research Database (Denmark)

    Vieta, Eduard; Angst, Jules; Reed, Catherine

    2009-01-01

    BACKGROUND: The risk of switching from mania to depression in bipolar disorder has been poorly studied. Large observational studies may be useful in identifying variables that predict switch to depression after mania and provide data on medication use and outcomes in "real world" patients. METHOD...... Depression Rating Scale. Switching was defined using CGI-BP mania and depression such that patients changed from manic and not depressed to depressed but not manic over two consecutive observations within the first 12 weeks of follow-up. Cox proportional hazards models identified baseline variables...... independently associated with switch to depression. RESULTS: Of 2390 patients who participated in the maintenance phase (i.e. up to 24 months), 120 (5.0%) switched to depression within the first 12 weeks. Factors associated with greater switching to depression include previous depressive episodes, substance...

  20. Observational studies in South African mines to mitigate seismic risks: a mid-project progress report

    CSIR Research Space (South Africa)

    Durrheim, RJ

    2013-10-01

    Full Text Available such as Japan. A 5-year collaborative project entitled "Observational studies in South African mines to mitigate seismic risks" was launched in 2010 to address these risks, drawing on over a century of South African and Japanese research experience... network in the mining districts. Figure 1. Schematic illustration of the research design. Jpn - Japanese researchers; CSIR - Council for Scientific and Industrial Research; CGS - Council for Geoscience The knowledge gained during the course...

  1. The value of postmortem computed tomography in paediatric natural cause of death : a Dutch observational study

    OpenAIRE

    Van Rijn, Rick R.; Beek, Erik J.; van de Putte, Elise M.; Teeuw, Arianne H.; Nikkels, Peter G.J.; Duijst, Wilma L.J.M.; Nievelstein, Rutger Jan A.

    2017-01-01

    Background Postmortem CT is a relatively new field of interest within paediatric radiology. This paper focusses on its value in cases of unexpected natural death. Objective We report on an observational Dutch study regarding the value of postmortem CT in children with an assumed natural unexpected death because postmortem CT is part of the Dutch NODO (additional investigations of cause of death) procedure. Materials and methods We included consecutive children who fulfilled criteria for the N...

  2. Can the cerebroplacental ratio (CPR) predict intrapartum fetal compromise? : a prospective observational study

    OpenAIRE

    Page, Ann-Sophie; Page, Geert; Dehaene, Isabelle; Roets, Ellen; Roelens, Kristien

    2017-01-01

    Objective: To investigate the potential clinical use of serial fetal CPR measurements during the last month of pregnancy for the prediction of adverse perinatal outcome in unselected low-risk pregnancies. Methods: A multicenter prospective observational cohort study in 315 consecutively recruited low-risk pregnancies. All eligible pregnancies underwent serial sonographic evaluation of fetal weight and Doppler indices at two week intervals, from 36 weeks gestation until delivery. Data were ...

  3. On-scene time and outcome after penetrating trauma: an observational study

    DEFF Research Database (Denmark)

    Funder, Kamillia S.; Steinmetz, Jacob; Petersen, John Asger

    2011-01-01

    This was an observational cohort study of penetrating trauma patients treated by the Mobile Emergency Care Unit in Copenhagen with a 30-day follow-up. Between January 2002 and September 2009, data were prospectively registered regarding the anatomical location of the trauma, time intervals and procedures performed......-scene time might be important in penetrating trauma, and ALS procedures should not delay transport to definite care at the hospital....

  4. Treatment of urinary incontinence in women in general practice: observational study.

    OpenAIRE

    Seim, A.; Sivertsen, B.; Eriksen, B. C.; Hunskaar, S.

    1996-01-01

    OBJECTIVE--To examine what is attainable when treating urinary incontinence in women in general practice. DESIGN--Observational study with 12 months' follow up. Interview and clinical examination before, during, and after treatment of women seeking help for urinary incontinence in general practice. SETTING--General practice in the rural district of Rissa, Norway. SUBJECTS--105 women aged 20 or more with urinary incontinence. INTERVENTIONS--Treatment with pelvic floor exercises, electrostimula...

  5. Compliance with smoke-free legislation and smoking behaviour: observational field study from Punjab, India.

    Science.gov (United States)

    Goel, Sonu; Sharma, Deepak; Gupta, Rakesh; Mahajan, Vini

    2017-08-10

    Indian smoke-free legislation requires prohibition of smoking at public places and owners of public places to display 'no smoking' signages. The study aims to assess the compliance of public places with smoke-free legislation and determine the factors associated with active smoking in public places. This was a cross-sectional analytic observational quantitative survey conducted by a team of trained field investigators using a structured observational checklist across 6875 public places in Punjab state of India. The study was carried out over a period of 3 years. A total of 6875 public places across 22 districts of Punjab were observed. The overall compliance to smoke-free law in Punjab was 83.8%. The highest overall compliance was observed in healthcare facilities (89.6%) and least in transit stations (78.8%). Less active smoking was observed in public places where display of 'no smoking' signage compliant with smoke-free law of India was present (adjusted OR 0.6). Further, there was a positive association between active smoking and places where the owner of public places smoked (OR 5.2, CI 2.5 to 11.1). More than 80% of the public places in a jurisdiction in north India were compliant with the smoke-free legislation of India. 'No smoking' signages displayed as per legislation have an effect on curbing smoking behaviours at public places. It is recommended that policymakers should focus more on implementing the smoke-free law at transit sites and structured training sessions should be organised for owners of workplaces. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. AN OBSERVATIONAL STUDY ON COMPLICATIONS OF CHRONIC DIABETES ENCOUNTERED IN A PULMONOLOGIST CLINIC

    Directory of Open Access Journals (Sweden)

    V. Vinod Kumar Viswanathan

    2017-07-01

    Full Text Available BACKGROUND With the ever increasing prevalence of diabetes, complications of diabetes are encountered across all specialities. Hence, it is imperative that all specialists should have a working knowledge of diabetes mellitus. This study was done to understand the prevalence and complications of diabetes among patients attending a pulmonologist OPD. Knowledge of diabetes and its complications will help pulmonary medicine specialists to identify and manage the complications of diabetes better. MATERIALS AND METHODS All patients attending a pulmonologist’s clinic for a period of one month were enquired regarding their diabetes status and patients with known history of diabetes were questioned using a standard questionnaire and their available records examined regarding their complications pertaining to diabetes and the results analysed. RESULTS In this study, 18.7% of patients attending pulmonologist clinic had diabetes mellitus and 13.5% of patients had diabetes of more than 10 years duration. Most of the patients were in the age group of 40 to 60 years and were predominantly male. Among the diabetic patients, 71.9% had complications due to diabetes. Infections were the most commonly associated complication followed by pulmonary and cardiovascular complications. Many cases of pulmonary tuberculosis were observed among these patients. Other respiratory infections observed included pneumonias and flu. Cardiovascular complications like systemic hypertension, coronary artery disease and dyslipidaemia were observed. CONCLUSION With the rising prevalence of diabetes mellitus, such cases are frequently observed across all medical specialities. Hence, it is vital that all specialists should be trained in a management of diabetes, which is a frequent comorbidity observed by all specialists. Knowledge of diabetes, identifying diabetes early and management of complications will go a long way in reducing the morbidity and mortality due to diabetes and also

  7. Rhabdomyolysis in Ebola Virus Disease. Results of an Observational Study in a Treatment Center in Guinea.

    Science.gov (United States)

    Cournac, Jean Marie; Karkowski, Ludovic; Bordes, Julien; Aletti, Marc; Duron, Sandrine; Janvier, Frédéric; Foissaud, Vincent; Savini, Hélène; de Greslan, Thierry; Rousseau, Claire; Billhot, Magali; Gagnon, Nicolas; Mac Nab, Christine; Dubrous, Philippe; Moroge, Sophie; Broto, Helene; Cotte, Jean; Maugey, Nancy; Cordier, Pierre-Yves; Sagui, Emmanuel; Merens, Audrey; Rapp, Christophe; Quentin, Benoit; Granier, Hervé; Carmoi, Thierry; Cellarier, Gilles

    2016-01-01

    The pathogenesis of Ebola virus disease (EVD) remains unclear. The sporadic nature of Ebola outbreaks and their occurrence in resource-limited settings have precluded the acquisition of extensive clinical and laboratory data. Rhabdomyolysis during EVD has been suggested to occur in previous studies showing increased aspartate aminotransferase-alanine aminotransferase ratios, but, to date, has not been confirmed with creatine kinase (CK) assays. We performed an observational study of 38 patients admitted to an Ebola treatment center from January to April 2015. CK values from patients with confirmed EVD were compared with those in patients without confirmed EVD. A panel of other analyses were also performed. In patients with EVD, characteristics were compared between survivors and nonsurvivors. High levels of CK were more frequent in patients with EVD than in those without (P = .002), and rhabdomyolysis was more frequent (59% vs 19%, respectively; P = .03). CK levels >5000 U/L were observed in 36% of patients with EVD. Also in patients with EVD, fatal outcome was significantly associated with higher creatinine and bilirubin levels, international normalized ratio, and viral load. Rhabdomyolysis is a frequent disorder in EVD and seems to be more common than in other viral infections. It may contribute to the renal failure observed in nonsurviving patients. More studies are needed to determine the impact of rhabdomyolysis on EVD outcome. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  8. Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan.

    Science.gov (United States)

    Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Shimizu, Taro; Kamiya, Toru; Sato, Yumiko; Arakawa, Soichi; Lee, Jong Ja; Iwata, Kentaro; Mihashi, Mutsuko; Tokuda, Yasuharu

    2016-03-01

    Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.

  9. Time standards of nursing in Primary Health Care: an observational study

    Directory of Open Access Journals (Sweden)

    Daiana Bonfim

    2016-02-01

    Full Text Available Abstract OBJECTIVE To determine time standards for interventions and activities conducted by nursing professionals in Family Health Units (FHU in Brazil to substantiate the calculation of work force. METHOD This was an observational study carried out in 27 FHU, in 12 municipalities in 10 states, in 2013. In each unit, nursing professionals were observed every 10 minutes, for eight work hours, on five consecutive days via the work sampling technique. RESULTS A total of 32,613 observations were made, involving 47 nurses and 93 nursing technicians/assistants. Appointments were the main intervention carried out by nurses, with a mean time of 25.3 minutes, followed by record-keeping, which corresponded to 9.7%. On average, nursing technicians/assistants spent 6.3% of their time keeping records and 30.6 intervention minutes on immunization/vaccination control. CONCLUSION The study resulted in standard times of interventions carried out by the FHU nursing team, which can underpin the determination of nursing staff size and human resource policies. Furthermore, the study showed the panorama of interventions currently employed, allowing for the work process to be reviewed and optimized.

