Large observer variation of clinical assessment of dyspnoeic wheezing children.

Science.gov (United States)

Bekhof, Jolita; Reimink, Roelien; Bartels, Ine-Marije; Eggink, Hendriekje; Brand, Paul L P

2015-07-01

In children with acute dyspnoea, the assessment of severity of dyspnoea and response to treatment is often performed by different professionals, implying that knowledge of the interobserver variation of this clinical assessment is important. To determine intraobserver and interobserver variation in clinical assessment of children with dyspnoea. From September 2009 to September 2010, we recorded a convenience sample of 27 acutely wheezing children (aged 3 months-7 years) in the emergency department of a general teaching hospital in the Netherlands, on video before and after treatment with inhaled bronchodilators. These video recordings were independently assessed by nine observers scoring wheeze, prolonged expiratory phase, retractions, nasal flaring and a general assessment of dyspnoea on a Likert scale (0-10). Assessment was repeated after 2 weeks to evaluate intraobserver variation. We analysed 972 observations. Intraobserver reliability was the highest for supraclavicular retractions (κ 0.84) and moderate-to-substantial for other items (κ 0.49-0.65). Interobserver reliability was considerably worse, with κ3 points) was larger than the minimal important change (meaning that in 69% of observations a clinically important change after treatment cannot be distinguished from measurement error. Intraobserver variation is modest, and interobserver variation is large for most clinical findings in children with dyspnoea. The measurement error induced by this variation is too large to distinguish potentially clinically relevant changes in dyspnoea after treatment in two-thirds of observations. The poor interobserver reliability of clinical dyspnoea assessment in children limits its usefulness in clinical practice and research, and highlights the need to use more objective measurements in these patients. 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.

[Clinical research XVII. χ(2) test, from the expected to the observed].

Science.gov (United States)

Rivas-Ruiz, Rodolfo; Castelán-Martínez, Osvaldo D; Pérez, Marcela; Talavera, Juan O

2013-01-01

When you want to show if there is a statistical association or differences between categorical variables, it is recommended to use the χ(2) test. This nonparametric test is one of the most used in clinical research; it contrasts nominal or ordinal qualitative variables that are observed in clinical practice. This test calculates the p value that determines whether differences between groups are real or due to chance. The χ(2) test is the basis of other tests to analyze qualitative ordinal variables as χ(2) for linear trend, which compares three groups with two outcomes or McNemar test, which contrasts two related samples (a before and afterward comparison) or Mantel-Haenszel χ(2), which controls for potential confounding variables. When using small samples, where the expected results are less than 5, Fisher's exact test should be used. These tests are the most widely used in the medical literature; however, they do not give us the magnitude or the direction of the event and a proper interpretation that requires clinical judgment is needed.

Clinical observation on individualized therapy for dry eye

Directory of Open Access Journals (Sweden)

Jing Tang

2013-05-01

Full Text Available AIM:To evaluate the efficacy of individualized therapy on dry eye induced by different reasons. METHODS: Totally 140 cases(140 eyesof dry eye were divided into three categories according to eye symptoms. First category: 60 cases(60 eyeswith meibomian gland dysfunction(MGDwere divided into A1 group(palpebralis margin treatment groupand B1 group(control group; Second category: 50 cases(50 eyeswith corneal epithelium damage(corneal fluorescence staining FL Score≥5were divided into A2 group(bandage contact lens groupand B2 group(control group; Third category: 30 cases(30 eyeswith low Schirmer test(Schirmer Ⅰ≤5mmwere divided into A3 group(lacrimal punctum plug groupand B3 group(control group. Both former categories treated by 1g/L fluorometholone eye drops and 1g/L hyaluronate sodium eye drops, but received limbus palpebralis cleaning, oral doxycycline in A1 group and bandage contact lens in A2 group else. The third category was treated by 10g/L cyclosporine A and carbomer eye gel, but lacrimal punctum plug in A3 group before received the drug treatment. Two weeks follow up, each case was examined by subjective symptom, cornea fluorescence colouration test, tear break-up time(BUT, and Schirmer test Ⅰ(SⅠtin the treatment groups(A1,A2,A3and the control groups(B1,B2,B3, the results pre- and post-treatment were compared. The t test was used for inferential statistics. RESULTS: There was no statistical difference between treatment groups(A1, A2, A3and control groups(B1, B2, B3before treatment. Two weeks after treatment, there was statistical difference between the treatment groups(A1, A2, A3and control groups(B1, B2, B3in subjective symptoms and BUT. The difference among A3 group(lacrimal punctum plug group, in which the lacrimal river line formed were observed 2 weeks after treatmentand B3 (control groupwas statistically significant in SⅠt. CONCLUSION:On base of anti-inflammatory and use of artificial tears, individualized therapy is an

Observation for clinical effect of phellodendron wet compress in treating the phlebitis caused by infusion.

Science.gov (United States)

Wan, Ying

2018-05-01

Aim of the study was to observe and analyze the clinical effect of phellodendron wet compress in treating the phlebitis caused by infusion. The research objects were 600 cases of phlebitis caused by infusion, all of which were treated in our hospital from June 2013 to June 2016. All patients were entitled to the right to know. They were randomly divided into the research group and the control group. Patients in the control group were treated with magnesium sulfate solution wet compress, while patients in the research group were treated with phellodendron wet compress. The effects in these two groups were observed and compared. Compared with the control group, the research group has better overall treatment efficiency, pred swelling and pain, p<0.05. Phellodendron wet compress shows a beneficial effect in treating the phlebitis caused by infusion. It can not only obviously shorten the onset of action, but also level up the overall treatment efficiency that helps patients to recover.

Accuracy of clinical observations of push-off during gait after stroke.

Science.gov (United States)

McGinley, Jennifer L; Morris, Meg E; Greenwood, Ken M; Goldie, Patricia A; Olney, Sandra J

2006-06-01

To determine the accuracy (criterion-related validity) of real-time clinical observations of push-off in gait after stroke. Criterion-related validity study of gait observations. Rehabilitation hospital in Australia. Eleven participants with stroke and 8 treating physical therapists. Not applicable. Pearson product-moment correlation between physical therapists' observations of push-off during gait and criterion measures of peak ankle power generation from a 3-dimensional motion analysis system. A high correlation was obtained between the observational ratings and the measurements of peak ankle power generation (Pearson r =.98). The standard error of estimation of ankle power generation was .32W/kg. Physical therapists can make accurate real-time clinical observations of push-off during gait following stroke.

Validation of Clinical Observations of Mastication in Persons with ALS.

Science.gov (United States)

Simione, Meg; Wilson, Erin M; Yunusova, Yana; Green, Jordan R

2016-06-01

Amyotrophic lateral sclerosis (ALS) is a progressive neurological disease that can result in difficulties with mastication leading to malnutrition, choking or aspiration, and reduced quality of life. When evaluating mastication, clinicians primarily observe spatial and temporal aspects of jaw motion. The reliability and validity of clinical observations for detecting jaw movement abnormalities is unknown. The purpose of this study is to determine the reliability and validity of clinician-based ratings of chewing performance in neuro-typical controls and persons with varying degrees of chewing impairments due to ALS. Adults chewed a solid food consistency while full-face video were recorded along with jaw kinematic data using a 3D optical motion capture system. Five experienced speech-language pathologists watched the videos and rated the spatial and temporal aspects of chewing performance. The jaw kinematic data served as the gold-standard for validating the clinicians' ratings. Results showed that the clinician-based rating of temporal aspects of chewing performance had strong inter-rater reliability and correlated well with comparable kinematic measures. In contrast, the reliability of rating the spatial and spatiotemporal aspects of chewing (i.e., range of motion of the jaw, consistency of the chewing pattern) was mixed. Specifically, ratings of range of motion were at best only moderately reliable. Ratings of chewing movement consistency were reliable but only weakly correlated with comparable measures of jaw kinematics. These findings suggest that clinician ratings of temporal aspects of chewing are appropriate for clinical use, whereas ratings of the spatial and spatiotemporal aspects of chewing may not be reliable or valid.

Bumpless Transfer between Observer-based Gain Scheduled Controllers

DEFF Research Database (Denmark)

Bendtsen, Jan Dimon; Stoustrup, Jakob; Trangbæk, Klaus

2005-01-01

This paper deals with bumpless transfer between a number of observer-based controllers in a gain scheduling architecture. Linear observer-based controllers are designed for a number of linear approximations of a nonlinear system in a set of operating points, and gain scheduling control can...

Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study.

Science.gov (United States)

Comin, Eva; Catalan-Ramos, Arantxa; Iglesias-Rodal, Manuel; Grau, Maria; Del Val, Jose Luis; Consola, Alicia; Amado, Ester; Pons, Angels; Mata-Cases, Manel; Franzi, Alicia; Ciurana, Ramon; Frigola, Eva; Cos, Xavier; Davins, Josep; Verdu-Rotellar, Jose M

To evaluate the impact of computerized clinical practice guidelines on the management, diagnosis, treatment, control, and follow-up of the main cardiovascular risk factors: hypertension, hypercholesterolaemia, and type 2 diabetes mellitus. Pre-post controlled study. Catalonia, autonomous community located in north-eastern Spain. Individuals aged 35-74 years assigned to general practitioners of the Catalan Health Institute. The intervention group consisted of individuals whose general practitioners had accessed the computerized clinical practice guidelines at least twice a day, while the control group consisted of individuals whose general practitioner had never accessed the computerized clinical practice guidelines platform. The Chi-squared test was used to detect significant differences in the follow-up, control, and treatment variables for all three disorders (hypertension, hypercholesterolaemia, and type 2 diabetes mellitus) between individuals assigned to users and non-users of the computerized clinical practice guidelines, respectively. A total of 189,067 patients were included in this study, with a mean age of 56 years (standard deviation 12), and 55.5% of whom were women. Significant differences were observed in hypertension management, treatment and control; type 2 diabetes mellitus management, treatment and diagnoses, and the management and control of hypercholesterolaemia in both sexes. Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Observable phenomena that reveal medical students' clinical reasoning ability during expert assessment of their history taking: a qualitative study.

Science.gov (United States)

Haring, Catharina M; Cools, Bernadette M; van Gurp, Petra J M; van der Meer, Jos W M; Postma, Cornelis T

2017-08-29

During their clerkships, medical students are meant to expand their clinical reasoning skills during their patient encounters. Observation of these encounters could reveal important information on the students' clinical reasoning abilities, especially during history taking. A grounded theory approach was used to analyze what expert physicians apply as indicators in their assessment of medical students' diagnostic reasoning abilities during history taking. Twelve randomly selected clinical encounter recordings of students at the end of the internal medicine clerkships were observed by six expert assessors, who were prompted to formulate their assessment criteria in a think-aloud procedure. These formulations were then analyzed to identify the common denominators and leading principles. The main indicators of clinical reasoning ability were abstracted from students' observable acts during history taking in the encounter. These were: taking control, recognizing and responding to relevant information, specifying symptoms, asking specific questions that point to pathophysiological thinking, placing questions in a logical order, checking agreement with patients, summarizing and body language. In addition, patients' acts and the course, result and efficiency of the conversation were identified as indicators of clinical reasoning, whereas context, using self as a reference, and emotion/feelings were identified by the clinicians as variables in their assessment of clinical reasoning. In observing and assessing clinical reasoning during history taking by medical students, general and specific phenomena to be used as indicators for this process could be identified. These phenomena can be traced back to theories on the development and the process of clinical reasoning.

Introduction to geometric nonlinear control; Linearization, observability, decoupling

Energy Technology Data Exchange (ETDEWEB)

Respondek, W [Laboratoire de Mathematiques, INSA de Rouen (France)

2002-07-15

These notes are devoted to the problems of linearization, observability, and decoupling of nonlinear control systems. Together with notes of Bronislaw Jakubczyk in the same volume, they form an introduction to geometric methods in nonlinear control theory. In the first part we discuss equivalence of control systems. We consider various aspects of the problem: state-space and feedback equivalence, local and global equivalence, equivalence to linear and partially linear systems. In the second part we present the notion of observability and give a geometric rank condition for local observability and an algebraic characterization of local observability. We discuss unm observability, decompositions of non-observable systems, and properties of generic observable systems. In the third part we introduce the notion of invariant distributions and discuss disturbance decoupling and input-output decoupling. Many concepts and results are illustrated with examples. (author)

Effectiveness and Persistence with Liraglutide Among Patients with Type 2 Diabetes in Routine Clinical Practice--EVIDENCE: A Prospective, 2-Year Follow-Up, Observational, Post-Marketing Study.

Science.gov (United States)

Gautier, Jean-Francois; Martinez, Luc; Penfornis, Alfred; Eschwège, Eveline; Charpentier, Guillaume; Huret, Benoît; Madani, Suliya; Gourdy, Pierre

2015-09-01

The aim of this study was to investigate whether the efficacy of liraglutide observed in randomized controlled trials translates into therapeutic benefits in the French population during routine clinical practice. This observational, prospective, multicenter study included 3152 adults with type 2 diabetes who had recently started or were about to start liraglutide treatment. During 2 years of follow-up, an evaluation of the reasons for prescribing liraglutide, maintenance dose of liraglutide, changes in combined antidiabetic treatments, level of glycemic control, change in body weight and body mass index (BMI), patient satisfaction with diabetes treatment and safety of liraglutide were investigated. The primary study endpoint was the proportion of patients still receiving liraglutide and presenting with HbA1c effectiveness of liraglutide in real-world clinical practice is similar to that observed in randomized controlled trials. Novo Nordisk A/S. ClinicalTrials.gov identifier, NCT01226966.

Effectiveness and safety of exenatide in Korean patients with type 2 diabetes inadequately controlled with oral hypoglycemic agents: an observational study in a real clinical practice.

Science.gov (United States)

Hwang, You-Cheol; Kim, Ari; Jo, Euna; Yang, Yeoree; Cho, Jae-Hyoung; Lee, Byung-Wan

2017-10-25

Randomized clinical trials have shown the efficacy and safety of short-acting exenatide in patients with type 2 diabetes mellitus (T2DM). The aim of this observational study was to investigate the effectiveness and safety of exenatide twice a day in Korean patients with T2DM who are suboptimally controlled with oral hypoglycemic agents. This study was a post hoc analysis of multi-center (71 centers), prospective, observational, single-arm, post-marketing study of short-acting exenatide 5 to 10 μg twice a day from March 2008 to March 2014 and analyzed those who finished the follow-up over 20 weeks of medication. Changes of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and body weight values before and after exenatide treatment were analyzed. Adverse events and adverse drug reactions were estimated in patients who were treated with exenatide at least once and for whom follow-up for safety has been completed. After 20 weeks treatment with exenatide, mean HbA1c and body weight were significantly reduced from 8.4% to 7.7% and from 83.4 kg to 80.2 kg, respectively (both p levels showed an independent association with a greater reduction in glucose level. In addition, short duration of diabetes less than 5 years was an independent predictor for the improvement in glucose level. The majority of study subjects showed a reduction in both body weight and glucose level (63.3%) after exenatide treatment. In terms of safety profile, exenatide treatment was generally well-tolerated and the incidence of severe adverse event was rare (0.8%). The gastrointestinal side effects were most common and hypoglycemia was reported in 1.7% of subjects. In real clinical practice, 20 weeks treatment with short-acting exenatide was well tolerated and showed a significant body weight and glucose reduction in Korean patients with T2D who are suboptimally controlled with oral hypoglycemic agents. ClinicalTirals.gov , number NCT02090673 , registered 14 February 2008.

Quality control of radiation therapy in clinical trials

International Nuclear Information System (INIS)

Kramer, S.; Lustig, R.; Grundy, G.

1983-01-01

The RTOG is a group of participating institutions which has a major interest in furthering clinical radiation oncology. They have formulated protocols for clinical investigation in which radiation therapy is the major modality of treatment. In addition, other modalities, such as chemotherapy, radiation sensitizers, and hyperthermia, are used in combined approach to cancer. Quality control in all aspects of patient management is necessary to insure quality data. These areas include evaluation of pathology, physics, and dosimetry, and clinical patient data. Quality control is both time consuming and expensive. However, by dividing these tasks into various levels and time frames, by using computerized data-control mechanisms, and by employing appropriate levels of ancillary personnel expertise, quality control can improve compliance and decrease the cost of investigational trials

[Clinical efficacy observation of acupuncture at suliao (GV 25) on improving regain of consciousness from coma in severe craniocerebral injury].

Science.gov (United States)

Xu, Kai-Sheng; Song, Jian-Hua; Huang, Tiao-Hua; Huang, Zhi-Hua; Yu, Lu-Chang; Zheng, Wei-Ping; Chen, Xiao-Shan; Liu, Chuan

2014-06-01

To compare the clinical therapeutic effects differences between acupuncture at Suliao (GV 25) and Shuigou (GV 26) on promoting regain of consciousness from coma in severe craniocerebral injury. Based on regular emergency treatments of neurosurgery, eighty-two cases of craniocerebral injury who were under stable condition were randomly divided into an observation group (42 cases) and a control group (40 cases). Suliao (GV 25) was selected as main aupoint, while Laogong (PC 8) and Yongquan (KI 1), etc. were selected as adjuvant acupoints and Neiguan (PC 6), Sanyinjiao (SP 6), Yifeng (TE 17) and Wangu (GB 12), etc. were selected as matching acupoints in the observation group where a strong needle manipulation was applied to improve the regain of consciousness. The main acupoint of Shuigou (GV 26) along with identical adjuvant acupoints and matching acupoints in the observation group were selected in the control group with identical strong needle manipulation. The treatment was given once a day in both groups, five times per week and ten times were considered as one session. The immediate clinical symptoms after acupuncture at Suliao (GV 25) and Shuigou (GV 26) were observed as well as Glasgow coma scale (GCS) before the treatment, after 45 days and 90 days of treatment to assess the resuscitation time and rate. Also the clinical efficacy was compared between both groups. The occurrence rate of sneezing reflex was 85.7% (36/42) in the observation group, which was higher than 25.0% (10/40) in the control group (P 0.05). Compared before the treatment, GCS were both improved after the treatment in two groups (both P coma in severe craniocerebral injury is positive. It could specifically improve sneezing reflex and stimulate respiratory center, which has more obvious effect than acupuncture at Shuigou (GV 26).

Control landscapes for observable preparation with open quantum systems

International Nuclear Information System (INIS)

Wu Rebing; Pechen, Alexander; Rabitz, Herschel; Hsieh, Michael; Tsou, Benjamin

2008-01-01

A quantum control landscape is defined as the observable as a function(al) of the system control variables. Such landscapes were introduced to provide a basis to understand the increasing number of successful experiments controlling quantum dynamics phenomena. This paper extends the concept to encompass the broader context of the environment having an influence. For the case that the open system dynamics are fully controllable, it is shown that the control landscape for open systems can be lifted to the analysis of an equivalent auxiliary landscape of a closed composite system that contains the environmental interactions. This inherent connection can be analyzed to provide relevant information about the topology of the original open system landscape. Application to the optimization of an observable expectation value reveals the same landscape simplicity observed in former studies on closed systems. In particular, no false suboptimal traps exist in the system control landscape when seeking to optimize an observable, even in the presence of complex environments. Moreover, a quantitative study of the control landscape of a system interacting with a thermal environment shows that the enhanced controllability attainable with open dynamics significantly broadens the range of the achievable observable values over the control landscape

Observer Backstepping Control for Variable Speed Wind Turbine

DEFF Research Database (Denmark)

Galeazzi, Roberto; Gryning, Mikkel Peter Sidoroff; Blanke, Mogens

2013-01-01

. The nonlinear controller aims at regulating the generator torque such that an optimal tip-speed ratio can be obtained. Simply relying on the measured rotor angular velocity the proposed observer backstepping controller guarantees global asymptotic tracking of the desired trajectory while maintaining a globally......This paper presents an observer backstepping controller as feasible solution to variable speed control of wind turbines to maximize wind power capture when operating between cut-in and rated wind speeds. The wind turbine is modeled as a two-mass drive-train system controlled by the generator torque...

Clinical effect observation of pranoprofen combined with deproteinized calf blood extract eye drops for moderate to severe dry eye

Directory of Open Access Journals (Sweden)

Jing-Hua Qiu

2018-04-01

Full Text Available AIM: To explore clinical effect of pranoprofen combined with deproteinized calf blood extract eye drops for moderate to severe dry eye. METHODS: A total of 84 patients(132 eyeswho received treatment at the Zhengzhou Second Hospital were selected from January 2016 to January 2017. According to random number table method they were divided into control group 42 cases(68 eyesand observation group 42 cases(64 eyes, the control group using polyvinyl alcohol eye drops with pranoprofen, observation group with pranoprofen with deproteinized extract of calf blood eye drops. Subjective and objective scores before and after treatment were recorded. RESULTS: There was no statistically significant difference on the four objective indicators of pretreatment FL, BUT, SⅠt, and vision between the two groups(P>0.05. Dry eye symptom scores of the two groups decreased after treatment, both with significantly different(PPPPCONCLUSION: The clinical effect of praprofen on the treatment of moderate to severe dry eye with the deproteinized calf blood extract is better.

[Clinical observation on treatment of type 2 cardiac and kidney syndrome by combination of traditional Chinese and Western medicines].

Science.gov (United States)

Hu, Xiao-Yan; Zhang, Hua; Rong, Yuan-Yuan; Zhang, Miao-Hai; Zhang, Xiang-Nong

2017-10-01

Clinical observation on treatment of type 2 cardiac and kidney syndrome by combination of traditional Chinese and Western medicine. The patients were divided into two groups： the simple Western medicine treatment group (control group) and the traditional Chinese medicine and Western medicine treatment group (treatment group). The patients in the two groups were treated with conventional western medicine.The treatment group was given based on Buxin Yishen decoction, a total of three courses of treatment to observe the two groups of patients before and after treatment of total efficacy, cardiac function indicators, changes in renal function indicators. The total efficacy of the treatment group and the control group were 91.80% and 72.41%, respectively. There were significant differences between the two groups (Ptraditional Chinese and Western medicine treatment can improve the clinical efficacy of type 2 heart and kidney syndrome, significantly improve heart and kidney function, better than conventional Western medicine treatment, and has good safety. Copyright© by the Chinese Pharmaceutical Association.

Applying Statistical Process Control to Clinical Data: An Illustration.

Science.gov (United States)

Pfadt, Al; And Others

1992-01-01

Principles of statistical process control are applied to a clinical setting through the use of control charts to detect changes, as part of treatment planning and clinical decision-making processes. The logic of control chart analysis is derived from principles of statistical inference. Sample charts offer examples of evaluating baselines and…

[Clinical observation on nanometer acupoint mounting method for alleviation of myospasm complicated by spinal injury].

Science.gov (United States)

Zhang, Su-Jie; Si, Tong; Li, Zhi

2008-11-01

To observe clinical effect of nanometer acupoint mounting method for alleviation of myospasm complicated by spinal injury. Sixty cases were randomly divided into an observation group and a control group, 30 cases in each group. The observation group were treated by nanometer mounting at 4 Jiaji (EX-B 2) points each on both sides of the affected spine and Shenshu (BL 23), Shangliao (BL 31), Ciliao (BL 32), Yang-lingquan (GB 34), Xuanzhong (GB 39); and the control group by mounting zinc oxide sticking tablets at the above acupoints. The mounting was replaced once each two days, 7 times constituting one course. One week and one month after the end of 3 courses, their results were recorded, respectively. Before treatment, there was no significant difference between the two groups in grades of the myospasm degree (P > 0.05). One week after the end of treatment, 15 cases were grade I of myospasm, 9 cases were grade II, 5 cases were grade III and 1 case was grade IV in the observation group, and 1 cases grade I, 7 cases grade II, 14 cases grade III, 8 cases grade IV in the control group. Ridit analysis on the data indicated that there were significant differences before and after treatment in the myospasm degree (P mounting method is a new one for alleviation of myospasm complicated by spinal injury, with convenience, safety and no side effect.

Wilson's disease: cranial MRI observations and clinical correlation

International Nuclear Information System (INIS)

Sinha, S.; Taly, A.B.; Prashanth, L.K.; Venugopal, K.S.; Arunodaya, G.R.; Swamy, H.S.; Ravishankar, S.; Vasudev, M.K.

2006-01-01

Study of MRI changes may be useful in diagnosis, prognosis and better understanding of the pathophysiology of Wilson's disease (WD). We aimed to describe and correlate the MRI abnormalities of the brain with clinical features in WD. MRI evaluation was carried out in 100 patients (57 males, 43 females; mean age 19.3±8.9 years) using standard protocols. All but 18 patients were on de-coppering agents. Their history, clinical manifestations and scores for severity of disease were noted. The mean duration of illness and treatment were 8.3±10.8 years and 7.5±7.1 years respectively. MRI of the brain was abnormal in all the 93 symptomatic patients. The most conspicuous observations were atrophy of the cerebrum (70%), brainstem (66%) and cerebellum (52%). Signal abnormalities were also noted: putamen (72%), caudate (61%), thalami (58%), midbrain (49%), pons (20%), cerebral white matter (25%), cortex (9%), medulla (12%) and cerebellum (10%). The characteristic T2-W globus pallidal hypointensity (34%), ''Face of giant panda'' sign (12%), T1-W striatal hyperintensity (6%), central pontine myelinosis (7%), and bright claustral sign (4%) were also detected. MRI changes correlated with disease severity scores (P<0.001) but did not correlate with the duration of illness. MRI changes were universal but diverse and involved almost all the structures of the brain in symptomatic patients. A fair correlation between MRI observations and various clinical features provides an explanation for the protean manifestations of the disease. (orig.)

Observability and Controllability of Networks: Symmetry in Representations of Brains and Controllers for Epidemics

Science.gov (United States)

Schiff, Steven

Observability and controllability are essential concepts to the design of predictive observer models and feedback controllers of networked systems. We present a numerical and group representational framework, to quantify the observability and controllability of nonlinear networks with explicit symmetries that shows the connection between symmetries and nonlinear measures of observability and controllability. In addition to the topology of brain networks, we have advanced our ability to represent network nodes within the brain using conservation principles and more accurate biophysics that unifies the dynamics of spikes, seizures, and spreading depression. Lastly, we show how symmetries in controller design can be applied to infectious disease epidemics. NIH Grants 1R01EB014641, 1DP1HD086071.

A Lambda Control Observer With Fault Correction

DEFF Research Database (Denmark)

Vigild, Christian; Struwe, Michael; Jensen, Per Buchbjerg

1998-01-01

bandwidth. It seldom exceeds 2 Hz. This is altogether too small for accurate transient air/fuel ratio control. This paper presents a new lambda (normalized air/fuel ratio) control methodology based on a time delay observer. This technique makes possible a significant increase of the lambda control bandwidth...

HISTIOCYTOSIS X: CLINICAL OBSERVATIONS

Directory of Open Access Journals (Sweden)

E. Y. Ponomareva

2012-01-01

Full Text Available Two clinical cases of pulmonary Langerhans cell histiocytosis X have been analyzed demonstrating lung and other inner organ pathology, common clinical and X-ray features but different life prognosis.

Diagnostic and clinical observation on the infectious bronchitis virus strain Q1 in Italy

Directory of Open Access Journals (Sweden)

Anna Toffan

2013-12-01

Full Text Available This paper describes the diagnostic and clinical observations of an infectious bronchitis virus (IBV variant, referred to as Q1, in clinically ill chickens in Italy. This IBV variant was described for the first time in 1998 in China. In the autumn of 2011 it caused a small-scale epidemic in non-vaccinated meat chickens in farms located in Northern Italy. The disease was characterized by increased mortality, kidney lesions and proventriculitis. Histopatological observations confirmed the nephritis and described an unusual erosive/necrotic proventriculitis with infiltration of lymphocytes, plasma cells and heterophils, as well as fibroplasia in the lamina propria. Despite these findings and the isolation of the Q1 IB virus directly from proventricular tissue, further studies are necessary to confirm the role of this IBV strain in the development of proventricular lesions. Phylogenetic analysis revealed that all the IBV isolates were very similar and probably had a common origin. The IBV Q1 variant appears to be now endemic in the North of Italy and at times it is detected in vaccinated backyard and commercial broiler farms. The importance of continuous monitoring in controlling the spread of known or emerging IBV variants is underlined.

Family physician clinical inertia in glycemic control among patients with type 2 diabetes.

Science.gov (United States)

Bralić Lang, Valerija; Bergman Marković, Biserka; Kranjčević, Ksenija

2015-02-05

Many patients with diabetes do not achieve target values. One of the reasons for this is clinical inertia. The correct explanation of clinical inertia requires a conjunction of patient with physician and health care system factors. Our aim was to determine the rate of clinical inertia in treating diabetes in primary care and association of patient, physician, and health care setting factors with clinical inertia. This was a national, multicenter, observational, cross-sectional study in primary care in Croatia. Each family physician (FP) provided professional data and collected clinical data on 15-25 type 2 diabetes (T2DM) patients. Clinical inertia was defined as a consultation in which treatment change based on glycated hemoglobin (HbA1c) levels was indicated but did not occur. A total of 449 FPs (response rate 89.8%) collected data on 10275 patients. Mean clinical inertia per FP was 55.6% (SD ±26.17) of consultations. All of the FPs were clinically inert with some patients, and 9% of the FPs were clinically inert with all patients. The main factors associated with clinical inertia were: higher percentage of HbA1c, oral anti-diabetic drug initiated by diabetologist, increased postprandial glycemia and total cholesterol, physical inactivity of patient, and administration of drugs other than oral antidiabetics. Clinical inertia in treating patients with T2DM is a serious problem. Patients with worse glycemic control and those whose therapy was initiated by a diabetologist experience more clinical inertia. More research on causes of clinical inertia in treating patients with T2DM should be conducted to help achieve more effective diabetes control.

Celiac disease: clinical observations

Directory of Open Access Journals (Sweden)

Yu. A. Emel’yanova

2016-01-01

Full Text Available Presented clinical cases of patients with a diagnosis of gluten enteropathy in treatment in the department of gastroenterology Regional Clinical Hospital. The case is of interest to doctors of different specialties for the differential diagnosis of anemia and malabsorption syndrome, demonstrate both the classic version, and atypical forms of the disease course. Diagnosis of celiac disease is based on three key positions: clinical findings, histology and serological markers. The clinical picture of celiac disease is characterized by pronounced polymorphism, by going beyond the a gastroenterological pathology. For screening of gluten sensitive celiac typically used an antibody to tissue transglutaminase. Morphological research of the mucous membrane of the small intestine is the determining criterion in the diagnosis of celiac disease. The use of specific gluten-free diet leads to the positive dynamics of the disease and improve the quality of life of patients.

Clinical outcomes of immediate/early loading of dental implants. A literature review of recent controlled prospective clinical studies.

Science.gov (United States)

Sennerby, L; Gottlow, J

2008-06-01

Two previous reviews have evaluated the clinical outcomes of immediate/early loading of dental implants based on studies published until 2005.(1,2) The aim of the present paper was to review controlled clinical studies on the subject published since 2005 including at least 10 patients in each group followed for at least one year in function. Six comparative studies were found and none of these showed any differences in survival rates or marginal bone loss after one to five years. Most authors used specified inclusion criteria to avoid known risk factors such as soft bone, short implants and bruxism. Data from one randomized study in the edentulous maxilla showed no differences between early and delayed loading in consecutive clinical routine cases including short implants and soft bone. Three additional studies comparing different surfaces or implant designs under immediate loading were reviewed. No differences between implants with a moderately rough or smooth surface topography were observed. The data add to the previous bulk of evidence that various designs of implants can be loaded shortly after their placement in both the mandible and the maxilla. However, one study reported on marginal bone loss around a novel one-piece implant design leading to implant failure which was not seen for control two-piece implants.(3).

ANALYSIS OF OBSERVED BEHAVIORS DISPLAYED BY DEPRESSED-PATIENTS DURING A CLINICAL INTERVIEW - RELATIONSHIPS BETWEEN BEHAVIORAL-FACTORS AND CLINICAL CONCEPTS OF ACTIVATION

NARCIS (Netherlands)

BOUHUYS, AL; JANSEN, CJ; VANDENHOOFDAKKER, RH

In 61 drug-free depressed patients, relationships were studied between observed behaviors and measures of common clinical concepts of activation. The behaviors were observed during a clinical interview and analyzed with ethological methods. Activation was assessed by means of self-ratings (Thayer,

ChronQC: a quality control monitoring system for clinical next generation sequencing.

Science.gov (United States)

Tawari, Nilesh R; Seow, Justine Jia Wen; Perumal, Dharuman; Ow, Jack L; Ang, Shimin; Devasia, Arun George; Ng, Pauline C

2018-05-15

ChronQC is a quality control (QC) tracking system for clinical implementation of next-generation sequencing (NGS). ChronQC generates time series plots for various QC metrics to allow comparison of current runs to historical runs. ChronQC has multiple features for tracking QC data including Westgard rules for clinical validity, laboratory-defined thresholds and historical observations within a specified time period. Users can record their notes and corrective actions directly onto the plots for long-term recordkeeping. ChronQC facilitates regular monitoring of clinical NGS to enable adherence to high quality clinical standards. ChronQC is freely available on GitHub (https://github.com/nilesh-tawari/ChronQC), Docker (https://hub.docker.com/r/nileshtawari/chronqc/) and the Python Package Index. ChronQC is implemented in Python and runs on all common operating systems (Windows, Linux and Mac OS X). tawari.nilesh@gmail.com or pauline.c.ng@gmail.com. Supplementary data are available at Bioinformatics online.

Multi-robot motion control for cooperative observation

Energy Technology Data Exchange (ETDEWEB)

Parker, L.E. [Oak Ridge National Lab., TN (United States). Center for Engineering Systems Advanced Research

1997-06-01

An important issue that arises in the automation of many security, surveillance, and reconnaissance tasks is that of monitoring (or observing) the movements of targets navigating in a bounded area of interest. A key research issue in these problems is that of sensor placement--determining where sensors should be located to maintain the targets in view. In complex applications involving limited-range sensors, the use of multiple sensors dynamically moving over time is required. In this paper, the authors investigate the use of a cooperative team of autonomous sensor-based robots for the observation of multiple moving targets. They focus primarily on developing the distributed control strategies that allow the robot team to attempt to minimize the total time in which targets escape observation by some robot team member in the area of interest. This paper first formalizes the problem and discusses related work. The authors then present a distributed approximate approach to solving this problem that combines low-level multi-robot control with higher-level reasoning control based on the ALLIANCE formalism. They analyze the effectiveness of the approach by comparing it to 3 other feasible algorithms for cooperative control, showing the superiority of the approach for a large class of problems.

Cooperative motion control for multi-target observation

Energy Technology Data Exchange (ETDEWEB)

Parker, L.E.

1997-08-01

An important issue that arises in the automation of many security, surveillance, and reconnaissance tasks is that of monitoring (or observing) the movements of targets navigating in a bounded area of interest. A key research issue in these problems is that of sensor placement--determining where sensors should be located to maintain the targets in view. In complex applications involving limited-range sensors, the use of multiple sensors dynamically moving over time is required. In this paper, the author investigates the use of a cooperative team of autonomous sensor-based robots for the observation of multiple moving targets. The focus is primarily on developing the distributed control strategies that allow the robot team to attempt to minimize the total time in which targets escape observation by some robot team member in the area of interest. This paper first formalizes the problem and discusses related work. The author then presents a distributed approximate approach to solving this problem that combines low-level multi-robot control with higher-level reasoning control based on the ALLIANCE formalism. The effectiveness of the approach is analyzed by comparing it to three other feasible algorithms for cooperative control, showing the superiority of the approach for a large class of problems.

Multi-robot motion control for cooperative observation

International Nuclear Information System (INIS)

Parker, L.E.

1997-01-01

An important issue that arises in the automation of many security, surveillance, and reconnaissance tasks is that of monitoring (or observing) the movements of targets navigating in a bounded area of interest. A key research issue in these problems is that of sensor placement--determining where sensors should be located to maintain the targets in view. In complex applications involving limited-range sensors, the use of multiple sensors dynamically moving over time is required. In this paper, the authors investigate the use of a cooperative team of autonomous sensor-based robots for the observation of multiple moving targets. They focus primarily on developing the distributed control strategies that allow the robot team to attempt to minimize the total time in which targets escape observation by some robot team member in the area of interest. This paper first formalizes the problem and discusses related work. The authors then present a distributed approximate approach to solving this problem that combines low-level multi-robot control with higher-level reasoning control based on the ALLIANCE formalism. They analyze the effectiveness of the approach by comparing it to 3 other feasible algorithms for cooperative control, showing the superiority of the approach for a large class of problems

Cooperative motion control for multi-target observation

International Nuclear Information System (INIS)

Parker, L.E.

1997-01-01

An important issue that arises in the automation of many security, surveillance, and reconnaissance tasks is that of monitoring (or observing) the movements of targets navigating in a bounded area of interest. A key research issue in these problems is that of sensor placement--determining where sensors should be located to maintain the targets in view. In complex applications involving limited-range sensors, the use of multiple sensors dynamically moving over time is required. In this paper, the author investigates the use of a cooperative team of autonomous sensor-based robots for the observation of multiple moving targets. The focus is primarily on developing the distributed control strategies that allow the robot team to attempt to minimize the total time in which targets escape observation by some robot team member in the area of interest. This paper first formalizes the problem and discusses related work. The author then presents a distributed approximate approach to solving this problem that combines low-level multi-robot control with higher-level reasoning control based on the ALLIANCE formalism. The effectiveness of the approach is analyzed by comparing it to three other feasible algorithms for cooperative control, showing the superiority of the approach for a large class of problems

Observability of linear control systems on Lie groups

International Nuclear Information System (INIS)

Ayala, V.; Hacibekiroglu, A.K.

1995-01-01

In this paper, we study the observability problem for a linear control system Σ on a Lie group G. The drift vector field of Σ is an infinitesimal automorphism of G and the control vectors are elements in the Lie algebra of G. We establish algebraic conditions to characterize locally and globally observability for Σ. As in the linear case on R n , these conditions are independent of the control vector. We give an algorithm on the co-tangent bundle of G to calculate the equivalence class of the neutral element. (author). 6 refs

Observer-Based Robust Control for Spacecraft Rendezvous with Thrust Saturation

Directory of Open Access Journals (Sweden)

Neng Wan

2014-01-01

Full Text Available This paper proposes an observer-based robust guaranteed cost control method for thrust-limited rendezvous in near-circular orbits. Treating the noncircularity of the target orbit as a parametric uncertainty, a linearized motion model derived from the two-body problem is adopted as the controlled plant. Based on this model, a robust guaranteed cost observer-controller is synthesized with a less conservative saturation control law, and sufficient condition for the existence of this observer-based rendezvous controller is derived. Finally, an illustrative example with immeasurable velocity states is presented to demonstrate the advantages and effectiveness of the control scheme.

Conveying Clinical Reasoning Based on Visual Observation via Eye-Movement Modelling Examples

Science.gov (United States)

Jarodzka, Halszka; Balslev, Thomas; Holmqvist, Kenneth; Nystrom, Marcus; Scheiter, Katharina; Gerjets, Peter; Eika, Berit

2012-01-01

Complex perceptual tasks, like clinical reasoning based on visual observations of patients, require not only conceptual knowledge about diagnostic classes but also the skills to visually search for symptoms and interpret these observations. However, medical education so far has focused very little on how visual observation skills can be…

[Two years clinical observation of a kind of castable ceramic--IPS Empress].

Science.gov (United States)

Liu, Y; Li, Y; Nie, Y

1999-03-01

We used this material in clinic since 1995. Discussion on the prosthetic effects of the above-mentioned material to spreat it clinically. Through half to two years clinical observations to evaluate the effect of IPS Empress crowns in anterior teeth and inlays in posteriors. and Prosthesis made of this kind of material IPS Empress is one kind of excellent all-ceramic prosthetic material. IPS Empress also could be used in post crowns and the clinical effect was satisfactory.

Composite control for raymond mill based on model predictive control and disturbance observer

Directory of Open Access Journals (Sweden)

Dan Niu

2016-03-01

Full Text Available In the raymond mill grinding process, precise control of operating load is vital for the high product quality. However, strong external disturbances, such as variations of ore size and ore hardness, usually cause great performance degradation. It is not easy to control the current of raymond mill constant. Several control strategies have been proposed. However, most of them (such as proportional–integral–derivative and model predictive control reject disturbances just through feedback regulation, which may lead to poor control performance in the presence of strong disturbances. For improving disturbance rejection, a control method based on model predictive control and disturbance observer is put forward in this article. The scheme employs disturbance observer as feedforward compensation and model predictive control controller as feedback regulation. The test results illustrate that compared with model predictive control method, the proposed disturbance observer–model predictive control method can obtain significant superiority in disturbance rejection, such as shorter settling time and smaller peak overshoot under strong disturbances.

Choosing a control intervention for a randomised clinical trial

Directory of Open Access Journals (Sweden)

Djulbegovic Benjamin

2003-04-01

Full Text Available Abstract Background Randomised controlled clinical trials are performed to resolve uncertainty concerning comparator interventions. Appropriate acknowledgment of uncertainty enables the concurrent achievement of two goals : the acquisition of valuable scientific knowledge and an optimum treatment choice for the patient-participant. The ethical recruitment of patients requires the presence of clinical equipoise. This involves the appropriate choice of a control intervention, particularly when unapproved drugs or innovative interventions are being evaluated. Discussion We argue that the choice of a control intervention should be supported by a systematic review of the relevant literature and, where necessary, solicitation of the informed beliefs of clinical experts through formal surveys and publication of the proposed trial's protocol. Summary When clinical equipoise is present, physicians may confidently propose trial enrollment to their eligible patients as an act of therapeutic beneficence.

On the clinical value of roentgenological observation of the clinical course of renal osteopathy

International Nuclear Information System (INIS)

Fritsch, R.; Freyschmidt, J.; Lustenberger, N.; Hesch, R.D.; Medizinische Hochschule Hannover

1980-01-01

Basing on radiological observation of the course of renal osteopathy confirmed both clinically and by bone biopsy in 96 patients - the X-ray examination comprising primarily the entire axial skeleton including the proximal extremities and hands - 60% of the patients showed mineralisation in their hands. The rest of the skeleton was affected only if there were identifiable alterations at the hands, although the affection of the axial skeleton was definitely lower in terms of percentage. Hence, radiological observation of renal osteopathy based on X-ray films of both hands with additional magnification technique appears both possible and meaningful. (orig.) [de

Celiac Patients: A Randomized, Controlled Clinical Study

Directory of Open Access Journals (Sweden)

Giuseppe Mazzarella

2012-01-01

Full Text Available A lifelong gluten-free diet (GFD is mandatory for celiac disease (CD but has poor compliance, justifying novel strategies. We found that wheat flour transamidation inhibited IFN-γ secretion by intestinal T cells from CD patients. Herein, the primary endpoint was to evaluate the ability of transamidated gluten to maintain GFD CD patients in clinical remission. Secondary endpoints were efficacy in prevention of the inflammatory response and safety at the kidney level, where reaction products are metabolized. In a randomized single blinded, controlled 90-day trial, 47 GFD CD patients received 3.7 g/day of gluten from nontransamidated (12 or transamidated (35 flour. On day 15, 75% and 37% of patients in the control and experimental groups, respectively, showed clinical relapse (=0.04 whereas intestinal permeability was mainly altered in the control group (50% versus 20%, =0.06. On day 90, 0 controls and 14 patients in the experimental group completed the challenge with no variation of antitransglutaminase IgA (=0.63, Marsh-Oberhuber grading (=0.08, or intestinal IFN-γ mRNA (>0.05. Creatinine clearance did not vary after 90 days of treatment (=0.46. In conclusion, transamidated gluten reduced the number of clinical relapses in challenged patients with no changes of baseline values for serological/mucosal CD markers and an unaltered kidney function.

Control of muscle relaxation during anesthesia: a novel approach for clinical routine.

Science.gov (United States)

Stadler, Konrad S; Schumacher, Peter M; Hirter, Sibylle; Leibundgut, Daniel; Bouillon, Thomas W; Glattfelder, Adolf H; Zbinden, Alex M

2006-03-01

During general anesthesia drugs are administered to provide hypnosis, ensure analgesia, and skeletal muscle relaxation. In this paper, the main components of a newly developed controller for skeletal muscle relaxation are described. Muscle relaxation is controlled by administration of neuromuscular blocking agents. The degree of relaxation is assessed by supramaximal train-of-four stimulation of the ulnar nerve and measuring the electromyogram response of the adductor pollicis muscle. For closed-loop control purposes, a physiologically based pharmacokinetic and pharmacodynamic model of the neuromuscular blocking agent mivacurium is derived. The model is used to design an observer-based state feedback controller. Contrary to similar automatic systems described in the literature this controller makes use of two different measures obtained in the train-of-four measurement to maintain the desired level of relaxation. The controller is validated in a clinical study comparing the performance of the controller to the performance of the anesthesiologist. As presented, the controller was able to maintain a preselected degree of muscle relaxation with excellent precision while minimizing drug administration. The controller performed at least equally well as the anesthesiologist.

Controllability and observability of Boolean networks arising from biology

Science.gov (United States)

Li, Rui; Yang, Meng; Chu, Tianguang

2015-02-01

Boolean networks are currently receiving considerable attention as a computational scheme for system level analysis and modeling of biological systems. Studying control-related problems in Boolean networks may reveal new insights into the intrinsic control in complex biological systems and enable us to develop strategies for manipulating biological systems using exogenous inputs. This paper considers controllability and observability of Boolean biological networks. We propose a new approach, which draws from the rich theory of symbolic computation, to solve the problems. Consequently, simple necessary and sufficient conditions for reachability, controllability, and observability are obtained, and algorithmic tests for controllability and observability which are based on the Gröbner basis method are presented. As practical applications, we apply the proposed approach to several different biological systems, namely, the mammalian cell-cycle network, the T-cell activation network, the large granular lymphocyte survival signaling network, and the Drosophila segment polarity network, gaining novel insights into the control and/or monitoring of the specific biological systems.

Comprehensive entropy weight observability-controllability risk ...

African Journals Online (AJOL)

Decision making for water resource planning is often related to social, economic and environmental factors. There are various methods for making decisions about water resource planning alternatives and measures with various shortcomings. A comprehensive entropy weight observability-controllability risk analysis ...

Advanced and controlled drug delivery systems in clinical disease management

NARCIS (Netherlands)

Brouwers, JRBJ

1996-01-01

Advanced and controlled drug delivery systems are important for clinical disease management. In this review the most important new systems which have reached clinical application are highlighted. Microbiologically controlled drug delivery is important for gastrointestinal diseases like ulcerative

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.

Observer-Based Robust Control of Uncertain Switched Fuzzy Systems with Combined Switching Controller

Directory of Open Access Journals (Sweden)

Hong Yang

2013-01-01

Full Text Available The observer-based robust control for a class of switched fuzzy (SF time-delay systems involving uncertainties and external disturbances is investigated in this paper. A switched fuzzy system, which differs from existing ones, is firstly employed to describe a nonlinear system. Next, a combined switching controller is proposed. The designed controller based on the observer instead of the state information integrates the advantages of both the switching controllers and the supplementary controllers but eliminates their disadvantages. The proposed controller provides good performance during the transient period, and the chattering effect is removed when the system state approaches the origin. Sufficient condition for the solvability of the robust control problem is given for the case that the state of system is not available. Since convex combination techniques are used to derive the delay-independent criteria, some subsystems are allowed to be unstable. Finally, various comparisons of the elaborated examples are conducted to demonstrate the effectiveness of the proposed control design approach.

Clinical observation of submandibular gland transfer for the prevention of xerostomia after radiotherapy for nasopharyngeal carcinoma: a prospective randomized controlled study of 32 cases

Science.gov (United States)

2014-01-01

Background The aim of this study was to evaluate the clinical efficacy of submandibular gland transfer for the prevention of xerostomia after radiotherapy for nasopharyngeal carcinoma. Methods Using the randomized controlled clinical research method, 65 patients with nasopharyngeal carcinoma were randomly divided into an experimental group consisting of 32 patients and a control group consisting of 33 patients. The submandibular glands were averted to the submental region in 32 patients with nasopharyngeal carcinoma before they received conventional radiotherapy; a lead block was used to shield the submental region during therapy. Prior to radiotherapy, the function of the submandibular glands was assessed using imaging. Submandibular gland function was measured using 99mTc radionuclide scanning at 60 months after radiotherapy. The data in the questionnaire regarding the degree of xerostomia were investigated and saliva secretion was measured at 3, 6, 12, and 60 months after radiotherapy. In addition, the 5-year survival rate was calculated. Results After follow-up for 3, 6, and 12 months, the incidence of moderate to severe xerostomia was significantly lower in the experimental group than in the control group. The average amount of saliva produced by the experimental and control groups was 1.60 g and 0.68 g, respectively (P xerostomia was significantly lower than in the control group (15.4% and 76.9%, respectively; P xerostomia after radiotherapy for nasopharyngeal carcinoma, we found that clinical efficacy was good. This approach could improve the quality of life of nasopharyngeal carcinoma patients after radiotherapy and would not affect long-term treatment efficacy. PMID:24555575

Difficult-to-control hypertension: identification of clinical predictors and use of ICT-based integrated care to facilitate blood pressure control.

Science.gov (United States)

Visco, Valeria; Finelli, Rosa; Pascale, Antonietta Valeria; Mazzeo, Pietro; Ragosa, Nicola; Trimarco, Valentina; Illario, Maddalena; Ciccarelli, Michele; Iaccarino, Guido

2018-05-01

Difficult-to-control (DTC) hypertension represents a burden in real life that can be partially solved through identification of the characteristics of clinical patterns and tailoring antihypertensive strategies, including ICT-enabled integrated care (ICT-IC). In the quest for clinical predictors of DTC hypertension, we screened 482 hypertensive patients who were consecutively referred to the departmental hypertension clinic. Following a data quality check, patients were divided into controlled (C, 49.37%) and uncontrolled (UC, 50.63%) groups based on their systolic blood pressure (BP) at follow-up. We then performed statistical analysis on the demographic, clinical, laboratory, and ultrasound data and observed that older age, female sex, higher BP levels, and a family history of hypertension were predictors of DTC hypertension. We then developed a pilot service of ICT-IC, including weekly home visits by nurses and patient education on self-monitoring of BP, heart rate, body weight, and oxygen saturation using 3G-connected devices. Self-monitored data were transmitted to the hospital servers on the electronic chart of the patient for remote assessment by the hospital hypertension specialists. A total of 20 UC patients (M/F = 10/10; age: 72.04 ± 2.17 years) were enrolled to verify the efficacy of BP control without changes in medical treatment. After 1 month of the ICT-IC program, BP was reduced both at the office assessment (systolic BP (SBP): 162.40 ± 2.23 mm Hg, beginning of the program vs. 138.20 ± 4.26 mm Hg at 1 month, p ICT-IC is a feasible therapeutic strategy to achieve BP control.

Effect of controlled-release PeriochipTM on clinical and microbiological parameters in patients of chronic periodontitis

Directory of Open Access Journals (Sweden)

Komal Puri

2013-01-01

Full Text Available Background: The aim of the present study was to evaluate and compare the clinical and microbiological effectiveness of Periochip TM as an adjunct to scaling and root planing (SRP with SRP alone in patients with chronic periodontitis. Materials and Methods: This randomized, split mouth, 3-month clinical and microbiological trial included 30 sites in 15 patients aged 30-50 years diagnosed with chronic periodontitis. In each patient, two bilateral pockets probing 5-7 mm were randomly assigned to test and control groups. The test group received SRP plus Periochip TM , whereas the control group received SRP alone. Clinical indices and anaerobic culture analysis was done at baseline, 1 month, and 3 months interval. Total bacterial count and analysis of four major periodontopathogenic bacteria Porphyromonas gingivalis (Pg, Prevotella intermedia (Pi, Aggregatibacter actinomycetemcomitans (Aa, and Fusobacterium nucleatum (Fn was done. Results: Significant improvement was obtained in all clinical variables in the test group as compared to the control group over the study period. Total colony counts were significantly reduced in the test group as compared to control over the period of time. At baseline Aa was recovered from 4 test group sites and 5 control group sites, Pg from 15 test group and 14 control group sites, Pi from 5 test group and 2 control group sites, Fn from 7 test and 7 control group sites. At 3 months, Aa was recovered from 1 test group and 4 control group sites, Pg from 4 test group and 8 control group sites, Pi from 1 test group and 1 control group site, Fn from 3 test and 4 control group sites. Conclusion: Periochip TM placement as an adjunct to SRP, showed promising results, when compared to SRP alone. Healthy microflora can be maintained for a longer period of time and delay in the repopulation by periodontopathic microorganisms was observed.

