WorldWideScience

Sample records for outcomes include generating

  1. A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention

    Science.gov (United States)

    Kennedy, Caitlin E.; Fonner, Virginia A.; O'Reilly, Kevin R.; Sweat, Michael D.

    2013-01-01

    Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. We conducted a systematic review by searching electronic databases from 1990-2012, examining secondary references, and hand searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of 5,218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with 6 conducted in sub-Saharan Africa, 3 in South or Southeast Asia, and 3 in Latin America and the Caribbean. Target populations included adult women (N=6), female sex workers/bar workers (N=3), and youth/orphans (N=3). All studies targeted females except 2 among youth/orphans. Study rigor was moderate, with 2 group-randomized trials and 2 individual-randomized trials. All interventions except 3 included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23-0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these interventions may have important effects

  2. A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention.

    Science.gov (United States)

    Kennedy, Caitlin E; Fonner, Virginia A; O'Reilly, Kevin R; Sweat, Michael D

    2014-01-01

    Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. The authors conducted a systematic review by searching electronic databases from 1990 to 2012, examining secondary references, and hand-searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care, or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of the 5218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with six conducted in sub-Saharan Africa, three in South or Southeast Asia, and three in Latin America and the Caribbean. Target populations included adult women (N = 6), female sex workers/bar workers (N = 3), and youth/orphans (N = 3). All studies targeted females except two among youth/orphans. Study rigor was moderate, with two group-randomized trials and two individual-randomized trials. All interventions except three included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners, or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23-0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these

  3. Theoretical Framework to Extend Adverse Outcome Pathways to Include Pharmacokinetic Considerations

    Science.gov (United States)

    Adverse Outcome Pathways (AOPs) have generated intense interest for their utility in linking known population outcomes to a molecular initiating event (MIE) that can be quantified using in vitro methods. While there are tens of thousands of chemicals in commercial use, biology h...

  4. Extinction Generates Outcome-Specific Conditioned Inhibition.

    Science.gov (United States)

    Laurent, Vincent; Chieng, Billy; Balleine, Bernard W

    2016-12-05

    Extinction involves altering a previously established predictive relationship between a cue and its outcome by repeatedly presenting that cue alone. Although it is widely accepted that extinction generates some form of inhibitory learning [1-4], direct evidence for this claim has been lacking, and the nature of the associative changes induced by extinction have, therefore, remained a matter of debate [5-8]. In the current experiments, we used a novel behavioral approach that we recently developed and that provides a direct measure of conditioned inhibition [9] to compare the influence of extinguished and non-extinguished cues on choice between goal-directed actions. Using this approach, we provide direct evidence that extinction generates outcome-specific conditioned inhibition. Furthermore, we demonstrate that this inhibitory learning is controlled by the infralimbic cortex (IL); inactivation of the IL using M4 DREADDs abolished outcome-specific inhibition and rendered the cue excitatory. Importantly, we found that context modulated this inhibition. Outside its extinction context, the cue was excitatory and functioned as a specific predictor of its previously associated outcome, biasing choice toward actions earning the same outcome. In its extinction context, however, the cue acted as a specific inhibitor and biased choice toward actions earning different outcomes. Context modulation of these excitatory and inhibitory memories was mediated by the dorsal hippocampus (HPC), suggesting that the HPC and IL act in concert to control the influence of conditioned inhibitors on choice. These findings demonstrate for the first time that extinction turns a cue into a net inhibitor that can influence choice via counterfactual action-outcome associations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. The Effect of Campaign-Generated Interpersonal Communication on Campaign-Targeted Health Outcomes: A Meta-Analysis.

    Science.gov (United States)

    Jeong, Michelle; Bae, Rosie Eungyuhl

    2017-06-16

    This study examined the effect of mass media campaign-generated conversations on campaign-targeted health outcomes, via a systematic meta-analysis of 28 studies (including 124 sub-studies and a total of 138,898 participants). The study also conducted a series of moderation analyses to examine the conditions under which interpersonal communication has larger effects on bringing about the desired outcomes. The findings of this meta-analysis indicate that campaign-generated conversations have a positive effect on inducing campaign-targeted outcomes (OR = 1.28) and show that this effect is moderated by health topic addressed by the campaign, the type of outcome being targeted by the campaign, and with whom people converse, along with several other campaign-relevant and study-relevant variables. The implications of these findings for future research are discussed.

  6. Gender differences in adolescent smoking: mediator and moderator effects of self-generated expected smoking outcomes.

    Science.gov (United States)

    Vidrine, Jennifer Irvin; Anderson, Cheryl B; Pollak, Kathryn I; Wetter, David W

    2006-01-01

    To examine relations among gender, self-generated smoking-outcome expectancies, and smoking in adolescents. Students from one all-girls' (n=350; 53%) and one all-boys' (n=315; 47%) Catholic high school participated. Analyses included binary and ordinal logistic regression. For boys, smoking behavior was associated with buzz (odds radio [OR] = 1.92, 95% confidence interval [CI]: 1.31-2.83, p exercise/sport impairment (OR = 2.84, 95% CI: 1.68-4.81, p gender-smoking relationship. Moderators included negative social (beta = -0.45, p = .021) and enhance self-esteem (beta = -1.07, p = .024). Interventions might benefit from tailoring on gender differences in smoking-outcome expectancies.

  7. Advanced methodology for generation expansion planning including interconnected systems

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, M; Yokoyama, R; Yasuda, K [Tokyo Metropolitan Univ. (Japan); Sasaki, H [Hiroshima Univ. (Japan); Ogimoto, K [Electric Power Development Co. Ltd., Tokyo (Japan)

    1994-12-31

    This paper reviews advanced methodology for generation expansion planning including interconnected systems developed in Japan, putting focus on flexibility and efficiency in a practical application. First, criteria for evaluating flexibility of generation planning considering uncertainties are introduced. Secondly, the flexible generation mix problem is formulated as a multi-objective optimization with more than two objective functions. The multi-objective optimization problem is then transformed into a single objective problem by using the weighting method, to obtain the Pareto optimal solution, and solved by a dynamics programming technique. Thirdly, a new approach for electric generation expansion planning of interconnected systems is presented, based on the Benders Decomposition technique. That is, large scale generation problem constituted by the general economic load dispatch problem, and several sub problems which are composed of smaller scale isolated system generation expansion plans. Finally, the generation expansion plan solved by an artificial neural network is presented. In conclusion, the advantages and disadvantages of this method from the viewpoint of flexibility and applicability to practical generation expansion planning are presented. (author) 29 refs., 10 figs., 4 tabs.

  8. Systematically Tabulated Outcomes Research Matrix (STORM): a methodology to generate research hypotheses.

    Science.gov (United States)

    Crompton, Joseph G; Oyetunji, Tolulope A; Haut, Elliott R; Cornwell, Edward E; Haider, Adil H

    2014-03-01

    Here we describe the Systematically Tabulated Outcomes Research Matrix (STORM) method to generate research questions from pre-existing databases with the aim of improving patient outcomes. STORM can be applied to a database by tabulating its variables into a matrix of independent variables (y-axis) and dependent variables (x-axis) and then applying each unique pairing of an independent and dependent variable to a patient population to generate potentially meaningful research questions. To demonstrate this methodology and establish proof-of-principle, STORM was applied on a small scale to the National Trauma Data Bank and generated at least seven clinically meaningful research questions. When coupled with rigorous clinical judgment, the STORM approach complements the traditional method of hypothesis formation and can be generalized to outcomes research using registry databases across different medical specialties. Copyright © 2014 Mosby, Inc. All rights reserved.

  9. Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations.

    Science.gov (United States)

    Magalhaes, Marco A; Minha, Sa'ar; Chen, Fang; Torguson, Rebecca; Omar, Al Fazir; Loh, Joshua P; Escarcega, Ricardo O; Lipinski, Michael J; Baker, Nevin C; Kitabata, Hironori; Ota, Hideaki; Suddath, William O; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2014-12-01

    Clinical presentation of bare metal stent in-stent restenosis (ISR) in patients undergoing target lesion revascularization is well characterized and negatively affects on outcomes, whereas the presentation and outcomes of first- and second-generation drug-eluting stents (DESs) remains under-reported. The study included 909 patients (1077 ISR lesions) distributed as follows: bare metal stent (n=388), first-generation DES (n=425), and second-generation DES (n=96), categorized into acute coronary syndrome (ACS) or non-ACS presentation mode at the time of first target lesion revascularization. ACS was further classified as myocardial infarction (MI) and unstable angina. For bare metal stent, first-generation DES and second-generation DES, ACS was the clinical presentation in 67.8%, 71.0%, and 66.7% of patients, respectively (P=0.470), whereas MI occurred in 10.6%, 10.1%, and 5.2% of patients, respectively (P=0.273). The correlates for MI as ISR presentation were current smokers (odds ratio, 3.02; 95% confidence interval [CI], 1.78-5.13; Ppresentations had an independent effect on major adverse cardiac events (death, MI, and re-target lesion revascularization) at 6 months (MI versus non-ACS: adjusted hazard ratio, 4.06; 95% CI, 1.84-8.94; Pclinical presentation is similar irrespective of stent type. MI as ISR presentation seems to be associated with patient and not device-related factors. ACS as ISR presentation has an independent effect on major adverse cardiac events, suggesting that ISR remains a hazard and should be minimized. © 2014 American Heart Association, Inc.

  10. Increased Heat Generation in Postcardiac Arrest Patients During Targeted Temperature Management Is Associated With Better Outcomes.

    Science.gov (United States)

    Uber, Amy J; Perman, Sarah M; Cocchi, Michael N; Patel, Parth V; Ganley, Sarah E; Portmann, Jocelyn M; Donnino, Michael W; Grossestreuer, Anne V

    2018-04-03

    Assess if amount of heat generated by postcardiac arrest patients to reach target temperature (Ttarget) during targeted temperature management is associated with outcomes by serving as a proxy for thermoregulatory ability, and whether it modifies the relationship between time to Ttarget and outcomes. Retrospective cohort study. Urban tertiary-care hospital. Successfully resuscitated targeted temperature management-treated adult postarrest patients between 2008 and 2015 with serial temperature data and Ttarget less than or equal to 34°C. None. Time to Ttarget was defined as time from targeted temperature management initiation to first recorded patient temperature less than or equal to 34°C. Patient heat generation ("heat units") was calculated as inverse of average water temperature × hours between initiation and Ttarget × 100. Primary outcome was neurologic status measured by Cerebral Performance Category score; secondary outcome was survival, both at hospital discharge. Univariate analyses were performed using Wilcoxon rank-sum tests; multivariate analyses used logistic regression. Of 203 patients included, those with Cerebral Performance Category score 3-5 generated less heat before reaching Ttarget (median, 8.1 heat units [interquartile range, 3.6-21.6 heat units] vs median, 20.0 heat units [interquartile range, 9.0-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.3 hr [interquartile range, 1.5-4.0 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01) than patients with Cerebral Performance Category score 1-2. Nonsurvivors generated less heat than survivors (median, 8.1 heat units [interquartile range, 3.6-20.8 heat units] vs median, 19.0 heat units [interquartile range, 6.5-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.2 hr [interquartile range, 1.5-3.8 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01). Controlling for average water temperature between initiation and Ttarget, the

  11. Generation and validation of a prognostic score to predict outcome after re-irradiation of recurrent glioma

    International Nuclear Information System (INIS)

    Combs, Stephanie E.; Welzel, Thomas; Debus, Juergen; Edler, Lutz; Rausch, Renate; Wick, Wolfgang

    2013-01-01

    Re-irradiation using high-precision radiation techniques has been established within the clinical routine for patients with recurrent gliomas. In the present work, we developed a practical prognostic score to predict survival outcome after re-irradiation. Patients and methods. Fractionated stereotactic radiotherapy (FSRT) was applied in 233 patients. Primary histology included glioblastoma (n = 89; 38%), WHO Grade III gliomas (n = 52; 22%) and low-grade glioma (n = 92; 40%). FSRT was applied with a median dose of 36 Gy in 2 Gy single fractions. We evaluated survival after re-irradiation as well as progression-free survival after re-irradiation; prognostic factors analyzed included age, tumor volume at re-irradiation, histology, time between initial radiotherapy and re-irradiation, age and Karnofsky Performance Score. Results. Median survival after FSRT was 8 months for glioblastoma, 20 months for anaplastic gliomas, and 24 months for recurrent low-grade patients. The strongest prognostic factors significantly impacting survival after re-irradiation were histology (p 12 months (p < 0.0001). We generated a four-class prognostic score to distinguish patients with excellent (0 points), good (1 point), moderate (2 points) and poor (3-4 points) survival after re-irradiation. The difference in outcome was highly significant (p < 0.0001). Conclusion. We generated a practical prognostic score index based on three clinically relevant factors to predict the benefit of patients from re-irradiation. This score index can be helpful in patient counseling, and for the design of further clinical trials. However, individual treatment decisions may include other patient-related factors not directly influencing outcome.

  12. Psychometrics of the Personal Questionnaire: A client-generated outcome measure.

    Science.gov (United States)

    Elliott, Robert; Wagner, John; Sales, Célia M D; Rodgers, Brian; Alves, Paula; Café, Maria J

    2016-03-01

    We present a range of evidence for the reliability and validity of data generated by the Personal Questionnaire (PQ), a client-generated individualized outcome measure, using 5 data sets from 3 countries. Overall pretherapy mean internal consistency (alpha) across clients was .80, and within-client alphas averaged .77; clients typically had 1 or 2 items that did not vary with the other items. Analyses of temporal structure indicated high levels of between-clients variance (58%), moderate pretherapy test-retest correlation (r = .57), and high session-to-session Lag-1 autocorrelation (.82). Scores on the PQ provided clear evidence of convergence with a range of outcome measures (within-client r = .41). Mean pre-post effects were large (d = 1.25). The results support a revised caseness cutoff of 3.25 and a reliable change index interval of 1.67. We conclude that PQ data meet criteria for evidence-based, norm-referenced measurement of client psychological distress for supporting psychotherapy practice and research. (c) 2016 APA, all rights reserved).

  13. Generation and validation of a prognostic score to predict outcome after re-irradiation of recurrent glioma

    Energy Technology Data Exchange (ETDEWEB)

    Combs, Stephanie E.; Welzel, Thomas; Debus, Juergen [Univ. Hospital of Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany)], E-mail: Stephanie.combs@med.uni-heidelberg.de; Edler, Lutz; Rausch, Renate [German Cancer Research Center (dkfz), Dept. of Biostatistics, Heidelberg (Germany); Wick, Wolfgang [Univ. Hospital of Heidelberg, Dept. of Neurooncology, Heidelberg (Germany)

    2013-01-15

    Re-irradiation using high-precision radiation techniques has been established within the clinical routine for patients with recurrent gliomas. In the present work, we developed a practical prognostic score to predict survival outcome after re-irradiation. Patients and methods. Fractionated stereotactic radiotherapy (FSRT) was applied in 233 patients. Primary histology included glioblastoma (n = 89; 38%), WHO Grade III gliomas (n = 52; 22%) and low-grade glioma (n = 92; 40%). FSRT was applied with a median dose of 36 Gy in 2 Gy single fractions. We evaluated survival after re-irradiation as well as progression-free survival after re-irradiation; prognostic factors analyzed included age, tumor volume at re-irradiation, histology, time between initial radiotherapy and re-irradiation, age and Karnofsky Performance Score. Results. Median survival after FSRT was 8 months for glioblastoma, 20 months for anaplastic gliomas, and 24 months for recurrent low-grade patients. The strongest prognostic factors significantly impacting survival after re-irradiation were histology (p <0.0001) and age (<50 vs. ={>=}50, p < 0.0001) at diagnosis and the time between initial radiotherapy and re-irradiation {<=}12 vs. >12 months (p < 0.0001). We generated a four-class prognostic score to distinguish patients with excellent (0 points), good (1 point), moderate (2 points) and poor (3-4 points) survival after re-irradiation. The difference in outcome was highly significant (p < 0.0001). Conclusion. We generated a practical prognostic score index based on three clinically relevant factors to predict the benefit of patients from re-irradiation. This score index can be helpful in patient counseling, and for the design of further clinical trials. However, individual treatment decisions may include other patient-related factors not directly influencing outcome.

  14. Active Learning Innovations in Knowledge Management Education Generate Higher Quality Learning Outcomes

    Directory of Open Access Journals (Sweden)

    Arthur Shelley

    2014-01-01

    Full Text Available Innovations in how a postgraduate course in knowledge management is delivered have generated better learning outcomes and made the course more engaging for learners. Course participant feedback has shown that collaborative active learning is preferred and provides them with richer insights into how knowledge is created and applied to generate innovation and value. The course applies an andragogy approach in which students collaborate in weekly dialogue of their experiences of the content, rather than learn the content itself. The approach combines systems thinking, learning praxis, and active learning to explore the interdependencies between topics and how they impact outcomes in real world situations. This has stimulated students to apply these ideas in their own workplaces.

  15. Electrode assemblies, plasma apparatuses and systems including electrode assemblies, and methods for generating plasma

    Science.gov (United States)

    Kong, Peter C; Grandy, Jon D; Detering, Brent A; Zuck, Larry D

    2013-09-17

    Electrode assemblies for plasma reactors include a structure or device for constraining an arc endpoint to a selected area or region on an electrode. In some embodiments, the structure or device may comprise one or more insulating members covering a portion of an electrode. In additional embodiments, the structure or device may provide a magnetic field configured to control a location of an arc endpoint on the electrode. Plasma generating modules, apparatus, and systems include such electrode assemblies. Methods for generating a plasma include covering at least a portion of a surface of an electrode with an electrically insulating member to constrain a location of an arc endpoint on the electrode. Additional methods for generating a plasma include generating a magnetic field to constrain a location of an arc endpoint on an electrode.

  16. Impact of stent length on clinical outcomes of first-generation and new-generation drug-eluting stents.

    Science.gov (United States)

    Konishi, Hirokazu; Miyauchi, Katsumi; Dohi, Tomotaka; Tsuboi, Shuta; Ogita, Manabu; Naito, Ryo; Kasai, Takatoshi; Tamura, Hiroshi; Okazaki, Shinya; Isoda, Kikuo; Daida, Hiroyuki

    2016-04-01

    The aim of this study is to compare first- and new-generation drug-eluting stents (DESs) which are implanted in long lesion. Stent length is known to be a predictor of adverse events after percutaneous coronary intervention (PCI), even with the first-generation DESs. The introduction of new-generation DESs has reduced the rates of adverse clinical events. However, the impact of stent length on long-term clinical outcomes is not well known. A total of 1181 consecutive patients who underwent PCI using either a first-generation DES (n = 885) or a new-generation DES (n = 296) between 2004 and 2011 were investigated. In each of the stent groups, the patients were divided into two groups by stent length (>32 and ≤32 mm) and compared. During the follow-up period, the incidence of major adverse cardiac events (MACEs) was significantly higher for patients with long stents implanted than with short stents (P stent groups in the new-generation DES group (P = 0.24; log-rank test). On multivariate Cox regression analysis, stent length was not associated with adverse events in the new-generation DES groups [hazard ratio (HR) 0.87; 95 % confidence interval (95 % CI) 0.71-1.04; P = 0.14]. Implanted stent length was significantly associated with a higher risk of MACEs in patients who received first-generation DESs, but not in patients who received the new-generation DESs.

  17. CycloPs: generating virtual libraries of cyclized and constrained peptides including nonnatural amino acids.

    Science.gov (United States)

    Duffy, Fergal J; Verniere, Mélanie; Devocelle, Marc; Bernard, Elise; Shields, Denis C; Chubb, Anthony J

    2011-04-25

    We introduce CycloPs, software for the generation of virtual libraries of constrained peptides including natural and nonnatural commercially available amino acids. The software is written in the cross-platform Python programming language, and features include generating virtual libraries in one-dimensional SMILES and three-dimensional SDF formats, suitable for virtual screening. The stand-alone software is capable of filtering the virtual libraries using empirical measurements, including peptide synthesizability by standard peptide synthesis techniques, stability, and the druglike properties of the peptide. The software and accompanying Web interface is designed to enable the rapid generation of large, structurally diverse, synthesizable virtual libraries of constrained peptides quickly and conveniently, for use in virtual screening experiments. The stand-alone software, and the Web interface for evaluating these empirical properties of a single peptide, are available at http://bioware.ucd.ie .

  18. Thermo-economic optimization of the impact of renewable generators on poly-generation smart-grids including hot thermal storage

    International Nuclear Information System (INIS)

    Rivarolo, M.; Greco, A.; Massardo, A.F.

    2013-01-01

    Highlights: ► We model a poly-generation grid including thermal storage and renewable generators. ► We analyze the impact of random renewable generators on the grid performance. ► We carry out the grid optimization using a time-dependent thermo-economic approach. ► We present the importance of the storage system to optimize the RES impact. - Abstract: In this paper, the impact of not controllable renewable energy generators (wind turbines and solar photovoltaic panels) on the thermo-economic optimum performance of poly-generation smart grids is investigated using an original time dependent hierarchical approach. The grid used for the analysis is the one installed at the University of Genoa for research activities. It is based on different prime movers: (i) 100 kWe micro gas turbine, (ii) 20 kWe internal combustion engine powered by gases to produce both electrical and thermal (hot water) energy and (iii) a 100 kWth adsorption chiller to produce cooling (cold water) energy. The grid includes thermal storage tanks to manage the thermal demand load during the year. The plant under analysis is also equipped with two renewable non-controllable generators: a small size wind turbine and photovoltaic solar panels. The size and the management of the system studied in this work have been optimized, in order to minimize both capital and variable costs. A time-dependent thermo-economic hierarchical approach developed by the authors has been used, considering the time-dependent electrical, thermal and cooling load demands during the year as problem constraints. The results are presented and discussed in depth and show the strong interaction between fossil and renewable resources, and the importance of an appropriate storage system to optimize the RES impact taking into account the multiproduct character of the grid under investigation.

  19. Including Emotional Intelligence in Pharmacy Curricula to Help Achieve CAPE Outcomes.

    Science.gov (United States)

    Nelson, Michael H; Fierke, Kerry K; Sucher, Brandon J; Janke, Kristin K

    2015-05-25

    The importance of emotional intelligence (EI) for effective teamwork and leadership within the workplace is increasingly apparent. As suggested by the 2013 CAPE Outcomes, we recommend that colleges and schools of pharmacy consider EI-related competencies to build self-awareness and professionalism among students. In this Statement, we provide two examples of the introduction of EI into pharmacy curricula. In addition, we provide a 4-phase process based on recommendations developed by EI experts for structuring and planning EI development. Finally, we make 9 recommendations' to inform the process of including EI in pharmacy curricula.

  20. Treatment outcomes in patients with third-generation cephalosporin-resistant Enterobacter bacteremia.

    Science.gov (United States)

    O'Neal, Catherine S; O'Neal, Hollis R; Daniels, Titus L; Talbot, Thomas R

    2012-10-01

    Infections with resistant Enterobacter spp. are increasingly described, yet data on outcomes associated with these infections are limited. A retrospective cohort study was conducted to investigate outcomes of hospitalized patients with third-generation cephalosporin-resistant (CR) Enterobacter bacteremia. Cephalosporin resistance was detected using cefotaxime and cefpodoxime. Patients with Enterobacter spp. bacteremia from January 2006 through February 2008 defined the population. We defined cases as those with CR isolates; controls were patients with bacteremia due to non-CR isolates. Treatment failure was defined as persistence of the presenting signs of infection 72 h after initial culture collection. Of the 95 Enterobacter cases identified, 31 (33%) were CR. CR cases were significantly associated with treatment failure (odds ratio (OR) 2.81, 95% confidence interval (CI) 1.14-6.94). This association was not seen after adjustment for age, simplified acute physiology score (SAPS II), and inappropriate empiric antibiotic therapy. Inappropriate empiric therapy (adjusted OR 3.86, 95% CI 1.32-11.31) and SAPS II score (adjusted OR 1.09, 95% CI 1.02-1.16) were significantly associated with treatment failure in the multivariate analysis. Third-generation cephalosporin-resistant Enterobacter bacteremia is associated with treatment failure due to receipt of inappropriate empiric antibiotic therapy and severity of illness.

  1. Modeling of the Direct Current Generator Including the Magnetic Saturation and Temperature Effects

    Directory of Open Access Journals (Sweden)

    Alfonso J. Mercado-Samur

    2013-11-01

    Full Text Available In this paper the inclusion of temperature effect on the field resistance on the direct current generator model DC1A, which is valid to stability studies is proposed. First, the linear generator model is presented, after the effect of magnetic saturation and the change in the resistance value due to temperature produced by the field current are included. The comparison of experimental results and model simulations to validate the model is used. A direct current generator model which is a better representation of the generator is obtained. Visual comparison between simulations and experimental results shows the success of the proposed model, because it presents the lowest error of the compared models. The accuracy of the proposed model is observed via Modified Normalized Sum of Squared Errors index equal to 3.8979%.

  2. Economic assessment of S-prism including development and generating costs

    Energy Technology Data Exchange (ETDEWEB)

    Boardman, Ch.E. [GE Nuclear Energy San Jose (United States)

    2001-07-01

    S-PRISM is an advanced Fast Reactor plant design that utilizes compact modular pool-type reactors sized to enable factory fabrication and an affordable prototype test of a single Nuclear Steam Supply System (NSSS) for design certification at minimum cost and risk. S-PRISM retains all of the key ALMR (advanced liquid metal reactor) design features including passive reactor shutdown, passive shutdown heat removal, and passive reactor cavity cooling that were developed under an earlier DOE program. Key factors that make S-PRISM competitive include: 1) The use of passive safety systems that eliminate the need for diesel generators and hardened active heat sinks to assure that sufficient heat is removed from the core, reactor, and containment systems following design and beyond design basis events. 2) A seven point advantage in the plant capacity factor (93 versus 86%) over a single large plant. 3) A much shorter construction schedule (45%) made possible by a modular design that allows near parallel (sequenced) construction of three relatively small, simple factory fabricated NSSSs instead of one large complex NSSS. This paper describes the approach, methods, and results of an in-depth economic assessment of S-PRISM. The assessment found that the generation cost from an NOAK plant would be less than 3 cents/kW-hr and that a design certification could be obtained in less than 15 years at a cost of 2.1 billion dollars. (authors)

  3. Economic assessment of S-prism including development and generating costs

    International Nuclear Information System (INIS)

    Boardman, Ch.E.

    2001-01-01

    S-PRISM is an advanced Fast Reactor plant design that utilizes compact modular pool-type reactors sized to enable factory fabrication and an affordable prototype test of a single Nuclear Steam Supply System (NSSS) for design certification at minimum cost and risk. S-PRISM retains all of the key ALMR (advanced liquid metal reactor) design features including passive reactor shutdown, passive shutdown heat removal, and passive reactor cavity cooling that were developed under an earlier DOE program. Key factors that make S-PRISM competitive include: 1) The use of passive safety systems that eliminate the need for diesel generators and hardened active heat sinks to assure that sufficient heat is removed from the core, reactor, and containment systems following design and beyond design basis events. 2) A seven point advantage in the plant capacity factor (93 versus 86%) over a single large plant. 3) A much shorter construction schedule (45%) made possible by a modular design that allows near parallel (sequenced) construction of three relatively small, simple factory fabricated NSSSs instead of one large complex NSSS. This paper describes the approach, methods, and results of an in-depth economic assessment of S-PRISM. The assessment found that the generation cost from an NOAK plant would be less than 3 cents/kW-hr and that a design certification could be obtained in less than 15 years at a cost of 2.1 billion dollars. (authors)

  4. Personality Development Within a Generational Context: Life Course Outcomes of Shy Children.

    Science.gov (United States)

    Schmidt, Louis A; Tang, Alva; Day, Kimberly L; Lahat, Ayelet; Boyle, Michael H; Saigal, Saroj; Van Lieshout, Ryan J

    2017-08-01

    Studies have shown that shy children born in the 1920s and 1950s had delayed marriage and parenthood, less stable careers, and lower occupational attainment as adults than other children. Do these effects still hold true? We examined demographic and social outcomes of children born between 1977 and 1982 in a prospective longitudinal study. We assessed shyness in childhood (age 8), adolescence (age 12-16), young adulthood (age 22-26), and adulthood (age 30-35), and derived three shyness trajectories (i.e., decreasing, increasing, and low-stable). Social and demographic outcomes for shy children who outgrew their shyness (i.e., decreasing trajectory) were indistinguishable from those who were consistently low on shyness measures. However, a shyness trajectory beginning in adolescence and increasing to adulthood was associated with poorer outcomes, similar to previous studies. These findings highlight the importance of multiple assessments in long-term longitudinal studies and the need to consider personality development within a generational context.

  5. Developing a framework to generate evidence of health outcomes from social media use in chronic disease management.

    Science.gov (United States)

    Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando

    2013-01-01

    While there is an abundance of evidence-based practice (EBP) recommendations guiding management of various chronic diseases, evidence suggesting best practice for using social media to improve health outcomes is inadequate. The variety of social media platforms, multiple potential uses, inconsistent definitions, and paucity of rigorous studies, make it difficult to measure health outcomes reliably in chronic disease management. Most published investigations report on an earlier generation of online tools, which are not as user-centered, participatory, engaging, or collaborative, and thus may work differently for health self-management. The challenge to establish a sound evidence base for social media use in chronic disease starts with the need to define criteria and methods to generate and evaluate evidence. The authors' key objective is to develop a framework for research and practice that addresses this challenge. This paper forms part of a larger research project that presents a conceptual framework of how evidence of health outcomes can be generated from social media use, allowing social media to be utilized in chronic disease management more effectively. Using mixed methods incorporating a qualitative literature review, a survey and a pilot intervention, the research closely examines the therapeutic affordances of social media, people with chronic pain (PWCP) as a subset of chronic disease management, valid outcome measurement of patient-reported (health) outcomes (PRO), the individual needs of people living with chronic disease, and finally translation of the combined results to improve evidence-based decision making about social media use in this context. Extensive review highlights various affordances of social media that may prove valuable to understanding social media's effect on individual health outcomes. However, without standardized PRO instruments, we are unable to definitively investigate these effects. The proposed framework that we offer outlines

  6. Modelling and control of a microgrid including photovoltaic and wind generation

    Science.gov (United States)

    Hussain, Mohammed Touseef

    Extensive increase of distributed generation (DG) penetration and the existence of multiple DG units at distribution level have introduced the notion of micro-grid. This thesis develops a detailed non-linear and small-signal dynamic model of a microgrid that includes PV, wind and conventional small scale generation along with their power electronics interfaces and the filters. The models developed evaluate the amount of generation mix from various DGs for satisfactory steady state operation of the microgrid. In order to understand the interaction of the DGs on microgrid system initially two simpler configurations were considered. The first one consists of microalternator, PV and their electronics, and the second system consists of microalternator and wind system each connected to the power system grid. Nonlinear and linear state space model of each microgrid are developed. Small signal analysis showed that the large participation of PV/wind can drive the microgrid to the brink of unstable region without adequate control. Non-linear simulations are carried out to verify the results obtained through small-signal analysis. The role of the extent of generation mix of a composite microgrid consisting of wind, PV and conventional generation was investigated next. The findings of the smaller systems were verified through nonlinear and small signal modeling. A central supervisory capacitor energy storage controller interfaced through a STATCOM was proposed to monitor and enhance the microgrid operation. The potential of various control inputs to provide additional damping to the system has been evaluated through decomposition techniques. The signals identified to have damping contents were employed to design the supervisory control system. The controller gains were tuned through an optimal pole placement technique. Simulation studies demonstrate that the STATCOM voltage phase angle and PV inverter phase angle were the best inputs for enhanced stability boundaries.

  7. Mid-term outcomes of the Absorb BVS versus second-generation DES: A systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Cordula M Felix

    Full Text Available Bioresorbable Vascular Scaffolds (BVS were introduced to overcome some of the limitations of drug-eluting stent (DES for PCI. Data regarding the clinical outcomes of the BVS versus DES beyond 2 years are emerging.To study mid-term outcomes.We searched online databases (PubMed/Medline, Embase, CENTRAL, several websites, meeting presentations and scientific session abstracts until August 8th, 2017 for studies comparing Absorb BVS with second-generation DES. The primary outcome was target lesion failure (TLF. Secondary outcomes were all-cause mortality, myocardial infarction, target lesion revascularization (TLR and definite/probable device thrombosis. Odds ratios (ORs with 95% confidence intervals (CIs were derived using a random effects model.Ten studies, seven randomized controlled trials and three propensity-matched observational studies, with a total of 7320 patients (BVS n = 4007; DES n = 3313 and a median follow-up duration of 30.5 months, were included. Risk of TLF was increased for BVS-treated patients (OR 1.34 [95% CI: 1.12-1.60], p = 0.001, I2 = 0%. This was also the case for all myocardial infarction (1.58 [95% CI: 1.27-1.96], p1 year device thrombosis was 6.10 [95% CI: 1.40-26.65], p = 0.02.At mid-term follow-up, BVS was associated with an increased risk of TLF, MI, TLR and definite/probable device thrombosis, but this did not result in an increased risk of all-cause mortality.

  8. Outcomes of social class and classism in first- and continuing-generation college students.

    Science.gov (United States)

    Allan, Blake A; Garriott, Patton O; Keene, Chesleigh N

    2016-07-01

    The purpose of this study was to examine perceptions of classism that may explain links between social class, first-generation college student status, and academic and well-being outcomes. Specifically, with a sample of 1,225 college students from a public university, we examined social class and first-generation status as predictors of institutionalized, citational, and interpersonal classism and classism as a predictor of life satisfaction, academic satisfaction, and grade point average (GPA). Partially supporting hypotheses, social class and first-generation status predicted institutionalized classism and interpersonal classism, and social class predicted citational classism. In turn, institutionalized classism and citational classism negatively predicted life satisfaction, and institutionalized classism negatively predicted academic satisfaction. Indirect effects were significant from social class to life satisfaction via institutionalized and citational classism, from social class to academic satisfaction via institutionalized classism, and from first-generation status to life satisfaction via institutionalized classism. Social class also had direct effects to life satisfaction, academic satisfaction, and GPA, and first-generation status had direct effects to academic satisfaction and GPA. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  9. Multigenerational Challenges: Team-Building for Positive Clinical Workforce Outcomes

    Science.gov (United States)

    Moore, Jill M; Everly, Marcee; Bauer, Renee

    2016-05-31

    Patient acuity in hospital settings continues to increase, and there is greater emphasis on patient outcomes. The current nursing workforce is comprised of four distinct generational cohorts that include veterans, baby boomers, millennials, and generation Xers. Each group has unique characteristics that add complexity to the workforce and this can add challenges to providing optimal patient care. Team building is one strategy to increase mutual understanding, communication, and respect, and thus potentially improve patient outcomes. In this article, we first briefly define generational cohorts by characteristics, and discuss differing expectations for work/life balance and potential negative outcomes. Our discussion offers team building strategies for positive outcomes, a case scenario, and concludes with resources for team building and organizational opportunities.

  10. Predicting Postsecondary Education and Employment Outcomes Using Results from the Transition Assessment and Goal Generator

    Science.gov (United States)

    Burnes, Jennifer J.; Martin, James E.; Terry, Robert; McConnell, Amber E.; Hennessey, Maeghan N.

    2018-01-01

    We conducted an exploratory study to investigate the relation between nonacademic behavior constructs measured by the "Transition Assessment and Goal Generator" (TAGG) and postsecondary education and employment outcomes for 297 high school leavers who completed the TAGG during their high school years. Four of eight TAGG constructs…

  11. Assessing CO2 Mitigation Options Utilizing Detailed Electricity Characteristics and Including Renewable Generation

    Science.gov (United States)

    Bensaida, K.; Alie, Colin; Elkamel, A.; Almansoori, A.

    2017-08-01

    This paper presents a novel techno-economic optimization model for assessing the effectiveness of CO2 mitigation options for the electricity generation sub-sector that includes renewable energy generation. The optimization problem was formulated as a MINLP model using the GAMS modeling system. The model seeks the minimization of the power generation costs under CO2 emission constraints by dispatching power from low CO2 emission-intensity units. The model considers the detailed operation of the electricity system to effectively assess the performance of GHG mitigation strategies and integrates load balancing, carbon capture and carbon taxes as methods for reducing CO2 emissions. Two case studies are discussed to analyze the benefits and challenges of the CO2 reduction methods in the electricity system. The proposed mitigations options would not only benefit the environment, but they will as well improve the marginal cost of producing energy which represents an advantage for stakeholders.

  12. Multiple time-scale optimization scheduling for islanded microgrids including PV, wind turbine, diesel generator and batteries

    DEFF Research Database (Denmark)

    Xiao, Zhao xia; Nan, Jiakai; Guerrero, Josep M.

    2017-01-01

    A multiple time-scale optimization scheduling including day ahead and short time for an islanded microgrid is presented. In this paper, the microgrid under study includes photovoltaics (PV), wind turbine (WT), diesel generator (DG), batteries, and shiftable loads. The study considers the maximum...... efficiency operation area for the diesel engine and the cost of the battery charge/discharge cycle losses. The day-ahead generation scheduling takes into account the minimum operational cost and the maximum load satisfaction as the objective function. Short-term optimal dispatch is based on minimizing...

  13. Energy-Water Nexus Relevant to Baseload Electricity Source Including Mini/Micro Hydropower Generation

    Science.gov (United States)

    Fujii, M.; Tanabe, S.; Yamada, M.

    2014-12-01

    Water, food and energy is three sacred treasures that are necessary for human beings. However, recent factors such as population growth and rapid increase in energy consumption have generated conflicting cases between water and energy. For example, there exist conflicts caused by enhanced energy use, such as between hydropower generation and riverine ecosystems and service water, between shale gas and ground water, between geothermal and hot spring water. This study aims to provide quantitative guidelines necessary for capacity building among various stakeholders to minimize water-energy conflicts in enhancing energy use. Among various kinds of renewable energy sources, we target baseload sources, especially focusing on renewable energy of which installation is required socially not only to reduce CO2 and other greenhouse gas emissions but to stimulate local economy. Such renewable energy sources include micro/mini hydropower and geothermal. Three municipalities in Japan, Beppu City, Obama City and Otsuchi Town are selected as primary sites of this study. Based on the calculated potential supply and demand of micro/mini hydropower generation in Beppu City, for example, we estimate the electricity of tens through hundreds of households is covered by installing new micro/mini hydropower generation plants along each river. However, the result is based on the existing infrastructures such as roads and electric lines. This means that more potentials are expected if the local society chooses options that enhance the infrastructures to increase micro/mini hydropower generation plants. In addition, further capacity building in the local society is necessary. In Japan, for example, regulations by the river law and irrigation right restrict new entry by actors to the river. Possible influences to riverine ecosystems in installing new micro/mini hydropower generation plants should also be well taken into account. Deregulation of the existing laws relevant to rivers and

  14. Developing a typology of patient-generated behavioral goals for cognitive behavioral therapy for chronic pain (CBT-CP): classification and predicting outcomes.

    Science.gov (United States)

    Heapy, Alicia A; Wandner, Laura; Driscoll, Mary A; LaChappelle, Kathryn; Czlapinski, Rebecca; Fenton, Brenda T; Piette, John D; Aikens, James E; Janevic, Mary R; Kerns, Robert D

    2018-04-01

    Patient-generated treatment goals describe what patients value, yet the content of these goals, and the relationship among goal types, goal accomplishment, and treatment outcomes has received little examination. We used inductive sorting to categorize patient-generated goals made by 147 adults receiving cognitive-behavioral therapy for chronic pain. The resulting goal categories were: Physical Activity (29.0%), Functional Status (24.6%), Wellness (16.3%), Recreational Activities (11.3%), House/Yard Work (9.7%), Socializing (7.1%), and Work/School (2.0%). Next, we examined associations between number of goals by category, goal accomplishment, and clinically meaningful improvements in pain-related interference, pain intensity and depressive symptoms. Improvement in all outcome domains was related to goal accomplishment. Additionally, depressive symptoms were related to number of Physical Activity, House/Yard Work, Recreational Activities, and Wellness goals, whereas improved pain-intensity was significantly related to House/Yard Work. Classifying patient-generated goals facilitates investigation of the relationships among goal type, goal accomplishment and treatment outcomes.

  15. DC Linked Hybrid Generation System with an Energy Storage Device including a Photo-Voltaic Generation and a Gas Engine Cogeneration for Residential Houses

    Science.gov (United States)

    Lung, Chienru; Miyake, Shota; Kakigano, Hiroaki; Miura, Yushi; Ise, Toshifumi; Momose, Toshinari; Hayakawa, Hideki

    For the past few years, a hybrid generation system including solar panel and gas cogeneration is being used for residential houses. Solar panels can generate electronic power at daytime; meanwhile, it cannot generate electronic power at night time. But the power consumption of residential houses usually peaks in the evening. The gas engine cogeneration system can generate electronic power without such a restriction, and it also can generate heat power to warm up house or to produce hot water. In this paper, we propose the solar panel and gas engine co-generation hybrid system with an energy storage device that is combined by dc bus. If a black out occurs, the system still can supply electronic power for special house loads. We propose the control scheme for the system which are related with the charging level of the energy storage device, the voltage of the utility grid which can be applied both grid connected and stand alone operation. Finally, we carried out some experiments to demonstrate the system operation and calculation for loss estimation.

  16. Conducting Accessible Research: Including People With Disabilities in Public Health, Epidemiological, and Outcomes Studies.

    Science.gov (United States)

    Rios, Dianne; Magasi, Susan; Novak, Catherine; Harniss, Mark

    2016-12-01

    People with disabilities are largely absent from mainstream health research. Exclusion of people with disabilities may be explicit, attributable to poorly justified exclusion criteria, or implicit, attributable to inaccessible study documents, interventions, or research measures. Meanwhile, people with disabilities experience poorer health, greater incidence of chronic conditions, and higher health care expenditure than people without disabilities. We outline our approach to "accessible research design"-research accessible to and inclusive of people with disabilities. We describe a model that includes 3 tiers: universal design, accommodations, and modifications. Through our work on several large-scale research studies, we provide pragmatic examples of accessible research design. Making efforts to include people with disabilities in public health, epidemiological, and outcomes studies will enhance the interpretability of findings for a significant patient population.

  17. Community attitudes toward a proposed nuclear power generating facility as a function of expected outcomes

    International Nuclear Information System (INIS)

    Sundstrom, E.; Lounsbury, J.W.; Schuller, C.R.; Fowler, J.R.; Mattingly, T.J. Jr.

    1977-01-01

    The relationship between attitudes toward a proposed nuclear power generating facility and the outcomes expected to accompany it are examined. In a survey of 350 residents of a small rural community, approximately 2/3 expressed favorable attitudes toward the proposed nuclear plant. A principal components factor analysis of the anticipated likelihoods of outcomes of the plant revealed five factors: hazards, economic growth, lower costs, social disruption, and community visibility. Using these factors as predictors, a simple multiple regression equation accounted for 52% of the variation in attitudes toward the plant. The strongest predictor was the perceived likelihood of hazards. These findings are discussed in terms of the relationship between attitudes and expectations, and in relation to decisions regarding public policy

  18. Unsatisfactory clinical outcomes of second-generation mobile bearing floating platform total knee arthroplasty: comparing outcomes with fixed bearing after five years minimum.

    Science.gov (United States)

    Yoon, Jung-Ro; Yang, Jae-Hyuk

    2018-03-20

    The purpose of this retrospective study was to analyze and compare the clinical and radiologic outcomes of fixed bearing ultracongruent (UC) insert total knee arthroplasty (TKA) and mobile bearing (MB) floating platform TKA using the navigation-assisted gap balancing technique with a minimum follow-up of five years. The study retrospectively enrolled 105 patients who received the UC type fixed bearing insert (group 1) and 95 patients who received the floating platform MB insert (group 2) during the period from August 2009 to June 2012. All surgery was performed using the navigation-assisted gap balancing technique. For strict assessment of gap measurements, the offset-type-force-controlled-spreader-system was used. Radiologic and clinical outcomes were assessed before operation and at the most recent follow-up using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. For statistical analysis, paired sample t tests were used. A p value less than 0.05 was considered significant. Although the radiologic alignments were satisfactory for both groups (99/105 [94%] cases were neutral for group 1 and 90/95 [94%] for group 2), the functional and total WOMAC scores were inferior in group 2 (p bearing exchange. The Kaplan-Meier survivorship rates for groups 1 and 2 at 77 months were 100.0 and 97.9%, respectively. Second-generation MB floating platform TKA cases did not have satisfactory outcomes. There were two cases of insert breakage, which required bearing exchange. Other patients who underwent surgery with second-generation MB floating platform were encouraged to avoid high knee flexion activities, resulting in lower clinical performance.

  19. Optimal design of power system stabilizer for power systems including doubly fed induction generator wind turbines

    International Nuclear Information System (INIS)

    Derafshian, Mehdi; Amjady, Nima

    2015-01-01

    This paper presents an evolutionary algorithm-based approach for optimal design of power system stabilizer (PSS) for multi-machine power systems that include doubly fed induction generator wind turbines. The proposed evolutionary algorithm is an improved particle swarm optimization named chaotic particle swarm optimization with passive congregation (CPSO-PC) applied for finding the optimal settings of PSS parameters. Two different eigenvalue-based objectives are combined as the objective function for the optimization problem of tuning PSS parameters. The first objective function comprises the damping factor of lightly damped electro-mechanical modes and the second one includes the damping ratio of these modes. The effectiveness of the proposed method to design PSS for the power systems including DFIG (Doubly Fed Induction Generator) is extensively demonstrated through eigenvalue analysis and time-domain simulations and also by comparing its simulation results with the results of other heuristic optimization approaches. - Highlights: • A new optimization model for design of PSS in power systems including DFIG is proposed. • A detailed and realistic modeling of DFIG is presented. • A new evolutionary algorithm is suggested for solving the optimization problem of designing PSS

  20. Assessment of the cost-effectiveness and clinical outcomes of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease.

    Science.gov (United States)

    Ho, Yi-Lwun; Yu, Jiun-Yu; Lin, Yen-Hung; Chen, Ying-Hsien; Huang, Ching-Chang; Hsu, Tse-Pin; Chuang, Pao-Yu; Hung, Chi-Sheng; Chen, Ming-Fong

    2014-06-10

    Telehealth programs are a growing field in the care of patients. The evolution of information technology has resulted in telehealth becoming a fourth-generation synchronous program. However, long-term outcomes and cost-effectiveness analysis of fourth-generation telehealth programs have not been reported in patients with chronic cardiovascular diseases. We conducted this study to assess the clinical outcomes and cost-effectiveness of a fourth-generation synchronous telehealth program for patients with chronic cardiovascular diseases. We retrospectively analyzed 575 patients who had joined a telehealth program and compared them with 1178 patients matched for sex, age, and Charlson comorbidity index. The program included: (1) instant transmission of biometric data, (2) daily telephone interview, and (3) continuous decision-making support. Data on hospitalization, emergency department (ED) visits, and medical costs were collected from the hospital's database and were adjusted to the follow-up months. The mean age was 64.5 years (SD 16.0). The mean number of monthly ED visits (mean 0.06 SD 0.13 vs mean 0.09 SD 0.23, P<.001), hospitalizations (mean 0.05 SD 0.12 vs mean 0.11 SD 0.21, P<.001), length of hospitalization (mean 0.77 days SD 2.78 vs mean 1.4 SD 3.6, P<.001), and intensive care unit admissions (mean 0.01 SD 0.07 vs mean 0.036 SD 0.14, P<.001) were lower in the telehealth group. The monthly mean costs of ED visits (mean US$20.90 SD 66.60 vs mean US$37.30 SD 126.20, P<.001), hospitalizations (mean US$386.30 SD 1424.30 vs mean US$878.20 SD 2697.20, P<.001), and all medical costs (mean US$587.60 SD 1497.80 vs mean US$1163.60 SD 3036.60, P<.001) were lower in the telehealth group. The intervention costs per patient were US$224.80 per month. Multivariate analyses revealed that age, telehealth care, and Charlson index were the independent factors for ED visits, hospitalizations, and length of hospitalization. A bootstrap method revealed the dominant cost

  1. High-efficiency photovoltaic technology including thermoelectric generation

    Science.gov (United States)

    Fisac, Miguel; Villasevil, Francesc X.; López, Antonio M.

    2014-04-01

    Nowadays, photovoltaic solar energy is a clean and reliable source for producing electric power. Most photovoltaic systems have been designed and built up for use in applications with low power requirements. The efficiency of solar cells is quite low, obtaining best results in monocrystalline silicon structures, with an efficiency of about 18%. When temperature rises, photovoltaic cell efficiency decreases, given that the short-circuit current is slightly increased, and the open-circuit voltage, fill factor and power output are reduced. To ensure that this does not affect performance, this paper describes how to interconnect photovoltaic and thermoelectric technology into a single structure. The temperature gradient in the solar panel is used to supply thermoelectric cells, which generate electricity, achieving a positive contribution to the total balance of the complete system.

  2. Satisfactory patient-based outcomes after surgical treatment for idiopathic clubfoot: includes surgeon's individualized technique.

    Science.gov (United States)

    Mahan, Susan T; Spencer, Samantha A; Kasser, James R

    2014-09-01

    Treatment of idiopathic clubfoot has shifted towards Ponseti technique, but previously surgical management was standard. Outcomes of surgery have varied, with many authors reporting discouraging results. Our purpose was to evaluate a single surgeon's series of children with idiopathic clubfoot treated with a la carte posteromedial and lateral releases using the Pediatric Outcomes Data Collection Instrument (PODCI) with a minimum of 2-year follow-up. A total of 148 patients with idiopathic clubfoot treated surgically by a single surgeon over 15 years were identified, and mailed PODCI questionnaires. Fifty percent of the patients were located and responded, resulting in 74 complete questionnaires. Median age at surgery was 10 months (range, 5.3 to 84.7 mo), male sex 53/74 (71.6%), bilateral surgery 31/74 (41.9%), and average follow-up of 9.7 years. PODCI responses were compared with previously published normal healthy controls using t test for each separate category. Included in the methods is the individual surgeon's operative technique. In PODCIs where a parent reports for their child or adolescent, there was no difference between our data and the healthy controls in any of the 5 categories. In PODCI where an adolescent self-reports, there was no difference in 4 of 5 categories; significant difference was only found between our data (mean = 95.2; SD = 7.427) and normal controls (mean = 86.3; SD = 12.5) in Happiness Scale (P = 0.0031). In this group of idiopathic clubfoot patients, treated with judicious posteromedial release by a single surgeon, primarily when surgery was treatment of choice for clubfoot, patient-based outcomes are not different from their normal healthy peers through childhood and adolescence. While Ponseti treatment has since become the treatment of choice for clubfoot, surgical treatment, in some hands, has led to satisfactory results. Level III.

  3. Use of 2D chemical structure and bioactivity profiles to generate chemical categories within an Adverse Outcome Pathway network

    Science.gov (United States)

    The Adverse Outcome Pathway (AOP) framework has emerged to capitalise on the vast quantity of mechanistic data generated by alternative techniques, as well as advances in systems biology, cheminformatics, and bioinformatics. AOPs provide a scaffold onto which mechanistic data can...

  4. Learning Outcomes Report

    NARCIS (Netherlands)

    Stoyanov, Slavi; Spoelstra, Howard; Burgoyne, Louise; O’Tuathaigh, Colm

    2018-01-01

    Aim of the study The learning outcomes study, conducted as part of WP3 of the BioApp project, has as objectives: (a) generating a comprehensive list of the learning outcomes; (b) reaching an agreement on the scope and priority of the learning outcomes, and (c) making suggestions for the further

  5. Practical framework for Bloom's based teaching and assessment of engineering outcomes

    Science.gov (United States)

    Mead, Patricia F.; Bennett, Mary M.

    2009-06-01

    ABET's outcomes-based assessment and evaluation requirements for engineering school accreditation has been a catalyst for curricular reform for engineering programs across the U.S. and around the world. Norfolk State University launched programs in Electronics and Optical Engineering in 2003. In 2007, Norfolk State became one of only six accredited Optical Engineering programs in the United States. In preparation for their first ABET evaluation in fall 2007, the faculty initiated an embedded-assessment program to insure continuous improvement toward the desired learning outcomes. The initial program design includes embedded assessments that have been generated using a practical framework for the creation of course activities based on Bloom's Learning Taxonomy. The framework includes specific performance criteria for each ABET-defined learning outcome. The embedded assessments are generated by individual faculty for courses that they are assigned to teach, and the performance criteria provide sufficient information to guide the faculty as they generate the embedded assignments. The assignments are typically administered through course exams, projects, electronic portfolio assignments, and other structured educational activities. The effectiveness of the assessment design is being evaluated through faculty surveys, faculty group discussions, and student performance. This paper outlines the assessment and evaluation plan, and the integrated processes that have been used to support the evaluation of learning outcomes using embedded assessment instruments.

  6. Autonomic nervous system modulation and clinical outcome after pulmonary vein isolation using the second-generation cryoballoon.

    Science.gov (United States)

    Miyazaki, Shinsuke; Nakamura, Hiroaki; Taniguchi, Hiroshi; Hachiya, Hitoshi; Kajiyama, Takatsugu; Watanabe, Tomonori; Igarashi, Miyako; Ichijo, Sadamitsu; Hirao, Kenzo; Iesaka, Yoshito

    2017-09-01

    The intrinsic cardiac autonomic nervous system (ANS) plays a significant role in atrial fibrillation (AF) mechanisms. This study evaluated the incidence and impact of intraprocedural vagal reactions and ANS modulation by pulmonary vein isolation (PVI) using second-generation cryoballoons on outcomes. One hundred three paroxysmal AF patients underwent PVI with one 28-mm second-generation balloon. The median follow-up was 15.0 (12.0-18.0) months. ANS modulation was defined as a >20% cycle length decrease on 3-minute resting electrocardiograms at 1, 3, 6, and 12 months postindex procedure relative to baseline if sinus rhythm was maintained. Marked sinus arrests/bradycardia and atrioventricular block (intraprocedural vagal reaction) occurred in 14 and 2 patients, and all sinus arrest/bradycardia occurred in 44 patients with left superior pulmonary veins (PVs) targeted before right PVs. ANS modulation was identified in 66 of 95 (69.5%) patients, and it persisted 12-month postprocedure in 36 (37.9%) patients. Additional β-blocker administration was required in 9 patients for sinus tachycardia. ANS modulation was similarly observed in patients with and without intraprocedural vagal reactions (P = 0.443). Forty-eight (46.6%) patients experienced early recurrences, and the single procedure success at 12 months was 72.7%. Neither intraprocedural vagal reactions nor ANS modulation predicted AF freedom within or after the blanking period. Thirty-three patients underwent second procedures, and reconnections were detected in 39 of 130 (30.0%) PVs among 23 (69.7%) patients. The incidence of reconnections was similar in patients with and without ANS modulation. Increased heart rate persisted in 37.9% of patients even at 12-month post-second-generation cryoballoon PVI. Neither intraprocedural vagal reactions nor increased heart rate predicted a single procedure clinical outcome. © 2017 Wiley Periodicals, Inc.

  7. Parents' childhood socioeconomic circumstances are associated with their children's asthma outcomes.

    Science.gov (United States)

    Chen, Edith; Shalowitz, Madeleine U; Story, Rachel E; Ehrlich, Katherine B; Manczak, Erika M; Ham, Paula J; Le, Van; Miller, Gregory E

    2017-09-01

    Previous literature documents associations between low socioeconomic status (SES) and poor health outcomes, including asthma. However, this literature has largely focused on the effects of current family circumstances. We sought to test an intergenerational hypothesis, that the childhood SES that parents experience will be associated with asthma outcomes in their children, independent of effects of current family SES. Second, we aimed to test whether this association is in part due to difficulties in current parent-child relationships. This was an observational study, whereby 150 parents were interviewed about their childhood SES and their children (physician-diagnosed asthma, ages 9-17 years) were interviewed about current family stress. Asthma control was assessed by parent report and child report (primary outcome), and blood was collected from children to measure cytokine production relevant to asthma (secondary outcomes). To the degree that parents had lower childhood SES, their offspring showed worse asthma outcomes across multiple indicators. This included lower asthma control scores (parent and child report, Ps childhood SES had current family relationships that were more stressful, and these difficulties, in turn, related to worse asthma control and greater cytokine production in children. These results suggest the potential "long reach" of low SES across generations, and the importance of expanding theories of how the social environment can affect childhood asthma to include characteristics of earlier generations. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. The rank-heat plot is a novel way to present the results from a network meta-analysis including multiple outcomes.

    Science.gov (United States)

    Veroniki, Areti Angeliki; Straus, Sharon E; Fyraridis, Alexandros; Tricco, Andrea C

    2016-08-01

    To present a novel and simple graphical approach to improve the presentation of the treatment ranking in a network meta-analysis (NMA) including multiple outcomes. NMA simultaneously compares many relevant interventions for a clinical condition from a network of trials, and allows ranking of the effectiveness and/or safety of each intervention. There are numerous ways to present the NMA results, which can challenge their interpretation by research users. The rank-heat plot is a novel graph that can be used to quickly recognize which interventions are most likely the best or worst interventions with respect to their effectiveness and/or safety for a single or multiple outcome(s) and may increase interpretability. Using empirical NMAs, we show that the need for a concise and informative presentation of results is imperative, particularly as the number of competing treatments and outcomes in an NMA increases. The rank-heat plot is an efficient way to present the results of ranking statistics, particularly when a large amount of data is available, and it is targeted to users from various backgrounds. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. A randomized controlled trial of Internet-Based Cognitive Behavior Therapy for perfectionism including an investigation of outcome predictors.

    Science.gov (United States)

    Rozental, Alexander; Shafran, Roz; Wade, Tracey; Egan, Sarah; Nordgren, Lise Bergman; Carlbring, Per; Landström, Andreas; Roos, Stina; Skoglund, Malin; Thelander, Elisabet; Trosell, Linnéa; Örtenholm, Alexander; Andersson, Gerhard

    2017-08-01

    Being highly attentive to details can be a positive feature. However, for some individuals, perfectionism can lead to distress and is associated with many psychiatric disorders. Cognitive behavior therapy has been shown to yield many benefits for those experiencing problems with perfectionism, but the access to evidence-based care is limited. The current study investigated the efficacy of guided Internet-based Cognitive Behavior Therapy (ICBT) and predictors of treatment outcome. In total, 156 individuals were included and randomized to an eight-week treatment or wait-list control. Self-report measures of perfectionism, depression, anxiety, self-criticism, self-compassion, and quality of life were distributed during screening and at post-treatment. Intention-to-treat were used for all statistical analyses. Moderate to large between-group effect sizes were obtained for the primary outcome measures, Frost Multidimensional Perfectionism Scale, subscales Concerns over Mistakes and Personal Standards, Cohen's d = 0.68-1.00, 95% Confidence Interval (CI) [0.36-1.33], with 35 (44.9%) of the patients in treatment being improved. Predictors were also explored, but none were related to treatment outcome. In sum, guided ICBT can be helpful for addressing problems with clinical perfectionism, but research of its long-term benefits is warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Including Emotional Intelligence in Pharmacy Curricula to Help Achieve CAPE Outcomes

    OpenAIRE

    Nelson, Michael H.; Fierke, Kerry K.; Sucher, Brandon J.; Janke, Kristin K.

    2015-01-01

    The importance of emotional intelligence (EI) for effective teamwork and leadership within the workplace is increasingly apparent. As suggested by the 2013 CAPE Outcomes, we recommend that colleges and schools of pharmacy consider EI-related competencies to build self-awareness and professionalism among students. In this Statement, we provide two examples of the introduction of EI into pharmacy curricula. In addition, we provide a 4-phase process based on recommendations developed by EI exper...

  11. Eddy Effects in the General Circulation, Spanning Mean Currents, Mesoscale Eddies, and Topographic Generation, Including Submesoscale Nests

    Science.gov (United States)

    2014-09-30

    alongshore winds favoring upwelling circulation. As for the other EBUS (e.g., Humboldt, Benguela, and Canary Currents ), equatorward winds drive...Eddy Effects in the General Circulation, Spanning Mean Currents , Mesoscale Eddies, and Topographic Generation, Including Submesoscale Nests...environments OBJECTIVES The central scientific questions are how the eddies control the persistent currents by their eddy-induced momentum and buoyancy fluxes

  12. Classical evolution and quantum generation in generalized gravity theories including string corrections and tachyons: Unified analyses

    International Nuclear Information System (INIS)

    Hwang, Jai-chan; Noh, Hyerim

    2005-01-01

    We present cosmological perturbation theory based on generalized gravity theories including string theory correction terms and a tachyonic complication. The classical evolution as well as the quantum generation processes in these varieties of gravity theories are presented in unified forms. These apply both to the scalar- and tensor-type perturbations. Analyses are made based on the curvature variable in two different gauge conditions often used in the literature in Einstein's gravity; these are the curvature variables in the comoving (or uniform-field) gauge and the zero-shear gauge. Applications to generalized slow-roll inflation and its consequent power spectra are derived in unified forms which include a wide range of inflationary scenarios based on Einstein's gravity and others

  13. Beyond the five-year horizon: long-term outcome of high-risk and inoperable patients undergoing TAVR with first-generation devices.

    Science.gov (United States)

    Deutsch, Marcus-André; Erlebach, Magdalena; Burri, Melchior; Hapfelmeier, Alexander; Witt, Olivia Ganga; Ziegelmueller, Johannes Amadeus; Wottke, Michael; Ruge, Hendrik; Krane, Markus; Piazza, Nicolo; Bleiziffer, Sabine; Lange, Rüdiger

    2018-05-20

    We sought to determine the long-term outcome of high-risk patients who underwent transcatheter aortic valve replacement (TAVR) with first-generation devices with a focus on the identification of predictors for mortality and valve durability. Consecutive patients in our prospective single-centre registry undergoing TAVR with first-generation devices (n=214 CoreValve; n=86 SAPIEN) between 06/2007 and 07/2009 were retrospectively analysed (n=300, mean age 81.43±6.55 years, mean STS score 6.5±4.5%). Kaplan-Meier estimates of survival and the Cox proportional hazards model were used to identify independent predictors of all-cause-mortality. At 1, 5, and 7 years, estimated survival rates were 76.0%, 40.2%, and 23.2%, respectively. Age-adjusted baseline predictors of mortality included atrial fibrillation, impaired kidney function, peripheral artery disease, and mitral regurgitation (≥moderate). Baseline risk-adjusted procedure-related predictors for all-cause mortality included acute kidney injury, neurological events, major vascular complications, and major/life-threatening bleeding. At both five and six years, 78.2% of surviving patients were in NYHA Class I or II. PVL was ≤mild in the majority of patients at discharge and throughout follow-up. At seven years, the overall crude cumulative incidence of structural valve deterioration according to the 2017 EAPCI/ESC/EACTS definition was 14.9% (CoreValve 11.8% vs. SAPIEN 22.6%; p=0.01). Seven years after TAVR, 23.2% of high-risk patients were still alive. Independent predictors of all-cause mortality included both patient- and procedure-related factors. With a cumulative incidence of 14.9% at seven years, there is some suggestion that SVD post TAVR may become increasingly relevant during longer-term follow-up.

  14. Core Outcomes for Colorectal Cancer Surgery: A Consensus Study.

    Directory of Open Access Journals (Sweden)

    Angus G K McNair

    2016-08-01

    second surveys, respectively. Consensus meetings generated agreement on a 12 domain COS. This constituted five perioperative outcome domains (including anastomotic leak, four quality of life outcome domains (including fecal urgency and incontinence, and three oncological outcome domains (including long-term survival.This study used robust consensus methodology to develop a core outcome set for use in colorectal cancer surgical trials. It is now necessary to validate the use of this set in research practice.

  15. Acculturation-Related Stress and Mental Health Outcomes among Three Generations of Hispanic Adolescents

    Science.gov (United States)

    Cervantes, Richard C.; Padilla, Amado M.; Napper, Lucy E.; Goldbach, Jeremy T.

    2013-01-01

    Stress associated with acculturation and minority status among Hispanic youth is understudied. Using survey data from the Hispanic Stress Inventory-Adolescent Version (HSI-A), we examined psychosocial stress across eight domains including family economic stress and acculturation-gap stress in a national sample of three generations (first, second,…

  16. Measuring Outcomes in Adult Weight Loss Studies That Include Diet and Physical Activity: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Rachel A. Millstein

    2014-01-01

    Full Text Available Background. Measuring success of obesity interventions is critical. Several methods measure weight loss outcomes but there is no consensus on best practices. This systematic review evaluates relevant outcomes (weight loss, BMI, % body fat, and fat mass to determine which might be the best indicator(s of success. Methods. Eligible articles described adult weight loss interventions that included diet and physical activity and a measure of weight or BMI change and body composition change. Results. 28 full-text articles met inclusion criteria. Subjects, settings, intervention lengths, and intensities varied. All studies measured body weight (−2.9 to −17.3 kg, 9 studies measured BMI (−1.1 to −5.1 kg/m2, 20 studies measured % body fat (−0.7 to −10.2%, and 22 studies measured fat mass (−0.9 to −14.9 kg. All studies found agreement between weight or BMI and body fat mass or body fat % decreases, though there were discrepancies in degree of significance between measures. Conclusions. Nearly all weight or BMI and body composition measures agreed. Since body fat is the most metabolically harmful tissue type, it may be a more meaningful measure of health change. Future studies should consider primarily measuring % body fat, rather than or in addition to weight or BMI.

  17. Training Peer Partners to Use a Speech-Generating Device With Classmates With Autism Spectrum Disorder: Exploring Communication Outcomes Across Preschool Contexts.

    Science.gov (United States)

    Thiemann-Bourque, Kathy S; McGuff, Sara; Goldstein, Howard

    2017-09-18

    This study examined effects of a peer-mediated intervention that provided training on the use of a speech-generating device for preschoolers with severe autism spectrum disorder (ASD) and peer partners. Effects were examined using a multiple probe design across 3 children with ASD and limited to no verbal skills. Three peers without disabilities were taught to Stay, Play, and Talk using a GoTalk 4+ (Attainment Company) and were then paired up with a classmate with ASD in classroom social activities. Measures included rates of communication acts, communication mode and function, reciprocity, and engagement with peers. Following peer training, intervention effects were replicated across 3 peers, who all demonstrated an increased level and upward trend in communication acts to their classmates with ASD. Outcomes also revealed moderate intervention effects and increased levels of peer-directed communication for 3 children with ASD in classroom centers. Additional analyses revealed higher rates of communication in the added context of preferred toys and snack. The children with ASD also demonstrated improved communication reciprocity and peer engagement. Results provide preliminary evidence on the benefits of combining peer-mediated and speech-generating device interventions to improve children's communication. Furthermore, it appears that preferred contexts are likely to facilitate greater communication and social engagement with peers.