  10. Cost-efficiency of knowledge creation: randomized controlled trials vs. observational studies.

    Science.gov (United States)

    Struck, Rafael; Baumgarten, Georg; Wittmann, Maria

    2014-04-01

    This article reviews traditional and current perspectives on randomized, controlled trials (RCTs) and observational studies relative to the economic implications for public healthcare stakeholders. It takes an average of 17 years to bring 14% of original research into clinical practice. Results from high-quality observational studies may complement limited RCTs in primary and secondary literature bases, and enhance the incorporation of sound evidence-based guidelines. Observational findings from comprehensive medical databases may offer valuable clues on the effectiveness and relevance of public healthcare interventions. Major expenditures associated with RCTs relate to recruitment, inappropriate site selection, conduct and reporting. Application of business strategies and economic evaluation tools, in addition to the planning and conduct of RCTs, may enhance clinical trial site performances. Considering the strengths and limitations of each study type, clinical researchers should explore the contextual worthiness of either design in promulgating knowledge. They should focus on quality of conduct and reporting that may allow for the liberation of limited public and private clinical research funding.

  11. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD statement.

    Directory of Open Access Journals (Sweden)

    Eric I Benchimol

    2015-10-01

    Full Text Available Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE. The REporting of studies Conducted using Observational Routinely collected health Data (RECORD statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist and explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included herein. This document, as well as the accompanying website and message board (http://www.record-statement.org, will enhance the implementation and understanding of RECORD. Through implementation of RECORD, authors, journals editors, and peer reviewers can encourage transparency of research reporting.

  12. Study of equatorial Kelvin waves using the MST radar and radiosonde observations

    Directory of Open Access Journals (Sweden)

    P. Kishore

    2005-06-01

    Full Text Available In this paper an attempt has been made to study equatorial Kelvin waves using a high power coherent VHF radar located at Gadanki (13.5° N, 79.2° E, a tropical station in the Indian sub-continent. Simultaneous radiosonde observations taken from a nearby meteorological station located in Chennai (13.04° N, 80.17° E were also used to see the coherence in the observed structures. These data sets were analyzed to study the mean winds and equatorial waves in the troposphere and lower stratosphere. Equatorial waves with different periodicities were identified. In the present study, particular attention has been given to the fast Kelvin wave (6.5-day and slow Kelvin wave (16-day. Mean zonal wind structures were similar at both locations. The fast Kelvin wave amplitudes were somewhat similar in both observations and the maximum amplitude is about 8m/s. The phase profiles indicated a slow downward progression. The slow Kelvin wave (16-day amplitudes shown by the radiosonde measurements are a little larger than the radar derived amplitudes. The phase profiles showed downward phase progression and it translates into a vertical wavelength of ~10-12km. The radar and radiosonde derived amplitudes of fast and slow Kelvin waves are larger at altitudes near the tropopause (15-17km, where the mean wind attains westward maximum.

  13. Periodontal disease and risk of preeclampsia: a meta-analysis of observational studies.

    Directory of Open Access Journals (Sweden)

    Ben-Juan Wei

    Full Text Available BACKGROUND: Many epidemiological studies have found a positive association between periodontal disease (PD and the risk of preeclampsia, but the magnitude of this association varies and independent studies have reported conflicting findings. We performed a meta-analysis to ascertain the relationship between PD and preeclampsia. METHODS: The PubMed database was searched up to January 12, 2013, for relevant observational studies on an association between PD and the risk of preeclampsia. Data were extracted and analyzed independently by two authors. The meta-analysis was performed using comprehensive meta-analysis software. RESULTS: Thirteen observational case-control studies and two cohort studies, involving 1089 preeclampsia patients, were identified. Based on a random-effects meta-analysis, a significant association between PD and preeclampsia was identified (odds ratio = 2.79, 95% confidence interval CI, 2.01-3.01, P<0.0001. CONCLUSIONS: Although the causality remains unclear, the association between PD and preeclampsia may reflect the induction of PD by the preeclamptic state, or it may be part of an overall exaggerated inflammatory response to pregnancy. Larger randomized controlled trials with preeclampsia as the primary outcome and pathophysiological studies are required to explore causality and to dissect the biological mechanisms involved.

  14. Periodontal disease and risk of chronic obstructive pulmonary disease: a meta-analysis of observational studies.

    Directory of Open Access Journals (Sweden)

    Xian-Tao Zeng

    Full Text Available BACKGROUND: Many epidemiological studies have found a positive association between periodontal disease (PD and risk of chronic obstructive pulmonary disease (COPD, but this association is varied and even contradictory among studies. We performed a meta-analysis to ascertain the relationship between PD and COPD. METHODS: PubMed and Embase database were searched up to January 10, 2012, for relevant observational studies on the association between PD and risk of COPD. Data from the studies selected were extracted and analyzed independently by two authors. The meta-analysis was performed using the Comprehensive Meta-Analysis software. RESULTS: Fourteen observational studies (one nested case-control, eight case-control, and five cross-sectional involving 3,988 COPD patients were yielded. Based on random-effects meta-analysis, a significant association between PD and COPD was identified (odds ratio = 2.08, 95% confidence interval = 1.48-2.91; P<0.001, with sensitivity analysis showing that the result was robust. Subgroups analyses according to study design, ethnicity, assessment of PD/COPD, and adjusted/unadjusted odds ratios also revealed a significant association. Publication bias was detected. CONCLUSIONS: Based on current evidence, PD is a significant and independent risk factor of COPD. However, whether a causal relationships exists remains unclear. Morever, we suggest performing randomized controlled trails to explore whether periodontal interventions are beneficial in regulating COPD pathogenesis and progression.

  15. An observational study based on the interaction between the paediatric patient and radiographer

    International Nuclear Information System (INIS)

    Harding, J.; Davis, M.

    2015-01-01

    Background: The practice of paediatric radiography requires a completely different skill set to that of adult radiography. Often, obtaining a paediatric patient's cooperation is the most difficult aspect of the role. Ensuring that a child cooperates for the examination can make positioning easier, thereby potentially providing a more diagnostic image. Aim: The aim of this study was to observe the interaction between the paediatric patient and the radiographer and to uncover techniques used by the radiographer to help alleviate any fear or stress that the child might have had. Method: A direct observational method was conducted, after both the radiographer and the child's guardians provided full written consent. The actions of the radiographer and resultant reactions from the child were recorded on an observational checklist designed for paediatric examinations. Results: Seventy-nine patients aged between three months to fifteen years and thirteen radiographers with no specific paediatric training other than experience were observed. Examinations observed included lower limb, upper limb, pelvis, abdomen and chest projections. The data gathered were the result of radiographer actions when interacting with both happy and sad children. Conclusions: Successful methods of alleviating a child's fear and anxiety whilst in the X-ray room included the use of child friendly equipment such as colourful lead protection and posters on the wall, a simple explanation of what the equipment is before moving it, offering rewards such as stickers and praise and showing the child their image after the examination. When time was short and the workload was high, it was observed that radiographers were less likely to spend time calming the child down and instead were more focused on completing the examination as quickly as possible. - Highlights: • Seventy-nine patients and thirteen radiographers were observed in this study. • The use of child-friendly equipment and

  16. Risk factors for suicide behaviors in the observational schizophrenia outpatient health outcomes (SOHO study

    Directory of Open Access Journals (Sweden)

    Brugnoli Roberto

    2012-07-01

    Full Text Available Abstract Background To identify risk factors for suicide using data from a large, 3-year, multinational follow-up study of schizophrenia (SOHO study. Methods Baseline characteristics of 8,871 adult patients with schizophrenia were included in a logistic regression post-hoc analysis comparing patients who attempted and/or committed suicide during the study with those who did not. Results 384 (4.3% patients attempted or committed suicide. Completed suicides were 27 (0.3%. The significant risk factors for suicide behaviors were previous suicidality, depressive symptoms, prolactin-related adverse events, male gender and history of hospitalization for schizophrenia. Conclusions In view of the observational design of the study and the post-hoc nature of the analysis, the identified risk factors should be confirmed by ad-hoc specifically designed studies.

  17. REFLECTIVE PRACTICE THROUGH JOURNAL WRITING AND PEER OBSERVATION: A Case Study

    Directory of Open Access Journals (Sweden)

    B. Samrajya LAKSHMI

    2014-10-01

    Full Text Available Journal writing and Peer Observation in an educational context have become popular techniques, with several different types of applications. They have now been used quite widely in both language teaching and in teacher training. However, despite its reported advantages in both teaching and research, there are not many Peer Observation and Diary studies available based on the writing of experienced language teachers. The Teacher participants maintain Journal writing and Peer Observation as a means of reflective practice. They consider these practices as a mirror, which reflects the teacher’s own image as a practioner. The post-reflection discussion reveals that the teacher participants believe in reflective practice as an effective means of self-evaluation and of developing sensitivity to students’ learning. This paper examines Peer Observation and journal writing of two teachers working on the same language programme in terms of a variety of topic headings, and suggests that reflective practice can be a useful tool for both classroom research and teachers’ professional development.

  18. Time use and physical activity in a specialised brain injury rehabilitation unit: an observational study.

    Science.gov (United States)

    Hassett, Leanne; Wong, Siobhan; Sheaves, Emma; Daher, Maysaa; Grady, Andrew; Egan, Cara; Seeto, Carol; Hosking, Talia; Moseley, Anne

    2018-04-18

    To determine what is the use of time and physical activity in people undertaking inpatient rehabilitation in a specialised brain injury unit. To determine participants' level of independence related to the use of time and physical activity. Design: Cross-sectional observation study. Fourteen people [mean (SD) age 40 (15) years] with brain injuries undertaking inpatient rehabilitation. Participants were observed every 12 minutes over 5 days (Monday to Friday from 7:30 am until 7:30 pm) using a behaviour mapping tool. Observation of location, people present, body position and activity engaged in (both therapeutic and nontherapeutic). Functional Independence Measure (FIM) scores were determined for each participant. Participants spent a large part of their time alone (34%) in sedentary positions (83%) and in their bedrooms (48%) doing non-therapeutic activities (78%). There was a positive relationship between a higher level of independence (higher FIM score) and being observed in active body positions (r=0.60; p=0.03) and participating in physically active therapeutic activities (r=0.53; p=0.05). Similar to stroke units, inpatients in a specialised brain injury unit spend large parts of the day sedentary, alone and doing non-therapeutic activities. Strategies need to be evaluated to address this problem, particularly for people with greater physical dependence.

  19. Epidemiology, quality and reporting characteristics of meta-analyses of observational studies published in Chinese journals.

    Science.gov (United States)

    Zhang, Zhe-wen; Cheng, Juan; Liu, Zhuan; Ma, Ji-chun; Li, Jin-long; Wang, Jing; Yang, Ke-hu

    2015-12-07

    The aim of this study was to examine the epidemiological and reporting characteristics as well as the methodological quality of meta-analyses (MAs) of observational studies published in Chinese journals. 5 Chinese databases were searched for MAs of observational studies published from January 1978 to May 2014. Data were extracted into Excel spreadsheets, and Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Assessment of Multiple Systematic Reviews (AMSTAR) checklists were used to assess reporting characteristics and methodological quality, respectively. A total of 607 MAs were included. Only 52.2% of the MAs assessed the quality of the included primary studies, and the retrieval information was not comprehensive in more than half (85.8%) of the MAs. In addition, 50 (8.2%) MAs did not search any Chinese databases, while 126 (20.8%) studies did not search any English databases. Approximately 41.2% of the MAs did not describe the statistical methods in sufficient details, and most (95.5%) MAs did not report on conflicts of interest. However, compared with the before publication of the MOOSE Checklist, the quality of reporting improved significantly for 20 subitems after publication of the MOOSE Checklist, and 7 items of the included MAs demonstrated significant improvement after publication of the AMSTAR Checklist (pstudies have been published in Chinese journals, the reporting quality is questionable. Thus, there is an urgent need to increase the use of reporting guidelines and methodological tools in China; we recommend that Chinese journals adopt the MOOSE and AMSTAR criteria. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. [The importance of defining methodology for post-marketing observational studies on cardiovascular therapies].

