WorldWideScience

Sample records for outcomes included change

  1. Five-year examination of utilization and drug cost outcomes associated with benefit design changes including reference pricing for proton pump inhibitors in a state employee health plan.

    Science.gov (United States)

    Johnson, Jill T; Neill, Kathryn K; Davis, Dwight A

    2011-04-01

    The Arkansas State Employee Benefits Division (EBD) is a self-insured program comprising public school and other state employees, their spouses, and dependents. Previous research published in JMCP (2006) showed drug cost savings of $2.20 per member per month (PMPM; 37.6%) or annualized savings of $3.4 million associated with a benefit design change and coverage of the proton pump inhibitor (PPI) omeprazole over-the-counter (OTC) beginning in March 2004. On May 1, 2005, brand esomeprazole was excluded from coverage, with current users grandfathered for 4 months until September 2005. Reference pricing for PPIs, including esomeprazole but excluding generic omeprazole, was implemented on September 1, 2005, and the beneficiary cost share for all PPIs except generic omeprazole was determined from comparison of the PPI actual price to the $0.90 omeprazole OTC reference price per unit. To examine PPI utilization and drug costs before and after (a) excluding esomeprazole from coverage (with grandfathering current users) and (b) implementing a therapeutic maximum allowable cost (TMAC), or reference-pricing benefit design, for the PPI class in a large state employee health plan with fairly stable enrollment of approximately 127,500 members in 2005 through 2008 and approximately 128,000 members in 2009 Q1. The pharmacy claims database for the EBD was used to examine utilization and cost data for PPIs in a longitudinal analysis for the 61-month period from March 1, 2004, through March 31, 2009. Pharmacy claims data were compared for the period 14 months prior to esomeprazole exclusion (preperiod), 4 months during the esomeprazole exclusion (postperiod 1), and the ensuing 43 months of PPI reference pricing (postperiod 2). PPI cost and utilization data for the intervention group of approximately 127,500 beneficiaries were compared with a group of 122 self-insured employers with a total of nearly 1 million beneficiaries whose pharmacy benefits did not include reference pricing for

  2. Including climate change in energy investment decisions

    International Nuclear Information System (INIS)

    Ybema, J.R.; Boonekamp, P.G.M.; Smit, J.T.J.

    1995-08-01

    To properly take climate change into account in the analysis of energy investment decisions, it is required to apply decision analysis methods that are capable of considering the specific characteristics of climate change (large uncertainties, long term horizon). Such decision analysis methods do exist. They can explicitly include evolving uncertainties, multi-stage decisions, cumulative effects and risk averse attitudes. Various methods are considered in this report and two of these methods have been selected: hedging calculations and sensitivity analysis. These methods are applied to illustrative examples, and its limitations are discussed. The examples are (1a) space heating and hot water for new houses from a private investor perspective and (1b) as example (1a) but from a government perspective, (2) electricity production with an integrated coal gasification combined cycle (ICGCC) with or without CO 2 removal, and (3) national energy strategy to hedge for climate change. 9 figs., 21 tabs., 42 refs., 1 appendix

  3. 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).

  4. Welfare State Changes and Outcomes

    DEFF Research Database (Denmark)

    Alves, Sonia

    2015-01-01

    . The conclusion of this article is that income inequality has been steadily increasing in Danish society; while in Portugal, despite improvements in many social domains (healthcare, poverty alleviation, unemployment protection), problems of inequality remain deeply embedded in the country’s social......It is well known that welfare states ensure a certain level of social protection affecting levels of well-being and the extent of inequalities in society. Changes within crucial domains of social policy, such as education, health, or social protection, have, therefore, a major effect upon...

  5. Stochastic modelling of two-phase flows including phase change

    International Nuclear Information System (INIS)

    Hurisse, O.; Minier, J.P.

    2011-01-01

    Stochastic modelling has already been developed and applied for single-phase flows and incompressible two-phase flows. In this article, we propose an extension of this modelling approach to two-phase flows including phase change (e.g. for steam-water flows). Two aspects are emphasised: a stochastic model accounting for phase transition and a modelling constraint which arises from volume conservation. To illustrate the whole approach, some remarks are eventually proposed for two-fluid models. (authors)

  6. 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.

  7. Systematic review on adverse birth outcomes of climate change

    Directory of Open Access Journals (Sweden)

    Parinaz Poursafa

    2015-01-01

    Full Text Available Background: Climate change and global warming have significant effects on human health. This systematic review presents the effects of the climate changes on pregnancy outcomes. Materials and Methods: The search process was conducted in electronic databases including ISI Web of Knowledge, PubMed, Scopus, and Google Scholar using key words of "environmental temperature" "pregnancy" "low birth weight (LBW" "pregnancy outcome," "climate change," "preterm birth (PTB," and a combination of them. We did not consider any time limitation; English-language papers were included. The related papers were selected in three phases. After quality assessment, two reviewers extracted the data while the third reviewer checked their extracted data. Finally, 15 related articles were selected and included in the current study. Results: Approximately all studies have reported a significant relationship between exposure variable and intended outcomes including eclampsia, preeclampsia, cataract, LBW, PTB, hypertension, sex ratio and length of pregnancy. According to conducted studies, decrease in birth weight is more possible in cold months. Increase in temperature was followed by increase in PTB rate. According to most of the studies, eclampsia and preeclampsia were more prevalent in cold and humid seasons. Two spectrums of heat extent, different seasons of the year, sunlight intensity and season of fertilization were associated with higher rates of PTB, hypertension, eclampsia, preeclampsia, and cataract. Conclusion: Climate change has unfavorable effects on eclampsia, preeclampsia, PTB, and cataract. The findings of this review confirm the crucial importance of the adverse health effects of climate change especially in the perinatal period.

  8. Transient simulations of historical climate change including interactive carbon emissions from land-use change.

    Science.gov (United States)

    Matveev, A.; Matthews, H. D.

    2009-04-01

    Carbon fluxes from land conversion are among the most uncertain variables in our understanding of the contemporary carbon cycle, which limits our ability to estimate both the total human contribution to current climate forcing and the net effect of terrestrial biosphere changes on atmospheric CO2 increases. The current generation of coupled climate-carbon models have made significant progress in simulating the coupled climate and carbon cycle response to anthropogenic CO2 emissions, but do not typically include land-use change as a dynamic component of the simulation. In this work we have incorporated a book-keeping land-use carbon accounting model into the University of Victoria Earth System Climate Model (UVic ESCM), and intermediate-complexity coupled climate-carbon model. The terrestrial component of the UVic ESCM allows an aerial competition of five plant functional types (PFTs) in response to climatic conditions and area availability, and tracks the associated changes in affected carbon pools. In order to model CO2 emissions from land conversion in the terrestrial component of the model, we calculate the allocation of carbon to short and long-lived wood products following specified land-cover change, and use varying decay timescales to estimate CO2 emissions. We use recently available spatial datasets of both crop and pasture distributions to drive a series of transient simulations and estimate the net contribution of human land-use change to historical carbon emissions and climate change.

  9. 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.

  10. 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.

  11. Aging and physiological changes of the kidneys including changes in glomerular filtration rate.

    Science.gov (United States)

    Musso, Carlos G; Oreopoulos, Dimitrios G

    2011-01-01

    In addition to the structural changes in the kidney associated with aging, physiological changes in renal function are also found in older adults, such as decreased glomerular filtration rate, vascular dysautonomia, altered tubular handling of creatinine, reduction in sodium reabsorption and potassium secretion, and diminished renal reserve. These alterations make aged individuals susceptible to the development of clinical conditions in response to usual stimuli that would otherwise be compensated for in younger individuals, including acute kidney injury, volume depletion and overload, disorders of serum sodium and potassium concentration, and toxic reactions to water-soluble drugs excreted by the kidneys. Additionally, the preservation with aging of a normal urinalysis, normal serum urea and creatinine values, erythropoietin synthesis, and normal phosphorus, calcium and magnesium tubular handling distinguishes decreased GFR due to normal aging from that due to chronic kidney disease. Copyright © 2011 S. Karger AG, Basel.

  12. 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.

  13. 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...

  14. Family Structure Changes and Children's Health, Behavior, and Educational Outcomes

    DEFF Research Database (Denmark)

    Rasmussen, Astrid Würtz

    decreased to 73% in 2005. Hence it is important to improve our understanding of the impact of "shocks" in family structure due to parental relationship dissolution on children. International studies mainly suggest a negative relationship between non-nuclear family structure and child outcomes. There are two...... relation between family structure changes and children's outcomes. Children who have experienced family structure changes during childhood seem to have worse educational outcomes and a higher propensity to being hospitalized and convicted of a crime. The children in the dataset experience up to 13 family...... structure changes during childhood. More family structure changes implies worse outcomes and might actually be more important than the number of years a child has spent in a single parent household. The age at which the family structure change occurs also seems to be important at least for some outcomes....

  15. Changes in dental care access upon health care benefit expansion to include scaling.

    Science.gov (United States)

    Park, Hee-Jung; Lee, Jun Hyup; Park, Sujin; Kim, Tae-Il

    2016-12-01

    This study aimed to evaluate the effects of a policy change to expand Korean National Health Insurance (KNHI) benefit coverage to include scaling on access to dental care at the national level. A nationally representative sample of 12,794 adults aged 20 to 64 years from Korea National Health and Nutritional Examination Survey (2010-2014) was analyzed. To examine the effect of the policy on the outcomes of interest (unmet dental care needs and preventive dental care utilization in the past year), an estimates-based probit model was used, incorporating marginal effects with a complex sampling structure. The effect of the policy on individuals depending on their income and education level was also assessed. Adjusting for potential covariates, the probability of having unmet needs for dental care decreased by 6.1% and preventative dental care utilization increased by 14% in the post-policy period compared to those in the pre-policy period (2010, 2012). High income and higher education levels were associated with fewer unmet dental care needs and more preventive dental visits. The expansion of coverage to include scaling demonstrated to have a significant association with decreasing unmet dental care needs and increasing preventive dental care utilization. However, the policy disproportionately benefited certain groups, in contrast with the objective of the policy to benefit all participants in the KNHI system.

  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. THORACOLUMBAR BURST FRACTURE: STRUCTURAL CHANGES AND CLINICAL OUTCOME OF TREATMENT

    Directory of Open Access Journals (Sweden)

    Rodrigo Arnold Tisot

    2016-03-01

    Full Text Available ABSTRACT Objective: To evaluate the correlation between structural changes in burst fractures of thoracic and lumbar spine with clinical outcome of the treatment. Methods: A retrospective study in 25 patients with fractures of thoracic and lumbar spine burst fractures without neurological deficit. Eleven patients underwent conservative treatment and for the remaining the treatment was surgical. All patients were followed up for at least 24 months. The cases were evaluated by a protocol that included: posttraumatic measurement of kyphosis, vertebral body collapse and narrowing of the spinal canal, the visual analog scale of pain, and the quality of life questionnaire SF-36 at the follow-up. For statistical analysis, the significance level was 5% and the software SPSS 18.0 was used. Results: No statistically significant difference was observed when comparing the clinical outcomes of one treatment over another. Similarly, there was no statistically significant correlation between kyphosis and post-traumatic narrowing of the spinal canal with clinical worsening in the follow-up, regardless of the treatment used. We found a positive correlation (p<0.05 between initial collapse and SF-36 domains in both groups (operated and non-operated. Conclusion: There was no significant superiority of one treatment over the other, and no correlation was found between kyphosis and spinal canal narrowing in burst fractures of the thoracic and lumbar spine without neurological deficit. However, there was correlation between initial collapse and clinical outcome in some domains of the SF-36 questionnaire.

  18. Acknowledging Disproportionate Outcomes and Changing Service Delivery

    Science.gov (United States)

    McRoy, Ruth G.

    2008-01-01

    Child welfare is not the only system in which disparities have been identified in U.S. foster care. According to the recent Children's Defense Fund's report "America's Cradle to Prison Pipeline," racial and economic disparities exist in many systems including child welfare, health care, mental health, education, and juvenile and criminal justice.…

  19. 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...

  20. Bioenergy production from perennial energy crops: A consequential LCA of 12 bioenergy scenarios including land use changes

    DEFF Research Database (Denmark)

    Tonini, Davide; Hamelin, Lorie; Wenzel, Henrik

    2012-01-01

    and IV) co-firing in large scale coal-fired CHP plants. Soil carbon changes, direct and indirect land use changes as well as uncertainty analysis (sensitivity, MonteCarlo) were included in the LCA. Results showed that global warming was the bottleneck impact, where only two scenarios, namely willow...... and Miscanthus co-firing, allowed for an improvement as compared with the reference (-82 and -45 t CO2-eq. ha-1, respectively). The indirect land use changes impact was quantified as 310 ± 170 t CO2-eq. ha-1, representing a paramount average of 41% of the induced greenhouse gas emissions. The uncertainty...... analysis confirmed the results robustness and highlighted the indirect land use changes uncertainty as the only uncertainty that can significantly change the outcome of the LCA results. © 2012 American Chemical Society....

  1. 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

  2. Outcome and value uncertainties in global-change policy

    International Nuclear Information System (INIS)

    Hammitt, J.K.

    1995-01-01

    Choices among environmental policies can be informed by analysis of the potential physical, biological, and social outcomes of alternative choices, and analysis of social preferences among these outcomes. Frequently, however, the consequences of alternative policies cannot be accurately predicted because of substantial outcome uncertainties concerning physical, chemical, biological, and social processes linking policy choices to consequences. Similarly, assessments of social preferences among alternative outcomes are limited by value uncertainties arising from limitations of moral principles, the absence of economic markets for many environmental attributes, and other factors. Outcome and value uncertainties relevant to global-change policy are described and their magnitudes are examined for two cases: stratospheric-ozone depletion and global climate change. Analysis of information available in the mid 1980s, when international ozone regulations were adopted, suggests that contemporary uncertainties surrounding CFC emissions and the atmospheric response were so large that plausible ozone depletion, absent regulation, ranged from negligible to catastrophic, a range that exceeded the plausible effect of the regulations considered. Analysis of climate change suggests that, important as outcome uncertainties are, uncertainties about values may be even more important for policy choice. 53 refs., 3 figs., 3 tabs

  3. Family Structure Changes and Children's Health, Behavior, and Educational Outcomes

    DEFF Research Database (Denmark)

    Rasmussen, Astrid Würtz

    More and more children do not grow up in traditional nuclear families. Instead they grow up in single parent households or in families with a step-parent. Hence it is important to improve our understanding of the impact of "shocks" in family structure due to parental relationship dissolution...... on children. In this study I empirically test whether children are traumatized both in the short and the long run by shocks in the family structure during childhood. I focus on educational, behavioral, and health outcomes. A population sample of Danish children born in January to May 1983, 1984, and 1985...... is used for the analysis. The empirical cross-sectional analysis indicates a negative relation between the number of family structure changes and children.s educational outcomes. Children experiencing many family structure changes also seem to have worse health outcomes....

  4. Six-month changes in spirituality and religiousness in alcoholics predict drinking outcomes at nine months.

    Science.gov (United States)

    Robinson, Elizabeth A R; Krentzman, Amy R; Webb, Jon R; Brower, Kirk J

    2011-07-01

    Although spiritual change is hypothesized to contribute to recovery from alcohol dependence, few studies have used prospective data to investigate this hypothesis. Prior studies have also been limited to treatment-seeking and Alcoholics Anonymous (AA) samples. This study included alcohol-dependent individuals, both in treatment and not, to investigate the effect of spiritual and religious (SR) change on subsequent drinking outcomes, independent of AA involvement. Alcoholics (N = 364) were recruited for a panel study from two abstinence-based treatment centers, a moderation drinking program, and untreated individuals from the local community. Quantitative measures of SR change between baseline and 6 months were used to predict 9-month drinking outcomes, controlling for baseline drinking and AA involvement. Significant 6-month changes in 8 of 12 SR measures were found, which included private SR practices, beliefs, daily spiritual experiences, three measures of forgiveness, negative religious coping, and purpose in life. Increases in private SR practices and forgiveness of self were the strongest predictors of improvements in drinking outcomes. Changes in daily spiritual experiences, purpose in life, a general measure of forgiveness, and negative religious coping also predicted favorable drinking outcomes. SR change predicted good drinking outcomes in alcoholics, even when controlling for AA involvement. SR variables, broadly defined, deserve attention in fostering change even among those who do not affiliate with AA or religious institutions. Last, future research should include SR variables, particularly various types of forgiveness, given the strong effects found for forgiveness of self.

  5. Outcomes of Global Education: External and Internal Change Associated with Study Abroad

    Science.gov (United States)

    Miller-Perrin, Cindy; Thompson, Don

    2014-01-01

    This chapter provides an overview of external and internal changes associated with collegiate study abroad experiences. A brief review of the research literature is included along with recent research that sheds light on potential mechanisms associated with study abroad-related change. Recommendations for enhancing outcomes associated with study…

  6. Changing Recruitment Outcomes: The "Why" and the "How"

    Science.gov (United States)

    MacLean, Lisa; Pato, Michele T.

    2011-01-01

    Objective: Residency programs compete for applicants and commit extensive resources to the recruitment process. After failing to fill in the match for 5 years (1999-2004), this program decided to make changes in its recruitment process. The authors describe one program's experience in improving recruitment outcomes. Methods: The new training…

  7. Family Structure Changes and Children's Health, Behavior, and Educational Outcomes

    DEFF Research Database (Denmark)

    Rasmussen, Astrid Würtz

    More and more children do not grow up in traditional nuclear families. Instead, they grow up in single-parent households or in families with a step-parent. Hence, it is important to improve our understanding of the impact of "shocks" in family structure due to parental relationship dissolution...... on children. In this study I empirically test whether children are traumatized both in the short and the long run by shocks in the family structure during childhood. I focus on educational, behavioral, and health outcomes. A population sample of Danish children born in January to May 1985 is used...... for the analysis. The empirical cross-sectional analysis indicates a negative relation between the number of family structure changes and children.s health, behavior, and educational outcomes. These results are con.rmed by a differences-in-differences analysis of health outcomes. This suggests...

  8. Information management for global environmental change, including the Carbon Dioxide Information Analysis Center

    Energy Technology Data Exchange (ETDEWEB)

    Stoss, F.W. [Oak Ridge National Lab., TN (United States). Carbon Dioxide Information Analysis Center

    1994-06-01

    The issue of global change is international in scope. A body of international organizations oversees the worldwide coordination of research and policy initiatives. In the US the National Science and Technology Council (NSTC) was established in November of 1993 to provide coordination of science, space, and technology policies throughout the federal government. NSTC is organized into nine proposed committees. The Committee on Environmental and Natural Resources (CERN) oversees the US Department of Energy`s Global Change Research Program (USGCRP). As part of the USGCRP, the US Department of Energy`s Global Change Research Program aims to improve the understanding of Earth systems and to strengthen the scientific basis for the evaluation of policy and government action in response to potential global environmental changes. This paper examines the information and data management roles of several international and national programs, including Oak Ridge National Laboratory`s (ORNL`s) global change information programs. An emphasis will be placed on the Carbon Dioxide Information Analysis Center (CDIAC), which also serves as the World Data Center-A for Atmospheric Trace Gases.

  9. Bioenergy production from perennial energy crops: a consequential LCA of 12 bioenergy scenarios including land use changes.

    Science.gov (United States)

    Tonini, Davide; Hamelin, Lorie; Wenzel, Henrik; Astrup, Thomas

    2012-12-18

    In the endeavor of optimizing the sustainability of bioenergy production in Denmark, this consequential life cycle assessment (LCA) evaluated the environmental impacts associated with the production of heat and electricity from one hectare of Danish arable land cultivated with three perennial crops: ryegrass (Lolium perenne), willow (Salix viminalis) and Miscanthus giganteus. For each, four conversion pathways were assessed against a fossil fuel reference: (I) anaerobic co-digestion with manure, (II) gasification, (III) combustion in small-to-medium scale biomass combined heat and power (CHP) plants and IV) co-firing in large scale coal-fired CHP plants. Soil carbon changes, direct and indirect land use changes as well as uncertainty analysis (sensitivity, MonteCarlo) were included in the LCA. Results showed that global warming was the bottleneck impact, where only two scenarios, namely willow and Miscanthus co-firing, allowed for an improvement as compared with the reference (-82 and -45 t CO₂-eq. ha⁻¹, respectively). The indirect land use changes impact was quantified as 310 ± 170 t CO₂-eq. ha⁻¹, representing a paramount average of 41% of the induced greenhouse gas emissions. The uncertainty analysis confirmed the results robustness and highlighted the indirect land use changes uncertainty as the only uncertainty that can significantly change the outcome of the LCA results.

  10. 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.

  11. 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

  12. Including land use, land-use change, and forestry in future climate change, agreements. Thinking outside the box

    Energy Technology Data Exchange (ETDEWEB)

    Benndorf, R. [Federal Environment Agency, Bismarckplatz 1, D-1419 Berlin (Germany); Federici, S.; Somogyi, Z. [Joint Research Centre, European Commission, Via Enrico Fermi 1, I-21020 Ispra (Italy); Forner, C. [Center for International Forestry Research CIFOR, Jalan CIFOR Situ Gede, Bogor Barat 16680 (Indonesia); Pena, N. [Pew Center on Global Climate Change, 2101 Wilson Boulevard, Arlington, VA 22201 (United States); Rametsteiner, E. [IIASA, A-2361 Laxenburg (Austria); Sanz, M.J. [Fundacion CEAM, Charles H. Darwin 14, S-46980 Paterna, Valencia (Spain)

    2007-06-15

    This paper presents a framework that encompasses a full range of options for including land use, land-use change, and forestry (LULUCF) within future agreements under the United Nations Convention on Climate Change (UNFCCC). The intent is to provide options that can address the broad range of greenhouse gas (GHG) emissions and removals as well as to bring the broadest possible range of nations into undertaking mitigation efforts. We suggest that the approach taken for the Kyoto Protocol's first commitment period is only one within a much larger universe of possible approaches. This larger universe includes partially or completely 'de-linking' LULUCF commitments from those in other sectors, and allowing commitments specified in terms other than tonnes of greenhouse gases. Such approaches may provide clarity and transparency concerning the role of the various sectors in the agreements and encourage participation in agreements by a more inclusive, diverse set of countries, resulting in a more effective use of LULUCF in addressing climate change.

  13. Including land use, land-use change, and forestry in future climate change, agreements: thinking outside the box

    Energy Technology Data Exchange (ETDEWEB)

    Benndorf, R. [Federal Environment Agency, Bismarckplatz 1, D-1419 Berlin (Germany); Federici, S. [Joint Research Centre, European Commission, Via Enrico Fermi 1, I-21020 Ispra (Italy); Forner, C. [Center for International Forestry Research (CIFOR), Jalan CIFOR Situ Gede, Bogor Barat 16680 (Indonesia); Pena, N. [Pew Center on Global Climate Change, 2101 Wilson Boulevard, Arlington, VA 22201 (United States)]. E-mail: penan@pewclimate.org; Rametsteiner, E. [IIASA, A-2361 Laxenburg (Austria); Sanz, M.J. [Fundacion CEAM, Charles H. Darwin 14, S-46980 Paterna, Valencia (Spain); Somogyi, Z. [Joint Research Centre, European Commission, Via Enrico Fermi 1, I-21020 Ispra (Italy)

    2007-06-15

    This paper presents a framework that encompasses a full range of options for including land use, land-use change, and forestry (LULUCF) within future agreements under the United Nations Convention on Climate Change (UNFCCC). The intent is to provide options that can address the broad range of greenhouse gas (GHG) emissions and removals as well as to bring the broadest possible range of nations into undertaking mitigation efforts. We suggest that the approach taken for the Kyoto Protocol's first commitment period is only one within a much larger universe of possible approaches. This larger universe includes partially or completely 'de-linking' LULUCF commitments from those in other sectors, and allowing commitments specified in terms other than tonnes of greenhouse gases. Such approaches may provide clarity and transparency concerning the role of the various sectors in the agreements and encourage participation in agreements by a more inclusive, diverse set of countries, resulting in a more effective use of LULUCF in addressing climate change.

  14. Including land use, land-use change, and forestry in future climate change, agreements: thinking outside the box

    International Nuclear Information System (INIS)

    Benndorf, R.; Federici, S.; Forner, C.; Pena, N.; Rametsteiner, E.; Sanz, M.J.; Somogyi, Z.

    2007-01-01

    This paper presents a framework that encompasses a full range of options for including land use, land-use change, and forestry (LULUCF) within future agreements under the United Nations Convention on Climate Change (UNFCCC). The intent is to provide options that can address the broad range of greenhouse gas (GHG) emissions and removals as well as to bring the broadest possible range of nations into undertaking mitigation efforts. We suggest that the approach taken for the Kyoto Protocol's first commitment period is only one within a much larger universe of possible approaches. This larger universe includes partially or completely 'de-linking' LULUCF commitments from those in other sectors, and allowing commitments specified in terms other than tonnes of greenhouse gases. Such approaches may provide clarity and transparency concerning the role of the various sectors in the agreements and encourage participation in agreements by a more inclusive, diverse set of countries, resulting in a more effective use of LULUCF in addressing climate change

  15. Women's health: periodontitis and its relation to hormonal changes, adverse pregnancy outcomes and osteoporosis.

    Science.gov (United States)

    Krejci, Charlene B; Bissada, Nabil F

    2012-01-01

    To examine the literature with respect to periodontitis and issues specific to women's health, namely, hormonal changes, adverse pregnancy outcomes and osteoporosis. The literature was evaluated to review reported associations between periodontitis and genderspecific issues, namely, hormonal changes, adverse pregnancy outcomes and osteoporosis. Collectively, the literature provided a large body of evidence that supports various associations between periodontitis and hormonal changes, adverse pregnancy outcomes and osteoporosis; however, certain shortcomings were noted with respect to biases involving definitions, sample sizes and confounding variables. Specific cause and effect relationships could not be delineated at this time and neither could definitive treatment interventions. Future research must include randomised controlled trials with consistent definitions, adequate controls and sufficiently large sample sizes in order to clarify specific associations, identify cause and effect relationships, define treatment options and determine treatment interventions which will lessen the untoward effects on the at-risk populations.

  16. An approach to include soil carbon changes in life cycle assessments

    DEFF Research Database (Denmark)

    Petersen, Bjorn Molt; Knudsen, Marie Trydeman; Hermansen, John Erik

    2013-01-01

    to estimate carbon sequestration to be included in LCA is suggested and applied to two examples where the inclusion of carbon sequestration is especially relevant: 1) Bioenergy: removal of straw from a Danish soil for energy purposes and 2) Organic versus conventional farming: comparative study of soybean...... comparable to the IPCC 2006 tier I approach in a time perspective of 20 year, where after the suggested methodology showed a continued soil carbon change toward a new steady state. The suggested method estimated a carbon sequestration for the first example when storing straw in the soil instead of using...... it for bioenergy of 54, 97 and 213 kg C t(-1) straw C in a 200, 100 and 20 years perspective, respectively. For the conversion from conventional to organic soybean production, a difference of 32, 60 or 143 kg soil C ha(-1) yr(-1) in a 200,100 or 20 years perspective, respectively was found. The study indicated...

  17. Upgraded safety analysis document including operations policies, operational safety limits and policy changes. Revision 2

    International Nuclear Information System (INIS)

    Batchelor, K.

    1996-03-01

    The National Synchrotron Light Source Safety Analysis Reports (1), (2), (3), BNL reports number-sign 51584, number-sign 52205 and number-sign 52205 (addendum) describe the basic Environmental Safety and Health issues associated with the department's operations. They include the operating envelope for the Storage Rings and also the rest of the facility. These documents contain the operational limits as perceived prior or during construction of the facility, much of which still are appropriate for current operations. However, as the machine has matured, the experimental program has grown in size, requiring more supervision in that area. Also, machine studies have either verified or modified knowledge of beam loss modes and/or radiation loss patterns around the facility. This document is written to allow for these changes in procedure or standards resulting from their current mode of operation and shall be used in conjunction with the above reports. These changes have been reviewed by NSLS and BNL ES and H committee and approved by BNL management

  18. Healthcare restructuring and hierarchical alignment: why do staff and managers perceive change outcomes differently?

    Science.gov (United States)

    Walston, Stephen L; Chou, Ann F

    2006-09-01

    Healthcare organizations have undergone major change efforts in the past decade. Sustained change is related to continued alignment among organizational participants and may fail with incongruent perceptions of change. This study identifies factors contributing to the alignment in perceptions of organizational change outcomes between executives and all other employees. The sample included 10 hospitals with survey responses from 421 executives and other employees. Using hierarchical linear modeling (HLM), perceptual alignment was modeled at the first level as a function of goal commitment, goal clarity, goal acceptance, goal specificity, staff participation, available skill set, and knowledge and at the second level as organizational size. Descriptive statistics showed employee perception of outcomes differed among personnel levels. HLM results showed that goal specificity, appropriate staff training, reward incentives, effective communication, information sharing, and organization's ability to sustain changes induced perceptual alignment in change outcomes. Staff involvement in designing change efforts increased perceptual misalignment, whereas involvement during implementation and maintenance phases increased alignment. This research uses cross-sectional data from 10 hospitals. Data were gathered from surveys that may have recall bias as hospitals were surveyed at different times after the implementation of their restructuring. Our findings enhance the understanding of processes and mechanisms that enable healthcare organizations to align organizational participants' efforts during change. Results suggest that decision-makers should create incentives to encourage innovative practices, institute effective communication mechanisms, selectively disseminate information, and involve participants in implementing and maintaining changes to achieve intended outcomes. ORIGINALITY/VALUE OF ARTICLE: This article provides unique insight into the importance and causes of

  19. Space Solar Patrol data and changes in weather and climate, including global warming

    International Nuclear Information System (INIS)

    Avakyan, S V; Leonov, N B; Voronin, N A; Baranova, L A; Savinov, E P

    2010-01-01

    In this paper, the results obtained during the execution of several ISTC projects are presented. The general aim of these projects has been the study of global changes in the environment, connected with solar activity. A brief description of the optical apparatus of the Space Solar Patrol (SSP) developed and built in the framework of the ISTC projects 385, 385.2, 1523 and 2500 is given. The SSP is intended for permanent monitoring of spectra and absolute fluxes of soft x-ray and extreme ultraviolet (x-ray/EUV) radiation from the full disk of the Sun which ionizes the upper atmosphere of the Earth. Permanent solar monitoring in the main part of the ionizing radiation spectra 0.8–115 (119) nm does not exist. The apparatus of the SSP was developed in the years 1996–2005 with multiyear experience of developing such apparatus in S I Vavilov State Optical Institute. The basis of this apparatus is the use of unique detectors of ionizing radiation—open secondary electron multipliers, which are 'solar blind' to near UV, visible and IR radiation from the Sun, and new methodology of these solar spectroradiometric absolute measurements. The prospects are discussed of using the SSP data for the investigation and forecast of the influence of solar variability on the weather and climate including global warming and also on the biosphere including human beings (proposal 3878)

  20. 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.

  1. White matter microstructural changes in adolescent anorexia nervosa including an exploratory longitudinal study

    Science.gov (United States)

    Vogel, Katja; Timmers, Inge; Kumar, Vinod; Nickl-Jockschat, Thomas; Bastiani, Matteo; Roebroek, Alard; Herpertz-Dahlmann, Beate; Konrad, Kerstin; Goebel, Rainer; Seitz, Jochen

    2016-01-01

    Background Anorexia nervosa (AN) often begins in adolescence, however, the understanding of the underlying pathophysiology at this developmentally important age is scarce, impeding early interventions. We used diffusion tensor imaging (DTI) to investigate microstructural white matter (WM) brain changes including an experimental longitudinal follow-up. Methods We acquired whole brain diffusion-weighted brain scans of 22 adolescent female hospitalized patients with AN at admission and nine patients longitudinally at discharge after weight rehabilitation. Patients (10–18 years) were compared to 21 typically developing controls (TD). Tract-based spatial statistics (TBSS) were applied to compare fractional anisotropy (FA) across groups and time points. Associations between average FA values of the global WM skeleton and weight as well as illness duration parameters were analyzed by multiple linear regression. Results We observed increased FA in bilateral frontal, parietal and temporal areas in AN patients at admission compared to TD. Higher FA of the global WM skeleton at admission was associated with faster weight loss prior to admission. Exploratory longitudinal analysis showed this FA increase to be partially normalized after weight rehabilitation. Conclusions Our findings reveal a markedly different pattern of WM microstructural changes in adolescent AN compared to most previous results in adult AN. This could signify a different susceptibility and reaction to semi-starvation in the still developing brain of adolescents or a time-dependent pathomechanism differing with extend of chronicity. Higher FA at admission in adolescents with AN could point to WM fibers being packed together more closely. PMID:27182488

  2. Space Solar Patrol data and changes in weather and climate, including global warming

    Science.gov (United States)

    Avakyan, S. V.; Baranova, L. A.; Leonov, N. B.; Savinov, E. P.; Voronin, N. A.

    2010-08-01

    In this paper, the results obtained during the execution of several ISTC projects are presented. The general aim of these projects has been the study of global changes in the environment, connected with solar activity. A brief description of the optical apparatus of the Space Solar Patrol (SSP) developed and built in the framework of the ISTC projects 385, 385.2, 1523 and 2500 is given. The SSP is intended for permanent monitoring of spectra and absolute fluxes of soft x-ray and extreme ultraviolet (x-ray/EUV) radiation from the full disk of the Sun which ionizes the upper atmosphere of the Earth. Permanent solar monitoring in the main part of the ionizing radiation spectra 0.8-115 (119) nm does not exist. The apparatus of the SSP was developed in the years 1996-2005 with multiyear experience of developing such apparatus in S I Vavilov State Optical Institute. The basis of this apparatus is the use of unique detectors of ionizing radiation—open secondary electron multipliers, which are 'solar blind' to near UV, visible and IR radiation from the Sun, and new methodology of these solar spectroradiometric absolute measurements. The prospects are discussed of using the SSP data for the investigation and forecast of the influence of solar variability on the weather and climate including global warming and also on the biosphere including human beings (proposal 3878). This article was originally submitted for inclusion with the papers from the 9th International Symposium on Measurement Science and Intelligent Instruments (ISMTII-2009), published in the May 2010 issue.

  3. Empirical Validation of a Thermal Model of a Complex Roof Including Phase Change Materials

    Directory of Open Access Journals (Sweden)

    Stéphane Guichard

    2015-12-01

    Full Text Available This paper deals with the empirical validation of a building thermal model of a complex roof including a phase change material (PCM. A mathematical model dedicated to PCMs based on the heat apparent capacity method was implemented in a multi-zone building simulation code, the aim being to increase the understanding of the thermal behavior of the whole building with PCM technologies. In order to empirically validate the model, the methodology is based both on numerical and experimental studies. A parametric sensitivity analysis was performed and a set of parameters of the thermal model has been identified for optimization. The use of the generic optimization program called GenOpt® coupled to the building simulation code enabled to determine the set of adequate parameters. We first present the empirical validation methodology and main results of previous work. We then give an overview of GenOpt® and its coupling with the building simulation code. Finally, once the optimization results are obtained, comparisons of the thermal predictions with measurements are found to be acceptable and are presented.

  4. Changes in bone mineral metabolism parameters, including FGF23, after discontinuing cinacalcet at kidney transplantation.

    Science.gov (United States)

    Barros, Xoana; Fuster, David; Paschoalin, Raphael; Oppenheimer, Federico; Rubello, Domenico; Perlaza, Pilar; Pons, Francesca; Torregrosa, Jose V

    2015-05-01

    Little is known about the effects of the administration of cinacalcet in dialytic patients who are scheduled for kidney transplantation, and in particular about the changes in FGF23 and other mineral metabolism parameters after surgery compared with recipients not on cinacalcet at kidney transplantation. We performed a prospective observational cohort study with recruitment of consecutive kidney transplant recipients at our institution. Patients were classified according to whether they were under treatment with cinacalcet before transplantation. Bone mineral metabolism parameters, including C-terminal FGF23, were measured at baseline, on day 15, and at 1, 3, and 6 months after transplantation. In previously cinacalcet-treated patients, cinacalcet therapy was discontinued on the day of surgery and was not restarted after transplantation. A total of 48 kidney transplant recipients, 20 on cinacalcet at surgery and 28 cinacalcet non-treated patients, completed the follow-up. Serum phosphate declined significantly in the first 15 days after transplantation with no differences between the two groups, whereas cinacalcet-treated patients showed higher FGF23 levels, although not significant. After transplantation, PTH and serum calcium were significantly higher in cinacalcet-treated patients. We conclude that patients receiving cinacalcet on dialysis presented similar serum phosphate levels but higher PTH and serum calcium levels during the initial six months after kidney transplantation than cinacalcet non-treated patients. The group previously treated with cinacalcet before transplantation showed higher FGF23 levels without significant differences, so further studies should investigate its relevance in the management of these patients.

  5. Changing existing qualifications into outcomes-based qualifications ...

    African Journals Online (AJOL)

    Various workshops were facilitated to determine the outcomes of each level of our qualification, B Tech: Policing. This led to the formulation of a purpose statement, exit level outcomes and specific outcomes as well as assessment criteria and the critical outcomes embedded in each level identified. Using the specific ...

  6. Correlating changes in lung function with patient outcomes in chronic obstructive pulmonary disease: a pooled analysis

    Directory of Open Access Journals (Sweden)

    Jones Paul W

    2011-12-01

    Full Text Available Abstract Background Relationships between improvements in lung function and other clinical outcomes in chronic obstructive pulmonary disease (COPD are not documented extensively. We examined whether changes in trough forced expiratory volume in 1 second (FEV1 are correlated with changes in patient-reported outcomes. Methods Pooled data from three indacaterol studies (n = 3313 were analysed. Means and responder rates for outcomes including change from baseline in Transition Dyspnoea Index (TDI, St. George's Respiratory Questionnaire (SGRQ scores (at 12, 26 and 52 weeks, and COPD exacerbation frequency (rate/year were tabulated across categories of ΔFEV1. Also, generalised linear modelling was performed adjusting for covariates such as baseline severity and inhaled corticosteroid use. Results With increasing positive ΔFEV1, TDI and ΔSGRQ improved at all timepoints, exacerbation rate over the study duration declined (P 1 was associated with improved TDI (0.46 units, ΔSGRQ (1.3-1.9 points and exacerbation rate (12% decrease. Overall, adjustments for baseline covariates had little impact on the relationship between ΔFEV1 and outcomes. Conclusions These results suggest that larger improvements in FEV1 are likely to be associated with larger patient-reported benefits across a range of clinical outcomes. Trial Registration ClinicalTrials.gov NCT00393458, NCT00463567, and NCT00624286

  7. 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

  8. Exergo-economic analysis of finned tube for waste heat recovery including phase change heat transfer

    International Nuclear Information System (INIS)

    Wu, Shuang Ying; Jiu, Jing Rui; Xiao, Lan; Li, You Rong; Liu, Chao; Xu, Jin Liang

    2013-01-01

    In this paper, an exergo-economic criterion, i.e. the net profit per unit transferred heat load, is established from the perspective of exergy recovery to evaluate the performance of finned tube used in waste heat recovery. Also, the dimensionless exergy change number is introduced to investigate the effect of the flow (mechanical) exergy loss rate on the recovered thermal exergy. Selecting R245fa as a working fluid and exhaust flue gas as a heat source, the effects of the internal Reynolds number Re_i, the external Reynolds number Re_o , the unit cost of thermal exergy ε_q , the geometric parameter of finned tube η_oβ and the phase change temperature T_v etc. on the performance of finned tube are discussed in detail. The results show that the higher T_v and η_oβ, and lower Re_i may lead to the negligible flow(mechanical) exergy loss rate. There exists an optimal value of Re_i where the net profit per unit transferred heat load peaks, while the variations of Re_o, ε_q and T_v cause monotonic change of the net profit per unit transferred heat load. The phase change temperature exerts relatively greater influence on the exergo-economic performance of finned tube in comparison with other parameters. And there exists a critical phase change temperature, where the net profit per unit transferred heat load is equal to zero.

  9. Coastal erosion's influencing factors include development, dams, wells, and climate change

    International Nuclear Information System (INIS)

    Aubrey, D.G.

    1993-01-01

    The demographic flight to the coast, begun in early civilization, continues unabated worldwide according to latest studies. The percentage of population living on the coast is expected to remain relatively constant over the next few decades, but the total numbers will increase as the population increases. Recent coastal battering by hurricanes and extratropical storms poses questions about coastal habitability and the real economics of coastal development. Repair costs are borne by private individuals as well as the public in various direct and indirect ways. As these costs escalate, it is fitting to ask what the future portends for storm and coastal-flood damage. It is known that development pressures will continue to increase along the coast, but what will happen concurrently to natural-hazard threats to this infrastructure? Though much emphasis has been placed on sea-level rise, the broader issue is climate change in general. Here, the author considers climate change in both its natural and anthropogenic perspectives. Without becoming mired in the debate about the greenhouse effect and human influence on climatic shifts, some of the broad classes of natural hazards that might accompany climate change are examined. There are several categories of possible global-change effects on coastal erosion. In the early 1980's, an Environmental Protection Agency (EPA) report postulated increases in global sea level up to 4 meters during the next 100 years. Though balanced somewhat by other, lower estimates of sea-level rise, this higher extreme grabbed public attention. During the next decade, scientists attempted to concur on a more reasonable estimate of global sea-level rise due to climate change. Recent credible estimates suggest that approximately 10 to 20 percent of EPA's earlier maximum estimate is most reasonable

  10. Bayesian Nonparametric Estimation of Targeted Agent Effects on Biomarker Change to Predict Clinical Outcome

    Science.gov (United States)

    Graziani, Rebecca; Guindani, Michele; Thall, Peter F.

    2015-01-01

    Summary The effect of a targeted agent on a cancer patient's clinical outcome putatively is mediated through the agent's effect on one or more early biological events. This is motivated by pre-clinical experiments with cells or animals that identify such events, represented by binary or quantitative biomarkers. When evaluating targeted agents in humans, central questions are whether the distribution of a targeted biomarker changes following treatment, the nature and magnitude of this change, and whether it is associated with clinical outcome. Major difficulties in estimating these effects are that a biomarker's distribution may be complex, vary substantially between patients, and have complicated relationships with clinical outcomes. We present a probabilistically coherent framework for modeling and estimation in this setting, including a hierarchical Bayesian nonparametric mixture model for biomarkers that we use to define a functional profile of pre-versus-post treatment biomarker distribution change. The functional is similar to the receiver operating characteristic used in diagnostic testing. The hierarchical model yields clusters of individual patient biomarker profile functionals, and we use the profile as a covariate in a regression model for clinical outcome. The methodology is illustrated by analysis of a dataset from a clinical trial in prostate cancer using imatinib to target platelet-derived growth factor, with the clinical aim to improve progression-free survival time. PMID:25319212

  11. White matter microstructural changes in adolescent anorexia nervosa including an exploratory longitudinal study

    Directory of Open Access Journals (Sweden)

    Katja Vogel

    2016-01-01

    Conclusions: Our findings reveal a markedly different pattern of WM microstructural changes in adolescent AN compared to most previous results in adult AN. This could signify a different susceptibility and reaction to semi-starvation in the still developing brain of adolescents or a time-dependent pathomechanism differing with extend of chronicity. Higher FA at admission in adolescents with AN could point to WM fibers being packed together more closely.

  12. 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...

  13. 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…

  14. Hypergravity disruption of homeorhetic adaptations to lactation in rat dams include changes in circadian clocks

    Directory of Open Access Journals (Sweden)

    Theresa Casey

    2012-04-01

    Altered gravity load induced by spaceflight (microgravity and centrifugation (hypergravity is associated with changes in circadian, metabolic, and reproductive systems. Exposure to 2-g hypergravity (HG during pregnancy and lactation decreased rate of mammary metabolic activity and increased pup mortality. We hypothesize HG disrupted maternal homeorhetic responses to pregnancy and lactation are due to changes in maternal metabolism, hormone concentrations, and maternal behavior related to gravity induced alterations in circadian clocks. Effect of HG exposure on mammary, liver and adipose tissue metabolism, plasma hormones and maternal behavior were analyzed in rat dams from mid-pregnancy (Gestational day [G]11 through early lactation (Postnatal day [P]3; comparisons were made across five time-points: G20, G21, P0 (labor and delivery, P1 and P3. Blood, mammary, liver, and adipose tissue were collected for analyzing plasma hormones, glucose oxidation to CO2 and incorporation into lipids, or gene expression. Maternal behavioral phenotyping was conducted using time-lapse videographic analyses. Dam and fetal-pup body mass were significantly reduced in HG in all age groups. HG did not affect labor and delivery; however, HG pups experienced a greater rate of mortality. PRL, corticosterone, and insulin levels and receptor genes were altered by HG. Mammary, liver and adipose tissue metabolism and expression of genes that regulate lipid metabolism were altered by HG exposure. Exposure to HG significantly changed expression of core clock genes in mammary and liver and circadian rhythms of maternal behavior. Gravity load alterations in dam's circadian system may have impacted homeorhetic adaptations needed for a successful lactation.

  15. Outcome of biopsy proven minimal change disease (MCD) in children

    African Journals Online (AJOL)

    Background and Objectives: MCD is the most common histological sub-type of nephrotic syndrome with variable clinical course in children. There are limited studies in literature on the outcome of biopsy proven MCD. The objective was to look at the treatment response and outcome of patients with MCD treated at a tertiary ...

  16. Axisymmetric disruption dynamics including current profile changes in the ASDEX-Upgrade tokamak

    International Nuclear Information System (INIS)

    Nakamura, Y.; Pautasso, G.; Gruber, O.; Jardin, S.C.

    2002-01-01

    Axisymmetric MHD simulations have revealed a new driving mechanism that governs the vertical displacement event (VDE) dynamics in tokamak disruptions. A rapid flattening of the plasma current profile during the disruption plays a substantial role in dragging a single null-diverted plasma vertically towards the divertor. As a consequence, the occurrence of downward-going VDEs predominates over the upward-going ones in bottom-diverted discharges. This dragging effect, due to an abrupt change in the current profile, is absent in up-down symmetric limiter discharges. These simulation results are consistent with experiments in ASDEX-Upgrade. Together with the attractive force that arises from passive shell currents induced by the plasma current quench, the dragging effect explains many details of the VDE dynamics over the whole period of the disruptive termination. (author)

  17. Should we include avoidance of deforestation in the international response to climate change?

    Energy Technology Data Exchange (ETDEWEB)

    Schlamadinger, B. [Joanneum Research, Graz (Austria); Ciccarese, L. [Italian Agency for Environmental Protection and Technical Services, Rome (Italy); Dutschke, M. [Hamburg Institute of International Economics, Hamburg (Germany); Fearnside, P.M. [Department of Ecology, National Institute for Amazonian Research INPA, Belem, Para (Brazil); Brown, S. [Winrock International, Little Rock, Arkansas (United States); Murdiyarso, D. [Center for International Forestry Research, Jakarta (Indonesia)

    2005-07-01

    Global deforestation and forest degradation rates have a significant impact on the accumulation of greenhouse gases (GHGs) in the atmosphere. The Food and Agriculture Organization (FAO) estimated that during the 1990's 16.1 million hectares per year were affected by deforestation, most of them in the tropics. The Intergovernmental Panel on Climate Change (IPCC) calculated that, for the same period, the contribution of land-use changes to GHG accumulation into the atmosphere was 1.6{+-}0.8 Giga (1G=109) tonnes of carbon per year, a quantity that corresponds to 25% of the total annual global emissions of GHGs. The United Nations Framework Convention on Climate Change (UNFCCC), in recognising climate change as a serious threat, urged counties to take up measures to enhance and conserve ecosystems such as forests that act as reservoirs and sinks of GHGs. The Kyoto Protocol (KP), adopted in 1997, complements the UNFCCC by providing an enforceable agreement with quantitative targets for reducing GHG emissions. For fulfilling their emission-limitation commitments under the KP, industrialized countries (listed in the KP's Annex I) can use land-based activities, such as reducing deforestation, establishing new forests (afforestation and reforestation) and other vegetation types, managing agricultural and forestlands in a way that the 'carbon sink' is maximized. Annex I countries may also claim credit for carbon sequestration in developing countries by afforestation and reforestation (AR) through the Clean Development Mechanism (CDM), one of the 'Kyoto Mechanisms' that allow countries to achieve reductions where it is economically efficient to do so. For the period 2008-2012, forestry activities under the CDM have been restricted to afforestation and reforestation on areas that were not forested in 1990. In addition, CDM projects must lead to emission reductions or net carbon uptake additional to what would have occurred without the CDM funding

  18. Early changes in brain structure correlate with language outcomes in children with neonatal encephalopathy.

    Science.gov (United States)

    Shapiro, Kevin A; Kim, Hosung; Mandelli, Maria Luisa; Rogers, Elizabeth E; Gano, Dawn; Ferriero, Donna M; Barkovich, A James; Gorno-Tempini, Maria Luisa; Glass, Hannah C; Xu, Duan

    2017-01-01

    Global patterns of brain injury correlate with motor, cognitive, and language outcomes in survivors of neonatal encephalopathy (NE). However, it is still unclear whether local changes in brain structure predict specific deficits. We therefore examined whether differences in brain structure at 6 months of age are associated with neurodevelopmental outcomes in this population. We enrolled 32 children with NE, performed structural brain MR imaging at 6 months, and assessed neurodevelopmental outcomes at 30 months. All subjects underwent T1-weighted imaging at 3 T using a 3D IR-SPGR sequence. Images were normalized in intensity and nonlinearly registered to a template constructed specifically for this population, creating a deformation field map. We then used deformation based morphometry (DBM) to correlate variation in the local volume of gray and white matter with composite scores on the Bayley Scales of Infant and Toddler Development (Bayley-III) at 30 months. Our general linear model included gestational age, sex, birth weight, and treatment with hypothermia as covariates. Regional brain volume was significantly associated with language scores, particularly in perisylvian cortical regions including the left supramarginal gyrus, posterior superior and middle temporal gyri, and right insula, as well as inferior frontoparietal subcortical white matter. We did not find significant correlations between regional brain volume and motor or cognitive scale scores. We conclude that, in children with a history of NE, local changes in the volume of perisylvian gray and white matter at 6 months are correlated with language outcome at 30 months. Quantitative measures of brain volume on early MRI may help identify infants at risk for poor language outcomes.

  19. Early changes in brain structure correlate with language outcomes in children with neonatal encephalopathy

    Directory of Open Access Journals (Sweden)

    Kevin A. Shapiro

    2017-01-01

    Full Text Available Global patterns of brain injury correlate with motor, cognitive, and language outcomes in survivors of neonatal encephalopathy (NE. However, it is still unclear whether local changes in brain structure predict specific deficits. We therefore examined whether differences in brain structure at 6 months of age are associated with neurodevelopmental outcomes in this population. We enrolled 32 children with NE, performed structural brain MR imaging at 6 months, and assessed neurodevelopmental outcomes at 30 months. All subjects underwent T1-weighted imaging at 3 T using a 3D IR-SPGR sequence. Images were normalized in intensity and nonlinearly registered to a template constructed specifically for this population, creating a deformation field map. We then used deformation based morphometry (DBM to correlate variation in the local volume of gray and white matter with composite scores on the Bayley Scales of Infant and Toddler Development (Bayley-III at 30 months. Our general linear model included gestational age, sex, birth weight, and treatment with hypothermia as covariates. Regional brain volume was significantly associated with language scores, particularly in perisylvian cortical regions including the left supramarginal gyrus, posterior superior and middle temporal gyri, and right insula, as well as inferior frontoparietal subcortical white matter. We did not find significant correlations between regional brain volume and motor or cognitive scale scores. We conclude that, in children with a history of NE, local changes in the volume of perisylvian gray and white matter at 6 months are correlated with language outcome at 30 months. Quantitative measures of brain volume on early MRI may help identify infants at risk for poor language outcomes.

  20. Monitoring risk-adjusted medical outcomes allowing for changes over time.

    Science.gov (United States)

    Steiner, Stefan H; Mackay, R Jock

    2014-10-01

    We consider the problem of monitoring and comparing medical outcomes, such as surgical performance, over time. Performance is subject to change due to a variety of reasons including patient heterogeneity, learning, deteriorating skills due to aging, etc. For instance, we expect inexperienced surgeons to improve their skills with practice. We propose a graphical method to monitor surgical performance that incorporates risk adjustment to account for patient heterogeneity. The procedure gives more weight to recent outcomes and down-weights the influence of outcomes further in the past. The chart is clinically interpretable as it plots an estimate of the failure rate for a "standard" patient. The chart also includes a measure of uncertainty in this estimate. We can implement the method using historical data or start from scratch. As the monitoring proceeds, we can base the estimated failure rate on a known risk model or use the observed outcomes to update the risk model as time passes. We illustrate the proposed method with an example from cardiac surgery. © The Author 2013. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. How do you tell whether a change in surgical technique leads to a change in outcome?

    Science.gov (United States)

    Vickers, Andrew J; Cronin, Angel M; Masterson, Timothy A; Eastham, James A

    2010-04-01

    Surgeons routinely evaluate and modify their surgical technique to improve patient outcome. It is also common for surgeons to analyze results before and after a change in technique to determine whether the change led to better results. Simple comparison of results before and after surgical modification may be confounded by the surgical learning curve. We developed a statistical method applicable to analyzing before/after surgical studies. We used simulation studies to compare different statistical analyses of before/after studies. We evaluated a simple 2-group comparison of results before and after the modification by the chi-square test and a novel bootstrap method that adjusts for the surgical learning curve. In the presence of the learning curve a simple 2-group comparison almost always showed an ineffective surgical modification to be of benefit. When the surgical modification was harmful, leading to a 10% decrease in the success rate, 2-group comparison nonetheless showed a statistically significant improvement in outcome about 80% of the time. The bootstrap method had only moderate power but did not show that ineffective surgical modifications were beneficial more than would be expected by chance. Simplistic approaches to the analysis of before/after surgical studies may lead to grossly erroneous results under the surgical learning curve. A straightforward alternative statistical method allows investigators to separate the effects of the learning curve from those of the surgical modification. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  2. Climate Change Professional Development: Design, Implementation, and Initial Outcomes on Teacher Learning, Practice, and Student Beliefs

    Science.gov (United States)

    Shea, Nicole A.; Mouza, Chrystalla; Drewes, Andrea

    2016-04-01

    In this work, we present the design, implementation, and initial outcomes of the Climate Academy, a hybrid professional development program delivered through a combination of face-to-face and online interactions, intended to prepare formal and informal science teachers (grades 5-16) in teaching about climate change. The Climate Academy was designed around core elements of successful environmental professional development programs and aligned with practices advocated in benchmarked science standards. Data were collected from multiple sources including observations of professional development events, participants' reflections on their learning, and collection of instructional units designed during the Academy. Data were also collected from a focal case study teacher in a middle school setting. Case study data included classroom observations, teacher interviews, and student beliefs toward climate change. Results indicated that the Climate Academy fostered increased learning among participants of both climate science content and pedagogical strategies for teaching about climate change. Additionally, results indicated that participants applied their new learning in the design of climate change instructional units. Finally, results from the case study indicated positive impacts on student beliefs and greater awareness about climate change. Results have implications for the design of professional development programs on climate change, a topic included for the first time in national standards.

  3. The relationship between change in subjective outcome and change in disease: a potential paradox.

    Science.gov (United States)

    Kievit, Wietske; Hendrikx, Jos; Stalmeier, Peep F M; van de Laar, Mart A F J; Van Riel, Piet L C M; Adang, Eddy M

    2010-09-01

    Response shift theory suggests that improvements in health lead patients to change their internal standards and re-assess former health states as worse than initially rated when using retrospective ratings via the then-test. The predictions of response shift theory can be illustrated using prospect theory, whereby a change in current health causes a change in reference frame. Therefore, if health deteriorates, the former health state will receive a better rating, whereas if it improves, the former health state will receive a worse rating. To explore the predictions of response shift and prospect theory by relating subjective change to objective change. Baseline and 3-month follow-up data from a cohort of rheumatoid arthritis patients (N = 197) starting on TNFalpha-blocking agents were used. Objective disease change was classified according to a disease-specific clinical outcome measure (DAS28). Visual analogue scales (VAS) for general health (GH) and pain were used as self-reported measures. Three months after starting on anti-TNFalpha, patients used the then-test to re-rate their baseline health with regard to general health and pain. Differences between then-test value and baseline values were calculated and tested between improved, non-improved and deteriorated patients by the Student t-test. At 3 months, 51 (25.9%) patients had good improvement in health, 83 (42.1%) had moderate improvement, and 63 (32.0%) had no improvement or deteriorated in health. All patients no matter whether they improved, did not improve, or even became worse rated their health as worse retrospectively. The difference between the then-test rating and the baseline value was similarly sized in all groups. More positive ratings of retrospective health are independent of disease change. This suggests that patients do not necessarily change their standards in line with their disease change, and therefore it is inappropriate to use the then-test to correct for such a change. If a then-test is

  4. 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.

  5. Gait Change Is Associated with Cognitive Outcome after an Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Sharmila Sagnier

    2017-05-01

    Full Text Available Background: Cognition and gait have often been studied separately after stroke whereas it has been suggested that these two domains could interact through a cognitive-motor interference.Objective: To evaluate the influence of gait changes on cognitive outcome after an ischemic stroke (IS.Methods: We conducted a prospective and monocentric study including patients admitted for an acute supratentorial IS with a National Institute of Health Stroke Score ≤ 15. Cognition, gait and motor disability were evaluated at baseline, 3 months and 1 year post-stroke, using the Montreal Cognitive Assessment (MoCA, the 10-m walking test (10-MWT and the Fugl-Meyer motor assessment (FMMA. The effect of changes in 10-MWT over the year of follow-up on MoCA changes was estimated using a generalized linear mixed model with FMMA, age and gender as covariates.Results: Two hundred and Twelve patients were included (71% male, age 64 ± 13 years old. 10-MWT improved from baseline to 1 year (p < 0.001, as did MoCA (p < 0.001 and FMMA (p < 0.001 scores. Ninety-nine patients (47% had a MoCA <26 at 1 year. Changes in 10-MWT were independently associated with changes in MoCA (β = −0.2, 95% CI −0.24 to −0.07, Bonferroni-corrected p-value = 0.002. Analyses of MoCA sub-scores suggested that changes in gait performance was associated with changes in executive functions and recall.Conclusion: Gait performance is associated with cognitive outcome after a mild to moderate IS, suggesting that they should be managed together to improve post-stroke independence.

  6. Validation on groundwater flow model including sea level change. Modeling on groundwater flow in coastal granite area

    International Nuclear Information System (INIS)

    Hasegawa, Takuma; Miyakawa, Kimio

    2009-01-01

    It is important to verify the groundwater flow model that reproduces pressure head, water chemistry, and groundwater age. However, water chemistry and groundwater age are considered to be influenced by historical events. In this study, sea level change during glacial-interglacial cycle was taken into account for simulating salinity and groundwater age at coastal granite area. As a result of simulation, salinity movement could not catch up with sea level changes, and mixing zone was formed below the fresh-water zone. This mixing zone was observed in the field measurement, and the observed salinities were agreed with simulated results including sea level change. The simulated residence time including sea level change is one-tenth of steady state. The reason is that the saline water was washed out during regression and modern sea-water was infiltrated during transgression. As mentioned before, considering sea level change are important to reproduce salinity and helium age at coastal area. (author)

  7. Participation in a National Lifestyle Change Program is associated with improved diabetes Control outcomes.

    Science.gov (United States)

    Jackson, Sandra L; Staimez, Lisa R; Safo, Sandra; Long, Qi; Rhee, Mary K; Cunningham, Solveig A; Olson, Darin E; Tomolo, Anne M; Ramakrishnan, Usha; Narayan, Venkat K M; Phillips, Lawrence S

    2017-09-01

    Clinical trials show lifestyle change programs are beneficial, yet large-scale, successful translation of these programs is scarce. We investigated the association between participation in the largest U.S. lifestyle change program, MOVE!, and diabetes control outcomes. This longitudinal, retrospective cohort study used Veterans Health Administration databases of patients with diabetes who participated in MOVE! between 2005 and 2012, or met eligibility criteria (BMI ≥25kg/m 2 ) but did not participate. Main outcomes were diabetic eye disease, renal disease, and medication intensification. There were 400,170 eligible patients with diabetes, including 87,366 (22%) MOVE! Included patients were 96% male, 77% white, with mean age 58years and BMI 34kg/m 2 . Controlling for baseline measurements and age, race, sex, BMI, and antidiabetes medications, MOVE! participants had lower body weight (-0.6kg), random plasma glucose (-2.8mg/dL), and HbA1c (-0.1%) at 12months compared to nonparticipants (each plifestyle change programs in U.S. health systems may improve health among the growing patient population with diabetes. Published by Elsevier Inc.

  8. A reanalysis of a behavioral intervention to prevent incident HIV infections: Including indirect effects in modeling outcomes of Project EXPLORE

    Science.gov (United States)

    Eaton, Lisa A.; Kalichman, Seth C.; Kenny, David A.; Harel, Ofer

    2013-01-01

    Background Project EXPLORE -- a large-scale, behavioral intervention tested among men who have sex with men (MSM) at-risk for HIV infection --was generally deemed as ineffective in reducing HIV incidence. Using novel and more precise data analytic techniques we reanalyzed Project EXPLORE by including both direct and indirect paths of intervention effects. Methods Data from 4,296 HIV negative MSM who participated in Project EXPLORE, which included ten sessions of behavioral risk reduction counseling completed from 1999-2005, were included in the analysis. We reanalyzed the data to include parameters that estimate the overtime effects of the intervention on unprotected anal sex and the over-time effects of the intervention on HIV status mediated by unprotected anal sex simultaneously in a single model. Results We found the indirect effect of intervention on HIV infection through unprotected anal sex to be statistically significant up through 12 months post-intervention, OR=.83, 95% CI=.72-.95. Furthermore, the intervention significantly reduced unprotected anal sex up through 18 months post-intervention, OR=.79, 95% CI=.63-.99. Discussion Our results reveal effects not tested in the original model that offer new insight into the effectiveness of a behavioral intervention for reducing HIV incidence. Project EXPLORE demonstrated that when tested against an evidence-based, effective control condition can result in reductions in rates of HIV acquisition at one year follow-up. Findings highlight the critical role of addressing behavioral risk reduction counseling in HIV prevention. PMID:23245226

  9. Teachable moments for health behavior change and intermediate patient outcomes.

    Science.gov (United States)

    Flocke, Susan A; Clark, Elizabeth; Antognoli, Elizabeth; Mason, Mary Jane; Lawson, Peter J; Smith, Samantha; Cohen, Deborah J

    2014-07-01

    Teachable moments (TM) are opportunities created through physician-patient interaction and used to encourage patients to change unhealthy behaviors. We examine the effectiveness of TMs to increase patients' recall of advice, motivation to modify behavior, and behavior change. A mixed-method observational study of 811 patient visits to 28 primary care clinicians used audio-recordings of visits to identify TMs and other types of advice in health behavior change talk. Patient surveys assessed smoking, exercise, fruit/vegetable consumption, height, weight, and readiness for change prior to the observed visit and 6-weeks post-visit. Compared to other identified categories of advice (i.e. missed opportunities or teachable moment attempts), recall was greatest after TMs occurred (83% vs. 49-74%). TMs had the greatest proportion of patients change in importance and confidence and increase readiness to change; however differences were small. TMs had greater positive behavior change scores than other categories of advice; however, this pattern was statistically non-significant and was not observed for BMI change. TMs have a greater positive influence on several intermediate markers of patient behavior change compared to other categories of advice. TMs show promise as an approach for clinicians to discuss behavior change with patients efficiently and effectively. Copyright © 2014. Published by Elsevier Ireland Ltd.

  10. Weight change from 3-year observational data: findings from the worldwide schizophrenia outpatient health outcomes database.

    Science.gov (United States)

    Bushe, Chris J; Slooff, Cees J; Haddad, Peter M; Karagianis, Jamie L

    2012-06-01

    Weight change data from randomized clinical trials are often of limited duration and trials do not always report a full range of clinically relevant categorical end points. We conducted a post hoc analysis of data from the observational Worldwide Schizophrenia Outpatient Health Outcomes database (2000-2005) on weight change in 4,626 patients completing 3 years of antipsychotic monotherapy with amisulpride, clozapine, olanzapine, quetiapine, risperidone, and oral and depot first-generation antipsychotics (FGAs). Reported outcomes included mean and categorical weight changes and the trajectories of different measures of weight change. Mean weight gain was lowest with amisulpride (1.8 kg; 95% CI, 0.2-3.3) and highest with olanzapine (4.2 kg; 95% CI, 3.9-4.5). Weight change for all antipsychotics was most rapid during the first 6 months; subsequent weight change was slower but did not plateau. All drugs showed considerable individual variation in weight change. The proportion losing ≥7% of their baseline bodyweight was highest with quetiapine (10%; 95% CI, 7%-16%) and lowest with depot FGAs (5%; 95% CI, 3%-10%). Between 7% and 15% of patients moved into an overweight or obese body mass index (kg/m2)category (≥25). The degree of weight gain varied between antipsychotics. All antipsychotics were associated with significant (≥7%) weight loss and gain from baseline. The mean rate of weight gain was maximal during the first 6 months but continued over 3 years without a plateau in this specific cohort. Patients should receive regular monitoring of weight throughout treatment. © Copyright 2012 Physicians Postgraduate Press, Inc.

