WorldWideScience

Sample records for policies day treatment

  1. [Economics and policy of day surgery].

    Science.gov (United States)

    Imanaka, Y

    2000-10-01

    With advances in technology, day surgery has become more efficient and has expanded remarkably due to the policies and economic incentives in some countries. In addition, day surgery could potentially serve as a model of explicit accountability for quality assurance and institutional processes for continuous improvement. It is recommended that Japan adapt its policies and systems to facilitate day surgery after a thorough analysis of the health effects and cost structure. Cost shifts to other services and parties should be considered carefully from a long-term, comprehensive perspective. It could be socially beneficial to subsidize start-up costs for the establishment of day surgery units, since significant capital and human resources are required for quality assurance. The encouragement of day surgery could be a driving force for the improvement of clinical technology and patient quality of life. It would foster collaboration between health service providers, including during preparation and follow-up, and allow patients to participate as partners in clinical processes and decisions. To ensure constant readiness, day surgery environments should be equipped with multisite, standardized databases on clinical and economic performance. An expansion of day surgery facilities could lead to the development of a new mechanism of professional quality improvement and to a new health insurance reimbursement system based on clinical achievements and resources.

  2. Costs of day hospital and community residential chemical dependency treatment.

    Science.gov (United States)

    Kaskutas, Lee Ann; Zavala, Silvana K; Parthasarathy, Sujaya; Witbrodt, Jane

    2008-03-01

    at residential versus day hospital programs were similar for women and for Whites. For non-Whites, and marginally for men, a preference for residential care would appear to come at a higher cost. Lengths of stay in residential treatment were significantly longer than in day hospital, but costs per week were lower. Women and Whites appear to be equally well-served in residential and day hospital programs, with no significant cost differential. Provision of residential treatment for non-Whites may be more costly than day hospital, because their residential stays are likely to be 3 times longer than they would be if treated in day hospital. For men, residential care will be marginally more costly. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Residential treatment appears to represent a cost-effective alternative to day hospital for female and White clients with severe alcohol and drug problems who are not at environmental risk. The much shorter stays in day hospital than at residential among non-Whites highlight the need for research to better understand how to best meet the needs and preferences of non-White clients when considering both costs and outcomes.

  3. Treatment of erythema migrans with doxycycline for 10 days versus 15 days.

    Science.gov (United States)

    Stupica, Dasa; Lusa, Lara; Ruzić-Sabljić, Eva; Cerar, Tjasa; Strle, Franc

    2012-08-01

    The efficacy of 10-day doxycycline treatment in patients with erythema migrans has been assessed in the United States but not in Europe. Experts disagree on the significance of post-Lyme borreliosis symptoms. In a noninferiority trial, the efficacies of 10 days and 15 days of oral doxycycline therapy were evaluated in adult European patients with erythema migrans. The prevalence of nonspecific symptoms was compared between patients with erythema migrans and 81 control subjects without a history of Lyme borreliosis. The efficacy of treatment, determined on the basis of clinical observations and microbiologic tests, was assessed at 14 days and at 2, 6, and 12 months. Nonspecific symptoms in patients and controls were compared at 6 months after enrollment. A total of 117 patients (52%) were treated with doxycycline for 15 days, and 108 (48%) received doxycycline for 10 days. Twelve months after enrollment, 85 of 91 patients (93.4%) in the 15-day group and 79 of 86 (91.9%) in the 10-day group had complete response (difference, 1.6 percentage points; upper limit of the 95% confidence interval, 9.1 percentage points). At 6 months, the frequency of nonspecific symptoms in the patients was similar to that among controls. The 10-day regimen of oral doxycycline was not inferior to the 15-day regimen among adult European patients with solitary erythema migrans. Six months after treatment, the frequency of nonspecific symptoms among erythema migrans patients was similar to that among control subjects. NCT00910715.

  4. Using the day treatment appropriateness scale with rural, alcoholic clients.

    Science.gov (United States)

    Loos, W R; Hargrove, D S; Berman, J J

    1986-09-01

    Inadequate selection of patients is one factor in the underutilization of day-treatment programs. The Day Treatment Appropriateness Scale (DTAS; Lefkovitz, P. M., Int. J. Part. Hosp. 1:45-47, 1982) is one of only two reported instruments designed to assist in patient selection; it has been shown to predict validly successful completion of a day-treatment program for chronic, psychiatric patients. This report addresses the use of the DTAS in an alcohol day-treatment program located in a rural, midwestern, community mental-health center. The DTAS was not found to predict accurately successful program completion among alcoholic clients in day treatment. Possible explanations of the findings and additional predictive variables are reported.

  5. Modeling Hepatitis C treatment policy.

    Energy Technology Data Exchange (ETDEWEB)

    Kuypers, Marshall A.; Lambert, Gregory Joseph; Moore, Thomas W.; Glass, Robert John,; Finley, Patrick D.; Ross, David; Chartier, Maggie

    2013-09-01

    Chronic infection with Hepatitis C virus (HCV) results in cirrhosis, liver cancer and death. As the nations largest provider of care for HCV, US Veterans Health Administration (VHA) invests extensive resources in the diagnosis and treatment of the disease. This report documents modeling and analysis of HCV treatment dynamics performed for the VHA aimed at improving service delivery efficiency. System dynamics modeling of disease treatment demonstrated the benefits of early detection and the role of comorbidities in disease progress and patient mortality. Preliminary modeling showed that adherence to rigorous treatment protocols is a primary determinant of treatment success. In depth meta-analysis revealed correlations of adherence and various psycho-social factors. This initial meta-analysis indicates areas where substantial improvement in patient outcomes can potentially result from VA programs which incorporate these factors into their design.

  6. Diabetes Dictating Policy: An Editorial Commemorating World Health Day 2016.

    Science.gov (United States)

    Takian, Amirhossein; Kazempour-Ardebili, Sara

    2016-06-18

    The 21st century is an era of great challenge for humankind; we are combating terrorism, climate change, poverty, human rights issues and last but not least non-communicable diseases (NCDs). The burden of the latter has become so large that it is being recognized by world leaders globally as an area that it is in need of much greater attention. In light of this concern, the World Health Organization (WHO) dedicated this year's World Health Day (held on April 7, 2016) to raising international awareness on diabetes, the fastest growing NCD in the world. This editorial is an account of the macro politics in place for fighting diabetes, both internationally and nationally. © 2016 by Kerman University of Medical Sciences.

  7. Optimal operation and forecasting policy for pump storage plants in day-ahead markets

    International Nuclear Information System (INIS)

    Muche, Thomas

    2014-01-01

    Highlights: • We investigate unit commitment deploying stochastic and deterministic approaches. • We consider day-ahead markets, its forecast and weekly price based unit commitment. • Stochastic and deterministic unit commitment are identical for the first planning day. • Unit commitment and bidding policy can be based on the deterministic approach. • Robust forecasting models should be estimated based on the whole planning horizon. - Abstract: Pump storage plants are an important electricity storage technology at present. Investments in this technology are expected to increase. The necessary investment valuation often includes expected cash flows from future price-based unit commitment policies. A price-based unit commitment policy has to consider market price uncertainty and the information revealing nature of electricity markets. For this environment stochastic programming models are suggested to derive the optimal unit commitment policy. For the considered day-ahead price electricity market stochastic and deterministic unit commitment policies are comparable suggesting an application of easier implementable deterministic models. In order to identify suitable unit commitment and forecasting policies, deterministic unit commitment models are applied to actual day-ahead electricity prices of a whole year. As a result, a robust forecasting model should consider the unit commitment planning period. This robust forecasting models result in expected cash flows similar to realized ones allowing a reliable investment valuation

  8. Evaluation of a policy to integrate physical activity into the school day.

    Science.gov (United States)

    Holt, Erin; Bartee, Todd; Heelan, Kate

    2013-05-01

    Implementing physical activity (PA) within academic curricula increases energy expenditure and enhances academic achievement in elementary students. The purposes of the study were to determine the extent teachers met the 20-minute PA policy, identify how teachers met the policy, and measure the level of intensity of PA provided. Four elementary schools (grades K-5; 68 classroom teachers) implemented a district-mandated 20-minute PA policy. Teachers recorded PA for 1 week in September 2010 and February 2011. A sample of 142 students (grades K-5) wore accelerometers to measure school day PA. While 40% and 4% of teachers in September and February respectively met the policy all 5 days, 72.5% and 45.7% of teachers in September and February respectively implemented PA at least 3 days/week. Accelerometry results indicated curriculum-based lessons (CBL; 59.92 ± 20.38 min) or walk/run periods (51.56 ± 18.67 min) significantly increased school day MVPA (P teachers did not meet the 20-minute policy every day, the increased amount of PA achieved each week through the teachers' efforts is a significant contributor to total daily PA levels of children.

  9. Day

    OpenAIRE

    Chapman, Neil; Stahl, Ola

    2014-01-01

    Contribution for a publication by Nico Dockx & Clara Meister entitled, 'A Poem A Day'.\\ud \\ud "When in 2012, Nico and I talked about utopias and the upcoming Utopia Station exhibition, our conversation quickly turned towards his poster A Poem a Day (2003). Very soon our verbal exchange turned into an idea, into a plan, into an open invitation to friends, asking them to respond to this idea of a poem for every day of the year. Open in the sense that poetry—especially in daily situations—an hap...

  10. Proceedings of the Fourth Forum: Energy Day of Croatia, Prices and Tariff Policy in Energy Supply

    International Nuclear Information System (INIS)

    1995-01-01

    The principle topic of the four Forums ''Croatian Energy Day'' was ''prices and tariff policy in energy supply''. 23 papers were presented, which were subdivided into four groups: 16th World Energy Council Congress, planning and prices in energetics, oil and natural gas prices and tariffs, and electric energy prices and tariffs

  11. Preferential treatment and exemption policy impacts energy

    International Nuclear Information System (INIS)

    Doelle, R.R.

    1991-01-01

    This paper reports on the preferential treatment and exemption policy of the Federal Energy Regulatory Commission (FERC) for State and State Agencies which creates an anticompetitive and restraint of trade attitude in California against the development of alternative energy resources by the private sector when such development competes directly with state owned power generation under the State Water and Central Valley Water Projects, particularly in the area of water and power supply. The existing state water policy fails to address the effects of global warming and the adverse potential of the greenhouse effect in California, i.e. rising tides can seriously impact sea water intrusion problems of the San Francisco Bay-Delta Area by not only flooding agricultural lands in the Delta and Central Valley, but impacting the supply of water to large population areas in Southern and Northern California, especially when coupled with drought conditions. The California investigative research results herein reported demonstrates the fallacy of a preferential treatment and exemption policy in a free market economy, especially when such policy creates the potential for excessive state budget burdens upon the public in the face of questionable subsidies to special interest, i.e., allowing the resulting windfall profits to be passed onto major utilities and commingled at the expense of public interest so as to undermine the financial means for development of alternative energy resources. The cited Congressional and State Legislative Laws which provide the ways and means to resolve any energy or water resource problems are only as good as the enforcement and the commitment by the executive branch of government and the lawmakers to up-hold existing laws

  12. The possibilities of day surgery system development within the health policy in Slovakia.

    Science.gov (United States)

    Šoltés, Vincent; Gavurová, Beáta

    2014-12-01

    In the day surgery system are intertwined elements of state health policy, health care payers' interests, employers of health care system, as well as the interests and wishes of patients. A problem in the health policy is to find a way to regulate ambulatory and short-term surgical procedures, which are hardly distinguishable, and still fulfil the requirements of transparent financing, quality and security. The objective of this paper is to highlight the reasons for the long-term stagnation in Slovakia day surgery and the possibilities of eliminating the structural drivers causing this negative phenomenon. Due to the nature of the analyzed data and desired outcomes, we selected application of correspondence analysis. Results of correspondence analysis provide valuable information necessary for the projection of specialization of one day surgery clinics for that type of procedure, as well as for the support of the new clinics creation (also with the potential state support), the pricing policy, systemic reduction of beds what is connected with reduction of underutilized departments in hospitals, in order to optimize management processes in the healthcare system. Contribution reveals negative aspects which causing a low level of day surgery in Slovakia. Moreover, it reveals the approaches of the different subjects of day surgery. Presented options for setting optimal strategy supporting its development are based on the results of the analysis. Correspondence analysis provided valuable information of present structure of the day surgery system. The determined similarity of the regions and association of specialized fields indicate specific settings of the day surgery system and its components that are inevitable to analyze in the subsequent analytical process. Results of the analysis are very important in order to set up the system measures in the process of its further development, which should be part of the strategic plan of each health system. On conceptual and

  13. Theme day: corrosion and surface treatments in nuclear facilities. Proceedings

    International Nuclear Information System (INIS)

    2012-02-01

    This document brings together the available presentations given at the theme day organized by the Bourgogne Nuclear Pole on the topic of corrosion and surface treatments in nuclear facilities. Eleven presentations (slides) are compiled in this document: 1 - Introduction - PNB centre of competitiveness and R and D activities (A. Mantovan, PNB); 2 - Corrosion damage (M. Foucault, Areva NP - Centre Technique Le Creusot); 3 - Corrosion mechanisms (R. Oltra, UB-ICB); 4 - Examples of expertise management (C. Duret-Thual, Institut de la corrosion/Corrosion Institute); 5 - General framework of surface treatments (C. Nouveau, ENSAM Cluny Paris Tech); 6 - Surfaces et interfaces characterisation - Part A (C. Langlade, Y. Gachon, UTBM and HEF); 7 - Surfaces et interfaces characterisation - Part B (C. Langlade, Y. Gachon, UTBM and HEF); 8 - Ion beam surface treatment (Y. Le Guellec, Quertech Ingenierie); 9 - Impact surface treatment (G. Saout, Sonats); 10 - Metal oxides Characterisation by US laser (R. Oltra, UB-ICB); 11 - Detection and Characterisation of intergranular corrosion (Y. Kernin, Stephane Bourgois, Areva Intercontrole)

  14. Penicillin for acute sore throat : randomised double blind trial of seven days versus three days treatment or placebo in adults

    NARCIS (Netherlands)

    Zwart, S; Sachs, APE; Ruijs, GJHM; Gubbels, JW; Hoes, AW; de Melker, RA

    2000-01-01

    Objective To assess whether treatment with penicillin for three days and the traditional treatment for seven days were equally as effective at accelerating resolution of symptoms in patients with sore throat compared with placebo. Design Randomised double blind placebo controlled trial. Setting 43

  15. Treatment of the mentally ill chemical abuser: description of the Hutchings Day Treatment Program.

    Science.gov (United States)

    Carey, K B

    1989-01-01

    Drug and alcohol abuse represents a major obstacle to the successful rehabilitation of psychiatrically-disabled persons. Prevalence estimates for current chemical abuse among individuals in psychiatric treatment range from 24% to 49%. Although specialized treatment programs for mentally ill chemical abusers (MICAs) have recently been developed, few of these innovative programs are described in the literature. This paper presents main features of the MICA Day Treatment Program at the Richard H. Hutchings Psychiatric Center, including staffing, schedule, maintenance of a drug-free treatment environment, and therapeutic programming. Recommendations are offered for treatment providers who are developing their own services for MICAs.

  16. Fair relationships and policies to support family day care educators' mental health: a qualitative study.

    Science.gov (United States)

    Corr, Lara; Davis, Elise; Cook, Kay; Waters, Elizabeth; LaMontagne, Anthony D

    2014-11-25

    High quality child care is a population health investment that relies on the capacity of providers. The mental health and wellbeing of child care educators is fundamental to care quality and turnover, yet sector views on the relationship between working conditions and mental health and wellbeing are scarce. This paper examines child care educators' and sector key informants' perspectives on how working in family day care influences educator's mental health and wellbeing. Semi-structured telephone interviews were conducted with Australian family day care educators (n = 16) and key informants (n = 18) comprised of representatives from family day care schemes, government and other relevant organisations regarding the relationship between working conditions and educator mental health. Thematic analysis referenced the assumptions and concepts of critical inquiry and used social exchange theory. Educators and key informants reported that educators' mental health was affected by the quality of their relationships with government, family day care schemes, and the parents and children using their services. These social relationships created and contributed to working conditions that were believed to promote or diminish educators' mental health. High quality relationships featured fair exchanges of educator work for key resources of social support and respect; adequate income; professional services; and information. Crucially, how exchanges influenced educator wellbeing was largely contingent on government policies that reflect the values and inequities present in society. Making policies and relationships between educators, government and family day care schemes fairer would contribute strongly to the protection and promotion of educator mental health and wellbeing, and in turn contribute to workforce stability and care quality.

  17. DISSEMINATE CYSTICERCOSIS. One-day treatment in a case

    Directory of Open Access Journals (Sweden)

    Mashiyi MK

    2004-01-01

    Full Text Available We report a patient presenting disseminated cysticercosis characterized by neurocysticercosis, subcutaneous, muscular, and cardiac cysticercosis treated with praziquantel during one day RESUMEN: Se comenta el caso de un paciente que presentó cisticercosis diseminada, caracterizada por neurocisticercosis, y cisticercosis subcutánea, muscular y cardiaca, tratada con praziquantel durante un dia.

  18. Present-day conservative treatment retinopathy of prematurity.

    Science.gov (United States)

    Monika, Modrzejewska; Katarzyna, Kubasik-Kładna; Leszek, Kuprjanowicz

    2013-01-01

    Retinopathy of prematurity occurs in prematurely born babies. Etiology of disease is multifactorial and frequency of retinopathy of prematurity diagnosis increases. Retinopathy is one of causes for major loss of vision and amaurosis in newborns around the world. Low efficacy of treatment leads to necessity for looking for new solutions and modern therapy use in treatment of this disease. So far, therapies used are: laser and cryotherapy and cases of retina detachment, the course is combined with surgical procedures of sclera and vitrectomy. The aim of the paper was detailed observation of available literature concerning new methods of management in retinopathy of prematurity. Newest reviews on role of vascular endothelial growth factor secreted under the influence of hypoxia indicate that it takes part in angiogenesis and neovascularization. Thus, in retinopathy of prematurity management vitreous application of vascular endothelial growth factor inhibitors such as ranibizumab, bevacizumab are used as supplement or treatment combined with laser therapy or surgical procedures, however there are many controversies on this form of treatment. Recently there has been an interest in vitreous application of Triamcinolon and other experimental substances inhibiting fibro-vascular proliferations in mouse models of retinopathy of prematurity. Hopes connected with high efficacy of retinopathy of prematurity treatment are also related to use of gene therapy, beta-blockers, supplementation with Omega-3 acids, matrix metalloproteinase-2 inhibitors, gold nanoparticles-GNP and anthrax lethal toxin.

  19. The first 500 days of life: policies to support maternal nutrition

    Directory of Open Access Journals (Sweden)

    John B. Mason

    2014-06-01

    Full Text Available Background: From conception to 6 months of age, an infant is entirely dependent for its nutrition on the mother: via the placenta and then ideally via exclusive breastfeeding. This period of 15 months – about 500 days – is the most important and vulnerable in a child's life: it must be protected through policies supporting maternal nutrition and health. Those addressing nutritional status are discussed here. Objective and design: This paper aims to summarize research on policies and programs to protect women's nutrition in order to improve birth outcomes in low- and middle-income countries, based on studies of efficacy from the literature, and on effectiveness, globally and in selected countries involving in-depth data collection in communities in Ethiopia, India and Northern Nigeria. Results of this research have been published in the academic literature (more than 30 papers. The conclusions now need to be advocated to policy-makers. Results: The priority problems addressed are: intrauterine growth restriction (IUGR, women's anemia, thinness, and stunting. The priority interventions that need to be widely expanded for women before and during pregnancy, are: supplementation with iron–folic acid or multiple micronutrients; expanding coverage of iodine fortification of salt particularly to remote areas and the poorest populations; targeted provision of balanced protein energy supplements when significant resources are available; reducing teenage pregnancies; increasing interpregnancy intervals through family planning programs; and building on conditional cash transfer programs, both to provide resources and as a platform for public education. All these have known efficacy but are of inadequate coverage and resourcing. The next steps are to overcome barriers to wide implementation, without which targets for maternal and child health and nutrition (e.g. by WHO are unlikely to be met, especially in the poorest countries. Conclusions: This

  20. Eating disorders in day treatment aspects of assessment and outcome

    NARCIS (Netherlands)

    Exterkate, C.C.

    2007-01-01

    Part I gives a general introduction and overview of the research with a naturalistic design that has been done in Amarum. Amarus is a specialized public health centre for the treatment of people with eating disorders where the development of Evidence Based Mental Health (EBMH) and the use of

  1. Eating disorders in day treatment aspects of assessment and outcome

    OpenAIRE

    Exterkate, C.C.

    2007-01-01

    Part I gives a general introduction and overview of the research with a naturalistic design that has been done in Amarum. Amarus is a specialized public health centre for the treatment of people with eating disorders where the development of Evidence Based Mental Health (EBMH) and the use of guidelines is of importance. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Guidelines...

  2. An interim assessment of the results of day-treatment in nursing homes

    NARCIS (Netherlands)

    Nies, H. L.G.R.

    1986-01-01

    Day-treatment has developed very rapidly in Dutch nursing homes. This development was due to several unproved positive expectations concerning the therapeutical results, the effects for relatives and caregivers at home and the substitutional effects of day-treatment. In this article these

  3. Effectiveness of Policies Maintaining or Restricting Days of Alcohol Sales on Excessive Alcohol Consumption and Related Harms

    Science.gov (United States)

    Middleton, Jennifer Cook; Hahn, Robert A.; Kuzara, Jennifer L.; Elder, Randy; Brewer, Robert; Chattopadhyay, Sajal; Fielding, Jonathan; Naimi, Timothy S.; Toomey, Traci; Lawrence, Briana

    2013-01-01

    Local, state, and national laws and policies that limit the days of the week on which alcoholic beverages may be sold may be a means of reducing excessive alcohol consumption and related harms. The methods of the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness for preventing excessive alcohol consumption and related harms of laws and policies maintaining or reducing the days when alcoholic beverages may be sold. Outcomes assessed in 14 studies that met qualifying criteria were excessive alcohol consumption and alcohol-related harms, including motor vehicle injuries and deaths, violence-related and other injuries, and health conditions. Qualifying studies assessed the effects of changes in days of sale in both on-premises settings (at which alcoholic beverages are consumed where purchased) and off-premises settings (at which alcoholic beverages may not be consumed where purchased). Eleven studies assessed the effects of adding days of sale, and three studies assessed the effects of imposing a ban on sales on a given weekend day. The evidence from these studies indicated that increasing days of sale leads to increases in excessive alcohol consumption and alcohol-related harms and that reducing the number of days that alcoholic beverages are sold generally decreases alcohol-related harms. Based on these findings, when the expansion of days of sale is being considered, laws and policies maintaining the number of days of the week that alcoholic beverages are sold at on- and off-premises outlets in local, state, and national jurisdictions are effective public health strategies for preventing excessive alcohol consumption and related harms. PMID:21084079

  4. Malaria Treatment Policy Change and Implementation: The Case of Uganda

    Directory of Open Access Journals (Sweden)

    Miriam Nanyunja

    2011-01-01

    Full Text Available Malaria due to P. falciparum is the number one cause of morbidity and mortality in Uganda where it is highly endemic in 95% of the country. The use of efficacious and effective antimalarial medicines is one of the key strategies for malaria control. Until 2000, Chloroquine (CQ was the first-line drug for treatment of uncomplicated malaria in Uganda. Due to progressive resistance to CQ and to a combination of CQ with Sulfadoxine-Pyrimethamine, Uganda in 2004 adopted the use of ACTs as first-line drug for treating uncomplicated malaria. A review of the drug policy change process and postimplementation reports highlight the importance of managing the policy change process, generating evidence for policy decisions and availability of adequate and predictable funding for effective policy roll-out. These and other lessons learnt can be used to guide countries that are considering anti-malarial drug change in future.

  5. Malaria treatment policy change and implementation: the case of Uganda.

    Science.gov (United States)

    Nanyunja, Miriam; Nabyonga Orem, Juliet; Kato, Frederick; Kaggwa, Mugagga; Katureebe, Charles; Saweka, Joaquim

    2011-01-01

    Malaria due to P. falciparum is the number one cause of morbidity and mortality in Uganda where it is highly endemic in 95% of the country. The use of efficacious and effective antimalarial medicines is one of the key strategies for malaria control. Until 2000, Chloroquine (CQ) was the first-line drug for treatment of uncomplicated malaria in Uganda. Due to progressive resistance to CQ and to a combination of CQ with Sulfadoxine-Pyrimethamine, Uganda in 2004 adopted the use of ACTs as first-line drug for treating uncomplicated malaria. A review of the drug policy change process and postimplementation reports highlight the importance of managing the policy change process, generating evidence for policy decisions and availability of adequate and predictable funding for effective policy roll-out. These and other lessons learnt can be used to guide countries that are considering anti-malarial drug change in future.

  6. Medical Student Views of Substance Abuse Treatment, Policy and Training

    Science.gov (United States)

    Agrawal, Shantanu; Everett, Worth W.; Sharma, Sonali

    2010-01-01

    Purpose: This study examined the impact of medical education on students' views of substance abuse treatment, public policy options and training. Method: A longitudinal survey was conducted on a single-class cohort of 101 students in a major American, urban medical school. The survey was administered in the Spring semesters of the first to third…

  7. Treatment of intracerebral hemorrhage in rats with 12 h, 3 days and 6 days of selective brain hypothermia.

    Science.gov (United States)

    Fingas, Matthew; Penner, Mark; Silasi, Gergely; Colbourne, Frederick

    2009-09-01

    Intracerebral hemorrhage (ICH) is a devastating stroke with no proven treatment to reduce brain injury. In this study we modeled ICH by injecting 100 microL of autologous blood into the striatum of rats. We then tested whether hypothermia would reduce brain injury and improve recovery as has been repeatedly observed for ischemic and traumatic brain damage. Aside from reducing blood-brain barrier disruption, inflammation and edema, hypothermia has not consistently improved behavioral or histological outcome after ICH in animal studies. As this might relate to the choice of cooling method and the duration of hypothermia, we used a system that selectively cooled the injured hemisphere to approximately 32 degrees C (striatum) while the body remained normothermic. Cooling (vs. normothermia) started 1 h after ICH and lasted for 12 h, 3 days or 6 days followed by slow re-warming (approximately 1 degrees C/h). Functional impairment was evaluated from 2 to 3 weeks post-ICH at which time brain injury was determined. The ICH caused significant impairment on a neurological deficit scale and in tests of walking (horizontal ladder), skilled reaching (tray task) and spontaneous limb usage (cylinder test). Only the limb use asymmetry deficit was significantly mitigated by hypothermia, and then only by the longest treatment. Lesion volume, which averaged 16.9 mm3, was not affected. These results, in conjunction with earlier studies, suggest that prolonged mild hypothermia will not be a profound neuroprotectant for patients with striatal ICH, but it may nonetheless improve functional recovery in addition to its use for treating cerebral edema.

  8. 76 FR 22802 - Interim Enforcement Policy for Minimum Days Off Requirements

    Science.gov (United States)

    2011-04-25

    ... consecutive days of restricted or poor quality sleep caused by such things as shift-work, extended work days... practices at plant sites, adversely [impact] the quality of life of covered workers, and [result] in... the NRC ``exercise enforcement discretion from the [MDO] provisions of the rule'' until the final...

  9. Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project.

    Science.gov (United States)

    Waisbourd, Michael; Shafa, Anousheh; Delvadia, Radha; Sembhi, Harjeet; Molineaux, Jeanne; Henderer, Jeffery; Pizzi, Laura T; Myers, Jonathan S; Hark, Lisa A; Katz, L Jay

    2016-10-01

    To report the outcomes of bilateral, same-day laser peripheral iridotomy (LPI) in the Philadelphia Glaucoma Detection and Treatment Project. The Philadelphia Glaucoma Detection and Treatment Project was a community-based initiative aimed to improve detection, management, treatment, and follow-up care of individuals at high risk for glaucoma. This novel project performed LPI, where 2 eyes received laser therapy on the same day. Of the 1649 patients examined between January 1, 2013 and May 31, 2014, patients who underwent bilateral, same-day LPI were included in our analysis. Main outcome measures were visual acuity, intraocular pressure (IOP), and postoperative complication rates. A total of 132 eyes of 66 patients underwent bilateral, same-day LPI. Mean visual acuity remained unchanged following treatment (P=0.85). Eight patients (12.1%) had IOP spikes >5 mm Hg following treatment, and 4 patients (6.1%) spiked >10 mm Hg. IOP returned to normal in all but 1 patient, who was diagnosed with chronic angle-closure glaucoma. Hyphema was reported in 2 patients (3%) and glare in 1 patient (1.5%). Thirteen patients (19.7%) had repeat LPI treatment. All patients successfully tolerated LPI treatment without serious complications. Performing bilateral, same-day LPI was well tolerated in a large community-based, glaucoma detection and treatment project. Applying this treatment strategy may be considered in similar settings, where patients' access to eye care is limited and it may be a cost-effective strategy.

  10. [Medical, social, and economic effectiveness of treatment of day-case patients with peptic ulcer].

    Science.gov (United States)

    Butorov, I V; Osoianu, Iu P; Maksimov, V V; Butorov, S I

    2006-01-01

    The purpose of the study was to evaluate medical, social, and economic effectiveness of treatment of day-case patients with peptic ulcer (PU). The subjects of the study were 60 day-case patients with duodenal ulcer aged 18 to 60, who underwent clinical and instrumental examination including esophagogastroduodenoscopy with biopsy and Helicobacter pylori (HP) detection. The patients received 7-day eradication therapy, which included omeprazol in a dose of 20 mg twice a day, clarithromycin--500 mg twice a day, and metronidazole--500 mg twice a day. There was a control group, which included 60 inpatients treated in Gastroenterology Division of the hospital. The use of the three-component medication in the day-case patients and the inpatients led to disappearance of pain syndrome 7.4 +/- 0.3 and 8.6 +/- 0.2 days after the beginning of the treatment, respectively; dyspepsia disappeared in the day-case patients and the inpatients 7.6 +/- 0.2 and 8.8 +/- 0.3 days after the beginning of the treatment, respectively. HP eradication was effective in 86.7% of the day-case patients, and in 88.3% of the inpatients. The course of the disease was recurrence-free during two years in 80% of the day-case patients, and in 76.4% of the inpatients; the cost of the treatment was 2.1 times higher in the group of inpatients. The results show that high effectiveness of the three-component medication, judging by the results of HP eradication, terms of disappearance of pain syndrome and ulcer healing, allows recommending this regimen for wide clinical application in day-case patients with PU.

  11. The impact of policies regulating alcohol trading hours and days on specific alcohol-related harms: a systematic review.

    Science.gov (United States)

    Sanchez-Ramirez, Diana C; Voaklander, Donald

    2018-02-01

    Evidence supports the expectation that changes in time of alcohol sales associate with changes in alcohol-related harm in both directions. However, to the best of our knowledge, no comprehensive systematic reviews had examined the effect of policies restricting time of alcohol trading on specific alcohol-related harms. To compile existing evidence related to the impact of policies regulating alcohol trading hours/days of on specific harm outcomes such as: assault/violence, motor vehicle crashes/fatalities, injury, visits to the emergency department/hospital, murder/homicides and crime. Systematic review of literature studying the impact of policies regulation alcohol trading times in alcohol-related harm, published between January 2000 and October 2016 in English language. Results support the premise that policies regulating times of alcohol trading and consumption can contribute to reduce injuries, alcohol-related hospitalisations/emergency department visits, homicides and crime. Although the impact of alcohol trading policies in assault/violence and motor vehicle crashes/fatalities is also positive, these associations seem to be more complex and require further study. Evidence suggests a potential direct effect of policies that regulate alcohol trading times in the prevention of injuries, alcohol-related hospitalisations, homicides and crime. The impact of these alcohol trading policies in assault/violence and motor vehicle crashes/fatalities is less compelling. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Body attitudes in patients with eating disorders at presentation and completion of intensive outpatient day treatment.

    NARCIS (Netherlands)

    Exterkate, C.C.; Vriesendorp, P.F.; Jong, C.A.J. de

    2009-01-01

    Due to the importance of the distorted body experience in eating disorder diagnosis and treatment, we wanted to explore body attitudes of patients with eating disorders before and after 5 months of intensive specialized outpatient day treatment. We assessed 193 patients diagnosed with Anorexia

  13. An Uncontrolled Examination of a 5-Day Intensive Treatment for Pediatric OCD

    Science.gov (United States)

    Whiteside, Stephen P.; Jacobsen, Amy Brown

    2010-01-01

    This study examined the feasibility of a 5-day intensive treatment for pediatric obsessive-compulsive disorder (OCD). Fifteen children with OCD received a week-long treatment based on exposure and response prevention (ERP). The intervention also emphasized teaching children and parents how to conduct ERP independently at home. All families…

  14. School Reading Performance and the Extended School Day Policy in Florida. REL 2016-141

    Science.gov (United States)

    Folsom, Jessica Sidler; Petscher, Yaacov; Osborne-Lampkin, La'Tara; Cooley, Stephan; Herrera, Sarah; Partridge, Mark; Smith, Kevin

    2016-01-01

    Florida law requires the 100 lowest performing elementary schools in reading to extend the school day by one hour to provide supplemental reading instruction. This study found that those schools were smaller than other elementary schools and served a higher proportion of racial/ethnic minority students and students eligible for the school lunch…

  15. [Prospective assessment of children with pervasive developmental disorder after 2 years of day-hospital treatment].

    Science.gov (United States)

    Poinso, F; Dubois, B; Chatel, C; Viellard, M; Bastard-Rosset, D; Girardot, A-M; Grandgeorge, P; De Martino, S; Sokolowsky, M; Salle-Collemiche, X; Da Fonseca, D

    2013-01-01

    The treatment of children with pervasive developmental disorders (PDD) has not been systematically assessed in French day-care units. In this prospective study, 11 children with a diagnosis of PDD were followed up for 2years in a day-care unit in the Marseille university hospital. The treatment they received is based on an initial assessment by the "Centre Ressources Autisme" (CRA PACA) and further included a continued observation of the child and an assessment of the child's abilities and needs. This treatment used various therapeutic approaches 10h weekly and also included parental counseling and coordinated work with schools. Treatment in our day-care unit can be categorized as eclectic, non-intensive therapy. It is based on methods such as TEACCH (Treatment and Education of Autistic and related Communication handicapped Children), Floor Time Play, speech and language therapy, developmental therapy, and psychotherapy. International studies on intensive behavioral therapies suggest that this treatment is superior to non-behavioral and/or non-intensive treatment. They suggest its efficiency is due both to the nature of the treatment (behavioral) and to its intensity (more than 25h a week). In this study, the CRA diagnosed children using the ADI and ADOS. The 11 children (mean age, 3years 5months) were tested twice, with the Vineland and CARS scales. The first assessment was on admission to the day hospital and the second was 2years later. The results showed developmental progress with a mean increase of 13.5 months at the Vineland Scale, and a decrease of the autism severity score on the CARS. The treatment presented here proves to be efficient; if compared to similar results in international studies, we obtained better results than their eclectic intensive or non-intensive treatment comparison group. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  16. Adolescents and eating disorders: an examination of a day treatment program.

    Science.gov (United States)

    Dancyger, I; Fornari, V; Schneider, M; Fisher, M; Frank, S; Goodman, B; Sison, C; Wisotsky, W

    2003-09-01

    In this study, we report on our day treatment program (DTP) for adolescents and young adults with eating disorders (EDs). Data for the 82 female patients in DTP were examined, compared across ED diagnosis and by age (adolescents vs. young adults). At admission, patients completed the Eating Disorder Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI) and the Family Adaptability and Cohesion Evaluation Scale- II (FACES-II). Forty-nine percent of patients successfully completed the day program and 13% required hospitalization following day treatment. Overall, there were no significant differences between the adolescents and adults at discharge of the day program. With shortened inpatient (IP) hospitalizations, DTPs can provide the long-term care required by many adolescent patients for psychological and physical recovery. This may be particularly important for the development of children and adolescents.

  17. Proceedings of 15th Forum: Energy Day in Croatia: Energy Policy Scenarios to 2050

    International Nuclear Information System (INIS)

    Granic, G.; Jelavic, B.

    2006-01-01

    Energy perspectives are in the focus of the whole energy community. Facing te growing needs for energy, limits to reserves, terrorist of war threats, and climate changes is the main driver in searching for long-term solutions which would make energy development less uncertain and less risky. Technological development is one of the answers to energy problems, but it is not the only one. Enhancing energy efficiency is a social challenge that goes beyond technology problem. Equally, accepting locations for construction of energy facilities is also a social challenge, because, together with other social challenges, may give am answer how to develop stable energy industry. Energy security is synergy of various factors: energy market, infrastructure which facilitates good connectivity, diversification of resources, enhanced use of renewable energy sources and energy efficiency, and it is important to stress that the only secure energy systems are well-balanced ones. World Energy Council initiated the global study Energy Policy Scenarios to 2050 with the aim to overview the future energy at global and regional levels

  18. Supragingival treatment as an aid to reduce subgingival needs: a 450-day investigation

    Directory of Open Access Journals (Sweden)

    Sabrina Carvalho Gomes

    2014-01-01

    Full Text Available This study investigated the clinical effects of using a supragingival biofilm control regimen (SUPRA as a step prior to scaling and root planing (SRP. A split-mouth clinical trial was performed in which 25 subjects with periodontitis (47.2 ± 6.5 years underwent treatment (days 0-60 and monitoring (days 90-450 phases. At Day 0 (baseline treatments were randomly assigned per quadrant: SUPRA, SRP and S30SRP (SUPRA 30 days before SRP. The full-mouth visible plaque index (VPI, gingival bleeding index (GBI, periodontal probing depth (PPD, bleeding on probing (BOP, and clinical attachment loss (CAL were examined on days 0, 30, 60, 90, 120, 270, and 450. Baseline data were similar among all groups. From days 0 to 60, the groups showed similar significant decreases in VPI and GBI. Reductions in PPD for the SRP (3.39 ± 0.17 to 2.42 ± 0.16 mm and S30SRP (3.31 ± 0.11 to 2.40 ± 0.07 mm groups were greater (p < 0.05 than those for the SUPRA group. This pattern was also observed for BOP. Attachment gain was similar and greater for the SRP (3.34 ± 0.28 to 2.58 ± 0.26 mm and S30SRP (3.25 ± 0.21 to 2.54 ± 0.19 mm groups compared to the SUPRA group. Results were maintained from day 90 forward. Overall, the S30SRP treatment reduced the subgingival treatment needs in 48.16%. Performance of a SUPRA step before SRP decreased subgingival treatment needs and maintained the periodontal stability over time.

  19. Examining Adolescent Student Photography and Related Processes to Inform Day Treatment School Curricula and Behavioral Interventions

    Science.gov (United States)

    Gorbel, Jason E.

    2017-01-01

    Adolescent students with psychiatric disorders who are educated in day treatment school classrooms manifest cognitive limitations, maladaptive behaviors, and social functioning deficits that often lead to academic failure, impeding their productivity when they become adults and causing them to run afoul of the criminal justice system. Informed by…

  20. A five-day inpatient EMDR treatment programme for PTSD: pilot study

    NARCIS (Netherlands)

    Zepeda Méndez, Mayaris; Nijdam, Mirjam J.; ter Heide, F. Jackie June; van der Aa, Niels; Olff, Miranda

    2018-01-01

    Conclusions: The majority of patients in our pilot study experienced symptom reduction consistent with reliable changes in this five-day inpatient treatment with EMDR and yoga. Randomized controlled trials - with longer follow up periods - are needed to properly determine efficacy and efficiency of

  1. Evaluation of the therapeutic community treatment model in Thailand: policy implications for compulsory and prison-based treatment.

    Science.gov (United States)

    Johnson, Knowlton W; Young, Linda; Shamblen, Stephen; Suresh, Geetha; Browne, Thom; Chookhare, Khun Warunee

    2012-01-01

    This study, conducted in 2005 to 2007, presents results that are based on a proscriptive cohort design. The sample consisted of 769 residents in 22 drug user treatment programs who stayed in treatment for at least 30 days to one year; 510 former residents (66%) from 21 programs (95%) were interviewed again at a 6-month post-treatment follow-up assessment. A majority of the participants were male, lived with family or relatives, had completed only primary school, and had a full-time or a part-time job prior to entering treatment. The participating therapeutic community (TC) programs were a mixture of volunteer, compulsory-probation, and prison-based programs. In-person interview data and urine testing showed that the self-reported drug use prevalence rates are reliable. The results show large positive treatment effects on 30-day and 6-month illegal drug use and small to medium effects on the severity of alcohol use and related problems. A multilevel regression analysis suggests that residents' reduced stigma, adaptation of the TC model, and frequency of alcohol and drug use-related consequences partially predict treatment success. Study limitations and policy implications are discussed.

  2. Efficacy, safety and tolerability of 3 day azithromycin versus 10 day co-amoxiclav in the treatment of children with acute lower respiratory tract infections

    NARCIS (Netherlands)

    A. Ferwerda (Annemarie); H.A. Moll (Henriëtte); W.C.J. Hop (Wim); J.M. Kouwenberg (Jan); C.V. Tjon Pian Gi

    2001-01-01

    textabstractTo compare the efficacy, safety and tolerability of a 3 day course of azithromycin with a 10 day course of co-amoxiclav in the treatment of children with acute lower respiratory tract infection (LRTI), 118 patients with community-acquired LRTI were

  3. A 14-day regimen of esomeprazole 20 mg/day for frequent heartburn: durability of effects, symptomatic rebound, and treatment satisfaction.

    Science.gov (United States)

    Peura, David; Le Moigne, Anne; Pollack, Charles; Nagy, Peter; Lind, Tore

    2016-08-01

    Esomeprazole 20 mg once daily has been shown to be effective for treating frequent heartburn over 14 days in subjects who are likely to self-treat with over-the-counter medications. These analyses were conducted to assess durability of effects and symptomatic rebound after cessation of treatment, treatment satisfaction, and rescue antacid use with esomeprazole 20 mg once daily for 14 days. Adults with frequent heartburn (≥ two days/week in the past four weeks) were randomly assigned to 14 days of double-blind treatment with esomeprazole 20 mg or placebo in two identical multicenter studies. All subjects entered a 1-week single-blind placebo follow-up period after treatment. The results of the primary efficacy endpoints were reported previously. The percentage of heartburn-free days during the 1-week follow-up, use of rescue antacids, and treatment satisfaction, measured with the Global Assessment Questions instrument, are described. The percentage of heartburn-free days was maintained during the 1-week follow-up period; the proportion was 43% among esomeprazole subjects in these studies, suggesting no evidence of symptomatic rebound. Rescue antacid use generally decreased compared with the run-in period in the 14-day treatment and 1-week follow-up periods. Significantly more subjects taking esomeprazole were "very satisfied" or "satisfied" with treatment versus placebo (Study 1: 78% vs. 63%, respectively, P = 0.0038; Study 2: 81% vs. 60%, respectively, P = 0.0002). Subjects who are likely to self-treat their frequent heartburn with over-the-counter medications reported satisfaction with esomeprazole 20 mg. Esomeprazole's treatment effect was maintained for ≥ one week after treatment ended, with no sign of symptomatic rebound. These trials were registered at ClinicalTrials.gov: NCT01370525; NCT01370538.

  4. A Latter-day Saint Approach to Addiction: Aetiology, Consequences and Treatment in a Theological Context

    Directory of Open Access Journals (Sweden)

    James D. Holt

    2014-12-01

    Full Text Available This article explores the theological underpinning of the nature, aetiology and treatment of addictions within The Church of Jesus Christ of Latter-day Saints. The first section outlines the “plan of salvation” and how this provides the theological framework for the source and solution to addictions. The final section explores addiction against this background in terms of its aetiology, types, consequences and treatment in a Latter-day Saint context. In so doing it builds on the recognition by the Church in recent years that addiction is a problem in the lives of some of its members and that treatment programs coherent with its teachings and beliefs are necessary. The article concludes by suggesting that while addiction may be more openly discussed within a Latter-day Saint context there is a need to keep this dialogue moving forward. This article does not examine Latter-day Saint teaching within the wider context of psychotherapy and other definitions of addiction; rather it explores the place of addiction as understood within the theological and ecclesiological context of Mormonism.

  5. Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment

    Directory of Open Access Journals (Sweden)

    Small Dan

    2006-05-01

    out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify.

  6. Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment.

    Science.gov (United States)

    Small, Dan; Drucker, Ernest

    2006-05-02

    require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify.

  7. Eating disorders in individuals with type 1 diabetes: case series and day hospital treatment outcome.

    Science.gov (United States)

    Colton, Patricia Anne; Olmsted, Marion Patricia; Wong, Harmonie; Rodin, Gary Michael

    2015-07-01

    Women with type 1 diabetes are at high risk for eating disorders (ED), a combination that can increase medical complications and mortality. As little is known about treatment response in this population, clinical presentation and treatment outcome in an extended case series were assessed. A chart review at the Eating Disorders Day Hospital Program at Toronto General Hospital identified a total of 100 individuals with type 1 diabetes assessed 1990-2012. Of 37 who attended day hospital, most experienced improvement in ED symptoms, but only 18.8% had a good immediate treatment outcome, while 43.8% had an intermediate outcome and 37.5% had a poor outcome (meeting diagnostic criteria at discharge). This is poorer than program outcomes in individuals without diabetes (χ(2)  = 12.2, df = 2; p = 0.002). Factors influencing treatment engagement and outcome must be further studied and used to improve treatment results in this high-risk group. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  8. Successful Surgical Treatment of a Spontaneous Rupture of the Esophagus Diagnosed Two Days after Onset

    Directory of Open Access Journals (Sweden)

    Hiroyuki Ando

    2012-05-01

    Full Text Available Esophageal perforation is a relatively uncommon disease with a high rate of mortality and morbidity. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40–60%. Primary repair is generally considered the gold standard for patients who present within the first 24 h following perforation of the esophagus. In this paper, we present a case of successful surgical treatment of spontaneous rupture of the esophagus that was diagnosed 2 days after onset. The patient was a 42-year-old man admitted to internal medicine with a diagnosis of pleuritis and complaining of chest and back pain. The next day, computed tomography revealed left-sided pleural effusion and mediastinal emphysema. An esophagogram revealed extravasation of the contrast medium from the lower left esophagus to the mediastinal cavity. These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed. The perforation was repaired with a single-layered closure and was covered with elevated great omentum obtained by laparotomy. The patient was discharged 23 days after the first surgery. In conclusion, primary repair surgery must be selected as the best treatment beyond 24 h if the patient’s general state was stable and there was no evidence of clinical sepsis.

  9. Substance Use and Mental Health Outcomes for Comorbid Patients in Psychiatric Day Treatment

    Directory of Open Access Journals (Sweden)

    Stephen Magura

    2009-01-01

    Full Text Available The study's purpose was to determine treatment outcomes for patients who present with drug use vs. those presenting with no drug use at admission to a psychiatric day treatment program. Consecutively admitted patients completed confidential interviews which included psychological distress and quality of life measures and provided urine specimens for toxicology at admission and six month follow-up. Subjects positive by past 30 day self-report or urinalysis were categorized as drug users. Major psychiatric diagnoses were: major depression 25%; bipolar, 13%; other mood 13%; schizoaffective 13%; schizophrenia 13%. Drug use at admission was: cocaine 35%; marijuana 33%; opiates 18%, (methamphetamines, 6% For each of these drugs, the percentage of patients positive at admission who remitted from using the drug significantly exceeded the percentage negative at baseline who initiated using the drug. Overall, there were significant decreases in psychological distress and significant improvement on quality of life, but no change on positive affect. There were no significant differences between drug users and non-drug users on symptom reduction and improvement in quality of life. Psychiatric day treatment appears to benefit comorbid patients by reducing the net number of patients who actively use certain common drugs and by improving psychological status and quality of life to the same degree as for non-drug using patients.

  10. ‘Forging change’? Collaboration between policy makers, academics, and civil society stakeholders at the ECI Day 2016

    Directory of Open Access Journals (Sweden)

    Lucy Hatton

    2017-04-01

    Full Text Available The ‘ECI Day 2016: Forging Change’ conference brought together policy makers, academics and civil society representatives to discuss how to maximise the effectiveness of the European Citizens’ Initiative (ECI, the EU’s only mechanism of participatory democracy, within its existing rules. Since 2012 these annual conferences have brought together a significant number of interested parties to evaluate the performance of the ECI and look to its future. Through a series of workshops and plenary sessions during ECI Day 2016, participants from diverse backgrounds interacted to produce a number of conclusions that will hopefully be used to inform the future development of the ECI tool. This review focuses on how the representatives of the EU’s institutions, academics and civil society representatives collaborated to create a productive environment and reach a clear conclusion to the proceedings. This was a strength of the conference that will hopefully contribute to ‘forging change’ for the ECI, though resistance to reform from one key stakeholder remains an obstacle.

  11. [Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program].

    Science.gov (United States)

    Krischer, Maya; Ponton-Rodriguez, Tamara; Gooran, Ghazal Rostami; Bender, Stephan

    2017-07-01

    Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program This paper focuses on the concept of transference focused psychotherapy (TFP) modified for juvenile borderline patients. Adolescents with borderline developmental personality disorder (bpd) have an essential deficit in their personality structure that leads to oscillations in their self-esteem and in a "split" perception of the world. They suffer from a variety of symptoms and severe impairments on their own and their families' quality of life. Their fragmented perception of themselves and others make relationships almost unbearable for them. Relationships are mostly marked by severe anxiety of resentment and rejection. For these patients this causes intolerable trouble at school where every day conflicts take place. Self-mutilation and suicidal thoughts often seem the only way out. By now, there is an agreement that an early specialized assessment and treatment is necessary in order to stop the typical consequences of their self-mutilative and dysfunctional behavior. Still, in contrast to adult age, empirical evidence is missing which proves the effectiveness of treating adolescent borderline patients. In this paper we present a research project on the effectiveness of transference focused psychotherapy with adolescent borderline patients (TFP-A) in a day clinic setting, combining TFP with group skills training as known from dialectic behavior therapy (DBT). Furthermore, we give first results on analyzing the effectiveness of our day clinic treatment program based on TFP-A, focusing on improving core symptoms such as affective problems, aggressive behavior against self and others and interpersonal problems.

  12. Employment is maintained and sick days decreased in psoriasis/psoriatic arthritis patients with etanercept treatment

    DEFF Research Database (Denmark)

    Boggs, Robert L; Kárpáti, Sarolta; Li, Wenzhi

    2014-01-01

    treatment in patients with moderate-to-severe plaque psoriasis and PsA and the main results have been presented previously. This analysis examined employment status, job duties and sick days, pre-defined endpoints in PRESTA, among this patient population. METHODS: Participants (N=752) were randomized....../QW) and 1.1 (QW/QW); p≤0.03 for each). No significant differences between the treatment groups were observed for any economic endpoint at any time point. CONCLUSIONS: For patients with moderate-to-severe plaque psoriasis and PsA, etanercept treatment resulted in reducing job responsibility changes due......BACKGROUND: Psoriasis and psoriatic arthritis (PsA) impair quality of life, including reduction in employment or job duties. The PRESTA (Psoriasis Randomized Etanercept STudy in Patients with Psoriatic Arthritis) study, a randomized, double-blind, two-dose trial, examined the efficacy of etanercept...

  13. GnRH analogue treatment on LH surge day 0 followed by single transvaginal artificial insemination with frozen semen on day 5 in bitches

    Science.gov (United States)

    OHTAKI, Tadatoshi; KOGA, Yasuna; ONO, Mamiko; WATANABE, Gen; TAYA, Kazuyoshi; TSUMAGARI, Shigehisa

    2014-01-01

    ABSTRACT Reproductive parameters were evaluated in 19 and 14 estrous beagles that received 100 µg of gonadotropin-releasing hormone (GnRH) and saline treatment, respectively, on the day of luteinizing hormone (LH) surge (Day 0; estimated by serial progesterone assay) and balloon catheter-aided single transvaginal artificial insemination of frozen semen on Day 5. Although the conception rate and litter size were similar between the GnRH and saline groups, the concentration of LH peak was significantly higher in GnRH-treated bitches (Pinsemination. PMID:25311914

  14. Striving for more good days: patient perspectives on botulinum toxin for the treatment of cervical dystonia

    Directory of Open Access Journals (Sweden)

    Poliziani M

    2016-08-01

    flexible treatment. Conclusion: The high burden of recurring primary and secondary symptoms of CD considerably affects patients’ quality of life. Patient-led assessments of disease burden revealed that personalized, more flexible, and/or shorter BoNT injection intervals may reduce the day-to-day impact of CD. Collaboration between patients, clinicians, and health care systems may effect change and improve treatment for patients with CD. Keywords: botulinum toxin type A, cervical dystonia, patient survey, spasmodic torticollis, treatment satisfaction

  15. 5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss.

    Science.gov (United States)

    Yeon, J H; Jung, J Y; Choi, J W; Kim, B J; Youn, S W; Park, K C; Huh, C H

    2011-02-01

    Various treatments have been attempted for female pattern hair loss (FPHL), including topical minoxidil, oral antiandrogen and finasteride. But, there is no consensus on the standard treatment options. Clinical efficacy of finasteride in treating FPHL is still in controversy, but there is a tendency to high dose finasteride, which is more effective than lower dose. The purpose of this study was to evaluate the clinical efficacy of high dose (5 mg/day) oral finasteride in normoandrogenic Asian women with FPHL. Total of 87 normoandrogenic, pre and post-menopausal women with FPHL were enrolled in this study. They were treated with oral finasteride (Proscar(®)), 5 mg daily for 12 months. Efficacy was evaluated with hair density and thickness changes assessed by phototrichogram and global photographs using 7-point scale. Eighty-six patients completed 12 months of finasteride treatment schedule. One patient (1.1%) withdrew due to headache. At initial visits, mean hair density was 90 ± 22/cm(2) and mean hair thickness was 64 ± 11 μm. After 12 months of finasteride treatment, hair density was significantly increased to 107 ± 23/cm(2) (Phair thickness was also significantly increased to 70 ± 9 μm (P=0.02). In global photographs, 70 (81.4%) of the 86 patients were improved (57 were slightly, 10 were moderately and four were greatly improved). Patients without any changes were 13 (15.1%) and 3 (3.5%) patients reported slightly aggravated. Four patients (4.6%) reported adverse events (headache, menstrual irregularity, dizziness and increased body hair growth). However, these adverse events were mild and disappeared soon.   Oral finasteride, 5 mg/day, may be an effective and safe treatment for normoandrogenic women with FPHL. © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.

  16. Day Hospital Treatment for Anorexia Nervosa: A 12-Month Follow-up Study.

    Science.gov (United States)

    Abbate-Daga, Giovanni; Marzola, Enrica; De-Bacco, Carlotta; Buzzichelli, Sara; Brustolin, Annalisa; Campisi, Stefania; Amianto, Federico; Migliaretti, Giuseppe; Fassino, Secondo

    2015-09-01

    Day hospitals (DHs) represent a treatment option for anorexia nervosa (AN), a mental disorder that is difficult to treat and has no evidence-based treatments available. We aimed to determine the effectiveness of a DH treatment that was specifically focused on the emotions of severe AN patients. Body mass index and eating psychopathology were the primary outcome measures. Fifty-six adult patients with AN were assessed upon admission, at the end of treatment (EOT) and at a 12-month follow-up evaluation (T18) using Eating Disorders Inventory-2, Beck Depression Inventory, Hamilton Rating Scale for Anxiety and Brief Social Phobia Scale. All participants received a multidisciplinary treatment programme that focused on psychodynamic psychotherapy. Seventy-eight per cent of participants reported positive outcomes at EOT and 68% at T18. Moreover, 82.1% and 65.4% of long-standing patients showed positive outcomes at EOT and T18, respectively. All measures of psychopathology were significantly improved at EOT and were maintained at follow-up. Our DH was effective at treating severe AN patients; however, further investigations of the processes of change are warranted. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  17. Body attitudes in patients with eating disorders at presentation and completion of intensive outpatient day treatment.

    Science.gov (United States)

    Exterkate, Cecile C; Vriesendorp, Patricia F; de Jong, Cor A J

    2009-01-01

    Due to the importance of the distorted body experience in eating disorder diagnosis and treatment, we wanted to explore body attitudes of patients with eating disorders before and after 5 months of intensive specialized outpatient day treatment. We assessed 193 patients diagnosed with Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Eating Disorder Not Otherwise Specified (EDNOS) using the Body Attitude Test (BAT), Body Mass Index (BMI), Eating Disorder Evaluation Scale (EDES) and Symptom Checklist 90 (SCL-90). Eating disorder subtypes differed in BMI, total body attitudes and negative appreciation of body size at intake, but not at termination of treatment. Following treatment, all patient groups reported large improvements in eating disorder pathology and all but the AN-Restrictive (AN-R) group, reported large improvements in overall psychological functioning. The AN patients demonstrated significant improvement in BMI, however the Anorexia Nervosa purging (AN-P) and Anorexia Nervosa restrictive (AN-R) subtypes differed in their changes in body attitudes. AN-R patients indicated no significant improvement in body attitudes. AN-P patients improved in total body attitudes, except one subscale. Patients with Bulimia Nervosa non-purging (BN-NP) subtype, Bulimia Nervosa purging (BN-P) subtype and EDNOS demonstrated similar improvements in total body attitudes (BAT). Body attitudes provide important insights into differences between eating disorder diagnostic categories and their treatment responsiveness.

  18. Same-day {sup 90}Y radioembolization: implementing a new treatment paradigm

    Energy Technology Data Exchange (ETDEWEB)

    Gabr, Ahmed; Kallini, Joseph Ralph; Gates, Vanessa L.; Hickey, Ryan; Desai, Kush; Thornburg, Bartley; Marshall, Karen; Salzig, Krystina; Williams, Melissa; Del Castillo, Carlene; Hohlastos, Elias; Lewandowski, Robert J. [Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Department of Radiology, Section of Interventional Radiology, Chicago, IL (United States); Kulik, Laura; Ganger, Daniel [Northwestern University, Department of Medicine, Division of Hepatology, Chicago, IL (United States); Baker, Talia [Northwestern University, Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Chicago, IL (United States); Salem, Riad [Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Department of Radiology, Section of Interventional Radiology, Chicago, IL (United States); Northwestern University, Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Chicago, IL (United States); Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Department of Medicine, Division of Hematology and Oncology, Chicago, IL (United States)

    2016-12-15

    To assess the feasibility of conducting pretreatment mesenteric angiography, coil embolization, {sup 99m}Tc macroaggregated albumin ({sup 99m}Tc-MAA) scintigraphy, and {sup 90}Y radioembolization treatment in a single, same-day, combined outpatient encounter. This was a retrospective study of 78 patients treated during the period 2008 - 2015 who were managed in a single outpatient encounter under the guidance of the Interventional Radiology Department and The Nuclear Medicine Department. Pretreatment planning was performed by reviewing baseline imaging and estimated perfused liver volume bearing the tumor. The region of interest was estimated using 3-D software; this value was used for dosimetry planning. Maximum lung shunting fractions of 10 % for hepatocellular carcinoma and 5 % for liver metastases were assumed. Subsequently, hepatic angiography and {sup 99m}Tc-MAA scintigraphy were performed followed by {sup 90}Y treatment in one outpatient encounter. Total in-room procedure time was recorded. All patients underwent same-day angiography, {sup 99m}Tc-MAA scintigraphy and {sup 90}Y radioembolization. Of the 78 patients, 16 received multiple segmental treatments to both lobes, 44 received treatment to the right lobe, and 18 received treatment to the left lobe. The median dose was 106 Gy. The median number of {sup 90}Y vials needed was two (range one to six). The median in-room time was 160 min (75 - 250 min). The residential status of the patients was as follows, 18 % (14/78) were local residents, 55 % (43/78) traveled from outside the city limits, 18 % (14/78) were from out-of-state, and 9 % (7/78) were resident abroad. Of the 78 patients, 61 (77 %) had hepatocellular carcinoma, and 17 (22 %) had liver metastases. The median lung dose was 3.5 Gy. This study demonstrated the feasibility of same-day {sup 90}Y evaluation and treatment while maintaining the principles of safe and effective {sup 90}Y infusion including tumoricidal dosimetry (lobar, segmentectomy

  19. Same-day 90Y radioembolization: implementing a new treatment paradigm

    International Nuclear Information System (INIS)

    Gabr, Ahmed; Kallini, Joseph Ralph; Gates, Vanessa L.; Hickey, Ryan; Desai, Kush; Thornburg, Bartley; Marshall, Karen; Salzig, Krystina; Williams, Melissa; Del Castillo, Carlene; Hohlastos, Elias; Lewandowski, Robert J.; Kulik, Laura; Ganger, Daniel; Baker, Talia; Salem, Riad

    2016-01-01

    To assess the feasibility of conducting pretreatment mesenteric angiography, coil embolization, 99m Tc macroaggregated albumin ( 99m Tc-MAA) scintigraphy, and 90 Y radioembolization treatment in a single, same-day, combined outpatient encounter. This was a retrospective study of 78 patients treated during the period 2008 - 2015 who were managed in a single outpatient encounter under the guidance of the Interventional Radiology Department and The Nuclear Medicine Department. Pretreatment planning was performed by reviewing baseline imaging and estimated perfused liver volume bearing the tumor. The region of interest was estimated using 3-D software; this value was used for dosimetry planning. Maximum lung shunting fractions of 10 % for hepatocellular carcinoma and 5 % for liver metastases were assumed. Subsequently, hepatic angiography and 99m Tc-MAA scintigraphy were performed followed by 90 Y treatment in one outpatient encounter. Total in-room procedure time was recorded. All patients underwent same-day angiography, 99m Tc-MAA scintigraphy and 90 Y radioembolization. Of the 78 patients, 16 received multiple segmental treatments to both lobes, 44 received treatment to the right lobe, and 18 received treatment to the left lobe. The median dose was 106 Gy. The median number of 90 Y vials needed was two (range one to six). The median in-room time was 160 min (75 - 250 min). The residential status of the patients was as follows, 18 % (14/78) were local residents, 55 % (43/78) traveled from outside the city limits, 18 % (14/78) were from out-of-state, and 9 % (7/78) were resident abroad. Of the 78 patients, 61 (77 %) had hepatocellular carcinoma, and 17 (22 %) had liver metastases. The median lung dose was 3.5 Gy. This study demonstrated the feasibility of same-day 90 Y evaluation and treatment while maintaining the principles of safe and effective 90 Y infusion including tumoricidal dosimetry (lobar, segmentectomy), minimization of nontarget flow, and minimization of

  20. Smoking Among Adolescents in Substance Abuse Treatment: A Study of Programs, Policy, and Prevalence

    OpenAIRE

    Chun, JongSerl; Guydish, Joseph; Chan, Ya-Fen

    2007-01-01

    The study was designed to: (1) identify smoking policies and interventions in adolescent residential treatment settings; (2) examine the prevalence of smoking among adolescents in these settings; and (3) assess relationships between program-level smoking policies and client-level smoking. The Center for Substance Abuse Treatment funded 17 sites to evaluate the effectiveness of Adolescent Residential Treatment (ART) programs for substance abuse. To describe program smoking policies and interve...

  1. Complexity of fiscal policy in Kosovo and their treatment

    Directory of Open Access Journals (Sweden)

    Gani Asllani

    2015-07-01

    Full Text Available Fiscal policy and monetary policy are two key instruments of economic policy of a country which are used to achieve macroeconomic goals. In Kosovo and in the new and consolidating countries the fiscal policy plays the primary role in the functioning of the state, its institutions and economic growth in general. In the study paper treated some of the most sensitive issues affecting fiscal and tax policies, theoretical approaches, modern trends of fiscal policy and addressed some of the reforms in neighboring countries. Special emphases is given fiscal policies applied in Kosovo, its reforms, actions to be taken on the occasion of the policymaking reforms and finally are given appropriate recommendations.

  2. Day-Case Treatment of Peripheral Arterial Disease: Results from a Multi-Center European Study

    Energy Technology Data Exchange (ETDEWEB)

    Spiliopoulos, Stavros, E-mail: stavspiliop@med.uoa.gr, E-mail: stavspiliop@upatras.gr; Karnabatidis, Dimitrios, E-mail: karnaby@med.upatras.gr [Patras University Hospital, Department of Interventional Radiology (Greece); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios, E-mail: adiamantopoulos@gmail.com [Guy’s and St Thomas’ Hospitals, NHS Foundation Trust, King’s Health Partners, Department of Interventional Radiology (United Kingdom); Ali, Tariq, E-mail: tariq.ali@addenbrookes.nhs.uk [Addenbrooke’s University Hospital, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom); Kitrou, Panagiotis, E-mail: panoskitrou@gmail.com [Patras University Hospital, Department of Interventional Radiology (Greece); Cannavale, Alessandro, E-mail: alessandro.cannavale@hotmail.com; Krokidis, Miltiadis, E-mail: miltiadis.krokidis@addenbrookes.nhs.uk [Addenbrooke’s University Hospital, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom)

    2016-12-15

    PurposeThe purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease.Materials and MethodsThis was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals. Exclusion criteria were not related to the type of lesion and included unavailability of an adult able to take care of patient overnight; high bleeding risk and ASA score ≥4. Primary efficacy outcome was the rate of procedures performed on an outpatient basis requiring no further hospitalization and primary safety outcome was freedom from 30-day major complications’ rate.ResultsThe study included 652 patients (male 75 %; mean age 68 ± 10 years; range: 27–93), 24.6 % treated for CLI. In 53.3 % of the cases a 6Fr sheath was used. Technical success was 97.1 %. Haemostasis was obtained by manual compression in 52.4 % of the accesses. The primary efficacy outcome occurred in 95.4 % (622/652 patients) and primary safety outcome in 98.6 % (643/652 patients). Major complications included five (0.7 %) retroperitoneal hematomas requiring transfusion; one (0.1 %) common femoral artery pseudoaneurysm successfully treated with US-guided thrombin injection, two cases of intra-procedural distal embolization treated with catheter-directed local thrombolysis and one on-table cardiac arrest necessitating >24 h recovery. No major complication was noted after same-day discharge.ConclusionsDay-case endovascular procedures for the treatment of IC or CLI can be safely and efficiently performed in experienced IR departments of large tertiary hospitals.

  3. ARTHROSCOPIC TREATMENT OF SHOULDER IMPINGEMENT SYNDROME IN ONE-DAY HOSPITAL

    Directory of Open Access Journals (Sweden)

    Martin Mikek

    2004-12-01

    Full Text Available Background. Arthroscopic subacromial decompression is the method of choice in operative treatment of subacromial rotator cuff impingement. In General Hospital Novo mesto the procedure is performed on a basis of one-day surgery.Methods. We present a prospective analysis of results of operative treatment of shoulder impingement in 36 patients. In all patients functional shoulder scores according to Constant, SST and UCLA were recorded before the operative procedure and again at least three months after the index procedure.Results. According to acromial morphology in the observed group there were three patients with type I acromion (8%, 22 patients had type II acromion (61% and 11 had acromion type III (31%. The average Constant score improved from 21 (SD ± 15 before the operation to 78 (SD ± 12 after the operation and average SST score improved from 4,7 (SD ± 2 to 7,5 (SD ± 1.4 and average UCLA score from 11 (SD ± 3 to 26 (SD ± 3.Conclusions. We conclude that arthroscopic subacromial decompression in properly selected patients enables attainment of good or excellent results in over 90% of patients. Because of minimal invasivness the procedure can be safely performed as one-day surgery.

  4. RETRACTED: Azithromycin 1.5% Ophthalmic Solution for Blepharitis Treatment: Comparison of 14- Versus 30-Day Treatment.

    Science.gov (United States)

    Altay, Yesim; Demirok, Gulizar; Balta, Ozgur; Bolu, Hulya

    2017-06-05

    The online-ahead-of-print published article, "Azithromycin 1.5% Ophthalmic Solution for Blepharitis Treatment: Comparison of 14- Versus 30-Day Treatment," by Altay Yesim, Demirok Gulizar, Balta Ozgur, and Bolu Hulya (DOI: 10.1089/jop.2015.0099) is being officially retracted from Journal of Ocular Pharmacology and Therapeutics (JOPT) due to post-publication authorship disputes and the discovery of simultaneous submission to both JOPT and the International Journal of Ophthalmology, which is a violation of the proper protocols of peer review. Journal of Ocular Pharmacology and Therapeutics and its editorial leadership are committed to maintaining the highest levels of scientific reporting and publishing, and therefore officially retracts the article based on the infringements listed herein.

  5. Treatment policies among Israeli specialists in paediatric dentistry.

    Science.gov (United States)

    Gordon, M; Gorfil, C; Segal, S; Mass, E

    2005-06-01

    This was to evaluate some suggested diagnostic procedures, treatment policies and professional attitudes of specialists in paediatric dentistry, in light of the periodically published guidelines by The American Academy of Pediatric Dentistry, The European Academy of Paediatric Dentistry and The British Society of Paediatric Dentistry. Using a structured questionnaire, 67% of the Israeli specialists in paediatric dentistry, who agreed to participate in this study, were personally interviewed. Only 7.5% of the participants reported that they carry out pulp capping of primary teeth in cases of pulp exposure. Over 50% reported restoring teeth after pulpotomy with preformed crowns. Most indicated sealing pit and fissures after considering depth and morphology of the fissures and correlation with the patient's risk to caries. Cleaning teeth after eruption of the first tooth was suggested by 75.5% of the participants. A striking majority (96%) claimed that they restored permanent anterior teeth with composite resins and most used these materials for occlusal restoration in both primary and permanent posterior teeth. Most specialists advocated the use of amalgam in proximal posterior restorations. The presence of a parent in the operatory/surgery was preferred by 85% of the dentists. Israeli specialists in paediatric dentistry mostly comply with the mentioned guidelines. Further studies of this nature should also be encouraged in other countries to emphasize the importance of monitoring compliance with established and evidence based guidelines.