    Science.gov (United States)

    Pelliccia, Francesco; Barillà, Francesco; Tanzilli, Gaetano; Viceconte, Nicola; Paravati, Vincenzo; Mangieri, Enrico; Gaudio, Carlo

    2017-01-01

    In recent years, a growing number of observational studies in cardiology have been carried out following the criticism that rigid design of randomized clinical trials produces information that is not applicable to the general patient. This approach is very common in several branches of medicine, first of all oncology, but has often been considered marginal in cardiology. The recent introduction of new oral anticoagulants (NOACs) on the market, however, has seen a proliferation of "real-life" studies, drawing the attention of cardiologists to the advantages and limitations of post-marketing studies. NOACs have been approved for use on the basis of large randomized clinical trials that have clearly documented their efficacy and safety. Since they have become available, the analysis of phase IV data has been considered crucial and therefore a great amount of information on the use of NOACs in daily practice has become available. It should be considered, however, that the possibility exists that results obtained from "real-world" studies, which do not apply rigid scientific criteria, may lead to incorrect conclusions. Accordingly, it is mandatory to fully define the operational standards of observational studies. All the protagonists of post-marketing analysis (physicians, epidemiologists, pharmacologists, statisticians) should handle the data strictly in order to ensure their reliability and comparability with other studies. To this end, it is crucial that researchers follow rigorous operational protocols for phase IV studies. Briefly, any "real-life" study should be prospective and adhere to what is prespecified by the research protocol - which must illustrate the background and rationale of the study, define its primary endpoint, and detail the methods, i.e. study design, population and variables.

  1. A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study

    DEFF Research Database (Denmark)

    Kasch, Helge; Kongsted, Alice; Qerama, Erisela

    2013-01-01

    within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed......OBJECTIVES: An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. DESIGN: The design was an observational prospective study of risk factors embedded in a randomised controlled study. SETTING: Acute whiplash...... and number of sick-listing days were related (Kruskal-Wallis, p

  2. Increased healing in diabetic toe ulcers in a multidisciplinary foot clinic—An observational cohort study

    DEFF Research Database (Denmark)

    Almdal, Thomas Peter; Nielsen, A.A.; Nielsen, K.E.

    2015-01-01

    AIM: To study toe ulcer healing in patients with diabetic foot ulcers attending a multidisciplinary foot clinic over a 10 years period. METHODS: The study was retrospective, consecutive and observational during 2001 through 2011. The patients were treated according to the International Consensus...... on the Diabetic Foot. During the period the chiropodist staffing in the foot clinic was doubled; new offloading material and orthopedic foot corrections for recalcitrant ulcers were introduced. Healing was investigated in toe ulcers in Cox regression models. RESULTS: 2634 patients developed foot ulcers, of which...

  3. Observing participating observation

    DEFF Research Database (Denmark)

    Keiding, Tina Bering

    2011-01-01

    Current methodology concerning participating observation in general leaves the act of observation unobserved. Approaching participating observation from systems theory offers fundamental new insights into the topic. Observation is always participation. There is no way to escape becoming...

  4. Observing participating observation

    DEFF Research Database (Denmark)

    Keiding, Tina Bering

    2010-01-01

    Current methodology concerning participating observation in general leaves the act of observation unobserved. Approaching participating observation from systems theory offers fundamental new insights into the topic. Observation is always participation. There is no way to escape becoming...

  5. Basal cortisol levels and metabolic syndrome: A systematic review and meta-analysis of observational studies.

    Science.gov (United States)

    Garcez, Anderson; Leite, Heloísa Marquardt; Weiderpass, Elisabete; Paniz, Vera Maria Vieira; Watte, Guilherme; Canuto, Raquel; Olinto, Maria Teresa Anselmo

    2018-05-17

    To perform a qualitative synthesis (systematic review) and quantitative analysis (meta-analysis) to summarize the evidence regarding the relationship between basal cortisol levels and metabolic syndrome (MetS) in adults. A systematic search was performed in the PubMed, Embase, and PsycINFO databases for observational studies on the association between basal cortisol levels and MetS. The quality of individual studies was assessed by the Newcastle-Ottawa score. A random effects model was used to report pooled quantitative results and the I 2 statistic was used to assess heterogeneity. Egger's and Begg's tests were used to evaluate publication bias. Twenty-six studies (19 cross-sectional and seven case-control) met the inclusion criteria for the systematic review. The majority was classified as having a low risk of bias and used established criteria for the diagnosis of MetS. Twenty-one studies provided data on basal cortisol levels as continuous values and were included in the meta-analysis; they comprised 35 analyses and 11,808 subjects. Pooled results showed no significant difference in basal cortisol levels between subjects with and without MetS (standardized mean difference [SMD] = 0.02, 95% confidence interval [CI]=-0.11 to 0.14). There was high heterogeneity between the studies when all comparisons were considered (I 2  = 83.1%;p meta-analysis of studies evaluating saliva samples showed no significantly lower basal cortisol levels among subjects with MetS (SMD=-0.18, 95% CI=-0.37 to 0.01), whereas those studies that evaluated serum samples (SMD = 0.11, 95% CI=-0.02 to 0.24) and urine samples (SMD = 0.73, 95% CI=-0.40 to 1.86) showed no significantly higher basal cortisol levels among subjects with MetS. In the subgroup and meta-regression analyses, a significant difference in basal cortisol levels was observed according to study design, population base, age, gender, cortisol level assessment method, and study quality. This systematic review

  6. Is meat consumption associated with depression? A meta-analysis of observational studies.

    Science.gov (United States)

    Zhang, Yi; Yang, Ye; Xie, Ming-Sheng; Ding, Xiang; Li, Hui; Liu, Zhi-Chen; Peng, Shi-Fang

    2017-12-28

    A number of epidemiological studies have examined the effect of meat consumption on depression. However, no conclusion has been reached. The aim of this study was to examine the relationship between meat consumption and depression. The electronic databases of PUBMED and EMBASE were searched up to March 2017, for observational studies that examined the relationship between meat consumption and depression. The pooled odds ratio (OR) for the prevalence of depression and the relative risk (RR) for the incidence of depression, as well as their corresponding 95% confidence interval (CI), were calculated respectively (the highest versus the lowest category of meat consumption). A total of eight observational studies (three cross-sectional, three cohort and two case-control studies) were included in this meta-analysis. Specifically, six studies were related to the prevalence of depression, and the overall multi-variable adjusted OR suggested no significant association between meat consumption and the prevalence of depression (OR = 0.89, 95% CI: 0.65 to 1.22; P = 0.469). In contrast, for the three studies related to the incidence of depression, the overall multi-variable adjusted RR evidenced an association between meat consumption and a moderately higher incidence of depression (RR = 1.13, 95% CI: 1.03 to 1.24; P = 0.013). Meat consumption may be associated with a moderately higher risk of depression. However, it still warrants further studies to confirm such findings due to the limited number of prospective studies.

  7. Depression and oxidative stress: results from a meta-analysis of observational studies.

    Science.gov (United States)

    Palta, Priya; Samuel, Laura J; Miller, Edgar R; Szanton, Sarah L

    2014-01-01

    To perform a systematic review and meta-analysis that quantitatively tests and summarizes the hypothesis that depression results in elevated oxidative stress and lower antioxidant levels. We performed a meta-analysis of studies that reported an association between depression and oxidative stress and/or antioxidant status markers. PubMed and EMBASE databases were searched for articles published from January 1980 through December 2012. A random-effects model, weighted by inverse variance, was performed to pool standard deviation (Cohen's d) effect size estimates across studies for oxidative stress and antioxidant status measures, separately. Twenty-three studies with 4980 participants were included in the meta-analysis. Depression was most commonly measured using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. A Cohen's d effect size of 0.55 (95% confidence interval = 0.47-0.63) was found for the association between depression and oxidative stress, indicating a roughly 0.55 of 1-standard-deviation increase in oxidative stress among individuals with depression compared with those without depression. The results of the studies displayed significant heterogeneity (I(2) = 80.0%, p < .001). A statistically significant effect was also observed for the association between depression and antioxidant status markers (Cohen's d = -0.24, 95% confidence interval = -0.33 to -0.15). This meta-analysis observed an association between depression and oxidative stress and antioxidant status across many different studies. Differences in measures of depression and markers of oxidative stress and antioxidant status markers could account for the observed heterogeneity. These findings suggest that well-established associations between depression and poor heath outcomes may be mediated by high oxidative stress.

  8. Tea consumption may decrease the risk of osteoporosis: an updated meta-analysis of observational studies.

    Science.gov (United States)

    Guo, Ming; Qu, Hua; Xu, Lin; Shi, Da-Zhuo

    2017-06-01

    Several epidemiological investigations have evaluated the correlation between tea consumption and risk of osteoporosis, but the results are inconsistent. Therefore, we conducted an updated meta-analysis of observational studies to assess this association. We searched for all relevant studies including cohort, cross-sectional, and case-control studies published from database inception to July 15, 2016, using MEDLINE EMBASE, and Cochrane Library. Polled odds ratios (ORs) were calculated using the random-effect model. Fourteen articles (16 studies) that examined 138523 patients were included in this meta-analysis. Seven studies concerning bone mineral density (BMD) showed an increase in BMD with tea consumption, including 4 cross-sectional studies (OR, 0.04, 95% confidence interval [CI], 0.01-0.08) and 3 cohort studies (OR, 0.01; 95% CI, 0.01-0.01). The remaining 9 studies concerning fracture, including 6 case-control studies and 3 cohort studies, showed no association between tea consumption and osteoporotic fracture (OR, 0.86; 95% CI, 0.74-1.01). This updated meta-analysis demonstrates that tea consumption could increase BMD, but the association with osteoporotic fracture requires further investigation. Together, the results highlight the need for future, high-quality-designed clinical trials on tea consumption and osteoporosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Scintigraphy in the diagnosis of liver cancers. Study of 54 observations with anatomical confrontation

    International Nuclear Information System (INIS)

    Labro, R.D.A.