  11. A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes.

    Directory of Open Access Journals (Sweden)

    Lee-Fay Low

    Full Text Available We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes.Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure.Sixty-three unique studies were broadly grouped according to clinical domain-oral health (3 studies, hygiene and infection control (3 studies, nutrition (2 studies, nursing home acquired pneumonia (2 studies, depression (2 studies appropriate prescribing (7 studies, reduction of physical restraints (3 studies, management of behavioral and psychological symptoms of dementia (6 studies, falls reduction and prevention (11 studies, quality improvement (9 studies, philosophy of care (10 studies and other (5 studies. No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy. Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes or organizational factors (e.g. funding, resources, logistics.Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and

  12. Family Structure Changes and Children's Health, Behavior, and Educational Outcomes

    DEFF Research Database (Denmark)

    Rasmussen, Astrid Würtz

    More and more children do not grow up in traditional nuclear families. Instead they grow up in single parent households or in families with a step-parent. Hence it is important to improve our understanding of the impact of 'shocks' in family structure due to parental relationship dissolution...... on children. In this study I empirically test whether children are traumatized by shocks in the family structure during childhood. I focus on both educational, behavioral, and health outcomes. A population sample of Danish children born in January to May 1983, 1984, and 1985 is used for the analysis...

  13. Change in Irrational Beliefs and the Outcome of Rational-Emotive Psychotherapy.

    Science.gov (United States)

    Smith, Timothy W.

    1983-01-01

    Examined correlations between pre- to posttreatment changes in beliefs and changes in treatment-outcome measures within the context of a previous study of rational-emotive therapy. Obtained reliable correlations between changes in beliefs and changes in emotional distress. This relationship occurred in control conditions as well as in treatment…

  14. Changes in agri-business outcomes among the dairy beneficiaries ...

    African Journals Online (AJOL)

    This study compared changes in uptake of agri-business practices, productivity and wealth creation between dairy beneficiaries and non-beneficiaries of Contracted Extension Service Delivery Model (CESDM) implemented by Kenya Agricultural Productivity and Agribusiness Project (KAPAP) in selected counties of Kenya ...

  15. A cultural trauma: Outcomes of the system change in post-socialist Poland

    Directory of Open Access Journals (Sweden)

    Kabzinska Iwona

    2009-01-01

    Full Text Available This paper discusses the outcomes of the system change in post-socialist Poland. The author discusses various important and inter-related issues in the Polish societal sphere: shock therapy accompanied by the changes since the 1990's, unemployment, uncontrolled privatization, cultural trauma and cultural plaint. Theoretically, the paper belongs to anthropology of transformation, and it is based on sociological literature for the most part. The paper also discusses 'societal diagnosis', its creators, crisis in confidence as a consequence of social and cultural traumas, the weakness of political elite and criteria used to measure poverty levels. Lately, there has been a change in mythical representation about easy life in Poland related to the state' affiliation with EU. The change includes a lack of global crisis influence, resistance of the Polish society toward media influence, a rise in optimism and decrease of cultural plaint. Is this change in attitude due to cyclical alteration between phases of depression and euphoria? What will happen if depression returns? Did the Polish handle the trauma of transformation exceptionally well? Possible answers to these and other relevant questions are sought by the author in this paper, who uses, as additional sources for research, a world of local communities and individual accounts.

  16. Associations between change in sedentary behavior and outcome in standard behavioral weight loss treatment.

    Science.gov (United States)

    Kerrigan, Stephanie G; Call, Christine; Schaumberg, Katherine; Forman, Evan; Butryn, Meghan L

    2018-03-01

    Sedentary behavior, particularly in prolonged periods, is an important determinant of health. Little research exploring changes in sedentary behavior during behavioral weight loss programs exists. This study evaluated the magnitude of changes in total and prolonged sedentary behavior and how these changes related to changes in weight and cardiovascular outcomes during a behavioral weight loss program. Participants (n = 450) in two lifestyle modification programs underwent assessments of sedentary behavior (by accelerometry), weight, waist circumference, blood pressure, and resting heart rate at baseline and after 6 months of treatment. Sedentary behavior was defined as both total and prolonged (≥30 continuous minutes) sedentary minutes/day. Reductions in total and prolonged sedentary time were significant and were accounted for by increases in moderate-to-vigorous physical activity (MVPA). Only changes in MVPA significantly predicted change in weight when entered into a model simultaneously with changes in sedentary behavior. Changes in total and prolonged sedentary time were not associated with changes in waist circumference, heart rate, or blood pressure. Change in sedentary time was not independently associated with change in health outcomes during a behavioral weight loss treatment. High variability in changes in sedentary time indicate that individual differences may be important to examine. Reducing sedentary time may not be powerful enough to impact these health outcomes above the effects of other changes made during these programs; alternatively, it may be that increasing focus in treatment on reducing sedentary time may engender greater decreases in sedentariness, which could lead to better health outcomes.

  17. A "small-changes" workplace weight loss and maintenance program: examination of weight and health outcomes.

    Science.gov (United States)

    Zinn, Caryn; Schofield, Grant M; Hopkins, Will G

    2012-10-01

    To compare the effect of "small-changes" and "usual care" workplace interventions on weight loss and to investigate the effect of small changes with or without maintenance on weight and health outcomes. Overweight/obese employees at two New Zealand worksites received a 12-month usual-care intervention (n = 53), followed by a 12-month small-changes intervention (n = 102). Small changes comprised a 12-week component, followed by 9 months of maintenance, implemented at only one worksite. Magnitudes of effects were assessed via a threshold of -5% (weight loss) and standardization (health outcomes). Small changes showed beneficial weight loss relative to usual care in both worksites. For small-changes interventions, worksites reduced weight (12 weeks) and maintained lost weight (12 months). One in every three participants lost 5% or more weight. Some improvements in health outcomes were shown. Regardless of maintenance, the small-changes intervention was successful in sustaining weight loss.

  18. Removing Supplementary Materials from Montessori Classrooms Changed Child Outcomes

    Science.gov (United States)

    Lillard, Angeline S.; Heise, Megan J.

    2016-01-01

    Montessori classrooms vary in the degree to which they adhere to Maria Montessori's model, including in the provision of materials. Specifically, some classrooms use only Montessori materials, whereas others supplement the Montessori materials with commercially available materials like puzzles and games. A prior study suggested such…

  19. 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

    above Institute of Medicine weight gain recommendations, retained an additional 3.1 kg and 4.7kg after three and greater than or equal to 15 years postpartum, respectively. The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index (kg/m2) between consecutive pregnancies (an average of two years) was much higher compared with women whose BMI changed from -1.0 and 0.9 units. Long-term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post-partum has been found to be a predictor of maternal overweight 15 years later.With around 14-20% of women retaining 5kg or more 12 months postpartum, the risk of developing conditions like diabetes, metabolic syndrome and cardiovascular disease may be increased. It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage.Lifestyle factors of overweight, having poor diet quality, and not undertaking enough moderate-to-vigorous physical activity are amongst the top five predictors of mortality in women. Additionally it is noted that, for many women, pregnancy and the postpartum period are associated with a reduction in physical activity. It is known that a combination of poor dietary choices, an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity. With this in mind, current research has focused on lifestyle interventions to limit GWG and PPWR. Thangaratinam et al. reviewed 44 randomized controlled trials (7278 women) where interventions including diet, physical activity or both were evaluated for their influence on maternal weight during pregnancy. Results indicate that all were significantly effective in

  20. Youth Psychotherapy Change Trajectories and Outcomes in Usual Care: Community Mental Health versus Managed Care Settings

    Science.gov (United States)

    Warren, Jared S.; Nelson, Philip L.; Mondragon, Sasha A.; Baldwin, Scott A.; Burlingame, Gary M.

    2010-01-01

    Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome…

  1. Learning Outcomes as a Key Concept in Policy Documents throughout Policy Changes

    Science.gov (United States)

    Prøitz, Tine Sophie

    2015-01-01

    Learning outcomes can be considered to be a key concept in a changing education policy landscape, enhancing aspects such as benchmarking and competition. Issues relating to concepts of performance have a long history of debate within the field of education. Today, the concept of learning outcomes has become central in education policy development,…

  2. 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.

  3. Revisiting out-of-home placed children's poor educational outcomes-Is school change part of the explanation?

    DEFF Research Database (Denmark)

    Olsen, Rikke Fuglsang; Montgomery, Christopher J.

    2018-01-01

    Adolescents in out-of-home care (OHC) have consistently been shown to have poorer educational outcomes than their peers. The ecological transition associated with school changes has been theorized to impact the learning outcomes of children and adolescents negatively, and it has been suggested...... and their never-placed peers, respectively. Using administrative data combined with two rounds of the Danish Longitudinal Study of Children born 1995 (measurements at age 11 and age 15), our sample consisted of 107 adolescents ever placed in OHC and 3,805 of their never placed peers. We found that school change...... was negatively related to educational outcomes for both groups and that this relationship was stronger for adolescents in OHC. This result persisted after including a measure of prior self-perceived academic abilities, self-reported experiences of being bullied, and several control variables. The results suggest...

  4. 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

  5. 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...

  6. Effect of changes in human ecology and behavior on patterns of sexually transmitted diseases, including human immunodeficiency virus infection.

    Science.gov (United States)

    Wasserheit, J N

    1994-01-01

    The last 20 years have witnessed six striking changes in patterns of sexually transmitted diseases (STDs): emergence of new STD organisms and etiologies, reemergence of old STDs, shifts in the populations in which STDs are concentrated, shifts in the etiological spectra of STD syndromes, alterations in the incidence of STD complications, and increases in antimicrobial resistance. For example, human immunodeficiency virus (HIV) emerged to devastate the United States with a fatal pandemic involving at least 1 million people. The incidence of syphilis rose progressively after 1956 to reach a 40-year peak by 1990. In both cases, disease patterns shifted from homosexual men to include minority heterosexuals. Over the last decade, gonorrhea became increasingly concentrated among adolescents, and several new types of antimicrobial resistance appeared. Three interrelated types of environments affect STD patterns. The microbiologic, hormonal, and immunologic microenvironments most directly influence susceptibility, infectiousness, and development of sequelae. These microenvironments are shaped, in part, by the personal environments created by an individual's sexual, substance-use, and health-related behaviors. The personal environments are also important determinants of acquisition of infection and development of sequelae but, in addition, they mediate risk of exposure to infection. These are, therefore, the environments that most directly affect changing disease patterns. Finally, individuals' personal environments are, in turn, molded by powerful macroenvironmental forces, including socioeconomic, demographic, geographic, political, epidemiologic, and technological factors. Over the past 20 years, the profound changes that have occurred in many aspects of the personal environment and the macroenvironment have been reflected in new STD patterns. PMID:8146135

  7. One-year change in health status and subsequent outcomes in COPD

    DEFF Research Database (Denmark)

    Wilke, Sarah; Jones, Paul W; Müllerova, H

    2015-01-01

    BACKGROUND: Poor health status has been associated with morbidity and mortality in patients with COPD. To date, the impact of changes in health status on these outcomes remains unknown. AIMS: To explore the relationship of clinically relevant changes in health status with exacerbation, hospitalis...

  8. Has growth mixture modeling improved our understanding of how early change predicts psychotherapy outcome?

    Science.gov (United States)

    Koffmann, Andrew

    2017-03-02

    Early change in psychotherapy predicts outcome. Seven studies have used growth mixture modeling [GMM; Muthén, B. (2001). Second-generation structural equation modeling with a combination of categorical and continuous latent variables: New opportunities for latent class-latent growth modeling. In L. M. Collins & A. G. Sawyers (Eds.), New methods for the analysis of change (pp. 291-322). Washington, DC: American Psychological Association] to identify patient classes based on early change but have yielded conflicting results. Here, we review the earlier studies and apply GMM to a new data set. In a university-based training clinic, 251 patients were administered the Outcome Questionnaire-45 [Lambert, M. J., Hansen, N. B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G., … Reisinger, C. W. (1996). Administration and scoring manual for the Outcome Questionnaire (OQ 45.2). Wilmington, DE: American Professional Credentialing Services] at each psychotherapy session. We used GMM to identify class structure based on change in the first six sessions and examined trajectories as predictors of outcome. The sample was best described as a single class. There was no evidence of autoregressive trends in the data. We achieved better fit to the data by permitting latent variables some degree of kurtosis, rather than to assume multivariate normality. Treatment outcome was predicted by the amount of early improvement, regardless of initial level of distress. The presence of sudden early gains or losses did not further improve outcome prediction. Early improvement is an easily computed, powerful predictor of psychotherapy outcome. The use of GMM to investigate the relationship between change and outcome is technically complex and computationally intensive. To date, it has not been particularly informative.

  9. 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.

  10. 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.

  11. Adolescent and parent motivation for change affects psychotherapy outcomes among youth with poorly controlled diabetes.

    Science.gov (United States)

    Ellis, Deborah A; Berio, Heidi; Carcone, April Idalski; Naar-King, Sylvie

    2012-01-01

    Investigate effect of baseline motivation for change on treatment fidelity, therapeutic alliance, treatment dose, and treatment outcome in a randomized controlled trial of family therapy for youth with poorly controlled diabetes. Seventy-four adolescents and caregivers completed measures of motivation for change. Measures of fidelity, alliance, dose, and youth health status were collected. Structural equation modeling was used to test the direct and indirect effects of motivation on treatment outcomes. Parent motivation was significantly related to alliance and fidelity. Only alliance was significantly related to posttreatment metabolic control. In adolescent models, only motivation was significantly related to alliance. In both models, motivation had a significant indirect effect on metabolic control through alliance. Findings demonstrate the importance of parent and youth initial motivational status and treatment alliance to treatment outcome among youth with poorly controlled diabetes. Additional research on treatment techniques that promote motivation for change is needed.

  12. Changes in Patient and Nurse Outcomes Associated with Magnet Hospital Recognition

    Science.gov (United States)

    Kutney-Lee, Ann; Stimpfel, Amy Witkoski; Sloane, Douglas M.; Cimiotti, Jeannie P.; Quinn, Lisa W.; Aiken, Linda H.

    2015-01-01

    Background Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes. Objective To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remained non-Magnet. Research Design Retrospective, two-stage panel design using four secondary data sources. Subjects 136 Pennsylvania hospitals (11 “emerging” Magnets and 125 non-Magnets) Measures American Nurses Credentialing Center Magnet recognition; risk-adjusted rates of surgical 30-day mortality and failure-to-rescue, nurse-reported quality measures, and nurse outcomes; the Practice Environment Scale of the Nursing Work Index Methods Fixed effects difference models were used to compare changes in outcomes between emerging Magnet hospitals and hospitals that remained non-Magnet. Results Emerging Magnet hospitals demonstrated markedly greater improvements in their work environments than other hospitals. On average, the changes in 30-day surgical mortality and failure-to-rescue rates over the study period were more pronounced in emerging Magnet hospitals than in non-Magnet hospitals, by 2.4 fewer deaths per 1000 patients (pMagnet hospitals and non-Magnet hospitals were observed in nurse-reported quality of care and nurse outcomes. Conclusions In general, Magnet recognition is associated with significant improvements over time in the quality of the work environment, and in patient and nurse outcomes that exceed those of non-Magnet hospitals. PMID:25906016

  13. 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.

  14. 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.

  15. Laboratory Studies of the Reactive Chemistry and Changing CCN Properties of Secondary Organic Aerosol, Including Model Development

    Energy Technology Data Exchange (ETDEWEB)

    Scot Martin

    2013-01-31

    The chemical evolution of secondary-organic-aerosol (SOA) particles and how this evolution alters their cloud-nucleating properties were studied. Simplified forms of full Koehler theory were targeted, specifically forms that contain only those aspects essential to describing the laboratory observations, because of the requirement to minimize computational burden for use in integrated climate and chemistry models. The associated data analysis and interpretation have therefore focused on model development in the framework of modified kappa-Koehler theory. Kappa is a single parameter describing effective hygroscopicity, grouping together several separate physicochemical parameters (e.g., molar volume, surface tension, and van't Hoff factor) that otherwise must be tracked and evaluated in an iterative full-Koehler equation in a large-scale model. A major finding of the project was that secondary organic materials produced by the oxidation of a range of biogenic volatile organic compounds for diverse conditions have kappa values bracketed in the range of 0.10 +/- 0.05. In these same experiments, somewhat incongruently there was significant chemical variation in the secondary organic material, especially oxidation state, as was indicated by changes in the particle mass spectra. Taken together, these findings then support the use of kappa as a simplified yet accurate general parameter to represent the CCN activation of secondary organic material in large-scale atmospheric and climate models, thereby greatly reducing the computational burden while simultaneously including the most recent mechanistic findings of laboratory studies.

  16. Climate Change Beliefs Count: Relationships With Voting Outcomes at the 2010 Australian Federal Election

    Directory of Open Access Journals (Sweden)

    Rod McCrea

    2015-05-01

    Full Text Available Climate change is a political as well as an environmental issue. Climate change beliefs are commonly associated with voting behaviour, but are they associated with swings in voting behaviour? The latter are arguably more important for election outcomes. This paper investigates the predictive power of these beliefs on voting swings at the 2010 Australian federal election after controlling for a range of other related factors (demographic characteristics of voters, different worldviews about nature and the role of government, and the perceived opportunity cost of addressing climate change. Drawing on data from two nationally representative surveys of voters and data from the Australian Electoral Commission, this paper investigates relationships between climate change beliefs and voting swings at both the individual and electorate levels. At an individual level, a hypothetical 10% change in climate change beliefs was associated with a 2.6% swing from a conservative Coalition and a 2.0% swing toward Labor and 1.7% toward the Greens party, both left on the political spectrum. At the electorate level, this equates to a shift of 21 seats between the two main political parties (the Coalition and Labor in Australia’s 150 seat parliament, after allocating Green preferences. Given many seats are marginal, even modest shifts in climate change beliefs can be associated with changes in electoral outcomes. Thus, climate change is expected to remain a politically contested issue in countries like Australia where political parties seek to distinguish themselves, in part, by their responses to climate change.

  17. Preschool and Children's Outcomes in Elementary School: Have Patterns Changed Nationwide Between 1998 and 2010?

    Science.gov (United States)

    Bassok, Daphna; Gibbs, Chloe R; Latham, Scott

    2018-04-17

    This study employs data from both kindergarten cohorts of the Early Childhood Longitudinal Study (n ~ 12,450 in 1998; n ~ 11,000 in 2010) to assess whether associations between preschool participation and children's academic and behavioral outcomes-both at school entry (M age  = 5.6 years in both cohorts) and through third grade-have changed over time. Findings are strikingly similar across these two, nationally representative, U.S. cohorts: preschool is positively associated with academic outcomes and negatively associated with behavioral outcomes both at school entry and as children progress through school. Heterogeneity is documented with respect to child and preschool characteristics. However, there is no evidence that associations between preschool and medium-term child outcomes differ by elementary school characteristics. © 2018 Society for Research in Child Development.

  18. 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

  19. Effect of Process Changes in Surgical Training on Quantitative Outcomes From Surgery Residency Programs.

    Science.gov (United States)

    Dietl, Charles A; Russell, John C

    2016-01-01

    The purpose of this article is to review the literature on process changes in surgical training programs and to evaluate their effect on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: surgery residency training, surgical education, competency-based surgical education, ACGME core competencies, ABSITE scores, and ABS pass rate. Our initial search list included 990 articles on surgery residency training models, 539 on competency-based surgical education, 78 on ABSITE scores, and 33 on ABS pass rate. Overall, 31 articles met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 5/31, 19/31, and 6/31 articles on process changes in surgical training programs had a positive effect on patient care, medical knowledge, and ABSITE scores, respectively. ABS certification was not analyzed. The other ACGME core competencies were addressed in only 6 studies. Several publications on process changes in surgical training programs have shown a positive effect on patient care, medical knowledge, and ABSITE scores. However, the effect on ABS certification, and other quantitative outcomes from residency programs, have not been addressed. Studies on education strategies showing evidence that residency program objectives are being achieved are still needed. This article addresses the 6 ACGME Core Competencies. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  20. Effects of Frequent Glove Change on Outcomes of Orthopaedic Surgical Procedures - A Multicenter Study on Surgical Gloves

    Directory of Open Access Journals (Sweden)

    Nishit Palo

    2017-10-01

    Full Text Available Introduction: Intact surgical gloves are a barrier to microorganisms migration between surgical team members and the patient. The surgical gloves are changed at various junctures but the effects of changing gloves during surgical procedures on various surgical parameters or clinical outcomes are not established. Aim: To determine rationale of glove change during orthopaedic procedures, differences amongst surgical parameters with and without changing the surgical gloves and whether frequent glove change affected surgical parameters or clinical outcomes. Materials and Methods: A prospective multicenter study conducted at three centers from January 2014 to January 2016. A 250 patients were divided into 2 groups (n=125 each in Group 1, surgical team operated with regular changing of gloves. In Group 2, only 1 set of double gloves were worn throughout the procedure. Surgical parameters or clinical outcomes were assessed for both the groups. Statistical analyses included the median, mode, range, Interquartile Range (IQR and sample standard deviation (s and independent-samples t-test. Bacterial counts were expressed as median with (IQR. Results: Surgical Timing Difference was 10 (S.D.- 4.2 minutes more in Group-1 (<0.05, Surgical Cost was higher in Group-1 by Rs.150-450 (<0.05. Outer glove micro-perforation rate was 5.85% and 8.15% in group-1 and 2 respectively with no inner glove perforation or Surgical Site Infections. Outer glove micro perforations were proportional to duration of surgery; operations lasting 120-210 and 61-120 minutes had 66.6% and 37.2% micro perforation rates respectively (p<0.05. Conclusion: Under standard operating conditions, procedures performed without glove change are shorter and cost effective than procedures performed with regular glove change with similar surgical and functional results. Judicious use of surgical gloves is a patient and environment friendly option, thereby reducing the hospital’s biomedical waste load.

  1. Changes Associated with Improved Outcomes for Cats Entering RSPCA Queensland Shelters from 2011 to 2016

    Directory of Open Access Journals (Sweden)

    Caroline Audrey Kerr

    2018-06-01

    Full Text Available This retrospective study of cat admissions to RSPCA Queensland shelters describes changes associated with improved outcomes ending in live release in 2016 compared to 2011. There were 13,911 cat admissions in 2011 and 13,220 in 2016, with approximately 50% in both years admitted as strays from the general public or council contracts. In contrast, owner surrenders halved from 30% to 15% of admissions. Percentages of admissions ending in euthanasia decreased from 58% to 15%. Only 5% of cat admissions were reclaimed in each of these years, but the percentage rehomed increased from 34% to 74%, of which 61% of the increase was contributed by in-shelter adoptions and 39% from non-shelter sites, predominately retail partnerships. The percentage temporarily fostered until rehoming doubled. In 2011, euthanasias were most common for medical (32% of all euthanasias, behavioral (36% and age/shelter number (30% reasons, whereas in 2016, 69% of euthanasias were for medical reasons. The number of young kittens euthanized decreased from 1116 in 2011 to 22 in 2016. The number of cats classified as feral and euthanized decreased from 1178 to 132, in association with increased time for assessment of behavior and increased use of behavior modification programs and foster care. We attribute the improved cat outcomes to strategies that increased adoptions and reduced euthanasia of young kittens and poorly socialized cats, including foster programs. To achieve further decreases in euthanasia, strategies to decrease intake would be highly beneficial, such as those targeted to reduce stray cat admissions.

  2. Climate Change Professional Development: Design, Implementation, and Initial Outcomes on Teacher Learning, Practice, and Student Beliefs

    Science.gov (United States)

    Shea, Nicole A.; Mouza, Chrystalla; Drewes, Andrea

    2016-01-01

    In this work, we present the design, implementation, and initial outcomes of the Climate Academy, a hybrid professional development program delivered through a combination of face-to-face and online interactions, intended to prepare formal and informal science teachers (grades 5-16) in teaching about climate change. The Climate Academy was…

  3. 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.

  4. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

    Science.gov (United States)

    Flodgren, Gerd; Eccles, Martin P; Shepperd, Sasha; Scott, Anthony; Parmelli, Elena; Beyer, Fiona R

    2014-01-01

    Background There is considerable interest in the effectiveness of financial incentives in the delivery of health care. Incentives may be used in an attempt to increase the use of evidence-based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive, diagnostic and treatment decisions, or both. Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way. Since there are numerous reviews performed within the healthcare area describing the effects of various types of financial incentives, it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals’ behaviour and patient outcomes. Objectives To conduct an overview of systematic reviews that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes. Methods We searched the Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library); Database of Abstracts of Reviews of Effectiveness (DARE); TRIP; MEDLINE; EMBASE; Science Citation Index; Social Science Citation Index; NHS EED; HEED; EconLit; and Program in Policy Decision-Making (PPd) (from their inception dates up to January 2010). We searched the reference lists of all included reviews and carried out a citation search of those papers which cited studies included in the review. We included both Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time series (ITSs) and controlled before and after studies (CBAs) that evaluated the effects of financial incentives on professional practice and patient outcomes, and that reported numerical results of the included individual studies. Two review authors independently extracted data and assessed the methodological quality of each

  5. 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

  6. Impact of changing trends of treatment on outcome of cerebral gliosarcoma: A tertiary care centre experience

    Directory of Open Access Journals (Sweden)

    Narendra Kumar

    2015-01-01

    Full Text Available Aim: To assess clinicopathological features and outcomes in patients of primary gliosarcoma with changing trends of treatment. Materials and Methods: Medical records were reviewed and data collected on primary gliosarcoma over a 5-year period (2009-2013 from the departmental case files. Results: A total 27 patients were included in this study. The median age of presentation was 54 years. There was a slight male preponderance, with male to female ratio of 1.25:1. The most common location of the tumor was temporal lobe (44.4%. Gross total resection was possible in 19 cases, near total excision was done in five cases, and only partial excision with decompression in three cases. Of the 27 patients, 80.8% patients received post-operative radical external beam radiotherapy of 60 Gy/30#/6 weeks. Concurrent and adjuvant temozolomide was used in 42.3% cases, depending on affordability and tolerance. Median overall survival was 9 months. On subgroup analysis, median overall survival in the radiotherapy plus temozolomide group was 10 months as compared to 9 months in the radiotherapy alone group; however, this was not statistically significant.(P = 0.244. Conclusion: Treating Gliosarcoma is a major therapeutic challenge for a clinician because of its poor prognosis, aggressive clinical behavior, rarity, and limited clinical experience. With surgery and concurrent chemoradiation, we were able to achieve a median overall survival of 9 months. Addition of temozolomide has shown a better trend in survival though it is not statistically significant.

  7. Habits as action sequences: hierarchical action control and changes in outcome value.

    Science.gov (United States)

    Dezfouli, Amir; Lingawi, Nura W; Balleine, Bernard W

    2014-11-05

    Goal-directed action involves making high-level choices that are implemented using previously acquired action sequences to attain desired goals. Such a hierarchical schema is necessary for goal-directed actions to be scalable to real-life situations, but results in decision-making that is less flexible than when action sequences are unfolded and the decision-maker deliberates step-by-step over the outcome of each individual action. In particular, from this perspective, the offline revaluation of any outcomes that fall within action sequence boundaries will be invisible to the high-level planner resulting in decisions that are insensitive to such changes. Here, within the context of a two-stage decision-making task, we demonstrate that this property can explain the emergence of habits. Next, we show how this hierarchical account explains the insensitivity of over-trained actions to changes in outcome value. Finally, we provide new data that show that, under extended extinction conditions, habitual behaviour can revert to goal-directed control, presumably as a consequence of decomposing action sequences into single actions. This hierarchical view suggests that the development of action sequences and the insensitivity of actions to changes in outcome value are essentially two sides of the same coin, explaining why these two aspects of automatic behaviour involve a shared neural structure. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  8. 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.

  9. 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

  10. Predicting species distribution and abundance responses to climate change: why it is essential to include biotic interactions across trophic levels.

    Science.gov (United States)

    Van der Putten, Wim H; Macel, Mirka; Visser, Marcel E

    2010-07-12

    Current predictions on species responses to climate change strongly rely on projecting altered environmental conditions on species distributions. However, it is increasingly acknowledged that climate change also influences species interactions. We review and synthesize literature information on biotic interactions and use it to argue that the abundance of species and the direction of selection during climate change vary depending on how their trophic interactions become disrupted. Plant abundance can be controlled by aboveground and belowground multitrophic level interactions with herbivores, pathogens, symbionts and their enemies. We discuss how these interactions may alter during climate change and the resulting species range shifts. We suggest conceptual analogies between species responses to climate warming and exotic species introduced in new ranges. There are also important differences: the herbivores, pathogens and mutualistic symbionts of range-expanding species and their enemies may co-migrate, and the continuous gene flow under climate warming can make adaptation in the expansion zone of range expanders different from that of cross-continental exotic species. We conclude that under climate change, results of altered species interactions may vary, ranging from species becoming rare to disproportionately abundant. Taking these possibilities into account will provide a new perspective on predicting species distribution under climate change.

  11. Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yip, Connie [King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom); National Cancer Centre, Department of Radiation Oncology, Singapore (Singapore); Imaging 2, Level 1, Lambeth Wing, St Thomas' Hospital, London (United Kingdom); Goh, Vicky [King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom); Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Davies, Andrew; Gossage, James; Mason, Robert [Guy' s and St Thomas' NHS Foundation Trust, Department of Upper Gastrointestinal and General Surgery, London (United Kingdom); Mitchell-Hay, Rosalind; Griffin, Nyree [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Hynes, Orla [Department of Dietetics, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Maisey, Nick; Ross, Paul; Gaya, Andrew [Department of Oncology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Landau, David B. [King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom); Department of Oncology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Cook, Gary J. [King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom)

    2014-05-15

    Sarcopenia and changes in body composition following neoadjuvant chemotherapy (NAC) may affect clinical outcome. We assessed the associations between CT body composition changes following NAC and outcomes in oesophageal cancer. A total of 35 patients who received NAC followed by oesophagectomy, and underwent CT assessment pre- and post-NAC were included. Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (FMR) and visceral to subcutaneous adipose tissue ratio (VA/SA) were derived from CT. Changes in FM, FFM, FMR, VA/SA and sarcopenia were correlated to chemotherapy dose reductions, postoperative complications, length of hospital stay (LOS), circumferential resection margin (CRM), pathological chemotherapy response, disease-free survival (DFS) and overall survival (OS). Nine (26 %) patients were sarcopenic before NAC and this increased to 15 (43 %) after NAC. Average weight loss was 3.7 % ± 6.4 (SD) in comparison to FM index (-1.2 ± 4.2), FFM index (-4.6 ± 6.8), FMR (-1.2 ± 24.3) and VA/SA (-62.3 ± 12.7). Changes in FM index (p = 0.022), FMR (p = 0.028), VA/SA (p = 0.024) and weight (p = 0.007) were significant univariable factors for CRM status. There was no significant association between changes in body composition and survival. Loss of FM, differential loss of VA/SA and skeletal muscle were associated with risk of CRM positivity. (orig.)

  12. Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer

    International Nuclear Information System (INIS)

    Yip, Connie; Goh, Vicky; Davies, Andrew; Gossage, James; Mason, Robert; Mitchell-Hay, Rosalind; Griffin, Nyree; Hynes, Orla; Maisey, Nick; Ross, Paul; Gaya, Andrew; Landau, David B.; Cook, Gary J.

    2014-01-01

    Sarcopenia and changes in body composition following neoadjuvant chemotherapy (NAC) may affect clinical outcome. We assessed the associations between CT body composition changes following NAC and outcomes in oesophageal cancer. A total of 35 patients who received NAC followed by oesophagectomy, and underwent CT assessment pre- and post-NAC were included. Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (FMR) and visceral to subcutaneous adipose tissue ratio (VA/SA) were derived from CT. Changes in FM, FFM, FMR, VA/SA and sarcopenia were correlated to chemotherapy dose reductions, postoperative complications, length of hospital stay (LOS), circumferential resection margin (CRM), pathological chemotherapy response, disease-free survival (DFS) and overall survival (OS). Nine (26 %) patients were sarcopenic before NAC and this increased to 15 (43 %) after NAC. Average weight loss was 3.7 % ± 6.4 (SD) in comparison to FM index (-1.2 ± 4.2), FFM index (-4.6 ± 6.8), FMR (-1.2 ± 24.3) and VA/SA (-62.3 ± 12.7). Changes in FM index (p = 0.022), FMR (p = 0.028), VA/SA (p = 0.024) and weight (p = 0.007) were significant univariable factors for CRM status. There was no significant association between changes in body composition and survival. Loss of FM, differential loss of VA/SA and skeletal muscle were associated with risk of CRM positivity. (orig.)

  13. The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders.

    Science.gov (United States)

    Turner, Hannah; Bryant-Waugh, Rachel; Marshall, Emily

    2015-10-01

    The present study explored the impact of early symptom change (cognitive and behavioural) and the early therapeutic alliance on treatment outcome in cognitive-behavioural therapy (CBT) for the eating disorders. Participants were 94 adults with diagnosed eating disorders who completed a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment, following the 6th session and at the end of treatment. They also completed a measure of therapeutic alliance following the 6th session. Greater early reduction in dietary restraint and eating concerns, and smaller levels of change in shape concern, significantly predicted later reduction in global eating pathology. The early therapeutic alliance was strong across the three domains of tasks, goals and bond. Early symptom reduction was a stronger predictor of later reduction in eating pathology than early therapeutic alliance. The early therapeutic alliance did not mediate the relationship between early symptom reduction and later reduction in global eating pathology. Instead, greater early symptom reduction predicted a strong early therapeutic alliance. Early clinical change was the strongest predictor of treatment outcome and this also facilitated the development of a strong early alliance. Clinicians should be encouraged to deliver all aspects of evidence-based CBT, including behavioural change. The findings suggest that this will have a positive impact on both the early therapeutic alliance and later change in eating pathology. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Motivation to change and perceptions of the admission process with respect to outcome in adolescent anorexia nervosa.

    Science.gov (United States)

    Hillen, Simona; Dempfle, Astrid; Seitz, Jochen; Herpertz-Dahlmann, Beate; Bühren, Katharina

    2015-07-02

    In patients with anorexia nervosa (AN), there is evidence that readiness to change is an important predictor of outcome with respect to weight gain and improvement in eating disorder psychopathology. In particular, young patients are characterized by a low level of motivation for recovery and perceive more coercion at hospitalization. Thus, a better understanding of the variables that influence readiness to change and perception of the admission process in adolescent AN may help to support patients in initiating change and staying motivated for treatment. In 40 adolescent patients diagnosed with AN according to DSM-IV criteria, we assessed in a prospective clinical cohort study the motivation to change using the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) at admission to inpatient treatment, in week 9 after admission and at discharge. Additional variables were assessed, including depressive symptoms (Beck Depression Inventory, BDI), eating disorder-specific psychopathology (Eating Disorder Inventory, EDI-2), body mass index (BMI) and the percentage of expected body weight (%EBW). The patients' perceptions of the admission process and their perceived need for hospitalization were assessed using a self-report scale developed by Guarda et al. (2007). Younger patients perceived more coercion than older patients did. Low %EBW and more severe eating disorder-specific psychopathology were associated with a greater perceived need for hospitalization. Moreover, low %EBW at admission and a longer duration of illness were accompanied by a greater motivation to change at admission, whereas more severe eating disorder psychopathology was associated with a low motivation to change. The motivation to change increased significantly between admission and discharge. Patients with a greater motivation to change at admission exhibited a higher weekly weight gain during treatment but did not show better outcome in eating disorder-specific psychopathology and depression

  15. Post-anoxic quantitative MRI changes may predict emergence from coma and functional outcomes at discharge.

    Science.gov (United States)

    Reynolds, Alexandra S; Guo, Xiaotao; Matthews, Elizabeth; Brodie, Daniel; Rabbani, Leroy E; Roh, David J; Park, Soojin; Claassen, Jan; Elkind, Mitchell S V; Zhao, Binsheng; Agarwal, Sachin

    2017-08-01

    Traditional predictors of neurological prognosis after cardiac arrest are unreliable after targeted temperature management. Absence of pupillary reflexes remains a reliable predictor of poor outcome. Diffusion-weighted imaging has emerged as a potential predictor of recovery, and here we compare imaging characteristics to pupillary exam. We identified 69 patients who had MRIs within seven days of arrest and used a semi-automated algorithm to perform quantitative volumetric analysis of apparent diffusion coefficient (ADC) sequences at various thresholds. Area under receiver operating characteristic curves (ROC-AUC) were estimated to compare predictive values of quantitative MRI with pupillary exam at days 3, 5 and 7 post-arrest, for persistence of coma and functional outcomes at discharge. Cerebral Performance Category scores of 3-4 were considered poor outcome. Excluding patients where life support was withdrawn, ≥2.8% diffusion restriction of the entire brain at an ADC of ≤650×10 -6 m 2 /s was 100% specific and 68% sensitive for failure to wake up from coma before discharge. The ROC-AUC of ADC changes at ≤450×10 -6 mm 2 /s and ≤650×10 -6 mm 2 /s were significantly superior in predicting failure to wake up from coma compared to bilateral absence of pupillary reflexes. Among survivors, >0.01% of diffusion restriction of the entire brain at an ADC ≤450×10 -6 m 2 /s was 100% specific and 46% sensitive for poor functional outcome at discharge. The ROC curve predicting poor functional outcome at ADC ≤450×10 -6 mm 2 /s had an AUC of 0.737 (0.574-0.899, p=0.04). Post-anoxic diffusion changes using quantitative brain MRI may aid in predicting persistent coma and poor functional outcomes at hospital discharge. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. 78 FR 38286 - Notice of Change to the CCC Sugar Purchase and Exchange To Include Certificates of Quota...

    Science.gov (United States)

    2013-06-26

    ... DEPARTMENT OF AGRICULTURE Commodity Credit Corporation Notice of Change to the CCC Sugar Purchase... Credit Corporation. ACTION: Notice. SUMMARY: The Commodity Credit Corporation (CCC) announces the intent... for sugar was projected at 19 percent in the June 2013 USDA World Agricultural Supply and Demand...

  17. Change for the better: an innovative model of care delivering positive patient and workforce outcomes.

    Science.gov (United States)

    Cann, Tina; Gardner, Anne

    2012-01-01

    To evaluate patient and workforce outcomes following the implementation of the Practice Partnership Model of Care. Pre-test-post-test design. A 29-bed surgical ward at a tertiary-level regional hospital. Summary de-identified data from all patients and ward nursing staff in the study period. The Practice Partnership Model of Care has four main components: working in partnership; clinical handover at the bedside; comfort rounds; and environmental modifications. These reflect patient-centered and quality focused initiatives and use a total quality improvement framework that aims to transform care at the bedside. Patient outcomes: changes in patient safety (measured by numbers of medication errors and patient falls); satisfaction with care (use of the call bell system, number of complaints and compliments). Workforce outcomes: changes in staff satisfaction (measured through staff sick leave). A statistically significant reduction in use of nurse call bells (p=<0.001) post-implementation. Medication errors and patient falls reduced, with an overall reduction of 4% in staff sick leave. The Practice Partnership Model of Care positively affected patient and workforce outcomes, suggesting further exploration of this model in other hospital contexts is warranted.

  18. Outcome indicators for the evaluation of energy policy instruments and technical change

    International Nuclear Information System (INIS)

    Neij, Lena; Astrand, Kerstin

    2006-01-01

    The aim of this paper is to propose a framework for the evaluation of policy instruments designed to affect development and dissemination of new energy technologies. The evaluation approach is based on the analysis of selected outcome indicators describing the process of technical change, i.e. the development and dissemination of new energy technologies, on the basis of a socio-technical systems approach. The outcome indicators are used to analyse the effect, in terms of outcome, and outcome scope of the policy instruments as well as the extent to which the policy instruments support diversity, learning and institutional change. The analysis of two cases of evaluations, of energy efficiency policy and wind energy policy in Sweden, shows that the approach has several advantages, allowing continuous evaluation and providing important information for the redesign of policy instruments. There are also disadvantages associated with the approach, such as complexity, possible high cost and the requirement of qualified evaluators. Nevertheless, it is concluded that the information on the continuous performance of different policy instruments and their effects on the introduction and dissemination of new energy technologies, provided by this evaluation approach, is essential for an improved adaptation and implementation of energy and climate policy

  19. Population changes, racial/ethnic disparities, and birth outcomes in Louisiana after Hurricane Katrina.

    Science.gov (United States)

    Harville, Emily W; Tran, Tri; Xiong, Xu; Buekens, Pierre

    2010-09-01

    To examine how the demographic and other population changes affected birth and obstetric outcomes in Louisiana, and the effect of the hurricane on racial disparities in these outcomes. Vital statistics data were used to compare the incidence of low birth weight (LBW) (birth (PTB) (37 weeks' gestation), cesarean section, and inadequate prenatal care (as measured by the Kotelchuck index), in the 2 years after Katrina compared to the 2 years before, for the state as a whole, region 1 (the area around New Orleans), and Orleans Parish (New Orleans). Logistic models were used to adjust for covariates. After adjustment, rates of LBW rose for the state, but preterm birth did not. In region 1 and Orleans Parish, rates of LBW and PTB remained constant or fell. These patterns were all strongest in African American women. Rates of cesarean section and inadequate prenatal care rose. Racial disparities in birth outcomes remained constant or were reduced. Although risk of LBW/PTB remained higher in African Americans, the storm does not appear to have exacerbated health disparities, nor did population shifts explain the changes in birth and obstetric outcomes.

  20. Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer.

    Science.gov (United States)

    Yip, Connie; Goh, Vicky; Davies, Andrew; Gossage, James; Mitchell-Hay, Rosalind; Hynes, Orla; Maisey, Nick; Ross, Paul; Gaya, Andrew; Landau, David B; Cook, Gary J; Griffin, Nyree; Mason, Robert

    2014-05-01

    Sarcopenia and changes in body composition following neoadjuvant chemotherapy (NAC) may affect clinical outcome. We assessed the associations between CT body composition changes following NAC and outcomes in oesophageal cancer. A total of 35 patients who received NAC followed by oesophagectomy, and underwent CT assessment pre- and post-NAC were included. Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (FMR) and visceral to subcutaneous adipose tissue ratio (VA/SA) were derived from CT. Changes in FM, FFM, FMR, VA/SA and sarcopenia were correlated to chemotherapy dose reductions, postoperative complications, length of hospital stay (LOS), circumferential resection margin (CRM), pathological chemotherapy response, disease-free survival (DFS) and overall survival (OS). Nine (26 %) patients were sarcopenic before NAC and this increased to 15 (43 %) after NAC. Average weight loss was 3.7 % ± 6.4 (SD) in comparison to FM index (-1.2 ± 4.2), FFM index (-4.6 ± 6.8), FMR (-1.2 ± 24.3) and VA/SA (-62.3 ± 12.7). Changes in FM index (p = 0.022), FMR (p = 0.028), VA/SA (p = 0.024) and weight (p = 0.007) were significant univariable factors for CRM status. There was no significant association between changes in body composition and survival. Loss of FM, differential loss of VA/SA and skeletal muscle were associated with risk of CRM positivity. • Changes in CT body composition occur after neoadjuvant chemotherapy in oesophageal cancer. • Sarcopenia was more prevalent after neoadjuvant chemotherapy. • Fat mass, fat-free mass and weight decreased after neoadjuvant chemotherapy. • Changes in body composition were associated with CRM positivity. • Changes in body composition did not affect perioperative complications and survival.

  1. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study.

    Science.gov (United States)

    Tentori, Francesca; Wang, Mia; Bieber, Brian A; Karaboyas, Angelo; Li, Yun; Jacobson, Stefan H; Andreucci, Vittorio E; Fukagawa, Masafumi; Frimat, Luc; Mendelssohn, David C; Port, Friedrich K; Pisoni, Ronald L; Robinson, Bruce M

    2015-01-07

    Elevated parathyroid hormone levels may be associated with adverse clinical outcomes in patients on dialysis. After the introduction of practice guidelines suggesting higher parathyroid hormone targets than those previously recommended, changes in parathyroid hormone levels and treatment regimens over time have not been well documented. Using data from the international Dialysis Outcomes and Practice Patterns Study, trends in parathyroid hormone levels and secondary hyperparathyroidism therapies over the past 15 years and the associations between parathyroid hormone and clinical outcomes are reported; 35,655 participants from the Dialysis Outcomes and Practice Patterns Study phases 1-4 (1996-2011) were included. Median parathyroid hormone increased from phase 1 to phase 4 in all regions except for Japan, where it remained stable. Prescriptions of intravenous vitamin D analogs and cinacalcet increased and parathyroidectomy rates decreased in all regions over time. Compared with 150-300 pg/ml, in adjusted models, all-cause mortality risk was higher for parathyroid hormone=301-450 (hazard ratio, 1.09; 95% confidence interval, 1.01 to 1.18) and >600 pg/ml (hazard ratio, 1.23; 95% confidence interval, 1.12 to 1.34). Parathyroid hormone >600 pg/ml was also associated with higher risk of cardiovascular mortality as well as all-cause and cardiovascular hospitalizations. In a subgroup analysis of 5387 patients not receiving vitamin D analogs or cinacalcet and with no prior parathyroidectomy, very low parathyroid hormone (secondary hyperparathyroidism treatments changed over time. Very low and very high parathyroid hormone levels were associated with adverse outcomes. In the absence of definitive evidence in support of a specific parathyroid hormone target, there is an urgent need for additional research to inform clinical practice. Copyright © 2015 by the American Society of Nephrology.

  2. Changes in hospital nurse work environments and nurse job outcomes: an analysis of panel data.

    Science.gov (United States)

    Kutney-Lee, Ann; Wu, Evan S; Sloane, Douglas M; Aiken, Linda H

    2013-02-01

    One strategy proposed to alleviate nursing shortages is the promotion of organizational efforts that will improve nurse recruitment and retention. Cross-sectional studies have shown that the quality of the nurse work environment is associated with nurse outcomes related to retention, but there have been very few longitudinal studies undertaken to examine this relationship. To demonstrate how rates of burnout, intention to leave, and job dissatisfaction changed in a panel of hospitals over time, and to explore whether these outcomes were associated with changes in nurse work environments. A retrospective, two-stage panel design was chosen for this study. Survey data collected from large random samples of registered nurses employed in Pennsylvania hospitals in 1999 and 2006 were used to derive hospital-level rates of burnout, intention to leave current position, and job dissatisfaction, and to classify the quality of nurses' work environments at both points in time. A two-period difference model was used to estimate the dependence of changes in rates of nurse burnout, intention to leave, and job dissatisfaction on changes in nurse work environments between 1999 and 2006 in 137 hospitals, accounting for concurrent changes in nurse staffing levels. In general, nurse outcomes improved between 1999 and 2006, with fewer nurses reporting burnout, intention to leave, and job dissatisfaction in 2006 as compared to 1999. Our difference models showed that improvements in work environment had a strong negative association with changes in rates of burnout (β=-6.42%, pjob dissatisfaction (β=-8.00%, pburnout, intention to leave current position, and job dissatisfaction. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. How Teachers' Beliefs About Climate Change Influence Their Instruction and Resulting Student Outcomes

    Science.gov (United States)

    Nation, M.; Feldman, A.; Smith, G.

    2017-12-01

    The purpose of the study was to understand the relationship between teachers' beliefs and understandings of climate change and their instructional practices to determine if and how they impact student outcomes. Limited research has been done in the area of teacher beliefs on climate change, their instruction, and resulting student outcomes. This study contributes to the greater understanding of teachers' beliefs and impact on climate change curriculum implementation. The study utilized a mixed methods approach to data collection and analysis. Data were collected in the form of classroom observations, surveys, and interviews from teachers and students participating in the study over a four-month period. Qualitative and quantitative findings were analyzed through thematic coding and descriptive analysis and compared in an effort to triangulate findings. The results of the study suggest teachers and students believe climate change is occurring and humans are largely to blame. Personal beliefs are important when teaching controversial topics, such as climate change, but participants maintained neutrality within their instruction of the topic, as not to appear biased or influence students' decisions about climate change, and avoid political controversy in the classroom. Overall, the study found teachers' level of understandings and beliefs about climate change had little impact on their instruction and resulting student outcomes. Based on the findings, simply adding climate change to the existing science curriculum is not sufficient for teachers or students. Teachers need to be better prepared about effective pedagogical practices of the content in order to effectively teach a climate-centered curriculum. The barriers that exist for the inclusion of teachers' personal beliefs need to be removed in order for teachers to assert their own personal beliefs about climate change within their classroom instruction. Administrators and stakeholders need to support science

  4. Outcome mapping for fostering and measuring change in risk management behaviour among urban dairy farmers in Nairobi, Kenya.

    Science.gov (United States)

    Nyangaga, Julius N; Grace, Delia; Kimani, Violet; Kiragu, Monica W; Langat, Alfred K; Mbugua, Gabriel; Mitoko, Grace; Kang'ethe, Erastus K

    2012-09-01

    A study was undertaken to investigate and mitigate the risk from zoonotic Cryptosporidium associated with dairy farming in Dagoretti division, Nairobi, Kenya. Outcome mapping (OM), a relatively new tool for planning and evaluation, was used to foster and then monitor changes in farmer management of health risks. Elements of the OM framework, including the vision, mission and expected progress markers, were developed in participatory sessions and a set of progress markers was used for monitoring behaviour change in farmers participating in the project (the boundary partners). Behaviour change (the outcome challenge) was supported by a range of awareness and educational campaigns, working with strategic partners (extension agents and administrative leaders). The farmers the project worked with made considerable progress according to the markers; they demonstrated an understanding of cryptosporidiosis, established or maintained clean and well drained cattle sheds, and took conscious effort to reduce possible infection. Farmers who did not participate in the project (non-contact farmers) were found to be less advanced on the progress marker indicators. Non-contact farmers who carried out risk-reducing practices had done so independently of the project team. The administration leaders, as strategic partners, had a positive attitude towards the project and confidence in their ability to support project objectives. The study demonstrates the utility of OM in helping to identify and support behavioural change.

  5. Potential for erroneous interpretation of poisoning outcomes due to changes in National Poison Data System reporting.

    Science.gov (United States)

    Anderson, Bruce; Ke, Xuehua; Klein-Schwartz, Wendy

    2010-08-01

    In 2006, the annual report of poison centers in the United States changed the method of reporting profiles for generic substance categories from all exposures to single-substance exposures only. The objective of this study is to describe the potential impact of this reporting change on longitudinal analysis of outcomes. Generic substance categories with data available for all years of the study were manually extracted from Table 22 of the National Poison Data System (NPDS) annual reports for 2002-2007. For each generic substance category, the following data were extracted for each of the 6 years: total number of substance mentions (2002-2005) or single-substance exposures (2006-2007), reason (unintentional or intentional), pediatric exposures (children age average annual number of reported deaths by substance category decreased by 80.8%, from 2,229 in year 2002-2005 to 428 after the 2006 reporting change (p average annual number of reported major outcomes by substance category dropped by 76.0% (p average number of deaths and major effects by substance category decreased by about 50% from 394 and 4,639 per year during 2002-2005 to 198 deaths (p average rates of reported deaths (61.7 and 35.9%) and major effects (36.3 and 11.2%) for drug categories and nondrug categories, respectively (p change in 2006 will yield inaccurate results if the change in reporting methodology is not taken into account.

  6. End-of-treatment abstinence self-efficacy, behavioral processes of change, and posttreatment drinking outcomes in Project MATCH.

    Science.gov (United States)

    Crouch, Taylor Berens; DiClemente, Carlo C; Pitts, Steven C

    2015-09-01

    This study evaluated whether alcohol abstinence self-efficacy at the end of alcohol treatment was moderated by utilization of behavioral processes of change (coping activities used during a behavior change attempt). It was hypothesized that self-efficacy would be differentially important in predicting posttreatment drinking outcomes depending on the level of behavioral processes, such that the relation between self-efficacy and outcomes would be stronger for individuals who reported low process use. Analyses were also estimated with end-of-treatment abstinence included as a covariate. Data were analyzed from alcohol-dependent individuals in both treatment arms of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity; N = 1,328), a large alcohol treatment study. Self-efficacy was moderated by behavioral process use in predicting drinking frequency 6 and 12 months posttreatment and drinking quantity 6 months posttreatment such that self-efficacy was more strongly related to posttreatment drinking when low levels of processes were reported than high levels, but interactions were attenuated when end-of-treatment abstinence was controlled for. Significant quadratic relations between end-of-treatment self-efficacy and 6- and 12-month posttreatment drinking quantity and frequency were found (p behavioral processes was attenuated when end-of-treatment abstinence was controlled for, the quadratic effect of self-efficacy on outcomes remained significant. The pattern of these effects did not support the idea of "overconfidence" as a negative indicator. (c) 2015 APA, all rights reserved).

  7. Frequency of changing enteral alimentation bags and tubing, and adverse clinical outcomes in patients in a long term care facility.

    Science.gov (United States)

    Graham, S; McIntyre, M; Chicoine, J; Gerard, B; Laughren, R; Cowley, G; Morrison, J; Aoki, F Y; Nicolle, L E

    1993-01-01

    Enteral alimentation, given via nasogastric or gastrostomy tubes, is a well established practice to provide nutrition for patients with significant neurological injury. The frequency with which enteral feeding bags and tubes require change and potential adverse effects associated with bacterial contamination of tube feeds remain controversial. The authors studied different times between enteral feeding bag and tube changes, and the effect on adverse clinical outcomes in residents of a long term care facility. In the first study, residents were randomized to 24 h (n = 2), 48 h (n = 3) or 72 h (n = 6) tube feeding and bag changes with clinical status monitored in a standardized fashion for six months. In the second study, patients were randomized to 24 h (n = 6) or 72 h (n = 6) changes. Patient-days of follow-up were 382, 574 and 1000 for the three arms of the first study period and 556 and 496 for the two arms of the second study. No differences in potential clinical adverse events--including fever, gastrointestinal symptoms or pneumonia--were observed with different durations of tubing change. This study suggests it is appropriate to change alimentation tube and feeding bags every 72 h (rather than every 24 h). The less frequent changes will decrease supply costs and free nursing time for other activities.

  8. Association of intervention outcomes with practice capacity for change: Subgroup analysis from a group randomized trial

    Directory of Open Access Journals (Sweden)

    Weyer Sharon

    2008-05-01

    Full Text Available Abstract Background The relationship between health care practices' capacity for change and the results and sustainability of interventions to improve health care delivery is unclear. Methods In the setting of an intervention to increase preventive service delivery (PSD, we assessed practice capacity for change by rating motivation to change and instrumental ability to change on a one to four scale. After combining these ratings into a single score, random effects models tested its association with change in PSD rates from baseline to immediately after intervention completion and 12 months later. Results Our measure of practices' capacity for change varied widely at baseline (range 2–8; mean 4.8 ± 1.6. Practices with greater capacity for change delivered preventive services to eligible patients at higher rates after completion of the intervention (2.7% per unit increase in the combined effort score, p Conclusion Greater capacity for change is associated with a higher probability that a practice will attain and sustain desired outcomes. Future work to refine measures of this practice characteristic may be useful in planning and implementing interventions that result in sustained, evidence-based improvements in health care delivery.

  9. Change in T2-Fat Saturation MRI Correlates With Outcome in Cervical Cancer Patients

    International Nuclear Information System (INIS)

    Ma, Daniel J.; Zhu Jianming; Grigsby, Perry W.

    2011-01-01

    Purpose: To compare pretreatment and midtreatment tumor intensity as measured by T2 fat-saturation (T2-FS) MRI and its association with treatment response in cervical cancer patients. Methods and Materials: Weekly MRI scans were performed for brachytherapy planning on 23 consecutive patients with clinical Stage IB1 to IIIB cervical cancer treated with definitive chemoradiotherapy. These scans were performed on a 1.5-T clinical scanner using a specialized pelvic coil. Mean signal intensity from T2-FS imaging was calculated for each tumor voxel. Average tumor intensity and tumor volume were recorded pre- and midtreatment (at Weeks 0 and 4). All patients subsequently underwent routine follow-up, including periodic clinical examinations and fluorodeoxyglucose–positron emission tomography imaging. Results: Mean follow-up for surviving patients was 14.5 months. Mean tumor volume at presentation was 49.6 cc, and mean midtreatment tumor volume was 16.0 cc. There was no correlation between initial tumor volume and pretreatment signal intensity (r = 0.44), nor was there a correlation between pre- or midtreatment tumor volume with disease-free survival (p = 0.18, p = 0.08 respectively.) However, having at least a 30% drop in signal intensity from pretreatment to midtreatment was correlated with having disease resolution on posttreatment fluorodeoxyglucose–positron emission tomography imaging (p = 0.05) and with disease-free survival (p = 0.03.) Estimated disease-free survival at 22 months was 100% for patients with at least a 30% drop in tumor signal intensity compared with 33% for patients above this selected threshold (p = 0.004). Conclusions: Longitudinal changes in T2-FS tumor intensity during chemoradiation correlated with disease-free survival in cervical cancer patients. Persistently high midtreatment tumor intensities correlated with a high risk of treatment failure, whereas large decreases in tumor intensity correlated with a favorable outcome.

  10. The effect on climate change impacts for building products when including the timing of greenhouse gas emissions

    Science.gov (United States)

    Richard D Bergman

    2012-01-01

    Greenhouse gases (GHGs) trap infrared radiation emitting from the Earth’s surface to generate the “greenhouse effect” thus keeping the planet warm. Many natural activities including rotting vegetation emit GHGs such as carbon dioxide to produce this natural affect. However, in the last 200 years or so, human activity has increased the atmospheric concentrations of GHGs...

  11. The Possible "Proton Sponge " Effect of Polyethylenimine (PEI) Does Not Include Change in Lysosomal pH

    DEFF Research Database (Denmark)

    Søndergaard, Rikke Vicki; Mattebjerg, Maria Ahlm; Henriksen, Jonas Rosager

    2013-01-01

    is still elusive. The "proton sponge " hypothesis remains the most generally accepted mechanism, although it is heavily debated. This hypothesis is associated with the large buffering capacity of PEI and other polycations, which has been interpreted to cause an increase in lysosomal pH even though...... no conclusive proof has been provided. In the present study, we have used a nanoparticle pH sensor that was developed for pH measurements in the endosomal/lysosomal pathway. We have carried out quantitative measurements of lysosomal pH as a function of PEI content and correlate the results to the "proton sponge...... " hypothesis. Our measurements show that PEI does not induce change in lysosomal pH as previously suggested and quantification of PEI concentrations in lysosomes makes it uncertain that the "proton sponge " effect is the dominant mechanism of polyplex escape.Molecular Therapy (2012); doi:10.1038/mt.2012.185....

  12. Bioenergy from crops and biomass residues: a consequential life-cycle assessment including land-use changes

    DEFF Research Database (Denmark)

    Tonini, Davide; Astrup, Thomas Fruergaard

    Biofuels are promising means to reduce fossil fuel depletion and mitigate greenhouse-gas (GHG) emissions. However, recent studies questioned the environmental benefits earlier attributed to biofuels, when these involve land-use changes (direct/indirect, i.e., dLUC/iLUC) (1-5). Yet, second...... to represent the actual environmental impacts. This study quantified the GHG emissions associated with a number of scenarios involving bioenergy production (as combined-heat-and-power, heating, and transport biofuel) from energy crops, industrial/agricultural residues, algae, and the organic fraction...... of municipal solid waste. Four conversion pathways were considered: combustion, fermentation-to-ethanol, fermentation-to-biogas, and thermal gasification. A total of 80 bioenergy scenarios were assessed. Consequential life-cycle assessment (CLCA) was used to quantify the environmental impacts. CLCA aimed...

  13. Global Studies of the Sulfur Cycle Including the Influence of DMS and Fossil Fuel Sulfur on Climate and Climate Change

    Science.gov (United States)

    Penner, Joyce E.

    1998-01-01

    The indirect effect of anthropogenic aerosols, wherein aerosol particles are thought to increase cloud droplet concentrations and cloud lifetime, is the most uncertain component of climate forcing over the past 100 years. Here, for the first time, we use a mechanistic treatment of droplet nucleation and a prognostic treatment of the number of cloud droplets to study the indirect aerosol effect from changes in carbonaceous and sulfate aerosols. Cloud droplet nucleation is parameterized as a function of total aerosol number concentration, updraft velocity and a shape parameter, which takes into account the mechanism, of sulfate aerosol formation, while cloud droplet number depends on the nucleation as well as on droplet sinks. Whereas previous treatments have predicted annual average indirect effects between -1 and -2 W/sq m, we obtain an indirect aerosol effect between -0.14 W/sq m and -0.42 W/sq m in the global mean.

  14. Treatment Outcome and Metacognitive Change in CBT and GET for Chronic Fatigue Syndrome.

    Science.gov (United States)

    Fernie, Bruce A; Murphy, Gabrielle; Wells, Adrian; Nikčević, Ana V; Spada, Marcantonio M

    2016-07-01

    Studies have reported that Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) are effective treatments for Chronic Fatigue Syndrome (CFS). One hundred and seventy-one patients undertook a course of either CBT (n = 116) or GET (n = 55) and were assessed on a variety of self-report measures at pre- and posttreatment and follow-up. In this paper we present analyses on treatment outcomes for CBT and GET in routine clinical practice and evaluate whether changes on subscales of the Metacognitions Questionnaire-30 (MCQ-30) predict fatigue severity independently of changes in other covariates, and across the two treatment modalities. Both CBT and GET were equally effective at decreasing fatigue, anxiety, and depression, and at increasing physical functioning. Changes on the subscales of the MCQ-30 were also found to have a significant effect on fatigue severity independently of changes in other covariates and across treatment modalities. The findings from the current study suggest that CFS treatment protocols for CBT and GET, based on those from the PACE trial, achieve similar to poorer outcomes in routine clinical practice as in a RCT.

  15. Methods for interpreting change over time in patient-reported outcome measures.

    Science.gov (United States)

    Wyrwich, K W; Norquist, J M; Lenderking, W R; Acaster, S

    2013-04-01

    Interpretation guidelines are needed for patient-reported outcome (PRO) measures' change scores to evaluate efficacy of an intervention and to communicate PRO results to regulators, patients, physicians, and providers. The 2009 Food and Drug Administration (FDA) Guidance for Industry Patient-Reported Outcomes (PRO) Measures: Use in Medical Product Development to Support Labeling Claims (hereafter referred to as the final FDA PRO Guidance) provides some recommendations for the interpretation of change in PRO scores as evidence of treatment efficacy. This article reviews the evolution of the methods and the terminology used to describe and aid in the communication of meaningful PRO change score thresholds. Anchor- and distribution-based methods have played important roles, and the FDA has recently stressed the importance of cross-sectional patient global assessments of concept as anchor-based methods for estimation of the responder definition, which describes an individual-level treatment benefit. The final FDA PRO Guidance proposes the cumulative distribution function (CDF) of responses as a useful method to depict the effect of treatments across the study population. While CDFs serve an important role, they should not be a replacement for the careful investigation of a PRO's relevant responder definition using anchor-based methods and providing stakeholders with a relevant threshold for the interpretation of change over time.

  16. Experimental test of a hot water storage system including a macro-encapsulated phase change material (PCM)

    Science.gov (United States)

    Mongibello, L.; Atrigna, M.; Bianco, N.; Di Somma, M.; Graditi, G.; Risi, N.

    2017-01-01

    Thermal energy storage systems (TESs) are of fundamental importance for many energetic systems, essentially because they permit a certain degree of decoupling between the heat or cold production and the use of the heat or cold produced. In the last years, many works have analysed the addition of a PCM inside a hot water storage tank, as it can allow a reduction of the size of the storage tank due to the possibility of storing thermal energy as latent heat, and as a consequence its cost and encumbrance. The present work focuses on experimental tests realized by means of an indoor facility in order to analyse the dynamic behaviour of a hot water storage tank including PCM modules during a charging phase. A commercial bio-based PCM has been used for the purpose, with a melting temperature of 58°C. The experimental results relative to the hot water tank including the PCM modules are presented in terms of temporal evolution of the axial temperature profile, heat transfer and stored energy, and are compared with the ones obtained by using only water as energy storage material. Interesting insights, relative to the estimation of the percentage of melted PCM at the end of the experimental test, are presented and discussed.

  17. Program Use and Outcome Change in a Web-Based Trauma Intervention: Individual and Social Factors.

    Science.gov (United States)

    Wang, Zhiyun; Wang, Jianping; Maercker, Andreas

    2016-09-09

    Insight into user adherence to Web-based intervention programs and into its relationship to intervention effect is needed. The objective of this study was to examine use of a Web-based self-help intervention program, the Chinese version of My Trauma Recovery (CMTR), among Chinese traumatized individuals, and to investigate the relationship between program use and user characteristics before the intervention and change in outcomes after the intervention and at 3-months' follow-up. The sample consisted of 56 urban survivors of different trauma types and 90 rural survivors of the 2008 Sichuan earthquake, who used the CMTR in 1 month on their own or guided by volunteers in a counseling center. Predictors were demographics (sex, age, highest education, marital status, and annual family income), health problems (trauma duration, posttraumatic symptoms, and depression), psychological factors (coping self-efficacy), and social factors (social functioning impairment and social support). Program use was assessed by general program usage (eg, number of visiting days) and program adherence (eg, webpages completed in modules). Outcome measures were the Posttraumatic Diagnostic Scale (PDS), Symptom Checklist 90-Depression (SCL-D), Trauma Coping Self-Efficacy scale (CSE), Crisis Support Scale (CSS), and Social Functioning Impairment questionnaire (SFI) adopted from the CMTR. (1) Program use: rural participants had a larger total number of visiting days (F1,144=40.50, Psocial factors at pretest. (3) Program use and outcomes change: in general, use of the triggers and self-talk modules showed a consistent positive association with improvement in PDS, SCL-D, SFI, and CSE. The relaxation module was associated with positive change in PDS, but with negative change in CSS and SFI. The professional help module was associated with positive change in SCL-D, but its use on the first day was associated with negative change in CSS and CSE. The unhelpful coping module was associated with

  18. Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy: a nationwide study in Denmark.

