WorldWideScience

Sample records for outcomes study design

  1. ESPRIT study design and outcomes--a critical appraisal.

    Science.gov (United States)

    Einhäupl, Karl

    2007-02-01

    Evidence is needed to guide therapeutic decisions on patients who had ischaemic cerebral events. The recently published European/Australasian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT), an open-label randomised controlled study, compared long-term treatment of patients randomised to aspirin 30-325 mg daily with (n = 1363) or without (n = 1376) dipyridamole 200 mg twice daily. The study found the combination to be superior to aspirin alone (13% vs. 16% events in a composite endpoint of vascular death, non-fatal stroke, non-fatal myocardial infarction, or major bleeding; hazard ratio 0.8; 95% confidence interval 0.66-0.98). In the interpretation of the results, criticism has been raised related to the study design (open-label, change during the study), the study conduct (half of the aspirin patients underdosed, 33% drop-out rate in the combination group, missing information on potential confounders such as protective concomitant medication), and the outcomes (lack of differences in the efficacy outcomes between the intent-to-treat and the on-treatment populations, lack of differences in minor bleedings between treatment groups, borderline statistical significance of primary study endpoint). Further studies are needed to determine the place of aspirin/dipyridamole combinations in the secondary prevention of stroke.

  2. Involving Latina/o parents in patient-centered outcomes research: Contributions to research study design, implementation and outcomes.

    Science.gov (United States)

    Pérez Jolles, Mónica; Martinez, Maria; Garcia, San Juanita; Stein, Gabriela L; Thomas, Kathleen C

    2017-10-01

    Comparative effectiveness research (CER) is supported by policymakers as a way to provide service providers and patients with evidence-based information to make better health-care decisions and ultimately improve services for patients. However, Latina/o patients are rarely involved as study advisors, and there is a lack of documentation on how their voices contribute to the research process when they are included as collaborators. The purpose of this article was to contribute to the literature by presenting concrete contributions of Latina/o parent involvement to study design, implementation and outcomes in the context of a CER study called Padres Efectivos (Parent Activation). Researchers facilitated a collaborative relationship with parents by establishing a mentor parent group. The contributions of parent involvement in the following stages of the research process are described: (i) proposal development, (ii) implementation of protocols, (iii) analysis plan and (iv) dissemination of results. Mentor parents' contributions helped tailor the content of the intervention to their needs during proposal, increased recruitment, validated the main outcome measure and added two important outcome measures, emphasized the importance of controlling for novice treatment status and developed innovative dissemination strategies. Mentor parents' guidance to the researchers has contributed to reaching recruitment goals, strengthened the study protocol, expanded findings, supported broad ownership of study implications and enriched the overall study data collection efforts. These findings can inform future research efforts seeking an active Latino parent collaboration and the timely incorporation of parent voices in each phase of the research process. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  3. The dialysis outcomes and practice patterns study phase 5 in the Gulf Cooperation Council countries: Design and study methods

    Directory of Open Access Journals (Sweden)

    Ronald L Pisoni

    2016-01-01

    Full Text Available The Dialysis Outcomes and Practice Patterns Study (DOPPS is an international prospective cohort study of the relationships between hemodialysis (HD care practices and HD patient outcomes. The DOPPS began in 1996, in the United States, and has since expanded to 21 countries, collecting detailed data from >75,000 HD patients, with >200 scientific publications, focused on describing HD practices associated with improved HD patient outcomes. The goal of DOPPS is to help HD patients "live better and live longer." Starting in 2012, the DOPPS was able to expand to all six of the Gulf Cooperation Council (GCC countries, namely, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. The DOPPS study design consists of selecting HD facilities for study participation in each country to represent the different types of HD facilities and geographic regions within each GCC country. Within each study site, HD patients were randomly selected for detailed data collection to represent the HD practices within each participating HD facility. Altogether, 41 HD facilities have participated in the GCC-DOPPS Phase 5 study including 20 facilities from Saudi Arabia, nine from the United Arab Emirates, four each from Kuwait and Oman, two from Qatar, and one from Bahrain. Herein, we provide a detailed description of the study design and methods, data collection, study management, scientific investigator oversight and guidance, and study governance and support for the GCCDOPPS Phase 5 study.

  4. Life Design Counseling Group Intervention with Portuguese Adolescents: A Process and Outcome Study

    Science.gov (United States)

    Cardoso, Paulo; Janeiro, Isabel Nunes; Duarte, Maria Eduarda

    2018-01-01

    This article examines the process and outcome of a life design counseling group intervention with students in Grades 9 and 12. First, we applied a quasi-experimental methodology to analyze the intervention's effectiveness in promoting career certainty, career decision-making, self-efficacy, and career adaptability in a sample of 236 students.…

  5. Examination of Student Outcomes in Play Therapy: A Qualitative Case Study Design

    Science.gov (United States)

    Dillman Taylor, Dalena L.; Blount, Ashley J.; Bloom, Zachary

    2017-01-01

    Outcome research examining the effectiveness of teaching methods in counselor education is sparse. The researchers conducted a qualitative investigation utilizing an instrumental case study to examine the influence of a constructivist-developmental format on a play therapy counseling course in a large CACREP accredited university in the…

  6. Design and methods of a strategic outcome study for chronic kidney disease: Frontier of Renal Outcome Modifications in Japan.

    Science.gov (United States)

    Yamagata, Kunihiro; Makino, Hirofumi; Akizawa, Tadao; Iseki, Kunitoshi; Itoh, Sadayoshi; Kimura, Kenjiro; Koya, Daisuke; Narita, Ichiei; Mitarai, Tetsuya; Miyazaki, Masanobu; Tsubakihara, Yoshiharu; Watanabe, Tsuyoshi; Wada, Takashi; Sakai, Osamu

    2010-04-01

    The continuous increase in the number of people requiring dialysis is a major clinical and socioeconomical issue in Japan and other countries. This study was designed to encourage chronic kidney disease (CKD) patients to consult a physician, enhance cooperation between nephrologists and general practices, and prevent the progression of kidney disease. Subjects comprise CKD patients aged between 40 and 74 years consulting a general physician, and patients in CKD stage 3 with proteinuria and diabetes or hypertension. This trial is a stratified open cluster-randomized study with two intervention groups: group A (weak intervention) and group B (strong intervention). We have recruited 49 local medical associations (clusters) in 15 different prefectures, which were classified into four regions (strata) based on the level of increase rate of dialysis patients. The patients in group A clusters were instructed initially to undergo treatment in accordance with the current CKD treatment guide, whereas patients in group B clusters were not only instructed in the same fashion but also received support from an information technology (IT)-based system designed to help achieve the goals of CKD treatment, consultation support centers, and consultations by dietitians visiting the local general practice offices. We assessed the rates of continued consultation, collaboration between general practitioners and nephrologists, and progression of CKD (as expressed by CKD stage). Through this study, filling the evidence-practice gap by facilitating effective communication and supporting general physicians and nephrologists, we will establish a CKD care system and decrease the number of advanced-stage CKD patients.

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

    Science.gov (United States)

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

    2009-02-01

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

  8. Automation of CT-based haemorrhagic stroke assessment for improved clinical outcomes: study protocol and design.

    Science.gov (United States)

    Chinda, Betty; Medvedev, George; Siu, William; Ester, Martin; Arab, Ali; Gu, Tao; Moreno, Sylvain; D'Arcy, Ryan C N; Song, Xiaowei

    2018-04-19

    Haemorrhagic stroke is of significant healthcare concern due to its association with high mortality and lasting impact on the survivors' quality of life. Treatment decisions and clinical outcomes depend strongly on the size, spread and location of the haematoma. Non-contrast CT (NCCT) is the primary neuroimaging modality for haematoma assessment in haemorrhagic stroke diagnosis. Current procedures do not allow convenient NCCT-based haemorrhage volume calculation in clinical settings, while research-based approaches are yet to be tested for clinical utility; there is a demonstrated need for developing effective solutions. The project under review investigates the development of an automatic NCCT-based haematoma computation tool in support of accurate quantification of haematoma volumes. Several existing research methods for haematoma volume estimation are studied. Selected methods are tested using NCCT images of patients diagnosed with acute haemorrhagic stroke. For inter-rater and intrarater reliability evaluation, different raters will analyse haemorrhage volumes independently. The efficiency with respect to time of haematoma volume assessments will be examined to compare with the results from routine clinical evaluations and planimetry assessment that are known to be more accurate. The project will target the development of an enhanced solution by adapting existing methods and integrating machine learning algorithms. NCCT-based information of brain haemorrhage (eg, size, volume, location) and other relevant information (eg, age, sex, risk factor, comorbidities) will be used in relation to clinical outcomes with future project development. Validity and reliability of the solution will be examined for potential clinical utility. The project including procedures for deidentification of NCCT data has been ethically approved. The study involves secondary use of existing data and does not require new consent of participation. The team consists of clinical neuroimaging

  9. TA Treatment of Depression - A Hermeneutic Single-Case Efficacy Design Study - ‘Linda’ - a mixed outcome case

    Directory of Open Access Journals (Sweden)

    Mark Widdowson

    2013-07-01

    Full Text Available Hermeneutic Single-Case EfficacyDesign (HSCED is a systematic case study research method involving the cross-examination of mixed method data to generate both plausible arguments that the client changed due to therapy and alternative explanations. The present study is the fourth article of a case series which has investigated the process and outcome of transactional analysis psychotherapy using Hermeneutic Single-Case Efficacy Design (Elliott 2002. The client, Linda, was a 45 yearold white British woman with mild depression who attended nine sessions of therapy. The conclusion of the judges was that this was a mixed-outcome case:whilst the client improved over the course of therapy and was positive about her experience of therapy, her changes did not last when she experienced considerable stressful events during follow-up. Linda provided a detailed and idiosyncratic description of the aspects of the therapy which were most helpful for her. A cross-case comparison with other cases in this series suggests several interesting features which are worthy of further investigation. Specifically, the use of a shared theoretical framework and an egalitarian therapeutic relationship were helpful. As with other cases in this series, the client experienced positive changes in her interpersonal relationships suggesting that this outcome of TA therapy warrants further investigation

  10. Study Design and Interim Outcomes of Guangzhou Institute of Respiratory Disease COPD Biobank.

    Science.gov (United States)

    Lu, Wenju; Zheng, Zeguang; Chen, Xindong; Tan, Hui; Wang, Jian; Zhang, Zili; Zheng, Jinping; Chen, Rongchang; Zhang, Chenting; Xu, Xiaoming; Chen, Yuqin; Yang, Quan; Xiong, Mingmei; Guo, Meihua; Zhou, Qipeng; Tang, Chun; Wang, Yingfeng; Ye, Jinmei; Li, Defu; Shu, Jiaze; Tan, Shu; Xu, Chuyi; Wang, Yan; Lai, Ning; Yang, Kai; Lu, Jiachun; Ran, Pixin; Zhong, Nanshan

    2016-01-01

    GIRD COPD Biobank is a multicenter observational study blood-based database with local characteristics, in order to investigate the causes, risk factors, pathogenesis, prevalence patterns and trends of COPD and promote new pathogenic insights in China. We enrolled 855 clinically COPD patients and 660 controls with normal lung function. Extensive data collection has been undertaken with questionnaires, clinical measurements, and collection and storage of blood specimens, following Standard Operating Procedures (SOP). All surveys had similar quality controls, supervisions, and training of the investigator team. Since September 2010, a total of 1515 subjects (1116 [73.7%] males; 855 [56.4%] diagnosed with COPD) were enrolled. Analyses of the design and interim results of the GIRD COPD Biobank Study identified patients with COPD were older, lower educational level, a longer history of pack-year smoking, less in kitchen fan usage, X-ray exposure, and history of disease (P < 0.01 for all); Most of the COPD subjects belonged to moderately severe or worse, stratified according to Global Lung Function Initiative (GLI); COPD patients had relatively more co-morbidities than controls; Environmental hazard exposures might be the main contributors to the reported respiratory symptoms; Cold air, haze, and influenza acted the top three factors to induce respiratory symptoms in both COPD cases and controls. The GIRD COPD Biobank Study has the potential to provide substantial novel insights into the genetics, biomarkers, environmental and lifestyle aspects of COPD. It is expected to provide new insights for pathogenesis and the long-term progression of COPD.

  11. Using case study within a sequential explanatory design to evaluate the impact of specialist and advanced practice roles on clinical outcomes: the SCAPE study.

    Science.gov (United States)

    Lalor, Joan G; Casey, Dympna; Elliott, Naomi; Coyne, Imelda; Comiskey, Catherine; Higgins, Agnes; Murphy, Kathy; Devane, Declan; Begley, Cecily

    2013-04-08

    The role of the clinical nurse/midwife specialist and advanced nurse/midwife practitioner is complex not least because of the diversity in how the roles are operationalised across health settings and within multidisciplinary teams. This aim of this paper is to use The SCAPE Study: Specialist Clinical and Advanced Practitioner Evaluation in Ireland to illustrate how case study was used to strengthen a Sequential Explanatory Design. In Phase 1, clinicians identified indicators of specialist and advanced practice which were then used to guide the instrumental case study design which formed the second phase of the larger study. Phase 2 used matched case studies to evaluate the effectiveness of specialist and advanced practitioners on clinical outcomes for service users. Data were collected through observation, documentary analysis, and interviews. Observations were made of 23 Clinical Specialists or Advanced Practitioners, and 23 matched clinicians in similar matched non-postholding sites, while they delivered care. Forty-one service users, 41 clinicians, and 23 Directors of Nursing or Midwifery were interviewed, and 279 service users completed a survey based on the components of CS and AP practice identified in Phase 1. A coding framework, and the generation of cross tabulation matrices in NVivo, was used to make explicit how the outcome measures were confirmed and validated from multiple sources. This strengthened the potential to examine single cases that seemed 'different', and allowed for cases to be redefined. Phase 3 involved interviews with policy-makers to set the findings in context. Case study is a powerful research strategy to use within sequential explanatory mixed method designs, and adds completeness to the exploration of complex issues in clinical practice. The design is flexible, allowing the use of multiple data collection methods from both qualitative and quantitative paradigms. Multiple approaches to data collection are needed to evaluate the impact

  12. Strategies and opportunities to STOP colon cancer in priority populations: pragmatic pilot study design and outcomes

    International Nuclear Information System (INIS)

    Coronado, Gloria D; Turner, Ann; Sanchez, Jennifer; Retecki, Sally; Nelson, Christine; Green, Beverly; Vollmer, William M; Petrik, Amanda; Aguirre, Josue; Kapka, Tanya; DeVoe, Jennifer; Puro, Jon; Miers, Tran; Lembach, Jennifer

    2014-01-01

    Colorectal-cancer is a leading cause of cancer death in the United States, and Latinos have particularly low rates of screening. Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) is a partnership among two research institutions and a network of safety net clinics to promote colorectal cancer screening among populations served by these clinics. This paper reports on results of a pilot study conducted in a safety net organization that serves primarily Latinos. The study assessed two clinic-based approaches to raise rates of colorectal-cancer screening among selected age-eligible patients not up-to-date with colorectal-cancer screening guidelines. One clinic each was assigned to: (1) an automated data-driven Electronic Health Record (EHR)-embedded program for mailing Fecal Immunochemical Test (FIT) kits (Auto Intervention); or (2) a higher-intensity program consisting of a mailed FIT kit plus linguistically and culturally tailored interventions delivered at the clinic level (Auto Plus Intervention). A third clinic within the safety-net organization was selected to serve as a passive control (Usual Care). Two simple measurements of feasibility were: 1) ability to use real-time EHR data to identify patients eligible for each intervention step, and 2) ability to offer affordable testing and follow-up care for uninsured patients. The study was successful at both measurements of feasibility. A total of 112 patients in the Auto clinic and 101 in the Auto Plus clinic met study inclusion criteria and were mailed an introductory letter. Reach was high for the mailed component (92.5% of kits were successfully mailed), and moderate for the telephone component (53% of calls were successful completed). After exclusions for invalid address and other factors, 206 (109 in the Auto clinic and 97 in the Auto Plus clinic) were mailed a FIT kit. At 6 months, fecal test completion rates were higher in the Auto (39.3%) and Auto Plus (36.6%) clinics

  13. Effects of Environmental Design on Patient Outcome

    DEFF Research Database (Denmark)

    Laursen, Jannie; Danielsen, Anne Kjaergaard; Rosenberg, Jacob

    2014-01-01

    OBJECTIVE: The aim of this systematic review was to assess how inpatients were affected by the built environment design during their hospitalization. BACKGROUND: Over the last decade, the healthcare system has become increasingly aware of how focus on healthcare environment might affect patient....... The following databases were searched: Medline/PubMed, Cinahl, and Embase. Inclusion criteria were randomized clinical trials (RCTs) investigating the effect of built environment design interventions such as music, natural murals, and plants in relation to patients' health outcome. RESULTS: Built environment...... satisfaction. The focus on environmental design has become a field with great potential because of its possible impact on cost control while improving quality of care. METHODS: A systematic literature search was conducted to identify current and past studies about evidence-based healthcare design...

  14. Optimum study designs.

    Science.gov (United States)

    Gu, C; Rao, D C

    2001-01-01

    Because simplistic designs will lead to prohibitively large sample sizes, the optimization of genetic study designs is critical for successfully mapping genes for complex diseases. Creative designs are necessary for detecting and amplifying the usually weak signals for complex traits. Two important outcomes of a study design--power and resolution--are implicitly tied together by the principle of uncertainty. Overemphasis on either one may lead to suboptimal designs. To achieve optimality for a particular study, therefore, practical measures such as cost-effectiveness must be used to strike a balance between power and resolution. In this light, the myriad of factors involved in study design can be checked for their effects on the ultimate outcomes, and the popular existing designs can be sorted into building blocks that may be useful for particular situations. It is hoped that imaginative construction of novel designs using such building blocks will lead to enhanced efficiency in finding genes for complex human traits.

  15. 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…

  16. Clinical research in implant dentistry: study design, reporting and outcome measurements: consensus report of Working Group 2 of the VIII European Workshop on Periodontology.

    Science.gov (United States)

    Tonetti, Maurizio; Palmer, Richard

    2012-02-01

    The objective of this working group was to assess and make specific recommendations to improve the quality of reporting of clinical research in implant dentistry and discuss ways to reach a consensus on choice of outcomes. Discussions were informed by three systematic reviews on quality of reporting of observational studies (case series, case-control and cohort) and experimental research (randomized clinical trials). An additional systematic review provided information on choice of outcomes and analytical methods. In addition, an open survey among all workshop participants was utilized to capture a consensus view on the limits of currently used survival and success-based outcomes as well as to identify domains that need to be captured by future outcome systems. The Workshop attempted to clarify the characteristics and the value in dental implant research of different study designs. In most areas, measurable quality improvements over time were identified. The Workshop recognized important aspects that require continued attention by clinical researchers, funding agencies and peer reviewers to decrease potential bias. With regard to choice of outcomes, the limitations of currently used systems were recognized. Three broad outcome domains that need to be captured by future research were identified: (i) patient reported outcome measures, (ii) peri-implant tissue health and (iii) performance of implant supported restorations. Peri-implant tissue health can be measured by marginal bone level changes and soft tissue inflammation and can be incorporated in time to event analyses. The Workshop recommended that collaboration between clinicians and epidemiologists/clinical trials specialists should be encouraged. Aspects of design aimed at limitation of potential bias should receive attention by clinical researchers, funding agencies and journal editors. Adherence to appropriate reporting guidelines such as STROBE and CONSORT are necessary standards. Research on outcome

  17. The chronic kidney disease outcomes and practice patterns study Brazil (CKDopps-Brazil: Design, data and methodology

    Directory of Open Access Journals (Sweden)

    Rodrigo Bueno de Oliveira

    2014-03-01

    Full Text Available Introduction: The chronic kidney disease outcomes and practice patterns study (CKDopps is an international observational, prospective, cohort study involving patients with chronic kidney disease (CKD stages 3-5 [estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m2, with a major focus upon care during the advanced CKD period (eGFR < 30 ml/min/1.73 m2]. During a 1-year enrollment period, each one of the 22 selected clinics will enroll up to 60 advanced CKD patients (eGFR < 30 ml/min/1.73 m2 and not dialysis-dependent and 20 earlier stage CKD patients (eGFR between 30-59 ml/min/1.73 m2. Exclusion criteria: age < 18 years old, patients on chronic dialysis or prior kidney transplant. The study timeline include up to one year for enrollment of patients at each clinic starting in the end of 2013, followed by up to 2-3 years of patient follow-up with collection of detailed longitudinal patient-level data, annual clinic practice-level surveys, and patient surveys. Analyses will apply regression models to evaluate the contribution of patient-level and clinic practice-level factors to study outcomes, and utilize instrumental variable-type techniques when appropriate. Conclusion: Launching in 2013, CKDopps Brazil will study advanced CKD care in a random selection of nephrology clinics across Brazil to gain understanding of variation in care across the country, and as part of a multinational study to identify optimal treatment practices to slow kidney disease progression and improve outcomes during the transition period to end-stage kidney disease.

  18. Design of a study on suboptimal cognitive acts in the diagnostic process, the effect on patient outcomes and the influence of workload, fatigue and experience of physician

    Directory of Open Access Journals (Sweden)

    van der Wal Gerrit

    2009-04-01

    Full Text Available Abstract Background Diagnostic error is an important error type since diagnostic adverse events are regularly judged as being preventable and the consequences are considered to be severe. Existing research often focuses on either diagnostic adverse events or on the errors in diagnostic reasoning. Whether and when an incorrect diagnostic process results in adverse outcomes has not been studied extensively. The present paper describes the design of a study that aims to study the relationship between a suboptimal diagnostic process and patient outcomes. In addition, the role of personal and circumstantial factors on the quality of the diagnostic process will be examined. Methods/Design The research questions were addressed using several data sources. First, the differential diagnosis was assessed concurrently to the diagnostic process. Second, the patient records of 248 patients suffering from shortness of breath were reviewed by expert internists in order to reveal suboptimal cognitive acts and (potential consequences for the patient. The suboptimal cognitive acts were discussed with the treating physicians and classified with the taxonomy of unsafe acts. Third, workload, fatigue and work experience were measured during the physicians work. Workload and fatigue were measured during the physicians shift using the NASA tlx questionnaire on a handheld computer. Physicians participating in the study also answered questions about their work experience. Discussion The design used in this study provides insight into the relationship between suboptimal cognitive acts in the diagnostic process and possible consequences for the patient. Suboptimal cognitive acts in the diagnostic process and its causes can be revealed. Additional measurements of workload, fatigue and experience allow examining the influence of these factors on the diagnostic process. In conclusion, the present design provides a method with which insights in weaknesses of the diagnostic

  19. Infant and childhood neurodevelopmental outcomes following prenatal exposure to selective serotonin reuptake inhibitors: overview and design of a Finnish Register-Based Study (FinESSI

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    Malm Heli

    2012-12-01

    Full Text Available Abstract Background Experimental animal studies and one population-based study have suggested an increased risk for adverse neurodevelopmental outcome after prenatal exposure to SSRIs. We describe the methods and design of a population-based study examining the association between prenatal SSRI exposure and neurodevelopment until age 14. Methods and design This is a cohort study of national registers in Finland: the Medical Birth Register, the Register of Congenital Malformations, the Hospital Discharge Register including inpatient and outpatient data, the Drug Reimbursement Register, and the Population Register. The total study population includes 845,345 women and their live-born, singleton offspring aged 14 or younger and born during Jan 1st 1996-Dec 31st 2010. We will compare the prevalence of psychiatric and neurodevelopmental outcomes in offspring exposed prenatally to SSRIs to offspring exposed to prenatal depression and unexposed to SSRIs. Associations between exposure and outcome are assessed by statistical methods including specific modeling to account for correlated outcomes within families and differences in duration of follow-up between the exposure groups. Descriptive results. Of all pregnant women with pregnancy ending in delivery (n = 859,359, 1.9% used SSRIs. The prevalence of diagnosed depression and depression-related psychiatric disorders within one year before or during pregnancy was 1.7%. The cumulative incidence of registered psychiatric or neurodevelopmental disorders was 6.9% in 2010 among all offspring born during the study period (age range 0–14 years. Discussion The study has the potential for significant public health importance in providing information on prenatal exposure to SSRIs and long-term neurodevelopment.

  20. The International Childhood Cardiovascular Cohort (i3C) consortium outcomes study of childhood cardiovascular risk factors and adult cardiovascular morbidity and mortality: Design and recruitment.

    Science.gov (United States)

    Sinaiko, Alan R; Jacobs, David R; Woo, Jessica G; Bazzano, Lydia; Burns, Trudy; Hu, Tian; Juonala, Markus; Prineas, Ronald; Raitakari, Olli; Steinberger, Julia; Urbina, Elaine; Venn, Alison; Jaquish, Cashell; Dwyer, Terry

    2018-04-22

    Although it is widely thought that childhood levels of cardiovascular (CV) risk factors are related to adult CV disease, longitudinal data directly linking the two are lacking. This paper describes the design and organization of the International Childhood Cardiovascular Cohort Consortium Outcomes Study (i3C Outcomes), the first longitudinal cohort study designed to locate adults with detailed, repeated, childhood biological, physical, and socioeconomic measurements and a harmonized database. I3C Outcomes uses a Heart Health Survey (HHS) to obtain information on adult CV endpoints, using mail, email, telephone, and clinic visits in the United States (U.S.) and Australia and a national health database in Finland. Microsoft Access, REsearch Data Capture (REDCap) (U.S.), LimeSurvey (Australia), and Medidata™ Rave data systems are used to collect, transfer and organize data. Self-reported CV events are adjudicated via hospital and doctor-released medical records. After the first two study years, participants (N = 10,968) were more likely to be female (56% vs. 48%), non-Hispanic white (90% vs. 80%), and older (10.4 ± 3.8 years vs. 9.4 ± 3.3 years) at their initial childhood study visit than the currently non-recruited cohort members. Over 48% of cohort members seen during both adulthood and childhood have been found and recruited, to date, vs. 5% of those not seen since childhood. Self-reported prevalences were 0.7% Type 1 Diabetes, 7.5% Type 2 Diabetes, 33% hypertension, and 12.8% CV event. 32% of CV events were judged to be true. I3C Outcomes is uniquely able to establish evidence-based guidelines for child health care and to clarify relations to adult CV disease. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. A systematic review assessing non-pharmacological conservative treatment studies for people with non-inflammatory multi-joint pain: clinical outcomes and research design considerations.

    Science.gov (United States)

    Comer, C; Smith, T O; Drew, B; Raja, R; Kingsbury, S R; Conaghan, Philip G

    2018-03-01

    To systematically review the evidence to determine the clinical outcomes and the important methodological quality features of interventional studies on adults with non-inflammatory multi-joint pain (MJP). Systematic search of published and unpublished literature using the databases: AMED, CINAHL, MEDLINE, EMBASE, psycINFO, SPORTDiscus, PEDro, OpenGrey, the EU Clinical Trials Register, World Health Organization International Clinical Trial Registry Platform, ClinicalTrials.gov and the ISRCTN registry (search: inception to 19th October 2017). All papers reporting the clinical outcomes of non-pharmacological interventions for people with non-inflammatory MJP were included. Studies were critically appraised using the Downs and Black Critical Appraisal and the TIDieR reporting checklists. Data were analysed using a Best Evidence Synthesis approach. From 3824 citations, four papers satisfied the eligibility criteria. Three studies reported outcomes from multidisciplinary rehabilitation programmes and one study reported the findings of a spa therapy intervention. All interventions significantly improved pain, function and quality of life in the short-term. There was limited reporting of measures for absenteeism, presenteeism and psychosocial outcomes. The evidence was 'weak', and due to a lack of controlled trials, there is limited evidence to ascertain treatment effectiveness. Design consideration for future trials surround improved reporting of participant characteristics, interventions and the standardisation of core outcome measures. There is insufficient high-quality trial data to determine the effectiveness of treatments for non-inflammatory MJP. Given the significant health burden which this condition presents on both individuals and wider society, developing and testing interventions and accurately reporting these, should be a research priority. Registration PROSPERO (CRD42013005888).

  2. Predicting the outcome of chronic kidney disease by the estimated nephron number: The rationale and design of PRONEP, a prospective, multicenter, observational cohort study

    Directory of Open Access Journals (Sweden)

    Imasawa Toshiyuki

    2012-03-01

    Full Text Available Abstract Background The nephron number is thought to be associated with the outcome of chronic kidney disease (CKD. If the nephron number can be estimated in the clinical setting, it could become a strong tool to predict renal outcome. This study was designed to estimate the nephron number in CKD patients and to establish a method to predict the outcome by using the estimated nephron number. Methods/Design The hypothesis of this study is that the estimated nephron number can predict the outcome of a CKD patient. This will be a multicenter, prospective (minimum 3 and maximum 5 years follow-up study. The subjects will comprise CKD patients aged over 14 years who have undergone a kidney biopsy. From January 2011 to March 2013, we will recruit 600 CKD patients from 10 hospitals belonging to the National Hospital Organization of Japan. The primary parameter for assessment is the composite of total mortality, renal death, cerebro-cardiovascular events, and a 50% reduction in the eGFR. The secondary parameter is the rate of eGFR decline per year. The nephron number will be estimated by the glomerular density in biopsy specimens and the renal cortex volume. This study includes one sub-cohort study to establish the equation to calculate the renal cortex volume. Enrollment will be performed at the time of the kidney biopsy, and the data will consist of a medical interview, ultrasound for measurement of the kidney size, blood or urine test, and the pathological findings of the kidney biopsy. Patients will continue to have medical consultations and receive examinations and/or treatment as usual. The data from the patients will be collected once a year after the kidney biopsy until March 2016. All data using this study are easily obtained in routine clinical practice. Discussion This study includes the first trials to estimate the renal cortex volume and nephron number in the general clinical setting. Furthermore, this is the first prospective study to

  3. Exposure to power-frequency magnetic fields and the risk of infertility and adverse pregnancy outcomes: update on the human evidence and recommendations for future study designs

    Science.gov (United States)

    Lewis, Ryan C.; Hauser, Russ; Maynard, Andrew D.; Neitzel, Richard L.; Wang, Lu; Kavet, Robert; Meeker, John D.

    2016-01-01

    Infertility and adverse pregnancy outcomes are significant public health concerns with global prevalence. Over the past 35 years, research has addressed whether exposure to power-frequency magnetic fields is one of the etiologic factors attributed to these conditions. However, no apparent authoritative reviews on this topic have been published in the peer-reviewed literature for nearly 15 years. This review provides an overview and critical analysis of human studies that were published in the peer-reviewed literature between 2002 and July 2015. Using PubMed, 13 epidemiology studies published during this timeframe that concern exposure to magnetic fields and adverse prenatal (e.g., miscarriage), neonatal (e.g., preterm birth or birth defects), and male fertility (e.g., poor semen quality) outcomes were identified. Some of these studies reported associations whereas others did not, and study design limitations may explain these inconsistencies. Future investigations need to be designed with these limitations in mind to address existing research gaps. In particular, the following issues are discussed: 1) importance of selecting the appropriate study population, 2) need for addressing confounding due to unmeasured physical activity, 3) importance of minimizing information bias from exposure measurement error, 4) consideration of alternative magnetic field exposure metrics, and 5) implications and applications of personal exposure data that is correlated within female-male couples. Further epidemiologic research is needed given the near ubiquitous exposures to power-frequency magnetic fields in the general population. PMID:27030583

  4. Preventing AVF thrombosis: the rationale and design of the Omega-3 fatty acids (Fish Oils and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED study

    Directory of Open Access Journals (Sweden)

    Rosman Johan

    2009-01-01

    Full Text Available Abstract Background Haemodialysis (HD is critically dependent on the availability of adequate access to the systemic circulation, ideally via a native arteriovenous fistula (AVF. The Primary failure rate of an AVF ranges between 20–54%, due to thrombosis or failure of maturation. There remains limited evidence for the use of anti-platelet agents and uncertainty as to choice of agent(s for the prevention of AVF thrombosis. We present the study protocol for a randomised, double-blind, placebo-controlled, clinical trial examining whether the use of the anti-platelet agents, aspirin and omega-3 fatty acids, either alone or in combination, will effectively reduce the risk of early thrombosis in de novo AVF. Methods/Design The study population is adult patients with stage IV or V chronic kidney disease (CKD currently on HD or where HD is planned to start within 6 months in whom a planned upper or lower arm AVF is to be the primary HD access. Using a factorial-design trial, patients will be randomised to aspirin or matching placebo, and also to omega-3 fatty acids or matching placebo, resulting in four treatment groups (aspirin placebo/omega-3 fatty acid placebo, aspirin/omega-3 fatty acid placebo, aspirin placebo/omega-3 fatty acid, aspirin/omega-3 fatty acid. Randomisation will be achieved using a dynamic balancing method over the two stratification factors of study site and upper versus lower arm AVF. The medication will be commenced pre-operatively and continued for 3 months post surgery. The primary outcome is patency of the AVF at three months after randomisation. Secondary outcome measures will include functional patency at six and twelve months, primary patency time, secondary (assisted patency time, and adverse events, particularly bleeding. Discussion This multicentre Australian and New Zealand study has been designed to determine whether the outcome of surgery to create de novo AVF can be improved by the use of aspirin and/or omega-3 fatty

  5. Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727

    Directory of Open Access Journals (Sweden)

    Law Mary

    2006-07-01

    Full Text Available Abstract Background A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning related to health outcome measures. Method/Design Physical and occupational therapists (n = 144 will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1 Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS, and 2 Online Problem-Based course (e-PBL. SHIPS will consist of face-to-face problem-based learning (PBL for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT

  6. Identifying Indicators Related to Constructs for Engineering Design Outcome

    Science.gov (United States)

    Wilhelmsen, Cheryl A.; Dixon, Raymond A.

    2016-01-01

    This study ranked constructs articulated by Childress and Rhodes (2008) and identified the key indicators for each construct as a starting point to explore what should be included on an instrument to measure the engineering design process and outcomes of students in high schools that use the PLTW and EbDTM curricula in Idaho. A case-study design…

  7. Preventing AVF thrombosis: the rationale and design of the Omega-3 fatty acids (Fish Oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study.

    Science.gov (United States)

    Irish, Ashley; Dogra, Gursharan; Mori, Trevor; Beller, Elaine; Heritier, Stephane; Hawley, Carmel; Kerr, Peter; Robertson, Amanda; Rosman, Johan; Paul-Brent, Peta-Anne; Starfield, Melissa; Polkinghorne, Kevan; Cass, Alan

    2009-01-21

    Haemodialysis (HD) is critically dependent on the availability of adequate access to the systemic circulation, ideally via a native arteriovenous fistula (AVF). The Primary failure rate of an AVF ranges between 20-54%, due to thrombosis or failure of maturation. There remains limited evidence for the use of anti-platelet agents and uncertainty as to choice of agent(s) for the prevention of AVF thrombosis. We present the study protocol for a randomised, double-blind, placebo-controlled, clinical trial examining whether the use of the anti-platelet agents, aspirin and omega-3 fatty acids, either alone or in combination, will effectively reduce the risk of early thrombosis in de novo AVF. The study population is adult patients with stage IV or V chronic kidney disease (CKD) currently on HD or where HD is planned to start within 6 months in whom a planned upper or lower arm AVF is to be the primary HD access. Using a factorial-design trial, patients will be randomised to aspirin or matching placebo, and also to omega-3 fatty acids or matching placebo, resulting in four treatment groups (aspirin placebo/omega-3 fatty acid placebo, aspirin/omega-3 fatty acid placebo, aspirin placebo/omega-3 fatty acid, aspirin/omega-3 fatty acid). Randomisation will be achieved using a dynamic balancing method over the two stratification factors of study site and upper versus lower arm AVF. The medication will be commenced pre-operatively and continued for 3 months post surgery. The primary outcome is patency of the AVF at three months after randomisation. Secondary outcome measures will include functional patency at six and twelve months, primary patency time, secondary (assisted) patency time, and adverse events, particularly bleeding. This multicentre Australian and New Zealand study has been designed to determine whether the outcome of surgery to create de novo AVF can be improved by the use of aspirin and/or omega-3 fatty acids. Recently a placebo-controlled trial has shown that

  8. Quality of reporting of descriptive studies in implant dentistry. Critical aspects in design, outcome assessment and clinical relevance

    NARCIS (Netherlands)

    Meijer, Henny J. A.; Raghoebar, Gerry M.

    Objectives: The aim of this study was to conduct a review on quality of reporting on descriptive studies in implant dentistry using the STROBE Statement and to analyse possible changes in quality of reporting on descriptive studies in implant dentistry over time. Material and Methods: A hand search

  9. Exploring academics' views on designs, methods, characteristics and outcomes of inclusive health research with people with intellectual disabilities: a modified Delphi study

    Science.gov (United States)

    Frankena, T K; Naaldenberg, J; Cardol, M; Meijering, J V; Leusink, G; van Schrojenstein Lantman-de Valk, H M J

    2016-01-01

    Background The British Medical Journal's (BMJ's) patient revolution strives for collaboration with patients in healthcare and health research. This paper studies collaboration with people with intellectual disabilities (ID) in health research, also known as inclusive health research. Currently, transparency and agreement among academics is lacking regarding its main aspects, preventing upscaling of the patient revolution. Objective This study aims to gain agreement among academics on 3 aspects of inclusive health research for people with ID: (1) designs and methods, (2) most important characteristics and (3) outcomes. Design A Delphi study was conducted with academics with experience in inclusive (health) research and on people with ID. The study consisted of 2 sequential questionnaire rounds (n=24; n=17), followed by in-depth interviews (n=10). Results Academics agreed on (1) a collaborative approach to be most suitable to inclusive health research, (2) characteristics regarding the accessibility and facilitation of inclusive health research, and (3) several outcomes of inclusive health research for people with ID and healthcare. Other characteristics agreed on included: atmosphere, relationship, engagement, partnership and power. It was stressed that these characteristics ensure meaningful inclusion. Interviewed academics voiced the need for a tool supporting the facilitation and evaluation of inclusive health research. There was ambiguity as to what this tool should comprise and the extent to which it was possible to capture the complex process of inclusive health research. Discussion and conclusions This study underlines the need for transparency, facilitation and evaluation of inclusive health research. The need for in-depth interviews after 2 Delphi rounds underlines its complexity and context dependence. To increase process transparency, future research should focus on gaining insight into inclusive health research in its context. A tool could be developed

  10. Effect of genetic testing for risk of type 2 diabetes mellitus on health behaviors and outcomes: study rationale, development and design

    Directory of Open Access Journals (Sweden)

    Cho Alex H

    2012-01-01

    Full Text Available Abstract Background Type 2 diabetes is a prevalent chronic condition globally that results in extensive morbidity, decreased quality of life, and increased health services utilization. Lifestyle changes can prevent the development of diabetes, but require patient engagement. Genetic risk testing might represent a new tool to increase patients' motivation for lifestyle changes. Here we describe the rationale, development, and design of a randomized controlled trial (RCT assessing the clinical and personal utility of incorporating type 2 diabetes genetic risk testing into comprehensive diabetes risk assessments performed in a primary care setting. Methods/Design Patients are recruited in the laboratory waiting areas of two primary care clinics and enrolled into one of three study arms. Those interested in genetic risk testing are randomized to receive either a standard risk assessment (SRA for type 2 diabetes incorporating conventional risk factors plus upfront disclosure of the results of genetic risk testing ("SRA+G" arm, or the SRA alone ("SRA" arm. Participants not interested in genetic risk testing will not receive the test, but will receive SRA (forming a third, "no-test" arm. Risk counseling is provided by clinic staff (not study staff external to the clinic. Fasting plasma glucose, insulin levels, body mass index (BMI, and waist circumference are measured at baseline and 12 months, as are patients' self-reported behavioral and emotional responses to diabetes risk information. Primary outcomes are changes in insulin resistance and BMI after 12 months; secondary outcomes include changes in diet patterns, physical activity, waist circumference, and perceived risk of developing diabetes. Discussion The utility, feasibility, and efficacy of providing patients with genetic risk information for common chronic diseases in primary care remain unknown. The study described here will help to establish whether providing type 2 diabetes genetic risk

  11. Impact of the Patient-Reported Outcomes Management Information System (PROMIS) upon the design and operation of multi-center clinical trials: a qualitative research study.

    Science.gov (United States)

    Eisenstein, Eric L; Diener, Lawrence W; Nahm, Meredith; Weinfurt, Kevin P

    2011-12-01

    New technologies may be required to integrate the National Institutes of Health's Patient Reported Outcome Management Information System (PROMIS) into multi-center clinical trials. To better understand this need, we identified likely PROMIS reporting formats, developed a multi-center clinical trial process model, and identified gaps between current capabilities and those necessary for PROMIS. These results were evaluated by key trial constituencies. Issues reported by principal investigators fell into two categories: acceptance by key regulators and the scientific community, and usability for researchers and clinicians. Issues reported by the coordinating center, participating sites, and study subjects were those faced when integrating new technologies into existing clinical trial systems. We then defined elements of a PROMIS Tool Kit required for integrating PROMIS into a multi-center clinical trial environment. The requirements identified in this study serve as a framework for future investigators in the design, development, implementation, and operation of PROMIS Tool Kit technologies.

  12. Evaluating a Dutch cardiology primary care plus intervention on the Triple Aim outcomes: study design of a practice-based quantitative and qualitative research.

    Science.gov (United States)

    Quanjel, Tessa C C; Spreeuwenberg, Marieke D; Struijs, Jeroen N; Baan, Caroline A; Ruwaard, Dirk

    2017-09-06

    In an attempt to deal with the pressures on the health-care system and to guarantee sustainability, changes are needed. This study focuses on a cardiology primary care plus intervention. Primary care plus (PC+) is a new health-care delivery model focused on substitution of specialist care in the hospital setting with specialist care in the primary care setting. The intervention consists of a cardiology PC+ centre in which cardiologists, supported by other health-care professionals, provide consultations in a primary care setting. The PC+ centre aims to improve the health of the population and quality of care as experienced by patients, and reduce the number of referrals to hospital-based outpatient specialist care in order to reduce health-care costs. These aims reflect the Triple Aim principle. Hence, the objectives of the study are to evaluate the cardiology PC+ centre in terms of the Triple Aim outcomes and to evaluate the process of the introduction of PC+. The study is a practice-based, quantitative study with a longitudinal observational design, and an additional qualitative study to supplement, interpret and improve the quantitative study. The study population of the quantitative part will consist of adult patients (≥18 years) with non-acute and low-complexity cardiology-related health complaints, who will be referred to the cardiology PC+ centre (intervention group) or hospital-based outpatient cardiology care (control group). All eligible patients will be asked to complete questionnaires at three different time points consisting of questions about their demographics, health status and experience of care. Additionally, quantitative data will be collected about health-care utilization and related health-care costs at the PC+ centre and the hospital. The qualitative part, consisting of semi-structured interviews, focus groups, and observations, is designed to evaluate the process as well as to amplify, clarify and explain quantitative results. This study

  13. A police education programme to integrate occupational safety and HIV prevention: protocol for a modified stepped-wedge study design with parallel prospective cohorts to assess behavioural outcomes

    Science.gov (United States)

    Strathdee, Steffanie A; Arredondo, Jaime; Rocha, Teresita; Abramovitz, Daniela; Rolon, Maria Luisa; Patiño Mandujano, Efrain; Rangel, Maria Gudelia; Olivarria, Horcasitas Omar; Gaines, Tommi; Patterson, Thomas L; Beletsky, Leo

    2015-01-01

    Introduction Policing practices are key drivers of HIV among people who inject drugs (PWID). This paper describes the protocol for the first study to prospectively examine the impact of a police education programme (PEP) to align law enforcement and HIV prevention. PEPs incorporating HIV prevention (including harm reduction programmes like syringe exchange) have been successfully piloted in several countries but were limited to brief pre–post assessments; the impact of PEPs on policing behaviours and occupational safety is unknown. Objectives Proyecto ESCUDO (SHIELD) aims to evaluate the efficacy of the PEP on uptake of occupational safety procedures, as assessed through the incidence of needle stick injuries (NSIs) (primary outcome) and changes in knowledge of transmission, prevention and treatment of HIV and viral hepatitis; attitudes towards PWID, adverse behaviours that interfere with HIV prevention and protective behaviours (secondary outcomes). Methods/analysis ESCUDO is a hybrid type I design that simultaneously tests an intervention and an implementation strategy. Using a modified stepped-wedge design involving all active duty street-level police officers in Tijuana (N=∼1200), we will administer one 3 h PEP course to groups of 20–50 officers until the entire force is trained. NSI incidence and geocoded arrest data will be assessed from department-wide de-identified data. Of the consenting police officers, a subcohort (N=500) will be randomly sampled from each class to undergo pre-PEP and post-PEP surveys with a semiannual follow-up for 2 years to assess self-reported NSIs, attitudes and behaviour changes. The impact on PWIDs will be externally validated through a parallel cohort of Tijuana PWIDs. Ethics/dissemination Research ethics approval was obtained from the USA and Mexico. Findings will be disseminated through open access to protocol materials through the Law Enforcement and HIV Network. Trial registration number NCT02444403. PMID:26260350

  14. Evaluation and mechanism for outcomes exploration of providing public health care in contract service in rural China: a multiple-case study with complex adaptive systems design.

    Science.gov (United States)

    Zhou, Huixuan; Zhang, Shengfa; Zhang, Weijun; Wang, Fugang; Zhong, You; Gu, Linni; Qu, Zhiyong; Tian, Donghua

    2015-02-27

    The Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future. Three pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework. Without sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders' positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the

  15. The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES study: background, design and rationale

    Directory of Open Access Journals (Sweden)

    McCargar Linda

    2010-10-01

    Full Text Available Abstract Background Extreme obesity affects nearly 8% of Canadians, and is debilitating, costly and ultimately lethal. Bariatric surgery is currently the most effective treatment available; is associated with reductions in morbidity/mortality, improvements in quality of life; and appears cost-effective. However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times. The objectives and hypotheses of this study were as follows: 1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time; 2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life; 3. To conduct a 3-year (1 year retrospective and 2 year prospective economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery. Methods/design Population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients. Subjects will be enrolled from the Edmonton Weight Wise Regional Obesity Program (Edmonton, Alberta, Canada, with prospective bi-annual follow-up for 2 years. Mixed methods data collection, linking primary data to provincial administrative databases will be employed. Major outcomes include generic, obesity-specific and preference

  16. Exploring academics' views on designs, methods, characteristics and outcomes of inclusive health research with people with intellectual disabilities: a modified Delphi study.

    Science.gov (United States)

    Frankena, T K; Naaldenberg, J; Cardol, M; Meijering, J V; Leusink, G; van Schrojenstein Lantman-de Valk, H M J

    2016-08-18

    The British Medical Journal's (BMJ's) patient revolution strives for collaboration with patients in healthcare and health research. This paper studies collaboration with people with intellectual disabilities (ID) in health research, also known as inclusive health research. Currently, transparency and agreement among academics is lacking regarding its main aspects, preventing upscaling of the patient revolution. This study aims to gain agreement among academics on 3 aspects of inclusive health research for people with ID: (1) designs and methods, (2) most important characteristics and (3) outcomes. A Delphi study was conducted with academics with experience in inclusive (health) research and on people with ID. The study consisted of 2 sequential questionnaire rounds (n=24; n=17), followed by in-depth interviews (n=10). Academics agreed on (1) a collaborative approach to be most suitable to inclusive health research, (2) characteristics regarding the accessibility and facilitation of inclusive health research, and (3) several outcomes of inclusive health research for people with ID and healthcare. Other characteristics agreed on included: atmosphere, relationship, engagement, partnership and power. It was stressed that these characteristics ensure meaningful inclusion. Interviewed academics voiced the need for a tool supporting the facilitation and evaluation of inclusive health research. There was ambiguity as to what this tool should comprise and the extent to which it was possible to capture the complex process of inclusive health research. This study underlines the need for transparency, facilitation and evaluation of inclusive health research. The need for in-depth interviews after 2 Delphi rounds underlines its complexity and context dependence. To increase process transparency, future research should focus on gaining insight into inclusive health research in its context. A tool could be developed to facilitate and evaluate inclusive health research. This tool

  17. A Framework for Designing a Healthcare Outcome Data Warehouse

    Science.gov (United States)

    Parmanto, Bambang; Scotch, Matthew; Ahmad, Sjarif

    2005-01-01

    Many healthcare processes involve a series of patient visits or a series of outcomes. The modeling of outcomes associated with these types of healthcare processes is different from and not as well understood as the modeling of standard industry environments. For this reason, the typical multidimensional data warehouse designs that are frequently seen in other industries are often not a good match for data obtained from healthcare processes. Dimensional modeling is a data warehouse design technique that uses a data structure similar to the easily understood entity-relationship (ER) model but is sophisticated in that it supports high-performance data access. In the context of rehabilitation services, we implemented a slight variation of the dimensional modeling technique to make a data warehouse more appropriate for healthcare. One of the key aspects of designing a healthcare data warehouse is finding the right grain (scope) for different levels of analysis. We propose three levels of grain that enable the analysis of healthcare outcomes from highly summarized reports on episodes of care to fine-grained studies of progress from one treatment visit to the next. These grains allow the database to support multiple levels of analysis, which is imperative for healthcare decision making. PMID:18066371

  18. A framework for designing a healthcare outcome data warehouse.

    Science.gov (United States)

    Parmanto, Bambang; Scotch, Matthew; Ahmad, Sjarif

    2005-09-06

    Many healthcare processes involve a series of patient visits or a series of outcomes. The modeling of outcomes associated with these types of healthcare processes is different from and not as well understood as the modeling of standard industry environments. For this reason, the typical multidimensional data warehouse designs that are frequently seen in other industries are often not a good match for data obtained from healthcare processes. Dimensional modeling is a data warehouse design technique that uses a data structure similar to the easily understood entity-relationship (ER) model but is sophisticated in that it supports high-performance data access. In the context of rehabilitation services, we implemented a slight variation of the dimensional modeling technique to make a data warehouse more appropriate for healthcare. One of the key aspects of designing a healthcare data warehouse is finding the right grain (scope) for different levels of analysis. We propose three levels of grain that enable the analysis of healthcare outcomes from highly summarized reports on episodes of care to fine-grained studies of progress from one treatment visit to the next. These grains allow the database to support multiple levels of analysis, which is imperative for healthcare decision making.

  19. Psychological risk factors of micro- and macrovascular outcomes in primary care patients with type 2 diabetes: rationale and design of the DiaDDZoB Study

    Directory of Open Access Journals (Sweden)

    Pop Victor JM

    2010-07-01

    Full Text Available Abstract Background Depression is a common psychiatric complication of diabetes, but little is known about the natural course and the consequences of depressive symptoms in primary care patients with type 2 diabetes. While depression has been related to poor glycemic control and increased risk for macrovascular disease, its association with microvascular complications remains understudied. The predictive role of other psychological risk factors such as Type D (distressed personality and the mechanisms that possibly link depression and Type D personality with poor vascular outcomes are also still unclear. Methods/Design This prospective cohort study will examine: (1 the course of depressive symptoms in primary care patients with type 2 diabetes; (2 whether depressive symptoms and Type D personality are associated with the development of microvascular and/or macrovascular complications and with the risk of all-cause or vascular mortality; and (3 the behavioral and physiological mechanisms that may mediate these associations. The DiaDDZoB Study is embedded within the larger DIAZOB Primary Care Diabetes study, which covers a comprehensive cohort of type 2 diabetes patients treated by over 200 primary care physicians in South-East Brabant, The Netherlands. These patients will be followed during their lifetime and are assessed annually for demographic, clinical, lifestyle and psychosocial factors. Measurements include an interviewer-administered and self-report questionnaire, regular care laboratory tests and physical examinations, and pharmacy medication records. The DiaDDZoB Study uses data that have been collected during the original baseline assessment in 2005 (M0; N = 2,460 and the 2007 (M1; N = 2,225 and 2008 (M2; N = 2,032 follow-up assessments. Discussion The DiaDDZoB Study is expected to contribute to the current understanding of the course of depression in primary care patients with type 2 diabetes and will also test whether depressed

  20. Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS): rationale, design, and methods

    NARCIS (Netherlands)

    Apers, Silke; Kovacs, Adrienne H.; Luyckx, Koen; Alday, Luis; Berghammer, Malin; Budts, Werner; Callus, Edward; Caruana, Maryanne; Chidambarathanu, Shanthi; Cook, Stephen C.; Dellborg, Mikael; Enomoto, Junko; Eriksen, Katrine; Fernandes, Susan M.; Jackson, Jamie L.; Johansson, Bengt; Khairy, Paul; Kutty, Shelby; Menahem, Samuel; Rempel, Gwen; Sluman, Maayke A.; Soufi, Alexandra; Thomet, Corina; Veldtman, Gruschen; Wang, Jou-Kou; White, Kamila; Moons, Philip; Maisuls, Héctor; Cabrera, Marcelo; Eaton, Sarah; Larion, Ruth; FengWang, Qi; van Deyk, Kristien; Goossens, Eva; Rassart, Jessica; Mackie, Andrew; Ballantyne, Ross; Rankin, Kathryn; Norris, Colleen; Taylor, Dylan; Vondermuhll, Isabelle; Windram, Jonathan; Heggie, Pamela; Lasiuk, Gerri; Proietti, Anna; Dore, Annie; Mercier, Lise-Andrée; Mongeon, François-Pierre; Marcotte, François; Mulder, Barbara

    2015-01-01

    Data on patient-reported outcomes (PROs) in adults with congenital heart disease (CHD) are inconsistent and vary across the world. Better understanding of PROs and their differences across cultural and geographic barriers can best be accomplished via international studies using uniform research

  1. Prospective outcomes of injury study.

    Science.gov (United States)

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

    2009-10-01

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

  2. The Things of Design Research: Diversity in Objects and Outcomes

    DEFF Research Database (Denmark)

    Jenkins, Tom; Andersen, Kristina; Gaver, Bill

    2017-01-01

    of attending to its made-material outcomes. The premise of this workshop is simple: We need additional social spaces and platforms for interacting with and reflecting upon material design outcomes at CHI. The goal of this workshop is to keep experimenting with such a space, with an emphasis on how prototyping...

  3. The CORE study protocol: a stepped wedge cluster randomised controlled trial to test a co-design technique to optimise psychosocial recovery outcomes for people affected by mental illness in the community mental health setting

    Science.gov (United States)

    Palmer, Victoria J; Chondros, Patty; Piper, Donella; Callander, Rosemary; Weavell, Wayne; Godbee, Kali; Potiriadis, Maria; Richard, Lauralie; Densely, Konstancja; Herrman, Helen; Furler, John; Pierce, David; Schuster, Tibor; Iedema, Rick; Gunn, Jane

    2015-01-01

    Introduction User engagement in mental health service design is heralded as integral to health systems quality and performance, but does engagement improve health outcomes? This article describes the CORE study protocol, a novel stepped wedge cluster randomised controlled trial (SWCRCT) to improve psychosocial recovery outcomes for people with severe mental illness. Methods An SWCRCT with a nested process evaluation will be conducted over nearly 4 years in Victoria, Australia. 11 teams from four mental health service providers will be randomly allocated to one of three dates 9 months apart to start the intervention. The intervention, a modified version of Mental Health Experience Co-Design (MH ECO), will be delivered to 30 service users, 30 carers and 10 staff in each cluster. Outcome data will be collected at baseline (6 months) and at completion of each intervention wave. The primary outcome is improvement in recovery score using the 24-item Revised Recovery Assessment Scale for service users. Secondary outcomes are improvements to user and carer mental health and well-being using the shortened 8-item version of the WHOQOL Quality of Life scale (EUROHIS), changes to staff attitudes using the 19-item Staff Attitudes to Recovery Scale and recovery orientation of services using the 36-item Recovery Self Assessment Scale (provider version). Intervention and usual care periods will be compared using a linear mixed effects model for continuous outcomes and a generalised linear mixed effects model for binary outcomes. Participants will be analysed in the group that the cluster was assigned to at each time point. Ethics and dissemination The University of Melbourne, Human Research Ethics Committee (1340299.3) and the Federal and State Departments of Health Committees (Project 20/2014) granted ethics approval. Baseline data results will be reported in 2015 and outcomes data in 2017. Trial registration number Australian and New Zealand Clinical Trials Registry ACTRN

  4. Designing satisfaction studies

    DEFF Research Database (Denmark)

    Kristensen, Kai; Eskildsen, Jacob Kjær

    2007-01-01

    In the effect sampling method, presentation of researcher, the intro text, the order of questions in the questionnaire along with the number of categories in the rating scale is tested in relation to the design of satisfaction studies. Based on the analyses specific recommendations for designing...... satisfaction studies are given....

  5. Attending to Objects as Outcomes of Design Research

    DEFF Research Database (Denmark)

    Jenkins, Tom; Andersen, Kristina; Gaver, William

    2016-01-01

    outcomes. The premise of this workshop is simple: We need additional spaces for interacting with and reflecting upon material design outcomes at CHI. The goal of this workshop is to experiment with such a space, and to initially do so without a strong theoretical or conceptual framing.......The goal for this workshop is to provide a venue at CHI for research through design practitioners to materially share their work with each other. Conversation will largely be centered upon a discussion of objects produced through a research through design process. Bringing together researchers...

  6. Computer-aided system of evaluation for population-based all-in-one service screening (CASE-PASS): from study design to outcome analysis with bias adjustment.

    Science.gov (United States)

    Chen, Li-Sheng; Yen, Amy Ming-Fang; Duffy, Stephen W; Tabar, Laszlo; Lin, Wen-Chou; Chen, Hsiu-Hsi

    2010-10-01

    Population-based routine service screening has gained popularity following an era of randomized controlled trials. The evaluation of these service screening programs is subject to study design, data availability, and the precise data analysis for adjusting bias. We developed a computer-aided system that allows the evaluation of population-based service screening to unify these aspects and facilitate and guide the program assessor to efficiently perform an evaluation. This system underpins two experimental designs: the posttest-only non-equivalent design and the one-group pretest-posttest design and demonstrates the type of data required at both the population and individual levels. Three major analyses were developed that included a cumulative mortality analysis, survival analysis with lead-time adjustment, and self-selection bias adjustment. We used SAS AF software to develop a graphic interface system with a pull-down menu style. We demonstrate the application of this system with data obtained from a Swedish population-based service screen and a population-based randomized controlled trial for the screening of breast, colorectal, and prostate cancer, and one service screening program for cervical cancer with Pap smears. The system provided automated descriptive results based on the various sources of available data and cumulative mortality curves corresponding to the study designs. The comparison of cumulative survival between clinically and screen-detected cases without a lead-time adjustment are also demonstrated. The intention-to-treat and noncompliance analysis with self-selection bias adjustments are also shown to assess the effectiveness of the population-based service screening program. Model validation was composed of a comparison between our adjusted self-selection bias estimates and the empirical results on effectiveness reported in the literature. We demonstrate a computer-aided system allowing the evaluation of population-based service screening

  7. The NordiNet® International Outcome Study and NovoNet® ANSWER Program®: rationale, design, and methodology of two international pharmacoepidemiological registry-based studies monitoring long-term clinical and safety outcomes of growth hormone therapy (Norditropin®).

    Science.gov (United States)

    Höybye, Charlotte; Sävendahl, Lars; Christesen, Henrik Thybo; Lee, Peter; Pedersen, Birgitte Tønnes; Schlumpf, Michael; Germak, John; Ross, Judith

    2013-01-01

    Randomized controlled trials have shown that growth hormone (GH) therapy has effects on growth, metabolism, and body composition. GH therapy is prescribed for children with growth failure and adults with GH deficiency. Carefully conducted observational study of GH treatment affords the opportunity to assess long-term treatment outcomes and the clinical factors and variables affecting those outcomes, in patients receiving GH therapy in routine clinical practice. The NordiNet® International Outcome Study (IOS) and the American Norditropin® Web Enabled Research (ANSWER Program®) are two complementary, non-interventional, observational studies that adhere to current guidelines for pharmacoepidemiological data. The studies include pediatric and adult patients receiving Norditropin®, as prescribed by their physicians. The studies gather long-term data on the safety and effectiveness of reallife treatment with the recombinant human GH, Norditropin®. We describe the origins, aims, objectives, and design methodology of the studies, as well as their governance and validity, strengths, and limitations. The NordiNet® IOS and ANSWER Program® studies will provide valid insights into the effectiveness and safety of GH treatment across a diverse and large patient population treated in accordance with real-world clinical practice and following the Good Pharmacoepidemiological Practice and STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines.

  8. Outcomes 30 days after ICU admission: the 30DOS study

    African Journals Online (AJOL)

    Objectives: This study was designed to provide data on ICU outcomes and disease ... The page number in the footer is not for bibliographic referencing ... Yet, the rational ..... illustrated that quality data collection and integration is possible.

  9. SPFC bus design studies

    Energy Technology Data Exchange (ETDEWEB)

    Potter, L.; Reinkingh, J.

    1999-07-01

    This report presents the results of a study assessing the design options for a solid polymer fuel cell bus. Commercial and operation requirements, environmental and market drivers, and fuel processor modeling are examined. Power train specifications and detailed system design are investigated covering fuel cell system dynamic response, hybrid system size, fuel cell system start-up time, system specifications, and hybrid bus component dimensions and costs. (UK)

  10. Educating Instructional Designers: Different Methods for Different Outcomes.

    Science.gov (United States)

    Rowland, Gordon; And Others

    1994-01-01

    Suggests new methods of teaching instructional design based on literature reviews of other design fields including engineering, architecture, interior design, media design, and medicine. Methods discussed include public presentations, visiting experts, competitions, artifacts, case studies, design studios, and internships and apprenticeships.…

  11. Designing a Language Study.

    Science.gov (United States)

    Brown, James Dean

    Some issues in the design of classroom research on second language teaching are discussed, with the intention of helping the researcher avoid conceptual pitfalls that may cripple the study later in the process. This begins with an examination of concerns in sampling, including definition of a population to be studied, alternative sampling…

  12. The Effects of Game Design on Learning Outcomes

    Science.gov (United States)

    Martin, Michael W.; Shen, Yuzhong

    2014-01-01

    This article details the administration and results of an experiment conducted to assess the impact of three video game design concepts upon learning outcomes. The principles tested include game aesthetics, player choice, and player competition. The experiment participants were asked to play a serious game over the course of a week, and the…

  13. The CORE study protocol: a stepped wedge cluster randomised controlled trial to test a co-design technique to optimise psychosocial recovery outcomes for people affected by mental illness in the community mental health setting.