  18. DNA copy number, including telomeres and mitochondria, assayed using next-generation sequencing

    Directory of Open Access Journals (Sweden)

    Jackson Stuart

    2010-04-01

    Full Text Available Abstract Background DNA copy number variations occur within populations and aberrations can cause disease. We sought to develop an improved lab-automatable, cost-efficient, accurate platform to profile DNA copy number. Results We developed a sequencing-based assay of nuclear, mitochondrial, and telomeric DNA copy number that draws on the unbiased nature of next-generation sequencing and incorporates techniques developed for RNA expression profiling. To demonstrate this platform, we assayed UMC-11 cells using 5 million 33 nt reads and found tremendous copy number variation, including regions of single and homogeneous deletions and amplifications to 29 copies; 5 times more mitochondria and 4 times less telomeric sequence than a pool of non-diseased, blood-derived DNA; and that UMC-11 was derived from a male individual. Conclusion The described assay outputs absolute copy number, outputs an error estimate (p-value, and is more accurate than array-based platforms at high copy number. The platform enables profiling of mitochondrial levels and telomeric length. The assay is lab-automatable and has a genomic resolution and cost that are tunable based on the number of sequence reads.

  19. Accelerating Adverse Outcome Pathway (AOP) development ...

    Science.gov (United States)

    The Adverse Outcome Pathway (AOP) framework is increasingly being adopted as a tool for organizing and summarizing the mechanistic information connecting molecular perturbations by environmental stressors with adverse outcomes relevant for ecological and human health outcomes. However, the conventional process for assembly of these AOPs is time and resource intensive, and has been a rate limiting step for AOP use and development. Therefore computational approaches to accelerate the process need to be developed. We previously developed a method for generating computationally predicted AOPs (cpAOPs) by association mining and integration of data from publicly available databases. In this work, a cpAOP network of ~21,000 associations was established between 105 phenotypes from TG-GATEs rat liver data from different time points (including microarray, pathological effects and clinical chemistry data), 994 REACTOME pathways, 688 High-throughput assays from ToxCast and 194 chemicals. A second network of 128,536 associations was generated by connecting 255 biological target genes from ToxCast to 4,980 diseases from CTD using either HT screening activity from ToxCast for 286 chemicals or CTD gene expression changes in response to 2,330 chemicals. Both networks were separately evaluated through manual extraction of disease-specific cpAOPs and comparison with expert curation of the relevant literature. By employing data integration strategies that involve the weighting of n

  20. Advanced exergy-based analyses applied to a system including LNG regasification and electricity generation

    Energy Technology Data Exchange (ETDEWEB)

    Morosuk, Tatiana; Tsatsaronis, George; Boyano, Alicia; Gantiva, Camilo [Technische Univ. Berlin (Germany)

    2012-07-01

    Liquefied natural gas (LNG) will contribute more in the future than in the past to the overall energy supply in the world. The paper discusses the application of advanced exergy-based analyses to a recently developed LNG-based cogeneration system. These analyses include advanced exergetic, advanced exergoeconomic, and advanced exergoenvironmental analyses in which thermodynamic inefficiencies (exergy destruction), costs, and environmental impacts have been split into avoidable and unavoidable parts. With the aid of these analyses, the potentials for improving the thermodynamic efficiency and for reducing the overall cost and the overall environmental impact are revealed. The objectives of this paper are to demonstrate (a) the potential for generating electricity while regasifying LNG and (b) some of the capabilities associated with advanced exergy-based methods. The most important subsystems and components are identified, and suggestions for improving them are made. (orig.)

  1. Using the International Classification of Functioning, Disability, and Health to identify outcome domains for a core outcome set for aphasia: a comparison of stakeholder perspectives.

    Science.gov (United States)

    Wallace, Sarah J; Worrall, Linda; Rose, Tanya; Le Dorze, Guylaine

    2017-11-12

    This study synthesised the findings of three separate consensus processes exploring the perspectives of key stakeholder groups about important aphasia treatment outcomes. This process was conducted to generate recommendations for outcome domains to be included in a core outcome set for aphasia treatment trials. International Classification of Functioning, Disability, and Health codes were examined to identify where the groups of: (1) people with aphasia, (2) family members, (3) aphasia researchers, and (4) aphasia clinicians/managers, demonstrated congruence in their perspectives regarding important treatment outcomes. Codes were contextualized using qualitative data. Congruence across three or more stakeholder groups was evident for ICF chapters: Mental functions; Communication; and Services, systems, and policies. Quality of life was explicitly identified by clinicians/managers and researchers, while people with aphasia and their families identified outcomes known to be determinants of quality of life. Core aphasia outcomes include: language, emotional wellbeing, communication, patient-reported satisfaction with treatment and impact of treatment, and quality of life. International Classification of Functioning, Disability, and Health coding can be used to compare stakeholder perspectives and identify domains for core outcome sets. Pairing coding with qualitative data may ensure important nuances of meaning are retained. Implications for rehabilitation The outcomes measured in treatment research should be relevant to stakeholders and support health care decision making. Core outcome sets (agreed, minimum set of outcomes, and outcome measures) are increasingly being used to ensure the relevancy and consistency of the outcomes measured in treatment studies. Important aphasia treatment outcomes span all components of the International Classification of Functioning, Disability, and Health. Stakeholders demonstrated congruence in the identification of important

  2. Five Conditions Commonly Used to Down-regulate Tor Complex 1 Generate Different Physiological Situations Exhibiting Distinct Requirements and Outcomes*

    Science.gov (United States)

    Tate, Jennifer J.; Cooper, Terrance G.

    2013-01-01

    Five different physiological conditions have been used interchangeably to establish the sequence of molecular events needed to achieve nitrogen-responsive down-regulation of TorC1 and its subsequent regulation of downstream reporters: nitrogen starvation, methionine sulfoximine (Msx) addition, nitrogen limitation, rapamycin addition, and leucine starvation. Therefore, we tested a specific underlying assumption upon which the interpretation of data generated by these five experimental perturbations is premised. It is that they generate physiologically equivalent outcomes with respect to TorC1, i.e. its down-regulation as reflected by TorC1 reporter responses. We tested this assumption by performing head-to-head comparisons of the requirements for each condition to achieve a common outcome for a downstream proxy of TorC1 inactivation, nuclear Gln3 localization. We demonstrate that the five conditions for down-regulating TorC1 do not elicit physiologically equivalent outcomes. Four of the methods exhibit hierarchical Sit4 and PP2A phosphatase requirements to elicit nuclear Gln3-Myc13 localization. Rapamycin treatment required Sit4 and PP2A. Nitrogen limitation and short-term nitrogen starvation required only Sit4. G1 arrest-correlated, long-term nitrogen starvation and Msx treatment required neither PP2A nor Sit4. Starving cells of leucine or treating them with leucyl-tRNA synthetase inhibitors did not elicit nuclear Gln3-Myc13 localization. These data indicate that the five commonly used nitrogen-related conditions of down-regulating TorC1 are not physiologically equivalent and minimally involve partially differing regulatory mechanisms. Further, identical requirements for Msx treatment and long-term nitrogen starvation raise the possibility that their effects are achieved through a common regulatory pathway with glutamine, a glutamate or glutamine metabolite level as the sensed metabolic signal. PMID:23935103

  3. Unbiased All-Optical Random-Number Generator

    Science.gov (United States)

    Steinle, Tobias; Greiner, Johannes N.; Wrachtrup, Jörg; Giessen, Harald; Gerhardt, Ilja

    2017-10-01

    The generation of random bits is of enormous importance in modern information science. Cryptographic security is based on random numbers which require a physical process for their generation. This is commonly performed by hardware random-number generators. These often exhibit a number of problems, namely experimental bias, memory in the system, and other technical subtleties, which reduce the reliability in the entropy estimation. Further, the generated outcome has to be postprocessed to "iron out" such spurious effects. Here, we present a purely optical randomness generator, based on the bistable output of an optical parametric oscillator. Detector noise plays no role and postprocessing is reduced to a minimum. Upon entering the bistable regime, initially the resulting output phase depends on vacuum fluctuations. Later, the phase is rigidly locked and can be well determined versus a pulse train, which is derived from the pump laser. This delivers an ambiguity-free output, which is reliably detected and associated with a binary outcome. The resulting random bit stream resembles a perfect coin toss and passes all relevant randomness measures. The random nature of the generated binary outcome is furthermore confirmed by an analysis of resulting conditional entropies.

  4. Implantable loop recorders for assessment of syncope: increased diagnostic yield and less adverse outcomes with the latest generation devices.

    Science.gov (United States)

    Bartoletti, A; Bocconcelli, P; De Santo, T; Ghidini Ottonelli, A; Giuli, S; Massa, R; Svetlich, C; Tarsi, G; Corbucci, G; Tronconi, F; Vitale, E

    2013-08-01

    Aim of the study was to compare the diagnostic yield of implantable loop recorders (ILR) of two successive generations for the assessment of syncope. Data on patients who had undergone ILR implantation for unexplained syncope in four Italian public hospitals were retrospectively acquired from the Medtronic Clinical Service database. After implantation, routine follow-up examinations were performed every 90 days, while urgent examinations were carried out in the event of syncope recurrence. The following findings were regarded as diagnostic: ECG documentation of a syncope recurrence; documentation of any of the arrhythmias listed by the current guidelines as diagnostic findings even if asymptomatic. Between November 2002 and March 2010, 107 patients received an ILR (40 Medtronic Reveal® Plus; 67 Medtronic Reveal® DX/XT) and underwent at least one follow-up examination. Diagnoses were made in 7 (17.5%) and 24 (35.8%) (P=0.043) patients, with a median time of 228 and 65 days, respectively. Three (42.9%) and 21 (87.5%) (P=0.029) diagnoses were based on automatically detected events, while adverse outcomes occurred in 6 and in 1 (P=0.01) patients, respectively. Our results show that the new-generation device offer a higher diagnostic yield, mainly as a result of its improved automatic detection function, and is associated with fewer adverse outcomes.

  5. Pupil Influence on the Visual Outcomes of a New-Generation Multifocal Toric Intraocular Lens With a Surface-Embedded Near Segment.

    Science.gov (United States)

    Wang, Mengmeng; Corpuz, Christine Carole C; Huseynova, Tukezban; Tomita, Minoru

    2016-02-01

    To evaluate the influences of preoperative pupil parameters on the visual outcomes of a new-generation multifocal toric intraocular lens (IOL) model with a surface-embedded near segment. In this prospective study, patients with cataract had phacoemulsification and implantation of Lentis Mplus toric LU-313 30TY IOLs (Oculentis GmbH, Berlin, Germany). The visual and optical outcomes were measured and compared preoperatively and postoperatively. The correlations between preoperative pupil parameters (diameter and decentration) and 3-month postoperative visual outcomes were evaluated using the Spearman's rank-order correlation coefficient (Rs) for the nonparametric data. A total of 27 eyes (16 patients) were enrolled into the current study. Statistically significant improvements in visual and refractive performances were found after the implantation of Lentis Mplus toric LU-313 30TY IOLs (P 0; P .05). Lentis Mplus toric LU-313 30TY IOLs provided excellent visual and optical performances during the 3-month follow-up. The preoperative pupil size is an important parameter when this toric multifocal IOL model is contemplated for surgery. Copyright 2016, SLACK Incorporated.

  6. Mentored residential writing retreats: a leadership strategy to develop skills and generate outcomes in writing for publication.

    Science.gov (United States)

    Jackson, Debra

    2009-01-01

    There is an increasing expectation that academic and clinical nurses will contribute to disciplinary and professional discourses through scholarly writing. However, the difficulties and challenges associated with writing for publication mean that many papers will never be written. This current paper describes an innovative approach developed to support skill development and outcomes in writing for publication. Intensive residential writing retreats informed by the principles of servant leadership and incorporating strategies such as mentoring and peer learning were conducted in 2005 and 2007. Positive outcomes and benefits included publications submitted to peer-reviewed journals, as well as positive effects on collegial relationships, and team building. Novice writers benefited from intensive and sustained support and coaching by experienced writers. Organisational benefits included increased participation by staff and research higher degree students in publication activities, enhanced collegial relationships and opportunities for senior established writers to work with inexperienced writers.

  7. Variant mannose-binding lectin alleles are not associated with susceptibility to or outcome of invasive pneumococcal infection in randomly included patients

    DEFF Research Database (Denmark)

    Kronborg, Gitte; Weis, Nina; Madsen, Hans O

    2002-01-01

    for pneumococcal infections. To assess the influence of MBL genotypes on the course and outcome of invasive pneumococcal disease, clinical data for 141 adult patients were collected prospectively and their genotypes were determined. All patients included had positive blood cultures for Streptococcus pneumoniae....... The distribution of variant MBL alleles related to low MBL serum concentrations was similar among the patients and healthy individuals, and MBL genotype was not associated with infection outcome. Thus, in a random adult population with invasive pneumococcal infection, MBL does not seem to play a role......Invasive pneumococcal disease is a serious infection that primarily affects very young children and elderly or immunocompromised individuals but also affects previously healthy people. Variant mannose-binding lectin (MBL) alleles are associated with recurrent infections and may be a risk factor...

  8. Development of a functional, internet-accessible department of surgery outcomes database.

    Science.gov (United States)

    Newcomb, William L; Lincourt, Amy E; Gersin, Keith; Kercher, Kent; Iannitti, David; Kuwada, Tim; Lyons, Cynthia; Sing, Ronald F; Hadzikadic, Mirsad; Heniford, B Todd; Rucho, Susan

    2008-06-01

    The need for surgical outcomes data is increasing due to pressure from insurance companies, patients, and the need for surgeons to keep their own "report card". Current data management systems are limited by inability to stratify outcomes based on patients, surgeons, and differences in surgical technique. Surgeons along with research and informatics personnel from an academic, hospital-based Department of Surgery and a state university's Department of Information Technology formed a partnership to develop a dynamic, internet-based, clinical data warehouse. A five-component model was used: data dictionary development, web application creation, participating center education and management, statistics applications, and data interpretation. A data dictionary was developed from a list of data elements to address needs of research, quality assurance, industry, and centers of excellence. A user-friendly web interface was developed with menu-driven check boxes, multiple electronic data entry points, direct downloads from hospital billing information, and web-based patient portals. Data were collected on a Health Insurance Portability and Accountability Act-compliant server with a secure firewall. Protected health information was de-identified. Data management strategies included automated auditing, on-site training, a trouble-shooting hotline, and Institutional Review Board oversight. Real-time, daily, monthly, and quarterly data reports were generated. Fifty-eight publications and 109 abstracts have been generated from the database during its development and implementation. Seven national academic departments now use the database to track patient outcomes. The development of a robust surgical outcomes database requires a combination of clinical, informatics, and research expertise. Benefits of surgeon involvement in outcomes research include: tracking individual performance, patient safety, surgical research, legal defense, and the ability to provide accurate information

  9. Comparing Outcomes and Cost of 3 Surgical Treatments for Sagittal Synostosis: A Retrospective Study Including Procedure-Related Cost Analysis.

    Science.gov (United States)

    Garber, Sarah T; Karsy, Michael; Kestle, John R W; Siddiqi, Faizi; Spanos, Stephen P; Riva-Cambrin, Jay

    2017-10-01

    Neurosurgical techniques for repair of sagittal synostosis include total cranial vault (TCV) reconstruction, open sagittal strip (OSS) craniectomy, and endoscopic strip (ES) craniectomy. To evaluate outcomes and cost associated with these 3 techniques. Via retrospective chart review with waiver of informed consent, the last consecutive 100 patients with sagittal synostosis who underwent each of the 3 surgical correction techniques before June 30, 2013, were identified. Clinical, operative, and process of care variables and their associated specific charges were analyzed along with overall charge. The study included 300 total patients. ES patients had fewer transfusion requirements (13% vs 83%, P cost savings compared with the TCV reconstruction. The charges were similar to those incurred with OSS craniectomy, but patients had a shorter length of stay and fewer revisions. Copyright © 2017 by the Congress of Neurological Surgeons

  10. Outcome of surgical implant generation network nail initiative in ...

    African Journals Online (AJOL)

    in Uganda, was propagated in to Kenya mainly in resource poor hospitals, and has changed long bone fractures' management and outcomes. The goal of this study was to describe applicability of the SIGN initiative in fracture care in a Kenyan hospital. AbstrAct. Background: Closed interlocked intra-medullary nailing (IM), ...

  11. Two-Year Clinical Outcomes of Newer-Generation Drug-Eluting Stent Implantation Following Rotational Atherectomy for Heavily Calcified Lesions.

    Science.gov (United States)

    Jinnouchi, Hiroyuki; Kuramitsu, Shoichi; Shinozaki, Tomohiro; Kobayashi, Yohei; Hiromasa, Takashi; Morinaga, Takashi; Mazaki, Toru; Sakakura, Kenichi; Soga, Yoshimitsu; Hyodo, Makoto; Shirai, Shinichi; Ando, Kenji

    2015-01-01

    Clinical outcomes of implantation of the newer-generation drug-eluting stent (DES) following rotational atherectomy for heavily calcified lesions remain unclear in the real-world setting. We enrolled 252 consecutive patients (273 lesions) treated with newer-generation DES following rotational atherectomy. The primary endpoint was the cumulative 2-year incidence of major adverse cardiovascular events (MACE), defined as cardiac death, myocardial infarction, clinically-driven target lesion revascularization, and definite stent thrombosis. Complete clinical follow-up information at 2-year was obtained for all patients. The mean age was 73.2±9.0 years and 155 patients (61.5%) were male. Cumulative 2-year incidence of MACE (cardiac death, myocardial infarction, clinically-driven target lesion revascularization and definite stent thrombosis) was 20.3% (7.0%, 2.1%, 18.1% and 2.1%, respectively). Predictors of MACE were presenting with acute coronary syndrome (hazard ratio [HR]: 3.80, 95% confidence interval [CI]: 1.29-11.2, P=0.02), hemodialysis (HR: 1.93, 95% CI: 1.04-3.56, P=0.04) and previous coronary artery bypass graft (HR: 2.26, 95% CI: 1.02-5.00, P=0.045). PCI for calcified lesions requiring rotational atherectomy is still challenging even in the era of newer-generation DES.

  12. Individual-level outcomes from a national clinical leadership development programme.

    Science.gov (United States)

    Patton, Declan; Fealy, Gerard; McNamara, Martin; Casey, Mary; Connor, Tom O; Doyle, Louise; Quinlan, Christina

    2013-08-01

    A national clinical leadership development programme was instituted for Irish nurses and midwives in 2010. Incorporating a development framework and leadership pathway and a range of bespoke interventions for leadership development, including workshops, action-learning sets, mentoring and coaching, the programme was introduced at seven pilot sites in the second half of 2011. The programme pilot was evaluated with reference to structure, process and outcomes elements, including individual-level programme outcomes. Evaluation data were generated through focus groups and group interviews, individual interviews and written submissions. The data provided evidence of nurses' and midwives' clinical leadership development through self and observer-reported behaviours and dispositions including accounts of how the programme participants developed and displayed particular clinical leadership competencies. A key strength of the new programme was that it involved interventions that focussed on specific leadership competencies to be developed within the practice context.

  13. Developing core economic outcome sets for asthma studies: a protocol for a systematic review.

    Science.gov (United States)

    Hounsome, Natalia; Fitzsimmons, Deborah; Phillips, Ceri; Patel, Anita

    2017-08-11

    Core outcome sets are standardised lists of outcomes, which should be measured and reported in all clinical studies of a specific condition. This study aims to develop core outcome sets for economic evaluations in asthma studies. Economic outcomes include items such as costs, resource use or quality-adjusted life years. The starting point in developing core outcome sets will be conducting a systematic literature review to establish a preliminary list of reporting items to be considered for inclusion in the core outcome set. We will conduct literature searches of peer-reviewed studies published from January 1990 to January 2017. These will include any comparative or observational studies (including economic models) and systematic reviews reporting economic outcomes. All identified economic outcomes will be tabulated together with the major study characteristics, such as population, study design, the nature and intensity of the intervention, mode of data collection and instrument(s) used to derive an outcome. We will undertake a 'realist synthesis review' to analyse the identified economic outcomes. The outcomes will be summarised in the context of evaluation perspectives, types of economic evaluation and methodological approaches. Parallel to undertaking a systematic review, we will conduct semistructured interviews with stakeholders (including people with personal experience of asthma, health professionals, researchers and decision makers) in order to explore additional outcomes which have not been considered, or used, in published studies. The list of outcomes generated from the systematic review and interviews with stakeholders will form the basis of a Delphi survey to refine the identified outcomes into a core outcome set. The review will not involve access to individual-level data. Findings from our systematic review will be communicated to a broad range of stakeholders including clinical guideline developers, research funders, trial registries, ethics

  14. Reliability assessment of distribution power systems including distributed generations

    International Nuclear Information System (INIS)

    Megdiche, M.

    2004-12-01

    Nowadays, power systems have reached a good level of reliability. Nevertheless, considering the modifications induced by the connections of small independent producers to distribution networks, there's a need to assess the reliability of these new systems. Distribution networks present several functional characteristics, highlighted by the qualitative study of the failures, as dispersed loads at several places, variable topology and some electrotechnical phenomena which must be taken into account to model the events that can occur. The adopted reliability calculations method is Monte Carlo simulations, the probabilistic method most powerful and most flexible to model complex operating of the distribution system. We devoted a first part on the case of a 20 kV feeder to which a cogeneration unit is connected. The method was applied to a software of stochastic Petri nets simulations. Then a second part related to the study of a low voltage power system supplied by dispersed generations. Here, the complexity of the events required to code the method in an environment of programming allowing the use of power system calculations (load flow, short-circuit, load shedding, management of units powers) in order to analyse the system state for each new event. (author)

  15. Agency alters perceptual decisions about action-outcomes.

    Science.gov (United States)

    Desantis, Andrea; Waszak, Florian; Gorea, Andrei

    2016-10-01

    Humans experience themselves as agents, capable of controlling their actions and the outcomes they generate (i.e., the sense of agency). Inferences of agency are not infallible. Research shows that we often attribute outcomes to our agency even though they are caused by another agent. Moreover, agents report the sensory events they generate to be less intense compared to the events that are generated externally. These effects have been assessed using highly suprathreshold stimuli and subjective measurements. Consequently, it remains unclear whether experiencing oneself as an agent lead to a decision criterion change and/or a sensitivity change. Here, we investigate this issue. Participants were told that their key presses generated an upward dot motion but that on 30 % of the trials the computer would take over and display a downward motion. The upward/downward dot motion was presented at participant's discrimination threshold. Participants were asked to indicate whether they (upward motion) or the computer (downward motion) generated the motion. This group of participants was compared with a 'no-agency' group who performed the same task except that subjects did not execute any actions to generate the dot motion. We observed that the agency group reported seeing more frequently the motion they expected to generate (i.e., upward motion) than the no-agency group. This suggests that agency distorts our experience of (allegedly) caused events by altering perceptual decision processes, so that, in ambiguous contexts, externally generated events are experienced as the outcomes of one's actions.

  16. Envisioning the Next Generation of Behavioral Health and Criminal Justice Interventions

    Science.gov (United States)

    Epperson, Matthew W.; Wolff, Nancy; Morgan, Robert D.; Fisher, William H.; Frueh, B. Christopher; Huening, Jessica

    2014-01-01

    The purpose of this paper is to cast a vision for the next generation of behavioral health and criminal justice interventions for persons with serious mental illnesses in the criminal justice system. The limitations of first generation interventions, including their primary focus on mental health treatment connection, are discussed. A person-place framework for understanding the complex factors that contribute to criminal justice involvement for this population is presented. We discuss practice and research recommendations for building more effective interventions to address both criminal justice and mental health outcomes. PMID:24666731

  17. Transient performances analysis of wind turbine system with induction generator including flux saturation and skin effect

    DEFF Research Database (Denmark)

    Li, H.; Zhao, B.; Han, L.

    2010-01-01

    In order to analyze correctly the effect of different models for induction generators on the transient performances of large wind power generation, Wind turbine driven squirrel cage induction generator (SCIG) models taking into account both main and leakage flux saturation and skin effect were...

  18. CHP in Switzerland from 1990 to 1998. Thermal power generation including combined heat and power

    International Nuclear Information System (INIS)

    Kaufmann, U.

    1999-01-01

    The results of a study on thermal power generation in Switzerland show that combined heat and power (CHP) systems have grown rapidly. Statistics are presented on the development of CHP-based power and also on thermal power stations without waste heat usage. Figures are given for gas and steam turbine installations, combined gas and steam turbine stations and motor-driven CHP units. Power production is categorised, separating small and large (over 1 Megawatt electrical) power generation facilities. On-site, distributed power generation at consumers' premises and the geographical distribution of plant is described

  19. The projected costs of electricity generation

    International Nuclear Information System (INIS)

    Cameron, R.; Keppler, J. H.

    2010-10-01

    This paper describes the outcomes from the joint report between the Nuclear Energy Agency and the International Energy Agency of the OECD on the projected costs of generating electricity. The study contains data on electricity generating costs for almost 200 power plants provided by 17 OECD member countries, 4 non-OECD countries and 4 industrial companies or industry organisations. The paper presents the projected costs of generating electricity calculated according to common methodological rules on the basis of the data provided by participating countries and organisations. Data were received for a wide variety of fuels and technologies, including coal, gas, nuclear, hydro, onshore and offshore wind, biomass, solar, wave and tidal. Cost estimates were also provided for combined heat and power plants, as well as for coal plants that include carbon capture. As in previous studies of the same series, all costs and benefits were discounted or capitalised to the date of commissioning in order to calculate the state of the electricity costs per MWh, based on plant operating lifetime data. In addition, the paper contains a discussion of a number of factors affecting the cost of capital, the outlook for carbon capture and storage and the working of electricity markets. (Author)

  20. Measuring Population Health Outcomes

    OpenAIRE

    Parrish, R. Gibson

    2010-01-01

    An ideal population health outcome metric should reflect a population's dynamic state of physical, mental, and social well-being. Positive health outcomes include being alive; functioning well mentally, physically, and socially; and having a sense of well-being. Negative outcomes include death, loss of function, and lack of well-being. In contrast to these health outcomes, diseases and injuries are intermediate factors that influence the likelihood of achieving a state of health. On the basis...

  1. Do psychopathic traits assessed in mid-adolescence predict mental health, psychosocial, and antisocial, including criminal outcomes, over the subsequent 5 years?

    Science.gov (United States)

    Hemphälä, Malin; Hodgins, Sheilagh

    2014-01-01

    To determine whether psychopathic traits assessed in mid-adolescence predicted mental health, psychosocial, and antisocial (including criminal) outcomes 5 years later and would thereby provide advantages over diagnosing conduct disorder (CD). Eighty-six women and 61 men were assessed in mid-adolescence when they first contacted a clinic for substance misuse and were reassessed 5 years later. Assessments in adolescence include the Psychopathy Checklist-Youth Version (PCL-YV), and depending on their age, either the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Aged Children or the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). Assessments in early adulthood included the SCID, self-reports of psychosocial functioning, aggressive behaviour, and criminality and official criminal records. The antisocial facet score positively predicted the number of anxiety symptoms and likelihood of receiving treatment for substance use disorders (SUDs). Lifestyle and antisocial facet scores negatively predicted Global Assessment of Functioning scores. By contrast, the interpersonal score and male sex independently and positively predicted the number of months worked or studied, as did the interaction of Lifestyle × Sex indicating that among men, but not women, an increase in lifestyle facet score was associated with less time worked or studied. Interpersonal and antisocial scores positively predicted school drop-out. Antisocial facet scores predicted the number of symptoms of antisocial personality disorder, alcohol and SUDs, and violent and nonviolent criminality but much more strongly among males than females. Predictions from numbers of CD symptoms were similar. Psychopathic traits among adolescents who misuse substances predict an array of outcomes over the subsequent 5 years. Information on the levels of these traits may be useful for planning treatment.

  2. Influence of the Emissions Trading Scheme on generation scheduling

    International Nuclear Information System (INIS)

    Kockar, Ivana; McDonald, James R.; Conejo, Antonio J.

    2009-01-01

    The paper investigates the effects of emissions constraints and Emissions Trading Scheme (ETS) on the generation scheduling outcome. ETS is a cap-and-trade market mechanism that has been introduced in European Union in order to facilitate CO 2 emissions management. This scheme gives generators certain amount of CO 2 allowances which they can use to cover emissions produced during energy generation. In a current setting, most of the allowances are given for free. However, under ETS generators also have an opportunity to buy and sell CO 2 allowances on the market. Since generation power outputs are bounded by the amount of CO 2 emissions that they are allowed to produce over time, it is becoming increasingly important for generating units to manage their allocations in the most profitable way and decide when and how much of permissions to spent to produce electricity. The method proposed here allows for modeling of this new limitation by including costs of buying and selling of CO 2 allowance in the generation scheduling procedure. It also introduces additional emissions constraints in the problem formulation. Although CO 2 permissions and energy are traded in separate markets, the proposed formulation permits analysis on how emission caps and emission market prices can influence market outcome. The method is illustrated on a 5-unit system. Given examples compare (i) a base-case when all generators have made a decision to use portions of their total free allocations that do not cause any shortfall during the investigated time period; (ii) two cases when the least expensive generators' decisions on the amount of free allowances they are willing to use during the considered period are insufficient. In all cases generators also submit prices at which they expect to be able to ''top-up'' or sell allowances on the market, however, only in the second and third case the ''buying'' option becomes active and affects generation scheduling and total costs. In addition, the

  3. Serratia marcescens meningitis: epidemiology, prognostic factors and treatment outcomes.

    Science.gov (United States)

    Wu, Yen-Mu; Hsu, Po-Chang; Yang, Chien-Chang; Chang, Hong-Jyun; Ye, Jung-Jr; Huang, Ching-Tai; Lee, Ming-Hsun

    2013-08-01

    Serratia marcescens is a rare pathogen of central nervous system infections. This study was to investigate the epidemiology, prognostic factors, and treatment outcomes of S. marcescens meningitis. This retrospective analysis included 33 patients with culture-proven S. marcescens meningitis hospitalized between January 2000 and June 2011. Of the 33 patients enrolled, only one did not receive neurosurgery before the onset of S. marcescens meningitis. Patients with S. marcescens meningitis had higher ratios of brain solid tumors (54.5%) and neurosurgery (97.0%) with a mortality rate of 15.2%. The mean interval between the first neurosurgical procedure and the diagnosis of meningitis was 17.1 days (range, 4-51 days). Only one third-generation cephalosporin-resistant S. marcescens isolate was recovered from the patients' cerebrospinal fluid (CSF) specimens. Compared with the favorable outcome group (n = 20), the unfavorable outcome group (n = 13) had a higher percentage of brain solid tumors, more intensive care unit stays, and higher Sequential Organ Failure Assessment score, CSF lactate and serum C-reactive protein concentrations at diagnosis of meningitis. Under the multiple regression analysis, CSF lactate concentration ≥2-fold the upper limit of normal (ULN) was independently associated with unfavorable outcomes (odds ratio, 7.20; 95% confidence interval, 1.08-47.96; p = 0.041). S. marcescens meningitis is highly associated with neurosurgical procedures for brain solid tumors. CSF lactate concentration ≥2x ULN may predict an unfavorable outcome. Its mortality is not high and empiric treatment with parenteral third-generation cephalosporins may have a satisfactory clinical response. Copyright © 2012. Published by Elsevier B.V.

  4. Motor/generator

    Science.gov (United States)

    Hickam, Christopher Dale [Glasford, IL

    2008-05-13

    A motor/generator is provided for connecting between a transmission input shaft and an output shaft of a prime mover. The motor/generator may include a motor/generator housing, a stator mounted to the motor/generator housing, a rotor mounted at least partially within the motor/generator housing and rotatable about a rotor rotation axis, and a transmission-shaft coupler drivingly coupled to the rotor. The transmission-shaft coupler may include a clamp, which may include a base attached to the rotor and a plurality of adjustable jaws.

  5. Acculturation and biobehavioral profiles in pregnant women of Hispanic origin: generational differences.

    Science.gov (United States)

    Ruiz, Roberta J; Stowe, Raymond P; Brown, Adama; Wommack, Joel

    2012-01-01

    In Hispanics, acculturation may lead to negative health outcomes. This study used a cross-sectional design to investigate the psychosocial and biological risks in acculturating pregnant women of Hispanic origin (n = 470). Psychosocial risks-depressive symptoms, anxiety, and stress-were assessed by self-report, whereas biological measures included stress-related and reproductive hormones. Mental health deteriorated across generations, with worsening depression, anxiety, and stress with successive generations. Stress and reproductive hormone levels decreased across generations, whereas body mass index and number of sexual partners increased. These data provide potential biobehavioral explanations of the relationship between acculturation and declining health among Hispanic women in the United States.

  6. A State-of-the-Art Report on Technologies of Volume Reduction and Self-Disposal for Large Metal Wastes including the Steam Generator of Nuclear Power Plants

    International Nuclear Information System (INIS)

    Lee, Kune Woo; Choi, W. K.; Kim, G. Y.

    2009-06-01

    This report focuses on technologies of volume reduction and self-disposal for large metal wastes including the steam generator of nuclear power plants. This report consists of the cases of treatments and foreign and domestic technologies for steam generator replacement

  7. Electric Power Monthly, August 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-11-29

    The Electric Power Monthly (EPM) presents monthly summaries of electric utility statistics at the national, Census division, and State level. The purpose of this publication is to provide energy decisionmakers with accurate and timely information that may be used in forming various perspectives on electric issues that lie ahead. Data includes generation by energy source (coal, oil, gas, hydroelectric, and nuclear); generation by region; consumption of fossil fuels for power generation; sales of electric power, cost data; and unusual occurrences. A glossary is included.

  8. Longitudinal effects of adaptive interventions with a speech-generating devicein minimally verbal children with ASD

    Science.gov (United States)

    Almirall, Daniel; DiStefano, Charlotte; Chang, Ya-Chih; Shire, Stephanie; Kaiser, Ann; Lu, Xi; Nahum-Shani, Inbal; Landa, Rebecca; Mathy, Pamela; Kasari, Connie

    2016-01-01

    Objective There are limited data on the effects of adaptive social communication interventions with a speech-generating device in autism. This study is the first to compare growth in communications outcomes among three adaptive interventions in school-aged children with autism spectrum disorder (ASD) who are minimally verbal. Methods Sixty-one children, aged 5–8 years participated in a sequential, multiple-assignment randomized trial (SMART). All children received a developmental communication intervention: joint attention, symbolic play, engagement and regulation (JASP) with enhanced milieu teaching (EMT). The SMART included three two-stage, 24-week adaptive interventions with different provisions of a speech-generating device (SGD) in the context of JASP+EMT. The first adaptive intervention, with no SGD, initially assigned JASP+EMT alone; then intensified JASP+EMT for slow responders. In the second adaptive intervention, slow responders to JASP+EMT were assigned JASP+EMT+SGD. The third adaptive intervention initially assigned JASP+EMT+SGD; then intensified JASP+EMT+SGD for slow responders. Analyses examined between-group differences in change in outcomes from baseline to week 36. Verbal outcomes included spontaneous communicative utterances and novel words. Non-linguistic communication outcomes included initiating joint attention and behavior regulation, and play. Results The adaptive intervention beginning with JASP+EMT+SGD was estimated as superior. There were significant (Pcommunicative utterances and initiating joint attention. Conclusions School-aged children with ASD who are minimally verbal make significant gains in communication outcomes with an adaptive intervention beginning with JASP+EMT+SGD. Future research should explore mediators and moderators of the adaptive intervention effects and second-stage intervention options that further capitalize on early gains in treatment. PMID:26954267

  9. Saskatchewan resources. [including uranium

    Energy Technology Data Exchange (ETDEWEB)

    1979-09-01

    The production of chemicals and minerals for the chemical industry in Saskatchewan are featured, with some discussion of resource taxation. The commodities mentioned include potash, fatty amines, uranium, heavy oil, sodium sulfate, chlorine, sodium hydroxide, sodium chlorate and bentonite. Following the successful outcome of the Cluff Lake inquiry, the uranium industry is booming. Some developments and production figures for Gulf Minerals, Amok, Cenex and Eldorado are mentioned.

  10. Nordic Nuclear Materials Forum for Generation IV Reactors

    Energy Technology Data Exchange (ETDEWEB)

    Anghel, C. (Studsvik Nuclear AB, Nykoeping (Sweden)); Penttilae, S. (Technical Research Centre of Finland, VTT (Finland))

    2010-03-15

    A network for material issues for Generation IV nuclear power has been initiated within the Nordic countries. The objectives of the Generation IV Nordic Nuclear Materials Forum (NOMAGE4) are to put the basis of a sustainable forum for Gen IV issues, especially focussing on fuels, cladding, structural materials and coolant interaction. Other issues include reactor physics, dynamics and diagnostics, core and fuel design. The present report summarizes the work performed during the year 2009. The efforts made include identification of organisations involved in Gen IV issues in the Nordic countries, update of the forum website, http://www.studsvik.se/GenerationIV, and investigation of capabilities for research within the area of Gen IV. Within the NOMAGE4 project a seminar on Generation IV Nuclear Energy Systems has been organized during 15-16th of October 2009. The aim of the seminar was to provide a forum for exchange of information, discussion on future research needs and networking of experts on Generation IV reactor concepts. As an outcome of the NOMAGE4, a few collaboration project proposals have been prepared/planned in 2009. The network was welcomed by the European Commission and was mentioned as an exemplary network with representatives from industries, universities, power companies and research institutes. NOMAGE4 has been invited to participate to the 'European Energy Research Alliance, EERA, workshop for nuclear structural materials' http://www.eera-set.eu/index.php?index=41 as external observers. Future plans include a new Nordic application for continuation of NOMAGE4 network. (author)

  11. Nordic Nuclear Materials Forum for Generation IV Reactors

    International Nuclear Information System (INIS)

    Anghel, C.; Penttilae, S.

    2010-03-01

    A network for material issues for Generation IV nuclear power has been initiated within the Nordic countries. The objectives of the Generation IV Nordic Nuclear Materials Forum (NOMAGE4) are to put the basis of a sustainable forum for Gen IV issues, especially focussing on fuels, cladding, structural materials and coolant interaction. Other issues include reactor physics, dynamics and diagnostics, core and fuel design. The present report summarizes the work performed during the year 2009. The efforts made include identification of organisations involved in Gen IV issues in the Nordic countries, update of the forum website, http://www.studsvik.se/GenerationIV, and investigation of capabilities for research within the area of Gen IV. Within the NOMAGE4 project a seminar on Generation IV Nuclear Energy Systems has been organized during 15-16th of October 2009. The aim of the seminar was to provide a forum for exchange of information, discussion on future research needs and networking of experts on Generation IV reactor concepts. As an outcome of the NOMAGE4, a few collaboration project proposals have been prepared/planned in 2009. The network was welcomed by the European Commission and was mentioned as an exemplary network with representatives from industries, universities, power companies and research institutes. NOMAGE4 has been invited to participate to the 'European Energy Research Alliance, EERA, workshop for nuclear structural materials' http://www.eera-set.eu/index.php?index=41 as external observers. Future plans include a new Nordic application for continuation of NOMAGE4 network. (author)

  12. Antecedents, mediators, and outcomes of authentic leadership in healthcare: A systematic review.

    Science.gov (United States)

    Alilyyani, Bayan; Wong, Carol A; Cummings, Greta

    2018-04-07

    performance) and patient outcomes. There were 23 mediators between authentic leadership and 35 different outcomes in the included studies and one antecedent of authentic leadership. Findings of this review provide support for authentic leadership theory and suggest need for additional testing in future studies using longitudinal and interventional designs in more varied healthcare settings with diverse and interprofessional healthcare samples. Knowledge generated through this systematic review provides a more comprehensive understanding of authentic leadership, which can be used to educate future leaders and has the potential to improve leadership development strategies and positive outcomes in healthcare workplaces. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. Long term outcomes of new generation drug eluting stents versus coronary artery bypass grafting for multivessel and/or left main coronary artery disease. A Bayesian network meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Mina, George S; Watti, Hussam; Soliman, Demiana; Shewale, Anand; Atkins, Jessica; Reddy, Pratap; Dominic, Paari

    2018-01-05

    Most data guiding revascularization of multivessel disease (MVD) and/or left main disease (LMD) favor coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI). However, those data are based on trials comparing CABG to bare metal stents (BMS) or old generation drug eluting stents (OG-DES). Hence, it is essential to outcomes of CABG to those of new generation drug eluting stents (NG-DES). We searched PUBMED and Cochrane database for trials evaluating revascularization of MVD and/or LMD with CABG and/or PCI. A Bayesian network meta-analysis was performed to calculate odds ratios (OR) and 95% credible intervals (CrI). Primary outcome was major adverse cardiovascular events (MACE) at 3-5 years. Secondary outcomes were mortality, cerebrovascular accidents (CVA), myocardial infarction (MI) and repeat revascularization. We included 10 trials with a total of 9287 patients. CABG was associated with lower MACE when compared to BMS or OG-DES. However, MACE was not significantly different between CABG and NG-DES (OR 0.79, CrI 0.45-1.40). Moreover, there were no significant differences between CABG and NG-DES in mortality (OR 0.78, CrI 0.45-1.37), CVA (OR 0.93 CrI 0.35-2.2) or MI (OR 0.6, CrI 0.17-2.0). On the other hand, CABG was associated with lower repeat revascularization (OR 0.55, CrI 0.36-0.84). Our study suggests that NG-DES is an acceptable alternative to CABG in patients with MVD and/or LMD. However, repeat revascularization remains to be lower with CABG than with PCI. Copyright © 2018. Published by Elsevier Inc.

  14. Power generation scheduling. A free market based procedure with reserve constraints included

    International Nuclear Information System (INIS)

    Huse, Einar Staale

    1998-01-01

    This thesis deals with the short-term scheduling of electric power generation in a competitive market. This involves determination of start-ups and shut-downs, and production levels of all units in all hours of the optimization period, considering unit characteristics and system restrictions. The unit characteristics and restrictions handled are minimum and maximum production levels, fuel cost function, start-up costs, minimum up time and minimum down time. The system restrictions handled are power balance (supply equals demand in all hours) and spinning reserve requirement. The thesis has two main contributions: (1) A new organization of an hourly electric power market that simultaneously sets the price of both energy and reserve power is proposed. A power exchange is used as a trading place for electricity. Its responsibility is to balance supply and demand bids and to secure enough spinning reserve. Routines for bidding and market clearing are developed. (2) A computer programme that simulates the proposed electricity market has been implemented. The program can also be used as a new method for solving the single owner generation scheduling problem. Simulations show that the performance of the program is excellent. Simulations also show that it is possible to obtain efficient schedules through the proposed electricity market. 37 refs., 20 figs., 15 tabs

  15. Power generation scheduling. A free market based procedure with reserve constraints included

    Energy Technology Data Exchange (ETDEWEB)

    Huse, Einar Staale

    1999-12-31

    This thesis deals with the short-term scheduling of electric power generation in a competitive market. This involves determination of start-ups and shut-downs, and production levels of all units in all hours of the optimization period, considering unit characteristics and system restrictions. The unit characteristics and restrictions handled are minimum and maximum production levels, fuel cost function, start-up costs, minimum up time and minimum down time. The system restrictions handled are power balance (supply equals demand in all hours) and spinning reserve requirement. The thesis has two main contributions: (1) A new organization of an hourly electric power market that simultaneously sets the price of both energy and reserve power is proposed. A power exchange is used as a trading place for electricity. Its responsibility is to balance supply and demand bids and to secure enough spinning reserve. Routines for bidding and market clearing are developed. (2) A computer programme that simulates the proposed electricity market has been implemented. The program can also be used as a new method for solving the single owner generation scheduling problem. Simulations show that the performance of the program is excellent. Simulations also show that it is possible to obtain efficient schedules through the proposed electricity market. 37 refs., 20 figs., 15 tabs.

  16. Power generation scheduling. A free market based procedure with reserve constraints included

    Energy Technology Data Exchange (ETDEWEB)

    Huse, Einar Staale

    1998-12-31

    This thesis deals with the short-term scheduling of electric power generation in a competitive market. This involves determination of start-ups and shut-downs, and production levels of all units in all hours of the optimization period, considering unit characteristics and system restrictions. The unit characteristics and restrictions handled are minimum and maximum production levels, fuel cost function, start-up costs, minimum up time and minimum down time. The system restrictions handled are power balance (supply equals demand in all hours) and spinning reserve requirement. The thesis has two main contributions: (1) A new organization of an hourly electric power market that simultaneously sets the price of both energy and reserve power is proposed. A power exchange is used as a trading place for electricity. Its responsibility is to balance supply and demand bids and to secure enough spinning reserve. Routines for bidding and market clearing are developed. (2) A computer programme that simulates the proposed electricity market has been implemented. The program can also be used as a new method for solving the single owner generation scheduling problem. Simulations show that the performance of the program is excellent. Simulations also show that it is possible to obtain efficient schedules through the proposed electricity market. 37 refs., 20 figs., 15 tabs.

  17. Iterative Authoring Using Story Generation Feedback: Debugging or Co-creation?

    Science.gov (United States)

    Swartjes, Ivo; Theune, Mariët

    We explore the role that story generation feedback may play within the creative process of interactive story authoring. While such feedback is often used as 'debugging' information, we explore here a 'co-creation' view, in which the outcome of the story generator influences authorial intent. We illustrate an iterative authoring approach in which each iteration consists of idea generation, implementation and simulation. We find that the tension between authorial intent and the partially uncontrollable story generation outcome may be relieved by taking such a co-creation approach.

  18. Construction and demolition waste generation rates for high-rise buildings in Malaysia.

    Science.gov (United States)

    Mah, Chooi Mei; Fujiwara, Takeshi; Ho, Chin Siong

    2016-12-01

    Construction and demolition waste continues to sharply increase in step with the economic growth of less developed countries. Though the construction industry is large, it is composed of small firms with individual waste management practices, often leading to the deleterious environmental outcomes. Quantifying construction and demolition waste generation allows policy makers and stakeholders to understand the true internal and external costs of construction, providing a necessary foundation for waste management planning that may overcome deleterious environmental outcomes and may be both economically and environmentally optimal. This study offers a theoretical method for estimating the construction and demolition project waste generation rate by utilising available data, including waste disposal truck size and number, and waste volume and composition. This method is proposed as a less burdensome and more broadly applicable alternative, in contrast to waste estimation by on-site hand sorting and weighing. The developed method is applied to 11 projects across Malaysia as the case study. This study quantifies waste generation rate and illustrates the construction method in influencing the waste generation rate, estimating that the conventional construction method has a waste generation rate of 9.88 t 100 m -2 , the mixed-construction method has a waste generation rate of 3.29 t 100 m -2 , and demolition projects have a waste generation rate of 104.28 t 100 m -2 . © The Author(s) 2016.

  19. Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

    Science.gov (United States)

    Marcus, Dawn A; Bernstein, Cheryl D; Haq, Adeel; Breuer, Paula

    2014-06-01

    Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p fibromyalgia treatment effectiveness. © 2013 John Wiley & Sons, Ltd.

  20. Advancing the Strategic Messages Affecting Robot Trust Effect: The Dynamic of User- and Robot-Generated Content on Human-Robot Trust and Interaction Outcomes.

    Science.gov (United States)

    Liang, Yuhua Jake; Lee, Seungcheol Austin

    2016-09-01

    Human-robot interaction (HRI) will soon transform and shift the communication landscape such that people exchange messages with robots. However, successful HRI requires people to trust robots, and, in turn, the trust affects the interaction. Although prior research has examined the determinants of human-robot trust (HRT) during HRI, no research has examined the messages that people received before interacting with robots and their effect on HRT. We conceptualize these messages as SMART (Strategic Messages Affecting Robot Trust). Moreover, we posit that SMART can ultimately affect actual HRI outcomes (i.e., robot evaluations, robot credibility, participant mood) by affording the persuasive influences from user-generated content (UGC) on participatory Web sites. In Study 1, participants were assigned to one of two conditions (UGC/control) in an original experiment of HRT. Compared with the control (descriptive information only), results showed that UGC moderated the correlation between HRT and interaction outcomes in a positive direction (average Δr = +0.39) for robots as media and robots as tools. In Study 2, we explored the effect of robot-generated content but did not find similar moderation effects. These findings point to an important empirical potential to employ SMART in future robot deployment.

  1. Self-Esteem, Locus of Control, College Adjustment, and GPA among First- and Continuing-Generation Students: A Moderator Model of Generational Status

    Science.gov (United States)

    Aspelmeier, Jeffery E.; Love, Michael M.; McGill, Lauren A.; Elliott, Ann N.; Pierce, Thomas W.

    2012-01-01

    The role of generational status (first-generation vs. continuing-generation college students) as a moderator of the relationship between psychological factors and college outcomes was tested to determine whether generational status acts as a risk factor or as a sensitizing factor. The sample consisted of 322 undergraduate students who completed…

  2. Wind Generators and Market Power

    DEFF Research Database (Denmark)

    Misir, Nihat

    price thresholds are significantly higher when the monopolist at the peakload level owns both types of generators. Furthermore, when producing electricity with the peakload generator, the monopolist can avoid facing prices below marginal cost by owning a certain share of the wind generators.......Electricity production from wind generators holds significant importance in European Union’s 20% renewable energy target by 2020. In this paper, I show that ownership of wind generators affects market outcomes by using both a Cournot oligopoly model and a real options model. In the Cournot...... oligopoly model, ownership of the wind generators by owners of fossil-fueled (peakload) generators decreases total peakload production and increases the market price. These effects increase with total wind generation and aggregate wind generator ownership. In the real options model, start up and shut down...

  3. Prediction of extubation outcome in preterm infants by composite extubation indices.

    Science.gov (United States)

    Dimitriou, Gabriel; Fouzas, Sotirios; Vervenioti, Aggeliki; Tzifas, Sotirios; Mantagos, Stefanos

    2011-11-01

    To determine whether composite extubation indices can predict extubation outcome in preterm infants. Prospective observational study. Level III neonatal intensive care unit. Fifty-six preterm infants cared for in the neonatal intensive care unit of a tertiary teaching hospital during 2007 and 2008. None. The study consisted of two parts. In the first part, different extubation indices were evaluated in a group of 28 neonates (derivation group). These indices included the diaphragmatic pressure-time index, the respiratory muscle pressure-time index, the maximal transdiaphragmatic pressure, the maximal inspiratory pressure, the airway pressure generated 100 milliseconds after an occlusion/maximal transdiaphragmatic pressure ratio, the airway pressure generated 100 milliseconds after an occlusion/maximal inspiratory pressure ratio, the tidal volume, and the respiratory rate to tidal volume ratio. After exploratory analysis, the best performing indices and the optimal threshold values to predict extubation outcome were selected. In the second part of the study, these indices were validated at the predetermined threshold values in an additional group of 28 preterm neonates (validation group). Four infants (14.3%) in the derivation group and four in the validation group (14.3%) failed extubation. Receiver operator characteristic curve analysis revealed that a diaphragmatic pressure-time index of ≤0.12, a respiratory muscle pressure-time index ≤0.10, a airway pressure generated 100 milliseconds after an occlusion/maximal transdiaphragmatic pressure of ≤0.14, and a airway pressure generated 100 milliseconds after an occlusion/maximal inspiratory pressure of ≤0.09 were the most accurate predictors of extubation outcome in the derivation group. In the validation group, a diaphragmatic pressure-time index of ≤0.12 and a respiratory muscle pressure-time index of ≤0.10 both had zero false-positive results, predicting with accuracy successful extubation. Composite

  4. Distributed generation induction and permanent magnet generators

    CERN Document Server

    Lai, L

    2007-01-01

    Distributed power generation is a technology that could help to enable efficient, renewable energy production both in the developed and developing world. It includes all use of small electric power generators, whether located on the utility system, at the site of a utility customer, or at an isolated site not connected to the power grid. Induction generators (IGs) are the cheapest and most commonly used technology, compatible with renewable energy resources. Permanent magnet (PM) generators have traditionally been avoided due to high fabrication costs; however, compared with IGs they are more reliable and productive. Distributed Generation thoroughly examines the principles, possibilities and limitations of creating energy with both IGs and PM generators. It takes an electrical engineering approach in the analysis and testing of these generators, and includes diagrams and extensive case study examples o better demonstrate how the integration of energy sources can be accomplished. The book also provides the ...

  5. Spanish generation market: structure, design and results

    International Nuclear Information System (INIS)

    Agosti, L.; Padilla, A. J.; Requejo, A.

    2007-01-01

    This paper provides an overview of the structure, design and outcome of the Spanish generation market from 1998, when the market was liberalised, to date. More precisely, this paper reviews the history of the liberalisation process; describes the structure of the generation market and its evolution over time; analyses the existence of market power; and evaluates the outcome of the liberalisation process from the viewpoint of its impact on al locative efficiency, productive efficiency and dynamic efficiency. The paper concludes with a brief summary of recent regulatory reforms. (Author)

  6. Meta-Analysis of Randomized Clinical Trials Comparing Biodegradable Polymer Drug-Eluting Stent to Second-Generation Durable Polymer Drug-Eluting Stents.

    Science.gov (United States)

    El-Hayek, Georges; Bangalore, Sripal; Casso Dominguez, Abel; Devireddy, Chandan; Jaber, Wissam; Kumar, Gautam; Mavromatis, Kreton; Tamis-Holland, Jacqueline; Samady, Habib

    2017-03-13

    The authors sought to perform a meta-analysis of randomized clinical trials (RCTs) comparing the safety and efficacy of biodegradable polymer drug-eluting stents (BP-DES) to second-generation durable polymer drug-eluting stents (DP-DES). Prior meta-analyses have established the superiority of BP-DES over bare-metal stents and first-generation DP-DES; however, their advantage compared with second-generation DP-DES remains controversial. The authors searched PubMed and Scopus databases for RCTs comparing BP-DES to the second-generation DP-DES. Outcomes included target vessel revascularization (TVR) as efficacy outcome and cardiac death, myocardial infarction (MI), and definite or probable stent thrombosis (ST) as safety outcomes. In addition, we performed landmark analysis for endpoints beyond 1 year of follow-up and a subgroup analysis based on the stent characteristics. The authors included 16 RCTs comprising 19,886 patients in the meta-analysis. At the longest available follow-up (mean duration 26 months), we observed no significant differences in TVR (p = 0.62), cardiac death (p = 0.46), MI (p = 0.98), or ST (risk ratio: 0.83, 95% confidence interval: 0.64 to 1.09; p = 0.19). Our landmark analysis showed that BP-DES were not associated with a reduction in the risk of very late ST (risk ratio: 0.87, 95% confidence interval: 0.49 to 1.53; p = 0.62). Similar outcomes were seen regardless of the eluting drug (biolimus vs. sirolimus), the stent platform (stainless steel vs. alloy), the kinetics of polymer degradation or drug release (6 months), the strut thickness of the BP-DES (thin 100 μm), or the DAPT duration (≥6 months vs. ≥12 months). BP-DES have similar safety and efficacy profiles to second-generation DP-DES. Published by Elsevier Inc.

  7. The association between HIV (treatment), pregnancy serum lipid concentrations and pregnancy outcomes: a systematic review.

    Science.gov (United States)

    Harmsen, Marissa J; Browne, Joyce L; Venter, Francois; Klipstein-Grobusch, Kerstin; Rijken, Marcus J

    2017-07-11

    Observed adverse effects of antiretroviral therapy (ART) on the lipid profile could be of significance in pregnancy. This systematic review aims to summarize studies that investigated the association between HIV, ART and serum lipids during pregnancy and adverse pregnancy outcomes. A systematic search was conducted in five electronic databases to obtain articles that measured serum lipid concentrations or the incidence of dyslipidaemia in HIV-infected pregnant women. Included articles were assessed for quality according to the Cochrane Risk of Bias Tool. The extracted data was analysed through descriptive analysis. Of the 1264 articles screened, 17 articles were included in this review; eleven reported the incidence of dyslipidaemia, and twelve on maternal serum lipid concentrations under the influence of HIV-infection and ART. No articles reported pregnancy outcomes in relation to serum lipids. Articles were of acceptable quality, but heterogenic in methods and study design. Lipid levels in HIV-infected women increased 1.5-3 fold over the trimesters of pregnancy, and remained within the physiological reference range. The percentage of women with dyslipidaemia was variable between the studies [0-88.9%] and highest in the groups on first generation protease inhibitors and for women on ART at conception. This systematic review observed physiologic concentrations of serum lipids for HIV-infected women receiving ART during pregnancy. Serum lipids were increased in users of first generation protease inhibitors and for those on treatment at conception. There was no information available about pregnancy outcomes. Future studies are needed which include HIV-uninfected control groups, control for potential confounders, and overcome limitations associated with included studies.

  8. First-Generation Versus Second-Generation Drug-Eluting Stents in Coronary Chronic Total Occlusions: Two-Year Results of a Multicenter Registry.

    Directory of Open Access Journals (Sweden)

    Jong-Hwa Ahn

    Full Text Available Limited data are available regarding the long-term clinical outcomes of second-generation drug-eluting stents (DES versus first-generation DES in patients with coronary chronic total occlusion (CTO who undergo percutaneous coronary intervention (PCI. The aim of this study was to compare the clinical outcomes of second-generation DES with those of first-generation DES for the treatment of CTO.Between March 2003 and February 2012, 1,006 consecutive patients with CTO who underwent successful PCI using either first-generation DES (n = 557 or second-generation DES (n = 449 were enrolled in a multicenter, observational registry. Propensity-score matching was also performed. The primary outcome was cardiac death over a 2-year follow-up period. No significant differences were observed between the two groups regarding the incidence of cardiac death (first-generation DES versus second-generation DES; 2.5% vs 2.0%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.37 to 1.98; p = 0.72 or major adverse cardiac events (MACE, 11.8% vs 11.4%; HR: 1.00; 95% CI: 0.67 to 1.50; p = 0.99. After propensity score matching, the incidences of cardiac death (HR: 0.86; 95% CI: 0.35 to 2.06; p = 0.86 and MACE (HR: 0.93; 95% CI: 0.63 to 1.37; p = 0.71 were still similar in both groups. Furthermore, no significant differences were observed between sirolimus-eluting, paclitaxel-eluting, zotarolimus-eluting, and everolimus-eluting stents regarding the incidence of cardiac death or MACE.This study shows that the efficacy of second-generation DES is comparable to that of first-generation DES for treatment of CTO over 2 years of follow-up.

  9. Sodium-glucose cotransporter-2 inhibitors and cardiovascular outcomes in type 2 diabetes mellitus: A systematic review

    Directory of Open Access Journals (Sweden)

    Ziad G Nasr

    2017-01-01

    Full Text Available Sodium-glucose cotransporter - 2 (SGLT2 inhibitors are a novel class of anti-diabetics proven to reduce blood pressure, blood glucose and body weight. However, the long-term cardiovascular (CV safety implications of these agents remain unclear. This systematic review aimed to evaluate the available clinical trial evidence pertaining to long-term cardiovascular safety of SGLT2 inhibitors. The databases EMBASE and MEDLINE were searched. Randomized controlled trials assessing CV safety of SGLT2 inhibitors compared with placebo or anti-diabetic medications were included. Two investigators independently extracted study data and completed risk of bias assessments (sequence generation, allocation concealment, blinding, incomplete outcome data, or selective outcome reporting and other biases. Outcomes included CV death, myocardial infarction, and stroke. A total of 464 studies were identified in the electronic search and 14 from other sources. Sixteen randomized clinical trials were included after full-text review. All studies reported at least one of the pre-defined outcomes (CV death, myocardial infarction, and stroke. Nineteen CV deaths were reported in SGLT2 inhibitors groups versus 10 CV deaths in placebo or other comparator arms; numerically higher in the dapagliflozin arms. The number of CV events was numerically higher in SGLT2 inhibitor groups than in other arms. Risk of bias assessment showed mixed results, with overall quality assessments deemed unclear for 6 of 16 studies (37.5%. Findings showed CV outcomes do occur in patients taking SGLT2 inhibitors yet the clinical significance remains unclear. These results can be considered hypothesis generating, as studies were limited by inadequate power and/or follow-up time. Future longitudinal studies are needed to further assess the efficacy and safety profiles of these new agents before they become widely adopted in clinical practice.

  10. Is da Vinci Xi Better than da Vinci Si in Robotic Rectal Cancer Surgery? Comparison of the 2 Generations of da Vinci Systems.

    Science.gov (United States)

    Ozben, Volkan; Cengiz, Turgut B; Atasoy, Deniz; Bayraktar, Onur; Aghayeva, Afag; Erguner, Ilknur; Baca, Bilgi; Hamzaoglu, Ismail; Karahasanoglu, Tayfun

    2016-10-01

    We aimed to compare perioperative outcomes for procedures using the latest generation of da Vinci robot versus its previous version in rectal cancer surgery. Fifty-three patients undergoing robotic rectal cancer surgery between January 2010 and March 2015 were included. Patients were classified into 2 groups (Xi, n=28 vs. Si, n=25) and perioperative outcomes were analyzed. The groups had significant differences including operative procedure, hybrid technique and redocking (P>0.05). In univariate analysis, the Xi group had shorter console times (265.7 vs. 317.1 min, P=0.006) and total operative times (321.6 vs. 360.4 min, P=0.04) and higher number of lymph nodes harvested (27.5 vs. 17.0, P=0.008). In multivariate analysis, Xi robot was associated with a shorter console time (odds ratio: 0.09, P=0.004) with no significant differences regarding other outcomes. Both generations of da Vinci robot led to similar short-term outcomes in rectal cancer surgery, but the Xi robot allowed shorter console times.

  11. Network meta-analysis of multiple outcome measures accounting for borrowing of information across outcomes.

    Science.gov (United States)

    Achana, Felix A; Cooper, Nicola J; Bujkiewicz, Sylwia; Hubbard, Stephanie J; Kendrick, Denise; Jones, David R; Sutton, Alex J

    2014-07-21

    Network meta-analysis (NMA) enables simultaneous comparison of multiple treatments while preserving randomisation. When summarising evidence to inform an economic evaluation, it is important that the analysis accurately reflects the dependency structure within the data, as correlations between outcomes may have implication for estimating the net benefit associated with treatment. A multivariate NMA offers a framework for evaluating multiple treatments across multiple outcome measures while accounting for the correlation structure between outcomes. The standard NMA model is extended to multiple outcome settings in two stages. In the first stage, information is borrowed across outcomes as well across studies through modelling the within-study and between-study correlation structure. In the second stage, we make use of the additional assumption that intervention effects are exchangeable between outcomes to predict effect estimates for all outcomes, including effect estimates on outcomes where evidence is either sparse or the treatment had not been considered by any one of the studies included in the analysis. We apply the methods to binary outcome data from a systematic review evaluating the effectiveness of nine home safety interventions on uptake of three poisoning prevention practices (safe storage of medicines, safe storage of other household products, and possession of poison centre control telephone number) in households with children. Analyses are conducted in WinBUGS using Markov Chain Monte Carlo (MCMC) simulations. Univariate and the first stage multivariate models produced broadly similar point estimates of intervention effects but the uncertainty around the multivariate estimates varied depending on the prior distribution specified for the between-study covariance structure. The second stage multivariate analyses produced more precise effect estimates while enabling intervention effects to be predicted for all outcomes, including intervention effects on

  12. Three-year patient-related and stent-related outcomes of second-generation everolimus-eluting Xience V stents versus zotarolimus-eluting resolute stents in real-world practice (from the Multicenter Prospective EXCELLENT and RESOLUTE-Korea Registries).

    Science.gov (United States)

    Lee, Joo Myung; Park, Kyung Woo; Han, Jung-Kyu; Yang, Han-Mo; Kang, Hyun-Jae; Koo, Bon-Kwon; Bae, Jang-Whan; Woo, Sung-Il; Park, Jin Sik; Jin, Dong-Kyu; Jeon, Dong Woon; Oh, Seok Kyu; Park, Jong-Seon; Kim, Doo-Il; Hyon, Min Su; Jeon, Hui-Kyung; Lim, Do-Sun; Kim, Myeong-Gon; Rha, Seung-Woon; Her, Sung-Ho; Hwang, Jin-Yong; Kim, Sanghyun; Choi, Young Jin; Kang, Jin Ho; Moon, Keon-Woong; Jang, Yangsoo; Kim, Hyo-Soo

    2014-11-01

    Long-term outcomes are imperative to confirm safety of drug-eluting stents. There have been 2 randomized controlled trials comparing everolimus-eluting stents (EESs) and Resolute zotarolimus-eluting stents (ZES-Rs). To date, long-term clinical outcomes of these stents were limited to only 1 report, which has recently reported 4-year comparisons of these stents. Therefore, more evidence is needed regarding long-term clinical outcomes of the second-generation stents. This study compared the long-term clinical outcomes of EES with ZES-R in "all-comer" cohorts up to 3-year follow-up. The EXCELLENT and RESOLUTE-Korea registries prospectively enrolled 3,056 patients treated with EES and 1,998 with ZES-R, respectively, without exclusions. Stent-related composite outcomes (target lesion failure) and patient-related composite events up to 3-year follow-up were compared in crude and propensity score-matched analyses. Of 5,054 patients, 3,830 patients (75.8%) had off-label indication (2,217 treated with EES and 1,613 treated with ZES-R). The stent-related outcome (189 [6.2%] vs 127 [6.4%], p = 0.812) and the patient-related outcome (420 [13.7%] vs 250 [12.5%], p = 0.581) did not differ between EES and ZES-R, respectively, at 3 years, which was corroborated by similar results from the propensity score-matched cohort (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.70 to 1.20, p = 0.523 and 0.85, 95% CI 0.70 to 1.02, p = 0.081, for stent- and patient-related outcomes, respectively). The rate of definite or probable stent thrombosis up to 3 years (22 [0.7%] vs 10 [0.5%], p = 0.370) was also similar. The rate of very late definite or probable stent thrombosis was very low and comparable between the 2 stents (3 [0.1%] vs 1 [0.1%], p = 0.657). In multivariate analysis, chronic renal failure (adjusted HR 3.615, 95% CI 2.440 to 5.354, p stents showed comparable safety and efficacy at 3-year follow-up in this robust real-world registry with unrestricted use of EES and

  13. Outcomes of dental hygiene baccalaureate degree education in Canada.

    Science.gov (United States)

    Kanji, Zul; Sunell, Susanne; Boschma, Geertje; Imai, Pauline; Craig, Bonnie J

    2011-03-01

    There is little published literature about the outcomes of dental hygiene baccalaureate degree education, particularly in Canada. Since there are various dental hygiene entry-to-practice educational models in Canada, exploring baccalaureate dental hygiene education is becoming an increasingly important subject. The purpose of this study was to explore the personal outcomes and dental hygiene practice outcomes of dental hygiene degree-completion education in Canada from the perspectives of diploma dental hygienists who have continued their education to the bachelor's degree level. This study employed a qualitative phenomenological design, using a maximum variation purposeful sampling strategy. Data generation occurred with sixteen dental hygienists across Canada through individual semistructured interviews. Interviews were audiorecorded, transcribed verbatim, and coded for data analysis, involving pattern recognition and thematic development. Themes that emerged included changes in self-perception, values, and knowledge base. Changes in self-perception were reflected in a reported increase in self-confidence and perceived credibility. Changes in values included a greater appreciation for lifelong learning. Advancements in knowledge strengthened the development of specific abilities that ultimately influenced participants' dental hygiene practice. These abilities included an increased ability to think critically, to make evidence-based decisions, and to provide more comprehensive care. Participants also commented on having more career opportunities available to them outside of the private clinical practice setting. These results reveal important insights into the impact of earning a dental hygiene baccalaureate degree on oneself and one's dental hygiene practice.