    1976-01-01

    This study attempts to judge the reliability of scintigraphy in the diagnosis of liver cancers. It concerns 54 observations with anatomical confrontation (laparoscopy, biopsy, laparotomy and/or autopsy). Technetium 99m scintigraphy gives a correct diagnosis in 81.5% of the cases, whether cirrhosis is present or not. Scintigraphy is only one stage in the investigation of neoplasic liver disease. This study shows that all too often it is practised alone since of 201 observations only 54 include another examination, and of these only 21 a laparoscopy. The simultaneous use of scintigraphy and laparoscopy eliminates false positives and reduces the percentage of false negatives from 7.5% to 4%. The two methods combined are therefore reliable to 96% (i.e. 96% of successful diagnosis in liver cancer tests. This work was performed with the techniques available in 1973. The quality of the scintigraphic image should be improved by technical progress in the form of new isotopic products, cameras with better definition and computerized data processing. With these new techniques it will certainly be possible to detect very small lacunae and to observe in more detail their diffusion in the liver parenchyma [fr

  10. Measuring the quality of observational study data in an international HIV research network.

    Directory of Open Access Journals (Sweden)

    Stephany N Duda

    Full Text Available Observational studies of health conditions and outcomes often combine clinical care data from many sites without explicitly assessing the accuracy and completeness of these data. In order to improve the quality of data in an international multi-site observational cohort of HIV-infected patients, the authors conducted on-site, Good Clinical Practice-based audits of the clinical care datasets submitted by participating HIV clinics. Discrepancies between data submitted for research and data in the clinical records were categorized using the audit codes published by the European Organization for the Research and Treatment of Cancer. Five of seven sites had error rates >10% in key study variables, notably laboratory data, weight measurements, and antiretroviral medications. All sites had significant discrepancies in medication start and stop dates. Clinical care data, particularly antiretroviral regimens and associated dates, are prone to substantial error. Verifying data against source documents through audits will improve the quality of databases and research and can be a technique for retraining staff responsible for clinical data collection. The authors recommend that all participants in observational cohorts use data audits to assess and improve the quality of data and to guide future data collection and abstraction efforts at the point of care.

  11. Training induces scapular dyskinesis in pain-free competitive swimmers: a reliability and observational study.

    Science.gov (United States)

    Madsen, Pernille H; Bak, Klaus; Jensen, Susanne; Welter, Ulrik

    2011-03-01

    Scapular dyskinesis is a major etiological factor in overhead athletes' shoulder problems. Our hypotheses were to evaluate if (1) visual observation of scapular dyskinesis during scaption has substantial interobserver reliability, and (2) scapular dyskinesis may be induced by swim training in pain-free swimmers. A reliability and observational study. Bachelor project at a college institution and at a private sports orthopedic hospital. Seventy-eight competitive swimmers with no history of shoulder pain were included in the study. Fourteen swimmers were evaluated regarding reliability. Inclusion criteria were competitive swimmers with high training volume who previously had no shoulder pain. Observations of scapular dyskinesis (yes/no) during simple scaption. The interobserver reliability of scaption and wall push-up was evaluated in 14 swimmers using kappa analysis. Prevalence of scapular dyskinesis at 4 time intervals during a swim training session. The scaption test resulted in a weighted kappa value of 0.75. Scapular dyskinesis was seen in 29 shoulders (37%) after the first time interval, in another 24 (cumulated prevalence 68%) after one-half of the training session, and in an additional 4 swimmers (cumulated prevalence 73%) after three-quarters of the training session. During the last quarter of the training session, another 7 swimmers had dyskinesis, resulting in a cumulated prevalence of 82%. The prevalence of abnormal scapular kinesis during a normal training session is high in previously pain-free swimmers. The prevalence increases with more training and occurs early during the training session.

  12. [Therapeutic characteristance and tolerance of topical comfrey preparations. Results of an observational study of patients].

    Science.gov (United States)

    Koll, R; Klingenburg, S

    2002-01-01

    To analyze the anti-inflammatory and analgetic properties of the topical comfrey, preparations Kytta-Salbe f, Kytta-Plasma f and Kytta-Balsam f applied to bruises, sprains and distortions and painful conditions of the muscles and joints. A prospective open multicentric observational study complying with paragraph 67(6) of the AMG and involving 162 general practitioners. During the two-week period of observation, the patients received an average of one to three applications of the comfrey preparation per day. All 492 questionnaires were evaluated. Efficacy and tolerability were assessed by both physician and patient. Pain at rest and on movement, as also tenderness, improved in the overall observation group by an average of 45-47%. The duration of morning joint stiffness decreased from 20 minutes initially to 3 minutes. During the course of treatment with comfrey, more than two-thirds of the patients were able to reduce or even discontinue their intake of non-steroidal anti-inflammatory drugs and other specific concomitant medication. In most of the cases, both effectiveness and tolerability were assessed to be excellent or good. The results of the study confirm the effectiveness and tolerability of the topical comfrey preparation investigated in the treatment of bruises, sprains and distortions as well as painful conditions affecting muscles and joints.

  13. A simulation study of particle energization observed by THEMIS spacecraft during a substorm

    Science.gov (United States)

    Ashour-Abdalla, Maha; Bosqued, Jean-Michel; El-Alaoui, Mostafa; Peroomian, Vahe; Zhou, Meng; Richard, Robert; Walker, Raymond; Runov, Andrei; Angelopoulos, Vassilis

    2009-09-01

    Energetic ions with hundreds of keV energy are frequently observed in the near-Earth tail during magnetospheric substorms. We examined the sources and acceleration of ions during a magnetospheric substorm on 1 March 2008 by using Time History of Events and Macroscale Interactions during Substorms (THEMIS) and Cluster observations and numerical simulations. Four of the THEMIS spacecraft were aligned at yGSM = 6 RE during a very large substorm (AE = 1200) while the Cluster spacecraft were located about 5 RE above the auroral ionosphere. For 2 h before the substorm, Cluster observed ionospheric oxygen flowing out into the magnetosphere. After substorm onset the THEMIS P3 and P4 spacecraft located in the near-Earth tail (xGSM = -9 RE and -8 RE, respectively) observed large fluxes of energetic ions up to 500 keV. We used calculations of millions of ions of solar wind and ionospheric origin in the time-dependent electric and magnetic fields from a global magnetohydrodynamic simulation of this event to study the source of these ions and their acceleration. The simulation did a good job of reproducing the particle observations. Both solar wind protons and ionospheric oxygen were accelerated by nonadiabatic motion across large (>˜5 mV/m) total electric fields (both potential and induced). The acceleration occurred in the "wall" region of the near-Earth tail where nonadiabatic motion dominates over convection and the particles move rapidly across the tail. The acceleration occurred mostly in regions with large electric fields and nonadiabatic motion. There was relatively little acceleration in regions with large electric fields and adiabatic motion or small electric fields and nonadiabatic motion. Prior to substorm onset, ionospheric ions were a significant contributor to the cross-tail current, but after onset, solar wind ions become more dominant.

  14. Observation and imitation of actions performed by humans, androids, and robots: an EMG study

    Science.gov (United States)

    Hofree, Galit; Urgen, Burcu A.; Winkielman, Piotr; Saygin, Ayse P.

    2015-01-01

    Understanding others’ actions is essential for functioning in the physical and social world. In the past two decades research has shown that action perception involves the motor system, supporting theories that we understand others’ behavior via embodied motor simulation. Recently, empirical approach to action perception has been facilitated by using well-controlled artificial stimuli, such as robots. One broad question this approach can address is what aspects of similarity between the observer and the observed agent facilitate motor simulation. Since humans have evolved among other humans and animals, using artificial stimuli such as robots allows us to probe whether our social perceptual systems are specifically tuned to process other biological entities. In this study, we used humanoid robots with different degrees of human-likeness in appearance and motion along with electromyography (EMG) to measure muscle activity in participants’ arms while they either observed or imitated videos of three agents produce actions with their right arm. The agents were a Human (biological appearance and motion), a Robot (mechanical appearance and motion), and an Android (biological appearance and mechanical motion). Right arm muscle activity increased when participants imitated all agents. Increased muscle activation was found also in the stationary arm both during imitation and observation. Furthermore, muscle activity was sensitive to motion dynamics: activity was significantly stronger for imitation of the human than both mechanical agents. There was also a relationship between the dynamics of the muscle activity and motion dynamics in stimuli. Overall our data indicate that motor simulation is not limited to observation and imitation of agents with a biological appearance, but is also found for robots. However we also found sensitivity to human motion in the EMG responses. Combining data from multiple methods allows us to obtain a more complete picture of action

  15. Prevention of pressure ulcers in patients undergoing subacute rehabilitation after severe brain injury: An observational study.

    Science.gov (United States)

    Sachs, Marianne Brostrup; Wolffbrandt, Mia Moth; Poulsen, Ingrid

    2018-01-09

    To uncover efforts made by healthcare professionals to prevent pressure ulcers in patients with severe brain injury undergoing treatment at a subacute rehabilitation department. Pressure ulcers are a major burden for patients and also generate considerable healthcare costs. Pressure ulcers are, nevertheless, prevalent in both secondary care and primary care. In this qualitative study, we performed 24-hour observation on four patients undergoing rehabilitation for severe brain injury. An observation guide was developed inspired by the Braden Scale and Spradley's theory and methods. Observations were analysed using content analysis. Patricia Benner's aspects of clinical grasp were employed in the interpretation of the observations. One overarching theme was identified: "Professionalism expressed by preventing intervention, involving the patient, employing clinical grasp and professional pride." Seven subcategories were summed up into the following three categories: organisation of clinical practice, professional assessment and interactions with the patient. The healthcare professionals' actions to prevent pressure ulcers consisted of attaining the necessary knowledge about pressure ulcer care and performing the activities. However, our observations revealed one important additional aspect: a very distinct impression that the healthcare professionals were committed to learning about the patients' former life and actively used this knowledge in their planning and provision of daily patient care. We believe this commitment has a very positive effect on prevention of pressure ulcers. Professional knowledge about prevention of pressure ulcer is a necessary requisite, but is not sufficient to ensure effective treatment. To transfer knowledge into practice, we recommend that patients' rehabilitation days be planned in such a manner that activities, mobilisation and training are conducted throughout the day and evening. We also recommend that professional staff are

  16. Observation and Imitation of Actions Performed by Humans, Androids and Robots: An EMG study

    Directory of Open Access Journals (Sweden)

    Galit eHofree

    2015-06-01

    Full Text Available Understanding others’ actions is essential for functioning in the physical and social world. In the past two decades research has shown that action perception involves the motor system, supporting theories that we understand others’ behavior via embodied motor simulation. Recently, action perception has been facilitated by using well-controlled artificial stimuli, such as robots. One key question this approach enables is what aspects of similarity between the observer and the observed agent facilitate motor simulation? Since humans have evolved among other humans and animals, using artificial stimuli such as robots allows us to probe whether our social perceptual systems are tuned to process other biological entities. In this study, we used humanoid robots with different degrees of humanlikeness in appearance and motion along with electromyography (EMG to measure muscle activity in participants’ arms while they either observed or imitated videos of three agents produce actions with their right arm. The agents were a Human (biological appearance and motion, a Robot (mechanical appearance and motion and an Android (biological appearance, mechanical motion. Right arm muscle activity increased when participants imitated all agents. Increased muscle activation was found also in the stationary arm both during imitation and observation. Furthermore, muscle activity was sensitive to motion dynamics: activity was significantly stronger for imitation of the human than both mechanical agents. There was also a relationship between the dynamics of the muscle activity and motion dynamics in stimuli. Overall our data indicate that motor simulation is not limited to observation and imitation of agents with a biological appearance, but is also found for robots. However we also found sensitivity to human motion in the EMG responses. Combining data from multiple methods allows us to obtain a more complete picture of action understanding and the underlying

  17. Observing the Testing Effect using Coursera Video-recorded Lectures: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Paul Zhihao eYONG

    2016-01-01

    Full Text Available We investigated the testing effect in Coursera video-based learning. One hundred and twenty-three participants either (a studied an instructional video-recorded lecture four times, (b studied the lecture three times and took one recall test, or (c studied the lecture once and took three tests. They then took a final recall test, either immediately or a week later, through which their learning was assessed. Whereas repeated studying produced better recall performance than did repeated testing when the final test was administered immediately, testing produced better performance when the final test was delayed until a week after. The testing effect was observed using Coursera lectures. Future directions are documented.