    Science.gov (United States)

    Palmer, Victoria J; Chondros, Patty; Piper, Donella; Callander, Rosemary; Weavell, Wayne; Godbee, Kali; Potiriadis, Maria; Richard, Lauralie; Densely, Konstancja; Herrman, Helen; Furler, John; Pierce, David; Schuster, Tibor; Iedema, Rick; Gunn, Jane

    2015-03-24

    User engagement in mental health service design is heralded as integral to health systems quality and performance, but does engagement improve health outcomes? This article describes the CORE study protocol, a novel stepped wedge cluster randomised controlled trial (SWCRCT) to improve psychosocial recovery outcomes for people with severe mental illness. An SWCRCT with a nested process evaluation will be conducted over nearly 4 years in Victoria, Australia. 11 teams from four mental health service providers will be randomly allocated to one of three dates 9 months apart to start the intervention. The intervention, a modified version of Mental Health Experience Co-Design (MH ECO), will be delivered to 30 service users, 30 carers and 10 staff in each cluster. Outcome data will be collected at baseline (6 months) and at completion of each intervention wave. The primary outcome is improvement in recovery score using the 24-item Revised Recovery Assessment Scale for service users. Secondary outcomes are improvements to user and carer mental health and well-being using the shortened 8-item version of the WHOQOL Quality of Life scale (EUROHIS), changes to staff attitudes using the 19-item Staff Attitudes to Recovery Scale and recovery orientation of services using the 36-item Recovery Self Assessment Scale (provider version). Intervention and usual care periods will be compared using a linear mixed effects model for continuous outcomes and a generalised linear mixed effects model for binary outcomes. Participants will be analysed in the group that the cluster was assigned to at each time point. The University of Melbourne, Human Research Ethics Committee (1340299.3) and the Federal and State Departments of Health Committees (Project 20/2014) granted ethics approval. Baseline data results will be reported in 2015 and outcomes data in 2017. Australian and New Zealand Clinical Trials Registry ACTRN12614000457640. Published by the BMJ Publishing Group Limited. For

  14. The Impact of Group Design Projects in Engineering on Achievement Goal Orientations and Academic Outcomes

    Science.gov (United States)

    Rambo-Hernandez, Karen E.; Atadero, Rebecca A.; Balgopal, Meena

    2017-01-01

    This study examined the impact of incorporating group design projects into a second-year engineering class on achievement goal orientations and two academic outcomes: concept inventory and final exam scores. In this study, two sections were taught using lecture format, but one section also completed three group design projects as part of their…

  15. Impact of the Patient-Reported Outcomes Management Information System (PROMIS) upon the Design and Operation of Multi-center Clinical Trials: a Qualitative Research Study

    OpenAIRE

    Eisenstein, Eric L.; Diener, Lawrence W.; Nahm, Meredith; Weinfurt, Kevin P.

    2010-01-01

    New technologies may be required to integrate the National Institutes of Health’s Patient Reported Outcome Management Information System (PROMIS) into multi-center clinical trials. To better understand this need, we identified likely PROMIS reporting formats, developed a multi-center clinical trial process model, and identified gaps between current capabilities and those necessary for PROMIS. These results were evaluated by key trial constituencies. Issues reported by principal investigators ...

  16. Scottish urban versus rural trauma outcome study.

    Science.gov (United States)

    McGuffie, A Crawford; Graham, Colin A; Beard, Diana; Henry, Jennifer M; Fitzpatrick, Michael O; Wilkie, Stewart C; Kerr, Gary W; Parke, Timothy R J

    2005-09-01

    Outcome following trauma and health care access are important components of health care planning. Resources are limited and quality information is required. We set the objective of comparing the outcomes for patients suffering significant trauma in urban and rural environments in Scotland. The study was designed as a 2 year prospective observational study set in the west of Scotland, which has a population of 2.58 million persons. Primary outcome measures were defined as the total number of inpatient days, total number of intensive care unit days, and mortality. The participants were patients suffering moderate (ISS 9-15) and major (ISS>15) trauma within the region. The statistical analysis consisted of chi square test for categorical data and Mann Whitney U test for comparison of medians. There were 3,962 urban (85%) and 674 rural patients (15%). Urban patients were older (50 versus 46 years, p = 0.02), were largely male (62% versus 57%, p = 0.02), and suffered more penetrating traumas (9.9% versus 1.9%, p rural patients (p rural major trauma group (p = 0.002). There were more serious head injuries in the urban group (p = 0.04), and also a higher proportion of urban patients with head injuries transferred to the regional neurosurgical unit (p = 0.037). There were no differences in length of total inpatient stay (median 8 days, p = 0.7), total length of stay in the intensive care unit (median two days, p = 0.4), or mortality (324 deaths, moderate trauma, p = 0.13; major trauma, p = 0.8). Long prehospital times in the rural environment were not associated with differences in mortality or length of stay in moderately and severely injured patients in the west of Scotland. This may lend support to a policy of rationalization of trauma services in Scotland.

  17. The LIBERTY study: Design of a prospective, observational, multicenter trial to evaluate the acute and long-term clinical and economic outcomes of real-world endovascular device interventions in treating peripheral artery disease.

    Science.gov (United States)

    Adams, George L; Mustapha, Jihad; Gray, William; Hargus, Nick J; Martinsen, Brad J; Ansel, Gary; Jaff, Michael R

    2016-04-01

    Most peripheral artery disease (PAD) clinical device trials are supported by commercial manufacturers and designed for regulatory device approval, with extensive inclusion/exclusion criteria to support homogeneous patient populations. High-risk patients with advanced disease, including critical limb ischemia (CLI), are often excluded leading to difficulty in translating trial results into real-world clinical practice. As a result, physicians have no direct guidance regarding the use of endovascular devices. There is a need for objectively assessed studies to evaluate clinical, functional, and economic outcomes in PAD patient populations. LIBERTY is a prospective, observational, multicenter study sponsored by Cardiovascular Systems Inc (St Paul, MN) to evaluate procedural and long-term clinical and economic outcomes of endovascular device interventions in patients with symptomatic lower extremity PAD. Approximately 1,200 patients will be enrolled and followed up to 5 years: 500 patients in the "Claudicant Rutherford 2-3" arm, 600 in the "CLI Rutherford 4-5" arm, and 100 in the "CLI Rutherford 6" arm. The study will use 4 core laboratories for independent analysis and will evaluate the following: procedural and lesion success, rates of major adverse events, duplex ultrasound interpretations, wound status, quality of life, 6-minute walk test, and economic analysis. The LIBERTY Patient Risk Score(s) will be developed as a clinical predictor of outcomes to provide guidance for interventions in this patient population. LIBERTY will investigate real-world PAD patients treated with endovascular revascularization with rigorous study guidelines and independent oversight of outcomes. This study will provide observational, all-comer patient clinical data to guide future endovascular therapy. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  18. Applying Universal Design to Disability Service Provision: Outcome Analysis of a Universal Design (UD) Audit

    Science.gov (United States)

    Beck, Tanja; Diaz del Castillo, Patricia; Fovet, Frederic; Mole, Heather; Noga, Brodie

    2014-01-01

    This article presents out an outcome analysis of a Universal Design (UD) audit to the various professional facets of a disability service (DS) provider's office on a large North American campus. The context of the audit is a broad campus-wide drive to implement Universal Design for Learning (UDL) in teaching practices. In an effort for consistency…

  19. Benchmarking bio-inspired designs with brainstorming in terms of novelty of design outcomes

    DEFF Research Database (Denmark)

    Keshwani, Sonal; Lenau, Torben Anker; Ahmed-Kristensen, Saeema

    2013-01-01

    With the increasing demand of innovative products in the market, there is a need for effective creativity approaches that will support development of creative design outcomes. Most researchers agree that novelty of design concepts is a major element of creativity; design outcomes are more creative...... generated using existing traditional creative problem solving approaches. In this research we have compared the novelty of design concepts produced by using biological analogies with the novelty of design concepts produced by using traditional brainstorming. Results show that there is an increase...... in the percentage of highly novel concepts produced in a design task, as well as the novelty of the concept space, when biological analogies are used over traditional brainstorming....

  20. Seal design alternatives study

    International Nuclear Information System (INIS)

    Van Sambeek, L.L.; Luo, D.D.; Lin, M.S.; Ostrowski, W.; Oyenuga, D.

    1993-06-01

    This report presents the results from a study of various sealing alternatives for the WIPP sealing system. Overall, the sealing system has the purpose of reducing to the extent possible the potential for fluids (either gas or liquid) from entering or leaving the repository. The sealing system is divided into three subsystems: drift and panel seals within the repository horizon, shaft seals in each of the four shafts, and borehole seals. Alternatives to the baseline configuration for the WIPP seal system design included evaluating different geometries and schedules for seal component installations and the use of different materials for seal components. Order-of-magnitude costs for the various alternatives were prepared as part of the study. Firm recommendations are not presented, but the advantages and disadvantages of the alternatives are discussed. Technical information deficiencies are identified and studies are outlined which can provide required information

  1. Korean Clinic Based Outcome Measure Studies

    OpenAIRE

    Jongbae Park

    2003-01-01

    Background: Evidence based medicine has become main tools for medical practice. However, conducting a highly ranked in the evidence hierarchy pyramid is not easy or feasible at all times and places. There remains a room for descriptive clinical outcome measure studies with admitting the limit of the intepretation. Aims: Presents three Korean clinic based outcome measure studies with a view to encouraging Korean clinicians to conduct similar studies. Methods: Three studies are presented...

  2. Rationale, study design and sample characteristics of a randomized controlled trial of directly administered antiretroviral therapy for HIV-infected prisoners transitioning to the community - a potential conduit to improved HIV treatment outcomes.

    Science.gov (United States)

    Saber-Tehrani, Ali Shabahang; Springer, Sandra A; Qiu, Jingjun; Herme, Maua; Wickersham, Jeffrey; Altice, Frederick L

    2012-03-01

    HIV-infected prisoners experience poor HIV treatment outcomes post-release. Directly administered antiretroviral therapy (DAART) is a CDC-designated, evidence-based adherence intervention for drug users, yet untested among released prisoners. Sentenced HIV-infected prisoners on antiretroviral therapy (ART) and returning to New Haven or Hartford, Connecticut were recruited and randomized 2:1 to a prospective controlled trial (RCT) of 6 months of DAART versus self-administered therapy (SAT); all subjects received case management services. Subjects meeting DSM-IV criteria for opioid dependence were offered immediate medication-assisted treatment. Trained outreach workers provided DAART once-daily, seven days per week, including behavioral skills training during the last intervention month. Both study groups were assessed for 6 months after the intervention period. Assessments occurred within 90 days pre-release (baseline), day of release, and then monthly for 12 months. Viral load (VL) and CD4 testing was conducted baseline and quarterly; genotypic resistance testing was conducted at baseline, 6 and 12 months. The primary outcome was pre-defined as viral suppression (VLHIV treatment outcomes after release from prison, a period associated with adverse HIV and other medical consequences. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Michigan Breast Reconstruction Outcomes Study

    National Research Council Canada - National Science Library

    Wilkins, Edwin

    1997-01-01

    ...: complication rates, aesthetic results, functional results, psychosocial status and costs. Study results will provide information to patients, providers, and payers for determining the procedure of choice...

  4. Fusion reactor design studies

    International Nuclear Information System (INIS)

    Emmert, G.A.; Kulcinski, G.L.; Santarius, J.F.

    1990-01-01

    This report discusses the following topics on the ARIES tokamak: systems; plasma power balance; impurity control and fusion ash removal; fusion product ripple loss; energy conversion; reactor fueling; first wall design; shield design; reactor safety; and fuel cost and resources

  5. Nippon Storm Study design

    Directory of Open Access Journals (Sweden)

    Takashi Kurita

    2012-10-01

    Full Text Available An understanding of the clinical aspects of electrical storm (E-storms in patients with implantable cardiac shock devices (ICSDs: ICDs or cardiac resynchronization therapy with defibrillator [CRT-D] may provide important information for clinical management of patients with ICSDs. The Nippon Storm Study was organized by the Japanese Heart Rhythm Society (JHRS and Japanese Society of Electrocardiology and was designed to prospectively collect a variety of data from patients with ICSDs, with a focus on the incidence of E-storms and clinical conditions for the occurrence of an E-storm. Forty main ICSD centers in Japan are participating in the present study. From 2002, the JHRS began to collect ICSD patient data using website registration (termed Japanese cardiac defibrillator therapy registration, or JCDTR. This investigation aims to collect data on and investigate the general parameters of patients with ICSDs, such as clinical backgrounds of the patients, purposes of implantation, complications during the implantation procedure, and incidence of appropriate and inappropriate therapies from the ICSD. The Nippon Storm Study was planned as a sub-study of the JCDTR with focus on E-storms. We aim to achieve registration of more than 1000 ICSD patients and complete follow-up data collection, with the assumption of a 5–10% incidence of E-storms during the 2-year follow-up.

  6. BWID System Design Study

    International Nuclear Information System (INIS)

    O'Brien, M.C.; Rudin, M.J.; Morrison, J.L.; Richardson, J.G.

    1991-01-01

    The mission of the Buried Waste Integrated Demonstration (BWID) System Design Study is to identify and evaluate technology process options for the cradle-to-grave remediation of Transuranic (TRU)-Contaminated Waste Pits and Trenches buried at the Idaho National Engineering Laboratory (INEL). Emphasis is placed upon evaluating system configuration options and associated functional and operational requirements for retrieving and treating the buried wastes. A Performance-Based Technology Selection Filter was developed to evaluate the identified remediation systems and their enabling technologies based upon system requirements and quantification of technical Comprehensive Environmental Response, Compensation, and Liability (CERCLA) balancing criteria. Remediation systems will also be evaluated with respect to regulatory and institutional acceptance and cost-effectiveness

  7. Can Research Design Explain Variation in Head Start Research Results? A Meta-Analysis of Cognitive and Achievement Outcomes

    Science.gov (United States)

    Shager, Hilary M.; Schindler, Holly S.; Magnuson, Katherine A.; Duncan, Greg J.; Yoshikawa, Hirokazu; Hart, Cassandra M. D.

    2013-01-01

    This study explores the extent to which differences in research design explain variation in Head Start program impacts. We employ meta-analytic techniques to predict effect sizes for cognitive and achievement outcomes as a function of the type and rigor of research design, quality and type of outcome measure, activity level of control group, and…

  8. Integrative medicine for chronic pain: A cohort study using a process-outcome design in the context of a department for internal and integrative medicine.

    Science.gov (United States)

    Saha, Felix J; Brüning, Alexander; Barcelona, Cyrus; Büssing, Arndt; Langhorst, Jost; Dobos, Gustav; Lauche, Romy; Cramer, Holger

    2016-07-01

    Integrative medicine inpatient treatment has been shown to improve physical and mental health in patients with internal medicine conditions. The aim of this study was to investigate the effectiveness of a 2-week integrative medicine inpatient treatment in patients with chronic pain syndromes and the association of treatment success with patient-related process variables. Inpatients with chronic pain syndromes participating in a 2-week integrative medicine inpatient program were included. Patients' pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were measured on admission, discharge, and 6 months after discharge. Likewise process variables including ability and will to change, emotional/rational disease acceptance, mindfulness, life and health satisfaction, and easiness of life were assessed. A total of 310 inpatients (91% female, mean age 50.7 ± 12.4 year, 26.5% low back pain, and 22.9% fibromyalgia) were included. Using mixed linear models, significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were found (all P medicine inpatient treatment can benefit patients with chronic pain conditions. Functional improvements are associated with improved ability to change and implementation, disease acceptance, and satisfaction.

  9. Studies in Interior Design

    Science.gov (United States)

    Environ Planning Design, 1970

    1970-01-01

    Floor plans and photographs illustrate a description of the Samuel C. Williams Library at Stevens Institute of Technology, Hoboken, N.J. The unusual interior design allows students to take full advantage of the library's resources. (JW)

  10. Sensitivity of adaptive enrichment trial designs to accrual rates, time to outcome measurement, and prognostic variables

    Directory of Open Access Journals (Sweden)

    Tianchen Qian

    2017-12-01

    Full Text Available Adaptive enrichment designs involve rules for restricting enrollment to a subset of the population during the course of an ongoing trial. This can be used to target those who benefit from the experimental treatment. Trial characteristics such as the accrual rate and the prognostic value of baseline variables are typically unknown when a trial is being planned; these values are typically assumed based on information available before the trial starts. Because of the added complexity in adaptive enrichment designs compared to standard designs, it may be of special concern how sensitive the trial performance is to deviations from assumptions. Through simulation studies, we evaluate the sensitivity of Type I error, power, expected sample size, and trial duration to different design characteristics. Our simulation distributions mimic features of data from the Alzheimer's Disease Neuroimaging Initiative cohort study, and involve two subpopulations based on a genetic marker. We investigate the impact of the following design characteristics: the accrual rate, the time from enrollment to measurement of a short-term outcome and the primary outcome, and the prognostic value of baseline variables and short-term outcomes. To leverage prognostic information in baseline variables and short-term outcomes, we use a semiparametric, locally efficient estimator, and investigate its strengths and limitations compared to standard estimators. We apply information-based monitoring, and evaluate how accurately information can be estimated in an ongoing trial.

  11. An outcome study of gestalt-oriented growth workshops.

    Science.gov (United States)

    Leung, Grace Suk Man; Leung, Timothy Yuk Ki; Ng, Monica Lai Tuen

    2013-01-01

    Compared to other intervention modalities, there are relatively few outcome studies of gestalt therapy. This study aimed to address this gap by evaluating the therapeutic effects of four gestalt-oriented group workshops designed to enhance well-being in professionals trained as social workers, counselors, and psychologists. The results of this preliminary, uncontrolled study indicated that the 55 participants had better emotional well-being and experienced a heightened sense of hope following the workshops. The factors leading to these positive outcomes are discussed.

  12. A Rapid Systematic Review of Outcomes Studies in Genetic Counseling.

    Science.gov (United States)

    Madlensky, Lisa; Trepanier, Angela M; Cragun, Deborah; Lerner, Barbara; Shannon, Kristen M; Zierhut, Heather

    2017-06-01

    As healthcare reimbursement is increasingly tied to value-of-service, it is critical for the genetic counselor (GC) profession to demonstrate the value added by GCs through outcomes research. We conducted a rapid systematic literature review to identify outcomes of genetic counseling. Web of Science (including PubMed) and CINAHL databases were systematically searched to identify articles meeting the following criteria: 1) measures were assessed before and after genetic counseling (pre-post design) or comparisons were made between a GC group vs. a non-GC group (comparative cohort design); 2) genetic counseling outcomes could be assessed independently of genetic testing outcomes, and 3) genetic counseling was conducted by masters-level genetic counselors, or non-physician providers. Twenty-three papers met the inclusion criteria. The majority of studies were in the cancer genetic setting and the most commonly measured outcomes included knowledge, anxiety or distress, satisfaction, perceived risk, genetic testing (intentions or receipt), health behaviors, and decisional conflict. Results suggest that genetic counseling can lead to increased knowledge, perceived personal control, positive health behaviors, and improved risk perception accuracy as well as decreases in anxiety, cancer-related worry, and decisional conflict. However, further studies are needed to evaluate a wider array of outcomes in more diverse genetic counseling settings.

  13. HYPER system design study

    Energy Technology Data Exchange (ETDEWEB)

    Park, Won S.; Han, Seok J.; Song, Tae Y. [Korea Atomic Energy Research Institute, Taejon (Korea)

    1999-04-01

    KAERI is developing ADS, named HYPER for the transmutation of nuclear waste. HYPER is designed to produce 1000 MWth with the subcriticality of 0.97. HYPER adopts a hollow cylinder type metal fuel and require 1.0GeV, 16mA proton beams. Pb-Bi is used as coolant and the inlet and outlet temperatures are 340 deg C, 510 deg C, respectively. In addition, Pb-Bi coolant is used as spallation target also. HYPER is expected to incinerate about 380 kg of TRU a year, which is corresponding to the support ratio 5 {approx} 6. 23 refs., 50 figs., 31 tabs. (Author)

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

    Directory of Open Access Journals (Sweden)

    Angus G K McNair

    2016-08-01

    Full Text Available Colorectal cancer (CRC is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for evaluating surgery is within well-designed randomized controlled trials (RCTs; however, the impact of RCTs is diminished by a lack of coordinated outcome measurement and reporting. A solution to these issues is to develop an agreed standard "core" set of outcomes to be measured in all trials to facilitate cross-study comparisons, meta-analysis, and minimize outcome reporting bias. This study defines a core outcome set for CRC surgery.The scope of this COS includes clinical effectiveness trials of surgical interventions for colorectal cancer. Excluded were nonsurgical oncological interventions. Potential outcomes of importance to patients and professionals were identified through systematic literature reviews and patient interviews. All outcomes were transcribed verbatim and categorized into domains by two independent researchers. This informed a questionnaire survey that asked stakeholders (patients and professionals from United Kingdom CRC centers to rate the importance of each domain. Respondents were resurveyed following group feedback (Delphi methods. Outcomes rated as less important were discarded after each survey round according to predefined criteria, and remaining outcomes were considered at three consensus meetings; two involving international professionals and a separate one with patients. A modified nominal group technique was used to gain the final consensus. Data sources identified 1,216 outcomes of CRC surgery that informed a 91 domain questionnaire. First round questionnaires were returned from 63 out of 81 (78% centers, including 90 professionals, and 97 out of 267 (35% patients. Second round response rates were high for all stakeholders (>80%. Analysis of responses lead to 45 and 23 outcome domains being retained after the first and

  15. Arts on prescription: a qualitative outcomes study.

    Science.gov (United States)

    Stickley, T; Eades, M

    2013-08-01

    In recent years, participatory community-based arts activities have become a recognized and regarded method for promoting mental health. In the UK, Arts on Prescription services have emerged as a prominent form of such social prescribing. This follow-up study reports on the findings from interviews conducted with participants in an Arts on Prescription programme two years after previous interviews to assess levels of 'distance travelled'. This follow-up study used a qualitative interview method amongst participants of an Arts on Prescription programme of work. Ten qualitative one-to-one interviews were conducted in community-based arts venues. Each participant was currently using or had used mental health services, and had been interviewed two years earlier. Interviews were digitally recorded, transcribed and analysed. For each of the 10 participants, a lengthy attendance of Arts on Prescription had acted as a catalyst for positive change. Participants reported increased self-confidence, improved social and communication skills, and increased motivation and aspiration. An analysis of each of the claims made by participants enabled them to be grouped according to emerging themes: education: practical and aspirational achievements; broadened horizons: accessing new worlds; assuming and sustaining new identities; and social and relational perceptions. Both hard and soft outcomes were identifiable, but most were soft outcomes. Follow-up data indicating progress varied between respondents. Whilst hard outcomes could be identified in individual cases, the unifying factors across the sample were found predominately in the realm of soft outcomes. These soft outcomes, such as raised confidence and self-esteem, facilitated the hard outcomes such as educational achievement and voluntary work. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  16. Explaining Kansei design studies

    NARCIS (Netherlands)

    Levy, P.D.; Vakamori, S.; Yamanaka, T.

    2008-01-01

    Within the last thirty years, Kansei studies have become an important field of research in Japan. More recently, foreign researchers have become more and more interested in understating the approach, despite the difficulties related to the cultural dimension of Kansei and Kansei studies. The aim of

  17. Outcome-Dependent Sampling Design and Inference for Cox's Proportional Hazards Model.

    Science.gov (United States)

    Yu, Jichang; Liu, Yanyan; Cai, Jianwen; Sandler, Dale P; Zhou, Haibo

    2016-11-01

    We propose a cost-effective outcome-dependent sampling design for the failure time data and develop an efficient inference procedure for data collected with this design. To account for the biased sampling scheme, we derive estimators from a weighted partial likelihood estimating equation. The proposed estimators for regression parameters are shown to be consistent and asymptotically normally distributed. A criteria that can be used to optimally implement the ODS design in practice is proposed and studied. The small sample performance of the proposed method is evaluated by simulation studies. The proposed design and inference procedure is shown to be statistically more powerful than existing alternative designs with the same sample sizes. We illustrate the proposed method with an existing real data from the Cancer Incidence and Mortality of Uranium Miners Study.

  18. Outcome-Dependent Sampling Design and Inference for Cox’s Proportional Hazards Model

    Science.gov (United States)

    Yu, Jichang; Liu, Yanyan; Cai, Jianwen; Sandler, Dale P.; Zhou, Haibo

    2016-01-01

    We propose a cost-effective outcome-dependent sampling design for the failure time data and develop an efficient inference procedure for data collected with this design. To account for the biased sampling scheme, we derive estimators from a weighted partial likelihood estimating equation. The proposed estimators for regression parameters are shown to be consistent and asymptotically normally distributed. A criteria that can be used to optimally implement the ODS design in practice is proposed and studied. The small sample performance of the proposed method is evaluated by simulation studies. The proposed design and inference procedure is shown to be statistically more powerful than existing alternative designs with the same sample sizes. We illustrate the proposed method with an existing real data from the Cancer Incidence and Mortality of Uranium Miners Study. PMID:28090134

  19. Serious game design principles: The impact of game design on learning outcomes

    Science.gov (United States)

    Martin, Michael W.

    This dissertation examines the research question "How do video game design principles affect learning outcomes in serious games?" This research first develops a theoretical foundation concerning the meaning of the terms "game" and "serious game". This conceptual clarification is broken down into analytic propositions, which state that games have participants, rules, goals and challenges, and synthetic propositions, which state that the games should be intrinsically compelling, provide meaningful choices, and be self encapsulated. Based on these synthetic propositions, three hypotheses were developed. The hypotheses are that games with an enhanced aesthetic presentation, more meaningful choices, or provide player competition will elicit higher learning outcomes than identical games without these factors. These hypotheses were tested via a quantitative experiment involving 172 undergraduate students in the Old Dominion University Chemistry Department. The students were asked to play a chemistry-oriented serious game entitled Element Solitaire©, which was created by the research author. The students were randomly given different treatments of the Element Solitaire© game to play, and the difference between their learning outcomes were compared. The experimental results demonstrated that the aesthetic presentation of a game can have a significant impact upon the learning outcome. The experiment was not able to discern significant effects from the choice or competition conditions, but further examination of the experimental data did reveal some insight into these aspects of serious game design. Choices need to provide the player with options that have a sufficient value that they will be considered and the application of competition within games needs to be judiciously implemented to promote a positive affect for all players. The results of the theoretical foundations and empirical evidence were then combined with additional theoretical research to develop a set of

  20. Locomotor dysfunction and risk of cardiovascular disease, quality of life, and medical costs: design of the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) and baseline characteristics of the study population.

    Science.gov (United States)

    Otani, Koji; Takegami, Misa; Fukumori, Norio; Sekiguchi, Miho; Onishi, Yoshihiro; Yamazaki, Shin; Ono, Rei; Otoshi, Kenichi; Hayashino, Yasuaki; Fukuhara, Shunichi; Kikuchi, Shin-Ichi; Konno, Shin-Ichi

    2012-05-01

    There is little evidence regarding long-term outcomes of locomotor dysfunction such as cardiovascular events, quality of life, and death. We are conducting a prospective cohort study to evaluate risk of cardiovascular disease, quality of life, medical costs, and mortality attributable to locomotor dysfunction. The present study determined baseline characteristics of participants in the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). Cohort participants were recruited from residents between 40 and 80 years old who received regular health check-ups conducted by local government each year between 2008 and 2010 in Minami-Aizu Town and Tadami Town in Fukushima Prefecture, Japan. Musculoskeletal examination included assessment of physical examination of the cervical and lumbar spine, and upper and lower extremities and of physical function, such as grasping power, one-leg standing time, and time for the 3-m timed up-and-go test. Cardiovascular risk factors, including blood pressure and biological parameters, were measured at annual health check-ups. We also conducted a self-administered questionnaire survey. LOHAS participants comprised 1,289 men (mean age 65.7 years) and 1,954 women (mean age 66.2 years) at the first year. The proportion of obese individuals (body mass index 25.0 kg/m(2)) was 31.9% in men and 34.3% in women, and 41.0% of participants reported being followed up for hypertension, 7.0% for diabetes, and 43.6% for hypercholesterolemia. Prevalence of lumbar spinal stenosis was 10.7% in men and 12.9% in women, while prevalence of low back pain was 15.8% in men and 17.6% in women. The LOHAS is a novel population-based prospective cohort study that will provide an opportunity to estimate the risk of cardiovascular disease, quality of life, medical costs, and mortality attributable to locomotor dysfunction, and to provide the epidemiological information required to develop policies for detection of locomotor dysfunction.

  1. Rationale, design, and baseline characteristics of the CArdiovascular safety and Renal Microvascular outcomE study with LINAgliptin (CARMELINA®): a randomized, double-blind, placebo-controlled clinical trial in patients with type 2 diabetes and high cardio-renal risk.

    Science.gov (United States)

    Rosenstock, Julio; Perkovic, Vlado; Alexander, John H; Cooper, Mark E; Marx, Nikolaus; Pencina, Michael J; Toto, Robert D; Wanner, Christoph; Zinman, Bernard; Baanstra, David; Pfarr, Egon; Mattheus, Michaela; Broedl, Uli C; Woerle, Hans-Juergen; George, Jyothis T; von Eynatten, Maximilian; McGuire, Darren K

    2018-03-14

    Cardiovascular (CV) outcome trials in type 2 diabetes (T2D) have underrepresented patients with chronic kidney disease (CKD), leading to uncertainty regarding their kidney efficacy and safety. The CARMELINA ® trial aims to evaluate the effects of linagliptin, a DPP-4 inhibitor, on both CV and kidney outcomes in a study population enriched for cardio-renal risk. CARMELINA ® is a randomized, double-blind, placebo-controlled clinical trial conducted in 27 countries in T2D patients at high risk of CV and/or kidney events. Participants with evidence of CKD with or without CV disease and HbA1c 6.5-10.0% (48-86 mmol/mol) were randomized 1:1 to receive linagliptin once daily or matching placebo, added to standard of care adjusted according to local guidelines. The primary outcome is time to first occurrence of CV death, non-fatal myocardial infarction, or non-fatal stroke. The key secondary outcome is a composite of time to first sustained occurrence of end-stage kidney disease, ≥ 40% decrease in estimated glomerular filtration rate (eGFR) from baseline, or renal death. CV and kidney events are prospectively adjudicated by independent, blinded clinical event committees. CARMELINA ® was designed to continue until at least 611 participants had confirmed primary outcome events. Assuming a hazard ratio of 1.0, this provides 90% power to demonstrate non-inferiority of linagliptin versus placebo within the pre-specified non-inferiority margin of 1.3 at a one-sided α-level of 2.5%. If non-inferiority of linagliptin for the primary outcome is demonstrated, then its superiority for both the primary outcome and the key secondary outcome will be investigated with a sequentially rejective multiple test procedure. Between July 2013 and August 2016, 6980 patients were randomized and took ≥ 1 dose of study drug (40.6, 33.1, 16.9, and 9.4% from Europe, South America, North America, and Asia, respectively). At baseline, mean ± SD age was 65.8 ± 9.1 years, HbA1c

  2. Using patient-reported outcomes in schizophrenia: the Scottish Schizophrenia Outcomes Study.

    Science.gov (United States)

    Hunter, Robert; Cameron, Rosie; Norrie, John

    2009-02-01

    The primary aim of the Scottish Schizophrenia Outcomes Study (SSOS) was to assess the feasibility and utility of routinely collecting outcome data in everyday clinical settings. Data were collected over three years in the Scottish National Health Service (NHS). There were two secondary aims of SSOS: first, to compare data from patient-rated, objective, and clinician-rated outcomes, and second, to describe trends in outcome data and service use across Scotland over the three years of the study (2002-2005). This study used a naturalistic, longitudinal, observational cohort design. A representative sample of 1,015 persons with ICD-10 F20-F29 diagnoses (schizophrenia, schizotypal disorders, or delusional disorders) was assessed annually using the clinician-rated measure, the Health of the Nation Outcome Scale (HoNOS), and the patient-reported assessment, the Avon Mental Health Measure (Avon). Objective outcomes data and information on services and interventions were collected. Data were analyzed with regression modeling. Of the 1,015 persons recruited, 78% of the cohort (N=789) completed the study. Over the study period, significant decreases were seen in the number of hospitalizations, incidence of attempted suicide and self-harm, and civil detentions. Avon scores indicated significant improvement on all subscales (behavior, social, access, and mental health) and on the total score. However, HoNOS scores on the behavior and symptom subscales did not change, scores on the impairment subscale increased significantly (indicating increased levels of impairment), and scores on the social subscale decreased significantly (indicating improved social functioning). This study has demonstrated that it is feasible within the Scottish NHS to routinely collect meaningful outcomes data in schizophrenia. Patient-reported assessments were also successfully collected and used in care plans. This model shows that it is possible to incorporate patient-reported assessments into routine

  3. Korean Clinic Based Outcome Measure Studies

    Directory of Open Access Journals (Sweden)

    Jongbae Park

    2003-02-01

    Full Text Available Background: Evidence based medicine has become main tools for medical practice. However, conducting a highly ranked in the evidence hierarchy pyramid is not easy or feasible at all times and places. There remains a room for descriptive clinical outcome measure studies with admitting the limit of the intepretation. Aims: Presents three Korean clinic based outcome measure studies with a view to encouraging Korean clinicians to conduct similar studies. Methods: Three studies are presented briefly here including 1 Quality of Life of liver cancer patients after 8 Constitutional acupuncture; 2 Developing a Korean version of Measuring yourself Medical Outcome profile (MYMOP; and 3 Survey on 5 Shu points: a pilot In the first study, we have included 4 primary or secondary liver cancer patients collecting their diagnostic X-ray film and clinical data f개m their hospital, and asked them to fill in the European Organization Research and Treatment of Cancer, Quality of Life Questionnaire before the commencement of the treatment. The acupuncture treatment is set up format but not disclosed yet. The translation and developing a Korean version of outcome measures that is Korean clinician friendly has been sought for MYMOP is one of the most appropriate one. The permission was granted, the translation into Korean was done, then back translated into English only based on the Korean translation by the researcher who is bilingual in both languages. The back translation was compared by the original developer of MYMOP and confirmed usable. In order to test the existence of acupoints and meridians through popular forms of Korean acupuncture regimes, we aim at collecting opinions from 101 Korean clinicians that have used those forms. The questions asked include most effective symptoms, 5 Shu points, points those are least likely to use due to either adverse events or the lack of effectiveness, theoretical reasons for the above proposals, proposing outcome measures

  4. Study protocol: The Intensive Care Outcome Network ('ICON' study

    Directory of Open Access Journals (Sweden)

    Barber Vicki S

    2008-06-01

    Full Text Available Abstract Background Extended follow-up of survivors of ICU treatment has shown many patients suffer long-term physical and psychological consequences that affect their health-related quality of life. The current lack of rigorous longitudinal studies means that the true prevalence of these physical and psychological problems remains undetermined. Methods/Design The ICON (Intensive Care Outcome Network study is a multi-centre, longitudinal study of survivors of critical illness. Patients will be recruited prior to hospital discharge from 20–30 ICUs in the UK and will be assessed at 3, 6, and 12 months following ICU discharge for health-related quality of life as measured by the Short Form-36 (SF-36 and the EuroQoL (EQ-5D; anxiety and depression as measured by the Hospital Anxiety and Depression Scale (HADS; and post traumatic stress disorder (PTSD symptoms as measured by the PTSD Civilian Checklist (PCL-C. Postal questionnaires will be used. Discussion The ICON study will create a valuable UK database detailing the prevalence of physical and psychological morbidity experienced by patients as they recover from critical illness. Knowledge of the prevalence of physical and psychological morbidity in ICU survivors is important because research to generate models of causality, prognosis and treatment effects is dependent on accurate determination of prevalence. The results will also inform economic modelling of the long-term burden of critical illness. Trial Registration ISRCTN69112866

  5. Designing clinical trials for assessing the effects of cognitive training and physical activity interventions on cognitive outcomes: The Seniors Health and Activity Research Program Pilot (SHARP-P Study, a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rejeski W Jack

    2011-05-01

    Full Text Available Abstract Background The efficacy of non-pharmacological intervention approaches such as physical activity, strength, and cognitive training for improving brain health has not been established. Before definitive trials are mounted, important design questions on participation/adherence, training and interventions effects must be answered to more fully inform a full-scale trial. Methods SHARP-P was a single-blinded randomized controlled pilot trial of a 4-month physical activity training intervention (PA and/or cognitive training intervention (CT in a 2 × 2 factorial design with a health education control condition in 73 community-dwelling persons, aged 70-85 years, who were at risk for cognitive decline but did not have mild cognitive impairment. Results Intervention attendance rates were higher in the CT and PACT groups: CT: 96%, PA: 76%, PACT: 90% (p=0.004, the interventions produced marked changes in cognitive and physical performance measures (p≤0.05, and retention rates exceeded 90%. There were no statistically significant differences in 4-month changes in composite scores of cognitive, executive, and episodic memory function among arms. Four-month improvements in the composite measure increased with age among participants assigned to physical activity training but decreased with age for other participants (intervention*age interaction p = 0.01. Depending on the choice of outcome, two-armed full-scale trials may require fewer than 1,000 participants (continuous outcome or 2,000 participants (categorical outcome. Conclusions Good levels of participation, adherence, and retention appear to be achievable for participants through age 85 years. Care should be taken to ensure that an attention control condition does not attenuate intervention effects. Depending on the choice of outcome measures, the necessary sample sizes to conduct four-year trials appear to be feasible. Trial Registration Clinicaltrials.gov Identifier: NCT00688155

  6. Reducing Bias and Increasing Precision by Adding Either a Pretest Measure of the Study Outcome or a Nonequivalent Comparison Group to the Basic Regression Discontinuity Design: An Example from Education

    Science.gov (United States)

    Tang, Yang; Cook, Thomas D.; Kisbu-Sakarya, Yasemin

    2015-01-01

    Regression discontinuity design (RD) has been widely used to produce reliable causal estimates. Researchers have validated the accuracy of RD design using within study comparisons (Cook, Shadish & Wong, 2008; Cook & Steiner, 2010; Shadish et al, 2011). Within study comparisons examines the validity of a quasi-experiment by comparing its…

  7. Repository design sensitivity study: Engineering study report

    International Nuclear Information System (INIS)

    1987-01-01

    A preliminary sensitivity study of the salt repository design has been performed to identify critical site and design parameters to help guide future site characterization and design optimization activities. The study considered the SCP-conceptual design at the Deaf Smith County site in Texas with the horizontal waste package emplacement mode as the base case. Relative to this base case, parameter variations were compared. Limited studies were performed which considered the vertical emplacement mode geometry. The report presents the reference data base and design parameters on which the study was based (including the range of parameters that might be expected). Detailed descriptions of the numerical modeling methods and assumptions are included for the thermal, thermomechanical and hydrogeological analyses. The impacts of parameter variations on the sensitivity of the rock mass response are discussed. Recommendations are provided to help guide site characterization activities and advanced conceptual design optimization activities. 47 refs., 119 refs., 22 tabs

  8. Study designs may influence results

    DEFF Research Database (Denmark)

    Johansen, Christoffer; Schüz, Joachim; Andreasen, Anne-Marie Serena

    2017-01-01

    appeared to show an inverse association, whereas nested case-control and cohort studies showed no association. For allergies, the inverse association was observed irrespective of study design. We recommend that the questionnaire-based case-control design be placed lower in the hierarchy of studies...... for establishing cause-and-effect for diseases such as glioma. We suggest that a state-of-the-art case-control study should, as a minimum, be accompanied by extensive validation of the exposure assessment methods and the representativeness of the study sample with regard to the exposures of interest. Otherwise...

  9. Total elbow arthroplasty: a radiographic outcome study

    Energy Technology Data Exchange (ETDEWEB)

    Bai, Xue Susan [University of Washington, Department of Radiology, Box 357115, Seattle, WA (United States); Petscavage-Thomas, Jonelle M. [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Ha, Alice S. [University of Washington, Department of Radiology, Box 354755, Seattle, WA (United States)

    2016-06-15

    Total elbow arthroplasty (TEA) is becoming a popular alternative to arthrodesis for patients with end-stage elbow arthrosis and comminuted distal humeral fractures. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TEA and to correlate with clinical symptoms such as pain. This is an IRB-approved retrospective review from 2005 to 2015 of all patients with semiconstrained TEA. All available elbow radiographs and clinical data were reviewed. Data analysis included descriptive statistics and Kaplan-Meier survival curves for radiographic and clinical survival. A total of 104 total elbow arthroplasties in 102 patients were reviewed; 75 % were in women and the mean patient age was 63.1 years. Mean radiographic follow-up was 826 days with average of four radiographs per patient. Seventy TEAs (67 %) developed radiographic complications, including heterotopic ossification (48 %), perihardware lucency (27 %), periprosthetic fracture (23 %), hardware subluxation/dislocation (7 %), polyethylene wear (3 %), and hardware fracture/dislodgement (3 %); 56 patients (55 %) developed symptoms of elbow pain or instability and 30 patients (30 %) underwent at least one reoperation. In patients with radiographic complications, 66 % developed elbow pain, compared to 19 % of patients with no radiologic complications (p = 0.001). Of the patients with radiographic complications, 39 % had at least one additional surgery compared to 0 % of patients without radiographic complications (p = 0.056). Radiographic complications are common in patients after total elbow arthroplasty. There is a strong positive association between post-operative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist. (orig.)

  10. Primary prevention research: a preliminary review of program outcome studies.

    Science.gov (United States)

    Schaps, E; Churgin, S; Palley, C S; Takata, B; Cohen, A Y

    1980-07-01

    This article reviews 35 drug abuse prevention program evaluations employing drug-specific outcome measures. Many of these evaluations assessed the effects of "new generation" prevention strategies: affective, peer-oriented, and multidimensional approaches. Only 14 studies evaluated purely informational programs. Evaluations were analyzed to ascertain (1) characteristics of the programs under study, (2) characteristics of the research designs, and (3) patterns among findings. This review provides some evidence that the newer prevention strategies may produce more positive and fewer negative outcomes than did older drug information approaches. Over 70% of the programs using the newer strategies produced some positive effects; only 29% showed negative effects. In contrast, 46% of informational programs showed positive effects; 46% showed negative effects. These findings must be approached with great caution, since the research was frequently scientifically inadequate, and since rigor of research was negatively correlated with intensity and duration of program services.

  11. A literature review of the effects of computer input device design on biomechanical loading and musculoskeletal outcomes during computer work.

    Science.gov (United States)

    Bruno Garza, J L; Young, J G

    2015-01-01

    Extended use of conventional computer input devices is associated with negative musculoskeletal outcomes. While many alternative designs have been proposed, it is unclear whether these devices reduce biomechanical loading and musculoskeletal outcomes. To review studies describing and evaluating the biomechanical loading and musculoskeletal outcomes associated with conventional and alternative input devices. Included studies evaluated biomechanical loading and/or musculoskeletal outcomes of users' distal or proximal upper extremity regions associated with the operation of alternative input devices (pointing devices, mice, other devices) that could be used in a desktop personal computing environment during typical office work. Some alternative pointing device designs (e.g. rollerbar) were consistently associated with decreased biomechanical loading while other designs had inconsistent results across studies. Most alternative keyboards evaluated in the literature reduce biomechanical loading and musculoskeletal outcomes. Studies of other input devices (e.g. touchscreen and gestural controls) were rare, however, those reported to date indicate that these devices are currently unsuitable as replacements for traditional devices. Alternative input devices that reduce biomechanical loading may make better choices for preventing or alleviating musculoskeletal outcomes during computer use, however, it is unclear whether many existing designs are effective.

  12. Visual Design Principles: An Empirical Study of Design Lore

    Science.gov (United States)

    Kimball, Miles A.

    2013-01-01

    Many books, designers, and design educators talk about visual design principles such as balance, contrast, and alignment, but with little consistency. This study uses empirical methods to explore the lore surrounding design principles. The study took the form of two stages: a quantitative literature review to determine what design principles are…

  13. Good research practices for comparative effectiveness research: approaches to mitigate bias and confounding in the design of nonrandomized studies of treatment effects using secondary data sources: the International Society for Pharmacoeconomics and Outcomes Research Good Research Practices for Retrospective Database Analysis Task Force Report--Part II.

    Science.gov (United States)

    Cox, Emily; Martin, Bradley C; Van Staa, Tjeerd; Garbe, Edeltraut; Siebert, Uwe; Johnson, Michael L

    2009-01-01

    The goal of comparative effectiveness analysis is to examine the relationship between two variables, treatment, or exposure and effectiveness or outcome. Unlike data obtained through randomized controlled trials, researchers face greater challenges with causal inference with observational studies. Recognizing these challenges, a task force was formed to develop a guidance document on methodological approaches to addresses these biases. The task force was commissioned and a Chair was selected by the International Society for Pharmacoeconomics and Outcomes Research Board of Directors in October 2007. This report, the second of three reported in this issue of the Journal, discusses the inherent biases when using secondary data sources for comparative effectiveness analysis and provides methodological recommendations to help mitigate these biases. The task force report provides recommendations and tools for researchers to mitigate threats to validity from bias and confounding in measurement of exposure and outcome. Recommendations on design of study included: the need for data analysis plan with causal diagrams; detailed attention to classification bias in definition of exposure and clinical outcome; careful and appropriate use of restriction; extreme care to identify and control for confounding factors, including time-dependent confounding. Design of nonrandomized studies of comparative effectiveness face several daunting issues, including measurement of exposure and outcome challenged by misclassification and confounding. Use of causal diagrams and restriction are two techniques that can improve the theoretical basis for analyzing treatment effects in study populations of more homogeneity, with reduced loss of generalizability.

  14. Outcomes of the DeepWind Conceptual Design

    DEFF Research Database (Denmark)

    Schmidt Paulsen, Uwe; Borg, Michael; Aagaard Madsen, Helge

    2015-01-01

    DeepWind has been presented as a novel floating offshore wind turbine concept with cost reduction potentials. Twelve international partners developed a Darrieus type floating turbine with new materials and technologies for deep-sea offshore environment. This paper summarizes results of the 5 MW...... the Deepwind floating 1 kW demonstrator. The 5 MW simulation results, loading and performance are compared to the OC3-NREL 5 MW wind turbine. Finally the paper elaborates the conceptual design on cost modelling....... DeepWind conceptual design. The concept was evaluated at the Hywind test site, described on its few components, in particular on the modified Troposkien blade shape and airfoil design. The feasibility of upscaling from 5 MW to 20 MW is discussed, taking into account the results from testing...

  15. Design and Co-design of Project-organized Studies

    DEFF Research Database (Denmark)

    Nielsen, Jørgen Lerche; Andreasen, Lars Birch

    2014-01-01

    The chapter contributes to discussions on design processes in relation to education, presenting different notions of design research and demonstrating how professors and students are involved together in designing innovative and constructive study processes that can help foster students' engagement...

  16. An Empirical Review of Internet Addiction Outcome Studies in China

    Science.gov (United States)

    Liu, Chennan; Liao, Minli; Smith, Douglas C.

    2012-01-01

    Objectives: The authors systematically reviewed the outcomes and methodological quality of 24 Internet addiction (IA) treatment outcome studies in China. Method: The authors used 15 attributes from the quality of evidence scores to evaluate 24 outcome studies. These studies came from both English and Chinese academic databases from 2000 to 2010.…

  17. 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.

  18. Designing the future of talking therapy: Using digital health to improve outcomes in psychosis

    Directory of Open Access Journals (Sweden)

    Amy Hardy

    2016-01-01

    A mobile app appears to be a feasible means of addressing barriers to access, uptake and adherence in talking therapies for psychosis, and may reduce costs and improve outcomes. Wellcome Trust funding has recently been obtained to investigate integrating wearable technology into the app, with the aim of increasing its sensitivity to user needs and further reducing processing demands. A Thinkthru digital platform is also being designed for use during therapy sessions and will be synchronised with the app. Further investigation of the platform and app’s potential to facilitate meaningful behaviour change is warranted, and a feasibility study and randomised controlled trial are planned.

  19. Controlled outcome studies of child clinical hypnosis.

    Science.gov (United States)

    Adinolfi, Barbara; Gava, Nicoletta

    2013-09-01

    Background Hypnosis is defined as "as an interaction in which the hypnotist uses suggested scenarios ("suggestions") to encourage a person's focus of attention to shift towards inner experiences". Aim of the work The focus of this review is to summarize the findings of controlled outcome studies investigating the potential of clinical hypnosis in pediatric populations. We will examine the following themes: anesthesia, acute and chronic pain, chemotherapy-related distress, along with other specific medical issues. Results Hypnosis is an effective method to reduce pain and anxiety before, during and after the administration of anesthetics, during local dental treatments, invasive medical procedures and in burn children. Hypnosis can be successfully used to manage recurrent headaches, abdominal pain, irritable bowel syndrome and chemotherapy-related distress. Hypnosis has an important role in managing symptoms and improving the quality of life of children suffering from asthma and cystic fibrosis and in facilitating the treatment of insomnia in school-age children. Finally, hypnosis can be effectively used for the treatment of some habitual disorders such as nocturnal enuresis and dermatologic conditions, including atopic dermatitis and chronic eczema Conclusions Clinical hypnosis seems to be a useful, cheap and side-effects free tool to manage fear, pain and several kinds of stressful experiences in pediatric populations. Children who receive self-hypnosis trainings achieve significantly greater improvements in their physical health, quality of life, and self-esteem.

  20. Methadone and perinatal outcomes: a prospective cohort study.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-08-01

      Methadone use in pregnancy has been associated with adverse perinatal outcomes and neonatal abstinence syndrome (NAS). This study aimed to examine perinatal outcomes and NAS in relation to (i) concomitant drug use and (ii) methadone dose.

  1. Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage : The SAHIT multinational cohort study

    NARCIS (Netherlands)

    Jaja, Blessing N R; Saposnik, Gustavo; Lingsma, Hester F.; Macdonald, Erin; Thorpe, Kevin E.; Mamdani, Muhammed; Steyerberg, Ewout W.; Molyneux, Andrew; Manoel, Airton Leonardo De Oliveira; Schatlo, Bawarjan; Hanggi, Daniel; Hasan, David M.; Wong, George K C; Etminan, Nima; Fukuda, Hitoshi; Torner, James C.; Schaller, Karl L.; Suarez, Jose I.; Stienen, Martin N.; Vergouwen, Mervyn D.I.; Rinkel, Gabriel J.E.; Spears, Julian; Cusimano, Michael D.; Todd, Michael; Le Roux, Peter; Kirkpatrick, Peter J.; Pickard, John; Van Den Bergh, Walter M.; Murray, Gordon D; Johnston, S. Claiborne; Yamagata, Sen; Mayer, Stephan A.; Schweizer, Tom A.; Macdonald, R. Loch

    2018-01-01

    Objective To develop and validate a set of practical prediction tools that reliably estimate the outcome of subarachnoid haemorrhage from ruptured intracranial aneurysms (SAH). Design Cohort study with logistic regression analysis to combine predictors and treatment modality. Setting Subarachnoid

  2. Principles for guiding the ONKALO prediction-outcome studies

    International Nuclear Information System (INIS)

    Andersson, J.; Hudson, J.A.; Anttila, P.; Koskinen, L.; Pitkaenen, P.; Hautojaervi, A.; Wikstroem, L.

    2005-09-01

    This document provides the necessary foundation for establishing the strategy for the Prediction-Outcome studies currently being conducted by the ONKALO Modelling Task Force (OMTF) during the construction of the ONKALO ramp. These studies relate to the geology, rock mechanics, hydrogeology and hydrogeochemistry. The purpose of the Prediction-Outcome campaign currently underway in the ONKALO ramp tunnel is to optimize Posiva's ability to predict rock conditions ahead of the excavation face. The aim of the work is: to enhance confidence in ability to predict rock conditions in general - and especially for the repository volumes; (later) testing and verification of repository design rules as it would not be possible to make too many additional boreholes in repository volume; and to support the ongoing construction work and make possible the application of the CEIC method. The document also presents current plans for at what stages of the ONKALO construction predictions and outcome assessments will be made as well as current plans for what properties and impacts will be predicted. These plans will evidently be subject to revision during the course of the work. (orig.)

  3. 02A. Design, Methods, and Outcomes for Recent Clinical Trials Utilizing Ayurvedic Medicine, Yoga, and Meditation

    Science.gov (United States)

    Saper, Robert; Vinjamury, Sivarama; Elder, Charles

    2013-01-01

    Focus Area: Integrative Approaches to Care The panel discussants will present on the outcomes of four recent pragmatic trials covering the spectrum of Ayurvedic medicine, yoga, and meditation as therapeutic approaches for both acute and chronic conditions. The presenters will discuss: (1) a pilot study of a whole-systems Ayurveda and Yoga Therapy intervention for obesity; (2) a comparative effectiveness randomized controlled trial of hatha yoga, physical therapy, and education for non-specific chronic low back pain in low-income minority populations; (3) an investigation of the therapeutic usefulness of Shirodhara (Ayurvedic oil dripping therapy) as a treatment for insomnia; and (4) a discussion of the evidence base supporting implementation of meditation interventions in schools and workplace settings. Discussants will present information on study designs, research methodology, and outcome measure selection to highlight special considerations in conducting research on whole medical systems that use multi-target therapies and focus on patient-centered outcomes. Ayurvedic medicine and yoga are characterized by low-cost, noninvasive interventions that can be usefully offered as part of an integrative medicine therapeutic approach.

  4. Miniplating of metacarpal fractures: an outcome study

    Directory of Open Access Journals (Sweden)

    Fallah E

    2011-05-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Trauma to the hand is very common and consequently, metacarpal fractures are not rare entities. Some of these fractures need surgery. Considering the diversity of surgical methods available for these kinds of fractures and also the importance of achieving full function and speedy return to work for patients that are mainly young workers or athletes, this study was undertaken to investigate the outcome of treating these fractures by mini-plates."n"nMethods : Eighteen patients with open or comminuted fractures of metacarpal bones who were admitted to the emergency department of Sina Hospital between the years 2007 and 2010 underwent fixation surgery using mini-plates. Fourteen patients with 17 metacarpal fractures completed the study."n"nResults : Thirteen out of 14 patients had complete fracture union. The patient with non-union underwent revision surgery and bone graft. Four individuals developed an extensor lag of 15 degrees without functional impairment. Two patients had joint stiffness that was relieved after a period of physiotherapy and one developed wound dehiscence and discharge that improved with debridement and use of antibiotics without plate removal. Six patients had

  5. Incidence and outcomes of bulimia nervosa : a nationwide population-based study

    NARCIS (Netherlands)

    Keski-Rahkonen, A.; Hoek, H. W.; Linna, M. S.; Raevuori, A.; Sihvola, E.; Bulik, C. M.; Rissanen, A.; Kaprio, J.

    Background. Little is known about the epidemiology of bulimia nervosa outside clinical settings. We report the incidence, prevalence and outcomes of bulimia nervosa using for the first time a nationwide Study design. Method. To assess the incidence and natural course and outcomes of DSM-IV bulimia

  6. Cumulative risk, cumulative outcome: a 20-year longitudinal study.

    Directory of Open Access Journals (Sweden)

    Leslie Atkinson

    Full Text Available Cumulative risk (CR models provide some of the most robust findings in the developmental literature, predicting numerous and varied outcomes. Typically, however, these outcomes are predicted one at a time, across different samples, using concurrent designs, longitudinal designs of short duration, or retrospective designs. We predicted that a single CR index, applied within a single sample, would prospectively predict diverse outcomes, i.e., depression, intelligence, school dropout, arrest, smoking, and physical disease from childhood to adulthood. Further, we predicted that number of risk factors would predict number of adverse outcomes (cumulative outcome; CO. We also predicted that early CR (assessed at age 5/6 explains variance in CO above and beyond that explained by subsequent risk (assessed at ages 12/13 and 19/20. The sample consisted of 284 individuals, 48% of whom were diagnosed with a speech/language disorder. Cumulative risk, assessed at 5/6-, 12/13-, and 19/20-years-old, predicted aforementioned outcomes at age 25/26 in every instance. Furthermore, number of risk factors was positively associated with number of negative outcomes. Finally, early risk accounted for variance beyond that explained by later risk in the prediction of CO. We discuss these findings in terms of five criteria posed by these data, positing a "mediated net of adversity" model, suggesting that CR may increase some central integrative factor, simultaneously augmenting risk across cognitive, quality of life, psychiatric and physical health outcomes.

  7. Design Evolution Study - Aging Options

    International Nuclear Information System (INIS)

    McDaniel, P.

    2002-01-01

    The purpose of this study is to identify options and issues for aging commercial spent nuclear fuel received for disposal at the Yucca Mountain Mined Geologic Repository. Some early shipments of commercial spent nuclear fuel to the repository may be received with high-heat-output (younger) fuel assemblies that will need to be managed to meet thermal goals for emplacement. The capability to age as much as 40,000 metric tons of heavy metal of commercial spent nuclear he1 would provide more flexibility in the design to manage this younger fuel and to decouple waste receipt and waste emplacement. The following potential aging location options are evaluated: (1) Surface aging at four locations near the North Portal; (2) Subsurface aging in the permanent emplacement drifts; and (3) Subsurface aging in a new subsurface area. The following aging container options are evaluated: (1) Complete Waste Package; (2) Stainless Steel inner liner of the waste package; (3) Dual Purpose Canisters; (4) Multi-Purpose Canisters; and (5) New disposable canister for uncanistered commercial spent nuclear fuel. Each option is compared to a ''Base Case,'' which is the expected normal waste packaging process without aging. A Value Engineering approach is used to score each option against nine technical criteria and rank the options. Open issues with each of the options and suggested future actions are also presented. Costs for aging containers and aging locations are evaluated separately. Capital costs are developed for direct costs and distributable field costs. To the extent practical, unit costs are presented. Indirect costs, operating costs, and total system life cycle costs will be evaluated outside of this study. Three recommendations for aging commercial spent nuclear fuel--subsurface, surface, and combined surface and subsurface are presented for further review in the overall design re-evaluation effort. Options that were evaluated but not recommended are: subsurface aging in a new

  8. [Saarland Growth Study: sampling design].

    Science.gov (United States)

    Danker-Hopfe, H; Zabransky, S

    2000-01-01

    The use of reference data to evaluate the physical development of children and adolescents is part of the daily routine in the paediatric ambulance. The construction of such reference data is based on the collection of extensive reference data. There are different kinds of reference data: cross sectional references, which are based on data collected from a big representative cross-sectional sample of the population, longitudinal references, which are based on follow-up surveys of usually smaller samples of individuals from birth to maturity, and mixed longitudinal references, which are a combination of longitudinal and cross-sectional reference data. The advantages and disadvantages of the different methods of data collection and the resulting reference data are discussed. The Saarland Growth Study was conducted for several reasons: growth processes are subject to secular changes, there are no specific reference data for children and adolescents from this part of the country and the growth charts in use in the paediatric praxis are possibly not appropriate any more. Therefore, the Saarland Growth Study served two purposes a) to create actual regional reference data and b) to create a database for future studies on secular trends in growth processes of children and adolescents from Saarland. The present contribution focusses on general remarks on the sampling design of (cross-sectional) growth surveys and its inferences for the design of the present study.

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

    Science.gov (United States)

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

    2017-08-11

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

  10. Exploring the outcomes in studies of primary frozen shoulder

    DEFF Research Database (Denmark)

    Rodgers, Sara; Brealey, Stephen; Jefferson, Laura

    2014-01-01

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

  11. AEROSOL PARTICLE COLLECTOR DESIGN STUDY

    Energy Technology Data Exchange (ETDEWEB)

    Lee, S; Richard Dimenna, R

    2007-09-27

    A computational evaluation of a particle collector design was performed to evaluate the behavior of aerosol particles in a fast flowing gas stream. The objective of the work was to improve the collection efficiency of the device while maintaining a minimum specified air throughput, nominal collector size, and minimal power requirements. The impact of a range of parameters was considered subject to constraints on gas flow rate, overall collector dimensions, and power limitations. Potential improvements were identified, some of which have already been implemented. Other more complex changes were identified and are described here for further consideration. In addition, fruitful areas for further study are proposed.

  12. Learning Program for Enhancing Visual Literacy for Non-Design Students Using a CMS to Share Outcomes

    Science.gov (United States)

    Ariga, Taeko; Watanabe, Takashi; Otani, Toshio; Masuzawa, Toshimitsu

    2016-01-01

    This study proposes a basic learning program for enhancing visual literacy using an original Web content management system (Web CMS) to share students' outcomes in class as a blog post. It seeks to reinforce students' understanding and awareness of the design of visual content. The learning program described in this research focuses on to address…

  13. Evaluation of multi-outcome longitudinal studies

    DEFF Research Database (Denmark)

    Jensen, Signe Marie; Pipper, Christian Bressen; Ritz, Christian

    2015-01-01

    Evaluation of intervention effects on multiple outcomes is a common scenario in clinical studies. In longitudinal studies, such evaluation is a challenge if one wishes to adequately capture simultaneous data behavior. In this situation, a common approach is to analyze each outcome separately...... conservative conclusions. We propose an alternative approach for multiplicity adjustment that incorporates dependence between outcomes, resulting in an appreciably less conservative evaluation. The ability of the proposed method to control the familywise error rate is evaluated in a simulation study...

  14. Methadone and perinatal outcomes: a retrospective cohort study.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-02-01

    OBJECTIVE: The purpose of this study was to examine the relationship among methadone maintenance treatment, perinatal outcomes, and neonatal abstinence syndrome. STUDY DESIGN: This was a retrospective cohort study of 61,030 singleton births at a large maternity hospital from 2000-2007. RESULTS: There were 618 (1%) women on methadone at delivery. Methadone-exposed women were more likely to be younger, to book late for antenatal care, and to be smokers. Methadone exposure was associated with an increased risk of very preterm birth <32 weeks of gestation (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.40-4.34), being small for gestational age <10th percentile (aOR, 3.27; 95% CI, 2.49-4.28), admission to the neonatal unit (aOR, 9.14; 95% CI, 7.21-11.57), and diagnosis of a major congenital anomaly (aOR, 1.94; 95% CI, 1.10-3.43). There was a dose-response relationship between methadone and neonatal abstinence syndrome. CONCLUSION: Methadone exposure is associated with an increased risk of adverse perinatal outcomes, even when known adverse sociodemographic factors have been accounted for. Methadone dose at delivery is 1 of the determinants of neonatal abstinence syndrome.

  15. Looking for students' personal characteristics predicting study outcome.

    NARCIS (Netherlands)

    Dr. A. Bakx; Theo Bergen; Dr. Cyrille A.C. Van Bragt; Marcel Croon

    2011-01-01

    Abstract The central goal of this study is to clarify to what degree former education and students' personal characteristics (the 'Big Five personality characteristics', personal orientations on learning and students' study approach) may predict study outcome (required credits and study

  16. HTS Insert Magnet Design Study

    CERN Document Server

    Devaux, M; Fleiter, J; Fazilleau, P; Lécrevisse, T; Pes, C; Rey, J-M; Rifflet, J-M; Sorbi, M; Stenvall, A; Tixador, P; Volpini, G

    2011-01-01

    Future accelerator magnets will need to reach higher field in the range of 20 T. This field level is very difficult to reach using only Low Temperature Superconductor materials whereas High Temperature Superconductors (HTS) provide interesting opportunities. High current densities and stress levels are needed to design such magnets. YBCO superconductor indeed carries large current densities under high magnetic field and provides good mechanical properties especially when produced using the IBAD approach. The HFM EUCARD program studies the design and the realization of an HTS insert of 6 T inside a Nb$_{3}$Sn dipole of 13T at 4.2 K. In the2HTS insert, engineering current densities higher than 250 MA/m under 19 T are required to fulfill the specifications. The stress level is also very severe. YBCO IBAD tapes theoretically meet these challenges from presented measurements. The insert protection is also a critical because HTS materials show low quench propagation velocities and the coupling with the Nb$_{3}$Sn m...

  17. Evidence-based architectural and space design supports Magnet® empirical outcomes.

    Science.gov (United States)

    Ecoff, Laurie; Brown, Caroline E

    2010-12-01

    This department expands nursing leaders' knowledge and competencies in health facility design. The editor of this department, Dr Jaynelle Stichler, asked guest authors, Drs Ecoff and Brown, to describe the process of using the conceptual models of a nursing evidence-based practice model and the Magnet Recognition Program® as a structured process to lead decision making in the planning and design processes and to achieve desired outcomes in hospital design.

