Sample records for previous observational studies

  1. Maternal and perinatal outcomes of delivery after a previous Cesarean section in Enugu, Southeast Nigeria: a prospective observational study.

    Ugwu, George O; Iyoke, Chukwuemeka A; Onah, Hyacinth E; Egwuatu, Vincent E; Ezugwu, Frank O


    Obstetricians in developing countries appear generally reluctant to conduct vaginal delivery in women with a previous Cesarean because of lack of adequate facilities for optimal fetomaternal monitoring. To describe delivery outcomes among women with one previous Cesarean section at a tertiary hospital in Southeast Nigeria. This was a prospective observational study to determine maternal and perinatal outcomes of attempted vaginal birth after Cesarean sections (VBAC) following one previous Cesarean section. Analysis was done with SPSS statistical software version 17.0 for Windows using descriptive and inferential statistics at 95% level of confidence. Two thousand six hundred and ten women delivered in the center during the study period, of whom 395 had one previous Cesarean section. A total of 370 women with one previous Cesarean section had nonrecurrent indications, of whom 355 consenting pregnant women with one previous Cesarean section were studied. A majority of the women (320/355, 90.1%) preferred to have vaginal delivery despite the one previous Cesarean section. However, only approximately 54% (190/355) were found suitable for trial of VBAC, out of whom 50% (95/190 had successful VBAC. Ninety-five women (50.0%) had failed attempt at VBAC and were delivered by emergency Cesarean section while 35 women (9.8%) had emergency Cesarean section for other obstetric indications (apart from failed VBAC). There was no case of uterine rupture or neonatal and maternal deaths recorded in any group. Apgar scores of less than 7 in the first minute were significantly more frequent amongst women who had vaginal delivery when compared to those who had elective repeat Cesarean section (P=0.03). Most women who had one previous Cesarean delivery chose to undergo trial of VBAC, although only about half were considered suitable for VBAC. The maternal and fetal outcomes of trial of VBAC in selected women with one previous Cesarean delivery for non-recurrent indications were good

  2. Alemtuzumab as rescue therapy in a cohort of 16 aggressive multiple sclerosis patients previously treated by Mitoxantrone: an observational study.

    Le Page, Emmanuelle; Deburghgraeve, Véronique; Lester, Marie-Antoinette; Cardiet, Isabelle; Leray, Emmanuelle; Edan, Gilles


    Our study aimed to describe safety and neurological impact of alemtuzumab as last-line rescue therapy in aggressive multiple sclerosis (MS) patients, previously treated by Mitoxantrone (MITOX). Between June 2004 and October 2013, 13 patients received alemtuzumab at 20 mg/day and 3 at 12 mg/day for 5 days. EDSS, relapses, secondary progression were prospectively assessed 12 and 6 months before treatment, at baseline and every 3 months. Mean follow-up was 6.2 years [1-10]. Mean age at alemtuzumab start was 40 years [26-49] for 8 Secondary Progressive (SP) and 30 years [26-35] for 8 Relapsing-Remitting (RR) patients. MS duration was 13.7 (± 3) and 8.3 (± 4) years, respectively. During the 12 months before alemtuzumab, annual relapse rate was 0.75 and 3.14, respectively and the 16 patients accumulated 2-30 new gadolinium enhancing lesions. 4 patients (suboptimal responders) received alemtuzumab during MITOX and 12 patients 1-7.8 years after MITOX. Out of 8 SPMS, 2 were disease free up to last visit (4.7 and 8 years), 5 improved or stabilized but only transiently and 1 worsened. Out of 8 RRMS, 1 remained stable up to last visit (8.7 years) despite 1 relapse and active MRI at 18 months and 7 improved (1-4 point EDSS): 4 remained disease free up to last visit (12, 24, 38 months and 7 years), 2 were successfully retreated at 25 and 33 months and 1 worsened progressively 24 months after alemtuzumab. 2 patients developed Grave's disease and 1 hypothyroidism. Alemtuzumab controls aggressive RRMS despite previous use of MITOX.

  3. Four Forensic Entomology Case Studies: Records and Behavioral Observations on Seldom Reported Cadaver Fauna With Notes on Relevant Previous Occurrences and Ecology.

    Lindgren, Natalie K; Sisson, Melissa S; Archambeault, Alan D; Rahlwes, Brent C; Willett, James R; Bucheli, Sibyl R


    A yearlong survey of insect taxa associated with human decomposition was conducted at the Southeast Texas Applied Forensic Science (STAFS) facility located in the Center for Biological Field Studies of Sam Houston State University in Huntsville, TX. During this study, four insect-cadaver interactions were observed that represent previously poorly documented yet forensically significant interactions: Syrphidae maggots colonized a corpse in an aquatic situation; Psychodidae adults mated and oviposited on an algal film that was present on a corpse that had been recently removed from water; several Panorpidae were the first insects to feed upon a freshly placed corpse in the autumn; and a noctuid caterpillar was found chewing and ingesting dried human skin. Baseline knowledge of insect-cadaver interactions is the foundation of forensic entomology, and unique observations have the potential to expand our understanding of decomposition ecology.

  4. Food intake during the previous 24 h as a percentage of usual intake: a marker of hypoxia in infants with bronchiolitis: an observational, prospective, multicenter study

    Corrard François


    Full Text Available Abstract Background Hypoxia associated with bronchiolitis is not always easy to assess on clinical grounds alone. The aim of this study was to determine the value of food intake during the previous 24 hours (bottle and spoon feeding, as a percentage of usual intake (24h FI, as a marker of hypoxia, and to compare its diagnostic value with that of usual clinical signs. Methods In this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants, aged from 0 to 6 months, with bronchiolitis (rhinorrhea + dyspnea + cough + expiratory sounds. Infants with risk factors (history of prematurity, chronic heart or lung disorders, breast-fed infants, and infants having previously been treated for bronchial disorders were excluded. The 24h FI, subcostal, intercostal, supracostal retractions, nasal flaring, respiratory rate, pauses, cyanosis, rectal temperature and respiratory syncytial virus test results were noted. The highest stable value of transcutaneous oxygen saturation (SpO2 was recorded. Hypoxia was noted if SpO2 was below 95% and verified. Results 24h FI ≥ 50% was associated with a 96% likelihood of SpO2 ≥ 95% [95% CI, 91–99]. In univariate analysis, 24h FI  Conclusion In practice, the measure of 24 h FI may be useful in identifying hypoxia and deserves further study.

  5. Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies.

    Malindu Eranga Fernando

    Full Text Available AIMS: Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers. METHODS: Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP and pressure time integral (PTI were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310. RESULTS: Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290-0.811, p<0.001; and 0.762, 95% CI 0.303-1.221, p = 0.001, respectively. Sub-group analyses demonstrated no significant difference in MPP for those with neuropathy with active ulceration compared to those without ulcers. A significant difference in MPP was found for those with neuropathy with a past history of ulceration compared to those without ulcers; (0.467, 95% CI 0.181- 0.753, p = 0.001. Statistical heterogeneity between studies was moderate. CONCLUSIONS: Plantar pressures appear to be significantly higher in patients with diabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic

  6. A gender-medicine post hoc analysis (MetaGeM project to test sex differences in previous observational studies in different diseases: methodology

    Colombo D


    Full Text Available Delia Colombo,1 Gilberto Bellia,1 Donatella Vassellatti,1 Emanuela Zagni,1 Simona Sgarbi,2 Sara Rizzoli21Novartis Farma, Origgio, 2MediData, Modena, ltaly Abstract: Only recently has medical research begun to understand the importance of taking sex into account, recognizing that symptoms and responses to medical treatment may be very different between males and females. However, the analyses provided by the pharmaceutical industry to regulatory authorities often do not present safety and efficacy data by sex. Novartis has started a gender-medicine project called MetaGeM, which includes nine observational studies sponsored by Novartis Farma, Italy; conducted in Italy between 2002 and 2013 in a range of different clinical areas. The MetaGeM project aims to analyze and describe by means of post hoc analyses and meta-analyses, clinical outcomes, therapeutic approaches, and safety data of these studies, by sex: PSYCHAE; GENDER ATTENTION in psoriasis; Synergy in psoriatic arthritis; ICEBERG in HBsAg carriers; SURF and CETRA in liver- and renal transplanted patients, respectively; DEEP in Parkinson's disease; and EVOLUTION and AXEPT in Alzheimer's disease. The present paper describes the methodology of the MetaGeM project.Keywords: gender-medicine, MetaGeM project, methodology

  7. The influence of previous and concomitant leflunomide on the efficacy and safety of infliximab therapy in patients with rheumatoid arthritis; a longitudinal observational study.

    Flendrie, M.; Creemers, M.C.W.; Welsing, P.M.J.; Riel, P.L.C.M. van


    OBJECTIVE: To investigate the influence of previous and concomitant leflunomide on the efficacy and safety of infliximab therapy in rheumatoid arthritis (RA) and to compare it to infliximab in combination with other disease-modifying anti-rheumatic drugs. METHODS: RA patients starting infliximab the

  8. The safety and effectiveness of once daily detemir in patients with type 2 diabetes previously failing oral agents:the Chinese cohort from SOL-VETM observational study



    Objective To evaluate the safety and effectiveness of initiating once-daily insulin detemir(Levemir) as add-on therapy in patients with type 2 diabetes mellitus(T2DM) who failed treatment of oral anti-diabetic drugs(OAD).Methods The present study was derived from the data of

  9. SMEI observations of previously unseen pulsation frequencies in gamma Doradus

    Tarrant, N J; Elsworth, Y P; Spreckley, S A; Stevens, I R


    Aims: As g-mode pulsators, gamma-Doradus-class stars may naively be expected to show a large number of modes. Taking advantage of the long photometric time-series generated by the Solar Mass Ejection Imager (SMEI) instrument, we have studied the star gamma Doradus to determine whether any other modes than the three already known are present at observable amplitude. Methods: High-precision photometric data from SMEI taken between April 2003 and March 2006 were subjected to periodogram analysis with the PERIOD04 package. Results: We confidently determine three additional frequencies at 1.39, 1.87, and 2.743 cycles per day. These are above and beyond the known frequencies of 1.320, 1.364, and 1.47 cycles per day. Conclusions: Two of the new frequencies, at 1.39 and 1.87 cycles per day, are speculated to be additional modes of oscillation, with the third frequency at 2.743 cycles per day a possible combination frequency.

  10. Columnar modelling of nucleation burst evolution in the convective boundary layer – first results from a feasibility study Part IV: A compilation of previous observations for valuation of simulation results from a columnar modelling study

    O. Hellmuth


    according to the parameterisation of the collision-controlled binary nucleation rate proposed by Weber et al. (1996, H2O vapour does not explicitly affect the particle formation. Since the H2SO4 concentration is overpredicted in the simulations presented in Paper III, the nucleation rates are too high compared to previous estimations. Therefore, the results are not directly comparable to measurements. Especially NPF events, where organics are suspected to play a key role, such as those observed at the boreal forest station in Hyytiälä (Southern Finland or at Hohenpeissenberg (mountain site in Southern Germany, can not be explained by employing simple sulphur/ammonia chemistry. However, some valuable hints regarding the role of CBL turbulence in NPF can be obtained. In the literature a number of observations on the link between turbulence and NPF can be found, whose burst patterns support a strong contribution of CBL turbulence to the NPF burst evolution simulated here. Observations, that do not correspond to the scenarios are discussed with respect to possible reasons for the differences between model and observation. The model simulations support some state-of-the-art hypotheses on the contribution of CBL turbulence to NPF. Considering the application of box models, the present study shows, that CBL turbulence, not explicitly considered in such models, can strongly affect the spatio-temporal NPF burst evolution. The columnar high-order model presented here is a helpful tool to elucidate gas-aerosol-turbulence interactions, especially the genesis of NPF bursts in the CBL. An advanced description of the cluster formation and condensation growth is required as well as a comprehensive verification/validation study using observed high-order moments. Further scenario simulations remain to be performed.

  11. Influence of Previous Knowledge, Language Skills and Domain-specific Interest on Observation Competency

    Kohlhauf, Lucia; Rutke, Ulrike; Neuhaus, Birgit


    Many epoch-making biological discoveries (e.g. Darwinian Theory) were based upon observations. Nevertheless, observation is often regarded as `just looking' rather than a basic scientific skill. As observation is one of the main research methods in biological sciences, it must be considered as an independent research method and systematic practice of this method is necessary. Because observation skills form the basis of further scientific methods (e.g. experiments or comparisons) and children from the age of 4 years are able to independently generate questions and hypotheses, it seems possible to foster observation competency at a preschool level. To be able to provide development-adequate individual fostering of this competency, it is first necessary to assess each child's competency. Therefore, drawing on the recent literature, we developed in this study a competency model that was empirically evaluated within learners ( N = 110) from different age groups, from kindergarten to university. In addition, we collected data on language skills, domain-specific interest and previous knowledge to analyse coherence between these skills and observation competency. The study showed as expected that previous knowledge had a high impact on observation competency, whereas the influence of domain-specific interest was nonexistent. Language skills were shown to have a weak influence. By utilising the empirically validated model consisting of three dimensions (`Describing', `Scientific reasoning' and `Interpreting') and three skill levels, it was possible to assess each child's competency level and to develop and evaluate guided play activities to individually foster a child's observation competency.

  12. Previous studies underestimate BMAA concentrations in cycad flour.

    Cheng, Ran; Banack, Sandra Anne


    The traditional diet of the Chamorro people of Guam has high concentrations of the neurotoxin BMAA, beta-methyl-amino-L-alanine, in cycad tortillas and from animals that feed on cycad seeds. We measured BMAA concentration in washed cycad flour and compared different extraction methods used by previous researchers in order to determine how much BMAA may have been unaccounted for in prior research. Samples were analyzed with AQC precolumn derivatization using HPLC-FD detection and verified with UPLC-UV, UPLC-MS, and triple quadrupole LC/MS/MS. Although previous workers had studied only the free amino acid component of BMAA in washed cycad flour, we detected significant levels of protein-associated BMAA in washed cycad flour. These data support a link between ALS/PDC and exposure to BMAA.

  13. New study reveals twice as many asteroids as previously believed


    The ISO satellite Credits: ESA ISO An artist's impression of the ISO spacecraft. The ISO Deep Asteroid Search indicates that there are between 1.1 million and 1.9 million 'space rocks' larger than 1 kilometre in diameter in the so-called 'main asteroid belt', about twice as many as previously believed. However, astronomers think it is premature to revise current assessments of the risk of the Earth being hit by an asteroid. Despite being in our own Solar System, asteroids can be more difficult to study than very distant galaxies. With sizes of up to one thousand kilometres in diameter, the brightness of these rocky objects may vary considerably in just a few minutes. They move very quickly with respect to the stars - they have been dubbed 'vermin of the sky' because they often appear as trails on long exposure images. This elusiveness explains why their actual number and size distribution remains uncertain. Most of the almost 40,000 asteroids catalogued so far (1) orbit the Sun forming the 'main asteroid belt', between Mars and Jupiter, too far to pose any threat to Earth. However, space-watchers do keep a closer eye on another category of asteroids, the 'Near Earth Asteroids' or 'NEAs', which are those whose orbits cross, or are likely to cross, that of our planet. The ISO Deep Asteroid Search (IDAS), the first systematic search for these objects performed in infrared light, focused on main belt asteroids. Because it is impossible to simply point the telescope at the whole main belt and count, astronomers choose selected regions of the belt and then use a theoretical model to extrapolate the data to the whole belt. Edward Tedesco (TerraSystems, Inc., New Hampshire, United States) and François-Xavier Desert (Observatoire de Grenoble, France) observed their main belt selected areas in 1996 and 1997 with ESA's ISO. They found that in the middle region of the belt the density of asteroids was 160 asteroids larger than 1 kilometre per square degree - an area of the

  14. Effectiveness and tolerability of treatment intensification to basal–bolus therapy in patients with type 2 diabetes on previous basal insulin-supported oral therapy with insulin glargine or supplementary insulin therapy with insulin glulisine: the PARTNER observational study

    Pfohl M


    Full Text Available Martin Pfohl,1 Thorsten Siegmund,2 Stefan Pscherer,3 Katrin Pegelow,4 Jochen Seufert5 1Medizinische Klinik I, Evangelisches Bethesda-Klinikum GmbH, Duisburg, Germany; 2Städtisches Klinikum München GmbH, Klinikum Bogenhausen, III. Medizinische Abteilung, München, Germany; 3Klinisches Diabeteszentrum Südostbayern, Innere Medizin – Diabetologie, Traunstein, Germany; 4Sanofi-Aventis Deutschland GmbH, Berlin, Germany; 5Medizinische Universitätsklinik, Klinik für Innere Medizin II, Abteilung für Endokrinologie und Diabetologie, Freiburg, Germany Background: Due to the progressive nature of type 2 diabetes mellitus (T2DM, antidiabetic treatment needs to be continuously intensified to avoid long-term complications. In T2DM patients on either basal insulin-supported oral therapy (BOT or supplementary insulin therapy (SIT presenting with HbA1c values above individual targets for 3–6 months, therapy should be intensified. This study investigated effectiveness and tolerability of an intensification of BOT or SIT to a basal–bolus therapy (BBT regimen in T2DM patients in daily clinical practice. Methods: This noninterventional, 8-month, prospective, multicenter study evaluated parameters of glucose control, occurrence of adverse events (eg, hypoglycemia, and acceptance of devices in daily clinical practice routine after 12 and 24 weeks of intensifying insulin therapy to a BBT regimen starting from either preexisting BOT with insulin glargine (pre-BOT or preexisting SIT with ≥3 daily injections of insulin glulisine (pre-SIT. Results: A total of 1,530 patients were documented in 258 German medical practices. A total of 1,301 patients were included in the full analysis set (55% male, 45% female; age median 64 years; body mass index median 30.8 kg/m2; pre-BOT: n=1,072; pre-SIT: n=229, and 1,515 patients were evaluated for safety. After 12 weeks, HbA1c decreased versus baseline (pre-BOT 8.67%; pre-SIT 8.46% to 7.73% and 7.66%, respectively (Δ mean

  15. Study of cystic artery by arteriography. Importance of previous cholecystography

    Machado, G.O.

    An oral cholecystography previously to celiac and mesenteric arteriography is performed, in order to identify the cystic artery, in 42 patients with pancreatitis, according Seldinger technique. The cystic artery was identified in all the cases, the pattern being the outlet of the cystic artery from the right hepatic artery. Infusion pump and seriography were not used.

  16. Influence of Previous Knowledge, Language Skills and Domain-Specific Interest on Observation Competency

    Kohlhauf, Lucia; Rutke, Ulrike; Neuhaus, Birgit


    Many epoch-making biological discoveries (e.g. Darwinian Theory) were based upon observations. Nevertheless, observation is often regarded as "just looking" rather than a basic scientific skill. As observation is one of the main research methods in biological sciences, it must be considered as an independent research method and systematic practice…

  17. Approximation of lateral distribution of atmospheric Cherenkov light at different observation levels. Comparison with previous results

    Mishev, A; Stamenov, J


    This work summarizes the results presented at 29th International Cosmic Ray Conference in Pune India. Generally the aim of this work is to obtain the lateral distribution of the atmospheric Cherenkov light in extensive air showers produced by different primary particles in wide energy range and at several observation levels and to fit the obtained lateral distributions. Using one large detector and partially modified CORSIKA code version are obtained the lateral distributions of Cherenkov light flux densities at several observation levels for different particle primaries precisely at 536 g/cm2 Chacaltaya, 700 g/cm2 Moussala and 875 g/cm2 Kartalska field observation levels for hadronic primaries and gamma quanta in the energy range 1011 eV-1016 eV. On the basis of the solution of over-determined inverse problem the approximation of these distributions is obtained. The same model function for all the primaries is used and for the different observation levels. The different model parameters for the different pri...

  18. Multiwavelength Observations of the Previously Unidentified Blazar RX J0648.7+1516

    Aliu, E; Beilicke, M; Benbow, W; Böttcher, M; Bouvier, A; Bradbury, S M; Buckley, J H; Bugaev, V; Cannon, A; Cesarini, A; Ciupik, L; Connolly, M P; Cui, W; Decerprit, G; Dickherber, R; Duke, C; Errando, M; Falcone, A; Feng, Q; Finnegan, G; Fortson, L; Furniss, A; Galante, N; Gall, D; Gillanders, G H; Godambe, S; Griffin, S; Grube, J; Gyuk, G; Hanna, D; Hivick, B; Holder, J; Huan, H; Hughes, G; Hui, C M; Humensky, T B; Kaaret, P; Karlsson, N; Kertzman, M; Kieda, D; Krawczynski, H; Krennrich, F; Maier, G; Majumdar, P; McArthur, S; McCann, A; Moriarty, P; Mukherjee, R; Nelson, T; Ong, R A; Orr, M; Otte, A N; Park, N; Perkins, J S; Pichel, A; Pohl, M; Prokoph, H; Quinn, J; Ragan, K; Reyes, L C; Reynolds, P T; Roache, E; Rose, H J; Ruppel, J; Saxon, D B; Sembroski, G H; Skole, C; Smith, A W; Staszak, D; Tesic, G; Theiling, M; Thibadeau, S; Tsurusaki, K; Tyler, J; Varlotta, A; Vassiliev, V V; Wakely, S P; Weekes, T C; Weinstein, A; Williams, D A; Zitzer, B; Ciprini, S; Fumagalli, M; Kaplan, K; Paneque, D; Prochaska, J X


    We report on the VERITAS discovery of very-high-energy (VHE) gamma- ray emission above 200 GeV from the high-frequency-peaked BL Lac object RXJ0648.7+1516 (GBJ0648+1516), associated with 1FGLJ0648.8+1516. The photon spectrum above 200 GeV is fit by a power law dN/dE = F0(E/E0)-{\\Gamma} with a photon index {\\Gamma} of 4.4 {\\pm} 0.8stat {\\pm}0.3syst and a flux normalization F0 of (2.3 {\\pm}0.5stat {\\pm} 1.2sys) {\\times} 10-11 TeV-1cm-2s-1 with E0 = 300 GeV. No VHE vari- ability is detected during VERITAS observations of RXJ0648.7+1516 between 2010 March 4 and April 15. Following the VHE discovery, the optical identifica- tion and spectroscopic redshift were obtained using the Shane 3-m Telescope at the Lick Observatory, showing the unidentified object to be a BL Lac type with a redshift of z = 0.179. Broadband multiwavelength observations contemporaneous with the VERITAS exposure period can be used to sub-classify the blazar as a high-frequency-peaked BL Lac (HBL) object, including data from the MDM ob- servato...

  19. Sourcing quality-of-life weights obtained from previous studies: theory and reality in Korea.

    Bae, SeungJin; Bae, Eun Young; Lim, Sang Hee


    The quality-of-life weights obtained in previous studies are frequently used in cost-utility analyses. The purpose of this study is to describe how the values obtained in previous studies are incorporated into the industry submissions requesting listing at the Korean National Health Insurance (NHI), focusing on the issues discussed in theoretical studies and national guidelines. The industry submissions requesting listing at the Korean NHI from January 2007 until December 2009 were evaluated by two independent researchers at the Health Insurance Review and Assessment Service (HIRA). Specifically, we observed the methods that were used to pool, predict joint health state utilities, and retain consistency within submissions in terms of the issues discussed in methodological research papers and recommendations from national guidelines. More than half of the submissions used QALY as an outcome measure, and most of these submissions were sourced from prior studies. Heterogeneous methodologies were frequently used within a submission, with the inconsistent use of upper and lower anchors being prevalent. Assumptions behind measuring joint health state utilities or pooling multiple values for single health states were omitted in all submissions. Most national guidelines were rather vague regarding how to predict joint health states, how to select the best available value, how to maintain consistency within a submission, and how to generalize values obtained from prior studies. Previously-generated values were commonly sourced, but this practice was frequently related to inconsistencies within and among submissions. Attention should be paid to the consistency and transparency of the value, especially if the value is sourced from prior studies.

  20. Chronic Chagas disease: PCR-xenodiagnosis without previous microscopic observation is a useful tool to detect viable Trypanosoma cruzi.

    Saavedra, Miguel; Zulantay, Inés; Apt, Werner; Martínez, Gabriela; Rojas, Antonio; Rodríguez, Jorge


    We evaluate the elimination of the microscopic stage of conventional xenodiagnosis (XD) to optimize the parasitological diagnosis of Trypanosoma cruzi in chronic Chagas disease. To this purpose we applied under informed consent two XD cages to 150 Chilean chronic chagasic patients. The fecal samples (FS) of the triatomines at 30, 60 and 90 days post feeding were divided into two parts: in one a microscopic search for mobile trypomastigote and/or epimastigote forms was performed. In the other part, DNA extraction-purification for PCR directed to the conserved region of kDNA minicircles of trypanosomes (PCR-XD), without previous microscopic observation was done. An XD was considered positive when at least one mobile T. cruzi parasite in any one of three periods of incubation was observed, whereas PCR-XD was considered positive when the 330 bp band specific for T. cruzi was detected. 25 of 26 cases with positive conventional XD were PCR-XD positive (concordance 96.2%), whereas 85 of 124 cases with negative conventional XD were positive by PCR-XD (68.5%). Human chromosome 12 detected by Real-time PCR used as exogenous internal control of PCR-XD reaction allowed to discounting of PCR inhibition and false negative in 40 cases with negative PCR-XD. PCR-XD performed without previous microscopic observation is a useful tool for detection of viable parasites with higher efficiency then conventional XD.

  1. Summary of Previous Chamber or Controlled Anthrax Studies and Recommendations for Possible Additional Studies

    Piepel, Gregory F.; Amidan, Brett G.; Morrow, Jayne B.


    This report and an associated Excel file(a) summarizes the investigations and results of previous chamber and controlled studies(b) to characterize the performance of methods for collecting, storing and/or transporting, extracting, and analyzing samples from surfaces contaminated by Bacillus anthracis (BA) or related simulants. This report and the Excel are the joint work of the Pacific Northwest National Laboratory (PNNL) and the National Institute of Standards and Technology (NIST) for the Department of Homeland Security, Science and Technology Directorate. The report was originally released as PNNL-SA-69338, Rev. 0 in November 2009 with limited distribution, but was subsequently cleared for release with unlimited distribution in this Rev. 1. Only minor changes were made to Rev. 0 to yield Rev. 1. A more substantial update (including summarizing data from other studies and more condensed summary tables of data) is underway


    Gurpreet Kaur


    Full Text Available Previous caesarean section sparks an area of controversy in Obstetrics. The management of women with previous caesarean section regarding the mode of delivery whether to opt for repeat caesarean section or vaginal delivery, is an area of debate. Very often the decision on management is not made on Principle of sound reasoning and many who choose the elective repeat caesarean section do so to circumvent the anxious moment that arise during conduct ion of labour. AIMS AND OBJECTIVE: To determine the maternal and fetal outcome in relation to type of delivery . MATERIALS AND METHOD S: A 18 month prospective observational study was conducted where in 150 patients who had a term pregnancy with a history of prior LSCS were included after obtaining their consent for participation. The obstetric and fetal outcomes of these patients in the present pregnancy were analyzed by Z test. RESULTS: Out of the 150 subjects 78 ( 52% were in age group of 26 - 30 years, 106 ( 70.67% patients belonged to the urban population, 116 ( 77.33% were booked patie nts, 107 ( 71.33% were housewives, 122 ( 81.33% belonged to middle class and 22 ( 14.67% were from high socio economic status. 67 ( 44.67% were second gravid, 112 ( 74.67% were para 1. Out of total 134 patients 29 ( 21.64% had elective caesarean section and 5 ( 3 .73% patients came as emergency admission and underwent caesarean section. Out of 134 patients, with one previous caesarean section. 32 had spontaneous onset of labour. Out of which 20 ( 68.97% had vaginal delivery and 9 ( 31.03% had repeat caesarean section. 13 patients had augmentation, 11 ( 84.62% had vaginal delivery and 2 ( 15.38% had caesarean section. In 58 patients labour was induced 29 ( 50% had section. 14 patients out of 50 who had previous 2 caesarean section only 1 ( 7.69% patient had spontane ous onset of labour and had caesarean section. 3 ( 92.86% patients had elective caesarean section. There were only 2 patients with previous 3 caesarean

  3. Clinical Observation of Erlotinib in the Treatment of Advanced and Previously Treated Non-small Cell Lung Cancer

    Liyan XU


    Full Text Available Background and objective Erlotinib is a small molecular inhibitor of tyrosine kinase. One study has confirmed that it can prolong the median progression-free survival time (PFS, and can improve the one-year survival rate of patients with advanced non-small cell lung cancer. The aim of this trial is to evaluate the response and adverse reaction of agent erlotinib in advanced and previously treated non-small-cell lung cancer. Methods The study was one part of the EAP (Expanded Access Programme study. Forty-five patients with advanced non-small cell lung cancer, which had been treated with 1-2 regimens containing platinum previously, were treated with erlotinib from Dec 2005. Erlotinib was prescribed at a dose of 150 mg daily. Results Forty-three patients were evaluated response and all patients were evaluated toxicity. Among these patients, CR 0 case, PR 19 cases (44.2%, RR (CR+PR 44.2% and SD 13 cases as their best response, disease control rate (DCR=CR+PR+SD 74.4%, PD 11cases (25.6%. The median progression-free survival time was 4.8 months; the median survival time was 15.0 months; the one-year survival rate was 68.8% (31/45. The median PFS of patients with adenocarcinoma and with non-adenocarcinoma was 7.6 months vs 2.6 months (P=0.018. The drug-related adverse reactions were skin rash (41 cases, 91.1%, billirubine increased (15 cases, 33.3%, ALT increased (9 cases, 20% and diarrhea (4 cases, 8.9%. For patients with and without skin rash, the median PFS was 7.5 months vs 1.1 months (P=0.001, and the median survival time was 15.6 months vs 5.2 months (P=0.002. Conclusion Erlotinib is effective in advanced and previously treated non-small cell lung cancer, and it is much more effective in adenocarcinoma and patients with skin rash. It is well tolerated, only with some minimal adverse reactions.

  4. The impact of previous traumatic brain injury on health and functioning: a TRACK-TBI study.

    Dams-O'Connor, Kristen; Spielman, Lisa; Singh, Ayushi; Gordon, Wayne A; Lingsma, Hester F; Maas, Andrew I R; Manley, Geoffrey T; Mukherjee, Pratik; Okonkwo, David O; Puccio, Ava M; Schnyer, David M; Valadka, Alex B; Yue, John K; Yuh, Esther L


    The idea that multiple traumatic brain injury (TBI) can have a cumulative detrimental effect on functioning is widely accepted. Most research supporting this idea comes from athlete samples, and it is not known whether remote history of previous TBI affects functioning after subsequent TBI in community-based samples. This study investigates whether a previous history of TBI with loss of consciousness (LOC) is associated with worse health and functioning in a sample of individuals who require emergency department care for current TBI. Twenty-three percent of the 586 individuals with current TBI in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study reported having sustained a previous TBI with LOC. Individuals with previous TBI were more likely to be unemployed (χ(2)=17.86; p=0.000), report a variety of chronic medical and psychiatric conditions (4.75≤χ(2)≥24.16; pTBI history. Those with a previous TBI had less-severe acute injuries, but experienced worse outcomes at 6-month follow-up. Results of a series of regression analyses controlling for demographics and acute injury severity indicated that individuals with previous TBI reported more mood symptoms, more postconcussive symptoms, lower life satisfaction, and had slower processing speed and poorer verbal learning, compared to those with no previous TBI history. These findings suggest that history of TBI with LOC may have important implications for health and psychological functioning after TBI in community-based samples.

  5. Collisions in outer space produced an icosahedral phase in the Khatyrka meteorite never observed previously in the laboratory

    Bindi, Luca; Lin, Chaney; Ma, Chi; Steinhardt, Paul J.


    We report the first occurrence of an icosahedral quasicrystal with composition Al62.0(8)Cu31.2(8)Fe6.8(4), outside the measured equilibrium stability field at standard pressure of the previously reported Al-Cu-Fe quasicrystal (AlxCuyFez, with x between 61 and 64, y between 24 and 26, z between 12 and 13%). The new icosahedral mineral formed naturally and was discovered in the Khatyrka meteorite, a recently described CV3 carbonaceous chondrite that experienced shock metamorphism, local melting (with conditions exceeding 5 GPa and 1,200 °C in some locations), and rapid cooling, all of which likely resulted from impact-induced shock in space. This is the first example of a quasicrystal composition discovered in nature prior to being synthesized in the laboratory. The new composition was found in a grain that has a separate metal assemblage containing icosahedrite (Al63Cu24Fe13), currently the only other known naturally occurring mineral with icosahedral symmetry (though the latter composition had already been observed in the laboratory prior to its discovery in nature). The chemistry of both the icosahedral phases was characterized by electron microprobe, and the rotational symmetry was confirmed by means of electron backscatter diffraction.


    Sallum, S.; Eisner, J. A.; Close, Laird M.; Hinz, Philip M.; Skemer, Andrew J.; Bailey, Vanessa; Follette, Katherine B.; Males, Jared R.; Morzinski, Katie M. [Astronomy Department, University of Arizona, 933 North Cherry Avenue, Tucson, AZ 85721 (United States); Briguglio, Runa; Puglisi, Alfio; Xompero, Marco [INAF-Osservatorio Astrofisico di Arcetri, I-50125 Firenze (Italy); Rodigas, Timothy J.; Weinberger, Alycia J., E-mail: [Carnegie Institution DTM, 5241 Broad Branch Rd, Washington, DC 20015 (United States)


    We present multi-epoch non-redundant masking observations of the T Cha transition disk, taken at the Very Large Telescope and Magellan in the H, Ks, and L' bands. T Cha is one of a small number of transition disks that host companion candidates discovered by high-resolution imaging techniques, with a putative companion at a position angle of 78°, separation of 62 mas, and contrast of ΔL' = 5.1 mag. We find comparable binary parameters in our re-reduction of the initial detection images, and similar parameters in the 2011 L', 2013 NaCo L', and 2013 NaCo Ks data sets. We find a close-in companion signal in the 2012 NaCo L' data set that cannot be explained by orbital motion, and a non-detection in the 2013 MagAO/Clio2 L' data. However, Monte Carlo simulations show that the best fits to the 2012 NaCo and 2013 MagAO/Clio2 followup data may be consistent with noise. There is also a significant probability of false non-detections in both of these data sets. We discuss physical scenarios that could cause the best fits, and argue that previous companion and scattering explanations are inconsistent with the results of the much larger data set presented here.

  7. Matched cohort study of external cephalic version in women with previous cesarean delivery.

    Keepanasseril, Anish; Anand, Keerthana; Soundara Raghavan, Subrahmanian


    To evaluate the efficacy and safety of external cephalic version (ECV) among women with previous cesarean delivery. A retrospective study was conducted using data for women with previous cesarean delivery and breech presentation who underwent ECV at or after 36 weeks of pregnancy during 2011-2016. For every case, two multiparous women without previous cesarean delivery who underwent ECV and were matched for age and pregnancy duration were included. Characteristics and outcomes were compared between groups. ECV was successful for 32 (84.2%) of 38 women with previous cesarean delivery and 62 (81.6%) in the control group (P=0.728). Multivariate regression analysis confirmed that previous cesarean was not associated with ECV success (odds ratio 1.89, 95% confidence interval 0.19-18.47; P=0.244). Successful vaginal delivery after successful ECV was reported for 19 (59.4%) women in the previous cesarean delivery group and 52 (83.9%) in the control group (Pcesarean delivery. To avoid a repeat cesarean delivery, ECV can be offered to women with breech presentation and previous cesarean delivery who are otherwise eligible for a trial of labor. © 2017 International Federation of Gynecology and Obstetrics.

  8. SEM observation of structural (non-mineralogical) alteration inside the previously crystallized nacreous layer of Crenomytilus grayanus (Bivalvia: Mytilidae).