  18. Seven challenges for model-driven data collection in experimental and observational studies

    Directory of Open Access Journals (Sweden)

    J. Lessler

    2015-03-01

    Full Text Available Infectious disease models are both concise statements of hypotheses and powerful techniques for creating tools from hypotheses and theories. As such, they have tremendous potential for guiding data collection in experimental and observational studies, leading to more efficient testing of hypotheses and more robust study designs. In numerous instances, infectious disease models have played a key role in informing data collection, including the Garki project studying malaria, the response to the 2009 pandemic of H1N1 influenza in the United Kingdom and studies of T-cell immunodynamics in mammals. However, such synergies remain the exception rather than the rule; and a close marriage of dynamic modeling and empirical data collection is far from the norm in infectious disease research. Overcoming the challenges to using models to inform data collection has the potential to accelerate innovation and to improve practice in how we deal with infectious disease threats.

  19. Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring.

    Science.gov (United States)

    van der Wal, Martijn B A; Vloemans, Jos F P M; Tuinebreijer, Wim E; van de Ven, Peter; van Unen, Ella; van Zuijlen, Paul P M; Middelkoop, Esther

    2012-01-01

    Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p burned (p  0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively. © 2012 by the Wound Healing Society.

  20. Source analysis of peroxyacetyl nitrate (PAN) in Guangzhou, China: a yearlong observation study

    Science.gov (United States)

    Wang, B. G.; Zhu, D.; Zou, Y.; Wang, H.; Zhou, L.; Ouyang, X.; Shao, H. F.; Deng, X. J.

    2015-06-01

    In recent years, photochemical smog has been a major cause of air pollution in the metropolitan area of Guangzhou, China, with a continuing increase in the concentrations of photochemical pollutants. The concentration of peroxyacetyl nitrate (PAN) has often been found to reach very high levels, posing a potential threat to the public health. To better understand the changes in PAN concentration and its sources, a study was carried from January to December of 2012 at the Guangzhou Panyu Atmospheric Composition Station (GPACS) to measure the atmospheric concentrations of PAN as well as those of ozone (O3), nitrogen oxides (NOx), and non-methane hydrocarbon (NMHC). These data were analyzed to investigate the quantitative relationships between PAN and its precursors. In the study period, the hourly concentrations of PAN varied from below instrument detection limit to 12.0 ppbv. The yearly mean concentration of PAN was 0.84 ppbv, with the daily mean concentration exceeding 5 ppbv in 32 of the total observation days. Calculations indicate that among the measured NMHC species, alkenes accounted for 53 % of the total NMHC contribution to the PAN production, with aromatics and alkanes accounting for about 11 and 7 % of the total, respectively. During the period of our observation only a modest correlation was found between the concentrations of PAN and O3 for daytime hours, and observed PAN concentrations were relatively high even though the observed NMHCs/NOx ratio was low. This suggests regional air mass transport of pollutants had a major impact on the PAN concentrations in Guangzhou area.

  1. Variability of linezolid concentrations after standard dosing in critically ill patients: a prospective observational study

    Science.gov (United States)

    2014-01-01

    Introduction Severe infections in intensive care patients show high morbidity and mortality rates. Linezolid is an antimicrobial drug frequently used in critically ill patients. Recent data indicates that there might be high variability of linezolid serum concentrations in intensive care patients receiving standard doses. This study was aimed to evaluate whether standard dosing of linezolid leads to therapeutic serum concentrations in critically ill patients. Methods In this prospective observational study, 30 critically ill adult patients with suspected infections received standard dosing of 600 mg linezolid intravenously twice a day. Over 4 days, multiple serum samples were obtained from each patient, in order to determine the linezolid concentrations by liquid chromatography tandem mass spectrometry. Results A high variability of serum linezolid concentrations was observed (range of area under the linezolid concentration time curve over 24 hours (AUC24) 50.1 to 453.9 mg/L, median 143.3 mg*h/L; range of trough concentrations (Cmin) linezolid concentrations over 24 hours and at single time points (defined according to the literature as AUC24  400 mg*h/L and Cmin > 10 mg/L) were observed for 7 of the patients. Conclusions A high variability of linezolid serum concentrations with a substantial percentage of potentially subtherapeutic levels was observed in intensive care patients. The findings suggest that therapeutic drug monitoring of linezolid might be helpful for adequate dosing of linezolid in critically ill patients. Trial registration Clinicaltrials.gov NCT01793012. Registered 24 January 2013. PMID:25011656

  2. Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study.

    Science.gov (United States)

    Hahlweg, Pola; Didi, Sarah; Kriston, Levente; Härter, Martin; Nestoriuc, Yvonne; Scholl, Isabelle

    2017-11-17

    The quality of decision-making in multidisciplinary team meetings (MDTMs) depends on the quality of information presented and the quality of team processes. Few studies have examined these factors using a standardized approach. The aim of this study was to objectively document the processes involved in decision-making in MDTMs, document the outcomes in terms of whether a treatment recommendation was given (none vs. singular vs. multiple), and to identify factors related to type of treatment recommendation. An adaptation of the observer rating scale Multidisciplinary Tumor Board Metric for the Observation of Decision-Making (MDT-MODe) was used to assess the quality of the presented information and team processes in MDTMs. Data was analyzed using descriptive statistics and mixed logistic regression analysis. N = 249 cases were observed in N = 29 MDTMs. While cancer-specific medical information was judged to be of high quality, psychosocial information and information regarding patient views were considered to be of low quality. In 25% of the cases no, in 64% one, and in 10% more than one treatment recommendations were given (1% missing data). Giving no treatment recommendation was associated with duration of case discussion, duration of the MDTM session, quality of case history, quality of radiological information, and specialization of the MDTM. Higher levels of medical and treatment uncertainty during discussions were found to be associated with a higher probability for more than one treatment recommendation. The quality of different aspects of information was observed to differ greatly. In general, we did not find MDTMs to be in line with the principles of patient-centered care. Recommendation outcome varied substantially between different specializations of MDTMs. The quality of certain information was associated with the recommendation outcome. Uncertainty during discussions was related to more than one recommendation being considered. Time constraints

  3. A cross-sectional observational study of helmet use among motorcyclists in Wa, Ghana.

    Science.gov (United States)

    Akaateba, Millicent Awialie; Amoh-Gyimah, Richard; Yakubu, Ibrahim

    2014-03-01

    Motorcyclists' injuries and fatalities are a major public health concern in many developing countries including Ghana. This study therefore aimed to investigate the prevalence of helmet use among motorcyclists in Wa, Ghana. The method used involved a cross-sectional roadside observation at 12 randomly selected sites within and outside the CBD of Wa. A total of 14,467 motorcyclists made up of 11,360 riders and 3107 pillion riders were observed during the study period. Most observed riders (86.5%) and pillion riders (61.7%) were males. The overall prevalence of helmet use among the observed motorcyclists was 36.9% (95% CI: 36.1-37.7). Helmet use for riders was 45.8% (95% CI: 44.8-46.7) whilst that for pillion riders was 3.7% (95 CI: 3.0-4.4). Based on logistic regression analysis, higher helmet wearing rates were found to be significantly associated with female gender, weekdays, morning periods and at locations within the CBD. Riders at locations outside the CBD were about 7 times less likely to wear a helmet than riders within the CBD (48.9% compared to 42.3%; χ(2)(1)=49.526; plegislation that mandates the use of helmets by both riders and pillion riders on all roads in Ghana, helmet use is generally low in Wa. This suggests that all stakeholders in road safety should jointly intensify education on helmet use and pursue rigorous enforcement on all road types especially at locations outside the CBD to improve helmet use in Wa. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. A prospective observational study of skin to subarachnoid space depth in the Indian population

    Directory of Open Access Journals (Sweden)

    Smita Prakash

    2014-01-01

    Full Text Available Background and Aims: A pre-puncture estimate of skin to subarachnoid space depth (SSD may guide spinal needle placement and reduce complications associated with lumbar puncture. Our aim was to determine (1 The SSD in Indian males, females, parturients and the overall population; (2 To derive formulae for predicting SSD and (3 To determine which previously suggested formula best suited our population. Methods: In this prospective, observational study, 800 adult Indian patients undergoing surgery under spinal anaesthesia were divided into three groups: Males (Group M, females (Group F and parturients (Group PF. SSD was measured after lumbar puncture. The relationship between SSD and patient characteristics was studied and statistical models were used to derive formula for predicting SSD. Statistical analysis included One-way ANOVA with post hoc analysis, forward stepwise multivariate regression analysis and paired t-tests. Results: Mean SSD was 4.71 ± 0.70 cm in the overall population. SSD in adult males (4.81 ± 0.68 cm was significantly longer than that observed in females (4.55 ± 0.66 cm but was comparable with SSD in parturients (4.73 ± 0.73 cm. Formula for predicting SSD in the overall population was 2.71 + 0.09 × Body Mass Index (BMI. Stocker′s formula when applied correlated best with the observed SSD. Formulae were derived for the three groups. Conclusions: We found gender-based differences in SSD, with SSD in males being significantly greater than that observed in the female population. SSD correlated with BMI in the parturient and the overall population. Amongst the previously proposed formulae, Stocker′s formula was most accurate in predicting SSD in our population.

  5. Dietary Fat Intake and Risk of Gastric Cancer: A Meta-Analysis of Observational Studies

    Science.gov (United States)

    Liu, Xiao; Meng, Qingyang; Xi, Qiulei; Zhuang, Qiulin; Han, Yusong; Gao, Ying; Ding, Qiurong; Wu, Guohao

    2015-01-01

    Background and Objectives Consumption of dietary fat has been reported to be associated with gastric cancer risk, but the results of epidemiologic studies remain inconsistent. We conducted a meta-analysis to summarize the evidence regarding the association between dietary fat intake and gastric cancer risk. Methods A comprehensive search of PubMed and EMBASE was performed to identify observational studies providing quantitative estimates between dietary fat and gastric cancer risk. Random effects model was used to calculate the summary relative risk(SRR) in the highest versus lowest analysis. Categorical dose-response analysis was conducted to quantify the association between dietary fat intake and gastric cancer risk. Heterogeneity among studies was evaluated using I2 and tau2(between study variance)statistics. Subgroup analysis and publication bias analysis were also performed. Results Twenty-two articles were included in the meta-analysis. The SRR for gastric cancer was 1.18 for individuals with highest intake versus lowest intake of total fat (95% confidence interval [CI]: 0.999–1.39; n = 28; Pgastric cancer risk were observed. Conclusions Our results suggest that intake of total fat is potentially positively associated with gastric cancer risk, and specific subtypes of fats account for different effects. However, these findings should be confirmed by further well-designed cohort studieswith detailed dietary assessments and strict control of confounders. PMID:26402223

  6. Development of a systematic observation protocol of physical exposure of the back: a preliminary study.

    Science.gov (United States)

    Tousignant, M; Tougas, G; Rossignol, M; Goulet, L

    2002-04-01

    At present there is no systematic observation protocol for the assessment of the multi-factorial aspects of physical exposure related to the back used within the constraints of occupational epidemiological research. In this context, a new preliminary systematic observation protocol is proposed to assess exposure to physical loading of the back using nine categories of physical risk factors: the SOPE back protocol. The objective of this study was to investigate whether the new protocol can correctly identify the level of exposure related to measured physical loading of the back. The subjects of this closed cohort study were 451 manual workers at a natural gas distribution company. The assessment of exposure was made with the protocol using groups with different job titles. The workers were followed for a 2 yr period to establish the risk of a new occurrence of complete disability related to the back (NOCD back injury) in each job grouping. Based on the median of the total scores derived from the protocol, two levels of exposure were identified (high and low). Taking into account the limitations of this study, the protocol in development may be a good tool to establish two levels of exposure to physical loading of the back in large epidemiological studies of occupational low back pain. Further research is needed to replicate these results with larger samples and to test the reliability and predictive validity of the protocol.