  18. Testing the association between psychosocial job strain and adverse birth outcomes - design and methods

    Directory of Open Access Journals (Sweden)

    Thulstrup Ane M

    2011-04-01

    Full Text Available Abstract Background A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated with the risk of giving birth to a child born preterm or small for gestational age. Methods and design We will use the Danish National Birth Cohort where 100.000 children are included at baseline. In the present study 49,340 pregnancies will be included. Multinomial logistic regression will be applied to estimate odds ratios for the outcomes: preterm; full term but small for gestational age; full term but large for gestational age, as a function of job-strain (high strain, active and passive versus low strain. In the analysis we control for maternal age, Body Mass Index, parity, exercise, smoking, alcohol use, coffee consumption, type of work (manual versus non-manual, maternal serious disease and parents' heights as well as gestational age at interview. Discussion The prospective nature of the design and the high number of participants strengthen the study. The large statistical power allows for interpretable results regardless of whether or not the hypotheses are confirmed. This is, however, not a controlled study since all kinds of 'natural' interventions takes place throughout pregnancy (e.g. work absence, medical treatment and job-redesign. The analysis will be performed from a public health perspective. From this perspective, we are not primarily interested in the effect of job strain per se but if there is residual effect of job strain after naturally occurring preventive measures have been taken.

  19. Outcome of strategy training in stroke patients with apraxia: a phase II study.

    NARCIS (Netherlands)

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Dijk, A.J. van; Stehmann-Saris, J.C.; Kinebanian, A.

    1998-01-01

    Objective: Evaluation of a therapy programme for srorke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists. Design: The outcome was studied in de

  20. Outcomes following vaginal prolapse repair and mid urethral sling (OPUS) trial--design and methods.

    Science.gov (United States)

    Wei, John; Nygaard, Ingrid; Richter, Holly; Brown, Morton; Barber, Matthew; Xiao Xu; Kenton, Kimberly; Nager, Charles; Schaffer, Joseph; Visco, Anthony; Weber, Anne

    2009-04-01

    The primary aims of this trial are to determine whether the use of a concomitant prophylactic anti-incontinence procedure may prevent stress urinary incontinence symptom development in women undergoing vaginal prolapse surgery and to evaluate the cost-effectiveness of this prophylactic approach. To present the rationale and design of a randomized controlled surgical trial (RCT), the Outcomes following vaginal Prolapse repair and mid Urethral Sling (OPUS) Trial highlighting the challenges in the design and implementation. The challenges of implementing this surgical trial combined with a cost-effectiveness study and patient preference group are discussed including the study design, ethical issues regarding use of sham incision, maintaining the masking of study staff, and pragmatic difficulties encountered in the collection of cost data. The trial is conducted by the NICHD-funded Pelvic Floor Disorders Network. The ongoing OPUS trial started enrollment in May 2007 with a planned accrual of 350. The use of sham incision was generally well accepted but the collection of cost data using conventional billing forms was found to potentially unmask key study personnel. This necessitated changes in the study forms and planned timing for collection of cost data. To date, the enrollment to the patient preference group has been lower than the limit established by the protocol suggesting a willingness on the part of women to participate in the randomization. Given the invasive nature of surgical intervention trials, potential participants may be reluctant to accept random assignment, potentially impacting generalizability. Findings from the OPUS trial will provide important information that will help surgeons to better counsel women on the benefits and risks of concomitant prophylactic anti-incontinence procedure at the time of vaginal surgery for prolapse. The implementation of the OPUS trial has necessitated that investigators consider ethical issues up front, remain flexible

  1. A study on Korean nursing students’ educational outcomes

    Directory of Open Access Journals (Sweden)

    Kasil Oh

    2011-04-01

    Full Text Available The purpose of this study was to describe outcome indicators of nursing education including critical thinking, professionalism, leadership, and communication and to evaluate differences among nursing programs and academic years. A descriptive research design was employed. A total of 454 students from four year baccalaureate (BS nursing programs and two three-year associate degree (AD programs consented to complete self-administered questionnaires. The variables were critical thinking, professionalism, leadership and communication. Descriptive statistics, χ2-test, t-tests, ANOVA, and the Tukey test were utilized for the data analysis. All the mean scores of the variables were above average for the test instruments utilized. Among the BS students, those in the upper classes tended to attain higher scores, but this tendency was not identified in AD students. There were significant differences between BS students and AD students for the mean scores of leadership and communication. These findings suggested the need for further research to define properties of nursing educational outcomes, and to develop standardized instruments for research replication and verification.

  2. Does knowledge of seat design and whiplash injury mechanisms translate to understanding outcomes?

    Science.gov (United States)

    Ivancic, Paul C

    2011-12-01

    Review of whiplash injury mechanisms and effects of anti-whiplash systems including active head restraint (AHR) and Whiplash Protection System (WHIPS). This article provides an overview of previous biomechanical and epidemiological studies of AHR and WHIPS and investigates whether seat design and biomechanical knowledge of proposed whiplash injury mechanisms translates to understanding outcomes of rear crash occupants. In attempt to reduce whiplash injuries, some newer automobiles incorporate anti-whiplash systems such as AHR or WHIPS. During a rear crash, mechanically based systems activate by occupant momentum pressing into the seatback whereas electronically based systems activate using crash sensors and an electronic control unit linked to the head restraint. To investigate the effects of AHR and WHIPS on occupant responses including head and neck loads and motions, biomechanical studies of simulated rear crashes have been performed using human volunteers, mathematical models, crash dummies, whole cadavers, and hybrid cadaveric/surrogate models. Epidemiological studies have evaluated the effects of AHR and WHIPS on reducing whiplash injury claims and lessening subjective complaints of neck pain after rear crashes. RESULTS.: Biomechanical studies indicate that AHR and WHIPS reduced the potential for some whiplash injuries but did not completely eliminate the injury risk. Epidemiological outcomes indicate reduced whiplash injury claims or subjective complaints of crash-related neck pain between 43 and 75% due to AHR and between 21% and 49% due to WHIPS as compared to conventional seats and head restraints. Yielding energy-absorbing seats aim to reduce occupant loads and accelerations whereas AHRs aim to provide early head support to minimize head and neck motions. Continued objective biomechanical and epidemiological studies of anti-whiplash systems together with industry, governmental, and clinical initiatives will ultimately lead to reduced whiplash injuries

  3. 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…

  4. Fetomaternal Outcome in Triplet and Quadruplet Pregnancies: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Maasoumeh Mirzamoradi

    2017-06-01

    Full Text Available Background: In recent decades, there has been a dramatic increase in the prevalence of multiple pregnancies. An important reason is the increased use of assisted reproductive techniques for conception. Despite the advances in prenatal care, maternal and neonatal morbidity and mortality caused by multiple pregnancies are still high. Aim: This study aimed to evaluate the fetomaternal complications in higher order multiple pregnancies. Design: The design is a retrospective study. Setting: Triplet and quadruplet pregnancies were investigated in this study. Methods: This study investigated the outcome of triplet and quadruplet pregnancies born alive at the Mahdiyeh hospital, Tehran, Iran from 2006 to 2015. Results: In this study, 111 triplet pregnancies and 24 quadruplet pregnancies were studied, 80% of which resulted from assisted reproductive technology. The average age of pregnancy termination was 31 weeks, the average weight of the first to third neonates was 1400 g and the average weight of the fourth neonate was 700 g. The most common reason for early termination of pregnancy was preterm labor, the most maternal complication was uterine atony and the most common neonatal complication was pre-maturity and then respiratory distress syndrome (RDS. The mean age of mother in triplets’ deliveries was significantly lower than in the quadruplets. The average weight of the first to third neonates, the average of 1st and 5th minutes Apgar score of the first neonates and the average gestational age of termination for the first and second neonates in triplets was significantly higher than in the quadruplets. Hospitalization due to preterm labor in quadruplets’ delivery was significantly higher than in triplets. Conclusion: Higher order multiple pregnancies are associated with higher maternal and neonatal complications. Mothers with such pregnancies needs more care in the prenatal period, during labor and in the postpartum period, and also their

  5. A study of everyday repair: informing interaction design

    OpenAIRE

    Maestri, Leah Adriana

    2012-01-01

    Repair is typically seen in design as the restoration of broken objects to their original state. Repair by non-experts, or everyday repair, can often lead to novel forms of repair resulting in the creative repurposing of objects that are often unforeseen by designers. Using a grounded theory approach, this study describes key aspects of repair including: the techniques non-experts employ for repairing their objects; the motivations that prompt acts of repair; and the outcomes that result fr...

  6. Outcome of strategy training in stroke patients with apraxia: a phase II study.

    OpenAIRE

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Dijk, A.J. van; Stehmann-Saris, J.C.; Kinebanian, A.

    1998-01-01

    Objective: Evaluation of a therapy programme for srorke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists. Design: The outcome was studied in de pre-post design. Measurements were conducted at baseline and 12 weeks later. Subjects: Thirty-three stroke patients with apraxia were treated at occupational therapy departments in general hospital...

  7. Advances on ELIC Design Studies

    International Nuclear Information System (INIS)

    Bogacz, S. Alex; Bogacz, S.; Chevtsov, P.; Derbenev, Ya.; Evtushenko, P.; Krafft, G.; Hutton, A.; Li, R.; Merminga, L.; Musson, J.; Yunn, B.; Zhang, Y.; Sayed, H.; Qiang, J.

    2008-01-01

    A conceptual design of a ring-ring electron-ion collider based on CEBAF with a center-of-mass energy up to 90 GeV at luminosity up to 1035 cm-2s-1 has been proposed at JLab to fulfill science requirements. Here, we summarize design progress including collider ring and interaction region optics with chromatic aberration compensation. Electron polarization in the Figure-8 ring, stacking of ion beams in an accumulator-cooler ring, beam-beam simulations and a faster kicker for the circulator electron cooler ring are also discussed

  8. Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials

    DEFF Research Database (Denmark)

    Savović, Jelena; Jones, Hayley E; Altman, Douglas G

    2012-01-01

    bias and increases in between-trial heterogeneity were driven primarily by trials with subjective outcomes, with little evidence of bias in trials with objective and mortality outcomes. This study is limited by incomplete trial reporting, and findings may be confounded by other study design...... characteristics. Bias associated with study design characteristics may lead to exaggeration of intervention effect estimates and increases in between-trial heterogeneity in trials reporting subjectively assessed outcomes....

  9. An outcome study of Gamblers Anonymous.

    Science.gov (United States)

    Stewart, R M; Brown, R I

    1988-02-01

    Retrospective and prospective studies of a total sample of 232 attenders at groups of Gamblers Anonymous suggest that total abstinence from gambling was maintained by 8% of all comers at one year from first attendance and by 7% at two years.

  10. Case-Cohort Studies: Design and Applicability to Hand Surgery.

    Science.gov (United States)

    Vojvodic, Miliana; Shafarenko, Mark; McCabe, Steven J

    2018-04-24

    Observational studies are common research strategies in hand surgery. The case-cohort design offers an efficient and resource-friendly method for risk assessment and outcomes analysis. Case-cohorts remain underrepresented in upper extremity research despite several practical and economic advantages over case-control studies. This report outlines the purpose, utility, and structure of the case-cohort design and offers a sample research question to demonstrate its value to risk estimation for adverse surgical outcomes. The application of well-designed case-cohort studies is advocated in an effort to improve the quality and quantity of observational research evidence in hand and upper extremity surgery. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  11. Urban ninth-grade girls interactions with and outcomes from a design-oriented physics project

    Science.gov (United States)

    Higginbotham, Thomas Eric Miksad

    Past literature has documented a shrinking but persistent gap in physics and engineering for females, both in school and in the workforce. A commonly recommended strategy to invite girls into science at the school level is to have students work on design-projects in groups, which has been shown to increase all students' learning outcomes and attitudes towards science. Students (n=28) in a ninth-grade inner-city physics class participated in such a project, in which they built remotely operated underwater vehicles (ROV's) over the course of one month. Students (n=23) in a comparison classroom learned the same content using the Active Physics curriculum during the same time frame. Mixed methods were used to study the ROV classroom. Students in both classes were given pre- and post-physics content tests. Qualitative data collected during the project included field notes, video, and teacher interviews. Macro-level data analysis was done, which informed further micro-analysis. Macro-analysis revealed significantly higher learning outcomes for the ROV class than for the non-ROV class. Within the ROV class, girls, and in particular, girls in female-majority groups had increased learning outcomes and high levels of interest and engagement with the project, while girls in mixed-sex and male-majority groups did not. Qualitative macro-analysis revealed that in all of the female-majority groups, females took leadership roles within the groups, while in all of the non female-majority groups, males took leadership roles. The only groups in which girls completely disengaged from the project were mixed-sex or male majority groups. Case studies and cross case analysis suggested that girls foregrounded group process over product, and used the level of group unity as a metric of the groups' success. Groups led by girls were more cooperative and exhibited distributed leadership and participation. These findings were interpreted through lenses of expectation states theory and social

  12. Designing a Prognostic Scoring System for Predicting the Outcomes of Proximal Fifth Metatarsal Fractures at 20 Weeks

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Tahririan

    2015-03-01

    Full Text Available Background: Fractures of the proximal fifth metatarsal bone are among the most common fractures observed in the foot and their classification and management has been subject to much discussion and disagreement. In this study, we aim to identify and quantify the effect of possible predictors of the outcome of the treatment of proximal fifth metatarsal fractures. Methods: Patients with established proximal fifth metatarsal fractures were enrolled in this prospective cohort and the outcome of their treatment was assessed using the AOFAS mid foot scale at 6 and 20 weeks. Results: 143 patients were included in the study. Our study showed that displacement, weight and type III fractures were significant independent predictors of poor outcome at 6 weeks while at 20 weeks in addition to these factors, gender and diabetes mellitus were also shown to be significant independent predictors of poor outcome. A scoring system was designed by assigning weight to these factors and it was shown to be a strong predictor of outcome at 20 weeks. Conclusion: We recommend that our scoring system would help surgeons to decide whether patients’ prognostic factors are significant enough for him/her to opt for a surgical approach to treatment rather than a conservative approach.

  13. Design dimensions: In-depth retrospective studies of K-12 science curriculum design

    NARCIS (Netherlands)

    Bernstein, Deborah; McKenney, Susan; Barber, Jacquey; Bopardikar, Anushree; Drayton, Brian; Walkup, Sara; Pareja Roblin, Natalie; Schunn, Christian

    2015-01-01

    Design and development are critically important to the educational enterprise. Unfortunately, there is little research on which design and development processes produce optimal outcomes for curricular materials intended for large-scale implementation. The Design Dimensions project asks: Across

  14. The Utility of Outcome Studies in Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Hani Sinno, MD, MEng

    2014-07-01

    Full Text Available Summary: Outcome studies help provide the evidence-based science rationalizing treatment end results that factor the experience of patients and the impact on society. They improve the recognition of the shortcoming in clinical practice and provide the foundation for the development of gold standard care. With such evidence, health care practitioners can develop evidence-based justification for treatments and offer patients with superior informed consent for their treatment options. Furthermore, health care and insurance agencies can recognize improved cost-benefit options in the purpose of disease prevention and alleviation of its impact on the patient and society. Health care outcomes are ultimately measured by the treatment of disease, the reduction of symptoms, the normalization of laboratory results and physical measures, saving a life, and patient satisfaction. In this review, we outline the tools available to measure outcomes in plastic surgery and subsequently allow the objective measurements of plastic surgical conditions. Six major outcome categories are discussed: (1 functional measures; (2 preference-based measures and utility outcome scores; (3 patient satisfaction; (4 health outcomes and time; (5 other tools: patient-reported outcome measurement information system, BREAST-Q, and Tracking Operations and Outcomes for Plastic Surgeons; and (6 cost-effectiveness analysis. We use breast hypertrophy requiring breast reduction as an example throughout this review as a representative plastic surgical condition with multiple treatments available.

  15. A Study of Fifth Graders' Environmental Learning Outcomes in Taipei

    Science.gov (United States)

    Lai, Ching-San

    2018-01-01

    Environmental education has recently received much more attention than before among elementary school students' science learning in Taiwan. The major purpose of this study is to explore the learning outcomes on environmental education for 5th graders in Taipei. A quasi-experimental design with a single group was used in this study. Students in the…

  16. Pregnancy outcome in hyperthyroidism: a case control study.

    Science.gov (United States)

    Aggarawal, Neelam; Suri, Vanita; Singla, Rimpi; Chopra, Seema; Sikka, Pooja; Shah, Viral N; Bhansali, Anil

    2014-01-01

    Data comparing pregnancy outcome in hyperthyroid women with euthyroid women are scarce. Hence, this study was carried out to assess the maternal and fetal outcome in pregnant women with hyperthyroidism to ascertain the effect of disease on pregnancy. This retrospective study was conducted over a period of 28 years. We compared the maternal and fetal outcomes of 208 hyperthyroid women with 403 healthy controls, between women with well-controlled and uncontrolled disease and amongst women diagnosed with hyperthyroidism before and during pregnancy. Maternal outcome: women with hyperthyroidism were at increased risk for preeclampsia (OR = 3.94), intrauterine growth restriction (OR = 2.16), spontaneous preterm labor (OR = 1.73), preterm birth (OR = 1.7), gestational diabetes mellitus (OR = 1.8), and cesarean delivery (OR = 1.47). Hyperthyroid women required induction of labor more frequently (OR = 3.61). Fetal outcome: newborns of hyperthyroid mothers had lower birth weight than normal ones (p = 0.0001). Women with uncontrolled disease had higher odds for still birth (OR = 8.42; 95% CI: 2.01-35.2) and lower birth weight (p = 0.0001). Obstetrical complications were higher in women with hyperthyroidism than normal women. Outcome was worsened by uncontrolled disease. Women with pregestational hyperthyroidism had better outcomes than those diagnosed with it during pregnancy. © 2014 S. Karger AG, Basel.

  17. Epidemiologic Tools to Study the Influence of Environmental Factors on Fecundity and Pregnancy-related Outcomes

    Science.gov (United States)

    Slama, Rémy; Ballester, Ferran; Casas, Maribel; Cordier, Sylvaine; Eggesbø, Merete; Iniguez, Carmen; Nieuwenhuijsen, Mark; Philippat, Claire; Rey, Sylvie; Vandentorren, Stéphanie; Vrijheid, Martine

    2014-01-01

    Adverse pregnancy outcomes entail a large health burden for the mother and offspring; a part of it might be avoided by better understanding the role of environmental factors in their etiology. Our aims were to review the assessment tools to characterize fecundity troubles and pregnancy-related outcomes in human populations and their sensitivity to environmental factors. For each outcome, we reviewed the possible study designs, main sources of bias, and their suggested cures. In terms of study design, for most pregnancy outcomes, cohorts with recruitment early during or even before pregnancy allow efficient characterization of pregnancy-related events, time-varying confounders, and in utero exposures that may impact birth outcomes and child health. Studies on congenital anomalies require specific designs, assessment of anomalies in medical pregnancy terminations, and, for congenital anomalies diagnosed postnatally, follow-up during several months after birth. Statistical analyses should take into account environmental exposures during the relevant time windows; survival models are an appropriate approach for fecundity, fetal loss, and gestational duration/preterm delivery. Analysis of gestational duration could distinguish pregnancies according to delivery induction (and possibly pregnancy-related conditions). In conclusion, careful design and analysis are required to better characterize environmental effects on human reproduction. PMID:24363355

  18. Looking for students'personal characteristics predicting study outcome

    NARCIS (Netherlands)

    Bergen, T.C.M.; Bragt, van C.A.C.; Bakx, A.W.E.A.; Croon, M.A.

    2011-01-01

    Abstract The central goal of this study is to clarify to what degree former education and students’ personal characteristics (the ‘Big Five personality characteristics’, personal orientations on learning and students’ study approach) may predict study outcome (required credits and study

  19. Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes.

    Science.gov (United States)

    Cheng, Huai Yong; Davis, Molly

    2017-02-01

    Prior reviews of geriatrics curricula for internal medicine (IM) and family medicine (FM) residents have not evaluated study quality or assessed learning objectives or specific IM or FM competencies. This review of geriatrics curricula for IM and FM residents seeks to answer 3 questions: (1) What types of learning outcomes were measured? (2) How were learning outcomes measured? and (3) What was the quality of the studies? We evaluated geriatrics curricula that reported learning objectives or competencies, teaching methods, and learning outcomes, and those that used a comparative design. We searched PubMed and 4 other data sets from 2003-2015, and assessed learning outcomes, outcome measures, and the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and Best Evidence Medical Education (BEME) methods. Fourteen studies met inclusion criteria. Most curricula were intended for IM residents in the inpatient setting; only 1 was solely dedicated to FM residents. Median duration was 1 month, and minimum geriatrics competencies covered were 4. Learning outcomes ranged from Kirkpatrick levels 1 to 3. Studies that reported effect size showed a considerable impact on attitudes and knowledge, mainly via pretests and posttests. The mean MERSQI score was 10.5 (range, 8.5-13) on a scale of 5 (lowest quality) to 18 (highest quality). Few geriatrics curricula for IM and FM residents that included learning outcome assessments were published recently. Overall, changes in attitudes and knowledge were sizeable, but reporting was limited to low to moderate Kirkpatrick levels. Study quality was moderate.

  20. Preliminary questions before studying mild traumatic brain injury outcome.

    Science.gov (United States)

    Fayol, P; Carrière, H; Habonimana, D; Dumond, J-J

    2009-07-01

    To point out from the literature the issues in mild traumatic brain injury outcome. METHODOLOGY-RESULTS: The literature review allows to point out several different factors involved in the difficulty to study mild traumatic brain injury: mild traumatic brain injury definition, postconcussional syndrome definition, diagnosis threshold, severity and functional symptoms outcome, neuropsychological tests, unspecific syndrome feature, individual factors, confounding factors and treatment interventions. The mild traumatic brain injury outcome study is complicated by the definitions issues and especially their practical use and by the multiplicity and the intricate interrelationships among involved factors. The individual outcome and social cost weight is widely emphasized for an event still considered as medically trivial. The well-ordered preventive interventions necessity and the targeted treatment programs need for the persisting postconcussive symptoms complete our critical review.

  1. Study design considerations in evaluating environmental impacts

    Science.gov (United States)

    Stan T. Lebow; Paul A. Cooper; Patricia Lebow

    2006-01-01

    The purpose of this chapter is to make the reader aware of how choices in study parameters may influence the outcome of treated-wood environmental impact evaluations. Evaluation of the leaching and environmental accumulation of preservatives from treated wood is a complex process. and many factors can influence the results of such studies. In laboratory studies, the...

  2. Muon System Design Studies for Detectors at CLIC

    CERN Document Server

    van der Kraaij, E

    2011-01-01

    The two concepts for CLIC detectors inherited their design of the muon systems from the ILC community. In this note the outcome of a reevaluation of the design for the CLIC environment is presented. Based on a full detector simulation, the muon identification performance is analysed for different detector layouts and different cellsizes. As a result, nine layers are suggested for the muon systems of the CLIC ILD and CLIC SiD detectors, which are arranged in three groups of three layers. The cellsizes have been kept at 30×30 mm2. These layouts are used for the performance studies of the CLIC Conceptual Design Report (CDR).

  3. Recycler ring conceptual design study

    International Nuclear Information System (INIS)

    Jackson, G.

    1995-01-01

    The Tevatron Collider provides the highest center of mass energy collisions in the world. To fully exploit this unique tool, Fermilab is committed to a program of accelerator upgrades for the purpose of increasing the Collider luminosity. Over the past 7 years the luminosity has been increased from a peak of 1.6x10 30 cm -2 sec -1 in 1989 to over 3x10 31 cm -2 sec -1 during 1995. The Main Injector will supply a larger flux of protons for antiproton production and more intense proton bunches for use in the Collider, and this is expected to increase the peak luminosity to close to 1x10 32 cm -2 sec -1 . Further increases in luminosity will require additional upgrades to the Fermilab accelerator complex. This report documents the design of a new fixed-energy storage ring to be placed in the Main Injector tunnel which will provide an initial factor of 2 increase to 2x10 32 cm -2 sec -1 , and ultimately provide the basis for an additional order of magnitude luminosity increase up to 1x10 33 cm -2 sec -1

  4. Vehicle systems design optimization study

    Energy Technology Data Exchange (ETDEWEB)

    Gilmour, J. L.

    1980-04-01

    The optimization of an electric vehicle layout requires a weight distribution in the range of 53/47 to 62/38 in order to assure dynamic handling characteristics comparable to current production internal combustion engine vehicles. It is possible to achieve this goal and also provide passenger and cargo space comparable to a selected current production sub-compact car either in a unique new design or by utilizing the production vehicle as a base. Necessary modification of the base vehicle can be accomplished without major modification of the structure or running gear. As long as batteries are as heavy and require as much space as they currently do, they must be divided into two packages - one at front under the hood and a second at the rear under the cargo area - in order to achieve the desired weight distribution. The weight distribution criteria requires the placement of batteries at the front of the vehicle even when the central tunnel is used for the location of some batteries. The optimum layout has a front motor and front wheel drive. This configuration provides the optimum vehicle dynamic handling characteristics and the maximum passsenger and cargo space for a given size vehicle.

  5. Service Design Outcomes in Finnish Book Industry : From Transition to Transformation

    OpenAIRE

    Nousiainen, Anu K.

    2013-01-01

    Service Design Outcomes in Finnish Book Industry - From Transition to Transformation Book industry is in transition especially due to technology advancements, converging operational environment and evolving consumer values and practices in the digital context. Simultaneously, the post-industrial paradigm shift from products to services, systems and experiences highlights the intangibles-driven economy, where existing value chain members need to find new directions and new business oppo...

  6. [Clinical skills and outcomes of chair-side computer aided design and computer aided manufacture system].

    Science.gov (United States)

    Yu, Q

    2018-04-09

    Computer aided design and computer aided manufacture (CAD/CAM) technology is a kind of oral digital system which is applied to clinical diagnosis and treatment. It overturns the traditional pattern, and provides a solution to restore defect tooth quickly and efficiently. In this paper we mainly discuss the clinical skills of chair-side CAD/CAM system, including tooth preparation, digital impression, the three-dimensional design of prosthesis, numerical control machining, clinical bonding and so on, and review the outcomes of several common kinds of materials at the same time.

  7. Spiral 2: preliminary design study

    International Nuclear Information System (INIS)

    2001-11-01

    The scientific council of GANIL asked to perform a comparative study on the production methods based on gamma induced fission and rapid-neutron induced fission concerning the nature and the intensity of the neutron-rich products. The production rate expected should be around 10 13 fissions per second. The study should include the implantation and the costs of the concerned accelerators. The scientific committee recommended also to study the possibility to re-inject the radioactive beams of SPIRAL-II in the cyclotrons available at GANIL in order to give access to an energy range from 1.7 to 100 MeV/nucleon. For that purpose, some study groups have been formed to evaluate the possibility of such a project in the different components: physics case, target-ion sources, drivers, post-acceleration and general infrastructure. The organization of the project study is given at the end of this report. The following report presents an overview of the study. Particularly the total costs have been assessed according to 3 options for the driver: 38.0*10 6 euros for a 40 MeV deuteron linac, 18.7*10 6 euros for a 45 MeV electron linac, and 29.1*10 6 euros for a 80 MeV deuteron cyclotron

  8. Spiral 2: preliminary design study

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-11-15

    The scientific council of GANIL asked to perform a comparative study on the production methods based on gamma induced fission and rapid-neutron induced fission concerning the nature and the intensity of the neutron-rich products. The production rate expected should be around 10{sup 13} fissions per second. The study should include the implantation and the costs of the concerned accelerators. The scientific committee recommended also to study the possibility to re-inject the radioactive beams of SPIRAL-II in the cyclotrons available at GANIL in order to give access to an energy range from 1.7 to 100 MeV/nucleon. For that purpose, some study groups have been formed to evaluate the possibility of such a project in the different components: physics case, target-ion sources, drivers, post-acceleration and general infrastructure. The organization of the project study is given at the end of this report. The following report presents an overview of the study. Particularly the total costs have been assessed according to 3 options for the driver: 38.0*10{sup 6} euros for a 40 MeV deuteron linac, 18.7*10{sup 6} euros for a 45 MeV electron linac, and 29.1*10{sup 6} euros for a 80 MeV deuteron cyclotron.

  9. Group interventions to improve health outcomes: a framework for their design and delivery

    Directory of Open Access Journals (Sweden)

    Avenell Alison

    2010-12-01

    Full Text Available Abstract Background Delivering an intervention to a group of patients to improve health outcomes is increasingly popular in public health and primary care, yet "group" is an umbrella term which encompasses a complex range of aims, theories, implementation processes and evaluation methods. We propose a framework for the design and process evaluation of health improvement interventions occurring in a group setting, which will assist practitioners, researchers and policy makers. Methods We reviewed the wider literature on health improvement interventions delivered to patient groups and identified a gap in the literature for designing, evaluating and reporting these interventions. We drew on our experiences conducting systematic reviews, intervention, mixed method and ethnographic studies of groups for breastfeeding and weight management. A framework for health improvement group design and delivery evolved through an iterative process of primary research, reference to the literature and research team discussion. Results Although there is an extensive literature on group processes in education, work, politics and psychological therapies, far less is known about groups where the aim is health improvement. Theories of behaviour change which are validated for individual use are often assumed to be generalisable to group settings, without being rigorously tested. Health improvement or behaviour change interventions delivered in a group setting are complex adaptive social processes with interactions between the group leader, participants, and the wider community and environment. Ecological models of health improvement, which embrace the complex relationship between behaviour, systems and the environment may be more relevant than an individual approach to behaviour change. Conclusion The evidence for effectiveness and cost-effectiveness of group compared with one-to-one interventions for many areas of health improvement in public health and primary care is

  10. Adult asthma disease management: an analysis of studies, approaches, outcomes, and methods.

    Science.gov (United States)

    Maciejewski, Matthew L; Chen, Shih-Yin; Au, David H

    2009-07-01

    Disease management has been implemented for patients with asthma in various ways. We describe the approaches to and components of adult asthma disease-management interventions, examine the outcomes evaluated, and assess the quality of published studies. We searched the MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane databases for studies published in 1986 through 2008, on adult asthma management. With the studies that met our inclusion criteria, we examined the clinical, process, medication, economic, and patient-reported outcomes reported, and the study designs, provider collaboration during the studies, and statistical methods. Twenty-nine articles describing 27 studies satisfied our inclusion criteria. There was great variation in the content, extent of collaboration between physician and non-physician providers responsible for intervention delivery, and outcomes examined across the 27 studies. Because of limitations in the design of 22 of the 27 studies, the differences in outcomes assessed, and the lack of rigorous statistical adjustment, we could not draw definitive conclusions about the effectiveness or cost-effectiveness of the asthma disease-management programs or which approach was most effective. Few well-designed studies with rigorous evaluations have been conducted to evaluate disease-management interventions for adults with asthma. Current evidence is insufficient to recommend any particular intervention.

  11. Comparison of patellofemoral outcomes after TKA using two prostheses with different patellofemoral design features.

    Science.gov (United States)

    Bae, Dae Kyung; Baek, Jong Hun; Yoon, Kyung Tack; Son, Hyuck Sung; Song, Sang Jun

    2017-12-01

    The purpose of the present study was to compare the clinical and radiographic results after TKA using two prostheses with different sagittal patellofemoral design features, including outcomes related to compatibility of the patellofemoral joint. The clinical and radiographic results of 81 patients (100 knees) who underwent TKA using the specific prosthesis (group A) were compared with those in a control group who underwent TKA using the other prosthesis (group B). The presence of anterior knee joint pain, patellar crepitation, and patellar clunk syndrome was also checked. The function score and maximum flexion angle at the last follow-up were slightly better in group A than those in group B (92.0 ± 2.3 vs. 90.6 ± 4.2) (133.6° ± 8.4° vs. 129.6° ± 11.4°). Anterior knee pain was observed in 6 knees and patellar crepitation in four knees in group A. In group B, these symptoms were observed in 22 knees and 18 knees, respectively. There was no patellar clunk syndrome in either group. The alignment was corrected with satisfactory positioning of components. The patellar height remained unchanged after TKA in the two groups. The differences between preoperative and postoperative patellar tilt angle and patellar translation were small. When comparing the clinical and radiographic results after TKA using two prostheses with different sagittal patellofemoral design features, TKA using the specific prosthesis provided satisfactory results with less clinical symptoms related to the patellofemoral kinematics with TKA using the other prosthesis. III.

  12. Cementless Hip Arthroplasty in Southern Iran, Midterm Outcome and Comparison of Two Designs

    Directory of Open Access Journals (Sweden)

    Gholam Hossein Shahcheraghi

    2015-09-01

    Full Text Available Background: Cementless hip prosthesis was designed to provide biologic fixation, without the use of cement. The second generation components have shown more reliable bone ingrowths and survival rates. We are reporting a midterm result of two designs of cementless prosthesis in a unique culture with different social habits and expectations. Methods: 52 primary cementless total hip arthroplasty in 42 patients with the mean age of 48.8 years were retrospectively studied. Two groups of prosthesis had been implanted: Harris-Galante II (HGII in 15 and Versys-Trilogy (V-T in 37 hips, both from Zimmer company. The patients were assessed clinically, radiographically and with Harris hip score, SF36, WOMAC, and MACTAR questionnaires, with 65 months (26-136 mean follow-up. Results: All the V-T prostheses had survived well. Eight of HG II were revised by the last follow-up in 19-102 months. All had undergone acetabular revision and 2 combined with femoral revision. Broken tines of HGII cups were seen in 4 radiographs. The 65 months overall survival was 96.2% for femoral and 84.6% for acetabular components. 90% had good or excellent Harris hip scores. The functional scores were poorer in the HG II group. Pain relief and improved walking were the two main patients’ expectations fulfilled in 97.6% and 92.8%, respectively. Conclusions: The outcome of cementless total hip arthroplasty (THA is satisfactory and comparable with the literature based on the results of function and survival of this small comparative group. The use of HGII acetabular component should be abandoned.

  13. Factors that influence outcomes in cochlear implantation in adults, based on patient related characteristics - a retrospective study

    NARCIS (Netherlands)

    Kraaijenga, Véronique J C; Smit, Adriana L; Stegeman, Inge; Smilde, Jeanet J M; van Zanten, G A; Grolman, Wilko

    2016-01-01

    OBJECTIVE: Outcomes in speech perception following cochlear implantation in adults vary widely. Many studies have been carried out to identify and quantify factors that influence outcomes. This paper adds a new dimension to pre-existing literature. DESIGN: Single center retrospective cohort study.

  14. The Impact of Instructional Design on College Students' Cognitive Load and Learning Outcomes in a Large Food Science and Human Nutrition Course

    Science.gov (United States)

    Andrade, Jeanette; Huang, Wen-Hao David; Bohn, Dawn M.

    2015-01-01

    The effective design of course materials is critical for student learning, especially for large lecture introductory courses. This quantitative study was designed to explore the effect multimedia and content difficulty has on students' cognitive load and learning outcomes. College students (n = 268) were randomized into 1 of 3 multimedia groups:…

  15. TLEP design study forges ahead

    CERN Multimedia

    Alain Blondel & Mike Koratzinos

    2013-01-01

    As the Future Circular Collider (FCC) study is launched, one of its component parts, TLEP, enjoys a successful workshop at CERN. The FCC study looks at all options for a future circular collider with the emphasis on a hadron machine with TLEP as a possible intermediate step.   The poster of the sixth TLEP workshop that took place at CERN. Japanese artist Kazuya Akimoto kindly agreed to the use of one of his works as the basis for the poster’s backdrop. October 16 to 18 saw a three-day workshop on TLEP, the sixth in the series. The workshop took place at CERN and was well attended, informative and stimulating. To name just one of the influential people present, Herwig Schopper, ex-Director General of CERN and instrumental in the approval, construction and success of LEP, was among the participants. But what exactly is TLEP? The name was, somehow serendipitously, coined from future lepton collider option studies and stands for triple-LEP, a machine three times the size of LEP. But th...

  16. Impact of Molecular Diagnostics for Tuberculosis on Patient-Important Outcomes: A Systematic Review of Study Methodologies.

    Directory of Open Access Journals (Sweden)

    Samuel G Schumacher

    Full Text Available Several reviews on the accuracy of Tuberculosis (TB Nucleic Acid Amplification Tests (NAATs have been performed but the evidence on their impact on patient-important outcomes has not been systematically reviewed. Given the recent increase in research evaluating such outcomes and the growing list of TB NAATs that will reach the market over the coming years, there is a need to bring together the existing evidence on impact, rather than accuracy. We aimed to assess the approaches that have been employed to measure the impact of TB NAATs on patient-important outcomes in adults with possible pulmonary TB and/or drug-resistant TB.We first develop a conceptual framework to clarify through which mechanisms the improved technical performance of a novel TB test may lead to improved patient outcomes and outline which designs may be used to measure them. We then systematically review the literature on studies attempting to assess the impact of molecular TB diagnostics on such outcomes and provide a narrative synthesis of designs used, outcomes assessed and risk of bias across different study designs.We found 25 eligible studies that assessed a wide range of outcomes and utilized a variety of experimental and observational study designs. Many potentially strong design options have never been used. We found that much of the available evidence on patient-important outcomes comes from a small number of settings with particular epidemiological and operational context and that confounding, time trends and incomplete outcome data receive insufficient attention.A broader range of designs should be considered when designing studies to assess the impact of TB diagnostics on patient outcomes and more attention needs to be paid to the analysis as concerns about confounding and selection bias become relevant in addition to those on measurement that are of greatest concern in accuracy studies.

  17. Exploratory Shaft Facility design basis study report

    International Nuclear Information System (INIS)

    Langstaff, A.L.

    1987-01-01

    The Design Basis Study is a scoping/sizing study that evaluated the items concerning the Exploratory Shaft Facility Design including design basis values for water and methane inflow; flexibility of the design to support potential changes in program direction; cost and schedule impacts that could result if the design were changed to comply with gassy mine regulations; and cost, schedule, advantages and disadvantages of a larger second shaft. Recommendations are proposed concerning water and methane inflow values, facility layout, second shaft size, ventilation, and gassy mine requirements. 75 refs., 3 figs., 7 tabs

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

    Directory of Open Access Journals (Sweden)

    Walker Bruce F

    2011-10-01

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

  19. Collective design in 3D printing: A large scale empirical study of designs, designers and evolution

    DEFF Research Database (Denmark)

    Özkil, Ali Gürcan

    2017-01-01

    This paper provides an empirical study of a collective design platform (Thingiverse); with the aim of understanding the phenomenon and investigating how designs concurrently evolve through the large and complex network of designers. The case study is based on the meta-data collected from 158 489 ...

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

    Science.gov (United States)

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

    2018-05-01

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

  1. EBTS: DESIGN AND EXPERIMENTAL STUDY

    International Nuclear Information System (INIS)

    PIKIN, A.; ALESSI, J.; BEEBE, E.; KPONOU, A.; PRELEC, K.; KUZNETSOV, G.; TIUNOV, M.

    2000-01-01

    Experimental study of the BNL Electron Beam Test Stand (EBTS), which is a prototype of the Relativistic Heavy Ion Collider (RHIC) Electron Beam Ion Source (EBIS), is currently underway. The basic physics and engineering aspects of a high current EBIS implemented in EBTS are outlined and construction of its main systems is presented. Efficient transmission of a 10 A electron beam through the ion trap has been achieved. Experimental results on generation of multiply charged ions with both continuous gas and external ion injection confirm stable operation of the ion trap

  2. Comparative study of the maternal and fetal outcome of women who ...

    African Journals Online (AJOL)

    Context: Antepartum haemorrhage is a grave and potentially life threatening condition and a major cause of both maternal and fetal mortality. Objective: To compare the fetal and maternal outcome of patients with abruption placenta and placental praevia. Design/Setting/Subjects: A retrospective comparative study ...

  3. Improved quality of nursing documentation: results of a nursing diagnoses, interventions, and outcomes implementation study.

    NARCIS (Netherlands)

    Muller-Staub, M.; Needham, I.; Odenbreit, M.; Lavin, M.A.; Achterberg, T. van

    2007-01-01

    PURPOSE: To evaluate the impact of the quality of nursing diagnoses, interventions, and outcomes in an acute care hospital following the implementation of an educational program. METHOD: In a pretest-posttest experimental design study, nurses from 12 wards of a Swiss hospital received an educational

  4. Dutch surgeons' views on the volume-outcome mechanism in surgery: A qualitative interview study

    NARCIS (Netherlands)

    Mesman, R.; Faber, M.J.; Westert, G.P.; Berden, H.

    2017-01-01

    Objective: To contribute to a better understanding of volume-outcome relationships in surgery by exploring Dutch surgeons' views on the underlying mechanism. Design: A qualitative study based on face-to-face semi structured interviews and an inductive content analysis approach. Setting: Interviews

  5. Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: Observational study of mortality outcomes

    NARCIS (Netherlands)

    P. Sooriakumaran (Prasanna); T. Nyberg (Tommy); O. Akre (Olof); L. Haendler (Leif); I. Heus (Inge); M. Olsson (Marita); S. Carlsson (Sigrid); M.J. Roobol-Bouts (Monique); G. Steineck (Gunnar); P. Wiklund (Peter)

    2014-01-01

    textabstractObjective: To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer. Design: Observational study. Setting: Sweden, 1996-2010. Participants: 34 515 men primarily treated for prostate cancer with surgery (n=21 533) or radiotherapy (n=12 982).

  6. The association of daily physical activity and birth outcome: A population-based cohort study

    NARCIS (Netherlands)

    M.I. Both (Marieke); M.A. Overvest (Mathilde); M.F. Wildhagen (Mark); J. Golding (Jean); H.I.J. Wildschut (Hajo)

    2010-01-01

    textabstractThe potential relationship between daily physical activity and pregnancy outcome remains unclear because of the wide variation in study designs and physical activity assessment measures. We sought to prospectively quantify the potential effects of the various domains of physical activity

  7. Comparison of intra-articular injections of Hyaluronic Acid and Corticosteroid in the treatment of Osteoarthritis of the hip in comparison with intra-articular injections of Bupivacaine. Design of a prospective, randomized, controlled study with blinding of the patients and outcome assessors

    Directory of Open Access Journals (Sweden)

    Bellemans Johan

    2010-11-01

    Full Text Available Abstract Background Although intra-articular hyaluronic acid is well established as a treatment for osteoarthritis of the knee, its use in hip osteoarthritis is not based on large randomized controlled trials. There is a need for more rigorously designed studies on hip osteoarthritis treatment as this subject is still very much under debate. Methods/Design Randomized, controlled trial with a three-armed, parallel-group design. Approximately 315 patients complying with the inclusion and exclusion criteria will be randomized into one of the following treatment groups: infiltration of the hip joint with hyaluronic acid, with a corticosteroid or with 0.125% bupivacaine. The following outcome measure instruments will be assessed at baseline, i.e. before the intra-articular injection of one of the study products, and then again at six weeks, 3 and 6 months after the initial injection: Pain (100 mm VAS, Harris Hip Score and HOOS, patient assessment of their clinical status (worse, stable or better then at the time of enrollment and intake of pain rescue medication (number per week. In addition patients will be asked if they have complications/adverse events. The six-month follow-up period for all patients will begin on the date the first injection is administered. Discussion This randomized, controlled, three-arm study will hopefully provide robust information on two of the intra-articular treatments used in hip osteoarthritis, in comparison to bupivacaine. Trial registration NCT01079455

  8. Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia : Dutch nationwide retrospective cohort study

    NARCIS (Netherlands)

    Kieboom, J. K.; Verkade, H. J.; Burgerhof, J. G.; Bierens, J. J.; van Rheenen, P. F.; Kneyber, M. C.; Albers, M. J.

    2015-01-01

    OBJECTIVES To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation. DESIGN Nationwide retrospective cohort study.

  9. CONSIDER - Core Outcome Set in IAD Research: study protocol for establishing a core set of outcomes and measurements in incontinence-associated dermatitis research.

    Science.gov (United States)

    Van den Bussche, Karen; De Meyer, Dorien; Van Damme, Nele; Kottner, Jan; Beeckman, Dimitri

    2017-10-01

    This study protocol describes the methodology for the development of a core set of outcomes and a core set of measurements for incontinence-associated dermatitis. Incontinence is a widespread disorder with an important impact on quality of life. One of the most common complications is incontinence-associated dermatitis, resulting from chemical and physical irritation of the skin barrier, triggering inflammation and skin damage. Managing incontinence-associated dermatitis is an important challenge for nurses. Several interventions have been assessed in clinical trials, but heterogeneity in study outcomes complicates the comparability and standardization. To overcome this challenge, the development of a core outcome set, a minimum set of outcomes and measurements to be assessed in clinical research, is needed. A project team, International Steering Committee and panelists will be involved to guide the development of the core outcome set. The framework of the Harmonizing Outcomes Measures for Eczema roadmap endorsed by Cochrane Skin Group Core Outcomes Set Initiative, is used to inform the project design. A systematic literature review, interviews to integrate the patients' perspective and a consensus study with healthcare researchers and providers using the Delphi procedure will be performed. The project was approved by the Ethics review Committee (April 2016). This is the first project that will identify a core outcome set of outcomes and measurements for incontinence-associated dermatitis research. A core outcome set will reduce possible reporting bias, allow results comparisons and statistical pooling across trials and strengthen evidence-based practice and decision-making. This project has been registered in the Core Outcome Measures in Effectiveness Trials (COMET) database and is part of the Cochrane Skin Group Core Outcomes Set Initiative (CSG-COUSIN). © 2016 John Wiley & Sons Ltd.

  10. Testing the association between psychosocial job strain and adverse birth outcomes--design and methods

    DEFF Research Database (Denmark)

    Larsen, Ann D; Hannerz, Harald; Obel, Carsten

    2011-01-01

    A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated with the r......A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated...... with the risk of giving birth to a child born preterm or small for gestational age....

  11. Mobile Variable Depth Sampling System Design Study

    International Nuclear Information System (INIS)

    BOGER, R.M.

    2000-01-01

    A design study is presented for a mobile, variable depth sampling system (MVDSS) that will support the treatment and immobilization of Hanford LAW and HLW. The sampler can be deployed in a 4-inch tank riser and has a design that is based on requirements identified in the Level 2 Specification (latest revision). The waste feed sequence for the MVDSS is based on Phase 1, Case 3S6 waste feed sequence. Technical information is also presented that supports the design study

  12. Mobile Variable Depth Sampling System Design Study

    Energy Technology Data Exchange (ETDEWEB)

    BOGER, R.M.

    2000-08-25

    A design study is presented for a mobile, variable depth sampling system (MVDSS) that will support the treatment and immobilization of Hanford LAW and HLW. The sampler can be deployed in a 4-inch tank riser and has a design that is based on requirements identified in the Level 2 Specification (latest revision). The waste feed sequence for the MVDSS is based on Phase 1, Case 3S6 waste feed sequence. Technical information is also presented that supports the design study.

  13. A longitudinal study of maternal attachment and infant developmental outcomes.

    Science.gov (United States)

    Alhusen, Jeanne L; Hayat, Matthew J; Gross, Deborah

    2013-12-01

    Extant research has demonstrated that compared to adults with insecure attachment styles, more securely attached parents tend to be more responsive, sensitive, and involved parents, resulting in improved outcomes for their children. Less studied is the influence of a mother's attachment style on her attachment to her unborn child during pregnancy and the consequent developmental outcomes of the child during early childhood. Thus, the aim of this prospective longitudinal study was to examine the relationship between maternal-fetal attachment (MFA) during pregnancy and infant and toddler outcomes and the role of mothers' attachment style on early childhood developmental outcomes in an economically disadvantaged sample of women and their children. Gamma regression modeling demonstrated that an avoidant maternal attachment style (b = .98, 95 % CI [.97, .98], p attachment styles and greater depressive symptomatology were more likely to have children demonstrating early childhood developmental delays than those women with less avoidant attachment styles and less depressive symptomatology. Furthermore, women reporting higher MFA during pregnancy had more secure attachment styles, and their children had more optimal early childhood development than those women reporting lower MFA and less secure attachment styles. Findings have implications for enhancing early intervention programs aimed at improving maternal and childhood outcomes. An earlier identification of disruptions in attachment may be beneficial in tailoring interventions focused on the mother-child dyad.

  14. WWC Study Review Guide: Group Design Studies

    Science.gov (United States)

    What Works Clearinghouse, 2018

    2018-01-01

    Underlying all What Works Clearinghouse (WWC) products are WWC Study Review Guides, which are intended for use by WWC certified reviewers to assess studies against the WWC evidence standards. As part of an ongoing effort to increase transparency, promote collaboration, and encourage widespread use of the WWC standards, the Institute of Education…

  15. Information and Communication Technology: Design, Delivery, and Outcomes from a Nursing Informatics Boot Camp

    Science.gov (United States)

    Kleib, Manal; Simpson, Nicole; Rhodes, Beverly

    2016-05-31

    Information and communication technology (ICT) is integral in today’s healthcare as a critical piece of support to both track and improve patient and organizational outcomes. Facilitating nurses’ informatics competency development through continuing education is paramount to enhance their readiness to practice safely and accurately in technologically enabled work environments. In this article, we briefly describe progress in nursing informatics (NI) and share a project exemplar that describes our experience in the design, implementation, and evaluation of a NI educational event, a one-day boot camp format that was used to provide foundational knowledge in NI targeted primarily at frontline nurses in Alberta, Canada. We also discuss the project outcomes, including lessons learned and future implications. Overall, the boot camp was successful to raise nurses’ awareness about the importance of informatics in nursing practice.

  16. Social-Ecological Correlates in Adult Autism Outcome Studies: A Scoping Review.

    Science.gov (United States)

    Anderson, Kristy A; Roux, Anne M; Kuo, Alice; Shattuck, Paul T

    2018-04-01

    The transition into adulthood is a critical period in the life course that shapes later outcomes. Many adults on the autism spectrum fare poorly across a wide range of quality of life indicators. Understanding the multilevel factors that influence transition outcomes is necessary to develop strategies that promote better outcomes. In this scoping review, we characterize the use of social-ecological factors in adult autism outcome studies, identify understudied areas of research, and provide recommendations for future research. We conducted a literature search for studies in which the relationship between social-ecological factors and transition outcomes among transition-age youth with autism was assessed. We organized variables used in studies across 5 levels of influence: family-, interpersonal-, institutional-, community-, and policy-level factors. Our findings reveal that both breadth and depth of social-ecological factors usage in autism outcomes studies is limited because of the narrow inclusion of variables across social-ecological levels, the overreliance on a limited number of national data sets, and the overall lack of variation in research design. We propose 9 recommendations to inform the development of multilevel studies. Copyright © 2018 by the American Academy of Pediatrics.

  17. Clinical Outcomes Used in Clinical Pharmacy Intervention Studies in Secondary Care

    Directory of Open Access Journals (Sweden)

    Lene Juel Kjeldsen

    2017-05-01

    Full Text Available The objective was to investigate type, frequency and result of clinical outcomes used in studies to assess the effect of clinical pharmacy interventions in inpatient care. The literature search using Pubmed.gov was performed for the period up to 2013 using the search phrases: “Intervention(s” and “pharmacist(s” and “controlled” and “outcome(s” or “effect(s”. Primary research studies in English of controlled, clinical pharmacy intervention studies, including outcome evaluation, were selected. Titles, abstracts and full-text papers were assessed individually by two reviewers, and inclusion was determined by consensus. In total, 37 publications were included in the review. The publications presented similar intervention elements but differed in study design. A large variety of outcome measures (135 had been used to evaluate the effect of the interventions; most frequently clinical measures/assessments by physician and health care service use. No apparent pattern was established among primary outcome measures with significant effect in favour of the intervention, but positive effect was most frequently related to studies that included power calculations and sufficient inclusion of patients (73% vs. 25%. This review emphasizes the importance of considering the relevance of outcomes selected to assess clinical pharmacy interventions and the importance of conducting a proper power calculation.

  18. Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes.

    Science.gov (United States)

    Cunningham, Shayna D; Lewis, Jessica B; Thomas, Jordan L; Grilo, Stephanie A; Ickovics, Jeannette R

    2017-05-18

    Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally. Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses. By bundling prevention and care services into a high-touch, high-tech group prenatal care model

  19. Using perinatal morbidity scoring tools as a primary study outcome.

    Science.gov (United States)

    Hutcheon, Jennifer A; Bodnar, Lisa M; Platt, Robert W

    2017-11-01

    Perinatal morbidity scores are tools that score or weight different adverse events according to their relative severity. Perinatal morbidity scores are appealing for maternal-infant health researchers because they provide a way to capture a broad range of adverse events to mother and newborn while recognising that some events are considered more serious than others. However, they have proved difficult to implement as a primary outcome in applied research studies because of challenges in testing if the scores are significantly different between two or more study groups. We outline these challenges and describe a solution, based on Poisson regression, that allows differences in perinatal morbidity scores to be formally evaluated. The approach is illustrated using an existing maternal-neonatal scoring tool, the Adverse Outcome Index, to evaluate the safety of labour and delivery before and after the closure of obstetrical services in small rural communities. Applying the proposed Poisson regression to the case study showed a protective risk ratio for adverse outcome following closures as compared with the original analysis, where no difference was found. This approach opens the door for considerably broader use of perinatal morbidity scoring tools as a primary outcome in applied population and clinical maternal-infant health research studies. © 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.

  20. Predictors of lifestyle intervention outcome and dropout: the SLIM study

    NARCIS (Netherlands)

    Roumen, C.; Feskens, E.J.M.; Corpeleijn, E.; Mensink, M.R.; Saris, W.H.M.; Blaak, E.E.

    2011-01-01

    Original Article European Journal of Clinical Nutrition (2011) 65, 1141–1147; doi:10.1038/ejcn.2011.74; published online 18 May 2011 Predictors of lifestyle intervention outcome and dropout: the SLIM study C Roumen1, E J M Feskens2, E Corpeleijn1, M Mensink2, W H M Saris1 and E E Blaak1 1Department

  1. Outcome evaluation of a pilot study using "nudges"

    Science.gov (United States)

    Every school day, over 31 million U.S. children eat school lunches. Unfortunately, students often do not choose the healthy options in the school cafeteria. This paper describes outcome results of a pilot study using "nudges" to improve elementary school students' fruits and vegetables selections. A...

  2. Some design aspects of transuranic field studies

    International Nuclear Information System (INIS)

    Gilbert, R.O.; Eberhardt, L.L.

    1977-01-01

    In this paper, we discuss some design aspects of transuranic field studies. Some of the principal steps in the design of such studies are given and illustrated using examples. This is followed by a review of sampling designs that have been used at nuclear detonation and safety-shot sites on the Nevada Test Site and elsewhere for estimating spatial pattern and total amounts in soil. Some design aspects of ecosystem-type transuranic studies for estimating total amounts as well as movement of transuranics between ecosystem components are also discussed. Acceptance sampling using either attributes or measurements is considered as a possible approach for deciding whether to clean up a contaminated site. Three general guidelines for the design of efficient transuranic studies are presented

  3. MANAGEMENT AND OUTCOMES FROM APPENDECTOMY: AN INTERNATIONAL, PROSPECTIVE, MULTICENTRE STUDY.

    Science.gov (United States)

    Camilleri-Brennan, J; Drake, T; Spence, R; Bhangu, A; Harrison, E

    2017-09-01

    To identify variation in surgical management and outcomes of appendicitis across low, middle and high Human Development Index (HDI) country groups. Multi-centre, international prospective cohort study of consecutive patients undergoing emergency appendectomy over a 6-month period. Follow-up lasted 30 days. Primary outcome measure was overall complication rate. 4546 patients from 52 countries underwent appendectomy (2499 high, 1540 middle and 507 low HDI groups). Complications were more frequent in low-HDI (OR 3.81, 95% CI 2.78 to 5.19, p accounting for case-mix, laparoscopy was still associated with fewer complications (OR 0.55, 95% CI 0.42 to 0.71, pintroduction of laparoscopy that if overcome, could result in significantly improved outcomes for patients in low-resource environments, with potential for wider health-system benefits.

  4. ACSYNT inner loop flight control design study

    Science.gov (United States)

    Bortins, Richard; Sorensen, John A.

    1993-01-01

    The NASA Ames Research Center developed the Aircraft Synthesis (ACSYNT) computer program to synthesize conceptual future aircraft designs and to evaluate critical performance metrics early in the design process before significant resources are committed and cost decisions made. ACSYNT uses steady-state performance metrics, such as aircraft range, payload, and fuel consumption, and static performance metrics, such as the control authority required for the takeoff rotation and for landing with an engine out, to evaluate conceptual aircraft designs. It can also optimize designs with respect to selected criteria and constraints. Many modern aircraft have stability provided by the flight control system rather than by the airframe. This may allow the aircraft designer to increase combat agility, or decrease trim drag, for increased range and payload. This strategy requires concurrent design of the airframe and the flight control system, making trade-offs of performance and dynamics during the earliest stages of design. ACSYNT presently lacks means to implement flight control system designs but research is being done to add methods for predicting rotational degrees of freedom and control effector performance. A software module to compute and analyze the dynamics of the aircraft and to compute feedback gains and analyze closed loop dynamics is required. The data gained from these analyses can then be fed back to the aircraft design process so that the effects of the flight control system and the airframe on aircraft performance can be included as design metrics. This report presents results of a feasibility study and the initial design work to add an inner loop flight control system (ILFCS) design capability to the stability and control module in ACSYNT. The overall objective is to provide a capability for concurrent design of the aircraft and its flight control system, and enable concept designers to improve performance by exploiting the interrelationships between

  5. Thrombocytopenia during Pregnancy and Its Outcome – A Prospective Study

    Directory of Open Access Journals (Sweden)

    Pallavi Satish Vishwekar

    2017-01-01

    Full Text Available Background: Thrombocytopenia is second to anemia as the most common hematological abnormality during pregnancy. Accurate etiological diagnosis is essential for optimal therapeutic management and thus can prevent maternal and fetal morbidity and mortality. Aims and Objectives: To determine various etiologies of maternal thrombocytopenia, their complications and fetomaternal outcome compared with normal pregnancy. Material and Methods: A prospective study was carried out in tertiary hospital, 1460 pregnant women who attended the Antenatal clinic regularly were enrolled. All were screened for thrombocytopenia in third trimester (after 28 weeks, women with normal platelet (n=1350 were taken in control group and those with low counts less than 150 x109/L (n=130 were included in study group. Etiology and fetomaternal outcome of thrombocytopenia in third trimester of pregnancy were evaluated and compared. Results: Gestational thrombocytopenia was the commonest etiology (68.46%. Incidence of thrombocytopenia due to severe preeclampsia and Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP syndrome in study group was 18.46% and 7.69% of them had medical cause like malarial or dengue fever. Major causes were Gestational Thrombocytopenia (GT, Idiopathic Thrombocytopenic Purpura (ITP, preeclampsia, HELLP syndrome, malaria, and dengue. Maternal complications due to bleeding tendencies like placental abruption, postpartum hemorrhage were evident in the study population. Fetal complications were significantly higher in study group. Early neonatal thrombocytopenia depended on etiology rather than severity of maternal thrombocytopenia. Conclusions: Outcome of pregnancy with moderate to severe thrombocytopenia depends mainly on the etiology of thrombocytopenia. Adverse outcomes are especially seen with pregnancy complicated by preeclampsia and HELLP syndrome. Fetomaternal outcome is favorable in gestational thrombocytopenia. Thus accurate etiological

  6. Mirror Advanced Reactor Study interim design report

    Energy Technology Data Exchange (ETDEWEB)

    1983-04-01

    The status of the design of a tenth-of-a-kind commercial tandem-mirror fusion reactor is described at the midpoint of a two-year study. When completed, the design is to serve as a strategic goal for the mirror fusion program. The main objectives of the Mirror Advanced Reactor Study (MARS) are: (1) to design an attractive tandem-mirror fusion reactor producing electricity and synfuels (in alternate versions), (2) to identify key development and technology needs, and (3) to exploit the potential of fusion for safety, low activation, and simple disposal of radioactive waste. In the first year we have emphasized physics and engineering of the central cell and physics of the end cell. Design optimization and trade studies are continuing, and we expect additional modifications in the end cells to further improve the performance of the final design.

  7. Cryostat design case studies, principles and engineering

    CERN Document Server

    2016-01-01

    This book enables the reader to learn the fundamental and applied aspects of practical cryostat design by examining previous design choices and resulting cryostat performance. Through a series of extended case studies the book presents an overview of existing cryostat design covering a wide range of cryostat types and applications, including the magnet cryostats that comprise the majority of the Large Hadron Collider at CERN, space-borne cryostats containing sensors operating below 1 K, and large cryogenic liquid storage vessels. It starts with an introductory section on the principles of cryostat design including practical data and equations. This section is followed by a series of case studies on existing cryostats, describing the specific requirements of the cryostat, the challenges involved and the design choices made along with the resulting performance of the cryostat. The cryostat examples used in the studies are chosen to cover a broad range of cryostat applications and the authors of each case are ...

  8. Mirror Advanced Reactor Study interim design report

    International Nuclear Information System (INIS)

    1983-04-01

    The status of the design of a tenth-of-a-kind commercial tandem-mirror fusion reactor is described at the midpoint of a two-year study. When completed, the design is to serve as a strategic goal for the mirror fusion program. The main objectives of the Mirror Advanced Reactor Study (MARS) are: (1) to design an attractive tandem-mirror fusion reactor producing electricity and synfuels (in alternate versions), (2) to identify key development and technology needs, and (3) to exploit the potential of fusion for safety, low activation, and simple disposal of radioactive waste. In the first year we have emphasized physics and engineering of the central cell and physics of the end cell. Design optimization and trade studies are continuing, and we expect additional modifications in the end cells to further improve the performance of the final design

  9. FED/INTOR reactor design studies

    International Nuclear Information System (INIS)

    Brown, T.G.; Cramer, B.A.; Davisson, J.P.; Kunselman, M.H.; Reiersen, W.T.; Sager, P.H.; Strickler, D.J.

    1982-03-01

    Upon completing the design studies identified in this report, an overall assessment of the design options is made that will form the bases to define the configuration of the next major Tokamak device. The TF coil size will be defined, along with the vacuum boundary, the PF coil arrangement, and the torus configuration. After the configuration is established, an overall performance and cost re-assessment should be made to finally trade off device performance with machine capital and operating costs to establish a reactor design point for a given set of design requirements

  10. Nuclear-Powered GPS Spacecraft Design Study

    Energy Technology Data Exchange (ETDEWEB)

    Raab, Bernard

    1977-05-01

    This is the final report of a study to investigate the potential benefits of a nuclear (radioisotope) - powered satellite for advanced phases of the Global Positioning System (GPS) program. The critical parameters were: power to user; mean mission duration; orbital predictability; thermal control of on-board frequency standards; and vulnerability. The reference design approach is described, and input data are given for two power systems that are under development: an organic Rankine system and a Brayton cycle system. Reference design details are provided and structural design and analysis are discussed, as well as thermal design and analysis. A higher altitude version is also considered.

  11. Flight Path Recovery System (FPRS) design study

    Energy Technology Data Exchange (ETDEWEB)

    1978-09-01

    The study contained herein presents a design for a Flight Path Recovery System (FPPS) for use in the NURE Program which will be more accurate than systems presently used, provide position location data in digital form suitable for automatic data processing, and provide for flight path recovery in a more economic and operationally suitable manner. The design is based upon the use of presently available hardware and technoloy, and presents little, it any, development risk. In addition, a Flight Test Plan designed to test the FPRS design concept is presented.