    Zuykov, Michael; Pelletier, Emilien; Kolyuchkina, Galina


    A microstructural and mineralogical study shows the transition of aragonitic nacreous tablets to aragonitic prisms inside previously secreted nacre, i.e. without contact with the mantle or extrapallial fluid, in a field-collected mytilid bivalve Crenomytilus grayanus (D.). The intermediate zone between nacre and new prisms is represented by nacre tablets "stuck together" or by disordered calcium carbonate material. The modified nacre forms aragonitic lenses of prisms (ALPs). These lenses may reach 500 μm in thickness below the tunnels excavated by the shell borers. ALPs are similar to myostracal prisms in mineralogy, morphology, and orientation, but differ from those in the outer shell layer. The process of ALPs formation is different to that of normal shell formation (e.g. nacre-prisms transition between prismatic and nacreous layers), remote biomineralization, extra shell thickening, as well as, shell repair, erosion, deformation or disease. Response to shell excavation by boring organisms is discussed as the reason for the appearance of ALPs.

  9. Developing Reading Comprehension through Metacognitive Strategies: A Review of Previous Studies

    Channa, Mansoor Ahmed; Nordin, Zaimuariffudin Shukri; Siming, Insaf Ali; Chandio, Ali Asgher; Koondher, Mansoor Ali


    This paper has reviewed the previous studies on metacognitive strategies based on planning, monitoring, and evaluating in order to develop reading comprehension. The main purpose of this review in metacognition, and reading domain is to help readers to enhance their capabilities and power reading through these strategies. The researchers reviewed…

  10. Vibrations of twisted cantilevered plates - Summary of previous and current studies

    Leissa, A. W.; Macbain, J. C.; Kielb, R. E.


    This work summarizes a comprehensive study made of the free vibrations of twisted, cantilevered plates of rectangular planform. Numerous theoretical and experimental investigations previously made by others have resulted in frequency results which disagree considerably. To clarify the problem a joint industry/government/university research effort was initiated to obtain comprehensive theoretical and experimental results for models having useful ranges of aspect ratios, thickness ratios and twist angles. Theoretical data came from 19 independent computer analyses, including finite element, shell theory and beam theory idealizations. Two independent sets of experimental data were also obtained. The theoretical and experimental results are summarized and compared.

  11. Assessing observational studies of medical treatments

    Butani Yogita


    Full Text Available Abstract Background Previous studies have assessed the validity of the observational study design by comparing results of studies using this design to results from randomized controlled trials. The present study examined design features of observational studies that could have influenced these comparisons. Methods To find at least 4 observational studies that evaluated the same treatment, we reviewed meta-analyses comparing observational studies and randomized controlled trials for the assessment of medical treatments. Details critical for interpretation of these studies were abstracted and analyzed qualitatively. Results Individual articles reviewed included 61 observational studies that assessed 10 treatment comparisons evaluated in two studies comparing randomized controlled trials and observational studies. The majority of studies did not report the following information: details of primary and ancillary treatments, outcome definitions, length of follow-up, inclusion/exclusion criteria, patient characteristics relevant to prognosis or treatment response, or assessment of possible confounding. When information was reported, variations in treatment specifics, outcome definition or confounding were identified as possible causes of differences between observational studies and randomized controlled trials, and of heterogeneity in observational studies. Conclusion Reporting of observational studies of medical treatments was often inadequate to compare study designs or allow other meaningful interpretation of results. All observational studies should report details of treatment, outcome assessment, patient characteristics, and confounding assessment.

  12. [Inter-observer variability of decision concerning the route of delivery in case of one previous cesarean section and abnormal pelvic measures].

    Bourdon, M; Ceccaldi, P F; Girard, G; Koskas, M; Goffinet, F; Le Ray, C


    To study inter-observer variability of decision concerning the route of delivery using pelvimetry in case of one previous cesarean section and abnormal pelvic measures. Observational study conducted in 2014 in 4 university maternity units among 36 obstetricians. Two groups of obstetricians - as they practiced in a center where pelvimetry was routinely performed (n=12) or not (n=24) - had to choose a route of delivery for 10 clinical cases of women with a single uterine scar and a tight pelvis. The "routine pelvimetry" group had pelvimetry results. The group "no pelvimetry" became aware of pelvimetry results as a second step and had to indicate whether this information changed or not their management. The measurement of the inter-observer variability was estimated by estimating the proportion of agreement according to Grant method. The proportion of agreements of an attempted vaginal delivery between obstetricians in the group "routine pelvimetry" was 64.7% (95% CI [61-68.5]) and 97.3% (95% CI [96.4 to 98.3]) in the group "no pelvimetry", prior knowledge of pelvimetry results. An attempted vaginal delivery was decided in 77.5% versus 98.7% (Pcesarean section, in case of tight pelvis discovered after pelvimetry, inter-observer variability of decision concerning the route of delivery is increased. Centers that choose to continue using the routine pelvimetry should develop procedures to limit this variability. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. Case-control study for colorectal cancer genetic susceptibility in EPICOLON: previously identified variants and mucins

    Moreno Victor


    Full Text Available Abstract Background Colorectal cancer (CRC is the second leading cause of cancer death in developed countries. Familial aggregation in CRC is also important outside syndromic forms and, in this case, a polygenic model with several common low-penetrance alleles contributing to CRC genetic predisposition could be hypothesized. Mucins and GALNTs (N-acetylgalactosaminyltransferase are interesting candidates for CRC genetic susceptibility and have not been previously evaluated. We present results for ten genetic variants linked to CRC risk in previous studies (previously identified category and 18 selected variants from the mucin gene family in a case-control association study from the Spanish EPICOLON consortium. Methods CRC cases and matched controls were from EPICOLON, a prospective, multicenter, nationwide Spanish initiative, comprised of two independent stages. Stage 1 corresponded to 515 CRC cases and 515 controls, whereas stage 2 consisted of 901 CRC cases and 909 controls. Also, an independent cohort of 549 CRC cases and 599 controls outside EPICOLON was available for additional replication. Genotyping was performed for ten previously identified SNPs in ADH1C, APC, CCDN1, IL6, IL8, IRS1, MTHFR, PPARG, VDR and ARL11, and 18 selected variants in the mucin gene family. Results None of the 28 SNPs analyzed in our study was found to be associated with CRC risk. Although four SNPs were significant with a P-value ADH1C (OR = 1.63, 95% CI = 1.06-2.50, P-value = 0.02, recessive, rs1800795 in IL6 (OR = 1.62, 95% CI = 1.10-2.37, P-value = 0.01, recessive, rs3803185 in ARL11 (OR = 1.58, 95% CI = 1.17-2.15, P-value = 0.007, codominant, and rs2102302 in GALNTL2 (OR = 1.20, 95% CI = 1.00-1.44, P-value = 0.04, log-additive 0, 1, 2 alleles], only rs3803185 achieved statistical significance in EPICOLON stage 2 (OR = 1.34, 95% CI = 1.06-1.69, P-value = 0.01, recessive. In the joint analysis for both stages, results were only significant for rs3803185 (OR = 1

  14. A longitudinal study of plasma insulin and glucagon in women with previous gestational diabetes

    Damm, P; Kühl, C; Hornnes, P


    OBJECTIVE: To investigate whether plasma insulin or glucagon predicts later development of diabetes in women with gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: The subjects studied were 91 women with diet-treated GDM and 33 healthy women. Plasma insulin and glucagon during a 50......-g oral glucose tolerance test (OGTT) were measured during pregnancy, postpartum, and at follow-up 5-11 years later. At follow-up, the women were also examined with a 75-g OGTT or an intravenous glucagon test. RESULTS: Twenty-seven (30%) of the women with previous GDM had abnormal glucose tolerance...... response) at all time points investigated; this was also found when only nonobese glucose-tolerant women were examined. Low insulin secretion during pregnancy together with a high fasting plasma glucose level at the diagnostic OGTT in pregnancy and hyperglycemia during the postpartum OGTT were predictive...

  15. A study about the interest and previous contact of high school students with Astronomy

    Carvalho, C. L.; Zanitti, M. H. R.; Felicidade, B. L.; Gomes, A. D. T.; Dias, E. W.; Coelho, F. O.


    The currently problems in Astronomy teaching in Brazilian Basic Education contrast with the space, and the popularity that astronomical themes have in various media in the country. In this work, we present the results of a study about the interest, and previous contact of high school students from a public school in the city of "São João del-Rei"/MG with topics related to Astronomy. The study and the pedagogical intervention were carried out by students of the PIBID/CAPES/UFSJ. The intervention was performed through an oral exposition with the students' participation, followed by the use of the Stellarium program. The results suggest the majority of students surveyed are interested in Astronomy, and have had some contact with the area. However, some inconsistencies in their responses were identified and examined. The implications for research and for Astronomy Education are discussed. We also make some considerations about relationship between the lack of specific knowledge and the misinformation as one possible reason for the little interest of students in various areas of Science.

  16. Assessment of empathy in first-episode psychosis and meta-analytic comparison with previous studies in schizophrenia.

    Achim, Amelie M; Ouellet, Rosalie; Roy, Marc-André; Jackson, Philip L


    Empathy is a multidimensional construct that relies on affective and cognitive component processes. A few studies have reported impairments of both cognitive and affective empathy components in patients with schizophrenia. It is, however, not known whether these difficulties are already present at psychosis onset. The affective and cognitive components of empathy were thus assessed in 31 patients with first-episode psychosis (FEP) and 31 matched healthy controls using the Interpersonal Reactivity Index (IRI). Our results were then compared to previous studies of empathy in patients with more chronic schizophrenia via a meta-analysis. In addition, we also assessed the relationship between empathy ratings, Mentalizing performance and clinical symptoms. Contrary to what has been reported in people with more chronic schizophrenia, the IRI ratings did not significantly differ between FEP and controls in our study, though a trend was observed for the Personal distress scale. For the Perspective taking scale, our meta-analysis revealed a significantly lower effect size in this study with FEP patients relative to previous schizophrenia studies. In the FEP group, the IRI ratings were not related to positive, negative or general psychopathology symptoms, but a significant relationship emerged between the Liebowitz Social Anxiety Scale and Perspective taking (negative correlation). In addition, a significant positive correlation was observed between the Empathic concern subscale and our theory of mind task. This study supports the idea that the cognitive component of empathy is less affected in patients with first-episode psychosis relative to patients with more chronic schizophrenia, and the impairments reported in previous reports with more chronic populations should be interpreted in light of a possible deterioration of this cognitive skill. The findings also provide some insight into the relationship between empathy and clinical symptoms such as social anxiety.

  17. Religious Identity in Iranian Society: A Systematic Review of Previous Studies (2001-2013


    literature on identity, evidence suggests that the role of religion in shaping individuals' and group's identity is widely ignored. However, a growing number of studies have begun to take into consideration the key role of religion (Arweck & Nesbitt 2010, King and Boyatzis 2004, Peek 2005. This article has attempted to review systematically previous research and conceptualizations on the religious identity based on national studies and surveys and academic dissertations.     Materials and Methods   As mentioned, the purpose of this study was to review the results of some influential researches in the field of religious identity. To get this purpose, one of the best known methods for reviewing previous studies, a systematic review, was applied. Systematic review deals with establishing and synthesizing of researches and evidences with focus on a specific question. This occurs through the organized, transparent, formal, clear and flexible procedures and processes. A systematic review of research is not limited to review the history and this overview and review can be used in different levels, fields and goals. During the first phase of the study, terms of "religious identity", "Islamic identity", "Iranian identity" and "religious identity" was searched at libraries and research centers and in databases such as Center for Scientific Information Database (SID, a database of Iranian journals and magazines (Magiran, Noor specialized journals database, and Science and Information Technology Institute (IrnaDoc. After reviewing the gathered documents and specifying its relationship with the object and purpose of the study, a total of 47 documents were selected. Documents based on the five major parameter were summarized and reviewed: 1-general information, 2-goals and research questions, 3-research methodology, 4-variables, 5-findings     Discussion of Results and Conclusion   Findings show that in the highest percentage (38.2% of researches, religious identity has been

  18. Phase II study of pegylated liposomal doxorubicin plus vinorelbine in breast cancer with previous anthracycline exposure.

    Martin, Miguel; García-Donas, Jesus; Casado, Antonio; de la Gándara, Isabel; Pérez-Segura, Pedro; García-Saenz, Jose-Angel; Ibáñez, Gabriel; Loboff, Belen; García-Ledo, Gemma; Moreno, Fernando; Grande, Enrique; Diaz-Rubio, Eduardo


    Thirty-five patients with metastatic breast cancer (MBC) entered a phase II study of pegylated liposomal doxorubicin 35 mg/m2 intravenously (i.v.) on day 1 plus vinorelbine 30 mg/m2 i.v. on day 1 every 4 weeks. Patients were required to have measurable disease, previous chemotherapy with an anthracycline-containing regimen, and a normal left ventricular ejection fraction (LVEF). Thirty-four patients were assessable for response and toxicity. The overall response rate (on an intent-to-treat basis) was 35% (12 of 34; 95% CI, 20%-54%). One complete response and 11 partial responses were noted. In addition, 14 patients (41%) had stable disease of > 4 months duration, and 7 patients (20.5%) had disease progression. The response rates to the combination when it was used as first- and second-line chemotherapy were 31% (4 of 13) and 38% (8 of 21), respectively. Median time to disease progression was 7 months (range, 1-35 months) and median overall survival was 13 months (range, 2 to > 62 months). Neutropenia was the most frequent toxicity (grade 4 in 44% of patients and 19% of cycles), but neutropenic fever was seen in only 3 cases. No septic deaths occurred. Nonhematologic grade 3 side effects included skin toxicity (palmar-plantar erythrodysesthesia syndrome, 6%) and mucositis (15%). Late alopecia was seen in 53% of patients (grade 1 in 41%, and grade 2 in 12%). The median LVEFs were 64% (range, 50%-81%) at baseline and 62% (range, 37%-70%) after treatment. Three patients presented an LVEF decrease to < 50%; however, no clinical heart failure was noted, and 2 of these patients recovered normal values after cessation of therapy. The combination of pegylated liposomal doxorubicin and vinorelbine can be safely administered to patients with anthracycline-pretreated MBC and is active in this population.

  19. Mirror activity in the human brain while observing hand movements: a comparison between EEG desynchronization in the mu-range and previous fMRI results.

    Perry, Anat; Bentin, Shlomo


    Mu (mu) rhythms are EEG oscillations between 8-13 Hz distinguished from alpha by having more anterior distribution and being desynchronized by motor rather than visual activity. Evidence accumulating during the last decade suggests that the desynchronization of mu rhythms (mu suppression) might be also a manifestation of a human Mirror Neuron System (MNS). To further explore this hypothesis we used a paradigm that, in a previous fMRI study, successfully activated this putative MNS in humans. Our direct goal was to provide further support for a link between modulation of mu rhythms and the MNS, by finding parallels between the reported patterns of fMRI activations and patterns of mu suppression. The EEG power in the mu range has been recorded while participants passively observed either a left or a right hand, reaching to and grasping objects, and compared it with that recorded while participants observed the movement of a ball, and while observing static grasping scenes or still objects. Mirroring fMRI results (Shmuelof, L., Zohary, E., 2005. Dissociation between ventral and dorsal fMRI activation during object and action recognition. Neuron 47, 457-470), mu suppression was larger in the hemisphere contra-lateral to the moving hand and larger when the hands grasped different objects in different ways than when the movement was repetitive. No suppression was found while participants observed still objects but mu suppression was also found while seeing static grasping postures. These data are discussed in light of similar parallels between modulations of alpha waves and fMRI while recording EEG in the magnet. The present data support a link between mu suppression and a human MNS.

  20. The biomechanics of running in athletes with previous hamstring injury: A case-control study.

    Daly, C; Persson, U McCarthy; Twycross-Lewis, R; Woledge, R C; Morrissey, D


    Hamstring injury is prevalent with persistently high reinjury rates. We aim to inform hamstring rehabilitation by exploring the electromyographic and kinematic characteristics of running in athletes with previous hamstring injury. Nine elite male Gaelic games athletes who had returned to sport after hamstring injury and eight closely matched controls sprinted while lower limb kinematics and muscle activity of the previously injured biceps femoris, bilateral gluteus maximus, lumbar erector spinae, rectus femoris, and external oblique were recorded. Intergroup comparisons of muscle activation ratios and kinematics were performed. Previously injured athletes demonstrated significantly reduced biceps femoris muscle activation ratios with respect to ipsilateral gluteus maximus (maximum difference -12.5%, P = 0.03), ipsilateral erector spinae (maximum difference -12.5%, P = 0.01), ipsilateral external oblique (maximum difference -23%, P = 0.01), and contralateral rectus femoris (maximum difference -22%, P = 0.02) in the late swing phase. We also detected sagittal asymmetry in hip flexion (maximum 8°, P = 0.01), pelvic tilt (maximum 4°, P = 0.02), and medial rotation of the knee (maximum 6°, P = 0.03) effectively putting the hamstrings in a lengthened position just before heel strike. Previous hamstring injury is associated with altered biceps femoris associated muscle activity and potentially injurious kinematics. These deficits should be considered and addressed during rehabilitation.

  1. New insights into the 243Am + 48Ca reaction products previously observed in the experiments on elements 113, 115, and 117.

    Oganessian, Yu Ts; Abdullin, F Sh; Dmitriev, S N; Gostic, J M; Hamilton, J H; Henderson, R A; Itkis, M G; Moody, K J; Polyakov, A N; Ramayya, A V; Roberto, J B; Rykaczewski, K P; Sagaidak, R N; Shaughnessy, D A; Shirokovsky, I V; Stoyer, M A; Subbotin, V G; Sukhov, A M; Tsyganov, Yu S; Utyonkov, V K; Voinov, A A; Vostokin, G K


    Results of a new series of experiments on the study of production cross sections and decay properties of the isotopes of element 115 in the reaction (243)Am+(48)Ca are presented. Twenty-one new decay chains originating from (288)115 were established as the product of the 3n-evaporation channel by measuring the excitation function at three excitation energies of the compound nucleus (291)115. The decay properties of all newly observed nuclei are in full agreement with those we measured in 2003. At the lowest excitation energy E*=33 MeV, for the first time we registered the product of the 2n-evaporation channel, (289)115, which was also observed previously in the reaction (249)Bk+(48)Ca as the daughter nucleus of the decay of (293)117. The maximum cross section for the production of (288)115 is found to be 8.5 pb at E*≈36 MeV.




    Full Text Available With the world - wide rising trend of caesarean delivery (CD, modern obstetric practice deals with a new group of mothers carrying reproductive performance upon a scarred uterus with obvious risk in feto - maternal outcome. AIMS: (1 To analyse the maternal & neonatal outcome in post - caesarean pregnancy. (2 To evaluate the factors influencing outcome in such cases. Design : Observational analytical study. MATERIALS & METHODS: The present study was carried out over two years (2010 - 11 taking consecutive 100 p ost - caesarean cases as admitted on my admission days & delivered in BR Singh Hospital. Data collection was done by interview technique along with hospital records. ANALYSIS USED: Percentage analysis was most often done. Categorical variables were compared with chi - square test; P value was calculated with 2012 Graphpad Software. Relative risk (RR & Odd ratio (OR were calculated with 1993 - 2012 Medcalc Software bvba (Version 12.3.0. All statistical tests were evaluated at the 0.05 significance level. RESULT S: Post - caesarean pregnancy rate was 26.02%. Vaginal birth after caesarean (VBAC incidence was 22% whereas VBAC success on trial of labour was 55%. VBAC gave best morbidity outcome (18.18% & 27.27%. But failed VBAC cases result more significant maternal morbidity (RR=3.97, P=0.0037 & NICU admission was also found highest in failed VBAC cases (38.89%. Maternal and neonatal morbidity were significantly high when scar integrity was lost; also significantly co - related with elderly mothers (>35 yrs., un - boo ked cases & non - admitted cases undergone repeat CD. CONCLUSIONS: Post - caesarean cases need meticulous antenatal check - up & mandatory institutional delivery with proper selection of mode of confinement to have a better maternal & neonatal outcome

  3. Rancidity inhibition study in frozen whole mackerel (scomber scombrus by a previous plant extract treatment.

    Aubourg, Santiago P.


    Full Text Available The effect of flaxseeds (Linum usitatissimum on rancidity development in frozen whole mackerel (Scomber scombrus was studied. For it, fresh mackerel were dipped in flaxseeds aqueous extract during 60 min, frozen at –80 ºC during 24 hours and kept frozen (–20 ºC up to 12 months. Sampling was carried out on the initial material and at months 1, 3, 5, 7, 9 and 12 of frozen storage at –20 ºC. A parallel experiment with non treated fish was carried out in the same conditions. Rancidity development was measured by several biochemical indices (free fatty acids, peroxides, conjugated dienes and trienes, secondary oxidation products and lipoxygenase activity and complemented by the sensory analysis (skin, flesh odour, consistency and flesh appearance. As a result of the previous antioxidant treatment, peroxides showed to breakdown faster (pSe ha estudiado el efecto del lino (Linum usitatissimum en el desarrollo de rancidez en caballa entera congelada (Scomber scombrus. Para ello, caballas frescas fueron sumergidas en extractos acuosos de semillas de lino durante 60 min, congeladas a -80 ºC durante 24 h y mantenidas congeladas ( -20 ºC durante 12 meses. Se tomaron muestras del material inicial y tras 1, 3, 5, 7, 9 y 12 meses de congelación a -20 ºC . Un experimento paralelo con pescado no tratado fue llevado acabo en las mismas condiciones. El desarrollo de la rancidez fue medido por varios índices bioquímicos (ácidos grasos libres, peróxidos, dienos y trienos conjugados, productos secundarios de oxidación y actividad lipoxigenasa y completado con análisis sensorial (piel, olor de la carne, consistencia y apariencia de la carne. Como resultado del tratamiento antioxidante, los peróxidos se degradaron más rápidos (p < 0.05 después del mes 7, y por tanto, contenidos mayores (p < 0.05 de dienos y trienos conjugados pudieron ser detectados en el pescado tratado. El tratamiento antioxidante también condujo a un

  4. Effect of Previous Irradiation on Vascular Thrombosis of Microsurgical Anastomosis: A Preclinical Study in Rats.

    Barrera-Ochoa, Sergi; Gallardo-Calero, Irene; López-Fernández, Alba; Romagosa, Cleofe; Vergés, Ramona; Aguirre-Canyadell, Marius; Soldado, Francisco; Velez, Roberto


    The objective of the present investigation was to compare the effect of neoadjuvant irradiation on the microvascular anastomosis in cervical bundle using an experimental model in rats. One hundred forty male Sprague-Dawley rats were allocated into 4 groups: group I, control, arterial microanastomosis; group II, control, venous microanastomosis; group III, arterial microanastomosis with previous irradiation (20 Gy); and group IV, venous microanastomosis with previous irradiation (20 Gy). Clinical parameters, technical values of anastomosis, patency, and histopathological parameters were evaluated. Irradiated groups (III and IV) and vein anastomosis groups (II and IV) showed significantly increased technical difficulties. Group IV showed significantly reduced patency rates (7/35) when compared with the control group (0/35). Radiotherapy significantly decreased the patency rates of the vein (7/35) when compared with the artery (1/35). Groups III and IV showed significantly reduced number of endothelial cells and also showed the presence of intimal thickening and adventitial fibrosis as compared with the control group. Neoadjuvant radiotherapy reduces the viability of the venous anastomosis in a preclinical rat model with a significant increase in the incidence of vein thrombosis.

  5. Countesthorpe College: an observant study

    Riley, Ann; Stamatabis, Kathy


    Discussed the objectives and the conditions which made possible a new school embodying radical innovations. The results of a observational study at an early stage of the school's development, undertaken by a group of students, are summarised here by two of them, both now teaching in Leicestershire Upper Schools. (Editor/RK)

  6. Sunspot latitudes during the Maunder Minimum: a machine-readable catalogue from previous studies

    Vaquero, J M; Sánchez-Bajo, F


    The Maunder Minimum (1645-1715 approximately) was a period of very low solar activity and a strong hemispheric asymmetry, with most of sunspots in the southern hemisphere. In this paper, two data sets of sunspot latitudes during the Maunder minimum have been recovered for the international scientific community. The first data set is constituted by latitudes of sunspots appearing in the catalogue published by Gustav Sp\\"orer nearly 130 years ago. The second data set is based on the sunspot latitudes displayed in the butterfly diagram for the Maunder Minimum which was published by Ribes and Nesme-Ribes almost 20 years ago. We have calculated the asymmetry index using these data sets confirming a strong hemispherical asymmetry in this period. A machine-readable version of this catalogue with both data sets is available in the Historical Archive of Sunspot Observations ( and in the appendix of this article.

  7. Does the previous diagnosis of arterial hypertension affect one´s daily life? Pró-Saúde Study

    Gilberto Senechal de Goffredo Filho


    Full Text Available In addition to damaging several target organs, arterial hypertension may negatively impact patients' activities of daily living. Biological and behavioral mechanisms underlying such limitations have yet to be clarified. The objectives of this study were to investigate whether having been previously told of a hypertension diagnosis is associated with the frequency and duration of temporary limitations in activities of daily living, and whether these relationships differ by gender, age, or socioeconomic position. We analyzed sectional data from 2,666 participants (56% women; 55% with high school or lower schooling at the baseline phase (1999 - 2001 of a longitudinal investigation of university employees in Rio de Janeiro, Brazil (Pró-Saúde Study, asking participants whether they had ever been diagnosed with hypertension by a health professional, if they had been unable to perform any activities of daily living due to a health problem in the previous 2 weeks, and for how many days that had occurred. Multinomial logistic regression models were fitted for the overall study population and for age, gender, educational level, and per capita household income strata. Associations between hypertension diagnosis and temporary limitations were not observed in the overall study population and in gender, education and income strata. However, there were higher odds of temporary limitations among participants aged 55 years old or more with hypertension diagnosis (adjusted OR = 9.5; 95%CI 1.5 - 58.6, regardless of blood pressure levels and use of antihypertensive medication. Elderly people may keep an attitude of higher vigilance regarding conditions or events potentially worsening their health status.

  8. Convergence in the Bilingual Lexicon: A Pre-registered Replication of Previous Studies

    White, Anne; Malt, Barbara C.; Storms, Gert


    Naming patterns of bilinguals have been found to converge and form a new intermediate language system from elements of both the bilinguals’ languages. This converged naming pattern differs from the monolingual naming patterns of both a bilingual’s languages. We conducted a pre-registered replication study of experiments addressing the question whether there is a convergence between a bilingual’s both lexicons. The replication used an enlarged set of stimuli of common household containers, providing generalizability, and more reliable representations of the semantic domain. Both an analysis at the group-level and at the individual level of the correlations between naming patterns reject the two-pattern hypothesis that poses that bilinguals use two monolingual-like naming patterns, one for each of their two languages. However, the results of the original study and the replication comply with the one-pattern hypothesis, which poses that bilinguals converge the naming patterns of their two languages and form a compromise. Since this convergence is only partial the naming pattern in bilinguals corresponds to a moderate version of the one-pattern hypothesis. These findings are further confirmed by a representation of the semantic domain in a multidimensional space and the finding of shorter distances between bilingual category centers than monolingual category centers in this multidimensional space both in the original and in the replication study. PMID:28167921

  9. Randomized phase 2 study of obinutuzumab monotherapy in symptomatic, previously untreated chronic lymphocytic leukemia.

    Byrd, John C; Flynn, Joseph M; Kipps, Thomas J; Boxer, Michael; Kolibaba, Kathryn S; Carlile, David J; Fingerle-Rowson, Guenter; Tyson, Nicola; Hirata, Jamie; Sharman, Jeff P


    Obinutuzumab is a glycoengineered, type 2 anti-CD20 humanized antibody with single-agent activity in relapsed chronic lymphocytic leukemia (CLL). With other CD20 antibodies, a dose-response relationship has been shown. We therefore performed a randomized phase 2 study in symptomatic, untreated CLL patients to evaluate if an obinutuzumab dose response exists. Obinutuzumab was given at a dose of 1000 mg (100 mg IV day 1, 900 mg day 2, 1000 mg day 8 and day 15 of cycle 1; 1000 mg day 1 of cycles 2-8) or 2000 mg (100 mg IV day 1, 900 mg day 2, 1000 mg day 3, 2000 mg day 8 and day 15 of cycle 1; 2000 mg day 1 of cycles 2-8). The primary end point was overall response rate (ORR). Eighty patients were enrolled with similar demographics: median age 67 years, 41% high-risk Rai disease, and 10% del(17p)(13.1). ORR (67% vs 49%, P = .08) and complete response (CR) or CR with incomplete cytopenia response (20% vs 5%) favored 2000 mg obinutuzumab. Overall, therapy was well tolerated, and infusion events were manageable. This study demonstrates significant efficacy of obinutuzumab monotherapy, for 1000 mg as well as for 2000 mg, in untreated CLL patients with acceptable toxicity. Although exploratory, a dose-response relationship may exist, but its relevance to improving progression-free survival is uncertain and will require further follow-up. This trial was registered at as #NCT01414205.

  10. Life cycle impact assessment of ammonia production in Algeria: A comparison with previous studies

    Makhlouf, Ali, E-mail:; Serradj, Tayeb; Cheniti, Hamza


    In this paper, a Life Cycle Analysis (LCA) from “cradle to gate” of one anhydrous ton of ammonia with a purity of 99% was achieved. Particularly, the energy and environmental performance of the product (ammonia) were evaluated. The eco-profile of the product and the share of each stage of the Life Cycle on the whole environmental impacts have been evaluated. The flows of material and energy for each phase of the life cycle were counted and the associated environmental problems were identified. Evaluation of the impact was achieved using GEMIS 4.7 software. The primary data collection was executed at the production installations located in Algeria (Annaba locality). The analysis was conducted according to the LCA standards ISO 14040 series. The results show that Cumulative Energy Requirement (CER) is of 51.945 × 10{sup 3} MJ/t of ammonia, which is higher than the global average. Global Warming Potential (GWP) is of 1.44 t CO{sub 2} eq/t of ammonia; this value is lower than the world average. Tropospheric ozone precursor and Acidification are also studied in this article, their values are: 549.3 × 10{sup −6} t NMVOC eq and 259.3 × 10{sup −6} t SO{sub 2} eq respectively.

  11. Experimental bluetongue virus infection of sheep; effect of previous vaccination: clinical and immunologic studies.

    Mahrt, C R; Osburn, B I


    Clinical and immunologic responses of sheep to vaccination and subsequent bluetongue virus (BTV) challenge exposure were studied and compared with those of non-vaccinated sheep. Sheep were vaccinated with inactivated BTV administered with aluminum hydroxide and cimetidine or levamisole. After sheep were vaccinated, precipitating group-specific antibodies to BTV were detected, but serotype-specific neutralizing antibodies were not detected. Cellular immune responses (lymphocyte blastogenesis) to BTV were not detected. After virulent BTV challenge exposure, vaccinated and nonvaccinated sheep developed acute clinical disease of similar severity. Clinical signs included hyperemia and petechiae of oral mucosa and coronary bands of the feet, excess salivation, nasal discharge with crusting, ulceration of the muzzle, and edema of lips and intermandibular space. Marked increases in serum creatine kinase activity were associated with stiff gait, reluctance to move, and vomiting. Fever and leukopenia were detected in most of the challenge-exposed sheep. Viremia and neutralizing antibodies were detected in vaccinated and nonvaccinated sheep after challenge exposure. Bluetongue virus-specific reaginic antibodies were not detected in sera from any of the sheep when the passive cutaneous anaphylaxis test was used.

  12. Phase III Randomized Study of Bendamustine Compared With Chlorambucil in Previously Untreated Patients With Chronic Lymphocytic Leukemia

    Wolfgang U. Knauf; Toshko Lissichkov; Ali Aldaoud; Anna Liberati; Javier Loscertales; Raoul Herbrecht; Gunnar Juliusson; Gerhard Postner; Liana Gercheva; Stefan Goranov; Martin Becker; Hans-Joerg Fricke; Francoise Huguet; Ilaria Del Giudice; Peter Klein; Lothar Tremmel; Karlheinz Merkle; Marco Montillo


    This randomized, open-label, parallel-group, multicenter study was designed to compare the efficacy and safety of bendamustine and chlorambucil in previously untreated patients with advanced (Binet stage B or C...

  13. Low back pain in military recruits in relation to social background and previous low back pain. A cross-sectional and prospective observational survey

    Hestbæk, L.; Larsen, K.; Weidich, F.


    BACKGROUND: Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low...... on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires...... to 1,711 recruits before and after this three-month period. RESULTS: Sedentary occupation was negatively associated with long-lasting low back pain (>30 days during the past year) at baseline with an odds ratios of 0.55 (95% CI: 0.33-0.90). This effect vanished during service. Having parents...

  14. Effective Teaching and Learning Environments and Principal Self-Efficacy in Oklahoma: Replication of a Previous Study

    Berry, Kathryn


    The purpose of this study was to replicate a previous study by Smith et al. (2006) that explored principal self-efficacy beliefs for facilitating effective instructional environments at their schools. There has been limited research conducted on principal's self-efficacy, and the studies that have been completed on the topic have not been…

  15. A phase I study of imatinib mesylate in combination with chlorambucil in previously treated chronic lymphocytic leukemia patients.

    Hebb, Jonathan; Assouline, Sarit; Rousseau, Caroline; Desjardins, Pierre; Caplan, Stephen; Egorin, Merrill J; Amrein, Lilian; Aloyz, Raquel; Panasci, Lawrence


    The tyrosine kinase inhibitor, imatinib, has the potential to indirectly inhibit DNA repair. This mechanism of action has been shown to mediate sensitization to chlorambucil in chronic lymphocytic leukemia (CLL). To evaluate this effect in vivo, we performed a phase I study of chlorambucil combined with imatinib in relapsed CLL patients. The three dose levels studied included imatinib at 300, 400, or 600 mg/day. Imatinib was given on days 1-10, and chlorambucil (8 mg/m(2) daily) was given on days 3-7 of a 28-day cycle (up to 6 cycles). Eleven patients participated in this study. Low-grade gastrointestinal toxicities were observed in a dose-dependent manner. Forty-five percent of patients responded (two unconfirmed CRs and three PRs). Two responding patients were fludarabine refractory. The in vitro IC(50) of chlorambucil alone or in the presence of 5 μM imatinib in CLL lymphocytes correlated with the decrease in lymphocyte counts on day 15. Imatinib plasma concentrations achieved in patients were in the range of those effective in in vitro sensitization studies. The combination of chlorambucil and imatinib in patients with previously treated CLL was well tolerated and showed evidence of clinical efficacy. Based on our results, we recommend the 400 mg daily dose of imatinib on days 1-10 with 8 mg/m(3) chlorambucil on days 3-7 every 28 days as the phase II dose. This represents the first clinical trial examining the potential synergy between a tyrosine kinase inhibitor and a conventional alkylating agent for the treatment of CLL.

  16. Central Arctic atmospheric summer conditions during the Arctic Summer Cloud Ocean Study (ASCOS: contrasting to previous expeditions

    M. Tjernström


    Full Text Available Understanding the rapidly changing climate in the Arctic is limited by a lack of understanding of underlying strong feedback mechanisms that are specific to the Arctic. Progress in this field can only be obtained by process-level observations; this is the motivation for intensive ice-breaker-based campaigns such as that described in this paper: the Arctic Summer Cloud-Ocean Study (ASCOS. However, detailed field observations also have to be put in the context of the larger-scale meteorology, and short field campaigns have to be analysed within the context of the underlying climate state and temporal anomalies from this.