  6. Exploring the perceived usefulness of practical food groups in day treatment for individuals with eating disorders.

    Science.gov (United States)

    Biddiscombe, Rachel J; Scanlan, Justin Newton; Ross, Jessica; Horsfield, Sarah; Aradas, Jessica; Hart, Susan

    2018-04-01

    Recovery from eating disorders is a challenging process. Emerging literature suggests that occupational therapists may provide a useful contribution in delivering purposeful eating-related interventions as a potential treatment to support sustained cognitive and behavioural changes for individuals with eating disorders. This study aimed to evaluate participants' perceptions of the contribution of occupational therapy practical food groups (food based outings and cooking groups) in supporting their functional recovery. Individuals attended practical food groups as part of standard treatment at an outpatient eating disorders day program. Ninety-nine participants completed questionnaires at discharge and up to three follow-up points (6, 12 and 24 months). Questions related to practical food groups were analysed, exploring participants' experiences and perceived usefulness of groups using rating-scale and open-ended questions. Open-ended responses were analysed using thematic analysis. Descriptive statistics were calculated for responses to rating-scale questions. At discharge, participants rated the importance and usefulness of practical food groups as high (4.73 and 4.43 on 5-point scales, respectively), but tended to rate their enjoyment of the groups lower (3.50 on a 5-point scale). Some skill transfer was typically reported by participants at discharge (3.92 on a 5-point scale). One core theme, 'success through participation', emerged from qualitative comments. Six subthemes were also identified: helpful components of practical food groups; perceived benefit of exposure; impact of applying cognitive and behavioural skills; challenges affecting participation; facilitating adaptation; and influence of eating disorders on challenging feared foods. This study highlights that participation in practical food groups was perceived as useful in assisting individuals to improve eating behaviours and, in some circumstances, transfer these skills into their lives outside of

  7. 5 versus 10 days of treatment with ceftriaxone for bacterial meningitis in children: a double-blind randomised equivalence study.

    Science.gov (United States)

    Molyneux, Elizabeth; Nizami, Shaikh Qamaruddin; Saha, Samir; Huu, Khanh Truong; Azam, Matloob; Bhutta, Zulfiqar Ahmad; Zaki, Ramadan; Weber, Martin Willi; Qazi, Shamim Ahmad

    2011-05-28

    Bacterial meningitis is an important cause of morbidity and mortality in developing countries, but the duration of treatment is not well established. We aimed to compare the efficacy of 5 and 10 days of parenteral ceftriaxone for the treatment of bacterial meningitis in children. We did a multicountry, double-blind, placebo-controlled, randomised equivalence study of 5 versus 10 days of treatment with ceftriaxone in children aged 2 months to 12 years with purulent meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae type B, or Neisseria meningitidis. Our study was done in ten paediatric referral hospitals in Bangladesh, Egypt, Malawi, Pakistan, and Vietnam. We randomly assigned children who were stable after 5 days of treatment, through site-balanced computer-generated allocation lists, to receive a further 5 days of ceftriaxone or placebo. Patients, their guardians, and staff were masked to study-group allocation. Our primary outcomes were bacteriological failure or relapse. Our analysis was per protocol. This study is registered with the International Standard Randomised Controlled Trial Number Register, number ISRCTN38717320. We included 1004 of 1027 children randomly assigned to study groups in our analyses; 496 received treatment with ceftriaxone for 5 days, and 508 for 10 days. In the 5-day treatment group, two children (one infected with HIV) had a relapse; there were no relapses in the 10-day treatment group and there were no bacteriological failures in either study group. Side-effects of antibiotic treatment were minor and similar in both groups. In children beyond the neonatal age-group with purulent meningitis caused by S pneumoniae, H influenzae type b, or N meningitidis who are stable by day 5 of ceftriaxone treatment, the antibiotic can be safely discontinued. United States Agency for International Development. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. SU-E-T-296: Single Field Per Day Vs. Multiple Fields Per Day and the Impact On BED in Proton Therapy Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Grantham, K [University of Missouri-Columbia, St. Louis, MO (United States); Wooten, H [Washington University School of Medicine, St Louis, MO (United States); Zhao, T [Washington University School of Medicine, St. Louis, MO (United States); Klein, E [Washington University, Saint Louis, MO (United States)

    2014-06-01

    Purpose: A common practice, in proton therapy, is to deliver a rotating subset of fields from the treatment plan for the daily fractions. This study compares the impact this practice has on the biological effective dose (BED) versus delivering all planned fields daily. Methods: For two scenarios (a phantom with a geometry approximating the anatomy of a prostate treatment with opposing lateral beams, and a clinical 3-field brain treatment), treatment plans were produced in Eclipse (Varian) to simulate delivery of one, two, and three fields per fraction. The RT-Dose file, structure set, and α/β ratios were processed using in-house MATLAB code to return a new RT-Dose file containing the BED (including a proton RBE of 1.1) which was imported back into Eclipse for analysis. Results: For targets and regions of field overlap in the treatment plan, BED is not affected by delivery regimen. In the phantom, BED in the femoral heads showed increased by 20% when a single field was used rather than two fields. In the brain treatment, the minimum BED to the left optic nerve and the pituitary gland increased by 13% and 10% respectively, for a one-field regime compared to three-fields per fraction. Comparing the two-field and threefield regimes, the optic nerve BED was not significantly affected and the minimum pituitary BED was 4% higher for two fields per day. Conclusion: Hypo-fractionation effects, in regions of non-overlap of fields, significantly increase the BED to the involved tissues by as much as 20%. Care should be taken to avoid inadvertently sacrificing plan effectiveness in the interest of reduced treatment time.

  9. Influence of 22-day treatment on the anticonvulsant properties of cannabinoids.

    Science.gov (United States)

    Karler, R; Borys, H K; Turkanis, S A

    1982-08-01

    Mice were given delta-9-tetrahydrocannabinol (delta-9-THC) cannabidiol (CBD) or phenytoin (PHT) daily for 22 days. Drug activity was measured weekly in three different anticonvulsant tests: the maximal electroshock threshold, the 60-Hz-electroshock threshold and the 6-Hz-electroshock threshold. In order to correlate potential pharmacodynamic and pharmacokinetic changes resulting from repeated treatment, brain-drug concentrations were determined at each test time. The results from the delta-9-THC study indicate that, although tolerance developed in all three tests, there were no changes in the brain-drug concentration. For CBD the pharmacodynamics were strikingly different: an increase in sensitivity to the drug developed in two of the tests, tolerance in only one test. Here again, there were no changes in brain-drug concentrations. The results of the PHT study differed from both the cannabinoids, for tolerance developed in one test, an increase in sensitivity in one test, and the activity was unchanged in the third test. Again, the brain concentrations remained constant throughout. The results demonstrate that both tolerance and increased sensitivity can develop concomitantly with anticonvulsant effects of the cannabinoids and PHT, and that these modifications in drug activity appear to result from cellular or functional rather than dispositional changes.

  10. Efficacy and tolerability of treatment with azacitidine for 5 days in elderly patients with acute myeloid leukemia

    International Nuclear Information System (INIS)

    Sadashiv, Santhosh K; Hilton, Christie; Khan, Cyrus; Rossetti, James M; Benjamin, Heather L; Fazal, Salman; Sahovic, Entezam; Shadduck, Richard K; Lister, John

    2014-01-01

    Acute myeloid leukemia (AML) patients aged ≥60 years tolerate standard induction chemotherapy poorly. Therapy with azacitidine at a dose of 75 mg/m 2 /day for 7 days appears to be better tolerated, and is approved by the Food and Drug Administration (FDA) for the treatment of elderly AML patients with bone marrow (BM) blast counts of 20–30%. Here, we report the results of a prospective, phase 2, open-label study that evaluated the tolerability and efficacy of a 5-day regimen of single-agent subcutaneous azacitidine 100 mg/m 2 /day administered every 28 days in 15 elderly patients with newly diagnosed AML, 14 of whom had BM blast counts >30%. The overall response rate was 47%. Complete remission, partial remission, and hematologic improvement were achieved by 20, 13, and 13% of patients, respectively. Median overall survival was 355 days for the entire cohort, and 532 days for responders. Median time to best response was 95 days, and median treatment duration was 198 days (range = 13–724 days). Grade 3–4 hematologic toxicities comprised predominantly febrile neutropenia (40%) and thrombocytopenia (20%). Febrile neutropenia was the most common cause of hospitalization. Nonhematologic toxicities, consisting of injection-site skin reactions and fatigue (Grades 1–2), occurred in 73% (n = 11) of patients. No treatment-related deaths occurred during the study. The dose and schedule of therapy remained constant in all but four patients. The findings of this study suggest that administration of subcutaneous azacitidine 100 mg/m 2 /day for 5 days every 28 days is a feasible, well-tolerated, and effective alternative to standard induction chemotherapy in elderly patients with AML

  11. Psychodynamic day treatment programme for patients with schizophrenia spectrum disorders: Dynamics and predictors of therapeutic change.

    Science.gov (United States)

    Pec, Ondrej; Bob, Petr; Pec, Jan; Hrubcova, Adela

    2017-09-13

    The purpose of this study was to test whether a psychodynamically based group psychotherapeutic programme might improve symptoms, social functions, or quality of life in patients with schizophrenia spectrum disorders and to investigate factors that might predict clinical improvement or dropouts from the programme. A quantitative prospective cohort study. We have investigated 81 patients with schizophrenia spectrum disorders who participated in a 9-month psychodynamically based psychotherapeutic day programme. The patients were assessed at the beginning and end of the programme, and then at 1-year follow-up. The assessment included psychotic manifestations (HoNOS), quality of life (WHOQOL-BREF), demographic data, and daily doses of medication. 21 patients dropped out from the programme, and 46 patients succeeded in undergoing follow-up assessment. The psychotic manifestations (self-rating version of HoNOS) and quality of life measured with WHOQOL-BREF (domains of social relationships and environment) were significantly improved at the end of the programme and at follow-up. However, the manifestations on the version for external evaluators of HoNOS were improved only at follow-up. Years of psychiatric treatment, number of hospitalizations or suicide attempts, and experience of relationships with a partner were negatively related to clinical improvement, whereas symptom severity, current working, or study activities were related positively. The results show that a group psychodynamic programme may improve the clinical status and quality of life of patients with schizophrenia spectrum disorders. This type of programme is more beneficial for patients with higher pre-treatment symptom severity and the presence of working or study activities. A psychodynamically based group programme improves the clinical status and quality of life in patients with schizophrenia spectrum disorders. Data indicate that changes on the subjective level are detectable by the end of the

  12. Effectiveness of Urban Wastewater Treatment Policies in Selected Countries

    DEFF Research Database (Denmark)

    Andersen, Mikael Skou; Smith, Carey; Kristensen, Peter

    , and two have only recently acceded to the EU and are therefore allowed more time to accomplish the environmental acquis. The report seeks to clarify the role of local authorities, policy instruments and financial mechanisms in securing effective implementation, and it also addresses the issue of cost...

  13. Opioid Misuse Trends in Treatment Seeking Populations: Revised Prescription Opioid Policy and Temporally Corresponding Changes.

    Science.gov (United States)

    Hoffman, Lauren A; Lewis, Ben; Nixon, Sara Jo

    2017-12-06

    Over the last two decades, U.S. rates of prescription opioid (PO) misuse have risen drastically. In response, federal and state governments have begun to implement new PO policies. Recent legislative changes warrant up-to-date assessments of today's misuse rates. To explore potential changes in opioid misuse trends among substance-using treatment seekers, in temporal relation to legislative response. Substance-use data were collected from two cross-sectional Florida-based inpatient cohorts during periods preceding (pre-policy; n = 647) and following (post-policy; n = 396) statewide PO policy initiatives. Participants provided information concerning their most frequently used drugs before treatment. PO and illicit opioid (IO) use prevalence, frequency and route of administration were examined for pre-policy vs. post-policy cohort differences. Relative to the pre-policy cohort, a greater percentage of the post-policy cohort reported recent misuse, daily use, and intravenous administration of POs. IO use was also more frequently reported post-policy. Non-opioid drug use prevalence did not significantly differ between cohorts. Among the opioid-using subsample, equivalent percentages of the pre- and post-policy cohorts reported the use of POs without IOs, IOs without POs, and POs/IOs concurrently. Conclusions/Importance: Florida's PO policy amendments were temporally accompanied by a higher prevalence of PO misuse and IO use among treatment-seekers assessed in this study. Whether our data reflect increased awareness of and treatment seeking for opioid use disorders or insufficient efficacy of new policies to reduce opioid misuse remains in question. Regardless, findings suggest the need for enhanced emphasis on mitigating hazardous PO-use behaviors (e.g., IV use).

  14. Changing the policy for intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy in Malawi.

    Science.gov (United States)

    Mwendera, Chikondi A; de Jager, Christiaan; Longwe, Herbert; Phiri, Kamija; Hongoro, Charles; Mutero, Clifford M

    2017-02-20

    The growing resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) treatment for uncomplicated malaria led to a recommendation by the World Health Organization for the use of artemisinin-based combination therapy. Inevitably, concerns were also raised surrounding the use of SP for intermittent prevention treatment of malaria during pregnancy (IPTp) amidst the lack of alternative drugs. Malawi was the first country to adopt intermittent prevention treatment with SP in 1993, and updated in 2013. This case study examines the policy updating process and the contribution of research and key stakeholders to this process. The findings support the development of a malaria research-to-policy framework in Malawi. Documents and evidence published from 1993 to 2012 were systematically reviewed in addition to key informant interviews. The online search identified 170 potential publications, of which eight from Malawi met the inclusion criteria. Two published studies from Malawi were instrumental in the WHO policy recommendation which in turn led to the updating of national policies. The updated policy indicates that more than two SP doses, as informed by research, overcome the challenges of the first policy of two SP doses only because of ineffectiveness by P. falciparum resistance and the global lack of replacement drugs to SP for IPTp. International WHO recommendations facilitated a smooth policy change driven by motivated local leadership with technical and financial support from development partners. Policy development and implementation should include key stakeholders and use local malaria research in a research-to-policy framework.

  15. Effectiveness of day hospital mentalization-based treatment for patients with severe borderline personality disorder : A matched control study

    NARCIS (Netherlands)

    Bales, D.; Timman, R.; Andrea, H.; Busschbach, J.J.V.; Verheul, R.; Kamphuis, J.

    2015-01-01

    The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization-Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who

  16. Effectiveness of Day Hospital Mentalization-Based Treatment for Patients with Severe Borderline Personality Disorder: A Matched Control Study

    NARCIS (Netherlands)

    Bales, D.L.; Timman, R.; Andrea, H.; Busschbach, J.J.V.; Verheul, R.; Kamphuis, J.H.

    2015-01-01

    The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization-Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who

  17. A Case Study in Coastal Transport and Sewage Treatment Policy

    Science.gov (United States)

    Cudaback, C.

    2008-12-01

    "Huntington Beach, California, is a popular surfing beach near Los Angeles. In July, 1999, the State of California instituted new beach cleanliness standards: beaches should be closed when bacterial concentrations exceed a certain amount. The beach promptly closed for two months. Local environmentalists blamed a nearby sewage outfall, prompting several million dollars worth of studies. How would you figure out whether the outfall was to blame, and what would you do about it?" From this starting point, my undergraduates work through the scientific, regulatory and policy issues involved in a decision about upgrading a coastal sewage outfall. They learn to interpret complex scientific data, discuss the role of science in policy and also reflect on their own priorities and decision-making processes. I will give a brief summary of my teaching methods, and provide CDs with HTML-based educational resources.

  18. Policy for the treatment of insulting and sensitive lexical items in the ...

    African Journals Online (AJOL)

    Keywords: policy, treatment, insulting lexical items, sensitive lexical items, dictionary, woordeboek van die afrikaanse taal, simplexes, compounds, expressions, general usage criterion, labelling, synonyms, metalanguage, collocations, editorial usage examples, citations, advisors, racist lexical items, neutral lemmas, ...

  19. Confronting a rising tide of eating disorders and obesity: treatment vs. prevention and policy.

    Science.gov (United States)

    Battle, E K; Brownell, K D

    1996-01-01

    Eating disorders and obesity are rising in prevalence and are problems of considerable public health significance. Prevailing treatments have a limited impact on public health because the disorders do not yield easily to intervention and because the treatments are costly and available to few. Shifting from a medical to a public health model argues for increased focus on both prevention and public policy. Research on prevention is in its early stages but must be aggressively pursued. Even less is known about policy, but recommendations are made to alter policy so that consumption of healthful foods increases, consumption of unhealthful foods decreases, and levels of physical activity are enhanced.

  20. Declining concentrations of dihydroartemisinin in plasma during 5-day oral treatment with artesunate for Falciparum malaria

    NARCIS (Netherlands)

    Khanh, N. X.; de Vries, P. J.; Ha, L. D.; van Boxtel, C. J.; Koopmans, R.; Kager, P. A.

    1999-01-01

    Six patients with uncomplicated falciparum malaria received artesunate for 5 days. Plasma concentrations of artesunate and dihydroartemisinin were determined by high-performance liquid chromatography with electrochemical detection. The concentrations of dihydroartemisinin in plasma 2 h after a dose

  1. Treatment outcome of 18-month, day hospital mentalization-based treatment (MBT) in patients with severe borderline personality in the Netherlands

    NARCIS (Netherlands)

    Bales, D.; van Beek, N.; Smits, M.; Willemsen, S.; Busschbach, J.J.V.; Verheul, R.; Andrea, H.

    2012-01-01

    Psychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United Kingdom (UK). As

  2. Treatment outcome of 18-month, day hospital Mentalization-Based Treatment (MBT) in patients with severe borderline personality disorder in the Netherlands

    NARCIS (Netherlands)

    D.L. Bales (Dawn); N. van Beek (Nicole); M. Smits (Maaike); S.P. Willemsen (Sten); J.J. van Busschbach (Jan); R. Verheul (Roel); H. Andrea (Helene)

    2012-01-01

    textabstractPsychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United

  3. Policy Forum Improving the screening and treatment of hypertension ...

    African Journals Online (AJOL)

    2008-12-27

    Dec 27, 2008 ... of these patients are unaware and therefore untreated.3. In a small HIV-infected cohort in Blantyre, 46% of patients were found to have elevated blood pressure.4. The lack of a well organised and funded national hypertension screening and treatment programme leaves hypertension in patients poorly ...

  4. Day Hospital Mentalization-Based Treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial

    Science.gov (United States)

    2014-01-01

    Background Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. Methods/design The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months’ intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning

  5. Day Hospital Mentalization-Based Treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial.

    Science.gov (United States)

    Laurenssen, Elisabeth M P; Westra, Dieuwertje; Kikkert, Martijn J; Noom, Marc J; Eeren, Hester V; van Broekhuyzen, Anna J; Peen, Jaap; Luyten, Patrick; Busschbach, Jan J V; Dekker, Jack J M

    2014-05-22

    Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months' intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning, personality functioning

  6. Effect of time of day for harvest and postharvest treatments on the sugar metabolism of broccoli (Brassica oleracea var. italica

    Directory of Open Access Journals (Sweden)

    Joaquin Hasperue

    2014-02-01

    Full Text Available     Loss of sugars contributes to accelerate postharvest senescence of broccoli. Several treatments have been developed to delay senescence, but in many cases their effects on sugar metabolism were not analyzed. We studied the effect of harvest at different times of day (08:00, 13:00 and 18:00 h and of several postharvest treatments as heat treatment (HT, modified atmosphere (MA and 1-methylcylcopropene (1-MCP on sugar levels and activities of enzymes related to sucrose and starch degradation. Harvesting at the end of day delayed the loss of chlorophylls and caused the lowest decrement in sugars, although no differences in invertase, sucrose synthase and β-amylase activities were detected among samples. Treatments of MA and 1-MCP caused a lower loss of glucose and fructose, while HT caused a lower decrement of sucrose. Treated samples maintained higher levels of chlorophylls. The treatments reduced the activity of invertase and sucrose synthase and induced higher levels of β-amylase activity. Harvesting at the end of day and performing simultaneously a MA treatment could be a good combination to maintain the green color of the inflorescence and sugar levels during postharvest of broccoli.

  7. Effect of a 5 day enrofloxacin treatment on Salmonella enterica serotype Typhimurium DT104 in the pig.

    Science.gov (United States)

    Delsol, Anne A; Woodward, Martin J; Roe, John M

    2004-02-01

    There are concerns that the use of enrofloxacin in livestock production may contribute to the development of fluoroquinolone resistance in zoonotic bacteria. The objective of our study was to investigate the effect of a single 5 day enrofloxacin treatment on Salmonella enterica serotype Typhimurium DT104 in a pig model. Our results showed that a single treatment failed to eradicate S. Typhimurium DT104, which continued to be isolated up to 35 days after treatment. We also provide evidence that treatment positively selects for S. Typhimurium DT104 strains that are already nalidixic acid resistant (gyrA Asn-87) or cyclohexane resistant, the latter being indicative of an up-regulated efflux pump. Emergence of fluoroquinolone resistance was not detected during treatment or post-treatment in any of the Salmonella strains monitored. However, the effect of enrofloxacin on the nalidixic acid-resistant and cyclohexane-resistant S. Typhimurium DT104 outlasted the current withdrawal time of 10 days for Baytril (commercial veterinary formulation of enrofloxacin). In conclusion, our study has provided direct evidence that enrofloxacin-treated pigs could be entering abattoirs with higher numbers of quinolone-resistant zoonotic bacteria than untreated pigs, increasing the risk of these entering the food chain.

  8. Treatment of a Psychotic Trainable Retarded Child in a Day Hospital for Children with Average Intelligence.

    Science.gov (United States)

    Zang, Louis C.; Cohen, Jonathan L.

    The case study describes the progress of a psychotic trainable mentally retarded child who at age seven entered a day psychiatric hospital for disturbed children with average intelligence. The boy's therapist describes changes in the child's peer interaction, academic performance, group psychotherapy participation, and psychological test…

  9. 78 FR 65675 - Proposed Collection; 60-Day Comment Request; Multidisciplinary Treatment Planning (MTP) Within...

    Science.gov (United States)

    2013-11-01

    ..., including the validity of the methodology and assumptions used; (3) Ways to enhance the quality, utility..., Division of Cancer Control & Population Sciences, National Cancer Institute, 9609 Medical Center Drive... Program (NCCCP) hospitals define, structure, and implement multidisciplinary treatment planning (MTP...

  10. A multimodal day treatment program for multi-problem young adults: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Luijks, Marie-jolette A.; Bevaart, Floor; Zijlmans, Josjan; Van Duin, Laura; Marhe, Reshmi; Doreleijers, Theo A H; Tiemeier, Henning; Asscher, Jessica J.|info:eu-repo/dai/nl/288661834; Popma, Arne

    2017-01-01

    Background Effective interventions for young adults with severe, multiple problems – such as psychosocial and psychiatric problems, delinquency, unemployment and substance use – are scarce but urgently needed in order to support an adequate transition to adulthood. A multimodal day treatment program

  11. Single dose oral azithromycin versus seven day doxycycline in the treatment of non-gonococcal mucopurulent endocervicitis.

    Science.gov (United States)

    Sendağ, F; Terek, C; Tuncay, G; Ozkinay, E; Güven, M

    2000-02-01

    The aim of this study was to compare single dose oral azithromycin versus seven-day doxycycline in the treatment of non-gonococcal mucopurulent cervicitis (MPC). One hundred and thirty-one women with non-gonococcal MPC were enrolled in a prospective-randomised study to compare the efficacy and safety of a single oral dose of 1 g azithromycin and a seven-day course of 100 mg doxycycline twice daily. Clinical examination and culture samples for Chlamydia trachomatis and other microorganisms were performed before and approximately 14 days after starting the treatment. Of the 131 women recruited (67 in the azithromycin group and 64 in the doxycycline group), Ureaplasma urealyticum was isolated from 21 (16%); Chlamydia trachomatis from 15 (11.5%); and Mycoplasma hominis from 3 (2.3%) of the patients at the initial examination. The eradication rate of baseline culture-positive cases at the follow-up visit in the azithromycin group was 71.4%, and 77.3% in the doxycycline group. There was no statistically significant difference in efficacy between the single dose azithromycin and seven-day course of doxycycline in the treatment of culture-positive cases. Azithromycin 1 g appears to be an effective and safe alternative to doxycycline for the treatment of non-gonococcal MPC.

  12. A randomized treatment trial: single versus 7-day dose of metronidazole for the treatment of Trichomonas vaginalis among HIV-infected women.

    Science.gov (United States)

    Kissinger, Patricia; Mena, Leandro; Levison, Judy; Clark, Rebecca A; Gatski, Megan; Henderson, Harold; Schmidt, Norine; Rosenthal, Susan L; Myers, Leann; Martin, David H

    2010-12-15

    To determine if the metronidazole (MTZ) 2-gm single dose (recommended) is as effective as the 7-day 500 mg twice a day dose (alternative) for treatment of Trichomonas vaginalis (TV) among HIV+ women. Phase IV randomized clinical trial; HIV+ women with culture confirmed TV were randomized to treatment arm: MTZ 2-gm single dose or MTZ 500 mg twice a day 7-day dose. All women were given 2-gm MTZ doses to deliver to their sex partners. Women were recultured for TV at a test-of-cure (TOC) visit occurring 6-12 days after treatment completion. TV-negative women at TOC were again recultured at a 3-month visit. Repeat TV infection rates were compared between arms. Two hundred seventy HIV+/TV+ women were enrolled (mean age = 40 years, ±9.4; 92.2% African American). Treatment arms were similar with respect to age, race, CD4 count, viral load, antiretroviral therapy status, site, and loss-to-follow up. Women in the 7-day arm had lower repeat TV infection rates at TOC [8.5% (11 of 130) versus 16.8% (21 of 125) (relative risk: 0.50, 95% confidence interval = 0.25, 1.00; P TV among HIV+ women.

  13. [Ten-day Sequential Therapy versus Bismuth Based Quadruple Therapy as Second Line Treatment for Helicobacter pylori Infection].

    Science.gov (United States)

    Kim, Sung Bum; Lee, Si Hyung; Kim, Kyeong Ok; Jang, Byung Ik; Kim, Tae Nyeun

    2015-11-01

    Ten-day sequential therapy has been evaluated as the first line therapy for Helicobacter pylori eradication but studies on sequential therapy as a second line therapy is lacking. The aim of this study was to compare the efficacy of 10-day sequential therapy and quadruple therapy as second line treatment for H. pylori eradication after failure of standard triple therapy. Patients who did not respond to standard triple therapy for H. pylori eradication were assigned to either 10-day sequential or bismuth based quadruple therapy as second line treatment from January 2009 to December 2014 at Yeungnam University Medical Center. Post treatment H. pylori status was determined by rapid urease test, giemsa staining, or (13)C-urea breath test. Eradication rate and side effects of both therapies were compared. A total of 158 H. pylori infected patients were included and 70 patients were treated by bismuth based quadruple therapy and 88 patients by 10-day sequential therapy. Age and sex were not significantly different between the two groups. Eradication rate was 84.3% (59/70) in quadruple group and 56.8% (50/88) in sequential group. Side effects occurred significantly higher in quadruple group than sequential group (27.1% vs. 11.4%, p=0.011). For second line H. pylori eradication after failure of standard triple therapy, bismuth based quadruple therapy showed significantly higher H. pylori eradication rate than 10-day sequential therapy. Further prospective studies are needed to evaluate the efficacy of 10-day sequential therapy as a second line H. pylori eradication treatment.

  14. Effectiveness of a psychosomatic day hospital treatment for the elderly: a naturalistic longitudinal study with waiting time before treatment as control condition.

    Science.gov (United States)

    Wunner, Christina; Reichhart, Corinne; Strauss, Bernhard; Söllner, Wolfgang

    2014-02-01

    In 2006 the psychosomatic day hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of this study was to determine treatment effectiveness and identify possible effects on health care utilization. Designed as a naturalistic study with waiting time before admission as a control condition, the primary outcome was the level of depressive symptoms as measured by the hospital anxiety and depression scale. Secondary outcomes were depressive and somatoform symptoms and syndromes as measured with the patient health questionnaire, patient perception of interpersonal problems and health care use before and after treatment. After treatment significant improvement (ppsychosomatic treatment a reduction in medical service usage was visible. Number of consultations (pre: 13, post: 9), number and length of hospital stays (pre: 1, 7 weeks, post: 0, 3 weeks) were both significantly (ppsychosomatic day hospital treatment of the elderly is successful. Reduced usage of health care and the lower costs for day hospital treatment compared to inpatient treatment point to a positive cost-effect-ratio. Expanding this psychosomatic intervention would be useful in reducing the current gap in mental health care for the elderly. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Improvement in Fatigue during Natalizumab Treatment is Linked to Improvement in Depression and Day-Time Sleepiness

    DEFF Research Database (Denmark)

    Penner, Iris-Katharina; Sivertsdotter, Eva Catharina; Celius, Elisabeth G

    2015-01-01

    BACKGROUND: Fatigue is a frequent symptom in multiple sclerosis (MS) and often interrelated with depression and sleep disorders making symptomatic treatment decisions difficult. In the single-arm, observational phase IV TYNERGY study, relapsing-remitting MS patients showed a clinically meaningful...... decrease in fatigue over 1 year of treatment with natalizumab. OBJECTIVE: To evaluate whether fatigue improvement might be directly linked to improved depression and day-time sleepiness. METHODS: Patients were assessed regarding fatigue, depression, and day-time sleepiness. The relation between changes...... of the two latter symptoms and changes in fatigue was analyzed. RESULTS: After 1 year of natalizumab treatment, the majority of patients (>92%) remained stable or improved in total, motor, and cognitive fatigue. Proportion of patients without depression increased by 17% while proportions of mildly depressed...

  16. Concomitant external pneumatic compression treatment with consecutive days of high intensity interval training reduces markers of proteolysis.

    Science.gov (United States)

    Haun, Cody T; Roberts, Michael D; Romero, Matthew A; Osburn, Shelby C; Healy, James C; Moore, Angelique N; Mobley, Christopher B; Roberson, Paul A; Kephart, Wesley C; Mumford, Petey W; Goodlett, Michael D; Pascoe, David D; Martin, Jeffrey S

    2017-12-01

    To compare the effects of external pneumatic compression (EPC) and sham when used concurrently with high intensity interval training (HIIT) on performance-related outcomes and recovery-related molecular measures. Eighteen recreationally endurance-trained male participants (age: 21.6 ± 2.4 years, BMI: 25.7 ± 0.5 kg/m 2 , VO 2peak : 51.3 ± 0.9 mL/kg/min) were randomized to balanced sham and EPC treatment groups. Three consecutive days of HIIT followed by EPC/sham treatment (Days 2-4) and 3 consecutive days of recovery (Days 5-7) with EPC/sham only on Days 5-6 were employed. Venipuncture, flexibility and pressure-to-pain threshold (PPT) measurements were made throughout. Vastus lateralis muscle was biopsied at PRE (i.e., Day 1), 1-h post-EPC/sham treatment on Day 2 (POST1), and 24-h post-EPC/sham treatment on Day 7 (POST2). 6-km run time trial performance was tested at PRE and POST2. No group × time interaction was observed for flexibility, PPT, or serum measures of creatine kinase (CK), hsCRP, and 8-isoprostane. However, there was a main effect of time for serum CK (p = 0.005). Change from PRE in 6-km run times at POST2 were not significantly different between groups. Significant between-groups differences existed for change from PRE in atrogin-1 mRNA (p = 0.018) at the POST1 time point (EPC: - 19.7 ± 8.1%, sham: + 7.7 ± 5.9%) and atrogin-1 protein concentration (p = 0.013) at the POST2 time point (EPC: - 31.8 ± 7.5%, sham: + 96.0 ± 34.7%). In addition, change from PRE in poly-Ub proteins was significantly different between groups at both the POST1 (EPC: - 26.0 ± 10.3%, sham: + 34.8 ± 28.5%; p = 0.046) and POST2 (EPC: - 33.7 ± 17.2%, sham: + 21.4 ± 14.9%; p = 0.037) time points. EPC when used concurrently with HIIT and in subsequent recovery days reduces skeletal muscle markers of proteolysis.

  17. Nursing performance in the policy transfer of directly observed treatment of tuberculosis

    Directory of Open Access Journals (Sweden)

    Káren Mendes Jorge de Souza

    2014-10-01

    Full Text Available Objective Analyzing the policy transfer of directly observed treatment of tuberculosis from the perspective of nursing. Method This is a descriptive study with qualitative approach, which had 10 nurses of the Family Health Strategy in São Paulo as subjects. The interviews were carried out between May and June 2013, and were adopted the technique of thematic content analysis and the referential of policy transfer. Results On the signification of this treatment, are related the senses of disciplinary monitoring, the bond and approximation to the context of patients’ lives. Operationally, nurses, community health agents and nursing technicians stand out as agents of implementation of this policy, developing multiple actions of user embracement. The nurse is evidenced as an educator in health, leader in the family health team, and capable of creating emotional bond with users. Conclusion It was found that the innovations proposed in the treatment are incipient in the daily work of nurses.

  18. On the effectiveness of the anti-gaming policy between the day-ahead and real-time electricity markets in The Netherlands

    International Nuclear Information System (INIS)

    Boogert, A.; Dupont, D.

    2005-01-01

    In the paper, we study the linkage between two related markets for electricity in The Netherlands: the day-ahead market and the real-time market. The Dutch regulator wants to prevent trading across these two markets and has set up a dual pricing system for this purpose. In this paper, we test the effectiveness of this policy by studying the ex post profitability of trading strategies spanning the two markets over various time segments. Our results show that profits generated by these strategies are rarely positive on average and always characterized by very large potential losses, which dwarf the mean profit when the latter is positive. (author)

  19. 30 day mortality in adult palliative radiotherapy – A retrospective population based study of 14,972 treatment episodes

    Science.gov (United States)

    Spencer, Katie; Morris, Eva; Dugdale, Emma; Newsham, Alexander; Sebag-Montefiore, David; Turner, Rob; Hall, Geoff; Crellin, Adrian

    2015-01-01

    Background: 30-day mortality (30DM) has been suggested as a clinical indicator of the avoidance of harm in palliative radiotherapy within the NHS, but no large-scale population-based studies exist. This large retrospective cohort study aims to investigate the factors that influence 30DM following palliative radiotherapy and consider its value as a clinical indicator. Methods: All radiotherapy episodes delivered in a large UK cancer centre between January 2004 and April 2011 were analysed. Patterns of palliative radiotherapy, 30DM and the variables affecting 30DM were assessed. The impact of these variables was assessed using logistic regression. Results: 14,972 palliative episodes were analysed. 6334 (42.3%) treatments were delivered to bone metastases, 2356 (15 7%) to the chest for lung cancer and 915 (5.7%) to the brain. Median treatment time was 1 day (IQR 1–7). Overall 30DM was 12.3%. Factors having a significant impact upon 30DM were sex, primary diagnosis, treatment site and fractionation schedule (p < 0.01). Conclusion: This is the first large-scale description of 30-day mortality for unselected adult palliative radiotherapy treatments. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy and require further study in other centres and health care systems. PMID:25861831

  20. 30 day mortality in adult palliative radiotherapy – A retrospective population based study of 14,972 treatment episodes

    International Nuclear Information System (INIS)

    Spencer, Katie; Morris, Eva; Dugdale, Emma; Newsham, Alexander; Sebag-Montefiore, David; Turner, Rob; Hall, Geoff; Crellin, Adrian

    2015-01-01

    Background: 30-day mortality (30DM) has been suggested as a clinical indicator of the avoidance of harm in palliative radiotherapy within the NHS, but no large-scale population-based studies exist. This large retrospective cohort study aims to investigate the factors that influence 30DM following palliative radiotherapy and consider its value as a clinical indicator. Methods: All radiotherapy episodes delivered in a large UK cancer centre between January 2004 and April 2011 were analysed. Patterns of palliative radiotherapy, 30DM and the variables affecting 30DM were assessed. The impact of these variables was assessed using logistic regression. Results: 14,972 palliative episodes were analysed. 6334 (42.3%) treatments were delivered to bone metastases, 2356 (15 7%) to the chest for lung cancer and 915 (5.7%) to the brain. Median treatment time was 1 day (IQR 1–7). Overall 30DM was 12.3%. Factors having a significant impact upon 30DM were sex, primary diagnosis, treatment site and fractionation schedule (p < 0.01). Conclusion: This is the first large-scale description of 30-day mortality for unselected adult palliative radiotherapy treatments. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy and require further study in other centres and health care systems

  1. Emotions in eating disorders: changes of anger control after an emotion-focused day hospital treatment.

    Science.gov (United States)

    Abbate-Daga, Giovanni; Marzola, Enrica; Gramaglia, Carla; Brustolin, Annalisa; Campisi, Stefania; De-Bacco, Carlotta; Amianto, Federico; Fassino, Secondo

    2012-11-01

    Emotional states are key elements of eating disorders (EDs), with anger and aggressiveness playing an important role. This study aimed to investigate anger features in ED patients before and after an intensive day hospital (DH) specifically focused on emotions. Forty-one ED patients were admitted to our DH, which specifically includes emotion-focused activities. They completed self-reported questionnaires at the beginning and after the intervention: Eating Disorders Inventory-2, State-Trait Anger Expression Inventory (STAXI) and Beck Depression Inventory (BDI). Anger Control (Axcon) subscale of STAXI decreased significantly, and both BDI and body mass index - in case of underweight patients - significantly improved after completion of DH. Axcon decrease correlated with BMI improvement. The majority of individuals showing good outcome reported also a significant improvement in Axcon levels. This study provided preliminary data about the effectiveness - mainly in anger coping - of an emotion-focused DH. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.

  2. Group art therapy as adjunct therapy for the treatment of schizophrenic patients in day hospital.

    Science.gov (United States)

    Gajić, Gordana Mandić

    2013-11-01

    The schizophrenics are frequently disinterested and resistant to standard care. We presented clinical observations of group art therapy of two schizophrenic patients during integrative therapy in Day Hospital. We modified the original "Synallactic collective image technique" (Vassiliou G, Vassiliou V.). The group is open, heterogeneous, meets once a week and discusses on exhibited drawings, drawn by free associations. The patients' drawings and group protocols showed clinical improvement by lowering depressive themes, more human figures and self-confidence. The obvious severity of markedly impairment on Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) scales on admission with minimal improvement at discharge was rated. Group art therapy enables visual expression of emotions, perceptions and cognitions, develops creative potentials and support within the group, thus facilitating the integrative therapeutic process of schizophrenics. It may be useful adjunctive therapy for schizoprenic patients.

  3. Group art therapy as adjunct therapy for the treatment of schizophrenic patients in day hospital

    Directory of Open Access Journals (Sweden)

    Mandić-Gajić Gordana

    2013-01-01

    Full Text Available Introduction. The schizophrenics are frequently disinterested and resistant to standard care. Case report. We presented clinical observations of group art therapy of two schizophrenic patients during integrative therapy in Day Hospital. We modified the original “Synallactic collective image technique” (Vassiliou G, Vassiliou V.. The group is open, heterogeneous, meets once a week and discusses on exhibited drawings, drawn by free associations. The patients' drawings and group protocols showed clinical improvement by lowering depressive themes, more human figures and self-confidence. The obvious severity of markedly impairment on Clinical Global Impression (CGI and Global Assessment of Functioning (GAF scales on admission with minimal improvement at discharge was rated. Conclusion. Group art therapy enables visual expression of emotions, perceptions and cognitions, develops creative potentials and support within the group, thus facilitating the integrative therapeutic process of schizophrenics. It may be useful adjunctive therapy for schizoprenic patients.

  4. [Introduction of performance- and day-based lump-sum remuneration for stationary psychiatric and psychosomatic treatments in Germany--analysis of incentives of the PEPP system].

    Science.gov (United States)

    Wolff-Menzler, C; Große, C

    2015-05-01

    This paper surveys the effects of day-based lump-sum remuneration as defined by the PEPP system on the patients' length of stay and compares its incentives to the mechanisms of the German DRG system and the former remunera-tion system for stationary psychiatric and psychosomatic treatments. The analysis identifies the economically optimal length of stay defined as the profit maximising duration of treatment by comparing marginal revenues and marginal costs. Since it is economically optimal to extend the treatment until the marginal costs exceed the marginal revenues, psychiatric and psychosomatic facilities are incentivised to minimise the time gap between average duration of treatment as expected duration of treatment and the economically optimal length of stay. Compared to the German DRG system, which provides a strong incentive to reduce length of stay, the incentives set by the PEPP system imply either a reduction or an extension of treatment duration depending on the underlying cost function. If a degressive cost function is assumed, which is typical for treatments of psychiatric and psychosomatic illnesses, the economically optimal duration of treatment will be at the last upper boundary of the interval of the marginal revenue function in which the average marginal revenues exceed the average marginal costs. It is also feasible that it is economically optimal to treat the patient for as long as possible. The hospital is incentivised to extend or reduce the time of treatment to this point in time. Psychiatric and psychosomatic hospitals are able to increase their profits by reducing or extending time of treatment. Therefore these facilities have to justify the extent of treatment to the health insurance companies. Since the incentives of the PEPP system and the DRG system diverge, the results of research on supply induced demand in the DRG system cannot be transferred to the discussion about the effects of the introduction of the PEPP system. As long as the

  5. Pre-treatment attachment anxiety predicts change in depressive symptoms in women who complete day hospital treatment for anorexia and bulimia nervosa.

    Science.gov (United States)

    Keating, Leah; Tasca, Giorgio A; Bissada, Hany

    2015-03-01

    Individuals with eating disorders are prone to depressive symptoms. This study examines whether depressive symptoms can change in women who complete intensive day treatment for anorexia and bulimia nervosa (BN), and whether these changes are associated with pre-treatment attachment insecurity. Participants were 141 women with anorexia nervosa restricting type (n = 24), anorexia nervosa binge purge type (n = 30), and BN (n = 87) who completed a day hospital treatment programme for eating disorders. They completed a pre-treatment self-report measure of attachment, and a pre-treatment and post-treatment self-report measure of depressive symptoms. Participants experienced significant reductions in depressive symptoms at post-treatment. Eating disorder diagnosis was not related to these improvements. However, participants lower in attachment anxiety experienced significantly greater improvement in depressive symptoms than those who were higher in attachment anxiety. These results suggest that clinicians may tailor eating disorders treatments to patients' attachment patterns and focus on their pre-occupation with relationships and affect regulation to improve depressive symptoms. That depressive symptoms can decrease in women who complete day hospital treatment for anorexia and BN. That improvements in depressive symptoms do not vary according to eating disorder diagnosis in these women. That patients who complete treatment and who have higher attachment anxiety experience less improvements in depressive symptoms compared to those lower in attachment anxiety. That clinicians may attend to aspects of attachment anxiety, such as need for approval and up-regulation of emotions, to improve depressive symptoms in female patients with eating disorders. © 2014 The British Psychological Society.

  6. Efficacy of treatment for hyperglycemic crisis in elderly diabetic patients in a day hospital

    Directory of Open Access Journals (Sweden)

    Benaiges D

    2014-05-01

    Full Text Available D Benaiges,1–3 JJ Chillarón,1–3 MJ Carrera,1,3 F Cots,3,4 J Puig de Dou,1 E Corominas,1 J Pedro-Botet,1–3 JA Flores-Le Roux,1–3 C Claret,1 A Goday,1–3 JF Cano1–3 1Department of Endocrinology and Nutrition, Hospital del Mar, 2Department of Medicine, Universitat Autònoma de Barcelona, 3Institut Hospital del Mar d’Investigacions Mèdiques, 4Epidemiology and Evaluation Department, Parc de Salut Mar, Barcelona, Spain Background: The purpose of this prospective cohort study was to compare the costs of day hospital (DH care for hyperglycemic crisis in elderly diabetic patients with those of conventional hospitalization (CH. Secondary objectives were to compare these two clinical scenarios in terms of glycemic control, number of emergency and outpatient visits, readmissions, hypoglycemic episodes, and nosocomial morbidity. Methods: The study population comprised diabetic patients aged >74 years consecutively admitted to a tertiary teaching hospital in Spain for hyperglycemic crisis (sustained hyperglycemia [>300 mg/dL] for at least 3 days with or without ketosis. The patients were assigned to DH or CH care according to time of admission and were followed for 6 months after discharge. Exclusion criteria were ketoacidosis, hyperosmolar crisis, hemodynamic instability, severe intercurrent illness, social deprivation, or Katz index >D.Results: Sixty-four diabetic patients on DH care and 36 on CH care were included, with no differences in baseline characteristics. The average cost per patient was 1,345.1±793.6 € in the DH group and 2,212.4±982.5 € in the CH group (P<0.001. There were no differences in number of subjects with mild hypoglycemia during follow-up (45.3% DH versus 33.3% CH, P=0.24, nor in the percentage of patients achieving a glycated hemoglobin (HbA1c <8% (67.2% DH versus 58.3% CH, P=0.375. Readmissions for hyperglycemic crisis and pressure ulcer rates were significantly higher in the CH group

  7. Effects of 14-day treatment with the schedule III anorectic phendimetrazine on choice between cocaine and food in rhesus monkeys.

    Science.gov (United States)

    Banks, Matthew L; Blough, Bruce E; Negus, S Stevens

    2013-08-01

    The clinical utility of monoamine releasers such as phenmetrazine or d-amphetamine as candidate agonist medications for cocaine dependence is hindered by their high abuse liability. Phendimetrazine is a clinically available schedule III anorectic that functions as a prodrug for phenmetrazine and thus may have lower abuse liability. This study determined the effects of continuous 14-day treatment with phendimetrazine on cocaine vs. food choice in rhesus monkeys (N=4). Responding was maintained under a concurrent schedule of food delivery (1-g pellets, fixed-ratio 100 schedule) and cocaine injections (0-0.1mg/kg/injection, fixed-ratio 10 schedule). Cocaine choice dose-effect curves were determined daily before and during 14-day periods of continuous intravenous treatment with saline or (+)-phendimetrazine (0.32-1.0mg/kg/h). Effects of 14-day treatment with (+)-phenmetrazine (0.1-0.32 mg/kg/h; N=5) and d-amphetamine (0.032-0.1mg/kg/h; N=6) were also examined for comparison. During saline treatment, food was primarily chosen during availability of low cocaine doses (0, 0.0032, and 0.01 mg/kg/injection), and cocaine was primarily chosen during availability of higher cocaine doses (0.032 and 0.1mg/kg/injection). Phendimetrazine initially decreased overall responding without significantly altering cocaine choice. Over the course of 14 days, tolerance developed to rate decreasing effects, and phendimetrazine dose-dependently decreased cocaine choice (significant at 0.032 mg/kg/injection cocaine). Phenmetrazine and d-amphetamine produced qualitatively similar effects. These results demonstrate that phendimetrazine can produce significant, though modest, reductions in cocaine choice in rhesus monkeys. Phendimetrazine may be especially suitable as a candidate medication for human studies because of its schedule III clinical availability. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Treatment with intravenous thrombolysis in acute ischemic stroke is associated with reduced bed day use

    DEFF Research Database (Denmark)

    Terkelsen, Thorkild; Schmitz, Marie Louise; Simonsen, Claus Z.

    2015-01-01

    Introduction: Several studies have demonstrated the beneficial effects of intravenous tissue-type plasminogen activator (IV-tPA) on neurological outcome in acute ischemic stroke. It is uncertain whether the improved neurological outcome also translates into less morbidity and lower need for hospi......Introduction: Several studies have demonstrated the beneficial effects of intravenous tissue-type plasminogen activator (IV-tPA) on neurological outcome in acute ischemic stroke. It is uncertain whether the improved neurological outcome also translates into less morbidity and lower need...... for hospital admissions during follow-up. Methods: We conducted a register-based nationwide propensity score-matched follow-up study among ischemic stroke patients in Denmark (2004-2011). IV-tPA-treated patients were propensity-score matched with IV-tPA eligible but non-treated ischemic stroke patients from...... stroke centers not offering tPA. The adjusted Hazard ratio (HR) for first readmission was estimated by multivariable Cox regression among patients who survived the initial stroke admission. Total all-cause bed day use in the first year after stroke admission was determined for patients with a potential...

  9. Treatment outcome of 18-month, day hospital mentalization-based treatment (MBT) in patients with severe borderline personality disorder in the Netherlands.

    Science.gov (United States)

    Bales, Dawn; van Beek, Nicole; Smits, Maaike; Willemsen, Sten; Busschbach, Jan J V; Verheul, Roel; Andrea, Helene

    2012-08-01

    Psychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United Kingdom (UK). As to yet it has not been shown whether manualized day hospital MBT would yield similar results when conducted by an independent institute outside the UK. We investigated the applicability and treatment outcome of 18-month, manualized day hospital MBT in the Netherlands by means of a prospective cohort study with 45 Dutch patients with severe BPD and a high degree of comorbid Axis I and Axis II disorders. Outcomes were assessed each six months. Symptom distress, social and interpersonal functioning, and personality pathology and functioning all improved significantly, with effect sizes between 0.7 and 1.7. Suicide attempts, acts of self-harm, and care consumption were also significantly reduced. The results indicate that MBT can effectively be implemented in an independent treatment institute outside the UK. This study also supports the clinical effectiveness of manualized day hospital MBT in patients with severe BPD and a high degree of psychiatric comorbidity.

  10. Hospital policies on life-sustaining treatments and advance directives in Canada.

    OpenAIRE

    Rasooly, I; Lavery, J V; Urowitz, S; Choudhry, S; Seeman, N; Meslin, E M; Lowy, F H; Singer, P A

    1994-01-01

    OBJECTIVE: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Canada. PARTICIPANTS: Chief executive officers or their designates at public general hospitals. MAIN OUTCOME MEASURES: Information regarding the exis...

  11. Polypharmacy May Be the Cause of Acute Lithium Intoxication at the Second Day of Treatment

    Directory of Open Access Journals (Sweden)

    Tursun Irfan

    2015-12-01

    Full Text Available Lithium is frequently used as a mood stabilizer in patients with mood disorders. Lithium has a narrow therapeutic index and high toxicity. Predisposing factors for intoxication are advanced age, diet disturbances, comorbid medical conditions affecting heart, kidneys or central nervous system and polypharmacy. CASE REPORT: Here we present a case of a 74-year-old woman with a history of Parkinson’s disease, hypertension and bipolar disorder. She was using quetiapine, valsartan with hydrochlorothiazide and levodopa with carbidopa. She presented with altered mental status and muscle rigidity. The patient was admitted with acute lithium intoxication after her second dose of treatment. Blood lithium level increased to 3.58 mEq/L. The woman was hospitalized in the Internal Medicine Intensive Care Unit. With hydration, her symptoms resolved and her lithium level returned to normal after 118 hours. CONCLUSIONS: Prescribing physicians and emergency room physicians should be aware of conditions which may cause a decreased threshold for intoxication.

  12. Daily light integral and day light quality: Potentials and pitfalls of nighttime UV treatments on cucumber powdery mildew.

    Science.gov (United States)

    Suthaparan, Aruppillai; Solhaug, Knut Asbjørn; Stensvand, Arne; Gislerød, Hans Ragnar

    2017-10-01

    Nighttime ultraviolet (UV) radiation, if applied properly, has a significant potential for management of powdery mildews in many crop species. In this study, the role of growth light duration, irradiance, a combination of both (daily light integral) and light spectral quality (blue or red) on the efficacy of UV treatments against powdery mildew caused by Podosphaera xanthii and the growth performance of cucumber plants was studied in growth chambers. Increasing daily light integral provided by high-pressure sodium lamps (HPS) decreased efficacy of nighttime UV treatments against P. xanthii, but it increased plant growth. Furthermore, the efficacy of nighttime UV decreased when day length was increased from 16 to 20h at a constant daily light integral. The efficacy of nighttime UV increased if red light was applied after UV treatment, showing the possibility of day length extension without reducing the effect of UV. Increasing the dose of blue light during daytime reduced the efficacy of nighttime UV in controlling the disease, whereas blue deficient growth light (treatment. Findings from this study showed that optimization of nighttime UV for management of powdery mildew is dependent on the spectral composition of the photosynthetically active radiation. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. From generic to gender-responsive treatment: changes in social policies, treatment services, and outcomes of women in substance abuse treatment.

    Science.gov (United States)

    Grella, Christine E

    2008-11-01

    In the past three decades, there has been increased recognition of the role of gender in influencing the course of substance use and treatment utilization. Concurrently, a substantial body of research on gender-related issues and substance abuse and its treatment has developed. This article reviews (1) policy initiatives that led to the growth of "specialized" treatment programs and services for women and recent policy changes that influence the provision of substance abuse treatment to women; (2) gender differences in the prevalence of substance use disorders and admissions to treatment; (3) gender differences in treatment needs,utilization, and outcomes, including long-term outcomes following treatment; (4) organizational characteristics of substance abuse treatment providers for women and the types of services provided in these programs; (5) treatment outcomes in gender-specific programs for women; and (6) the effectiveness of evidence-based treatment practices that have either been modified, or have the potential to be adapted, to address the treatment needs of women. This body of research is viewed within the context of a series of paradigm shifts from a generic treatment approach to a focus on gender differences and gender specificity and, most recently, to an emergent focus on gender responsiveness.

  14. Effects of a four-day nocturnal melatonin treatment on the 24 h plasma melatonin, cortisol and prolactin profiles in humans.

    Science.gov (United States)

    Mallo, C; Zaidan, R; Faure, A; Brun, J; Chazot, G; Claustrat, B

    1988-12-01

    An oral preparation of melatonin was administered daily at 22.00 h to 6 healthy volunteers during summer on 4 consecutive days (days 1-4). The daily dose was 8 mg of melatonin as a single. Three 24-h melatonin, cortisol and prolactin profiles were determined in plasma by radioimmunological methods: 1) before treatment (day 0); 2) the first day after the 4-day treatment had been stopped (day 5), 3) the third day after withdrawal of this treatment (day 7). For the melatonin rhythm, an advanced phase was observed at day 7 vs day 0, whereas the amplitude and the mesor were not modified, whatever the day. For the prolactin profile, a significant increase as compared with the control day (day 0) was detected only at day 7 between 19.00 and 21.00 h. No modification was recorded for the plasma cortisol secretion. These results suggest that melatonin, when administered at a high dose over a short period, can influence the endocrine rhythms, and especially its own endogenous secretion. This effect must be investigated over several days after the treatment has ended.

  15. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury

    DEFF Research Database (Denmark)

    Cnossen, Maryse C; Huijben, Jilske A; van der Jagt, Mathieu

    2017-01-01

    BACKGROUND: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management...... strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. METHODS: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion...... the others were considered more conservative (n = 34, 52%). CONCLUSIONS: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide...

  16. Institutional stakeholder perceptions of barriers to addiction treatment under Mexico's drug policy reform.

    Science.gov (United States)

    Werb, Dan; Strathdee, Steffanie A; Meza, Emilo; Rangel Gomez, Maria Gudelia; Palinkas, Lawrence; Medina-Mora, Maria Elena; Beletsky, Leo

    2017-05-01

    Mexico has experienced disproportionate drug-related harms given its role as a production and transit zone for illegal drugs destined primarily for the USA. In response, in 2009, the Mexican federal government passed legislation mandating pre-arrest diversion of drug-dependent individuals towards addiction treatment. However, this federal law was not specific about how the scale-up of the addiction treatment sector was to be operationalised. We therefore conducted in-depth qualitative interviews with key 'interactors' in fields affected by the federal legislation, including participants from the law enforcement, public health, addiction treatment, and governmental administration sectors. Among 19 participants from the municipal, state and federal levels were interviewed and multiple barriers to policy reform were identified. First, there is a lack of institutional expertise to implement the reform. Second, the operationalisation of the reform was not accompanied by a coordinated action plan. Third, the law is an unfunded mandate. Institutional barriers are likely hampering the implementation of Mexico's policy reform. Addressing the concerns expressed by interactors through the scale-up of services, the provision of increased training and education programmes for stakeholders and a coordinated action plan to operationalise the policy reform are likely needed to improve the policy reform process.

  17. Brachytherapy days

    International Nuclear Information System (INIS)

    Peiffert, D.

    2002-01-01

    The loco regional control of cancers stays the absolute objective of the treatment. The thought of these days has allowed to evaluate the equipment and the practices, and to consider the developments to undertake in harmony with the investments of external radiotherapy. (N.C.)

  18. Effects of Increasing Hydrocortisone to 300 mg Per Day in the Treatment of Septic Shock: a Pilot Study.

    Science.gov (United States)

    Hyvernat, Hervé; Barel, Rémy; Gentilhomme, Anne; Césari-Giordani, Jean François; Freche, Annie; Kaidomar, Michel; Goubaux, Bernard; Pradier, Christian; Dellamonica, Jean; Bernardin, Gilles

    2016-11-01

    The Surviving Sepsis Campaign guidelines recommend hydrocortisone in septic shock only when fluid resuscitation and vasopressors fail to restore hemodynamic stability. Hydrocortisone administration modalities are supported only by low-grade recommendations. Our main objective here was to determine differences in 28-day mortality between two low-dose hydrocortisone regimens for the treatment of septic shock. We performed a multicenter, prospective, randomized, double-blind, pilot study in four adult medical intensive care units. Patients presenting septic shock were rapidly administered one of two regimens of hydrocortisone, either a 50-mg intravenous bolus every 6 h during 7 days (200-mg group; n = 59) or a 100-mg initial bolus followed by a continuous infusion of 300 mg daily for 5 days (300-mg group; n = 63). Hydrocortisone was stopped abruptly at the end of treatment. There were no significant differences between the 200-mg and 300-mg groups as concerns 28-day mortality (respectively 52.5% vs. 44.4% [RR 0.84, 95% CI, 0.58-1.22, P = 0.47]), refractory shock incidence or delay from shock to vasopressor cessation. There were also no differences in adverse events between the groups. Shock relapse after hydrocortisone cessation was independent of hydrocortisone regimens, but it was associated with the persistence of infection and the use of etomidate. The resumption of hydrocortisone due to shock relapse was significantly more frequent in the 300-mg group. We found no differences in mortality or adverse events between the two hydrocortisone administration regimens. Shock relapse was significantly associated with the persistence of infection and the use of etomidate.

  19. Mutagenic treatments towards increasing the frequency of day-neutral mutations and standardization of procedures for tissue culture, in potato

    International Nuclear Information System (INIS)

    Upadhya, M.D.; Chandra, R.; Abraham, M.J.

    1976-01-01

    Various chemical mutagens and gamma radiation have been used on single dormant eyes and true seeds with a view to finding effective mutagenic treatment for the induction of day-length neutral mutants in potato using an effective screening technique for the isolation of day-length neutral mutants. Sodium meta bisulphite (SMS) was found to be an efficient mutagen in inducing mutations for this trait in true seeds although the same concentrations, when used for treating the single tuber eyes proved lethal. Pre-soaking the seeds for 24 hrs prior to treatment with 0.0025M SMS gave highest frequency of the mutants followed by 48 hrs presoaking, indicating a sensitive stage during the cell cycle in true seeds. Other mutagen treatments gave different frequencies of mutations. The highest frequency of day-length neutral mutants was observed when seeds irradiated with 40 Kr of gamma radiation were treated with 0.05M hydrazinium dichloride solution. Screening procedures have also been standardised with the development of synethetic media for the isolation of biochemical mutants at the true seed level. Initial efforts have yielded mutants resistant to LD 100 doses of ethionine. Another aspect of the study was to develop a proper potato callus culture technique. A medium has been developed to produce and maintain callus from potato leaf strips. Efforts on the regeneration of shoot and roots from callus, have so far lead to differentiation of callus to form roots. The ultimate aim of these studies is to develop plantlets from single cell which would form the units of mutation induction and isolation. (author)

  20. [Changes in defense mechanisms resulting from a Day Treatment Center therapy in persons suffering from psychotic disorders].

    Science.gov (United States)

    Cichocki, Lukasz

    2008-01-01

    The objectives of this investigation are to describe the changes in the psychopathological state and defense mechanisms occurring during therapy in a Day Treatment Center. The study group consisted of 55 persons suffering from psychotic disorders. Most of them suffered from schizophrenia, some from schizophrenia spectrum disorders, bipolar disorder and organic psychotic disorder. In the course of therapy in the Day Treatment Center, apart from pharmacotherapy and individual care, the patients took part in an intensive psychosocial therapeutic programme. The study was a pre-post design. The first investigation took place two weeks after admission into the Day Treatment Center and the second in the last week of therapy (average time of hospitalization was 3 months). The psychopathological state was examined according to the PANSS scale. Defense mechanisms were investigated with the Defense Style Questionnaire 40. The results of the study show significant changes occurring, both in psychopathological state, as well as defensive functioning of the patients during the therapy. Changes in the psychopathological state occurred in all subscales of the PANSS scale: positive, negative and global. Changes in defense mechanisms occurred in the mature factor of the defense mechanisms and in two separate immature mechanisms: autistic fantasies and displacement. A change in defense mechanisms did not influence changes that occurred in the psychopathological state. This could mean that psychopathological state--Axis I in DSM IV and defense mechanisms--part of the Axis II are partly independent elements. Defense functioning seems to be a useful construct in understanding changes occuring in the course of therapy. The Defense Style Questionnaire 40 is a practical instrument in measuring conscious derivates of defense mechanisms.

  1. Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya.

    Science.gov (United States)

    Mostert, S; Njuguna, F; van de Ven, P M; Olbara, G; Kemps, L J P A; Musimbi, J; Strother, R M; Aluoch, L M; Skiles, J; Buziba, N G; Sitaresmi, M N; Vreeman, R C; Kaspers, G J L

    2014-05-01

    Kenyan national policies for public hospitals dictate that patients are retained on hospital wards until their hospital bills are paid, but this payment process differs for patients with or without access to National Hospital Insurance Fund (NHIF) at diagnosis. Whether these differences impact treatment outcomes has not been described. Our study explores whether childhood cancer treatment outcomes in Kenya are influenced by health-insurance status and hospital retention policies. This study combined retrospective review of medical records with an illustrative case report. We identified children diagnosed with malignancies at a large Kenyan academic hospital between 2007 and 2009, their treatment outcomes, and health-insurance status at diagnosis. Between 2007 and 2009, 222 children were diagnosed with malignancies. Among 180 patients with documented treatment outcome, 54% abandoned treatment, 22% had treatment-related death, 4% progressive/relapsed disease, and 19% event-free survival. Health-insurance status at diagnosis was recorded in 148 children: 23% had NHIF and 77% had no NHIF. For children whose families had NHIF compared with those who did not, the relative risk for treatment abandonment relative to event-free survival was significantly smaller (relative-risk ratio = 0.31, 95% CI = 0.12-0.81, P = 0.016). The case report illustrates difficulties that Kenyan families might face when their child is diagnosed with cancer, has no NHIF, and is retained in hospital. Children with NHIF at diagnosis had significantly lower chance of abandoning treatment and higher chance of survival. Childhood cancer treatment outcomes could be improved by interventions that prevent treatment abandonment and improve access to NHIF. Hospital retention of patients over unpaid medical bills must stop. © 2013 Wiley Periodicals, Inc.

  2. Effects of a 7-day treatment with midodrine in non-azotemic cirrhotic patients with and without ascites.

    Science.gov (United States)

    Kalambokis, Georgios; Fotopoulos, Andreas; Economou, Michalis; Pappas, Konstantinos; Tsianos, Epameinondas V

    2007-02-01

    Splanchnic arterial vasodilatation has been causally related with hyperdynamic circulation and impaired natriuresis in advanced cirrhosis and has also been suggested to be responsible for the subtle sodium retention in pre-ascitic cirrhosis. This study evaluated the effects of a 7-day treatment with the alpha1-adrenergic agonist midodrine in non-azotemic cirrhotic patients with and without ascites. Thirty-nine cirrhotic patients were studied at baseline and 7 days after administration of oral midodrine 10mg, t.i.d. (11 without and 12 with ascites) or placebo (8 without and 8 with ascites). A significant increase in urine sodium excretion was noted after midodrine administration in patients without and with ascites, in line with significant increases in mean arterial pressure and systemic vascular resistance, and significant decreases in cardiac output and heart rate. Significant increases in glomerular filtration rate, filtration fraction, and urine volume and significant decreases in plasma renin activity and aldosterone were observed in patients with ascites. Placebo had no effect in any study group. The administration of midodrine for 7 days improves systemic haemodynamics and sodium excretion in non-azotemic cirrhotic patients without or with ascites. In patients with ascites, but not in those without ascites, these effects are associated with a suppression of the activity of the renin-angiotensin-aldosterone system, suggesting that the increase in natriuresis is related to the improvement in the effective arterial blood volume.

  3. Malaria treatment policy change in Uganda: what role did evidence play?

    Science.gov (United States)

    Nabyonga-Orem, Juliet; Ssengooba, Freddie; Macq, Jean; Criel, Bart

    2014-09-02

    Although increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent. The present study explores the role of evidence, barriers, and factors facilitating the uptake of evidence in the change in malaria treatment policy in Uganda, building on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitatory factors for KT. Application of the MRT to a health policy case will contribute to refining it. Using a case study approach and mixed methods, perceptions of respondents on whether evidence was available, had been considered and barriers and facilitatory factors to the uptake of evidence were explored. In addition, the respondents' rating of the degree of consistency between the policy decision and available evidence was assessed. Data collection methods included key informant interviews and document review. Qualitative data were analysed using content thematic analysis, whereas quantitative data were analysed using Excel spreadsheets. The two data sets were eventually triangulated. Evidence was used to change the malaria treatment policy, though the consistency between evidence and policy decisions varied along the policy development cycle. The availability of high-quality and contextualized evidence, including effective dissemination, Ministry of Health institutional capacity to lead the KT process, intervention of the WHO and a regional professional network, the existence of partnerships for KT with mutual trust and availability of funding, tools, and inputs to implement evidence, were the most important facilitatory factors that enhanced the uptake of evidence. Among the barriers that had to be overcome were resistance from implementers, the health system capacity to implement evidence, and financial sustainability. The results agree with facilitatory factors identified in the earlier developed MRT, though additional factors emerged. These

  4. Sustained melatonin treatment blocks body mass, pelage, reproductive, and fever responses to short day lengths in female Siberian hamsters.

    Science.gov (United States)

    Fenn, Ashley M; Fonken, Laura K; Nelson, Randy J

    2011-09-01

    Winter imposes physiological challenges on individuals including increased thermoregulatory demands, risk of infection, and decreased food availability. To survive these challenges, animals living outside the tropics must appropriately distribute their energetic costs across the year, including reproduction and immune function. Individuals of many species use the annual cycle of changing day lengths (photoperiod), which is encoded by the nightly duration of melatonin secretion, to adjust physiology. Siberian hamsters exposed to short days (SD) (long nights/prolonged endogenous melatonin secretion) enhance some aspects of immune function, but curtail other energetically expensive immune functions including the febrile response. The purpose of this study was twofold. First, we determined whether sustained melatonin treatment would inhibit the development of the SD phenotype in female hamsters as it does in males. Second, we examined whether the SD attenuation of fever would be blocked by continuous exposure to exogenous melatonin. Hamsters were implanted with melatonin or empty capsules, housed in either long days (LD) or SD for 8-9 weeks, and then challenged with lipopolysaccharide; body temperature and locomotor activity were recorded. Unlike hamsters with empty capsules, hamsters with melatonin implants did not respond to SD and maintained a LD phenotype including summer-like spleen, uterine and body masses, and pelage characteristics. Further, sustained melatonin treatment blocked the SD attenuation of febrile responses and prolonged the behavioral components of the sickness response. These results suggest that the daily fluctuations in endogenous melatonin may be masked by continuous exposure to exogenous melatonin, thus inhibiting functional photoperiodic responses to SD. © 2011 John Wiley & Sons A/S.

  5. Brain Temperature Is Increased During the First Days of Life in Asphyxiated Newborns: Developing Brain Injury Despite Hypothermia Treatment.

    Science.gov (United States)

    Owji, Z P; Gilbert, G; Saint-Martin, C; Wintermark, P

    2017-11-01

    Therapeutic hypothermia is the current treatment for neonates with hypoxic-ischemic encephalopathy. It is believed to work by decreasing the brain temperature and reducing the baseline metabolism and energy demand of the brain. This study aimed to noninvasively assess brain temperature during the first month of life in neonates with hypoxic-ischemic encephalopathy treated with hypothermia. Neonates with hypoxic-ischemic encephalopathy treated with hypothermia and healthy neonates were enrolled prospectively. MR imaging was used to identify the presence and extent of brain injury. MR imaging multivoxel spectroscopy was used to derive brain temperatures in the basal ganglia and white matter at different time points during the first month of life. Brain temperature measurements were compared between neonates with hypoxic-ischemic encephalopathy and healthy neonates. Forty-three term neonates with hypoxic-ischemic encephalopathy treated with hypothermia had a total of 74 spectroscopy scans, and 3 healthy term neonates had a total of 9 spectroscopy scans during the first month of life. Brain temperatures were lower in neonates with hypoxic-ischemic encephalopathy during hypothermia, compared with the healthy neonates (respectively, on day 1 of life: basal ganglia, 38.81°C ± 2.08°C, and white matter, 39.11°C ± 1.99°C; and on days 2-3 of life: basal ganglia, 38.25°C ± 0.91°C, and white matter, 38.54°C ± 2.79°C). However, neonates with hypoxic-ischemic encephalopathy who developed brain injury had higher brain temperatures during hypothermia (respectively, on day 1 of life: basal ganglia, 35.55°C ± 1.31°C, and white matter, 37.35°C ± 2.55°C; and on days 2-3 of life: basal ganglia, 35.20°C ± 1.15°C, and white matter, 35.44°C ± 1.90°C) compared with neonates who did not develop brain injury (respectively, on day 1 of life: basal ganglia, 34.46°C ± 1.09°C, and white matter, 33.97°C ± 1.42°C; and on days 2-3 of life: basal ganglia, 33.90°C ± 1

  6. Group therapy with male asylum seekers and refugees with posttraumatic stress disorder: a controlled comparison cohort study of three day-treatment programs.

    Science.gov (United States)

    Drožđek, Boris; Kamperman, Astrid M; Bolwerk, Nina; Tol, Wietse A; Kleber, Rolf J

    2012-09-01

    Studies on group treatment of posttraumatic stress disorder (PTSD) in asylum seekers and refugees are scarce. The aim of this study was to evaluate the effectiveness of three different trauma-focused day-treatment group programs for treatment of PTSD in male asylum seekers and refugees. Three treatment groups (n = 56) and a waitlisted control group (n = 16) of help-seeking Iranian and Afghani patients were assessed with a set of self-rated symptom checklists for PTSD, anxiety, depression, and psychoticism 1 week before and 2 weeks after treatment. There are no indications that the 2 days' group program with three nonverbal and two group psychotherapy sessions per week is less effective in reducing symptoms than the program with the same amount of sessions spread over 3 days per week. The trauma-focused day-treatment group seems a promising approach for treatment of PTSD among asylum seekers and refugees in industrialized settings.