  12. Flight Path Recovery System (FPRS) design study

    International Nuclear Information System (INIS)

    1978-09-01

    The study contained herein presents a design for a Flight Path Recovery System (FPPS) for use in the NURE Program which will be more accurate than systems presently used, provide position location data in digital form suitable for automatic data processing, and provide for flight path recovery in a more economic and operationally suitable manner. The design is based upon the use of presently available hardware and technoloy, and presents little, it any, development risk. In addition, a Flight Test Plan designed to test the FPRS design concept is presented

  13. Outcomes of Orphanhood in Ethiopia: A Mixed Methods Study

    OpenAIRE

    Camfield, Laura

    2011-01-01

    The paper addresses the question of whether parental death always has a strongly negative effect on children’s outcomes using quantitative and qualitative data from Young Lives, a longitudinal study of childhood poverty in Ethiopia. It investigates the validity of potential mediating factors identified by other studies in Sub-Saharan Africa using data from the whole sample (n = 973) and explores these processes in-depth through the experiences of three orphans in one community in Addis Ababa....

  14. Montessori Preschool Elevates and Equalizes Child Outcomes: A Longitudinal Study.

    Science.gov (United States)

    Lillard, Angeline S; Heise, Megan J; Richey, Eve M; Tong, Xin; Hart, Alyssa; Bray, Paige M

    2017-01-01

    Quality preschool programs that develop the whole child through age-appropriate socioemotional and cognitive skill-building hold promise for significantly improving child outcomes. However, preschool programs tend to either be teacher-led and didactic, or else to lack academic content. One preschool model that involves both child-directed, freely chosen activity and academic content is Montessori. Here we report a longitudinal study that took advantage of randomized lottery-based admission to two public Montessori magnet schools in a high-poverty American city. The final sample included 141 children, 70 in Montessori and 71 in other schools, most of whom were tested 4 times over 3 years, from the first semester to the end of preschool (ages 3-6), on a variety of cognitive and socio-emotional measures. Montessori preschool elevated children's outcomes in several ways. Although not different at the first test point, over time the Montessori children fared better on measures of academic achievement, social understanding, and mastery orientation, and they also reported relatively more liking of scholastic tasks. They also scored higher on executive function when they were 4. In addition to elevating overall performance on these measures, Montessori preschool also equalized outcomes among subgroups that typically have unequal outcomes. First, the difference in academic achievement between lower income Montessori and higher income conventionally schooled children was smaller at each time point, and was not (statistically speaking) significantly different at the end of the study. Second, defying the typical finding that executive function predicts academic achievement, in Montessori classrooms children with lower executive function scored as well on academic achievement as those with higher executive function. This suggests that Montessori preschool has potential to elevate and equalize important outcomes, and a larger study of public Montessori preschools is warranted.

  15. Montessori Preschool Elevates and Equalizes Child Outcomes: A Longitudinal Study

    Directory of Open Access Journals (Sweden)

    Angeline S. Lillard

    2017-10-01

    Full Text Available Quality preschool programs that develop the whole child through age-appropriate socioemotional and cognitive skill-building hold promise for significantly improving child outcomes. However, preschool programs tend to either be teacher-led and didactic, or else to lack academic content. One preschool model that involves both child-directed, freely chosen activity and academic content is Montessori. Here we report a longitudinal study that took advantage of randomized lottery-based admission to two public Montessori magnet schools in a high-poverty American city. The final sample included 141 children, 70 in Montessori and 71 in other schools, most of whom were tested 4 times over 3 years, from the first semester to the end of preschool (ages 3–6, on a variety of cognitive and socio-emotional measures. Montessori preschool elevated children’s outcomes in several ways. Although not different at the first test point, over time the Montessori children fared better on measures of academic achievement, social understanding, and mastery orientation, and they also reported relatively more liking of scholastic tasks. They also scored higher on executive function when they were 4. In addition to elevating overall performance on these measures, Montessori preschool also equalized outcomes among subgroups that typically have unequal outcomes. First, the difference in academic achievement between lower income Montessori and higher income conventionally schooled children was smaller at each time point, and was not (statistically speaking significantly different at the end of the study. Second, defying the typical finding that executive function predicts academic achievement, in Montessori classrooms children with lower executive function scored as well on academic achievement as those with higher executive function. This suggests that Montessori preschool has potential to elevate and equalize important outcomes, and a larger study of public Montessori

  16. Demonstration of a software design and statistical analysis methodology with application to patient outcomes data sets.

    Science.gov (United States)

    Mayo, Charles; Conners, Steve; Warren, Christopher; Miller, Robert; Court, Laurence; Popple, Richard

    2013-11-01

    With emergence of clinical outcomes databases as tools utilized routinely within institutions, comes need for software tools to support automated statistical analysis of these large data sets and intrainstitutional exchange from independent federated databases to support data pooling. In this paper, the authors present a design approach and analysis methodology that addresses both issues. A software application was constructed to automate analysis of patient outcomes data using a wide range of statistical metrics, by combining use of C#.Net and R code. The accuracy and speed of the code was evaluated using benchmark data sets. The approach provides data needed to evaluate combinations of statistical measurements for ability to identify patterns of interest in the data. Through application of the tools to a benchmark data set for dose-response threshold and to SBRT lung data sets, an algorithm was developed that uses receiver operator characteristic curves to identify a threshold value and combines use of contingency tables, Fisher exact tests, Welch t-tests, and Kolmogorov-Smirnov tests to filter the large data set to identify values demonstrating dose-response. Kullback-Leibler divergences were used to provide additional confirmation. The work demonstrates the viability of the design approach and the software tool for analysis of large data sets.

  17. The Impact of Simulated Nature on Patient Outcomes: A Study of Photographic Sky Compositions.

    Science.gov (United States)

    Pati, Debajyoti; Freier, Patricia; O'Boyle, Michael; Amor, Cherif; Valipoor, Shabboo

    2016-01-01

    To examine whether incorporation of simulated nature, in the form of ceiling mounted photographic sky compositions, influences patient outcomes. Previous studies have shown that most forms of nature exposure have a positive influence on patients. However, earlier studies have mostly focused on wall-hung nature representations. The emergence of simulated nature products has raised the question regarding the effects of the new product on patient outcomes. A between-subject experimental design was adopted, where outcomes from five inpatient rooms with sky composition ceiling fixture were compared to corresponding outcomes in five identical rooms without the intervention. Data were collected from a total of 181 subjects on 11 outcomes. Independent sample tests were performed to identify differences in mean outcomes. Significant positive outcomes were observed in environmental satisfaction and diastolic blood pressure (BP). Environmental satisfaction in the experimental group was 12.4% higher than the control group. Direction of association for diastolic BP, nausea/indigestion medication, acute stress, anxiety, pain, and environmental satisfaction were consistent with a priori hypothesis. A post hoc exploratory assessment involving patients who did not self-request additional pain and sleep medication demonstrated confirmatory directions for all outcomes except Systolic BP, and statistically significant outcomes for Acute Stress and Anxiety-Acute Stress and Anxiety levels of the experimental group subjects was 53.4% and 34.79% lower, respectively, than that of the control group subjects. Salutogenic benefits of photographic sky compositions render them better than traditional ceiling tiles and offer an alternative to other nature interventions. © The Author(s) 2015.

  18. Studying Design Engineers Use Of Information Systems

    DEFF Research Database (Denmark)

    Restrepo-Giraldo, John Dairo

    2006-01-01

    Studying information usage by design engineers involves considering technical, social, cognitive and volitional factors. This makes it challenging, especially for researchers without a cognitive psychology background. This paper presents a summary of key findings in researching information use...

  19. Outcomes of a systematically designed strategy for the implementation of sex education in Dutch secondary schools

    NARCIS (Netherlands)

    Wiefferink, C.H.; Poelman, J.; Linthorst, M.; Vanwesenbeeck, I.; Wijngaarden, J.C.M. van; Paulussen, T.G.W.M.

    2005-01-01

    This study examines the effects of a systematically designed innovation strategy on teachers' implementation of a sex education curriculum and its related determinants. A quasi-experimental group design was used to assess the effectiveness of the innovation strategy. Teachers filled in

  20. Effects of study design and trends for EVAR versus OSR

    Directory of Open Access Journals (Sweden)

    Robert Hopkins

    2008-10-01

    Full Text Available Robert Hopkins1, James Bowen1, Kaitryn Campbell1, Gord Blackhouse4, Guy De Rose2,3, Teresa Novick2, Daria O’Reilly1,4, Ron Goeree1,4, Jean-Eric Tarride1,41Programs for the Assessment of Technology in Health (PATH Research Institute, Department of Clinical Epidemiology and Biostatistics; 2Division of Vascular Surgery, Department of Surgery, London Health Sciences Centre, London, Ontario, Canada; 3Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, University of Western Ontario, London, Ontario, Canada; 4Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, CanadaPurpose: To investigate if study design factors such as randomization, multi-centre versus single centre evidence, institutional surgical volume, and patient selection affect the outcomes for endovascular repair (EVAR versus open surgical repair (OSR. Finally, we investigate trends over time in EVAR versus OSR outcomes.Methods: Search strategies for comparative studies were performed individually for: OVID’s MEDLINE, EMBASE, CINAHL, HAPI, and Evidence Based Medicine (EBM Reviews (including Cochrane DSR, ACP Journal Club, DARE and CCTR, limited to 1990 and November 2006.Results: Identified literature: 84 comparative studies pertaining to 57,645 patients. These include 4 randomized controlled trials (RCTs, plus 2 RCTs with long-term follow-up. The other 78 comparative studies were nonrandomized with 75 reporting perioperative outcomes, of which 16 were multi-centre, and 59 single-centre studies. Of the single-centre studies 31 were low-volume and 28 were high-volume centres. In addition, 5 studies had all patients anatomically eligible for EVAR, and 8 studies included high-risk patients only. Finally, 25 long term observational studies reported outcomes up to 3 years.Outcomes: Lower perioperative mortality and rates of complications for EVAR versus OSR varied across study designs and patient

  1. Interactive design computation : A case study on quantum design paradigm

    NARCIS (Netherlands)

    Feng, H.

    2013-01-01

    The ever-increasing complexity of design processes fosters novel design computation models to be employed in architectural research and design in order to facilitate accurate data processing and refined decision making. These computation models have enabled designers to work with complex geometry

  2. Rhetorical Design Studies: The Art of Making Design Choices Explicit

    DEFF Research Database (Denmark)

    Halstrøm, Per L.

    2017-01-01

    Design has the potential to affect the situations we are in, the choices we make and the beliefs we live by. Being such an affective field, one might expect that canonized design thinking models and methods would be much concerned with how designers can discover arguments for their design choices...

  3. Empathic climate and learning outcomes: a study of teaching empathy in relation to mathematics learning outcomes

    OpenAIRE

    Buckley, Finian

    1993-01-01

    This study examined the influence of Empathie Teaching Climate on Mathematics Learnmg'andMathematics and General School Self-Concepts, in sateen schools in Dublin, Ireland. The study required the design development and validation of the Student-Teacher Interaction Questionnaire (STIQ), which measures specific behavioural indices of classroom Teaching Empathy. The research monitored the effects of Teaching Empathy on students (N=387) in their first year of secondary schooling, as they complete...

  4. Quality of life and visual acuity outcomes in the Registry in Glaucoma Outcomes Research study.

    Science.gov (United States)

    Coleman, Anne L; Lum, Flora C; Gliklich, Richard E; Velentgas, Priscilla; Su, Zhaohui

    2016-01-01

    The RiGOR study evaluated the association of treatment and patient-reported outcomes for open-angle glaucoma patients. The Glaucoma Symptom Scale (National Eye Institute-Visual Function Questionnaire (NEI-VFQ) and visual acuity (VA) were collected as quality of life measures. The proportion of patients with improvement of at least two lines of vision was highest in the incisional surgery group (14.2% compared with 9.9% for laser surgery and 10.9% for additional medication). No clinically relevant differences were seen in benefit for the laser surgery or incisional surgery groups compared with additional medications for the Glaucoma Symptom Scale or NEI-VFQ measures or subscales. Differences in quality of life by race need to be explored in further studies.

  5. Outcome reporting across randomised trials and observational studies evaluating treatments for Twin-Twin Transfusion Syndrome: a systematic review.

    Science.gov (United States)

    Perry, Helen; Duffy, James M N; Umadia, Ogochukwu; Khalil, Asma

    2018-04-01

    Twin-Twin Transfusion syndrome is associated with significant mortality and morbidity. Potential treatments require robust evaluation. The aim of this study was to evaluate outcome reporting across observational studies and randomised controlled trials assessing treatments for twin-twin transfusion syndrome (TTTS). Cochrane Central Register of Controlled Trials, EMBASE and Medline were searched from inception to August 2016. Observational studies and randomised controlled trials reporting outcomes following a treatment for TTTS in monochorionic-diamniotic twin pregnancies and monochorionic-triamniotic or dichorionic-triamniotic triplet pregnancies were included. We systematically extracted and categorised outcome reporting. Six randomised trials and 94 observational studies, reporting data from 20,071 maternal participants and 3,199 children, were included. Six different treatments were evaluated. Included studies reported sixty-two different outcomes, including 10 fetal, 28 neonatal, 6 early childhood and 18 maternal outcomes. The outcomes were inconsistently reported across trials. For example, when considering offspring mortality, 31 studies (31%) reported live birth, 31 studies (31%) reported intrauterine death, 49 studies (49%) reported neonatal mortality, and 17 studies (17%) reported perinatal mortality. Four studies (4%) reported respiratory distress syndrome. Only 19 (19%) of studies were designed for long-term follow-up and 11 of these studies (11%) reported cerebral palsy. Most studies evaluating treatments for TTTS, have often neglected to report clinically important outcomes, especially neonatal morbidity outcomes. Most studies are not designed for long-term follow-up. The development of a core outcome set could help standardised outcome collection and reporting in Twin-Twin Transfusion syndrome studies. This article is protected by copyright. All rights reserved.

  6. Study populations and casemix: influence on analysis of postoperative outcomes.

    Science.gov (United States)

    Isbister, W H

    2000-04-01

    The importance of patient casemix as a determinant of surgical outcome is now being recognized. The present study was undertaken in order to compare the presentation and outcomes in colorectal patients managed surgically by the same surgeon, in the same way, in different settings. Colorectal outcome data from the University Department of Surgery in Wellington and the King Faisal Specialist Hospital in Riyadh were analysed in order to determine casemix differences between the two hospitals. Data relating to the type of surgery, the surgeon, the patient's disease, the operation performed and the postoperative complications were compared. Specific colorectal clinical indicators were compared for two commonly performed operations for rectal cancer: anterior resection and abdomino-perineal resection of the rectum. Wellington patients were slightly older and there were more females. Emergency surgery was more frequent in Wellington. Left hemicolectomy, sigmoid colectomy, abscess drainage and pilonidal surgery were more common in Wellington whereas abdomino-perineal resection and anterior resection of the rectum, stoma closure, fistula surgery, seton insertion, restorative proctocolectomy and ileostomy were undertaken more frequently in Riyadh. More complex anal fistulas were managed in Riyadh. Condylomata accuminata, pilonidal abscess, anorectal abscess, rectal prolapse and diverticular disease were rarely seen in Riyadh. There were more postoperative pulmonary and cardiac complications in Wellington. Patients having anterior resection of the rectum were younger in Riyadh and there were proportionally more females. There were some obvious numerical outcome differences in postoperative atelectasis, wound infection, anastomotic leak and deep vein thrombosis rates but none of these reached statistical significance except atelectasis. In Riyadh the usual male-to-female ratio of patients undergoing abdomino-perineal resection was reversed but, again, none of the numerical

  7. Health and social determinants and outcomes of home cooking: A systematic review of observational studies.

    Science.gov (United States)

    Mills, Susanna; White, Martin; Brown, Heather; Wrieden, Wendy; Kwasnicka, Dominika; Halligan, Joel; Robalino, Shannon; Adams, Jean

    2017-04-01

    Many dietary interventions assume a positive influence of home cooking on diet, health and social outcomes, but evidence remains inconsistent. We aimed to systematically review health and social determinants and outcomes of home cooking. Given the absence of a widely accepted, established definition, we defined home cooking as the actions required for preparing hot or cold foods at home, including combining, mixing and often heating ingredients. Nineteen electronic databases were searched for relevant literature. Peer-reviewed studies in English were included if they focussed mainly on home cooking, and presented post 19 th century observational or qualitative data on participants from high/very high human development index countries. Interventional study designs, which have previously been reviewed, were excluded. Themes were summarised using narrative synthesis. From 13,341 unique records, 38 studies - primarily cross-sectional in design - met the inclusion criteria. A conceptual model was developed, mapping determinants of home cooking to layers of influence including non-modifiable, individual, community and cultural factors. Key determinants included female gender, greater time availability and employment, close personal relationships, and culture and ethnic background. Putative outcomes were mostly at an individual level and focused on potential dietary benefits. Findings show that determinants of home cooking are more complex than simply possessing cooking skills, and that potential positive associations between cooking, diet and health require further confirmation. Current evidence is limited by reliance on cross-sectional studies and authors' conceptualisation of determinants and outcomes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  8. Residential energy efficiency retrofits: How program design affects participation and outcomes

    International Nuclear Information System (INIS)

    Hoicka, Christina E.; Parker, Paul; Andrey, Jean

    2014-01-01

    Better methods of characterizing and addressing heterogeneity in preferences and decision making are needed to stimulate reductions in household greenhouse gas emissions. Four residential energy efficiency programs were delivered consecutively in the Region of Waterloo, Canada, between 1999 and 2011, and each offered a unique combination of information, financial reward structure, and price. A natural quasi-experimental intervention design was employed to assess differences in outcomes across these program structures. Participation at the initial (evaluation by an energy advisor) and follow-up (verification of retrofit) stages, and the material characteristics (e.g., energy performance) were measured and compared between the groups of houses included in each program at each stage. The programs appealed to people with different types of material concerns; each phase of the program was associated with houses with a different mix of material characteristics and depths of recommended and achieved changes. While a performance-based reward attracted fewer houses at each stage than a larger list-based reward, older houses with poorer energy performance were included at each stage. The findings support experimentation with program designs to target sub-populations of housing stock; future program designs should experiment more carefully and with larger performance-based rewards and test parallels with potential carbon market structures. - Highlights: • Multi-program data over 12 years detailing residential energy retrofits. • Natural experimental intervention research design for program evaluation. • Number and attributes of participating households differed by program design. • Financial rewards attracted more participants to the verification stage. • Performance-based incentives have the largest potential for energy savings

  9. Periodontal disease and adverse birth outcomes: a study from Pakistan.

    Science.gov (United States)

    Mobeen, N; Jehan, I; Banday, N; Moore, J; McClure, E M; Pasha, O; Wright, L L; Goldenberg, R L

    2008-05-01

    Periodontal disease may increase the risk of adverse birth outcomes; however, results have been mixed. Few studies have examined periodontal disease in developing countries. We describe the relationship between periodontal disease and birth outcomes in a community setting in Pakistan. This was a prospective cohort study. Enrollment occurred at 20-26 weeks of gestation. A study dentist performed the periodontal examination to assess probing depth, clinical attachment level, gingival index, and plaque index. Outcomes included stillbirth, neonatal death, perinatal death, increasing periodontal disease severity by quartiles. Dental examinations and outcome data were completed for 1152 women: 81% of the women were multiparous, with a mean age of 27 years; 33% of the women had no education. Forty-seven percent of the women had dental caries; 27% of the women had missing teeth, and 91% of the women had had no dental care in the last year. Periodontal disease was common: 76% of the women had > or = 3 teeth with a probing depth of > or = 3 mm; 87% of the women had > or = 4 teeth with a clinical attachment level of > or = 3 mm; 56% of the women had > or = 4 teeth with a plaque index of 3; and 60% of the women had > or = 4 teeth with a gingival index of 3. As the measures of periodontal disease increased from the 1st to 4th quartile, stillbirth and neonatal and perinatal death also increased, with relative risks of approximately 1.3. Early preterm birth increased, but the results were not significant. Late preterm birth and low birthweight were not related to measures of periodontal disease. Pregnant Pakistani women have high levels of moderate-to-severe dental disease. Stillbirth and neonatal and perinatal deaths increased with the severity of periodontal disease.

  10. Improving the analysis of designed studies by combining statistical modelling with study design information

    NARCIS (Netherlands)

    Thissen, U.; Wopereis, S.; Berg, S.A.A. van den; Bobeldijk, I.; Kleemann, R.; Kooistra, T.; Dijk, K.W. van; Ommen, B. van; Smilde, A.K.

    2009-01-01

    Background: In the fields of life sciences, so-called designed studies are used for studying complex biological systems. The data derived from these studies comply with a study design aimed at generating relevant information while diminishing unwanted variation (noise). Knowledge about the study

  11. Controlled air incinerator conceptual design study

    International Nuclear Information System (INIS)

    1982-01-01

    This report presents a conceptual design study for a controlled air incinerator facility for incineration of low level combustible waste at Three Mile Island Unit 2 (TMI-2). The facility design is based on the use of a Helix Process Systems controlled air incinerator. Cost estimates and associated engineering, procurement, and construction schedules are also provided. The cost estimates and schedules are presented for two incinerator facility designs, one with provisions for waste ash solidification, the other with provisions for packaging the waste ash for transport to an undefined location

  12. Engineering study for ISSTRS design concept

    Energy Technology Data Exchange (ETDEWEB)

    Hertzel, J.S.

    1997-01-31

    Los Alamos Technical Associates, Inc., is pleased to transmit the attached Conceptual Design Package for the Initial Single Shell Tank Retrieval System (ISSTRS), 90% Conceptual Design Review. The package includes the following: (1) ISSTRS Trade Studies: (a) Retrieval Facility Cooling Requirements; (b) Equipment Re-usability between Project W-320 and Tanks 241-C-103 and 241-C-1 05; (c) Sluice Line Options; and (d) Options for the Location of Tanks AX-103 and A-1 02 HVAC Equipment; (2) Drawings; (3) Risk Management Plan; (4) 0850 Interface Control Document; (5) Requirements Traceability Report; and (6) Project Design Specification.

  13. Extrap conceptual fusion reactor design study

    International Nuclear Information System (INIS)

    Eninger, J.E; Lehnert, B.

    1987-12-01

    A study has recently been initiated to asses the fusion reactor potential of the Extrap concept. A reactor model is defined that fulfills certain economic and environmental criteria. This model is applied to Extrap and a reference reactor is outlined. The design is optimized by varying parameters subject to both physics and engineering constraints. Several design options are examined and key engineering issues are identified and addressed. Some preliminary results and conclusions of this work are summarized. (authors)

  14. Design study of laser fusion rocket

    International Nuclear Information System (INIS)

    Nakashima, Hideki; Shoyama, Hidetoshi; Kanda, Yukinori

    1991-01-01

    A design study was made on a rocket powered by laser fusion. Dependence of its flight performance on target gain, driver repetition rate and fuel composition was analyzed to obtain optimal design parameters of the laser fusion rocket. The results indicate that the laser fusion rocket fueled with DT or D 3 He has the potential advantages over other propulsion systems such as fission rocket for interplanetary travel. (author)

  15. Distribution Network Design--literature study based

    OpenAIRE

    LI, ANG

    2012-01-01

    The focus of this research is companies' outbound distribution network design in supply chain management. Within the present competitive market, it is a fundamental importance for companies to achieve high level business performance with an effective supply chain. Outbound distribution network design as an important part in supply chain management, to a large extent decides whether companies can fulfill customers' requirement or not. Therefore, such a study is important for manufacturers and ...

  16. Schematic representation of case study research designs.

    Science.gov (United States)

    Rosenberg, John P; Yates, Patsy M

    2007-11-01

    The paper is a report of a study to demonstrate how the use of schematics can provide procedural clarity and promote rigour in the conduct of case study research. Case study research is a methodologically flexible approach to research design that focuses on a particular case - whether an individual, a collective or a phenomenon of interest. It is known as the 'study of the particular' for its thorough investigation of particular, real-life situations and is gaining increased attention in nursing and social research. However, the methodological flexibility it offers can leave the novice researcher uncertain of suitable procedural steps required to ensure methodological rigour. This article provides a real example of a case study research design that utilizes schematic representation drawn from a doctoral study of the integration of health promotion principles and practices into a palliative care organization. The issues discussed are: (1) the definition and application of case study research design; (2) the application of schematics in research; (3) the procedural steps and their contribution to the maintenance of rigour; and (4) the benefits and risks of schematics in case study research. The inclusion of visual representations of design with accompanying explanatory text is recommended in reporting case study research methods.

  17. Conceptual study of advanced PWR core design

    International Nuclear Information System (INIS)

    Kim, Young Jin; Chang, Moon Hee; Kim, Keung Ku; Joo, Hyung Kuk; Kim, Young Il; Noh, Jae Man; Hwang, Dae Hyun; Kim, Taek Kyum; Yoo, Yon Jong.

    1997-09-01

    The purpose of this project is for developing and verifying the core design concepts with enhanced safety and economy, and associated methodologies for core analyses. From the study of the sate-of-art of foreign advanced reactor cores, we developed core concepts such as soluble boron free, high convertible and enhanced safety core loaded semi-tight lattice hexagonal fuel assemblies. To analyze this hexagonal core, we have developed and verified some neutronic and T/H analysis methodologies. HELIOS code was adopted as the assembly code and HEXFEM code was developed for hexagonal core analysis. Based on experimental data in hexagonal lattices and the COBRA-IV-I code, we developed a thermal-hydraulic analysis code for hexagonal lattices. Using the core analysis code systems developed in this project, we designed a 600 MWe core and studied the feasibility of the core concepts. Two additional scopes were performed in this project : study on the operational strategies of soluble boron free core and conceptual design of large scale passive core. By using the axial BP zoning concept and suitable design of control rods, this project showed that it was possible to design a soluble boron free core in 600 MWe PWR. The results of large scale core design showed that passive concepts and daily load follow operation could be practiced. (author). 15 refs., 52 tabs., 101 figs

  18. Conceptual study of advanced PWR core design

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Jin; Chang, Moon Hee; Kim, Keung Ku; Joo, Hyung Kuk; Kim, Young Il; Noh, Jae Man; Hwang, Dae Hyun; Kim, Taek Kyum; Yoo, Yon Jong

    1997-09-01

    The purpose of this project is for developing and verifying the core design concepts with enhanced safety and economy, and associated methodologies for core analyses. From the study of the sate-of-art of foreign advanced reactor cores, we developed core concepts such as soluble boron free, high convertible and enhanced safety core loaded semi-tight lattice hexagonal fuel assemblies. To analyze this hexagonal core, we have developed and verified some neutronic and T/H analysis methodologies. HELIOS code was adopted as the assembly code and HEXFEM code was developed for hexagonal core analysis. Based on experimental data in hexagonal lattices and the COBRA-IV-I code, we developed a thermal-hydraulic analysis code for hexagonal lattices. Using the core analysis code systems developed in this project, we designed a 600 MWe core and studied the feasibility of the core concepts. Two additional scopes were performed in this project : study on the operational strategies of soluble boron free core and conceptual design of large scale passive core. By using the axial BP zoning concept and suitable design of control rods, this project showed that it was possible to design a soluble boron free core in 600 MWe PWR. The results of large scale core design showed that passive concepts and daily load follow operation could be practiced. (author). 15 refs., 52 tabs., 101 figs.

  19. Bayesian dose selection design for a binary outcome using restricted response adaptive randomization.

    Science.gov (United States)

    Meinzer, Caitlyn; Martin, Renee; Suarez, Jose I

    2017-09-08

    In phase II trials, the most efficacious dose is usually not known. Moreover, given limited resources, it is difficult to robustly identify a dose while also testing for a signal of efficacy that would support a phase III trial. Recent designs have sought to be more efficient by exploring multiple doses through the use of adaptive strategies. However, the added flexibility may potentially increase the risk of making incorrect assumptions and reduce the total amount of information available across the dose range as a function of imbalanced sample size. To balance these challenges, a novel placebo-controlled design is presented in which a restricted Bayesian response adaptive randomization (RAR) is used to allocate a majority of subjects to the optimal dose of active drug, defined as the dose with the lowest probability of poor outcome. However, the allocation between subjects who receive active drug or placebo is held constant to retain the maximum possible power for a hypothesis test of overall efficacy comparing the optimal dose to placebo. The design properties and optimization of the design are presented in the context of a phase II trial for subarachnoid hemorrhage. For a fixed total sample size, a trade-off exists between the ability to select the optimal dose and the probability of rejecting the null hypothesis. This relationship is modified by the allocation ratio between active and control subjects, the choice of RAR algorithm, and the number of subjects allocated to an initial fixed allocation period. While a responsive RAR algorithm improves the ability to select the correct dose, there is an increased risk of assigning more subjects to a worse arm as a function of ephemeral trends in the data. A subarachnoid treatment trial is used to illustrate how this design can be customized for specific objectives and available data. Bayesian adaptive designs are a flexible approach to addressing multiple questions surrounding the optimal dose for treatment efficacy

  20. Student Academic Performance Outcomes of a Classroom Physical Activity Intervention: A Pilot Study

    OpenAIRE

    Heather ERWIN; Alicia FEDEWA; Soyeon AHN

    2012-01-01

    Physical activity is beneficial to children’s health, yet academic pressures limit opportunities for students throughout the school day. The purpose of this study was to determine the effect of a classroom PA intervention on student academic performance outcomes. Intervention participants (n=15) received daily PA breaks. Reading and mathematics fluency, PA, grades, and standardized test scores were collected. Effects of the intervention were examined using mixed-design ANOVAs. Intervention st...

  1. Outcome of severely injured trauma patients at a designated trauma centre in the Hong Kong Special Administrative Region.

    Science.gov (United States)

    Leung, Ka Kit Gilberto; Ho, Wendy; Tong, King Hung Daniel; Yuen, Wai Key

    2010-05-20

    The Hong Kong Special Administrative Region (HKSAR) of the People's Republic of China (PRC) has seen significant changes in its trauma service over the last ten years including the implementation of a regional trauma system. The author's institution is one of the five trauma centres designated in 2003. This article reports our initial clinical experience. A prospective single-centre trauma registry from January 2004 to December 2008 was reviewed. The primary clinical outcome measure was hospital mortality. The Trauma and Injury Severity Score (TRISS) methodology was used for bench-marking with the North America Major Trauma Outcome Study (MTOS) database. There were 1451 patients. The majority (83.9%) suffered from blunt injury. The overall mortality rate was 7.8%. Severe injury, defined as the Injury Severity Score > 15, occurred in 22.5% of patients, and was associated with a mortality rate of 31.6%. A trend of progressive improvement was noted. The M-statistic was 0.99, indicating comparable case-mix with the MTOS. The Z- and W-statistics of each individual year revealed fewer, but not significantly so, number of survivors than expected. Trauma centre designation was feasible in the HKSAR and was associated with a gradual improvement in patient care. Trauma system implementation may be considered in regions equipped with the necessary socio-economic and organizational set-up.

  2. A study protocol to evaluate the relationship between outdoor air pollution and pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Selemane Ismael

    2010-10-01

    Full Text Available Abstract Background The present study protocol is designed to assess the relationship between outdoor air pollution and low birth weight and preterm births outcomes performing a semi-ecological analysis. Semi-ecological design studies are widely used to assess effects of air pollution in humans. In this type of analysis, health outcomes and covariates are measured in individuals and exposure assignments are usually based on air quality monitor stations. Therefore, estimating individual exposures are one of the major challenges when investigating these relationships with a semi-ecologic design. Methods/Design Semi-ecologic study consisting of a retrospective cohort study with ecologic assignment of exposure is applied. Health outcomes and covariates are collected at Primary Health Care Center. Data from pregnant registry, clinical record and specific questionnaire administered orally to the mothers of children born in period 2007-2010 in Portuguese Alentejo Litoral region, are collected by the research team. Outdoor air pollution data are collected with a lichen diversity biomonitoring program, and individual pregnancy exposures are assessed with spatial geostatistical simulation, which provides the basis for uncertainty analysis of individual exposures. Awareness of outdoor air pollution uncertainty will improve validity of individual exposures assignments for further statistical analysis with multivariate regression models. Discussion Exposure misclassification is an issue of concern in semi-ecological design. In this study, personal exposures are assigned to each pregnant using geocoded addresses data. A stochastic simulation method is applied to lichen diversity values index measured at biomonitoring survey locations, in order to assess spatial uncertainty of lichen diversity value index at each geocoded address. These methods assume a model for spatial autocorrelation of exposure and provide a distribution of exposures in each study location

  3. Experimental design of a waste glass study

    International Nuclear Information System (INIS)

    Piepel, G.F.; Redgate, P.E.; Hrma, P.

    1995-04-01

    A Composition Variation Study (CVS) is being performed to support a future high-level waste glass plant at Hanford. A total of 147 glasses, covering a broad region of compositions melting at approximately 1150 degrees C, were tested in five statistically designed experimental phases. This paper focuses on the goals, strategies, and techniques used in designing the five phases. The overall strategy was to investigate glass compositions on the boundary and interior of an experimental region defined by single- component, multiple-component, and property constraints. Statistical optimal experimental design techniques were used to cover various subregions of the experimental region in each phase. Empirical mixture models for glass properties (as functions of glass composition) from previous phases wee used in designing subsequent CVS phases

  4. A comparative study of two shovel designs.

    Science.gov (United States)

    Degani, A; Asfour, S S; Waly, S M; Koshy, J G

    1993-10-01

    In the present study a modified shovel design with two perpendicular shafts is presented. This modified, two-shaft shovel was compared with a regular shovel. The modified shovel was evaluated and tested in a controlled laboratory environment using surface electromyography recorded from the lumbar paraspinal muscles. The new shovel design was also tested in a field study using ratings of perceived exertion. The results indicate that there was a significant reduction in EMG values of the lumbar paraspinal muscles and a consistent reduction in perceived exertion ratings while the modified shovel was being used for removing dirt in digging trenches up to 90 cm in depth.

  5. SSDOnt: An Ontology for Representing Single-Subject Design Studies.

    Science.gov (United States)

    Berges, Idoia; Bermúdez, Jesus; Illarramendi, Arantza

    2018-02-01

    Single-Subject Design is used in several areas such as education and biomedicine. However, no suited formal vocabulary exists for annotating the detailed configuration and the results of this type of research studies with the appropriate granularity for looking for information about them. Therefore, the search for those study designs relies heavily on a syntactical search on the abstract, keywords or full text of the publications about the study, which entails some limitations. To present SSDOnt, a specific purpose ontology for describing and annotating single-subject design studies, so that complex questions can be asked about them afterwards. The ontology was developed following the NeOn methodology. Once the requirements of the ontology were defined, a formal model was described in a Description Logic and later implemented in the ontology language OWL 2 DL. We show how the ontology provides a reference model with a suitable terminology for the annotation and searching of single-subject design studies and their main components, such as the phases, the intervention types, the outcomes and the results. Some mappings with terms of related ontologies have been established. We show as proof-of-concept that classes in the ontology can be easily extended to annotate more precise information about specific interventions and outcomes such as those related to autism. Moreover, we provide examples of some types of queries that can be posed to the ontology. SSDOnt has achieved the purpose of covering the descriptions of the domain of single-subject research studies. Schattauer GmbH.

  6. Core design and fuel management studies

    International Nuclear Information System (INIS)

    Min, Byung Joo; Chan, P.

    1997-06-01

    The design target for the CANDU 9 requires a 20% increase in electrical power output from an existing 480-channel CANDU core. Assuming a net electrical output of 861 MW(e) for a natural uranium fuelled Bruce-B/Darlington reactor in a warm water site, the net electrical output of the reference CANDU 9 reactor would be 1033 MW(e). This report documents the result of the physics studies for the design of the CANDU 9 480/SEU core. The results of the core design and fuel management studies of the CANDU 9 480/SEU reactor indicated that up to 1033 MW(e) output can be achieved in a 480-channel CANDU core by using SEU core can easily be maintained indefinitely using an automated refuelling program. Fuel performance evaluation based on the data of the 500 FPDs refuelling simulation concluded that SEU fuel failure is not expected. (author). 2 tabs., 38 figs., 5 refs

  7. Designs for mechanical circulatory support device studies.

    Science.gov (United States)

    Neaton, James D; Normand, Sharon-Lise; Gelijns, Annetine; Starling, Randall C; Mann, Douglas L; Konstam, Marvin A

    2007-02-01

    There is increased interest in mechanical circulatory support devices (MCSDs), such as implantable left ventricular assist devices (LVADs), as "destination" therapy for patients with advanced heart failure. Because patient availability to evaluate these devices is limited and randomized trials have been slow in enrolling patients, a workshop was convened to consider designs for MCSD development including alternatives to randomized trials. A workshop was jointly planned by the Heart Failure Society of America and the US Food and Drug Administration and was convened in March 2006. One of the panels was asked to review different designs for evaluating new MCSDs. Randomized trials have many advantages over studies with no controls or with nonrandomized concurrent or historical controls. These advantages include the elimination of bias in the assignment of treatments and the balancing, on average, of known and unknown baseline covariates that influence response. These advantages of randomization are particularly important for studies in which the treatments may not differ from one another by a large amount (eg, a head-to-head study of an approved LVAD with a new LVAD). However, researchers have found it difficult to recruit patients to randomized studies because the number of clinical sites that can carry out the studies is not large. Also, there is a reluctance to randomize patients when the control device is considered technologically inferior. Thus ways of improving the design of randomized trials were discussed, and the advantages and disadvantages of alternative designs were considered. The panel concluded that designs should include a randomized component. Randomized designs might be improved by allowing the control device to be chosen before randomization, by first conducting smaller vanguard studies, and by allowing crossovers in trials with optimal medical management controls. With use of data from completed trials, other databases, and registries, alternative

  8. Modular Stellarator Reactor conceptual design study

    International Nuclear Information System (INIS)

    Miller, R.L.; Bathke, C.G.

    1983-01-01

    A conceptual design study of the Modular Stellarator Reactor is summarized. The physics basis of the approach is elucidated with emphasis on magnetics performance optimization. Key engineering features of the fusion power core are described. Comparisons with an analogous continuous-helical-coil (torsatron) system are made as the basis of a technical and economic assessment

  9. Quiet engine program flight engine design study

    Science.gov (United States)

    Klapproth, J. F.; Neitzel, R. E.; Seeley, C. T.

    1974-01-01

    The results are presented of a preliminary flight engine design study based on the Quiet Engine Program high-bypass, low-noise turbofan engines. Engine configurations, weight, noise characteristics, and performance over a range of flight conditions typical of a subsonic transport aircraft were considered. High and low tip speed engines in various acoustically treated nacelle configurations were included.

  10. Modular stellarator reactor conceptual design study

    International Nuclear Information System (INIS)

    Miller, R.L.; Krakowski, R.A.; Bathke, C.G.

    1983-01-01

    A conceptual design study of the Modular Stellarator Reactor is summarized. The physics basis of the approach is elucidated with emphasis on magnetics performance optimization. Key engineering features of the fusion power core are described. Comparisons with an analogous continuous-helical-coil (torsatron) system are made as the basis of a technical and economic assessment

  11. Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study Proceso asistencial y resultados en la cirugía de cáncer digestivo: diseño y resultados iniciales de un estudio de cohortes multicéntrico

    Directory of Open Access Journals (Sweden)

    M. Espallargues

    2009-10-01

    Full Text Available Background: most studies that analyze the influence of structure factors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume. Objective: to study variations in the process and outcomes of oncologic surgery for esophagus, stomach, pancreas, liver metastases and rectum cancers in Catalonia, as well as the factors associated with these variations. Patients and method: a retrospective (2002 and prospective (2003-05 multicenter cohort study. Data forms were designed to collect patient, process, and care outcome characteristics before surgery, at hospital discharge, and at 3 and 6 months after discharge. Main outcome measures were hospital and follow-up mortality, complications, re-interventions, and relapse rates. Results: 49 hospitals (80% participated in the retrospective phase, 44 of which (90% also participated in the prospective phase: 3,038 patients (98% were included. No differences were observed in the profile of operated patients according to hospital level of complexity, but clinical-pathological staging and other functional status variables could not be assessed because of over 20% of missing values. There was significant variability in the volume of interventions as well as in certain aspects of the healthcare process depending on type of cancer and center complexity. High rates of esophageal cancer mortality (18.2% at discharge, 27.3% at 6 months and of complications and re-interventions for all cancers assessed, especially rectal cancer (18.4% re-interventions at 6 months, were identified. Conclusions: the study of the variability identified will require adequate risk-adjustment and should take into account different structure factors. It is necessary that information included in medical records be improved.Antecedentes: la mayoría de estudios que analizan la influencia de factores de estructura sobre los resultados son retrospectivos, realizados con bases de datos

  12. Management of acute bursitis: outcome study of a structured approach.

    Science.gov (United States)

    Stell, I M

    1999-01-01

    In patients with septic bursitis the indications for admission and surgical intervention remain unclear, and practice has varied widely. The effectiveness of a conservative outpatient based approach was assessed by an outcome study in a prospective case series. Consecutive patients attending an emergency department with acute swelling of the olecranon or prepatellar bursa were managed according to a structured approach, subjective and objective outcomes being assessed after two to three days, and subsequently as required until clinical discharge. Long-term outcomes were assessed by telephone follow-up for up to eighteen months. 47 patients were included in the study: 22 had septic bursitis, 15 of the olecranon bursa and 7 of the prepatellar bursa. The mean visual analogue pain scores of those with septic bursitis improved from 4.8 at presentation to 1.7 at first follow-up for olecranon bursitis, and from 3.8 to 2.7 for prepatellar bursitis. Symptoms improved more slowly for patients with non-septic bursitis. No patients were admitted initially, but 2 were admitted (two days each) after the first follow-up appointment. One patient had incision and drainage on the third attendance, and 3 patients developed discharging sinuses, which all healed spontaneously. All patients made a good long-term symptomatic recovery and all could lean on the elbow or kneel by the end of the follow-up period. The management protocol, with specific criteria for admission and surgical intervention, thus produced good results with little need for operation or admission. PMID:10692903

  13. 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.

  14. How Mobile App Design Impacts User Responses to Mixed Self-Tracking Outcomes: Randomized Online Experiment to Explore the Role of Spatial Distance for Hedonic Editing

    Science.gov (United States)

    Lorenz, Jana

    2018-01-01

    Background Goal setting is among the most common behavioral change techniques employed in contemporary self-tracking apps. For these techniques to be effective, it is relevant to understand how the visual presentation of goal-related outcomes employed in the app design affects users’ responses to their self-tracking outcomes. Objective This study examined whether a spatially close (vs distant) presentation of mixed positive and negative self-tracking outcomes from multiple domains (ie, activity, diet) on a digital device’s screen can provide users the opportunity to hedonically edit their self-tracking outcome profile (ie, to view their mixed self-tracking outcomes in the most positive light). Further, this study examined how the opportunity to hedonically edit one’s self-tracking outcome profile relates to users’ future health behavior intentions. Methods To assess users’ responses to a spatially close (vs distant) presentation of a mixed-gain (vs mixed-loss) self-tracking outcome profile, a randomized 2×2 between-subjects online experiment with a final sample of 397 participants (mean age 27.4, SD 7.2 years; 71.5%, 284/397 female) was conducted in Germany. The experiment started with a cover story about a fictitious self-tracking app. Thereafter, participants saw one of four manipulated self-tracking outcome profiles. Variables of interest measured were health behavior intentions, compensatory health beliefs, health motivation, and recall of the outcome profile. We analyzed data using chi-square tests (SPSS version 23) and moderated mediation analyses with the PROCESS macro 2.16.1. Results Spatial distance facilitated hedonic editing, which was indicated by systematic memory biases in users’ recall of positive and negative self-tracking outcomes. In the case of a mixed-gain outcome profile, a spatially close (vs distant) presentation tended to increase the underestimation of the negative outcome (P=.06). In the case of a mixed-loss outcome profile, a

  15. A study protocol to evaluate the relationship between outdoor air pollution and pregnancy outcomes.

    Science.gov (United States)

    Ribeiro, Manuel C; Pereira, Maria J; Soares, Amílcar; Branquinho, Cristina; Augusto, Sofia; Llop, Esteve; Fonseca, Susana; Nave, Joaquim G; Tavares, António B; Dias, Carlos M; Silva, Ana; Selemane, Ismael; de Toro, Joaquin; Santos, Mário J; Santos, Fernanda

    2010-10-15

    The present study protocol is designed to assess the relationship between outdoor air pollution and low birth weight and preterm births outcomes performing a semi-ecological analysis. Semi-ecological design studies are widely used to assess effects of air pollution in humans. In this type of analysis, health outcomes and covariates are measured in individuals and exposure assignments are usually based on air quality monitor stations. Therefore, estimating individual exposures are one of the major challenges when investigating these relationships with a semi-ecologic design. Semi-ecologic study consisting of a retrospective cohort study with ecologic assignment of exposure is applied. Health outcomes and covariates are collected at Primary Health Care Center. Data from pregnant registry, clinical record and specific questionnaire administered orally to the mothers of children born in period 2007-2010 in Portuguese Alentejo Litoral region, are collected by the research team. Outdoor air pollution data are collected with a lichen diversity biomonitoring program, and individual pregnancy exposures are assessed with spatial geostatistical simulation, which provides the basis for uncertainty analysis of individual exposures. Awareness of outdoor air pollution uncertainty will improve validity of individual exposures assignments for further statistical analysis with multivariate regression models. Exposure misclassification is an issue of concern in semi-ecological design. In this study, personal exposures are assigned to each pregnant using geocoded addresses data. A stochastic simulation method is applied to lichen diversity values index measured at biomonitoring survey locations, in order to assess spatial uncertainty of lichen diversity value index at each geocoded address. These methods assume a model for spatial autocorrelation of exposure and provide a distribution of exposures in each study location. We believe that variability of simulated exposure values at

  16. Powersail High Power Propulsion System Design Study

    Science.gov (United States)

    Gulczinski, Frank S., III

    2000-11-01

    A desire by the United States Air Force to exploit the space environment has led to a need for increased on-orbit electrical power availability. To enable this, the Air Force Research Laboratory Space Vehicles Directorate (AFRL/ VS) is developing Powersail: a two-phased program to demonstrate high power (100 kW to 1 MW) capability in space using a deployable, flexible solar array connected to the host spacecraft using a slack umbilical. The first phase will be a proof-of-concept demonstration at 50 kW, followed by the second phase, an operational system at full power. In support of this program, the AFRL propulsion Directorate's Spacecraft Propulsion Branch (AFRL/PRS ) at Edwards AFB has commissioned a design study of the Powersail High Power Propulsion System. The purpose of this study, the results of which are summarized in this paper, is to perform mission and design trades to identify potential full-power applications (both near-Earth and interplanetary) and the corresponding propulsion system requirements and design. The design study shall farther identify a suitable low power demonstration flight that maximizes risk reduction for the fully operational system. This propulsion system is expected to be threefold: (1) primary propulsion for moving the entire vehicle, (2) a propulsion unit that maintains the solar array position relative to the host spacecraft, and (3) control propulsion for maintaining proper orientation for the flexible solar array.

  17. A Design Study for Standard Nanofluid Coolants

    International Nuclear Information System (INIS)

    Bang, In Cheol; Heo, Gyun Young

    2007-01-01

    The experimental data for nanofluids in thermal-fluid systems have shown that the new fluids promise to become advanced heat transfer fluids in terms of thermal performance. While enhancing thermal characteristics, the solid-liquid mixtures present an unavoidable disadvantage in terms of pumping cost for economic operation of thermal-fluid systems. In addition, there is a lack of agreement between experimental data provided in the literature. We can find that this issue of nanofluids resembles that of designing new materials. Many nanofluids researchers tend to view the nanofluid field as a highly coupled 'tetrahedro' whose four vertices (performance, properties, structure, and processes) are interconnected to each other. The present design study has a big merit to systemize the nanofluid work and to reduce a lot of trial-error efforts. The present work found that there would be no comprehensible design strategy in developing nanofluids. In this work, the Axiomatic Design (AD) theory is applied to standardize the design of nanofluids in order to bring its practical use forward. According to the Independence Axiom of the AD theory, the excessive couplings between the functional requirements and the parameters of a nanofluid system prevent from meeting the functional goals of the entire system. At a parametric level, the design of a nanofluid system is inherently coupled due to the characteristics of thermal-fluid system; the design parameters physically affect each other sharing sub-level parameters for nanoparticles with making a feedback loop. Even though parts of the nanofluids are naturally coupled, it is possible to reduce and/or eliminate the degree of coupling by help of AD principles. From the perspective of AD, this implies that we are able to ascertain which nanofluid system is better one in the light of functional achievement

  18. RF quadrupole beam dynamics design studies

    International Nuclear Information System (INIS)

    Crandall, K.R.; Stokes, R.H.; Wangler, T.P.

    1979-01-01

    The radio-frequency quadrupole (RFQ) linear accelerator structure is expected to permit considerable flexibility in achieving linac design objectives at low velocities. Calculational studies show that the RFQ can accept a high-current, low-velocity, dc beam, bunch it with high efficiency, and accelerate it to a velocity suitable for injection into a drift-tube linac. Although it is relatively easy to generate a satisfactory design for an RFQ linac for low beam currents, the space-charge effects produced by high currents dominate the design criteria. Methods have been developed to generate solutions that make suitable compromises between the effects of emittance growth, transmission efficiency, and overall structure length. Results are given for a test RFQ linac operating at 425 MHz

  19. Thermodynamic Studies for Drug Design and Screening

    Science.gov (United States)

    Garbett, Nichola C.; Chaires, Jonathan B.

    2012-01-01

    Introduction A key part of drug design and development is the optimization of molecular interactions between an engineered drug candidate and its binding target. Thermodynamic characterization provides information about the balance of energetic forces driving binding interactions and is essential for understanding and optimizing molecular interactions. Areas covered This review discusses the information that can be obtained from thermodynamic measurements and how this can be applied to the drug development process. Current approaches for the measurement and optimization of thermodynamic parameters are presented, specifically higher throughput and calorimetric methods. Relevant literature for this review was identified in part by bibliographic searches for the period 2004 – 2011 using the Science Citation Index and PUBMED and the keywords listed below. Expert opinion The most effective drug design and development platform comes from an integrated process utilizing all available information from structural, thermodynamic and biological studies. Continuing evolution in our understanding of the energetic basis of molecular interactions and advances in thermodynamic methods for widespread application are essential to realize the goal of thermodynamically-driven drug design. Comprehensive thermodynamic evaluation is vital early in the drug development process to speed drug development towards an optimal energetic interaction profile while retaining good pharmacological properties. Practical thermodynamic approaches, such as enthalpic optimization, thermodynamic optimization plots and the enthalpic efficiency index, have now matured to provide proven utility in design process. Improved throughput in calorimetric methods remains essential for even greater integration of thermodynamics into drug design. PMID:22458502

  20. Thermodynamic studies for drug design and screening.

    Science.gov (United States)

    Garbett, Nichola C; Chaires, Jonathan B

    2012-04-01

    A key part of drug design and development is the optimization of molecular interactions between an engineered drug candidate and its binding target. Thermodynamic characterization provides information about the balance of energetic forces driving binding interactions and is essential for understanding and optimizing molecular interactions. This review discusses the information that can be obtained from thermodynamic measurements and how this can be applied to the drug development process. Current approaches for the measurement and optimization of thermodynamic parameters are presented, specifically higher throughput and calorimetric methods. Relevant literature for this review was identified in part by bibliographic searches for the period 2004 - 2011 using the Science Citation Index and PUBMED and the keywords listed below. The most effective drug design and development platform comes from an integrated process utilizing all available information from structural, thermodynamic and biological studies. Continuing evolution in our understanding of the energetic basis of molecular interactions and advances in thermodynamic methods for widespread application are essential to realize the goal of thermodynamically driven drug design. Comprehensive thermodynamic evaluation is vital early in the drug development process to speed drug development toward an optimal energetic interaction profile while retaining good pharmacological properties. Practical thermodynamic approaches, such as enthalpic optimization, thermodynamic optimization plots and the enthalpic efficiency index, have now matured to provide proven utility in the design process. Improved throughput in calorimetric methods remains essential for even greater integration of thermodynamics into drug design. © 2012 Informa UK, Ltd.

  1. Design study on metal fuel FBR cores

    International Nuclear Information System (INIS)

    Yokoo, T.; Tanaka, Y.; Ogata, T.

    1991-01-01

    A design approach for metal fuel FBR core to maintain fuel integrity during transient events by limiting eutectic/liquid phase formation is proposed based on the current status of metallic fuel development. Its impact as the limitation on the core outlet temperature is assessed through its application to two of CRIEPI's core concepts, high linear power 1000 MWe homogeneous design and medium linear power 300 MWe radially heterogeneous design. SESAME/SALT code is used in this study to analyze steady state and transient fuel behavior. SE2-FA code is developed based on SUPERENERGY-2 and used to analyze core thermal-hydraulics with uncertainties. As the result, the core outlet temperatures of both designs are found to be limited to ≤500degC if it is required to prevent eutectic/liquid phase formation during operational transients in order to guarantee the fuel integrity. Additional assessment is made assuming an advanced limiting condition that allows small liquid phase formation based on the liquid phase penetration rate derived from existing experimental results. The result indicates possibility of raising core outlet temperature to ∼ 530degC. Also, it is found that core design technology improvements such as hot spot factors reduction can contribute to the core outlet temperature extension by 10 ∼ 20degC. (author)

  2. An Introduction to the Outcomes of Children with Hearing Loss Study.

    Science.gov (United States)

    Moeller, Mary Pat; Tomblin, J Bruce

    2015-01-01

    The landscape of service provision for young children with hearing loss has shifted in recent years as a result of newborn hearing screening and the early provision of interventions, including hearing technologies. It is expected that early service provision will minimize or prevent linguistic delays that typically accompany untreated permanent childhood hearing loss. The post-newborn hearing screening era has seen a resurgence of interest in empirically examining the outcomes of children with hearing loss to determine if service innovations have resulted in expected improvements in children's functioning. The Outcomes of Children with Hearing Loss (OCHL) project was among these recent research efforts, and this introductory article provides background in the form of literature review and theoretical discussion to support the goals of the study. The Outcomes of Children with Hearing Loss project was designed to examine the language and auditory outcomes of infants and preschool-age children with permanent, bilateral, mild-to-severe hearing loss, and to identify factors that moderate the relationship between hearing loss and longitudinal outcomes. The authors propose that children who are hard of hearing experience limitations in access to linguistic input, which lead to a decrease in uptake of language exposure and an overall reduction in linguistic experience. The authors explore this hypothesis in relation to three primary factors that are proposed to influence children's access to linguistic input: aided audibility, duration and consistency of hearing aid use, and characteristics of caregiver input.

  3. The Importance of Interior Design Elements as They Relate to Student Outcomes.

    Science.gov (United States)

    Tanner, C. Kenneth; Langford, Ann

    This study investigated the following questions: (1) "What are the perceptions that elementary school principals have concerning the influence of interior design elements such as floor and wall coverings, lighting, flexibility, acoustics, color, texture, patterns, cleanliness, and maintenance on student achievement, teacher retention, and student…

  4. Direct renin inhibition in addition to or as an alternative to angiotensin converting enzyme inhibition in patients with chronic systolic heart failure: rationale and design of the Aliskiren Trial to Minimize OutcomeS in Patients with HEart failuRE (ATMOSPHERE) study

    DEFF Research Database (Denmark)

    Krum, Henry; Massie, Barry; Abraham, William T

    2011-01-01

    S for Patients with HEart failuRE (ATMOSPHERE) study is to evaluate the effect of both aliskiren and enalapril monotherapy and aliskiren/enalapril combination therapy on cardiovascular death and HF hospitalization in patients with chronic systolic HF, NYHA functional class II-IV symptoms, and elevated plasma......-inferior to enalapril monotherapy on this endpoint. Perspective The ATMOSPHERE study will definitively determine the role of a DRI strategy additional to or as an alternative to conventional RAAS blockade in patients with chronic systolic HF....

  5. Variation in choice of study design: findings from the Epidemiology Design Decision Inventory and Evaluation (EDDIE) survey.

    Science.gov (United States)

    Stang, Paul E; Ryan, Patrick B; Overhage, J Marc; Schuemie, Martijn J; Hartzema, Abraham G; Welebob, Emily

    2013-10-01

    Researchers using observational data to understand drug effects must make a number of analytic design choices that suit the characteristics of the data and the subject of the study. Review of the published literature suggests that there is a lack of consistency even when addressing the same research question in the same database. To characterize the degree of similarity or difference in the method and analysis choices made by observational database research experts when presented with research study scenarios. On-line survey using research scenarios on drug-effect studies to capture method selection and analysis choices that follow a dependency branching based on response to key questions. Voluntary participants experienced in epidemiological study design solicited for participation through registration on the Observational Medical Outcomes Partnership website, membership in particular professional organizations, or links in relevant newsletters. Description (proportion) of respondents selecting particular methods and making specific analysis choices based on individual drug-outcome scenario pairs. The number of questions/decisions differed based on stem questions of study design, time-at-risk, outcome definition, and comparator. There is little consistency across scenarios, by drug or by outcome of interest, in the decisions made for design and analyses in scenarios using large healthcare databases. The most consistent choice was the cohort study design but variability in the other critical decisions was common. There is great variation among epidemiologists in the design and analytical choices that they make when implementing analyses in observational healthcare databases. These findings confirm that it will be important to generate empiric evidence to inform these decisions and to promote a better understanding of the impact of standardization on research implementation.

  6. Analysis of Genome-Wide Association Studies with Multiple Outcomes Using Penalization

    Science.gov (United States)

    Liu, Jin; Huang, Jian; Ma, Shuangge

    2012-01-01

    Genome-wide association studies have been extensively conducted, searching for markers for biologically meaningful outcomes and phenotypes. Penalization methods have been adopted in the analysis of the joint effects of a large number of SNPs (single nucleotide polymorphisms) and marker identification. This study is partly motivated by the analysis of heterogeneous stock mice dataset, in which multiple correlated phenotypes and a large number of SNPs are available. Existing penalization methods designed to analyze a single response variable cannot accommodate the correlation among multiple response variables. With multiple response variables sharing the same set of markers, joint modeling is first employed to accommodate the correlation. The group Lasso approach is adopted to select markers associated with all the outcome variables. An efficient computational algorithm is developed. Simulation study and analysis of the heterogeneous stock mice dataset show that the proposed method can outperform existing penalization methods. PMID:23272092

  7. The Ahmed Versus Baerveldt study: one-year treatment outcomes.

    Science.gov (United States)

    Christakis, Panos G; Kalenak, Jeffrey W; Zurakowski, David; Tsai, James C; Kammer, Jeffrey A; Harasymowycz, Paul J; Ahmed, Iqbal I K

    2011-11-01

    To report the 1-year treatment outcomes of the Ahmed Versus Baerveldt (AVB) Study. Multicenter randomized clinical trial. A total of 238 patients were enrolled in the study, including 124 in the Ahmed group and 114 in the Baerveldt group. Patients aged 18 years or older with uncontrolled glaucoma refractory to medicinal, laser, and surgical therapy were randomized to undergo implantation of an Ahmed-FP7 valve (New World Medical, Inc., Rancho Cucamonga, CA) or a Baerveldt-350 implant (Abbott Medical Optics, Inc., Santa Ana, CA), to be followed for 5 years. The primary outcome measure was failure, defined as intraocular pressure (IOP) out of target range (5-18 mmHg with ≥ 20% reduction from baseline) for 2 consecutive visits after 3 months, vision-threatening complications, additional glaucoma procedures, or loss of light perception. Secondary outcome measures included IOP, medication use, visual acuity, complications, and interventions. There were no significant differences in baseline ocular or demographic characteristics between the study groups with the exception of sex. Preoperatively, the study group had a mean IOP of 31.4 ± 10.8 mmHg on a mean of 3.1 ± 1.0 glaucoma medications with a median Snellen acuity of 20/100. The cumulative probability of failure a 1-year was 43% in the Ahmed group and 28% in the Baerveldt group (P = 0.02). The mean IOP at 1 year was 16.5 ± 5.3 mmHg in the Ahmed group and 13.6 ± 4.8 mmHg in the Baerveldt group (P glaucoma medications required was 1.6 ± 1.3 in the Ahmed group and 1.2 ± 1.3 in the Baerveldt group (P = 0.03). Visual acuity was similar in both groups at all visits in the first year (P = 0.66). In the first year after surgery, there were a similar number of patients who experienced postoperative complications in the 2 groups (45% Ahmed, 54% Baerveldt, P = 0.19), but a greater number of patients in the Baerveldt group required interventions (26% Ahmed vs. 42% Baerveldt, P = 0.009). The Baerveldt-350 group had a higher

  8. Outcome of Adolescent Pregnancy: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    S Ozdogan

    2015-05-01

    Full Text Available Objective: The aim of this study is to review the sociodemographic characteristics, maternal, natal and postnatal outcomes of adolescent pregnancy. Subjects and method: The records of all adolescent pregnancies (aged 13–19 years delivered at Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey, over a period of two years were reviewed. Structured survey was conducted with adolescent mothers over the phone. Results: The incidence of adolescent pregnancy was 7.06%; 91.1% of the cases were reported to be married. Consanguineous marriage was found to be 27.6%. Maternal anaemia was detected in 43.1% of cases. Premature birth rate was 6.3%. The rate of Cesarean section was 31.8%. Adolescent mothers were categorized into two groups: 17 years and below and above 17 years. The maternal, natal and postnatal outcomes were not statistically different between the two groups. Conclusions: Health policies should be revised and improved to take the necessary steps for providing adequate health services for adolescents and for improving prenatal, natal and postnatal care of pregnant adolescents.

  9. The Child Anxiety Prevention Study: intervention model and primary outcomes.

    Science.gov (United States)

    Ginsburg, Golda S

    2009-06-01

    The article presents the intervention model and primary outcomes of a preventive intervention designed to reduce anxiety symptoms and prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Participants were 40 volunteer children (mean age = 8.94 years; 45% girls; 90% Caucasian) whose parents met criteria for a broad range of anxiety disorders. Families were randomly assigned to an 8-week cognitive-behavioral intervention, the Coping and Promoting Strength program (CAPS; n = 20) or a wait list control condition (WL; n = 20). Independent evaluators (IEs) conducted diagnostic interviews, and children and parents completed measures of anxiety symptoms. Assessments were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment. On the basis of intent to treat analyses, 30% of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0% in the CAPS group. IE and parent-reported (but not child-reported) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up assessment in the CAPS but not the WL group. Parental satisfaction with the intervention was high. Findings suggest that a family-based intervention may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Copyright 2009 APA

  10. Comparison of closed-cell and hybrid-cell stent designs in carotid artery stenting: clinical and procedural outcomes

    Directory of Open Access Journals (Sweden)

    Ersan TatlI

    2017-05-01

    Full Text Available Introduction: Carotid artery stenting (CAS is a promising alternative to surgery in high-risk patients. However, the impact of stent cell design on outcomes in CAS is a matter of continued debate. Aim : To compare the periprocedural and clinical outcomes of different stent designs for CAS with distal protection devices. Material and methods : All CAS procedures with both closed- and hybrid-cell stents performed at our institution between February 2010 and December 2015 were analyzed retrospectively. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack and myocardial infarction. Periprocedural and 30-day adverse events and internal carotid artery (ICA vasospasm rates were compared between the closed-cell and hybrid-cell stent groups. Results : The study included 234 patients comprising 146 patients with a closed-cell stent (Xact stent, Abbott Vascular (mean age: 68.5 ±8.6; 67.1% male and 88 patients with a hybrid-cell stent (Cristallo Ideale, Medtronic (mean age: 67.2 ±12.8; 68.2% male. There was no significant difference between the groups with respect to periprocedural or 30-day adverse event rates. While there was no difference in terms of tortuosity index between the groups, there was a higher procedural ICA vasospasm rate in the closed-cell stent group (35 patients, 23% compared with the hybrid-cell stent group (10 patients, 11% (p = 0.017. Conclusions : The results of this study showed no significant difference in the clinical adverse event rates after CAS between the closed-cell stent group and the hybrid-cell stent group. However, procedural ICA vasospasm was more common in the closed-cell stent group.