    To aid in the analysis of other parameters or processes observed during this campaign, this paper provides an overview of the synoptic-scale meteorology and its climatic anomaly during the ASCOS field deployment. It also provides a statistical analysis of key features during the campaign, such as some key meteorological variables, the vertical structure of the lower troposphere and clouds, and energy fluxes at the surface. In order to assess the representativity of the ASCOS results, we also compare these features to similar observations obtained during three earlier summer experiments in the Arctic Ocean, the AOE-96, SHEBA and AOE-2001 expeditions.

    We find that these expeditions share many key features of the summertime lower troposphere. Taking ASCOS and the previous expeditions together, a common picture emerges with a large amount of low-level cloud in a well-mixed shallow boundary layer, capped by a weak to moderately strong inversion where moisture, and sometimes also cloud top, penetrate into the lower parts of the inversion. Much of the boundary-layer mixing is due to cloud-top cooling and subsequent buoyant overturning of the cloud. The cloud layer may, or may not, be connected with surface processes depending on the depths of the cloud and surface-based boundary layers and on the relative strengths of

  17. Pilot Study of an Individualised Early Postpartum Intervention to Increase Physical Activity in Women with Previous Gestational Diabetes

    Harold David McIntyre


    Full Text Available Optimal strategies to prevent progression towards overt diabetes in women with recent gestational diabetes remain ill defined. We report a pilot study of a convenient, home based exercise program with telephone support, suited to the early post-partum period. Twenty eight women with recent gestational diabetes were enrolled at six weeks post-partum into a 12 week randomised controlled trial of Usual Care (n=13 versus Supported Care (individualised exercise program with regular telephone support; n=15. Baseline characteristics (Mean ± SD were: Age  33±4  years; Weight 80 ± 20 kg and Body Mass Index (BMI 30.0±9.7 kg/m2. The primary outcome, planned physical activity {Median (Range}, increased by 60 (0–540 mins/week in the SC group versus 0 (0–580 mins/week in the UC group (P=0.234. Walking was the predominant physical activity. Body weight, BMI, waist circumference, % body fat, fasting glucose and insulin did not change significantly over time in either group. This intervention designed to increase physical activity in post-partum women with previous gestational diabetes proved feasible. However, no measurable improvement in metabolic or biometric parameters was observed over a three month period.

  18. Estimating the effect of current, previous and never use of drugs in studies based on prescription registries

    Nielsen, Lars Hougaard; Løkkegaard, Ellen; Andreasen, Anne Helms;


    PURPOSE: Many studies which investigate the effect of drugs categorize the exposure variable into never, current, and previous use of the study drug. When prescription registries are used to make this categorization, the exposure variable possibly gets misclassified since the registries do not ca...... with Hazard Ratios ranging from 1.68 to 1.78 for current use compared to never use. CONCLUSIONS: The findings suggest that it is possible to estimate the effect of never, current and previous use of HT on breast cancer using prescription data.......PURPOSE: Many studies which investigate the effect of drugs categorize the exposure variable into never, current, and previous use of the study drug. When prescription registries are used to make this categorization, the exposure variable possibly gets misclassified since the registries do...... not carry any information on the time of discontinuation of treatment.In this study, we investigated the amount of misclassification of exposure (never, current, previous use) to hormone therapy (HT) when the exposure variable was based on prescription data. Furthermore, we evaluated the significance...

  19. Observational Study of Travelers' Diarrhea.



    Background: European air travelers returning from Algeria, Egypt, Mexico, Morocco, and Tunisia were interviewed about their experience of travelers' diseases upon arrival in Brussels. Diarrhea was mentioned by 37% of the adults and 27% of the children. These subjects were questioned about the types of measures taken, type and duration of drug treatment (if any), and about duration of diarrhea and side effects experienced. Methods: Final analysis was performed based on 2160 interviews. The largest proportion of diarrhea was reported in the age group 15-24 years (46%). Results: The majority of the 2160 subjects had opted for drug treatment (81%): 927 subjects for loperamide alone, 235 for loperamide in combination with nifuroxazide, and 178 for nifuroxazide alone. Other drugs had been used less frequently. The median time to recovery was 2.4 days with loperamide compared to 3.2 days with nifuroxazide and to 3.4 days for the no-treatment group. Conclusions: A stratification of the results by severity of the diarrhea suggests a rank of antidiarrheal potency as follows: loperamide > nifuroxazide > no-drug treatment. The side effect with the highest incidence was constipation (2.4% with loperamide). (J Travel Med 2:11-15, 1995) Travelers' diarrhea is usually defined as the passage of at least three unformed stools per day or any number of such stools when accompanied by fever, abdominal cramping, or vomiting. The definition may be broadened to include more trivial bowel disturbance.1,2 The duration of this self-limited disease generally is 3 to 5 days. Medical intervention aims at shortening the duration of disease, thus allowing the sufferer to resume his or her usual activities at an early stage. A shortened period of recovery to physical well-being has obvious favorable economic implications if the traveler is on business and may help the maintenance of a desired level of quality of life while a traveler is on holiday. An observational study of various medical

  20. Science Studies from Archived Observations

    Armstrong, T. P.; Manweiler, J. W.; Patterson, J. D.


    Goals for spaceflight investigations include the discovery and characterization of physical features of the in- situ and remote environment. Abundant successes of flight investigations are easily documented. Prudent scientific practice dictates that to the maximum extent possible, observations should be well-characterized, reliably catalogued, and knowledgeably interpreted. This is especially true of data sets used in the publication of results in the reviewed literature. Typical scientific standards include making primary data numbers available to other investigators for replicated study. While NASA's contracts with investigators have required that data be submitted to agency official archives, the details, completeness (especially of ancillary and metadata) and forms differ from investigation to investigation and project to project. After several generations of improvements and refinements, modern computing and communications technology makes it possible to link multiple data sets at multiple locations through a unified data model. Virtual Observatories provide the overall organizational structures and SPASE-compliant XML defines the data granules that can be located. Proofs of the feasibility and value of this latest approach remain to be seen, but its ultimate goal of improving archival research using flight-derived data sets appears to depend on user acceptance and efficient use of the VxO resources. Criteria based on the authors experience in science derived from archival sources follow: 1. Interfaces and tools must be easy to learn, easy to use, and reliable. 2. Data numbers must be promptly downloadable in plain text. 3. Data must be available in or readily converted to physical units using calibrations and algorithms easily traceable as part of the search. Knowledge about (or heritage of) specific data items present in the science literature must be associated with the search for that item. 4. Data items must be trustworthy, having quoted uncertainties and

  1. Persistence of cardiovascular risk factors in women with previous preeclampsia: a long-term follow-up study.

    Aykas, Fatma; Solak, Yalcin; Erden, Abdulsamet; Bulut, Kadir; Dogan, Selcuk; Sarli, Bahadr; Acmaz, Gokhan; Afsar, Baris; Siriopol, Dimitrie; Covic, Adrian; Sharma, Shailendra; Johnson, Richard J; Kanbay, Mehmet


    Preeclampsia is a cardiovascular (CV) disease risk factor, and lifestyle modifications are recommended. It was suggested that preeclampsia may increase the prevalence of various CV disease risk factors such as metabolic syndrome, hypertension, insulin resistance, microalbuminuria, and endothelial dysfunction, among others. Here, we investigate the role of serum uric acid in preeclampsia in the development of CV complications. This was an observational case-control study that compared women with history of preeclampsia (n = 25) with age-matched controls with uncomplicated pregnancies (n = 20) who were followed for at least 5 years. Measurements included clinical and ambulatory blood pressure monitoring, ultrasound-measured flow-mediated dilatation (FMD), microalbuminuria, carotid intima-media thickness (CIMT) and serum uric acid, as well as clinical and demographic features. Cardiovascular disease risk factors were compared in women with and without previous preeclampsia. At the time of index gestation, preeclamptic women had higher serum uric acid values (4.36 ± 0.61 vs 2.27 ± 0.38 mg/dL, P preeclampsia were more likely to have hypertension and had higher serum uric acid levels, higher microalbuminuria and CIMT levels, and lower FMD values than did the patients who did not have preeclampsia. The 2 groups were similar with regard to various ambulatory blood pressure parameters. Univariate associates of FMD were history of preeclampsia and the current hypertension status. Microalbuminuria correlated with gestational uric acid levels (coefficient of correlation of 0.40, P = 0.01 for FMD and coefficient of correlation of 0.37, P = 0.01 for CIMT, respectively). Preeclampsia might be a risk factor for the development of cardiovascular risk factors at least 5 years after index pregnancy. Serum uric acid and microalbuminuria may be mechanistic mediators of heightened risk, along with impaired endothelial function in preeclampsia.

  2. An fMRI study of neuronal activation in schizophrenia patients with and without previous cannabis use

    Else-Marie eLøberg


    Full Text Available Previous studies have mostly shown positive effects of cannabis use on cognition in patients with schizophrenia, which could reflect lower neurocognitive vulnerability. There are however no studies comparing whether such cognitive differences have neuronal correlates. Thus, the aim of the present study was to compare whether patients with previous cannabis use differ in brain activation from patients who has never used cannabis. The patients groups were compared on the ability to up-regulate an effort mode network during a cognitive task and down-regulate activation in the same network during a task-absent condition. Task-present and task-absent brain activation was measured by functional magnetic resonance neuroimaging (fMRI. Twenty-six patients with a DSM-IV and ICD-10 diagnosis of schizophrenia were grouped into a previous cannabis user group and a no-cannabis group. An auditory dichotic listening task with instructions of attention focus on either the right or left ear stimulus was used to tap verbal processing, attention and cognitive control, calculated as an aggregate score. When comparing the two groups, there were remaining activations in the task-present condition for the cannabis group, not seen in the no-cannabis group, while there was remaining activation in the task-absent condition for the no-cannabis group, not seen in the cannabis group. Thus, the patients with previous cannabis use showed increased activation in an effort mode network and decreased activation in the default mode network as compared to the no-cannabis group. It is concluded that the present study show some differences in brain activation to a cognitively challenging task between previous cannabis and no-cannabis schizophrenia patients.

  3. Low back pain in military recruits in relation to social background and previous low back pain. A cross-sectional and prospective observational survey

    Weidick Flemming


    Full Text Available Abstract Background Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low back pain in the development of low back pain in military recruits. Methods During a three-month period, Danish military recruits with different social backgrounds live and work under the same conditions. Thus, there is an opportunity to investigate the influence of social background on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires to 1,711 recruits before and after this three-month period. Results Sedentary occupation was negatively associated with long-lasting low back pain (>30 days during the past year at baseline with an odds ratios of 0.55 (95% CI: 0.33–0.90. This effect vanished during service. Having parents with higher education increased the risk of low back pain during service (OR: 1.9;1.2–3.0, for the highest educated group, but not of the consequences (leg pain and exemption from duty, whereas high IQ decreased the risk of these consequences (odds ratios as low as 0.2;0.1–0.8 for exemption from duty in the group with highest IQ. Long-lasting low back pain prior to service increased the risk of long-lasting low back pain (OR: 4.8;2.1–10.8, leg pain (OR: 3.3;1.3–8.3 and exemption from duty during service (OR: 5.9;2.4–14.8. Conclusion Sedentary occupation is negatively associated with low back pain at baseline. This protective effect disappears, when the person becomes physically active. For predicting trouble related to the low back during service, the

  4. Factors Associated with Unfavorable Treatment Outcomes in New and Previously Treated TB Patients in Uzbekistan: A Five Year Countrywide Study.

    Jamshid Gadoev

    Full Text Available TB is one of the main health priorities in Uzbekistan and relatively high rates of unfavorable treatment outcomes have recently been reported. This requires closer analysis to explain the reasons and recommend interventions to improve the situation. Thus, by using countrywide data this study sought to determine trends in unfavorable outcomes (lost-to-follow-ups, deaths and treatment failures and describe their associations with socio-demographic and clinical factors.A countrywide retrospective cohort study of all new and previously treated TB patients registered in the National Tuberculosis programme between January 2006 and December 2010.Among 107,380 registered patients, 67% were adults, with smaller proportions of children (10%, adolescents (4% and elderly patients (19%. Sixty per cent were male, 66% lived in rural areas, 1% were HIV-infected and 1% had a history of imprisonment. Pulmonary TB (PTB was present in 77%, of which 43% were smear-positive and 53% were smear-negative. Overall, 83% of patients were successfully treated, 6% died, 6% were lost-to-follow-up, 3% failed treatment and 2% transferred out. Factors associated with death included being above 55 years of age, HIV-positive, sputum smear positive, previously treated, jobless and living in certain provinces. Factors associated with lost-to-follow-up were being male, previously treated, jobless, living in an urban area, and living in certain provinces. Having smear-positive PTB, being an adolescent, being urban population, being HIV-negative, previously treated, jobless and residing in particular provinces were associated with treatment failure.Overall, 83% treatment success rate was achieved. However, our study findings highlight the need to improve TB services for certain vulnerable groups and in specific areas of the country. They also emphasize the need to develop unified monitoring and evaluation tools for drug-susceptible and drug-resistant TB, and call for better TB

  5. UFOs: Observations, Studies and Extrapolations

    Baer, T; Barnes, M J; Bartmann, W; Bracco, C; Carlier, E; Cerutti, F; Dehning, B; Ducimetière, L; Ferrari, A; Ferro-Luzzi, M; Garrel, N; Gerardin, A; Goddard, B; Holzer, E B; Jackson, S; Jimenez, J M; Kain, V; Zimmermann, F; Lechner, A; Mertens, V; Misiowiec, M; Nebot Del Busto, E; Morón Ballester, R; Norderhaug Drosdal, L; Nordt, A; Papotti, G; Redaelli, S; Uythoven, J; Velghe, B; Vlachoudis, V; Wenninger, J; Zamantzas, C; Zerlauth, M; Fuster Martinez, N


    UFOs (“ Unidentified Falling Objects”) could be one of the major performance limitations for nominal LHC operation. Therefore, in 2011, the diagnostics for UFO events were significantly improved, dedicated experiments and measurements in the LHC and in the laboratory were made and complemented by FLUKA simulations and theoretical studies. The state of knowledge is summarized and extrapolations for LHC operation in 2012 and beyond are presented. Mitigation strategies are proposed and related tests and measures for 2012 are specified.

  6. Bispectrum speckle interferometry observations and radiative transfer modelling of the red supergiant NML Cyg. Multiple dust-shell structures evidencing previous superwind phases

    Blöcker, T.; Balega, Y.; Hofmann, K.-H.; Weigelt, G.


    NML Cyg is a highly evolved OH/IR supergiant, one of the most prominent infrared objects due to its strong obscuration by dust, and supposed to be among the most luminous supergiants in the galaxy. We present the first diffraction-limited 2.13 mu m observations of NML Cyg with 73 mas resolution. The speckle interferograms were obtained with the 6 m telescope at the Special Astrophysical Observatory, and the image reconstruction is based on the bispectrum speckle-interferometry method. The visibility function declines towards the diffraction limit to ~ 0.6. Radiative transfer calculations have been carried out to model the spectral energy distribution, given by ground-based photometry and ISO spectroscopy, and our 2.13 mu m visibility function. Additionally, mid-infrared visibility functions at 11 mu m were considered. The observed dust shell properties do not appear to be in accordance with standard single-shell (uniform outflow) models but seem to require multiple components. Considering previous periods of enhanced mass-loss, various density enhancements in the dust shell were taken into account. An extensive grid of models was calculated for different locations and strenghts of such superwind regions in the dust shell. To match the observations from the optical to the sub-mm domain requires at least two superwind regions embedded in the shell. The best model includes a dust shell with a temperature of 1000 K at its inner radius of 6.2 R*, a close embedded superwind shell extending from 15.5 R* to 21.7 R* with an amplitude (factor of density enhancement) of 10, and a far-out density enhancement at 186 R* with an amplitude of 5. The angular diameters of the central star and of the inner rim of the dust shell amount to 16.2 mas and 105 mas, resp. The diameter of the embedded close superwind region extends from 263 mas to 368 mas, and the inner boundary of the distant superwind region has a diameter of 3\\farcs 15. In the near-infrared the dust condensation zone is

  7. Psychotic illness in first-time mothers with no previous psychiatric hospitalizations: a population-based study.

    Unnur Valdimarsdóttir


    Full Text Available BACKGROUND: Psychotic illness following childbirth is a relatively rare but severe condition with unexplained etiology. The aim of this study was to investigate the impact of maternal background characteristics and obstetric factors on the risk of postpartum psychosis, specifically among mothers with no previous psychiatric hospitalizations. METHODS AND FINDINGS: We investigated incidence rates and potential maternal and obstetric risk factors of psychoses after childbirth in a national cohort of women who were first-time mothers from 1983 through 2000 (n = 745,596. Proportional hazard regression models were used to estimate relative risks of psychoses during and after the first 90 d postpartum, among mothers without any previous psychiatric hospitalization and among all mothers. Within 90 d after delivery, 892 women (1.2 per 1,000 births; 4.84 per 1,000 person-years were hospitalized due to psychoses and 436 of these (0.6 per 1,000 births; 2.38 per 1,000 person-years had not previously been hospitalized for any psychiatric disorder. During follow-up after the 90 d postpartum period, the corresponding incidence rates per 1,000 person-years were reduced to 0.65 for all women and 0.49 for women not previously hospitalized. During (but not after the first 90 d postpartum the risk of psychoses among women without any previous psychiatric hospitalization was independently affected by: maternal age (35 y or older versus 19 y or younger; hazard ratio 2.4, 95% confidence interval [CI] 1.2 to 4.7; high birth weight (> or = 4,500 g; hazard ratio 0.3, 95% CI 0.1 to 1.0; and diabetes (hazard ratio 0. CONCLUSIONS: The incidence of psychotic illness peaks immediately following a first childbirth, and almost 50% of the cases are women without any previous psychiatric hospitalization. High maternal age increases the risk while diabetes and high birth weight are associated with reduced risk of first-onset psychoses, distinctly during the postpartum period.

  8. A multicenter phase II study of irinotecan in patients with advanced colorectal cancer previously treated with 5-fluorouracil.

    Méndez, Miguel; Salut, Antonieta; García-Girón, Carlos; Navalon, Marta; Diz, Pilar; García López, Maria José; España, Pilar; de la Torre, Ascensión; Martínez del Prado, Purificación; Duarte, Isabel; Pujol, Eduardo; Arizcun, Alberto; Cruz, Juan Jesús


    This multicenter, open-label, phase II study was performed to assess the efficacy and toxicity of irinotecan 350 mg/m2 intravenously every 3 weeks in patients with advanced colorectal cancer (CRC) previously treated with 5-fluorouracil (5-FU). The study enrolled 115 patients and a total of 558 cycles (median, 6 per patient) were administered. The overall objective response rate on an intent-to-treat basis was 18% (with 1 complete response and 20 partial responses), whereas 42 patients (37%) showed stable disease. Median time to progression was 4.8 months and median survival was 13.6 months. Grade 3/4 toxicities included delayed diarrhea (19.1%), nausea/vomiting (10.4%), and neutropenia (8.7%). There were 2 toxic deaths, 1 from delayed diarrhea and 1 from hemorrhage and grade 4 mucositis. In conclusion, the present study confirms the antitumor efficacy of irinotecan monotherapy in patients with CRC pretreated with 5-FU.

  9. Outcomes of induction of labour in women with previous caesarean delivery: a retrospective cohort study using a population database.

    Sarah J Stock

    Full Text Available BACKGROUND: There is evidence that induction of labour (IOL around term reduces perinatal mortality and caesarean delivery rates when compared to expectant management of pregnancy (allowing the pregnancy to continue to await spontaneous labour or definitive indication for delivery. However, it is not clear whether IOL in women with a previous caesarean section confers the same benefits. The aim of this study was to describe outcomes of IOL at 39-41 weeks in women with one previous caesarean delivery and to compare outcomes of IOL or planned caesarean delivery to those of expectant management. METHODS AND FINDINGS: We performed a population-based retrospective cohort study of singleton births greater than 39 weeks gestation, in women with one previous caesarean delivery, in Scotland, UK 1981-2007 (n = 46,176. Outcomes included mode of delivery, perinatal mortality, neonatal unit admission, postpartum hemorrhage and uterine rupture. 40.1% (2,969/7,401 of women who underwent IOL 39-41 weeks were ultimately delivered by caesarean. When compared to expectant management IOL was associated with lower odds of caesarean delivery (adjusted odds ratio [AOR] after IOL at 39 weeks of 0.81 [95% CI 0.71-0.91]. There was no significant effect on the odds of perinatal mortality but greater odds of neonatal unit admission (AOR after IOL at 39 weeks of 1.29 [95% CI 1.08-1.55]. In contrast, when compared with expectant management, elective repeat caesarean delivery was associated with lower perinatal mortality (AOR after planned caesarean at 39 weeks of 0.23 [95% CI 0.07-0.75] and, depending on gestation, the same or lower neonatal unit admission (AOR after planned caesarean at 39 weeks of 0.98 [0.90-1.07] at 40 weeks of 1.08 [0.94-1.23] and at 41 weeks of 0.77 [0.60-1.00]. CONCLUSIONS: A more liberal policy of IOL in women with previous caesarean delivery may reduce repeat caesarean delivery, but increases the risks of neonatal complications.

  10. Birth outcome in women with previously treated breast cancer--a population-based cohort study from Sweden.

    Kristina Dalberg


    Full Text Available BACKGROUND: Data on birth outcome and offspring health after the appearance of breast cancer are limited. The aim of this study was to assess the risk of adverse birth outcomes in women previously treated for invasive breast cancer compared with the general population of mothers. METHODS AND FINDINGS: Of all 2,870,932 singleton births registered in the Swedish Medical Birth Registry during 1973-2002, 331 first births following breast cancer surgery--with a mean time to pregnancy of 37 mo (range 7-163--were identified using linkage with the Swedish Cancer Registry. Logistic regression analysis was used. The estimates were adjusted for maternal age, parity, and year of delivery. Odds ratios (ORs and 95% confidence intervals (CIs were used to estimate infant health and mortality, delivery complications, the risk of preterm birth, and the rates of instrumental delivery and cesarean section. The large majority of births from women previously treated for breast cancer had no adverse events. However, births by women exposed to breast cancer were associated with an increased risk of delivery complications (OR 1.5, 95% CI 1.2-1.9, cesarean section (OR 1.3, 95% CI 1.0-1.7, very preterm birth (<32 wk (OR 3.2, 95% CI 1.7-6.0, and low birth weight (<1500 g (OR 2.9, 95% CI 1.4-5.8. A tendency towards an increased risk of malformations among the infants was seen especially in the later time period (1988-2002 (OR 2.1, 95% CI 1.2-3.7. CONCLUSIONS: It is reassuring that births overall were without adverse events, but our findings indicate that pregnancies in previously treated breast cancer patients should possibly be regarded as higher risk pregnancies, with consequences for their surveillance and management.

  11. Predicting DUI recidivism of male drunken driving: a prospective study of the impact of alcohol markers and previous drunken driving.

    Portman, M; Penttilä, A; Haukka, J; Eriksson, P; Alho, H; Kuoppasalmi, K


    The aim of the present study was to determine whether the alcohol biomarkers CDT, GGT, the biomarker gamma-CDT index and previous drunken driving contributed significantly to the prediction of DUI recidivism. The subjects consisted of two different samples of drivers, viz. drivers who were found to have a positive breath alcohol concentration during random breath testing surveys (n=237), and drunken drivers who were apprehended during ordinary police work (n=193). The drunken driving events were monitored using a data-base both retrospectively and prospectively. It was found that the biomarker index, gamma-CDT, emerged as a notable predictor of recidivism in the group of random breath tested drivers. Measurement of gamma-CDT and its impact on DUI recidivism has not to our knowledge been applied to random breath tested drivers before. The apprehended drunken drivers, on the other hand, did not show a significant relationship between gamma-CDT and DUI recidivism. However, in both groups of drivers it was found that a previous conviction for drunken driving strongly predicted DUI recidivism. More attention should be paid by both physicians and the police to the high risk of recidivism among those convicted of drunken driving.

  12. The suitability of XRF analysis for compositional classification of archaeological ceramic fabric: A comparison with a previous NAA study

    Padilla, R. [Centro de Aplicaciones Tecnologicas y Desarrollo Nuclear (CEADEN), Laboratorio de Analisis Quimico, Calle 30 no. 502, Playa, Ciudad Habana (Cuba)]. E-mail:; Espen, P. van [University of Antwerp (Belgium); Torres, P.P. Godo [Centro de Antropologia, Havana (Cuba)


    The main drawbacks of EDXRF techniques, restricting its more frequent use for the specific purpose of compositional analysis of archaeological ceramic fabric, have been the insufficient sensitivity to determine some important elements (like Cr, REE, among others), a somewhat worse precision and the inability to perform standard-less quantitative procedures in the absence of suitable certified reference materials (CRM) for ceramic fabric. This paper presents the advantages of combining two energy dispersive X-ray fluorescence methods for fast and non-destructive analysis of ceramic fabric with increased sensitivity. Selective polarized excitation using secondary targets (EDPXRF) and radioisotope excitation (R-XRF) using a {sup 241}Am source. The analytical performance of the methods was evaluated by analyzing several CRM of sediment type, and the fitness for the purpose of compositional classification was compared with that obtained by using Instrumental Neutron Activation Analysis in a previous study of Cuban aborigine pottery.

  13. Evaluation of questionnaire-based information on previous physical work loads. Stockholm MUSIC 1 Study Group. Musculoskeletal Intervention Center.

    Torgén, M; Winkel, J; Alfredsson, L; Kilbom, A


    The principal aim of the present study was to evaluate questionnaire-based information on past physical work loads (6-year recall). Effects of memory difficulties on reproducibility were evaluated for 82 subjects by comparing previously reported results on current work loads (test-retest procedure) with the same items recalled 6 years later. Validity was assessed by comparing self-reports in 1995, regarding work loads in 1989, with worksite measurements performed in 1989. Six-year reproducibility, calculated as weighted kappa coefficients (k(w)), varied between 0.36 and 0.86, with the highest values for proportion of the workday spent sitting and for perceived general exertion and the lowest values for trunk and neck flexion. The six-year reproducibility results were similar to previously reported test-retest results for these items; this finding indicates that memory difficulties was a minor problem. The validity of the questionnaire responses, expressed as rank correlations (r(s)) between the questionnaire responses and workplace measurements, varied between -0.16 and 0.78. The highest values were obtained for the items sitting and repetitive work, and the lowest and "unacceptable" values were for head rotation and neck flexion. Misclassification of exposure did not appear to be differential with regard to musculoskeletal symptom status, as judged by the calculated risk estimates. The validity of some of these self-administered questionnaire items appears sufficient for a crude assessment of physical work loads in the past in epidemiologic studies of the general population with predominantly low levels of exposure.

  14. Confounding in publications of observational intervention studies

    Groenwold, Rolf H. H.; Hoes, Arno W.; Hak, Eelko


    We conducted a systematic literature search in Medline to assess the proportion of observational intervention studies appreciating confounding bias in peer-reviewed medical literature from 1985 through 2005. This study shows only 9% of all papers on observational intervention studies published in pe

  15. Patterns and Determinants of Treatment Seeking among Previously Untreated Psychotic Patients in Aceh Province, Indonesia: A Qualitative Study

    Marthoenis Marthoenis


    Full Text Available Immediate treatment of first-episode psychosis is essential in order to achieve a positive outcome. However, Indonesian psychiatric patients often delay accessing health services, the reason for which is not yet fully understood. The current study aimed to understand patterns of treatment seeking and to reveal determinants of the delay in accessing psychiatric care among first-time user psychotic patients. Qualitative interviews were conducted with sixteen family members who accompanied the patients to a psychiatric hospital. Many families expressed beliefs that mental illness appertains to village sickness and not hospital sickness; therefore, they usually take the patients to traditional or religious healers before taking them to a health professional. They also identified various factors that potentially delay accessing psychiatric treatment: low literacy and beliefs about the cause of the illness, stigmatisation, the role of extended family, financial problems, and long distance to the psychiatric hospital. On the other hand, the family mentioned various factors related to timely help seeking, including being a well-educated family, living closer to health facilities, previous experience of successful psychotic therapy, and having more positive symptoms of psychosis. The findings call for mental health awareness campaigns in the community.

  16. Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia.

    Knauf, Wolfgang U; Lissichkov, Toshko; Aldaoud, Ali; Liberati, Anna; Loscertales, Javier; Herbrecht, Raoul; Juliusson, Gunnar; Postner, Gerhard; Gercheva, Liana; Goranov, Stefan; Becker, Martin; Fricke, Hans-Joerg; Huguet, Francoise; Del Giudice, Ilaria; Klein, Peter; Tremmel, Lothar; Merkle, Karlheinz; Montillo, Marco


    This randomized, open-label, parallel-group, multicenter study was designed to compare the efficacy and safety of bendamustine and chlorambucil in previously untreated patients with advanced (Binet stage B or C) chronic lymphocytic leukemia (CLL). Patients (chlorambucil 0.8 mg/kg (Broca's normal weight) orally on days 1 and 15; treatment cycles were repeated every 4 weeks for a maximum of six cycles. The response to treatment was assessed according to National Cancer Institute Working Group criteria, and the final determination of response was made by a blinded independent review committee. A total of 319 patients were randomly assigned (162 bendamustine, 157 chlorambucil). Complete or partial responses were achieved in 110 (68%) of 162 bendamustine-treated and 48 (31%) of 157 chlorambucil-treated patients (P chlorambucil (31% v 2%). Median progression-free survival was 21.6 months with bendamustine and 8.3 months with chlorambucil (P chlorambucil (median, 21.8 v 8.0 months). Hematologic National Cancer Institute Common Toxicity Criteria grade 3 to 4 adverse events were more common with bendamustine than with chlorambucil (occurring in 40% v 19% of patients). Severe infections (grade 3 to 4) occurred in 8% of bendamustine-treated patients and 3% of chlorambucil-treated patients. Bendamustine offers significantly greater efficacy than chlorambucil, and a manageable toxicity profile, when used as first-line therapy in patients with advanced CLL.

  17. Integrating Sonography Training Into Undergraduate Medical Education: A Study of the Previous Exposure of One Institution's Incoming Residents.

    Day, James; Davis, Joshua; Riesenberg, Lee Ann; Heil, Daniel; Berg, Katherine; Davis, Robyn; Berg, Dale


    Sonography is a crucial and versatile tool within the field of medicine. Recent advancements in technology have led to increased use of point-of-care sonography. We designed a survey to assess prior point-of-care sonography training among incoming interns at an academic teaching hospital. In 2012 and 2013, we surveyed incoming interns (n = 154 and 145, respectively) regarding point-of-care sonography training received during medical school. The survey questions included formal didactic sessions, bedside instruction, and the use of simulation technology. One-fourth (26.3% in 2012 and 23.4% in 2013) of responding interns reported having never done an ultrasound scan at the bedside. In 2012 and 2013, 55.0% and 55.6% of respondents reported never having done an ultrasound scan in a simulation center, respectively. Interns agreed that sonography education should be provided during medical school. On average, interns disagreed with the statement that sonography should be taught in residency only. There was no significant difference in the sex or general previous experience with sonography across both intern classes. Point-of-care sonography is inconsistently taught in medical school. The interns in our study also thought that sonography education should begin in medical school, and sonography should be taught by using simulation and at the bedside. © 2015 by the American Institute of Ultrasound in Medicine.

  18. Risk factors and therapeutic coverage at 6 years in patients with previous myocardial infarction: the CASTUO study

    Félix-Redondo, Francisco Javier; Lozano Mera, Luis; Consuegra-Sánchez, Luciano; Giménez Sáez, Fernando; Garcipérez de Vargas, Francisco Javier; Castellano Vázquez, José María; Fernández-Bergés, Daniel


    Objectives To determine the degree of risk factor control, the clinical symptoms and the therapeutic management of patients with a history of previous myocardial infarction. Methods Cross-sectional study at 6 years of a first episode of acute myocardial infarction between 2000 and 2009, admitted at a hospital in the region of Extremadura (Spain). Of 2177 patients with this diagnosis, 1365 remained alive and therefore were included in the study. Results We conducted a person-to-person survey in 666 (48.8%) individuals and telephone survey in 437 (31.9%) individuals. The former are analysed. 130 were female (19.5%). The mean age was 67.4 years and the median time since the event was 5.8 (IQR 3.6–8.2) years. Active smokers made up 13.8%, low-density lipoprotein (LDL) cholesterol was ≥70 mg/dL: 82%, blood pressure ≥140/90 mm Hg (≥140/85 in diabetics): 49.8%, fasting glucose ≥126 mg/dL: 26%, heart rate 50–59 bpm: 60.7%, and obesity: 45.9%. Patients reported presenting angina comprised 22.4% and those with dyspnoea, 29.3%. Drug coverage was: 88.0% antiplatelet drugs, 86.5% statins, 75.6% β-blockers and 65.8% blockers of the renin-angiotensin system. Patients receiving all four types of drugs made up 41.9%, with only 3.0% having jointly controlled cholesterol, blood pressure, heart rate and glycaemia. Conclusions LDL cholesterol, heart rate and blood pressure were risk factors with less control. More than 1/5 of patients had angina and more than 1/4, dyspnoea. Risk factor control and the clinical condition were far from optimal, as was drug coverage, although to a lesser degree. PMID:27127637

  19. Sitagliptin added to previously taken antidiabetic agents on insulin resistance and lipid profile: a 2-year study evaluation.

    Derosa, Giuseppe; Ragonesi, Pietro Dario; Fogari, Elena; Cicero, Arrigo Francesco Giuseppe; Bianchi, Lucio; Bonaventura, Aldo; Romano, Davide; Maffioli, Pamela


    The aim of this study was to evaluate whether the positive effects of sitagliptin on glycemic control and insulin resistance were maintained also after 2 years of therapy and whether sitagliptin could be effective also in improving lipid profile. In this randomized, double-blind, placebo-controlled trial, 205 patients with type 2 diabetes in therapy with different antidiabetic drugs were randomized to add sitagliptin 100 mg once a day or placebo to their current therapy. We evaluated at the baseline and after 6, 12, 18, and 24 months the following parameters: body mass index, glycated hemoglobin (HbA1c ), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), fasting plasma insulin (FPI), homeostasis model assessment insulin resistance index (HOMA-IR), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (Tg). Sitagliptin, added to previously taken antidiabetic agents, proved to be effective in improving glycemic profile, reducing HbA1c by -17.5%, FPG by -12.7%, PPG by -20.5%. Regarding insulin resistance, sitagliptin decreased FPI by -8.3% and HOMA-IR by -20.0%, confirming that what have been already reported in short-term studies can be applied also after 2 years of treatment. Sitagliptin also reduced body weight by -4.3%. Our study also showed the positive effect of sitagliptin on lipid profile; in particular, sitagliptin decreased TC by -13.3%, LDL-C by -20.4%, and Tg by -32.3%, and also increased HDL-C by + 13.6%. Sitagliptin proved to be effective on glycemic profile and insulin resistance even after 2 years of therapy and to be effective in improving body weight and lipid profile. © 2012 The Authors Fundamental and Clinical Pharmacology © 2012 Société Française de Pharmacologie et de Thérapeutique.

  20. The impact of smoking and previous periodontal disease on peri-implant microbiota and health: a retrospective study up to 7-year follow-up.