Alternative Observers for SI Engine Air/Fuel Ratio Control

DEFF Research Database (Denmark)

Hendricks, Elbert; Poulsen, Jannik; Olsen, Mads Bruun

1996-01-01

In earlier work it has been shown that a nonlinear observer based on the use of the manifold pressure state equation and a nonlinear fuel film compensator can maintain accurate A/F ratio control during both steady state and transient operation. This observer may be called a manifold absolute pres...... engine control system designer with a variety of robust control systems which can easily be made redundant in order to satisfy newer engine emissions and diagnosis requirements and legislation...

A cooperative control algorithm for camera based observational systems.

Energy Technology Data Exchange (ETDEWEB)

Young, Joseph G.

2012-01-01

Over the last several years, there has been considerable growth in camera based observation systems for a variety of safety, scientific, and recreational applications. In order to improve the effectiveness of these systems, we frequently desire the ability to increase the number of observed objects, but solving this problem is not as simple as adding more cameras. Quite often, there are economic or physical restrictions that prevent us from adding additional cameras to the system. As a result, we require methods that coordinate the tracking of objects between multiple cameras in an optimal way. In order to accomplish this goal, we present a new cooperative control algorithm for a camera based observational system. Specifically, we present a receding horizon control where we model the underlying optimal control problem as a mixed integer linear program. The benefit of this design is that we can coordinate the actions between each camera while simultaneously respecting its kinematics. In addition, we further improve the quality of our solution by coupling our algorithm with a Kalman filter. Through this integration, we not only add a predictive component to our control, but we use the uncertainty estimates provided by the filter to encourage the system to periodically observe any outliers in the observed area. This combined approach allows us to intelligently observe the entire region of interest in an effective and thorough manner.

Impulse control disorders in Parkinson's disease: clinical characteristics and implications.

Science.gov (United States)

Leeman, Robert F; Potenza, Marc N

2011-04-01

Impulse control disorders (ICDs), specifically those related to excessive gambling, eating, sex and shopping, have been observed in a subset of people with Parkinson's disease (PD). Although some initial case reports claimed that dopamine replacement therapies, particularly dopamine agonists, cause ICDs, more recent, larger and better controlled studies indicate a more complicated picture. While dopamine replacement therapy use is related to ICDs, other vulnerabilities, some related to PD and/or its treatment directly and others seemingly unrelated to PD, have also been associated with ICDs in PD. This suggests a complex etiology with multiple contributing factors. As ICDs occur in a sizable minority of PD patients and can be associated with significant distress and impairment, further investigation is needed to identify factors that can predict who may be more likely to develop ICDs. Clinical implications are discussed and topics for future research are offered.

Clinical decision making in dermatology: observation of consultations and the patients' perspectives.

Science.gov (United States)

Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

2010-01-01

Clinical decision making is a complex process and might be influenced by a wide range of clinical and non-clinical factors. Little is known about this process in dermatology. The aim of this study was to explore the different types of management decisions made in dermatology and to identify factors influencing those decisions from observation of consultations and interviews with the patients. 61 patient consultations were observed by a physician with experience in dermatology. The patients were interviewed immediately after each consultation. Consultations and interviews were audio recorded, transcribed and their content analysed using thematic content analysis. The most common management decisions made during the consultations included: follow-up, carrying out laboratory investigation, starting new topical treatment, renewal of systemic treatment, renewal of topical treatment, discharging patients and starting new systemic treatment. Common influences on those decisions included: clinical factors such as ineffectiveness of previous therapy, adherence to prescribing guidelines, side-effects of medications, previous experience with the treatment, deterioration or improvement in the skin condition, and chronicity of skin condition. Non-clinical factors included: patient's quality of life, patient's friends or relatives, patient's time commitment, travel or transportation difficulties, treatment-related costs, availability of consultant, and availability of treatment. The study has shown that patients are aware that management decisions in dermatology are influenced by a wide range of clinical and non-clinical factors. Education programmes should be developed to improve the quality of decision making. Copyright © 2010 S. Karger AG, Basel.

Active Disturbance Rejection Approach for Robust Fault-Tolerant Control via Observer Assisted Sliding Mode Control

Directory of Open Access Journals (Sweden)

John Cortés-Romero

2013-01-01

Full Text Available This work proposes an active disturbance rejection approach for the establishment of a sliding mode control strategy in fault-tolerant operations. The core of the proposed active disturbance rejection assistance is a Generalized Proportional Integral (GPI observer which is in charge of the active estimation of lumped nonlinear endogenous and exogenous disturbance inputs related to the creation of local sliding regimes with limited control authority. Possibilities are explored for the GPI observer assisted sliding mode control in fault-tolerant schemes. Convincing improvements are presented with respect to classical sliding mode control strategies. As a collateral advantage, the observer-based control architecture offers the possibility of chattering reduction given that a significant part of the control signal is of the continuous type. The case study considers a classical DC motor control affected by actuator faults, parametric failures, and perturbations. Experimental results and comparisons with other established sliding mode controller design methodologies, which validate the proposed approach, are provided.

Comorbidities of patients in tiotropium clinical trials: comparison with observational studies of patients with chronic obstructive pulmonary disease

Directory of Open Access Journals (Sweden)

Miravitlles M

2015-03-01

Full Text Available Marc Miravitlles,1 David Price,2 Klaus F Rabe,3,7 Hendrik Schmidt,4 Norbert Metzdorf,5 Bartolome Celli6 1Pneumology Department, Hospital Universitari Vall d’Hebron, Ciber de Enfermedades Respiratorias (CIBERES, Barcelona, Spain; 2Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; 3Department of Medicine, Christian-Albrechts-Universität zu Kiel (CAU, Großhansdorf, Germany; 4Global Biometrics and Clinical Applications, Boehringer Ingelheim Pharma GmbH and Co KG, Ingelheim am Rhein, Germany; 5TA Respiratory Diseases, Boehringer Ingelheim Pharma GmbH and Co KG, Ingelheim am Rhein, Germany; 6Pulmonary Division, Brigham and Women’s Hospital, Boston, MA, USA; 7LungenClinic Grosshansdorf, Großhansdorf, Germany Background: There is an ongoing debate on whether patients with chronic obstructive pulmonary disease (COPD seen in real-life clinical settings are represented in randomized controlled trials (RCTs of COPD. It is thought that the stringent inclusion and exclusion criteria of RCTs may prevent the participation of patients with specific characteristics or risk factors.Methods: We surveyed a database of patients recruited into 35 placebo-controlled tiotropium RCTs and also conducted a systematic literature review of large-scale observational studies conducted in patients with a documented diagnosis of COPD between 1990 and 2013. Patient demographics and comorbidities with a high prevalence in patients with COPD were compared between the two patient populations at baseline. Using the Medical Dictionary for Regulatory Activities (MedDRA; v 14.0, patient comorbidities in the pooled tiotropium RCTs were classified according to system organ class, pharmacovigilance (PV endpoints, and Standardised MedDRA Queries to enable comparison with the observational studies.Results: We identified 24,555 patients in the pooled tiotropium RCTs and 61,361 patients among the 13 observational studies that met our

Observer enhanced control for spin-stabilized tethered formation in earth orbit

Science.gov (United States)

Guang, Zhai; Yuyang, Li; Liang, Bin

2018-04-01

This paper addresses the issues relevant to control of spin-stabilized tethered formation in circular orbit. Due to the dynamic complexities and nonlinear perturbations, it is challenging to promote the control precision for the formation deployment and maintenance. In this work, the formation dynamics are derived with considering the spinning rate of the central body, then major attention is dedicated to develop the nonlinear disturbance observer. To achieve better control performance, the observer-enhanced controller is designed by incorporating the disturbance observer into the control loop, benefits from the disturbance compensation are demonstrated, and also, the dependences of the disturbance observer performance on some important parameters are theoretically and numerically analyzed.

Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

Science.gov (United States)

Christofides, Elena A

2016-01-01

In acromegaly, achieving biochemical control (growth hormone [GH] level acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

Voluntarily controlled but not merely observed visual feedback affects postural sway

Science.gov (United States)

Asai, Tomohisa; Hiromitsu, Kentaro; Imamizu, Hiroshi

2018-01-01

Online stabilization of human standing posture utilizes multisensory afferences (e.g., vision). Whereas visual feedback of spontaneous postural sway can stabilize postural control especially when observers concentrate on their body and intend to minimize postural sway, the effect of intentional control of visual feedback on postural sway itself remains unclear. This study assessed quiet standing posture in healthy adults voluntarily controlling or merely observing visual feedback. The visual feedback (moving square) had either low or high gain and was either horizontally flipped or not. Participants in the voluntary-control group were instructed to minimize their postural sway while voluntarily controlling visual feedback, whereas those in the observation group were instructed to minimize their postural sway while merely observing visual feedback. As a result, magnified and flipped visual feedback increased postural sway only in the voluntary-control group. Furthermore, regardless of the instructions and feedback manipulations, the experienced sense of control over visual feedback positively correlated with the magnitude of postural sway. We suggest that voluntarily controlled, but not merely observed, visual feedback is incorporated into the feedback control system for posture and begins to affect postural sway. PMID:29682421

Clinical observation of alprostadil combined with glucocorticoids on acute optic neuritis

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Ke-Shun Fan

2015-09-01

Full Text Available AIM: To study the clinical effect of alprostadil combined with glucocorticoids in the treatment of acute optic neuritis(AON.METHODS: Seventy patients(70 eyeswith AON from January, 2012 to June, 2014 were randomly divided into two groups. 35 patients in observation group were used 10ug alprostadil with 10mL normal saline(NSby intravenous injection, once/d for 7d/one treatment course, and 10mL NS was used by intravenous injection in 35 patients of control group. Besides, the two groups were treated with the combined therapy as follows: 20mg methylprednisolone was injected periglomerularly beside the eyeballs, once /3d for 3 times; 800～1 000mg of methylprednisolone through intravenous drip for 3d, once/d; after 3d, oral administration of prednisone acetate for 1wk, 1mg/(kg·d; after 1wk, the dose decreased to 5mg/wk until withdraw. Simultaneously, oral administration of ranitidine capsules, calcium carbonate and vitamin D3 tablets were combined in the supportive treament. The differences of curative effect between two groups were comparatively analyzed.RESULTS: In the observation group, 25 eyes(71.4%were markedly effective, 7 eyes(20.0%were valid and 3 eyes(8.6%were invalid, and the total effective rate was 91.4%. In the control group, 15 eyes(42.9%were markedly effective, 14 eyes(40.0%were valid and 6 eyes(17.1%were invalid, and the total effective rate was 82.9%. The difference of total effective rate between the two groups was not statistically significant(P=0.477, but there was a significant difference in markedly effective rate between the two groups(χ2=5.833, P=0.016.CONCLUSION: Alprostadil combined with glucocorticoids is effective for AON, and it is worth of advocation.

Future control architecture and emerging observability needs

DEFF Research Database (Denmark)

Morch, Andrei Z.; Jakobsen, Sigurd Hofsmo; Visscher, Klaas

2015-01-01

The paper presents the first findings from workpackage "Increased Observability" in EU FP7 project ELECTRA. Accommodation of intermittent generation into the network and its reliable operation require a gradual evolution of the network structure and in particular improvement of its monitoring...... or observing. The present practices of observing distribution networks are quite limited and vary from country to country. New network architectures are expected to evolve in the close future, including web-of-cells (concept defined in ELECTRA), which will result in new control schemes, significantly different...

A controlled clinical trial of implant-retained mandibular overdentures : Clinical aspects

NARCIS (Netherlands)

Boerrigter, EM; VanOort, RP; Raghoebar, GM; Stegenga, B; Schoen, PJ; Boering, G

In a controlled clinical trial, treatment effects of mandibular overdentures on two different implant-systems in edentulous patients were compared one year after insertion of the new dentures. The implant-systems used were the Branemark system (Bra) and the IMZ-system. Treatment was randomly

Identifying Opportunities for Peer Learning: An Observational Study of Medical Students on Clinical Placements.

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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

Randomized Clinical Trial of Lansoprazole for Poorly Controlled Asthma in Children

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Holbrook, Janet T.; Wise, Robert A.; Gold, Benjamin D.; Blake, Kathryn; Brown, Ellen D.; Castro, Mario; Dozor, Allen J.; Lima, John; Mastronarde, John G.; Sockrider, Marianna; Teague, W. Gerald

2013-01-01

Context Asymptomatic gastroesophageal reflux (GER) is prevalent in children with asthma. It is not known whether treatment of GER with a proton-pump inhibitor (PPI) improves asthma control. Objective To determine whether lansoprazole is effective in reducing asthma symptoms in children without overt GER. Design, Setting, and Patients A multicenter, randomized, masked, placebo controlled, parallel clinical trial comparing lansoprazole to placebo in children with poor asthma control on inhaled corticosteroid treatment conducted at 18 academic clinical centers. Participants were followed for 24 weeks. A subgroup had an esophageal pH study before randomization. Intervention Children received either lansoprazole (15 mg daily lansoprazole and placebo groups, respectively (P=0.12). There were no detectable treatment differences in secondary outcomes (mean (95% CI) for FEV1(0.00 (−0.08, 0.08)), asthma quality of life (−0.1 (−0.4, 0.1) or episodes of poor asthma control, hazard ratio of 1.18 (95% CI 0.91, 1.53). Among the 115 children with esophageal pH studies, the prevalence of GER was 43%. In the subgroup with a positive pH study, no treatment effect for lansoprazole versus placebo was observed for any asthma outcome. Children treated with lansoprazole reported more upper respiratory infections (63% vs 49%, P=0.02), sore throats (52% vs 39%, P=0.02), and bronchitis (7% vs 2%, P=0.05). Conclusion Among children with poorly controlled asthma without symptoms of GER who were using inhaled corticosteroids, the addition of lansoprazole, as compared to placebo, did not improve symptoms nor lung function but was associated with increased adverse events. PMID:22274684

[Critical role of clinical laboratories in hospital infection control].

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Yagi, Tetsuya

2010-11-01

The hospital infection control and prevention is recognized to be more and more important according to the advances in modern medical treatment and care. Clinical microbiology laboratory play critical roles in the hospital infection control as a member of infection control team (ICT). They are the first in a hospital to identify outbreak of MRSA in NICU and molecular epidemiological analysis of the isolates lead proper intervention of ICT to the concerned ward. From a viewpoint of infectious disease specialist, rapid and precise microbiological information is essential for the appropriate diagnosis and treatment of infectious diseases. Each medical technologist need to make efforts to understand the characteristics of the examinations for infectious diseases and send out information useful for clinical practices. In our hospital, with the participation of all members of medical technologists, rapid reporting system was developed for blood culture examinations, which greatly contribute to the appropriate treatment of bloodstream infections. Collaborations of clinical microbiology laboratory with other members of ICT realize high quality hospital infection control. They also need to be aware of themselves as good practitioners of infection control measures to prevent hospital infections.

The clinical and radiological observation of congenital syphilis

International Nuclear Information System (INIS)

Nah, Byung Sik; Chung, Ung Ki

1983-01-01

Congenital syphilis is transmitted through the placenta by the infected mother after 16 weeks of gestation. Since the incidence of syphilis is again on the increase, syphilis remains at the present time a public problem of major and increasing proportions. Recently, congenital syphilis has different formas of presentation. The authors observed clinically and radiologically 27 cases of congenital syphilis in the neonates and infants treated at the pediatric ward of Chonnam National University Hospital from Jan. 1977 to Mar. 1982. The results are as follows: 1. The number of observed patients was 27 cases, 22 cases in male, 5 cases in female. 2. Onset of first clinical symptoms and signs was within the 4th week life in 14 cases (52%), 1-2 months in 6 cases (22%), 2-3 months in 4 cases (15%), 3-4 months in 3 cases (11%). All cases was within 6 months. 3. The order of the frequency of common clinical manifestations was hepatomegaly (96%), splenomegaly (78%), skin lesion (63%), anemia (63%), nasal snuffle (56%). 4. Of 11 cases with known birth weight, 10 cases were low birth weight. 5. The serologic test (VDRL slide test) of 27 tested caes revealed reactive response in 26 cases, non-reactive response in 1 case, and that of syphilitic mothers except one revealed reactive in 23 cases, non- reactive in 3 cases. 6. Roentgenographic syphilitic bony changes were detected in 26 cases (96%), of 27 studied cases, osteochondritis was present in 24 cases (89%), periostitis in 21 case (78%), osteomyelitis in 11 cases (41%). 7. The most common sites affected were as follows. Radius and ulna were the most frequently affected, the next were in order of tibia and fibula. Considering osteochondiritis only, the distal end of radius and ulna (78% respectively) and proximal end of tibra (67%) were the most frequently affected sites, the proximal end of femur (33%) was least frequently affected site. 8. On chest films of 27 case, osseous changes (mainly periostitis) of clavicle were noted

Clinical observation on parathion poisoning

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Park, Heung Il; Kwun, Chung Sik [Chonnam University Medical School, Kwangju (Korea, Republic of)

1972-09-15

A total of 158 cases of parathion poisoning were clinically observed in Chonnam University Hospital from January, 1968 to June, 1972 with the following results. 1. The males were 133 and the females, 25 (radio, about 5:1) with 93 patients (58.9%) in the age group of 21 to 40 years old and the majority of the patients were farmers. 2. 158 cases could be divided into 38 cases of inhalation group (group I) and 120 cases of ingestion group (group II). The group I entirely occurred by accident during spraying the parathion, whereas the group II mostly developed by ingestion of the parathion for the suicide purpose. 3. During the period from 1968 to 1972, more frequent incidence of parathion poisoning showed up in 1971 and 1972. Inhalation group mostly occurred on July, August, and September, but several cases appeared sporadically in the rest of the months. 4. Most patients came to our Hospital within 4 hours after parathion poisoning and were discharged from the Hospital within one or two days after admission. Mortality was 2 cases (5.3%) out of 38 cases in inhalation group and was 26 cases (21.7%) out of 120 cases in ingestion group. 5. Clinical signs and symptoms showing high incidence were bronchorrhoea (incidence of 38.6%), dyspnea (57.6%), vomiting (62.0%), abdominal cramps (20.0%), sialorrhoea (53.8%), tachycardia (32.2%), miosis (67.7%), fasciculation (19.0%), hypertension (27.9%), drowsiness and confusion (50.0%), leukocytosis (58.3%), elevation of SGOT (23.0%), whereas mydriasis (5.7%), and proteinuria (4.0%) were low in incidence. All the ten cases (6.3%) showing involuntary defecation expired. 6. Roentgenographs of the chest were taken to 39 cases out of a total of 158 cases and revealed 21 cases (54.0%) of normal chest, 11 cases (28.0%) of bilateral pulmonary congestion, 7 cases (18.0%) of pulmonary edema or pneumonic consolidation.

Utilizing visual art to enhance the clinical observation skills of medical students.

Science.gov (United States)

Jasani, Sona K; Saks, Norma S

2013-07-01

Clinical observation is fundamental in practicing medicine, but these skills are rarely taught. Currently no evidence-based exercises/courses exist for medical student training in observation skills. The goal was to develop and teach a visual arts-based exercise for medical students, and to evaluate its usefulness in enhancing observation skills in clinical diagnosis. A pre- and posttest and evaluation survey were developed for a three-hour exercise presented to medical students just before starting clerkships. Students were provided with questions to guide discussion of both representational and non-representational works of art. Quantitative analysis revealed that the mean number of observations between pre- and posttests was not significantly different (n=70: 8.63 vs. 9.13, p=0.22). Qualitative analysis of written responses identified four themes: (1) use of subjective terminology, (2) scope of interpretations, (3) speculative thinking, and (4) use of visual analogies. Evaluative comments indicated that students felt the exercise enhanced both mindfulness and skills. Using visual art images with guided questions can train medical students in observation skills. This exercise can be replicated without specially trained personnel or art museum partnerships.

Attitudes toward Placebo-Controlled Clinical Trials of Patients with Schizophrenia in Japan.

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Norio Sugawara

Full Text Available Although the use of placebo in clinical trials of schizophrenia patients is controversial because of medical and ethical concerns, placebo-controlled clinical trials are commonly used in the licensing of new drugs.The objective of this study was to assess the attitudes toward placebo-controlled clinical trials among patients with schizophrenia in Japan.Using a cross-sectional design, we recruited patients (n = 251 aged 47.7±13.2 (mean±SD with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder who were admitted to six psychiatric hospitals from December 2013 to March 2014. We employed a 14-item questionnaire specifically developed to survey patients' attitudes toward placebo-controlled clinical trials.The results indicated that 33% of the patients would be willing to participate in a placebo-controlled clinical trial. Expectations for improvement of disease, a guarantee of hospital treatment continuation, and encouragement by family or friends were associated with the willingness to participate in such trials, whereas a belief of additional time required for medical examinations was associated with non-participation.Fewer than half of the respondents stated that they would be willing to participate in placebo-controlled clinical trials. Therefore, interpreting the results from placebo-controlled clinical trials could be negatively affected by selection bias.

Some observations about quality control tests of Spect

International Nuclear Information System (INIS)

Robilotta, C.C.; Rebelo, M.F.S.; Oliveira, M.A.

1987-01-01

Some observations about quality control tests done in the tomographic system of Heart Institute are described. Among the tests, the traditional test of quality control with scintillation camera and the specific test for tomography systems are induced. The traditional tests are essential, but not sufficient for evaluating the Spect equipment and the specific tests have been effectuated in controlled conditions. (C.G.C.) [pt

Exploring the context for effective clinical governance in infection control.

Science.gov (United States)

Halton, Kate; Hall, Lisa; Gardner, Anne; MacBeth, Deborough; Mitchell, Brett G

2017-03-01

Effective clinical governance is necessary to support improvements in infection control. Historically, the focus has been on ensuring that infection control practice and policy is based on evidence, and that there is use of surveillance and auditing for self-regulation and performance feedback. There has been less exploration of how contextual and organizational factors mediate an infection preventionists (IP's) ability to engage with evidence-based practice and enact good clinical governance. A cross sectional Web-based survey of IPs in Australia and New Zealand was undertaken. Questions focused on engagement in evidence-based practice and perceptions about the context, culture, and leadership within the infection control team and organization. Responses were mapped against dimensions of Scally and Donaldson's clinical governance framework. Three hundred surveys were returned. IPs appear well equipped at an individual level to undertake evidence-based practice. The most serious set of perceived challenges to good clinical governance related to a lack of leadership or active resistance to infection control within the organization. Additional challenges included lack of information technology solutions and poor access to specialist expertise and financial resources. Focusing on strengthening contextual factors at the organizational level that otherwise undermine capacity to implement evidence-based practice is key to sustaining current infection control successes and promoting further practice improvements. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Clinical observations with AN-1792 using TAPIR analyses.

Science.gov (United States)

Hock, Christoph; Nitsch, Roger M

2005-01-01

Clinical observations with AN-1792 using tissue amyloid plaque immunoreactivity (TAPIR) analyses established for the first time evidence in humans that antibodies against beta-amyloid-related epitopes are capable of slowing progression in Alzheimer's disease. Antibodies derived upon TAPIR assay selection may specifically target the pathologic neoepitopes of aggregated A beta species present in amyloid plaques and some of their aggregated, protofibrillar and low molecular weight oligomeric precursors. We briefly summarize here how the proof of concept was established and why it provides the basis for a potential cure for Alzheimer's disease. Copyright 2005 S. Karger AG, Basel.

Levo-α-acetylmethadol (LAAM induced QTc-prolongation - results from a controlled clinical trial

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Wieneke H

2009-01-01

Full Text Available Abstract Background Due to potential proarrhythmic side-effects levo-α-Acetylmethadol (LAAM is currently not available in EU countries as maintenance drug in the treatment of opiate addiction. However, recent studies and meta-analyses underline the clinical advantages of LAAM with respect to the reduction of heroin use. Thus a reappraisal of LAAM has been demanded. The aim of the present study was to evaluate the relative impact of LAAM on QTc-interval, as a measure of pro-arrhythmic risk, in comparison to methadone, the current standard in substitution therapy. Methods ECG recordings were analysed within a randomized, controlled clinical trial evaluating the efficacy and tolerability of maintenance treatment with LAAM compared with racemic methadone. Recordings were done at two points: 1 during a run-in period with all patients on methadone and 2 24 weeks after randomisation into methadone or LAAM treatment group. These ECG recordings were analysed with respect to QTc-values and QTc-dispersion. Mean values as well as individual changes compared to baseline parameters were evaluated. QTc-intervals were classified according to CPMP-guidelines. Results Complete ECG data sets could be obtained in 53 patients (31 LAAM-group, 22 methadone-group. No clinical cardiac complications were observed in either group. After 24 weeks, patients receiving LAAM showed a significant increase in QTc-interval (0.409 s ± 0.022 s versus 0.418 s ± 0.028 s, p = 0.046, whereas no significant changes could be observed in patients remaining on methadone. There was no statistically significant change in QTc-dispersion in either group. More patients with borderline prolonged and prolonged QTc-intervals were observed in the LAAM than in the methadone treatment group (n = 7 vs. n = 1; p = 0.1. Conclusions In this controlled trial LAAM induced QTc-prolongation in a higher degree than methadone. Given reports of severe arrhythmic events, careful ECG-monitoring is recommended

Gain Scheduling of Observer-Based Controllers with Integral Action

DEFF Research Database (Denmark)

Trangbæk, Klaus; Stoustrup, Jakob; Bendtsen, Jan Dimon

2006-01-01

 This paper presents a method for continuous gain scheduling of  observer-based controllers with integral action. Given two stabilising controllers for a given system, explicit state space formulae are presented, allowing to change gradually from one  controller to the other while preserving...

Clinical observation of submandibular gland transfer for the prevention of xerostomia after radiotherapy for nasopharyngeal carcinoma: a prospective randomized controlled study of 32 cases

International Nuclear Information System (INIS)

Zhang, Xiangmin; Liu, Folin; Lan, Xiaolin; Yu, Lijiang; Wu, Wei; Wu, Xiuhong; Xiao, Fufu; Li, Shaojin

2014-01-01

The aim of this study was to evaluate the clinical efficacy of submandibular gland transfer for the prevention of xerostomia after radiotherapy for nasopharyngeal carcinoma. Using the randomized controlled clinical research method, 65 patients with nasopharyngeal carcinoma were randomly divided into an experimental group consisting of 32 patients and a control group consisting of 33 patients. The submandibular glands were averted to the submental region in 32 patients with nasopharyngeal carcinoma before they received conventional radiotherapy; a lead block was used to shield the submental region during therapy. Prior to radiotherapy, the function of the submandibular glands was assessed using imaging. Submandibular gland function was measured using 99mTc radionuclide scanning at 60 months after radiotherapy. The data in the questionnaire regarding the degree of xerostomia were investigated and saliva secretion was measured at 3, 6, 12, and 60 months after radiotherapy. In addition, the 5-year survival rate was calculated. After follow-up for 3, 6, and 12 months, the incidence of moderate to severe xerostomia was significantly lower in the experimental group than in the control group. The average amount of saliva produced by the experimental and control groups was 1.60 g and 0.68 g, respectively (P < 0.001). After follow-up for 60 months, the uptake and secretion functions of the submandibular glands in the experimental group were found to be significantly higher than in the control group (P < 0.001 and P < 0.001, respectively). The incidence of moderate or severe xerostomia was significantly lower than in the control group (15.4% and 76.9%, respectively; P < 0.001). The 5-year survival rates of the experimental group and the control group were 81.3% and 78.8%, respectively, and there was no significant difference between the two groups (P = 0.806). After a 5 year follow-up period involving 32 patients who had their submandibular glands transferred for the

Adaptive Observer-Based Fault-Tolerant Control Design for Uncertain Systems

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Huaming Qian

2015-01-01

Full Text Available This study focuses on the design of the robust fault-tolerant control (FTC system based on adaptive observer for uncertain linear time invariant (LTI systems. In order to improve robustness, rapidity, and accuracy of traditional fault estimation algorithm, an adaptive fault estimation algorithm (AFEA using an augmented observer is presented. By utilizing a new fault estimator model, an improved AFEA based on linear matrix inequality (LMI technique is proposed to increase the performance. Furthermore, an observer-based state feedback fault-tolerant control strategy is designed, which guarantees the stability and performance of the faulty system. Moreover, the adaptive observer and the fault-tolerant controller are designed separately, whose performance can be considered, respectively. Finally, simulation results of an aircraft application are presented to illustrate the effectiveness of the proposed design methods.

Sexual orientations of women with polycystic ovary syndrome: Clinical observation in Taiwan

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Ching-Hui Chen

2014-12-01

Conclusion: Our preliminary data showed that sexual orientation influenced the BMI of women with PCOS, but did not affect hyperandrogenism-related clinical or biochemical characteristics. This observation requires further confirmation.

Clinical Observation on Thyroid Carcinoma

Energy Technology Data Exchange (ETDEWEB)

Park, Seon Yang; Shin, Yong Tae; Cho, Bo Yun; Kim, Byung Kuk; Koh, Chang Soon; Lee, Mun Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1978-09-15

Clinical features of 147 patients with biopsy-proven thyroid carcinomas were investigated from January, 1972 to April, 1978 at the Seoul National University Hospital with the following results. 1) The incidence of thyroid carcinomas according to their histopathological classification revealed 76.2% of papillary carcinoma, 19.0% of follicular carcinoma, and 3 cases of occult sclerozing carcinoma, 1 case of giant cell carcinoma and 1 case of metastatic melanoma. 2) The ratio of male to female patients was 1:8.3 and showed no difference between papillary and follicular carcinomas. 3) The age distribution showed the peak incidence in the fourth decade (29.3%) followed by the fifth and sixth decades. 4) The average duration of illness from the onset of symptoms was about 5 years while it was 4.4 years and 7.6 years in the papillary and follicular carcinomas respectively. 5) The diameter of the thyroid masses was smaller than 5 cm in 53.6% of the patients, from 5 cm to 10 cm in 40.0% and larger than 10 cm in 6.4%. 6) In 36.4% of the patients with thyroid carcinomas the thyroid masses were fixed to adjacent tissues. 7) Metastasis to the regional lymph nodes was noted in 40.0% of the total cases, and in 45.2% and 17.6% of the papillary and follicular carcinomas respectively, while the lung and bone metastases were found in 10.0% and 4.4% in each type respectively. 8) 88.9% of the patients showed cold areas in the thyroid scans using {sup 131}I. 9) Typical psammoma bodies were observed in 21.3% of the cases in the microscopic examination of the pathological specimens. 10) The initial diagnosis of thyroid malignancy could be made before histological confirmation in 64.5% of the patients. 11) The clinical staging slightly modified from Schulz method revealed 43.6% of the patients in stage I, 26.4% in stage II, 20.9% in stage III and 9.1% in stage IV. 12) The association with Hashimoto's thyroiditis was noted in 4 cases, with nodular goiter in 3 cases, and with follicular

Cinacalcet and achievement of the NKF/K-DOQI recommended target values for bone and mineral metabolism in real-world clinical practice--the ECHO observational study

DEFF Research Database (Denmark)

Urena, P.; Jacobson, S.H.; Zitt, E.

2009-01-01

sevelamer; use of calcium-based phosphate binders increased by 5.6%. There was no unexpected safety or tolerability concerns. CONCLUSION: This analysis of current European clinical practice shows that-consistent with findings from randomized controlled trials and retrospective observational studies...

The clinical utility of nuclear magnetic resonance spectroscopy: recent in vitro, in vivo animal and clinical observations

International Nuclear Information System (INIS)

Blackstock, A. William; Kwock, Lester; Mukherji, Suresh K.; Schiro, Sharon; Tepper, Joel E.

1995-01-01

Purpose/Objective: Combined radiation and 5-fluorouracil (5-FU) has resulted in improved outcomes in patients treated with gastrointestinal malignancies and squamous cancers of the head and neck. In our first aim, we proposed that the enhanced cell kill and tumor regression observed with the combination of 5-FU and radiation is related to radiation potentiating the anti-tumor effects of 5-FU. Using fluorine-19 ( 19 F) nuclear magnetic resonance (nmr) we non-invasively determined the tumor clearance rates of 5-FU +/- radiation in an animal model and used this research tool to predict tumor response in patients receiving concurrent radiation and 5-FU therapy. Our second aim was to evaluate the use of proton ( 1 H) nmr spectroscopy to non-invasively determine the spectral characteristics of malignant tumors in the head and neck and liver and correlate these clinical observations with in vitro and in vivo data. Materials and Methods: 1 H and 19 F spectroscopic analysis were performed with a 2.0T Otsuka magnetic resonance imaging and spectroscopy system. 1 H nmr patient studies were done on a clinical 1.5T Philips MR system. In vitro magnetic resonance spectroscopy (MRS) studies were performed on a 11 T Bruker nmr system. Animal experiments for the 19 F nmr studies were performed on 3-6 week old female (Nu/Nu) athymic nude mice. Animals were injected s.c. with 10 6 human colon adenocarcinoma (HT-29) cells. At a tumor size of 1.0 cm, animals in the first group received i.v. 5-FU (100 mg/kg) immediately prior to spectroscopic analysis. Animals in the second group were treated with a single radiation dose of either 2 Gy or 10 Gy just prior to the 5-FU injection and subsequent spectroscopy. Spectroscopic analyses were performed at 20-30 minute intervals for 4-6 hr's. Results: 19 F nmr: A decrease in tumor clearance was observed in tumors pre-treated with a single dose of irradiation (2.0 Gy and 10 Gy). The clearance rate of the 5-FU for non-irradiated animals was 0.0178 min

[Nursing students' satisfaction and perception of their first clinical placement: observational study].

Science.gov (United States)

Comparcini, Dania; Simonetti, Valentina; Tomietto, Marco; Galli, Francesco; Fiorani, Catia; Di Labio, Luisa; Cicolini, Giancarlo

2014-01-01

Clinical learning environments are defined as an interactive network of forces within the clinical context that influence students' learning outcomes. Nursing students' satisfaction could be strictly related to their learning outcomes. Aim. To analyze the first year nursing students' clinical learning experience and to identify the main determinants of students' satisfaction. The observational study was carried out in five Italian nursing degree courses. 420 students filled out the validated Italian version of the "Clinical Learning Environment and Supervision plus Nurse Teacher (CLES+T) scale" after the conclusion of their first clinical placement. The mean values of the main sub-dimensions of CLES+T varied from 4.02 (pedagogical atmosphere) to 3.30 (supervisory relationship). Students were mainly satisfied with their clinical placement, however the findings showed statistical significantly differences among the five nursing courses. The main determinants of the overall students' satisfaction are the nurse manager's leadership style and the integration between theoretical knowledge and everyday practice of nursing through the relationship among students, clinical tutors and nurse teacher. Our results may contribute to better understand nursing students' perception of their first clinical placement. However, further research are needed to evaluate which organizational factors and clinical training models may enhance the clinical learning experience.

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study

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Daniel Spadoto Dias

Full Text Available CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation.DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital.METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used.RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001, premenstrual symptoms (P < 0.001, dysmenorrhea (P = 0.019 and noncyclic pelvic pain (P = 0.001; and reductions in the number of sexual intercourse occurrences per week (P = 0.001 and in libido (P = 0.001. Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions.CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity.

Effect of nonsurgical periodontal treatment on clinical response and glycemic control in type 2 diabetic patients with periodontitis: Controlled clinical trial

Directory of Open Access Journals (Sweden)

Ajitha Kanduluru

2014-01-01

Full Text Available Background: Type 2 diabetes mellitus (type 2 DM and chronic periodontitis are common chronic diseases in adults in the world population. Once periodontal disease is established, the chronic nature of this infection may contribute to worsening of diabetic status leading to more severe diabetes-related complications. It has been proposed that the relation of periodontitis and diabetes is bidirectional. Objectives: The objective was to compare the clinical response and glycemic control in type 2 DM patients with periodontitis, before and after the nonsurgical periodontal treatment with controls. Materials and Methods: A total 70 type 2 DM patients with chronic generalized moderate periodontitis was divided into 2 groups. Treatment group (35 received one stage full mouth scaling and root planning plus oral hygiene instructions; the control group (35 received only oral hygiene instructions. At baseline, 1 st month and 3 rd month, the clinical periodontal parameters (plaque index [PI], gingival index [GI], pocket depth [PD], clinical attachment loss [CAL], gingival recession [GR], and bleeding on probing [BOP] and glycemic parameters (fasting blood sugar [FBS], and postprandial blood sugar [PPBS] were recorded, whereas the glycated hemoglobin (HbA1c was recorded only at baseline and 3rd month. The collected data were subjected to statistical analysis. Results: When comparing the mean scores of clinical parameters for both the groups, there was a significant difference in all clinical parameters, that is, mean PI, GI, BOP, PD, CAL scores except mean GR, whereas for the glycemic parameters, there was a significant difference in mean FBS; PPBS values and no significant difference in mean percentage of HbA1c for treatment group at 3 rd month follow-up. Conclusion: Findings of the present study showed that nonsurgical periodontal treatment resulted in lower glycemic levels and the reduction of clinical parameters of periodontal infection, confirming the

Truth telling in medical practice: students' opinions versus their observations of attending physicians' clinical practice.

Science.gov (United States)

Tang, Woung-Ru; Fang, Ji-Tseng; Fang, Chun-Kai; Fujimori, Maiko

2013-07-01

Truth telling or transmitting bad news is a problem that all doctors must frequently face. The purpose of this cross-sectional study was to investigate if medical students' opinions of truth telling differed from their observations of attending physicians' actual clinical practice. The subjects were 275 medical clerks/interns at a medical center in northern Taiwan. Data were collected on medical students' opinions of truth telling, their observations of physicians' clinical practice, students' level of satisfaction with truth telling practiced by attending physicians, and cancer patients' distress level when they were told the truth. Students' truth-telling awareness was significantly higher than the clinical truth-telling practice of attending physicians (pmedical students' opinions on truth telling and attending physicians' actual clinical practice. More research is needed to objectively assess physicians' truth telling in clinical practice and to study the factors affecting the method of truth telling used by attending physicians in clinical practice. Copyright © 2012 John Wiley & Sons, Ltd.

The impacts of observing flawed and flawless demonstrations on clinical skill learning.

Science.gov (United States)

Domuracki, Kurt; Wong, Arthur; Olivieri, Lori; Grierson, Lawrence E M

2015-02-01

Clinical skills expertise can be advanced through accessible and cost-effective video-based observational practice activities. Previous findings suggest that the observation of performances of skills that include flaws can be beneficial to trainees. Observing the scope of variability within a skilled movement allows learners to develop strategies to manage the potential for and consequences associated with errors. This study tests this observational learning approach on the development of the skills of central line insertion (CLI). Medical trainees with no CLI experience (n = 39) were randomised to three observational practice groups: a group which viewed and assessed videos of an expert performing a CLI without any errors (F); a group which viewed and assessed videos that contained a mix of flawless and errorful performances (E), and a group which viewed the same videos as the E group but were also given information concerning the correctness of their assessments (FA). All participants interacted with their observational videos each day for 4 days. Following this period, participants returned to the laboratory and performed a simulation-based insertion, which was assessed using a standard checklist and a global rating scale for the skill. These ratings served as the dependent measures for analysis. The checklist analysis revealed no differences between observational learning groups (grand mean ± standard error: [20.3 ± 0.7]/25). However, the global rating analysis revealed a main effect of group (d.f.2,36 = 4.51, p = 0.018), which describes better CLI performance in the FA group, compared with the F and E groups. Observational practice that includes errors improves the global performance aspects of clinical skill learning as long as learners are given confirmation that what they are observing is errorful. These findings provide a refined perspective on the optimal organisation of skill education programmes that combine physical and observational practice

Wilson's disease: cranial MRI observations and clinical correlation

Energy Technology Data Exchange (ETDEWEB)

Sinha, S.; Taly, A.B.; Prashanth, L.K.; Venugopal, K.S.; Arunodaya, G.R.; Swamy, H.S. [National Institute of Mental Health and Neurosciences (NIMHANS), Department of Neurology, Bangalore (India); Ravishankar, S.; Vasudev, M.K. [National Institute of Mental Health and Neurosciences (NIMHANS), Department of Neuroimaging and Interventional Radiology, Bangalore (India)

2006-09-15

Study of MRI changes may be useful in diagnosis, prognosis and better understanding of the pathophysiology of Wilson's disease (WD). We aimed to describe and correlate the MRI abnormalities of the brain with clinical features in WD. MRI evaluation was carried out in 100 patients (57 males, 43 females; mean age 19.3{+-}8.9 years) using standard protocols. All but 18 patients were on de-coppering agents. Their history, clinical manifestations and scores for severity of disease were noted. The mean duration of illness and treatment were 8.3{+-}10.8 years and 7.5{+-}7.1 years respectively. MRI of the brain was abnormal in all the 93 symptomatic patients. The most conspicuous observations were atrophy of the cerebrum (70%), brainstem (66%) and cerebellum (52%). Signal abnormalities were also noted: putamen (72%), caudate (61%), thalami (58%), midbrain (49%), pons (20%), cerebral white matter (25%), cortex (9%), medulla (12%) and cerebellum (10%). The characteristic T2-W globus pallidal hypointensity (34%), ''Face of giant panda'' sign (12%), T1-W striatal hyperintensity (6%), central pontine myelinosis (7%), and bright claustral sign (4%) were also detected. MRI changes correlated with disease severity scores (P<0.001) but did not correlate with the duration of illness. MRI changes were universal but diverse and involved almost all the structures of the brain in symptomatic patients. A fair correlation between MRI observations and various clinical features provides an explanation for the protean manifestations of the disease. (orig.)

Clinical pathology observation on orbit IgG4 related disease

Directory of Open Access Journals (Sweden)

Ji-Hua Guo

2015-09-01

Full Text Available AIM:To discuss clinical pathological features of orbit IgG4 related disease(IgG4-RD. METHODS: The clinical pathological materials of 23 patients(35 eyeswith orbit IgG4-RD were collected. They were observed in terms of histology and immunohistochemistry, and its clinical and pathologic characteristics were summarized. RESULTS: There were 23 patients(35 eyeswith orbit IgG4-RD(8 male patients, 9 eyes; 15 female patients, 26 eyes, with an average age of 52.1 year-old(from age 28 to 72. 19 patients(30 eyesoccured in lacrimal gland and 4 cases(5 eyesin other places, and they went to hospital for lacrimal gland cyst or exophthalmos. There were 11 cases in one side and 12 cases in both sides. The disease lasted from 1mo to 10a, averaging 27mo. It recureded in one patient(1 eyeafter 1mo. In general inspection: Gray nodular goiter, thin fibrous coat wrapping around the lacrimal gland could be observed. Histologic characteristics: lacrimal gland bubble and catheter group shrinked or even disappeared, substituted by lymphocyte, plasma cells and lymphoid follicle and accompanied with fibrosis. Immunohistochemical staining: IgG4 positive plasma cells of 23 cases(35 eyeswas >50/HPF, and IgG4/IgG ratio of positive plasma cells was >40%. CONCLUSION: Orbit IgG4-RD mainly occures in lacrimal gland tissue, and expression of IgG4 can be detected through histologic characteristics and immunohistochemical staining. IgG4-RD should be screened, prevented and treated in the early phase.

Participants' perception of pharmaceutical clinical research: a cross-sectional controlled study

Directory of Open Access Journals (Sweden)

González-Saldivar G

2016-04-01

Full Text Available Gerardo González-Saldivar,1 René Rodríguez-Gutiérrez,2 José Luis Viramontes-Madrid,3 Alejandro Salcido-Montenegro,2 Kevin Erick Gabriel Carlos-Reyna,2 Andrés Marcelo Treviño-Alvarez,2 Neri Alejandro Álvarez-Villalobos,4 José Gerardo González-González2 1Ophthalmology Department, 2Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, 3Instituto Nacional de Salud Pública, Cuernavaca, Morelos, 4Medical Statistics Department, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico Background: There is scarce scientific information assessing participants’ perception of pharmaceutical research in developed and developing countries concerning the risks, safety, and purpose of clinical trials.Methods: To assess the perception that 604 trial participants (cases and 604 nonparticipants (controls of pharmaceutical clinical trials have about pharmaceutical clinical research, we surveyed participants with one of four chronic diseases from 12 research sites throughout Mexico.Results: Participation in clinical trials positively influences the perception of pharmaceutical clinical research. More cases (65.4% than controls (50.7% perceived that the main purpose of pharmaceutical research is to cure more diseases and to do so more effectively. In addition, more cases considered that there are significant benefits when participating in a research study, such as excellent medical care and extra free services, with this being the most important motivation to participate for both groups (cases 52%, controls 54.5%. We also found a sense of trust in their physicians to deal with adverse events, and the perception that clinical research is a benefit to their health, rather than a risk. More controls believed that clinical trial participants’ health is put at risk

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

Clinical observation of modified hydroxyapatite implant in scleral shell

Directory of Open Access Journals (Sweden)

Qing-Wei Du

2014-10-01

Full Text Available AIM: To evaluate the clinical effects of modified hydroxyapatite implant in scleral shell.METHODS:Thirty-four cases were performed eye evisceration, autogenous sclera shell anterior and posterior petaloid shape with posterior sclera fenestration, hydroxyapatite artificial eyeballs were implanted at stage I, and conjunctival wound, orbital activity and other complications were observed after surgery.RESULTS: The follow-up was 6～12mo. There was no patients with implant exposure, sclera dissolution, conjunctival wound dehiscence, conjunctival sac constriction noted. All the patients got good activity of artificial globe, and the active range of side motion of the HA was 10°～15°.The artificial eyes looked symmetrical, and the eyes socket were full.CONCLUSION: The modified hydroxyapatite implant in scleral shell can maintain the normal anatomy of the orbital tissue, and also can get full eyes socket and good activity, It was an easy and simple surgery which could obtain satisfactory clinical effect and less complications.

Disturbance attenuation of nonlinear control systems using an observer-based fuzzy feedback linearization control

International Nuclear Information System (INIS)

Chen, C.-C.; Hsu, C.-H.; Chen, Y.-J.; Lin, Y.-F.

2007-01-01

The almost disturbance decoupling and trajectory tracking of nonlinear control systems using an observer-based fuzzy feedback linearization control (FLC) is developed. Because not all of the state variables of the nonlinear dynamic equations are available, a nonlinear state observer is employed to estimate the state variables. The feedback linearization control guarantees the almost disturbance decoupling performance and the uniform ultimate bounded stability of the tracking error system. Once the tracking errors are driven to touch the global final attractor with the desired radius, the fuzzy logic control is immediately applied via human expert's knowledge to improve the convergence rate. One example, which cannot be solved by the first paper on the almost disturbance decoupling problem, is proposed in this paper to exploit the fact that the tracking and the almost disturbance decoupling performances are easily achieved by our proposed approach. In order to demonstrate the practical applicability, the study has investigated a pendulum control system

Quality of glycaemic control in ambulatory diabetics at the out-patient clinic of Kenyatta National Hospital, Nairobi.

Science.gov (United States)

Otieno, C F; Kariuki, M; Ng'ang'a, L

2003-08-01

Treatment of diabetes mellitus is based on the evidence that lowering blood glucose as close to normal range as possible is a primary strategy for reducing or preventing complications or early mortality from diabetes. This suggests poorer glycaemic control would be associated with excess of diabetes-related morbidity and mortality. This presumption is suspected to reach high proportions in developing countries where endemic poverty abets poor glycaemic control. There is no study published on Kenyan patients with diabetes mellitus about their glycaemic control as an audit of diabetes care. To determine the glycaemic control of ambulatory diabetic patients. Cross-sectional study on each clinic day of a randomly selected sample of both type 1 and 2 diabetic patients. Kenyatta National Hospital. Over a period of six months, January 1998 to June 1998. During routine diabetes care in the clinic, mid morning random blood sugar and glycated haemoglobin (HbA1c) were obtained. A total of 305 diabetic patients were included, 52.8% were females and 47.2% were males. 58.3% were on Oral Hypoglycaemic Agent (OHA) only, 22.3% on insulin only; 9.2% on OHA and insulin and 4.6% on diet only. 39.5% had mean HbA1c or = 8%. Patients on diet-only therapy had the best mean HbA1c = 7.04% while patients on OHA-only had the worst mean HbA1c = 9.06%. This difference was significant (p=0.01). The former group, likely, had better endogenous insulin production. The influence of age, gender and duration of diabetes on the level of glycaemic control observed did not attain statistically significant proportions. The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin production. Poor glycaemic control was presumed to be due to sub-optimal medication and

Management Control Systems and Clinical Experience of Managers in Public Hospitals

Science.gov (United States)

Naranjo-Gil, David

2018-01-01

Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector. PMID:29673192

When to base clinical policies on observational versus randomized trial data.

Science.gov (United States)

Hornberger, J; Wrone, E

1997-10-15

Physicians must decide when the evidence is sufficient to adopt a new clinical policy. Analysis of large clinical and administrative databases is becoming an important source of evidence for changing clinical policies. Because such analysis cannot control for the effects of all potential confounding variables, physicians risk drawing the wrong conclusion about the cause-and-effect relation between a change in clinical policy and outcomes. Randomized studies offer protection against drawing a conclusion that would lead to adoption of an inferior policy. However, a randomized study may be difficult to justify because of the extra costs of collecting data for a randomized study and concerns that a study will not directly benefit the patients enrolled in the study. This article reviews the advantages and disadvantages of basing clinical policy on analysis of large databases compared with conducting a randomized study. A technique is described and illustrated for accessing the potential costs and benefits of conducting such a study. This type of analysis formed the basis for a physician-managed health care organization deciding to sponsor a randomized study among patients with end-stage renal disease as part of a quality-improvement initiative.

The Asthma Control Questionnaire as a clinical trial endpoint

DEFF Research Database (Denmark)

Barnes, P J; Casale, T B; Dahl, Ronald

2014-01-01

these component endpoints; however, there is no consensus on the optimal instrument for use in clinical trials. The Asthma Control Questionnaire (ACQ) has been shown to be a valid, reliable instrument that allows accurate and reproducible assessment of asthma control that compares favourably with other commonly...

[Clinical observation of peptic ulcer treated with acupuncture based on theory of "the compatibility of the five meridians" in Huxiang].

Science.gov (United States)

Li, Cuiying; Li, Jinxiang; Pan, Shimin; Zhang, Xi; Li, Ying

2017-08-12

To compare the effects differences for peptic ulcer between acupuncture based on the theory of "the compatibility of the five meridians" in Huxiang and conventional western medication. Sixty patients with peptic ulcer of liver-stomach disharmony type (LSDT) and weakness of spleen and stomach type (WSST) were assigned into an observation group and a control group by block randomization according to syndrome differentiation.Finally,28 cases (17 with LSDT and 11 with WSST) in the observation group,29 cases (18 with LSDT and 11 with WSST) in the control group were included.In the observation group,patients with LSDT were treated with acupuncture at Zhongwan (CV 12),Taichong (LR 3),Xingjian (LR 2),Qimen (LR 14),Zusanli (ST 36),Gongsun (SP 4),Shaofu (HT 8),Jingqu (LU 8),Neiguan (PC 6); those with WSST,at Zhongwan (CV 12),Dadu (SP 2),Taibai (SP 3),Yinlingquan (SP 9),Zusanli (ST 36),Shaofu (HT 8), Taichong (LR 3),Yingu (KI 10),Taixi (KI 3),Taiyuan (LU 9) according to the theory of "the compatibility of the five meridians" in Huxiang .Reinforcing and reducing were according to syndrome differentiation.The treatment was given once a day with needle retained for 30 min,5 days a week,2 days at interval.In the control group,the conventional triple drugs (omeprazole,amoxicillin and clarithromycin) were prescribed orally for Hp positive patients,and omeprazole for Hp negative patients.All the patients were treated for 4 weeks.The clinical syndrome score,ulcer healing under gastroscope,anti-Hp infection and Hp negative conversion ratio rate were observed in the two groups before and after treatment as well as 1 month after treatment.The total effects were evaluated. The syndrome scores after treatment and at 1 month ofter treatment decreased in the two groups (all P 0.05).The scores within the group between the two syndromes showed no significance in the two groups (both P >0.05).The cure rates under gastroscope,anti-Hp infection rates and the total rates had no statistically

[Clinical observation on controlling antihypertension with the general anesthesia of TEAS and anesthetics in endoscopic endonasal surgery].