    Science.gov (United States)

    Karlsson, Lena I M; Wissenberg, Mads; Fosbøl, Emil L; Hansen, Carolina Malta; Lippert, Freddy K; Bagai, Akshay; McNally, Bryan; Granger, Christopher B; Christensen, Erika Frischknecht; Folke, Fredrik; Rajan, Shahzleen; Weeke, Peter; Nielsen, Søren L; Køber, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian

    2014-09-01

    To investigate diurnal variations in incidence and outcomes following out-of-hospital cardiac arrest (OHCA). OHCA of presumed cardiac etiology were identified through the nationwide Danish Cardiac Arrest Registry (2001-2010). Time of day was divided into three time periods: daytime 07.00-14.59; evening 15.00-22.59; and nighttime 23.00-06.59. We identified 18,929 OHCA patients, aged ≥18 years. The median age was 72 years (IQR 62-80) and the majority were male (67.5%). OHCA occurrence varied across time periods, with 43.9%, 35.7% and 20.6% occurring during daytime, evening and nighttime, respectively. Nighttime patients were more likely to have: severe comorbidity (i.e. COPD), arrest in private home (87.2% vs. 69.0% and 73.0% daytime and evening, respectively), non-witnessed arrest (51.2% vs. 48.4% and 43.7%), no bystander CPR (75.9% vs. 68.4% and 66.1%), longer time interval from recognition of OHCA to rhythm analysis (12 min vs. 11 min and 11 min), and non-shockable heart rhythm (80.1% vs. 70.3% and 69.4%), all p<0.0001. Nighttime patients were less likely to achieve return of spontaneous circulation on arrival at the hospital (7.5% vs. 14.8% and 15.1%) and 1-year survival (2.8% vs. 7.2% and 7.1%), p<0.0001. Overall, the lower 1-year survival rate persisted after adjusting for patient-related and cardiac-arrest related characteristics mentioned above (OR 0.47, 95%CI 0.37-0.59; OR 0.51, 95%CI 0.40-0.65, compared to daytime and evening, respectively). We found nighttime patients to have a lower survival compared to daytime and evening that persisted when adjusting for patient-related and cardiac-arrest related characteristics including comorbidities. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Efficacy of a "small-changes" workplace weight loss initiative on weight and productivity outcomes.

    Science.gov (United States)

    Zinn, Caryn; Schofield, Grant M; Hopkins, Will G

    2012-10-01

    The effect of weight reduction on workplace productivity is unknown. We have investigated a "small-changes" workplace weight loss intervention on weight and productivity outcomes. Overweight/obese employees at two New Zealand worksites (n = 102) received the 12-week intervention. One site received an extra 9-month weight-maintenance component. Magnitudes of effects on weight and productivity were assessed via standardization. Both groups reduced weight at 12 weeks and maintained lost weight at 12 months. There were small possible improvements in productivity at one worksite and trivial reductions at the other by 12 weeks, with little subsequent change during maintenance in either group. At an individual level, weight change was associated with at most only small improvements or small reductions in productivity. Workplace weight loss initiatives may need to be more intensive or multidimensional to enhance productivity.

  20. Outer Retinal Changes Including the Ellipsoid Zone Band in Usher Syndrome 1B due to MYO7A Mutations.

    Science.gov (United States)

    Sumaroka, Alexander; Matsui, Rodrigo; Cideciyan, Artur V; McGuigan, David B; Sheplock, Rebecca; Schwartz, Sharon B; Jacobson, Samuel G

    2016-07-01

    To study transition zones from normal to abnormal retina in Usher syndrome IB (USH1B) caused by myosin 7A (MYO7A) mutations. Optical coherence tomography (OCT) scattering layers in outer retina were segmented in patients (n = 16, ages 2-42; eight patients had serial data, average interval 4.5 years) to quantify outer nuclear layer (ONL) and outer segments (OS) as well as the locus of EZ (ellipsoid zone) edge and its extent from the fovea. Static perimetry was measured under dark-adapted (DA) and light-adapted (LA) conditions. Ellipsoid zone edge in USH1B-MYO7A could be located up to 23° from the fovea. Ellipsoid zone extent constricted at a rate of 0.51°/year with slower rates at smaller eccentricities. A well-defined EZ line could be associated with normal or abnormal ONL and/or OS thickness; detectable ONL extended well beyond EZ edge. At the EZ edge, the local slope of LA sensitivity loss was 2.6 (±1.7) dB/deg for central transition zones. At greater eccentricities, the local slope of cone sensitivity loss was shallower (1.1 ± 0.4 dB/deg for LA) than that of rod sensitivity loss (2.8 ± 1.2 dB/deg for DA). In USH1B-MYO7A, constriction rate of EZ extent depends on the initial eccentricity of the transition. Ellipsoid zone edges in the macula correspond to large local changes in cone vision, but extramacular EZ edges show more pronounced losses on rod-based vision tests. It is advisable to use not only the EZ line but also other structural and functional parameters for estimating natural history of disease and possible therapeutic effects in future clinical trials of USH1B-MYO7A.

  1. Motor Experts Care about Consistency and Are Reluctant to Change Motor Outcome.

    Directory of Open Access Journals (Sweden)

    Volker Kast

    Full Text Available Thousands of hours of physical practice substantially change the way movements are performed. The mechanisms underlying altered behavior in highly-trained individuals are so far little understood. We studied experts (handballers and untrained individuals (novices in visuomotor adaptation of free throws, where subjects had to adapt their throwing direction to a visual displacement induced by prismatic glasses. Before visual displacement, experts expressed lower variability of motor errors than novices. Experts adapted and de-adapted slower, and also forgot the adaptation slower than novices. The variability during baseline was correlated with the learning rate during adaptation. Subjects adapted faster when variability was higher. Our results indicate that experts produced higher consistency of motor outcome. They were still susceptible to the sensory feedback informing about motor error, but made smaller adjustments than novices. The findings of our study relate to previous investigations emphasizing the importance of action exploration, expressed in terms of outcome variability, to facilitate learning.

  2. Motor Experts Care about Consistency and Are Reluctant to Change Motor Outcome.

    Science.gov (United States)

    Kast, Volker; Leukel, Christian

    2016-01-01

    Thousands of hours of physical practice substantially change the way movements are performed. The mechanisms underlying altered behavior in highly-trained individuals are so far little understood. We studied experts (handballers) and untrained individuals (novices) in visuomotor adaptation of free throws, where subjects had to adapt their throwing direction to a visual displacement induced by prismatic glasses. Before visual displacement, experts expressed lower variability of motor errors than novices. Experts adapted and de-adapted slower, and also forgot the adaptation slower than novices. The variability during baseline was correlated with the learning rate during adaptation. Subjects adapted faster when variability was higher. Our results indicate that experts produced higher consistency of motor outcome. They were still susceptible to the sensory feedback informing about motor error, but made smaller adjustments than novices. The findings of our study relate to previous investigations emphasizing the importance of action exploration, expressed in terms of outcome variability, to facilitate learning.

  3. White matter changes in stroke patients. Relationship with stroke subtype and outcome

    DEFF Research Database (Denmark)

    Leys, D; Englund, E; Del Ser, T

    1999-01-01

    or white matter lesions or leukoencephalopathy or leukoaraiosis' and 'stroke or cerebral infarct or cerebral hemorrhage or cerebrovascular disease or transient ischemic attack (TIA)'. WMC, as defined radiologically, are present in up to 44% of patients with stroke or TIA and in 50% of patients...... of death or dependency, recurrent stroke of any type, cerebral bleeding under anticoagulation, myocardial infarction, and poststroke dementia. WMC in stroke patients are often associated with small-vessel disease and lead to a higher risk of death, and poor cardiac and neurological outcome. However......White matter changes (WMC), detected by imaging techniques, are frequent in stroke patients. The aim of the study was to determine how WMC relate to stroke subtypes and to stroke outcome. We made a systematic Medline search for articles appearing with two of the following key words: either 'WMC...

  4. Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?

    Directory of Open Access Journals (Sweden)

    Eide Geir E

    2010-11-01

    Full Text Available Abstract Background Upper neck ligament high-signal changes on magnetic resonance imaging (MRI have been found in patients with whiplash-associated disorders (WAD but also in non-injured controls. The clinical relevance of such changes is controversial. Their prognostic role has never been evaluated. The purpose of this study was to examine if alar and transverse ligament high-signal changes on MRI immediately following the car accident are related to outcome after 12 months for patients with acute WAD grades 1-2. Methods Within 13 days after a car accident, 114 consecutive acute WAD1-2 patients without prior neck injury or prior neck problems underwent upper neck high-resolution proton-weighted MRI. High-signal changes of the alar and transverse ligaments were graded 0-3. A questionnaire including the impact of event scale for measuring posttraumatic stress response and questions on patients' expectations of recovery provided clinical data at injury. At 12 months follow-up, 111 (97.4% patients completed the Neck Disability Index (NDI and an 11-point numeric rating scale (NRS-11 on last week neck pain intensity. Factors potentially related to these outcomes were assessed using multiple logistic regression analyses. Results Among the 111 responders (median age 29.8 years; 63 women, 38 (34.2% had grades 2-3 alar ligament changes and 25 (22.5% had grades 2-3 transverse ligament changes at injury. At 12 months follow-up, 49 (44.1% reported disability (NDI > 8 and 23 (20.7% neck pain (NRS-11 > 4. Grades 2-3 ligament changes in the acute phase were not related to disability or neck pain at 12 months. More severe posttraumatic stress response increased the odds for disability (odds ratio 1.46 per 10 points on the impact of event scale, p = 0.007 and so did low expectations of recovery (odds ratio 4.66, p = 0.005. Conclusions High-signal changes of the alar and transverse ligaments close after injury did not affect outcome for acute WAD1-2 patients

  5. 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

  6. 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.

  7. Cognitive outcome and reliable change indices two years following bilateral subthalamic nucleus deep brain stimulation.

    Science.gov (United States)

    Williams, Amy E; Arzola, Gladys Marina; Strutt, Adriana M; Simpson, Richard; Jankovic, Joseph; York, Michele K

    2011-06-01

    Subthalamic nucleus deep brain stimulation (STN-DBS) is currently the treatment of choice for medication-resistant levodopa-related motor complications in patients with Parkinson's disease (PD). While STN-DBS often results in meaningful motor improvements, consensus regarding long-term neuropsychological outcome continues to be debated. We assessed the cognitive outcomes of 19 STN-DBS patients compared to a group of 18 medically-managed PD patients on a comprehensive neuropsychological battery at baseline and two years post-surgery. Patients did not demonstrate changes in global cognitive functioning on screening measures. However, neuropsychological results revealed impairments in nonverbal recall, oral information processing speed, and lexical and semantic fluency in STN-DBS patients compared to PD controls 2 years post-surgery in these preliminary analyses. Additionally, reliable change indices revealed that approximately 50% of STN-DBS patients demonstrated significant declines in nonverbal memory and oral information processing speed compared to 25-30% of PD controls, and 26% of STN-DBS patients declined on lexical fluency compared to 11% of PD patients. Approximately 30% of both groups declined on semantic fluency. The number of STN-DBS patients who converted to dementia 2 years following surgery was not significantly different from the PD participants (32% versus 16%, respectively). Our results suggest that neuropsychological evaluations may identify possible mild cognitive changes following surgery. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. The relationship between early changes in the HAMD-17 anxiety/somatization factor items and treatment outcome among depressed outpatients.

    Science.gov (United States)

    Farabaugh, Amy; Mischoulon, David; Fava, Maurizio; Wu, Shirley L; Mascarini, Alessandra; Tossani, Eliana; Alpert, Jonathan E

    2005-03-01

    The 17-item Hamilton Rating Scale for Depression (HAMD-17) Anxiety/Somatization factor includes six items: Anxiety (psychic), Anxiety (somatic), Somatic Symptoms (gastrointestinal), Somatic Symptoms (general), Hypochondriasis and Insight. This study examines the relationship between early changes (defined as those observed between baseline and week 1) in these HAMD-17 Anxiety/Somatization Factor items and treatment outcome among major depressive disorder (MDD) patients who participated in a study comparing the antidepressant efficacy of a standardized extract of hypericum with both placebo and fluoxetine. Following a 1-week, single-blind washout, patients with MDD diagnosed by the Structured Clinical Interview for DSM-IV (SCID) were randomized to 12 weeks of double-blind treatment with hypericum extract (900 mg/day), fluoxetine (20 mg/day) or placebo. The relationship between early changes in HAMD-17 anxiety/somatization factor items and treatment outcome was assessed separately for patients who received study treatment (hypericum or fluoxetine) versus placebo with a logistic regression method. One hundred and thirty-five patients (female 57%, mean age=37.3+/-11.0 years; mean baseline HAMD-17=19.7+/-3.2 years) were randomized to double-blind treatment and were included in the intent-to-treat (ITT) analyses. After adjusting for baseline HAMD-17 scores and for multiple comparisons with the Bonferroni correction, patients who remitted (HAMD-17 score Somatic Symptoms (General) scores than non-remitters. No other significant differences in early changes were noted for the remaining items between remitters versus non-remitters who received active treatment. For patients treated with placebo, early change was not predictive of remission for any of the items after Bonferroni correction. In conclusion, the presence of early improvement on the HAMD-17 item concerning fatigue and general somatic symptoms is significantly predictive of achieving remission at endpoint with

  9. Effects of early changes in organ dysfunctions on the outcomes of critically ill patients in need of renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Elizabeth Maccariello

    2008-01-01

    Full Text Available INTRODUCTION: Acute kidney injury usually develops in critically ill patients in the context of multiple organ dysfunctions. OBJECTIVE: To evaluate the effect of changes in associated organ dysfunctions over the first three days of renal replacement therapy on the outcomes of patients with acute kidney injury. METHODS: Over a 19-month period, we evaluated 260 patients admitted to the intensive care units of three tertiary-care hospitals who required renal replacement therapy for > 48 h. Organ dysfunctions were evaluated by SOFA score (excluding renal points on the first (D1 and third (D3 days of renal replacement therapy. Absolute (A-SOFA and relative (D-SOFA changes in SOFA scores were also calculated. RESULTS: Hospital mortality rate was 75%. Organ dysfunctions worsened (A-SOFA>0 in 53%, remained unchanged (A-SOFA=0 in 17% and improved (A-SOFA<0 in 30% of patients; and mortality was lower in the last group (80% vs. 84% vs. 61%, p=0.003. SOFA on D1 (p<0.001, SOFA on D3 (p<0.001, A-SOFA (p=0.019 and D-SOFA (p=0.016 were higher in non-survivors. However, neither A-SOFA nor D-SOFA discriminated survivors from non-survivors on an individual basis. Adjusting for other covariates (including SOFA on D1, A-SOFA and D-SOFA were associated with increased mortality, and patients in whom SOFA scores worsened or remained unchanged had poorer outcomes. CONCLUSIONS: In addition to baseline values, early changes in SOFA score after the start of renal replacement therapy were associated with hospital mortality. However, no prognostic score should be used as the only parameter to predict individual outcomes.

  10. Phenotypic changes of methicillin-resistant Staphylococcus aureus during vancomycin therapy for persistent bacteraemia and related clinical outcome.

    Science.gov (United States)

    Kim, T; Kim, E S; Park, S Y; Sung, H; Kim, M-N; Kim, S-H; Lee, S-O; Choi, S-H; Jeong, J-Y; Woo, J H; Chong, Y P; Kim, Y S

    2017-08-01

    Persistent bacteraemia (PB) due to methicillin-resistant Staphylococcus aureus (MRSA) that fails to respond to glycopeptide therapy is a well-documented clinical problem. There are limited data on changes in agr functionality, vancomycin susceptibility and heteroresistance during MRSA PB. Thus, the frequency of these changes and their clinical significance remain unclear. Only patients with MRSA PB (≥7 days) from a prospective cohort of S. aureus bacteraemia were included. We collected isogenic paired strains and compared vancomycin MIC, vancomycin heteroresistance, and agr functionality between initial and final blood isolates. We also assessed the clinical outcome. A total of 49 patients had MRSA PB over 22 months. Bacteraemia persisted for a median of 13 days and most patients (98%) received glycopeptide as initial therapy. Among 49 isogenic pairs, only one pair showed a vancomycin MIC increase ≥2-fold by broth microdilution method, and only seven (14%) by E-test. Significant portions of initial isolates had vancomycin heteroresistance (49%) and agr dysfunction (76%). Development of vancomycin heteroresistance during PB occurred in four (16%) among 25 initial vancomycin-susceptible isolates, and acquisition of agr dysfunction occurred in two (16%) among 12 initial agr-functional isolates. Changes in the opposite direction occasionally occurred. These phenotypic changes during PB were not associated with mortality, whereas agr dysfunction of the initial isolates was significantly associated with mortality. During MRSA PB, phenotypic changes of MRSA isolates occurred occasionally under prolonged vancomycin exposure but were not significantly associated with clinical outcome. In contrast, initial agr dysfunction could be a predictor for mortality in MRSA PB.

  11. 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

  12. Insect herbivores change the outcome of plant competition through both inter- and intraspecific processes.

    Science.gov (United States)

    Kim, Tania N; Underwood, Nora; Inouye, Brian D

    2013-08-01

    Insect herbivores can affect plant abundance and community composition, and theory suggests that herbivores influence plant communities by altering interspecific interactions among plants. Because the outcome of interspecific interactions is influenced by the per capita competitive ability of plants, density dependence, and intrinsic rates of increase, measuring herbivore effects on all these processes is necessary to understand the mechanisms by which herbivores influence plant communities. We fit alternative competition models to data from a response surface experiment conducted over four years to examine how herbivores affected the outcome of competition between two perennial plants, Solidago altissima and Solanum carolinense. Within a growing season, herbivores reduced S. carolinense plant size but did not affect the size of S. altissima, which exhibited compensatory growth. Across seasons, herbivores did not affect S. carolinense density or biomass but reduced both the density and population growth of S. altissima. The best-fit models indicated that the effects of herbivores varied with year. In some years, herbivores increased the per capita competitive effect of S. altissima on S. carolinense; in other years, herbivores influenced the intrinsic rate of increase of S. altissima. We examined possible herbivore effects on the longer-term outcome of competition (over the time scale of a typical old-field habitat), using simulations based on the best-fit models. In the absence of herbivores, plant coexistence was observed. In the presence of herbivores, S. carolinense was excluded by S. altissima in 72.3% of the simulations. We demonstrate that herbivores can influence the outcome of competition through changes in both per capita competitive effects and intrinsic rates of increase. We discuss the implications of these results for ecological succession and biocontrol.

  13. The Impact of Waiting List BMI Changes on the Short-term Outcomes of Lung Transplantation.

    Science.gov (United States)

    Jomphe, Valérie; Mailhot, Geneviève; Damphousse, Véronic; Tahir, Muhammad-Ramzan; Receveur, Olivier; Poirier, Charles; Ferraro, Pasquale

    2018-02-01

    Obesity and underweight are associated with a higher postlung transplantation (LTx) mortality. This study aims to assess the impact of the changes in body mass index (BMI) during the waiting period for LTx on early postoperative outcomes. Medical records of 502 consecutive cases of LTx performed at our institution between 1999 and 2015 were reviewed. Patients were stratified per change in BMI category between pre-LTx assessment (candidate BMI) and transplant BMI as follows: A-candidate BMI, less than 18.5 or 18.5 to 29.9 and transplant BMI, less than 18.5; B-candidate BMI, less than 18.5 and transplant BMI, 18.5 to 29.9; C-candidate BMI, 18.5 to 29.9 and transplant BMI, 18.5 to 29.9; D-candidate BMI, 30 or greater and transplant BMI, 18.5 to 29.9; and E-candidate BMI, 30 or greater or 18.5 to 29.9 and transplant BMI, 30 or greater. Our primary outcome was in-hospital mortality and secondary outcomes were length of mechanical ventilation, intensive care unit length of stay (LOS), hospital LOS and postoperative complications. BMI variation during the waiting time was common, as 1/3 of patients experienced a change in BMI category. Length of mechanical ventilation (21 days vs 9 days; P = 0.018), intensive care unit LOS (26 days vs 15 days; P = 0.035), and rates of surgical complications (76% vs 44%; P = 0.018) were significantly worse in patients of group E versus group D. Obese candidates who failed to decrease BMI less than 30 by transplant exhibited an increased risk of postoperative mortality (odds ratio, 2.62; 95% confidence interval, 1.01-6.48) compared with patients in group C. Pre-LTx BMI evolution had no impact on postoperative morbidity and mortality in underweight patients. Our results suggest that obese candidates with an unfavorable pretransplant BMI evolution are at greater risk of worse post-LTx outcomes.

  14. Prevalence of electrocardiographic changes in patients with acute aneurysmal subarachnoid hemorrhage and their relationship with outcome

    Directory of Open Access Journals (Sweden)

    Saktheeswaran Mahesh Kumar

    2013-01-01

    Full Text Available Background: Electrocardiographic (ECG alterations occurring after subarachnoid hemorrhage (SAH have been described frequently, but the prognostic significance of these changes has not been well characterized. Aim and Objectives: To report the prevalence and patterns of ECG alterations in patients with acute aneurysmal SAH and to study the relationship between ECG alterations and the neurological outcome, if any. Materials and Methods: Records of consecutive patients admitted to the neurosurgical intensive care unit of the SCTIMST, Trivandrum between January 1999 and January 2011 with acute aneurysmal SAH were retrospectively analyzed. Results: Of the 321 patients with SAH, 190 (59.2% had abnormal ECGs. Repolarization abnormalities were the most common, with T wave inversion in the anterolateral leads occurring in 155 (48.3% patients. By univariate analysis, female sex, Glasgow Coma Score (GCS at admission of I, ST segment depression or T inversion in anterolateral leads, prolonged corrected QT interval, and sinus bradycardia were associated with increased risk of death. By multivariate analysis, only GCS and WFNS grade independently predicted mortality and none of the ECG changes predicted the same. Presence of tall T waves in anterior leads, T inversion in anterolateral leads, sinus bradycardia, and WFNS grade >1 were independently associated with GCS <15 and poor outcome at discharge. Conclusions: In patients with acute aneurysmal SAH, repolarization abnormalities are the commonest ECG alterations. ECG alterations do not independently predict death, but independently predict poor discharge neurological status.

  15. Impact of policy and built environment changes on obesity-related outcomes: a systematic review of naturally occurring experiments.

    Science.gov (United States)

    Mayne, S L; Auchincloss, A H; Michael, Y L

    2015-05-01

    Policies and changes to the built environment are promising targets for obesity prevention efforts and can be evaluated as 'natural'- or 'quasi'-experiments. This systematic review examined the use of natural- or quasi-experiments to evaluate the efficacy of policy and built environment changes on obesity-related outcomes (body mass index, diet or physical activity). PubMed (Medline) was searched for studies published 2005-2013; 1,175 abstracts and 115 papers were reviewed. Of the 37 studies included, 18 studies evaluated impacts on nutrition/diet, 17 on physical activity and 3 on body mass index. Nutrition-related studies found greater effects because of bans/restrictions on unhealthy foods, mandates offering healthier foods, and altering purchase/payment rules on foods purchased using low-income food vouchers compared with other interventions (menu labelling, new supermarkets). Physical activity-related studies generally found stronger impacts when the intervention involved improvements to active transportation infrastructure, longer follow-up time or measured process outcomes (e.g., cycling rather than total physical activity), compared with other studies. Only three studies directly assessed body mass index or weight, and only one (installing light-rail system) observed a significant effect. Studies varied widely in the strength of their design and studies with weaker designs were more likely to report associations in the positive direction. © 2015 World Obesity.

  16. Changes in North Carolina maternal health service use and outcomes among medicaid-enrolled pregnant women during state budget cuts.

    Science.gov (United States)

    Cilenti, Dorothy; Kum, Hye-Chung; Wells, Rebecca; Whitmire, J Timothy; Goyal, Ravi K; Hillemeier, Marianne M

    2015-01-01

    The recent recession has weakened the US health and human service safety net. Questions about implications for mothers and children prompted this study, which tested for changes in maternal service use and outcomes among North Carolina women with deliveries covered through Medicaid before and after a year of significant state budget cuts. Data for Medicaid covered deliveries from April-June 2009 (pre) and from April-June 2010 (post) were derived from birth certificates, Medicaid claims and eligibility files, and WIC (Special Supplemental Food Program for Women, Infants and Children) records. These time periods represent the quarter immediately before as well as the final quarter of a state fiscal year 2010 (July 2009-June 2010) characterized by substantial state budget cuts, including an October 2009 reduction in reimbursement rates for maternity care coordination. We examined how often women received medical care, maternity care coordination, family planning services, and the average numbers of obstetrical encounters, as well as the prevalence of excessive pregnancy weight gain, preterm delivery, and low birth weight. By the end of a year of substantial state budget cuts, women covered through Medicaid had fewer obstetrical visits in all trimesters as well as postpartum (P budget cuts. Maternal and infant child health outcomes measured in this study did not change during that year. Future monitoring is warranted to ensure that maternal health service access remains adequate.

  17. 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.

  18. Conservative treatment for patients with subacromial impingement: Changes in clinical core outcomes and their relation to specific rehabilitation parameters

    Directory of Open Access Journals (Sweden)

    Mikkel B. Clausen

    2018-02-01

    Full Text Available Background Impaired patient-reported shoulder function and pain, external-rotation strength, abduction strength, and abduction range-of-motion (ROM is reported in patients with subacromial impingement (SIS. However, it is unknown how much strength and ROM improves in real-life practice settings with current care. Furthermore, outcomes of treatment might depend on specific rehabilitation parameters, such as the time spent on exercises (exercise-time, number of physiotherapy sessions (physio-sessions and number of corticosteroid injections, respectively. However, this has not previously been investigated. The purpose of this study was to describe changes in shoulder strength, ROM, patient-reported function and pain, in real-life practice settings, and explore the association between changes in clinical core outcomes and specific rehabilitation parameters. Methods Patients diagnosed with SIS at initial assessment at an outpatient hospital clinic using predefined criteria’s, who had not undergone surgery after 6 months, were included in this prospective cohort study. After initial assessment (baseline, all patients underwent treatment as usual, with no interference from the investigators. The outcomes Shoulder Pain and Disability Index (SPADI:0–100, average pain (NRS:0–10, external rotation strength, abduction strength and abduction ROM, pain during each test (NRS:0–10, were collected at baseline and at six month follow-up. Amount of exercise-time, physio-sessions and steroid-injections was recorded at follow-up. Changes in outcomes were analyzed using Wilcoxon Signed-Rank test, and the corresponding effect sizes (ES were estimated. The associations between changes in outcomes and rehabilitation parameters were explored using multiple regression analyses. Results Sixty-three patients completed both baseline and follow-up testing. Significant improvements were seen in SPADI (19 points, ES:0.53, p  0.2. A higher number of physio-sessions was

  19. Outcomes of changing immunosuppressive therapy after treatment failure in patients with noninfectious uveitis.

    Science.gov (United States)

    Joshi, Lavnish; Talat, Lazha; Yaganti, Satish; Sandhu, Sartaj; Taylor, Simon R J; Wakefield, Denis; McCluskey, Peter; Lightman, Susan

    2014-05-01

    To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure. Retrospective cohort study. Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia. Participants with a history of using immunosuppressive therapy were identified in clinics, and notes were reviewed by doctors trained in uveitis therapy. Each treatment episode/course (starting or changing a therapy) was identified, and demographic details, clinical characteristics, drug used (second-line immunosuppressive agent [ISA] or biologicals), and drug doses were obtained. For each treatment episode, the reasons for changing therapy, corticosteroid-sparing effects, and control of inflammation were determined. A total of 147 patients were identified who underwent 309 different treatment episodes. Fifty-five percent of patients eventually required a change in treatment after their first treatment episode/course. Forty-five episodes involved switching from one ISA to another, with 50% to 100% of these patients achieving "success" (prednisolone ≤10 mg and sustained control) with the new ISA. A combination of ISAs were used in 53 episodes, with "success" being achieved in 50% to 71% of these patients. Biological agents were used in 45 episodes, the most common one being infliximab, which achieved success in 80% of patients. Our data suggest that control of inflammation can be achieved after switching or combining ISAs. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  20. Climate change policies in Norway and the Netherlands: different instruments, similar outcome?

    International Nuclear Information System (INIS)

    Christer, C.A.; Birger, S.J.

    2005-01-01

    This paper examines the extent to which climate change policies and instruments in Norway and the Netherlands have provided continuous incentives for the development, adoption and diffusion of new abatement technologies. More specifically, the paper examines whether differences between the types of instruments adopted (Dutch voluntary agreements and the Norwegian CO 2 tax), problem type and domestic political context have affected technological change in the two countries' petroleum sectors. In brief, empirical evidence suggests that the two cases display quite similar outcomes in terms of technological change. That said, there are also important differences, pertaining most notably to the development and adoption of radical innovations in the Norwegian petroleum sector. The differences are in turn attributed to the interplay between the respective policy instruments adopted and the political contexts in which they are applied. These findings are important not only for policymakers involved in the selection of effective instruments in climate change policy, but also for the development of theories and analytical frameworks to examine and assess dynamic efficiency. (author)

  1. Early life status epilepticus and stress have distinct and sex-specific effects on learning, subsequent seizure outcomes, including anticonvulsant response to phenobarbital.

    Science.gov (United States)

    Akman, Ozlem; Moshé, Solomon L; Galanopoulou, Aristea S

    2015-02-01

    Neonatal status epilepticus (SE) is often associated with adverse cognitive and epilepsy outcomes. We investigate the effects of three episodes of kainic acid-induced SE (3KA-SE) and maternal separation in immature rats on subsequent learning, seizure susceptibility, and consequences, and the anticonvulsant effects of phenobarbital, according to sex, type, and age at early life (EL) event. 3KA-SE or maternal separation was induced on postnatal days (PN) 4-6 or 14-16. Rats were tested on Barnes maze (PN16-19), or lithium-pilocarpine SE (PN19) or flurothyl seizures (PN32). The anticonvulsant effects of phenobarbital (20 or 40 mg/kg/rat, intraperitoneally) pretreatment were tested on flurothyl seizures. FluoroJadeB staining assessed hippocampal injury. 3KA-SE or separation on PN4-6 caused more transient learning delays in males and did not alter lithium-pilocarpine SE latencies, but aggravated its outcomes in females. Anticonvulsant effects of phenobarbital were preserved and potentiated in specific groups depending on sex, type, and age at EL event. Early life 3KA-SE and maternal separation cause more but transient cognitive deficits in males but aggravate the consequences of subsequent lithium-pilocarpine SE in females. In contrast, on flurothyl seizures, EL events showed either beneficial or no effect, depending on gender, type, and age at EL events. © 2014 John Wiley & Sons Ltd.

  2. "Love me, parents!": impact evaluation of a national social and behavioral change communication campaign on maternal health outcomes in Tanzania.

    Science.gov (United States)

    Kaufman, Michelle R; Harman, Jennifer J; Smelyanskaya, Marina; Orkis, Jennifer; Ainslie, Robert

    2017-09-15

    Despite marked improvements over the last few decades, maternal mortality in Tanzania remains among the world's highest at 454 maternal deaths per 100,000 live births. Many factors contribute to this disparity, such as a lack of attendance at antenatal care (ANC) services and low rates of delivery at a health facility with a skilled provider. The Wazazi Nipendeni (Love me, parents) social and behavioral change communication campaign was launched in Tanzania in 2012 to improve a range of maternal health outcomes, including individual birth planning, timely ANC attendance, and giving birth in a healthcare facility. An evaluation to determine the impact of the national Wazazi Nipendeni campaign was conducted in five purposively selected regions of Tanzania using exit interviews with pregnant and post-natal women attending ANC clinics. A total of 1708 women were interviewed regarding campaign exposure, ANC attendance, and individual birth planning. Over one third of interviewed women (35.1%) reported exposure to the campaign in the last month. The more sources from which women reported hearing the Wazazi Nipendeni message, the more they planned for the birth of their child (β = 0.08, p = .001). Greater numbers of types of exposure to the Wazazi Nipendeni message was associated with an increase in ANC visits (β = 0.05, p = .004). Intervention exposure did not significantly predict the timing of the first ANC visit or HIV testing in the adjusted model, however, findings showed that exposure did predict whether women delivered at a health care facility (or not) and whether they tested for HIV with a partner in the unadjusted models. The Wazazi Nipendeni campaign shows promise that such a behavior change communication intervention could lead to better pregnancy and childbirth outcomes for women in low resource settings. For outcomes such as HIV testing, message exposure showed some promising effects, but demographic variables such as age and socioeconomic status

  3. RSV prophylaxis guideline changes and outcomes in children with congenital heart disease.

    Science.gov (United States)

    Walpert, Adam S; Thomas, Ian D; Lowe, Merlin C; Seckeler, Michael D

    2018-02-13

    The aim of this study was to compare inpatient outcomes and costs for children with respiratory syncytial virus and congenital heart disease before and after the change in management guidelines for respiratory syncytial virus prophylaxis. Hospital discharge data from the Vizient (formerly University HealthSystem Consortium) were queried from October 2012 to June 2014 (Era 1) and July 2014 to April 2016 (Era 2) for patients aged Disease (ICD)-9 or ICD-10 code for congenital heart disease (745-747.49, Q20.0-Q26.4) and a primary or secondary admitting diagnosis of respiratory syncytial virus infection (079.6, J20.5), acute bronchiolitis due to respiratory syncytial virus (466.11, J21.0) or respiratory syncytial virus pneumonia (480.1, J12.1). This study is a review of a national administrative discharge database. Respiratory syncytial virus admissions were identified in 1269 patients aged congenital heart disease, with 644 patients in Era 1 and 625 in Era 2. Patients 0-12 months old represented 83% of admissions. Prior to 2014, children aged 0-24 months with congenital heart disease were eligible to receive respiratory syncytial virus prophylaxis. Updated guidelines, published in 2014, restricted the recommendation to administer palivizumab respiratory syncytial virus prophylaxis to children with congenital heart disease only if they are ≤12 months old. The outcome measures are hospital length of stay, ICU admission rate, mortality, and direct costs. There was no change in length of stay, ICU admission rate, in-hospital mortality, or direct costs for children 13-24 months old with congenital heart disease after the change in guidelines. There were no deaths in 13-24 month olds, regardless of era. Our findings provide additional support for the new guideline recommendations to provide respiratory syncytial virus prophylaxis only for children ≤12 months old with congenital heart disease. © 2018 Wiley Periodicals, Inc.

  4. Explaining Dynamic Strategies for Defending Company Legitimacy : The Changing Outcomes of Anti-Sweatshop Campaigns in France and Switzerland

    OpenAIRE

    Balsiger, Philip

    2018-01-01

    This article analyzes and compares the dynamically changing outcomes of anti-sweatshop campaigns in France and Switzerland through a qualitative comparative case study using interviews and analysis of firsthand and secondary data. In both countries, some targeted firms made early concessions and later withdrew from those concessions. To explain these changing outcomes over time, the article develops a perspective that puts emphasis on interaction phases and highlights corporate strategic resp...

  5. Association between changes on the Negative Symptom Assessment scale (NSA-16) and measures of functional outcome in schizophrenia.

    Science.gov (United States)

    Velligan, Dawn I; Alphs, Larry; Lancaster, Scott; Morlock, Robert; Mintz, Jim

    2009-09-30

    We examined whether changes in negative symptoms, as measured by scores on the 16-item Negative Symptom Assessment scale (NSA-16), were associated with changes in functional outcome. A group of 125 stable outpatients with schizophrenia were assessed at baseline and at 6 months using the NSA-16, the Brief Psychiatric Rating Scale, and multiple measures of functional outcome. Baseline adjusted regression coefficients indicated moderate correlations between negative symptoms and functional outcomes when baseline values of both variables were controlled. Results were nearly identical when we controlled for positive symptoms. Cross-lag panel correlations and Structural Equation Modeling were used to examine whether changes in negative symptoms drove changes in functional outcomes over time. Results indicated that negative symptoms drove the changes in the Social and Occupational Functioning Scale (SOFAS) rather than the reverse. Measures of Quality of Life and measures of negative symptoms may be assessing overlapping constructs or changes in both may be driven by a third variable. Negative symptoms were unrelated over time to scores on a performance-based measure of functional capacity. This study indicates that the relationship between negative symptom change and the change in functional outcomes is complex, and points to potential issues in selection of assessments.

  6. Is the presence of Modic changes associated with the outcomes of different treatments? A systematic critical review

    Directory of Open Access Journals (Sweden)

    Jensen Rikke K

    2011-08-01

    Full Text Available Abstract Background Modic changes (MCs have been identified as a diagnostic subgroup associated with low back pain (LBP. The aetiology of MCs is still unknown and there is no effective treatment available. If MCs constitute a specific subgroup of LBP, it seems reasonable to expect different effects from different treatments. The objective of this systematic critical literature review was therefore to investigate if there is evidence in the literature that the presence of MCs at baseline is associated with a favourable outcome depending on the treatment provided for LBP. Methods The databases MEDLINE and EMBASE were searched for relevant articles from 1984 to December 2010. A checklist including items related to the research questions and quality of the articles was used for data extraction and quality assessment. Of the 1650 articles found, five (six studies were included in this review but because the studies were so heterogeneous, the results have been reported separately for each study. Results The treatments studied were: lumbar epidural steroid injections (n = 1, lumbar intradiscal steroid injections (n = 2, lumbar disc replacement (n = 1, fusion surgery (n = 1 and exercise therapy (n = 1. One of the two studies investigating treatment with intradiscal steroid injections and the study investigating fusion surgery reported that MCs were positively associated with the outcomes of pain and disability. The other study on lumbar intradiscal steroid injections and the study on lumbar epidural steroid injections reported mixed results, whereas the study on lumbar disc replacement and the study on exercise therapy reported that MCs were not associated with the outcomes of pain and disability. Conclusions The available studies on the topic were too few and too heterogeneous to reach a definitive conclusion and it is therefore still unclear if MCs may be of clinical importance when guiding or prescribing the 'right' treatment for a patient with LBP.

  7. Do symptom-specific stages of change predict eating disorder treatment outcome?

    Science.gov (United States)

    Ackard, Diann M; Cronemeyer, Catherine L; Richter, Sara; Egan, Amber

    2015-03-01

    Interview methods to assess stages of change (SOC) in eating disorders (ED) indicate that SOC are positively correlated with symptom improvement over time. However, interviews require significant time and staff training and global measures of SOC do not capture varying levels of motivation across ED symptoms. This study used a self-report, ED symptom-specific SOC measure to determine prevalence of stages across symptoms and identify if SOC predict treatment outcome. Participants [N = 182; age 13-58 years; 92% Caucasian; 96% female; average BMI 21.7 (SD = 5.9); 50% ED not otherwise specified (EDNOS), 30.8% bulimia nervosa (BN), 19.2% anorexia nervosa (AN)] seeking ED treatment at a diverse-milieu multi-disciplinary facility in the United States completed stages of change, behavioral (ED symptom use and frequency) and psychological (ED concerns, anxiety, depression) measures at intake assessment and at 3, 6 and 12 months thereafter. Descriptive summaries were generated using ANOVA or Kruskal-Wallis (continuous) and χ (2) (categorical) tests. Repeated measures linear regression models with autoregressive correlation structure predicted treatment outcome. At intake assessment, 53.3% of AN, 34.0% of BN and 18.1% of EDNOS patients were in Preparation/Action. Readiness to change specific symptoms was highest for binge-eating (57.8%) and vomiting (56.5%). Frequency of fasting and restricting behaviors, and scores on all eating disorder and psychological measures improved over time regardless of SOC at intake assessment. Symptom-specific SOC did not predict reductions in ED symptom frequency. Overall SOC predicted neither improvement in Eating Disorder Examination Questionnaire (EDE-Q) scores nor reduction in depression or trait anxiety; however, higher overall SOC predicted lower state anxiety across follow-up. Readiness to change ED behaviors varies considerably. Most patients reduced eating disorder behaviors and increased psychological functioning regardless of stages

  8. Reduction in food away from home is associated with improved child relative weight and body composition outcomes and this relation is mediated by changes in diet quality.

    Science.gov (United States)

    Altman, Myra; Cahill Holland, Jodi; Lundeen, Delaney; Kolko, Rachel P; Stein, Richard I; Saelens, Brian E; Welch, R Robinson; Perri, Michael G; Schechtman, Kenneth B; Epstein, Leonard H; Wilfley, Denise E

    2015-09-01

    Reducing consumption of food away from home is often targeted during pediatric obesity treatment, given the associations with weight status and gain. However, the effects of this dietary change on weight loss are unknown. Our aim was to evaluate associations between changes in dietary factors and child anthropometric outcomes after treatment. It is hypothesized that reduced consumption of food away from home will be associated with improved dietary intake and greater reductions in anthropometric outcomes (standardized body mass index [BMI] and percent body fat), and the relationship between food away from home and anthropometric outcomes will be mediated by improved child dietary intake. We conducted a longitudinal evaluation of associations between dietary changes and child anthropometric outcomes. Child diet (three 24-hour recalls) and anthropometric data were collected at baseline and 16 weeks. Participants were 170 overweight and obese children ages 7 to 11 years who completed a 16-week family-based behavioral weight-loss treatment as part of a larger multi-site randomized controlled trial conducted in two cohorts between 2010 and 2011 (clinical research trial). Dietary treatment targets during family-based behavioral weight-loss treatment included improving diet quality and reducing food away from home. The main outcome measures in this study were child relative weight (standardized BMI) and body composition (percent body fat). We performed t tests and bootstrapped single-mediation analyses adjusting for relevant covariates. As hypothesized, decreased food away from home was associated with improved diet quality and greater reductions in standardized BMI (Paway from home and anthropometric outcomes were mediated by changes in diet quality. Specifically, change in total energy intake and added sugars mediated the association between change in food away from home and standardized BMI, and change in overall diet quality, fiber, added sugars, and added fats

  9. Fashion retail innovation: about context, antecedents and outcome in technological change projects

    DEFF Research Database (Denmark)

    Tambo, Torben

    2015-01-01

    Fashion retail is recognised for its strong capabilities in product innovation, while also having the potential to improve the governance of technology-based process innovation. This chapter proposes a model perspective in management of technology and innovation, including special requirements...... of fashion retailing. In particular, this chapter discusses the context of fashion retailing understood as product and brand-based characteristics. A case study-based methodology is then used to guide an analysis of antecedents and (expected) outcome of fashion retail innovation. IT-based innovation...... dominates, but innovation is suggested to include a broader scope of technologies. Contrary to innovation maturity models, this chapter proposes to consider innovation as a continuous refinement between dynamic capabilities and absorptive capacity where technologies must be adapted to the special...

  10. Stages of change for physical activity and dietary habits in persons with type 2 diabetes included in a mobile health intervention: the Norwegian study in RENEWING HEALTH.

    Science.gov (United States)

    Holmen, Heidi; Wahl, Astrid; Torbjørnsen, Astrid; Jenum, Anne Karen; Småstuen, Milada Cvancarova; Ribu, Lis

    2016-01-01

    The aim of this study was to investigate stages of change for physical activity and dietary habits using baseline data from persons with type 2 diabetes included in a mobile health intervention. We examined the associations between stages of change for physical activity change and dietary change, and between stages of change for each behavior and individual characteristics, health-related quality of life, self-management, depressive symptoms, and lifestyle. We examined 151 persons with type 2 diabetes with an glycated hemoglobin (HbA1c) level ≥7.1%, aged ≥18 years at baseline of a randomized controlled trial, before testing a mobile app with or without health counseling. Stages of change were dichotomized into 'pre-action' and 'action'. Self-management was measured using the Health Education Impact Questionnaire (heiQ) where a higher score reflects increased self-management, and health-related quality of life was measured with the Short-Form-36 (SF-36). Logistic regression modeling was performed. The median HbA1c level was 7.9% (7.1-12.4), 90% were overweight or obese, and 20% had ≥3 comorbidities. 58% were in the preaction stage for physical activity change and 79% in the preaction stage for dietary change. Higher scores of self-management were associated with an increased chance of being in the action stage for both dietary change and physical activity change. Higher body mass index was associated with an 8% reduced chance of being in the action stage for physical activity change (OR 0.92, 95% CI 0.86 to 0.99). Being in the action stage was associated with higher scores of self-management, crucial for type 2 diabetes. Over half of the participants were in the preaction stage for physical activity and dietary change, and many had a high disease burden with comorbidities and overweight. NCT01315756.

  11. Rudiments of recent fertility decline in Hungary: Postponement, educational differences, and outcomes of changing partnership forms

    Directory of Open Access Journals (Sweden)

    Zsolt Spéder

    2006-10-01

    Full Text Available Our study describes fundamental changes in childbearing behavior in Hungary. It documents current postponement of entry into motherhood (first birth and uncovers signs of delay in second birth. We place the behavioral modifications into historical time and reveal the basic role of the political, economic, and societal transformation of Hungary that started in 1989-1990 in these modifications. We document postponement as well as differentiation, and mothers' highest level of education will represent the structural position of individuals. We shed light on the different speed of postponement and support the assumption of behavioral differences according to the highest level of education. Particular attention will be paid to changing partnership relations: Fertility outcomes remain to be strongly associated with the type of partnership and its development; profound changes in partnership formation, namely the proliferation of cohabitation and the increasing separation rate of first partnerships, may therefore facilitate fertility decline in Hungary. The analysis is based on the first wave of the Hungarian panel survey "Turning points of the life course" carried out in 2001/2002.

  12. Changes in spiritual well-being and psychological outcomes in ovarian cancer survivors.

    Science.gov (United States)

    Davis, Lauren Z; Cuneo, Michaela; Thaker, Premal H; Goodheart, Michael J; Bender, David; Lutgendorf, Susan K

    2018-02-01

    Because of the poor prognosis of ovarian cancer and concomitant distress, understanding contributors to positive well-being is critical. This study examines spiritual growth as a domain of posttraumatic growth and its contribution to longitudinal emotional outcomes in ovarian cancer. Ovarian cancer patients (N = 241) completed measures assessing spirituality (Functional Assessment of Chronic Illness Therapy-Spiritual Well-being-12; subscales: faith, meaning, and peace), depression (Center for Epidemiologic Studies Depression Scale), cancer-specific anxiety (Impact of Event Scale), and total mood disturbance (TMD; Profile of Mood States) prior to surgery and 1-year postsurgery. Stressful life events in the year after diagnosis were measured at 1-year postsurgery. Regressions examined the association between changes in spirituality and depression, anxiety, and TMD at 1-year postsurgery. Additionally, spiritual change was examined as a moderator of the effect of recent life events on mood. Increases in peace were related to lower depression (β = -.40, P spiritual growth in cancer patients. Furthermore, changes in peace appear to moderate the effect of life events on psychological well-being. Copyright © 2017 John Wiley & Sons, Ltd.

  13. Tongue motion variability with changes of upper airway stimulation electrode configuration and effects on treatment outcomes.

    Science.gov (United States)

    Steffen, Armin; Kilic, Ayse; König, Inke R; Suurna, Maria V; Hofauer, Benedikt; Heiser, Clemens

    2017-12-27

    Upper airway stimulation (UAS) is an effective treatment for obstructive sleep apnea (OSA). Previous data have demonstrated a correlation between the phenotype of tongue motion and therapy response. Closed loop hypoglossal nerve stimulation implant offers five different electrode configuration settings which may result in different tongue motion. Two-center, prospective consecutive trial in a university hospital setting. Clinical outcomes of 35 patients were analyzed after at least 12 months of device use. Tongue motion was assessed at various electrode configuration settings. Correlation between the tongue motion and treatment response was evaluated. OSA severity was significantly reduced with the use of UAS therapy (P < .001). Changes in tongue motion patterns were frequently observed (58.8%) with different electrode configuration settings. Most of the patients alternated between right and bilateral protrusion (73.5%), which are considered to be the optimal phenotypes for selective UAS responses. Different voltage settings were required to achieve functional stimulation levels when changing between the electrode settings. UAS is highly effective for OSA treatment in selected patients with an apnea-hypopnea index between 15 and 65 events per hour and higher body mass index. Attention should be given to patients with shifting tongue movement in response to change of electrode configuration. The intraoperative cuff placement should be reassessed when tongue movement shifting is observed. 4 Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Dietary transition, nutritional and health outcomes, and changing agrifood production and trade patterns

    DEFF Research Database (Denmark)

    Yu, Wusheng; Jensen, Hans Grinsted; Cao, Lijuan

    efficiency and welfare consequences. Realizing that changing dietary trends are likely to be costly, in a more refined scenario, we consider public policy options to influence consumer choices for purposes of reaching a given alternative diet target. Since the costs of the policy intervention...... and health outcomes of diet transition and alternative diets on the one hand and the associated agricultural and food production and trade effects on the other hand, using the Chinese case as an example. We base this analysis in a modified GTAP model featuring the demand, production and supply and trade...... of major agricultural and food products. Taking advantages of recent methodological advances in building calorie and other nutrition data sourced from the FAO into the GTAP model and database, we further represent current and predicted dietary patterns for China in a baseline projection. The projected...

  15. Tape functionality: position, change in shape, and outcome after TVT procedure--mid-term results.

    Science.gov (United States)

    Kociszewski, Jacek; Rautenberg, Oliver; Kolben, Sebastian; Eberhard, Jakob; Hilgers, Reinhard; Viereck, Volker

    2010-07-01

    This study evaluates the relevance of the tape position and change in shape (tape functionality) under in vivo conditions for mid-term outcome. Changes in the sonographic tension-free vaginal tape (TVT) position relative to the percentage urethral length and the tape-urethra distance were determined after 6 and 48 months in 41 women with stress urinary incontinence. At 48 months, 76% (31/41) of women were cured, 17% (7/41) were improved, and 7% (3/41) were failures. Disturbed bladder voiding was present in 12% (5/41), de novo urge incontinence in 7% (3/41). The median TVT position was at 63% of urethral length. Median tape-urethra distance was 2.7 mm, ranging from 2.9 mm in continent patients without complications to 1.1 mm in those with obstructive complications. Patients with postoperative urine loss had a median distance of 3.9 mm. The tape was stretched at rest and C-shaped during straining in 15 of 41 women (37%) at 48 months (all continent). Patients with this tape functionality at 6 months were also cured at 48 months in 86% of cases (19/22), and only 14% (3/22) showed recurrent incontinence. Mid-term data suggest an optimal outcome if the tape is positioned at least 2 mm from the urethra at the junction of the middle and distal thirds. Patients with optimal tape functionality at 6 months are likely to show mid-term therapeutic success.

  16. Body temperature change and outcomes in patients undergoing long-distance air medical transport.

    Science.gov (United States)

    Nakajima, Mikio; Aso, Shotaro; Yasunaga, Hideo; Shirokawa, Masamitsu; Nakano, Tomotsugu; Miyakuni, Yasuhiko; Goto, Hideaki; Yamaguchi, Yoshihiro

    2018-04-30

    Short-distance air medical transport for adult emergency patients does not significantly affect patients' body temperature and outcomes. This study aimed to examine the influence of long-distance air medical transport on patients' body temperatures and the relationship between body temperature change and mortality. We retrospectively enrolled consecutive patients transferred via helicopter or plane from isolated islands to an emergency medical center in Tokyo, Japan between April 2010 and December 2016. Patients' average body temperature was compared before and after air transport using a paired t-test, and corrections between body temperature change and flight duration were calculated using Pearson's correlation coefficient. Multivariable logistic regression models were then used to examine the association between body temperature change and in-hospital mortality. Of 1253 patients, the median age was 72 years (interquartile range, 60-82 years) and median flight duration was 71 min (interquartile range, 54-93 min). In-hospital mortality was 8.5%, and average body temperature was significantly different before and after air transport (36.7 °C versus 36.3 °C; difference: -0.36 °C; 95% confidence interval, -0.30 to -0.42; p 38.0 °C) or normothermia (36.0-37.9 °C) before air transport and hypothermia after air transport (odds ratio, 2.08; 95% confidence interval, 1.20-3.63; p = 0.009), and (ii) winter season (odds ratio, 2.15; 95% confidence interval, 1.08-4.27; p = 0.030). Physicians should consider body temperature change during long-distance air transport in patients with not only hypothermia but also normothermia or hyperthermia before air transport, especially in winter. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. Change of Patient-Reported Aesthetic Outcome Over Time and Identification of Factors Characterizing Poor Aesthetic Outcome After Breast-Conserving Therapy: Long-Term Results of a Prospective Cohort Study.

    Science.gov (United States)

    Hennigs, André; Biehl, Hannah; Rauch, Geraldine; Golatta, Michael; Tabatabai, Patrik; Domschke, Christoph; Schott, Sarah; Wallwiener, Markus; Schütz, Florian; Sohn, Christof; Heil, Jörg

    2016-05-01

    We analyzed the change of aesthetic outcome (AO) over time and explored factors characterizing poor AO after breast-conserving surgery (BCS). This prospective single-center cohort study included 849 patients preoperatively planned for BCS between September 2007 and December 2011. Long-term follow-up was made once in 2013. AO was measured by the Aesthetic Status (AS) of the Breast Cancer Treatment Outcome Scale questionnaire. Clinical, surgical, and pathologic variables were evaluated to identify predictors of poor AO. We applied single factor variance analyses and univariable logistic regression analyses for outcome analysis. The long-term follow-up rate in 2013 was 73 % (621 nonrecurrent with final BCS). A poor or fair AO was reported in 30 (4.8 %) and 98 (15.8 %) of these 621 patients, respectively. Single factor variance analysis showed a negative impact of higher specimen weight on AO (p procedures.

  18. Achieving excellence in private intensive care units: The effect of transformational leadership and organisational culture on organisational change outcomes

    Directory of Open Access Journals (Sweden)

    Portia J. Jordan

    2015-12-01

    Full Text Available Orientation: Organisational change outcomes in private intensive care units are linked to higher patient satisfaction, improved quality of patient care, family support, cost-effective care practices and an increased level of excellence. Transformational leadership and fostering a positive organisational culture can contribute to these change outcomes. Research purpose: The study determined whether transformational leadership and a supportive organisational culture were evident in six private intensive care units in the Eastern Cape, South Africa. A conceptual framework to investigate the relationship between transformational leadership, organisational culture, and organisational change outcomes, was proposed and tested. Motivation for the study: The prevalence of transformational leadership, a positive organisational culture and their effect on organisational change outcomes in private healthcare industries require further research in order to generate appropriate recommendations. Research design, approach and method: A positivistic, quantitative design was used. A survey was conducted using a questionnaire which, in previous studies, produced scores with Cronbach’s alpha coefficients greater than 0.80, to collect data from a sample of 130 professional nurses in private intensive care units. Main findings: Transformational leadership and a positive organisational culture were evident in the private intensive care units sampled. A strong, positive correlation exists between transformational leadership, organisational culture, and organisational change outcomes. This correlation provides sufficient evidence to accept the postulated research hypotheses. Innovation and intellectual stimulation were identified as the factors in need of improvement. Practical or managerial implications: The findings of the study may be used by managers in intensive care units to promote organisational change outcomes, linked to transformational leadership and a

  19. Addiction treatment outcomes, process and change: Texas Institute of Behavioral Research at Texas Christian University.

    Science.gov (United States)

    Simpson, D Dwayne; Joe, George W; Dansereau, Donald F; Flynn, Patrick M

    2011-10-01

    For more than 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs-the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-89), the second focused upon modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus upon adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases, organizational and systems functioning, treatment costs and process related to implementation of evidence-based practices. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

  20. Addiction treatment outcomes, process, and change: Texas Institute of Behavioral Research at TCU

    Science.gov (United States)

    Simpson, D. Dwayne; Joe, George W.; Dansereau, Donald F.; Flynn, Patrick M.

    2010-01-01

    For over 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services, and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs – the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-1989), the second focused on modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process, and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus on adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of HIV/AIDS and other infectious diseases, organizational and systems functioning, treatment costs, and process related to implementation of evidence-based practices. PMID:20840168

  1. Psychosocial constructs and postintervention changes in physical activity and dietary outcomes in a lifestyle intervention, HUB City Steps, 2010

    Science.gov (United States)

    Purpose: To examine relationships among psychosocial constructs (PSC) of behavior change and post-intervention changes in physical activity (PA) and dietary outcomes. Design: Non-controlled, pre- post-experimental intervention. Setting: Midsized, southern United States city. Subjects: 269 prima...

  2. Changes in heart rate associated with contest outcome in agonistic encounters in lobsters.

    Science.gov (United States)

    Hernáindez-Falcón, Jesús; Basu, Alo C; Govindasamy, Siddhartan; Kravitz, Edward A

    2005-03-01

    Agonistic contests between lobsters housed together in a confined space progress through encounters of increasing intensity until a dominance relationship is established. Once this relationship is established, losing animals continually retreat from the advances of winners. These encounters are likely to consume much energy in both winning and losing animals. Therefore, one might expect involvement of many physiological systems before, during and after fights. Here, we report effects of agonistic encounters on cardiac frequency in winning and losing adult lobsters involved in dyadic interactions. The results show that: (i) small but significant increases in heart rate are observed upon chemical detection of a conspecific; (ii) during agonistic interactions, further increases in heart rate are seen; and (iii) ultimate winners exhibit greater increases in heart rate lasting longer periods of time compared to ultimate losers. Heart rate in winners remains elevated for at least 15 min after the contests have ended and animals have been returned to their home tanks. Reduced effects are seen in second and third pairings between familiar opponents. The sustained changes in heart rate that we observe in winning lobsters may result from hormonal modulation of cardiac function related to the change in social status brought about by contest outcome.

  3. Worksite tobacco prevention in the Canton of Zurich: stages of change, predictors, and outcomes.

    Science.gov (United States)

    Friedrich, Verena; Brügger, Adrian; Bauer, Georg

    2009-01-01

    This study provides information about the prevalence of tobacco prevention (TP) and the stages of change with respect to the introduction of TP among companies in the Canton of Zurich (n = 1,648). It explores the factors that predict restrictiveness of smoking policies, number of individual support measures, interest in services to promote TP, and the relationship between TP and health outcomes. Data were gathered by means of a written questionnaire and analysed using ordinal regression models. Whereas many companies maintain smoke-free policies, only few provide cessation-courses. Health and welfare organisations have strictest, and building and hospitality companies have least strict policies. Company size predicts number of individual support measures but not policy restrictiveness. Both measures are predicted by personal concern of the representative. Interest in services is predicted by tobacco-related problems and medium stages of change. Finally, stricter policies are associated with lower proportion of smokers and less tobacco-related problems. Health professionals should support less advanced companies in their endeavour to implement TP. The findings provide a baseline to evaluate the implementation of the forthcoming smoke-free legislation.

  4. Sequential computerized tomography changes and related final outcome in severe head injury patients

    International Nuclear Information System (INIS)

    Lobato, R.D.; Gomez, P.A.; Alday, R.

    1997-01-01

    The authors analyzed the serial computerized tomography (CT) findings in a large series of severely head injured patients in order to assess the variability in gross intracranial pathology through the acute posttraumatic period and determine the most common patterns of CT change. A second aim was to compare the prognostic significance of the different CT diagnostic categories used in the study (Traumatic Coma Data Bank CT pathological classification) when gleaned either from the initial (postadmission) or the control CT scans, and determine the extent to which having a second CT scan provides more prognostic information than only one scan. 92 patients (13.3 % of the total population) died soon after injury. Of the 587 who survived long enough to have at least one control CT scan 23.6 % developed new diffuse brain swelling, and 20.9 % new focal mass lesions most of which had to be evacuated. The relative risk for requiring a delayed operation as related to the diagnostic category established by using the initial CT scans was by decreasing order: diffuse injury IV (30.7 %), diffuse injury III (30.5 %), non evacuated mass (20 %), evacuated mass (20.2 %), diffuse injury II (12.1 %), and diffuse injury I (8.6 %). Overall, 51.2 % of the patients developed significant CT changes (for worse or better) occurring either spontaneously or following surgery, and their final outcomes were more closely related to the control than to the initial CT diagnoses. In fact, the final outcome was more accurately predicted by using the control CT scans (81.2 % of the cases) than by using the initial CT scans (71.5 % of the cases only). Since the majority of relevant CT changes developed within 48 hours after injury a pathological categorization made by using an early control CT scan seems to be most useful for prognostic purposes. Prognosis associated with the CT pathological categories used in the study was similar independently of the moment of the acute posttraumatic period at which

  5. Changes in inflammatory mediators in gingival crevicular fluid following periodontal disease treatment in pregnancy: relationship to adverse pregnancy outcome.

    Science.gov (United States)

    Penova-Veselinovic, Blagica; Keelan, Jeffrey A; Wang, Carol A; Newnham, John P; Pennell, Craig E

    2015-11-01

    Periodontal disease (PD) in pregnancy is associated with an increased risk of adverse pregnancy outcomes including miscarriage and preterm birth. Evidence exists that periodontal disease treatment may reduce inflammatory mediators in gingival crevicular fluid (GCF) and the risk of inflammation-associated pregnancy complications. The aim was to determine if periodontal disease treatment during mid-pregnancy alters local inflammation in GCF and has beneficial effects on clinical dental parameters. Eighty pregnant women with clinically diagnosed PD were recruited from a randomised controlled trial on the treatment of periodontal disease in pregnancy conducted in Perth, Australia. The treatment group underwent intensive PD treatment (20-28 weeks' GA), while the control group underwent the same treatment postnatally. GCF was collected at 20 and 28 weeks' gestation and concentrations of cytokines determined by multiplex assay: IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17, TNF-α and MCP-1. Periodontal treatment significantly reduced the GCF levels of IL-1β, IL-10, IL-12p70 and IL-6 at 28 weeks' GA compared with controls, while levels of MCP-1, IL-8 and TNF-α exhibited a significant gestational age-dependent increase, but no treatment response. Post-treatment clinical parameters improved with significant reductions in bleeding on probing, clinical attachment loss, and probing depth. No changes in pregnancy-related outcomes were observed, although the severity of periodontal disease was significantly associated with an increased risk of infants born small for gestational age. PD treatment in pregnancy reduces the levels of some inflammatory mediators in the GCF and improves dental parameters, with no overt effects on pregnancy outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Perceived age change after aesthetic facial surgical procedures quantifying outcomes of aging face surgery.

    Science.gov (United States)

    Chauhan, Nitin; Warner, Jeremy P; Adamson, Peter A

    2012-01-01

    To quantify the degree of perceived age change after aesthetic facial surgical procedures to provide an objective measure of surgical success. Sixty patients undergoing various aging face surgical procedures were randomly chosen for analysis. Preoperative and postoperative photographs were evaluated. Raters were presented with photographs in a random assortment and were asked to estimate the age of the patient. Perceived age difference was defined as the difference between the chronological age and the estimated age, and the change in this value after surgery was the chief outcome of interest. Statistical models were designed to account for any effects of interrater differences, preoperative chronological age, rater group, photograph order, or surgical procedure performed. Our patient population was divided into the following 3 groups based on the surgical procedure performed: group 1 (face- and neck-lift [22 patients]), group 2 (face- and neck-lift and upper and lower blepharoplasty [17 patients]), and group 3 (face- and neck-lift, upper and lower blepharoplasty, and forehead-lift [21 patients]). Adjusted means demonstrated that patient ages were estimated to be 1.7 years younger than their chronological age before surgery and 8.9 years younger than their chronological age after surgery. The effect was less substantial for group 1 patients and was most dramatic for group 3 patients, who had undergone all 3 aging face surgical procedures. Our study is novel in that it quantifies the degree of perceived age change after aging face surgical procedures and demonstrates a significant and consistent reduction in perceived age after aesthetic facial surgery. This effect is more substantial when the number of surgical procedures is increased, an effect unrelated to the preoperative age of a patient and unaffected by other variables that we investigated. The ability to perceive age correctly is accurate and consistent.

  7. Eco-efficient production of spring barley in a changed climate: A Life Cycle Assessment including primary data from future climate scenarios

    DEFF Research Database (Denmark)

    Niero, Monia; Ingvordsen, Cathrine Heinz; Peltonen-Sainio, Pirjo

    2015-01-01

    The paper has two main objectives: (i) to assess the eco-efficiency of spring barley cultivation for malting in Denmark in a future changed climate (700 ppm [CO2] and +5 °C) through Life Cycle Assessment (LCA) and (ii) to compare alternative future cultivation scenarios, both excluding and includ......The paper has two main objectives: (i) to assess the eco-efficiency of spring barley cultivation for malting in Denmark in a future changed climate (700 ppm [CO2] and +5 °C) through Life Cycle Assessment (LCA) and (ii) to compare alternative future cultivation scenarios, both excluding...