    Quaranta, Alessandro; Assenza, Bartolomeo; D'Isidoro, Orlando; Profili, Fabia; Polimeni, Antonella; Vozza, Iole


    To evaluate the impact of smoking and previous periodontal disease on peri-implant microbiota and health in medium to long-term maintained patients. A retrospective evaluation of partial edentulous patients restored with dental implants and enrolled in a regular supportive therapy was performed. Inclusion criteria were: medium to long-term periodontal and implant maintenance (at least 5 years), a minimum of 2 implants placed in each patient, absence of systemic diseases that may affect osseointegration. 30 implants in 15 patients were included in the study. Subjects were divided in smokers or non-smokers and between patients previously affected by periodontal disease and periodontally healthy. Peri-implant and periodontal parameters were assessed (PD,BoP, mPI). Microbiological samples were collected around implant and an adjacent tooth. Real- Time Polymerase Chain Reaction (RT-PCR) analysis was performed. In all the three groups no differences in bacterial counts between dental and implant sites were observed. Non smoker, healthy patients: healthy clinical parameters, significant counts of spirochetes in isolated patients. Non smokers with previous periodontal disease: occasional positive BoP values, significant high counts of pathogenic bacteria. Smokers with previous periodontal disease: clinical signs of inflammation including deep pockets and slight bone resorption, significant counts of pathogenic bacteria. Over a follow-up of 5 to 7 years, it is possible to state that the absence of smoking habit and previous periodontal disease positively influences the peri-implant microbiological and clinical conditions in partial edentulous patients restored with dental implants and enrolled in a strict regular supportive therapy.

  1. Missing osteoconductive effect of a resorbable PEO/PBT copolymer in human bone defects: a clinically relevant pilot study with contrary results to previous animal studies.

    Roessler, M; Wilke, A; Griss, P; Kienapfel, H


    PEO/PBT 70/30 (POLYACTIVE(R) 70/30), a degradable porous copolymer with elastic properties, was found to be osteoconductive in many animal studies. The aim of this study was to determine the osteoconductive effect in a human paired control iliac defect model. In seven patients undergoing anterior spinal interbody fusion surgery, two bicortical iliac defects for autograft harvesting were created. The defect size was identical for both defects measuring about 40 x 15 mm (group I). One defect was filled with the degradable implants, whereas the remaining one was left untreated as a control. The defect site for treatment was chosen randomly. In three further patients, only one defect measuring about 40 x 35 mm was created (group II). All patients were examined clinically and radiologically by spiral-CT after 1, 6, 12, 24, and 52 weeks. Three-dimensional reconstructions as well as CT-volumetric measurements using 1 mm sections were used as evaluation methods. In group I, a two-tailed paired t-test showed that the treated defects had significantly less formation of new bone than the untreated ones (p < 0.05 after 12 weeks, p < 0.01 after 52 weeks). Also, in group II, not much bone ingrowth could be observed. The histological evaluation of one patient in group I revealed no bone within the pores, and a fibrous layer between bone and implant was always present. Therefore, PEO/PBT 70/30 cannot be recommended as a bone substitute for clinical use. Differences in bone regeneration between humans and certain animal species as well as inapplicable defect models in previous animal studies are discussed as possible reasons for the failure.

  2. STRengthening analytical thinking for observational studies

    Altman, Douglas G.; le Cessie, Saskia; Abrahamowicz, Michal


    The validity and practical utility of observational medical research depends critically on good study design, excellent data quality, appropriate statistical methods and accurate interpretation of results. Statistical methodology has seen substantial development in recent times. Unfortunately, ma...

  3. Observing Protein & Energy Nutrition (OPEN) Study

    The Observing Protein and Energy Nutrition (OPEN) Study was designed to assess dietary measurement error by comparing results from self-reported dietary intake data with four dietary biomarkers: doubly labeled water and urinary nitrogen, sodium, and potassium.

  4. Community Engagement in Observational Human Exposure Studies

    Although observational human exposure studies do not deliberately expose participants to chemicals or environmental conditions, merely involving people as research participants and conducting research inside homes raises ethical issues. Community engagement offers a promising st...

  5. Discussion on further studies to measure and evaluate fitness and motor performance for preschool children; summary and previous studies in Japan and future consideratin

    Murase, Tomohiko; Demura, Shinichi


    This article discusses and summarizes previous studies dealing with fitness and motor performance in preschool children from the viewpoint of measurement and evaluation, and determines topics for further studies. The studies reviewed in this article were mainly published in the “Japan Journal of Physical Education, Health and Sport Sciences” (edited by the Japan Society of Physical Education, Health and Sport Sciences), and the “Japanese Journal of Physical Fitness and Sports Medicine” (edite...

  6. Randomized, multicenter, phase 2 study (EVOLUTION) of combinations of bortezomib, dexamethasone, cyclophosphamide, and lenalidomide in previously untreated multiple myeloma.

    Kumar, Shaji; Flinn, Ian; Richardson, Paul G; Hari, Parameswaran; Callander, Natalie; Noga, Stephen J; Stewart, A Keith; Turturro, Francesco; Rifkin, Robert; Wolf, Jeffrey; Estevam, Jose; Mulligan, George; Shi, Hongliang; Webb, Iain J; Rajkumar, S Vincent


    Combinations of bortezomib (V) and dexamethasone (D) with either lenalidomide (R) or cyclophosphamide (C) have shown significant efficacy. This randomized phase 2 trial evaluated VDC, VDR, and VDCR in previously untreated multiple myeloma (MM). Patients received V 1.3 mg/m2 (days 1, 4, 8, 11) and D 40 mg (days 1, 8, 15), with either C 500 mg/m2 (days 1, 8) and R 15 mg (days 1-14; VDCR), R 25 mg (days 1-14; VDR), C 500 mg/m2 (days 1, 8; VDC) or C 500 mg/m2 (days 1, 8, 15; VDC-mod) in 3-week cycles (maximum 8 cycles), followed by maintenance with V 1.3 mg/m2 (days 1, 8, 15, 22) for four 6-week cycles (all arms)≥very good partial response was seen in 58%, 51%, 41%, and 53% (complete response rate of 25%, 24%, 22%, and 47%) of patients (VDCR, VDR, VCD, and VCD-mod, respectively); the corresponding 1-year progression-free survival was 86%, 83%, 93%, and 100%, respectively. Common adverse events included hematologic toxicities, peripheral neuropathy, fatigue, and gastrointestinal disturbances. All regimens were highly active and well tolerated in previously untreated MM, and, based on this trial, VDR and VCD-mod are preferred for clinical practice and further comparative testing. No substantial advantage was noted with VDCR over the 3-drug combinations. This trial is registered at (NCT00507442).

  7. [The Strengthening the Reporting of Observational Studies in Epidemiology [STROBE] statement: guidelines for reporting observational studies

    Elm, E. von; Altman, D.G.; Egger, M.


    Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed rec...

  8. [Critical reading of analytical observational studies].

    García Villar, C; Marín León, I


    Analytical observational studies provide very important information about real-life clinical practice and the natural history of diseases and can suggest causality. Furthermore, they are very common in scientific journals. The aim of this article is to review the main concepts necessary for the critical reading of articles about radiological studies with observational designs. It reviews the characteristics that case-control and cohort studies must have to ensure high quality. It explains a method of critical reading that involves checking the attributes that should be evaluated in each type of article using a structured list of specific questions. It underlines the main characteristics that confer credibility and confidence on the article evaluated. Readers are provided with tools for the critical analysis of the observational studies published in scientific journals. Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  9. Statistical challenges in observational cohort studies

    Hof, M.H.P.


    For over a century observational cohort studies have been used to study determinants of health and disease. Within a sample from the population, we can determine the relation between health outcomes (e.g. death) and a broad range of factors as genetic markers, environmental exposures, and lifestyle

  10. Statistical challenges in observational cohort studies

    Hof, M.H.P.


    For over a century observational cohort studies have been used to study determinants of health and disease. Within a sample from the population, we can determine the relation between health outcomes (e.g. death) and a broad range of factors as genetic markers, environmental exposures, and lifestyle

  11. Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter-based studies.

    Sweis, R; Fox, M; Anggiansah, R; Anggiansah, A; Basavaraju, K; Canavan, R; Wong, T


    Standard pH monitoring is performed over 24 h with a naso-oesophageal catheter (C-pH). Limitations include naso-pharyngeal discomfort, nausea and social embarrassment resulting in reduced reflux-provoking activities. Recently a catheter-free pH-monitoring technique has become available. The tolerability and diagnostic yield of this system in patients who failed standard monitoring remain unknown. To examine the tolerability and diagnostic outcome of catheter-free pH-monitoring technique in patients who failed standard monitoring. Patients referred for C-pH and catheter-free pH monitoring completed a tolerability questionnaire. Acid exposure in the distal oesophagus and symptom index (SI) were reviewed. Over 4 years, 883/1751 (50%) of patients with typical reflux symptoms referred for C-pH were diagnosed with gastro-oesophageal reflux disease (GERD) based on a pathological percentage time acid exposure (%time pH patients failed C-pH and, of these, 129 successfully completed 2-day catheter-free pH monitoring. Ninety-eight (76%) of these patients had a pathological percentage pH patients (P patients who had previously failed C-pH; catheter-free pH monitoring assists the definitive diagnosis of GERD in this group.

  12. Biomechanical jumping differences among elite female handball players with and without previous anterior cruciate ligament reconstruction: a novel inertial sensor unit study.

    Setuain, Igor; Millor, Nora; González-Izal, Miriam; Gorostiaga, Esteban M; Gómez, Marisol; Alfaro-Adrián, Jesús; Maffiuletti, Nicola A; Izquierdo, Mikel


    Persistent biomechanical and jumping capacity alterations have been observed among female athletes who have sustained anterior cruciate ligament (ACL) injuries. The purpose of this study was to examine if biomechanical jumping differences persist among a cohort of elite female handball players with previous ACL reconstruction several years after return to top-level competition. In order to achieve this goal, a direct mechanics simplified analysis by using a single Inertial Sensor Unit (IU) was used. Twenty-one elite female (6 anterior cruciate ligament reconstructed and 15 uninjured control players) handball players were recruited and evaluated 6.0 ± 3.5 years after surgical anterior cruciate ligament reconstruction. Bilateral and unilateral vertical jumps were performed to evaluate the functional performance and a single inertial sensor unit was employed in order to collect 3D acceleration and 3D orientation data. Previously ACL-reconstructed analysed athletes demonstrated significant (p reconstruction. Identification of the encountered deficits through the use of an IU devise could provide clinicians with a new reliable tool for movement analysis in a clinical setting.

  13. A Study of the Relationship between Previous Exposure to Education and Practice-Teaching Performance at the University of Ife.

    Olatunji, S. A.


    A study to identify relationships between the amount of exposure students have to education (as a discipline) and their student teaching performances is reported. Students attending the University of Ife from 1973-1976 were studied. A positive relationship was discovered, but other factors need to be researched further. (MLW)

  14. Lifting techniques for finger marks on human skin previous enhancement by Swedish Black powder--a preliminary study.

    Trapecar, Matej


    An examination was done to investigate whether certain lifting techniques can lift recovered latent fingerprints on human skin surfaces of living subjects. For recovery Swedish Soot powder mixture (Swedish Black) was used. Donors intentionally placed fingerprints on the skin surface of living subjects. Finger marks were then in all cases recovered with Swedish Black powder. The procedure was repeated after 1 h and 4 h. Treated finger marks were secured and preserved as latent fingerprint evidence by different lifting processes. Having examined skin surfaces and finger marks we observed that the lifters such as white instant lifter, white fingerprint gelatin, black fingerprint gelatin, silicone, transparent adhesive tape, are suitable. Moreover, white fingerprint gelatin and white instant lifter proved to be very good at lifting treated finger marks. Black fingerprint gelatin was very good also, but finger marks were examined by slant light.

  15. Immunogenicity and safety of tetravalent dengue vaccine in 2-11 year-olds previously vaccinated against yellow fever: randomized, controlled, phase II study in Piura, Peru.

    Lanata, Claudio F; Andrade, Teresa; Gil, Ana I; Terrones, Cynthia; Valladolid, Omar; Zambrano, Betzana; Saville, Melanie; Crevat, Denis


    In a randomized, placebo-controlled, monocenter, observer blinded study conducted in an area where dengue is endemic, we assessed the safety and immunogenicity of a recombinant, live, attenuated, tetravalent dengue vaccine candidate (CYD-TDV) in 2-11 year-olds with varying levels of pre-existing yellow-fever immunity due to vaccination 1-7 years previously. 199 children received 3 injections of CYD-TDV (months 0, 6 and 12) and 99 received placebo (months 0 and 6) or pneumococcal polysaccharide vaccine (month 12). One month after the third dengue vaccination, serotype specific neutralizing antibody GMTs were in the range of 178-190 (1/dil) (versus 16.7-38.1 in the control group), a 10-20 fold-increase from baseline, and 94% of vaccines were seropositive to all four serotypes (versus 39% in the control group). There were no vaccine-related SAEs. The observed reactogenicity profile was consistent with phase I studies, with severity grade 1-2 injection site pain, headache, malaise and fever most frequently reported and no increase after subsequent vaccinations. Virologically confirmed dengue cases were seen after completion of the 3 doses: 1 in the CYD-TDV group (N=199), and 3 in the control group (N=99). A 3-dose regimen of CYD-TDV had a good safety profile in 2-11 year olds with a history of YF vaccination and elicited robust antibody responses that were balanced against the four serotypes.

  16. Marine fouling community in the Eastern harbour of Alexandria, Egypt compared with four decades of previous studies



    Full Text Available The aim of the present study is to compare the fouling communities between the years 1960 and 1999 in the Eastern harbour of Alexandria, Egypt and to study the main factors that may be controlling these communities. This comparison is based on monthly durations of panel immersion. By using roughened white polystyrene test panels (12.5x12.5 cm, monthly samples of marine fouling were collected from the harbour from October 1998 through September 1999. It is clear that a remarkable variation in number and diversity of fouling communities throughout the last four decades is evident. The minimum diversities were recorded during the studies of 1960 and 1970 (19 and 20 species respectively, while the maximum diversity (35 species was achieved during the 1991 study. Moreover, a small shift among the four dominant groups (Polychaeta, Cirripedia, Bryozoa and Amphipoda was noted during the four decades of the studies. The present comparison indicated that many factors may contribute to this variation, of which nutrient enrichment is the most important and the nature of the applied test panel is lees so.

  17. A cross-sectional study of personality traits in women previously treated or untreated for alcohol use disorders

    Sundh Valter


    Full Text Available Abstract Background A better understanding of the relationship between treatment-seeking for alcohol problems and personality traits could give useful insight in factors promoting or hindering treatment for alcohol use disorders (AUD. The aim of this study was to analyze the associations between treatment-seeking for AUD, personality traits, and psychiatric co-morbidity in women. The study was based on pooled cross-sectional data from three population based samples and one clinical sample (n = 1,339. Comparisons were made between treated and untreated women with AUD, and between those with resolved and unresolved AUD. Results A stepwise logistic regression model showed that treatment-seeking for AUD was not associated with personality traits. Among women with lifetime AUD (n = 217, those who had been treated (n = 42 had significantly higher scores than untreated women (n = 175 on three personality traits of the Karolinska Scales of Personality (KSP; somatic anxiety, muscular tension, and guilt. Women with resolved AUD, who had received treatment (n = 23 had significantly higher scores on scales measuring somatic anxiety, psychic anxiety, muscular tension, irritability, and guilt than untreated women with resolved AUD. The latter group resembled women without AUD on most personality traits. There were no differences in occurrence of lifetime psychiatric disorders between the treated and the untreated women, whereas treated women with current AUD had increased risk of lifetime anxiety (OR: 3.1, 95% CI: 1.1–8.7. Conclusion Treatment-seeking was not associated with personality traits in this study. Still, it can be concluded that women with resolved AUD who had received treatment had high scores on the KSP-scales measuring psychic and somatic anxiety, tension, irritability, and feelings of guilt. This suggests that personality assessment might be a useful tool in tailoring individual treatment programs for women with AUD. Future studies need to

  18. Chemical Processes with Supercritical CO2 in Engineered Geologic Systems: Significance, Previous Study, and Path Forward (Invited)

    Xu, T.; Pruess, K.


    Chemical reactions with dissolved CO2 in the aqueous phase have long been considered in fundamental geosciences and practical applications. Recently, studies on geologic carbon sequestration and enhanced geothermal systems using CO2 as heat transmission fluid have brought new interests in chemical reaction processes directly with supercritical CO2 (scCO2, or gas phase). In the vicinity of a CO2 injection well, the aqueous fluid initially present in a geological formation would be quickly removed by dissolution (evaporation) into the flowing gas stream and by immiscible displacement by the scCO2, creating a gas phase dominant zone. In this zone, the water evaporation could cause formation dry-out and precipitation of salt near the injection well, reducing formation porosity, permeability, and injectivity. The scCO2 may directly attack well construction materials such as cement. Over time, the gas phase will tend to migrate upwards towards the caprock because the density of the scCO2 is lower than that of the aqueous phase. In the upper portions of the reservoir, the scCO2 will directly react with caprock minerals and alter the hydrological properties and mechanical strength. On the other hand, the scCO2 phase will maintain the dissolution into the aqueous phase, lowering pH, inducing mineral dissolution, complexing with dissolved cations, increasing CO2 solubility, increasing the density of the aqueous phase, and promoting “convective mixing”. Chemical processes are quite different in the scCO2 dominant geologic systems. The absence of an aqueous phase poses unique questions, as little is presently known about the chemistry of non-aqueous systems. Additional issues arise from the reactivity of water that is dissolved in the ScCO2 phase. In this presentation, the author will discuss the importance, state of the studies performed, and future research directions.

  19. Ozone Lidar Observations for Air Quality Studies

    Wang, Lihua; Newchurch, Mike; Kuang, Shi; Burris, John F.; Huang, Guanyu; Pour-Biazar, Arastoo; Koshak, William; Follette-Cook, Melanie B.; Pickering, Kenneth E.; McGee, Thomas J.; Sullivan, John T.; Langford, Andrew O.; Senff, Christoph J.; Alvarez, Raul; Eloranta, Edwin


    Tropospheric ozone lidars are well suited to measuring the high spatio-temporal variability of this important trace gas. Furthermore, lidar measurements in conjunction with balloon soundings, aircraft, and satellite observations provide substantial information about a variety of atmospheric chemical and physical processes. Examples of processes elucidated by ozone-lidar measurements are presented, and modeling studies using WRF-Chem, RAQMS, and DALES/LES models illustrate our current understanding and shortcomings of these processes.

  20. Warfarin dosing after bariatric surgery: a retrospective study of 10 patients previously stable on chronic warfarin therapy.

    Schullo-Feulner, A M; Stoecker, Z; Brown, G A; Schneider, J; Jones, T A; Burnett, B


    Many changes associated with bariatric surgery have the potential to affect warfarin dosing; yet current literature includes little data describing this phenomenon. Investigating this relationship may allow for determination of post-bariatric surgery warfarin dosing using stable pre-operative dosing levels. A retrospective chart review was completed for 10 patients stabilized on chronic warfarin therapy who underwent bariatric surgery. Data collection consisted of the following: warfarin requirement in mg/week, time in target range (TTR), creatinine, liver function, diarrhoea, medication changes, diet, and signs of bleeding and/or thrombosis. Three study patients underwent laparoscopic adjustable gastric banding procedures and seven patients underwent Roux-en-Y gastric bypass. The average (standard deviation) weekly warfarin dose required in the immediate post-operative interval was 64% (25%) of baseline dosing, corresponding to a TTR of 48%. At 6 months, patients required 85% (19%) of baseline weekly dosing, with TTR of 53.4%. At 1 year, dosing was 90% (16%) of baseline with TTR of 63.5%. Patients underwent medication changes as well as transient bouts of diarrhoea. Two patients suffered unspecified haemorrhages of the gastrointestinal tract (international normalized ratio [INR] = 2.3 and 9.8). This patient set demonstrated an initial drop in warfarin requirement, followed by escalating dosing trends that became more predictable as patients were farther out from procedure.


    Kevin M. Kostelnik; James H. Clarke; Jerry L. Harbour


    Environmental remediation efforts that are underway at hundreds of contaminated sites in the United States will not be able to remediate large portions of those sites to conditions that would permit unrestricted access. Rather, large volumes of waste materials, contaminated soils and cleanup residuals will have to be isolated either in place or in new, often on-site, disposal cells with long term monitoring, maintenance and institutional control needs. The challenge continues to be to provide engineering systems and controls that can ensure the protection of public health and the environment over very long time horizons (hundreds to perhaps thousands of years) with minimal intervention. Effective long term management of legacy hazardous and nuclear waste requires an integrated approach that addresses both the engineered containment and control system itself and the institutional controls and other responsibilities that are needed. Decisions concerning system design, monitoring and maintenance, and the institutional controls that will be employed are best done through a "risk-nformed, performance-based" approach. Such an approach should incorporate an analysis of potential "failure" modes and consequences for all important system features, together with lessons learned from experience with systems already in place. The authors will present the preliminary results of a case study approach that included several sites where contamination isolation systems including institutional controls have been implemented. The results are being used together with failure trees and logic diagrams that have been developed for both the engineered barriers and the institutional controls. The use of these analytical tools to evaluate the potential for different levels of failure and associated consequences will be discussed. Of special interest is the robustness of different approaches to providing long-term protection through redundancy and defense in depth.

  2. Variations of the accessory nerve: anatomical study including previously undocumented findings-expanding our misunderstanding of this nerve.

    Tubbs, R Shane; Ajayi, Olaide O; Fries, Fabian N; Spinner, Robert J; Oskouian, Rod J


    The anatomy of the accessory nerve has been well described but continued new clinical and anatomical findings exemplify our lack of a full understanding of the course of this nerve. Therefore, this study aimed to expand on our knowledge of the course of the 11th cranial nerve via anatomical dissections. Fifty-six cadavers (112 sides) underwent dissection of the accessory nerve from its cranial and spinal origins to its emergence into the posterior cervical triangle. Immunohistochemistry was performed when appropriate. Our findings included two cases (1.8%) where the nerve was duplicated, one intracranially and one extracranially. One accessory nerve (0.9%) was found to enter its own dural compartment within the jugular foramen. The majority of sides (80%) were found to have a cranial root of the accessory nerve. Thirty-one sides (28%) had connections to cervical dorsal roots medially and three sides (2.7%) laterally. Medial connections were most common with the C1 nerve. Medial components of these dorsal root connections were all sensory in nature. However, lateral components were motor on two sides (1.8%). Nerves traveled anterior to the internal jugular vein on 88% of sides. One (0.9%) left side nerve joined an interneural anastomosis between the dorsal rootlets. Macroganglia were found on the spinal part of the intracranial nerve on 13% of sides. The lesser occipital nerve arose directly from the accessory nerve on two sides (1.8%) and communicated with the accessory nerve on 5.4% of sides. One side (0.9%) was found to communicate with the facial nerve with both nerves innervating the sternocleidomastoid muscle. Additional anatomical knowledge of the variants of the accessory nerve may benefit patient care when this nerve is pathologically involved.

  3. Refractory status epilepticus: a prospective observational study.

    Novy, Jan; Logroscino, Giancarlo; Rossetti, Andrea O


    Status epilepticus (SE) that is resistant to two antiepileptic compounds is defined as refractory status epilepticus (RSE). In the few available retrospective studies, estimated RSE frequency is between 31% and 43% of patients presenting an SE episode; almost all seem to require a coma induction for treatment. We prospectively assessed RSE frequency, clinical predictors, and outcome in a tertiary clinical setting. Over 2 years we collected 128 consecutive SE episodes (118 patients) in adults. Clinical data and their relationship to outcome (mortality and return to baseline clinical conditions) were analyzed. Twenty-nine of 128 SE episodes (22.6%) were refractory to first- and second-line antiepileptic treatments. Severity of consciousness impairment and de novo episodes were independent predictors of RSE. RSE showed a worse outcome than non-RSE (39% vs. 11% for mortality; 21% vs. 63% for return to baseline clinical conditions). Only 12 patients with RSE (41%) required coma induction for treatment. This prospective study identifies clinical factors predicting the onset of SE refractoriness. RSE appears to be less frequent than previously reported in retrospective studies; furthermore, most RSE episodes were treated outside the intensive care unit (ICU). Nonetheless, we confirm that RSE is characterized by high mortality and morbidity.

  4. The NOAA Satellite Observing System Architecture Study

    Volz, Stephen; Maier, Mark; Di Pietro, David


    NOAA is beginning a study, the NOAA Satellite Observing System Architecture (NSOSA) study, to plan for the future operational environmental satellite system that will follow GOES and JPSS, beginning about 2030. This is an opportunity to design a modern architecture with no pre-conceived notions regarding instruments, platforms, orbits, etc. The NSOSA study will develop and evaluate architecture alternatives to include partner and commercial alternatives that are likely to become available. The objectives will include both functional needs and strategic characteristics (e.g., flexibility, responsiveness, sustainability). Part of this study is the Space Platform Requirements Working Group (SPRWG), which is being commissioned by NESDIS. The SPRWG is charged to assess new or existing user needs and to provide relative priorities for observational needs in the context of the future architecture. SPRWG results will serve as input to the process for new foundational (Level 0 and Level 1) requirements for the next generation of NOAA satellites that follow the GOES-R, JPSS, DSCOVR, Jason-3, and COSMIC-2 missions.

  5. The influence of previous infections and antichlamydia pneumoniae seropositivity on functional outcome in ischemic stroke patients: results from the IN2 study.

    Consoli, Domenico; Vidale, Simone; Aguglia, Umberto; Bassi, Pietro; Cavallini, Anna; Consoli, Arturo; Galati, Franco; Guidetti, Donata; Micieli, Giuseppe; Neri, Giuseppe; Rasura, Maurizia; Sterzi, Roberto; Toni, Danilo; Inzitari, Domenico


    Although a growing attention is being paid to acute ischemic stroke patients, the correlation between clinical outcome and infectious events in this population has been poorly investigated. 749 ischemic stroke (mean age 71 years old, males 56%) patients were enrolled in this prospective case-control study by 11 Italian Stroke Units. Demographic data, vascular risk factors, previous infections and post-stroke infections (PSIs) were recorded. Blood samples were collected and the enzyme-linked immunoassay was chosen to measure Chlamydia pneumoniae IgG and IgA plasma antibodies (antibody titers were classified with specific cut-off levels: IgA > 1:16 and IgG > 1:64). Early poor outcome was defined as mRS score >2 at discharge, while poor outcome at 6-month follow-up. Univariate and multivariate analyses were performed. Median NIHSS was 7, IgA and IgG antichlamydia pneumoniae seropositivities were observed in 308 (37.1%) and 207 (23.6%) patients, respectively. Multivariate analyses showed significant correlations between PSIs and NIHSS (RR: 1.06; 95% CI 1.02-1.09; p < 0.001) and PSIs and IgA antichlamydia pneumoniae seropositivity (RR: 3.84; 95% CI 2.53-5.84; p < 0.001). Significant disability was associated with baseline NIHSS (RR: 1.32; 95% CI 1.16-1.50; p < 0.001), IgA (RR: 2.67; 95% CI 1.06-6.70; p = 0.035) and IgG antichlamydia (RR: 5.75; 95% CI 1.83-18.03; p = 0.003) seropositivity and atrial fibrillation (RR: 2.58; 95% CI 1.81-3.67; p < 0.001). While previous infections were not associated with functional outcome, antichlamydia antibodies play a negative role in ischemic stroke patients. Preventive strategies may reduce the stroke burden and improve the clinical outcome.

  6. Globally Gridded Satellite observations for climate studies

    Knapp, K.R.; Ansari, S.; Bain, C.L.; Bourassa, M.A.; Dickinson, M.J.; Funk, C.; Helms, C.N.; Hennon, C.C.; Holmes, C.D.; Huffman, G.J.; Kossin, J.P.; Lee, H.-T.; Loew, A.; Magnusdottir, G.


    Geostationary satellites have provided routine, high temporal resolution Earth observations since the 1970s. Despite the long period of record, use of these data in climate studies has been limited for numerous reasons, among them that no central archive of geostationary data for all international satellites exists, full temporal and spatial resolution data are voluminous, and diverse calibration and navigation formats encumber the uniform processing needed for multisatellite climate studies. The International Satellite Cloud Climatology Project (ISCCP) set the stage for overcoming these issues by archiving a subset of the full-resolution geostationary data at ~10-km resolution at 3-hourly intervals since 1983. Recent efforts at NOAA's National Climatic Data Center to provide convenient access to these data include remapping the data to a standard map projection, recalibrating the data to optimize temporal homogeneity, extending the record of observations back to 1980, and reformatting the data for broad public distribution. The Gridded Satellite (GridSat) dataset includes observations from the visible, infrared window, and infrared water vapor channels. Data are stored in Network Common Data Format (netCDF) using standards that permit a wide variety of tools and libraries to process the data quickly and easily. A novel data layering approach, together with appropriate satellite and file metadata, allows users to access GridSat data at varying levels of complexity based on their needs. The result is a climate data record already in use by the meteorological community. Examples include reanalysis of tropical cyclones, studies of global precipitation, and detection and tracking of the intertropical convergence zone.

  7. Observed and Expected Mortality in Cohort Studies.

    Richardson, David B; Keil, Alexander P; Cole, Stephen R; MacLehose, Richard F


    Epidemiologists often compare the observed number of deaths in a cohort with the expected number of deaths, obtained by multiplying person-time accrued in the cohort by mortality rates for a reference population (ideally, a reference that represents the mortality rate in the cohort in the absence of exposure). However, if exposure is hazardous (or salutary), this calculation will not consistently estimate the number of deaths expected in the absence of exposure because exposure will have affected the distribution of person-time observed in the study cohort. While problems with interpretation of this standard calculation of expected counts were discussed more than 2 decades ago, these discussions had little impact on epidemiologic practice. The logic of counterfactuals may help clarify this topic as we revisit these issues. In this paper, we describe a simple way to consistently estimate the expected number of deaths in such settings, and we illustrate the approach using data from a cohort study of mortality among underground miners. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail:

  8. Effects of testosterone replacement therapy on nocturia and quality of life in men with hypogonadism: a subanalysis of a previous prospective randomized controlled study in Japan.

    Shigehara, Kazuyoshi; Konaka, Hiroyuki; Koh, Eitetsu; Izumi, Koji; Kitagawa, Yasuhide; Mizokami, Atsushi; Nakashima, Takao; Shimamura, Masayoshi; Iwamoto, Teruaki; Namiki, Mikio


    We investigated the effects of testosterone replacement therapy (TRT) on nocturia and general health among men with hypogonadism and nocturia. From our previous EARTH study population, 64 patients with a clinical diagnosis of nocturia (two or more times per one night) and hypogonadism, comprising the TRT group (n = 31) and controls (n = 33), were included in this analysis. The TRT group was administered 250 mg of testosterone enanthate as an intramuscular injection every 4 weeks for 6 months. All patients responded to the following questionnaires: International Prostatic Symptoms Score (IPSS), Aging Male Symptoms (AMS) score and Short Form-36 health survey at baseline and 6-month visit. These categories were compared based on changes from baseline to the 6-month visit between TRT and control groups. At the 6-month visit, the TRT group had a significant decrease in IPSS question no. 7 and AMS question no. 4, whereas no significant changes were observed in the control group. Additionally, role limitation because of health program, vitality and mental health domains were significantly improved in the TRT group. Six-month TRT may improve nocturia, sleep conditions and quality of life among men with hypogonadism and nocturia.

  9. Perturbation of lipids and glucose metabolism associated with previous 2,4-D exposure: a cross-sectional study of NHANES III data, 1988-1994

    Schreinemachers Dina M


    Full Text Available Abstract Background Results from previous population studies showed that mortality rates from acute myocardial infarction and type-2 diabetes during the 1980s and 1990s in rural, agricultural counties of Minnesota, Montana, North and South Dakota, were higher in counties with a higher level of spring wheat farming than in counties with lower levels of this crop. Spring wheat, one of the major field crops in these four states, was treated for 85% or more of its acreage with chlorophenoxy herbicides. In the current study NHANES III data were reviewed for associations of 2,4-dichlorophenoxy acetic acid (2,4-D exposure, one of the most frequently used chlorophenoxy herbicides, with risk factors that are linked to the pathogenesis of acute myocardial infarction and type-2 diabetes, such as dyslipidemia and impaired glucose metabolism. Methods To investigate the toxicity pattern of chlorophenoxy herbicides, effects of a previous 2,4-D exposure were assessed by comparing levels of lipids, glucose metabolism, and thyroid stimulating hormone in healthy adult NHANES III subjects with urinary 2,4-D above and below the level of detection, using linear regression analysis. The analyses were conducted for all available subjects and for two susceptible subpopulations characterized by high glycosylated hemoglobin (upper 50th percentile and low thyroxine (lower 50th percentile. Results Presence of urinary 2,4-D was associated with a decrease of HDL levels: 8.6% in the unadjusted data (p-value = 0.006, 4.8% in the adjusted data (p-value = 0.08, and 9% in the adjusted data for the susceptible subpopulation with low thyroxine (p-value = 0.02. An effect modification of the inverse triglycerides-HDL relation was observed in association with 2,4-D. Among subjects with low HDL, urinary 2,4-D was associated with increased levels of triglycerides, insulin, C-peptide, and thyroid stimulating hormone, especially in the susceptible subpopulations. In contrast, subjects with

  10. Quantifying the influence of previously burned areas on suppression effectiveness and avoided exposure: A case study of the Las Conchas Fire

    Matthew P. Thompson; Patrick Freeborn; Jon D. Rieck; Dave Calkin; Julie W. Gilbertson-Day; Mark A. Cochrane; Michael S. Hand


    We present a case study of the Las Conchas Fire (2011) to explore the role of previously burned areas (wildfires and prescribed fires) on suppression effectiveness and avoided exposure. Methodological innovations include characterisation of the joint dynamics of fire growth and suppression activities, development of a fire line effectiveness framework, and...

  11. Study of some physical aspects previous to design of an exponential experiment; Estudio de algunos aspectos fisicos previos al diseno de una experiencia exponencial

    Caro, R.; Francisco, J. L. de


    This report presents the theoretical study of some physical aspects previous to the design of an exponential facility. The are: Fast and slow flux distribution in the multiplicative medium and in the thermal column, slowing down in the thermal column, geometrical distribution and minimum needed intensity of sources access channels and perturbations produced by possible variations in its position and intensity. (Author) 4 refs.

  12. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE statement: guidelines for reporting observational studies.

    Erik von Elm


    Full Text Available Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the Web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.

  13. Phase II study of reintroduction of oxaliplatin for advanced colorectal cancer in patients previously treated with oxaliplatin and irinotecan: RE-OPEN study

    Suenaga M


    Full Text Available Mitsukuni Suenaga,1 Nobuyuki Mizunuma,1 Satoshi Matsusaka,1 Eiji Shinozaki,1 Masato Ozaka,1 Mariko Ogura,1 Toshiharu Yamaguchi21Department of Gastroenterology, 2Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, JapanBackground: The effectiveness of reintroducing oxaliplatin in patients with metastatic colorectal cancer refractory to standard chemotherapy has not been verified. We performed a single-arm, open-label, Phase II study to evaluate the safety and efficacy of reintroducing oxaliplatin. Methods: Eligible patients had received prior chemotherapy including oxaliplatin and irinotecan that achieved a response or stable disease followed by confirmed disease progression ≥6 months previously during prior oxaliplatin-based therapy. The primary endpoint was the disease control rate (DCR after 12 weeks of treatment starting. The DCR was defined as the sum of patients with complete response, partial response, and stable disease. Results: Thirty-three patients were enrolled. The median age was 62 (range: 35–77 years and the male/female ratio was 19/14. Eastern Cooperative Oncology Group performance status was 0 in 84.8%. Fourteen primary tumors were in the colon and 19 were in the rectum. All patients received modified FOLFOX6 as the protocol treatment. After 12 weeks of treatment starting, the DCR was 39.4% (95% confidence interval 21.8–57.0 and the response rate (complete response and partial response was 6.1%. The median number of chemotherapy cycles was five and the median total dose of oxaliplatin was 425 mg/m2. Median progression-free survival time was 98 days and median overall survival was 300 days. The incidence of grade ≥1 and grade ≥3 allergic reactions was 28.1% and 3.1%, respectively. The incidence of grade ≥1 and grade ≥3 peripheral sensory neuropathy was 53.1% and 0%, respectively. There were no other severe adverse events and no treatment

  14. Distribution of interferon lambda-3 gene polymorphisms in Australian patients with previously untreated genotype 1 chronic hepatitis C: Analysis from the PREDICT and CHARIOT studies.