Science.gov (United States)

Zhao, Wensheng; Zhao Xian; Li, Jinjin; Fang, Jianqiao

2015-12-01

To study whether the dose of controlling antihypertensive drug is reduced by transcutaneous electrical acupoint stimulation (TEAS) and the anesthetics, as well as the control of blood pressure (BP) and heart rate (HR) in endoscopic endonasal surgery with general anesthesia. Sixty patients for selective endoscopic endonasal surgery with general anesthetics and controlling antihypertension involved were selected and randomized into a TEAS group, a sham-TEAS group, 30 cases in each one. The electric pads were attached to bilateral Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6) and Quchi (LI 11), stimulated with Hans-200 apparatus, 3 to 5 mA, 2 Hz/100 Hz in the TEAS group based on the patients' response to comfort. No electric stimulation was applied to the sham-TEAS group. The general anesthesia started after 30 min intervention and lasted till the end of surgery. The BP and HR were observed and recorded at the end of monitoring in operation room, 10 min after tranquilization (T0), 30 min after intervention (Tj, after induction~of general anestiesa (T2), 30 min after surgery start (T3), 60 min after surgery start (T4) and 30 min after extubation (T5). The doses of vecuronium bromide, propofol and nitroglycerin were recorded statistically in surgery, as well as the operative bleeding volume, the operative time, the resuscitation time and the visual analogue scale (VAS) score after resuscitation. Compared with that at T0, the mean arterial pressure (MAP) at T2, T3, T4 and T5 in the TEAS group and at T3 and T4 in the sham-TEAS group was all reduced, indicating the significant difference (all P 0.05). HR was different at T2 to Ts in the sham-TEAS group statistically (all P 0.05). The general anesthesia with TEAS and anesthetics involved for controlling antihypertension contributes to the control of BP and HR in the patients in endoscopic endonasal surgery. The impacts are not obvious on the doses of antihypertensive drug, the general anesthetics, the operative bleeding

Automated characterization of perceptual quality of clinical chest radiographs: Validation and calibration to observer preference

International Nuclear Information System (INIS)

Samei, Ehsan; Lin, Yuan; Choudhury, Kingshuk R.; Page McAdams, H.

2014-01-01

Purpose: The authors previously proposed an image-based technique [Y. Lin et al. Med. Phys. 39, 7019–7031 (2012)] to assess the perceptual quality of clinical chest radiographs. In this study, an observer study was designed and conducted to validate the output of the program against rankings by expert radiologists and to establish the ranges of the output values that reflect the acceptable image appearance so the program output can be used for image quality optimization and tracking. Methods: Using an IRB-approved protocol, 2500 clinical chest radiographs (PA/AP) were collected from our clinical operation. The images were processed through our perceptual quality assessment program to measure their appearance in terms of ten metrics of perceptual image quality: lung gray level, lung detail, lung noise, rib–lung contrast, rib sharpness, mediastinum detail, mediastinum noise, mediastinum alignment, subdiaphragm–lung contrast, and subdiaphragm area. From the results, for each targeted appearance attribute/metric, 18 images were selected such that the images presented a relatively constant appearance with respect to all metrics except the targeted one. The images were then incorporated into a graphical user interface, which displayed them into three panels of six in a random order. Using a DICOM calibrated diagnostic display workstation and under low ambient lighting conditions, each of five participating attending chest radiologists was tasked to spatially order the images based only on the targeted appearance attribute regardless of the other qualities. Once ordered, the observer also indicated the range of image appearances that he/she considered clinically acceptable. The observer data were analyzed in terms of the correlations between the observer and algorithmic rankings and interobserver variability. An observer-averaged acceptable image appearance was also statistically derived for each quality attribute based on the collected individual acceptable ranges

Automated characterization of perceptual quality of clinical chest radiographs: Validation and calibration to observer preference

Energy Technology Data Exchange (ETDEWEB)

Samei, Ehsan, E-mail: samei@duke.edu [Carl E. Ravin Advanced Imaging Laboratories, Departments of Radiology, Physics, Biomedical Engineering, Electrical and Computer Engineering, Medical Physics Graduate Program, Duke Clinical Imaging Physics Group, Duke University, Durham, North Carolina 27710 (United States); Lin, Yuan [Carl E. Ravin Advanced Imaging Laboratories, Departments of Radiology and Physics, Duke University, Durham, North Carolina 27710 (United States); Choudhury, Kingshuk R. [Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology and Biostatistics and Bioinformatics, Duke University, Durham, North Carolina 27710 (United States); Page McAdams, H. [Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University, Durham, North Carolina 27710 (United States)

2014-11-01

Purpose: The authors previously proposed an image-based technique [Y. Lin et al. Med. Phys. 39, 7019–7031 (2012)] to assess the perceptual quality of clinical chest radiographs. In this study, an observer study was designed and conducted to validate the output of the program against rankings by expert radiologists and to establish the ranges of the output values that reflect the acceptable image appearance so the program output can be used for image quality optimization and tracking. Methods: Using an IRB-approved protocol, 2500 clinical chest radiographs (PA/AP) were collected from our clinical operation. The images were processed through our perceptual quality assessment program to measure their appearance in terms of ten metrics of perceptual image quality: lung gray level, lung detail, lung noise, rib–lung contrast, rib sharpness, mediastinum detail, mediastinum noise, mediastinum alignment, subdiaphragm–lung contrast, and subdiaphragm area. From the results, for each targeted appearance attribute/metric, 18 images were selected such that the images presented a relatively constant appearance with respect to all metrics except the targeted one. The images were then incorporated into a graphical user interface, which displayed them into three panels of six in a random order. Using a DICOM calibrated diagnostic display workstation and under low ambient lighting conditions, each of five participating attending chest radiologists was tasked to spatially order the images based only on the targeted appearance attribute regardless of the other qualities. Once ordered, the observer also indicated the range of image appearances that he/she considered clinically acceptable. The observer data were analyzed in terms of the correlations between the observer and algorithmic rankings and interobserver variability. An observer-averaged acceptable image appearance was also statistically derived for each quality attribute based on the collected individual acceptable ranges

Controllers with Minimal Observation Power (Application to Timed Systems)

DEFF Research Database (Denmark)

Bulychev, Petr; Cassez, Franck; David, Alexandre

2012-01-01

We consider the problem of controller synthesis under imper- fect information in a setting where there is a set of available observable predicates equipped with a cost function. The problem that we address is the computation of a subset of predicates sufficient for control and whose cost is minimal...

Management Control Systems and Clinical Experience of Managers in Public Hospitals

Directory of Open Access Journals (Sweden)

Rogério Joao Lunkes

2018-04-01

Full Text Available Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.

Clinical observation of Artisan iris-clip intraocular lens implantation at stage Ⅰ

Directory of Open Access Journals (Sweden)

Qing Zhou

2014-09-01

Full Text Available AIM: To observe the clinical efficacy of Artisan iris-clip intraocular lens(IOLimplantation on cataract with a wide range of lens dislocation.METHODS: Twenty-four hospital patients(28 eyesof cataract with lens subluxation by trauma(20 patients, 20 eyesand Marfan's syndrome(4 patients, 8 eyesduring May 2007 to December 2011 were selected. All of them underwent phacoemulsification or an anterior vitrectomy and Artisan iris-clip IOL implantation at stage Ⅰ. Postoperative visual acuity, corneal endothelial cell count, intraocular lens position and postoperative complications were observed. Follow-up time was 6mo.RESULTS:Compared with the preoperative, postoperative best corrected visual acuity improved to varying degrees, visual acuity of 0.1-0.5 was in 20 eyes, 0.5-1.0 in 8 eyes. After followed up 1-6mo, no artificial lens shift, iris inflammation, iris atrophy and corneal decompensation and other complications were observed.CONCLUSION: Cataract surgery with a wide range of lens dislocation is difficult, but as long as surgeons who have a wealth of clinical experience and superb skills, still can carry out phacoemulsification surgery or anterior vitrectomy and Artisan iris-clip IOL implantation and obtain a better outcome.

Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity

Directory of Open Access Journals (Sweden)

Birtwhistle Richard

2003-12-01

Full Text Available Abstract Background Controlled clinical trials of health care interventions are either explanatory or pragmatic. Explanatory trials test whether an intervention is efficacious; that is, whether it can have a beneficial effect in an ideal situation. Pragmatic trials measure effectiveness; they measure the degree of beneficial effect in real clinical practice. In pragmatic trials, a balance between external validity (generalizability of the results and internal validity (reliability or accuracy of the results needs to be achieved. The explanatory trial seeks to maximize the internal validity by assuring rigorous control of all variables other than the intervention. The pragmatic trial seeks to maximize external validity to ensure that the results can be generalized. However the danger of pragmatic trials is that internal validity may be overly compromised in the effort to ensure generalizability. We are conducting two pragmatic randomized controlled trials on interventions in the management of hypertension in primary care. We describe the design of the trials and the steps taken to deal with the competing demands of external and internal validity. Discussion External validity is maximized by having few exclusion criteria and by allowing flexibility in the interpretation of the intervention and in management decisions. Internal validity is maximized by decreasing contamination bias through cluster randomization, and decreasing observer and assessment bias, in these non-blinded trials, through baseline data collection prior to randomization, automating the outcomes assessment with 24 hour ambulatory blood pressure monitors, and blinding the data analysis. Summary Clinical trials conducted in community practices present investigators with difficult methodological choices related to maintaining a balance between internal validity (reliability of the results and external validity (generalizability. The attempt to achieve methodological purity can

Future enhanced clinical role of pharmacists in emergency departments in England:multi-site observational evaluation

OpenAIRE

Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony

2017-01-01

Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at thei...

Control of anxiety through music in a head and neckoutpatient clinic: a randomized clinical trial

Directory of Open Access Journals (Sweden)

Mariana Alves Firmeza

Full Text Available Abstract OBJECTIVE Evaluating the effectiveness of a musical intervention in reducing anxiety and vital parameters in people suffering from head and neck cancer. METHOD A randomized controlled clinical trial, performed in a head and neck outpatient clinic with 40 participants, subdivided into two groups (intervention and control.The classicalmusic“Spring” from The Four Seasons by Vivaldi was used as an intervention.The State-Trait Anxiety Inventory (STAI was used as the data collectioninstrument,along with an inventory of socio-demographic and clinical data. Student'st-test was used to verify intragroup and intergroup statistical significance. RESULTS Participants presented a statistically significant reduction in levels of perceived anxiety (t= 12.68; p<0.001,as well as blood pressure levels (t = 4.56; p<0.001; pulse (t = 6.15; p<0.001 and respiratory rate (t = 5.10; p<0.001. CONCLUSION Music has proven to be an effective non-pharmacological therapeutic resource in managinganxiety in an outpatient setting for people with cancer, as well as in reducing blood pressure, pulse and respiratory rate. Brazilian Registry of Clinical Trials: RBR-7W4YJJ

Clinical Observation on Hyperthyroidism

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Lee, Kyu Bo; Kang, Bann; Song, Suk Ho; Park, Hi Myung; Whnag, Kee Suk [Kyungpook National University School of Medicine, Deagu (Korea, Republic of)

1969-09-15

A clinical analysis was made on 161 cases of hyperthyroidism seen at the Radioisotope Laboratory of Kyungpook National University Hospital. This series consisted of 144 cases of diffuse goiter and 17 cases of nodular goiter. 1) Hyperthyroidism was most prevalent in the 4th decade and male to female ratio was 1 : 4.6. 2) Cardinal symptoms in the order of frequency were weakness, easy fatigability, palpitation, weight loss, nervousness, perspiration, heat intolerance, increased appetite, insomnia and dysmenorrhoea. 3) Major physical findings in the order of frequency were goiter, fine tremor, tachycardia, wide pulse pressure, emaciation, warm moist skin, exophthalmos, systolic hypertension and atrial fibrillation. 4) The complications were ophthalmopathy (34.2%), thyrotoxic heart disease (5.6%), thyroid crisis (1 case), pretibial myxedema (1 case) and thyrotoxic myopathy (1 case). 5) Mean values of the six hour and twenty-four hour {sup 131}I uptakes by the thyroid glands were 67.5% and 71.6%, respectively, in diffuse goiter and 64.5% and 65.0%, respectively, in nodular goiter. 6) Mean values of twenty-four PB{sup 131}I conversion ratio were 76.3% in diffuse goiter and 70.2% in nodular goiter and those of the basal metabolic rate was +51% in the former and +41% in the latter. Mean serum cholesterol level was 152 mg% in diffuse goiter and that in nodular goiter was 175 mg%. 7) Among the 134 cases treated with {sup 131}I, 66 cases (49.3%) were successfully controlled with single dose and in the majority of the cases the initial therapeutic dose required was 4.1-4.0 mC in diffuse goiter and 5.1-6.0 mC in nodular goiter. 8) With {sup 131}I treatment the symptoms improved in the following order: heat intolerance, emaciation, nervousness, insomnia, easy fatigability, weakness, fine tremor, goiter, perspiration, exertional dyspnea and palpitation. And in a few cases improvement of even exophthalmos was seen. 9) Following {sup 131}I treatment myxedema occurred in 4 cases (3

Clinical Observation on Hyperthyroidism

International Nuclear Information System (INIS)

Lee, Kyu Bo; Kang, Bann; Song, Suk Ho; Park, Hi Myung; Whnag, Kee Suk

1969-01-01

A clinical analysis was made on 161 cases of hyperthyroidism seen at the Radioisotope Laboratory of Kyungpook National University Hospital. This series consisted of 144 cases of diffuse goiter and 17 cases of nodular goiter. 1) Hyperthyroidism was most prevalent in the 4th decade and male to female ratio was 1 : 4.6. 2) Cardinal symptoms in the order of frequency were weakness, easy fatigability, palpitation, weight loss, nervousness, perspiration, heat intolerance, increased appetite, insomnia and dysmenorrhoea. 3) Major physical findings in the order of frequency were goiter, fine tremor, tachycardia, wide pulse pressure, emaciation, warm moist skin, exophthalmos, systolic hypertension and atrial fibrillation. 4) The complications were ophthalmopathy (34.2%), thyrotoxic heart disease (5.6%), thyroid crisis (1 case), pretibial myxedema (1 case) and thyrotoxic myopathy (1 case). 5) Mean values of the six hour and twenty-four hour 131 I uptakes by the thyroid glands were 67.5% and 71.6%, respectively, in diffuse goiter and 64.5% and 65.0%, respectively, in nodular goiter. 6) Mean values of twenty-four PB 131 I conversion ratio were 76.3% in diffuse goiter and 70.2% in nodular goiter and those of the basal metabolic rate was +51% in the former and +41% in the latter. Mean serum cholesterol level was 152 mg% in diffuse goiter and that in nodular goiter was 175 mg%. 7) Among the 134 cases treated with 131 I, 66 cases (49.3%) were successfully controlled with single dose and in the majority of the cases the initial therapeutic dose required was 4.1-4.0 mC in diffuse goiter and 5.1-6.0 mC in nodular goiter. 8) With 131 I treatment the symptoms improved in the following order: heat intolerance, emaciation, nervousness, insomnia, easy fatigability, weakness, fine tremor, goiter, perspiration, exertional dyspnea and palpitation. And in a few cases improvement of even exophthalmos was seen. 9) Following 131 I treatment myxedema occurred in 4 cases (3%) and reoccurrence in 9

New definitions of 6 clinical signs of perceptual disorder in children with cerebral palsy: an observational study through reliability measures.

Science.gov (United States)

Ferrari, A; Sghedoni, A; Alboresi, S; Pedroni, E; Lombardi, F

2014-12-01

Recently authors have begun to emphasize the non-motor aspects of Cerebral Palsy and their influence on motor control and recovery prognosis. Much has been written about single clinical signs (i.e., startle reaction) but so far no definitions of the six perceptual signs presented in this study have appeared in literature. This study defines 6 signs (startle reaction, upper limbs in startle position, frequent eye blinking, posture freezing, averted eye gaze, grimacing) suggestive of perceptual disorders in children with cerebral palsy and measures agreement on sign recognition among independent observers and consistency of opinions over time. Observational study with both cross-sectional and prospective components. Fifty-six videos presented to observers in random order. Videos were taken from 19 children with a bilateral form of cerebral palsy referred to the Children Rehabilitation Unit in Reggio Emilia. Thirty-five rehabilitation professionals from all over Italy: 9 doctors and 26 physiotherapists. Measure of agreement among 35 independent observers was compiled from a sample of 56 videos. Interobserver reliability was determined using the K index of Fleiss and reliability intra-observer was calculated by the Spearman correlation index between ranks (rho - ρ). Percentage of agreement between observers and Gold Standard was used as criterion validity. Interobserver reliability was moderate for startle reaction, upper limb in startle position, adverted eye gaze and eye-blinking and fair for posture freezing and grimacing. Intraobserver reliability remained consistent over time. Criterion validity revealed very high agreement between independent observer evaluation and gold standard. Semiotics of perceptual disorders can be used as a specific and sensitive instrument in order to identify a new class of patients within existing heterogeneous clinical types of bilateral cerebral palsy forms and could help clinicians in identifying functional prognosis. To provide

Cardiovascular Topics Blood pressure control at a hospital day clinic ...

African Journals Online (AJOL)

1999-02-01

Feb 1, 1999 ... control in a hospital day clinic population receiving cal- cium channel ... we had showed poor control of blood pressure in this hospital-based population .... Assessment of com- .... Program are obering: 19 almost half of newly treated hyper- tensives will di ... blood pressure control and quality of life. There is ...

Should we reconsider the routine use of placebo controls in clinical research?

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Avins Andrew L

2012-04-01

Full Text Available Abstract Background Modern clinical-research practice favors placebo controls over usual-care controls whenever a credible placebo exists. An unrecognized consequence of this preference is that clinicians are more limited in their ability to provide the benefits of the non-specific healing effects of placebos in clinical practice. Methods We examined the issues in choosing between placebo and usual-care controls. We considered why placebo controls place constraints on clinicians and the trade-offs involved in the choice of control groups. Results We find that, for certain studies, investigators should consider usual-care controls, even if an adequate placebo is available. Employing usual-care controls would be of greatest value for pragmatic trials evaluating treatments to improve clinical care and for which threats to internal validity can be adequately managed without a placebo-control condition. Conclusions Intentionally choosing usual-care controls, even when a satisfactory placebo exists, would allow clinicians to capture the value of non-specific therapeutic benefits that are common to all interventions. The result could be more effective, patient-centered care that makes the best use of both specific and non-specific benefits of medical interventions.

Should we reconsider the routine use of placebo controls in clinical research?

Science.gov (United States)

Avins, Andrew L; Cherkin, Daniel C; Sherman, Karen J; Goldberg, Harley; Pressman, Alice

2012-04-27

Modern clinical-research practice favors placebo controls over usual-care controls whenever a credible placebo exists. An unrecognized consequence of this preference is that clinicians are more limited in their ability to provide the benefits of the non-specific healing effects of placebos in clinical practice. We examined the issues in choosing between placebo and usual-care controls. We considered why placebo controls place constraints on clinicians and the trade-offs involved in the choice of control groups. We find that, for certain studies, investigators should consider usual-care controls, even if an adequate placebo is available. Employing usual-care controls would be of greatest value for pragmatic trials evaluating treatments to improve clinical care and for which threats to internal validity can be adequately managed without a placebo-control condition. Intentionally choosing usual-care controls, even when a satisfactory placebo exists, would allow clinicians to capture the value of non-specific therapeutic benefits that are common to all interventions. The result could be more effective, patient-centered care that makes the best use of both specific and non-specific benefits of medical interventions.

Continuous quality control of the blood sampling procedure using a structured observation scheme.

Science.gov (United States)

Seemann, Tine Lindberg; Nybo, Mads

2016-10-15

An observational study was conducted using a structured observation scheme to assess compliance with the local phlebotomy guideline, to identify necessary focus items, and to investigate whether adherence to the phlebotomy guideline improved. The questionnaire from the EFLM Working Group for the Preanalytical Phase was adapted to local procedures. A pilot study of three months duration was conducted. Based on this, corrective actions were implemented and a follow-up study was conducted. All phlebotomists at the Department of Clinical Biochemistry and Pharmacology were observed. Three blood collections by each phlebotomist were observed at each session conducted at the phlebotomy ward and the hospital wards, respectively. Error frequencies were calculated for the phlebotomy ward and the hospital wards and for the two study phases. A total of 126 blood drawings by 39 phlebotomists were observed in the pilot study, while 84 blood drawings by 34 phlebotomists were observed in the follow-up study. In the pilot study, the three major error items were hand hygiene (42% error), mixing of samples (22%), and order of draw (21%). Minor significant differences were found between the two settings. After focus on the major aspects, the follow-up study showed significant improvement for all three items at both settings (P < 0.01, P < 0.01, and P = 0.01, respectively). Continuous quality control of the phlebotomy procedure revealed a number of items not conducted in compliance with the local phlebotomy guideline. It supported significant improvements in the adherence to the recommended phlebotomy procedures and facilitated documentation of the phlebotomy quality.

Observer-based linear parameter varying H∞ tracking control for hypersonic vehicles

Directory of Open Access Journals (Sweden)

Yiqing Huang

2016-11-01

Full Text Available This article aims to develop observer-based linear parameter varying output feedback H∞ tracking controller for hypersonic vehicles. Due to the complexity of an original nonlinear model of the hypersonic vehicle dynamics, a slow–fast loop linear parameter varying polytopic model is introduced for system stability analysis and controller design. Then, a state observer is developed by linear parameter varying technique in order to estimate the unmeasured attitude angular for slow loop system. Also, based on the designed linear parameter varying state observer, a kind of attitude tracking controller is presented to reduce tracking errors for all bounded reference attitude angular inputs. The closed-loop linear parameter varying system is proved to be quadratically stable by Lypapunov function technique. Finally, simulation results show that the developed linear parameter varying H∞ controller has good tracking capability for reference commands.

Canine trypanosomosis: Clinical observations and morphological ...

African Journals Online (AJOL)

Clinical and pathological aspects of canine trypanosomosis were determined in naturally infected dogs presented to the Veterinary Teaching Hospital, Federal University of Agriculture, Abeokuta, at different times between 2012 and 2013. The breeds, sexes, ages and body weights of the dogs were recorded. Clinical signs ...

Observation of clinical efficacy of pattern scan laser photocoagulation on diabetic retinopathy

Directory of Open Access Journals (Sweden)

Zhi-Hua Peng

2013-08-01

Full Text Available AIM: To evaluate the clinical efficacy of pattern scan laser photocoagulation(Pascalon proliferative diabetic retinopathy(PDR.METHODS: A total of 93 patients with retinopathy(186 eyeswere randomly divided into treatment group(96 eyes of 48 patientswho treated with panretinal photocoagulation(PRPusing Pascal at one time and control group(90 eyes of 45 patientswho treated with PRP using multi-wavelength krypton laser in 4-5 times. The visual acuity, FFA, OCT, visual field will be evaluated of each patient before and after the treatment.RESULTS: The visual acuity findings were stated as below: the overall effective rate of visual acuity in treatment group is 85.4% while it is 82.2% in control group. The overall effective rate in two groups has no significant difference. The retinal sensitivity has no significant decrease in the treatment group while which decreased significantly in the control group.CONCLUSION: The clinical efficacy of Pascal on treating the PDR is better than which of the regular argon laser. The field of vision has no significant narrowed after the Pascal treatment which can efficiently shorten the length of treatment and reduce the pain sensation.

Partial observation control in an anticipating environment

International Nuclear Information System (INIS)

Oeksendal, B; Sulem, A

2004-01-01

A study is made of a controlled stochastic system whose state X(t) at time t is described by a stochastic differential equation driven by Levy processes with filtration {F t } telementof[0,T] . The system is assumed to be anticipating, in the sense that the coefficients are assumed to be adapted to a filtration {G t } t≥0 with F t subset of equal G t for all t element of [0,T]. The corresponding anticipating stochastic differential equation is interpreted in the sense of forward integrals, which naturally generalize semimartingale integrals. The admissible controls are assumed to be adapted to a filtration {E t } telementof[0,T] such that E t subset of equal F t for all t element of [0,T]. The general problem is to maximize a given performance functional of this system over all admissible controls. This is a partial observation stochastic control problem in an anticipating environment. Examples of applications include stochastic volatity models in finance, insider influenced financial markets, and stochastic control of systems with delayed noise effects. Some particular cases in finance, involving optimal portfolios with logarithmic utility, are solved explicitly

Randomized controlled clinical trial comparing two dental implants with different neck configurations.

Science.gov (United States)

Sanz-Martín, Ignacio; Sanz-Sánchez, Ignacio; Noguerol, Fernando; Cok, Susy; Ortiz-Vigón, Alberto; Sanz, Mariano

2017-06-01

Peri-implant bone levels can vary according to the implant neck macro-design and the implant-abutment interface. To compare the changes in soft and hard tissues when using a one-piece implant with a machined collar (TG) versus a two-piece implant with a progressive platform widening and a platform switching connection (SP). Partially edentulous patients willing to receive one or two implants in the posterior maxilla or mandible were randomized to the control (TG) or to the test group (SP). Final prostheses were delivered after 12 months. Radiographic measurements of interproximal bone levels (primary outcome) were assessed at implant loading and 1-year postloading. Clinical, patient related outcomes and adverse events were assessed at loading and after 6 and 12 months. Sixty-one implants were placed in 47 patients, 37 patients (18 in the TG group and 19 in the SP group), and 47 implants (23 TG and 24 SP) completed the 24-months follow up. At the patient level, a significantly greater bone resorption from baseline to implant loading was observed in the SP group (-0.42 ± 0.45 vs -0.07 ± 0.45; P = .001*), while from loading to the final visit, the TG group had significantly greater bone loss than the SP group (-0.26 ± 0.22 vs -0.11 ± 0.2; P = .020*). At 24 months after surgery, there were no significant differences between both groups (control: 0.33 ± 0.49 vs test: 0.53 ± 0.53; P = .230). Similarly, no significant differences were observed for the secondary outcomes. Both types of implant reported high survival rates and similar bone level changes, clinical parameters, and patient related outcomes after 12 months of loading. © 2017 Wiley Periodicals, Inc.

Pulmonary rehabilitation in lymphangioleiomyomatosis: a controlled clinical trial.

Science.gov (United States)

Araujo, Mariana S; Baldi, Bruno G; Freitas, Carolina S G; Albuquerque, André L P; Marques da Silva, Cibele C B; Kairalla, Ronaldo A; Carvalho, Celso R F; Carvalho, Carlos R R

2016-05-01

Lymphangioleiomyomatosis (LAM) is a cystic lung disease frequently associated with reduced exercise capacity. The aim of this study was to assess safety and efficacy of pulmonary rehabilitation in LAM.This controlled clinical trial included 40 patients with LAM and a low physical activity level. The pulmonary rehabilitation programme comprised 24 aerobic and muscle strength training sessions and education. The primary outcome was exercise capacity (endurance time during a constant work rate exercise test). Secondary outcomes included health-related quality of life (St George's Respiratory Questionnaire (SGRQ)), 6-min walking distance (6MWD), dyspnoea, peak oxygen consumption (V'O2 ), daily physical activity (pedometer), symptoms of anxiety and depression, lung function and peripheral muscle strength (one-repetition maximum).The baseline characteristics were well balanced between the groups. The pulmonary rehabilitation group exhibited improvements in the following outcomes versus controls: endurance time (median (interquartile range) 169 (2-303) s versus -33 (-129-39) s; p=0.001), SGRQ (median (interquartile range) -8 (-16-2) versus 2 (-4-5); p=0.002) and 6MWD (median (interquartile range) 59 (13-81) m versus 20 (-12-30) m; p=0.002). Dyspnoea, peak V'O2 , daily physical activity and muscle strength also improved significantly. No serious adverse events were observed.Pulmonary rehabilitation is a safe intervention and improves exercise capacity, dyspnoea, daily physical activity, quality of life and muscle strength in LAM. Copyright ©ERS 2016.

Efficacy and tolerability of rasagiline in daily clinical use--a post-marketing observational study in patients with Parkinson's disease.

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Reichmann, H; Jost, W H

2010-09-01

The MAO-B inhibitor rasagiline is indicated for the treatment of idiopathic Parkinson's disease (PD), and its use is supported by evidence from large-scale, controlled clinical studies. The post-marketing observational study presented here investigated the efficacy and tolerability of rasagiline treatment (monotherapy or combination therapy) in daily clinical practice. The study included patients with idiopathic PD who received rasagiline (recommended dose 1 mg, once daily) as monotherapy or combination therapy. The treatment and observation period was approximately 4 months. Outcome measures included the change from baseline in the Columbia University Rating Scale (CURS), the Unified PD Rating Scale fluctuation subscale, daily OFF time (patient home diaries) and the PD Questionnaire-39. Adverse drug reactions/adverse events (ADRs/AEs) and the physician's global judgement of tolerability and efficacy were also examined. Overall, 754 patients received rasagiline during the study. Patients treated with rasagiline (monotherapy or combination therapy) showed significant improvements from baseline in symptom severity (including classical motor and non-classical motor/non-motor symptoms) and quality of life (QoL). Patients receiving combination therapy also experienced significant reductions in daily OFF time. Tolerability was rated as good/very good in over 90% of patients. In daily clinical practice, monotherapy or combination therapy with rasagiline is able to improve PD symptoms, reduce OFF time, and improve QoL, whilst demonstrating favourable tolerability. In addition, rasagiline has a simple dosing schedule of one tablet, once daily, with no titration. These results are consistent with the pivotal rasagiline clinical studies (TEMPO, LARGO and PRESTO).

The concept of control of COPD in clinical practice

Directory of Open Access Journals (Sweden)

Soler-Cataluña JJ

2014-12-01

Full Text Available Juan José Soler-Cataluña,1,2 Bernardino Alcázar-Navarrete,3 Marc Miravitlles2,4 1Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES, 3Respiratory Department, Hospital de Alta Resolucion, Granada, Spain; 4Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain Abstract: Treatment of chronic obstructive pulmonary disease (COPD requires a personalized approach according to the clinical characteristics of the patients, the level of severity, and the response to the different therapies. Furthermore, patients with the same level of severity measured by the degree of airflow obstruction or even with multidimensional indices may have very different symptoms and limitations for daily activities. The concept of control has been extensively developed in asthma but has not been defined in COPD. Here, we propose a definition of COPD control based on the concepts of impact and stability. Impact is a cross-sectional concept that can be measured by questionnaires such as the COPD Assessment Test or the Clinical COPD Questionnaire. Alternatively, impact can be assessed by the degree of dyspnea, the use of rescue medication, the level of physical activity, and sputum color. Stability is a longitudinal concept that requires the absence of exacerbations and deterioration in the aforementioned variables or in the COPD Assessment Test or Clinical COPD Questionnaire scores. Control is defined by low impact (adjusted for severity and stability. The concept of control in COPD can be useful in the decision making regarding an increase or decrease in medication in the stable state. Keywords: COPD, control, CAT, CCQ, exacerbations, prognosis

Hybrid dynamical systems observation and control

CERN Document Server

Defoort, Michael

2015-01-01

This book is a collection of contributions defining the state of current knowledge and new trends in hybrid systems – systems involving both continuous dynamics and discrete events – as described by the work of several well-known groups of researchers. Hybrid Dynamical Systems presents theoretical advances in such areas as diagnosability, observability and stabilization for various classes of system. Continuous and discrete state estimation and self-triggering control of nonlinear systems are advanced. The text employs various methods, among them, high-order sliding modes, Takagi–Sugeno representation and sampled-data switching to achieve its ends. The many applications of hybrid systems from power converters to computer science are not forgotten; studies of flexible-joint robotic arms and – as representative biological systems – the behaviour of the human heart and vasculature, demonstrate the wide-ranging practical significance of control in hybrid systems. The cross-disciplinary origins of study ...

Disturbance Observer based internal Model Controller Design: Applications to Tracking Control of Optical Disk Drive

Energy Technology Data Exchange (ETDEWEB)

Choi, Hyun Taek; Suh, Il Hong [Hanyang University (Korea, Republic of)

1999-02-01

A digital tracking controller is proposed for a precise positioning control under a large repetitive and/or non repetitive disturbances. The proposed controller consists of the internal model controller and the disturbance observer to eliminate the modeling uncertainty. A sufficient condition is given for robust stability of the proposed control system. Numerical Examples are illustrated for a precise head positioning of optical disk drives regardless of a torque disturbance and/or output disturbance. (author). 8 refs., 19 figs.

A nonrandomized controlled clinical pilot trial on 8 wk of intermittent fasting (24 h/wk).

Science.gov (United States)

Kessler, Christian S; Stange, Rainer; Schlenkermann, Maike; Jeitler, Michael; Michalsen, Andreas; Selle, Antonia; Raucci, Franca; Steckhan, Nico

2018-02-01

The aim of the study was to evaluate whether intermittent fasting (IF) is an effective preventive measure, and whether it is feasible for healthy volunteers under every day conditions. A nonrandomized controlled clinical trial on IF was performed with healthy volunteers over a period of 8 wk, and a subsequent 4-mo follow-up. Outcomes were assessed at baseline, after 8 wk, and after 6 mo. Volunteers who were not interested in fasting served as a control group. Participants in the fasting group were asked to continue their regular nutritional habits on the nonfasting days, whereas the control group maintained their habitual nutrition throughout the whole period. Outcomes included changes of metabolic parameters (insulin, glucose, insulin resistance, insulin-like growth factor-1, brain-derived neurotropic factor, lipids, liver enzymes, hemoglobin A1c) and coagulation markers; bioelectrical impedance analysis; body mass index; abdominal girth; blood pressure; general quality of life (five-item World Health Organization Well-Being Index [WHO-5] questionnaire), as well as mood and anxiety (Hospital Anxiety and Depression Scale [HADS], Profile of Mood States, Flourishing-Scale, visual analog scale, Likert scales). The intervention consisted of a fasting day, which was repeated every week for 8 wk, with abstinence from solid food between 00:00 and 23:59 at minimum and a maximum caloric intake of 300 kcal on each fasting day. A per-protocol analysis was performed. P < 0.05 was considered significant. Thirty-six volunteers were included; 22 allocated themselves to the fasting group, and 14 to the control group. Thirty-three data sets were included in the final analysis. Although significant in-group changes were observed in both groups for a number of outcomes after 8 wk and 6 mo, no significant between-group differences were observed for any outcome other than overall body fat mass after 8 wk as well as for the HADS total score and the WHO-5 total score after 6�

The clinical meaning of gastric-wall hyperactivity observed on sestamibi cardiac single-photon emission computed tomography

Energy Technology Data Exchange (ETDEWEB)

Cote, C.; Dumont, M. [Centre Hospitalier Universitaire de Quebec, Dept. of Nuclear Medicine, Quebec, Quebec (Canada)]. E-mail: christian.cote@chuq.qc.ca

2004-06-01

To evaluate prospectively the incidence and clinical meaning, if any, of gastric-wall hyperactivity observed on sestamibi cardiac single-photon emission computed tomography (SPECT). This phenomenon is completely different from the well-known intraluminal gastric reflux of sestamibi. A group of 819 patients who underwent sestamibi cardiac SPECT was studied from January 2000 to October 2000. Gastric-wall activity was graded qualitatively. Only patients with gastric-wall activity near or equivalent to their heart activity were considered for subsequent analysis. The medical records of patient candidates were reviewed, and their family physicians were asked to respond to a questionnaire by telephone when further information was needed. We identified 13 patients with significant gastric-wall hyperactivity, which was more intense on rest images. Our review of the clinical data shows that all these patients were suffering from dyspepsia and were taking gastric medication. These 13 cases were assigned to 3 groups: gastroesophageal reflux, chronic functional dyspepsia and nonspecific gastritis. Significant gastric-wall hyperactivity is an infrequent observation on sestamibi cardiac SPECT. Our results indicate that the presence of significant gastric-wall hyperactivity is associated with dyspepsia. It is important to realize that this gastric-wall hyperactivity by its proximity to the inferior myocardial wall could in some circumstances lead to either false-negative or false-positive findings, representing a diagnostic problem. Although infrequent, this situation could be avoided by proper quality control, including a systematic review of the raw cine data before reading the images. (author)

Clinical observed performance evaluation: a prospective study in final year students of surgery.

LENUS (Irish Health Repository)

Markey, G C

2010-06-24

We report a prospective study of clinical observed performance evaluation (COPE) for 197 medical students in the pre-qualification year of clinical education. Psychometric quality was the main endpoint. Students were assessed in groups of 5 in 40-min patient encounters, with each student the focus of evaluation for 8 min. Each student had a series of assessments in a 25-week teaching programme. Over time, several clinicians from a pool of 16 surgical consultants and registrars evaluated each student by direct observation. A structured rating form was used for assessment data. Variance component analysis (VCA), internal consistency and inter-rater agreement were used to estimate reliability. The predictive and convergent validity of COPE in relation to summative OSCE, long case, and overall final examination was estimated. Median number of COPE assessments per student was 7. Generalisability of a mean score over 7 COPE assessments was 0.66, equal to that of an 8 x 7.5 min station final OSCE. Internal consistency was 0.88-0.97 and inter-rater agreement 0.82. Significant correlations were observed with OSCE performance (R = 0.55 disattenuated) and long case (R = 0.47 disattenuated). Convergent validity was 0.81 by VCA. Overall final examination performance was linearly related to mean COPE score with standard error 3.7%. COPE permitted efficient serial assessment of a large cohort of final year students in a real world setting. Its psychometric quality compared well with conventional assessments and with other direct observation instruments as reported in the literature. Effect on learning, and translation to clinical care, are directions for future research.

Sliding mode control-based linear functional observers for discrete-time stochastic systems

Science.gov (United States)

Singh, Satnesh; Janardhanan, Sivaramakrishnan

2017-11-01

Sliding mode control (SMC) is one of the most popular techniques to stabilise linear discrete-time stochastic systems. However, application of SMC becomes difficult when the system states are not available for feedback. This paper presents a new approach to design a SMC-based functional observer for discrete-time stochastic systems. The functional observer is based on the Kronecker product approach. Existence conditions and stability analysis of the proposed observer are given. The control input is estimated by a novel linear functional observer. This approach leads to a non-switching type of control, thereby eliminating the fundamental cause of chatter. Furthermore, the functional observer is designed in such a way that the effect of process and measurement noise is minimised. Simulation example is given to illustrate and validate the proposed design method.

Integral sliding mode-based formation control of multiple unertain robots via nonlinear disturbane observer

Directory of Open Access Journals (Sweden)

Dianwei Qian

2016-11-01

Full Text Available This article proposes a control scheme for formation of maneuvers of a team of mobile robots. The control scheme integrates the integral sliding mode control method with the nonlinear disturbance observer technique. The leader–follower formation dynamics suffer from uncertainties originated from the individual robots. The uncertainties challenge the formation control of such robots. Assuming that the uncertainties are unknown but bounded, an nonlinear disturbance observer-based observer is utilized to approximate them. The observer outputs feed on an integral sliding mode control-based controller. The controller and observer are integrated into the control scheme to realize formation maneuvers despite uncertainties. The formation stability is analyzed by means of the Lyapunov’s theorem. In the sense of Lyapunov, not only the convergence of the approximation errors is guaranteed but also such a control scheme can asymptotically stabilize the formation system. Compared to the results by the sole integral sliding mode control, some simulations are presented to demonstrate the feasibility and performance of the control scheme.

Clinical competence of biopsychosocially trained physicians and controls.

Science.gov (United States)

Adler, Rolf H; Minder, Christoph E

2012-07-25

To assess and compare clinical observations and interpretations by physicians trained in biopsychosocial internal medicine (group A) and a control group (C) of physicians with no such special training. A verbatim first-interview of a 36-year old woman, seen for consultation by RHA, was presented to both groups (A, trained physicians: n = 30, and C, controls: n = 29). The patient's symptoms included: shaky knees, strange sensations in the abdomen and chest, insecurity and dizziness. The symptoms had begun before her final nursing- exam and exacerbated on her mother's 60th birthday two months later. The patient's mother is the sole caretaker for the patient's sister, who also attended the birthday party. The patient's sister is 19 and had been diagnosed with storage disease and is wheelchair-bound. The doctors were asked to record their observations and interpretations while reviewing the case report. Group A-physicians mentioned and interpreted the physician-patient relationship and the patient's body language as described in the case report more often (p = 0.002, Wilcoxon-Mann-Whitney rank sum test (RS)), mentioned physical symptoms more often (p = 0.0099, Fisher's exact test (FE)) and more often interpreted illness settings with respect to the patient's fear and guilt (Fisher's exact test, p = 0.007 and p = 0.015). A precise integrative diagnosis (life events leading to stress, the latter evoking fear and guilt, leading to symptoms of the fight-flight reaction) was suggested by 7 of group A and 4 of group C. Extensive laboratory work-up and requests for consultations were more frequently asked for by the C group (p = 0.048, RS). Residency training in biopsychosocial medicine in an Internal Medicine Department increased sensitivity to and interpretation of biological and psychosocial data many years after the training and decreased the extent of work-up and consultation costs. However it only tended to enhance psychosomatic conceptualisation with respect to anxiety

A controlled evaluation of case clinical effect coding by poison center specialists for detection of WMD scenarios.

Science.gov (United States)

Beuhler, Michael C; Wittler, Mary A; Ford, Marsha; Dulaney, Anna R

2011-08-01

Many public health entities employ computer-based syndromic surveillance to monitor for aberrations including possible exposures to weapons of mass destruction (WMD). Often, this is done by screening signs and symptoms reported for cases against syndromic definitions. Poison centers (PCs) may offer significant contributions to public health surveillance because of their detailed clinical effect data field coding and real-time data entry. Because improper clinical effect coding may impede syndromic surveillance, it is important to assess this accuracy for PCs. An AAPCC-certified regional PC assessed the accuracy of clinical effect coding by specialists in poison information (SPIs) listening to audio recordings of standard cases. Eighteen different standardized cases were used, consisting of six cyanide, six botulism, and six control cases. Cases were scripted to simulate clinically relevant telephone conversations and converted to audio recordings. Ten SPIs were randomly selected from the center's staff to listen to and code case information from the recorded cases. Kappa scores and the percentage of correctly coding a present clinical effect were calculated for individual clinical effects summed over all test cases along with corresponding 95% confidence intervals. The rate of the case coding by the SPIs triggering the PC's automated botulism and cyanide alerts was also determined. The kappa scores and the percentage of correctly coding a present clinical effect varied depending on the specific clinical effect, with greater accuracy observed for the clinical effects of vomiting and agitation/irritability, and poor accuracy observed for the clinical effects of visual defect and anion gap increase. Lack of correct coding resulted in only 60 and 86% of the cases that met the botulism and cyanide surveillance definitions, respectively, triggering the corresponding alert. There was no difference observed in the percentage of coding a present clinical effect between

Non-Hodgkin's lymphoma in the practice of the family doctor (clinical observation).

OpenAIRE

I. V. Vasylevska

2018-01-01

There is presented a clinical observation on the problem of establishing an oncological diagnosis by a family doctor, the route to a doctor-oncologist for specific treatment with subsequent work in the brigade team and medical support during the course of chemotherapy for the prevention and timely elimination of side effects and complications.

The prevalence of secondary dentinal lesions in cheek teeth from horses with clinical signs of pulpitis compared to controls.

Science.gov (United States)

Casey, M B; Tremaine, W H

2010-01-01

With the advent of detailed oral examination in horses using dental mirrors and rigid endoscopy, secondary dentinal lesions are observed more frequently. More information regarding the association of secondary dentinal defects with apical dental disease would improve the sensitivity of oral examination as a diagnostic aid for pulpitis. To assess prevalence and severity of secondary dentinal defects observed on examination of occlusal surfaces of cheek teeth (CT) from horses showing clinical signs of pulpitis compared to asymptomatic controls. Records from all cases of equine CT exodontia at the University of Bristol over a 4 year period were examined. Case selection criteria included the presence of clinical signs of pulpitis, an intact extracted tooth and availability of a complete history and follow up. Cases where coronal fracture or periodontal pocketing featured were excluded. CT from cadavers with no history of dental disease served as normal controls. Triadan positions and eruption ages of control teeth were matched with those of teeth extracted from cases. CT from selected cases and control teeth were examined occlusally. Secondary dentinal defects were identified and graded. Prevalence of occlusal lesions in CT with pulpitis and controls was compared. From the records of 120 horses where exodontia was performed, 40 cases matched selection criteria. Twenty-three mandibular and 21 maxillary CT were extracted from cases. The controls consisted of 60 mandibular and 60 maxillary CT from 7 cadaver skulls. Secondary dentinal defects were significantly over-represented in CT extracted from cases of pulpitis (P pulpitis in equine CT.

Traction control of an electric vehicle based on nonlinear observers

Directory of Open Access Journals (Sweden)

Diego A. Aligia

2017-12-01

Full Text Available A traction control strategy for a four-wheel electric vehicle is proposed in this paper. The strategy is based on nonlinear observers which allows estimating the maximum force that can be transmitted to the road. Knowledge of the maximum force allows controlling the slip of the driving wheels, preventing the wheel’s slippage in low-grip surfaces. The proposed strategy also allows to avoid the undesired yaw moment in the vehicle which occurs when road conditions on either side of it are dierent. This improves the eciency and the control of the vehicle, avoiding possible losses of stability that can result in risks for its occupants. Both the proposed observer and the control strategy are designed based on a dynamic rotational model of the wheel and a brush force model. Simulation results are obtained based on a complete vehicle model on the Simulink/CarSim platform.

Wideband Motion Control by Position and Acceleration Input Based Disturbance Observer

Science.gov (United States)

Irie, Kouhei; Katsura, Seiichiro; Ohishi, Kiyoshi

The disturbance observer can observe and suppress the disturbance torque within its bandwidth. Recent motion systems begin to spread in the society and they are required to have ability to contact with unknown environment. Such a haptic motion requires much wider bandwidth. However, since the conventional disturbance observer attains the acceleration response by the second order derivative of position response, the bandwidth is limited due to the derivative noise. This paper proposes a novel structure of a disturbance observer. The proposed disturbance observer uses an acceleration sensor for enlargement of bandwidth. Generally, the bandwidth of an acceleration sensor is from 1Hz to more than 1kHz. To cover DC range, the conventional position sensor based disturbance observer is integrated. Thus, the performance of the proposed Position and Acceleration input based disturbance observer (PADO) is superior to the conventional one. The PADO is applied to position control (infinity stiffness) and force control (zero stiffness). The numerical and experimental results show viability of the proposed method.

Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies.

Science.gov (United States)

Wiedermann, Christian J; Wiedermann, Wolfgang; Joannidis, Michael

2010-10-01

To test the hypothesis that hypoalbuminemia is independently associated with increased risk of acute kidney injury (AKI). A meta-analysis was performed of observational clinical studies evaluating the relationship between serum albumin level and the occurrence of AKI by multivariate methods. Additionally, the impact was assessed of lower serum albumin on mortality in patients who developed AKI. Eligible studies were sought by multiple methods, and adjusted odds ratios (OR) were quantitatively combined using a random effects model. Seventeen clinical studies with 3,917 total patients were included: 11 studies (6 in surgical or intensive care unit patients and 5 in other hospital settings) evaluating the influence of serum albumin on AKI incidence and 6 studies describing the relationship between serum albumin and mortality among patients who had developed AKI. Lower serum albumin was an independent predictor both of AKI and of death after AKI development. With each 10 g L(-1) serum albumin decrement, the odds of AKI increased by 134%. The pooled OR for AKI was 2.34 with a 95% confidence interval (CI) of 1.74-3.14. Among patients who had developed AKI, the odds of death rose 147% (pooled OR 2.47, 95% CI 1.51-4.05) with each 10 g L(-1) serum albumin decrement. This meta-analysis provides evidence that hypoalbuminemia is a significant independent predictor both of AKI and of death following AKI development. Serum albumin determinations may be of utility in identifying patients at increased risk for AKI or for death after AKI. Controlled studies are warranted to assess interventions aimed at correcting hypoalbuminemia.

Clinical outcomes research in gynecologic oncology.

Science.gov (United States)

Melamed, Alexander; Rauh-Hain, J Alejandro; Schorge, John O

2017-09-01

Clinical outcomes research seeks to understand the real-world manifestations of clinical care. In particular, outcomes research seeks to reveal the effects of pharmaceutical, procedural, and structural aspects of healthcare on patient outcomes, including mortality, disease control, toxicity, cost, and quality of life. Although outcomes research can utilize interventional study designs, insightful use of observational data is a defining feature of this field. Many questions in gynecologic oncology are not amenable to investigation in randomized clinical trials due to cost, feasibility, or ethical concerns. When a randomized trial is not practical or has not yet been conducted, well-designed observational studies have the potential to provide the best available evidence about the effects of clinical care. Such studies may use surveys, medical records, disease registries, and a variety of administrative data sources. Even when a randomized trial has been conducted, observational studies can be used to estimate the real-world effect of an intervention, which may differ from the results obtained in the controlled setting of a clinical trial. This article reviews the goals, methodologies, data sources, and limitations of clinical outcomes research, with a focus on gynecologic oncology. Copyright © 2017. Published by Elsevier Inc.

Stock Versus CAD/CAM Customized Zirconia Implant Abutments – Clinical and Patient‐Based Outcomes in a Randomized Controlled Clinical Trial

Science.gov (United States)

Meijer, Henny J.A.; Kerdijk, Wouter; Raghoebar, Gerry M.; Cune, Marco

2016-01-01

Abstract Background Single‐tooth replacement often requires a prefabricated dental implant and a customized crown. The benefits of individualization of the abutment remain unclear. Purpose This randomized controlled clinical trial aims to study potential benefits of individualization of zirconia implant abutments with respect to preservation of marginal bone level and several clinical and patient‐based outcome measures. Material and Methods Fifty participants with a missing premolar were included and randomly assigned to standard (ZirDesign, DentsplySirona Implants, Mölndal, Sweden) or computer aided design/computer aided manufacturing (CAD/CAM) customized (Atlantis, DentsplySirona Implants, Mölndal, Sweden) zirconia abutment therapy. Peri‐implant bone level (primary outcome), Plaque‐index, calculus formation, bleeding on probing, gingiva index, probing pocket depth, recession, appearance of soft tissues and patients' contentment were assessed shortly after placement and one year later. Results No implants were lost and no complications related to the abutments were observed. Statistically significant differences between stock and CAD/CAM customized zirconia abutments could not be demonstrated for any of the operationalized variables. Conclusion The use of a CAD/CAM customized zirconia abutment in single tooth replacement of a premolar is not associated with an improvement in clinical performance or patients' contentment when compared to the use of a stock zirconia abutment. PMID:27476829

Design control for clinical translation of 3D printed modular scaffolds.

Science.gov (United States)

Hollister, Scott J; Flanagan, Colleen L; Zopf, David A; Morrison, Robert J; Nasser, Hassan; Patel, Janki J; Ebramzadeh, Edward; Sangiorgio, Sophia N; Wheeler, Matthew B; Green, Glenn E

2015-03-01

The primary thrust of tissue engineering is the clinical translation of scaffolds and/or biologics to reconstruct tissue defects. Despite this thrust, clinical translation of tissue engineering therapies from academic research has been minimal in the 27 year history of tissue engineering. Academic research by its nature focuses on, and rewards, initial discovery of new phenomena and technologies in the basic research model, with a view towards generality. Translation, however, by its nature must be directed at specific clinical targets, also denoted as indications, with associated regulatory requirements. These regulatory requirements, especially design control, require that the clinical indication be precisely defined a priori, unlike most academic basic tissue engineering research where the research target is typically open-ended, and furthermore requires that the tissue engineering therapy be constructed according to design inputs that ensure it treats or mitigates the clinical indication. Finally, regulatory approval dictates that the constructed system be verified, i.e., proven that it meets the design inputs, and validated, i.e., that by meeting the design inputs the therapy will address the clinical indication. Satisfying design control requires (1) a system of integrated technologies (scaffolds, materials, biologics), ideally based on a fundamental platform, as compared to focus on a single technology, (2) testing of design hypotheses to validate system performance as opposed to mechanistic hypotheses of natural phenomena, and (3) sequential testing using in vitro, in vivo, large preclinical and eventually clinical tests against competing therapies, as compared to single experiments to test new technologies or test mechanistic hypotheses. Our goal in this paper is to illustrate how design control may be implemented in academic translation of scaffold based tissue engineering therapies. Specifically, we propose to (1) demonstrate a modular platform approach

Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study.