  14. Power Generation for River and Tidal Generators

    Energy Technology Data Exchange (ETDEWEB)

    Muljadi, Eduard [National Renewable Energy Lab. (NREL), Golden, CO (United States); Wright, Alan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Donegan, James [Ocean Renewable Power Company (ORPC), Portland, ME (United States); Marnagh, Cian [Ocean Renewable Power Company (ORPC), Portland, ME (United States); McEntee, Jarlath [Ocean Renewable Power Company (ORPC), Portland, ME (United States)

    2016-06-01

    Renewable energy sources are the second largest contributor to global electricity production, after fossil fuels. The integration of renewable energy continued to grow in 2014 against a backdrop of increasing global energy consumption and a dramatic decline in oil prices during the second half of the year. As renewable generation has become less expensive during recent decades, and it becomes more accepted by the global population, the focus on renewable generation has expanded from primarily wind and solar to include new types with promising future applications, such as hydropower generation, including river and tidal generation. Today, hydropower is considered one of the most important renewable energy sources. In river and tidal generation, the input resource flow is slower but also steadier than it is in wind or solar generation, yet the level of water turbulent flow may vary from one place to another. This report focuses on hydrokinetic power conversion.

  15. Problem- and case-based learning in science: an introduction to distinctions, values, and outcomes.

    Science.gov (United States)

    Allchin, Douglas

    2013-01-01

    Case-based learning and problem-based learning have demonstrated great promise in reforming science education. Yet an instructor, in newly considering this suite of interrelated pedagogical strategies, faces a number of important instructional choices. Different features and their related values and learning outcomes are profiled here, including: the level of student autonomy; instructional focus on content, skills development, or nature-of-science understanding; the role of history, or known outcomes; scope, clarity, and authenticity of problems provided to students; extent of collaboration; complexity, in terms of number of interpretive perspectives; and, perhaps most importantly, the role of applying versus generating knowledge.

  16. Predictability of psychic outcome for exercise training and exercise training including relaxation therapy after myocardial infarction

    NARCIS (Netherlands)

    H.J. Duivenvoorden (Hugo); J. van Dixhoorn (J.)

    1991-01-01

    markdownabstractAbstract Predictability of the psychic outcome for two cardiac rehabilitation programmes was investigated in 119 myocardial infarction patients. They were randomly assigned to either a five-week daily exercise training or to an identical training in combination with six sessions

  17. Projected costs of electricity generation

    International Nuclear Information System (INIS)

    Cameron, R.

    2010-01-01

    This paper describes the outcomes of a study on the projected costs of generating electricity. It presents the latest data available on electricity generating costs for a wide variety of fuels and technologies, including coal, gas, nuclear, hydro, onshore and offshore wind, biomass, solar, wave and tidal. The study reaches 2 key conclusions. First, at a 5% real interest rate, nuclear energy is the most competitive solution for base-load electricity generation followed by coal-fired plants without carbon capture and natural gas-fired combined plants. It should be noted that coal with carbon capture has not reached a commercial phase. Second, at a 10% interest rate, nuclear remains the most competitive in Asia and North America but in Europe, coal without carbon capture equipment, followed by coal with carbon capture equipment, and gas-fired combined cycle turbines are overall more competitive than nuclear energy. The results highlight the paramount importance of interest rates (this dependence is a direct consequence of the nuclear energy's high capital costs) and of the carbon price. For instance if we assume a 10% interest rate and a cost of 50 dollar per tonne of CO 2 , nuclear energy would become competitive against both coal and gas. (A.C.)

  18. The surgery of peripheral nerves (including tumors)

    DEFF Research Database (Denmark)

    Fugleholm, Kåre

    2013-01-01

    Surgical pathology of the peripheral nervous system includes traumatic injury, entrapment syndromes, and tumors. The recent significant advances in the understanding of the pathophysiology and cellular biology of peripheral nerve degeneration and regeneration has yet to be translated into improved...... surgical techniques and better outcome after peripheral nerve injury. Decision making in peripheral nerve surgery continues to be a complex challenge, where the mechanism of injury, repeated clinical evaluation, neuroradiological and neurophysiological examination, and detailed knowledge of the peripheral...... nervous system response to injury are prerequisite to obtain the best possible outcome. Surgery continues to be the primary treatment modality for peripheral nerve tumors and advances in adjuvant oncological treatment has improved outcome after malignant peripheral nerve tumors. The present chapter...

  19. A NEW GENERATION OF PARSEC-COLIBRI STELLAR ISOCHRONES INCLUDING THE TP-AGB PHASE

    International Nuclear Information System (INIS)

    Marigo, Paola; Aringer, Bernhard; Chen, Yang; Dussin, Marco; Nanni, Ambra; Pastorelli, Giada; Rodrigues, Thaíse S.; Trabucchi, Michele; Bladh, Sara; Montalbán, Josefina; Girardi, Léo; Bressan, Alessandro; Rosenfield, Philip; Dalcanton, Julianne; Groenewegen, Martin A. T.; Wood, Peter R.

    2017-01-01

    We introduce a new generation of PARSEC–COLIBRI stellar isochrones that includes a detailed treatment of the thermally pulsing asymptotic giant branch (TP-AGB) phase, covering a wide range of initial metallicities (0.0001 < Z i < 0.06). Compared to previous releases, the main novelties and improvements are use of new TP-AGB tracks and related atmosphere models and spectra for M and C-type stars; inclusion of the surface H+He+CNO abundances in the isochrone tables, accounting for the effects of diffusion, dredge-up episodes and hot-bottom burning; inclusion of complete thermal pulse cycles, with a complete description of the in-cycle changes in the stellar parameters; new pulsation models to describe the long-period variability in the fundamental and first-overtone modes; and new dust models that follow the growth of the grains during the AGB evolution, in combination with radiative transfer calculations for the reprocessing of the photospheric emission. Overall, these improvements are expected to lead to a more consistent and detailed description of properties of TP-AGB stars expected in resolved stellar populations, especially in regard to their mean photometric properties from optical to mid-infrared wavelengths. We illustrate the expected numbers of TP-AGB stars of different types in stellar populations covering a wide range of ages and initial metallicities, providing further details on the “C-star island” that appears at intermediate values of age and metallicity, and about the AGB-boosting effect that occurs at ages close to 1.6-Gyr for populations of all metallicities. The isochrones are available through a new dedicated web server.

  20. A NEW GENERATION OF PARSEC-COLIBRI STELLAR ISOCHRONES INCLUDING THE TP-AGB PHASE

    Energy Technology Data Exchange (ETDEWEB)

    Marigo, Paola; Aringer, Bernhard; Chen, Yang; Dussin, Marco; Nanni, Ambra; Pastorelli, Giada; Rodrigues, Thaíse S.; Trabucchi, Michele; Bladh, Sara; Montalbán, Josefina [Dipartimento di Fisica e Astronomia Galileo Galilei, Università di Padova, Vicolo dell’Osservatorio 3, I-35122 Padova (Italy); Girardi, Léo [Osservatorio Astronomico di Padova—INAF, Vicolo dell’Osservatorio 5, I-35122 Padova (Italy); Bressan, Alessandro [SISSA, via Bonomea 365, I-34136 Trieste (Italy); Rosenfield, Philip [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Dalcanton, Julianne [Department of Astronomy, University of Washington, Box 351580, Seattle, WA 98195 (United States); Groenewegen, Martin A. T. [Koninklijke Sterrenwacht van België, Ringlaan 3, B-1180 Brussels (Belgium); Wood, Peter R. [Research School of Astronomy and Astrophysics, Australian National University, Cotter Road, Weston Creek, ACT 2611 (Australia)

    2017-01-20

    We introduce a new generation of PARSEC–COLIBRI stellar isochrones that includes a detailed treatment of the thermally pulsing asymptotic giant branch (TP-AGB) phase, covering a wide range of initial metallicities (0.0001 < Z {sub i} < 0.06). Compared to previous releases, the main novelties and improvements are use of new TP-AGB tracks and related atmosphere models and spectra for M and C-type stars; inclusion of the surface H+He+CNO abundances in the isochrone tables, accounting for the effects of diffusion, dredge-up episodes and hot-bottom burning; inclusion of complete thermal pulse cycles, with a complete description of the in-cycle changes in the stellar parameters; new pulsation models to describe the long-period variability in the fundamental and first-overtone modes; and new dust models that follow the growth of the grains during the AGB evolution, in combination with radiative transfer calculations for the reprocessing of the photospheric emission. Overall, these improvements are expected to lead to a more consistent and detailed description of properties of TP-AGB stars expected in resolved stellar populations, especially in regard to their mean photometric properties from optical to mid-infrared wavelengths. We illustrate the expected numbers of TP-AGB stars of different types in stellar populations covering a wide range of ages and initial metallicities, providing further details on the “C-star island” that appears at intermediate values of age and metallicity, and about the AGB-boosting effect that occurs at ages close to 1.6-Gyr for populations of all metallicities. The isochrones are available through a new dedicated web server.

  1. Integrating publicly-available data to generate computationally-predicted adverse outcome pathways for hepatic steatosis

    Science.gov (United States)

    The adverse outcome pathway (AOP) framework provides a way of organizing knowledge related to the key biological events that result in a particular health outcome. For the majority of environmental chemicals, the availability of curated pathways characterizing potential toxicity ...

  2. Gender, renal function, and outcomes on the liver transplant waiting list: assessment of revised MELD including estimated glomerular filtration rate.

    Science.gov (United States)

    Myers, Robert P; Shaheen, Abdel Aziz M; Aspinall, Alexander I; Quinn, Robert R; Burak, Kelly W

    2011-03-01

    The Model for End-Stage Liver Disease (MELD) allocation system for liver transplantation (LT) may present a disadvantage for women by including serum creatinine, which is typically lower in females. Our objectives were to investigate gender disparities in outcomes among LT candidates and to assess a revised MELD, including estimated glomerular filtration rate (eGFR), for predicting waiting list mortality. Adults registered for LT between 2002 and 2007 were identified using the UNOS database. We compared components of MELD, MDRD-derived eGFR, and the 3-month probability of LT and death between genders. Discrimination of MELD, MELDNa, and revised models including eGFR for mortality were compared using c-statistics. A total of 40,393 patients (36% female) met the inclusion criteria; 9% died and 24% underwent LT within 3 months of listing. Compared with men, women had lower median serum creatinine (0.9 vs. 1.0 mg/dl), eGFR (72 vs. 83 ml/min/1.73 m(2)), and mean MELD (16.5 vs. 17.2; all p discrimination for 3-month mortality (c-statistics: MELD 0.896, MELD-eGFR 0.894, MELDNa 0.911, MELDNa-eGFR 0.905). Women are disadvantaged under MELD potentially due to its inclusion of creatinine. However, since including eGFR in MELD does not improve mortality prediction, alternative refinements are necessary. Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  3. Gamma ray generator

    Science.gov (United States)

    Firestone, Richard B; Reijonen, Jani

    2014-05-27

    An embodiment of a gamma ray generator includes a neutron generator and a moderator. The moderator is coupled to the neutron generator. The moderator includes a neutron capture material. In operation, the neutron generator produces neutrons and the neutron capture material captures at least some of the neutrons to produces gamma rays. An application of the gamma ray generator is as a source of gamma rays for calibration of gamma ray detectors.

  4. TIAM1 variants improve clinical outcome in neuroblastoma.

    Science.gov (United States)

    Sanmartín, Elena; Yáñez, Yania; Fornés-Ferrer, Victoria; Zugaza, José L; Cañete, Adela; Castel, Victoria; Font de Mora, Jaime

    2017-07-11

    Identification of tumor driver mutations is crucial for improving clinical outcome using a personalized approach to the treatment of cancer. Neuroblastoma is a tumor of the peripheral sympathetic nervous system for which only a few driver alterations have been described including MYCN amplification and ALK mutations. We assessed 106 primary neuroblastoma tumors by next generation sequencing using a customized amplicon-based gene panel. Our results reveal that genetic variants in TIAM1 gene associate with better clinical outcome, suggesting a role for these TIAM1 variants in preventing progression of this disease. The detected variants are located within the different domains of TIAM1 that signal to the upstream regulator RAS and downstream effector molecules MYC and RAC, which are all implicated in neuroblastoma etiology and progression. Clinical outcome was improved in tumors where a TIAM1 variant was present concomitantly with either ALK mutation or MYCN amplification. Given the function of these signaling molecules in cell survival, proliferation, differentiation and neurite outgrowth, our data suggest that the TIAM1-mediated network is essential to neuroblastoma and thus, inhibiting TIAM1 reflects a rational strategy for improving therapy efficacy in neuroblastoma.

  5. Generation, language, body mass index, and activity patterns in Hispanic children.

    Science.gov (United States)

    Taverno, Sharon E; Rollins, Brandi Y; Francis, Lori A

    2010-02-01

    The acculturation hypothesis proposes an overall disadvantage in health outcomes for Hispanic immigrants with more time spent living in the U.S., but little is known about how generational status and language may influence Hispanic children's relative weight and activity patterns. To investigate associations among generation and language with relative weight (BMI z-scores), physical activity, screen time, and participation in extracurricular activities (i.e., sports, clubs) in a U.S.-based, nationally representative sample of Hispanic children. Participants included 2012 Hispanic children aged 6-11 years from the cross-sectional 2003 National Survey of Children's Health. Children were grouped according to generational status (first, second, or third), and the primary language spoken in the home (English versus non-English). Primary analyses included adjusted logistic and multinomial logistic regression to examine the relationships among variables; all analyses were conducted between 2008 and 2009. Compared to third-generation, English speakers, first- and second-generation, non-English speakers were more than two times more likely to be obese. Moreover, first-generation, non-English speakers were half as likely to engage in regular physical activity and sports. Both first- and second-generation, non-English speakers were less likely to participate in clubs compared to second- and third-generation, English speakers. Overall, non-English-speaking groups reported less screen time compared to third-generation, English speakers. The hypothesis that Hispanics lose their health protection with more time spent in the U.S. was not supported in this sample of Hispanic children. Copyright 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  6. Self-Reported Health Experiences of Children Living with Congenital Heart Defects: Including Patient-Reported Outcomes in a National Cohort Study.

    Science.gov (United States)

    Knowles, Rachel Louise; Tadic, Valerija; Hogan, Ailbhe; Bull, Catherine; Rahi, Jugnoo Sangeeta; Dezateux, Carol

    2016-01-01

    Understanding children's views about living with congenital heart defects (CHDs) is fundamental to supporting their successful participation in daily life, school and peer relationships. As an adjunct to a health and quality of life outcomes questionnaire, we asked school-age children who survived infant heart procedures to describe their experiences of living with CHDs. In a UK-wide cohort study, children aged 10 to 14 years with CHDs self-completed postal questionnaires that included an open question about having a 'heart problem'. We compared the characteristics of children with more and less severe cardiac diagnoses and, through collaborative inductive content analysis, investigated the subjective experiences and coping strategies described by children in both clinical severity groups. Text and/or drawings were returned by 436 children (246 boys [56%], mean age 12.1 years [SD 1.0; range 10-14]); 313 had less severe (LS) and 123 more severe (MS) cardiac diagnoses. At the most recent hospital visit, a higher proportion of the MS group were underweight (more than two standard deviations below the mean for age) or cyanosed (underweight: MS 20.0%, LS 9.9%; cyanosed: MS 26.2%, LS 3.5%). Children in the MS group described concerns about social isolation and feeling 'different', whereas children with less severe diagnoses often characterised their CHD as 'not a big thing'. Some coping strategies were common to both severity groups, including managing health information to avoid social exclusion, however only children in the LS group considered their CHD 'in the past' or experienced a sense of survivorship. Children's reported experiences were not dependent on their cardiac diagnosis, although there were clear qualitative differences by clinical severity group. Children's concerns emphasised social participation and our findings imply a need to shift the clinical focus from monitoring cardiac function to optimising participation. We highlight the potential for informing

  7. Patient-generated subjective global assessment: Innovation from paper to digital app

    OpenAIRE

    Ottery, Faith D.; Kasenic, Suzanne; Sealy, Martine J.; DeBolt, Susan P.; Isenring, Elizabeth; Jager-Wittenaar, Harriët

    2015-01-01

    Purpose: The Patient-Generated Subjective Global Assessment (PG-SGA), including the PG-SGA Short Form (SF, aka ‘abridged’), was originally developed in the mid 1990’s as a scored, patient self-report, paperbased instrument and has been widely validated. The PG-SGA (SF) has been used for screening, assessment and monitoring, triageing for multimodal intervention and for evaluation of clinical and health economic outcomes. There have been ad hoc translations, often with permission of the origin...

  8. Using public policy to improve outcomes for asthmatic children in schools.

    Science.gov (United States)

    Lynn, Jewlya; Oppenheimer, Sophie; Zimmer, Lorena

    2014-12-01

    School-based services to improve asthma management need to be accompanied by public policies that can help sustain services, scale effective interventions, create greater equity across schools, and improve outcomes for children. Several national organizations, including the Centers for Disease Control and Prevention, have recommended specific public policies the adoption of which in school settings can improve asthma outcomes for children. Although many states and school districts have adopted some of these policies, adoption is not universal, and implementation is not always successful, leaving inequities in children's access to asthma services and supports. These issues can be addressed by changing public policy. Policy change is a complex process, but it is one that will benefit from greater involvement by asthma experts, including the researchers who generate the knowledge base on what services, supports, and policies have the best outcomes for children. Asthma experts can participate in the policy process by helping to build awareness of the need for school-based asthma policy, estimating the costs associated with policy options and with inaction, advocating for the selection of specific policies, assisting in implementation (including providing feedback), conducting the research that can evaluate the effectiveness of implementation, and ultimately providing information back into the policy process to allow for improvements to the policies. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  9. Evolution of poor reporting and inadequate methods over time in 20 920 randomised controlled trials included in Cochrane reviews: research on research study.

    Science.gov (United States)

    Dechartres, Agnes; Trinquart, Ludovic; Atal, Ignacio; Moher, David; Dickersin, Kay; Boutron, Isabelle; Perrodeau, Elodie; Altman, Douglas G; Ravaud, Philippe

    2017-06-08

    Objective  To examine how poor reporting and inadequate methods for key methodological features in randomised controlled trials (RCTs) have changed over the past three decades. Design  Mapping of trials included in Cochrane reviews. Data sources  Data from RCTs included in all Cochrane reviews published between March 2011 and September 2014 reporting an evaluation of the Cochrane risk of bias items: sequence generation, allocation concealment, blinding, and incomplete outcome data. Data extraction  For each RCT, we extracted consensus on risk of bias made by the review authors and identified the primary reference to extract publication year and journal. We matched journal names with Journal Citation Reports to get 2014 impact factors. Main outcomes measures  We considered the proportions of trials rated by review authors at unclear and high risk of bias as surrogates for poor reporting and inadequate methods, respectively. Results  We analysed 20 920 RCTs (from 2001 reviews) published in 3136 journals. The proportion of trials with unclear risk of bias was 48.7% for sequence generation and 57.5% for allocation concealment; the proportion of those with high risk of bias was 4.0% and 7.2%, respectively. For blinding and incomplete outcome data, 30.6% and 24.7% of trials were at unclear risk and 33.1% and 17.1% were at high risk, respectively. Higher journal impact factor was associated with a lower proportion of trials at unclear or high risk of bias. The proportion of trials at unclear risk of bias decreased over time, especially for sequence generation, which fell from 69.1% in 1986-1990 to 31.2% in 2011-14 and for allocation concealment (70.1% to 44.6%). After excluding trials at unclear risk of bias, use of inadequate methods also decreased over time: from 14.8% to 4.6% for sequence generation and from 32.7% to 11.6% for allocation concealment. Conclusions  Poor reporting and inadequate methods have decreased over time, especially for sequence generation

  10. Automatic generation control with thyristor controlled series compensator including superconducting magnetic energy storage units

    Directory of Open Access Journals (Sweden)

    Saroj Padhan

    2014-09-01

    Full Text Available In the present work, an attempt has been made to understand the dynamic performance of Automatic Generation Control (AGC of multi-area multi-units thermal–thermal power system with the consideration of Reheat turbine, Generation Rate Constraint (GRC and Time delay. Initially, the gains of the fuzzy PID controller are optimized using Differential Evolution (DE algorithm. The superiority of DE is demonstrated by comparing the results with Genetic Algorithm (GA. After that performance of Thyristor Controlled Series Compensator (TCSC has been investigated. Further, a TCSC is placed in the tie-line and Superconducting Magnetic Energy Storage (SMES units are considered in both areas. Finally, sensitivity analysis is performed by varying the system parameters and operating load conditions from their nominal values. It is observed that the optimum gains of the proposed controller need not be reset even if the system is subjected to wide variation in loading condition and system parameters.

  11. Partially ionized plasmas including the third symposium on uranium plasmas

    Energy Technology Data Exchange (ETDEWEB)

    Krishnan, M. [ed.

    1976-09-01

    Separate abstracts are included for 28 papers on electrically generated plasmas, fission generated plasmas, nuclear pumped lasers, gaseous fuel reactor research, and applications. Five papers have been previously abstracted and included in ERA.

  12. Systematic review with meta-analysis: online psychological interventions for mental and physical health outcomes in gastrointestinal disorders including irritable bowel syndrome and inflammatory bowel disease.

    Science.gov (United States)

    Hanlon, I; Hewitt, C; Bell, K; Phillips, A; Mikocka-Walus, A

    2018-06-14

    Online psychotherapy has been successfully used as supportive treatment in many chronic illnesses. However, there is a lack of evidence on its role in the management of gastrointestinal (GI) diseases. To examine whether online psychological interventions improve mental and physical outcomes in gastrointestinal diseases. We searched CINAHL Plus, MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, British Nursing Index, Cochrane Library, a specialised register of the IBD/FBD Cochrane Group, MEDLINE (PubMed) WHO International Clinical Trial Registry, ClinicalTrials.gov, and reference lists of all papers included in the review. The Cochrane Risk of Bias Tool was used to assess internal validity. Where possible, data were pooled using random-effects meta-analysis. We identified 11 publications (encompassing nine studies) meeting inclusion criteria. One study had a high risk of selection bias (allocation concealment), all studies had a high risk of performance and detection bias. Eight studies were included in the meta-analyses (6 on irritable bowel syndrome [IBS] and two on inflammatory bowel disease [IBD]). Online cognitive behavioural therapy (CBT) was shown to significantly improve gastrointestinal symptom-specific anxiety (MD: -8.51, 95% CI -12.99 to -4.04, P = 0.0002) and lessen symptom-induced disability (MD: -2.78, 95% CI -5.43 to -0.12, P = 0.04) in IBS post intervention. There was no significant effect of online CBT on any other outcomes in IBS. No significant effect of online psychotherapy was demonstrated in IBD. There is insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases. © 2018 John Wiley & Sons Ltd.

  13. Entropy generation impact on peristaltic motion in a rotating frame

    Directory of Open Access Journals (Sweden)

    H. Zahir

    Full Text Available Outcome of entropy generation in peristalsis of Casson fluid in a rotating frame is intended. Formulation is based upon thermal radiation, viscous dissipation and slip conditions of velocity and temperature. Lubrication approach is followed. The velocity components, temperature and trapping are examined. Specifically the outcomes of Taylor number, fluid parameter, slip parameters, Brinkman, radiation and compliant wall effects are focused. In addition entropy generation and Bejan numbers are examined. It is observed that entropy is controlled through slip effects. Keywords: Casson fluid, Radiative heat flux, Entropy generation, Rotating frame, Slip conditions, Wall properties

  14. Implementation of learning outcome attainment measurement system in aviation engineering higher education

    Science.gov (United States)

    Salleh, I. Mohd; Mat Rani, M.

    2017-12-01

    This paper aims to discuss the effectiveness of the Learning Outcome Attainment Measurement System in assisting Outcome Based Education (OBE) for Aviation Engineering Higher Education in Malaysia. Direct assessments are discussed to show the implementation processes that become a key role in the successful outcome measurement system. A case study presented in this paper involves investigation on the implementation of the system in Aircraft Structure course for Bachelor in Aircraft Engineering Technology program in UniKL-MIAT. The data has been collected for five semesters, starting from July 2014 until July 2016. The study instruments used include the report generated in Learning Outcomes Measurements System (LOAMS) that contains information on the course learning outcomes (CLO) individual and course average performance reports. The report derived from LOAMS is analyzed and the data analysis has revealed that there is a positive significant correlation between the individual performance and the average performance reports. The results for analysis of variance has further revealed that there is a significant difference in OBE grade score among the report. Independent samples F-test results, on the other hand, indicate that the variances of the two populations are unequal.

  15. Steam generator life cycle management: Ontario Power Generation (OPG) experience

    International Nuclear Information System (INIS)

    Maruska, C.C.

    2002-01-01

    A systematic managed process for steam generators has been implemented at Ontario Power Generation (OPG) nuclear stations for the past several years. One of the key requirements of this managed process is to have in place long range Steam Generator Life Cycle Management (SG LCM) plans for each unit. The primary goal of these plans is to maximize the value of the nuclear facility through safe and reliable steam generator operation over the expected life of the units. The SG LCM plans integrate and schedule all steam generator actions such as inspection, operation, maintenance, modifications, repairs, assessments, R and D, performance monitoring and feedback. This paper discusses OPG steam generator life cycle management experience to date, including successes, failures and how lessons learned have been re-applied. The discussion includes relevant examples from each of the operating stations: Pickering B and Darlington. It also includes some of the experience and lessons learned from the activities carried out to refurbish the steam generators at Pickering A after several years in long term lay-up. The paper is structured along the various degradation modes that have been observed to date at these sites, including monitoring and mitigating actions taken and future plans. (author)

  16. Psychopathology, cognition and outcome in Dutch and immigrant first-episode psychosis patients.

    Science.gov (United States)

    Stouten, Luyken H; Veling, Wim; Laan, Winfried; Van der Gaag, Mark

    2018-03-30

    The primary aim was to examine differences in baseline symptom expression, neurocognition, social cognition and psychosocial functioning between Dutch, first-generation immigrants and second-generation immigrants with a first-episode psychosis (FEP). The secondary aim was to examine functional and symptomatic change and between-group differences at 12-months follow-up. Associations between migration, baseline characteristics and outcome were explored. Forty-six Dutch, 56 second-generation- and 60 first-generation immigrant patients completed baseline measures for 6 symptom dimensions (positive symptoms, negative symptoms, neurocognitive functioning, social cognitive functioning, excitement and emotional distress) and 5 domains of psychosocial functioning (general functioning, work and study, relationships, self-care and disturbing behaviour). Functioning and psychotic symptoms were assessed at baseline and 12-months follow-up. ANCOVA and t tests were used to assess between-group differences. General linear models were used to explore within-group differences. Backward-regression was used to explore predictors of outcome. Levels of positive symptoms, excitement and emotional distress did not differ between groups at baseline or follow-up. Dutch patients had lower levels of negative symptoms than both immigrant groups at follow-up. On neurocognition and social cognition, Dutch performed better than second-generation immigrants, who in turn performed better than first-generation immigrants. Psychosocial functioning across all domains at baseline and at 12-months follow-up was similar across groups. Baseline levels of general psychosocial functioning and income were the strongest predictors of outcome at follow-up. Psychosocial functioning and symptom profiles are comparable between Dutch, first-generation immigrant and second-generation immigrant FEP patients, excluding neurocognitive and social cognitive deficits. A range of baseline characteristics predicted

  17. Aggregated Demand Modelling Including Distributed Generation, Storage and Demand Response

    OpenAIRE

    Marzooghi, Hesamoddin; Hill, David J.; Verbic, Gregor

    2014-01-01

    It is anticipated that penetration of renewable energy sources (RESs) in power systems will increase further in the next decades mainly due to environmental issues. In the long term of several decades, which we refer to in terms of the future grid (FG), balancing between supply and demand will become dependent on demand actions including demand response (DR) and energy storage. So far, FG feasibility studies have not considered these new demand-side developments for modelling future demand. I...

  18. Modifying the Sleep Treatment Education Program for Students to include technology use (STEPS-TECH): Intervention effects on objective and subjective sleep outcomes.

    Science.gov (United States)

    Barber, Larissa K; Cucalon, Maria S

    2017-12-01

    University students often have sleep issues that arise from poor sleep hygiene practices and technology use patterns. Yet, technology-related behaviors are often neglected in sleep hygiene education. This study examined whether the Sleep Treatment Education Program for Students-modified to include information regarding managing technology use (STEPS-TECH)-helps improve both subjective and objective sleep outcomes among university students. Results of an experimental study among 78 university students showed improvements in objective indicators of sleep quantity (total sleep time) and sleep quality (less awakenings) during the subsequent week for students in the STEPS-TECH intervention group compared to a control group. Exploratory analyses indicated that effects were driven by improvements in weekend days immediately following the intervention. There were also no intervention effects on subjective sleep quality or quantity outcomes. In terms of self-reported behavioral responses to educational content in the intervention, there were no group differences in sleep hygiene practices or technology use before bedtime. However, the intervention group reported less technology use during sleep periods than the control group. These preliminary findings suggest that STEPS-TECH may be a useful educational tool to help improve objective sleep and reduce technology use during sleep periods among university students. Copyright © 2017 John Wiley & Sons, Ltd.

  19. Childhood Income Volatility and Adult Outcomes. University of Kentucky Center for Poverty Research Discussion Paper Series, DP2012-03

    Science.gov (United States)

    Hardy, Bradley

    2012-01-01

    Using data linked across generations in the Panel Study of Income Dynamics, I estimate the relationship between exposure to volatile income during childhood and a set of socioeconomic outcomes in adulthood. The empirical framework is an augmented intergenerational income mobility model that includes controls for income volatility. I measure income…

  20. Including policy and management in socio-hydrology models: initial conceptualizations

    Science.gov (United States)

    Hermans, Leon; Korbee, Dorien

    2017-04-01

    Socio-hydrology studies the interactions in coupled human-water systems. So far, the use of dynamic models that capture the direct feedback between societal and hydrological systems has been dominant. What has not yet been included with any particular emphasis, is the policy or management layer, which is a central element in for instance integrated water resources management (IWRM) or adaptive delta management (ADM). Studying the direct interactions between human-water systems generates knowledges that eventually helps influence these interactions in ways that may ensure better outcomes - for society and for the health and sustainability of water systems. This influence sometimes occurs through spontaneous emergence, uncoordinated by societal agents - private sector, citizens, consumers, water users. However, the term 'management' in IWRM and ADM also implies an additional coordinated attempt through various public actors. This contribution is a call to include the policy and management dimension more prominently into the research focus of the socio-hydrology field, and offers first conceptual variables that should be considered in attempts to include this policy or management layer in socio-hydrology models. This is done by drawing on existing frameworks to study policy processes throughout both planning and implementation phases. These include frameworks such as the advocacy coalition framework, collective learning and policy arrangements, which all emphasis longer-term dynamics and feedbacks between actor coalitions in strategic planning and implementation processes. A case about longter-term dynamics in the management of the Haringvliet in the Netherlands is used to illustrate the paper.

  1. Pharmacists' interventions on clinical asthma outcomes: a systematic review.

    Science.gov (United States)

    Garcia-Cardenas, Victoria; Armour, Carol; Benrimoj, Shalom I; Martinez-Martinez, Fernando; Rotta, Inajara; Fernandez-Llimos, Fernando

    2016-04-01

    The objective of this systematic review was to evaluate the impact of pharmacists' interventions on clinical asthma outcomes on adult patients and to identify the outcome indicators used.PubMed, Scopus, Web of Science and Scielo were searched. Studies addressing pharmacists' interventions on adult asthma patients reporting clinical asthma outcomes were incorporated.11 clinical outcomes were identified in 21 studies. 10 studies measured the impact of the intervention on asthma control. Randomised controlled trials (RCT) and non-RCTs found positive results in percentages of controlled patients and Asthma Control Questionnaire (ACQ) scores. Discordant results were found for Asthma Control Test results. Asthma severity was assessed in four studies. One RCT found a significant decrease in the percentage of severe patients; two non-RCTs found significant improvements in severity scores. 11 studies reported pulmonary function indicators, showing inconsistent results. Eight studies measured asthma symptoms; three RCTs and four non-RCTs showed significant improvements.RCTs and non-RCTs generated similar results for most outcomes. Based on the evidence generated by RCTs, pharmacists' have a positive impact on the percentage of controlled patients, ACQ scores, severity and symptoms. Future research should report using the core outcome set of indicators established for asthma (PROSPERO CRD42014007019). Copyright ©ERS 2016.

  2. Generation Y and the Integrated Plastic Surgery Residency Match: A Cross-sectional Study of the 2011 Match Outcomes

    Science.gov (United States)

    Narayan, Deepak

    2013-01-01

    Background: Plastic surgery is the most competitive specialty in medicine. We sought to identify factors associated with the successful match of generation Y applicants into integrated plastic surgery residency. Methods: We utilized the most recent data from the Charting Outcomes in the Match published by the National Resident Matching Program in 2011. We had data on US senior or independent applicant status, Alpha Omega Alpha (AOA) status, attendance of top 40 medical schools, advanced degree status, and number of contiguous ranks within plastic surgery. Our main outcome measure was match status. Results: A total of 81 out of 197 applicants (41.1%) successfully matched into integrated plastic surgery in the 2011 main match. US seniors matched at a significantly higher rate compared to independent applicants (44.0% vs 24.1%, P = 0.044). Matched US seniors were more likely to have AOA membership compared to unmatched US seniors (45.9% vs 27.7%, P = 0.014) and attend a top 40 medical school (52.7% vs 35.1%, P = 0.022). There were no differences in terms of advanced degrees between matched and unmatched US seniors. Unmatched US seniors were more likely to have 3 or fewer contiguous ranks of plastic surgery residency programs than matched US seniors (86.2% vs 68.9%, P = 0.007). Conclusions: US senior status, AOA membership, and attendance at a top 40 medical school are predictors of matching into integrated plastic surgery. Program directors need to be aware of the background of the millennial applicants to recruit and maintain top residents. PMID:25289227

  3. Second-Generation Outcomes of the Great Migration.

    Science.gov (United States)

    Alexander, J Trent; Leibbrand, Christine; Massey, Catherine; Tolnay, Stewart

    2017-12-01

    The mass migration of African Americans out of the South during the first two-thirds of the twentieth century represents one of the most significant internal migration flows in U.S. Those undertaking the Great Migration left the South in search of a better life, and their move transformed the cultural, social, and political dynamics of African American life specifically and U.S. society more generally. Recent research offers conflicting evidence regarding the migrants' success in translating their geographic mobility into economic mobility. Due in part to the lack of a large body of longitudinal data, almost all studies of the Great Migration have focused on the migrants themselves, usually over short periods of their working lives. Using longitudinally linked census data, we take a broader view, investigating the long-term economic and social effects of the Great Migration on the migrants' children. Our results reveal modest but statistically significant advantages in education, income, and poverty status for the African American children of the Great Migration relative to the children of southerners who remained in the South. In contrast, second-generation white migrants experienced few benefits from migrating relative to southern or northern stayers.

  4. Survey indicated that core outcome set development is increasingly including patients, being conducted internationally and using Delphi surveys.

    Science.gov (United States)

    Biggane, Alice M; Brading, Lucy; Ravaud, Philippe; Young, Bridget; Williamson, Paula R

    2018-02-17

    There are numerous challenges in including patients in a core outcome set (COS) study, these can vary depending on the patient group. This study describes current efforts to include patients in the development of COS, with the aim of identifying areas for further improvement and study. Using the COMET database, corresponding authors of COS projects registered or published from 1 January 2013 to 2 February 2017 were invited via a personalised email to participate in a short online survey. The survey and emails were constructed to maximise the response rate by following the academic literature on enhancing survey responses. Personalised reminder emails were sent to non-responders. This survey explored the frequency of patient input in COS studies, who was involved, what methods were used and whether or not the COS development was international. One hundred and ninety-two COS developers were sent the survey. Responses were collected from 21 February 2017 until 7 May 2017. One hundred and forty-six unique developers responded, yielding a 76% response rate and data in relation to 195 unique COSs (as some developers had worked on multiple COSs). Of focus here are their responses regarding 162 COSs at the published, completed or ongoing stages of development. Inclusion of patient participants was indicated in 87% (141/162) of COSs in the published completed or ongoing stages and over 94% (65/69) of ongoing COS projects. Nearly half (65/135) of COSs included patient participants from two or more countries and 22% (30/135) included patient participants from five or more countries. The Delphi survey was reported as being used singularly or in combination with other methods in 85% (119/140) of projects. Almost a quarter (16/65) of ongoing studies reported using a combination of qualitative interviews, Delphi survey and consensus meeting. These findings indicated that the Delphi survey is the most popular method of facilitating patient participation, while the combination of

  5. Retrospective analysis of factors associated with outcome of proximal interphalangeal joint arthrodesis in 82 horses including Warmblood and Thoroughbred sport horses and Quarter Horses (1992-2014).

    Science.gov (United States)

    Herthel, T D; Rick, M C; Judy, C E; Cohen, N D; Herthel, D J

    2016-09-01

    Outcomes associated with arthrodesis of the proximal interphalangeal (PIP) joint in Quarter Horses used for Western performance activities are well documented but little is known regarding outcomes for other types of horses. To identify factors associated with outcomes, including breed and activity, after arthrodesis of the PIP joint in Warmbloods, Thoroughbreds and Quarter Horses. Retrospective case series. Surgical case records of 82 Quarter Horses principally engaged in Western performance and Thoroughbred or Warmblood breeds principally engaged in showing, showjumping and dressage, with arthrodesis of the PIP joint were reviewed. Arthrodesis was performed with either 3 transarticular cortex bone screws placed in lag fashion, a dynamic compression plate (DCP) with 2 transarticular cortex bone screws placed in lag fashion, or a locking compression plate (LCP) with 2 transarticular cortex bone screws placed in lag fashion. Demographic data, clinical presentation, radiographic findings, surgical technique, post operative treatment and complications were recorded. Long-term follow-up was obtained for all 82 horses. Osteoarthritis of the PIP joint was the most common presenting condition requiring arthrodesis, which was performed with either the 3 screw technique (n = 41), DCP fixation (n = 22), or LCP fixation (n = 19). Post operatively, 23/31 (74%) Warmbloods/Thoroughbreds and 44/51 (87%) Quarter Horses achieved successful outcomes. Thirteen of 23 (57%) Warmbloods/Thoroughbreds and 24 of 38 (63%) Quarter Horses, used for athletic performance, returned to successful competition. Within this subgroup of horses engaged in high-level activity, regardless of breed type, horses undergoing hindlimb arthrodesis were significantly more likely to return to successful competition (73%; 33/45) than those with forelimb arthrodesis (25%; 4/16, P = 0.002). Arthrodesis of the PIP joint in Warmbloods/Thoroughbreds and Quarter Horses results in a favourable outcome for return to

  6. Contributors to Frequent Telehealth Alerts Including False Alerts for Patients with Heart Failure: A Mixed Methods Exploration

    Science.gov (United States)

    Radhakrishna, K.; Bowles, K.; Zettek-Sumner, A.

    2013-01-01

    Summary Background Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients. Objective To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency. Materials and Methods A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses’ notes on follow-up actions to patients’ telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency. Results Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (ppatient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable telehealth alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management. PMID:24454576

  7. In vitro bactericidal activity of aminoglycosides, including the next-generation drug plazomicin, against Brucella spp.

    Science.gov (United States)

    Plazomicin is a next-generation aminoglycoside with a potentially improved safety profile compared to other aminoglycosides. This study assessed plazomicin MICs and MBCs in four Brucella spp. reference strains. Like other aminoglycosides and aminocyclitols, plazomicin MBC values equaled MIC values ...

  8. Early life nutrition and gastrointestinal and allergic outcomes: the Generation R Study

    NARCIS (Netherlands)

    J.C. Kiefte-de Jong (Jessica)

    2012-01-01

    textabstractThis thesis particularly focused on the outcomes of constipation, celiac disease auto antibodies, asthma-like symptoms, and atopic dermatitis, which are all prevalent in the general population. In line with this, the main goals of this thesis were to assess: · Infant nutrition: o

  9. An electricity generation planning model incorporating demand response

    International Nuclear Information System (INIS)

    Choi, Dong Gu; Thomas, Valerie M.

    2012-01-01

    Energy policies that aim to reduce carbon emissions and change the mix of electricity generation sources, such as carbon cap-and-trade systems and renewable electricity standards, can affect not only the source of electricity generation, but also the price of electricity and, consequently, demand. We develop an optimization model to determine the lowest cost investment and operation plan for the generating capacity of an electric power system. The model incorporates demand response to price change. In a case study for a U.S. state, we show the price, demand, and generation mix implications of a renewable electricity standard, and of a carbon cap-and-trade policy with and without initial free allocation of carbon allowances. This study shows that both the demand moderating effects and the generation mix changing effects of the policies can be the sources of carbon emissions reductions, and also shows that the share of the sources could differ with different policy designs. The case study provides different results when demand elasticity is excluded, underscoring the importance of incorporating demand response in the evaluation of electricity generation policies. - Highlights: ► We develop an electric power system optimization model including demand elasticity. ► Both renewable electricity and carbon cap-and-trade policies can moderate demand. ► Both policies affect the generation mix, price, and demand for electricity. ► Moderated demand can be a significant source of carbon emission reduction. ► For cap-and-trade policies, initial free allowances change outcomes significantly.

  10. Five generations in the nursing workforce: implications for nursing professional development.

    Science.gov (United States)

    Bell, Julie A

    2013-01-01

    Positive patient outcomes require effective teamwork, communication, and technological literacy. These skills vary among the unprecedented five generations in the nursing workforce, spanning the "Silent Generation" nurses deferring retirement to the newest "iGeneration." Nursing professional development educators must understand generational differences; address communication, information technology, and team-building competencies across generations; and promote integration of learner-centered strategies into professional development activities.

  11. Predictors and outcomes of cardiac resynchronization therapy extended to the second generator.

    Science.gov (United States)

    Li, Xuping; Yang, Dachun; Kusumoto, Fred; Shen, Win-Kuang; Mulpuru, Siva; Zhou, Shenghua; Liang, Jinjun; Wu, Gang; Yang, Mei; Liu, Jin-Qu; Friedman, Paul A; Cha, Yong-Mei

    2017-12-01

    A proportion of patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) live to receive a second generator. Controversy exists on whether an implantable cardioverter-defibrillator (ICD) should be offered to patients who have normalized or near-normalized left ventricular ejection fraction (LVEF) at the time of generator replacement (GR). The purpose of this study was to evaluate incidence of appropriate ICD therapy after CRT-D GR. This series involved 1026 consecutive patients who underwent CRT-D implant between January 1, 2002 and December 31, 2012. Echocardiography was assessed before the initial device implant and before GR. ICDs were monitored at our device clinic in person or remotely, or both. Of the cohort, 227 patients (22.1%) underwent CRT-D GR at our institution. Approximately 48% of the patients who received new CRT-D generators were no longer meeting the guidelines indication for ICD use at the time of GR. These patients received subsequent appropriate ICD therapies at a significantly lower rate than those with LVEF generator after GR. Improvement in LVEF after CRT-D GR is associated with significantly reduced incidence of appropriate ICD therapy. Ventricular arrhythmia is less likely to develop with normalized LVEF in nonischemic cardiomyopathy. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  12. Computed tomography of the brain in predicting outcome of traumatic intracranial haemorrhage in Malaysian patients

    International Nuclear Information System (INIS)

    Azian, A.A.; Nurulazman, A.A.; Shuaib, I.L.; Mahayidin, M.; Ariff, A.R.; Naing, N.N.; Abdullah, J.

    2001-01-01

    Head injury is a significant economic, social and medical problem all over the world. Road accidents are the most frequent cause of head injury in Malaysia which highest risk in the young (15 to 24 years old). The associated outcomes include good recovery, possibility of death for the severely injured, which may cause disruption of the lives of their family members. It is important to predict the outcome as it will provide sound information to assist clinicians in Malaysia in providing prognostic information to patients and their families, to assess the effectiveness of different modes of treatment in promoting recovery and to document the significance of head injury as a public health problem. Results. A total of 103 cases with intracranial hemorrhage i.e. intracerebral hemorrhage, extradural hemorrhage, subdural hemorrhage, intraventricular hemorrhage, hemorrhagic contusion and subarachnoid hemorrhage, following motor vehicle accidents was undertaken to study factors contributing to either good or poor outcome according to the Glasgow outcome scale. Patients below 12 years of age were excluded. The end point of the study was taken at 24 months post injury. The selected variables were incorporated into models generated by logistic regression techniques of multivariate analysis to see the significant predictors of outcome as well as the correlation between the CT findings with GCS. Conclusion. Significant predictors of outcome were GCS on arrival in the accident emergency department, pupillary reflex and the CT scan findings. The CT predictors of outcome include ICH, EDH, IVH, present of SAH, site of ICH, volumes of EDH and SDH as well as midline shift. (author)

  13. Irradiation of rainbow trout at early life stages results in trans-generational effects including the induction of a bystander effect in non-irradiated fish

    International Nuclear Information System (INIS)

    Smith, Richard W.; Seymour, Colin B.; Moccia, Richard D.; Mothersill, Carmel E.

    2016-01-01

    The bystander effect, a non-targeted effect (NTE) of radiation, which describes the response by non-irradiated organisms to signals emitted by irradiated organisms, has been documented in a number of fish species. However transgenerational effects of radiation (including NTE) have yet to be studied in fish. Therefore rainbow trout, which were irradiated as eggs at 48 h after fertilisation, eyed eggs, yolk sac larvae or first feeders, were bred to generate a F1 generation and these F1 fish were bred to generate a F2 generation. F1 and F2 fish were swam with non-irradiated bystander fish. Media from explants of F1 eyed eggs, F1 one year old fish gill and F1 two year old fish gill and spleen samples, and F2 two year old gill and spleen samples, as well as from bystander eggs/fish, was used to treat a reporter cell line, which was then assayed for changes in cellular survival/growth. The results were complex and dependent on irradiation history, age (in the case of the F1 generation), and were tissue specific. For example, irradiation of one parent often resulted in effects not seen with irradiation of both parents. This suggests that, unlike mammals, in certain circumstances maternal and paternal irradiation may be equally important. This study also showed that trout can induce a bystander effect 2 generations after irradiation, which further emphasises the importance of the bystander effect in aquatic radiobiology. Given the complex community structure in aquatic ecosystems, these results may have significant implications for environmental radiological protection. - Highlights: • We evaluated the transgenerational effect of early life irradiation in rainbow trout. • Trout irradiated as eggs, yolk sac larvae or first feeders were crossed. • A transgenerational effect was evident in two generations after irradiation. • F1 and F2 generation fish induced a bystander effect in non-irradiated fish. • The precise effects were tissue specific and dependent on

  14. Irradiation of rainbow trout at early life stages results in trans-generational effects including the induction of a bystander effect in non-irradiated fish

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Richard W., E-mail: rich.wilson.smith@gmail.com [Department of Animal Biosciences, University of Guelph, Guelph, Ontario (Canada); Department of Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, Ontario (Canada); Seymour, Colin B. [Department of Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, Ontario (Canada); Moccia, Richard D. [Department of Animal Biosciences, University of Guelph, Guelph, Ontario (Canada); Mothersill, Carmel E. [Department of Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, Ontario (Canada)

    2016-02-15

    The bystander effect, a non-targeted effect (NTE) of radiation, which describes the response by non-irradiated organisms to signals emitted by irradiated organisms, has been documented in a number of fish species. However transgenerational effects of radiation (including NTE) have yet to be studied in fish. Therefore rainbow trout, which were irradiated as eggs at 48 h after fertilisation, eyed eggs, yolk sac larvae or first feeders, were bred to generate a F1 generation and these F1 fish were bred to generate a F2 generation. F1 and F2 fish were swam with non-irradiated bystander fish. Media from explants of F1 eyed eggs, F1 one year old fish gill and F1 two year old fish gill and spleen samples, and F2 two year old gill and spleen samples, as well as from bystander eggs/fish, was used to treat a reporter cell line, which was then assayed for changes in cellular survival/growth. The results were complex and dependent on irradiation history, age (in the case of the F1 generation), and were tissue specific. For example, irradiation of one parent often resulted in effects not seen with irradiation of both parents. This suggests that, unlike mammals, in certain circumstances maternal and paternal irradiation may be equally important. This study also showed that trout can induce a bystander effect 2 generations after irradiation, which further emphasises the importance of the bystander effect in aquatic radiobiology. Given the complex community structure in aquatic ecosystems, these results may have significant implications for environmental radiological protection. - Highlights: • We evaluated the transgenerational effect of early life irradiation in rainbow trout. • Trout irradiated as eggs, yolk sac larvae or first feeders were crossed. • A transgenerational effect was evident in two generations after irradiation. • F1 and F2 generation fish induced a bystander effect in non-irradiated fish. • The precise effects were tissue specific and dependent on

  15. Irradiation of rainbow trout at early life stages results in trans-generational effects including the induction of a bystander effect in non-irradiated fish.

    Science.gov (United States)

    Smith, Richard W; Seymour, Colin B; Moccia, Richard D; Mothersill, Carmel E

    2016-02-01

    The bystander effect, a non-targeted effect (NTE) of radiation, which describes the response by non-irradiated organisms to signals emitted by irradiated organisms, has been documented in a number of fish species. However transgenerational effects of radiation (including NTE) have yet to be studied in fish. Therefore rainbow trout, which were irradiated as eggs at 48h after fertilisation, eyed eggs, yolk sac larvae or first feeders, were bred to generate a F1 generation and these F1 fish were bred to generate a F2 generation. F1 and F2 fish were swam with non-irradiated bystander fish. Media from explants of F1 eyed eggs, F1 one year old fish gill and F1 two year old fish gill and spleen samples, and F2 two year old gill and spleen samples, as well as from bystander eggs/fish, was used to treat a reporter cell line, which was then assayed for changes in cellular survival/growth. The results were complex and dependent on irradiation history, age (in the case of the F1 generation), and were tissue specific. For example, irradiation of one parent often resulted in effects not seen with irradiation of both parents. This suggests that, unlike mammals, in certain circumstances maternal and paternal irradiation may be equally important. This study also showed that trout can induce a bystander effect 2 generations after irradiation, which further emphasises the importance of the bystander effect in aquatic radiobiology. Given the complex community structure in aquatic ecosystems, these results may have significant implications for environmental radiological protection. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Learning Process and Learning Outcomes of Video Podcasts Including the Instructor and PPT Slides: A Chinese Case

    Science.gov (United States)

    Pi, Zhongling; Hong, Jianzhong

    2016-01-01

    Video podcasts have become one of the fastest developing trends in learning and teaching. The study explored the effect of the presenting mode of educational video podcasts on the learning process and learning outcomes. Prior to viewing a video podcast, the 94 Chinese undergraduates participating in the study completed a demographic questionnaire…

  17. Combustion modeling including heat loss using flamelet generated manifolds: a validation study in OpenFOAM

    NARCIS (Netherlands)

    Ottino, G.M.; Fancello, A.; Falcone, M.; Bastiaans, R.J.M.; Goey, de L.P.H.

    In numerical combustion applications the Flamelet Generated Manifolds technique (FGM) is being used at an increasingly number of occasions. This technique is an approach to reduce the chemistry efficiently and accurately. In the present work FGM is coupled to an OpenFOAM-based CFD solver. The

  18. Acculturation and Adverse Birth Outcomes in a Predominantly Puerto Rican Population.

    Science.gov (United States)

    Barcelona de Mendoza, Veronica; Harville, Emily; Theall, Katherine; Buekens, Pierre; Chasan-Taber, Lisa

    2016-06-01

    Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominantly Puerto Rican population. Methods We conducted a secondary analysis of Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011. A convenience sample of pregnant Latina women were recruited from a tertiary care hospital in Massachusetts. Acculturation was measured in early pregnancy; directly via the Psychological Acculturation Scale, and via proxies of language preference and generation in the United States. Birth outcomes (gestational age and birthweight) were abstracted from medical records (n = 1362). Results After adjustment, psychological acculturation, language preference, and generation was not associated with odds of preterm birth. However, every unit increase in psychological acculturation score was associated with an increase in gestational age of 0.22 weeks (SE = 0.1, p = 0.04) among all births. Women who preferred to speak Spanish (β = -0.39, SE = 0.2, p = 0.02) and who were first generation in the US (β = -0.33, SE = 0.1, p = 0.02) had significantly lower gestational ages than women who preferred English or who were later generation, respectively. Similarly, women who were first generation had babies who weighed 76.11 g less (SE = 35.2, p = 0.03) than women who were later generation. Discussion We observed a small, but statistically significant adverse impact of low acculturation on gestational age and birthweight in this predominantly Puerto Rican population.

  19. Development of a core outcome set for clinical trials in inflammatory bowel disease: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey.

    Science.gov (United States)

    Ma, Christopher; Panaccione, Remo; Fedorak, Richard N; Parker, Claire E; Khanna, Reena; Levesque, Barrett G; Sandborn, William J; Feagan, Brian G; Jairath, Vipul

    2017-06-09

    Crohn's disease (CD) and ulcerative colitis (UC), the main forms of inflammatory bowel disease (IBD), are chronic, progressive and disabling disorders of the gastrointestinal tract. Although data from randomised controlled trials (RCTs) provide the foundation of evidence that validates medical therapy for IBD, considerable heterogeneity exists in the measured outcomes used in these studies. Furthermore, in recent years, there has been a paradigm shift in IBD treatment targets, moving from symptom-based scoring to improvement or normalisation of objective measures of inflammation such as endoscopic appearance, inflammatory biomarkers and histological and radiographic end points. The abundance of new treatment options and evolving end points poses opportunities and challenges for all stakeholders involved in drug development. Accordingly, there exists a need to harmonise measures used in clinical trials through the development of a core outcome set (COS). The development of an IBD-specific COS includes four steps. First, a systematic literature review is performed to identify outcomes previously used in IBD RCTs. Second, semistructured qualitative interviews are conducted with key stakeholders, including patients, clinicians, researchers, pharmaceutical industry representatives, healthcare payers and regulators to identify additional outcomes of importance. Using the outcomes generated from literature review and stakeholder interviews, an international two-round Delphi survey is conducted to prioritise outcomes for inclusion in the COS. Finally, a consensus meeting is held to ratify the COS and disseminate findings for application in future IBD trials. Given that over 30 novel therapeutic compounds are in development for IBD treatment, the design of robust clinical trials measuring relevant and standardised outcomes is crucial. Standardising outcomes through a COS will reduce heterogeneity in trial reporting, facilitate valid comparisons of new therapies and improve

  20. Center-size as a predictor of weight-loss outcome in multicenter trials including a low-calorie diet

    DEFF Research Database (Denmark)

    Gasteyger, Christoph Rolf; Christensen, Robin; Larsen, Thomas Meinert

    2010-01-01

    weight loss. This is a post hoc analysis of an existing database: 701 obese subjects (77% women, 23% men, mean BMI: 38.9 kg/m(2)) were enrolled at 22 sites (4-85 subjects/site) in five countries to follow a LCD providing 800-1,000 kcal/day during 8 weeks. The main outcome measure was the percentage...

  1. Impact of Postapproval Evidence Generation on the Biopharmaceutical Industry.

    Science.gov (United States)

    Milne, Christopher-Paul; Cohen, Joshua P; Felix, Abigail; Chakravarthy, Ranjana

    2015-08-01

    Meeting marketplace demands for proving the value of new products requires more data than the industry has routinely produced. These data include evidence from comparative effectiveness research (CER), including randomized, controlled trials; pragmatic clinical trials; observational studies; and meta-analyses. We designed and conducted a survey to examine the industry's perceptions on new data requirements regarding CER evidence, the acceptability of postapproval study types, payer-specific issues related to CER, communication of data being generated postapproval, and methods used for facilitating postapproval evidence generation. CER is being used by payers for most types of postapproval decisions. Randomized, controlled trials were indicated as the most acceptable form of evidence. At the same time, there was support for the utility of other types of studies, such as pragmatic clinical trials and observational studies. Respondents indicated the use of multiple formats for communicating postapproval data with many different stakeholders including regulators, payers, providers, and patients. Risk-sharing agreements with payers were unanimously supported by respondents with regard to certain products with unclear clinical and economic outcomes at launch. In these instances, conditional reimbursement through coverage with evidence development was considered a constructive option. The Food and Drug Administration's initiative called Regulatory Science was considered by the respondents as having the most impact on streamlining the generation of postapproval research-related evidence. The biopharmaceutical industry is faced with a broad and complex set of challenges related to evidence generation for postapproval decisions by a variety of health care system stakeholders. Uncertainty remains as to how the industry and payers use postapproval studies to guide decision making with regard to pricing and reimbursement status. Correspondingly, there is uncertainty regarding

  2. The strategic use of outcome information.

    Science.gov (United States)

    Thompson, D I; Sirio, C; Holt, P

    2000-10-01

    Most health care executives see outcome measurement as a technical or tactical matter rather than as a strategic tool. Accordingly, provider investment in outcome measurement and management is relatively small. Nevertheless, outcome information can be key to achieving an organization's strategic objectives. Advances in risk adjustment and improvements in technology for data collection and analysis have made outcome measurement a practical tool for individual hospital use. Strategically integrated outcome measurement efforts can give providers a competitive advantage over organizations that only use outcomes tactically. One of the best examples of an acute care provider that has used outcome information for strategic advantage is Intermountain Health Care (IHC; Salt Lake City). In 1997 IHC made clinical quality and outcomes the primary focus of its five-year strategic plan. To support the new strategy IHC's board of trustees approved the development of an outcome information system that generated data along clinical processes of care and the creation of a new management structure to use these data to hold professionals accountable and to set and achieve clinical improvement goals. From 1996 to 1999, IHC's share of the commercial health care market in Utah increased from roughly 50% to about 62% of the market, with the result that it has stopped actively marketing its services. Health care executives will not willingly invest in outcomes until they believe that they have business value. Therefore, making the business case for outcomes can help improve the quality of health care and the lives of individuals.

  3. Development of a patient-reported outcome

    DEFF Research Database (Denmark)

    Juul, Tina; Søgaard, Karen; Roos, Ewa M.

    2015-01-01

    removed from the original 69. A multidimensional questionnaire, divided into five subscales, was developed from the remaining 34 items: mobility; symptoms; sleep disturbance; everyday activity and pain; and participation in everyday life. Exploratory factor analysis supported a 5-subscale structure......OBJECTIVE: To develop a patient-reported outcome evaluating the impact of neck pain. The results of item generation and reduction and subscale structure in support of the content and construct validity of the measure are reported. METHODS: Items were generated from the literature and through focus...

  4. Action-outcome learning and prediction shape the window of simultaneity of audiovisual outcomes.

    Science.gov (United States)

    Desantis, Andrea; Haggard, Patrick

    2016-08-01

    To form a coherent representation of the objects around us, the brain must group the different sensory features composing these objects. Here, we investigated whether actions contribute in this grouping process. In particular, we assessed whether action-outcome learning and prediction contribute to audiovisual temporal binding. Participants were presented with two audiovisual pairs: one pair was triggered by a left action, and the other by a right action. In a later test phase, the audio and visual components of these pairs were presented at different onset times. Participants judged whether they were simultaneous or not. To assess the role of action-outcome prediction on audiovisual simultaneity, each action triggered either the same audiovisual pair as in the learning phase ('predicted' pair), or the pair that had previously been associated with the other action ('unpredicted' pair). We found the time window within which auditory and visual events appeared simultaneous increased for predicted compared to unpredicted pairs. However, no change in audiovisual simultaneity was observed when audiovisual pairs followed visual cues, rather than voluntary actions. This suggests that only action-outcome learning promotes temporal grouping of audio and visual effects. In a second experiment we observed that changes in audiovisual simultaneity do not only depend on our ability to predict what outcomes our actions generate, but also on learning the delay between the action and the multisensory outcome. When participants learned that the delay between action and audiovisual pair was variable, the window of audiovisual simultaneity for predicted pairs increased, relative to a fixed action-outcome pair delay. This suggests that participants learn action-based predictions of audiovisual outcome, and adapt their temporal perception of outcome events based on such predictions. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  5. Isotope generator

    International Nuclear Information System (INIS)

    1979-01-01

    The patent describes an isotope generator incorporating the possibility of stopping elution before the elution vessel is completely full. Sterile ventilation of the whole system can then occur, including of both generator reservoir and elution vessel. A sterile, and therefore pharmaceutically acceptable, elution fluid is thus obtained and the interior of the generator is not polluted with non-sterile air. (T.P.)

  6. The 2nd Generation Street Children (SGSC) in Accra: Developing Teaching Strategies to Enhance Positive Learning Outcomes in Schools

    Science.gov (United States)

    Kuyini, Alhassan Abdul-Razak; Abosi, Okechuwu

    2011-01-01

    Ghana is witnessing an increasing number of 2nd generation street children (SGSC) living in the street of Accra, the capital city as a result of many factors including teenage pregnancy among street girls, ethnic conflicts and rural-urban migration. Street presents enormous risks to street children; they are excluded from safe-family environment,…

  7. Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Catena, Vittorio, E-mail: v.catena@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Palussiere, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)

    2016-10-15

    AimTo review outcomes and local evolution of treated lesions following percutaneous image-guided screw fixation (PIGSF) of pathological/insufficiency fractures (PF/InF) and impeding fractures (ImF) in cancer patients at two tertiary centres.Materials and methodsThirty-two consecutive patients (mean age 67.5 years; range 33–86 years) with a range of tumours and prognoses underwent PIGSF for non/minimally displaced PF/InF and ImF. Screws were placed under CT/fluoroscopy or cone-beam CT guidance, with or without cementoplasty. Clinical outcomes were assessed using a simple 4-point scale (1 = worse; 2 = stable; 3 = improved; 4 = significantly improved). Local evolution was reviewed on most recent follow-up imaging. Technical success, complications, and overall survival were evaluated.ResultsThirty-six lesions were treated with 74 screws mainly in the pelvis and femoral neck (58.2 %); including 47.2 % PF, 13.9 % InF, and 38.9 % ImF. Cementoplasty was performed in 63.9 % of the cases. Technical success was 91.6 %. Hospital stay was ≤3 days; 87.1 % of lesions were improved at 1-month follow-up; three major complications (early screw-impingement radiculopathy; accelerated coxarthrosis; late coxofemoral septic arthritis) and one minor complication were observed. Unfavourable local evolution at imaging occurred in 3/24 lesions (12.5 %) at mean 8.7-month follow-up, including poor consolidation (one case) and screw loosening (two cases, at least 1 symptomatic). There were no cases of secondary fractures.ConclusionsPIGSF is feasible for a wide range of oncologic patients, offering good short-term efficacy, acceptable complication rates, and rapid recovery. Unfavourable local evolution at imaging may be relatively frequent, and requires close clinico-radiological surveillance.

  8. Using patient reported outcome measures in health services: A qualitative study on including people with low literacy skills and learning disabilities

    Directory of Open Access Journals (Sweden)

    Jahagirdar Deepa

    2012-11-01

    Full Text Available Abstract Background Patient reported outcome measures (PROMs are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated stakeholder views on the accessibility and use of PROMs to develop suggestions for more inclusive practice. Methods Taking PROMs recommended for chronic obstructive pulmonary disease (COPD as an example, we conducted 8 interviews with people with low literacy skills and/or learning disabilities, and 4 focus groups with 20 health professionals and people with COPD. Discussions covered the format and delivery of PROMs using the EQ-5D and St George Respiratory Questionnaire as prompts. Thematic framework analysis focused on three main themes: Accessibility, Ease of Use, and Contextual factors. Results Accessibility included issues concerning the questionnaire format, and suggestions for improvement included larger font sizes and more white space. Ease of Use included discussion about PROMs’ administration. While health professionals suggested PROMs could be completed in waiting rooms, patients preferred settings with more privacy and where they could access help from people they know. Contextual Factors included other challenges and wider issues associated with completing PROMs. While health professionals highlighted difficulties created by the system in managing patients with low literacy/learning disabilities, patient participants stressed that understanding the purpose of PROMs was important to reduce intimidation. Conclusions Adjusting PROMs’ format, giving an explicit choice of where patients can complete them, and clearly conveying PROMs’ purpose and benefit to patients may help to prevent inequality when using PROMs in health services.