  7. Lung cancer detection with digital chest tomosynthesis: first round results from the SOS observational study.

    Science.gov (United States)

    Bertolaccini, Luca; Viti, Andrea; Tavella, Chiara; Priotto, Roberto; Ghirardo, Donatella; Grosso, Maurizio; Terzi, Alberto

    2015-04-01

    Baseline results of the Studio OSservazionale (SOS), observational study, a single-arm observational study of digital chest tomosynthesis for lung cancer detection in an at-risk population demonstrated a detection rate of lung cancer comparable to that of studies that used low dose CT scan (LDCT). We present the results of the first round. Totally 1,703 out of 1,843 (92%) subjects who had a baseline digital chest tomosynthesis underwent a first round reevaluation after 1 year. At first round chest digital tomosynthesis, 13 (0.7%) subjects had an indeterminate nodule larger than 5 mm and underwent low-dose CT scan for nodule confirmation. PET/CT study was obtained in 10 (0.5%) subjects and 2 subjects had a low-dose CT follow up. Surgery, either video-assisted thoracoscopic or open surgery for indeterminate pulmonary nodules was performed in 10 (0.2%) subjects. A lung cancer was diagnosed and resected in five patients. The lung cancer detection rate at first round was 0.3% (5/1,703). The detection rate of lung cancer at first round for tomosynthesis is comparable to rates reported for CT. In addition, results of first round digital chest tomosynthesis confirm chest tomosynthesis as a possible first-line lung cancer-screening tool.

  8. Primary and secondary patient data in contrast: the use of observational studies like RABBIT.

    Science.gov (United States)

    Richter, Adrian; Meißner, Yvette; Strangfeld, Anja; Zink, Angela

    2016-01-01

    The study of secondary patient data, particularly represented by claims data, has increased in recent years. The strength of this approach involves easy access to data that have been generated for administrative purposes. By contrast, collection of primary data for research is time-consuming and may therefore appear outdated. Both administrative data and data collected prospectively in clinical care can address similar research questions concerning effectiveness and safety of treatments. Therefore, why should we invest the precious time of rheumatologists to generate primary patient data? This article will outline some features of primary patient data collection illustrated by the German biologics register RABBIT (Rheumatoid arthritis: observation of biologic therapy). RABBIT is a long-term observational cohort study that was initiated more than 15 years ago. We will discuss as quality indicators: (i) study design, (ii) type of documentation, standardisation of (iii) clinical and (iv) safety data, (v) monitoring of the longitudinal follow-up, (vi) losses to follow-up as well as (vii) the possibilities to link the data base. The impact of these features on interpretation and validity of results is illustrated using recent publications. We conclude that high quality and completeness of data prospectively-collected offers many advantages over large quantities of non-standardised data collected in an unsupervised manner. We expect the enthusiasm about the use of secondary patient data to decline with more awareness of their methodological limitations while studies with primary patient data like RABBIT will maintain and broaden their impact on daily clinical practice.

  9. An update on psoriasis and metabolic syndrome: A meta-analysis of observational studies.

    Directory of Open Access Journals (Sweden)

    Sanminder Singh

    Full Text Available The relationship between psoriasis and metabolic syndrome is not well understood. Though multiple epidemiologic studies have suggested a link between psoriasis and metabolic syndrome, there is a lack of a comprehensive meta-analysis synthesizing the results of all available observational studies to date. In this meta-analysis, we examined global data on the relationship between psoriasis and odds of metabolic syndrome by searching for studies published between 1946-2016. Specifically, we analyzed the results from 35 observational studies from 20 countries with 1,450,188 total participants, of which 46,714 were psoriasis patients. The pooled odds ratio based on random effects analysis was 2.14 (95% CI 1.84-2.48. Publication bias was present, as evidenced by an Egger test and graphical visualization through a funnel plot (p = 0.001. Based on this comprehensive meta-analysis, psoriasis patients have higher odds of having metabolic syndrome when compared with the general population.

  10. The value of pragmatic and observational studies in health care and public health.

    Science.gov (United States)

    Barnish, Maxwell S; Turner, Steve

    2017-01-01

    Evidence-based practice is an important component of health care service delivery. However, there is a tendency, embodied in tools such as Grades of Recommendation, Assessment, Development, and Evaluation, to focus principally on the classification of study design, at the expense of a detailed assessment of the strengths and limitations of the individual study. Randomized controlled trials (RCTs), and in particular the classical "explanatory" RCT, have a privileged place in the hierarchy of evidence. However, classical RCTs have substantial limitations, most notably a lack of generalizability, which limit their direct applicability to clinical practice implementation. Pragmatic and observational studies can provide an invaluable perspective into real-world applicability. This evidence could be used more widely to complement ideal-condition results from classical RCTs, following the principle of triangulation. In this review article, we discuss several types of pragmatic and observational studies that could be used in this capacity. We discuss their particular strengths and how their limitations may be overcome and provide real-life examples by means of illustration.

  11. [Association between chronic periodontitis and hyperlipidemia: a Meta-analysis based on observational studies].

    Science.gov (United States)

    Lianhui, Yang; Meifei, Lian; Zhongyue, Hu; Yunzhi, Feng

    2017-08-01

    Objective The aim of this study is to evaluate the relationship between periodontitis and hyperlipidemia risks through Meta-analysis. Methods Two researchers conducted an electronic search on PubMed, Cochrane Library, Embase, CBM, CNKI, Wanfang and VIP databases established until July 2016 for observational studies on the association between periodontitis and hyperlipidemia. The language used was limited to Chinese and English. After data extraction and quality evaluation of included trials, Meta-analysis was conducted using the RevMan 5.3 software. The GRADE 3.6 software was used to evaluate the quality level of the evidence. Results Six case-control studies and one cohort study were included. The results of Meta-analysis showed that serum triglyceride (TG) in patients with periodontitis was significantly higher than that of the periodontal health group (MD=50.50, 95% confidence interval=39.57-61.42, Pchronic periodontitis were 4.73 times (OR=4.73, 95% confidence interval=2.74-8.17, Pperiodontal healthy patients. No significant difference was observed between the group with high-density lipoprotein cholesterol (HDL-C) and that with low density lipoprotein cholesterol (LDL-C). Conclusion Current evidence indicates that a correlation exists between chronic periodontitis and hyperlipidemia, and chronic periodontitis is an independent risk factor for hyperlipidemia, especially for TC and TG in serum.

  12. Firm handling; the information exchange interaction by parents in paediatric care – An observational study

    Directory of Open Access Journals (Sweden)

    Carina Berterö

    2011-01-01

    Full Text Available Background: Information exchange is fundamental in the paediatric care encounter. Health care professionals need further background knowledge to encounter the parents/guardians from their perspective in their minors’ paediatric care. The parents’/guardians’ ability to manage the situation is dependent on their receiving optimal information, which is why it is important to study how information is exchanged.Aim: The aim of this study was to identify, describe and conceptualize how parents/guardians resolved their main concern ininformation exchange with health care professionals in paediatric care situations involving their minors.Methodology: Glaser’s grounded theory method was used and all data were analysed using constant comparative analysis. The observational study took place at three paediatric outpatient units at a university hospital and 24 parents/guardians participated. Data sources were field notes from 37 observations of paediatric care situations and five adherent excerpts from the minors’ medical records. Grounded theory is a method of conceptualising behaviour, which is why an observational study of parents’/guardians’ information exchange and social interaction in the context of nursing care is relevant as research design.Results: Firm handling was revealed as the way the parents/guardians resolved their main concerns when they were exchanging information about their minors’ paediatric care. Firm handling is built on five inter-related categories: representative advocating, collaborating, aim sharing, supportive resourcing and minor bypassing.Conclusions: This knowledge suggests possible ways for health care professionals to design paediatric care that supports, facilitates, strengthens and improves the parents’/guardians’ firm handling. The key issue is to find ways to support parents/guardians and minors so they can participate in health care encounters according to their preferences. Firm handling gives an

  13. Identifying Opportunities for Peer Learning: An Observational Study of Medical Students on Clinical Placements.

    Science.gov (United States)

    Tai, Joanna H; Canny, Benedict J; Haines, Terry P; Molloy, Elizabeth K

    2017-01-01

    Phenomenon: Peer assisted learning (PAL) is frequently employed and researched in preclinical medical education. Fewer studies have examined PAL in the clinical context: These have focused mainly on the accuracy of peer assessment and potential benefits to learner communication and teamwork skills. Research has also examined the positive and negative effects of formal, structured PAL activities in the clinical setting. Given the prevalence of PAL activities during preclinical years, and the unstructured nature of clinical placements, it is likely that nonformal PAL activities are also undertaken. How PAL happens formally and informally and why students find PAL useful in this clinical setting remain poorly understood. This study aimed to describe PAL activities within the context of clinical placement learning and to explore students' perceptions of these activities. An ethnographic study was conducted to gather empirical data on engagement in clinical placement learning activities, including observations and interviews with students in their 1st clinical year, along with their supervising clinicians. Thematic analysis was used to interrogate the data. On average, students used PAL for 5.19 hours per week in a range of activities, of a total of 29.29 hours undertaking placements. PAL was recognized as a means of vicarious learning and had greater perceived value when an educator was present to guide or moderate the learning. Trust between students was seen as a requirement for PAL to be effective. Students found passive observation a barrier to PAL and were able to identify ways to adopt an active stance when observing peers interacting with patients. For example, learners reported that the expectation that they had to provide feedback to peers after task observation, resulted in them taking on a more critical gaze where they were encouraged to consider notions of good practice. Insights: Students use PAL in formal (i.e., tutorial) and nonformal (e.g., peer

  14. Infant-mother attachment can be improved through group intervention: a preliminary evaluation in Spain in a non-randomized controlled trial.