Science.gov (United States)

Orban, Kristina; Ekelin, Maria; Edgren, Gudrun; Sandgren, Olof; Hovbrandt, Pia; Persson, Eva K

2017-09-11

Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method. In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed. The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone. Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

[Assessment of clinical observation skills of last year medical students].

Science.gov (United States)

Steichen, O; Georgin-Lavialle, S; Grateau, G; Ranque, B

2015-05-01

Clinical examination skills are poorly evaluated by theoretical tests. We observed the clinical examination of real patients by 6th year medical students. Four internists involved in teaching activities defined 11 clinical examination items, with two objective performance criteria each. The students were evaluated in two internal medicine departments during the rotation preceding or following their national graduation test. Scores by item and by criterion and an overall score were calculated and correlated with their rank at the national graduation test. Thirty-two students were evaluated in one department and 18 in the other; each evaluation lasted approximately 30 minutes. The results were similar in both departments. Only 2 items got a score over 75% in this students' sample (acute respiratory failure, peripheral pulses); 4 items were satisfied at less than 50% (lymph nodes, right heart failure, liver failure, and attention). The mean overall score was 6.5/11 (standard deviation 1.5). National rankings were good (median 1605/8001, interquartile 453-3036) but uncorrelated with the global score (Spearman coefficient -0.13; P=0.39). Bedside evaluation of the students reveals substantial deficiencies, a few months or weeks before taking their position as residents. Several elementary skills are mastered by a minority of them (search for an asterixis, distended jugular veins, deep tendon reflexes), even among those successful at the national graduation test. Bedside evaluation of clinical examination skills should be more systematically performed. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

The barriers and motivators to learning infection control in clinical placements: interviews with midwifery students.

Science.gov (United States)

Ward, Deborah J

2013-05-01

To investigate the barriers to and motivators for learning infection prevention and control as identified by midwifery students. Semi-structured interviews were undertaken with 15 undergraduate midwifery students within one large university. Data were analysed using Framework Analysis. Barriers to good clinical practice were identified by students which were concordant with previous literature related to reasons for non-compliance with infection control precautions. Issues such as competing demands specific to midwifery were also identified. Factors which act as barriers to learning good practice in placements included conflicting information and practices from different staff and placement areas and staff attitudes towards students who tried to comply with precautions. Motivators to good practice included the perceived vulnerability of infants to infection, the role modelling of good practice to new mothers and the monitoring of practice. This study demonstrated that midwifery students perceive barriers and motivators to learning infection prevention and control in their clinical placements. Many of the barriers identified are related to the attitudes and practices of qualified staff. Some of the motivators are related specifically to midwifery practice. Midwives need to be aware of the effects of what is observed in practice on midwifery students and how their practices and attitudes can influence learning both positively and negatively. As healthcare-associated infection and poor compliance with precautions are a global problem, this research should be of benefit to midwives and midwifery educators worldwide in terms of addressing barriers and ensuring better clinical education. Copyright © 2012 Elsevier Ltd. All rights reserved.

Non-fragile observer-based output feedback control for polytopic uncertain system under distributed model predictive control approach

Science.gov (United States)

Zhu, Kaiqun; Song, Yan; Zhang, Sunjie; Zhong, Zhaozhun

2017-07-01

In this paper, a non-fragile observer-based output feedback control problem for the polytopic uncertain system under distributed model predictive control (MPC) approach is discussed. By decomposing the global system into some subsystems, the computation complexity is reduced, so it follows that the online designing time can be saved.Moreover, an observer-based output feedback control algorithm is proposed in the framework of distributed MPC to deal with the difficulties in obtaining the states measurements. In this way, the presented observer-based output-feedback MPC strategy is more flexible and applicable in practice than the traditional state-feedback one. What is more, the non-fragility of the controller has been taken into consideration in favour of increasing the robustness of the polytopic uncertain system. After that, a sufficient stability criterion is presented by using Lyapunov-like functional approach, meanwhile, the corresponding control law and the upper bound of the quadratic cost function are derived by solving an optimisation subject to convex constraints. Finally, some simulation examples are employed to show the effectiveness of the method.

Future enhanced clinical role of pharmacists in Emergency Departments in England: multi-site observational evaluation.

Science.gov (United States)

Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony

2017-08-01

Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.

Sensorless Vector Control of AC Induction Motor Using Sliding-Mode Observer

Directory of Open Access Journals (Sweden)

Phuc Thinh Doan

2013-06-01

Full Text Available This paper develops a sensorless vector controlled method for AC induction motor using sliding-mode observer. For developing the control algorithm, modeling of AC induction motor is presented. After that, a sliding mode observer is proposed to estimate the motor speed, the rotor flux, the angular position of the rotor flux and the motor torque from monitored stator voltages and currents. The use of the nonlinear sliding mode observer provides very good performance for both low and high speed motor operation. Furthermore, the proposed system is robust in motor losses and load variations. The convergence of the proposed observer is obtained using the Lyapunov theory. Hardware and software for simulation and experiment of the AC induction motor drive are introduced. The hardware consists of a 1.5kw AC induction motor connected in series with a torque sensor and a powder brake. A controller is developed based on DSP TMS320F28355. The simulation and experimental results illustrate that fast torque and speed response with small torque ripples can be achieved. The proposed control scheme is suitable to the application fields that require high performance of torque response such as electric vehicles. doi:http://dx.doi.org/10.12777/ijse.4.2.2013.39-43 [How to cite this article: Doan, P. T., Nguyen, T. T., Jeong, S. K., Oh, S. J., & Kim, S. B. (2013. Sensorless Vector Control of AC Induction Motor Using Sliding-Mode Observer. INTERNATIONAL JOURNAL OF SCIENCE AND ENGINEERING, 4(2, 39-43; doi: http://dx.doi.org/10.12777/ijse.4.2.2013.39-43

A Randomized, Controlled Clinical Trial Comparing Efficacy, Safety ...

African Journals Online (AJOL)

A Randomized, Controlled Clinical Trial Comparing Efficacy, Safety and Cost Effectiveness of Lornoxicam with Diclofenac Sodium in Patients of Osteoarthritis Knee. ... All patients were assessed with visual analogue scale and 100 meter walking test before starting of therapy, at 15 days and at 1, 2 and 3 months of therapy.

Non-Hodgkin's lymphoma in the practice of the family doctor (clinical observation.

Directory of Open Access Journals (Sweden)

I. V. Vasylevska

2018-05-01

Full Text Available There is presented a clinical observation on the problem of establishing an oncological diagnosis by a family doctor, the route to a doctor-oncologist for specific treatment with subsequent work in the brigade team and medical support during the course of chemotherapy for the prevention and timely elimination of side effects and complications.

Clinical observation of radiation urinary bladder disease

International Nuclear Information System (INIS)

Jin Yuke; Liu Libo; Zhang Haiying; Liang Shuo; Chen Dawei; Wu Zhenfeng; Dong Lihua; Lu Xuejun

2004-01-01

Objective: Clinical characteristic, diagnosis and treatment of radiation urinary bladder disease induced by radiation therapy for cancers in the pelvis were inquired into for providing diagnostic basis. Methods: Statistical analysis for the clinical cases was carried out. Results: The incidence of radiation bladder diseases induced by radiation therapy of cervix cancer are about 0.8%-2.96%, with an average of 2.14%. Radiation bladder disease is divided into acute radiation cystitis, chronic radiation cystitis and radiation vesical fistula. Chronic radiation cystitis is seen most often in the clinic and its main clinical symptom is painless macroscopic hematuria, which is again subdivided into slight and severe degrees. Diagnosis should include history of exposure to radiation, which dose exceed the dose threshold, and typical clinical characteristics. Conclusion: The characteristics, types and diagnostic basis of radiation urinary bladder disease analyzed in this study can provide the reference for drawing up diagnostic standard

Process control analysis of IMRT QA: implications for clinical trials

International Nuclear Information System (INIS)

Pawlicki, Todd; Rice, Roger K; Yoo, Sua; Court, Laurence E; McMillan, Sharon K; Russell, J Donald; Pacyniak, John M; Woo, Milton K; Basran, Parminder S; Boyer, Arthur L; Bonilla, Claribel

2008-01-01

The purpose of this study is two-fold: first is to investigate the process of IMRT QA using control charts and second is to compare control chart limits to limits calculated using the standard deviation (σ). Head and neck and prostate IMRT QA cases from seven institutions in both academic and community settings are considered. The percent difference between the point dose measurement in phantom and the corresponding result from the treatment planning system (TPS) is used for analysis. The average of the percent difference calculations defines the accuracy of the process and is called the process target. This represents the degree to which the process meets the clinical goal of 0% difference between the measurements and TPS. IMRT QA process ability defines the ability of the process to meet clinical specifications (e.g. 5% difference between the measurement and TPS). The process ability is defined in two ways: (1) the half-width of the control chart limits, and (2) the half-width of ±3σ limits. Process performance is characterized as being in one of four possible states that describes the stability of the process and its ability to meet clinical specifications. For the head and neck cases, the average process target across institutions was 0.3% (range: -1.5% to 2.9%). The average process ability using control chart limits was 7.2% (range: 5.3% to 9.8%) compared to 6.7% (range: 5.3% to 8.2%) using standard deviation limits. For the prostate cases, the average process target across the institutions was 0.2% (range: -1.8% to 1.4%). The average process ability using control chart limits was 4.4% (range: 1.3% to 9.4%) compared to 5.3% (range: 2.3% to 9.8%) using standard deviation limits. Using the standard deviation to characterize IMRT QA process performance resulted in processes being preferentially placed in one of the four states. This is in contrast to using control charts for process characterization where the IMRT QA processes were spread over three of the

Fault tolerant control of wind turbines using unknown input observers

DEFF Research Database (Denmark)

Odgaard, Peter Fogh; Stoustrup, Jakob

2012-01-01

This paper presents a scheme for accommodating faults in the rotor and generator speed sensors in a wind turbine. These measured values are important both for the wind turbine controller as well as the supervisory control of the wind turbine. The scheme is based on unknown input observers, which...

A New Family of Nonlinear Observers for SI Engine Air/Fuel Ratio Control

DEFF Research Database (Denmark)

Jensen, P. B.; Olsen, M. B.; Poulsen, J.

1997-01-01

The paper treats a newly developed set of nonlinear observers for advanced spark ignition engine control.......The paper treats a newly developed set of nonlinear observers for advanced spark ignition engine control....

Active Video Game Exercise Training Improves the Clinical Control of Asthma in Children: Randomized Controlled Trial

Science.gov (United States)

Gomes, Evelim L. F. D.; Carvalho, Celso R. F.; Peixoto-Souza, Fabiana Sobral; Teixeira-Carvalho, Etiene Farah; Mendonça, Juliana Fernandes Barreto; Stirbulov, Roberto; Sampaio, Luciana Maria Malosá; Costa, Dirceu

2015-01-01

Objective The aim of the present study was to determine whether aerobic exercise involving an active video game system improved asthma control, airway inflammation and exercise capacity in children with moderate to severe asthma. Design A randomized, controlled, single-blinded clinical trial was carried out. Thirty-six children with moderate to severe asthma were randomly allocated to either a video game group (VGG; N = 20) or a treadmill group (TG; n = 16). Both groups completed an eight-week supervised program with two weekly 40-minute sessions. Pre-training and post-training evaluations involved the Asthma Control Questionnaire, exhaled nitric oxide levels (FeNO), maximum exercise testing (Bruce protocol) and lung function. Results No differences between the VGG and TG were found at the baseline. Improvements occurred in both groups with regard to asthma control and exercise capacity. Moreover, a significant reduction in FeNO was found in the VGG (p video game had a positive impact on children with asthma in terms of clinical control, improvementin their exercise capacity and a reductionin pulmonary inflammation. Trial Registration Clinicaltrials.gov NCT01438294 PMID:26301706

Active Video Game Exercise Training Improves the Clinical Control of Asthma in Children: Randomized Controlled Trial.

Science.gov (United States)

Gomes, Evelim L F D; Carvalho, Celso R F; Peixoto-Souza, Fabiana Sobral; Teixeira-Carvalho, Etiene Farah; Mendonça, Juliana Fernandes Barreto; Stirbulov, Roberto; Sampaio, Luciana Maria Malosá; Costa, Dirceu

2015-01-01

The aim of the present study was to determine whether aerobic exercise involving an active video game system improved asthma control, airway inflammation and exercise capacity in children with moderate to severe asthma. A randomized, controlled, single-blinded clinical trial was carried out. Thirty-six children with moderate to severe asthma were randomly allocated to either a video game group (VGG; N = 20) or a treadmill group (TG; n = 16). Both groups completed an eight-week supervised program with two weekly 40-minute sessions. Pre-training and post-training evaluations involved the Asthma Control Questionnaire, exhaled nitric oxide levels (FeNO), maximum exercise testing (Bruce protocol) and lung function. No differences between the VGG and TG were found at the baseline. Improvements occurred in both groups with regard to asthma control and exercise capacity. Moreover, a significant reduction in FeNO was found in the VGG (p video game had a positive impact on children with asthma in terms of clinical control, improvement in their exercise capacity and a reduction in pulmonary inflammation. Clinicaltrials.gov NCT01438294.

Speed tracking control of pneumatic motor servo systems using observation-based adaptive dynamic sliding-mode control

Science.gov (United States)

Chen, Syuan-Yi; Gong, Sheng-Sian

2017-09-01

This study aims to develop an adaptive high-precision control system for controlling the speed of a vane-type air motor (VAM) pneumatic servo system. In practice, the rotor speed of a VAM depends on the input mass air flow, which can be controlled by the effective orifice area (EOA) of an electronic throttle valve (ETV). As the control variable of a second-order pneumatic system is the integral of the EOA, an observation-based adaptive dynamic sliding-mode control (ADSMC) system is proposed to derive the differential of the control variable, namely, the EOA control signal. In the ADSMC system, a proportional-integral-derivative fuzzy neural network (PIDFNN) observer is used to achieve an ideal dynamic sliding-mode control (DSMC), and a supervisor compensator is designed to eliminate the approximation error. As a result, the ADSMC incorporates the robustness of a DSMC and the online learning ability of a PIDFNN. To ensure the convergence of the tracking error, a Lyapunov-based analytical method is employed to obtain the adaptive algorithms required to tune the control parameters of the online ADSMC system. Finally, our experimental results demonstrate the precision and robustness of the ADSMC system for highly nonlinear and time-varying VAM pneumatic servo systems.

The mystery of the cerebellum: clues from experimental and clinical observations.

Science.gov (United States)

Lawrenson, Charlotte; Bares, Martin; Kamondi, Anita; Kovács, Andrea; Lumb, Bridget; Apps, Richard; Filip, Pavel; Manto, Mario

2018-01-01

The cerebellum has a striking homogeneous cytoarchitecture and participates in both motor and non-motor domains. Indeed, a wealth of evidence from neuroanatomical, electrophysiological, neuroimaging and clinical studies has substantially modified our traditional view on the cerebellum as a sole calibrator of sensorimotor functions. Despite the major advances of the last four decades of cerebellar research, outstanding questions remain regarding the mechanisms and functions of the cerebellar circuitry. We discuss major clues from both experimental and clinical studies, with a focus on rodent models in fear behaviour, on the role of the cerebellum in motor control, on cerebellar contributions to timing and our appraisal of the pathogenesis of cerebellar tremor. The cerebellum occupies a central position to optimize behaviour, motor control, timing procedures and to prevent body oscillations. More than ever, the cerebellum is now considered as a major actor on the scene of disorders affecting the CNS, extending from motor disorders to cognitive and affective disorders. However, the respective roles of the mossy fibres, the climbing fibres, cerebellar cortex and cerebellar nuclei remains unknown or partially known at best in most cases. Research is now moving towards a better definition of the roles of cerebellar modules and microzones. This will impact on the management of cerebellar disorders.

The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials.

Science.gov (United States)

Stanmore, Emma; Stubbs, Brendon; Vancampfort, Davy; de Bruin, Eling D; Firth, Joseph

2017-07-01

Physically-active video games ('exergames') have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively-demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta-analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non-clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random-effects meta-analyses found exergames significantly improved global cognition (g=0.436, 95% CI=0.18-0.69, p=0.001). Significant effects still existed when excluding waitlist-only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p<0.05). Domain-specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta-analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Involving clinical librarians at the point of care: results of a controlled intervention.

Science.gov (United States)

Aitken, Elizabeth M; Powelson, Susan E; Reaume, Renée D; Ghali, William A

2011-12-01

To measure the effect of including a clinical librarian in the health care team on medical residents and clinical clerks. In 2009, medical residents and clinical clerks were preassigned to one of two patient care teams (intervention and control). Each team had a month-long rotation on the general medicine teaching unit. The clinical librarian joined the intervention team for morning intake, clinical rounding, or an afternoon patient list review, providing immediate literature searches, formal group instruction, informal bedside teaching, and/or individual mentoring for use of preappraised resources and evidence-based medicine search techniques. Both intervention and control teams completed pre and post surveys comparing their confidence levels and awareness of resources as well as their self-reported use of evidence for making patient care decisions. The nonintervention team was surveyed as the control group. The clinical librarian intervention had a significant positive effect on medical trainees' self-reported ability to independently locate and evaluate evidence resources to support patient care decisions. Notably, 30 of 34 (88%) reported having changed a treatment plan based on skills taught by the clinical librarian, and 27 of 34 (79%) changed a treatment plan based on the librarian's mediated search support. Clinical librarians on the care team led to positive effects on self-reported provider attitudes, provider information retrieval tendencies, and, notably, clinical decision making. Future research should evaluate economic effects of widespread implementation of on-site clinical librarians.

Neural-network-observer-based optimal control for unknown nonlinear systems using adaptive dynamic programming

Science.gov (United States)

Liu, Derong; Huang, Yuzhu; Wang, Ding; Wei, Qinglai

2013-09-01

In this paper, an observer-based optimal control scheme is developed for unknown nonlinear systems using adaptive dynamic programming (ADP) algorithm. First, a neural-network (NN) observer is designed to estimate system states. Then, based on the observed states, a neuro-controller is constructed via ADP method to obtain the optimal control. In this design, two NN structures are used: a three-layer NN is used to construct the observer which can be applied to systems with higher degrees of nonlinearity and without a priori knowledge of system dynamics, and a critic NN is employed to approximate the value function. The optimal control law is computed using the critic NN and the observer NN. Uniform ultimate boundedness of the closed-loop system is guaranteed. The actor, critic, and observer structures are all implemented in real-time, continuously and simultaneously. Finally, simulation results are presented to demonstrate the effectiveness of the proposed control scheme.

Switched-Observer-Based Adaptive Neural Control of MIMO Switched Nonlinear Systems With Unknown Control Gains.

Science.gov (United States)

Long, Lijun; Zhao, Jun

2017-07-01

In this paper, the problem of adaptive neural output-feedback control is addressed for a class of multi-input multioutput (MIMO) switched uncertain nonlinear systems with unknown control gains. Neural networks (NNs) are used to approximate unknown nonlinear functions. In order to avoid the conservativeness caused by adoption of a common observer for all subsystems, an MIMO NN switched observer is designed to estimate unmeasurable states. A new switched observer-based adaptive neural control technique for the problem studied is then provided by exploiting the classical average dwell time (ADT) method and the backstepping method and the Nussbaum gain technique. It effectively handles the obstacle about the coexistence of multiple Nussbaum-type function terms, and improves the classical ADT method, since the exponential decline property of Lyapunov functions for individual subsystems is no longer satisfied. It is shown that the technique proposed is able to guarantee semiglobal uniformly ultimately boundedness of all the signals in the closed-loop system under a class of switching signals with ADT, and the tracking errors converge to a small neighborhood of the origin. The effectiveness of the approach proposed is illustrated by its application to a two inverted pendulum system.

$H_2$ optimal controllers with observer based architecture for continuous-time systems : separation principle

NARCIS (Netherlands)

Saberi, A.; Sannuti, P.; Stoorvogel, A.A.

1994-01-01

For a general H2 optimal control problem, at first all Hz optimal measurement feedback controllers are characterized and parameterized, and then attention is focused on controllers with observer based architecture. Both full order as well as reduced order observer based H2 optimal controllers are

Nonlinear adaptive observer-based sliding mode control for LAMOST mount driving

International Nuclear Information System (INIS)

Zhou Wangping; Guo Wei; Yu Li; Yang Changsong; Zheng Yi

2010-01-01

Heavy disturbances caused mainly by wind and friction in the mount drive system greatly impair the pointing accuracy of the Large Sky Area Multi-Object Fiber Spectroscopic Telescope (LAMOST). To overcome this negative effect, a third order Higher Order Sliding Mode (HOSM) controller is proposed. The key part of this approach is to design an appropriate observer which obtains the acceleration state. A nonlinear adaptive observer is proposed in which a novel polynomial model is applied to estimate the internal disturbances of the mount drive system. Theoretical analysis demonstrates the stability of the proposed observer. Simulation results show that this nonlinear adaptive observer can obtain a high precision acceleration signal which completes the HOSM controller. Furthermore, the HOSM approach can easily satisfy the position tracking requirements of the LAMOST mount drive system.

An autonomous observation and control system based on EPICS and RTS2 for Antarctic telescopes

Science.gov (United States)

Zhang, Guang-yu; Wang, Jian; Tang, Peng-yi; Jia, Ming-hao; Chen, Jie; Dong, Shu-cheng; Jiang, Fengxin; Wu, Wen-qing; Liu, Jia-jing; Zhang, Hong-fei

2016-01-01

For unattended telescopes in Antarctic, the remote operation, autonomous observation and control are essential. An EPICS-(Experimental Physics and Industrial Control System) and RTS2-(Remote Telescope System, 2nd Version) based autonomous observation and control system with remoted operation is introduced in this paper. EPICS is a set of open source software tools, libraries and applications developed collaboratively and used worldwide to create distributed soft real-time control systems for scientific instruments while RTS2 is an open source environment for control of a fully autonomous observatory. Using the advantage of EPICS and RTS2, respectively, a combined integrated software framework for autonomous observation and control is established that use RTS2 to fulfil the function of astronomical observation and use EPICS to fulfil the device control of telescope. A command and status interface for EPICS and RTS2 is designed to make the EPICS IOC (Input/Output Controller) components integrate to RTS2 directly. For the specification and requirement of control system of telescope in Antarctic, core components named Executor and Auto-focus for autonomous observation is designed and implemented with remote operation user interface based on browser-server mode. The whole system including the telescope is tested in Lijiang Observatory in Yunnan Province for practical observation to complete the autonomous observation and control, including telescope control, camera control, dome control, weather information acquisition with the local and remote operation.

[Post-marketing reevaluation for potential quality risk and quality control in clinical application of traditional Chinese medicines].

Science.gov (United States)

Li, Hong-jiao; He, Li-yun; Liu, Bao-yan

2015-06-01

The effective quality control in clinical practices is an effective guarantee for the authenticity and scientificity of the findings. The post-marketing reevaluation for traditional Chinese medicines (TCM) focuses on the efficacy, adverse reaction, combined medication and effective dose of drugs in the market by expanded clinical trials, and requires a larger sample size and a wider range of patients. Therefore, this increases the difficulty of quality control in clinical practices. With the experience in quality control in clinical practices for the post-marketing reevaluation for Kangbingdu oral for cold, researchers in this study reviewed the study purpose, project, scheme design and clinical practice process from an overall point of view, analyzed the study characteristics of the post-marketing reevaluation for TCMs and the quality control risks, designed the quality control contents with quality impacting factors, defined key review contents and summarized the precautions in clinical practices, with the aim to improve the efficiency of quality control of clinical practices. This study can provide reference to clinical units and quality control-related personnel in the post-marketing reevaluation for TCMs.

Synthesis of state observer and nonlinear output feedback controller design of AC machines

International Nuclear Information System (INIS)

Al-Tahir, Ali Abdul Razzaq

2016-01-01

The research work developed in this thesis has been mainly devoted to the observation and sensor-less control problems of electrical systems. Three major contributions have been carried out using the high - gain concept and output feedback adaptive nonlinear control for online UPS. In this thesis, we dealt with synthesis of sampled high - gain observers for nonlinear systems application to PMSMs and DFIGs. We particularly focus on two constraints: sampling effect and tracking unmeasured mechanical and magnetic state variables. The first contribution consists in a high gain observer design that performs a relatively accurate estimation of both mechanical and magnetic state variable using the available measurements on stator currents and voltages of PMSM. We propose a global exponential observer having state predictor for a class of nonlinear globally Lipschitz system. In second contribution, we proposed a novel non - standard HGO design for non-injective feedback relation application to variable speed DFIG based WPGS. Meanwhile, a reduced system model is analyzed, provided by observability test to check is it possible synthesis state observer for sensor-less control. In last contribution, an adaptive observer for states and parameters estimation are designed for a class of state - affine systems application to output feedback adaptive nonlinear control of three-phase AC/DC boost power converter for online UPS systems. Basically, the problem focused on cascade nonlinear adaptive controller that is developed making use Lyapunov theory. The parameters uncertainties are processed by the practical control laws under back-stepping design techniques with capacity of adaptation. (author)

Dynamic Surface Adaptive Robust Control of Unmanned Marine Vehicles with Disturbance Observer

Directory of Open Access Journals (Sweden)

Pengchao Zhang

2018-01-01

Full Text Available This paper presents a dynamic surface adaptive robust control method with disturbance observer for unmanned marine vehicles (UMV. It uses adaptive law to estimate and compensate the disturbance observer error. Dynamic surface is introduced to solve the “differential explosion” caused by the virtual control derivation in traditional backstepping method. The final controlled system is proved to be globally uniformly bounded based on Lyapunov stability theory. Simulation results illustrate the effectiveness of the proposed controller, which can realize the three-dimensional trajectory tracking for UMV with the systematic uncertainty and time-varying disturbances.

Nonlinear Disturbance Observer Based Robust Tracking Control of Pneumatic Muscle

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Youssif Mohamed Toum Elobaid

2014-01-01

Full Text Available Presently pneumatic muscles (PMs are used in various applications due to their simple construction, lightweight, and high force-to-weight ratio. However, pneumatic muscles are facing various problems due to their nonlinear characteristics and various uncertainties in real applications. To cope with the uncertainties and strong nonlinearity of a PM model, a nonlinear disturbance observer (NDO is designed to estimate the lumped disturbance. Based on the disturbance observer, the tracking control of PM is studied. Stability analysis based on Lyapunov method with respect to our proposed control law is discussed. The simulation results show the validity, effectiveness, and enhancing robustness of the proposed methods.

Utilizing measure-based feedback in control-mastery theory: A clinical error.

Science.gov (United States)

Snyder, John; Aafjes-van Doorn, Katie

2016-09-01

Clinical errors and ruptures are an inevitable part of clinical practice. Often times, therapists are unaware that a clinical error or rupture has occurred, leaving no space for repair, and potentially leading to patient dropout and/or less effective treatment. One way to overcome our blind spots is by frequently and systematically collecting measure-based feedback from the patient. Patient feedback measures that focus on the process of psychotherapy such as the Patient's Experience of Attunement and Responsiveness scale (PEAR) can be used in conjunction with treatment outcome measures such as the Outcome Questionnaire 45.2 (OQ-45.2) to monitor the patient's therapeutic experience and progress. The regular use of these types of measures can aid clinicians in the identification of clinical errors and the associated patient deterioration that might otherwise go unnoticed and unaddressed. The current case study describes an instance of clinical error that occurred during the 2-year treatment of a highly traumatized young woman. The clinical error was identified using measure-based feedback and subsequently understood and addressed from the theoretical standpoint of the control-mastery theory of psychotherapy. An alternative hypothetical response is also presented and explained using control-mastery theory. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Anatomical, Clinical and Electrical Observations in Piriformis Syndrome

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Assoum Hani A

2010-01-01

Full Text Available Abstract Background We provided clinical and electrical descriptions of the piriformis syndrome, contributing to better understanding of the pathogenesis and further diagnostic criteria. Methods Between 3550 patients complaining of sciatica, we concluded 26 cases of piriformis syndrome, 15 females, 11 males, mean age 35.37 year-old. We operated 9 patients, 2 to 19 years after the onset of symptoms, 5 had piriformis steroids injection. A dorsolumbar MRI were performed in all cases and a pelvic MRI in 7 patients. The electro-diagnostic test was performed in 13 cases, between them the H reflex of the peroneal nerve was tested 7 times. Results After a followup 1 to 11 years, for the 17 non operated patients, 3 patients responded to conservative treatment. 6 of the operated had an excellent result, 2 residual minor pain and one failed. 3 new anatomical observations were described with atypical compression of the sciatic nerve by the piriformis muscle. Conclusion While the H reflex test of the tibial nerve did not give common satisfaction in the literature for diagnosis, the H reflex of the peroneal nerve should be given more importance, because it demonstrated in our study more specific sign, with six clinical criteria it contributed to improve the method of diagnosis. The cause of this particular syndrome does not only depend on the relation sciatic nerve-piriformis muscle, but the environmental conditions should be considered with the series of the anatomical anomalies to explain the real cause of this pain.

Clinical observation of phacoemulsification in patients with previous trabeculectomy

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Li Li

2013-09-01

Full Text Available AIM: To observe the clinical effect of transparent corneal incision phacoemulsification in cataract patients who had undergone different kinds of glaucoma filtration surgeries.METHODS: Totally 43 cases(50 eyes, in which 23 patients with primary angle-closure glaucoma(group A, 26 eyesand 20 patients with primary open angle glaucoma(group B, 24 eyes, all had undergone glaucoma filtration surgery for more than 6 months. Visual acuity, intraocular pressure, slit lamp, gonioscope, corneal endothelial cell counts, etc., were done before surgery.And transparent corneal incision phacoemulsification combined with artificial lens implantation operation were preformed, postoperative follow-up of 3 to 12 months, visual acuity, intraocular pressure, corneal endothelial cell counts and vision field, etc. were observed and recorded.RESULTS: The visual acuity of 50 eyes(100%increased with different degree postoperatively, 41 eyes(82%with postoperative visual acuity ≥0.3; average preoperative intraocular pressure: group A 18.08±5.08mmHg(1mmHg=0.133kpa, group B 14.48±3.52mmHg; Postoperative follow-up average intraocular pressure: group A 13.65±3.51mmHg, group B 14.28±3.41 mmHg, intraocular pressure changed significantly pre and post-operation in group A(PP>0.05; Postoperative intraocular pressure of 1 eye in group A and 3 eyes in group B rose within three days post-operation, the intraocular pressure fluctuated between 21-33mmHg, with drug therapy and drug withdral when intraocular pressure epistrophy; Intraocular pressure was stable in the follow-up process.Corneal endothelial cell density: pre-operation group A was 2 293.57±352.24(cells/mm2, group B 2 658.14±458.69(cells/mm2, post- operation group A 2 175.95±379.16(cells/mm2, group B 2 442.97±477.30(cells/mm2, cell loss rate: 5.13% in group A, and 8.10% in group B. Postoperative visual acuity was related to vision field damage in patients, the more visual field damage, the longer the duration

Hemozoin Inhibition and Control of Clinical Malaria

Directory of Open Access Journals (Sweden)

Chibueze Peter Ihekwereme

2014-01-01

Full Text Available Malaria has a negative impact on health and social and economic life of residents of endemic countries. The ultimate goals of designing new treatment for malaria are to prevent clinical infection, reduce morbidity, and decrease mortality. There are great advances in the understanding of the parasite-host interaction through studies by various scientists. In some of these studies, attempts were made to evaluate the roles of malaria pigment or toxins in the pathogenesis of malaria. Hemozoin is a key metabolite associated with severe malaria anemia (SMA, immunosuppression, and cytokine dysfunction. Targeting of this pigment may be necessary in the design of new therapeutic products against malaria. In this review, the roles of hemozoin in the morbidity and mortality of malaria are highlighted as an essential target in the quest for effective control of clinical malaria.

Robust Non-Chattering Observer Based Sliding Control Concept for Electro-Hydraulic Drives

DEFF Research Database (Denmark)

Schmidt, Lasse; Andersen, Torben Ole; Pedersen, Henrik C.

2013-01-01

This paper presents an observer-based sliding mode control concept with chattering reduction, generally applicable for position tracking control of electro-hydraulic valve-cylinder drives (VCD's). The proposed control concept requires only common data sheet information and no knowledge on load...... extensive knowledge on system parameters nor advanced control theory. In order to accomplish this task, an integral sliding mode controller designed for the control derivative employing state observation is proposed, based on a generalized reduced order model structure of a VCD with unmatched valve ow......- and cylinder asymmetries. It is shown that limited attention can be given to bounds on parameter estimates, that chattering is reduced and the number of tuning parameters is reduced to the level seen in conventional PID schemes. Furthermore, simulation results demonstrate a high level of robustness when...

Clinical coaching in primary care: Capable of improving control in patients with type 2 diabetes mellitus?

Science.gov (United States)

González-Guajardo, Eduardo Enrique; Salinas-Martínez, Ana María; Botello-García, Antonio; Mathiew-Quiros, Álvaro

2016-06-01

Few clinical coaching studies are both endorsed by real cases and focused on reducing suboptimal diabetes control. We evaluated the effectiveness of coaching on improving type 2 diabetes goals after 3 years of implementation in primary care. A cross-sectional study with follow up was conducted during 2008-2011. Coaching consisted of guiding family doctors to improve their clinical abilities, and it was conducted by a medical doctor trained in skill building, experiential learning, and goal setting. Effectiveness was assessed by means of fasting plasma glucose and glycosylated hemoglobin outcomes. The main analysis consisted of 1×3 and 2×3 repeated measures ANOVAs. A significant coaching×time interaction was observed, indicating that the difference in glucose between primary care units with and without coaching increased over time (Wilks' lambda multivariate test, PCoaching increased 1.4 times (95%CI 1.3, 1.5) the possibility of reaching the fasting glucose goal after controlling for baseline values. There was also a significant improvement in glycosylated hemoglobin (Bonferroni-corrected p-value for pairwise comparisons, Pcoaching was found to be worth the effort to improve type 2 diabetes control in primary care. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Disturbance Observer-Based Backstepping Control of PMSM for the Mine Traction Electric Locomotive

Directory of Open Access Journals (Sweden)

Jiande Yan

2018-01-01

Full Text Available For the Permanent Magnet Synchronous Motor (PMSM control system of the Mine Traction Electric Locomotive (MTEL, the fluctuation of the load will lead to the resonance of the velocity of the MTEL. In addition, the speed sensor is easy to be damaged due to the moisture, dust, and vibration. To solve the above problems, a disturbance observer-based (DOB backstepping control of PMSM for the MTEL is proposed in this paper. First, a full-dimensional Luenberger observer for PMSM is designed and the asymptotically stability of the observer is proved. Next, through the designing of the virtual control input that includes the reconstruction disturbances and using backstepping control strategy, the DOB controller is proposed. The obtained controller can achieve high precision speed tracking and disturbance rejection. Finally, the effectiveness and feasibility of the designed system are verified by Matlab simulation and experiment results.

Scapular positioning and motor control in children and adults: a laboratory study using clinical measures.

Science.gov (United States)

Struyf, Filip; Nijs, Jo; Horsten, Stijn; Mottram, Sarah; Truijen, Steven; Meeusen, Romain

2011-04-01

The scapular muscular system is the major determinant of scapular positioning. In addition, strength and muscular endurance develops from childhood through adolescence. It is not known whether differences in scapular positioning and motor control between adults and children may exist. Ninety-two shoulders of 46 adults (mean = 39.4; 18-86 years; SD = 22.5), and 116 shoulders of 59 children (mean = 11.6; 6-17 years; SD = 3.5), were included in the study. Scapular positioning data were collected using a clinical assessment protocol including visual observation of titling and winging, measurement of forward shoulder posture, measurement of scapular upward rotation, and the Kinetic Medial Rotation Test (KMRT). The observation protocol for scapular winging and tilting did not show significant differences between adults and children. After controlling for height, forward shoulder posture (relaxed (0.28 cm/cm (0.06) vs. 0.31 cm/cm (0.07) and retracted (0.15 cm/cm (0.05) vs. 0.20 cm/cm (0.06)) were significantly smaller in children than in adults (P < 0.01). In addition, children showed greater scapular upward rotation (18.6°; SD 9.6°) than adults (14.5°; SD 10.9°) at 90° shoulder abduction. No significant differences were seen between children (19% positive test) and adults (24% positive test) using the KMRT. Children and adults show significant but small differences in scapular upward rotation and forward shoulder posture. These data provide useful reference values using a clinical protocol. Copyright © 2010 Elsevier Ltd. All rights reserved.

[Clinical study on the effect of anti-gingivitis IgY toothpaste in control of gingivitis and dental plaque].

Science.gov (United States)

Zhang, Wei; Feng, Xi-Ping; Tao, Dan-Ying; Chen, Jian-Fen

2016-08-01

To observe the effect of anti-gingivitis IgY toothpaste in control of gingivitis and plaque. The study was a double-blind, randomized, parallel-controlled clinical trail with a total of 100 subjects who were divided into two groups, experimental group and control group. The subjects in experimental group used anti-gingivitis IgY toothpaste to brush twice daily for 3 minutes, and the subjects in control group used none anti-gingivitis IgY toothpaste. The examiner recorded GI, PI and BOP index of all subjects at the baseline, 6-weeks and 12-weeks. SPSS21.0 software package was used for statistical analysis. Twelve weeks later, there were significant differences in GI and BOP between the two groups. Yet no significant difference was found in PI. Anti-gingivitis IgY toothpaste is effective in control of gingivitis.

Radiological and clinical observation on benign prostatic hyperplasia

Energy Technology Data Exchange (ETDEWEB)

Oh, Jai Hee; Kim, Young Chul; Kim, Yeon; Han, Jung Suh [College of Medicine, Cho-Sun University, Seoul (Korea, Republic of)

1980-12-15

A radiological and clinical observation was made on 77 cases of benign prostatic hyperplasia admitted to the department of Urology, Cho-Sun University Hospital during the period from January 1972 to December 1979 and following results were obtained. 1. Incidence of PBH was 8.1% to 953 total inpatients, 11.3% to 679 male inpatients, and 34.5% to male inpatients of 50 years more. 2. Majority of cases was found in 7th and 8th decades (80.5%) with mean age of 69.4 years old. 3. A gradual tendency of annual increase of the cases was observed and the mean interval elapsed from initial symptoms to visit was 29.9 months. Common symptoms were dysuria in 72 cases (93.5%), hematuria in 53 cases (68.8%), frequency in 51 cases (66.2%) and 12 cases (15.6%) were acute urinary retention. 4. I. V. P. findings of BPH were elevation of the bladder base in 71 cases (92.2%), trabeculation of the bladder wall in 58 cases (75.3%), hypertrophy of the bladder in 24 cases (31.2%) and the complications-hydronephrosis and hydroureter 16 cases (20.8%), bladder diverticula 9 cases (11.7%) and bladder stone were 5 cases (6.5%). 5. Cystourethrographic findings of the posterior urethra with 33 cases of PBH were smooth, gentle sloping in 28 cases 84.8%), widening in sagittal plane in 23 cases (69.7%), elongation and narrowing of the urethra in 26 cases (78.8%)

Radiological and clinical observation on benign prostatic hyperplasia

International Nuclear Information System (INIS)

Oh, Jai Hee; Kim, Young Chul; Kim, Yeon; Han, Jung Suh

1980-01-01

A radiological and clinical observation was made on 77 cases of benign prostatic hyperplasia admitted to the department of Urology, Cho-Sun University Hospital during the period from January 1972 to December 1979 and following results were obtained. 1. Incidence of PBH was 8.1% to 953 total inpatients, 11.3% to 679 male inpatients, and 34.5% to male inpatients of 50 years more. 2. Majority of cases was found in 7th and 8th decades (80.5%) with mean age of 69.4 years old. 3. A gradual tendency of annual increase of the cases was observed and the mean interval elapsed from initial symptoms to visit was 29.9 months. Common symptoms were dysuria in 72 cases (93.5%), hematuria in 53 cases (68.8%), frequency in 51 cases (66.2%) and 12 cases (15.6%) were acute urinary retention. 4. I. V. P. findings of BPH were elevation of the bladder base in 71 cases (92.2%), trabeculation of the bladder wall in 58 cases (75.3%), hypertrophy of the bladder in 24 cases (31.2%) and the complications-hydronephrosis and hydroureter 16 cases (20.8%), bladder diverticula 9 cases (11.7%) and bladder stone were 5 cases (6.5%). 5. Cystourethrographic findings of the posterior urethra with 33 cases of PBH were smooth, gentle sloping in 28 cases 84.8%), widening in sagittal plane in 23 cases (69.7%), elongation and narrowing of the urethra in 26 cases (78.8%)

Sepsis and meningitis in hospitalized children: performance of clinical signs and their prediction rules in a case-control study.

Science.gov (United States)

Verbakel, Jan Y; MacFaul, Roderick; Aertgeerts, Bert; Buntinx, Frank; Thompson, Matthew

2014-06-01

Feverish illness is a common presentation to acute pediatric services. Clinical staff faces the challenge of differentiating the few children with meningitis or sepsis from the majority with self-limiting illness. We aimed to determine the diagnostic value of clinical features and their prediction rules (CPR) for identifying children with sepsis or meningitis among those children admitted to a District General Hospital with acute febrile illness. Acutely ill children admitted to a District General Hospital in England were included in this case-control study between 2000 and 2005. We examined the diagnostic accuracy of individual clinical signs and 6 CPRs, including the National Institute for Clinical Excellence "traffic light" system, to determine clinical utility in identifying children with a diagnosis of sepsis or meningitis. Loss of consciousness, prolonged capillary refill, decreased alertness, respiratory effort, and the physician's illness assessment had high positive likelihood ratios (9-114), although with wide confidence intervals, to rule in sepsis or meningitis. The National Institute for Clinical Excellence traffic light system, the modified Yale Observation Scale, and the Pediatric Advanced Warning Score performed poorly with positive likelihood ratios ranging from 1 to 3. The pediatrician's overall illness assessment was the most useful feature to rule in sepsis or meningitis in these hospitalized children. Clinical prediction rules did not effectively rule in sepsis or meningitis. The modified Yale Observation Scale should be used with caution. Single clinical signs could complement these scores to rule in sepsis or meningitis. Further research is needed to validate these CPRs.

What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial.

Science.gov (United States)

Sharma, Anjana E; Willard-Grace, Rachel; Hessler, Danielle; Bodenheimer, Thomas; Thom, David H

2016-05-01

Health coaching is effective for chronic disease self-management in the primary care safety-net setting, but little is known about the persistence of its benefits. We conducted an observational study evaluating the maintenance of improved cardiovascular risk factors following a health coaching intervention. We performed a naturalistic follow-up to the Health Coaching in Primary Care Study, a 12-month randomized controlled trial (RCT) comparing health coaching to usual care for patients with uncontrolled diabetes, hypertension, or hyperlipidemia. Participants were followed up 24 months from RCT baseline. The primary outcome was the proportion at goal for at least 1 measure (hemoglobin A1c, systolic blood pressure, or LDL cholesterol) that had been above goal at enrollment; secondary outcomes included each individual clinical goal. Chi-square tests and paired t-tests compared dichotomous and continuous measures. 290 of 441 participants (65.8%) participated at both 12 and 24 months. The proportion of patients in the coaching arm of the RCT who achieved the primary outcome dropped only slightly from 47.1% at 12 to 45.9% at 24 months (P = .80). The proportion at goal for hemoglobin A1c dropped from 53.4% to 36.2% (P = .03). All other clinical metrics had small, nonsignificant changes between 12 and 24 months. Results support the conclusion that most improved clinical outcomes persisted 1 year after the completion of the health coaching intervention. © 2016 Annals of Family Medicine, Inc.

Nonlinear Robust Control of a Hypersonic Flight Vehicle Using Fuzzy Disturbance Observer

Directory of Open Access Journals (Sweden)

Lei Zhengdong

2013-01-01

Full Text Available This paper is concerned with a novel tracking controller design for a hypersonic flight vehicle in complex and volatile environment. The attitude control model is challengingly constructed with multivariate uncertainties and external disturbances, such as structure dynamic and stochastic wind disturbance. In order to resist the influence of uncertainties and disturbances on the flight control system, nonlinear disturbance observer is introduced to estimate them. Moreover, for the sake of high accuracy and sensitivity, fuzzy theory is adopted to improve the performance of the nonlinear disturbance observer. After the total disturbance is eliminated by dynamic inversion method, a cascade system is obtained and then stabilized by a sliding-mode controller. Finally, simulation results show that the strong robust controller achieves excellent performance when the closed-loop control system is influenced by mass uncertainties and external disturbances.

A Semi-Automatic, Remote-Controlled Video Observation System for Transient Luminous Events

DEFF Research Database (Denmark)

Allin, Thomas Højgaard; Neubert, Torsten; Laursen, Steen

2003-01-01

In support for global ELF/VLF observations, HF measurements in France, and conjugate photometry/VLF observations in South Africa, we developed and operated a semi-automatic, remotely controlled video system for the observation of middle-atmospheric transient luminous events (TLEs). Installed...

Effect of Dexmedetomidine and Propofol on Basal Ganglia Activity in Parkinson Disease: A Controlled Clinical Trial.

Science.gov (United States)

Martinez-Simon, Antonio; Alegre, Manuel; Honorato-Cia, Cristina; Nuñez-Cordoba, Jorge M; Cacho-Asenjo, Elena; Trocóniz, Iñaki F; Carmona-Abellán, Mar; Valencia, Miguel; Guridi, Jorge

2017-06-01

Deep brain stimulation electrodes can record oscillatory activity from deep brain structures, known as local field potentials. The authors' objective was to evaluate and quantify the effects of dexmedetomidine (0.2 μg·kg·h) on local field potentials in patients with Parkinson disease undergoing deep brain stimulation surgery compared with control recording (primary outcome), as well as the effect of propofol at different estimated peak effect site concentrations (0.5, 1.0, 1.5, 2.0, and 2.5 μg/ml) from control recording. A nonrandomized, nonblinded controlled clinical trial was carried out to assess the change in local field potentials activity over time in 10 patients with Parkinson disease who underwent deep brain stimulation placement surgery (18 subthalamic nuclei). The relationship was assessed between the activity in nuclei in the same patient at a given time and repeated measures from the same nucleus over time. No significant difference was observed between the relative beta power of local field potentials in dexmedetomidine and control recordings (-7.7; 95% CI, -18.9 to 7.6). By contrast, there was a significant decline of 12.7% (95% CI, -21.3 to -4.7) in the relative beta power of the local field potentials for each increment in the estimated peak propofol concentrations at the effect site relative to the control recordings. Dexmedetomidine (0.2 μg·kg·h) did not show effect on local field potentials compared with control recording. A significant deep brain activity decline from control recording was observed with incremental doses of propofol.

Evaluation of different ranges of LH:FSH ratios in polycystic ovarian syndrome (PCOS) - Clinical based case control study.

Science.gov (United States)

Malini, N A; Roy George, K

2018-05-01

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine and metabolic disorder among reproductive aged women, leading to infertility. One of the common clinical manifestations in PCOS is that there is a difference in the range of LH production in different case of PCOS and accordingly variability in LH:FSH ratio was observed. The aim of the present study was to evaluate different ranges of LH:FSH ratios in PCOS. In this cross sectional study, a consecutive series of 745 women (aged 28.11 ± 0.2) who were subjected to infertility treatment at specialist infertility clinics in central Travancore region were considered. About 50 healthy females (aged 27.58 ± 0.4) with regular menstrual cycles were regarded as control. The data were collected from hospital records using subject's written informed consent. PCOS patients were observed to have different ranges of LH:FSH ratios from PCOS. Copyright © 2018 Elsevier Inc. All rights reserved.

Randomized, blinded, controlled clinical trial shows no benefit of homeopathic mastitis treatment in dairy cows.

Science.gov (United States)

Ebert, Fanny; Staufenbiel, Rudolf; Simons, Julia; Pieper, Laura

2017-06-01

Mastitis is one of the most common diseases in dairy production, and homeopathic remedies have been used increasingly in recent years to treat it. Clinical trials evaluating homeopathy have often been criticized for their inadequate scientific approach. The objective of this triple-blind, randomized controlled trial was to assess the efficacy of homeopathic treatment in bovine clinical mastitis. The study was conducted on a conventionally managed dairy farm between June 2013 and May 2014. Dairy cows with acute mastitis were randomly allocated to homeopathy (n = 70) or placebo (n = 92), for a total of 162 animals. The homeopathic treatment was selected based on clinical symptoms but most commonly consisted of a combination of nosodes with Streptococcinum, Staphylococcinum, Pyrogenium, and Escherichia coli at a potency of 200c. Treatment was administered to cows in the homeopathy group at least once per day for an average of 5 d. The cows in the placebo group were treated similarly, using a placebo preparation instead (lactose globules without active ingredients). If necessary, we also used allopathic drugs (e.g., antibiotics, udder creams, and anti-inflammatory drugs) in both groups. We recorded data relating to the clinical signs of mastitis, treatment, time to recovery, milk yield, somatic cell count at first milk recording after mastitis, and culling. We observed cows for up to 200 d after clinical recovery. Base-level data did not differ between the homeopathy and placebo groups. Mastitis lasted for an average of 6 d in both groups. We observed no significant differences in time to recovery, somatic cell count, risk of clinical cure within 14 d after disease occurrence, mastitis recurrence risk, or culling risk. The results indicated no additional effect of homeopathic treatment compared with placebo. The advantages or disadvantages of homeopathy should be carefully assessed for individual farms. Copyright © 2017 American Dairy Science Association. Published by

Robust Dynamics and Control of a Partially Observed Markov Chain

International Nuclear Information System (INIS)

Elliott, R. J.; Malcolm, W. P.; Moore, J. P.

2007-01-01

In a seminal paper, Martin Clark (Communications Systems and Random Process Theory, Darlington, 1977, pp. 721-734, 1978) showed how the filtered dynamics giving the optimal estimate of a Markov chain observed in Gaussian noise can be expressed using an ordinary differential equation. These results offer substantial benefits in filtering and in control, often simplifying the analysis and an in some settings providing numerical benefits, see, for example Malcolm et al. (J. Appl. Math. Stoch. Anal., 2007, to appear).Clark's method uses a gauge transformation and, in effect, solves the Wonham-Zakai equation using variation of constants. In this article, we consider the optimal control of a partially observed Markov chain. This problem is discussed in Elliott et al. (Hidden Markov Models Estimation and Control, Applications of Mathematics Series, vol. 29, 1995). The innovation in our results is that the robust dynamics of Clark are used to compute forward in time dynamics for a simplified adjoint process. A stochastic minimum principle is established

Clinical evaluation of an automatic blood pressure controller during cardiac surgery

NARCIS (Netherlands)

Meijers, R.H.A.M.; Schmartz, D.; Cantraine, F.R.L.; Barvais, L.; d Hollander, A.A.; Blom, J.A.

1997-01-01

During surgery, computers can be of great use to support the anesthesiologist in providing task automation. In this paper we describe a closed loop blood pressure controller and show the results of its clinical evalua- tion.Methods. The controller is based on a simple and robust

Informing potential participants about research: observational study with an embedded randomized controlled trial.