  9. Interplay of task and outcome interdependence in generating work team members' affective responses : Some new findings

    NARCIS (Netherlands)

    Emans, B J M; Van der Vegt, G S; Van de Vliert, E; Vartiainen, M; Avallone, F; Anderson, N

    2000-01-01

    Two distinct, basic dimensions of a work team's internal structure are outcome interdependence and task interdependence. Task interdependence is a characteristic of team members' jobs. It is defined as their interconnectedness with jobs of co-members. Outcome interdependence is a characteristic of

  10. Do pigeons prefer alternatives that include near-hit outcomes?

    Science.gov (United States)

    Stagner, Jessica P; Case, Jacob P; Sticklen, Mary F; Duncan, Amanda K; Zentall, Thomas R

    2015-07-01

    Pigeons show suboptimal choice on a gambling-like task similar to that shown by humans. Humans also show a preference for gambles in which there are near hits (losses that come close to winning). In the present research, we asked if pigeons would show a preference for alternatives with near-hit-like trials. In Experiment 1, we included an alternative that presented a near hit, in which a stimulus associated with reinforcement (a presumed conditioned reinforcer) changed to a stimulus associated with the absence of reinforcement (a presumed conditioned inhibitor). The pigeons tended to avoid this alternative. In Experiment 2, we varied the duration of the presumed conditioned reinforcer (2 vs. 8 s) that changed to a presumed conditioned inhibitor (8 vs. 2 s) and found that the longer the conditioned reinforcer was presented, the more the pigeons avoided it. In Experiment 3, the near-hit alternative involved an ambiguous stimulus for 8 s that changed to a presumed conditioned reinforcer (or a presumed conditioned inhibitor) for 2 s, but the pigeons still avoided it. In Experiment 4, we controlled for the duration of the conditioned reinforcer by presenting it first for 2 s followed by the ambiguous stimulus for 8 s. Once again, the pigeons avoided the alternative with the near-hit trials. In all 4 experiments, the pigeons tended to avoid alternatives that provided near-hit-like trials. We concluded that humans may be attracted to near-hit trials because near-hit trials give them the illusion of control, whereas this does not appear to be a factor for pigeons. (c) 2015 APA, all rights reserved).

  11. The young generation - guarantors for the future of the nuclear industry

    International Nuclear Information System (INIS)

    Broy, Y.

    2000-01-01

    The concept of the 'Young Generation' has been meeting with considerable interest in many European countries for a number of years already. On the basis of the Young Generation Network initiated by Jan Runermark, Sweden, Young Generation networks have been created in a number of European countries, including Germany. Since October 1998, Germany's Young Generation has worked in a changed political environment: As a result of the outcome of the elections to the federal parliament in 1998 and the establishment of a federal government by SPD (the Social Democratic Party) and Alliance 90/The Greens, opting out of the peaceful uses of nuclear power has become one of the guiding principles and goals. Hence, the qualified and highly motivated young employees of nuclear companies are bound to ask themselves whether there is any future for them in nuclear engineering. The Young Generation will work for the future of nuclear technology by embarking on a series of activities. Discussions with the public, transfer of know-how, and also an intensification of contacts among all companies active in the nuclear field are only some of the items of their agenda. The purpose of the activities, and the principle, of the Young Generation is this: The Young Generation is aware of its responsibility for the future, and is ready to meet the challenges. (orig.) [de

  12. Olfactory neuroblastoma: the long-term outcome and late toxicity of multimodal therapy including radiotherapy based on treatment planning using computed tomography

    International Nuclear Information System (INIS)

    Mori, Takashi; Onimaru, Rikiya; Onodera, Shunsuke; Tsuchiya, Kazuhiko; Yasuda, Koichi; Hatakeyama, Hiromitsu; Kobayashi, Hiroyuki; Terasaka, Shunsuke; Homma, Akihiro; Shirato, Hiroki

    2015-01-01

    Olfactory neuroblastoma (ONB) is a rare tumor originating from olfactory epithelium. Here we retrospectively analyzed the long-term treatment outcomes and toxicity of radiotherapy for ONB patients for whom computed tomography (CT) and three-dimensional treatment planning was conducted to reappraise the role of radiotherapy in the light of recent advanced technology and chemotherapy. Seventeen patients with ONB treated between July 1992 and June 2013 were included. Three patients were Kadish stage B and 14 were stage C. All patients were treated with radiotherapy with or without surgery or chemotherapy. The radiation dose was distributed from 50 Gy to 66 Gy except for one patient who received 40 Gy preoperatively. The median follow-up time was 95 months (range 8–173 months). The 5-year overall survival (OS) and relapse-free survival (RFS) rates were estimated at 88% and 74%, respectively. Five patients with stage C disease had recurrence with the median time to recurrence of 59 months (range 7–115 months). Late adverse events equal to or above Grade 2 in CTCAE v4.03 were observed in three patients. Multimodal therapy including radiotherapy with precise treatment planning based on CT simulation achieved an excellent local control rate with acceptable toxicity and reasonable overall survival for patients with ONB

  13. Community capacity building and sustainability: outcomes of community-based participatory research.

    Science.gov (United States)

    Hacker, Karen; Tendulkar, Shalini A; Rideout, Catlin; Bhuiya, Nazmim; Trinh-Shevrin, Chau; Savage, Clara P; Grullon, Milagro; Strelnick, Hal; Leung, Carolyn; DiGirolamo, Ann

    2012-01-01

    For communities, the value of community-based participatory research (CBPR) is often manifested in the outcomes of increased capacity and sustainable adoption of evidence-based practices for social change. Educational opportunities that promote discourse between community and academic partners can help to advance CBPR and better define these outcomes. This paper describes a community-academic conference to develop shared definitions of community capacity building and sustainability related to CBPR and to identify obstacles and facilitators to both. "Taking It to the Curbside: Engaging Communities to Create Sustainable Change for Health" was planned by five Clinical Translational Science Institutes and four community organizations. After a keynote presentation, breakout groups of community and academic members met to define community capacity building and sustainability, and to identify facilitators and barriers to achieving both. Groups were facilitated by researcher-community partner teams and conversations were recorded and transcribed. Qualitative analysis for thematic content was conducted by a subset of the planning committee. Important findings included learning that (1) the concepts of capacity and sustainability were considered interconnected; (2) partnership was perceived as both a facilitator and an outcome of CBPR; (3) sustainability was linked to "transfer of knowledge" from one generation to another within a community; and (4) capacity and sustainability were enhanced when goals were shared and health outcomes were achieved. Community capacity building and sustainability are key outcomes of CBPR for communities. Co-learning opportunities that engage and mutually educate both community members and academics can be useful strategies for identifying meaningful strategies to achieve these outcomes.

  14. Incorporating outcome uncertainty and prior outcome beliefs in stated preferences

    DEFF Research Database (Denmark)

    Lundhede, Thomas; Jacobsen, Jette Bredahl; Hanley, Nick

    2015-01-01

    Stated preference studies tell respondents that policies create environmental changes with varying levels of uncertainty. However, respondents may include their own a priori assessments of uncertainty when making choices among policy options. Using a choice experiment eliciting respondents......’ preferences for conservation policies under climate change, we find that higher outcome uncertainty reduces utility. When accounting for endogeneity, we find that prior beliefs play a significant role in this cost of uncertainty. Thus, merely stating “objective” levels of outcome uncertainty...

  15. Social inequalities in pregnancy outcomes and early childhood behaviour: the Generation R study

    NARCIS (Netherlands)

    P.W. Jansen (Pauline)

    2009-01-01

    textabstractaim of this thesis was to extend the existing knowledge on the relation of social disadvantage with pregnancy outcomes and early childhood behaviour. More specifically, we aimed to identify the mechanisms underlying this association. In this thesis, several indicators of social

  16. Clinical Outcome Assessments: Conceptual Foundation-Report of the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force.

    Science.gov (United States)

    Walton, Marc K; Powers, John H; Hobart, Jeremy; Patrick, Donald; Marquis, Patrick; Vamvakas, Spiros; Isaac, Maria; Molsen, Elizabeth; Cano, Stefan; Burke, Laurie B

    2015-09-01

    An outcome assessment, the patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. Outcome assessments are used to define efficacy endpoints when developing a therapy for a disease or condition. Most efficacy endpoints are based on specified clinical assessments of patients. When clinical assessments are used as clinical trial outcomes, they are called clinical outcome assessments (COAs). COAs include any assessment that may be influenced by human choices, judgment, or motivation. COAs must be well-defined and possess adequate measurement properties to demonstrate (directly or indirectly) the benefits of a treatment. In contrast, a biomarker assessment is one that is subject to little, if any, patient motivational or rater judgmental influence. This is the first of two reports by the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. This report provides foundational definitions important for an understanding of COA measurement principles. The foundation provided in this report includes what it means to demonstrate a beneficial effect, how assessments of patients relate to the objective of showing a treatment's benefit, and how these assessments are used in clinical trial endpoints. In addition, this report describes intrinsic attributes of patient assessments and clinical trial factors that can affect the properties of the measurements. These factors should be considered when developing or refining assessments. These considerations will aid investigators designing trials in their choice of using an existing assessment or developing a new outcome assessment. Although the focus of this report is on the development of a new COA to define endpoints in a clinical trial, these principles may be applied more generally. A critical element in appraising or developing a COA is to

  17. Logarithmic-function generator

    Science.gov (United States)

    Caron, P. R.

    1975-01-01

    Solid-state logarithmic-function generator is compact and provides improved accuracy. Generator includes a stable multivibrator feeding into RC circuit. Resulting exponentially decaying voltage is compared with input signal. Generator output is proportional to time required for exponential voltage to decay from preset reference level to level of input signal.

  18. Lexicon generation methods, lexicon generation devices, and lexicon generation articles of manufacture

    Science.gov (United States)

    Carter, Richard J [Richland, WA; McCall, Jonathon D [West Richland, WA; Whitney, Paul D [Richland, WA; Gregory, Michelle L [Richland, WA; Turner, Alan E [Kennewick, WA; Hetzler, Elizabeth G [Kennewick, WA; White, Amanda M [Kennewick, WA; Posse, Christian [Seattle, WA; Nakamura, Grant C [Kennewick, WA

    2010-10-26

    Lexicon generation methods, computer implemented lexicon editing methods, lexicon generation devices, lexicon editors, and articles of manufacture are described according to some aspects. In one aspect, a lexicon generation method includes providing a seed vector indicative of occurrences of a plurality of seed terms within a plurality of text items, providing a plurality of content vectors indicative of occurrences of respective ones of a plurality of content terms within the text items, comparing individual ones of the content vectors with respect to the seed vector, and responsive to the comparing, selecting at least one of the content terms as a term of a lexicon usable in sentiment analysis of text.

  19. FlexibleSUSY-A spectrum generator generator for supersymmetric models

    Science.gov (United States)

    Athron, Peter; Park, Jae-hyeon; Stöckinger, Dominik; Voigt, Alexander

    2015-05-01

    We introduce FlexibleSUSY, a Mathematica and C++ package, which generates a fast, precise C++ spectrum generator for any SUSY model specified by the user. The generated code is designed with both speed and modularity in mind, making it easy to adapt and extend with new features. The model is specified by supplying the superpotential, gauge structure and particle content in a SARAH model file; specific boundary conditions e.g. at the GUT, weak or intermediate scales are defined in a separate FlexibleSUSY model file. From these model files, FlexibleSUSY generates C++ code for self-energies, tadpole corrections, renormalization group equations (RGEs) and electroweak symmetry breaking (EWSB) conditions and combines them with numerical routines for solving the RGEs and EWSB conditions simultaneously. The resulting spectrum generator is then able to solve for the spectrum of the model, including loop-corrected pole masses, consistent with user specified boundary conditions. The modular structure of the generated code allows for individual components to be replaced with an alternative if available. FlexibleSUSY has been carefully designed to grow as alternative solvers and calculators are added. Predefined models include the MSSM, NMSSM, E6SSM, USSM, R-symmetric models and models with right-handed neutrinos.

  20. Modeling strategy to identify patients with primary immunodeficiency utilizing risk management and outcome measurement.

    Science.gov (United States)

    Modell, Vicki; Quinn, Jessica; Ginsberg, Grant; Gladue, Ron; Orange, Jordan; Modell, Fred

    2017-06-01

    This study seeks to generate analytic insights into risk management and probability of an identifiable primary immunodeficiency defect. The Jeffrey Modell Centers Network database, Jeffrey Modell Foundation's 10 Warning Signs, the 4 Stages of Testing Algorithm, physician-reported clinical outcomes, programs of physician education and public awareness, the SPIRIT® Analyzer, and newborn screening, taken together, generates P values of less than 0.05%. This indicates that the data results do not occur by chance, and that there is a better than 95% probability that the data are valid. The objectives are to improve patients' quality of life, while generating significant reduction of costs. The advances of the world's experts aligned with these JMF programs can generate analytic insights as to risk management and probability of an identifiable primary immunodeficiency defect. This strategy reduces the uncertainties related to primary immunodeficiency risks, as we can screen, test, identify, and treat undiagnosed patients. We can also address regional differences and prevalence, age, gender, treatment modalities, and sites of care, as well as economic benefits. These tools support high net benefits, substantial financial savings, and significant reduction of costs. All stakeholders, including patients, clinicians, pharmaceutical companies, third party payers, and government healthcare agencies, must address the earliest possible precise diagnosis, appropriate intervention and treatment, as well as stringent control of healthcare costs through risk assessment and outcome measurement. An affected patient is entitled to nothing less, and stakeholders are responsible to utilize tools currently available. Implementation offers a significant challenge to the entire primary immunodeficiency community.

  1. Coronary Stents: The Impact of Technological Advances on Clinical Outcomes.

    Science.gov (United States)

    Mennuni, Marco G; Pagnotta, Paolo A; Stefanini, Giulio G

    2016-02-01

    Percutaneous coronary interventions (PCI) were proposed in the late 1970s as an alternative to surgical coronary artery bypass grafting for the treatment of coronary artery disease. Important technological progress has been made since. Balloon angioplasty was replaced by bare metal stents, which allowed to permanently scaffold the coronary vessel avoiding acute recoil and abrupt occlusion. Thereafter, the introduction of early generation drug-eluting stents (DES) has significantly improved clinical outcomes, primarily by markedly reducing the risk of restenosis. New generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, have further improved upon the safety and efficacy profile of early generation DES. The present article aims to review the impact of technological advances on clinical outcomes in the field of PCI with coronary stents, and to provide a brief overview on clinical margins of improvement and unmet needs of available DES.

  2. Learning Technology through Three Generations of Technology Enhanced Distance Education Pedagogy

    Science.gov (United States)

    Anderson, Terry; Dron, Jon

    2012-01-01

    This paper updates earlier work in which we defined three generations of distance education pedagogy. We then describe emerging technologies that are most conducive to instructional designs that evolve with each generation. Finally we discuss matching the pedagogies with learning outcomes. (Contains 3 figures.)

  3. Device-independent randomness generation from several Bell estimators

    Science.gov (United States)

    Nieto-Silleras, Olmo; Bamps, Cédric; Silman, Jonathan; Pironio, Stefano

    2018-02-01

    Device-independent randomness generation and quantum key distribution protocols rely on a fundamental relation between the non-locality of quantum theory and its random character. This relation is usually expressed in terms of a trade-off between the probability of guessing correctly the outcomes of measurements performed on quantum systems and the amount of violation of a given Bell inequality. However, a more accurate assessment of the randomness produced in Bell experiments can be obtained if the value of several Bell expressions is simultaneously taken into account, or if the full set of probabilities characterizing the behavior of the device is considered. We introduce protocols for device-independent randomness generation secure against classical side information, that rely on the estimation of an arbitrary number of Bell expressions or even directly on the experimental frequencies of measurement outcomes. Asymptotically, this results in an optimal generation of randomness from experimental data (as measured by the min-entropy), without having to assume beforehand that the devices violate a specific Bell inequality.

  4. J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results.

    Science.gov (United States)

    Okkabaz, Nuri; Haksal, Mustafa; Atici, Ali Emre; Altuntas, Yunus Emre; Gundogan, Ersin; Gezen, Fazli Cem; Oncel, Mustafa

    2017-11-01

    To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Exhausted implanted pulse generator in sacral nerve stimulation for faecal incontinence: What next in daily practice for patients?

    Science.gov (United States)

    Duchalais, Emilie; Meurette, Guillaume; Perrot, Bastien; Wyart, Vincent; Kubis, Caroline; Lehur, Paul-Antoine

    2016-02-01

    The efficacy of sacral nerve stimulation in faecal incontinence relies on an implanted pulse generator known to have a limited lifespan. The long-term use of sacral nerve stimulation raises concerns about the true lifespan of generators. The aim of the study was to assess the lifespan of sacral nerve stimulation implanted pulse generators in daily practice, and the outcome of exhausted generator replacement, in faecal incontinent patients. Faecal incontinent patients with pulse generators (Medtronic Interstim™ or InterstimII™) implanted in a single centre from 2001 to 2014 were prospectively followed up. Generator lifespan was measured according to the Kaplan-Meier method. Patients with a generator explanted/turned off before exhaustion were excluded. Morbidity of exhausted generator replacement and the outcome (Cleveland Clinic Florida Faecal Incontinence (CCF-FI) and Faecal Incontinence Quality of Life (FIQL) scores) were recorded. Of 135 patients with an implanted pulse generator, 112 (InterstimII 66) were included. Mean follow-up was 4.9 ± 2.8 years. The generator reached exhaustion in 29 (26%) cases. Overall median lifespan of an implanted pulse generator was approximately 9 years (95% CI 8-9.2). Interstim and InterstimII 25th percentile lifespan was 7.2 (CI 6.4-8.3) and 5 (CI 4-not reached) years, respectively. After exhaustion, generators were replaced, left in place or explanted in 23, 2 and 4 patients, respectively. Generator replacement was virtually uneventful. CCF-FI/FIQL scores remained unchanged after generator replacement (CCF-FI 8 ± 2 vs 7 ± 3; FIQL 3 ± 0.6 vs 3 ± 0.5; p = ns). In this study, the implanted pulse generator observed median lifespan was 9 years. After exhaustion, generators were safely and efficiently replaced. The study also gives insight into long-term needs and costs of sacral nerve stimulation (SNS) therapy.

  6. Exploring the outcomes in studies of primary frozen shoulder

    DEFF Research Database (Denmark)

    Rodgers, Sara; Brealey, Stephen; Jefferson, Laura

    2014-01-01

    PURPOSE: In our study we explored the need to define a core outcome set for primary frozen shoulder. METHODS: We investigated the outcomes used by studies included in a systematic review of the management of primary frozen shoulder; surveyed which primary outcome measures health care professionals...... and 104 respondents, respectively) were most often cited by health care professionals as the primary outcome measure that should be used. Searches identified one paper that included patients' views. Outcomes of importance to patients were pain at night, general pain, reduced mobility (resulting...

  7. The external costs of electricity generation: a comparison of generation technologies

    Energy Technology Data Exchange (ETDEWEB)

    Ozdemiroglu, E [Economics for the Environment Consultancy, London (United Kingdom)

    1995-12-01

    Electricity generation, like any economic activity, leads to costs that can be grouped in two categories: (a) private or internal and (b) external. Private costs are those paid by the buyers and sellers of energy within the market system. The external costs, however, are not included in the market price mechanism as they accrue to third parties other than the buyer and the seller. External costs include environmental external costs and non-environmental external costs. There are two conditions for the existence of external costs: (a) market failure, or the inability of markets to account for the cost of environmental impacts of energy generation and the market structure and (b) government or policy failure, or the policies that cause private generators to pay either higher or lower costs than they would if these interventions did not exist. A third reason can be added for the existence of non-environmental externalities: energy security, or certain costs faced by society as a result of over-reliance on imported energy. Section A introduces the concept of external costs and benefits. Section B looks at the environmental externalities of energy generation. The procedure is to develop the methodology to estimate what are known as externality adders, i.e. a monetary value for the environmental costs and benefits associated with selected generation technologies, expressed in pence per kilowatt-hour. The result is an `adder` because, in principle, the sum can be added to the private cost of generating electricity to obtain a measure of the `full` or `social` cost. The selected generation technologies are conventional coal, wind power, small-scale hydro, energy crops, incineration of municipal solid waste and energy recovery from landfill. The data reported are based on the application of the technologies in Scotland, but the methodology can be applied anywhere. Section C takes a brief look at the non-environmental externalities including the general theory and evidence

  8. The external costs of electricity generation: a comparison of generation technologies

    International Nuclear Information System (INIS)

    Ozdemiroglu, E.

    1995-01-01

    Electricity generation, like any economic activity, leads to costs that can be grouped in two categories: (a) private or internal and (b) external. Private costs are those paid by the buyers and sellers of energy within the market system. The external costs, however, are not included in the market price mechanism as they accrue to third parties other than the buyer and the seller. External costs include environmental external costs and non-environmental external costs. There are two conditions for the existence of external costs: (a) market failure, or the inability of markets to account for the cost of environmental impacts of energy generation and the market structure and (b) government or policy failure, or the policies that cause private generators to pay either higher or lower costs than they would if these interventions did not exist. A third reason can be added for the existence of non-environmental externalities: energy security, or certain costs faced by society as a result of over-reliance on imported energy. Section A introduces the concept of external costs and benefits. Section B looks at the environmental externalities of energy generation. The procedure is to develop the methodology to estimate what are known as externality adders, i.e. a monetary value for the environmental costs and benefits associated with selected generation technologies, expressed in pence per kilowatt-hour. The result is an 'adder' because, in principle, the sum can be added to the private cost of generating electricity to obtain a measure of the 'full' or 'social' cost. The selected generation technologies are conventional coal, wind power, small-scale hydro, energy crops, incineration of municipal solid waste and energy recovery from landfill. The data reported are based on the application of the technologies in Scotland, but the methodology can be applied anywhere. Section C takes a brief look at the non-environmental externalities including the general theory and evidence

  9. Conditional prediction intervals of wind power generation

    DEFF Research Database (Denmark)

    Pinson, Pierre; Kariniotakis, Georges

    2010-01-01

    A generic method for the providing of prediction intervals of wind power generation is described. Prediction intervals complement the more common wind power point forecasts, by giving a range of potential outcomes for a given probability, their so-called nominal coverage rate. Ideally they inform...... on the characteristics of prediction errors for providing conditional interval forecasts. By simultaneously generating prediction intervals with various nominal coverage rates, one obtains full predictive distributions of wind generation. Adapted resampling is applied here to the case of an onshore Danish wind farm...... to the case of a large number of wind farms in Europe and Australia among others is finally discussed....

  10. Designing the next generation (fifth generation computers)

    International Nuclear Information System (INIS)

    Wallich, P.

    1983-01-01

    A description is given of the designs necessary to develop fifth generation computers. An analysis is offered of problems and developments in parallelism, VLSI, artificial intelligence, knowledge engineering and natural language processing. Software developments are outlined including logic programming, object-oriented programming and exploratory programming. Computer architecture is detailed including concurrent computer architecture

  11. The natural language of the surgeon's clinical note in outcomes assessment: a qualitative analysis of the medical record.

    Science.gov (United States)

    Miller, J Michael; Velanovich, Vic

    2010-06-01

    Physician-generated clinical notes are the central document in recording the clinical decision-making and outcome of care. This is particularly true in an environment where outcomes assessment is becoming increasingly important. The hypothesis of this study is that these notes are inadequate to assess patient-centered outcomes and determine surgeons' core competencies. We preformed a retrospective review of postoperative clinical notes of general surgery patients for a 1-month period. Information from these notes underwent qualitative analysis using the reductionist thematic approach for patient-centered and physician-centered outcomes. Outcomes included 2 physician-centered items (physical examination and objective tests) and 3 patient-centered items (postoperative complications, functional status, and satisfaction). The presence or absence of each item in the clinical note was recorded. Six hundred eighty-one patients of 18 general surgeons were included. Among the surgeons, 28% failed to document symptomatic change in even 1 patient; similarly, 67% failed to document functional change, and 50% failed to document satisfaction. Among all 681 clinical notes only 7% of records mentioned symptomatic change, 1% functional change, 87% physical examination, 26% objective tests, and 3% patient satisfaction. These results were not affected by procedure type or number of patients seen. In general surgery practice, the surgeon's clinical note is a poor measure of physician-centered or patient-centered outcomes, implying that an audit of clinical notes would be an inaccurate method to assess patient outcomes. This has implications for issues surrounding maintenance of certification. Copyright 2010 Elsevier Inc. All rights reserved.

  12. Modeling the economic outcomes of immuno-oncology drugs: alternative model frameworks to capture clinical outcomes.

    Science.gov (United States)

    Gibson, E J; Begum, N; Koblbauer, I; Dranitsaris, G; Liew, D; McEwan, P; Tahami Monfared, A A; Yuan, Y; Juarez-Garcia, A; Tyas, D; Lees, M

    2018-01-01

    Economic models in oncology are commonly based on the three-state partitioned survival model (PSM) distinguishing between progression-free and progressive states. However, the heterogeneity of responses observed in immuno-oncology (I-O) suggests that new approaches may be appropriate to reflect disease dynamics meaningfully. This study explored the impact of incorporating immune-specific health states into economic models of I-O therapy. Two variants of the PSM and a Markov model were populated with data from one clinical trial in metastatic melanoma patients. Short-term modeled outcomes were benchmarked to the clinical trial data and a lifetime model horizon provided estimates of life years and quality adjusted life years (QALYs). The PSM-based models produced short-term outcomes closely matching the trial outcomes. Adding health states generated increased QALYs while providing a more granular representation of outcomes for decision making. The Markov model gave the greatest level of detail on outcomes but gave short-term results which diverged from those of the trial (overstating year 1 progression-free survival by around 60%). Increased sophistication in the representation of disease dynamics in economic models is desirable when attempting to model treatment response in I-O. However, the assumptions underlying different model structures and the availability of data for health state mapping may be important limiting factors.

  13. Key performance outcomes of patient safety curricula: root cause analysis, failure mode and effects analysis, and structured communications skills.

    Science.gov (United States)

    Fassett, William E

    2011-10-10

    As colleges and schools of pharmacy develop core courses related to patient safety, course-level outcomes will need to include both knowledge and performance measures. Three key performance outcomes for patient safety coursework, measured at the course level, are the ability to perform root cause analyses and healthcare failure mode effects analyses, and the ability to generate effective safety communications using structured formats such as the Situation-Background-Assessment-Recommendation (SBAR) situational briefing model. Each of these skills is widely used in patient safety work and competence in their use is essential for a pharmacist's ability to contribute as a member of a patient safety team.

  14. Embedding Affective Learning Outcomes in Library Instruction

    Directory of Open Access Journals (Sweden)

    Ellysa Stern Cahoy

    2012-12-01

    Full Text Available While information literacy in higher education has long been focused on cognitive learning outcomes, attention must be paid to students’ affective, emotional needs throughout the research process. This article identifies models for embedding affective learning outcomes within information literacy instruction, and provides strategies to help librarians discover, articulate, and address students’ self-efficacy, motivation, emotions and attitudes. Worksheets to assist in creating affective learning outcomes are included to bring structure to an area of learning that is often challenging to articulate and measure. Also included in the article are the results of a recent survey of instruction librarians’ familiarity and inclusion of affective learning outcomes within teaching and learning initiatives.

  15. Beyond total treatment effects in randomised controlled trials: Baseline measurement of intermediate outcomes needed to reduce confounding in mediation investigations.

    Science.gov (United States)

    Landau, Sabine; Emsley, Richard; Dunn, Graham

    2018-06-01

    Random allocation avoids confounding bias when estimating the average treatment effect. For continuous outcomes measured at post-treatment as well as prior to randomisation (baseline), analyses based on (A) post-treatment outcome alone, (B) change scores over the treatment phase or (C) conditioning on baseline values (analysis of covariance) provide unbiased estimators of the average treatment effect. The decision to include baseline values of the clinical outcome in the analysis is based on precision arguments, with analysis of covariance known to be most precise. Investigators increasingly carry out explanatory analyses to decompose total treatment effects into components that are mediated by an intermediate continuous outcome and a non-mediated part. Traditional mediation analysis might be performed based on (A) post-treatment values of the intermediate and clinical outcomes alone, (B) respective change scores or (C) conditioning on baseline measures of both intermediate and clinical outcomes. Using causal diagrams and Monte Carlo simulation, we investigated the performance of the three competing mediation approaches. We considered a data generating model that included three possible confounding processes involving baseline variables: The first two processes modelled baseline measures of the clinical variable or the intermediate variable as common causes of post-treatment measures of these two variables. The third process allowed the two baseline variables themselves to be correlated due to past common causes. We compared the analysis models implied by the competing mediation approaches with this data generating model to hypothesise likely biases in estimators, and tested these in a simulation study. We applied the methods to a randomised trial of pragmatic rehabilitation in patients with chronic fatigue syndrome, which examined the role of limiting activities as a mediator. Estimates of causal mediation effects derived by approach (A) will be biased if one of

  16. Assessment of COPD-related outcomes via a national electronic medical record database.

    Science.gov (United States)

    Asche, Carl; Said, Quayyim; Joish, Vijay; Hall, Charles Oaxaca; Brixner, Diana

    2008-01-01

    The technology and sophistication of healthcare utilization databases have expanded over the last decade to include results of lab tests, vital signs, and other clinical information. This review provides an assessment of the methodological and analytical challenges of conducting chronic obstructive pulmonary disease (COPD) outcomes research in a national electronic medical records (EMR) dataset and its potential application towards the assessment of national health policy issues, as well as a description of the challenges or limitations. An EMR database and its application to measuring outcomes for COPD are described. The ability to measure adherence to the COPD evidence-based practice guidelines, generated by the NIH and HEDIS quality indicators, in this database was examined. Case studies, before and after their publication, were used to assess the adherence to guidelines and gauge the conformity to quality indicators. EMR was the only source of information for pulmonary function tests, but low frequency in ordering by primary care was an issue. The EMR data can be used to explore impact of variation in healthcare provision on clinical outcomes. The EMR database permits access to specific lab data and biometric information. The richness and depth of information on "real world" use of health services for large population-based analytical studies at relatively low cost render such databases an attractive resource for outcomes research. Various sources of information exist to perform outcomes research. It is important to understand the desired endpoints of such research and choose the appropriate database source.

  17. Preparing for what might happen: An episodic specificity induction impacts the generation of alternative future events.

    Science.gov (United States)

    Jing, Helen G; Madore, Kevin P; Schacter, Daniel L

    2017-12-01

    A critical adaptive feature of future thinking involves the ability to generate alternative versions of possible future events. However, little is known about the nature of the processes that support this ability. Here we examined whether an episodic specificity induction - brief training in recollecting details of a recent experience that selectively impacts tasks that draw on episodic retrieval - (1) boosts alternative event generation and (2) changes one's initial perceptions of negative future events. In Experiment 1, an episodic specificity induction significantly increased the number of alternative positive outcomes that participants generated to a series of standardized negative events, compared with a control induction not focused on episodic specificity. We also observed larger decreases in the perceived plausibility and negativity of the original events in the specificity condition, where participants generated more alternative outcomes, relative to the control condition. In Experiment 2, we replicated and extended these findings using a series of personalized negative events. Our findings support the idea that episodic memory processes are involved in generating alternative outcomes to anticipated future events, and that boosting the number of alternative outcomes is related to subsequent changes in the perceived plausibility and valence of the original events, which may have implications for psychological well-being. Published by Elsevier B.V.

  18. Influences on call outcomes among Veteran callers to the National Veterans Crisis Line

    Science.gov (United States)

    Britton, Peter C.; Bossarte, Robert M.; Thompson, Caitlin; Kemp, Janet; Conner, Kenneth R.

    2016-01-01

    This evaluation examined the association of caller and call characteristics with proximal outcomes of Veterans Crisis Line calls. From October 1-7, 2010, 665 Veterans with recent suicidal ideation or a history of attempted suicide called the Veterans Crisis Line, 646 had complete data and were included in the analyses. A multivariable multinomial logistic regression was conducted to identify correlates of a favorable outcome, either a resolution or a referral, when compared to an unfavorable outcome, no resolution or referral. A multivariable logistic regression was used to identify correlates of responder-rated caller risk in a subset of calls. Approximately 84% of calls ended with a favorable outcome, 25% with a resolution and 59% with a referral to a local health care provider. Calls from high-risk callers had greater odds of ending with a referral than without a resolution or referral, as did weekday calls (6:00 am to 5:59 pm EST, Monday through Friday). Responders used caller intent to die and the absence of future plans to determine caller risk. Findings suggest that the Veterans Crisis Line is a useful mechanism for generating referrals for high-risk Veteran callers. Responders appeared to use known risk and protective factors to determine caller risk. PMID:23611446

  19. Integrating publicly-available data to generate computationally ...

    Science.gov (United States)

    The adverse outcome pathway (AOP) framework provides a way of organizing knowledge related to the key biological events that result in a particular health outcome. For the majority of environmental chemicals, the availability of curated pathways characterizing potential toxicity is limited. Methods are needed to assimilate large amounts of available molecular data and quickly generate putative AOPs for further testing and use in hazard assessment. A graph-based workflow was used to facilitate the integration of multiple data types to generate computationally-predicted (cp) AOPs. Edges between graph entities were identified through direct experimental or literature information or computationally inferred using frequent itemset mining. Data from the TG-GATEs and ToxCast programs were used to channel large-scale toxicogenomics information into a cpAOP network (cpAOPnet) of over 20,000 relationships describing connections between chemical treatments, phenotypes, and perturbed pathways measured by differential gene expression and high-throughput screening targets. Sub-networks of cpAOPs for a reference chemical (carbon tetrachloride, CCl4) and outcome (hepatic steatosis) were extracted using the network topology. Comparison of the cpAOP subnetworks to published mechanistic descriptions for both CCl4 toxicity and hepatic steatosis demonstrate that computational approaches can be used to replicate manually curated AOPs and identify pathway targets that lack genomic mar

  20. Grid generation methods

    CERN Document Server

    Liseikin, Vladimir D

    2017-01-01

    This new edition provides a description of current developments relating to grid methods, grid codes, and their applications to actual problems. Grid generation methods are indispensable for the numerical solution of differential equations. Adaptive grid-mapping techniques, in particular, are the main focus and represent a promising tool to deal with systems with singularities. This 3rd edition includes three new chapters on numerical implementations (10), control of grid properties (11), and applications to mechanical, fluid, and plasma related problems (13). Also the other chapters have been updated including new topics, such as curvatures of discrete surfaces (3). Concise descriptions of hybrid mesh generation, drag and sweeping methods, parallel algorithms for mesh generation have been included too. This new edition addresses a broad range of readers: students, researchers, and practitioners in applied mathematics, mechanics, engineering, physics and other areas of applications.

  1. Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop.

    Science.gov (United States)

    Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C; O'Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny I; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C

    2017-01-01

    Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis therapy. Key stakeholders including 8 patients/caregivers and 47 health professionals (nephrologists, policymakers, industry, and researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations, flexibility to consider evolving priorities over time, deconstruction of language and meaning for conceptual consistency and clarity, understanding of potential overlap and associations between outcomes, and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive, and validated outcome measures that could be used in clinical care (quality indicators) and trials (including pragmatic trials) and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment and improved patient outcomes. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  2. Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Consensus Workshop

    Science.gov (United States)

    Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C.; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C.; O’Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C.

    2017-01-01

    Evidence-informed decision-making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient-centered. The Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis. Key stakeholders including eight patients/caregivers and 47 health professionals (nephrologists, policy makers, industry, researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations; flexibility to consider evolving priorities over time; deconstruction of language and meaning for conceptual consistency and clarity; understanding of potential overlap and associations between outcomes; and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive and validated outcome measures that could be used in clinical care (quality ndicators) and trials (including pragmatic trials), and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment, and improved patient outcomes. PMID:27497527

  3. Protocol for the development of a core domain set for hidradenitis suppurativa trial outcomes

    DEFF Research Database (Denmark)

    Thorlacius, Linnea; Ingram, John R; Garg, Amit

    2017-01-01

    . A recent systematic review found a total of 30 outcome measure instruments in 12 RCTs. This use of a broad range of outcome measures can increase difficulties in interpretation and comparison of results and may potentially obstruct appropriate evidence synthesis by causing reporting bias. One strategy...... of candidate items will be obtained by combining three data sets: (1) a systematic review of the literature, (2) US and Danish qualitative interview studies involving patients with HS and (3) an online healthcare professional (HCP) item generation survey. To reach consensus on the COS, 4 anonymous online...... Delphi rounds are then planned together with 2 face-to-face consensus meetings (1 in Europe and 1 in the USA) to ensure global representation. ETHICS AND DISSEMINATION: The study will be performed according to the Helsinki declaration. All results from the study, including inconclusive or negative...

  4. Generated effect modifiers (GEM's) in randomized clinical trials.

    Science.gov (United States)

    Petkova, Eva; Tarpey, Thaddeus; Su, Zhe; Ogden, R Todd

    2017-01-01

    In a randomized clinical trial (RCT), it is often of interest not only to estimate the effect of various treatments on the outcome, but also to determine whether any patient characteristic has a different relationship with the outcome, depending on treatment. In regression models for the outcome, if there is a non-zero interaction between treatment and a predictor, that predictor is called an "effect modifier". Identification of such effect modifiers is crucial as we move towards precision medicine, that is, optimizing individual treatment assignment based on patient measurements assessed when presenting for treatment. In most settings, there will be several baseline predictor variables that could potentially modify the treatment effects. This article proposes optimal methods of constructing a composite variable (defined as a linear combination of pre-treatment patient characteristics) in order to generate an effect modifier in an RCT setting. Several criteria are considered for generating effect modifiers and their performance is studied via simulations. An example from a RCT is provided for illustration. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Implementing patient-reported outcome measures in palliative care clinical practice: a systematic review of facilitators and barriers.

    Science.gov (United States)

    Antunes, Bárbara; Harding, Richard; Higginson, Irene J

    2014-02-01

    Many patient-reported outcome measures have been developed in the past two decades, playing an increasingly important role in palliative care. However, their routine use in practice has been slow and difficult to implement. To systematically identify facilitators and barriers to the implementation of patient-reported outcome measures in different palliative care settings for routine practice, and to generate evidence-based recommendations, to inform the implementation process in clinical practice. Systematic literature review and narrative synthesis. Medline, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Embase and British Nursing Index were systematically searched from 1985. Hand searching of reference lists for all included articles and relevant review articles was performed. A total of 3863 articles were screened. Of these, 31 articles met the inclusion criteria. First, data were integrated in the main themes: facilitators, barriers and lessons learned. Second, each main theme was grouped into either five or six categories. Finally, recommendations for implementation on outcome measures at management, health-care professional and patient levels were generated for three different points in time: preparation, implementation and assessment/improvement. Successful implementation of patient-reported outcome measures should be tailored by identifying and addressing potential barriers according to setting. Having a coordinator throughout the implementation process seems to be key. Ongoing cognitive and emotional processes of each individual should be taken into consideration during changes. The educational component prior to the implementation is crucial. This could promote ownership and correct use of the measure by clinicians, potentially improving practice and the quality of care provided through patient-reported outcome measure data use in clinical decision-making.

  6. Pediatric hydrocephalus outcomes: a review

    Directory of Open Access Journals (Sweden)

    Vinchon Matthieu

    2012-08-01

    Full Text Available Abstract The outcome of pediatric hydrocephalus, including surgical complications, neurological sequelae and academic achievement, has been the matter of many studies. However, much uncertainty remains, regarding the very long-term and social outcome, and the determinants of complications and clinical outcome. In this paper, we review the different facets of outcome, including surgical outcome (shunt failure, infection and independence, and complications of endoscopy, clinical outcome (neurological, sensory, cognitive sequels, epilepsy, schooling and social integration. We then provide a brief review of the English-language literature and highlighting selected studies that provide information on the outcome and sequelae of pediatric hydrocephalus, and the impact of predictive variables on outcome. Mortality caused by hydrocephalus and its treatments is between 0 and 3%, depending on the duration of follow-up. Shunt event-free survival (EFS is about 70% at one year and 40% at ten years. The EFS after endoscopic third ventriculostomy (ETV appears better but likely benefits from selection bias and long-term figures are not available. Shunt infection affects between 5 and 8% of surgeries, and 15 to 30% of patients according to the duration of follow-up. Shunt independence can be achieved in 3 to 9% of patients, but the definition of this varies. Broad variations in the prevalence of cognitive sequelae, affecting 12 to 50% of children, and difficulties at school, affecting between 20 and 60%, attest of disparities among studies in their clinical evaluation. Epilepsy, affecting 6 to 30% of patients, has a serious impact on outcome. In adulthood, social integration is poor in a substantial number of patients but data are sparse. Few controlled prospective studies exist regarding hydrocephalus outcomes; in their absence, largely retrospective studies must be used to evaluate the long-term consequences of hydrocephalus and its treatments. This review

  7. Generated effect modifiers (GEM’s) in randomized clinical trials

    Science.gov (United States)

    Petkova, Eva; Tarpey, Thaddeus; Su, Zhe; Ogden, R. Todd

    2017-01-01

    In a randomized clinical trial (RCT), it is often of interest not only to estimate the effect of various treatments on the outcome, but also to determine whether any patient characteristic has a different relationship with the outcome, depending on treatment. In regression models for the outcome, if there is a non-zero interaction between treatment and a predictor, that predictor is called an “effect modifier”. Identification of such effect modifiers is crucial as we move towards precision medicine, that is, optimizing individual treatment assignment based on patient measurements assessed when presenting for treatment. In most settings, there will be several baseline predictor variables that could potentially modify the treatment effects. This article proposes optimal methods of constructing a composite variable (defined as a linear combination of pre-treatment patient characteristics) in order to generate an effect modifier in an RCT setting. Several criteria are considered for generating effect modifiers and their performance is studied via simulations. An example from a RCT is provided for illustration. PMID:27465235

  8. Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in coastal Kenya.

    Science.gov (United States)

    Graham, Susan M; Mugo, Peter; Gichuru, Evanson; Thiong'o, Alexander; Macharia, Michael; Okuku, Haile S; van der Elst, Elise; Price, Matthew A; Muraguri, Nicholas; Sanders, Eduard J

    2013-05-01

    African men who have sex with men (MSM) face significant stigma and barriers to care. We investigated antiretroviral therapy (ART) adherence among high-risk adults, including MSM, participating in a clinic-based cohort. Survival analysis was used to compare attrition across patient groups. Differences in adherence, weight gain, and CD4 counts after ART initiation were assessed. Among 250 HIV-1-seropositive adults, including 108 MSM, 15 heterosexual men, and 127 women, patient group was not associated with attrition. Among 58 participants who were followed on ART, 40 % of MSM had less than 95 % adherence, versus 28.6 % of heterosexual men and 11.5 % of women. Although MSM gained less weight after ART initiation than women (adjusted difference -3.5 kg/year), CD4 counts did not differ. More data are needed on barriers to adherence and clinical outcomes among African MSM, to ensure that MSM can access care and derive treatment and prevention benefits from ART.

  9. Functional Outcomes for Clinical Evaluation of Implant Restorations

    NARCIS (Netherlands)

    Bassi, Francesco; Carr, Alan B.; Chang, Ting-Ling; Estafanous, Emad W.; Garrett, Neal R.; Happonen, Risto-Pekka; Koka, Sreenivas; Laine, Juhani; Osswald, Martin; Reintsema, Harry; Rieger, Jana; Roumanas, Eleni; Salinas, Thomas J.; Stanford, Clark M.; Wolfaardt, Johan

    2013-01-01

    The functional outcomes related to treating patients afflicted with tooth loss are an important hallmark in substantiating prosthodontic intervention. The Oral Rehabilitation Outcomes Network (ORONet) conducted two international workshops to develop a core set of outcome measures, including a

  10. The impact of HIV/AIDS on children's educational outcome: a critical review of global literature.

    Science.gov (United States)

    Guo, Yan; Li, Xiaoming; Sherr, Lorraine

    2012-01-01

    The number of children losing one or both parents to HIV/AIDS has continued to rise in the past decade, with most of them being school-aged children. This study reviews global literature on the effects of HIV/AIDS (e.g., parental HIV-related illness or death) on children's schooling. Systematic review procedures generated 23 studies for examination. Existing studies show educational disadvantages among children affected by AIDS in various educational outcomes, including school enrollment and attendance, school behavior and performance, school completion, and educational attainment. A number of individual and contextual factors potentially moderate or mediate the effect of HIV/AIDS on children's education. These factors include gender of child, pattern of parental loss (maternal vs. paternal vs. dual), living arrangement (relationship with caregivers, gender of the household head), and household poverty. Current literature indicates limitations in number and scope of existing studies and in educational outcome measurements. There is a lack of studies with longitudinal design and data collection from multiple sources (e.g., students, teachers, caregivers), and a lack of studies on the relationship between psychosocial well-being of children affected by AIDS and their educational outcomes. Future studies need to employ more rigorous methodology and incorporate both individual and contextual factors for children affected by AIDS in various regions. More efforts are needed to design and implement culturally appropriate and context-specific approaches to improve the educational outcomes of children affected by AIDS.

  11. Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes.

    Science.gov (United States)

    Kappen, Isabelle Francisca Petronella Maria; Bittermann, Dirk; Janssen, Laura; Bittermann, Gerhard Koendert Pieter; Boonacker, Chantal; Haverkamp, Sarah; de Wilde, Hester; Van Der Heul, Marise; Specken, Tom Fjmc; Koole, Ron; Kon, Moshe; Breugem, Corstiaan Cornelis; Mink van der Molen, Aebele Barber

    2017-05-01

    No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (Pspeech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry. The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

  12. EU Framework 6 Project: Predictive Toxicology (PredTox)-overview and outcome

    International Nuclear Information System (INIS)

    Suter, Laura; Schroeder, Susanne; Meyer, Kirstin; Gautier, Jean-Charles; Amberg, Alexander; Wendt, Maria; Gmuender, Hans; Mally, Angela; Boitier, Eric; Ellinger-Ziegelbauer, Heidrun; Matheis, Katja; Pfannkuch, Friedlieb

    2011-01-01

    In this publication, we report the outcome of the integrated EU Framework 6 Project: Predictive Toxicology (PredTox), including methodological aspects and overall conclusions. Specific details including data analysis and interpretation are reported in separate articles in this issue. The project, partly funded by the EU, was carried out by a consortium of 15 pharmaceutical companies, 2 SMEs, and 3 universities. The effects of 16 test compounds were characterized using conventional toxicological parameters and 'omics' technologies. The three major observed toxicities, liver hypertrophy, bile duct necrosis and/or cholestasis, and kidney proximal tubular damage were analyzed in detail. The combined approach of 'omics' and conventional toxicology proved a useful tool for mechanistic investigations and the identification of putative biomarkers. In our hands and in combination with histopathological assessment, target organ transcriptomics was the most prolific approach for the generation of mechanistic hypotheses. Proteomics approaches were relatively time-consuming and required careful standardization. NMR-based metabolomics detected metabolite changes accompanying histopathological findings, providing limited additional mechanistic information. Conversely, targeted metabolite profiling with LC/GC-MS was very useful for the investigation of bile duct necrosis/cholestasis. In general, both proteomics and metabolomics were supportive of other findings. Thus, the outcome of this program indicates that 'omics' technologies can help toxicologists to make better informed decisions during exploratory toxicological studies. The data support that hypothesis on mode of action and discovery of putative biomarkers are tangible outcomes of integrated 'omics' analysis. Qualification of biomarkers remains challenging, in particular in terms of identification, mechanistic anchoring, appropriate specificity, and sensitivity.

  13. Measures of outcome for stimulant trials: ACTTION recommendations and research agenda.

    Science.gov (United States)

    Kiluk, Brian D; Carroll, Kathleen M; Duhig, Amy; Falk, Daniel E; Kampman, Kyle; Lai, Shengan; Litten, Raye Z; McCann, David J; Montoya, Ivan D; Preston, Kenzie L; Skolnick, Phil; Weisner, Constance; Woody, George; Chandler, Redonna; Detke, Michael J; Dunn, Kelly; Dworkin, Robert H; Fertig, Joanne; Gewandter, Jennifer; Moeller, F Gerard; Ramey, Tatiana; Ryan, Megan; Silverman, Kenneth; Strain, Eric C

    2016-01-01

    The development and approval of an efficacious pharmacotherapy for stimulant use disorders has been limited by the lack of a meaningful indicator of treatment success, other than sustained abstinence. In March, 2015, a meeting sponsored by Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) was convened to discuss the current state of the evidence regarding meaningful outcome measures in clinical trials for stimulant use disorders. Attendees included members of academia, funding and regulatory agencies, pharmaceutical companies, and healthcare organizations. The goal was to establish a research agenda for the development of a meaningful outcome measure that may be used as an endpoint in clinical trials for stimulant use disorders. Based on guidelines for the selection of clinical trial endpoints, the lessons learned from prior addiction clinical trials, and the process that led to identification of a meaningful indicator of treatment success for alcohol use disorders, several recommendations for future research were generated. These include a focus on the validation of patient reported outcome measures of functioning, the exploration of patterns of stimulant abstinence that may be associated with physical and/or psychosocial benefits, the role of urine testing for validating self-reported measures of stimulant abstinence, and the operational definitions for reduction-based measures in terms of frequency rather than quantity of stimulant use. These recommendations may be useful for secondary analyses of clinical trial data, and in the design of future clinical trials that may help establish a meaningful indicator of treatment success. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. The Gel Generator option

    International Nuclear Information System (INIS)

    Boyd, R.E.

    1999-01-01

    The development of a national policy for guaranteeing an ample supply of 99m Tc to nuclear medicine, involves issues which go beyond the means by which radioactivation is achieved. Indeed, in such an exercise the pragmatic dictates of business and the sensitivities of politics must also be taken into account. Furthermore where a preference towards the nuclear reactor or the potential of cyclotrons is being questioned, the debate is incomplete if the only options that are considered are the fission-based 99 Mo generator versus the direct cyclotron production of 99m Tc. There is a third option (also neutron γ-based), an alternative to the fission 99 Mo generator, which ought not be overlooked. The application of low specific activity (n,γ) 99 Mo to a new type of generator, the Gel Generator, has been the focus of much research, particularly in Australia and more recently in China. After the initial concept had been established in the laboratory, the Australian researchers then undertook a comprehensive program of tests on the Gel Generator to assess its potential, either in the clinical laboratory or the centralised radiopharmacy, for supplying 99m Tc suitable for nuclear medicine. The outcome of this program was a clear indication that the Gel Generator innovation had the capability to provide both technical and economic advantages to the nuclear medicine industry. These advantages are described. Since that time the Gel Generator has been selected for routine use in China where it now satisfies more than 30% of the 99m Tc demand. (author)

  15. Microfluidic devices and methods including porous polymer monoliths

    Science.gov (United States)

    Hatch, Anson V; Sommer, Gregory J; Singh, Anup K; Wang, Ying-Chih; Abhyankar, Vinay V

    2014-04-22

    Microfluidic devices and methods including porous polymer monoliths are described. Polymerization techniques may be used to generate porous polymer monoliths having pores defined by a liquid component of a fluid mixture. The fluid mixture may contain iniferters and the resulting porous polymer monolith may include surfaces terminated with iniferter species. Capture molecules may then be grafted to the monolith pores.

  16. [Outcome Quality in Medical Rehabilitation: Relationship Between "Patient-Reported Outcomes" (PROs) and Social Security Contributions].

    Science.gov (United States)

    Nübling, R; Kaluscha, R; Krischak, G; Kriz, D; Martin, H; Müller, G; Renzland, J; Reuss-Borst, M; Schmidt, J; Kaiser, U; Toepler, E

    2017-02-01

    Aim of the Study The outcome quality of medical rehabilitation is evaluated often by "Patient Reported Outcomes" (PROs). It is examined to what extent these PROs are corresponding with "hard" or "objective" outcomes such as payments of contributions to social insurance. Methods The "rehabilitation QM outcome study" includes self-reports of patients as well as data from the Rehabilitation Statistics Database (RSD) of the German pension insurance Baden-Wurttemberg. The sample for the question posed includes N=2 947 insured who were treated in 2011 in 21 clinics of the "health quality network" and who were either employed or unemployed at the time of the rehabilitation application (e. g. the workforce or labour force group, response rate: 55%). The sample turned out widely representative for the population of the insured persons. Results PROs and payment of contributions to pension insurance clearly correspond. In the year after the rehabilitation improved vs. not improved rehabilitees differed clearly with regard to their payments of contributions. Conclusions The results support the validity of PROs. For a comprehensive depiction of the outcome quality of rehabilitation PROs and payments of contributions should be considered supplementary. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Provider volume and outcomes for oncological procedures.

    LENUS (Irish Health Repository)

    Killeen, S D

    2012-02-03

    BACKGROUND: Oncological procedures may have better outcomes if performed by high-volume providers. METHODS: A review of the English language literature incorporating searches of the Medline, Embase and Cochrane collaboration databases was performed. Studies were included if they involved a patient cohort from 1984 onwards, were community or population based, and assessed health outcome as a dependent variable and volume as an independent variable. The studies were also scored quantifiably to assess generalizability with respect to any observed volume-outcome relationship and analysed according to organ system; numbers needed to treat were estimated where possible. RESULTS: Sixty-eight relevant studies were identified and a total of 41 were included, of which 13 were based on clinical data. All showed either an inverse relationship, of variable magnitude, between provider volume and mortality, or no volume-outcome effect. All but two clinical reports revealed a statistically significant positive relationship between volume and outcome; none demonstrated the opposite. CONCLUSION: High-volume providers have a significantly better outcome for complex cancer surgery, specifically for pancreatectomy, oesphagectomy, gastrectomy and rectal resection.

  18. Review of Micro Magnetic Generator

    OpenAIRE

    Lin DU; Gengchen SHI; Jingjing ZHAO

    2014-01-01

    This paper discusses the research progress of micro magnetic generator systems. Micro magnetic generator systems convert energy from the environment to electric energy with advantages as high reliability, high power density, long life time and can be applied to extreme environment. This paper summarizes methods for improving generator performance of micro magnetic generator, including rotational magnetic generator, vibrational magnetic generator and hybrid magnetic generator, analyzes and com...

  19. Core outcome sets in dermatology: report from the second meeting of the International Cochrane Skin Group Core Outcome Set Initiative.

    Science.gov (United States)

    Kottner, J; Jacobi, L; Hahnel, E; Alam, M; Balzer, K; Beeckman, D; Busard, C; Chalmers, J; Deckert, S; Eleftheriadou, V; Furlan, K; Horbach, S E R; Kirkham, J; Nast, A; Spuls, P; Thiboutot, D; Thorlacius, L; Weller, K; Williams, H C; Schmitt, J

    2018-04-01

    Results of clinical trials are the most important information source for generating external clinical evidence. The use of different outcomes across trials, which investigate similar interventions for similar patient groups, significantly limits the interpretation, comparability and clinical application of trial results. Core outcome sets (COSs) aim to overcome this limitation. A COS is an agreed standardized collection of outcomes that should be measured and reported in all clinical trials for a specific clinical condition. The Core Outcome Set Initiative within the Cochrane Skin Group (CSG-COUSIN) supports the development of core outcomes in dermatology. In the second CSG-COUSIN meeting held in 2017, 11 COS development groups working on skin diseases presented their current work. The presentations and discussions identified the following overarching methodological challenges for COS development in dermatology: it is not always easy to define the disease focus of a COS; the optimal method for outcome domain identification and level of detail needed to specify such domains is challenging to many; decision rules within Delphi surveys need to be improved; appropriate ways of patient involvement are not always clear. In addition, there appear to be outcome domains that may be relevant as potential core outcome domains for the majority of skin diseases. The close collaboration between methodologists in the Core Outcome Set Initiative and the international Cochrane Skin Group has major advantages for trialists, systematic reviewers and COS developers. © 2018 British Association of Dermatologists.

  20. Sensitive endpoints in extended one-generation reproductive toxicity study versus two generation?

    DEFF Research Database (Denmark)

    Christiansen, Sofie

    . The protocol includes assessment of novel endpoints of concern and developmental landmarks such as anogenital distance, nipple retention (both sensitive endpoints for anti-androgenic effects in male offspring) and mammary gland development (sensitive endpoint for oestrogen action) and may also include...... during critical period of development in contrast to the parental generation. Retrospective analysis of available two-generation studies, however, indicate that the assessment included in the study of other endpoints in the male offspring such as histopathology of reproductive organs and semen quality...

  1. Prospective outcomes of injury study.

    Science.gov (United States)

    Derrett, S; Langley, J; Hokowhitu, B; Ameratunga, S; Hansen, P; Davie, G; Wyeth, E; Lilley, R

    2009-10-01

    In New Zealand (NZ), 20% of adults report a disability, of which one-third is caused by injury. No prospective epidemiological studies of predictors of disability following all-cause injury among New Zealanders have been undertaken. Internationally, studies have focused on a limited range of predictors or specific injuries. Although these studies provide useful insights, applicability to NZ is limited given the importance of NZ's unique macro-social factors, such as NZ's no-fault accident compensation and rehabilitation scheme, the Accident Compensation Corporation (ACC). (1) To quantitatively determine the injury, rehabilitation, personal, social and economic factors leading to disability outcomes following injury in NZ. (2) To qualitatively explore experiences and perceptions of injury-related outcomes in face-to-face interviews with 15 Māori and 15 other New Zealanders, 6 and 12 months after injury. Four geographical regions within NZ. Prospective cohort study with telephone interviews 1, 4 and 12 months after injury. 2500 people (including 460 Māori), aged 18-64 years, randomly selected from ACC's entitlement claims register (people likely to be off work for at least 1 week or equivalent). Telephone interviews, electronic hospital and ACC injury data. Exposures include demographic, social, economic, work-related, health status, participation and/or environmental factors. Primary: disability (including WHODAS II) and health-related quality of life (including EQ-5D). Secondary: participation (paid and unpaid activities), life satisfaction and costs. Separate regression models will be developed for each of the outcomes. Repeated measures outcomes will be modelled using general estimating equation models and generalised linear mixed models.

  2. Stabilization and control of tie-line power flow of microgrid including wind generation by distributed energy storage

    Energy Technology Data Exchange (ETDEWEB)

    Molina, M.G.; Mercado, P.E. [CONICET, Instituto de Energia Electrica, Universidad Nacional de San Juan, Av. Libertador San Martin Oeste 1109, J5400ARL San Juan (Argentina)

    2010-06-15

    High penetration of wind generation in electrical microgrids causes fluctuations of tie-line power flow and significantly affects the power system operation. This can lead to severe problems, such as system frequency oscillations, and/or violations of power lines capability. With proper control, a distribution static synchronous compensator (DSTATCOM) integrated with superconducting magnetic energy storage (SMES) is able to significantly enhance the dynamic security of the power system. This paper proposes the use of a SMES system in combination with a DSTATCOM as effective distributed energy storage (DES) for stabilization and control of the tie-line power flow of microgrids incorporating wind generation. A new detailed model of the integrated DSTATCOM-SMES device is derived and a novel three-level control scheme is designed. The dynamic performance of the proposed control schemes is fully validated using MATLAB/Simulink. (author)

  3. Measuring outcomes in psychiatry: an inpatient model.

    Science.gov (United States)

    Davis, D E; Fong, M L

    1996-02-01

    This article describes a system for measuring outcomes recently implemented in the department of psychiatry of Baptist Memorial Hospital, a 78-bed inpatient and day treatment unit that represents one service line of a large, urban teaching hospital in Memphis. In June 1993 Baptist Hospital began a 15-month pilot test of PsychSentinel, a measurement tool developed by researchers in the Department of Community Medicine at the University of Connecticut. The hospital identified the following four primary goals for this pilot project: provide data for internal hospital program evaluation, provide data for external marketing in a managed care environment, satisfy requirements of the Joint Commission on Accreditation of Health Care Organizations, and generate studies that add to the literature in psychiatry and psychology. PsychSentinel is based on the standardized diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The outcome measure assesses the change in the number of symptoms of psychopathology that occurs between admission and discharge from the hospital. Included in the nonproprietary system are risk adjustment factors, as well as access to a national reference database for comparative analysis purposes. Data collection can be done by trained ancillary staff members, with as much or as little direct physician involvement as desired. The system has proven to be both time effective and cost effective, and it provides important outcome information both at the program level and at the clinician level. After the pilot test, the staff at Baptist Memorial Hospital determined that the system met all initial objectives identified and recently adopted the system as an ongoing measure of quality patient care in the department of psychiatry.

  4. Customer adoption of small-scale on-site power generation

    Energy Technology Data Exchange (ETDEWEB)

    Siddiqui, Afzal S.; Marnay, Chris; Hamachi, Kristina S.; Rubio, F. Javier

    2001-04-01

    The electricity supply system is undergoing major regulatory and technological change with significant implications for the way in which the sector will operate (including its patterns of carbon emissions) and for the policies required to ensure socially and environmentally desirable outcomes. One such change stems from the rapid emergence of viable small-scale (i.e., smaller than 500 kW) generators that are potentially competitive with grid delivered electricity, especially in combined heat and power configurations. Such distributed energy resources (DER) may be grouped together with loads in microgrids. These clusters could operate semi-autonomously from the established power system, or macrogrid, matching power quality and reliability more closely to local end-use requirements. In order to establish a capability for analyzing the effect that microgrids may have on typical commercial customers, such as office buildings, restaurants, shopping malls, and grocery stores, an economic mod el of DER adoption is being developed at Berkeley Lab. This model endeavors to indicate the optimal quantity and type of small on-site generation technologies that customers could employ given their electricity requirements. For various regulatory schemes and general economic conditions, this analysis produces a simple operating schedule for any installed generators. Early results suggest that many commercial customers can benefit economically from on-site generation, even without considering potential combined heat and power and reliability benefits, even though they are unlikely to disconnect from the established power system.

  5. Customer adoption of small-scale on-site power generation

    International Nuclear Information System (INIS)

    Siddiqui, Afzal S.; Marnay, Chris; Hamachi, Kristina S.; Rubio, F. Javier

    2001-01-01

    The electricity supply system is undergoing major regulatory and technological change with significant implications for the way in which the sector will operate (including its patterns of carbon emissions) and for the policies required to ensure socially and environmentally desirable outcomes. One such change stems from the rapid emergence of viable small-scale (i.e., smaller than 500 kW) generators that are potentially competitive with grid delivered electricity, especially in combined heat and power configurations. Such distributed energy resources (DER) may be grouped together with loads in microgrids. These clusters could operate semi-autonomously from the established power system, or macrogrid, matching power quality and reliability more closely to local end-use requirements. In order to establish a capability for analyzing the effect that microgrids may have on typical commercial customers, such as office buildings, restaurants, shopping malls, and grocery stores, an economic mod el of DER adoption is being developed at Berkeley Lab. This model endeavors to indicate the optimal quantity and type of small on-site generation technologies that customers could employ given their electricity requirements. For various regulatory schemes and general economic conditions, this analysis produces a simple operating schedule for any installed generators. Early results suggest that many commercial customers can benefit economically from on-site generation, even without considering potential combined heat and power and reliability benefits, even though they are unlikely to disconnect from the established power system

  6. The Long Reach of Divorce: Divorce and Child Well-Being across Three Generations

    Science.gov (United States)

    Amato, Paul R.; Cheadle, Jacob

    2005-01-01

    We used data from the study of Marital Instability Over the Life Course to examine links between divorce in the grandparent generation and outcomes in the grandchild generation (N= 691). Divorce in the first (G1) generation was associated with lower education, more marital discord, weaker ties with mothers, and weaker ties with fathers in the…

  7. Factors contributing to outcome following traumatic brain injury.

    Science.gov (United States)

    Ponsford, Jennie

    2013-01-01

    Traumatic brain injury results in some distinctive patterns of cognitive, behavioural and physical impairment which impact significantly on independent living skills and participation in work or study, social and leisure activities and interpersonal relationships. There is, however, still considerable variability in outcome across individuals in each of the reported domains. This has led to a significant body of research examining factors associated with outcome. A range of injury-related, personal and social factors have been shown to influence survival, as well as cognitive, functional and employment outcome. This paper reviews the factors associated with each of these aspects of outcome specifically injury-related factors, including neuroimaging findings, GCS and PTA, other injuries, and cognitive and behavioural impairments; demographic factors, including age, gender, genetic status, education, pre-injury IQ and employment status; and social factors including family and other social support, cultural factors, pre-injury psychiatric history and coping style. The paper identifies contributions and complex interrelationships of all of these factors to outcome following TBI. It concludes with a brief discussion of the implications of these factors for the rehabilitation process.

  8. Non-cognitive Child Outcomes and Universal High Quality Child Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Simonsen, Marianne

    2010-01-01

    universal preschool programs and family day care vis-à-vis home care. We find that, compared to home care, being enrolled in preschool at age three does not lead to significant differences in child outcomes at age seven no matter the gender or the mother's level of education. Family day care, on the other...... hand, seems to significantly deteriorate outcomes for boys whose mothers have a lower level of education. Finally, longer hours in non-parental care lead to poorer child outcomes.......Exploiting a rich panel data child survey merged with administrative records along with a pseudoexperiment generating variation in the take-up of preschool across municipalities, we provide evidence of the effects on non-cognitive child outcomes of participating in large scale publicly provided...

  9. Automatic generation and verification of railway interlocking control tables using FSM and NuSMV

    Directory of Open Access Journals (Sweden)

    Mohammad B. YAZDI

    2009-01-01

    Full Text Available Due to their important role in providing safe conditions for train movements, railway interlocking systems are considered as safety critical systems. The reliability, safety and integrity of these systems, relies on reliability and integrity of all stages in their lifecycle including the design, verification, manufacture, test, operation and maintenance.In this paper, the Automatic generation and verification of interlocking control tables, as one of the most important stages in the interlocking design process has been focused on, by the safety critical research group in the School of Railway Engineering, SRE. Three different subsystems including a graphical signalling layout planner, a Control table generator and a Control table verifier, have been introduced. Using NuSMV model checker, the control table verifier analyses the contents of control table besides the safe train movement conditions and checks for any conflicting settings in the table. This includes settings for conflicting routes, signals, points and also settings for route isolation and single and multiple overlap situations. The latest two settings, as route isolation and multiple overlap situations are from new outcomes of the work comparing to works represented on the subject recently.

  10. Generational differences in male sexuality that may affect ...

    African Journals Online (AJOL)

    Objective: To determine generational differences in male sexuality, which could predispose men's female sexual partners to STDs/HlV. Design: Cross-sectional study. Setting: Harare, Zimbabwe. Subjects: Three hundred and ninety seven male adults aged eighteen years and above. Main outcome measures: Number of ...