  7. 30-day mortality after systemic anticancer treatment for breast and lung cancer in England: a population-based, observational study.

    Science.gov (United States)

    Wallington, Michael; Saxon, Emma B; Bomb, Martine; Smittenaar, Rebecca; Wickenden, Matthew; McPhail, Sean; Rashbass, Jem; Chao, David; Dewar, John; Talbot, Denis; Peake, Michael; Perren, Timothy; Wilson, Charles; Dodwell, David

    2016-09-01

    30-day mortality might be a useful indicator of avoidable harm to patients from systemic anticancer treatments, but data for this indicator are limited. The Systemic Anti-Cancer Therapy (SACT) dataset collated by Public Health England allows the assessment of factors affecting 30-day mortality in a national patient population. The aim of this first study based on the SACT dataset was to establish national 30-day mortality benchmarks for breast and lung cancer patients receiving SACT in England, and to start to identify where patient care could be improved. In this population-based study, we included all women with breast cancer and all men and women with lung cancer residing in England, who were 24 years or older and who started a cycle of SACT in 2014 irrespective of the number of previous treatment cycles or programmes, and irrespective of their position within the disease trajectory. We calculated 30-day mortality after the most recent cycle of SACT for those patients. We did logistic regression analyses, adjusting for relevant factors, to examine whether patient, tumour, or treatment-related factors were associated with the risk of 30-day mortality. For each cancer type and intent, we calculated 30-day mortality rates and patient volume at the hospital trust level, and contrasted these in a funnel plot. Between Jan 1, and Dec, 31, 2014, we included 23 228 patients with breast cancer and 9634 patients with non-small cell lung cancer (NSCLC) in our regression and trust-level analyses. 30-day mortality increased with age for both patients with breast cancer and patients with NSCLC treated with curative intent, and decreased with age for patients receiving palliative SACT (breast curative: odds ratio [OR] 1·085, 99% CI 1·040-1·132; p<0·0001; NSCLC curative: 1·045, 1·013-1·079; p=0·00033; breast palliative: 0·987, 0·977-0·996; p=0·00034; NSCLC palliative: 0·987, 0·976-0·998; p=0·0015). 30-day mortality was also significantly higher for patients

  8. Blended care; development of a day treatment program for medically unexplained physical symptoms (MUPS) in the Dutch Armed Forces.

    Science.gov (United States)

    Zeylemaker, M M P; Linn, F H H; Vermetten, E

    2015-01-01

    A subgroup of servicemen can be identified that seek a disproportionally amount of health care in comparison to diagnostic and therapeutic perspectives. This group can be identified on the basis of an absence of a structural medical explanation for their symptoms. The symptoms manifest predominantly as fatigue and pain, and are often chronic. Patients with medical unexplained medical symptoms (MUPS) often have multiple and complex problems that would be best treated by a multidisciplinary team of medical specialists and paramedics. The military is characterized by high loyalty towards peers and leadership, leading to neglect for personal care. While consensus on the biological basis for these complaints is lacking, awareness on the need for effective treatments for this patient group is high. Based on reviews, expert recommendations and clinical demand, a specialized treatment program for soldiers with MUPS has recently been developed and implemented in the system of health care in the Netherlands Armed Forces. We developed a functional rehabilitation program with blended care elements of cognitive behavioral therapy (CBT), physical therapy, case management, and psychoeducation, embedded in a day treatment setting. The program received high scores on participant as well as team satisfaction. The program is illustrated by two clinical vignettes. The blended care program for MUPS that focused on allostatic load awareness offered a more holistic and preventive approach that contributed to a reduction of unnecessary medical consumption, and increased job participation. We recommend that the development of guidelines for diagnoses and treatment of these complaints in military settings will improve the quality of patient care, reduce disability, facilitate reintegration, and encourage scientific research.

  9. Treatment policy for psoriasis and eczema: a survey among dermatologists in the Netherlands and Belgian Flanders.

    Science.gov (United States)

    Roelofzen, Judith H J; Aben, Katja K H; Khawar, Ali J M; Van de Kerkhof, Peter C M; Kiemeney, Lambertus A L M; Van Der Valk, Pieter G M

    2007-01-01

    Today, many therapies are available for the treatment of psoriasis and eczema. One of the oldest topical therapies is coal tar. Coal tar has been used for decades, but over the past years, the use of coal tar has decreased for several reasons, including the supposed carcinogenicity of coal tar. We investigated the current and past treatment policies for psoriasis and eczema with special emphasis on the use of tar products; a postal survey was conducted among all dermatologists in two European countries: the Netherlands (n = 360) and the Flemish speaking part of Belgium (Flanders) (n = 328). This study was conducted as part of the ongoing LATER-study ("Late effects of coal tar treatment in eczema and psoriasis; the Radboud study"). All practising dermatologists received a questionnaire. Dermatologists were asked to describe their treatment policies in mild/moderate psoriasis, severe psoriasis, mild/moderate eczema and severe eczema. The response rate to the questionnaire was 62.5% for the Dutch dermatologists and 45.7% for the Flemish dermatologists. Almost all dermatologists prescribe topical corticosteroids. In eczema, most of the dermatologists prescribe the recently introduced calcineurin inhibitors (95%). Coal tar is a second choice topical therapy. Dutch dermatologists mainly use tar in the treatment of eczema (72% vs. 48% in Flanders), whereas in Flanders, tar is mainly prescribed in psoriasis (60% vs. 41% in Holland). Flemish dermatologists very frequently prescribe PUVA in psoriasis (93% vs. 63%). Topical treatment, especially topical corticosteroids, is the mainstay in psoriasis and eczema. Coal tar still is an important (second choice) therapy for the topical treatment of psoriasis and eczema, but its use varies from country to country. Despite the carcinogenicity of PUVA, this photochemotherapy is frequently prescribed by dermatologists, mainly in Flanders.

  10. The water treatment and recycling in 105-day bioregenerative life support experiment in the Lunar Palace 1

    Science.gov (United States)

    Xie, Beizhen; Zhu, Guorong; Liu, Bojie; Su, Qiang; Deng, Shengda; Yang, Lige; Liu, Guanghui; Dong, Chen; Wang, Minjuan; Liu, Hong

    2017-11-01

    In the bioregenerative life support system (BLSS), water recycling is one of the essential issues. The Lunar Palace 1, a ground-based bioregenerative life support system experimental facility, has been developed by our team and a 105-day closed bioregenerative life support experiment with multi-crew involved has been accomplished within this large-scale facility. During the 105-day experiment, activated carbon-absorption/ultra-filtration, membrane-biological activated carbon reactor and reduced pressure distillation technology have been used to purify the condensate water, sanitary & kitchen wastewater and urine, respectively. The results demonstrated that the combination of those technologies can achieve 100% regeneration of the water inside the Lunar Palace 1. The purified condensate water (the clean water) could meet the standards for drinking water quality in China (GB5749-2006). The treatment capacity of the membrane-biological activated carbon reactor for sanitary & kitchen wastewater could reach 150 kg/d. During the 105-d experiment, the average volume loading of the bioreactor was 0.441 kgCOD/(m3d), and the average COD removal efficiency was about 85.3%. The quality of the purified sanitary & kitchen wastewater (the greywater) could meet the standards for irrigation water quality (GB 5084-2005). In addition, during the 105-day experiment, the total excreted urine volume of three crew members was 346 L and the contained water was totally treated and recovered. The removal efficiency of ion from urine was about 88.12%. Moreover, partial nitrogen within the urine was recovered as well and the average recovery ratio was about 20.5%. The study laid a foundation for the water recycling technologies which could be used in BLSS for lunar or Mars bases.

  11. Effect and safety of high-dose dienogest (20 mg/day) in the treatment of women with endometriosis.

    Science.gov (United States)

    Schindler, Adolf E; Henkel, Alexandra; Moore, Claudia; Oettel, Michael

    2010-11-01

    Hormonal treatment of endometriosis is often continued for long periods and has the potential to affect many essential metabolic processes. The current study aimed to determine the effects and safety of high-dose dienogest as a medical endometriosis therapy. The effects and safety of high-dose dienogest, 20-30 mg/day for 24 weeks, were examined in 21 women aged 18-52 years with laparoscopically and histologically proven endometriosis stage I-IV (according to revised American Society of Reproductive Medicine criteria). At baseline and week 24, sera were obtained and stored at -20°C prior to analysis. The study showed no clinically significant effect of high-dose dienogest on thyroid or adrenal function, electrolyte balance or haematopoiesis. High-dose dienogest therapy also had no appreciable effects on glucose and lipid metabolism, liver enzymes or haemostasis. For instance, although dienogest mediated small increases in the haemostatic variables prothrombin fragment 1 + 2, antithrombin III and protein C, final levels (at week 24) remained within normal reference ranges for these parameters. The exception was the HDL-3 cholesterol concentration at week 24 (0.97 mmol/l), which increased beyond the normal range of 0.28-0.64 mmol/l. This investigation yielded a unique dataset on the safety of high-dose dienogest in endometriosis stage I-IV. High-dose dienogest (20-30 mg/day) had little influence upon all the parameters measured. It is therefore likely that lower doses of dienogest would have similarly neutral safety effects: an important consideration in the use of dienogest for the treatment of endometriosis.

  12. Public opinion of drug treatment policy: exploring the public's attitudes, knowledge, experience and willingness to pay for drug treatment strategies.

    Science.gov (United States)

    Matheson, C; Jaffray, M; Ryan, M; Bond, C M; Fraser, K; Kirk, M; Liddell, D

    2014-05-01

    Research evidence is strong for opiate replacement treatment (ORT). However, public opinion (attitudes) can be at odds with evidence. This study explored the relationships between, attitudes, knowledge of drugs and a range of socio-demographic variables that potentially influence attitude. This is relevant in the current policy arena in which a major shift from harm reduction to, rehabilitation is underway. A cross sectional postal questionnaire survey in Scotland was conducted where the drug, treatment strategy has changed from harm-reduction to recovery-based. A random sample (N=3000), of the general public, >18 years, and on the electoral register was used. The questionnaire was largely structured with tick box format but included two open questions for qualitative responses. Valuation was measured using the economic willingness-to-pay (WTP) method. The response rate was 38.1% (1067/2803). Less than 10% had personal experience of drug, misuse but 16.7% had experience of drug misuse via a friend/acquaintance. Regression modelling revealed more positive attitudes towards drug users in those with personal experience of drug misuse, (p£50,000 per, annum compared to public attitudes and evidence regarding drug treatment. Findings suggest a way forward might be to develop and evaluate treatment that integrates ORT with a community rehabilitative approach. Evaluation of public engagement/education to improve knowledge of drug treatment effectiveness is recommended. Copyright © 2013 Elsevier B.V. All rights reserved.

  13. The effect of Medicaid policies on the diagnosis and treatment of children's mental health problems in primary care.

    Science.gov (United States)

    Turner, Lesley J

    2015-02-01

    Primary care physicians play a substantial role in diagnosing and treating children's mental health disorders, but Medicaid managed care policies may limit these physicians' ability to serve low-income children. Using data from the universe of Medicaid recipients in three states, I evaluate how Medicaid managed care policies impact primary care diagnosis and treatment of children's mental health disorders. Specific policies examined include the presence of a behavioral carve-out, traditional health maintenance organization, or primary care case management program. To alleviate concerns of endogenous patient sorting, my preferred identification strategy uses variation in Medicaid policy penetration to instrument for individual plan choices. I show that while health maintenance organizations reduce diagnosis and non-drug treatment of mental health disorders, primary care case management program policies shift in diagnosis and treatment from within primary care to specialist providers such as psychiatrists, where serious mental health conditions are more likely to be identified. Copyright © 2013 John Wiley & Sons, Ltd.

  14. Efficiency of epilepsy treatment in the Moscow Region under the present-day conditions of drug provision

    Directory of Open Access Journals (Sweden)

    Irina Gennadyevna Rudakova

    2015-01-01

    Full Text Available Objective: to evaluate the efficiency of epilepsy therapy in the two periods 2006–2007 and 2013–2014 due to drug provision-related changes: the use of antiepileptic drugs (AEDs in accordance with their international nonproprietary name.Patients and methods. The continuous sample survey enrolled patients aged 18 years and older, who had been seen by an epileptologist at the Moscow Regional Research Clinical Institute in 2006–2007 (n=1200 and 2013–2014 (n=1450. The patients who had received initial therapy (n=384 were divided into 2 groups in accordance with the type of drug provision. Group 1 (n=124 had recommended AEDs. In Group 2 (n=260, there was switching between AED analogues in 80% of the patients. Therapeutic efficiency was comparatively analyzed in relation to the AEDs used and treatment policies.Results. In 2013–2014 versus 2006–2007, the rate of remissions and the number of respondents was halved. The analysis demonstrated significant differences (p<0.05 between Groups 1 and 2 in the following indicators: the number of respondents (75:52%, remission rates (58:38%, pharmacoresistance (25:47%, the frequency of use of brand (54:34% and generic (45:65% AEDs, and that of switching between AED analogues (0:80%.

  15. Patient organization involvement and the challenge of securing access to treatments for rare diseases: report of a policy engagement workshop.

    Science.gov (United States)

    Mikami, Koichi; Sturdy, Steve

    2017-01-01

    Patients with rare diseases often help to develop new treatments for their conditions. But once developed, those treatments are sometimes priced too high for many patients to access them. We became aware that this is a problem in the course of a social science research project that examines the place of rare diseases in health policy. We therefore organized a two-day workshop to try and understand why this problem occurs and what might be done about it. The people who participated in our workshop were: representatives of rare disease patient organizations, experts in matters of drug regulation and assessment of new health technologies, consultants involved with companies producing treatments for rare diseases, and social scientists researching related issues. The main conclusions to emerge from the discussions were as follows: Problems of access to treatments for rare diseases are not just due to high prices; procedures for regulating, assessing and delivering new treatments also need to be better organized. Patients and patient organizations have much to contribute to this process. However, their resources are often very limited. Consequently, more needs to be done to help them use those resources as effectively as possible. In particular, regulators and healthcare providers need to ensure that their procedures are clear and efficiently managed, so as not to waste patient organizations' time and money. Clearer guidance is needed on what patient organizations can do to provide evidence of the effectiveness of new drugs. Insights gained in tackling rare diseases might also be applicable to common disorders. Finally, the consequences of Brexit for UK policies on rare diseases urgently need to be assessed. Since the enactment of orphan drug legislation in the USA, Europe and several other countries, an increasing number of treatments for rare diseases have been developed and many of them been approved for marketing. However, such treatments tend to be priced very high

  16. Sustainable development and migration policies: their treatment within the Latin American economic integration blocks.

    Science.gov (United States)

    Marmora, L

    1994-01-01

    Without an equal sharing of costs and benefits of natural and human resources worldwide, imbalances and lack of human development lead to migration within and between countries. Economic integration blocks in Latin America provide a context for shared development: in Central America, in the Andean Region, and in the Southern Cone. Over the past 60 years migration policy was based on national protectionism, labor supply, and/or occupation of territory. When economic conditions changed to market economies and world markets, migration policy was redefined. Each of the economic integration blocks has developed its own strategies. The Andean Agreement on Labor Migrations was established to determine the rules for bilateral and multilateral treatment of problems. In the Southern Cone bilateral agreements have been longstanding. Multilateral efforts were recently underway within the Southern Common Market and throughout the region. The Central American Organization for Migrations has spearheaded the adoption of a multilateral strategy. All three regions have made considerable progress in the last three years in constructing multilateral policies for economic integration. Government awareness has been the primary force in these policy changes. Government has come to an understanding that clear domestic and regional migration policies were lacking and that obsolete migration practices of the 1930s did not meet the needs of the 1990s. Migration policy was considered an instrument of development. Movement of economic factors or goods was considered equally with movement of labor. Migration policies must integrate the human rights of migrants into their definitions. Methods of facilitating the movements of populations need to be constructed within the computerization and modernization of the migration administration. Legalization of illegal immigrants has occurred among a number of countries. PROCAM and PRIMCOS were action programs which aimed to integrate migration and

  17. Cohesion to the Group and Its Association with Attendance and Early Treatment Response in an Adult Day-Hospital Program for Eating Disorders: A Preliminary Clinical Investigation

    Science.gov (United States)

    Crino, Natalie; Djokvucic, Ivana

    2010-01-01

    Treatment outcome studies demonstrate that day-hospital programs are effective in the treatment of eating disorders. Few descriptions are available on the specifics of treatment, particularly the process of therapy. The group therapy modality is thought to provide important therapeutic benefits. The present study aimed to examine the association…

  18. Using a decline in serum hCG between days 0–4 to predict ectopic pregnancy treatment success after single-dose methotrexate: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Skubisz Monika

    2013-02-01

    Full Text Available Abstract Background The current measure of treatment efficacy of single-dose methotrexate for ectopic pregnancy, is a fall in serum hCG of ≥15% between days 4–7 of treatment, which has a positive predictive value of 93% for treatment success. Two small studies have proposed a fall in serum hCG between days 0–4 after treatment confers similar, earlier prognostic information, with positive predictive values of 100% and 88% for treatment success. We sought to validate this in a large, independent cohort because of the potentially significant clinical implications. Methods We conducted a retrospective study of women (n=206 treated with single-dose methotrexate for ectopic pregnancy (pre-treatment serum hCG levels ≤3000 IU/L at Scottish hospitals between 2006–2011. Women were divided into two cohorts based on whether their serum hCG levels rose or fell between days 0–4 after methotrexate. Treatment outcomes of women in each cohort were compared, and the test performance characteristics calculated. This methodology was repeated for the current measure (≥15% fall in serum hCG between days 4–7 of treatment and an alternate early measure ( Results In our cohort, the positive predictive value of the current clinical measure was 89% (95% CI 84-94% (121/136. A falling serum hCG between days 0–4 predicted treatment success in 85% (95% CI 79-92% of cases (94/110 and a Conclusions We have verified that a decline in serum hCG between days 0–4 after methotrexate treatment for ectopic pregnancies, with pre-treatment serum hCG levels ≤3000 IU/L, provides an early indication of likelihood of treatment success, and performs just as well as the existing measure, which only provides prognostic information on day 7.

  19. Public views on food addiction and obesity: implications for policy and treatment.

    Directory of Open Access Journals (Sweden)

    Natalia M Lee

    Full Text Available According to their advocates, neurobiological explanations of overeating, or "food addiction", have the potential to impact public understanding and treatment of obesity. In this study, we examine the public's acceptance of the concept of food addiction as an explanation of overeating and assess its effects upon their attitudes toward obese persons and the treatment of obesity.We conducted an online survey of 479 adults from the US (n = 215 and Australia (n = 264. There was substantial support for the idea of food addiction, particularly among obese participants. Over half favoured treating obesity as a type of addiction. Psychotherapy was believed to be the most effective treatment and educational and support programs were the preferred policies to address food addiction. There was very little support for increasing taxes on obesogenic foods. Despite the strong support for seeing obesity as a form of addiction, respondents still saw obesity as primarily the result of personal choices and emphasized the need for individuals to take responsibility for their eating.Our sample of the general public strongly supported the idea of obesity as a form of food addiction; but this did not translate into support of clinical and public health policies that experts believe are most likely to reduce the prevalence of obesity. The reasons for the apparent disjunction between support for food addiction and a strong emphasis on personal choice for weight warrant further examination.

  20. Public views on food addiction and obesity: implications for policy and treatment.

    Science.gov (United States)

    Lee, Natalia M; Lucke, Jayne; Hall, Wayne D; Meurk, Carla; Boyle, Frances M; Carter, Adrian

    2013-01-01

    According to their advocates, neurobiological explanations of overeating, or "food addiction", have the potential to impact public understanding and treatment of obesity. In this study, we examine the public's acceptance of the concept of food addiction as an explanation of overeating and assess its effects upon their attitudes toward obese persons and the treatment of obesity. We conducted an online survey of 479 adults from the US (n = 215) and Australia (n = 264). There was substantial support for the idea of food addiction, particularly among obese participants. Over half favoured treating obesity as a type of addiction. Psychotherapy was believed to be the most effective treatment and educational and support programs were the preferred policies to address food addiction. There was very little support for increasing taxes on obesogenic foods. Despite the strong support for seeing obesity as a form of addiction, respondents still saw obesity as primarily the result of personal choices and emphasized the need for individuals to take responsibility for their eating. Our sample of the general public strongly supported the idea of obesity as a form of food addiction; but this did not translate into support of clinical and public health policies that experts believe are most likely to reduce the prevalence of obesity. The reasons for the apparent disjunction between support for food addiction and a strong emphasis on personal choice for weight warrant further examination.

  1. The Brazilian policy of withholding treatment for ADHD is probably increasing health and social costs

    Directory of Open Access Journals (Sweden)

    Carlos R. Maia

    2015-03-01

    Full Text Available Objective: To estimate the economic consequences of the current Brazilian government policy for attention-deficit/hyperactivity disorder (ADHD treatment and how much the country would save if treatment with immediate-release methylphenidate (MPH-IR, as suggested by the World Health Organization (WHO, was offered to patients with ADHD. Method: Based on conservative previous analyses, we assumed that 257,662 patients aged 5 to 19 years are not receiving ADHD treatment in Brazil. We estimated the direct costs and savings of treating and not treating ADHD on the basis of the following data: a spending on ADHD patients directly attributable to grade retention and emergency department visits; and b savings due to impact of ADHD treatment on these outcomes. Results: Considering outcomes for which data on the impact of MPH-IR treatment are available, Brazil is probably wasting approximately R$ 1.841 billion/year on the direct consequences of not treating ADHD in this age range alone. On the other hand, treating ADHD in accordance with WHO recommendations would save approximately R$ 1.163 billion/year. Conclusions: By increasing investments on MPH-IR treatment for ADHD to around R$ 377 million/year, the country would save approximately 3.1 times more than is currently spent on the consequences of not treating ADHD in patients aged 5 to 19 years.

  2. State policy influence on the early diffusion of buprenorphine in community treatment programs

    Directory of Open Access Journals (Sweden)

    Abraham Amanda J

    2008-06-01

    Full Text Available Abstract Background Buprenorphine was approved for use in the treatment of opioid dependence in 2002, but its diffusion into everyday clinical practice in community-based treatment programs has been slow. This study examines the net impact of efforts by state agencies, including provision of Medicaid coverage, on program-level adoption of buprenorphine as of 2006. Methods Interviews were conducted with key informants in 49 of the 50 state agencies with oversight responsibility for addiction treatment services. Information from these interviews was integrated with organizational data from the 2006 National Survey of Substance Abuse Treatment Services. A multivariate logistic regression model was estimated to identify the effects of state efforts to promote the use of this medication, net of a host of organizational characteristics. Results The availability of Medicaid coverage for buprenorphine was a significant predictor of its adoption by treatment organizations. Conclusion Inclusion of buprenorphine on state Medicaid formularies appears to be a key element in ensuring that patients have access to this state-of-the-art treatment option. Other potential barriers to the diffusion of buprenorphine require identification, and the value of additional state-level policies to promote its use should be evaluated.

  3. Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens.

    Science.gov (United States)

    Bohnert, Kipling M; Sripada, Rebecca K; Mach, Jennifer; McCarthy, John F

    2016-01-01

    The study examined whether same-day integrated mental health services are associated with increased diagnosis and treatment initiation among primary care patients with positive posttraumatic stress disorder (PTSD) screens. Data were from a national sample of Veterans Health Administration (VHA) primary care patients with a positive PTSD screen (N=21,427). Patients were assessed for PTSD diagnosis and treatment initiation on the screening day and ≤ 7 days, ≤ 12 weeks, ≤ 6 months, and ≤ 1 year after screening positive. The service setting on screening day was categorized as primary care only, same-day primary care-mental health integration (PC-MHI), or same-day specialty mental health care. Multivariable generalized estimating equations logistic regression was used to estimate associations between category of screening day services and diagnosis and treatment initiation, with adjustment for demographic characteristics, prior psychiatric diagnoses, prior VHA service utilization, and PTSD screen score. Of the 21,427 patients with positive PTSD screens, 10,809 (50.4%) received a diagnosis within one year of screening positive. Same-day PC-MHI services were associated with greater odds of PTSD diagnosis, both on the same day as (odds ratio [OR]=2.23) and one year (OR=1.67) after screening positive compared with primary care-only services (pprimary care only (pmental health services may help facilitate PTSD diagnosis and treatment initiation after a positive screen.

  4. HIV Reactivation from Latency after Treatment Interruption Occurs on Average Every 5-8 Days--Implications for HIV Remission.

    Directory of Open Access Journals (Sweden)

    Mykola Pinkevych

    2015-07-01

    Full Text Available HIV infection can be effectively controlled by anti-retroviral therapy (ART in most patients. However therapy must be continued for life, because interruption of ART leads to rapid recrudescence of infection from long-lived latently infected cells. A number of approaches are currently being developed to 'purge' the reservoir of latently infected cells in order to either eliminate infection completely, or significantly delay the time to viral recrudescence after therapy interruption. A fundamental question in HIV research is how frequently the virus reactivates from latency, and thus how much the reservoir might need to be reduced to produce a prolonged antiretroviral-free HIV remission. Here we provide the first direct estimates of the frequency of viral recrudescence after ART interruption, combining data from four independent cohorts of patients undergoing treatment interruption, comprising 100 patients in total. We estimate that viral replication is initiated on average once every ≈6 days (range 5.1- 7.6 days. This rate is around 24 times lower than previous thought, and is very similar across the cohorts. In addition, we analyse data on the ratios of different 'reactivation founder' viruses in a separate cohort of patients undergoing ART-interruption, and estimate the frequency of successful reactivation to be once every 3.6 days. This suggests that a reduction in the reservoir size of around 50-70-fold would be required to increase the average time-to-recrudescence to about one year, and thus achieve at least a short period of anti-retroviral free HIV remission. Our analyses suggests that time-to-recrudescence studies will need to be large in order to detect modest changes in the reservoir, and that macaque models of SIV latency may have much higher frequencies of viral recrudescence after ART interruption than seen in human HIV infection. Understanding the mean frequency of recrudescence from latency is an important first step in

  5. Biological contributions to addictions in adolescents and adults: prevention, treatment, and policy implications.

    Science.gov (United States)

    Potenza, Marc N

    2013-02-01

    Despite significant advances in our understanding of the biological bases of addictions, these disorders continue to represent a huge public health burden that is associated with substantial personal suffering. Efforts to target addictions require consideration of how the improved biological understanding of addictions may lead to improved prevention, treatment, and policy initiatives. In this article, we provide a narrative review of current biological models for addictions with a goal of placing existing data and theories within a translational and developmental framework targeting the advancement of prevention, treatment, and policy strategies. Data regarding individual differences, intermediary phenotypes, and main and interactive influences of genetic and environmental contributions in the setting of developmental trajectories that may be influenced by addictive drugs or behavior indicate complex underpinnings of addictions. Consideration and further elucidation of the biological etiologies of addictions hold significant potential for making important gains and reducing the public health impact of addictions. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  6. Implementation of China`s three synchronizations policy: Case studies of wastewater treatment measures at new and renovated factories

    Energy Technology Data Exchange (ETDEWEB)

    Sinkule, B.J.

    1994-03-01

    The Three Synchronizations Policy requires that the design, construction, and operation of a new factory, or an existing factory that expands or changes production processes, be synchronized with the design, construction and operation of appropriate waste treatment facilities. Under this policy, when a new factory is designed, wastewater treatment facilities must be included as part of the overall factory design: when the factory is constructed, the wastewater treatment facilities must be constructed along with construction of the production facilities; and finally, when the factory begins to operate, the waste treatment facilities must begin operation as well. This research includes case studies of wastewater treatment measures at sixteen factories in the Pearl River Delta Region of China. Implementation of the Three Synchronizations Policy is examined in detail for two of the factories: Fengfu Weaving and Dyeing Plant and Zhongguan Printing and Dyeing Plant. The results of this research suggest that the Three Synchronizations Policy has been an effective means of forcing new and renovated factories to comply with wastewater discharge standards, mainly because the Three Synchronizations Policy gives environmental protection bureaus authority to regulate at each step of a new industrial facility`s development. In practice, this authority has been exercised through formalizing the {open_quotes}synchronizations{close_quotes} into a management system with specific regulatory requirements, each of which requires EPB approval. EPBs ran stall operation by withholding its approval of certification of a factory`s wastewater treatment facilities; EPBs also use fines and limited time treatment orders to enforce the Three Synchronizations Policy. The research results demonstrate that the Three Synchronizations Policy was more important than the Pollutant Discharge Fee Program in motivating existing factories to build wastewater treatment facilities.

  7. High dose (4 mg/kg/day) versus usual dose (2 mg/kg/day) oral prednisolone for treatment of infantile spasms: an open-label, randomized controlled trial.

    Science.gov (United States)

    Chellamuthu, Prabaharan; Sharma, Suvasini; Jain, Puneet; Kaushik, Jaya Shankar; Seth, Anju; Aneja, Satinder

    2014-10-01

    This study aimed to test the hypothesis that high-dose prednisolone (4 mg/kg/day) may be more efficacious than usual-dose (2 mg/kg/day) prednisolone for spasm resolution at 14-days in children with infantile spasms. This was a randomized, open-label-trial conducted at a tertiary-level-hospital from February-2012 to March-2013. Children aged 3-months to 2-years presenting with infantile spasms in clusters (at least 1 cluster/day) with hypsarrhythmia or its variants on EEG were enrolled. The study participants were randomized to receive either high-dose prednisolone (4 mg/kg/day) or the usual-dose (2 mg/kg/day) prednisolone. The primary outcome measure was the proportion of children who achieved spasm freedom for 48-h at day-14 after treatment initiation as per parental reports in both the groups. The adverse effects were also monitored. The study was registered with the clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT01575639). Sixty-three children were randomized into the two groups with comparable baseline characteristics. The proportion of children with spasm cessation on day-14 was significantly higher in the high-dose group as compared to the usual-dose group (51.6% vs. 25%, p=0.03). The absolute risk reduction was 26.6% (95% confidence interval 11.5-41.7%) with number needed to treat being 4. The adverse effects were comparable in both the groups. High-dose prednisolone (4 mg/kg/d) was more effective than low-dose prednisolone (2mg/kg/d) in achieving spasm cessation at 14-days (as per parental reports) in children with infantile spasms. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Using a decline in serum hCG between days 0-4 to predict ectopic pregnancy treatment success after single-dose methotrexate: a retrospective cohort study.

    Science.gov (United States)

    Skubisz, Monika; Dutton, Philip; Duncan, William Colin; Horne, Andrew W; Tong, Stephen

    2013-02-01

    The current measure of treatment efficacy of single-dose methotrexate for ectopic pregnancy, is a fall in serum hCG of ≥15% between days 4-7 of treatment, which has a positive predictive value of 93% for treatment success. Two small studies have proposed a fall in serum hCG between days 0-4 after treatment confers similar, earlier prognostic information, with positive predictive values of 100% and 88% for treatment success. We sought to validate this in a large, independent cohort because of the potentially significant clinical implications. We conducted a retrospective study of women (n=206) treated with single-dose methotrexate for ectopic pregnancy (pre-treatment serum hCG levels ≤3000 IU/L) at Scottish hospitals between 2006-2011. Women were divided into two cohorts based on whether their serum hCG levels rose or fell between days 0-4 after methotrexate. Treatment outcomes of women in each cohort were compared, and the test performance characteristics calculated. This methodology was repeated for the current measure (≥15% fall in serum hCG between days 4-7 of treatment) and an alternate early measure (treatment), and all three measures were compared for their ability to predict medical treatment success. In our cohort, the positive predictive value of the current clinical measure was 89% (95% CI 84-94%) (121/136). A falling serum hCG between days 0-4 predicted treatment success in 85% (95% CI 79-92%) of cases (94/110) and a treatment success in 94% (95% CI 88-100%) of cases (59/63). There was no significant difference in the ability of these tests to predict medical treatment success. We have verified that a decline in serum hCG between days 0-4 after methotrexate treatment for ectopic pregnancies, with pre-treatment serum hCG levels ≤3000 IU/L, provides an early indication of likelihood of treatment success, and performs just as well as the existing measure, which only provides prognostic information on day 7.

  9. βhCG monitoring after single-dose methotrexate treatment of tubal ectopic pregnancy: is the Day 4 βhCG necessary? A retrospective cohort study.

    Science.gov (United States)

    Atkinson, Monique; Gupta, Sarika; Mcgee, Therese

    2014-10-01

    In ectopic pregnancy (EP) management, failure of βhCG to fall more than 15% between Days 4 and 7 after methotrexate administration indicates the need for a second dose. Regimens preferring a 25% fall in βhCG between methotrexate administration and Day 7 have been proposed. Our study analysed these and other regimens' performance in predicting treatment success. Secondarily, we investigated how each regimen guided the prescription of additional methotrexate doses. Medical files of 88 women with ultrasound confirmed tubal EP and pretreatment βhCG Treatment success was defined if the EP resolved without surgical intervention. Statistical analysis was performed using McNemar's test. Overall, treatment success with methotrexate was 92% (n = 81/88). Predicting success of methotrexate (PPV 98-100%) and detecting those needing surgery (specificity 86-100%) were equivalent across all monitoring regimens. However, the 25% Day 0/1-7 fall (and the Day 0/1-4 regimens) over-selected women for a second dose of methotrexate (P treatment success. However, a regimen aiming for a 25% fall in βhCG Day 0/1-7 over-selects patients for a second methotrexate dose. In comparison, any drop in βhCG Day 0/1-7 does not over-select women and eliminates Day 4 testing. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  10. Postnatal development and neoplastic disease pattern in NMRI-mice after combined treatment with ethylnitrosourea and X-irradiation on different days of the fetal period

    International Nuclear Information System (INIS)

    Wiggenhauser, A.

    1987-01-01

    Mice were X-irradiated on either day 14, 15, or 16 of gestation with 1,0 Gy. This did not result in an increased tumor frequency in offspring until 12 months. Mice treated parallelly with ENU (45 mg/kg) on the same gestation days developed a significantly increased tumor frequency of the lungs and the liver in all treated groups, and of the ovaries after treatment on day 15 of gestation. This experiment was the first to show that ENU-treatment resulted in hemangiosarcomas of the subcutis at a low incidence. After combined treatment in the sequence X+ENU and an interval of 4 hours, increased tumor frequency was observed only in the offspring treated on gestation day 16. The diagnoses liver tumors and hemangiosarcomas were significantly augmented after X+ENU-treatment on day 15 and 16 and day 14 and 16, respectively. In the reverse sequence (ENU+X) the total tumor outcome was not significantly altered in comparison with the effects of ENU alone. However, detailed analysis also showed a synergistic action on liver tumor frequency on days 15 and 16. (orig./ECB) [de

  11. A Retrospective Chart Review of Dietary Diversity and Feeding Behavior of Children with Autism Spectrum Disorder before and after Admission to a Day-Treatment Program

    Science.gov (United States)

    Sharp, William G.; Jaquess, David L.; Morton, Jane F.; Miles, Aida G.

    2011-01-01

    The nutritional status and mealtime performance among a group of children with autism spectrum disorders (ASD) were examined before and after admission to an intensive feeding day-treatment program. Treatment involved escape extinction, reinforcement, and stimulus fading procedures. Outcomes focused on dietary diversity and mealtime performance,…

  12. Speed of flea knockdown of spinosad compared to afoxolaner, and of spinosad through 28 days post-treatment in controlled laboratory studies.

    Science.gov (United States)

    Snyder, Daniel E; Rumschlag, Anthony J; Young, Lisa Marie; Ryan, William G

    2015-11-09

    The speed of flea knockdown by different products and their duration of effectiveness are factors which affect veterinarian prescribing decisions. To further validate the month-long pulicidal effectiveness of spinosad and determine its rate of flea knockdown to that of afoxolaner, three studies were conducted in two laboratories in the United States, utilizing flea infestations from colonies which are regularly refreshed through introduction of locally caught fleas. All study assessors were blinded, dogs were ranked by pre-study flea counts and randomized accordingly, and treatments administered on Day 0. All studies included a negative control group; two also included an afoxolaner group. In one study, flea challenges for treated and control dogs (10 per group) were completed 21 and 28 days after treatment and counts were performed 24 h later. In each of two speed-of-knockdown (SOK) studies, 36 dogs were randomized, six dogs per group, to: untreated controls; administered oral afoxolaner (2.6-6.2 mg/kg); or oral spinosad (32.1-59.2 mg/kg). In the SOK studies, live fleas from Day -1 infestations were counted after being combed off at 1 and 3 h after treatment, and after reinfestations on Day 7. There were no treatment-related adverse events. Spinosad was 98.6% effective at 28 days post treatment. For SOK, geometric mean live flea counts for afoxolaner were not different from controls at any assessment. For spinosad, all mean counts were significantly lower than in controls (p ≤ 0.0128) except at 1 h post treatment in both studies. Spinosad was significantly more effective than afoxolaner in both studies at 3 h post treatment (p ≤ 0.0065) and post-Day 7 infestation (p ≤ 0.0054), and at 1 h post treatment (p = 0.0276) and post-Day 7 infestation in one study. These data validate spinosad's faster onset of flea knockdown than afoxolaner against infestations present at the time of treatment, and faster residual speed of flea knockdown for at least

  13. Availability of tobacco cessation services in substance use disorder treatment programs: Impact of state tobacco control policy.

    Science.gov (United States)

    Abraham, Amanda J; Bagwell-Adams, Grace; Jayawardhana, Jayani

    2017-08-01

    Given the high prevalence of smoking among substance use disorder (SUD) patients, the specialty SUD treatment system is an important target for adoption and implementation of tobacco cessation (TC) services. While research has addressed the impact of tobacco control on individual tobacco consumption, largely overlooked in the literature is the potential impact of state tobacco control policies on availability of services for tobacco cessation. This paper examines the association between state tobacco control policy and availability of TC services in SUD treatment programs in the United States. State tobacco control and state demographic data (n=51) were merged with treatment program data from the 2012 National Survey of Substance Abuse Treatment Services (n=10.413) to examine availability of TC screening, counseling and pharmacotherapy services in SUD treatment programs using multivariate logistic regression models clustered at the state-level. Approximately 60% of SUD treatment programs offered TC screening services, 41% offered TC counseling services and 26% offered TC pharmacotherapy services. Results of multivariate logistic regression showed the odds of offering TC services were greater for SUD treatment programs located in states with higher cigarette excise taxes and greater spending on tobacco prevention and control. Findings indicate cigarette excise taxes and recommended funding levels may be effective policy tools for increasing access to TC services in SUD treatment programs. Coupled with changes to insurance coverage for TC under the Affordable Care Act, state tobacco control policy tools may further reduce tobacco use in the United States. Published by Elsevier Ltd.

  14. Twelve-hour brain lithium concentration in lithium maintenance treatment of manic-depressive disorder: daily versus alternate-day dosing schedule

    DEFF Research Database (Denmark)

    Jensen, H.V.; Plenge, P; Stensgaard, A

    1996-01-01

    The 12-h brain lithium concentration was measured by lithium-7 magnetic resonance spectroscopy in ten manic-depressive patients receiving daily or alternate-day lithium carbonate treatment. The median dose of lithium carbonate was 800 mg in the daily treatment group and 1200 mg in the alternate......-day group. Median 12-h serum lithium concentration in the two groups was 0.86 mmol l-1 and 0.55 mmol l-1, respectively, while the corresponding concentration in brain was 0.67 mmol l-1 and 0.52 mmol l-1, respectively. The 12-h brain lithium concentration was independent of lithium dosing schedule (multiple......-depressive relapse during alternate-day lithium treatment is in our experience 3-fold greater than with daily treatment (at similar mean 12-h serum lithium concentration), the findings suggest that the difference in the prophylactic efficacy of the two dosing schedules is unrelated to differences in the 12-h brain...

  15. Secondary water treatment optimization in French PWRs: Recent ways of investigation and policy

    Energy Technology Data Exchange (ETDEWEB)

    Millet, L.; Serres, F. [Electricite de France, Group des Laboratoires (France); Vermeeren, D. [Electricite de France, Groupe Ingenierie Process (France); Moreaux, D. [Electricite de France, Groupe Environnement (France)

    2002-07-01

    In French nuclear power plants, the secondary water conditioning is essentially based on the use of a volatile amine and a reducing reagent. The additional use of a corrosion inhibitor is limited to units with secondary side corrosion of Alloy 600 MA SG tubes. The main aim of secondary water treatment optimisation is to achieve the best compromise as follows: to minimize the different types of corrosion of the different PWRs materials (copper corrosion, flow assisted corrosion, SG fouling and secondary side corrosion), to reduce operation and maintenance costs (short term and long term), to minimise the impacts on the environment, to protect workers health. In a first part, this paper describes the studies recently carried out to try to optimise the secondary water treatment in French PWRs. They concern the possibility to use ethanolamine (ETA) in replacement of morpholine and ammonia and the possibility to use carbohydrazide (CBH) in replacement of hydrazine. In a second part, this paper presents the French secondary water treatment policy established in 2000, which is depending on the presence or not of copper alloys. (authors)

  16. Secondary water treatment optimization in French PWRs: Recent ways of investigation and policy

    International Nuclear Information System (INIS)

    Millet, L.; Serres, F.; Vermeeren, D.; Moreaux, D.

    2002-01-01

    In French nuclear power plants, the secondary water conditioning is essentially based on the use of a volatile amine and a reducing reagent. The additional use of a corrosion inhibitor is limited to units with secondary side corrosion of Alloy 600 MA SG tubes. The main aim of secondary water treatment optimisation is to achieve the best compromise as follows: to minimize the different types of corrosion of the different PWRs materials (copper corrosion, flow assisted corrosion, SG fouling and secondary side corrosion), to reduce operation and maintenance costs (short term and long term), to minimise the impacts on the environment, to protect workers health. In a first part, this paper describes the studies recently carried out to try to optimise the secondary water treatment in French PWRs. They concern the possibility to use ethanolamine (ETA) in replacement of morpholine and ammonia and the possibility to use carbohydrazide (CBH) in replacement of hydrazine. In a second part, this paper presents the French secondary water treatment policy established in 2000, which is depending on the presence or not of copper alloys. (authors)

  17. Distress Tolerance Among Students Referred for Treatment Following Violation of Campus Cannabis Use Policy: Relations to Use, Problems, and Motivation

    OpenAIRE

    Buckner, Julia D.; Jeffries, Emily R.; Terlecki, Meredith A.; Ecker, Anthony H.

    2015-01-01

    Students referred to treatment after violating campus drug policies represent a high-risk\\ud group. Identification of factors related to these students’ cannabis use could inform prevention\\ud and treatment efforts. Distress tolerance (DT) is negatively related to substance-related\\ud behaviors and may be related to high-risk cannabis use vulnerability factors that can impact\\ud treatment outcome. Thus, the current study tested whether DT was related to cannabis use\\ud frequency, cannabis-rel...

  18. Effects of 21-day d-amphetamine and risperidone treatment on cocaine vs food choice and extended-access cocaine intake in male rhesus monkeys.

    Science.gov (United States)

    Hutsell, Blake A; Negus, S Stevens; Banks, Matthew L

    2016-11-01

    Clinical trial data suggest amphetamine treatment is most efficacious in moderate to high frequency cocaine users. However, preclinical studies have examined amphetamine treatment effects under relatively limited cocaine access conditions with low to moderate cocaine intakes. This study determined d-amphetamine treatment effects on cocaine self-administration in rhesus monkeys under cocaine access conditions allowing for high daily cocaine intake. For comparison and as a negative control, treatment effects with the antipsychotic risperidone were also examined. Continuous 21-day treatments with ramping doses of d-amphetamine (days 1-7: 0.032mg/kg/h; days 8-21: 0.1mg/kg/h, i.v.) or risperidone (days 1-7: 0.001mg/kg/h; days 8-14: 0.0032mg/kg/h; days 15-21: 0.0056mg/kg/h, i.v.) were administered to rhesus monkeys (n=4) with daily access to two types of cocaine self-administration sessions: (1) a 2-h 'choice' session with concurrent availability of 1-g food pellets and intravenous cocaine injections (0-0.1mg/kg per injection) and (2) a 20-h 'extended-access' session with 0.1mg/kg per injection cocaine availability. Total daily cocaine intake increased >6-fold during extended cocaine access. d-Amphetamine significantly decreased total cocaine intake, but not cocaine vs food choice. In contrast, risperidone did not significantly alter either total cocaine intake or cocaine vs. food choice. These results confirm and extend previous results supporting treatment effectiveness for monoamine releasers, but not dopamine antagonists, to reduce cocaine self-administration. Moreover, these results suggest amphetamine treatment efficacy to decrease preclinical cocaine vs. food choice may depend upon cocaine access conditions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Responding to the challenge of antimalarial drug resistance by routine monitoring to update national malaria treatment policies

    DEFF Research Database (Denmark)

    Vestergaard, Lasse S; Ringwald, Pascal

    2007-01-01

    Reduced sensitivity of Plasmodium falciparum to formerly recommended cheap and well-known antimalarial drugs places an increasing burden on malaria control programs and national health systems in endemic countries. The high costs of the new artemisinin-based combination treatments underline the use...... of rational and updated malaria treatment policies, but defining and updating such policies requires a sufficient volume of high-quality drug-resistance data collected at national and regional levels. Three main tools are used for drug resistance monitoring, including therapeutic efficacy tests, in vitro...... tests, and analyses of molecular markers. Data obtained with the therapeutic efficacy test conducted according to the standard protocol of the World Health Organization are most useful for updating national treatment policies, while the in vitro test and molecular markers can provide important...

  20. A multimodal day treatment program for multi-problem young adults: Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Luijks, M.-J.A. (Marie-Jolette A.); F. Bevaart (Floor); J. Zijlmans (Josjan); L. van Duin (Laura); R. Marhe (Reshmi); T. Doreleijers (Theo); H.W. Tiemeier (Henning); J.J. Asscher (Jessica J.); Popma, A. (Arne)

    2017-01-01

    textabstractBackground: Effective interventions for young adults with severe, multiple problems - such as psychosocial and psychiatric problems, delinquency, unemployment and substance use - are scarce but urgently needed in order to support an adequate transition to adulthood. A multimodal day

  1. The effect of an occupational therapy mental health day treatment centre on the use of inpatient services in the Western Cape, South Africa.

    Science.gov (United States)

    Engelbrecht, Riekie; Plastow, Nicola; Botha, Ulla; Niehaus, Djh; Koen, Liezl

    2018-04-27

    The aim of this study was to determine whether attendance at an occupational therapy-led day treatment centre for mental health care users affects the use of inpatient services in South Africa. A retrospective pre-test/post-test quasi-experimental study design was used to compare admissions and days spent in hospital during the 24 months before and after attendance at the centre, using the hospital's electronic records. Total population sampling yielded data for 44 mental health care users who made first contact with the service between July 2009 and June 2010. Data were compared using the Kruskal-Wallis test, Wilcoxon Signed Ranks test and Mann-Whitney U test. There was a significant decrease in the number of admissions (z = -4.093, p = 0.00) and the number of days spent in hospital (z = -4.730, p = 0.00). Participants were admitted to psychiatric care 33 times less in the 24 months' post-intervention, indicating a medium effect (r = 0.436). They also spend 2569 days less in hospital, indicating a large effect (r = 0.504). The findings suggest that an occupational therapy-led day treatment centre could be effective in reducing the use of inpatient mental health services in South Africa. Implications for Rehabilitation Attendance at an occupational therapy-led community day treatment centre decreases the number of admissions and number of days spent in hospital and is therefore beneficial to mental health care users and service providers. The study indicates that the successful implementation of a community day treatment centre for mental health care users on the grounds of a tertiary hospital by utilising existing resources is possible.

  2. Short-Term Treatment of Bothersome Bleeding for Etonogestrel Implant Users Using a 14-Day Oral Contraceptive Pill Regimen: A Randomized Controlled Trial.

    Science.gov (United States)

    Guiahi, Maryam; McBride, Madeline; Sheeder, Jeanelle; Teal, Stephanie

    2015-09-01

    To understand whether using oral contraceptive pills (OCPs) results in temporary interruption of bleeding for etonogestrel contraceptive implant users during a 14-day course. In this double-blind trial, we randomly assigned etonogestrel implant users reporting 7 consecutive days or more of bothersome bleeding to receive 14 pills of study drug (150 microgram levonorgestrel and 30 microgram ethinyl estradiol combined OCPs) or an identical-appearing placebo. The primary outcome was the proportion of women in each group who stopped bleeding during therapy and continued to report no bleeding at the end of therapy. Prespecified secondary outcomes were number of days until temporary interruption of bleeding occurred, number of days without bleeding during therapy, and number of days to recurrence of bleeding after discontinuation of therapy. We hypothesized that temporary interruption of bleeding would occur in 80% of the treatment group compared with 20% in the control group; using 80% power, we needed a sample size of 26 women. We performed intent-to-treat analysis. From November 2013 through December 2014, 66 women were screened and 32 were randomized: OCPs (n=16) or placebo (n=16). The majority was young, Caucasian women with reported bleeding as extremely or very annoying; groups had similar baseline characteristics. Participants randomized OCPs were more likely (14 of 16 [87.5%±16.2%] compared with six of 16 [37.5%±23.7%]) to have a temporary interruption of bleeding during the study drug period (odds ratio 11.7, 95% confidence interval 1.9-70.2). Of women in the OCP arm who had a temporary interruption, 85.7% had bleeding recurrence within 10 days after treatment. Bothersome bleeding in etonogestrel contraceptive implant users will usually stop with 14-day OCP treatment, but bleeding most often resumes within days of treatment cessation. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01968135. I.

  3. Use of queue modelling in the analysis of elective patient treatment governed by a maximum waiting time policy

    DEFF Research Database (Denmark)

    Kozlowski, Dawid; Worthington, Dave

    2015-01-01

    Many public healthcare systems struggle with excessive waiting lists for elective patient treatment. Different countries address this problem in different ways, and one interesting method entails a maximum waiting time guarantee. Introduced in Denmark in 2002, it entitles patients to treatment...... chain and discrete event simulation models, to provide an insightful analysis of the public hospital performance under the policy rules. The aim of this paper is to support the enhancement of the quality of elective patient care, to be brought about by better understanding of the policy implications...

  4. AEC sets basic policy line on treatment and disposal of radioactive waste

    International Nuclear Information System (INIS)

    Anon.

    1976-01-01

    The AEC's new policy line for the treatment and disposal of radioactive wastes is explained with three tables added. The first table was prepared by MITI's Nuclear Fuel Advisory Committee regarding the projections on the amounts of radioactive wastes to be discharged from nuclear power plants, fuel fabrication plants and reprocessing plants, and the other two tables were made by the AEC committee on technical development of radioactive waste management, the one proposed the developmental steps necessary for establishing waste management technologies, and the other showed the related research and development items with target time schedule. The proper treatment and disposal of radioactive waste S are the problems that have to be resolved prior to the full development and utilization of nuclear energy. The Atomic Energy Commission set up a committee on July 29, 1975, to discuss the technologies on the management of radioactive wastes. The principle essential to the radioactive waste management was set, and it is desirable that this principle is put into practice with the cooperation and understanding of the people and all parties concerned. The countermeasures proposed will be subject to review yet as the technology makes further progress and they are as follows: on the high level radioactive waste management and the low-and intermediate-level radioactive waste management, the basic idea, targets and measures are given, and the methods for promoting experimental ocean dumping of low level radioactive wastes are proposed. (Iwakiri, K.)

  5. Not Enough Time in the Day: A Qualitative Assessment of In-School Physical Activity Policy as Viewed by Administrators, Teachers, and Students.

    Science.gov (United States)

    Gamble, Abigail; Chatfield, Sheryl L; Cormack, Michael L; Hallam, Jeffrey S

    2017-01-01

    In recent decades, the alignment of health and education has been at the forefront of school reform. Whereas the establishment of national in-school physical activity (ISPA) recommendations and state-level mandates demonstrates success, there has been less achievement in areas that address health disparities. The purpose of this investigation was to explore barriers and facilitators to implementing state-mandated ISPA policies in the Mississippi Delta. Focus groups or interviews were conducted with district administrators, school principals, teachers, and students. A total of 2 semistructured moderator guides were developed to focus on (1) student ISPA practices and preferences and (2) facilitators and barriers to implementing ISPA policies and practices. A total of 6 themes were developed. In that, 2 themes addressed participant-described barriers (primary challenges and interferences and excuses). Three themes highlighted participant-described facilitators (compromises, things that work, and being active at school). Finally, 1 theme encompassed the participant-described need to address educating the whole child. There is a critical need for meaningful and relevant solutions to circumvent challenges to implementing ISPA policies and practices in the Mississippi Delta. The Whole School, Whole Community, Whole Child model offers a broad means of visualizing rural, low-income, racially concentrated schools to circumvent challenges and foster ISPA policies and practices. © 2016, American School Health Association.

  6. Abstract Collection of 24th Forum: Energy Day in Croatia: EU Energy Policy after 21st Conference of the Parties to the UN Framework Convention on Climate Changes

    International Nuclear Information System (INIS)

    2015-01-01

    This year's Forum coincides with 21st Conference of the Parties to the UN Framework Convention on Climate Changes (COP21) in Paris. For energy sector, political agreement about climate change in Paris opens the discussion about realization of the climate policy of CO2 emission reduction, with reference on conceiving an energy policy that will be based on complete implementation of climate protection policy. While content and commitments will be discussed in Paris, EU, which supports climate protection policy, will be discussing about elements of climate and energy policy implementation. In Paris the main question will be: is it possible to achieve an agreement on climate change, that would be legally binding, fair and feasible? The majority answer would probably be: difficult, but absolutely necessary. What is the problem in achieving a legally binding agreement on climate policy? Legally binding climate change agreement has its consequence - every country would be legally bound to change its climate policy, include climate protection in energy costs, modify or change technology in the entire manufacturing chain, transport/transfer, distribution and energy supply, increase in energy efficiency, production of energy from renewable energy sources and other measures that contribute to reduction of CO2 emissions. In the start-up phase, it will directly affect the citizens and entrepreneurship with the increase in expenses and then the competitiveness of economy and living standard of citizens. Where it only for the expenses of energy in question, in which every country would be in the same position, there probably would not be any problem in achieving of the agreement. The larger problem lies in thresholds of emission reductions for every country, which produces the differences between countries - from which level to start and to which level to get to in certain amount of time. The starting point is not the same, responsibility for the current emission levels is

  7. [Effects of psychosomatic treatment for the elderly on cognition and quality of life : Naturalistic study at the psychosomatic day care hospital for the elderly in Nuremberg].

    Science.gov (United States)

    Wunner, Christina; Reichhart, Corinne; Strauss, Bernhard; Söllner, Wolfgang

    2016-11-16

    In 2006 the psychosomatic day care hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of the study was to determine treatment effectiveness regarding quality of life and cognition. Designed as a naturalistic study of a population sample of 116 patients, the cognitive capacity (memory performance and cognitive speed) and the subjective quality of life were measured by the Nuremberg aging inventory (NAI) and the World Health Organization quality of life for elderly persons (WHOQOL-OLD). The patients were surveyed at four points in time including at 8‑month follow-up. A 5-week waiting time before admission to the 5‑week therapy was implemented as a control condition. In comparison with the waiting time, after treatment significant improvement (psychosomatic day care hospital treatment of the elderly improves subjective quality of life and cognitive capacity.

  8. The required number of treatment imaging days for an effective off-line correction of systematic errors in conformal radiotherapy of prostate cancer -- a radiobiological analysis

    International Nuclear Information System (INIS)

    Amer, Ali M.; Mackay, Ranald I.; Roberts, Stephen A.; Hendry, Jolyon H.; Williams, Peter C.

    2001-01-01

    Background and purpose: To use radiobiological modelling to estimate the number of initial days of treatment imaging required to gain most of the benefit from off-line correction of systematic errors in the conformal radiation therapy of prostate cancer. Materials and methods: Treatment plans based on the anatomical information of a representative patient were generated assuming that the patient is treated with a multi leaf collimator (MLC) four-field technique and a total isocentre dose of 72 Gy delivered in 36 daily fractions. Target position variations between fractions were simulated from standard deviations of measured data found in the literature. Off-line correction of systematic errors was assumed to be performed only once based on the measured errors during the initial days of treatment. The tumour control probability (TCP) was calculated using the Webb and Nahum model. Results: Simulation of daily variations in the target position predicted a marked reduction in TCP if the planning target volume (PTV) margin was smaller than 4 mm (TCP decreased by 3.4% for 2 mm margin). The systematic components of target position variations had greater effect on the TCP than the random components. Off-line correction of estimated systematic errors reduced the decrease in TCP due to target daily displacements, nevertheless, the resulting TCP levels for small margins were still less than the TCP level obtained with the use of an adequate PTV margin of ∼10 mm. The magnitude of gain in TCP expected from the correction depended on the number of treatment imaging days used for the correction and the PTV margin applied. Gains of 2.5% in TCP were estimated from correction of systematic errors performed after 6 initial days of treatment imaging for a 2 mm PTV margin. The effect of various possible magnitudes of systematic and random components on the gain in TCP expected from correction and on the number of imaging days required was also investigated. Conclusions: Daily

  9. Abstract Collection of 23rd Forum: Energy Day in Croatia: How to define and implement an energy policy in light of new EU guidelines for the year 2030?

    International Nuclear Information System (INIS)

    2014-01-01

    The 23rd Forum is dedicated to the issues of implementation of EU climate and energy policy up to 2030. If the necessity of CO2 emissions reduction would be accepted, as the highest EU political goal, the basic problem of the implementation policy is how to implement the envisaged goals. Until now, the implementation policy, commonly stated as 3x20, has shown as insufficient to achieve the goals. The main problems of the implementation policy in the professional discussions are stated as follow: 1) Should the CO2 emission reduction be stated as the single goal or should the reaming two goals (RES and energy efficiency), which in fact are means of achieving CO2 emission reduction, be retained as well; 2) How to insure the financing of the climate policy measures due to the fact that Emission Trade System has not fulfilled expectations; 3) How to define renewable energy sources position without disturbance of the market. The recent period shows the great confrontation of the market and administration to the detriment of the market. If the current processes continue there will be less of the market and more of the administration. Therefore, for the period around 2050 - the market would not be a basic concept of the relation in EU. Among professionals can be noticed certain frustration due to the fact that political solutions neglect objective problems in energy systems, especially in electric power system which is the most sophisticated due to necessary balance between production and demand side. The political measures couldn't change the basic principles and laws of physics and electrical engineering. Due to that, consequences are reflected on the operation of electric power system, the prices, the development plans and security of supply as well. It is expected that the discussion will show the way in which the solutions of implementation policy should be sought. The solutions which will comply with the technical and energy conditions of electric power system

  10. Abstract Collection of 25th Forum: Energy Day in Croatia: A Unique Energy and Climate Policy in Open Energy Market - A Year After COP 21

    International Nuclear Information System (INIS)

    2016-01-01

    Ever since Croatian Energy Association was founded and became a member of the World Energy Council (WEC), a total of 25 Forums were organised, with subjects of utter importance for the energy sector. Experts and the public were familiarized with problems, trends, visions and experiences from different countries through papers and presentations presented on those forums, which were also an outlook to the future. The subjects of the forums already held were as following: 1992, Croatian Energy During and After the War; 1993, New Technologies and Energy Management; 1994, Problems of the Energy Sector Transition; 1995, Prices and Tariff Policy in the Energy Industry; 1996, Expectations in the Energy Consumption until 2020; 1997, Goals, Methodology and Experiences of Regional Planning as a part of a National Energy Sector; 1998, Future of the Energy Industry After the Kyoto Protocol; 1999, Energy Market and Energy Efficiency in the Transition Countries; 2000, Restructure, Privatisation and Market Change of Linked Energy Systems; 2001, Liberalisation and Privatisation of the Energy Sector in Transition Countries and in the European Union - Experiences and Perspective; 2002, Regulation Problem on the Energy Services Market; 2003, Energy Consumers in the Open Market Conditions; 2004, Long-term Planning and Supply Security in the Open Market Conditions; 2005, Energy Perspectives Today and Tomorrow - WORLD EUROPE CROATIA; 2006, Energy Perspectives to 2050 - WORLD EUROPE CROATIA; 2007, Energy Future in the Light of Conditions and Integration Processes in Europe; 2008, Europe, Region and Croatia in 2030; 2009, Quo Vadis Energy in the Period of Climate Change; 2010, Energy Future - Vision Until 2050; 2011, Third package and other energy directives - What they do and do not bring, and what we can expect in the future; 2012, Reducing CO2 Emissions by 80 percent by 2050 - Reality or Utopia; 2013, How to Accomplish Goals of Reducing CO2 Emissions by 2050; 2014, How to Define and

  11. Responding to the challenge of antimalarial drug resistance by routine monitoring to update national malaria treatment policies

    DEFF Research Database (Denmark)

    Vestergaard, Lasse S; Ringwald, Pascal

    2007-01-01

    additional information about changing patterns of resistance. However, some of the tests are technically demanding, and thus there is a need for more resources for training and capacity building in endemic countries to be able to adequately respond to the challenge of drug resistance....... of rational and updated malaria treatment policies, but defining and updating such policies requires a sufficient volume of high-quality drug-resistance data collected at national and regional levels. Three main tools are used for drug resistance monitoring, including therapeutic efficacy tests, in vitro...... tests, and analyses of molecular markers. Data obtained with the therapeutic efficacy test conducted according to the standard protocol of the World Health Organization are most useful for updating national treatment policies, while the in vitro test and molecular markers can provide important...

  12. Changing the malaria treatment protocol policy in Timor-Leste: an examination of context, process, and actors’ involvement

    Science.gov (United States)

    2013-01-01

    In 2007 Timor-Leste, a malaria endemic country, changed its Malaria Treatment Protocol for uncomplicated falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. The change in treatment policy was based on the rise in morbidity due to malaria and perception of increasing drug resistance. Despite a lack of nationally available evidence on drug resistance, the Ministry of Health decided to change the protocol. The policy process leading to this change was examined through a qualitative study on how the country developed its revised treatment protocol for malaria. This process involved many actors and was led by the Timor-Leste Ministry of Health and the WHO country office. This paper examines the challenges and opportunities identified during this period of treatment protocol change. PMID:23672371

  13. Perception of chloroquine efficacy and alternative treatments for uncomplicated malaria in children in a holoendemic area of Tanzania: implications for the change of treatment policy

    DEFF Research Database (Denmark)

    Tarimo, D S; Minjas, J N; Bygbjerg, I C

    2001-01-01

    Prior to policy change from chloroquine (CQ) to sulphadoxine/pyrimethamine (S/P; Fansidar) we assessed the perception of CQ efficacy and the alternative treatment options for malaria in children among parents/guardians (N=527) of under-fives attending first level health facilities on account...

  14. Evaluation of the flukicide treatment policy for dairy cattle in Galicia (NW Spain).

    Science.gov (United States)

    Mezo, Mercedes; González-Warleta, Marta; Castro-Hermida, José Antonio; Ubeira, Florencio M

    2008-11-07

    Fasciola hepatica infection is an important cause of lost productivity in livestock worldwide. Effective control of fasciolosis is difficult, especially in milking cows, which can only be treated during dry periods, a control strategy that has not been yet evaluated. In this cross-sectional study, we investigated the effect of the type of flukicide treatment on the prevalence and intensity of infection in dairy cattle from Galicia, an area where fasciolosis is endemic and which is also the main milk-producing region in Spain. Faecal samples were taken from 5188 dairy cows on 275 randomly selected farms for measurement of the concentration of F. hepatica coproantigens by a monoclonal antibody based immunoassay (MM3-COPRO ELISA). On the same day as the sampling, each farm owner/manager was questioned about the types of treatment used on the farm. Three groups of farms were considered according to the fasciolicide treatment: (A) flukicides were not used, (B) an anthelmintic effective against mature stages of flukes was used (albendazole or netobimin) and (C) a fasciolicide effective against immature and mature stages was used (triclabendazole: TCBZ). Results indicated that 16.0% (832/5188) cows from 61.1% (168/275) herds were infected by F. hepatica. The mean coproantigen concentration in infected herds was 13.0ng/ml (range 0.9-112.6ng/ml). The highest individual concentration recorded was 496.6ng/ml. Herd and within-herd prevalences of F. hepatica were similar in all three groups, but surprisingly, individual prevalence and antigen concentration were higher in Group C (p25% was very high in all three groups, and no significant differences were observed. In contrast, the percentage of herds with mean antigen concentrations >20ng/ml was significantly lower (p<0.05) in Groups A and B (14.4% and 14.9%, respectively) than in Group C (50.0%). The proportion of herds that exceeded both limits (25% for prevalence and/or 20ng/ml for coproantigen concentration) was also

  15. The effect of short-term (21-day) orlistat treatment on the physiologic balance of six selected macrominerals and microminerals in obese adolescents.

    Science.gov (United States)

    Zhi, Jianguo; Moore, Rema; Kanitra, Linda

    2003-10-01

    Orlistat is a gastrointestinal lipase inhibitor used to reduce dietary fat absorption and could be used to treat overweight and obesity in adolescents. The primary objective was to assess whether orlistat has an effect on the physiologic balance of three macrominerals (calcium, phosphorus and magnesium) and three microminerals (iron, zinc and copper). This was a 21-day, double-blind, randomized, parallel-group, placebo-controlled mineral balance study conducted in adolescent obese volunteers (BMI >or=85th percentile, adjusted for age and gender). Subjects were maintained on a hypocaloric diet with a normal daily mineral content in both treatment groups and received oral treatment with orlistat 120 mg (n = 16) or placebo (n = 16) three times daily for 21 days. Following a 14-day equilibration period, balances for calcium, phosphorus, magnesium, iron, copper and zinc were measured for days 15-21. Serum and urine electrolytes were also measured at baseline and at the end of treatment. On average, orlistat inhibited dietary fat absorption by approximately 27%. This degree of dietary fat inhibition caused no significant changes in mineral balance between orlistat and placebo groups. In addition, serum and urine electrolytes (sodium and potassium) as well as urinary creatinine excretion were not affected by orlistat treatment. Orlistat was well tolerated; adverse events occurred mainly in the gastrointestinal tract and were of mild or moderate intensities. Administration of orlistat had no significant effect on the balance of six selected minerals in adolescent obese patients.

  16. Identifying Barriers to Appropriate Use of Metabolic/Bariatric Surgery for Type 2 Diabetes Treatment:Policy Lab Results

    OpenAIRE

    Rubin, Jennifer K.; Hinrichs-Krapels, Saba; Hesketh, Rachel; Martin, Adam; Herman, William H.; Rubino, Francesco

    2016-01-01

    Despite increasing recognition of the efficacy, safety, and cost-effectiveness of bariatric/metabolic surgery in the treatment of type 2 diabetes, few patients who may be appropriate candidates and may benefit from this type of surgery avail themselves of this treatment option. To identify conceptual and practical barriers to appropriate use of surgical procedures, a Policy Lab was hosted at the 3rd World Congress on Interventional Therapies for Type 2 Diabetes on 29 September 2015. Twenty-si...

  17. Effects of 7-day continuous D-amphetamine, methylphenidate, and cocaine treatment on choice between methamphetamine and food in male rhesus monkeys.

    Science.gov (United States)

    Schwienteck, Kathryn L; Banks, Matthew L

    2015-10-01

    Methamphetamine addiction is a significant public health problem for which no Food and Drug Administration-approved pharmacotherapies exist. Preclinical drug vs. food choice procedures have been predictive of clinical medication efficacy in the treatment of opioid and cocaine addiction. Whether preclinical choice procedures are predictive of candidate medication effects for other abused drugs, such as methamphetamine, remains unclear. The present study aim was to determine continuous 7-day treatment effects with the monoamine releaser d-amphetamine and the monoamine uptake inhibitor methylphenidate on methamphetamine vs. food choice. In addition, 7-day cocaine treatment effects were also examined. Behavior was maintained under a concurrent schedule of food delivery (1-g pellets, fixed-ratio 100 schedule) and methamphetamine injections (0-0.32mg/kg/injection, fixed-ratio 10 schedule) in male rhesus monkeys (n=4). Methamphetamine choice dose-effect functions were determined daily before and during 7-day periods of continuous intravenous treatment with d-amphetamine (0.01-0.1mg/kg/h), methylphenidate (0.032-0.32mg/kg/h), or cocaine (0.1-0.32mg/kg/h). During saline treatment, increasing methamphetamine doses resulted in a corresponding increase in methamphetamine vs. food choice. Continuous 7-day treatments with d-amphetamine, methylphenidate or cocaine did not significantly attenuate methamphetamine vs. food choice up to doses that decreased rates of operant responding. However, 0.1mg/kg/h d-amphetamine did eliminate methamphetamine choice in two monkeys. The present subchronic treatment results support the utility of preclinical methamphetamine choice to evaluate candidate medications for methamphetamine addiction. Furthermore, these results confirm and extend previous results demonstrating differential pharmacological mechanisms between cocaine choice and methamphetamine choice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Effects of 7-day continuous d-amphetamine, methylphenidate, and cocaine treatment on choice between methamphetamine and food in male rhesus monkeys*

    Science.gov (United States)

    Schwienteck, Kathryn L.; Banks, Matthew L.