Directory of Open Access Journals (Sweden)

Helen M Kirkby

Full Text Available OBJECTIVES: To assess: 1 the feasibility of electronic information provision; 2 gather evidence on the topics and level of detail of information potential research participant's accessed; 3 to assess satisfaction and understanding. DESIGN: Observational study with an embedded randomised controlled trial. SETTING: Low risk intervention study based in primary care. PARTICIPANTS: White British & Irish, South Asian and African-Caribbean subjects aged between 40-74 years eligible for a blood pressure monitoring study. INTERVENTIONS: PDF copy of the standard paper participant information sheet (PDF-PIS and an electronic Interactive Information Sheet (IIS where participants could choose both the type and level of detail accessed. MAIN OUTCOME MEASURES: 1 Proportion of participants providing an email address and accessing electronic information 2 Willingness to participate in a recruitment clinic. 3 Type and depth of information accessed on the IIS. 4 Participant satisfaction and understanding. RESULTS: 1160 participants were eligible for the study. Of these, 276 (24% provided an active email address, of whom 84 did not respond to the email. 106 responded to the email but chose not to access any electronic information and were therefore ineligible for randomisation. 42 were randomised to receive the PDF-PIS and 44 to receive the IIS (with consent rates of 48% and 36%, respectively; odds ratio 0.6, 95% confidence interval 0.25 to 1.4. Electronic observation of information accessed by potential participants showed 41% chose to access no information and only 9% accessed the detail presented on the Research Ethics Committee approved participant information sheet before booking to attend a recruitment clinic for the intervention study. 63 of the 106 participants (59% who chose not to access any electronic information also booked an appointment. CONCLUSIONS: Current written information about research may not be read, emphasising the importance of the consent

Observer-Based Load Frequency Control for Island Microgrid with Photovoltaic Power

Directory of Open Access Journals (Sweden)

Chaoxu Mu

2017-01-01

Full Text Available As renewable energy is widely integrated into the power system, the stochastic and intermittent power generation from renewable energy may cause system frequency deviating from the prescribed level, especially for a microgrid. In this paper, the load frequency control (LFC of an island microgrid with photovoltaic (PV power and electric vehicles (EVs is investigated, where the EVs can be treated as distributed energy storages. Considering the disturbances from load change and PV power, an observer-based integral sliding mode (OISM controller is designed to regulate the frequency back to the prescribed value, where the neural network observer is used to online estimate the PV power. Simulation studies on a benchmark microgrid system are presented to illustrate the effectiveness of OISM controller, and comparative results also demonstrate that the proposed method has a superior performance for stabilizing the frequency over the PID control.

Clinical observation of Qiming granule combined with Dextran and Hypromellose eye drops for dry eye

OpenAIRE

Jin-Lan Wan; Ming-Chang Zhang

2013-01-01

AIM: To observe the efficacy of Qiming granule combined with Dextran and Hypromellose eye drops in treatment of dry eye.METHODS: A randomized, parallel-control approach was adopted, 100 cases of dry eye patients were divided into treatment group and control group equally, observation on the treatment of 3 months. The treatment group was applied Dextran and Hypromellose eye drops combined with oral Qiming granule, simply Dextran and Hypromellose eye drops for control group. Before and after tr...

Observations of infection prevention and control practices in primary health care, Kenya.

Science.gov (United States)

Bedoya, Guadalupe; Dolinger, Amy; Rogo, Khama; Mwaura, Njeri; Wafula, Francis; Coarasa, Jorge; Goicoechea, Ana; Das, Jishnu

2017-07-01

To assess compliance with infection prevention and control practices in primary health care in Kenya. We used an observational, patient-tracking tool to assess compliance with infection prevention and control practices by 1680 health-care workers during outpatient interactions with 14 328 patients at 935 health-care facilities in 2015. Compliance was assessed in five domains: hand hygiene; protective glove use; injections and blood sampling; disinfection of reusable equipment; and waste segregation. We calculated compliance by dividing the number of correct actions performed by the number of indications and evaluated associations between compliance and the health-care worker's and facility's characteristics. Across 106 464 observed indications for an infection prevention and control practice, the mean compliance was 0.318 (95% confidence interval, CI: 0.315 to 0.321). The compliance ranged from 0.023 (95% CI: 0.021 to 0.024) for hand hygiene to 0.871 (95% CI: 0.866 to 0.876) for injection and blood sampling safety. Compliance was weakly associated with the facility's characteristics (e.g. public or private, or level of specialization) and the health-care worker's knowledge of, and training in, infection prevention and control practices. The observational tool was effective for assessing compliance with infection prevention and control practices across multiple domains in primary health care in a low-income country. Compliance varied widely across infection prevention and control domains. The weak associations observed between compliance and the characteristics of health-care workers and facilities, such as knowledge and the availability of supplies, suggest that a broader focus on behavioural change is required.

Laboratory implementation of quantum-control-mechanism identification through Hamiltonian encoding and observable decoding

International Nuclear Information System (INIS)

Rey-de-Castro, R.; Rabitz, H.

2010-01-01

We report on the laboratory implementation of quantum-control-mechanism identification through Hamiltonian encoding and observable decoding (HE-OD). Over a sequence of experiments, HE-OD introduces a special encoded signature into the components of a previously determined control field expressed in a chosen representation. The outcome appears as a modulated signal in the controlled system observable. Decoding the modulated signal identifies the hierarchy of correlations between components of the control field in a particular representation. In cases where the initial quantum state and observable operator are fully known, then HE-OD can also identify the transition amplitudes of the various Dyson expansion orders contributing to the controlled dynamics. The basic principles of HE-OD are illustrated for second harmonic generation when the components of the field representation are simply taken as the pixels in the pulse shaper. The outcome of HE-OD agrees well with simulations, verifying the concept.

Clinical outcomes of elite controllers, viremic controllers, and long-term nonprogressors in the US Department of Defense HIV natural history study.

Science.gov (United States)

Okulicz, Jason F; Marconi, Vincent C; Landrum, Michael L; Wegner, Scott; Weintrob, Amy; Ganesan, Anuradha; Hale, Braden; Crum-Cianflone, Nancy; Delmar, Judith; Barthel, Vincent; Quinnan, Gerald; Agan, Brian K; Dolan, Matthew J

2009-12-01

Durable control of human immunodeficiency virus (HIV) replication and lack of disease progression in the absence of antiretroviral therapy were studied in a military cohort of 4586 subjects. We examined groups of elite controllers (ie, subjects with plasma HIV RNA levels of <50 copies/mL; prevalence, 0.55% [95% confidence interval {CI}, 0.35%-0.80%]), viremic controllers (ie, subjects with plasma HIV RNA levels of 50-2000 copies/mL; prevalence, 3.34% [95% CI, 2.83%-3.91%]), and subjects with a lack of disease progression (ie, long-term nonprogressors [LTNPs]) through 7 years of follow-up (LTNP7s; prevalence, 3.32% [95% CI, 2.70%-4.01%]) or 10 years of follow-up (LTNP10s; prevalence, 2.04% [95% CI, 1.52%-2.68%]). For elite and viremic controllers, spontaneous virologic control was established early and was typically observed when the initial viral load measurement was obtained within 1 year of estimated seroconversion. Elite controllers had favorable time to development of AIDS (P=.048), a CD4 cell count of 350 cells/microL (P= .009), and more-stable CD4 cell trends, compared with viremic controllers. LTNPs defined by 10-year versus 7-year criteria had a longer survival time (P=.001), even after adjustment for differing periods of invulnerability (P= .042). Definitions of controllers and LTNPs describe distinct populations whose differing clinical outcomes improve with the stringency of criteria, underscoring the need for comparability between study populations.

Design of neuro fuzzy fault tolerant control using an adaptive observer

International Nuclear Information System (INIS)

Anita, R.; Umamaheswari, B.; Viswanathan, B.

2001-01-01

New methodologies and concepts are developed in the control theory to meet the ever-increasing demands in industrial applications. Fault detection and diagnosis of technical processes have become important in the course of progressive automation in the operation of groups of electric drives. When a group of electric drives is under operation, fault tolerant control becomes complicated. For multiple motors in operation, fault detection and diagnosis might prove to be difficult. Estimation of all states and parameters of all drives is necessary to analyze the actuator and sensor faults. To maintain system reliability, detection and isolation of failures should be performed quickly and accurately, and hardware should be properly integrated. Luenberger full order observer can be used for estimation of the entire states in the system for the detection of actuator and sensor failures. Due to the insensitivity of the Luenberger observer to the system parameter variations, state estimation becomes inaccurate under the varying parameter conditions of the drives. Consequently, the estimation performance deteriorates, resulting in ordinary state observers unsuitable for fault detection technique. Therefore an adaptive observe, which can estimate the system states and parameter and detect the faults simultaneously, is designed in our paper. For a Group of D C drives, there may be parameter variations for some of the drives, and for other drives, there may not be parameter variations depending on load torque, friction, etc. So, estimation of all states and parameters of all drives is carried out using an adaptive observer. If there is any deviation with the estimated values, it is understood that fault has occurred and the nature of the fault, whether sensor fault or actuator fault, is determined by neural fuzzy network, and fault tolerant control is reconfigured. Experimental results with neuro fuzzy system using adaptive observer-based fault tolerant control are good, so as

An Optimal Medium Access Control with Partial Observations for Sensor Networks

Directory of Open Access Journals (Sweden)

Servetto Sergio D

2005-01-01

Full Text Available We consider medium access control (MAC in multihop sensor networks, where only partial information about the shared medium is available to the transmitter. We model our setting as a queuing problem in which the service rate of a queue is a function of a partially observed Markov chain representing the available bandwidth, and in which the arrivals are controlled based on the partial observations so as to keep the system in a desirable mildly unstable regime. The optimal controller for this problem satisfies a separation property: we first compute a probability measure on the state space of the chain, namely the information state, then use this measure as the new state on which the control decisions are based. We give a formal description of the system considered and of its dynamics, we formalize and solve an optimal control problem, and we show numerical simulations to illustrate with concrete examples properties of the optimal control law. We show how the ergodic behavior of our queuing model is characterized by an invariant measure over all possible information states, and we construct that measure. Our results can be specifically applied for designing efficient and stable algorithms for medium access control in multiple-accessed systems, in particular for sensor networks.

Total-body irradiation and bone-marrow transplantation - first observations on clinical tolerance

International Nuclear Information System (INIS)

Gocheva, L.; Sergieva, K.; Koleva, I.; Mlachkova, D.; Michailov, G.; Avramova, B.

2004-01-01

complications in 5 of the cases. The transplantation was accompanied by allergic reactions in two patients. Acute GvHD was developed in only one patient. No pneumonitis was developed and we attribute this to the fact that the planned dose in the lungs was not exceeded - it was verified to be 8 Gy by in vivo measurements. Powerful antibiotic, antifungal, antiviral, substituting and symptomatic therapy was accomplished in all patients. No clinically displayed infections were observed in 6 of them despite of the presence of positive uro- and coprocultures. Six patients were discharged in good general condition within the interval of 16 to 30 days after the transplantation with compensated hematological parameters and stable transplant effect.The aspiration for widening the scope of indications for TBI treatment with subsequent allogeneic PSCT continues to be in the bases of the routine practice in the country and the clinical observations proceed in this context. Key words: total-body irradiation. bone-marrow transplantation. clinical tolerance

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

Observer-based attitude controller for lifting re-entry vehicle with non-minimum phase property

Directory of Open Access Journals (Sweden)

Wenming Nie

2017-05-01

Full Text Available This article concentrates on the attitude control problem for the lifting re-entry vehicle with non-minimum phase property. A novel attitude control method is proposed for this kind of lifting re-entry vehicle without assuming the internal dynamics to be measurable. First, an internal dynamics extended state observer is developed to deal with the unmeasurable problem of the internal dynamics. And then, the control scheme which adopts output feedback method is proposed by modifying the traditional output redefinition technique with internal dynamics extended state observer. This control scheme only requires the system output to be measurable, and it can still stabilize the unstable internal dynamics and track attitude commands. Besides, because of the inherent property of extended state observer in rejecting uncertainties and disturbances, the control precision of the proposed controller is higher than the controller designed with traditional output redefinition technique. Finally, the effectiveness and robustness of the proposed attitude controller are demonstrated by the simulation results.

Novel Observer Scheme of Fuzzy-MRAS Sensorless Speed Control of Induction Motor Drive

Science.gov (United States)

Chekroun, S.; Zerikat, M.; Mechernene, A.; Benharir, N.

2017-01-01

This paper presents a novel approach Fuzzy-MRAS conception for robust accurate tracking of induction motor drive operating in a high-performance drives environment. Of the different methods for sensorless control of induction motor drive the model reference adaptive system (MRAS) finds lot of attention due to its good performance. The analysis of the sensorless vector control system using MRAS is presented and the resistance parameters variations and speed observer using new Fuzzy Self-Tuning adaptive IP Controller is proposed. In fact, fuzzy logic is reminiscent of human thinking processes and natural language enabling decisions to be made based on vague information. The present approach helps to achieve a good dynamic response, disturbance rejection and low to plant parameter variations of the induction motor. In order to verify the performances of the proposed observer and control algorithms and to test behaviour of the controlled system, numerical simulation is achieved. Simulation results are presented and discussed to shown the validity and the performance of the proposed observer.

Robust Predictive Functional Control for Flight Vehicles Based on Nonlinear Disturbance Observer

Directory of Open Access Journals (Sweden)

Yinhui Zhang

2015-01-01

Full Text Available A novel robust predictive functional control based on nonlinear disturbance observer is investigated in order to address the control system design for flight vehicles with significant uncertainties, external disturbances, and measurement noise. Firstly, the nonlinear longitudinal dynamics of the flight vehicle are transformed into linear-like state-space equations with state-dependent coefficient matrices. And then the lumped disturbances are considered in the linear structure predictive model of the predictive functional control to increase the precision of the predictive output and resolve the intractable mismatched disturbance problem. As the lumped disturbances cannot be derived or measured directly, the nonlinear disturbance observer is applied to estimate the lumped disturbances, which are then introduced to the predictive functional control to replace the unknown actual lumped disturbances. Consequently, the robust predictive functional control for the flight vehicle is proposed. Compared with the existing designs, the effectiveness and robustness of the proposed flight control are illustrated and validated in various simulation conditions.

Glycemic control in the infectious diseases ward; role of clinical pharmacist interventions.

Science.gov (United States)

Farsaei, Shadi; Karimzadeh, Iman; Elyasi, Sepideh; Hatamkhani, Shima; Khalili, Hossein

2014-04-15

Hyperglycemia is one of the most frequent metabolic complications in hospitalized patients. Increased risk of infection following hyperglycemia has been reported in hospitalized patients and infections may also cause insulin resistance which complicates the control of blood glucose level. In this study the impact of the clinical pharmacist interventions on the glycemic control in patients admitted to infectious diseases ward has been evaluated. We conducted a prospective, pre-post interventional study among patients with hyperglycemia. The clinical pharmacist-led multidisciplinary team managed the glycemic profile of patients according to an established insulin protocol commonly used in internal wards. Clinical pharmacists reviewed patients' medical charts for proper insulin administration, evaluated nurses' technique for insulin injection and blood glucose measurement, and educated patients about symptoms of hypoglycemia and the importance of adherence to different aspects of their glycemic management. The percentage of controlled random blood sugar increased from 13.8% in the pre-intervention to 22.3% in the post-intervention group (p value percentage of controlled fasting blood sugars in the post-intervention group was non-significantly higher than in the pre-intervention group. Pharmacists and additional health care providers from other departments such as nursing and dietary departments need to be devoted to glycemic control service. Collaborative practice agreement between physicians is necessary to promote this service and help to increase the use of such services in different settings for diabetes control.

Dynamic surface tracking controller design for a constrained hypersonic vehicle based on disturbance observer

Directory of Open Access Journals (Sweden)

Fang Wang

2017-05-01

Full Text Available The tracking control problem of a flexible air-breathing hypersonic vehicle subjects to aerodynamic parameter uncertainty and input constraint is investigated by combining nonlinear disturbance observer and dynamic surface control. To design controller simply, a control-oriented model is firstly derived and divided into two subsystems, velocity subsystem and altitude subsystem based on the engineering backgrounds of flexible air-breathing hypersonic vehicle. In every subsystem, compounded disturbances are included to consider aerodynamic uncertainty and the effect of the flexible modes. Then, disturbance observer is not only used to handle the compounded disturbance but also to handle the input constraint, where the estimation error converges to a random small region through appropriately choosing the observer parameters. To sequel, the disturbance observer–based robust control scheme and the disturbance observer-based dynamic surface control scheme are developed for the velocity subsystem and altitude subsystem, respectively. Besides, novel filters are designed to alleviate the problem of “explosion of terms” induced by backstepping method. On the basis of Lyapunov stability theory, the presented control scheme can assure that tracking error converges to an arbitrarily small neighborhood around zero by rigorous theoretical analysis. At last, simulation result shows the effectiveness of the presented control method.

Clinical Observation on Insomnia Treated by Wei-Defensive Qi-Regulating and Brain-Strengthening Needling Technique

Institute of Scientific and Technical Information of China (English)

GAO Xi-yan; LI Xing-rui; MA Qiao-lin; ZHAO Xin-ji; SHAO Su-ju; WEI Yu-long; SUN Wei-xia; HANG Guo-qi

2007-01-01

In order to make a report on 90 cases of insomnia treated by the Wei-defensive qi-regulating and brain-strengthening needling technique,as a clinical subject of the multiple center,for assessing the preliminary standardized indications and operating methods and making an initial summary for writing the draft of the technique operation.Methods:By ratio of 1:1,the patients in conformity with the criteria were randomly divided into the experimental group and control group.In the experimental group,45 cases were treated with the Wei-defensive qi-regulating and brain-strengthening needling technique on Baihui (GV 20),Dazhui(GV 14),Shenmai(BL 62),Zhaohai(KI 6),plus ear points.In the control group,45 cases were treated with routine acupuncture on Sishencong(Ex-HN 1),Shenmen (HT 7),Sanyinjiao(SP 6),etc.The therapeutic effects in the two groups were observed and assessed in comparison.Results:The results showed cure in 15 cases.remarkable effect in 27 cases,effect in 42 cases,failure in 6 cases,and the total eriective rate in 94.4% in 90 cases of insomnia.In the three centers,the statistic management was performed based upon PSQI integral and showed significant difference(P＜0.01),and no significant difference among various groups(P＞0.01).Conclusion:The therapeutic effect in the treatment of insomnia by Wei-defensive qi-regulating and brain-strengthening needling technique is better than the control group and the therapeutic effect and methods in various centers are stable.without any deviation.

Clinical pharmacists on medical care of pediatric inpatients: a single-center randomized controlled trial.

Directory of Open Access Journals (Sweden)

Chuan Zhang

Full Text Available OBJECTIVE: To explore the best interventions and working patterns of clinical pharmacists in pediatrics and to determine the effectiveness of clinical pharmacists in pediatrics. METHODS: We conducted a randomized controlled trial of 160 pediatric patients with nerve system disease, respiratory system disease or digestive system disease, who were randomly allocated into two groups, with 80 in each group. Interventions by clinical pharmacists in the experimental group included answering questions of physicians and nurses, giving advice on treating patients, checking prescriptions and patient counseling at discharge. In the control group, patients were treated without clinical pharmacist interventions. RESULTS: Of the 109 interventions provided by clinical pharmacists during 4 months, 47 were consultations for physicians and nurses, 31 were suggestions of treatment, with 30 accepted by physicians (96.77% and 31 were medical errors found in 641 prescriptions. Five adverse drug reactions were submitted to the adverse drug reaction monitoring network, with three in the experimental group and two in the control group. The average length of stay (LOS for patients with respiratory system diseases in the experimental group was 6.45 days, in comparison with 10.83 days in the control group, which was statistically different (p value<0.05; Average drug compliance rate in the experimental group was 81.41%, in comparison with 70.17% of the control group, which was statistically different (p value<0.05. Cost of drugs and hospitalization and rate of readmission in two weeks after discharge in the two groups were not statistically different. CONCLUSION: Participation by clinical pharmacists in the pharmacotherapy of pediatric patients can reduce LOS of patients with respiratory system disease and improve compliance rate through discharge education, showing no significant effects on prevention of ADR, reduction of cost of drugs and hospitalization and readmission

Clinical observations on the use of new anti-VEGF drug, conbercept, in age-related macular degeneration therapy: a meta-analysis

Directory of Open Access Journals (Sweden)

Cui C

2017-12-01

Full Text Available Chunmei Cui, Hong Lu Department of Ophthalmology, Beijing Chao-Yang Hospital, Beijing, China Purpose: Conbercept is a new anti-vascular endothelial growth factor (VEGF drug approved for the treatment of age-related macular degeneration (AMD. Although this novel drug has been widely used in clinic, unlike other anti-VEGF drugs, validation and consensus on its method of clinical application and clinical safety have not yet been achieved.Methods: Relevant literature was searched on PubMed, Web of Science, China National Knowledge Internet, and Wanfang Data. Stata 12.0 was used for data analysis. Random- and fixed-effect models were employed to evaluate heterogeneity. Best-corrected visual acuity (BCVA and central retinal thickness (CRT were utilized to measure the improvement of AMD patients.Results: In this study, we analyzed conbercept administration and compared its application with other control clinical methods for AMD treatment. Ranibizumab, triamcinolone, and traditional transpupillary thermotherapy (TTT were administered in the control group. No differences were found in the BCVA and CRT improvement between the groups treated with conbercept and ranibizumab. However, the conbercept group had a lower serum VEGF level. After 3 months of treatment, conbercept led to a more significant BCVA and CRT improvement than triamcinolone. A more considerable BCVA improvement was observed in the group treated with conbercept than in the group treated with TTT. Moreover, even 6 months after the treatment, the effect of conbercept on CRT improvement was still more pronounced than that of TTT.Conclusion: In AMD patients, conbercept exerts considerably more positive effects on the long-term BCVA and CRT improvement than triamcinolone and TTT. The serum VEGF level in the conbercept group was lower than that in the ranibizumab group. Keywords: AMD, VEGF, conbercept, BCVA, CRT

New insight into the comparative power of quality-control rules that use control observations within a single analytical run.

Science.gov (United States)

Parvin, C A

1993-03-01

The error detection characteristics of quality-control (QC) rules that use control observations within a single analytical run are investigated. Unlike the evaluation of QC rules that span multiple analytical runs, most of the fundamental results regarding the performance of QC rules applied within a single analytical run can be obtained from statistical theory, without the need for simulation studies. The case of two control observations per run is investigated for ease of graphical display, but the conclusions can be extended to more than two control observations per run. Results are summarized in a graphical format that offers many interesting insights into the relations among the various QC rules. The graphs provide heuristic support to the theoretical conclusions that no QC rule is best under all error conditions, but the multirule that combines the mean rule and a within-run standard deviation rule offers an attractive compromise.

Parameterized Disturbance Observer Based Controller to Reduce Cyclic Loads of Wind Turbine

Directory of Open Access Journals (Sweden)

Raja M. Imran

2018-05-01

Full Text Available This paper is concerned with bump-less transfer of parameterized disturbance observer based controller with individual pitch control strategy to reduce cyclic loads of wind turbine in full load operation. Cyclic loads are generated due to wind shear and tower shadow effects. Multivariable disturbance observer based linear controllers are designed with objective to reduce output power fluctuation, tower oscillation and drive-train torsion using optimal control theory. Linear parameterized controllers are designed by using a smooth scheduling mechanism between the controllers. The proposed parameterized controller with individual pitch was tested on nonlinear Fatigue, Aerodynamics, Structures, and Turbulence (FAST code model of National Renewable Energy Laboratory (NREL’s 5 MW wind turbine. The closed-loop system performance was assessed by comparing the simulation results of proposed controller with a fixed gain and parameterized controller with collective pitch for full load operation of wind turbine. Simulations are performed with step wind to see the behavior of the system with wind shear and tower shadow effects. Then, turbulent wind is applied to see the smooth transition of the controllers. It can be concluded from the results that the proposed parameterized control shows smooth transition from one controller to another controller. Moreover, 3p and 6p harmonics are well mitigated as compared to fixed gain DOBC and parameterized DOBC with collective pitch.

Dengue Fever in American Military Personnel in the Philippines: Clinical Observations on Hospitalized Patients during a 1984 Epidemic

Science.gov (United States)

1989-03-01

the mean maximum temperature was Hypotenson 15 (62.5) 102.0 + 1.3 F. A "saddle back" or dip- Rash (Non- Petechial ) 13 (54.2) hasic fever pattern was not...DENGUE FEVER IN AMERICAN MILITARY PERSONNEL IN THE PHILIPPINES: CLINICAL OBSERVATIONS ON HOSPITALIZED PATIENS DURING A 1984 EPIDEMIC C.G. Hayes, T.F...Accession Tr~I Jti ti DENGUE FEVER IN AMERICAN MILITARY PERSONNEL IN THE PHILIPPINES: CLINICAL OBSERVATIONS ON HOSPITALIZED PATIENTS DURING A 1984

Pain control in orthodontics using a micropulse vibration device: A randomized clinical trial.

Science.gov (United States)

Lobre, Wendy D; Callegari, Brent J; Gardner, Gary; Marsh, Curtis M; Bush, Anneke C; Dunn, William J

2016-07-01

To investigate the relationship between a micropulse vibration device and pain perception during orthodontic treatment. This study was a parallel group, randomized clinical trial. A total of 58 patients meeting eligibility criteria were assigned using block allocation to one of two groups: an experimental group using the vibration device or a control group (n  =  29 for each group). Patients used the device for 20 minutes daily. Patients rated pain intensity on a visual analog scale at appropriate intervals during the weeks after the separator or archwire appointment. Data were analyzed using repeated measures analysis of variance at α  =  .05. During the 4-month test period, significant differences between the micropulse vibration device group and the control group for overall pain (P  =  .002) and biting pain (P  =  .003) were identified. The authors observed that perceived pain was highest at the beginning of the month, following archwire adjustment. The micropulse vibration device significantly lowered the pain scores for overall pain and biting pain during the 4-month study period.

Observer-Based Fuel Control Using Oxygen Measurement

DEFF Research Database (Denmark)

Andersen, Palle; Bendtsen, Jan Dimon; Mortensen, Jan Henrik

is constructed and validated against data obtained at the plant. A Kalman filter based on measurements of combustion air flow led into the furnace and oxygen concentration in the flue gas is designed to estimate the actual coal flow. With this estimate, it becomes possible to close an inner loop around the coal......This report describes an attempt to improve the existing control af coal mills used at the Danish power plant Nordjyllandsværket Unit 3. The coal mills are not equipped with coal flow sensors; thus an observer-based approach is investigated. A nonlinear differential equation model of the boiler...

A COMPARISON OF SOME ROBUST BIVARIATE CONTROL CHARTS FOR INDIVIDUAL OBSERVATIONS

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Moustafa Omar Ahmed Abu - Shawiesh

2014-06-01

Full Text Available This paper proposed and considered some bivariate control charts to monitor individual observations from a statistical process control. Usual control charts which use mean and variance-covariance estimators are sensitive to outliers. We consider the following robust alternatives to the classical Hoteling's T2: T2MedMAD, T2MCD, T2MVE a simulation study has been conducted to compare the performance of these control charts. Two real life data are analyzed to illustrate the application of these robust alternatives.

Observable-preserving control of quantum dynamics over a family of related systems

International Nuclear Information System (INIS)

Rothman, Adam; Ho, T.-S.; Rabitz, Herschel

2005-01-01

Quantum control aims at the manipulation of atomic- and molecular-scale dynamics phenomena. An important objective in this regard is the understanding of dynamical control within a family of related quantum systems. To explore this issue, diffeomorphic changes in the system Hamiltonian H(s,t) are introduced by scanning over a homotopy parameter s and then monitoring the control field response needed to maintain the value of a specified target observable. This operation is implemented through a procedure referred to as diffeomorphic modulation under observable-response-preserving homotopy (D-MORPH). The governing D-MORPH differential equation determining the control laser field E(s,t) is shown to explicitly allow for innumerable solutions, with each characterized by the choice of an arbitrary function f(s,t) of s and time t. The presence of f(s,t) in the D-MORPH differential equation makes clear the origin of multiple control fields that produce the same observable objective. A stable algorithm is presented for practical execution of D-MORPH with the only criterion that the Hamiltonian H(s,t) permit reaching the objective over the full domain of s being sampled. Both analytic and numerical examples are presented to illustrate the D-MORPH concept

Chattering-free sliding mode observer for speed sensorless control of PMSM

Directory of Open Access Journals (Sweden)

Mahmoud M. Gaballah

2017-07-01

Full Text Available This article presents a new speed observer based on fuzzy logic for speed sensorless control applications of permanent magnet synchronous motor “PMSM”. The switch function in traditional Sliding Mode Observer “SMO” is replaced by a rule based fuzzy logic system. The proposed observer not only improves the system dynamic performance during disturbances or parameter variations, but also has a high accuracy tracking performance with sufficient chattering reduction. The validity of the new observer corroborated through experimental results using TMS320F28069M Digital Signal Processor “DSP”.

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.

A Clustering Based Approach for Observability and Controllability Analysis for Optimal Placement of PMU

Science.gov (United States)

Murthy, Ch; MIEEE; Mohanta, D. K.; SMIEE; Meher, Mahendra

2017-08-01

Continuous monitoring and control of the power system is essential for its healthy operation. This can be achieved by making the system observable as well as controllable. Many efforts have been made by several researchers to make the system observable by placing the Phasor Measurement Units (PMUs) at the optimal locations. But so far the idea of controllability with PMUs is not considered. This paper contributes how to check whether the system is controllable or not, if not then how make it controllable using a clustering approach. IEEE 14 bus system is considered to illustrate the concept of controllability.

Dementia Prevention: optimizing the use of observational data for personal, clinical, and public health decision-making.

Science.gov (United States)

Dacks, Penny A; Andrieu, Sandrine; Blacker, Deborah; Carman, Aaron J; Green, Allan M; Grodstein, Francine; Henderson, Victor W; James, Bryan D; Lane, Rachel F; Lau, Joseph; Lin, Pei-Jung; Reeves, Barnaby C; Shah, Raj C; Vellas, Bruno; Yaffe, Kristine; Yurko-Mauro, Karin; Shineman, Diana W; Bennett, David A; Fillit, Howard M

2014-02-01

Worldwide, over 35 million people suffer from Alzheimer's disease and related dementias. This number is expected to triple over the next 40 years. How can we improve the evidence supporting strategies to reduce the rate of dementia in future generations? The risk of dementia is likely influenced by modifiable factors such as exercise, cognitive activity, and the clinical management of diabetes and hypertension. However, the quality of evidence is limited and it remains unclear whether specific interventions to reduce these modifiable risk factors can, in turn, reduce the risk of dementia. Although randomized controlled trials are the gold-standard for causality, the majority of evidence for long-term dementia prevention derives from, and will likely continue to derive from, observational studies. Although observational research has some unavoidable limitations, its utility for dementia prevention might be improved by, for example, better distinction between confirmatory and exploratory research, higher reporting standards, investment in effectiveness research enabled by increased data-pooling, and standardized exposure and outcome measures. Informed decision-making by the general public on low-risk health choices that could have broad potential benefits could be enabled by internet-based tools and decision-aids to communicate the evidence, its quality, and the estimated magnitude of effect.

APPLICATION OF FILTEK SILORANE-INITIAL OBSERVATIONS AND PROSPECTIVE CLINICAL TRIAL FOR 12 MONTH

Directory of Open Access Journals (Sweden)

Lyubomir Vangelov

2010-12-01

Full Text Available Polymerization shrinkage and related adverse effects are still considered a major problem of dental composites. To solve this problem different approaches are offered. Currently, 3M ESPE developed a new monomer system based on cationic ring opening, the goal is to create a composite material with low polymerization shrinкage called siloran. Aim: To investigate the clinical presentation of Filtek д Silorane Low Shrink Posterior Restorative for an observation period of 12 months. Material and methods: The study included 36 patients. Total of 66 restorations are made. They were evaluated using modified USPHS criteria of Ryge and Cvar. After their assessment, restorations were captured with a digital camera and X-rays were taken in parallel technique. On control examination after one year, 31 patients (63 restorations were available for the study. Same parameters were assessed and new digital pictures and X-rays were made. The statistics was made with software SPSS version 17. For statistical analysis a Criterion Pirson (x2 was used. Results: With the exception of one of the criteria, it was shown that no statistically significant difference exists between the baseline and after one year (p> 0,05. Only the criterion surface of the filling was found to have statistically significant difference (p <0,05

Effect of precipitation on clinic-diagnosed enteric infections in children in Rwanda: an observational study

Directory of Open Access Journals (Sweden)

Miles Kirby, PhD

2018-05-01

Full Text Available Background: Enteric infections are a major cause of morbidity and mortality in low-income and middle-income countries, particularly among children younger than 5 years. Climate change projections for Rwanda predict increases in average temperature, along with increases in total precipitation and frequency of extreme rainfall events. Previous research in Rwanda has found that extreme rainfall events increase the risk of contaminated drinking water, a substantial contributor to diarrhoea in this setting. Relatively little is known about the effect of precipitation on more severe clinic-diagnosed infections in rural, low-income settings such as Rwanda. In the context of a randomised controlled trial to assess the effect of a national environmental health campaign in Rwanda, we did a substudy to assess the effect of total and extreme rainfall on enteric infections in children younger than 5 years. Methods: For this observational study, we collected data from all government health facilities in Rusizi District, Western Province, for the year 2015. Patient data for children younger than 5 years from 150 study villages were extracted from paper-based registers. Gridded daily precipitation data were downloaded from the Tropical Applications of Meteorology using SATellite and ground based observations (TAMSAT rainfall dataset in addition to local weather station data. We modelled the effect of total rainfall (in mm and occurrence of an extreme rainfall event (95th percentile in the past 2 years on daily health facility visits for enteric symptoms (diarrhoea, gastroenteritis, or vomiting, using Poisson regression with a Newey-West estimator to adjust for serial autocorrelation. We examined total and extreme rainfall within the previous 1, 2, 3, and 4 weeks, controlling for weekend day because we observed a consistent reduction in case counts on weekends. Findings: Data were extracted from 46 facilities, with a study catchment area of approximately 12�

The artificial satellite observation chronograph controlled by single chip microcomputer.

Science.gov (United States)

Pan, Guangrong; Tan, Jufan; Ding, Yuanjun

1991-06-01

The instrument specifications, hardware structure, software design, and other characteristics of the chronograph mounting on a theodolite used for artificial satellite observation are presented. The instrument is a real time control system with a single chip microcomputer.

Observer-based output feedback control of networked control systems with non-uniform sampling and time-varying delay

Science.gov (United States)

Meng, Su; Chen, Jie; Sun, Jian

2017-10-01

This paper investigates the problem of observer-based output feedback control for networked control systems with non-uniform sampling and time-varying transmission delay. The sampling intervals are assumed to vary within a given interval. The transmission delay belongs to a known interval. A discrete-time model is first established, which contains time-varying delay and norm-bounded uncertainties coming from non-uniform sampling intervals. It is then converted to an interconnection of two subsystems in which the forward channel is delay-free. The scaled small gain theorem is used to derive the stability condition for the closed-loop system. Moreover, the observer-based output feedback controller design method is proposed by utilising a modified cone complementary linearisation algorithm. Finally, numerical examples illustrate the validity and superiority of the proposed method.

Active Video Game Exercise Training Improves the Clinical Control of Asthma in Children: Randomized Controlled Trial.

Directory of Open Access Journals (Sweden)

Evelim L F D Gomes

Full Text Available The aim of the present study was to determine whether aerobic exercise involving an active video game system improved asthma control, airway inflammation and exercise capacity in children with moderate to severe asthma.A randomized, controlled, single-blinded clinical trial was carried out. Thirty-six children with moderate to severe asthma were randomly allocated to either a video game group (VGG; N = 20 or a treadmill group (TG; n = 16. Both groups completed an eight-week supervised program with two weekly 40-minute sessions. Pre-training and post-training evaluations involved the Asthma Control Questionnaire, exhaled nitric oxide levels (FeNO, maximum exercise testing (Bruce protocol and lung function.No differences between the VGG and TG were found at the baseline. Improvements occurred in both groups with regard to asthma control and exercise capacity. Moreover, a significant reduction in FeNO was found in the VGG (p < 0.05. Although the mean energy expenditure at rest and during exercise training was similar for both groups, the maximum energy expenditure was higher in the VGG.The present findings strongly suggest that aerobic training promoted by an active video game had a positive impact on children with asthma in terms of clinical control, improvement in their exercise capacity and a reduction in pulmonary inflammation.Clinicaltrials.gov NCT01438294.

Clinical observation of pingyangmycin, lidocaine, iodipin emulsion and absorbable gelatine sponge granules embolization treatment for hysteromyoma

International Nuclear Information System (INIS)

Hua Cun; Zhou Guangde; Teng Jun; Zhang Kuiyang

2008-01-01

Objective: To study the feasibility and availability of uterine arterial embolization for hysteromyoma with pingyangmycin, lidocaine, iodipin emulsion and absorbable gelatine sponge granules immersed with lidocaine. Methods: The observation of pain sensation change of clinical symptoms, size of hysteromyoma, change of uterus volume together with the specimens and pathological features of 68 cases of hysteromyoma during and after the embolization by using pingyangmyein, lidocaine, iodipin emulsion and absorbable gelatine sponge granules immersed with lidocaine were carried out and compared. Results: Intramuscular analgesic injection couldn't control the pain in 13 cases, covering 19.1%, symptom remission rate was 92.3%, including 89.2% menstruation recovery, 90.8% disappearance of pelvic pain, abdominal distension and compression symptoms, 78.8% average shrinkage of tumor size and 47.5% reduction of uterus volumes. Conclusion: Pingyangmyein, lidocaine, iodipin emulsion and absorbable gelatine sponge granules immersed with lidocaine are the ideal embolization material for treating hysteromyoma. (authors)

Comparability of patients with ANCA-associated vasculitis enrolled in clinical trials or in observational cohorts

NARCIS (Netherlands)

Pagnoux, C.; Carette, S.; Khalidi, N. A.; Walsh, M.; Hiemstra, T. F.; Cuthbertson, D.; Langford, C.; Hoffman, G.; Koening, C. L.; Monach, P. A.; Moreland, L.; Mouthon, L.; Seo, P.; Specks, U.; Ytterbere, S.; Westman, K.; Hoglund, P.; Harper, L.; Flossmann, O.; Luqmani, R.; Savage, C.; Rasmussen, N.; de Groot, K.; Tesar, V.; Jayne, D.; Merkel, P. A.; Guillevin, L.; Stegeman, C. A.

2015-01-01

Objective. To analyse the differences between patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) entered into randomised clinical trials (RCTs) and those followed in large observational cohorts. Methods. The main characteristics and outcomes of patients with

Full-mouth disinfection as a therapeutic protocol for type-2 diabetic subjects with chronic periodontitis: twelve-month clinical outcomes: a randomized controlled clinical trial.

Science.gov (United States)

Santos, Vanessa R; Lima, Jadson A; Miranda, Tamires S; Gonçalves, Tiago E D; Figueiredo, Luciene C; Faveri, Marcelo; Duarte, Poliana M

2013-02-01

The aim of this randomized controlled clinical trial was to evaluate the clinical effects of chlorhexidine (CHX) application in a full-mouth disinfection (FMD) protocol in poorly controlled type-2 diabetic subjects with generalized chronic periodontitis. Thirty-eight subjects were randomly assigned into FMD group (n=19): full-mouth scaling and root planing (FMSRP) within 24 h + local application of CHX gel + CHX rinses for 60 days or Control group (n = 19): FMSRP within 24 h + local application of placebo gel + placebo rinses for 60 days. Clinical parameters, glycated haemoglobin and fasting plasma glucose were assessed at baseline, 3, 6 and 12 months post-therapies. All clinical parameters improved significantly at 3, 6 and 12 months post-therapies for both groups (p clinical parameters, and glycemic condition at any time-point (p > 0.05). The treatments did not differ with respect to clinical parameters, including the primary outcome variable (i.e. changes in clinical attachment level in deep pockets), for up to 12 months post-treatments. © 2012 John Wiley & Sons A/S.

Clinical characteristics and pregnancy outcomes of Syrian refugees: a case-control study in a tertiary care hospital in Istanbul, Turkey.

Science.gov (United States)

Erenel, Hakan; Aydogan Mathyk, Begum; Sal, Veysel; Ayhan, Isil; Karatas, Suat; Koc Bebek, Arzu

2017-01-01

We aimed to compare the clinical characteristics and pregnancy outcomes in women who are Syrian refugees and Turkish women who are non-refugees at a maternity center in Istanbul, Turkey. A total of 600 singleton pregnancies who delivered at Sisli Hamidiye Etfal Training and Research Hospital were included in the study. Demographic data, obstetrical history, clinical findings, obstetrical and neonatal outcomes were compared between 300 Syrian refugees and 300 control patients. The Syrian refugee patients were significantly younger than Turkish patients. The percentage of adolescents aged 12-19 years were significantly higher in the Syrian patients (14.3 vs. 5.3 %, p refugee patients had no antenatal care. However, this ratio was only 7.7 % for the control group (p refugee control patients, refugee women in our study had poor antenatal care but no adverse perinatal outcomes were observed. Further larger multicenter studies may provide more convincing data about obstetric outcomes in the Syrian refugee population as well as adolescent pregnancies in this population.

Contribution of family social support to the metabolic control of people with diabetes mellitus: A randomized controlled clinical trial.

Science.gov (United States)

Gomes, Lilian Cristiane; Coelho, Anna Claudia Martins; Gomides, Danielle Dos Santos; Foss-Freitas, Maria Cristina; Foss, Milton César; Pace, Ana Emilia

2017-08-01

This randomized controlled clinical trial aimed to evaluate the contribution of family social support to the clinical/metabolic control of people with type 2 diabetes mellitus. Diabetes mellitus is a chronic disease that requires continuous care in order for individuals to reach glycemic control, the primordial goal of treatment. Family social support is essential to the development of care skills and their maintenance. However, there are few studies that investigate the contribution of family social support to diabetes control. The study was developed between June 2011 and May 2013, and included 164 people who were randomized using simple randomization. The intervention group differed from the control group in that it included a family caregiver, who was recognized by the patient as a source of social support. The educational interventions received by people with diabetes mellitus were used as the basis of the education provided through telephone calls to patients' family members and caregivers, and their purpose was to encourage dialogue between the patients and their relatives about the topics related to diabetes. Regarding the clinical impact, the results showed that there was a greater reduction in blood pressure and glycated hemoglobin in the intervention group than in the control group, showing a positive effect on the control of the disease. Families should be incorporated into the care of people with diabetes mellitus and especially in health care programs, in particular those that can promote different forms of social support to strengthen the bond between family members. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of criteria for clinical control in a prospective, international, multicenter study of patients with COPD

DEFF Research Database (Denmark)

Miravitlles, Marc; Sliwinski, Pawel; Rhee, Chin Kook

2018-01-01

BACKGROUND: The concept of clinical control in COPD has been developed to help in treatment decisions, but it requires validation in prospective studies. METHOD: This international, multicenter, prospective study aimed to validate the concept of control in COPD [control = stability (no...... exacerbations or impairment in CAT scores) + low impact (low level of symptoms)]. Data from the screening visit was used to: investigate the level of control, compare characteristics of patients according to the control status, and perform a sensitivity analysis of the levels of control using either clinical...... criteria or questionnaires (COPD Assessment Test -CAT- or Clinical COPD Questionnaire -CCQ-). RESULTS: A total of 314 patients were analysed, mean age was 68.5 years and mean FEV1 was 52.6% of predicted. According to the prespecified criteria 21% of patients were classified as controlled, all of them...

Monitoring and measurement of variables - assurance of observability and controllability of the reactor equipment

International Nuclear Information System (INIS)

Durnev, V.N.; Mitelman, M.G.

2001-01-01

The presentation presents main conclusions on the basis of analysis of the existing situation with assurance of observability and controllability of the reactor installation. A methodology of classification of variables of the controlled object state and proposals on selection and substantiation of measurement and inspection monitoring techniques is given. Main problems associated with assurance of observability and controllability of the reactor installation are presented for various operation modes. (Authors)

A Randomised Controlled Trial of a Brief Online Mindfulness-Based Intervention on Paranoia in a Non-Clinical Sample.

Science.gov (United States)

Shore, Robert; Strauss, Clara; Cavanagh, Kate; Hayward, Mark; Ellett, Lyn

2018-01-01

Paranoia is common and distressing in the general population and can impact on health, emotional well-being and social functioning, such that effective interventions are needed. Brief online mindfulness-based interventions (MBIs) have been shown to reduce symptoms of anxiety and depression in non-clinical samples; however, at present, there is no research investigating whether they can reduce paranoia. The current study explored whether a brief online MBI increased levels of mindfulness and reduced levels of paranoia in a non-clinical population. The mediating effect of mindfulness on any changes in paranoia was also investigated. One hundred and ten participants were randomly allocated to either a 2-week online MBI including 10 min of daily guided mindfulness practice or to a waitlist control condition. Measures of mindfulness and paranoia were administered at baseline, post-intervention and 1-week follow-up. Participants in the MBI group displayed significantly greater reductions in paranoia compared to the waitlist control group. Mediation analysis demonstrated that change in mindfulness skills (specifically the observe, describe and non-react facets of the FFMQ) mediated the relationship between intervention type and change in levels of paranoia. This study provides evidence that a brief online MBI can significantly reduce levels of paranoia in a non-clinical population. Furthermore, increases in mindfulness skills from this brief online MBI can mediate reductions in non-clinical paranoia. The limitations of the study are discussed.

An international observational study suggests that artificial intelligence for clinical decision support optimizes anemia management in hemodialysis patients.

Science.gov (United States)

Barbieri, Carlo; Molina, Manuel; Ponce, Pedro; Tothova, Monika; Cattinelli, Isabella; Ion Titapiccolo, Jasmine; Mari, Flavio; Amato, Claudia; Leipold, Frank; Wehmeyer, Wolfgang; Stuard, Stefano; Stopper, Andrea; Canaud, Bernard

2016-08-01

Managing anemia in hemodialysis patients can be challenging because of competing therapeutic targets and individual variability. Because therapy recommendations provided by a decision support system can benefit both patients and doctors, we evaluated the impact of an artificial intelligence decision support system, the Anemia Control Model (ACM), on anemia outcomes. Based on patient profiles, the ACM was built to recommend suitable erythropoietic-stimulating agent doses. Our retrospective study consisted of a 12-month control phase (standard anemia care), followed by a 12-month observation phase (ACM-guided care) encompassing 752 patients undergoing hemodialysis therapy in 3 NephroCare clinics located in separate countries. The percentage of hemoglobin values on target, the median darbepoetin dose, and individual hemoglobin fluctuation (estimated from the intrapatient hemoglobin standard deviation) were deemed primary outcomes. In the observation phase, median darbepoetin consumption significantly decreased from 0.63 to 0.46 μg/kg/month, whereas on-target hemoglobin values significantly increased from 70.6% to 76.6%, reaching 83.2% when the ACM suggestions were implemented. Moreover, ACM introduction led to a significant decrease in hemoglobin fluctuation (intrapatient standard deviation decreased from 0.95 g/dl to 0.83 g/dl). Thus, ACM support helped improve anemia outcomes of hemodialysis patients, minimizing erythropoietic-stimulating agent use with the potential to reduce the cost of treatment. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

77 FR 75670 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services,Inc.

Science.gov (United States)

2012-12-21

... Registration; Fisher Clinical Services,Inc. By Notice dated September 20, 2012, and published in the Federal Register on October 2, 2012, 77 FR 60143, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... that the registration of Fisher Clinical Services, Inc., to import the basic class of controlled...

78 FR 23958 - Importer of Controlled Substances: Notice of Registration; Fisher Clinical Services, Inc.

Science.gov (United States)

2013-04-23

... Registration; Fisher Clinical Services, Inc. By Notice dated November 27, 2012, and published in the Federal Register on December 5, 2012, 77 FR 72409, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... the registration of Fisher Clinical Services, Inc., to import the basic class of controlled substance...

78 FR 5497 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services, Inc.

Science.gov (United States)

2013-01-25

... Registration; Fisher Clinical Services, Inc. By Notice dated November 1, 2012, and published in the Federal Register on November 9, 2012, 77 FR 67396, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... the registration of Fisher Clinical Services, Inc., to import the basic class of controlled substance...

Development of a novel disturbance observer based fractional order PD controller for a gun control system.

Science.gov (United States)

Gao, Qiang; Zheng, Liang; Chen, Jilin; Wang, Li; Hou, Yuanlong

2014-01-01

Motion control of gun barrels is an ongoing topic for the development of gun control equipment (GCE) with excellent performances. In this paper, a novel disturbance observer (DOB) based fractional order PD (FOPD) control strategy is proposed for the GCE. By adopting the DOB, the control system behaves as if it were the nominal closed-loop system in the absence of disturbances and uncertainties. The optimal control parameters of the FOPD are determined from the loop-shaping perspective, and the Q-filter of the DOB is deliberately designed with consideration of system robustness. The linear frame of the proposed control system will enable the analysis process more convenient. The disturbance rejection properties and the tracking performances of the control system are investigated by both numerical and experimental tests, the results demonstrate that the proposed DOB based FOPD control system is of more robustness, and it is much more suitable for the gun control system with strong nonlinearity and disturbance.

Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial.

Science.gov (United States)

Myint, Ma Wai Wai; Wu, Jenny; Wong, Euann; Chan, Suk Ping; To, Tze Shing Jess; Chau, Mei Wa Rosanna; Ting, Kwai Hing; Fung, Pui Man; Au, Kit Sing Derrick

2013-01-01

malnutrition is an important risk factor for poor outcome in patients recovering after hip fracture surgery. This study aimed to investigate the clinical, nutritional and rehabilitation effects of an oral nutritional supplementation (ONS) in an inpatient rehabilitation setting. this was an observer-blinded randomised controlled trial of elderly post-surgical proximal femoral fracture patients. A ready-to-use oral liquid nutritional supplementation (18-24 g protein and 500 kcal per day) in addition to hospital diet was compared with hospital diet only. Both groups received usual rehabilitation therapy and oral calcium and vitamin D supplements. Outcomes were compared at discharge from rehabilitation and after 4 weeks of discharge. The primary outcome parameters were the serum albumin level, the body mass index (BMI), the functional independence measure (FIM) and the elderly mobility scale (EMS). Secondary outcome parameters were frequency of complications, inpatient length of stay, mortality and acute hospital use within 6 months after discharge. a total of 126 patients were recruited, 65 in the supplementation arm and 61 in the control arm. There was a significant difference in change in BMI with a decrease of 0.25 and 0.03 kg/m(2) in the ONS group and 0.72 and 0.49 kg/m(2) in the control group at hospital discharge and follow-up, respectively (P = 0.012). The length of stay in rehabilitation ward was shortened by 3.80 (SE = 1.81, P = 0.04) days favouring the ONS group. The total number of infection episodes was also reduced significantly. No difference was observed in the rate of change of the serum albumin level, the FIM and the EMS. clinical and nutritional benefits were seen in this trial but rehabilitation benefits could not be demonstrated.

Model Predictive Flight Control System with Full State Observer using H∞ Method

Science.gov (United States)

Sanwale, Jitu; Singh, Dhan Jeet

2018-03-01

This paper presents the application of the model predictive approach to design a flight control system (FCS) for longitudinal dynamics of a fixed wing aircraft. Longitudinal dynamics is derived for a conventional aircraft. Open loop aircraft response analysis is carried out. Simulation studies are illustrated to prove the efficacy of the proposed model predictive controller using H ∞ state observer. The estimation criterion used in the {H}_{∞} observer design is to minimize the worst possible effects of the modelling errors and additive noise on the parameter estimation.

Control of variable speed variable pitch wind turbine based on a disturbance observer

Science.gov (United States)

Ren, Haijun; Lei, Xin

2017-11-01

In this paper, a novel sliding mode controller based on disturbance observer (DOB) to optimize the efficiency of variable speed variable pitch (VSVP) wind turbine is developed and analyzed. Due to the highly nonlinearity of the VSVP system, the model is linearly processed to obtain the state space model of the system. Then, a conventional sliding mode controller is designed and a DOB is added to estimate wind speed. The proposed control strategy can successfully deal with the random nature of wind speed, the nonlinearity of VSVP system, the uncertainty of parameters and external disturbance. Via adding the observer to the sliding mode controller, it can greatly reduce the chattering produced by the sliding mode switching gain. The simulation results show that the proposed control system has the effectiveness and robustness.