  11. Rechargeable radioactive isotope generator

    International Nuclear Information System (INIS)

    Thornton, A.K.; Cerone, F.E.

    1978-01-01

    The description is given of a rechargeable radioactive isotope generator having the following features: a box containing a transport shield, a shielded generator including elements for the absorption and holding of the parent isotope, an eluant tank, a first pipe causing this tank to communicate with the transport shield, a second pipe causing this transport shield to communicate with the shielded generator and a third pipe placing the shielded generator in communication with the outside of the unit. It also includes a shelf across the external front part of the unit a part of which is shielded by external components, a shielded elution flask in which the eluate is poured and a filter set at a point between the flask and the third pipe [fr

  12. [Combined forecasting system of peritonitis outcome].

    Science.gov (United States)

    Lebedev, N V; Klimov, A E; Agrba, S B; Gaidukevich, E K

    To create a reliable system for assessing of severity and prediction of the outcome of peritonitis. Critical analysis of the systems for peritonitis severity assessment is presented. The study included outcomes of 347 patients who admitted at the Department of Faculty Surgery of Peoples' Friendship University of Russia in 2015-2016. The cause of peritonitis were destructive forms of acute appendicitis, cholecystitis, perforated gastroduodenal ulcer, various perforation of small and large intestines (including tumor). Combined forecasting system for peritonitis severity assessment is created. The system includes clinical, laboratory data, assessment of systemic inflammatory response (SIRS) and severity of organ failure (qSOFA). The authors focused on easily identifiable parameters which are available in virtually any surgical hospital. Threshold value (lethal outcome probability over 50%) is 8 scores in this system. Sensitivity, specificity and accuracy were 93.3, 99.7 and 98.9%, respectively according to ROC-curve that exceeds those parameters of MPI and APACHE II.

  13. The Microbiome and Metabolome of Preterm Infant Stool Are Personalized and Not Driven by Health Outcomes, Including Necrotizing Enterocolitis and Late-Onset Sepsis.

    Science.gov (United States)

    Wandro, Stephen; Osborne, Stephanie; Enriquez, Claudia; Bixby, Christine; Arrieta, Antonio; Whiteson, Katrine

    2018-06-27

    The assembly and development of the gut microbiome in infants have important consequences for immediate and long-term health. Preterm infants represent an abnormal case for bacterial colonization because of early exposure to bacteria and frequent use of antibiotics. To better understand the assembly of the gut microbiota in preterm infants, fecal samples were collected from 32 very low birth weight preterm infants over the first 6 weeks of life. Infant health outcomes included health, late-onset sepsis, and necrotizing enterocolitis (NEC). We characterized bacterial compositions by 16S rRNA gene sequencing and metabolomes by untargeted gas chromatography-mass spectrometry. Preterm infant fecal samples lacked beneficial Bifidobacterium spp. and were dominated by Enterobacteriaceae , Enterococcus , and Staphylococcus organisms due to nearly uniform antibiotic administration. Most of the variance between the microbial community compositions could be attributed to the baby from which the sample derived (permutational multivariate analysis of variance [PERMANOVA] R 2 = 0.48, P PERMANOVA R 2 = 0.43, P < 0.001) and weakly associated with bacterial composition (Mantel statistic r = 0.23 ± 0.05, P < 0.05). No measured metabolites were found to be associated with necrotizing enterocolitis, late-onset sepsis, or a healthy outcome. Overall, preterm infant gut microbial communities were personalized and reflected antibiotic usage. IMPORTANCE Preterm infants face health problems likely related to microbial exposures, including sepsis and necrotizing enterocolitis. However, the role of the gut microbiome in preterm infant health is poorly understood. Microbial colonization differs from that of healthy term babies because it occurs in the NICU and is often perturbed by antibiotics. We measured bacterial compositions and metabolomic profiles of 77 fecal samples from 32 preterm infants to investigate the differences between microbiomes in health and disease. Rather than finding

  14. Direct comparison of risk-adjusted and non-risk-adjusted CUSUM analyses of coronary artery bypass surgery outcomes.

    Science.gov (United States)

    Novick, Richard J; Fox, Stephanie A; Stitt, Larry W; Forbes, Thomas L; Steiner, Stefan

    2006-08-01

    We previously applied non-risk-adjusted cumulative sum methods to analyze coronary bypass outcomes. The objective of this study was to assess the incremental advantage of risk-adjusted cumulative sum methods in this setting. Prospective data were collected in 793 consecutive patients who underwent coronary bypass grafting performed by a single surgeon during a period of 5 years. The composite occurrence of an "adverse outcome" included mortality or any of 10 major complications. An institutional logistic regression model for adverse outcome was developed by using 2608 contemporaneous patients undergoing coronary bypass. The predicted risk of adverse outcome in each of the surgeon's 793 patients was then calculated. A risk-adjusted cumulative sum curve was then generated after specifying control limits and odds ratio. This risk-adjusted curve was compared with the non-risk-adjusted cumulative sum curve, and the clinical significance of this difference was assessed. The surgeon's adverse outcome rate was 96 of 793 (12.1%) versus 270 of 1815 (14.9%) for all the other institution's surgeons combined (P = .06). The non-risk-adjusted curve reached below the lower control limit, signifying excellent outcomes between cases 164 and 313, 323 and 407, and 667 and 793, but transgressed the upper limit between cases 461 and 478. The risk-adjusted cumulative sum curve never transgressed the upper control limit, signifying that cases preceding and including 461 to 478 were at an increased predicted risk. Furthermore, if the risk-adjusted cumulative sum curve was reset to zero whenever a control limit was reached, it still signaled a decrease in adverse outcome at 166, 653, and 782 cases. Risk-adjusted cumulative sum techniques provide incremental advantages over non-risk-adjusted methods by not signaling a decrement in performance when preoperative patient risk is high.

  15. Transcatheter Aortic Valve Replacement With Early- and New-Generation Devices in Bicuspid Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Yoon, Sung Han; Lefèvre, Thierry; Ahn, Jung Ming

    2016-01-01

    Background Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). Particularly, limited data exist comparing the results of TAVR with new-generation devices versus early-generation devices.  Objectives...... This study sought to evaluate the clinical outcomes of TAVR for bicuspid AS with early- and new-generation devices.  Methods The Bicuspid TAVR Registry is an international multicenter study enrolling consecutive patients with bicuspid AS undergoing TAVR between April 2005 and May 2015.  Results Of 301...... patients, 199 patients (71.1%) were treated with early-generation devices (Sapien XT [Edwards Lifesciences Corporation, Irvine, California]: n = 87; CoreValve [Medtronic, Minneapolis, Minnesota]: n = 112) and 102 with new-generation devices (Sapien 3 [Edwards Lifesciences Corporation]: n = 91; Lotus...

  16. Uniform random number generators

    Science.gov (United States)

    Farr, W. R.

    1971-01-01

    Methods are presented for the generation of random numbers with uniform and normal distributions. Subprogram listings of Fortran generators for the Univac 1108, SDS 930, and CDC 3200 digital computers are also included. The generators are of the mixed multiplicative type, and the mathematical method employed is that of Marsaglia and Bray.

  17. Electromechanical x-ray generator

    Science.gov (United States)

    Watson, Scott A; Platts, David; Sorensen, Eric B

    2016-05-03

    An electro-mechanical x-ray generator configured to obtain high-energy operation with favorable energy-weight scaling. The electro-mechanical x-ray generator may include a pair of capacitor plates. The capacitor plates may be charged to a predefined voltage and may be separated to generate higher voltages on the order of hundreds of kV in the AK gap. The high voltage may be generated in a vacuum tube.

  18. International and Interdisciplinary Identification of Health Care Transition Outcomes.

    Science.gov (United States)

    Fair, Cynthia; Cuttance, Jessica; Sharma, Niraj; Maslow, Gary; Wiener, Lori; Betz, Cecily; Porter, Jerlym; McLaughlin, Suzanne; Gilleland-Marchak, Jordan; Renwick, Amy; Naranjo, Diana; Jan, Sophia; Javalkar, Karina; Ferris, Maria

    2016-03-01

    There is a lack of agreement on what constitutes successful outcomes for the process of health care transition (HCT) among adolescent and young adults with special health care needs. To present HCT outcomes identified by a Delphi process with an interdisciplinary group of participants. A Delphi method involving 3 stages was deployed to refine a list of HCT outcomes. This 18-month study (from January 5, 2013, of stage 1 to July 3, 2014, of stage 3) included an initial literature search, expert interviews, and then 2 waves of a web-based survey. On this survey, 93 participants from outpatient, community-based, and primary care clinics rated the importance of the top HCT outcomes identified by the Delphi process. Analyses were performed from July 5, 2014, to December 5, 2014. Health care transition outcomes of adolescents and young adults with special health care needs. Importance ratings of identified HCT outcomes rated on a Likert scale from 1 (not important) to 9 (very important). The 2 waves of surveys included 117 and 93 participants as the list of outcomes was refined. Transition outcomes were refined by the 3 waves of the Delphi process, with quality of life being the highest-rated outcome with broad agreement. The 10 final outcomes identified included individual outcomes (quality of life, understanding the characteristics of conditions and complications, knowledge of medication, self-management, adherence to medication, and understanding health insurance), health services outcomes (attending medical appointments, having a medical home, and avoidance of unnecessary hospitalization), and a social outcome (having a social network). Participants indicated that different outcomes were likely needed for individuals with cognitive disabilities. Quality of life is an important construct relevant to HCT. Future research should identify valid measures associated with each outcome and further explore the role that quality of life plays in the HCT process. Achieving

  19. Molecular diagnostics for congenital hearing loss including 15 deafness genes using a next generation sequencing platform

    Directory of Open Access Journals (Sweden)

    De Keulenaer Sarah

    2012-05-01

    Full Text Available Abstract Background Hereditary hearing loss (HL can originate from mutations in one of many genes involved in the complex process of hearing. Identification of the genetic defects in patients is currently labor intensive and expensive. While screening with Sanger sequencing for GJB2 mutations is common, this is not the case for the other known deafness genes (> 60. Next generation sequencing technology (NGS has the potential to be much more cost efficient. Published methods mainly use hybridization based target enrichment procedures that are time saving and efficient, but lead to loss in sensitivity. In this study we used a semi-automated PCR amplification and NGS in order to combine high sensitivity, speed and cost efficiency. Results In this proof of concept study, we screened 15 autosomal recessive deafness genes in 5 patients with congenital genetic deafness. 646 specific primer pairs for all exons and most of the UTR of the 15 selected genes were designed using primerXL. Using patient specific identifiers, all amplicons were pooled and analyzed using the Roche 454 NGS technology. Three of these patients are members of families in which a region of interest has previously been characterized by linkage studies. In these, we were able to identify two new mutations in CDH23 and OTOF. For another patient, the etiology of deafness was unclear, and no causal mutation was found. In a fifth patient, included as a positive control, we could confirm a known mutation in TMC1. Conclusions We have developed an assay that holds great promise as a tool for screening patients with familial autosomal recessive nonsyndromal hearing loss (ARNSHL. For the first time, an efficient, reliable and cost effective genetic test, based on PCR enrichment, for newborns with undiagnosed deafness is available.

  20. An assessment model in outcomes-based education and training ...

    African Journals Online (AJOL)

    The study addresses a concern in higher education and specifically in health sciences and technology regarding integrated and authentic assessment with an outcomes-based approach. Interviews were conducted with head-hunted academics in health sciences and technology. From the information generated, an ...

  1. Patient-reported outcomes in borderline personality disorder

    Science.gov (United States)

    Hasler, Gregor; Hopwood, Christopher J.; Jacob, Gitta A.; Brändle, Laura S.; Schulte-Vels, Thomas

    2014-01-01

    Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder's high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes. PMID:25152662

  2. Outcome of Minnesota's gambling treatment programs.

    Science.gov (United States)

    Stinchfield, R; Winters, K C

    2001-01-01

    This study measured the outcome of four state-supported outpatient gambling treatment programs in Minnesota. The programs were developed specifically for the treatment of pathological gamblers and offered multiple modalities of treatment including individual, group, education, twelve-step work, family groups, and financial counseling. The therapeutic orientation was eclectic with an emphasis on the twelve steps of Gamblers Anonymous (GA) and a treatment goal of abstinence. The sample included 348 men and 220 women treated between January 1992 and January 1995. A pretest-posttest design was utilized with multidimensional assessments obtained at intake, discharge, six-months, and twelve-months post-discharge. Variables assessed included a range of clinical and outcome variables. At six month follow-up, 28% reported that they had abstained from gambling during the six months following discharge and an additional 20% had gambled less than once per month. Almost half of the sample (48%) showed clinically significant improvement in gambling frequency at six month follow-up. Outcome variables of gambling frequency, SOGS scores, amount of money gambled, number of friends who gamble, psychosocial problems, and number of financial problems, all showed statistically significant improvements from pretreatment to follow-up. The treatment programs yielded outcome results similar to those reported for alcohol and drug abuse treatment programs.

  3. The expected-outcome model of two-player games

    CERN Document Server

    Abramson, Bruce

    1990-01-01

    The Expected-Outcome Model of Two-Player Games deals with the expected-outcome model of two-player games, in which the relative merit of game-tree nodes, rather than board positions, is considered. The ambiguity of static evaluation and the problems it generates in the search system are examined and the development of a domain-independent static evaluator is described. Comprised of eight chapters, this book begins with an overview of the rationale for the mathematical study of games, followed by a discussion on some previous artificial intelligence (AI) research efforts on game-trees. The nex

  4. Emerging uses of patient generated health data in clinical research.

    Science.gov (United States)

    Wood, William A; Bennett, Antonia V; Basch, Ethan

    2015-05-01

    Recent advancements in consumer directed personal computing technology have led to the generation of biomedically-relevant data streams with potential health applications. This has catalyzed international interest in Patient Generated Health Data (PGHD), defined as "health-related data - including health history, symptoms, biometric data, treatment history, lifestyle choices, and other information-created, recorded, gathered, or inferred by or from patients or their designees (i.e. care partners or those who assist them) to help address a health concern."(Shapiro et al., 2012) PGHD offers several opportunities to improve the efficiency and output of clinical trials, particularly within oncology. These range from using PGHD to understand mechanisms of action of therapeutic strategies, to understanding and predicting treatment-related toxicity, to designing interventions to improve adherence and clinical outcomes. To facilitate the optimal use of PGHD, methodological research around considerations related to feasibility, validation, measure selection, and modeling of PGHD streams is needed. With successful integration, PGHD can catalyze the application of "big data" to cancer clinical research, creating both "n of 1" and population-level observations, and generating new insights into the nature of health and disease. Copyright © 2014 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

  5. The P300 in middle cerebral artery strokes or hemorrhages: Outcome predictions and source localization.

    Science.gov (United States)

    Ehlers, Mana R; López Herrero, Carmen; Kastrup, Andreas; Hildebrandt, Helmut

    2015-08-01

    There are no reliable outcome predictors for severely impaired patients suffering from large infarctions or hemorrhages within the territory of the middle cerebral artery. This study investigated whether the amplitude of the event-related potential (ERP) component P300 predicts if a patient will be transferred to the next stage of rehabilitation (positive outcome) or to a nursing home (negative outcome). The second goal was to look for lesion locations determining the generation of the P300 amplitude. Forty-seven patients performed an auditory oddball task to elicit the P300 and were assessed with different scores for activities of daily living (ADL). Patients were divided in two groups according to their outcome. P300 amplitudes were compared between these groups controlling for age and gender. Post-hoc analyses were performed to analyse the relationship between P300 amplitude and neurological outcome scores. In addition, lesion overlaps were created to detect which lesion pattern affects P300 generation. Patients with a positive outcome showed higher P300 amplitudes at frontal electrode sites than those with a negative outcome. P300 amplitude correlated with ADL score difference. Lesions in the superior temporal gyrus, middle and inferior frontal and prefrontal regions led to visibly diminished P300 amplitudes. The findings suggest that an impairment of attention (P300 amplitude reduction) negatively influences successful neurological rehabilitation. Left superior temporal lobe and the left premotor/prefrontal areas are essential brain areas for the generation of the P300. P300 amplitude may be used as an outcome predictor for severely impaired patients suffering from middle cerebral artery strokes or hemorrhages. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  6. Machine learning approach for the outcome prediction of temporal lobe epilepsy surgery.

    Directory of Open Access Journals (Sweden)

    Rubén Armañanzas

    Full Text Available Epilepsy surgery is effective in reducing both the number and frequency of seizures, particularly in temporal lobe epilepsy (TLE. Nevertheless, a significant proportion of these patients continue suffering seizures after surgery. Here we used a machine learning approach to predict the outcome of epilepsy surgery based on supervised classification data mining taking into account not only the common clinical variables, but also pathological and neuropsychological evaluations. We have generated models capable of predicting whether a patient with TLE secondary to hippocampal sclerosis will fully recover from epilepsy or not. The machine learning analysis revealed that outcome could be predicted with an estimated accuracy of almost 90% using some clinical and neuropsychological features. Importantly, not all the features were needed to perform the prediction; some of them proved to be irrelevant to the prognosis. Personality style was found to be one of the key features to predict the outcome. Although we examined relatively few cases, findings were verified across all data, showing that the machine learning approach described in the present study may be a powerful method. Since neuropsychological assessment of epileptic patients is a standard protocol in the pre-surgical evaluation, we propose to include these specific psychological tests and machine learning tools to improve the selection of candidates for epilepsy surgery.

  7. The activL® Artificial Disc: a next-generation motion-preserving implant for chronic lumbar discogenic pain

    Science.gov (United States)

    Yue, James J; Garcia, Rolando; Miller, Larry E

    2016-01-01

    Degeneration of the lumbar intervertebral discs is a leading cause of chronic low back pain in adults. Treatment options for patients with chronic lumbar discogenic pain unresponsive to conservative management include total disc replacement (TDR) or lumbar fusion. Until recently, only two lumbar TDRs had been approved by the US Food and Drug Administration − the Charité Artificial Disc in 2004 and the ProDisc-L Total Disc Replacement in 2006. In June 2015, a next-generation lumbar TDR received Food and Drug Administration approval − the activL® Artificial Disc (Aesculap Implant Systems). Compared to previous-generation lumbar TDRs, the activL® Artificial Disc incorporates specific design enhancements that result in a more precise anatomical match and allow a range of motion that better mimics the healthy spine. The results of mechanical and clinical studies demonstrate that the activL® Artificial Disc results in improved mechanical and clinical outcomes versus earlier-generation artificial discs and compares favorably to lumbar fusion. The purpose of this report is to describe the activL® Artificial Disc including implant characteristics, intended use, surgical technique, postoperative care, mechanical testing, and clinical experience to date. PMID:27274317

  8. Which outcomes are most important to people with aphasia and their families?

    DEFF Research Database (Denmark)

    Wallace, Sarah J.; Worrall, Linda; Rose, Tanya

    2017-01-01

    Purpose: To identify important treatment outcomes from the perspective of people with aphasia and their families using the ICF as a frame of reference. Methods: The nominal group technique was used with people with aphasia and their family members in seven countries to identify and rank important...... for research outcome measurement and clinical service provision which currently focuses on the measurement of body function outcomes. The wide range of desired outcomes generated by both people with aphasia and their family members, highlights the importance of collaborative goal setting within a family...... function components of the ICF. • The outcomes identified in this study suggest a broad role for clinicians working in aphasia rehabilitation. The categories of identified outcomes may be used clinically as a starting point in goal-setting discussions with clients and their families....

  9. Solar fuels generator

    Science.gov (United States)

    Lewis, Nathan S.; Spurgeon, Joshua M.

    2016-10-25

    The solar fuels generator includes an ionically conductive separator between a gaseous first phase and a second phase. A photoanode uses one or more components of the first phase to generate cations during operation of the solar fuels generator. A cation conduit is positioned provides a pathway along which the cations travel from the photoanode to the separator. The separator conducts the cations. A second solid cation conduit conducts the cations from the separator to a photocathode.

  10. Parental investments in child health - maternal health behaviours and birth outcomes

    DEFF Research Database (Denmark)

    Wüst, Miriam

    consumption, exercise and diet during pregnancy on birth outcomes and considers the problem of identifying the causal effect of these endogenous maternal health behaviours. The analysis controls for a wide range of covariates and exploits sibling variation in the Danish National Birth Cohort. The paper...... the ways in which child health is generated, and - for children of higher birth order - earlier children's outcomes will shape parental investments in child health....

  11. Self-assembling software generator

    Science.gov (United States)

    Bouchard, Ann M [Albuquerque, NM; Osbourn, Gordon C [Albuquerque, NM

    2011-11-25

    A technique to generate an executable task includes inspecting a task specification data structure to determine what software entities are to be generated to create the executable task, inspecting the task specification data structure to determine how the software entities will be linked after generating the software entities, inspecting the task specification data structure to determine logic to be executed by the software entities, and generating the software entities to create the executable task.

  12. Comparison of Long-Term Clinical Outcomes of Lesions Exhibiting Focal and Segmental Peri-Stent Contrast Staining.

    Science.gov (United States)

    Tokuda, Takahiro; Yamawaki, Masahiro; Takahara, Mitsuyohi; Mori, Shinsuke; Makino, Kenji; Honda, Yosuke; Takafuji, Hiroya; Takama, Takuro; Tsutsumi, Masakazu; Sakamoto, Yasunari; Takimura, Hideyuki; Kobayashi, Norihiro; Araki, Motoharu; Hirano, Keisuke; Ito, Yoshiaki

    2016-03-18

    Peri-stent contrast staining (PSS) after metallic drug-eluting stent deployment is associated with target lesion revascularization and very late stent thrombosis. However, the type of PSS that influences the clinical outcomes is unknown. Therefore, we aimed to reveal which PSS type was influencing clinical outcomes. This study included 5580 de novo lesions of 4405 patients who were implanted with a first- or second-generation drug-eluting stent and who were evaluated using follow-up angiography within 12 months after stent implantation. We compared the clinical outcomes of patients divided into focal PSS and segmental PSS groups for 6 years after stent implantation. Total PSS was observed in 97 lesions (2.2%), of which 42 and 55 lesions were focal and segmental PSS, respectively. Baseline characteristics were similar between groups, except for intraoperative chronic total occlusion (segmental PSS=47.3% versus focal PSS=11.9%, P=0.0001). The incidence of segmental PSS tended to be higher in patients with a first-generation drug-eluting stent (83.6% versus 16.4%, P=0.05). The cumulative incidence of stent thrombosis in the 6 years of segmental PSS group was significantly higher than that of the focal PSS group (13.9% versus 0%, P=0.04). The cumulative incidence of overall target lesion revascularization for restenosis, excluding target lesion revascularization procedures for stent thrombosis, was significantly higher in the segmental PSS group (38.0% versus 0%, P=0.01). The incidence of segmental PSS tended to be higher in patients with a first-generation drug-eluting stent and appeared to be significantly associated with target lesion revascularization and stent thrombosis. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  13. The effect of neighborhood socioeconomic status on education and health outcomes for children living in social housing.

    Science.gov (United States)

    Martens, Patricia J; Chateau, Daniel G; Burland, Elaine M J; Finlayson, Gregory S; Smith, Mark J; Taylor, Carole R; Brownell, Marni D; Nickel, Nathan C; Katz, Alan; Bolton, James M

    2014-11-01

    We explored differences in health and education outcomes between children living in social housing and not, and effects of social housing's neighborhood socioeconomic status. In this cohort study, we used the population-based repository of administrative data at the Manitoba Centre for Health Policy. We included children aged 0 to 19 years in Winnipeg, Manitoba, in fiscal years 2006-2007 to 2008-2009 (n = 13,238 social housing; n = 174,017 others). We examined 5 outcomes: age-2 complete immunization, a school-readiness measure, adolescent pregnancy (ages 15-19 years), grade-9 completion, and high-school completion. Logistic regression and generalized estimating equation modeling generated rates. We derived neighborhood income quintiles (Q1 lowest, Q5 highest) from average household income census data. Children in social housing fared worse than comparative children within each neighborhood income quintile. When we compared children in social housing by quintile, preschool indicators (immunization and school readiness) were similar, but adolescent outcomes (grade-9 and high-school completion, adolescent pregnancy) were better in Q3 to Q5. Children in social housing had poorer health and education outcomes than all others, but living in social housing in wealthier areas was associated with better adolescent outcomes.

  14. When your smoking is not just about you: antismoking advertising, interpersonal pressure, and quitting outcomes.

    Science.gov (United States)

    Dunlop, Sally M; Cotter, Trish; Perez, Donna

    2014-01-01

    The authors investigated the potential for antismoking advertising to generate interpersonal pressure on smokers to quit using the Cancer Institute NSW's Tobacco Tracking Survey, a telephone tracking survey of adult smokers conducted throughout the year with approximately 50 interviews per week (N = 5,448). The survey includes questions relating to recently broadcast antismoking advertisements, including whether smokers have received pressure from family and friends as a result of their seeing the advertisements. The authors conducted multivariate logistic regression analyses to predict: (a) receiving ad-stimulated interpersonal pressure; and (b) quitting outcomes. All analyses controlled for smoker characteristics and potential exposure to the advertisements. Compared with ads coded as having a low level of emotion (by independent coders), ads coded as highly emotional were more likely to have generated interpersonal pressure. Ad-stimulated interpersonal pressure was associated with an increased likelihood of recent quit attempts and with salient quitting thoughts, with a greater effect on quitting thoughts for interpersonal pressure generated by highly and moderately emotional ads. These results support previous research suggesting that highly emotional antismoking ads with personal stories or graphic imagery are effective in promoting smoking cessation, and these results help to identify communication processes that contribute to the ads' success.

  15. Power generation, operation and control

    CERN Document Server

    Wood, Allen J; Sheblé, Gerald B

    2013-01-01

    Since publication of the second edition, there have been extensive changes in the algorithms, methods, and assumptions in energy management systems that analyze and control power generation. This edition is updated to acquaint electrical engineering students and professionals with current power generation systems. Algorithms and methods for solving integrated economic, network, and generating system analysis are provided. Also included are the state-of-the-art topics undergoing evolutionary change, including market simulation, multiple market analysis, multiple interchange contract analysis, c

  16. The JUPITER registry: One-year outcomes of transapical aortic valve implantation using a second generation transcatheter heart valve for aortic regurgitation.

    Science.gov (United States)

    Silaschi, Miriam; Conradi, Lenard; Wendler, Olaf; Schlingloff, Friederike; Kappert, Utz; Rastan, Ardawan J; Baumbach, Hardy; Holzhey, David; Eichinger, Walter; Bader, Ralf; Treede, Hendrik

    2018-06-01

    We present 1-year outcomes of the post-market registry of a next-generation transcatheter heart valve used for aortic regurgitation (AR). Transcatheter aortic valve replacement (TAVR) is routine in high-risk patients with aortic stenosis but is not recommended for AR. The JenaValve™ (JenaValve Technology GmbH, Munich, Germany) overcomes technical challenges in AR patients through a leaflet clipping mechanism. The JenaValve EvalUation of Long Term Performance and Safety In PaTients with SEvere Aortic Stenosis oR Aortic Insufficiency (JUPITER) Registry is a European study to evaluate safety and effectiveness of this THV. From 2012-2015, 30 patients with AR were enrolled. Mean age was 74.4 ± 9.3 years. Procedural success was 96.7% (29/30). One patient was converted to open surgery. No annular rupture or coronary ostia obstruction occurred. Mortality at 30 days was 10.0% (3/30). Combined safety endpoint was met in 13.3% (4/30). Paravalvular regurgitation was not present/trivial in 84.6% (22/26) and mild in 15.4% (4/26). Rate of permanent pacemaker implantation was 3.8% (1/26). One-year Kaplan-Meier survival was 79.9%, one-year combined efficacy was 73.1% (19/30). No further strokes were observed during 1 year of follow-up. The JenaValve overcomes technical challenges of TAVR in AR through a clipping mechanism. We report satisfactory outcomes of a multicenter registry using the JenaValve for predominant AR, as rate of THV embolization, residual AR and permanent pacemaker implantation was low. One-year results using the JenaValve for AR encourage its use for this indication. © 2017 Wiley Periodicals, Inc.

  17. Performance of Generating Plant: Managing the Changes. Part 4: Markets and Risk Management Strategy

    Energy Technology Data Exchange (ETDEWEB)

    Moss, Terry; Loedolff, Gerhard; Griffin, Rob; Kydd, Robert; Micali, Vince [Eskom (South Africa)

    2008-05-15

    The WEC Committee on the Performance of Generating Plant (PGP) has been collecting and analysing power plant performance statistics worldwide for more than 30 years and has produced regular reports, which include examples of advanced techniques and methods for improving power plant performance through benchmarking. A series of reports from the various working groups was issued in 2008. This reference presents the results of Working Group 4 (WG4). WG4 will monitor the development of power markets, in particular from the market risk management point of view, including operational risks. It will assess various risk management strategies used by market players around the world and develop recommendations for a wider deployment of successful strategies. The report covers the project approach and outcomes.

  18. Generation Y Health Professional Students ’ Preferred Teaching and Learning Approaches: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Caroline Mary Hills

    2017-01-01

    Full Text Available Generation Y or Millennials are descriptors for those born between 1982 and 2000. This cohort has grown up in the digital age and is purported to have different learning preferences from previous generations. Students are important stakeholders in identifying their preferred teaching and learning approaches in health professional programs. This study aimed to identify, appraise, and synthesize the best available evidence regarding the teaching and learning preferences of Generation Y health professional students. The review considered any objectively measured or self-reported outcomes of teaching and learning reported from Generation Y health professional student perspectives. In accordance with a previously published Joanna Briggs Institute Protocol, a three-step search strategy was completed. Two research articles (nursing and dental hygiene students and three dissertations (nursing were critically appraised. All studies were cross-sectional descriptive studies. A range of pedagogical approaches was reported, including lecture, group work, and teaching clinical skills. Based on the Joanna Briggs Institute levels of evidence, reviewers deemed the evidence as Level 3. Some generational differences were reported, but these were inconsistent across the studies reviewed. There is, therefore, insufficient evidence to provide specific recommendations for the preferred educational approaches of health professional students and further research is warranted.

  19. Improving healthcare and outcomes for high-risk children and teens: formation of the National Consortium for Pediatric and Adolescent Evidence-Based Practice.

    Science.gov (United States)

    Melnyk, Bernadette Mazurek; Fineout-Overholt, Ellen; Hockenberrry, Marilyn; Huth, Myra; Jamerson, Patricia; Latta, Linda; Lewandowski, Linda; Gance-Cleveland, Bonnie

    2007-01-01

    Although major healthcare and professional organizations as well as key leaders have long emphasized the importance of evidence-based practice (EBP) in improving patient care and outcomes, the majority of healthcare professionals do not implement EBP. There is a huge gap in time that exists between the generation of research findings and the translation of those findings into clinical practice. Many efficacious interventions are not being used in clinical practice even though research findings suggest that they improve child and adolescent health and development. Conversely, many clinical practices are being implemented without sufficient evidence to support their use. Because of the need to accelerate EBP and to generate evidence to support best practices, the first EBP Leadership Summit focused on children and adolescents was conducted in February 2007. Several nationally recognized EBP experts and healthcare leaders from a number of children's hospitals and colleges of nursing across the U.S. participated in the Summit. This article describes the process used and outcomes generated from this landmark event in child and adolescent healthcare, including the launching of the new National Consortium for Pediatric and Adolescent EBP (NCPAEP). Future directions of the consortium also are highlighted.

  20. Large scale renewable power generation advances in technologies for generation, transmission and storage

    CERN Document Server

    Hossain, Jahangir

    2014-01-01

    This book focuses on the issues of integrating large-scale renewable power generation into existing grids. It includes a new protection technique for renewable generators along with the inclusion of current status of smart grid.

  1. Observational safety study of specific outcomes after trivalent cell culture seasonal influenza vaccination (Optaflu® ) among adults in THIN database of electronic UK primary healthcare records.

    Science.gov (United States)

    Hall, Gillian C; Davies, Paul T G; Karim, M Yousuf; Haag, Mendel D M; O'Leary, Caroline

    2018-01-01

    To investigate the safety of trivalent seasonal influenza vaccine (TIVc) (Optaflu ® ), the first cell culture seasonal trivalent influenza vaccine available in Europe. Codes and unstructured text in adult electronic healthcare records (The Health Improvement Network) were searched for a TIVc brand name or batch number and possible outcomes within a 3 month pre- to 6 month post-TIVc exposure study period (2012-2015). The outcomes were severe allergic reactions, Bell's palsy, convulsions, demyelination, paresthesia, noninfectious encephalitis, neuritis (optic and brachial), vasculitis, inflammatory bowel disease, and thrombocytopenia. Risk periods were defined based on biologically plausible time frame postvaccination when an outcome caused by the vaccine might be expected to occur. Possible outcomes were adjudicated against outcome specific case definitions and a date of onset assigned by using electronic and other medical records. Observed (risk period) to expected (outside risk and preexposure periods) rate ratios, postexposure incidence, and plots of time from exposure to outcome were reported. Sixteen of 1011 events from 4578 exposures fulfilled a primary case definition and had a date of onset during the study period. Three were in observed time. The observed-to-expected rate ratios were (3.3, 95% CI 0.3, 31.7) for convulsions and (1.5, 95% CI 0.2, 14.9) for thrombocytopenia with 1 outcome each in observed time. There was 1 incident inflammatory bowel disease in observed, but none in expected, time. The small sample size restricts interpretation; however, no hypothesis of an increased risk of a study outcome was generated. Adjudication of events against case definitions to reduce misclassification of onset and outcomes allowed use of precise risk periods. KEY POINTS This observational study did not generate a hypothesis of an association between the first cell-culture seasonal influenza vaccination available in the European Union and any of the study

  2. Evaluating stakeholder participation in water management: intermediary outcomes as potential indicators for future resource management outcomes

    Science.gov (United States)

    Carr, Gemma; Bloeschl, Guenter; Loucks, Daniel Pete

    2013-04-01

    Evaluation of participation programmes, projects and activities is essential to identify whether stakeholder involvement has been successful in achieving its aims. Aims may include an improvement in water resource management such as enhanced ecological functioning, an improvement in human wellbeing and economic conditions, or overcoming a conflict between interest groups. Evaluating against "interest-based" resource management criteria requires that a desirable outcome can be identified, agreed upon and be measured at the time of evaluation. In many water management situations where collaborative approaches are applied, multiple interests and objectives are present, or stakeholders have not yet identified their own positions and priorities. Even if a resource management objective has been identified and strategy agreed upon, resource management changes tend to emerge over longer timescales and evaluation frequently takes place before they can be recognised. Evaluating against resource management criteria may lead evaluators to conclude that a programme has failed because it has not achieved a resource management objective at the time of evaluation. This presents a critical challenge to researchers assessing the effectiveness of stakeholder participation programmes. One strategy to overcome this is to conduct "goal-free" evaluation to identify what the programme is actually achieving. An evaluation framework that includes intermediary outcomes that are both tangible achievements such as innovation, creation of new organisations, and shared information and knowledge, as well as intangible achievements such as trust and network development can be applied to more broadly assess a programme's success. Analysis of case-studies in the published literature for which a resource management outcome has been achieved shows that intermediary outcomes frequently precede resource management outcomes. They seem to emerge over shorter timescales than resource management outcomes

  3. Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness.

    Science.gov (United States)

    Wysham, Nicholas G; Abernethy, Amy P; Cox, Christopher E

    2014-10-01

    Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with integrated electronic patient-reported outcomes to optimize patient-centered care, including critical care outcome prediction. A learning health system infrastructure integrating electronic patient-reported outcomes may aid in the management of critical illness-associated conditions and yield tools to improve prognostication of patient-centered outcomes in critical illness.

  4. Racial and ethnic disparities in human papillomavirus-associated cancer burden with first-generation and second-generation human papillomavirus vaccines.

    Science.gov (United States)

    Burger, Emily A; Lee, Kyueun; Saraiya, Mona; Thompson, Trevor D; Chesson, Harrell W; Markowitz, Lauri E; Kim, Jane J

    2016-07-01

    In the United States, the burden of human papillomavirus (HPV)-associated cancers varies by racial/ethnic group. HPV vaccination may provide opportunities for primary prevention of these cancers. Herein, the authors projected changes in HPV-associated cancer burden among racial/ethnic groups under various coverage assumptions with the available first-generation and second-generation HPV vaccines to evaluate changes in racial/ethnic disparities. Cancer-specific mathematical models simulated the burden of 6 HPV-associated cancers. Model parameters, informed using national registries and epidemiological studies, reflected sex-specific, age-specific, and racial/ethnic-specific heterogeneities in HPV type distribution, cancer incidence, stage of disease at detection, and mortality. Model outcomes included the cumulative lifetime risks of developing and dying of 6 HPV-associated cancers. The level of racial/ethnic disparities was evaluated under each alternative HPV vaccine scenario using several metrics of social group disparity. HPV vaccination is expected to reduce the risks of developing and dying of HPV-associated cancers in all racial/ethnic groups as well as reduce the absolute degree of disparities. However, alternative metrics suggested that relative disparities would persist and in some scenarios worsen. For example, when assuming high uptake with the second-generation HPV vaccine, the lifetime risk of dying of an HPV-associated cancer for males decreased by approximately 60%, yet the relative disparity increased from 3.0 to 3.9. HPV vaccines are expected to reduce the overall burden of HPV-associated cancers for all racial/ethnic groups and to reduce the absolute disparity gap. However, even with the second-generation vaccine, relative disparities will likely still exist and may widen if the underlying causes of these disparities remain unaddressed. Cancer 2016;122:2057-66. © 2016 American Cancer Society. © 2016 American Cancer Society.

  5. Patient-Reported Outcome and Observer-Reported Outcome Assessment in Rare Disease Clinical Trials: An ISPOR COA Emerging Good Practices Task Force Report.

    Science.gov (United States)

    Benjamin, Katy; Vernon, Margaret K; Patrick, Donald L; Perfetto, Eleanor; Nestler-Parr, Sandra; Burke, Laurie

    Rare diseases (RDs) affect a small number of people within a population. About 5000 to 8000 distinct RDs have been identified, with an estimated 6% to 8% of people worldwide suffering from an RD. Approximately 75% of RDs affect children. Frequently, these conditions are heterogeneous; many are progressive. Regulatory incentives have increased orphan drug designations and approvals. To develop emerging good practices for RD outcomes research addressing the challenges inherent in identifying, selecting, developing, adapting, and implementing patient-reported outcome (PRO) and observer-reported outcome (ObsRO) assessments for use in RD clinical trials. This report outlines the challenges and potential solutions in determining clinical outcomes for RD trials. It follows the US Food and Drug Administration Roadmap to Patient-Focused Outcome Measurement in Clinical Trials. The Roadmap consists of three columns: 1) Understanding the Disease or Condition, 2) Conceptualizing Treatment Benefit, and 3) Selecting/Developing the Outcome Measure. Challenges in column 1 include factors such as incomplete natural history data and heterogeneity of disease presentation and patient experience. Solutions include using several information sources, for example, clinical experts and patient advocacy groups, to construct the condition's natural history and understand treatment patterns. Challenges in column 2 include understanding and measuring treatment benefit from the patient's perspective, especially given challenges in defining the context of use such as variations in age or disease severity/progression. Solutions include focusing on common symptoms across patient subgroups, identifying short-term outcomes, and using multiple types of COA instruments to measure the same constructs. Challenges in column 3 center around the small patient population and heterogeneity of the condition or study sample. Few disease-specific instruments for RDs exist. Strategies include adapting existing

  6. Radiotracer Generators for Industrial Applications

    International Nuclear Information System (INIS)

    2013-01-01

    restricted because their half-lives are relatively short and only a limited number of radiotracers derived from them have been proven under industrial conditions. Recognizing the potential usefulness of several radionuclide generators, including 68 Ge/ 68 Ga and 137 Cs/ 137 mBa and of radiotracers derived from them, the Agency organized a Coordinated Research Project (CRP) on the Evaluation and Validation of Radionuclide Generator-based Radiotracers for Industrial Applications. The objectives of the CRP , which was implemented over the period 2007-2011, was to coordinate the development of industrial radionuclide generators and to validate generator based radiotracers for use in harsh industrial conditions. It was anticipated that an important outcome would be the production of radionuclide generators designed specifically for industrial purposes. Their cost would be considerably lower than those of medical generators since the high costs of the facilities required to produce generators suitable for in vivo use can be avoided. The IAEA facilitates the transfer of technology, and an important part of this process is the provision of relevant literature that may be used for reference purposes or as an aid to teaching. This monograph contains guidelines for the selection and preparation of radiotracers derived from radionuclide generators, as well as reports from participants of the CRP

  7. Teleophthalmology: improving patient outcomes?

    Directory of Open Access Journals (Sweden)

    Sreelatha OK

    2016-02-01

    Full Text Available Omana Kesary Sreelatha,1 Sathyamangalam VenkataSubbu Ramesh2 1Ophthalmology Department, Sultan Qaboos University Hospital, Muscat, Oman; 2Department of Optometry, School of Allied Health Sciences, Manipal University, Manipal, India Abstract: Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP. Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR, glaucoma, age-related macular degeneration (ARMD, and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time

  8. Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

    Directory of Open Access Journals (Sweden)

    Isabelle Francisca Petronella Maria Kappen

    2017-05-01

    Full Text Available BackgroundNo consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP.MethodsThis was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation.ResultsForty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years. Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001. In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%–17% of the patients exhibited increased nasalance scores, assessed through nasometry.ConclusionsThe present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

  9. Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

    Science.gov (United States)

    Bittermann, Dirk; Janssen, Laura; Bittermann, Gerhard Koendert Pieter; Boonacker, Chantal; Haverkamp, Sarah; de Wilde, Hester; Van Der Heul, Marise; Specken, Tom FJMC; Koole, Ron; Kon, Moshe; Breugem, Corstiaan Cornelis; Mink van der Molen, Aebele Barber

    2017-01-01

    Background No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). Methods This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Results Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%–17% of the patients exhibited increased nasalance scores, assessed through nasometry. Conclusions The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence. PMID:28573094

  10. Methodology toward second generation expert systems

    International Nuclear Information System (INIS)

    Dormoy, J.L.

    1989-01-01

    So-called First Generation Expert Systems were aimed at capturing the expert's know-how. Though providing remarkable achievements, this first wave did not give the expected outcome. A new generation is getting out from the laboratories. Instead of remaining at a shallow level of knowledge - that is the unmotivated reasoning processes expressed by an expert when he is forced to tell them - one attempts to re-build this level of knowledge from the first principles which constitute the basis of an expert's knowledge. These systems are called deep knowledge-based, or second generation expert systems. Discussion in the three first parts rests on two examples: A first generation and a half system for process control in nuclear powers plants, than the system EXTRA for alarm processing in nuclear plants, wherein fonctional knowledge is explicitely represented. We show how deep knowledge can be implemented, and the advantages that can be expected from this methodology. Qualitative Physics is discussed in the next part. Future research developments as well as potential payoffs are mentioned [fr

  11. Seismic wave generator

    International Nuclear Information System (INIS)

    Devaure, Bernard.

    1982-01-01

    This invention concerns a device for simulating earth tremors. This device includes a seismic wave generator formed of a cylinder, one end of which is closed by one of the walls of a cell containing a soil, the other end being closed by a wall on which are fixed pyrotechnic devices generating shock waves inside the cylinder. These waves are transmitted from the cylinder to the cell through openings made in the cell wall. This device also includes a mechanical device acting as low-pass filter, located inside the cylinder and close to the cell wall [fr

  12. Unfavourable outcomes in orthognathic surgery

    Science.gov (United States)

    Bonanthaya, Krishnamurthy; Anantanarayanan, P.

    2013-01-01

    Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution. PMID:24501454

  13. Unfavourable outcomes in orthognathic surgery

    Directory of Open Access Journals (Sweden)

    Krishnamurthy Bonanthaya

    2013-01-01

    Full Text Available Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A Pre- Treatment B During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

  14. Unfavourable outcomes in orthognathic surgery.

    Science.gov (United States)

    Bonanthaya, Krishnamurthy; Anantanarayanan, P

    2013-05-01

    Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

  15. Treatment outcome and prognostic factor analysis in transplant-eligible Chinese myeloma patients receiving bortezomib-based induction regimens including the staged approach, PAD or VTD

    Directory of Open Access Journals (Sweden)

    Chim Chor

    2012-06-01

    Full Text Available Abstract Background We have reported promising outcomes using a staged approach, in which bortezomib/thalidomide/dexamethasone was used only in 14 patients with suboptimal response to VAD (vincristine/adriamycin/dexamethasone before autologous stem cell transplantation (ASCT. Here we compared the outcomes of the staged approach with frontline PAD (bortezomib/doxorubicin/dexamethasone or VTD (bortezomib/thalidomide/dexamethasone induction, and analysed prognostic factors for outcome. Patients and methods Ninety-one transplant-eligible Chinese patients received three induction regimens prior to ASCT [staged approach (N = 25, PAD (N = 31, VTD (N = 35]. and received thalidomide maintenance for 2 years post-ASCT. Results 43 (47.3% patients had International Staging System (ISS III disease. By an intention-to-treat analysis, the overall CR/nCR rate were 37.4% post-induction, and 62.6% post-ASCT. Five-year overall (OS and event-free (EFS survivals were 66% and 45.1%. There was no difference of the post-induction CR/nCR rate, EFS or OS between patients induced by these three regimens. Moreover, ISS III disease did not affect CR/nCR rates. Multivariate analysis showed that ISS and post-ASCT CR/nCR impacted OS while ISS and post-induction CR/nCR impacted EFS. Conclusions These three induction regimens produced comparable and favorable outcomes in myeloma. The unfavorable outcome of ISS stage III persisted despite upfront/early use of bortezomib. CR/nCR predicted favorable survivals.

  16. Validated Outcomes in the Grafting of Autologous Fat to the Breast: The VOGUE Study. Development of a Core Outcome Set for Research and Audit.

    Science.gov (United States)

    Agha, Riaz A; Pidgeon, Thomas E; Borrelli, Mimi R; Dowlut, Naeem; Orkar, Ter-Er K; Ahmed, Maziyah; Pujji, Ojas; Orgill, Dennis P

    2018-05-01

    Autologous fat grafting is an important part of the reconstructive surgeon's toolbox when treating women affected by breast cancer and subsequent tumor extirpation. The debate over safety and efficacy of autologous fat grafting continues within the literature. However, work performed by the authors' group has shown significant heterogeneity in outcome reporting. Core outcome sets have been shown to reduce heterogeneity in outcome reporting. The authors' goal was to develop a core outcome set for autologous fat grafting in breast reconstruction. The authors published their protocol a priori. A Delphi consensus exercise among key stakeholders was conducted using a list of outcomes generated from their previous work. These outcomes were divided into six domains: oncologic, clinical, aesthetic and functional, patient-reported, process, and radiologic. In the first round, 55 of 78 participants (71 percent) completed the Delphi consensus exercise. Consensus was reached on nine of the 13 outcomes. The clarity of the results and lack of additional suggested outcomes deemed further rounds to be unnecessary. The VOGUE Study has led to the development of a much-needed core outcome set in the active research front and clinical area of autologous fat grafting. The authors hope that clinicians will use this core outcome set to audit their practice, and that researchers will implement these outcomes in their study design and reporting of autologous fat grafting outcomes. The authors encourage journals and surgical societies to endorse and encourage use of this core outcome set to help refine the scientific quality of the debate, the discourse, and the literature. Therapeutic, V.

  17. Hydrogen Fuel Cell Analysis: Lessons Learned from Stationary Power Generation Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Scott E. Grasman; John W. Sheffield; Fatih Dogan; Sunggyu Lee; Umit O. Koylu; Angie Rolufs

    2010-04-30

    This study considered opportunities for hydrogen in stationary applications in order to make recommendations related to RD&D strategies that incorporate lessons learned and best practices from relevant national and international stationary power efforts, as well as cost and environmental modeling of pathways. The study analyzed the different strategies utilized in power generation systems and identified the different challenges and opportunities for producing and using hydrogen as an energy carrier. Specific objectives included both a synopsis/critical analysis of lessons learned from previous stationary power programs and recommendations for a strategy for hydrogen infrastructure deployment. This strategy incorporates all hydrogen pathways and a combination of distributed power generating stations, and provides an overview of stationary power markets, benefits of hydrogen-based stationary power systems, and competitive and technological challenges. The motivation for this project was to identify the lessons learned from prior stationary power programs, including the most significant obstacles, how these obstacles have been approached, outcomes of the programs, and how this information can be used by the Hydrogen, Fuel Cells & Infrastructure Technologies Program to meet program objectives primarily related to hydrogen pathway technologies (production, storage, and delivery) and implementation of fuel cell technologies for distributed stationary power. In addition, the lessons learned address environmental and safety concerns, including codes and standards, and education of key stakeholders.

  18. Coal-fired generation

    CERN Document Server

    Breeze, Paul

    2015-01-01

    Coal-Fired Generation is a concise, up-to-date and readable guide providing an introduction to this traditional power generation technology. It includes detailed descriptions of coal fired generation systems, demystifies the coal fired technology functions in practice as well as exploring the economic and environmental risk factors. Engineers, managers, policymakers and those involved in planning and delivering energy resources will find this reference a valuable guide, to help establish a reliable power supply address social and economic objectives. Focuses on the evolution of the traditio

  19. Economic/Environmental power dispatch for power systems including wind farms

    Directory of Open Access Journals (Sweden)

    Imen BEN JAOUED

    2015-05-01

    Full Text Available This paper presents the problem of the Economic/Environmental power Dispatching (EED of hybrid power system including wind energies. The power flow model for a stall regulated fixed speed wind generator (SR-FSWG system is discussed to assess the steady-state condition of power systems with wind farms. Modified Newton-Raphson algorithm including SR-FSWG is used to solve the load flow equations in which the state variables of the wind generators are combined with the nodal voltage magnitudes and angles of the entire network. The EED problem is a nonlinear constrained multi-objective optimization problem, two competing fuel cost and pollutant emission objectives should be minimized simultaneously while satisfying certain system constraints. In this paper, the resolution is done by the algorithm multi-objective particle swarm optimization (MOPSO. The effectiveness of the proposed method has been verified on IEEE 6-generator 30-bus test system and using MATLAB software package.

  20. Cost-effectiveness analysis in severe mental illness : Outcome measures selection

    NARCIS (Netherlands)

    Stant, A. Dennis; Buskens, Erik; Jenner, Jack A.; Wiersma, Durk; TenVergert, Elisabeth M.

    Background: Most economic evaluations conducted in mental healthcare did not include widely recommended preference-based health outcomes like the QALY (Quality-Adjusted Life Years). Instead, studies have mainly been designed as cost-effectiveness analyses that include single outcome measures aimed

  1. Dynamic models for distributed generation resources

    Energy Technology Data Exchange (ETDEWEB)

    Morched, A.S. [BPR Energie, Sherbrooke, PQ (Canada)

    2010-07-01

    Distributed resources can impact the performance of host power systems during both normal and abnormal system conditions. This PowerPoint presentation discussed the use of dynamic models for identifying potential interaction problems between interconnected systems. The models were designed to simulate steady state behaviour as well as transient responses to system disturbances. The distributed generators included directly coupled and electronically coupled generators. The directly coupled generator was driven by wind turbines. Simplified models of grid-side inverters, electronically coupled wind generators and doubly-fed induction generators (DFIGs) were presented. The responses of DFIGs to wind variations were evaluated. Synchronous machine and electronically coupled generator responses were compared. The system model components included load models, generators, protection systems, and system equivalents. Frequency responses to islanding events were reviewed. The study demonstrated that accurate simulations are needed to predict the impact of distributed generation resources on the performance of host systems. Advances in distributed generation technology have outpaced the development of models needed for integration studies. tabs., figs.

  2. Investigating conceptions of intentional action by analyzing participant generated scenarios

    Science.gov (United States)

    Skulmowski, Alexander; Bunge, Andreas; Cohen, Bret R.; Kreilkamp, Barbara A. K.; Troxler, Nicole

    2015-01-01

    We describe and report on results of employing a new method for analyzing lay conceptions of intentional and unintentional action. Instead of asking people for their conceptual intuitions with regard to construed scenarios, we asked our participants to come up with their own scenarios and to explain why these are examples of intentional or unintentional actions. By way of content analysis, we extracted contexts and components that people associated with these action types. Our participants associated unintentional actions predominantly with bad outcomes for all persons involved and linked intentional actions more strongly to positive outcomes, especially concerning the agent. People’s conceptions of intentional action seem to involve more aspects than commonly assumed in philosophical models of intentional action that solely stress the importance of intentions, desires, and beliefs. The additional aspects include decisions and thoughts about the action. In addition, we found that the criteria that participants generated for unintentional actions are not a mere inversion of those used in explanations for intentional actions. Associations between involuntariness and unintentional action seem to be stronger than associations between aspects of voluntariness and intentional action. PMID:26594182

  3. HTGR steam generator development

    International Nuclear Information System (INIS)

    Schuetzenduebel, W.G.; Hunt, P.S.; Weber, M.

    1976-01-01

    More than 40 gas-cooled reactor plants have produced in excess of 400 reactor years of operating experience which have proved a reasonably high rate of gas-cooled reactor steam generator availability. The steam generators used in these reactors include single U-tube and straight-tube steam generators as well as meander type and helically wound or involute tube steam generators. It appears that modern reactors are being equipped with helically wound steam generators of the once-through type as the end product of steam generator evolution in gas-cooled reactor plants. This paper provides a general overview of gas-cooled reactor steam generator evolution and operating experience and shows how design criteria and constraints, research and development, and experience data are factored into the design/development of modern helically wound tube steam generators for the present generation of gas-cooled reactors

  4. Self-correcting random number generator

    Science.gov (United States)

    Humble, Travis S.; Pooser, Raphael C.

    2016-09-06

    A system and method for generating random numbers. The system may include a random number generator (RNG), such as a quantum random number generator (QRNG) configured to self-correct or adapt in order to substantially achieve randomness from the output of the RNG. By adapting, the RNG may generate a random number that may be considered random regardless of whether the random number itself is tested as such. As an example, the RNG may include components to monitor one or more characteristics of the RNG during operation, and may use the monitored characteristics as a basis for adapting, or self-correcting, to provide a random number according to one or more performance criteria.

  5. Consequences of Parenting on Adolescent Outcomes

    Directory of Open Access Journals (Sweden)

    Donna Hancock Hoskins

    2014-09-01

    Full Text Available In recent years, substantial gains have been made in our understanding of the influence of parenting behaviors and styles on adolescent emotional and behavioral outcomes. Empirical work focusing on the associations between parenting and adolescent outcomes is important because the influence of parenting during adolescence continues to affect behaviors into adulthood. Additionally, there has been considerable attention paid to the mechanisms that shape parenting that then influence adolescent outcomes. For instance, researchers have found that neighborhood conditions moderated the association between parenting and adolescent development. In this paper, several covariates and contextual effects associated with parenting and adolescent outcomes will be discussed. Also, parental behaviors, parental styles and adolescent outcomes are discussed in this literature review. This review provides an assessment of the literature on parenting and adolescent outcomes from the past decade and includes advancements in parenting research. The review concludes with a summary of major research findings, as well as a consideration of future directions and implications for practice and policy.

  6. Psychosocial predictors of treatment outcome for trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per

    2016-01-01

    at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients' past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social...... situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms...

  7. Understanding portable generators

    Energy Technology Data Exchange (ETDEWEB)

    Hills, A.; Hawkins, B. [Guelph Univ., ON (Canada); Clarke, S. [Ontario Ministry of Agriculture, Food and Rural Affairs, Toronto, ON (Canada)

    2000-06-01

    This factsheet is intended to help consumers select a small portable generator for emergency electrical needs. Interest in standby generators has been heightened ever since the prolonged power outage in Eastern Ontario and Southwestern Quebec during the 1998 ice storm and the concern over Y2K related outages. Farmers, in particular, have been reassessing their need for emergency electrical power supply. This document presents some of the factors that should be considered when purchasing and operating a portable generator in the 3 to 12 kW size. It provides a detailed review of power quality and describes the use of tractor-driven power-take-off generators of 15 kW and larger. Several manufacturers make portable generators in many sizes with a whole range of features. This document includes a table depicting generator Feature/Benefit analysis to help consumers understand the differences between features and benefits. A second table provides a check list for generator feature/benefits. Specific details for the operations of various generators are available from manufacturers, distributors and electrical contractors. 2 tabs., 1 fig.

  8. Radionuclide generators

    International Nuclear Information System (INIS)

    Lambrecht, R.M.

    1983-01-01

    The status of radionuclide generators for chemical research and applications related to the life sciences and biomedical research are reviewed. Emphasis is placed upon convenient, efficient and rapid separation of short-lived daughter radionuclides in a chemical form suitable for use without further chemical manipulation. The focus is on the production of the parent, the radiochemistry associated with processing the parent and daughter, the selection and the characteristic separation methods, and yields. Quality control considerations are briefly noted. The scope of this review includes selected references to applications of radionuclide generators in radiopharmaceutical chemistry, and the life sciences, particularly in diagnostic and therapeutic medicine. The 99 Mo-sup(99m)Tc generator was excluded. 202 references are cited. (orig.)

  9. [Knowledge produced from the outcomes of the "Nursing Outcomes Classification--NOC": integrative review].

    Science.gov (United States)

    da Silva, Natália Chantal Magalhães; de Souza Oliveira, Ana Railka; de Carvalho, Emília Campos

    2015-12-01

    To identify the knowledge produced from the outcomes of the Nursing Outcomes Classification (NOC). A literature review using the integrative databases: Latin American and Caribbean Health Sciences (LILACS), US National Library of Medicine (PubMed), Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Scopus Info Site (SCOPUS), during the months of August and September 2014. The review consisted of 21 articles that addressed different issues: Translation and Cultural adaptation (4.77%); Applicability in clinical practice (33.33%); and, Validation (63.90%). Analysis of these articles showed that the knowledge produced from the Nursing Outcomes Classification includes translation and cultural adaptation, evaluation of applicability and validation of its items. Considering the continuous evolution of this classification, periodic reviews should be carried out to identify the knowledge, use and effects of the NOC.

  10. Optimizing outcomes with multifocal intraocular lenses

    Directory of Open Access Journals (Sweden)

    Gitansha Shreyas Sachdev

    2017-01-01

    Full Text Available Modern day cataract surgery is evolving from a visual restorative to a refractive procedure. The advent of multifocal intraocular lenses (MFIOLs allows greater spectacle independence and increased quality of life postoperatively. Since the inception in 1980s, MFIOLs have undergone various technical advancements including trifocal and extended depth of vision implants more recently. A thorough preoperative workup including the patients' visual needs and inherent ocular anatomy allows us to achieve superior outcomes. This review offers a comprehensive overview of the various types of MFIOLs and principles of optimizing outcomes through a comprehensive preoperative screening and management of postoperative complications.

  11. Psychosocial determinants of outcomes in knee replacement.

    Science.gov (United States)

    Lopez-Olivo, Maria A; Landon, Glenn C; Siff, Sherwin J; Edelstein, David; Pak, Chong; Kallen, Michael A; Stanley, Melinda; Zhang, Hong; Robinson, Kausha C; Suarez-Almazor, Maria E

    2011-10-01

    To identify potential psychosocial and educational barriers to clinical success following knee replacement. The authors evaluated 241 patients undergoing total knee replacement, preoperatively and 6 months after surgery. Outcomes included the Western Ontario McMaster (WOMAC) scale and the Knee Society rating system (KSRS). Independent variables included: the medical outcome study-social support scale; depression, anxiety and stress scale; brief COPE inventory; health locus of control; arthritis self-efficacy scale and the life orientation test-revised. Multiple regression models evaluated associations of baseline demographic and psychosocial variables with outcomes at 6 months, controlling for body mass index, comorbidities and baseline outcome scores. Patients' mean age was 65 ± 9 years; 65% were women. Most patients improved outcomes after surgery. Several psychosocial variables were associated with outcomes. Regression analyses indicated lower education, less tangible support, depression, less problem-solving coping, more dysfunctional coping, lower internal locus of control were associated with worse WOMAC scores (R(2) contribution of psychosocial variables for pain 0.07; for function, 0.14). Older age, lower education, depression and less problem-solving coping were associated with poorer total KSRS scores (R(2) contribution of psychosocial variables to total KSRS model 0.09). Psychosocial variables as a set contributed from 25% to 74% of total explained variance across the models tested. Patients' level of education, tangible support, depression, problem-solving coping, dysfunctional coping and internal locus of control were associated with pain and functional outcomes after knee replacement. The findings suggest that, in addition to medical management, perioperative psychosocial evaluation and intervention are crucial in enhancing knee replacement outcomes.

  12. Distributed generation hits market

    International Nuclear Information System (INIS)

    Anon.

    1997-01-01

    The pace at which vendors are developing and marketing gas turbines and reciprocating engines for small-scale applications may signal the widespread growth of distributed generation. Loosely defined to refer to applications in which power generation equipment is located close to end users who have near-term power capacity needs, distributed generation encompasses a broad range of technologies and load requirements. Disagreement is inevitable, but many industry observers associate distributed generation with applications anywhere from 25 kW to 25 MW. Ten years ago, distributed generation users only represented about 2% of the world market. Today, that figure has increased to about 4 or 5%, and probably could settle in the 20% range within a 3-to-5-year period, according to Michael Jones, San Diego, Calif.-based Solar Turbines Inc. power generation marketing manager. The US Energy Information Administration predicts about 175 GW of generation capacity will be added domestically by 2010. If 20% comes from smaller plants, distributed generation could account for about 35 GW. Even with more competition, it's highly unlikely distributed generation will totally replace current market structures and central stations. Distributed generation may be best suited for making market inroads when and where central systems need upgrading, and should prove its worth when the system can't handle peak demands. Typical applications include small reciprocating engine generators at remote customer sites or larger gas turbines to boost the grid. Additional market opportunities include standby capacity, peak shaving, power quality, cogeneration and capacity rental for immediate demand requirements. Integration of distributed generation systems--using gas-fueled engines, gas-fired combustion engines and fuel cells--can upgrade power quality for customers and reduce operating costs for electric utilities

  13. Culturally Sensitive and Environment-Friendly Outcome Measures in

    African Journals Online (AJOL)

    Dr Olaleye

    A systematic review of evidence on culturally sensitive and environment-friendly outcome measures in ..... which included manual grass cutting/hoeing, assuming the Islamic ... who opined that the starting point for any outcome measure is to ...

  14. Apparatuses and methods for generating electric fields

    Science.gov (United States)

    Scott, Jill R; McJunkin, Timothy R; Tremblay, Paul L

    2013-08-06

    Apparatuses and methods relating to generating an electric field are disclosed. An electric field generator may include a semiconductive material configured in a physical shape substantially different from a shape of an electric field to be generated thereby. The electric field is generated when a voltage drop exists across the semiconductive material. A method for generating an electric field may include applying a voltage to a shaped semiconductive material to generate a complex, substantially nonlinear electric field. The shape of the complex, substantially nonlinear electric field may be configured for directing charged particles to a desired location. Other apparatuses and methods are disclosed.

  15. Web-based depression treatment: associations of clients' word use with adherence and outcome.

    Science.gov (United States)

    Van der Zanden, Rianne; Curie, Keshia; Van Londen, Monique; Kramer, Jeannet; Steen, Gerard; Cuijpers, Pim

    2014-05-01

    The growing number of web-based psychological treatments, based on textual communication, generates a wealth of data that can contribute to knowledge of online and face-to-face treatments. We investigated whether clients' language use predicted treatment outcomes and adherence in Master Your Mood (MYM), an online group course for young adults with depressive symptoms. Among 234 participants from a randomised controlled trial of MYM, we tested whether their word use on course application forms predicted baseline levels of depression, anxiety and mastery, or subsequent treatment adherence. We then analysed chat session transcripts of course completers (n=67) to investigate whether word use changes predicted changes in treatment outcomes. Depression improvement was predicted by increasing use of 'discrepancy words' during treatment (e.g. should). At baseline, more discrepancy words predicted higher mastery level. Adherence was predicted by more words used at application, more social words and fewer discrepancy words. Many variables were included, increasing the chance of coincidental results. This risk was constrained by examining only those word categories that have been investigated in relation to depression or adherence. This is the first study to link word use during treatment to outcomes of treatment that has proven to be effective in an RCT. The results suggest that paying attention to the length of problem articulation at application and to 'discrepancy words' may be wise, as these seem to be psychological markers. To expand knowledge of word use as psychological marker, research on web-based treatment should include text analysis. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  16. Generating method-specific Reference Ranges - A harmonious outcome?

    Science.gov (United States)

    Lee, Graham R; Griffin, Alison; Halton, Kieran; Fitzgibbon, Maria C

    2017-12-01

    When laboratory Reference Ranges (RR) do not reflect analytical methodology, result interpretation can cause misclassification of patients and inappropriate management. This can be mitigated by determining and implementing method-specific RRs, which was the main objective of this study. Serum was obtained from healthy volunteers (Male + Female, n > 120) attending hospital health-check sessions during June and July 2011. Pseudo-anonymised aliquots were stored (at - 70 °C) prior t° analysis on Abbott ARCHITECT c16000 chemistry and i 2000SR immunoassay analysers. Data were stratified by gender where appropriate. Outliers were excluded statistically (Tukey method) to generate non-parametric RRs (2.5th + 97.5th percentiles). RRs were compared to those quoted by Abbott and UK Pathology Harmony (PH) where possible. For 7 selected tests, RRs were verified using a data mining approach. For chemistry tests (n = 23), Upper or Lower Reference Limits (LRL or URL) were > 20% different from Abbott ranges in 25% of tests (11% from PH ranges) but in 38% for immunoassay tests (n = 13). RRs (mmol/L) for sodium (138-144), potassium (3.8-4.9) and chloride (102-110) were considerably narrower than PH ranges (133-146, 3.5-5.0 and 95-108, respectively). The gender difference for ferritin (M: 29-441, F: 8-193 ng/mL) was more pronounced than reported by Abbott (M: 22-275, F: 5-204 ng/mL). Verification studies showed good agreement for chemistry tests (mean [SD] difference = 0.4% [1.2%]) but less so for immunoassay tests (27% [29%]), particularly for TSH (LRL). Where resource permits, we advocate using method-specific RRs in preference to other sources, particularly where method bias and lack of standardisation limits RR transferability and harmonisation.