    2015-01-01

    Background Methamphetamine addiction is a significant public health problem for which no Food and Drug Administration-approved pharmacotherapies exist. Preclinical drug vs. food choice procedures have been predictive of clinical medication efficacy in the treatment of opioid and cocaine addiction. Whether preclinical choice procedures are predictive of candidate medication effects for other abused drugs, such as methamphetamine, remains unclear. The present study aim was to determine continuous 7-day treatment effects with the monoamine releaser d-amphetamine and the monoamine uptake inhibitor methylphenidate on methamphetamine vs. food choice.In addition, 7-day cocaine treatment effects were also examined. Methods Behavior was maintained under a concurrent schedule of food delivery (1-g pellets, fixed-ratio 100 schedule) and methamphetamine injections (0-0.32 mg/kg/injection, fixed-ratio 10 schedule) in male rhesus monkeys (n=4). Methamphetamine choice dose-effect functions were determined daily before and during 7-day periods of continuous intravenous treatment with d-amphetamine (0.01-0.1 mg/kg/h), methylphenidate (0.032-0.32 mg/kg/h), or cocaine (0.1-0.32 mg/kg/h). Results During saline treatment, increasing methamphetamine doses resulted in a corresponding increase in methamphetamine vs. food choice. Continuous 7-day treatments with d-amphetamine, methylphenidate or cocaine did not significantly attenuate methamphetamine vs. food choice up to doses that decreased rates of operant responding. However, 0.1 mg/kg/h d-amphetamine did eliminate methamphetamine choice in two monkeys. Conclusions The present subchronic treatment resultssupport the utility of preclinical methamphetamine choice to evaluate candidate medications for methamphetamine addiction. Furthermore, these results confirm and extend previous results demonstrating differential pharmacological mechanisms between cocaine choice and methamphetamine choice. PMID:26361713

  19. The Legal and Policy Framework for Waste Disposition - Legal and policy framework for low level waste treatment and disposal

    International Nuclear Information System (INIS)

    Leech, Jonathan

    2014-01-01

    UK policy and strategy for the management of LLW has changed significantly in recent years, not least through development and implementation of the 'UK Strategy for the Management of Solid Low Level Radioactive Waste from the Nuclear Industry' as part of the UK Nuclear Decommissioning Authority's mission. This has influenced all aspects of LLW management in the UK, including metals recycling and VLLW disposal. The paper will outline the legal context for these changes in the UK and highlight how international conventions and legal frameworks have influenced these developments. In particular, the paper will look at the following important influences on choices for recycling and disposal of LLW and VLLW. - The Paris and Brussels Conventions on third party liabilities for nuclear damage; - on-going work to implement the 2004 Protocols to those conventions, including the impact on disposal sites and proposals to exclude VLLW disposal sites from liabilities regimes; - The Revised Waste Framework Directive and Waste Hierarchy; - Relevant European pollution prevention and control legislation and Best Available Techniques. (author)

  20. Two overlooked contributors to abandonment of childhood cancer treatment in Kenya: parents' social network and experiences with hospital retention policies.

    Science.gov (United States)

    Mostert, S; Njuguna, F; Langat, S C; Slot, A J M; Skiles, J; Sitaresmi, M N; van de Ven, P M; Musimbi, J; Vreeman, R C; Kaspers, G J L

    2014-06-01

    The principal reason for childhood cancer treatment failure in low-income countries is treatment abandonment, the most severe form of nonadherence. Two often neglected factors that may contribute to treatment abandonment are as follows: (a) lack of information and guidance by doctors, along with the negative beliefs of family and friends advising parents, which contributes to misconceptions regarding cancer and its treatment, and (b) a widespread policy in public hospitals by which children are retained after doctor's discharge until medical bills are settled. This study explored parents' experiences with hospital retention policies in a Kenyan academic hospital and the impact of attitudes of family and friends on parents' decisions about continuing cancer treatment for their child. Home visits were conducted to interview parents of childhood cancer patients who had been diagnosed between 2007 and 2009 and who had abandoned cancer treatment. Retrospective chart review revealed 98 children diagnosed between 2007 and 2009 whose parents had made the decisions to abandon treatment. During 2011-2012, 53 families (54%) could be reached, and 46 (87%) of these agreed to be interviewed. Parents reported the attitudes of community members (grandparents, relatives, friends, villagers, and church members); 61% believed that the child had been bewitched by some individual, and 74% advised parents to seek alternative treatment or advised them to stop medical treatment (54%). Parents also reported that they were influenced by discussions with other parents who had a child being treated, including that their child's life was in God's hands (87%), the trauma to the child and family of forced hospital stays (84%), the importance of completing treatment (81%), the financial burden of treatment (77%), and the incurability of cancer (74%). These discussions influenced their perceptions of cancer treatment and its usefulness (65%). Thirty-six families (78%) had no health insurance, and

  1. Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial.

    Science.gov (United States)

    McCarthy, Elizabeth A; Subramaniam, Hamsa L; Prust, Margaret L; Prescott, Marta R; Mpasela, Felton; Mwango, Albert; Namonje, Leah; Moyo, Crispin; Chibuye, Benjamin; van den Broek, Jan Willem; Hehman, Lindsey; Moberley, Sarah

    2017-01-01

    In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence. Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients. We designed a quality improvement intervention to improve the operationalization of this policy. We conducted a cluster-randomized controlled trial in sixteen facilities in Lusaka with the primary objective of examining the intervention's impact on the proportion of stable patients receiving three-month refills. The secondary objective was examining whether the quality improvement intervention reduced facility congestion measured through two proxy indicators: daily volume of clinic visits and average clinic wait times for services. The mean change in the proportion of three-month refills among control facilities from baseline to endline was 10% (from 38% to 48%), compared to a 25% mean change (an increase from 44% to 69%) among intervention facilities. This represents a significant 15% mean difference (95% CI: 2%-29%; P = 0.03) in the change in proportion of patients receiving three-month refills. On average, control facilities had 15 more visits per day in the endline than in the baseline, while intervention facilities had 20 fewer visits per day in endline than in baseline, a mean difference of 35 fewer visits per day (P = 0.1). The change in the mean facility total wait time for intervention facilities dropped 19 minutes between baseline and endline when compared to control facilities (95% CI: -10.2-48.5; P = 0.2). A more patient-centred service delivery schedule of three-month prescription refills for stable patients is viable. We encourage the expansion of this sustainable

  2. Reversal by desferrioxamine of tau protein aggregates following two days of treatment in aluminum-induced neurofibrillary degeneration in rabbit: implications for clinical trials in Alzheimer's disease.

    Science.gov (United States)

    Savory, J; Huang, Y; Wills, M R; Herman, M M

    1998-04-01

    A clinical trial in patients with Alzheimer's disease has indicated that frequent intramuscular (i.m.) treatment with desferrioxamine (DFO) slows progression of the disease. Confirmatory trials have not been carried out, partly because of the rigors of twice daily intramuscular injections over a period of 2 years, even though the initial report gave promising results. The aim of the present study was to determine an optimal DFO treatment protocol in an animal model exhibiting Alzheimer's-like intraneuronal protein aggregates, previously shown to be partially reversed by such treatment. New Zealand white rabbits were injected intracisternally with either aluminum (Al) maltolate or with saline on day 0. Intramuscular injections of DFO were given to selected rabbits for 2 days prior to sacrifice on days 4, 6 or 8. Bielschowsky's silver impregnation demonstrated widespread neurofibrillary degeneration (NFD) in neuronal cell bodies and neurites of brain and spinal cord from Al-treated rabbits. Monoclonal antibodies Tau-2, AT8, PHF-1 and Alz-50, all of which characteristically stain neurofibrillary tangles associated with Alzheimer's disease, strongly labeled the Al-induced NFD. The number of positive neurons and staining intensities were much less in rabbits treated with Al and subsequently with DFO, than in animals only given Al. Control rabbit receiving intracisternal saline were negative for NFD. The results of quantitative immunohistochemistry using image analysis confirmed that immunostaining densities with all tau mAbs were higher in Al-treated than in Al-DFO-treated or in saline-treated controls. Furthermore, it appears that hyperphosphorylation of tau does not make this protein resistant to degradation once Al has been removed by DFO treatment. The effectiveness of only two days of DFO treatment in reversing Al-induced neurofibrillary degeneration suggests that further clinical trials of DFO for treatment of Alzheimer's disease should be attempted using much

  3. New Metrics for Economic Evaluation in the Presence of Heterogeneity: Focusing on Evaluating Policy Alternatives Rather than Treatment Alternatives.

    Science.gov (United States)

    Kim, David D; Basu, Anirban

    2017-11-01

    Cost-effectiveness analysis (CEA) methods fail to acknowledge that where cost-effectiveness differs across subgroups, there may be differential adoption of technology. Also, current CEA methods are not amenable to incorporating the impact of policy alternatives that potentially influence the adoption behavior. Unless CEA methods are extended to allow for a comparison of policies rather than simply treatments, their usefulness to decision makers may be limited. We conceptualize new metrics, which estimate the realized value of technology from policy alternatives, through introducing subgroup-specific adoption parameters into existing metrics, incremental cost-effectiveness ratios (ICERs) and Incremental Net Monetary Benefits (NMBs). We also provide the Loss with respect to Efficient Diffusion (LED) metrics, which link with existing value of information metrics but take a policy evaluation perspective. We illustrate these metrics using policies on treatment with combination therapy with a statin plus a fibrate v. statin monotherapy for patients with diabetes and mixed dyslipidemia. Under the traditional approach, the population-level ICER of combination v. monotherapy was $46,000/QALY. However, after accounting for differential rates of adoption of the combination therapy (7.2% among males and 4.3% among females), the modified ICER was $41,733/QALY, due to the higher rate of adoption in the more cost-effective subgroup (male). The LED metrics showed that an education program to increase the uptake of combination therapy among males would provide the largest economic returns due to the significant underutilization of the combination therapy among males under the current policy. This framework may have the potential to improve the decision-making process by producing metrics that are better aligned with the specific policy decisions under consideration for a specific technology.

  4. Family Life and the Impact of Previous and Present Residential and Day Care Support for Children with Major Cognitive and Behavioural Challenges: A Dilemma for Services and Policy

    Science.gov (United States)

    Brown, R. I.; Geider, S.; Primrose, A.; Jokinen, N. S.

    2011-01-01

    Introduction: Since the development of inclusion and integration, parents have increasingly become the major, and sometimes the only, carers of their children with disabilities. Many families speak of stress and frustration with service and community support, and some have turned to residential and specialised day care services to overcome…

  5. Treatment of simple snoring using radio waves for ablation of uvula and soft palate : A day-case surgery procedure

    NARCIS (Netherlands)

    Wedman, Jan; Miljeteig, H

    Objective. Uvulopalatoplasty, performed with high-frequency radio waves, was evaluated as a treatment for social snoring. Methods: Forty male social snorers were included in this prospective, nonrandomized study. Patients' subjective complaints before, during, and 3 months after radio-assisted

  6. Growing degree day calculator

    Science.gov (United States)

    Degree-day benchmarks indicate discrete biological events in the development of insect pests. For the Sparganothis fruitworm, we have isolated all key development events and linked them to degree-day accumulations. These degree-day accumulations can greatly improve treatment timings for cranberry IP...

  7. Distress Tolerance Among Students Referred for Treatment Following Violation of Campus Cannabis Use Policy: Relations to Use, Problems, and Motivation.

    Science.gov (United States)

    Buckner, Julia D; Jeffries, Emily R; Terlecki, Meredith A; Ecker, Anthony H

    2016-09-01

    Students referred to treatment after violating campus drug policies represent a high-risk group. Identification of factors related to these students' cannabis use could inform prevention and treatment efforts. Distress tolerance (DT) is negatively related to substance-related behaviors and may be related to high-risk cannabis use vulnerability factors that can impact treatment outcome. Thus, the current study tested whether DT was related to cannabis use frequency, cannabis-related problems, and motivation to change cannabis use among 88 students referred for treatment after violating campus cannabis policies. DT was robustly, negatively related to cannabis use and related problems. DT was also significantly, negatively correlated with coping, conformity, and expansion motives. DT was directly and indirectly related to cannabis problems via coping (not conformity or expansion) motives. Motives did not mediate the relation of DT to cannabis use frequency. DT may be an important target in treatment with students who violate campus cannabis policies. © The Author(s) 2015.

  8. [Current status of day care units where rheumatology treatments are administered in the autonomous community of Valencia].

    Science.gov (United States)

    Román Ivorra, José A; Gómez-Salazar, José Rosas; Calvo Catalá, Javier

    2010-01-01

    To evaluate and characterize the current status of the Rheumatology Day Hospital Care units in the Autonomous Community of Valencia. A structured brainstorming meeting was organized with 12 rheumatologists and a nurse and, after that, a questionnaire was sent to 20 rheumatologists to know more about the centers. Variability was found in the services that the day care units have for their own operation and for patient care. Rheumatologists place more importance on having some services that are not present in all centers at the moment: specialized nursing, quick drug delivery from the pharmacy and administration supervision by a rheumatologist. The following deficiencies were identified: sharing the workspaces with other specialties, drug delivery delays from the pharmacy, few resources (few spaces, few locations and little time for drug administration), lack of specialized nursing, lack of some services for patients (i.e. hot-line telephone service or patient education), few clinical sessions and lack of some procedures. It is necessary to establish measures that lead to the resolution of deficiencies and improve the services offered to patients. Copyright © 2009 Elsevier España, S.L. All rights reserved.

  9. Impact of anti-tumour necrosis factor alpha treatment on admissions to hospital and days of sick leave in patients with ankylosing spondylitis.

    Science.gov (United States)

    Listing, J; Brandt, J; Rudwaleit, M; Zink, A; Sieper, J; Braun, J

    2004-12-01

    To analyse the impact of infliximab treatment on the number of hospital inpatient days and days of sick leave in patients with active ankylosing spondylitis (AS). The data of a 2 year open extension study of a 12 week, double blind, randomised, placebo controlled trial, in which all patients with AS were treated with 5 mg/kg infliximab, were used to investigate the effect of anti-TNF treatment on admissions to hospital and days of sick leave. All patients were interviewed at baseline and at regular intervals during the study to collect this information by questionnaires. Patients who completed 2 years of treatment (n = 49) and those who did not (n = 20) were analysed separately. Sick leave analysis was restricted to currently employed patients (n = 38). During the 12 months before the screening visit, 20/49 (41%) completers had been admitted to hospital. After 1 and 2 years of treatment this percentage was reduced to 5/49 (10%; ppatients with active AS reduces some important costs of AS, but additional studies with detailed cost calculations are needed.

  10. Hansen's disease in the state of Amazonas: policy and institutional treatment of a disease.

    Science.gov (United States)

    Schweickardt, Julio Cesar; Xerez, Luena Matheus de

    2015-12-01

    This article discusses the historical aspects of the policies for controlling Hansen's disease in the state of Amazonas from the second half of the nineteenth century until the dismantling of this model in 1978. We present the historical changes in the local institutions and policies, and their relationship with national policies. The history and policies related to Hansen's disease in the state of Amazonas are analyzed through the following institutions: Umirisal, the Oswaldo Cruz Dispensary, the Paricatuba Leprosarium, the Antônio Aleixo Colony, and the Gustavo Capanema Preventorium. We seek to show that these institutions cared for the people who suffered from Hansen's disease and those related to them, and were also responsible for carrying out the policies for fighting and controlling the disease.

  11. Current-day precision oncology: from cancer prevention, screening, drug development, and treatment - have we fallen short of the promise?

    Science.gov (United States)

    Morgan, Gilberto; Aftimos, Philippe; Awada, Ahmad

    2016-09-01

    Precision oncology has been a strategy of prevention, screening, and treatment. Although much has been invested, have the results fallen so far short of the promise? The advancement of technology and research has opened new doors, yet a variety of pitfalls are present. This review presents the successes, failures, and opportunities of precision oncology in the current landscape. The use of targeted gene sequencing and the overwhelming results of superresponders have generated much excitement and support for precision oncology from the medical community. Despite notable successes, many challenges still pave the way of precision oncology: intratumoral heterogeneity, the need for serial biopsies, availability of treatments, target prioritization, ethical issues with germline incidental findings, medical education, clinical trial design, and costs. Precision oncology shows much potential through the use of next-generation sequencing and molecular advances, but does this potential warrant the investment? There are many obstacles on the way of this technology that should make us question if the investment (both monetary and man-hours) will live up to the promise. The review aims to not criticize this technology, but to give a realistic view of where we are, especially regarding cancer treatment and prevention.

  12. Randomized trial on 14 versus 7 days of esomeprazole, moxifloxacin, and amoxicillin for second-line or rescue treatment of Helicobacter pylori infection.

    Science.gov (United States)

    Miehlke, Stephan; Krasz, Susanne; Schneider-Brachert, Wulf; Kuhlisch, Eberhard; Berning, Marco; Madisch, Ahmed; Laass, Martin W; Neumeyer, Michael; Jebens, Claus; Zekorn, Christian; Knoth, Holger; Vieth, Michael; Stolte, Manfred; Lehn, Norbert; Morgner, Andrea

    2011-12-01

    Triple therapy with a proton pump inhibitor, moxifloxacin, and amoxicillin has been proven effective in first-line treatment of Helicobacter pylori infection. To explore 1, the value of triple therapy with esomeprazole, moxifloxacin, and amoxicillin in second-line or rescue treatment of Caucasian patients and 2, the impact of treatment duration on eradication success. H. pylori-infected patients with at least one previous treatment failure were randomized to oral esomeprazole 20 mg b.i.d., moxifloxacin 400 mg o.d., and amoxicillin 1000 mg b.i.d. for either 7 (EMA-7) or 14 days (EMA-14). Eradication was confirmed by 13C urea breath test. Antimicrobial susceptibility testing was performed in all patients at baseline and in patients who failed treatment. Eighty patients were randomized, and 60% had ≥ 2 previous treatment failures. Pretreatment resistance against clarithromycin and metronidazole was found in 70.5 and 61.5% of cases, respectively. The intention-to-treat eradication rate was significantly higher after EMA-14 compared with EMA-7 (95.0 vs 78.9%, p = .036). No independent risk factor for treatment failure could be identified. There were no serious adverse events. Five of the EMA-14 patients (12.5%) compared with none of the EMA-7 patients discontinued prematurely because of adverse events (p = .031). Post-treatment resistance against moxifloxacin was found in one of seven patients with isolated organisms (14.3%). Second-line/rescue H. pylori eradication therapy with esomeprazole, moxifloxacin, and amoxicillin is very effective and well tolerated. Fourteen days of treatment significantly increase the eradication rate but also the rate of adverse events. © 2011 Blackwell Publishing Ltd.

  13. Dinosaur Day!

    Science.gov (United States)

    Nakamura, Sandra; Baptiste, H. Prentice

    2006-01-01

    In this article, the authors describe how they capitalized on their first-grade students' love of dinosaurs by hosting a fun-filled Dinosaur Day in their classroom. On Dinosaur Day, students rotated through four dinosaur-related learning stations that integrated science content with art, language arts, math, and history in a fun and time-efficient…

  14. Organizational change in a perinatal treatment setting: integration of clinical practice and policies on tobacco and smoking cessation.

    Science.gov (United States)

    Jessup, Martha A

    2007-12-01

    Perinatal smoking presents serious health risks to the fetus, mother, and child. Despite extensive evidence of risk and high rates of smoking among in-treatment perinatal women substance abusers, tobacco-related practice and policy change has not been widely transferred for application in drug abuse treatment programs for pregnant and parenting women. This qualitative study investigated the process of change and the resultant adoption of clinical policy and treatment innovation in a residential drug abuse treatment program that converted from tobacco-tolerant to tobacco-free with provision of smoking cessation services. Informed by the Organizational Readiness for Change Model, staff interviews and data analysis were conducted to examine program characteristics affecting adoption. An organizational climate of openness to change and the program's clarity of mission, expressed in perinatal-specific motivators for change, influenced the adoption of tobacco-related clinical practice and policy. Re-allocation of time, previously occupied by smoking behaviors, allowed for added promotion of maternal-child interaction and positive role-modelpan>ing for children.

  15. Treatment policy change to dihydroartemisinin-piperaquine contributes to the reduction of adverse maternal and pregnancy outcomes.

    Science.gov (United States)

    Poespoprodjo, Jeanne Rini; Fobia, Wendelina; Kenangalem, Enny; Lampah, Daniel A; Sugiarto, Paulus; Tjitra, Emiliana; Anstey, Nicholas M; Price, Richard N

    2015-07-15

    In Papua, Indonesia, maternal malaria is prevalent, multidrug resistant and associated with adverse outcomes for mother and baby. In March 2006, anti-malarial policy was revised for the second and third trimester of pregnancy to dihydroartemisinin-piperaquine (DHP) for all species of malaria. This study presents the temporal analysis of adverse outcomes in pregnancy and early life following this policy change. From April 2004 to May 2010, a standardized questionnaire was used to collect information from all pregnant women admitted to the maternity ward. A physical examination was performed on all live birth newborns. The relative risks (RR) and the associated population attributable risks (PAR) of adverse outcomes in women with a history of malaria treatment to the risk in those without a history of malaria during the current pregnancy were examined to evaluate the temporal trends before and after DHP deployment. Of 6,556 women enrolled with known pregnancy outcome, 1,018 (16%) reported prior anti-malarial treatment during their pregnancy. The proportion of women with malaria reporting treatment with DHP rose from 0% in 2004 to 64% (121/189) in 2010. In those with history of malaria during pregnancy, the increasing use of DHP was associated with a 54% fall in the proportion of maternal malaria at delivery and a 98% decrease in congenital malaria (from 7.1% prior to 0.1% after policy change). Overall policy change to more effective treatment was associated with an absolute 2% reduction of maternal severe anaemia and absolute 4.5% decrease in low birth weight babies. Introduction of highly effective treatment in pregnancy was associated with a reduction of maternal malaria at delivery and improved neonatal outcomes. Ensuring universal access to arteminisin combination therapy (ACT) in pregnancy in an area of multidrug resistance has potential to impact significantly on maternal and infant health.

  16. The efficacy of second-line anti-Helicobacter pylori therapy using an extended 14-day levofloxacin/amoxicillin/proton-pump inhibitor treatment--a pilot study.

    Science.gov (United States)

    Chuah, Seng-Kee; Tai, Wei-Chen; Hsu, Pin-I; Wu, Deng-Chyang; Wu, Keng-Liang; Kuo, Chung-Mou; Chiu, Yi-Chun; Hu, Ming-Luen; Chou, Yeh-Pin; Kuo, Yuan-Hung; Liang, Chih-Ming; Chiu, King-Wah; Hu, Tsung-Hui

    2012-10-01

    Large meta-analyses of second-line Helicobacter pylori eradication with fluoroquinolone triple therapy have shown that neither 7-day nor 10-day therapy provides 90% or better treatment success. Reports describing second-line H. pylori eradication using 14-day fluoroquinolone-containing triple therapy are few. Current study aimed to determine the efficacy of a 14-day levofloxacin/amoxicillin/proton-pump inhibitor regimen as second-line therapy and the clinical factors influencing the outcome. One-hundred and one patients who failed H. pylori eradication using the standard triple therapy for 7 days were randomly assigned to either a levofloxacin/amoxicillin/esomeprazole group (levofloxacin 500 mg once daily, amoxicillin 1 g twice daily, and esomeprazole 40 mg twice daily for 14 days) or a esomeprazole/metronidazole/bismuth salt/tetracycline group (esomeprazole 40 mg twice daily, metronidazole 250 mg four times daily, tripotassium dicitrate bismuthate 300 mg four times daily, and tetracycline 500 mg four times daily for 14 days). Follow-up to assess treatment response consisted of either endoscopy or a urea breath test, which were carried out 8 weeks later. Eradication rates attained by levofloxacin/amoxicillin/esomeprazole and esomeprazole/metronidazole/bismuth salt/tetracycline treatments in the per-protocol analysis were 44/47 (93.6%; 95% CI = 86-99.8) and 43/47 (91.8%; 95% CI = 83.2-98.5). In the intention-to-treat analysis, these were 43/47 (86.3%; 95% CI = 76.5-96.1) in the LAE group (four lost to follow-up) and 43/50 (86%; 95% CI = 76-96) in the EMBT groups. The observed adverse events were 25.5% and 38.5% among the two groups. There was 100% drug compliance among the levofloxacin/amoxicillin/esomeprazole group. Levofloxacin-resistant strains occurred at a frequency of 32.3%. H. pylori eradication rates for the levofloxacin-susceptible strains and levofloxacin-resistant strains were 92% (11/12) and 33% (1/3) in the per-protocol analysis. A

  17. Impact of anti-tumour necrosis factor α treatment on admissions to hospital and days of sick leave in patients with ankylosing spondylitis

    OpenAIRE

    Listing, J; Brandt, J; Rudwaleit, M; Zink, A; Sieper, J; Braun, J

    2004-01-01

    Methods: The data of a 2 year open extension study of a 12 week, double blind, randomised, placebo controlled trial, in which all patients with AS were treated with 5 mg/kg infliximab, were used to investigate the effect of anti-TNF treatment on admissions to hospital and days of sick leave. All patients were interviewed at baseline and at regular intervals during the study to collect this information by questionnaires. Patients who completed 2 years of treatment (n = 49) and those who did no...

  18. Identifying Barriers to Appropriate Use of Metabolic/Bariatric Surgery for Type 2 Diabetes Treatment: Policy Lab Results

    Science.gov (United States)

    Rubin, Jennifer K.; Hesketh, Rachel; Martin, Adam; Herman, William H.; Rubino, Francesco

    2016-01-01

    Despite increasing recognition of the efficacy, safety, and cost-effectiveness of bariatric/metabolic surgery in the treatment of type 2 diabetes, few patients who may be appropriate candidates and may benefit from this type of surgery avail themselves of this treatment option. To identify conceptual and practical barriers to appropriate use of surgical procedures, a Policy Lab was hosted at the 3rd World Congress on Interventional Therapies for Type 2 Diabetes on 29 September 2015. Twenty-six stakeholders participated in the Policy Lab, including academics, clinicians, policy-makers, industry leaders, and patient representatives. Participants were provided with a summary of available evidence about the cost-effectiveness of bariatric/metabolic surgery and the costs of increasing the use of bariatric/metabolic surgery, using U.K. and U.S. scenarios as examples of distinct health care systems. There was widespread agreement among this group of stakeholders that bariatric/metabolic surgery is a legitimate and cost-effective approach to the treatment of type 2 diabetes in obese patients. The following four building blocks were identified to facilitate policy changes: 1) communicating the scale of the costs and harms associated with rising prevalence of type 2 diabetes; 2) properly articulating the role of bariatric/metabolic surgery for certain population groups; 3) identifying new funding sources for bariatric/metabolic surgery; and 4) incorporating bariatric/metabolic surgery into the appropriate clinical pathways. Although more research is needed to identify specific clinical scenarios for the prioritization of bariatric/metabolic surgery, the case appears to be strong enough to engage relevant policy-makers and practitioners in a concerted discussion of how to better use metabolic surgical resources in conjunction with other interventions in good diabetes practice. PMID:27222554

  19. Older adult falls prevention behaviors 60 days post-discharge from an urban emergency department after treatment for a fall.

    Science.gov (United States)

    Shankar, Kalpana Narayan; Treadway, Nicole J; Taylor, Alyssa A; Breaud, Alan H; Peterson, Elizabeth W; Howland, Jonathan

    2017-12-01

    Falls are a common and debilitating health problem for older adults. Older adults are often treated and discharged home by emergency department (ED)-based providers with the hope they will receive falls prevention resources and referrals from their primary care provider. This descriptive study investigated falls prevention activities, including interactions with primary care providers, among community-dwelling older adults who were discharged home after presenting to an ED with a fall-related injury. We enrolled English speaking patients, aged ≥ 65 years, who presented to the ED of an urban level one trauma center with a fall or fall related injury and discharged home. During subjects' initial visits to the ED, we screened and enrolled patients, gathered patient demographics and provided them with a flyer for a Matter of Balance course. Sixty-days post enrollment, we conducted a phone follow-up interview to collect information on post-fall behaviors including information regarding the efforts to engage family and the primary care provider, enroll in a falls prevention program, assess patients' attitudes towards falling and experiences with any subsequent falls. Eighty-seven community-dwelling people between the ages of 65 and 90 were recruited, the majority (76%) being women. Seventy-one percent of subjects reported talking to their provider regarding the fall; 37% reported engaging in falls prevention activities. No subjects reported enrolling in a fall prevention program although two reported contacting falls program staff. Fourteen percent of subjects (n=12) reported a recurrent fall and 8% (7) reported returning to the ED after a recurrent fall. Findings indicate a low rate of initiating fall prevention behaviors following an ED visit for a fall-related injury among community-dwelling older adults, and highlight the ED visit as an important, but underutilized, opportunity to mobilize health care resources for people at high risk for subsequent falls.

  20. Safety of lornoxicam in the treatment of postoperative pain: a post-marketing study of analgesic regimens containing lornoxicam compared with standard analgesic treatment in 3752 day-case surgery patients.

    Science.gov (United States)

    Rawal, Narinder; Krøner, Karsten; Simin-Geertsen, Marija; Hejl, Charlotte; Likar, Rudolf

    2010-01-01

    Post-marketing surveillance studies can provide supplemental data on the safety of medications in the general population. This study aimed to evaluate the safety of analgesic regimens including the NSAID lornoxicam in the short-term treatment of postoperative pain in a clinically relevant population. Randomized, open-label, multicentre, multinational, observational cohort study of 4 days' duration. In-hospital postoperative setting, with discharge to home treatment within 24 hours of surgery. Adults aged > or =18 years expected to be in need of analgesic treatment after day-case surgery. Analgesic regimens containing lornoxicam were compared with a standard analgesic treatment, which was defined as the treatment that the patient would normally receive at the centre. Following day-case surgery, patients were provided with appropriate analgesic medication, and adverse events (AEs; defined as all recorded events with symptoms) were recorded by the investigator during the in-hospital stay and by the patient for the next 3 days using entries recorded morning and evening in a patient diary. Statistical analyses tested for between-treatment differences in AEs, adverse drug reactions (ADRs; defined as events probably, possibly or unlikely to be related to treatment) and gastrointestinal AEs (GI-AEs). A total of 4152 patients were randomized to treatment. Since 400 patients did not take any analgesic, the safety population consisted of 1838 patients for lornoxicam and 1914 patients for standard analgesic treatment. Demographic and disease characteristics were similar between the two treatment groups, as were the type of surgery and the anaesthesia used in surgery. In the safety population, 16.9% of patients received no analgesic in hospital, and when analgesics were provided they were often administered in combination. Similarly, approximately 17% of patients did not take any analgesics at home. AEs were reported in 27.1% and 29.4% of patients in the lornoxicam and standard

  1. Translating research into policy: lessons learned from eclampsia treatment and malaria control in three southern African countries

    Directory of Open Access Journals (Sweden)

    Matinhure Sheillah

    2009-12-01

    Full Text Available Abstract Background Little is known about the process of knowledge translation in low- and middle-income countries. We studied policymaking processes in Mozambique, South Africa and Zimbabwe to understand the factors affecting the use of research evidence in national policy development, with a particular focus on the findings from randomized control trials (RCTs. We examined two cases: the use of magnesium sulphate (MgSO4 in the treatment of eclampsia in pregnancy (a clinical case; and the use of insecticide treated bed nets and indoor residual household spraying for malaria vector control (a public health case. Methods We used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data. Findings Prior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO4 and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO4 than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO4, and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three

  2. Pharmacodynamic analysis and clinical trial of amoxicillin sprinkle administered once daily for 7 days compared to penicillin V potassium administered four times daily for 10 days in the treatment of tonsillopharyngitis due to Streptococcus pyogenes in children.

    Science.gov (United States)

    Pichichero, M E; Casey, J R; Block, S L; Guttendorf, R; Flanner, H; Markowitz, D; Clausen, S

    2008-07-01

    An a priori pharmacokinetic/pharmacodynamic (PK/PD) target of 40% daily time above the MIC (T >MIC; based on the MIC(90) of 0.06 microg/ml for Streptococcus pyogenes reported in the literature) was shown to be achievable in a phase 1 study of 23 children with a once-daily (QD) modified-release, multiparticulate formulation of amoxicillin (amoxicillin sprinkle). The daily T >MIC achieved with the QD amoxicillin sprinkle formulation was comparable to that achieved with a four-times-daily (QID) penicillin VK suspension. An investigator-blinded, randomized, parallel-group, multicenter study involving 579 children 6 months to 12 years old with acute streptococcal tonsillopharyngitis was then undertaken. Children were randomly assigned 1:1 to receive either the amoxicillin sprinkle (475 mg for ages 6 months to 4 years, 775 mg for ages 5 to 12 years) QD for 7 days or 10 mg/kg of body weight of penicillin VK QID for 10 days (up to the maximum dose of 250 mg QID). Unexpectedly, the rates of bacteriological eradication at the test of cure were 65.3% (132/202) for the amoxicillin sprinkle and 68.0% (132/194) for penicillin VK (95% confidence interval, -12.0% to 6.6%). Thus, neither antibiotic regimen met the minimum criterion of > or =85% eradication ordinarily required by the U.S. FDA for first-line treatment of tonsillopharyngitis due to S. pyogenes. The results of subgroup analyses across demographic characteristics and current infection characteristics and by age/weight categories were consistent with the primary-efficacy result. The clinical cure rates for amoxicillin sprinkle and penicillin VK were 86.1% (216/251) and 91.9% (204/222), respectively (95% confidence interval, -11.6% to -0.4%). The results of a post hoc PD analysis suggested that a requirement for 60% daily T >MIC(90) more accurately predicted the observed high failure rates for bacteriologic eradication with the amoxicillin sprinkle and penicillin VK suspension studied. Based on the association between

  3. Pharmacodynamic Analysis and Clinical Trial of Amoxicillin Sprinkle Administered Once Daily for 7 Days Compared to Penicillin V Potassium Administered Four Times Daily for 10 Days in the Treatment of Tonsillopharyngitis Due to Streptococcus pyogenes in Children▿

    Science.gov (United States)

    Pichichero, M. E.; Casey, J. R.; Block, S. L.; Guttendorf, R.; Flanner, H.; Markowitz, D.; Clausen, S.

    2008-01-01

    An a priori pharmacokinetic/pharmacodynamic (PK/PD) target of 40% daily time above the MIC (T >MIC; based on the MIC90 of 0.06 μg/ml for Streptococcus pyogenes reported in the literature) was shown to be achievable in a phase 1 study of 23 children with a once-daily (QD) modified-release, multiparticulate formulation of amoxicillin (amoxicillin sprinkle). The daily T >MIC achieved with the QD amoxicillin sprinkle formulation was comparable to that achieved with a four-times-daily (QID) penicillin VK suspension. An investigator-blinded, randomized, parallel-group, multicenter study involving 579 children 6 months to 12 years old with acute streptococcal tonsillopharyngitis was then undertaken. Children were randomly assigned 1:1 to receive either the amoxicillin sprinkle (475 mg for ages 6 months to 4 years, 775 mg for ages 5 to 12 years) QD for 7 days or 10 mg/kg of body weight of penicillin VK QID for 10 days (up to the maximum dose of 250 mg QID). Unexpectedly, the rates of bacteriological eradication at the test of cure were 65.3% (132/202) for the amoxicillin sprinkle and 68.0% (132/194) for penicillin VK (95% confidence interval, −12.0% to 6.6%). Thus, neither antibiotic regimen met the minimum criterion of ≥85% eradication ordinarily required by the U.S. FDA for first-line treatment of tonsillopharyngitis due to S. pyogenes. The results of subgroup analyses across demographic characteristics and current infection characteristics and by age/weight categories were consistent with the primary-efficacy result. The clinical cure rates for amoxicillin sprinkle and penicillin VK were 86.1% (216/251) and 91.9% (204/222), respectively (95% confidence interval, −11.6% to −0.4%). The results of a post hoc PD analysis suggested that a requirement for 60% daily T >MIC90 more accurately predicted the observed high failure rates for bacteriologic eradication with the amoxicillin sprinkle and penicillin VK suspension studied. Based on the association between longer

  4. Denial of Treatment to Obese Patients—the Wrong Policy on Personal Responsibility for Health

    Directory of Open Access Journals (Sweden)

    Nir Eyal

    2013-01-01

    Full Text Available In many countries around the world, including Iran, obesity is reaching epidemic proportions. Doctors have recently taken, or expressed support for, an extreme ‘personal responsibility for health’ policy against obesity: refusing services to obese patients. This policy may initially seem to improve patients’ incentives to fight obesity. But turning access to medical services into a benefit dependent on health improvement is a bad policy. It conditions the very aid that patients need in order to become healthier or success in becoming healthier. Whatever else we may think of personal responsibility for health policies, this particular one is absurd. Unfortunately, quite a few personal responsibility for health policies use similar absurd conditioning. They mistakenly use ‘carrots’ or ‘sticks’ for adherence the basic means to the same health outcomes that they seek to promote. This perspective proposes the following rule of thumb: any conditional incentive for healthy choice should be in a currency other than the basic means to that healthy choice.

  5. Effects of 7-day repeated treatment with the 5-HT2A inverse agonist/antagonist pimavanserin on methamphetamine vs. food choice in male rhesus monkeys.

    Science.gov (United States)

    Banks, Matthew L

    2016-08-01

    Preclinical drug vs. food choice is an emerging group of drug self-administration procedures that have shown predictive validity to clinical drug addiction. Emerging data suggest that serotonin (5-HT)2A receptors modulate mesolimbic dopamine function, such that 5-HT2A antagonists blunt the abuse-related neurochemical effects of monoamine transporter substrates, such as amphetamine or methamphetamine. Whether subchronic 5-HT2A antagonist treatment attenuates methamphetamine reinforcement in any preclinical drug self-administration procedure is unknown. The study aim was therefore to determine 7-day treatment effects with the 5-HT2A inverse agonist/antagonist pimavanserin on methamphetamine vs. food choice in monkeys. Behavior was maintained under a concurrent schedule of food delivery (1g pellets, fixed-ratio 100 schedule) and intravenous methamphetamine injections (0-0.32 mg/kg/injection, fixed-ratio 10 schedule) in male rhesus monkeys (n=3). Methamphetamine choice dose-effect functions were determined daily before and during 7-day repeated pimavanserin (1.0-10mg/kg/day, intramuscular) treatment periods. Under control conditions, increasing methamphetamine doses resulted in a corresponding increase in methamphetamine vs. food choice. Repeated pimavanserin administration failed to attenuate methamphetamine choice and produce a reciprocal increase in food choice in any monkey up to doses (3.2-10mg/kg) that suppressed rates of operant responding primarily during components where behavior was maintained by food pellets. Repeated 5-HT2A receptor inverse agonist/antagonist treatment did not attenuate methamphetamine reinforcement under a concurrent schedule of intravenous methamphetamine and food presentation in nonhuman primates. Overall, these results do not support the therapeutic potential of 5-HT2A inverse agonists/antagonists as candidate medications for methamphetamine addiction. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights

  6. Surgeon-performed touch preparation of breast core needle biopsies may provide accurate same-day diagnosis and expedite treatment planning.

    Science.gov (United States)

    Gadgil, Pranjali V; Korourian, Soheila; Malak, Sharp; Ochoa, Daniela; Lipschitz, Riley; Henry-Tillman, Ronda; Suzanne Klimberg, V

    2014-04-01

    We aimed to determine the accuracy of surgeon-performed touch-preparation cytology (TPC) of breast core-needle biopsies (CNB) and the ability to use TPC results to initiate treatment planning at the same patient visit. A single-institution retrospective review of TPC results of ultrasound-guided breast CNB was performed. All TPC slides were prepared by surgeons performing the biopsy and interpreted by the pathologist. TPC results were reported as positive/suspicious, atypical, negative/benign, or deferred; these were compared with final pathology of cores to calculate accuracy. Treatment planning was noted as having taken place if the patient had requisition of advanced imaging, referrals, or surgical planning undertaken during the same visit. Four hundred forty-seven CNB specimens with corresponding TPC were evaluated from 434 patient visits, and 203 samples (45.4 %) were malignant on final pathology. When the deferred, atypical, and benign results were considered negative and positive/suspicious results were considered positive, sensitivity and specificity were 83.7 % (77.9-88.5 %) and 98.4 % (95.9-99.6 %), respectively; positive and negative predictive values were 97.7 % (94.2-99.4 %) and 87.9 % (83.4-91.5 %), respectively. In practice, patients with atypical or deferred results were asked to await final pathology. An accurate same-day diagnosis (TPC positive/suspicious) was hence feasible in 83.7 % (170 of 203) of malignant and 79.5 % (194 of 244) of benign cases (TPC negative). Of patients who had a same-day diagnosis of a new malignancy, 77.3 % had treatment planning initiated at the same visit. Surgeon-performed TPC of breast CNB is an accurate method of same-day diagnosis that allows treatment planning to be initiated at the same visit and may serve to expedite patient care.

  7. Socioeconomic disparities in access to ART treatment and the differential impact of a policy that increased consumer costs.

    Science.gov (United States)

    Chambers, G M; Hoang, V P; Illingworth, P J

    2013-11-01

    What was the impact on access to assisted reproductive technology (ART) treatment by different socioeconomic status (SES) groups after the introduction of a policy that increased patient out-of-pocket costs? After the introduction of a policy that increased out-of-pocket costs in Australia, all SES groups experienced a similar percentage reduction in fresh ART cycles per 1000 women of reproductive age. Higher SES groups experienced a progressively greater reduction in absolute numbers of fresh ART cycles due to existing higher levels of utilization. Australia has supportive public funding arrangements for ARTs. Policies that substantially increase out-of-pocket costs for ART treatment create financial barriers to access and an overall reduction in utilization. Data from the USA suggests that disparities exist in access to ART treatment based on ethnicity, education level and income. Time series analysis of utilization of ART, intrauterine insemination (IUI) and clomiphene citrate by women from varying SES groups before and after the introduction of a change in the level of public funding for ART. Women undertaking fertility treatment in Australia between 2007 and 2010. Women from higher SES quintiles use more ART treatment than those in lower SES quintiles, which likely reflects a greater ability to pay for treatment and a greater need for ART treatment as indicated by the trend to later childbearing. In 2009, 10.13 and 5.17 fresh ART cycles per 1000 women of reproductive age were performed in women in the highest and lowest SES quintiles respectively. In the 12 months after the introduction of a policy that increased out-of-pocket costs from ∼$1500 Australian dollars (€1000) to ∼$2500 (€1670) for a fresh IVF cycle, there was a 21-25% reduction in fresh ART cycles across all SES quintiles. The absolute reduction in fresh ART cycles in the highest SES quintile was double that in the lowest SES quintile. In this study, SES was based on the average relative

  8. Substance Use and HIV Among Female Sex Workers and Female Prisoners: Risk Environments and Implications for Prevention, Treatment, and Policies.

    Science.gov (United States)

    Strathdee, Steffanie A; West, Brooke S; Reed, Elizabeth; Moazen, Babak; Moazan, Babak; Azim, Tasnim; Dolan, Kate

    2015-06-01

    Female sex workers (FSWs) and female prisoners experience elevated HIV prevalence relative to the general population because of unprotected sex and unsafe drug use practices, but the antecedents of these behaviors are often structural in nature. We review the literature on HIV risk environments for FSWs and female prisoners, highlighting similarities and differences in the physical, social, economic, and policy/legal environments that need to be understood to optimize HIV prevention, treatment, and policy responses. Sex work venues, mobility, gender norms, stigma, debt, and the laws and policies governing sex work are important influences in the HIV risk environment among FSWs, affecting their exposure to violence and ability to practice safer sex and safer drug use behaviors. Female prisoners are much more likely to have a drug problem than do male prisoners and have higher HIV prevalence, yet are much less likely to have access to HIV prevention and treatment and access to drug treatment in prison. Women who trade sex or are imprisoned and engage in substance use should not be considered in separate silos because sex workers have high rates of incarceration and many female prisoners have a history of sex work. Repeated cycles of arrest, incarceration, and release can be socially and economically destabilizing for women, exacerbating their HIV risk. This dynamic interplay requires a multisectoral approach to HIV prevention and treatment that appreciates and respects that not all women are willing, able, or want to stop sex work or drug use. Women who engage in sex work, use drugs, or are imprisoned come from all communities and deserve sustained access to HIV prevention and treatment for substance use and HIV, helping them and their families to lead healthy and satisfying lives.

  9. Early results of endovascular treatment of patients with bilateral stenoses of the internal carotid arteries using proximal protection systems at 30-day follow-up.

    Science.gov (United States)

    Latacz, Paweł; Simka, Marian; Popiela, Tadeusz; Kazibudzki, Marek; Mrowiecki, Tomasz

    Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, carotid artery stenting (CAS) with use of proximal protection systems (PPS) plays an very important role as alternative treatment modality, especially in patients with critical, symptomatic lesions. This study was single-centre study to evaluate the technical and clinical success of proximal protection devices as the first choice for embolic protection in symptomatic and asymptomatic carotid stenosis in patients with bilateral, advanced lesions of carotid arteries (bilateral stenoses or stenosis and occlusion). This was a post hoc analysis, with 30-day follow up. We analyzed results of treatment of 38 patients who underwent 38 CAS with PPS, 17 such procedures in asymptomatic (group A), and 21 in symptomatic individuals (group B). The GORE ® Flow Reversal System (W.L. Gore, Flagstaff, AZ, USA) was used in 2 patients, and the Mo.Ma Ultra device (Medtronic, Minneapolis, MN, USA) in 36 patients. Mean age was 68±7 years, 65% percent of patient were male. There were no procedural and during 30-day follow-up neurologic events. Intolerance of occlusion system occurred in 4 patients (11%) in both groups with any later symptoms. Risk factors of this adverse event comprised: lesions of the left internal carotid lesion and coexisiting diabetes mellitus. CAS in high risk patients with bilateral lesions of carotid arteries with the use of PPS seems to be a relatively very safe procedure. Copyright © 2017. Published by Elsevier Urban & Partner Sp. z o.o.

  10. Pamphlet day

    OpenAIRE

    Eastwood, Phil; Dunne, Chris; Fowler, Stephen

    2017-01-01

    Pamphlet Day: A Political Protest Pamphlet and Zine Event focused around the occupation of Loughborough Public Library, Granby Street, Loughborough, LE11 3DZ, UK. ABSTRACT “Throughout the 20th Century artists have engaged provocatively with text, images and performance, publishing writings, pamphlets, and manifestos that challenge the status quo.” (1) Loughborough Echo, May 2017 https://www.loughboroughecho.net/whats-on/arts-culture-news/pamphlet-art-feature-events-13038989 A s...

  11. Health service costs and clinical gains of psychotherapy for personality disorders: a randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice

    Science.gov (United States)

    2013-01-01

    Background Day-hospital-based treatment programmes have been recommended for poorly functioning patients with personality disorders (PD). However, more research is needed to confirm the cost-effectiveness of such extensive programmes over other, presumably simpler, treatment formats. Methods This study compared health service costs and psychosocial functioning for PD patients randomly allocated to either a day-hospital-based treatment programme combining individual and group psychotherapy in a step-down format, or outpatient individual psychotherapy at a specialist practice. It included 107 PD patients, 46% of whom had borderline PD, and 40% of whom had avoidant PD. Costs included the two treatment conditions and additional primary and secondary in- and outpatient services. Psychosocial functioning was assessed using measures of global (observer-rated GAF) and occupational (self-report) functioning. Repeated assessments over three years were analysed using mixed models. Results The costs of step-down treatment were higher than those of outpatient treatment, but these high costs were compensated by considerably lower costs of other health services. However, costs and clinical gains depended on the type of PD. For borderline PD patients, cost-effectiveness did not differ by treatment condition. Health service costs declined during the trial, and functioning improved to mild impairment levels (GAF > 60). For avoidant PD patients, considerable adjuvant health services expanded the outpatient format. Clinical improvements were nevertheless superior to the step-down condition. Conclusion Our results indicate that decisions on treatment format should differentiate between PD types. For borderline PD patients, the costs and gains of step-down and outpatient treatment conditions did not differ. For avoidant PD patients, the outpatient format was a better alternative, leaning, however, on costly additional health services in the early phase of treatment. Trial

  12. Theme day: corrosion and surface treatments in nuclear facilities. Proceedings; Journee Thematique: Corrosion et Traitements de surface dans les Installations Nucleaires. Recueil des presentations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-02-15

    This document brings together the available presentations given at the theme day organized by the Bourgogne Nuclear Pole on the topic of corrosion and surface treatments in nuclear facilities. Eleven presentations (slides) are compiled in this document: 1 - Introduction - PNB centre of competitiveness and R and D activities (A. Mantovan, PNB); 2 - Corrosion damage (M. Foucault, Areva NP - Centre Technique Le Creusot); 3 - Corrosion mechanisms (R. Oltra, UB-ICB); 4 - Examples of expertise management (C. Duret-Thual, Institut de la corrosion/Corrosion Institute); 5 - General framework of surface treatments (C. Nouveau, ENSAM Cluny Paris Tech); 6 - Surfaces et interfaces characterisation - Part A (C. Langlade, Y. Gachon, UTBM and HEF); 7 - Surfaces et interfaces characterisation - Part B (C. Langlade, Y. Gachon, UTBM and HEF); 8 - Ion beam surface treatment (Y. Le Guellec, Quertech Ingenierie); 9 - Impact surface treatment (G. Saout, Sonats); 10 - Metal oxides Characterisation by US laser (R. Oltra, UB-ICB); 11 - Detection and Characterisation of intergranular corrosion (Y. Kernin, Stephane Bourgois, Areva Intercontrole)

  13. [10-day triple therapy with esomeprazole 40 mg/12 h vs. quadruple concomitant non-bismuth therapy as first line treatment for Helicobacter pylori infection].

    Science.gov (United States)

    Campillo, Ana; Amorena, Edurne; Ostiz, Miriam; Kutz, Marcos; LaIglesia, Matilde

    2016-11-01

    Quadruple concomitant non-bismuth therapy has recently become the most widely prescribed first-line treatment for Helicobacter pylori infection in Spain. Whether optimized conventional triple therapy can achieve comparable efficacy rates remains to be seen. Retrospective study comparing the efficacy of triple and quadruple concomitant therapy, and sub-analysis following administration of both for 10 days with esomeprazole 40mg/12h. A first-line therapy was administered to 657 patients from 1st January 2012 to 31st December 2014. Quadruple therapy (n=371) showed higher efficacy than triple therapy (n=248) for both intention-to-treat (85.9% vs. 65.7%; Pesomeprazole 40mg/12h administered for 10 days, quadruple concomitant therapy (n=108) also had higher efficacy than triple therapy (n=76) for intention-to-treat (90.7% vs. 73.6%; P=.003) and per protocol analysis (92.5% vs.74.6%; P=.002). Quadruple concomitant therapy with high dose proton pump inhibitor (PPI) for 10 days achieves a significantly higher eradication outcome than optimized triple therapy, with rates of over 90% when the PPI prescribed is esomeprazole 40mg/12h. Copyright © 2016 Elsevier España, S.L.U. y AEEH y AEG. All rights reserved.

  14. Point Climat no. 20 'CDM Policy Dialogue: a traditional 'treatment' coupled with new 'prescriptions' '

    International Nuclear Information System (INIS)

    Shishlov, Igor; Bellassen, Valentin

    2012-01-01

    Among the publications of CDC Climat Research, 'Climate Briefs' presents, in a few pages, hot topics in climate change policy. This issue addresses the following points: As the Clean Development Mechanism (CDM) reached the milestone billionth CER issued and the secondary CER price tipped below 2 euros, the recommendations of the High Level Panel on the CDM Policy Dialogue published on 11 September 2012 could not be timelier. By focusing on the current supply-demand disequilibrium that threatens the very survival of the CDM, the Panel extended its recommendations beyond the traditional scope of CDM reform. The Panel's ambition to pro-actively engage with other climate initiatives such as the Green Fund and regional markets is also innovative. Indeed, the CDM toolbox enriched by 10-years of experience stands to apply to or be partly recycled through new mechanisms. Along the 51 recommendations from the Policy Dialogue, there are calls for further standardization and streamlining, together with both old and new ideas on governance and contribution of the CDM to sustainable development

  15. Treatment of Petroleum Sludge By Using Solidification/Stabilization (S/S) Method : Effect of Hydration Days to Heavy Metals Leaching and Strength

    Science.gov (United States)

    Murshid, N.; Kamil, N. A. F. M.; Kadir, A. A.

    2018-04-01

    Petroleum sludge is one of the major solid wastes generated in the petroleum industry. Generally, there are numbers of heavy metals in petroleum sludge and one treatment that is gaining prominence to treat a variety of mixed organic and inorganic waste is solidification/stabilization (S/S) method. The treatment protects human health and the environment by immobilizing contaminants within the treated material and prevents migration of the contaminants. In this study, solidification/stabilization (S/S) method has been used to treat the petroleum sludge. The comparison of hydration days, namely, 7th and 28th days in these cement-based waste materials were studied by using Synthetic Precipitate Leaching Procedure (SPLP). The results were compared to the United States Environmental Protection Agency (USEPA) standards. The results for leaching test concluded that less percentage OPC gave maximum concentration of heavy metals leaching due to deficient in Calcium Oxide (CaO), which is can caused weak solidification in the mixture. Physical and mechanical properties conducted such as compressive strength and density test. From the results, it shows addition up to of 30percentage PS give results which comply with minimum landfill dispose limit. The results shows correlation between strength and density are strong regression coefficient of 82.7%. In conclusion, S/S method can be alternative disposal method for PS in the same time complies with standard for minimum landfill disposal limit. The results for leaching test concluded the less OPC percentage gave maximum concentration of heavy metals leaching.

  16. Aggression Regulation in Day Treatment of Eating Disorders: Two-Centre RCT of a Brief Body and Movement-Oriented Intervention.

    Science.gov (United States)

    Boerhout, Cees; Swart, Marte; Voskamp, Marjon; Troquete, Nadine A C; van Busschbach, Jooske T; Hoek, Hans W

    2017-01-01

    The objective is to evaluate a body and movement-oriented intervention on aggression regulation, specifically aimed towards reducing anger internalization in patients with an eating disorder. Patients were randomized to treatment-as-usual (TAU) plus the intervention (n = 38) or to TAU only (n = 32). The intervention was delivered by a psychomotor therapist. TAU consisted of multidisciplinary day treatment (3-5 days per week during 3-9 months). Anger coping (Self-Expression and Control Scale) and eating pathology (Eating Disorder Examination-Self-report Questionnaire) were measured at baseline and follow-up. Differences between pre-intervention and post-intervention scores were tested by using repeated measures ANOVA. The intervention group showed a significantly larger decrease of anger internalization than the control group (η 2  = 0.16, p = 0.001). Both groups showed a significant reduction in eating pathology, but differences between groups were not significant. A body and movement-oriented therapy seems a viable add-on for treating anger internalization in patients with an eating disorder. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

  17. [Cost differences in the treatment of severe sepsis between survivors and non-survivors on the first day of intensive care admission].

    Science.gov (United States)

    Csomós, Akos; Szentkereszty, Zoltán; Fülesdi, Béla

    2007-09-30

    Patients admitted to intensive care unit with severe sepsis have high mortality and use significant resources. Determination of variable cost differences on day 1 between survivors and non-survivors of severe sepsis in Hungary. A sample of 6 intensive care units (ICU) included 70 patients who were admitted with severe sepsis to their ICU. Retrospective data collection of resource consumption for 24 hours following ICU admission using medical and nursing records. 59 different resource uses were collected separately for radiology, biochemistry and disposables. Blood products and drugs/fluids were collected individually. The authors identified the price of each resource for the cost calculation. The ICU mortality of severe sepsis in our sample was found to be 64%, the average length of stay for survivors was 19.9 (SD +/- 11.4) and for non-survivors was 13.0 (SD +/- 8.5). Mean ICU variable cost on day 1 of severe sepsis was HUF 60 957 (247 Euro), more for non-survivors (HUF 70 835 vs. 40 108, p = 0.020). The use of blood products is higher in non-survivors ( p = 0.047) and so is the use of drugs/fluids ( p = 0.003). The use of more colloids ( p = 0.016) and more expensive antibiotics ( p = 0.021) was responsible for the higher drugs/fluids spending in non-survivors. The mortality of severe sepsis is high and the cost of sepsis treatment is low in Hungary compared to international data. Non-survivors cost almost twice as much even on day 1, this warrants the need for early diagnosis and adequate treatment.

  18. Thirty-five Day Fluoxetine Treatment Limits Sensory-Motor Deficit and Biochemical Disorders in a Rat Model of Decompression Sickness

    Directory of Open Access Journals (Sweden)

    Caroline Cosnard

    2017-09-01

    Full Text Available According to the OECD statistical base for 2014, anti-depressants will, on average, be distributed at a rate of 62 daily doses per 1,000 inhabitants for the 25 countries surveyed (Health at a glance: Europe 2014; OECD Health Statistics; World Health Organization and OECD Health Statistics, 2014. Divers must be concerned. On another hand, divers are potentially exposed to decompression sickness including coagulation inflammation and ischemia, which can result in neurological lesions or even death. The purpose of this study is to assess whether chronic treatment with anti-depressants may represent a contraindication to the practice of an at-risk activity, such as, scuba diving, or even presents a benefit by attenuating the severity of the symptoms. We study for the first time the effect of a 35-day fluoxetine treatment (20 mg/kg on the occurrence of decompression sickness in laboratory rats (n = 79. Following exposure to the hazardous protocol, there is a significant correlation between the type of treatment and the clinical status of the rats in favor of a better clinical prognosis for the rats treated with fluoxetine with a significantly higher number of No DCS status and a lower number of Severe DCS status in the Flux, compared to Controls. The treatment modifies the rat performances both significantly and favorably during the physical and behavioral tests, just like their biological and biochemical constants. After decompression, rats under treatment display lower sensory-motor deficit and lowers biochemical disorders. From a biological point of view, we conclude fluoxetine should not be seen as a contraindication for diving on the basis of anticipated increased physiological risk.

  19. Treatment or Involuntary Euthanasia for Severely Handicapped Newborns: Issues of Philosophy and Public Policy.

    Science.gov (United States)

    Powell, T. Hennessy; And Others

    1982-01-01

    Recent reports have indicated that parents and/or physicians occasionally decide not to provide life-sustaining treatment (referred to as involuntary euthanasia), thus ensuring that the severely handicapped newborn will die. The issues involved relative to treatment or involuntary euthanasia are reviewed from two opposing perspectives…

  20. Azithromycin 1.5g Over 5 Days Compared to 1g Single Dose in Urethral Mycoplasma genitalium: Impact on Treatment Outcome and Resistance.

    Science.gov (United States)

    Read, Tim R H; Fairley, Christopher K; Tabrizi, Sepehr N; Bissessor, Melanie; Vodstrcil, Lenka; Chow, Eric P F; Grant, Mieken; Danielewski, Jennifer; Garland, Suzanne M; Hocking, Jane S; Chen, Marcus Y; Bradshaw, Catriona S

    2017-02-01

    We evaluated the impact of extended azithromycin (1.5g over 5 days) on selection of macrolide resistance and microbiological cure in men with Mycoplasma genitalium urethritis during 2013-2015 and compared this to cases treated with azithromycin 1g in 2012-2013. Microbiological cure was determined for men with M. genitalium urethritis treated with azithromycin 1.5g using quantitative polymerase chain reaction specific for M. genitalium DNA on samples 14-100 days post-treatment. Pre- and post-treatment macrolide resistance mutations were detected by sequencing the 23 S gene. There was no difference in proportions with microbiological cure between azithromycin 1.5g and 1g: 62/106 (58%; 95% confidence interval [CI], 49%, 68%) and 56/107 (52%; 95%CI 42-62%), P = .34, respectively. Also, there was no difference in the proportion of wild-type 23 S rRNA (presumed macrolide sensitive) infections cured after 1.5g and azithromycin 1g: 28/34 (82%; 95%CI 65-92%) and 49/60 (82%; 95%CI 70-90%), P=1.0, respectively. There was no difference between 1.5g and 1g in the proportions of wild-type infections with post-treatment resistance mutations: 4/34 (12%; 95%CI 3-27%) and 11/60 (18%; 95%CI 10-30%), respectively, P = .40. Pre-treatment resistance was present in 51/98 (52%; 95%CI 42-62%) cases in 2013-2015 compared to 47/107 (44%; 95%CI 34-54%) in 2012-2013, P = .25. Extended azithromycin 1.5g was no more effective than a single 1g dose at achieving cure of M. genitalium urethritis and importantly did not reduce the selection of macrolide resistance. Nonmacrolide and new approaches for the treatment of M. genitalium urethritis are required. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  1. A prospective, multi centre, randomized clinical study to compare the efficacy and safety of Ertapenem 3 days versus Ampicillin - Sulbactam 3 days in the treatment of localized community acquired intra-abdominal infection. (T.E.A. Study: Three days Ertapenem vs three days Ampicillin-sulbactam

    Directory of Open Access Journals (Sweden)

    Gazzotti Filippo

    2011-04-01

    Full Text Available Abstract Background The recommendations outlined in the latest guidelines published by the Surgical Infection Society (SIS and the Infectious Disease Society of America (IDSA regarding the proper duration of antibiotic therapy in patients with intra-abdominal infections are limited and non-specific. This ambiguity is due mainly to the lack of clinical trials on the topic of optimal duration of therapy. It is well known that the overuse of antibiotics has several important consequences such as increased treatment costs, reduced clinical efficacy, and above all, the increased emergence of antibiotic-resistant pathogens. Ampicillin-Sulbactam is a commonly used "first line" antibiotic for intra-abdominal infections. Ertapenem and Ampicillin-sulbactam are recommended as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. Methods/Design This study is a prospective multi-center randomized investigation. The study will be performed in the Departments of General, Emergency, and Transplant Surgery of Sant'Orsola-Malpighi University Hospital in Bologna, Italy, in the General Surgery Department of the Ospedali Riuniti of Bergamo, Italy, and in the Trauma and Emergency Surgery Department of Maggiore Hospital in Bologna, Italy, and will be conducted by all surgeons willing to participate in the study. The inclusion period of the study will take approximately two years before the planned number of 142 enrolled patients is reached. Discussion Ertapenem and Ampicillin-sulbactam are recommended both as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. As one of the discussed topic is the optimal duration of the antibiotic therapy and this ambiguity is due mainly to the lack of clinical trials on the topic, the present study aims for obtain precise data. Trial Registration ClinicalTrials.gov: NCT00630513

  2. Differential Effect of Glycosylated Hemoglobin Value and Antidiabetic Treatment on the Risk of 30-day Readmission Following a Hospitalization for Acute Heart Failure.

    Science.gov (United States)

    Núñez, Julio; Bonanad, Clara; Navarro, Juan Paulo; Bondanza, Lourdes; Artero, Ana; Ventura, Silvia; Núñez, Eduardo; Miñana, Gema; Sanchis, Juan; Real, José

    2015-10-01

    In patients with heart failure and type 2 diabetes, low glycosylated hemoglobin has been related with higher risk of mortality but information regarding morbidity is scarce. We sought to evaluate the association between glycosylated hemoglobin and 30-day readmission in patients with type 2 diabetes and acute heart failure. Glycosylated hemoglobin was measured before discharge in 835 consecutive patients with acute heart failure and type 2 diabetes. Cox regression analysis adapted for competing events was used. Mean (standard deviation) age was 72.9 (9.6) years and median glycosylated hemoglobin was 7.2% (6.5%-8.0%). Patients treated with insulin or insulin/sulfonylurea/meglitinides were 41.1% and 63.2% of the cohort, respectively. At 30 days post-discharge, 109 (13.1%) patients were readmitted. A multivariate analysis revealed that the effect of glycosylated hemoglobin on the risk of 30-day readmission was differentially affected by the type of treatment (P for interaction<.01). Glycosylated hemoglobin (per 1% decrease) was inversely associated with higher risk in those receiving insulin (hazard ratio = 1.45; 95% confidence interval, 1.13-1.86; P=.003) or insulin/sulfonylurea/meglitinides (hazard ratio = 1.44; 95% confidence interval, 1.16-1.80; P=.001). Conversely, glycosylated hemoglobin (per 1% increase) had no effect in non-insulin dependent diabetes (hazard ratio = 1.01; 95% confidence interval, 0.87-1.17; P=.897) or even a positive effect in patients not receiving insulin/sulfonylurea/meglitinides (hazard ratio = 1.12; 95% confidence interval, 1.03-1.22; P=.011). In acute heart failure, glycosylated hemoglobin showed to be inversely associated to higher risk of 30-day readmission in insulin-dependent or those treated with insulin/sulfonylurea/meglitinides. A marginal effect was found in the rest. Whether this association reflects a treatment-related effect or a surrogate of more advanced disease should be clarified in further studies. Copyright © 2014

  3. Public Views on Food Addiction and Obesity: Implications for Policy and Treatment

    OpenAIRE

    Lee, Natalia M.; Lucke, Jayne; Hall, Wayne D.; Meurk, Carla; Boyle, Frances M.; Carter, Adrian

    2013-01-01

    Background According to their advocates, neurobiological explanations of overeating, or ?food addiction?, have the potential to impact public understanding and treatment of obesity. In this study, we examine the public?s acceptance of the concept of food addiction as an explanation of overeating and assess its effects upon their attitudes toward obese persons and the treatment of obesity. Methods and Findings We conducted an online survey of 479 adults from the US (n?=?215) and Australia (n?=...

  4. Survey of Policies and Guidelines on Antioxidant Use for Cancer Prevention, Treatment, and Survivorship in North American Cancer Centers: What Do Institutions Perceive as Evidence?

    Science.gov (United States)

    Hong, Gyeongyeon; White, Jennifer; Zhong, Lihong; Carlson, Linda E

    2015-07-01

    Health care policies and guidelines that are clear and consistent with research evidence are important for maximizing clinical outcomes. To determine whether cancer centers in Canada and the United States had policies and/or guidelines about antioxidant use, and whether policies were aligned with the evidence base, we reviewed current research evidence in the field, and we undertook a survey of the policies and guidelines on antioxidant use at cancer institutions across North America. A survey of policies and guidelines on antioxidant use and the development and communication of the policies and guidelines was conducted by contacting cancer institutions in North America. We also conducted a Website search for each institution to explore any online resources. Policies and guidelines on antioxidant use were collected from 78 cancer institutions. Few cancer institutions had policies (5%) but most provided guidelines (69%). Antioxidants from diet were generally encouraged at cancer institutions, consistent with the current research evidence. In contrast, specific antioxidant supplements were generally not recommended at cancer institutions. Policies and guidelines were developed using evidence-based methods (53%), by consulting another source (35%), or through discussions/conference (26%), and communicated mainly through online resources (65%) or written handouts (42%). For cancer institutions that had no policy or guideline on antioxidants, lack of information and lack of time were the most frequently cited reasons. Policies and guidelines on antioxidants from diet were largely consistent with the research evidence. Policies and guidelines on antioxidant supplements during treatment were generally more restrictive than the research evidence might suggest, perhaps due to the specificity of results and the inability to generalize findings across antioxidants, adding to the complexity of their optimal and safe use. Improved communication of comprehensive research

  5. Effect of chlorine treatment on inhibition of E. coli serogroup O2 incorporation into 7-day-old biofilm on polyvinylchloride surface.

    Science.gov (United States)

    Maharjan, P; Dey, S; Huff, G; Zhang, W; Phillips, G K; Watkins, S

    2017-08-01

    Poultry waterlines are constructed using polyvinylchloride (PVC) material on which bacterial biofilm can easily form. Biofilm can harbor pathogens including avian pathogenic E. coli (APEC) strains. An in vitro evaluation was performed to determine if E. coli sero group O2 (avian pathogenic) could attach on a PVC surface that had pre-formed biofilm and if this phenomenon could be affected when water was treated with chlorine. Initially, biofilm growth was induced in PVC test coupons (15.16 cm2) for a 7-day period mimicking the waterline scenario in the first wk of poultry brooding; and then this biofilm was challenged with E. coli O2 seeded water in presence/absence of chlorine treatment. After rinsing, test coupons were sampled for bacterial (APC) and E. coli O2 enumeration at various occasions post seeding the pathogen and chlorine treatment. Day 7 APC recovered from coupons was 4.35 log10 cfu/cm2 in trial 1 and 3.66 log10 cfu/cm2 in trial 2. E. coli O2 was not recovered from chlorine treated test coupons (P  3 log10 cfu/cm2 in trial 1 and > 2 log10 cfu/cm2 in trial 2). This study suggests that E. coli O2 can incorporate into pre-formed biofilm on a PVC surface within 24 h if water sanitation is not present, and the attachment time of the pathogen can prolong in the absence of already formed biofilm. © 2017 Poultry Science Association Inc.

  6. The Neurobiology of "Food Addiction" and Its Implications for Obesity Treatment and Policy.

    Science.gov (United States)

    Carter, Adrian; Hendrikse, Joshua; Lee, Natalia; Yücel, Murat; Verdejo-Garcia, Antonio; Andrews, Zane; Hall, Wayne

    2016-07-17

    There is a growing view that certain foods, particularly those high in refined sugars and fats, are addictive and that some forms of obesity can usefully be treated as a food addiction. This perspective is supported by a growing body of neuroscience research demonstrating that the chronic consumption of energy-dense foods causes changes in the brain's reward pathway that are central to the development and maintenance of drug addiction. Obese and overweight individuals also display patterns of eating behavior that resemble the ways in which addicted individuals consume drugs. We critically review the evidence that some forms of obesity or overeating could be considered a food addiction and argue that the use of food addiction as a diagnostic category is premature. We also examine some of the potential positive and negative clinical, social, and public policy implications of describing obesity as a food addiction that require further investigation.

  7. Optimal policies for activated sludge treatment systems with multi effluent stream generation

    Directory of Open Access Journals (Sweden)

    Gouveia R.

    2000-01-01

    Full Text Available Most industrial processes generate liquid waste, which requires treatment prior to disposal. These processes are divided into sectors that generate effluents with time dependent characteristics. Each sector sends the effluent to wastewater treatment plants through pumping-stations. In general, activated sludge is the most suitable treatment and consists of equalization, aeration and settling tanks. During the treatment, there is an increase in the mass of microorganisms, which needs to be removed. Sludge removal represents the major operating costs for wastewater treatment plants. The objective of this work is to propose an optimization model to minimize sludge generation using a superstructure in which the streams from pumping-stations can be sent to the equalization tank. In addition, the aeration tank is divided into cells that can be fed in series and parallel. The model relies on mass balances, kinetic equations, and the resulting Nonlinear Programming problem generates the best operational strategy for the system feed streams with a high substrate removal. Reductions of up to 30 % can be achieved with the proposed strategy maintened BOD efficiency removal upper than 98 %.