Heart rate control with adrenergic blockade: Clinical outcomes in cardiovascular medicine

Directory of Open Access Journals (Sweden)

David Feldman

2010-05-01

Full Text Available David Feldman1, Terry S Elton2, Doron M Menachemi3, Randy K Wexler41Heart Failure/Transplant and VAD Programs, Minneapolis Heart Institute, Minneapolis, Minnesota, USA; 2Division of Pharmacology, College of Pharmacology, The Ohio State University, Columbus, Ohio, USA; 3Heart Failure Services, Edith Wolfson Medical Center, The Heart Institute, Sakler School of Medicine, Tel-Aviv University, Holon, Israel; 4Department of Clinical Family Medicine, The Ohio State University, Columbus, Ohio, USAAbstract: The sympathetic nervous system is involved in regulating various cardiovascular parameters including heart rate (HR and HR variability. Aberrant sympathetic nervous system expression may result in elevated HR or decreased HR variability, and both are independent risk factors for development of cardiovascular disease, including heart failure, myocardial infarction, and hypertension. Epidemiologic studies have established that impaired HR control is linked to increased cardiovascular morbidity and mortality. One successful way of decreasing HR and cardiovascular mortality has been by utilizing β-blockers, because their ability to alter cell signaling at the receptor level has been shown to mitigate the pathogenic effects of sympathetic nervous system hyperactivation. Numerous clinical studies have demonstrated that β-blocker-mediated HR control improvements are associated with decreased mortality in postinfarct and heart failure patients. Although improved HR control benefits have yet to be established in hypertension, both traditional and vasodilating β-blockers exert positive HR control effects in this patient population. However, differences exist between traditional and vasodilating β-blockers; the latter reduce peripheral vascular resistance and exert neutral or positive effects on important metabolic parameters. Clinical evidence suggests that attainment of HR control is an important treatment objective for patients with cardiovascular

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.

Diagnosis, clinical staging, and treatment of breast cancer: a retrospective multiyear study of a large controlled population.

Science.gov (United States)

Legorreta, Antonio P; Chernicoff, Helen O; Trinh, Jennifer B; Parker, Robert G

2004-04-01

This study compares diagnosis, staging, and treatment of newly diagnosed breast cancer cases over a several-year period. The study design was a retrospective, multiyear comparison between new breast cancer cases diagnosed in 1995 (n = 827) and 1997 (n = 815). Cases were identified through claims data, and medical record abstraction was used to verify each case and to identify clinical staging and type of treatment. All medical records were reviewed by one physician to maximize internal reliability. Both cohorts were predominantly 40 and older, white, married, and postmenopausal. The latter cohort (1997) had a higher proportion of women aged 70 to 79 and a lower proportion of women aged 40 to 49. In both cohorts, women age 40 and older were likely to be diagnosed with breast cancer at the time of mammographic screening, while women younger than 40 were more likely to be diagnosed by clinical breast examination. In logistic regression analyses, controlling for confounding factors such as age, undergoing mammographic screening increased the likelihood of having a low cancer stage at diagnosis by more than three and a half times. Mammographic screening was statistically significantly positively associated with having eligibility for breast-conserving treatment (BCT); however, although an increase in BCT eligibility was observed, actual use of BCT did not change. Mammography leads to a lower clinical stage as well as a greater likelihood of BCT eligibility at time of breast cancer diagnosis, but may not have a substantial effect on treatment choice (lumpectomy vs. mastectomy). Between 1995 and 1997, a trend was observed toward downstaging of disease at diagnosis; further research is warranted to observe whether this trend continues over time.

Tidal Control of Jet Eruptions Observed by Cassini ISS

Science.gov (United States)

Hurford, T. A.; Helfenstein, P.; Spitale, J. N.

2012-01-01

Observations by Cassini's Imaging Science Subsystem (ISS) of Enceladus' south polar region at high phase angles has revealed jets of material venting into space. Observations by Cassini's Composite Infrared Spectrometer (CIRS) have also shown that the south polar region is anomalously warm with hotspots associated with geological features called the Tiger Stripes. The Tiger Stripes are large rifts near the south pole of Enceladus, which are typically about 130 km in length, 2 km wide, with a trough 500 m deep, and are l1anked on each side by 100m tall ridges. Preliminary triangulation of jets as viewed at different times and with different viewing geometries in Cassini ISS images taken between 2005 and 2007 have constrained the locations of eight major eruptions of material and found all of them associated with the south polar fractures unofficially the 'Tiger Stripes', and found four of them coincident with the hotspots reported in 2006 by CIRS. While published ISS observations of jet activity suggest that individual eruption sites stay active on the timescale of years, any shorter temporal variability (on timescales of an orbital period, or 1.3 Earth days, for example) is more difficult to establish because of the spotty temporal coverage and the difficulty of visually isolating one jet from the forest of many seen in a typical image. Consequently, it is not known whether individual jets are continuously active, randomly active, or if they erupt on a predictable, periodic schedule. One mechanism that may control the timing of eruptions is diurnal tidal stress, which oscillates between compression/tension as well as right and left lateral shear at any given location throughout Enceladus' orbit and may allow the cracks to open and close regularly. We examine the stresses on the Tiger Stripe regions to see how well diurnal tidal stress caused by Enceladus' orbital eccentricity may possibly correlate with and thus control the observed eruptions. We then identify

Clinical application of OCTA in observation of macular blood flow density in patients with diabetic retinopathy

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Xiang Xiang

2017-07-01

Full Text Available AIM: Using optical coherence tomography angiography(OCTAto observe the changes and clinical significance of macular blood flow density in patients with diabetic retinopathy(DR.METHODS: Totally 47 eyes(28 patientswith diabetic retinopathy(DRwere enrolled in the DR group. According to the international clinical grading criteria of diabetic retinopathy, 30 eyes(19 patientswith non-proliferative diabetic retinopathy were classified as the NPDR group, and 17 eyes(11 patientswith proliferative diabetic retinopathy were classified as PDR group. A total of 46(27 subjectshealthy eyes with matched age were enrolled in the control group. All the subjects underwent the 3mm×3mm scanning of macular retina by optical coherence tomography angiography(OCTA, obtaining 4 levels of macular blood flow density map. The macular blood flow density at 3 levels, including superficial retinal layer, deep retinal layer and choroidal capillaries layer, were measured. RESULTS: The macular blood flow density of superfical retinal layer, deep retinal layer and choroidal capillaries layer in DR group were 0.4963±0.0840, 0.4798±0.0801 and 0.5290±0.0528, respectively. Among them, the blood flow density of each layer were 0.5064±0.0843,0.4983±0.0766,0.5345±0.0529, respectively, for the NPDR group, and were 0.4786±0.0830, 0.4473±0.0778,0.5192±0.0526, respectively, for the PDR group. For the control group, the density of each layers were 0.5919±0.0704, 0.6301±0.0527, 0.5691±0.0169, respectively. The macular blood flow density was significantly different in the superficial retinal layer, deep retinal layer and choroidal capillary layer between the control group and the NPDR group, as well as the PDR group and the DR group(total PP=0.029, but not in the superficial retina layer and choroid capillary layer(P=0.236, 0.268. CONCLUSION: Compared with the control group, the macular blood flow density of superficial retinal layer, deep retinal layer and choroidal capillary

Assessing clinically meaningful treatment effects in controlled trials: chronic migraine as an example.

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Dodick, David W; Turkel, Catherine C; DeGryse, Ronald E; Diener, Hans-Christoph; Lipton, Richard B; Aurora, Sheena K; Nolan, Marissa E; Silberstein, Stephen D

2015-02-01

In addition to headache, persons with chronic migraine (CM) experience multiple symptoms, both ictal and interictal, that may contribute to their suffering. Translating clinical trial results into practice requires assessment of the results' clinical meaningfulness. When examining treatment benefit in this disabled patient population, multiple headache-symptom measures should be considered to fully reflect clinical relevance. Currently, only onabotulinumtoxinA is approved specifically for headache prophylaxis in adults with CM. Topiramate is the only other therapeutic agent with double-blind, placebo-controlled evidence in this population. Herein we evaluate the clinical meaningfulness of onabotulinumtoxinA and topiramate as headache prophylaxis in CM by comparing primary endpoints from the placebo-controlled, double-blind phase of the Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical program and the topiramate clinical trial (frequency of headache days [primary endpoint in PREEMPT; secondary in topiramate trial] and migraine/migrainous days [primary in topiramate trial, or "migraine/probable-migraine days"; secondary in PREEMPT]). Additionally, outcome measures such as responder rates, health-related quality of life, discontinuation rates, safety, and tolerability profiles are important clinical considerations. The clinical data indicate that statistically significant, clinically relevant treatment benefits exist for both onabotulinumtoxinA and topiramate. These data support these treatments as meaningful headache prophylaxis in adults with CM. CM is a chronic pain condition. We sought to determine the clinical relevance of recent trials in this disabled population. Clinical data indicate that statistically significant, clinically relevant treatment benefits exist for both onabotulinumtoxinA and topiramate, and support use of these treatments as meaningful headache prophylaxis in CM. Copyright © 2015 American Pain Society. Published

Adaptive extended-state observer-based fault tolerant attitude control for spacecraft with reaction wheels

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Ran, Dechao; Chen, Xiaoqian; de Ruiter, Anton; Xiao, Bing

2018-04-01

This study presents an adaptive second-order sliding control scheme to solve the attitude fault tolerant control problem of spacecraft subject to system uncertainties, external disturbances and reaction wheel faults. A novel fast terminal sliding mode is preliminarily designed to guarantee that finite-time convergence of the attitude errors can be achieved globally. Based on this novel sliding mode, an adaptive second-order observer is then designed to reconstruct the system uncertainties and the actuator faults. One feature of the proposed observer is that the design of the observer does not necessitate any priori information of the upper bounds of the system uncertainties and the actuator faults. In view of the reconstructed information supplied by the designed observer, a second-order sliding mode controller is developed to accomplish attitude maneuvers with great robustness and precise tracking accuracy. Theoretical stability analysis proves that the designed fault tolerant control scheme can achieve finite-time stability of the closed-loop system, even in the presence of reaction wheel faults and system uncertainties. Numerical simulations are also presented to demonstrate the effectiveness and superiority of the proposed control scheme over existing methodologies.

Role of the clinical microbiology laboratory in infection control - a Danish perspective

DEFF Research Database (Denmark)

Kolmos, H J

2001-01-01

for standardization and documentation of quality. Currently a national standard for infection control is being prepared. It consists of a main standard defining requirements for the management system and 12 subsidiary standards defining requirements for specific areas of infection control. Adoption of the standard...... will undoubtedly require additional resources for infection control at a local level, and some organizational changes may also be needed. Infection control should be maintained as an integrated part of clinical microbiology....

Stem cell-based treatments against stroke: observations from human proof-of-concept studies and considerations regarding clinical applicability

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Thorsten Roland Doeppner

2014-10-01

Full Text Available Ischemic stroke remains a heavy burden for industrialized countries. The only causal therapy is the recanalization of occluded vessels via thrombolysis, which due to a narrow time window still can be offered only to a minority of patients. Since the majority of patients continues to exhibit neurological deficits even following successful thrombolysis, restorative therapies are urgently needed that promote brain remodeling and repair once stroke injury has occurred. Due to their unique properties of action, stem cell-based strategies gained increasing interest during recent years. Using various stroke models in both rodents and primates, the transplantation of stem cells, namely of bone marrow derived mesenchymal stem cells (MSCs or neural progenitor cells (NPCs, has been shown to promote neurological recovery most likely via indirect bystander actions. In view of promising observations, clinical proof-of-concept studies are currently under way, in which effects of stem and precursor cells are evaluated in human stroke patients. In this review we summarize already published studies, which due to the broad experience in other medical contexts mostly employed bone marrow-derived MSCs by means of intravenous transplantation. With the overall number of clinical trials limited in number, only a fraction of these studies used non-treated control groups, and only single studies were adequately blinded. Despite these limitations, first promising results justify the need for more elaborate clinical trials in order to make stem cell transplantation a success for stroke treatment in the future.

Clinical observation of Qiming granule combined with Dextran and Hypromellose eye drops for dry eye

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Jin-Lan Wan

2013-09-01

Full Text Available AIM: To observe the efficacy of Qiming granule combined with Dextran and Hypromellose eye drops in treatment of dry eye.METHODS: A randomized, parallel-control approach was adopted, 100 cases of dry eye patients were divided into treatment group and control group equally, observation on the treatment of 3 months. The treatment group was applied Dextran and Hypromellose eye drops combined with oral Qiming granule, simply Dextran and Hypromellose eye drops for control group. Before and after treatment, tear secretion volume, break-up time, corneal fluorescein staining and symptom were observed.RESULTS: After treatment, there was statistical significance for the break-up time, SⅠt and corneal fluorescein staining in both groups when compared with before treatment(PPCONCLUSION: The combined Dextran and Hypromellose eye drops and Qiming granule perform better than Dextran and Hypromellose eye drops only in treatment of dry eye.

Clinical and radiological observations in the spondylolysis

International Nuclear Information System (INIS)

Sol, Chang Hyo; Kim, Dong Woon; Kim, Byung Soo

1980-01-01

The spondylolysis is a defective ossification in the pars interarticularis of the neural arches without displacement of the vertebral body and it sometimes confuses with other spinal lesions complaining of low back pain. The authors analyzed with clinical observations in 88 cases of spondylolysis diagnosed radiologically at B.N.U.H. from January 1977 to August 1978. The results obtained as follows: 1. Among 88 cases of the spondylolysis, the highest incidence of the age was second decade in 55.7%, and the sex ratio was 4.2 to 1 in male to female. 2. The prominent symptoms were a low back pain in 71.6%, the radiating pain with the low backache in 27.3% and the paresis of low extremities in 1.2%. 3. The frequent sites of the involvement were fifth lumbar vertebra in 83.6%, fourth lumbar vertebra in 9.8%, third lumbar vertebra in 5.5%, first lumbar vertebra in 1.1% and second lumbar vertebra in zero. 4. Bilateral lesions were in 68.2% and unilateral lesion was 20.9% in the right side and 10.9% in the left. 5. The combined abnormal findings of the spine were spondylitis in 36.1%, suspicious H.N.P. in 27.8%, spondylolisthesis in 25.0%, spina bifida in 8.3% and lumbarization in 2.8% in that order. 6. The cause of spondylolysis are still uncertain, but we are experienced 9 cases (10.3%) in the definite history of the trauma.

Clinical and radiological observations in the spondylolysis

Energy Technology Data Exchange (ETDEWEB)

Sol, Chang Hyo; Kim, Dong Woon; Kim, Byung Soo [Busan National University College of Medicine, Pusan (Korea, Republic of)

1980-06-15

The spondylolysis is a defective ossification in the pars interarticularis of the neural arches without displacement of the vertebral body and it sometimes confuses with other spinal lesions complaining of low back pain. The authors analyzed with clinical observations in 88 cases of spondylolysis diagnosed radiologically at B.N.U.H. from January 1977 to August 1978. The results obtained as follows: 1. Among 88 cases of the spondylolysis, the highest incidence of the age was second decade in 55.7%, and the sex ratio was 4.2 to 1 in male to female. 2. The prominent symptoms were a low back pain in 71.6%, the radiating pain with the low backache in 27.3% and the paresis of low extremities in 1.2%. 3. The frequent sites of the involvement were fifth lumbar vertebra in 83.6%, fourth lumbar vertebra in 9.8%, third lumbar vertebra in 5.5%, first lumbar vertebra in 1.1% and second lumbar vertebra in zero. 4. Bilateral lesions were in 68.2% and unilateral lesion was 20.9% in the right side and 10.9% in the left. 5. The combined abnormal findings of the spine were spondylitis in 36.1%, suspicious H.N.P. in 27.8%, spondylolisthesis in 25.0%, spina bifida in 8.3% and lumbarization in 2.8% in that order. 6. The cause of spondylolysis are still uncertain, but we are experienced 9 cases (10.3%) in the definite history of the trauma.

Ergonomic analysis of work in energy control plants: factors to be observed

International Nuclear Information System (INIS)

Rivas, R.

1987-01-01

To make evident the incidence of the technology modification due to the increasing automation of energy control plants on man, whose activity is limited to observation and control, with low working metabolism and high attention and concentration. The methodology is fundamentally based on the individual analysis of the factors affecting man. The following will be considered: a) load volume: the load volume generated by the above mentioned activity depends on the observation period, the number of indicators to be observed and the frequency of control activities; b) active participation: the lack of active participation due to a motionless task requires a constant yield disposition to develop an unusual activity; c) monotonous activity: the load is produced by maintaining a suitable physic-mental state through a volition effort; d) change of disposition: this component, which is not willingly admitted, changes the mechanism of compared functions during the day, following a biological law that depends from the hour; e) environment influence: the unfavorable physical influences, like climate, lack of light, noise, etc. also affect man. The analysis of mental load is specially important due to its influence on the performance, the accident risk and the safety of the system to be controlled. (Author)

A randomised, controlled clinical study on total hip arthroplasty using 4 different bearings

DEFF Research Database (Denmark)

Borgwardt, Arne; Zerahn, Bo; Fabricius, Sandra D

2017-01-01

PURPOSE: To compare 4 different bearings in total hip arthroplasty (THA) in a randomised controlled clinical study on clinical performance. METHODS: 393 patients with osteoarthritis of the hip or avascular necrosis were included and allocated to 1 of the head-and-cup couples zirconia...

Quality control of the translation of the laboratory research into clinical practice

International Nuclear Information System (INIS)

Denekamp, J.

1997-01-01

This paper discusses the biological basis of new treatment strategies that are being introduced into the clinic in the form of controlled clinical trials. There is an increasing awareness of the need for quality assurance in the design, execution and analysis of these trials. However there is little awareness of the need to critically assess the biological basis of the trial design, to ensure that no other biological principles have been contravened in the attempt to optimise just one of the many parameters that determine the differential in sensitivity between tumours and normal tissues. Some examples are given of the changes that have recently occurred in the laboratory interpretation of both the mechanism of action and the therapeutic gain of several novel approaches. If these are not considered, the carefully controlled clinical trials may be wasted, because of being based on an incomplete consideration of all the interconnected biological factors. (author)

Synchronizing Spatiotemporal Chaos via a Composite Disturbance Observer-Based Sliding Mode Control

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Congyan Chen

2014-01-01

Full Text Available The sliding mode control schemes are investigated to synchronize two spatiotemporal chaotic systems, which are two arrays of a large number of coupled chaotic oscillators. Firstly, sliding mode manifolds with the desired performance are designed. The asymptotic convergence to the origin of the synchronization errors is also proved. However, the terms from parameter fluctuations in equivalent controls are usually impossible to be measured directly. So we regard them as lumped disturbances, but, for practical application, it is difficult to obtain the upper bound of lumped disturbances in advance which often results in a conservative sliding mode control law with large control effort, causing a large amount of chattering. To reduce the chattering and improve the performance of the system, a disturbance observer is designed to estimate the lumped disturbances. A composite synchronization controller that consists of a sliding mode feedback part and a feedforward compensation part based on disturbance observer is developed. The numerical simulation results are presented to show the effectiveness of the proposed methods.

78 FR 46371 - Importer of Controlled Substances; Notice of Registration; Almac Clinical Services, Inc.

Science.gov (United States)

2013-07-31

... Register on April 19, 2013, 78 FR 23594, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton... registration of Almac Clinical Services, Inc., (ACSI) to import the basic classes of controlled substances is..., conventions, or protocols in effect on May 1, 1971. DEA has investigated Almac Clinical Services, Inc., (ACSI...

Ethnic bias and clinical decision-making among New Zealand medical students: an observational study.

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Harris, Ricci; Cormack, Donna; Stanley, James; Curtis, Elana; Jones, Rhys; Lacey, Cameron

2018-01-23

Health professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (indigenous peoples) compared with New Zealand European) among medical students and associations with clinical decision-making. All final year New Zealand (NZ) medical students in 2014 and 2015 (n = 888) were invited to participate in a cross-sectional online study. Key components included: two chronic disease vignettes (cardiovascular disease (CVD) and depression) with randomized patient ethnicity (Māori or NZ European) and questions on patient management; implicit bias measures (an ethnicity preference Implicit Association Test (IAT) and an ethnicity and compliant patient IAT); and, explicit ethnic bias questions. Associations between ethnic bias and clinical decision-making responses to vignettes were tested using linear regression. Three hundred and two students participated (34% response rate). Implicit and explicit ethnic bias favoring NZ Europeans was apparent among medical students. In the CVD vignette, no significant differences in clinical decision-making by patient ethnicity were observed. There were also no differential associations by patient ethnicity between any measures of ethnic bias (implicit or explicit) and patient management responses in the CVD vignette. In the depression vignette, some differences in the ranking of recommended treatment options were observed by patient ethnicity and explicit preference for NZ Europeans was associated with increased reporting that NZ European patients would benefit from treatment but not Māori (slope difference 0.34, 95% CI 0.08, 0.60; p = 0.011), although this was the only significant finding in these analyses. NZ medical students demonstrated ethnic bias, although

Laparoscopic anterior pelvic exenteration with sigmoid colon resection (clinical observation

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A. O. Rasulov

2017-01-01

Full Text Available The clinical observation demonstrates a successful surgical treatment of a 61-year-old female patient K. (body mass index 38.4 diagnosed with locally advanced sigmoid colon cancer protruded into the bladder and uterus (сT4bN2M0 with formation of a colovesical fistula. The patient underwent surgical treatment in the form of laparoscopic resection of the sigmoid colon and supralevator anterior pelvic exenteration with formation of a Bricker conduit. Intraoperative blood loss was 200 ml. Postoperative period was smooth, with fast track rehabilitation; the patient was discharged on day 9. Considering cancer stage, the patient received XELOX as adjuvant chemotherapy for 6 months after the surgery. During a year of follow-up, no signs of disease progression were evident. The patient is fully socially rehabilitated.  

Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial.

Science.gov (United States)

Capeding, Maria Rosario; Tran, Ngoc Huu; Hadinegoro, Sri Rezeki S; Ismail, Hussain Imam H J Muhammad; Chotpitayasunondh, Tawee; Chua, Mary Noreen; Luong, Chan Quang; Rusmil, Kusnandi; Wirawan, Dewa Nyoman; Nallusamy, Revathy; Pitisuttithum, Punnee; Thisyakorn, Usa; Yoon, In-Kyu; van der Vliet, Diane; Langevin, Edith; Laot, Thelma; Hutagalung, Yanee; Frago, Carina; Boaz, Mark; Wartel, T Anh; Tornieporth, Nadia G; Saville, Melanie; Bouckenooghe, Alain

2014-10-11

An estimated 100 million people have symptomatic dengue infection every year. This is the first report of a phase 3 vaccine efficacy trial of a candidate dengue vaccine. We aimed to assess the efficacy of the CYD dengue vaccine against symptomatic, virologically confirmed dengue in children. We did an observer-masked, randomised controlled, multicentre, phase 3 trial in five countries in the Asia-Pacific region. Between June 3, and Dec 1, 2011, healthy children aged 2-14 years were randomly assigned (2:1), by computer-generated permuted blocks of six with an interactive voice or web response system, to receive three injections of a recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV), or placebo, at months 0, 6, and 12. Randomisation was stratified by age and site. Participants were followed up until month 25. Trial staff responsible for the preparation and administration of injections were unmasked to group allocation, but were not included in the follow-up of the participants; allocation was concealed from the study sponsor, investigators, and parents and guardians. Our primary objective was to assess protective efficacy against symptomatic, virologically confirmed dengue, irrespective of disease severity or serotype, that took place more than 28 days after the third injection. The primary endpoint was for the lower bound of the 95% CI of vaccine efficacy to be greater than 25%. Analysis was by intention to treat and per procotol. This trial is registered with ClinicalTrials.gov, number NCT01373281. We randomly assigned 10,275 children to receive either vaccine (n=6851) or placebo (n=3424), of whom 6710 (98%) and 3350 (98%), respectively, were included in the primary analysis. 250 cases of virologically confirmed dengue took place more than 28 days after the third injection (117 [47%] in the vaccine group and 133 [53%] in the control group). The primary endpoint was achieved with 56·5% (95% CI 43·8-66·4) efficacy. We recorded 647 serious adverse

Mucoceles of minor salivary glands in children. Own clinical observations.

Science.gov (United States)

Lewandowski, Bogumił; Brodowski, Robert; Pakla, Paweł; Makara, Aleksander; Stopyra, Wojciech; Startek, Bartek

Mucoceles are benign lesions associated with the pathology of the oral mucosa of minor salivary glands. Two types of cysts are distinguished depending on their pathogenesis. Most often they occur as a result of mechanical trauma and mucus extravasation into tissues or obstruction of the gland ducts. The aim of the study was to present our own experiences regarding mucoceles of minor salivary glands in the oral cavity taking into account how frequently the individual types of cysts occur in children. The research was carried out based on medical files from the years 2005-2015. These were: medical case records, operating books and the medical registry of patients treated at the Clinic of Maxillofacial Surgery, Frederic Chopin Clinical Regional Hospital in Rzeszow. In that period 64 children and teenagers, 28 girls and 36 boys were treated. What was considered was the age and gender of the patients, the reason for their appointment with a doctor, the location, size and histopathological type of the cysts, as well as the course and results of the diagnostic and therapeutic process. In the group analyzed, the reasons for referral to the Clinic were: in 25 patients accidental ascertainment of a non-symptomatic tumor in the oral cavity during examination by a dentist, pediatrician or laryngologist which had not caused any discomfort to the children; in 13 patients concern had been raised by a gradually increasing tumor; in 18 cases there was an increased tissue tension surrounding the tumor, while in 3 children red oedema was observed in the oral cavity (suspicion of abscess). The most frequent mucocele location was the lower lip (34 children). The most frequent size was 2.1-3 cm (28 children). The most frequent histological type was MEP. All the patients were treated at the Clinic in the one-day surgery mode, with good outcome. Mucocele ascertainment in children's oral cavity could be made accidentally in routine pediatric examination, therefore it is necessary to extend

Incidence of dizziness and vertigo in Japanese primary care clinic patients with lifestyle-related diseases: an observational study.

Science.gov (United States)

Wada, Masaoki; Takeshima, Taro; Nakamura, Yosikazu; Nagasaka, Shoichiro; Kamesaki, Toyomi; Oki, Hiroshi; Kajii, Eiji

2015-01-01

Dizziness and vertigo are highly prevalent symptoms among patients presenting at primary care clinics, and peripheral vestibular disorder (PVD) is their most frequent cause. However, the incidence of PVD has not been well documented. This study aimed to investigate the incidence of dizziness, vertigo, and PVD among patients presenting at a primary care clinic. This was an observational study. Between November 2011 and March 2013, we observed 393 patients, all at least 20 years old, who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for at least 6 months at a primary clinic (Oki Clinic) in Japan. The main outcome of interest was new incidence of dizziness, vertigo, and PVD events. During the 1-year follow-up period, the otorhinolaryngologist diagnosed and reported new PVD events. The mean age of the 393 participants at entry was 65.5 years. Of the study participants, 12.7%, 82.4%, and 92.6% had diabetes mellitus, hypertension, and dyslipidemia, respectively. We followed up all the participants (100%). During the 662.5 person-years of follow-up, 121 cases of dizziness or vertigo (dizziness/vertigo) and 76 cases of PVD were observed. The incidence of dizziness/vertigo and PVD was 194.7 (95% confidence interval: 161.6-232.6) per 1,000 person-years and 115.7 (95% confidence interval: 92.2-142.6) per 1,000 person-years, respectively. There were 61 cases of acute peripheral vestibulopathy, 12 of benign paroxysmal positional vertigo, and three of Meniere's disease among the 76 PVD patients. We reported the incidence of dizziness/vertigo among Japanese primary care clinic patients, which was higher than that usually observed in the general population. Furthermore, we described the incidence of PVD and found that it was a major cause of dizziness/vertigo.

Incidence of dizziness and vertigo in Japanese primary care clinic patients with lifestyle-related diseases: an observational study

Science.gov (United States)

Wada, Masaoki; Takeshima, Taro; Nakamura, Yosikazu; Nagasaka, Shoichiro; Kamesaki, Toyomi; Oki, Hiroshi; Kajii, Eiji

2015-01-01

Objective Dizziness and vertigo are highly prevalent symptoms among patients presenting at primary care clinics, and peripheral vestibular disorder (PVD) is their most frequent cause. However, the incidence of PVD has not been well documented. This study aimed to investigate the incidence of dizziness, vertigo, and PVD among patients presenting at a primary care clinic. Design This was an observational study. Setting and participants Between November 2011 and March 2013, we observed 393 patients, all at least 20 years old, who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for at least 6 months at a primary clinic (Oki Clinic) in Japan. Outcome The main outcome of interest was new incidence of dizziness, vertigo, and PVD events. During the 1-year follow-up period, the otorhinolaryngologist diagnosed and reported new PVD events. Results The mean age of the 393 participants at entry was 65.5 years. Of the study participants, 12.7%, 82.4%, and 92.6% had diabetes mellitus, hypertension, and dyslipidemia, respectively. We followed up all the participants (100%). During the 662.5 person-years of follow-up, 121 cases of dizziness or vertigo (dizziness/vertigo) and 76 cases of PVD were observed. The incidence of dizziness/vertigo and PVD was 194.7 (95% confidence interval: 161.6–232.6) per 1,000 person-years and 115.7 (95% confidence interval: 92.2–142.6) per 1,000 person-years, respectively. There were 61 cases of acute peripheral vestibulopathy, 12 of benign paroxysmal positional vertigo, and three of Meniere’s disease among the 76 PVD patients. Conclusion We reported the incidence of dizziness/vertigo among Japanese primary care clinic patients, which was higher than that usually observed in the general population. Furthermore, we described the incidence of PVD and found that it was a major cause of dizziness/vertigo. PMID:25931828

Clinical Evaluation of the Use of a Multifunctional Remotely Controlled Insulin Pump

Science.gov (United States)

Pinget, Michel; Lachgar, Karim; Parkin, Christopher G.; Grulet, Hervé; Guillon-Metz, Françoise; Weissmann, Joerg

2014-01-01

Current insulin pumps now feature advanced functions for calculating insulin dosages, delivering insulin and analyzing data, however, the perceived usefulness of these functions in clinical settings has not been well studied. We assessed the use and patient perceptions of an insulin delivery system (Accu-Chek® Combo, Roche Diagnostics, Mannheim, Germany) that combines an insulin pump and a handheld multifunctional blood glucose meter with integrated remote control functions. This prospective, observational, multicenter study enrolled 74 type 1 diabetes patients within 13 weeks after starting use of the pump system. At 4 to 24 weeks, investigators collected usage data from the latest 14-day period. Seventy-two patients completed the evaluation, aged 39 ± 15 years, diabetes duration 16 ± 13 years, HbA1c 8.3 ± 1.6%. At follow-up, 62 (86.1%) patients used the remote control for ≥50% of all boluses, 20 (27.8%) used the bolus advisor for ≥50% of all boluses, and 42 (58.3%) viewed at least 1 of the e-logbook reports. More than 95% of users appraised the functions as easy-to-use and useful; median scores from VAS (0 = useless to 100 = indispensable) ranged from 72 to 85. A high percentage of study patients used the system’s advanced features, especially the remote control feature for bolusing. Overall, patients assessed the functions as useful and easy to use. Results support the implementation of these smart capabilities in further insulin pump developments. PMID:25107708

Clinical effect of venlafaxine combined with methylphenidate hydrochloride on narcolepsy

Directory of Open Access Journals (Sweden)

YAN Bin

2013-11-01

Full Text Available This study aims to explore the clinical effect of venlafaxine sustained-release capsules combined with methylphenidate hydrochloride tablets on narcolepsy. Thirty-eight cases of narcoleptic patients were randomly divided into venlafaxine combined with methylphenidate hydrochloride treatment group (observation group, N = 19 and methylphenidate hydrochloride and clomipramine treatment group (control group, N = 19. After a total of 12-week treatment, clinical curative effect and adverse drug reactions were observed in 2 groups of patients. The results showed that effective rate of the treatment for excessive daytime sleepiness (EDS in observation group was higher than that of the control group (15/19 vs 8/19, P = 0.044, and effective rate of the treatment for cataplexy in observation group was higher than that of the control group (13/19 vs 6/19, P = 0.048. The rate of adverse drug reactions in observation group was lower than that in the control group (χ2 = 8.889, P = 0.003. It was indicated that venlafaxine combined with methylphenidate had good curative effect on narcolepsy with EDS and cataplexy symptoms.

An Open-Label, Multicenter Observational Study for Patients with Alzheimer’s Disease Treated with Memantine in the Clinical Practice

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S.S. Stamouli

2011-01-01

Full Text Available Background/Aims: In this post-marketing observational study, the safety and effectiveness of memantine were evaluated in patients with Alzheimer’s disease (AD. Methods: In a 6-month, observational, open-label study at 202 specialist sites in Greece, the effectiveness of memantine was evaluated using the Mini-Mental State Examination (MMSE and the Instrumental Activities of Daily Living (IADL scale at baseline, and after 3 and 6 months. Discontinuation rates and adverse drug reactions (ADRs were also recorded to evaluate the safety profile of memantine. Results: 2,570 patients participated in the study. Three and 6 months after baseline, MMSE and IADL scores were significantly improved compared to baseline. At the end of the study, 67% of the patients had improved their MMSE score; 7.1% of the patients reported ≧1 ADRs, and treatment was discontinued due to ADR in 0.7%. Conclusion: Memantine was well tolerated and had a positive effect on the patient’s cognitive and functional ability in real-life clinical practice, in agreement with randomized, controlled trials.

Use of historical control data for assessing treatment effects in clinical trials

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Viele, Kert; Berry, Scott; Neuenschwander, Beat; Amzal, Billy; Chen, Fang; Enas, Nathan; Hobbs, Brian; Ibrahim, Joseph G.; Kinnersley, Nelson; Lindborg, Stacy; Micallef, Sandrine; Roychoudhury, Satrajit; Thompson, Laura

2014-01-01

Clinical trials rarely, if ever, occur in a vacuum. Generally, large amounts of clinical data are available prior to the start of a study, particularly on the current study’s control arm. There is obvious appeal in using (i.e., ‘borrowing’) this information. With historical data providing information on the control arm, more trial resources can be devoted to the novel treatment while retaining accurate estimates of the current control arm parameters. This can result in more accurate point estimates, increased power, and reduced type I error in clinical trials, provided the historical information is sufficiently similar to the current control data. If this assumption of similarity is not satisfied, however, one can acquire increased mean square error of point estimates due to bias and either reduced power or increased type I error depending on the direction of the bias. In this manuscript, we review several methods for historical borrowing, illustrating how key parameters in each method affect borrowing behavior, and then, we compare these methods on the basis of mean square error, power and type I error. We emphasize two main themes. First, we discuss the idea of ‘dynamic’ (versus ‘static’) borrowing. Second, we emphasize the decision process involved in determining whether or not to include historical borrowing in terms of the perceived likelihood that the current control arm is sufficiently similar to the historical data. Our goal is to provide a clear review of the key issues involved in historical borrowing and provide a comparison of several methods useful for practitioners. PMID:23913901

Use of historical control data for assessing treatment effects in clinical trials.

Science.gov (United States)

Viele, Kert; Berry, Scott; Neuenschwander, Beat; Amzal, Billy; Chen, Fang; Enas, Nathan; Hobbs, Brian; Ibrahim, Joseph G; Kinnersley, Nelson; Lindborg, Stacy; Micallef, Sandrine; Roychoudhury, Satrajit; Thompson, Laura

2014-01-01

Clinical trials rarely, if ever, occur in a vacuum. Generally, large amounts of clinical data are available prior to the start of a study, particularly on the current study's control arm. There is obvious appeal in using (i.e., 'borrowing') this information. With historical data providing information on the control arm, more trial resources can be devoted to the novel treatment while retaining accurate estimates of the current control arm parameters. This can result in more accurate point estimates, increased power, and reduced type I error in clinical trials, provided the historical information is sufficiently similar to the current control data. If this assumption of similarity is not satisfied, however, one can acquire increased mean square error of point estimates due to bias and either reduced power or increased type I error depending on the direction of the bias. In this manuscript, we review several methods for historical borrowing, illustrating how key parameters in each method affect borrowing behavior, and then, we compare these methods on the basis of mean square error, power and type I error. We emphasize two main themes. First, we discuss the idea of 'dynamic' (versus 'static') borrowing. Second, we emphasize the decision process involved in determining whether or not to include historical borrowing in terms of the perceived likelihood that the current control arm is sufficiently similar to the historical data. Our goal is to provide a clear review of the key issues involved in historical borrowing and provide a comparison of several methods useful for practitioners. Copyright © 2013 John Wiley & Sons, Ltd.

Neural Network Observer-Based Finite-Time Formation Control of Mobile Robots

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Caihong Zhang

2014-01-01

Full Text Available This paper addresses the leader-following formation problem of nonholonomic mobile robots. In the formation, only the pose (i.e., the position and direction angle of the leader robot can be obtained by the follower. First, the leader-following formation is transformed into special trajectory tracking. And then, a neural network (NN finite-time observer of the follower robot is designed to estimate the dynamics of the leader robot. Finally, finite-time formation control laws are developed for the follower robot to track the leader robot in the desired separation and bearing in finite time. The effectiveness of the proposed NN finite-time observer and the formation control laws are illustrated by both qualitative analysis and simulation results.

New Designs of Reduced-Order Observer-Based Controllers for Singularly Perturbed Linear Systems

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Heonjong Yoo

2017-01-01

Full Text Available The slow and fast reduced-order observers and reduced-order observer-based controllers are designed by using the two-stage feedback design technique for slow and fast subsystems. The new designs produce an arbitrary order of accuracy, while the previously known designs produce the accuracy of O(ϵ only where ϵ is a small singular perturbation parameter. Several cases of reduced-order observer designs are considered depending on the measured state space variables: only all slow variables are measured, only all fast variables are measured, and some combinations of the slow and fast variables are measured. Since the two-stage methods have been used to overcome the numerical ill-conditioning problem for Cases (III–(V, they have similar procedures. The numerical ill-conditioning problem is avoided so that independent feedback controllers can be applied to each subsystem. The design allows complete time-scale separation for both the reduced-order observer and controller through the complete and exact decomposition into slow and fast time scales. This method reduces both offline and online computations.

Remote observing from the bottom up: the architecture of the WIYN telescope control system

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Percival, Jeffrey W.

1995-06-01

Remote observing has many definitions, ranging from unattended batch-mode use through simple remote logins to fully faithful off-site observing centers indistinguishable from the on- site telescope control room. There are problems with each of these ideas: batch mode operation, for example, precludes remote interactive target acquisition and remote access to targets of opportunity. Simple remote login suffers from network problems such as full-duplex character latency; shipping screens instead of the underlying data can cause bandwidth problems and interferes with analyzing or archiving data. Brute-force reproduction of the control room requires expensive fiber or satellite connections. The WIYN Telescope control system was designed to be inexpensive to build and inexpensive to maintain. We emphasized the use of standard tools, portable implementations, and network friendliness. These techniques and features are precisely those that underlie a powerful remote observing capability. The WIYN Telescope control system therefore supports remote observing from the very lowest levels, and does so effectively and inexpensively using a carefully planned architecture, standard software and network tools, and innovative methods to ship large digital images over low bandwidth connections such as phone lines. Even before the construction was complete, these techniques proved their value by allowing remote access for the purposes of eavesdropping, troubleshooting, and servo tuning. This paper presents a block diagram and detailed descriptions of the WIYN Telescope control system architecture. Each aspect of the control system is discussed with respect to its contribution to the overall goal of remote observing, including multi-user access, bandwidth conservation, interoperability, and portability.

Observable phenomena that reveal medical students' clinical reasoning ability during expert assessment of their history taking: a qualitative study

NARCIS (Netherlands)

Haring, C.M.; Cools, B.M.; Gurp, P.J.M. van; Meer, J.W.M. van der; Postma, C.T.

2017-01-01

BACKGROUND: During their clerkships, medical students are meant to expand their clinical reasoning skills during their patient encounters. Observation of these encounters could reveal important information on the students' clinical reasoning abilities, especially during history taking. METHODS: A

Observer-based leader-following tracking control under both fixed and switching topologies

Institute of Scientific and Technical Information of China (English)

Jinhuan WANG; Pengxiao ZHANG; Zhixin LIU; Xiaoming HU

2016-01-01

This paper studies the tracking problem for a class of leader-follower multi-agent systems moving on the plane using observer-based cooperative control strategies. In our set-up, only a subset of the followers can obtain some relative information on the leader. We assume that the control input of the leader is not known to any of the followers while the system matrix is broadcast to all the followers. To track such a leader, an observer-based decentralized feedback controller is designed for each follower and detailed analysis for the convergence is presented for both fixed and switching interaction topologies between agents with the method of common Lyapunov function. We can also generalize the result to the higher dimension case for fixed topology and some special system matrices of the leader for switching topology.

Approaching control for tethered space robot based on disturbance observer using super twisting law

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Hu, Yongxin; Huang, Panfeng; Meng, Zhongjie; Wang, Dongke; Lu, Yingbo

2018-05-01

Approaching control is a key mission for the tethered space robot to perform the task of removing space debris. But the uncertainties of the TSR such as the change of model parameter have an important effect on the approaching mission. Considering the space tether and the attitude of the gripper, the dynamic model of the TSR is derived using Lagrange method. Then a disturbance observer is designed to estimate the uncertainty based on STW control method. Using the disturbance observer, a controller is designed, and the performance is compared with the dynamic inverse controller which turns out that the proposed controller performs better. Numerical simulation validates the feasibility of the proposed controller on the position and attitude tracking of the TSR.

Observer-Based Bilinear Control of First-Order Hyperbolic PDEs: Application to the Solar Collector

KAUST Repository

Mechhoud, Sarra

2015-12-18

In this paper, we investigate the problem of bilinear control of a solar collector plant using the available boundary and solar irradiance measurements. The solar collector is described by a first-order 1D hyperbolic partial differential equation where the pump volumetric flow rate acts as the plant control input. By combining a boundary state observer and an internal energy-based control law, a nonlinear observer based feedback controller is proposed. With a feed-forward control term, the effect of the solar radiation is cancelled. Using the Lyapunov approach we prove that the proposed control guarantees the global exponential stability of both the plant and the tracking error. Simulation results are provided to illustrate the performance of the proposed method.

Clinical observations of a Cantonese cognitive-behavioral treatment program for Chinese immigrants.

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Shen, Edward K; Alden, Lynn E; Söchting, Ingrid; Tsang, Pheobe

2006-01-01

In this article, the authors describe our clinical observations about the process of delivering a Cantonese-language cognitive- behavioral therapy program to treat depression in Hong Kong immigrants to Vancouver, Canada. Our experiences indicated that standard referral and assessment procedures were not optimal for this population. Other factors that required consideration were how to convert Cantonese terms for dysphoric affect into English equivalents and how to implement cognitive modification strategies when dealing with culture-syntonic beliefs about social relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Use of Vitex agnus-castus in migrainous women with premenstrual syndrome: an open-label clinical observation.

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Ambrosini, Anna; Di Lorenzo, Cherubino; Coppola, Gianluca; Pierelli, Francesco

2013-03-01

Premenstrual syndrome (PMS) affects most women during their reproductive life. Headache is regarded as a typical symptom of PMS and, close to menses, migrainous women could experience their worst migraine attacks. Vitex agnus-castus (VAC) is a phytopharmaceutical compound, considered worldwide to be a valid tool to treat PMS. Aim of this study is to explore if headache is ameliorate in migrainous women treated with VAC for PMS by an open-label clinical observation. Migrainous women with PMS were enrolled in the study and advised to assume a treatment with VAC (40 mg/day) for PMS for a 3-month period. Effects both on PMS and headache were assessed. Out of 107 women, 100 completed the 3-month treatment for PMS. Out of them, 66 women reported a dramatic reduction of PMS symptoms, 26 a mild reduction, and 8 no effect. Concerning migraine, 42 % of patients experienced a reduction higher than 50 % in frequency of monthly attacks, and 57 % of patients experienced a reduction higher than 50 % in monthly days with headache. No patients reported remarkable side effects. Pending a placebo-controlled trial to confirm our results, we observed that the use of VAC in migrainous women affected by PMS resulted to be safe and well tolerated, and may positively influence the frequency and duration of migraine attacks.

Observational study to analyze patterns of treatment of breakthrough dyspnea in cancer patients in clinical practice.

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Cabezón-Gutiérrez, Luis; Delgado-Mingorance, Ignacio; Nabal-Vicuña, María; Jiménez-López, Antonio Javier; Cabezón-Álvarez, Ana; Soler-López, Begoña

2018-06-12

Although breakthrough dyspnea is very frequent in cancer patients, there are no precise recommendations for treating it. The main objective of this study was to analyze what treatments are used in clinical practice for the management of breakthrough dyspnea in cancer patients in Spain and the secondary objectives were to describe the characteristics of cancer patients with breakthrough dyspnea and the attributes of the disorder. Cancer patients over 18 years of age, with breakthrough dyspnea and a Karnofsky performance score of ≥30, who were treated at departments of oncology in institutes across Spain were included in this cross-sectional observational study. The characteristics of breakthrough dyspnea, history of treatment, anthropometric variables, Mahler dyspnea index, Borg scale, Edmonton Symptoms Assessment Scale, and patient satisfaction with current breakthrough dyspnea treatment were assessed. The mean age of the 149 included patients was 66 years (95% confidence interval: 64.3 to 67.9), and 53 were females (35.6%). The mean breakthrough dyspnea intensity was 5.85 (95% confidence interval 5.48 to 6.22, Borg scale). A total of 55.1% of the first-choice treatments consisted of opioids, followed by oxygen (17.3%). A total of 119 patients (79.9%) received monotherapy for breakthrough dyspnea. Patients presenting with basal dyspnea received oxygen in a greater proportion of cases (21.1% vs 7.4%; p = 0.07). Patients with predictable dyspnea received a greater proportion of opioids (70.9% vs 44.4%; p = 0.01). Opioids constitute first-line therapy for breakthrough dyspnea in routine clinical practice, though the scientific evidence supporting their use is scarce. Further information derived from controlled clinical trials is needed regarding the comparative efficacy of the different treatments in order to justify their use.

Recognizing and managing a deteriorating patient: a randomized controlled trial investigating the effectiveness of clinical simulation in improving clinical performance in undergraduate nursing students.

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Stayt, Louise Caroline; Merriman, Clair; Ricketts, Barry; Morton, Sean; Simpson, Trevor

2015-11-01

To report the results of a randomized controlled trial which explored the effectiveness of clinical simulation in improving the clinical performance of recognizing and managing an adult deteriorating patient in hospital. There is evidence that final year undergraduate nurses may lack knowledge, clinical skills and situation awareness required to manage a deteriorating patient competently. The effectiveness of clinical simulation as a strategy to teach the skills required to recognize and manage the early signs of deterioration needs to be evaluated. This study was a two centre phase II single, randomized, controlled trial with single blinded assessments. Data were collected in July 2013. Ninety-eight first year nursing students were randomized either into a control group, where they received a traditional lecture, or an intervention group where they received simulation. Participants completed a pre- and postintervention objective structured clinical examination. General Perceived Self Efficacy and Self-Reported Competency scores were measured before and after the intervention. Student satisfaction with teaching was also surveyed. The intervention group performed significantly better in the post-objective structured clinical examination. There was no significant difference in the postintervention General Perceived Self Efficacy and Self-Reported Competency scores between the control and intervention group. The intervention group was significantly more satisfied with their teaching method. Simulation-based education may be an effective educational strategy to teach nurses the skills to effectively recognize and manage a deteriorating patient. © 2015 John Wiley & Sons Ltd.

Effectiveness of dasabuvir/ombitasvir/paritaprevir/ritonavir for hepatitis C virus in clinical practice: A population-based observational study.

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Maya Leventer-Roberts

Full Text Available Direct acting antivirals for hepatitis C virus have shown dramatic results in clinical trials. However, their effectiveness has yet to be demonstrated within observational cohorts which lack exclusion criteria found in randomized control trials.To determine the effectiveness of dasabuvir/ombitasvir/paritaprevir/ritonavir in achieving sustained virological response.Retrospective observational cohort study of all Clalit Health Services members with hepatitis C virus genotype 1 who were dispensed dasabuvir/ombitasvir/paritaprevir/ritonavir from January 1, 2015 to-November 31, 2015.There were 564 participants during the study period. The average age was 61.9 years, 52.0% were male, and 61.5% were born Eastern/Central Europe or Central Asia. The prevalence of diabetes was 31.7% and 70.3% were overweight/obese. Cirrhosis was present in 41.0% of participants, of whom 52.8% had stage 4 fibrosis. Of the cohort, 416 (74.8% had follow-up viral load testing at 10 or more weeks after the end of treatment. We report a sustained virological response of 98.8% among those tested.Treatment with dasabuvir/ombitasvir/paritaprevir/ritonavir demonstrated a near universal effectiveness in achieving a sustained virological response among HCV patients in a large cohort.

Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy.

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Wang, Zhi-Gang; Zhang, Yong; Zeng, Xian-Dong; Zhang, Tie-Hui; Zhu, Qi-Dong; Liu, De-Long; Qiao, Yun-Yu; Mu, Nan; Yin, Zhi-Tao

2015-02-28

To compare the effects and postoperative complications between tissue selecting therapy stapler (TST) and Milligan-Morgan hemorrhoidectomy (M-M). Four hundred and eighty patients with severe prolapsing hemorrhoids, who were admitted to the Shenyang Coloproctology Hospital between 2009 and 2012, were randomly divided into observation (n=240) and control (n=240) groups. Hemorrhoidectomies were performed with TST in the observation group and with the M-M technique in the control group. The therapeutic effects, operation security, and postoperative complications in the two groups were compared. The immediate and long-term complications were assessed according to corresponding criteria. Pain was assessed on a visual analogue scale. The efficacy was assessed by specialized criteria. The follow-up was conducted one year after the operation. The total effective rates of the observation and control groups were 99.5% (217/218) and 98.6% (218/221) respectively; the difference was not statistically significant (P=0.322). Their were significant differences between observation and control groups in intraoperative blood loss (5.07±1.14 vs 2.45±0.57, P=0.000), pain (12 h after the surgery: 5.08±1.62 vs 7.19±2.01, P=0.000; at first dressing change: 2.64±0.87 vs 4.34±1.15, P=0.000; first defecation: 3.91±1.47 vs 5.63±1.98, P=0.001), urine retention (n=22 vs n=47, P=0.001), anal pendant expansion after the surgery (2.35±0.56 vs 5.16±1.42, P=0.000), operation time (18.3±5.6 min vs 29.5±8.2 min, P=0.000), and the length of hospital stay (5.3±0.6 d vs 11.4±1.8 d, P=0.000). Moreover TST showed significant reductions compared to M-M in the rates of long-term complications such as fecal incontinence (n=3 vs n=16, P=0.003), difficult bowel movement (n=1 vs n=9, P=0.011), intractable pain (n=2 vs n=12, P=0.007), and anal discharge (n=3 vs n=23, P=0.000). TST for severe prolapsing hemorrhoids is a satisfactory technique for more rapid recovery, lower complication rates, and

Overview: clinical and physiological comparison of meditation with other self-control strategies.

Science.gov (United States)

Shapiro, D H

1982-03-01

In 1977 the American Psychiatric Association called for a critical examination of the clinical effectiveness of meditation. The author provides a review of the literature bearing on clinical and physiological comparisons of meditation with other self-control strategies. He begins by providing a definition of mediation and then cites the literature comparing mediation with such self-regulation strategies as biofeedback, hypnosis, and progressive relaxation. He pays particular attention to the "uniqueness" of mediation as a clinical intervention strategy a well as the adverse effects of meditation. Finally, he offers suggestions and guidelines for future research.