  17. The medial tibial stress syndrome score: Item generation for a new ...

    African Journals Online (AJOL)

    The medial tibial stress syndrome score: Item generation for a new patient reported outcome measure. ... instrument that evaluates injury severity and treatment effects for medial tibial stress syndrome (MTSS) patients. ... from 32 Countries:.

  18. Next-generation negative symptom assessment for clinical trials: validation of the Brief Negative Symptom Scale.

    Science.gov (United States)

    Strauss, Gregory P; Keller, William R; Buchanan, Robert W; Gold, James M; Fischer, Bernard A; McMahon, Robert P; Catalano, Lauren T; Culbreth, Adam J; Carpenter, William T; Kirkpatrick, Brian

    2012-12-01

    The current study examined the psychometric properties of the Brief Negative Symptom Scale (BNSS), a next-generation rating instrument developed in response to the NIMH sponsored consensus development conference on negative symptoms. Participants included 100 individuals with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder who completed a clinical interview designed to assess negative, positive, disorganized, and general psychiatric symptoms, as well as functional outcome. A battery of anhedonia questionnaires and neuropsychological tests were also administered. Results indicated that the BNSS has excellent internal consistency and temporal stability, as well as good convergent and discriminant validity in its relationships with other symptom rating scales, functional outcome, self-reported anhedonia, and neuropsychological test scores. Given its brevity (13-items, 15-minute interview) and good psychometric characteristics, the BNSS can be considered a promising new instrument for use in clinical trials. Copyright © 2012 Elsevier B.V. All rights reserved.

  19. Power generation and the environment

    International Nuclear Information System (INIS)

    Robert, L.E.J.; Liss, P.S.; Saunders, P.A.H.

    1990-01-01

    This book reviews environmental aspects of large-scale power generation. It includes historic background of present-generation patterns and a discussion of fossil fuel, nuclear energy, and renewable technologies

  20. Steam generators - problems and prognosis

    International Nuclear Information System (INIS)

    Tapping, R.L.

    1997-05-01

    Steam-generator problems, largely a consequence of corrosion and fouling, have resulted in increased inspection requirements and more regulatory attention to steam-generator integrity. In addition, utilities have had to develop steam-generator life-management strategies, including cleaning and replacement, to achieve design life. This paper summarizes the pertinent data to 1993/1994, and presents an overview of current steam-generator management practices. (author)

  1. Health outcome after major trauma: what are we measuring?

    Science.gov (United States)

    Hoffman, Karen; Cole, Elaine; Playford, E Diane; Grill, Eva; Soberg, Helene L; Brohi, Karim

    2014-01-01

    Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. MEDLINE, EMBASE, and CINAHL (from 2006-2012) were searched for studies evaluating health outcome after traumatic injuries. Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.

  2. The association of generation status and health insurance among U.S. children.

    Science.gov (United States)

    BeLue, Rhonda; Miranda, Patricia Y; Elewonibi, Bilikisu Reni; Hillemeier, Marianne M

    2014-08-01

    The Patient Protection and Affordable Care Act (ACA) has the potential to reduce the number of uninsured children in the United States by as much as 40%. The extent to which immigrant families are aware of and interested in obtaining insurance for their children is unclear. Data from the 2011-2012 National Survey of Children's Health were analyzed to examine differences by immigrant generational status in awareness of children's health insurance options. Adjusted odds ratios (AORs) were calculated for each outcome variable that showed statistical significance by generation status. Barriers to obtaining insurance for children in immigrant (first- and second-generation) families include awareness of and experience with various health insurance options, perceived costs and benefits of insurance, structural/policy restrictions on eligibility, and lower likelihood of working in large organizations that offer employee insurance coverage. Although noncitizen immigrants are not covered by ACA insurance expansions, only 38% of first-generation families report being uninsured because of the inability to meet citizenship requirements. Most families in this sample also worked for employers with employees, making them less likely to benefit from expansions in employer-based insurance. In multivariate analyses, third-generation families have increased odds of knowing how to enroll in health insurance (AOR 7.1 [3.6-13.0]) and knowing where to find insurance information (AOR 7.7 [3.8-15.4]) compared with first-generation families. ACA navigators and health services professionals should be aware of potential unique challenges to helping immigrant families negotiate Medicaid expansions and state and federal exchanges. Copyright © 2014 by the American Academy of Pediatrics.

  3. Review of Micro Magnetic Generator

    Directory of Open Access Journals (Sweden)

    Lin DU

    2014-08-01

    Full Text Available This paper discusses the research progress of micro magnetic generator systems. Micro magnetic generator systems convert energy from the environment to electric energy with advantages as high reliability, high power density, long life time and can be applied to extreme environment. This paper summarizes methods for improving generator performance of micro magnetic generator, including rotational magnetic generator, vibrational magnetic generator and hybrid magnetic generator, analyzes and compares their design and performance, and concludes key technologies and ongoing challenges for further progress. The paper is instructive and meaningful to for research work of related field.

  4. Quantum random number generator

    Science.gov (United States)

    Pooser, Raphael C.

    2016-05-10

    A quantum random number generator (QRNG) and a photon generator for a QRNG are provided. The photon generator may be operated in a spontaneous mode below a lasing threshold to emit photons. Photons emitted from the photon generator may have at least one random characteristic, which may be monitored by the QRNG to generate a random number. In one embodiment, the photon generator may include a photon emitter and an amplifier coupled to the photon emitter. The amplifier may enable the photon generator to be used in the QRNG without introducing significant bias in the random number and may enable multiplexing of multiple random numbers. The amplifier may also desensitize the photon generator to fluctuations in power supplied thereto while operating in the spontaneous mode. In one embodiment, the photon emitter and amplifier may be a tapered diode amplifier.

  5. Design of improved controller for thermoelectric generator used in distributed generation

    Energy Technology Data Exchange (ETDEWEB)

    Molina, M.G. [CONICET, Instituto de Energia Electrica, Universidad Nacional de San Juan, Av. Libertador San Martin Oeste, 1109, J5400ARL, San Juan (Argentina); Juanico, L.E. [CONICET, Centro Atomico Bariloche, 8400 Bariloche (Argentina); Rinalde, G.F.; Taglialavore, E.; Gortari, S. [Centro Atomico Bariloche, 8400 Bariloche (Argentina)

    2010-06-15

    This paper investigates the application of thermal generation based on solid-state devices such as thermoelectric generators (TEGs) as a novel technological alternative of distributed generation (DG). The full detailed modeling and the dynamic simulation of a three-phase grid-connected TEG used as a dispersed generator is studied. Moreover, a new control scheme of the TEG is proposed, which consists of a multi-level hierarchical structure and incorporates a maximum power point tracker (MPPT) for better use of the thermal resource. In addition, reactive power compensation of the electric grid is included, operating simultaneously and independently of the active power generation. Validation of models and control schemes is performed by using the MATLAB/Simulink environment. Moreover, a small-scale TEG experimental set-up was employed to demonstrate the accuracy of proposed models. (author)

  6. Nutrition and Helicobacter pylori: Host Diet and Nutritional Immunity Influence Bacterial Virulence and Disease Outcome

    Directory of Open Access Journals (Sweden)

    Kathryn P. Haley

    2016-01-01

    Full Text Available Helicobacter pylori colonizes the stomachs of greater than 50% of the world’s human population making it arguably one of the most successful bacterial pathogens. Chronic H. pylori colonization results in gastritis in nearly all patients; however in a subset of people, persistent infection with H. pylori is associated with an increased risk for more severe disease outcomes including B-cell lymphoma of mucosal-associated lymphoid tissue (MALT lymphoma and invasive adenocarcinoma. Research aimed at elucidating determinants that mediate disease progression has revealed genetic differences in both humans and H. pylori which increase the risk for developing gastric cancer. Furthermore, host diet and nutrition status have been shown to influence H. pylori-associated disease outcomes. In this review we will discuss how H. pylori is able to create a replicative niche within the hostile host environment by subverting and modifying the host-generated immune response as well as successfully competing for limited nutrients such as transition metals by deploying an arsenal of metal acquisition proteins and virulence factors. Lastly, we will discuss how micronutrient availability or alterations in the gastric microbiome may exacerbate negative disease outcomes associated with H. pylori colonization.

  7. The Association of Generation Status and Health Insurance Among US Children

    Science.gov (United States)

    Miranda, Patricia Y.; Elewonibi, Bilikisu Reni; Hillemeier, Marianne M.

    2014-01-01

    BACKGROUND: The Patient Protection and Affordable Care Act (ACA) has the potential to reduce the number of uninsured children in the United States by as much as 40%. The extent to which immigrant families are aware of and interested in obtaining insurance for their children is unclear. METHODS: Data from the 2011–2012 National Survey of Children’s Health were analyzed to examine differences by immigrant generational status in awareness of children’s health insurance options. Adjusted odds ratios (AORs) were calculated for each outcome variable that showed statistical significance by generation status. RESULTS: Barriers to obtaining insurance for children in immigrant (first- and second-generation) families include awareness of and experience with various health insurance options, perceived costs and benefits of insurance, structural/policy restrictions on eligibility, and lower likelihood of working in large organizations that offer employee insurance coverage. Although noncitizen immigrants are not covered by ACA insurance expansions, only 38% of first-generation families report being uninsured because of the inability to meet citizenship requirements. Most families in this sample also worked for employers with employees, making them less likely to benefit from expansions in employer-based insurance. In multivariate analyses, third-generation families have increased odds of knowing how to enroll in health insurance (AOR 7.1 [3.6–13.0]) and knowing where to find insurance information (AOR 7.7 [3.8–15.4]) compared with first-generation families. CONCLUSIONS: ACA navigators and health services professionals should be aware of potential unique challenges to helping immigrant families negotiate Medicaid expansions and state and federal exchanges. PMID:25002670

  8. Workplace-related generational characteristics of nurses: A mixed-method systematic review.

    Science.gov (United States)

    Stevanin, Simone; Palese, Alvisa; Bressan, Valentina; Vehviläinen-Julkunen, Katri; Kvist, Tarja

    2018-06-01

    The aim of this study was to describe and summarize workplace characteristics of three nursing generations: Baby Boomers, Generations X and Y. Generational differences affect occupational well-being, nurses' performance, patient outcomes and safety; therefore, nurse managers, administrators and educators are interested increasingly in making evidence-based decisions about the multigenerational nursing workforce. Mixed-method systematic review. Medline, CINAHL, PsycINFO and Scopus (January 1991-January 2017). (1) The Joanna Briggs Institute's method for conducting mixed-method systematic reviews; (2) the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and (3) the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. The studies' methodological quality was assessed with the Mixed-Methods Appraisal Tool. Quantitative and mixed-method studies were transformed into qualitative methods using a convergent qualitative synthesis and qualitative findings were combined with a narrative synthesis. Thirty-three studies were included with three main themes and 11 subthemes: (1) Job attitudes (work engagement; turnover intentions, reasons for leaving; reasons, incentives/disincentives to continue nursing); (2) Emotion-related job aspects (stress/resilience; well-being/job satisfaction; affective commitment; unit climate; work ethic) and (3) Practice and leadership-related aspects (autonomy; perceived competence; leadership relationships and perceptions). Baby Boomers reported lower levels of stress and burnout than did Generations X and Y, different work engagement, factors affecting workplace well-being and retention and greater intention to leave compared with Generation Y, which was less resilient, but more cohesive. Although several studies reported methodological limitations and conflicting findings, generational differences in nurses' job attitudes, emotional, practice and leadership factors should be considered to enhance

  9. Relationship between Leadership Style, Leadership Outcomes, Gender, and Generation of Administrators in the Illinois Public School Setting

    Science.gov (United States)

    Ryder, Denise R.

    2016-01-01

    As the Millennial generation (individuals born 1982-2004) of leaders emerge in the educational setting, it is important to consider how these individuals may lead or work alongside a more veteran generation of teachers and administrators. While most of the evidence on leadership focuses on the characteristics of Baby Boomer and Generation X…

  10. Using patient reported outcome measures in health services: A qualitative study on including people with low literacy skills and learning disabilities

    NARCIS (Netherlands)

    Jahagirdar, D.; Kroll, T.; Ritchie, K.; Wyke, S.

    2012-01-01

    ABSTRACT: BACKGROUND: Patient reported outcome measures (PROMs) are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated

  11. Neutron generator instrumentation at the Department 2350 Neutron Generator Test Facility

    International Nuclear Information System (INIS)

    Bryant, T.C.; Mowrer, G.R.

    1979-06-01

    The computer and waveform digitizing capability at the test facility has allowed several changes in the techniques used to test neutron generators. These changes include methods used to calibrate the instrumentation and changes in the operation of the test facility. These changes have increased the efficiency of the test facility as well as increasing both timing and amplitude accuracy of neutron generator waveforms

  12. Access, treatment and outcomes of care: a study of ethnic minorities in Europe.

    Science.gov (United States)

    Hanssens, Lise G M; Detollenaere, Jens; Hardyns, Wim; Willems, Sara J T

    2016-05-01

    Recent research has shown that ethnic minorities still have less access to medical care and are less satisfied with the treatment they receive and the outcomes of the health care process. This article assesses how migrants in Europe experience access, treatment and outcomes in the European health care systems. Data were obtained from the QUALICOPC study (Quality and Costs of Primary Care in Europe). Regression analyses were used to estimate the access, treatment and outcomes of care for ethnic minorities. In several countries, migrants experience that the opening hours of their GP practice were too limited and indicate that the practice was too far away from their work or home (lower access). They are more likely to report negative patient-doctor communication and less continuity of care than native patients (worse treatment). In addition, they are less satisfied with the care they received and are more likely to postpone care (worse outcomes). In general, migrants are still disadvantaged during the health care process. However, our results also indicate that satisfaction with the health care process improves for second-generation migrants in comparison with first-generation migrants.

  13. A Review of Educational Outcomes in the Children's Mental Health Treatment Literature

    Science.gov (United States)

    Becker, Kimberly D.; Brandt, Nicole Evangelista; Stephan, Sharon H.; Chorpita, Bruce F.

    2014-01-01

    We examined the measurement of educational outcomes related to children's mental health treatments. A total of 85 papers describing 88 randomized controlled trials that included at least one educational outcome and one mental health outcome were included in these analyses. Forty-five different measures were identified as the primary educational…

  14. Economic incentives for evidence generation: promoting an efficient path to personalized medicine.

    Science.gov (United States)

    Towse, Adrian; Garrison, Louis P

    2013-01-01

    The preceding articles in this volume have identified and discussed a wide range of methodological and practical issues in the development of personalized medicine. This concluding article uses the resulting insights to identify implications for the economic incentives for evidence generation. It argues that promoting an efficient path to personalized medicine is going to require appropriate incentives for evidence generation including: 1) a greater willingness on the part of payers to accept prices that reflect value; 2) consideration of some form of intellectual property protection (e.g., data exclusivity) for diagnostics to incentivize generation of evidence of clinical utility; 3) realistic expectations around the standards for evidence; and 4) public investment in evidence collection to complement the efforts of payers and manufacturers. It concludes that such incentives could build and maintain a balance among: 1) realistic thresholds for evidence and the need for payers to have confidence in the clinical utility of the drugs and tests they use; 2) payment for value, with prices that ensure cost-effectiveness for health systems; and 3) levels of intellectual property protection for evidence generation that provide a return for those financing research and development, while encouraging competition to produce both better and more efficient tests. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

  15. Surry steam generator - examination and evaluation

    International Nuclear Information System (INIS)

    Clark, R.A.; Doctor, P.G.; Ferris, R.H.

    1985-10-01

    This report summarizes research conducted during the fourth year of the five year Steam Generator Group Project. During this period the project conducted numerous nondestructive examination (NDE) round robin inspections of the original Surry 2A steam generator. They included data acquisition/analysis and analysis-only round robins using multifrequency bobbin coil eddy current tests. In addition, the generator was nondestructively examined by alternate or advanced techniques including ultrasonics, optical fiber, profilometry and special eddy current instrumentation. The round robin interpretation data were compared. To validate the NDE results and for tube integrity testing, a selection of tubing samples, determined to be representative of the generator, was designated for removal. Initial sample removals from the generator included three sections of tube sheet, two sections of support plate and encompassed tubes, and a number of straight and U-bend tubing sections. Metallographic examination of these sections was initiated. Details of significant results are presented in the following paper. 13 figs

  16. Surry steam generator - examination and evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Clark, R A; Doctor, P G; Ferris, R H

    1987-01-01

    This report summarizes research conducted during the fourth year of the five year Steam Generator Group Project. During this period the project conducted numerous nondestructive examination (NDE) round robin inspections of the original Surry 2A steam generator. They included data acquisition/analysis and analysis-only round robins using multifrequency bobbin coil eddy current tests. In addition, the generator was nondestructively examined by alternate or advanced techniques including ultrasonics, optical fiber, profilometry and special eddy current instrumentation. The round robin interpretation data were compared. To validate the NDE results and for tube integrity testing, a selection of tubing samples, determined to be representative of the generator, was designated for removal. Initial sample removals from the generator included three sections of tube sheet, two sections of support plate and encompassed tubes, and a number of straight and U-bend tubing sections. Metallographic examination of these sections was initiated. Details of significant results are presented in the following paper.

  17. Incidence, predicting factors, and clinical outcomes of periprocedural myocardial infarction after percutaneous coronary intervention for chronic total occlusion in the era of new-generation drug-eluting stents.

    Science.gov (United States)

    Kim, Jin-Ho; Kim, Byeong-Keuk; Kim, Seunghwan; Ahn, Chul-Min; Kim, Jung-Sun; Ko, Young-Guk; Choi, Donghoon; Hong, Myeong-Ki; Jang, Yangsoo

    2017-12-20

    This study aimed to examine predictors and clinical outcomes of periprocedural myocardial infarction (PMI) after chronic total occlusion (CTO) intervention. There are limited data on the clinical implications of PMI after CTO intervention in the new-generation drug-eluting stent (DES) era. We enrolled 337 patients who underwent CTO intervention and met the study criteria. We evaluated the incidence and predictors of PMI, defined as an increase in creatine kinase-MB ≥3× the upper limit of normal (ULN) after intervention and compared the occurrence rates of major adverse cardiac and cerebrovascular events (MACCE, defined as the composite of cardiac death, myocardial infarction, stent thrombosis, target-vessel revascularization, or cerebrovascular accidents) between the PMI and non-PMI groups. PMI occurred in 23 (6.8%) patients after CTO intervention. Significant independent predictors were previous bypass surgery [odds ratio (OR) = 5.52, 95% confidence interval (CI) = 1.17-25.92; P = 0.03], Japan-CTO score ≥3 (OR = 7.06, 95%CI = 2.57-19.39; P PMI group had a significantly higher MACCE rate than the non-PMI group (23.7 vs. 5.6%, P = 0.008 by log-rank test). PMI was an independent predictor of MACCE (HR = 4.26, 95%CI = 1.35-13.43; P = 0.01). The MACCE rate gradually increased in a CK-MB-dependent fashion and was highest in patients with ≥10× ULN (P = 0.005). Previous bypass surgery, high Japan-CTO score, side branch occlusion, and longer procedure time were strongly related to PMI occurrence after CTO intervention. PMI was significantly associated with worse clinical outcomes in the new-generation DES era. © 2017 Wiley Periodicals, Inc.

  18. Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice.

    Science.gov (United States)

    Orimo, Tatsuya; Kamiyama, Toshiya; Yokoo, Hideki; Wakayama, Kenji; Shimada, Shingo; Tsuruga, Yosuke; Kamachi, Hirofumi; Taketomi, Akinobu

    2016-08-01

    This study aimed to evaluate the short- and long-term outcomes of hepatectomy for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT), including cases with obstructive jaundice. The study reviewed 42 HCC patients with BDTT, including six patients who needed preoperative biliary drainage due to obstructive jaundice, and 732 HCC patients without BDTT. The authors analyzed the impact of BDTT on the surgical outcomes and assessed the outcomes of hepatectomy for patients presenting with obstructive jaundice. The HCC patients with BDTT, almost all with stage 3 or 4 disease, had increased alpha-fetoprotein expression, larger tumors, and more portal vein invasion status. The survival of the HCC patients with BDTT was significantly inferior to that of the patients without BDTT (p = 0.0003). Survival did not differ significantly between the HCC patients with BDTT and those without BDTT when the two groups were matched by stage (p = 0.3366). The HCC patients with BDTT who presented with obstructive jaundice demonstrated outcomes similar to those for the HCC patients with BDTT who did not present with obstructive jaundice in terms of the overall survival rate (p = 0.5469). The perioperative outcomes for the HCC patients with BDTT did not depend on the presence or absence of preoperative jaundice. No patients in either BDTT group demonstrated 90-day mortality in this study. Hepatectomy should be considered for HCC patients with BDTT, even for patients with obstructive jaundice, because the surgical outcomes equivalent to those for HCC without BDTT can be achieved.

  19. Implant rehabilitation of the atrophic edentulous maxilla including immediate fixed provisional restoration without the use of bone grafting: a review of 1-year outcome data from a long-term prospective clinical trial.

    Science.gov (United States)

    Toljanic, Joseph A; Baer, Russell A; Ekstrand, Karl; Thor, Andreas

    2009-01-01

    The literature suggests that predictable integration can be achieved when dental implant placement is combined with immediate fixed provisional restoration in a variety of clinical situations. Fewer data are available, however, regarding outcomes for immediate provisional restoration of implants in the edentulous maxilla. This report presents 1-year data acquired from a long-term prospective clinical trial designed to assess outcomes following the immediate provisional fixed restoration of implants in the atrophic edentulous maxilla without the use of bone augmentation. Fifty-one subjects diagnosed with an atrophic edentulous maxilla received a total of 306 implants (six implants per subject) followed by fixed provisional restoration within 24 hours of implant placement. No subjects underwent grafting to enhance bone volume in preparation for implant treatment. Data acquired included bone quantity and quality, implant dimensions, implant locations, and implant placement stability. Subjects returned for 1-year follow-up examinations to assess implant integration and restoration function. Periapical radiographs were obtained and compared to baseline images to assess marginal bone height maintenance. At the 3-month follow-up examination, 294 of 306 implants placed in 51 subjects were found to be integrated. This represents a cumulative implant survival rate of 96%. At the 1-year follow-up examination, mean marginal bone loss of 0.5 mm was noted, with no further loss of implants. These results support the contention that predictable long-term outcomes may be obtained for the atrophic edentulous maxilla when treated with an implant rehabilitation protocol that includes immediate fixed provisional restoration without the use of bone grafting. This strategy offers a promising treatment alternative for the patient with an atrophic edentulous maxilla.

  20. Knowledge produced from the outcomes of the "Nursing Outcomes Classification - NOC": integrative review

    Directory of Open Access Journals (Sweden)

    Natália Chantal Magalhães da Silva

    Full Text Available Objective: To identify the knowledge produced from the outcomes of the Nursing Outcomes Classification (NOC. Method: A literature review using the integrative databases: Latin American and Caribbean Health Sciences (LILACS, US National Library of Medicine (PubMed, Cumulative Index to Nursing & Allied Health Literature (CINAHL and Scopus Info Site (SCOPUS, during the months of August and September 2014. Results: The review consisted of 21 articles that addressed different issues: Translation and Cultural adaptation (4.77%; Applicability in clinical practice (33.33%; and, Validation (63.90%. Analysis of these articles showed that the knowledge produced from the Nursing Outcomes Classification includes translation and cultural adaptation, evaluation of applicability and validation of its items. Conclusion: Considering the continuous evolution of this classification, periodic reviews should be carried out to identify the knowledge, use and effects of the NOC.

  1. Life-span development of self-esteem and its effects on important life outcomes.

    Science.gov (United States)

    Orth, Ulrich; Robins, Richard W; Widaman, Keith F

    2012-06-01

    We examined the life-span development of self-esteem and tested whether self-esteem influences the development of important life outcomes, including relationship satisfaction, job satisfaction, occupational status, salary, positive and negative affect, depression, and physical health. Data came from the Longitudinal Study of Generations. Analyses were based on 5 assessments across a 12-year period of a sample of 1,824 individuals ages 16 to 97 years. First, growth curve analyses indicated that self-esteem increases from adolescence to middle adulthood, reaches a peak at about age 50 years, and then decreases in old age. Second, cross-lagged regression analyses indicated that self-esteem is best modeled as a cause rather than a consequence of life outcomes. Third, growth curve analyses, with self-esteem as a time-varying covariate, suggested that self-esteem has medium-sized effects on life-span trajectories of affect and depression, small to medium-sized effects on trajectories of relationship and job satisfaction, a very small effect on the trajectory of health, and no effect on the trajectory of occupational status. These findings replicated across 4 generations of participants--children, parents, grandparents, and their great-grandparents. Together, the results suggest that self-esteem has a significant prospective impact on real-world life experiences and that high and low self-esteem are not mere epiphenomena of success and failure in important life domains. 2012 APA, all rights reserved

  2. Fuel oil systems for standby diesel-generators

    International Nuclear Information System (INIS)

    Anon.

    1976-01-01

    This Standard provides the design requirements for fuel oil system for diesel-generators that provide standby power for a nuclear power generating station. The system includes all essential equipment from and including fuel oil storage tanks up to the terminal connection on the diesel-engine. It does not include that portion of the fuel oil system supplied by the diesel-generator manufacturer which is in accordance with Trial-Use Criteria for Diesel-Generator Units Applied as Standby Power Supplies for Nuclear Power Generating Stations, IEEE-387-1972. This definition of scope is intended to exclude only those factory-assembled, engine-mounted appurtances supplied with a diesel-generator unit. Integral tanks are, however, within the scope of this Standard. It also excludes motors, motor control centers, switchgear, cables, and other electrical equipment which is used in operation of the fuel oil system, except to define interface requirements

  3. Outcomes of endovascular aortic repair in the modern era

    DEFF Research Database (Denmark)

    Budtz-Lilly, Jacob; Wanhainen, Anders; Mani, Kevin

    2018-01-01

    Monitoring outcomes following endovascular aortic repair (EVAR) is critical. Although evidence from randomized controlled trials has solidified the role of EVAR, the analysis of outcomes and "real-world" data has uncovered limitations, improved the selection of appropriate patients, and underscored...... the importance of instructions for use. Subsequent studies demonstrated the learning curve of EVAR and gradual improvement of outcomes over time. Outcomes analyses will continue to play an important role, particularly as technological growth of endovascular therapy has enabled treatment of more complex aneurysm...... pathologies and patients. The important analyses are herein reviewed, following the development of EVAR in the treatment of intact abdominal aortic aneurysms (AAA) to ruptured AAAs, and finally to complex aneurysms, including thoracoabdominal aortic aneurysms and mycotic aneurysms. This includes an overview...

  4. The effect of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women: a systematic review protocol.

    Science.gov (United States)

    Spencer, Lisa; Rollo, Megan; Hauck, Yvonne; MacDonald-Wicks, Lesley; Wood, Lisa; Hutchesson, Melinda; Giglia, Roslyn; Smith, Roger; Collins, Clare

    2015-01-01

    What are the effects of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women?The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aimed at limiting gestational weight gain and postpartum weight retention in women.The second objective of this systematic review is to investigate included intervention components with respect to effect on weight-related outcomes. This may include, but is not limited to: length of intervention, use of face-to-face counselling, group or individual consultations, use of other interventions components including exercise, use of goals and use of support tools like food diaries, coaching, including email or text message support. Around half of all women of reproductive age are either overweight or obese, with women aged 25-34 years having a greater risk of substantial weight gain compared with men of all ages. Excessive gestational weight gain (GWG) and postpartum weight retention (PPWR) may play a significant role in long term obesity. Having one child doubles the five- and 10-year obesity incidence for women, with many women who gain excessive weight during pregnancy remaining obese permanently. Excessive GWG and/or PPWR can also significantly contribute to short- and long-term adverse health outcomes for mother, baby and future pregnancies.Maternal obesity increases the risk of pregnancy related complications such as pre-eclampsia, gestational diabetes mellitus, stillbirth and the rate of caesarean section. Childhood obesity is a further long term complication of maternal obesity for offspring, which may persist in to adulthood. Excess GWG is also a risk factor for PPWR both in the short and long-term. Nehring et al. conducted a meta-analysis with over 65,000 women showing that, compared to women who gained weight within recommendations during pregnancy, women with GWG

  5. Core Outcome Set-STAndards for Development: The COS-STAD recommendations.

    Directory of Open Access Journals (Sweden)

    Jamie J Kirkham

    2017-11-01

    Full Text Available The use of core outcome sets (COS ensures that researchers measure and report those outcomes that are most likely to be relevant to users of their research. Several hundred COS projects have been systematically identified to date, but there has been no formal quality assessment of these studies. The Core Outcome Set-STAndards for Development (COS-STAD project aimed to identify minimum standards for the design of a COS study agreed upon by an international group, while other specific guidance exists for the final reporting of COS development studies (Core Outcome Set-STAndards for Reporting [COS-STAR].An international group of experienced COS developers, methodologists, journal editors, potential users of COS (clinical trialists, systematic reviewers, and clinical guideline developers, and patient representatives produced the COS-STAD recommendations to help improve the quality of COS development and support the assessment of whether a COS had been developed using a reasonable approach. An open survey of experts generated an initial list of items, which was refined by a 2-round Delphi survey involving nearly 250 participants representing key stakeholder groups. Participants assigned importance ratings for each item using a 1-9 scale. Consensus that an item should be included in the set of minimum standards was defined as at least 70% of the voting participants from each stakeholder group providing a score between 7 and 9. The Delphi survey was followed by a consensus discussion with the study management group representing multiple stakeholder groups. COS-STAD contains 11 minimum standards that are the minimum design recommendations for all COS development projects. The recommendations focus on 3 key domains: the scope, the stakeholders, and the consensus process.The COS-STAD project has established 11 minimum standards to be followed by COS developers when planning their projects and by users when deciding whether a COS has been developed using

  6. Core Outcome Set-STAndards for Development: The COS-STAD recommendations.

    Science.gov (United States)

    Kirkham, Jamie J; Davis, Katherine; Altman, Douglas G; Blazeby, Jane M; Clarke, Mike; Tunis, Sean; Williamson, Paula R

    2017-11-01

    The use of core outcome sets (COS) ensures that researchers measure and report those outcomes that are most likely to be relevant to users of their research. Several hundred COS projects have been systematically identified to date, but there has been no formal quality assessment of these studies. The Core Outcome Set-STAndards for Development (COS-STAD) project aimed to identify minimum standards for the design of a COS study agreed upon by an international group, while other specific guidance exists for the final reporting of COS development studies (Core Outcome Set-STAndards for Reporting [COS-STAR]). An international group of experienced COS developers, methodologists, journal editors, potential users of COS (clinical trialists, systematic reviewers, and clinical guideline developers), and patient representatives produced the COS-STAD recommendations to help improve the quality of COS development and support the assessment of whether a COS had been developed using a reasonable approach. An open survey of experts generated an initial list of items, which was refined by a 2-round Delphi survey involving nearly 250 participants representing key stakeholder groups. Participants assigned importance ratings for each item using a 1-9 scale. Consensus that an item should be included in the set of minimum standards was defined as at least 70% of the voting participants from each stakeholder group providing a score between 7 and 9. The Delphi survey was followed by a consensus discussion with the study management group representing multiple stakeholder groups. COS-STAD contains 11 minimum standards that are the minimum design recommendations for all COS development projects. The recommendations focus on 3 key domains: the scope, the stakeholders, and the consensus process. The COS-STAD project has established 11 minimum standards to be followed by COS developers when planning their projects and by users when deciding whether a COS has been developed using reasonable

  7. Wroclaw neutrino event generator

    International Nuclear Information System (INIS)

    Nowak, J A

    2006-01-01

    A neutrino event generator developed by the Wroclaw Neutrino Group is described. The physical models included in the generator are discussed and illustrated with the results of simulations. The considered processes are quasi-elastic scattering and pion production modelled by combining the Δ resonance excitation and deep inelastic scattering

  8. Generating efficiency: The power of price caps in the public and private Spanish electricity sectors

    International Nuclear Information System (INIS)

    Arocena, P.; Price, C.W.

    1999-01-01

    Economic regulation of firms with market power has placed increasing emphasis on incentive-based regulation such as price caps. The move to such regulation often coincides with a change of ownership, making it difficult to separate the incentive effects. We focus on the effect of regulation alone by analysing the imposition of price cap type regulation on both publicly and privately owned Spanish electricity generators in 1988, several years before three was any change of ownership. Our initial results indicate that the publicly owned generators are generally more efficient than the private ones, but that the effect of price caps is to increase the efficiency of private sector plants faster than those in the public sector. We introduce two novelties into the analysis: we incorporate levels of CO2 and NOx emissions; and we include declared plant availability as an output. The outcome is dependent on the choice of inputs and outputs, and we argue that our measures are more appropriate than traditional measures for a system of central despatch for generators facing environmental constraints. (au) 37 refs

  9. Evaluation of three sampling methods to monitor outcomes of antiretroviral treatment programmes in low- and middle-income countries.

    Science.gov (United States)

    Tassie, Jean-Michel; Malateste, Karen; Pujades-Rodríguez, Mar; Poulet, Elisabeth; Bennett, Diane; Harries, Anthony; Mahy, Mary; Schechter, Mauro; Souteyrand, Yves; Dabis, François

    2010-11-10

    Retention of patients on antiretroviral therapy (ART) over time is a proxy for quality of care and an outcome indicator to monitor ART programs. Using existing databases (Antiretroviral in Lower Income Countries of the International Databases to Evaluate AIDS and Médecins Sans Frontières), we evaluated three sampling approaches to simplify the generation of outcome indicators. We used individual patient data from 27 ART sites and included 27,201 ART-naive adults (≥15 years) who initiated ART in 2005. For each site, we generated two outcome indicators at 12 months, retention on ART and proportion of patients lost to follow-up (LFU), first using all patient data and then within a smaller group of patients selected using three sampling methods (random, systematic and consecutive sampling). For each method and each site, 500 samples were generated, and the average result was compared with the unsampled value. The 95% sampling distribution (SD) was expressed as the 2.5(th) and 97.5(th) percentile values from the 500 samples. Overall, retention on ART was 76.5% (range 58.9-88.6) and the proportion of patients LFU, 13.5% (range 0.8-31.9). Estimates of retention from sampling (n = 5696) were 76.5% (SD 75.4-77.7) for random, 76.5% (75.3-77.5) for systematic and 76.0% (74.1-78.2) for the consecutive method. Estimates for the proportion of patients LFU were 13.5% (12.6-14.5), 13.5% (12.6-14.3) and 14.0% (12.5-15.5), respectively. With consecutive sampling, 50% of sites had SD within ±5% of the unsampled site value. Our results suggest that random, systematic or consecutive sampling methods are feasible for monitoring ART indicators at national level. However, sampling may not produce precise estimates in some sites.

  10. Generations of decay: the political geography of decommissioning

    International Nuclear Information System (INIS)

    Blowers, A.

    1990-01-01

    Energy is politics. We rarely find it where we need it, it imposes upon other areas when we move it, and the less control we have over its development and use, the more politically insecure we feel. Nuclear power appears to avoid the traditional politics of energy supply by geographically internalizing much of the fuel cycle. But the problem of waste disposal, including decommissioning, is a major source of political conflict and uncertainty affecting the whole future of the nuclear industry. One of the most politically motivated decisions of the decommissioning era will be in choosing whether the process will be immediate or deferred. Deferred decommissioning is the most likely strategy, and that geographical inertia is the likely outcome. Such inertia is a feature of industrial decline, with each industrial epoch leaving the detritus of past decisions for future generations to discover and deal with. The political basis of the nuclear fuel cycle is its links with considerations of wastes, hazards, longevity, and equity, all matters of public interest and concern. As part of the nuclear fuel cycle, decommissioning will include these considerations too, and it is for this reason that, wherever decommissioning takes place, political questions arise. (author)

  11. Participation process and outcome interactions: Exploring participation in water resource management

    Science.gov (United States)

    Carr, G.; Loucks, D. P.; Blöschl, G.

    2012-04-01

    Evaluating participation programmes, projects and activities aids understanding of effective mechanisms and enables the identification of improvements to current strategies. Characteristics of participation processes, such whether the process is cost effective, adequately facilitated, accessible, includes a representative section of society or interest groups and allocates power equivalently between participants, are commonly described and evaluated in the literature. A key question concerns whether effective processes lead to desirable outcomes. Two types of outcomes can be identified from participation programmes - tangible and non-tangible. Tangible outcomes include resource management changes or resource quality changes. Non tangible outcomes include developing and strengthening communication and action networks, building trust between individuals and/or organisations, developing innovative solutions, or developing shared knowledge and understandings of issues. To better understand how participation impacts upon resource management it is necessary to identify i) how non-tangible outcomes lead to resource management outcomes and ii) which characteristics of the participation process are connected to achieving non-tangible outcomes. This has been attempted with a literature based meta-analysis. Literature has been analysed to identify outcomes from participations programmes, and the process characteristics present that are associated with promoting or inhibiting their achievement. Preliminary analysis shows that process characteristics such as representation, facilitation and accessibility are important for achieving non-tangible outcomes. The relationship between non-tangible outcomes and resource management outcomes is less clear in the literature. This may be due to the different timescales over which the different types of outcomes emerge (resource management outcomes emerge over longer time periods) and the different contexts or settings in which

  12. Health outcome after major trauma: what are we measuring?

    Directory of Open Access Journals (Sweden)

    Karen Hoffman

    Full Text Available Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients.To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma.MEDLINE, EMBASE, and CINAHL (from 2006-2012 were searched for studies evaluating health outcome after traumatic injuries.Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF were used to evaluate to what extent outcome measures captured health impacts.34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%, functional activities (11% and environmental factors (2%.Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.

  13. PULSE SYNTHESIZING GENERATOR

    Science.gov (United States)

    Kerns, Q.A.

    1963-08-01

    >An electronlc circuit for synthesizing electrical current pulses having very fast rise times includes several sinewave generators tuned to progressively higher harmonic frequencies with signal amplitudes and phases selectable according to the Fourier series of the waveform that is to be synthesized. Phase control is provided by periodically triggering the generators at precisely controlled times. The outputs of the generators are combined in a coaxial transmission line. Any frequency-dependent delays that occur in the transmission line can be readily compensated for so that the desired signal wave shape is obtained at the output of the line. (AEC)

  14. Novel Phenotypic Outcomes Identified for a Public Collection of Approved Drugs from a Publicly Accessible Panel of Assays.

    Directory of Open Access Journals (Sweden)

    Jonathan A Lee

    Full Text Available Phenotypic assays have a proven track record for generating leads that become first-in-class therapies. Whole cell assays that inform on a phenotype or mechanism also possess great potential in drug repositioning studies by illuminating new activities for the existing pharmacopeia. The National Center for Advancing Translational Sciences (NCATS pharmaceutical collection (NPC is the largest reported collection of approved small molecule therapeutics that is available for screening in a high-throughput setting. Via a wide-ranging collaborative effort, this library was analyzed in the Open Innovation Drug Discovery (OIDD phenotypic assay modules publicly offered by Lilly. The results of these tests are publically available online at www.ncats.nih.gov/expertise/preclinical/pd2 and via the PubChem Database (https://pubchem.ncbi.nlm.nih.gov/ (AID 1117321. Phenotypic outcomes for numerous drugs were confirmed, including sulfonylureas as insulin secretagogues and the anti-angiogenesis actions of multikinase inhibitors sorafenib, axitinib and pazopanib. Several novel outcomes were also noted including the Wnt potentiating activities of rotenone and the antifolate class of drugs, and the anti-angiogenic activity of cetaben.

  15. Motivating the Generations: Economic and Educational Influences

    Science.gov (United States)

    Herley, Wade

    2009-01-01

    This paper examines the various generations that include the greatest generation, the baby-boomers, generation X, and generation Y. The research encompasses many motivational elements that each generation covets, rejects, or shares. These generations are at different stages in life and each plays a vital role within our society. The workforce has…

  16. Scope and design of the Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements (FREEDOM) Study.

    Science.gov (United States)

    Jaber, Bertrand L; Finkelstein, Fredric O; Glickman, Joel D; Hull, Alan R; Kraus, Michael A; Leypoldt, John K; Liu, Jiannong; Gilbertson, David; McCarthy, James; Miller, Brent W; Moran, John; Collins, Allan J

    2009-02-01

    Conventional thrice-weekly hemodialysis (HD) has limited the ability to generate further improvements in patient quality of life, morbidity, and mortality. Daily HD (DHD) offers the promise of providing clinical and economic benefits. The objectives of the Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements Study are to evaluate outcomes of DHD (6 times/wk) with the NxStage System One (NxStage Medical Inc, Lawrence, MA) device. Cohort study with matched control group. The DHD group will include up to 500 participants at 70 clinical sites, enrolling for 3 years with a minimum of 1-year follow-up. Study candidates include adult patients (age >or= 18 years) with end-stage renal disease who are considered suitable candidates for DHD with the NxStage System One device by the treating physician and who have Medicare as their primary insurance payer. The control group will consist of a matched thrice-weekly in-center HD cohort derived from the US Renal Data System database using a 10:1 ratio, totaling 5,000 patients. Treatment with DHD and "standard of care" thrice-weekly HD. The primary intent-to-treat analysis compares hospitalization days/patient-year between the DHD and thrice-weekly HD groups. Other outcomes recorded in both groups include non-treatment-related medical expenditures. In addition, in the DHD cohort, changes in quality-of-life measures (baseline, 4 and 12 months, and every 6 months thereafter); urea kinetics; parameters related to anemia, bone and mineral metabolism, and nutrition; vascular access interventions; and use of medications will be examined. This study has the potential to elucidate the health and economic benefits of DHD and complement results of current clinical trials.

  17. Core Health Outcomes In Childhood Epilepsy (CHOICE): protocol for the selection of a core outcome set.

    Science.gov (United States)

    Morris, Christopher; Dunkley, Colin; Gibbon, Frances M; Currier, Janet; Roberts, Deborah; Rogers, Morwenna; Crudgington, Holly; Bray, Lucy; Carter, Bernie; Hughes, Dyfrig; Tudur Smith, Catrin; Williamson, Paula R; Gringras, Paul; Pal, Deb K

    2017-11-28

    There is increasing recognition that establishing a core set of outcomes to be evaluated and reported in trials of interventions for particular conditions will improve the usefulness of health research. There is no established core outcome set for childhood epilepsy. The aim of this work is to select a core outcome set to be used in evaluative research of interventions for children with rolandic epilepsy, as an exemplar of common childhood epilepsy syndromes. First we will identify what outcomes should be measured; then we will decide how to measure those outcomes. We will engage relevant UK charities and health professional societies as partners, and convene advisory panels for young people with epilepsy and parents of children with epilepsy. We will identify candidate outcomes from a search for trials of interventions for childhood epilepsy, statutory guidance and consultation with our advisory panels. Families, charities and health, education and neuropsychology professionals will be invited to participate in a Delphi survey following recommended practices in the development of core outcome sets. Participants will be able to recommend additional outcome domains. Over three rounds of Delphi survey participants will rate the importance of candidate outcome domains and state the rationale for their decisions. Over the three rounds we will seek consensus across and between families and health professionals on the more important outcomes. A face-to-face meeting will be convened to ratify the core outcome set. We will then review and recommend ways to measure the shortlisted outcomes using clinical assessment and/or patient-reported outcome measures. Our methodology is a proportionate and pragmatic approach to expediently produce a core outcome set for evaluative research of interventions aiming to improve the health of children with epilepsy. A number of decisions have to be made when designing a study to develop a core outcome set including defining the scope

  18. Outcomes of a statewide anti-tobacco industry youth organizing movement.

    Science.gov (United States)

    Dunn, Caroline L; Pirie, Phyllis L; Oakes, J Michael

    2004-01-01

    To outline the design and present select findings from an evaluation of a statewide anti-tobacco industry youth organizing movement. A telephone survey was administered to teenagers to assess associations between exposure to anti-industry youth organizing activities and tobacco-related attitudes and behaviors. A group-level comparison between areas high and low in youth organizing activities was planned. Methodological obstacles necessitated a subject-level analytic approach, with comparisons being made between youth at higher and lower levels of exposure. Six rural areas (comprising 13 counties) and two urban regions of Minnesota were selected for survey. The study comprised 852 youth, aged 15 to 17 years old, randomly selected from county-specific sampling frames constructed from a marketing research database. Exposure index scores were developed for two types of activities designed to involve youth in the anti-industry program: branding (creating awareness of the movement in general) and messaging (informing about the movement's main messages). Attitudinal outcomes measured attitudes about the tobacco industry and the effectiveness of youth action. Behavioral outcomes included taking action to get involved in the organization, spreading an anti-industry message, and smoking susceptibility. Branding index scores were significantly correlated with taking action to get involved (p strategy for involving youth in tobacco prevention and generating negative attitudes about the industry.

  19. Predicting Social Anxiety Treatment Outcome Based on Therapeutic Email Conversations.

    Science.gov (United States)

    Hoogendoorn, Mark; Berger, Thomas; Schulz, Ava; Stolz, Timo; Szolovits, Peter

    2017-09-01

    Predicting therapeutic outcome in the mental health domain is of utmost importance to enable therapists to provide the most effective treatment to a patient. Using information from the writings of a patient can potentially be a valuable source of information, especially now that more and more treatments involve computer-based exercises or electronic conversations between patient and therapist. In this paper, we study predictive modeling using writings of patients under treatment for a social anxiety disorder. We extract a wealth of information from the text written by patients including their usage of words, the topics they talk about, the sentiment of the messages, and the style of writing. In addition, we study trends over time with respect to those measures. We then apply machine learning algorithms to generate the predictive models. Based on a dataset of 69 patients, we are able to show that we can predict therapy outcome with an area under the curve of 0.83 halfway through the therapy and with a precision of 0.78 when using the full data (i.e., the entire treatment period). Due to the limited number of participants, it is hard to generalize the results, but they do show great potential in this type of information.

  20. Predictors for major cardiovascular outcomes in stable ischaemic heart disease (PREMAC)

    DEFF Research Database (Denmark)

    Winkel, Per; Jakobsen, Janus Christian; Hilden, Jørgen

    2017-01-01

    The purpose of the predictors for major cardiovascular outcomes in stable ischaemic Heart disease (PREMAC) study is exploratory and hypothesis generating. We want to identify biochemical quantities which—conditionally on the values of available standard demographic, anamnestic, and biochemical data...

  1. Maternal nutrition and birth outcomes.

    Science.gov (United States)

    Abu-Saad, Kathleen; Fraser, Drora

    2010-01-01

    In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.

  2. Imatinib mesylate in chronic myeloid leukemia: frontline treatment and long-term outcomes.

    Science.gov (United States)

    Stagno, Fabio; Stella, Stefania; Spitaleri, Antonio; Pennisi, Maria Stella; Di Raimondo, Francesco; Vigneri, Paolo

    2016-01-01

    The tyrosine kinase inhibitor Imatinib Mesylate has dramatically improved the clinical outcome of chronic myeloid leukemia (CML) patients in the chronic phase of the disease, generating unprecedented rates of complete hematologic and cytogenetic responses and sustained reductions in BCR-ABL transcripts. Here, we present an overview on the efficacy and safety of Imatinib and describe the most important clinical studies employing this drug for the frontline treatment of chronic phase CML. We also discuss recent reports describing the long-term outcome of patients receiving Imatinib for their disease. The imminent availability of generic forms of Imatinib coupled with the approval of expensive second-generation tyrosine kinase inhibitors underlines an unmet need for early molecular parameters that may distinguish CML patients likely to benefit from the drug from those that should receive alternative forms of treatment.

  3. TFTR Motor Generator

    International Nuclear Information System (INIS)

    Murray, J.G.; Bronner, G.; Horton, M.

    1977-01-01

    A general description is given of 475 MVA pulsed motor generators for TFTR at Princeton Plasma Physics Laboratory. Two identical generators operating in parallel are capable of supplying 950 MVA for an equivalent square pulse of 6.77 seconds and 4,500 MJ at 0.7 power factor to provide the energy for the pulsed electrical coils and heating system for TFTR. The description includes the operational features of the 15,000 HP wound rotor motors driving each generator with its starting equipment and cycloconverter for controlling speed, power factor, and regulating line voltage during load pulsing where the generator speed changes from 87.5 to 60 Hz frequency variation to provide the 4,500 MJ or energy. The special design characteristics such as fatigue stress calculations for 10 6 cycles of operation, forcing factor on exciter to provide regulation, and low generator impedance are reviewed

  4. Automated outcome scoring in a virtual reality simulator for endodontic surgery.

    Science.gov (United States)

    Yin, Myat Su; Haddawy, Peter; Suebnukarn, Siriwan; Rhienmora, Phattanapon

    2018-01-01

    We address the problem of automated outcome assessment in a virtual reality (VR) simulator for endodontic surgery. Outcome assessment is an essential component of any system that provides formative feedback, which requires assessing the outcome, relating it to the procedure, and communicating in a language natural to dental students. This study takes a first step toward automated generation of such comprehensive feedback. Virtual reference templates are computed based on tooth anatomy and the outcome is assessed with a 3D score cube volume which consists of voxel-level non-linear weighted scores based on the templates. The detailed scores are transformed into standard scoring language used by dental schools. The system was evaluated on fifteen outcome samples that contained optimal results and those with errors including perforation of the walls, floor, and both, as well as various combinations of major and minor over and under drilling errors. Five endodontists who had professional training and varying levels of experiences in root canal treatment participated as raters in the experiment. Results from evaluation of our system with expert endodontists show a high degree of agreement with expert scores (information based measure of disagreement 0.04-0.21). At the same time they show some disagreement among human expert scores, reflecting the subjective nature of human outcome scoring. The discriminatory power of the AOS scores analyzed with three grade tiers (A, B, C) using the area under the receiver operating characteristic curve (AUC). The AUC values are generally highest for the {AB: C} cutoff which is cutoff at the boundary between clinically acceptable (B) and clinically unacceptable (C) grades. The objective consistency of computed scores and high degree of agreement with experts make the proposed system a promising addition to existing VR simulators. The translation of detailed level scores into terminology commonly used in dental surgery supports natural

  5. A Framework for Including Family Health Spillovers in Economic Evaluation.

    Science.gov (United States)

    Al-Janabi, Hareth; van Exel, Job; Brouwer, Werner; Coast, Joanna

    2016-02-01

    Health care interventions may affect the health of patients' family networks. It has been suggested that these "health spillovers" should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the "health care perspective"). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society. © The Author(s) 2015.

  6. Catalysis for alternative energy generation

    CERN Document Server

    2012-01-01

    Summarizes recent problems in using catalysts in alternative energy generation and proposes novel solutions  Reconsiders the role of catalysis in alternative energy generation  Contributors include catalysis and alternative energy experts from across the globe

  7. Culturally Sensitive and Environment-Friendly Outcome Measures in

    African Journals Online (AJOL)

    Dr Olaleye

    to review research studies on outcome measures that were developed for ... A systematic review of evidence on culturally sensitive and environment- ... Various databases including Google Scholar, PEDro and PubMed were accessed to search for relevant empirical ... utilization of disease-specific, patient-centered outcome.

  8. Environmental Outcomes in the South African Learnership System ...

    African Journals Online (AJOL)

    Since 1994, the published environmental goals and objectives of the South African Government include environmental education outcomes in all education and ... of manifest and latent environmental outcomes distributed across learnerships and SETAs; a strong influence of occupational health and safety legislation; and a ...

  9. Synthetic pulse radar including a microprocessor based controller

    International Nuclear Information System (INIS)

    Fowler, J.C.; Rubin, L.A.; Still, W.L.

    1980-01-01

    This invention relates to pulse radar detection of targets in extended media, including natural phenomena such as oil, coal and ore deposits within the earth. In particular, this invention relates to a pulse radar system employing a synthetic pulse formed from a fourier spectrum of frequencies generated and detected by a digitally controlled transmitter and receiver circuits

  10. Novel Approach to Tourism Analysis with Multiple Outcome Capability Using Rough Set Theory

    Directory of Open Access Journals (Sweden)

    Chun-Che Huang

    2016-12-01

    Full Text Available To explore the relationship between characteristics and decision-making outcomes of the tourist is critical to keep competitive tourism business. In investigation of tourism development, most of the existing studies lack of a systematic approach to analyze qualitative data. Although the traditional Rough Set (RS based approach is an excellent classification method in qualitative modeling, but it is canarsquo;t deal with the case of multiple outcomes, which is a common situation in tourism. Consequently, the Multiple Outcome Reduct Generation (MORG and Multiple Outcome Rule Extraction (MORE approaches based on RS to handle multiple outcomes are proposed. This study proposes a ranking based approach to induct meaningful reducts and ensure the strength and robustness of decision rules, which helps decision makers understand touristarsquo;s characteristics in a tourism case.

  11. A data based random number generator for a multivariate distribution (using stochastic interpolation)

    Science.gov (United States)

    Thompson, J. R.; Taylor, M. S.

    1982-01-01

    Let X be a K-dimensional random variable serving as input for a system with output Y (not necessarily of dimension k). given X, an outcome Y or a distribution of outcomes G(Y/X) may be obtained either explicitly or implicity. The situation is considered in which there is a real world data set X sub j sub = 1 (n) and a means of simulating an outcome Y. A method for empirical random number generation based on the sample of observations of the random variable X without estimating the underlying density is discussed.

  12. Analysing data from patient-reported outcome and quality of life endpoints for cancer clinical trials

    DEFF Research Database (Denmark)

    Bottomley, Andrew; Pe, Madeline; Sloan, Jeff

    2016-01-01

    Measures of health-related quality of life (HRQOL) and other patient-reported outcomes generate important data in cancer randomised trials to assist in assessing the risks and benefits of cancer therapies and fostering patient-centred cancer care. However, the various ways these measures are anal......Measures of health-related quality of life (HRQOL) and other patient-reported outcomes generate important data in cancer randomised trials to assist in assessing the risks and benefits of cancer therapies and fostering patient-centred cancer care. However, the various ways these measures...... are analysed and interpreted make it difficult to compare results across trials, and hinders the application of research findings to inform publications, product labelling, clinical guidelines, and health policy. To address these problems, the Setting International Standards in Analyzing Patient......-Reported Outcomes and Quality of Life Endpoints Data (SISAQOL) initiative has been established. This consortium, directed by the European Organisation for Research and Treatment of Cancer (EORTC), was convened to provide recommendations on how to standardise the analysis of HRQOL and other patient-reported outcomes...

  13. Re-Examination of the BEST Trial Using Composite Outcomes, Including Emergency Department Visits

    DEFF Research Database (Denmark)

    Shen, Li; Jhund, Pardeep S.; Mogensen, Ulrik M.

    2017-01-01

    that included emergency department (ED) visits. We also undertook an analysis of recurrent events primarily using the Lin, Wei, Ying, and Yang model. Results Overall, 448 (33%) patients on placebo and 411 (30%) patients on bucindolol died (hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.78 to 1.02; p...... = 0.11). A total of 730 (54%) patients experienced CVD/HFH on placebo and 624 (46%) on bucindolol (HR: 0.80; 95% CI: 0.72 to 0.89; p 0.90; p

  14. Method for protecting an electric generator

    Science.gov (United States)

    Kuehnle, Barry W.; Roberts, Jeffrey B.; Folkers, Ralph W.

    2008-11-18

    A method for protecting an electrical generator which includes providing an electrical generator which is normally synchronously operated with an electrical power grid; providing a synchronizing signal from the electrical generator; establishing a reference signal; and electrically isolating the electrical generator from the electrical power grid if the synchronizing signal is not in phase with the reference signal.

  15. Outcomes management: incorporating and sustaining processes critical to using outcome data to guide practice improvement.

    Science.gov (United States)

    Hodges, Kay; Wotring, James R

    2012-04-01

    An outcomes management system (OMS) greatly facilitates an organization or state achieving requirements regarding accountability and use of empirically based interventions. A case example of the authors' experience with a successful and enduring OMS is presented, followed by a review of the literature and a proposed model delineating the key components and benefits of an OMS. Building capacity to measure performance requires embedding utilization of youth-specific, clinically meaningful outcome data into the organization's processes and structures. An OMS measures outcomes associated with services, facilitates implementation of evidence-based practices, informs case decision making, enables better and more efficient clinical management, and provides aggregated information used to improve services. A case-specific supervisory model based on instantaneously available information, including progress to date, helps maximize consumer outcomes. Continuous quality improvement activities, which are databased and goal-oriented, become a positive change management tool. This paper describes organizational processes that facilitate the development of a highly functional OMS.

  16. GUDM: Automatic Generation of Unified Datasets for Learning and Reasoning in Healthcare.

    Science.gov (United States)

    Ali, Rahman; Siddiqi, Muhammad Hameed; Idris, Muhammad; Ali, Taqdir; Hussain, Shujaat; Huh, Eui-Nam; Kang, Byeong Ho; Lee, Sungyoung

    2015-07-02

    A wide array of biomedical data are generated and made available to healthcare experts. However, due to the diverse nature of data, it is difficult to predict outcomes from it. It is therefore necessary to combine these diverse data sources into a single unified dataset. This paper proposes a global unified data model (GUDM) to provide a global unified data structure for all data sources and generate a unified dataset by a "data modeler" tool. The proposed tool implements user-centric priority based approach which can easily resolve the problems of unified data modeling and overlapping attributes across multiple datasets. The tool is illustrated using sample diabetes mellitus data. The diverse data sources to generate the unified dataset for diabetes mellitus include clinical trial information, a social media interaction dataset and physical activity data collected using different sensors. To realize the significance of the unified dataset, we adopted a well-known rough set theory based rules creation process to create rules from the unified dataset. The evaluation of the tool on six different sets of locally created diverse datasets shows that the tool, on average, reduces 94.1% time efforts of the experts and knowledge engineer while creating unified datasets.

  17. Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients

    OpenAIRE

    Song, Guang-Ying; Zhao, Zhi-He; Ding, Yin; Bai, Yu-Xing; Wang, Lin; He, Hong; Shen, Gang; Li, Wei-Ran; Baumrind, Sheldon; Geng, Zhi; Xu, Tian-Min

    2013-01-01

    This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 pat...

  18. Effect of battery longevity on costs and health outcomes associated with cardiac implantable electronic devices: a Markov model-based Monte Carlo simulation.

    Science.gov (United States)

    Schmier, Jordana K; Lau, Edmund C; Patel, Jasmine D; Klenk, Juergen A; Greenspon, Arnold J

    2017-11-01

    The effects of device and patient characteristics on health and economic outcomes in patients with cardiac implantable electronic devices (CIEDs) are unclear. Modeling can estimate costs and outcomes for patients with CIEDs under a variety of scenarios, varying battery longevity, comorbidities, and care settings. The objective of this analysis was to compare changes in patient outcomes and payer costs attributable to increases in battery life of implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D). We developed a Monte Carlo Markov model simulation to follow patients through primary implant, postoperative maintenance, generator replacement, and revision states. Patients were simulated in 3-month increments for 15 years or until death. Key variables included Charlson Comorbidity Index, CIED type, legacy versus extended battery longevity, mortality rates (procedure and all-cause), infection and non-infectious complication rates, and care settings. Costs included procedure-related (facility and professional), maintenance, and infections and non-infectious complications, all derived from Medicare data (2004-2014, 5% sample). Outcomes included counts of battery replacements, revisions, infections and non-infectious complications, and discounted (3%) costs and life years. An increase in battery longevity in ICDs yielded reductions in numbers of revisions (by 23%), battery changes (by 44%), infections (by 23%), non-infectious complications (by 10%), and total costs per patient (by 9%). Analogous reductions for CRT-Ds were 23% (revisions), 32% (battery changes), 22% (infections), 8% (complications), and 10% (costs). Based on modeling results, as battery longevity increases, patients experience fewer adverse outcomes and healthcare costs are reduced. Understanding the magnitude of the cost benefit of extended battery life can inform budgeting and planning decisions by healthcare providers and insurers.

  19. Microfluidic droplet generator with controlled break-up mechanism

    KAUST Repository

    Gonzalez, David Conchouso

    2017-04-13

    Droplet generation devices and systems that parallelize droplet generation devices are provided. The droplet generation devices can include a symmetric block-and-break system and a tapered droplet generation zone. The symmetric block-and-break system can include a pair of break channels and a pair of bypass channels symmetrically arranged with respect to the dispersed-phase input channel and the output channel. The droplet generation devices can generate monodisperse droplets with a predefined volume over a range of flow rates, pressures, and fluid properties. The droplet generation devices are therefore capable of parallelization to achieve large-capacity droplet generation, e.g. greater than 1 L/hr, with small overall coefficients of variation.

  20. Generation 4 International Forum (GIF). 2015 Annual Report

    International Nuclear Information System (INIS)

    2016-01-01

    This ninth edition of the Generation IV International Forum (GIF) Annual Report highlights the main achievements of the Forum in 2015. On 26 February 2015, the Framework Agreement for International Collaboration on Research and Development of Generation IV Nuclear Energy Systems was extended for another ten years, thereby paving the way for continued collaboration among participating countries. GIF organised the 3. Symposium in Makuhari Messe, Japan in May 2015 to present progress made in the development of the six generation IV systems: the gas-cooled fast reactor, the sodium-cooled fast reactor, the supercritical-water-cooled reactor, the very-high-temperature reactor, the lead-cooled fast reactor and the molten salt reactor. The report gives a detailed description of progress made in the 11 existing project arrangements. It also describes the development of safety design criteria and guidelines for the sodium-cooled fast reactor, in addition to the outcome of GIF engagement with regulators on safety approaches for generation IV systems. (authors)

  1. Airburst-Generated Tsunamis

    Science.gov (United States)

    Berger, Marsha; Goodman, Jonathan

    2018-04-01

    This paper examines the questions of whether smaller asteroids that burst in the air over water can generate tsunamis that could pose a threat to distant locations. Such airburst-generated tsunamis are qualitatively different than the more frequently studied earthquake-generated tsunamis, and differ as well from tsunamis generated by asteroids that strike the ocean. Numerical simulations are presented using the shallow water equations in several settings, demonstrating very little tsunami threat from this scenario. A model problem with an explicit solution that demonstrates and explains the same phenomena found in the computations is analyzed. We discuss the question of whether compressibility and dispersion are important effects that should be included, and show results from a more sophisticated model problem using the linearized Euler equations that begins to addresses this.

  2. Systematic Review of Treatment Outcome Measures for Vulvodynia.

    Science.gov (United States)

    Sadownik, Leslie A; Yong, Paul J; Smith, Kelly B

    2018-07-01

    To systematically evaluate the literature regarding vulvodynia treatment outcome measures. A systematic literature search on OVID, PubMed, and PsycINFO databases was conducted from inception until May 2016. Studies were included/excluded based on prespecified criteria. Reported outcome measures were organized into 6 core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT): pain; physical functioning, emotional functioning, participant ratings of global improvement and satisfaction with treatment, symptoms and adverse events, and participant disposition. Of the 206 articles identified for full-text screening, 33 met our criteria. One study adhered to all IMMPACT recommendations. The number of outcomes measured per study ranged from 1 to greater than 20. Patient-reported pain outcomes were found in the majority (27/33; 82%) of studies. Pain severity with intercourse was reported by 24 (73%) of 33 studies-9 different scales were used to measure this outcome. Clinician-reported outcomes were present in 14 (42%) of 33 studies. Methods of measuring vestibular sensitivity by "cotton swab" test were different in 8 of 10 studies. Other domains reported included; physical function (8/33 studies; 24%), sexual function (23/33 studies; 70%), and emotional function (13/33 studies; 39%). Symptoms and adverse events were reported by 15 (45%) of 33 studies. One study formally reported participant disposition using all the information recommended by CONSORT. Comparison of clinical trial results in vulvodynia is not possible because of a lack of standard treatment outcome measures. Vulvodynia researchers should apply the IMMPACT criteria to guide the development of a minimum core set of standard outcome measures that measure holistic health.

  3. Constant potential high-voltage generator

    International Nuclear Information System (INIS)

    Resnick, T.A.; Dupuis, W.A.; Palermo, T.

    1980-01-01

    An X-ray tube voltage generator with automatic stabilization circuitry is disclosed. The generator includes a source of pulsating direct current voltage such as from a rectified 3 phase transformer. This pulsating voltage is supplied to the cathode and anode of an X-ray tube and forms an accelerating potential for electrons within that tube. The accelerating potential is stabilized with a feedback signal which is provided by a feedback network. The network includes an error signal generator which compares an instantaneous accelerating potential with a preferred reference accelerating potential and generates an error function. This error function is transmitted to a control tube grid which in turn causes the voltage difference between X-ray tube cathode and anode to stabilize and thereby reduce the error function. In this way stabilized accelerating potentials are realized and uniform X-ray energy distributions produced. (Auth.)

  4. Self-Powered Functional Device Using On-Chip Power Generation

    KAUST Repository

    Hussain, Muhammad Mustafa

    2012-01-26

    An apparatus, system, and method for a self-powered device using on-chip power generation. In some embodiments, the apparatus includes a substrate, a power generation module on the substrate, and a power storage module on the substrate. The power generation module may include a thermoelectric generator made of bismuth telluride.

  5. Self-Powered Functional Device Using On-Chip Power Generation

    KAUST Repository

    Hussain, Muhammad Mustafa

    2012-01-01

    An apparatus, system, and method for a self-powered device using on-chip power generation. In some embodiments, the apparatus includes a substrate, a power generation module on the substrate, and a power storage module on the substrate. The power generation module may include a thermoelectric generator made of bismuth telluride.

  6. Magnetic field generation device for magnetohydrodynamic electric power generation

    International Nuclear Information System (INIS)

    Kuriyama, Yoshihiko.

    1993-01-01

    An existent magnetic field generation device for magnetohydrodynamic electric power generation comprises at least a pair of permanent magnets disposed to an inner circumferential surface of a yoke having such a cross sectional area that two pairs of parallel sides are present, in which different magnetic poles are opposed while interposing a flow channel for a conductive fluid therebetween. Then, first permanent magnets which generate main magnetic fields are disposed each at a gap sandwiching a plane surface including a center axis of a flow channel for the conductive fluid. Second permanent magnets which generate auxiliary magnetic fields are disposed to an inner circumferential surface of a yoke intersecting the yoke to which the first permanent magnets are disposed. The magnetic poles on the side of the flow channel for the second permanent magnets have identical polarity with that of the magnetic poles of the adjacent first permanent magnets. As a result, a magnetic flux density in the flow channel for the conductive fluid can be kept homogeneous and at a high level from a position of the axial line of the flow channel to the outer circumference, thereby enabling to remarkably improve a power generation efficiency. (N.H.)