  8. Decline in Child Marriage and Changes in Its Effect on Reproductive Outcomes in Bangladesh

    Science.gov (United States)

    2012-01-01

    This paper explores the decline in child marriage and changes in its effect on reproductive outcomes of Bangladeshi women, using the 2007 Bangladesh Demographic and Health Survey data. Chi-square tests, negative binomial Poisson regression and binary logistic regression were performed in analyzing the data. Overall, 82% of women aged 20-49 years were married-off before 18 years of age, and 63% of the marriages took place before 16 years of age. The incidence of child marriage was significantly less among the young women aged 20-24 years compared to their older counterparts. Among others, women's education appeared as the most significant single determinant of child marriage as well as decline in child marriage. Findings revealed that, after being adjusted for sociodemographic factors, child marriage compared to adult marriage appeared to be significantly associated with lower age at first birth (OR=0.81, 95% CI=76-0.86), higher fertility (IRR=1.45, 95% WCI=1.35-1.55), increased risk of child mortality (IRR=1.64, 95% WCI=1.44-1.87), decreased risk of contraceptive-use before any childbirths (OR=0.56, 95% CI=0.50-0.63), higher risk of giving three or more childbirth (OR=3.94, 95% CI=3.38-4.58), elevated risk of unplanned pregnancies (OR=1.21, 95% CI=1.02-1.45), increased risk of pregnancy termination (OR=1.16, 95% CI=1.00-1.34), and higher risk of the use of any current contraceptive method (OR=1.20, 95% CI=1.06-1.35). Increased enforcement of existing policies is crucial for the prevention of child marriage. Special programmes should be undertaken to keep girls in school for longer period to raise the age of females at first marriage in Bangladesh and thereby reduce the adverse reproductive outcomes. PMID:23082634

  9. Outcomes-Based Assessment and Learning: Trialling Change in a Postgraduate Civil Engineering Course

    Science.gov (United States)

    El-Maaddawy, Tamer; Deneen, Christopher

    2017-01-01

    This paper aims to demonstrate how assessment tasks can function within an outcomes-based learning framework to evaluate student attainment of learning outcomes. An outcomes-based learning framework designed to integrate teaching, learning, and assessment activities was developed and implemented in a civil engineering master-level course. The…

  10. Ten-year outcome including patterns of failure and toxicity for adjuvant whole abdominopelvic irradiation in high-risk and poor histologic feature patients with endometrial carcinoma

    International Nuclear Information System (INIS)

    Stewart, Kimberly D.; Martinez, Alvaro A.; Weiner, Sheldon; Podratz, Karl; Stromberg, Jannifer S.; Schray, Mark; Mitchell, Christina; Sherman, Alfred; Chen, Peter; Brabbins, Donald A.

    2002-01-01

    Purpose: To evaluate the long-term results of treatment using adjuvant whole abdominal irradiation (WAPI) with a pelvic/vaginal boost in patients with Stage I-III endometrial carcinoma at high risk of intra-abdominopelvic recurrence, including clear cell (CC) and serous-papillary (SP) histologic features. Methods and Materials: In a prospective nonrandomized trial, 119 patients were treated with adjuvant WAPI between November 1981 and April 2000. All patients were analyzed, including those who did not complete therapy. The mean age at diagnosis was 66 years (range 39-88). Thirty-eight patients (32%) had 1989 FIGO Stage I-II disease and 81 (68%) had Stage III. The pathologic features included the following: 64 (54%) with deep myometrial invasion, 48 (40%) with positive peritoneal cytologic findings, 69 (58%) with high-grade lesions, 21 (18%) with positive pelvic/para-aortic lymph nodes, and 44 (37%) with SP or CC histologic findings. Results: The mean follow-up was 5.8 years (range 0.2-14.7). For the entire group, the 5- and 10-year cause-specific survival (CSS) rate was 75% and 69% and the disease-free survival (DFS) rate was 58% and 48%, respectively. When stratified by histologic features, the 5- and 10-year CSS rate for adenocarcinoma was 76% and 71%, and for serous papillary/CC subtypes, it was 74% and 63%, respectively (p=0.917). The 5- and 10-year DFS rate for adenocarcinoma was 60% and 50% and was 54% and 37% serous papillary/CC subtypes, respectively (p=0.498). For surgical Stage I-II, the 5-year CSS rate was 82% for adenocarcinoma and 87% for SP/CC features (p=0.480). For Stage III, it was 75% and 57%, respectively (p=0.129). Thirty-seven patients had a relapse, with the first site of failure the abdomen/pelvis in 14 (38%), lung in 8 (22%), extraabdominal lymph nodes in 7 (19%), vagina in 6 (16%), and other in 2 (5%). When stratified by histologic variant, 32% of patients with adenocarcinoma and 30% with the SP/CC subtype developed recurrent disease. Most

  11. Immediate postoperative outcome of orthognathic surgical planning, and prediction of positional changes in hard and soft tissue, independently of the extent and direction of the surgical corrections required

    DEFF Research Database (Denmark)

    Donatsky, Ole; Bjørn-Jørgensen, Jens; Hermund, Niels Ulrich

    2011-01-01

    orthognathic correction using the computerised, cephalometric, orthognathic, surgical planning system (TIOPS). Preoperative cephalograms were analysed and treatment plans and prediction tracings produced by computerised interactive simulation. The planned changes were transferred to models and finally...... with the presently included soft tissue algorithms, the current study shows relatively high mean predictability of the immediately postoperative hard and soft tissue outcome, independent of the extent and direction of required orthognathic correction. Because of the relatively high individual variability, caution...

  12. Patellofemoral Osteoarthritis Progression and Alignment Changes after Open-Wedge High Tibial Osteotomy Do Not Affect Clinical Outcomes at Mid-term Follow-up.

    Science.gov (United States)

    Goshima, Kenichi; Sawaguchi, Takeshi; Shigemoto, Kenji; Iwai, Shintaro; Nakanishi, Akira; Ueoka, Ken

    2017-10-01

    To evaluate the clinical and radiological outcomes of open-wedge high tibial osteotomy (OWHTO) with respect to the patellofemoral joint and to assess whether patellofemoral osteoarthritis (OA) progression and alignment changes after OWHTO affect clinical outcomes. Inclusion criteria were consecutive patients who underwent OWHTO from March 2005 to September 2013. Exclusion criteria were loss to follow-up within 2 years and absence of second-look arthroscopy findings at the time of plate removal. The clinical parameters, including anterior knee pain while climbing stairs, Japanese Orthopedic Association score, and Oxford Knee Score, were evaluated. Radiological outcomes, including weight-bearing line ratio, modified Blackburne-Peel ratio, posterior tibial slope, tilting angle, lateral shift ratio, and patellofemoral OA (Kellgren-Lawrence grade), were evaluated preoperatively and at the final follow-up. Cartilage status (International Cartilage Repair Society grade) was evaluated at the initial HTO and at plate removal. Fifty-three patients (60 knees) were included in this study. The mean follow-up was 58.2 ± 22.4 months. Two knees (3%) presented with mild anterior knee pain after OWHTO. The mean Japanese Orthopedic Association score (66.9 ± 11.2 to 91.2 ± 9.7) significantly improved (P patellofemoral OA had progressed in 15 knees (27%), and arthroscopically patellofemoral cartilage degeneration had progressed in 27 knees (45%). However, there was no significant correlation between changes in patellofemoral alignment and clinical outcomes. Changes in patellofemoral alignment and patellofemoral OA progression did not affect the clinical outcomes of OWHTO at mid-term follow-up. Level IV, therapeutic case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. CHANGES IN LETHAL OUTCOMES IN TUBERCULOSIS CASES OVER 17 YEARS IN KEMEROVO REGION

    Directory of Open Access Journals (Sweden)

    I. F. Kopylova

    2016-01-01

    Full Text Available Lethal outcomes were studied in 704 tuberculosis patients in Kemerovo Region over 2 periods of time: 1995-1997 – 255 cases (including 229 with autopsy and 2012-2014 – 449 cases (including 413 with autopsy in three in-patient units of Kemerovo Regional Clinical TB Dispensary (continuous sampling. The number of those died during the second period increased due to co-infection of HIV and tuberculosis. During the second period there was an abrupt increase in disseminated forms of tuberculosis while the number of fibrous-cavernous forms went down, which was due to specific features of tuberculosis in HIV patients given the severe immune deficiency in them. At the same time the increase in the disseminated forms of tuberculosis was detected during the 2nd period in the HIV negative patients.

  14. Hyperfractionated radiotherapy and simultaneous cisplatin for stage-III and -IV carcinomas of the head and neck. Long-term results including functional outcome

    International Nuclear Information System (INIS)

    Huguenin, P.; Glanzmann, C.; Taussky, D.; Luetolf, U.M.; Schmid, S.; Moe, K.

    1998-01-01

    Purpose: To assess the survival rate, the probability of local control, the patterns of relapse and late sequelae including self-reported quality of life in patients treated with hyperfractionated radiotherapy (RT) and simultaneous CDDP chemotherapy for stage-III to stage-IV carcinomas of the head and neck. Methods: From 1988 to 1994, 64 patients (median age 55.5 years) with carcinomas of different subsites, excluding the nasopharynx, were treated in a pilot study with 1.2 Gy bid (6 h interval; total dose 74.4 Gy) and simultaneous CDDP (20 mg/m 2 daily, 5 days in week 1 and 5) and followed at regular intervals. Overall survival and local control, as well as the rates of late toxicity, were estimated using the actuarial method. Median follow-up was 3.3 years for all and 5.2 years for surviving patients. To assess the quality of life, the EORTC QLQ-C 30 questionnaire and the H and N35 module questionnaire were sent to the patients surviving with no evidence of disease or second primary tumors; they were answered by 15/23 (67%). Results: Overall survival was 37% at 5 years, whereas disease-specific survival was 59%. Twenty-three patients died from uncontrolled head and neck cancer. Second primary tumors were observed in 13 patients, most frequently in the lung. Local control without salvage surgery was 74% at 5 years for all subsites and stages, and loco-regional disease-free survival was 72%. Eleven patients developed distant metastases, which was the only site of failure in 6 cases. Salvage surgery was successful in 2 cases. The actuarial estimates of ≥grade-3 late toxicity was 4% for the mandibular bone and 23% for dysphagia, and 50% of the patients experienced a permanent xerostomy. Self-reported global quality of life in surviving patients was good (mean 68 points on a scale 0 to 100); consequences of impaired salivary function had most impact on nutritional and social aspects. Conclusions: Hyperfractionated RT with concomitant CDDP is well tolerated and highly

  15. Towards the centralization of digestive oncologic surgery: changes in activity, techniques and outcome

    Directory of Open Access Journals (Sweden)

    Cristian Tebé

    Full Text Available Aim: The objective of the present study was to examine changes in the activity, surgical techniques and results from the process of centralization of complex digestive oncologic surgery in 2005-2012 as compared to 1996-2000. Material and methods: A retrospective cohort study employing the minimum basic data set of hospital discharge (MBDSHD 1996-2012 from public centers in Catalonia (Spain was performed. The population consisted of individuals aged > 18 who underwent digestive oncologic surgery (esophagus, pancreas, liver, stomach or rectum. Medical centers were divided into low, medium, and high-volume centers (≤ 5, 6-10, and > 10 interventions/year, respectively. The tendency Chi-squared test was used to assess the centralization of patients in high-volume centers and hospital mortality evolution during the study period. Logistic regression was performed to assess the relationship between volume and outcome. Results: A centralization of complex oncologic digestive surgery between 10% (liver and 46% (esophagus was obtained by means of a reduction in the number of hospitals that perform these interventions and a significant rise in the number of patients operated in high-volume centers (all types p ≤ 0.0001, except for esophagus. A significant decrease in mortality was observed, especially in esophagus (from 15% in 1996/2000 to 7% in 2009/12, p = 0.003 and pancreas (from 12% in 1996/2000 to 6% in 2009/12, p trend < 0.0001. Conclusions: A centralization of oncologic digestive surgery in high-volume centers and a reduction of hospital mortality in Catalonia were reported among esophageal and pancreatic cancers. However, no significant changes were found for others cancer types.

  16. The surgical management of the rheumatoid spine: Has the evolution of surgical intervention changed outcomes?

    Directory of Open Access Journals (Sweden)

    Robin Bhatia

    2014-01-01

    Full Text Available Context: Surgery for the rheumatoid cervical spine has been shown to stabilize the unstable spine; arrest/improve the progression of neurological deficit, help neck pain, and possibly decelerate the degenerative disease process. Operative intervention for the rheumatoid spine has significantly changed over the last 30 years. Aims: The purpose of this study was to review all cases of cervical rheumatoid spine requiring surgical intervention in a single unit over the last 30 years. Materials and Methods: A prospectively-maintained spine database was retrospectively searched for all cases of rheumatoid spine, leading to a review of indications, imaging, Ranawat and Myelopathy Disability Index measures, surgical morbidity, and survival curve analysis. Results: A total of 224 cases were identified between 1981 and 2011. Dividing the data into three time-epochs, there has been a significant increase in the ratio of segment-saving Goel-Harms C1-C2: Occipitocervical fixation (OCF surgery and survival has increased between 1981 and 2011 from 30% to 51%. Patients undergoing C1-C2 fixation were comparatively less myelopathic and in a better Ranawat class preoperatively, but postoperative outcome measures were well-preserved with favorable mortality rates over mean 39.6 months of follow-up. However, 11% of cases required OCF at mean 28 months post-C1-C2 fixation, largely due to instrumentation failure (80%. Conclusion: We present the largest series of surgically managed rheumatoid spines, revealing comparative data on OCF and C1-C2 fixation. Although survival has improved over the last 30 years, there have been changes in medical, surgical and perioperative management over that period of time too confounding the interpretation; however, the analysis presented suggests that rheumatoid patients presenting early in the disease process may benefit from C1 to C2 fixation, albeit with a proportion requiring OCF at a later time.

  17. Driving change in rural workforce planning: the medical schools outcomes database.

    Science.gov (United States)

    Gerber, Jonathan P; Landau, Louis I

    2010-01-01

    The Medical Schools Outcomes Database (MSOD) is an ongoing longitudinal tracking project ofmedical students from all medical schools in Australia and New Zealand. It was established in 2005 to track the career trajectories of medical students and will directly help develop models of workforce flow, particularly with respect to rural and remote shortages. This paper briefly outlines the MSOD project and reports on key methodological factors in tracking medical students. Finally, the potential impact of the MSOD on understanding changes in rural practice intentions is illustrated using data from the 2005 pilot cohort (n = 112). Rural placements were associated with a shift towards rural practice intentions, while those who intended to practice rurally at both the start and end of medical school tended to be older and interested in a generalist career. Continuing work will track these and future students as they progress through the workforce, as well as exploring issues such as the career trajectories of international fee-paying students, workforce succession planning, and the evaluation of medical education initiatives.

  18. Hyperfractionated radiotherapy and simultaneous cisplatin for stage-III and -IV carcinomas of the head and neck. Long-term results including functional outcome

    Energy Technology Data Exchange (ETDEWEB)

    Huguenin, P.; Glanzmann, C.; Taussky, D.; Luetolf, U.M. [Univ. Hospital Zurich (Switzerland). Radiation Oncology Dept.; Schmid, S.; Moe, K. [Univ. Hospital Zurich (Switzerland). Dept. of Head and Neck Surgery

    1998-08-01

    Purpose: To assess the survival rate, the probability of local control, the patterns of relapse and late sequelae including self-reported quality of life in patients treated with hyperfractionated radiotherapy (RT) and simultaneous CDDP chemotherapy for stage-III to stage-IV carcinomas of the head and neck. Methods: From 1988 to 1994, 64 patients (median age 55.5 years) with carcinomas of different subsites, excluding the nasopharynx, were treated in a pilot study with 1.2 Gy bid (6 h interval; total dose 74.4 Gy) and simultaneous CDDP (20 mg/m{sup 2} daily, 5 days in week 1 and 5) and followed at regular intervals. Overall survival and local control, as well as the rates of late toxicity, were estimated using the actuarial method. Median follow-up was 3.3 years for all and 5.2 years for surviving patients. To assess the quality of life, the EORTC QLQ-C 30 questionnaire and the H and N35 module questionnaire were sent to the patients surviving with no evidence of disease or second primary tumors; they were answered by 15/23 (67%). Results: Overall survival was 37% at 5 years, whereas disease-specific survival was 59%. Twenty-three patients died from uncontrolled head and neck cancer. Second primary tumors were observed in 13 patients, most frequently in the lung. Local control without salvage surgery was 74% at 5 years for all subsites and stages, and loco-regional disease-free survival was 72%. Eleven patients developed distant metastases, which was the only site of failure in 6 cases. Salvage surgery was successful in 2 cases. The actuarial estimates of {>=}grade-3 late toxicity was 4% for the mandibular bone and 23% for dysphagia, and 50% of the patients experienced a permanent xerostomy. Self-reported global quality of life in surviving patients was good (mean 68 points on a scale 0 to 100); consequences of impaired salivary function had most impact on nutritional and social aspects. Conclusions: Hyperfractionated RT with concomitant CDDP is well tolerated and

  19. Western land managers will need all available tools for adapting to climate change, including grazing: a critique of Beschta et al.

    Science.gov (United States)

    Svejcar, Tony; Boyd, Chad; Davies, Kirk; Madsen, Matthew; Bates, Jon; Sheley, Roger; Marlow, Clayton; Bohnert, David; Borman, Mike; Mata-Gonzàlez, Ricardo; Buckhouse, John; Stringham, Tamzen; Perryman, Barry; Swanson, Sherman; Tate, Kenneth; George, Mel; Ruyle, George; Roundy, Bruce; Call, Chris; Jensen, Kevin; Launchbaugh, Karen; Gearhart, Amanda; Vermeire, Lance; Tanaka, John; Derner, Justin; Frasier, Gary; Havstad, Kris

    2014-06-01

    In a previous article, Beschta et al. (Environ Manag 51(2):474-491, 2013) argue that grazing by large ungulates (both native and domestic) should be eliminated or greatly reduced on western public lands to reduce potential climate change impacts. The authors did not present a balanced synthesis of the scientific literature, and their publication is more of an opinion article. Their conclusions do not reflect the complexities associated with herbivore grazing. Because grazing is a complex ecological process, synthesis of the scientific literature can be a challenge. Legacy effects of uncontrolled grazing during the homestead era further complicate analysis of current grazing impacts. Interactions of climate change and grazing will depend on the specific situation. For example, increasing atmospheric CO₂ and temperatures may increase accumulation of fine fuels (primarily grasses) and thus increase wildfire risk. Prescribed grazing by livestock is one of the few management tools available for reducing fine fuel accumulation. While there are certainly points on the landscape where herbivore impacts can be identified, there are also vast grazed areas where impacts are minimal. Broad scale reduction of domestic and wild herbivores to help native plant communities cope with climate change will be unnecessary because over the past 20-50 years land managers have actively sought to bring populations of native and domestic herbivores in balance with the potential of vegetation and soils. To cope with a changing climate, land managers will need access to all available vegetation management tools, including grazing.

  20. Daily Megavoltage Computed Tomography in Lung Cancer Radiotherapy: Correlation Between Volumetric Changes and Local Outcome

    International Nuclear Information System (INIS)

    Bral, Samuel; De Ridder, Mark; Duchateau, Michael; Gevaert, Thierry; Engels, Benedikt; Schallier, Denis; Storme, Guy

    2011-01-01

    Purpose: To assess the predictive or comparative value of volumetric changes, measured on daily megavoltage computed tomography during radiotherapy for lung cancer. Patients and Methods: We included 80 patients with locally advanced non-small-cell lung cancer treated with image-guided intensity-modulated radiotherapy. The radiotherapy was combined with concurrent chemotherapy, combined with induction chemotherapy, or given as primary treatment. Patients entered two parallel studies with moderately hypofractionated radiotherapy. Tumor volume contouring was done on the daily acquired images. A regression coefficient was derived from the volumetric changes on megavoltage computed tomography, and its predictive value was validated. Logarithmic or polynomial fits were applied to the intratreatment changes to compare the different treatment schedules radiobiologically. Results: Regardless of the treatment type, a high regression coefficient during radiotherapy predicted for a significantly prolonged cause-specific local progression free-survival (p = 0.05). Significant differences were found in the response during radiotherapy. The significant difference in volumetric treatment response between radiotherapy with concurrent chemotherapy and radiotherapy plus induction chemotherapy translated to a superior long-term local progression-free survival for concurrent chemotherapy (p = 0.03). An enhancement ratio of 1.3 was measured for the used platinum/taxane doublet in comparison with radiotherapy alone. Conclusion: Contouring on daily megavoltage computed tomography images during radiotherapy enabled us to predict the efficacy of a given treatment. The significant differences in volumetric response between treatment strategies makes it a possible tool for future schedule comparison.

  1. Indigenous VET Participation, Completion and Outcomes: Change over the Past Decade. Research Report

    Science.gov (United States)

    Windley, Georgina

    2017-01-01

    It has been eight years since the National Indigenous Reform Agreement (also known as "Closing the Gap") set out a series of areas and targets designed to close the gap between Indigenous and non-Indigenous outcomes on a range of measures. A key objective was to halve the gap in employment outcomes between Indigenous and non-Indigenous…

  2. Sex differences in adult outcomes by changes in weight status from adolescence to adulthood: results from Add Health.

    Science.gov (United States)

    Chung, Arlene E; Skinner, Asheley Cockrell; Maslow, Gary R; Halpern, Carolyn T; Perrin, Eliana M

    2014-01-01

    Changes in weight status from adolescence to adulthood may be associated with varying social, vocational, economic, and educational outcomes, which may differ by sex. We studied whether there are differences in adult outcomes by sex for different weight status changes in the transition to adulthood. Using data from the National Longitudinal Study of Adolescent Health, participants were categorized by weight status from adolescence into adulthood. We examined self-reported outcomes in adulthood for living with parents, being married, being a parent, employment, receipt of public assistance, income, and college graduation by weight groupings (healthy-healthy, healthy-overweight/obese, overweight/obese-overweight/obese, overweight/obese-healthy). The effect of changes in weight status on the adult outcomes was modeled, controlling for sex, age, parental education, and race/ethnicity. There were differences by sex for many of the self-reported outcomes, especially educational and economic outcomes. Female subjects who became overweight/obese between adolescence and adulthood or remained so had worse economic and educational findings as adults compared to male subjects. Overall, for female subjects, becoming and remaining overweight/obese was associated with worse outcomes, while for male subjects, adolescent obesity was more important than isolated adult obesity. The relationship between obesity and life situations may be more negative for female subjects in the transition to adulthood. The findings emphasize that adolescent obesity, and not just obesity isolated in adulthood, is important for characteristics achieved in adulthood. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  3. Volatility and change in chronic pain severity predict outcomes of treatment for prescription opioid addiction.

    Science.gov (United States)

    Worley, Matthew J; Heinzerling, Keith G; Shoptaw, Steven; Ling, Walter

    2017-07-01

    Buprenorphine-naloxone (BUP-NLX) can be used to manage prescription opioid addiction among persons with chronic pain, but post-treatment relapse is common and difficult to predict. This study estimated whether changes in pain over time and pain volatility during BUP-NLX maintenance would predict opioid use during the taper BUP-NLX taper. Secondary analysis of a multi-site clinical trial for prescription opioid addiction, using data obtained during a 12-week BUP-NLX stabilization and 4-week BUP-NLX taper. Community clinics affiliated with a national clinical trials network in 10 US cities. Subjects with chronic pain who entered the BUP-NLX taper phase (n = 125) with enrollment occurring from June 2006 to July 2009 (52% male, 88% Caucasian, 31% married). Outcomes were weekly biologically verified and self-reported opioid use from the 4-week taper phase. Predictors were estimates of baseline severity, rate of change and volatility in pain from weekly self-reports during the 12-week maintenance phase. Controlling for baseline pain and treatment condition, increased pain [odds ratio (OR) = 2.38, P = 0.02] and greater pain volatility (OR = 2.43, P = 0.04) predicted greater odds of positive opioid urine screen during BUP-NLX taper. Increased pain (IRR = 1.40, P = 0.04) and greater pain volatility [incidence-rate ratio (IRR) = 1.66, P = 0.009] also predicted greater frequency of self-reported opioid use. Adults with chronic pain receiving out-patient treatment with buprenorphine-naloxone (BUP-NLX) for prescription opioid addiction have an elevated risk for opioid use when tapering off maintenance treatment. Those with relative persistence in pain over time and greater volatility in pain during treatment are less likely to sustain abstinence during BUP-NLX taper. © 2017 Society for the Study of Addiction.

  4. The association between retrospective outcome evaluations and pre-post-treatment changes in psychodynamic group-psychotherapy

    DEFF Research Database (Denmark)

    Jensen, Hans Henrik; Mortensen, Erik Lykke; Lotz, Martin

    2008-01-01

    In the present study of 203 patients in psychodynamic group psychotherapy, we explore associations between patient and therapist global retrospective outcome evaluations (ROE), and pre-post-treatment changes on the Symptom Check List 90 Revised (SCL-90-R) and non-symptomatic focus of therapy. The......, and associated with personality factors or domains not captured by standard questionnaires....

  5. Evaluation of the Dutch version of the Foot and Ankle Outcome Score (FAOS): Responsiveness and Minimally Important Change

    NARCIS (Netherlands)

    Sierevelt, I. N.; van Eekeren, I. C. M.; Haverkamp, D.; Reilingh, M. L.; Terwee, C. B.; Kerkhoffs, G. M. M. J.

    2016-01-01

    The aim of this study was to evaluate the responsiveness of the Foot and Ankle Outcome Score (FAOS) and provide data on the Minimally Important Change (MIC) in patients 1 year after hindfoot and ankle surgery. Prospective pre-operative and 1 year post-operative FAOS scores were collected from 145

  6. Calculating Clinically Significant Change: Applications of the Clinical Global Impressions (CGI) Scale to Evaluate Client Outcomes in Private Practice

    Science.gov (United States)

    Kelly, Peter James

    2010-01-01

    The Clinical Global Impressions (CGI) scale is a therapist-rated measure of client outcome that has been widely used within the research literature. The current study aimed to develop reliable and clinically significant change indices for the CGI, and to demonstrate its application in private psychological practice. Following the guidelines…

  7. Relation between change in blood pressure in acute stroke and risk of early adverse events and poor outcome

    DEFF Research Database (Denmark)

    Sandset, Else C; Murray, Gordon D; Bath, Philip M W

    2012-01-01

    The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of candesartan in acute stroke. In the present analysis we aim to investigate the effect of change in blood pressure during the first 2 days of stroke on the risk of early adverse events and poor outcome....

  8. Discordance Between Body Mass Index (BMI) and a Novel Body Composition Change Index (BCCI) as Outcome Measures in Weight Change Interventions.

    Science.gov (United States)

    Nugent, Stephen D; Kaats, Gilbert R; Preuss, Harry G

    2018-01-01

    A general assumption is that the body mass index (BMI) reflects changes in fat mass (FM). However, it fails to distinguish the type of weight that is lost or gained-fat mass (FM) or fat-free mass (FFM). The BMI treats both changes the same although they have opposite health consequences. The objective of this study was to propose a more precise measure, a body composition change index (BCCI), which distinguishes between changes in FM and FFM, and this study compares it with using the BMI as an outcome measure. Data were obtained from 3,870 subjects who had completed dual-energy x-ray absorptiometry (DEXA) total body scans at baseline and end-of-study when participating in a variety of weight-loss interventions. Since height remained constant in this adult cohort, changes in the BMI corresponded with scale weight changes (r = 0.994), allowing BMI changes to be converted to "lbs." to match the statistic used for calculation of the BCCI. The BCCI is calculated by scoring increases in FFM (lbs.) and decreases in FM (lbs.) as positive outcomes and scoring decreases in FFM and increases in FM as negative outcomes. The BCCI is the net sum of these calculations. Differences between scale weight changes and BCCI values were subsequently compared to obtain "discordance scores." Discordance scores ranged from 0.0 lbs. to >30.0 lbs. with a mean absolute value of between the two measures of 7.79 lbs. (99% confidence interval: 7.49-8.10, p BCCI and the BMI to evaluate the efficacy of weight loss interventions. If assessing changes in body composition is a treatment goal, use of the BMI could result in significantly erroneous conclusions.

  9. Readiness for change and short-term outcomes of female adolescents in residential treatment for anorexia nervosa.

    Science.gov (United States)

    McHugh, Matthew D

    2007-11-01

    To determine if readiness for change (RFC) at admission predicted length of stay (LOS) and short-term outcomes among female adolescents in residential treatment for anorexia nervosa (AN). Using a prospective cohort design to collect data from participants (N = 65) at admission and discharge, Kaplan-Meier survival analysis and Cox regression tested whether RFC on admission predicted time in LOS to a favorable short-term outcome--a composite endpoint based on minimum criteria for weight gain, drive for thinness, depression, anxiety, and health-related quality of life (HRQOL). Participants with low RFC had a mean survival time to a favorable short-term outcome of 59.4 days compared to 34.1 days for those with high RFC (log rank = 8.44, df = 1, p = .003). The probability of a favorable short-term outcome was 5.30 times greater for participants with high RFC. Readiness for change is a useful predictor of a favorable short-term outcome and should be considered in the assessment profile of patients with AN. (c) 2007 by Wiley Periodicals, Inc.

  10. A long-term evaluation of the stage of change approach and compensable injury outcomes - a cluster-randomised trial.

    Science.gov (United States)

    Rothmore, Paul; Aylward, Paul; Gray, Jodi; Karnon, Jonathan

    2017-05-01

    This study investigated the long-term injury outcomes for workers in companies from a range of industries which had been randomly allocated to receive ergonomics interventions tailored according to the stage of change (SOC) approach or standard ergonomics advice. Differences in compensable injury outcomes between the groups were analysed using logistic regression models. Questionnaire results from face-to-face interviews to assess musculoskeletal pain and discomfort (MSPD), job satisfaction and other factors were also analysed. Although not significant at the 0.05 level, after adjusting for workgroup clustering, workers in receipt of tailored advice were 55% (OR = 0.45, 95% CI = 0.19-1.08) less likely to report a compensable injury than those in receipt of standard ergonomics advice. Workload, job satisfaction and MSPD were significantly correlated with injury outcomes. The observed outcomes support the potential value of the SOC approach, as well as highlighting the need to consider workload, job satisfaction and MSPD when planning injury prevention programmes. Practitioner Summary: This study investigated compensable injury outcomes for workers who had received ergonomics advice tailored according to the stage of change (SOC) approach compared with standard ergonomics advice. The results support the potential value of the SOC approach and highlight the need to consider workload, job satisfaction and musculoskeletal pain and discomfort when planning injury prevention interventions.

  11. Influence of Flow Sequencing Attributed to Climate Change and Climate Variability on the Assessment of Water-dependent Ecosystem Outcomes

    Science.gov (United States)

    Wang, J.; Nathan, R.; Horne, A.

    2017-12-01

    Traditional approaches to characterize water-dependent ecosystem outcomes in response to flow have been based on time-averaged hydrological indicators, however there is increasing recognition for the need to characterize ecological processes that are highly dependent on the sequencing of flow conditions (i.e. floods and droughts). This study considers the representation of flow regimes when considering assessment of ecological outcomes, and in particular, the need to account for sequencing and variability of flow. We conducted two case studies - one in the largely unregulated Ovens River catchment and one in the highly regulated Murray River catchment (both located in south-eastern Australia) - to explore the importance of flow sequencing to the condition of a typical long-lived ecological asset in Australia, the River Red Gum forests. In the first, the Ovens River case study, the implications of representing climate change using different downscaling methods (annual scaling, monthly scaling, quantile mapping, and weather generator method) on the sequencing of flows and resulting ecological outcomes were considered. In the second, the Murray River catchment, sequencing within a historic drought period was considered by systematically making modest adjustments on an annual basis to the hydrological records. In both cases, the condition of River Red Gum forests was assessed using an ecological model that incorporates transitions between ecological conditions in response to sequences of required flow components. The results of both studies show the importance of considering how hydrological alterations are represented when assessing ecological outcomes. The Ovens case study showed that there is significant variation in the predicted ecological outcomes when different downscaling techniques are applied. Similarly, the analysis in the Murray case study showed that the drought as it historically occurred provided one of the best possible outcomes for River Red Gum

  12. Do Changes in Patellofemoral Joint Offset Lead to Adverse Outcomes in Total Knee Arthroplasty With Patellar Resurfacing? A Radiographic Review.

    Science.gov (United States)

    Matz, Jacob; Howard, James L; Morden, David J; MacDonald, Steven J; Teeter, Matthew G; Lanting, Brent A

    2017-03-01

    Patellofemoral joint biomechanics contribute to anterior knee pain, instability, and dysfunction following total knee arthroplasty (TKA). Information about specific factors leading to anterior knee pain and dysfunction is currently limited. Changes in patellofemoral joint offset (PFO) refers to a mismatch between the preoperative and postoperative anteroposterior geometry of the patellofemoral joint. It remains unclear whether these changes lead to adverse outcomes in TKA. A retrospective radiographic review of 970 knees pre-TKA and post-TKA was completed to correlate the radiographic and clinical outcomes of changing the PFO using a posterior-stabilized single knee design with patellar resurfacing. A total of 970 patients were reviewed. Postoperatively, the anterior femoral offset, anteroposterior femoral size, and anterior patellar offset were changed in 40%, 60%, and 71% of knees, respectively, compared to preoperative values. The Western Ontario and McMasters Osteoarthritis Index total score as well as subscale scores for pain and function were not significantly affected by an increase or decrease in PFO. Similarly, Knee Society Scores and range of motion were not significantly affected. Increased anterior patellar offset was, however, associated with increased postoperative patellar tilt. Postoperative patellar tilt was not correlated with adverse patient satisfaction scores or loss of range of motion. Changes in PFO (decreased, maintained, or increased) are common post-TKA and are not associated with a difference in clinical outcomes. Increases in anterior patellar offset led to increased patellar tilt, which was not associated with adverse patient satisfaction scores. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Multiple behaviour change intervention and outcomes in recently diagnosed type 2 diabetes: the ADDITION-Plus randomised controlled trial.

    Science.gov (United States)

    Griffin, Simon J; Simmons, Rebecca K; Prevost, A Toby; Williams, Kate M; Hardeman, Wendy; Sutton, Stephen; Brage, Søren; Ekelund, Ulf; Parker, Richard A; Wareham, Nicholas J; Kinmonth, Ann Louise

    2014-07-01

    The aim of this study was to assess whether or not a theory-based behaviour change intervention delivered by trained and quality-assured lifestyle facilitators can achieve and maintain improvements in physical activity, dietary change, medication adherence and smoking cessation in people with recently diagnosed type 2 diabetes. An explanatory randomised controlled trial was conducted in 34 general practices in Eastern England (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care-Plus [ADDITION-Plus]). In all, 478 patients meeting eligibility criteria (age 40 to 69 years with recently diagnosed screen or clinically detected diabetes) were individually randomised to receive either intensive treatment (n = 239) or intensive treatment plus a theory-based behaviour change intervention led by a facilitator external to the general practice team (n = 239). Randomisation was central and independent using a partial minimisation procedure to balance stratifiers between treatment arms. Facilitators taught patients skills to facilitate change in and maintenance of key health behaviours, including goal setting, self-monitoring and building habits. Primary outcomes included physical activity energy expenditure (individually calibrated heart rate monitoring and movement sensing), change in objectively measured fruit and vegetable intake (plasma vitamin C), medication adherence (plasma drug levels) and smoking status (plasma cotinine levels) at 1 year. Measurements, data entry and laboratory analysis were conducted with staff unaware of participants' study group allocation. Of 475 participants still alive, 444 (93%; intervention group 95%, comparison group 92%) attended 1-year follow-up. There were no significant differences between groups in physical activity (difference: +1.50 kJ kg(-1) day(-1); 95% CI -1.74, 4.74), plasma vitamin C (difference: -3.84 μmol/l; 95% CI -8.07, 0.38), smoking (OR 1.37; 95% CI 0.77, 2.43) and

  14. Change in patients' interpersonal impacts as a mediator of the alliance-outcome association in treatment for chronic depression.

    Science.gov (United States)

    Constantino, Michael J; Laws, Holly B; Coyne, Alice E; Greenberg, Roger P; Klein, Daniel N; Manber, Rachel; Rothbaum, Barbara O; Arnow, Bruce A

    2016-12-01

    Theories posit that chronically depressed individuals have hostile and submissive interpersonal styles that undermine their interpersonal effectiveness and contribute to the cause and maintenance of their depression. Recent findings support this theory and demonstrate that chronically depressed patients' interpersonal impacts on their therapist become more adaptive (i.e., less hostile and submissive, and more friendly and assertive) during a targeted chronic depression treatment: cognitive-behavioral analysis system of psychotherapy (CBASP). In this study, the authors examined whether such changes in interpersonal impacts (as rated by clinicians' experiences of interacting with their patients) mediated the association between early patient-rated alliance quality and final session depression. Data derived from a large trial for chronic depression that compared the efficacy of CBASP, nefazodone, and their combination. The current subsample (N = 220) included patients in the CBASP and combined conditions who completed at least 1 depression assessment and the alliance measure, and whose therapists completed at least 1 interpersonal impacts assessment. Mediation models were fit using a bootstrapping procedure for assessing indirect effects. As hypothesized, results supported a mediating effect; higher early alliance predicted decreases in patient hostile-submissiveness during therapy, which in turn related to lower final session depression (indirect effect B = -.02, 95% confidence interval: -.07, -.001). This indirect effect accounted for 13% of the total effect of alliance on depression. There was no moderating effect of treatment condition on the indirect effect. Results further support CBASP change theory and suggest a candidate mechanism of the alliance's effect on outcome. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  15. Including land cover change in analysis of greenness trends using all available Landsat 5, 7, and 8 images: A case study from Guangzhou, China (2000–2014)

    Science.gov (United States)

    Zhu, Zhe; Fu, Yingchun; Woodcock, Curtis; Olofsson, Pontus; Vogelmann, James; Holden, Christopher; Wang, Min; Dai, Shu; Yu, Yang

    2016-01-01

    Remote sensing has proven a useful way of evaluating long-term trends in vegetation “greenness” through the use of vegetation indices like Normalized Differences Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI). In particular, analyses of greenness trends have been performed for large areas (continents, for example) in an attempt to understand vegetation response to climate. These studies have been most often used coarse resolution sensors like Moderate Resolution Image Spectroradiometer (MODIS) and Advanced Very High Resolution Radiometer (AVHRR). However, trends in greenness are also important at more local scales, particularly in and around cities as vegetation offers a variety of valuable ecosystem services ranging from minimizing air pollution to mitigating urban heat island effects. To explore the ability to monitor greenness trends in and around cities, this paper presents a new way for analyzing greenness trends based on all available Landsat 5, 7, and 8 images and applies it to Guangzhou, China. This method is capable of including the effects of land cover change in the evaluation of greenness trends by separating the effects of abrupt and gradual changes, and providing information on the timing of greenness trends.

  16. Audit of Trichomonas vaginalis test requesting by community referrers after a change from culture to molecular testing, including a cost analysis.

    Science.gov (United States)

    Bissessor, Liselle; Wilson, Janet; McAuliffe, Gary; Upton, Arlo

    2017-06-16

    Trichomonas vaginalis (TV) prevalence varies among different communities and peoples. The availability of robust molecular platforms for the detection of TV has advanced diagnosis; however, molecular tests are more costly than phenotypic methodologies, and testing all urogenital samples is costly. We recently replaced culture methods with the Aptima Trichomonas vaginalis nucleic acid amplification test on specific request and as reflex testing by the laboratory, and have audited this change. Data were collected from August 2015 (microbroth culture and microscopy) and August 2016 (Aptima TV assay) including referrer, testing volumes, results and test cost estimates. In August 2015, 10,299 vaginal swabs, and in August 2016, 2,189 specimens (urogenital swabs and urines), were tested. The positivity rate went from 0.9% to 5.3%, and overall more TV infections were detected in 2016. The number needed to test and cost for one positive TV result respectively was 111 and $902.55 in 2015, and 19 and $368.92 in 2016. Request volumes and positivity rates differed among referrers. The methodology change was associated with higher overall detection of TV, and reductions in the numbers needed to test/cost for one TV diagnosis. Our audit suggests that there is room for improvement with TV test requesting in our community.

  17. Developmental responses of bread wheat to changes in ambient temperature following deletion of a locus that includes FLOWERING LOCUS T1.

    Science.gov (United States)

    Dixon, Laura E; Farré, Alba; Finnegan, E Jean; Orford, Simon; Griffiths, Simon; Boden, Scott A

    2018-01-04

    FLOWERING LOCUS T (FT) is a central integrator of environmental signals that regulates the timing of vegetative to reproductive transition in flowering plants. In model plants, these environmental signals have been shown to include photoperiod, vernalization, and ambient temperature pathways, and in crop species, the integration of the ambient temperature pathway remains less well understood. In hexaploid wheat, at least 5 FT-like genes have been identified, each with a copy on the A, B, and D genomes. Here, we report the characterization of FT-B1 through analysis of FT-B1 null and overexpression genotypes under different ambient temperature conditions. This analysis has identified that the FT-B1 alleles perform differently under diverse environmental conditions; most notably, the FT-B1 null produces an increase in spikelet and tiller number when grown at lower temperature conditions. Additionally, absence of FT-B1 facilitates more rapid germination under both light and dark conditions. These results provide an opportunity to understand the FT-dependent pathways that underpin key responses of wheat development to changes in ambient temperature. This is particularly important for wheat, for which development and grain productivity are sensitive to changes in temperature. © 2018 The Authors Plant, Cell & Environment Published by John Wiley & Sons Ltd.

  18. Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes

    Directory of Open Access Journals (Sweden)

    Hun-Sung Kim

    2017-05-01

    Full Text Available BackgroundWhen patients with diabetes mellitus (DM are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication on blood glucose levels.MethodsThe study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management.ResultsPatients were divided into those who received no diabetic medications (n=66 and those who received an OHA (n=124. Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for 10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024.ConclusionFor patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.

  19. 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.

  20. Measuring psychological change during cognitive behaviour therapy in primary care: a Polish study using 'PSYCHLOPS' (Psychological Outcome Profiles.

    Directory of Open Access Journals (Sweden)

    Slawomir Czachowski

    Full Text Available BACKGROUND: Psychological outcome measures are evolving into measures that depict progress over time. Interval measurement during therapy has not previously been reported for a patient-generated measure in primary care. We aimed to determine the sensitivity to change throughout therapy, using 'PSYCHLOPS' (Psychological Outcome Profiles, and to determine if new problems appearing during therapy diminish overall improvement. METHODS: Responses to PSYCHLOPS, pre-, during- and post-therapy were compared. SETTING: patients offered brief cognitive behaviour therapy in primary care in Poland. RESULTS: 238 patients completed the pre-therapy questionnaire, 194 (81.5% the during-therapy questionnaire and 142 the post-therapy questionnaire (59.7%. For those completing all three questionnaires (n = 135, improvement in total scores produced an overall Effect Size of 3.1 (2.7 to 3.4. We estimated change using three methods for dealing with missing values. Single and multiple imputation did not significantly change the Effect Size; 'Last Value Carried Forward', the most conservative method, produced an overall Effect Size of 2.3 (1.9 to 2.6. New problems during therapy were reported by 81 patients (60.0%: new problem and original problem scores were of similar magnitude and change scores were not significantly different when compared to patients who did not report new problems. CONCLUSION: A large proportion of outcome data is lost when outcome measures depend upon completed end of therapy questionnaires. The use of a during-therapy measure increases data capture. Missing data still produce difficulties in interpreting overall effect sizes for change. We found no evidence that new problems appearing during therapy hampered overall recovery.

  1. Sensitivity to change of youth treatment outcome measures: a comparison of the CBCL, BASC-2, and Y-OQ.

    Science.gov (United States)

    McClendon, Debra T; Warren, Jared S; Green, Katherine M; Burlingame, Gary M; Eggett, Dennis L; McClendon, Richard J

    2011-01-01

    This study evaluated the relative sensitivity to change of the Child Behavior Checklist/6-18 (CBCL), the Behavior Assessment System for Children-2 (BASC-2), and the Youth Outcome Questionnaire 2.01 (Y-OQ). Participants were 134 parents and 44 adolescents receiving routine outpatient services in a community mental health system. Hierarchical linear modeling analyses were used to examine change trajectories for the 3 measures across 3 groups: parent informants, parent and adolescent dyads, and adolescent informants. Results indicated that for parent-report measures, the Y-OQ was most change sensitive; the BASC-2 and CBCL were not statistically different from each other. Significant differences in change sensitivity were not observed for youth self-report of symptoms. Results suggest that the Y-OQ may be particularly useful for evaluating change in overall psychosocial functioning in children and adolescents. © 2010 Wiley Periodicals, Inc.

  2. The Role of Transport Use in Adolescent Wilderness Treatment: Its Relationship to Readiness to Change and Outcomes

    Science.gov (United States)

    Tucker, Anita R.; Bettmann, Joanna E.; Norton, Christine L.; Comart, Casey

    2015-01-01

    Background: Considering the sensitive ethical issues related to involuntary treatment of adolescents, research investigating youth transport practices and treatment outcomes is clearly needed. Youth transport is common practice in many private pay programs, including wilderness therapy programs. Objective: This study of 350 adolescents in…

  3. The compressed work week as organizational change: behavioral and attitudinal outcomes.

    Science.gov (United States)

    Ronen, S; Primps, S B

    1981-01-01

    The results from recent studies on the compressed work week have been compiled and categorized in order to provide some basis for generalizing the effects of the work schedule on employee attitudes and behavior. It appears that attitudes toward the compressed week are favorable, with some generalization to job attitudes. Performance outcomes are ambiguous, although there are no reported decreases; fatigue seems to be the only negative aspect of the longer day. An examination of mediating variables suggests more complex relationships between the implementation of the compressed work week and potential outcomes. These relationships are described and directions are indicated for future research.

  4. Neuroscience curriculum changes and outcomes: medical university of South Carolina, 2006 to 2010.

    Science.gov (United States)

    Holden, Kenton R; Cooper, S Lewis; Wong, Jeffrey G

    2012-07-01

    To develop future neurologists and translational neuroscientists, we created a neurosciences pathway throughout our medical school curriculum that included early exposure to clinical neurosciences decision-making and added variety to the choices of later clinical neurosciences experiences. Our curricular innovation had 3 parts: (1) integrating basic neurosciences content into an explicit clinical context in a College of Medicine (COM) first year of medical school; (2) expanding pathophysiological principles related to neurosciences in COM second year of medical school; and (3) creating a variety of 3-week clinical neurosciences selectives in COM third year of medical school and 4-week electives/externships for interested learners in COM fourth year of medical school. These new changes were evaluated (1) by comparing national standardized examinations including Neurology Subject examination scores for students choosing clinical neurosciences selectives; (2) by student satisfaction Graduate Questionnaires; and (3) by the total number of our graduates matching in US neurosciences disciplines. Students taking neuroscience selectives demonstrated a nonsignificant trend toward higher Step 2 Clinical Knowledge scores. The students' Neurology Subject examination scores were comparable with those scores reported nationally for other US COM third year of medical school students on 4-week rotations. Student-reported satisfaction in clinical neurology teaching improved from 43.9% (before) to 81.8% (after). The percentage of students matching into clinical neuroscience disciplines rose from 2% (before) to 6% (after). Our neurosciences curricular innovation increased graduating student satisfaction scores, had a mild positive impact on Step 2 Clinical Knowledge scores, and increased the number of students choosing careers in the clinical neurosciences. This model may be a consideration for other medical schools who wish to integrate neurosciences teaching throughout their

  5. Monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time?

    Science.gov (United States)

    Tsang, Victor T; Brown, Katherine L; Synnergren, Mats Johanssen; Kang, Nicholas; de Leval, Marc R; Gallivan, Steve; Utley, Martin

    2009-02-01

    Risk adjustment of outcomes in pediatric congenital heart surgery is challenging due to the great diversity in diagnoses and procedures. We have previously shown that variable life-adjusted display (VLAD) charts provide an effective graphic display of risk-adjusted outcomes in this specialty. A question arises as to whether the risk model used remains appropriate over time. We used a recently developed graphic technique to evaluate the performance of an existing risk model among those patients at a single center during 2000 to 2003 originally used in model development. We then compared the distribution of predicted risk among these patients with that among patients in 2004 to 2006. Finally, we constructed a VLAD chart of risk-adjusted outcomes for the latter period. Among 1083 patients between April 2000 and March 2003, the risk model performed well at predicted risks above 3%, underestimated mortality at 2% to 3% predicted risk, and overestimated mortality below 2% predicted risk. There was little difference in the distribution of predicted risk among these patients and among 903 patients between June 2004 and October 2006. Outcomes for the more recent period were appreciably better than those expected according to the risk model. This finding cannot be explained by any apparent bias in the risk model combined with changes in case-mix. Risk models can, and hopefully do, become out of date. There is scope for complacency in the risk-adjusted audit if the risk model used is not regularly recalibrated to reflect changing standards and expectations.

  6. Assertiveness training: Effects of treatment, maintenance of change and therapists' contribution in therapy outcome

    Directory of Open Access Journals (Sweden)

    Tovilović Snežana

    2005-01-01

    Full Text Available In this research is shown part of results concerning evaluation study of group assertiveness training. Treatment, which has been organized as structured program of assertiveness training, has been applied on 18 groups of subjects during 9 group sessions. This treatment has been adjusted to non-psychiatric clients from our country. Groups were lead by two therapists. During 20 months of our research 215 voluntary participants of full age have joined training groups. Final sample consisted of 158 subjects who had finished treatment and who had fulfilled criteria for taking repeated measurement. Subjects had taken battery of questionnaires before the treatment and eight weeks after they had completed treatment. Subsample, which included 35 subjects from one therapist’s groups, took retest after twice longer time period. Results of conducted research have confirmed the hypothesis concerning the potentiality of assertiveness training to produce expected and significant improvements of treated subjects. Therapy effect is found on symptomatic level through reduction of symptoms of non-assertive behaviors, which were target of the treatment. Contrary to expectation interactive effect of treatment and therapist to reduction of symptoms of non-assertive behavior has been found, which implies need for further investigation of variables that are related to therapists. Through the medium of treatment therapeutic changes in structural level, in domain of general assertiveness, social anxiety and treated subjects' self-concept are produced. The effect of therapy we might consider stabled and maintained after 16 weeks of finishing the treatment.

  7. Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral.

    Science.gov (United States)

    Rahman, Rachel Jane; Thogersen-Ntoumani, Cecilie; Thatcher, Joanne; Doust, Jonathan

    2011-11-01

    Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N = 293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.

  8. A Longitudinal Study of the Determinants and Outcomes of Career Change

    Science.gov (United States)

    Carless, Sally A.; Arnup, Jessica L.

    2011-01-01

    The present longitudinal field study investigated the antecedents and consequences of an actual career change. The framework for this study was Rhodes and Doering's (1983) model of career change. We examined the effect of individual and organisational characteristics on career change behaviour. The individual characteristics were: traits (Openness…

  9. Making Change Visible: The Possibilities in Assessing Mental Health Counseling Outcomes

    Science.gov (United States)

    Leibert, Todd W.

    2006-01-01

    The product of mental health counseling, unlike that of most professions, remains invisible to most people, leaving counselors vulnerable in a competitive market. The author argues that clinicians should recognize the value of, understand, and begin using outcome measures in their work. Research focusing on critical problems in psychotherapy…

  10. Change Processes in Residential Cognitive and Interpersonal Psychotherapy for Social Phobia: A Process-Outcome Study

    Science.gov (United States)

    Hoffart, Asle; Borge, Finn-Magnus; Sexton, Harold; Clark, David M.

    2009-01-01

    The purpose of this study was to test cognitive and interpersonal models for improving social phobia. Eighty patients with social phobia were randomized to 10-week residential cognitive (RCT) or residential interpersonal psychotherapy (RIPT). They completed process measures every Thursday and a sub-outcome measure every Monday. The ratings were…

  11. Changes in outcome and management of perforated diverticulitis over a 10 year period.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2013-03-04

    Aggressive non-operative intervention and evolving surgical strategies have altered the treatment of perforated diverticulitis in the acute setting. These strategies have predominantly been implemented over the last decade. The aim of this study was to assess the impact of this on patient outcome during their index admission and subsequently.

  12. Autism Litigation: Outcomes for 2010, Trends in Decision Making and Changes in Diagnostic Criteria

    Science.gov (United States)

    Hill, Doris Adams; Kearley, Regina

    2013-01-01

    The diagnosis of autism spectrum disorder has systematically risen since Kanner's description in 1943 and Asperger's definition in 1944. An increase in numbers has met with an increase in litigation regarding autism spectrum disorder (ASD) and the Individuals with Disabilities Education Improvement Act (IDEIA). Outcomes that first favored parents…

  13. Effects of changes in management of active infective endocarditis on outcome in a 25-year period

    NARCIS (Netherlands)

    Verheul, H. A.; van den Brink, R. B.; van Vreeland, T.; Moulijn, A. C.; Düren, D. R.; Dunning, A. J.

    1993-01-01

    The clinical outcome and long-term follow-up of 130 consecutive patients (141 episodes) with active infective endocarditis who were treated between 1966 and 1991 were analyzed. There was a shift toward a higher proportion of referred patients (39 to 78%), patients aged > 60 years (11 to 41%) and

  14. Future Scenarios as a Research Tool: Investigating Climate Change Impacts, Adaptation Options and Outcomes for the Great Barrier Reef, Australia.

    Science.gov (United States)

    Evans, Louisa S; Hicks, Christina C; Fidelman, Pedro; Tobin, Renae C; Perry, Allison L

    2013-01-01

    Climate change is a significant future driver of change in coastal social-ecological systems. Our knowledge of impacts, adaptation options, and possible outcomes for marine environments and coastal industries is expanding, but remains limited and uncertain. Alternative scenarios are a way to explore potential futures under a range of conditions. We developed four alternative future scenarios for the Great Barrier Reef and its fishing and tourism industries positing moderate and more extreme (2-3 °C above pre-industrial temperatures) warming for 2050 and contrasting 'limited' and 'ideal' ecological and social adaptation. We presented these scenarios to representatives of key stakeholder groups to assess the perceived viability of different social adaptation options to deliver desirable outcomes under varied contexts.

  15. 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.

  16. Interpregnancy weight changes and impact on pregnancy outcome in a cohort of women with a macrosomic first delivery: a prospective longitudinal study.

    LENUS (Irish Health Repository)

    Crosby, David A

    2017-06-06

    To determine the median interpregnancy maternal weight change between first and second pregnancies, and second and third pregnancies and to assess the impact of this weight change on pregnancy outcome in a cohort of women with a macrosomic first delivery.

  17. Children's Perceptions of Hypothetical Peers With Undesirable Characteristics: Role of the Peers' Desire to Change, Source of Effort to Change, and Outcome.

    Science.gov (United States)

    Barnett, Mark A; Sonnentag, Tammy L; Wadian, Taylor W; Jones, Tucker L; Langley, Courtney A

    2015-01-01

    The present study, involving sixth- to eighth-grade students, is an extension of a prior investigation (Barnett, Livengood, Sonnentag, Barlett, & Witham, 2010) that examined children's perceptions of hypothetical peers with various undesirable characteristics. Results indicate that children's perceptions of hypothetical peers with an undesirable characteristic are influenced by the peers' desire to change, the source of effort to change, and the peers' success or failure in changing the characteristic. The children anticipated responding more favorably to peers who were successful in overcoming an undesirable characteristic than peers who were unsuccessful. Regardless of the peers' outcome, the children anticipated responding more favorably to peers who tried to change than peers who relied on the effort of adult authorities to motivate change. The children perceived successful peers as experiencing more positive affect than their unsuccessful counterparts, especially if the success was presented as a fulfillment of the peers' desire to change their undesirable characteristic. Finally, the children's ratings reflected the belief that, among peers who failed to change their undesirable characteristic, lacking the desire to change increases the relative likelihood that the characteristic will be permanent.

  18. Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength, pain, and disability in chronic low back pain.

    Science.gov (United States)

    Steele, James; Fisher, James; Perrin, Craig; Conway, Rebecca; Bruce-Low, Stewart; Smith, Dave

    2018-01-12

    Secondary analysis of data from studies utilising isolated lumbar extension exercise interventions for correlations among changes in isolated lumbar extension strength, pain, and disability. Studies reporting isolated lumbar extension strength changes were examined for inclusion criteria including: (1) participants with chronic low back pain, (2) intervention ≥ four weeks including isolated lumbar extension exercise, (3) outcome measures including isolated lumbar extension strength, pain (Visual Analogue Scale), and disability (Oswestry Disability Index). Six studies encompassing 281 participants were included. Correlations among change in isolated lumbar extension strength, pain, and disability. Participants were grouped as "met" or "not met" based on minimal clinically important changes and between groups comparisons conducted. Isolated lumbar extension strength and Visual Analogue Scale pooled analysis showed significant weak to moderate correlations (r = -0.391 to -0.539, all p Disability Index pooled analysis showed significant weak correlations (r = -0.349 to -0.470, all p disability, isolated lumbar extension strength changes were greater for those "met" compared with those "not met" (p disability. This study shows significant correlations between increases in isolated lumbar extension strength and reductions in pain and disability. Strengthening of the lumbar extensor musculature could be considered an important target for exercise interventions.

  19. Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992-2011.

    Science.gov (United States)

    Koroukian, Siran M; Basu, Jayasree; Schiltz, Nicholas K; Navale, Suparna; Bakaki, Paul M; Warner, David F; Dor, Avi; Given, Charles W; Stange, Kurt C

    2018-01-01

    Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results. To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time. Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and health outcomes between MCEs and FFSBs across 3 time periods: 1992-1998, 1999-2004, and 2005-2011. We used multivariable analysis, stratified by, and pooled across the study periods. The unit of analysis was the person-wave (n=167,204). HRS participants who were also enrolled in Medicare. Outcome measures included self-reported fair/poor health, 2-year self-rated worse health, and 2-year mortality. Our main covariate was a composite measure of multimorbidity (MM), MM0-MM3, defined as the co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. The case-mix differential between MCEs and FFSBs persisted over time. Results from multivariable models on the pooled data and incorporating interaction terms between managed care status and study period indicated that MCEs and FFSBs were as likely to die within 2 years from the HRS interview (P=0.073). This likelihood remained unchanged across the study periods. However, MCEs were more likely than FFSBs to report fair/poor health in the third study period (change in probability for the interaction term: 0.024, P=0.008), but less likely to rate their health worse in the last 2 years, albeit at borderline significance (change in probability: -0.021, P=0.059). Despite the persistence of selection bias, the differential in self-reported fair/poor status between MCEs and FFSBs seems to be closing over time.

  20. Personality trait level and change as predictors of health outcomes: findings from a national study of Americans (MIDUS).

    Science.gov (United States)

    Turiano, Nicholas A; Pitzer, Lindsay; Armour, Cherie; Karlamangla, Arun; Ryff, Carol D; Mroczek, Daniel K

    2012-01-01

    Personality traits predict numerous health outcomes, but previous studies have rarely used personality change to predict health. The current investigation utilized a large national sample of 3,990 participants from the Midlife in the U.S. study (MIDUS) to examine if both personality trait level and personality change longitudinally predict 3 different health outcomes (i.e., self-rated physical health, self-reported blood pressure, and number of days limited at work or home due to physical health reasons) over a 10-year span. Each of the Big Five traits, except openness, predicted self-rated health. Change in agreeableness, conscientiousness, and extraversion also predicted self-rated health. Trait levels of conscientiousness and neuroticism level predicted self-reported blood pressure. All trait levels except agreeableness predicted number of work days limited. Only change in conscientiousness predicted the number of work days limited. Findings demonstrate that a full understanding of the link between personality and health requires consideration of trait change as well as trait level.

  1. Openness to Experience as a Predictor and Outcome of Upward Job Changes into Managerial and Professional Positions

    Science.gov (United States)

    Nieß, Christiane; Zacher, Hannes

    2015-01-01

    In industrial and organizational psychology, there is a long tradition of studying personality as an antecedent of work outcomes. Recently, however, scholars have suggested that personality characteristics may not only predict, but also change due to certain work experiences, a notion that is depicted in the dynamic developmental model (DDM) of personality and work. Upward job changes are an important part of employees’ careers and career success in particular, and we argue that these career transitions can shape personality over time. In this study, we investigate the Big Five personality characteristics as both predictors and outcomes of upward job changes into managerial and professional positions. We tested our hypotheses by applying event history analyses and propensity score matching to a longitudinal dataset collected over five years from employees in Australia. Results indicated that participants’ openness to experience not only predicted, but that changes in openness to experience also followed from upward job changes into managerial and professional positions. Our findings thus provide support for a dynamic perspective on personality characteristics in the context of work and careers. PMID:26110527

  2. ASSESSMENT OF THE CHANGES IN BLOOD PRESSURE CIRCADIAN PROFILE AND VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE AND ARTERIAL HYPERTENSION DURING COMBINED THERAPY INCLUDING IVABRADINE

    Directory of Open Access Journals (Sweden)

    M. V. Surovtseva

    2012-01-01

    Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm. 

  3. ASSESSMENT OF THE CHANGES IN BLOOD PRESSURE CIRCADIAN PROFILE AND VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE AND ARTERIAL HYPERTENSION DURING COMBINED THERAPY INCLUDING IVABRADINE

    Directory of Open Access Journals (Sweden)

    M. V. Surovtseva

    2015-12-01

    Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm. 

  4. Changing pattern and outcome of pediatric chest injuries in urban Syria.

    Science.gov (United States)

    Darwish, Bassam; Mahfouz, Mohammad Z; Al-Nosairat, Saeed; Izzat, Mohammad Bashar

    2018-01-01

    Background Pediatric chest injuries were infrequent in our practice, but the outbreak of the Syrian crisis resulted in an increase in number and a change in the pattern of thoracic trauma incidents. We compared our experience of pediatric chest injuries before and during the crisis. Methods We reviewed the records of 256 children aged 12.8 ± 5 years who were admitted to our hospital with the diagnosis of chest trauma over a 12-year period. Collected data included mechanism of injury, associated injuries, method of management, length of hospital stay, complications, and mortality. Results The incidence of pediatric chest injuries increased significantly following the outbreak of the crisis, and penetrating injuries prevailed, mainly due to shrapnel, bullets, and stab wounds. Forty percent of patients with blunt injuries and 20% of those with penetrating injuries were managed conservatively, whereas urgent thoracotomies were indicated in 10%, mostly in patients with penetrating injuries. Associated injuries were more frequent in patients with blunt injuries and resulted in a longer hospital stay and an increased mortality rate. The overall mortality rate was 7.8% and it was higher in children younger than 7 years of age and in patients who had been subjected to blunt injuries. Conclusions There has been a recent substantial upsurge in the incidence of pediatric thoracic trauma, with a predominance of penetrating injuries. Most patients could be managed nonoperatively, but a small subset required an open thoracotomy. The presence of associated injuries constitutes the main determinant of prognosis in this group of patients.

  5. Greenhouse gas balances and mitigation costs of 70 modern Germany-focused and 4 traditional biomass pathways including land-use change effects

    International Nuclear Information System (INIS)

    Sterner, Michael; Fritsche, Uwe

    2011-01-01

    With Germany as the point of energy end-use, 70 current and future modern pathways plus 4 traditional biomass pathways for heat, power and transport have been compiled and examined in one single greenhouse gas (GHG) balancing assessment. This is needed to broaden the narrow focus on biofuels for transport and identify the role of bioenergy in GHG mitigation. Sensitivity analysis for land-use changes and fossil reference systems are included. Co-firing of woody biomass and fermentation of waste biomass are the most cost-efficient and effective biomass applications for GHG emission reduction in modern pathways. Replacing traditional biomass with modern biomass applications offers an underestimated economic potential of GHG emission reduction. The range of maximum CO 2 equivalent GHG reduction potential of bioenergy is identified in a range of 2.5–16 Gt a −1 in 2050 (5–33% of today’s global GHG emissions), and has an economic bioenergy potential of 150 EJ a −1 .

  6. 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.

  7. Working Alliance and Stages of Change for Employment: The Intermediary Role of Autonomous Motivation, Outcome Expectancy and Vocational Rehabilitation Engagement.

    Science.gov (United States)

    Iwanaga, Kanako; Chan, Fong; Tansey, Timothy N; Strauser, David; Ritter, Ellen; Bishop, Malachy; Brooks, Jessica

    2018-05-30

    Purpose Working alliance is one of the most important common factors for successful counseling/psychotherapy outcomes. Based on the empirical literature about working alliance, it seems that self-determination and self-efficacy theory (SDT/SET) can potentially be used as a motivational model to explain the relationship between working alliance and vocational rehabilitation (VR) outcomes. The purpose of this study is to evaluate three primary SDT/SET constructs, autonomous motivation, expectancy and engagement, as mediators for the relationship between working alliance and stages of change (SOC) for employment. Methods A serial multiple mediation analysis (SMMA) was computed to evaluate autonomy, outcome expectancy, and VR engagement as mediators of the relationship between working alliance and SOC for employment in a sample of 277 people with chronic illness and disability (CID) receiving services from state VR agencies in the United States. Results The SMMA results indicated that working alliance was positively associated with SOC for employment (total effect), while the direct effect between working alliance and SOC for employment was not significant after controlling for the effects of the mediators, indicating significant mediation effects. The mediation effects were estimates of the indirect effects for working alliance on SOC for employment through (a) autonomous motivation, (b) outcome expectancy, (c) VR engagement, and (d) autonomous motivation, outcome expectancy and VR engagement together. Conclusions The results indicated that a strong working alliance has the benefit of helping consumers develop autonomous motivation to work and increasing their vocational outcome expectancy and engagement in VR services, leading to employment.