    Roberts, Stuart K; Mitchell, Joanne; Leung, Reynold; Booth, David; Bollipo, Steven; Ostapowicz, George; Sloss, Andrew; McCaughan, Geoffrey W; Dore, Gregory J; Thompson, Alexander; Crawford, Darrell Hg; Sievert, William; Weltman, Martin; Cheng, Wendy; George, Jacob


    The aim of this study was to examine the distribution of interferon lambda-3 (IFN-λ3) gene polymorphisms in previously untreated Australian patients with genotype 1 (Gt1) chronic hepatitis C (CHC) and to compare the IFN-λ3 genotype frequency among the different ethnic populations. This was a prospective, multicenter, observational study undertaken by the Australian Liver Association Clinical Research Network. Eligible subjects had Gt1 CHC and were being considered for and/or undergoing treatment. IFN-λ3 single nucleotide polymorphisms were genotyped by the Applied Biosystems's Taqman single nucleotide polymorphism genotyping assay. Between May 2012 and June 2012, 1132 patients were recruited from 38 treatment clinics across Australia. Also, 561 subjects from the CHARIOT (collaborative group hepatitis C study using high dose Pegasys RBV Induction dose in genotype one) study of high-dose interferon who had baseline serum available were retrospectively tested. The overall frequency of IFN-λ3 rs12979860 CC/CT/TT genotypes was 36%, 52%, and 12%, and that of rs8099917 TT/TG/GG genotypes was 54%, 41%, and 5%, respectively. The prevalence of the favorable IFN-λ3 rs12979860 CC and rs8099917 TT genotypes in Causcasians, Asians, Aboriginals, Maori/Pacific Islanders, and Mediterraneans was 32% and 52%, 80% and 86%, 33% and 63%, 77% and 88%, and 19% and 29%, respectively. Compared with Caucasians, the frequency of IFN-λ3 CC was significantly higher among Asians (P < 0.0001) and Maori/Pacific Islander subjects (P < 0.0001). The distribution of IFN-λ3 polymorphisms among untreated patients with Gt1 CHC in Australia appears similar to that reported from North America. The frequency of the favorable response alleles varies considerably according to ethnicity, being more common in self-reported Asians and Maori/Pacific Islanders than Caucasians, Aboriginals, and Mediterraneans. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty

  15. An observational study of sexual behavior in demented male patients.

    Zeiss, A M; Davies, H D; Tinklenberg, J R


    Concerns have been expressed that patients with dementia will display disinhibited, inappropriate sexual behavior. Retrospective research suggests that this is rare, but no observational research has been reported. The purpose of this study was to conduct such an observational study. Subjects were 40 patients with a dementia diagnosis who were living in institutional settings; subjects ranged in age from 60 to 98. Coders observed subjects on nine separate occasions, three in the morning, three in the afternoon, and three in the evening. Subjects were observed in multiple situations; coding included appropriate, ambiguous, and inappropriate sexual behaviors. Reliability coding was obtained for 42% of the patients on 11% of coded episodes. Behaviors could be coded with high reliability (94% to 100% across categories of behavior). On average, patients displayed 43 appropriate sexual behaviors, 1.48 ambiguous behaviors, and .83 inappropriate behaviors across the nine observation periods. This was not evenly distributed across patients, however; only 18% of patients ever displayed a sexually inappropriate behavior, and these were usually brief and minor. Inappropriate sexual behavior was observed in only 1.6% of the observed one-minute time segments. Observational research documents what had been previously suggested by retrospective reports: inappropriate sexual behavior is uncommon in dementia patients and brief and minor even when it occurs. Ambiguous behaviors, such as appearing in public incompletely dressed, which could suggest exhibitionism but more likely reflects self-care deficits, were more common. Misinterpretation of these events may be the source for some of the persistent lore regarding sexually disinhibited behavior in dementia patients.

  16. Multicenter observational prehospital resuscitation on helicopter study.

    Holcomb, John B; Swartz, Michael D; DeSantis, Stacia M; Greene, Thomas J; Fox, Erin E; Stein, Deborah M; Bulger, Eileen M; Kerby, Jeffrey D; Goodman, Michael; Schreiber, Martin A; Zielinski, Martin D; O'Keeffe, Terence; Inaba, Kenji; Tomasek, Jeffrey S; Podbielski, Jeanette M; Appana, Savitri N; Yi, Misung; Wade, Charles E


    Earlier use of in-hospital plasma, platelets, and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from January to November 2015. Five helicopter systems had plasma and/or RBCs, whereas the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high-risk criteria were analyzed. Patients receiving PHT were compared with patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. Twenty-five thousand one hundred eighteen trauma patients were admitted, 2,341 (9%) were transported by helicopter, of which 1,058 (45%) met the highest-risk criteria. Five hundred eighty-five of 1,058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and Glasgow Coma Scale (7 vs 14) was significantly lower, whereas median Injury Severity Score was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 hours (8.4% vs 3.6%), 24 hours (12.6% vs 8.9%), and 30 days (19.3% vs 13.3%). Twenty-four percent of eligible patients received a PHT. A median of 1 unit of RBCs and plasma were transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs, and 69% received both. In the propensity score matching analysis (n = 109), PHT was not significantly associated with mortality

  17. National study of emergency department observation services.

    Wiler, Jennifer L; Ross, Michael A; Ginde, Adit A


    The objective was to describe patient and facility characteristics of emergency department (ED) observation services in the United States. The authors analyzed the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Characteristics of EDs with observation units (OUs) were compared to those without, and patients with a disposition of ED observation were compared to those with a "short-stay" (observational analysis. An estimated 1,746 U.S. EDs (36%) reported having OUs, of which 56% are administratively managed by ED staff. Fifty-two percent of hospitals with ED-managed OUs are in an urban location, and 89% report ED boarding, compared to 29 and 65% of those that do not have an OU. The admission rate is 38% at those with ED-managed OUs and 15% at those without OUs. Of the 15.1% of all ED patients who are kept in the hospital following an ED visit, one-quarter are kept for either a short-stay admission (1.8%) or an ED observation admission (2.1%). Most (82%) ED observation patients were discharged from the ED. ED observation patients were similar to short-stay admission patients in terms of age (median = 52 years for both, interquartile range = 36 to 70 years), self-pay (12% vs. 10%), ambulance arrival (37% vs. 36%), urgent/emergent triage acuity (77% vs. 74%), use of ≥1 ED medication (64% vs.76%), and the most common primary chief complaints and primary diagnoses. Over one-third of U.S. EDs have an OU. Short-stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs. © 2011 by the Society for Academic Emergency Medicine.

  18. Century Scale Evaporation Trend: An Observational Study

    Bounoui, Lahouari


    Several climate models with different complexity indicate that under increased CO2 forcing, runoff would increase faster than precipitation overland. However, observations over large U.S watersheds indicate otherwise. This inconsistency between models and observations suggests that there may be important feedbacks between climate and land surface unaccounted for in the present generation of models. We have analyzed century-scale observed annual runoff and precipitation time-series over several United States Geological Survey hydrological units covering large forested regions of the Eastern United States not affected by irrigation. Both time-series exhibit a positive long-term trend; however, in contrast to model results, these historic data records show that the rate of precipitation increases at roughly double the rate of runoff increase. We considered several hydrological processes to close the water budget and found that none of these processes acting alone could account for the total water excess generated by the observed difference between precipitation and runoff. We conclude that evaporation has increased over the period of observations and show that the increasing trend in precipitation minus runoff is correlated to observed increase in vegetation density based on the longest available global satellite record. The increase in vegetation density has important implications for climate; it slows but does not alleviate the projected warming associated with greenhouse gases emission.

  19. ATLANTIC-DIP: prevalence of metabolic syndrome and insulin resistance in women with previous gestational diabetes mellitus by International Association of Diabetes in Pregnancy Study Groups criteria.

    Noctor, Eoin; Crowe, Catherine; Carmody, Louise A; Kirwan, Breda; O'Dea, Angela; Glynn, Liam G; McGuire, Brian E; O'Shea, Paula M; Dunne, Fidelma P


    Women with previous gestational diabetes (GDM) are a high-risk group for future development of diabetes, metabolic syndrome, and cardiovascular disease. The new International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria significantly increase the number of women diagnosed with GDM. The long-term metabolic outcome in these women is unknown. We set out to determine the prevalence of metabolic syndrome, using adult treatment panel-III criteria; and insulin resistance, using HOMA2-IR, in white European women with previous GDM. Using a cohort design, we invited women meeting IADPSG GDM criteria across four Irish antenatal centres between 2007 and 2010 to participate. Two hundred and sixty-five women with previous values meeting IADPSG criteria for GDM participated (44 % of the population eligible for participation). Mean age was 36.7 years (SD 5.0). These women were compared with a randomly selected control group of 378 women (mean age 37.6 years, SD 5.1) known to have normal glucose tolerance (NGT) in pregnancy during the same period. A total of 25.3 % of women with previous IADPSG-defined GDM met metabolic syndrome criteria, compared to 6.6 % of women with NGT [at 2.6 (SD 1.0) vs. 3.3 years (SD 0.7) post-partum]. The prevalence of HOMA2-IR >1.8 was higher in women with previous IADPSG-defined GDM (33.6 vs. 9.1 % with NGT, p Women with previous GDM by IADPSG criteria demonstrate a greater than threefold prevalence of metabolic syndrome compared to women with NGT in pregnancy. Efforts to prevent projected long-term consequences of this should focus on interventions both in the preconception and post-partum periods.

  20. Observations of radiographer communication: An exploratory study using Transactional Analysis

    Booth, Lisa A. [School of Medical Imaging Sciences, St. Martin' s College, Bowerham Road, Lancaster LA1 3JD (United Kingdom)]. E-mail:; Manning, David J. [School of Medical Imaging Sciences, St. Martin' s College, Bowerham Road, Lancaster LA1 3JD (United Kingdom)


    Purpose: Communication in medical imaging is a neglected area of research, despite the necessity for good communication if optimum diagnostic images are to be achieved. Methods: The present study has investigated the styles of communication used in medical imaging, using an approach known as Transactional Analysis. This approach has been demonstrated previously as having reliability and validity, using observations and supporting interviews with medical imaging staff, along with inter-rater observations of radiographer-patient interactions. Results: The results indicate that Transactional Analysis can be used effectively for identifying and naming interaction events in diagnostic radiography, with diagnostic radiographers using five styles of communication. Conclusion: Radiographers tend to use Parental styles of communicating; these styles are commonly associated with a practitioner-centred approach to dealing with patients which often result in non-adherence.

  1. Prevention and health promotion in undergraduate medical education: Preferences, attitudes and previous knowledge of medical students - a cross-sectional study

    Klement, Andreas; Bretschneider, Kristin; Lautenschläger, Christine; Stang, Andreas; Herrmann, Markus; Haerting, Johannes


    Objective: The interdisciplinary topic "prevention and health promotion" (Q10) was introduced into the medical training in Germany by the new medical licensing regulations in 2004. For the conception of an effective curriculum, it is helpful to know student preferences concerning teaching-formats, attitudes and self-estimated previous knowledge. Little is known concerning student perception of “prevention and health promotion” in Germany. Thus, this explorative cross-sectional study aims to p...

  2. Continous controversy about radiation oncologists' choice of treatment regimens for bone metatases: should we blame doctors, canser-related features, or design of previous clinical studies

    Nieder, Carsten; Pawinski, Adam; Dalhaug, Astrid


    Recent studies from Italy, Japan and Norway have confirmed previous reports, which found that a large variety of palliative radiotherapy regimens are used for painful bone metastases. Routine use of single fraction treatment might or might not be the preferred institutional approach. It is not entirely clear why inter-physician and inter-institution differences continue to persist despite numerous randomized trials, meta-analyses and guidelines, which recommend against more costly and inconve...

  3. Role of previous hospitalization in clinically-significant MRSA infection among HIV-infected inpatients: results of a case-control study

    Festa Anna


    Full Text Available Abstract Background HIV-infected subjects have high incidence rates of Staphylococcus aureus infections, with both methicillin-susceptible and methicillin-resistant (MRSA strains. Possible explanations could include the high burden of colonization, the behavioral risk factors, and the frequent exposures to health care facilities of HIV-infected patients. The purpose of the study was to assess the risk factors for clinically- significant methicillin-resistant Staphylococcus aureus (CS-MRSA infections in HIV-infected patients admitted to Infectious Diseases Units. Methods From January 1, 2002 to December 31, 2005, we conducted a retrospective case-control (1:2 study. We identified all the cases of CS-MRSA infections in HIV-infected patients admitted to the National Institute for Infectious Diseases (INMI "Lazzaro Spallanzani" in the 4-year study period. A conditional logistic regression model was used to identify risk factors for CS-MRSA infection. Results We found 27 CS-MRSA infections, i.e. 0.9 CS-MRSA infections per 100 HIV-infected individuals cared for in our Institute. At multivariate analysis, independent predictors of CS-MRSA infection were cumulative hospital stay, invasive procedures in the previous year, and low CD4 cell count. Particularly, the risk for CS-MRSA increased by 14% per an increase of 5 days hospitalization in the previous year. Finally, we identified a low frequency of community-acquired MRSA infections (only 1 of 27; 3.7% among HIV-infected patients. Conclusion Clinicians should be aware of the risk for CS-MRSA infection in the clinical management of HIV-infected patients, especially in those patients with a low CD4 cell count, longer previous hospital stay, and previous invasive procedures.

  4. Role of previous hospitalization in clinically-significant MRSA infection among HIV-infected inpatients: results of a case-control study

    Drapeau, Cecilia MJ; Angeletti, Claudio; Festa, Anna; Petrosillo, Nicola


    Background HIV-infected subjects have high incidence rates of Staphylococcus aureus infections, with both methicillin-susceptible and methicillin-resistant (MRSA) strains. Possible explanations could include the high burden of colonization, the behavioral risk factors, and the frequent exposures to health care facilities of HIV-infected patients. The purpose of the study was to assess the risk factors for clinically- significant methicillin-resistant Staphylococcus aureus (CS-MRSA) infections in HIV-infected patients admitted to Infectious Diseases Units. Methods From January 1, 2002 to December 31, 2005, we conducted a retrospective case-control (1:2) study. We identified all the cases of CS-MRSA infections in HIV-infected patients admitted to the National Institute for Infectious Diseases (INMI) "Lazzaro Spallanzani" in the 4-year study period. A conditional logistic regression model was used to identify risk factors for CS-MRSA infection. Results We found 27 CS-MRSA infections, i.e. 0.9 CS-MRSA infections per 100 HIV-infected individuals cared for in our Institute. At multivariate analysis, independent predictors of CS-MRSA infection were cumulative hospital stay, invasive procedures in the previous year, and low CD4 cell count. Particularly, the risk for CS-MRSA increased by 14% per an increase of 5 days hospitalization in the previous year. Finally, we identified a low frequency of community-acquired MRSA infections (only 1 of 27; 3.7%) among HIV-infected patients. Conclusion Clinicians should be aware of the risk for CS-MRSA infection in the clinical management of HIV-infected patients, especially in those patients with a low CD4 cell count, longer previous hospital stay, and previous invasive procedures. PMID:17470274

  5. Clinical evaluation of recombinant factor VIII preparation (Kogenate) in previously treated patients with hemophilia A: descriptive meta-analysis of post-marketing study data.

    Yoshioka, A; Fukutake, K; Takamatsu, J; Shirahata, A


    The safety and efficacy of Kogenate, a recombinant factor VIII (rFVIII) preparation for the treatment of bleeding episodes, were studied in a 123-patient meta-analysis population of previously treated patients (PTPs), including 15 enrolled in the registration Phase III trial (PTP-I group), 93 from the post-marketing special investigation (PTP-II group), and 15 from short-term special investigations in surgery or tooth extraction (SI group). These patients (82 severe, 31 moderate, 9 mild, and 1 unknown), aged 11 months to 72 years, were enrolled in 28 centers in Japan. Blood samples taken at the baseline and at 3, 6, 9, 12, 18, and 24 months after the introduction of Kogenate were evaluated for FVIII inhibitor antibodies, antibodies formed against trace proteins derived from the rFVIII production process, and for general changes in laboratory test results. Mean exposure to Kogenate was 1103 days in PTP-I, 86 days in PTP-II, 27 days in patients in surgery, and 2 days in patients with tooth extraction. Assessment of FVIII inhibitor activity was conducted in 115 of the 123 patients by means of the Bethesda assay. Twelve patients were found to have a low titer of FVIII inhibitor (0.5-3.0 BU/mL) prior to any administration of Kogenate, and 103 were inhibitor-negative at the baseline. Among this latter group, 3 patients (2.9%) tested inhibitor-positive, with titers ranging from 1.2 to 2.1 BU/mL, with 4 patients below 1.0 BU/mL. One patient in the 11 PTPs investigated (PTP-I) developed antibodies against baby hamster kidney protein and mouse immunoglobulin G, but these findings were transient and asymptomatic. Hemostasis was achieved (markedly effective or effective) in 3666 of the 3855 bleeding episodes (95.1%) observed in 108 patients. Only 1 infusion was necessary in 3790 (98.3%) of these episodes. These data indicate that Kogenate is safe and very effective for the treatment of bleeding in PTPs with hemophilia A.

  6. Molecular Carbon in the Galaxy: Laboratory and Observational Studies

    Saykally, Richard James


    In a collaboration with the Mats Larsson group from Stockholm, we carried out a new measurement of the rate of dissociative recombination of H(sup *, sub j), using a new pulsed supersonic beam source of rotationally cold H(sup *, sub j). This source was first designed and characterized in our lab by IR cavity ringdown spectroscopy, determining a rotationaYtranslationa1 temperature of 20-60K, depending on conditions. This new source was then taken to Stockholm for the recombination rate studies at the CRYRING storage ring. The recombination rate constant measured against temperature yields values consistent with the most recent calculations, whereas previous experimental measurements varied over a range of 10(exp 4) and were poor agreement with theory. This is a crucial achievement for understanding the ion chemistry of diffuse clouds. Moreover, this result in combination with recent observations implies a greatly enhanced (factor of 40) cosmic ray ionization rate in a diffuse cloud (zeta Persei) relative to previous studies. The implications of this are discussed in our recent Nature paper. An enhanced cosmic-ray flux towards zeta Persei inferred from a laboratory study of the H(sup *, sub j)-e(sup -) recombination rate.

  7. Observational Study of Solar Magnetic Active Phenomena

    Hongqi Zhang


    The electric current separated into two parts reflected the quantative properties of heterogeneity and chirality of magnetic field, and defined them as the shear and twist components of current. We analyze the basic configuration and evolution of superactive region NOAA 6580-6619-6659. It is found that the contribution of the twist component of current cannot be reflected in the normal analysis of the magnetic shear and gradient of the active regions. The observational evidence of kink magnetic ropes generated from the subatmosphere cannot be found completely in some super delta active regions.

  8. Potential New Lidar Observations for Cloud Studies

    Winker, Dave; Hu, Yong; Narir, Amin; Cai, Xia


    The response of clouds to global warming represents a major uncertainty in estimating climate sensitivity. These uncertainties have been tracked to shallow marine clouds in the tropics and subtropics. CALIOP observations have already been used extensively to evaluate model predictions of shallow cloud fraction and top height (Leahy et al. 2013; Nam et al 2012). Tools are needed to probe the lowest levels of the troposphere. The large footprint of satellite lidars gives large multiple scattering from clouds which presents new possibilities for cloud retrievals to constrain model predictions.

  9. Phase II study of capecitabine as palliative treatment for patients with recurrent and metastatic squamous head and neck cancer after previous platinum-based treatment

    Martinez-Trufero, J; Isla, D; Adansa, J C; Irigoyen, A; Hitt, R; Gil-Arnaiz, I; Lambea, J; Lecumberri, M J; Cruz, J J


    Background: Platinum-based therapy (PBT) is the standard therapy for recurrent and/or metastatic head and neck cancer (HNC), but the incidence of recurrence remains high. This study evaluates the efficacy and tolerability of capecitabine as palliative monotherapy for recurrent HNC previously treated with PBT. Methods: Patients aged 18–75 years, with Eastern Cooperative Oncology Group performance status 0–2, squamous HNC with locoregional and/or metastatic recurrence previously treated with PBT and adequate organ functions, were included. Capecitabine (1.250 mg m−2 BID) was administered on days 1–14 every 21 days for at least two cycles. Results: A total of 40 male patients with a median age of 58 years were analysed. All patients received a median number of four cycles of capecitabine (range: 1–9) and the median relative dose intensity was 91%. Seven patients were not evaluable for response. Overall response rate was 24.2%. Median time to progression and overall survival were 4.8 and 7.3 months, respectively. Haematological adverse events (AEs) grade 3/4 were reported in six patients. Most common grade 3/4 non-haematological AEs were asthenia (12.5%), palmar-plantar eritrodisestesia (10%), mucositis (10%), dysphagia (10%) and diarrhoea (7.5%). Conclusions: Capecitabine seems to be an active, feasible and well-tolerated mode of palliative treatment for advanced HNC patients who have previously received PBT schedules. PMID:20485287

  10. Geomagnetic Observations for Main Field Studies

    Matzka, Jürgen; Chulliat, A.; Mandea, M.


    Direct measurements of the geomagnetic field have been made for more than 400 years, beginning with individual determinations of the angle between geographic and magnetic North. This was followed by the start of continuous time series of full vector measurements at geomagnetic observatories and t...... for magnetic field measurements on ground and in space and covers geomagnetic observatories, repeat stations, automatic observatories, satellites and historic observations. Special emphasis is laid on the global network of geomagnetic observatories....... and the beginning of geomagnetic repeat stations surveys in the 19th century. In the second half of the 20th century, true global coverage with geomagnetic field measurements was accomplished by magnetometer payloads on low-Earth-orbiting satellites. This article describes the procedures and instruments...

  11. Risk for High Depressive Symptoms in Diagnosed and Previously Undetected Diabetes: 5-Year Follow-Up Results of the Heinz Nixdorf Recall Study

    Icks, Andrea; Albers, Bernd; Haastert, Burkhard; Pechlivanis, Sonali; Pundt, Noreen; Slomiany, Uta; Erbel, Raimund; Jöckel, Karl-Heinz; Kruse, Johannes; Kulzer, Bernd; Nowotny, Bettina; Herder, Christian; Giani, Guido; Moebus, Susanne


    Objective The objective of this study was to determine the risk for the development of high depressive symptoms in study participants with diagnosed and previously undetected diabetes mellitus compared to those without diabetes in a prospective population-based cohort study in Germany. Methods We estimated the 5-year cumulative incidence of high depressive symptoms in participants without high depressive symptoms at baseline (n = 3,633, 51.4% men, mean age (SD) 59.1 (7.6) years, 7.0% diagnosed diabetes, 5.3% previously undetected diabetes) from the population-based Heinz Nixdorf Recall study. Diabetes was assessed by self-report, medication, and blood glucose. High depressive symptoms were assessed using CES-D. We calculated odds ratios and their corresponding 95% confidence interval, using multiple logistic regression analyses. Result Cumulative 5-year incidences (95% CI) of high depressive symptoms in participants with diagnosed, undetected, and without diabetes were 7.1 (4.2–10.9), 4.1 (1.8–8.0), and 6.5 (5.6–7.4), respectively. The age-sex-adjusted OR for developing high depressive symptoms was 1.22 (0.74–2.03) in participants with diagnosed compared to those without diabetes, and 1.00 (0.59–1.68) after adjustment for BMI, physical activity, education, stroke, and myocardial infarction. The age-sex adjusted OR for developing high depressive symptoms in participants with previously undetected diabetes compared to those without diabetes was 0.72; 0.35–1.48; and fully adjusted 0.62; 0.30–1.30. Conclusion We found no significant associations, maybe due to low power. However, our results are in line with a recent meta-analysis suggesting that risk of developing high depressive symptoms in patients with diagnosed diabetes may be moderately higher than in those without diabetes, and that comorbidity may explain in part this association. In participants with previously undetected diabetes, this first longitudinal study indicates that the risk is not

  12. Risk for high depressive symptoms in diagnosed and previously undetected diabetes: 5-year follow-up results of the Heinz Nixdorf Recall study.

    Andrea Icks

    Full Text Available OBJECTIVE: The objective of this study was to determine the risk for the development of high depressive symptoms in study participants with diagnosed and previously undetected diabetes mellitus compared to those without diabetes in a prospective population-based cohort study in Germany. METHODS: We estimated the 5-year cumulative incidence of high depressive symptoms in participants without high depressive symptoms at baseline (n = 3,633, 51.4% men, mean age (SD 59.1 (7.6 years, 7.0% diagnosed diabetes, 5.3% previously undetected diabetes from the population-based Heinz Nixdorf Recall study. Diabetes was assessed by self-report, medication, and blood glucose. High depressive symptoms were assessed using CES-D. We calculated odds ratios and their corresponding 95% confidence interval, using multiple logistic regression analyses. RESULT: Cumulative 5-year incidences (95% CI of high depressive symptoms in participants with diagnosed, undetected, and without diabetes were 7.1 (4.2-10.9, 4.1 (1.8-8.0, and 6.5 (5.6-7.4, respectively. The age-sex-adjusted OR for developing high depressive symptoms was 1.22 (0.74-2.03 in participants with diagnosed compared to those without diabetes, and 1.00 (0.59-1.68 after adjustment for BMI, physical activity, education, stroke, and myocardial infarction. The age-sex adjusted OR for developing high depressive symptoms in participants with previously undetected diabetes compared to those without diabetes was 0.72; 0.35-1.48; and fully adjusted 0.62; 0.30-1.30. CONCLUSION: We found no significant associations, maybe due to low power. However, our results are in line with a recent meta-analysis suggesting that risk of developing high depressive symptoms in patients with diagnosed diabetes may be moderately higher than in those without diabetes, and that comorbidity may explain in part this association. In participants with previously undetected diabetes, this first longitudinal study indicates that the risk is not

  13. Cutaneous hypopigmentary disorders – An observational study

    Kalegowda Deepadarshan


    Full Text Available Background: Hypopigmented skin lesions is very common among people of all age groups. There are limited studies in India about evaluation of hypopigmented skin conditions. The aim of my study is to evaluate the different etiologies of cutaneous hypopigmentation. Aim: The present study was undertaken to find the relative incidence of the various disorders causing a hypopigmented lesion in a random sample of 200 cases and to study site, distribution and characteristics of the lesions. Methods: A random sample of 200 patients presenting with one or more hypopigmented lesions to the outpatient department of Dermatology, Venereology and Leprosy in KVG Medical College and Hospital, Sullia from December 2011 to January 2013 was studied. Detailed history including address and occupation with special reference to onset and duration, preceding skin conditions, exposure to chemicals, topical application and family history was taken. Various characteristics of the lesion like site, size, number, distribution, surface and sensation were studied. After this samples were taken for relevant investigations like complete hemogram, biopsy, slit skin smear, KOH mount and assessed for the causes of hypopigmented lesions. Results: In our study, most common cause with cutaneous hypopigmentation was pityriasis versicolor, seen in 52%, followed by post inflammatory hypopigmentation in 32%, pre vitiligo in 6.5%, Hansen’s disease, idiopathic guttate hypomelanosis, nevus anemicus each in 2%, Woronoff’s ring in 1.5% and miscellaneous conditions in 2% of the cases. Commonest age group affected was 21-30 years. Males (49% and females (51% were almost equally affected. Conclusion: The study concludes that various conditions comes under hypopigmentary disorders. More common in young adults. Most common scaly condition was pityriasis versicolor and non scaly condition was pre vitiligo. Proper counseling and ruling out Hansen’s disease is required to alleviate the patient

  14. Shallow landslide susceptibility model for the Oria river basin, Gipuzkoa province (North of Spain). Application of the logistic regression and comparison with previous studies.

    Bornaetxea, Txomin; Antigüedad, Iñaki; Ormaetxea, Orbange


    In the Oria river basin (885 km2) shallow landslides are very frequent and they produce several roadblocks and damage in the infrastructure and properties, causing big economic loss every year. Considering that the zonification of the territory in different landslide susceptibility levels provides a useful tool for the territorial planning and natural risk management, this study has the objective of identifying the most prone landslide places applying an objective and reproducible methodology. To do so, a quantitative multivariate methodology, the logistic regression, has been used. Fieldwork landslide points and randomly selected stable points have been used along with Lithology, Land Use, Distance to the transport infrastructure, Altitude, Senoidal Slope and Normalized Difference Vegetation Index (NDVI) independent variables to carry out a landslide susceptibility map. The model has been validated by the prediction and success rate curves and their corresponding area under the curve (AUC). In addition, the result has been compared to those from two landslide susceptibility models, covering the study area previously applied in different scales, such as ELSUS1000 version 1 (2013) and Landslide Susceptibility Map of Gipuzkoa (2007). Validation results show an excellent prediction capacity of the proposed model (AUC 0,962), and comparisons highlight big differences with previous studies.

  15. How safe do teenagers behave on Facebook? An observational study.

    Vanderhoven, Ellen; Schellens, Tammy; Valcke, Martin; Raes, Annelies


    The substantial use of social network sites by teenagers has raised concerns about privacy and security. Previous research about behavior on social network sites was mostly based on surveys and interviews. Observational research overcomes problems inherent to this research method, for example social desirability. However, existing observational research mostly focuses on public profiles of young adults. Therefore, the current observation-study includes 1050 public and non-public Facebook-profiles of teenagers (13-18) to investigate (1) what kind of information teenagers post on their profile, (2) to what extent they protect this information using privacy-settings and (3) how much risky information they have on their profile. It was found that young people mostly post pictures, interests and some basic personal information on their profile. Some of them manage their privacy-settings as such that this information is reserved for friends' eyes only, but a lot of information is accessible on the friends-of-friends' pages. Although general risk scores are rather low, more detailed analyses show that teenagers nevertheless post a significant amount of risky information. Moreover, older teenagers and girls post more (risky) information while there are no differences in applying privacy settings. We found no differences in the Facebook behavior of teenagers enrolled in different education forms. Implications of these results are discussed.

  16. Management of rheumatic chorea: an observational study

    Araújo Alexandra Prufer de Queiroz Campos


    Full Text Available BACKGROUND: Rheumatic chorea (RC has recently been linked to an antibody-mediated immune mechanism. OBJECTIVE/METHOD: To verify if this knowledge reflected in management changes we conceived a descriptive study. RESULTS: The medical charts of 20 children (13 females aged 6 to 12 years (mean 8 years, diagnosed as RC from June 1996 to June 1999, were reviewed. All patients received some medical treatment. Haloperidol was the most prescribed medication (15 patients - 75 %. Sulpiride, diazepam and valproate were also used as symptomatic treatment. Imune-modulating therapy with prednisone was prescribed for seven children. The shortest course of chorea (16 days occurred in a patient treated with prednisone. CONCLUSION: Prednisone has been prescribed for rheumatic chorea besides the traditional symptomatic approach. A great variety of antichoreic drugs are being employed.

  17. Vitamin D deficiency in medical patients at a central hospital in Malawi: a comparison with TB patients from a previous study.

    Yamikani Mastala

    Full Text Available OBJECTIVES: To determine the prevalence of vitamin D deficiency (VDD in adult medical, non-tuberculous (non-TB patients. To investigate associations with VDD. To compare the results with a similar study in TB patients at the same hospital. DESIGN: Cross-sectional sample. SETTING: Central hospital in Malawi. PARTICIPANTS: Adult non-TB patients (n = 157, inpatients and outpatients. OUTCOME MEASURES: The primary outcome was the prevalence of VDD. Potentially causal associations sought included nutritional status, in/outpatient status, HIV status, anti-retroviral therapy (ART and, by comparison with a previous study, a diagnosis of tuberculosis (TB. RESULTS: Hypovitaminosis D (≤75 nmol/L occurred in 47.8% (75/157 of patients, 16.6% (26/157 of whom had VDD (≤50 nmol/L. None had severe VDD (≤25 nmol/L. VDD was found in 22.8% (23/101 of in-patients and 5.4% (3/56 of out-patients. In univariable analysis in-patient status, ART use and low dietary vitamin D were significant predictors of VDD. VDD was less prevalent than in previously studied TB patients in the same hospital (68/161 = 42%. In multivariate analysis of the combined data set from both studies, having TB (OR 3.61, 95%CI 2.02-6.43 and being an in-patient (OR 2.70, 95%CI 1.46-5.01 were significant independent predictors of VDD. CONCLUSIONS: About half of adult medical patients without TB have suboptimal vitamin D status, which is more common in in-patients. VDD is much more common in TB patients than non-TB patients, even when other variables are controlled for, suggesting that vitamin D deficiency is associated with TB.

  18. An observational study of hand hygiene compliance in paediatric wards.

    Randle, Jacqueline; Firth, Joseph; Vaughan, Natalie


    To measure healthcare workers', children's and visitors' hand hygiene compliance in a paediatric oncology ward and a paediatric respiratory ward in an English hospital. Children are especially vulnerable to healthcare-associated infections, yet few studies have reported on hand hygiene compliance in paediatric clinical areas. This was an observational study. We measured hand hygiene compliance over an eight-hour period in two hospital wards using the 'five moments of hand hygiene' observation tool. We monitored a total of 407 hand hygiene opportunities. Overall opportunities for compliance were 74% for healthcare workers (n = 315) and children and visitors 23% (n = 92). Compliance was 84% for allied health professionals, 81% for doctors, 75% for nurses and 73% for ancillary and other staff. Hand hygiene compliance varied depending on which of the five moments of hygiene healthcare workers were undertaking (p hygiene compliance, and for visitors to the oncology ward, hand hygiene compliance was higher (p hygiene compliance; however, visitors' compliance was low. Among healthcare workers, levels of compliance were higher compared with previous reported estimates. Visitors had the lowest level of compliance yet owing to the nature of the clinical environments, nearly a quarter of care is delivered by them rather than healthcare workers, and so, this offers opportunities for specific future interventions aimed at families and carers. © 2012 Blackwell Publishing Ltd.

  19. Memantine (Ebixa) in clinical practice - results of an observational study.

    Calabrese, Pasquale; Essner, Ute; Forstl, Hans


    In a post-marketing observational study, the efficacy and tolerability of memantine were examined in patients with moderate to severe Alzheimer's disease. The patients were treated with 20 mg/day of memantine for a 6-month period. The efficacy of memantine was evaluated using the Mini-Mental State Examination, the Nurses' Observation Scale for Geriatric Patients (NOSGER) and the Explorationsmodul Demenz (EMD) scale. In addition, a global assessment was made by the physician. After 6 months of open-label treatment with memantine, the patients' cognitive function, ability to perform daily activities and global performance all showed a marked improvement. In the overall evaluation by the physician, improvement or stabilisation had been achieved by 78.8% of patients after 6 months of therapy. Memantine also demonstrated an excellent tolerability profile. The results of this naturalistic study support the significant efficacy and tolerability of memantine that has been previously demonstrated in randomised, controlled clinical Alzheimer's disease trials. (c) 2007 S. Karger AG, Basel.

  20. Myocardial adaptation to high-intensity (interval) training in previously untrained men with a longitudinal cardiovascular magnetic resonance imaging study (Running Study and Heart Trial).