  7. [Relationship experiences and therapeutic outcome in inpatient psychotherapy].

    Science.gov (United States)

    Sammet, Isa; Staats, Herrmann; Schauenburg, Henning

    2004-01-01

    Inpatient psychotherapy includes the patient's manifold contacts with different therapists, nurses and fellow patients. The present study investigated the association between these multiple relationships and therapy outcome. Pre-post measures of symptom load (Brief Symptom Inventory), interpersonal problems (IIP) and self-efficacy (SEB) were used to define three groups with positive (N=129), unchanged (N=44) or negative (N=40) outcome. These groups were compared 1) by their alliance with an individual therapist, their relationship to the therapeutic team, their experience of cohesion and climate concerning fellow patients in the ward (measured weekly by the "Stationserfahrungsbogen" SEB), and 2) by their differences in mean correlations between the courses of relationship experiences and symptom load. Cohesion and relationship to the therapeutic team were not associated with therapy outcome. Therapeutic alliance with the individual therapist and climate among fellow patients turned out to be moderate indicators of the therapeutic outcome. It is recommended to include these process parameters systematically into the process diagnostics of inpatient psychotherapy.

  8. The Next Great Generation?

    Science.gov (United States)

    Brownstein, Andrew

    2000-01-01

    Discusses ideas from a new book, "Millennials Rising: The Next Great Generation," (by Neil Howe and William Strauss) suggesting that youth culture is on the cusp of a radical shift with the generation beginning with this year's college freshmen who are typically team oriented, optimistic, and poised for greatness on a global scale. Includes a…

  9. A New Current Control Strategy of Maximizing The Generated Power From a Doubly Fed Induction Generator System

    DEFF Research Database (Denmark)

    Li, Hui; Chen, Zhe

    2006-01-01

    Switched reluctance generator (SR Generator) has various desirable features which include simple and solid structure, easiness of maintenance, small moment of rotor inertia and low cost. However, the SR generator has not been put into practical use widely because an optimum design of SR generator...... is consist of half number of switching devices for the AHBC. The operating characteristics of the SR generators were discussed based on FEM analysis and experiments....

  10. A Combination of Outcome and Process Feedback Enhances Performance in Simulations of Child Sexual Abuse Interviews Using Avatars

    Directory of Open Access Journals (Sweden)

    Francesco Pompedda

    2017-09-01

    Full Text Available Simulated interviews in alleged child sexual abuse (CSA cases with computer-generated avatars paired with feedback improve interview quality. In the current study, we aimed to understand better the effect of different types of feedback in this context. Feedback was divided into feedback regarding conclusions about what happened to the avatar (outcome feedback and feedback regarding the appropriateness of question-types used by the interviewer (process feedback. Forty-eight participants each interviewed four different avatars. Participants were divided into four groups (no feedback, outcome feedback, process feedback, and a combination of both feedback types. Compared to the control group, interview quality was generally improved in all the feedback groups on all outcome variables included. Combined feedback produced the strongest effect on increasing recommended questions and correct conclusions. For relevant and neutral details elicited by the interviewers, no statistically significant differences were found between feedback types. For wrong details, the combination of feedback produced the strongest effect, but this did not differ from the other two feedback groups. Nevertheless, process feedback produced a better result compared to outcome feedback. The present study replicated previous findings regarding the effect of feedback in improving interview quality, and provided new knowledge on feedback characteristics that maximize training effects. A combination of process and outcome feedback showed the strongest effect in enhancing training in simulated CSA interviews. Further research is, however, needed.

  11. Environmental implications of electricity generation in an integrated long-term planning framework

    International Nuclear Information System (INIS)

    Turner, Graham M.; West, James

    2012-01-01

    Long-term, integrated modelling of electricity generation capacity and its operational requirements is important for coherent energy policy because of the multi-decadal lifespan of such plant, and because related fuel requirements, water consumption, and greenhouse gas emissions impact other sectors. This paper describes a physical model of electricity generation designed for long-term simulations, including the reproduction of decades of historical data, and its application to key policy questions. The simulation uses a dynamic, physical input–output model for the basic material and energy industries, embedded in an economy-wide stocks and flows framework (SFF). The historical reproduction, illustrated for the state of Victoria, is based on integrating bottom-up technical data on physical processes as inputs, and validating output against top-down aggregate data. We show that while greenhouse gas emissions would decrease significantly with the aggressive introduction of cleaner generation technology, long-term reductions are difficult to maintain against ongoing growth in consumption. Additionally, our sensitivity analysis identifies the importance of rapid action due to the age structure of operating power stations. We also identify significant imposts of alternative power generation on land and water resources, though a business-as-usual scenario would impose greater losses of water resources. - Highlights: ► System-wide dynamic analysis is needed to avoid unintended adverse environmental outcomes. ► Dynamics of long-lived plant is important in transitions for reducing greenhouse gas emissions. ► Large gains in GHG emissions efficiency of generation portfolios fail to maintain low emissions.

  12. Methods and apparatus for cooling wind turbine generators

    Science.gov (United States)

    Salamah, Samir A [Niskayuna, NY; Gadre, Aniruddha Dattatraya [Rexford, NY; Garg, Jivtesh [Schenectady, NY; Bagepalli, Bharat Sampathkumaran [Niskayuna, NY; Jansen, Patrick Lee [Alplaus, NY; Carl, Jr., Ralph James

    2008-10-28

    A wind turbine generator includes a stator having a core and a plurality of stator windings circumferentially spaced about a generator longitudinal axis. A rotor is rotatable about the generator longitudinal axis, and the rotor includes a plurality of magnetic elements coupled to the rotor and cooperating with the stator windings. The magnetic elements are configured to generate a magnetic field and the stator windings are configured to interact with the magnetic field to generate a voltage in the stator windings. A heat pipe assembly thermally engaging one of the stator and the rotor to dissipate heat generated in the stator or rotor.

  13. Impact of ectopic pregnancy for reproductive prognosis in next generation

    DEFF Research Database (Denmark)

    Kårhus, Line Lund; Egerup, Pia; Skovlund, Charlotte Wessel

    2014-01-01

    The impact of an ectopic pregnancy in the next generation is unknown. Our aim was to compare reproductive outcomes in daughters of women with and without ectopic pregnancy. Designed as a historical prospective controlled cohort study with data collected in four Danish registries from 1977-2009, w...

  14. Reliability of computerized cephalometric outcome predictions of mandibular set-back surgery

    Directory of Open Access Journals (Sweden)

    Stefanović Neda

    2011-01-01

    Full Text Available Introduction. A successful treatment outcome in dentofacial deformity patients commonly requires combined orthodontic-surgical therapy. This enables us to overcome functional, aesthetic and psychological problems. Since most patients state aesthetics as the primary motive for seeking therapy, cephalometric predictions of treatment outcome have become the essential part of treatment planning, especially in combined orthodontic-surgical cases. Objective. The aim of this study was to evaluate the validity and reliability of computerized orthognathic surgery outcome predictions generated using the Nemotec Dental Studio NX 2005 software. Methods. The sample of the study consisted of 31 patients diagnosed with mandibular prognathism who were surgically treated at the Hospital for Maxillofacial Surgery in Belgrade. Investigation was done on lateral cephalograms made before and after surgical treatment. Cephalograms were digitized and analyzed using computer software. According to measurements made on superimposed pre- and postsurgical cephalograms, the patients were retreated within the software and the predictions were assessed by measuring seven angular and three linear parameters. Prediction measurements were then compared with the actual outcome. Results. Results showed statistically significant changes between posttreatment and predicted values for parameters referring to lower lip and mentolabial sulcus position. Conclusion. Computerized cephalometric predictions for hard-tissue structures in the sagittal and vertical planes, as well as the VTO parameters, generated using the Nemotec Dental Studio NX 2005 software are reliable, while lower lip and mentolabial sulcus position predictions are not reliable enough.

  15. Generators of Modern Wind Turbines

    DEFF Research Database (Denmark)

    Chen, Zhe

    2008-01-01

    In this paper, various types of wind generator configurations, including power electronic grid interfaces, drive trains, are described The performance in power systems is briefed. Then the optimization of generator system is presented. Some investigation results are presented and discussed....

  16. A third generation of performance contracting in danish central government?

    DEFF Research Database (Denmark)

    Kristiansen, Mads Bøge

    2017-01-01

    This paper compares the content of performance contracts in Danish central government over time in order to identify whether – and if so, how – it develops. The analysis is conducted as a two-step, mixed methods study. First, a quantitative study was carried out based on a study of all performance...... contracts in Danish central government in 2002, 2006, 2009, 2012 and 2014. For each year, all performance contracts have been coded according to the number and type of targets included in them. A range of qualitative interviews was then carried out, and Ministry of Finance recommendations were consulted...... of outcomes has increased, activity-oriented targets have decreased, and targets for internal management decreased in the mid-2000s before again increasing more recently. On this basis, performance contracting in Danish central government is argued to have entered a third generation....

  17. Uncertainties in model-based outcome predictions for treatment planning

    International Nuclear Information System (INIS)

    Deasy, Joseph O.; Chao, K.S. Clifford; Markman, Jerry

    2001-01-01

    Purpose: Model-based treatment-plan-specific outcome predictions (such as normal tissue complication probability [NTCP] or the relative reduction in salivary function) are typically presented without reference to underlying uncertainties. We provide a method to assess the reliability of treatment-plan-specific dose-volume outcome model predictions. Methods and Materials: A practical method is proposed for evaluating model prediction based on the original input data together with bootstrap-based estimates of parameter uncertainties. The general framework is applicable to continuous variable predictions (e.g., prediction of long-term salivary function) and dichotomous variable predictions (e.g., tumor control probability [TCP] or NTCP). Using bootstrap resampling, a histogram of the likelihood of alternative parameter values is generated. For a given patient and treatment plan we generate a histogram of alternative model results by computing the model predicted outcome for each parameter set in the bootstrap list. Residual uncertainty ('noise') is accounted for by adding a random component to the computed outcome values. The residual noise distribution is estimated from the original fit between model predictions and patient data. Results: The method is demonstrated using a continuous-endpoint model to predict long-term salivary function for head-and-neck cancer patients. Histograms represent the probabilities for the level of posttreatment salivary function based on the input clinical data, the salivary function model, and the three-dimensional dose distribution. For some patients there is significant uncertainty in the prediction of xerostomia, whereas for other patients the predictions are expected to be more reliable. In contrast, TCP and NTCP endpoints are dichotomous, and parameter uncertainties should be folded directly into the estimated probabilities, thereby improving the accuracy of the estimates. Using bootstrap parameter estimates, competing treatment

  18. Physically demanding work, fetal growth and the risk of adverse birth outcomes. The Generation R Study

    NARCIS (Netherlands)

    C.A. Snijder (Claudia); T. Brand (Teus); V.W.V. Jaddoe (Vincent); A. Hofman (Albert); J.P. Mackenbach (Johan); E.A.P. Steegers (Eric); A. Burdorf (Alex)

    2012-01-01

    textabstractObjectives: Work-related risk factors, such as long work hours, and physically demanding work have been suggested to adversely influence pregnancy outcome. The authors aimed to examine associations between various aspects of physically demanding work with fetal growth in different

  19. 10-Year Clinical Outcome After Randomization to Treatment by Sirolimus- or Paclitaxel-Eluting Coronary Stents

    DEFF Research Database (Denmark)

    Galløe, Anders M; Kelbæk, Henning; Thuesen, Leif

    2017-01-01

    of patients included in a large randomized trial for 10 years to enable detection of late changes in annual event rates that could necessitate medical attention. METHODS: A total of 2,098 unselected all-comer patients (50% with acute coronary syndrome) were randomly assigned to have a first-generation DES...... for both stent types, with no apparent late changes. Although there is no need for extraordinary medical attention for these patients, the absence of declines in annual event rates calls for continuous surveillance. (Danish Organization on Randomized Trials With Clinical Outcome II [SORT OUT II]; NCT...

  20. Steam generator tube rupture (SGTR) scenarios

    International Nuclear Information System (INIS)

    Auvinen, A.; Jokiniemi, J.K.; Laehde, A.; Routamo, T.; Lundstroem, P.; Tuomisto, H.; Dienstbier, J.; Guentay, S.; Suckow, D.; Dehbi, A.; Slootman, M.; Herranz, L.; Peyres, V.; Polo, J.

    2005-01-01

    The steam generator tube rupture (SGTR) scenarios project was carried out in the EU 5th framework programme in the field of nuclear safety during years 2000-2002. The first objective of the project was to generate a comprehensive database on fission product retention in a steam generator. The second objective was to verify and develop predictive models to support accident management interventions in steam generator tube rupture sequences, which either directly lead to severe accident conditions or are induced by other sequences leading to severe accidents. The models developed for fission product retention were to be included in severe accident codes. In addition, it was shown that existing models for turbulent deposition, which is the dominating deposition mechanism in dry conditions and at high flow rates, contain large uncertainties. The results of the project are applicable to various pressurised water reactors, including vertical steam generators (western PWR) and horizontal steam generators (VVER)

  1. Global health diplomacy in Iraq: international relations outcomes of multilateral tuberculosis programmes.

    Science.gov (United States)

    Kevany, Sebastian; Jaf, Payman; Workneh, Nibretie Gobezie; Abu Dalod, Mohammad; Tabena, Mohammed; Rashid, Sara; Al Hilfi, Thamer Kadum Yousif

    2014-01-01

    International development programmes, including global health interventions, have the capacity to make important implicit and explicit benefits to diplomatic and international relations outcomes. Conversely, in the absence of awareness of these implications, such programmes may generate associated threats. Due to heightened international tensions in conflict and post-conflict settings, greater attention to diplomatic outcomes may therefore be necessary. We examine related 'collateral' effects of Global Fund-supported tuberculosis programmes in Iraq. During site visits to Iraq conducted during 2012 and 2013 on behalf of the Global Fund to Fight AIDS, Tuberculosis and Malaria, on-site service delivery evaluations, unstructured interviews with clinical and operational staff, and programme documentary review of Global Fund-supported tuberculosis treatment and care programmes were conducted. During this process, a range of possible external or collateral international relations and diplomatic effects of global health programmes were assessed according to predetermined criteria. A range of positive diplomatic and international relations effects of Global Fund-supported programmes were observed in the Iraq setting. These included (1) geo-strategic accessibility and coverage; (2) provisions for programme sustainability and alignment; (3) contributions to nation-building and peace-keeping initiatives; (4) consistent observation of social, cultural and religious norms in intervention selection; and (5) selection of the most effective and cost-effective tuberculosis treatment and care interventions. Investments in global health programmes have valuable diplomatic, as well as health-related, outcomes, associated with their potential to prevent, mitigate or reverse international tension and hostility in conflict and post-conflict settings, provided that they adhere to appropriate criteria. The associated international presence in such regions may also contribute to peace

  2. The Popularity of Outcome Measures for Hip and Knee Arthroplasties.

    Science.gov (United States)

    Lovelock, Thomas M; Broughton, Nigel S; Williams, Cylie M

    2018-01-01

    The optimal methods of determining outcomes following hip and knee arthroplasty remain controversial. The objectives of this study were to determine the most frequently used outcome measures in randomized controlled trials (RCT) and study protocols registered with clinical trials registries (CTR) on hip and knee arthroplasty. A systematic search strategy was undertaken to identify the outcome measures used in RCT and CTR following joint arthroplasty. Databases searched included Embase, Ovid MEDLINE (including In-Process), Cochrane Central Register of Controlled Trials, CINAHL Plus, clinicaltrials.gov, ISRCTN registry, and ANZCTR. Differences in the use of outcome measures between RCT and CTR were assessed using logistic regression. There were 291 RCT and 113 CTR on hip arthroplasty and 452 RCT and 184 CTR on knee arthroplasty that met the inclusion criteria. The most popular outcome measures were the Harris Hip Score and the Knee Society Score. Multiple outcome measures were used in greater than 50% of the included studies. The Oxford Hip Score, Oxford Knee Score, EuroQol-5D, and Knee Injury and Osteoarthritis Outcome Score (all P < .001) were used in significantly more CTR than RCT. There is a clear preference for the use of the Harris Hip Score and Knee Society Score, contrary to existing international guidelines and reviews on the topic. Both measures require clinician input, which potentially influences their validity and increases their overall administration cost. Some patient-reported outcome measures, such as the Oxford Hip and Knee Scores, EuroQol-5D, and KOOS, appear to be increasing in popularity. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. GeneratorSE: A Sizing Tool for Variable-Speed Wind Turbine Generators

    Energy Technology Data Exchange (ETDEWEB)

    Sethuraman, Latha [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Dykes, Katherine L [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-22

    This report documents a set of analytical models employed by the optimization algorithms within the GeneratorSE framework. The initial values and boundary conditions employed for the generation of the various designs and initial estimates for basic design dimensions, masses, and efficiency for the four different models of generators are presented and compared with empirical data collected from previous studies and some existing commercial turbines. These models include designs applicable for variable-speed, high-torque application featuring direct-drive synchronous generators and low-torque application featuring induction generators. In all of the four models presented, the main focus of optimization is electromagnetic design with the exception of permanent-magnet and wire-wound synchronous generators, wherein the structural design is also optimized. Thermal design is accommodated in GeneratorSE as a secondary attribute by limiting the winding current densities to acceptable limits. A preliminary validation of electromagnetic design was carried out by comparing the optimized magnetic loading against those predicted by numerical simulation in FEMM4.2, a finite-element software for analyzing electromagnetic and thermal physics problems for electrical machines. For direct-drive synchronous generators, the analytical models for the structural design are validated by static structural analysis in ANSYS.

  4. Electric power monthly, September 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-17

    The purpose of this report is to provide energy decision makers with accurate and timely information that may be used in forming various perspectives on electric issues. The power plants considered include coal, petroleum, natural gas, hydroelectric, and nuclear power plants. Data are presented for power generation, fuel consumption, fuel receipts and cost, sales of electricity, and unusual occurrences at power plants. Data are compared at the national, Census division, and state levels. 4 figs., 52 tabs. (CK)

  5. Evaluating outcomes of patients lost to follow-up in a large comprehensive care treatment program in western Kenya

    Science.gov (United States)

    Rachlis, B; Ochieng, D; Geng, E; Rotich, E; Ochieng, V; Maritim, B; Ndege, S; Naanyu, V; Martin, J; Keter, A; Ayuo, P; Diero, L; Nyambura, M; Braitstein, P

    2014-01-01

    Background The Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients. Methods LTFU was defined as missing a scheduled visit by ≥ 3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status. Results Of 14,811 LTFU patients, 2,540 were randomly selected for tracing (2,179 adults, 1,071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died while 29% had disengaged from care for various reasons. The remaining patients had moved away (n=458, 25%) or were still receiving HIV care (n=443 total, 25%). Conclusions Our findings demonstrate the feasibility of a large scale sampling-based approach. A significant proportion of patients were found not to be LTFU and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences. PMID:25692336

  6. Procedure for generating steam and steam generator for operating said procedure

    International Nuclear Information System (INIS)

    Chlique, Bernard.

    1975-01-01

    This invention concerns the generation of steam by bringing the water to be vaporised into indirect thermal exchange relation with the heating steam which condenses when passing in series, along alternate routes, through bundles of tubes immersed in a vaporising chamber. A number of steam generators working on this principle already exist. The purpose of the invention is to modify the operating method of these steam generators by means of a special disposition making it possible to build a compact unit including an additional bundle of tubes heated by the condensates collected at the outlet of each bundle through which the heating steam passes [fr

  7. Power generation systems and methods

    Science.gov (United States)

    Jones, Jack A. (Inventor); Chao, Yi (Inventor)

    2011-01-01

    A power generation system includes a plurality of submerged mechanical devices. Each device includes a pump that can be powered, in operation, by mechanical energy to output a pressurized output liquid flow in a conduit. Main output conduits are connected with the device conduits to combine pressurized output flows output from the submerged mechanical devices into a lower number of pressurized flows. These flows are delivered to a location remote of the submerged mechanical devices for power generation.

  8. Pediatric pancreas transplantation, including total pancreatectomy with islet autotransplantation.

    Science.gov (United States)

    Bondoc, Alexander J; Abu-El-Haija, Maisam; Nathan, Jaimie D

    2017-08-01

    Unlike other solid-organ transplants, whole pancreas transplantation in children is relatively rare, and it occurs more frequently in the context of multivisceral or composite organ transplantation. Because children only infrequently suffer severe sequelae of type 1 diabetes mellitus, pancreas transplantation is rarely indicated in the pediatric population. More commonly, pediatric pancreas transplant occurs in the setting of incapacitating acute recurrent or chronic pancreatitis, specifically islet autotransplantation after total pancreatectomy. In this clinical scenario, total pancreatectomy removes the nidus of chronic pain and debilitation, while autologous islet transplantation aims to preserve endocrine function. The published experiences with pediatric total pancreatectomy with islet autotransplantation (TPIAT) in children has demonstrated excellent outcomes including liberation from chronic opioid use, as well as improved mental and physical quality of life with good glycemic control. Given the complexity of the operation, risk of postoperative complication, and long-term physiologic changes, appropriate patient selection and comprehensive multidisciplinary care teams are critical to ensuring optimal outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Physically demanding work, fetal growth and the risk of adverse birth outcomes. The Generation R Study

    NARCIS (Netherlands)

    Snijder, Claudia A.; Brand, Teus; Jaddoe, Vincent; Hofman, Albert; Mackenbach, Johan P.; Steegers, Eric A. P.; Burdorf, Alex

    2012-01-01

    Objectives Work-related risk factors, such as long work hours, and physically demanding work have been suggested to adversely influence pregnancy outcome. The authors aimed to examine associations between various aspects of physically demanding work with fetal growth in different trimesters during

  10. Self generation, small generation, and embedded generation issues

    International Nuclear Information System (INIS)

    2001-01-01

    The New Brunswick Market Design Committee for electric power restructuring has been directed to examine issues regarding cogeneration and small-scale, on-site generation and how they will fit within the framework of the bilateral contract market. The Committee will also have to deal with issues of generation embedded in a distribution system. The Committee has defined cogeneration as the simultaneous production of electricity and useful thermal energy. Self-generation has been defined as small-scale power generation by an end-user, while embedded generation has been defined as a generation facility that is located within a distribution utility but is not directly connected to the transmission system. The Committee has postponed its decision on whether embedded generation will be eligible to participate under the bilateral contract market for electricity. This report discusses general issues such as the physical support of generation, market support of generation, transition issues and policy issues. It also discusses generation support issues such as operating reserves, transmission tariff issues, and distribution tariffs. Market support issues such as transmission access for generation sales were also considered, along with market access for generation sales, and net metering for behind the meter generation. 7 refs., 1 tab

  11. Relationship between maternal hemoglobin and perinatal outcome

    International Nuclear Information System (INIS)

    Bakhtiar, U.J.; Khan, Y.; Nisar, R.

    2007-01-01

    To Study the Relationship between Maternal Hemoglobin and Perinatal outcome in a cohort of 860 pregnant women and to highlight the importance of antenatal care regarding maternal health and fetal outcome. All Singleton pregnancies delivering at Pakistan Railway Hospital Rawalpindi from January 2004 to December 2005 that fulfilled the required criteria were included. Out of the 860 patients, 402 were anemic (<11gm/dl) and 458 were non anemic. Perinatal outcome included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low apgr scores and intrauterine fetal deaths. Risk of preterm and Low birth weight among anemic women was 3.4 and 1.8 times more than non anaemic women. The neonates of anemic woman also had 1.7 times increased risk of having low apgr scores at 1 min. Among anemic women there was 2.2 times greater risk of intrauterine fetal death than the non-anemic women. Regular antenatal care from first trimester has a vital role in assessing and managing maternal anemia timely and it directly affects the perinatal outcome. The patients with anemia have also higher risk of having low birth weight, preterm births and intra uterine fetal death. (author)

  12. Next Generation Sequencing Methods for Diagnosis of Epilepsy Syndromes

    Directory of Open Access Journals (Sweden)

    Paul Dunn

    2018-02-01

    Full Text Available Epilepsy is a neurological disorder characterized by an increased predisposition for seizures. Although this definition suggests that it is a single disorder, epilepsy encompasses a group of disorders with diverse aetiologies and outcomes. A genetic basis for epilepsy syndromes has been postulated for several decades, with several mutations in specific genes identified that have increased our understanding of the genetic influence on epilepsies. With 70-80% of epilepsy cases identified to have a genetic cause, there are now hundreds of genes identified to be associated with epilepsy syndromes which can be analyzed using next generation sequencing (NGS techniques such as targeted gene panels, whole exome sequencing (WES and whole genome sequencing (WGS. For effective use of these methodologies, diagnostic laboratories and clinicians require information on the relevant workflows including analysis and sequencing depth to understand the specific clinical application and diagnostic capabilities of these gene sequencing techniques. As epilepsy is a complex disorder, the differences associated with each technique influence the ability to form a diagnosis along with an accurate detection of the genetic etiology of the disorder. In addition, for diagnostic testing, an important parameter is the cost-effectiveness and the specific diagnostic outcome of each technique. Here, we review these commonly used NGS techniques to determine their suitability for application to epilepsy genetic diagnostic testing.

  13. Ecologically Sound Procedural Generation of Natural Environments

    Directory of Open Access Journals (Sweden)

    Benny Onrust

    2017-01-01

    Full Text Available Current techniques for the creation and exploration of virtual worlds are largely unable to generate sound natural environments from ecological data and to provide interactive web-based visualizations of such detailed environments. We tackle this challenge and propose a novel framework that (i explores the advantages of landscape maps and ecological statistical data, translating them to an ecologically sound plant distribution, and (ii creates a visually convincing 3D representation of the natural environment suitable for its interactive visualization over the web. Our vegetation model improves techniques from procedural ecosystem generation and neutral landscape modeling. It is able to generate diverse ecological sound plant distributions directly from landscape maps with statistical ecological data. Our visualization model integrates existing level of detail and illumination techniques to achieve interactive frame rates and improve realism. We validated with ecology experts the outcome of our framework using two case studies and concluded that it provides convincing interactive visualizations of large natural environments.

  14. Unintended outcomes evaluation approach: A plausible way to evaluate unintended outcomes of social development programmes.

    Science.gov (United States)

    Jabeen, Sumera

    2018-06-01

    Social development programmes are deliberate attempts to bring about change and unintended outcomes can be considered as inherent to any such intervention. There is now a solid consensus among the international evaluation community regarding the need to consider unintended outcomes as a key aspect in any evaluative study. However, this concern often equates to nothing more than false piety. Exiting evaluation theory suffers from overlap of terminology, inadequate categorisation of unintended outcomes and lack of guidance on how to study them. To advance the knowledge of evaluation theory, methods and practice, the author has developed an evaluation approach to study unintended effects using a theory building, testing and refinement process. A comprehensive classification of unintended outcomes on the basis of knowability, value, distribution and temporality helped specify various type of unintended outcomes for programme evaluation. Corresponding to this classification, a three-step evaluation process was proposed including a) outlining programme intentions b) forecasting likely unintended effects c) mapping the anticipated and understanding unanticipated unintended outcomes. This unintended outcomes evaluation approach (UOEA) was then trialled by undertaking a multi-site and multi-method case study of a poverty alleviation programme in Pakistan and refinements were made to the approach.The case study revealed that this programme was producing a number of unintended effects, mostly negative, affecting those already disadvantaged such as the poorest, women and children. The trialling process demonstrated the effectiveness of the UOEA and suggests that this can serve as a useful guide for future evaluation practice. It also provides the discipline of evaluation with an empirically-based reference point for further theoretical developments in the study of unintended outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Condition Monitoring of the SSE Generation Fleet

    Science.gov (United States)

    Twiddle, J.; Muthuraman, S.; Connolly, N.

    2012-05-01

    SSE (previously known as Scottish and Southern Energy) operates a diverse portfolio of generation plant, including coal, gas and renewable plant with a total generation capacity of 11,375MW (Sept 2011). In recent years a group of specialists dedicated to providing condition monitoring services has been established at the Equipment Performance Centre (EPC) based at Knottingley, West Yorkshire. We aim to illustrate the role of the EPC and the methods used for monitoring the generation fleet with the objective of maintaining asset integrity, reducing risk of plant failure and unplanned outages and describe the challenges which have been overcome in establishing the EPC. This paper describes methods including vibration and process data analysis, model-based techniques and on-site testing used for monitoring of generation plant, including gas turbines, steam turbines, generators and steam raising plant. These condition monitoring processes utilise available data, adding value to the business, by bringing services in-house and capturing knowledge of plant operation for the benefit of the whole fleet.

  16. Piezoelectric Energy Generation from Vehicle Traffic with Technoeconomic Analysis

    Directory of Open Access Journals (Sweden)

    Hiba Najini

    2017-01-01

    Full Text Available This paper presents a technical simulation based system to support the concept of generating energy from road traffic using piezoelectric materials. The simulation based system design replicates a real life system implementation. It investigates practicality and feasibility using a real-time simulation platform known as MATLAB-Simulink. The system design structure was proposed considering factors involved with the field of material sciences for piezoelectric generator modeling and field of power electronics for additional components in producing a realist outcome. It also ensures ease of vehicle performance, as this system utilizes energy source derived as kinetic energy released from vehicles into electrical power output, that is, obtained by harnessing kinetic energy due to strain of vehicles over asphalt road surface. Due to the real-time simulation platform, the system simulation predicts the effective global carbon footprint. In addition to evaluating technical viability, a technoeconomical business analysis provides a strategic perspective. By using the simulation based power generation results, an estimation of implementation cost and payback time in real life (for United Arab Emirates was derived, hence validating and predicting real-time economic outcome. This is followed by a comparative study with other sources of renewable energy based on levelized energy cost factor that justifies the performance of the proposed system over other renewable energy sources, in support of providing an economical solution on reducing global carbon footprint.

  17. Predicting outcome of status epilepticus.

    Science.gov (United States)

    Leitinger, M; Kalss, G; Rohracher, A; Pilz, G; Novak, H; Höfler, J; Deak, I; Kuchukhidze, G; Dobesberger, J; Wakonig, A; Trinka, E

    2015-08-01

    Status epilepticus (SE) is a frequent neurological emergency complicated by high mortality and often poor functional outcome in survivors. The aim of this study was to review available clinical scores to predict outcome. Literature review. PubMed Search terms were "score", "outcome", and "status epilepticus" (April 9th 2015). Publications with abstracts available in English, no other language restrictions, or any restrictions concerning investigated patients were included. Two scores were identified: "Status Epilepticus Severity Score--STESS" and "Epidemiology based Mortality score in SE--EMSE". A comprehensive comparison of test parameters concerning performance, options, and limitations was performed. Epidemiology based Mortality score in SE allows detailed individualization of risk factors and is significantly superior to STESS in a retrospective explorative study. In particular, EMSE is very good at detection of good and bad outcome, whereas STESS detecting bad outcome is limited by a ceiling effect and uncertainty of correct cutoff value. Epidemiology based Mortality score in SE can be adapted to different regions in the world and to advances in medicine, as new data emerge. In addition, we designed a reporting standard for status epilepticus to enhance acquisition and communication of outcome relevant data. A data acquisition sheet used from patient admission in emergency room, from the EEG lab to intensive care unit, is provided for optimized data collection. Status Epilepticus Severity Score is easy to perform and predicts bad outcome, but has a low predictive value for good outcomes. Epidemiology based Mortality score in SE is superior to STESS in predicting good or bad outcome but needs marginally more time to perform. Epidemiology based Mortality score in SE may prove very useful for risk stratification in interventional studies and is recommended for individual outcome prediction. Prospective validation in different cohorts is needed for EMSE, whereas

  18. Comparison of the dielectric electroactive polymer generator energy harvesting cycles

    DEFF Research Database (Denmark)

    Dimopoulos, Emmanouil; Trintis, Ionut; Munk-Nielsen, Stig

    2013-01-01

    The Dielectric ElectroActive Polymer (DEAP) generator energy harvesting cycles have been in the spotlight of the scientific interest for the past few years. Indeed, several articles have demonstrated thorough and comprehensive comparisons of the generator fundamental energy harvesting cycles......, namely Constant Charge (CC), Constant Voltage (CV) and Constant E-field (CE), based on averaged theoretical models. Yet, it has not been possible until present to validate the outcome of those comparisons via respective experimental results. In this paper, all three primary energy harvesting cycles...... are experimentally compared, based upon the coupling of a DEAP generator with a bidirectional non-isolated power electronic converter, by means of energy gain, energy harvesting efficiency and energy conversion efficiency....

  19. Impacts on power generation

    International Nuclear Information System (INIS)

    Myers, J.; Sidebotton, P.

    1998-01-01

    The future impact of the arrival of natural gas in the Maritime provinces on electricity generation in the region was discussed. Currently, electrical generation sources in Nova Scotia include hydro generation (9 per cent), coal generation (80 per cent), heavy fuel oil generation (8 per cent), and light oil, wood chips and purchased power (3 per cent). It is expected that with the introduction of natural gas electric utilities will take advantage of new gas combustion turbines which have high efficiency rates. An overview of Westcoast Power's operations across Canada was also presented. The Company has three projects in the Maritimes - the Courtney Bay project in New Brunswick, the Bayside Power project, the Irving Paper project - in addition to the McMahon cogeneration plant in Taylor, B.C. figs

  20. Initial constructs for patient-centered outcome measures to evaluate brain-computer interfaces.

    Science.gov (United States)

    Andresen, Elena M; Fried-Oken, Melanie; Peters, Betts; Patrick, Donald L

    2016-10-01

    The authors describe preliminary work toward the creation of patient-centered outcome (PCO) measures to evaluate brain-computer interface (BCI) as an assistive technology (AT) for individuals with severe speech and physical impairments (SSPI). In Phase 1, 591 items from 15 existing measures were mapped to the International Classification of Functioning, Disability and Health (ICF). In Phase 2, qualitative interviews were conducted with eight people with SSPI and seven caregivers. Resulting text data were coded in an iterative analysis. Most items (79%) were mapped to the ICF environmental domain; over half (53%) were mapped to more than one domain. The ICF framework was well suited for mapping items related to body functions and structures, but less so for items in other areas, including personal factors. Two constructs emerged from qualitative data: quality of life (QOL) and AT. Component domains and themes were identified for each. Preliminary constructs, domains and themes were generated for future PCO measures relevant to BCI. Existing instruments are sufficient for initial items but do not adequately match the values of people with SSPI and their caregivers. Field methods for interviewing people with SSPI were successful, and support the inclusion of these individuals in PCO research. Implications for Rehabilitation Adapted interview methods allow people with severe speech and physical impairments to participate in patient-centered outcomes research. Patient-centered outcome measures are needed to evaluate the clinical implementation of brain-computer interface as an assistive technology.

  1. The use of bootstrap methods for analysing health-related quality of life outcomes (particularly the SF-36

    Directory of Open Access Journals (Sweden)

    Campbell Michael J

    2004-12-01

    Full Text Available Abstract Health-Related Quality of Life (HRQoL measures are becoming increasingly used in clinical trials as primary outcome measures. Investigators are now asking statisticians for advice on how to analyse studies that have used HRQoL outcomes. HRQoL outcomes, like the SF-36, are usually measured on an ordinal scale. However, most investigators assume that there exists an underlying continuous latent variable that measures HRQoL, and that the actual measured outcomes (the ordered categories, reflect contiguous intervals along this continuum. The ordinal scaling of HRQoL measures means they tend to generate data that have discrete, bounded and skewed distributions. Thus, standard methods of analysis such as the t-test and linear regression that assume Normality and constant variance may not be appropriate. For this reason, conventional statistical advice would suggest that non-parametric methods be used to analyse HRQoL data. The bootstrap is one such computer intensive non-parametric method for analysing data. We used the bootstrap for hypothesis testing and the estimation of standard errors and confidence intervals for parameters, in four datasets (which illustrate the different aspects of study design. We then compared and contrasted the bootstrap with standard methods of analysing HRQoL outcomes. The standard methods included t-tests, linear regression, summary measures and General Linear Models. Overall, in the datasets we studied, using the SF-36 outcome, bootstrap methods produce results similar to conventional statistical methods. This is likely because the t-test and linear regression are robust to the violations of assumptions that HRQoL data are likely to cause (i.e. non-Normality. While particular to our datasets, these findings are likely to generalise to other HRQoL outcomes, which have discrete, bounded and skewed distributions. Future research with other HRQoL outcome measures, interventions and populations, is required to

  2. Generating Community, Generating Justice? The production and circulation of value in community energy initiatives

    Directory of Open Access Journals (Sweden)

    Taylor Chase Dotson

    2016-12-01

    Full Text Available In this paper, we explore the potentialities and interconnections between existing and hypothetical community energy systems and the concept of generative justice. New York State’s more recent official energy plan, for instance, includes provisions for community-scale microgrids, and several European nations offer significant financial support to citizens interested in building micro and intermediate-scale renewable energy systems. Such efforts and technologies appear to promise some degree of generative justice, returning much of the value generated by distributed renewable energy back to the community producing it. However, most currently conceived and implemented community energy systems recirculate value in very narrow and limited ways. Building upon an analysis of New York energy policy and on-the-ground cases, we explore community energy’s potential. What kinds of value are being generated by community energy systems and for whom? How could such efforts be more generative of justice across a broad range of values, not just electrons and dollars? Through the attempt to broaden thinking not only about community energy systems but also the concept of generative justice, we connect technological and organizational configurations of community energy systems and the forms of value they have the potential to generate: including, the production of grassroots energy and organizational expertise, the capacity for local and personal autonomy in energy planning and decision-making, and the enhancement of an affective sense and embodied experience of community. Finally, we examine some of the barriers to realizing more generatively just community energy systems. 

  3. Cognitive outcome of surgery.

    Science.gov (United States)

    Gallagher, Anne; Jambaqué, Isabelle; Lassonde, Maryse

    2013-01-01

    Epilepsy surgery is now widely accepted as an effective therapeutic option for carefully selected children with medically refractory epilepsy. The surgical procedure may cause cognitive deficits or exacerbate existing impairments, but it may also improve cognitive abilities by the restoration of functions located in adjacent or contralateral areas that had been secondarily affected by the epilepsy or the underlying pathology. Compared to adults, better cognitive outcome has been reported in children, a finding probably due to the developing state of the brain, which possesses considerable structural and functional plasticity. More extensive and effective surgery such as hemispherectomy is more commonly used in the pediatric population, and this must also influence surgical outcome. However, studies related to cognitive outcome of epilepsy surgery in children are limited, and controversial results are often reported. In this chapter, we provide a current overview of the literature on cognitive outcomes in children who undergo different types of epilepsy surgery, including focal resections as well as corpus callosotomy and hemispherectomy. Early surgical intervention appears to be a rational option for the treatment of childhood epilepsy since many cognitive deficits are linked to the epileptic process and may disappear when seizures are controlled. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. PATIENT-REPORTED OUTCOMES (PROs): PUTTING THE PATIENT PERSPECTIVE IN PATIENT-CENTERED OUTCOMES RESEARCH

    Science.gov (United States)

    Snyder, Claire F.; Jensen, Roxanne E.; Segal, Jodi B.; Wu, Albert W.

    2013-01-01

    Patient-centered outcomes research (PCOR) aims to improve care quality and patient outcomes by providing information that patients, clinicians, and family members need regarding treatment alternatives, and emphasizing patient input to inform the research process. PCOR capitalizes on available data sources and generates new evidence to provide timely and relevant information and can be conducted using prospective data collection, disease registries, electronic medical records, aggregated results from prior research, and administrative claims. Given PCOR’s emphasis on the patient perspective, methods to incorporate patient-reported outcomes (PROs) are critical. PROs are defined by the U.S. Food & Drug Administration as “Any report coming directly from patients… about a health condition and its treatment.” However, PROs have not routinely been collected in a way that facilitates their use in PCOR. Electronic medical records, disease registries, and administrative data have only rarely collected, or been linked to, PROs. Recent technological developments facilitate the electronic collection of PROs and linkage of PRO data, offering new opportunities for putting the patient perspective in PCOR. This paper describes the importance of and methods for using PROs for PCOR. We (1) define PROs; (2) identify how PROs can be used in PCOR, and the critical role of electronic data methods for facilitating the use of PRO data in PCOR; (3) outline the challenges and key unanswered questions that need to be addressed for the routine use of PROs in PCOR; and (4) discuss policy and research interventions to accelerate the integration of PROs with clinical data. PMID:23774513

  5. Predicting unfavourable outcome in herpetic meningoencephalitis

    DEFF Research Database (Denmark)

    Erdem, Hakan; Cag, Yasemin; Karaahmetoglu, Gokhan

    BACKGROUND: Herpetic meningoencephalitis is the most frequent form of sporadic fatal encephalitis in the world and accounts for 10- 20% of all viral encephalitides. There were studies assessing the outcomes particularly by comparing the efficacies of antiviral drugs in the past. To the best of our...... knowledge, no datum exists in the literature on the mortality indicators of HME patients with definite microbiological diagnosis. Thus, our study makes use of the largest case series ever reported in the literature to provide data for the predictors of unfavorable outcome in HME cases. METHODS...... outcome in HME. Thus, it appears that both host and therapeutic parameters contribute to success in these cases. Table. Final model including independent predictors of unfavorable outcome 95% CIs OR [1] Low High p Age (years) 1.04 1.02 1.05 0.000 Glasgow coma scale 0.84 0.77 0.93 0.000 Elapsed time [2] >2...

  6. She Bought the Unicorn from the Pet Store: Six- to Seven-Year-Olds Are Strongly Inclined to Generate Natural Explanations

    Science.gov (United States)

    Nancekivell, Shaylene E.; Friedman, Ori

    2017-01-01

    In two experiments (N = 64), we told 6- to 7-year-olds about improbable or impossible outcomes (Experiment 1) and about impossible outcomes concerning ordinary or magical agents (Experiment 2). In both experiments, children claimed that the outcomes were impossible and could not happen, but nonetheless generated realistic and natural explanations…

  7. Persistent ovarian masses and pregnancy outcomes.

    Science.gov (United States)

    Goh, William A; Rincon, Monica; Bohrer, Justin; Tolosa, Jorge E; Sohaey, Roya; Riaño, Rene; Davis, James; Zalud, Ivica

    2013-07-01

    To determine if persistent ovarian masses in pregnancy are associated with increased adverse outcomes. This is a retrospective cohort of 126 pregnant women with a persistent ovarian mass measuring 5 cm or greater who delivered at two university hospitals between 2001 and 2009. Maternal outcomes included gestational age (GA) at diagnosis, delivery and surgery as well as miscarriage, preterm birth (PTB), ovarian torsion and hospital admission for pain. Neonatal outcomes included birth weight, respiratory distress syndrome (RDS), intra-ventricular hemorrhage (IVH), death and sepsis. A total of 1225 ovarian masses were identified (4.9%) in 24,868 patients. A persistent ovarian mass was found in 0.7%. Average GA at diagnosis was 17.8 weeks. Miscarriage rate was 3.3%. Average GA at delivery was 37.9 weeks. Of the patients, 8.5% had ovarian torsion, 10.3% had admission for pain and 9.3% had PTBs. The mean cesarean delivery rate was 46.3%. The average neonatal weight was 3273 g. There was one neonatal death in this cohort. The rate of RDS was 2.8%, IVH 0.9% and neonatal sepsis 1.9%. The most common surgical pathologic diagnosis was dermoids (37.6%). No overt malignancies were seen. A persistent ovarian mass in pregnancy does not confer an increased risk of adverse pregnancy outcomes.

  8. Reporting bias inflates the reputation of medical treatments: A comparison of outcomes in clinical trials and online product reviews.

    Science.gov (United States)

    de Barra, Mícheál

    2017-03-01

    People often hold unduly positive expectations about the outcomes of medicines and other healthcare products. Here the following explanation is tested: people who have a positive outcome tend to tell more people about their disease/treatment than people with poor or average outcomes. Akin to the file drawer problem in science, this systematically and positively distorts the information available to others. If people with good treatment outcomes are more inclined to tell others, then they should also be more inclined to write online medical product reviews. Therefore, average treatment outcomes in these reviews should be more positive than those found in randomised controlled trials (RCTs). Data on duration of treatment and outcome (i.e., weight/cholesterol change) were extracted from user-generated health product reviews on Amazon.com and compared to RCT data for the same treatments using ANOVA. The sample included 1675 reviews of cholesterol reduction (Benecol, CholestOff) and weight loss (Orlistat) treatments and the primary outcome was cholesterol change (Bencol and CholestOff) or weight change (Orlistat). In three independent tests, average outcomes reported in the reviews were substantially more positive than the outcomes reported in the medical literature (η 2  = 0.01 to 0.06; p = 0.04 to 0.001). For example, average cholesterol change following use of Benecol is -14 mg/dl in RCTs and -45 mg/dl in online reviews. People with good treatment outcomes are more inclined to share information about their treatment, which distorts the information available to others. People who rely on word of mouth reputation, electronic or real life, are likely to develop unduly positive expectations. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  9. Chaos-based Pseudo-random Number Generation

    KAUST Repository

    Barakat, Mohamed L.

    2014-04-10

    Various methods and systems related to chaos-based pseudo-random number generation are presented. In one example, among others, a system includes a pseudo-random number generator (PRNG) to generate a series of digital outputs and a nonlinear post processing circuit to perform an exclusive OR (XOR) operation on a first portion of a current digital output of the PRNG and a permutated version of a corresponding first portion of a previous post processed output to generate a corresponding first portion of a current post processed output. In another example, a method includes receiving at least a first portion of a current output from a PRNG and performing an XOR operation on the first portion of the current PRNG output with a permutated version of a corresponding first portion of a previous post processed output to generate a corresponding first portion of a current post processed output.

  10. Chaos-based Pseudo-random Number Generation

    KAUST Repository

    Barakat, Mohamed L.; Mansingka, Abhinav S.; Radwan, Ahmed Gomaa Ahmed; Salama, Khaled N.

    2014-01-01

    Various methods and systems related to chaos-based pseudo-random number generation are presented. In one example, among others, a system includes a pseudo-random number generator (PRNG) to generate a series of digital outputs and a nonlinear post processing circuit to perform an exclusive OR (XOR) operation on a first portion of a current digital output of the PRNG and a permutated version of a corresponding first portion of a previous post processed output to generate a corresponding first portion of a current post processed output. In another example, a method includes receiving at least a first portion of a current output from a PRNG and performing an XOR operation on the first portion of the current PRNG output with a permutated version of a corresponding first portion of a previous post processed output to generate a corresponding first portion of a current post processed output.

  11. Early Adolescent Affect Predicts Later Life Outcomes.

    Science.gov (United States)

    Kansky, Jessica; Allen, Joseph P; Diener, Ed

    2016-07-01

    Subjective well-being as a predictor for later behavior and health has highlighted its relationship to health, work performance, and social relationships. However, the majority of such studies neglect the developmental nature of well-being in contributing to important changes across the transition to adulthood. To examine the potential role of subjective well-being as a long-term predictor of critical life outcomes, we examined indicators of positive and negative affect at age 14 as predictors of relationship, adjustment, self-worth, and career outcomes a decade later at ages 23 to 25, controlling for family income and gender. We utilised multi-informant methods including reports from the target participant, close friends, and romantic partners in a demographically diverse community sample of 184 participants. Early adolescent positive affect predicted fewer relationship problems (less self-reported and partner-reported conflict, and greater friendship attachment as rated by close peers) and healthy adjustment to adulthood (lower levels of depression, anxiety, and loneliness). It also predicted positive work functioning (higher levels of career satisfaction and job competence) and increased self-worth. Negative affect did not significantly predict any of these important life outcomes. In addition to predicting desirable mean levels of later outcomes, early positive affect predicted beneficial changes across time in many outcomes. The findings extend early research on the beneficial outcomes of subjective well-being by having an earlier assessment of well-being, including informant reports in measuring a large variety of outcome variables, and by extending the findings to a lower socioeconomic group of a diverse and younger sample. The results highlight the importance of considering positive affect as an important component of subjective well-being distinct from negative affect. © 2016 The International Association of Applied Psychology.

  12. Widening the Aim of Health Promotion to Include the Most Disadvantaged: Vulnerable Adolescents and the Social Determinants of Health

    Science.gov (United States)

    Mohajer, Nicole; Earnest, Jaya

    2010-01-01

    Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health…

  13. Cluster generator

    Science.gov (United States)

    Donchev, Todor I [Urbana, IL; Petrov, Ivan G [Champaign, IL

    2011-05-31

    Described herein is an apparatus and a method for producing atom clusters based on a gas discharge within a hollow cathode. The hollow cathode includes one or more walls. The one or more walls define a sputtering chamber within the hollow cathode and include a material to be sputtered. A hollow anode is positioned at an end of the sputtering chamber, and atom clusters are formed when a gas discharge is generated between the hollow anode and the hollow cathode.

  14. Staffing Levels and Inpatient Outcomes at Military Health Care Facilities: A Resource-Based View

    National Research Council Canada - National Science Library

    Yap, Glenn

    2004-01-01

    Using a Resource-Based Theory/View of the firm, this study examined if increased inpatient staffing levels at military hospitals can generate a competitive advantage based on better patient quality outcomes...

  15. Aboriginal Children and Their Caregivers Living with Low Income: Outcomes from a Two-Generation Preschool Program

    OpenAIRE

    Benzies, Karen; Tough, Suzanne; Edwards, Nancy; Mychasiuk, Richelle; Donnelly, Carlene

    2010-01-01

    The development of preschool children of Aboriginal heritage is jeopardized by the inter-generational transmission of risk that has created, and continues to create, social disadvantage. Early intervention programs are intended to mitigate the impact of social disadvantage. Yet, evidence of the effectiveness of these programs for children of Aboriginal heritage is limited. The purpose of this study was to examine the effects of a two-generation, multi-cultural preschool program on 45 children...

  16. Modeling the economic outcomes of immuno-oncology drugs: alternative model frameworks to capture clinical outcomes

    Directory of Open Access Journals (Sweden)

    Gibson EJ

    2018-03-01

    Full Text Available EJ Gibson,1 N Begum,1 I Koblbauer,1 G Dranitsaris,2 D Liew,3 P McEwan,4 AA Tahami Monfared,5,6 Y Yuan,7 A Juarez-Garcia,7 D Tyas,8 M Lees9 1Wickenstones Ltd, Didcot, UK; 2Augmentium Pharma Consulting Inc, Toronto, ON, Canada; 3Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, VIC, Australia; 4Health Economics and Outcomes Research Ltd, Cardiff, UK; 5Bristol-Myers Squibb Canada, Saint-Laurent, QC Canada; 6Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; 7Bristol-Myers Squibb, Princeton, NJ, USA; 8Bristol-Myers Squibb, Uxbridge, UK; 9Bristol-Myers Squibb, Rueil-Malmaison, France Background: Economic models in oncology are commonly based on the three-state partitioned survival model (PSM distinguishing between progression-free and progressive states. However, the heterogeneity of responses observed in immuno-oncology (I-O suggests that new approaches may be appropriate to reflect disease dynamics meaningfully. Materials and methods: This study explored the impact of incorporating immune-specific health states into economic models of I-O therapy. Two variants of the PSM and a Markov model were populated with data from one clinical trial in metastatic melanoma patients. Short-term modeled outcomes were benchmarked to the clinical trial data and a lifetime model horizon provided estimates of life years and quality adjusted life years (QALYs. Results: The PSM-based models produced short-term outcomes closely matching the trial outcomes. Adding health states generated increased QALYs while providing a more granular representation of outcomes for decision making. The Markov model gave the greatest level of detail on outcomes but gave short-term results which diverged from those of the trial (overstating year 1 progression-free survival by around 60%. Conclusion: Increased sophistication in the representation of disease dynamics in economic models

  17. Random Number Generation in HIV Disease: Associations with Neuropsychological Functions and Activities of Daily Living.

    Science.gov (United States)

    Sheppard, David P; Woods, Steven Paul; Doyle, Katie L; Verduzco, Marizela

    2017-02-01

    HIV is associated with frontostriatal dysregulation and executive dysfunction. This study evaluated whether HIV-infected individuals evidence deficits in random number generation (RNG), which is a strategic task requiring paced, rule-guided production of digits. In total, 74 HIV+ adults and 54 seronegative comparison participants completed a comprehensive research neuropsychological battery. Participants produced a random digit sequence by avoiding any order and using numbers 1 through 10 for 100 s at a pace of 1 digit/s. Outcomes included intrusions, repetitions, seriation (1-2-3-4), and cycling (median length of gaps between repeating digits). HIV disease was associated with higher levels of seriation and cycling (ps  .10). Among HIV+ individuals, higher seriation was associated with neuropsychological performance including poorer auditory attention, verbal learning, and delayed memory, whereas higher cycling scores were associated with poorer delayed memory and verbal fluency (ps random sequences, which showed medium associations with higher order verbal abilities and may contribute to greater declines in everyday functioning outcomes. Future studies might examine RNG's role in health behaviors such as medical decision-making or medication adherence. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Long-term outcome of craniopharyngioma in children. A review

    International Nuclear Information System (INIS)

    Tamiya, Takashi; Okada, Masaki; Miyake, Keisuke; Kawai, Nobuyuki

    2011-01-01

    The treatment for pediatric craniopharyngioma remains challenging and controversial. Although this tumor is histologically benign, the treatments include radical surgery, conservative surgery, radiotherapy, intracystic chemotherapy and multimodality approaches. In addition, the long-term functional outcomes including visual function, endocrine function, cognitive function, hypothalamic function, and quality of life are complex and major problems among survivors. In this paper, we reviewed the recent treatments for pediatric craniopharyngioma and the long-term outcomes after treatment in literatures. (author)

  19. Occupational exposures and health outcomes among Latina hotel cleaners.

    Science.gov (United States)

    Hsieh, Yu-Chin Jerrie; Apostolopoulos, Yorghos; Hatzudis, Kiki; Sönmez, Sevil

    2014-01-01

    The poor working conditions of Latina hotel cleaners render them particularly vulnerable to elevated occupational hazards that lead to adverse health outcomes. This article presents a comprehensive review of occupational risks (including physical, chemical, biological, and psychosocial risk factors) and health outcomes (including musculoskeletal disorders, respiratory diseases, dermatological diseases and allergies, and psychological disorders) for Latina hotel cleaners, within their unique sociocultural contexts. Preventive interventions for improving Latina hotel cleaners' work and health conditions are recommended.

  20. Assessing the impact of wind generation on wholesale prices and generator dispatch in the Australian National Electricity Market

    International Nuclear Information System (INIS)

    Forrest, Sam; MacGill, Iain

    2013-01-01

    Growing climate change and energy security concerns are driving major wind energy deployment in electricity industries around the world. Despite its many advantages, growing penetrations of this highly variable and somewhat unpredictable energy source pose new challenges for electricity industry operation. One issue receiving growing attention is the so-called ‘merit order effect’ of wind generation in wholesale electricity markets. Wind has very low operating costs and therefore tends to displace higher cost conventional generation from market dispatch, reducing both wholesale prices and conventional plant outputs. This paper extends the current literature on this effect through an empirical study employing a range of econometric techniques to quantify the impacts of growing wind penetrations in the Australian National Electricity Market (NEM). The results suggest that wind is having a marked impact on spot market prices and, while wind is primarily offsetting higher operating cost gas generation, it is now also significantly reducing dispatch of emissions intensive brown coal generation. Great care needs to be taken in extrapolating these results to longer-term implications, however, the study does propose a methodology for assessing this effect, highlights the impacts that wind is already having on NEM outcomes and suggests promising directions for future research. - Highlights: ► Proposes methodologies to estimate short run impact of wind on electricity markets. ► Quantifies the merit order effect of wind generation on wholesale spot price. ► Wind is found to be significantly effecting gas fired generation. ► Evidence is found for wind having a notable impact on baseload coal generation. ► Discusses the implications for development of wind generation in Australia

  1. Realization of a Quantum Random Generator Certified with the Kochen-Specker Theorem

    Science.gov (United States)

    Kulikov, Anatoly; Jerger, Markus; Potočnik, Anton; Wallraff, Andreas; Fedorov, Arkady

    2017-12-01

    Random numbers are required for a variety of applications from secure communications to Monte Carlo simulation. Yet randomness is an asymptotic property, and no output string generated by a physical device can be strictly proven to be random. We report an experimental realization of a quantum random number generator (QRNG) with randomness certified by quantum contextuality and the Kochen-Specker theorem. The certification is not performed in a device-independent way but through a rigorous theoretical proof of each outcome being value indefinite even in the presence of experimental imperfections. The analysis of the generated data confirms the incomputable nature of our QRNG.

  2. The Stereotype-Matching Effect: Greater Influence on Functioning When Age Stereotypes Correspond to Outcomes

    Science.gov (United States)

    Levy, Becca R.; Leifheit-Limson, Erica

    2009-01-01

    Older individuals assimilate, and are targeted by, contradictory positive and negative age stereotypes. It was unknown whether the influence of stereotype valence is stronger when the stereotype content corresponds to the outcome domain. We randomly assigned older individuals to either positive-cognitive, negative-cognitive, positive-physical, or negative-physical subliminal-age-stereotype groups and assessed cognitive and physical outcomes. As predicted, when the age stereotypes corresponded to the outcome domains, their valence had a significantly greater impact on cognitive and physical performance. This suggests that if a match occurs, it is more likely to generate expectations that become self-fulfilling prophecies. PMID:19290757

  3. Response to Therapy and Outcomes in Oropharyngeal Cancer Are Associated With Biomarkers Including Human Papillomavirus, Epidermal Growth Factor Receptor, Gender, and Smoking

    International Nuclear Information System (INIS)

    Kumar, Bhavna; Cordell, Kitrina G.; Lee, Julia S.; Prince, Mark E.; Tran, Huong H.; Wolf, Gregory T.; Urba, Susan G.; Worden, Francis P.; Chepeha, Douglas B.; Teknos, Theodoros N.; Eisbruch, Avraham; Tsien, Christina I.; Taylor, Jeremy; D'Silva, Nisha J.; Yang, Kun; Kurnit, David M.; Bradford, Carol R.

    2007-01-01

    Induction chemotherapy and concurrent chemoradiation for responders or immediate surgery for non-responders is an effective treatment strategy head and neck squamous cell carcinoma (HNSCC) of the larynx and oropharynx. Biomarkers that predict outcome would be valuable in selecting patients for therapy. In this study, the presence and titer of high risk human papilloma virus (HPV) and expression of epidermal growth factor receptor (EGFR) in pre-treatment biopsies, as well as smoking and gender were examined in oropharynx cancer patients enrolled in an organ sparing trial. HPV16 copy number was positively associated with response to therapy and with overall and disease specific survival, whereas EGFR expression, current or former smoking behavior, and female gender (in this cohort) were associated with poor response and poor survival in multivariate analysis. Smoking cessation and strategies to target EGFR may be useful adjuncts for therapy to improve outcome in the cases with the poorest biomarker profile

  4. Experimental nonlocality-based randomness generation with nonprojective measurements

    Science.gov (United States)

    Gómez, S.; Mattar, A.; Gómez, E. S.; Cavalcanti, D.; Farías, O. Jiménez; Acín, A.; Lima, G.

    2018-04-01

    We report on an optical setup generating more than one bit of randomness from one entangled bit (i.e., a maximally entangled state of two qubits). The amount of randomness is certified through the observation of Bell nonlocal correlations. To attain this result we implemented a high-purity entanglement source and a nonprojective three-outcome measurement. Our implementation achieves a gain of 27% of randomness as compared with the standard methods using projective measurements. Additionally, we estimate the amount of randomness certified in a one-sided device-independent scenario, through the observation of Einstein-Podolsky-Rosen steering. Our results prove that nonprojective quantum measurements allow extending the limits for nonlocality-based certified randomness generation using current technology.

  5. Shut-down margin study for the next generation VVER-1000 reactor including 13 x 13 hexagonal annular assemblies

    International Nuclear Information System (INIS)

    Faghihi, Farshad; Mirvakili, S. Mohammad

    2011-01-01

    Highlights: → Shut-Down Margin (SDM) for the next generation annular fuel core of typical VVER-1000, 13 x 13 assemblies are calculated. → The MCNP-5 code is run for many cases with different core burn up at various core temperatures. → There is a substantial drop in SDM in the case of annular fuel for the same power level. → SDM for our proposed VVER-1000 annular pins is calculated for specific average fuel burn up values at the BOC, MOC, and EOC. - Abstract: Shut-Down Margin (SDM) for the next generation annular fuel core of typical VVER-1000, 13 x 13 assemblies are calculated as the main aim of the present research. We have applied the MCNP-5 code for many cases with different values of core burn up at various core temperatures, and therefore their corresponding coolant densities and boric acid concentrations. There is a substantial drop in SDM in the case of annular fuel for the same power level. Specifically, SDM for our proposed VVER-1000 annular pins is calculated when the average fuel burn up values at the BOC, MOC, and EOC are 0.531, 11.5, and 43 MW-days/kg-U, respectively.

  6. Impact of a pain protocol including hypnosis in major burns.

    Science.gov (United States)

    Berger, Mette M; Davadant, Maryse; Marin, Christian; Wasserfallen, Jean-Blaise; Pinget, Christophe; Maravic, Philippe; Koch, Nathalie; Raffoul, Wassim; Chiolero, René L

    2010-08-01

    Pain is a major issue after burns even when large doses of opioids are prescribed. The study focused on the impact of a pain protocol using hypnosis on pain intensity, anxiety, clinical course, and costs. All patients admitted to the ICU, aged >18 years, with an ICU stay >24h, accepting to try hypnosis, and treated according to standardized pain protocol were included. Pain was scaled on the Visual Analog Scale (VAS) (mean of daily multiple recordings), and basal and procedural opioid doses were recorded. Clinical outcome and economical data were retrieved from hospital charts and information system, respectively. Treated patients were matched with controls for sex, age, and the burned surface area. Forty patients were admitted from 2006 to 2007: 17 met exclusion criteria, leaving 23 patients, who were matched with 23 historical controls. Altogether patients were 36+/-14 years old and burned 27+/-15%BSA. The first hypnosis session was performed after a median of 9 days. The protocol resulted in the early delivery of higher opioid doses/24h (ppatient. A pain protocol including hypnosis reduced pain intensity, improved opioid efficiency, reduced anxiety, improved wound outcome while reducing costs. The protocol guided use of opioids improved patient care without side effects, while hypnosis had significant psychological benefits.

  7. Universal Preschool Programs and Long-Term Child Outcomes

    DEFF Research Database (Denmark)

    Dietrichson, Jens; Kristiansen, Ida Lykke; Viinholt Nielsen, Bjørn Christian

    2018-01-01

    This systematic review included 25 studies using natural experiments to estimate the effects of universal preschool programs for children aged 0-6 years on child outcomes measured from third grade to adulthood. Studies comparing preschool with parental, family, or other informal modes of care...... alternative types of universal preschool programs in terms of long-term outcomes....

  8. Radioactive material generator

    International Nuclear Information System (INIS)

    Czaplinski, T.V.; Bolter, B.J.; Heyer, R.E.; Bruno, G.A.

    1975-01-01

    A radioactive material generator includes radioactive material in a column, which column is connected to inlet and outlet conduits, the generator being embedded in a lead casing. The inlet and outlet conduits extend through the casing and are topped by pierceable closure caps. A fitting, containing means to connect an eluent supply and an eluate container, is adapted to pierce the closure caps. The lead casing and the fitting are compatibly contoured such that they will fit only if properly aligned with respect to each other

  9. Fetomaternal outcome in triplet pregnancy

    International Nuclear Information System (INIS)

    Mazhar, S.B.; Furukh, T; Rahim, F.

    2008-01-01

    To determine maternal outcome as antenatal and postnatal complications and neonatal outcome as birth weight, morbidity and mortality in triplet gestation. All the patients with triplet pregnancy beyond 28 weeks gestation, who delivered at the study place during above period were included in the study. The primary outcome measures were frequency of maternal complications and neonatal birth, weight and morbidity. Secondary outcome measures included the frequency of assisted conception in the studied cohart. Eighteen women had triplet pregnancy beyond 28 weeks. Nine were booked, 6 non-booked and 3 of them were referred. Mean duration of gestation was 237.8 days (33.8 weeks). The antenatal complications were preterm delivery in 50%, hypertension in 50%, anemia in 44.4% and obstetric cholestasis in 5.6%. Eight patients (44.4%) suffered postpartum hemorrhage. One patient had peripartum hysterectomy and later expired in intensive care unit after three weeks. Maternal mortality ratio was 5.6%. Fifty five percent women had induction of ovulation with Clomiphene, while none had In Vitro Fertilization (IVF) or Intracytoplasmic Insemination (ICSI) or received gonadotrophins. Fifteen sets of triplets were delivered abdominally. Mean birth weights of 1st, 2nd and 3rd triplet were 1651, 1640 and 1443 grams respectively. Five sets of triplets (27.8%) had more than 25% discordance for birth weight. The mean Apgar scores of the babies at 1 and 10 minutes after birth were 6.0 and 8.0, 5.6 and 7.5; and 5.2 and 7.0 respectively. Of the 54 infants, 18 required Neonatal Intensive Care Unit (NICU) admission and 14 were admitted in nursery. Two died shortly after birth. Total perinatal mortalities were 13 including 4 cases of intra-uterine demise. Three babies suffered from jaundice, 7 had sepsis and 8 had respiratory distress syndrome. Triplet gestation had a high rate of fetomaternal complications. Majority had history of assisted conception. (author)

  10. [Outcomes after planned home births].

    Science.gov (United States)

    Blix, Ellen; Øian, Pål; Kumle, Merethe

    2008-11-06

    About 150 planned home births take place in Norway annually. Professionals have different opinions on whether such births are safe or not. The aim of the present study was to perform a systematic literature review on maternal and neonatal outcomes after planned home births. A review was performed of literature retrieved from searches in MEDLINE, PubMed, Embase, Cinahl and The Cochrane Library and relevant references found in the articles. The searches were limited to studies published in 1985 and later. 10 studies with data from 30 204 women who had planned and were selected to home birth at the onset of labour were included. Three of the studies had control groups including women with planned hospital births. All included studies were assessed to be of medium quality. Between 9.9 and 23.1 % of women and infants were transferred to hospital during labour or after birth. There were few caesarean sections, other interventions or complications in the studies assessed; the total perinatal mortality rate was 2.9/1000 and the intrapartum mortality rate 0.8/1000. There is no sound basis for discouraging low-risk women from planning a home birth. Results from the included studies do not directly apply to Norwegian conditions. Outcomes and transfers after planned home births should be systematically registered.