  11. Direct renin inhibition in addition to or as an alternative to angiotensin converting enzyme inhibition in patients with chronic systolic heart failure: rationale and design of the Aliskiren Trial to Minimize OutcomeS in Patients with HEart failuRE (ATMOSPHERE) study

    DEFF Research Database (Denmark)

    Krum, Henry; Massie, Barry; Abraham, William T

    2011-01-01

    AIMS: The renin-angiotensin-aldosterone system (RAAS) represents a key therapeutic target in heart failure (HF) management. However, conventional agents that block this system induce a reflex increase in plasma renin activity (PRA), which may lead to RAAS 'escape'. Direct renin inhibitors (DRIs......S for Patients with HEart failuRE (ATMOSPHERE) study is to evaluate the effect of both aliskiren and enalapril monotherapy and aliskiren/enalapril combination therapy on cardiovascular death and HF hospitalization in patients with chronic systolic HF, NYHA functional class II-IV symptoms, and elevated plasma...... levels of BNP. Methods Patients tolerant to at least 10 mg or equivalent of enalapril will undergo an open-label run-in period where they receive enalapril then aliskiren. Approximately 7000 patients tolerating this run-in period will then be randomized 1:1:1 to aliskiren monotherapy, enalapril...

  12. Parametric study for design of thermal sleeves

    International Nuclear Information System (INIS)

    Mukherjee, A.B.; Mehra, V.K.

    1985-01-01

    Thermal sleeves are used inside nozzle in many reactor components. Basic aim in design of thermal sleeve is to arrive at a set of dimensions for gap and annulus length, which will give rise to minimum thermal gradient in the base metal of the associated nozzle. Study includes the minimisation of the thermal gradient in the crotch zone by suitable choice of gap and annulus length. Three different geometries of nozzle radii 50.00 mm., 100 mm. and 200.0 mm. are studied for single and two concentric thermal sleeves model. The paper also presents effect of parameters like velocity of flow, temperature of fluid, materials etc. on the design of thermal sleeves. (orig.)

  13. DU-AGG pilot plant design study

    International Nuclear Information System (INIS)

    Lessing, P.A.; Gillman, H.

    1996-07-01

    The Idaho National Engineering Laboratory (INEL) is developing new methods to produce high-density aggregate (artificial rock) primarily consisting of depleted uranium oxide. The objective is to develop a low-cost method whereby uranium oxide powder (UO[sub 2], U[sub 3]O[sub ]8, or UO[sub 3]) can be processed to produce high-density aggregate pieces (DU-AGG) having physical properties suitable for disposal in low-level radioactive disposal facilities or for use as a component of high-density concrete used as shielding for radioactive materials. A commercial company, G-M Systems, conducted a design study for a manufacturing pilot plant to process DU-AGG. The results of that study are included and summarized in this report. Also explained are design considerations, equipment capacities, the equipment list, system operation, layout of equipment in the plant, cost estimates, and the proposed plan and schedule

  14. Design studies for the Positron Factory

    International Nuclear Information System (INIS)

    Okada, S.; Sunaga, H.; Kaneko, H.; Masuno, S.; Kawasuso, A.; Sakai, T.; Takizawa, H.; Yotsumoto, K.; Honda, Y.; Tagawa, S.

    1996-01-01

    In the design study for the Positron Factory, a feasibility of simultaneous extraction of multi-channel monoenergetic positron beams, which had been proposed at the previous conference (Linac 94), was demonstrated by an experiment using an electron linac. On the basis of the experimental result, an efficient moderator structure, which is composed of honeycomb-like assembled moderator foils and reflectors, is proposed. (author)

  15. RARtool: A MATLAB Software Package for Designing Response-Adaptive Randomized Clinical Trials with Time-to-Event Outcomes.

    Science.gov (United States)

    Ryeznik, Yevgen; Sverdlov, Oleksandr; Wong, Weng Kee

    2015-08-01

    Response-adaptive randomization designs are becoming increasingly popular in clinical trial practice. In this paper, we present RARtool , a user interface software developed in MATLAB for designing response-adaptive randomized comparative clinical trials with censored time-to-event outcomes. The RARtool software can compute different types of optimal treatment allocation designs, and it can simulate response-adaptive randomization procedures targeting selected optimal allocations. Through simulations, an investigator can assess design characteristics under a variety of experimental scenarios and select the best procedure for practical implementation. We illustrate the utility of our RARtool software by redesigning a survival trial from the literature.

  16. Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study.

    Science.gov (United States)

    Ahn, Rosa; Woodbridge, Alexandra; Abraham, Ann; Saba, Susan; Korenstein, Deborah; Madden, Erin; Boscardin, W John; Keyhani, Salomeh

    2017-01-17

     To examine the association between the presence of individual principal investigators' financial ties to the manufacturer of the study drug and the trial's outcomes after accounting for source of research funding.  Cross sectional study of randomized controlled trials (RCTs).  Studies published in "core clinical" journals, as identified by Medline, between 1 January 2013 and 31 December 2013.  Random sample of RCTs focused on drug efficacy.  Association between financial ties of principal investigators and study outcome.  A total of 190 papers describing 195 studies met inclusion criteria. Financial ties between principal investigators and the pharmaceutical industry were present in 132 (67.7%) studies. Of 397 principal investigators, 231 (58%) had financial ties and 166 (42%) did not. Of all principal investigators, 156 (39%) reported advisor/consultancy payments, 81 (20%) reported speakers' fees, 81 (20%) reported unspecified financial ties, 52 (13%) reported honorariums, 52 (13%) reported employee relationships, 52 (13%) reported travel fees, 41 (10%) reported stock ownership, and 20 (5%) reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% (103/136) among positive studies and 49% (29/59) among negative studies. In unadjusted analyses, the presence of a financial tie was associated with a positive study outcome (odds ratio 3.23, 95% confidence interval 1.7 to 6.1). In the primary multivariate analysis, a financial tie was significantly associated with positive RCT outcome after adjustment for the study funding source (odds ratio 3.57 (1.7 to 7.7). The secondary analysis controlled for additional RCT characteristics such as study phase, sample size, country of first authors, specialty, trial registration, study design, type of analysis, comparator, and outcome measure. These characteristics did not appreciably affect the relation between financial ties and study outcomes (odds ratio 3.37, 1

  17. Child incarceration and long-term adult health outcomes: a longitudinal study.

    Science.gov (United States)

    Barnert, Elizabeth S; Abrams, Laura S; Tesema, Lello; Dudovitz, Rebecca; Nelson, Bergen B; Coker, Tumaini; Bath, Eraka; Biely, Christopher; Li, Ning; Chung, Paul J

    2018-03-12

    Purpose Although incarceration may have life-long negative health effects, little is known about associations between child incarceration and subsequent adult health outcomes. The paper aims to discuss this issue. Design/methodology/approach The authors analyzed data from 14,689 adult participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health) to compare adult health outcomes among those first incarcerated between 7 and 13 years of age (child incarceration); first incarcerated at>or=14 years of age; and never incarcerated. Findings Compared to the other two groups, those with a history of child incarceration were disproportionately black or Hispanic, male, and from lower socio-economic strata. Additionally, individuals incarcerated as children had worse adult health outcomes, including general health, functional limitations (climbing stairs), depressive symptoms, and suicidality, than those first incarcerated at older ages or never incarcerated. Research limitations/implications Despite the limitations of the secondary database analysis, these findings suggest that incarcerated children are an especially medically vulnerable population. Practical implications Programs and policies that address these medically vulnerable children's health needs through comprehensive health and social services in place of, during, and/or after incarceration are needed. Social implications Meeting these unmet health and social service needs offers an important opportunity to achieve necessary health care and justice reform for children. Originality/value No prior studies have examined the longitudinal relationship between child incarceration and adult health outcomes.

  18. Developmental outcome at 18 and 24 months of age in very preterm children: a cohort study from 1996 to 1997

    NARCIS (Netherlands)

    Stoelhorst, Gerlinde M. S. J.; Rijken, Monique; Martens, Shirley E.; van Zwieten, Paul H. T.; Feenstra, J.; Zwinderman, Aeilko H.; Wit, Jan Maarten; Veen, Sylvia

    2003-01-01

    Objective: To determine the effect of prematurity (gestational age (GA) <32 weeks) on developmental outcome at the corrected age of 18 and 24 months in a regionally defined, prospective cohort study. Study design: The Leiden Follow-Up Project on Prematurity (LFUPP) includes all liveborn infants <32

  19. Design Study for Pulsed Proton Beam Generation

    Directory of Open Access Journals (Sweden)

    Han-Sung Kim

    2016-02-01

    Full Text Available Fast neutrons with a broad energy spectrum, with which it is possible to evaluate nuclear data for various research fields such as medical applications and the development of fusion reactors, can be generated by irradiating proton beams on target materials such as beryllium. To generate short-pulse proton beam, we adopted a deflector and slit system. In a simple deflector with slit system, most of the proton beam is blocked by the slit, especially when the beam pulse width is short. Therefore, the available beam current is very low, which results in low neutron flux. In this study, we proposed beam modulation using a buncher cavity to increase the available beam current. The ideal field pattern for the buncher cavity is sawtooth. To make the field pattern similar to a sawtooth waveform, a multiharmonic buncher was adopted. The design process for the multiharmonic buncher includes a beam dynamics calculation and three-dimensional electromagnetic simulation. In addition to the system design for pulsed proton generation, a test bench with a microwave ion source is under preparation to test the performance of the system. The design study results concerning the pulsed proton beam generation and the test bench preparation with some preliminary test results are presented in this paper.

  20. Quantitative methods for studying design protocols

    CERN Document Server

    Kan, Jeff WT

    2017-01-01

    This book is aimed at researchers and students who would like to engage in and deepen their understanding of design cognition research. The book presents new approaches for analyzing design thinking and proposes methods of measuring design processes. These methods seek to quantify design issues and design processes that are defined based on notions from the Function-Behavior-Structure (FBS) design ontology and from linkography. A linkograph is a network of linked design moves or segments. FBS ontology concepts have been used in both design theory and design thinking research and have yielded numerous results. Linkography is one of the most influential and elegant design cognition research methods. In this book Kan and Gero provide novel and state-of-the-art methods of analyzing design protocols that offer insights into design cognition by integrating segmentation with linkography by assigning FBS-based codes to design moves or segments and treating links as FBS transformation processes. They propose and test ...

  1. Outcome study of brief relational-cultural therapy in a women's mental health center.

    Science.gov (United States)

    Oakley, M Anne; Addison, Shirley C; Piran, Niva; Johnston, Gary J; Damianakis, Mary; Curry, Joyce; Dunbar, Christine; Weigeldt, Almuth

    2013-01-01

    The current study is the first to evaluate the effectiveness of a brief relational-cultural model of therapy in a community-based mental health center for women. The study was distinctive in its use of a hybrid model that employed elements of randomized control and naturalistic design. Results showed that the entire treatment group of 91 women improved significantly on all eight outcome measures. Therapeutic gains were maintained at 3- and 6-month follow-ups. The results lend support to the importance of including relational-cultural factors in the treatment of women. An adherence scale/manual was developed and implemented and will allow for replication.

  2. A within-country study of leadership perceptions and outcomes across native and immigrant employees

    DEFF Research Database (Denmark)

    Holten, Ann-Louise; Bøllingtoft, Anne; Carneiro, Isabella Gomes

    2017-01-01

    This study investigates the universality of transformational leadership with respect to employee perceptions and three outcomes: job satisfaction, self-rated health, and well-being. We do so among employees of different national and cultural backgrounds, yet within a shared national and sectorial...... setting. Our study has a repeated measures design based on survey data from 2,947 employees (2,836 natives Danes and 111 immigrants) in the Danish elder care sector. While we find no difference between native Danes and immigrants in their perception of transformational leadership, we find...

  3. Adaptive designs for dose-finding in non-cancer phase II trials: influence of early unexpected outcomes.

    Science.gov (United States)

    Resche-Rigon, Matthieu; Zohar, Sarah; Chevret, Sylvie

    2008-01-01

    In non-cancer phase II trials, dose-finding trials are usually carried out using fixed designs, in which several doses including a placebo are randomly distributed to patients. However, in certain vulnerable populations, such as neonates or infants, there is an heightened requirement for safety, precluding randomization. To estimate the minimum effective dose of a new drug from a non-cancer phase II trial, we propose the use of adaptive designs like the Continual Reassessment Method (CRM). This approach estimates the dose closest to some target response, and has been shown to be unbiased and efficient in cancer phase I trials. Based on a motivating example, we point out the individual influence of first outliers in this setting. A weighted version of the CRM is proposed as a theoretical benchmark to control for these outliers. Using simulations, we illustrate how this approach provides further insight into the behavior of the CRM. When dealing with low targets like a 10% failure rate, the CRM appears unable to rapidly overcome an early unexpected outcome. This behavior persisted despite changing the inference (Bayesian or likelihood), underlying dose-response model (though slightly improved using the power model), and the number of patients enrolled at each dose level. The choices for initial guesses of failure rates, the vague prior for the model parameter, and the log-log shape of weights can appear somewhat arbitrary. In phase II dose-finding studies in which failure targets are below 20%, the CRM appears quite sensitive to first unexpected outcomes. Using a power model for dose-response improves some behavior if the trial is started at the first dose level and includes at least three to five patients at the starting dose before applying the CRM allocation rule.

  4. Building a Bridge Between Genetics and Outcomes Research: Application in Autism (The AutGO Study).

    Science.gov (United States)

    Talebizadeh, Zohreh; Shah, Ayten

    2018-03-05

    Concerns over the need to improve translational aspects of genetics research studies and engaging community members in the research process have been noted in the literature and raised by patient advocates. In addition to the work done by patient advocacy groups, organizations such as the Patient-Centered Outcomes Research Institute advocate for a change in the culture of research from being researcher-driven to becoming more patient-driven. Our project, Autism Genetics and Outcomes (AutGO), consists of two phases. The goal for phase I was to initiate a general discussion around the main topic (i.e., linking genetics and outcomes research). We used the Patient-Centered Outcomes Research Institute engagement approach to: (aim 1) develop a partnership with a wide range of stakeholders to assess their perspective on developing projects that use both genetics and outcomes research data/principles; (aim 2) identify barriers, facilitators, and needs to promote engagement in patient-centered genetics research; and (aim 3) distill and describe actions that may facilitate utilization of patient/parent perspectives in designing genetics research studies. In phase I, we formed a community advisory board composed of 33 participants, including outcomes and genetics researchers, clinicians, healthcare providers, patients/family members, and community/industry representatives, and convened six sessions over the 12-month period. We structured the sessions as a combination of online PowerPoint presentations, surveys, and in-person group discussions. During the sessions, we discussed topics pertaining to linking genetics and outcomes research and reviewed relevant materials, including patient stories, research projects, and existing resources. Two sets of surveys, project evaluations (k = 2) and session evaluations (k = 6), were distributed among participants. Feedback was analyzed using content analysis strategies to identify the themes and subthemes. Herein, we describe: the

  5. The Chiasmus of Design: Paradoxical Outcomes in the e-Government Reform of UK Children's Services

    Science.gov (United States)

    Wastell, David; White, Sue; Broadhurst, Karen

    This paper describes a detailed ethnographic study of the design problems of a major national IT system in the UK- The Integrated Children’s System (ICS). The implementation of the ICS has disrupted social work practice and engendered growing professional resistance, prompting a fundamental review of its design. Marshall McLuhan’s concept of chiasmus is a central feature of our analysis of the vicissitudes of ICS. Chiasmus refers to the tendency of any system, when pushed too far, to produce unintended contradictory effects, and is an intrinsic feature of the behaviour of complex, socio-technical systems. The dysfunctions of the ICS provide a pertinent, large-scale example. The ICS constitutes an attempt, via technological means, to re-organize child welfare services in the UK. Whilst aimed at improving child safety, the ICS has had the opposite effect of increasing the potential for error. This chiasmus has been exposed through the multi-site ethnography reported here, which shows how rigidly designed processes, enforced by IT systems, force social work professionals into unsafe investigative and recording practices which increase the risk of errors. The paper ends by proposing an alternative approach to design, based on socio-technical precepts, emphasizing the principles of minimum critical specification, user-centeredness and local autonomy.

  6. The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods.

    Science.gov (United States)

    Kaplan, Bonnie J; Giesbrecht, Gerald F; Leung, Brenda M Y; Field, Catherine J; Dewey, Deborah; Bell, Rhonda C; Manca, Donna P; O'Beirne, Maeve; Johnston, David W; Pop, Victor J; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P; Eliasziw, Misha; McCargar, Linda J; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M; Letourneau, Nicole; Martin, Jonathan W

    2014-01-01

    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration. © 2012 John Wiley & Sons Ltd.

  7. Interim report on the tandem mirror hybrid design study

    International Nuclear Information System (INIS)

    Moir, R.W.

    1979-01-01

    The initial phase of a 2-year design study of a tandem mirror fusion reactor is presented. The following chapters are included: (1) mechanical design of the plant; (2) plasma physics; (3) blanket design; (4) magnet design; (5) injector design; (6) direct convertor design; (7) balance of plant design; (8) fission burner reactor; (9) environment and safety; and (10) economic analysis

  8. Design and analysis of biomedical studies

    DEFF Research Database (Denmark)

    Hansen, Merete Kjær

    been allocated this field. It is utterly important to utilize these ressources responsibly and efficiently by constantly striving to ensure high-quality biomedical studies. This involves the use of a sound statistical methodology regarding both the design and analysis of biomedical studies. The focus...... have conducted a literature study strongly indicating that this structure commonly is neglected in the statistical analysis. Based on this closed-form expressions for the approximate type I error rate are formulated. The type I error rates are assessed for a number of factor combinations as they appear...... in practice and in all cases the type I error rates are demonstrated to be severely inflated. Prior to conducting a study it is important to perform power and sample size determinations to ensure that reliable conclusions can be drawn from the statistical analysis. We have formulated closed-form expressions...

  9. Preliminary Systems Design Study assessment report

    International Nuclear Information System (INIS)

    Mayberry, J.L.; Feizollahi, F.; Del Signore, J.C.

    1992-01-01

    The System Design Study (SDS), part of the Waste Technology Development Department at the Idaho National Engineering Laboratory (INEL), examined techniques available for the remediation of hazardous and transuranic waste stored at the Radioactive Waste Management Complex's Subsurface Disposal Area at the INEL. Using specific technologies, system concepts for treating the buried waste and the surrounding contaminated soil were evaluated. Evaluation included implementability, effectiveness, and cost. The SDS resulted in the development of technology requirements including demonstration, testing, and evaluation activities needed for implementing each concept. This volume of the Systems Design Study contain four Appendixes that were part of the study. Appendix A is an EG ampersand G Idaho, Inc., report that represents a review and compilation of previous reports describing the wastes and quantities disposed in the Subsurface Disposal Area of the Idaho National Engineering Laboratory. Appendix B contains the process flowsheets considered in this study, but not selected for detailed analysis. Appendix C is a historical tabulation of radioactive waste incinerators. Appendix D lists Department of Energy facilities where cementation stabilization systems have been used

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

    Science.gov (United States)

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

    2017-06-01

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

  11. Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study

    DEFF Research Database (Denmark)

    Jensen, Dorte; Damm, Peter; Moelsted-Pedersen, Lars

    2004-01-01

    The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population.......The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population....

  12. VXIbus data collection system -- A design study

    International Nuclear Information System (INIS)

    Hacker, U.; Richter, B.; Weinert, A.; Arlt, R.; Lewis, W.; Swinhoe, M.

    1995-01-01

    The German support program has sponsored the work to investigate the VXIbus as integration platform for safeguards instrumentation. This paper will cover the analysis of the user requirements for a VXIbus based monitoring system for integrated safeguards -- primarily for reliable unattended in-field collection of large amounts of data. The goal is to develop a suitable system architecture. The design of the system makes use of the VXIbus standard as the selected hardware platform Based upon the requirement analysis and the overriding need for high reliability and robustness, a systematic investigation of different operating system options, as well as development and integration tools will be considered. For the software implementation cycle high and low level programming tools are required. The identification of the constraints for the programming platform and the tool selection will be presented. Both the strategic approach, the rules for analysis and design work as well as the executive components for the support of the implementation and production cycle are given. Here all the conditions for reliable, unattended and integrated safeguards monitoring systems will be addressed. The definition of the basic and advanced design principles are covered. The paper discusses the results of a study on a system produced to demonstrate a high data rate timer/counter application

  13. Outcomes of tuberculous meningitis in children: a case review study

    Directory of Open Access Journals (Sweden)

    Yazid Dimyati

    2011-10-01

    Conclusions Tuberculous meningitis starts with nonspecific symptoms and is often only diagnosed when brain damage has already occurred. Outcome is directly associated with age and the stage of tuberculous meningitis. Earlier diagnosis may significantly improve outcomes. [Paediatr Indones. 2011;51:288-93].

  14. Autogenic training: a meta-analysis of clinical outcome studies.

    Science.gov (United States)

    Stetter, Friedhelm; Kupper, Sirko

    2002-03-01

    Autogenic training (AT) is a self-relaxation procedure by which a psychophysiological determined relaxation response is elicited. A meta-analysis was performed to evaluate the clinical effectiveness of AT. Seventy-three controlled outcome studies were found (published 1952-99). Sixty studies (35 randomized controlled trials [RCT]) qualified for inclusion in the meta-analysis. Medium-to-large effect sizes (ES) occurred for pre-post comparisons of disease-specific AT-effects, with the RCTs showing larger ES. When AT was compared to real control conditions, medium ES were found. Comparisons of AT versus other psychological treatment mostly resulted in no effects or small negative ES. This pattern of results was stable at follow-up. Unspecific AT-effects (i.e., effects on mood, cognitive performance, quality of life, and physiological variables) tended to be even larger than main effects. Separate meta-analyses for different disorders revealed a significant reduction of the heterogeneity of ES. Positive effects (medium range) of AT and of AT versus control in the meta-analysis of at least 3 studies were found for tension headache/migraine, mild-to-moderate essential hypertension, coronary heart disease, asthma bronchiale, somatoform pain disorder (unspecified type), Raynaud's disease, anxiety disorders, mild-to-moderate depression/dysthymia, and functional sleep disorders.

  15. Fuel pin design algorithm for conceptual design studies

    International Nuclear Information System (INIS)

    Uselman, J.P.

    1979-01-01

    Two models are available which are currently verified by part of the requirements and which are adaptable as algorithms for the complete range. Fuel thermal performance is described by the HEDL SIEX model. Cladding damage and total deformation are determined by the GE GRO-II structural analysis code. A preliminary fuel pin performance model for analysis of (U, P/sub U/)O 2 pins in the COROPT core conceptual design system has been constructed by combining the key elements of SIEX and GRO-II. This memo describes the resulting pin performance model and its interfacing with COROPT system. Some exemplary results are presented

  16. Protecting count queries in study design.

    Science.gov (United States)

    Vinterbo, Staal A; Sarwate, Anand D; Boxwala, Aziz A

    2012-01-01

    Today's clinical research institutions provide tools for researchers to query their data warehouses for counts of patients. To protect patient privacy, counts are perturbed before reporting; this compromises their utility for increased privacy. The goal of this study is to extend current query answer systems to guarantee a quantifiable level of privacy and allow users to tailor perturbations to maximize the usefulness according to their needs. A perturbation mechanism was designed in which users are given options with respect to scale and direction of the perturbation. The mechanism translates the true count, user preferences, and a privacy level within administrator-specified bounds into a probability distribution from which the perturbed count is drawn. Users can significantly impact the scale and direction of the count perturbation and can receive more accurate final cohort estimates. Strong and semantically meaningful differential privacy is guaranteed, providing for a unified privacy accounting system that can support role-based trust levels. This study provides an open source web-enabled tool to investigate visually and numerically the interaction between system parameters, including required privacy level and user preference settings. Quantifying privacy allows system administrators to provide users with a privacy budget and to monitor its expenditure, enabling users to control the inevitable loss of utility. While current measures of privacy are conservative, this system can take advantage of future advances in privacy measurement. The system provides new ways of trading off privacy and utility that are not provided in current study design systems.

  17. Preliminary systems design study assessment report

    International Nuclear Information System (INIS)

    Mayberry, J.L.; Feizollahi, F.; Del Signore, J.C.

    1991-09-01

    The System Design Study (SDS), part of the Waste Technology Development Department at the Idaho National Engineering Laboratory (INEL), examined techniques available for the remediation of hazardous and transuranic waste stored at the Radioactive Waste Management Complex's Subsurface Disposal Area at the INEL. Using specific technologies, system concepts for treating the buried waste and the surrounding contaminated soil were evaluated. Evaluation included implementability, effectiveness, and cost. The SDS resulted in the development of technology requirements including demonstration, testing, and evaluation activities needed for implementing each concept

  18. SP-100 radiator design trade study

    International Nuclear Information System (INIS)

    Ewell, R.

    1992-01-01

    This paper reports on a design trade study of the SP-100 heat rejection subsystem (HRSS) which was made. A system code was used to evaluate the sensitivity of the HRSS mass and performance to changes. Variations in heat pipe diameter and cross-section, fin length and thickness, armor thickness, and overall configuration and materials were evaluated. The analysis indicates that the minimum system mass occurs for the case with many small diameter heat pipes, with ducting that maximizes the fraction of the heat pipe evaporator perimeter in contract with it

  19. Design studies of the LHC beam dump

    CERN Document Server

    Zazula, J M

    1997-01-01

    This paper is a compilation of the results of the recent 5 years studies of the beam dump system for the LHC proton collider at CERN, with a special emphasis on feasibility of the central absorber. Simulations of energy deposition by particle cascades, optimisation of the beam sweeping system and core layout, and thermal analysis have been completed; the structural deformation, stress and vibration analyses are well advanced, and a new concept of the shielding design has recently been approved. The material characteristics, geometry, performance parameters and safety precautions for different components of the beam dump are actually close to completion, which augurs well for the start of construction work according to schedule.

  20. A study of labour outcome in breech delivery

    Directory of Open Access Journals (Sweden)

    Suman Budania

    2017-01-01

    Full Text Available Aim: Breech is the most common form of malpresentation. It is defined as when foetus occupies a longitudinal lie with the pelvic extremity at the pelvic brim and head at the fundus of the uterus. The present study was conducted on 100 cases of breech presentation to find out the labour outcome in breech deliveries and various factors affecting it. Materials and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Umaid Hospital, attached to Dr. S.N. Medical College, Jodhpur. A total of 100 cases of breech presentation including single as well as plural pregnancies in which one or more foetuses were presenting as breech were taken. Both booked and unbooked cases in primigravidae and multigravidae were studied. The cases were selected at random among those who got admitted in labour room. Results: In the present series, incidence of breech deliveries came to be 4.1094%. Incidence of breech presentation was maximum (45% in the age group of 21–25 years. In this study, out of 100 cases, 62 were multigravidae and 38 were primigravidae, and 43 cases (43% were associated with factors which endanger of life of the foetus, among which twin pregnancy and pre-eclamptic toxaemia were the most commonly associated factors. In the present series, among 100 cases studied, 14 were breech babies and congenital malformation, of which hydrocephalus was the most common malformation found. Conclusion: The study concludes that prematurity is associated with high incidence of breech presentation. The most common variety of breech presentation is flexed breech, which is found more in multigravidae. Caesarean section is the mode of delivery of choice as it carries minimal foetal loss. Extended variety of breech is safest for the baby and carries minimal foetal loss.

  1. STUDY OF MATERNAL AND FOETAL OUTCOME IN TWIN PREGNANCY

    Directory of Open Access Journals (Sweden)

    Burri Sandhya Rani

    2018-01-01

    Full Text Available BACKGROUND In comparison to singleton pregnancies, twin pregnancies are considered a high risk pregnancies associated with perinatal mortalities and maternal morbidities due to unnecessary use of ovulation induced drugs. The aim of the study is to evaluate the maternal and foetal outcomes in twin gestations and to find the various factors that contribute to adverse perinatal outcome. MATERIALS AND METHODS This study was carried out in Laxmi Narasimha Hospital, Warangal, Hanamkonda, Telangana, an over a period of May 2015 to August 2016. RESULTS Most of the women were in their fertile age i.e. in between 20-30 years of age (86.6%. In both primigravida and multigravidas, the twins were equal. Preterm labour complications were seen in 88.8% of the patients and PIH was seen in 11.2% of the patients. Anaemia was the most common mal-presentation seen in the patients which constituted to 33.3%. Number of patients who underwent mode of delivery through spontaneous vaginal section were 60 which constituted 66.7%, caesarean section were 25 which constituted 27.7%, instrumental vaginal section were 5 which constituted 5.6%. The number of patients who had the foetal birth weight 2000 grams were 55 which constituted 30.6%. The number of male babies were 110 (61.1% and female babies were 70 (38.9%. Number of live births were 170 (94.4%, still births were 10 (5.6%. Number of patients admitted in ICU were 100 (55.6%, Neonatal morbidity was seen in 38 patients (21.1%, neonatal mortality was seen in 10 patients (5.6%. The most common cause of neonatal death was septicaemia followed by respiratory distress, pulmonary distress and DIC. CONCLUSION This study concluded that deaths were majorly due to extremely premature and very low birth weight babies. These babies had septicaemia or respiratory distress. By averting pre-term births, by taking good rest, cervical encerclage, when incompetence is suspected, short term tocolysis, prevention of anaemia and pre

  2. Study Of Lampungnese Traditional Home Garden Design

    Science.gov (United States)

    Pratiwi, R. A.; Gunawan

    2017-10-01

    Lampung is one area in Indonesia which has a traditional culture that comes from two groups of descents, they are ulun Lampung Pepadun and ulun Lampung Saibatin. Lampungnese traditional culture has been well-known by Indonesian people for its traditional dances, traditional clothing, or traditional home architecture. However, Lampungnese traditional home garden recently may not yet been described. Information related to Lampungnese traditional home garden is still very limited and it does not yet represented the culture based design concept. This research was directed to identify the elements of the home garden and map it into design concept of the Lampungnese traditional home garden based on information of Lampungnese traditional culture. The study was conducted by using descriptive approach through literature review, interviews and cultural exploration, as well as field observation. The study was able to identify the elements forming the Lampungnese traditional home garden, namely gakhang hadap, walai, outdoor kitchenette, firewood place, outdoor kitchen, livestock barns, as well as plants. Space layout of the home garden comprises front yard (tengahbah/terambah/beruan), side yard (kebik/kakebik), and backyard (kudan/juyu/kebon). Each element of the garden is located in the right place of the space layout.

  3. A quasi-experimental design based on regional variations: discussion of a method for evaluating outcomes of medical practice

    DEFF Research Database (Denmark)

    Loft, A; Andersen, T F; Madsen, Mette

    1989-01-01

    A large proportion of common medical practices are subject to substantial regional variation resulting in numerous natural experiments. Opportunities are thereby provided for outcome evaluation through quasi-experimental design. If patients treated in different regions were comparable a natural...... experiment involving alternative treatments could be regarded as 'pseudo randomised', but empirical investigations are needed to verify this prerequisite. This paper discusses the role of quasi-experimental designs in assessment of medical care with evaluation of outcomes after hysterectomy in Denmark...... groups are elicited from administrative data. We conclude that it is possible to establish a quasi-experimental design based on regional variations and that the comparability of the groups included may be assessed through registry data. The importance of technology diffusion for the prospects...

  4. Design study of the compact ERL

    International Nuclear Information System (INIS)

    Hajima, Ryoichi; Nakamura, Norio; Sakanaka, Shogo; Kobayashi, Yukinori

    2008-02-01

    Energy-recovery linac (ERL) is a promising device for future X-ray light sources, which can produce coherent X-rays and femto-second X-ray pulses. In Japan, we have organized a collaboration team, consisting of the members of KEK, JAEA, ISSP and other laboratories, toward realization of future ERL light sources, and started R and D efforts to establish accelerator technologies relevant to the ERL light source. In order to demonstrate all the accelerator technologies working together, we have decided to build a small facility, the Compact ERL. This report presents a design study of the Compact ERL, which includes R and D issues for each accelerator component, studies on the beam dynamics, performance of the Compact ERL as a light source of THz and X-ray. (author)

  5. Low activation diagnostic equipment design studies

    International Nuclear Information System (INIS)

    Hopkins, G.R.; Cheng, E.T.; Fisher, R.K.

    1985-01-01

    The low activation fusion concept has been applied to the diagnostic equipment in a fusion reactor. The components where fabrication from low activation materials is feasible have been identified. Other systems where higher activation elements are required can have their activation reduced by design approaches which include shielding and operation only in low flux regions of the reactor. Some components will not operate in a high flux so activation is not a major concern. This low activation diagnostic equipment study completes a series of low activation studies where all the components in a fusion power reactor have now been evaluated. It is concluded that a completely low activation fusion reactor is feasible with all components meeting the functional requirements. This provides an environmentally benign energy source with a high confidence level in meeting safety criteria in operation, maintenance and waste disposal

  6. DEMO port plug design and integration studies

    Science.gov (United States)

    Grossetti, G.; Boccaccini, L. V.; Cismondi, F.; Del Nevo, A.; Fischer, U.; Franke, T.; Granucci, G.; Hernández, F.; Mozzillo, R.; Strauß, D.; Tran, M. Q.; Vaccaro, A.; Villari, R.

    2017-11-01

    The EUROfusion Consortium established in 2014 and composed by European Fusion Laboratories, and in particular the Power Plant Physics and Technology department aims to develop a conceptual design for the Fusion DEMOnstration Power Plant, DEMO. With respect to present experimental machines and ITER, the main goals of DEMO are to produce electricity continuously for a period of about 2 h, with a net electrical power output of a few hundreds of MW, and to allow tritium self-sufficient breeding with an adequately high margin in order to guarantee its planned operational schedule, including all planned maintenance intervals. This will eliminate the need to import tritium fuel from external sources during operations. In order to achieve these goals, extensive engineering efforts as well as physics studies are required to develop a design that can ensure a high level of plant reliability and availability. In particular, interfaces between systems must be addressed at a very early phase of the project, in order to proceed consistently. In this paper we present a preliminary design and integration study, based on physics assessments for the EU DEMO1 Baseline 2015 with an aspect ratio of 3.1 and 18 toroidal field coils, for the DEMO port plugs. These aim to host systems like electron cyclotron heating launchers currently developed within the Work Package Heating and Current Drive that need an external radial access to the plasma and through in-vessel systems like the breeder blanket. A similar approach shown here could be in principle followed by other systems, e.g. other heating and current drive systems or diagnostics. The work addresses the interfaces between the port plug and the blanket considering the helium-cooled pebble bed and the water cooled lithium lead which are two of four breeding blanket concepts under investigation in Europe within the Power Plant Physics and Technology Programme: the required openings will be evaluated in terms of their impact onto the

  7. A systematic review of protocol studies on conceptual design cognition: design as search and exploration

    OpenAIRE

    Hay, Laura; Duffy, Alex H.B.; McTeague, Chris; Pidgeon, Laura M.; Vuletic, Tijana; Grealy, Madeleine

    2017-01-01

    This paper reports findings from the first systematic review of protocol studies focusing specifically on conceptual design cognition, aiming to answer the following research question: What is our current understanding of the cognitive processes involved in conceptual design tasks carried out by individual designers? We reviewed 47 studies on architectural design, engineering design and product design engineering. This paper reports 24 cognitive processes investigated in a subset of 33 studie...

  8. Randomised studies of income supplementation: a lost opportunity to assess health outcomes.

    Science.gov (United States)

    Connor, J; Rodgers, A; Priest, P

    1999-11-01

    Despite the wealth of evidence linking low income to ill health, there is little information from randomised studies on how much and how quickly these risks can be reversed by improvements in income. To conduct a systematic review of randomised studies of income supplementation, with particular reference to health outcomes. Extensive searches of electronic databases and contact with previous authors. As well as searching for trials that were specifically designed to assess the effects of increased income, studies of winners and losers of lotteries were also sought: if winning is purely chance, such studies are, in effect, randomised trials of increased income. Ten relevant studies were identified, all conducted in North America, mostly in the late 1960s and 1970s. Five trials were designed to assess the effects of income supplementation on workforce participation and randomised a total of 10,000 families to 3-5 years of various combinations of minimum income guarantees and reduced tax rates. Two trials were designed to assess re-offending rates in recently released prisoners and randomised a total of 2400 people to 3-6 months of benefits. One trial was designed to assess housing allowances and randomised 3500 families to three years of income supplements. One trial assessed the health effects of 12 months of income supplementation in 54 people with severe mental illness. Finally, one study compared three groups of people who won different amounts of money in a state lottery. In all these studies the interventions resulted in increases in income of at least one fifth. However, no reliable analyses of health outcome data are available. Extensive opportunities to reliably assess the effects of increases in income on health outcomes have been missed. Such evidence might have increased the consideration of potential health effects during deliberations about policies that have major implications for income, such as taxation rates, benefit policies, and minimum wage

  9. Meta-analysis of studies comparing oncologic outcomes of radical prostatectomy and brachytherapy for localized prostate cancer.

    Science.gov (United States)

    Cozzi, Gabriele; Musi, Gennaro; Bianchi, Roberto; Bottero, Danilo; Brescia, Antonio; Cioffi, Antonio; Cordima, Giovanni; Delor, Maurizio; Di Trapani, Ettore; Ferro, Matteo; Matei, Deliu Victor; Russo, Andrea; Mistretta, Francesco Alessandro; De Cobelli, Ottavio

    2017-11-01

    The aim of this study was to compare oncologic outcomes of radical prostatectomy (RP) with brachytherapy (BT). A literature review was conducted according to the 'Preferred reporting items for systematic reviews and meta-analyses' (PRISMA) statement. We included studies reporting comparative oncologic outcomes of RP versus BT for localized prostate cancer (PCa). From each comparative study, we extracted the study design, the number and features of the included patients, and the oncologic outcomes expressed as all-cause mortality (ACM), PCa-specific mortality (PCSM) or, when the former were unavailable, as biochemical recurrence (BCR). All of the data retrieved from the selected studies were recorded in an electronic database. Cumulative analysis was conducted using the Review Manager version 5.3 software, designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK). Statistical heterogeneity was tested using the Chi-square test. Our cumulative analysis did not show any significant difference in terms of BCR, ACM or PCSM rates between the RP and BT cohorts. Only three studies reported risk-stratified outcomes of intermediate- and high-risk patients, which are the most prone to treatment failure. our analysis suggested that RP and BT may have similar oncologic outcomes. However, the analysis included a limited number of studies, and most of them were retrospective, making it impossible to derive any definitive conclusion, especially for intermediate- and high-risk patients. In this scenario, appropriate urologic counseling remains of utmost importance.

  10. The design briefing process matters: a case study on telehealthcare device providers in the UK.

    Science.gov (United States)

    Yang, Fan; Renda, Gianni

    2018-01-23

    The telehealthcare sector has been expanding steadily in the UK. However, confusing, complex and unwieldy designs of telehealthcare devices are at best, less effective than they could be, at worst, they are potentially dangerous to the users. This study investigated the factors within the new product development process that hindered satisfactory product design outcomes, through working collaboratively with a leading provider based in the UK. This study identified that there are too many costly late-stage design changes; a critical and persistent problem area ripe for improvement. The findings from analyzing 30 recent devices, interviewing key stakeholders and observing on-going projects further revealed that one major cause of the issue was poor practice in defining and communicating the product design criteria and requirements. Addressing the characteristics of the telehealthcare industry, such as multiple design commissioners and frequent deployment of design subcontracts, this paper argues that undertaking a robust process of creating the product design brief is the key to improving the outcomes of telehealthcare device design, particularly for the small and medium-sized enterprises dominating the sector. Implications for rehabilitation Product design criteria and requirements are frequently ill-defined and ineffectively communicated to the designers within the processes of developing new telehealthcare devices. The absence of a (robust) process of creating the design brief is the root cause of the identified issues in defining and communicating the design task. Deploying a formal process of creating the product design brief is particularly important for the telehealthcare sector.

  11. The Ahmed versus Baerveldt study: three-year treatment outcomes.

    Science.gov (United States)

    Christakis, Panos G; Tsai, James C; Kalenak, Jeffrey W; Zurakowski, David; Cantor, Louis B; Kammer, Jeffrey A; Ahmed, Iqbal I K

    2013-11-01

    To compare 2 commonly used aqueous drainage devices for the treatment of refractory glaucoma. International, multicenter, randomized trial. Patients aged 18 years or older with uncontrolled or high-risk glaucoma refractory to maximum medical therapy, many of whom had failed trabeculoplasty and trabeculectomy. Eligible patients were randomized to an Ahmed-FP7 valve implant (New World Medical, Inc., Rancho Cucamonga, CA) or a Baerveldt-350 implant (Abbott Medical Optics, Inc., Santa Ana, CA) using a standardized surgical technique. The primary outcome was failure, defined as intraocular pressure (IOP) outside of the target range (5-18 mmHg, with ≥20% reduction from baseline) for 2 consecutive visits after 3 months, vision-threatening complications, de novo glaucoma procedures, or loss of light perception. Secondary outcome measures include IOP, medication use, visual acuity, complications, and interventions. A total of 238 patients were enrolled and randomized; 124 received the Ahmed implant and 114 received the Baerveldt implant. Baseline characteristics were similar in both groups. Half the study group had secondary glaucoma, and 37% had previously failed trabeculectomy. The mean preoperative IOP was 31.4±10.8 mmHg on 3.1±1.0 glaucoma medications. Median baseline Snellen visual acuity was 20/100. At 3 years, the cumulative probability of failure was 51% in the Ahmed group and 34% in the Baerveldt group (P = 0.03). Mean IOP was 15.7±4.8 mmHg in the Ahmed group (49% reduction) and 14.4±5.1 mmHg in the Baerveldt group (55% reduction; P = 0.09). Mean number of glaucoma medications was 1.8±1.4 in the Ahmed group (42% reduction) and 1.1±1.3 in the Baerveldt group (65% reduction; P = 0.002). There was a moderate but similar decrease in visual acuity in both groups (PAhmed, 62% Baerveldt; P = 0.12); however, the Baerveldt group had a higher rate of hypotony-related vision-threatening complications (0% Ahmed, 6% Baerveldt; P = 0.005). More interventions were

  12. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study

    DEFF Research Database (Denmark)

    Wood, L.; Egger, M.; Gluud, L.L.

    2008-01-01

    OBJECTIVE: To examine whether the association of inadequate or unclear allocation concealment and lack of blinding with biased estimates of intervention effects varies with the nature of the intervention or outcome. DESIGN: Combined analysis of data from three meta-epidemiological studies based o...

  13. Inertial Motion Capture Costume Design Study

    Directory of Open Access Journals (Sweden)

    Agnieszka Szczęsna

    2017-03-01

    Full Text Available The paper describes a scalable, wearable multi-sensor system for motion capture based on inertial measurement units (IMUs. Such a unit is composed of accelerometer, gyroscope and magnetometer. The final quality of an obtained motion arises from all the individual parts of the described system. The proposed system is a sequence of the following stages: sensor data acquisition, sensor orientation estimation, system calibration, pose estimation and data visualisation. The construction of the system’s architecture with the dataflow programming paradigm makes it easy to add, remove and replace the data processing steps. The modular architecture of the system allows an effortless introduction of a new sensor orientation estimation algorithms. The original contribution of the paper is the design study of the individual components used in the motion capture system. The two key steps of the system design are explored in this paper: the evaluation of sensors and algorithms for the orientation estimation. The three chosen algorithms have been implemented and investigated as part of the experiment. Due to the fact that the selection of the sensor has a significant impact on the final result, the sensor evaluation process is also explained and tested. The experimental results confirmed that the choice of sensor and orientation estimation algorithm affect the quality of the final results.

  14. Second Generation Waste Package Design Study

    International Nuclear Information System (INIS)

    Armijo, J.S.; Misra, M.; Kar, Piyush

    2007-01-01

    The following describes the objectives of Project Activity 023 ''Second Generation Waste Package Design Study'' under DOE Cooperative Agreement DE-FC28-04RW12232. The objectives of this activity are: to review the current YMP baseline environment and establish corrosion test environments representative of the range of dry to intermittently wet conditions expected in the drifts as a function of time; to demonstrate the oxidation and corrosion resistance of A588 weathering steel and reference Alloy 22 samples in the representative dry to intermittently dry conditions; and to evaluate backfill and design features to improve the thermal performance analyses of the proposed second-generation waste packages using existing models developed at the University of Nevada, Reno(UNR). The work plan for this project activity consists of three major tasks: Task 1. Definition of expected worst-case environments (humidity, liquid composition and temperature) at waste package outer surfaces as a function of time, and comparison with environments defined in the YMP baseline; Task 2. Oxidation and corrosion tests of proposed second-generation outer container material; and Task 3. Second Generation waste package thermal analyses. Full funding was not provided for this project activity

  15. Large Coil Program magnetic system design study

    International Nuclear Information System (INIS)

    Moses, S.D.; Johnson, N.E.

    1977-01-01

    The primary objective of the Large Coil Program (LCP) is to demonstrate the reliable operation of large superconducting coils to provide a basis for the design principles, materials, and fabrication techniques proposed for the toroidal magnets for the THE NEXT STEP (TNS) and other future tokamak devices. This paper documents a design study of the Large Coil Test Facility (LCTF) in which the structural response of the Toroidal Field (TF) Coils and the supporting structure was evaluated under simulated reactor conditions. The LCP test facility structural system consists of six TF Coils, twelve coil-to-coil torsional restraining beams (torque rings), a central bucking post with base, and a Pulse Coil system. The NASTRAN Finite Element Structural Analysis computer Code was utilized to determine the distribution of deflections, forces, and stresses for each of the TF Coils, torque rings, and the central bucking post. Eleven load conditions were selected to represent probable test operations. Pulse Coils suspended in the bore of the test coil were energized to simulate the pulsed field environment characteristic of the TNS reactor system. The TORMAC Computer Code was utilized to develop the magnetic forces in the TF Coils for each of the eleven loading conditions examined, with or without the Pulse Coils energized. The TORMAC computer program output forces were used directly as input load conditions for the NASTRAN analyses. Results are presented which demonstrate the reliability of the LCTF under simulated reactor operating conditions

  16. Next Step Spherical Torus Design Studies

    International Nuclear Information System (INIS)

    Neumeyer, C.; Heitzenroeder, P.; Kessel, C.; Ono, M.; Peng, M.; Schmidt, J.; Woolley, R.; Zatz, I.

    2002-01-01

    Studies are underway to identify and characterize a design point for a Next Step Spherical Torus (NSST) experiment. This would be a ''Proof of Performance'' device which would follow and build upon the successes of the National Spherical Torus Experiment (NSTX) a ''Proof of Principle'' device which has operated at PPPL since 1999. With the Decontamination and Decommissioning (DandD) of the Tokamak Fusion Test Reactor (TFTR) nearly completed, the TFTR test cell and facility will soon be available for a device such as NSST. By utilizing the TFTR test cell, NSST can be constructed for a relatively low cost on a short time scale. In addition, while furthering spherical torus (ST) research, this device could achieve modest fusion power gain for short-pulse lengths, a significant step toward future large burning plasma devices now under discussion in the fusion community. The selected design point is Q=2 at HH=1.4, P subscript ''fusion''=60 MW, 5 second pulse, with R subscript ''0''=1.5 m, A=1.6, I subscript ''p''=10vMA, B subscript ''t''=2.6 T, CS flux=16 weber. Most of the research would be conducted in D-D, with a limited D-T campaign during the last years of the program

  17. Study and Design of Differential Microphone Arrays

    CERN Document Server

    Benesty, Jacob

    2013-01-01

    Microphone arrays have attracted a lot of interest over the last few decades since they have the potential to solve many important problems such as noise reduction/speech enhancement, source separation, dereverberation, spatial sound recording, and source localization/tracking, to name a few. However, the design and implementation of microphone arrays with beamforming algorithms is not a trivial task when it comes to processing broadband signals such as speech. Indeed, in most sensor arrangements, the beamformer tends to have a frequency-dependent response. One exception, perhaps, is the family of differential microphone arrays (DMAs) that have the promise to form frequency-independent responses. Moreover, they have the potential to attain high directional gains with small and compact apertures. As a result, this type of microphone arrays has drawn much research and development attention recently. This book is intended to provide a systematic study of DMAs from a signal processing perspective. The primary obj...

  18. Preliminary systems design study assessment report

    International Nuclear Information System (INIS)

    Mayberry, J.L.; Feizollahi, F.; Del Signore, J.C.

    1992-01-01

    The System Design Study (SDS), part of the Waste Technology Development Department at the Idaho National Engineering Laboratory (INEL), examined techniques available for the remediation of hazardous and transuranic waste stored at the Radioactive Waste Management Complex's Subsurface Disposal Area at the INEL. Using specific technologies, system concepts for treating the buried waste and the surrounding contaminated soil were evaluated. Evaluation included implementability, effectiveness, and cost. The SDS resulted in the development of technology requirements including demonstration, testing, and evaluation activities needed for implementing each. This volume contains the descriptions and other relevant information of the four subsystems required for most of the ex situ processing systems. This volume covers the metal decontamination and sizing subsystem, soils processing subsystem, low-level waste subsystem, and retrieval subsystem

  19. Design study of prestressed rotor spar concept

    Science.gov (United States)

    Gleich, D.

    1980-01-01

    Studies on the Bell Helicopter 540 Rotor System of the AH-1G helicopter were performed. The stiffness, mass and geometric configurations of the Bell blade were matched to give a dynamically similar prestressed composite blade. A multi-tube, prestressed composite spar blade configuration was designed for superior ballistic survivability at low life cycle cost. The composite spar prestresses, imparted during fabrication, are chosen to maintain compression in the high strength cryogenically stretchformed 304-L stainless steel liner and tension in the overwrapped HTS graphite fibers under operating loads. This prestressing results in greatly improved crack propagation and fatigue resistance as well as enhanced fiber stiffness properties. Advantages projected for the prestressed composite rotor spar concept include increased operational life and improved ballistic survivability at low life cycle cost.

  20. Preliminary Systems Design Study assessment report

    International Nuclear Information System (INIS)

    Mayberry, J.L.; Quapp, W.J.; Feizollahi, F.; Del Signore, J.C.

    1991-07-01

    The System Design Study (SDS), part of the Waste Technology Development Department at Idaho National Engineering Laboratory (INEL), examined techniques available for the remediation of hazardous and transuranic (TRU) waste stored at the Radioactive Waste Management Complex's (RWMC's) Subsurface Disposal Area (SDA) at INEL. Using specific technologies, system concepts for treating the buried waste and the surrounding contaminated soil were evaluated. Evaluation included implementability, effectiveness, and cost. SDS resulted in the development of technology requirements including demonstration, testing and evaluation activities needed for implementing each concept. The SDS results are published in eight volumes. Volume 1 contains an executive summary. The SDS summary and analysis of results are presented in volume 2. Volumes 3 through 7 contain detailed descriptions of twelve system and four subsystem concepts. Volume 8 contains the appendices. 3 figs., 3 tabs

  1. Preliminary Systems Design Study assessment report

    International Nuclear Information System (INIS)

    Mayberry, J.L.; Quapp, W.J.; Feizollahi, F.; Del Signore, J.C.

    1991-07-01

    The System Design Study (SDS), part of the Waste Technology Development Department at the Idaho National Engineering Laboratory (INEL), examined techniques available for the remediation of hazardous and transuranic waste stored at the Radioactive Waste Management Complex's Subsurface Disposal Area at the INEL. Using specific technologies, system concepts for treating the buried waste and the surrounding contaminated soil were evaluated. Evaluation included implementability, effectiveness, and cost. SDS resulted in the development of technology requirements including demonstration, testing, and evaluation activities needed for implementing each concept. The SDS results are published in eight volumes. Volume 1 contains an executive summary. The SDS summary and analysis of results are presented in Volume 2. Volumes 3 through 7 contain detailed descriptions of twelve system and four subsystem concepts. Volume 8 contains the appendixes. 23 refs., 23 figs., 16 tabs

  2. Effect of Piroxicam on ART Outcome: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Farnaz Sohrabvand

    2014-11-01

    Full Text Available Background: One of the most important factors affecting success rates in assisted reproductive techniques (ART besides the number of oocytes retrieved and high quality embryos derived from them is the technical aspects of embryo transfer. It seems that pretreatement with uterine relaxants can be helpful in preventing unpleasant cramps which can have an adverse effect on ART outcome. In this respect, some drugs such as prostaglandin inhibitors or sedatives have been evaluated but not confirmed yet remain controversial. This study was performed in order to assess the effect of administrating Piroxicam prior to embryo transfer on pregnancy rates in ART cycles. Materials and Methods: This pilot study was performed from August 2010 through December 2011 on 50 infertile women in ART cycles. Recombinant follicle stimulating hormone (rFSH with a long gonadotropin releasing hormone (GnRH analogue protocol were used for controlled ovarian hyperstimulation. The subjects were randomly allocated into two groups of 25 patients after obtaining written consent. Group A received a 10 mg Piroxicam capsule 30 minutes before embryo transfer and group B was the control group with no treatment. Data were analyzed by Chi-square and analysis of variance (ANOVA. Results: Pregnancy rate was 34% (n=17 totally, with 32% (n=8 in group A and 36% (n=9 in group B (p=0.75. Uterine cramps were experienced by 4 women (16% in group B, while none were reported by women in group A (p=0.037. Conclusion: It seems that Piroxicam administration 30 minutes prior to embryo transfer cannot increase pregnancy rates, but can prevent or reduce uterine cramps after the procedure.

  3. Neurofeedback and biofeedback with 37 migraineurs: a clinical outcome study

    Directory of Open Access Journals (Sweden)

    Lappin Martha S

    2010-02-01

    Full Text Available Abstract Background Traditional peripheral biofeedback has grade A evidence for effectively treating migraines. Two newer forms of neurobiofeedback, EEG biofeedback and hemoencephalography biofeedback were combined with thermal handwarming biofeedback to treat 37 migraineurs in a clinical outpatient setting. Methods 37 migraine patients underwent an average of 40 neurofeedback sessions combined with thermal biofeedback in an outpatient biofeedback clinic. All patients were on at least one type of medication for migraine; preventive, abortive or rescue. Patients kept daily headache diaries a minimum of two weeks prior to treatment and throughout treatment showing symptom frequency, severity, duration and medications used. Treatments were conducted an average of three times weekly over an average span of 6 months. Headache diaries were examined after treatment and a formal interview was conducted. After an average of 14.5 months following treatment, a formal interview was conducted in order to ascertain duration of treatment effects. Results Of the 37 migraine patients treated, 26 patients or 70% experienced at least a 50% reduction in the frequency of their headaches which was sustained on average 14.5 months after treatments were discontinued. Conclusions All combined neuro and biofeedback interventions were effective in reducing the frequency of migraines with clients using medication resulting in a more favorable outcome (70% experiencing at least a 50% reduction in headaches than just medications alone (50% experience a 50% reduction and that the effect size of our study involving three different types of biofeedback for migraine (1.09 was more robust than effect size of combined studies on thermal biofeedback alone for migraine (.5. These non-invasive interventions may show promise for treating treatment-refractory migraine and for preventing the progression from episodic to chronic migraine.

  4. Neurofeedback and biofeedback with 37 migraineurs: a clinical outcome study

    Science.gov (United States)

    2010-01-01

    Background Traditional peripheral biofeedback has grade A evidence for effectively treating migraines. Two newer forms of neurobiofeedback, EEG biofeedback and hemoencephalography biofeedback were combined with thermal handwarming biofeedback to treat 37 migraineurs in a clinical outpatient setting. Methods 37 migraine patients underwent an average of 40 neurofeedback sessions combined with thermal biofeedback in an outpatient biofeedback clinic. All patients were on at least one type of medication for migraine; preventive, abortive or rescue. Patients kept daily headache diaries a minimum of two weeks prior to treatment and throughout treatment showing symptom frequency, severity, duration and medications used. Treatments were conducted an average of three times weekly over an average span of 6 months. Headache diaries were examined after treatment and a formal interview was conducted. After an average of 14.5 months following treatment, a formal interview was conducted in order to ascertain duration of treatment effects. Results Of the 37 migraine patients treated, 26 patients or 70% experienced at least a 50% reduction in the frequency of their headaches which was sustained on average 14.5 months after treatments were discontinued. Conclusions All combined neuro and biofeedback interventions were effective in reducing the frequency of migraines with clients using medication resulting in a more favorable outcome (70% experiencing at least a 50% reduction in headaches) than just medications alone (50% experience a 50% reduction) and that the effect size of our study involving three different types of biofeedback for migraine (1.09) was more robust than effect size of combined studies on thermal biofeedback alone for migraine (.5). These non-invasive interventions may show promise for treating treatment-refractory migraine and for preventing the progression from episodic to chronic migraine. PMID:20205867

  5. Improved Outcome Prediction Using CT Angiography in Addition to Standard Ischemic Stroke Assessment: Results from the STOPStroke Study

    Science.gov (United States)

    González, R. Gilberto; Lev, Michael H.; Goldmacher, Gregory V.; Smith, Wade S.; Payabvash, Seyedmehdi; Harris, Gordon J.; Halpern, Elkan F.; Koroshetz, Walter J.; Camargo, Erica C. S.; Dillon, William P.; Furie, Karen L.

    2012-01-01

    Purpose To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA). Methods In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as “major” by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores>10. Results Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS− (p10/BASIS+ compared to patients who are NIHSS≤10/BASIS−; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+. Conclusions BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment. PMID:22276182

  6. Bilateral Versus Unilateral Cochlear Implants in Children: A Study of Spoken Language Outcomes

    Science.gov (United States)

    Harris, David; Bennet, Lisa; Bant, Sharyn

    2014-01-01

    Objectives: Although it has been established that bilateral cochlear implants (CIs) offer additional speech perception and localization benefits to many children with severe to profound hearing loss, whether these improved perceptual abilities facilitate significantly better language development has not yet been clearly established. The aims of this study were to compare language abilities of children having unilateral and bilateral CIs to quantify the rate of any improvement in language attributable to bilateral CIs and to document other predictors of language development in children with CIs. Design: The receptive vocabulary and language development of 91 children was assessed when they were aged either 5 or 8 years old by using the Peabody Picture Vocabulary Test (fourth edition), and either the Preschool Language Scales (fourth edition) or the Clinical Evaluation of Language Fundamentals (fourth edition), respectively. Cognitive ability, parent involvement in children’s intervention or education programs, and family reading habits were also evaluated. Language outcomes were examined by using linear regression analyses. The influence of elements of parenting style, child characteristics, and family background as predictors of outcomes were examined. Results: Children using bilateral CIs achieved significantly better vocabulary outcomes and significantly higher scores on the Core and Expressive Language subscales of the Clinical Evaluation of Language Fundamentals (fourth edition) than did comparable children with unilateral CIs. Scores on the Preschool Language Scales (fourth edition) did not differ significantly between children with unilateral and bilateral CIs. Bilateral CI use was found to predict significantly faster rates of vocabulary and language development than unilateral CI use; the magnitude of this effect was moderated by child age at activation of the bilateral CI. In terms of parenting style, high levels of parental involvement, low amounts of

  7. An observational study of the hand hygiene initiative: a comparison of preintervention and postintervention outcomes

    Science.gov (United States)

    Mukerji, Amit; Narciso, Janet; Moore, Christine; McGeer, Allison; Kelly, Edmond; Shah, Vibhuti

    2013-01-01

    Objectives To evaluate the impact of implementing a simple, user-friendly eLearning module on hand hygiene (HH) compliance and infection rates. Design Preintervention and postintervention observational study. Participants All neonates admitted to the neonatal intensive care unit (NICU) over the study period were eligible for participation and were included in the analyses. A total of 3422 patients were admitted over a 36-month span (July 2009 to June 2012). Interventions In the preintervention and postintervention periods (phases I and II), all healthcare providers were trained on HH practices using an eLearning module. The principles of the ‘4 moments of HH’ and definition of ‘baby space’ were incorporated using interactive tools. The intervention then extended into a long-term sustainability programme (phase III), including the requirement of an annual recertification of the module and introduction of posters and screensavers throughout the NICU. Primary and secondary outcome measures The primary outcome was HH compliance rates among healthcare providers in the three phases. The secondary outcome was healthcare-associated infection rates in the NICU. Results HH compliance rates declined initially in phase II then improved in phase III with the addition of a long-term sustainability programme (76%, 67% and 76% in phases I, II and III, respectively (pchallenging to implement and sustain with the need for ongoing reinforcement and education. PMID:23793705

  8. Optimizing Functional Outcomes in Mandibular Condyle Reconstruction With the Free Fibula Flap Using Computer-Aided Design and Manufacturing Technology.

    Science.gov (United States)

    Lee, Z-Hye; Avraham, Tomer; Monaco, Casian; Patel, Ashish A; Hirsch, David L; Levine, Jamie P

    2018-05-01

    Mandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint (TMJ) because it requires precise bone graft alignment for full restoration of joint function. The use of computer-aided design and manufacturing (CAD/CAM) technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study was to analyze clinical and functional outcomes after reconstruction of mandibular condyle defects using only a free fibula graft with the help of virtual surgery techniques. A retrospective review was performed to identify all patients who underwent mandibular reconstruction with only a free fibula flap without any TMJ adjuncts after a total condylectomy. Three-dimensional modeling software was used to plan and execute reconstruction for all patients. From 2009 through 2014, 14 patients underwent reconstruction of mandibular defects involving the condyle with the aid of virtual surgery technology. The average age was 38.7 years (range, 11 to 77 yr). The average follow-up period was 2.6 years (range, 0.8 to 4.2 yr). Flap survival was 100% (N = 14). All patients reported improved facial symmetry, adequate jaw opening, and normal dental occlusion. In addition, they achieved good functional outcomes, including normal intelligible speech and the tolerance of a regular diet with solid foods. Maximal interincisal opening range for all patients was 25 to 38 mm with no lateral deviation or subjective joint pain. No patient had progressive joint hypomobility or condylar migration. One patient had ankylosis, which required release. TMJ reconstruction poses considerable challenges in bone graft alignment for full restoration of joint function. The use of CAD/CAM technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise

  9. Design Study for A Low-Cost LH2 Turbopump

    Science.gov (United States)

    Japikse, David; Baines, Nicholas; Platt, Michael J.

    2000-01-01

    A preliminary design study, focusing on potential component selections and design for manufacturing and assembly (DFMAR1) analysis, is presented in this study. The investigation focused on a nominal cost liquid hydrogen turbopump suitable for a private launch class vehicle. Utilizing a "turbocharger-like" design philosophy, preliminary feasibility studies of the basic pump design class, the rotordynamic design class, and the turbine design class were conducted with associated DFMA evaluations. Reasonable cost levels and sensible levels of product assurance have been established.