  8. Changes in self-efficacy, collective efficacy and patient outcome following interprofessional simulation training on postpartum haemorrhage.

    Science.gov (United States)

    Egenberg, Signe; Øian, Pål; Eggebø, Torbjørn Moe; Arsenovic, Mirjana Grujic; Bru, Lars Edvin

    2017-10-01

    To examine whether interprofessional simulation training on management of postpartum haemorrhage enhances self-efficacy and collective efficacy and reduces the blood transfusion rate after birth. Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide, although it is preventable in most cases. Interprofessional simulation training might help improve the competence of health professionals dealing with postpartum haemorrhage, and more information is needed to determine its potential. Multimethod, quasi-experimental, pre-post intervention design. Interprofessional simulation training on postpartum haemorrhage was implemented for midwives, obstetricians and auxiliary nurses in a university hospital. Training included realistic scenarios and debriefing, and a measurement scale for perceived postpartum haemorrhage-specific self-efficacy, and collective efficacy was developed and implemented. Red blood cell transfusion was used as the dependent variable for improved patient outcome pre-post intervention. Self-efficacy and collective efficacy levels were significantly increased after training. The overall red blood cell transfusion rate did not change, but there was a significant reduction in the use of ≥5 units of blood products related to severe bleeding after birth. The study contributes to new knowledge on how simulation training through mastery and vicarious experiences, verbal persuasion and psychophysiological state might enhance postpartum haemorrhage-specific self-efficacy and collective efficacy levels and thereby predict team performance. The significant reduction in severe postpartum haemorrhage after training, indicated by reduction in ≥5 units of blood transfusions, corresponds well with the improvement in collective efficacy, and might reflect the emphasis on collective efforts to counteract severe cases of postpartum haemorrhage. Interprofessional simulation training in teams may contribute to enhanced prevention and

  9. Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial.

    Science.gov (United States)

    Hawkes, Anna L; Chambers, Suzanne K; Pakenham, Kenneth I; Patrao, Tania A; Baade, Peter D; Lynch, Brigid M; Aitken, Joanne F; Meng, Xingqiong; Courneya, Kerry S

    2013-06-20

    Colorectal cancer survivors are at risk for poor health outcomes because of unhealthy lifestyles, but few studies have developed translatable health behavior change interventions. This study aimed to determine the effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes among colorectal cancer survivors. In this two-group randomized controlled trial, 410 colorectal cancer survivors were randomly assigned to the health coaching intervention (11 theory-based telephone-delivered health coaching sessions delivered over 6 months focusing on physical activity, weight management, dietary habits, alcohol, and smoking) or usual care. Assessment of primary (ie, physical activity [Godin Leisure Time Index], health-related quality of life [HRQoL; Short Form-36], and cancer-related fatigue [Functional Assessment of Chronic Illness Therapy Fatigue Scale]) and secondary outcomes (ie, body mass index [kg/m(2)], diet and alcohol intake [Food Frequency Questionnaire], and smoking) were conducted at baseline and 6 and 12 months. At 12 months, significant intervention effects were observed for moderate physical activity (28.5 minutes; P = .003), body mass index (-0.9 kg/m(2); P = .001), energy from total fat (-7.0%; P = .006), and energy from saturated fat (-2.8%; P = .016). A significant intervention effect was reported for vegetable intake (0.4 servings per day; P = .001) at 6 months. No significant group differences were found at 6 or 12 months for HRQoL, cancer-related fatigue, fruit, fiber, or alcohol intake, or smoking. The CanChange intervention was effective for improving physical activity, dietary habits, and body mass index in colorectal cancer survivors. The intervention is translatable through existing telephone cancer support and information services in Australia and other countries.

  10. Strategies for Developing Positive Behaviour Management. Teacher Behaviour Outcomes and Attitudes to the Change Process

    Science.gov (United States)

    Hayes, Ben; Hindle, Sarah; Withington, Paul

    2007-01-01

    This paper describes an extended action research project run in a large secondary school over an 18-month period. The work was part of a wider strategy for change within the school. The data presented here describes some of the features of the change process and reflections on its impact. A key aim was to challenge and enable teachers to modify…

  11. State Systems Change Spotlight: Nevada. Transforming State Systems to Improve Outcomes for Children with Disabilities

    Science.gov (United States)

    Ruedel, Kristin; Nelson, Gena; Bailey, Tessie; Pierce, Jennifer

    2018-01-01

    Data show that effective and ongoing communication and evaluation can have a positive impact on local and statewide systems change. Local and statewide systems change requires ongoing communication and evaluation. The Nevada Department of Education (NDE) used a communication protocol to support implementation of the Assess-Plan-Teach (APT) model.…

  12. Within-Year Changes in Children's Intrinsic and Extrinsic Motivational Orientations: Contextual Predictors and Academic Outcomes

    Science.gov (United States)

    Corpus, Jennifer Henderlong; McClintic-Gilbert, Megan S.; Hayenga, Amynta O.

    2009-01-01

    The present study was designed to investigate the nature, timing, and correlates of motivational change among a large sample (N = 1051) of third- through eighth-grade students. Analyses of within-year changes in students' motivational orientations revealed that both intrinsic and extrinsic motivations decreased from fall to spring, with declines…

  13. Changes in Weight and Comorbidities among Adolescents Undergoing Bariatric Surgery: 1-Year Results from the Bariatric Outcomes Longitudinal Database

    Science.gov (United States)

    Messiah, Sarah E.; Lopez-Mitnik, Gabriela; Winegar, Deborah; Sherif, Bintu; Arheart, Kristopher L.; Reichard, Kirk W.; Michalsky, Marc P.; Lipshultz, Steven E.; Miller, Tracie L.; Livingstone, Alan S.; De La Cruz-Muñoz, Nestor

    2012-01-01

    Background Bariatric surgery is one of the few effective treatments for morbid obesity but the weight loss and other health related outcomes for this procedure in large, diverse adolescent patient populations are not well characterized. Objective To analyze the prospective Bariatric Outcomes Longitudinal Database (BOLD) to determine the weight loss and health related outcomes in adolescents. Setting BOLD data is collected from 423 surgeons at 360 facilities in the United States. Methods Main outcome measures included anthropometric and comorbidity status at baseline (n=890) and at 3 (n=786), 6 (n=541), and 12 (n=259) months after surgery. Adolescents (75% female; 68% non-Hispanic white, 14% Hispanic, 11% non-Hispanic black, and 6% other) age 11-to-19 years were included in the analyses. Results The overall one year mean weight loss for those who underwent gastric bypass surgery was more than twice that of those who underwent adjustable gastric band surgery (48.6 kg versus 20 kg, Psurgery types (Psurgery. There were a total of 45 readmissions among gastric bypass patients and 10 among adjustable gastric band patients with 29 and 8 reoperations required, respectively. Conclusions Weight loss at 3-, 6-, and 12-months after surgery is approximately double in adolescent males and females who underwent gastric bypass surgery versus those who underwent adjustable gastric band surgery. Bariatric surgery can safely and substantially reduce weight and related comorbidities in morbidly obese adolescents for at least 1 year. PMID:22542199

  14. Long-term post-stroke changes include myelin loss, specific deficits in sensory and motor behaviors and complex cognitive impairment detected using active place avoidance.

    Directory of Open Access Journals (Sweden)

    Jin Zhou

    Full Text Available Persistent neurobehavioral deficits and brain changes need validation for brain restoration. Two hours middle cerebral artery occlusion (tMCAO or sham surgery was performed in male Sprague-Dawley rats. Neurobehavioral and cognitive deficits were measured over 10 weeks included: (1 sensory, motor, beam balance, reflex/abnormal responses, hindlimb placement, forepaw foot fault and cylinder placement tests, and (2 complex active place avoidance learning (APA and simple passive avoidance retention (PA. Electroretinogram (ERG, hemispheric loss (infarction, hippocampus CA1 neuronal loss and myelin (Luxol Fast Blue staining in several fiber tracts were also measured. In comparison to Sham surgery, tMCAO surgery produced significant deficits in all behavioral tests except reflex/abnormal responses. Acute, short lived deficits following tMCAO were observed for forelimb foot fault and forelimb cylinder placement. Persistent, sustained deficits for the whole 10 weeks were exhibited for motor (p<0.001, sensory (p<0.001, beam balance performance (p<0.01 and hindlimb placement behavior (p<0.01. tMCAO produced much greater and prolonged cognitive deficits in APA learning (maximum on last trial of 604±83% change, p<0.05 but only a small, comparative effect on PA retention. Hemispheric loss/atrophy was measured 10 weeks after tMCAO and cross-validated by two methods (e.g., almost identical % ischemic hemispheric loss of 33.4±3.5% for H&E and of 34.2±3.5% for TTC staining. No visual dysfunction by ERG and no hippocampus neuronal loss were detected after tMCAO. Fiber tract damage measured by Luxol Fast Blue myelin staining intensity was significant (p<0.01 in the external capsule and striatum but not in corpus callosum and anterior commissure. In summary, persistent neurobehavioral deficits were validated as important endpoints for stroke restorative research in the future. Fiber myelin loss appears to contribute to these long term behavioral dysfunctions and

  15. Shape of the self-concept clarity change during group psychotherapy predicts the outcome: an empirical validation of the theoretical model of the self-concept change

    Science.gov (United States)

    Styła, Rafał

    2015-01-01

    Background: Self-Concept Clarity (SCC) describes the extent to which the schemas of the self are internally integrated, well defined, and temporally stable. This article presents a theoretical model that describes how different shapes of SCC change (especially stable increase and “V” shape) observed in the course of psychotherapy are related to the therapy outcome. Linking the concept of Jean Piaget and the dynamic systems theory, the study postulates that a stable SCC increase is needed for the participants with a rather healthy personality structure, while SCC change characterized by a “V” shape or fluctuations is optimal for more disturbed patients. Method: Correlational study in a naturalistic setting with repeated measurements (M = 5.8) was conducted on the sample of 85 patients diagnosed with neurosis and personality disorders receiving intensive eclectic group psychotherapy under routine inpatient conditions. Participants filled in the Self-Concept Clarity Scale (SCCS), Symptoms' Questionnaire KS-II, and Neurotic Personality Questionnaire KON-2006 at the beginning and at the end of the course of psychotherapy. The SCCS was also administered every 2 weeks during psychotherapy. Results: As hypothesized, among the relatively healthiest group of patients the stable SCC increase was related to positive treatment outcome, while more disturbed patients benefited from the fluctuations and “V” shape of SCC change. Conclusions: The findings support the idea that for different personality dispositions either a monotonic increase or transient destabilization of SCC is a sign of a good treatment prognosis. PMID:26579001

  16. Flexibility in change practices and job outcomes for nurses: exploring the role of subjective fit.

    Science.gov (United States)

    Newton, Cameron; Teo, Stephen T T; Pick, David; Yeung, Melissa; Salamonson, Yenna

    2013-12-01

    To integrate existing theoretical perspectives on change management, subjective fit and occupational stress to better understand the effects of change on employee adjustment. Although subjective fit with organizational goals and objectives has been shown to have positive effects on employee adjustment, its role in the organizational change-occupational stress context is not understood. This represents a caveat in research when considering the notion that those who feel that they fit with the organization's goals may be better equipped to reconcile and deal with change. A cross-sectional survey of nurses from public and non-profit sector hospitals was conducted. Data were collected from 252 public and non-profit sector nurses via online surveys. Data were collected from June-October in 2010. Structural equation modelling was used to test the direct and indirect effects among the focal variables. The results showed that public and non-profit nurses experience flexibility-limiting and flexibility-promoting change initiatives and that these are differentially related to the perception of administrative stressors and adjustment with these relationships directly and indirectly influenced by perceptions of subjective fit. Flexibility-limiting change initiatives led to lower levels of subjective fit, higher levels of administrative stressors and less favourable adjustment. On the other hand, flexibility-promoting change practices led to higher levels of subjective fit, lower levels of administrative stressors and ultimately better adjustment. The results further the theoretical understanding of the role of subjective fit in organizational change and occupational stress theories. © 2013 John Wiley & Sons Ltd.

  17. Chromosomal Changes in relation to Clinical Outcome in Larynx and Pharynx Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Mario Hermsen

    2005-01-01

    Full Text Available Invasive head and neck squamous carcinomas are among the cytogenetically most complex tumors. Perhaps for this reason, there is little consensus on the prognostic value of specific chromosomal aberrations. Here we present Results of CGH analysis of 56 clinically well-characterized set of head and neck cancers, consisting of larynx and pharynx only. The aim was to find possible associations with clinical outcome. The major chromosome arms showing gains were (in decreasing order: 3q, 7q, 8q, 5p, 11q13, 17q and 18p, and losses occurred at 3p, 11qter, 4p, 18q, and 5q. The segments most frequently amplified were 3q26-qter, 11q13, 11q22, 3q12–13, 18p11.3, 18q11.2 and 8q24.3. Tumors with stages III and IV, and lymph node positive tumors had a worse clinical outcome. Surprisingly, no specific chromosomal abnormality correlated with disease-free survival. The only aberration that correlated to one of the clinico-pathological parameters was amplification 11q13, that occurred solely in lymph node positive, stage IV tumors. However 11q13 amplification did not correlate with disease-free survival. These Results seem to indicate that genetic alterations at the level of chromosomes have limited prognostic value in patients with invasive larynx and pharynx squamous cell carcinomas.

  18. 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

  19. 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.

  20. 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.

  1. Examination of the association between lifestyle behavior changes and weight outcomes in preschoolers receiving treatment for obesity.

    Science.gov (United States)

    Kuhl, Elizabeth S; Clifford, Lisa M; Bandstra, Nancy F; Filigno, Stephanie S; Yeomans-Maldonado, Gloria; Rausch, Joseph R; Stark, Lori J

    2014-01-01

    Preschoolers (ages 2-5 years) have been significantly underrepresented in the obesity treatment outcome literature, despite estimates that 12.1% are already obese. As such, little is known about the most important intervention targets for weight management within this age group. The aims of this study were (a) to examine lifestyle behavior changes for 30 obese preschoolers participating in a weight-control intervention and (b) to explore which lifestyle behavior changes predicted changes in body mass index (BMI) z score. Preschooler height, weight, diet (three 24-hr recalls), physical activity (accelerometry), and television use (parent report) were measured at baseline and posttreatment (6 months). A linear regression was conducted to examine pre- to posttreatment changes in diet (i.e., intake of calories, sugar-sweetened beverages, fruits and vegetables, and sweet and salty snacks) and activity (i.e., moderate-to-vigorous activity and television use) behaviors on changes in BMI z score. Despite significant reductions in sugar-sweetened beverage intake and television use, and increases in fruit and vegetable intake, only reductions in absolute caloric intake significantly predicted reductions in BMI z score. Our findings suggest that attaining healthy caloric goals may be the most important component of weight-control interventions for preschoolers. Future research using innovative methodologies, such as the Multiphase Optimization Strategy, may be helpful to prospectively identifying the lifestyle behavior changes that are most effective in helping families to achieve healthy weight outcomes for preschoolers and thereby improve intervention efficiency and decrease treatment burden for families. 2014 APA, all rights reserved

  2. Mediterranean diet or extended fasting's influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study.

    Science.gov (United States)

    Michalsen, Andreas; Riegert, Markus; Lüdtke, Rainer; Bäcker, Marcus; Langhorst, Jost; Schwickert, Myriam; Dobos, Gustav J

    2005-12-22

    Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases. While microbiological fecal culture analysis is now increasingly used, little is known about the relationship of changes in intestinal flora, dietary patterns and clinical outcome in specific diseases. To clarify the role of microbiological culture analysis we aimed to evaluate whether in patients with rheumatoid arthritis (RA) or fibromyalgia (FM) a Mediterranean diet or an 8-day fasting period are associated with changes in fecal flora and whether changes in fecal flora are associated with clinical outcome. During a two-months-period 51 consecutive patients from an Integrative Medicine hospital department with an established diagnosis of RA (n = 16) or FM (n = 35) were included in the study. According to predefined clinical criteria and the subjects' choice the patients received a mostly vegetarian Mediterranean diet (n = 21; mean age 50.9 +/-13.3 y) or participated in an intermittent modified 8-day fasting therapy (n = 30; mean age 53.7 +/- 9.4 y). Quantitative aerob and anaerob bacterial flora, stool pH and concentrations of secretory immunoglobulin A (sIgA) were analysed from stool samples at the beginning, at the end of the 2-week hospital stay and at a 3-months follow-up. Clinical outcome was assessed with the DAS 28 for RA patients and with a disease severity rating scale in FM patients. We found no significant changes in the fecal bacterial counts following the two dietary interventions within and between groups, nor were significant differences found in the analysis of sIgA and stool ph. Clinical improvement at the end of the hospital stay tended to be greater in fasting vs. non-fasting patients with RA (p = 0.09). Clinical outcome was not related to alterations in the intestinal flora. Neither Mediterranean diet nor fasting treatments affect the microbiologically assessed intestinal

  3. Mediterranean diet or extended fasting's influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study

    Directory of Open Access Journals (Sweden)

    Schwickert Myriam

    2005-12-01

    Full Text Available Abstract Background Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases. While microbiological fecal culture analysis is now increasingly used, little is known about the relationship of changes in intestinal flora, dietary patterns and clinical outcome in specific diseases. To clarify the role of microbiological culture analysis we aimed to evaluate whether in patients with rheumatoid arthritis (RA or fibromyalgia (FM a Mediterranean diet or an 8-day fasting period are associated with changes in fecal flora and whether changes in fecal flora are associated with clinical outcome. Methods During a two-months-period 51 consecutive patients from an Integrative Medicine hospital department with an established diagnosis of RA (n = 16 or FM (n = 35 were included in the study. According to predefined clinical criteria and the subjects' choice the patients received a mostly vegetarian Mediterranean diet (n = 21; mean age 50.9 +/-13.3 y or participated in an intermittent modified 8-day fasting therapy (n = 30; mean age 53.7 +/- 9.4 y. Quantitative aerob and anaerob bacterial flora, stool pH and concentrations of secretory immunoglobulin A (sIgA were analysed from stool samples at the beginning, at the end of the 2-week hospital stay and at a 3-months follow-up. Clinical outcome was assessed with the DAS 28 for RA patients and with a disease severity rating scale in FM patients. Results We found no significant changes in the fecal bacterial counts following the two dietary interventions within and between groups, nor were significant differences found in the analysis of sIgA and stool ph. Clinical improvement at the end of the hospital stay tended to be greater in fasting vs. non-fasting patients with RA (p = 0.09. Clinical outcome was not related to alterations in the intestinal flora. Conclusion Neither Mediterranean diet nor fasting

  4. Changes in anxiety and depression symptoms associated to the outcome of MOH

    DEFF Research Database (Denmark)

    Bottiroli, Sara; Allena, Marta; Sances, Grazia

    2018-01-01

    Aims To evaluate the impact of treatment success on depression and anxiety symptoms in medication-overuse headache (MOH) and whether depression and anxiety can be predictors of treatment outcome. Methods All consecutive patients entering the detoxification program were analysed in a prospective......, non-randomised fashion over a six-month period. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. Results A total of 663 MOH patients were evaluated, and 492 completed the entire protocol. Of these, 287 ceased overuse and reverted to an episodic pattern (responders......) and 23 relapsed into overuse. At the final evaluation, the number of patients with depressive symptoms was reduced by 63.2% among responders ( p 

  5. Changes in body weight, blood pressure and selected metabolic biomarkers with an energy-restricted diet including twice daily sweet snacks and once daily sugar-free beverage

    OpenAIRE

    Nickols-Richardson, Sharon M.; Piehowski, Kathryn E.; Metzgar, Catherine J.; Miller, Debra L.; Preston, Amy G.

    2014-01-01

    BACKGROUND/OBJECTIVES The type of sweet snack incorporated into an energy-restricted diet (ERD) may produce differential effects on metabolic improvements associated with body weight (BW) loss. This study compared effects of incorporating either twice daily energy-controlled dark chocolate snacks plus once daily sugar-free cocoa beverage (DC) to non-chocolate snacks plus sugar-free non-cocoa beverage (NC) into an ERD on BW loss and metabolic outcomes. MATERIALS/METHODS In an 18-week randomize...

  6. Early cranial ultrasound changes as predictors of outcome during first year of life in term infants with perinatal asphyxia.

    Science.gov (United States)

    Boo, N Y; Chandran, V; Zulfiqar, M A; Zamratol, S M; Nyein, M K; Haliza, M S; Lye, M S

    2000-08-01

    To identify the types of early cranial ultrasound changes that were significant predictors of adverse outcome during the first year of life in asphyxiated term infants. This was a prospective cohort study. Shortly after birth, cranial ultrasonography was carried out via the anterior fontanelles of 70 normal control infants and 104 asphyxiated infants with a history of fetal distress and Apgar scores of less than 6 at 1 and 5 min of life, or requiring endotracheal intubation and manual intermittent positive pressure ventilation for at least 5 min after birth. Neurodevelopmental assessment was carried out on the survivors at 1 year of age. Abnormal cranial ultrasound changes were detected in a significantly higher proportion (79.8%, or n = 83) of asphyxiated infants than controls (39.5%, or n = 30) (P < 0.0001). However, logistic regression analysis showed that only three factors were significantly associated with adverse outcome at 1 year of life among the asphyxiated infants. These were: (i) decreasing birthweight (for every additional gram of increase in birthweight, adjusted odds ratio (OR) = 0.999, 95% confidence interval (CI) 0.998, 1.000; P = 0.047); (ii) a history of receiving ventilatory support during the neonatal period (adjusted OR = 8.3; 95%CI 2.4, 28.9; P = 0.0009); and (iii) hypoxic-ischaemic encephalopathy stage 2 or 3 (adjusted OR = 5.8; 95%CI 1.8, 18.6; P = 0.003). None of the early cranial ultrasound changes was a significant predictor. Early cranial ultrasound findings, although common in asphyxiated infants, were not significant predictors of adverse outcome during the first year of life in asphyxiated term infants.

  7. The identity of three South American “smiliine” treehoppers (Hemiptera: Membracidae) and related taxonomic changes, including description of a new genus in Thuridini

    Science.gov (United States)

    Based on examination of holotype or interpretation of original descriptions, four taxonomic changes are proposed for South American species erroneously placed in the tribe Smiliini: Flynnia, n. gen. (Thuridini) and F. fascipennis (Funkhouser), n. comb. from Bolivia; Antianthe atromarginata (Goding),...

  8. Positive life change and remission of non-psychotic mental illness - A competing outcomes approach

    NARCIS (Netherlands)

    Neeleman, J; Oldehinkel, AJ; Ormel, J

    Background: Episode duration in non-psychotic mental illness is associated with personal characteristics of patients, like age or personality. Part of these links may be mediated by life change, a predictor of episode duration in its own right. Methods: In 170 primary care patients who suffered 4171

  9. Predicting community and ecosystem outcomes of mycorrhizal responses to global change.

    NARCIS (Netherlands)

    Johnson, N.C.; Angelard, C.; Sanders, I.R.; Kiers, E.T.

    2013-01-01

    Mycorrhizal symbioses link the biosphere with the lithosphere by mediating nutrient cycles and energy flow though terrestrial ecosystems. A more mechanistic understanding of these plant-fungal associations may help ameliorate anthropogenic changes to C and N cycles and biotic communities. We explore

  10. Outcomes following a programme for lifestyle changes with people with hypertension.

    Science.gov (United States)

    Drevenhorn, Eva; Kjellgren, Karin I; Bengtson, Ann

    2007-07-01

    The purpose of the study was to explore the effects of using a structured nursing intervention programme in hypertension care. Counselling on lifestyle changes to address hypertension helps patients reduce risk factors such as smoking, high alcohol consumption, overweight, dyslipidemia, negative stress and physical inactivity. The study was performed as a pre-test-post-test study. All 177 patients diagnosed with hypertension visiting a health centre in Southern Sweden were invited to be counselled by a public health nurse about hypertension, cardiovascular risk factors and non-pharmacological treatment with 15 months follow up. One hundred patients participated in the study. Systolic blood pressure decreased overall (p changed their medication. The level of exercise increased and a reduction in systolic blood pressure and in women's weight were the most obvious results of this intervention study. The study elucidates the challenge of executing health behaviour changes. Counselling following a hypertension programme gives hypertensive patients a chance to execute lifestyle changes and have their medication adjusted to achieve goals for blood pressure control. Further prospective studies in this area, with well-defined intervention approaches and several years of follow up, are necessary.

  11. The Relationship between Curriculum Change and Student Outcomes in a Registered Nursing Program

    Science.gov (United States)

    King, Jim

    2013-01-01

    Nursing schools face the challenge of improving student academic performance and completion rates. The current supply of newly graduated nurses fails to meet the increasing demands of society. In 2009, Cochise College responded by implementing a major change in their curriculum to improve student retention and academic performance. The problem…

  12. Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012

    DEFF Research Database (Denmark)

    Bonet, Mercedes; Cuttini, M; Piedvache, A

    2017-01-01

    OBJECTIVE: to investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTI) between 2003 and 2012 and concurrent trends in their mortality and morbidity in ten European regions. DESIGN: population-based cohort studies in 2003 (MOSAIC study) and 2011/12 (EPIC...

  13. A Decade of Field Changing Atmospheric Aerosol Research: Outcomes of EPA’s STAR Program

    Science.gov (United States)

    Conference: Gordon Research Conference in Atmospheric Chemistry, July 28 – August 2, 2013, VermontPresentation Type: PosterTitle: An Analysis of EPA’s STAR Program and a Decade of Field Changing Research in Atmospheric AerosolsAuthors: Kristina M. Wagstrom1,2, Sherri ...

  14. Complexities of sibling analysis when exposures and outcomes change with time and birth order

    OpenAIRE

    Sudan, M; Kheifets, LI; Arah, OA; Divan, HA; Olsen, J

    2014-01-01

    In this study, we demonstrate the complexities of performing a sibling analysis with a re-examination of associations between cell phone exposures and behavioral problems observed previously in the Danish National Birth Cohort. Children (52,680; including 5441 siblings) followed up to age 7 were included. We examined differences in exposures and behavioral problems between siblings and non-siblings and by birth order and birth year. We estimated associations between cell phone exposures and b...

  15. Situation awareness and documentation of changes that affect patient outcomes in progress notes.

    Science.gov (United States)

    Tower, Marion; Chaboyer, Wendy

    2014-05-01

    To report on registered nurses' situation awareness as a precursor to decision-making when recording changes in patients' conditions. Progress notes are important to communicate patients' progress and detail changes in patients' conditions. However, documentation is often poorly completed. There is little work that examines nurses' decision-making during documentation. This study focused on describing situation awareness as a precursor to decision-making during documentation. This study used Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) work on situation awareness to guide and conceptualise information. The study was situated in a naturalistic paradigm to provide an interpretation of nurses' decision-making. Think-aloud research methods and semi-structured interviews were employed to illuminate decision-making processes. Audio recordings and interview texts were individually examined for evidence of cues, informed by Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) descriptions of situation awareness. As patients' conditions changed, nurses used complex mental models and pattern-matching of information, drawing on all 3 levels of situation awareness during documentation. Level 1 situation awareness provided context, level 2 situation awareness signified a change in condition and its significance for the patient, and level 3 situation awareness was evident when nurses thought aloud about what this information indicated. Three themes associated with changes in patients' conditions emerged: deterioration in condition, not responding to prescribed treatments as expected and issues related to professional practice that impacted on patients' conditions. Nurses used a complex mental model for decision-making, drawing on 3 levels of situation awareness. Hamm's cognitive continuum theory, when related to situation awareness, is a useful decision-making theory to provide a

  16. PRISM, a Patient-Reported Outcome Instrument, Accurately Measures Symptom Change in Refractory Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Fuller, Garth; Bolus, Roger; Whitman, Cynthia; Talley, Jennifer; Erder, M Haim; Joseph, Alain; Silberg, Debra G; Spiegel, Brennan

    2017-03-01

    Most patients with gastroesophageal reflux disease (GERD) experience relief following treatment with proton pump inhibitors (PPIs) (Vakil et al. in Am J Gastroenterol 101:1900-1920, 2006; Everhart and Ruhl in Gastroenterology 136:376-386, 2009). As many as 17-44% of patients, however, exhibit only partial response to therapy. Most extant GERD patient-reported outcome (PRO) instruments fail to meet development best practices as described by the FDA (Talley and Wiklund in Qual Life Res 14:21-33, 2005; Van Pinxteren et al. in Cochrane Database Syst Rev 18:CD002095, 2004; El-Serag et al. in Aliment Pharmacol Ther 32:720-737, 2010). To develop and validate a PRO instrument for clinical trials involving patients with GERD who are PPI partial responders. We prepared a systematic literature review, held patient focus groups, convened an expert panel, and conducted cognitive interviews to establish content validity. Eligible participants took PPI therapy for at least 8 weeks, had undergone an upper endoscopy, and scored at least 8 points on the GerdQ [6]. Qualitative data guided development of 26 draft items. Items were reviewed by expert panels and debriefed with patients. The resulting 21-item instrument underwent psychometric evaluation during a Phase IIB trial. During the trial, confirmatory factor analysis (n = 220) resulted in a four-factor model displaying the highest goodness of fit. All domains had a high inter-item correlation (Cronbach's α > 0.8). Test-retest reliability and convergent validity were strong, with highly significant (p < 0.01) correlations between average weekly PRISM scores and severity anchors and significant (p < 0.05) correlations with anchor subscales. Cumulative distribution functions revealed significant differences between responders and non-responders. Analysis in a clinical trial setting demonstrated strong psychometric properties suggesting validity of PRISM. Developed in line with FDA guidance on PROs, PRISM represents an

  17. New Ways of Working: does flexibility in time and location of work change work behavior and affect business outcomes?

    Science.gov (United States)

    Blok, Merle M; Groenesteijn, Liesbeth; Schelvis, Roos; Vink, Peter

    2012-01-01

    In the changing modern economy some new factors have been addressed that are of importance for productivity and economic growth, such as human skills, workplace organization, information and communication technologies (ICT) and knowledge sharing. An increasing number of companies and organizations are implementing measures to better address these factors, often referred to as 'the New Ways of Working (NWW)'. This consists of a large variety of measures that enable flexibility in the time and location of work. Expectations of these measures are often high, such as a reduction in operating costs and an increase of productivity. However, scientific proof is still lacking, and it is worth asking whether al these implementations actually cause a change in work behavior and effect business outcomes positively. This article describes a case study of three departments (total of 73 employees) that changed from a traditional way of working towards a new way of working. Questionnaires and a new developed objective measurement system called 'work@task' were used to measure changes in work behavior (i.e. increased variation in work location, work times and a change towards NWW management style) and the effect on business objectives such as knowledge sharing, employees satisfaction, and collaboration.

  18. New ways of working: does flexibility in time and location of work change work behavior and affect business outcomes?

    Science.gov (United States)

    Blok, Merle M; Groenesteijn, Liesbeth; Schelvis, Roos; Vink, Peter

    2012-01-01

    In the changing modern economy some new factors have been addressed that are of importance for productivity and economic growth, such as human skills, workplace organization, information and communication technologies (ICT) and knowledge sharing. An increasing number of companies and organizations are implementing measures to better address these factors, often referred to as 'the New Ways of Working (NWW)'. This consists of a large variety of measures that enable flexibility in the time and location of work. Expectations of these measures are often high, such as a reduction in operating costs and an increase of productivity. However, scientific proof is still lacking, and it is worth asking whether al these implementations actually cause a change in work behavior and effect business outcomes positively. This article describes a case study of three departments (total of 73 employees) that changed from a traditional way of working towards a new way of working. Questionnaires and a new developed objective measurement system called 'work@task' were used to measure changes in work behavior (i.e. increased variation in work location, work times and a change towards NWW management style) and the effect on business objectives such as knowledge sharing, employees satisfaction, and collaboration.

  19. Meaningful Change Scores in the Knee Injury and Osteoarthritis Outcome Score in Patients Undergoing Anterior Cruciate Ligament Reconstruction

    DEFF Research Database (Denmark)

    Ingelsrud, Lina Holm; Terwee, Caroline B; Terluin, Berend

    2018-01-01

    BACKGROUND: Meaningful change scores in the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients undergoing anterior cruciate ligament (ACL) reconstruction have not yet been established. PURPOSE: To define the minimal important change (MIC) for the KOOS after ACL reconstruction. STUDY...... data for at least one of the KOOS subscales were obtained from 542 (45.3%) participants. Predictive modeling MIC values were 12.1 for the KOOS subscales of Sport and Recreational Function and 18.3 for Knee-Related Quality of Life. These values aid in interpreting within-group improvement over time...... and can be used as responder criteria when comparing groups. The corresponding and much lower values for the subscales of Pain (2.5), Symptoms (-1.2), and Activities of Daily Living (2.4) are the results from patients reporting, on average, only mild problems with these domains preoperatively. Although 4...

  20. Counterclockwise and Clockwise Rotation of QRS Transitional Zone: Prospective Correlates of Change and Time-Varying Associations With Cardiovascular Outcomes.

    Science.gov (United States)

    Patel, Siddharth; Kwak, Lucia; Agarwal, Sunil K; Tereshchenko, Larisa G; Coresh, Josef; Soliman, Elsayed Z; Matsushita, Kunihiro

    2017-11-03

    A few studies have recently reported clockwise and counterclockwise rotations of QRS transition zone as predictors of mortality. However, their prospective correlates and associations with individual cardiovascular disease (CVD) outcomes are yet to be investigated. Among 13 567 ARIC (Atherosclerosis Risk in Communities) study participants aged 45 to 64 years, we studied key correlates of changes in the status of clockwise and counterclockwise rotation over time as well as the association of rotation status with incidence of coronary heart disease (2408 events), heart failure (2196 events), stroke (991 events), composite CVD (4124 events), 898 CVD deaths, and 3469 non-CVD deaths over 23 years of follow-up. At baseline, counterclockwise rotation was most prevalent (52.9%), followed by no (40.5%) and clockwise (6.6%) rotation. Of patients with no rotation, 57.9% experienced counterclockwise or clockwise rotation during follow-up, with diabetes mellitus and black race significantly predicting clockwise and counterclockwise conversion, respectively. Clockwise rotation was significantly associated with higher risk of heart failure (hazard ratio, 1.20; 95% confidence interval [CI], 1.02-1.41) and non-CVD death (hazard ratio, 1.28; 95% CI, 1.12-1.46) after adjusting for potential confounders including other ECG parameters. On the contrary, counterclockwise rotation was significantly related to lower risk of composite CVD (hazard ratio, 0.93; 95% CI, 0.87-0.99]), CVD mortality (hazard ratio, 0.76; 95% CI, 0.65-0.88), and non-CVD deaths (hazard ratio, 0.92; 95% CI, 0.85-0.99 [borderline significance with heart failure]). Counterclockwise rotation, the most prevalent QRS transition zone pattern, demonstrated the lowest risk of CVD and mortality, whereas clockwise rotation was associated with the highest risk of heart failure and non-CVD mortality. These results have implications on how to interpret QRS transition zone rotation when ECG was recorded. © 2017 The Authors

  1. Patient outcomes can be associated with organizational changes: a quality improvement case study.

    Science.gov (United States)

    Timmers, Tim K; Hulstaert, Puck F; Leenen, Luke P H

    2014-01-01

    We report the results of a university surgical intensive care (SICU), which are influenced by a reorganization of the department because of a downsizing of beds with the corresponding reduction of personnel resulting in a decrease in nurse-to-bed ratio. Moreover, we report the subsequent interventions and adjustments resulting in favorable results. We performed a prospective observational cohort study of all consecutive surgical patients entering the SICU of our hospital, over the period 2000-2004. In order to meet the budget cuts, a reduction of number of SICU beds with a corresponding reduction of nursing staff was implemented. In the subsequent period culminating on the year 2002, collaboration problems arose between medical and nursing staff: resulting in fierce discussions on the floor. Supported through external mediators, structures/work ethics/communication/collaborative behavior, and organization of the SICU were reviewed and restructured. A total of 1477 patients were admitted to the SICU. The characteristics, Acute Physiology and Chronic Health Evaluation II score and therapeutic intervention scoring system points, were not different throughout the years. The intensive care unit-length of stay (ICU-LOS) in the admission year 2002 was significantly longer (P = .001) and the crude ICU mortality was higher (P = .02) compared with the 2 admission years before. The adjusted mortality (ICU standardized mortality ratio) was also worse in 2002, however, statistically not different. After the intervention (2003 and 2004), a better result (crude ICU mortality, length of ICU stay, and ICU standardized mortality ratio) was achieved. Intensive care reorganization, in which higher workload is seen in medical and nursing staff, could have a negative effect on ICU outcome and length of ICU stay. Interventions in ICU structures, communication, work ethics, and organization have a positive impact in conflict management.

  2. Changes in depression mediate the effects of AA attendance on alcohol use outcomes.

    Science.gov (United States)

    Wilcox, Claire E; Tonigan, J Scott

    2018-01-01

    Depression may contribute to increased drinking in individuals with alcohol use disorder. Although Alcoholics Anonymous (AA) attendance predicts drinking reductions, there is conflicting information regarding the intermediary role played by reductions in depression. We explored whether AA attendance reduces depressive symptoms, the degree to which improvement in depression results in reductions in drinking, and in which subgroups these effects occur. 253 early AA affiliates (63% male) were recruited and assessed at baseline 3, 6, 9, 12, 18, and 24 months. Depression was measured using the Beck Depression Inventory (BDI) and was administered at baseline 3, 6, 12, 18, and 24 months. AA attendance and alcohol use outcomes were obtained with the Form 90. Mediation analyses were performed at early (3, 6, and 9 months) and late (12, 18, and 24 months) follow-up to investigate the degree to which reductions in depression mediated the effect of AA attendance on drinking, controlling for concurrent drinking. In addition, a series of moderated mediation analyses were performed using baseline depression severity as a moderator. At early follow-up, reductions in depression (6 months) mediated the effects of AA attendance (3 months) on later drinking (drinks per drinking day) (9 months) (b = -0.02, boot CI [-0.055, -0.0004]), controlling for drinking at 6 months. Baseline depression severity did not moderate the degree to which BDI mediated the effects of AA attendance on alcohol use (ps > .05). These findings provide further evidence that depression reduction is a mechanism by which AA attendance leads to reductions in alcohol use. Improving depression may help reduce alcohol use in individuals with AUD, and AA attendance may be an effective way to achieve that goal.

  3. Changes in case-mix and outcomes of critically ill patients in an Australian tertiary intensive care unit.

    Science.gov (United States)

    Williams, T A; Ho, K M; Dobb, G J; Finn, J C; Knuiman, M W; Webb, S A R

    2010-07-01

    Critical care service is expensive and the demand for such service is increasing in many developed countries. This study aimed to assess the changes in characteristics of critically ill patients and their effect on long-term outcome. This cohort study utilised linked data between the intensive care unit database and state-wide morbidity and mortality databases. Logistic and Cox regression was used to examine hospital survival and five-year survival of 22,298 intensive care unit patients, respectively. There was a significant increase in age, severity of illness and Charlson Comorbidity Index of the patients over a 16-year study period. Although hospital mortality and median length of intensive care unit and hospital stay remained unchanged, one- and five-year survival had significantly improved with time, after adjusting for age, gender; severity of illness, organ failure, comorbidity, 'new' cancer and diagnostic group. Stratified analyses showed that the improvement in five-year survival was particularly strong among patients admitted after cardiac surgery (P = 0.001). In conclusion, although critical care service is increasingly being provided to patients with a higher severity of acute and chronic illnesses, long-term survival outcome has improved with time suggesting that critical care service may still be cost-effectiveness despite the changes in case-mix.

  4. Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people.

    Science.gov (United States)

    McCormack, Brendan; Dewing, Jan; Breslin, Liz; Coyne-Nevin, Ann; Kennedy, Kate; Manning, Mary; Peelo-Kilroe, Lorna; Tobin, Catherine; Slater, Paul

    2010-06-01

    To present the nursing outcomes from the evaluation of developments in the care environment in residential settings for older people. The evaluation data reported here is derived from a larger national programme of work that focused on the development of person-centred practice in residential services for older people using an emancipatory practice development framework. A multi-method evaluation framework was utilised. Outcome data were collected at three time points between December 2007 and September 2009. The data reported here were collected using an instrument called the 'Person-Centred Nursing Index'. Heavy workload was the main cause of stress among nurses. Personal and professional satisfaction with the job was scored highest by the total sample of nurses. Nineteen factors were examined using the Person-Centred Nursing Index. Statistically significant changes were observed in 12 of these. In addition, there were statistically significant changes in nurses' perceptions of caring, indicating a shift from a dominant focus on 'technical' aspects of care, to one where 'intimate' aspects of care were more highly valued. The findings highlight the importance of the development of effective teamwork, workload management, time management and staff relationships in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person-centred relationships. © 2010 Blackwell Publishing Ltd.

  5. Brain metabolite alterations in infants born preterm with intrauterine growth restriction: association with structural changes and neurodevelopmental outcome.

    Science.gov (United States)

    Simões, Rui V; Muñoz-Moreno, Emma; Cruz-Lemini, Mónica; Eixarch, Elisenda; Bargalló, Núria; Sanz-Cortés, Magdalena; Gratacós, Eduard

    2017-01-01

    Intrauterine growth restriction and premature birth represent 2 independent problems that may occur simultaneously and contribute to impaired neurodevelopment. The objective of the study was to assess changes in the frontal lobe metabolic profiles of 1 year old intrauterine growth restriction infants born prematurely and adequate-for-gestational-age controls, both premature and term adequate for gestational age and their association with brain structural and biophysical parameters and neurodevelopmental outcome at 2 years. A total of 26 prematurely born intrauterine growth restriction infants (birthweight intrauterine growth restriction infants had slightly smaller brain volumes and increased frontal lobe white matter mean diffusivity compared with both prematurely born but adequate for gestational age and term adequate for gestational age controls. Frontal lobe N-acetylaspartate levels were significantly lower in prematurely born intrauterine growth restriction than in prematurely born but adequate for gestational age infants but increased in prematurely born but adequate for gestational age compared with term adequate-for-gestational-age infants. The prematurely born intrauterine growth restriction group also showed slightly lower choline compounds, borderline decrements of estimated glutathione levels, and increased myoinositol to choline ratios, compared with prematurely born but adequate for gestational age controls. These specific metabolite changes were locally correlated to lower gray matter content and increased mean diffusivity and reduced white matter fraction and fractional anisotropy. Prematurely born intrauterine growth restriction infants also showed a tendency for poorer neurodevelopmental outcome at 2 years, associated with lower levels of frontal lobe N-acetylaspartate at 1 year within the preterm subset. Preterm intrauterine growth restriction infants showed altered brain metabolite profiles during a critical stage of brain maturation, which

  6. Complexities of sibling analysis when exposures and outcomes change with time and birth order

    NARCIS (Netherlands)

    Sudan, Madhuri; Kheifets, Leeka I.; Arah, Onyebuchi A.; Divan, Hozefa A.; Olsen, Jørn

    2014-01-01

    In this study, we demonstrate the complexities of performing a sibling analysis with a re-examination of associations between cell phone exposures and behavioral problems observed previously in the Danish National Birth Cohort. Children (52,680; including 5441 siblings) followed up to age 7 were

  7. The effects of training in time-limited dynamic psychotherapy: changes in therapeutic outcome.

    Science.gov (United States)

    Bein, E; Anderson, T; Strupp, H; Henry, W; Schacht, T; Binder, J; Butler, S

    2000-02-01

    The present study explored the effects on therapeutic outcomes of training therapists in brief manualized therapy. As part of the Vanderbilt II project, each of 16 therapists (8 psychiatrists and 8 clinical psychologists) treated 2 moderately disturbed adult patients using his or her customary short-term treatment methods; they then received a year of training in a manualized form of brief dynamic therapy, Time-Limited Dynamic Psychotherapy (TLDP); finally, they administered TLDP to 2 additional patients. It was hypothesized that training would result in improved outcomes generally and that differentially greater improvement would be seen in patients commonly considered less suitable for brief dynamic therapy. Outcome data obtained at termination failed to support either hypothesis. Measurements of interpersonal dependency obtained at a one-year follow-up were consistent with the first hypothesis, but the follow-up data were inconsistent with the second. A systematic review of the 32 posttraining cases suggested that the majority of the therapists had not achieved basic competence at TLDP. Die hier beschriebene Studie untersucht die Wirkungen eines Trainings in manualisierter Kurzzeitherapie auf das Therapierergebnis. Als Teil des Vanderbilt II Projektes behandelten jeweils 16 Therapeuten (8 Psychiater und 8 klinische Psychologen) zwei mittelgradig beeinrächtigte erwachsene Patienten mit den ihnen vertrauten Kurzzeitbehandlungsmethoden. Danach wurden sie über ein Jahr in einer manualisierten Form psychodynamischer Kurzzeittherapie ausgebildet und wandten diese Therapie auf zwei weitere Patienten an. Es wurde angenommen, dass die Ausbildung in besseren Ergebnisdaten, die bei Ende der Therapie erhoben wurden, konnten diese Hypothese nicht bestätigen. Maße für die interpersonale Abhängigkeit zu einem Einjahreskatamnesezeitpunkt waren mit der ersten Hypothese konform, aber inkonsistent mit der zweiten. Eine systematische Untersuchung der 32 nach der Ausbildung

  8. Can community change be measured for an outcomes-based initiative? A comparative case study of the success by 6 initiative.

    Science.gov (United States)

    Minich, Lisa; Howe, Steven; Langmeyer, Daniel; Corcoran, Kevin

    2006-12-01

    One of the challenges facing nonprofit organizations today is the demand for measurable results. Increasingly, these organizations are focusing less on program outputs and program outcomes in favor of community outcomes or changes demonstrated in the larger community. Success by 6(R) is a popular United Way initiative that emphasizes defining and measuring community outcomes. In this paper, we describe our work with 24 Success by 6(R) initiatives around the country. It is clear that not all of these initiatives are measuring community outcomes. Of those initiatives that are experiencing some success measuring community outcomes, similar measurement strategies are reported. Additionally, our experience suggests several United Way employees express dissatisfaction with the logic model as a framework for defining and measuring community outcomes although no preferred alternative model is identified. Evaluators working with community-wide initiatives must find ways to communicate the differences between program and community outcomes to key stakeholders and funders.

  9. Shape of the self-concept clarity change during group psychotherapy predicts the outcome: An empirical validation of the theoretical model of the self-concept change

    Directory of Open Access Journals (Sweden)

    Rafał eStyła

    2015-10-01

    Full Text Available Background: Self-concept clarity describes the extent to which the schemas of the self are internally integrated, well defined, and temporally stable. This article presents a theoretical model that describes how different shapes of self-concept clarity change (especially stable increase and V shape observed in the course of psychotherapy are related to the therapy outcome. Linking the concept of Jean Piaget and the dynamic systems theory, the study postulates that a stable self-concept clarity increase is needed for the participants with a rather healthy personality structure, while self-concept clarity change characterized by a V shape or fluctuations is optimal for more disturbed patients. Method: Correlational study in a naturalistic setting with repeated measurements (M=5.8 was conducted on the sample of 85 patients diagnosed with neurosis and personality disorders receiving intensive eclectic group psychotherapy under routine inpatient conditions. Participants filled in the Self-Concept Clarity Scale, Symptoms’ Questionnaire KS-II, and Neurotic Personality Questionnaire KON-2006 at the beginning and at the end of the course of psychotherapy. The Self-Concept Clarity Scale was also administered every two weeks during psychotherapy. Results: As hypothesized, among the relatively healthiest group of patients the stable self-concept clarity increase was related to positive treatment outcome, while more disturbed patients benefited from the fluctuations and V shape of self-concept clarity change. Conclusions: The findings support the idea that for different personality dispositions either a monotonic increase or transient destabilization of self-concept clarity is a sign of a good treatment prognosis.

  10. Who will be sicker in the morning? Changes in the Simple Clinical Score the day after admission and the subsequent outcomes of acutely ill unselected medical patients.

    LENUS (Irish Health Repository)

    Kellett, John

    2011-08-01

    All doctors are haunted by the possibility that a patient they reassured yesterday will return seriously ill tomorrow. We examined changes in the Simple Clinical Score (SCS) the day after admission, factors that might influence these changes and the relationship of these changes to subsequent clinical outcome.

  11. Treatment of Chronic Pain for Adults 65 and Over: Analyses of Outcomes and Changes in Psychological Flexibility Following Interdisciplinary Acceptance and Commitment Therapy (ACT).

    Science.gov (United States)

    Scott, Whitney; Daly, Aisling; Yu, Lin; McCracken, Lance M

    2017-02-01

    The purpose of this study was to examine the effectiveness of acceptance and commitment therapy (ACT) for older adults with chronic pain. Secondarily, we examined the associations between changes on processes of psychological flexibility and treatment outcome variables. Participants were 60 adults with chronic pain age 65 and older selected from a larger consecutive sample of 928 adults of any age. All participants had longstanding pain that was associated with significant distress and disability. Participants completed measures of pain, functioning, and depression, and processes of psychological flexibility at baseline, immediately post-treatment, and at a 9-month follow-up. Treatment consisted of a 2- or 4-week residential program based on principles of ACT delivered by an interdisciplinary team. Treatment was designed to increase daily functioning by enhancing key processes of psychological flexibility, including openness, awareness, and committed action. Participants showed significant improvements in functioning and mental health at posttreatment. Participants also showed significant increases in pain acceptance and committed action from pre- to post-treatment. Small effect sizes were observed for most treatment outcome and process variables in the pre-treatment to follow-up intervals; however, these improvements were not statistically significant. In secondary analyses, changes in facets of psychological flexibility were significantly associated with improvements in social functioning and mental health. This study supports the potential effectiveness of ACT for chronic pain among older adults. Future research is needed to determine how to maximize the impact of this treatment, particularly through greater impact on psychological flexibility.

  12. Report of two patients with Paget′s disease - one with typical clinical and radiological manifestations including cardiac involvement and the other subclinical but with radiological changes

    Directory of Open Access Journals (Sweden)

    B Sivapatha Sundharam

    2006-01-01

    Full Text Available Osteitis deformans or Paget′s disease of bone, fondly referred to as the ′collage of matrix madness′, is a unique skeletal disease characterized by furious osteoclastic bone resorption followed by a period of hectic bone formation, resulting in again in the bone mass wherein the newly formed bone is disordered and architecturally unsound. A disease of obscure etiology, it usually manifests as progressive enlargement of one or multiple bones of the skeleton. Herewith we present a typical example of a polyostotic form of Paget′s disease with classical clinical features and radiologic changes in one patient and a subclinical form of Paget′s disease with marked radiological changes in the other patient.

  13. Pulmonary response to surface‐coated nanotitanium dioxide particles includes induction of acute phase response genes, inflammatory cascades, and changes in microRNAs: A toxicogenomic study

    DEFF Research Database (Denmark)

    Halappanavar, Sabina; Jackson, Petra; Williams, Andrew

    2011-01-01

    with acute phase, inflammation and immune response 5 days post exposure with concomitant changes in several miRNAs. The role of these miRNAs in pulmonary response to inhaled particles is unknown and warrants further research. Environ. Mol. Mutagen., 2011. © 2011 Wiley‐Liss, Inc....... in increased levels of mRNA for acute phase markers serum amyloid A‐1 (Saa1) and serum amyloid A‐3 (Saa3), several C‐X‐C and C‐C motif chemokines, and cytokine tumor necrosis factor genes. Protein analysis of Saa1 and 3 showed selective upregulation of Saa3 in lung tissues. Sixteen miRNAs were induced by more...... than 1.2‐fold (adjusted P‐value changes in the expression of genes associated...

  14. From coexistence to competitive exclusion: can overfishing change the outcome of competition in skates (Chondrichthyes, Rajidae?

    Directory of Open Access Journals (Sweden)

    Natalia L Ruocco

    2012-03-01

    Full Text Available Competition for food could be a major force driving changes in the community structure of skates (Rajidae subjected to fishing exploitation. Under this hypothesis, small skates are released from competition with larger skates after fishing has depleted the larger species. Here, we compare the abundance patterns of two sympatric skates with similar niches but different life histories, Bathyraja albomaculata (larger and slow-reproducing and Bathyraja macloviana (smaller and faster-reproducing, before (1971, 1978 and after (1998-2004 a 108% increase in industrial bottom trawling on the southeastern South American shelf in order to test the prediction that B. macloviana should competitively exclude B. albomaculata after the increase in fishing mortality. In 1971 and 1978, there was no relationship between the abundance of both species, indicating that they coexisted over large scales. In 1998-2004, the relationship between the abundances of these skates was bell-shaped, indicating that both species increased in abundance at low densities until peaking, after which B. albomaculata decreased when B. macloviana became more abundant, consistent with resource competition. We tested whether food may be a potential limiting resource by comparing the diet of both species. The two species consumed mostly polychaetes, differing only in the consumption of polychaetes from the family Nephthyidae, which was much higher for B. macloviana. Bathyraja macloviana could replace B. albomaculata at high densities when food resources may become scarce. These results support the hypothesis that competition release is an important factor explaining the changes in skate communities in overexploited areas.

  15. Volumetric changes and clinical outcome for petroclival meningiomas after primary treatment with Gamma Knife radiosurgery.

    Science.gov (United States)

    Sadik, Zjiwar H A; Lie, Suan Te; Leenstra, Sieger; Hanssens, Patrick E J

    2018-01-26

    OBJECTIVE Petroclival meningiomas (PCMs) can cause devastating clinical symptoms due to mass effect on cranial nerves (CNs); thus, patients harboring these tumors need treatment. Many neurosurgeons advocate for microsurgery because removal of the tumor can provide relief or result in symptom disappearance. Gamma Knife radiosurgery (GKRS) is often an alternative for surgery because it can cause tumor shrinkage with improvement of symptoms. This study evaluates qualitative volumetric changes of PCM after primary GKRS and its impact on clinical symptoms. METHODS The authors performed a retrospective study of patients with PCM who underwent primary GKRS between 2003 and 2015 at the Gamma Knife Center of the Elisabeth-Tweesteden Hospital in Tilburg, the Netherlands. This study yields 53 patients. In this study the authors concentrate on qualitative volumetric tumor changes, local tumor control rate, and the effect of the treatment on trigeminal neuralgia (TN). RESULTS Local tumor control was 98% at 5 years and 93% at 7 years (Kaplan-Meier estimates). More than 90% of the tumors showed regression in volume during the first 5 years. The mean volumetric tumor decrease was 21.2%, 27.1%, and 31% at 1, 3, and 6 years of follow-up, respectively. Improvement in TN was achieved in 61%, 67%, and 70% of the cases at 1, 2, and 3 years of follow-up, respectively. This was associated with a mean volumetric tumor decrease of 25% at the 1-year follow-up to 32% at the 3-year follow-up. CONCLUSIONS GKRS for PCMs yields a high tumor control rate with a low incidence of neurological deficits. Many patients with TN due to PCM experienced improvement in TN after radiosurgery. GKRS achieves significant volumetric tumor decrease in the first years of follow-up and thereafter.

  16. Interval Changes in Myocardial Performance Index Predict Outcome in Severe Sepsis.

    Science.gov (United States)

    Nizamuddin, Junaid; Mahmood, Feroze; Tung, Avery; Mueller, Ariel; Brown, Samuel M; Shaefi, Shahzad; O'Connor, Michael; Talmor, Daniel; Shahul, Sajid

    2017-06-01

    Septic cardiomyopathy is a well-described consequence of septic shock and is associated with increased sepsis-related mortality. The myocardial performance index (MPI), a parameter derived from echocardiographic tissue Doppler measurements, allows for a more sensitive assessment of global cardiac function than do traditional metrics for cardiac function. The authors hypothesized that changes in left ventricular MPI in patients with severe sepsis would be associated with a higher 90-day mortality. Prospective, observational study. Intensive care units of a tertiary medical center. The study comprised 47 patients admitted with new diagnoses of severe sepsis or septic shock. All patients underwent transthoracic echocardiograms with assessment of MPI at enrollment and 24 hours later. Hemodynamic data and information on sepsis-related mortality were collected. In the primary analysis, the association between change in MPI from enrollment to 24 hours and sepsis-related 90-day mortality was assessed. Of the 47 patients enrolled, 30 demonstrated an improvement in MPI from 0 to 24 hours ("improved" group), and MPI worsened in the remaining 17 patients ("worsened" group). Despite no significant differences in ejection fraction or severity of illness, the median MPI at enrollment in the "improved" group was higher than baseline values in the "worsened" group (p = 0.005). A worsening MPI over the 24-hour study interval was associated with increased mortality at 90 days (p = 0.04), which remained significant (hazard ratio 3.72; 95% confidence interval 1.12-12.41; p = 0.03) after adjusting for severity of illness (Acute Physiology and Chronic Health Evaluation II score), intravenous fluids, and vasopressor use. In patients admitted to the intensive care unit with a diagnosis of severe sepsis or septic shock, a worsening MPI during the first 24 hours after intensive care unit admission was associated with higher 90-day mortality. Copyright © 2017 Elsevier Inc. All rights

  17. Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes.

    Science.gov (United States)

    Yalcin, E; Keskin Akca, A; Selcuk, B; Kurtaran, A; Akyuz, M

    2012-02-01

    Plantar heel pain, a chronic and disabling foot alignment, occurs in the adult population. Extracorporal shock wave therapy (ESWT) offers a nonsurgical option in addition to stretching exercises, heel cups, NSAI, and corticosteroid injections. This study aimed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes. The study involved 108 patients with heel pain and radiologically diagnosed heel spurs. All patients underwent ESWT once a week for 5 weeks at the clinic. Each patient received 2,000 impulses of shock waves, starting with 0.05 mJ/mm2 (1.8 bar) and increasing to 0.4 mJ/mm2 (4.0 bar). Standard radiographies of the affected heels were obtained before and after the therapy. Clinical results demonstrated excellent (no pain) in 66.7% of the cases, good (50% of pain reduced) in 15.7% of the cases, and unsatisfactory (no reduction in pain) in 17.6%. After five ESWT treatments, no patients who received shock wave applications had significant spur reductions, but 19 patients (17.6%) had a decrease in the angle of the spur, 23 patients (21.3%) had a decrease in the dimensions of the spur, and one patient had a broken spur. Therefore, results showed no correlation between clinical outcome and radiologic changes. The present study supports the finding that even with no radiologic change after ESWT therapy, the therapy produces significant effects in reducing patients' complaints about heel spurs.

  18. Complexities of sibling analysis when exposures and outcomes change with time and birth order.

    Science.gov (United States)

    Sudan, Madhuri; Kheifets, Leeka I; Arah, Onyebuchi A; Divan, Hozefa A; Olsen, Jørn

    2014-01-01

    In this study, we demonstrate the complexities of performing a sibling analysis with a re-examination of associations between cell phone exposures and behavioral problems observed previously in the Danish National Birth Cohort. Children (52,680; including 5441 siblings) followed up to age 7 were included. We examined differences in exposures and behavioral problems between siblings and non-siblings and by birth order and birth year. We estimated associations between cell phone exposures and behavioral problems while accounting for the random family effect among siblings. The association of behavioral problems with both prenatal and postnatal exposure differed between siblings (odds ratio (OR): 1.07; 95% confidence interval (CI): 0.69-1.66) and non-siblings (OR: 1.54; 95% CI: 1.36-1.74) and within siblings by birth order; the association was strongest for first-born siblings (OR: 1.72; 95% CI: 0.86-3.42) and negative for later-born siblings (OR: 0.63; 95% CI: 0.31-1.25), which may be because of increases in cell phone use with later birth year. Sibling analysis can be a powerful tool for (partially) accounting for confounding by invariant unmeasured within-family factors, but it cannot account for uncontrolled confounding by varying family-level factors, such as those that vary with time and birth order.

  19. Impacts of Climate Change and of Anthropisation on Water Resources: from the Risk Assessment to Adaptation, the Case of the Seine Basin (including Paris, France)

    Science.gov (United States)

    Habets, F.; Viennot, P.; Thierion, C.; Vergnes, J. P.; Ait Kaci, A.; Caballero, Y.

    2015-12-01

    The Seine river, located in the temperate climate of northern France and flowing over a large sedimentary basins that hosts multilayer aquifers, is characterized by small temporal variations of its discharge. However, the presence of a megacity (Paris) and a wide area of intensive agriculture combined with climate change puts pressure on the water resources both in terms of quality and quantity. Previous research projects have estimated the impact of climate change on the water resource of the Seine basin, with the uncertainties associated to climate projections, hydrological models or downscaling methods. The water resource was projected to decrease by -14 % ± 10 % in 2050 and -28 +/-16% in 2100. This led to new studies that focus on the combined impact of climate change and adaptations. The tested adaptations are: a reduction of the groundwater abstractions, evolution of land use, development of small dams to « harvest water » or artificial recharge of aquifers. The communication of the results of these projects to stakeholders have led to the development on new indicators that better express the risk on the water resource management, especially for the groundwater. For instance maps of the evolution of piezometric head are difficult to interpret. To better express the risk evolution, a new indicator was defined: the evolution of the groundwater crisis duration, ie, the period when the charge of the aquifer is below the crisis piezometric level defined by the stakeholders. Such crisis piezometric levels are used to help defining the period when the groundwater abstraction should be reduced. Such maps are more efficient to communicate with water resources managers. This communication will focus on the results from the MEDDE Explore 2070 and ANR Oracle projects.

  20. The changing contexts of fertility outcomes: case studies from a remote village in Bali, Indonesia.

    Science.gov (United States)

    Withers, Mellissa; Browner, Carole H

    2012-01-01

    In the context of ready access to contraceptives, we sought to determine which individual and socio-cultural factors were most important in the dramatic fertility decline seen in an impoverished rural Balinese community. The study built on a 2002 longitudinal survey of 1528 Balinese reproductive-age married women that four years later found a significant proportion did not meet their expressed fertility aspirations. Four case studies of women whose expressed fertility intentions evolved over the study period are described. Culturally specific contextual factors (notably son preference), in interaction with increasing poverty, helped explained when and why their expressed fertility intentions changed. Moreover, many categorized in the second survey as not having meet their previously reported fertility aspirations were, in fact, intentionally spacing births. Although many women opted for smaller families than they actually wanted, and a decades-long, aggressive, two-child government campaign helped make them socially acceptable, contraception enabled the women to engage in strategic birth planning. We conclude that it is unrealistic to expect women in such settings, or indeed any setting, to give meaningful answers to questions in demographic surveys regarding future fertility aspirations.

  1. Species management benchmarking: outcomes over outputs in a changing operating environment.

    Science.gov (United States)

    Hogg, Carolyn J; Hibbard, Chris; Ford, Claire; Embury, Amanda

    2013-03-01

    Species management has been utilized by the zoo and aquarium industry, since the mid-1990s, to ensure the ongoing genetic and demographic viability of populations, which can be difficult to maintain in the ever-changing operating environments of zoos. In 2009, the Zoo and Aquarium Association Australasia reviewed their species management services, focusing on addressing issues that had arisen as a result of the managed programs maturing and operating environments evolving. In summary, the project examined resourcing, policies, processes, and species to be managed. As a result, a benchmarking tool was developed (Health Check Report, HCR), which evaluated the programs against a set of broad criteria. A comparison of managed programs (n = 98), between 2008 and 2011, was undertaken to ascertain the tool's effectiveness. There was a marked decrease in programs that were designated as weak (37 down to 13); and an increase in excellent programs (24 up to 49) between the 2 years. Further, there were significant improvements in the administration benchmarking area (submission of reports, captive management plan development) across a number of taxon advisory groups. This HCR comparison showed that a benchmarking tool enables a program's performance to be quickly assessed and any remedial measures applied. The increases observed in program health were mainly due to increased management goals being attained. The HCR will be an ongoing program, as the management of the programs increases and goals are achieved, criteria will be refined to better highlight ongoing issues and ways in which these can be resolved. © 2012 Wiley Periodicals, Inc.

  2. Accounting for the risk of extreme outcomes in an integrated assessment of climate change

    International Nuclear Information System (INIS)

    Gerst, Michael D.; Howarth, Richard B.; Borsuk, Mark E.

    2010-01-01

    The potential for climate catastrophes, represented by 'fat-tailed' distributions on consequences, has attracted much attention recently. To date, however, most integrated assessment models have either been largely deterministic or deterministic with ex-post sensitivity analysis. The conclusions of such analyses are likely to differ from those employing models that accurately characterize society's joint preferences concerning time and risk, especially when distributions are fat-tailed. Using a dynamic stochastic general equilibrium model adapted from Nordhaus's DICE model, we show that failing to accurately account for risk can lead to substantial underestimation of the net benefits of greenhouse gas abatement. A robust finding of our analysis is that a lenient 'policy ramp' emissions reduction strategy is preferable over a more aggressive strategy-such as that advocated by the Stern Review-only if the model does not account for uncertainty about the climate system, the carbon cycle and economic damages, and specifies a consumption discount rate that is counterfactually higher than the historical global weighted average cost of capital of 4.0%. In the debate over uncertainty and time discounting, our results imply that what matters most in climate change assessment is the inclusion and particular specification of uncertainty rather than the precise choice of discount rate.

  3. Analytic 1D pn junction diode photocurrent solutions following ionizing radiation and including time-dependent changes in the carrier lifetime.