  8. Efficacy of low-dose cinacalcet on alternate days for the treatment of secondary hyperparathyroidism in hemodialysis patients: a single-center study

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    Gojaseni P

    2017-02-01

    Full Text Available Pongsathorn Gojaseni, Dolnapa Pattarathitinan, Anutra Chittinandana Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand Introduction: Cinacalcet is effective in reducing serum parathyroid hormone (PTH in patients with secondary hyperparathyroidism (HPT. This study focused on testing whether a prescription of low-dose cinacalcet on alternate days could be an option for treatment of secondary HPT.Materials and methods: A retrospective clinical study was conducted on chronic maintenance hemodialysis patients. Patients with secondary HPT who received cinacalcet at a starting dose of 25 mg on alternate days were reviewed (low-dose group. Patients who were being treated with a standard dose of cinacalcet in the same period of time were selected as the control group. The primary outcome was difference in the percentage of patients achieving >30% reduction of intact parathyroid hormone (iPTH levels at 16 weeks. The changes of serum iPTH and other biochemical data were also tested.Results: A total of 30 patients (16 low doses and 14 controls took part in the study. Baseline iPTH levels in the low-dose and control group were 1,065.9±477.7 and 1,214.1±497.6 pg/mL, respectively (p=0.413. The analysis showed that the percentage of patients who achieved the primary outcome showed little or no difference (33.3% in the low-dose group compared with 38.5% in the control group, p=1.0. Serum iPTH reduction during 16 weeks of study period in the low-dose and control group was 253.5±316.1 and 243.4±561.3 pg/mL, respectively (p=0.957. There was no difference in the adverse events between both groups.Conclusion: Among patients with secondary HPT, initial treatment with cinacalcet 25 mg on alternate days can decrease serum PTH levels. The role of low-dose cinacalcet in secondary HPT should be further determined in large-scale, randomized controlled trials. Keywords

  9. Context matters : water governance assessment of the wastewater treatment plant policy in Central Mexico

    NARCIS (Netherlands)

    Casiano Flores, Cesar Augusto

    2017-01-01

    A lack of wastewater treatment is one of the main water problems worldwide. In high-income countries, 70% of wastewater is typically treated, but the rate falls to an average 28% in lower-middle-income countries. This low level has negative consequences for human health and for nature, with high

  10. Treatment policy for psoriasis and eczema: a survey among dermatologists in the Netherlands and Belgian Flanders.

    NARCIS (Netherlands)

    Roelofzen, J.H.J.; Aben, K.K.H.; Khawar, A.J.M.; Kerkhof, P.C.M. van de; Kiemeney, L.A.L.M.; Valk, P.G.M. van der

    2007-01-01

    Today, many therapies are available for the treatment of psoriasis and eczema. One of the oldest topical therapies is coal tar. Coal tar has been used for decades, but over the past years, the use of coal tar has decreased for several reasons, including the supposed carcinogenicity of coal tar.We

  11. Cross Sectional Study of Burn Infections and Antibiotic Susceptibility Pattern for the Improvement of Treatment Policy

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    Neda Pirbonyeh

    2017-04-01

    Conclusion: By evaluating the infectious agents during the period of the study, it was found that due to the focus on treatment of Gram negative bacteria, Gram positive bacteria especially Staphylococcus aureus and Coagulase Negative Staphylococcus have at least doubled. This increase in two important nosocomial infections is a next threat of infection and septicemia for burn victims.

  12. Getting research into policy - Herpes simplex virus type-2 (HSV-2) treatment and HIV infection: international guidelines formulation and the case of Ghana.

    Science.gov (United States)

    Burris, H; Parkhurst, J; Adu-Sarkodie, Y; Mayaud, P

    2011-06-16

    Observational epidemiological and biological data indicate clear synergies between Herpes simplex virus type 2 (HSV-2) and HIV, whereby HSV-2 enhances the potential for HIV acquisition or transmission. In 2001, the World Health Organization (WHO) launched a call for research into the possibilities of disrupting this cofactor effect through the use of antiherpetic therapy. A WHO Expert Meeting was convened in 2008 to review the research results. The results of the trials were mostly inconclusive or showed no impact. However, the WHO syndromic management treatment guidelines were modified to include acyclovir as first line therapy to treat genital ulcer disease on the basis of the high prevalence of HSV-2 in most settings, impact and cost-benefit of treatment on ulcer healing and quality of life among patients. This paper examines the process through which the evidence related to HIV-HSV-2 interactions influenced policy at the international level and then the mechanism of international to national policy transfer, with Ghana as a case study. To better understand the context within which national policy change occurs, special attention was paid to the relationships between researchers and policy-makers as integral to the process of getting evidence into policy. Data from this study were then collected through interviews conducted with researchers, program managers and policy-makers working in sexual health/STI at the 2008 WHO Expert Meeting in Montreux, Switzerland, and in Accra, Ghana. The major findings of this study indicate that investigations into HSV-2 as a cofactor of HIV generated the political will necessary to reform HSV-2 treatment policy. Playing a pivotal role at both the international level and within the Ghanaian policy context were 'policy networks' formed either formally (WHO) or informally (Ghana) around an issue area. These networks of professionals serve as the primary conduit of information between researchers and policy-makers. Donor influence

  13. Preventing Superinfection in Malaria Spreads with Repellent and Medical Treatment Policy

    Science.gov (United States)

    Fitri, Fanny; Aldila, Dipo

    2018-03-01

    Malaria is a kind of a vector-borne disease. That means this disease needs a vector (in this case, the anopheles mosquito) to spread. In this article, a mathematical model for malaria disease spread will be discussed. The model is constructed as a seven-dimensional of a non-linear ordinary differential equation. The interventions of treatment for infected humans and use of repellent are included in the model to see how these interventions could be considered as alternative ways to control the spread of malaria. Analysis will be made of the disease-free equilibrium point along with its local stability criteria, construction of the next generation matrix which followed with the sensitivity analysis of basic reproduction number. We found that both medical treatment and repellent intervention succeeded in reducing the basic reproduction number as the endemic indicator of the model. Finally, some numerical simulations are given to give a better interpretation of the analytical results.

  14. Play distraction versus pharmacological treatment to reduce anxiety levels in children undergoing day surgery: a randomized controlled non-inferiority trial.

    Science.gov (United States)

    Al-Yateem, N; Brenner, M; Shorrab, A A; Docherty, C

    2016-07-01

    Perioperative experience can be one of the most distressful experiences in a child's life if not managed properly by healthcare professionals. Its consequences can extend well beyond surgery and recovery into the child's future life. Healthcare professionals have a responsibility to decrease the anxiety associated with this experience, improve the child's and the parent's experience and prevent negative consequences. This has traditionally been performed through pharmacological treatment which might have negative side effects. More developmentally appropriate distraction methods are currently being trialled globally to augment the evidence that supports their use as a similarly efficient alternative. The aim of this study was to explore the efficiency of storytelling, pictures and colouring activities as an anxiolytic intervention in comparison to the traditional pharmacological premedication technique in a non-inferiority study. A randomized non-inferiority controlled trial was carried out in 168 children scheduled for day surgery. Children's perioperative anxiety was assessed by a trained anaesthetist using the modified Yale Preoperative Assessment Scale and by parents using the State-Trait Anxiety Inventory for Children. Children's vital signs were also collected preoperatively during the induction period and during the recovery period. The primary endpoint, which is non-inferiority in terms of anxiety as per Yale Preoperative Assessment Scale survey between play distraction and preoperative medication, was met [average score 10.95 vs. 10.94, respectively, 95% confidence interval (-0.35; 0.37); P = 0.941]. Moreover, anxiety scores of both the intervention and the control group were quite comparable as per STAIC survey [20.90 vs. 20.73, respectively, 95% confidence interval (-0.52; 0.88); P = 0.708] and in terms of vital signs. The results indicate that the distraction technique employed can be considered as an efficient alternative to traditional

  15. Malaria diagnostic testing and treatment practices in three different Plasmodium falciparum transmission settings in Tanzania: before and after a government policy change

    Directory of Open Access Journals (Sweden)

    Bousema Teun

    2011-04-01

    Full Text Available Abstract Background Patterns of decreasing malaria transmission intensity make presumptive treatment of malaria an unjustifiable approach in many African settings. The controlled use of anti-malarials after laboratory confirmed diagnosis is preferable in low endemic areas. Diagnosis may be facilitated by malaria rapid diagnostic tests (RDTs. In this study, the impact of a government policy change, comprising the provision of RDTs and advice to restrict anti-malarial treatment to RDT-positive individuals, was assessed by describing diagnostic behaviour and treatment decision-making in febrile outpatients Methods Prospective data from Biharamulo and Rubya Designated District Hospital (DDH were collected before and after policy change, in Sumve DDH no new policy was implemented. Diagnosis of malaria was confirmed by RDT; transmission intensity was evaluated by a serological marker of malaria exposure in hospital attendees. Results Prior to policy change, there was no evident association between the actual level of transmission intensity and drug-prescribing behaviour. After policy change, there was a substantial decrease in anti-malarial prescription and an increase in prescription of antibiotics. The proportion of parasite-negative individuals who received anti-malarials decreased from 89.1% (244/274 to 38.7% (46/119 in Biharamulo and from 76.9% (190/247 to 10.0% (48/479 in Rubya after policy change. Conclusion This study shows that an official policy change, where RDTs were provided and healthcare providers were advised to adhere to RDT results in prescribing drugs can be followed by more rational drug-prescribing behaviour. The current findings are promising for improving treatment policy in Tanzanian hospitals.

  16. Health policy strategies for the treatment of obesity: a systematic review

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    Konstantina Karaouli

    2010-01-01

    Full Text Available Introduction: The phenomenon of obesity has nowadays become an epidemic, as it seems to greatly affect the populations of both developed and developing countries. General issues involving the evaluation of the phenomenon, its consequences and the health policies that can be used to confront it, are discussed.Objectives: The objectives of this paper were to critically discuss and analyze the relation between obesity and major diseases of the western societies such as cancers and diabetes mellitus. Furthermore its aim was to demonstrate the direct relation between various prevention strategies and the reduction of the phenomenon.Method: An online search in Medline, Pumed and the Cochrane Database of peer-reviewed Systematic Reviews and meta-analysis was conducted. Retrieved studies were screened to meet certain inclusion criteria, i.e. relevance, significant meanings in correspondence with this paper’s objectives and of interest to an international health-professional readership.Results: There is a clear demonstration of the direct relation between obesity and a series of diseases such as cancer, diabetes and coronary disease. Obesity also seems to be directly related to an increased incidence of caesarian sections and gestational diabetes mellitus. Reduced smoking rates during pregnancy and an increased time of breastfeeding seem to have a protective role. The importance of physical training, of a “healthy nutritional model” adopted by the parents, and of the Mediterranean diet are shown to be fundamental in the confrontation of the phenomenon. Additionally, family doctor interventions, cognitivebehavioral therapy and internet-mediated actions seem to sufficiently aid in its prevention.Conclusion: There is a clear proof that certain primary and secondary prevention strategies along with the the increase of health-concience in communities may lead to the decrease in the rates of obesity and its undoubtfully harmful consequences.

  17. Compliance with a three-day course of artesunate-mefloquine combination and baseline anti-malarial treatment in an area of Thailand with highly multidrug resistant falciparum malaria

    Directory of Open Access Journals (Sweden)

    Na-Bangchang Kesara

    2010-02-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT is presently recommended by the World Health Organization as first-line treatment for uncomplicated Plasmodium falciparum malaria in several countries, as a mean of prolonging the effectiveness of first-line malaria treatment regimens. A three-day course of artesunate-mefloquine (4 mg/kg body weight once daily for three consecutive days, plus 15 and 10 mg/kg body weight mefloquine on the first and second days has been adopted by Malaria Control Programme of Thailand as first-line treatment for uncomplicated falciparum malaria all over the country since 2008. The gametocytocydal anti-malarial drug primaquine is administered at the dose of 30 mg (0.6 mg/kg on the last day. The aim of the present study was to assess patient compliance of this combination regimen when applied to field condition. Methods A total of 240 patients (196 males and 44 females who were attending the malaria clinics in Mae-Sot, Tak Province and presenting with symptomatic acute uncomplicated falciparum malaria, with no reappearance of Plasmodium vivax parasitaemia during follow-up were included into the study. The first dose of the treatment was given to the patients under direct supervision. All patients were given the medication for self-treatment at home and were requested to come back for follow-up on day 3 of the initial treatment. Baseline (day 0 and day 3 whole blood mefloquine and plasma primaquine concentrations were determined by high performance liquid chromatography. Results Two patients had recrudescence on days 28 and 35. The Kaplan-Meier estimate of the 42-day efficacy rate of this combination regimen was 99.2% (238/240. Based on whole blood mefloquine and plasma primaquine concentrations on day 3 of the initial treatment, compliance with mefloquine and primaquine in this three-day artesunate-mefloquine combination regimen were 96.3% (207/215, and 98.5% (197/200, respectively. Baseline mefloquine

  18. Anal cancer with large metastases into the perirectal fat: differential diagnosis and treatment policy

    Directory of Open Access Journals (Sweden)

    A. O. Rasulov

    2015-01-01

    Full Text Available Selected squamous-cell anal carcinoma (SCAC patients are initially presented with large pararectal lymph node metastases.The aim of this study was to investigate safety, efficacy and long-term outcome of chemoradiotherapy in this patient group.Materials and methods. SCAC patients, initially referred with gastrointestinal stromal tumors, rectal cancer diagnosis or patients with regional metastatic lymph nodes more than twice the size of the primary tumour were included in this retrospective analysis. Previous treatment, diagnostic and clinical mistakes of primary care specialists, short- and long-term outcome of chemoradiotherapy were analyzed.Results. 6 patients were included. Primary tumour size varied between 0.5 and 6.5 cm (median – 1.7 cm, metastatic lymph node size varied between 4.2 and 7.4 cm (median – 6.4 cm. All patients received radical doses of chemoradiation. All patients developed grade 3 toxicities, 2 patients developed grade 4 toxicities. Median followup was 15.5 months. 5 out of 6 patients had persistent complete clinical response. 1 patient died of disease progression (incomplete response and metachronous distant metastases.Conclusion. SCAC patients with large regional lymph node metastases have equal prognosis with the rest of the patient group of adequate treatment was carried out.

  19. Meropenem vs standard of care for treatment of late onset sepsis in children of less than 90 days of age: study protocol for a randomised controlled trial

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    de Cabre Vincent

    2011-09-01

    Full Text Available Abstract Background Late onset neonatal sepsis (LOS with the mortality of 17 to 27% is still a serious disease. Meropenem is an antibiotic with wide antibacterial coverage. The advantage of it over standard of care could be its wider antibacterial coverage and thus the use of mono-instead of combination therapy. Methods NeoMero-1, an open label, randomised, comparator controlled, superiority trial aims to compare the efficacy of meropenem with a predefined standard of care (ampicillin + gentamicin or cefotaxime + gentamicin in the treatment of LOS in neonates and infants aged less than 90 days admitted to a neonatal intensive care unit. A total of 550 subjects will be recruited following a 1:1 randomisation scheme. The trial includes patients with culture confirmed (at least one positive culture from normally sterile site except coagulase negative staphylococci in addition to one clinical or laboratory criterion or clinical sepsis (at least two laboratory and two clinical criteria suggestive of LOS in subjects with postmenstrual age The study will start recruitment in September 2011; the total duration is of 24 months. Trial registration EudraCT 2011-001515-31

  20. Cost-effectiveness analysis of the national decentralization policy of antiretroviral treatment programme in Zambia.

    Science.gov (United States)

    Miyano, Shinsuke; Syakantu, Gardner; Komada, Kenichi; Endo, Hiroyoshi; Sugishita, Tomohiko

    2017-01-01

    In resource-limited settings with a high prevalence of human immunodeficiency virus (HIV) infection such as Zambia, decentralization of HIV/acquired immunodeficiency syndrome (HIV/AIDS) treatment and care with effective use of resources is a cornerstone of universal treatment and care. This research aims to analyse the cost effectiveness of the National Mobile Antiretroviral Therapy (ART) Services Programme in Zambia as a means of decentralizing ART services. Cost-effectiveness analyses were performed using a decision analytic model and Markov model to compare the original ART programme, 'Hospital-based ART', with the intervention programme, Hospital-based plus 'Mobile ART', from the perspective of the district government health office in Zambia. The total cost of ART services, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were examined. The mean annual per-patient costs were 1259.16 USD for the original programme and 2601.02 USD for the intervention programme, while the mean number of QALYs was 6.81 for the original and 7.27 for the intervention programme. The ICER of the intervention programme relative to the original programme was 2965.17 USD/QALY, which was much below the willingness-to-pay (WTP), or three times the GDP per capita (4224 USD), but still over the GDP per capita (1408 USD). In the sensitivity analysis, the ICER of the intervention programme did not substantially change. The National Mobile ART Services Programme in Zambia could be a cost-effective approach to decentralizing ART services into rural areas in Zambia. This programme could be expanded to more districts where it has not yet been introduced to improve access to ART services and the health of people living with HIV (PLHIV) in rural areas.

  1. [Diagnosis, follow-up, and treatment policy making in patients with acute pancreatitis (CT and MRI evidence)].

    Science.gov (United States)

    Arablinskiï, A V; Shabunin, A V; Lukin, A Iu; Sidorova, Iu V

    2012-01-01

    The paper deals with the use of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis, followup, and treatment policy making in patients with severe acute severe pancreatitis with manifestations as pancreatic necrosis, fluid collections (exudate accumulations in peripancreatic and retroperitoneal spaces), as well as that complicated by infection, abscess, and pseudocysts. The results of examining 502 patients with acute pancreatitis (AP) with different complications, who had been treated at the S.P. Botkin City Clinical Hospital in 2007 to 2010, were used to analyze the data of the study, to detail tactics in the diagnosis and follow-up of patients with AP, by using bolus contrast-enhanced CT in combination with MRI, which allows one to reveal the nature and severity of the disease with a high accuracy, to make its prognosis, and to determine the effective procedure of treatment. Substantiation of the imperfection of the 1992 Atlanta classification and its specifying Balthazar classification figures high in the paper.

  2. Gambling in Singapore: an overview of history, research, treatment and policy.

    Science.gov (United States)

    Winslow, Munidasa; Cheok, Christopher; Subramaniam, Mythily

    2015-09-01

    This paper describes the current situation regarding gambling in Singapore in relation to its historical and cultural context. A computerized search was performed of two databases (PubMed and PsychINFO) and the reference lists from the papers searched manually to identify relevant studies. The findings were synthesized and their implications assessed. In addition to state lotteries and much informal gambling, Singapore has two large resort casinos, which rank third after Las Vegas and Macau in terms of gross revenues. The major ethnic subgroups in Singapore have different cultural connections to gambling, including the active involvement of the Chinese and religious prohibition among the Malay. A range of secondary prevention and treatment services has been developed to attempt to minimize potential negative impacts. Overall, the prevalence of pathological gambling and problem gambling has decreased in recent years: an estimated 0.2% are classified as probable pathological gamblers compared with 1.4% in 2011, 1.2% in 2008 and 2.1% in 2005. Singapore has experienced a reduction in problem gambling prevalence which may reflect the influence of multiple initiatives. © 2015 Society for the Study of Addiction.

  3. Double Standards in Global Health: Medicine, Human Rights Law and Multidrug-Resistant TB Treatment Policy.

    Science.gov (United States)

    Nicholson, Thomas; Admay, Catherine; Shakow, Aaron; Keshavjee, Salmaan

    2016-06-01

    The human rights arguments that underpinned the fight against HIV over the last three decades were poised, but ultimately failed, to provide a similar foundation for success against multidrug-resistant TB (MDR-TB) and other diseases of the poor. With more than 1.5 million deaths since 2000 attributed to strains of MDR-TB, and with half a million new, and mostly untreated, MDR-TB cases in the world each year, the stakes could not be higher. The World Health Organization (WHO), whose mandate is to champion the attainment by all peoples of the highest possible level of health, recommended unsound medical treatment for MDR-TB patients in resource-poor settings from 1993-2002. Citing cost considerations, WHO did not recommend the available standard of care that had been successfully used to contain and defeat MDR-TB in rich countries. By acting as a strategic gatekeeper in its technical advisory role to donor agencies and countries, it also facilitated the global implementation of a double standard for TB care in low- and middle-income countries (LMICs), upending important legal and scientific priorities. This raises serious questions about whether the organization violated international human rights standards and those established in its own constitution. While calling for additional analysis and discussion on this topic, the authors propose that policymakers should reject double standards of this kind and instead embrace the challenge of implementing the highest standard of care on a global level.

  4. A margin-of-the-day online adaptive intensity-modulated radiotherapy strategy for cervical cancer provides superior treatment accuracy compared to clinically recommended margins: a dosimetric evaluation.

    Science.gov (United States)

    Ahmad, Rozilawati; Bondar, Luiza; Voet, Peter; Mens, Jan-Willem; Quint, Sandra; Dhawtal, Glenn; Heijmen, Ben; Hoogeman, Mischa

    2013-10-01

    To dosimetrically evaluate a margin-of-the-day (MoD) online adaptive intensity-modulated radiotherapy (IMRT) strategy for cervical cancer patients. The strategy is based on a single planning computed tomography (CT) scan and a pretreatment constructed IMRT plan library with incremental clinical target volumes (CTV)-to-planning target volumes (PTV) margins. For 14 patients, 9-10 variable bladder filling CT scans acquired at pretreatment and after 40 Gy were available. Bladder volume variability during the treatment course was recorded by twice-weekly US bladder-volume measurements. A MoD strategy that selects the best IMRT plan of the day from a library of plans with incremental margins in steps of 5 mm was compared with a clinically recommended population-based margin (15 mm). To compare the strategies, for each fraction that had a recorded US bladder-volume measurement, the CT scan with the nearest bladder volume was selected from the pretreatment CT series and from the CT series acquired after 40 Gy. A frequency-weighted average of the dose-volume histograms (DVH) parameters calculated for the two selected CT scans was used to estimate the DVH parameters of the fraction of interest. The 15-mm recommended margin resulted in cervix-uterus underdosage in six of 14 patients. Compared with the 15-mm margin, the MoD strategy resulted in significantly better cervix-uterus coverage (p = 0.008) without a significant difference in the sparing of rectum, bladder, and small bowel. For each patient, 3-8 (median 5) plans were needed in the library of plans for the MoD strategy. The required range of the MoD was 5-45 mm (median 15 mm). Twenty-five percent of all fractions could be treated with a MoD of 5 mm and 81% of all fractions could be treated with a MoD up to 25 mm. Compared with a clinically recommended margin, a simple online adaptive strategy resulted in better cervix-uterus coverage without compromising organs at risk sparing.

  5. Evaluation of the efficacy and tolerance of a short 7 day third-generation cephalosporin treatment in the management of acute pyelonephritis in young women in the emergency department.

    Science.gov (United States)

    Moustafa, F; Nguyen, G; Mathevon, T; Baud, O; Saint-Denis, J; Dublanchet, N; Pereira, B; Shinjo, C; Romaszko, J P; Dopeux, L; Dutheil, F; Schmidt, J

    2016-06-01

    Urinary tract infections, among the leading causes of antibiotic prescriptions in adult women, are complicated by increasing antibiotic resistance. Current recommendations propose a 7 day treatment with fluoroquinolones or a 10-14 day course of third-generation cephalosporins (3GC). Our aim was to study the efficiency and tolerance of a short 7 day treatment with 3GC in uncomplicated acute pyelonephritis in women aged between 18 and 65 years. This study was an open, prospective, non-comparative, monocentric pilot study with consecutive patients. We included women between 18 and 65 years old who had been admitted to the emergency department with a diagnosis of acute pyelonephritis. The treatment consisted of 1 g of ceftriaxone injection followed by 6 days of 400 mg of cefixime per day. The primary endpoint was negative urine cultures on day 9. We opted for Fleming's multistage design for this trial. ClinicalTrials.gov number: NCT01390623. Thirty-seven patients were analysed. The bacteriological response consisted of negative urine cultures for all 37 patients on day 9. On day 9, 30 patients were completely asymptomatic, while 7 exhibited clinical improvement though persistence of bladder irritation or flank pain. On day 37, there were no remaining symptoms and no recurrences of urinary tract infection, as noted during the last follow-up visits. These results suggest that acute pyelonephritis in women could be successfully treated with a short-term course of 1 g of ceftriaxone on the first day followed by 400 mg of cefixime per day for 6 days. These positive results must be confirmed by a non-inferiority study. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  6. A scoping review of home-produced heroin and amphetamine-type stimulant substitutes: implications for prevention, treatment, and policy.

    Science.gov (United States)

    Hearne, Evelyn; Grund, Jean-Paul Cornelius; Van Hout, Marie Claire; McVeigh, Jim

    2016-04-19

    Several home-produced substances such as krokodil and boltushka are prevalent in many Eastern European countries. Anecdotal reports of its use have been circulating in Germany and Norway; however, this has not been confirmed. Its use has also been reported by the media in the USA, although only one confirmed report of its use exists. Home-produced drugs are associated with high levels of morbidity and a number of complex health issues such as the spread of blood borne viruses, gangrene, and internal organ damage. The high incidence of HIV rates amongst people who inject home-produced substances is a public health concern. The resulting physical health consequences of injecting these crude substances are very severe in comparison to heroin or amphetamine acquired in black markets. Due to this fact and the increased mortality associated with these substances, professionals in the area of prevention, treatment, and policy development need to be cognisant of the presentation, harms, and the dangers associated with home-produced substances globally. This scoping review aimed to examine existing literature on the subject of home-produced heroin and amphetamine-type stimulant substitutes. The review discussed the many implications such research may have in the areas of policy and practice. Data were gathered through the use of qualitative secondary resources such as journal articles, reports, reviews, case studies, and media reports. The home production of these substances relies on the utilisation of precursor drugs such as less potent stimulants, tranquillizers, analgesics, and sedatives or natural plant ingredients. The Internet underpins the facilitation of this practice as recipes, and diverted pharmaceutical sales are available widely online, and currently, ease of access to the Internet is evident worldwide. This review highlights the necessity of prevention, education, and also harm reduction related to home-produced drugs and also recommends consistent monitoring

  7. The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico.

    Science.gov (United States)

    Leff, Jared A; Hernández, Diana; Teixeira, Paul A; Castellón, Pedro C; Feaster, Daniel J; Rodriguez, Allan E; Santana-Bagur, Jorge L; De León, Sandra Miranda; Vidot, José Vargas; Metsch, Lisa R; Schackman, Bruce R

    2017-03-23

    HIV prevalence in Puerto Rico is nearly twice that of the mainland United States, a level that was substantially fueled by injection drug use. Puerto Rico has a longstanding history of health provision by the public sector that directly affects how HIV and substance use disorder (SUD) treatment services are provided and funded. As part of pre-implementation research for a randomized trial of a community-level intervention to enhance HIV care access for substance users in San Juan, Puerto Rico, we sought to understand the structural and health policy environment for providing HIV and SUD treatments. We conducted semi-structured qualitative interviews (n = 8) with government and program administrators in English and Spanish. Data were analyzed to identify dominant and recurrent themes. Participants discussed how lack of integration among medical and mental health service providers, lack of public transportation, and turnover in appointed government officials were barriers to integrated HIV and SUD treatment. Federal funding for support services for HIV patients was a facilitator. The Affordable Care Act has limited impact in Puerto Rico because provisions related to health insurance reform do not apply to U.S. territories. Implications for intervention design include the need to provide care coordination for services from multiple providers, who are often physically separated and working in different reimbursement systems, and the potential for mobile and patient transportation services to bridge these gaps. Continuous interaction with political leaders is needed to maintain current facilitators. These findings are relevant as the current economic crisis in Puerto Rico affects funding, and may be relevant for other settings with substance use-driven epidemics.

  8. [Orthopaedic day surgery in Emilia-Romagna].

    Science.gov (United States)

    Rolli, M; Rodler, M; Petropulacos, K; Baldi, R

    2001-09-01

    It is well known that the organizational model of day surgery, concerning surgical problems defined by the literature as minor, has the aim of optimising the use of hospital resources and facilitating patients and their families, from a psychological and social point of view, by reducing hospitalisation time and the associated complications, and ensuring the same efficacy and more appropriateness of treatment. This study is firstly aimed at analysing the impact that the healthcare policy of the Emilia Romagna Region has had on the development of day surgery practice. Secondly, it compares the patients treated in orthopaedic day surgery in the hospitals of Bologna, Modena, Ferrara, Parma, Reggio Emilia, Maggiore hospital of Bologna and Rizzoli Orthopaedic Institute of Bologna (II.OO.R). In the period 1997-2000 there was a marked increase in the number of operations carried out in day surgery in all of the above-mentioned hospitals. Also in the unispecialistic orthopaedic hospital there was a surprising increase in the percentage of operations carried out in day surgery with respect to the total number of operations performed. The aim of the Rizzoli Orthopaedic Institute and the Emilia Romagna Region is to further implement this form of healthcare, contextually potentiating the appropriateness of hospital admission and avoiding, when not necessary, other forms of healthcare.

  9. Day surgery in Bristol.

    Science.gov (United States)

    Carrington, S

    1993-02-01

    As in the rest of the United Kingdom, day surgery in Bristol is on the increase. In the Bristol Royal Infirmary day surgery unit (DSU) we treat approximately 3,500 patients a year. We have recently opened a second operating theatre. This has shifted the proportion of cases from our general theatres. This has also improved our case mix, less minor surgery under local anaesthetics, to more of the recommended 'basket type' surgery ie hernia repair, varicose vein surgery, excision of breast lumps etc. We have recently introduced an appointment booking system that is progressing. Such changes have to be introduced with good preparation, communication and a lot of diplomacy. I would like to outline the management aspects that help to expand and improve on the service we give, including patient selection and the appointment booking system we have introduced. I will describe how we drew up a policy involving the organisation of operation lists and staff involvement in day surgery management and accountability for patient care from admission through to discharge including our latest care plan. Finally I will outline the methods we have developed for evaluating the care we give.

  10. Employing Policy and Purchasing Levers to Increase the Use of Evidence-Based Practices in Community-Based Substance Abuse Treatment Settings: Reports from Single State Authorities

    Science.gov (United States)

    Rieckmann, Traci R.; Kovas, Anne E.; Cassidy, Elaine F.; McCarty, Dennis

    2011-01-01

    State public health authorities are critical to the successful implementation of science based addiction treatment practices by community-based providers. The literature to date, however, lacks examples of state level policy strategies that promote evidence-based practices (EBPs). This mixed-methods study documents changes in two critical…

  11. Oral health status and treatment needs of children and young adults attending a day centre for individuals with special health care needs

    Directory of Open Access Journals (Sweden)

    Akindayomi Yinka

    2008-10-01

    Full Text Available Abstract Background The oral health condition of individuals with special health care needs have been reported in literature to be influenced by various sociodemographic factors, including living conditions and severity of impairment. This study was carried out to determine the oral health status and treatment needs of children and young adults attending a day institution for those with special needs. Methods This study was carried out as part of an oral health screening program organized by the institution and consent was obtained from parents and guardians before the screening. All information was supplied by the parents during the screening using a questionnaire completed by the dentist. Oral examination was carried out on all consenting subjects in attendance on the days of screening in the school clinic with parents and teachers in attendance, using standard World Health Organisation oral health indices to assess dental caries, oral hygiene status, malocclusion and other oral health parameters. Results Fifty-four subjects aged 3–26 years (mean 12.28 ± 6.82 years and comprising 72.2% males and 27.8% females participated in the study. Over 90% were from parents of high and middle level educational background. Thirty-six (66.7% were caries free, with a mean dmft score of 0.7 ± 1.77 and mean DMFT score of 0.4 ± 1.44 with no significant difference across gender (p = 0.5 and parents' educational status (p = 0.43. The mean OHI-S of the total population in this study was 1.36 ± 0.16. Females had a mean score of 0.88 ± 1.10 while males had a mean score of 1.55 ± 1.24 with no significant difference (p = 0.6. Twenty-five (46.3% had good oral hygiene, 17 (31.5% had fair oral hygiene and 12 (22.2% had poor oral hygiene, with no significant difference across gender (p = 1.11 and age groups (p = 0.07. Fifteen (27.8% had gingivitis with no significant difference across age groups (p = 0.17. Forty-five (83.3% had Angle's class I malocclusion, 6

  12. "A Day Without Immigrants"

    DEFF Research Database (Denmark)

    Heiskanen, Benita

    2009-01-01

    , policy makers, and participants. Although much of these debates ostensibly centered around illegal Latino/a immigration to the United States, underneath the discussion ran a curious ideological thread, one that invoked groups' right to be in the United States in the first place. The article argues...... that the rhetoric used in these discourses pitted various class-based ethnoracial groups against each other not so much to tackle the proposed immigration bill but, rather, to comment on the ramifications of an increasingly multiracial United States. Udgivelsesdato: 01 December 2009......Abstract This article considers the debates surrounding the "Day Without Immigrants" protests organized in major U.S. cities on 1 May 2006, prompted by H.R. 4437, the Border Protection, Anti-Terrorism, and Illegal Immigration Control Act of 2005, from the multiple perspectives of scholars, pundits...

  13. Act local, think global: how the Malawi experience of scaling up antiretroviral treatment has informed global policy

    Directory of Open Access Journals (Sweden)

    Anthony D. Harries

    2016-09-01

    Full Text Available Abstract The scale-up of antiretroviral therapy (ART in Malawi was based on a public health approach adapted to its resource-poor setting, with principles and practices borrowed from the successful tuberculosis control framework. From 2004 to 2015, the number of new patients started on ART increased from about 3000 to over 820,000. Despite being a small country, Malawi has made a significant contribution to the 15 million people globally on ART and has also contributed policy and service delivery innovations that have supported international guidelines and scale up in other countries. The first set of global guidelines for scaling up ART released by the World Health Organization (WHO in 2002 focused on providing clinical guidance. In Malawi, the ART guidelines adopted from the outset a more operational and programmatic approach with recommendations on health systems and services that were needed to deliver HIV treatment to affected populations. Seven years after the start of national scale-up, Malawi launched a new strategy offering all HIV-infected pregnant women lifelong ART regardless of the CD4-cell count, named Option B+. This strategy was subsequently incorporated into a WHO programmatic guide in 2012 and WHO ART guidelines in 2013, and has since then been adopted by the majority of countries worldwide. In conclusion, the Malawi experience of ART scale-up has become a blueprint for a public health response to HIV and has informed international efforts to end the AIDS epidemic by 2030.

  14. US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity.

    Science.gov (United States)

    Gomez, G; Stanford, F C

    2017-11-20

    Obesity is now the most prevalent chronic disease in the United States, which amounts to an estimated $147 billion in health care spending annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for private and public health insurance plans that expanded coverage for lifestyle/behavior modification and bariatric surgery for the treatment of obesity. Pharmacotherapy, however, has not been included despite their evidence-based efficacy. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans. We examined coverage for phentermine, diethylpropion, phendimetrazine, Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide (Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and marketplace insurance plans in 34 states. Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. Medicare policy strictly excludes drug therapy for obesity. Only seven state Medicaid programs have drug coverage. Obesity requires an integrated approach to combat its public health threat. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease.International Journal of Obesity advance online publication, 9 January 2018; doi:10.1038/ijo.2017.287.

  15. Fenticonazole nitrate for treatment of vulvovaginitis: efficacy, safety, and tolerability of 1-gram ovules, administered as ultra-short 2-day regimen.

    Science.gov (United States)

    Fernández-Alba, J; Valle-Gay, A; Dibildox, M; Vargas, J A; González, J; García, M; López, L H

    2004-04-01

    Because of its potential as a low cost first-line monotherapy for the most common vulvovaginal infections, we evaluated fenticonazole nitrate in a prospective, open-label, multicenter pilot study with 101 sexually active women (per-protocol; 16 to 61 years of age) with vulvovaginitis involving single or mixed infections with Candida albicans, Trichomonas vaginalis, and/or Gardnerella vaginalis. Fenticonazole nitrate (1 g) was administered as vaginal ovules, once daily on days 1 and 3. Eradication (direct phase-contrast microscopy of vaginal swabs and/or microbiological culture) on day 8 was 90% (C. albicans, 26/29, p symptoms improved from 7.0 (baseline) to 1.7 (day 8), and 0.71 (day 28), (p approach in larger and well controlled clinical trials.

  16. Effects of policosanol 20 versus 40 mg/day in the treatment of patients with type II hypercholesterolemia: a 6-month double-blind study.

    Science.gov (United States)

    Castaño, G; Mas, R; Fernández, L; Illnait, J; Gámez, R; Alvarez, E

    2001-01-01

    Policosanol is a well defined mixture of higher aliphatic primary alcohols isolated from sugar cane wax with cholesterol-lowering effects proven for a dose range from 5-20 mg/day in patients with type II hypercholesterolemia and dyslipidemia associated with noninsulin dependent diabetes mellitus. This randomized, double-blind study investigated the cholesterol-lowering efficacy and tolerability of policosanol 20 mg/day compared with 40 mg/day. Changes in low-density lipoprotein (LDL)-cholesterol levels were predefined as the primary efficacy endpoint. Patients with type II hypercholesterolemia were enrolled in the study and instructed to continue a step I cholesterol-lowering diet for 6 weeks and those eligible to be included (89) were randomly allocated to receive under double-blind conditions placebo (n = 30), policosanol 20 mg/day (n = 29) or 40 mg/day (n = 30). After 24 weeks, policosanol at 20 and 40 mg/day significantly (p < 0.00001) lowered LDL-cholesterol by 27.4% and 28.1%, total cholesterol (p < 0.00001) by 15.6% and 17.3%, and the LDL-cholesterol/high-density lipoprotein (HDL)-cholesterol ratio by 37.2% and 36.5%, respectively The ratio of total cholesterol/HDL-cholesterol was lowered by 27.1% and 27.5%, while HDL-cholesterol levels increased (p < 0.001) by 17.6% and 17.0%, respectively. Compared with baseline, policosanol 20 mg/day lowered triglycerides (p < 0.05) by 12.7%, while they were lowered (p < 0.01) by 15.6% at a dose of policosanol 40 mg/day All the above-mentioned significant differences were also different from placebo and no significant changes occurred in any lipid profile parameters in the placebo group. Based on the mean values of LDL-cholesterol levels at study completion, the mean percent reductions from baseline were 27.4% and 28.1% for the 20 and 40 mg/day groups, respectively. Thus, the effects of both policosanol doses on the main efficacy variable were practically identical. Consistent with the data obtained for LDL

  17. “It’s my business, it’s my body, it’s my money”: Experiences of smokers who are not planning to quit in the next 30 days and their views about treatment options

    OpenAIRE

    Bartlett, Kiera; Gartland, Nicola; Wearden, Alison; Armitage, C J; Borrelli, Belinda

    2016-01-01

    Background: Current evidence-based smoking cessation treatments in the UK are only offered to smokers ready to quit within 30 days. This study reports the experiences of smokers who are not ready to quit and explores the types of intervention approaches that might engage them. Methods: Five focus groups were conducted with smokers who had no plans to quit within 30 days (n = 32, 44% female). Verbatim transcripts were analyzed thematically using Nvivo 10 software. Results: Participants were am...

  18. Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up

    Directory of Open Access Journals (Sweden)

    Paweł Latacz

    2017-03-01

    Full Text Available Introduction: Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. Aim : To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure. Material and methods: This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions. Results : There were 6 (1.5% strokes, including 2 (0.5% major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0% minor strokes. In asymptomatic patients there was 1 (0.3% minor stroke. Transient ischemic attacks occurred in 5 (1.2% patients. There were 2 (0.5% non-STEMI myocardial infarctions and 2 (0.5% non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation. Conclusions : Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe.

  19. Policies and laws affecting Mexican-origin immigrant access and utilization of substance abuse treatment: obstacles to recovery and immigrant health.

    Science.gov (United States)

    Moya, Eva M; Shedlin, Michele G

    2008-01-01

    This article reports the results of a study carried out with 30 Mexican-origin immigrants in drug user treatment in the United States-Mexico Border city of El Paso, Texas during 2007. Qualitative, semi-structured interviews were implemented to assess the dynamic social and economic factors that affect the delivery and utilization of treatment services, with emphasis on the impact of recent immigration-related laws and policies. The research provides initial data for evidence-based intervention and reinforces the need for culturally and gender appropriate treatment services for poor immigrants and their families. The study's limitations are noted.

  20. A Prospective, Randomized Study Comparing 7-day and 14-day ...

    African Journals Online (AJOL)

    2018-02-07

    Feb 7, 2018 ... H. pylori infection in Turkey. KEYWORDS: Duodenum, dyspepsia, Helicobacter pylori, gastritis, stomach. A Prospective, Randomized Study Comparing 7-day and 14-day. Quadruple Therapies as First-line Treatments for Helicobacter pylori. Infection in Patients with Functional Dyspepsia. A Yağbasan, DÖ ...

  1. A Prospective, Randomized Study Comparing 7-day and 14-day ...

    African Journals Online (AJOL)

    Objective: Standard triple therapy for Helicobacter pylori has a low eradication rate in Turkey. The aim of this study was to evaluate and compare the effectiveness of 7-day and 14-day lansoprazole, amoxicillin, clarithromycin, and bismuth subsalicylate (LACB) treatment regimens as first-line H. pylori eradication therapies.

  2. Patient Enrolment into HIV Care and Treatment within 90 Days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-Based Registers

    NARCIS (Netherlands)

    Kayigamba, Felix R.; Bakker, Mirjam I.; Fikse, Hadassa; Mugisha, Veronicah; Asiimwe, Anita; Schim van der Loeff, Maarten F.

    2012-01-01

    Introduction: Access to antiretroviral therapy (ART) has increased greatly in sub-Saharan Africa. However many patients do not enrol timely into HIV care and treatment after HIV diagnosis. We studied enrolment into care and treatment and determinants of non-enrolment in Rwanda. Methods: Data were

  3. Repeated 7-Day Treatment with the 5-HT2C Agonist Lorcaserin or the 5-HT2A Antagonist Pimavanserin Alone or in Combination Fails to Reduce Cocaine vs Food Choice in Male Rhesus Monkeys.

    Science.gov (United States)

    Banks, Matthew L; Negus, S Stevens

    2017-04-01

    Cocaine use disorder is a global public health problem for which there are no Food and Drug Administration-approved pharmacotherapies. Emerging preclinical evidence has implicated both serotonin (5-HT) 2C and 2A receptors as potential mechanisms for mediating serotonergic attenuation of cocaine abuse-related neurochemical and behavioral effects. Therefore, the present study aim was to determine whether repeated 7-day treatment with the 5-HT 2C agonist lorcaserin (0.1-1.0 mg/kg per day, intramuscular; 0.032-0.1 mg/kg/h, intravenous) or the 5-HT 2A inverse agonist/antagonist pimavanserin (0.32-10 mg/kg per day, intramuscular) attenuated cocaine reinforcement under a concurrent 'choice' schedule of cocaine and food availability in rhesus monkeys. During saline treatment, cocaine maintained a dose-dependent increase in cocaine vs food choice. Repeated pimavanserin (3.2 mg/kg per day) treatments significantly increased small unit cocaine dose choice. Larger lorcaserin (1.0 mg/kg per day and 0.1 mg/kg/h) and pimavanserin (10 mg/kg per day) doses primarily decreased rates of operant behavior. Coadministration of ineffective lorcaserin (0.1 mg/kg per day) and pimavanserin (0.32 mg/kg per day) doses also failed to significantly alter cocaine choice. These results suggest that neither 5-HT 2C receptor activation nor 5-HT 2A receptor blockade are sufficient to produce a therapeutic-like decrease in cocaine choice and a complementary increase in food choice. Overall, these results do not support the clinical utility of 5-HT 2C agonists and 5-HT 2A inverse agonists/antagonists alone or in combination as candidate anti-cocaine use disorder pharmacotherapies.

  4. Pattern of induced estrus and conception rate following Ovsynch and Ovsynch based gonadotropin-releasing hormone treatments initiated on day 6 of estrous cycle in repeat breeding crossbred cows

    Science.gov (United States)

    Ahmed, N.; Kathiresan, D.; Ahmed, F. A.; Lalrintluanga, K.; Mayengbam, P.; Gali, J. M.

    2016-01-01

    Aim: The aim was to evaluate the estrus response, incidence of accessory corpus luteum formation and fertility following different hormonal protocols in repeat breeding crossbred cows. Materials and Methods: This study was carried out on 24 repeat breeding crossbred cows allotted into four groups. Cows of Group I was not given any treatment, Group II was treated with gonadotropin-releasing hormone (GnRH) injection on day 6 post-estrus, Group III was treated with Ovsynch protocol, and Group IV was treated with Ovsynch based GnRH treatment. Estrus responses such as duration, onset, percentage, and intensity of estrus were recorded during the study. The incidence of accessory corpus luteum was recorded per rectally on day 7 after first and additional GnRH of Ovsynch treatment. The conception rate for all groups was calculated by the absence of estrus and on day 45 after artificial insemination (AI) per rectum. Serum samples were collected at AI and day 12 post-AI in Group I and II. Serum samples were also collected at GnRH, Prostaglandin F2α (PGF2α), timed AI (TAI) and day 12 post-TAI in Group III and IV. Results: Ovsynch and Ovsynch based GnRH treatments are resulted in 100.00% induction of estrus after the PGF2α injection. Onset of induced estrus after the PGF2α injection for Group III and IV was recorded as 48.750±0.713 and 51.472±1.989 h, respectively, and it was not significant. There was no significant difference in duration of estrus among the groups. The incidence of intermediate estrus intensity was found to be highest. All the cows showed the incidence of formation of accessory corpus luteum subsequent to GnRH treatment on day 6 of the estrous cycle in Group II, III, and IV. The conception rate was 0.00%, 16.67%, 50.00%, and 50.00% in Group I, II, III, and IV, respectively. Conclusion: Ovsynch and Ovsynch based GnRH treatments initiated on day 6 of estrous cycle capable of responding with a higher percentage of ovulation and formation of accessory

  5. The role of civil society in health policy making in South Africa: a review of the strategies adopted by the Treatment Action Campaign.

    Science.gov (United States)

    Sabi, Stella C; Rieker, Mark

    2017-03-01

    The diagnosis of AIDS in 1982 in South Africa was followed by a rapid rise in the number of people living with the virus and dying from AIDS-related illnesses. The 2016 report by the Statistics South Africa indicated that about 7.03 million South Africans were infected with HIV/AIDS - the highest rate in the world. Despite the emergence of effective drugs in the mid-1990s, medical treatment remained unavailable in South Africa, particularly in public hospitals. This prompted civil society groups to establish platforms to discuss health policy change in South Africa. Prominent among these was the Treatment Action Campaign (TAC), formed in 1998, which aimed to advocate for improved HIV/AIDS health service delivery. The efforts succeeded in shaping the current HIV/AIDS policy through various initiatives such as the use of constitutional law in legal action against profiteering drug companies. This paper examines the role of civil society, and particularly the TAC engagement with the state in health policy making, and the subsequent implementation of health policy on HIV/AIDS in post-apartheid South Africa.

  6. International Women's Day speech.

    Science.gov (United States)

    Kazibwe, S W

    1993-01-01

    The objectives of the International Women's Day are: 1) to celebrate the struggle for women's rights in the economic, social, political, and cultural domain; 2) to reaffirm women's solidarity in the struggle for peace; 3) and to show what women have achieved. In 1988, Uganda's government of the National Resistance Movement created the Ministry of Women in Development. The period 1988-1990 was one of consultations, needs assessment, planning, and recruiting staff for the Ministry. From 1990 to 1993, measurable results have been achieved. The Ministry's gender concerns pertained to the sector policies of the Ministries of Agriculture, Animal Industry and Fisheries, Education, Health, Water, Energy, Minerals, and Environment Protection. Under the Umbrella Project for Women in Development, gender sensitization has been achieved with policy makers in ministries, at district level, and in the media. Gender issues have also been incorporated in the National Political School Curriculum. The Ministry has also trained a corps of 73 women trainers from 38 districts. The Ministry, with funding from DANIDA, collected women's views on the constitution through meetings and seminars in all the districts in the country. Recommendations were submitted in a consolidated report to the Constitution Commission. A pilot para-legal scheme is successfully being implemented in Kamuli district. A community-based pool of legal advisors has been developed. Legal matters that affect both women and men are undertaken at the community level. The economic emancipation of women is a crucial part of the Ministry's mandate. In conjunction with NGOs, pilot credit programs are being run in Mukono, Jinja, Mbale, and Kapchorwa districts. Cross-sectoral programs are in close collaboration with the rural water and sanitation program, the Northern Uganda rehabilitation program, and the integrated Basic Education Pilot Project to be implemented in 8 districts.

  7. Early response evaluation using CT-perfusion one day after transarterial chemoembolization for HCC predicts treatment response and long-term disease control.

    Science.gov (United States)

    Tamandl, Dietmar; Waneck, Fredrik; Sieghart, Wolfgang; Unterhumer, Sylvia; Kölblinger, Claus; Baltzer, Pascal; Ba-Ssalamah, Ahmed; Loewe, Christian

    2017-05-01

    To determine the value of CT perfusion (CTP) for early response assessment after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Between April 2013 and April 2015, 41 HCC (16 patients) were included in this study. CT perfusion was performed before and one day after TACE. Blood flow (BF), blood volume (BV), time to start (TTS), arterial liver perfusion (ALP), portal liver perfusion (PVP) and hepatic perfusion index (HPI) were measured. Quantitative perfusion values before and after TACE were compared to the response assessed using mRECIST criteria six weeks after TACE and long-term outcome was assessed. Twenty-one lesions (51%) had complete remission (CR) and five (12%) had partial response (PR) six weeks after TACE. CTP parameters were significantly reduced after TACE in responders (PR, CR, pCT perfusion detects lesions with complete response one day after TACE, and is a feasible tool for early response assessment. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. A systematic review and meta-analysis to compare the efficacy of acyclovir 3% ophthalmic ointment to idoxuridine in curing herpetic keratitis by Day 7 of treatment.

    Science.gov (United States)

    Balderson, Diane E; Cai, Gengqian; Fries, Michael A; Kleinman, David M; McLaughlin, Megan M; Trivedi, Trupti M; Wurzelmann, John I; Young, Sheila B

    2015-04-17

    This objective of the review and analysis is to demonstrate that acyclovir (ACV) 3% ophthalmic ointment is superior to idoxuridine (IDU) in treating herpetic keratitis (HK) presenting as dendritic and geographic ulcer sub-types. Publications in human subjects were identified by searching the Ovid MEDLINE database through April 2011, combining medical subject headings (MESH) "Keratitis, Herpetic/" AND "Acyclovir/" limiting by the key words "topical" OR "ointment" and also restricted to MESH "Administration, Topical/" OR "Ointments/". The results were cross checked with the references used in the Cochrane Database Syst Rev. 1:1-134, 2009 and GlaxoSmithKline clinical documents related to acyclovir. Randomized, double-masked studies in subjects diagnosed with HK with head to head comparator arms of ACV ophthalmic ointment and topical IDU that had actual or calculable healing rates at Day seven. Data independently extracted from identified articles by two authors of this manuscript. Data from seven randomized, controlled trials (RCT) evaluating 432 subjects that met inclusion criteria (214 were treated with ACV and 218 were treated with IDU) and had Day seven healing rates calculable. All sub-classified lesions were identified as either dendritic ulcers (n = 185) or geographic ulcers (n = 35). The Cochran-Mantel-Haenszel (CMH) method in Biometrics 10:417-51, 1954 and JNCI 22:719-48, 1959, controlling for study, was performed as the primary analysis using SAS v9. Homogeneity was assessed using Breslow-Day-Tarone (BDT) test in IARC 1:1-32, 1980 and Biometrika 72:91-5, 1985. The analysis was performed with outliers removed to assess their impact. ACV showed statistically significant greater odds of healing HK at Day seven in all subjects (Odds Ratio 3.95, 95% CI2.60, 6.00, p p p = 0.0244). ACV 3% ophthalmic ointment is a valuable intervention for dendritic and geographic corneal ulcers. ACV and IDU were generally well tolerated in the studies reviewed.

  9. National responses to global health targets: exploring policy transfer in the context of the UNAIDS '90-90-90' treatment targets in Ghana and Uganda.

    Science.gov (United States)

    McRobie, Ellen; Matovu, Fred; Nanyiti, Aisha; Nonvignon, Justice; Abankwah, Daniel Nana Yaw; Case, Kelsey K; Hallett, Timothy B; Hanefeld, Johanna; Conteh, Lesong

    2018-01-01

    Global health organizations frequently set disease-specific targets with the goal of eliciting adoption at the national-level; consideration of the influence of target setting on national policies, programme and health budgets is of benefit to those setting targets and those intended to respond. In 2014, the Joint United Nations Programme on HIV/AIDS set 'ambitious' treatment targets for country adoption: 90% of HIV-positive persons should know their status; 90% of those on treatment; 90% of those achieving viral suppression. Using case studies from Ghana and Uganda, we explore how the target and its associated policy content have been adopted at the national level. That is whether adoption is in rhetoric only or supported by programme, policy or budgetary changes. We review 23 (14 from Ghana, 9 from Uganda) national policy, operational and strategic documents for the HIV response and assess commitments to '90-90-90'. In-person semi-structured interviews were conducted with purposively sampled key informants (17 in Ghana, 20 in Uganda) involved in programme-planning and resource allocation within HIV to gain insight into factors facilitating adoption of 90-90-90. Interviews were transcribed and analysed thematically, inductively and deductively, guided by pre-existing policy theories, including Dolowitz and Marsh's policy transfer framework to describe features of the transfer and the Global Health Advocacy and Policy Project framework to explain observations. Regardless of notable resource constraints, transfer of the 90-90-90 targets was evident beyond rhetoric with substantial shifts in policy and programme activities. In both countries, there was evidence of attempts to minimize resource constraints by seeking programme efficiencies, prioritization of programme activities and devising domestic financing mechanisms; however, significant resource gaps persist. An effective health network, comprised of global and local actors, mediated the adoption and adaptation

  10. AAS 227: Day 2

    Science.gov (United States)

    Kohler, Susanna

    2016-01-01

    Editors Note:This week were at the 227th AAS Meeting in Kissimmee, FL. Along with several fellow authors from astrobites.com, I will bewritingupdates on selectedevents at themeeting and posting at the end of each day. Follow along here or atastrobites.com, or catch ourlive-tweeted updates from the@astrobites Twitter account. The usual posting schedule for AAS Nova will resumenext week.Welcome to Day 2 of the winter American Astronomical Society (AAS) meeting in Kissimmee! Several of us are attending the conference this year, and we will report highlights from each day here on astrobites. If youd like to see more timely updates during the day, we encourage you to follow @astrobites on twitter or search the #aas227 hashtag.Plenary Session: Black Hole Physics with the Event Horizon Telescope (by Susanna Kohler)If anyone needed motivation to wake up early this morning, they got it in the form of Feryal Ozel (University of Arizona) enthralling us all with exciting pictures, videos, and words about black holes and the Event Horizon Telescope. Ozel spoke to a packed room (at 8:30am!) about where the project currently stands, and where its heading in the future.The EHT has pretty much the coolest goal ever: actually image the event horizons of black holes in our universe. The problem is that the largest black hole we can look at (Sgr A*, in the center of our galaxy) has an event horizon size of 50 as. For this kind of resolution roughly equivalent to trying to image a DVD on the Moon! wed need an Earth-sized telescope. EHT has solved this problem by linking telescopes around the world, creating one giant, mm-wavelength effective telescope with a baseline the size of Earth.Besides producing awesome images, the EHT will be able to test properties of black-hole spacetime, the no-hair theorem, and general relativity (GR) in new regimes.Ozel walked us through some of the theory prep work we need to do now in order to get the most science out of the EHT, including devising new

  11. A Point Source of a Different Color: Identifying a Gap in United States Regulatory Policy for “Green” CSO Treatment Using Constructed Wetlands

    Directory of Open Access Journals (Sweden)

    Zeno F. Levy

    2014-04-01

    Full Text Available Up to 850 billion gallons of untreated combined sewer overflow (CSO is discharged into waters of the United States each year. Recent changes in CSO management policy support green infrastructure (GI technologies as “front of the pipe” approaches to discharge mitigation by detention/reduction of urban stormwater runoff. Constructed wetlands for CSO treatment have been considered among suites of GI solutions. However, these wetlands differ fundamentally from other GI technologies in that they are “end of the pipe” treatment systems that discharge from a point source, and are therefore regulated in the U.S. under the National Pollution Discharge Elimination System (NPDES. We use a comparative regulatory analysis to examine the U.S. policy framework for CSO treatment wetlands. We find in all cases that permitting authorities have used best professional judgment to determine effluent limits and compliance monitoring requirements, referencing technology and water quality-based standards originally developed for traditional “grey” treatment systems. A qualitative comparison with Europe shows less stringent regulatory requirements, perhaps due to institutionalized design parameters. We recommend that permitting authorities develop technical guidance documents for evaluation of “green” CSO treatment systems that account for their unique operational concerns and benefits with respect to sustainable development.

  12. Biomass granulation in an upflow anaerobic sludge blanket reactor treating 500 m3/day low-strength sewage and post treatment in high-rate algal pond.

    Science.gov (United States)

    Chatterjee, Pritha; Ghangrekar, M M

    2017-09-01

    A pilot-scale upflow anaerobic sludge blanket-moving bed biofilm (UASB-MBB) reactor followed by a high-rate algal pond (HRAP) was designed and operated to remove organic matter, nutrients and pathogens from sewage and to facilitate reuse. For an influent chemical oxygen demand (COD) concentration of 233 ± 20 mg/L, final effluent COD was 50 ± 6 mg/L. Successful biomass granulation was observed in the sludge bed of the upflow anaerobic sludge blanket (UASB) reactor after 5 months of operation. Ammonia removal in HRAP was 85.1 ± 2.4% with average influent and effluent ammonia nitrogen concentrations of 20 ± 3 mg/L and 3 ± 1 mg/L, respectively. Phosphate removal after treatment in the HRAP was 91 ± 1%. There was a 2-3 log scale pathogen removal after treatment in HRAP with most probable number (MPN) of the final effluent being 600-800 per 100 mL, which is within acceptable standards for surface irrigation. The blackwater after treatment in UASB-MBBR-HRAP is being reused for gardening and landscaping. This proper hydro-dynamically designed UASB reactor demonstrated successful granulation and moving bed media improved sludge retention in UASB reactor. This combination of UASB-MBB reactor followed by HRAP demonstrated successful sewage treatment for a year covering all seasons.

  13. Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma.

    Science.gov (United States)

    Tompkins, D Andrew; Hobelmann, J Greg; Compton, Peggy

    2017-04-01

    Over 100 million Americans are living with chronic pain, and pain is the most common reason that patients seek medical attention. Despite the prevalence of pain, the practice of pain management and the scientific discipline of pain research are relatively new fields compared to the rest of medicine - contributing to a twenty-first century dilemma for health care providers asked to relieve suffering in the "Fifth Vital Sign" era. This manuscript provides a narrative review of the basic mechanisms of chronic pain and history of chronic pain management in the United States - including the various regulatory, health system and provider factors that contributed to the decline of multidisciplinary pain treatment in favor of the predominant opioid treatment strategy seen today. Multiple non-opioid pain treatment strategies are then outlined. The manuscript concludes with three key questions to help guide future research at the intersection of pain and addiction. The assessment and treatment of chronic pain will continue to be one of the most common functions of a health care provider. To move beyond an over reliance on opioid medications, the addiction and pain research communities must unite with chronic pain patients to increase the evidence base supporting non-opioid analgesic strategies. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  14. Aggression Regulation in Day Treatment of Eating Disorders : Two-Centre RCT of a Brief Body and Movement-Oriented Intervention

    NARCIS (Netherlands)

    Boerhout, Cees; Swart, Marte; Voskamp, Marjon; Troquete, Nadine A. C.; van Busschbach, Jooske T.; Hoek, Hans W.

    ObjectiveThe objective is to evaluate a body and movement-oriented intervention on aggression regulation, specifically aimed towards reducing anger internalization in patients with an eating disorder. MethodPatients were randomized to treatment-as-usual (TAU) plus the intervention (n=38) or to TAU

  15. Antibiotic policy

    OpenAIRE

    Gyssens, Inge

    2011-01-01

    There is a clear association between antibiotic use and resistance both on individual and population levels. In the European Union, countries with large antibiotic consumption have higher resistance rates. Antibiotic resistance leads to failed treatments, prolonged hospitalisations, increased costs and deaths. With few new antibiotics in the Research & Development pipeline, prudent antibiotic use is the only option to delay the development of resistance. Antibiotic policy consists of prescrib...

  16. CANVAS 1 and 2: analysis of clinical response at day 3 in two phase 3 trials of ceftaroline fosamil versus vancomycin plus aztreonam in treatment of acute bacterial skin and skin structure infections.

    Science.gov (United States)

    Friedland, H David; O'Neal, Tanya; Biek, Donald; Eckburg, Paul B; Rank, Douglas R; Llorens, Lily; Smith, Alex; Witherell, Gary W; Laudano, Joseph B; Thye, Dirk

    2012-05-01

    Scientific and regulatory interest in assessing clinical endpoints after 48 to 72 h of treatment for acute bacterial skin and skin structure infections (ABSSSI) has increased. Historical, pre-antibiotic-era data suggest that a treatment effect relative to untreated controls can be discerned in this time interval. Ceftaroline fosamil, a broad-spectrum bactericidal cephalosporin with activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA), and Gram-negative organisms was efficacious in two phase 3 trials of complicated skin infections (CANVAS 1 and 2) using clinical cure rates at the test-of-cure visit. To assess an early clinical response in the CANVAS trials, a retrospective analysis using a day 3 clinical endpoint was conducted. Adults with ABSSSI received intravenous ceftaroline fosamil at 600 mg every 12 h (q12h) or vancomycin at 1 g plus aztreonam at 1 g (V/A) q12h for 5 to 14 days. Clinical response at day 3, defined as cessation of infection spread and absence of fever, was analyzed in patients with a lesion size of ≥ 75 cm(2) and either deep and/or extensive cellulitis, major abscess, or an infected wound. Day 3 integrated CANVAS clinical response rates were 74.0% (296/400) for ceftaroline and 66.2% (263/397) for V/A (difference, 7.8%; 95% confidence interval [CI], 1.3% to 14.0%). In the individual studies, absolute treatment differences of 9.4% (CANVAS 1) and 5.9% (CANVAS 2) favoring ceftaroline were observed. For ABSSSI due to MRSA, response rates were 81.7% and 77.4% in the ceftaroline and V/A groups, respectively. In this retrospective analysis, ceftaroline fosamil monotherapy had a numerically higher clinical response than V/A at day 3 in the treatment of ABSSSI.

  17. Water Governance Decentralisation and River Basin Management Reforms in Hierarchical Systems: Do They Work for Water Treatment Policy in Mexico’s Tlaxcala Atoyac Sub-Basin?

    Directory of Open Access Journals (Sweden)

    Cesar Casiano Flores

    2016-05-01

    Full Text Available In the last decades, policy reforms, new instruments development, and economic resources investment have taken place in water sanitation in Mexico; however, the intended goals have not been accomplished. The percentage of treated wastewater as intended in the last two federal water plans has not been achieved. The creation of River Basin Commissions and the decentralisation process have also faced challenges. In the case of Tlaxcala, the River Basin Commission exists only on paper and the municipalities do not have the resources to fulfil the water treatment responsibilities transferred to them. This lack of results poses the question whether the context was sufficiently considered when the reforms were enacted. In this research, we will study the Tlaxcala Atoyac sub-basin, where water treatment policy reforms have taken place recently with a more context sensitive approach. We will apply the Governance Assessment Tool in order to find out whether the last reforms are indeed apt for the context. The Governance Assessment Tool includes four qualities, namely extent, coherence, flexibility, and intensity. The assessment allows deeper understanding of the governance context. Data collection involved semi-structured in-depth interviews with stakeholders. The research concludes that the observed combination of qualities creates a governance context that partially supports the implementation of the policy. This has helped to increase the percentage of wastewater treated, but the water quality goals set by the River Classification have not been achieved. With the last reforms, in this hierarchical context, decreasing the participation of municipal government levels has been shown to be instrumental for improving water treatment plants implementation policy, although many challenges remain to be addressed.

  18. Efficacy and safety of topical oxymetazoline cream 1.0% for treatment of persistent facial erythema associated with rosacea: findings from the 2 phase 3, 29-day, randomized, controlled REVEAL trials.

    Science.gov (United States)

    Stein-Gold, Linda; Kircik, Leon H; Draelos, Zoe Diane; Werschler, Philip; DuBois, Janet; Lain, Edward; Baumann, Leslie; Goldberg, David J; Kaufman, Joely; Tanghetti, Emil A; Alvandi, Nancy; Weng, Emily; Berk, David R; Ahluwalia, Gurpreet

    2018-01-31

    Rosacea is a chronic dermatologic condition with limited treatment options. To evaluate topical oxymetazoline cream 1.0% in patients with moderate-to-severe persistent erythema of rosacea. Data were pooled from 2 identically designed phase 3 trials. Patients were randomized to receive oxymetazoline or vehicle once daily for 29 days and were followed for 28 days after treatment. The primary efficacy outcome was the proportion of patients with a 2-grade or greater improvement from baseline on both the Clinician Erythema Assessment (CEA) and Subject Self-Assessment for rosacea facial redness (SSA) at 3, 6, 9, and 12 hours after the dose on day 29. The pooled population included 885 patients (78.8% of whom were female); 85.8% and 91.2% had moderate erythema according to the CEA and SSA, respectively. The primary outcome was achieved by significantly more patients in the oxymetazoline group than in the vehicle group (P < .001). Individual CEA and SSA scores and reduction in facial erythema (digital image analysis) favored oxymetazoline over vehicle (P < .001). The incidence of treatment-emergent adverse events was low (with oxymetazoline, 16.4%; with vehicle, 11.8%). No clinically relevant worsening of erythema (based on the CEA and SSA) was observed during the 28-day post-treatment follow-up period (with oxymetazoline, 1.7%; with vehicle, 0.6%). Short-term treatment period. Oxymetazoline effectively reduced moderate-to-severe persistent facial erythema of rosacea and was well tolerated. Copyright © 2018 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  19. Short-term intensive psychodynamic group therapy versus cognitive-behavioral group therapy in day treatment of anxiety disorders and comorbid depressive or personality disorders: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Suszek, Hubert; Holas, Paweł; Wyrzykowski, Tomasz; Lorentzen, Steinar; Kokoszka, Andrzej

    2015-07-29

    Psychodynamic and cognitive-behavioral group therapies are frequently applied in day hospitals for the treatment of anxiety disorders and comorbid depressive or personality disorders in Poland and other Eastern European countries. Yet there is not enough evidence as to their effectiveness in this environment; this study addresses this gap. The aim of the study is to determine the effectiveness of these two kinds of day treatment care consisting of intensive, short-term group psychodynamic and cognitive-behavioral therapy, for patients with anxiety disorders and/or comorbid depressive or personality disorders. Our objectives are to: 1) show the effectiveness of each treatment in a day-care setting relative to the wait-list control group; 2) demonstrate the relative short- and long-term effectiveness of the two active treatments; 3) carry out a preliminary examination of the predictors and moderators of treatment response; 4) carry out a preliminary examination of the mediators of therapeutic change; and 5) compare the impact of both methods of treatment on the outcome of the measures used in this study. In this randomized controlled trial, a total of 199 patients with anxiety disorders and comorbid depressive and/or personality disorders will be assigned to one of three conditions: 1) psychodynamic group therapy; 2) cognitive-behavioral group therapy; or 3) wait-list control group. The therapy will last 12 weeks. Both treatments will be manualized (the manuals will address comorbidity). Primary outcome measures will include self-reported symptoms of anxiety, observer-rated symptoms of anxiety, global improvement, and recovery rate. Secondary outcome measures will include the number of pathological personality traits, depression, self-esteem, defense mechanisms, beliefs about self and others, interpersonal problems, object relations, parental bonding, meta-cognition, and quality of life. Measures will be taken at baseline, post-treatment, and at six months following

  20. Effectiveness of self-esteem and social skills group therapy in adolescent eating disorder patients attending a day hospital treatment programme.

    Science.gov (United States)

    Lázaro, L; Font, E; Moreno, E; Calvo, R; Vila, M; Andrés-Perpiñá, S; Canalda, G; Martínez, E; Castro-Fornieles, J

    2011-01-01

    To evaluate self-esteem and social skills in adolescent eating disorder patients before and after specific group therapy as part of a Day Hospital Programme. One hundred and sixty adolescent eating disorder patients, classified as anorexia nervosa and related disorders (AN-rd) (N = 116) or bulimia nervosa and related disorders (BN-rd) (N = 44) received structured group therapy for developing self-esteem and social skills. BN-rd patients had poorer perceptions of some self-esteem and social skills variables. After group therapy, both groups presented significant improvements in their perceptions of physical appearance, their self-concept related to weight and shape and to others, happiness and satisfaction, social withdrawal and leadership. BN-rd patients presented more changes on many of the variables. Specific self-esteem and social skills group therapy in patients with eating disorders can be useful in improving certain core features. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

  1. The predictive value of treatment response using FDG PET performed on day 21 of chemoradiotherapy in patients with oesophageal squamous cell carcinoma. A prospective, multicentre study (RTEP3)

    International Nuclear Information System (INIS)

    Palie, Odre; Vera, Pierre; Michel, Pierre; Di Fiore, Frederic; Menard, Jean-Francois; Rousseau, Caroline; Bridji, Boumediene; Rio, Emmanuel; Benyoucef, Ahmed; Meyer, Marc-Etienne; Jalali, Khadija; Bardet, Stephane; M'Vondo, Che Mabubu; Olivier, Pierre; Faure, Guillaume; Itti, Emmanuel; Diana, Christian; Houzard, Claire; Mornex, Francoise

    2013-01-01

    FDG PET has been suggested to have predictive value in the prognosis of oesophageal carcinoma. However, the retrospective studies reported in the literature have shown discordant results. Additionally, only four studies have evaluated FDG PET during chemoradiotherapy (CRT) in patients with different histological lesions. The purpose of this study was to investigate the predictive value of FDG PET performed early during CRT (on day 21) in a population of patients with oesophageal squamous cell carcinoma. Included in this prospective study were 57 patients with a histological diagnosis of squamous cell carcinoma of the oesophagus. Of these 57 patients, 48 (84 %) were evaluated (aged 63 ± 11 years; 44 men, 4 women). Each patient underwent FDG PET (4.5 MBq/kg) before CRT, according to the Herskovic protocol (t0; PET 1 ) and on day 21 ± 3 from the start of CRT (d21; PET 2 ). The response assessment included a clinical examination, CT scan or FDG PET and histological analysis 3 months and 1 year after PET 1 . The patients were classified as showing a complete response (CR) or a noncomplete response. A quantitative analysis was carried out for PET 1 and PET 2 using the following parameters: SUVmax, SUVmean (with SUVmean 40 as the 3-D volume at an SUVmax threshold of 40 % and SUVmean p as that defined by a physician), tumour volume (TV, with TV 40 defined as the TV at 40 % of SUVmax, and TV p as that defined by a physician); and the total lesion glycolysis (TLG, SUVmean x TV, with TLG 40 defined as the TLG at 40 % of SUVmax, and TLG p as that defined by a physician). The differences in responses at 3 months and 1 year between PET 1 (t0) and PET 2 (d21) were assessed in terms of variations in SUV, TV and TLG using a repeated measures of variance (ANOVA). SUVmax, SUVmean and TLG decreased significantly between PET 1 (t0) and PET 2 (d21; p p (p = 0.02); TV 40 did not decrease significantly. With respect to the predictive value of PET 1 , only TV 40 1 and TV p 1 values, and

  2. Provider knowledge of treatment policy and dosing regimen with artemether-lumefantrine and quinine in malaria-endemic areas of western Kenya.