  10. Prenatal emotion management improves obstetric outcomes: a randomized control study.

    Science.gov (United States)

    Huang, Jian; Li, He-Jiang; Wang, Jue; Mao, Hong-Jing; Jiang, Wen-Ying; Zhou, Hong; Chen, Shu-Lin

    2015-01-01

    Negative emotions can cause a number of prenatal problems and disturb obstetric outcomes. We determined the effectiveness of prenatal emotional management on obstetric outcomes in nulliparas. All participants completed the PHQ-9 at the baseline assessment. Then, the participants were randomly assigned to the emotional management (EM) and usual care (UC) groups. The baseline evaluation began at 31 weeks gestation and the participants were followed up to 42 days postpartum. Each subject in the EM group received an extra EM program while the participants in the UC groups received routine prenatal care and education only. The PHQ-9 and Edinburgh Postnatal Depression scale (EPDS) were used for assessment. The EM group had a lower PHQ-9 score at 36 weeks gestation, and 7 and 42 days after delivery (P Prenatal EM intervention could control anxiety and depressive feelings in nulliparas, and improve obstetric outcomes. It may serve as an innovative approach to reduce the cesarean section rate in China.

  11. Safety in the ARIES Tokamak Design Study

    International Nuclear Information System (INIS)

    Herring, J.S.; Wong, C.P.-C.; Cheng, E.T.; Grotz, S.

    1989-01-01

    Safety is one of the primary goals of the ARIES Tokamak Design Study. Public safety goals are the achievement passive safety which is demonstrable in tests that could precede operation and the assurance that releases from accidents be passively limited such that no evacuation plan in necessary. Strategies for safety of the plant investment are factory fabrication, short construction times and a design such that no off-normal operational transient results in damage which could not be repaired in routine maintenance. ARIES-I, the first of three 'visions' of potential tokamak reactors, will use He at 5 MPa as a blanket coolant and SiC/composite ceramic for the first wall and blanket materials. Both the coolant and the structural material were chosen for their low activation, both in the short term after accidents and for long term waste management. The breeder, Li 4 SiO 4 , was also chosen for low activation. Contemporary plasma physics and aggressive technology are used in ARIES-I, which results in very high toroidal fields (24 T maximum at the coil). The stored TF energy will be about 130 GJ. A central concern is the safe discharge of this stored energy under electrical fault conditions and prevention of a failure in the magnet set from propagating into systems containing radioactive inventories. The TF coil system consists of 16 coils, each containing two separate windings powered by two independent power supplies. Arcs and shorts between the two power supply systems and across individual windings have been modeled. In addition, delay or failure in circuit breaker opening has been modeled. The safety impacts of LOCA, LOFA and disruptive events have also been evaluated. 8 refs., 4 figs., 7 tabs

  12. Feasibility study of a family-focused intervention to improve outcomes for children with FASD.

    Science.gov (United States)

    Reid, Natasha; Dawe, Sharon; Harnett, Paul; Shelton, Doug; Hutton, Lauren; O'Callaghan, Frances

    2017-08-01

    Growing evidence shows that children with fetal alcohol spectrum disorder (FASD) can benefit from interventions, and specifically interventions focused on improving self-regulation. However, novel ways of improving outcomes for children with FASD need further investigation so that programs target not only the individual child but also the family context, which includes the parent-child relationship. The current study aimed to evaluate the feasibility of an adapted version of the Parents under Pressure (PuP) program that addresses self-regulatory processes, through improving the parent-child relationship and the use of mindfulness-based strategies for both children and parents. This was a mixed methods study. Feasibility was examined by evaluating recruitment, data collection/outcome measures, and intervention procedures. The study used a phenomenological approach to obtain qualitative information from caregivers and a single-case experimental design to evaluate the preliminary participant responses to the intervention. Two out of three families completed treatment. The recruitment and intervention procedures were found to be suitable for and acceptable to the families involved. Some concerns were identified regarding the outcome measures that would need to be addressed in future research. Quantitative and qualitative outcomes were positive. The results provide preliminary support for the feasibility of an adapted version of the PuP program. Thus, offering a potential multi-component option, that aims to improve self-regulatory skills for children with FASD, through focusing on improving the parent-child relationship and incorporating mindfulness-based techniques for both parents and children. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Standard mirror fusion reactor design study

    International Nuclear Information System (INIS)

    Moir, R.W.

    1978-01-01

    This report covers the work of the Magnetic Fusion Energy Division's reactor study group during FY 1976 on the standard mirror reactor. The ''standard'' mirror reactor is characterized as a steady state, neutral beam sustained, D-T fusioning plasma confined by a Yin-Yang magnetic mirror field. The physics parameters are obtained from the same physics model that explains the 2XIIB experiment. The model assumes that the drift cyclotron loss cone mode occurs on the boundary of the plasma, and that it is stabilized by warm plasma with negligible energy investment. The result of the study was a workable mirror fusion power plant, steady-state blanket removal made relatively simple by open-ended geometry, and no impurity problem due to the positive plasma potential. The Q (fusion power/injected beam power) turns out to be only 1.1 because of loss out the ends from Coulomb collisions, i.e., classical losses. This low Q resulted in 77% of the gross electrical power being used to power the injectors, thereby causing the net power cost to be high. The low Q stimulated an intensive search for Q-enhancement concepts, resulting in the LLL reactor design effort turning to the field reversal mirror and the tandem mirror, each having Q of order 5

  14. A case study in value design

    Directory of Open Access Journals (Sweden)

    M. Sinclair

    2003-12-01

    Full Text Available The design of a special type of valve gave rise to a problem which lead the mechanical engineers who designed the valve to call in the help of the author. The final solution to the problem may not be mathematically sophisticated (in fact, it may seem trivial to some readers, but the steps through which the design team struggled and the final approach which resulted in a practically feasible solution may be of interest to other practitioners.

  15. Impact of Site Selection and Study Conduct on Outcomes in Global Clinical Trials.

    Science.gov (United States)

    Sarwar, Chaudhry M S; Vaduganathan, Muthiah; Butler, Javed

    2017-08-01

    There are over 25 million patients living with heart failure globally. Overall, and especially post-discharge, clinical outcomes have remained poor in heart failure despite multiple trials, with both successes and failures over the last two decades. Matching therapies to the right patient population, identifying high-quality sites, and ensuring optimal trial design and execution represent important considerations in the development of novel therapeutics in this space. While clinical trials have undergone rapid globalization, this has come with regional variation in comorbidities, clinical parameters, and even clinical outcomes and treatment effects across international sites. These issues have now highlighted knowledge gaps about the conduct of trials, selection of study sites, and an unmet need to develop and identify "ideal" sites. There is a need for all stakeholders, including academia, investigators, healthcare organizations, patient advocacy groups, industry sponsors, research organizations, and regulatory authorities, to work as a multidisciplinary group to address these problems and develop practical solutions to improve trial conduct, efficiency, and execution. We review these trial-level issues using examples from contemporary studies to inform and optimize the design of future global clinical trials in heart failure.

  16. Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design.

    Science.gov (United States)

    Hartzler, Andrea L; Chaudhuri, Shomir; Fey, Brett C; Flum, David R; Lavallee, Danielle

    2015-01-01

    The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients-physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT). We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery. Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs. Our work illustrates a range of engagement methods guided by human-centered principles and design recommendations for optimizing PRO Dashboards for patient

  17. Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design

    Science.gov (United States)

    Hartzler, Andrea L.; Chaudhuri, Shomir; Fey, Brett C.; Flum, David R.; Lavallee, Danielle

    2015-01-01

    Introduction: The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients—physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT). Methods: We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery. Findings: Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs. Conclusion: Our work illustrates a range of engagement methods guided by human-centered principles and design

  18. The LIFE Cognition Study: design and baseline characteristics

    Science.gov (United States)

    Sink, Kaycee M; Espeland, Mark A; Rushing, Julia; Castro, Cynthia M; Church, Timothy S; Cohen, Ronald; Gill, Thomas M; Henkin, Leora; Jennings, Janine M; Kerwin, Diana R; Manini, Todd M; Myers, Valerie; Pahor, Marco; Reid, Kieran F; Woolard, Nancy; Rapp, Stephen R; Williamson, Jeff D

    2014-01-01

    Observational studies have shown beneficial relationships between exercise and cognitive function. Some clinical trials have also demonstrated improvements in cognitive function in response to moderate–high intensity aerobic exercise; however, these have been limited by relatively small sample sizes and short durations. The Lifestyle Interventions and Independence for Elders (LIFE) Study is the largest and longest randomized controlled clinical trial of physical activity with cognitive outcomes, in older sedentary adults at increased risk for incident mobility disability. One LIFE Study objective is to evaluate the effects of a structured physical activity program on changes in cognitive function and incident all-cause mild cognitive impairment or dementia. Here, we present the design and baseline cognitive data. At baseline, participants completed the modified Mini Mental Status Examination, Hopkins Verbal Learning Test, Digit Symbol Coding, Modified Rey–Osterrieth Complex Figure, and a computerized battery, selected to be sensitive to changes in speed of processing and executive functioning. During follow up, participants completed the same battery, along with the Category Fluency for Animals, Boston Naming, and Trail Making tests. The description of the mild cognitive impairment/dementia adjudication process is presented here. Participants with worse baseline Short Physical Performance Battery scores (prespecified at ≤7) had significantly lower median cognitive test scores compared with those having scores of 8 or 9 with modified Mini Mental Status Examination score of 91 versus (vs) 93, Hopkins Verbal Learning Test delayed recall score of 7.4 vs 7.9, and Digit Symbol Coding score of 45 vs 48, respectively (all P<0.001). The LIFE Study will contribute important information on the effects of a structured physical activity program on cognitive outcomes in sedentary older adults at particular risk for mobility impairment. In addition to its importance in the

  19. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

    NARCIS (Netherlands)

    Brocklehurst, P.; Kwee, A.; Birthplace in England Collaborative Group

    2011-01-01

    Objective: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design: Prospective cohort study. Setting: England: all NHS trusts providing intrapartum care at home,

  20. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria

    Directory of Open Access Journals (Sweden)

    Christopher R. Watts

    2016-02-01

    Full Text Available Abstract Background Reduced vocal intensity is a core impairment of hypokinetic dysarthria in Parkinson’s disease (PD. Speech treatments have been developed to rehabilitate the vocal subsystems underlying this impairment. Intensive treatment programs requiring high-intensity voice and speech exercises with clinician-guided prompting and feedback have been established as effective for improving vocal function. Less is known, however, regarding long-term outcomes of clinical benefit in speakers with PD who receive these treatments. Methods A retrospective cohort design was utilized. Data from 78 patient files across a three year period were analyzed. All patients received a structured, intensive program of voice therapy focusing on speaking intent and loudness. The dependent variable for all analyses was vocal intensity in decibels (dBSPL. Vocal intensity during sustained vowel production, reading, and novel conversational speech was compared at pre-treatment, post-treatment, six month follow-up, and twelve month follow-up periods. Results Statistically significant increases in vocal intensity were found at post-treatment, 6 months, and 12 month follow-up periods with intensity gains ranging from 5 to 17 dB depending on speaking condition and measurement period. Significant treatment effects were found in all three speaking conditions. Effect sizes for all outcome measures were large, suggesting a strong degree of practical significance. Conclusions Significant increases in vocal intensity measured at 6 and 12 moth follow-up periods suggested that the sample of patients maintained treatment benefit for up to a year. These findings are supported by outcome studies reporting treatment outcomes within a few months post-treatment, in addition to prior studies that have reported long-term outcome results. The positive treatment outcomes experienced by the PD cohort in this study are consistent with treatment responses subsequent to other treatment

  1. OUTCOME OF PREGNANCIES COMPLICATED BY THREATENED ABORTION IN THE SECOND TRIMESTER OF PREGNANCY - PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Rajeswary

    2015-11-01

    Full Text Available AIM: To compare the outcome of pregnancies complicated by bleeding per vaginum between 14- 20 weeks with those not complicated by bleeding per vaginum before 20 weeks. To evaluate the potential determinants of outcome such as gestational age at bleeding, number of bleeding episodes, extent of placental separation or sub chorionic bleed, incidence of complications as placenta previa, abruptio placenta, development of gestational hypertension and pre eclampsia, intra uterine growth restriction, and neonatal outcomes as birth weight, mode of delivery, neonatal ICU admission, and congenital anomalies. SETTINGS AND DESIGN: This was a prospective, comparative study, for a duration of one year. STUDY POPULATION: Cases- 100 women admitted in IMCH with first episode of bleeding per vaginum between 14- 20 weeks and continuing their pregnancy after 20 weeks. CONTROLS: 200 uncomplicated pregnancies attending antenatal outpatient clinic which were followed up till delivery. EXCLUSION CRITERIA: 1. Women with history of threatened abortion in first trimester were not included in the study. 2. Subjects age more than 35 years. 3. Previous history of abortion. 4. Any significant medical, surgical or gynecological history. RESULTS: When patients who presented with bleeding pv after completion of 1st trimester were analyzed by USS, a significant number of them had evidence of sub chorionic bleed, heavier the bleed, more the likelihood of presence of sub placental hematoma. There was no significant difference in prevalence of development of hypertensive disorders of pregnancy in both study groups. There was no significant rise in ante partum hemorrhage between cases and controls. Incidence of IUGR, PPROM, PRE TERM LABOR was significantly increased in study group. LSCS rate was not significantly different in both groups. In this study, there was no significant difference in incidence of congenital anomalies in both groups. STUDY AREA: Tertiary health center

  2. The Digital Divide and Health Outcomes: A Teleretinal Imaging Study

    Science.gov (United States)

    Connolly, Kathleen Kihmm

    2013-01-01

    The purpose of this research project was to understand, explore and describe the digital divide and the relationship between technology utilization and health outcomes. Diabetes and diabetic eye disease was used as the real-life context for understanding change and exploring the digital divide. As an investigational framework, a telemedicine…

  3. An Outcome Study of Anorexia Nervosa in an Adolescent Unit.

    Science.gov (United States)

    Jenkins, M. E.

    1987-01-01

    Adolescent girls (N=21) treated for anorexia nervosa in a hospital operating a strict refeeding program were examined 3 years after treatment. Outcome was considered good for 10 girls, intermediate for 4 girls, and poor for 5 girls. Found lack of separation from parents at follow-up. Discusses relevance of findings to treatment approach and to…

  4. Observational study of choice of anaesthesia and outcome in ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia ... of anaesthetic that was administered was determined and compared for maternal intraoperative haemodynamic changes and maternal and neonatal outcomes. ... Neonatal morbidity and mortality occurred in 33.3% of GA and in 10.3% of spinal anaesthesia cases.

  5. Screening Characteristics of TIMI Score in Predicting Acute Coronary Syndrome Outcome; a Diagnostic Accuracy Study

    Directory of Open Access Journals (Sweden)

    Mostafa Alavi-Moghaddam

    2017-01-01

    Full Text Available Introduction: In cases with potential diagnosis of ischemic chest pain, screening high risk patients for adverse outcomes would be very helpful. The present study was designed aiming to determine the diagnostic accuracy of thrombolysis in myocardial infarction (TIMI score in Patients with potential diagnosis of ischemic chest pain.Method: This diagnostic accuracy study was designed to evaluate the screening performance characteristics of TIMI score in predicting 30-day outcomes of mortality, myocardial infarction (MI, and need for revascularization in patients presenting to ED with complaint of typical chest pain and diagnosis of unstable angina or Non-ST elevation MI.Results: 901 patients with the mean age of 58.17 ± 15.00 years (19-90 were studied (52.9% male. Mean TIMI score of the studied patients was 0.97 ± 0.93 (0-5 and the highest frequency of the score belonged to 0 to 2 with 37.2%, 35.3%, and 21.4%, respectively. In total, 170 (18.8% patients experienced the outcomes evaluated in this study. Total sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio of TIMI score were 20 (95% CI: 17 – 24, 99 (95% CI: 97 – 100, 98 (95% CI: 93 – 100, 42 (95% CI: 39 – 46, 58 (95% CI: 14 – 229, and 1.3 (95% CI: 1.2 – 1.4, respectively. Area under the ROC curve of this system for prediction of 30-day mortality, MI, and need for revascularization were 0.51 (95% CI: 0.47 – 0.55, 0.58 (95% CI: 0.54 – 0.62 and 0.56 (95% CI: 0.52 – 0.60, respectively.Conclusion: Based on the findings of the present study, it seems that TIMI score has a high specificity in predicting 30-day adverse outcomes of mortality, MI, and need for revascularization following acute coronary syndrome. However, since its sensitivity, negative predictive value, and negative likelihood ratio are low, it cannot be used as a proper screening tool for ruling out low risk patients in ED.

  6. Sustainable Design Approach: A case study of BIM use

    Directory of Open Access Journals (Sweden)

    Abdelhameed Wael

    2017-01-01

    The paper describes the methodology of this design approach through BIM strategies adopted in design creation. Case studies of architectural designs are used to highlight the details and benefits of this proposed approach.

  7. A Case Study in CAD Design Automation

    Science.gov (United States)

    Lowe, Andrew G.; Hartman, Nathan W.

    2011-01-01

    Computer-aided design (CAD) software and other product life-cycle management (PLM) tools have become ubiquitous in industry during the past 20 years. Over this time they have continuously evolved, becoming programs with enormous capabilities, but the companies that use them have not evolved their design practices at the same rate. Due to the…

  8. On-Line Investment Analysis and Portfolio Management: Using Learning Outcome Statements To Design Projects.

    Science.gov (United States)

    Pettijohn, James B.; Ragan, Gay A.; Ragan, Kent P.

    2003-01-01

    Describes an Internet-based project to familiarize students with online investment analysis and stock portfolio management. Outlines a process for writing learning outcomes that address three levels of cognition: knowledge/comprehension, application/analysis, and synthesis/evaluation. (SK)

  9. Effect of pretransplant diabetes on short-term outcomes after liver transplantation: a national cohort study.

    Science.gov (United States)

    Hoehn, Richard S; Singhal, Ashish; Wima, Koffi; Sutton, Jeffrey M; Paterno, Flavio; Steve Woodle, E; Hohmann, Sam; Abbott, Daniel E; Shah, Shimul A

    2015-07-01

    We sought to analyse the effect of pretransplant diabetes on post-operative outcomes and resource utilization following liver transplantation. A retrospective cohort study was designed using a linkage between the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases. We identified 12 442 patients who underwent liver transplantation at 63 centres from 2007-2011 and separated cohorts of patients with diabetes (n = 2971; 24%) and without (n = 9471; 76%) at the time of transplant. We analysed transplant related outcomes and short-term survival. Diabetic recipients were more likely to be male (70% vs 67%), non-white (32% vs 26%), older (age ≥60; 41% vs 28%), and have a higher BMI (29 vs 27; P diabetic patients were on haemodialysis (10% vs 7%), had cirrhosis caused by NASH (24% vs 9%; P 1.49; 46% vs 42%; P diabetic recipients had longer hospital length of stay (10 vs 9 days), higher peri-transplant mortality (5% vs 4%) and 30-day readmission rates (41% vs 37%), were less often discharged to home (83% vs 87%; P diabetics ($105 078 vs $100 624, P diabetic recipients were less likely discharged home following transplant (75% vs 82%, P diabetes is associated with inferior post-operative outcomes and increased resource utilization after liver transplantation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Monitoring of IVF birth outcomes in Finland: a data quality study

    Directory of Open Access Journals (Sweden)

    Hemminki Elina

    2004-03-01

    Full Text Available Abstract Background The collection of information on infertility treatments is important for the surveillance of potential health consequences and to monitor service provision. Study design We compared the coverage and outcomes of IVF children reported in aggregated IVF statistics, the Medical Birth Register (subsequently: MBR and research data based on reimbursements for IVF treatments in Finland in 1996–1998. Results The number of newborns were nearly equal in the three data sources (N = 4331–4384, but the linkage between the MBR and the research data revealed that almost 40% of the reported IVF children were not the same individuals. The perinatal outcomes in the three data sources were similar, excluding the much lower incidence of major congenital anomalies in the IVF statistics (157/10 000 newborns compared to other sources (409–422/10 000 newborns. Conclusion The differences in perinatal outcomes in the three data sets were in general minor, which suggests that the observed non-recording in the MBR is most likely unbiased.

  11. Community integration outcomes of people with spinal cord injury and multiple matched controls: A pilot study.

    Science.gov (United States)

    Callaway, Libby; Enticott, Joanne; Farnworth, Louise; McDonald, Rachael; Migliorini, Christine; Willer, Barry

    2017-06-01

    Australia's National Disability Insurance Scheme (NDIS) is designed to influence home, social and economic participation for Scheme participants. Given the major disability reform underway, this pilot study aimed to: (i) examine community integration outcomes of people with spinal cord injury (SCI); (ii) compare findings with multiple matched controls and (iii) consider findings within the context of Australia's NDIS. Setting: Victoria, Australia. Matched analysis (people with and without SCI). Community Integration Questionnaire (CIQ). n = 40 adults with SCI (M age = 52.8 years; 61% male; 77% traumatic SCI). Matched analyses from each SCI subject aged integration (ρ = 0.02). Relative risk of low home integration was significant in the SCI cohort (conditional RR (95% CI) = 3.1 (1.5-6.3), ρ = 0.001). Relative risk of low CIQ total, social integration and productivity scores did not reach significance. This cohort of SCI participants was less integrated into home and productive occupations than matched norms, holding implications for planning and allocation of supports to influence outcomes within an NDIS. Further research is necessary to understand community integration outcomes in larger matched samples. © 2016 Occupational Therapy Australia.

  12. Delivery outcomes for nulliparous women at the extremes of maternal age - a cohort study.

    LENUS (Irish Health Repository)

    Vaughan, DA

    2013-06-12

    OBJECTIVE: To examine the associations between extremes of maternal age (≤17 years or ≥40 years) and delivery outcomes. DESIGN: Retrospective cohort study. SETTING: Urban maternity hospital in Ireland. POPULATION: A total of 36 916 nulliparous women with singleton pregnancies who delivered between 2000 and 2011. METHODS: The study population was subdivided into five maternal age groups based on age at first booking visit: ≤17 years, 18-19 years, 20-34 years, 35-39 years and women aged ≥40 years. Logistic regression analyses were performed to examine the associations between extremes of maternal age and delivery outcomes, adjusting for potential confounding factors. MAIN OUTCOME MEASURES: Preterm birth, admission to the neonatal unit, congenital anomaly, caesarean section. RESULTS: Compared with maternal age 20-34 years, age ≤17 years was a risk factor for preterm birth (adjusted odds ratio [adjOR] 1.83, 95% confidence interval [95% CI] 1.33-2.52). Babies born to mothers ≥40 years were more likely to require admission to the neonatal unit (adjOR 1.35, 95% CI 1.06-1.72) and to have a congenital anomaly (adjOR 1.71, 95% CI 1.07-2.76). The overall caesarean section rate in nulliparous women was 23.9% with marked differences at the extremes of maternal age; 10.7% at age ≤17 years (adjOR 0.46, 95% CI 0.34-0.62) and 54.4% at age ≥40 years (adjOR 3.24, 95% CI 2.67-3.94). CONCLUSIONS: Extremes of maternal age need to be recognised as risk factors for adverse delivery outcomes. Low caesarean section rates in younger women suggest that a reduction in overall caesarean section rates may be possible.

  13. Periodontal infection and adverse pregnancy outcomes: a systematic review of epidemiological studies

    Directory of Open Access Journals (Sweden)

    Vettore Mario Vianna

    2006-01-01

    Full Text Available The objective of this systematic review was to evaluate analytical studies on periodontal disease as a possible risk factor for adverse pregnancy outcomes. A literature search of the MEDLINE, SciELO, and LILACS bibliographic databases and CAPES thesis database was conducted up to December 2005, covering epidemiological studies of periodontal disease and adverse pregnancy outcomes. Of the 964 papers identified, 36 analytical studies met the inclusion criteria. Twenty-six epidemiological studies reported associations between periodontal disease and adverse pregnancy outcomes. There was a clear heterogeneity between studies concerning measurement of periodontal disease and selection of type of adverse pregnancy outcome. Therefore no meta-analysis was performed. Most studies did not control for confounders, thus raising serious doubts about their conclusions. The methodological limitations of most studies did not allow conclusions concerning the effects of periodontal disease on adverse pregnancy outcomes. Larger and methodologically rigorous analytical studies using reliable outcomes and exposure measures are recommended.

  14. Preliminary Systems Design Study assessment report

    International Nuclear Information System (INIS)

    Mayberry, J.L.; Feizollahi, F.; Del Signore, J.C.

    1992-01-01

    The System Design Study (SDS), part of the Waste Technology Development Department at the Idaho National Engineering Laboratory (INEL), examined techniques for the remediation of hazardous and transuranic waste stored at Radioactive Waste Management Complex's Subsurface Disposal Area at the INEL. Using specific technologies, system concepts for treating the buried waste and the surrounding contaminated soil were evaluated. Evaluation included implementability, effectiveness, and cost. The SDS resulted in the development of technology requirements including demonstration, testing, and evaluation activities needed for implementing each concept. This volume contains introduction section containing a brief SDS background and lists the general assumptions and considerations used during the development of the system concepts. The introduction section is followed by sections describing two system concepts that produce a waste form in compliance with the Waste Isolation Pilot Plant (WIPP) Waste Acceptance Criteria (WAC) and transportation package (TRAMPAC) requirements. This system concept category is referred to as Waste Form 4, ''WIPP and TRAMPAC Acceptable.'' The following two system concepts are under this category: Sort, Treat, and Repackage System (4-BE-2); Volume Reduction and Packaging System (4-BE-4)

  15. Assessing the quality of studies supporting genetic susceptibility and outcomes of ARDS

    Directory of Open Access Journals (Sweden)

    Marialbert eAcosta-Herrera

    2014-02-01

    Full Text Available The acute respiratory distress syndrome (ARDS is a severe inflammatory disease manifested as a result of pulmonary and systemic responses to several insults. It is now well accepted that genetic variation influences these responses. However, little is known about the genes that are responsible for patient susceptibility and outcome of ARDS. Methodological flaws are still abundant among genetic association studies with ARDS and here, we aimed to highlight the quality criteria where the standards have not been reached, to expose the associated genes to facilitate replication attempts, and to provide quick-reference guidance for future studies. We conducted a PubMed search from January 2008 to September 2012 for original articles. Studies were considered if a statistically significant association was declared with either susceptibility or outcomes of all-cause ARDS. Fourteen criteria were used for evaluation and results were compared to those from a previous quality assessment report. Significant improvements affecting study design and statistical analysis were detected. However, major issues such as adjustments for the underlying population stratification and replication studies remain poorly addressed.

  16. Neurological outcomes following suicidal hanging: A prospective study of 101 patients

    Directory of Open Access Journals (Sweden)

    Mohammed Turab Jawaid

    2017-01-01

    Full Text Available Context: Survivors of suicidal hanging can have variable neurological outcomes – from complete recovery to irreversible brain damage. Literature on the neurological outcomes in these patients is confined to retrospective studies and case series. Hence, this prospective study was carried out. Aims: The aim is to study the neurological outcomes in suicidal hanging. Settings and Design: This was a prospective observational study carried out from July 2014 to July 2016. Subjects and Methods: Consecutive patients admitted to the emergency and medicine wards were included in the study. Details of the clinical and radiological findings, course in hospital and at 1 month postdischarge were analyzed. Statistical Analysis Used: Statistical analysis was performed using IBM SPSS advanced statistics 20.0 (SPSS Inc., Chicago, USA. Univariate analysis was performed using Chi-square test for significance and Odd's ratio was calculated. Results: Of the 101 patients, 6 died and 4 had residual neuro deficits. Cervical spine injury was seen in 3 patients. Interestingly, 39 patients could not remember the act of hanging (retrograde amnesia. Hypotension, pulmonary edema, Glasgow coma scale (GCS score <8 at admission, need for mechanical ventilation, and cerebral edema on plain computed tomography were more in those with amnesia as compared to those with normal memory and these findings were statistically significant. Conclusions: Majority of patients recovered without any sequelae. Routine imaging of cervical spine may not be warranted in all patients, even in those with poor GCS. Retrograde amnesia might be more common than previously believed and further studies are needed to analyze this peculiar feature.

  17. How system designers think: a study of design thinking in human factors engineering.

    Science.gov (United States)

    Papantonopoulos, Sotiris

    2004-11-01

    The paper presents a descriptive study of design thinking in human factors engineering. The objective of the study is to analyse the role of interpretation in design thinking and the role of design practice in guiding interpretation. The study involved 10 system designers undertaking the allocation of cognitive functions in three production planning and control task scenarios. Allocation decisions were recorded and verbal protocols of the design process were collected to elicit the subjects' thought processes. Verbal protocol analysis showed that subjects carried out the design of cognitive task allocation as a problem of applying a selected automation technology from their initial design deliberations. This design strategy stands in contrast to the predominant view of system design that stipulates that user requirements should be thoroughly analysed prior to making any decisions about technology. Theoretical frameworks from design research and ontological design showed that the system design process may be better understood by recognizing the role of design hypotheses in system design, as well as the diverse interactions between interpretation and practice, means and ends, and design practice and the designer's pre-understanding which shape the design process. Ways to balance the bias exerted on the design process were discussed.

  18. Reference values for generic instruments used in routine outcome monitoring: the leiden routine outcome monitoring study

    Directory of Open Access Journals (Sweden)

    Schulte-van Maaren Yvonne WM

    2012-11-01

    Full Text Available Abstract Introduction The Brief Symptom Inventory (BSI, Mood & Anxiety Symptom Questionnaire −30 (MASQ-D30, Short Form Health Survey 36 (SF-36, and Dimensional Assessment of Personality Pathology-Short Form (DAPP-SF are generic instruments that can be used in Routine Outcome Monitoring (ROM of patients with common mental disorders. We aimed to generate reference values usually encountered in 'healthy' and ‘psychiatrically ill’ populations to facilitate correct interpretation of ROM results. Methods We included the following specific reference populations: 1294 subjects from the general population (ROM reference group recruited through general practitioners, and 5269 psychiatric outpatients diagnosed with mood, anxiety, or somatoform (MAS disorders (ROM patient group. The outermost 5% of observations were used to define limits for one-sided reference intervals (95th percentiles for BSI, MASQ-D30 and DAPP-SF, and 5th percentiles for SF-36 subscales. Internal consistency and Receiver Operating Characteristics (ROC analyses were performed. Results Mean age for the ROM reference group was 40.3 years (SD=12.6 and 37.7 years (SD=12.0 for the ROM patient group. The proportion of females was 62.8% and 64.6%, respectively. The mean for cut-off values of healthy individuals was 0.82 for the BSI subscales, 23 for the three MASQ-D30 subscales, 45 for the SF-36 subscales, and 3.1 for the DAPP-SF subscales. Discriminative power of the BSI, MASQ-D30 and SF-36 was good, but it was poor for the DAPP-SF. For all instruments, the internal consistency of the subscales ranged from adequate to excellent. Discussion and conclusion Reference values for the clinical interpretation were provided for the BSI, MASQ-D30, SF-36, and DAPP-SF. Clinical information aided by ROM data may represent the best means to appraise the clinical state of psychiatric outpatients.

  19. Authentic tasks in higher education: Studying design principles for assessment

    NARCIS (Netherlands)

    van Keulen, H.; van den Berg, I.; Ramaekers, S.

    2006-01-01

    Students may benefit significantly from learning through authentic tasks. But how do we assess their learning outcomes, taking into account the specific characteristics of authentic tasks? In the second presentation of this symposium on design principles for authentic tasks we present and discuss

  20. A Cohort Study on Long-Term Adverse Effects of Parental Drinking: Background and Study Design

    Directory of Open Access Journals (Sweden)

    Ingunn Olea Lund

    2015-01-01

    Full Text Available Although many studies have addressed adverse outcomes in children of parents with alcohol abuse/dependence, less is known about the possible long-term effects of more normative patterns of parental alcohol consumption, including drinking at lower risk levels and heavy episodic or binge drinking. The extent of harm from parental drinking may therefore be underestimated. With this research proposal, we describe a project that aims to assess possible long-term adverse effects of parental drinking by combining survey and nationwide registry data. Advantages of a longitudinal general population cohort design include that it allows for detailed information on parental drinking through survey data and identification of possible negative long-term health and social outcomes from exposure to parental drinking 1–19 years after exposure through continuously updated nationwide registers. The rich information available from combining survey and registry data allows us to take into account important confounders, mediators, and moderators.

  1. Using Formal Game Design Methods to Embed Learning Outcomes into Game Mechanics and Avoid Emergent Behaviour

    Science.gov (United States)

    Grey, Simon; Grey, David; Gordon, Neil; Purdy, Jon

    2017-01-01

    This paper offers an approach to designing game-based learning experiences inspired by the Mechanics-Dynamics-Aesthetics (MDA) model (Hunicke et al., 2004) and the elemental tetrad model (Schell, 2008) for game design. A case for game based learning as an active and social learning experience is presented including arguments from both teachers and…

  2. Exploring Study Designs for Evaluation of Interventions Aimed to Reduce Occupational Diseases and Injuries

    Directory of Open Access Journals (Sweden)

    Henk F. van der Molen

    2016-03-01

    Full Text Available Effective interventions to reduce work-related exposures are available for many types of work-related diseases or injuries. However, knowledge of the impact of these interventions on injury or disease outcomes is scarce due to practical and methodological reasons. Study designs are considered for the evaluation of occupational health interventions on occupational disease or injury. Latency and frequency of occurrence of the health outcomes are two important features when designing an evaluation study with occupational disease or occupational injury as an outcome measure. Controlled evaluation studies—giving strong indications for an intervention effect—seem more suitable for more frequently occurring injuries or diseases. Uncontrolled evaluation time or case series studies are an option for evaluating less frequently occurring injuries or diseases. Interrupted time series offer alternatives to experimental randomized controlled trials to give an insight into the effectiveness of preventive actions in the work setting to decision and policy makers.

  3. Study of Army Design Hover Criteria

    Science.gov (United States)

    2017-09-01

    INFORMATION SECURITY PROGRAM REGULATION, CHAPTER IX. FOR UNCLASSIFIED, LIMITED DOCUMENTS, DESTROY BY ANY METHOD THAT WILL PREVENT DISCLOSURE OF...margin at 4,000 feet pressure altitude and 95 degree Fahrenheit ambient temperature design point. This recommendation did not account for diurnal...margin capability to account for realistic helicopter operating conditions. However, the design point remained at 4K/95 for development and

  4. Continuous Improvement and Employee Engagement, Part 2: Design, Implementation, and Outcomes of a Daily Management System.

    Science.gov (United States)

    Maurer, Marsha; Browall, Pamela; Phelan, Cynthia; Sanchez, Sandra; Sulmonte, Kimberlyann; Wandel, Jane; Wang, Allison

    2018-04-01

    A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or work flow and to address them on a daily basis. Through a DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 2 describes the implementation and outcomes of the program.

  5. Preliminary design study for a corkscrew gantry

    International Nuclear Information System (INIS)

    Koehler, A.M.

    1987-01-01

    For two years or more a group including the author has been working together to study some problems related to the design of a gentry system for flexible direction of a proton beam for clinical treatments. Some consideration was given to the classic gantry geometry. Attempting to reduce the radius of the gantry arm by reducing the drift space after the scattering foils led to an analysis of the significance of inverse square intensity effects. The conclusion reached is that a drift space of about 3 meters is required to preserve some skin sparing for larger targets. To circumvent this problem the scattering foils ere put somewhere inside or even before the gantry system, accepting the fact that magnet apertures would have to be increased. This gantry system has the interesting ability to produce oblong fields of excellent uniformity with reasonable efficiency, preferentially with the long axis of the field parallel to the axis of rotation. It was disappointing, however, to find that the overall size of the gantry with its counterweights remained very large. Another change in geometry was proposed therefore in order to reduce the space taken up by the gantry and its counterweight. The beam is bent 45 0 in the horizontal plane and then again by 45 0 so that it is pointing away from isocenter, but in the plan of rotation of the gantry. The beam is now bent in that plane of rotation until it is pointed at isocenter. This is accomplished by two bends of 135 0 each with a suitable drift space between them so that the beam is pointed vertically downward at isocenter. The three dimensional complexity of the beam trajectory led to the name Corkscrew Gantry

  6. Identifying the barriers to conducting outcomes research in integrative health care clinic settings - a qualitative study

    Directory of Open Access Journals (Sweden)

    Findlay-Reece Barbara

    2010-01-01

    Full Text Available Abstract Background Integrative health care (IHC is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a further study in 2008, to explore the reasons why IHC clinics are not conducting outcomes research and to identify strategies for conducting successful in-house outcomes research programs. The results of the latter study are reported here. Methods A total of 25 qualitative interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews. Results Barriers identified by participants fell into four categories: organizational culture, organizational resources, organizational environment and logistical challenges. Cultural challenges relate to the philosophy of IHC, organizational leadership and practitioner attitudes and beliefs. Participants also identified significant issues relating to their organization's lack of resources such as funding, compensation, infrastructure and partnerships/linkages. Environmental challenges such as the nature of a clinic's patient population and logistical issues such as the actual implementation of a research program and the applicability of research data also posed challenges to the conduct of research. Embedded research leadership, integration of personal and professional values about research, alignment of research activities and clinical workflow processes are some of the factors identified by participants that support IHC clinics' ability to conduct outcomes research. Conclusions Assessing and enhancing the broader

  7. Enhanced Access Design Alternative I Study

    International Nuclear Information System (INIS)

    Eble, G.B.

    1999-01-01

    The purpose of this document is to evaluate Enhanced Design Alternative (EDA) 1, the low temperature repository design concept (CRWMS M and O 1999a). This technical document will provide supporting information for Site Recommendation (SR) and License Application (LA). Preparation of this evaluation will be in accordance with the technical document preparation plan (TDPP), (CRWMS M and O 1999b). EDA 1, one of five EDAs, was evolved from evaluation of a series of design features and alternatives developed during the first phase of the License Application Design Selection (LADS) process. Low, medium, and high temperature concepts were developed from the design features and alternatives prepared during Phase 1 of the LADS effort (CRWMS M and O 1999a). EDA 1 will first be evaluated against a single Screening Criterion, outlined in CRWMS M and O 1999a, which addresses post-closure performance of the repository. The performance of the repository is defined quantitatively as the peak radiological dose rate to an average individual of a critical group at a distance of 20 km from the repository site within 10,000 years. To satisfy this criterion the peak dose rate must not exceed the anticipated regulatory level of 25 mrem/yr within 10,000 years. If the EDA meets the screening criterion, the EDA will be further evaluated against the LADS Phase 2 Evaluation Criteria contained in CRWMS M and O 1999a

  8. Initial DEMO tokamak design configuration studies

    Energy Technology Data Exchange (ETDEWEB)

    Bachmann, Christian, E-mail: christian.bachmann@efda.org [EFDA, Boltzmannstraße 2, 85748 Garching (Germany); Aiello, G. [CEA-Saclay, DEN, DM2S, SEMT, F-91191 Gif-Sur-Yvette (France); Albanese, R.; Ambrosino, R. [ENEA/CREATE, Universita di Napoli Federico II, Naples (Italy); Arbeiter, F. [Karlsruhe Institute of Technology (KIT), Karlsruhe (Germany); Aubert, J. [CEA-Saclay, DEN, DM2S, SEMT, F-91191 Gif-Sur-Yvette (France); Boccaccini, L.; Carloni, D. [Karlsruhe Institute of Technology (KIT), Karlsruhe (Germany); Federici, G. [EFDA, Boltzmannstraße 2, 85748 Garching (Germany); Fischer, U. [Karlsruhe Institute of Technology (KIT), Karlsruhe (Germany); Kovari, M. [CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB (United Kingdom); Li Puma, A. [CEA-Saclay, DEN, DM2S, SEMT, F-91191 Gif-Sur-Yvette (France); Loving, A. [CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB (United Kingdom); Maione, I. [Karlsruhe Institute of Technology (KIT), Karlsruhe (Germany); Mattei, M. [ENEA/CREATE, Universita di Napoli Federico II, Naples (Italy); Mazzone, G. [ENEA C.R. Frascati, via E. Fermi 45, 00044 Frascati, Roma (Italy); Meszaros, B. [EFDA, Boltzmannstraße 2, 85748 Garching (Germany); Palermo, I. [Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid (Spain); Pereslavtsev, P. [Karlsruhe Institute of Technology (KIT), Karlsruhe (Germany); Riccardo, V. [CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB (United Kingdom); and others

    2015-10-15

    Highlights: • A definition of main DEMO requirements. • A description of the DEMO tokamak design configuration. • A description of issues yet to be solved. - Abstract: To prepare the DEMO conceptual design phase a number of physics and engineering assessments were carried out in recent years in the frame of EFDA concluding in an initial design configuration of a DEMO tokamak. This paper gives an insight into the identified engineering requirements and constraints and describes their impact on the selection of the technologies and design principles of the main tokamak components. The EU DEMO program aims at making best use of the technologies developed for ITER (e.g., magnets, vessel, cryostat, and to some degree also the divertor). However, other systems in particular the breeding blanket require design solutions and advanced technologies that will only partially be tested in ITER. The main differences from ITER include the requirement to breed, to extract, to process and to recycle the tritium needed for plasma operation, the two orders of magnitude larger lifetime neutron fluence, the consequent radiation dose levels, which limit remote maintenance options, and the requirement to use low-activation steel for in-vessel components that also must operate at high temperature for efficient energy conversion.

  9. Effect of implant macro-design on primary stability: A prospective clinical study

    OpenAIRE

    Lozano-Carrascal, Naroa; Salom?-Coll, Oscar; Gilabert-Cerd?, Marta; Farr?-Pag?s, Nuria; Gargallo-Albiol, Jordi; Hern?ndez-Alfaro, Federico

    2016-01-01

    Background Implant restorations have become a high predictable treatment option. Several caracteristics such as surgical technique and implant design can influence the treatment outcomes. The aim of the present study was to evaluate the influence of implant macro-design on primary stability measured with resonance frequency analysis (RFA) and insertion torque (IT). Material and Methods A total of 47 implants divided in two groups: Test group (TI): 22 Tapered MIS? Seven implants; Control group...

  10. Development of a core outcome set for studies involving patients undergoing major lower limb amputation for peripheral arterial disease: study protocol for a systematic review and identification of a core outcome set using a Delphi survey.

    Science.gov (United States)

    Ambler, Graeme K; Bosanquet, David C; Brookes-Howell, Lucy; Thomas-Jones, Emma; Waldron, Cherry-Ann; Edwards, Adrian G K; Twine, Christopher P

    2017-12-28

    The development of a standardised reporting set is important to ensure that research is directed towards the most important outcomes and that data is comparable. To ensure validity, the set must be agreed by a consensus of stakeholders including patients, healthcare professionals and lay representatives. There is currently no agreed core outcome set for patients undergoing major lower limb amputation for peripheral arterial disease (PAD) for either short- or medium-term research outcomes. By developing these sets we aim to rationalise future trial outcomes, facilitate meta-analysis and improve the quality and applicability of amputation research. We will undertake a comprehensive systematic review of studies of patients undergoing major lower limb amputation for PAD. Data regarding all primary and secondary outcomes reported in relevant studies will be extracted and summarised as outcome domains. We will then undertake focus groups with key stakeholders (patients, carers, health and social care workers) to collect qualitative data to identify the main short- and medium-term research outcomes for patients undergoing major lower limb amputation. Results of the systematic review and focus groups will be combined to create a comprehensive list of potential key outcomes. Stakeholders (patients, researchers and health and social care workers) will then be polled to determine which of the outcomes are considered to be important in a general context using a three-phase Delphi process. After preliminary analysis, results will be presented at a face-to-face meeting of key stakeholders for discussion and voting on the final set of core outcomes. This project is being run in parallel with a feasibility trial assessing perineural catheters in patients undergoing lower limb amputation (the PLACEMENT trial). Full ethical approval has been granted for the study (Wales REC 3 reference number 16/WA/0353). Core outcome sets will be developed for short- and medium-term outcomes of

  11. Challenges and learning outcomes of educational design research for PhD students

    NARCIS (Netherlands)

    Bronkhorst, L.H.; de Kleijn, R.A.M.

    2016-01-01

    Educational design research (EDR) is described as a complex research approach. The challenges resulting from this complexity are typically described as procedural, whereas EDR might also be challenging for different reasons, specifically for early career researchers. Yet challenging experiences may

  12. The study and design of tension controller

    Science.gov (United States)

    Jun, G.; Lamei, X.

    2018-02-01

    Tension control is a wide used technology in areas such as textiles, paper and plastic films. In this article, the tension control system release and winding process is analyzed and the mathematical model of tension control system is established, and a high performance tension controller is designed. In hardware design, STM32F130 single chip microcomputer is used as the control core, which has the characteristics of fast running speed and rich peripheral features. In software design, μC/OS-II operating system is introduced to improve the efficiency of single chip microcomputer, and enhance the independence of each module, and make development and maintenance more convenient. The taper tension control is adopted in the winding part, which can effectively solve the problem of rolling shrinkage. The results show that the tension controller has the characteristics of simple structure, easy operation and stable performance.

  13. Understanding experiences and outcomes in treatment of binge eating disorder and obesity: A mixed method study

    DEFF Research Database (Denmark)

    Meyer, Lene; Tjørnhøj-Thomsen, Tine; Lau, Marianne Engelbrecht

    Background: Binge eating disorder (BED) has recently been recognized as a diagnosis in the DSM-5 (Diagnostic Manual of Mental Disorders). BED is a severe eating disorder with physical, social and psychological consequences. The prevalence of BED is 2-3% and the majority develop weight problems...... and obesity. Treatment is found effective in reducing eating disorder symptomatology, but rarely leads to weight loss. It is still unknown how the issue of obesity can be addressed in BED treatment without increasing the risk of binge eating relapse. Objectives: The study is an explorative investigation...... of the outcome of a newly developed group based treatment that combines psychotherapy and either weight loss or well-being components for patients with binge eating disorders and obesity. Methods: The study uses a convergent mixed methods design. Qualitative and quantitative data are gathered using in...

  14. Study on design of proton linacs

    International Nuclear Information System (INIS)

    Yu Qingchang

    2000-01-01

    Two important directions in the development of proton linacs are high-current proton linacs (mainly applied in nuclear power field) and compact proton linacs (for proton therapy). There are some common characteristics in them: (1) Employment of the novel accelerating structures, which are combination and evolution of the conventional ones; (2) Accelerating beam with small emittance; (3) Requirement for high reliability. The construction of the former is, however, much more difficult because it still needs low beam lose rate and as high power transformation efficiency as possible. Some important problems in the design of these accelerators are discussed and some schemes designed are presented

  15. Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews.

    Science.gov (United States)

    Saini, Pooja; Loke, Yoon K; Gamble, Carrol; Altman, Douglas G; Williamson, Paula R; Kirkham, Jamie J

    2014-11-21

    To determine the extent and nature of selective non-reporting of harm outcomes in clinical studies that were eligible for inclusion in a cohort of systematic reviews. Cohort study of systematic reviews from two databases. Outcome reporting bias in trials for harm outcomes (ORBIT II) in systematic reviews from the Cochrane Library and a separate cohort of systematic reviews of adverse events. 92 systematic reviews of randomised controlled trials and non-randomised studies published in the Cochrane Library between issue 9, 2012 and issue 2, 2013 (Cochrane cohort) and 230 systematic reviews published between 1 January 2007 and 31 December 2011 in other publications, synthesising data on harm outcomes (adverse event cohort). A 13 point classification system for missing outcome data on harm was developed and applied to the studies. 86% (79/92) of reviews in the Cochrane cohort did not include full data from the main harm outcome of interest of each review for all of the eligible studies included within that review; 76% (173/230) for the adverse event cohort. Overall, the single primary harm outcome was inadequately reported in 76% (705/931) of the studies included in the 92 reviews from the Cochrane cohort and not reported in 47% (4159/8837) of the 230 reviews in the adverse event cohort. In a sample of primary studies not reporting on the single primary harm outcome in the review, scrutiny of the study publication revealed that outcome reporting bias was suspected in nearly two thirds (63%, 248/393). The number of reviews suspected of outcome reporting bias as a result of missing or partially reported harm related outcomes from at least one eligible study is high. The declaration of important harms and the quality of the reporting of harm outcomes must be improved in both primary studies and systematic reviews. © Saini et al 2014.

  16. Design and clinical outcome of a novel 3D-printed prosthetic joint replacement for the human temporomandibular joint.

    Science.gov (United States)

    Ackland, David; Robinson, Dale; Lee, Peter Vee Sin; Dimitroulis, George

    2018-05-11

    Stock prosthetic temporomandibular joint replacements come in limited sizes, and do not always encompass the joint anatomy that presents clinically. The aims of this study were twofold. Firstly, to design a personalized prosthetic total joint replacement for the treatment of a patient's end-stage temporomandibular joint osteoarthritis, to implant the prosthesis into the patient, and assess clinical outcome 12-months post-operatively; and secondly, to evaluate the influence of changes in prosthetic condyle geometry on implant load response during mastication. A 48-year-old female patient with Grade-5 osteoarthritis to the left temporomandibular joint was recruited, and a prosthesis developed to match the native temporomandibular joint anatomy. The prosthesis was 3D printed, sterilized and implanted into the patient, and pain and function measured 12-months post-operatively. The prosthesis load response during a chewing-bite and maximum-force bite was evaluated using a personalized multi-body musculoskeletal model. Simulations were performed after perturbing condyle thickness, neck length and head sphericity. Increases in prosthetic condyle neck length malaligned the mandible and perturbed temporomandibular joint force. Changes in condylar component thickness greatly influenced fixation screw stress response, while a more eccentric condylar head increased prosthetic joint-contact loading. Post-operatively, the prosthetic temporomandibular joint surgery reduced patient pain from 7/10 to 1/10 on a visual analog scale, and increased intercisal opening distance from 22 mm to 38 mm. This study demonstrates effectiveness of a personalized prosthesis that may ultimately be adapted to treat a wide-range of end-stage temporomandibular joint conditions, and highlights sensitivity of prosthesis load response to changes in condylar geometry. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. A case study analysis of the application of design for manufacture principles by industrial design students

    OpenAIRE

    Marshall, R; Page, T

    2016-01-01

    This paper describes a case study evaluation of a module that engages students on product and industrial design programmes with the principles of Design for Manufacturing (DFM). The primary element of the module is to expose students to the constraints of a full design to manufacture process. The module explores the design of a small polymer promotional item, together with the means of mass producing that item. This is done through the process of injection moulding and students design an inje...

  18. Argonne Tau-charm factory collider design study

    International Nuclear Information System (INIS)

    Teng, L.C.; Crosbie, E.A.; Norem, J.

    1995-01-01

    The design approach and design principles for a Tau-charm Factory at Argonne were studied. These studies led to a set of preliminary parameters and tentative component features as presented in this paper

  19. Argonne Tau-charm Factory collider design study

    International Nuclear Information System (INIS)

    Teng, L.C.; Crosbie, E.A.; Norem, J.; Repond, J.

    1996-01-01

    The design approach and design principles for a Tau-charm Factory at Argonne were studied. These studies led to a set of preliminary parameters and tentative component features as presented in this paper. copyright 1996 American Institute of Physics

  20. Tokamak blanket design study, final report

    International Nuclear Information System (INIS)

    1980-08-01

    A cylindrical module concept was developed, analyzed, and incorporated in a tokamak blanket system that includes piping systems, vacuum boundary sealing, and support structures. The design is based on the use of state-of-the-art structural materials (20% cold-worked type 316 stainless steel), lithium as the breeding material, and pressurized helium as the coolant. The module design consists of nested concentric cylinders (with an outer diameter of 10 cm) and features direct wall cooling by helium flowing between the outer (first-wall) cylinder and the inner (lithium-containing) cylinder. Each cylinder can withstand full coolant pressure, thus enhancing reliability. Results show that stainless steel is a viable material for a first wall subjected to a neutron wall loading of 4 MW/m 2 and a particle heat flux of 1 MW/m 2 . Lifetime analysis shows that the first-wall design meets the goal of operating at 20-min cycles with 95% duty for 100,000 cycles. To reduce system complexity, a larger 20-cm-diam module also was analyzed for incorporation in the blanket assembly. Reliability assessment indicates that it may be possible to double the module in size from 10 to 20 cm in diameter. With a modest increase in coolant pumping power, a blanket assembly comprising 20-cm-diam modules can still achieve 100,000 operating cycles - equivalent to a 3.6-year design lifetime - with only one or two helium coolant leaks into the plasma

  1. Tokamak blanket design study, final report

    Energy Technology Data Exchange (ETDEWEB)

    1980-08-01

    A cylindrical module concept was developed, analyzed, and incorporated in a tokamak blanket system that includes piping systems, vacuum boundary sealing, and support structures. The design is based on the use of state-of-the-art structural materials (20% cold-worked type 316 stainless steel), lithium as the breeding material, and pressurized helium as the coolant. The module design consists of nested concentric cylinders (with an outer diameter of 10 cm) and features direct wall cooling by helium flowing between the outer (first-wall) cylinder and the inner (lithium-containing) cylinder. Each cylinder can withstand full coolant pressure, thus enhancing reliability. Results show that stainless steel is a viable material for a first wall subjected to a neutron wall loading of 4 MW/m/sup 2/ and a particle heat flux of 1 MW/m/sup 2/. Lifetime analysis shows that the first-wall design meets the goal of operating at 20-min cycles with 95% duty for 100,000 cycles. To reduce system complexity, a larger 20-cm-diam module also was analyzed for incorporation in the blanket assembly. Reliability assessment indicates that it may be possible to double the module in size from 10 to 20 cm in diameter. With a modest increase in coolant pumping power, a blanket assembly comprising 20-cm-diam modules can still achieve 100,000 operating cycles - equivalent to a 3.6-year design lifetime - with only one or two helium coolant leaks into the plasma.

  2. Design study of plastic film heat exchanger

    Science.gov (United States)

    Guyer, E. C.; Brownell, D. L.

    1986-02-01

    This report presents the results of an effort to develop and design a unique thermoplastic film heat exchanger for use in an industrial heat pump evaporator system and other energy recovery applications. The concept for the exchanger is that of individual heat exchange elements formed by two adjoining and freely hanging plastic films. Liquid flows downward in a regulated fashion between the films due to the balance of hydrostatic and frictional forces. The fluid stream on the outside of film may be a free-falling liquid film, a condensing gas, or a noncondensing gas. The flow and structural principles are similar to those embodied in an earlier heat exchange system developed for use in waste water treatment systems (Sanderson). The design allows for high heat transfer rates while working within the thermal and structural limitations of thermoplastic materials. The potential of this new heat exchanger design lies in the relatively low cost of plastic film and the high inherent corrosion and fouling resistance. This report addresses the selection of materials, the potential heat transf er performance, the mechanical design and operation of a unit applied in a low pressure steam recovery system, and the expected selling price in comparison to conventional metallic shell and tube heat exchangers.

  3. The design, rationale, and baseline characteristics of a nationwide cohort registry in China: blood pressure and clinical outcome in TIA or ischemic stroke.

    Science.gov (United States)

    Xu, Jie; Liu, Yi; Tao, Yongli; Xie, Xuewei; Gu, Hongqiu; Pan, Yuesong; Zhao, Xingquan; Wang, Yongjun; Yan, Aoshuang; Wang, Yilong

    2016-01-01

    The relationship between poststroke blood pressure (BP) and clinical outcomes in ischemic stroke (IS) is still controversial. However, there is no large BP database for IS or transient ischemic attack (TIA) in China. This study aims to describe the rationale, study design, and baseline characteristics of a nationwide BP database in IS or TIA patients in China. The BOSS (blood pressure and clinical outcome in TIA or ischemic stroke) study was a hospital-based, prospective cohort study aiming to assess BP parameters and clinical outcome in IS/TIA patients. BP parameters were based on office BP, ambulatory BP, and home BP. Clinical outcomes included stroke recurrence, combined vascular events, and disability. Electronic case-report forms were used to record baseline and follow-up data. The patients were followed up for clinical outcomes at 3 months through face-to-face interview and at 12 months by telephone. Between October 2012 and February 2014, the BOSS registry recruited 2,608 patients from 61 hospitals, with a mean age of 62.5 years, 32.4% of whom were female, 88.9% with an entry diagnosis of IS, and 86% diagnosed with hypertension. The rates of patients lost-to-follow-up were 3.1% at 3 months and 5.1% at 1 year; 93% of patients completed ambulatory BP monitoring during hospitalization and 94.7% finished a 3-month BP diary. The BOSS registry will provide important evidence about BP management in the acute phase and secondary prevention for IS/TIA patients.

  4. Spillover effects in epidemiology: parameters, study designs and methodological considerations

    Science.gov (United States)

    Benjamin-Chung, Jade; Arnold, Benjamin F; Berger, David; Luby, Stephen P; Miguel, Edward; Colford Jr, John M; Hubbard, Alan E

    2018-01-01

    Abstract Many public health interventions provide benefits that extend beyond their direct recipients and impact people in close physical or social proximity who did not directly receive the intervention themselves. A classic example of this phenomenon is the herd protection provided by many vaccines. If these ‘spillover effects’ (i.e. ‘herd effects’) are present in the same direction as the effects on the intended recipients, studies that only estimate direct effects on recipients will likely underestimate the full public health benefits of the intervention. Causal inference assumptions for spillover parameters have been articulated in the vaccine literature, but many studies measuring spillovers of other types of public health interventions have not drawn upon that literature. In conjunction with a systematic review we conducted of spillovers of public health interventions delivered in low- and middle-income countries, we classified the most widely used spillover parameters reported in the empirical literature into a standard notation. General classes of spillover parameters include: cluster-level spillovers; spillovers conditional on treatment or outcome density, distance or the number of treated social network links; and vaccine efficacy parameters related to spillovers. We draw on high quality empirical examples to illustrate each of these parameters. We describe study designs to estimate spillovers and assumptions required to make causal inferences about spillovers. We aim to advance and encourage methods for spillover estimation and reporting by standardizing spillover parameter nomenclature and articulating the causal inference assumptions required to estimate spillovers. PMID:29106568

  5. Design studies of Tokamak power reactor in JAERI

    International Nuclear Information System (INIS)

    Tone, T.; Nishikawa, M.; Tanaka, Y.

    1985-01-01

    Recent design studies of tokamak power reactor and related activities conducted in JAERI are presented. A design study of the SPTR (Swimming-Pool Type Reactor) concept was carried out in FY81 and FY82. The reactor design studies in the last two years focus on nuclear components, heat transport and energy conversion systems. In parallel of design studies, tokamak systems analysis code is under development to evaluate reactor performances, cost and net energy balance

  6. Designing Biodiversity Friendly Communities. Liveable Cities Forum: Key outcomes and findings

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-10-15

    The Liveable Cities Forum, held 21-22 August in Montreal Canada, created a platform to share best practices on biodiversity management and application at the local level. The Forum also highlighted the importance of partnership building and presented instruments (such as the Singapore Index on Cities' Biodiversity) that help to move the biodiversity agenda forward. A findings report on the Forum has recently been released, offering panel and workshop summaries, key outcomes, and a scope of future opportunities for local governments. Some of the key outcomes are as follows: Biodiversity protection is at its core a local issue, and in order to mitigate biodiversity loss in cities, there is an undeniable need for local governments to come together and work through solutions collectively; Urban centers influence local, regional and global biodiversity. Therefore, it is important that cities con-serve their local biodiversity through the sustainable use of resources beyond their borders; It is important for municipalities to engage and partner with local residents, academic institutions, and organizations, not only to have a finger on the pulse, but also to have local allies and secure long-term support; and Integrated policies help drive action. To effectively mainstream biodiversity at the local level, it is important to incorporate biodiversity considerations into multiple departments, plans and programs.

  7. Comparison of intra-articular injections of Hyaluronic Acid and Corticosteroid in the treatment of Osteoarthritis of the hip in comparison with intra-articular injections of Bupivacaine. Design of a prospective, randomized, controlled study with blinding of the patients and outcome assessors

    NARCIS (Netherlands)

    Colen, S.; van den Bekerom, M.P.J.; Bellemans, J.; Mulier, M.

    2010-01-01

    Background: Although intra-articular hyaluronic acid is well established as a treatment for osteoarthritis of the knee, its use in hip osteoarthritis is not based on large randomized controlled trials. There is a need for more rigorously designed studies on hip osteoarthritis treatment as this

  8. Comparison of intra-articular injections of hyaluronic acid and corticosteroid in the treatment of osteoarthritis of the hip in comparison with intra-articular injections of bupivacaine. Design of a prospective, randomized, controlled study with blinding of the patients and outcome assessors

    NARCIS (Netherlands)

    Colen, Sascha; van den Bekerom, Michel P. J.; Bellemans, Johan; Mulier, Michiel

    2010-01-01

    Although intra-articular hyaluronic acid is well established as a treatment for osteoarthritis of the knee, its use in hip osteoarthritis is not based on large randomized controlled trials. There is a need for more rigorously designed studies on hip osteoarthritis treatment as this subject is still

  9. Proximity operations concept design study, task 6

    Science.gov (United States)

    Williams, A. N.

    1990-01-01

    The feasibility of using optical technology to perform the mission of the proximity operations communications subsystem on Space Station Freedom was determined. Proximity operations mission requirements are determined and the relationship to the overall operational environment of the space station is defined. From this information, the design requirements of the communication subsystem are derived. Based on these requirements, a preliminary design is developed and the feasibility of implementation determined. To support the Orbital Maneuvering Vehicle and National Space Transportation System, the optical system development is straightforward. The requirements on extra-vehicular activity are such as to allow large fields of uncertainty, thus exacerbating the acquisition problem; however, an approach is given that could mitigate this problem. In general, it is found that such a system could indeed perform the proximity operations mission requirement, with some development required to support extra-vehicular activity.

  10. Design Study: ELENA Bending Magnet Prototype

    CERN Document Server

    Schoerling, D

    2013-01-01

    The ELENA bending magnet prototype shall prove that the proposed design meets the requirements set by the ELENA beam dynamics. The following points will be discussed in detail: (i) production process of a magnetic yoke diluted with stainless steel plates, (ii) the stability and repeatability of the field homogeneity of such a yoke over the full working range, (iii) choice of soft magnetic steel, (iv) hysteresis effects, (v) mechanical deformations, (vi) thermal insulation to intercept heat load from baking for activation of NEG coating in the vacuum chamber, (vii) end shim design. In order to verify these points the following measurements will be performed: (i) Hall probe scanning, (ii) integrated field homogeneity measurement (DC), (iii) integrated field homogeneity measurement (AC).

  11. Experimental Study on Various Solar Still Designs

    OpenAIRE

    T. Arunkumar; K. Vinothkumar; Amimul Ahsan; R. Jayaprakash; Sanjay Kumar

    2012-01-01

    Humankind has depended for ages on underground water reservoirs for its fresh water needs. But these sources do not always prove to be useful due to the presence of excessive salinity in the water. In this paper, the fabrication of seven solar still designs such as spherical solar still, pyramid solar still, hemispherical solar still, double basin glass solar still, concentrator coupled single slope solar still, tubular solar still and tubular solar still coupled with pyramid solar still and ...