    Science.gov (United States)

    Torres, Bárbara; Alonso-Arbiol, Itziar; Cantero, María José; Abubakar, Amina

    2011-11-01

    The quality of infant-mother attachment has been linked to competence in different domains of child development. Research indicates that early intervention can enhance the quality of infant-mother attachment, though its efficacy in a group format has yet to be evaluated. The current study is aimed at examining the usefulness of a group intervention in enhancing infant-mother attachment. An intervention aimed at addressing aspects such as maternal responsivity, sensitivity and childrearing behaviour was developed by the researchers and experienced psychologists. The intervention spanned a period of 14 months starting from the third quarter of pregnancy. The intervention was evaluated among 24 mothers from the Basque region of Spain. The sample consisted of children of both genders in a similar proportion: 45.8% were boys and 54.2% were girls. The children in this sample were full-term born and did not present symptoms of any serious pre- or postnatal complications. The intervention had a statistically non-significant medium effect. Infants whose mothers had received the intervention showed higher rates of secure attachment compared to children from the control group, as assessed by the Strange Situation observation procedure. A potentially significant confounding variable, maternal attachment, was balanced across the intervention and comparison groups. We can tentatively point out that a group intervention may enhance the quality of infant-mother attachment. Nevertheless, because the study design was not randomized, the results of this study remain preliminary and need replication in a full randomized controlled trial designed study.

  15. Association between dietary nitrate and nitrite intake and sitespecific cancer risk: evidence from observational studies.

    Science.gov (United States)

    Xie, Li; Mo, Miao; Jia, Hui-Xun; Liang, Fei; Yuan, Jing; Zhu, Ji

    2016-08-30

    Epidemiological studies have reported inconsistent findings on the association between dietary nitrate and nitrite intake and cancer risk. We performed a meta-analysis of epidemiological studies to summarize available evidence on the association between dietary nitrate and nitrite intake and cancer risk from published prospective and case-control studies. PubMed database was searched to identify eligible publications through April 30th, 2016. Study-specific relative risks (RRs) with corresponding 95% confidence interval (CI) from individual studies were pooled by using random- or fixed- model, and heterogeneity and publication bias analyses were conducted. Data from 62 observational studies, 49 studies for nitrates and 51 studies for nitrites, including a total of 60,627 cancer cases were analyzed. Comparing the highest vs. lowest levels, dietary nitrate intake was inversely associated with gastric cancer risk (RR = 0.78; 95%CI = 0.67-0.91) with moderate heterogeneity (I2 = 42.3%). In contrast, dietary nitrite intake was positively associated with adult glioma and thyroid cancer risk with pooled RR of 1.21 (95%CI = 1.03-1.42) and 1.52 (95%CI = 1.12-2.05), respectively. No significant associations were found between dietary nitrate/nitrite and cancers of the breast, bladder, colorectal, esophagus, renal cell, non-Hodgkin lymphoma, ovarian, and pancreas. The present meta-analysis provided modest evidence that positive associations of dietary nitrate and negative associations of dietary nitrite with certain cancers.

  16. JAKE® Multimodal Data Capture System: Insights from an Observational Study of Autism Spectrum Disorder.

    Science.gov (United States)

    Ness, Seth L; Manyakov, Nikolay V; Bangerter, Abigail; Lewin, David; Jagannatha, Shyla; Boice, Matthew; Skalkin, Andrew; Dawson, Geraldine; Janvier, Yvette M; Goodwin, Matthew S; Hendren, Robert; Leventhal, Bennett; Shic, Frederick; Cioccia, Walter; Pandina, Gahan

    2017-01-01

    Objective: To test usability and optimize the Janssen Autism Knowledge Engine (JAKE®) system's components, biosensors, and procedures used for objective measurement of core and associated symptoms of autism spectrum disorder (ASD) in clinical trials. Methods: A prospective, observational study of 29 children and adolescents with ASD using the JAKE system was conducted at three sites in the United States. This study was designed to establish the feasibility of the JAKE system and to learn practical aspects of its implementation. In addition to information collected by web and mobile components, wearable biosensor data were collected both continuously in natural settings and periodically during a battery of experimental tasks administered in laboratory settings. This study is registered at clinicaltrials.gov, NCT02299700. Results: Feedback collected throughout the study allowed future refinements to be planned for all components of the system. The Autism Behavior Inventory (ABI), a parent-reported measure of ASD core and associated symptoms, performed well. Among biosensors studied, the eye-tracker, sleep monitor, and electrocardiogram were shown to capture high quality data, whereas wireless electroencephalography was difficult to use due to its form factor. On an exit survey, the majority of parents rated their overall reaction to JAKE as positive/very positive. No significant device-related events were reported in the study. Conclusion: The results of this study, with the described changes, demonstrate that the JAKE system is a viable, useful, and safe platform for use in clinical trials of ASD, justifying larger validation and deployment studies of the optimized system.

  17. Virtual study groups and online Observed Structured Clinical Examinations practices - enabling trainees to enable themselves.

    Science.gov (United States)

    Davidson, Dennisa; Evans, Lois

    2018-03-01

    To explore online study groups as augmentation tools in preparing for the Royal Australian and New Zealand College of Psychiatrists Observed Structured Clinical Examinations (OSCE) for fellowship. An online survey of New Zealand trainees was carried out to assess exam preparedness and openness to virtual study groups and results analysed. Relevant material around virtual study groups for fellowship examinations was reviewed and used to inform a pilot virtual study group. Four New Zealand trainees took part in the pilot project, looking at using a virtual platform to augment OSCE preparation. Of the 50 respondents 36% felt adequately prepared for the OSCE. Sixty-four per cent were interested in using a virtual platform to augment their study. Virtual study groups were noted to be especially important for rural trainees, none of whom felt able to form study groups for themselves. The pilot virtual study group was trialled successfully. All four trainees reported the experience as subjectively beneficial to their examination preparation. Virtual platforms hold promise as an augmentation strategy for exam preparation, especially for rural trainees who are more geographically isolated and less likely to have peers preparing for the same examinations.

  18. A multievent study of broadband electrons observed by the DMSP satellites and their relation to red aurora observed at midlatitude stations

    International Nuclear Information System (INIS)

    Shiokawa, K.; Meng, C.; Reeves, G.D.; Rich, F.J.; Yumoto, K.

    1997-01-01

    Broadband electrons during magnetic storms are characterized by an unusually intense flux of precipitating electrons in the broadband energy range from 30 eV to 30 keV near the equatorward edge of the auroral oval (47 degree endash 66 degree magnetic latitude). Broadband electrons were first reported by Shiokawa et al. [1996]. In this paper, we report a multievent study of broadband electrons, using particle data obtained by the Defense Meteorological Satellite Program (DMSP) satellites during 23 magnetic storms from January 1989 through May 1992. Twelve broadband electron events are identified. Most of them are observed in the night sector, but some are observed in the morning sector. Particle data for successive polar passes of the DMSP multisatellites are used to show that broadband electrons generally last for less than 30 min and that for some events, they precipitate over a wide range of local times simultaneously. On the basis of a quantitative calculation of optical emissions from electrons in the neutral atmosphere, we conclude that broadband electrons are a possible cause of red auroras observed at midlatitude ground stations. We suggest that broadband electrons are associated with certain substorms during the main phase of magnetic storms. This conjecture comes from observations of H component positive bays and Pi 2 pulsations observed at low-latitude magnetic stations and from magnetic field variations observed at geosynchronous satellites. We conclude that the magnetospheric source of broadband electrons lies within the inner part of the plasma sheet. This conclusion is based on the facts that broadband electrons appear in latitudes where plasma sheet particles were observed before the event and that broadband electrons are observed poleward of the subauroral ion drifts, a position that corresponds to the inner edge of the injected particle layer during storms. (Abstract Truncated)

  19. Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology—Veterinary (STROBE-Vet) Statement

    DEFF Research Database (Denmark)

    Sargeant, J. M.; O'Connor, A. M.; Dohoo, I. R.

    2016-01-01

    Reporting of observational studies in veterinary research presents challenges that often are not addressed in published reporting guidelines. Our objective was to develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses...... unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety. We conducted a consensus meeting with 17 experts in Mississauga, Canada. Experts completed a premeeting survey about whether items in the STROBE statement should...... should improve reporting of observational studies in veterinary research by recognizing unique features of observational studies involving food-producing and companion animals, products of animal origin, aquaculture, and wildlife....

  20. Predictors for early introduction of solid food among Danish mothers and infants: an observational study

    DEFF Research Database (Denmark)

    Kronborg, Hanne; Foverskov, Else; Væth, Michael

    2014-01-01

    introduced to solid food. Full breastfeeding at five weeks was the most influential predictor for later introduction of solid food (OR = 2.52 CI: 1.93-3.28). Among infant factors male gender, increased gestational age at birth, and higher birth weight were found to be statistically significant predictors......BACKGROUND: Early introduction of complementary feeding may interfere with breastfeeding and the infant's self-controlled appetite resulting in increased growth. The aim of the present study was to investigate predictors for early introduction of solid food. METHODS: In an observational study...... Danish mothers filled in a self-administered questionnaire approximately six months after birth. The questionnaire included questions about factors related to the infant, the mother, attachment and feeding known to influence time for introduction of solid food. The study population consisted of 4503...

  1. Ethical issues for radiographers: General observations and a pilot qualitative study

    International Nuclear Information System (INIS)

    Gruppetta, E.

    2009-01-01

    This paper is based on general observation arising from many years experience in managing and delivering radiography services in the health service. In addition, it presents the results of a pilot qualitative study based on unstructured interviews. The interviews were undertaken with a view to identifying the reasons for radiography that may not be well justified. The study was undertaken in the public and private sectors and many of the reasons are shared by both. The reasons for poor justification include: inadequate radiation protection education for referrers; avoidance of medical litigation; defensive medicine attitude by referrers and, in the private sector, pursuit of profit. The study provides a starting point for further more quantitative investigations that are clearly required in the area. (authors)

  2. A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study

    DEFF Research Database (Denmark)

    Kasch, Helge; Kongsted, Alice; Qerama, Erisela

    2013-01-01

    OBJECTIVES: An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. DESIGN: The design was an observational prospective study of risk factors embedded in a randomised controlled study. SETTING: Acute whiplash...... patients from units, general practitioners in four Danish counties were referred to two research centres. PARTICIPANTS: During a 2-year inclusion period, acute consecutive whiplash-injured (age 18-70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I-III, symptoms...... and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability. RESULTS: The risk score...

  3. Predictors of switching from mania to depression in a large observational study across Europe (EMBLEM).

    Science.gov (United States)

    Vieta, Eduard; Angst, Jules; Reed, Catherine; Bertsch, Jordan; Haro, Josep Maria

    2009-11-01

    The risk of switching from mania to depression in bipolar disorder has been poorly studied. Large observational studies may be useful in identifying variables that predict switch to depression after mania and provide data on medication use and outcomes in "real world" patients. EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) is a 2-year, prospective, observational study of patients with a manic/mixed episode. Symptom severity measures included Clinical Global Impression-Bipolar Disorder scale (CGI-BP), Young Mania Rating Scale (YMRS) and 5-item Hamilton Depression Rating Scale. Switching was defined using CGI-BP mania and depression such that patients changed from manic and not depressed to depressed but not manic over two consecutive observations within the first 12 weeks of follow-up. Cox proportional hazards models identified baseline variables independently associated with switch to depression. Of 2390 patients who participated in the maintenance phase (i.e. up to 24 months), 120 (5.0%) switched to depression within the first 12 weeks. Factors associated with greater switching to depression include previous depressive episodes, substance abuse, greater CGI-BP overall severity and benzodiazepine use. Factors associated with lower switching rates were greater CGI-BP depression, lower YMRS severity and atypical antipsychotic use. The definition of switching biased against patients with mixed episodes being likely to switch. Strictly defined, switch to depression from mania occurs in a small proportion of bipolar patients. Clinical history, illness severity, co-morbidities and treatment patterns are associated with switching to depression. Atypical antipsychotics may protect against switch to depression.