    Science.gov (United States)

    Watsierah, Carren A; Onyango, Rosebella O; Ombaka, James H; Abong'o, Benard O; Ouma, Collins

    2012-12-29

    Due to widespread anti-malarial drug resistance in many countries, Kenya included, artemisinin-based Combination Therapy (ACT) has been adopted as the most effective treatment option against malaria. Artemether-lumefantrine (AL) is the first-line ACT for treatment of uncomplicated malaria in Kenya, while quinine is preferred for complicated and severe malaria. Information on the providers' knowledge and practices prior to or during AL and quinine implementation is scanty. The current study evaluated providers' knowledge and practices of treatment policy and dosing regimens with AL and quinine in the public, private and not-for-profit drug outlets. A cross-sectional survey using three-stage sampling of 288 (126 public, 96 private and 66 not-for-profits) providers in drug outlets was conducted in western Kenya in two Plasmodium falciparum-endemic regions with varying malarial risk. Information on provider in-service training, knowledge (qualification, treatment policy, dosing regimen, recently banned anti-malarials) and on practices (request for written prescription, prescription of AL, selling partial packs and advice given to patients after prescription), was collected. Only 15.6% of providers in private outlets had received any in-service training on AL use. All (100%) in public and majority (98.4%) in not-for-profit outlets mentioned AL as first line-treatment drug. Quinine was mentioned as second-line drug by 47.9% in private outlets. A total of 92.0% in public, 57.3% in private and 78.8% in not-for-profit outlets stated correct AL dose for adults. A total of 85.7% of providers in public, 30.2% in private and 41.0% in not-for-profit outlets were aware that SP recommendations changed from treatment for mild malaria to IPTp in high risk areas. In-service training influenced treatment regimen for uncomplicated malaria (P = 0.039 and P = 0.039) and severe malaria (P < 0.0001 and P = 0.002) in children and adults, respectively. Most (82.3%) of private

  3. Provider knowledge of treatment policy and dosing regimen with artemether-lumefantrine and quinine in malaria-endemic areas of western Kenya

    Directory of Open Access Journals (Sweden)

    Watsierah Carren A

    2012-12-01

    Full Text Available Abstract Background Due to widespread anti-malarial drug resistance in many countries, Kenya included, artemisinin-based Combination Therapy (ACT has been adopted as the most effective treatment option against malaria. Artemether-lumefantrine (AL is the first-line ACT for treatment of uncomplicated malaria in Kenya, while quinine is preferred for complicated and severe malaria. Information on the providers’ knowledge and practices prior to or during AL and quinine implementation is scanty. The current study evaluated providers’ knowledge and practices of treatment policy and dosing regimens with AL and quinine in the public, private and not-for-profit drug outlets. Methods A cross-sectional survey using three-stage sampling of 288 (126 public, 96 private and 66 not-for-profits providers in drug outlets was conducted in western Kenya in two Plasmodium falciparum-endemic regions with varying malarial risk. Information on provider in-service training, knowledge (qualification, treatment policy, dosing regimen, recently banned anti-malarials and on practices (request for written prescription, prescription of AL, selling partial packs and advice given to patients after prescription, was collected. Results Only 15.6% of providers in private outlets had received any in-service training on AL use. All (100% in public and majority (98.4% in not-for-profit outlets mentioned AL as first line-treatment drug. Quinine was mentioned as second-line drug by 47.9% in private outlets. A total of 92.0% in public, 57.3% in private and 78.8% in not-for-profit outlets stated correct AL dose for adults. A total of 85.7% of providers in public, 30.2% in private and 41.0% in not-for-profit outlets were aware that SP recommendations changed from treatment for mild malaria to IPTp in high risk areas. In-service training influenced treatment regimen for uncomplicated malaria (P = 0.039 and P = 0.039 and severe malaria (P P = 0.002 in children and adults

  4. Environmental impact assessment and end-of-life treatment policy analysis for Li-ion batteries and Ni-MH batteries.

    Science.gov (United States)

    Yu, Yajuan; Chen, Bo; Huang, Kai; Wang, Xiang; Wang, Dong

    2014-03-18

    Based on Life Cycle Assessment (LCA) and Eco-indicator 99 method, a LCA model was applied to conduct environmental impact and end-of-life treatment policy analysis for secondary batteries. This model evaluated the cycle, recycle and waste treatment stages of secondary batteries. Nickel-Metal Hydride (Ni-MH) batteries and Lithium ion (Li-ion) batteries were chosen as the typical secondary batteries in this study. Through this research, the following results were found: (1) A basic number of cycles should be defined. A minimum cycle number of 200 would result in an obvious decline of environmental loads for both battery types. Batteries with high energy density and long life expectancy have small environmental loads. Products and technology that help increase energy density and life expectancy should be encouraged. (2) Secondary batteries should be sorted out from municipal garbage. Meanwhile, different types of discarded batteries should be treated separately under policies and regulations. (3) The incineration rate has obvious impact on the Eco-indicator points of Nickel-Metal Hydride (Ni-MH) batteries. The influence of recycle rate on Lithium ion (Li-ion) batteries is more obvious. These findings indicate that recycling is the most promising direction for reducing secondary batteries' environmental loads. The model proposed here can be used to evaluate environmental loads of other secondary batteries and it can be useful for proposing policies and countermeasures to reduce the environmental impact of secondary batteries.

  5. The Treatment of Possible Severe Infection in Infants: An Open Randomized Safety Trial of Parenteral Benzylpenicillin and Gentamicin Versus Ceftriaxone in Infants <60 days of Age in Malawi.

    Science.gov (United States)

    Molyneux, Elizabeth M; Dube, Queen; Banda, Francis M; Chiume, Msandeni; Singini, Isaac; Mallewa, Macpherson; Schwalbe, Edward C; Heyderman, Robert S

    2017-12-01

    The World Health Organization recommends benzylpenicillin and gentamicin as antimicrobial treatment for infants with sepsis in low-income settings, and ceftriaxone or cefotaxime as an alternative. In a meta-analysis from 13 low-income settings, Staphylococcus aureus, Klebsiella spp. and Escherichia coli accounted for 55% of infants with sepsis. In a review of bacterial meningitis, resistance to third generation cephalosporins was >50% of all isolates, and 44% of Gram-negative isolates were gentamicin resistant. However, ceftriaxone may cause neonatal jaundice, and gentamicin may cause deafness. Therefore, we compared parenteral benzylpenicillin plus gentamicin with ceftriaxone as first-line treatment, assessing outcome and adverse events. This was an open randomized trial carried out in the Queen Elizabeth Central Hospital, Blantyre, Malawi, from 2010 to 2013. Infants ceftriaxone. Adverse events and outcomes were recorded until 6 months post discharge. Three-hundred forty-eight infants were included in analyses. Outcome in the benzylpenicillin and gentamicin and ceftriaxone groups was similar; deaths were 13.7% and 16.5% and sequelae were 14.5% and 11.2%, respectively. More infants in the penicillin/gentamicin group required phototherapy: 15% versus 5%, P = 0.03. Thirteen (6%) survivors had bilateral hearing loss. There was no difference between the treatment groups. By 6 months post discharge, 11 more infants had died, and 17 more children were found to have sequelae. Ceftriaxone and gentamicin are safe for infants in our setting. Infants should receive long-term follow-up as many poor outcomes occurred after hospital discharge.

  6. Spillover effects of HIV testing policies: changes in HIV testing guidelines and HCV testing practices in drug treatment programs in the United States

    Directory of Open Access Journals (Sweden)

    Jemima A. Frimpong

    2016-07-01

    Full Text Available Abstract Background To examine the extent to which state adoption of the Centers for Disease Control and Prevention (CDC 2006 revisions to adult and adolescent HIV testing guidelines is associated with availability of other important prevention and medical services. We hypothesized that in states where the pretest counseling requirement for HIV testing was dropped from state legislation, substance use disorder treatment programs would have higher availability of HCV testing services than in states that had maintained this requirement. Methods We analyzed a nationally representative sample of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey (NDATSS. Data were collected from program directors and clinical supervisors through telephone surveys. Multivariate logistic regression models were used to measure associations between state adoption of CDC recommended guidelines for HIV pretest counseling and availability of HCV testing services. Results The effects of HIV testing legislative changes on HCV testing practices varied by type of opioid treatment program. In states that had removed the requirement for HIV pretest counseling, buprenorphine-only programs were more likely to offer HCV testing to their patients. The positive spillover effect of HIV pretest counseling policies, however, did not extend to methadone programs and did not translate into increased availability of on-site HCV testing in either program type. Conclusions Our findings highlight potential positive spillover effects of HIV testing policies on HCV testing practices. They also suggest that maximizing the benefits of HIV policies may require other initiatives, including resources and programmatic efforts that support systematic integration with other services and effective implementation.

  7. Orthopaedics in day surgery

    African Journals Online (AJOL)

    emergency patients for a surgical procedure, returning home the same day (1). Ambulatory orthopaedics happens to have double meaning, so in this communication day surgery will be the preferred term. In Kenya the three models of day.

  8. The predictive value of treatment response using FDG PET performed on day 21 of chemoradiotherapy in patients with oesophageal squamous cell carcinoma. A prospective, multicentre study (RTEP3)

    Energy Technology Data Exchange (ETDEWEB)

    Palie, Odre; Vera, Pierre [Henri Becquerel Cancer Center and Rouen University Hospital, and QuantIF - LITIS (EA 4108), University of Rouen, Department of Nuclear Medicine, Faculty of Medicine, Rouen (France); Michel, Pierre; Di Fiore, Frederic [Rouen University Hospital and University of Rouen, Digestive Oncology Unit, Hepatogastroenterology Department, Rouen (France); Menard, Jean-Francois [Rouen University Hospital and University of Rouen, Department of Biostatistic, Rouen (France); Rousseau, Caroline; Bridji, Boumediene [Department of Nuclear Medicine, Renee Gauducheau Cancer Center, Nantes (France); Rio, Emmanuel [Department of Radiotherapy, Renee Gauducheau Cancer Center, Nantes (France); Benyoucef, Ahmed [Department of Radiotherapy, Henri Becquerel Cancer Center, Rouen (France); Meyer, Marc-Etienne [Amiens University Hospital, Department of Nuclear Medicine, Amiens (France); Jalali, Khadija [Amiens University Hospital, Department of Radiotherapy, Amiens (France); Bardet, Stephane [Department of Nuclear Medicine, Francois Baclesse Cancer Center, Caen (France); M' Vondo, Che Mabubu [Department of radiotherapy, Francois Baclesse Cancer Center, Caen (France); Olivier, Pierre [Brabois University Hospital, Department of Nuclear Medicine, Nancy (France); Faure, Guillaume [Department of Radiotherapy, Centre prive de Radiotherapie de Metz, Metz (France); Itti, Emmanuel [Henri Mondor University Hospital, Department of Nuclear Medicine, Creteil (France); Diana, Christian [Henri Mondor University Hospital, Department of Radiotherapy, Creteil (France); Houzard, Claire [Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon (France); Mornex, Francoise [Department of Radiotherapy, Hospices Civils de Lyon, Lyon (France)

    2013-09-15

    FDG PET has been suggested to have predictive value in the prognosis of oesophageal carcinoma. However, the retrospective studies reported in the literature have shown discordant results. Additionally, only four studies have evaluated FDG PET during chemoradiotherapy (CRT) in patients with different histological lesions. The purpose of this study was to investigate the predictive value of FDG PET performed early during CRT (on day 21) in a population of patients with oesophageal squamous cell carcinoma. Included in this prospective study were 57 patients with a histological diagnosis of squamous cell carcinoma of the oesophagus. Of these 57 patients, 48 (84 %) were evaluated (aged 63 {+-} 11 years; 44 men, 4 women). Each patient underwent FDG PET (4.5 MBq/kg) before CRT, according to the Herskovic protocol (t0; PET{sub 1}) and on day 21 {+-} 3 from the start of CRT (d21; PET{sub 2}). The response assessment included a clinical examination, CT scan or FDG PET and histological analysis 3 months and 1 year after PET{sub 1}. The patients were classified as showing a complete response (CR) or a noncomplete response. A quantitative analysis was carried out for PET{sub 1} and PET{sub 2} using the following parameters: SUVmax, SUVmean (with SUVmean{sub 40} as the 3-D volume at an SUVmax threshold of 40 % and SUVmean{sub p} as that defined by a physician), tumour volume (TV, with TV{sub 40} defined as the TV at 40 % of SUVmax, and TV{sub p} as that defined by a physician); and the total lesion glycolysis (TLG, SUVmean x TV, with TLG{sub 40} defined as the TLG at 40 % of SUVmax, and TLG{sub p} as that defined by a physician). The differences in responses at 3 months and 1 year between PET{sub 1} (t0) and PET{sub 2} (d21) were assessed in terms of variations in SUV, TV and TLG using a repeated measures of variance (ANOVA). SUVmax, SUVmean and TLG decreased significantly between PET{sub 1} (t0) and PET{sub 2} (d21; p < 0.0001). The TV significantly decreased only when assessed

  9. IBD Around the world: comparing the epidemiology, diagnosis, and treatment: proceedings of the World Digestive Health Day 2010--Inflammatory Bowel Disease Task Force meeting.

    Science.gov (United States)

    Baumgart, Daniel C; Bernstein, Charles N; Abbas, Zaigham; Colombel, Jean F; Day, Andrew S; D'Haens, Geert; Dotan, Iris; Goh, Khean L; Hibi, Toshifumi; Kozarek, Richard A; Quigley, Eamonn M M; Reinisch, Walter; Sands, Bruce E; Sollano, Jose D; Steinhart, A Hillary; Steinwurz, Flávio; Vatn, Morten H; Yamamoto-Furusho, Jesús K

    2011-02-01

    Every May 29th the World Gastroenterology Organization (WGO) celebrates World Digestive Health Day (WDHD) and initiates a worldwide public health campaign through its 110 national societies and 50,000 members. Each year focuses on a particular digestive disorder in order to increase general public awareness of prevention and therapy. 2010 is dedicated to inflammatory bowel disease (IBD). Upon this occasion a WGO IBD task force was compiled from leading international specialists and researchers. The task force also included members of the American Gastroenterological Association (AGA), International Organization for the Study of Inflammatory Diseases (IOIBD) and the European Crohn's and Colitis Organization (ECCO) of the United European Gastroenterology Federation (UEGF). The goal of the task force was to bring together IBD specialists from around the world to discuss the epidemiology, diagnosis, and management of IBD within different regions. This is a summary of the WGO task force meeting at the American Gastroenterological Association's (AGA) Digestive Disease Week, held in New Orleans, Louisiana, USA, May, 2010. The expert panel identified the most pressing issues in IBD worldwide: reliable epidemiological data, global collaboration in clinical and basic research, the approach to distinguishing intestinal tuberculosis from Crohn's disease, access to specialist care and access to the latest diagnostic and therapeutic strategies.

  10. Effects of a 5-day treatment with the UV-filter octyl-methoxycinnamate (OMC) on the function of the hypothalamo-pituitary-thyroid function in rats.

    Science.gov (United States)

    Klammer, Holger; Schlecht, Christiane; Wuttke, Wolfgang; Schmutzler, Cornelia; Gotthardt, Inka; Köhrle, Josef; Jarry, Hubertus

    2007-09-05

    Octyl-methoxycinnamate (OMC) is one of the most frequently used UV-filters in sunscreens to protect the skin against the noxious influence of UV radiation. Recently, OMC was suspected to act as an "endocrine active chemical" (EAC) with estrogenic actions. While EACs have been investigated thoroughly for interference with reproductive function in mammalians, surprisingly little efforts have been made to investigate an interference of EACs with the hypothalamo-pituitary-thyroid (HPT) axis despite the expression of estrogen receptors in all parts of this axis. Therefore, we conducted an in vivo study with ovariectomised rats treated for 5 days with different doses of OMC or 17beta-estradiol (E2) as a control. Determined parameters comprised serum levels of TSH, T4 and T3, hypothalamic TRH mRNA expression, protein-expression of the sodium-iodide-symporter (NIS) and the TSH receptor and the activities of thyroid peroxidase (TPO) in the thyroid and the T3-responsive hepatic type I 5'deiodinase (Dio1) in the liver. While E2 did not affect TSH-, T4- or T3-levels, OMC caused a dose-dependent decrease of serum concentrations of all of these hormones. TRH expression remained unaffected, while in the thyroid, expression of the TSH receptor but not of NIS was stimulated by OMC. TPO activity was unaltered but Dio1 activity was reduced by OMC. Thus, our results demonstrate a non-estrogenic interference of OMC within the rodent HPT axis with inadequate feedback response to impaired thyroid hormone status, indicated by decreased serum thyroid hormone and hepatic Dio1 levels.

  11. Effects of a 5-day treatment with the UV-filter octyl-methoxycinnamate (OMC) on the function of the hypothalamo-pituitary-thyroid function in rats

    International Nuclear Information System (INIS)

    Klammer, Holger; Schlecht, Christiane; Wuttke, Wolfgang; Schmutzler, Cornelia; Gotthardt, Inka; Koehrle, Josef; Jarry, Hubertus

    2007-01-01

    Octyl-methoxycinnamate (OMC) is one of the most frequently used UV-filters in sunscreens to protect the skin against the noxious influence of UV radiation. Recently, OMC was suspected to act as an 'endocrine active chemical' (EAC) with estrogenic actions. While EACs have been investigated thoroughly for interference with reproductive function in mammalians, surprisingly little efforts have been made to investigate an interference of EACs with the hypothalamo-pituitary-thyroid (HPT) axis despite the expression of estrogen receptors in all parts of this axis. Therefore, we conducted an in vivo study with ovariectomised rats treated for 5 days with different doses of OMC or 17β-estradiol (E2) as a control. Determined parameters comprised serum levels of TSH, T4 and T3, hypothalamic TRH mRNA expression, protein-expression of the sodium-iodide-symporter (NIS) and the TSH receptor and the activities of thyroid peroxidase (TPO) in the thyroid and the T3-responsive hepatic type I 5'deiodinase (Dio1) in the liver. While E2 did not affect TSH-, T4- or T3-levels, OMC caused a dose-dependent decrease of serum concentrations of all of these hormones. TRH expression remained unaffected, while in the thyroid, expression of the TSH receptor but not of NIS was stimulated by OMC. TPO activity was unaltered but Dio1 activity was reduced by OMC. Thus, our results demonstrate a non-estrogenic interference of OMC within the rodent HPT axis with inadequate feedback response to impaired thyroid hormone status, indicated by decreased serum thyroid hormone and hepatic Dio1 levels

  12. Ideology, Family Policy, Production, and (ReEducation: Literary Treatment of Abortion in the GDR of the Early 1980s

    Directory of Open Access Journals (Sweden)

    Heinz Bulmahn

    1997-06-01

    Full Text Available The decision by the Constitutional Court in Karlsruhe of placing restrictions on the right to an abortion will profoundly affect German women's right to choose. This decision is a culmination of efforts to errode the right to choose for West as well as East German women. In the former GDR, even though liberal abortion laws allowed women access to free abortions, for ideological reasons, the government devised policies that discouraged abortions as a means of birth control. This policy becomes particularly apparent in the early 1980s when the East German government, confronted with a declining birth rate, faced the dilemma of how to leave the existing liberal abortion law intact while discouraging women from aborting their fetuses. To accomplish this task officials persuaded writers to produce literary works that promoted a three-child family policy where abortion was relegated to an inappropriate option. The article analyzes several literary works written in the early 1980s within the context of this renewed effort to encourage women to produce more children at the expense of their personal choice, and concludes that, in spite of the liberal abortion rights in the former GDR, the conditions for exercising these rights proved to be far less favorable.

  13. Does Prior Antiplatelet Treatment Increase the Risk of Hemorrhagic Transformation and Unfavorable Outcome on Day 90 after Intravenous Thrombolysis in Acute Ischemic Stroke Patients?

    Science.gov (United States)

    Chen, Siyan; Lu, Xia; Zhang, Wanli; Han, Zhao; Yang, Wen; Huang, Xuerong; Jin, Xiaoping; Wang, Zhimin; Liang, Haiyan; Qiu, Weiwen; Cheng, Jianhua; Shao, Bei

    2016-06-01

    The effect of prior antiplatelet (AP) therapy on the risk of hemorrhagic transformation (HT), and on functional outcomes of acute ischemic stroke (AIS) after intravenous thrombolysis (IVT), is not known. We performed a retrospective analysis to determine whether history of AP therapy is associated with post-thrombolysis HT and poor prognosis in AIS patients. Data pertaining to 145 patients with AIS, who underwent IVT between October 2008 and January 2015, were analyzed. The patients were divided into 2 groups based on whether or not they had received prior AP therapy. Neurological outcomes at 24 hours and 3 months after IVT therapy were assessed. Intergroup difference in cost of treatment was also evaluated. A multivariate logistic regression model was used to identify independent predictors of post-thrombolysis HT. Among 145 patients, 23 (15.8%) had received prior AP therapy. On multivariate analyses, older age (odds ratio [OR]: 1.084; confidence interval [CI], 1.028-1.144) and prior AP therapy (OR: 3.318; CI, 1.172-9.398) were found to be independent predictors of HT. In this study, prior AP therapy was independently associated with post-thrombolysis HT in AIS. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Disclosing details about the medical treatment of a deceased public figure in a book: Who should have consented to the disclosures in Mandela's Last Days?

    Science.gov (United States)

    McQuoid-Mason, D J

    2017-11-27

    A recently published book by the head of Nelson Mandela's medical team made personal disclosures about his treatment of the late president in his final years up until his death. The author claimed that he had written the book at the request of family members. This was contested by some family members and the executors of Mandela's estate, and the book was subsequently withdrawn by the publishers. The Mandela book case raises ethical and legal questions about who should consent to publication of medical information about public figures after their death. The ethical rules of conduct of the Health Professions Council of South Africa (HPCSA) state that confidential information about a deceased person should only be divulged 'with the written consent of his or her next of kin or the executor of his or her estate'. 'Next of kin' is not defined, however, and problems arise when family members and the executors are divided about giving such written consent. It is recommended that in such cases the specific order of priority for consent by relatives in the National Health Act be followed. However, conduct that is unethical under the rules of the HPCSA may not necessarily be actionable under the law. For instance, the law does not protect the confidentiality of deceased persons, and generally when people die their constitutional and common-law personality rights - including their right to privacy and confidentiality - die with them. This means that the next of kin or executors of the estates of deceased persons may not bring actions for damages on behalf of such persons for breaches of confidentiality arising after their deaths. The next of kin may, however, sue in their personal capacity if they can show that the disclosures were an unlawful invasion of their own privacy. Conversely, if the privacy of interests of the next of kin are not harmed where there has been publication without their consent, they will not be able to sue for damages.

  15. Trends in malaria case management following changes in the treatment policy to artemisinin combination therapy at the Mbakong Health Centre, Cameroon 2006-2012: a retrospective study.

    Science.gov (United States)

    Ndong, Ignatius C; Reenen, Mari van; Boakye, Daniel A; Mbacham, Wilfred F; Grobler, Anne F

    2015-10-01

    National malaria treatment policies are devised to guide health professionals and to facilitate diagnosis and case management. Following the recommendations of the WHO, Cameroon changed its malaria treatment policy from monotherapy to artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. We report an investigation into trends of case management following this change in policy. Data was collected retrospectively, through consultation and perusal of laboratory and prescription registers of the Mbakong Health Centre. Analysis of data was done using SPSS and SAS Statistics. Data presented herein demonstrate that from 2006 to 2012, a total of 2484 (58.7%) of the total prescriptions included an anti-malarial, 1989 (47.0%) included an antibiotic and 1935(45.7%) included an antipyretic. The anti-malarials prescribed were Anti-malaria combination therapy (ACT) - 1216 (47.6%), quinine 1044 (40.8%) or SP 296 (11.6%). Of the 1216 patients prescribed an ACT, 441(36.3%) had a positive malaria parasite confirmation, 746 (61.3%) were negative for plasmodium. Overall, 29 patients (2.4%) were treated either with an ACT without any test performed. Quinine intake was recorded in 566 (54.2%) patients positive for plasmodium. ACT prescription increased from 23% in 2007 to between 44 and 45% in 2008-2009. During this period there was a corresponding drop in the prescription of quinine from 38% in 2007 to 13% in 2009 (r=-0.43, p>0.05). Sulphadoxine-Pyrimethamine (SP) was restrictively prescribed to women of childbearing age (97.0%) after 2008. Antibiotics prescription dropped from 53.7% to 39.3% from 2010 to 2012. The odds of being prescribed an antibiotic was significantly higher in patients with a malaria negative result compared to malaria positive patients (OR=6.12, CI 4.74-7.91, p<0.00001). Overall, there is an over treatment of malaria, thus departing from the WHO guidelines of appropriate treatment. Although there is an overall increase

  16. Unacceptable treatment outcomes and associated factors among India's initial cohorts of multidrug-resistant tuberculosis (MDR-TB) patients under the revised national TB control programme (2007-2011): Evidence leading to policy enhancement.

    Science.gov (United States)

    Parmar, Malik M; Sachdeva, Kuldeep Singh; Dewan, Puneet K; Rade, Kiran; Nair, Sreenivas A; Pant, Rashmi; Khaparde, Sunil D

    2018-01-01

    Globally, India has the world's highest burden of multidrug-resistant tuberculosis (MDR-TB). Programmatic Management of Drug Resistant TB (PMDT) in India began in 2007 and nationwide coverage was achieved in early 2013. Poor initial microbiological outcomes under the Revised National Tuberculosis Control Programme (RNTCP) prompted detailed analysis. This is the first study on factors significantly associated with poor outcomes in MDR-TB patients treated under the RNTCP. To evaluate initial sputum culture conversion, culture reversion and final treatment outcomes among MDR-TB patients registered in India from 2007 to early 2011 who were treated with a standard 24-month regimen under daily-observed treatment. This is a retrospective cohort study. Clinical and microbiological data were abstracted from PMDT records. Initial sputum culture conversion, culture reversion and treatment outcomes were defined by country adaptation of the standard WHO definitions (2008). Cox proportional hazards modeling with logistic regression, multinomial logistic regression and adjusted odds ratio was used to evaluate factors associated with interim and final outcomes respectively, controlling for demographic and clinical characteristics. In the cohort of 3712 MDR-TB patients, 2735 (73.6%) had initial sputum culture conversion at 100 median days (IQR 92-125), of which 506 (18.5%) had culture reversion at 279 median days (IQR 202-381). Treatment outcomes were available for 2264 (60.9%) patients while 1448 (39.0%) patients were still on treatment or yet to have a definite outcome at the time of analysis. Of 2264 patients, 781 (34.5%) had treatment success, 644 (28.4%) died, 670 (29.6%) were lost to follow up, 169 (7.5%) experienced treatment failure or were changed to XDR-TB treatment. Factors significantly associated with either culture non-conversion, culture reversion and/or unfavorable treatment outcomes were baseline BMI TB patients, 62 (59.6%) had Ofloxacin resistance among whom only

  17. SU-E-J-73: Extension of a Clinical OIS/EMR/R&V System to Deliver Safe and Efficient Adaptive Plan-Of-The-Day Treatments Using a Fully Customizable Plan-Library-Based Workflow

    Energy Technology Data Exchange (ETDEWEB)

    Akhiat, A. [Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam (Netherlands); Elekta, Sunnyvale, CA (United States); Kanis, A.P.; Penninkhof, J.J.; Sodjo, S.; O’Neill, T.; Quint, S.; Doorn, X. van; Schillemans, W.; Heijmen, B.; Hoogeman, M. [Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam (Netherlands); Linton, N.; Coleman, A. [Elekta, Sunnyvale, CA (United States)

    2015-06-15

    Purpose: To extend a clinical Record and Verify (R&V) system to enable a safe and fast workflow for Plan-of-the-Day (PotD) adaptive treatments based on patient-specific plan libraries. Methods: Plan libraries for PotD adaptive treatments contain for each patient several pre-treatment generated treatment plans. They may be generated for various patient anatomies or CTV-PTV margins. For each fraction, a Cone Beam CT scan is acquired to support the selection of the plan that best fits the patient’s anatomy-of-the-day. To date, there are no commercial R&V systems that support PotD delivery strategies. Consequently, the clinical workflow requires many manual interventions. Moreover, multiple scheduled plans have a high risk of excessive dose delivery. In this work we extended a commercial R&V system (MOSAIQ) to support PotD workflows using IQ-scripting. The PotD workflow was designed after extensive risk analysis of the manual procedure, and all identified risks were incorporated as logical checks. Results: All manual PotD activities were automated. The workflow first identifies if the patient is scheduled for PotD, then performs safety checks, and continues to treatment plan selection only if no issues were found. The user selects the plan to deliver from a list of candidate plans. After plan selection, the workflow makes the treatment fields of the selected plan available for delivery by adding them to the treatment calendar. Finally, control is returned to the R&V system to commence treatment. Additional logic was added to incorporate off-line changes such as updating the plan library. After extensive testing including treatment fraction interrupts and plan-library updates during the treatment course, the workflow is running successfully in a clinical pilot, in which 35 patients have been treated since October 2014. Conclusion: We have extended a commercial R&V system for improved safety and efficiency in library-based adaptive strategies enabling a wide

  18. SU-E-J-73: Extension of a Clinical OIS/EMR/R&V System to Deliver Safe and Efficient Adaptive Plan-Of-The-Day Treatments Using a Fully Customizable Plan-Library-Based Workflow

    International Nuclear Information System (INIS)

    Akhiat, A.; Kanis, A.P.; Penninkhof, J.J.; Sodjo, S.; O’Neill, T.; Quint, S.; Doorn, X. van; Schillemans, W.; Heijmen, B.; Hoogeman, M.; Linton, N.; Coleman, A.

    2015-01-01

    Purpose: To extend a clinical Record and Verify (R&V) system to enable a safe and fast workflow for Plan-of-the-Day (PotD) adaptive treatments based on patient-specific plan libraries. Methods: Plan libraries for PotD adaptive treatments contain for each patient several pre-treatment generated treatment plans. They may be generated for various patient anatomies or CTV-PTV margins. For each fraction, a Cone Beam CT scan is acquired to support the selection of the plan that best fits the patient’s anatomy-of-the-day. To date, there are no commercial R&V systems that support PotD delivery strategies. Consequently, the clinical workflow requires many manual interventions. Moreover, multiple scheduled plans have a high risk of excessive dose delivery. In this work we extended a commercial R&V system (MOSAIQ) to support PotD workflows using IQ-scripting. The PotD workflow was designed after extensive risk analysis of the manual procedure, and all identified risks were incorporated as logical checks. Results: All manual PotD activities were automated. The workflow first identifies if the patient is scheduled for PotD, then performs safety checks, and continues to treatment plan selection only if no issues were found. The user selects the plan to deliver from a list of candidate plans. After plan selection, the workflow makes the treatment fields of the selected plan available for delivery by adding them to the treatment calendar. Finally, control is returned to the R&V system to commence treatment. Additional logic was added to incorporate off-line changes such as updating the plan library. After extensive testing including treatment fraction interrupts and plan-library updates during the treatment course, the workflow is running successfully in a clinical pilot, in which 35 patients have been treated since October 2014. Conclusion: We have extended a commercial R&V system for improved safety and efficiency in library-based adaptive strategies enabling a wide

  19. Modelling the relationship between antiretroviral treatment and HIV prevention: limitations of the Spectrum AIDS Impact Model in a changing policy environment.

    Science.gov (United States)

    Nattrass, Nicoli

    2007-08-01

    This paper shows how two publicly available epidemiological modelling packages, namely the Spectrum AIDS Impact Model and the ASSA2003 AIDS and Demographic Model, predict very different impacts from rolling out highly active antiretroviral treatment (HAART) on new HIV infections. Using South Africa as a case study, it shows that the ASSA2003 model predicts a significant drop in new HIV infections as HAART is rolled out, whereas the Spectrum model assumes that HAART does not have a preventative impact (and in fact generates a small increase in new HIV infections). Users will thus draw different conclusions about the public health benefits of HAART depending on which modelling package they use. Despite being presented as a policy-oriented modelling tool capable of exploring 'what if' questions about the impact of different policy choices, the Spectrum model is illequipped to do so with regard to a HAART rollout. Unlike Spectrum, ASSA2003 is more flexible and its assumptions are clear. Better modelling and more information (including about the relationship between HAART and sexual risk behaviour) is required to develop appropriate public-policy modelling for the HAART era.

  20. 'Cosmetic boob jobs' or evidence-based breast surgery: an interpretive policy analysis of the rationing of 'low value' treatments in the English National Health Service.

    Science.gov (United States)

    Russell, Jill; Swinglehurst, Deborah; Greenhalgh, Trisha

    2014-09-20

    In England the National Health Service (NHS) is not allowed to impose 'blanket bans' on treatments, but local commissioners produce lists of 'low value' procedures that they will normally not fund. Breast surgery is one example. However, evidence suggests that some breast surgery is clinically effective, with significant health gain. National guidelines indicate the circumstances under which breast surgery should be made available on the NHS, but there is widespread variation in their implementation.The purpose of this study was to explore the work practices of 'individual funding request' (IFR) panels, as they considered 'one-off' funding requests for breast surgery; examine how the notion of 'value' is dialogically constructed, and how decisions about who is deserving of NHS funding and who is not are accomplished in practice. We undertook ethnographic exploration of three IFR panels. We extracted all (22) breast surgery cases considered by these panels from our data set and progressively focused on three case discussions, one from each panel, covering the three main breast procedures.We undertook a microanalysis of the talk and texts arising from these cases, within a conceptual framework of interpretive policy analysis. Through an exploration of the symbolic artefacts (language, objects and acts) that are significant carriers of policy meaning, we identified the ways in which IFR panels create their own 'interpretive communities', within which deliberations about the funding of breast surgery are differently framed, and local decisions come to be justified. In particular, we demonstrated how each decision was contingent on [a] the evaluative accent given to certain words, [b] the work that documentary objects achieve in foregrounding particular concerns, and [c] the act of categorising. Meaning was constructed dialogically through local interaction and broader socio-cultural discourses about breasts and 'cosmetic' surgery. Despite the appeal of calls to tackle

  1. [Molecular markers for malaria drug resistance: necessary but not sufficient criteria to decide change in treatment policy].

    Science.gov (United States)

    Mbacham, W; Njikam, N

    2007-04-01

    Molecular markers or gene mutations that are associated with resistance have been the recent focus for an attempt to promptly determine the establishment of resistance to known and currently used antimalaria drugs. For control managers, the effective management of malaria would involve strategies of interruption of the malaria transmission and/or improved therapeutic management of malaria. To place molecular markers within the context of control programs requires that one recognises the two data pools necessary for effective evidence-based policy change. These include data on socio-economic determinants on the one hand and biomedical data on the other. The markers for clinical efficacy of drugs have principally been genes either associated with transport or metabolism of the drug. In malaria those that have been the most characterised are the Pfcrt, Pfmdrl for the quinolines and the dhfr and dhps genes for the anti-folates. The PfATPase has been suggested to be involved in the recently developed artermisinine based combination therapies (ACT). To consider changes in drug policy, a control manager needs to address: efficacy, transmissibility, disease dynamics, safety, epidemics, tolerability and compliance. Except for safety and tolerability/compliance, molecular markers do provide useful information. However these markers still have to be validated alongside in vitro studies and in many different ecological settings and shown to be stable over time or associated with changing drug efficacy situations. Besides the evidence provided with these tools, the government will be required to ensure a mass education of the population and care providers, and fight against illicit street vendors. The governments will therefore still wary on the resources necessary to occasion an effective switch in drug policy especially at the district level and in the rural areas where meaningful, cost-effective programs are most needed.

  2. Are pharmacological properties of anticoagulants reflected in pharmaceutical pricing and reimbursement policy? Out-patient treatment of venous thromboembolism and utilization of anticoagulants in Poland.

    Science.gov (United States)

    Bochenek, T; Czarnogorski, M; Nizankowski, R; Pilc, A

    2014-06-01

    Pharmacotherapy with vitamin K antagonists (VKA) and low-molecular-weight heparins (LMWH) is a major cost driver in the treatment of venous thromboembolism (VTE). Major representatives of anticoagulants in Europe include: acenocoumarol and warfarin (VKA), enoxaparin, dalteparin, nadroparin, reviparin, parnaparin and bemiparin (LMWH). Aim of this report is to measure and critically assess the utilization of anticoagulants and other resources used in the out-patient treatment of VTE in Poland. To confront the findings with available scientific evidence on pharmacological and clinical properties of anticoagulants. The perspectives of the National Health Fund (NHF) and the patients were adopted, descriptive statistics methods were used. The data were gathered at the NHF and the clinic specialized in treatment of coagulation disorders. Non-pharmacological costs of treatment were for the NHF 1.6 times higher with VKA than with LMWH. Daily cost of pharmacotherapy with LMWH turned out higher than with VKA (234 times for the NHF, 42 times per patient). Within both LMWH and VKA the reimbursement due for the daily doses of a particular medication altered in the manner inversely proportional to the level of patient co-payment. Utilization of long-marketed and cheap VKA was dominated by LMWH, when assessed both through the monetary measures and by the actual volume of sales. Pharmaceutical reimbursement policy favored the more expensive equivalents among VKA and LMWH, whereas in the financial terms the patients were far better off when remaining on a more expensive alternative. The pharmaceutical pricing and reimbursement policy of the state should be more closely related to the pharmacological properties of anticoagulants.

  3. Ten-Day Quadruple Therapy Comprising Proton Pump Inhibitor, Bismuth, Tetracycline, and Levofloxacin is More Effective than Standard Levofloxacin Triple Therapy in the Second-Line Treatment of Helicobacter pylori Infection: A Randomized Controlled Trial.

    Science.gov (United States)

    Hsu, Ping-I; Tsai, Feng-Woei; Kao, Sung-Shuo; Hsu, Wen-Hung; Cheng, Jin-Shiung; Peng, Nan-Jing; Tsai, Kuo-Wang; Hu, Huang-Ming; Wang, Yao-Kuang; Chuah, Seng-Kee; Chen, Angela; Wu, Deng-Chyang

    2017-09-01

    Proton pump inhibitor (PPI)-amoxicillin-fluoroquinolone triple therapy is recommended as a second-line treatment of Helicobacter pylori infection in the Maastricht V/Florence Consensus Report. However, the eradication rate of this standard salvage treatment is suboptimal. The objective of this study is to compare the efficacy of esomeprazole-bismuth-tetracycline-levofloxacin therapy (TL quadruple therapy) and esomeprazole-amoxicillin-levofloxacin triple therapy (AL triple therapy) in rescue treatment for H. pylori infection. Consecutive H. pylori-infected subjects after failure of first-line therapies were randomly allocated to receive either TL quadruple therapy (esomeprazole 40 mg b.d., bismuth 120 mg q.d.s., tetracycline 500 mg q.d.s., and levofloxacin 500 mg o.d.) or AL triple therapy (esomeprazole 40 mg b.d., amoxicillin 500 mg q.d.s., and levofloxacin 500 mg o.d.) for 10 days. H. pylori status was assessed 6 weeks after the end of treatment. The study was stopped after an interim analysis. Of 50 patients in the TL quadruple therapy, 49 (98.0%) had successful eradication of H. pylori infection. Cure of H. pylori infection was achieved in 36 of 52 patients (69.2%) receiving AL triple therapy. Intention-to-treat analysis demonstrated that TL quadruple therapy achieved a markedly higher eradication rate than AL triple therapy (difference: 28.8%; 95% confidence interval: 15.7% to 41.9%; Pbismuth quadruple therapy (95.0% vs. 52.6%; P=0.003). Ten-day PPI-bismuth-tetracycline-levofloxacin quadruple therapy is a good option for rescue treatment of H. pylori infection following failure of standard triple or non-bismuth quadruple therapy.

  4. Day Care Centers

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of day care centers for 50 states and Washington D.C. and Puerto Rico. The dataset only includes center based day care locations...

  5. Is day surgery safe?

    DEFF Research Database (Denmark)

    Majholm, Birgitte; Engbæk, J; Bartholdy, Jens

    2012-01-01

    Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort.......Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort....

  6. Every Day Is Mathematical

    Science.gov (United States)

    Barger, Rita H.; Jarrah, Adeeb M.

    2012-01-01

    March 14 is special because it is Pi Day. Mathematics is celebrated on that day because the date, 3-14, replicates the first three digits of pi. Pi-related songs, websites, trivia facts, and more are at the fingertips of interested teachers and students. Less celebrated, but still fairly well known, is National Metric Day, which falls on October…

  7. Environment-Concerned Treatment, Proper Policies for Different Households, Targeted Improvement: Industry Poverty Alleviation Mode of Ji’an County

    Directory of Open Access Journals (Sweden)

    Zhang Xiaoxia

    2017-01-01

    Full Text Available The article describes the experience gained in Ji’an County (Ji’an Prefecture-Level City, Jiangxi Province on the implementation of policies aimed to alleviate poverty through the implementation of the “Four-One” Industry Targeted Poverty Alleviation Project including 1 “Pomelo of One Mu for One Household”, 2 “Hengjiang Grape of One Mu for One Household”, 3 “One Chicken Coop for One Household”, and 4 “One Post in the Park for One Household”. It is proved that households that implement such projects can get out of poverty. The goal of the study is to help people living in poverty get out of it, and to help the poor county become richer. The author relies on the idea that is developing in modern social science and that deals with the structural poverty typical of different historical eras and economic paradigms. In this case, the following types of structural poverty are distinguished: pre-industrial, industrial and post-industrial poverty. The preindustrial type accompanies pre-capitalist development of society. Industrial poverty is typical of the countries that are at the stage of industrial development, it is caused by excess supply of low and semi-skilled labor. A common way to alleviate industrial poverty is to stimulate the creation of highly skilled jobs with the help of investment and tax policy, education and advanced training systems available to general public. The post-industrial type of poverty is different from the industrial type in a way that this poverty is also formed with participation of the labor market, but this market is not so much local as global. The economic basis of post-industrial poverty is structural changes in the global economy and the increase in competition for jobs in the international framework

  8. “It’s my business, it’s my body, it’s my money”: experiences of smokers who are not planning to quit in the next 30 days and their views about treatment options

    Directory of Open Access Journals (Sweden)

    YK Bartlett

    2016-08-01

    Full Text Available Abstract Background Current evidence-based smoking cessation treatments in the UK are only offered to smokers ready to quit within 30 days. This study reports the experiences of smokers who are not ready to quit and explores the types of intervention approaches that might engage them. Methods Five focus groups were conducted with smokers who had no plans to quit within 30 days (n = 32, 44 % female. Verbatim transcripts were analyzed thematically using Nvivo 10 software. Results Participants were ambivalent towards their own smoking, but the majority indicated they would like to quit someday. Smoking was seen both to hinder and facilitate social interactions, depending on the social norms of the participant’s social circle. Participants reported that, when they perceive pressure to quit smoking, they respond defensively; concurrently, existing approaches to encouraging smoking cessation were seen as unappealing. In contrast, the importance of intrinsic motivation to quit was emphasized, and interventions that were tailored, increased intrinsic motivation and kept the smoker engaged in activities incompatible with smoking were preferred. Conclusions Despite not planning to quit in the next 30 days, the majority of participants wanted to quit smoking at some point. Even if existing services were offered to smokers not planning to quit in the next 30 days, it is unlikely that these services would meet the needs of this population. Future research should explore novel approaches to appeal specifically to smokers not planning to quit in the next 30 days, such as encouraging engagement with activities incompatible with smoking and fostering non-smoking habits.

  9. Locoregional Prostate Cancer Treatment Pattern Variation in Independent Cancer Centers: Policy Effect, Patient Preference, or Physician Incentive?

    Directory of Open Access Journals (Sweden)

    Andrew S. Camarata

    2015-01-01

    Full Text Available Surveillance, Epidemiologic, and End Results (SEER registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45–64-year old men diagnosed with locoregional prostate cancer (LRPC across states with or without radiation therapy-directed certificate of need (CON laws and across independent cancer centers (ICCs compared to large multi-specialty groups (LMSGs. Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT, combination brachytherapy with EBRT, brachytherapy, and observation were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs. LRPC EBRT rates were no different across CON regions, but are increased in ICCs compared to LMSGs (37.00% vs. 13.23%, P < 0.001. Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs established by the Patient Protection and Affordable Care Act of 2010 (PPACA and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.

  10. A 3-day regimen with azithromycin 1.5% eyedrops for the treatment of purulent bacterial conjunctivitis in children: efficacy on clinical signs and impact on the burden of illness

    Directory of Open Access Journals (Sweden)

    Bremond-Gignac D

    2015-04-01

    Full Text Available Dominique Bremond-Gignac,1,2 Riadh Messaoud,3 Sihem Lazreg,4 Claude Speeg-Schatz,5 Didier Renault,6 Frédéric Chiambaretta7,8 On behalf of the Azithromycin Pediatric Study Group 1Ophthalmology Department, Centre St Victor, University Hospital of Amiens, Picardie Jules Verne University, Amiens, France; 2CNRS FR3636, Paris V University, France; 3Ophthalmology Department, Tahar Sfar University Hospital, Mahdia, Tunisia; 4Dar El Beida, Blida, Algeria; 5Ophthalmology Department, University Hospital of Strasbourg, Strasbourg, France; 6Laboratoires THÉA, Clermont-Ferrand, France; 7Ophthalmology Department, University Hospital of Clermont-Ferrand, Gabriel Montpied Hospital, Clermont-Ferrand, France; 8EA 7281 R2D2, Auvergne University, Clermont-Ferrand, France Purpose: To compare the efficacy of azithromycin 1.5% versus tobramycin 0.3% eyedrops on clinical ocular signs and symptoms of bacterial conjunctivitis in children and to assess the parents’ satisfaction regarding the dosing regimen.Patients and methods: An international, multicenter, randomized, investigator-masked, controlled clinical trial conducted in children (1 day to 18 years old with bulbar conjunctival hyperemia and purulent discharge. Azithromycin 1.5% was administered as 1 drop twice daily for 3 days, and tobramycin 0.3% as 1 drop every 2 hours for 2 days, then 4 times daily for 5 days.Results: A total of 286 patients (mean age: 3.2 years were enrolled. In children with bacteriologically positive cultures (N=203, azithromycin produced a significantly greater improvement in conjunctival discharge (P<0.01 and a trend (P=0.054 toward improvement in conjunctival hyperemia at day 7 than did tobramycin. Complete resolution of conjunctival discharge was significantly more frequent at day 3 on azithromycin than tobramycin (P=0.005. More parents found azithromycin easier to use (in terms of treatment duration, total number of instillations, instilling drops during the day, and difficulty in

  11. The Intelence aNd pRezista Once A Day Study (INROADS): a multicentre, single-arm, open-label study of etravirine and darunavir/ritonavir as dual therapy in HIV-1-infected early treatment-experienced subjects.

    Science.gov (United States)

    Ruane, P J; Brinson, C; Ramgopal, M; Ryan, R; Coate, B; Cho, M; Kakuda, T N; Anderson, D

    2015-05-01

    Following antiretroviral therapy failure, patients are often treated with a three-drug regimen that includes two nucleoside/tide reverse transcriptase inhibitors [N(t)RTIs]. An alternative two-drug nucleoside-sparing regimen may decrease the pill burden and drug toxicities associated with the use of N(t)RTIs. The Intelence aNd pRezista Once A Day Study (INROADS; NCT01199939) evaluated the nucleoside-sparing regimen of etravirine 400 mg with darunavir/ritonavir 800/100 mg once-daily in HIV-1-infected treatment-experienced subjects or treatment-naïve subjects with transmitted resistance. In this exploratory phase 2b, single-arm, open-label, multicentre, 48-week study, the primary endpoint was the proportion of subjects who achieved HIV-1 RNA treatment-experienced subjects or treatment-naïve subjects with transmitted resistance was virologically efficacious and well tolerated. © 2014 British HIV Association.

  12. Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice.

    Science.gov (United States)

    Babor, Thomas F; Del Boca, Frances; Bray, Jeremy W

    2017-02-01

    This paper describes the major findings and public health implications of a cross-site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA). Eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross-site evaluation used a multi-method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings. SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi-experimental nature of the outcome evaluation does not permit causal inferences, pre-post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances. Sixty-nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges. The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the

  13. Health worker and policy-maker perspectives on use of intramuscular artesunate for pre-referral and definitive treatment of severe malaria at health posts in Ethiopia.

    Science.gov (United States)

    Kefyalew, Takele; Kebede, Zelalem; Getachew, Dawit; Mukanga, David; Awano, Tessema; Tekalegne, Agonafer; Batisso, Esey; Edossa, Wasihun; Mekonnen, Emebet; Tibenderana, James; Baba, Ebenezer Sheshi; Shumba, Constance; Nankabirwa, Joaniter I; Hamade, Prudence

    2016-10-18

    The World Health Organization (WHO) recommends injectable artesunate given either intravenously or by the intramuscular route for definitive treatment for severe malaria and recommends a single intramuscular dose of intramuscular artesunate or intramuscular artemether or intramuscular quinine, in that order of preference as pre-referral treatment when definitive treatment is not possible. Where intramuscular injections are not available, children under 6 years may be administered a single dose of rectal artesunate. Although the current malaria treatment guidelines in Ethiopia recommend intra-rectal artesunate or alternatively intramuscular artemether or intramuscular quinine as pre-referral treatment for severe malaria at the health posts, there are currently no WHO prequalified suppliers of intra-rectal artesunate and when available, its use is limited to children under 6 years of age leaving a gap for the older age groups. Intramuscular artesunate is not part of the drugs recommended for pre-referral treatment in Ethiopia. This study assessed the perspectives of health workers, and policy-makers on the use of intramuscular artesunate as a pre-referral and definitive treatment for severe malaria at the health post level. In-depth interviews were held with 101 individuals including health workers, malaria focal persons, and Regional Health Bureaus from Oromia and southern nations, nationalities, and peoples' region, as well as participants from the Federal Ministry of Health and development partners. An interview guide was used in the data collection and thematic content analysis was employed for analysis. Key findings from this study are: (1) provision of intramuscular artesunate as pre-referral and definitive treatment for severe malaria at health posts could be lifesaving; (2) with adequate training, and provision of facilities including beds, health posts can provide definitive treatment for severe malaria using intramuscular artesunate where referral is

  14. Health worker and policy-maker perspectives on use of intramuscular artesunate for pre-referral and definitive treatment of severe malaria at health posts in Ethiopia

    Directory of Open Access Journals (Sweden)

    Takele Kefyalew

    2016-10-01

    Full Text Available Abstract Background The World Health Organization (WHO recommends injectable artesunate given either intravenously or by the intramuscular route for definitive treatment for severe malaria and recommends a single intramuscular dose of intramuscular artesunate or intramuscular artemether or intramuscular quinine, in that order of preference as pre-referral treatment when definitive treatment is not possible. Where intramuscular injections are not available, children under 6 years may be administered a single dose of rectal artesunate. Although the current malaria treatment guidelines in Ethiopia recommend intra-rectal artesunate or alternatively intramuscular artemether or intramuscular quinine as pre-referral treatment for severe malaria at the health posts, there are currently no WHO prequalified suppliers of intra-rectal artesunate and when available, its use is limited to children under 6 years of age leaving a gap for the older age groups. Intramuscular artesunate is not part of the drugs recommended for pre-referral treatment in Ethiopia. This study assessed the perspectives of health workers, and policy-makers on the use of intramuscular artesunate as a pre-referral and definitive treatment for severe malaria at the health post level. Methods In-depth interviews were held with 101 individuals including health workers, malaria focal persons, and Regional Health Bureaus from Oromia and southern nations, nationalities, and peoples’ region, as well as participants from the Federal Ministry of Health and development partners. An interview guide was used in the data collection and thematic content analysis was employed for analysis. Results Key findings from this study are: (1 provision of intramuscular artesunate as pre-referral and definitive treatment for severe malaria at health posts could be lifesaving; (2 with adequate training, and provision of facilities including beds, health posts can provide definitive treatment for severe

  15. Abstracts from Rambam Research Day

    Directory of Open Access Journals (Sweden)

    Shraga Blazer

    2015-01-01

    Full Text Available [Extract] This Supplement of Rambam Maimonides Medical Journal presents the abstracts from the Eleventh Rambam Research Day. These abstracts represent the newest basic and clinical research coming out of Rambam Health Care Campus—research that is the oxygen for education and development of today’s generation of physicians. Hence, the research presented on Rambam Research Day is a foundation for future generations to understand patient needs and improve treatment modalities. Bringing research from the bench to the bedside and from the bedside to the community is at the heart of Maimonides’ scholarly and ethical legacy.

  16. Efficacy and safety of tadalafil 20 mg on demand vs. tadalafil 5 mg once-a-day in the treatment of post-radiotherapy erectile dysfunction in prostate cancer men: a randomized phase II trial.

    Science.gov (United States)

    Ricardi, Umberto; Gontero, Paolo; Ciammella, Patrizia; Badellino, Serena; Valentino, Franco; Munoz, Fernando; Guarneri, Alessia; Rondi, Nadia; Moretto, Francesco; Filippi, Andrea Riccardo; Ragona, Riccardo; Tizzani, Alessandro

    2010-08-01

    The role of phosphodiesterase type 5 inhibitors in the treatment of post-radiotherapy erectile dysfunction (ED) has not been extensively investigated. To compare the efficacy and safety of on-demand 20-mg tadalafil (arm A) with the newly released tadalafil 5-mg once-a-day dosing (arm B) in patients with ED following radiotherapy for prostate cancer (PC). Randomized study to receive on-demand 20-mg or once-a-day 5-mg tadalafil for 12 weeks. Main Outcome Measures.  Changes in the International Index of Erectile Function (IIEF) domain scores and Sexual Encounter Profile (SEP) question 2 and 3 positive response rates. Fifty-two out of 86 screened patients were randomized. Forty-four patients were evaluable for efficacy. A significant improvement in all domains of the IIEF was observed in both arms (P = 0.0001) with mean erectile function domain scores values of 25 and 27.1 for the 20-mg and 5-mg tadalafil, respectively (P = 0.19). SEP 2 and 3 positive response rates increased from 0% in both arms at baseline to 81% and 70% in the 20-mg arm and 90% and 73% in the 5-mg arm, respectively, at the end of treatment (P = 0.27). End of treatment global efficacy question positive answers were 86% in the 20-mg arm and 95% in the 5-mg arm (P = 0.27). Higher treatment compliance was shown in arm B (100%) as compared with arm A (86%). There was a nonstatistically significant trend toward fewer side effects in favor of the 5-mg daily dose arm. In the study population, both tadalafil formulations generated significantly high response rates according to the outcome measures and were well tolerated. The once-a-day 5-mg dosing showed higher compliance and marginally reduced side effects, thus making it an attractive alternative to on-demand therapy for ED in post-radiotherapy PC patients. © 2010 International Society for Sexual Medicine.

  17. Open Day at SHMI.

    Science.gov (United States)

    Jarosova, M.

    2010-09-01

    During the World Meteorological Day there has been preparing "Open Day" at Slovak Hydrometeorological Institute. This event has more than 10 years traditions. "Open Day" is one of a lot of possibilities to give more information about meteorology, climatology, hydrology too to public. This "Day" is executed in whole Slovakia. People can visit the laboratories, the forecasting room....and meteo and clima measuring points. The most popular is visiting forecasting room. Visitors are interested in e.g. climatologic change in Slovakia territory, preparing weather forecasting, dangerous phenomena.... Every year we have more than 500 visitors.

  18. Breast cancer arising within fibroadenoma: collective analysis of case reports in the literature and hints on treatment policy.

    Science.gov (United States)

    Wu, Yu-Ting; Chen, Shou-Tung; Chen, Chih-Jung; Kuo, Yao-Lung; Tseng, Ling-Ming; Chen, Dar-Ren; Kuo, Shou-Jen; Lai, Hung-Wen

    2014-11-10

    Breast cancer arising within a fibroadenoma (BcaFad) is rare; the rate varies from 0.002% to 0.125% in fibroadenoma specimens. Owing to its rarity, the clinicopathologic feature and treatment principle of BcaFad is still not clear. Therefore, the aim of this study was to perform a collective analysis of case reports in the literature to identify the characteristics and optimal treatment for BcaFad. We analyzed an aggregated sample of 30 patients with BcaFad from case reports in the literature (n=24 cases) and our present study (n=6 cases). We collected and analyzed the clinicopathologic features and prognoses of patients with BcaFad, as well as treatments they received. The patients' mean age at diagnosis was 46.9 years. Twenty BcaFad patients (66.7%) received breast-conserving surgery (BCS), and nine other patients (30.0%) were treated with mastectomy. The rate of lymph node metastasis in BcaFad patients was 23.8%. The breakdown of the histological types of BcaFad was invasive ductal carcinoma (53.3%), followed by ductal carcinoma in situ (23.3%), lobular carcinoma in situ (16.7%) and invasive lobular carcinoma (13.3%). More than half of patients with positive hormone receptor status received hormone therapy. Most BcaFad patients with lymph node metastases received chemotherapy, and 20.0% of BcaFad patients treated with BCS received further radiotherapy. Only one patient had recurrence after surgery, and another had lung metastasis when diagnosed with BcaFad. Most BcaFad patients could be managed by BCS. Adjuvant radiotherapy could be performed, but was not mandatory. Chemotherapy should be considered as a treatment option in the presence of lymph node metastasis.

  19. Access to antiretroviral treatment, issues of well-being and public health governance in Chad: what justifies the limited success of the universal access policy?

    Science.gov (United States)

    Azétsop, Jacquineau; Diop, Blondin A

    2013-08-01

    Universal access to antiretroviral treatment (ART) in Chad was officially declared in December 2006. This presidential initiative was and is still funded 100% by the country's budget and external donors' financial support. Many factors have triggered the spread of AIDS. Some of these factors include the existence of norms and beliefs that create or increase exposure, the low-level education that precludes access to health information, social unrest, and population migration to areas of high economic opportunities and gender-based discrimination. Social forces that influence the distribution of dimensions of well-being and shape risks for infection also determine the persistence of access barriers to ART. The universal access policy is quite revolutionary but should be informed by the systemic barriers to access so as to promote equity. It is not enough to distribute ARVs and provide health services when health systems are poorly organized and managed. Comprehensive access to ART raises many organizational, ethical and policy problems that need to be solved to achieve equity in access. This paper argues that the persistence of access barriers is due to weak health systems and a poor public health leadership. AIDS has challenged health systems in a manner that is essentially different from other health problems.

  20. [Psychiatric and psychosomatic day hospitals in Austria].

    Science.gov (United States)

    Evans, Janet; Dummer, Verena; Kinzl, Johann

    2016-12-01

    This paper on psychiatric and psychosomatic day hospitals in Austria first looks at the overall situation of Austrian day clinics then, in a second step, compares psychiatric and psychosomatic day hospitals. For this purpose, a questionnaire was developed and sent to all psychiatric and psychosomatic day hospitals in Austria. The first part consisted of closed questions and was used to gather and evaluate the categories: general conditions for treatment in day hospitals, tasks of day hospitals, therapeutic paradigms, indication and contraindication, diagnostics, day hospital organisation, interdisciplinary cooperation and the offering in day hospitals. The second section consisted of open questions which were used to gather and evaluate active factors, difficulties, specifics and requests for future treatment in day hospitals. The results show that there is a trend towards more day hospitals. Psychosomatic day hospitals are a rather new phenomenon. Furthermore, the distinction between psychiatric and psychosomatic day hospitals is important in order to offer patients distinguishable treatment options in future. The results show that psychiatric and psychosomatic day hospitals both have a strong focus on psychotherapy and both fulfill the active factors for psychotherapy by Grawe.

  1. Measuring treatment costs of typical waste electrical and electronic equipment: A pre-research for Chinese policy making.

    Science.gov (United States)

    Li, Jinhui; Dong, Qingyin; Liu, Lili; Song, Qingbin

    2016-11-01

    Waste Electrical and Electronic Equipment (WEEE) volume is increasing, worldwide. In 2011, the Chinese government issued new regulations on WEEE recycling and disposal, establishing a WEEE treatment subsidy funded by a levy on producers of electrical and electronic equipment. In order to evaluate WEEE recycling treatment costs and revenue possibilities under the new regulations, and to propose suggestions for cost-effective WEEE management, a comprehensive revenue-expenditure model (REM), were established for this study, including 7 types of costs, 4 types of fees, and one type of revenue. Since TV sets dominated the volume of WEEE treated from 2013 to 2014, with a contribution rate of 87.3%, TV sets were taken as a representative case. Results showed that the treatment cost varied from 46.4RMB/unit to 82.5RMB/unit, with a treatment quantity of 130,000 units to 1,200,000 units per year in China. Collection cost accounted for the largest portion (about 70.0%), while taxes and fees (about 11.0 %) and labor cost (about 7.0 %) contributed less. The average costs for disposal, sales, and taxes had no influence on treatment quantity (TQ). TQ might have an adverse effect on average labor and management costs; while average collection and purchase fees, and financing costs, would vary with purchase price, and the average sales fees and taxes would vary with the sales of dismantled materials and other recycled products. Recycling enterprises could reduce their costs by setting up online and offline collection platforms, cooperating with individual collectors, creating door-to-door collection channels, improving production efficiency and reducing administrative expenditures. The government could provide economic incentives-such as subsidies, low-cost loans, tax cuts and credits-and could also raise public awareness of waste management and environmental protection, in order to capture some of the WEEE currently discarded into the general waste stream. Foreign companies with

  2. Identification and Sensitivity Analysis for Average Causal Mediation Effects with Time-Varying Treatments and Mediators: Investigating the Underlying Mechanisms of Kindergarten Retention Policy.

    Science.gov (United States)

    Park, Soojin; Steiner, Peter M; Kaplan, David

    2018-03-01

    Considering that causal mechanisms unfold over time, it is important to investigate the mechanisms over time, taking into account the time-varying features of treatments and mediators. However, identification of the average causal mediation effect in the presence of time-varying treatments and mediators is often complicated by time-varying confounding. This article aims to provide a novel approach to uncovering causal mechanisms in time-varying treatments and mediators in the presence of time-varying confounding. We provide different strategies for identification and sensitivity analysis under homogeneous and heterogeneous effects. Homogeneous effects are those in which each individual experiences the same effect, and heterogeneous effects are those in which the effects vary over individuals. Most importantly, we provide an alternative definition of average causal mediation effects that evaluates a partial mediation effect; the effect that is mediated by paths other than through an intermediate confounding variable. We argue that this alternative definition allows us to better assess at least a part of the mediated effect and provides meaningful and unique interpretations. A case study using ECLS-K data that evaluates kindergarten retention policy is offered to illustrate our proposed approach.

  3. Tough Policies, Incredible Policies?

    OpenAIRE

    Andres Velasco; Alejandro Neut

    2003-01-01

    We revisit the question of what determines the credibility of macroeconomic policies here, of promises to repay public debt. Almost all thinking on the issue has focused on governments' strategic decision to default (or erode the value of outstanding debt via inflation/devaluation). But sometimes governments default not because they want to, but because they cannot avoid it: adverse shocks leave them no option. We build a model in which default/devaluation can occur deliberately (for strategi...

  4. Treatment efficacy of azithromycin 1 g single dose versus doxycycline 100 mg twice daily for 7 days for the treatment of rectal chlamydia among men who have sex with men - a double-blind randomised controlled trial protocol.

    Science.gov (United States)

    Lau, Andrew; Kong, Fabian; Fairley, Christopher K; Donovan, Basil; Chen, Marcus; Bradshaw, Catriona; Boyd, Mark; Amin, Janaki; Timms, Peter; Tabrizi, Sepehr; Regan, David G; Lewis, David A; McNulty, Anna; Hocking, Jane S

    2017-01-06

    Rectal infection with Chlamydia trachomatis is one of the most common bacterial sexually transmissible infections among men who have sex with men (MSM) with diagnosis rates continuing to rise. Current treatment guidelines recommend either azithromycin 1 g single dose or doxycycline 100 mg twice daily for 7 days. However, there are increasing concerns about treatment failure with azithromycin. We are conducting the first randomised controlled trial (RCT) to compare treatment efficacy of azithromycin versus doxycycline for the treatment of rectal chlamydia in MSM. The Rectal Treatment Study will recruit 700 MSM attending Australian sexual health clinics for the treatment of rectal chlamydia. Participants will be asked to provide rectal swabs and will be randomised to either azithromycin 1 g single dose or doxycycline 100 mg twice daily for 7 days. Participants will be asked to complete questionnaires about adverse drug reactions, sexual behaviour and drug adherence via short message service and online survey. The primary outcome is the treatment efficacy as determined by a negative chlamydia nucleic acid amplification test at 4 weeks post treatment. Secondary outcomes will utilise whole genome sequencing and mRNA assay to differentiate between treatment failure, reinfection or false positive results. Rectal chlamydia is an increasing public health concern as use of pre-exposure prophylaxis against HIV becomes commonplace. Optimal, evidence-based treatment is critical to halting ongoing transmission. This study will provide the first RCT evidence comparing azithromycin and doxycycline for the treatment of rectal chlamydia. The results of this trial will establish which treatment is more efficacious and inform international management guidelines. Australian New Zealand Clinical Trials Registry ACTRN12614001125617.

  5. Intervening in global markets to improve access to HIV/AIDS treatment: an analysis of international policies and the dynamics of global antiretroviral medicines markets.

    Science.gov (United States)

    Waning, Brenda; Kyle, Margaret; Diedrichsen, Ellen; Soucy, Lyne; Hochstadt, Jenny; Bärnighausen, Till; Moon, Suerie

    2010-05-25

    Universal access to antiretroviral therapy (ART) in low- and middle-income countries faces numerous challenges: increasing numbers of people needing ART, new guidelines recommending more expensive antiretroviral (ARV) medicines, limited financing, and few fixed-dose combination (FDC) products. Global initiatives aim to promote efficient global ARV markets, yet little is known about market dynamics and the impact of global policy interventions. We utilize several data sources, including 12,958 donor-funded, adult first-line ARV purchase transactions, to describe the market from 2002-2008. We examine relationships between market trends and: World Health Organization (WHO) HIV/AIDS treatment guidelines; WHO Prequalification Programme (WHO Prequal) and United States (US) Food and Drug Administration (FDA) approvals; and procurement policies of the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM), US President's Emergency Plan for AIDS Relief (PEPFAR) and UNITAID. WHO recommended 7, 4, 24, and 6 first-line regimens in 2002, 2003, 2006 and 2009 guidelines, respectively. 2009 guidelines replaced a stavudine-based regimen ($88/person/year) with more expensive zidovudine- ($154-260/person/year) or tenofovir-based ($244-465/person/year) regimens. Purchase volumes for ARVs newly-recommended in 2006 (emtricitabine, tenofovir) increased >15-fold from 2006 to 2008. Twenty-four generic FDCs were quality-approved for older regimens but only four for newer regimens. Generic FDCs were available to GFATM recipients in 2004 but to PEPFAR recipients only after FDA approval in 2006. Price trends for single-component generic medicines mirrored generic FDC prices. Two large-scale purchasers, PEPFAR and UNITAID, together accounted for 53%, 84%, and 77% of market volume for abacavir, emtricitabine, and tenofovir, respectively, in 2008. PEPFAR and UNITAID purchases were often split across two manufacturers. Global initiatives facilitated the creation of fairly efficient markets

  6. Intervening in global markets to improve access to HIV/AIDS treatment: an analysis of international policies and the dynamics of global antiretroviral medicines markets

    Directory of Open Access Journals (Sweden)

    Hochstadt Jenny

    2010-05-01

    Full Text Available Abstract Background Universal access to antiretroviral therapy (ART in low- and middle-income countries faces numerous challenges: increasing numbers of people needing ART, new guidelines recommending more expensive antiretroviral (ARV medicines, limited financing, and few fixed-dose combination (FDC products. Global initiatives aim to promote efficient global ARV markets, yet little is known about market dynamics and the impact of global policy interventions. Methods We utilize several data sources, including 12,958 donor-funded, adult first-line ARV purchase transactions, to describe the market from 2002-2008. We examine relationships between market trends and: World Health Organization (WHO HIV/AIDS treatment guidelines; WHO Prequalification Programme (WHO Prequal and United States (US Food and Drug Administration (FDA approvals; and procurement policies of the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM, US President's Emergency Plan for AIDS Relief (PEPFAR and UNITAID. Results WHO recommended 7, 4, 24, and 6 first-line regimens in 2002, 2003, 2006 and 2009 guidelines, respectively. 2009 guidelines replaced a stavudine-based regimen ($88/person/year with more expensive zidovudine- ($154-260/person/year or tenofovir-based ($244-465/person/year regimens. Purchase volumes for ARVs newly-recommended in 2006 (emtricitabine, tenofovir increased >15-fold from 2006 to 2008. Twenty-four generic FDCs were quality-approved for older regimens but only four for newer regimens. Generic FDCs were available to GFATM recipients in 2004 but to PEPFAR recipients only after FDA approval in 2006. Price trends for single-component generic medicines mirrored generic FDC prices. Two large-scale purchasers, PEPFAR and UNITAID, together accounted for 53%, 84%, and 77% of market volume for abacavir, emtricitabine, and tenofovir, respectively, in 2008. PEPFAR and UNITAID purchases were often split across two manufacturers. Conclusions Global initiatives

  7. NO TOBACCO DAY

    CERN Multimedia

    Medical Service

    2002-01-01

    The CERN Medical Service is joining in with the world no tobacco day, which takes place on 31 May 2002. We encourage you to take this opportunity to stop smoking for good. Nurses and Doctors will be present on that day to give out information on methods to stop smoking and to assist you in your efforts.

  8. Day care health risks

    Science.gov (United States)

    ... as head lice and scabies are other common health problems that occur in day care centers. You can do a number of ... for the child How to contact your child's health care provider ... sure your child's day care staff knows how to follow that plan.