    Scharf, Michael; Schmid, Axel; Kemmler, Wolfgang; von Stengel, Simon; May, Matthias S; Wuest, Wolfgang; Achenbach, Stephan; Uder, Michael; Lell, Michael M


    To prospectively evaluate whether short-term high-intensity (interval) training (HI(I)T) induces detectable morphological cardiac changes in previously untrained men in cardiovascular magnetic resonance imaging. Eighty-four untrained volunteers were randomly assigned to a HI(I)T group (n=42; 44.1±4.7 years) or an inactive control group (n=42; 42.3±5.6 years). HI(I)T focused on interval runs (intensity: 95%-105% of individually calculated heart rate at the anaerobic threshold). Before and after 16 weeks, all subjects underwent physiological examination, stepwise treadmill test with blood lactate analysis, and contrast-enhanced cardiovascular magnetic resonance imaging (cine, tagging, and delayed enhancement). Indexed left ventricular (LV) and right ventricular (RV) volume (LV, 77.1±8.5-83.9±8.6; RV, 80.5±8.5-86.6±8.1) and mass (LV, 58.2±6.4-63.4±8.1; RV, 14.8±1.7-16.1±2.1) significantly increased with HI(I)T. Changes in LV and RV morphological parameters with HI(I)T were highly correlated with an increase in maximal aerobic capacity (VO2max) and a decrease in blood lactate concentration at the anaerobic threshold. Mean LV and RV remodeling index of HI(I)T group did not alter with training (0.76 ±0.09 and 0.24±0.10 g/mL, respectively [P=0.97 and P=0.72]), indicating balanced cardiac adaptation. Myocardial circumferential strain decreased after HI(I)T within all 6 basal segments (anteroseptal, P=0.01 and anterolateral, PHeart Association, Inc.

  1. A longitudinal study of relationships between previous academic achievement, emotional intelligence and personality traits with psychological health of medical students during stressful periods.

    Yusoff, Muhamad Saiful Bahri; Esa, Ab Rahman; Mat Pa, Mohamad Najib; Mey, See Ching; Aziz, Rosniza Abdul; Abdul Rahim, Ahmad Fuad


    There is considerable evidence that emotional intelligence, previous academic achievement (i.e. cumulative grade point average (GPA)) and personality are associated with success in various occupational settings. This study evaluated the relationships of these variables with psychological health of first year medical students during stressful periods. A 1-year prospective study was done with students accepted into the School of Medical Sciences, Universiti Sains Malaysia. Information on emotional intelligence, GPA and personality traits were obtained prior to admission. The validated Universiti Sains Malaysia Emotional Quotient Inventory and Universiti Sains Malaysia Personality Inventory were used to measure emotional intelligence and personality traits, respectively. Stress, anxiety and depression were measured by the 21-item Depression Anxiety Stress Scale during the end-of-course (time 1) and final (time 2) examinations. At the less stressful period (time 1), stress level was associated with agreeableness and the final GPA, anxiety level was associated with emotional control and emotional conscientiousness and depression level was associated with the final GPA and extraversion. At the more stressful period (time 2), neuroticism associated with stress level, anxiety level was associated with neuroticism and emotional expression, and depression level was associated with neuroticism. This study found that neuroticism was the strongest associated factor of psychological health of medical students during their most stressful testing period. Various personality traits, emotional intelligence and previous academic performance were associated factors of psychological health during a less stressful period. These data suggest that early identification of medical students who are vulnerable to the stressful environment of medical schools might help them maintain psychological well-being during medical training.

  2. Study on the Properties of TiN Coatings on Previously Ion-Implanted Pure Magnesium Surface by MEVVA Ion Implantation

    ZHOU Hai; CHEN Fei; WANG Jian-ping


    A metal vapor vacuum arc (MEVVA) is used in ion implantation for substrate preparation before the deposition process which would ensure the improvement of mechanical properties of the coating.Ti ion is implanted into pure magnesium surface by MEVVA implanter operated with a modified cathode.Implanting energy is kept at 45 keV and dose is set at 3×1017 cm-2.TiN coatings are deposited by magnetically filtered vacuum-arc plasma source on unimplanted and previously implanted substrates.Microstructure and phase composition are analysed using scanning electron microscopy (SEM) and X-ray diffraction (XRD).The property of corrosion resistance of TiN coatings was studied by CS300P electrochemistry-corrosion workstation,and the main impact factor of the corrosion resistance was also analyzed.

  3. Phase II study of a 3-day schedule with topotecan and cisplatin in patients with previously untreated small cell lung cancer and extensive disease

    Sorensen, M.; Lassen, Ulrik Niels; Jensen, Peter Buhl;


    and cisplatin are needed. The aim of this phase II study was to establish the response rate and response duration in chemo-naive patients with SCLC receiving a 3-day topotecan and cisplatin schedule. METHODS: Simons optimal two-stage design was used. Patients with previously untreated extensive disease SCLC......, adequate organ functions and performance status less than 3 were eligible. Topotecan (2.0 mg/m, intravenously) was administered on days 1 to 3 with cisplatin (50 mg/m, intravenously) on day 3 every 3 weeks for a total of six cycles. RESULTS: Forty-three patients received 219 cycles of chemotherapy. Median.......3-7.7), respectively. CONCLUSION: Three-day topotecan with cisplatin on day 3 is active and safe in extensive disease SCLC. An ongoing phase III randomized trial compares this combination to standard treatment Udgivelsesdato: 2008/8...


    Hausmann, Jennifer C; Wack, Allison N; Allender, Matthew C; Cranfield, Mike R; Murphy, Kevin J; Barrett, Kevin; Romero, Jennell L; Wellehan, James F X; Blum, Stella A; Zink, M Christine; Bronson, Ellen


    The Maryland Zoo in Baltimore experienced an outbreak of Frog virus-3 (FV3)-like ranavirus during the summer of 2011, during which 14 of 27 (52%) of its captive eastern box turtles (Terrapene carolina carolina) survived. To assess survival, immunity, and viral shedding, an experimental challenge study was performed in which the surviving, previously infected turtles were reinfected with the outbreak strain of FV3-like ranavirus. Seven turtles were inoculated with virus intramuscularly and four control turtles received saline intramuscularly. The turtles were monitored for 8 wk with blood and oral swabs collected for quantitative polymerase chain reaction (qPCR). During that time, one of seven (14%) inoculated turtles and none of the controls (0%) died; there was no significant difference in survival. Clinical signs of the inoculated turtles, except for the turtle that died, were mild compared to the original outbreak. Quantitative PCR for FV3-like ranavirus on blood and oral swabs was positive for all inoculated turtles and negative for all controls. The turtle that died had intracytoplasmic inclusion bodies in multiple organs. Three inoculated and two control turtles were euthanized at the end of the study. No inclusion bodies were present in any of the organs. Quantitative PCR detected FV3-like ranavirus in the spleen of a control turtle, which suggested persistence of the virus. The surviving five turtles were qPCR-negative for FV3-like ranavirus from blood and oral swabs after brumation. Quantitative PCR for Terrapene herpesvirus 1 found no association between ranavirus infection and herpesvirus loads. In conclusion, previously infected eastern box turtles can be reinfected with the same strain of FV3-like ranavirus and show mild to no clinical signs but can shed the virus from the oral cavity.

  5. Clinical evaluation of balloon occlusion of the lower abdominal aorta in patients with placenta previa and previous cesarean section: A retrospective study on 43 cases.

    Chen, Manru; Xie, Lan


    This study investigated the efficacy of balloon occlusion of the lower abdominal aorta in cesarean section surgery for the patients with placenta previa and previous cesarean section. The patients who had placenta previa and underwent cesarean section (CS) were evaluated. The patients treated with CS to terminate the pregnancy were used as control group (23 cases); the patients treated with the preset abdominal aorta balloon before CS was taken as study group (20 cases). The investigated indicators included the intraoperative blood loss, blood loss within postoperative 24 h, the transfusion amount of red cell suspension (RCS), hospital stay, incidence rate of disseminated intravascular coagulation (DIC), the asphyxia, premature delivery and the mortality of the newborns. The two groups are comparable. The intraoperative blood loss, blood loss within postoperative 24 h, the transfusion amount of RCS and the percentage of uterus resection in the study group were significantly lower (P < 0.05) than that in the control group. The percentage of uterine cavity filling with ribbon gauze in the study group was higher than the control group (P < 0.05). The balloon occlusion of lower abdominal aorta seems effective in reducing postpartum hemorrhage and the blood transfusion and decreasing the risk of hysterectomy without harming the newborns. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.


    S. A. Shal'nova


    Full Text Available Principles and fundamentals of proper presentation of observational epidemiological study results are focused. Principles of observational study publication developed by expert epidemiologists (STROBE statement are explained in detail.

  7. Biomarker-driven trial in metastatic pancreas cancer: feasibility in a multicenter study of saracatinib, an oral Src inhibitor, in previously treated pancreatic cancer.

    Arcaroli, John; Quackenbush, Kevin; Dasari, Arvind; Powell, Rebecca; McManus, Martine; Tan, Aik-Choon; Foster, Nathan R; Picus, Joel; Wright, John; Nallapareddy, Sujatha; Erlichman, Charles; Hidalgo, Manuel; Messersmith, Wells A


    Src tyrosine kinases are overexpressed in pancreatic cancers, and the oral Src inhibitor saracatinib has shown antitumor activity in preclinical models of pancreas cancer. We performed a CTEP-sponsored Phase II clinical trial of saracatinib in previously treated pancreas cancer patients, with a primary endpoint of 6-month survival. A Simon MinMax two-stage phase II design was used. Saracatinib (175 mg/day) was administered orally continuously in 28-day cycles. In the unselected portion of the study, 18 patients were evaluable. Only two (11%) patients survived for at least 6 months, and three 6-month survivors were required to move to second stage of study as originally designed. The study was amended as a biomarker-driven trial (leucine rich repeat containing protein 19 [LRRC19] > insulin-like growth factor-binding protein 2 [IGFBP2] "top scoring pairs" polymerase chain reaction [PCR] assay, and PIK3CA mutant) based on preclinical data in a human pancreas tumor explant model. In the biomarker study, archival tumor tissue or fresh tumor biopsies were tested. Biomarker-positive patients were eligible for the study. Only one patient was PIK3CA mutant in a 3' untranslated region (UTR) portion of the gene. This patient was enrolled in the study and failed to meet the 6-month survival endpoint. As the frequency of biomarker-positive patients was very low (pancreatic cancer patients treated with a Src inhibitor based on a biomarker would improve 6-month survival, we demonstrate that testing pancreatic tumor samples for a biomarker-driven, multicenter study in metastatic pancreas cancer is feasible.

  8. A Phase III Study of Durvalumab (MEDI4736) With or Without Tremelimumab for Previously Treated Patients With Advanced NSCLC: Rationale and Protocol Design of the ARCTIC Study.

    Planchard, David; Yokoi, Takashi; McCleod, Michael J; Fischer, Jürgen R; Kim, Young-Chul; Ballas, Marc; Shi, Kelvin; Soria, Jean-Charles


    Anti-programmed cell death-1 and anti-programmed cell death ligand-1 (PD-L1) monotherapies have shown promising clinical activity in advanced, refractory non-small-cell lung cancer (NSCLC), but antitumor activity appears to be greater in patients with PD-L1(+) tumors compared with patients harboring PD-L1(-) tumors. Combining the anti-PD-L1 antibody durvalumab and the anti-cytotoxic T-lymphocyte antigen 4 antibody tremelimumab offers the potential for antitumor activity in patients with advanced NSCLC, regardless of PD-L1 tumor status. ARCTIC (NCT02352948) is a global, phase III, randomized, open-label multicenter study in patients with advanced NSCLC assessing the safety and clinical activity of durvalumab versus standard of care (SoC; erlotinib, gemcitabine, or vinorelbine) in patients with PD-L1(+) tumors (≥25% of tumor cells with membrane staining using VENTANA PD-L1 [SP263] CDx Assay) (Sub-study A) and the combination of durvalumab + tremelimumab or either agent as monotherapy versus SoC in patients with PD-L1(-) tumors (Sub-study B). Eligible patients are those with locally advanced or metastatic NSCLC (Stage IIIB/IV), without epidermal growth factor receptor tyrosine kinase activating mutations or anaplastic lymphoma kinase rearrangements, who have received at least 2 prior systemic regimens, including 1 platinum-based chemotherapy regimen. Co-primary endpoints are progression-free survival and overall survival. Secondary endpoints include the proportion of patients alive at 12 months, objective response rate, duration of response, progression-free survival at 6 and 12 months, safety and tolerability, pharmacokinetics, immunogenicity, and quality of life. The exploratory endpoints will assess potential biomarkers of treatment response. Recruitment started in January 2015 and is ongoing.

  9. Phase III study of 5FU, etoposide and leucovorin (FELV) compared to epirubicin, cisplatin and 5FU (ECF) in previously untreated patients with advanced biliary cancer.

    Rao, S; Cunningham, D; Hawkins, R E; Hill, M E; Smith, D; Daniel, F; Ross, P J; Oates, J; Norman, A R


    The purpose of this study was to determine whether epirubicin, cisplatin and infused 5FU (ECF) improves overall survival (OS) compared to 5FU, etoposide and leucovorin (FELV) in patients with previously untreated advanced biliary cancer in a prospective randomised study. Patients were randomly assigned to receive epirubicin, cisplatin and infused 5FU ECF or bolus 5FU etoposide and leucovorin (FELV). The primary end point was OS with secondary end points of objective response rate (ORR), failure-free survival (FFS), quality of life (QOL) and toxicity. In all, 54 patients were recruited with 27 randomly assigned to each arm. The median OS for ECF was 9.02 months (95% confidence interval (CI): 6.46-11.51) and FELV 12.03 months (95% CI: 9.3-14.7), P=0.2059. Objective response rates were similar for both arms: ECF 19.2% (95% CI: 6.55-39.3); FELV 15% (95% CI: 3.2-37.9), P=0.72. There was significantly increased grade 3/4 neutropenia with FELV vs ECF (53.8 vs 29.5%, respectively, P=0.020). Symptom resolution was impressive for both regimens. This is the largest reported randomised study to date in this setting. ECF did not improve OS compared to FELV, but was associated with less acute toxicity. These data suggest that chemotherapy can prolong OS and achieve good symptomatic relief in advanced biliary cancer.

  10. Simulation Study Of Early Afterglows Observed With Swift

    Nishikawa, Ken-Ichi; Hededal, C.; Hardee, P.; Mizuno, Y.; Fishman, G. J.


    A 3-D relativistic particle-in-cell code has been used to simulate the dynamics of forward and reverse shocks with thin and thick shells within the parameter constraints provided by present Swift observations and the present models of GRB emission. Our 3-D RPIC simulations have provided the dynamics of collisionless shocks in electron-ion and electron-positron plasmas with and without initial ambient magnetic fields and revealed the importance of ``jitter radiation'' with prompt and afterglow spectra due to the inhomogeneous magnetic fields generated by the Weibel instability. It is different from synchrotron radiation, which is usually assumed to be the dominant radiation process. We have investigated gamma-ray burst emissions from prompt, early, and late afterglows considering microscopic processes. Based on our previous investigation of the Weibel instability for each stage of evolution of ejecta propagating in the ISM, we have incorporated the plasma conditions (relativistic jets) with the density and composition of the plasmas, the magnetic field strength ($\\sigma$-values (the ratio of the electromagnetic energy flux to the particle energy flux)) and its direction, and the Lorentz factor for the different stages in prompt and afterglows. Systematic simulation studies of the relativistic collisionless shocks, associated particle acceleration, magnetic field generation and self-consistent radiation provide insight into undetermined issues in prompt and afterglows observed by Swift. Self-consistently calculated lightcurves, spectra, spectral evolutions, and polarization as function of viewing angle will be done to light a shed on recent new observations by Swift, in particular, X-ray flares, early steep decay, and shallow decay.

  11. A Retrospective Case-Control Study Evaluating the Role of Mifepristone for Induction of Labor in Women with Previous Cesarean Section.

    Sharma, Chanderdeep; Soni, Anjali; Soni, Pawan K; Verma, Suresh; Verma, Ashok; Gupta, Amit


    To investigate the role of "mifepristone" for induction of labor (IOL) in pregnant women with prior cesarean section (CS). In this retrospective study, all pregnant women with prior CS who received oral mifepristone (400 mg) for IOL (as per clear obstetric indications) [group 1] were compared with pregnant women with prior CS who had spontaneous onset of labor (SOL) [group 2], with respect to incidence of vaginal delivery, CS, duration of labor, and various maternal and fetal outcomes. During the study period, 72 women received mifepristone (group 1) for IOL and 346 had SOL (group 2). In group 1 after mifepristone administration, 40 (55.6 %) women had labor onset, and 24 (33.3 %) women had cervical ripening (Bishop Score ≥ 8) within 48 h. There were no statistically significant differences with respect to duration of labor (p value: 0.681), mode of delivery (i.e., normal delivery or CS-p value: 0.076 or 0.120, respectively), or maternal (blood loss or scar dehiscence/rupture uterus), or fetal outcomes (NICU admission) compared to women with previous CS with SOL (group 2). However, the need of oxytocin (p value 0.020) and dose of oxytocin requirement (p value 0.008) were more statistically significant in group 1. Mifepristone may be considered as an agent for IOL in women with prior CS.

  12. ACTG-HIV symptoms changes in patients switched to RPV/FTC/TDF due to previous intolerance to CART. Interim analysis of the PRO-STR study

    Daniel Podzamczer


    Full Text Available Introduction: Tolerability and convenience are crucial aspects for the long-term success of combined antiretroviral therapy (cART. The aim of this study was to investigate the impact in routine clinical practice of switching to the single tablet regimen (STR RPV/FTC/TDF in patients with intolerance to previous cART, in terms of patients’ well-being, assessed by several validated measures. Methods: Prospective, multicenter study. Adult HIV-infected patients with viral load under 1.000 copies/mL while receiving a stable ART for at least the last three months and switched to RPV/FTC/TDF due to intolerance of previous regimen, were included. Analyses were performed by ITT. Presence/magnitude of symptoms (ACTG-HIV Symptom Index, quality of life (EQ-5D, EUROQoL & MOS-HIV, adherence (SMAQ, preference of treatment and perceived ease of medication (ESTAR through 48 weeks were performed. Results: Interim analysis of 125 patients with 16 weeks of follow up was performed. 100 (80% were male, mean age 46 years. Mean CD4 at baseline was 629.5±307.29 and 123 (98.4% had viral load <50 copies/mL; 15% were HCV co-infected. Ninety two (73.6% patients switched from a NNRTI (84.8% from EFV/FTC/TDF and 33 (26.4% from a PI/r. The most frequent reasons for switching were psychiatric disorders (51.2%, CNS adverse events (40.8%, gastrointestinal (19.2% and metabolic disorders (19.2%. At the time of this analysis (week 16, four patients (3.2% discontinued treatment: one due to adverse events, two virologic failures and one with no data. A total of 104 patients (83.2% were virologically suppressed (<50 copies/mL. The average degree of discomfort in the ACTG-HIV Symptom Index significantly decreased from baseline (21±15.55 to week 4 (10.89±12.36 & week 16 (10.81±12.62, p<0.001. In all the patients, quality of life tools showed a significant benefit in well-being of the patients (Table 1. Adherence to therapy significantly and progressively increased (SMAQ from

  13. Late tamoxifen in patients previously operated for breast cancer without postoperative tamoxifen: 5-year results of a single institution randomised study

    Bidoli Ettore


    Full Text Available Abstract Background A population of breast cancer patients exists who, for various reasons, never received adjuvant post-operative tamoxifen (TAM. This study was aimed to evaluate the role of late TAM in these patients. Methods From 1997 to 2003, patients aged 35 to 75 years, operated more than 2 years previously for monolateral breast cancer without adjuvant TAM, with no signs of metastases and no contraindication to TAM were randomized to TAM 20 mg/day orally for 2 years or follow-up alone. Events were categorized as locoregional relapse, distant metastases, metachronous breast cancer, tumours other than breast cancer and death from any causes, whichever occurred first. The sample size (197 patients per arm, plus 10% allowance was based on the assumption of a 30% decrease in the number of events occurring at a rate of 5% annually in the 10 years following randomization. Four hundred and thirty-three patients were randomized in the study (TAM 217, follow-up 216. Patients characteristics (TAM/follow-up included: median age 55/55 years, median time from surgery 25/25 months (range, 25-288/25-294, in situ carcinoma 18/24, oestrogen receptor (ER positive in 75/68, negative in 70/57, unknown in 72/91 patients. Previous adjuvant treatment included chemotherapy in 131/120 and an LHRH analogue in 11/13 patients. Results Thirty-six patients prematurely discontinued TAM after a median of 1 month, mostly because of subjective intolerance. Eighty-three events (TAM 39, follow-up 44 occurred: locoregional relapse in 10/8, distant metastases in 14/16, metachronous breast cancer in 4/10, other tumours in 11/10 patients. Less ER-positive secondary breast cancers occurred in the TAM treated patients than in follow-up patients (1 vs 10, p = 0.005. Event-free survival was similar in both groups of patients. Conclusions This 5-year analysis revealed significantly less metachronous ER-positive breast cancers in the TAM treated patients. No other statistically

  14. In vitro evaluation of oestrogenic/androgenic activity of the serum organochlorine pesticide mixtures previously described in a breast cancer case–control study

    Rivero, Javier; Luzardo, Octavio P., E-mail:; Henríquez-Hernández, Luis A.; Machín, Rubén P.; Pestano, José; Zumbado, Manuel; Boada, Luis D.; Camacho, María; Valerón, Pilar F.


    Some organochlorine pesticides (OCs) have been individually linked to breast cancer (BC) because they exert oestrogenic effects on mammary cells. However, humans are environmentally exposed to more or less complex mixtures of these organochlorines, and the biological effects of these mixtures must be elucidated. In this work we evaluated the in vitro effects exerted on human BC cells by the OC mixtures that were most frequently detected in two groups of women who participated in a BC case–control study developed in Spain: healthy women and women diagnosed with BC. The cytotoxicity, oestrogenicity, and androgenicity of the most prevalent OC mixtures found in healthy women (H-mixture) and in BC patients (BC-mixture) were tested at concentrations that resembled those found in the serum of the evaluated women. Our results showed that both OC mixtures presented a similar oestrogenic activity and effect on cell viability, but BC-mixture showed an additional anti-androgenic effect. These results indicate that although the proliferative effect exerted by these mixtures on human breast cells seems to depend mainly on their oestrogenic action, the BC-mixture might additionally induce cell proliferation due to its anti-androgenic activity, therefore increasing the carcinogenic potential of this mixture. The findings of this study demonstrate that subtle variations in the composition of a mixture may induce relevant changes in its biological action. - Highlights: • E-screen and A-screen of two mixtures of organochlorine pesticides (OCP) • Assay concentrations based on a previous breast cancer case–control study • Only non-cytotoxic concentrations assayed • Both OCP mixtures induce proliferation mediated by oestrogen receptor. • OCP mixture of breast cancer patients exhibits additional androgenic activity.

  15. Evaluation of the Widal tube agglutination test for the diagnosis of typhoid fever among children admitted to a rural hdospital in Tanzania and a comparison with previous studies

    Malahiyo Rajabu


    Full Text Available Abstract Background The diagnosis of typhoid fever is confirmed by culture of Salmonella enterica serotype Typhi (S. typhi. However, a more rapid, simpler, and cheaper diagnostic method would be very useful especially in developing countries. The Widal test is widely used in Africa but little information exists about its reliability. Methods We assessed the performance of the Widal tube agglutination test among febrile hospitalized Tanzanian children. We calculated the sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV of various anti-TH and -TO titers using culture-confirmed typhoid fever cases as the "true positives" and all other febrile children with blood culture negative for S. typhi as the "true negatives." Results We found that 16 (1% of 1,680 children had culture-proven typhoid fever. A single anti-TH titer of 1:80 and higher was the optimal indicator of typhoid fever. This had a sensitivity of 75%, specificity of 98%, NPV of 100%, but PPV was only 26%. We compared our main findings with those from previous studies. Conclusion Among febrile hospitalized Tanzanian children with a low prevalence of typhoid fever, a Widal titer of ≥ 1:80 performed well in terms of sensitivity, specificity, and NPV. However a test with improved PPV that is similarly easy to apply and cost-efficient is desirable.

  16. Efficacy of confrontational counselling for smoking cessation in smokers with previously undiagnosed mild to moderate airflow limitation: study protocol of a randomized controlled trial

    Huibers Marcus JH


    Full Text Available Abstract Background The use of spirometry for early detection of chronic obstructive pulmonary disease (COPD is still an issue of debate, particularly because of a lack of convincing evidence that spirometry has an added positive effect on smoking cessation. We hypothesise that early detection of COPD and confrontation with spirometry for smoking cessation may be effective when applying an approach we have termed "confrontational counselling"; a patient-centred approach which involves specific communication skills and elements of cognitive therapy. An important aspect is to confront the smoker with his/her airflow limitation during the counselling sessions. The primary objective of this study is to test the efficacy of confrontational counselling in comparison to regular health education and promotion for smoking cessation delivered by specialized respiratory nurses in current smokers with previously undiagnosed mild to moderate airflow limitation. Methods/Design The study design is a randomized controlled trial comparing confrontational counselling delivered by a respiratory nurse combined with nortriptyline for smoking cessation (experimental group, health education and promotion delivered by a respiratory nurse combined with nortriptyline for smoking cessation (control group 1, and "care as usual" delivered by the GP (control group 2. Early detection of smokers with mild to moderate airflow limitation is achieved by means of a telephone interview in combination with spirometry. Due to a comparable baseline risk of airflow limitation and motivation to quit smoking, and because of the standardization of number, duration, and scheduling of counselling sessions between the experimental group and control group 1, the study enables to assess the "net" effect of confrontational counselling. The study has been ethically approved and registered. Discussion Ethical as well as methodological considerations of the study are discussed in this protocol. A

  17. Phase II Study of Bortezomib as a Single Agent in Patients with Previously Untreated or Relapsed/Refractory Acute Myeloid Leukemia Ineligible for Intensive Therapy

    Chiara Sarlo


    Full Text Available We explored the safety and efficacy of bortezomib given as single agent in patients with untreated or relapsed/refractory acute myeloid leukemia (AML, unfit for conventional chemotherapy. Fourteen patients were treated with bortezomib 1.5 mg/m2 administered twice weekly for two weeks, every 3 weeks. Median age was 70 years (range 60–81 and the median number of cycles delivered was 2 (range 1–4. Of 13 evaluable patients, in 8 (61%, the administration of bortezomib resulted in an antileukemic effect as demonstrated by peripheral blood and/or bone marrow blast reduction. In 4 (50% of these 8, a decrease by 37% of transfusion requirement was also observed . Overall median survival was 4 months (range 0.25–10. Neurotoxicity was the most frequent adverse event with 7 of 13 (54% patients experiencing grades 3-4 peripheral neuropathy. Neurotoxicity led to treatment discontinuation in 4 (57% of 7. In conclusion, the observed anti-leukemic activity of bortezomib indicates that there is room for designing additional studies in which combination with other chemotherapeutic agents should be considered. Clinical registration no.: EUDRACT 2006-006923-38.

  18. Ground-water quality in Geauga County, Ohio; review of previous studies, status in 1999, and comparison of 1986 and 1999 data

    Jagucki, Martha L.; Darner, Robert A.


    Most residents in Geauga County, Ohio, rely on ground water as their primary source of drinking water. With population growing at a steady rate, the possibility that human activity will affect ground-water quality becomes considerable. This report presents the results of a study by the U.S. Geological Survey (USGS), in cooperation with the Geauga County Planning Commission and Board of County Commissioners, to provide a brief synopsis of work previously done within the county, to assess the present (1999) ground-water quality, and to determine any changes in ground-water quality between 1986 and 1999. Previous studies of ground-water quality in the county have consistently reported that manganese and iron concentrations in ground water in Geauga County often exceed the U.S. Environmental Protection Agency (USEPA) Secondary Maximum Contaminant Level (SMCL). Road salt and, less commonly, oil-field brines and volatile organic compounds (VOCs) have been found in ground water at isolated locations. Nitrate has not been detected above the USEPA Maximum Contaminant Level (MCL) of 10 milligrams per liter as N; however, nitrate has been found in some locations at levels that may indicate the effects of fertilizer application or effluent from septic systems. Between June 7 and July 1, 1999, USGS personnel collected a total of 31 water-quality samples from wells completed in glacial deposits, the Pottsville Formation, the Cuyahoga Group, and the Berea Sandstone. All samples were analyzed for VOCs, sulfide, dissolved organic carbon, major ions, trace elements, alkalinity, total coliforms, and Escherichia coli bacteria. Fourteen of the samples also were analyzed for tritium. Water-quality data were used to determine (1) suitability of water for drinking, (2) age of ground water, (3) stratigraphic variation in water quality, (4) controls on water quality, and (5) temporal variation in water quality. Water from 16 of the 31 samples exceeded the Geauga County General Health

  19. Observational Study of Spinal Muscular Atrophy Type 2 and 3

    Kaufmann, Petra; McDermott, Michael P.; Darras, Basil T.; Finkel, Richard; Kang, Peter; Oskoui, Maryam; Constantinescu, Andrei; Sproule, Douglas Michael; Foley, A. Reghan; Yang, Michele; Tawil, Rabi; Chung, Wendy; Martens, Bill; Montes, Jacqueline; O'Hagen, Jessica; Dunaway, Sally; Flickinger, Jean M.; Quigley, Janet; Riley, Susan; Glanzman, Allan M.; Benton, Maryjane; Ryan, Patricia A.; Irvine, Carrie; Annis, Christine L.; Butler, Hailly; Caracciolo, Jayson; Montgomery, Megan; Marra, Jonathan; Koo, Benjamin; De Vivo, Darryl C.


    Objective To characterize the short-term course of spinal muscular atrophy (SMA) in a genetically and clinically well-defined cohort of patients with SMA. Design A comprehensive multicenter, longitudinal, observational study. Setting The Pediatric Neuromuscular Clinical Research Network for SMA, a consortium of clinical investigators at 3 clinical sites. Participants Sixty-five participants with SMA types 2 and 3, aged 20 months to 45 years, were prospectively evaluated. Intervention We collected demographic and medical history information and determined the SMN2 copy number. Main Outcome Measures Clinical outcomes included measures of motor function (Gross Motor Function Measure and expanded Hammersmith Functional Motor Scale), pulmonary function (forced vital capacity), and muscle strength (myometry). Participants were evaluated every 2 months for the initial 6 months and every 3 months for the subsequent 6 months. We evaluated change over 12 months for all clinical outcomes and examined potential correlates of change over time including age, sex, SMA type, ambulatory status, SMN2 copy number, medication use, and baseline function. Results There were no significant changes over 12 months in motor function, pulmonary function, and muscle strength measures. There was evidence of motor function gain in ambulatory patients, especially in those children younger than 5 years. Scoliosis surgery during the observation period led to a subsequent decline in motor function. Conclusions Our results confirm previous clinical reports suggesting that SMA types 2 and 3 represent chronic phenotypes that have relatively stable clinical courses. We did not detect any measurable clinical disease progression in SMA types 2 and 3 over 12 months, suggesting that clinical trials will have to be designed to measure improvement rather than stabilization of disease progression. PMID:21320981

  20. Leflunomide in Takayasu arteritis – A long term observational study

    Souza, Alexandre Wagner Silva de [UNIFESP; Agustinelli,Renan de Almeida; Almeida,Hemerli de Cinque; Oliveira,Patrícia Bermudes; Pinheiro,Frederico Augusto Gurgel; Oliveira,Ana Cecilia Diniz; Sato, Emilia Inoue [UNIFESP


    ABSTRACT Objective: To evaluate the extended follow-up data on efficacy and toxicity of leflunomide therapy in Takayasu arteritis (TA) patients previously enrolled in the original open-label study of short-term effects of leflunomide in TA. Methods: An open-label long-term longitudinal study was performed in TA patients who fulfilled the 1990 American College of Rheumatology criteria for TA and had participated in a previous study that evaluated short-term efficacy of leflunomide in TA. Com...

  1. Observational studies and the difficult quest for causality

    Lipsitch, Marc; Jha, Ayan; Simonsen, Lone


    be answered once the vaccine is in use, from observational studies. However, such studies are inherently at risk for bias. Using a causal framework and illustrating with examples, we review newer approaches to detecting and avoiding confounding and selection bias in three major classes of observational study...

  2. Alfalfa (Medicago sativa L.) is tolerant to higher levels of salinity than previous guidelines indicated: Implications of field and greenhouse studies

    Putnam, Daniel H.; Benes, Sharon; Galdi, Giuliano; Hutmacher, Bob; Grattan, Steve


    Alfalfa (Medicago sativa L.) is the most widely grown leguminous forage crop in North America and is valued for high productivity, quality, economic value, and for dairy productivity. Alfalfa has historically been classified as moderately sensitive to saline conditions, with yield declines predicted at >2 dS/m in the saturated soil paste extract. However, greenhouse, sand tank, and field studies over the past five years have confirmed that alfalfa can be grown with limited negative effects at much higher salinity levels. A broad collection of alfalfa varieties has exhibited a range of resistance at irrigation water salinities >5 dS/m ECw in greenhouse trials, with significant variation due to variety. USDA-ARS sand tank studies indicated similar or greater tolerances closer to 8 dS/m in the soil water, in addition to confirmation of significant varietal differences. A three-year field study on clay loam soil with applications of 5-7 dS/m ECw irrigation water indicated normal yields and excellent stand survivability. A second field study in the same soil type with levels from 8-10 dS/m ECw showed yield reductions of 10-15% but economic yields were still achieved at those levels. Field and greenhouse studies were conducted with mixed salt saline sodic waters typical of the San Joaquin Valley of California. Field evaluation of variety performance was subject to greater variation due to secondary salinity-soil interactions including water infiltration and crusting problems, not only salinity per-se. Thus, adequate irrigation water availability to the crop may be as important as salinity in impacting yields under field conditions. Once established, the deep-rooted characteristics of alfalfa enable utilization of deeper subsurface moisture, even at moderate to high salinity levels, as documented by USDA lysimeter studies. Significant advantages to salinity-tolerant varieties have been observed. It will be important to consider specific management factors which may enable

  3. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)

    Vandenbroucke, Jan P; von Elm, Erik; Altman, Douglas G


    Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical conside......, and the associated Web site ( should be helpful resources to improve reporting of observational research....... to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how...

  4. Erlotinib dosing-to-rash: A phase II intrapatient dose escalation and pharmacologic study of erlotinib in previously treated advanced non-small cell lung cancer

    A. mita (Alain); K. Papadopoulos (K.); M.J.A. de Jonge (Maja); G. Schwartz (G.); J. Verweij (Jaap); A. Ricart (A.); Q.S.C. Chu (Q. S C); A.W. Tolcher (A. W.); L. Wood (Lori); S.W. McCarthy (Stanley); M. Hamilton; K.K. Iwata (Kenneth); B. Wacker; K. de Witte (Karel); E.K. Rowinsky (Eric Keith)


    textabstractBackground: To evaluate the anticancer activity of erlotinib in patients with previously treated, advanced non-small cell lung cancer (NSCLC) whose dose is increased to that associated with a maximal level of tolerable skin toxicity (i.e., target rash (TR)); to characterise the pharmacok

  5. Phase I study of cisplatin, hyperthermia, and lapatinib in patients with recurrent carcinoma of the uterine cervix in a previously irradiated area

    E.V. Meerten (Esther Van); M. Franckena (Martine); E.A.C. Wiemer (Erik); L.V. Doorn (Lena Van); J. Kraan (Jaco); A.M. Westermann (Anneke); S. Sleijfer (Stefan)


    textabstractBackground. Patients with recurrent cervical cancer in a previously irradiated area might benefit from cisplatin combined with hyperthermia. Lapatinib inhibits the intracellular tyrosine kinase domain of the epidermal growth factor receptor (EGFR) and HER2. Overexpression of EGFR and

  6. Impact of previous percutaneous transluminal coronary angioplasty and/or stenting revascularization on outcomes after surgical revascularization : insights from the imagine study

    Chocron, Sidney; Baillot, Richard; Rouleau, Jean Lucien; Warnica, Wayne J.; Block, Pierre; Johnstone, David; Myers, Martin G.; Calciu, Cristina Dana; Nozza, Anna; Martineau, Pierre; van Gilst, Wiek H.