    Energy Technology Data Exchange (ETDEWEB)

    Axness, Carl L.; Keiter, Eric Richard; Kerr, Bert (New Mexico Tech, Socorro, NM)

    2011-04-01

    Circuit simulation tools (e.g., SPICE) have become invaluable in the development and design of electronic circuits in radiation environments. These codes are often employed to study the effect of many thousands of devices under transient current conditions. Device-scale simulation tools (e.g., MEDICI) are commonly used in the design of individual semiconductor components, but require computing resources that make their incorporation into a circuit code impossible for large-scale circuits. Analytic solutions to the ambipolar diffusion equation, an approximation to the carrier transport equations, may be used to characterize the transient currents at nodes within a circuit simulator. We present new transient 1D excess carrier density and photocurrent density solutions to the ambipolar diffusion equation for low-level radiation pulses that take into account a finite device geometry, ohmic fields outside the depleted region, and an arbitrary change in the carrier lifetime due to neutron irradiation or other effects. The solutions are specifically evaluated for the case of an abrupt change in the carrier lifetime during or after, a step, square, or piecewise linear radiation pulse. Noting slow convergence of the raw Fourier series for certain parameter sets, we use closed-form formulas for some of the infinite sums to produce 'partial closed-form' solutions for the above three cases. These 'partial closed-form' solutions converge with only a few tens of terms, which enables efficient large-scale circuit simulations.

  4. Electrocardiographic changes associated with smoking and smoking cessation: outcomes from a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Adam D Gepner

    Full Text Available Cardiovascular disease (CVD can be detected and quantified by analysis of the electrocardiogram (ECG; however the effects of smoking and smoking cessation on the ECG have not been characterized.Standard 12-lead ECGs were performed at baseline and 3 years after subjects enrolled in a prospective, randomized, placebo-controlled clinical trial of smoking cessation pharmacotherapies. ECGs were interpreted using the Minnesota Code ECG Classification. The effects of (i smoking burden on the prevalence of ECG findings at baseline, and (ii smoking and smoking cessation on ECG changes after 3 years were investigated by multivariable and multinomial regression analyses.At baseline, 532 smokers were (mean [SD] 43.3 (11.5 years old, smoked 20.6 (7.9 cigarettes/day, with a smoking burden of 26.7 (18.6 pack-years. Major and minor ECG criteria were identified in 87 (16.4% and 131 (24.6% of subjects, respectively. After adjusting for demographic data and known CVD risk factors, higher pack-years was associated with major ECG abnormalities (p = 0.02, but current cigarettes/day (p = 0.23 was not. After 3 years, 42.9% of subjects were abstinent from smoking. New major and minor ECG criteria were observed in 7.2% and 15.6% of subjects respectively, but in similar numbers of abstinent subjects and continuing smokers (p>0.2 for both. Continuing smokers showed significant reduction in current smoking (-8.4 [8.8] cigarettes/day, p<0.001 compared to baseline.In conclusion, major ECG abnormalities are independently associated with lifetime smoking burden. After 3 years, smoking cessation was not associated with a decrease in ECG abnormalities, although cigarettes smoked/day decreased among continuing smokers.

  5. Drivers of soil organic matter vulnerability to climate change, Part II: RothC modelling of carbon dynamics including radiocarbon data

    Science.gov (United States)

    Studer, Mirjam S.; Abiven, Samuel; González Domínguez, Beatriz R.; Hagedorn, Frank; Reisser, Moritz; Walthert, Lorenz; Zimmermann, Stephan; Niklaus, Pascal A.

    2016-04-01

    It is still largely unknown what drives the vulnerability of soil organic carbon (SOC) stocks to climate change, i.e. the likelihood of a soil to loose its SOC along with the change in environmental conditions. Our objective is to assess the SOC vulnerability of Swiss forest soils and identify its potential drivers: climate (temperature, soil moisture), soil (clay content, pH) and landscape (slope, aspect) properties. Fifty-four sites were selected for balanced spatial and driver magnitudes distribution. We measured the SOC characteristics (content and radiocarbon) and studied the C decomposition by laboratory soil incubations (details in Part I, abstract by B. González Domínguez). In order to assess the current SOC pool distribution and its radiocarbon signatures, we extended the Rothamsted Carbon (RothC) model with radiocarbon (14C) isotope modelling (RothCiso). The RothC model distinguishes four active SOC pools, decomposable and resistant plant material, microbial biomass and humified organic matter, and an inert SOC pool (Jenkinson 1990). The active pools are decomposed and mineralized to CO2 by first order kinetics. The RothCiso assigns all pools a 14C signature, based on the atmospheric 14C concentrations of the past century (plant C inputs) and their turnover. Currently we constrain the model with 14C signatures measured on the 54 fresh and their corresponding archived bulk soil samples, taken 12-24 years before. We were able to reproduce the measured radiocarbon concentrations of the SOC with the RothCiso and first results indicate, that the assumption of an inert SOC pool, that is radiocarbon dead, is not appropriate. In a second step we will compare the SOC mean residence time assessed by the two methodological approaches - incubation (C efflux based) and modelling (C stock based) - and relate it to the environmental drivers mentioned above. With the combination of the two methodological approaches and 14C analysis we hope to gain more insights into

  6. Health locus of control in patients undergoing coronary artery surgery - changes and associated outcomes: a seven-year cohort study.

    Science.gov (United States)

    Rideout, Andrew; Tolmie, Elizabeth; Lindsay, Grace

    2017-01-01

    Health locus of control is a measure of an individual's beliefs in factors that are thought to determine health experiences. Scores are generated and form a graduated linear scale from external to internal control, with respect to their views on health causality. Health locus of control has been considered to be a relatively stable entity. However, it is not clear if this status changes in the advent of serious health challenges, such as coronary artery bypass graft surgery. The aim of this study is to explore the variability of health locus of control and its association with postoperative health in this context. In a longitudinal cohort study of patients undergoing coronary artery bypass graft surgery, a purposive sample ( n=215) were recruited from the waiting list and followed up postoperatively, at approximately one year and seven years later. Patients undergoing coronary artery bypass graft surgery demonstrated marked fluctuations in health locus of control in their peri-operative and rehabilitative phases. Mean health locus of control became more external (often associated with poorer outcomes) peri-operatively, and more internal (generally associated with better health outcomes) in the rehabilitative period. Health locus of control scores were shown to be changeable during a major health care intervention, with possible consequences for patient outcomes and care needs. The significant health belief upheaval demonstrated in this cohort should be considered in assessing patients preoperatively, and managed as part of the patients' clinical journey by both acute and rehabilitation staff. It is likely to have particular importance in individualised assessment and management of future prevention advice for patients.

  7. Analysis of the impact of climate change on groundwater related hydrological fluxes: a multi-model approach including different downscaling methods

    Directory of Open Access Journals (Sweden)

    S. Stoll

    2011-01-01

    Full Text Available Climate change related modifications in the spatio-temporal distribution of precipitation and evapotranspiration will have an impact on groundwater resources. This study presents a modelling approach exploiting the advantages of integrated hydrological modelling and a broad climate model basis. We applied the integrated MIKE SHE model on a perialpine, small catchment in northern Switzerland near Zurich. To examine the impact of climate change we forced the hydrological model with data from eight GCM-RCM combinations showing systematic biases which are corrected by three different statistical downscaling methods, not only for precipitation but also for the variables that govern potential evapotranspiration. The downscaling methods are evaluated in a split sample test and the sensitivity of the downscaling procedure on the hydrological fluxes is analyzed. The RCMs resulted in very different projections of potential evapotranspiration and, especially, precipitation. All three downscaling methods reduced the differences between the predictions of the RCMs and all corrected predictions showed no future groundwater stress which can be related to an expected increase in precipitation during winter. It turned out that especially the timing of the precipitation and thus recharge is very important for the future development of the groundwater levels. However, the simulation experiments revealed the weaknesses of the downscaling methods which directly influence the predicted hydrological fluxes, and thus also the predicted groundwater levels. The downscaling process is identified as an important source of uncertainty in hydrological impact studies, which has to be accounted for. Therefore it is strongly recommended to test different downscaling methods by using verification data before applying them to climate model data.

  8. An integrated view of molecular changes, histopathology and outcomes in kidney transplants.

    Science.gov (United States)

    Halloran, P F; de Freitas, D G; Einecke, G; Famulski, K S; Hidalgo, L G; MengeL, M; Reeve, J; Sellares, J; Sis, B

    2010-10-01

    Data-driven approaches to deteriorating kidney transplants, incorporating histologic, molecular and HLA antibody findings, have created a new understanding of transplant pathology and why transplants fail. Transplant dysfunction is best understood in terms of three elements: diseases, the active injury-repair response and the cumulative burden of injury. Progression to failure is mainly attributable to antibody-mediated rejection, nonadherence and glomerular disease. Antibody-mediated rejection usually develops late due to de novo HLA antibodies, particularly anti-class II, and is often C4d negative. Pure treated T cell-mediated rejection does not predispose to graft loss because it responds well, even with endothelialitis, but it may indicate nonadherence. The cumulative burden of injury results in atrophy-fibrosis (nephron loss), arterial fibrous intimal thickening and arteriolar hyalinosis, but these are not progressive without ongoing disease/injury, and do not explain progression. Calcineurin inhibitor toxicity has been overestimated because burden-of-injury lesions invite this default diagnosis when diseases such as antibody-mediated rejection are missed. Disease/injury triggers a stereotyped active injury-repair response, including de-differentiation, cell cycling and apoptosis. The active injury-repair response is the strongest correlate of organ function and future progression to failure, but should always prompt a search for the initiating injury or disease.

  9. Scaling-Stimulated Salivary Antioxidant Changes and Oral-Health Behavior in an Evaluation of Periodontal Treatment Outcomes

    Directory of Open Access Journals (Sweden)

    Po-Sheng Yang

    2014-01-01

    Full Text Available Aim. Our goal was to investigate associations among scaling-stimulated changes in salivary antioxidants, oral-health-related behaviors and attitudes, and periodontal treatment outcomes. Materials and Methods. Thirty periodontitis patients with at least 6 pockets with pocket depths of >5 mm and more than 16 functional teeth were enrolled in the study. Patients were divided into three groups: an abandoned group (AB group, a nonprogress outcome group (NP group, and an effective treatment group (ET group. Nonstimulated saliva was collected before and after scaling were received to determine superoxide dismutase (SOD and the total antioxidant capacity (TAOC. Results. Salivary SOD following scaling significantly increased from 83.09 to 194.30 U/g protein in patients who had irregular dental visit patterns (<1 visit per year. After scaling, the TAOC was significantly higher in patients who had regular dental visits than in patients who had irregular dental visits (3.52 versus 0.70 mmole/g protein, P<0.01. The scaling-stimulated increase in SOD was related to a higher severity of periodontitis in the NP group, while the scaling-stimulated increase in the TAOC was inversely related to the severity of periodontitis in the AB group. Conclusions. These results demonstrate the importance of scaling-stimulated salivary antioxidants as prognostic biomarkers of periodontal treatment.

  10. Linking climate change and health outcomes: Examining the relationship between temperature, precipitation and birth weight in Africa

    Science.gov (United States)

    Grace, Kathryn; Davenport, Frank; Hanson, Heidi; Funk, Christopher C.; Shukla, Shraddhanand

    2015-01-01

    This paper examined the relationship between birth weight, precipitation, and temperature in 19 African countries. We matched recorded birth weights from Demographic and Health Surveys covering 1986 through 2010 with gridded monthly precipitation and temperature data derived from satellite and ground-based weather stations. Observed weather patterns during various stages of pregnancy were also used to examine the effect of temperature and precipitation on birth weight outcomes. In our empirical model we allowed the effect of weather factors to vary by the dominant food production strategy (livelihood zone) in a given region as well as by household wealth, mother's education and birth season. This allowed us to determine if certain populations are more or less vulnerable to unexpected weather changes after adjusting for known covariates. Finally we measured effect size by observing differences in birth weight outcomes in women who have one low birth weight experience and at least one healthy birth weight baby. The results indicated that climate does indeed impact birth weight and at a level comparable, in some cases, to the impact of increasing women's education or household electricity status.

  11. Corrective Action Investigation Plan for Corrective Action Unit 204: Storage Bunkers, Nevada Test Site, Nevada (December 2002, Revision No.: 0), Including Record of Technical Change No. 1

    Energy Technology Data Exchange (ETDEWEB)

    NNSA/NSO

    2002-12-12

    The Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office's approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 204 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 204 is located on the Nevada Test Site approximately 65 miles northwest of Las Vegas, Nevada. This CAU is comprised of six Corrective Action Sites (CASs) which include: 01-34-01, Underground Instrument House Bunker; 02-34-01, Instrument Bunker; 03-34-01, Underground Bunker; 05-18-02, Chemical Explosives Storage; 05-33-01, Kay Blockhouse; 05-99-02, Explosive Storage Bunker. Based on site history, process knowledge, and previous field efforts, contaminants of potential concern for Corrective Action Unit 204 collectively include radionuclides, beryllium, high explosives, lead, polychlorinated biphenyls, total petroleum hydrocarbons, silver, warfarin, and zinc phosphide. The primary question for the investigation is: ''Are existing data sufficient to evaluate appropriate corrective actions?'' To address this question, resolution of two decision statements is required. Decision I is to ''Define the nature of contamination'' by identifying any contamination above preliminary action levels (PALs); Decision II is to ''Determine the extent of contamination identified above PALs. If PALs are not exceeded, the investigation is completed. If PALs are exceeded, then Decision II must be resolved. In addition, data will be obtained to support waste management decisions. Field activities will include radiological land area surveys, geophysical surveys to identify any subsurface metallic and nonmetallic debris, field screening for applicable contaminants of potential concern, collection and analysis of surface and subsurface soil samples from biased locations

  12. Organizational Uses of Health Information Exchange to Change Cost and Utilization Outcomes: A Typology from a Multi-Site Qualitative Analysis.

    Science.gov (United States)

    Vest, Joshua R; Abramson, Erika

    2015-01-01

    Health information exchange (HIE) systems facilitate access to patient information for a variety of health care organizations, end users, and clinical and organizational goals. While a complex intervention, organizations' usage of HIE is often conceptualized and measured narrowly. We sought to provide greater specificity to the concept of HIE as an intervention by formulating a typology of organizational HIE usage. We interviewed representatives of a regional health information organization and health care organizations actively using HIE information to change patient utilization and costs. The resultant typology includes three dimensions: user role, usage initiation, and patient set. This approach to categorizing how health care organizations are actually applying HIE information to clinical and business tasks provides greater clarity about HIE as an intervention and helps elucidate the conceptual linkage between HIE an organizational and patient outcomes.

  13. Changing physician incentives for cancer care to reward better patient outcomes instead of use of more costly drugs.

    Science.gov (United States)

    Newcomer, Lee N

    2012-04-01

    More-sophisticated chemotherapy regimens have improved the outlook for cancer patients since the 1970s, but the payment system for cancer chemotherapy has not changed during that time span. The "buy and bill" approach for reimbursement provides incentives for medical oncologists to use expensive medications when less costly alternatives that deliver similar results are available. Furthermore, the system does nothing to assess how much value society derives from high-price drugs. This paper reviews the historical context of "buy and bill" reimbursement and considers the use of clinical pathways and bundled payments, two alternative strategies that are being tried to reward physicians for improving outcomes and reducing the total cost of cancer care.

  14. Changes on Tendon Stiffness and Clinical Outcomes in Athletes Are Associated With Patellar Tendinopathy After Eccentric Exercise.

    Science.gov (United States)

    Lee, Wai-Chun; Ng, Gabriel Yin-Fat; Zhang, Zhi-Jie; Malliaras, Peter; Masci, Lorenzo; Fu, Siu-Ngor

    2017-12-19

    Eccentric exercise is commonly used as a form of loading exercise for individuals with patellar tendinopathy. This study investigated the change of mechanical properties and clinical outcomes and their interrelationships after a 12-week single-legged decline-board exercise with and without extracorporeal shockwave therapy (ESWT). Randomized controlled trial. Outpatient clinic of a university. Thirty-four male in-season athletes with patellar tendinopathy for more than 3 months were randomized into exercise and combined groups. The exercise group received a 12-week single-legged decline-squat exercise, and the combined group performed an identical exercise program in addition to a weekly session of ESWT in the initial 6 weeks. Tendon stiffness and strain were examined using ultrasonography and dynamometry. Visual analog scale and Victoria Institute of Sports Assessment-patella (VISA-p) score were used to assess pain and dysfunction. These parameters were measured at preintervention and postintervention. Significant time effect but no significant group effect on the outcome measures; significant reduction in tendon stiffness (P = 0.02) and increase in tendon strain (P = 0.00); and reduction of intensity of pain (P = 0.00) and dysfunction (P = 0.00) were observed. Significant correlations between changes in tendon stiffness and VISA-p score (ρ = -0.58, P = 0.05); alteration in tendon strain, pain intensity (ρ = -0.63, P = 0.03); and VISA-p score (ρ = 0.60, P = 0.04) were detected after the exercise program. Eccentric exercise-induced modulation on tendon mechanical properties and clinical symptoms are associated in athletes with patellar tendinopathy.

  15. Changes in the physicochemical characteristics, including flavour components and Maillard reaction products, of non-centrifugal cane brown sugar during storage.

    Science.gov (United States)

    Asikin, Yonathan; Kamiya, Asahiro; Mizu, Masami; Takara, Kensaku; Tamaki, Hajime; Wada, Koji

    2014-04-15

    Changes in the quality attributes of non-centrifugal cane brown sugar represented by physicochemical characteristics as well as flavour components and Maillard reaction products (MRPs) were monitored every 3 months over 1 year of storage. Stored cane brown sugar became darker, and its moisture content and water activity (a(w)) increased during storage. Fructose and glucose levels decreased as non-enzymatic browning via the Maillard reaction occurred in the stored sample, and a similar trend was also discovered in aconitic and acetic acids. Stored cane brown sugar lost its acidic and sulfuric odours (58.70-39.35% and 1.85-0.08%, respectively); subsequently, the nutty and roasted aroma increased from 26.52% to 38.59% due to the volatile MRPs. The browning rate of stored cane brown sugar was positively associated with the development of volatile MRPs (Pearson's coefficient = 0.860), whereas the amount of 3-deoxyglucosone, an intermediate product of the Maillard reaction, had a lower association with the brown colour due to its relatively slow degradation rate. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Deciphering the mechanisms involved in Portulaca oleracea (C4) response to drought: metabolic changes including crassulacean acid-like metabolism induction and reversal upon re-watering.

    Science.gov (United States)

    D'Andrea, Rodrigo Matías; Andreo, Carlos Santiago; Lara, María Valeria

    2014-11-01

    Portulaca oleracea is a C(4) plant; however, under drought it can change its carbon fixation metabolism into a crassulacean acid metabolism (CAM)-like one. While the C(3) -CAM shift is well known, the C(4) -CAM transition has only been described in Portulaca. Here, a CAM-like metabolism was induced in P. oleracea by drought and then reversed by re-watering. Physiological and biochemical approaches were undertaken to evaluate the drought and recovery responses. In CAM-like plants, chlorophyll fluorescence parameters were transitory affected and non-radiative energy dissipation mechanisms were induced. Induction of flavonoids, betalains and antioxidant machinery may be involved in photosynthetic machinery protection. Metabolic analysis highlights a clear metabolic shift, when a CAM-like metabolism is induced and then reversed. Increases in nitrogenous compounds like free amino acids and urea, and of pinitol could contribute to withstand drought. Reciprocal variations in arginase and urease in drought-stressed and in re-watered plants suggest urea synthesis is strictly regulated. Recovery of C(4) metabolism was accounted by CO(2) assimilation pattern and malate levels. Increases in glycerol and in polyamines would be of importance of re-watered plants. Collectively, in P. oleracea multiple strategies, from induction of several metabolites to the transitory development of a CAM-like metabolism, participate to enhance its adaptation to drought. © 2014 Scandinavian Plant Physiology Society.

  17. Corrective Action Investigation Plan for Corrective Action Unit 536: Area 3 Release Site, Nevada Test Site, Nevada (Rev. 0 / June 2003), Including Record of Technical Change No. 1

    Energy Technology Data Exchange (ETDEWEB)

    None

    2003-06-27

    This Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office's approach to collect the data necessary to evaluate corrective action alternatives (CAAs) appropriate for the closure of Corrective Action Unit (CAU) 536: Area 3 Release Site, Nevada Test Site, Nevada, under the Federal Facility Agreement and Consent Order. Corrective Action Unit 536 consists of a single Corrective Action Site (CAS): 03-44-02, Steam Jenny Discharge. The CAU 536 site is being investigated because existing information on the nature and extent of possible contamination is insufficient to evaluate and recommend corrective action alternatives for CAS 03-44-02. The additional information will be obtained by conducting a corrective action investigation (CAI) prior to evaluating CAAs and selecting the appropriate corrective action for this CAS. The results of this field investigation are to be used to support a defensible evaluation of corrective action alternatives in the corrective action decision document. Record of Technical Change No. 1 is dated 3-2004.

  18. Introducing the Concept of the Minimally Important Difference to Determine a Clinically Relevant Change on Patient-Reported Outcome Measures in Patients with Intermittent Claudication

    International Nuclear Information System (INIS)

    Conijn, Anne P.; Jonkers, Wilma; Rouwet, Ellen V.; Vahl, Anco C.; Reekers, Jim A.; Koelemay, Mark J. W.

    2015-01-01

    PurposeThe minimally important difference (MID) represents the smallest change in score on patient-reported outcome measures that is relevant to patients. The aim of this study was to introduce the MID for the Vascular Quality of Life Questionnaire (VascuQol) and the walking impairment questionnaire (WIQ) for patients with intermittent claudication (IC).MethodsIn this multicenter study, we recruited 294 patients with IC between July and October 2012. Patients completed the VascuQol, with scores ranging from 1 to 7 (worst to best), and the WIQ, with scores ranging from 0 to 1 (worst to best) at first visit and after 4 months follow-up. In addition, patients answered an anchor-question rating their health status compared to baseline, as being improved, unchanged, or deteriorated. The MID for improvement and deterioration was calculated by an anchor-based approach, and determined with the upper and lower limits of the 95 % confidence interval of the mean change of the group who had not changed according to the anchor-question.ResultsFor the MID analyses of the VascuQol and WIQ, 163 and 134 patients were included, respectively. The MID values for the VascuQol (mean baseline score 4.25) were 0.87 for improvement and 0.23 for deterioration. For the WIQ (mean baseline score 0.39), we found MID values of 0.11 and −0.03 for improvement and deterioration, respectively.ConclusionIn this study, we calculated the MID for the VascuQol and the WIQ. Applying these MID facilitates better interpretation of treatment outcomes and can help to set treatment goals for individual care

  19. Introducing the Concept of the Minimally Important Difference to Determine a Clinically Relevant Change on Patient-Reported Outcome Measures in Patients with Intermittent Claudication

    Energy Technology Data Exchange (ETDEWEB)

    Conijn, Anne P., E-mail: a.p.conijn@amc.nl [Academic Medical Center, Departments of Vascular Surgery and Interventional Radiology (Netherlands); Jonkers, Wilma, E-mail: wilma.jonkers@achmea.nl [Achmea Insurances, Division of Health Care (Netherlands); Rouwet, Ellen V., E-mail: e.rouwet@erasmusmc.nl [Erasmus Medical Center, Department of Vascular Surgery (Netherlands); Vahl, Anco C., E-mail: a.c.vahl@olvg.nl [Onze Lieve Vrouwe Gasthuis, Department of Vascular Surgery (Netherlands); Reekers, Jim A., E-mail: j.a.reekers@amc.nl [Academic Medical Center, Department of Radiology (Netherlands); Koelemay, Mark J. W., E-mail: m.j.koelemaij@amc.nl [Academic Medical Center, Department of vascular surgery (Netherlands)

    2015-10-15

    PurposeThe minimally important difference (MID) represents the smallest change in score on patient-reported outcome measures that is relevant to patients. The aim of this study was to introduce the MID for the Vascular Quality of Life Questionnaire (VascuQol) and the walking impairment questionnaire (WIQ) for patients with intermittent claudication (IC).MethodsIn this multicenter study, we recruited 294 patients with IC between July and October 2012. Patients completed the VascuQol, with scores ranging from 1 to 7 (worst to best), and the WIQ, with scores ranging from 0 to 1 (worst to best) at first visit and after 4 months follow-up. In addition, patients answered an anchor-question rating their health status compared to baseline, as being improved, unchanged, or deteriorated. The MID for improvement and deterioration was calculated by an anchor-based approach, and determined with the upper and lower limits of the 95 % confidence interval of the mean change of the group who had not changed according to the anchor-question.ResultsFor the MID analyses of the VascuQol and WIQ, 163 and 134 patients were included, respectively. The MID values for the VascuQol (mean baseline score 4.25) were 0.87 for improvement and 0.23 for deterioration. For the WIQ (mean baseline score 0.39), we found MID values of 0.11 and −0.03 for improvement and deterioration, respectively.ConclusionIn this study, we calculated the MID for the VascuQol and the WIQ. Applying these MID facilitates better interpretation of treatment outcomes and can help to set treatment goals for individual care.

  20. Significance of change in serum bilirubin in predicting left ventricular reverse remodeling and outcomes in heart failure patients with cardiac resynchronization therapy.

    Science.gov (United States)

    Hosoda, Junya; Ishikawa, Toshiyuki; Matsumoto, Katsumi; Iguchi, Kohei; Matsushita, Hirooki; Ogino, Yutaka; Taguchi, Yuka; Sugano, Teruyasu; Ishigami, Tomoaki; Kimura, Kazuo; Tamura, Kouichi

    2017-11-01

    Research on the correlation of serum bilirubin level with cardiac function as well as outcomes in heart failure patients with cardiac resynchronization therapy (CRT) has not yet been reported. The aim of this study was to analyze the relationship between change in serum bilirubin level and left ventricular reverse remodeling, and also to clarify the impact of bilirubin change on clinical outcomes in CRT patients. We evaluated 105 consecutive patients who underwent CRT. Patients who had no serum total-bilirubin data at both baseline and 3-9 months' follow-up or had died less than 3 months after CRT implantation were excluded. Accordingly, a total of 69 patients were included in the present analysis. The patients were divided into two groups: decreased bilirubin group (serum total-bilirubin level at follow-up≤that at baseline; n=48) and increased bilirubin group (serum total-bilirubin level at follow-up>that at baseline; n=21). Mean follow-up period was 39.3 months. In the decreased bilirubin group, mean left ventricular end-systolic diameter decreased from 54.5mm to 50.2mm (p=0.001) and mean left ventricular ejection fraction increased significantly from 29.8% to 37.0% (p=0.001). In the increased bilirubin group, there was no significant change in echocardiographic parameters from baseline to follow-up. In Kaplan-Meyer analysis, cardiac mortality combined with heart failure hospitalization in the increased bilirubin group was significantly higher than that in the decreased bilirubin group (log-rank p=0.018). Multivariate Cox regression analysis revealed that increased bilirubin was an independent predictor of cardiac mortality combined with heart failure hospitalization (OR=2.66, p=0.023). The change in serum bilirubin is useful for assessment of left ventricular reverse remodeling and prediction of outcomes in heart failure patients with CRT. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  1. How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change.

    Science.gov (United States)

    Gilissen, J; Pivodic, L; Gastmans, C; Vander Stichele, R; Deliens, L; Breuer, E; Van den Block, L

    2018-02-14

    Advance care planning (ACP) has been identified as particularly relevant for nursing home residents, but it remains unclear how or under what circumstances ACP works and can best be implemented in such settings. We aimed to develop a theory that outlines the hypothetical causal pathway of ACP in nursing homes, i.e. what changes are expected, by means of which processes and under what circumstances. The Theory of Change approach is a participatory method of programme design and evaluation whose underlying intention is to improve understanding of how and why a programme works. It results in a Theory of Change map that visually represents how, why and under what circumstances ACP is expected to work in nursing home settings in Belgium. Using this approach, we integrated the results of two workshops with stakeholders (n = 27) with the results of a contextual analysis and a systematic literature review. We identified two long-term outcomes that ACP can achieve: to improve the correspondence between residents’ wishes and the care/treatment they receive and to make sure residents and their family feel involved in planning their future care and are confident their care will be according to their wishes. Besides willingness on the part of nursing home management to implement ACP and act accordingly, other necessary preconditions are identified and put in chronological order. These preconditions serve as precursors to, or requirements for, accomplishing successful ACP. Nine original key intervention components with specific rationales are identified at several levels (resident/family, staff or nursing home) to target the preconditions: selection of a trainer, ensuring engagement by management, training ACP reference persons, in-service education for healthcare staff, information for staff, general practitioners, residents and their family, ACP conversations and documentation, regular reflection sessions, multidisciplinary meetings, and formal monitoring. The Theory of

  2. SRS Public Involvement in Waste Management Has Resulted in Effective Decisions Supported by the Public Including Disposal Changes and Top-to-Bottom Review Initiative Consensus

    International Nuclear Information System (INIS)

    Goldston, W. T.; Villasor, H. P.

    2003-01-01

    In the Savannah River Site's (SRS') Solid Waste Management Program, a key to success is the Public Involvement Program. The Solid Waste Division at SRS manages the site's transuranic, low-level, mixed, and hazardous wastes. All decisions associated with management of this waste are of interest to the public and successful program implementation would be impossible without a vigorous public involvement program. The SRS Solid Waste Division (SWD) and its Department of Energy (DOE) customer developed, implemented, and maintain a comprehensive public participation and communications program. It is staffed by public participation and technical specialists to ensure information is presented in a manner that is technically accurate while being tailored for understanding by people without a technical background. The program provides the public with accurate, complete, timely information and early meaningful participation opportunities. It also fulfills the public participation activities required by laws, regulations, DOE Orders, and negotiated agreements. The primary goal of the SWD Public Participation Program is to fulfill the objectives of the SWD and SRS Strategic Plans to ''build trust and communicate openly, honestly, and responsibly with employees, customers, stakeholders, and regulators,'' and to ''work to extend the support of external stakeholders for the pursuit of SRS and DOE Complex business goals.'' This paper focuses on the public participation program goals, the implementation through formal plans and objectives, targeted waste management programs and specific audiences, and specific effects of the program on waste management activities. A discussion of the DOE and contractor teaming along with how plans are carried out is also included

  3. Early Self-Regulation, Early Self-Regulatory Change, and Their Longitudinal Relations to Adolescents' Academic, Health, and Mental Well-Being Outcomes.

    Science.gov (United States)

    Howard, Steven J; Williams, Kate E

    2018-05-16

    To evaluate the extent to which early self-regulation and early changes in self-regulation are associated with adolescents' academic, health, and mental well-being outcomes. Data were collected from 1 of the cohorts in a large dual-cohort cross-sequential study of Australian children. This cohort consisted of a nationally representative data set of 4983 Australian children assessed at 4 to 5 years of age, who were followed longitudinally to 14 to 15 years of age. Using regression within a path analysis framework, we first sought to investigate associations of early self-regulation (at 4-5 years and 6-7 years of age) with a broad range of academic, health, and mental well-being outcomes in adolescence (at 14-15 years). We next investigated the extent to which an early change in self-regulation (from 4 to 7 years of age) predicted these adolescents' outcomes. Early self-regulation predicted the full range of adolescents' outcomes considered such that a 1-SD increase in self-regulation problems was associated with a 1.5- to 2.5-times greater risk of more-negative outcomes. An early positive change in self-regulation was associated with a reduced risk of these negative outcomes for 11 of the 13 outcomes considered. These results suggest the potential of early self-regulation interventions, in particular, in influencing long-term academic, health, and well-being trajectories.

  4. Fertility in Namibia. Changes in fertility levels in North-Central Namibia 1960-2001, including an assessment of the impact of HIV

    Directory of Open Access Journals (Sweden)

    Riikka Shemeikka

    2006-01-01

    has been employed in the study region since the 1980s, but in the early 1990s, use of contraceptives was still so limited that fertility was higher in North-Central Namibia than in other regions of the country. In the 1990s, fertility decline was largely a result of the increased prevalence of contraception. HIV prevalence among pregnant women increased from 4% in 1992 to 25% in 2001. In 2001, total fertility among HIV-infected women (3.7 was lower than that among other women (4.8, resulting in total fertility of 4.4 among the general population in 2001. The HIV epidemic explained more than a quarter of the decline in total fertility at population level during most of the 1990s. The HIV epidemic also reduced the number of children born by reducing the number of potential mothers.  In the future, HIV will have an extensive influence on both the size and age structure of the Namibian population. Although HIV influences demographic development through both fertility and mortality, the effect through changes in fertility will be smaller than the effect through mortality. In the study region, as in some other regions of southern Africa, a new type of demographic transition is under way, one in which population growth stagnates or even reverses because of the combined effects of declining fertility and increasing mortality, both of which are consequences of the HIV pandemic.

  5. The Relationship of ST Segment Changes in Lead aVR with Outcomes after Myocardial Infarction; a Cross Sectional Study

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Beyranvand

    2017-01-01

    Full Text Available Introduction: Among the 12 leads studied in electrocardiography (ECG, lead aVR can be considered as the most forgotten part of it since no attention is paid to it as the mirror image of other leads. Therefore, the present study has been designed with the aim of evaluating the prevalence of ST segment changes in lead aVR and its relationship with the outcome of these patients.Methods: In this retrospective cross sectional study medical profiles of patients who had presented to emergency department with the final diagnosis of myocardial infarction (MI in a 4-year period were evaluated regarding changes of ST segment in lead aVR and its relationship with in-hospital mortality, the number of vessels involved, infarct location and cardiac ejection fraction.Results: 288 patients with the mean age of 59.00 ± 13.14 (18 – 91 were evaluated (79.2% male. 168 (58.3% patients had the mentioned changes (79.2% male. There was no significant relationship between presence of ST changes in lead aVR with infarct location (p = 0.976, number of vessels involved (p = 0.269 and ejection fraction on admission (p = 0.801. However, ST elevation ≥ 1 mv in lead aVR had a significant relationship with mortality (Odds = 7.72, 95% CI: 3.07 – 19.42, p < 0.001. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of ST elevation ≥ 1 for prediction of in-hospital mortality were 41.66 (95% CI: 22.79 – 63.05, 91.53 (95% CI: 87.29 – 94.50, 31.25 (95% CI: 16.74 – 50.13, 94.44 (95% CI: 90.65 – 96.81, 0.45 (95% CI: 0.25 – 0.79, and 0.05 (95% CI: 0.03 – 0.09, respectively.Conclusion: Based on the results of the present study, the prevalence of ST segment changes in lead aVR was estimated to be 58.3%. There was no significant relationship between these changes and the number of vessels involved in angiography, infarct location and cardiac ejection fraction. However, presence of ST elevation ≥ 1 in lead a

  6. Do associations between employee self-reported organizational assessments and attitudinal outcomes change over time? An analysis of four Veterans Health Administration surveys using structural equation modelling.

    Science.gov (United States)

    Das, Sonali; Chen, Ming-Hui; Warren, Nicholas; Hodgson, Michael

    2011-12-01

    This paper evaluates relationships between healthcare employees' perceptions of three hospital organizational constructs (Leadership, Support and Resources), and their assessment of two employee-related outcomes (employee satisfaction and retention) and two patient-related outcomes (patient satisfaction and quality of care). Using four all-employee surveys conducted by the Veterans Health Administration in the United States between 1997 and 2006, we examine the strength of these relationships and their changes over time. Exposure and outcome measures are employee-assessed in all the surveys. Because it can accommodate both latent and measured variables into the model, Structural Equation Modelling (SEM) is used to capture and quantify the relationship structure. The aim of the project is to identify possible intervention foci. The analyses revealed that employee-related outcomes are improved by increases in Leadership and Support, and, not surprisingly, the outcome variable of employee satisfaction reduced turnover intention. The employee assessed patient-related outcomes of satisfaction and quality of care were most improved by increases in Resources. Results also indicate that the three organizational constructs and the web of associations characterized by SEM underwent changes over the study period, perhaps in relation to changes in VHA policy emphases, changes in survey wording and other possible unmeasured factors. Copyright © 2010 John Wiley & Sons, Ltd.

  7. Impact of Weight Change During the Course of Concurrent Chemoradiation Therapy on Outcomes in Stage IIIB Non-Small Cell Lung Cancer Patients: Retrospective Analysis of 425 Patients

    International Nuclear Information System (INIS)

    Topkan, Erkan; Parlak, Cem; Selek, Ugur

    2013-01-01

    Purpose: We retrospectively investigated the impact of weight change (WC) during concurrent chemoradiation therapy (C-CRT) on clinical outcomes of stage 3B non-small cell lung cancer (NSCLC) patients. Methods and Materials: A total of 425 patients treated with C-CRT were included. All patients received 60 to 66 Gy of thoracic radiation therapy concurrently with 1 to 3 cycles of platinum-based chemotherapy. Pre- and posttreatment weight measurements on first and last days of C-CRT were used for WC. Patients were divided into 2 groups: group 1 = weight loss (WL); group 2 = weight preservation/gain (WP) for comparative analyses. Results: Following C-CRT, 252 patients (59.3%) experienced WL, while 89 patients (20.9%) and 84 patients (19.8%) showed WP or WG. At median 24.2 months of follow-up, 142 patients (33.4%) were alive (84 WP [48.6%] and 58 WL [23.0%]), and 58 (13.6%) of them were free of disease progression (41 [23.7%] for WP and 17 [6.7%] for WL). Median overall survival (OS), locoregional progression-free survival (LRPFS), progression-free survival (PFS), and distant metastases-free survival (DMFS) for the entire population were 22.8, 14.4, 10.6, and 11.7 months, respectively. Intergroup comparisons between WP and WL cohorts revealed significantly superior OS, LRPFS, PFS, and DMFS in WP patients (P<.05 for each). On multivariate analyses, only WL and advanced T stage were associated with poor prognosis (P<.05). Conclusions: Present results in 425 stage 3B NSCLC patients demonstrated that WL during C-CRT is strongly associated with inferior survival outcomes compared to WP. This emerging finding might be useful by forming an encouraging basis for future investigations in facilitating a way to improve the outcomes of these patients experiencing WL during C-CRT

  8. Correlating Computed Tomography Perfusion Changes in the Pharyngeal Constrictor Muscles During Head-and-Neck Radiotherapy to Dysphagia Outcome

    Energy Technology Data Exchange (ETDEWEB)

    Truong, Minh Tam, E-mail: mitruong@bu.edu [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Lee, Richard [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Saito, Naoko [Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Qureshi, Muhammad M. [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Ozonoff, Al [Department of Biostatistics, Boston University School of Public Health, Boston, MA (United States); Romesser, Paul B. [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Wang, Jimmy; Sakai, Osamu [Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States)

    2012-02-01

    Purpose: To measure changes in perfusion of the pharyngeal constrictor muscles (PCM) using CT perfusion (CTP) imaging during a course of definitive radiotherapy (RT) in head-and-neck cancer (HNC) patients and correlate with dysphagia outcome after RT. Methods and Materials: Fifteen HNC patients underwent CTP imaging of the PCM at baseline and Weeks 2, 4, and 6 during RT and 6 weeks after RT. Blood flow and blood volume were measured in the PCM, and percentage change from baseline scan was determined. A single physician-based assessment of dysphagia was performed every 3 months after RT using the Common Terminology Criteria for Adverse Events, version 3.0 grading system. Results: With a median follow-up of 28 months (range, 6-44 months), Grade 3 dysphagia was present in 7 of 15 patients, and 8 patients experienced Grade 0-2 dysphagia. The CTP parameters at Week 2 of RT demonstrated an increase in mean PCM blood flow of 161.9% vs. 12.3% (p = 0.007) and an increase in mean PCM blood volume of 96.6% vs. 8.7% (p = 0.039) in patients with 6-month post-RT Grade 3 dysphagia and Grade 0-2 dysphagia, respectively. On multivariate analysis, when adjusting for smoking history, tumor volume, and baseline dysphagia status, an increase in blood flow in the second week of RT was significant for 3- and 6-month Grade 3 dysphagia (p < 0.05). Conclusions: Perfusion changes in the PCM during Week 2 of RT in the PCM may predict the severity of dysphagia after HNC RT.

  9. Correlating Computed Tomography Perfusion Changes in the Pharyngeal Constrictor Muscles During Head-and-Neck Radiotherapy to Dysphagia Outcome

    International Nuclear Information System (INIS)

    Truong, Minh Tam; Lee, Richard; Saito, Naoko; Qureshi, Muhammad M.; Ozonoff, Al; Romesser, Paul B.; Wang, Jimmy; Sakai, Osamu

    2012-01-01

    Purpose: To measure changes in perfusion of the pharyngeal constrictor muscles (PCM) using CT perfusion (CTP) imaging during a course of definitive radiotherapy (RT) in head-and-neck cancer (HNC) patients and correlate with dysphagia outcome after RT. Methods and Materials: Fifteen HNC patients underwent CTP imaging of the PCM at baseline and Weeks 2, 4, and 6 during RT and 6 weeks after RT. Blood flow and blood volume were measured in the PCM, and percentage change from baseline scan was determined. A single physician-based assessment of dysphagia was performed every 3 months after RT using the Common Terminology Criteria for Adverse Events, version 3.0 grading system. Results: With a median follow-up of 28 months (range, 6–44 months), Grade 3 dysphagia was present in 7 of 15 patients, and 8 patients experienced Grade 0–2 dysphagia. The CTP parameters at Week 2 of RT demonstrated an increase in mean PCM blood flow of 161.9% vs. 12.3% (p = 0.007) and an increase in mean PCM blood volume of 96.6% vs. 8.7% (p = 0.039) in patients with 6-month post-RT Grade 3 dysphagia and Grade 0–2 dysphagia, respectively. On multivariate analysis, when adjusting for smoking history, tumor volume, and baseline dysphagia status, an increase in blood flow in the second week of RT was significant for 3- and 6-month Grade 3 dysphagia (p < 0.05). Conclusions: Perfusion changes in the PCM during Week 2 of RT in the PCM may predict the severity of dysphagia after HNC RT.

  10. 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...

  11. Behavior change techniques used in group-based behavioral support by the English stop-smoking services and preliminary assessment of association with short-term quit outcomes.

    Science.gov (United States)

    West, Robert; Evans, Adam; Michie, Susan

    2011-12-01

    To develop a reliable coding scheme for components of group-based behavioral support for smoking cessation, to establish the frequency of inclusion in English Stop-Smoking Service (SSS) treatment manuals of specific components, and to investigate the associations between inclusion of behavior change techniques (BCTs) and service success rates. A taxonomy of BCTs specific to group-based behavioral support was developed and reliability of use assessed. All English SSSs (n = 145) were contacted to request their group-support treatment manuals. BCTs included in the manuals were identified using this taxonomy. Associations between inclusion of specific BCTs and short-term (4-week) self-reported quit outcomes were assessed. Fourteen group-support BCTs were identified with >90% agreement between coders. One hundred and seven services responded to the request for group-support manuals of which 30 had suitable documents. On average, 7 BCTs were included in each manual. Two were positively associated with 4-week quit rates: "communicate group member identities" and a "betting game" (a financial deposit that is lost if a stop-smoking "buddy" relapses). It is possible to reliably code group-specific BCTs for smoking cessation. Fourteen such techniques are present in guideline documents of which 2 appear to be associated with higher short-term self-reported quit rates when included in treatment manuals of English SSSs.

  12. 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.

  13. Blood pressure changes associated with sibutramine and weight management - an analysis from the 6-week lead-in period of the sibutramine cardiovascular outcomes trial (SCOUT)

    DEFF Research Database (Denmark)

    Sharma, A M; Caterson, I D; Coutinho, W

    2009-01-01

    OBJECTIVE: To explore vital sign changes among patient subgroups during the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial. METHODS: SCOUT is an ongoing, double-blind, randomized, placebo-controlled outcome trial in overweight/obese patients at high risk of a cardi......OBJECTIVE: To explore vital sign changes among patient subgroups during the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial. METHODS: SCOUT is an ongoing, double-blind, randomized, placebo-controlled outcome trial in overweight/obese patients at high risk...... of a cardiovascular event. During the 6-week lead-in period, 10,742 patients received sibutramine and weight management. Vital sign changes were assessed post hoc by initial blood pressure (mmHg) categorized as normal (or=140/>or=90); weight change...... categories (weight gain/no weight change, >0 to 2.5% weight loss, >2.5 to 5% weight loss and >5% weight loss) and current antihypertensive medication class use (none, one, or two or more). To assess the impact of sibutramine on blood pressure and pulse rate, only patients (N = 10,025) who reported no change...

  14. Value of Lung Ultrasonography in the Diagnosis and Outcome Prediction of Pediatric Community-Acquired Pneumonia with Necrotizing Change.

    Directory of Open Access Journals (Sweden)

    Shen-Hao Lai

    Full Text Available Lung ultrasonography has been advocated in diagnosing pediatric community-acquired pneumonia. However, its function in identifying necrotizing pneumonia, a complication, has not been explored. This study investigated the value of lung ultrasonography in diagnosing pediatric necrotizing pneumonia and its role in predicting clinical outcomes.We retrospectively reviewed 236 children with community-acquired pneumonia who were evaluated using lung ultrasonography within 2-3 days after admission. The ultrasonographic features assessed included lung perfusion, the presence of hypoechoic lesions, and the amount of pleural effusion. Chest computed tomography was also performed in 96 patients as clinically indicated. Detailed records of clinical information were obtained.Our results showed a high correlation between the degree of impaired perfusion in ultrasonography and the severity of necrosis in computed tomography (r = 0.704. The degree of impaired perfusion can favorably be used to predict massive necrosis in computed tomography (area under the receiver operating characteristic curve, 0.908. The characteristics of impaired perfusion and hypoechoic lesions in ultrasonography were associated with an increased risk of pneumatocele formation (odds ratio (OR, 10.11; 95% CI, 2.95-34.64 and the subsequent requirement for surgical lung resection (OR, 8.28; 95% CI, 1.86-36.93. Furthermore, a longer hospital stay would be expected if moderate-to-massive pleural effusion was observed in addition to impaired perfusion in ultrasonography (OR, 3.08; 95% CI, 1.15-8.29.Lung ultrasonography is favorably correlated with chest computed tomography in the diagnosis of necrotizing pneumonia, especially regarding massive necrosis of the lung. Because it is a simple and reliable imaging tool that is valuable in predicting clinical outcomes, we suggest that ultrasonography be applied as a surrogate for computed tomography for the early detection of severe necrotizing

  15. Engagement with the auditory processing system during targeted auditory cognitive training mediates changes in cognitive outcomes in individuals with schizophrenia.

    Science.gov (United States)

    Biagianti, Bruno; Fisher, Melissa; Neilands, Torsten B; Loewy, Rachel; Vinogradov, Sophia

    2016-11-01

    Individuals with schizophrenia who engage in targeted cognitive training (TCT) of the auditory system show generalized cognitive improvements. The high degree of variability in cognitive gains maybe due to individual differences in the level of engagement of the underlying neural system target. 131 individuals with schizophrenia underwent 40 hours of TCT. We identified target engagement of auditory system processing efficiency by modeling subject-specific trajectories of auditory processing speed (APS) over time. Lowess analysis, mixed models repeated measures analysis, and latent growth curve modeling were used to examine whether APS trajectories were moderated by age and illness duration, and mediated improvements in cognitive outcome measures. We observed significant improvements in APS from baseline to 20 hours of training (initial change), followed by a flat APS trajectory (plateau) at subsequent time-points. Participants showed interindividual variability in the steepness of the initial APS change and in the APS plateau achieved and sustained between 20 and 40 hours. We found that participants who achieved the fastest APS plateau, showed the greatest transfer effects to untrained cognitive domains. There is a significant association between an individual's ability to generate and sustain auditory processing efficiency and their degree of cognitive improvement after TCT, independent of baseline neurocognition. APS plateau may therefore represent a behavioral measure of target engagement mediating treatment response. Future studies should examine the optimal plateau of auditory processing efficiency required to induce significant cognitive improvements, in the context of interindividual differences in neural plasticity and sensory system efficiency that characterize schizophrenia. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  16. Effects of Changes in Potassium With Valsartan Use on Diabetes Risk: Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) Trial

    Science.gov (United States)

    Thomas, Laine; Svetkey, Laura; Brancati, Frederick L.; Califf, Robert M.; Edelman, David

    2013-01-01

    BACKGROUND Low and low-normal serum potassium is associated with an increased risk of diabetes. We hypothesized that the protective effect of valsartan on diabetes risk could be mediated by its effect of raising serum potassium. METHODS We analyzed data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial, which randomized participants at risk for diabetes to either valsartan (up to 160mg daily) or no valsartan. Using Cox models, we evaluated the effect of valsartan on diabetes risk over a median of 4 years of follow-up and calculated the mediation effect of serum potassium as the difference in treatment hazard ratios from models excluding and including 1-year change in serum potassium. The 95% confidence interval (CI) for the difference in log hazard ratios was computed by bootstrapping. RESULTS The hazard ratio for developing diabetes among those on valsartan vs. no valsartan was 0.866 (95% CI = 0.795–0.943) vs. 0.868 (95% CI = 0.797–0.945), after controlling for 1-year change in potassium. The bootstrap 95% CI for a difference in these log hazard ratios was not statistically significant (−0.003 to 0.009). CONCLUSIONS Serum potassium does not appear to significantly mediate the protective effect of valsartan on diabetes risk. PMID:23417031

  17. The changing pattern of human brucellosis: clinical manifestations, epidemiology, and treatment outcomes over three decades in Georgia

    Directory of Open Access Journals (Sweden)

    Zenaishvili Otar

    2010-12-01

    Full Text Available Abstract Background Brucellosis is an endemic infection in Georgia. We conducted a review of patient records with a suspected or confirmed diagnosis of brucellosis over three decades at the central referral hospital for brucellosis cases, the Institute of Parasitology and Tropical Medicine (IPTM in Tbilisi. The purpose was to describe the demographic profile and clinical characteristics as well as diagnostic and treatment strategies in patients with brucellosis. Methods Data were abstracted from randomly selected patient records at the IPTM. In total, 300 records were reviewed from three time periods: 1970-73, 1988-89, and 2004-2008. Results The age distribution of patients shifted from a median age of 40 years in the first time period to 20 years in the third time period. Azeri ethnicity was an increasing proportion of the total number of cases. The frequency of relapsed infection was 14.7% (44 cases. A total of 50 patients received vaccine therapy, and although the vaccine produced immune responses, demonstrated by an increase in agglutination titers, it was not associated with improved outcome. Conclusion The demographics of brucellosis in Georgia fit a profile of persons that tend sheep. Osteoarticular complications were commonly detected, especially in children. The changing pattern of brucellosis in Georgia suggests clinicians should be updated about different trends in brucellosis in their country.

  18. Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes.

    Science.gov (United States)

    Leal, Paulo Roberto Lacerda; Barbier, Charlotte; Hermier, Marc; Souza, Miguel Angelo; Cristino-Filho, Gerardo; Sindou, Marc

    2014-06-01

    The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes. Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22-79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient. The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm(3)) was significantly smaller (p controls (78.62 ± 24.62 mm(3) and 89.09 ± 14.72 mm(3), respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm(2)) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm(2) and 5.64 ± 0.85 mm(2), respectively). The ipsilateralTN with NVC Grade III

  19. Longitudinal changes in seizure outcomes after resection of cerebral cavernous malformations in patients presenting with seizures: a long-term follow-up of 46 patients.

    Science.gov (United States)

    Kim, Jiha; Kim, Chi Heon; Chung, Chun Kee

    2014-08-01

    Seizure is the most common presentation in patients with cerebral cavernous malformations (CCMs). Although many articles have documented seizure outcomes after resection of CCM, few have conducted long-term follow-ups; thus, the fluctuating seizure outcomes have been neglected. The purpose of this study is to describe long-term postoperative seizure outcomes in patients with CCM and to compare seizure outcomes between patients with sporadic seizures and those with chronic seizures. Forty-six patients with CCM presenting with seizures underwent surgery. The male-to-female ratio was 1:1, and the average age at initial seizure onset was 27.6 years. The mean preoperative seizure duration was 42.7 months. Patients were divided into two groups: a chronic group (N = 20) and a sporadic group (N = 26) according to seizure frequency and duration. The mean postoperative follow-up duration was 96.3 months, and the postoperative seizure outcomes were checked annually based upon Engel's classification. After the first year of follow-up, 80.8 % of the sporadic group and 75.0 % of the chronic group were evaluated as Engel class I. These rates increased to 100.0 % and 90.0 %, respectively, at the eighth year of follow-up. Overall, 29 (63.0 %) of the 46 patients experienced changes in seizure outcomes over the follow-up period. Despite their delayed improvements, the chronic group showed less favorable outcomes throughout follow-up (p = 0.025). Long-term follow-up is indispensable for accurately assessing postoperative seizure outcomes because these outcomes change continuously. We recommend earlier surgery to achieve seizure-free status in patients with CCM. However, even in the chronic group, surgery is recommended, considering the overall delayed improvement.

  20. Psychosocial factors associated with change in pain and disability outcomes in chronic low back pain patients treated by physiotherapist: A systematic review.

    Science.gov (United States)

    Alhowimel, Ahmed; AlOtaibi, Mazyad; Radford, Kathryn; Coulson, Neil

    2018-01-01

    Almost 80% of people have low back pain at least once in their life. Clinical guidelines emphasize the use of conservative physiotherapy and the importance of staying active. While the psychological factors predicting poor recovery following surgical intervention are understood, the psychosocial factors associated with poor outcomes following physiotherapy have yet to be identified. Electronic searches of PubMed, Medline, CINAHL, PsycINFO and EBSCO were conducted using terms relating to psychosocial factors, chronic low back pain, disability and physiotherapy. Papers examining the relationship between psychosocial factors and pain and disability outcomes following physiotherapy were included. Two reviewers selected, appraised and extracted studies independently. In total, 10 observational studies were identified that suggested an association between fear of movement, depression, self-efficacy and catastrophizing in modifying pain and disability outcomes following physiotherapy. Although limited by methodological shortcomings of included studies, and heterogeneity of physiotherapy interventions and measures of disability and psychosocial outcomes, the findings are consistent with other research in the context of back pain and physiotherapy, which suggest an association between psychosocial factors, including fear of movement, catastrophizing and self-efficacy and pain and disability outcomes in chronic low back pain patients treated by physiotherapist. However, a direct relationship cannot be concluded from this study. Findings suggest an association between psychosocial factors, including fear of movement, catastrophizing and self-efficacy and pain and disability outcomes in chronic low back pain patients treated by physiotherapist, which warrants further study.

  1. The changing concept of competence and categorisation of learning outcomes in Europe: Implications for the design of higher education radiography curricula at the European level

    International Nuclear Information System (INIS)

    Castillo, Joseph; Caruana, Carmel J.; Wainwright, David

    2011-01-01

    The Bologna process has made the qualifications framework of the European Higher Educational Area based on three cycles and on learning outcomes central to curriculum development in higher education in Europe. The Tuning Educational Structures in Europe project recommended that learning outcomes be expressed in terms of competences. The expression of educational programme learning outcomes as inventories of competences has since become the norm at the European level. However, the more recent European Qualifications Framework for lifelong learning utilises a tripartite set of categories of learning outcomes, namely, knowledge, skills and competence. In addition, the definition of competence used though overlapping with that used by Tuning, is however not identical. This article reviews and discusses the changing definition of the concept of competence and changes in categorisation of learning outcomes in Europe and their potential impact on curriculum development in radiography at the European level. It is proposed that the shift in the definition of competence and in the categorisation of learning outcomes should be taken into account in the formulation of new European curricula or the updating of present ones so that they may reference in a more direct manner to the levels of the European Qualifications Framework.

  2. Clinical and Virologic Outcomes After Changes in First Antiretroviral Regimen at 7 Sites in the Caribbean, Central and South America Network.

    Science.gov (United States)

    Wolff, Marcelo; Shepherd, Bryan E; Cortés, Claudia; Rebeiro, Peter; Cesar, Carina; Wagner Cardoso, Sandra; Pape, Jean W; Padgett, Denis; Sierra-Madero, Juan; Echevarria, Juan; McGowan, Catherine C

    2016-01-01

    HIV-infected persons in resource-limited settings may experience high rates of antiretroviral therapy (ART) change, particularly because of toxicity or other nonfailure reasons. Few reports address patient outcomes after these modifications. HIV-infected adults from the 7 Caribbean, Central and South America network clinical cohorts who modified >1 drug from the first ART regimen (ART-1) for any reason thereby starting a second regimen (ART-2) were included. We assessed cumulative incidence of, and factors associated with, death, virologic failure (VF), and regimen change after starting ART-2. Five thousand five hundred sixty-five ART-naive highly active ART initiators started ART-2 after a median of 9.8 months on ART-1; 39% changed to ART-2 because of toxicity and 11% because of failure. Median follow-up after starting ART-2 was 2.9 years; 45% subsequently modified ART-2. Cumulative incidences of death at 1, 3, and 5 years after starting ART-2 were 5.1%, 8.4%, and 10.5%, respectively. In adjusted analyses, death was associated with older age, clinical AIDS, lower CD4 at ART-2 start, earlier calendar year, and starting ART-2 because of toxicity (adjusted hazard ratio = 1.5 vs. failure, 95% confidence interval: 1.0 to 2.1). Cumulative incidences of VF after 1, 3, and 5 years were 9%, 19%, and 25%. In adjusted analyses, VF was associated with younger age, earlier calendar year, lower CD4 at the start of ART-2, and starting ART-2 because of failure (adjusted hazard ratio = 2.1 vs. toxicity, 95% confidence interval: 1.5 to 2.8). Among patients modifying the first ART regimen, risks of subsequent modifications, mortality, and virologic failure were high. Access to improved antiretrovirals in the region is needed to improve initial treatment success.

  3. Early serum creatinine changes and outcomes in patients admitted for acute heart failure: the cardio-renal syndrome revisited.

    Science.gov (United States)

    Núñez, Julio; Garcia, Sergio; Núñez, Eduardo; Bonanad, Clara; Bodí, Vicent; Miñana, Gema; Santas, Enrique; Escribano, David; Bayes-Genis, Antonio; Pascual-Figal, Domingo; Chorro, Francisco J; Sanchis, Juan

    2017-08-01

    The changes in renal function that occurred in patients with acute decompensated heart failure (ADHF) are prevalent, and have multifactorial etiology and dissimilar prognosis. To what extent the prognostic role of such changes may vary according to the presence of renal insufficiency at admission is not clear. Accordingly, we sought to determine whether early creatinine changes (ΔCr) (admission to 48-72 hours) had an effect on 1-year mortality relative to the presence of renal insufficiency at admission. We included 705 consecutive patients admitted with the diagnosis of ADHF. Admission renal insufficiency was defined as serum creatinine ≥1.4mg/dl (A-RI cr ) or estimated glomerular filtration rate renal insufficiency (24.7% and 42.8% for A-RIcr and A-RIGFR, respectively) had higher prevalence of extreme values in ΔCr in either direction (increasing/decreasing). At 1-year follow-up, 114 (16.2%) deaths were registered. The multivariable analysis showed a significant interaction between admission renal insufficiency and ΔCr ( p=0.004 and p=0.019 for A-RIcr and A-RIGFR, respectively). In the presence of renal insufficiency, the continuum of ΔCr followed a positive and almost linear relationship with mortality risk. Conversely, in patients without renal insufficiency, those changes adopted a 'J-shape' trajectory with increased mortality at both ends of the curve distribution. In patients with ADHF the effect of ΔCr on 1-year mortality varied according to its magnitude and the presence of admission renal insufficiency. There was a graded-association with mortality when renal insufficiency was present on admission.

  4. Temporal changes in outcomes of women and men undergoing percutaneous coronary intervention for chronic total occlusion: 2005-2013.

    Science.gov (United States)

    Toma, Aurel; Stähli, Barbara E; Gick, Michael; Ferenc, Miroslaw; Mashayekhi, Kambis; Buettner, Heinz Joachim; Neumann, Franz-Josef; Gebhard, Catherine

    2018-06-01

    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has undergone impressive progress during the last decade, both in strategies and equipment. It is unknown whether technical refinement has translated into improved outcomes in women undergoing CTO-PCI. A total of 2002 consecutive patients (17% females, mean age 65.2 ± 10.7 years) undergoing PCI of at least one CTO lesion at our center between 01/2005 and 12/2013 were evaluated. The incidence of adverse events was compared between two time series (2005-2009 and 2010-2013). A significant increase in adverse lesion characteristics over time was noted in both, women and men (p men but not in women (p trend  men and p trend =0.9 in women). The incidence of procedural complications was significantly higher in women as compared to men and increased over the study period in women (p men. Accordingly, multivariate logistic regression analysis identified female sex as a strong predictor of PCI-related complications in recent years, while this was not the case in earlier years (adjusted HR 2.03, 95% CI 0.62-6.6, p = 0.2 and adjusted HR 4.7, 95% CI 1.8-12.3, p = 0.002, respectively, p men (log rank = 0.046), while no changes were observed in women. While higher success rates and a reduced rate of MACE have been achieved in men, the incidence of procedural complications in women undergoing CTO-PCI has increased over time.

  5. Segmented regression analysis of interrupted time series data to assess outcomes of a South American road traffic alcohol policy change.

    Science.gov (United States)

    Nistal-Nuño, Beatriz

    2017-09-01

    In Chile, a new law introduced in March 2012 decreased the legal blood alcohol concentration (BAC) limit for driving while impaired from 1 to 0.8 g/l and the legal BAC limit for driving under the influence of alcohol from 0.5 to 0.3 g/l. The goal is to assess the impact of this new law on mortality and morbidity outcomes in Chile. A review of national databases in Chile was conducted from January 2003 to December 2014. Segmented regression analysis of interrupted time series was used for analyzing the data. In a series of multivariable linear regression models, the change in intercept and slope in the monthly incidence rate of traffic deaths and injuries and association with alcohol per 100,000 inhabitants was estimated from pre-intervention to postintervention, while controlling for secular changes. In nested regression models, potential confounding seasonal effects were accounted for. All analyses were performed at a two-sided significance level of 0.05. Immediate level drops in all the monthly rates were observed after the law from the end of the prelaw period in the majority of models and in all the de-seasonalized models, although statistical significance was reached only in the model for injures related to alcohol. After the law, the estimated monthly rate dropped abruptly by -0.869 for injuries related to alcohol and by -0.859 adjusting for seasonality (P < 0.001). Regarding the postlaw long-term trends, it was evidenced a steeper decreasing trend after the law in the models for deaths related to alcohol, although these differences were not statistically significant. A strong evidence of a reduction in traffic injuries related to alcohol was found following the law in Chile. Although insufficient evidence was found of a statistically significant effect for the beneficial effects seen on deaths and overall injuries, potential clinically important effects cannot be ruled out. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd

  6. Do associations between employee self-reported organisational assessments and attitudinal outcomes change over time? An analysis of four Veterans Health Administration surveys using structural equation modelling

    CSIR Research Space (South Africa)

    Das, Sonali

    2010-12-01

    Full Text Available and their changes over time. Exposure and outcome measures are employee-assessed in all the surveys. Because it can accommodate both latent and measured variables into the model, Structural Equation Modelling (SEM) is used to capture and quantify the relationship...

  7. Complex Dynamic Systems View on Conceptual Change: How a Picture of Students' Intuitive Conceptions Accrue from Dynamically Robust Task Dependent Learning Outcomes

    Science.gov (United States)

    Koponen, Ismo T.; Kokkonen, Tommi; Nousiainen, Maiji

    2017-01-01

    We discuss here conceptual change and the formation of robust learning outcomes from the viewpoint of complex dynamic systems (CDS). The CDS view considers students' conceptions as context dependent and multifaceted structures which depend on the context of their application. In the CDS view the conceptual patterns (i.e. intuitive conceptions…

  8. New Zealand's Fourth National Communication under the United Nations Framework Convention on Climate Change. Including the Report on the Global Climate Observing System and the Report on Demonstrable Progress under the Kyoto Protocol

    International Nuclear Information System (INIS)

    2006-03-01

    The New Zealand Government is committed to playing its part in the global response to climate change. This Fourth National Communication provides a snapshot of New Zealand's progress with implementing the United Nations Framework Convention on Climate Change (UNFCCC). This document covers the period from the submission of the Third National Communication in January 2002 through to the end of December 2005. This document also contains New Zealand's Report on the Global Climate Observing System and the Report on Demonstrable Progress under the Kyoto Protocol. New Zealand's response to climate change has evolved substantially since the Third National Communication was submitted. On 19 December 2002, New Zealand became the 101st nation to ratify the Kyoto Protocol. In 2002, the New Zealand Parliament passed the Climate Change Response Act. This Act established a New Zealand climate change registry and corresponding institutional arrangements in accordance with Kyoto Protocol requirements. Other achievements are detailed throughout this Fourth National Communication. When the Government introduced its climate change policy package in 2002, it anticipated there would be three reviews of the package not later than 2005, 2007 and 2010. The reviews would be necessary to monitor progress with emissions reductions, assess the effectiveness of policies, and confirm that New Zealand was positioned to meet its commitments. The first of these reviews was commissioned by the Government in mid-2005 and completed by November 2005. The review concluded that some elements of the Government's 2002 climate change policy package should be modified to better position New Zealand to respond to the longer-term challenges of climate change. A key outcome of the policy review was the announcement by the newly elected Government in December 2005 that the previously announced carbon tax would not proceed. In addition, a suite of future work programmes would be required to inform Government

  9. Behavioral outcome including attention deficit hyperactivity disorder/hyperactivity disorder and minor neurological signs in perinatal high-risk newborns at 4-6 years of age with relation to risk factors.