  9. The Presidents' Day Game

    Science.gov (United States)

    Maxwell, D. Jackson

    2008-01-01

    The history behind the holiday commonly called "Presidents' Day" is a bit confusing. It started as a federal holiday called Washington's Birthday. It was a day set aside to honor George Washington for his accomplishments as a founding father of the country. Later, many northern states began to recognize Abraham Lincoln's Birthday as well for his…

  10. First Day of Life

    Science.gov (United States)

    ... Educators Search English Español The First Day of Life KidsHealth / For Parents / The First Day of Life What's in this article? What Your Newborn Looks ... usually begin within the first few hours of life. Your Feelings Having a baby is a life- ...

  11. Spanish-language community-based mental health treatment programs, policy-required language-assistance programming, and mental health treatment access among Spanish-speaking clients.

    Science.gov (United States)

    Snowden, Lonnie R; McClellan, Sean R

    2013-09-01

    We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California's Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997-2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services.

  12. Spanish-Language Community-Based Mental Health Treatment Programs, Policy-Required Language-Assistance Programming, and Mental Health Treatment Access Among Spanish-Speaking Clients

    Science.gov (United States)

    McClellan, Sean R.

    2013-01-01

    Objectives. We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California’s Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Methods. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997–2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. Results. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Conclusions. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services. PMID:23865663

  13. Degradation of benzodiazepines after 120 days of EMS deployment.

    Science.gov (United States)

    McMullan, Jason T; Jones, Elizabeth; Barnhart, Bruce; Denninghoff, Kurt; Spaite, Daniel; Zaleski, Erin; Silbergleit, Robert

    2014-01-01

    EMS treatment of status epilepticus improves outcomes, but the benzodiazepine best suited for EMS use is unclear, given potential high environmental temperature exposures. To describe the degradation of diazepam, lorazepam, and midazolam as a function of temperature exposure and time over 120 days of storage on active EMS units. Study boxes containing vials of diazepam, lorazepam, and midazolam were distributed to 4 active EMS units in each of 2 EMS systems in the southwestern United States during May-August 2011. The boxes logged temperature every minute and were stored in EMS units per local agency policy. Two vials of each drug were removed from each box at 30-day intervals and underwent high-performance liquid chromatography to determine drug concentration. Concentration was analyzed as mean (and 95%CI) percent of initial labeled concentration as a function of time and mean kinetic temperature (MKT). 192 samples were collected (2 samples of each drug from each of 4 units per city at 4 time-points). After 120 days, the mean relative concentration (95%CI) of diazepam was 97.0% (95.7-98.2%) and of midazolam was 99.0% (97.7-100.2%). Lorazepam experienced modest degradation by 60 days (95.6% [91.6-99.5%]) and substantial degradation at 90 days (90.3% [85.2-95.4%]) and 120 days (86.5% [80.7-92.3%]). Mean MKT was 31.6°C (95%CI 27.1-36.1). Increasing MKT was associated with greater degradation of lorazepam, but not midazolam or diazepam. Midazolam and diazepam experienced minimal degradation throughout 120 days of EMS deployment in high-heat environments. Lorazepam experienced significant degradation over 120 days and appeared especially sensitive to higher MKT exposure.

  14. In vitro sensitivity of antimalarial drugs and correlation with clinico-parasitological response following treatment with a 3-day artesunate-mefloquine combination in patients with falciparum malaria along the Thai-Myanmar border.

    Science.gov (United States)

    Muhamad, Phunuch; Thiengsusuk, Artitaya; Phompradit, Papichaya; Na-Bangchang, Kesara

    2017-02-01

    A 3-day artesunate-mefloquine combination therapy has been using as first-line treatment for acute uncomplicated Plasmodium falciparum malaria in Thailand since 1995 on the background of mefloquine resistance. The aim of the present study was to assess sensitivity of P. falciparum isolates (n=44) in an area along the Thai-Myanmar border (year 2009) to artesunate, mefloquine, chloroquine and quinine, including their correlation with clinico-parasitological response. Twenty, 19, and 5 isolates were collected from patients with 'Adequate Clinical and Parasitological Response (ACPR)', 'Late Parasitological Failure (LPF)' and 're-infection', respectively. The IC 50 of artesunate and mefloquine were significantly higher in patients with LPF compared with ACPR and re-infection. The proportion of isolates with declined artesunate or mefloquine sensitivity in the LPF group (47.4%) was significantly higher than the ACPR group (5.0%). A weak but statistical significant correlation (r=0.384, p=0.01) was observed between IC 50 values of artesunate and parasite clearance time (PCT). There was no significant relationship between in vitro sensitivity of parasite isolates to chloroquine or quinine and clinical response. In vitro susceptibility of P. falciparum isolates to artesunate and mefloquine may be used as a useful reliable tool to predict clinico-pathological response following a 3-day artesunate-mefloquine combination therapy. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Open Day: General Information

    CERN Multimedia

    2004-01-01

    http://www.cern.ch/cern50/ With 50 visit points, including theatre performances, debates and visits to installations that have never before been opened to the public, CERN's 50th anniversary Open Day is set to be a day to remember. Seven hundred volunteers have signed up to help for the day. The Open Day team truly appreciates this wonderful show of support! The Open Day would not be possible without their help. Car parking and Access Cars with a CERN sticker can access all CERN sites as normal. However, to avoid congestion on Meyrin site, we ask you to park in areas that will not be open to the public (see below) and to use the shuttle services wherever possible for your transport during the day. Private cars on the French side of the border without a CERN sticker will be diverted to a car park area in the Prévessin site. There is a shuttle service connecting the Meyrin and Prévessin sites via SM18 every 20 minutes. Private cars on the Swiss side of the border without a CERN sticker will be diverte...

  16. Sun-Earth Days

    Science.gov (United States)

    Thieman, J.; Ng, C.; Lewis, E.; Cline, T.

    2010-08-01

    Sun-Earth Day is a well-coordinated series of programs, resources and events under a unique yearly theme highlighting the fundamentals of heliophysics research and missions. A menu of activities, conducted throughout the year, inspire and educate participants. Sun-Earth Day itself can vary in date, but usually is identified by a celebration on or near the spring equinox. Through the Sun-Earth Day framework we have been able to offer a series of coordinated events that promote and highlight the Sun, its connection to Earth and the other planets. Sun-Earth Day events are hosted by educators, museums, amateur astronomers and scientists and occur at schools, community groups, parks, planetaria and science centers around the globe. Sun-Earth Day raises the awareness and knowledge of formal and informal education audiences concerning space weather and heliophysics. By building on the success of Sun-Earth Day yearly celebrations, we seek to affect people of all backgrounds and ages with the wonders of heliophysics science, discovery, and exploration in ways that are both tangible and meaningful to their lives.

  17. Exploration of an Optimal Policy for Water Resources Management Including the Introduction of Advanced Sewage Treatment Technologies in Zaozhuang City, China

    Directory of Open Access Journals (Sweden)

    Gengyu He

    2016-12-01

    Full Text Available Water shortage and water pollution are important factors restricting sustainable social and economic development. As a typical coal resource-exhausted city and a node city of the South-to-North Water Transfer East Route Project in China, Zaozhuang City’s water resources management faces multiple constraints such as transformation of economic development, restriction of groundwater exploitation, and improvement of water environment. In this paper, we develop a linear optimization model by input–output analysis to study water resources management with the introduction of three advanced sewage treatment technologies for pollutant treatment and reclaimed water production. The simulation results showed that from 2014 to 2020, Zaozhuang City will realize an annual GDP growth rate of 7.1% with an annual chemical oxygen demand (COD emissions reduction rate of 5.5%. The proportion of primary industry, secondary industry, and tertiary industry would be adjusted to 5.6%, 40.8%, and 53.6%, respectively. The amount of reclaimed water supply could be increased by 91% and groundwater supply could be decreased by 6%. Based on the simulation, this model proposes a scientific reference on water resources management policies, including water environment control, water supply plan, and financial subsidy, to realize the sustainable development of economy and water resources usage.

  18. Factors affecting treatment-seeking for febrile illness in a malaria endemic block in Boudh district, Orissa, India: policy implications for malaria control.

    Science.gov (United States)

    Das, Ashis; Ravindran, Tk Sundari

    2010-12-30

    Orissa state in eastern India accounts for the highest malaria burden to the nation. However, evidences are limited on its treatment-seeking behaviour in the state. We assessed the treatment-seeking behaviour towards febrile illness in a malaria endemic district in Orissa. A cross-sectional community-based survey was carried out during the high malaria transmission season of 2006 in Boudh district. Respondents (n = 300) who had fever with chills within two weeks prior to the day of data collection were selected through a multi-stage sampling and interviewed with a pre-tested and structured interview schedule. Malaria treatment providers (n = 23) were interviewed in the district to gather their insights on factors associated with prompt and effective treatment through a semi-structured and open-ended interview guideline. Majority of respondents (n = 281) sought some sort of treatment e.g. government health facility (35.7%), less qualified providers (31.3%), and community level health workers and volunteers (24.3%). The single most common reason (66.9%) for choosing a provider was proximity. Over a half (55.7%) sought treatment from appropriate providers within 48 hours of onset of symptoms. Respondents under five years (OR 2.00, 95% CI 0.84-4.80, P = 0.012), belonging to scheduled tribe community (OR 2.13, 95% CI 1.11-4.07, P = 0.022) and visiting a provider more than five kilometers (OR 2.04, 95% CI 1.09-3.83, P = 0.026) were more likely to have delayed or inappropriate treatment. Interviews with the providers indicated that patients' lack of trust in community volunteers providing treatment led to inappropriate treatment-seeking from the less qualified providers. The reasons for the lack of trust included drug side effects, suspicions about drug quality, stock-outs of drugs and inappropriate attitude of the provider. Large-scale involvement of less qualified providers is suggested in the malaria control programme as volunteers after appropriate capacity

  19. 4th Optimization Day

    CERN Document Server

    Eberhard, Andrew; Ralph, Daniel; Glover, Barney M

    1999-01-01

    Although the monograph Progress in Optimization I: Contributions from Aus­ tralasia grew from the idea of publishing a proceedings of the Fourth Optimiza­ tion Day, held in July 1997 at the Royal Melbourne Institute of Technology, the focus soon changed to a refereed volume in optimization. The intention is to publish a similar book annually, following each Optimization Day. The idea of having an annual Optimization Day was conceived by Barney Glover; the first of these Optimization Days was held in 1994 at the University of Ballarat. Barney hoped that such a yearly event would bring together the many, but widely dispersed, researchers in Australia who were publishing in optimization and related areas such as control. The first Optimization Day event was followed by similar conferences at The University of New South Wales (1995), The University of Melbourne (1996), the Royal Melbourne Institute of Technology (1997), and The University of Western Australia (1998). The 1999 conference will return to Ballarat ...

  20. AAS 227: Day 1

    Science.gov (United States)

    Kohler, Susanna

    2016-01-01

    Editors Note:This week were at the 227th AAS Meeting in Kissimmee, FL. Along with several fellow authors from astrobites.com, I will bewritingupdates on selectedevents at themeeting and posting at the end of each day. Follow along here or at astrobites.com, or catch ourlive-tweeted updates from the @astrobites Twitter account. The usual posting schedule for AAS Nova will resumenext week.Things kicked off last night at our undergraduate reception booth. Thanks to all of you who stopped by we were delightedto have so many people tell us that they already know about and useastrobites, and we were excited to introduce a new cohort of students at AAS to astrobites for the first time.Tuesday morning was the official start of the meeting. Here are just a few of the talks and workshops astrobiters attended today.Opening Address (by Becky Smethurst)The President of the AAS, aka our fearless leader Meg Urry kicked off the meeting this morning at the purely coffee powered hour of 8am this morning. She spoke about the importance of young astronomers at the meeting (heres looking at you reader!) and also the importance of the new Working Group for Accessibility and Disabilities (aka WGAD pronounced like wicked) at the AAS. The Society has made extra effort this year to make the conference accessible to all,a message which was very well received by everyone in attendance.Kavli Lecture: New Horizons Alan Stern (by Becky Smethurst)We were definitely spoilt with the first Plenary lecture at this years conference Alan Stern gave us a a review of the New Horizons mission of the Pluto Fly By (astrobites covered the mission back in July with this post). We were treated to beautiful images, wonderful results and a foray into geology.Before (Hubble) and after #NewHorizons. #thatisall #science #astro alanstern #aas227 pic.twitter.com/kkMt6RsSIR Science News (@topsciencething) January 5, 2016Some awesome facts from the lecture that blew my mind:New Horizons is now 2AU (!) beyond Pluto

  1. The policies

    International Nuclear Information System (INIS)

    Laruelle, Ph.; Snegaroff, Th.; Moreau, S.; Tellenne, C.; Brunel, S.

    2005-01-01

    Fourth chapter of the book on the geo-policy of the sustainable development, this chapter deal with the different and international policies concerned by the problem. The authors analyze the american energy attitude and policy, the economical equilibrium facing the environmental equilibrium for the european policy, the sanctified and sacrificed nature and the japanese attitude, India and China, the great fear of the 21 century and the sustainable development in Africa. (A.L.B.)

  2. Controversies in knowledge translation for community-based drug treatment: the need to the end policies of the war on drugs and mass incarceration of drug offenders to achieve health equity.

    Science.gov (United States)

    Wallace, Barbara C

    2012-12-01

    The purpose of this article was to discuss significant challenges to the achievement of urban health, specifically acknowledging numerous controversies in knowledge translation for community-based drug treatment that prevent the achievement of health equity. Seven specific controversies are analyzed in this article. The results of the analysis are recommendations for moving toward the resolution of each controversy. Among the most important recommendations is a call to end the policies of the war on drugs and mass incarceration of drug offenders-as policies reflecting how politics and the misuse of power may derail knowledge translation. The article provides justification for evidence-based policy that supports community-based drug treatment as a public health approach consistent with the goals of health equity, ethical practice, and effective knowledge translation.

  3. National hearing day

    CERN Multimedia

    2003-01-01

    The 12th of June 2003 Is the French National Hearing Day. The Medical Service invites everyone working at CERN to come and have an ear test at the infirmary. Bld. 57, ground floor, between 9h00 and 16h00 Tel. 73802

  4. NATIONAL HEARING DAY

    CERN Multimedia

    2003-01-01

    The 12th of June 2003 Is the French National Hearing Day. The Medical Service invites everyone working at CERN to come and have an ear test at the infirmary. Bld. 57, ground floor, between 9h00 and 16h00 Tel. 73802

  5. CERN openlab Open Day

    CERN Multimedia

    Purcell, Andrew Robert

    2015-01-01

    The CERN openlab Open Day took place on 10 June, 2015. This was the first in a series of annual events at which research and industrial teams from CERN openlab can present their projects, share achievements, and collect feedback from their user communities.

  6. World Heart Day

    Centers for Disease Control (CDC) Podcasts

    2009-09-01

    For World Heart Day, learn more about what heart-healthy steps you can take in the workplace.  Created: 9/1/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 9/9/2009.

  7. Radiochemistry days; Journees radiochimie

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-09-01

    This document provides the 44 papers (transparencies used during the presentations and posters) presented at the Radiochemistry Days, held September 3-4, 1998 in Nantes, France. The main studied topics were problematic questions concerning the nuclear fuel cycle and in particular the management, storage of radioactive wastes and the environmental impact. (O.M.)

  8. My Day of Silence.

    Science.gov (United States)

    Brown, Scott C.

    1999-01-01

    A heterosexual doctoral student discusses his experiences when he tries to take part in a day of silence to help combat homophobia and heterosexism. His vow of silence teaches him that he will never fully understand the experience of a person who has been historically, socially, and legally silent. (Author/MKA)

  9. Fabulous Weather Day

    Science.gov (United States)

    Marshall, Candice; Mogil, H. Michael

    2007-01-01

    Each year, first graders at Kensington Parkwood Elementary School in Kensington, Maryland, look forward to Fabulous Weather Day. Students learn how meteorologists collect data about the weather, how they study wind, temperature, precipitation, basic types/characteristics of clouds, and how they forecast. The project helps the students grow in…

  10. Adult Day Services

    Science.gov (United States)

    ... institutional care while still providing consistent medical monitoring Average Annual Cost Per Person 6 $75,000 $50,000 Homemaker Home Health Aide Semi Private Private $25,000 Adult Day Servi Acesssisted Living Home Care Nursing Homes $0 1. General information based on ...

  11. Understanding Educational Policy Formation: The Case of School Violence Policies in Israel

    Science.gov (United States)

    Fast, Idit

    2016-01-01

    This study explores mechanisms underlying processes of educational policy formation. Previous studies have given much attention to processes of diffusion when accounting for educational policy formation. Less account has been given to the day-to-day institutional dynamics through which educational policies develop and change. Building on extensive…

  12. Indigenous peoples, HIV and public policy in Latin America: an exploration of the current situations of epidemiological prevalence, prevention, care and timely treatment

    Directory of Open Access Journals (Sweden)

    Patricia Ponce

    2017-10-01

    Full Text Available This article aims to describe and analyze the situations of epidemiological prevalence, prevention, care and treatment of HIV in indigenous populations of Latin America. In order to do so, 304 published materials – including declarations, public policy and health program protocols, case studies and literature reviews with local, national and regional scopes – were identified, classified and analyzed. The differential social vulnerability to HIV infection and the inequity in health care access among indigenous populations can be attributed to the juxtaposition of factors such as structural violence, gender, racism, and discrimination due health condition (living with HIV as well as the subordinated position of indigenous peoples in societies stratified not only socially and economically but also ethnically and culturally. The few studies done in the region on epidemiological prevalence, morbidity and mortality that are disaggregated by ethnicity reveal alarming data highlighting the need for further information on the epidemic in this population so as to address its repercussions in terms of prevention, care and timely follow-up.

  13. The views of policy influencers and mental health officers concerning the Named Person provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003.

    Science.gov (United States)

    Berzins, Kathryn M; Atkinson, Jacqueline M

    2010-10-01

    The Mental Health (Care and Treatment) (Scotland) Act 2003 introduced the role of the Named Person, who can be nominated by service users to protect their interests if they become subject to compulsory measures and replaces the Nearest Relative. If no nomination is made, the primary carer or nearest relative is appointed the Named Person. The views of professionals involved in the development and implementation of the provisions were unknown. To describe the perceptions of mental health officers and policy makers involved in the development and implementation of the new provisions. Sixteen professionals were interviewed to explore their perceptions of and experiences with the Named Person provisions. Data were analysed using Thematic Analysis. Perceptions of the Named Person provisions were generally favourable but concerns were expressed over low uptake; service users' and carers' lack of understanding of the role; and potential conflict with human rights legislation over choice and information sharing. Legislation should be amended to allow the choice of no Named Person and the prevention of information being shared with the default appointed Named Person. Removal of the default appointment should be considered.

  14. The potential effects of changing HIV treatment policy on tuberculosis outcomes in South Africa: results from three tuberculosis-HIV transmission models.

    Science.gov (United States)

    Pretorius, Carel; Menzies, Nicolas A; Chindelevitch, Leonid; Cohen, Ted; Cori, Anne; Eaton, Jeffrey W; Fraser, Christophe; Gopalappa, Chaitra; Hallett, Timothy B; Salomon, Joshua A; Stover, John; White, Richard G; Dodd, Peter J

    2014-01-01

    Many countries are considering expanding HIV treatment following recent findings emphasizing the effects of antiretroviral therapy (ART) on reducing HIV transmission in addition to already established survival benefits. Given the close interaction of tuberculosis (TB) and HIV epidemics, ART expansion could have important ramifications for TB burden. Previous studies suggest a wide range of possible TB impacts following ART expansion. We used three independently developed TB-HIV models to estimate the TB-related impact of expanding ART in South Africa. We considered two dimensions of ART expansion--improving coverage of pre-ART and ART services, and expanding CD4-based ART eligibility criteria (from CD4 South African HIV-TB epidemic, and used to assess standardized ART policy changes. Key TB impact indicators were projected from 2014 to 2033. Compared with current eligibility and coverage, cumulative TB incidence was projected to decline by 6-30% over the period 2014-2033 if ART eligibility were expanded to all HIV positive individuals, and by 28-37% if effective ART coverage were additionally increased to 80%. Overall, expanding ART was estimated to avert one TB case for each 10-13 additional person-years of ART. All models showed that TB incidence and mortality reductions would grow over time, but would stabilize towards the end of the projection period. ART expansion could substantially reduce TB incidence and mortality in South Africa and could provide a platform for collaborative HIV-TB programs to effectively halt HIV-associated TB.

  15. Computer Security Day

    CERN Multimedia

    CERN Bulletin

    2010-01-01

      Viruses, phishing, malware and cyber-criminals can all threaten your computer and your data, even at CERN! Experts will share their experience with you and offer solutions to keep your computer secure. Thursday, 10 June 2010, 9.30, Council Chamber Make a note in your diary! Presentations in French and English: How do hackers break into your computer? Quels sont les enjeux et conséquences des attaques informatiques contre le CERN ? How so criminals steal your money on the Internet? Comment utiliser votre ordinateur de manière sécurisée ? and a quiz: test your knowledge and win one of the many prizes that will be on offer! For more information and to follow the day's events via a live webcast go to: http://cern.ch/SecDay.  

  16. CERN Heart Days

    CERN Multimedia

    2003-01-01

    14 & 15 OCTOBER 2003 The Medical Service and the Fire Brigade invite everyone working at CERN to participate in the above event. INFIRMARY 9 am to 16.30 pm Building 57, ground floor no need to book HEALTHY HEART? • Evaluation of personal cardiac risks through the monitoring of: Blood pressure Cholesterol and sugar levels Body Mass Index ... and more • Leaflets, information and advice concerning cardiac issues FIRE BRIGADE 9 to 12 am - Building 65 Please book (limited to 15 people/day) FIRST AID COURSES • What to do in a Cardiac Emergency (3 h. duration) Places are limited and on reservation only (15 people/day). To book, e-mail the Medical Services on: service.medical@cern.ch

  17. CERN Heart Days

    CERN Document Server

    2003-01-01

    14 & 15 OCTOBER 2003 The Medical Service and the Fire Brigade invite everyone working at CERN to participate in the above event. INFIRMARY 9 am to 16.30 pm Building 57, ground floor No need to book HEALTHY HEART? Evaluation of personal cardiac risks through the monitoring of: Blood pressure Cholesterol and sugar levels Body Mass Index ... and more Leaflets, information and advice concerning cardiac issues FIRE BRIGADE 9 to 12am - Building 65 Please book (limited to 15 people/day) FIRST AID COURSES What to do in a Cardiac Emergency (3 h. duration) Places are limited and on reservation only (15 people/day). To book, e-mail the Medical Services on: service.medical@cern.ch

  18. One Day on Earth

    CERN Multimedia

    2011-01-01

    In collaboration with the CineGlobe Film Festival, the One Day on Earth global film project invites you to share your story of scientific inspiration, scientific endeavors and technological advancement on 11 November 2011 (11.11.11).   Technology in the 21st century continuously inspires us to re-imagine the world. From outer-space to cyberspace, new ideas that we hope will improve the lives of future generations keep us in a state of change. However, these new technologies may alter the nature of our shared existence in ways not yet known. On 11.11.11, we invite you to record the exciting ways that science is a part of your life, together with people around the world who will be documenting their lives on this day of global creation. See www.onedayonearth.org for details on how to participate.

  19. LHC days 2003

    CERN Document Server

    LHC days 2003

    2003-01-01

    The LHC days 2003, held in Les Diablerets from 2nd to 4th June 2003 and attended by more than 130 participants from 6 divisions of CERN, bear witness of the broad involvement of CERN in the LHC, and of the development of the project in its construction and installation phases. The core responsibilities of the Accelerator Technology division, such as superconducting magnets, cryogenics and vacuum, took a large share of the program, but the related topics of machine installation, commissioning, testing and operation, as well as the interface with the experimental areas and their physics detectors provided the occasion of dynamic exchanges and intense discussions, as they constitute the forthcoming phases of our work on the project. This report summarizes the presentations and discussions which took place during these three days.

  20. Open Days in 2008

    CERN Multimedia

    Corinne Pralavorio

    CERN will be organising two Open Days in 2008, one for CERN employees and their families on Saturday, 5 April, and another for the general public on Sunday, 6 April. This is the one last chance to see the LHC and its experiments. In addition to the surface facilities, visitors will be able to go underground to see the accelerator and will have acces to the experiment caverns. Exceptionally, most of the points along the ring will be open. We need a large number of volunteers to ensure the success of these two very special days. Full details of the events will be published in the first January edition of the Bulletin. Volunteers will be able to register by completing an electronic form and an information session will be organised.

  1. National HIV Testing Day

    Centers for Disease Control (CDC) Podcasts

    2011-06-09

    Dr. Kevin A. Fenton, Director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, discusses National HIV Testing Day, an annual observance which raises awareness of the importance of knowing one's HIV status and encourages at-risk individuals to get an HIV test.  Created: 6/9/2011 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 6/9/2011.

  2. World water day

    International Nuclear Information System (INIS)

    2005-01-01

    The symposium on world water day for the year 2005 was held on 22nd March by the Pakistan Engineering congress in collaboration with Water and Power Development Authority (WAPDA). Six technical papers by engineers/experts presented on the diverse fields from large dams to drinking water and public hygiene. Paper published in this volume are open for written discussion. (orig./A.B.)

  3. 'EU divertor celebration day'

    International Nuclear Information System (INIS)

    Merola, M.

    2002-01-01

    The meeting 'EU divertor celebration day' organized on 16 January 2002 at Plansee AG, Reutte, Austria was held on the occasion of the completion of manufacturing activities of a complete set of near full-scale prototypes of divertor components including the vertical target, the dome liner and the cassette body. About 30 participants attended the meeting including Dr. Robert Aymar, ITER Director, representatives from EFDA, CEA, ENEA, IPP and others

  4. Combined and separated effects of gamma irradiation and bifuran plant extract on the dietary profile of the black cutworm, agitators ipsilon (Hun.) 1- treatment of the eight days old larvae

    International Nuclear Information System (INIS)

    El-Naggar, S.E.M.; Ibrahim, S.M.; Mohamed, H.F.

    2007-01-01

    The combined and separate effects of two sub sterilizing doses 100 or 150 Gy of gamma irradiation and the plant extract Conyza dioscorides (Barnoof) on eight days- old larvae of F1 generation of Agrotis ipsilon as to their ability to consume, digest and utilize food were studied. Gamma irradiation alone reduced the amount of food consumed and digested by the larvae as compared to non-irradiated ones. Also, the utilization efficiency was decreased more significantly at the dose level 150 Gy than at the dose level 100 Gy leading to a reduction in weight gain. The effect of plant extract (Barnoof) alone was non-significantly different at the two tested concentrations 1.5 or 3 % by the solvent (Petroleum ether) treatment. The combined effect of gamma radiation and plant extract on F1 larvae significantly decreased the growth rate of the larvae than when treating them alone as compared to the untreated larvae. Also, the combined effects of gamma radiation and plant extract significantly decreased the utilization of food as indicated by determining both efficiency of conversion of ingested food (E.C.I.) and digested food (E.C.D.) to body matters

  5. A randomized open-label trial with a crossover comparison of sexual self-confidence and other treatment outcomes following tadalafil once a day vs. tadalafil or sildenafil on-demand in men with erectile dysfunction.

    Science.gov (United States)

    Rubio-Aurioles, Eusebio; Porst, Hartmut; Kim, Edward D; Montorsi, Francesco; Hackett, Geoff; Morales, Antonio Martin; Stuckey, Bronwyn; Būttner, Hartwig; West, Teena M; Huynh, Ngan N; Lenero, Enrique; Burns, Patrick; Kopernicky, Vladimir

    2012-05-01

    To compare Sexual Self-Confidence and other treatment outcomes following 8 weeks of treatment with tadalafil 5 mg once a day (OaD) vs. tadalafil 20 mg or sildenafil 100 mg as needed (pro re nata [PRN]) in patients with erectile dysfunction (ED). A randomized, open-label, crossover study in men ≥18 years of age with history of ED and satisfactory response to current oral phosphodiesterase 5 (PDE5) inhibitor PRN. Data were analyzed with a mixed effects model for crossover design. The primary outcome measure was the Sexual Self-Confidence domain of the Psychological and Interpersonal Relationship Scales (PAIRS) between tadalafil OaD and sildenafil PRN. SECONDARY OUTCOMES INCLUDED: Time Concerns and Spontaneity domains of PAIRS, and the Self-Esteem and Relationship (SEAR) scale. Men naive to tadalafil OaD were enrolled (N = 378), with 61-69% prior PDE5 inhibitor use. There were improvements in all PAIRS domains from baseline when comparing tadalafil OaD and PRN with sildenafil PRN (P Self-Confidence domain improved from baseline and was 0.50 ± 0.78 following tadalafil OaD, 0.5 ± 0.72 for tadalafil PRN, and 0.39 ± 0.67 for sildenafil PRN. The difference in least-squares mean was 0.12 ± 0.04 (confidence interval [CI] = 0.04, 0.19; P = 0.001) between tadalafil OaD and sildenafil PRN and 0.01 ± 0.04 (CI = -0.06, 0.08; P = 0.872) between tadalafil OaD and tadalafil PRN. The Time Concerns domain score was lower with tadalafil OaD than tadalafil PRN (P Self-Confidence, Time Concerns, and Spontaneity. There was no significant difference in Sexual Self-Confidence between tadalafil OaD and tadalafil PRN. Changes in SEAR, the erectile function domain of the International Index of Erectile Function, and the Erectile Dysfunction Inventory of Treatment Satisfaction scores from baseline to end point were similar. © 2012 International Society for Sexual Medicine.

  6. 30 days in medicine

    African Journals Online (AJOL)

    Mouthwash reduces oral gonorrhoea. Gargling daily with the antiseptic mouthwash, Listerine, may control oral gonorrhoea, according to a study in Australia. Researchers in. Melbourne looked at 196 gay or bisexual men positive for Neisseria gonorrhoea, who presented at the Melbourne Sexual Health Centre for treatment.

  7. CERN hearing day

    CERN Multimedia

    2005-01-01

    1 in 10 people suffer from hearing loss - do you? The Medical Service invites everyone working on CERN premises to participate in the National Hearing Day on: Thursday 10th March From 9am to 4pm The Infirmary, Blg. 57, Gr.Fl. We will be offering hearing tests (audiogram); information, advice on hearing loss, tinnitus and more. Deafness does not just affect the elderly: in Europe, 50% the hearing-impaired are under the age of 55. Exposure to excessive noise is one of the main reasons for hearing loss. But prevention is possible and effective: for example, Hearing protection devices could reduce tinnitus cases by 80%.

  8. CERN hearing day

    CERN Multimedia

    2005-01-01

    1 in 10 people suffer from hearing loss ? do you? The Medical Service invites everyone working on the CERN site to participate in the NATIONAL HEARING DAY on: Thursday 10th March 2005 From 9am to 4pm The Infirmary, Blg. 57, Ground Floor We will be offering hearing tests (audiograms), as well as information and advice on hearing loss, tinnitus, etc. Deafness does not just affect the elderly: in Europe, 50% of the hearing-impaired are under the age of 55. Exposure to excessive noise is one of the main reasons for hearing problems but prevention is possible. For example, hearing protection devices can prevent 80% of tinnitus cases.

  9. CERN hearing day

    CERN Document Server

    2005-01-01

    1 in 10 people suffer from hearing loss - do you? The Medical Service invites everyone working on CERN premises to participate in the National Hearing Day on: Thursday 10th March From 9am to 4pm The Infirmary, Blg. 57, Gr.Fl. We will be offering hearing tests (audiogram); information, advice on hearing loss, tinnitus and more. Deafness does not just affect the elderly: in Europe, 50% the hearing-impaired are under the age of 55. Exposure to excessive noise is one of the main reasons for hearing loss. But PREVENTION IS POSSIBLE AND EFFECTIVE: for example, Hearing protection devices could reduce tinnitus cases by 80%.

  10. CERN hearing day

    CERN Document Server

    2005-01-01

    1 in 10 people suffer from hearing loss - do you? The Medical Service invites everyone working on the CERN site to participate in the NATIONAL HEARING DAY on: Thursday 10th March 2005 From 9am to 4pm The Infirmary, Blg. 57, Ground Floor We will be offering hearing tests (audiograms), as well as information and advice on hearing loss, tinnitus, etc. Deafness does not just affect the elderly: in Europe, 50% of the hearing-impaired are under the age of 55. Exposure to excessive noise is one of the main reasons for hearing problems but PREVENTION IS POSSIBLE. For example, hearing protection devices can prevent 80% of tinnitus cases.

  11. Gis Day 2005

    Directory of Open Access Journals (Sweden)

    Esri Italia Esri Italia

    2005-10-01

    Full Text Available Si è svolto nelle Marche, ad Urbino, città simbolo del legame tra scienza e Rinascimento, il GIS DAY 2005; l’evento ha avuto il patrocinio di DAMAC – INTERREG SECUR SEA ed il supporto di: Regione Marche - Giunta Regionale, Contea di Zara (Croazia, Centro di Geobiologia - Università di Urbino, Forum delle Città dell’Adriatico e dello Ionio e Adriatic Action Plan 2020 ed ha sviluppato il tema dedicato ad “Un GIS interoperabile e internazionale”.

  12. DARPA 7-Day Challenge

    Science.gov (United States)

    2014-03-17

    and LF 59,60 . These complexes are then taken up by a clatherin dependent mechanism where changes in pH cause pore formation and entry of EF and LF...in Ac-DEX nano/ mico -particles (particles). Mice were inoculated at 20 µg lysate /mouse. Mice were challenged day 21, 26 and 33 i.p with 232-402...due to the complex immune response that is necessary to protect against highly virulent strains94. Furthermore, in the development of a rapid response

  13. Hard-hat day

    CERN Multimedia

    2003-01-01

    CERN will be organizing a special information day on Friday, 27th June, designed to promote the wearing of hard hats and ensure that they are worn correctly. A new prevention campaign will also be launched.The event will take place in the hall of the Main Building from 11.30 a.m. to 2.00 p.m., when you will be able to come and try on various models of hard hat, including some of the very latest innovative designs, ask questions and pass on any comments and suggestions.

  14. The Future Days

    OpenAIRE

    Cerezo Rodríguez, Carlos

    2014-01-01

    In this memorandum it will be read all the documentation related to the Final Project Degree of Carlos Cerezo Rodríguez, The Future Days. The objective of this project has been to realise a mini-game (in form of interactive animation in Flash). So that, it will rest prepared for his posterior upload to websites that offer these services. As it will be appreciated in the writing, the process of construction of the project has been made through a phase of planning and preproduction, a phase of ...

  15. Comparison of ectopic pregnancy risk among transfers of embryos vitrified on day 3, day 5, and day 6.

    Science.gov (United States)

    Du, Tong; Chen, Hong; Fu, Rong; Chen, Qiuju; Wang, Yun; Mol, Ben W; Kuang, Yanping; Lyu, Qifeng

    2017-07-01

    To compare ectopic pregnancy risk among transfers of embryos vitrified on day 3, day 5, and day 6. Retrospective cohort study. Academic tertiary-care medical center. A total of 10,736 pregnancies after 23,730 frozen-thawed embryo transfer (FET) cycles of in vitro fertilization/intracytoplasmic sperm injection from March 2003 to May 2015. The ectopic pregnancy rate was compared among pregnancies resulting from transfers of embryos vitrified on day 3, day 5, and day 6. Generalized estimation equation regression models were used to calculate unadjusted and adjusted odds ratios and 95% confidence intervals for the association between ectopic pregnancy and selected patient and treatment characteristics. We studied this association in both the group that achieved pregnancy and the group that underwent an FET cycle. Odds of ectopic pregnancy. The overall rate of ectopic pregnancy was 2.8% (304/10,736). Ectopic pregnancy rates after day-3, day-5, and day-6 vitrified embryo transfers were 3.1% (287/9,224), 2.0% (11/562), and 0.6% (6/950), respectively. After adjusting for confounders, the risks of ectopic pregnancy in day-3 and day-5 vitrified embryo transfers were both significantly higher than in day-6 vitrified embryo transfers. The associations were similar when we did calculations per cycle. In women undergoing FET, day-6 vitrified embryo transfer is associated with a significantly lower risk of ectopic pregnancy than both day-3 and day-5 vitrified embryo transfers. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  16. 2015 Barcelona Asteroid Day

    CERN Document Server

    Gritsevich, Maria; Palme, Herbert

    2017-01-01

    This volume is a compilation of the research presented at the International Asteroid Day workshop which was celebrated at Barcelona on June 30th, 2015. The proceedings discuss the beginning of a new era in the study and exploration of the solar system’s minor bodies. International Asteroid Day commemorates the Tunguska event of June 30th, 1908. The workshop’s goal was to promote the importance of dealing proactively with impact hazards from space. Multidisciplinary experts contributed to this discussion by describing the nature of comets and asteroids along with their offspring, meteoroids. New missions to return material samples of asteroids back to Earth such as Osiris-REx and Hayabusa 2, as well as projects like AIM and DART which will test impact deflection techniques for Potentially Hazardous Asteroids encounters were also covered. The proceedings include both an outreach level to popularize impact hazards and a scientific character which covers the latest knowledge on these topics, as well as offeri...

  17. Higgs Boson Pizza Day

    CERN Multimedia

    Stefania Pandolfi

    2016-01-01

    CERN celebrated the fourth anniversary of the historical Higgs boson announcement with special pizzas.    400 pizzas were served on Higgs pizza day in Restaurant 1 at CERN to celebrate the fourth anniversary of the announcement of the discovery of the Higgs Boson (Image: Maximilien Brice/ CERN) What do the Higgs boson and a pizza have in common? Pierluigi Paolucci, INFN and CMS collaboration member, together with INFN president Fernando Ferroni found out the answer one day in Naples: the pizza in front of them looked exactly like a Higgs boson event display. A special recipe was then created in collaboration with the chef of the historic “Ettore” pizzeria in the St. Lucia area of Naples, and two pizzas were designed to resemble two Higgs boson decay channel event displays. The “Higgs Boson Pizza Day” was held on Monday, 4 July 2016, on the fourth anniversary of the announcement of the discovery of the Higgs boso...

  18. 5th Optimization Day

    CERN Document Server

    Mees, Alistair; Fisher, Mike; Jennings, Les

    2000-01-01

    'Optimization Day' (OD) has been a series of annual mini-conferences in Australia since 1994. The purpose of this series of events is to gather researchers in optimization and its related areas from Australia and their collaborators, in order to exchange new developments of optimization theories, methods and their applications. The first four OD mini-conferences were held in The Uni­ versity of Ballarat (1994), The University of New South Wales (1995), The University of Melbourne (1996) and Royal Melbourne Institute of Technology (1997), respectively. They were all on the eastern coast of Australia. The fifth mini-conference Optimization Days was held at the Centre for Ap­ plied Dynamics and Optimization (CADO), Department of Mathematics and Statistics, The University of Western Australia, Perth, from 29 to 30 June 1998. This is the first time the OD mini-conference has been held at the west­ ern coast of Australia. This fifth OD preceded the International Conference on Optimization: Techniques and Applica...

  19. A day to celebrate

    CERN Multimedia

    Laëtitia Pedroso

    2010-01-01

    After several weeks of preparations and hard work on the part of many people, the events to mark International Women's Day at CERN on 8 March were a genuine success. They were followed with great interest by the outside world, judging by the flurry of activity on twitter, various blogs and the media coverage they generated.   Women on shift in the CERN control rooms. Women were overwhelmingly in the majority at the controls of the experiments and accelerators throughout the day, as well as acting as the guides for all official visits. There was no shortage of enthusiasm! "I'm very happy that CERN has supported the project, and I'm especially encouraged by the enthusiastic response from everyone who's taken part", says Pauline Gagnon, a physicist from the Indiana University group and a member of the ATLAS collaboration, who was behind the idea. "I hope that this kind of initiative will help to show that women have a place in science and that young women thinkin...

  20. Global policy review of antiretroviral therapy eligibility criteria for treatment and prevention of HIV and tuberculosis in adults, pregnant women, and serodiscordant couples.

    Science.gov (United States)

    Gupta, Somya; Granich, Reuben; Suthar, Amitabh B; Smyth, Caoimhe; Baggaley, Rachel; Sculier, Delphine; Date, Anand; Desai, Mitesh A; Lule, Frank; Raizes, Elliot; Blanc, Leopold; Hirnschall, Gottfried

    2013-03-01

    This article reviews the antiretroviral therapy (ART)initiation criteria from national treatment guidelines for 70 countries and determines the extent of consistency with the current World Health Organization (WHO) recommendations. Published ART guidelines were collected from the Internet, databases, and WHO staff. ART eligibility criteria for asymptomatic people, pregnant women, people with HIV-associated tuberculosis, serodiscordant couples, injecting drug users, men who have sex with men, and sex workers were abstracted from them. Multiple regression analysis was used to determine the relation between ART eligibility criteria, ART coverage, and various population characteristics and policy interventions. Of the 70 countries, 42 (60%) follow WHO’s ART guidelines for asymptomatic people and 31 (44%) for pregnant women,recommending ART at CD4 count of ≤350 cells/mm(3). Twenty-three(33%) countries recommend ART for people with HIV-associated tuberculosis irrespective of CD4 count. Nineteen countries are also recommending or considering earlier ART above CD4 count ≤350 cell/mm(3) for asymptomatic people, pregnant women, and/or serodiscordant couples. Multiple linear regression analysis shows that HIV prevalence, year of publication of guidelines, and HIV expenditure are significantly associated with published ART eligibility criteria. On average, the ART coverage is similar irrespective of published guidelines being consistent with the WHO recommendation(P , 0.53). Published guidelines from a significant number of countries are not following WHO recommendations. Although published guidelines may not reflect practice, it is important to adapt recommendations and services quickly to reflect the emerging science on the health and prevention benefits of earlier access to ART.

  1. Treatment of uncertainties in the existence of free berths with risk analysis techniques. Establishment of policies in port of Cadiz (SPAIN)

    Energy Technology Data Exchange (ETDEWEB)

    Awad Nuñez, S.; Camarero Orive, A.; Romero Sanchez-Brunete, M.; Camarero Orive, A.; Gonzalez Cancelas, N.

    2016-07-01

    This research discusses the challenges involved in the treatment of uncertainties in the existence of free berths during the arrival of cruise ships at seaports. Pursuing this goal, a three-step methodology is adopted: 1) Identifying risk sources and critical risk variables and how they are related; 2) Fitting the Probability Distribution Functions that best represent the behaviour of each critical risk variable; and 3) Simulating the probability of a ship having to wait because there are no free berths using a technique that combines statistical concepts (random sampling) with the ability of computers to generate pseudo-random numbers and automate estimations of the values of the set of critical risk variables. The innovative use of risk analysis techniques in this field allows the establishment of policies to improve the planning and management of port infrastructure, for example, deciding when it is necessary to work to increase the number of berths. As a case of study, we applied this methodology to study whether the enlargement of the wharf in the port of Cadiz (Spain) is necessary right now considering the number of cruise ships that have arrived at the port in the past three years, their date and hour of arrival, their length and draught, the duration of their stay in port and their waiting time before being able to enter the port. This action would require moving logistics activities to a new terminal, but would bring to the city the opportunity to rethink the seafront, introducing new cruiser links with the city centre and developing a better seaport-city integration. (Author)

  2. Policy Innovation in Innovation Policy

    DEFF Research Database (Denmark)

    Borras, Susana

    as with national and sub-national governments in Europe, all of them introducing interesting novelties in their innovation policy. These changes refer to different aspects of policy, mainly the content of policy initiatives towards science, technology and innovation; the instruments governments are using...... to achieve their goals; and the actors in the policy system that are being mobilised in pursuing these goals. This paper deals with these policy changes, paying special attention to the novelties introduced since the early 1990s in Europe. The perspective of this paper deals mainly on the changes introduced...... at the EU level, and mentions similar trends taking place at national and sub-national levels. The questions that guide the contents here are essentially three, namely, what are the main traits of innovation policies in Europe since the 1990s and how have the EU and different national governments approached...

  3. ITER days in Moscow

    International Nuclear Information System (INIS)

    Golubchikov, L.

    2001-01-01

    In connection with the successful completion of the Engineering Design of the International Thermonuclear Reactor (ITER) and the 50th anniversary of fusion research in the USSR, the Ministry of the Russian Federation for Atomic Energy (Minatom) with the participation of the Russian Academy of Sciences, organized the International Symposium 'ITER days in Moscow' on 7-8 June 2001. About 250 people from more than 20 states took part in the Meeting. The participants welcomed the R and D results of the ITER project and considered it as a necessary step to establish a basis for a fusion energy source. There were also some scientific presentations on the following topics: ITER physics basis; Effect of fusion research on general physics; Fusion power reactors; US interests in burning plasma

  4. CERN Heart Days

    CERN Document Server

    2003-01-01

    14 & 15 OCTOBER 2003 The Medical Service and the Fire Brigade invite everyone working at CERN to participate in the above event. INFIRMARY 9 am to 16.30 pm Building 57, ground floor HEALTHY HEART? ♥ Evaluation of personal cardiac risks through the monitoring of: • Blood pressure • Cholesterol and sugar levels • Body Mass Index ... and more ♥ Leaflets, information and advice concerning cardiac issues FIRE BRIGADE 9 to 12am Building 65 FIRST AID COURSES ♥ What to do in a Cardiac Emergency (3 h duration) Places are limited and on reservation only (15 people / day) To book, E-mail the Medical Services on: service.medical@cern.ch

  5. Injector MD Days 2017

    CERN Document Server

    Rumolo, G

    2017-01-01

    The Injector Machine Development (MD) days 2017 were held on 23-24 March, 2017, at CERN with thefollowing main goals:Give a chance to the MD users to present their results and show the relevant progress made in 2016 onseveral fronts.Provide the MD users and the Operation (OP) crews with a general overview on the outcome and theimpact of all ongoing MD activities.Identify the open questions and consequently define - with priorities - a list of machine studies in theinjectors for 2017 (covering the operational beams, LHC Injectors Upgrade, High Luminosity LHC,Physics Beyond Colliders, other projects).Create the opportunity to collect and document the highlights of the 2016 MDs and define the perspectivesfor 2017.Discuss how to make best use of the MD time, in particular let the main MD user express their wishesand see whether/how OP teams can contribute to their fulfilment.

  6. Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial.

    Science.gov (United States)

    George, Christine Marie; Jung, Danielle S; Saif-Ur-Rahman, K M; Monira, Shirajum; Sack, David A; Mahamud-ur Rashid; Mahmud, Md Toslim; Mustafiz, Munshi; Rahman, Zillur; Bhuyian, Sazzadul Islam; Winch, Peter J; Leontsini, Elli; Perin, Jamie; Begum, Farzana; Zohura, Fatema; Biswas, Shwapon; Parvin, Tahmina; Sack, R Bradley; Alam, Munirul

    2016-02-01

    Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention. © The American Society of Tropical Medicine and Hygiene.

  7. Malaria: Antimalarial resistance and policy ramificationsand challenges

    Directory of Open Access Journals (Sweden)

    Kshirsagar N

    2006-01-01

    Full Text Available ′The National health Policy 2002" of India and the "Roll Back Malaria" policy makers have set up an ambitious goal of reducing malaria mortality and morbidity by 25% by 2007, and by 50% by 2010. To achieve these goals, problems should be identified, available evidence analyzed and policy should be changed early. Infection with drug resistant malarial parasites has a tremendous impact on health (prolonged recurrent illness, increased hospital admissions and death, health system (higher cost of treatment and socioeconomics of the region. In view of the evidence of the economic burden of malaria, it has been suggested that second line treatment could be considered at 10% failure instead of 25%. Effective schizonticidal drugs will not only reduce morbidity and mortality but will also reduce transmission. Studies have shown that prevalence of viable (as tested by exflagellation test gametocytes is considerably more after the Chloroquine or Chloroquine + Sulphadoxine-Pyrimethamine treatment compared to Quinine. Unfortunately, the only gametocytocidal drug for Plasmodium falciparum, primaquine, is also loosing its efficacy. 45 mg Primaquine reduces gametocyte prevalence by 50% while a new drug, 75 mg bulaquine or 60 mg primaquine reduces it by 90%. Plasmodium vivax forms 60-70% of malaria cases in India. Relapses which occur in 10-20% of cases adds to the burden. Efficacy, as confirmed by Polymerase Chain Reaction-Single Strand Conformational Polymorphism (PCRSSCP to differentiate relapse and re-infection, of standard dose of primaquine (15 mg/day for 5 days, even 15 mg/day for 14 days for vivax malaria is reducing. Fourteen day treatment is also impractical as compliance is poor. Newer drugs, newer drug delivery systems are thus needed. Slow release formulations with blood levels maintained for one week may be useful. Rationale of giving primaquine in higher doses and different timing need to be considered. The genome of Plasmodium falciparum and

  8. Informed policies

    International Development Research Centre (IDRC) Digital Library (Canada)

    cation technology (ICT) and now. Minister of Science and Technology, was one of the architects of Mozam- bique's ICT policy in 2000 — the first in Africa. Nationwide access to these technologies is one of the pillars of the government's science and technology policy. “We don't believe in politicians, but we believe in politics.

  9. Can Better National Policy End Family Homelessness?

    Science.gov (United States)

    Roman, Nan

    2010-01-01

    An understanding of the close link between federal policy and family homelessness is critical for ensuring that one day no child in the United States is homeless. This article discusses the nature of family homelessness, the national policy framework that exists to help vulnerable families, the homeless assistance system that federal policy has…

  10. [Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part III: Treatment of Resistant Depression and Psychotic Depression, Occupational Therapy and Day Hospital Treatment].

    Science.gov (United States)

    Gómez-Restrepo, Carlos; Peñaranda, Adriana Patricia Bohórquez; Valencia, Jenny García; Guarín, Maritza Rodríguez; Ángel, Juliana Rodríguez; Jaramillo, Luis Eduardo; Acosta, Carlos Alberto Palacio; Pedraza, Ricardo Sánchez; Díaz, Sergio Mario Castro; de la Hoz Bradford, Ana María

    2012-12-01

    This article presents recommendations based on the evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder. Emphasis was given to general treatment issues of resistant depression and psychotic depression, occupational therapy and day hospital treatment so as to grant diagnosed adult patients the health care parameters based on the best and more updated evidence available and achieve minimum quality standards. A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while de novo questions were developed. Recommendations 23-25 corresponding to the management of depression are presented. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  11. Seven remarkable days

    CERN Multimedia

    This has been a truly remarkable seven days for CERN. Things have moved so fast that it has sometimes been hard to separate fact from fiction – all the more so since facts have often seemed too good to be true. It’s been a week of many firsts. Monday was the first time we’ve had two captured beams in the LHC. It’s the first time the LHC has functioned as a particle accelerator, boosting particles to the highest beam energy so far achieved at CERN. And it’s been a week in which we’ve seen the highest energy proton-proton collisions ever produced at CERN: our last hadron collider, the SPS was a proton-antiproton collider, a technically simpler machine than the LHC. This week’s successes are all the more remarkable precisely because of the complexity of the LHC. Unlike the SPS collider, it is two accelerators not one, making the job of commissioning nearly twice as difficult. I’d like to express my heartfelt thanks and congra...

  12. CERN Diabetes Awareness Days

    CERN Document Server

    2005-01-01

    Do you have diabetes without knowing it? Following last year's successful campaign, the CERN Infirmary has organised two further diabetes prevention and screening days on 10th & 11th October 2005 from 9am to 4pm (INFIRMARY, Bldg 57, ground floor) open to everyone working on the CERN site who was unable to participate in 2004. Testing of blood pressure, cholesterol and sugar levels, Body Mass Index, etc. Information - documentation - personal and individual advice. Presence of a dietician from 2 p.m. to 4 p.m. In cooperation with the NOVAE, DSR & AVENANCE restaurants Diabetes is reaching epidemic proportions in many countries and, if not diagnosed sufficiently early, can be a major cause of blindness and of heart and kidney disease, etc. Prevention is possible through screening and life-style changes such as improved dietary habits and regular physical exercise. Diabetes is not a serious condition in itself if it is diagnosed and treated early enough but it can have very serious consequences...

  13. CERN diabetes awareness days

    CERN Multimedia

    2005-01-01

    Do you have diabetes without knowing it? Following last year's successful campaign, the CERN Infirmary has organised two further diabetes prevention and screening days on 10th & 11th October 2005 from 9am to 4pm (INFIRMARY, Bldg 57, ground floor) open to everyone working on the CERN site who was unable to participate in 2004. Testing of blood pressure, cholesterol and sugar levels, Body Mass Index, etc. Information - documentation - personal and individual advice. Presence of a dietician from 2 p.m. to 4 p.m. In cooperation with the NOVAE, DSR & AVENANCE restaurants. Diabetes is reaching epidemic proportions in many countries and, if not diagnosed sufficiently early, can be a major cause of blindness, heart and kidney disease, etc. Prevention is possible through screening and life-style changes such as improved dietary habits and regular physical exercise. Diabetes is not a serious condition in itself if diagnosed and treated early enough but it can have very serious consequences if und...

  14. Printshop open days

    CERN Multimedia

    Anaïs Schaeffer

    2013-01-01

    With new machines, new services and new opening hours, the CERN Printshop has turned over many new leaves at the start of 2013. Come and find out more from 25 to 27 March at the Printshop open days!   The CERN Printshop’s new 8-metre long black and white printer. The CERN Printshop’s new 8-metre long black-and-white printer is a technical marvel. It can produce 160 pages per minute (it prints on both sides in one pass) and can also staple, punch holes, do thermal binding and make A4 or A5 brochures. The new colour printer is more discreet but no less efficient: it churns out 70 A4 or A3 pages per minute. Once they are printed, colour documents can be inserted into the black and white machine to be hole-punched, made into brochures or bound. They can even be mixed in with black-and-white pages and, as if by magic, come out in the right order! Having recently acquired a state-of-the-art large-format printer, the CERN Printshop can now print posters in A2, A1 or A0 format. ...

  15. Two days of films

    CERN Document Server

    2011-01-01

    The Chinese community at CERN and the CERN CineClub, on the occasion of the Chinese New Year, invite everyone to two days of films Thursday 3 February 2011 at 20:30 - CERN Council Chamber Eat drink man woman Directed by Ang LEE (Taiwan, 1994) 122 min. With Sihung Lung, Yu-Wen Wang, Chien-Lien Wu, Kuei-Mei Yang Senior Master Chef Chu lives in a large house in Taipei with his three unmarried daughters, Jia-Jen, a chemistry teacher converted to Christianity, Jia-Chien, an airline executive, and Jia-Ning, a student who also works in a fast food restaurant. Life in the house revolves around the ritual of an elaborate dinner each Sunday, and the love lives of all the family members. Original version Mandarin with English subtitles Friday 4 February 2011 at 19:30 - CERN Council Chamber Adieu, ma concubine Directed by Chen KAIGE (China / Hong Kong, 1993) 171 min. With Leslie Cheung, Fengyi Zhang, Li Gong "Farewell, My Concubine" is a movie with two parallel, intertwined stories. It is the story of two performers in t...

  16. Treatment

    Directory of Open Access Journals (Sweden)

    Safaa M. Raghab

    2013-08-01

    The main goal of this study is to utilize a natural low cost material “as an accelerator additive to enhance the chemical treatment process using Alum coagulant and the accelerator substances were Perlite and Bentonite. The performance of the chemical treatment was enhanced using the accelerator substances with 90 mg/l Alum as a constant dose. Perlite gave better performance than the Bentonite effluent. The removal ratio for conductivity, turbidity, BOD and COD for Perlite was 86.7%, 87.4%, 89.9% and 92.8% respectively, and for Bentonite was 83.5%, 85.0%, 86.5% and 85.0% respectively at the same concentration of 40 mg/l for each.

  17. AAS 227: Day 4

    Science.gov (United States)

    Kohler, Susanna

    2016-01-01

    Editors Note:This week were at the 227th AAS Meeting in Kissimmee, FL. Along with several fellow authors from astrobites.com, I will bewritingupdates on selectedevents at themeeting and posting at the end of each day. Follow along here or atastrobites.com, or catch ourlive-tweeted updates from the@astrobites Twitter account. The usual posting schedule for AAS Nova will resumenext week.Welcome to Day 4 of the winter American Astronomical Society (AAS) meeting in Kissimmee! Several of us are attending the conference this year, and we will report highlights from each day here on astrobites. If youd like to see more timely updates during the day, we encourage you to follow @astrobites on twitter or search the #aas227 hashtag.Helen B. Warner Prize: Origins of Structure in Planetary Systems (by Erika Nesvold)Another excellent prize lecture started off todays sessions. The Helen B. Warner Prize is awarded for achievement in observational or theoretical astrophysics by a young researcher (no more than eight years after their Ph.D.). This years Warner Prize was presented to Ruth Murray-Clay of UC Santa Barbara. For her award lecture, Murray-Clay told us all about planetary system architecture: the number, masses, and orbits of planets in a given system.Ruth Murray-Clay [photo from http://web.physics.ucsb.edu/ ~murray/biocv.html]The underlying question motivating this type of research is: How rare is the Solar System? In other words, how likely is it that a given planetary system will have rocky planets close to their star, gas giants farther out, and ice giants at the outer reaches of the system? Answering this question will help us solve the physics problem of how and where planets form, and will also help us on our search for other planets like Earth.The data on exoplanet population from transit and radial velocity observations and from direct imaging tell us that our Solar System is not common (many systems we observe have much more eccentric gas giants), but that doesnt

  18. IAEA Supports World Cancer Day

    International Nuclear Information System (INIS)

    ElBaradei, M.

    2008-01-01

    Full text: Cancer can strike anyone at anytime, young or old, rich or poor. It knows no borders. World Cancer Day, on 4 February, was initiated to raise global awareness of cancer issues and stimulate new strategies and thinking to combat the killer disease. Nowhere is the need greater than in the developing world, where millions of people are suffering and dying due to lack of cancer prevention and treatment. According to the World Health Organisation (WHO), 84 million people will die of cancer in the next 10 years, more than 70% of them in low-income countries, unless action is taken now. The IAEA's Programme of Action for Cancer Therapy (PACT) was created to help poorer countries confront the growing cancer crisis by integrating radiotherapy into comprehensive cancer control programmes. As it celebrates its third birthday on World Cancer Day, PACT can claim significant progress in building effective relationships with a broad array of stakeholders, initiating six pilot projects and gaining increasing support from Member States. The IAEA commends all organizations, agencies and individuals engaged in the battle to defeat this dreadful disease. We look forward to continued collaboration with international partners to help bring hope to cancer patients, to relieve their suffering and to save lives. (IAEA)

  19. AAS 227: Day 3

    Science.gov (United States)

    Kohler, Susanna

    2016-01-01

    Editors Note:This week were at the 227th AAS Meeting in Kissimmee, FL. Along with several fellow authors from astrobites.com, I will bewritingupdates on selectedevents at themeeting and posting at the end of each day. Follow along here or atastrobites.com, or catch ourlive-tweeted updates from the@astrobites Twitter account. The usual posting schedule for AAS Nova will resumenext week.Welcome to Day 3 of the winter American Astronomical Society (AAS) meeting in Kissimmee! Several of us are attending the conference this year, and we will report highlights from each day here on astrobites. If youd like to see more timely updates during the day, we encourage you to follow @astrobites on twitter or search the #aas227 hashtag.Henry Norris Russell Lecture: Viewing the Universe with Infrared Eyes: The Spitzer Space Telescope (by Erika Nesvold)The Henry Norris Russell Award is the highest honor given by the AAS, for a lifetime of eminence in astronomy research. This years award went to Giovanni Fazio of the Harvard-Smithsonian Center for Astrophysics. Fazio became a leader in gamma ray astronomy before switching mid-career to the study of infrared astronomy, and he gave his award lecture on the latter subject, specifically on the Spitzer Space Telescope, one of the most successful infrared telescopes of all time.Artists rendering of the Spitzer space telescope. [NASA/JPL-Caltech]Spitzer has been operating for more than twelve years, and has resulted in over six thousand papers in refereed journals in that time. The telescope sits in an Earth-trailing orbit around the Sun, and is now farther from the Earth (1.4 AU) than the Earth is from the Sun. Fazio gave the audience a fascinating overview of the science done by Spitzer over more than a decade. One of the most productive areas of research for Spitzer is the study of exoplanets, which hadnt even been discovered when the Spitzer Telescope was first conceived. Spitzers high sensitivity and ability to observe exoplanets over

  20. Tritium conference days

    International Nuclear Information System (INIS)

    Garnier-Laplace, J.; Lebaron-Jacobs, L.; Sene, M.; Devin, P.; Chretien, V.; Le Guen, B.; Guetat, Ph.; Baglan, N.; Ansoborlo, E.; Boyer, C.; Masson, M.; Bailly-Du-Bois, P.; Jenkinson, St.; Wakeford, R.; Saintigny, Y.; Romeo, P.H.; Thompson, P.; Leterq, D.; Chastagner, F.; Cortes, P.; Philippe, M.; Paquet, F.; Fournier, M.

    2009-01-01

    This document gathers the slides of the available presentations given during this conference day. Twenty presentations out of 21 are assembled in the document and deal with: 1 - tritium in the environment (J. Garnier-Laplace); 2 - status of knowledge about tritium impact on health (L. Lebaron-Jacobs); 3 - tritium, discrete but present everywhere (M. Sene); 4 - management of tritium effluents from Areva NC La Hague site - related impact and monitoring (P. Devin); 5 - tritium effluents and impact in the vicinity of EDF's power plants (V. Chretien and B. Le Guen); 6 - contribution of CEA-Valduc centre monitoring to the knowledge of atmospheric tritiated water transfers to the different compartments of the environment (P. Guetat); 7 - tritium analysis in environment samples: constraints and means (N. Baglan); 8 - organically-linked tritium: the analyst view (E. Ansoborlo); 9 - study of tritium transfers to plants via OBT/HTO air and OBT/HTO free (C. Boyer); 10 - tritium in the British Channel (M. Masson and P. Bailly-Du-Bois); 11 - tritium in British coastal waters (S. Jenkinson); 12 - recent results from epidemiology (R. Wakeford); 13 - effects of tritiated thymidine on hematopoietic stem cells (P.H. Romeo); 14 - tritium management issue in Canada: the point of view from authorities (P. Thompson); 15 - experience feedback of the detritiation process of Valduc centre (D. Leterq); 16 - difficulties linked with tritiated wastes confinement (F. Chastagner); 17 - optimisation of tritium management in the ITER project (P. Cortes); 18 - elements of thought about the management of tritium generated by nuclear facilities (M. Philippe); 19 - CIPR's position about the calculation of doses and risks linked with tritium exposure (F. Paquet); 20 - tritium think tanks (M. Fournier). (J.S.)

  1. Astrophysics days and MHD

    International Nuclear Information System (INIS)

    Falgarone, Edith; Rieutord, Michel; Richard, Denis; Zahn, Jean-Paul; Dauchot, Olivier; Daviaud, Francois; Dubrulle, Berengere; Laval, Jean-Philippe; Noullez, Alain; Bourgoin, Mickael; Odier, Philippe; Pinton, Jean-Francois; Leveque, Emmanuel; Chainais, Pierre; Abry, Patrice; Mordant, Nicolas; Michel, Olivier; Marie, Louis; Chiffaudel, Arnaud; Daviaud, Francois; Petrelis, Francois; Fauve, Stephan; Nore, C.; Brachet, M.-E.; Politano, H.; Pouquet, A.; Leorat, Jacques; Grapin, Roland; Brun, Sacha; Delour, Jean; Arneodo, Alain; Muzy, Jean-Francois; Magnaudet, Jacques; Braza, Marianna; Boree, Jacques; Maurel, S.; Ben, L.; Moreau, J.; Bazile, R.; Charnay, G.; Lewandowski, Roger; Laveder, Dimitri; Bouchet, Freddy; Sommeria, Joel; Le Gal, P.; Eloy, C.; Le Dizes, S.; Schneider, Kai; Farge, Marie; Bottausci, Frederic; Petitjeans, Philippe; Maurel, Agnes; Carlier, Johan; Anselmet, Fabien

    2001-05-01

    This publication gathers extended summaries of presentations proposed during two days on astrophysics and magnetohydrodynamics (MHD). The first session addressed astrophysics and MHD: The cold interstellar medium, a low ionized turbulent plasma; Turbulent convection in stars; Turbulence in differential rotation; Protoplanetary disks and washing machines; gravitational instability and large structures; MHD turbulence in the sodium von Karman flow; Numerical study of the dynamo effect in the Taylor-Green eddy geometry; Solar turbulent convection under the influence of rotation and of the magnetic field. The second session addressed the description of turbulence: Should we give up cascade models to describe the spatial complexity of the velocity field in a developed turbulence?; What do we learn with RDT about the turbulence at the vicinity of a plane surface?; Qualitative explanation of intermittency; Reduced model of Navier-Stokes equations: quickly extinguished energy cascade; Some mathematical properties of turbulent closure models. The third session addressed turbulence and coherent structures: Alfven wave filamentation and formation of coherent structures in dispersive MHD; Statistical mechanics for quasi-geo-strophic turbulence: applications to Jupiter's coherent structures; Elliptic instabilities; Physics and modelling of turbulent detached unsteady flows in aerodynamics and fluid-structure interaction; Intermittency and coherent structures in a washing machine: a wavelet analysis of joint pressure/velocity measurements; CVS filtering of 3D turbulent mixing layer using orthogonal wavelets. The last session addressed experimental methods: Lagrangian velocity measurements; Energy dissipation and instabilities within a locally stretched vortex; Study by laser imagery of the generation and breakage of a compressed eddy flow; Study of coherent structures of turbulent boundary layer at high Reynolds number

  2. Public Policies of Solar Energy

    International Nuclear Information System (INIS)

    Bouvier, Yves; Pehlivanian, Sophie; Teissier, Pierre; Chauvin-Michel, Marion; Forget, Marie; Raymond, Roland; Hyun Jin Yu, Julie; Popiolek, Nathalie; Guthleben, Denis

    2013-01-01

    This dossier about the Public Policies of Solar Energy brings together the presentations given in June 2013 at a colloquium organised by the Savoie university of Chambery (France): Introduction (Yves Bouvier, Sophie Pehlivanian); Passive solar energy in the shade of the French energy policy, 1945-1986 (Pierre Teissier); Solar architectures and energy policies in France: from oil crisis to solar crisis (Marion Chauvin-Michel); Sun in media, between promotion and contestation (Sophie Pehlivanian); Public policies of solar energy and territorial jurisdictions: the example of village photovoltaic power plants (Marie Forget); Energy social system and ordinary creative movement (Roland Raymond); The Historical Evolution of South Korea's Solar PV Policies since the 1970's (Julie Hyun Jin Yu, Nathalie Popiolek); Research on solar energy from yesterday to the present day: an historical project (Denis Guthleben); Photovoltaic power: public policies and economical consequences. The French choices in the international context - 1973-2013 (Alain Ricaud)

  3. Policy stories

    DEFF Research Database (Denmark)

    Ren, Carina Bregnholm; Rasmussen, Rasmus Kjærgaard

    planning and execution and of event outcomes beyond the narrow confines of bed nights and legacies. Second, we introduce policies as an entry point to unlock discussions and manifestations of value and futures which connect to AWG. In order to exemplify the workings of the AWG event in these domains, we...... present three central policy stories from the field. The stories tell of how the event was first interested, then activated and finally evaluated. Besides adding a new understanding to policy-driven events as a locus of value creation, we also argue that the AWG 2016 offer speculative bets for new...

  4. A new once-a-day fentanyl citrate patch (Fentos Tape) could be a new treatment option in patients with end-of-dose failure using a 72-h transdermal fentanyl matrix patch.

    Science.gov (United States)

    Koike, Kazuhiko; Terui, Takeshi; Nagasako, Tomokazu; Horiuchi, Iori; Machino, Takayuki; Kusakabe, Toshiro; Hirayama, Yasuo; Mihara, Hiroyoshi; Yamakage, Michiaki; Kato, Junji; Nishisato, Takuji; Ishitani, Kunihiko

    2016-03-01

    The recommended dosing interval for transdermal fentanyl is every 72 h. However, some patients will have "end-of-dose failure," which may be seen as an increase of episodes of severe pain flares at the third day after application of the patch. A new once-a-day fentanyl patch was developed in Japan since 2010. This study aimed to assess the efficacy of the once-a-day fentanyl citrate patch for patients with cancer-related pain receiving the 72-h transdermal fentanyl not lasting 72 h. We performed a cross-sectional retrospective analysis of 445 inpatients with the 72-h transdermal fentanyl at Higashi Sapporo Hospital. We could switch to the once-a-day fentanyl citrate patch if patients reported inadequate pain relief beyond 48 h after application of the 72-h transdermal fentanyl. Patients recorded baseline scores for background pain intensity (PI) and the frequency of use of daily rescue medication for breakthrough cancer pain (BTcP). Of all patients, 10.1% showed the increase in PI of 30% or more baseline PI on the third day after application of the 72-h transdermal fentanyl. Of patients, 84.4% were converted from equivalent dose of the 72-h transdermal fentanyl to the once-a-day fentanyl citrate patch. On the third day after switching, 60.5% of patients showed a reduction of more than 30% from baseline PI. Switching to the once-a-day fentanyl citrate patch significantly reduced the mean frequency of daily rescue dose for BTcP. A once-a-day fentanyl citrate patch provided stable pain control. Its use may be considered as the dominant strategy for patients receiving a 72-h transdermal fentanyl not lasting 72 h.