  12. Designing groupwork activities: a case study

    OpenAIRE

    Durant, Alan

    1996-01-01

    This chapter starts from college teachers’ frequent recognition that pedagogic materials, in ‘language through literature’ as in many other fields, often work best when designed with a particular group (or at least kind) of student in mind, and with sensitivity to linguistic, cultural and other factors which characterise a given teaching situation. Despite widespread acknowledgement of the value in targeting materials this way, however, not much importance is given in teacher-development or d...

  13. The Bipolar Interactive Psychoeducation (BIPED study: trial design and protocol

    Directory of Open Access Journals (Sweden)

    Jones Ian

    2009-08-01

    Full Text Available Abstract Background Bipolar disorders affect between 3–5% of the population and are associated with considerable lifelong impairment. Since much of the morbidity associated with bipolar disorder is caused by recurrent depressive symptoms, which are often only poorly responsive to antidepressants, there is a need to develop alternative, non-pharmacological interventions. Psychoeducational interventions have emerged as promising long-term therapeutic options for bipolar disorder. Methods/design The study is an exploratory, individually randomised controlled trial. The intervention known as 'Beating Bipolar' is a psychoeducational programme which is delivered via a novel web-based system. We will recruit 100 patients with a diagnosis of DSM-IV bipolar disorder (including type I and type II currently in clinical remission. The primary outcome is quality of life. This will be compared for those patients who have participated in the psychoeducational programme with those who received treatment as usual. Quality of life will be assessed immediately following the intervention as well as 10 months after randomisation. Secondary outcomes include current depressive and manic symptoms, number of episodes of depression and mania/hypomania experienced during the follow-up period, global functioning, functional impairment and insight. An assessment of costs and a process evaluation will also be conducted which will explore the feasibility and acceptability of the intervention as well as potential barriers to effectiveness. Discussion Bipolar disorder is common, under-recognised and often poorly managed. It is a chronic, life-long, relapsing condition which has an enormous impact on the individual and the economy. This trial will be the first to explore the effectiveness of a novel web-based psychoeducational intervention for patients with bipolar disorder which has potential to be easily rolled out to patients. Trial registration Current Controlled Trials

  14. Therapy optimization in multiple sclerosis: a prospective observational study of therapy compliance and outcomes.

    Science.gov (United States)

    Coyle, Patricia K; Cohen, Bruce A; Leist, Thomas; Markowitz, Clyde; Oleen-Burkey, MerriKay; Schwartz, Marc; Tullman, Mark J; Zwibel, Howard

    2014-03-13

    Data sources for MS research are numerous but rarely provide an objective measure of drug therapy compliance coupled with patient-reported health outcomes. The objective of this paper is to describe the methods and baseline characteristics of the Therapy Optimization in MS (TOP MS) study designed to investigate the relationship between disease-modifying therapy compliance and health outcomes. TOP MS was designed as a prospective, observational, nationwide patient-focused study using an internet portal for data entry. The protocol was reviewed and approved by Sterling IRB. The study was registered with ClinicalTrials.gov. It captured structured survey data monthly from MS patients recruited by specialty pharmacies. Data collection included the clinical characteristics of MS such as MS relapses. Disability, quality of life and work productivity and activity impairment were assessed quarterly with well-validated scales. When events like severe fatigue or new or worsening depression were reported, feedback was provided to treating physicians. The therapy compliance measure was derived from pharmacy drug shipment records uploaded to the study database. The data presented in this paper use descriptive statistics. The TOP MS Study enrolled 2966 participants receiving their disease-modifying therapy (DMT) from specialty pharmacies. The mean age of the sample was 49 years, 80.4% were female, 89.9% were Caucasian and 55.7% were employed full or part time. Mean time since first symptoms was 11.5 years; mean duration since diagnosis was 9.5 years. Patient-reported EDSS was 3.5; 72.2% had a relapsing-remitting disease course. The most commonly reported symptoms at the time of enrollment were fatigue (74.7%), impaired coordination or balance (61.8%) and numbness and tingling (61.2%). Half of the sample was using glatiramer acetate and half was using beta-interferons. Demographic and clinical characteristics of the TOP MS sample at enrollment are consistent with other community

  15. Empirical studies of design software: Implications for software engineering environments

    Science.gov (United States)

    Krasner, Herb

    1988-01-01

    The empirical studies team of MCC's Design Process Group conducted three studies in 1986-87 in order to gather data on professionals designing software systems in a range of situations. The first study (the Lift Experiment) used thinking aloud protocols in a controlled laboratory setting to study the cognitive processes of individual designers. The second study (the Object Server Project) involved the observation, videotaping, and data collection of a design team of a medium-sized development project over several months in order to study team dynamics. The third study (the Field Study) involved interviews with the personnel from 19 large development projects in the MCC shareholders in order to study how the process of design is affected by organizationl and project behavior. The focus of this report will be on key observations of design process (at several levels) and their implications for the design of environments.

  16. Reporting outcomes of back pain trials: a modified Delphi study

    DEFF Research Database (Denmark)

    Froud, R.; Eldridge, S.; Kovacs, F.

    2011-01-01

    trials. METHODS: We presented experts with clinicians' views on different reporting methods and asked them to rate and comment on the suitability reporting methods for inclusion in a standardized set. Panellists developed a statement of recommendation over three online rounds. We used a modified Delphi......BACKGROUND: Low back pain is a common and expensive health complaint. Many low back pain trials have been conducted, but these are reported in a variety of ways and are often difficult to interpret. AIM: To facilitate consensus on a statement recommending reporting methods for future low back pain...... process and the RAND/UCLA appropriateness method as a formal framework for establishing appropriateness and quantifying panel disagreement. RESULTS: A group of 63 experts from 14 countries participated. Consensus was reached on a statement recommending that the continuous patient-reported outcomes...

  17. Response Scales in Voting Advice Applications : Do Different Designs Produce Different Outcomes?

    NARCIS (Netherlands)

    Rosema, M.; Louwerse, T.

    2016-01-01

    Voting Advice Applications (VAAs) represent popular election campaign tools in many countries, enabling voters to discover which party or candidate provides the best match with their political preferences. This article examines the effects of design choices on these tools by focusing on the response

  18. Response Scales in Voting Advice Applications: Do Different Designs Produce Different Outcomes?

    NARCIS (Netherlands)

    Rosema, Martin; Louwerse, Tom

    2016-01-01

    Voting Advice Applications (VAAs) represent popular election campaign tools in many countries, enabling voters to discover which party or candidate provides the best match with their political preferences. This article examines the effects of design choices on these tools by focusing on the response

  19. Job design under lean manufacturing and its impact on employee outcomes

    NARCIS (Netherlands)

    Cullinane, S.J.; Bosak, J.; Flood, P.; Demerouti, E.

    2013-01-01

    The implications of lean manufacturing for employee well-being remain unclear as previous research yields conflicting findings and struggles to identify an applicable model of job design. This paper adapts and integrates both the job characteristics model and the job demands–resources model to

  20. Teaching an Aerospace Engineering Design Course via Virtual Worlds: A Comparative Assessment of Learning Outcomes

    Science.gov (United States)

    Okutsu, Masataka; DeLaurentis, Daniel; Brophy, Sean; Lambert, Jason

    2013-01-01

    To test the concept of multiuser 3D virtual environments as media to teach semester-long courses, we developed a software prototype called Aeroquest. An aerospace design course--offered to 135 second-year students for university credits in Fall 2009--was divided into two groups: the real-world group attending lectures, physically, in a campus hall…

  1. The outcome of children with selective mutism following cognitive behavioral intervention: a follow-up study.

    Science.gov (United States)

    Lang, Claudia; Nir, Ziv; Gothelf, Ayelet; Domachevsky, Shoshi; Ginton, Lee; Kushnir, Jonathan; Gothelf, Doron

    2016-04-01

    Selective mutism (SM) is a relatively rare childhood disorder and is underdiagnosed and undertreated. The purpose of the retrospective naturalistic study was to examine the long-term outcome of children with SM who were treated with specifically designed modular cognitive behavioral therapy (MCBT). Parents of 36 children who met diagnostic criteria of SM that received MCBT treatment were invited for a follow-up evaluation. Parents were interviewed using structured scales and completed questionnaires regarding the child, including the Selective Mutism Questionnaire (SMQ). Twenty-four subjects were identified and evaluated. Their mean age ± SD of onset of SM symptoms, beginning of treatment, and age at follow-up were 3.4 ± 1.4, 6.4 ± 3.1, and 9.3 ± 3.4 years, respectively. There was robust improvement from beginning of treatment to follow-up evaluation in SM, social anxiety disorder, and specific phobia symptoms. The recovery rate from SM was 84.2 %. SM-focused MCBT is feasible in children and possibly effective in inducing long-term reduction of SM and comorbid anxiety symptoms. • There are limited empirical data on selective mutism (SM) treatment outcome and specifically on cognitive-behavioral therapy, with the majority of studies being uncontrolled case reports of 1 to 2 cases each. • There is also limited data on the long-term outcome of children with SM following treatment. What is New: • Modular cognitive behavioral treatment is a feasible and possibly effective treatment for SM. Intervention at a younger age is more effective comparing to an older age. • Treatment for SM also decreases the rate of psychiatric comorbidities, including separation anxiety disorder and specific phobia.

  2. Critical care outreach referrals: a mixed-method investigative study of outcomes and experiences.

    Science.gov (United States)

    Pattison, Natalie; Eastham, Elizabeth

    2012-01-01

    To explore referrals to a critical care outreach team (CCOT), associated factors around patient management and survival to discharge, and the qualitative exploration of referral characteristics (identifying any areas for service improvement around CCOT). A single-centre mixed method study in a specialist hospital was undertaken, using an explanatory design: participant selection model. In this model, quantitative results (prospective and retrospective episode of care review, including modified early warning system (MEWS), time and delay of referral and patient outcomes for admission and survival) are further explained by qualitative (interview) data with doctors and nurses referring to outreach. Quantitative data were analysed using SPSS +17 and 19, and qualitative data were analysed using grounded theory principles. A large proportion of referrals (124/407 = 30·5%) were made by medical staff. For 97 (97/407 = 23·8%) referrals, there was a delay between the point at which patients deteriorated (as verified by retrospective record review and MEWS score triggers) and the time at when patients were referred. The average delay was 2·96 h (95% CI 1·97-3·95; SD 9·56). Timely referrals were associated with improved outcomes; however, no causal attribution can be made from the circumstances around CCOT referral. Qualitative themes included indications for referral, facilitating factors for referral, barriers to referral and consequences of referral, with an overarching core theory of reassurance. Outreach was seen as back-up and this core theory demonstrates the important, and somewhat less tangible, role outreach has in supporting ward staff to care for at-risk patients. Mapping outreach episodes of care and patient outcomes can help highlight areas for improvement. This study outlines reasons for referral and how outreach can facilitate patient pathways in critical illness. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care

  3. Radiotherapy outcomes in laryngeal cancer - a retrospective study

    International Nuclear Information System (INIS)

    Hliniak, A.; Rolski, W.; Michalski, W.; Szutkowski, Z.; Jarzabski, A.; Laskus, Z.; Frenkiel, Z.; Osmolski, A.

    2002-01-01

    To analyze the importance of pre-treatment factors (age, sex, T, N, histological differentiation, site, Hb level, performance status) and to investigate the influence of cigarette smoking and pulmonary and cardiac diseases on treatment outcomes in laryngeal cancer patients. From the year 1989 until May 1995 372 consecutive patients with cancer of the larynx were radically irradiated at the 2nd Teleradiotherapy Department of the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology in Warsaw (MSCMCC). Pt. characteristics - 88% men, 12% women, age: 29-82 years, stages: T1-20%, T2 -34%, T3 -30%, T4 -16%, lymph node metastases: 27%. Complete response to treatment (CR) - 71% of cases. Loco-regional control after 2 years 52% (T1-T2 - 64%, T3 - T4 - 40%). Early reactions: pain on swallowing, confluent mucositis and moist skin reaction in 69%, 48% and 41 % of cases, respectively. Serious late complications - 19 patients. In a majority of these cases several forms of serious damage were observed. Patients with advanced disease (T3-T4) present a two times higher death risk as compared to patients in earlier stages of the disease (T1-T2). Patients with cervical node metastases also present a two times higher death risk as compared to N0 cases. Patients with performance status 1 or more had a respectively three or four times higher death risk than patients with performance status - 0. No significant influence of sex, histological differentiation, site, hemoglobin level and cigarette smoking, pulmonary and coronary diseases on treatment outcome has been found. The survival curves come down steeply three and more years after treatment completion due to causes other than local failure. The limited number of serious early and late reactions suggests the possibility of a total dose increase. (author)

  4. Design, Intervention Fidelity, and Behavioral Outcomes of a School-Based Water, Sanitation, and Hygiene Cluster-Randomized Trial in Laos

    Directory of Open Access Journals (Sweden)

    Anna N. Chard

    2018-03-01

    Full Text Available Evidence of the impact of water, sanitation, and hygiene (WASH in schools (WinS interventions on pupil absence and health is mixed. Few WinS evaluations rigorously report on output and outcome measures that allow for comparisons of effectiveness between interventions to be made, or for an understanding of why programs succeed. The Water, Sanitation, and Hygiene for Health and Education in Laotian Primary Schools (WASH HELPS study was a randomized controlled trial designed to measure the impact of the United Nations Children’s Fund (UNICEF Laos WinS project on child health and education. We also measured the sustainability of intervention outputs and outcomes, and analyzed the effectiveness of group hygiene activities on behavior change and habit formation. Here, we present the design and intermediate results from this study. We found the WinS project improved the WASH environment in intervention schools; 87.8% of schools received the intervention per design. School-level adherence to outputs was lower; on average, schools met 61.4% of adherence-related criteria. The WinS project produced positive changes in pupils’ school WASH behaviors, specifically increasing toilet use and daily group handwashing. Daily group hygiene activities are effective strategies to improve school WASH behaviors, but a complementary strategy needs to be concurrently promoted for effective and sustained individual handwashing practice at critical times.

  5. Student academic performance outcomes of a classroom physical activity ıntervention: A pilot study

    Directory of Open Access Journals (Sweden)

    Heather Erwin

    2012-06-01

    Full Text Available A Physical activity is beneficial to children’s health, yet academic pressures limit opportunities for students throughout the school day. The purpose of this study was to determine the effect of a classroom PA intervention on student academic performance outcomes. Intervention participants (n=15 received daily PA breaks. Reading and mathematics fluency, PA, grades, and standardized test scores were collected. Effects of the intervention were examined using mixed-design ANOVAs. Intervention students had significantly higher reading fluency and mathematics scores post-intervention and higher means for standardized reading and mathematics scores as well as grades. Short bouts of PA are important for improving CBM math and reading fluency scores. Classroom teachers should be encouraged to devote time during academic learning to incorporate PA.

  6. Student Academic Performance Outcomes of a Classroom Physical Activity Intervention: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Heather ERWIN

    2012-01-01

    Full Text Available A Physical activity is beneficial to children’s health, yet academic pressures limit opportunities forstudents throughout the school day. The purpose of this study was to determine the effect of aclassroom PA intervention on student academic performance outcomes. Intervention participants(n=15 received daily PA breaks. Reading and mathematics fluency, PA, grades, and standardized testscores were collected. Effects of the intervention were examined using mixed-design ANOVAs.Intervention students had significantly higher reading fluency and mathematics scores postinterventionand higher means for standardized reading and mathematics scores as well as grades.Short bouts of PA are important for improving CBM math and reading fluency scores. Classroomteachers should be encouraged to devote time during academic learning to incorporate PA.

  7. Student Academic Performance Outcomes of a Classroom Physical Activity Intervention: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Heather ERWIN

    2013-03-01

    Full Text Available Physical activity is beneficial to children’s health, yet academic pressures limit opportunities for students throughout the school day. The purpose of this study was to determine the effect of a classroom PA intervention on student academic performance outcomes. Intervention participants (n=15 received daily PA breaks. Reading and mathematics fluency, PA, grades, and standardized test scores were collected. Effects of the intervention were examined using mixed-design ANOVAs. Intervention students had significantly higher reading fluency and mathematics scores post-intervention and higher means for standardized reading and mathematics scores as well as grades. Short bouts of PA are important for improving CBM math and reading fluency scores. Classroom teachers should be encouraged to devote time during academic learning to incorporate PA

  8. Japan Diabetic Nephropathy Cohort Study: study design, methods, and implementation.

    Science.gov (United States)

    Furuichi, Kengo; Shimizu, Miho; Toyama, Tadashi; Koya, Daisuke; Koshino, Yoshitaka; Abe, Hideharu; Mori, Kiyoshi; Satoh, Hiroaki; Imanishi, Masahito; Iwano, Masayuki; Yamauchi, Hiroyuki; Kusano, Eiji; Fujimoto, Shouichi; Suzuki, Yoshiki; Okuda, Seiya; Kitagawa, Kiyoki; Iwata, Yasunori; Kaneko, Shuichi; Nishi, Shinichi; Yokoyama, Hitoshi; Ueda, Yoshihiko; Haneda, Masakazu; Makino, Hirofumi; Wada, Takashi

    2013-12-01

    Diabetic nephropathy, leading to end-stage renal disease, has a considerable impact on public health and the social economy. However, there are few national registries of diabetic nephropathy in Japan. The aims of this prospective cohort study are to obtain clinical data and urine samples for revising the clinical staging of diabetic nephropathy, and developing new diagnostic markers for early diabetic nephropathy. The Japanese Society of Nephrology established a nationwide, web-based, and prospective registry system. On the system, there are two basic registries; the Japan Renal Biopsy Registry (JRBR), and the Japan Kidney Disease Registry (JKDR). In addition to the two basic registries, we established a new prospective registry to the system; the Japan Diabetic Nephropathy Cohort Study (JDNCS), which collected physical and laboratory data. We analyzed the data of 321 participants (106 female, 215 male; average age 65 years) in the JDNCS. Systolic and diastolic blood pressure was 130.1 and 72.3 mmHg, respectively. Median estimated glomerular filtration rate (eGFR) was 33.3 ml/min/1.73 m(2). Proteinuria was 1.8 g/gCr, and serum levels of albumin were 3.6 g/dl. The majority of the JDNCS patients presented with preserved eGFR and low albuminuria or low eGFR and advanced proteinuria. In the JRBR and JKDR registries, 484 and 125 participants, respectively, were enrolled as having diabetes mellitus. In comparison with the JRBR and JKDR registries, the JDNCS was characterized by diabetic patients presenting with low proteinuria with moderately preserved eGFR. There are few national registries of diabetic nephropathy to evaluate prognosis in Japan. Future analysis of the JDNCS will provide clinical insights into the epidemiology and renal and cardiovascular outcomes of type 2 diabetic patients in Japan.

  9. Outcome in anorectal malformation type rectovesical fistula : a nationwide cohort study in The Netherlands

    NARCIS (Netherlands)

    van der Steeg, H. J. J.; Botden, S. M. B. I.; Sloots, C. E. J.; van der Steeg, A. F. W.; Broens, P. M. A.; van Heurn, L. W. E.; Travassos, D. V.; van Rooij, I. A. L. M.; de Blaauw, I.

    Purpose: Outcomes of patients with an ARM-type rectovesical fistula are scarcely reported in medical literature. This study evaluates associated congenital anomalies and long-term colorectal and urological outcome in this group of ARM-patients. Methods: A retrospective Dutch cohort study on patients

  10. Women, Co-occurring Disorders, and Violence Study: evaluation design and study population.

    Science.gov (United States)

    McHugo, G J; Kammerer, N; Jackson, E W; Markoff, L S; Gatz, M; Larson, M J; Mazelis, R; Hennigan, K

    2005-03-01

    The Women, Co-occurring Disorders, and Violence Study (WCDVS) was a multi-site cooperative study to evaluate new service models for women with co-occurring mental health and substance use disorders and a history of physical and/or sexual abuse. Despite common features in the service interventions and evaluation procedures, diversity across the nine sites plus differences introduced by non-random assignment led to numerous methodological challenges. This article describes the design, measurement, and analysis decisions behind the WCDVS and lays the foundation for understanding participant-level outcomes and service costs. This article also describes the study population, as recruited and following attrition at the 6-month follow-up, in order to address the threat of selection bias to inferences drawn from this multi-site study.

  11. Empirical evidence of study design biases in randomized trials

    DEFF Research Database (Denmark)

    Page, Matthew J.; Higgins, Julian P. T.; Clayton, Gemma

    2016-01-01

    search September 2012), and searched Ovid MEDLINE and Ovid EMBASE for studies indexed from Jan 2012-May 2015. Data were extracted by one author and verified by another. We combined estimates of average bias (e.g. ratio of odds ratios (ROR) or difference in standardised mean differences (dSMD)) in meta......-analyses using the random-effects model. Analyses were stratified by type of outcome ("mortality" versus "other objective" versus "subjective"). Direction of effect was standardised so that ROR SMD ... studies). For these characteristics, the average bias appeared to be larger in trials of subjective outcomes compared with other objective outcomes. Also, intervention effects for subjective outcomes appear to be exaggerated in trials with lack of/unclear blinding of participants (versus blinding) (dSMD...

  12. Innovative Offshore Wind Plant Design Study

    Energy Technology Data Exchange (ETDEWEB)

    Hurley, William L. [Glosten Associates, Inc., Seattle, WA (United States); Nordstrom, Charles J. [Glosten Associates, Inc., Seattle, WA (United States); Morrison, Brent J. [Glosten Associates, Inc., Seattle, WA (United States)

    2013-12-18

    Technological advancements in the Glosten PelaStar floating wind turbine system have led to projected cost of energy (COE) reductions from today’s best-in-class offshore wind systems. The PelaStar system is projected to deliver a COE that is 35% lower than that delivered by the current offshore wind plants. Several technology developments have been achieved that directly target significant cost of energy reductions. These include: Application of state-of-the-art steel construction materials and methods, including fatigue-resistant welding techniques and technologies, to reduce hull steel weight; Advancements in synthetic fiber tendon design for the mooring system, which are made possible by laboratory analysis of full-scale sub-rope specimens; Investigations into selected anchor technologies to improve anchor installation methods; Refinement of the installation method, specifically through development of the PelaStar Support Barge design. Together, these technology developments drive down the capital cost and operating cost of offshore wind plants and enable access to superb wind resources in deep water locations. These technology developments also reduce the uncertainty of the PelaStar system costs, which increases confidence in the projected COE reductions.

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

    Science.gov (United States)

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

    2007-06-01

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

  14. The Ahmed Versus Baerveldt Study: Five-Year Treatment Outcomes.

    Science.gov (United States)

    Christakis, Panos G; Kalenak, Jeffrey W; Tsai, James C; Zurakowski, David; Kammer, Jeffrey A; Harasymowycz, Paul J; Mura, Juan J; Cantor, Louis B; Ahmed, Iqbal I K

    2016-10-01

    To compare 2 frequently used aqueous shunts for the treatment of glaucoma. International, multicenter, randomized trial. Patients aged 18 years or older with uncontrolled glaucoma despite maximum tolerated medical therapy, many of whom had failed or were at high risk of failing trabeculectomy. Eligible patients were randomized to receive an Ahmed-FP7 valve implant (New World Medical, Inc, Rancho Cucamonga, CA) or a Baerveldt-350 implant (Abbott Medical Optics, Inc, Santa Ana, CA) using a standardized surgical technique. The primary outcome was failure, defined as intraocular pressure (IOP) outside the target range (5-18 mmHg) or reduced glaucoma surgery. Secondary outcomes measures included IOP, medication use, visual acuity, complications, and interventions. A total of 238 patients were randomized; 124 received the Ahmed-FP7 implant, and 114 received the Baerveldt-350 implant. Baseline characteristics were similar between groups. Mean preoperative IOP was 31.4±10.8 mmHg on 3.1±1.0 glaucoma medications. At 5 years, the cumulative failure rate was 53% in the Ahmed group and 40% in the Baerveldt group (P = 0.04). The main reason for failure in both groups was high IOP, and the cumulative de novo glaucoma reoperation rate was 18% in the Ahmed group and 11% in the Baerveldt group (P = 0.22). Hypotony resulted in failure in 5 patients (4%) in the Baerveldt group compared with none in the Ahmed group (P = 0.02). Mean IOP was 16.6±5.9 mmHg in the Ahmed group (47% reduction) and 13.6±5.0 mmHg in the Baerveldt group (57% reduction, P = 0.001). Mean medication use was 1.8±1.5 mmHg in the Ahmed group (44% reduction) and 1.2±1.3 mmHg in the Baerveldt group (61% reduction, P = 0.03). The 2 groups had similar complication rates (Ahmed 63%, Baerveldt 69%) and intervention rates (Ahmed 41%, Baerveldt 41%). Most complications were transient, and most interventions were slit-lamp procedures. Both implants were effective in reducing IOP and the need for glaucoma

  15. Gene expression signatures predict outcome in non-muscle invasive bladder carcinoma - a multi-center validation study

    DEFF Research Database (Denmark)

    Andersen, Lars Dyrskjøt; Zieger, Karsten; Real, Francisco X.

    2007-01-01

    and carcinoma in situ (CIS) and for predicting disease recurrence and progression. EXPERIMENTAL DESIGN: We analyzed tumors from 404 patients diagnosed with bladder cancer in hospitals in Denmark, Sweden, England, Spain, and France using custom microarrays. Molecular classifications were compared with pathologic....... CONCLUSION: This multicenter validation study confirms in an independent series the clinical utility of molecular classifiers to predict the outcome of patients initially diagnosed with non-muscle-invasive bladder cancer. This information may be useful to better guide patient treatment....

  16. Automated simulation and study of spatial-structural design processes

    NARCIS (Netherlands)

    Davila Delgado, J.M.; Hofmeyer, H.; Stouffs, R.; Sariyildiz, S.

    2013-01-01

    A so-called "Design Process Investigation toolbox" (DPI toolbox), has been developed. It is a set of computational tools that simulate spatial-structural design processes. Its objectives are to study spatial-structural design processes and to support the involved actors. Two case-studies are

  17. User Design: A Case Study on Corporate Change

    Science.gov (United States)

    Pastore, Raymond S.; Carr-Chellman, Alison A.; Lohmann, Neal

    2011-01-01

    The purpose of this study was to examine the effects of implementing user design strategies within the corporate culture. Using a case study design approach, this article explores the change process within a "Fortune" 100 company in which users were given significant decision-making powers. The main focus is on the unique nature of user design in…

  18. One-Year Strabismus Outcomes in the Infant Aphakia Treatment Study

    Science.gov (United States)

    Bothun, Erick D.; Cleveland, Julia; Lynn, Michael J.; Christiansen, Stephen P.; Vanderveen, Deborah K.; Neely, Dan E.; Kruger, Stacey J.; Lambert, Scott R.

    2015-01-01

    Objective To evaluate the characteristics of strabismus in infants who underwent cataract surgery with and without intraocular lens (IOL) implantation. Design Secondary outcome analysis in a prospective, randomized clinical trial Participants The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter (n = 12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract. Intervention Infants underwent cataract surgery with or without placement of an IOL. Main Outcome Measures The proportion of patients who developed strabismus during the first 12 months of follow-up was calculated using the life-table method, and compared across treatment groups and age strata using a log-rank test. Results Strabismus developed within the first 12 months of follow-up in 38 (life table estimate: 66.7%) pseudophakic infants and 42 (life table estimate: 74.5%) infants treated with contact lenses (p=0.59). The younger cohort (strabismus (29 of 50, life table estimate: 58.0%) than the older cohort (≥ 49 days) (51 of 64, life table estimate: 80.0%) (pstrabismus following congenital cataract surgery. However, strabismus was less likely to develop in infants whose cataract was removed at an earlier age. PMID:23419803

  19. Clinical and entomological factors influence the outcome of sting challenge studies.

    Science.gov (United States)

    Golden, David B K; Breisch, Nancy L; Hamilton, Robert G; Guralnick, Miles W; Greene, Albert; Craig, Timothy J; Kagey-Sobotka, Anne

    2006-03-01

    The reported frequency of systemic reactions to challenge sting varies greatly. To evaluate the interaction of clinical and entomological factors that determine the outcome of a challenge sting. Patients allergic to yellow jacket were stung and monitored for systemic reaction. The frequency and severity of sting reactions were analyzed in relation to the species of insect used and patient characteristics. Objective systemic reactions occurred in 21 of 69 patients (30%) stung with Vespula maculifrons and in 8 of 71 patients (11%) with Vespula germanica (P=.005). Systemic reactions were more frequent in patients with a severe history (9/30; 30%) than in those with a mild or moderate history (21/145; 14%; P=.04). In only 1 of 111 patients (0.9%) was the reaction to sting challenge more severe than previous reactions. The reaction rate was higher when venom skin tests were positive at <1.0 microg/mL (17/75=23%) than when sensitivity was milder (9/100=9%; P=.012). We compared sting outcome and venom-induced histamine release in relation to insects collected in July or in October, and found no difference. Allergic reactions to sting challenge are determined by the species of yellow jacket used, the severity of previous sting reactions, and the degree of skin test sensitivity, but not by the time of year. These factors are important to clinicians when they evaluate the chance of reaction to a future sting and to researchers when they design and report sting challenge studies.

  20. The influence of maternal life stressors on breastfeeding outcomes: a US population-based study.

    Science.gov (United States)

    Kitsantas, Panagiota; Gaffney, Kathleen F; Nirmalraj, Lavanya; Sari, Mehmet

    2018-01-08

    The purpose of this study was to examine the contribution of maternal financial, emotional, traumatic, and partner-associated stressors on breastfeeding initiation and duration. Data (216,756 records) from the Pregnancy Risk Assessment Monitoring System surveys were used in the analysis. Logistic regressions were conducted to estimate the magnitude and direction of associations between maternal stressors occurring in the 12 months prior to infant birth and both breastfeeding initiation and duration up to 4 weeks infant age. A substantial proportion of mothers (42%) reported having experienced one or two major stressors during the 12 months prior to the birth of their infant. Mothers who reported at least one major life stressor in the year before their baby was born were less likely to initiate breastfeeding and more likely to cease by 4 weeks infant age. Emotional and traumatic stressors were found to have the greatest impact on breastfeeding outcomes. Findings support the design and implementation of screening protocols for major maternal life stressors during regularly scheduled prenatal and newborn visits. Screening for at-risk mothers may lead to more targeted anticipatory guidance and referral with positive effects on breastfeeding outcomes and overall well-being of the mothers and their families.

  1. Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study.

    Science.gov (United States)

    Andrew, Rachel; Tiggemann, Marika; Clark, Levina

    2016-03-01

    This study aimed to investigate prospective predictors and health-related outcomes of positive body image in adolescent girls. In so doing, the modified acceptance model of intuitive eating was also examined longitudinally. A sample of 298 girls aged 12 to 16 years completed a questionnaire containing measures of body appreciation, potential predictors, and a range of health outcomes, at 2 time points separated by 1 year. Longitudinal change regression models showed that perceived body acceptance by others (positively), self-objectification and social comparison (negatively), and body appreciation (positively) prospectively predicted intuitive eating 1 year later, consistent with the acceptance model of intuitive eating. Perceived body acceptance by others was the only proposed predictor to prospectively predict an increase in body appreciation over time. Time 1 body appreciation prospectively predicted a decrease in dieting, alcohol, and cigarette use, and an increase in physical activity 1 year later. In particular, girls with low body appreciation were more likely than girls with high body appreciation to take up alcohol and cigarette use between time points. The results highlight body appreciation as an important target for interventions designed to prevent or delay the uptake of alcohol and cigarette consumption among girls. More broadly, they suggest that a positive body image can confer considerable benefit for adolescent girls. (c) 2016 APA, all rights reserved).

  2. Interprofessional Collaborative Practice to Improve Patient Outcomes: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Jennifer Styron

    2014-06-01

    Full Text Available This project focused on a pilot project implemented during the 2013-2014 academic year. The overall purpose was to facilitate interprofessional collaborative practice innovations through the development of leadership, core competencies, and the use of technology, especially among nurses. Nursing, medicine, and physician assistant students were educated on the IOM competencies for interprofessional teams and the core competencies identified by the Interprofessional Education Collaborative Expert Panel [1] to develop knowledge, skills, and attitudes needed to practice in the collaborative practice environments. The project addressed four goals: Develop faculty expertise and leadership in interprofessional collaborative practice to provide a current, high quality education to nursing, physician assistant, and medical students; Implement a culturally responsive and respectful collaborative interprofessional practice curriculum to prepare nurses, physician assistants, and medical students to deliver high quality, efficient, team-based care in a dynamically evolving environment; Focus interprofessional collaborative practice education on models and practices that lead to improvement in patient outcomes; and Evaluate the program and disseminate best practices. Findings from this pilot include strategies to engage different health professions' students and faculty, partnering with community agencies, building an effective interprofessional team to guide the project, and seeking funding for extension and expansion of the offerings.

  3. Infusing Technology Driven Design Thinking in Industrial Design Education: A Case Study

    Science.gov (United States)

    Mubin, Omar; Novoa, Mauricio; Al Mahmud, Abdullah

    2017-01-01

    Purpose: This paper narrates a case study on design thinking-based education work in an industrial design honours program. Student projects were developed in a multi-disciplinary setting across a Computing and Engineering faculty that allowed promoting technologically and user-driven innovation strategies. Design/methodology/approach: A renewed…

  4. Term Elective Induction of Labor and Perinatal Outcomes in Obese Women: Retrospective Cohort Study

    Science.gov (United States)

    Lee, Vanessa R.; Darney, Blair G.; Snowden, Jonathan M.; Main, Elliott K.; Gilbert, William; Chung, Judith; Caughey, Aaron B.

    2015-01-01

    Objective To compare perinatal outcomes between elective induction of labor (eIOL) and expectant management in obese women. Design Retrospective cohort study. Setting Deliveries in California in 2007. Population Term, singleton, vertex, nonanomalous deliveries among obese women (n=74,725). Methods Women who underwent eIOL at 37 weeks were compared with women who were expectantly managed at that gestational age. Similar comparisons were made at 38, 39, and 40 weeks. Results were stratified by parity. Chi-square tests and multivariable logistic regression were used for statistical comparison. Main Outcome Measures Method of delivery, severe perineal lacerations, postpartum hemorrhage, chorioamnionitis, macrosomia, shoulder dystocia, brachial plexus injury, respiratory distress syndrome. Results The odds of cesarean delivery were lower among nulliparous women with eIOL at 37 weeks (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.34–0.90) and 39 weeks (OR 0.77, 95% CI 0.63–0.95) compared to expectant management. Among multiparous women with a prior vaginal delivery, eIOL at 37 (OR 0.39, 95% CI 0.24–0.64), 38 (OR 0.65, 95% CI 0.51–0.82), and 39 weeks (OR 0.67, 95% CI 0.56–0.81) was associated with lower odds of cesarean. Additionally, eIOL at 38, 39, and 40 weeks was associated with lower odds of macrosomia. There were no differences in the odds of operative vaginal delivery, lacerations, brachial plexus injury, or respiratory distress syndrome. Conclusions In obese women, term eIOL may decrease the risk of cesarean delivery, particularly in multiparas, without increasing the risks of other adverse outcomes when compared with expectant management. Tweetable Abstract Elective induction of labor in obese women does not increase risk of cesarean or other perinatal morbidities. PMID:26840780

  5. A Novel Prosthetic Foot Designed to Maximize Functional Abilities, Health Outcomes and Quality of Life in People with Transtibial Amputation

    Science.gov (United States)

    2016-09-01

    gait quality, energy expenditure, and perceived function and satisfaction are assessed. Participants are then provided the other prosthesis and...walking activity, endurance, walking performance, gait quality, energy expenditure, and perceived function and satisfaction ) are compared between... values ). Aesthetic  satisfaction  was comparable across study  participants.     Conclusion:   This study suggests that patient‐centered health outcomes

  6. Techniques for Conducting Effective Concept Design and Design-to-Cost Trade Studies

    Science.gov (United States)

    Di Pietro, David A.

    2015-01-01

    Concept design plays a central role in project success as its product effectively locks the majority of system life cycle cost. Such extraordinary leverage presents a business case for conducting concept design in a credible fashion, particularly for first-of-a-kind systems that advance the state of the art and that have high design uncertainty. A key challenge, however, is to know when credible design convergence has been achieved in such systems. Using a space system example, this paper characterizes the level of convergence needed for concept design in the context of technical and programmatic resource margins available in preliminary design and highlights the importance of design and cost evaluation learning curves in determining credible convergence. It also provides techniques for selecting trade study cases that promote objective concept evaluation, help reveal unknowns, and expedite convergence within the trade space and conveys general practices for conducting effective concept design-to-cost studies.

  7. FitKids360: Design, Conduct, and Outcomes of a Stage 2 Pediatric Obesity Program

    Directory of Open Access Journals (Sweden)

    Jared M. Tucker

    2014-01-01

    Full Text Available This paper describes FitKids360, a stage 2 pediatric weight management program. FitKids360 is a physician-referred, multicomponent, low-cost healthy lifestyle program for overweight and obese youth 5–16 years of age and their families. FitKids360 provides an evidence-based approach to the treatment of pediatric overweight by targeting patients’ physical activity, screen time, and dietary behaviors using a family-centered approach. The intervention begins with a two-hour orientation and assessment period followed by six weekly sessions. Assessments include lifestyle behaviors, anthropometry, and the Family Nutrition and Physical Activity (FNPA survey, which screens for obesogenic risk factors in the home environment. Outcomes are presented from 258 patients who completed one of 33 FitKids360 classes. After completing FitKids360, patients increased moderate to vigorous physical activity by 14 minutes (P=0.019, reduced screen time by 44 minutes (P<0.001, and improved key dietary behaviors. Overall, FNPA scores increased by 9% (P<0.001 and 69% of patients with “high risk” FNPA scores at baseline dropped below the “high risk” range by followup. Patients also lowered BMIs (P=0.011 and age- and sex-adjusted BMI z-scores (P<0.001 after completing the 7-week program. We hope this report will be useful to medical and public health professionals seeking to develop stage 2 pediatric obesity programs.

  8. Nationwide prospective audit of pancreatic surgery: design, accuracy, and outcomes of the Dutch Pancreatic Cancer Audit.

    Science.gov (United States)

    van Rijssen, L Bengt; Koerkamp, Bas G; Zwart, Maurice J; Bonsing, Bert A; Bosscha, Koop; van Dam, Ronald M; van Eijck, Casper H; Gerhards, Michael F; van der Harst, Erwin; de Hingh, Ignace H; de Jong, Koert P; Kazemier, Geert; Klaase, Joost; van Laarhoven, Cornelis J; Molenaar, I Quintus; Patijn, Gijs A; Rupert, Coen G; van Santvoort, Hjalmar C; Scheepers, Joris J; van der Schelling, George P; Busch, Olivier R; Besselink, Marc G

    2017-10-01

    Auditing is an important tool to identify practice variation and 'best practices'. The Dutch Pancreatic Cancer Audit is mandatory in all 18 Dutch centers for pancreatic surgery. Performance indicators and case-mix factors were identified by a PubMed search for randomized controlled trials (RCT's) and large series in pancreatic surgery. In addition, data dictionaries of two national audits, three institutional databases, and the Dutch national cancer registry were evaluated. Morbidity, mortality, and length of stay were analyzed of all pancreatic resections registered during the first two audit years. Case ascertainment was cross-checked with the Dutch healthcare inspectorate and key-variables validated in all centers. Sixteen RCT's and three large series were found. Sixteen indicators and 20 case-mix factors were included in the audit. During 2014-2015, 1785 pancreatic resections were registered including 1345 pancreatoduodenectomies. Overall in-hospital mortality was 3.6%. Following pancreatoduodenectomy, mortality was 4.1%, Clavien-Dindo grade ≥ III morbidity was 29.9%, median (IQR) length of stay 12 (9-18) days, and readmission rate 16.0%. In total 97.2% of >40,000 variables validated were consistent with the medical charts. The Dutch Pancreatic Cancer Audit, with high quality data, reports good outcomes of pancreatic surgery on a national level. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  9. Conceptual design study of IFMIF target system

    International Nuclear Information System (INIS)

    Kato, Y.; Nakamura, H.; Ida, M.; Maekawa, H.; Katsuta, H.; Hua, T.; Cevolani, S.

    1997-01-01

    IFMIF-CDA (International Fusion Materials Irradiation Facility - Conceptual Design Activity) had been carried out during 1995 and 1996, under the auspices of the IEA. The mission of this facility is to provide an accelerator based deuterium-lithium (D-Li) neutron source to test the candidate materials of radiation - resistant and low - activation materials up to about a full lifetime of anticipated use in fusion energy reactors. The neutrons of about 14 MeV are obtained by the stripping reaction of the deuteron of Max. 40 MeV with target lithium. Total deuteron beam current is about 250 mA and beam footprint is 20 cm x 5 cm on the free surface of lithium jet. In this report general characteristics of the target lithium system and the results of thermal and flow analysis for the target lithium jet are described. (author)

  10. Design of Diagnostics: Case Studies for Wendelstein 7-X

    International Nuclear Information System (INIS)

    Dreier, H.; Dinklage, A.; Fischer, R.; Hirsch, M.; Kornejew, P.; Pasch, E.

    2005-01-01

    The set of start-up diagnostics for Wendelstein 7-X is oriented to resolve physical issues of stellarator optimization [1]. The diagnostics philosophy of W7-X aims at extendable set-ups which are to be supplemented along the operation of the device. Planning diagnostics directly lead to the requirement to optimize their respective outcome. In many cases, the optimization is much restricted by technical constraints. But even in those cases, figures of robustness of the chosen design settings are beneficial for the diagnostic strategy. In this paper a framework for diagnostic design is presented employing the Bayesian probability theory. Part of the approach can be regarded as a virtual diagnostic, which describes the future experimental unit including its error statistics and is able to produce artificial data. The virtual diagnostic is fed with mock-up quantities of interest and hence it enables the designer to compare the outcome of the virtual diagnostic with its input. For the design of diagnostics in fusion experiments several figures of merit are possible, depend- ing on the optimization goal. Here physical questions like estimation of the density distribution or the density gradient are possible optimization targets as well as technical issues as the robustness of density measurements, e.g, for controlling purposes. Also the estimation of derived quantities - like gradients needed for modeling of the bootstrap current or of the radial electric field - might be considered to be the goal of a diagnostic design. (Author)

  11. Methodological and Design Considerations in Evaluating the Impact of Prevention Programs on Violence and Related Health Outcomes.

    Science.gov (United States)

    Massetti, Greta M; Simon, Thomas R; Smith, Deborah Gorman

    2016-10-01

    Drawing on research that has identified specific predictors and trajectories of risk for violence and related negative outcomes, a multitude of small- and large-scale preventive interventions for specific risk behaviors have been developed, implemented, and evaluated. One of the principal challenges of these approaches is that a number of separate problem-specific programs targeting different risk areas have emerged. However, as many negative health behaviors such as substance abuse and violence share a multitude of risk factors, many programs target identical risk factors. There are opportunities to understand whether evidence-based programs can be leveraged for potential effects across a spectrum of outcomes and over time. Some recent work has documented longitudinal effects of evidence-based interventions on generalized outcomes. This work has potential for advancing our understanding of the effectiveness of promising and evidence-based prevention strategies. However, conducting longitudinal follow-up of established interventions presents a number of methodological and design challenges. To answer some of these questions, the Centers for Disease Control and Prevention convened a panel of multidisciplinary experts to discuss opportunities to take advantage of evaluations of early prevention programs and evaluating multiple long-term outcomes. This special section of the journal Prevention Science includes a series of papers that begin to address the relevant considerations for conducting longitudinal follow-up evaluation research. This collection of papers is intended to inform our understanding of the challenges and strategies for conducting longitudinal follow-up evaluation research that could be used to drive future research endeavors.

  12. Outcome in design-specific comparisons between highly crosslinked and conventional polyethylene in total hip arthroplasty

    DEFF Research Database (Denmark)

    Johanson, Per-Erik; Furnes, Ove; Ivar Havelin, Leif

    2017-01-01

    assessed risk of revision for any reason and for aseptic loosening using Cox regression adjusted for age, sex, femoral head material and size, surgical approach, stem fixation, and presence of hydroxyapatite coating (uncemented cups). Results - The CPE version of the ZCA cup had a risk of revision for any...... for any reason and revision due to aseptic loosening and/or osteolysis. Patients and methods - Using the Nordic Arthroplasty Register Association (NARA) database, we identified cup and liner designs where either XLPE or CPE had been used in more than 500 THAs performed for primary hip osteoarthritis. We...

  13. THE IMPACT OF HOPE IN MEDIATING PSYCHOTHERAPY EXPECTATIONS AND OUTCOMES: A STUDY OF BRAZILIAN CLIENTS

    Directory of Open Access Journals (Sweden)

    Nicki L. Aubuchon-Endsley

    2015-12-01

    Full Text Available Client treatment expectations and hope are robustly associated with treatment outcome. Despite this, no known studies have examined client hope as a mediator to the relationship between expectancies and psychotherapy session outcomes. In addition, recent literature also supports cross-cultural differences in relations between treatment expectancies and outcomes. This article presents a cross-sectional study with a sample of Brazilian psychotherapy clients collected via referral sampling, in which existing clients referred potential participants. Participants were asked about their symptomatology and expectations of psychotherapy. The current study found that, within this Brazilian sample, trait hope partially mediated relations between expectancies and treatment session outcomes. Further studies are needed to investigate these effects and session outcomes in a culturally competent manner.

  14. Study on integrated design and analysis platform of NPP

    International Nuclear Information System (INIS)

    Lu Dongsen; Gao Zuying; Zhou Zhiwei

    2001-01-01

    Many calculation software have been developed to nuclear system's design and safety analysis, such as structure design software, fuel design and manage software, thermal hydraulic analysis software, severe accident simulation software, etc. This study integrates those software to a platform, develops visual modeling tool for Retran, NGFM90. And in this platform, a distribution calculation method is also provided for couple calculation between different software. The study will improve the design and analysis of NPP

  15. Dark triad traits and health outcomes: An exploratory study

    Directory of Open Access Journals (Sweden)

    Jasna Hudek-Knežević

    2016-04-01

    in the context of possible mechanisms through which DarkTriad traits may exert negative, but also positive effects on various health outcomes.

  16. Association between intracranial plasmacytoma and multiple myeloma: clinicopathological outcome study.

    Science.gov (United States)

    Schwartz, T H; Rhiew, R; Isaacson, S R; Orazi, A; Bruce, J N

    2001-11-01

    Intracranial plasmacytomas are rare lesions that can arise from the calvarium, dura, or cranial base and exhibit a benign course unless associated with myeloma. Attention has recently been focused on the role of the cell adhesion molecules CD56 and CD31 in the pathogenesis of myeloma. No such information is available for intracranial plasmacytomas and myeloma-associated lesions. We investigated the relationship between CD56 and CD31 expression, intracranial location, and progression to myeloma for a series of nine intracranial plasmacytomas (three dural, one calvarial, and five cranial base lesions). These parameters were also correlated with proliferation indices, as assessed by MIB-1 immunostaining of the histological sections. A single pathologist (AO) performed immunohistochemical analyses and reviewed all slides. Intracranial plasmacytomas presented more commonly in female patients (89%). The three dural lesions were CD56- and CD31-negative and exhibited MIB-1 staining of less than 10%; no patient developed myeloma or recurrence. Of the five cranial base lesions, three were CD56-positive, none was CD31-positive, and two exhibited MIB-1 labeling of more than 45%, with plasmablastic morphological features. Compared with other intracranial plasmacytomas, five of five patients with cranial base lesions developed bone marrow biopsy-proven myeloma (P myeloma soon after diagnosis. Both of the two highly proliferative plasmablastic lesions recurred, one after gross total resection without radiotherapy and the other after a biopsy and 2000-cGy radiotherapy. Among intracranial plasmacytomas, cranial base location was the strongest predictor of the development of multiple myeloma. Expression of the cell adhesion molecules CD31 and CD56 was not predictive of outcome. Extramedullary dural-based lesions were CD56-negative and were not associated with myeloma. A high proliferation index and plasmablastic morphological features were predictive of a short time to recurrence

  17. Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study.

    Science.gov (United States)

    Hamre, Harald Johan; Kiene, Helmut; Ziegler, Renatus; Tröger, Wilfried; Meinecke, Christoph; Schnürer, Christof; Vögler, Hendrik; Glockmann, Anja; Kienle, Gunver Sophia

    2014-01-01

    Anthroposophic medicine is a physician-provided complementary therapy system that was founded by Rudolf Steiner and Ita Wegman. Anthroposophic therapy includes special medicinal products, artistic therapies, eurythmy movement exercises, and special physical therapies. The Anthroposophic Medicine Outcomes Study (AMOS) was a prospective observational multicenter study of 1631 outpatients starting anthroposophic therapy for anxiety disorders, asthma, attention deficit hyperactivity disorder, depression, low back pain, migraine, and other chronic indications under routine conditions in Germany. AMOS INCORPORATED TWO FEATURES PROPOSED FOR THE EVALUATION OF INTEGRATIVE THERAPY SYSTEMS: (1) a sequential approach, starting with the whole therapy system (use, safety, outcomes, perceived benefit), addressing comparative effectiveness and proceeding to the major system components (physician counseling, anthroposophic medicinal products, art therapy, eurythmy therapy, rhythmical massage therapy) and (2) a mix of different research methods to build an information synthesis, including pre-post analyses, prospective comparative analyses, economic analyses, and safety analyses of individual patient data. AMOS fostered two methodological innovations for the analysis of single-arm therapy studies (combined bias suppression, systematic outcome comparison with corresponding cohorts in other studies) and the first depression cost analysis worldwide comparing primary care patients treated for depression vs depressed patients treated for another disorder vs nondepressed patients. A total of 21 peer-reviewed publications from AMOS have resulted. This article provides an overview of the main research questions, methods, and findings from these publications: anthroposophic treatment was safe and was associated with clinically relevant improvements in symptoms and quality of life without cost increase; improvements were found in all age, diagnosis, and therapy modality groups and were

  18. Critical Outcomes in Longitudinal Observational Studies and Registries in Patients with Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Zamora, Natalia V; Christensen, Robin; Goel, Niti

    2017-01-01

    OBJECTIVE: Outcomes important to patients are those that are relevant to their well-being, including quality of life, morbid endpoints, and death. These outcomes often occur over the longterm and can be identified in prospective longitudinal observational studies (PLOS). There are no standards...... for which outcome domains should be considered. Our overarching goal is to identify critical longterm outcome domains for patients with rheumatic diseases, and to develop a conceptual framework to measure and classify them within the scope of OMERACT Filter 2.0. METHODS: The steps of this initiative...

  19. Design study on small CANDLE reactor

    Energy Technology Data Exchange (ETDEWEB)

    Sekimoto, H; Yan, M [Research Laboratory for Nuclear Reactors, Tokyo Institute of Technology (Japan)

    2007-07-01

    A new reactor burnup strategy CANDLE was proposed, where shapes of neutron flux, nuclide densities and power density distributions remain constant but move to an axial direction. Here important points are that the solid fuel is fixed at each position and that any movable burnup reactivity control mechanisms such as control rods are not required. This burnup strategy can derive many merits. The change of excess reactivity along burnup is theoretically zero, and shim rods will not be required for this reactor. The reactor becomes free from accidents induced by unexpected control rods withdrawal. The core characteristics, such as power feedback coefficients and power peaking factor, are not changed along burnup. Therefore, the operation of the reactor becomes much easier than the conventional reactors especially for high burnup reactors. The transportation and storage of replacing fuels become easy and safe, since they are free from criticality accidents. In our previous works it is appeared that application of this burnup strategy to neutron rich fast reactors makes excellent performances. Only natural or depleted uranium is required for the replacing fuels. The average burnup of the spent fuel is about 40% that is equivalent to 40% utilization of the natural uranium without the reprocessing and enrichment. This reactor can be realized for large reactor, since the neutron leakage becomes small and its neutron economy becomes improved. In the present paper we try to design small CANDLE reactor whose performance is similar to the large reactor by increasing its fuel volume ration of the core, since its performance is strongly required for local area usage. Small long life reactor is required for some local areas. Such a characteristic that only natural uranium is required after second core is also strong merit for this case. The core with 1.0 m radius, 2.0 m length can realize CANDLE burn-up with nitride (enriched N-15) natural uranium as fresh fuel. Lead-Bismuth is

  20. Design study on small CANDLE reactor

    International Nuclear Information System (INIS)

    Sekimoto, H.; Yan, M.

    2007-01-01

    A new reactor burnup strategy CANDLE was proposed, where shapes of neutron flux, nuclide densities and power density distributions remain constant but move to an axial direction. Here important points are that the solid fuel is fixed at each position and that any movable burnup reactivity control mechanisms such as control rods are not required. This burnup strategy can derive many merits. The change of excess reactivity along burnup is theoretically zero, and shim rods will not be required for this reactor. The reactor becomes free from accidents induced by unexpected control rods withdrawal. The core characteristics, such as power feedback coefficients and power peaking factor, are not changed along burnup. Therefore, the operation of the reactor becomes much easier than the conventional reactors especially for high burnup reactors. The transportation and storage of replacing fuels become easy and safe, since they are free from criticality accidents. In our previous works it is appeared that application of this burnup strategy to neutron rich fast reactors makes excellent performances. Only natural or depleted uranium is required for the replacing fuels. The average burnup of the spent fuel is about 40% that is equivalent to 40% utilization of the natural uranium without the reprocessing and enrichment. This reactor can be realized for large reactor, since the neutron leakage becomes small and its neutron economy becomes improved. In the present paper we try to design small CANDLE reactor whose performance is similar to the large reactor by increasing its fuel volume ration of the core, since its performance is strongly required for local area usage. Small long life reactor is required for some local areas. Such a characteristic that only natural uranium is required after second core is also strong merit for this case. The core with 1.0 m radius, 2.0 m length can realize CANDLE burn-up with nitride (enriched N-15) natural uranium as fresh fuel. Lead-Bismuth is

  1. Rationale and Design of the 'MITOCARE' Study

    DEFF Research Database (Denmark)

    Clemmensen, Peter

    2012-01-01

    resonance). The study is being financed under an EU-FP7 grant and conducted under the auspices of the MITOCARE research consortium, which includes experts from clinical and basic research centers, as well as commercial enterprises, throughout Europe. Results from this study will contribute to a better...

  2. International prospective observational study of upper gastrointestinal haemorrhage: Does weekend admission affect outcome?

    DEFF Research Database (Denmark)

    Murray, Iain A.; Dalton, Harry R.; Stanley, Adrian J.

    2017-01-01

    Introduction Out of hours admissions have higher mortality for many conditions but upper gastrointestinal haemorrhage studies have produced variable outcomes. Methods Prospective study of 12 months consecutive admissions of upper gastrointestinal haemorrhage from four international high volume...

  3. A study for designing YBCO power transformer

    International Nuclear Information System (INIS)

    Hayashi, H.; Okamoto, H.; Harimoto, T.; Imayoshi, T.; Tomioka, A.; Bouno, T.; Konno, M.; Iwakuma, M.

    2007-01-01

    It is highly expected that superconducting transformers, which are characterized by incombustibility, light weight, and compactness, will be used practically for equipment in substations and office buildings sited in urban areas. In recent years, remarkable improvements in the performance of YBaCuO (YBCO) tape wire have been seen. This kind of tape wire has the property that its critical current is large in a highly magnetic field; and, its use is expected to reduce AC loss by applying slit processing on the tape wire, contributing to future cost reductions. In addition, the development of efficient, economical cryogenic units is also expected. The authors have developed a conceptual design for a 66 kV/20 MVA power transformer using YBCO tape wires, or an YBCO power transformer. As a result, we were able to identify the transformer's optimal system structure including coil winding comprised of coils and tape wires; and, we confirmed that the devised transformer can made to be both compact and highly efficient

  4. 280 GHz Gyro-BWO design study: Final report

    International Nuclear Information System (INIS)

    1988-07-01

    This report summarizes the results of a design study of a 280 GHz Gyro-BWO tunable source. The purpose of this study is to identify and propose viable design alternatives for any significant technological risk associated with building an operational BWO system. The tunable Gyro-BWO system will have three major components: a Gyro-BWO microwave tube, a superconducting magnet, and a power supply/modulator. The design tasks for this study in order of decreasing importance are: design and specification of the superconducting magnet; preliminary design and layout of a Gyro-BWO microwave tube; and specification for the power supply/modulator. 2 refs., 4 figs

  5. Commentary on a participatory inquiry paradigm used to assess EOL simulation participant outcomes and design.

    Science.gov (United States)

    Gannon, Jane M

    2017-11-20

    Care at the end-of-life has attracted global attention, as health care workers struggle with balancing cure based care with end-of-life care, and knowing when to transition from the former to the latter. Simulation is gaining in popularity as an education strategy to facilitate health care provider decision-making by improving communication skills with patients and family members. This commentary focuses on the authors' simulation evaluation process. When data were assessed using a participatory inquiry paradigm, the evaluation revealed far more than a formative or summative evaluation of participant knowledge and skills in this area of care. Consequently, this assessment strategy has ramifications for best practices for simulation design and evaluation.

  6. Treatment outcomes in the DRy Eye Amniotic Membrane (DREAM study

    Directory of Open Access Journals (Sweden)

    McDonald MB

    2018-04-01

    Full Text Available Marguerite B McDonald,1 Hosam Sheha,2–5 Sean Tighe,2,3 Susan B Janik,6 Frank W Bowden,7 Amit R Chokshi,8 Michael A Singer,9 Seema Nanda,10 Mujtaba A Qazi,11 Damon Dierker,12 Adam T Shupe,13 Brittany J McMurren14 1Ophthalmic Consultants of Long Island, Lynbrook, NY, USA; 2Ocular Surface Center and TissueTech, Inc., Miami, FL, USA; 3Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA; 4Hofstra University School of Medicine, Hempstead, NY, USA; 5Research Institute of Ophthalmology, Cairo, Egypt; 6Solinsky Eye Care, Kensington, CT, USA; 7Bowden Eye & Associates, Jacksonville, FL, USA; 8Florida Eye Specialists, Jacksonville, FL, USA; 9Medical Center Ophthalmology Associates, San Antonio, TX, USA; 10TX Eye Institute, Houston, TX, USA; 11Pepose Vision Institute, Chesterfield, MO, USA; 12Eye Surgeons of Indiana, Indianapolis, IN, USA; 13Royo Eye Care, Marysville, CA, USA; 14Gordon and Weiss Vision Institute, San Diego, CA, USA Purpose: To evaluate the efficacy of cryopreserved amniotic membrane (CAM in reducing signs and symptoms of dry eye disease (DED in a large patient population. Methods: A retrospective chart review at 10 clinical sites was done of patients with refractory DED who received CAM and completed at least 3 months of follow-up. Data collected were demographics; medical history including previous and current ocular treatment, diagnosis, clinical presentations, comorbidity, duration and frequency of treatment with CAM; and concomitant medications. The primary outcome was the change in dry eye workshop (DEWS score after treatment. Results: A total of 97 eyes of 84 patients exhibited severe dry eye despite maximal medical treatments including topical artificial tears, cyclosporine-A, serum, antibiotics, and steroids. Patients manifested with superficial punctate keratitis (86%, filamentary keratitis (13%, exposure keratitis (19%, neurotrophic keratitis (2%, and corneal epithelial defect (7%. After CAM

  7. Systematic review of the neurocognitive outcomes used in studies of paediatric anaesthesia neurotoxicity

    DEFF Research Database (Denmark)

    Clausen, Nicola Groes

    2018-01-01

    Summary Neurotoxicity of anaesthetics in developing brain cells is well documented in preclinical studies, yet results are conflicting in humans. The use of many and different outcome measures in human studies may contribute to this disagreement. We conducted a systematic review to identify all...... for studies investigating neurocognitive outcome after GA in children countries during 1990-2017. Most assessments were performed within cognition, sensory-motor development, academic achievement or neuropsychological diagnosis. Few studies assessed other...... Anaesthesia, General; Child Development; Infant; Review...

  8. A Correlational Study on Critical Thinking in Nursing as an Outcome Variable for Success

    Science.gov (United States)

    Porter, Rebecca Jean

    2018-01-01

    Critical thinking is a required curricular outcome for nursing education; however, the literature shows a gap related to valid and reliable tools to measure critical thinking specific to nursing and relating that critical thinking measurement to meaningful outcomes. This study examined critical thinking scores, as measured by Assessment…

  9. Outcomes for depression and anxiety in primary care and details of treatment : a naturalistic longitudinal study

    NARCIS (Netherlands)

    Prins, Marijn A.; Verhaak, Peter F. M.; Hilbink-Smolders, Mirrian; Spreeuwenberg, Peter; Laurant, Miranda G. H.; van der Meer, Klaas; van Marwijk, Harm W. J.; Penninx, Brenda W. J. H.; Bensing, Jozien M.

    2011-01-01

    Background: There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general

  10. Outcomes for depression and anxiety in primary care and details of treatment: a naturalistic longitudinal study

    NARCIS (Netherlands)

    Prins, M.A.; Verhaak, P.F.; Hilbink-Smolders, M.; Spreeuwenberg, P.; Laurant, M.G.; van der Meer, K.; van Marwijk, H.W.J.; Penninx, B.W.J.H.; Bensing, J.M.

    2011-01-01

    Background: There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general

  11. Outcomes for depression and anxiety in primary care and details of treatment: a naturalistic longitudinal study.

    NARCIS (Netherlands)

    Prins, M.A.; Verhaak, P.F.M.; Hilbink-Smolders, M.; Spreeuwenberg, P.; Laurant, M.G.H.; Meer, K. van der; Marwijk, H.W.J. van; Penninx, B.W.J.H.; Bensing, J.M.

    2011-01-01

    Background: There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general

  12. Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

    Directory of Open Access Journals (Sweden)

    Lott Alison

    2007-06-01

    Full Text Available Abstract Background There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: 1 prescription of antibiotics for sore throat, where we hypothesize overestimation of benefit and underestimation of harm leads to over-prescription of antibiotics; and 2 initiation of anticoagulation for patients with atrial fibrillation (AF, where we hypothesize that underestimation of benefit and overestimation of harm leads to under-prescription of warfarin. Methods For each of the two conditions, we will administer surveys of two types (Type 1 and Type 2 to different samples of Canadian physicians. The primary goal of the Type 1 survey is to assess physicians' perceived outcome probabilities (both good and bad outcomes for the target treatment. Type 1 surveys will assess judged outcome probabilities in the context of a representative patient, and include questions about how physicians currently treat such cases, the recollection of rare or vivid outcomes, as well as practice and demographic details. The primary goal of the Type 2 surveys is to measure the specific factors that drive individual clinical judgments and treatment decisions, using a 'clinical judgment analysis' or 'lens modeling' approach. This survey will manipulate eight clinical variables across a series of sixteen realistic case vignettes. Based on the survey responses, we will be

  13. How Do Social Networks Influence Learning Outcomes? A Case Study in an Industrial Setting

    Science.gov (United States)

    Maglajlic, Seid; Helic, Denis

    2012-01-01

    and Purpose: The purpose of this research is to shed light on the impact of implicit social networks to the learning outcome of e-learning participants in an industrial setting. Design/methodology/approach: The paper presents a theoretical framework that allows the authors to measure correlation coefficients between the different affiliations that…

  14. A clinical study on etiology, prognosis, outcome and role of ...

    African Journals Online (AJOL)

    Upper gastrointestinal bleed is defined as bleeding proximal to the ligament of Treitz. The aim of this study was to know the cause of upper GI bleed, prognosis of the patients and role of upper gastrointestinal endoscopy (UGIE) in the management of upper gastrointestinal bleed (UGIB). A study of 140 cases was carried out ...