    Science.gov (United States)

    Sato, Masuko; Aotani, Hirofumi; Hattori, Ritsuko; Funato, Masahisa

    2004-06-01

    Diagnostic problems with the criteria of attention deficit hyperactivity disorder (ADHD) in the Diagnostic Statistical Manual, 4th edn, have been identified. The aim of this study was to clarify whether the minor neurological signs test (MNT) the authors had previously reported was a predictor for the criteria of ADHD or hyperactivity disorder (HD) in perinatal risk children at 4-6 years of age and what kind of risk factors related to MNT. A total of 136 children discharged from neonatal intensive care units were examined at the age of 4-6 years by a developmental neuropediatrician using both MNT and diagnostic criteria of DSM-IV ADHD/ICD-10 (International Classification of Diseases, 10th edn) HD. SPSS base and professional were used for statistical analysis. On comparison of diagnostic criteria between ADHD (11.0%) and HD (27.5%), the incidence in the same subjects showed significant difference. MNT scores showed significant correlation with criteria of ADHD (P Apgar 5 in the NLBW group and toxemia of pregnancy and small for gestational age (SGA) in VLBW group were highly correlated with behavioral outcome. Minor neurological signs test score was a significant predictor for criteria of ADHD and HD. High incidences of positive MNT were suspected in not only VLBW children but also NLBW children and Apgar 5 in NLBW children and toxemia of pregnancy and SGA in VLBW children influenced behavioral outcome.

  10. A Web-Based Lifestyle Medicine Curriculum: Facilitating Education About Lifestyle Medicine, Behavioral Change, and Health Care Outcomes

    Science.gov (United States)

    Xiao, Ryan C; Sannidhi, Deepa; McBride, Yasamina; McCargo, Tracie; Stern, Theodore A

    2017-01-01

    Background Lifestyle medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of disease, and has gained significant momentum as a specialty in recent years. College is a critical time for maintenance and acquisition of healthy habits. Longer-term, more intensive web-based and in-person lifestyle medicine interventions can have a positive effect. Students who are exposed to components of lifestyle medicine in their education have improvements in their health behaviors. A semester-long undergraduate course focused on lifestyle medicine can be a useful intervention to help adopt and sustain healthy habits. Objective To describe a novel, evidence based curriculum for a course teaching the concepts of Lifestyle Medicine based on a web-based course offered at the Harvard Extension School. Methods The course was delivered in a web-based format. The Lifestyle Medicine course used evidence based principles to guide students toward a “coach approach” to behavior change, increasing their self-efficacy regarding various lifestyle-related preventive behaviors. Students are made to understand the cultural trends and national guidelines that have shaped lifestyle medicine recommendations relating to behaviors. They are encouraged to engage in behavior change. Course topics include physical activity, nutrition, addiction, sleep, stress, and lifestyle coaching and counseling. The course addressed all of the American College of Preventive Medicine/American College of Lifestyle Medicine competencies save for the competency of office systems and technologies to support lifestyle medicine counseling. Results The course was well-received, earning a ranking of 4.9/5 at the school. Conclusions A novel, semester-long course on Lifestyle Medicine at the Harvard Extension School is described. Student evaluations suggest the course was well-received. Further research is needed to evaluate whether such a course empowers students to

  11. England's time to change antistigma campaign: one-year outcomes of service user-rated experiences of discrimination.

    Science.gov (United States)

    Henderson, Claire; Corker, Elizabeth; Lewis-Holmes, Elanor; Hamilton, Sarah; Flach, Clare; Rose, Diana; Williams, Paul; Pinfold, Vanessa; Thornicroft, Graham

    2012-01-01

    This study evaluated the progress at one year of England's Time to Change (TTC) program, launched in 2009, toward meeting its target to reduce mental health-related stigma and discrimination by 5%. TTC comprises three national components: antistigma marketing campaign activities, mass physical exercise events (Time to Get Moving) to facilitate social contact between people with and without mental health problems, and an online resource on mental health and employment (Time to Challenge). Part of the TTC evaluation consists of an annual national phone survey of mental health service users. Participants (537 in 2008 and 1,047 in 2009) were current outpatient service users aged 18-65 registered with National Health Service community mental health teams that are selected annually to represent the range of socioeconomic deprivation. Telephone interviews were conducted with service users with the Discrimination and Stigma Scale (DISC) to document experienced discrimination and anticipated discrimination in the past 12 months. One or more experiences of discrimination were reported by 9-1% of participants in 2008 and 87% of participants in 2009 (p = .03). In 2009 significantly less discrimination was reported from a number of common sources, including family (reported by 53% in 2008 and 46% in 2009), friends (53% and 39%), finding employment (24% and 16%), and keeping employment (from 17% to 13%). Experiences of discrimination from mental health professionals did not change significantly (reported by about one-third of participants in both years). Results suggest positive progress toward meeting the program's targeted 5% reduction in discrimination.

  12. The Relationship between Obsessive Compulsive Personality and Obsessive Compulsive Disorder Treatment Outcomes: Predictive Utility and Clinically Significant Change.

    Science.gov (United States)

    Sadri, Shalane K; McEvoy, Peter M; Egan, Sarah J; Kane, Robert T; Rees, Clare S; Anderson, Rebecca A

    2017-09-01

    The evidence regarding whether co-morbid obsessive compulsive personality disorder (OCPD) is associated with treatment outcomes in obsessive compulsive disorder (OCD) is mixed, with some research indicating that OCPD is associated with poorer response, and some showing that it is associated with improved response. We sought to explore the role of OCPD diagnosis and the personality domain of conscientiousness on treatment outcomes for exposure and response prevention for OCD. The impact of co-morbid OCPD and conscientiousness on treatment outcomes was examined in a clinical sample of 46 participants with OCD. OCPD diagnosis and scores on conscientiousness were not associated with poorer post-treatment OCD severity, as indexed by Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, although the relative sample size of OCPD was small and thus generalizability is limited. This study found no evidence that OCPD or conscientiousness were associated with treatment outcomes for OCD. Further research with larger clinical samples is required.

  13. Impact of violence against women on severe acute maternal morbidity in the intensive care unit, including neonatal outcomes: a case-control study protocol in a tertiary healthcare facility in Lima, Peru.

    Science.gov (United States)

    Ayala Quintanilla, Beatriz Paulina; Pollock, Wendy E; McDonald, Susan J; Taft, Angela J

    2018-03-14

    Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU). These women represent the most critically ill obstetric patients of the maternal morbidity spectrum and should be studied to complement the review of maternal mortality. VAW has been associated with all-cause maternal deaths, and since many women (30%) endure violence usually exerted by their intimate partners and this abuse can be severe during pregnancy, it is important to determine whether it impacts SAMM. Thus, this study aims to investigate the impact of VAW on SAMM in the ICU. This will be a prospective case-control study undertaken in a tertiary healthcare facility in Lima-Peru, with a sample size of 109 cases (obstetric patients admitted to the ICU) and 109 controls (obstetric patients not admitted to the ICU selected by systematic random sampling). Data on social determinants, medical and obstetric characteristics, VAW, pregnancy and neonatal outcome will be collected through interviews and by extracting information from the medical records using a pretested form. Main outcome will be VAW rate and neonatal mortality rate between cases and controls. VAW will be assessed by using the WHO instrument. Binary logistic followed by stepwise multivariate regression and goodness of fit test will assess any association between VAW and SAMM. Ethical approval has been granted by the La Trobe University, Melbourne-Australia and the tertiary healthcare facility in Lima-Peru. This research follows the WHO ethical and safety recommendations for research on VAW. Findings will be presented at conferences and published in peer-reviewed journals. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

  14. Impact of violence against women on severe acute maternal morbidity in the intensive care unit, including neonatal outcomes: a case–control study protocol in a tertiary healthcare facility in Lima, Peru

    Science.gov (United States)

    Ayala Quintanilla, Beatriz Paulina; Pollock, Wendy E; McDonald, Susan J; Taft, Angela J

    2018-01-01

    Introduction Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU). These women represent the most critically ill obstetric patients of the maternal morbidity spectrum and should be studied to complement the review of maternal mortality. VAW has been associated with all-cause maternal deaths, and since many women (30%) endure violence usually exerted by their intimate partners and this abuse can be severe during pregnancy, it is important to determine whether it impacts SAMM. Thus, this study aims to investigate the impact of VAW on SAMM in the ICU. Methods and analysis This will be a prospective case-control study undertaken in a tertiary healthcare facility in Lima-Peru, with a sample size of 109 cases (obstetric patients admitted to the ICU) and 109 controls (obstetric patients not admitted to the ICU selected by systematic random sampling). Data on social determinants, medical and obstetric characteristics, VAW, pregnancy and neonatal outcome will be collected through interviews and by extracting information from the medical records using a pretested form. Main outcome will be VAW rate and neonatal mortality rate between cases and controls. VAW will be assessed by using the WHO instrument. Binary logistic followed by stepwise multivariate regression and goodness of fit test will assess any association between VAW and SAMM. Ethics and dissemination Ethical approval has been granted by the La Trobe University, Melbourne-Australia and the tertiary healthcare facility in Lima-Peru. This research follows the WHO ethical and safety recommendations for research on VAW. Findings will be presented at conferences and published in peer-reviewed journals. PMID:29540421

  15. Residual limb fluid volume change and volume accommodation: Relationships to activity and self-report outcomes in people with trans-tibial amputation.

    Science.gov (United States)

    Sanders, Joan E; Youngblood, Robert T; Hafner, Brian J; Ciol, Marcia A; Allyn, Katheryn J; Gardner, David; Cagle, John C; Redd, Christian B; Dietrich, Colin R

    2018-02-01

    Fluctuations in limb volume degrade prosthesis fit and require users to accommodate changes using management strategies, such as donning and doffing prosthetic socks. To examine how activities and self-report outcomes relate to daily changes in residual limb fluid volume and volume accommodation. Standardized, two-part laboratory protocol with an interim observational period. Participants were classified as "accommodators" or "non-accommodators," based on self-report prosthetic sock use. Participants' residual limb fluid volume change was measured using a custom bioimpedance analyzer and a standardized in-laboratory activity protocol. Self-report health outcomes were assessed with the Socket Comfort Score and Prosthesis Evaluation Questionnaire. Activity was monitored while participants left the laboratory for at least 3 h. They then returned to repeat the bioimpedance test protocol. Twenty-nine people were enrolled. Morning-to-afternoon percent limb fluid volume change per hour was not strongly correlated to percent time weight-bearing or to self-report outcomes. As a group, non-accommodators ( n = 15) spent more time with their prosthesis doffed and reported better outcomes than accommodators. Factors other than time weight-bearing may contribute to morning-to-afternoon limb fluid volume changes and reported satisfaction with the prosthesis among trans-tibial prosthesis users. Temporary doffing may be a more effective and satisfying accommodation method than sock addition. Clinical relevance Practitioners should be mindful that daily limb fluid volume change and prosthesis satisfaction are not dictated exclusively by activity. Temporarily doffing the prosthesis may slow daily limb fluid volume loss and should be investigated as an alternative strategy to sock addition.

  16. Clinical and virologic outcomes after changes in first antiretroviral regimen at 7 sites in the Caribbean, Central and South America Network (CCASAnet)

    Science.gov (United States)

    Wolff, Marcelo; Shepherd, Bryan E.; Cortés, Claudia; Rebeiro, Peter; Cesar, Carina; Cardoso, Sandra Wagner; Pape, Jean W.; Padgett, Denis; Sierra-Madero, Juan; Echevarria, Juan; McGowan, Catherine C.

    2015-01-01

    Background HIV-infected persons in lower income countries may experience high rates of antiretroviral therapy (ART) change, particularly due to toxicity or other non-failure reasons. Few reports address patient outcomes after these modifications. Methods HIV-infected adults from 7 Caribbean, Central and South America network (CCASAnet) clinical cohorts who modified > or = 1 drug from first ART regimen (ART-1) for any reason thereby starting a second regimen (ART-2) were included. Results 5,565 ART-naïve HAART initiators started ART-2 after a median of 9.8 months on ART-1; 39% changed to ART-2 due to toxicity and 11% due to failure. Median follow-up after starting ART-2 was 2.9 years; 45% subsequently modified ART-2. Cumulative incidences of death at 1, 3, and 5 years after starting ART-2 were 5.1%, 8.4% and 10.5%, respectively. In adjusted analyses, death was associated with older age, clinical AIDS, lower CD4 at ART-2 start, earlier calendar year, and starting ART-2 because of toxicity (adjusted hazard ratio[aHR]=1.5 vs. failure, 95% confidence interval[CI]=1.0–2.1). Cumulative incidences of VF after 1, 3, and 5 years were 9%, 19%, and 25%. In adjusted analyses, VF was associated with younger age, earlier calendar year, lower CD4 at start of ART-2, and starting ART-2 because of failure (aHR=2.1 vs. toxicity, 95% CI=1.5–2.8). Conclusions Among patients modifying first ART regimen, risks of subsequent modifications, mortality, and virologic failure were high. Access to improved antiretrovirals in the region is needed to improve initial treatment success. PMID:26761273

  17. Do Savings Mediate Changes in Adolescents' Future Orientation and Health-Related Outcomes? Findings From Randomized Experiment in Uganda.

    Science.gov (United States)

    Karimli, Leyla; Ssewamala, Fred M

    2015-10-01

    This present study tests the proposition that an economic strengthening intervention for families caring for AIDS-orphaned adolescents would positively affect adolescent future orientation and psychosocial outcomes through increased asset accumulation (in this case, by increasing family savings). Using longitudinal data from the cluster-randomized experiment, we ran generalized estimating equation models with robust standard errors clustering on individual observations. To examine whether family savings mediate the effect of the intervention on adolescents' future orientation and psychosocial outcomes, analyses were conducted in three steps: (1) testing the effect of intervention on mediator; (2) testing the effect of mediator on outcomes, controlling for the intervention; and (3) testing the significance of mediating effect using Sobel-Goodman method. Asymmetric confidence intervals for mediated effect were obtained through bootstrapping-to address the assumption of normal distribution. Results indicate that participation in a matched Child Savings Account (CSA) program improved adolescents' future orientation and psychosocial outcomes by reducing hopelessness, enhancing self-concept, and improving adolescents' confidence about their educational plans. However, the positive intervention effect on adolescent future orientation and psychosocial outcomes was not transmitted through saving. In other words, participation in the matched CSA program improved adolescent future orientation and psychosocial outcomes regardless of its impact on reported savings. Further research is necessary to understand exactly how participation in economic strengthening interventions, for example, those that employ matched CSAs, shape adolescent future orientation and psychosocial outcomes: what, if not savings, transmits the treatment effect and how? Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  18. Change in cross-sectional area of esophageal muscle does not correlate with the outcome of achalasia after pneumatic balloon dilatation.

    Science.gov (United States)

    Sinn, Dong Hyun; Choi, Yong Sung; Kim, Jeong Hwan; Kim, Eun Ran; Son, Hee Jung; Kim, Jae J; Rhee, Jong Chul; Rhee, Poong-Lyul

    2010-03-01

    Patients with achalasia have a thicker muscularis propria compared to normal patients. Because pneumatic balloon dilatation (PD) is an effective treatment for achalasia, the changes in the esophageal muscles after PD may predict treatment outcomes, if muscular change is of primary importance. In the present study, we aimed to observe the changes in esophageal muscle thickness following PD and assessed whether symptom relapse can be predicted on the basis of the esophageal muscle cross-sectional area (CSA), as measured by high-frequency intraluminal ultrasound (HFIUS). Fifteen patients treated by PD were studied and followed up for a median of 3.6 years. An HFIUS was done before PD and 6 months after PD. The esophageal muscle CSA measured at the lower esophageal sphincter (LES), and 3 and 6 cm above the LES, was used to see whether any association was present between symptom recurrence and the esophageal muscle CSA. A single PD resulted in a 2-year remission rate of 66%. A significance variance in change (-65%-248%) was noticed in the muscle CSA after PD. The predilation muscle CSA, post-dilation muscle CSA, and change in the muscle CSA after PD was not associated with symptom recurrence. Our findings suggest that measuring the muscle CSA does not help to predict treatment outcome. Muscular changes in achalasia might be just reactive changes.

  19. Changes in highly sensitive alpha-fetoprotein for the prediction of the outcome in patients with hepatocellular carcinoma after hepatectomy

    International Nuclear Information System (INIS)

    Toyoda, Hidenori; Kumada, Takashi; Tada, Toshifumi; Ito, Takanori; Maeda, Atsuyuki; Kaneoka, Yuji; Kagebayashi, Chiaki; Satomura, Shinji

    2014-01-01

    We investigated changes in highly sensitive lens culinaris agglutinin A-reactive fraction of alpha-fetoprotein (hsAFP-L3) measured using a novel method and its predictive ability for prognosis in patients with hepatocellular carcinoma (HCC) who underwent curative hepatectomy, comparing to other HCC tumor markers, that is, AFP, des-gamma-carboxy prothrombin (DCP), and AFP-L3 measured with conventional method (cAFP-L3). AFP, DCP, and AFP-L3 including both cAFP-L3 and hsAFP-L3 were measured before and after curative hepatectomy in 187 patients. The percentage of patients with elevated tumor marker levels pre- and postoperatively was compared, and recurrence-free and overall survival rates were analyzed based on changes in tumor markers. The percentages of patients with elevated AFP, DCP, and cAFP-L3 decreased postoperatively. In contrast, the percentage of patients with elevated hsAFP-L3 did not decrease postoperatively. Both recurrence-free and overall survival rates were significantly lower in patients whose tumor marker levels remained elevated postoperatively than patients without tumor marker elevation postoperatively. Recurrence-free and overall survival rates of patients in whom hsAFP-L3 became elevated postoperatively despite normal preoperative hsAFP-L3 levels were significantly lower than those of patients with normal hsAFP-L3 postoperatively, and were similar to those of patients with persistent elevation. Preoperative elevations of AFP, DCP, and cAFP normalized in many patients postoperatively, but not for hsAFP-L3. The elevation of hsAFP-L3 identifies patients with poor prognosis despite the normalization of AFP and DCP

  20. Health-related quality of life before and after pediatric epilepsy surgery: the influence of seizure outcome on changes in physical functioning and social functioning.

    Science.gov (United States)

    Titus, Jeffrey B; Lee, Amy; Kasasbeh, Aimen; Thio, Liu Lin; Stephenson, Jennifer; Steger-May, Karen; Limbrick, David D; Smyth, Matthew D

    2013-06-01

    Health-related quality of life (HRQOL) is an important outcome in pediatric epilepsy surgery, but there are few studies that utilize presurgical ratings to assess the effect of surgery on HRQOL. We collected parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 28 children who participated in neuropsychological assessment before and after epilepsy surgery. Our results revealed significant improvements in overall HRQOL after surgery, especially in physical and social activities. These changes were apparent despite generally unchanged intellectual and psychological functioning. Children with better seizure outcome had more improvement in HRQOL; however, improvements were not statistically different among children with Engel class I, II, and III outcomes. Our results suggest that children can experience significant improvements in HRQOL following epilepsy surgery even when neuropsychological functioning remains unchanged. Moreover, improvements in HRQOL appear evident in children who experience any worthwhile improvement in seizure control (Engel class III or better). Copyright © 2013 Elsevier Inc. All rights reserved.

  1. The Effect of Significant International Sports Events on Qualified Detoxification Treatment Outcome - Do Drop-Out Rates Change during UEFA European Championship?

    Directory of Open Access Journals (Sweden)

    Yvonne Sofin

    Full Text Available No previous studies have evaluated the influence of significant international sports events on qualified detoxification treatment outcome. This prospective study examines the impact of the 2012 UEFA European Football Championship on inpatient treatment outcome of alcohol dependent patients. Hospital admission and premature drop-out rates of consecutively admitted alcohol dependent patients were determined before, during and immediately after the UEFA Championship in the year 2012. The admission rate of male patients increased significantly after the European Football Championship had ended whereas for female patients, no change in admission rate was found. Daily average discharge rate was calculated. No statistically relevant differences between the treatment days before, during and after the UEFA Championship was found for the discharges. During the tournament, exclusively male patients dropped out. Our results are consistent with an interpretation of an association between European Football Championship and detoxification treatment outcome. Further research to replicate and extend our findings is necessary.

  2. A Web-Based Lifestyle Medicine Curriculum: Facilitating Education About Lifestyle Medicine, Behavioral Change, and Health Care Outcomes.

    Science.gov (United States)

    Frates, Elizabeth Pegg; Xiao, Ryan C; Sannidhi, Deepa; McBride, Yasamina; McCargo, Tracie; Stern, Theodore A

    2017-09-11

    Lifestyle medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of disease, and has gained significant momentum as a specialty in recent years. College is a critical time for maintenance and acquisition of healthy habits. Longer-term, more intensive web-based and in-person lifestyle medicine interventions can have a positive effect. Students who are exposed to components of lifestyle medicine in their education have improvements in their health behaviors. A semester-long undergraduate course focused on lifestyle medicine can be a useful intervention to help adopt and sustain healthy habits. To describe a novel, evidence based curriculum for a course teaching the concepts of Lifestyle Medicine based on a web-based course offered at the Harvard Extension School. The course was delivered in a web-based format. The Lifestyle Medicine course used evidence based principles to guide students toward a "coach approach" to behavior change, increasing their self-efficacy regarding various lifestyle-related preventive behaviors. Students are made to understand the cultural trends and national guidelines that have shaped lifestyle medicine recommendations relating to behaviors. They are encouraged to engage in behavior change. Course topics include physical activity, nutrition, addiction, sleep, stress, and lifestyle coaching and counseling. The course addressed all of the American College of Preventive Medicine/American College of Lifestyle Medicine competencies save for the competency of office systems and technologies to support lifestyle medicine counseling. The course was well-received, earning a ranking of 4.9/5 at the school. A novel, semester-long course on Lifestyle Medicine at the Harvard Extension School is described. Student evaluations suggest the course was well-received. Further research is needed to evaluate whether such a course empowers students to adopt behavior changes. ©Elizabeth Pegg Frates, Ryan C

  3. Assessment of reliability, validity, responsiveness and minimally important change of the German Hip dysfunction and osteoarthritis outcome score (HOOS) in patients with osteoarthritis of the hip.

    Science.gov (United States)

    Arbab, Dariusch; van Ochten, Johannes H M; Schnurr, Christoph; Bouillon, Bertil; König, Dietmar

    2017-12-01

    Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopedic procedures. The intention of this study was to evaluate reliability, validity, responsiveness and minimally important change of the German version of the Hip dysfunction and osteoarthritis outcome score (HOOS). The German HOOS was investigated in 251 consecutive patients before and 6 months after total hip arthroplasty. All patients completed HOOS, Oxford-Hip Score, Short-Form (SF-36) and numeric scales for pain and disability. Test-retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. The German HOOS demonstrated excellent test-retest reliability with intraclass correlation coefficient values > 0.7. Cronbach´s alpha values demonstrated strong internal consistency. As hypothesized, HOOS subscales strongly correlated with corresponding OHS and SF-36 domains. All subscales showed excellent (effect size/standardized response means > 0.8) responsiveness between preoperative assessment and postoperative follow-up. The HOOS and all subdomains showed higher changes than the minimal detectable change which indicates true changes. The German version of the HOOS demonstrated good psychometric properties. It proved to be valid, reliable and responsive to the changes instrument for use in patients with hip osteoarthritis undergoing total hip replacement.

  4. Association between outcome and changes in plasma lactate concentration during presurgical treatment in dogs with gastric dilatation-volvulus: 64 cases (2002-2008).

    Science.gov (United States)

    Zacher, Laurie A; Berg, John; Shaw, Scott P; Kudej, Raymond K

    2010-04-15

    To determine whether changes in presurgical plasma lactate concentration (before and after initial fluid resuscitation and gastric decompression) were associated with short-term outcome for dogs with gastric dilatation-volvulus (GDV). Retrospective case series. 64 dogs. Medical records were reviewed, and signalment, history, resuscitative treatments, serial presurgical lactate concentrations, surgical findings, and short-term outcome were obtained for dogs with confirmed GDV. 36 of 40 (90%) dogs with an initial lactate concentration dogs with a high initial lactate (HIL) concentration (> 9.0 mmol/L). Within HIL dogs, there was no difference in mean +/- SD initial lactate concentration between survivors and nonsurvivors (10.6 +/- 2.3 mmol/L vs 11.2 +/- 2.3 mmol/L, respectively); however, there were significant differences in post-treatment lactate concentration, absolute change in lactate concentration, and percentage change in lactate concentration following resuscitative treatment. By use of optimal cutoff values within HIL dogs, survival rates for dogs with final lactate concentration > 6.4 mmol/L (23%), absolute change in lactate concentration dogs with a final lactate concentration 4 mmol/L (86%), or percentage change in lactate concentration > 42.5% (100%). Calculating changes in plasma lactate concentration following initial treatment in dogs with GDV may assist in determining prognosis and identifying patients that require more aggressive treatment.

  5. Campus Climate Matters: Changing the Mental Health Climate on College Campuses Improves Student Outcomes and Benefits Society. Research Brief

    Science.gov (United States)

    RAND Corporation, 2016

    2016-01-01

    California, which has some 2.8 million students on its public higher education campuses, is taking steps to reduce the gap between students' need for mental health treatment and their use of mental health services. Beginning in 2011, as part of a statewide initiative to improve mental health outcomes for all Californians, the California Mental…

  6. Treatment outcome and long-term stability of skeletal changes following maxillary distraction in adult subjects of cleft lip and palate

    OpenAIRE

    Satinder Pal Singh; Ashok Kumar Jena; Vidya Rattan; Ashok Kumar Utreja

    2012-01-01

    Aim : To evaluate the treatment outcome and long-term stability of skeletal changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Materials and Methods: Total 12 North Indian adult patients in the age range of 17-34 years with cleft lip and palate underwent advancement of maxilla by distraction osteogenesis. Lateral cephalograms recorded prior to distraction, at the end of distraction, 6 months after distraction, and at least 24 month...

  7. Managing burn victims of suicide bombing attacks: outcomes, lessons learnt, and changes made from three attacks in Indonesia.

    Science.gov (United States)

    Chim, Harvey; Yew, Woon Si; Song, Colin

    2007-01-01

    Terror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003 (Jakarta), 2004 (Jakarta), and 2005 (Bali) have turned terrorist attacks into an ever-present reality. The authors reviewed medical charts of victims evacuated to the Singapore General Hospital (SGH) Burns Centre during three suicide attacks involving Bali (2002 and 2005) and the Jakarta Marriott hotel (2003). Problems faced, lessons learnt, and costs incurred are discussed. A burns disaster plan drawing on lessons learnt from these attacks is presented. Thirty-one patients were treated at the SGH Burns Centre in three attacks (2002 Bali attack [n = 15], 2003 Jakarta attack [n = 14], and 2005 Bali attack [n = 2]). For the 2002 Bali attack, median age was 29 years (range 20 to 50 years), median percentage of total burn surface area (TBSA) was 29% (range 5% to 55%), and median abbreviated burn severity index (ABSI) was 6 (range 3 to 10). Eight of 15 patients were admitted to the intensive care unit. For the 2003 Jakarta attack, median age was 35 years (range 24 to 56 years), median percentage of TBSA was 10% (range 2% to 46%), and median ABSI was 4 (range 3 to 9). A large number of patients had other injuries. Problems faced included manpower issues, lack of bed space, shortage of blood products, and lack of cadaver skin. The changing nature of terror attacks mandates continued vigilance and disaster preparedness. The multidimensional burns patient, complicated by other injuries, is likely to become increasingly common. A burns disaster plan with emphasis on effective command, control, and communication as well as organisation of health care personnel following a 'team concept' will do much to ensure that the sudden onset of a crisis situation at an unexpected time does not overwhelm hospital manpower and resources.

  8. Impact of choice of future climate change projection on growth chamber experimental outcomes: a preliminary study in potato

    Science.gov (United States)

    Leisner, Courtney P.; Wood, Joshua C.; Vaillancourt, Brieanne; Tang, Ying; Douches, Dave S.; Robin Buell, C.; Winkler, Julie A.

    2017-11-01

    Understanding the impacts of climate change on agriculture is essential to ensure adequate future food production. Controlled growth experiments provide an effective tool for assessing the complex effects of climate change. However, a review of the use of climate projections in 57 previously published controlled growth studies found that none considered within-season variations in projected future temperature change, and few considered regional differences in future warming. A fixed, often arbitrary, temperature perturbation typically was applied for the entire growing season. This study investigates the utility of employing more complex climate change scenarios in growth chamber experiments. A case study in potato was performed using three dynamically downscaled climate change projections for the mid-twenty-first century that differ in terms of the timing during the growing season of the largest projected temperature changes. The climate projections were used in growth chamber experiments for four elite potato cultivars commonly planted in Michigan's major potato growing region. The choice of climate projection had a significant influence on the sign and magnitude of the projected changes in aboveground biomass and total tuber count, whereas all projections suggested an increase in total tuber weight and a decrease in specific gravity, a key market quality trait for potato, by mid-century. These results demonstrate that the use of more complex climate projections that extend beyond a simple incremental change can provide additional insights into the future impacts of climate change on crop production and the accompanying uncertainty.

  9. Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

    Science.gov (United States)

    Matthews, Lynda R; Hanley, Francine; Lewis, Virginia; Howe, Caroline

    2015-01-01

    With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers

  10. Photoreceptor change and visual outcome after idiopathic epiretinal membrane removal with or without additional internal limiting membrane peeling.

    Science.gov (United States)

    Ahn, Seong Joon; Ahn, Jeeyun; Woo, Se Joon; Park, Kyu Hyung

    2014-01-01

    To compare the postoperative photoreceptor status and visual outcome after epiretinal membrane removal with or without additional internal limiting membrane (ILM) peeling. Medical records of 40 eyes from 37 patients undergoing epiretinal membrane removal with residual ILM peeling (additional ILM peeling group) and 69 eyes from 65 patients undergoing epiretinal membrane removal without additional ILM peeling (no additional peeling group) were reviewed. The length of defects in cone outer segment tips, inner segment/outer segment junction, and external limiting membrane line were measured using spectral domain optical coherence tomography images of the fovea before and at 1, 3, 6, and 12 months after the surgery. Cone outer segment tips and inner segment/outer segment junction line defects were most severe at postoperative 1 month and gradually restored at 12 months postoperatively. The cone outer segment tips line defect in the additional ILM peeling group was significantly greater than that in the no additional peeling group at postoperative 1 month (P = 0.006), and best-corrected visual acuity was significantly worse in the former group at the same month (P = 0.001). There was no significant difference in the defect size and best-corrected visual acuity at subsequent visits and recurrence rates between the two groups. Patients who received epiretinal membrane surgery without additional ILM peeling showed better visual and anatomical outcome than those with additional ILM peeling at postoperative 1 month. However, surgical outcomes were comparable between the two groups, thereafter. In terms of visual outcome and photoreceptor integrity, additional ILM peeling may not be an essential procedure.

  11. 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....

  12. Fibroadenoma and phyllodes tumors of anogenital mammary-like glands: a series of 13 neoplasms in 12 cases, including mammary-type juvenile fibroadenoma, fibroadenoma with lactation changes, and neurofibromatosis-associated pseudoangiomatous stromal hyperplasia with multinucleated giant cells.

    Science.gov (United States)

    Kazakov, Dmitry V; Spagnolo, Dominic V; Stewart, Colin J; Thompson, Jane; Agaimy, Abbas; Magro, Gaetano; Bisceglia, Michele; Vazmitel, Marina; Kacerovska, Denisa; Kutzner, Heinz; Mukensnabl, Petr; Michal, Michal

    2010-01-01

    The authors present a series of 13 fibroepithelial neoplasms involving anogenital mammary-like glands, all occurring in 12 female patients, whose age at diagnosis ranged from 30 to 51 years (mean, 38 y; median, 42 y). All women presented with a solitary asymptomatic nodule in the vulva (n=8), perineum (n=2), or near the anus (n=2) ranging in size from 1.5 to 4.5 cm. Microscopically, 8 lesions were classified as fibroadenoma, and 5, including 1 recurrent tumor, as phyllodes tumor, of which 1 was benign and 4 low-grade malignant. In addition to conventional findings, we describe several hitherto unreported features including juvenile fibroadenoma-like proliferation, fibroadenoma with lactation change, and pseudoangiomatous stromal hyperplasia with multinucleated stromal giant cells in a patient with neurofibromatosis, type 1 all constituting potential diagnostic pitfalls, which are best averted by using the same approach to diagnosis as for their analogous mammary counterparts.

  13. Developing an analytical tool for evaluating EMS system design changes and their impact on cardiac arrest outcomes: combining geographic information systems with register data on survival rates

    Directory of Open Access Journals (Sweden)

    Sund Björn

    2013-02-01

    Full Text Available Abstract Background Out-of-hospital cardiac arrest (OHCA is a frequent and acute medical condition that requires immediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical tool for evaluating Emergency Medical Services (EMS system design changes. The study also is an attempt to validate the proposed model used to generate the outcome measures for the study. Methods and results This was done by combining a geographic information systems (GIS simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the ambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first responders (dual dispatch increased survival to 6.2 per cent from the baseline level. The model predictions were validated using empirical data. Conclusion We have presented an analytical tool that easily can be generalized to other regions or countries. The model can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the alarm process, e.g. (1 static changes such as trimming the emergency call handling time or (2 dynamic changes such as location of emergency resources or which resources should carry a defibrillator.

  14. Funding source and primary outcome changes in clinical trials registered on ClinicalTrials.gov are associated with the reporting of a statistically significant primary outcome: a cross-sectional study [v2; ref status: indexed, http://f1000r.es/5bj

    Directory of Open Access Journals (Sweden)

    Sreeram V Ramagopalan

    2015-04-01

    Full Text Available Background: We and others have shown a significant proportion of interventional trials registered on ClinicalTrials.gov have their primary outcomes altered after the listed study start and completion dates. The objectives of this study were to investigate whether changes made to primary outcomes are associated with the likelihood of reporting a statistically significant primary outcome on ClinicalTrials.gov. Methods: A cross-sectional analysis of all interventional clinical trials registered on ClinicalTrials.gov as of 20 November 2014 was performed. The main outcome was any change made to the initially listed primary outcome and the time of the change in relation to the trial start and end date. Findings: 13,238 completed interventional trials were registered with ClinicalTrials.gov that also had study results posted on the website. 2555 (19.3% had one or more statistically significant primary outcomes. Statistical analysis showed that registration year, funding source and primary outcome change after trial completion were associated with reporting a statistically significant primary outcome. Conclusions: Funding source and primary outcome change after trial completion are associated with a statistically significant primary outcome report on clinicaltrials.gov.

  15. Treatment outcome and long-term stability of skeletal changes following maxillary distraction in adult subjects of cleft lip and palate

    Directory of Open Access Journals (Sweden)

    Satinder Pal Singh

    2012-01-01

    Full Text Available Aim : To evaluate the treatment outcome and long-term stability of skeletal changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Materials and Methods: Total 12 North Indian adult patients in the age range of 17-34 years with cleft lip and palate underwent advancement of maxilla by distraction osteogenesis. Lateral cephalograms recorded prior to distraction, at the end of distraction, 6 months after distraction, and at least 24 months (mean 25.5 ± 1.94 months after distraction osteogenesis were used for the evaluation of treatment outcome and long-term stability of the skeletal changes. Descriptive analysis, ANOVA, and post-hoc test were used, and P-value 0.05 was considered as a statistically significant level. Results: Maxillary distraction resulted in significant advancement of maxilla (P<0.001. Counterclockwise rotation of the palatal plane took place after maxillary distraction. The position of the mandible and facial heights were stable during distraction. During the first 6 months of the post-distraction period, the maxilla showed relapse of approximately 30%. However, after 6 months post distraction, the relapse was very negligible. Conclusions: Successful advancement of maxilla was achieved by distraction osteogenesis in adult subjects with cleft lip and palate. Most of the relapse occurred during the first 6 months of post-distraction period, and after that the outcomes were stable.

  16. Treatment outcome and long-term stability of skeletal changes following maxillary distraction in adult subjects of cleft lip and palate.

    Science.gov (United States)

    Singh, Satinder Pal; Jena, Ashok Kumar; Rattan, Vidya; Utreja, Ashok Kumar

    2012-04-01

    To evaluate the treatment outcome and long-term stability of skeletal changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Total 12 North Indian adult patients in the age range of 17-34 years with cleft lip and palate underwent advancement of maxilla by distraction osteogenesis. Lateral cephalograms recorded prior to distraction, at the end of distraction, 6 months after distraction, and at least 24 months (mean 25.5 ± 1.94 months) after distraction osteogenesis were used for the evaluation of treatment outcome and long-term stability of the skeletal changes. Descriptive analysis, ANOVA, and post-hoc test were used, and P-value 0.05 was considered as a statistically significant level. Maxillary distraction resulted in significant advancement of maxilla (Pmaxillary distraction. The position of the mandible and facial heights were stable during distraction. During the first 6 months of the post-distraction period, the maxilla showed relapse of approximately 30%. However, after 6 months post distraction, the relapse was very negligible. Successful advancement of maxilla was achieved by distraction osteogenesis in adult subjects with cleft lip and palate. Most of the relapse occurred during the first 6 months of post-distraction period, and after that the outcomes were stable.

  17. Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

    OpenAIRE

    Kang, Byung Ju; Jo, Kyung-Wook; Park, Tai Sun; Yoo, Jung-Wan; Lee, Sei Won; Choi, Chang-Min; Oh, Yeon-Mok; Lee, Sang-Do; Kim, Woo Sung; Kim, Dong Soon; Shim, Tae Sun

    2013-01-01

    Background The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified ...

  18. New seismograph includes filters

    Energy Technology Data Exchange (ETDEWEB)

    1979-11-02

    The new Nimbus ES-1210 multichannel signal enhancement seismograph from EG and G geometrics has recently been redesigned to include multimode signal fillers on each amplifier. The ES-1210F is a shallow exploration seismograph for near subsurface exploration such as in depth-to-bedrock, geological hazard location, mineral exploration, and landslide investigations.

  19. Climate change and the potential effects on maternal and pregnancy outcomes: an assessment of the most vulnerable--the mother, fetus, and newborn child.

    Science.gov (United States)

    Rylander, Charlotta; Odland, Jon Øyvind; Sandanger, Torkjel Manning

    2013-03-11

    In 2007, the Intergovernmental Panel on Climate Change (IPCC) presented a large amount of evidence about global warming and the impact of human activities on global climate change. The Lancet Commission have identified a number of ways in which climate change can influence human health: lack of food and safe drinking water, poor sanitation, population migration, changing disease patterns and morbidity, more frequent extreme weather events, and lack of shelter. Pregnant women, the developing fetus, and young children are considered the most vulnerable members of our species and are already marginalized in many countries. Therefore, they may have increased sensitivity to the effects of climate change. Published literature in the fields of climate change, human health, tropical diseases, and direct heat exposure were assessed through the regular search engines. This article demonstrates that climate change will increase the risk of infant and maternal mortality, birth complications, and poorer reproductive health, especially in tropical, developing countries. Thus, climate change will have a substantial impact on the health and survival of the next generation among already challenged populations. There is limited knowledge regarding which regions will be most heavily affected. Research efforts are therefore required to identify the most vulnerable populations, fill knowledge gaps, and coordinate efforts to reduce negative health consequences. The effects of malnutrition, infectious diseases, environmental problems, and direct heat exposure on maternal health outcomes will lead to severe health risks for mothers and children. Increased focus on antenatal care is recommended to prevent worsening maternal health and perinatal mortality and morbidity. Interventions to reduce the negative health impacts caused by climate change are also crucial. Every effort should be made to develop and maintain good antenatal care during extreme life conditions as a result of climate

  20. Climate change and the potential effects on maternal and pregnancy outcomes: an assessment of the most vulnerable – the mother, fetus, and newborn child

    Directory of Open Access Journals (Sweden)

    Charlotta Rylander

    2013-03-01

    Full Text Available In 2007, the Intergovernmental Panel on Climate Change (IPCC presented a large amount of evidence about global warming and the impact of human activities on global climate change. The Lancet Commission have identified a number of ways in which climate change can influence human health: lack of food and safe drinking water, poor sanitation, population migration, changing disease patterns and morbidity, more frequent extreme weather events, and lack of shelter. Pregnant women, the developing fetus, and young children are considered the most vulnerable members of our species and are already marginalized in many countries. Therefore, they may have increased sensitivity to the effects of climate change. Published literature in the fields of climate change, human health, tropical diseases, and direct heat exposure were assessed through the regular search engines. This article demonstrates that climate change will increase the risk of infant and maternal mortality, birth complications, and poorer reproductive health, especially in tropical, developing countries. Thus, climate change will have a substantial impact on the health and survival of the next generation among already challenged populations. There is limited knowledge regarding which regions will be most heavily affected. Research efforts are therefore required to identify the most vulnerable populations, fill knowledge gaps, and coordinate efforts to reduce negative health consequences. The effects of malnutrition, infectious diseases, environmental problems, and direct heat exposure on maternal health outcomes will lead to severe health risks for mothers and children. Increased focus on antenatal care is recommended to prevent worsening maternal health and perinatal mortality and morbidity. Interventions to reduce the negative health impacts caused by climate change are also crucial. Every effort should be made to develop and maintain good antenatal care during extreme life conditions as a

  1. Estimation of changes in C-reactive protein level and pregnancy outcome after nonsurgical supportive periodontal therapy in women affected with periodontitis in a rural set up of India

    Directory of Open Access Journals (Sweden)

    Mayur S Khairnar

    2015-01-01

    Full Text Available Aims and Objectives: Estimation of changes in C-reactive protein (CRP level and pregnancy outcome after nonsurgical supportive periodontal therapy in pregnant women affected with Periodontitis. Materials and Methods: A total of 100 pregnant females with periodontitis were assigned to treatment and control groups. All the details about previous and current pregnancies were obtained. Full-mouth periodontal examination was done at baseline, which included oral hygiene index simplified plaque index, gingival index, and clinical attachment loss. CRP level was also measured from collected blood sample initially at baseline and later after the delivery in both the group. Subjects in the treatment group received nonsurgical periodontal treatment during the second trimester of gestational period, and those in the control group did not receive any periodontal therapy during this period. Periodontal therapy included mechanical plaque control instructions and scaling and root planning. Outcome measures assessed were changes in CRP levels, gestational age, and birth weight of the infants. When delivery occurred at 0.05. Conclusion: Nonsurgical supportive periodontal therapy may lower the risk of preterm delivery in females affected with periodontitis by reducing CRP level.

  2. Analytic device including nanostructures

    KAUST Repository

    Di Fabrizio, Enzo M.; Fratalocchi, Andrea; Totero Gongora, Juan Sebastian; Coluccio, Maria Laura; Candeloro, Patrizio; Cuda, Gianni

    2015-01-01

    A device for detecting an analyte in a sample comprising: an array including a plurality of pixels, each pixel including a nanochain comprising: a first nanostructure, a second nanostructure, and a third nanostructure, wherein size of the first nanostructure is larger than that of the second nanostructure, and size of the second nanostructure is larger than that of the third nanostructure, and wherein the first nanostructure, the second nanostructure, and the third nanostructure are positioned on a substrate such that when the nanochain is excited by an energy, an optical field between the second nanostructure and the third nanostructure is stronger than an optical field between the first nanostructure and the second nanostructure, wherein the array is configured to receive a sample; and a detector arranged to collect spectral data from a plurality of pixels of the array.

  3. ECO2M: A TOUGH2 Fluid Property Module for Mixtures of Water, NaCl, and CO2, Including Super- and Sub-Critical Conditions, and Phase Change Between Liquid and Gaseous CO2

    Energy Technology Data Exchange (ETDEWEB)

    Pruess, K.

    2011-04-01

    ECO2M is a fluid property module for the TOUGH2 simulator (Version 2.0) that was designed for applications to geologic storage of CO{sub 2} in saline aquifers. It includes a comprehensive description of the thermodynamics and thermophysical properties of H{sub 2}O - NaCl - CO{sub 2} mixtures, that reproduces fluid properties largely within experimental error for temperature, pressure and salinity conditions in the range of 10 C {le} T {le} 110 C, P {le} 600 bar, and salinity from zero up to full halite saturation. The fluid property correlations used in ECO2M are identical to the earlier ECO2N fluid property package, but whereas ECO2N could represent only a single CO{sub 2}-rich phase, ECO2M can describe all possible phase conditions for brine-CO{sub 2} mixtures, including transitions between super- and sub-critical conditions, and phase change between liquid and gaseous CO{sub 2}. This allows for seamless modeling of CO{sub 2} storage and leakage. Flow processes can be modeled isothermally or non-isothermally, and phase conditions represented may include a single (aqueous or CO{sub 2}-rich) phase, as well as two-and three-phase mixtures of aqueous, liquid CO{sub 2} and gaseous CO{sub 2} phases. Fluid phases may appear or disappear in the course of a simulation, and solid salt may precipitate or dissolve. TOUGH2/ECO2M is upwardly compatible with ECO2N and accepts ECO2N-style inputs. This report gives technical specifications of ECO2M and includes instructions for preparing input data. Code applications are illustrated by means of several sample problems, including problems that had been previously solved with TOUGH2/ECO2N.

  4. 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

  5. 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.

  6. 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.

  7. Changing perspectives in pre-existing diabetes and obesity in pregnancy: maternal and infant short- and long-term outcomes.

    Science.gov (United States)

    Barbour, Linda A

    2014-08-01

    Climbing obesity rates in women have propelled the increasing prevalence of type 2 diabetes mellitus (T2DM) in pregnancy, and an increasing number of women with type 1 diabetes mellitus (T1DM) are also affected by obesity. Increasing recognition that an intrauterine environment characterized by obesity, insulin resistance, nutrient excess, and diabetes may be fueling the obesity epidemic in children has created enormous pressure to re-examine the conventional wisdom of our current approaches. Compelling data in pregnancies complicated by diabetes, in particular those accompanied by insulin resistance and obesity, support a fetal programming effect resulting in increased susceptibility to metabolic disease for the offspring later in life. Recent data also underscore the contribution of obesity, lipids, and lesser degrees of hyperglycemia on fetal fat accretion, challenging the wisdom of current gestational weight gain recommendations with and without diabetes. The risks of adverse pregnancy outcomes in T2DM are at least as high as in T1DM and there remains controversy about the ideal glucose treatment targets, the benefit of different insulin analogues, and the role of continuous glucose monitoring in T1DM and T2DM. It has become unmistakably evident that achieving optimal outcomes in mothers with diabetes is clearly impacted by ideal glycemic control but goes far beyond it. The intrauterine metabolic environment seems to have long-term implications on the future health of the offspring so that the effectiveness of our current approaches can no longer be simply measured by whether or not maternal glucose values are at goal.

  8. Do post-operative changes of neck-shaft angle and femoral component anteversion have an effect on clinical outcome following uncemented total hip arthroplasty?

    Science.gov (United States)

    Müller, M; Abdel, M P; Wassilew, G I; Duda, G; Perka, C

    2015-12-01

    The accurate reconstruction of hip anatomy and biomechanics is thought to be important in achieveing good clinical outcomes following total hip arthroplasty (THA). To this end some newer hip designs have introduced further modularity into the design of the femoral component such that neck-shaft angle and anteversion, which can be adjusted intra-operatively. The clinical effect of this increased modularity is unknown. We have investigated the changes in these anatomical parameters following conventional THA with a prosthesis of predetermined neck-shaft angle and assessed the effect of changes in the hip anatomy on clinical outcomes. In total, 44 patients (mean age 65.3 years (standard deviation (SD) 7); 17 male/27 female; mean body mass index 26.9 (kg/m²) (SD 3.1)) underwent a pre- and post-operative three-dimensional CT scanning of the hip. The pre- and post-operative neck-shaft angle, offset, hip centre of rotation, femoral anteversion, and stem alignment were measured. Additionally, a functional assessment and pain score were evaluated before surgery and at one year post-operatively and related to the post-operative anatomical changes. The mean pre-operative neck-shaft angle was significantly increased by 2.8° from 128° (SD 6.2; 119° to 147°) to 131° (SD 2.1; 127° to 136°) (p = 0.009). The mean pre-operative anteversion was 24.9° (SD 8; 7.9 to 39.1) and reduced to 7.4° (SD 7.3; -11.6° to 25.9°) post-operatively (p shaft angles was found with a significant decrease of the post-operative anteversion and slight increase of the neck-shaft angles, but without any impact on clinical outcome. ©2015 The British Editorial Society of Bone & Joint Surgery.

  9. New ways of working : Does flexibility in time and location of work change work behavior and affect business outcomes?

    NARCIS (Netherlands)

    Blok, M.M.; Groenesteijn, L.; Schelvis, R.; Vink, P.

    2012-01-01

    In the changing modern economy some new factors have been addressed that are of importance for productivity and economic growth, such as human skills, workplace organization, information and communication technologies (ICT) and knowledge sharing. An increasing number of companies and organizations

  10. New ways of working: Does flexibility in time and location of work change work behavior and affect business outcomes?

    NARCIS (Netherlands)

    Blok, M.M.; Groenesteijn, L.; Schelvis, R.; Vink, P.

    2012-01-01

    In the changing modern economy some new factors have been addressed that are of importance for productivity and economic growth, such as human skills, workplace organization, information and communication technologies (ICT) and knowledge sharing. An increasing number of companies and organizations

  11. Changes in Preservice Elementary Teachers' Personal Science Teaching Efficacy and Science Teaching Outcome Expectancies: The Influence of Context

    Science.gov (United States)

    Hechter, Richard P.

    2011-01-01

    This study investigated contextual changes in perceptions of science teaching self-efficacy through pre-, post- and retrospective administrations of the Science Teaching Expectancy Belief Instrument (STEBI-B) among preservice elementary teachers when exposed to a science teaching methods course. Findings revealed that the number of postsecondary…

  12. Effect of individual parameter changes on the outcome of the estimated short-term dietary exposure to pesticides.

    NARCIS (Netherlands)

    van der Velde-Koerts, Trijntje; Breysse, Nicolas; Pattingre, Lauriane; Hamey, Paul Y; Lutze, Jason; Mahieu, Karin; Margerison, Sam; Ossendorp, Bernadette C; Reich, Hermine; Rietveld, Anton; Sarda, Xavier; Vial, Gaelle; Sieke, Christian

    2018-01-01

    In 2015 a scientific workshop was held in Geneva, where updating the International Estimate of Short-Term Intake (IESTI) equations was suggested. This paper studies the effects of the proposed changes in residue inputs, large portions, variability factors and unit weights on the overall short-term

  13. Instructional Design, Facilitation, and Perceived Learning Outcomes: An Exploratory Case Study of a Human Trafficking MOOC for Attitudinal Change

    Science.gov (United States)

    Watson, Sunnie Lee; Loizzo, Jamie; Watson, William R.; Mueller, Chad; Lim, Jieun; Ertmer, Peggy A.

    2016-01-01

    This exploratory case study describes the design and facilitation of a massive open online course (MOOC) for attitudinal change regarding human trafficking. It examines the course from the learners', instructor's, and instructional designer's perspectives. Two interviews with the instructor and instructional designer were conducted, and data from…

  14. Long-term outcome of biopsy-proven, frequently relapsing minimal-change nephrotic syndrome in children.

    NARCIS (Netherlands)

    Kyrieleis, H.A.; Lowik, M.M.; Pronk, I.; Cruysberg, J.R.M.; Kremer, J.A.M.; Oyen, W.J.G.; Heuvel, L.P.W.J. van den; Wetzels, J.F.M.; Levtchenko, E.N.

    2009-01-01

    BACKGROUND AND OBJECTIVES: Frequently relapsing and steroid-dependent minimal-change nephrotic syndrome (MCNS) that originates in childhood can persist after puberty in >20% of patients. These patients require immunosuppressive treatment during several decades of their life. We examined long-term

  15. Different Mechanisms of Soil Microbial Response to Global Change Result in Different Outcomes in the MIMICS-CN Model

    Science.gov (United States)

    Kyker-Snowman, E.; Wieder, W. R.; Grandy, S.

    2017-12-01

    Microbial-explicit models of soil carbon (C) and nitrogen (N) cycling have improved upon simulations of C and N stocks and flows at site-to-global scales relative to traditional first-order linear models. However, the response of microbial-explicit soil models to global change factors depends upon which parameters and processes in a model are altered by those factors. We used the MIcrobial-MIneral Carbon Stabilization Model with coupled N cycling (MIMICS-CN) to compare modeled responses to changes in temperature and plant inputs at two previously-modeled sites (Harvard Forest and Kellogg Biological Station). We spun the model up to equilibrium, applied each perturbation, and evaluated 15 years of post-perturbation C and N pools and fluxes. To model the effect of increasing temperatures, we independently examined the impact of decreasing microbial C use efficiency (CUE), increasing the rate of microbial turnover, and increasing Michaelis-Menten kinetic rates of litter decomposition, plus several combinations of the three. For plant inputs, we ran simulations with stepwise increases in metabolic litter, structural litter, whole litter (structural and metabolic), or labile soil C. The cumulative change in soil C or N varied in both sign and magnitude across simulations. For example, increasing kinetic rates of litter decomposition resulted in net releases of both C and N from soil pools, while decreasing CUE produced short-term increases in respiration but long-term accumulation of C in litter pools and shifts in soil C:N as microbial demand for C increased and biomass declined. Given that soil N cycling constrains the response of plant productivity to global change and that soils generate a large amount of uncertainty in current earth system models, microbial-explicit models are a critical opportunity to advance the modeled representation of soils. However, microbial-explicit models must be improved by experiments to isolate the physiological and stoichiometric

  16. Smallest detectable change and test-retest reliability of a self-reported outcome measure: Results of the Center for Epidemiologic Studies Depression Scale, General Self-Efficacy Scale, and 12-item General Health Questionnaire.

    Science.gov (United States)

    Ohno, Shotaro; Takahashi, Kana; Inoue, Aimi; Takada, Koki; Ishihara, Yoshiaki; Tanigawa, Masaru; Hirao, Kazuki

    2017-12-01

    This study aims to examine the smallest detectable change (SDC) and test-retest reliability of the Center for Epidemiologic Studies Depression Scale (CES-D), General Self-Efficacy Scale (GSES), and 12-item General Health Questionnaire (GHQ-12). We tested 154 young adults at baseline and 2 weeks later. We calculated the intra-class correlation coefficients (ICCs) for test-retest reliability with a two-way random effects model for agreement. We then calculated the standard error of measurement (SEM) for agreement using the ICC formula. The SEM for agreement was used to calculate SDC values at the individual level (SDC ind ) and group level (SDC group ). The study participants included 137 young adults. The ICCs for all self-reported outcome measurement scales exceeded 0.70. The SEM of CES-D was 3.64, leading to an SDC ind of 10.10 points and SDC group of 0.86 points. The SEM of GSES was 1.56, leading to an SDC ind of 4.33 points and SDC group of 0.37 points. The SEM of GHQ-12 with bimodal scoring was 1.47, leading to an SDC ind of 4.06 points and SDC group of 0.35 points. The SEM of GHQ-12 with Likert scoring was 2.44, leading to an SDC ind of 6.76 points and SDC group of 0.58 points. To confirm that the change was not a result of measurement error, a score of self-reported outcome measurement scales would need to change by an amount greater than these SDC values. This has important implications for clinicians and epidemiologists when assessing outcomes. © 2017 John Wiley & Sons, Ltd.

  17. Being Included and Excluded

    DEFF Research Database (Denmark)

    Korzenevica, Marina

    2016-01-01

    Following the civil war of 1996–2006, there was a dramatic increase in the labor mobility of young men and the inclusion of young women in formal education, which led to the transformation of the political landscape of rural Nepal. Mobility and schooling represent a level of prestige that rural...... politics. It analyzes how formal education and mobility either challenge or reinforce traditional gendered norms which dictate a lowly position for young married women in the household and their absence from community politics. The article concludes that women are simultaneously excluded and included from...... community politics. On the one hand, their mobility and decision-making powers decrease with the increase in the labor mobility of men and their newly gained education is politically devalued when compared to the informal education that men gain through mobility, but on the other hand, schooling strengthens...

  18. Changes in Transformational Leadership and Empirical Quality Outcomes in a Finnish Hospital over a Two-Year Period: A Longitudinal Study

    Science.gov (United States)

    Mäntynen, Raija; Vehviläinen-Julkunen, Katri; Partanen, Pirjo; Turunen, Hannele; Miettinen, Merja; Kvist, Tarja

    2014-01-01

    This paper describes the changes in transformational leadership and quality outcomes that occurred between 2008 and 2011 in a Finnish university hospital that is aiming to meet the Magnet standards. Measurements were conducted in 2008-2009 and subsequently in 2010-2011 by surveying nursing staff and patients. Nursing staff were surveyed using web-based surveys to collect data on transformational leadership (n 1 = 499, n 2 = 498) and patient safety culture (n 1 = 234, n 2 = 512) and using both postal and web-based surveys to gather information on job satisfaction (n 1 = 1176, n 2 = 779). Questionnaires were used to collect data on care satisfaction from patients (n 1 = 678, n 2 = 867). Transformational leadership was measured using the 54-item TLS, job satisfaction with the 37-item KUHJSS, patient safety culture with the 42-item HSPSC, and patient satisfaction using the 42-item RHCS questionnaire. Transformational leadership, which was the weakest area, was at the same level between the two measurement occasions. Job satisfaction scores increased between 2008 and 2010, although they were generally excellent in 2008. The scores for nonpunitive responses to errors and events reported were also higher in the 2010-2011 surveys. The highest empirical outcome scores related to patient satisfaction. The project and the development initiatives undertaken since 2008 seem to have had positive effects on empirical quality outcomes. PMID:25009744

  19. Effect of individual parameter changes on the outcome of the estimated short-term dietary exposure to pesticides.

    Science.gov (United States)

    van der Velde-Koerts, Trijntje; Breysse, Nicolas; Pattingre, Lauriane; Hamey, Paul Y; Lutze, Jason; Mahieu, Karin; Margerison, Sam; Ossendorp, Bernadette C; Reich, Hermine; Rietveld, Anton; Sarda, Xavier; Vial, Gaelle; Sieke, Christian

    2018-06-03

    In 2015 a scientific workshop was held in Geneva, where updating the International Estimate of Short-Term Intake (IESTI) equations was suggested. This paper studies the effects of the proposed changes in residue inputs, large portions, variability factors and unit weights on the overall short-term dietary exposure estimate. Depending on the IESTI case equation, a median increase in estimated overall exposure by a factor of 1.0-6.8 was observed when the current IESTI equations are replaced by the proposed IESTI equations. The highest increase in the estimated exposure arises from the replacement of the median residue (STMR) by the maximum residue limit (MRL) for bulked and blended commodities (case 3 equations). The change in large portion parameter does not have a significant impact on the estimated exposure. The use of large portions derived from the general population covering all age groups and bodyweights should be avoided when large portions are not expressed on an individual bodyweight basis. Replacement of the highest residue (HR) by the MRL and removal of the unit weight each increase the estimated exposure for small-, medium- and large-sized commodities (case 1, case 2a or case 2b equations). However, within the EU framework lowering of the variability factor from 7 or 5 to 3 counterbalances the effect of changes in other parameters, resulting in an estimated overall exposure change for the EU situation of a factor of 0.87-1.7 and 0.6-1.4 for IESTI case 2a and case 2b equations, respectively.

  20. Changes in albuminuria and renal outcome in patients with type 2 diabetes and hypertension: a real-life observational study.

    Science.gov (United States)

    Viazzi, Francesca; Ceriello, Antonio; Fioretto, Paola; Giorda, Carlo; Guida, Pietro; Russo, Giuseppina; Greco, Eulalia; De Cosmo, Salvatore; Pontremoli, Roberto

    2018-04-19

    To assess the predictive role of changes in albuminuria on the loss of renal function under antihypertensive treatment in patients with type 2 diabetes (T2D). Clinical records from a total of 12 611 patients with hypertension and T2D, attending 100 antidiabetic centers in Italy, with normal estimated glomerular filtration rate (eGFR) at baseline and regular visits during a 4-year period were retrieved and analyzed. We assessed the association between changes in albuminuria status during a 1-year baseline period and time updated blood pressure (BP) and eGFR loss over the subsequent 4-year follow-up. Mean age at baseline was 65 ± 9 years, known duration of diabetes11 ± 8 years, eGFR 85 ± 13 ml/min and BP 142 ± 17/81 ± 9 mmHg. Patients with persistent albuminuria showed the highest 4-year risk of eGFR loss more than 30% from baseline or onset of stage 3 chronic kidney disease (eGFR < 60 ml/min) as compared with those with persistent normal albuminuria (odds ratio 2.00, confidence interval 1.71-2.34; P < 0.001). Female sex, age, disease duration, BMI, low baseline eGFR, lipid profile, the number of antihypertensive drugs and variations in albuminuria status were associated with renal risk in the whole study population. Furthermore, lower time updated BP values and the use of renin-angiotensin-aldosterone-system-inhibitors were related to the occurrence of renal endpoints only in the subgroup of patients without albuminuria. In patients with hypertension and T2D under real-life clinical conditions, changes in albuminuria parallel changes of renal risk. Albuminuria status could be a guide to optimize therapeutic strategy.

  1. Weight change by baseline BMI from three-year observational data: findings from the Worldwide Schizophrenia Outpatient Health Outcomes Database.

    Science.gov (United States)

    Bushe, Chris J; Slooff, Cees J; Haddad, Peter M; Karagianis, Jamie L

    2013-04-01

    The aim was to explore weight and body mass index (BMI) changes by baseline BMI in patients completing three years of monotherapy with various first- and second-generation antipsychotics in a large cohort in a post hoc analysis of three-year observational data. Data were analyzed by antipsychotic and three baseline BMI bands: underweight/normal weight (BMI 30 kg/m²). Baseline BMI was associated with subsequent weight change irrespective of the antipsychotic given. Specifically, a smaller proportion of patients gained ≥7% baseline bodyweight, and a greater proportion of patients lost ≥7% baseline bodyweight with increasing baseline BMI. For olanzapine (the antipsychotic associated with highest mean weight gain in the total drug cohort), the percentage of patients gaining ≥7% baseline weight was 45% (95% CI: 43-48) in the underweight/normal weight BMI cohort and 20% (95% CI: 15-27) in the obese BMI cohort; 7% (95% CI: 6-8) of the underweight/normal cohort and 19% (95% CI: 13-27) of the obese cohort lost ≥7% baseline weight. BMI has an association with the likelihood of weight gain or loss and should be considered in analyses of antipsychotic weight change.

  2. Exploring the effect of at-risk case management compensation on hospital pay-for-performance outcomes: tools for change.

    Science.gov (United States)

    Granata, Randy L; Hamilton, Karen

    2015-01-01

    Acute care nurse case managers are charged with compliance oversight, managing throughput, and ensuring safe care transitions. Leveraging the roles of nurse case managers and social workers during care transitions translates into improved fiscal performance under the Affordable Care Act. This article aims to equip leaders in the field of case management with tools to facilitate the alignment of case management systems with hospital pay-for-performance measures. A quality improvement project was implemented at a hospital in south Alabama to examine the question: for acute care case managers, what is the effect of key performance indictors using an at-risk compensation model in comparison to past nonincentive models on hospital readmissions, lengths of stay, and patient satisfaction surrounding the discharge process. Inpatient acute care hospital. The implementation of an at-risk compensation model using key performance indicators, Lean Six Sigma methodology, and Creative Health Care Management's Relationship-Based Care framework demonstrated reduced length of stay, hospital readmissions, and improved patient experiences. Regulatory changes and new models of reimbursement in the acute care environment have created the perfect storm for case management leaders. Hospital fiscal performance is dependent on effective case management processes and the ability to optimize scarce resources. The quality improvement project aimed to further align case management systems and structures with hospital pay-for-performance measures. Tools for change were presented to assist leaders with the change acceleration process.

  3. Characteristics of patients in routine psycho-oncological care, and changes in outcome variables during and after their treatment.

    Science.gov (United States)

    Garssen, Bert; Van der Lee, Marije; Van der Poll, Amber; Ranchor, Adelita V; Sanderman, Robbert; Schroevers, Maya J

    2016-10-01

    The primary aim of this study was to determine the characteristics of clients and interventions in routine psycho-oncological care. The secondary aim was to determine the course of symptomatology during and after the psychological interventions. During a period of nine months, all clients who sought help in one of the seven psycho-oncological care institutes in the Netherlands were approached to participate in the present study (N = 483). Information was gathered with respect to demographic and medical characteristics, and type and duration of the interventions. In addition, depression, anxiety, well-being, quality of life, fatigue and daily function were determined before interventions and three and nine months later. Compared to the Dutch cancer population, patients in psycho-oncological care were more often young and female. Compared to the general Dutch population, they were highly educated and were more likely to have a partner. Clinical levels of depression, anxiety and/or fatigue were found among 83% of the patients. After three months, only 23% had completed their intervention; this figure was 62% after nine months. Symptoms decreased significantly for all outcome variables. An importance difference with randomised controlled trials is the low session frequency and the long intervention time of patients in clinical care.

  4. Do Sexual Assault Bystander Interventions Change Men's Intentions? Applying the Theory of Normative Social Behavior to Predicting Bystander Outcomes.