  4. Afterglow Population Studies from Swift Follow-Up Observations of Fermi LAT GRBs

    Science.gov (United States)

    Racusin, Judith L.; Oates, S. R.; McEnery, J.; Vasileiou, V.; Troja, E.; Gehrels, N.

    2010-01-01

    The small population of Fermi LAT detected GRBs discovered over the last year has been providing interesting and unexpected clues into GRB prompt and afterglow emission mechanisms. Over the last 5 years, it has been Swift that has provided the robust data set of UV/optical and X-ray afterglow observations that opened many windows into other components of GRB emission structure. We explore the new ability to utilize both of these observatories to study the same GRBs over 10 orders of magnitude in energy, although not always concurrently. Almost all LAT GRBs that have been followed-up by Swift within 1-day have been clearly detected and carefully observed. We will present the context of the lower-energy afterglows of this special subset of GRBs that has > 100 MeV emission compared to the hundreds in the Swift database that may or may not have been observed by LAT, and theorize upon the relationship between these properties and the origin of the high energy gamma-ray emission.

  5. The impact of documentation on communication during patient-physiotherapist interactions: A qualitative observational study.

    Science.gov (United States)

    Schoeb, Veronika; Hiller, Amy

    2018-01-31

    Documentation is an essential component of physiotherapy practice for clinical, legal, and ethical reasons. Research in other healthcare contexts suggests that documentation impacts upon communication in patient-practitioner interactions. Thus, the objective of this qualitative study was to examine how physiotherapists and their patients communicate during episodes of documentation. The research was informed by ethnomethodology and ethnography. In total, 113 patient-physiotherapist interactions were observed in Switzerland and Australia with video-recordings, audio-recordings, and field notes collected as data. Episodes of documentation within these interactions were transcribed, and both verbal and non-verbal communication were analyzed inductively. Analysis identified that communication during documentation was characterized by: pauses in conversation, pre-established order of questioning, minimal eye contact, use of direct communication, and an emphasis on objectivity. The use of documentation was observed to alter the wording of questioning as well as the sequence and flow of conversation between patient and physiotherapist. In addition, the observed communicative features seemed to restrict patient participation, and may hinder the achievement of a patient-centered approach. Recognizing the importance of documentation, we address the challenges that our research highlighted by proposing strategies to assist educators and clinicians to optimize communication with patients when incorporating documentation into practice.

  6. Full Polarimetric Synthetic Aperture Radar (SAR) Data for ionosphere observation - A comparative study

    Science.gov (United States)

    Mohanty, S.; Singh, G.

    2017-12-01

    Ionosphere, predominantly, govern the propagation of radio waves, especially at L-band and lower frequencies. Small-scale, rapid fluctuations in the electron density, termed as scintillation phenomenon, cause rapid variations in signal amplitude and phase. Scintillation studies have been done using ground-based radio transmitter and beacon GPS signals. In this work, attempt has been made to utilize full polarimetric synthetic aperture radar (SAR) satellite signal at L-band (1.27 GHz) to develop a new measurement index for SAR signal intensity fluctuation. Datasets acquired from Japan's latest Advanced Land Observation Satellite (ALOS)-2 over the Indian subcontinent on two different dates, with varying ionospheric activities, have been utilized to compare the index. A 20% increase in the index values for a scintillation-affected day has been observed. The result coincides with the nature of ionospheric scintillation pattern typically observed over the equatorial belt. Total electron content values, for the two dates of acquisition, obtained from freely available Ionosphere Exchange (IONEX) data have been used to validate the varying ionospheric activities as well as the trend in index results. Another interesting finding of the paper is the demarcation of the equatorial anomaly belt. The index values are comparatively higher at these latitudes on a scintillation-affected day. Furthermore, the SAR signal intensity fluctuation index has great potential in being used as a preliminary measurement index to identify low frequency SAR data affected by ionospheric scintillation.

  7. Study of ionospheric disturbances over the China mid- and low-latitude region with GPS observations

    Science.gov (United States)

    Ning, Yafei; Tang, Jun

    2018-01-01

    Ionospheric disturbances constitute the main restriction factor for precise positioning techniques based on global positioning system (GPS) measurements. Simultaneously, GPS observations are widely used to determine ionospheric disturbances with total electron content (TEC). In this paper, we present an analysis of ionospheric disturbances over China mid- and low-latitude area before and during the magnetic storm on 17 March 2015. The work analyses the variation of magnetic indices, the amplitude of ionospheric irregularities observed with four arrays of GPS stations and the influence of geomagnetic storm on GPS positioning. The results show that significant ionospheric TEC disturbances occurred between 10:30 and 12:00 UT during the main phase of the large storm, and the static position reliability for this period are little affected by these disturbances. It is observed that the positive and negative disturbances propagate southward along the meridian from mid-latitude to low-latitude regions. The propagation velocity is from about 200 to 700 m s-1 and the amplitude of ionospheric disturbances is from about 0.2 to 0.9 TECU min-1. Moreover, the position dilution of precession (PDOP) with static precise point positioning (PPP) on storm and quiet days is 1.8 and 0.9 cm, respectively. This study is based on the analysis of ionospheric variability with differential rate of vertical TEC (DROVT) and impact of ionospheric storm on positioning with technique of GPS PPP.

  8. Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists' Observable Behaviors.

    Science.gov (United States)

    Sotero, Luciana; Cunha, Diana; da Silva, José Tomás; Escudero, Valentín; Relvas, Ana Paula

    2017-12-01

    This study aimed to compare therapists' observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists' contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients' engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists' alliance-building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research. © 2016 Family Process Institute.

  9. The role of the observational approach in RI planning: WAG 5 case study

    International Nuclear Information System (INIS)

    Brill, A.K.; Kuhaida, A.J. Jr.

    1992-10-01

    A Remedial Investigation (RI) Plan was developed for the Oak Ridge National Laboratory (ORNL) Waste Area Grouping (WAG) 5 in March 1988 and submitted to the Environmental Protection Agency (EPA) Region IV and the State of Tennessee for review and approval. The observational approach was evaluated by the ORNL Environmental Restoration (ER) Program and accepted by EPA as an accelerated and cost-effective approach to the RI/Feasibility Study (FS) process for remediation of WAG 5. The traditional approach used in preparing the 1988 RI Plan focused on data completeness, included a typical range of RI data-gathering activities for determining the nature and extent of contamination at WAG 5, and used multiple iterations of sampling activities to deal with uncertainties without consideration of potential deviations. In fall 1991, a revised Field Sampling Plan (FSP) was developed that used the observational approach to integrate site characterization with site remediation needs. This approach recognized the uncertainties of site characterization/remedial planning and developed contingency plans for dealing with them. The observational approach emphasizes data sufficiency to support remedial planning decisions for WAG 5

  10. World Health Organization Member States and Open Health Data: An Observational Study

    Directory of Open Access Journals (Sweden)

    Charles J Greenberg

    2016-09-01

    Full Text Available Background Open health data has implications for clinical care, research, public health, and health policy at regional, national, and global levels. No published attempts have been made to determine, collectively, whether WHO member states and governments have embraced the promise and effort required to officially share open health data. The observational study will provide evidence that World Health Organization (WHO member states individually and collectively have adopted open data recommended principles, providing access to open health data. Methods Using the WHO list of member states (n=194, the researchers identified the presence of open health data or initiatives. With each country, the following types of official government web pages were recorded: a Ministry of Health web page; a conspicuous link on a government web page to open health data; additional government health web sites; national government-sponsored open data repositories; unique attributes of national health data web sites; and adherence to the principles of open government data for health. A supplemental PDF file provides a representation of data used for analysis and observations. Our complete data is available at: https://goo.gl/Kwj7mb Observations and Discussion Open health data is easily discoverable in less than one-third of the WHO member states. 13 nations demonstrate the principle to provide comprehensive open data. Only 16 nations distribute primary, non-aggregated health data. 24 % of the WHO observed member states are providing some health data in a non-proprietary formats such as comma-separated values. The sixth, seventh, and eighth open government data principles for health, representing universal access, non-proprietary formats, and non-patent protection, are observed in about one-third of the WHO member states. While there are examples of organized national open health data, no more than a one-third minority of the world’s nations have portals set up to

  11. Fathers' Representation in Observational Studies on Parenting and Childhood Obesity: A Systematic Review and Content Analysis.

    Science.gov (United States)

    Davison, Kirsten K; Gicevic, Selma; Aftosmes-Tobio, Alyssa; Ganter, Claudia; Simon, Christine L; Newlan, Sami; Manganello, Jennifer A

    2016-11-01

    The involvement of fathers in caregiving has increased substantially over the past 30 years. Yet in child and adolescent psychopathology, few studies include fathers as research participants and few present results for fathers separate from those for mothers. We test for the first time whether a similar pattern exists in research on parenting and childhood obesity. To conduct a systematic review and quantitative content analysis of observational studies on parenting and childhood obesity to (1) document the inclusion of fathers, relative to mothers, as research participants and (2) examine characteristics of studies that did and did not include fathers. This study presents new data on the number and gender of parent research participants. We searched title, abstract, and Medical Subject Headings term fields in 5 research databases (PubMed, EMBASE, Academic Search Premier, PsycINFO, and CINAHL) using terms combining parents or parenting (e.g., mother, father, caregiver, parenting style, food parenting) and obesity (e.g., obesity, body weight, overweight) or obesity-related lifestyle behaviors (e.g., diet, snacking, physical activity, outdoor play, exercise, media use). We identified and screened studies as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) published between January 2009 and December 2015, examining links between parenting and childhood obesity, including parents or caregivers as research participants, and written in English. We excluded interventions, nonhuman studies, dissertations, conference abstracts, and studies on youths with specific medical conditions. Of 5557 unique studies, 667 studies were eligible. For each of the 667 studies, 4 coders were trained to code characteristics of the study (e.g., publication year, geographic region, journal, study focus) and parent research participants (e.g., parent gender, demographic background, biological relationship with child, and residential status). We established

  12. Evaluation of team lifting on work demands, workload and workers' evaluation: an observational field study.

    Science.gov (United States)

    Visser, Steven; van der Molen, Henk F; Kuijer, P Paul F M; Hoozemans, Marco J M; Frings-Dresen, Monique H W

    2014-11-01

    The objective of this study was to assess differences in work demands, energetic workload and workers' discomfort and physical effort in two regularly observable workdays in ironwork; one where loads up to 50kg were handled with two persons manually (T50) and one where loads up to 100kg were handled manually with four persons (T100). Differences between these typical workdays were assessed with an observational within-subject field study of 10 ironworkers. No significant differences were found for work demands, energetic workload or discomfort between T50 and T100 workdays. During team lifts, load mass exceeded 25kg per person in 57% (T50 workday) and 68% (T100 workday) of the lifts. Seven ironworkers rated team lifting with two persons as less physically demanding compared with lifting with four persons. When loads heavier than 25kg are lifted manually with a team, regulations of the maximum mass weight are frequently violated. Loads heavier than 25