    Aim To determine the impact of previous coronary artery revascularization by percutaneous transluminal coronary angioplasty and/or stenting (PCI) on outcome after subsequent coronary artery bypass grafting (CABG). Methods and results The ischaemia management with Accupril post-bypass Graft via Inhib

  7. Concatenation of observed grasp phases with observer's distal movements: a behavioural and TMS study.

    Elisa De Stefani

    Full Text Available The present study aimed at determining how actions executed by two conspecifics can be coordinated with each other, or more specifically, how the observation of different phases of a reaching-grasping action is temporary related to the execution of a movement of the observer. Participants observed postures of initial finger opening, maximal finger aperture, and final finger closing of grasp after observation of an initial hand posture. Then, they opened or closed their right thumb and index finger (experiments 1, 2 and 3. Response times decreased, whereas acceleration and velocity of actual finger movements increased when observing the two late phases of grasp. In addition, the results ruled out the possibility that this effect was due to salience of the visual stimulus when the hand was close to the target and confirmed an effect of even hand postures in addition to hand apparent motion due to the succession of initial hand posture and grasp phase. In experiments 4 and 5, the observation of grasp phases modulated even foot movements and pronunciation of syllables. Finally, in experiment 6, transcranial magnetic stimulation applied to primary motor cortex 300 ms post-stimulus induced an increase in hand motor evoked potentials of opponens pollicis muscle when observing the two late phases of grasp. These data suggest that the observation of grasp phases induced simulation which was stronger during observation of finger closing. This produced shorter response times, greater acceleration and velocity of the successive movement. In general, our data suggest best concatenation between two movements (one observed and the other executed when the observed (and simulated movement was to be accomplished. The mechanism joining the observation of a conspecific's action with our own movement may be precursor of social functions. It may be at the basis for interactions between conspecifics, and related to communication between individuals.

  8. Observation

    Patell, Hilla


    In order to achieve the goal of observation, preparation of the adult, the observer, is necessary. This preparation, says Hilla Patell, requires us to "have an appreciation of the significance of the child's spontaneous activities and a more thorough understanding of the child's needs." She discusses the growth of both the desire to…

  9. Observation

    Kripalani, Lakshmi A.


    The adult who is inexperienced in the art of observation may, even with the best intentions, react to a child's behavior in a way that hinders instead of helping the child's development. Kripalani outlines the need for training and practice in observation in order to "understand the needs of the children understand how to remove…

  10. Learning to observe mathematical learning in lesson studies

    Rasmussen, Klaus; Østergaard, Camilla Hellsten; Foss, Kristian Kildemoes


    This poster deals with lesson study (LS) in pre-service teacher education. In particular how to prepare for, carry out, and reflect upon, observations of pupil learning. Observation is of crucial importance to the lesson study process, and here we present a study of observation features which...... enable or hinder fruitful lesson study. While substantial research has been carried out in the general field of bserving pupils’ learning processes and teachers’ pedagogical practice, little is known about this in the particular setting of lesson study....

  11. Observation of pentaquark states and perspectives of further studies

    Shen, Cheng-Ping


    In this invited short "news and views", we review very briefly the history of pentaquark studies and the recent observations of the tetraquark and pentaquark states. We also discuss further experimental studies such as at Belle-II.

  12. A foundational observation method for studying design situations

    Cash, Philip; Hicks, Ben; Culley, Steve


    Observational studies of designers play an important role in engineering design research, yet there is currently no accepted standard approach for comparing, combining, or contrasting studies. Consequentially, reuse, reanalysis, replication, and aggregation of data are limited and the potential...... impact of individual studies is severely constrained. This paper begins to address this issue by introducing and developing a foundational method for observational design research to improve replicability, reuse, and overall comparability of empirical studies. A three-step foundational method is proposed...

  13. A cross-sectional study of 'yaws' in districts of Ghana which have previously undertaken azithromycin mass drug administration for trachoma control.

    Rosanna Ghinai


    Full Text Available Yaws, caused by Treponema pallidum ssp. pertenue, is reportedly endemic in Ghana. Mass distribution of azithromycin is now the cornerstone of the WHO yaws eradication campaign. Mass distribution of azithromycin at a lower target dose was previously undertaken in two regions of Ghana for the control of trachoma. Ongoing reporting of yaws raises the possibility that resistance may have emerged in T. pallidum pertenue, or that alternative infections may be responsible for some of the reported cases. We conducted a cross-sectional survey in thirty communities in two districts of Ghana where MDA for trachoma had previously been conducted. Children aged 5-17 years with ulcerative lesions compatible with yaws were enrolled. Samples for treponemal serology and lesion PCR were collected from all children. 90 children with 98 lesions were enrolled. Syphilis serology was negative in all of them. PCR for T. pallidum ssp pertenue was negative in all children, but Haemophilus ducreyi DNA was detected in 9 lesions. In these communities, previously treated for trachoma, we found no evidence of ongoing transmission of yaws. H. ducreyi was associated with a proportion of skin lesions, but the majority of lesions remain unexplained. Integration of diagnostic testing into both pre and post-MDA surveillance systems is required to better inform yaws control programmes.

  14. A cross-sectional study of 'yaws' in districts of Ghana which have previously undertaken azithromycin mass drug administration for trachoma control.

    Ghinai, Rosanna; El-Duah, Philip; Chi, Kai-Hua; Pillay, Allan; Solomon, Anthony W; Bailey, Robin L; Agana, Nsiire; Mabey, David C W; Chen, Cheng-Yen; Adu-Sarkodie, Yaw; Marks, Michael


    Yaws, caused by Treponema pallidum ssp. pertenue, is reportedly endemic in Ghana. Mass distribution of azithromycin is now the cornerstone of the WHO yaws eradication campaign. Mass distribution of azithromycin at a lower target dose was previously undertaken in two regions of Ghana for the control of trachoma. Ongoing reporting of yaws raises the possibility that resistance may have emerged in T. pallidum pertenue, or that alternative infections may be responsible for some of the reported cases. We conducted a cross-sectional survey in thirty communities in two districts of Ghana where MDA for trachoma had previously been conducted. Children aged 5-17 years with ulcerative lesions compatible with yaws were enrolled. Samples for treponemal serology and lesion PCR were collected from all children. 90 children with 98 lesions were enrolled. Syphilis serology was negative in all of them. PCR for T. pallidum ssp pertenue was negative in all children, but Haemophilus ducreyi DNA was detected in 9 lesions. In these communities, previously treated for trachoma, we found no evidence of ongoing transmission of yaws. H. ducreyi was associated with a proportion of skin lesions, but the majority of lesions remain unexplained. Integration of diagnostic testing into both pre and post-MDA surveillance systems is required to better inform yaws control programmes.

  15. Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study

    Schramm, Tina Ken; Gislason, Gunnar Hilmar; Vaag, Allan


    % confidence intervals): 1.32 (1.24-1.40), glibenclamide: 1.19 (1.11-1.28), glipizide: 1.27 (1.17-1.38), and tolbutamide: 1.28 (1.17-1.39) were associated with increased all-cause mortality in patients without previous MI. The corresponding results for patients with previous MI were as follows: glimepiride: 1.......30 (1.11-1.44), glibenclamide: 1.47 (1.22-1.76), glipizide: 1.53 (1.23-1.89), and tolbutamide: 1.47 (1.17-1.84). Results for gliclazide [1.05 (0.94-1.16) and 0.90 (0.68-1.20)] and repaglinide and [0.97 (0.81-1.15) and 1.29 (0.86-1.94)] were not statistically different from metformin in both patients...... without and with previous MI, respectively. Results were similar for cardiovascular mortality and for the composite endpoint. Conclusion Monotherapy with the most used ISs, including glimepiride, glibenclamide, glipizide, and tolbutamide, seems to be associated with increased mortality and cardiovascular...

  16. Observational cohort study of HIV-infected African children.

    Laufer, M.K.; Oosterhout, J.J. van; Perez, M.A.; Kanyanganlika, J.; Taylor, T.E.; Plowe, C.V.; Graham, S.M.


    BACKGROUND: Most information about children living with HIV is based on follow up from children identified through mother-to-child transmission studies. Children identified through voluntary counseling and testing (VCT) represent a unique cohort that has not been previously described in the literatu

  17. Effects of dopaminergic replacement therapy on motor speech disorders in Parkinson's disease: longitudinal follow-up study on previously untreated patients.

    Rusz, Jan; Tykalová, Tereza; Klempíř, Jiří; Čmejla, Roman; Růžička, Evžen


    Although speech disorders represent an early and common manifestation of Parkinson's disease (PD), little is known about their progression and relationship to dopaminergic replacement therapy. The aim of the current study was to examine longitudinal motor speech changes after the initiation of pharmacotherapy in PD. Fifteen newly-diagnosed, untreated PD patients and ten healthy controls of comparable age were investigated. PD patients were tested before the introduction of antiparkinsonian therapy and then twice within the following 6 years. Quantitative acoustic analyses of seven key speech dimensions of hypokinetic dysarthria were performed. At baseline, PD patients showed significantly altered speech including imprecise consonants, monopitch, inappropriate silences, decreased quality of voice, slow alternating motion rates, imprecise vowels and monoloudness. At follow-up assessment, preservation or slight improvement of speech performance was objectively observed in two-thirds of PD patients within the first 3-6 years of dopaminergic treatment, primarily associated with the improvement of stop consonant articulation. The extent of speech improvement correlated with L-dopa equivalent dose (r = 0.66, p = 0.008) as well as with reduction in principal motor manifestations based on the Unified Parkinson's Disease Rating Scale (r = -0.61, p = 0.02), particularly reflecting treatment-related changes in bradykinesia but not in rigidity, tremor, or axial motor manifestations. While speech disorders are frequently present in drug-naive PD patients, they tend to improve or remain relatively stable after the initiation of dopaminergic treatment and appear to be related to the dopaminergic responsiveness of bradykinesia.

  18. Case Study Observational Research: A Framework for Conducting Case Study Research Where Observation Data Are the Focus.

    Morgan, Sonya J; Pullon, Susan R H; Macdonald, Lindsay M; McKinlay, Eileen M; Gray, Ben V


    Case study research is a comprehensive method that incorporates multiple sources of data to provide detailed accounts of complex research phenomena in real-life contexts. However, current models of case study research do not particularly distinguish the unique contribution observation data can make. Observation methods have the potential to reach beyond other methods that rely largely or solely on self-report. This article describes the distinctive characteristics of case study observational research, a modified form of Yin's 2014 model of case study research the authors used in a study exploring interprofessional collaboration in primary care. In this approach, observation data are positioned as the central component of the research design. Case study observational research offers a promising approach for researchers in a wide range of health care settings seeking more complete understandings of complex topics, where contextual influences are of primary concern. Future research is needed to refine and evaluate the approach.

  19. Meta-analysis of observational epidemiological studies: a review.

    Jones, D R


    Meta-analyses (integration of findings by quantitative analyses of results of individual studies) are already widely used in the psychological and educational sciences and in the pooling of clinical trial results. Examples of the application of such techniques to the results of observational epidemiological studies are now proliferating. In this paper meta-analysis of the results of observational epidemiological studies is reviewed. Uncritical adoption of techniques used in pooled analyses of...

  20. Phase 2 study of tabalumab, a human anti-B-cell activating factor antibody, with bortezomib and dexamethasone in patients with previously treated multiple myeloma.

    Raje, Noopur S; Moreau, Philippe; Terpos, Evangelos; Benboubker, Lotfi; Grząśko, Norbert; Holstein, Sarah A; Oriol, Albert; Huang, Shang-Yi; Beksac, Meral; Kuliczkowski, Kazimierz; Tai, Datchen F; Wooldridge, James E; Conti, Ilaria; Kaiser, Christopher J; Nguyen, Tuan S; Cronier, Damien M; Palumbo, Antonio


    In this double-blind, Phase 2 study, 220 patients with relapsed/refractory multiple myeloma were randomly assigned 1:1:1 to receive placebo (N = 72), tabalumab 100 mg (N = 74), or tabalumab 300 mg (N = 74), each in combination with dexamethasone 20 mg and subcutaneous bortezomib 1·3 mg/m(2) on a 21-day cycle. No significant intergroup differences were observed among primary (median progression-free survival [mPFS]) or secondary efficacy outcomes. The mPFS was 6·6, 7·5 and 7·6 months for the tabalumab 100, 300 mg and placebo groups, respectively (tabalumab 100 mg vs. placebo Hazard ratio (HR) [95% confidence interval (CI)] = 1·13 [0·80-1·59], P = 0·480; tabalumab 300 mg vs. placebo HR [95% CI] = 1·03 [0·72-1·45], P = 0·884). The most commonly-reported treatment-emergent adverse events were thrombocytopenia (37%), fatigue (37%), diarrhoea (35%) and constipation (32%). Across treatments, patients with low baseline BAFF (also termed TNFSF13B) expression (n = 162) had significantly longer mPFS than those with high BAFF expression (n = 55), using the 75th percentile cut-off point (mPFS [95% CI] = 8·3 [7·0-9·3] months vs. 5·8 [3·7-6·6] months; HR [95% CI] = 1·59 [1·11-2·29], P = 0·015). Although generally well tolerated, PFS was not improved during treatment with tabalumab compared to placebo. A higher dose of 300 mg tabalumab did not improve efficacy compared to the 100 mg dose. Nonetheless, BAFF appears to have some prognostic value in patients with multiple myeloma. © 2016 John Wiley & Sons Ltd.

  1. The EULAR Study Group for Registers and Observational Drug Studies

    Kearsley-Fleet, Lianne; Závada, Jakub; Hetland, Merete Lund


    OBJECTIVE: Under the auspices of the European League Against Rheumatism (EULAR), a study group of investigators representing European biologic DMARD (bDMARD) registers was convened. The purpose of this initial assessment was to collect and compare a cross section of patient characteristics...

  2. MOOSES: Multiple Option Observation System for Experimental Studies.

    Tapp, Jon; Wehby, Joseph

    The Multiple Option Observation System for Experimental Studies (MOOSES) is a flexible data collection and analysis package for applied behavioral research that addresses the needs of researchers interested in live coding of observational data. MOOSES allows the researcher to design a coding system for a particular research question. General types…

  3. Treatment of advanced, recurrent, resistant to previous treatments basal and squamous cell skin carcinomas with a synergistic formulation of interferons. Open, prospective study

    Lopez-Saura Pedro


    Full Text Available Abstract Background Aggressive non-melanoma skin cancer (deeply infiltrating, recurrent, and morphea form lesions are therapeutically challenging because they require considerable tissue loss and may demand radical disfiguring surgery. Interferons (IFN may provide a non-surgical approach to the management of these tumors. The aim of this work was to evaluate the effect of a formulation containing IFNs-α and -γ in synergistic proportions on patients with recurrent, advanced basal cell (BCC or squamous cell skin carcinomas (SCSC. Methods Patients with extensive, recurrent, resistant to other procedures BCC or SCSC received the IFN formulation peri- and intralesionally, three times per week for 3 weeks. They had been previously treated with surgery and/or radiotherapy or chemotherapy. Thirteen weeks after the end of treatment, the original lesion sites were examined for histological evidence of remaining tumor. Results Sixteen elder (median 70 years-old patients were included. They beared 12 BCC and 4 SCSC ranging from 1.5 to 12.5 cm in the longest dimension. At the end of treatment 47% CR (complete tumor elimination, 40% PR (>30% tumor reduction, and 13% stable disease were obtained. None of the patients relapsed during the treatment period. The median duration of the response was 38 months. Only one patient with complete response had relapsed until today. Principal adverse reactions were influenza-like symptoms well known to occur with interferon therapy, which were well tolerated. Conclusion The peri- and intralesional combination of IFNs-α and -γ was safe and showed effect for the treatment of advanced, recurrent and resistant to previous treatments of BCC and SCSC in elder patients. This is the first report of such treatment in patients with advance non-melanoma skin cancer. The encouraging result justifies further confirmatory trials. Trial registration Current Controlled Trials RPCEC00000052.

  4. Cataract surgery in previously vitrectomized eyes.

    Akinci, A; Batman, C; Zilelioglu, O


    To evaluate the results of extracapsular cataract extraction (ECCE) and phacoemulsification (PHACO) performed in previously vitrectomized eyes. In this retrospective study, 56 vitrectomized eyes that had ECCE and 60 vitrectomized eyes that had PHACO were included in the study group while 65 eyes that had PHACO in the control group. The evaluated parameters were the incidence of intra-operative and postoperative complications (IPC) and visual outcomes. Chi-squared, independent samples and paired samples tests were used for comparing the results. Deep anterior chamber (AC) was significantly more common in the PHACO group of vitrectomized eyes (PGVE) and observed in eyes that had undergone extensive vitreous removal (p ECCE group and the PGVE (p > 0.05). Some of the intra-operative conditions such as posterior synechiae, primary posterior capsular opacification (PCO) and postoperative complications such as retinal detachment (RD), PCO were significantly more common in vitrectomized eyes than the controls (p ECCE group and the PGVE (p > 0.05). Deep AC is more common in eyes with extensive vitreous removal during PHACO than ECCE. Decreasing the bottle height is advised in this case. Except for this, the results of ECCE and PHACO are similar in previously vitrectomized eyes. Posterior synechiaes, primary and postoperative PCO and RD are more common in vitrectomized eyes than the controls.

  5. Management of Symptomatic Tarlov Cysts: A Retrospective Observational Study.

    Jiang, Wei; Hu, Zhenming; Hao, Jie


    Symptomatic Tarlov cysts are a common cause of chronic pain. Many methods have been reported to treat this disease, with variable results. Most previous reports concerning the treatment methods of symptomatic Tarlov cysts were either sporadic case reports or series of limited cases. This study aimed to further optimize the management for patients with symptomatic Tarlov cysts (TCs) by analyzing the results of 82 patients who were treated with different strategies. Three different strategies were applied to 82 patients with symptomatic TCs and their clinical effects were evaluated in 13 months to 12 years follow-up. A pain management practice, a medical center, major metropolitan city, China. From June 2003 to August 2015, a total number of 82 patients with symptomatic TCs were treated with 3 different methods (microsurgical cyst fenestration and imbrication, C-arm fluoroscopy guided percutaneous fibrin gel injection, and conservative management) in the first affiliated hospital of Chongqing Medical University. The pain severity was assessed according to visual analog scale (VAS), and imaging changes were evaluated by magnetic resonance imaging (MRI). Patient improvements in pain and neurologic function were evaluated during a follow-up the period of 13 months to 12 years. All the patients who underwent microsurgical cyst fenestration and imbrication had either complete (7 patients, 50%) or substantial (7 patients, 50%) resolution of their preoperative symptoms and neurological deficits. However, 3 patients (21%) had cerebrospinal fluid (CSF) leakage and 3 patients (21%) suffered from recurrent symptoms. In C-arm fluoroscopy guided percutaneous fibrin gel injection group, 34 patients (61%) had complete resolution and 22 patients had (39%) substantial resolution, and no CSF leakage or recurrence occurred. Only 3 patients (25%) got substantial resolution in the conservative management group, but 9 patients (75%) had aggravation. An observational study with a

  6. A RAPD based study revealing a previously unreported wide range of mesophilic and thermophilic spore formers associated with milk powders in China.

    Sadiq, Faizan A; Li, Yun; Liu, TongJie; Flint, Steve; Zhang, Guohua; He, GuoQing


    Aerobic spore forming bacteria are potential milk powder contaminants and are viewed as indicators of poor quality. A total of 738 bacteria, including both mesophilic and thermophilic, isolated from twenty-five powdered milk samples representative of three types of milk powders in China were analyzed based on the random amplified polymorphic DNA (RAPD) protocol to provide insight into species diversity. Bacillus licheniformis was found to be the most prevalent bacterium with greatest diversity (~43% of the total isolates) followed by Geobacillus stearothermophilus (~21% of the total isolates). Anoxybacillus flavithermus represented only 8.5% of the total profiles. Interestingly, actinomycetes represented a major group of the isolates with the predominance of Laceyella sacchari followed by Thermoactinomyces vulgaris, altogether comprising of 7.3% of the total isolates. Out of the nineteen separate bacterial species (except five unidentified groups) recovered and identified from milk powders, twelve proved to belong to novel or previously unreported species in milk powders. Assessment and characterization of the harmful effects caused by this particular micro-flora on the quality and safety of milk powders will be worth doing in the future.

  7. Update of the pompe disease mutation database with 60 novel GAA sequence variants and additional studies on the functional effect of 34 previously reported variants.

    Kroos, Marian; Hoogeveen-Westerveld, Marianne; Michelakakis, Helen; Pomponio, Robert; Van der Ploeg, Ans; Halley, Dicky; Reuser, Arnold


    Pompe disease is an autosomal recessive lysosomal glycogen storage disorder, characterized by progressive muscle weakness. Deficiency of acid α-glucosidase (EC; can be caused by numerous pathogenic variants in the GAA gene. The Pompe Disease Mutation Database at aims to list all variants and their effect. This update reports on 94 variants. We examined 35 novel and 34 known mutations by site-directed mutagenesis and transient expression in COS-7 cells or HEK293T cells. Each of these mutations was given a severity rating using a previously published system, based on the level of acid α-glucosidase activity in medium and transfected cells and on the quantity and quality of the different molecular mass species in the posttranslational modification and transport of acid α-glucosidase. This approach enabled to classify 55 missense mutations as pathogenic and 13 as likely nonpathogenic. Based on their nature and the use of in silico analysis (Alamut® software), 12 of the additional 25 novel mutations were predicted to be pathogenic including 4 splicing mutations, 6 mutations leading to frameshift, and 2 point mutations causing stop codons. Seven of the additional mutations were considered nonpathogenic (4 silent and 3 occurring in intron regions), and 6 are still under investigation.

  8. Prognostic factors in multiple myeloma: definition of risk groups in 410 previously untreated patients: a Grupo Argentino de Tratamiento de la Leucemia Aguda study.

    Corrado, C; Santarelli, M T; Pavlovsky, S; Pizzolato, M


    Four hundred ten previously untreated multiple myeloma patients entered onto two consecutive Grupo Argentino de Tratamiento de la Leucemia Aguda (GATLA) protocols were analyzed to identify significant prognostic factors influencing survival. The univariate analysis selected the following variables: performance status, renal function, percentage of bone marrow plasma cells at diagnosis, hemoglobin, and age. A multivariate analysis showed that performance status, renal function, percentage of bone marrow plasma cells, hemoglobin, and age were the best predictive variables for survival. A score was assigned to each patient according to these variables, which led to their classification in three groups: good, intermediate, and poor risk, with a probability of survival of 26% and 10% at 96 months, and 5% at 56 months, and median survival of 60, 37, and 14 months, respectively (P = .0000). In our patient population, this model proved to be superior to the Durie-Salmon staging system in defining prognostic risk groups, and separating patients with significantly different risks within each Durie-Salmon stage.

  9. No Previous Public Services Required

    Taylor, Kelley R.


    In 2007, the Supreme Court heard a case that involved the question of whether a school district could be required to reimburse parents who unilaterally placed their child in private school when the child had not previously received special education and related services in a public institution ("Board of Education v. Tom F."). The…

  10. Issues of reporting in observational studies in veterinary medicine.

    Sargeant, Jan M; O'Connor, Annette M


    Observational studies are common in veterinary medicine; the results may be used to inform decision-making, future research, or as inputs to systematic reviews or risk assessment. To be of use, the results must be published, all of the outcomes that were assessed must be included in the publication, and the research (methods and results) must be reported in sufficient detail that the reader can evaluate the internal and external validity. In human healthcare, concerns about the completeness of reporting - and evidence that poor reporting is associated with study results - have led to the creation of reporting guidelines; these include the STROBE statement for observational studies. There is evidence from a limited body of research that there also are reporting inadequacies in veterinary observational studies. There are differences between human and veterinary observational studies that might be relevant to recommendations for reporting. Such differences include: the use of observational studies in animal populations for simultaneously estimating disease frequency and risk-factor identification; the distinction between the animal owners who consent to participate and the animals that are the study subjects; and the complexity of organizational levels inherent in animal research (in particular, for studies in livestock species). In veterinary medicine, it is common to have clustering within outcomes (due to animal grouping) and clustering of predictor variables. We argue that there is a compelling need for the scientific community involved in veterinary observational studies to use the STROBE statement, use an amended version of STROBE, or to develop and use reporting guidelines that are specific to veterinary medicine to improve reporting of these studies.

  11. Providing Visions of a Different Life: Self-study Narrative Inquiry as an Instrument for Seeing Ourselves in Previously-Unimagined Places

    Carmen Shields


    Full Text Available In this paper, we share stories of coming to narrative self-study research in graduate studies, and the impact this choice has had on personal and professional directions in ways we could not have imagined when graduate studies were initially embarked upon. Central to self-study narrative inquiry is a focus on life experience as a tool for connection with our own storied pasts. There we find the roots of our present-day perspectives and actions that we can incorporate into our everyday meaning-making, using our emergent understanding to choose present and future possibilities in our relationships.

  12. Laser induced fluorescence and optogalvanic spectroscopy applied to find previously unknown energy levels of La I and studies of their Zeeman structure

    Sobolewski, Ł. M.; Binder, T.; Güney, C.; Gamper, B.; Kwela, J.; Windholz, L.


    After the excitation of the La-Ar plasma in a hollow cathode lamp we observed in optogalvanic spectra a number of atomic lines that could not be interpreted as transitions between already known La energy levels. Using the laser induced fluorescence (LIF) method and computer simulations of the hyperfine structure patterns, we derived 14 unknown La levels, all with even parity, in the energy range between 40 877 cm-1 and 43 485 cm-1. The existence of these levels was then confirmed by excitations from other known lower levels. We performed also investigations of the Zeeman structure of some of these lines in order to verify the J values of newly found levels and to determine their gJ factors.

  13. Using the Nordic Geodetic Observing System for land uplift studies

    Nordman, M.; Poutanen, M.; Kairus, A.; Virtanen, J.


    Geodetic observing systems have been planned and developed during the last decade. An ideal observing system consists of a network of geodetic observing stations with several techniques at the same site, publicly accessible databases, and as a product delivers data time series, combination of techniques or some other results obtained from the data sets. Globally, there is the International Association of Geodesy (IAG) Global Geodetic Observing System (GGOS), and there are ongoing attempts to create also regional observing systems. In this paper we introduce one regional system, the Nordic Geodetic Observing System (NGOS) hosted by the Nordic Geodetic Commission (NKG). Data availability and accessibility are one of the major issues today. We discuss in general data-related topics, and introduce a pilot database project of NGOS. As a demonstration of the use of such a database, we apply it for postglacial rebound studies in the Fennoscandian area. We compare land uplift values from three techniques, GNSS, tide gauges and absolute gravity, with the Nordic Geodetic Commission NKG2005LU land uplift model for Fennoscandia. The purpose is to evaluate the data obtained from different techniques and different sources and get the most reliable values for the uplift using publicly available data. The primary aim of observing systems will be to produce data and other products needed by multidisciplinary projects, such as Upper Mantle Dynamics and Quaternary Climate in Cratonic Areas (DynaQlim) or the European Plate Observing System (EPOS), but their needs may currently exceed the scope of an existing observing system. We discuss what requirements the projects pose to observing systems and their development. To make comparisons between different studies possible and reliable, the researcher should document what they have in detail, either in appendixes, supplementary material or some other available format.

  14. Passive output feedback and observer based autopilots: A comparative study

    Marit Paulsen


    Full Text Available Two methods for course-keeping of a ship are studied where no measurements of the yaw rate are available. The two methods are a passive output feedback controller and a controller-observer structure. A comparison with special attention to stability and wave filtering properties, is provided. Finally, a case study of a ship autopilot is included.

  15. The change in motivating factors influencing commencement, adherence and retention to a supervised resistance training programme in previously sedentary post-menopausal women: a prospective cohort study.

    Viljoen, Janet Erica; Christie, Candice Jo-Anne


    Understanding motivators for exercise participation in post-menopausal women may impact retention to exercise programmes and inform intervention trial designs. The purpose of this investigation was to assess self-reported motivational factors influencing adherence and retention to a 24-week progressive resistance training programme. Post-menopausal females (n = 34) were passively recruited to undertake a 24-week progressive resistance training protocol, in small-group sessions, on three non-consecutive days of the week. Attendance was recorded by the researcher. Qualitative reports were sourced from the sample for four phases of the study: pre-study (prior to week 1), recruitment (week 1), during study (weeks 2 - 24), and post-intervention (beyond week 24). Responses were categorised according to ten descriptors: specific health index improvement, education, flexibility of time, social contact, conscience (loyalty to the researcher), wellness, weight management, organisation parameters (pertaining to the study programme) and enjoyment of the exercises. Of the initial sample, 76.5% (n = 26) met the specified ≥80% attendance criterion. The primary findings were that motivation to volunteer for the study was driven by a perceived need for a structured exercise programme (50% of respondents). A commitment to the researcher was the primary motivator for continued adherence to the study for 50% of participants. Social contact with other participants was cited by 60% of the sample as the primary reason for adherence for the full duration of 24 weeks. A desire to maintain the "wellness" derived from the programme was cited by 60% as a reason for continuing an exercise routine post-study. This study identified that routine and supervision initially attract women to exercise programmes, while social cohesion of the group setting contributes to retention over time. Understanding the changing nature of motivating factors may contribute to better overall adherence

  16. Multiclass pesticide analysis in fruit-based baby food: A comparative study of sample preparation techniques previous to gas chromatography-mass spectrometry.

    Petrarca, Mateus H; Fernandes, José O; Godoy, Helena T; Cunha, Sara C


    With the aim to develop a new gas chromatography-mass spectrometry method to analyze 24 pesticide residues in baby foods at the level imposed by established regulation two simple, rapid and environmental-friendly sample preparation techniques based on QuEChERS (quick, easy, cheap, effective, robust and safe) were compared - QuEChERS with dispersive liquid-liquid microextraction (DLLME) and QuEChERS with dispersive solid-phase extraction (d-SPE). Both sample preparation techniques achieved suitable performance criteria, including selectivity, linearity, acceptable recovery (70-120%) and precision (⩽20%). A higher enrichment factor was observed for DLLME and consequently better limits of detection and quantification were obtained. Nevertheless, d-SPE provided a more effective removal of matrix co-extractives from extracts than DLLME, which contributed to lower matrix effects. Twenty-two commercial fruit-based baby food samples were analyzed by the developed method, being procymidone detected in one sample at a level above the legal limit established by EU.

  17. Observations

    Rossiter, John R.; Percy, Larry


    unrealistic laboratory studies, textbook writers continuing to ignore practitioners' research appearing in trade publications and practitioner-oriented journals, and practitioners peeling off into high-sounding but meaningless jargon. also evident is the tendency to regard the new electronic media...... as a classification of the new advertising formats in terms of traditional analogs with mainstream media advertising....

  18. A brief review of the estimated economic burden of sexually transmitted diseases in the United States: inflation-adjusted updates of previously published cost studies.

    Chesson, Harrell W; Gift, Thomas L; Owusu-Edusei, Kwame; Tao, Guoyu; Johnson, Ana P; Kent, Charlotte K


    We conducted a literature review of studies of the economic burden of sexually transmitted diseases in the United States. The annual direct medical cost of sexually transmitted diseases (including human immunodeficiency virus) has been estimated to be $16.9 billion (range: $13.9-$23.0 billion) in 2010 US dollars.

  19. Does hyperbaric oxygen treatment have the potential to increase salivary flow rate and reduce xerostomia in previously irradiated head and neck cancer patients? A pilot study

    Forner, Lone; Hansen, Ole Hyldegaard; von Brockdorff, Annet Schack


    Irradiated head and neck cancer survivors treated in the Hyperbaric Oxygen (HBO) Unit, Copenhagen University Hospital, spontaneously reported improvement of radiation-induced dry mouth feeling. The aim of this pilot study was to evaluate salivary flow rate and xerostomia before and after HBO...

  20. Role of micronized progesterone in prevention of preterm labour in women with previous history of one or more preterm births: a research study at a tertiary care hospital

    Rashmi Ahuja


    Conclusions: The study concluded that progesterone use was associated with 64.2% reduction in the incidence of preterm delivery (p=0.029.Antenatal administration of progesterone reduces the risk of preterm birth before 37 weeks and 34 weeks as well as the risk of a newborn being born with a birth weight of less than 2500 gms. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1176-1180

  1. A Retrospective Study of Capecitabine/Temozolomide (CAPTEM Regimen in the Treatment of Metastatic Pancreatic Neuroendocrine Tumors (pNETs after Failing Previous Therapy

    Muhammad Wasif Saif


    Full Text Available Context Pancreatic neuroendocrine tumors (pNETs are notoriously resistant to currently available chemotherapy agents.Preclinical data has suggested synergy between temozolomide and capecitabine. Objective To report a retrospective data on the efficacy and safety of capecitabine and temozolomide (CAPTEM regimen in patients with metastatic pancreaticneuroendocrine tumors (pNETs who have failed prior therapies. Methods We reviewed the medical records of 7 patientswith metastatic pNETs who had had progressive cancer prior to treatment despite therapy, including long-acting releaseoctreotide (60 mg/month, chemotherapy and hepatic chemoembolization. Capecitabine was administered at a flat dose of1,000 mg orally twice daily on days 1-14 and temozolomide 200 mg/m2 was given in two divided doses daily on days 10-14of a 28-day cycle. Tumor assessments were repeated every two cycles and serum tumor markers were measured every cycle. Response to treatment was assessed using Response Evaluation Criteria in Solid Tumors (RECIST parameters, and toxicity was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE, version 3.0. Results Among 7 patients treated, three patients achieved a partial response, and two patients had stable disease. Totalresponse rate was 43%, and clinical benefit (responders and stable disease was 71%. Median duration of response was 8months (range: 4-12 months. Grade 3 and 4 toxicities included grade 3 thrombocytopenia in one patient and grade 3 fatigue in one patient. The most common toxicities were grade 1 and 2 neutropenia, grade 1 fatigue, grade 1 and 2 hand-foot syndrome. Conclusions Our retrospective study showed that modified CAPTEM regimen was well-tolerated and produced comparable response to historical data in neuroendocrine tumors, including pNETs. Our study is unique as it only included patients with pNETs. Further prospective studies are warranted to evaluate the combination of

  2. Observations

    Rossiter, John R.; Percy, Larry


    as requiring a new model of how advertising communicates and persuades, which, as the authors' textbooks explain, is sheer nonsense and contrary to the goal of integrated marketing. We provide in this article a translation of practitioners' jargon into more scientifically acceptable terminology as well...... product or service or to achieve a higher price that consumers are willing to pay than would obtain in the absence of advertising. What has changed in recent years is the notable worsening of the academic-practitioner divide, which has seen academic advertising researchers pursuing increasingly...... unrealistic laboratory studies, textbook writers continuing to ignore practitioners' research appearing in trade publications and practitioner-oriented journals, and practitioners peeling off into high-sounding but meaningless jargon. also evident is the tendency to regard the new electronic media...