    Science.gov (United States)

    Mabry, Amanda; Turner, Monique Mitchell

    2016-01-01

    The high prevalence of sexual assault on college campuses has led to the implementation of health communication programs to prevent sexual assault. A few novel programs focus on primary prevention by targeting social norms related to gender and masculinity among men through bystander intervention. Guided by the theory of normative social behavior, this study sought to examine the relative effect of campaigns communicating positive versus negative injunctive norms and the interaction between exposure to such campaign messages and perceived descriptive norms and relevant cognitive moderators (e.g., outcome expectations, injunctive norms, group identity, ego involvement) among men. A 2 (high/low descriptive norms) × 2 (high/low moderator) × 3 (public service announcement) independent groups quasi-experimental design (N = 332) was used. Results indicated that messages communicating positive injunctive norms were most effective among men who were least likely to engage in bystander intervention. Furthermore, descriptive norms played a significant role in behavioral intentions, such that those with stronger norms were more likely to report intentions to engage in bystander behaviors in the future. Similarly, the moderators of aspiration, injunctive norms, social approval, and ego involvement had a significant positive effect on behavioral intentions. These findings have important implications for future message design strategy and audience segmentation.

  5. Changes in weight and co-morbidities among adolescents undergoing bariatric surgery: 1-year results from the Bariatric Outcomes Longitudinal Database.

    Science.gov (United States)

    Messiah, Sarah E; Lopez-Mitnik, Gabriela; Winegar, Deborah; Sherif, Bintu; Arheart, Kristopher L; Reichard, Kirk W; Michalsky, Marc P; Lipshultz, Steven E; Miller, Tracie L; Livingstone, Alan S; de la Cruz-Muñoz, Nestor

    2013-01-01

    Bariatric surgery is 1 of the few effective treatments of morbid obesity. However, the weight loss and other health-related outcomes for this procedure in large, diverse adolescent patient populations have not been well characterized. Our objective was to analyze the prospective Bariatric Outcomes Longitudinal Database (BOLD) to determine the weight loss and health related outcomes in adolescents. The BOLD data are collected from 423 surgeons at 360 facilities in the United States. The main outcome measures included the anthropometric and co-morbidity status at baseline (n = 890) and at 3 (n = 786), 6 (n = 541), and 12 (n = 259) months after surgery. Adolescents (75% female; 68% non-Hispanic white, 14% Hispanic, 11% non-Hispanic black, and 6% other) aged 11 to 19 years were included in the present analyses. The overall 1-year mean weight loss for those who underwent gastric bypass surgery was more than twice that of those who underwent adjustable gastric band surgery (48.6 versus 20 kg, P surgery types (P surgery. A total of 45 readmissions occurred among gastric bypass patients and 10 among adjustable gastric band patients, with 29 and 8 reoperations required, respectively. The weight loss at 3, 6, and 12 months after surgery is approximately double in adolescent males and females who underwent gastric bypass surgery versus those who underwent adjustable gastric band surgery. Bariatric surgery can safely and substantially reduce weight and related co-morbidities in morbidly obese adolescents for ≥1 year. Copyright © 2013 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  6. Changing prostate-specific antigen outcome after surgery or radiotherapy for localized prostate cancer during the prostate-specific antigen era

    International Nuclear Information System (INIS)

    D'Amico, Anthony V.; Chen, M.-H.; Oh-Ung, Jean; Renshaw, Andrew A.; Cote, Kerri; Loffredo, Marian; Richie, Jerome P.

    2002-01-01

    Purpose: To evaluate the change in prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) or external beam radiotherapy (EBRT), controlling for follow-up during the PSA era. Methods and Materials: The study cohort consisted of 1440 patients with clinically localized prostate cancer managed with RP (n=1059) or EBRT (n=381) between 1989 and 2000. A single genitourinary pathologist reviewed all pathology specimens. For patients with a 2-year minimal follow-up, the 2-year actual PSA outcome stratified by risk group (low vs. high) was calculated for three periods (January 1, 1989 to December 31, 1992; January 1, 1993 to December 31, 1996; and January 1, 1997 to December 31, 2000) and compared for each treatment modality. PSA failure was defined using the American Society for Therapeutic Radiology and Oncology consensus definition for all patients, and comparisons were made using a chi-square metric. Results: During the study period, the proportion of patients treated with RP and EBRT with low-risk disease increased significantly (p <0.0001) from 60% to 89% and from 26% to 76%, respectively. In addition, the 2-year actual PSA outcome also improved from 60% to 82% (RP: p<0.0001) and from 67% to 91% (RT: p=0.0008). The 2-year actual PSA outcome was not significantly different in the low-risk patients but improved during the three periods in the high-risk patients treated with RP (from 20% to 39% to 75%, p=0.0004) or EBRT (from 50% to 59% to 83%, p=0.01). This improvement in PSA outcome could be explained by a shift toward a more favorable PSA level (RP: p=0.0002; RT: p=0.006) and clinical T stage (RP: p=0.0008, RT: p<0.0001) distribution for patients with biopsy Gleason score ≥7 disease. Conclusion: Improved PSA outcome during the PSA era after RP or EBRT has resulted from a shift in presentation toward low-risk disease and earlier detection of high-grade disease

  7. Interpregnancy weight changes and impact on pregnancy outcome in a cohort of women with a macrosomic first delivery: a prospective longitudinal study.

    Science.gov (United States)

    Crosby, David A; Walsh, Jennifer M; Segurado, Ricardo; McAuliffe, Fionnuala M

    2017-06-06

    To determine the median interpregnancy maternal weight change between first and second pregnancies, and second and third pregnancies and to assess the impact of this weight change on pregnancy outcome in a cohort of women with a macrosomic first delivery. Prospective longitudinal study conducted over three pregnancies from 2007 to 2015. Tertiary referral maternity hospital, Dublin, Ireland. Women were recruited if their first baby weighed >4.0 kg. The pregnancy outcomes in the second and third pregnancies were analysed separately. Data were also analysed for both interpregnancy intervals comparing outcomes for those who gained any weight, or more weight than the median, with those who did not. Recurrent fetal macrosomia ≥4.0 kg and gestational diabetes mellitus. There were 280 women who delivered a third baby between 2011 and 2015. There were no differences in pregnancy outcomes for the second pregnancy in women who gained interpregnancy weight compared with those who did not and those who gained more interpregnancy weight than the median compared with those who did not. There was a statistically significant increase in birth weight ≥4.0 kg (54.0% vs 39.6% p=0.03) in those women who gained any weight between the second and third pregnancies. In those women who gained more interpregnancy weight than the median (1.70 kg) between a second and third pregnancy, there was a significant increase in the rate of gestational diabetes (6.5% vs 1.4%, p=0.03). This longitudinal study demonstrates that within this cohort maternal interpregnancy weight change between a second and third pregnancy is associated with an increase in birth weight ≥4.0 kg. Additionally, a gain of more weight than the median (1.70 kg) is associated with a higher rate of gestational diabetes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Preliminary study into the components of the fear-avoidance model of LBP: change after an initial chiropractic visit and influence on outcome

    Directory of Open Access Journals (Sweden)

    Newell Dave

    2010-07-01

    Full Text Available Abstract Background In the last decade the sub grouping of low back pain (LBP patients according to their likely response to treatment has been identified as a research priority. As with other patient groups, researchers have found few if any factors from the case history or physical examination that are helpful in predicting the outcome of chiropractic care. However, in the wider LBP population psychosocial factors have been identified that are significantly prognostic. This study investigated changes in the components of the LBP fear-avoidance beliefs model in patients pre- and post- their initial visit with a chiropractor to determine if there was a relationship with outcomes at 1 month. Methods Seventy one new patients with lower back pain as their primary complaint presenting for chiropractic care to one of five clinics (nine chiropractors completed questionnaires before their initial visit (pre-visit and again just before their second appointment (post-visit. One month after the initial consultation, patient global impression of change (PGIC scores were collected. Pre visit and post visit psychological domain scores were analysed for any association with outcomes at 1 month. Results Group mean scores for Fear Avoidance Beliefs (FAB, catastrophisation and self-efficacy were all improved significantly within a few days of a patient's initial chiropractic consultation. Pre-visit catastrophisation as well as post-visit scores for catastrophisation, back beliefs (inevitability and self-efficacy were weakly correlated with patient's global impression of change (PGIC at 1 month. However when the four assessed psychological variables were dichotomised about pre-visit group medians those individuals with 2 or more high variables post-visit had a substantially increased risk (OR 36.4 (95% CI 6.2-213.0 of poor recovery at 1 month. Seven percent of patients with 1 or fewer adverse psychological variables described poor benefit compared to 73% of those

  9. The Embodied Self in Parkinson's Disease: Feasibility of a Single Tango Intervention for Assessing Changes in Psychological Health Outcomes and Aesthetic Experience

    Science.gov (United States)

    Koch, Sabine C.; Mergheim, Katja; Raeke, Judith; Machado, Clarissa B.; Riegner, Eliane; Nolden, Joachim; Diermayr, Gudrun; von Moreau, Dorothee; Hillecke, Thomas K.

    2016-01-01

    Background: Dance is an embodied activity with benefits for mobility, balance, and quality of life (QoL) of persons affected by Parkinson's Disease (PD). It is enjoyable and likely to support adherence to movement prescriptions. The objective of this study was to assess the feasibility of measuring changes in psychological outcomes, specifically well-being, body self-efficacy, outcome expectations, and experienced beauty after a single Argentine Tango intervention in a workshop format. To anchor experienced beauty in a theory, the article introduces a model of embodied aesthetics featuring active art-making as a central aspect of healing in arts-based interventions. Methods: In a single-group pre–post design, we tested the feasibility of measuring psychological changes of 34 PD patients from Southern Germany after an introductory workshop in Argentine Tango. They participated in a 90 min Tango for PD intervention and completed the Heidelberg State Inventory (HSI-24; (Koch et al., 2007)), the Body Self-Efficacy Scale (BSE; (Fuchs and Koch, 2014)) with a sub-dimension on aesthetic experience, and the Credibility-Expectancy Questionnaire (CEQ; (Devilly and Borkovec, 2000)) before and after the intervention. A subgroup completed the therapeutic factors of arts therapies-scale, a new measure to elaborate on the aesthetic experience. We analyzed pre–post-differences with a t-test for paired samples. Results and Discussion: The study supports the feasibility of measuring health-related psychological changes from a single Argentine Tango intervention for PD patients, as well as acceptance and appropriateness of the intervention for the patient group. After the tango intervention, well-being, body self-efficacy, and outcome expectancies increased. Participants also experienced an increase in beauty of their movements and other aesthetic aspects. We suspect that, in addition to the functional and psychological factors identified so far, the aesthetic experience in dance

  10. Change in self-assessed comfort level of first-year pharmacy students as an alternative approach to measure teaching effectiveness and learning outcomes.

    Science.gov (United States)

    Oelschlaeger, Peter

    2017-05-01

    Objective measures for assessing teaching effectiveness and learning outcomes in the pharmacy curriculum are needed for improving quality of instruction and faculty development. The purpose of this article is to introduce a new teaching assessment method that focuses on self-assessed change in student comfort with the topics taught rather than evaluation of the instructor and to evaluate its performance in comparison to conventional student evaluations of teaching (SET). Six successive cohorts of first-year pharmacy students were surveyed regarding their comfort level at the beginning and end of a 10-week pharmacology course. The change in self-assessed comfort level (ΔSACL) was interpreted as the amount of learning that occurred. This indicator was compared to ratings of a statement from SET designed to obtain the same information. An increasing ΔSACL suggests an increase in learning over time. Differences were observed between ΔSACL and corresponding results from SET, suggesting that there could be extrinsic factors influencing the results. The use of ΔSACL could provide an alternative or complementary approach to assess teaching effectiveness that focuses less on the instructor and more on the actual student learning outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Quality of Life Outcomes in Community-based Mental Health Consumers: Comparisons with Population Norms and Changes over Time.

    Science.gov (United States)

    Happell, Brenda; Stanton, Robert; Hodgetts, Danya; Scott, David

    2016-01-01

    Quality of life is shown to be lower in people diagnosed with mental illness in comparison to the general population. The aim of this study is to examine the Quality of life in a subset of people accessing mental health services in a regional Queensland Centre. Thirty-seven people accessing mental health services completed the SF36 Health Survey on three occasions. Differences and relationships between Physical Composite Scores and Mental Composite Scores, comparisons with Australian population norms, and temporal change in Quality of Life were examined. Physical Composite Scores were significantly different to, but significantly correlated with, Mental Composite Scores on each occasion. Physical Composite Scores and Mental Composite Scores were significantly different to population norms, and did not vary significantly across time. The poor Quality of life of people with mental illness remains a significant challenge for the mental health workforce.

  12. Outcomes of long-term outpatient tinnitus-coping therapy: psychometric changes and value of tinnitus-control instruments.

    Science.gov (United States)

    Caffier, Philipp P; Haupt, Heidemarie; Scherer, Hans; Mazurek, Birgit

    2006-12-01

    Increasing tinnitus compliance and coping are desirable aims of successful treatment in chronic tinnitus. However, application of established procedures such as tinnitus retraining therapy (TRT) is often relatively short. In addition, the value of tinnitus control instruments (TCI) is questionable, especially for minor severity levels of tinnitus, and the comparability of treatment results is low. To evaluate long-term changes of tinnitus-related distress, defined psychometric data were collected in patients with compensated tinnitus (cT) or decompensated tinnitus (dT) during a standardized 2-yr outpatient tinnitus-coping therapy (TCT). In a prospective clinical investigation, the data of 70 tinnitus patients were recorded at the beginning and at 6-mo intervals, with a final investigation after 24 mo. The first group consisted of 40 patients with cT and dT who were randomly assigned to a treatment group and a waiting-list control group. After a period of 12 mo without treatment, the control group was treated similarly. The tinnitus questionnaire (TQ) of Goebel and Hiller, visual analog scales (VAS), and a severity questionnaire for tinnitus-associated complaints were used as psychodiagnostic instruments. Therapy components consisted of counseling, fitting patients with TCIs (TCI provision), auditory and relaxation training, and psychosomatic care if necessary. A second group of 30 patients with cT receiving TCT without TCI devices was investigated to evaluate the additive efficacy of TCI in cT. The initial TQ score did not differ between the treatment group and the waiting-list control group. After 12 mo, the control group did not show any significant changes, but the treatment group had improved significantly. During TCT, the combined data of both groups showed a statistically significant decrease of the TQ score in dT (59.1 to 34.8) and cT (32.8 to 24.0). These changes were especially reflected by the subscales of cognitive and emotional distress and also by the

  13. Temporal changes in the outcomes of patients with diabetes mellitus undergoing percutaneous coronary intervention in the National Heart, Lung, and Blood Institute dynamic registry.

    Science.gov (United States)

    Holper, Elizabeth M; Abbott, J Dawn; Mulukutla, Suresh; Vlachos, Helen; Selzer, Faith; McGuire, Darren; Faxon, David P; Laskey, Warren; Srinivas, Vankeepuram S; Marroquin, Oscar C; Jacobs, Alice K

    2011-02-01

    Patients with diabetes mellitus (DM) are at higher risk for adverse outcomes following percutaneous coronary intervention (PCI). To determine whether outcomes have improved over time, we analyzed data from 2,838 consecutive patients with medically treated DM, including 1,066 patients (37.6%) treated with insulin, in the National Heart, Lung, and Blood Institute Dynamic Registry undergoing PCI registered in waves 1 (1997-1998), 2 (1999), 3 (2001-2002), 4 (2004), and 5 (2006). We compared baseline demographics and 1-year outcomes in the overall cohort and in analyses stratified by recruitment wave and insulin use. Crude mortality rates by chronological wave were 9.5%, 12.5%, 8.9%, 11.6%, and 6.6% (P value(trend) = .33) among those treated with insulin and, respectively, 9.7%, 6.5%, 4.1%, 5.4%, and 4.7% (P value(trend) = .006) among patients treated with oral agents,. The adjusted hazard ratios of death, myocardial infarction (MI), and overall major adverse cardiovascular events (death, MI, revascularization) in insulin-treated patients with DM in waves 2 to 5 as compared with wave 1 were either higher or the same. In contrast, the similar adjusted hazard ratios for oral agent-treated patients with DM were either similar or lower. Significant improvements over time in adverse events by 1 year were detected in patients with DM treated with oral agents. In insulin-treated diabetic patients, despite lower rates of repeat revascularization over time, death and MI following PCI have not significantly improved. These findings underscore the need for continued efforts at optimizing outcomes among patients with DM undergoing PCI, especially those requiring insulin treatment. Copyright © 2011 Mosby, Inc. All rights reserved.

  14. The changing face of chronic illness management in primary care: a qualitative study of underlying influences and unintended outcomes.

    Science.gov (United States)

    Hunt, Linda M; Kreiner, Meta; Brody, Howard

    2012-01-01

    Recently, there has been dramatic increase in the diagnosis and pharmaceutical management of common chronic illnesses. Using qualitative data collected in primary care clinics, we assessed how these trends play out in clinical care. This qualitative study focused on management of type 2 diabetes and hypertension in 44 primary care clinics in Michigan and was based on interviews with 58 clinicians and 70 of their patients, and observations of 107 clinical consultations. We assessed clinicians' treatment strategies and discussions of factors influencing treatment decisions, and patients' understandings and experiences in managing these illnesses. Clinicians focused on helping patients achieve test results recommended by national guidelines, and most reported combining 2 or more medications per condition to reach targets. Medication selection and management was the central focus of the consultations we observed. Polypharmacy was common among patients, with more than one-half taking 5 or more medications. Patient interviews indicated that heavy reliance on pharmaceuticals presents challenges to patient well-being, including financial costs and experiences of adverse health effects. Factors promoting heavy use of pharmaceuticals include lower diagnostic and treatment thresholds, clinician-auditing and reward systems, and the prescribing cascade, whereby more medications are prescribed to control the effects of already-prescribed medications. We present a conceptual model, the inverse benefit law, to provide insight into the impact of pharmaceutical marketing efforts on the observed trends. We make recommendations about limiting the influence of the pharmaceutical industry on clinical practice, toward improving the well-being of patients with chronic illness.

  15. A brief psychological intervention for mothers of children with food allergy can change risk perception and reduce anxiety: Outcomes of a randomized controlled trial.

    Science.gov (United States)

    Boyle, R J; Umasunthar, T; Smith, J G; Hanna, H; Procktor, A; Phillips, K; Pinto, C; Gore, C; Cox, H E; Warner, J O; Vickers, B; Hodes, M

    2017-10-01

    Mothers of children with food allergy have increased anxiety, which may be influenced by healthcare professionals' communication of risk. To evaluate a brief psychological intervention for reducing anxiety in mothers of children with food allergy. Two hundred mothers of children with food allergy were recruited from allergy clinics. A computer-generated randomization list was used to allocate participants to a single-session cognitive behavioural therapy intervention including a risk communication module, or standard care. Anxiety and risk perception were assessed at 6 weeks and 1 year. Primary outcome was state anxiety at 6 weeks. Secondary outcomes included state anxiety at 1 year, risk perception at 6 weeks and 1 year, and salivary cortisol response to a simulated anaphylaxis scenario at 1 year. We found no significant difference in the primary outcome state anxiety at 6 weeks, with mean 31.9 (SD 10.2) intervention, 34.0 (10.2) control; mean difference 2.1 (95% CI -0.9, 5.0; P=.17). There was significantly reduced state anxiety at 6 weeks in the intervention group, in the subgroup of participants with moderate/high anxiety at enrolment (103/200, 52%), with mean 33.0 (SD 9.3) intervention, 37.8 (SD 10.0) control; mean difference 4.8 (95% CI 0.9, 8.7; P=.016; Cohen's d effect size 0.50). The psychological intervention also reduced risk perception and salivary cortisol response (P=.032; effect size 0.36). We found evidence that a brief psychological intervention which incorporates accurate risk information may impact on anxiety, risk perception and physiological stress response in mothers of children with food allergy. © 2017 John Wiley & Sons Ltd.

  16. 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...

  17. The effect of fifth grade science teachers' pedagogical content knowledge on their decision making and student learning outcomes on the concept of chemical change

    Science.gov (United States)

    Ogletree, Glenda Lee

    This study investigated the science pedagogical content knowledge (PCK) among teachers as they taught the concept of chemical change to fifth grade students. The purpose was to identify teachers' PCK and its impact in middle grade science classrooms. A second purpose was to investigate the possible relationship of teachers' science PCK to teacher actions and student learning outcomes in the classroom. The instruments used to capture PCK were background and demographic information, Content Representations (CoRe), and Professional and Pedagogical experience Repertoire (PaP-eR). The study investigated CoRe and PaP-eR with seven classroom teachers as they planned and taught chemical change to fifth grade students. Four levels of a Pedagogical Content Knowledge rubric were used to describe varying levels of PCK. The four levels were content knowledge of chemical change; knowledge of students' thinking; knowledge of how to represent chemical change to promote student learning; and professional development, collaboration, and leadership roles in science. The Reformed Teaching Observation Protocol (RTOP) described and evaluated science teaching performance levels of the teachers. In this study, 176 students were assessed to determine understanding of chemical change. There was a significant correlation between teachers' PCK scores and student achievement. The study also determined that a significant correlation existed between teachers' PCK scores and their RTOP scores revealing that RTOP scores could be predictors of PCK. Through this approach, understandings of PCK emerged that are of interest to university preservice preparation programs, research in understanding effective teachers and teaching, and the planning and implementation of professional development for teachers of science with middle grade students.

  18. Changes in rainfall amount and frequency do not affect the outcome of the interaction between the shrub Retama sphaerocarpa and its neighbouring grasses in two semiarid communities

    Science.gov (United States)

    Soliveres, Santiago; García-Palacios, Pablo; Maestre, Fernando T.; Escudero, Adrián; Valladares, Fernando

    2015-01-01

    We evaluated the net outcome of the interaction between the shrub Retama sphaerocarpa, our target plant, and different herbaceous neighbours in response to changes in the magnitude and frequency of rainfall events during three years. The experiment was conducted in natural and anthropogenic grasslands dominated by a perennial stress-tolerator and ruderal annual species, respectively. In spite of the neutral or positive effects of neighbours on water availability, neighbouring plants reduced the performance of Retama juveniles, suggesting competition for resources other than water. The negative effects of grasses on the photochemical efficiency of Retama juveniles decreased with higher water availabilities or heavier irrigation pulses, depending on the grassland studied; however, these effects did not extent to the survival and growth of Retama juveniles. Our findings show the prevalence of competitive interactions among the studied plants, regardless of the water availability and its temporal pattern. These results suggest that positive interactions may not prevail under harsher conditions when shade-intolerant species are involved. This study could be used to further refine our predictions of how plant-plant interactions will respond to changes in rainfall, either natural or increased by the ongoing climatic change, in ecosystems where grass-shrubs interactions are prevalent. PMID:25914429

  19. Changes in rainfall amount and frequency do not affect the outcome of the interaction between the shrub Retama sphaerocarpa and its neighbouring grasses in two semiarid communities.

    Science.gov (United States)

    Soliveres, Santiago; García-Palacios, Pablo; Maestre, Fernando T; Escudero, Adrián; Valladares, Fernando

    2013-04-01

    We evaluated the net outcome of the interaction between the shrub Retama sphaerocarpa , our target plant, and different herbaceous neighbours in response to changes in the magnitude and frequency of rainfall events during three years. The experiment was conducted in natural and anthropogenic grasslands dominated by a perennial stress-tolerator and ruderal annual species, respectively. In spite of the neutral or positive effects of neighbours on water availability, neighbouring plants reduced the performance of Retama juveniles, suggesting competition for resources other than water. The negative effects of grasses on the photochemical efficiency of Retama juveniles decreased with higher water availabilities or heavier irrigation pulses, depending on the grassland studied; however, these effects did not extent to the survival and growth of Retama juveniles. Our findings show the prevalence of competitive interactions among the studied plants, regardless of the water availability and its temporal pattern. These results suggest that positive interactions may not prevail under harsher conditions when shade-intolerant species are involved. This study could be used to further refine our predictions of how plant-plant interactions will respond to changes in rainfall, either natural or increased by the ongoing climatic change, in ecosystems where grass-shrubs interactions are prevalent.

  20. How to capture patients’ concerns and related changes: Comparing the MYCaW questionnaire, semi-structured interview and a priority list of outcome areas

    DEFF Research Database (Denmark)

    Ostenfeld-Rosenthal, Ann; Johannessen, Helle

    2014-01-01

    as rehabilitation after colorectal cancer, a sub-sample of 31 participants completed the MYCaW questionnaire and the priority list and were interviewed before, during and after the treatment period. Setting Treatments were provided in healers’ clinics in Denmark. Main outcome measures For each participant......Objectives To compare the capacity of the MYCaW questionnaire, a priority list of concerns covered by validated questionnaires, and semi-structured interviews to identify patients’ personalized concerns and related changes. Design In a pragmatic trial on the effectiveness of energy healing...... experience with the treatment, while concerns stated in interviews and the priority list remained stable throughout the study; (2) emotional concerns were reported more often in interviews than in MYCaW, physical concerns were predominant in MYCaW, and quality of life was marked as a primary concern most...

  1. Patterns of Change in Collaboration Are Associated with Baseline Characteristics and Predict Outcome and Dropout Rates in Treatment of Multi-Problem Families. A Validation Study

    Directory of Open Access Journals (Sweden)

    Egon Bachler

    2017-07-01

    Full Text Available Objective: The present study validates the Multi-Problem Family (MPF-Collaboration Scale, which measures the progress of goal directed collaboration of patients in the treatment of families with MPF and its relation to drop-out rates and treatment outcome.Method: Naturalistic study of symptom and competence-related changes in children of ages 4–18 and their caregivers.Setting: Integrative, structural outreach family therapy.Measures: The data of five different groups of goal directed collaboration (deteriorating collaboration, stable low collaboration, stable medium collaboration, stable high collaboration, improving collaboration were analyzed in their relation to treatment expectation, individual therapeutic goals (ITG, family adversity index, severity of problems and global assessment of a caregiver’s functioning, child, and relational aspects.Results: From N = 810 families, 20% displayed stable high collaboration (n = 162 and 21% had a pattern of improving collaboration. The families with stable high or improving collaboration rates achieved significantly more progress throughout therapy in terms of treatment outcome expectancy (d = 0.96; r = 0.43, reaching ITG (d = 1.17; r = 0.50, family adversities (d = 0.55; r = 0.26, and severity of psychiatric symptoms (d = 0.31; r = 0.15. Furthermore, families with stable high or improving collaboration maintained longer treatments and had a bigger chance of finishing the therapy as planned. The odds of having a stable low or deteriorating collaboration throughout treatment were significantly higher for subjects who started treatment with low treatment expectation or high family-related adversities.Conclusion: The positive outcomes of homebased interventions for multi-problem families are closely related to “stable high” and an “improving” collaboration as measured with the MPF-Collaboration Scale. Patients who fall into these groups have a high treatment outcome expectancy and reduce

  2. Fenofibrate-associated changes in renal function and relationship to clinical outcomes among individuals with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) experience.

    Science.gov (United States)

    Bonds, D E; Craven, T E; Buse, J; Crouse, J R; Cuddihy, R; Elam, M; Ginsberg, H N; Kirchner, K; Marcovina, S; Mychaleckyj, J C; O'Connor, P J; Sperl-Hillen, J-A

    2012-06-01

    Fenofibrate has been noted to cause an elevation in serum creatinine in some individuals. Participants in the Action to Control Cardiovascular Risk in Diabetes Lipid Study were studied to better characterise who is at risk of an increase in creatinine level and to determine whether those with creatinine elevation have a differential risk of adverse renal or cardiovascular outcomes. A fenofibrate-associated creatinine increase (FACI) was defined as an increase in serum creatinine of at least 20% from baseline to month 4 in participants assigned to fenofibrate. Baseline patient characteristics, and baseline and 4-month drug, clinical, laboratory characteristics and study outcomes were examined by FACI status. Of the sample, 48% of those randomised to receive fenofibrate had at least a 20% increase in serum creatinine within 4 months. In multivariable analysis, participants who were older, male, used an ACE inhibitor at baseline, used a thiazolidinedione (TZD) at 4 months post-randomisation, had baseline CVD, and had lower baseline serum creatinine and LDL-cholesterol levels were all more likely to meet the criteria for FACI. Participants in the FACI group were also more likely to have a decrease in their serum triacylglycerol level from baseline to 4 months. No differences in study outcomes were seen by FACI criteria. Several characteristics predict a rapid rise in serum creatinine upon starting fenofibrate. Participants who met the criteria for FACI also had a greater change in triacylglycerol levels. In the setting of careful renal function surveillance and reduction of fenofibrate dose as indicated, no increase in renal disease or cardiovascular outcome was seen in those individuals demonstrating FACI. ClincalTrials.gov: NCT00000620. The ACCORD Trial was supported by grants (N01-HC-95178, N01-HC-95179, N01-HC-95180, N01-HC-95181, N01-HC-95182, N01-HC-95183, N01-HC-95184, IAA-Y1-HC-9035 and IAA-Y1-HC-1010) from the National Heart, Lung, and Blood Institute; by the

  3. Self-Monitoring vs. Implementation Intentions: a Comparison of Behaviour Change Techniques to Improve Sleep Hygiene and Sleep Outcomes in Students.

    Science.gov (United States)

    Mairs, Lucinda; Mullan, Barbara

    2015-10-01

    This study seeks to investigate and compare the efficacy of self-monitoring and implementation intentions-two post-intentional behaviour change techniques-for improving sleep hygiene behaviours and sleep outcomes in university students. Seventy-two undergraduate students completed baseline measures of four sleep hygiene behaviours (making the sleep environment restful, avoiding going to bed hungry/thirsty, avoiding stress/anxiety-provoking activities near bed time and avoiding caffeine in the evening), as well as the Pittsburgh sleep quality index (PSQI) and the insomnia severity index (ISI). Participants were randomly assigned to an active-control diary-keeping, self-monitoring condition or completed implementation intentions for each behaviour. Post-intervention measurement was completed 2 weeks after baseline. Repeated measures analyses of variance found significant main effects of time for improvements in making the sleep environment restful and avoiding going to bed hungry or thirsty, as well as PSQI and ISI scores. Non-significant interactions suggested no group differences on any variable, except for increasing avoidance of stress and anxiety-provoking activities before bed time, for which only implementation intentions were found to be effective. Attrition was higher amongst self-monitoring participants. Both self-monitoring and implementation intentions appear to be promising behaviour change techniques for improving sleep hygiene and sleep. Future research should examine the acceptability of the two behaviour change techniques and the relationship with differential attrition, as well as effect size variations according to behaviour and technique. Researchers should investigate potential additive or interactive effects of the techniques, as they could be utilised in a complementary manner to target different processes in effecting behaviour change.

  4. Evaluation of the Predictive Value of Intraoperative Changes in Motor-Evoked Potentials of Caudal Cranial Nerves for the Postoperative Functional Outcome.

    Science.gov (United States)

    Kullmann, Marcel; Tatagiba, Marcos; Liebsch, Marina; Feigl, Guenther C

    2016-11-01

    The predictive value of changes in intraoperatively acquired motor-evoked potentials (MEPs) of the lower cranial nerves (LCN) IX-X (glossopharyngeal-vagus nerve) and CN XII (hypoglossal nerve) on operative outcomes was investigated. MEPs of CN IX-X and CN XII were recorded intraoperatively in 63 patients undergoing surgery of the posterior cranial fossa. We correlated the changes of the MEPs with postoperative nerve function. For CN IX-X, we found a correlation between the amplitude of the MEP ratio and uvula deviation (P = 0.028) and the amplitude duration of the MEP and gag reflex function (P = 0.027). Patients with an MEP ratio of the glossopharyngeal-vagus amplitude ≤1.47 μV had a 3.4 times increased risk of developing a uvula deviation. Patients with a final MEP duration of the CN IX-X ≤11.6 milliseconds had a 3.6 times increased risk for their gag reflex to become extinct. Our study greatly contributes to the current knowledge of intraoperative MEPs as a predictor for postoperative cranial nerve function. We were able to extent previous findings on MEP values of the facial nerve on postoperative nerve function to 3 additional cranial nerves. Finding reliable predictors for postoperative nerve function is of great importance to the overall quality of life for a patient undergoing surgery of the posterior cranial fossa. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Assessing the stroke-specific quality of life for outcome measurement in stroke rehabilitation: minimal detectable change and clinically important difference.

    Science.gov (United States)

    Lin, Keh-chung; Fu, Tiffany; Wu, Ching-yi; Hsieh, Ching-ju

    2011-01-19

    This study was conducted to establish the minimal detectable change (MDC) and clinically important differences (CIDs) of the physical category of the Stroke-Specific Quality of Life Scale in patients with stroke. MDC and CIDs scores were calculated from the data of 74 participants enrolled in randomized controlled trials investigating the effects of two rehabilitation programs in patients with stroke. These participants received treatments for 3 weeks and underwent clinical assessment before and after treatment. To obtain test-retest reliability for calculating MDC, another 25 patients with chronic stroke were recruited. The MDC was calculated from the standard error of measurement (SEM) to indicate a real change with 95% confidence for individual patients (MDC95). Distribution-based and anchor-based methods were adopted to triangulate the ranges of minimal CIDs. The percentage of scale width was calculated by dividing the MDC and CIDs by the total score range of each physical category. The percentage of patients exceeding MDC95 and minimal CIDs was also reported. The MDC95 of the mobility, self-care, and upper extremity (UE) function subscales were 5.9, 4.0, and 5.3 respectively. The minimal CID ranges for these 3 subscales were 1.5 to 2.4, 1.2 to 1.9, and 1.2 to 1.8. The percentage of patients exceeding MDC95 and minimal CIDs of the mobility, self-care, and UE function subscales were 9.5% to 28.4%, 6.8% to 28.4%, and 12.2% to 33.8%, respectively. The change score of an individual patient has to reach 5.9, 4.0, and 5.3 on the 3 subscales to indicate a true change. The mean change scores of a group of patients with stroke on these subscales should reach the lower bound of CID ranges of 1.5 (6.3% scale width), 1.2 (6.0% scale width), and 1.2 (6.0% scale width) to be regarded as clinically important change. This information may facilitate interpretations of patient-reported outcomes after stroke rehabilitation. Future research is warranted to validate these findings.

  6. Changes in the Concept of Family Justice in Japan: The Impact of Modern Egalitarian Attitudes on Family Equality in the Areas of Inheritance and Domestic Violence (Including Murder of an Lineal Ascendant)

    OpenAIRE

    五十子, 敬子

    2008-01-01

    I Family justice in Japan: a brief overviewII Equality in the Japanese inheritance laws since 1947III Equality of treatment in sentencing: the murder of a lineal ascendantIV Changes in the concept of family justice in domestic violence: the Prevention of Spousal Violence and the Protection of Victims Act 2001V Conclusion: key points of change in the concept of family justice

  7. Comparison of endoscopic endonasal and bifrontal craniotomy approaches for olfactory groove meningiomas: A matched pair analysis of outcomes and frontal lobe changes on MRI.

    Science.gov (United States)

    de Almeida, John R; Carvalho, Felipe; Vaz Guimaraes Filho, Francisco; Kiehl, Tim-Rasmus; Koutourousiou, Maria; Su, Shirley; Vescan, Allan D; Witterick, Ian J; Zadeh, Gelareh; Wang, Eric W; Fernandez-Miranda, Juan C; Gardner, Paul A; Gentili, Fred; Snyderman, Carl H

    2015-11-01

    We compare the outcomes and postoperative MRI changes of endoscopic endonasal (EEA) and bifrontal craniotomy (BFC) approaches for olfactory groove meningiomas (OGM). All patients who underwent either BFC or EEA for OGM were eligible. Matched pairs were created by matching tumor volumes of an EEA patient with a BFC patient, and matching the timing of the postoperative scans. The tumor dimensions, peritumoral edema, resectability issues, and frontal lobe changes were recorded based on preoperative and postoperative MRI. Postoperative fluid-attenuated inversion recovery (FLAIR) hyperintensity and residual cystic cavity (porencephalic cave) volume were compared using univariable and multivariable analyses. From a total of 70 patients (46 EEA, 24 BFC), 10 matched pairs (20 patients) were created. Three patients (30%) in the EEA group and two (20%) in the BFC had postoperative cerebrospinal fluid leaks (p=0.61). Gross total resections were achieved in seven (70%) of the EEA group and nine (90%) of the BFC group (p=0.26), and one patient from each group developed a recurrence. On postoperative MRI, there was no significant difference in FLAIR signal volumes between EEA and BFC approaches (6.9 versus 13.3 cm(3); p=0.17) or in porencephalic cave volumes (1.7 versus 5.0 cm(3); p=0.11) in univariable analysis. However, in a multivariable analysis, EEA was associated with less postoperative FLAIR change (p=0.02) after adjusting for the volume of preoperative edema. This study provides preliminary evidence that EEA is associated with quantifiable improvements in postoperative frontal lobe imaging. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. A prospective study of the association of patient expectations with changes in health-related quality of life outcomes, following total joint replacement.

    Science.gov (United States)

    Gonzalez Saenz de Tejada, Marta; Escobar, Antonio; Bilbao, Amaia; Herrera-Espiñeira, Carmen; García-Perez, Lidia; Aizpuru, Felipe; Sarasqueta, Cristina

    2014-07-23

    Patient expectations regarding surgery may be related to outcomes in total joint replacement (TJR). The aim of this study was to determine the association of patient expectations with health related quality of life (HRQoL) outcomes measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 12 (SF-12) and satisfaction with current symptoms measured on a 4-point Likert scale, one year after surgery, adjusting for Body Mass Index (BMI), age, gender, joint, education, previous intervention and baseline scores. Consecutive patients preparing for TJR of the knee or hip due to primary osteoarthritis (OA) in 15 hospitals in Spain were recruited for the study. Patients completed questionnaires before surgery and 12 months afterwards: five questions about expectations before surgery; an item to measure satisfaction; two HRQoL instruments-WOMAC and SF-12; as well as questions about sociodemographic information. To determine the association of patient expectations at baseline, with changes in HRQoL 12 months after surgery and with satisfaction, general linear models and logistic regression analysis were performed. A total of 892 patients took part in the study. Patients who had higher pain relief or ability to walk expectations improved more in HRQoL at 12 months. Moreover, patients with high daily activity expectations were more satisfied. Patients with higher baseline expectations for TJR, improved more in HRQoL at one year and had more likelihood to be satisfied than patients with lower expectations, adjusted for BMI, age, gender, joint, education, previous intervention and HRQoL baseline scores.

  9. Social support and moment-to-moment changes in treatment self-efficacy in men living with HIV: Psychosocial moderators and clinical outcomes

    Science.gov (United States)

    Turan, Bulent; Fazeli, Pariya; Raper, James L.; Mugavero, Michael J.; Johnson, Mallory O.

    2016-01-01

    Objective For people living with HIV, treatment adherence self-efficacy is an important predictor of treatment adherence and therefore of clinical outcomes. Using experience sampling method (ESM), this study aimed to examine: (1) the within-person association between moment-to-moment changes in social support and HIV treatment self-efficacy; (2) the moderators of this within-person association, (3) the concordance between questionnaire and ESM measurement of treatment self-efficacy; and (4) the utility of each approach (ESM and questionnaire) in predicting adherence to medication, adherence to clinic visits, CD4 counts, and viral load. Methods 109 men living with HIV responded to the same set of ESM questions 3 times a day for 7 days via a smart phone given to them for the study. They also completed cross-sectional questionnaires and their clinic data was extracted from medical records in order to examine predictors and consequences of state and trait treatment self-efficacy. Results In within-person hierarchical linear modeling (HLM) analyses, receipt of recent social support predicted higher current ESM treatment self-efficacy. This association was stronger for individuals reporting higher avoidance coping with HIV. The correlation between ESM and questionnaire measures of treatment self-efficacy was r = .37. ESM measure of average treatment self-efficacy predicted medication adherence, visit adherence, CD4 counts, and viral load, while questionnaire-based self-efficacy did not predict these outcomes. Conclusion Interventions aimed at improving treatment adherence may target social support processes, which may improve treatment self-efficacy and adherence. PMID:27089459

  10. Mass Spectrometry Analysis of Wild-Type and Knock-in Q140/Q140 Huntington's Disease Mouse Brains Reveals Changes in Glycerophospholipids Including Alterations in Phosphatidic Acid and Lyso-Phosphatidic Acid.

    Science.gov (United States)

    Vodicka, Petr; Mo, Shunyan; Tousley, Adelaide; Green, Karin M; Sapp, Ellen; Iuliano, Maria; Sadri-Vakili, Ghazaleh; Shaffer, Scott A; Aronin, Neil; DiFiglia, Marian; Kegel-Gleason, Kimberly B

    2015-01-01

    Huntington's disease (HD) is a neurodegenerative disease caused by a CAG expansion in the HD gene, which encodes the protein Huntingtin. Huntingtin associates with membranes and can interact directly with glycerophospholipids in membranes. We analyzed glycerophospholipid profiles from brains of 11 month old wild-type (WT) and Q140/Q140 HD knock-in mice to assess potential changes in glycerophospholipid metabolism. Polar lipids from cerebellum, cortex, and striatum were extracted and analyzed by liquid chromatography and negative ion electrospray tandem mass spectrometry analysis (LC-MS/MS). Gene products involved in polar lipid metabolism were studied using western blotting, immuno-electron microscopy and qPCR. Significant changes in numerous species of glycerophosphate (phosphatidic acid, PA) were found in striatum, cerebellum and cortex from Q140/Q140 HD mice compared to WT mice at 11 months. Changes in specific species could also be detected for other glycerophospholipids. Increases in species of lyso-PA (LPA) were measured in striatum of Q140/Q140 HD mice compared to WT. Protein levels for c-terminal binding protein 1 (CtBP1), a regulator of PA biosynthesis, were reduced in striatal synaptosomes from HD mice compared to wild-type at 6 and 12 months. Immunoreactivity for CtBP1 was detected on membranes of synaptic vesicles in striatal axon terminals in the globus pallidus. These novel results identify a potential site of molecular pathology caused by mutant Huntingtin that may impart early changes in HD.

  11. Development of mathematical models to elaborate strategies, select alternatives and development of plans for adaptation of communities to climate change in different geographical areas including costs to implement it

    Science.gov (United States)

    Anton, J. M.; Grau, J. B.; Tarquis, A. M.; Andina, D.; Cisneros, J. M.

    2012-04-01

    There is evidence that the climate changes and that now, the change is influenced and accelerated by the CO2 augmentation in atmosphere due to combustion by humans. Such "Climate change" is on the policy agenda at the global level, with the aim of understanding and reducing its causes and to mitigate its consequences. In most countries and international organisms UNO (e.g. Rio de Janeiro 1992), OECD, EC, etc … the efforts and debates have been directed to know the possible causes, to predict the future evolution of some variable conditioners, and trying to make studies to fight against the effects or to delay the negative evolution of such. The Protocol of Kyoto 1997 set international efforts about CO2 emissions, but it was partial and not followed e.g. by USA and China …, and in Durban 2011 the ineffectiveness of humanity on such global real challenges was set as evident. Among all that, the elaboration of a global model was not boarded that can help to choose the best alternative between the feasible ones, to elaborate the strategies and to evaluate the costs, and the authors propose to enter in that frame for study. As in all natural, technological and social changes, the best-prepared countries will have the best bear and the more rapid recover. In all the geographic areas the alternative will not be the same one, but the model must help us to make the appropriated decision. It is essential to know those areas that are more sensitive to the negative effects of climate change, the parameters to take into account for its evaluation, and comprehensive plans to deal with it. The objective of this paper is to elaborate a mathematical model support of decisions, which will allow to develop and to evaluate alternatives of adaptation to the climatic change of different communities in Europe and Latin-America, mainly in especially vulnerable areas to the climatic change, considering in them all the intervening factors. The models will consider criteria of physical

  12. Naturalistic follow-up of subjects affected with anorexia nervosa 8 years after multimodal treatment: Personality and psychopathology changes and predictors of outcome.

    Science.gov (United States)

    Amianto, F; Spalatro, A; Ottone, L; Abbate Daga, G; Fassino, S

    2017-09-01

    Eating disorders (EDs) are serious mental illnesses of growing clinical and social impact. Despite their severity, there is still no satisfactory evidence-based treatment. Follow-up investigations are the most reliable studies to enlighten long-term outcome predictors and modifiers. In total, 59 subjects affected with anorexia nervosa were assessed 8 years after their admission into an outpatient multimodal treatment program for eating disorders. The follow-up changes in diagnostic criteria were compared with Chi-square test. Improved and not-improved subjects were compared. Clinical, personality and psychopathology features between T0 and T1 were compared with t-test for repeated measures. Correlation between T0 features and changes at T1 in personality and psychopathology features were assessed. The rate of complete remission was 42%, an overall rate of 67.8% improved, a rate of 18.6% worsened. Concerning personality, a significant decrease of harm avoidance and increase in self-directedness were evidenced. Interoceptive awareness, drive for thinness, bulimia were significantly reduced at follow-up. Many T0 personality facets were related to personality and psychopathology improvement at follow-up. Multimodal treatment encompassing psychiatric, nutritional and psychological approaches is at the moment the most reliable approach for the treatment of moderate to severe anorexia nervosa with a discrete rate of improvement. Some personality and psychopathology characteristics may represent specific factors which favor resistance and impair improvement. Future approaches should consider the personalization of therapeutic approach according to these features. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Prenatal cigarette smoke exposure: Pregnancy outcome and gestational changes in plasma nicotine concentration, hematocrit, and carboxyhemoglobin in a newly standardized rat model

    International Nuclear Information System (INIS)

    Farkas, Svetlana; Hussein, Jabeen; Ariano, Robert E.; Sitar, Daniel S.; Hasan, Shabih U.

    2006-01-01

    Epidemiological studies support an association between perinatal cigarette smoke (CS) exposure and a number of severe pre- and postnatal complications. However, the mechanisms through which CS enhances such risks largely remain unknown. One of the reasons for our inability to discover such mechanisms has been the unavailability of a clinically relevant and physiologically concordant animal model. A number of studies have previously used nicotine (Nic) as surrogate for CS. We sought to (1) establish the amount of CS exposure to achieve plasma Nic concentrations observed among moderate to heavy smokers (20-60 ng/ml) (2) investigate the temporal changes in plasma Nic concentrations, carboxyhemoglobin, and hematocrit with advancing pregnancy, and (3) elucidate the effects of CS exposure on pregnancy outcome. Pregnant Sprague-Dawley rats were exposed to various doses of CS or room air (Sham) from days 6 to 21 of gestation. Exposure to 6000 ml/day of CS led to very high plasma Nic concentrations and increased maternal and fetal mortality (P < 0.001). The plasma Nic concentrations remained higher than those observed in moderate smokers until the CS dose was reduced to 1000 ml/day and showed dose-dependent temporal changes with advancing gestational age. Significant increases in carboxyhemoglobin and hematocrit were observed in the CS group as compared with the Sham group (P < 0.001). In addition, prenatally CS exposed fetuses had lower birth weight as compared with the Sham group (P = 0.04). Our current study establishes a newly standardized and physiologically relevant model to investigate the mechanisms of CS-mediated adverse effects during the critical period of fetal development

  14. A randomized trial of a lifestyle intervention in obese endometrial cancer survivors: quality of life outcomes and mediators of behavior change

    Directory of Open Access Journals (Sweden)

    Kavanagh Mary

    2009-02-01

    Full Text Available Abstract Background To examine the effects of a 6 month lifestyle intervention on quality of life, depression, self-efficacy and eating behavior changes in overweight and obese endometrial cancer survivors. Methods Early stage endometrial cancer survivors were randomized to intervention (n = 23 or usual care (n = 22 groups. Chi-square, Student's t-test and repeated measures analysis of variance were used in intent-to-treat analyses. Outcomes were also examined according to weight loss. Results Morbidly obese patients had significantly lower self-efficacy, specifically when feeling physical discomfort. There was a significant improvement for self-efficacy related to social pressure (p = .03 and restraint (p = .02 in the LI group. There was a significant difference for emotional well-being quality of life (p = .02, self-efficacy related to negative emotions (p Conclusion This pilot lifestyle intervention had no effect on quality of life or depression but did improve self-efficacy and some eating behaviors. Trial Registration http://www.clinicaltrials.gov; NCT00420979

  15. 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...

  16. Association Between Changes in CMS Reimbursement Policy and Drug Labels for Erythrocyte-Stimulating Agents With Outcomes for Older Patients Undergoing Hemodialysis Covered by Fee-for-Service Medicare.

    Science.gov (United States)

    Wang, Cunlin; Kane, Robert; Levenson, Mark; Kelman, Jeffrey; Wernecke, Michael; Lee, Joo-Yeon; Kozlowski, Steven; Dekmezian, Carmen; Zhang, Zhiwei; Thompson, Aliza; Smith, Kimberly; Wu, Yu-Te; Wei, Yuqin; Chillarige, Yoganand; Ryan, Qin; Worrall, Chris; MaCurdy, Thomas E; Graham, David J

    2016-12-01

    In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect. To assess the effects of the changes in reimbursement policy and the ESA drug label on patients who underwent incident hemodialysis. For this retrospective cohort study, patients 66 years or older who had undergone incident hemodialysis, and were enrolled in Medicare parts A, B, or D for at least 12 months prior to hemodialysis initiation between January 1, 2008, and December 31, 2013, were recruited from hemodialysis centers across the United States. Patients were divided into 2 cohorts based on their date of hemodialysis initiation and followed: January 1, 2008, to December 31, 2009, for the prepolicy cohort and July 1, 2011, to June 30, 2013, for the postpolicy cohort, with the exclusion of January 1, 2010, to June 30, 2011, as a transition period. Changes in CMS reimbursement policy for dialysis and the FDA label for ESAs. Major adverse cardiovascular events (MACEs), including acute myocardial infarction (AMI), stroke, and all-cause mortality; hospitalized congestive heart failure (H-CHF); venous thromboembolism; and red blood cell transfusions. Secondary outcomes included evaluating effects on black and other patient subgroups. Baseline characteristics of the 69 718 incident hemodialysis patients were similar between cohorts. Compared with the prepolicy period, the risk of MACE, death, H-CHF, and venous thromboembolism were similar in the postpolicy period, and the risk of stroke decreased (hazard ratio [HR], 0.77; 95

  17. Visual outcome and changes in corneal endothelial cell density following aphakic iris-fixated intraocular lens implantation in pediatric eyes with subluxated lenses.

    Science.gov (United States)

    Siddiqui, Sorath Noorani; Khan, Ayesha

    2013-01-01

    To evaluate the visual outcome and corneal endothelial cell density after Artisan aphakic intraocular lens (IOL) implantation (Ophtec, Groningen, the Netherlands) in pediatric eyes with subluxated lenses. Artisan aphakic IOLs were implanted in 18 eyes of 11 children with subluxated lenses. Idiopathic subluxations and ectopia lentis due to Marfan syndrome were included, whereas subluxations due to trauma or buphthalmos were excluded. Best-corrected visual acuity (BCVA) and endothelial cell density were monitored. Mean postoperative BCVA and endothelial cell density at last follow-up visit were calculated. The age of children at the time of Artisan aphakic IOL implantation ranged from 8 to 16 years (mean: 11.58 ± 2.9 years). Mean follow-up was 9.12 ± 4.30 months. Mean postoperative logarithm of the minimum angle of resolution BCVA was 0.26 ± 0.13 (P = .001) and mean postoperative endothelial cell density was 2,860 ± 435 cells/mm(2) (P = .000). Mean endothelial cell loss was 17.1%. Artisan aphakic IOL implantation is a safe surgical choice in the management of ectopia lentis in the pediatric age group. It has minimal complications and is less traumatic to pediatric eyes. However, long-term follow-up of these children is required.[J Pediatr Ophthalmol Strabismus 2013;50(3):178-182.]. Copyright 2013, SLACK Incorporated.

  18. The association between changes in synovial fluid levels of ARGS-aggrecan fragments, progression of radiographic osteoarthritis and self-reported outcomes: a cohort study

    DEFF Research Database (Denmark)

    Larsson, S; Englund, M; Struglics, A

    2012-01-01

    of tibiofemoral or patellofemoral OA according to the Osteoarthritis Research Society International (OARSI) atlas, and scored patient-reported outcomes using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Using logistic regression (adjusted for age, gender, body mass index, time between examinations...

  19. Patient's quality of life after high-dose radiation therapy for thoracic carcinomas. Changes over time and influence on clinical outcome

    International Nuclear Information System (INIS)

    Schroeder, Christina; Engenhart-Cabillic, Rita; Vorwerk, Hilke; Schmidt, Michael; Huhnt, Winfried; Blank, Eyck; Sidow, Dietrich; Buchali, Andre

    2017-01-01

    Quality of life (QoL) is an important factor in patient care. This analysis is focused on QoL before and after radio(chemo)therapy in patients with thoracic carcinomas, as well as on its influence on clinical follow-up and survival, and the correlation with treatment-related toxicities. The analysis included 81 patients with intrathoracic carcinoma receiving radio(chemo)therapy. For analysis of QoL, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the lung cancer-specific supplement (EORTC QLQ-LC13) were used. QoL data were collected before radiation treatment (RT), and 6 weeks, 12 weeks, 6 months, and 12 months after RT. Other factors were additionally analyzed, including clinical outcome, survival, and side effects. The functional scales showed maximum values or at least a recovery 12 weeks after RT. Symptoms with a high mean symptom score (> 40) at all appointments were fatigue, dyspnea, and coughing. Insomnia, peripheral neuropathy, appetite loss, dyspnea (from QLQ-LC13), and all pain parameters had an intermediate mean score (10-40). There were low mean scores of < 10 for nausea and vomiting, diarrhea, sore mouth, and hemoptysis. There was a significant correlation between clinical dysphagia and radiation pneumonitis with the associated symptom scales. None of the QoL scores had a significant influence on local and distant control or survival. 12 weeks after RT the QLQ-C30 functional scales show the highest scores or at least a temporary recovery. The symptom scales accurately reflect the common symptoms and treatment-related toxicities. QoL did not prove to be a significant predictor for local and distant control or survival. (orig.) [de

  20. Changing trends in the aetiology, treatment and outcomes of bloodstream infection occurring in the first year after solid organ transplantation: a single-centre prospective cohort study.

    Science.gov (United States)

    Oriol, Isabel; Sabé, Núria; Simonetti, Antonella F; Lladó, Laura; Manonelles, Anna; González, Jose; Tubau, Fe; Carratalà, Jordi

    2017-09-01

    To analyse trends in the aetiology, treatment and outcomes of bloodstream infection (BSI) within the first year post-transplant over the last 10-year period, we prospectively recorded all episodes of BSI occurring in solid organ transplant (SOT) recipients during the first year post-transplant from 2007 to 2016. Trends of factors were analysed by 2-year periods. Of 475 consecutive episodes of BSI, 218 occurred within a year of SOT in 178 SOT recipients. Gram-positive BSI decreased over time (40.5-2.2%). In contrast, there was a steady increase in Gram-negative bacilli (GNB) BSI (54.1-93.3%; P < 0.001), mainly due to Pseudomonas aeruginosa (2.4-20.4%) and Klebsiella pneumoniae (7.1-26.5%). Multidrug-resistant (MDR) GNB (4.8-38.8%; P < 0.001) rose dramatically, especially due to extended-spectrum β-lactamase (ESBL) production (7.1-34.7%). There was a sharp rise in the use of carbapenems, both as empirical (11.9-55.3%; P < 0.001) and as targeted antibiotic treatment (11.9-46.9%; P < 0.001). In conclusion, today, GNB are the leading causative agents of BSI in SOT recipients within the first year after SOT. In addition, MDR GNB have emerged mainly due to ESBL-producing strains. In spite of these changes, length of hospital stay, days of treatment and mortality have remained stable over time. © 2017 Steunstichting ESOT.

  1. Corrective Action Investigation Plan for Corrective Action Unit 214: Bunkers and Storage Areas Nevada Test Site, Nevada: Revision 0, Including Record of Technical Change No. 1 and No. 2

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

    2003-05-16

    This Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office's approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 214 under the Federal Facility Agreement and Consent Order. Located in Areas 5, 11, and 25 of the Nevada Test Site, CAU 214 consists of nine Corrective Action Sites (CASs): 05-99-01, Fallout Shelters; 11-22-03, Drum; 25-99-12, Fly Ash Storage; 25-23-01, Contaminated Materials; 25-23-19, Radioactive Material Storage; 25-99-18, Storage Area; 25-34-03, Motor Dr/Gr Assembly (Bunker); 25-34-04, Motor Dr/Gr Assembly (Bunker); and 25-34-05, Motor Dr/Gr Assembly (Bunker). These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). The suspected contaminants and critical analyte s for CAU 214 include oil (total petroleum hydrocarbons-diesel-range organics [TPH-DRO], polychlorinated biphenyls [PCBs]), pesticides (chlordane, heptachlor, 4,4-DDT), barium, cadmium, chronium, lubricants (TPH-DRO, TPH-gasoline-range organics [GRO]), and fly ash (arsenic). The land-use zones where CAU 214 CASs are located dictate that future land uses will be limited to nonresidential (i.e., industrial) activities. The results of this field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the corrective action decision document.

  2. Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions.

    Science.gov (United States)

    Ferris, Rosie; Blaum, Caroline; Kiwak, Eliza; Austin, Janet; Esterson, Jessica; Harkless, Gene; Oftedahl, Gary; Parchman, Michael; Van Ness, Peter H; Tinetti, Mary E

    2018-06-01

    To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.

  3. Structural and Community Change Outcomes of the Connect-to-Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care.

    Science.gov (United States)

    Miller, Robin Lin; Reed, Sarah J; Chiaramonte, Danielle; Strzyzykowski, Trevor; Spring, Hannah; Acevedo-Polakovich, Ignacio D; Chutuape, Kate; Cooper-Walker, Bendu; Boyer, Cherrie B; Ellen, Jonathan M

    2017-09-01

    Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community. © Society for Community Research and Action 2017.

  4. Corrective Action Investigation Plan for Corrective Action Unit 165: Areas 25 and 26 Dry Well and Washdown Areas, Nevada Test Site, Nevada (including Record of Technical Change Nos. 1, 2, and 3) (January 2002, Rev. 0)

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office (NNSA/NV)

    2002-01-09

    This Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office's approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 165 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 165 consists of eight Corrective Action Sites (CASs): CAS 25-20-01, Lab Drain Dry Well; CAS 25-51-02, Dry Well; CAS 25-59-01, Septic System; CAS 26-59-01, Septic System; CAS 25-07-06, Train Decontamination Area; CAS 25-07-07, Vehicle Washdown; CAS 26-07-01, Vehicle Washdown Station; and CAS 25-47-01, Reservoir and French Drain. All eight CASs are located in the Nevada Test Site, Nevada. Six of these CASs are located in Area 25 facilities and two CASs are located in Area 26 facilities. The eight CASs at CAU 165 consist of dry wells, septic systems, decontamination pads, and a reservoir. The six CASs in Area 25 are associated with the Nuclear Rocket Development Station that operated from 1958 to 1973. The two CASs in Area 26 are associated with facilities constructed for Project Pluto, a series of nuclear reactor tests conducted between 1961 to 1964 to develop a nuclear-powered ramjet engine. Based on site history, the scope of this plan will be a two-phased approach to investigate the possible presence of hazardous and/or radioactive constituents at concentrations that could potentially pose a threat to human health and the environment. The Phase I analytical program for most CASs will include volatile organic compounds, semivolatile organic compounds, Resource Conservation and Recovery Act metals, total petroleum hydrocarbons, polychlorinated biphenyls, and radionuclides. If laboratory data obtained from the Phase I investigation indicates the presence of contaminants of concern, the process will continue with a Phase II investigation to define the extent of contamination. Based on the

  5. Corrective Action Investigation Plan for Corrective Action Unit 5: Landfills, Nevada Test Site, Nevada (Rev. No.: 0) includes Record of Technical Change No. 1 (dated 9/17/2002)

    Energy Technology Data Exchange (ETDEWEB)

    IT Corporation, Las Vegas, NV

    2002-05-28

    This Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office's approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 5 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 5 consists of eight Corrective Action Sites (CASs): 05-15-01, Sanitary Landfill; 05-16-01, Landfill; 06-08-01, Landfill; 06-15-02, Sanitary Landfill; 06-15-03, Sanitary Landfill; 12-15-01, Sanitary Landfill; 20-15-01, Landfill; 23-15-03, Disposal Site. Located between Areas 5, 6, 12, 20, and 23 of the Nevada Test Site (NTS), CAU 5 consists of unlined landfills used in support of disposal operations between 1952 and 1992. Large volumes of solid waste were produced from the projects which used the CAU 5 landfills. Waste disposed in these landfills may be present without appropriate controls (i.e., use restrictions, adequate cover) and hazardous and/or radioactive constituents may be present at concentrations and locations that could potentially pose a threat to human health and/or the environment. During the 1992 to 1995 time frame, the NTS was used for various research and development projects including nuclear weapons testing. Instead of managing solid waste at one or two disposal sites, the practice on the NTS was to dispose of solid waste in the vicinity of the project. A review of historical documentation, process knowledge, personal interviews, and inferred activities associated with this CAU identified the following as potential contaminants of concern: volatile organic compounds, semivolatile organic compounds, polychlorinated biphenyls, pesticides, petroleum hydrocarbons (diesel- and gasoline-range organics), Resource Conservation and Recovery Act Metals, plus nickel and zinc. A two-phase approach has been selected to collect information and generate data to satisfy needed resolution

  6. Changes in the level of cardiac troponine and disorders in pulmonary gas exchange as predictors of short- and long-term outcomes of patients with aneurysm subarachnoid haemorrhage.

    Science.gov (United States)

    Burzyńska, Małgorzata; Uryga, Agnieszka; Kasprowicz, Magdalena; Kędziora, Jarosław; Szewczyk, Ewa; Woźniak, Jowita; Jarmundowicz, Włodzimierz; Kübler, Andrzej

    2017-12-01

    Cardiopulmonary abnormalities are common after aneurysmal subarachnoid haemorrhage (aSAH). However, the relationship between short- and long-term outcome is poorly understood. In this paper, we present how cardiac troponine elevations (cTnI) and pulmonary disorders are associated with short- and long-term outcomes assessed by the Glasgow Outcome Scale (GOS) and Extended Glasgow Outcome Scale (GOSE). A total of 104 patients diagnosed with aSAH were analysed in the study. The non-parametric U Mann-Whitney test was used to evaluate the difference between good (GOS IV-V, GOSE V-VIII) and poor (GOS I-III, GOSE I-IV) outcomes in relation to cTnI elevation and pulmonary disorders. Outcome was assessed at discharge from the hospital, and then followed up 6 and 12 months later. Pulmonary disorders were determined by the PaO 2 /FiO 2 ratio and radiography. The areas under the ROC curves (AUCs) were used to determine the predictive power of these factors. In the group with good short-term outcomes cTnI elevation on the second day after aSAH was significantly lower (p = .00007) than in patients with poor short-term outcomes. The same trend was observed after 6 months, although there were different results 12 months from the onset (p = .024 and n.s., respectively). A higher peak of cTnI was observed in the group with a pathological X-ray (p = .008) and pathological PaO 2 /FiO 2 ratio (p ≪ .001). cTnI was an accurate predictor of short-term outcomes (AUC = 0.741, p ≪ .001) and the outcome after 6 months (AUC = 0.688, p = .015). The results showed that cardiopulmonary abnormalities perform well as predictive factors for short- and long-term outcomes after aSAH.

  7. Corrective Action Investigation Plan for Corrective Action Unit 168: Areas 25 and 26 Contaminated Materials and Waste Dumps, Nevada Test Site, Nevada (Rev. 0) includes Record of Technical Change No. 1 (dated 8/28/2002), Record of Technical Change No. 2 (dated 9/23/2002), and Record of Technical Change No. 3 (dated 6/2/2004)

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration Nevada

    2001-11-21

    This Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office's approach to collect data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit 168 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 168 consists of a group of twelve relatively diverse Corrective Action Sites (CASs 25-16-01, Construction Waste Pile; 25-16-03, MX Construction Landfill; 25-19-02, Waste Disposal Site; 25-23-02, Radioactive Storage RR Cars; 25-23-18, Radioactive Material Storage; 25-34-01, NRDS Contaminated Bunker; 25-34-02, NRDS Contaminated Bunker; CAS 25-23-13, ETL - Lab Radioactive Contamination; 25-99-16, USW G3; 26-08-01, Waste Dump/Burn Pit; 26-17-01, Pluto Waste Holding Area; 26-19-02, Contaminated Waste Dump No.2). These CASs vary in terms of the sources and nature of potential contamination. The CASs are located and/or associated wit h the following Nevada Test Site (NTS) facilities within three areas. The first eight CASs were in operation between 1958 to 1984 in Area 25 include the Engine Maintenance, Assembly, and Disassembly Facility; the Missile Experiment Salvage Yard; the Reactor Maintenance, Assembly, and Disassembly Facility; the Radioactive Materials Storage Facility; and the Treatment Test Facility Building at Test Cell A. Secondly, the three CASs located in Area 26 include the Project Pluto testing area that operated from 1961 to 1964. Lastly, the Underground Southern Nevada Well (USW) G3 (CAS 25-99-16), a groundwater monitoring well located west of the NTS on the ridgeline of Yucca Mountain, was in operation during the 1980s. Based on site history and existing characterization data obtained to support the data quality objectives process, contaminants of potential concern (COPCs) for CAU 168 are primarily radionuclide; however, the COPCs for several CASs were not defined. To address COPC