Observer-Based Controller Design for a Class of Nonlinear Networked Control Systems with Random Time-Delays Modeled by Markov Chains

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Yanfeng Wang

2017-01-01

Full Text Available This paper investigates the observer-based controller design problem for a class of nonlinear networked control systems with random time-delays. The nonlinearity is assumed to satisfy a global Lipschitz condition and two dependent Markov chains are employed to describe the time-delay from sensor to controller (S-C delay and the time-delay from controller to actuator (C-A delay, respectively. The transition probabilities of S-C delay and C-A delay are both assumed to be partly inaccessible. Sufficient conditions on the stochastic stability for the closed-loop systems are obtained by constructing proper Lyapunov functional. The methods of calculating the controller and the observer gain matrix are also given. Two numerical examples are used to illustrate the effectiveness of the proposed method.

The Individualized Quality Control Plan - Coming Soon to Clinical Microbiology Laboratories Everywhere!

Science.gov (United States)

Anderson, Nancy

2015-11-15

As of January 1, 2016, microbiology laboratories can choose to adopt a new quality control option, the Individualized Quality Control Plan (IQCP), under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). This voluntary approach increases flexibility for meeting regulatory requirements and provides laboratories the opportunity to customize QC for their testing in their unique environments and by their testing personnel. IQCP is an all-inclusive approach to quality based on risk management to address potential errors in the total testing process. It includes three main steps, (1) performing a risk assessment, (2) developing a QC plan, and (3) monitoring the plan through quality assessment. Resources are available from the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, American Society for Microbiology, Clinical and Laboratory Standards Institute, and accrediting organizations, such as the College of American Pathologists and Joint Commission, to assist microbiology laboratories implementing IQCP.

Are specialist outreach clinics for orthodontic consultation effective? A randomised controlled trial

OpenAIRE

Mandall, Nicola; O'Brien, K.

2001-01-01

Objective To develop outreach clinics for orthodontic consultation and evaluate their costs and effectiveness. Design Single centre randomised controlled trial with random allocation of referred patients to outreach or main base consultation appointments. Setting One hospital orthodontic department and three community health centre clinics in Greater Manchester. Subjects 324 patients who were referred for orthodontic treatment. Main outcome measures The outcome of consultation, the cost and d...

Practices, patients and (imperfect data - feasibility of a randomised controlled clinical drug trial in German general practices

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Hummers-Pradier Eva

2011-04-01

Full Text Available Abstract Background Randomised controlled clinical (drug trials supply high quality evidence for therapeutic strategies in primary care. Until now, experience with drug trials in German general practice has been sparse. In 2007/2008, the authors conducted an investigator-initiated, non-commercial, double-blind, randomised controlled pilot trial (HWI-01 to assess the clinical equivalence of ibuprofen and ciprofloxacin in the treatment of uncomplicated urinary tract infection (UTI. Here, we report the feasibility of this trial in German general practices and the implementation of Good Clinical Practice (GCP standards as defined by the International Conference on Harmonisation (ICH in mainly inexperienced general practices. Methods This report is based on the experience of the HWI-01 study conducted in 29 German general practices. Feasibility was defined by 1 successful practice recruitment, 2 sufficient patient recruitment, 3 complete and accurate data collection and 4 appropriate protection of patient safety. Results The final practice recruitment rate was 18%. In these practices, 79 of 195 screened UTI patients were enrolled. Recruitment differed strongly between practices (range 0-12, mean 2.8 patients per practice and was below the recruitment goal of approximately 100 patients. As anticipated, practice nurses became the key figures in the screening und recruitment of patients. Clinical trial demands, in particular for completing symptom questionnaires, documentation of source data and reporting of adverse events, did not agree well with GPs' documentation habits and required support from study nurses. In many cases, GPs and practice staff seemed to be overwhelmed by the amount of information and regulations. No sudden unexpected serious adverse reactions (SUSARs were observed during the trial. Conclusions To enable drug trials in general practice, it is necessary to adapt the setup of clinical research infrastructure to the needs of GPs and

Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies - a randomized prospective controlled clinical trial.

Science.gov (United States)

Geburek, Florian; Gaus, Moritz; van Schie, Hans T M; Rohn, Karl; Stadler, Peter M

2016-09-07

Regenerative and anti-inflammatory effects on tendinopathies have been attributed to blood-derived biologicals. To date the evidence for the efficacy of autologous platelet-rich plasma (PRP) treatment of naturally occurring equine tendinopathies is limited. The purpose of this placebo-controlled clinical trial was to describe the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters. Twenty horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group (n = 10) or control group (n = 10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0). All horses participated in a standardized exercise programme and were re-examined clinically, with B-mode ultrasonography (5 times at regular intervals) and ultrasound tissue characterization (week 12 and 24 after treatment) until week 24. Long-term performance was estimated via telephone inquiry. Compared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultrasonographically there was no difference in the summarized cross sectional area between the groups at any time point. Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group. Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24 weeks after PRP treatment. Eighty percent of the PRP treated horses reached their previous or a higher level of performance after 12 months compared to 50 % in the CG. After 24 months these proportions were 60 % and 50 %, respectively. A single intralesional treatment with PRP up to 8 weeks after onset of clinical signs of tendinopathy contributes

A cluster randomized controlled trial of a clinical pathway for hospital treatment of heart failure: study design and population

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Gardini Andrea

2007-11-01

Full Text Available Abstract Background The hospital treatment of heart failure frequently does not follow published guidelines, potentially contributing to the high morbidity, mortality and economic cost of this disorder. Consequently the development of clinical pathways has the potential to reduce the current variability in care, enhance guideline adherence, and improve outcomes for patients. Despite enthusiasm and diffusion, the widespread acceptance of clinical pathways remain questionable because very little prospective controlled data demonstrated their effectiveness. The Experimental Prospective Study on the Effectiveness and Efficiency of the Implementation of Clinical Pathways was designed in order to conduct a rigorous evaluation of clinical pathways in hospital treatment of acute heart failure. The primary objective of the trial was to evaluate the effectiveness of the implementation of clinical pathways for hospital treatment of heart failure in Italian hospitals. Methods/design Two-arm, cluster-randomized trial. 14 community hospitals were randomized either to arm 1 (clinical pathway: appropriate use of practice guidelines and supplies of drugs and ancillary services, new organization and procedures, patient education, etc. or to arm 2 (no intervention, usual care. 424 patients sample (212 in each group, 80% of power at the 5% significance level (two-sided. The primary outcome measure is in-hospital mortality. We will also analyze the impact of the clinical pathways comparing the length and the appropriateness of the stay, the rate of unscheduled readmissions, the customers' satisfaction and the costs treating the patients with the pathways and with the current practice along all the observation period. The quality of the care will be assessed by monitoring the use of diagnostic and therapeutic procedures during hospital stay and by measuring key quality indicators at discharge. Discussion This paper examines the design of the evaluation of a complex

Clinical observation of transepithelial photorefractive keratectomy for myopia

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Xiao-Ning Yang

2013-10-01

Full Text Available AIM: To assess the effectiveness and safety of transepithelial photorefractive keratectomy(TransPRKusing the AMARIS laser platform. METHODS: Eighty myopic cases(156 eyeswith or without astigmatism were treated by TransPRK. In all eyes, treatments were planned with Custom Ablation Manager Software and ablations performed with the SCHWIND AMARIS system. Clinical outcomes of visual acuity, manifest refraction, intraocular pressure, and corneal topography were observed and analyzed. The follow-up period was one year.RESULTS: All patients completed the 1-year follow-up. After one-year follow-up, 47 cases(92 eyes, 58.8%achieved an uncorrected distance visual acuity(UDVA≥1.0. Twenty cases(40 eyes, 25%was 0.8 and 13 cases(24 eyes, 16.3%was 0.6. Sixty-three cases(121 eyes, 78.8%were close to or above best corrected visual acuity(BCVA. Seventeen cases(34 eyes, 21.2%were slightly lower than BCVA 1 row or two. Nine cases(18 eyes, 11.3%got dry eye postoperatively. 16 cases(32 eyes, 20%complain of glare and poor night vision. CONCLUSION: The results show that TransPRK for myopia with or without astigmatism is safe and effective. The postoperative visual outcomes are stable.

Clinical observation of four-fixable intraocular lens suspensory

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Yu-Ming Teng

2015-06-01

Full Text Available AIM: To discuss the four-fixable intraocular lens(IOLsuspensory in the absence of capsular intraocular lens implantation, suspensory ligament rupture caused by congenital dislocation of the lens, traumatic cataract and posterior capsular rupture without capsular support, which need to line hanging IOL for intraoperative clinical observation.METHODS: The 31 cases(32 eyeswho were accepted the four-fixable IOL suspensory from May 2012 to May 2014 in our hospital were retrospectively analyzed. The postoperative visual acuity, corneal astigmatism, intraoperative and postoperative complications were comprehensively analyzed.RESULTS: Patients were followed up 6mo～1a, corrected visual acuity >0.5(12 eyes, 38%, 0.1～0.5(18 eyes, 56%, and CONCLUSION: It is designed to support non-capsular IOL implantation and design, and the concept of changing the past presence of suspended dislocated IOL implantation surgery, positional deviation and, sutures and other complications split the incidence is greatly reduced. It is consistent with the physiological characteristics of the human eye, and it is the IOL surgical sling best stability, intraoperative and postoperative complications, the best visual acuity and corneal astigmatism minimal surgical approachat least, and the four-point suspension suture fixation of IOL is designed to obtain a practical transformation of Chinese patent.

Randomized, controlled clinical trial evaluating the efficacy of pulsed signal therapy in dogs with osteoarthritis.

Science.gov (United States)

Sullivan, Meghan O; Gordon-Evans, Wanda J; Knap, Kim E; Evans, Richard B

2013-04-01

To evaluate the efficacy of pulsed signal therapy (PST) in reducing pain and increasing function in dogs with osteoarthritis (OA) using a randomized, blinded, controlled clinical trial. Randomized, controlled, blinded clinical trial. Adult dogs (n = 60) with moderate-to-severe clinical signs of OA. Dogs were randomized by age into 2 groups: dogs ≥ 9 years and dogs Goniometry and gait analysis were performed, and the Canine Brief Pain Inventory (CBPI) questionnaire was given to the owners to fill out without supervision. Outcome measures were repeated at the end of treatment (Day 11) and 6 weeks after beginning treatment (Day 42). The PST group performed significantly better than the control group as measured by the CBPI Severity and Interference scores (P Veterinary Surgeons.

Clinical simulation training improves the clinical performance of Chinese medical students

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Ming-ya Zhang

2015-10-01

Full Text Available Background: Modern medical education promotes medical students’ clinical operating capacity rather than the mastery of theoretical knowledge. To accomplish this objective, clinical skill training using various simulations was introduced into medical education to cultivate creativity and develop the practical ability of students. However, quantitative analysis of the efficiency of clinical skill training with simulations is lacking. Methods: In the present study, we compared the mean scores of medical students (Jinan University who graduated in 2013 and 2014 on 16 stations between traditional training (control and simulative training groups. In addition, in a clinical skill competition, the objective structured clinical examination (OSCE scores of participating medical students trained using traditional and simulative training were compared. The data were statistically analyzed and qualitatively described. Results: The results revealed that simulative training could significantly enhance the graduate score of medical students compared with the control. The OSCE scores of participating medical students in the clinical skill competition, trained using simulations, were dramatically higher than those of students trained through traditional methods, and we also observed that the OSCE marks were significantly increased for the same participant after simulative training for the clinical skill competition. Conclusions: Taken together, these data indicate that clinical skill training with a variety of simulations could substantially promote the clinical performance of medical students and optimize the resources used for medical education, although a precise analysis of each specialization is needed in the future.

Incidence of dizziness and vertigo in Japanese primary care clinic patients with lifestyle-related diseases: an observational study

Directory of Open Access Journals (Sweden)

Wada M

2015-04-01

Full Text Available Masaoki Wada,1,2 Taro Takeshima,1 Yosikazu Nakamura,3 Shoichiro Nagasaka,4 Toyomi Kamesaki,1 Hiroshi Oki,2 Eiji Kajii1 1Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan; 2Oki Clinic, Ibaraki, Japan; 3Department of Public Health, Jichi Medical University, Tochigi, Japan; 4Department of Internal Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Tochigi, Japan Objective: Dizziness and vertigo are highly prevalent symptoms among patients presenting at primary care clinics, and peripheral vestibular disorder (PVD is their most frequent cause. However, the incidence of PVD has not been well documented. This study aimed to investigate the incidence of dizziness, vertigo, and PVD among patients presenting at a primary care clinic. Design: This was an observational study. Setting and participants: Between November 2011 and March 2013, we observed 393 patients, all at least 20 years old, who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for at least 6 months at a primary clinic (Oki Clinic in Japan. Outcome: The main outcome of interest was new incidence of dizziness, vertigo, and PVD events. During the 1-year follow-up period, the otorhinolaryngologist diagnosed and reported new PVD events. Results: The mean age of the 393 participants at entry was 65.5 years. Of the study participants, 12.7%, 82.4%, and 92.6% had diabetes mellitus, hypertension, and dyslipidemia, respectively. We followed up all the participants (100%. During the 662.5 person-years of follow-up, 121 cases of dizziness or vertigo (dizziness/vertigo and 76 cases of PVD were observed. The incidence of dizziness/vertigo and PVD was 194.7 (95% confidence interval: 161.6–232.6 per 1,000 person-years and 115.7 (95% confidence interval: 92.2–142.6 per 1,000 person-years, respectively. There were 61 cases of acute peripheral vestibulopathy, 12 of

Observation and control of blinking nitrogen-vacancy centres in discrete nanodiamonds.

Science.gov (United States)

Bradac, C; Gaebel, T; Naidoo, N; Sellars, M J; Twamley, J; Brown, L J; Barnard, A S; Plakhotnik, T; Zvyagin, A V; Rabeau, J R

2010-05-01

Nitrogen-vacancy colour centres in diamond can undergo strong, spin-sensitive optical transitions under ambient conditions, which makes them attractive for applications in quantum optics, nanoscale magnetometry and biolabelling. Although nitrogen-vacancy centres have been observed in aggregated detonation nanodiamonds and milled nanodiamonds, they have not been observed in very small isolated nanodiamonds. Here, we report the first direct observation of nitrogen-vacancy centres in discrete 5-nm nanodiamonds at room temperature, including evidence for intermittency in the luminescence (blinking) from the nanodiamonds. We also show that it is possible to control this blinking by modifying the surface of the nanodiamonds.

A new fuzzy-disturbance observer-enhanced sliding controller for vibration control of a train-car suspension with magneto-rheological dampers

Science.gov (United States)

Nguyen, Sy Dzung; Choi, Seung-Bok; Nguyen, Quoc Hung

2018-05-01

Semi-active train-car suspensions are always impacted negatively by uncertainty and disturbance (UAD). In order to deal with this, we propose a novel optimal fuzzy disturbance observer-enhanced sliding mode controller (FDO-SMC) for magneto-rheological damper (MRD)-based semi-active train-car suspensions subjected to UAD whose variability rate may be high but bounded. The two main parts of the FDO-SMC are an adaptive sliding mode controller (ad-SMC) and an optimal fuzzy disturbance observer (op-FDO). As the first step, the initial structures of the sliding mode controller (SMC) and disturbance observer (DO) are built. Adaptive update laws for the SMC and DO are then set up synchronously via Lyapunov stability analysis. Subsequently, an optimal fuzzy system (op-FS) is designed to fully implement a parameter constraint mechanism so as to guarantee the system stability converging to the desired state even if the UAD variability rate increases in a given range. As a result, both the ad-SMC and op-FDO are formulated. It is shown from the comparative work with existing controllers that the proposed method provides the best vibration control capability with relatively low consumed power.

Sliding observer-based demagnetisation fault-tolerant control in permanent magnet synchronous motors

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Changfan Zhang

2017-04-01

Full Text Available This study proposes a fault-tolerant control method for permanent magnet synchronous motors (PMSMs based on the active flux linkage concept, which addresses permanent magnet (PM demagnetisation faults in PMSMs. First, a mathematical model for a PMSM is established based on active flux linkage, and then the effect of PM demagnetisation on the PMSM is analysed. Second, the stator current in the static coordinate is set as the state variable, an observer is designed based on a sliding-mode variable structure, and an equation for active flux linkage is established for dynamic estimation based on the equivalent control principle of sliding-mode variable structure. Finally, the active flux linkage for the next moment is predicted according to the operating conditions of the motor and the observed values of the current active flux linkage. The deadbeat control strategy is applied to eliminate errors in the active flux linkage and realise the objective of fault-tolerant control. A timely and effective control for demagnetisation faults is achieved using the proposed method, which validity and feasibility are verified by the simulation and experiment results.

Nano positioning control for dual stage using minimum order observer

International Nuclear Information System (INIS)

Kim, Hong Gun

2012-01-01

A nano positioning control is developed using the ultra-precision positioning apparatus such as actuator, sensor, guide, power transmission element with an appropriate control method. Using established procedures, a single plane X-Y stage with ultra-precision positioning is manufactured. A global stage for materialization with robust system is combined by using an AC servo motor with a ball screw and rolling guide. An ultra-precision positioning system is developed using a micro stage with an elastic hinge and piezo element. Global and micro servos for positioning with nanometer accuracy are controlled simultaneously using an incremental encoder and a laser interferometer to measure displacement. Using established procedures, an ultra-precision positioning system (100 mm stroke and ±10 nm positioning accuracy) with a single plane X-Y stage is fabricated. Its performance is evaluated through simulation using Matlab. After analyzing previous control algorithms and adapting modern control theory, a dual servo algorithm is developed for a minimum order observer to secure the stability and priority on the controller. The simulations and experiments on the ultra precision positioning and the stability of the ultra-precision positioning system with single plane X-Y stage and the priority of the control algorithm are secured by using Matlab with Simulink and ControlDesk made in dSPACE

Nano positioning control for dual stage using minimum order observer

Energy Technology Data Exchange (ETDEWEB)

Kim, Hong Gun [Jeonju University, Jeonju (Korea, Republic of)

2012-03-15

A nano positioning control is developed using the ultra-precision positioning apparatus such as actuator, sensor, guide, power transmission element with an appropriate control method. Using established procedures, a single plane X-Y stage with ultra-precision positioning is manufactured. A global stage for materialization with robust system is combined by using an AC servo motor with a ball screw and rolling guide. An ultra-precision positioning system is developed using a micro stage with an elastic hinge and piezo element. Global and micro servos for positioning with nanometer accuracy are controlled simultaneously using an incremental encoder and a laser interferometer to measure displacement. Using established procedures, an ultra-precision positioning system (100 mm stroke and {+-}10 nm positioning accuracy) with a single plane X-Y stage is fabricated. Its performance is evaluated through simulation using Matlab. After analyzing previous control algorithms and adapting modern control theory, a dual servo algorithm is developed for a minimum order observer to secure the stability and priority on the controller. The simulations and experiments on the ultra precision positioning and the stability of the ultra-precision positioning system with single plane X-Y stage and the priority of the control algorithm are secured by using Matlab with Simulink and ControlDesk made in dSPACE.

Temperature-Controlled Delivery of Radiofrequency Energy in Fecal Incontinence: A Randomized Sham-Controlled Clinical Trial.

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Visscher, Arjan P; Lam, Tze J; Meurs-Szojda, Maria M; Felt-Bersma, Richelle J F

2017-08-01

Controlled delivery of radiofrequency energy has been suggested as treatment for fecal incontinence. The aim of this study was to determine whether the clinical response to the radiofrequency energy procedure is superior to sham in patients with fecal incontinence. This was a randomized sham-controlled clinical trial from 2008 to 2015. This study was conducted in an outpatient clinic. Forty patients with fecal incontinence in whom maximal conservative management had failed were randomly assigned to receiving either radiofrequency energy or sham procedure. Fecal incontinence was measured using the Vaizey incontinence score (range, 0-24). The impact of fecal incontinence on quality of life was measured by using the fecal incontinence quality-of-life score (range, 1-4). Measurements were performed at baseline and at 6 months. Anorectal function was evaluated using anal manometry and anorectal endosonography at baseline and at 3 months. At baseline, Vaizey incontinence score was 16.8 (SD 2.9). At t = 6 months, the radiofrequency energy group improved by 2.5 points on the Vaizey incontinence score compared with the sham group (13.2 (SD 3.1), 15.6 (SD 3.3), p = 0.02). The fecal incontinence quality-of-life score at t = 6 months was not statistically different. Anorectal function did not show any alteration. Patients with severe fecal incontinence were included in the study, thus making it difficult to generalize the results. Both radiofrequency energy and sham procedure improved the fecal incontinence score, the radiofrequency energy procedure more than sham. Although statistically significant, the clinical impact for most of the patients was negligible. Therefore, the radiofrequency energy procedure should not be recommended for patients with fecal incontinence until patient-related factors associated with treatment success are known. See Video Abstract at http://links.lww.com/DCR/A373.

Female Gynecologists and Their Birth Control Clinics: Eugenics in Practice in 1920s-1930s China.

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David, Mirela

2018-01-01

Yang Chao Buwei, the first Chinese translator of Margaret Sanger's What Every Girl Should Know, was the first female gynecologist to open up a birth control clinic in China. By the 1930s, other female gynecologists, like Guo Taihua, had internalized and combined national and eugenic concerns of race regeneration to focus on the control of women's reproduction. This symbiosis between racial regeneration and birth control is best seen in Yang Chongrui's integration of birth control into her national hygiene program. This article traces the efforts of pioneer gynecologists in giving contraceptive advice at their birth control clinics, which they framed as a humanitarian effort to ease the reproductive burden of working-class women. It also examines their connections with Sanger's international birth control movement, and their advocacy of contraception as practitioners, translators, and educators. The author argues that these Chinese female gynecologists not only borrowed, but adapted, Western scientific knowledge to Chinese social conditions through their writings and translations and in their clinical work.

Protocol for a randomised controlled trial for Reducing Arthritis Fatigue by clinical Teams (RAFT) using cognitive-behavioural approaches.

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Hewlett, S; Ambler, N; Almeida, C; Blair, P S; Choy, E; Dures, E; Hammond, A; Hollingworth, W; Kirwan, J; Plummer, Z; Rooke, C; Thorn, J; Tomkinson, K; Pollock, J

2015-08-06

Rheumatoid arthritis (RA) fatigue is distressing, leading to unmanageable physical and cognitive exhaustion impacting on health, leisure and work. Group cognitive-behavioural (CB) therapy delivered by a clinical psychologist demonstrated large improvements in fatigue impact. However, few rheumatology teams include a clinical psychologist, therefore, this study aims to examine whether conventional rheumatology teams can reproduce similar results, potentially widening intervention availability. This is a multicentre, randomised, controlled trial of a group CB intervention for RA fatigue self-management, delivered by local rheumatology clinical teams. 7 centres will each recruit 4 consecutive cohorts of 10-16 patients with RA (fatigue severity ≥ 6/10). After consenting, patients will have baseline assessments, then usual care (fatigue self-management booklet, discussed for 5-6 min), then be randomised into control (no action) or intervention arms. The intervention, Reducing Arthritis Fatigue by clinical Teams (RAFT) will be cofacilitated by two local rheumatology clinicians (eg, nurse/occupational therapist), who will have had brief training in CB approaches, a RAFT manual and materials, and delivered an observed practice course. Groups of 5-8 patients will attend 6 × 2 h sessions (weeks 1-6) and a 1 hr consolidation session (week 14) addressing different self-management topics and behaviours. The primary outcome is fatigue impact (26 weeks); secondary outcomes are fatigue severity, coping and multidimensional impact, quality of life, clinical and mood status (to week 104). Statistical and health economic analyses will follow a predetermined plan to establish whether the intervention is clinically and cost-effective. Effects of teaching CB skills to clinicians will be evaluated qualitatively. Approval was given by an NHS Research Ethics Committee, and participants will provide written informed consent. The copyrighted RAFT package will be freely available. Findings

Reported and observed controlling feeding practices predict child eating behavior after 12 months.

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Bergmeier, Heidi J; Skouteris, Helen; Haycraft, Emma; Haines, Jess; Hooley, Merrilyn

2015-06-01

Controlling feeding practices are linked to children's self-regulatory eating practices and weight status. Maternal reports of controlling feeding practices are not always significantly related to independently rated mealtime observations. However, prior studies only assessed 1 mealtime observation, which may not be representative of typical mealtime settings or routines. The first aim was to examine associations between reported and observed maternal pressure to eat and restriction feeding practices at baseline (T1) and after ∼ 12 mo (T2). The second aim was to evaluate relations between maternal and child factors [e.g., concern about child weight, child temperament, child body mass index (BMI)-for-age z scores (BMIz)] at T1 and reported and observed maternal pressure to eat and restriction feeding practices (T1 and T2). The third aim was to assess prospective associations between maternal feeding practices (T1) and child eating behaviors (T2) and child BMIz (T2). A sample of 79 mother-child dyads in Victoria, Australia, participated in 2 lunchtime home observations (T1 and T2). BMI measures were collected during the visits. Child temperament, child eating behaviors, maternal parenting styles, and maternal feeding practices were evaluated at T1 and T2 via questionnaires. Associations were assessed with Pearson's correlation coefficients, paired t tests, and hierarchical regressions. Reported restriction (T1) was inversely associated with observed restriction at T1 (r = -0.24, P controlling strategies. © 2015 American Society for Nutrition.

Nonlinear observer-based Lyapunov boundary control of distributed heat transfer mechanisms for membrane distillation plant

KAUST Repository

Eleiwi, Fadi

2016-09-19

This paper presents a nonlinear observer-based Lyapunov control for a membrane distillation (MD) process. The control considers the inlet temperatures of the feed and the permeate solutions as inputs, transforming it to boundary control process, and seeks to maintain the temperature difference along the membrane boundaries around a sufficient level to promote water production. MD process is modeled with advection diffusion equation model in two dimensions, where the diffusion and convection heat transfer mechanisms are best described. Model analysis, effective order reduction and parameters physical interpretation, are provided. Moreover, a nonlinear observer has been designed to provide the control with estimates of the temperature evolution at each time instant. In addition, physical constraints are imposed on the control to have an acceptable range of feasible inputs, and consequently, better energy consumption. Numerical simulations for the complete process with real membrane parameter values are provided, in addition to detailed explanations for the role of the controller and the observer. (C) 2016 Elsevier Ltd. All rights reserved.

Quality Control Assays for Clinical-Grade Human Mesenchymal Stromal Cells: Validation Strategy.

Science.gov (United States)

Radrizzani, Marina; Soncin, Sabrina; Bolis, Sara; Lo Cicero, Viviana; Andriolo, Gabriella; Turchetto, Lucia

2016-01-01

The present chapter focuses on the validation of the following analytical methods for the control of mesenchymal stromal cells (MSC) for cell therapy clinical trials: Microbiological control for cellular product Endotoxin assay Mycoplasma assay Cell count and viability Immunophenotype Clonogenic potential (CFU-F assay) In our lab, these methods are in use for product release, process control or control of the biological starting materials. They are described in detail in the accompanying Chapter 19.For each method, validation goals and strategy are presented, and a detailed experimental scheme is proposed.

Chaos suppression via observer based active control scheme: Application to Duffing's oscillator

International Nuclear Information System (INIS)

Aguilar-Lopez, Ricardo; Martinez-Guerra, Rafael

2007-01-01

The aim of this paper is the synthesis of a robust control law for chaos suppression of a class of non-linear oscillator with affine control input. A robust state observer based active controller, which provides robustness against model uncertainties and noisy output measurements is proposed. The closed-loop stability for the underlying closed-loop system is done via the regulation and estimation errors dynamics. The performance of the proposed control law is illustrated with numerical simulations. The method is general and can be applied to various non-linear systems which satisfy the conditions required

Clinical aspects of pulmonary radioactivity observed in radiocolloid liver scintigraphy

International Nuclear Information System (INIS)

So, Young; Lee, Kang Wook; Lee, Heon Young; Lee, Won Woo

2002-01-01

We studied clinical aspects and courses of patients with pulmonary radioactivity on liver scintigraphy and speculated the mechanism of pulmonary uptake of radiocolloids. Forty-nine patients with pulmonary radioactivity were classified into 5 diseases groups-liver disease, infection, cancer, ischemic necrosis of liver, etc.- and their presence of absence of chronic liver disease (CLD), Child-Pugh class, serum levels of AST and ALT, results of follow-up liver scintigraphy and clinical course were checked. Of total 49 patients 25 had CLD; there were 23 liver disease patients, 16 infection patients, 7 advanced cancer patients, 2 ischemic necrosis of liver patients, and 1 hemolytic anemia patient. Reversible rise of serum levels of AST and ALT was observed in all patients with liver disease and ischemic necrosis of liver; on one-way ANOVA, these rise were statistically significant (p<0.01). Serum level of ALT of liver disease group patients without CLD was significantly higher than that of infection group patients without CLD (p<0.05). Among 17 patients who underwent follow-up liver scintigraphy, 13 showed no pulmonary radioactivity. Total 12 patients died during follow-up and most of them were terminal cancer patients or CLD patients of Child-Pugh class C. Pulmonary radioactivity of radiocolloid liver scintigraphy could be attributed to the mobilization of reticuloendothelial system (RES) cells by the activation of RES cells in severe infection and terminal cancer, and also by the extensive liver desctruction in liver diseases

Individualized Quality Control Plan (IQCP): Is It Value-Added for Clinical Microbiology?

OpenAIRE

Sharp, Susan E.; Miller, Melissa B.; Hindler, Janet

2015-01-01

The Center for Medicaid and Medicare Services (CMS) recently published their Individualized Quality Control Plan (IQCP [https://www.cms.gov/regulations-and-guidance/legislation/CLIA/Individualized_Quality_Control_Plan_IQCP.html]), which will be the only option for quality control (QC) starting in January 2016 if laboratories choose not to perform Clinical Laboratory Improvement Act (CLIA) [U.S. Statutes at Large 81(1967):533] default QC. Laboratories will no longer be able to use “equivalent ...

Observer Based Sliding Mode Attitude Control: Theoretical and Experimental Results

Directory of Open Access Journals (Sweden)

U. Jørgensen

2011-07-01

Full Text Available In this paper we present the design of a sliding mode controller for attitude control of spacecraft actuated by three orthogonal reaction wheels. The equilibrium of the closed loop system is proved to be asymptotically stable in the sense of Lyapunov. Due to cases where spacecraft do not have angular velocity measurements, an estimator for the generalized velocity is derived and asymptotic stability is proven for the observer. The approach is tested on an experimental platform with a sphere shaped Autonomous Underwater Vehicle SATellite: AUVSAT, developed at the Norwegian University of Science and Technology.

An artificial neural network estimation of gait balance control in the elderly using clinical evaluations.

Directory of Open Access Journals (Sweden)

Vipul Lugade

Full Text Available The use of motion analysis to assess balance is essential for determining the underlying mechanisms of falls during dynamic activities. Clinicians evaluate patients using clinical examinations of static balance control, gait performance, cognition, and neuromuscular ability. Mapping these data to measures of dynamic balance control, and the subsequent categorization and identification of community dwelling elderly fallers at risk of falls in a quick and inexpensive manner is needed. The purpose of this study was to demonstrate that given clinical measures, an artificial neural network (ANN could determine dynamic balance control, as defined by the interaction of the center of mass (CoM with the base of support (BoS, during gait. Fifty-six elderly adults were included in this study. Using a feed-forward neural network with back propagation, combinations of five functional domains, the number of hidden layers and error goals were evaluated to determine the best parameters to assess dynamic balance control. Functional domain input parameters included subject characteristics, clinical examinations, cognitive performance, muscle strength, and clinical balance performance. The use of these functional domains demonstrated the ability to quickly converge to a solution, with the network learning the mapping within 5 epochs, when using up to 30 hidden nodes and an error goal of 0.001. The ability to correctly identify the interaction of the CoM with BoS demonstrated correlation values up to 0.89 (P<.001. On average, using all clinical measures, the ANN was able to estimate the dynamic CoM to BoS distance to within 1 cm and BoS area to within 75 cm2. Our results demonstrated that an ANN could be trained to map clinical variables to biomechanical measures of gait balance control. A neural network could provide physicians and patients with a cost effective means to identify dynamic balance issues and possible risk of falls from routinely collected clinical

Dulce Wireless Tijuana: A Randomized Control Trial Evaluating the Impact of Project Dulce and Short-Term Mobile Technology on Glycemic Control in a Family Medicine Clinic in Northern Mexico.

Science.gov (United States)

Anzaldo-Campos, María Cecilia; Contreras, Sonia; Vargas-Ojeda, Adriana; Menchaca-Díaz, Rufino; Fortmann, Addie; Philis-Tsimikas, Athena

2016-04-01

The global epidemic of diabetes calls for innovative interventions. This study evaluated the effectiveness of the Project Dulce model, with and without wireless technology, on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico. Adults with type 2 diabetes and a glycated hemoglobin A1c (HbA1c) level of ≥8% were recruited from Family Medical Unit #27 of the Instituto Mexicano del Seguro Social (IMSS) in Tijuana, México, and randomly assigned to one of three groups: Project Dulce-only (PD); Project Dulce technology-enhanced with mobile tools (PD-TE); or IMSS standard of care/control group (CG). Clinical and self-reported outcomes were assessed at baseline, Month 4, and Month 10. Time-by-group interactions and within-group changes were analyzed. HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE (-3.0% [-33 mmol/mol]) and PD (-2.6% [-28.7 mmol/mol]) compared with CG (-1.3% [-14.2 mmol/mol]) (P = 0.009 and 0.001, respectively). PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG (P improvements were observed on other clinical and self-report indicators but did not vary significantly across groups. Project Dulce with and without wireless technology substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit, suggesting that integrating peer-led education, nurse coordination, and 3G wireless technology is an effective approach for improving diabetes outcomes in high-risk populations.

Application of indices Cp and Cpk to improve quality control capability in clinical biochemistry laboratories.

Science.gov (United States)

Chen, Ming-Shu; Wu, Ming-Hsun; Lin, Chih-Ming

2014-04-30

The traditional criteria for acceptability of analytic quality may not be objective in clinical laboratories. To establish quality control procedures intended to enhance Westgard multi-rules for improving the quality of clinical biochemistry tests, we applied the Cp and Cpk quality-control indices to monitor tolerance fitting and systematic variation of clinical biochemistry test results. Daily quality-control data of a large Taiwanese hospital in 2009 were analyzed. The test items were selected based on an Olympus biochemistry machine and included serum albumin, aspartate aminotransferase, cholesterol, glucose and potassium levels. Cp and Cpk values were calculated for normal and abnormal levels, respectively. The tolerance range was estimated with data from 50 laboratories using the same instruments and reagents. The results showed a monthly trend of variation for the five items under investigation. The index values of glucose were lower than those of the other items, and their values were usually quality control, but also for revealing inter-laboratory qualitycontrol capability differences.

Distributed Adaptive Fuzzy Control for Nonlinear Multiagent Systems Via Sliding Mode Observers.

Science.gov (United States)

Shen, Qikun; Shi, Peng; Shi, Yan

2016-12-01

In this paper, the problem of distributed adaptive fuzzy control is investigated for high-order uncertain nonlinear multiagent systems on directed graph with a fixed topology. It is assumed that only the outputs of each follower and its neighbors are available in the design of its distributed controllers. Equivalent output injection sliding mode observers are proposed for each follower to estimate the states of itself and its neighbors, and an observer-based distributed adaptive controller is designed for each follower to guarantee that it asymptotically synchronizes to a leader with tracking errors being semi-globally uniform ultimate bounded, in which fuzzy logic systems are utilized to approximate unknown functions. Based on algebraic graph theory and Lyapunov function approach, using Filippov-framework, the closed-loop system stability analysis is conducted. Finally, numerical simulations are provided to illustrate the effectiveness and potential of the developed design techniques.

Comparability of patients with ANCA-associated vasculitis enrolled in clinical trials or in observational cohorts

Science.gov (United States)

Pagnoux, Christian; Carette, Simon; Khalidi, Nader A.; Walsh, Michael; Hiemstra, Thomas F.; Cuthbertson, David; Langford, Carol; Hoffman, Gary S.; Koening, Curry L.; Monach, Paul A.; Moreland, Larry; Mouthon, Luc; Seo, Phil; Specks, Ulrich; Ytterberg, Steven; Westman, Kerstin; Hoglund, Peter; Harper, Lorraine; Flossmann, Oliver; Luqmani, Raashid; Savage, Caroline; Rasmussen, Niels; de Groot, Kirstin; Tesar, Vladimir; Jayne, David; Merkel, Pater A.; Guillevin, Loic

2015-01-01

Objective To analyse the differences between patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) entered into randomised clinical trials (RCTs) and those followed in large observational cohorts. Methods The main characteristics and outcomes of patients with generalised and/or severe GPA or MPA with a five-factor score ≥1 enrolled in the French Vasculitis Study Group (FVSG) or the US-Canadian-based Vasculitis Clinical Research Consortium cohorts were compared to those enrolled in one of 2 FVSG clinical RCTs (WEG91, WEGENT) or 3 European Vasculitis Society clinical trials (CYCLOPS, CYCAZAREM, IMPROVE). Results 657 patients (65.3% with GPA) in RCTs were compared to 437 in cohorts (90.6% with GPA). RCT patients were older at diagnosis than the cohort patients (56.6±13.9 vs. 46.8±17.3 years), had higher Birmingham vasculitis activity score (19.5±9.1 vs. 16.9±7.4), and more frequent kidney disease (84.0% vs. 54.9%) but fewer ear, nose, and throat symptoms (56.8% vs. 72.2%). At 56 months post-diagnosis, mortality and relapse rates, adjusted for age and renal function, were higher for patients with GPA in RCTs vs. cohorts (10.7% vs. 2.5% [p=0.001] and 22.5% vs. 15.6% [p=0.03], respectively) but similar for patients with MPA (6.2% vs. 6.6% [p=0.92] and 16.6% vs. 10.1% [p=0.39], respectively). Conclusion Patients with GPA or MPA in RCTs and those in observational cohorts show important differences that should be remembered when interpreting results based on these study populations. PMID:26016754

Terminal Sliding Mode Control with Unidirectional Auxiliary Surfaces for Hypersonic Vehicles Based on Adaptive Disturbance Observer

Directory of Open Access Journals (Sweden)

Naibao He

2015-01-01

Full Text Available A novel flight control scheme is proposed using the terminal sliding mode technique, unidirectional auxiliary surfaces and the disturbance observer model. These proposed dynamic attitude control systems can improve control performance of hypersonic vehicles despite uncertainties and external disturbances. The terminal attractor is employed to improve the convergence rate associated with the critical damping characteristics problem noted in short-period motions of hypersonic vehicles. The proposed robust attitude control scheme uses a dynamic terminal sliding mode with unidirectional auxiliary surfaces. The nonlinear disturbance observer is designed to estimate system uncertainties and external disturbances. The output of the disturbance observer aids the robust adaptive control scheme and improves robust attitude control performance. Finally, simulation results are presented to illustrate the effectiveness of the proposed terminal sliding mode with unidirectional auxiliary surfaces.

Disturbance observer based Takagi-Sugeno fuzzy control for an active seat suspension

Science.gov (United States)

Ning, Donghong; Sun, Shuaishuai; Zhang, Fei; Du, Haiping; Li, Weihua; Zhang, Bangji

2017-09-01

In this paper, a disturbance observer based Takagi-Sugeno (TS) fuzzy controller is proposed for an active seat suspension; both simulations and experiments have been performed verifying the performance enhancement and stability of the proposed controller. The controller incorporates closed-loop feedback control using the measured acceleration of the seat and deflection of the suspension; these two variables can be easily measured in practical applications, thus allowing the proposed controller to be robust and adaptable. A disturbance observer that can estimate the disturbance caused by friction, model simplification, and controller output error has also been used to compensate a H∞ state feedback controller. The TS fuzzy control method is applied to enhance the controller's performance by considering the variation of driver's weight during operation. The vibration of a heavy duty vehicle seat is largest in the frequency range between 2 Hz and 4 Hz, in the vertical direction; therefore, it is reasonable to focus on controlling low frequency vibration amplitudes and maintain the seat suspensions passivity at high frequency. Moreover, both the simulation and experimental results show that the active seat suspension with the proposed controller can effectively isolate unwanted vibration amplitudes below 4.5 Hz, when compared with a well-tuned passive seat suspension. The active controller has been further validated under bump and random road tests with both a 55 kg and a 70 kg loads. The bump road test demonstrated the controller has good transient response capabilities. The random road test result has been presented both in the time domain and the frequency domain. When with the above two loads, the controlled seat suspensions root-mean-square (RMS) accelerations were reduced by 45.5% and 49.5%, respectively, compared with a well-tuned passive seat suspension. The proposed active seat suspension controller has great potential and is very practical for application

Nonlinear disturbance observer based sliding mode control of a cable-driven rehabilitation robot.

Science.gov (United States)

Niu, Jie; Yang, Qianqian; Chen, Guangtao; Song, Rong

2017-07-01

This paper introduces a cable-driven robot for upper-limb rehabilitation. Kinematic and dynamic of this rehabilitation robot is analyzed. A sliding mode controller combined with a nonlinear disturbance observer is proposed to control this robot in the presence of disturbances. Simulation is carried out to prove the effectiveness of the proposed control scheme, and the results of the proposed controller is compared with a PID controller and a traditional sliding mode controller. Results show that the proposed controller can effectively improve the tracking performance as compared with the other two controllers and cause lower chattering as compared with a traditional sliding mode controller.

Relations of Anxiety Sensitivity, Control Beliefs, and Maternal Over-Control to Fears in Clinic-Referred Children with Specific Phobia.

Science.gov (United States)

Kane, Elisabeth J; Braunstein, Kara; Ollendick, Thomas H; Muris, Peter

2015-07-01

The relations of fear to anxiety sensitivity, control beliefs, and maternal overprotection were examined in 126 7- to 13-year-old clinically referred children with specific phobias. Results indicated that anxiety sensitivity and control beliefs were significant predictors of children's fear levels, accounting for approximately 48% of the total variance. Unexpectedly, age, gender, and maternal overprotection did not emerge as significant predictors of fear in the overall sample. In subsequent analyses, anxiety sensitivity was found to be a consistent, significant predictor for both girls and boys, for both younger and older children, and for children with and without an additional anxiety disorder diagnosis. Control beliefs were only a significant predictor for girls, younger children, and children with an additional anxiety diagnosis. Maternal overprotection was not a significant predictor for any group. Children with an additional anxiety disorder diagnosis had higher levels of fear, anxiety sensitivity, and maternal overprotection, as well as lower levels of control beliefs than the non-additional anxiety disorder subgroup. Future directions and clinical implications are explored.

Curative effect observation of n-flap and off-flap EPi-LASIK in ametropia

Directory of Open Access Journals (Sweden)

Chao Liu

2015-11-01

Full Text Available AIM:To observe the clinical effect of on-flap and off-flap epipolis laser in situ keratomileusis(EPi-LASIKin ametropia.METHODS: Sixty-eight myopia patients(136 eyesreceiving surgical treatment were selected and divided into research group and control group according to different therapies. The patients in research group adopted off-flap EPi-LASIK and those in control group adopted on-flap EPi-LASIK. The index like uncorrected visual acuity, diopter and Haze of two groups before surgery, 1wk, 1 and 4mo after surgery was observed. RESULTS: One month after surgery, the uncorrected visual acuity of research group was 1.33±0.22 while that of control group was 1.22±0.19(PPPCONCLUSION:On-flap and off-flap EPi-LASIK are safe and effective surgery approaches in the clinical treatment of ametropia. The presence of corneal epithelial flap has a certain effect in the postoperative clinical outcome at early stage. The impact will be gradually reduced over time.

Robust output observer-based control of neutral uncertain systems with discrete and distributed time delays: LMI optimization approach

International Nuclear Information System (INIS)

Chen, J.-D.

2007-01-01

In this paper, the robust control problem of output dynamic observer-based control for a class of uncertain neutral systems with discrete and distributed time delays is considered. Linear matrix inequality (LMI) optimization approach is used to design the new output dynamic observer-based controls. Three classes of observer-based controls are proposed and the maximal perturbed bound is given. Based on the results of this paper, the constraint of matrix equality is not necessary for designing the observer-based controls. Finally, a numerical example is given to illustrate the usefulness of the proposed method

Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: a retrospective observational study

OpenAIRE

Vinluan, Jessele; Retegan, Claudia; Chen, Andrew; Beiles, Charles Barry

2014-01-01

Objective Clinical management issues are contributory factors to mortality. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM), an educational peer-review process for surgeons, to discover differences in the incidence of these issues between surgical specialties in order to focus attention to areas of care that might be improved. Design This study used retrospectively analysed observational data from VASM. Clinical management issues between eight speci...

Calculation of controllability and observability matrices for special case of continuous-time multi-order fractional systems.

Science.gov (United States)

Hassanzadeh, Iman; Tabatabaei, Mohammad

2017-03-28

In this paper, controllability and observability matrices for pseudo upper or lower triangular multi-order fractional systems are derived. It is demonstrated that these systems are controllable and observable if and only if their controllability and observability matrices are full rank. In other words, the rank of these matrices should be equal to the inner dimension of their corresponding state space realizations. To reduce the computational complexities, these matrices are converted to simplified matrices with smaller dimensions. Numerical examples are provided to show the usefulness of the mentioned matrices for controllability and observability analysis of this case of multi-order fractional systems. These examples clarify that the duality concept is not necessarily true for these special systems. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

77 FR 67396 - Importer of Controlled Substances; Notice of Application, Fisher Clinical Services, Inc.

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2012-11-09

... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application, Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34(a), this is notice that on August 20, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, [[Page 67397...

77 FR 60143 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc.

Science.gov (United States)

2012-10-02

... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34(a), this is notice that on July 18, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

77 FR 72409 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc.

Science.gov (United States)

2012-12-05

... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34 (a), this is notice that on October 16, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

78 FR 59064 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc.

Science.gov (United States)

2013-09-25

... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations (CFR) 1301.34 (a), this is notice that on June 21, 2013, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

Parenting clinically anxious versus healthy control children aged 4-12 years

NARCIS (Netherlands)

van der Sluis, C.M.; van Steensel, F.J.A.; Bögels, S.M.

2015-01-01

This study investigated whether parenting behaviors differed between parents of 68 clinically anxious children and 106 healthy control children aged 4-12 years. The effects of parent gender, child gender and child age on parenting were explored. Mothers and fathers completed a questionnaire to

Green tea (Camellia sinensis) for patients with knee osteoarthritis: A randomized open-label active-controlled clinical trial.

Science.gov (United States)

Hashempur, Mohammad Hashem; Sadrneshin, Sara; Mosavat, Seyed Hamdollah; Ashraf, Alireza

2018-02-01

Green tea is known as a dietary supplement and a novel functional food worldwide. Since there are increasing preclinical evidence about efficacy of green tea for treating osteoarthritis, this study has aimed at assessing its efficacy and safety for patients with knee osteoarthritis. This is a randomized open-label active-controlled clinical trial. As many as fifty adults with osteoarthritis of knee were randomly allocated to receive the green tea extract (in dosage form of tablet) plus diclofenac tablet as "intervention group"; or: diclofenac tablet alone as "control group" for a period of four weeks. Patients were assessed at the beginning of intervention, and then 4 weeks later, in terms of pain score via visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire's total score in addition to its 3 sub-scores. Furthermore, they were asked about any adverse effects during intervention period. Mean differences of VAS pain, total WOMAC, and WOMAC physical function scores in green tea group showed a significant reduction, compared with the control group (P = 0.038, P = 0.006, and P = 0.004, respectively). However, No significant differences between the two groups were observed, regarding mean differences of WOMAC pain and stiffness scores of the enrolled patients (P = 0.163, and P = 0.150, respectively). Additionally, only 1 patient reported gastric upset [in control group]. It seems that green tea extract might well be considered as an adjunctive treatment both for control of pain and for the betterment of knee joint physical function in adults with osteoarthritis. However, further studies of longer duration and larger sample size are needed. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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

Improved control of distributed parameter systems using wireless sensor and actuator networks: An observer-based method

International Nuclear Information System (INIS)

Jiang Zheng-Xian; Cui Bao-Tong; Lou Xu-Yang; Zhuang Bo

2017-01-01

In this paper, the control problem of distributed parameter systems is investigated by using wireless sensor and actuator networks with the observer-based method. Firstly, a centralized observer which makes use of the measurement information provided by the fixed sensors is designed to estimate the distributed parameter systems. The mobile agents, each of which is affixed with a controller and an actuator, can provide the observer-based control for the target systems. By using Lyapunov stability arguments, the stability for the estimation error system and distributed parameter control system is proved, meanwhile a guidance scheme for each mobile actuator is provided to improve the control performance. A numerical example is finally used to demonstrate the effectiveness and the advantages of the proposed approaches. (paper)

[Effects of blood glucose control on glucose variability and clinical outcomes in patients with severe acute pancreatitis in intensive care unit].

Science.gov (United States)

Wu, Jing; Sun, Qiuhong; Yang, Hua

2015-05-19

To explore the effects of blood glucose control on glucose variability and clinical outcomes in patients with severe acute pancreatitis in intensive care unit (ICU). A total of 72 ICU patients with severe acute pancreatitis were recruited and divided randomly into observation and control groups (n = 36 each). Both groups were treated conventionally. And the observation group achieved stable blood glucose at 6.1-8.3 mmol/L with intensive glucose control. The length of ICU and hospital stays, ICU mortality rate, transit operative rate, concurrent infection rate, admission blood glucose, glycosylated hemoglobin, mean insulin dose, mean blood glucose, blood glucose value standard deviation (GLUSD), glycemic liability index (GLUGLI) and mean amplitude of glycemic excursion (GLUMAGE) of two groups were compared. At the same time, the relationship between blood glucose variability, ICU mortality rate and its predictive value were analyzed by correlation analysis and receiver operating characteristic curve (ROC). The lengths of ICU and hospital stays of observation group were all significantly less than those of the control group [(11.7 ± 9.9) vs (15.9 ± 8.02) days, (21.8 ± 10.8) vs (28.2 ± 12.7) days, P blood glucose value and GLUSD of observation group were significantly lower than those of control group [(7.4 ± 1.1) vs (9.6 ± 1.2), (1.8 ± 1.0) vs (2.5 ± 1.3) mmol/L]. The differences were statistically significant (P curve analysis showed that, AUC of GLUGLI was 0.748 and 95% CI 0.551-0.965 (P glucose control in patients with severe acute pancreatitis helps reduce the blood sugar fluctuations, lower the risks of infectious complications and promote the patient rehabilitation. And GLUGLI is positively correlated with ICU mortality rate. It has good predictive values.

[Clinical application of moving cupping therapy based on skin reaction observation and syndrome differentiation].

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Deng, Xiao-Lan; Chen, Bo; Chen, Ze-Lin

2014-12-01

The diagnostic evidence on clinical diseases and theoretic basis of moving cupping therapy were ex- plored in the paper. By the observation of the local reaction, such as skin appearance and color, the affected location, duration of sickness and nature of disease were judged. Different moving cupping methods were selected for different disorders. It was discovered that the property of syndromes should be recognized by the palpation on skin and muscle in the moving cupping therapy so that the pathogenesis and treating principle could be carefully determined. The moving cupping therapy is the important component of body surface therapy. Skin reaction observation and syndrome differentiation is the essential guidance of the moving cupping therapy.

Full-order Luenberger observer based on fuzzy-logic control for sensorless field-oriented control of a single-sided linear induction motor.

Science.gov (United States)

Holakooie, Mohammad Hosein; Ojaghi, Mansour; Taheri, Asghar

2016-01-01

This paper investigates sensorless indirect field oriented control (IFOC) of SLIM with full-order Luenberger observer. The dynamic equations of SLIM are first elaborated to draw full-order Luenberger observer with some simplifying assumption. The observer gain matrix is derived from conventional procedure so that observer poles are proportional to SLIM poles to ensure the stability of system for wide range of linear speed. The operation of observer is significantly impressed by adaptive scheme. A fuzzy logic control (FLC) is proposed as adaptive scheme to estimate linear speed using speed tuning signal. The parameters of FLC are tuned using an off-line method through chaotic optimization algorithm (COA). The performance of the proposed observer is verified by both numerical simulation and real-time hardware-in-the-loop (HIL) implementation. Moreover, a detailed comparative study among proposed and other speed observers is obtained under different operation conditions. Copyright © 2015 ISA. Published by Elsevier Ltd. All rights reserved.

Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol of a randomized clinical trial

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Ertelt Denis

2012-06-01

Full Text Available Abstract Background Evidence exist that motor observation activates the same cortical motor areas that are involved in the performance of the observed actions. The so called “mirror neuron system” has been proposed to be responsible for this phenomenon. We employ this neural system and its capability to re-enact stored motor representations as a tool for rehabilitating motor control. In our new neurorehabilitative schema (videotherapy we combine observation of daily actions with concomitant physical training of the observed actions focusing on the upper limbs. Following a pilot study in chronic patients in an ambulatory setting, we currently designed a new multicenter clinical study dedicated to patients in the sub-acute state after stroke using a home-based self-induced training. Within our protocol we assess 1 the capability of action observation to elicit rehabilitational effects in the motor system, and 2 the capacity of this schema to be performed by patients without assistance from a physiotherapist. The results of this study would be of high health and economical relevance. Methods/design A controlled, randomized, multicenter, paralleled, 6 month follow-up study will be conducted on three groups of patients: one group will be given the experimental treatment whereas the other two will participate in control treatments. All patients will undergo their usual rehabilitative treatment beside participation in the study. The experimental condition consists in the observation and immediate imitation of common daily hand and arm actions. The two parallel control groups are a placebo group and a group receiving usual rehabilitation without any trial-related treatment. Trial randomization is provided via external data management. The primary efficacy endpoint is the improvement of the experimental group in a standardized motor function test (Wolf Motor Function Test relative to control groups. Further assessments refer to subjective and

Children’s Behavioral Pain Cues: Implicit Automaticity and Control Dimensions in Observational Measures

Directory of Open Access Journals (Sweden)

Kamal Kaur Sekhon

2017-01-01

Full Text Available Some pain behaviors appear to be automatic, reflexive manifestations of pain, whereas others present as voluntarily controlled. This project examined whether this distinction would characterize pain cues used in observational pain measures for children aged 4–12. To develop a comprehensive list of cues, a systematic literature search of studies describing development of children’s observational pain assessment tools was conducted using MEDLINE, PsycINFO, and Web of Science. Twenty-one articles satisfied the criteria. A total of 66 nonredundant pain behavior items were identified. To determine whether items would be perceived as automatic or controlled, 277 research participants rated each on multiple scales associated with the distinction. Factor analyses yielded three major factors: the “Automatic” factor included items related to facial expression, paralinguistics, and consolability; the “Controlled” factor included items related to intentional movements, verbalizations, and social actions; and the “Ambiguous” factor included items related to voluntary facial expressions. Pain behaviors in observational pain scales for children can be characterized as automatic, controlled, and ambiguous, supporting a dual-processing, neuroregulatory model of pain expression. These dimensions would be expected to influence judgments of the nature and severity of pain being experienced and the extent to which the child is attempting to control the social environment.

Assuring Quality Control of Clinical Education in Multiple Clinical Affiliates.

Science.gov (United States)

Davis, Judith A.

A plan was developed to assure equivalency of clinical education among the medical laboratory technician (MLT) programs affiliated with Sandhills Community College. The plan was designed by faculty to monitor the quality of clinical courses offered by the clinical affiliates. The major strategies were to develop competencies, slide/tape modules, a…

Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a "Hospital without Pain" certificate.

Science.gov (United States)

Tomaszek, Lucyna; Dębska, Grażyna

2018-04-01

(i) To compare knowledge and compliance with good clinical practices regarding control of postoperative pain among nurses employed at hospitals with and without a "Hospital without Pain" certificate, (ii) to identify the determinants of nurses' knowledge and (iii) to define barriers to effective control of postoperative pain. Only a slight improvement in postoperative pain control has been observed recently, if any. Implementation of good clinical practices in the control of postoperative pain requires involvement of nurses. A cross-sectional study. The study included 257 nurses from hospitals with a "Hospital without Pain" certificate and 243 nurses from noncertified hospitals, with mean job seniority of 17.6 ± 9.6 years. All respondents answered 26 questions regarding postoperative pain control-related issues. Based on the answers, overall scores were calculated for (i) nurses' knowledge, (ii) compliance with good clinical practices and (iii) barriers to effective control of postoperative pain. Nurses from the certified hospitals presented with significantly higher levels of knowledge and compliance with good clinical practices and identified significantly more barriers to effective control of postoperative pain. Apart from certification of a hospital, better knowledge of postoperative pain control was determined by higher education, participation in postgraduate training programmes and other relevant courses, self-education from medical journals, employment at paediatric ward or intensive care unit. The most commonly reported barriers to effective control of pain included too low doses of painkillers prescribed by physicians and inability to modify the protocol of pain treatment by the nurse. Control of postoperative pain can be improved by enrolling nurses in various forms of continuous training and by providing them with greater autonomy in administering painkillers to surgical patients. Better quality of care offered to patients with postoperative pain

Observer based output-feedback control to eliminate rorsional drill-string vibrations

NARCIS (Netherlands)

Vromen, T.G.M.; van de Wouw, N.; Doris, A.; Astrid, P.; Nijmeijer, H.

2014-01-01

Torsional stick-slip vibrations decrease the performance and reliability of drilling systems used for the exploration of energy and mineral resources. In this work, we present the design of a nonlinear observer-based outputfeedback control strategy to eliminate these vibrations. We apply the

A parameterization of observer-based controllers: Bumpless transfer by covariance interpolation

DEFF Research Database (Denmark)

Stoustrup, Jakob; Komareji, Mohammad

2009-01-01

This paper presents an algorithm to interpolate between two observer-based controllers for a linear multivariable system such that the closed loop system remains stable throughout the interpolation. The method interpolates between the inverse Lyapunov functions for the two original state feedback...

Internal hydraulic control in the Little Belt, Denmark - observations of flow configurations and water mass formation

Science.gov (United States)

Holtegaard Nielsen, Morten; Vang, Torben; Chresten Lund-Hansen, Lars

2017-12-01

Internal hydraulic control, which occurs when stratified water masses are forced through an abrupt constriction, plays an enormous role in nature on both large and regional scales with respect to dynamics, circulation, and water mass formation. Despite a growing literature on this subject surprisingly few direct observations have been made that conclusively show the existence of and the circumstances related to internal hydraulic control in nature. In this study we present observations from the Little Belt, Denmark, one of three narrow straits connecting the Baltic Sea and the North Sea. The observations (comprised primarily of along-strait, detailed transects of salinity and temperature; continuous observations of flow velocity, salinity, and temperature at a permanent station; and numerous vertical profiles of salinity, temperature, fluorescence, and flow velocity in various locations) show that internal hydraulic control is a frequently occurring phenomenon in the Little Belt. The observations, which are limited to south-going flows of approximately two-layered water masses, show that internal hydraulic control may take either of two configurations, i.e. the lower or the upper layer being the active, accelerating one. This is connected to the depth of the pycnocline on the upstream side and the topography, which is both deepening and contracting toward the narrow part of the Little Belt. The existence of two possible flow configurations is known from theoretical and laboratory studies, but we believe that this has never been observed in nature and reported before. The water masses formed by the intense mixing, which is tightly connected with the presence of control, may be found far downstream of the point of control. The observations show that these particular water masses are associated with chlorophyll concentrations that are considerably higher than in adjacent water masses, showing that control has a considerable influence on the primary production and

ICARUS study: prevalence and clinical features of impulse control disorders in Parkinson's disease.

Science.gov (United States)

Antonini, Angelo; Barone, Paolo; Bonuccelli, Ubaldo; Annoni, Karin; Asgharnejad, Mahnaz; Stanzione, Paolo

2017-04-01

Impulse control disorders/other compulsive behaviours ('ICD behaviours') occur in Parkinson's disease (PD), but prospective studies are scarce, and prevalence and clinical characteristics of patients are insufficiently defined. To assess the presence of ICD behaviours over a 2-year period, and evaluate patients' clinical characteristics. A prospective, non-interventional, multicentre study (ICARUS (Impulse Control disorders And the association of neuRopsychiatric symptoms, cognition and qUality of life in ParkinSon disease); SP0990) in treated Italian PD outpatients. Study visits: baseline, year 1, year 2. Surrogate primary variable: presence of ICD behaviours and five ICD subtypes assessed by modified Minnesota Impulsive Disorder Interview (mMIDI). 1069/1095 (97.6%) patients comprised the Full Analysis Set. Point prevalence of ICD behaviours (mMIDI; primary analysis) was stable across visits: 28.6% (306/1069) at baseline, 29.3% (292/995) at year 1, 26.5% (245/925) at year 2. The most prevalent subtype was compulsive eating, followed by punding, compulsive sexual behaviour, gambling and buying disorder. Patients who were ICD positive at baseline were more likely to be male, younger, younger at PD onset, have longer disease duration, more severe non-motor symptoms (including mood and sexual function), depressive symptoms, sleep impairment and poorer PD-related quality of life. However, they did not differ from the ICD-negative patients in their severity of PD functional disability, motor performance and cognitive function. Prevalence of ICD behaviours was relatively stable across the 2-year observational period. ICD-positive patients had more severe depression, poorer sleep quality and reduced quality of life. © 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.

Observational therapeutics: Scope, challenges, and organization.

Science.gov (United States)

Vaidya, Rama

2011-10-01

The importance of Observational Therapeutics in the progress of medicine has been neglected in the current era of the hierarchal position imparted to Randomized Controlled Trials (RCTs) for new drug discovery and practice of evidence-based medicine. There is a need to reflect on the reason for many new drugs being withdrawn during post marketing surveillance. There are several examples in literature where drug-discovery has originated initially from keen clinical and / or laboratory observations. The roots of these discoveries have often been from observations made by practitioners of traditional medicine including Ayurveda. The present article draws attention to the scope and challenges for observational therapeutics. There is an urgent need for the meticulous planning for a systematic organization of developing observational therapeutics, with a full understanding of its strengths and limitations.

Observational therapeutics: Scope, challenges, and organization

Directory of Open Access Journals (Sweden)

Rama Vaidya

2011-01-01

Full Text Available The importance of Observational Therapeutics in the progress of medicine has been neglected in the current era of the hierarchal position imparted to Randomized Controlled Trials (RCTs for new drug discovery and practice of evidence-based medicine. There is a need to reflect on the reason for many new drugs being withdrawn during post marketing surveillance. There are several examples in literature where drug-discovery has originated initially from keen clinical and / or laboratory observations. The roots of these discoveries have often been from observations made by practitioners of traditional medicine including Ayurveda. The present article draws attention to the scope and challenges for observational therapeutics. There is an urgent need for the meticulous planning for a systematic organization of developing observational therapeutics, with a full understanding of its strengths and limitations.

Neural Network Control for the Probe Landing Based on Proportional Integral Observer

Directory of Open Access Journals (Sweden)

Yuanchun Li

2015-01-01

Full Text Available For the probe descending and landing safely, a neural network control method based on proportional integral observer (PIO is proposed. First, the dynamics equation of the probe under the landing site coordinate system is deduced and the nominal trajectory meeting the constraints in advance on three axes is preplanned. Then the PIO designed by using LMI technique is employed in the control law to compensate the effect of the disturbance. At last, the neural network control algorithm is used to guarantee the double zero control of the probe and ensure the probe can land safely. An illustrative design example is employed to demonstrate the effectiveness of the proposed control approach.

Ear Acupuncture Therapy for Masticatory Myofascial and Temporomandibular Pain: A Controlled Clinical Trial

Directory of Open Access Journals (Sweden)

Luciano Ambrosio Ferreira

2015-01-01

Full Text Available Ear acupuncture works by reducing painful sensations with analgesic effect through microsystem therapy and has been demonstrated to be as effective as conventional therapies in the control of facial pain. This clinical trial aimed to evaluate the adjuvant action of auricular acupuncture through an observation of the evolution of temporomandibular and masticatory myofascial symptoms in two groups defined by the therapies elected: auricular acupuncture associated with occlusal splint (study and the use of the occlusal splint plate alone (control. We have selected 20 patients, who were randomly allocated into two groups of ten individuals. Symptoms were evaluated in five different moments, every seven days. We analyzed the orofacial muscle and joint palpation in order to measure the intensity of the experienced pain. Both groups showed a statistically significant decrease in muscle and joint symptoms (p<0.05. However, comparisons between the groups showed an expressive and significant reduction of symptomatology in the study group (p<0.05 already on the first week of therapy. According to the results, to the methodological criteria developed and statistical analysis applied, the conclusion is that auricular acupuncture therapy has synergistic action on conventional occlusal splint treatment. It was demonstrated to be effective in the reduction of symptoms in the short term.

Prolonged delay for controlling KPC-2-producing Klebsiella pneumoniae outbreak: the role of clinical management.

Science.gov (United States)

Delory, T; Seringe, E; Antoniotti, G; Novakova, I; Goulenok, C; Paysant, I; Boyer, S; Carbonne, A; Naas, T; Astagneau, P

2015-10-01

Carbapenemase-producing Enterobacteriaceae (CPE) are becoming of immediate concern for infection control policies. Prompt detection of CPE on health care setting admission is crucial to halt the spread of an outbreak. We report a cluster of 13 Klebsiella pneumoniae carbapenemase (KPC)-2-producing K pneumoniae cases in a tertiary care hospital.The objective of this study was to identify contributing factors originating the outbreak. An outbreak investigation was conducted using descriptive epidemiology, observation of health care practices, and interviews of management staff. A root cause analysis was performed to identify patent and latent failures of infection control measures using the association of litigation and risk management method. The main patent failure was the delay in identifying KPC-2-producing K pneumoniae carriers. Contributing factors were work and environmental factors: understaffing, lack of predefined protocols, staff members' characteristics, and underlying patients' characteristics. Latent failures were as follows: no promotion of the national guidelines for prevention of CPE transmission, no clear procedure for the management of patients hospitalized abroad, no clear initiative for promoting a culture of quality in the hospital, biologic activity recently outsourced to a private laboratory, and poor communication among hospital members. Clinical management should be better promoted to control hospital outbreaks and should include team work and safety culture. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Stock Versus CAD/CAM Customized Zirconia Implant Abutments - Clinical and Patient-Based Outcomes in a Randomized Controlled Clinical Trial

NARCIS (Netherlands)

Schepke, Ulf; Meijer, Henny J. A.; Kerdijk, Wouter; Raghoebar, Gerry M.; Cune, Marco

BackgroundSingle-tooth replacement often requires a prefabricated dental implant and a customized crown. The benefits of individualization of the abutment remain unclear. PurposeThis randomized controlled clinical trial aims to study potential benefits of individualization of zirconia implant

Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study.

Directory of Open Access Journals (Sweden)

Sarah M Khayyat

Full Text Available To assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia.Hypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8, an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients' sociodemographic, medical and medication data.Two hundred and four patients, of which 71.6% were females, participated in the study. Patients' mean age was 59.1 (SD 12.2. The mean number of medication used by patients was 4.4 (SD 1.89. More than half (110; 54% of the patients were non-adherent to their medications (MMAS score 65 years (OR 2.0 [95% CI: 1.0-4.2; P = 0.04], and being diabetic (OR 0.25 [95% CI: 0.1-0.6; P = 0.04] were found to be independent predictors of medication adherence.Medication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients.

A controlled clinical trial of implant-retained mandibular overdentures : 10 years' results of clinical aspects and aftercare of IMZ implants and Branemark implants

NARCIS (Netherlands)

Meijer, HJA; Raghoebar, GM; Van't Hof, MA; Visser, A

The aim of this prospective randomized controlled clinical trial was to evaluate the clinical outcomes and prosthetic aftercare of edentulous patients with a mandibular overdenture retained by two IMZ implants or two Branemark implants during a 10-year period. Patients were allocated to the IMZ

The role of clinical toxicologists and poison control centers in public health.

Science.gov (United States)

Sutter, Mark E; Bronstein, Alvin C; Heard, Stuart E; Barthold, Claudia L; Lando, James; Lewis, Lauren S; Schier, Joshua G

2010-06-01

Poison control centers and clinical toxicologists serve many roles within public health; however, the degree to which these entities collaborate is unknown. The objective of this survey was to identify successful collaborations of public health agencies with clinical toxicologists and poison control centers. Four areas including outbreak identification, syndromic surveillance, terrorism preparedness, and daily public health responsibilities amenable to poison control center resources were assessed. An online survey was sent to the directors of poison control centers, state epidemiologists, and the most senior public health official in each state and selected major metropolitan areas. This survey focused on three areas: service, structure within the local or state public health system, and remuneration. Questions regarding remuneration and poison control center location within the public health structure were asked to assess if these were critical factors of successful collaborations. Senior state and local public health officials were excluded because of a low response rate. The survey was completed in October 2007. A total of 111 respondents, 61 poison control centers and 50 state epidemiologists, were eligible for the survey. Sixty-nine (62%) of the 111 respondents, completed and returned the survey. Thirty-three (54%) of the 61 poison control centers responded, and 36 of the 50 state epidemiologists (72%) responded. The most frequent collaborations were terrorism preparedness and epidemic illness reporting. Additional collaborations also exist. Important collaborations exist outside of remuneration or poison control centers being a formal part of the public health structure. Poison control centers have expanded their efforts to include outbreak identification, syndromic surveillance, terrorism preparedness, and daily public health responsibilities amenable to poison control center resources. Collaboration in these areas and others should be expanded. Published

Clinical Relevance of Nontuberculous Mycobacteria Isolated from Sputum in a Gold Mining Workforce in South Africa: An Observational, Clinical Study

Directory of Open Access Journals (Sweden)

Clare L. van Halsema

2015-01-01

Full Text Available Background. The clinical relevance of nontuberculous mycobacteria (NTM, detected by liquid more than solid culture in sputum specimens from a South African mining workforce, is uncertain. We aimed to describe the current spectrum and relevance of NTM in this population. Methods. An observational study including individuals with sputum NTM isolates, recruited at workforce tuberculosis screening and routine clinics. Symptom questionnaires were administered at the time of sputum collection and clinical records and chest radiographs reviewed retrospectively. Results. Of 232 individuals included (228 (98% male, median age 44 years, M. gordonae (60 individuals, M. kansasii (50, and M. avium complex (MAC: 38 were the commonest species. Of 38 MAC isolates, only 2 (5.3% were from smear-positive sputum specimens and 30/38 grew in liquid but not solid culture. MAC was especially prevalent among symptomatic, HIV-positive individuals. HIV prevalence was high: 57/74 (77% among those tested. No differences were found in probability of death or medical separation by NTM species. Conclusions. M. gordonae, M. kansasii, and MAC were the commonest NTM among miners with suspected tuberculosis, with most MAC from smear-negative specimens in liquid culture only. HIV testing and identification of key pathogenic NTM in this setting are essential to ensure optimal treatment.

Observer-based output-feedback control to eliminate torsional drill-string vibrations

NARCIS (Netherlands)

Vromen, T.G.M.; Wouw, van de N.; Doris, A.; Astrid, P.; Nijmeijer, H.

2014-01-01

Torsional stick-slip vibrations decrease the performance and reliability of drilling systems used for the exploration of energy and mineral resources. In this work, we present the design of a nonlinear observer-based output-feedback control strategy to eliminate these vibrations. We apply the

77 FR 50162 - Importer of Controlled Substances; Notice of Registration; Almac Clinical Services, Inc.

Science.gov (United States)

2012-08-20

... Register on April 26, 2012, 77 FR 24985, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton... that the registration of Almac Clinical Services, Inc. (ACSI) to import the basic classes of controlled..., Inc. (ACSI) to ensure that the company's registration is consistent with the public interest. The...

Clinical features of diabetes mellitus in Japan as observed in a hospital outpatient clinic

Energy Technology Data Exchange (ETDEWEB)

Wada, Sunao; Toda, Shintaro; Omori, Yoshiaki; Yamakido, Michio; Blackard, W G

1963-04-18

A university diabetes clinic in Japan was characterized by age at examination, age at onset, sex ratio, microangiopathies, atherosclerotic complications, weight, heredity, and diet. The findings in this clinic, along with those from other diabetes clinics in Japan, were compared with studies on Western diabetics. The similarities between the 2 diabetic populations far outnumbered the dissimilarities. However, diabetes mellitus in Japan is distinguished by infrequent occurrence of juvenile diabetes and ketosis, relative lack of atherosclerotic complications, and reversal of the sex ratio. 39 references, 7 tables.

Fault Diagnosis and Tolerant Control Using Observer Banks Applied to Continuous Stirred Tank Reactor

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Martin F. Pico

2017-04-01

Full Text Available This paper focuses on studying the problem of fault tolerant control (FTC, including a detailed fault detection and diagnosis (FDD module using observer banks which consists of output and unknown input observers applied to a continuous stirred tank reactor (CSTR. The main objective of this paper is to use a FDD module here proposed to estimate the fault in order to apply this result in a FTC system (FTCS, to prevent a lost of of the control system performance. The benefits of the observer bank and fault adaptation here studied are illustrated by numerical simulations which assumes faults in manipulated and measuring elements of the CSTR.

Achieving blood pressure control among renal transplant recipients by integrating electronic health technology and clinical pharmacy services.

Science.gov (United States)

Migliozzi, Daniel R; Zullo, Andrew R; Collins, Christine; Elsaid, Khaled A

2015-11-15

The implementation and outcomes of a program combining electronic home blood pressure monitoring (HBPM) and pharmacist-provided medication therapy management (MTM) services in a renal transplantation clinic are described. Patients enrolled in the program were provided with a computer-enabled blood pressure monitor. A dedicated renal transplantation pharmacist was integrated into the renal transplantation team under a collaborative care practice agreement. The collaborative care agreement allowed the pharmacist to authorize medication additions, deletions, and dosage changes. Comprehensive disease and blood pressure education was provided by a clinical pharmacist. In the pretransplantation setting, the pharmacist interviewed the renal transplant candidate and documents allergies, verified the patient's medication profile, and identified and assessed barriers to medication adherence. A total of 50 renal transplant recipients with at least one recorded home blood pressure reading and at least one year of follow-up were included in our analysis. A significant reduction in mean systolic and diastolic blood pressure values were observed at 30, 90, 180, and 360 days after enrollment in the program (p services implemented in a renal transplant clinic was associated with sustained improvements in blood pressure control. Incorporation of a pharmacist in the renal transplant clinic resulted in the detection and resolution of medication-related problems. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Ior-CEA-1: Labelling, quality control and clinical evaluation

International Nuclear Information System (INIS)

Pimentel, G.J.

1998-01-01

Within the Co-ordinated Programme on Labelling, Quality Control and Evaluation of Monoclonal Antibodies, the IAEA has made a great effort to expand efficient labelling methods, mainly those with radioisotopes which have been used for radioimmunoscintigraphy. In this sense, more recently 99 Tc m has been mostly employed in the majority of the investigations due to its ideal physical characteristics. Efficient labelling of monoclonal antibodies depends on a number of factors including the method and way of the label incorporation into the protein. During the last years several direct labelling approaches have been developed, which led to attain simple and inexpensive methods for medical practice, as well as safe and stable techniques which bring accurate and good quality images. Accordingly, this paper describes the results obtained during last five years which come from the comparison among different labelling systems, passing through the quality control to test the labelled monoclonal stability and the protein bioreactivity, to continue in the clinical evaluation of ior-CEA-1, as well as the evaluation of other antibodies. Up to now we have evaluated more than 70 patients with the anti-CEA monoclonal antibody (ior-CEA-1), examined in different clinical assays such as: pilot, phase I-II and extensive phase III-IV trials, whose results are encouraging. It confirms that the employed labelling approach was safe and adequate

Motion Sensorless Control of BLDC PM Motor with Offline FEM Info Assisted State Observer

DEFF Research Database (Denmark)

Stirban, Alin; Boldea, Ion; Andreescu, Gheorghe-Daniel

2010-01-01

This paper describes a new offline FEM assisted position and speed observer, for brushless dc (BLDC) PM motor drive sensorless control, based on the line-to-line PM flux linkage estimation. The zero-crossing of the line-to-line PM flux linkage occurs right in the middle of two commutation points...... identification. Digital simulations and experimental results are shown, demonstrating the reliability of the FEM assisted position and speed observer for BLDC PM motor sensorless control operation....

Extended observer based on adaptive second order sliding mode control for a fixed wing UAV.

Science.gov (United States)

Castañeda, Herman; Salas-Peña, Oscar S; León-Morales, Jesús de

2017-01-01

This paper addresses the design of attitude and airspeed controllers for a fixed wing unmanned aerial vehicle. An adaptive second order sliding mode control is proposed for improving performance under different operating conditions and is robust in presence of external disturbances. Moreover, this control does not require the knowledge of disturbance bounds and avoids overestimation of the control gains. Furthermore, in order to implement this controller, an extended observer is designed to estimate unmeasurable states as well as external disturbances. Additionally, sufficient conditions are given to guarantee the closed-loop stability of the observer based control. Finally, using a full 6 degree of freedom model, simulation results are obtained where the performance of the proposed method is compared against active disturbance rejection based on sliding mode control. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

Effects of Intensive Control of Glycemia on Clinical Kidney Outcomes in Type 2 Diabetes Patients Compared with Standard Control: A Meta-Analysis

Directory of Open Access Journals (Sweden)

Francisco Herrera-Gómez

2017-11-01

Full Text Available Background: Association between poor control of glycemia and the onset of microvascular complications in type 2 diabetes mellitus (T2DM patients is a hard issue. However, it seems that the impact of pharmacological treatment is important only in early stages of diabetic nephropathy. We sought to examine whether intensive glycemic control is associated with improvement of clinical Chronic Kidney Disease (CKD outcomes compared to standard glycemic control.Methods: Meta-analysis of published and unpublished randomized controlled trials (RCT and post-hoc analysis of RCTs comparing anti-diabetic drugs and/or insulin (intensive control vs. dietary measures (standard control for relevant outcomes related to progression of CKD clinically manifest was undertaken. Summary estimates obtained by random effects model and funnel plots for assessing reporting bias are presented.Results: Our analysis was based on four RCTs representing 27,391 adult T2DM patients with CKD from around the world. The pooled OR for the outcomes of doubling of serum creatinine and need of dialysis were, respectively, of 0.98 with 95% confidence interval (95% CI 0.81–1.19, and 0.84 with 95% CI 0.69–1.02. The pooled OR for the outcome of death from kidney failure was 0.62 with 95% CI 0.39–0.98. Clinical differences between studies were not translated in statistical heterogeneity. Reporting bias may be present.Conclusions: Intensive glycemic control has an effect on death from kidney failure compared to standard glycemic control. Better comprehension of glycemic control effects on both T2DM patients with and without CKD is important for individualization of these two treatment modalities.

Well-posedness and exact controllability of a fourth order Schrodinger equation with variable coefficients and Neumann boundary control and collocated observation

Directory of Open Access Journals (Sweden)

Ruili Wen

2016-08-01

Full Text Available We consider an open-loop system of a fourth order Schrodinger equation with variable coefficients and Neumann boundary control and collocated observation. Using the multiplier method on Riemannian manifold we show that that the system is well-posed in the sense of Salamon. This implies that the exponential stability of the closed-loop system under the direct proportional output feedback control and the exact controllability of open-loop system are equivalent. So in order to conclude feedback stabilization from well-posedness, we study the exact controllability under a uniqueness assumption by presenting the observability inequality for the dual system. In addition, we show that the system is regular in the sense of Weiss, and that the feedthrough operator is zero.

Predictive Sliding Mode Control for Attitude Tracking of Hypersonic Vehicles Using Fuzzy Disturbance Observer

Directory of Open Access Journals (Sweden)

Xianlei Cheng

2015-01-01

Full Text Available We propose a predictive sliding mode control (PSMC scheme for attitude control of hypersonic vehicle (HV with system uncertainties and external disturbances based on an improved fuzzy disturbance observer (IFDO. First, for a class of uncertain affine nonlinear systems with system uncertainties and external disturbances, we propose a predictive sliding mode control based on fuzzy disturbance observer (FDO-PSMC, which is used to estimate the composite disturbances containing system uncertainties and external disturbances. Afterward, to enhance the composite disturbances rejection performance, an improved FDO-PSMC (IFDO-PSMC is proposed by incorporating a hyperbolic tangent function with FDO to compensate for the approximate error of FDO. Finally, considering the actuator dynamics, the proposed IFDO-PSMC is applied to attitude control system design for HV to track the guidance commands with high precision and strong robustness. Simulation results demonstrate the effectiveness and robustness of the proposed attitude control scheme.

Value-based HR practices, i-deals and clinical error control with CSR as a moderator.

Science.gov (United States)

Luu, Tuan; Rowley, Chris; Siengthai, Sununta; Thanh Thao, Vo

2017-05-08

Purpose Notwithstanding the rising magnitude of system factors in patient safety improvement, "human factors" such as idiosyncratic deals (i-deals) which also contribute to the adjustment of system deficiencies should not be neglected. The purpose of this paper is to investigate the role of value-based HR practices in catalyzing i-deals, which then influence clinical error control. The research further examines the moderating role of corporate social responsibility (CSR) on the effect of value-based HR practices on i-deals. Design/methodology/approach The data were collected from middle-level clinicians from hospitals in the Vietnam context. Findings The research results confirmed the effect chain from value-based HR practices through i-deals to clinical error control with CSR as a moderator. Originality/value The HRM literature is expanded through enlisting i-deals and clinical error control as the outcomes of HR practices.

Clinical observation on application of CAD/CAM technique in orbital reconstruction

Directory of Open Access Journals (Sweden)

Chang-Fu Peng

2016-05-01

Full Text Available AIM:To evaluate the clinical application of CAD/CAM(computer-aided design/computer-aided manufacturingtechnique in orbital reconstruction. METHODS:Thirty-three patients(33 eyeswere included who were admitted and accepted orbital reconstructionin operation in our hospital from June 2011 and October 2015. The three-dimensional(3Dmodel was made by CAD/CAM technology, according to the orbital three-dimensional CT examination for each patient preoperatively, and the repairing materials were shaped under 3D entity model in operation. The patients were followed up for 3-12mo, and the orbital shape, enophthalmos, diplopia and eye movement were observed. RESULTS:Among the 33 cases(33 eyes, except that 1 case required to remove the implants postoperative because of overcorrection, the patients were satisfied with the orbital shape. Enophthalmos were corrected. The effective rate was 97%. Among 19 cases(19 eyeswith diplopia and eye movement disorders, symptoms in 16 cases(16 eyeswere disappeared or improved, the efficiency rate was 84%. There were no operative complications. CONCLUSION:The CAD/CAM technique is effective and practical in the reconstruction of orbital deformity with shorter operation time, higher efficacy, better outcomes and lower risk, and it is worth to be popularized in clinical application. But the fabrication of 3D model costs certain money which may bring economic pressures to poor patients.

Optimal Tuning of Multivariable Disturbance-Observer-Based Control for Flicker Mitigation Using Individual Pitch Control of Wind Turbine

DEFF Research Database (Denmark)

Raja, Muhammad Imran; Hussain, Dil muhammed Akbar; Soltani, Mohsen

2017-01-01

Multivariable disturbance accommodated observer based control (DOBC) scheme is presented to mitigate loads generated due to wind shear and tower shadow using individual blade pitch for above-rated wind speed condition of wind turbine. Wind shear and tower shadow add flickers as 1p, 3p, 6p and so on......, (p is the rotor rotational frequency) for three-bladed wind turbine. Novel DOBC with individual pitch control (IPC) to mitigate the flickers is presented and linear state-space model of wind turbine with tower dynamics is developed. The proposed controller is tuned using optimal control theory...... density of generator speed, drive-train torsion and tower fore-aft moment shows better mitigation to the flickers by proposed controller as compared with proportional–integral (PI) and disturbance accommodation control (DAC) with collective pitch control. Furthermore, it shows less degradation...

A Predictive Velocity Observer in Wire Bonder’s Control System

Directory of Open Access Journals (Sweden)

Lei Zhou

2014-01-01

Full Text Available Wire bonder is a typical high speed machine. The motion speed of XY-stage is the key factor of bonding efficiency. However, phase lag elements in the servo system limit the bandwidth and slow down the system’s response. A predictive velocity observer is proposed to compensate for those phase lags. Then, the velocity loop controller can be designed as for a servo system which does not have those phase lags. Loop gains are enlarged and bandwidth is enlarged correspondingly. Then, the motion speed is improved and settling time is decreased. Experiment results verify that the predictive velocity observer provided a significant phase lead and the performance of wire bonder is improved.

[Clinical observation of post-extension pulling massage in treating lumbar disc herniation].

Science.gov (United States)

Lü, Li-Jiang; Ke, Xue-Ai; Mao, Xu-Dan; Chen, Xiao-Jie; Wu, Fang-Chao; Tong, Hong-Jie

2010-10-01

To observe the clinical effect of post-extension pulling massage in treating lumbar disc herniation. From January 2008 to December 2008, 61 patients with lumbar disc herniation, 34 males and 27 females, ranging in age from 17 to 67 years with an average of 42.6 years, were treated with post-extension pulling massage after continued traction for 30 minutes (on alternate days one time, 3 times as a course of treatment). There was bulging type in 9 cases, hernia type in 22, free type in 30. After a course of treatment, the clinical effects were evaluated according to standard of Macnab, the items included pain, lumbar activity, normal work and life of patients. All patients were followed up from 1 to 9 months with an average of 4.6 months. After treatment, the symptoms and signs of patients had obviously improved in above aspects. According to standard of Macnab, 48 cases got excellent result, 10 good, 2 fair, 1 poor. The post-extension pulling massage in treating lumbar disc herniation can obtain satisfactory results, which have localized site of action, small compression for vertebral body and can reduce accidental injury.

Disturbance Observer for Lateral Trajectory Tracking Control for Autonomous and Cooperative Driving

OpenAIRE

Christian Rathgeber; Franz Winkler; Dirk Odenthal; Steffen Muller

2015-01-01

In this contribution a structure for high level lateral vehicle tracking control based on the disturbance observer is presented. The structure is characterized by stationary compensating side forces disturbances and guaranteeing a cooperative behavior at the same time. Driver inputs are not compensated by the disturbance observer. Moreover the structure is especially useful as it robustly stabilizes the vehicle. Therefore the parameters are selected using the Parameter Space Approach. The imp...

Risk factors for pulmonary tuberculosis: a clinic-based case control study in The Gambia

Directory of Open Access Journals (Sweden)

Adegbola Richard A

2006-06-01

Full Text Available Abstract Background The tuberculosis (TB epidemic in Africa is on the rise, even in low-HIV prevalence settings. Few studies have attempted to identify possible reasons for this. We aimed to identify risk factors for pulmonary tuberculosis in those attending a general outpatients clinic in The Gambia, a sub-Saharan African country with relatively low HIV prevalence in the community and in TB patients. Methods We conducted a case control study at the Medical Research Council Outpatients' clinic in The Gambia. Pulmonary TB cases were at least 15 years old, controls were age and sex matched clinic attendees. Participants were interviewed using a structured questionnaire. Results 100 sputum smear positive TB cases and 200 clinic controls were recruited. HIV prevalence was 6.1% in cases and 3.3% in controls. Multivariable assessment of host factors showed that risk of TB was increased among the Jola ethnic group and smokers, and decreased in those in a professional occupation. Assessment of environmental factors showed an increased risk with household crowding, history of household exposure to a known TB case, and absence of a ceiling in the house. In a combined multivariable host-environment model, the risk of TB increased with crowding, exposure to a known TB case, as well as amongst the Jola ethnic group. Conclusion In The Gambia, household crowding and past household exposure to a known TB case are the standout risk factors for TB disease. Further research is needed to identify why risk of TB seems to differ according to ethnicity.

Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study

Directory of Open Access Journals (Sweden)

Eva Comin

2017-08-01

Conclusions: Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear.

The clinical value of Huangqi injection in the treatment of leucopenia: a meta-analysis of clinical controlled trials.

Directory of Open Access Journals (Sweden)

Changsong Zhang

Full Text Available BACKGROUND: Huangqi injection is derived from Astragalus membranaceus root. In China, recent reports of Huangqi injection for the treatment of leucopenia have emerged. However, a systematic review of these reports has not been performed. Thus, we conducted a meta-analysis of clinical controlled trials to assess the clinical value of Huangqi injection in the treatment of leucopenia. METHODS: We searched the Chinese Biomedical Literature Database (CBM, Wanfang Database, China National Knowledge Infrastructure (CNKI, Chinese Scientific Journals Full-text Database (VIP, as well as PubMed and EMBASE to collect the data about trials of Huangqi injection for treating leucopenia. A meta-analysis was performed using RevMan 5.2 software. RESULTS: A total of 13 studies involving 841 patients were included in this study. The overall study quality was lower according to the Jadad scale. The meta-analysis showed that experimentally treated patients experienced greater therapeutic efficacy and lower white blood cell counts than control groups treated with Western medicine (P < 0.05. No publication bias was evident, according to Egger's test. CONCLUSIONS: The validity of this meta-analysis was limited by the overall poor quality of the included studies. Huangqi injection may have potential clinical value in the treatment of leucopenia, but confirmation with rigorously well-designed multi-center trials is needed.

Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports

Directory of Open Access Journals (Sweden)

Duric Nezla S

2012-08-01

Full Text Available Abstract Background A randomized and controlled clinical study was performed to evaluate the use of neurofeedback (NF to treat attention-deficit/hyperactivity disorder (ADHD in children and adolescents. Methods The ADHD population was selected from an outpatient clinic for Child and Adolescent Mental Health in Norway. Ninety-one of the 275 children and adolescents ranging in age from 6 to 18 years (10.5 years participated in 30 sessions of an intensive NF program. The reinforcement contingency was based on the subjects’ production of cortical beta1 activity (15–18 Hz. The ADHD participants were randomized into three groups, with 30 in the NF group, 31 controls in a group that was given methylphenidate, and 30 in a group that received NF and methylphenidate. ADHD core symptoms were reported by parents using the parent form of the Clinician’s Manual for Assessment by Russell A. Barkley. Results Ninety-one children and adolescents were effectively randomized by age, sex, intelligence and distribution of ADHD core symptoms. The parents reported significant effects of the treatments, but no significant differences between the treatment groups were observed. Conclusions NF was as effective as methylphenidate at treating the attentional and hyperactivity symptoms of ADHD, based on parental reports. Trial registration Current Controlled Trials NCT01252446

Telemedicine for the Management of Glycemic Control and Clinical Outcomes of Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Directory of Open Access Journals (Sweden)

Shaun W. H. Lee

2017-05-01

Full Text Available Importance: Telemedicine has been shown to be an efficient and effective means of providing care to patients with chronic disease especially in remote and undeserved regions, by improving access to care and reduce healthcare cost. However, the evidence surrounding its applicability in type 1 diabetes remains scarce and conflicting.Objective: To synthesize evidence and quantify the effectiveness of telemedicine interventions for the management of glycemic and clinical outcomes in type 1 diabetes patients, relative to comparator conditions.Data Sources: MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, and CINAHL were searched for published articles since inception until December 2016.Study Selection: Original articles reporting the results of randomized controlled studies on the effectiveness of telemedicine in people with type 1 diabetes were included.Data Extraction and Synthesis: Two reviewers independently extracted data, assessed quality, and strength of evidence. Interventions were categorized based upon the telemedicine focus (monitoring, education, consultation, case-management, and peer mentoring.Main Outcome and Measure: Absolute change in glycosylated hemoglobin A1c (HbA1c from baseline to follow-up assessment.Results: A total of 38 studies described in 41 articles were identified. Positive effects on glycemic control were noted with studies examining telemedicine, with a mean reduction of 0.18% at the end of intervention. Studies with longer duration (>6 months who had recruited patients with a higher baseline HbA1c (≥9% were associated with larger effects. Telemedicine interventions that involve individualized assessments, audit with feedback and skill building were also more effective in improving glycemic control. However, no benefits were observed on blood pressure, lipids, weight, quality of life, and adverse events.Conclusions and Relevance: There is insufficient evidence to support telemedicine use for glycemic

Clinical efficacy of pranoprofen and sodium hyaluronate for dry eye

Directory of Open Access Journals (Sweden)

Hong-Chao Hou

2016-01-01

Full Text Available AIM:To observe the clinical efficacy of pranoprofen and sodium hyaluronate for dry eye, and to provide the reference for clinical treatment of dry eye. METHODS: From January 2012 to January 2015 inour hospital, 106 patients with dry eye were tested and observed. In accordance with the number table, patients were divided into observation group and control group, 53 patients in the control group using conventional treatment plus single sodium hyaluronate eye drops, observation group using pranoprofen combined sodium hyaluronate eye drops, besides conventional treatment. Clinical outcomes between the two groups before and after treatments, dry eye score, fluorescein staining score, Schirmer I test and tear film break up time(BUTwere observed and analyzed. RESULTS:The effective rates of the two groups were 94.3%(50/53and 84.9%(45/53. Dry eye score of observation group before and after treatment were 3.24±0.52 and 0.32±0.06points, those of the control group were 3.26±0.48 and 0.75±0.24points. BUT of the experimental group before and after treatments were 5.67±3.052 and 12.95±2.865s, those of the control group were 6.23±2.985 and 9.85±2.714s.The differences between the two groups on the indicators above were statistically significant(PCONCLUSION: The combination of pranoprofen and sodium hyaluronate for the treatment of dry eye is effective, with high security and water holding capacity, which can improve the symptoms of dry eye and the patients' life quality.

Control and fault diagnosis based sliding mode observer of a multicellular converter: Hybrid approach

KAUST Repository

Benzineb, Omar

2013-01-01

In this article, the diagnosis of a three cell converter is developed. The hybrid nature of the system represented by the presence of continuous and discrete dynamics is taken into account in the control design. The idea is based on using a hybrid control and an observer-type sliding mode to generate residuals from the observation errors of the system. The simulation results are presented at the end to illustrate the performance of the proposed approach. © 2013 FEI STU.

Control and fault diagnosis based sliding mode observer of a multicellular converter: Hybrid approach

KAUST Repository

Benzineb, Omar; Taibi, Fateh; Laleg-Kirati, Taous-Meriem; Boucherit, Mohamed Seghir; Tadjine, Mohamed

2013-01-01

control and an observer-type sliding mode to generate residuals from the observation errors of the system. The simulation results are presented at the end to illustrate the performance of the proposed approach. © 2013 FEI STU.

Effect of clinical parameters on the control of myoelectric robotic prosthetic hands.

Science.gov (United States)

Atzori, Manfredo; Gijsberts, Arjan; Castellini, Claudio; Caputo, Barbara; Hager, Anne-Gabrielle Mittaz; Elsig, Simone; Giatsidis, Giorgio; Bassetto, Franco; Müller, Henning

2016-01-01

Improving the functionality of prosthetic hands with noninvasive techniques is still a challenge. Surface electromyography (sEMG) currently gives limited control capabilities; however, the application of machine learning to the analysis of sEMG signals is promising and has recently been applied in practice, but many questions still remain. In this study, we recorded the sEMG activity of the forearm of 11 male subjects with transradial amputation who were mentally performing 40 hand and wrist movements. The classification performance and the number of independent movements (defined as the subset of movements that could be distinguished with >90% accuracy) were studied in relationship to clinical parameters related to the amputation. The analysis showed that classification accuracy and the number of independent movements increased significantly with phantom limb sensation intensity, remaining forearm percentage, and temporal distance to the amputation. The classification results suggest the possibility of naturally controlling up to 11 movements of a robotic prosthetic hand with almost no training. Knowledge of the relationship between classification accuracy and clinical parameters adds new information regarding the nature of phantom limb pain as well as other clinical parameters, and it can lay the foundations for future "functional amputation" procedures in surgery.

Design of a Polynomial Fuzzy Observer Controller With Sampled-Output Measurements for Nonlinear Systems Considering Unmeasurable Premise Variables

OpenAIRE

Liu, Chuang; Lam, H. K.

2015-01-01

In this paper, we propose a polynomial fuzzy observer controller for nonlinear systems, where the design is achieved through the stability analysis of polynomial-fuzzy-model-based (PFMB) observer-control system. The polynomial fuzzy observer estimates the system states using estimated premise variables. The estimated states are then employed by the polynomial fuzzy controller for the feedback control of nonlinear systems represented by the polynomial fuzzy model. The system stability of the P...

Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation.

Science.gov (United States)

Hayes, Andrew F; Rockwood, Nicholas J

2017-11-01

There have been numerous treatments in the clinical research literature about various design, analysis, and interpretation considerations when testing hypotheses about mechanisms and contingencies of effects, popularly known as mediation and moderation analysis. In this paper we address the practice of mediation and moderation analysis using linear regression in the pages of Behaviour Research and Therapy and offer some observations and recommendations, debunk some popular myths, describe some new advances, and provide an example of mediation, moderation, and their integration as conditional process analysis using the PROCESS macro for SPSS and SAS. Our goal is to nudge clinical researchers away from historically significant but increasingly old school approaches toward modifications, revisions, and extensions that characterize more modern thinking about the analysis of the mechanisms and contingencies of effects. Copyright © 2016 Elsevier Ltd. All rights reserved.

The use of placebo control in clinical trials: An overview of the ...

African Journals Online (AJOL)

The use of placebo control in clinical trials: An overview of the ethical issues involved for the protection of human research participants. ... A placebo looks exactly like the experimental drugs in every respect both in appearance and wrappings ...

Direct Power Control for Three-Phase Two-Level Voltage-Source Rectifiers Based on Extended-State Observation

DEFF Research Database (Denmark)

Song, Zhanfeng; Tian, Yanjun; Yan, Zhuo

2016-01-01

This paper proposed a direct power control strategy for three-phase two-level voltage-source rectifiers based on extended-state observation. Active and reactive powers are directly regulated in the stationary reference frame. Similar to the family of predictive controllers whose inherent characte......This paper proposed a direct power control strategy for three-phase two-level voltage-source rectifiers based on extended-state observation. Active and reactive powers are directly regulated in the stationary reference frame. Similar to the family of predictive controllers whose inherent...

Controlled outcome studies of child clinical hypnosis.

Science.gov (United States)

Adinolfi, Barbara; Gava, Nicoletta

2013-09-01

Background Hypnosis is defined as "as an interaction in which the hypnotist uses suggested scenarios ("suggestions") to encourage a person's focus of attention to shift towards inner experiences". Aim of the work The focus of this review is to summarize the findings of controlled outcome studies investigating the potential of clinical hypnosis in pediatric populations. We will examine the following themes: anesthesia, acute and chronic pain, chemotherapy-related distress, along with other specific medical issues. Results Hypnosis is an effective method to reduce pain and anxiety before, during and after the administration of anesthetics, during local dental treatments, invasive medical procedures and in burn children. Hypnosis can be successfully used to manage recurrent headaches, abdominal pain, irritable bowel syndrome and chemotherapy-related distress. Hypnosis has an important role in managing symptoms and improving the quality of life of children suffering from asthma and cystic fibrosis and in facilitating the treatment of insomnia in school-age children. Finally, hypnosis can be effectively used for the treatment of some habitual disorders such as nocturnal enuresis and dermatologic conditions, including atopic dermatitis and chronic eczema Conclusions Clinical hypnosis seems to be a useful, cheap and side-effects free tool to manage fear, pain and several kinds of stressful experiences in pediatric populations. Children who receive self-hypnosis trainings achieve significantly greater improvements in their physical health, quality of life, and self-esteem.

Clinical trials in orthopaedics and the future direction of clinical investigations for femoroacetabular impingement

DEFF Research Database (Denmark)

Clohisy, John C; Kim, Young-Jo; Lurie, Jon

2013-01-01

to be further defined. To date, clinical research reports have included primarily surgical case series. Future clinical investigations are needed to establish improved clinical evidence to guide patient care. Most urgent is the need to better understand the potential role of standardized nonsurgical treatment......Femoroacetabular impingement (FAI) represents a heterogeneous group of disorders that affect a diverse patient population. The natural history of the disease, the role of nonsurgical management, the indications for surgery, optimal surgical techniques, and the predictors of treatment outcomes need...... options for FAI and to define the predictors of surgical and nonsurgical outcomes. Future randomized controlled trials and large observational cohort studies targeted at these clinical research deficiencies will strengthen the evidence and improve informed decision making regarding the management...

Disturbance observer based model predictive control for accurate atmospheric entry of spacecraft

Science.gov (United States)

Wu, Chao; Yang, Jun; Li, Shihua; Li, Qi; Guo, Lei

2018-05-01

Facing the complex aerodynamic environment of Mars atmosphere, a composite atmospheric entry trajectory tracking strategy is investigated in this paper. External disturbances, initial states uncertainties and aerodynamic parameters uncertainties are the main problems. The composite strategy is designed to solve these problems and improve the accuracy of Mars atmospheric entry. This strategy includes a model predictive control for optimized trajectory tracking performance, as well as a disturbance observer based feedforward compensation for external disturbances and uncertainties attenuation. 500-run Monte Carlo simulations show that the proposed composite control scheme achieves more precise Mars atmospheric entry (3.8 km parachute deployment point distribution error) than the baseline control scheme (8.4 km) and integral control scheme (5.8 km).

Nurses' Clinical Decision Making on Adopting a Wound Clinical Decision Support System.

Science.gov (United States)

Khong, Peck Chui Betty; Hoi, Shu Yin; Holroyd, Eleanor; Wang, Wenru

2015-07-01

Healthcare information technology systems are considered the ideal tool to inculcate evidence-based nursing practices. The wound clinical decision support system was built locally to support nurses to manage pressure ulcer wounds in their daily practice. However, its adoption rate is not optimal. The study's objective was to discover the concepts that informed the RNs' decisions to adopt the wound clinical decision support system as an evidence-based technology in their nursing practice. This was an exploratory, descriptive, and qualitative design using face-to-face interviews, individual interviews, and active participatory observation. A purposive, theoretical sample of 14 RNs was recruited from one of the largest public tertiary hospitals in Singapore after obtaining ethics approval. After consenting, the nurses were interviewed and observed separately. Recruitment stopped when data saturation was reached. All transcribed interview data underwent a concurrent thematic analysis, whereas observational data were content analyzed independently and subsequently triangulated with the interview data. Eight emerging themes were identified, namely, use of the wound clinical decision support system, beliefs in the wound clinical decision support system, influences of the workplace culture, extent of the benefits, professional control over nursing practices, use of knowledge, gut feelings, and emotions (fear, doubt, and frustration). These themes represented the nurses' mental outlook as they made decisions on adopting the wound clinical decision support system in light of the complexities of their roles and workloads. This research has provided insight on the nurses' thoughts regarding their decision to interact with the computer environment in a Singapore context. It captured the nurses' complex thoughts when deciding whether to adopt or reject information technology as they practice in a clinical setting.

Observability and Decision Support for Supervision of Distributed Power System Control

DEFF Research Database (Denmark)

Pertl, Michael

in NorthernCalifornia. Two possible applications of the model are presented: peak reduction compared to uncontrolled charging, and an energy arbitrage scenario. Overall, it is shown that a combination of classical and innovative approaches can contribute to improved situation awareness of control room...... operational information, relevant to the current grid condition, need to be developed. This dissertation covers three areas where specific challenges for improved observability and decision support in future control rooms are addressed: Classical large power system stability issues, innovative data......-network-based approach for real-time voltage estimation in active distribution grids, and a modeling approach to harness the flexibility of an aggregation of electric vehicles. For improved monitoring and maintaining power system stability, a decision support tool for transient stability preventive control, based...

Design of Nonlinear Robust Rotor Current Controller for DFIG Based on Terminal Sliding Mode Control and Extended State Observer

Directory of Open Access Journals (Sweden)

Guowei Cai

2014-01-01

Full Text Available As to strong nonlinearity of doubly fed induction generators (DFIG and uncertainty of its model, a novel rotor current controller with nonlinearity and robustness is proposed to enhance fault ride-though (FRT capacities of grid-connected DFIG. Firstly, the model error, external disturbances, and the uncertain factors were estimated by constructing extended state observer (ESO so as to achieve linearization model, which is compensated dynamically from nonlinear model. And then rotor current controller of DFIG is designed by using terminal sliding mode variable structure control theory (TSMC. The controller has superior dynamic performance and strong robustness. The simulation results show that the proposed control approach is effective.

Self-decomposition of radiochemicals. Principles, control, observations and effects