  11. Clinical Outcomes Used in Clinical Pharmacy Intervention Studies in Secondary Care

    Directory of Open Access Journals (Sweden)

    Lene Juel Kjeldsen

    2017-05-01

    Full Text Available The objective was to investigate type, frequency and result of clinical outcomes used in studies to assess the effect of clinical pharmacy interventions in inpatient care. The literature search using Pubmed.gov was performed for the period up to 2013 using the search phrases: “Intervention(s” and “pharmacist(s” and “controlled” and “outcome(s” or “effect(s”. Primary research studies in English of controlled, clinical pharmacy intervention studies, including outcome evaluation, were selected. Titles, abstracts and full-text papers were assessed individually by two reviewers, and inclusion was determined by consensus. In total, 37 publications were included in the review. The publications presented similar intervention elements but differed in study design. A large variety of outcome measures (135 had been used to evaluate the effect of the interventions; most frequently clinical measures/assessments by physician and health care service use. No apparent pattern was established among primary outcome measures with significant effect in favour of the intervention, but positive effect was most frequently related to studies that included power calculations and sufficient inclusion of patients (73% vs. 25%. This review emphasizes the importance of considering the relevance of outcomes selected to assess clinical pharmacy interventions and the importance of conducting a proper power calculation.

  12. Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients.

    Directory of Open Access Journals (Sweden)

    Shama D Ahuja

    Full Text Available Treatment of multidrug resistant tuberculosis (MDR-TB is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0], ofloxacin (aOR: 2.5 [1.6-3.9], ethionamide or prothionamide (aOR: 1.7 [1.3-2.3], use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9], and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]. Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3], ofloxacin (aOR: 2.3 [1.3-3.8], ethionamide or prothionamide (aOR: 1.7 [1.4-2.1], use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9], and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0].In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary.

  13. Spanish generation market: structure, design and results; El Mercado de Generacion Electrica en Espana: Estructura, Funcionamiento y Resultados

    Energy Technology Data Exchange (ETDEWEB)

    Agosti, L.; Padilla, A. J.; Requejo, A.

    2007-07-01

    This paper provides an overview of the structure, design and outcome of the Spanish generation market from 1998, when the market was liberalised, to date. More precisely, this paper reviews the history of the liberalisation process; describes the structure of the generation market and its evolution over time; analyses the existence of market power; and evaluates the outcome of the liberalisation process from the viewpoint of its impact on al locative efficiency, productive efficiency and dynamic efficiency. The paper concludes with a brief summary of recent regulatory reforms. (Author)

  14. Stochastic model of wind-fuel cell for a semi-dispatchable power generation

    DEFF Research Database (Denmark)

    Alvarez-Mendoza, Fernanda; Bacher, Peder; Madsen, Henrik

    2017-01-01

    electrolyte membrane fuel cell, which are embedded in one complete system with the wind power. This study uses historic wind speed data from Mexico; the forecasts are obtained using the recursive least square algorithm with a forgetting factor. The proposed approach provides probabilistic information......Hybrid systems are implemented to improve the efficiency of individual generation technologies by complementing each other. Intermittence is a challenge to overcome especially for renewable energy sources for electric generation, as in the case of wind power. This paper proposes a hybrid system...... for short-term wind power generation and electric generation as the outcome of the hybrid system. A method for a semi-dispatchable electric generation based on time series analysis is presented, and the implementation of wind power and polymer electrolyte membrane fuel cell models controlled by a model...

  15. Health Outcomes Survey - Limited Data Set

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Health Outcomes Survey (HOS) limited data sets (LDS) are comprised of the entire national sample for a given 2-year cohort (including both respondents...

  16. Fort Calhoun Station, Unit 1. Annual operation report: January-December 1977 (including environmental report)

    International Nuclear Information System (INIS)

    1978-02-01

    Net electrical energy generated in 1977 was 2,922,683.7 MWH with the generator on line 6,959.8 hours. Information is presented concerning operations, power generation, shutdowns, maintenance, changes, tests, experiments, occupational personnel radiation exposures, and primary coolant chemistry. Data on radioactive effluent releases, meteorology, environmental monitoring, and potential radiation doses to individuals for July 7, 1977 to December 31, 1977 are also included

  17. A study of the public opinion concerning nuclear power generation in the United States

    International Nuclear Information System (INIS)

    Oiso, Shinichi

    2008-01-01

    In this study, I surveyed the outcome of opinion poll about people's attitude toward nuclear power and analysed their awareness of nuclear power generation in the United States. As a result, it was found that percentage of the people who have positive attitude toward nuclear power has been over 60% since 1998. This result corresponds to the fact that people's preference is tending more toward nuclear power generation which is called the nuclear power Renaissance in the United States. Furthermore, analysis of the outcome of the opinion poll in power stations site region was also conducted and it was found that attitude of the people in the site region was more positive than that of average level in the United States. (author)

  18. Internet interventions for chronic pain including headache: A systematic review

    Directory of Open Access Journals (Sweden)

    Monica Buhrman

    2016-05-01

    Full Text Available Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n = 12 were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g = −0.39, for pain intensity Hedge's g = −0.33, for catastrophizing Hedge's g = −0.49 and for mood variables (depression Hedge's g = −0.26.

  19. Magnetohydrodynamic generators in power generation (a bibliography with abstracts). Report for 1964--Jun 1976

    International Nuclear Information System (INIS)

    Grooms, D.W.

    1976-06-01

    The results of Government-sponsored research on the use of magnetohydrodynamic generators in electric power production are presented. The report includes research on performance, costs, efficiency, and design of MHD generators and their use in fusion and fission reactors, and fossil fueled plants. (This updated bibliography contains 120 abstracts, 25 of which are new entries to the previous edition.)

  20. Generative electronic background music system

    Energy Technology Data Exchange (ETDEWEB)

    Mazurowski, Lukasz [Faculty of Computer Science, West Pomeranian University of Technology in Szczecin, Zolnierska Street 49, Szczecin, PL (Poland)

    2015-03-10

    In this short paper-extended abstract the new approach to generation of electronic background music has been presented. The Generative Electronic Background Music System (GEBMS) has been located between other related approaches within the musical algorithm positioning framework proposed by Woller et al. The music composition process is performed by a number of mini-models parameterized by further described properties. The mini-models generate fragments of musical patterns used in output composition. Musical pattern and output generation are controlled by container for the mini-models - a host-model. General mechanism has been presented including the example of the synthesized output compositions.

  1. Generative electronic background music system

    International Nuclear Information System (INIS)

    Mazurowski, Lukasz

    2015-01-01

    In this short paper-extended abstract the new approach to generation of electronic background music has been presented. The Generative Electronic Background Music System (GEBMS) has been located between other related approaches within the musical algorithm positioning framework proposed by Woller et al. The music composition process is performed by a number of mini-models parameterized by further described properties. The mini-models generate fragments of musical patterns used in output composition. Musical pattern and output generation are controlled by container for the mini-models - a host-model. General mechanism has been presented including the example of the synthesized output compositions

  2. Event generators in particle physics

    International Nuclear Information System (INIS)

    Sjostrand, Torbjorn

    1994-01-01

    This presentation gives an introduction to the topic of event generators in particle physics . The emphasis is on the physics aspects that have to be considered in the construction of a generator, and what lessons we have learned from comparisons with data. A brief survey of existing generators is also included. As illustration, a few topics of current interest are covered in a bit more detail: QCD uncertainties in W mass determinations and γp/γγ physics. (author)

  3. Influence of peer review on the reporting of primary outcome(s) and statistical analyses of randomised trials.

    Science.gov (United States)

    Hopewell, Sally; Witt, Claudia M; Linde, Klaus; Icke, Katja; Adedire, Olubusola; Kirtley, Shona; Altman, Douglas G

    2018-01-11

    primary outcome, or funding source. Thirty-six percent (n = 94) of authors had been asked to include additional analyses that had not been included in the original manuscript; in 77% (n = 72) these were not pre-specified in the protocol. Twenty-three percent (n = 60) had been asked to modify their overall conclusion, usually (n = 53; 88%) to provide a more cautious conclusion. Overall, most changes, as a result of the peer review process, resulted in improvements to the published manuscript; there was little evidence of a negative impact in terms of post hoc changes of the primary outcome. However, some suggested changes might be considered inappropriate, such as unplanned additional analyses, and should be discouraged.

  4. Psychological distress and in vitro fertilization outcome.

    Science.gov (United States)

    Pasch, Lauri A; Gregorich, Steven E; Katz, Patricia K; Millstein, Susan G; Nachtigall, Robert D; Bleil, Maria E; Adler, Nancy E

    2012-08-01

    To examine whether psychological distress predicts IVF treatment outcome as well as whether IVF treatment outcome predicts subsequent psychological distress. Prospective cohort study over an 18-month period. Five community and academic fertility practices. Two hundred two women who initiated their first IVF cycle. Women completed interviews and questionnaires at baseline and at 4, 10, and 18 months' follow-up. IVF cycle outcome and psychological distress. In a binary logistic model including covariates (woman's age, ethnicity, income, education, parity, duration of infertility, and time interval), pretreatment depression and anxiety were not significant predictors of the outcome of the first IVF cycle. In linear regression models including covariates (woman's age, income, education, parity, duration of infertility, assessment point, time since last treatment cycle, and pre-IVF depression or anxiety), experiencing failed IVF was associated with higher post-IVF depression and anxiety. IVF failure predicts subsequent psychological distress, but pre-IVF psychological distress does not predict IVF failure. Instead of focusing efforts on psychological interventions specifically aimed at improving the chance of pregnancy, these findings suggest that attention be paid to helping patients prepare for and cope with treatment and treatment failure. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  5. Expectations and outcome: The role of Proposer features in the Ultimatum Game

    NARCIS (Netherlands)

    Marchetti, A.; Castelli, I.; Harlé, K.M.; Sanfey, A.G.

    2011-01-01

    In social decision-making individuals make choices in an interactive context and their decisions may therefore be influenced by information they receive about features of the other player. These features may 'frame' the other player in particular ways and generate expectations about the outcome.

  6. Managing Multiple Generations in the Workplace.

    Science.gov (United States)

    Clark, Kevin R

    2017-03-01

    Today's workplace often includes workers from 4 distinct generations, and each generation brings a unique set of core values and characteristics to an organization. These generational differences can produce benefits, such as improved patient care, as well as challenges, such as conflict among employees. This article reviews current research on generational differences in educational settings and the workplace and discusses the implications of these findings for medical imaging and radiation therapy departments. ©2017 American Society of Radiologic Technologists.

  7. Method of operating a thermoelectric generator

    Science.gov (United States)

    Reynolds, Michael G; Cowgill, Joshua D

    2013-11-05

    A method for operating a thermoelectric generator supplying a variable-load component includes commanding the variable-load component to operate at a first output and determining a first load current and a first load voltage to the variable-load component while operating at the commanded first output. The method also includes commanding the variable-load component to operate at a second output and determining a second load current and a second load voltage to the variable-load component while operating at the commanded second output. The method includes calculating a maximum power output of the thermoelectric generator from the determined first load current and voltage and the determined second load current and voltage, and commanding the variable-load component to operate at a third output. The commanded third output is configured to draw the calculated maximum power output from the thermoelectric generator.

  8. 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.

  9. 2020 Vision: Envisioning a New Generation of STEM Learning Research

    Science.gov (United States)

    Dierking, Lynn D.; Falk, John H.

    2016-01-01

    In this issue, we have compiled six original papers, outcomes from the U.S. National Science Foundation (US-NSF)-funded REESE (Research and Evaluation on Education in Science and Engineering) 2020 Vision: The Next Generation of STEM Learning Research project. The purpose of 2020 Vision was to re-envision the questions and frameworks guiding STEM…

  10. Occupation and first episode psychosis in Northern Italy: better outcomes for migrants.

    Science.gov (United States)

    Tarricone, Ilaria; Morgan, Craig; Boydell, Jane; Panigada, Serena; Morigi, Raffaele; Braca, Mauro; Sutti, Enrico; Boldri, Pierluigi; Di Forti, Marta; Murray, Robin M; Berardi, Domenico

    2017-12-01

    Many studies show that migrants have a higher incidence of psychosis compared to natives, but the influence of migration on psychosis outcomes is little investigated. We aimed to evaluate the occupational outcomes of a first episode psychosis (FEP) sample in Bologna (Northern Italy). An incidence cohort of FEP patients presenting at the Bologna West Community Mental Health Centers between 2002 and 2009 was assessed at the baseline and at 12th month follow-up. Return to school or work was used as occupational outcome. Most of the patients (82.8%) were still in contact at 12 months. Migrants showed significantly higher rate of return to work compared to natives (adjusted OR 4.45, 95% CI 1.55-12.76). First generation migrants had better occupational outcomes. Further cross-cultural studies are needed to further explain these findings. © 2016 John Wiley & Sons Australia, Ltd.

  11. Nursing Practice Environment and Outcomes for Oncology Nursing

    Science.gov (United States)

    Shang, Jingjing; Friese, Christopher R.; Wu, Evan; Aiken, Linda H.

    2012-01-01

    Background It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness. Objectives The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes. Methods A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and χ2 test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care. Results Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position. Conclusions Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes. Implications for Practice Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses’ participation in hospital decision making. PMID:22751101

  12. A Next Generation BioPhotonics Workstation

    DEFF Research Database (Denmark)

    Glückstad, Jesper; Palima, Darwin; Tauro, Sandeep

    2011-01-01

    We are developing a Next Generation BioPhotonics Workstation to be applied in research on regulated microbial cell growth including their underlying physiological mechanisms, in vivo characterization of cell constituents and manufacturing of nanostructures and meta-materials.......We are developing a Next Generation BioPhotonics Workstation to be applied in research on regulated microbial cell growth including their underlying physiological mechanisms, in vivo characterization of cell constituents and manufacturing of nanostructures and meta-materials....

  13. Development of a Novel Quantitative Adverse Outcome Pathway Predictive Model for Lung Cancer

    Science.gov (United States)

    Traditional methods for carcinogenicity testing are resource-intensive, retrospective, and time consuming. An increasing testing burden has generated interest in the adverse outcome pathway (AOP) concept as a tool to evaluate chemical safety in a more efficient, rapid and effecti...

  14. Expanding Health Technology Assessments to Include Effects on the Environment.

    Science.gov (United States)

    Marsh, Kevin; Ganz, Michael L; Hsu, John; Strandberg-Larsen, Martin; Gonzalez, Raquel Palomino; Lund, Niels

    2016-01-01

    There is growing awareness of the impact of human activity on the climate and the need to stem this impact. Public health care decision makers from Sweden and the United Kingdom have started examining environmental impacts when assessing new technologies. This article considers the case for incorporating environmental impacts into the health technology assessment (HTA) process and discusses the associated challenges. Two arguments favor incorporating environmental impacts into HTA: 1) environmental changes could directly affect people's health and 2) policy decision makers have broad mandates and objectives extending beyond health care. Two types of challenges hinder this process. First, the nascent evidence base is insufficient to support the accurate comparison of technologies' environmental impacts. Second, cost-utility analysis, which is favored by many HTA agencies, could capture some of the value of environmental impacts, especially those generating health impacts, but might not be suitable for addressing broader concerns. Both cost-benefit and multicriteria decision analyses are potential methods for evaluating health and environmental outcomes, but are less familiar to health care decision makers. Health care is an important and sizable sector of the economy that could warrant closer policy attention to its impact on the environment. Considerable work is needed to track decision makers' demands, augment the environmental evidence base, and develop robust methods for capturing and incorporating environmental data as part of HTA. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  15. Outcomes of the 'Data Curation for Geobiology at Yellowstone National Park' Workshop

    Science.gov (United States)

    Thomer, A.; Palmer, C. L.; Fouke, B. W.; Rodman, A.; Choudhury, G. S.; Baker, K. S.; Asangba, A. E.; Wickett, K.; DiLauro, T.; Varvel, V.

    2013-12-01

    The continuing proliferation of geological and biological data generated at scientifically significant sites (such as hot springs, coral reefs, volcanic fields and other unique, data-rich locales) has created a clear need for the curation and active management of these data. However, there has been little exploration of what these curation processes and policies would entail. To that end, the Site-Based Data Curation (SBDC) project is developing a framework of guidelines and processes for the curation of research data generated at scientifically significant sites. A workshop was held in April 2013 at Yellowstone National Park (YNP) to gather input from scientists and stakeholders. Workshop participants included nine researchers actively conducting geobiology research at YNP, and seven YNP representatives, including permitting staff and information professionals from the YNP research library and archive. Researchers came from a range of research areas -- geology, molecular and microbial biology, ecology, environmental engineering, and science education. Through group discussions, breakout sessions and hands-on activities, we sought to generate policy recommendations and curation guidelines for the collection, representation, sharing and quality control of geobiological datasets. We report on key themes that emerged from workshop discussions, including: - participants' broad conceptions of the long-term usefulness, reusability and value of data. - the benefits of aggregating site-specific data in general, and geobiological data in particular. - the importance of capturing a dataset's originating context, and the potential usefulness of photographs as a reliable and easy way of documenting context. - researchers' and resource managers' overlapping priorities with regards to 'big picture' data collection and management in the long-term. Overall, we found that workshop participants were enthusiastic and optimistic about future collaboration and development of community

  16. Mapping the impacts of thermoelectric power generation: a global, spatially explicit database

    Science.gov (United States)

    Raptis, Catherine; Pfister, Stephan

    2017-04-01

    Thermoelectric power generation is associated with environmental pressures resulting from emissions to air and water, as well as water consumption. The need to achieve global coverage in related studies has become pressing in view of climate change. At the same time, the ability to quantify impacts from power production on a high resolution remains pertinent, given their highly regionalized nature, particularly when it comes to water-related impacts. Efforts towards global coverage have increased in recent years, but most work on the impacts of global electricity production presents a coarse geographical differentiation. Over the past few years we have begun a concerted effort to create and make available a global georeferenced inventory of thermoelectric power plant operational characteristics and emissions, by modelling the relevant processes on the highest possible level: that of a generating unit. Our work extends and enhances a commercially available global power plant database, and so far includes: - Georeferencing the generating units and populating the gaps in their steam properties. - Identifying the cooling system for 92% of the global installed thermoelectric power capacity. - Using the completed steam property data, along with local environmental temperature data, to systematically solve the Rankine cycle for each generating unit, involving: i) distinguishing between simple, reheat, and cogenerative cycles, and accounting for particularities in nuclear power cycles; ii) accounting for the effect of different cooling systems (once-through, recirculating (wet tower), dry cooling) on the thermodynamic cycle. One of the direct outcomes of solving the Rankine cycle is the cycle efficiency, an indispensable parameter in any study related to power production, including the quantification of air emissions and water consumption. Another direct output, for those units employing once-through cooling, is the rate of heat rejection to water, which can lead to

  17. Life cycle management at Ontario Power Generation

    International Nuclear Information System (INIS)

    Spekkens, P.

    2006-01-01

    This paper outlines the Life Cycle Management (LCM) program at Ontario Power Generation. LCM is carried out at different levels that includes components, systems, unit and fleet. A system involves cumulative effect of individual component aging. These components include steam generators, pressure tubes and feeders. A unit involves an overall unit aging strategy integrating all systems. At the fleet level, there is an optimal strategy for plant-level investments including end-of-life of a unit

  18. Hydrogen generator characteristics for storage of renewably-generated energy

    International Nuclear Information System (INIS)

    Kotowicz, Janusz; Bartela, Łukasz; Węcel, Daniel; Dubiel, Klaudia

    2017-01-01

    The paper presents a methodology for determining the efficiency of a hydrogen generator taking the power requirements of its auxiliary systems into account. Authors present results of laboratory experiments conducted on a hydrogen generator containing a PEM water electrolyzer for a wide range of device loads. On the basis of measurements, the efficiency characteristics of electrolyzers were determined, including that of an entire hydrogen generator using a monitored power supply for its auxiliary devices. Based on the results of the experimental tests, the authors have proposed generalized characteristics of hydrogen generator efficiency. These characteristics were used for analyses of a Power-to-Gas system cooperating with a 40 MW wind farm with a known yearly power distribution. It was assumed that nightly-produced hydrogen is injected into the natural gas transmission system. An algorithm for determining the thermodynamic and economic characteristics of a Power-to-Gas installation is proposed. These characteristics were determined as a function of the degree of storage of the energy produced in a Renewable Energy Sources (RES) installation, defined as the ratio of the amount of electricity directed to storage to the annual amount of electricity generated in the RES installation. Depending on the degree of storage, several quantities were determined. - Highlights: • The efficiency characteristics of PEM electrolyzer are determined. • Generalized characteristics of hydrogen generator efficiency are proposed. • Method of choice of electrolyser nominal power for Power-to-Gas system was proposed. • Development of Power-to-Gas systems requires implementation of support mechanisms.

  19. Emerging risks and outcomes of blood transfusion in surgery.

    Science.gov (United States)

    Shander, Aryeh

    2004-01-01

    Prior to 1900, blood transfusions were fraught with danger and often caused more complications than the underlying disease. Discovery of the ABO compatibility system in the early twentieth century opened the modern era of blood transfusion, yet ABO incompatibility-as a result of clerical error-remains a significant threat to the recipient today. The risk of disease transmission now includes new and emerging agents, such as Trepanosoma cruzii and West Nile Virus (WNV), as well as other existing pathogens. Transfusion-related immunomodulation (TRIM) presents a further risk to recipient patients. Confounding these problems are shortages of safe blood and the accelerated rise in the cost of blood due to increased testing. Outcome data on transfusion therapy have not always been favorable, particularly in the areas of postoperative infection, systemic inflammatory response syndrome (SIRS), multiple organ failure (MOF), and mortality. Such data have generated extensive efforts to determine association versus underlying cause of post-transfusion complications. In addition, unprecedented global initiatives to minimize the use of allogeneic blood are on the way. Options may include, but are not limited to, the use of "blood substitutes," although validation of such products is still required. In the meantime, blood product conservation techniques should become part of routine transfusion medicine.

  20. Psychological contract breach and outcomes: Combining meta-analysis and structural equation models.

    Science.gov (United States)

    Topa Cantisano, Gabriela; Morales Domínguez, J Francisco; Depolo, Marco

    2008-08-01

    In this study, meta-analytic procedures were used to examine the relationships between psychological contract perceived breach and certain outcome variables, such as organizational commitment, job satisfaction and organizational citizenship behaviours (OCB). Our review of the literature generated 41 independent samples in which perceived breach was used as a predictor of these personal and organizational outcomes. A medium effect size (ES) for desirable outcomes (job satisfaction, organizational commitment, organizational trust, OCB and performance) was obtained (r=-.35). For undesirable outcomes (neglect in role duties and intention to leave), ES were also medium (r=.31). When comparing attitudinal (job satisfaction, organizational commitment, organizational trust) and behavioural outcomes (OCB, neglect in role duties and performance), a stronger ES was found for attitudinal (r=-.24) than for behavioural outcomes (r=-.11). Potential moderator variables were examined, and it was found that they explained only a percentage of variability of primary studies. Structural equation analysis of the pooled meta-analytical correlation matrix indicated that the relationships of perceived breach with satisfaction, OCB, intention to leave and performance are fully mediated by organizational trust and commitment. Results are discussed in order to suggest theoretical and empirical implications.

  1. Next-generation phylogenomics

    Directory of Open Access Journals (Sweden)

    Chan Cheong Xin

    2013-01-01

    Full Text Available Abstract Thanks to advances in next-generation technologies, genome sequences are now being generated at breadth (e.g. across environments and depth (thousands of closely related strains, individuals or samples unimaginable only a few years ago. Phylogenomics – the study of evolutionary relationships based on comparative analysis of genome-scale data – has so far been developed as industrial-scale molecular phylogenetics, proceeding in the two classical steps: multiple alignment of homologous sequences, followed by inference of a tree (or multiple trees. However, the algorithms typically employed for these steps scale poorly with number of sequences, such that for an increasing number of problems, high-quality phylogenomic analysis is (or soon will be computationally infeasible. Moreover, next-generation data are often incomplete and error-prone, and analysis may be further complicated by genome rearrangement, gene fusion and deletion, lateral genetic transfer, and transcript variation. Here we argue that next-generation data require next-generation phylogenomics, including so-called alignment-free approaches. Reviewers Reviewed by Mr Alexander Panchin (nominated by Dr Mikhail Gelfand, Dr Eugene Koonin and Prof Peter Gogarten. For the full reviews, please go to the Reviewers’ comments section.

  2. Early neurodevelopmental outcomes of extremely preterm infants.

    Science.gov (United States)

    Rogers, Elizabeth E; Hintz, Susan R

    2016-12-01

    Infants born at extreme preterm gestation are at risk for both death and disability. Although rates of survival have improved for this population, and some evidence suggests a trend toward decreased neuromotor impairment over the past decades, a significant improvement in overall early neurodevelopmental outcome has not yet been realized. This review will examine the rates and types of neurodevelopmental impairment seen after extremely preterm birth, including neurosensory, motor, cognitive, and behavioral outcomes. We focus on early outcomes in the first 18-36 months of life, as the majority of large neonatal studies examining neurodevelopmental outcomes stop at this age. However, this early age is clearly just a first glimpse into lifetime outcomes; the neurodevelopmental effects of extreme prematurity may last through school age, adolescence, and beyond. Importantly, prematurity appears to be an independent risk factor for adverse development, but this population demonstrates considerable variability in the types and severity of impairments. Understanding both the nature and prevalence of neurodevelopmental impairment among extremely preterm infants is important because it can lead to targeted interventions that in turn may lead to improved outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Symptom outcomes important to women with anal incontinence: a conceptual framework.

    Science.gov (United States)

    Sung, Vivian W; Rogers, Rebecca G; Bann, Carla M; Arya, Lily; Barber, Matthew D; Lowder, Jerry; Lukacz, Emily S; Markland, Alayne; Siddiqui, Nazema; Wilmot, Amanda; Meikle, Susan F

    2014-05-01

    To develop a framework that describes the most important symptom outcomes for anal incontinence treatment from the patient perspective. A conceptual framework was developed by the Pelvic Floor Disorders Network based on four semistructured focus groups and confirmed in two sets of 10 cognitive interviews including women with anal incontinence. We explored: 1) patient-preferred terminology for describing anal incontinence symptoms; 2) patient definitions of treatment "success"; 3) importance of symptoms and outcomes in the framework; and 4) conceptual gaps (defined as outcomes not previously identified as important). Sessions were conducted according to grounded theory transcribed, coded, and qualitatively and quantitatively analyzed to identify relevant themes. Content and face validity of the framework were further assessed using cognitive interviews. Thirty-four women participated in focus groups and 20 in cognitive interviews. Overall, 29 (54%) were aged 60 years or older, 42 (78%) were white, and 10 (19%) had a high school degree or less. Two overarching outcome themes were identified: "primary bowel leakage symptoms" and "ancillary bowel symptoms." Subdomains important in primary bowel leakage symptoms included leakage characteristics (symptom frequency, amount of leakage, symptom bother) and conditions when bowel leakage occurs (predictability, awareness, urgency). Subdomains important under ancillary bowel symptoms included emptying disorders (constipation, obstructed defecation, and wiping issues) and discomfort (pain, burning). New outcomes identified included predictability, awareness, wiping issues, and discomfort. Women with anal incontinence desire a wide range of symptom outcomes after treatment. These are captured in our conceptual framework, which can aid clinicians and researchers in assessing anal incontinence. LEVEL OF EVIEDENCE: II.

  4. Outcome after relapse of acute lymphoblastic leukemia in adult patients included in four consecutive risk-adapted trials by the PETHEMA Study Group.

    Science.gov (United States)

    Oriol, Albert; Vives, Susana; Hernández-Rivas, Jesús-María; Tormo, Mar; Heras, Inmaculada; Rivas, Concepción; Bethencourt, Concepción; Moscardó, Federico; Bueno, Javier; Grande, Carlos; del Potro, Eloy; Guardia, Ramon; Brunet, Salut; Bergua, Juan; Bernal, Teresa; Moreno, Maria-José; Calvo, Carlota; Bastida, Pilar; Feliu, Evarist; Ribera, Josep-Maria

    2010-04-01

    About one half of adults with acute lymphoblastic leukemia are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed acute lymphoblastic leukemia. We analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult patients with acute lymphoblastic leukemia (excluding those with mature B-cell acute lymphoblastic leukemia) prospectively enrolled in four consecutive risk-adapted PETHEMA trials. The median overall survival after relapse was 4.5 months (95% CI, 4-5 months) with a 5-year overall survival of 10% (95% CI, 8%-12%); 45% of patients receiving intensive second-line treatment achieved a second complete remission and 22% (95% CI, 14%-30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 years (2-year overall survival of 21% versus 10% for those over 30 years old; P<0.022) and a first remission lasting more than 2 years (2-year overall survival of 36% versus 17% among those with a shorter first remission; P<0.001). Patients under 30 years old whose first complete remission lasted longer than 2 years had a 5-year overall survival of 38% (95% CI, 23%-53%) and a 5-year disease-free survival of 53% (95% CI, 34%-72%). The prognosis of adult patients with acute lymphoblastic leukemia who relapse is poor. Those aged less than 30 years with a first complete remission lasting longer than 2 years have reasonable possibilities of becoming long-term survivors while patients over this age or those who relapse early cannot be successfully rescued using the therapies currently available.

  5. Distributed generation connected to the local network - a guide

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    This guide provides advice to the developers and operators of small distributed generation plant (including microgenerators) in the UK about the practical issues associated with connecting their plant and trading their output. Particular attention is given to sales revenues and how to access these revenue streams, including the mechanisms for purchasing Renewable Obligation Certificates (ROCs). The guide clarifies key terms, explains the wholesale trading system and provides an overview of sales opportunities (including ROCs and Levy Exemption Certificates (LECs)). Requirements on small distributed generation (including licensing, claiming class exemptions and metering) are described and the commercial aspects of connection (including the recent reduction in the barriers to connection) examined. Microgeneration (ie generators below 10 kW) issues are covered in their own chapter. The six appendices contain: background information about the industry; a list of purchasers of electricity from small distributed generators; descriptions of the generation, transmission and supply industries; information about industry standards and their governance; the role of government departments and institutions; and a glossary and other links.

  6. Steam generator life management

    International Nuclear Information System (INIS)

    King, P.; McGillivray, R.; Reinhardt, W.; Millman, J.; King, B.; Schneider, W.

    2003-01-01

    'Full-Text:' Steam Generator Life Management responsibility embodies doing whatever is necessary to maintain the steam generation equipment of a nuclear plant in effective, reliable service. All comes together in that most critical deliverable, namely the submission of the documentation which wins approval for return to service after an outage program. Life management must address all aspects of SG reliability over the life of the plant. Nevertheless, the life management activities leading up to return to service approval is where all of it converges. Steam Generator Life Management activities entail four types of work, all equally important in supporting the objective of successful operation. These activities are i) engineering functions; including identification of inspection and maintenance requirements, outage planning and scope definition plus engineering assessment, design and analysis as necessary to support equipment operation, ii) fitness of service work; including the expert evaluation of degradation mechanisms, disposition of defects for return to service or not, and the fitness for service analysis as required to justify ongoing operation with acceptable defects, iii) inspection work; including large scale eddy current inspection of tubing, the definition of defect size and character, code inspections of pressure vessel integrity and visual inspections for integrity and iv) maintenance work; including repairs, retrofits, cleaning and modifications, all as necessary to implement the measures defined during activities i) through iii). The paper discusses the approach and execution of the program for the achievement of the above objectives and particularly of items i) and ii). (author)

  7. Retrospective comparison of perinatal outcomes following emergency cervical cerclage with or without prolapsed membranes.

    Science.gov (United States)

    Steenhaut, Patricia; Hubinont, Corinne; Bernard, Pierre; Debiève, Frédéric

    2017-06-01

    To compare perinatal outcomes following emergency cerclage between patients with singleton pregnancies with prolapsed and non-prolapsed membranes. The present retrospective cohort study included data from women who underwent physical examination-indicated emergency cerclage at between 15 and 25 weeks of pregnancy at Saint Luc University Hospital, Brussels, Belgium, between January 1, 2000, and December 31, 2014. Outcomes were compared based on the presence of prolapsed or non-prolapsed membranes. The primary outcome measures were the duration of pregnancy at delivery and the interval between cerclage and delivery. Secondary outcomes included delivery weight, fetal or neonatal death, and neonatal morbidity, including neonatal intensive care unit admission. Data were included from 140 patients with cervical dilation of at least 1 cm; 85 women had non-prolapsed membranes and 55 women had prolapsed membranes. Among patients with non-prolapsed membranes, the mean duration of pregnancy at delivery was later (Pmembranes was associated with improved perinatal outcomes following emergency cerclage. © 2017 International Federation of Gynecology and Obstetrics.

  8. Factors influencing the use of outcome measures in physical therapy practice.

    Science.gov (United States)

    Wedge, Frances M; Braswell-Christy, Jennifer; Brown, Cynthia J; Foley, Kathleen T; Graham, Cecilia; Shaw, Sharon

    2012-02-01

    Use of outcome measures in physical therapy practice is central to evaluating the effectiveness of treatment interventions, providing accountability and addressing quality of physical therapy programs. There is limited discussion on barriers and facilitators to using outcome measures in physical therapy practice. The purpose of this study was to identify factors that influence a physical therapist when deciding to use outcome measures in clinical practice. Participants were 21 physical therapists, seven each from skilled nursing facilities, outpatient clinics, and inpatient rehabilitation facilities. A grounded theory approach was used for interview and data collection. Common themes were determined from the data and a theory developed to explain the rationale behind physical therapists' decisions to use or not use outcome measures in clinical practice. Three overlapping themes related to (1) concepts of time, (2) knowledge, and (3) facility culture were indentified as factors influencing the use of outcome measures. A fourth encompassing theme, professionalism, identified the value placed on the use of outcome measures in practice. Data revealed that therapists require more information on the outcome measures available, and this information needs to be easily accessible within the workplace. Therapists value information generated by using outcome measures in the clinical setting, but need information on what measures are available and psychometric properties. Information must be easily accessible and measures easy to use. Newer graduates and recent learners have a foundation in the use of outcome measures, but more needs to be done in the clinic and through continuing education to promote increased use and understanding.

  9. Long-term functional outcome of pediatric stroke survivors.

    Science.gov (United States)

    Hurvitz, Edward; Warschausky, Seth; Berg, Michelle; Tsai, Shane

    2004-01-01

    To examine the long-term functional, psychosocial, and medical outcome of pediatric stroke survivors. This was a descriptive survey performed on patients with childhood stroke who participated in an earlier study. Measures included the Vineland Adaptive Behavior Scales (VABS) and the Diener Satisfaction with Life Scale. Current information on living situation, school placement, employment, and medical outcome were obtained. Twenty-nine (58%) patients participated. The mean age was 19.3 years (SD = 6.6), mean age of onset of stroke was 7.0 years (SD = 5.4), and mean follow-up time was 11.9 years (SD = 3.9). Diagnoses included hemorrhagic (31%) and ischemic (69%) stroke. All but one adult had finished high school, and the majority of participants had gone to college. 60% of patients over age 16 were employed. The average VABS levels for communication, daily living skills, socialization, and adaptive behavior fell into the moderately low range. Use of seizure medications and ADL dependence were the predictors for lower VABS levels (p life satisfaction. Patients who scored below adequate on VABS tended toward lower life satisfaction. Pediatric stroke survivors had good educational and mobility outcomes, but communication, ADL, and socialization fell into the low-moderate range. The different predictors of functional and subjective quality of life outcomes suggest that functional outcomes may mediate the relations between medical factors and satisfaction with life.

  10. Ketenimines Generated from Ynamides: Versatile Building Blocks for Nitrogen-Containing Scaffolds.

    Science.gov (United States)

    Dodd, Robert H; Cariou, Kevin

    2018-02-16

    Using ynamides as readily available starting materials, a single step can generate highly reactive ketenimines, which can then undergo a variety of transformations. The choice of the method for generating the ketenimine dictates the outcome of the reaction that can, moreover, be precisely steered through minor variations of the starting material. This Concept gives an overview of the different existing methodologies for this objective, showcasing the diverse nitrogen-containing frameworks that can be obtained by this highly versatile strategy. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  11. Establishing a national knowledge translation and generation network in kidney disease: the CAnadian KidNey KNowledge TraNslation and GEneration NeTwork.

    Science.gov (United States)

    Manns, Braden; Barrett, Brendan; Evans, Michael; Garg, Amit; Hemmelgarn, Brenda; Kappel, Joanne; Klarenbach, Scott; Madore, Francois; Parfrey, Patrick; Samuel, Susan; Soroka, Steven; Suri, Rita; Tonelli, Marcello; Wald, Ron; Walsh, Michael; Zappitelli, Michael

    2014-01-01

    Patients with chronic kidney disease (CKD) do not always receive care consistent with guidelines, in part due to complexities in CKD management, lack of randomized trial data to inform care, and a failure to disseminate best practice. At a 2007 conference of key Canadian stakeholders in kidney disease, attendees noted that the impact of Canadian Society of Nephrology (CSN) guidelines was attenuated given limited formal linkages between the CSN Clinical Practice Guidelines Group, kidney researchers, decision makers and knowledge users, and that further knowledge was required to guide care in patients with kidney disease. The idea for the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) developed from this meeting. CANN-NET is a pan-Canadian network established in partnership with CSN, the Kidney Foundation of Canada and other professional societies to improve the care and outcomes of patients with and at risk for kidney disease. The initial priority areas for knowledge translation include improving optimal timing of dialysis initiation, and increasing the appropriate use of home dialysis. Given the urgent need for new knowledge, CANN-NET has also brought together a national group of experienced Canadian researchers to address knowledge gaps by encouraging and supporting multicentre randomized trials in priority areas, including management of cardiovascular disease in patients with kidney failure.

  12. Shared values and organizational citizenship behavior of generational cohorts: A review and future directions

    Directory of Open Access Journals (Sweden)

    I. Yogamalar

    2016-12-01

    Full Text Available The literature implies that in the contemporary workforce, one of the interesting and challenging tasks of the management is to effectively handle different generations who possess various value systems. Hence, the foremost aspiration of the current study is to present the empirical evidence on the diverse characteristics and values of generational cohorts; the interests of HR specialists, managers and researchers in dealing with multigenerational workforce and their impact on work-related outcomes, the responsibility of management; the influence of values on behavior (especially, in-role and extra-role behaviours and various positive outcomes to employees and organizations. This article also reviewed the previous studies related to shared values or P-O fit, OCB and highlighted that very little research was conducted in academic institutions. This study shows the generational categories from the Western context and the Indian context. It also intends to identify the gaps in the generational research and pave the way for further investigation. Finally, based on the research gaps identified, this article suggests and discusses the importance of generational difference on shared values and OCB in academic field in the Indian context as well as reframes the list of shared values from academic perspective for further investigation. Moreover, academic field is one of the predominant workplaces where intergenerational communication is at a high rate. Thus, the more attention needs to be given to the behaviours of generational cohorts in order to attain the goal of the institution.

  13. "I am a scientist": How setting conditions that enhance focused concentration positively relate to student motivation and achievement outcomes in inquiry-based science

    Science.gov (United States)

    Ellwood, Robin B.

    This research investigated how student social interactions within two approaches to an inquiry-based science curriculum could be related to student motivation and achievement outcomes. This qualitative case study consisted of two cases, Off-Campus and On-Campus, and used ethnographic techniques of participant observation. Research participants included eight eighth grade girls, aged thirteen to fourteen years old. Data sources included formal and informal participant interviews, participant journal reflections, curriculum artifacts including quizzes, worksheets, and student-generated research posters, digital video and audio recordings, photographs, and researcher field notes. Data were transcribed verbatim and coded, then collapsed into emergent themes using NVIVO 9. The results of this research illustrate how setting conditions that promote focused concentration and communicative interactions can be positively related to student motivation and achievement outcomes in inquiry-based science. Participants in the Off-Campus case experienced more frequent states of focused concentration and out performed their peers in the On-Campus case on forty-six percent of classroom assignments. Off-Campus participants also designed and implemented a more cognitively complex research project, provided more in-depth analyses of their research results, and expanded their perceptions of what it means to act like a scientist to a greater extent than participants in the On-Campus case. These results can be understood in relation to Flow Theory. Student interactions that promoted the criteria necessary for initiating flow, which included having clearly defined goals, receiving immediate feedback, and maintaining a balance between challenges and skills, fostered enhanced student motivation and achievement outcomes. This research also illustrates the positive gains in motivation and achievement outcomes that emerge from student experiences with extended time in isolated areas referred to

  14. Psychiatric outcomes after pediatric sports-related concussion.

    Science.gov (United States)

    Ellis, Michael J; Ritchie, Lesley J; Koltek, Mark; Hosain, Shahid; Cordingley, Dean; Chu, Stephanie; Selci, Erin; Leiter, Jeff; Russell, Kelly

    2015-12-01

    The objectives of this study were twofold: (1) to examine the prevalence of emotional symptoms among children and adolescents with a sports-related concussion (SRC) who were referred to a multidisciplinary pediatric concussion program and (2) to examine the prevalence, clinical features, risk factors, and management of postinjury psychiatric outcomes among those in this clinical population. The authors conducted a retrospective chart review of all patients with SRC referred to a multidisciplinary pediatric concussion program between September 2013 and October 2014. Clinical assessments carried out by a single neurosurgeon included clinical history, physical examination, and Post-Concussion Symptom Scale (PCSS) scoring. Postinjury psychiatric outcomes were defined as a subjective worsening of symptoms of a preinjury psychiatric disorder or new and isolated suicidal ideation or diagnosis of a novel psychiatric disorder (NPD). An NPD was defined as a newly diagnosed psychiatric disorder that occurred in a patient with or without a lifetime preinjury psychiatric disorder after a concussion. Clinical resources, therapeutic interventions, and clinical and return-to-play outcomes are summarized. One hundred seventy-four patients (mean age 14.2 years, 61.5% male) were included in the study. At least 1 emotional symptom was reported in 49.4% of the patients, and the median emotional PCSS subscore was 4 (interquartile range 1-8) among those who reported at least 1 emotional symptom. Overall, 20 (11.5%) of the patients met the study criteria for a postinjury psychiatric outcome, including 14 patients with an NPD, 2 patients with isolated suicidal ideation, and 4 patients with worsening symptoms of a preinjury psychiatric disorder. Female sex, a higher initial PCSS score, a higher emotional PCSS subscore, presence of a preinjury psychiatric history, and presence of a family history of psychiatric illness were significantly associated with postinjury psychiatric outcomes

  15. Assessment of Outcome in Hypospadias Surgery - A Review

    Directory of Open Access Journals (Sweden)

    Alexander eSpringer

    2014-01-01

    Full Text Available Hypospadias is a challenging field of urogenital reconstructive surgery with different techniques being currently used. Modern surgery claims that it is possible to create a functionally and cosmetically normal penis. Continuous reevaluation and assessment of outcome may have a major impact on future clinical practice. Assessment of outcome includes: complication rate, cosmetic appearance of the penis, functional outcome (micturition, sexuality and psychological factors such as quality of life and psychosexual life. This article briefly reviews current strategies of outcome assessment and outlines that in the future long-term assessment should be designed in web-based prospective studies multicenter studies. Somehow in the future we will be able to give an accurate estimation of the long-term consequences of being born with hypospadias.

  16. A randomized controlled trial undertaken to test a nurse-led weight management and exercise intervention designed for people with serious mental illness who take second generation antipsychotics.

    Science.gov (United States)

    Usher, Kim; Park, Tanya; Foster, Kim; Buettner, Petra

    2013-07-01

    To test the effect of a nurse-led intervention on weight gain in people with serious mental illness prescribed and taking second generation antipsychotic medication. Weight gain and obesity has reached epidemic proportions in the general population with the prevalence of Metabolic Syndrome reaching 20-25% of the global population. People with serious mental illness are at even higher risk, particularly those taking second generation antipsychotic medication. An experimental randomized controlled trial was undertaken. The control group received a 12-week healthy lifestyle booklet. In addition to the booklet, the intervention group received weekly nutrition and exercise education, exercise sessions, and nurse support. Participants (n = 101) were assessed at baseline and 12 weeks. Data were collected between March 2008-December 2010. Seven outcome measures were used: body measurements included girth (cm), weight (kg), height (cm), and body mass index (kg/m(2) ); questionnaires included the medication compliance questionnaire, the Drug Attitude Inventory, the Liverpool University Neuroleptic Side Effect Rating Scale, and the Medical Outcomes Study Short Form 36. Differences in primary outcome measures between baseline and 12 weeks follow-up were compared between intervention and control groups using standard bi-variate statistical tests. The study was conducted between 2008-2010. The analysis of outcome measures for the control group (n = 50) and intervention group (n = 51) was not statistically significant. There was a mean weight change of -0·74 kg at 12 weeks for the intervention group (n = 51), while the control group (n = 50) had a mean weight change of -0·17 kg at 12 weeks. The results were not statistically significant. © 2012 Blackwell Publishing Ltd.

  17. Perinatal outcomes among Asian-white interracial couples.

    Science.gov (United States)

    Nystrom, Michael J; Caughey, Aaron B; Lyell, Deirdre J; Druzin, Maurice L; El-Sayed, Yasser Y

    2008-10-01

    To investigate whether perinatal outcomes among interracial Asian-white couples are different than among Asian-Asian and white-white couples. This was a retrospective study of Asian, white, and Asian-white couples delivered at the Lucile Packard Children's Hospital from 2000-2005. Asian-white couples were subdivided into white-mother/Asian-father or Asian-mother/white-father. Perinatal outcomes included gestational diabetes, hypertensive disorders of pregnancy, preterm delivery, birth weight >4000 g and interracial Asian-white couples.

  18. Korean Clinic Based Outcome Measure Studies

    Directory of Open Access Journals (Sweden)

    Jongbae Park

    2003-02-01

    Full Text Available Background: Evidence based medicine has become main tools for medical practice. However, conducting a highly ranked in the evidence hierarchy pyramid is not easy or feasible at all times and places. There remains a room for descriptive clinical outcome measure studies with admitting the limit of the intepretation. Aims: Presents three Korean clinic based outcome measure studies with a view to encouraging Korean clinicians to conduct similar studies. Methods: Three studies are presented briefly here including 1 Quality of Life of liver cancer patients after 8 Constitutional acupuncture; 2 Developing a Korean version of Measuring yourself Medical Outcome profile (MYMOP; and 3 Survey on 5 Shu points: a pilot In the first study, we have included 4 primary or secondary liver cancer patients collecting their diagnostic X-ray film and clinical data f개m their hospital, and asked them to fill in the European Organization Research and Treatment of Cancer, Quality of Life Questionnaire before the commencement of the treatment. The acupuncture treatment is set up format but not disclosed yet. The translation and developing a Korean version of outcome measures that is Korean clinician friendly has been sought for MYMOP is one of the most appropriate one. The permission was granted, the translation into Korean was done, then back translated into English only based on the Korean translation by the researcher who is bilingual in both languages. The back translation was compared by the original developer of MYMOP and confirmed usable. In order to test the existence of acupoints and meridians through popular forms of Korean acupuncture regimes, we aim at collecting opinions from 101 Korean clinicians that have used those forms. The questions asked include most effective symptoms, 5 Shu points, points those are least likely to use due to either adverse events or the lack of effectiveness, theoretical reasons for the above proposals, proposing outcome measures

  19. Factors affecting the impact of professional development programs on teachers' knowledge, practice, student outcomes & efficacy.

    Directory of Open Access Journals (Sweden)

    Lawrence Ingvarson

    2005-01-01

    Full Text Available This report examines effects of structural and process features of professional development programs on teachers' knowledge, practice and efficacy. It is based on four recent (2002-2003 studies undertaken through the Australian Government Quality Teacher Programme, designed to enhance teacher quality. The total data set for the survey study includes 3,250 teachers who had participated in eighty individual professional development1 activities within these studies. Teachers were surveyed at least three months after participating in an activity, which provided them with the opportunity to gauge the impact of programs on their practice. To investigate factors affecting impact, a theoretical model was developed based on recent research into the characteristics of effective professional development and tested using blockwise regression analysis. The model included contextual factors (e.g., school support, structural features of programs (e.g. ,length, process features (e.g., emphasis on content; active learning; examination of student work; feedback; follow-up, a mediating variable (level of professional community generated, and four outcome measures (knowledge; practice; student learning and efficacy. Consistent significant direct effects were found across the four studies for the impact of content focus, active learning, and follow-up on knowledge and professional community. Feedback was rarely incorporated into program design. Impact on efficacy was strongly related to the perceived impact of activities on teachers' practice and student learning outcomes.

  20. Workload and surgeon's specialty for outcome after colorectal cancer surgery

    DEFF Research Database (Denmark)

    Archampong, David; Borowski, David; Wille-Jørgensen, Peer

    2012-01-01

    A large body of research has focused on investigating the effects of healthcare provider volume and specialization on patient outcomes including outcomes of colorectal cancer surgery. However there is conflicting evidence about the role of such healthcare provider characteristics in the management...

  1. Striatal Activity and Reward Relativity: Neural Signals Encoding Dynamic Outcome Valuation.

    Science.gov (United States)

    Webber, Emily S; Mankin, David E; Cromwell, Howard C

    2016-01-01

    The striatum is a key brain region involved in reward processing. Striatal activity has been linked to encoding reward magnitude and integrating diverse reward outcome information. Recent work has supported the involvement of striatum in the valuation of outcomes. The present work extends this idea by examining striatal activity during dynamic shifts in value that include different levels and directions of magnitude disparity. A novel task was used to produce diverse relative reward effects on a chain of instrumental action. Rats ( Rattus norvegicus ) were trained to respond to cues associated with specific outcomes varying by food pellet magnitude. Animals were exposed to single-outcome sessions followed by mixed-outcome sessions, and neural activity was compared among identical outcome trials from the different behavioral contexts. Results recording striatal activity show that neural responses to different task elements reflect incentive contrast as well as other relative effects that involve generalization between outcomes or possible influences of outcome variety. The activity that was most prevalent was linked to food consumption and post-food consumption periods. Relative encoding was sensitive to magnitude disparity. A within-session analysis showed strong contrast effects that were dependent upon the outcome received in the immediately preceding trial. Significantly higher numbers of responses were found in ventral striatum linked to relative outcome effects. Our results support the idea that relative value can incorporate diverse relationships, including comparisons from specific individual outcomes to general behavioral contexts. The striatum contains these diverse relative processes, possibly enabling both a higher information yield concerning value shifts and a greater behavioral flexibility.

  2. Generators of nonequilibrium low-temperature plasma

    International Nuclear Information System (INIS)

    Dautov, G.Yu.

    1988-01-01

    Results are described of a study and of the characteristics of sources of a non-equilibrium gas-discharge plasma. The plasma generators considered include glow, high frequency, and arc discharge generators. Thermodynamic, ionic, and electronic processes occurring in the plasmas are evaluated

  3. Web-based depression treatment : Associations of clients' word use with adherence and outcome

    NARCIS (Netherlands)

    Van der Zanden, Rianne; Curie, Keshia; van Londen - Barentsen, Monique|info:eu-repo/dai/nl/072312742; Kramer, Jeannet; Steen, Gerard; Cuijpers, Pim

    Background: The growing number of web-based psychological treatments, based on textual communication, generates a wealth of data that can contribute to knowledge of online and face-to-face treatments. We investigated whether clients' language use predicted treatment outcomes and adherence in Master

  4. Clinical and economic outcomes assessment in nuclear cardiology

    International Nuclear Information System (INIS)

    Shaw, L.J.; Miller, D.D.; Berman, D.S.; Hachamovitch, R.

    2000-01-01

    The future of nuclear medicine procedures, as understood within our current economic climate, depends upon its ability to provide relevant clinical information at similar or lower comparative costs. With an ever-increasing emphasis on cost containment, outcome assessment forms the basis of preserving the quality of patient care. Today, outcomes assessment encompasses a wide array of subjects including clinical, economic, and humanistic (i.e., quality of life) outcomes. For nuclear cardiology, evidence-based medicine would require a threshold level of evidence in order to justify the added cost of any test in a patient's work-up. This evidence would include large multicenter, observational series as well as randomized trial data in sufficiently large and diverse patient populations. The new movement in evidence-based medicine is also being applied to the introduction of new technologies, in particular when comparative modalities exist. In the past 5 years, it has seen a dramatic shift in the quality of outcomes data published in nuclear cardiology. This includes the use of statistically rigorous risk-adjusted techniques as well as large populations (i.e., >500 patients) representing multiple diverse medical care settings. This has been the direct result of the development of multiple outcomes databases that have now amassed thousands of patients worth of data. One of the benefits of examining outcomes in large patient datasets is the ability to assess individual endpoints (e.g., cardiac death) as compared with smaller datasets that often assess combined endpoints (e.g., death, myocardial infarction, or unstable angina). New technologies for the diagnosis of coronary artery disease have contributed to the rising costs of care. In the United States and in Europe, costs of care have risen dramatically, consuming an ever-increasing amount of available resources. The overuse of diagnostic angiography often leads to unnecessary revascularization that does not lead to

  5. Association between organisational and workplace cultures, and patient outcomes: systematic review.

    Science.gov (United States)

    Braithwaite, Jeffrey; Herkes, Jessica; Ludlow, Kristiana; Testa, Luke; Lamprell, Gina

    2017-11-08

    Every organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes. A variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts. The articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review. Patient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience. The search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction. Synthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare

  6. Integrated health outcomes research strategies in drug or medical device development, pre- and postmarketing: time for change.

    Science.gov (United States)

    Badía, Xavier; Guyver, Alice; Magaz, Sol; Bigorra, Juan

    2002-06-01

    The implementation of health outcomes research as a healthcare decision-making tool has expanded rapidly in the last decade. Drugs and medical devices are increasingly being required to demonstrate not only their efficacy and safety characteristics, but also their performance in at least three core dimensions of health outcomes research: clinical effectiveness, patient-reported outcomes and economic outcomes. However, the current integration of health outcomes research lacks coordination and communication and as a result, money and time is being spent on the generation of health outcomes research data which can be both insufficient and fail to satisfy the information demands of all the relevant stakeholders. In response to this, a new paradigm is evolving which involves the implementation of health outcomes research strategies that encompass the development, pre- and postmarketing stages of a drug or medical device.

  7. Perinatal outcomes following an earlier post-term labour induction policy

    DEFF Research Database (Denmark)

    Hedegaard, M.; Lidegaard, Ø; Skovlund, C W

    2015-01-01

    : Perinatal outcomes were estimated using a logistic regression analysis with adjustment for gestational age, maternal age, parity, plurality, smoking and body mass index. MAIN OUTCOME MEASURES: Perinatal outcomes. RESULTS: A total of 770 926 infants were included. Labour induction from 37 weeks increased...... from 9.7% in 2000-02 to 22.5% in 2011-12. From 2003-05 to 2011-12, the risk of umbilical cord pH care units...

  8. Electric Power Plants and Generation Stations, Power Plants - is a seperate layer, however, we have them included in local building layer as well, Published in 2010, 1:2400 (1in=200ft) scale, Effingham County Government.

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Electric Power Plants and Generation Stations dataset current as of 2010. Power Plants - is a seperate layer, however, we have them included in local building layer...

  9. Periodontal disease and pregnancy outcomes: time to move on?

    Science.gov (United States)

    Srinivas, Sindhu K; Parry, Samuel

    2012-02-01

    Maternal periodontal disease is a highly prevalent condition that has been studied extensively in relation to adverse pregnancy outcomes, including preterm delivery, preeclampsia, and low birth weight. Investigators speculate that hematogenous transport of bacteria and/or pro-inflammatory mediators from sites of periodontal infection into the placenta, fetal membranes, and amniotic cavity induces pathological processes that lead to these adverse outcomes. Preliminary observational studies supported this hypothesis, but more recent work by our group and others do not demonstrate an increased risk of adverse pregnancy outcomes among women with periodontal disease, and most randomized trials fail to demonstrate improved perinatal outcomes following treatment of periodontal disease in pregnancy.

  10. Community to clinic navigation to improve diabetes outcomes

    Directory of Open Access Journals (Sweden)

    Nancy E. Schoenberg

    2017-03-01

    Full Text Available Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers' offices for appointments, making reminder calls, and facilitating transportation and dependent care. Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction. Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950, and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment.

  11. Perioperative vitamin D levels correlate with clinical outcomes after ankle fracture fixation.

    Science.gov (United States)

    Warner, Stephen J; Garner, Matthew R; Nguyen, Joseph T; Lorich, Dean G

    2016-03-01

    Hypovitaminosis D is common in patients undergoing orthopaedic trauma surgery. While previous studies have shown that vitamin D levels correlate with functional outcome after hip fracture surgery, the significance of vitamin D levels on outcomes after surgery in other orthopaedic trauma patients is unknown. The purpose of this study was to determine if vitamin D levels correlated with outcomes in ankle fracture patients. We reviewed a prospective registry of patients who underwent operative treatment for ankle fractures from 2003 to 2012. Preoperative serum 25-hydroxyvitamin D (25[OH]D) levels were measured, and the primary and secondary outcomes included foot and ankle outcome scores (FAOS) and ankle range of motion. Data were also collected on patient comorbidities, articular malreductions, and wound complications. Included patients had at least 12 months of clinical outcome data. Ninety-eight patients operatively treated for ankle fractures met our inclusion criteria. Of these 98 patients, 36 (37%) were deficient in vitamin D (ankle fractures, preoperative vitamin D deficiency correlated with inferior clinical outcomes at a minimum of 1 year follow-up. Our study suggests that deficient vitamin D levels may result in worse outcomes in orthopaedic trauma patients recovering from fracture fixation.

  12. Adaptive Encoding of Outcome Prediction by Prefrontal Cortex Ensembles Supports Behavioral Flexibility.

    Science.gov (United States)

    Del Arco, Alberto; Park, Junchol; Wood, Jesse; Kim, Yunbok; Moghaddam, Bita

    2017-08-30

    The prefrontal cortex (PFC) is thought to play a critical role in behavioral flexibility by monitoring action-outcome contingencies. How PFC ensembles represent shifts in behavior in response to changes in these contingencies remains unclear. We recorded single-unit activity and local field potentials in the dorsomedial PFC (dmPFC) of male rats during a set-shifting task that required them to update their behavior, among competing options, in response to changes in action-outcome contingencies. As behavior was updated, a subset of PFC ensembles encoded the current trial outcome before the outcome was presented. This novel outcome-prediction encoding was absent in a control task, in which actions were rewarded pseudorandomly, indicating that PFC neurons are not merely providing an expectancy signal. In both control and set-shifting tasks, dmPFC neurons displayed postoutcome discrimination activity, indicating that these neurons also monitor whether a behavior is successful in generating rewards. Gamma-power oscillatory activity increased before the outcome in both tasks but did not differentiate between expected outcomes, suggesting that this measure is not related to set-shifting behavior but reflects expectation of an outcome after action execution. These results demonstrate that PFC neurons support flexible rule-based action selection by predicting outcomes that follow a particular action. SIGNIFICANCE STATEMENT Tracking action-outcome contingencies and modifying behavior when those contingencies change is critical to behavioral flexibility. We find that ensembles of dorsomedial prefrontal cortex neurons differentiate between expected outcomes when action-outcome contingencies change. This predictive mode of signaling may be used to promote a new response strategy at the service of behavioral flexibility. Copyright © 2017 the authors 0270-6474/17/378363-11$15.00/0.

  13. Infertility trial outcomes: healthy moms and babies.

    Science.gov (United States)

    Silver, Robert

    2014-05-01

    Traditionally, the primary outcome of infertility trials has been a positive pregnancy test or a clinically recognized pregnancy. However, parents desire a healthy baby that grows up to be a healthy adult, rather than a positive pregnancy test. Too often results of infertility trials are lacking in crucial obstetric details. This is problematic because treatments for infertility have the capacity to increase the risk for a variety of adverse obstetric outcomes. This review will outline important obstetric variables that should be included when reporting infertility research. The rationale for including these data, precise definitions of the variables, and cost-effective strategies for obtaining these obstetric details will be highlighted. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Thyroid dysfunction and pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Sima Nazarpour

    2015-07-01

    Full Text Available Background: Pregnancy has a huge impact on the thyroid function in both healthy women and those that have thyroid dysfunction. The prevalence of thyroid dysfunction in pregnant women is relatively high. Objective: The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction including hyperthyroidism, hypothyroidism and thyroid autoimmune positivity on pregnancy outcomes. Materials and Methods: In this review, Medline, Embase and the Cochrane Library were searched with appropriate keywords for relevant English manuscript. We used a variety of studies, including randomized clinical trials, cohort (prospective and retrospective, case-control and case reports. Those studies on thyroid disorders among non-pregnant women and articles without adequate quality were excluded. Results: Overt hyperthyroidism and hypothyroidism has several adverse effects on pregnancy outcomes. Overt hyperthyroidism was associated with miscarriage, stillbirth, preterm delivery, intrauterine growth retardation, low birth weight, preeclampsia and fetal thyroid dysfunction. Overt hypothyroidism was associated with abortion, anemia, pregnancy-induced hypertension, preeclampsia, placental abruption, postpartum hemorrhage, premature birth, low birth weight, intrauterine fetal death, increased neonatal respiratory distress and infant neuro developmental dysfunction. However the adverse effect of subclinical hypothyroidism, and thyroid antibody positivity on pregnancy outcomes was not clear. While some studies demonstrated higher chance of placental abruption, preterm birth, miscarriage, gestational hypertension, fetal distress, severe preeclampsia and neonatal distress and diabetes in pregnant women with subclinical hypothyroidism or thyroid autoimmunity; the other ones have not reported these adverse effects. Conclusion: While the impacts of overt thyroid dysfunction on feto-maternal morbidities have been clearly

  15. Engaging the hearts and minds of clinicians in outcome measurement - the UK Rehabilitation Outcomes Collaborative approach.

    Science.gov (United States)

    Turner-Stokes, Lynne; Williams, Heather; Sephton, Keith; Rose, Hilary; Harris, Sarah; Thu, Aung

    2012-01-01

    This article explores the rationale for choosing the instruments included within the UK Rehabilitation Outcomes Collaborative (UKROC) data set. Using one specialist neuro-rehabilitation unit as an exemplar service, it describes an approach to engaging the hearts and minds of clinicians in recording the data. Measures included within a national data set for rehabilitation should be psychometrically robust and feasible to use in routine clinical practice; they should also support clinical decision-making so that clinicians actually want to use them. Learning from other international casemix models and benchmarking data sets, the UKROC team has developed a cluster of measures to inform the development of effective and cost-efficient rehabilitation services. These include measures of (1) "needs" for rehabilitation (complexity), (2) inputs provided to meet those needs (nursing and therapy intervention), and (3) outcome, including the attainment of personal goals as well as gains in functional independence. By integrating the use of the data set measures in everyday clinical practice, we have achieved a very high rate of compliance with data collection. However, staff training and ongoing commitment from senior staff and managers are critical to the maintenance of effort required to provide assurance of data quality in the longer term.

  16. Workload and surgeon's specialty for outcome after colorectal cancer surgery

    DEFF Research Database (Denmark)

    Archampong, David; Borowski, David; Wille-Jørgensen, Peer

    2012-01-01

    A large body of research has focused on investigating the effects of healthcare provider volume and specialization on patient outcomes including outcomes of colorectal cancer surgery. However there is conflicting evidence about the role of such healthcare provider characteristics in the management...... of colorectal cancer....

  17. Musculoskeletal ultrasound including definitions for ultrasonographic pathology

    DEFF Research Database (Denmark)

    Wakefield, RJ; Balint, PV; Szkudlarek, Marcin

    2005-01-01

    Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints...... in a short period of time. However, there are scarce data regarding its validity, reproducibility, and responsiveness to change, making interpretation and comparison of studies difficult. In particular, there are limited data describing standardized scanning methodology and standardized definitions of US...... pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis....

  18. Generator technology for HTGR power plants

    International Nuclear Information System (INIS)

    Lomba, D.; Thiot, D.

    1997-01-01

    Approximately 15% of the worlds installed capacity in electric energy production is from generators developed and manufactured by GEC Alsthom. GEC Alsthom is now working on the application of generators for HTGR power conversion systems. The main generator characteristics induced by the different HTGR power conversion technology include helium immersion, high helium pressure, brushless excitation system, magnetic bearings, vertical lineshaft, high reliability and long periods between maintenance. (author)

  19. Non-cognitive Child Outcomes and Universal High Quality Child Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Simonsen, Århus Universitet, Marianne

    universal pre-school programs and family day care vis-à-vis home care. We find that, compared to home care, being enrolled in pre-school at age three does not lead to significant differences in child outcomes at age seven no matter the gender or mother’s level of education. Family day care, on the other......Exploiting a rich panel data child survey merged with administrative records along with a pseudo-experiment generating variation in the take-up of pre-school across municipalities, we provide evidence of the effects on non-cognitive child outcomes of participating in large scale publicly provided...... hand, seems to significantly deteriorate outcomes for boys whose mothers have a lower level of education. Finally, increasing hours in family day care from 30-40 hours per week to 40-50 hours per week and hours in pre-school from 20-30 hours per week to 30-40 hours per week leads to significantly...

  20. Non-cognitive Child Outcomes and Universal High Quality Child Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Simonsen, Marianne

    universal pre-school programs and family day care vis-à-vis home care. We find that, compared to home care, being enrolled in pre-school at age three does not lead to significant differences in child outcomes at age seven no matter the gender or mother's level of education. Family day care, on the other......Exploiting a rich panel data child survey merged with administrative records along with a pseudo-experiment generating variation in the take-up of pre-school across municipalities, we provide evidence of the effects on non-cognitive child outcomes of participating in large scale publicly provided...... hand, seems to significantly deteriorate outcomes for boys whose mothers have a lower level of education. Finally, increasing hours in family day care from 30-40 hours per week to 40-50 hours per week and hours in pre-school from 20-30 hours per week to 30-40 hours per week leads to significantly...