  15. A clinical study on etiology, prognosis, outcome and role of ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    In our study, the Rockall scoring system was seen to predict the mortality in patients with upper GI .... 100 bpm. SBP < 100. mmHg; Pulse ≥. 100 bpm. Comorbid illness. No major. CHF, IHD, .... This study provides new information in that the.

  16. Girl-Child Education Outcomes: A Case Study from Ghana

    Science.gov (United States)

    Arku, Frank S.; Angmor, Emmanuel N.; Tetteh, Isaac K.

    2014-01-01

    The importance of girl-child education is largely documented and initiatives to promote girl-child education are widespread. However, studies on service delivery methods, processes and the impacts are limited in the literature. This study assessed the Plan Ghana's girl-child educational project. According to the findings, the project has helped to…

  17. SAS Macros for Calculation of Population Attributable Fraction in a Cohort Study Design

    Directory of Open Access Journals (Sweden)

    Maarit A. Laaksonen

    2011-08-01

    Full Text Available The population attributable fraction (PAF is a useful measure for quantifying the impact of exposure to certain risk factors on a particular outcome at the population level. Recently, new model-based methods for the estimation of PAF and its confidence interval for different types of outcomes in a cohort study design have been proposed. In this paper, we introduce SAS macros implementing these methods and illustrate their application with a data example on the impact of different risk factors on type 2 diabetes incidence.

  18. Clinical outcomes between different stent designs with the same polymer and drug: comparison between the Taxus Express and Taxus Liberte stents.

    Science.gov (United States)

    Son, Jang-Won; Kim, Ung; Park, Jong-Seon; Kim, Young-Jo; Jang, Jae-Sik; Yang, Tae-Hyun; Kim, Dong-Soo; Kim, Dong-Kie; Seol, Sang-Hoon; Kim, Doo-Il; Nam, Chang-Wook; Hur, Seung-Ho; Kim, Kwon-Bae

    2013-01-01

    The Taxus Liberte stent (Boston Scientific Co.) evolved from the Taxus Express stent, with enhanced stent deliverability and uniform drug delivery. This study was designed to compare angiographic and clinical outcomes in real-world practice between the Taxus Liberte and Taxus Express stents. Between 2006 and 2008, 240 patients receiving the Taxus Liberte stent at three centers were registered and compared to historical control patients who had received the Taxus Express stent (n = 272). After propensity score matching, 173 patients treated with the Taxus Liberte stent and the same number of patients treated with the Taxus Express stent were selected. The primary outcome was a composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), ischemia driven target vessel revascularization (TVR), and stent thrombosis (ST) at 1 year. An additional angiographic assessment was conducted at 9 to 12 months. The study showed no significant difference between the Taxus Express and Taxus Liberte stents (death, 1.73% vs. 2.31%, p = 1.000; MI, 0% vs. 1.73%, p = 0.2478; TVR, 2.31% vs. 1.16%, p = 0.6848; and ST, 0% vs. 1.16%, p = 0.4986). The total MACE rate at 1 year did not differ between the groups (4.05% in Taxus Express vs. 4.05% in Taxus Liberte, p = 1.000). In addition, the binary restenosis rate did not differ (2.25% in Taxus Express vs. 1.80% in Taxus Liberte, p = 0.6848). In real-world experience with the two Taxus stent designs, both stents showed similarly good clinical and angiographic outcomes at 1 year. A long-term follow-up study is warranted.

  19. Study on Product Innovative Design Process Driven by Ideal Solution

    Science.gov (United States)

    Zhang, Fuying; Lu, Ximei; Wang, Ping; Liu, Hui

    Product innovative design in companies today relies heavily on individual members’ experience and creative ideation as well as their skills of integrating creativity and innovation tools with design methods agilely. Creative ideation and inventive ideas generation are two crucial stages in product innovative design process. Ideal solution is the desire final ideas for given problem, and the striving reaching target for product design. In this paper, a product innovative design process driven by ideal solution is proposed. This design process encourages designers to overcome their psychological inertia, to foster creativity in a systematic way for acquiring breakthrough creative and innovative solutions in a reducing sphere of solution-seeking, and results in effective product innovative design rapidly. A case study example is also presented to illustrate the effectiveness of the proposed design process.

  20. Laser fusion system design study. Final report

    International Nuclear Information System (INIS)

    1975-01-01

    The following studies were completed: (1) The synthesis of a pointing/control system compatible with existing and advanced laser opto-mechanical configurations. (2) Attainment of the required pointing angle, longitudinal focus, and differential pathlength accuracies. (3) Maximum modularization of the sensor and gimbal assemblies to provide the required accuracies at minimum cost. Detailed information is given on each. (MOW)

  1. Scaffolding Preservice Teachers' WebQuest Design: A Qualitative Study

    Science.gov (United States)

    Wang, Feng; Hannafin, Michael J.

    2009-01-01

    This study examined how participating preservice teachers reported their perceptions and use of different scaffolds provided to support their WebQuest design. Sixteen preservice teachers participated in a succession of course activities designed to guide WebQuest design and development. Results indicated that while participants followed, adapted,…

  2. Embracing Wicked Problems: The Turn to Design in Composition Studies

    Science.gov (United States)

    Marback, Richard

    2009-01-01

    Recent appeal to the concept of design in composition studies benefits teaching writing in digital media. Yet the concept of design has not been developed enough to fully benefit composition instruction. This article develops an understanding of design as a matter of resolving wicked problems and makes a case for the advantages of this…

  3. Green Diesel from Hydrotreated Vegetable Oil Process Design Study

    NARCIS (Netherlands)

    Hilbers, T.J.; Sprakel, Lisette Maria Johanna; van den Enk, L.B.J.; Zaalberg, B.; van den Berg, Henderikus; van der Ham, Aloysius G.J.

    2015-01-01

    A systematic approach was applied to study the process of hydrotreating vegetable oils. During the three phases of conceptual, detailed, and final design, unit operations were designed and sized. Modeling of the process was performed with UniSim Design®. Producing green diesel and jet fuel from

  4. Design tradeoff studies and sensitivity analysis. Appendix B

    Energy Technology Data Exchange (ETDEWEB)

    1979-05-25

    The results of the design trade-off studies and the sensitivity analysis of Phase I of the Near Term Hybrid Vehicle (NTHV) Program are presented. The effects of variations in the design of the vehicle body, propulsion systems, and other components on vehicle power, weight, cost, and fuel economy and an optimized hybrid vehicle design are discussed. (LCL)

  5. 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.

  6. Shoe sole tread designs and outcomes of slipping and falling on slippery floor surfaces.

    Directory of Open Access Journals (Sweden)

    Li-Wen Liu

    Full Text Available A gait experiment was conducted under two shoe sole and three floor conditions. The shoe soles and floors were characterized by the tread and groove designs on the surface. The coefficients of friction (COF on the floor in the target area were measured. The subjects were required to walk on a walkway and stepping on a target area covered with glycerol. The motions of the feet of the subjects were captured. Gait parameters were calculated based on the motion data. Among the 240 trials, there were 37 no-slips, 81 microslips, 45 slides, and 77 slips. It was found that the condition with shoe sole and floor had both tread grooves perpendicular to the walking direction had the highest COF, the shortest slip distance, and the lowest percentages of slide and slip. The condition with shoe sole and floor had both tread grooves parallel to the walking direction had the lowest COF and the longest slip distance among all experimental conditions. The Pearson's correlation coefficients between slip distance and slip velocity, time to foot flat, foot angle, and compensatory step length were 0.82 (p<0.0001, 0.33 (p<0.0001, -0.54 (p<0.0001, and -0.51 (p<0.0001, respectively.

  7. Posttraumatic stress, effort regulation, and academic outcomes among college students: A longitudinal study.

    Science.gov (United States)

    Boyraz, Güler; Granda, Rebecca; Baker, Camille N; Tidwell, Lacey Lorehn; Waits, J Brandon

    2016-07-01

    Entering college with posttraumatic stress disorder (PTSD) symptomatology has been linked to poor academic performance and increased risk for dropping out of college; however, little is known regarding the mechanisms by which PTSD symptoms have deleterious effects on college outcomes. Drawing from a self-regulated learning (SRL) perspective, which suggests that students' learning behaviors and outcomes can be influenced by contextual and developmental factors, we hypothesized that students who enter college with high PTSD symptomatology may experience difficulties in effort regulation, which in turn, may have deleterious effects on their academic performance and college persistence. These hypothesized relationships, as well as the potential gender differences in these relationships were examined using a longitudinal study design and a multigroup structural equation modeling approach. Of the 928 1st-year students who participated in the study, 484 (52.2%) students who reported lifetime exposure to traumatic events constituted the final sample of the study. The prevalence of PTSD among the trauma-exposed participants was 12.4%. After controlling for participation in on-campus activities and American College Testing (ACT) assessment scores, the relationship between PTSD symptomatology in the 1st semester of college and 2nd-year enrollment was mediated by effort regulation and 1st-year cumulative grade-point average (GPA). Specifically, participants who started college with higher levels of PTSD symptomatology also reported lower levels of effort regulation, which in turn, had a significant indirect effect on 2nd-year enrollment through 1st-year GPA. Results also indicated that the paths in the hypothesized model were not significantly different for men and women. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  8. Comparison study between bacteriological aetiology and outcome of VAT & VAP

    Directory of Open Access Journals (Sweden)

    Nasr H. Kahlil

    2017-01-01

    Conclusion: From the study we concluded that VAT infection is as severe as VAP and it needs more attention to prevent its presence as, once present, it usually progress to VAP increasing mortality rate in ICU.

  9. The South African Surgical Outcomes Study: a seven-day ...

    African Journals Online (AJOL)

    LR Mathivha, TR Mokoena, S Monokoane, Rui Moreno, David ... Method: A seven-day national, multicentre, prospective, observational cohort study was conducted in 50 government-funded hospitals in South .... Dr George Mukhari Hospital.

  10. A randomized controlled trial on the effectiveness of strength training on clinical and muscle cellular outcomes in patients with prostate cancer during androgen deprivation therapy: rationale and design

    International Nuclear Information System (INIS)

    Thorsen, Lene; Nilsen, Tormod S; Raastad, Truls; Courneya, Kerry S; Skovlund, Eva; Fosså, Sophie D

    2012-01-01

    Studies indicate that strength training has beneficial effects on clinical health outcomes in prostate cancer patients during androgen deprivation therapy. However, randomized controlled trials are needed to scientifically determine the effectiveness of strength training on the muscle cell level. Furthermore, close examination of the feasibility of a high-load strength training program is warranted. The Physical Exercise and Prostate Cancer (PEPC) trial is designed to determine the effectiveness of strength training on clinical and muscle cellular outcomes in non-metastatic prostate cancer patients after high-dose radiotherapy and during ongoing androgen deprivation therapy. Patients receiving androgen deprivation therapy for 9-36 months combined with external high-dose radiotherapy for locally advanced prostate cancer are randomized to an exercise intervention group that receives a 16 week high-load strength training program or a control group that is encouraged to maintain their habitual activity level. In both arms, androgen deprivation therapy is continued until the end of the intervention period. Clinical outcomes are body composition (lean body mass, bone mineral density and fat mass) measured by Dual-energy X-ray Absorptiometry, serological outcomes, physical functioning (muscle strength and cardio-respiratory fitness) assessed with physical tests and psycho-social functioning (mental health, fatigue and health-related quality of life) assessed by questionnaires. Muscle cellular outcomes are a) muscle fiber size b) regulators of muscle fiber size (number of myonuclei per muscle fiber, number of satellite cells per muscle fiber, number of satellite cells and myonuclei positive for androgen receptors and proteins involved in muscle protein degradation and muscle hypertrophy) and c) regulators of muscle fiber function such as proteins involved in cellular stress and mitochondrial function. Muscle cellular outcomes are measured on muscle cross sections and

  11. Design studies for the Double Chooz trigger

    International Nuclear Information System (INIS)

    Cucoanes, Andi Sebastian

    2009-01-01

    The main characteristic of the neutrino mixing effect is assumed to be the coupling between the flavor and the mass eigenstates. Three mixing angles (θ 12 , θ 23 , θ 13 ) are describing the magnitude of this effect. Still unknown, θ 13 is considered very small, based on the measurement done by the CHOOZ experiment. A leading experiment will be Double Chooz, placed in the Ardennes region, on the same site as used by CHOOZ. The Double Chooz goal is the exploration of ∝80% from the currently allowed θ 13 region, by searching the disappearance of reactor antineutrinos. Double Chooz will use two similar detectors, located at different distances from the reactor cores: a near one at ∝150 m where no oscillations are expected and a far one at 1.05 km distance, close to the first minimum of the survival probability function. The measurement foresees a precise comparison of neutrino rates and spectra between both detectors. The detection mechanism is based on the inverse β-decay. The Double Chooz detectors have been designed to minimize the rate of random background. In a simplified view, two optically separated regions are considered. The target, filled with Gd-doped liquid scintillator, is the main antineutrino interaction volume. Surrounding the target, the inner veto region aims to tag the cosmogenic muon background which hits the detector. Both regions are viewed by photomultipliers. The Double Chooz trigger system has to be highly efficient for antineutrino events as well as for several types of background. The trigger analyzes discriminated signals from the central region and the inner veto photomultipliers. The trigger logic is fully programmable and can combine the input signals. The trigger conditions are based on the total energy released in event and on the PMT groups multiplicity. For redundancy, two independent trigger boards will be used for the central region, each of them receiving signals from half of the photomultipliers. A third trigger board

  12. Design studies for the Double Chooz trigger

    Energy Technology Data Exchange (ETDEWEB)

    Cucoanes, Andi Sebastian

    2009-07-24

    The main characteristic of the neutrino mixing effect is assumed to be the coupling between the flavor and the mass eigenstates. Three mixing angles ({theta}{sub 12}, {theta}{sub 23}, {theta}{sub 13}) are describing the magnitude of this effect. Still unknown, {theta}{sub 13} is considered very small, based on the measurement done by the CHOOZ experiment. A leading experiment will be Double Chooz, placed in the Ardennes region, on the same site as used by CHOOZ. The Double Chooz goal is the exploration of {proportional_to}80% from the currently allowed {theta}{sub 13} region, by searching the disappearance of reactor antineutrinos. Double Chooz will use two similar detectors, located at different distances from the reactor cores: a near one at {proportional_to}150 m where no oscillations are expected and a far one at 1.05 km distance, close to the first minimum of the survival probability function. The measurement foresees a precise comparison of neutrino rates and spectra between both detectors. The detection mechanism is based on the inverse {beta}-decay. The Double Chooz detectors have been designed to minimize the rate of random background. In a simplified view, two optically separated regions are considered. The target, filled with Gd-doped liquid scintillator, is the main antineutrino interaction volume. Surrounding the target, the inner veto region aims to tag the cosmogenic muon background which hits the detector. Both regions are viewed by photomultipliers. The Double Chooz trigger system has to be highly efficient for antineutrino events as well as for several types of background. The trigger analyzes discriminated signals from the central region and the inner veto photomultipliers. The trigger logic is fully programmable and can combine the input signals. The trigger conditions are based on the total energy released in event and on the PMT groups multiplicity. For redundancy, two independent trigger boards will be used for the central region, each of

  13. The significance of clinical experience on learning outcome from resuscitation training-a randomised controlled study

    DEFF Research Database (Denmark)

    Jensen, Morten Lind; Lippert, Freddy; Hesselfeldt, Rasmus

    2008-01-01

    CONTEXT: The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. AIM: To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome...... and retention of learning. MATERIALS AND METHODS: This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS...... immediately following graduation. RESULTS: Invitation to participate was accepted by 154/240 (64%) graduates and 117/154 (76%) completed the study. There was no difference between the intervention and control groups with regard to the immediate learning outcome. The intervention group had significantly higher...

  14. Outcome of strategy training in stroke patients with apraxia: a phase II study.

    Science.gov (United States)

    van Heugten, C M; Dekker, J; Deelman, B G; van Dijk, A J; Stehmann-Saris, J C; Kinebanian, A

    1998-08-01

    Evaluation of a therapy programme for stroke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists. The outcome was studied in a pre-post test design. Measurements were conducted at baseline and 12 weeks later. Thirty-three stroke patients with apraxia were treated at occupational therapy departments n general hospitals, rehabilitation centres and nursing homes. The following measurements were conducted: an apraxia test, a motor functioning test, observation of activities of daily living (ADL), Barthel Index, and an ADL questionnaire for the therapist and the patient. The patients showed large improvements in ADL functioning on all measures and small improvements on the apraxia test and the motor functioning test. The effect sizes for the disabilities, ranging from 0.92 to 1.06, were large compared to the effect sizes for apraxia (0.34) and motor functioning (0.19). The significant effect of treatment is also seen when individual improvement and subjective improvement are considered. Measured with the Barthel Index for instance, 71% of the patients improved. These results suggest that the programme seems to be successful in teaching patients compensatory strategies that enable them to function more independently, despite the lasting presence of apraxia.

  15. Clinical Research That Matters: Designing Outcome-Based Research for Older Adults to Qualify for Systematic Reviews and Meta-Analyses.

    Science.gov (United States)

    Lee, Jeannie K; Fosnight, Susan M; Estus, Erica L; Evans, Paula J; Pho, Victoria B; Reidt, Shannon; Reist, Jeffrey C; Ruby, Christine M; Sibicky, Stephanie L; Wheeler, Janel B

    2018-01-01

    Though older adults are more sensitive to the effects of medications than their younger counterparts, they are often excluded from manufacturer-based clinical studies. Practice-based research is a practical method to identify medication-related effects in older patients. This research also highlights the role of a pharmacist in improving care in this population. A single study rarely has strong enough evidence to change geriatric practice, unless it is a large-scale, multisite, randomized controlled trial that specifically targets older adults. It is important to design studies that may be used in systematic reviews or meta-analyses that build a stronger evidence base. Recent literature has documented a gap in advanced pharmacist training pertaining to research skills. In this paper, we hope to fill some of the educational gaps related to research in older adults. We define best practices when deciding on the type of study, inclusion and exclusion criteria, design of the intervention, how outcomes are measured, and how results are reported. Well-designed studies increase the pool of available data to further document the important role that pharmacists have in optimizing care of older patients.

  16. Stereotactic Body Radiation Therapy for Prostate Cancer: What is the Appropriate Patient-Reported Outcome for Clinical Trial Design?

    Directory of Open Access Journals (Sweden)

    Jennifer Ai-Lian Woo

    2015-03-01

    Full Text Available Purpose: Stereotactic body radiation therapy (SBRT is increasingly utilized as primary treatment for clinically localized prostate cancer. Consensus regarding the appropriate patient-reported outcome (PRO endpoints for clinical trials for early stage prostate cancer RT is lacking. To aid in trial design, this study presents PROs over 36 months following SBRT for clinically localized prostate cancer. Methods: 174 hormone-naïve patients were treated with 35-36.25 Gy SBRT in 5 fractions. Patients completed the EPIC-26 questionnaire at baseline and all follow-ups; the proportion of patients developing a clinically significant decline in each EPIC domain was determined. The minimally important difference (MID was defined as a change of one-half SD from the baseline. Per RTOG 0938, we examined the percentage of patients who reported decline in EPIC urinary summary score of >2 points and EPIC bowel summary score of >5 points from baseline to one year. Results: 174 patients received SBRT with minimum follow-up of 36 months. The proportion of patients reporting a clinically significant decline in EPIC urinary/bowel scores was 34%/30%, 40%/32.2%, and 32.8%/21.5% at 6, 12, and 36 months. The percentage of patients reporting decline in the EPIC urinary summary score of >2 points was 43.2%, 51.6% and 41.8% at 6, 12, and 36 months. The percentage of patients reporting decline in EPIC bowel domain summary score of >5 points was 29.6% 29% and 22.4% at 6, 12, and 36 months. Conclusion: Our treatment protocol meets the RTOG 0938 criteria for advancing to a Phase III trial compared to conventionally fractionated RT. Between 12-36 months, the proportion of patients reporting decrease in both EPIC urinary and bowel scores declined, suggesting late improvement in these domains. Further investigation is needed to elucidate 1 which domains bear the greatest influence on post-treatment QOL, and 2 at what time point PRO endpoint(s should be assessed.

  17. Predictors and outcome of hypoxemia in severely malnourished children under five with pneumonia: a case control design.

    Directory of Open Access Journals (Sweden)

    Mohammod Jobayer Chisti

    Full Text Available There is lack of information in the medical literature on predictors of hypoxemia in severely malnourished children with pneumonia, although hypoxemia is common and is often associated with fatal outcome in this population. We explored the predictors of hypoxemia in under-five children who were hospitalized for the management of pneumonia and severe acute malnutrition (SAM.In this unmatched case-control design, SAM children of both sexes, aged 0-59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B with radiological pneumonia and hypoxemia during April 2011 to April 2012 were studied. SAM children with pneumonia and hypoxemia (SpO(2<90% constituted the cases (n = 37, and randomly selected SAM children with pneumonia but without hypoxemia constituted controls (n = 111.The case-fatality was significantly higher among the cases than the controls (30% vs. 4%; p<0.001. In logistic regression analysis, after adjusting for potential confounders such as nasal flaring, head nodding, inability to drink, and crackles in lungs, fast breathing (95% CI = 1.09-13.55, lower chest wall in-drawing (95% CI = 2.48-43.41, and convulsion at admission (95% CI = 3.14-234.01 were identified as independent predictors of hypoxemia in this population. The sensitivity of fast breathing, lower chest wall in-drawing and convulsion at admission and their 95% confidence intervals (CI to predict hypoxemia were 84 (67-93%, 89 (74-96%, and 19 (9-36% respectively, and their specificity were 53 (43-63%, 60 (51-69% and 98 (93-100% respectively.Fast breathing and lower chest wall in-drawing were the best predictors of hypoxemia in SAM children with pneumonia. There thus, in resources poor settings where pulse oximetry is not available, identification of these simple clinical predictors of hypoxemia in such children could be reliably used for early O(2 supplementation in addition to other

  18. Determinants of care outcomes for patients who die in hospital in Ireland: a retrospective study.

    LENUS (Irish Health Repository)

    McKeown, Kieran

    2015-04-18

    More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008\\/9. The study was undertaken as part of the Irish Hospice Foundation\\'s Hospice Friendly Hospitals Programme (2007-2012).

  19. Radiological assessments, environmental monitoring, and study design

    International Nuclear Information System (INIS)

    Hansen, W.R.; Elle, D.R.

    1980-01-01

    Studies of the behavior of transuranic elements in the environment form the basic data for applied programs in radiological assessment, environmental monitoring, derivation of radiation-protection standards, and environmental impact statements. This chapter introduces some of the major information requirements of these applications of transuranic research data. Characteristics of the source terms from nuclear activities usually are needed for an analysis of environmental pathways or deployment of monitoring systems. Major inhalation and ingestion pathways are considered in assessments of hazards from transuranics and are discussed from the viewpoint of research needed

  20. Study of new anticoincidence systems design

    International Nuclear Information System (INIS)

    Chabaud, J.; Laurent, P.; Baronick, J.-P.; Oger, R.; Prévôt, G.

    2012-01-01

    The scientific performances of future hard X-ray missions will necessitate a very low detector background level. This will imply thorough background simulations, and efficient background rejection systems. It necessitates also a very good knowledge of the detectors to be shielded. We got experience on these activities by conceiving and optimizing the active and passive background rejection system of the Simbol-X and IXO/HXI missions. Considering that this work may naturally be extended to other X-ray missions, we have initiated with CNES, in 2010, a R and T project on the study of background rejection systems, whose status will be presented in this paper.

  1. Study of new anticoincidence systems design

    Science.gov (United States)

    Chabaud, J.; Laurent, P.; Baronick, J.-P.; Oger, R.; Prévôt, G.

    2012-12-01

    The scientific performances of future hard X-ray missions will necessitate a very low detector background level. This will imply thorough background simulations, and efficient background rejection systems. It necessitates also a very good knowledge of the detectors to be shielded. We got experience on these activities by conceiving and optimizing the active and passive background rejection system of the Simbol-X and IXO/HXI missions. Considering that this work may naturally be extended to other X-ray missions, we have initiated with CNES, in 2010, a R&T project on the study of background rejection systems, whose status will be presented in this paper.

  2. Study of new anticoincidence systems design

    Energy Technology Data Exchange (ETDEWEB)

    Chabaud, J., E-mail: chabaud@apc.univ-paris7.fr [Laboratoire APC, 10 rue Alice Domon et Leonie Duquet, F-75205, Paris Cedex 13 (France); Laurent, P. [Laboratoire APC, 10 rue Alice Domon et Leonie Duquet, F-75205, Paris Cedex 13 (France); CEA DSM/IRFU/SAp-Service d' Astrophysique, F-91191, Gif sur Yvette (France); Baronick, J.-P.; Oger, R.; Prevot, G. [Laboratoire APC, 10 rue Alice Domon et Leonie Duquet, F-75205, Paris Cedex 13 (France)

    2012-12-11

    The scientific performances of future hard X-ray missions will necessitate a very low detector background level. This will imply thorough background simulations, and efficient background rejection systems. It necessitates also a very good knowledge of the detectors to be shielded. We got experience on these activities by conceiving and optimizing the active and passive background rejection system of the Simbol-X and IXO/HXI missions. Considering that this work may naturally be extended to other X-ray missions, we have initiated with CNES, in 2010, a R and T project on the study of background rejection systems, whose status will be presented in this paper.

  3. Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study.

    Science.gov (United States)

    Van Bogaert, Peter; Peremans, Lieve; Van Heusden, Danny; Verspuy, Martijn; Kureckova, Veronika; Van de Cruys, Zoë; Franck, Erik

    2017-01-01

    High levels of work-related stress, burnout, job dissatisfaction, and poor health are common within the nursing profession. A comprehensive understanding of nurses' psychosocial work environment is necessary to respond to complex patients' needs. The aims of this study were threefold: (1) To retest and confirm two structural equation models exploring associations between practice environment and work characteristics as predictors of burnout (model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses' and nurse managers' perceptions and experiences of staff nurses' workload; (3) To explain and interpret the two models by using the qualitative study findings. This mixed method study is based on an explanatory sequential study design. We first performed a cross-sectional survey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured interviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study data was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and interpreting the findings of the two models. The two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data. Nurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the unit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and between 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job outcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (≤5%). The qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary collaboration, communication and teamwork; staff nurse personal

  4. Outcomes of Zika virus infection during pregnancy: contributions to the debate on the efficiency of cohort studies.

    Science.gov (United States)

    Duarte, Elisabeth Carmen; Garcia, Leila Posenato; de Araújo, Wildo Navegantes; Velez, Maria P

    2017-12-02

    Zika infection during pregnancy (ZIKVP) is known to be associated with adverse outcomes. Studies on this matter involve both rare outcomes and rare exposures and methodological choices are not straightforward. Cohort studies will surely offer more robust evidences, but their efficiency must be enhanced. We aim to contribute to the debate on sample selection strategies in cohort studies to assess outcomes associated with ZKVP. A study can be statistically more efficient than another if its estimates are more accurate (precise and valid), even if the studies involve the same number of subjects. Sample size and specific design strategies can enhance or impair the statistical efficiency of a study, depending on how the subjects are distributed in subgroups pertinent to the analysis. In most ZIKVP cohort studies to date there is an a priori identification of the source population (pregnant women, regardless of their exposure status) which is then sampled or included in its entirety (census). Subsequently, the group of pregnant women is classified according to exposure (presence or absence of ZIKVP), respecting the exposed:unexposed ratio in the source population. We propose that the sample selection be done from the a priori identification of groups of pregnant women exposed and unexposed to ZIKVP. This method will allow for an oversampling (even 100%) of the pregnant women with ZKVP and a optimized sampling from the general population of pregnant women unexposed to ZIKVP, saving resources in the unexposed group and improving the expected number of incident cases (outcomes) overall. We hope that this proposal will broaden the methodological debate on the improvement of statistical power and protocol harmonization of cohort studies that aim to evaluate the association between Zika infection during pregnancy and outcomes for the offspring, as well as those with similar objectives.

  5. Responsiveness of physical function outcomes following physiotherapy intervention for osteoarthritis of the knee: an outcome comparison study.

    Science.gov (United States)

    French, Helen P; Fitzpatrick, Martina; FitzGerald, Oliver

    2011-12-01

    To compare the responsiveness of two self-report measures and three physical performance measures of function following physiotherapy for osteoarthritis of the knee. Single centre study in acute hospital setting. Patients referred for physiotherapy with osteoarthritis of the knee were recruited. The Western Ontario and McMaster Universities (WOMAC), Lequesne Algofunctional Index (LAI), timed-up-and-go test (TUGT), timed-stand test (TST) and six-minute walk test (6MWT) were administered at first and final physiotherapy visits. Wilcoxon Signed Rank tests were used to determine the effect of physiotherapy on each outcome. Responsiveness was calculated using effect size, standardised response mean and a median-based measure of responsiveness due to some outlying data. Thirty-nine patients with a mean age of 65.3 (standard deviation 6.9) years were investigated before and after a course of exercise-based physiotherapy. There was a significant improvement in all outcomes except the WOMAC scores. All measures demonstrated small effect sizes for all statistics (Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  6. The Advanced Glaucoma Intervention Study (AGIS): 1. Study design and methods and baseline characteristics of study patients.

    Science.gov (United States)

    Ederer, F; Gaasterland, D E; Sullivan, E K

    1994-08-01

    Medical therapy has been the standard initial treatment for open-angle glaucoma. When some visual field has been lost and maximum tolerated and effective medical therapy does not succeed in controlling the disease, the patient is considered to have advanced glaucoma, and the first of a potential sequence of surgical treatments is usually indicated. Little is known about the long-term course and prognosis of advanced glaucoma or about the long-term effectiveness of sequential surgical treatments in controlling the disease and preventing vision loss and blindness. The Advanced Glaucoma Intervention Study was designed to study, in advanced glaucoma, the long-term clinical course and prognosis, and, in a randomized trial, the comparative outcomes of two sequences of surgical treatments. Toward these goals, 789 eyes in 591 patients were enrolled at 11 clinical centers between 1988 and 1992. Follow-up will continue until 1996. Eyes were randomly assigned to one of two sequences of surgical treatments. One sequence begins with argon laser trabeculoplasty (ALT), is followed by trabeculectomy, an incisional surgical filtering procedure, should ALT fail to control the disease, and by a second trabeculectomy should the first trabeculectomy fail. The other sequence begins with trabeculectomy, is followed by ALT should the trabeculectomy fail, and by a second trabeculectomy should ALT fail. The main outcome of interest is visual function (visual field and visual acuity). Other important outcomes are intraocular pressure, complications of surgery, time to treatment failure, and extent of need for additional medical therapy. We present in this paper the rationale, objectives, design and methods of the study, and the baseline characteristics of study patients and eyes.

  7. Study design and patient recruitment for the Japan Polyp Study

    Directory of Open Access Journals (Sweden)

    Sano Y

    2014-05-01

    , Japan Background: The Japan Polyp Study (JPS Workgroup was established in 2000 to evaluate colonoscopic follow-up surveillance strategies. The JPS was a multicenter randomized controlled trial designed to evaluate follow-up surveillance strategies in patients who had undergone two complete colonoscopies for control of colorectal cancer, with removal of all detected polyps. The aim of the present analysis was to assess the patient recruitment and whether the clinical characteristics were adequate for enrollment at the participating centers. Materials and methods: Among referrals for colonoscopy at the eleven participating centers, all patients who were 40–69 years old, without a family or personal history of familial polyposis, Lynch syndrome, inflammatory bowel disease, or a personal history of polypectomy with unknown histology, and had no invasive colorectal cancer or colectomy, were considered for inclusion from February 2003. Results: Among 4,752 referrals, a total of 3,926 patients with a mean age of 57.3 (range 40–69 years, including 2,440 (62% males, were included in the JPS. The participation rate was 83%. Among them, a total of 2,757 patients who had undergone two complete colonoscopies with removal of all detected polyps were eligible, giving an eligibility rate of 70% (2,757 of 3,926. Among the eligible patients, 2,166 were assigned to randomized groups, and 591 patients to a nonrandomized group. The last steps of data lock, analysis, and complete histopathological assessment based on a pathology review are ongoing. Conclusion: Eligible patients recruited for the JPS were successfully assigned on the basis of the expected sample-size calculation. Keywords: colonoscopy, follow-up surveillance strategies, Japan Polyp Study (JPS, study design, multicenter randomized controlled trial

  8. Teacher Behavior and Student Outcomes : Results of a European Study

    NARCIS (Netherlands)

    Panayiotou, A.; Kyriakides, L.; Creemers, B.P.M.; McMahon, L.; Vanlaar, G.; Pfeifer, M.; Rekalidou, G.; Bren, M.

    This study investigates the extent to which the factors included in the dynamic model of educational effectiveness are associated with student achievement gains in six different European countries. At classroom level, the dynamic model refers to eight factors relating to teacher behavior in the

  9. The South African Surgical Outcomes Study: A 7-day prospective ...

    African Journals Online (AJOL)

    To investigate the perioperative mortality and need for critical care admission in patients undergoing inpatient non-cardiac surgery in SA. Methods. A 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient noncardiac surgery between 19 and 26 May 2014 at ...

  10. Cooperative context is a determinant of the social influence on outcome evaluation: An electrophysiological study.

    Science.gov (United States)

    Kimura, Kenta; Katayama, Jun'ichi

    2016-02-01

    The present study examined whether or not a cooperative context is a determinant of the social influence on the evaluation of two action outcomes: a monetary outcome and a conflict of opinion with other group members. In the present study, three-person groups were randomly assigned to be either a cooperative or individual group and asked to perform a gambling task. The monetary outcomes in the cooperative group were interrelated among group members, whereas those in the individual group did not influence each other. The present results showed that monetary outcomes elicited feedback-related negativity (FRN) and a conflict of opinion with other group members elicited FRN-like negativity, which reflect an evaluation of the motivational significance of action outcomes. The FRN elicited by monetary outcomes was reduced when participants shared decisions with other group members only in the cooperative group, indicating that the cooperative context reduced the motivational significance of monetary outcomes through the diffusion of responsibility. The FRN-like negativity elicited by a conflict of opinion showed a different pattern between the cooperative and individual groups, indicating that the cooperative context can influence the evaluation of a conflict of opinion, possibly via the modulation of group cohesiveness or conflict processing. The present results suggest that a cooperative context, rather than the social setting, is a determinant of the social influence on outcome evaluation. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. FFAG Designs for the International Design Study for the Neutrino Factory

    Energy Technology Data Exchange (ETDEWEB)

    Berg, J.S.; Machida, S.

    2009-05-04

    The International Design Study for the Neutrino Factory (IDS-NF) aims to produce a design report for a neutrino factory. One component of that design is a linear nonscaling fixed-field alternating gradient accelerator (FFAG) that will accelerate to the final energy of 25 GeV. An FFAG is used to reduce the machine cost by maximizing the number of passes made through the RF cavities. We present some design options for this FFAG, individually optimized for cost. We study the addition of nonlinear magnets to the lattice to improve the performance of the lattice and consider the negative effects of doing so.

  12. Twin-Twin Transfusion Syndrome: study protocol for developing, disseminating, and implementing a core outcome set.

    Science.gov (United States)

    Khalil, Asma; Perry, Helen; Duffy, James; Reed, Keith; Baschat, Ahmet; Deprest, Jan; Hecher, Kurt; Lewi, Liesbeth; Lopriore, Enrico; Oepkes, Dick

    2017-07-14

    Twin-Twin Transfusion Syndrome (TTTS) is associated with an increased risk of perinatal mortality and morbidity. Several treatment interventions have been described for TTTS, including fetoscopic laser surgery, amnioreduction, septostomy, expectant management, and pregnancy termination. Over the last decade, fetoscopic laser surgery has become the primary treatment. The literature to date reports on many different outcomes, making it difficult to compare results or combine data from individual studies, limiting the value of research to guide clinical practice. With the advent and ongoing development of new therapeutic techniques, this is more important than ever. The development and use of a core outcome set has been proposed to address these issues, prioritising outcomes important to the key stakeholders, including patients. We aim to produce, disseminate, and implement a core outcome set for TTTS. An international steering group has been established to oversee the development of this core outcome set. This group includes healthcare professionals, researchers and patients. A systematic review is planned to identify previously reported outcomes following treatment for TTTS. Following completion, the identified outcomes will be evaluated by stakeholders using an international, multi-perspective online modified Delphi method to build consensus on core outcomes. This method encourages the participants towards consensus 'core' outcomes. All key stakeholders will be invited to participate. The steering group will then hold a consensus meeting to discuss results and form a core outcome set to be introduced and measured. Once core outcomes have been agreed, the next step will be to determine how they should be measured, disseminated, and implemented within an international context. The development, dissemination, and implementation of a core outcome set in TTTS will enable its use in future clinical trials, systematic reviews and clinical practice guidelines. This is

  13. Mortality analysis in hip fracture patients: implications for design of future outcome trials

    DEFF Research Database (Denmark)

    Foss, N B; Kehlet, H

    2006-01-01

    Patients with hip fractures are usually frail and elderly with a 30-day mortality in excess of 10% in European series. Perioperative morbidity is often multifactorial in nature, and unimodal interventions will not necessarily decrease mortality. The purpose of this prospective study was to analys...

  14. How to design and evaluate interventions to improve outcomes for patients with multimorbidity

    DEFF Research Database (Denmark)

    Smith, Susan M.; Bayliss, Elizabeth A.; Mercer, Stewart W.

    2014-01-01

    of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden...

  15. Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Saywell Nicola

    2012-12-01

    Full Text Available Abstract Background In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location. Currently most people receive no treatment beyond three months post stroke. The study aims to determine if the Augmented Community Telerehabilitation Intervention (ACTIV results in better physical function for people with stroke than usual care, as measured by the Stroke Impact Scale, physical subcomponent. Methods/design This study will use a multi-site, two-arm, assessor blinded, parallel randomised controlled trial design. People will be eligible if they have had their first ever stroke, are over 20 and have some physical impairment in either arm or leg, or both. Following discharge from formal physiotherapy services (inpatient, outpatient or community, participants will be randomised into ACTIV or usual care. ACTIV uses readily available technology, telephone and mobile phones, combined with face-to-face visits from a physiotherapist over a six-month period, to help people with stroke resume activities they enjoyed before the stroke. The impact of stroke on physical function and quality of life will be assessed, measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options. These outcomes will be collected at baseline, six months and 12 months. In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study. Discussion The lack of on-going rehabilitation for people with stroke diminishes the chance of their

  16. The clinical outcomes of surgical treatment of noncontiguous spinal tuberculosis: a retrospective study in 23 cases.

    Directory of Open Access Journals (Sweden)

    Jia Huang

    Full Text Available STUDY DESIGN: A retrospective clinical study. OBJECTIVE: To evaluate the clinical efficacy of the surgical treatment of noncontiguous spinal tuberculosis (NSTB, and to discuss its therapeutic strategies. METHODS: We performed a retrospective review of clinical and radiographic data that were prospectively collected on 550 consecutive spinal tubercular patients including 27 patients who were diagnosed and treated as NSTB in our institution from June 2005 to June 2011. Apart from 4 patients being treated conservatively, the remainder received surgery by posterior transforaminal debridement, interbody fusion with instrumentation, posterior instrumentation and anterior debridement with fusion in a single or two-stage operation. The clinical outcomes were evaluated before and after treatment in terms of hematologic and radiographic examinations, bone fusion and neurologic status. The Oswestry Disability Index score was determined before treatment and at the last follow-up visit. RESULTS: 23 patients (15 M/8F, averaged 44.6 ± 14.2 years old (range, 19 to 70 yd, who received surgical treatment, were followed up after surgery for a mean of 52.5 ± 19.5 months (range, 24 to 72 months. The kyphotic angle was changed significantly between pre- and postoperation (P<0.05. The mean amount of correction was 12.6 ± 7.2 degrees, with a small loss of correction at last follow-up. All patients achieved solid bone fusion. No patients with neurological deficit deteriorated postoperatively. Neither mortalities nor any major complications were found. There was a significant difference of Oswestry Disability Index scores between preoperation and the final follow-up. CONCLUSION: The outcomes of follow-up showed that posterior and posterior-anterior surgical treatment methods were both viable surgical options for NSTB. Posterior transforaminal debridement, interbody fusion and posterior instrumentation, as a less invasive technique, was feasible and effective to treat

  17. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

    Directory of Open Access Journals (Sweden)

    McDermott Robyn

    2010-05-01

    Full Text Available Abstract Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE project has facilitated the implementation of modern Continuous Quality Improvement (CQI approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1 explore the factors associated with variation in clinical performance; 2 examine specific strategies that have been effective in improving primary care clinical performance; and 3 work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. Methods/Design The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. Discussion By linking researchers directly to users of research (service providers, managers and policy makers, the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary

  18. The outcomes of partnerships with mental health service users in interprofessional education: a case study.

    Science.gov (United States)

    Barnes, Di; Carpenter, John; Dickinson, Claire

    2006-09-01

    This paper reports findings from a 5-year evaluation (1998-2003) of a postqualifying programme in community mental health in England which made a sustained attempt to develop partnerships with service users. Users were involved in the commissioning of the programme and its evaluation, as trainers and as course members. The evaluation employed mixed methods to assess: learners' reactions to user-trainers and users as course members; changes in knowledge, attitudes and skills; and changes in individual and organisational practice. Data were collected from participant observation of training, 23 individual and 18 group interviews with students and their managers (n=13), and student ratings of knowledge and skills at the beginning and end of the programme (n=49). The quality of care provided by students was rated by service users (n=120) with whom they worked, using a user-defined questionnaire. The quality of care, and mental health and quality of life outcomes were compared to those for two comparison groups (n=44) in areas where no training had taken place. In general, the students reported positive learning outcomes associated with the partnership orientation of the programme, and learning directly from and with service users. A higher proportion of programme users reported good user-centred assessment and care planning, and showed greater improvement in life skills compared to the comparators. This case study provides evidence of the value of partnership working with service users in interprofessional postqualifying education in mental health. The success is attributed to the design of the programme and the responsiveness of the programme board, which included service users. It may provide a useful model for programmes elsewhere and for other user groups. The case study itself provides a possible model for the systematic evaluation of partnerships with users in education and training.

  19. [Professional outcomes and psychological health after workplace bullying: an exploratory follow-up study].

    Science.gov (United States)

    Fiabane, Elena; Flachi, Daniela; Giorgi, Ines; Crepaldi, Ilaria; Candura, Stefano M; Mazzacane, Fulvio; Argentero, Piergiorgio

    2015-07-08

    The literature shows that workplace bullying can lead to negative consequences for both individuals' health and professional outcomes. Most of these studies used cross-sectional designs and self-report questionnaires and further research is needed in order to explore long-term effects of workplace bullying. This follow-up study aimed to explore professional and psychological outcomes in a sample of subjects who required a specialized and multidisciplinary assessment for psychological problems related, in their opinion, to workplace bullying. The sample includes 71 patients with a baseline diagnosis of work-related psychological disorder who were assessed at follow-up by means of a structured telephone interview. The interview included structured questions about professional career developments and psycho-somatic health, and administration of the General Health Questionnaire-12. 62.0% of the participants were currently working and, of these, 59.1% had changed workplace after experiencing mobbing. Patients who changed workplace scored significantly higher on job satisfaction levels (p<0.01) and showed lower levels of social dysfunction (p<0.01) compared to those who did not change their job. Patients with a baseline diagnosis of Adjustment disorder/Post-Traumatic Stress disorder had higher levels of general dysphoria (p<0.04) and social dysfunction (p<0.01) at follow-up than other patients. These findings  stress the importance of an accurate diagnostic assessment of mobbing-related psychopathological disorder. Victims of workplace bullying require early and continuous psychological support in order to promote their psychological well-being and work reinstatement.

  20. The Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes: I. Description of methods and populations.

    Science.gov (United States)

    Charuluxananan, Somrat; Suraseranivongse, Suwannee; Punjasawadwong, Yodying; Somboonviboon, Wanna; Nipitsukarn, Thana; Sothikarnmanee, Thepakorn; Vasinanukorn, Mayuree; Werawatganon, Thewarug; Tanudsintum, Surasak; Lekprasert, Varinee; Hintong, Thanoo

    2005-11-01

    Since anesthesia, unlike medical or surgical specialties, does not constitute treatment, The Royal College of Anesthesiologists of Thailand host the Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes to determine factors related to anesthesia related adverse events. A prospective descriptive study of occurrence screening was conducted in 20 hospitals comprised of 7 university, 4 general and 4 district hospitals across Thailand. Anesthesia personnels were required to fill up patient-related, surgical-related, anesthesia-related variables and adverse outcomes on a strutured data entry form. The data included preanesthetic evaluation intraoperative period and 24 hr postoperative period. Adverse events specific form was recorded when adverse events occurred. All data were keyed in data management unit with double entry technique and descriptive statistics was used in the first phase of this study. A total of 163403 consecutive cases were recorded in one year. The mean (S.D.) of age, weight and height of patients were 38.6(2.3) yrs, 53.9(17.7) kgs and 153.4(22.7) cm respectively. There were more female (52.9%) than male (47. 1%) patients with ASA PS 1, 2, 3, 4, 5 = 50.8%, 36.3%, 10.7%, 2.0%, 0.2% respectively. Hypertension (11.6%), anemia (7.7%) and diabetes melitus (6.8%) were the three most common abnormalities in preanesthetic history taking. Mallampati score of 111870 patients grade 1, 2, 3, 4 were 54.0%, 39.7%, 5.6%, 0.7% and laryngoscopic grade 1, 2, 3, 4 of 74888 patients were 81.0%, 15.5%, 3.0% and 0.5% respectively. The first phase of THAI study epidemiological project can represent both the anesthesia and surgical profiles in Thailand. The collected data available should be useful for the improvement of the quality of anesthesia, guidelines for clinical practices, medical education and for further research.

  1. The use of pathological grief outcomes in bereavement studies on African Americans.

    Science.gov (United States)

    Granek, Leeat; Peleg-Sagy, Tal

    2017-06-01

    Pathological bereavement outcomes (i.e., complicated grief, traumatic grief, prolonged grief disorder) are a robust and growing research area in the psychological and medical sciences. Although grief is considered to be a universal phenomenon, it is well documented that grieving processes and outcomes are culturally and contextually bound. The objectives of this study were: (a) to examine representations of African Americans in the grief and mourning literature and to assess the extent to which this research utilizes pathological grief outcomes; and (b) to examine the characteristics of pathological grief constructs in the literature to assess their relevance for African American populations. We conducted comprehensive searches of three scientific databases including PsycNET, Medline, and CINAHL, which contain the majority of grief and mourning literature published between January 1998 and February 2014. We found 59 studies addressing grief and mourning in African Americans. Thirteen of these studies used pathological grief outcomes. Pathological grief outcomes that were constructed and validated on White populations were frequently used as outcome variables with African American participants. We discuss the implications for the grief and mourning field and argue that the failure to use culturally sensitive outcome measures in research studies is a form of epistemological violence that may have negative research and clinical implications for African Americans and other ethnic minorities.

  2. Sleep quality, the neglected outcome variable in clinical studies focusing on locomotor system; a construct validation study

    Directory of Open Access Journals (Sweden)

    Röder Christoph

    2010-09-01

    Full Text Available Abstract Background In addition to general health and pain, sleep is highly relevant to judging the well-being of an individual. Of these three important outcome variables, however, sleep is neglected in most outcome studies. Sleep is a very important resource for recovery from daily stresses and strains, and any alteration of sleep will likely affect mental and physical health, especially during disease. Sleep assessment therefore should be standard in all population-based or clinical studies focusing on the locomotor system. Yet current sleep assessment tools are either too long or too specific for general use. Methods Based on a literature review and subsequent patient-based rating of items, an expert panel designed a four-item questionnaire about sleep. Construct validation of the questionnaire in a random sample of the German-speaking Swiss population was performed in 2003. Reliability, correlation, and tests for internal consistency and validity were analyzed. Results Overall, 16,634 (70% out of 23,763 eligible individuals participated in the study. Test-retest reliability coefficients ranged from 0.72 to 0.87, and a Cronbach's alpha of 0.83 indicates good internal consistency. Results show a moderate to good correlation between sleep disturbances and health perception, and between sleep disturbances and overall pain. Conclusions The Sleep Standard Evaluation Questionnaire (SEQ-Sleep is a reliable and short tool with confirmed construct validity for sleep assessment in population-based observational studies. It is easy to administer and therefore suitable for postal surveys of the general population. Criterion validity remains to be determined.

  3. Design study of underground facility of the Underground Research Laboratory

    International Nuclear Information System (INIS)

    Hibiya, Keisuke; Akiyoshi, Kenji; Ishizuka, Mineo; Anezaki, Susumu

    1998-03-01

    Geoscientific research program to study deep geological environment has been performed by Power Reactor and Nuclear Fuel Development Corporation (PNC). This research is supported by 'Long-Term Program for Research, Development and Utilization of Nuclear Energy'. An Underground Research Laboratory is planned to be constructed at Shoma-sama Hora in the research area belonging to PNC. A wide range of geoscientific research and development activities which have been previously studied at the Tono Area is planned in the laboratory. The Underground Research Laboratory is consisted of Surface Laboratory and Underground Research Facility located from the surface down to depth between several hundreds and 1,000 meters. Based on the results of design study in last year, the design study performed in this year is to investigate the followings in advance of studies for basic design and practical design: concept, design procedure, design flow and total layout. As a study for the concept of the underground facility, items required for the facility are investigated and factors to design the primary form of the underground facility are extracted. Continuously, design methods for the vault and the underground facility are summarized. Furthermore, design procedures of the extracted factors are summarized and total layout is studied considering the results to be obtained from the laboratory. (author)

  4. TRIGLYCERIDES, ATHEROSCLEROSIS, AND CARDIOVASCULAR OUTCOME STUDIES: FOCUS ON OMEGA-3 FATTY ACIDS.

    Science.gov (United States)

    Handelsman, Yehuda; Shapiro, Michael D

    2017-01-01

    To provide an overview of the roles of triglycerides and triglyceride-lowering agents in atherosclerosis in the context of cardiovascular outcomes studies. We reviewed the published literature as well as ClinicalTrials.gov entries for ongoing studies. Despite improved atherosclerotic cardiovascular disease (ASCVD) outcomes with statin therapy, residual risk remains. Epidemiologic data and recent genetic insights provide compelling evidence that triglycerides are in the causal pathway for the development of atherosclerosis, thereby renewing interest in targeting triglycerides to improve ASCVD outcomes. Fibrates, niacin, and omega-3 fatty acids (OM3FAs) are three classes of triglyceride-lowering drugs. Outcome studies with triglyceride-lowering agents have been inconsistent. With regard to OM3FAs, the JELIS study showed that eicosapentaenoic acid (EPA) significantly reduced major coronary events in statin-treated hypercholesterolemic patients. Regarding other agents, extended-release niacin and fenofibrate are no longer recommended as statin add-on therapy (by some guidelines, though not all) because of the lack of convincing evidence from outcome studies. Notably, subgroup analyses from the outcome studies have generated the hypothesis that triglyceride lowering may provide benefit in statin-treated patients with persistent hypertriglyceridemia. Two ongoing OM3FA outcome studies (REDUCE-IT and STRENGTH) are testing this hypothesis in high-risk, statin-treated patients with triglyceride levels of 200 to 500 mg/dL. There is consistent evidence that triglycerides are in the causal pathway of atherosclerosis but inconsistent evidence from cardiovascular outcomes studies as to whether triglyceride-lowering agents reduce cardiovascular risk. Ongoing outcomes studies will determine the role of triglyceride lowering in statin-treated patients with high-dose prescription OM3FAs in terms of improved ASCVD outcomes. AACE = American Association of Clinical Endocrinologists

  5. Rationale and study design of the Japan environment and children’s study (JECS)

    Science.gov (United States)

    2014-01-01

    Background There is global concern over significant threats from a wide variety of environmental hazards to which children face. Large-scale and long-term birth cohort studies are needed for better environmental management based on sound science. The primary objective of the Japan Environment and Children’s Study (JECS), a nation-wide birth cohort study that started its recruitment in January 2011, is to elucidate environmental factors that affect children’s health and development. Methods/Design Approximately 100,000 expecting mothers who live in designated study areas will be recruited over a 3-year period from January 2011. Participating children will be followed until they reach 13 years of age. Exposure to environmental factors will be assessed by chemical analyses of bio-specimens (blood, cord blood, urine, breast milk, and hair), household environment measurements, and computational simulations using monitoring data (e.g. ambient air quality monitoring) as well as questionnaires. JECS’ priority outcomes include reproduction/pregnancy complications, congenital anomalies, neuropsychiatric disorders, immune system disorders, and metabolic/endocrine system disorders. Genetic factors, socioeconomic status, and lifestyle factors will also be examined as covariates and potential confounders. To maximize representativeness, we adopted provider-mediated community-based recruitment. Discussion Through JECS, chemical substances to which children are exposed during the fetal stage or early childhood will be identified. The JECS results will be translated to better risk assessment and management to provide healthy environment for next generations. PMID:24410977

  6. Current trends in outcome studies for children with hearing loss and the need to establish a comprehensive framework of measuring outcomes in children with hearing loss in China

    Directory of Open Access Journals (Sweden)

    Xueman Liu

    2016-06-01

    Full Text Available Since the 1970s, outcome studies for children with hearing loss expanded from focusing on assessing auditory awareness and speech perception skills to evaluating language and speech development. Since the early 2000s, the multi-center large scale research systematically studied outcomes in the areas of auditory awareness, speech-perception, language development, speech development, educational achievements, cognitive development, and psychosocial development. These studies advocated the establishment of baseline and regular follow-up evaluations with a comprehensive framework centered on language development. Recent research interests also include understanding the vast differences in outcomes for children with hearing loss, understanding the relationships between neurocognitive development and language acquisition in children with hearing loss, and using outcome studies to guide evidence-based clinical practice. After the establishment of standardized Mandarin language assessments, outcomes research in Mainland China has the potential to expand beyond auditory awareness and speech perception studies.

  7. Relations between student perceptions of assessment authenticity, study approaches and learning outcome

    NARCIS (Netherlands)

    Gulikers, J.T.M.; Bastiaens, Th.J.; Kirschner, P.A.; Kester, L.

    2006-01-01

    This article examines the relationships between perceptions of authenticity and alignment on study approach and learning outcome. Senior students of a vocational training program performed an authentic assessment and filled in a questionnaire about the authenticity of various assessment

  8. Conceptual design study of Fusion Experimental Reactor (FY87FER)

    International Nuclear Information System (INIS)

    1988-05-01

    The design study of Fusion Experimental Reactor(FER) which has been proposed to be the next step fusion device has been conducted by JAERI Reactor System Laboratory since 1982 and by FER design team since 1984. This is the final report of the FER design team program and describes the results obtained in FY1987 (partially in FY1986) activities. The contents of this report consist of the reference design which is based on the guideline in FY1986 by the Subcomitees set up in Nuclear Fusion Council of Atomic Energy Commission of Japan, the Low-Physics-Risk reactor design for achieving physics mission more reliably and the system study of FER design candidates including above two designs. (author)

  9. A solar fuels roadmap for Australia - study outcomes

    Science.gov (United States)

    Hinkley, James T.; McNaughton, Robbie K.; Hayward, Jennifer A.; Lovegrove, Keith

    2017-06-01

    This paper summarises the key findings and recommendations of a 3.5 year study into the research, development and demonstration priorities to establish a solar fuels industry in Australia. While Australia has one of the best solar resources in the world, it also has an abundance of conventional fuels such as coal and natural gas. The country is heavily dependent on fossil fuels for its primary energy supply and international trade, and is seeking pathways to reduce emissions intensity. While renewable electricity will be able to displace fossil fuels in the electricity sector, this only addresses about 16% of energy consumption by end use. Concentrating solar fuels (CSF) are produced either in full or in part from concentrated solar energy, and can provide either complete or partial reduction of the CO2 emissions associated with energy consumption. Our study reviewed the various potential solar thermal technology pathways and feedstocks available to produce a range of CSF products such as hydrogen, ammonia, methanol and synthetic gasoline or diesel. We conducted what we believe to be the broadest and most sophisticated evaluation of the many options to identify those that are most prospective, including an evaluation of the expected final fuel costs. The study identified the following opportunities for CSF: • Australia: substitution of imported liquid fuels (gasoline and diesel) with synthetic CSF options would provide fuel security through the utilization of domestic resources. Ammonia is also a potentially attractive CSF product as it is produced in large quantities for fertilisers and explosives. • Export markets: Australia has significant trading relationships with many Asian countries in the energy domain, and CSF fuels could provide a long term future to enable such relationships to continue - or grow - in a carbon constrained world. Japan in particular is considering how to transition to a hydrogen economy, and could be a customer for CSF hydrogen or

  10. Paired split-plot designs of multireader multicase studies.

    Science.gov (United States)

    Chen, Weijie; Gong, Qi; Gallas, Brandon D

    2018-07-01

    The widely used multireader multicase ROC study design for comparing imaging modalities is the fully crossed (FC) design: every reader reads every case of both modalities. We investigate paired split-plot (PSP) designs that may allow for reduced cost and increased flexibility compared with the FC design. In the PSP design, case images from two modalities are read by the same readers, thereby the readings are paired across modalities. However, within each modality, not every reader reads every case. Instead, both the readers and the cases are partitioned into a fixed number of groups and each group of readers reads its own group of cases-a split-plot design. Using a [Formula: see text]-statistic based variance analysis for AUC (i.e., area under the ROC curve), we show analytically that precision can be gained by the PSP design as compared with the FC design with the same number of readers and readings. Equivalently, we show that the PSP design can achieve the same statistical power as the FC design with a reduced number of readings. The trade-off for the increased precision in the PSP design is the cost of collecting a larger number of truth-verified patient cases than the FC design. This means that one can trade-off between different sources of cost and choose a least burdensome design. We provide a validation study to show the iMRMC software can be reliably used for analyzing data from both FC and PSP designs. Finally, we demonstrate the advantages of the PSP design with a reader study comparing full-field digital mammography with screen-film mammography.

  11. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

    Directory of Open Access Journals (Sweden)

    Satish Shervegar

    2015-10-01

    Full Text Available Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation

  12. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

    Directory of Open Access Journals (Sweden)

    Satish Shervegar

    2015-09-01

    Full Text Available Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation

  13. Improving Neurodevelopmental Outcomes in Children with Congenital Heart Disease: An Intervention Study

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-16-1-0741 TITLE: Improving Neurodevelopmental Outcomes in Children with Congenital Heart Disease: An Intervention Study...2017 4. TITLE AND SUBTITLE Improving Neurodevelopmental Outcomes in Children with Congenital Heart Disease: An Intervention Study 5a. CONTRACT NUMBER...the most prevalent, and arguably the most distressing, long-term morbidity in the burgeoning population with congenital heart disease (CHD). Deficits

  14. Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.

    LENUS (Irish Health Repository)

    Hickey, Oonagh T

    2012-02-03

    BACKGROUND AND OBJECTIVE: One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus. METHODS: A prospective observational pilot study of patients (n = 39) was performed. Quantitative sensory testing, visual analogue scales for anxiety and pain, the Hospital Anxiety and Depression (HADS) Scale and the McGill Pain Questionnaire were completed, and serum nitric oxide metabolites were measured perioperatively. Excised disc tissue was examined histologically, and immunohistochemistry for phospholipase A2 was performed. RESULTS: Ten patients (26%) had an unsatisfactory outcome. Those with a satisfactory outcome had greater preoperative pain perception thresholds over the affected dermatome, which decreased by 2 months postoperatively. These patients also demonstrated a decrease in nitric oxide metabolites from preoperatively to 18 h postoperatively. Greater preoperative HADS scores, and greater pain intensity 4 h and 24 h postoperatively were associated with an unsatisfactory outcome. CONCLUSION: Patients with a satisfactory outcome demonstrate a decrease in pain perception thresholds and plasma concentration of stable nitric oxide metabolites during the perioperative period. Patients with an unsatisfactory outcome following lumbar discectomy experience greater preoperative anxiety and greater pain during the early postoperative period. These findings justify a larger prospective observational study.

  15. Evaluation of alternative school feeding models on nutrition, education, agriculture and other social outcomes in Ghana: rationale, randomised design and baseline data.

    Science.gov (United States)

    Gelli, Aulo; Masset, Edoardo; Folson, Gloria; Kusi, Anthoni; Arhinful, Daniel K; Asante, Felix; Ayi, Irene; Bosompem, Kwabena M; Watkins, Kristie; Abdul-Rahman, Lutuf; Agble, Rosanna; Ananse-Baden, Getrude; Mumuni, Daniel; Aurino, Elisabetta; Fernandes, Meena; Drake, Lesley

    2016-01-20

    'Home-grown' school feeding programmes are complex interventions with the potential to link the increased demand for school feeding goods and services to community-based stakeholders, including smallholder farmers and women's groups. There is limited rigorous evidence, however, that this is the case in practice. This evaluation will examine explicitly, and from a holistic perspective, the simultaneous impact of a national school meals programme on micronutrient status, alongside outcomes in nutrition, education and agriculture domains. The 3-year study involves a cluster-randomised control trial designed around the scale-up of the national school feeding programme, including 116 primary schools in 58 districts in Ghana. The randomly assigned interventions are: 1) a school feeding programme group, including schools and communities where the standard government programme is implemented; 2) 'home-grown' school feeding, including schools and communities where the standard programme is implemented alongside an innovative pilot project aimed at enhancing nutrition and agriculture; and 3) a control group, including schools and households from communities where the intervention will be delayed by at least 3 years, preferably without informing schools and households. Primary outcomes include child health and nutritional status, school participation and learning, and smallholder farmer income. Intermediate outcomes along the agriculture and nutrition pathways will also be measured. The evaluation will follow a mixed-method approach, including child-, household-, school- and community-level surveys as well as focus group discussions with project stakeholders. The baseline survey was completed in August 2013 and the endline survey is planned for November 2015. The tests of balance show significant differences in the means of a number of outcome and control variables across the intervention groups. Important differences across groups include marketed surplus, livestock income

  16. Child Anxiety Prevention Study: Impact on Functional Outcomes.

    Science.gov (United States)

    Pella, Jeffrey E; Drake, Kelly L; Tein, Jenn-Yun; Ginsburg, Golda S

    2017-06-01

    This study examined the impact of a selective anxiety prevention program for offspring of clinically anxious parents on three domains of child functioning: (1) social, (2) familial, and (3) emotional/behavioral. Dyads were randomized into either the Coping and Promoting Strength program (CAPS; n = 70) or Information Monitoring (IM; n = 66) comparison group. Multi-informant assessments were conducted at baseline, post intervention, and 6 and 12 months follow-ups. Random effects mixed models under the linear growth modeling (LGM) framework was used to assess the impact of CAPS on growth trajectories. Over time, children in the CAPS group had significantly lower anxiety, anxious/depressed symptoms, and lower total behavior problems (parent report), compared to children in IM group. The intervention did not impact other domains assessed (e.g., social functioning), which may be due to "floor effects" on these measures. Longitudinal follow-up data is needed to provide valuable information about this high risk population.

  17. Innovation in the teaching of astrophysics and space science - spacecraft design group study

    International Nuclear Information System (INIS)

    Castelli, C

    2003-01-01

    This paper describes h