  5. 2016 SPD: Day 1

    Science.gov (United States)

    Kohler, Susanna

    2016-06-01

    Editors note: This week were in Boulder, Colorado at the 47th meeting of the AAS Solar Physics Division (SPD). Follow along to catch some of the latest news from the field of solar physics!The 2016 SPD meeting was launched this morning from the University of Colorado Boulder campus. Two of the hot topics at this years meeting include celebration of the recent move of the National Solar Observatorys headquarters to Boulder, and discussion of the future Daniel K. Inouye Solar Telescope (DKIST, formerly the Advanced Technology Solar Telescope, ATST). DKIST, planned for a 2019 completion in Hawaii, is the next big telescope on the horizon for solar physics.Todays press conference had an interesting focus: instruments providing new high-energy observations of the Sun. Representatives from four different instruments were here to talk about some of the latest X-ray solar observations.GRIPSThe GRIPS payload flew at 130,000 ft over Antarctica on a giant balloon in January 2016. [NASA/Albert Shih]First up, Albert Shih (NASA Goddard) described the Gamma-Ray Imager/Polarimeter for Solar flares, or GRIPS. GRIPS is a balloon-borne instrument designed to detect X-rays and gamma rays emitted during solar flares. Up to tens of a percent of the energy in solar flares is emitted in the form of accelerated particles, but the physics behind this process is not well understood. GRIPS observes where the highest-energy particles are accelerated, in an effort to learn more about the process.GRIPS was launched on 19 January, 2016 and flew for roughly 12 days gathering ~1 million seconds of data! The logistics of this instruments flight are especially interesting, since it was launched from Antarctica and carried by a balloon at a whopping elevation of 130,000 ft (to get high enough that the atmosphere doesnt absorb all the photons GRIPS is trying to observe). Though the data from the mission has been retrieved, the bulk of the hardware remains where it landed at the end of January. It must

  6. Human rights and migration policies.

    Science.gov (United States)

    Marmora, L

    1990-01-01

    This paper concerns the history of migration, migration policies, and the rights of migrants in Latin America from 1500 to the present. In the first part of the article, the author identifies and discusses the basic rights of migrants. In the second part, migration policies, migration flows, and the treatment of migrants are examined over time.

  7. 2016 SPD: Day 3

    Science.gov (United States)

    Kohler, Susanna

    2016-06-01

    last the longest 2 minutes and 40 seconds is the small town of Hopkinsville, KY. WKU is located a little over an hour away, and both locations are prepared for a large influx of people on eclipse day!Partial solar eclipse as viewed by the space-based Solar Dynamics Observatory. [NASA/SDO]WKU is located just off the centerline of eclipse path, which has some advantages: this provides better viewing of some of the chromospheric features of the Sun during the eclipse, like priminences and solar loops. WKU is setting up a variety of educational and public outreach activities at their football stadium and the WKU farm, and they encourage you to come visit for the eclipse!In addition, they are participating in a nationwide experiment called Citizen CATE, short for the Continental American Telescopic Eclipse. This project will use 60 telescopes spanning the 2500 mile path of totality to record continuous data of the eclipse as it travels across the US. The result will be data of a remarkable 90 minutes of totality, revealing the activity of the solar corona and providing an extended view of the eclipse as has never been seen before.Science During the EclipseNext up was Shadia Habbal (University of Hawaii), who is a co-leader of the AAS 2017 Eclipse Task Force. In addition to her education and outreach efforts associated with the eclipse, however, Habbal is a solar eclipse researcher. She and her collaborators are known as the Solar Wind Sherpas, due to the fact that they hand-carry their science equipment around the world for solar eclipses!Solar corona during a 2008 eclipse, with color overlay indicating emission from highly ionized iron lines. [Habbal et al. 2010]The primary science done during solar eclipses is the study of the solar corona, the region that extends from the solar surface out to several solar radii. This region is too faint to observe normally, but when the light from the Suns disk is blocked out, we can examine it.Unfortunately, the space telescopes that

  8. AAS 228: Day 4

    Science.gov (United States)

    Kohler, Susanna

    2016-06-01

    Editors Note: Lastweek we were at the 228th AAS Meeting in San Diego, CA. Here is a final post aboutselectedevents on the last day of the meeting, written by authors fromastrobites.com, a grad-student collaborative project with which we recently announced a new partnership! Starting in July,keep an eye out for astrobites postsat AAS Nova in between Highlights(i.e., on Tuesdays and Thursdays).Were excited to be working together to bring you more recent astronomy research from AAS journals!Extrasolar Planets: Detection (by Leonardo dos Santos)Thursdays first session on exoplanets was about detecting these distant worlds, and the opening talk was given by Robert Siverd (Las Cumbres Observatory). He describes the NRES, a network of spectrographs that will look for exoplanets using the radial velocity method. One of the coolest aspects of this instrument is that it will feature an on the fly scheduling system that will perform observations as efficiently as possible. The spectrograph is still being tested, but a unit will be deployed at CTIO later this year.@lcogt contracted by @NASA_TESS for follow up of their candidates. #aas228 Jessie Christiansen (@aussiastronomer) June 16, 2016Measuring the depths of transits and eclipses in Spitzer has been problematic in the past, since the Spitzer instrument IRAC (InfraRed Array Camera) has a non-uniform response in its detectors pixels. But, as reported by James Ingalls (Spitzer Science Center, Caltech), observers are circumventing this issue by using what they call the staring mode (avoiding large pointing jumps) and an algorithm to pick sweet spot pixels. Moreover, the results from the IRAC Data Challenge are helping to better understand its behavior. Giuseppe Morello (University College London), on the other hand, explained how his research group gets rid of instrumental effects from IRAC using machine learning. This method removes systematics from exoplanet transit data no matter if the noise source is from an instrument or

  9. The Ukrainian regulatory authority policy in respect of reducing the quantity of radiation sources which are subject to treatment and disposal in the Ukraine

    International Nuclear Information System (INIS)

    Holubiev, V.; Makarovska, O.

    2000-01-01

    The problem of safe management of disused radiation sources generated from the use of radionuclides in industry, research and medicine is very important for the Ukraine. This paper discusses some methods to solve this problem. The methods could be termed preventive and are aimed at determining and implementing an appropriate national regulatory policy in the sphere of activities with sealed sources. This policy includes a wide spectrum of measures: from political steps to the creation of a State computerized inventory system. It has led to a reduction in the quantity of radiation sources which have to be subject to reprocessing and disposal in the Ukraine. The content, reason and phases of realization of each issue of this policy in the Ukraine are discussed. (author)

  10. Four Days...Oslo 1976

    Science.gov (United States)

    Education and Culture, 1977

    1977-01-01

    Summarizes the four main themes dealt with at the Oslo Conference in 1976: the challenge to cultural policy in a changing society, cultural policy as an instrument for improving the quality of life, support and encouragement of artistic creation and cultural cooperation. Also considers four secondary themes: culture and the child, migrant workers,…

  11. Methodology of Day-To-Day Ship Costs Assessment

    Directory of Open Access Journals (Sweden)

    Milojka Počuča

    2006-09-01

    Full Text Available The paper presents a methodology of assessing the day-to-day fixed costs of maritime cargo ships. The authoress refersthe reader to factors that affect the amount affixed daily costsand the day-to-day voyage costs of ships. In the last chapter thepaper presents an estimation of the average daily fixed costsand day-to-day voyage costs of ships per type and size for theyear 2003. Besides particular explanations, the reader is refe"ed to data bases that authentically impart data on the structureof maritime fleets and their technical characteristics, aswell as databases on prices and costs in maritime transport.

  12. Water Governance Decentralisation and River Basin Management Reforms in Hierarchical Systems: Do They Work for Water Treatment Policy in Mexico’s Tlaxcala Atoyac Sub-Basin?

    NARCIS (Netherlands)

    Casiano Flores, Cesar Augusto; Vikolainen, Vera; Bressers, Johannes T.A.

    2016-01-01

    In the last decades, policy reforms, new instruments development, and economic resources investment have taken place in water sanitation in Mexico; however, the intended goals have not been accomplished. The percentage of treated wastewater as intended in the last two federal water plans has not

  13. Post-exceptionalism in public policy

    DEFF Research Database (Denmark)

    Daugbjerg, Carsten; Feindt, Peter H.

    2017-01-01

    Framing the special issue on the transformation of Food and Agricultural Policy, this article introduces the concept of post-exceptionalism in public policies. The analysis of change in agri-food policy serves as a generative example to conceptualize current transformations in sectoral policy...... arrangements in democratic welfare states. Often these arrangements have been characterized by an exceptionalist ideational framework that legitimizes a sector’s special treatment through compartmentalized, exclusive and producer-centered policies and politics. In times of internationalization of policy......-making, increasing interlinkage of policy areas and trends towards self-regulation, liberalization and performance-based policies, policy exceptionalism is under pressure to either transform or give way to (neo-)liberal policy arrangements. Post-exceptionalism denotes a partial transformation of exceptionalist ideas...

  14. Policy Reader

    International Nuclear Information System (INIS)

    1985-09-01

    This policy reader comprises: Correspondence; Memorandum of Understanding between the US Department of Transportation and the US Department of Energy for the Transportation of Radioactive Materials under the Nuclear Waste Policy Act; Internal Guidelines for Interactions with Communities and Local Governments; Statement by Ben C. Rusche before the Committee on Interior and Insular Affairs, Subcommittee on Energy and the Environment, US House of Representatives, September 13, 1985; Speech presented by Ben C. Rusche before the ANS/CNS/AESJ/ENS Topical Meeting, Pasco, Washington, September 24, 1985 - ''Status of the United States' High-Level Nuclear Waste Disposal Program''; and ''DOE Seeks Comments on Nuclear Transportation Planning,'' DOE News, September 30, 1985

  15. Population policy.

    Science.gov (United States)

    1987-03-01

    Participants in the Seminar on Population Policies for Top-level Policy Makers and Program Managers, meeting in Thailand during January 1987, examined the challenges now facing them regarding the implementation of fertility regulation programs in their respective countries -- Bangladesh, China, India, Indonesia, Malaysia, Nepal, Pakistan, the Philippines, the Republic of Korea, and Thailand. This Seminar was organized to coincide with the completion of an Economic and Social Commission for Asia and the Pacific (ESCAP) study investigating the impact and efficiency of family planning programs in the region. Country studies were reviewed at the Seminar along with policy issues about the status of women, incentive and disincentive programs, and socioeconomic factors affecting fertility. In Bangladesh the government recognizes population growth as its top priority problem related to the socioeconomic development of the country and is working to promote a reorientation strategy from the previous clinic-oriented to a multidimensional family welfare program. China's family planning program seeks to postpone marraige, space the births of children between 3-5 years, and promote the 1-child family. Its goal is to reduce the rate of natural increase from 12/1000 in 1978 to 5/1000 by 1985 and 0 by 2000. India's 7th Five-Year-Plan (1986-90) calls for establishing a 2-child family norm by 2000. In Indonesia the government's population policy includes reducing the rate of population growth, achieving a redistribution of the population, adjusting economic factors, and creating prosperous families. The government of Indonesia reversed its policy to reduce the population growth rate in 1984 and announced its goal of achieving a population of 70 million by 2100 in order to support mass consumption industries. It has created an income tax deduction system favoring large families and maternity benefits for women who have up to 5 children as incentives. Nepal's official policy is to

  16. Language Policy

    DEFF Research Database (Denmark)

    Lauridsen, Karen M.

    2008-01-01

    Like any other text, instructive texts function within a given cultural and situational setting and may only be available in one language. However, the end users may not be familiar with that language and therefore unable to read and understand the instructions. This article therefore argues...... that instructive texts should always be available in a language that is understood by the end users, and that a corporate communication policy which includes a language policy should ensure that this is in fact the case for all instructive texts....

  17. An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement : Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units

    NARCIS (Netherlands)

    Bosslet, Gabriel T.; Pope, Thaddeus M.; Rubenfeld, Gordon D.; Lo, Bernard; Truog, Robert D.; Rushton, Cynda H.; Curtis, J. Randall; Ford, Dee W.; Osborne, Molly; Misak, Cheryl; Au, David H.; Azoulay, Elie; Brody, Baruch; Fahy, Brenda G.; Hall, Jesse B.; Kesecioglu, Jozef; Kon, Alexander A.; Lindell, Kathleen O.; White, Douglas B.

    2015-01-01

    Background: There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered. Purpose: This multisociety statementprovides recommendations to prevent and manage intractable disagreements about the use of such treatments in

  18. 17th World Food Day observed.

    Science.gov (United States)

    1997-01-01

    The UN Food and Agriculture Organization has dubbed October 16 World Food Day in an effort to create awareness and generate interest in the efforts being made to alleviate hunger and malnutrition, and to increase food production. A flag-raising ceremony marked the 17th World Food Day, on investing in food security, in Accra, Ghana. The Vice-President of Ghana noted at the ceremony that his government has made agriculture its top priority and is determined to invest as much as needed to achieve significant growth in the sector. The government is also taking steps to make agriculture so attractive that both private individuals and companies will find it a profitable sector in which to partake. The government of Ghana will provide its fullest cooperation and support in all technical and logistical aspects of the production process to prospective investors in the sector. Enlightened government policies are needed to ensure a broader framework for improving food security through agricultural development.

  19. 76 FR 76025 - World AIDS Day, 2011

    Science.gov (United States)

    2011-12-06

    ... to turn the corner on the HIV/AIDS pandemic by investing in research that promises new and proven.... And research is ongoing to devise new prevention methods that may one day offer innovative ways to... next breakthrough treatment in the fight against HIV, continuing research to develop a vaccine, and...

  20. Flexibility-friendly support policies:

    DEFF Research Database (Denmark)

    Boscán Flores, Luis Rafael; Skytte, Klaus; Soysal, Emilie Rosenlund

    2017-01-01

    This paper introduces the concept of flexibilityfriendly support policies, i.e. state of-the-system-dependent subsidies given to producers of electricity who base their output on renewable energy sources (RES). Such policies increase with demand, decrease with the availability of Variable Renewable...... Energy (VRE) producers and, overall, follow the power system’s residual load. The paper presents a microeconomic framework to analyze this and other desirable properties of support mechanisms. To illustrate the concept, it uses the present-day policies of Nordic and Baltic countries (Denmark, Estonia......, Finland, Latvia, Lithuania, Sweden and Norway) as a case study....

  1. OBESITY : A MODERN DAY PLAGUE.

    Science.gov (United States)

    Yadav, Yatendra Kumar

    2002-01-01

    Obesity is the presence of excess body fat. Unfortunately obesity is taken as a mere cosmetic problem and not a medical one. Today obesity is being 'dealt' with more by the self-proclaimed fitness experts running the rapidly mushrooming fitness centres rather than by medical professionals. But rather than merely a cosmetic problem, obesity should be viewed as a disease because there are multiple biologic hazards at surprisingly low levels of excess fat With the rapid pace of industrialisation and economic progress, today more and more jobs are becoming sedentary and dietary patterns are also changing with a decline in the cereal intake and increase in the intake of sugar and fats. However, inherited physiologic differences in response to eating and exercise are also important factors. Treating obesity can often be a frustrating experience for both the physician and the patient because of the great difficulty in maintaining weight loss over the long term. However, a clear understanding of the causes of obesity and a treatment strategy based on a combination of diet, nutrition, education, exercise, behaviour modification and social support can go a long way in containing this 'modern day plague' before it acquires epidemic proportions.

  2. 30-Day, 90-day and 1-year mortality after emergency colonic surgery

    DEFF Research Database (Denmark)

    Pedersen, T; Watt, S K; Tolstrup, M-B

    2017-01-01

    PURPOSE: Emergency surgery is an independent risk factor in colonic surgery resulting in high 30-day mortality. The primary aim of this study was to report 30-day, 90-day and 1-year mortality rates after emergency colonic surgery, and to report factors associated with 30-day, 90-day and 1-year...... mortality. Second, the aim was to report 30-day postoperative complications and their relation to in-hospital mortality. METHODS: All patients undergoing acute colonic surgery in the period from May 2009 to April 2013 at Copenhagen University Hospital Herlev, Denmark, were identified. Perioperative data...... postoperative deaths. CONCLUSION: Mortality and complication rates after emergency colonic surgery are high and associated with patient related risk factors that cannot be modified, but also treatment related outcomes that are modifiable. An increased focus on medical and other preventive measures should...

  3. Harm minimization or abstinence: an evaluation of current policies and practices in the treatment and control of intravenous drug using groups in Australia.

    Science.gov (United States)

    Lennings, C J

    The past decade has seen Australia cited as a significant leader in the development of harm-minimization policies towards illicit drug use. Such policies have been developed on the premise that harm minimization would lead to substantial long-term gains to society in the areas of: (1) decreased health costs for intravenous drug users (IDU); (2) decreased mortality rates for IDU groups; (3) increases in social productivity of IDU (through such things as gaining and retaining employment); and (4) decreased criminal activity leading to substantial gains in law enforcement budgets, and reduced community crime costs (theft and burglaries, etc. Evaluation of the success of harm minimization is notoriously difficult. By its nature success often means there are no ways of comparing potential losses against potential gains. An alternative to harm minimization, abstinence models, exist. In Australia the harm minimization policy has come under review in some States, and has never been fully implemented in the Northern Territory. This paper reviews the merits and demerits of both approaches, and initiates discussion regarding the development of future services for IDU groups in Australian society.

  4. Health worker and policy-maker perspectives on use of intramuscular artesunate for pre-referral and definitive treatment of severe malaria at health posts in Ethiopia

    OpenAIRE

    Kefyalew, Takele; Kebede, Zelalem; Getachew, Dawit; Mukanga, David; Awano, Tessema; Tekalegne, Agonafer; Batisso, Esey; Edossa, Wasihun; Mekonnen, Emebet; Tibenderana, James; Baba, Ebenezer Sheshi; Shumba, Constance; Nankabirwa, Joaniter I.; Hamade, Prudence

    2016-01-01

    Abstract Background The World Health Organization (WHO) recommends injectable artesunate given either intravenously or by the intramuscular route for definitive treatment for severe malaria and recommends a single intramuscular dose of intramuscular artesunate or intramuscular artemether or intramuscular quinine, in that order of preference as pre-referral treatment when definitive treatment is not possible. Where intramuscular injections are not available, children under 6 years may be admin...

  5. The effects of x-ray treatments on bioaccumulated murine norovirus-1 (MNV-1) and survivability, inherent microbiota, color, and firmness of Atlantic oysters (Crassostrea virginica) during storage at 5°C for 20 days

    Science.gov (United States)

    In this study, we investigated the inactivation of human norovirus (HuNoV) surrogate Murine norovirus (MNV-1) by X-ray in whole-shell Atlantic oysters (Crassostrea virginica). We also investigated the effects of X-ray treatments on the survivability, inherent microbiota, color, and firmness of treat...

  6. Performance-Based Contracting in Residential Care and Treatment: Driving Policy and Practice Change through Public-Private Partnership in Illinois

    Science.gov (United States)

    Kearney, Kathleen A.; McEwen, Erwin; Bloom-Ellis, Brice; Jordan, Neil

    2010-01-01

    The National Quality Improvement Center on the Privatization of Child Welfare Services selected Illinois as a demonstration site in 2007 to evaluate performance-based contracting in residential treatment services. This article discusses the first two years of project implementation including developing residential treatment performance indicators,…

  7. Internet Policy

    Science.gov (United States)

    Lehr, William H.; Pupillo, Lorenzo Maria

    The Internet is now widely regarded as essential infrastructure for our global economy and society. It is in our homes and businesses. We use it to communicate and socialize, for research, and as a platform for E-commerce. In the late 1990s, much was predicted about what the Internet has become at present; but now, we have actual experience living with the Internet as a critical component of our everyday lives. Although the Internet has already had profound effects, there is much we have yet to realize. The present volume represents a third installment in a collaborative effort to highlight the all-encompassing, multidisciplinary implications of the Internet for public policy. The first installment was conceived in 1998, when we initiated plans to organize an international conference among academic, industry, and government officials to discuss the growing policy agenda posed by the Internet. The conference was hosted by the European Commission in Brussels in 1999 and brought together a diverse mix of perspectives on what the pressing policy issues would be confronting the Internet. All of the concerns identified remain with us today, including how to address the Digital Divide, how to modify intellectual property laws to accommodate the new realities of the Internet, what to do about Internet governance and name-space management, and how to evolve broadcast and telecommunications regulatory frameworks for a converged world.

  8. Day-to-day reliability of gait characteristics in rats

    DEFF Research Database (Denmark)

    Raffalt, Peter Christian; Nielsen, Louise R; Madsen, Stefan

    2018-01-01

    day-to-day reliability of the gait pattern parameters observed in rats during treadmill walking. The results of the present study may serve as a reference material that can help future intervention studies on rat gait characteristics both with respect to the selection of outcome measures...

  9. World Town Planning Day and GIS Day to be celebrated

    OpenAIRE

    Trulove, Susan

    2003-01-01

    On Wednesday, Nov. 19, Montgomery County will unveil the county's new comprehensive plan during a joint celebration of the fifth anniversary of Geographic Information Systems Day and the 30th anniversary of World Town Planning Day. The event will feature programs by the Virginia Tech Center for Geospatial Information Technology (CGIT) and Virginia's Geospatial Extension Program (GEP).

  10. Study of the Half-Day/Full-Day Kindergarten Model

    Science.gov (United States)

    McInroy, Thomas R.

    2012-01-01

    This case study and problem analysis was an in-depth investigation of the half-day/full-day kindergarten model by utilizing interviews and focus groups to provide insight from parents, teachers, and other district personnel as to how the model has impacted the social, emotional, and academic development of the participating students. This study…

  11. Day-to-day route choice modeling incorporating inertial behavior

    NARCIS (Netherlands)

    van Essen, Mariska Alice; Rakha, H.; Vreeswijk, Jacob Dirk; Wismans, Luc Johannes Josephus; van Berkum, Eric C.

    2015-01-01

    Accurate route choice modeling is one of the most important aspects when predicting the effects of transport policy and dynamic traffic management. Moreover, the effectiveness of intervention measures to a large extent depends on travelers’ response to the changes these measures cause. As a

  12. Cross-sectional study of morbidity, morbidity-associated factors and cost of treatment in Ngaoundere, Cameroon, with implications for health policy in developing countries and development assistance policy

    Directory of Open Access Journals (Sweden)

    Holtedahl Knut

    2002-04-01

    Full Text Available Abstract Background In a population-based epidemiological study in Ngaoundere, Cameroon, we studied cross-sectional child morbidity and the cost of necessary investigation and treatment. Methods Three teams of two to three health workers visited haphazardly selected households in all major housing quarters. We asked permission to enter for a health survey. Children with cough, fever or weight loss as well as sick adults were offered free-of-charge local hospital examination and treatment. Results From 177 households with 1777 persons, 51 (2.9% persons were referred. Thirty-five of them had an undiagnosed disease threatening individual health and in many cases also public health. Seven were hospitalised, including three adults with tuberculosis. Malnutrition was diagnosed in nine small children. Four patients had AIDS, seven had malaria. Average total cost for ambulant patients was 15 USD, for hospitalised patients 110 USD. In the households, almost half of the women 16–50 years of age had no schooling. Two per cent of women and nine per cent of men were daily smokers. Coughing children were more likely than non-coughing children to live in a household with at least one smoker (OR = 3.58, 95% CI 1.72 to 7.46, and they generally lived in more poor households (P = 0.018. Twelve of 16 children with weight loss were referred from households with a high poverty score. Conclusions Adult smoking and poverty affect children's health. The cost of hospitalisation or long-lasting therapy is beyond the means of most ordinary families. Diseases with severe consequences for public health, like tuberculosis, AIDS and malaria should have national programs with free, decentralised examination and treatment. Access to generic drugs is important. A major educational effort is needed to improve public health.

  13. Scientific days of Marcoule 2006

    International Nuclear Information System (INIS)

    2006-01-01

    The sixth scientific days of Marcoule 2006 took place in La Grande Motte, on 15-19 May 2006. During these days, the research works of the PhD students of Marcoule and Pierrelatte centers are presented. A summary of the progress of each PhD thesis is given below. (O.M.)

  14. Green accounts & day high schools

    DEFF Research Database (Denmark)

    Jørgensen, Michael Søgaard

    1997-01-01

    The arcticle presents the concept of green accounts and describes how it can be used in the daily work and the teaching at day high schools.......The arcticle presents the concept of green accounts and describes how it can be used in the daily work and the teaching at day high schools....

  15. Montessori All Day, All Year

    Science.gov (United States)

    Black, Connie; Davis, Liza

    2015-01-01

    Introducing real community into the Children's House goes back to the roots of Montessori education through all-day Montessori. The all-day environment is a house where children live with a "developmental room" of Montessori materials including a living room, kitchen, dining area, bedroom, bathroom, greeting rooms, and outdoor spaces.…

  16. Bacteriological, histological and functional examination of rat kidneys during 5-days gentamycin therapy of experimental E. coli pyelonephritis as compared to 9-days therapy

    International Nuclear Information System (INIS)

    Hagemann, I.; Briedigkeit, H.; Strangfeld, D.; Ditscherlein, G.; Schuerer, M.; Pietsch, R.; Kruse, L.; Camu, A.; Blank, W.

    1985-01-01

    Short-term antibiotic treatment is recommended in infections of the lower urinary tract but its effectiveness is questioned in upper urinary tract infections. 5 and 9-days treatment of experimental E. coli 022 pyelonephritis after unilateral nephrectomy in 127 male Wistar rats were compared. 9 mg gentamycin per kg b.w. twice daily were applied. 131 I-hippurate excretion was not decreased during the 5 day treatment but was temporarily diminished during 9-days treatment. Histologically the severe acute pyelonephritis was decreased after 9-days treatment but not after 5 days of treatment. Bacteriologically almost all the kidneys were sterile after 9-days treatment but the majority of the kidneys showed the injected strain of E. coli after 5-days treatment. The results indicated that the shortened treatment was much less effective in acute experimental pyelonephritis. (author)

  17. 29 CFR 780.317 - Man-day exclusion.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Man-day exclusion. 780.317 Section 780.317 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED...

  18. 29 CFR 780.305 - 500 man-day provision.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false 500 man-day provision. 780.305 Section 780.305 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND...

  19. 29 CFR 780.309 - Man-day exclusion.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Man-day exclusion. 780.309 Section 780.309 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED...

  20. Procedures and practices for day-to-day operation

    International Nuclear Information System (INIS)

    Distler, K.

    1986-01-01

    This lecture deals with problems of safe plant operation under day-to-day conditions. Operation, maintenance and surveillance have to be organized in a preventive manner. It will be shown that nearly all expected jobs and proceedings can be done rule-based. The connection of documentation and work preparation will be lined out. Moreover, the need for control and quality assurance for nearly all proceedings will be pointed out. The question of communication and scheduling will be touched. (orig.)

  1. Medical management in locally advanced and metastatic prostate cancer: Does changes in treatment policy have any specific effect on PSA levels?

    Science.gov (United States)

    Bagcioglu, Murat; Surcel, Cristian; Ozcan, Serkan; Mirvald, Cristian; Karagoz, Mehmet Ali; Karadag, Mert Ali; Huri, Emre; Sarica, Kemal

    2017-12-31

    Androgen deprivation therapy (ADT) is commonly used as a first-line treatment for locally advanced and metastatic prostatic cancer (Pca). There is no consensus about which alternative treatment should be used after the failure of initial ADT. We aimed to investigate the effect of changes in treatment on PSA and testosterone levels. A total of 120 patients with an established diagnosis of either locally advanced or metastatic Pca in two different centers. Depending on the type of medical and/or surgical management protocol planned at initial presentation, all cases were divided into three main groups as follows. Group 1 (n: 80) included the patients who underwent medical management during whole follow-up period in whom the initial management protocol was later on switched to another medical treatment with different agents, Group 2 (n: 20) included patients who were initially treated with a medical management protocol and switched to surgical castration during follow-up evaluation and lastly Group 3 (n: 20) included the patients undergoing treated surgical castration as initial treatment modality without any further medical management protocol. Evaluation of our data did clearly demonstrate a statistically significant difference between the initial and final PSA as well as testosterone levels in Group 1 cases. Mean PSA and testosterone levels increased significantly in these cases despite a change in hormonal therapy by using another agent for androgen deprivation. Cases in Group 2 and 3 cases did not show any statistically significant difference with respect to the mean PSA as well as testosterone values during the same follow-up period. Our data clearly indicated that in case of a biochemical progression, switching into another alternative medical treatment was not effective enough in limiting the rising PSA levels in a statistically significant manner when compared with the approaches of switching to surgical castration after initial medical treatment or

  2. Medical management in locally advanced and metastatic prostate cancer: Does changes in treatment policy have any specific effect on PSA levels?

    Directory of Open Access Journals (Sweden)

    Murat Bagcioglu

    2017-12-01

    Full Text Available Objective: Androgen deprivation therapy (ADT is commonly used as a first-line treatment for locally advanced and metastatic prostatic cancer (Pca. There is no consensus about which alternative treatment should be used after the failure of initial ADT. We aimed to investigate the effect of changes in treatment on PSA and testosterone levels. Material and methods: A total of 120 patients with an established diagnosis of either locally advanced or metastatic Pca in two different centers. Depending on the type of medical and/or surgical management protocol planned at initial presentation, all cases were divided into three main groups as follows. Group 1 (n: 80 included the patients who underwent medical management during whole follow-up period in whom the initial management protocol was later on switched to another medical treatment with different agents, Group 2 (n: 20 included patients who were initially treated with a medical management protocol and switched to surgical castration during follow-up evaluation and lastly Group 3 (n: 20 included the patients undergoing treated surgical castration as initial treatment modality without any further medical management protocol. Results: Evaluation of our data did clearly demonstrate a statistically significant difference between the initial and final PSA as well as testosterone levels in Group 1 cases. Mean PSA and testosterone levels increased significantly in these cases despite a change in hormonal therapy by using another agent for androgen deprivation. Cases in Group 2 and 3 cases did not show any statistically significant difference with respect to the mean PSA as well as testosterone values during the same follow-up period. Conclusions: Our data clearly indicated that in case of a biochemical progression, switching into another alternative medical treatment was not effective enough in limiting the rising PSA levels in a statistically significant manner when compared with the approaches of

  3. Breast cancer and early retirement: Associations with disease characteristics, treatment, comorbidity, social position and participation in a six-day rehabilitation course in a register-based study in Denmark

    DEFF Research Database (Denmark)

    Damkjaer, L. H.; Deltour, I.; Suppli, N. P.

    2011-01-01

    information on receipt of unemployment benefits, sickness benefits and early retirement pension for each of the years 1996-2007. Multivariate cox-regression models were used to analyze disease-specific, treatment-related, comorbidity and sociodemographics factors associated with early retirement after breast...... cancer and to evaluate the effect of attending a rehabilitation course on taking early retirement. Results. The rate of retirement was higher for women with somatic comorbidity (hazard ratio [HR], 1.91; 95% CI, 1.3; 2.9 for score 1, and HR 1.42; 95% CI, 0.7; 2.7 for score >= 2), previous depression (HR...... or in combination with anti-hormone treatment, reduced the hazard ratio (HR, 0.49; 95% CI, 0.3; 0.8 and HR, 0.5; 95% CI, 0.3; 0.8, respectively). The rate of retirement was higher for women the year after attending the rehabilitation course but returned to unity by three years. Discussion. The results of this study...

  4. Use of the evidence base in substance abuse treatment programs for American Indians and Alaska Natives: pursuing quality in the crucible of practice and policy.

    Science.gov (United States)

    Novins, Douglas K; Aarons, Gregory A; Conti, Sarah G; Dahlke, Dennis; Daw, Raymond; Fickenscher, Alexandra; Fleming, Candace; Love, Craig; Masis, Kathleen; Spicer, Paul

    2011-06-16

    A variety of forces are now shaping a passionate debate regarding the optimal approaches to improving the quality of substance abuse services for American Indian and Alaska Native communities. While there have been some highly successful efforts to meld the traditions of American Indian and Alaska Native tribes with that of 12-step approaches, some American Indian and Alaska Natives remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse treatment in their communities. This longstanding tension has now been complicated by the emergence of a number of evidence-based treatments that, while holding promise for improving treatment for American Indian and Alaska Natives with substance use problems, may conflict with both American Indian and Alaska Native and 12-step healing traditions. We convened a panel of experts from American Indian and Alaska Native communities, substance abuse treatment programs serving these communities, and researchers to discuss and analyze these controversies in preparation for a national study of American Indian and Alaska Native substance abuse services. While the panel identified programs that are using evidence-based treatments, members still voiced concerns about the cultural appropriateness of many evidence-based treatments as well as the lack of guidance on how to adapt them for use with American Indians and Alaska Natives. The panel concluded that the efforts of federal and state policymakers to promote the use of evidence-based treatments are further complicating an already-contentious debate within American Indian and Alaska Native communities on how to provide effective substance abuse services. This external pressure to utilize evidence-based treatments is particularly problematic given American Indian and Alaska Native communities' concerns about protecting their sovereign status. Broadening this conversation beyond its primary focus on the use of evidence-based treatments to other

  5. The ocean sampling day consortium

    DEFF Research Database (Denmark)

    Kopf, Anna; Bicak, Mesude; Kottmann, Renzo

    2015-01-01

    Ocean Sampling Day was initiated by the EU-funded Micro B3 (Marine Microbial Biodiversity, Bioinformatics, Biotechnology) project to obtain a snapshot of the marine microbial biodiversity and function of the world’s oceans. It is a simultaneous global mega-sequencing campaign aiming to generate...... the largest standardized microbial data set in a single day. This will be achievable only through the coordinated efforts of an Ocean Sampling Day Consortium, supportive partnerships and networks between sites. This commentary outlines the establishment, function and aims of the Consortium and describes our...

  6. “A Day Without Immigrants”

    Directory of Open Access Journals (Sweden)

    Benita Heiskanen

    2009-12-01

    Full Text Available This article considers the debates surrounding the “Day Without Immigrants” protests organized in major U.S. cities on 1 May 2006, prompted by H.R. 4437, the Border Protection, Anti-Terrorism, and Illegal Immigration Control Act of 2005, from the multiple perspectives of scholars, pundits, policy makers, and participants. Although much of these debates ostensibly centered around illegal Latino/a immigration to the United States, underneath the discussion ran a curious ideological thread, one that invoked groups’ right to be in the United States in the first place. The article argues that the rhetoric used in these discourses pitted various class-based ethnoracial groups against each other not so much to tackle the proposed immigration bill but, rather, to comment on the ramifications of an increasingly multiracial United States.

  7. Proceedings, Dean's Day 1999

    Energy Technology Data Exchange (ETDEWEB)

    Zanner, M.A.

    1999-03-01

    On January 14--15, 1999, Sandia National Laboratories sponsored Deans Day, a conference for the Deans of Engineering and other executive-level representatives from 29 invited universities. Through breakout sessions and a wrap-up discussion, university and Sandia participants identified activities to further develop their strategic relationships. The four primary activities are: (A) concentrate joint efforts on current and future research strengths and needs; (B) attract the best students (at all grade levels) to science and engineering; (C) promote awareness of the need for and work together to influence a national science and technology R and D policy; and (D) enable the universities and Sandia to be true allies, jointly pursuing research opportunities and funding from government agencies and industry.

  8. Lifelong learning policy in two national contexts

    DEFF Research Database (Denmark)

    Rasmussen, Palle

    2014-01-01

    This article describes and discusses the development of lifelong learning policy in two EU member states, Denmark and Portugal. The purpose is to show how different societal and historical contexts shape the development and implementation of lifelong learning policies, even though these policies...... have significant common elements. As a basis for the discussion an inventory of policy elements is presented. Denmark and Portugal have been chosen as examples of smaller EU member states with different historical, social and cultural characteristics. Developments and policies in the two countries......, including the links with EU education policy, are described. The discussion includes comparison drawing on the inventory of policy elements. A main conclusion is that the different historical trajectories of the two countries remain very important for present-day education and for the advancement...

  9. Earth Day Illustrated Haiku Contest

    Science.gov (United States)

    2007-02-01

    As part of their 2007 Chemists Celebrate Earth Day Celebration, the American Chemical Society is sponsoring an illustrated haiku contest for students in grades K 12 around the theme, Recycling—Chemistry Can!

  10. Police Incident Blotter (30 Day)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The 30 Day Police Blotter contains the most recent initial crime incident data, updated on a nightly basis. All data is reported at the block/intersection level,...

  11. Summary of the Day (CDMP)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This Summary of the Day data file contains daily selected elements of observations recorded by certified observers. The stations were located in the U.S. and were...

  12. Comorbidity and age affect treatment policy for cervical cancer: a population-based study in the south of The Netherlands, 1995-2004

    NARCIS (Netherlands)

    van der Aa, M.A.; Siesling, Sabine; Kruitwagen, R.F.P.M.; Lybeert, M.L.M.; Coebergh, J.W.W.; Janssen-Heijnen, M.L.G.

    2008-01-01

    OBJECTIVE: The aim of this study was to estimate the effects of age and comorbidity on the choice of treatment modalities and prognosis for patients with cervical cancer. METHODS: All patients with cervical cancer newly diagnosed between 1995 and 2004 (n=775) were selected from the population-based

  13. Experience with day stay surgery.

    Science.gov (United States)

    Cohen, D; Keneally, J; Black, A; Gaffney, S; Johnson, A

    1980-02-01

    Potential advantages of day stay surgery are cost saving, improved utilization of staff and hospital facilities, and reduction of stress for the paediatric patient and his family. The successful program requires careful case selection, full operating and anesthetic facilities and good follow-up. Day stay surgery was initiated at Royal Alexandra Hospital for Children in 1974. Experience is reviewed in relation to the total number and nature of surgical admissions and the daily utilisation of the facility. Utilization has markedly increased in the past 2 yr. Current practice is reviewed with regard to initial assessment, preparation for surgery and overall management during the day admission. Parental attitudes towards day stay surgery were evaluated indicating both the advantages and the problems encountered. These related mainly to insufficient information, transport difficulties and afternoon operations. Recommendations for improving the day stay service are discussed with special reference to: (1) communication with the parents as to adequate pre-operative explanation, revision of the day stay information pamphlet and improved distribution, and clear postoperative instructions, (2) the timing of operations, and (3) transport and parking facilities.

  14. Access to artesunate-amodiaquine, quinine and other anti-malarials: policy and markets in Burundi

    Directory of Open Access Journals (Sweden)

    Dismas Baza

    2011-02-01

    Full Text Available Abstract Background Malaria is the leading cause of morbidity and mortality in post-conflict Burundi. To counter the increasing challenge of anti-malarial drug resistance and improve highly effective treatment Burundi adopted artesunate-amodiaquine (AS-AQ as first-line treatment for uncomplicated Plasmodium falciparum malaria and oral quinine as second-line treatment in its national treatment policy in 2003. Uptake of this policy in the public, private and non-governmental (NGO retail market sectors of Burundi is relatively unknown. This study was conducted to evaluate access to national policy recommended anti-malarials. Methods Adapting a standardized methodology developed by Health Action International/World Health Organization (HAI/WHO, a cross-sectional survey of 70 (24 public, 36 private, and 10 NGO medicine outlets was conducted in three regions of Burundi, representing different levels of transmission of malaria. The availability on day of the survey, the median prices, and affordability (in terms of number of days' wages to purchase treatment of AS-AQ, quinine and other anti-malarials were calculated. Results Anti-malarials were stocked in all outlets surveyed. AS-AQ was available in 87.5%, 33.3%, and 90% of public, private, and NGO retail outlets, respectively. Quinine was the most common anti-malarial found in all outlet types. Non-policy recommended anti-malarials were mainly found in the private outlets (38.9% compared to public (4.2% and NGO (0% outlets. The median price of a course of AS-AQ was US$0.16 (200 Burundi Francs, FBu for the public and NGO markets, and 3.5-fold higher in the private sector (US$0.56 or 700 FBu. Quinine tablets were similarly priced in the public (US$1.53 or 1,892.50 FBu, private and NGO sectors (both US$1.61 or 2,000 FBu. Non-policy anti-malarials were priced 50-fold higher than the price of AS-AQ in the public sector. A course of AS-AQ was affordable at 0.4 of a day's wage in the public and NGO sectors

  15. Concomitant contraceptive implant and efavirenz use in women living with HIV: perspectives on current evidence and policy implications for family planning and HIV treatment guidelines.

    Science.gov (United States)

    Patel, Rena C; Morroni, Chelsea; Scarsi, Kimberly K; Sripipatana, Tabitha; Kiarie, James; Cohen, Craig R

    2017-05-11

    Preventing unintended pregnancies is important among all women, including those living with HIV. Increasing numbers of women, including HIV-positive women, choose progestin-containing subdermal implants, which are one of the most effective forms of contraception. However, drug-drug interactions between contraceptive hormones and efavirenz-based antiretroviral therapy (ART) may reduce implant effectiveness. We present four inter-related perspectives on this issue. First, as a case study, we discuss how limited data prompted country-level guidance against the use of implants among women concomitantly using efavirenz in South Africa and its subsequent negative effects on the use of implants in general. Second, we discuss the existing clinical data on this topic, including the observational study from Kenya showing women using implants plus efavirenz-based ART had three-fold higher rates of pregnancy than women using implants plus nevirapine-based ART. However, the higher rates of pregnancy in the implant plus efavirenz group were still lower than the pregnancy rates among women using common alternative contraceptive methods, such as injectables. Third, we discuss the four pharmacokinetic studies that show 50-70% reductions in plasma progestin concentrations in women concurrently using efavirenz-based ART as compared to women not on any ART. These pharmacokinetic studies provide the biologic basis for the clinical findings. Fourth, we discuss how data on this topic have marked implications for both family planning and HIV programmes and policies globally. This controversy underlines the importance of integrating family planning services into routine HIV care, counselling women appropriately on increased risk of pregnancy with concomitant implant and efavirenz use, and expanding contraceptive method mix for all women. As global access to ART expands, greater research is needed to explore implant effectiveness when used concomitantly with newer ART regimens. Data on how

  16. Day-to-Day Market Power and Efficiency in Tradable Mobility Credits

    Directory of Open Access Journals (Sweden)

    Ye Tian

    2015-09-01

    Full Text Available An active transportation and demand management framework focusing on tradable mobility credits (TMC is integrated into an agent-based modeling and simulation (ABMS platform. In this framework, it is conceived that an auction market within which mobility credits can be transferred between buyers and sellers is constructed in general. The idea of ABMS is extensively incorporated to mimic system users’ daily route choices as well as market-related micro-economical decision making process under TMC circumstance. Users are able to form individual propensities towards available bid/ask choices by reinforcement learning principles. The integrated platform offers a brand new insight view of microscopic aspect of the daily operations of credit transfer market, which has hardly been obtained by prior analytical models. Day-to-day traffic dynamics and market dynamics can be captured. Besides, market MOEs, including convergence, stability, efficiency and relative market powers of buyers and sellers under different market policies are investigated.

  17. Day-to-day and within-day variation in urinary iodine excretion

    DEFF Research Database (Denmark)

    Rasmussen, Lone Banke; Ovesen, L.; Christiansen, E.

    1999-01-01

    Objective: To examine the day-to-day and within-day variation in urinary iodine excretion and the day-to-day variation in iodine intake. Design: Collection of consecutive 24-h urine samples and casual urine samples over 24 h. Setting: The study population consisted of highly motivated subjects from...... was collected into separate containers. In both studies dietary records were kept. Main outcome measures: Twenty-four-hour urinary iodine excretion, 24-h urinary iodine excretion estimated as I/Cr*24 h Cr and as a concentration in casual urine samples. Results: Study 1: Both iodine excreted in 24-h urine...... and iodine intake varied from day-to-day. Iodine excretion correlated with iodine intake (r = 0.46, P = 0.01). Iodine intake (mean 89 +/- 6.5 mu g/d) was not significantly different from iodine excretion (mean 95 +/- 5.3 mu g/d). Study 2. Twenty-four hour iodine excretion estimated as I/Cr*24 h Cr from...

  18. Fiscal policy under alternative monetary policy regimes

    OpenAIRE

    Diaz-Roldan; Carmelo Monteagudo-Cuerva

    2013-01-01

    In the particular policy framework of a monetary union, the management of fiscal policy becomes an issue of special relevance, because the fiscal discipline imposed by the monetary agreements could limit the scope of stabilization fiscal policies, and its implications on economic growth. Therefore, is not trivial to manage fiscal policy in such particular economic framework. In this paper we will review the implications of fiscal policy in open economies. But we will pay special attention to ...

  19. Day case laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Hamid Abboudi

    2017-10-01

    Full Text Available Background: To evaluate the feasibility of performing laparoscopic radical prostatectomy (LRP as a day case procedure while maintaining patient satisfaction and safety. Herein we report our experience, selection criteria, and discharge criteria for day case LRP. Methods: We performed a prospective study with 32 patients undergoing extraperitoneal LRP. These patients were counselled before the procedure that they would go home the same evening of the procedure. Pain scores and quality of life data were recorded day 1 postoperatively via a telephone consultation. The patients underwent routine blood tests on day 2 and an outpatient review on day 7 and regularly thereafter via an assigned key worker. Socio-demographic data, comorbidities, and outcomes were collected for analysis. Results: All patients were successfully discharged the same day of surgery. Mean patient age was 62 years with a mean body mass index of 25. Mean operative time was 147 minutes, and estimated blood loss was 101 ml. Three patients were treated for post operative urinary tract infections; two patients developed infected lymphoceles which required percutaneous drainage and one patient required re-catheterisation due to a burst catheter balloon. Of these six complications four patients required re-admission. Post-operative pain, nausea and vomiting were low whilst patient satisfaction scores were unanimously high in all patients surveyed. Conclusions: The early experience with extraperitoneal LRP as a same day surgery is promising although patients who are at high risk of lymphocele should be excluded. Preoperative patient counselling and selection is paramount. Patient satisfaction is not adversely affected by the shortened stay. Surgeon experience, a well-motivated patient, meticulous attention to detail through an integrated pathway, a multidisciplinary team and adequate postoperative assessment are essential.

  20. Discharge on the day of birth, parental response and health and schooling outcomes.

    Science.gov (United States)

    Sievertsen, Hans Henrik; Wüst, Miriam

    2017-09-01

    Exploiting the Danish roll-out of same-day discharge policies after uncomplicated births, we find that treated newborns have a higher probability of hospital readmission in the first month after birth. While these short-run effects may indicate substitution of hospital stays with readmissions, we also find that-in the longer run-a same-day discharge decreases children's 9th grade GPA. This effect is driven by children and mothers, who prior to the policy change would have been least likely to experience a same-day discharge. Using administrative and survey data to assess potential mechanisms, we show that a same-day discharge impacts those parents' health investments and their children's medium-run health. Our findings point to important negative effects of policies that expand same-day discharge policies to broad populations of mothers and children. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Health and mental health policies' role in better understanding and closing African American-White American disparities in treatment access and quality of care.

    Science.gov (United States)

    Snowden, Lonnie R

    2012-10-01

    Since publication of the U.S. Surgeon General's report Mental Health: Culture, Race and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001), several federal initiatives signal a sustained focus on addressing African American-White American disparities in mental health treatment access and quality and open the way to unprecedented disparity reduction. These initiatives include institutional commitments to (a) research by the National Center for Minority Health and Health Disparities; (b) disparities monitoring by the Agency for Healthcare Research and Quality; (c) new epidemiologic and service delivery information on African American populations from the National Survey of American Life sponsored by the National Institute of Mental Health; as well as (d) opportunities inherent in the World Health Organization's interest in disease burden for making it possible to view African Americans' likely greater disease burden from mental illness as a legitimate source of concern. The Patient Protection and Affordable Care Act affords unprecedented opportunities for increasing African Americans' treatment access and quality of care nationwide. By familiarizing themselves with these initiatives, and taking advantage of possibilities they offer, those committed to reducing African American-White American disparities in mental illness, and treatment access and quality, can make inroads toward improving African Americans' mental health and facilitating their successful functioning in all spheres of community living.

  2. Barriers to the implementation of medication-assisted treatment for substance use disorders: The importance of funding policies and medical infrastructure

    Science.gov (United States)

    Knudsen, Hannah K.; Abraham, Amanda J.; Oser, Carrie B.

    2011-01-01

    Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program’s lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results. PMID:21371752

  3. English Day--A Whole Day of English.

    Science.gov (United States)

    Cohen, Yehudit Od

    1997-01-01

    English Day is celebrated annually at one Israeli school through language- and culture-related activities. One year, the school implemented whole-language learning strategies and involved parents and students in related activities at a series of activity stations featuring movies, books, television, fashion, comics, games, technology, science,…

  4. Gun policy and serious mental illness: priorities for future research and policy.

    Science.gov (United States)

    McGinty, Emma Elizabeth; Webster, Daniel W; Barry, Colleen L

    2014-01-01

    In response to recent mass shootings, policy makers have proposed multiple policies to prevent persons with serious mental illness from having guns. The political debate about these proposals is often uninformed by research. To address this gap, this review article summarizes the research related to gun restriction policies that focus on serious mental illness. Gun restriction policies were identified by researching the THOMAS legislative database, state legislative databases, prior review articles, and the news media. PubMed, PsycINFO, and Web of Science databases were searched for publications between 1970 and 2013 that addressed the relationship between serious mental illness and violence, the effectiveness of gun policies focused on serious mental illness, the potential for such policies to exacerbate negative public attitudes, and the potential for gun restriction policies to deter mental health treatment seeking. Limited research suggests that federal law restricting gun possession by persons with serious mental illness may prevent gun violence from this population. Promotion of policies to prevent persons with serious mental illness from having guns does not seem to exacerbate negative public attitudes toward this group. Little is known about how restricting gun possession among persons with serious mental illness affects suicide risk or mental health treatment seeking. Future studies should examine how gun restriction policies for serious mental illness affect suicide, how such policies are implemented by states, how persons with serious mental illness perceive policies that restrict their possession of guns, and how gun restriction policies influence mental health treatment seeking among persons with serious mental illness.

  5. An Ounce of Prevention: An Administrative Guide for Day Care Center Directors.

    Science.gov (United States)

    Gray, Norma; Hall, Don

    One of three training manuals developed for day care center staff, this administrative guide was written to assist day care center directors in developing policies and procedures aimed at improving all aspects of the day care program, and thus reducing the risk of child abuse. Four chapters focus on (1) selection of staff, including recruiting,…

  6. Open Access Policy for CERN Physics Publications

    CERN Document Server

    2014-01-01

    CERN is committed to Open Access. It represents one of the values written in our Convention sixty years ago and is increasingly important for our Member States.   In the last edition of the Bulletin, this article described how CERN is doing with regards to open access publishing today. On Thursday this week, the Open Access Policy for CERN Physics Publications* was endorsed by the Scientific Information Policy Board (SIPB) and approved by the Director-General the same day . For any clarifications regarding the policy, please contact the Scientific Information Service library.desk@cern.ch. * A French version of the policy will be made available shortly.

  7. Tax policy

    International Nuclear Information System (INIS)

    1990-07-01

    This report contains information on the effects of additional tax incentives for the petroleum production industry. It considers the effects of additional incentives on petroleum production and federal revenues, the federal tax burden on new domestic petroleum production investments under current law, and the comparative tax treatment of petroleum production investments in the United States and other nations

  8. Registration Day-Camp 2016

    CERN Multimedia

    Nursery School

    2016-01-01

    Reminder Registration for the CERN Staff Association Day-camp are open for children from 4 to 6 years old More information on the website: http://nurseryschool.web.cern.ch/. The day-camp is open to all children. An inscription per week is proposed, cost 480.-CHF/week, lunch included The camp will be open weeks 27, 28, 29 and 30, from 8:30 am to 5:30 pm. For further questions, thanks you for contacting us by email at Summer.Camp@cern.ch.

  9. Day hospital versus out-patient care for psychiatric disorders.

    Science.gov (United States)

    Marshall, M; Crowther, R; Almaraz-Serrano, A M; Tyrer, P

    2001-01-01

    This review considers the use of day hospitals as an alternative to out-patient care. Three types of day hospital are covered by the review: 'day treatment programmes', 'day care centres' and 'transitional' day hospitals. Day treatment programmes offer more intense treatment for patients who have failed to respond to out-patient care (usually patients with affective or personality disorders). Day care centres offer structured support to patients with long-term severe mental disorders (mainly schizophrenia), who would otherwise be treated in the out-patient clinic. Transitional day hospitals offer time-limited care to patients who have just been discharged from in-patient care. The review had three objectives. First, to assess the effectiveness of day treatment programmes versus out-patient care for people with treatment-refractory disorders. Second, to assess the effectiveness of day care centres versus out-patient care for people with severe long term disorders. Third, to assess the effectiveness of transitional day hospital care for people who had just been discharged from hospital. We searched the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2000), MEDLINE (January 1966 to December 2000), EMBASE (1980 to December 2000), CINAHL (1982 to December 2000), Psyc LIT (1966 to December 2000), and the reference lists of articles. Researchers were approached to identify unpublished studies. Randomised controlled trials comparing day hospital care (including day treatment programme, day care centre, and transitional day hospital) against out-patient care. Studies were ineligible if a majority of participants were under 18 or over 65, or who had a primary diagnosis of substance abuse or organic brain disorder. Data were extracted independently by two reviewers and cross-checked. Relative risks and 95% confidence intervals (CI) were calculated for dichotomous data. Weighted or standardised means were calculated for continuous data. There was evidence from

  10. Food policy an ethics

    DEFF Research Database (Denmark)

    Coff, Christian Eyde; Kemp, Peter

    2014-01-01

    makes of food policy a highly complex and diverse area. The entry opens with at description of the concept of policy and food policy and how it relates to ethical principles and values. The fourth section discusses some influental definitions of food policy. The final section contains a description......This entry gives an overview of food policy and major ethical principles that in the last decades have been proposed and advocated for in debates on food policy. Food policies touch upon a vast area of interrelated policies (like health, transport, environment, poverty, animal welfare etc.) which...... of ethical principles and ideas of relevance to food policy....

  11. Food policy an ethics

    DEFF Research Database (Denmark)

    Coff, Christian Eyde; Kemp, Peter

    2014-01-01

    This entry gives an overview of food policy and major ethical principles that in the last decades have been proposed and advocated for in debates on food policy. Food policies touch upon a vast area of interrelated policies (like health, transport, environment, poverty, animal welfare etc.) which...... makes of food policy a highly complex and diverse area. The entry opens with at description of the concept of policy and food policy and how it relates to ethical principles and values. The fourth section discusses some influental definitions of food policy. The final section contains a description...... of ethical principles and ideas of relevance to food policy....

  12. Treatment for Uncomplicated Plasmodium falciparum Malaria in French Soldiers Deployed in Sub-Saharan Africa: Gaps Between Policy and Field Practice.

    Science.gov (United States)

    Perisse, Anne; Velut, Guillaume; Javelle, Emilie; Loarer, Gwion; Michel, Remy; Simon, F

    2018-02-07

    Malaria prevention and treatment are big challenges for the French forces deployed in sub-Saharan Africa. Since December 2013, 1,800 French soldiers have been deployed at any one time in the Central African Republic in the framework of "Operation Sangaris" and European Union Force (EUFOR). Over the 2014-2015 period, about 500 cases of malaria were notified in these troops during the operation or after their return (annual incidence: 13.4 p.100 person-year). The recommendation to use dihydroartemisinin-piperaquine (DHA-PQ) as the first-line treatment for French soldiers suffering from uncomplicated Plasmodium falciparum malaria in endemic areas is not always followed in practice in the field by French military general practitioners (GPs). We conduced a retrospective Knowledge-Attitude-Practice study by self-administered questionnaire, to all military French doctors who were in mission in Central African Republic from January 2014 to July 2015 to try to understand what were the reasons for the GP not to prescribe DHA-PQ on the field. Thirty-six GPs (53%) answered to the questionnaire. Eighty-three percent of them knew about the recommendation to use DHA-PQ for un uncomplicated Pf malaria. Fifty-eight percent had a favorable attitude toward DHA-PQ. The factors associated with the prescription of another drug (Atovaquone-proguanil) were: the habit (odds ratio [OR] 0.1, confidence interval (CI) 0-0.6], the fact that Atovaquone-proguanil is more practical to use [OR 0.01, CI 0-0.1]. In practice, only 37.5% prescribed DHA-PQ the most of the time during their mission. Factors associated with a non-favorable attitude toward DHA-PQ were: the necessity to calculate a QTc interval during the treatment [OR 0.2, confidence interval 0-0.9], and the fact that DHA-PQ must be taken on an empty stomach [OR 0.3, CI 0.1-0.8]. GP who received a formation before their mission about malaria and treatment had a favorable attitude toward DHA-PQ. There is very satisfactory knowledge by the

  13. Earth Day 2012: Greening Government

    Centers for Disease Control (CDC) Podcasts

    2012-04-19

    This podcast describes sustainability efforts at CDC in relation to Earth Day celebrations and details agency greenhouse gas reduction strategies and successes.  Created: 4/19/2012 by Office of the Chief Operating Officer (OCOO)/ Chief Sustainability Office (CSO).   Date Released: 4/23/2012.

  14. XXIVth days of nuclear medicine

    International Nuclear Information System (INIS)

    1986-01-01

    Abstracts are presented of papers submitted to the 24th Days of Nuclear Medicine held in Opava, Czechoslovakia between Oct 9 and 11, 1985. The conference proceeded in three sessions, namely nuclear pediatrics, miscellaneous and technicians' session. The publication also contains abstracts of posters. (L.O.)

  15. World AIDS Day PSA (:30)

    Centers for Disease Control (CDC) Podcasts

    2011-11-16

    December 1 is World AIDS Day. In this PSA, communities are encouraged to get tested for HIV.  Created: 11/16/2011 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 11/16/2011.

  16. Colour Day: an innovative project

    CERN Multimedia

    Staff Association

    2016-01-01

    This year, the Children’s Day-Care Centre (EVE) and School works on the theme of colours. Every class has their own project revolving around this common theme. The class of Claire, Sandrine and Nadia, introduced a monthly “Colour Day”. The objective of this day is to offer children different activities (arts and crafts, baking, etc.) designed around a specific colour. The children get a chance to decorate their classroom and learn in many different ways inspired by the colours blue, red, and many others. The parents are also called to contribute and invited to dress their children in the colour of the day. In September, we discovered the colour blue, in October it was time for red, and in mid-November yellow will brighten up our structure. Everyone plays along, making this a very festive day for us all. On Tuesday, 20 September, we saw the whole School turn blue! We were all dressed in blue and we made blue paintings, too! We made beautiful artwork inspired by artists like Ma...

  17. A day in the life

    Science.gov (United States)

    Rao, Achintya

    2017-12-01

    Even the most avid physics enthusiast does not necessarily awaken each morning and turn their mind to the various physical processes they will encounter over the course of their day. Yet this is precisely the sort of journey that author James Kakalios takes us on in his book The Physics of Everyday Things.

  18. Day-Care in Denmark

    DEFF Research Database (Denmark)

    Bundgaard, Helle

    2011-01-01

      The chapter explores central notions of appropriate social behavior in what is arguably the most important institution in Denmark when it comes to social integration, namely day-care, also known as pre-school. Moral values guiding everyday practices are generally taken for granted. When...

  19. Day case surgery in Nigeria

    African Journals Online (AJOL)

    Therefore, it is important to introduce and popularize the concept of day case surgery, as this may help hospitals and healthcare ... practised in developed countries. DSUs are the best way to achieve results and so it is important for all to embrace this ..... There should be teamwork between groups. • Liaison with community ...

  20. Infectious Diseases in Day Care.

    Science.gov (United States)

    Sleator, Esther K.

    Discussed in this publication are infectious illnesses for which children attending day care appear to be at special risk. Also covered are the common cold, some infectious disease problems receiving media attention, and some other annoying but not serious diseases, such as head lice, pinworms, and contagious skin conditions. Causes,…

  1. Children and Modern Day Slavery

    African Journals Online (AJOL)

    DrNneka

    Abstract. This paper examines the concept of slavery in these modern times, as it relates to and affects Children, highlighting the very many shades of the debasing scourge. It starts off by tracing its early manifestations from the time of yore, chronicling its evolution and persistence to this day. It decries the varied proliferation ...

  2. ATLAS Assembly Hall Open Day

    CERN Multimedia

    Patrice Loiez

    2004-01-01

    To mark the 50th Anniversary of the founding of CERN, a day of tours, displays and presentations was held in October 2004. The assembly halls for the experiments that were waiting to be installed on the LHC, such as ATLAS shown here, were transformed into display areas and cafés.

  3. Open Days a smash hit!

    CERN Multimedia

    2008-01-01

    The general public seized the one and only opportunity to visit the Large Hadron Collider before it goes into service. The Open Days on 5 and 6 April attracted record numbers of visitors, with 53,000 visitors on the Sunday alone!

  4. Let's Celebrate! Canada's Special Days.

    Science.gov (United States)

    Parry, Caroline

    Designed for children ages 8 to 13, this teaching resource presents an explanation of seasons, calendars, and why people celebrate particular days. The four seasons are discussed. Canada's national holidays, and the seasonal, social and religious holidays celebrated by diverse Canadian culture groups are described. A separate section presents…

  5. Research for health policy

    National Research Council Canada - National Science Library

    Bell, Erica

    2010-01-01

    ... Explicit, implicit, and pragmatic dimensions of policy-maker's needs and context 31 Constraints on policy-makers 32 Deciphering trade-offs 33 The policy-problem: deciphering uncertainty and the problem of innovation 34 A tool for deciphering policy problems 35 The different components of the policy problem 37 Recommended reading 38 Case studies in...

  6. Old-growth Policy

    Directory of Open Access Journals (Sweden)

    Diane Vosick

    2007-12-01

    Full Text Available Most federal legislation and policies (e.g., the Wilderness Act, Endangered Species Act, National Forest Management Act fail to speak directly to the need for old-growth protection, recruitment, and restoration on federal lands. Various policy and attitudinal barriers must be changed to move beyond the current situation. For example, in order to achieve the goal of healthy old growth in frequent-fire forests, the public must be educated regarding the evolutionary nature of these ecosystems and persuaded that collaborative action rather than preservation and litigation is the best course for the future of these forests. Land managers and policy makers must be encouraged to look beyond the single-species management paradigm toward managing natural processes, such as fire, so that ecosystems fall within the natural range of variability. They must also see that, given their recent evidence of catastrophic fires, management must take place outside the wildland-urban interface in order to protect old-growth forest attributes and human infrastructure. This means that, in some wilderness areas, management may be required. Land managers, researchers, and policy makers will also have to agree on a definition of old growth in frequent-fire landscapes; simply adopting a definition from the mesic Pacific Northwest will not work. Moreover, the culture within the federal agencies needs revamping to allow for more innovation, especially in terms of tree thinning and wildland fire use. Funding for comprehensive restoration treatments needs to be increased, and monitoring of the Healthy Forest Initiative and Healthy Forest Restoration Act must be undertaken.

  7. State policy affecting pain management: recent improvements and the positive impact of regulatory health policies.

    Science.gov (United States)

    Gilson, Aaron M; Maurer, Martha A; Joranson, David E

    2005-10-01

    Criteria-driven policy analysis resources from the University of Wisconsin Pain and Policy Studies Group (PPSG) evaluated drug control and professional practice policies that can influence use of controlled substances for pain management, and documented changes over a 3-year period. Additional research was needed to determine the extent of change, the types of messages contained in the policies, and what has contributed to changing policy content. Four research aims guided this study: (1) evaluate change between 2000 and 2003 of state policy that can affect pain relief, (2) describe content differences for statutes, regulations, guidelines, and policy statements, (3) evaluate differences between policies specific to pain management and policies governing general healthcare practice, and (4) compare content of policies specific to pain management created by healthcare regulatory boards to those created by state legislatures. Results showed that more current policies, especially policies regulating health professionals, tend to encourage pain management and avoid language that restricts professional decision-making and patient treatment. In addition, pain policies from healthcare regulatory boards were generally less restrictive than statutes or policies that govern general healthcare practice. These findings suggest that the positive policy change results primarily from state medical, pharmacy, and nursing boards adopting policies promoting pain management and the use of opioids, while containing few if any restrictions. Despite this improvement, further progress can be made when states continue to abrogate additional restrictions or clinically obsolete provisions from policies. PPSG policy evaluations provide guidance to lawmakers, healthcare regulators, and clinicians who are striving to achieve balanced policy, an attainable but redoubtable goal, to benefit patient care.

  8. Old Torreon Navajo Day School, Cuba, NM: NN0030341

    Science.gov (United States)

    NPDES Permit and Fact Sheet explaining EPA's action under the Clean Water Act to issue NPDES Permit No. NN0030341 to Bureau of Indian Affairs Old Torreon Navajo Day School Wastewater Treatment Lagoon.

  9. Cysticercosis. A modern day plague.

    Science.gov (United States)

    Brown, W J; Voge, M

    1985-08-01

    The authors describe the magnitude of the cysticercosis problem and describe the organism, the clinical features of the disease, the propensity of the organism for development in the central nervous system, pathologic considerations, clinical diagnosis, and treatment.

  10. Last Days of Life (PDQ)

    Science.gov (United States)

    ... of life, including treatment of common symptoms and ethical questions that may come up. It may help ... to have doubts about their beliefs or religious values and cause spiritual distress . Some studies show that ...

  11. From Policy to Practice: Implementation of Water Policies in Child Care Centers in Connecticut

    Science.gov (United States)

    Middleton, Ann E.; Henderson, Kathryn E.; Schwartz, Marlene B.

    2013-01-01

    Objective: Child care policies may contribute to healthy beverage consumption patterns. This study documented availability and accessibility of water and correspondence with state and federal policy and accreditation standards in child care centers. Design: One-day observations were conducted in a random sample of 40 Child and Adult Care Food…

  12. Familial dysautonomy (Riley-Day syndrome

    Directory of Open Access Journals (Sweden)

    Edward R. Tonholo Silva

    1994-03-01

    Full Text Available Familial dysautonomia, also known as Riley-Day syndrome, is a disorder of autonomic nervous system with an autosomal recessive mode of inheritance. Reduction and/or loss of unmyelinated and small myelinated fibers is found, as reduction of dopamine beta-hydroxylase in blood. The diagnosis is based on clinical features: diminished lacrimation, insensitivity to pain, poor temperature control, abolished deep tendon reflexes, postural hypotension, vomiting attacks, poor motor coordenation, and mental retardation. The treatment is symptomatic and many children die during the first years of life, usually as a result of repeated aspiration pneumonia. We report the case of a 1 year-old child with familial dysautonomia.

  13. Office microlaparoscopic intrafallopian transfer of day one zygote ...

    African Journals Online (AJOL)

    The objective of the study was to investigate whether transferring zygotes on day 1 would result in similar pregnancy rates compared to transferring cleavage stage embryos on day 3 in a prospective randomized trial, using the office microlaparoscopic procedure. Patients undergoing IVF/ICSI treatments were randomized to ...

  14. Registration Day-Camp 2016

    CERN Multimedia

    Nursery School

    2016-01-01

    Registration for the CERN SA Day-camp are open for children from 4 to 6 years old From March 14 to 25 for children already enrolled in CERN SA EVE and School From April 4 to 15 for the children of CERN members of the personnel (MP) From April 18 for other children More information on the website: http://nurseryschool.web.cern.ch/. The day-camp is open to all children. An inscription per week is proposed, cost 480.-CHF/week, lunch included The camp will be open weeks 27, 28, 29 and 30, from 8:30 am to 5:30 pm. For further questions, thanks you for contacting us by email at Summer.Camp@cern.ch.

  15. Three Presidents in one day

    CERN Multimedia

    2009-01-01

    Cristina Fernández de Kirchner, President of Argentina, in the ATLAS cavern with Minister of Science and Technology, Lino Barañao. The President of Mozambique, Armando Guebuza, being shown a crystal from the CMS calorimeter by Jim Virdee, CMS spokesperson, and Felicitas Pauss, CERN Coordinator for External Relations. The President of Poland, Lech Kaczyński, and the First Lady visited the CMS experiment. It was a busy day for many at CERN on 15 June with visits from the Presidents of Argentina, Poland and Mozambique all in one day! The three Presidents were in Geneva for a summit organized by the International Labour Organization (ILO), and couldn’t resist the opportunity to see CERN before heading home. Cristina Fernández de Kirchner, President of Argentina, visited the ATLAS cavern with Minister of Science and Technology, Lino Barañao. While at CERN Kirchner signed an agreement be...

  16. 2005 yearly days of petroleum

    International Nuclear Information System (INIS)

    Constant, R.; Susbielles, G.

    2005-01-01

    14 articles are gathered in this data sheet; they deal with the opening address of the 2005 petroleum days; the hydrocarbons: the evolutive resource; the para-petroleum engineers and the Europe; the speech of Mr Francois Loos; the Shell global scenarios to 2025; the evolution of the gas resource and its uses; the French para-petroleum industry; Bernard Bensaid, Corinne Sagary, Armelle Saniere, economic studies, IFP; the contribution of the innovation and of the technology in the diversification of the hydrocarbons supply; innovation and diversification of the petroleum resource: the point of view of Total; research, development and diversification of the petroleum resource; innovation in services companies; innovation in study and development and engineering; the closing address of the 2005 petroleum days. (O.M.)

  17. Policy Archaeology: A New Policy Studies Methodology.

    Science.gov (United States)

    Scheurich, James Joseph

    1994-01-01

    Discusses policy archaeology, a radically different approach to policy studies in education drawn from the poststructuralist work of Foucault. Policy archaeology examines the social construction of problems before they become visible, focusing on five social regularities (race, gender, class, governmentality, and professionalization) comprising…

  18. "Every day..." : [poems] / Doris Kareva

    Index Scriptorium Estoniae

    Kareva, Doris, 1958-

    2003-01-01

    Autori tutvustus lk. 282. Sisu: "Every day..." ; "I dream that I heard Satan speak..." ; "Rainbow-coloured confusion bears us..." ; "Viewing the rainbowing world..." ; "No time to write the final draft..." ; "Burnt poems..." ; Midas ; Pygmalion ; Enigma 1-5 ; Concerto strumenti e voce. Orig.: "Iga päev..." ; "Ma nägin unes - Saatan kõneles..." ; "Viib sünnieelsest unest surmaunne..." ; "Vaadeldes vikerkaarlevat maailma..." ; "Põletatud luuletused..." ; Pygmalion ; Müsteerium 1-5 ; Concerto strumenti e voce

  19. Innovation and energy. ECRIN day

    International Nuclear Information System (INIS)

    2004-01-01

    ECRIN is an association jointly created by the French atomic energy commission (CEA) and the French national center of scientific research (CNRS). It gathers experts from the research and industry worlds, representatives of institutions and decision making peoples in order to work on important topics like energy. This document gathers the working documents and transparencies presented at the ECRIN day on energy and innovation: opening talk of C. Birraux (head of the parliamentary office of evaluation of scientific and technological choices); the energy of seas (offshore wind power, wave energy, tide currents energy, thermal energy of seas, osmotic energy, tidal energy); synthetic fuels (stakes, possible options, Fischer-Tropsch synthesis, GTL, CTL, BTL, production with CO 2 recycling); capture and geological sequestration of CO 2 : a general overview (stakes, solut