  3. Observer rated sleepiness and real road driving: an explorative study.

    Anna Anund

    Full Text Available The aim of the present study was to explore if observer rated sleepiness (ORS is a feasible method for quantification of driver sleepiness in field studies. Two measures of ORS were used: (1 one for behavioural signs based on facial expression, body gestures and body movements labelled B-ORS, and (2 one based on driving performance e.g. if swerving and other indicators of impaired driving occurs, labelled D-ORS. A limited number of observers sitting in the back of an experimental vehicle on a motorway about 2 hours repeatedly 3 times per day (before lunch, after lunch, at night observed 24 participant's sleepiness level with help of the two observer scales. At the same time the participant reported subjective sleepiness (KSS, EOG was recorded (for calculation of blink duration and several driving measure were taken and synchronized with the reporting. Based on mixed model Anova and correlation analysis the result showed that observer ratings of sleepiness based on drivers' impaired performance and behavioural signs are sensitive to extend the general pattern of time awake, circadian phase and time of driving. The detailed analysis of the subjective sleepiness and ORS showed weak correspondence on an individual level. Only 16% of the changes in KSS were predicted by the observer. The correlation between the observer ratings based on performance (D-ORS and behavioural signs (B-ORS are high (r = .588, and the B-ORS shows a moderately strong association (r = .360 with blink duration. Both ORS measures show an association (r>0.45 with KSS, whereas the association with driving performance is weak. The results show that the ORS-method detects the expected general variations in sleepy driving in field studies, however, sudden changes in driver sleepiness on a detailed level as 5 minutes is usually not detected; this holds true both when taking into account driving behaviour or driver behavioural signs.

  4. A study of the presence of B. burgdorferi, Anaplasma (previously Ehrlichia) phagocytophilum, Rickettsia, and Babesia in Ixodes ricinus collected within the territory of Belluno, Italy.

    Piccolin, G; Benedetti, G; Doglioni, C; Lorenzato, C; Mancuso, S; Papa, N; Pitton, L; Ramon, M C; Zasio, C; Bertiato, G


    In the years 2000 and 2001, we sampled ticks in order to establish the distribution of Ixodes ricinus in the province of Belluno; 5987 tick samples from 244 sites throughout the province were gathered, by dragging for a 5-min period. In 40 sites, seasonal variations and cycle stages of the parasites were studied at monthly intervals from March to September. A polymerase chain reaction (PCR) technique was used to identify the tick-infected sites. Of 1931 individual ticks, 8.23% were positive for Borrelia burgdorferi, 4.4% were positive for Ehrlichia, 1.6% were positive for Rickettsia, and 1.6% were positive for Babesia. The co-presence of Borrelia and Ehrlichia (1.2%) and Babesia (0.5%), Borrelia, Ehrlichia and Rickettsia (0.1%) was also found.

  5. Performance of the new 2012 EULAR/ACR classification criteria for polymyalgia rheumatica: comparison with the previous criteria in a single-centre study.

    Macchioni, Pierluigi; Boiardi, Luigi; Catanoso, Mariagrazia; Pazzola, Giulia; Salvarani, Carlo


    To compare the performance of published classification/diagnostic criteria for polymyalgia rheumatica (PMR), including the new 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria, in a single-centre study. We studied all consecutive patients with new-onset PMR seen in our centre over 6 years, whose diagnosis was confirmed during a prospective 12-month follow-up period. Subjects were classified by each of the seven different criteria. Sensitivity and specificity were compared. Control population consisted of all consecutive patients aged ≥50 years seen in a 4-year period in our early arthritis clinic who had a 12-month confirmation of a diagnosis of rheumatoid arthritis (RA) or other inflammatory articular diseases. Data were collected from 136 cases and 149 controls, including 94 patients with RA. The most sensitive criteria were the new 2012 EULAR/ACR classification criteria (92.6%). Adding ultrasound (US) specificity increased from 81.5% to 91.3% in total cases and from 79.7% to 89.9% in RA. Bird criteria had a sensitivity of 89.2% but the lowest specificity (40.2% in total cases and 72.5% in RA). Jones and Nobunaga criteria were the most specific criteria (96.7% and 97.8% in total cases and 98.6% and 99.5% in RA) but the less sensitive (63.1% and 58.2%) ones. Overall, discriminatory ability, as reflected by the area under the receiver operating characteristic curve, was better for the 2012 US EULAR/ACR criteria (0.920 in total cases and 0.910 in RA). The new EULAR/ACR criteria in new-onset PMR patients perform best in discriminating PMR from RA and other inflammatory articular diseases. Ultrasound further increases the specificity of the criteria.

  6. Study of white-light flares observed by Hinode

    Hai-Min Wang


    White-light flares are considered to be the most energetic flaring events that are observable in the optical broad-band continuum of the solar spectrum. They have not been commonly observed. Observations of white-light flares with sub-arcsecond resolution have been very rare. The continuous high resolution observations of Hinode provide a unique opportunity to systematically study the white-light flares with a spatial resolution around 0.2 arcsec. We surveyed all the flares above GOES magnitude C5.0 since the launch of Hinode in 2006 October. 13 of these kinds of flares were covered by the Hinode G-band observations. We analyzed the peak contrasts and equivalent areas (calculated via integrated excess emission contrast) of these flares as a function of the GOES X-ray flux, and found that the cut-off visibility is likely around M1 flares under the observing limit of Hinode. Many other observational and physical factors should affect the visibility of white-light flares; as the observing conditions are improved, smaller flares are likely to have detectable white-light emissions. We are cautious that this limiting visibility is an overestimate, because G-band observations contain emissions from the upper atmosphere.Among the 13 events analyzed, only the M8.7 flare of 2007 June 4 had near-simultaneous observations in both the G-band and the blue continuum. The blue continuum had a peak contrast of 94% vs. 175% in G-band for this event. The equivalent area in the blue continuum is an order of magnitude lower than that in the G-band. Very recently, Jess et al.studied a C2.0 flare with a peak contrast of 300% in the blue continuum. Compared to the events presented in this letter, that event is probably an unusual white-light flare: a very small kernel with a large contrast that can be detected in high resolution observations.

  7. Leflunomide in Takayasu arteritis – A long term observational study

    Alexandre Wagner Silva de Souza

    Full Text Available ABSTRACT Objective: To evaluate the extended follow-up data on efficacy and toxicity of leflunomide therapy in Takayasu arteritis (TA patients previously enrolled in the original open-label study of short-term effects of leflunomide in TA. Methods: An open-label long-term longitudinal study was performed in TA patients who fulfilled the 1990 American College of Rheumatology criteria for TA and had participated in a previous study that evaluated short-term efficacy of leflunomide in TA. Complete follow-up information could be retrieved from 12 out of 15 patients enrolled in the original study. Disease activity was evaluated by Kerr's criteria and by the Indian Takayasu Activity Score 2010 (ITAS2010. Results: The mean follow up time was 43.0 ± 7.6 months and 5 (41.6% TA patients remained on leflunomide therapy while 7 (58.3% TA patients had to change to another therapy due to failure to prevent relapses in 6 patients and toxicity in one patient. No significant differences were found between patients who remained on leflunomide therapy and those who changed to another agent regarding age at study entry, time since diagnosis, prednisone daily dose at study entry, baseline ITAS2010, mean or maximum ESR and CRP, and cumulative prednisone dose at study end. Among TA patients who had changed leflunomide to another agent, two had an additional clinical relapse and needed to change therapy. Conclusion: Leflunomide led to sustained remission in approximately half of patients at a mean time of 12 months and was well tolerated by TA patients.

  8. UK pneumonectomy outcome study (UKPOS: a prospective observational study of pneumonectomy outcome

    Davies Paul


    Full Text Available Abstract Background In order to assess the short term risks of pneumonectomy for lung cancer in contemporary practice a one year prospective observational study of pneumonectomy outcome was made. Current UK practice for pneumonectomy was observed to note patient and treatment factors associated with major complications. Methods A multicentre, prospective, observational cohort study was performed. All 35 UK thoracic surgical centres were invited to submit data to the study. All adult patients undergoing pneumonectomy for lung cancer between 1 January and 31 December 2005 were included. Patients undergoing pleuropneumonectomy, extended pneumonectomy, completion pneumonectomy following previous lobectomy and pneumonectomy for benign disease, were excluded from the study. The main outcome measure was suffering a major complication. Major complications were defined as: death within 30 days of surgery; treated cardiac arrhythmia or hypotension; unplanned intensive care admission; further surgery or inotrope usage. Results 312 pneumonectomies from 28 participating centres were entered. The major complication incidence was: 30-day mortality 5.4%; treated cardiac arrhythmia 19.9%; unplanned intensive care unit admission 9.3%; further surgery 4.8%; inotrope usage 3.5%. Age, American Society of Anesthesiologists physical status ≥ P3, pre-operative diffusing capacity for carbon monoxide (DLCO and epidural analgesia were collectively the strongest risk factors for major complications. Major complications prolonged median hospital stay by 2 days. Conclusion The 30 day mortality rate was less than 8%, in agreement with the British Thoracic Society guidelines. Pneumonectomy was associated with a high rate of major complications. Age, ASA physical status, DLCO and epidural analgesia appeared collectively most associated with major complications.

  9. Can a Repeated Sprint Ability Test Help Clear a Previously Injured Soccer Player for Fully Functional Return to Activity? A Pilot Study.

    Padulo, Johnny; Attene, Giuseppe; Ardigò, Luca P; Bragazzi, Nicola L; Maffulli, Nicola; Zagatto, Alessandro M; Dello Iacono, Antonio


    To investigate the effects of fatigue induced by a repeated sprint ability (RSA) test on the neuromuscular responses of soccer players with a recent history of lower limb injuries (CH) and a matched control group in good fitness condition (GH). This was a case-control study. Nine CH and 9 GH. Allocation to CH or GH. Each player was assessed for blood lactate concentration and jumping performance [squat jump (SJ) and countermovement jump (CMJ)] before/after RSA. Post-RSA rate of perceived exertion (RPE) was obtained. Receiver operating characteristic analysis was performed to calculate RSA sensitivity and specificity in distinguishing between CH and GH. Intraclass correlation coefficient was used to assess reliability. No baseline differences were found for any variable. ΔSJ before/after RSA was -14 ± 2% and -5 ± 2% in CH and GH, respectively (P Repeated sprint ability is a simple, low-cost field test potentially able to assist in clinical decision making for return to sport.

  10. Prevalence of pain in the head, back and feet in refugees previously exposed to torture: a ten-year follow-up study

    Olsen, Dorthe Reff; Montgomery, Edith; Bøjholm, Søren


    exposed to torture in their home country were interviewed at a Danish rehabilitation clinic on average 8 years after their final release from confinement and re-interviewed 10 years later. Interviews focused on history of exposure to physical and mental torture and on pain in the head, back and feet...... prevalent at study. RESULTS: The mean number of times imprisoned was 2.5 and the mean cumulative duration of imprisonment 19.4 months. The most frequent physical torture method reported was beating (95.0%) and the main mental torture method deprivation (88.5%). Pain reported at follow-up was strongly...... associated with pain reported at baseline, and the prevalence of pain increased considerably (pain in the head, 47.5% at baseline and 58.3% at follow-up; back, 48.2% and 75.5%; feet, 23.7% and 63.3%). Predictor patterns at baseline and at follow-up had common traits, so that pain in the head and pain...

  11. SABRE observations of Pi2 pulsations: case studies

    Bradshaw, E. G.; Lester, M.


    The characteristics of substorm-associated Pi2 pulsations observed by the SABRE coherent radar system during three separate case studies are presented. The SABRE field of view is well positioned to observe the differences between the auroral zone pulsation signature and that observed at mid-latitudes. During the first case study the SABRE field of view is initially in the eastward electrojet, equatorward and to the west of the substorm-enhanced electrojet current. As the interval progresses, the western, upward field-aligned current of the substorm current wedge moves westward across the longitudes of the radar field of view. The westward motion of the wedge is apparent in the spatial and temporal signatures of the associated Pi2 pulsation spectra and polarisation sense. During the second case study, the complex field-aligned and ionospheric currents associated with the pulsation generation region move equatorward into the SABRE field of view and then poleward out of it again after the third pulsation in the series. The spectral content of the four pulsations during the interval indicate different auroral zone and mid-latitude signatures. The final case study is from a period of low magnetic activity when SABRE observes a Pi2 pulsation signature from regions equatorward of the enhanced substorm currents. There is an apparent mode change between the signature observed by SABRE in the ionosphere and that on the ground by magnetometers at latitudes slightly equatorward of the radar field of view. The observations are discussed in terms of published theories of the generation mechanisms for this type of pulsation. Different signatures are observed by SABRE depending on the level of magnetic activity and the position of the SABRE field of view relative to the pulsation generation region. A twin source model for Pi2 pulsation generation provides the clearest explanation of the signatures observed Acknowledgements. The authors are grateful to Prof. D. J. Southwood

  12. Scientific and Ethical Approaches for Observational Exposure Studies

    Researchers conduct observational human exposure studies to understand how and the extent to which people come into contact with chemicals and environmental stressors in their everyday lives, through the air they breathe, the food and liquids they consume, and the things they tou...

  13. Serum YKL-40 and gestational diabetes - an observational cohort study

    Gybel-Brask, Dorte; Johansen, Julia S; Christiansen, Ib J


    To examine serum YKL-40 in women developing gestational diabetes mellitus (GDM). In the present large observational cohort study of 1179 pregnant women, we determined serum YKL-40 four times during pregnancy (at gestational age 12, 20, 25, and 32 weeks). Pregnancy outcome was obtained from medical...

  14. Comparative study of Hg xCd 1-xTe films grown on CdTe thin films previously deposited from two different techniques

    Ali, A.; Abbas Shah, N.; Maqsood, A.


    High quality cadmium telluride (CdTe) thin films were grown on glass substrates with two different techniques, two evaporation source (TES) and closed space sublimation (CSS). Further to the above mercury telluride (HgTe) was then deposited by using single source on both CdTe thin films for obtaining Hg xCd 1-xTe samples. The crystalline structure of the Hg xCd 1-xTe sample grown from CSS-CdTe showed the preferential (1 1 1) orientation with smoother and larger grain size than those of TES-CdTe. The optical transmission for TES-CdTe sample was above 90% in the 1000-1500 nm range whereas it was significantly below 80% for CSS-CdTe sample. The optical transmission for TES-Hg xCd 1-xTe and CSS-Hg xCd 1-xTe was ˜60%. The resistivity at room temperature of TES-CdTe and CSS-CdTe was ˜3.33×10 9 Ω cm and ˜2.20×10 8 Ω cm, respectively, while the resistivity of TES-Hg xCd 1-xTe and CSS-Hg xCd 1-xTe samples was ˜1.73 Ω cm and ˜5.34×10 5 Ω cm, respectively. The comparative study of ternary compound prepared with the above techniques has been carried out for the first time.

  15. Intravenous C.E.R.A. maintains stable haemoglobin levels in patients on dialysis previously treated with darbepoetin alfa: results from STRIATA, a randomized phase III study

    Canaud, Bernard; Mingardi, Giulio; Braun, Johann; Aljama, Pedro; Kerr, Peter G.; Locatelli, Francesco; Villa, Giuseppe; Van Vlem, Bruno; McMahon, Alan W.; Kerloëguen, Cécile; Beyer, Ulrich


    Background. Extending the administration interval of erythropoiesis-stimulating agents (ESAs) represents an opportunity to improve the efficiency of anaemia management in patients with chronic kidney disease (CKD). However, effective haemoglobin (Hb) maintenance can be challenging with epoetin alfa and epoetin beta administered at extended intervals. C.E.R.A., a continuous erythropoietin receptor activator, has a unique pharmacologic profile and long half-life (∼130 h), allowing administration at extended intervals. Phase III results have demonstrated that C.E.R.A. administered once every 4 weeks effectively maintains stable Hb levels in patients with CKD on dialysis. Methods. STRIATA (Stabilizing haemoglobin TaRgets in dialysis following IV C.E.R.A. Treatment for Anaemia) was a multicentre, open-label randomized phase III study to evaluate the efficacy and safety of intravenous C.E.R.A. administered once every 2 weeks (Q2W) for Hb maintenance following direct conversion from darbepoetin alfa (DA). Adult patients on dialysis receiving stable intravenous DA once weekly (QW) or Q2W were randomized (1:1) to continue their current DA regimen (n = 156) or receive intravenous C.E.R.A. Q2W (n = 157) for 52 weeks. Doses were adjusted to maintain Hb levels within ± 1.0 g/dl of baseline and between 10.0 and 13.5 g/dl. The primary endpoint was the mean Hb change between baseline and the evaluation period (weeks 29–36). Results. Most patients (>80%) received DA QW before randomization. The mean (95% CI) difference between C.E.R.A. and DA in the primary endpoint was 0.18 g/dl (−0.05, 0.41), within a pre-defined non-inferiority limit. C.E.R.A. was clinically non-inferior to DA (P < 0.0001) in maintaining Hb levels. Both treatments were well tolerated. Conclusions. Stable Hb levels were successfully maintained in patients on haemodialysis directly converted to Q2W intravenous C.E.R.A. from DA. PMID:18586762

  16. RapidArc, intensity modulated photon and proton techniques for recurrent prostate cancer in previously irradiated patients: a treatment planning comparison study

    Ratib Osman


    Full Text Available Abstract Background A study was performed comparing volumetric modulated arcs (RA and intensity modulation (with photons, IMRT, or protons, IMPT radiation therapy (RT for patients with recurrent prostate cancer after RT. Methods Plans for RA, IMRT and IMPT were optimized for 7 patients. Prescribed dose was 56 Gy in 14 fractions. The recurrent gross tumor volume (GTV was defined on 18F-fluorocholine PET/CT scans. Plans aimed to cover at least 95% of the planning target volume with a dose > 50.4 Gy. A maximum dose (DMax of 61.6 Gy was allowed to 5% of the GTV. For the urethra, DMax was constrained to 37 Gy. Rectal DMedian was 90 parameters. Results Tumor coverage (GTV and PTV was improved with RA (V95% 92.6 ± 7.9 and 83.7 ± 3.3%, when compared to IMRT (V95% 88.6 ± 10.8 and 77.2 ± 2.2%. The corresponding values for IMPT were intermediate for the GTV (V95% 88.9 ± 10.5% and better for the PTV (V95%85.6 ± 5.0%. The percentages of rectal and urethral volumes receiving intermediate doses (35 Gy were significantly decreased with RA (5.1 ± 3.0 and 38.0 ± 25.3% and IMPT (3.9 ± 2.7 and 25.1 ± 21.1%, when compared to IMRT (9.8 ± 5.3 and 60.7 ± 41.7%. CI90 was 1.3 ± 0.1 for photons and 1.6 ± 0.2 for protons. Integral Dose was 1.1 ± 0.5 Gy*cm3 *105 for IMPT and about a factor three higher for all photon's techniques. Conclusion RA and IMPT showed improvements in conformal avoidance relative to fixed beam IMRT for 7 patients with recurrent prostate cancer. IMPT showed further sparing of organs at risk.

  17. Observer study to evaluate the simulation of mammographic calcification clusters

    Sousa, Maria A. Z.; Marcomini, Karem D.; Bakic, Predrag R.; Maidment, Andrew D. A.; Schiabel, Homero


    Numerous breast phantoms have been developed to be as realistic as possible to ensure the accuracy of image quality analysis, covering a greater range of applications. In this study, we simulated three different densities of the breast parenchyma using paraffin gel, acrylic plates and PVC films. Hydroxyapatite was used to simulate calcification clusters. From the images acquired with a GE Senographe DR 2000D mammography system, we selected 68 regions of interest (ROIs) with and 68 without a simulated calcification cluster. To validate the phantom simulation, we selected 136 ROIs from the University of South Florida's Digital Database for Screening Mammography (DDSM). Seven trained observers performed two observer experiments by using a high-resolution monitor Barco mod. E-3620. In the first experiment, the observers had to distinguish between real or phantom ROIs (with and without calcification). In the second one, the observers had to indicate the ROI with calcifications between a pair of ROIs. Results from our study show that the hydroxyapatite calcifications had poor contrast in the simulated breast parenchyma, thus observers had more difficulty in identifying the presence of calcification clusters in phantom images. Preliminary analysis of the power spectrum was conducted to investigate the radiographic density and the contrast thresholds for calcification detection. The values obtained for the power spectrum exponent (β) were comparable with those found in the literature.

  18. An Observational Study of Entrainment Rate in Deep Convection

    Xiaohao Guo; Chunsong Lu; Tianliang Zhao; Guang J. Zhang; Yangang Liu


    This study estimates entrainment rate and investigates its relationships with cloud properties in 156 deep convective clouds based on in-situ aircraft observations during the TOGA-COARE (Tropical Ocean Global Atmosphere Coupled Ocean Atmosphere Response Experiment) field campaign over the western Pacific. To the authors’ knowledge, this is the first study on the probability density function of entrainment rate, the relationships between entrainment rate and cloud microphysics, and the effects...

  19. Observational studies of transiting extrasolar planets (invited review)

    Southworth, John


    The study of transiting extrasolar planets is only 15 years old, but has matured into a rich area of research. I review the observational aspects of this work, concentrating on the discovery of transits, the characterisation of planets from photometry and spectroscopy, the Homogeneous Studies project, starspots, orbital obliquities, and the atmospheric properties of the known planets. I begin with historical context and conclude with a glance to a future of TESS, CHEOPS, Gaia and PLATO.

  20. Review of previous geophysical and geological studies

    Levchenko, O.V; Neprochnov, Y.P.; Rao, D; Subrahmanyam, C; Murthy, K.S.R

    stream_size 5 stream_content_type text/plain stream_name Mem_Geol_Soc_India_39_5.pdf.txt stream_source_info Mem_Geol_Soc_India_39_5.pdf.txt Content-Encoding ISO-8859-1 Content-Type text/plain; charset=ISO-8859-1 ...

  1. Pharmacokinetics, efficacy and safety of BAX326, a novel recombinant factor IX: a prospective, controlled, multicentre phase I/III study in previously treated patients with severe (FIX level <1%) or moderately severe (FIX level ≤2%) haemophilia B.

    Windyga, J; Lissitchkov, T; Stasyshyn, O; Mamonov, V; Rusen, L; Lamas, J L; Oh, M-S; Chapman, M; Fritsch, S; Pavlova, B G; Wong, W-Y; Abbuehl, B E


    BAX326 is a recombinant factor IX (rFIX; nonacog gamma) manufactured without the addition of any materials of human or animal origin, and with two viral inactivation steps (solvent/detergent treatment and 15 nm nanofiltration). The aim of this prospective trial was to investigate the pharmacokinetics, haemostatic efficacy and safety of BAX326 in previously treated patients aged 12-65 years with severe or moderately severe haemophilia B. BAX326 was safe and well tolerated in all 73 treated subjects; adverse events considered related to treatment (2.7% incidence, all non-serious) were transient and mild, and no hypersensitivity reactions, inhibitor formation or thrombotic events were observed. Pharmacokinetic (PK) equivalence (n = 28) between BAX326 and a licensed rFIX was confirmed in terms of the ratio of geometric mean AUC(0-72) h per dose. Twice-weekly prophylaxis [mean duration 6.2 (±0.7) months; 1.8 (±0.1) infusions per week, 49.5 (±4.8) IU kg(-1) per infusion] was effective in preventing bleeding episodes, with a significantly lower (79%, P < 0.001) annualized bleed rate (4.2) compared to an on-demand treatment in a historical control group (20.0); 24 of 56 subjects on prophylaxis (43%) did not bleed throughout the study observation period. Of 249 total acute bleeds, 211 (84.7%) were controlled with one to two infusions of BAX326. Haemostatic efficacy at resolution of bleed was rated excellent or good in 96.0% of all treated bleeding episodes. The results of this study indicate that BAX326 is safe and efficacious in treating bleeds and routine prophylaxis in patients aged 12 years and older with haemophilia B.

  2. Usefulness of indirect alcohol biomarkers for predicting recidivism of drunk-driving among previously convicted drunk-driving offenders: results from the recidivism of alcohol-impaired driving (ROAD) study.

    Maenhout, Thomas M; Poll, Anneleen; Vermassen, Tijl; De Buyzere, Marc L; Delanghe, Joris R


    In several European countries, drivers under the influence (DUI), suspected of chronic alcohol abuse are referred for medical and psychological examination. This study (the ROAD study, or Recidivism Of Alcohol-impaired Driving) investigated the usefulness of indirect alcohol biomarkers for predicting drunk-driving recidivism in previously convicted drunk-driving offenders. The ROAD study is a prospective study (2009-13) that was performed on 517 randomly selected drivers in Belgium. They were convicted for drunk-driving for which their licence was confiscated. The initial post-arrest blood samples were collected and analysed for percentage carbohydrate-deficient transferrin (%CDT), transaminsase activities [alanine amino transferase (ALT), aspartate amino transferase (AST)], gamma-glutamyltransferase (γGT) and red cell mean corpuscular volume (MCV). The observation time for each driver was 3 years and dynamic. A logistic regression analysis revealed that ln(%CDT) (P drunk-driving. The ROAD index (which includes ln(%CDT), ln(γGT), -ln(ALT) and the sex of the driver) was calculated and had a significantly higher area under the receiver operator characteristic curve (0.71) than the individual biomarkers for drunk-driving recidivism. Drivers with a high risk of recidivating (ROAD index ≥ 25%; third tertile) could be distinguished from drivers with an intermediate risk (16% ≤ ROAD index drunk-driving. The association with gamma-glutamyltransferase, alanine amino transferase and the sex of the driver could have additional value for identifying drunk-drivers at intermediate risk of recidivism. Non-specific indirect alcohol markers, such as alanine amino transferase, gamma-glutamyltransferase, aspartate amino transferase and red cell mean corpuscular volume have minimal added value to % carbohydrate-deficient transferrin for distinguishing drunk drivers with a low or high risk of recidivism. © 2013 Society for the Study of Addiction.


    Dhiman Kamini


    Full Text Available In folk medicines, Chaturbeeja(combination of seeds of four plants i.e Trigonella Foenum-graecum, Lepidium sativum , Nigella sativa, Trachyspermum ammi in equal quantity has been traditionally used for variety of applications including treatment of Dysmenorrhoea, the most common gynaecological symptom reported by women. To promote the proper use of such medicines and to determine their potential as sources for new drugs, it is essential to study medicinal plants, which have folklore reputation in a more intensified way. A Single blind, prospective observational clinical study was conducted to evaluate the efficacy of Chaturbeeja powder in Primary Dysmenorrhoea (Kashtartava. 25 patients were administered Chaturbeeja powder in a single dose of 3g with hot water at night, 7 days before starting of menstruation till 3rd day of the menstruation cycle. After assessing the results it was observed that12 patients were markedly improved, 8 moderately improved and 5 were improved.

  4. Study of the upper atmosphere observation by artificial ion beam

    Sugimoto, Sachiko; Kuninaka, Hitoshi; TOKI, Kyoichiro; Arakawa, Yoshihiro; 杉本 幸子; 國中 均; 都木 恭一郎; 荒川 義博


    The observing method that uses ENA (Energetic Neutral Atoms), produced by ion beam injected from an ion thruster, is studied and researched in order to estimate the density of neutral particles in the upper atmosphere. The ion beam experiences charge exchange collision (CEX) with neighboring neutral particles to transform into ENAs. The ENA preserves the information about the particles concerned with those collisions. A new method of estimating the density and the composition of the neutral p...

  5. Observed Orbit Effects during Long Range Beam-Beam Studies

    Alemany, R; Buffat, X; Calaga, R; Fitterer, M; Giachino, R; Hemelsoet, GH; Herr, W; Papotti, G; Pieloni, T; Poyer, M; Schaumann, M; Trad, G; Wollmann, D


    Possible limitations due to long range beam-beam effects at the LHC have been studied and are presented in this note. With a larger number of bunches and collisions in all interaction points, the crossing angles were reduced to enhance long range beam-beam effects. The analysis of the effects on the dynamic aperture and losses are documented in [1]. This note concentrates on the bunch-by-bunch orbit effects observed during the experiment.

  6. Strategies GeoCape Intelligent Observation Studies @ GSFC

    Cappelaere, Pat; Frye, Stu; Moe, Karen; Mandl, Dan; LeMoigne, Jacqueline; Flatley, Tom; Geist, Alessandro


    This presentation provides information a summary of the tradeoff studies conducted for GeoCape by the GSFC team in terms of how to optimize GeoCape observation efficiency. Tradeoffs include total ground scheduling with simple priorities, ground scheduling with cloud forecast, ground scheduling with sub-area forecast, onboard scheduling with onboard cloud detection and smart onboard scheduling and onboard image processing. The tradeoffs considered optimzing cost, downlink bandwidth and total number of images acquired.

  7. Observational study of maternal anthropometry and fetal insulin

    Soltani-K, H; Bruce, C; Fraser, R


    AIMS—To examine the relation between maternal body fat and fetal metabolism.
METHODS—In this observational study, cord blood samples were collected from 60 infants of healthy women for the measurement of insulin and C peptide concentrations. Maternal weight, height, body mass index (BMI) and body composition (skinfold thickness measurements and bioelectrical impedance) were assessed at 13-15 weeks of gestation. Twenty five of the volunteers agreed to have a 75 g oral gluc...

  8. The value of including observational studies in systematic reviews was unclear: a descriptive study.

    Seida, Jennifer; Dryden, Donna M; Hartling, Lisa


    To evaluate (1) how often observational studies are included in comparative effectiveness reviews (CERs); (2) the rationale for including observational studies; (3) how data from observational studies are appraised, analyzed, and graded; and (4) the impact of observational studies on strength of evidence (SOE) and conclusions. Descriptive study of 23 CERs published through the Effective Health Care Program of the U.S. Agency for Healthcare Research and Quality. Authors searched for observational studies in 20 CERs, of which 18 included a median of 11 (interquartile range, 2-31) studies. Sixteen CERs incorporated the observational studies in their SOE assessments. Seventy-eight comparisons from 12 CERs included evidence from both trials and observational studies; observational studies had an impact on SOE and conclusions for 19 (24%) comparisons. There was diversity across the CERs regarding decisions to include observational studies; study designs considered; and approaches used to appraise, synthesize, and grade SOE. Reporting and methods guidance are needed to ensure clarity and consistency in how observational studies are incorporated in CERs. It was not always clear that observational studies added value in light of the additional resources needed to search for, select, appraise, and analyze such studies. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Using data mining techniques to characterize participation in observational studies.

    Linden, Ariel; Yarnold, Paul R


    Data mining techniques are gaining in popularity among health researchers for an array of purposes, such as improving diagnostic accuracy, identifying high-risk patients and extracting concepts from unstructured data. In this paper, we describe how these techniques can be applied to another area in the health research domain: identifying characteristics of individuals who do and do not choose to participate in observational studies. In contrast to randomized studies where individuals have no control over their treatment assignment, participants in observational studies self-select into the treatment arm and therefore have the potential to differ in their characteristics from those who elect not to participate. These differences may explain part, or all, of the difference in the observed outcome, making it crucial to assess whether there is differential participation based on observed characteristics. As compared to traditional approaches to this assessment, data mining offers a more precise understanding of these differences. To describe and illustrate the application of data mining in this domain, we use data from a primary care-based medical home pilot programme and compare the performance of commonly used classification approaches - logistic regression, support vector machines, random forests and classification tree analysis (CTA) - in correctly classifying participants and non-participants. We find that CTA is substantially more accurate than the other models. Moreover, unlike the other models, CTA offers transparency in its computational approach, ease of interpretation via the decision rules produced and provides statistical results familiar to health researchers. Beyond their application to research, data mining techniques could help administrators to identify new candidates for participation who may most benefit from the intervention. © 2016 John Wiley & Sons, Ltd.

  10. Efficacy and safety of the combination paclitaxel/carboplatin in patients with previously treated advanced ovarian carcinoma: a multicenter French Groupe des Investigateurs Nationaux pour l'Etude des Cancers Ovariens phase II study.

    Pujade-Lauraine, E; Guastalla, J P; Weber, B; Curé, H; Orfeuvre, H; Mousseau, M; Vincent, P; Diéras, V; Tubiana-Mathieu, N; Jacquin, J P; Mignot, L; Leduc, B; Paraïso, D; Viens, P


    The French Groupe des Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) conducted a multicenter phase II study of carboplatin and paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) to evaluate the efficacy and side effects of this combination in pretreated advanced ovarian cancer. Patients with progressive ovarian carcinoma during or after platinum-based chemotherapy received paclitaxel 175 mg/m2 intravenously over 3 hours followed by intravenous carboplatin over 30 minutes every 4 weeks. The dose of carboplatin was calculated using a projected area under the concentration-time curve of 5 mg/mL x min. Of the 50 patients entered, 50 were evaluable for toxicity and 42 for response. There were eight complete and 10 partial responses, for an overall response rate of 43% (95% confidence interval, 28% to 56%). Overall response rates in platinum refractory patients and in those with early (> or = 3 and or = 12 months) relapse was 28%, 33%, and 71%, respectively. Median response duration, progression-free survival, and overall survivals were 8, 6, and 14 months, respectively. The most frequent and severe toxicity was myelosuppression. Grades 3 and 4 neutropenia occurred in 30% and 23% of cycles, and granulocyte colony-stimulating factor was administered in 6%. Only one case of neutropenic fever was observed. Grades 3 and 4 thrombocytopenia occurred in 3% and 1% of cycles, respectively. Alopecia and moderate nausea or vomiting were frequent. Transitory peripheral neuropathy was present in 45% of patients but was severe in only one patient. One early death was observed due to progressive disease and possibly to therapy. The combination of paclitaxel 175 mg/m2 as a 3-hour infusion and carboplatin dosed to an area under the concentration-time curve of 5 is an effective therapy in patients previously treated with platinum-based chemotherapy and may be administered safely to outpatients who relapse after one or two lines of chemotherapy.

  11. Harvesting Collective Trend Observations from Large Scale Study Trips

    Eriksen, Kaare; Ovesen, Nis


    To enhance industrial design students’ decoding and understanding of the technological possibilities and the diversity of needs and preferences in different cultures it is not unusual to arrange study trips where such students acquire a broader view to strengthen their professional skills...... and approach, hence linking the design education and the design culture of the surrounding world. To improve the professional learning it is useful, though, to facilitate and organize the trips in a way that involves systematic data collection and reporting. This paper presents a method for facilitating study...... trips for engineering students in architecture & design and the results from crowd-collecting a large amount of trend observations as well as the derived experience from using the method on a large scale study trip. The method has been developed and formalized in relation to study trips with large...

  12. Parental behaviour in paediatric chronic pain: a qualitative observational study.

    Dunford, Emma; Thompson, Miles; Gauntlett-Gilbert, Jeremy


    Parental behaviour appears to influence the adjustment of children with chronic pain. However, research in this area has failed to produce consistent evidence. Studies have tended to rely on self-report measures derived from adult pain populations. This qualitative, observational research provides descriptive data of parental behaviour in a clinical environment. A qualitative observational study was made of parents and adolescents in a physically stressful setting. Modified grounded theory was used to analyse verbal and non-verbal behaviours. Eight parent-adolescent dyads seeking treatment for chronic pain were videoed during physical exercise sessions. Verbal and non-verbal behaviours were recorded and transcribed. Four overarching categories emerged: 'monitoring', 'protecting', 'encouraging' and 'instructing'. These often had both verbal and non-verbal aspects. Within these categories, more precise behavioural groups were also identified. This research identifies categories of parental behaviour that were derived directly from observation, rather than imposed on the basis of results from different populations. Four categories of behaviour were derived, which clarify and extend dimensions used in existing self-report instruments. Careful description of parental behaviours showed features that past research has neglected, and highlighted potential drawbacks of apparently positive parental actions. © The Author(s) 2013.

  13. Linking Indigenous Knowledge and Observed Climate Change Studies

    Alexander, Chief Clarence; Bynum, Nora; Johnson, Liz; King, Ursula; Mustonen, Tero; Neofotis, Peter; Oettle, Noel; Rosenzweig, Cynthia; Sakakibara, Chie; Shadrin, Chief Vyacheslav; Vicarelli, Marta; Waterhouse, Jon; Weeks, Brian


    We present indigenous knowledge narratives and explore their connections to documented temperature and other climate changes and observed climate change impact studies. We then propose a framework for enhancing integration of these indigenous narratives of observed climate change with global assessments. Our aim is to contribute to the thoughtful and respectful integration of indigenous knowledge with scientific data and analysis, so that this rich body of knowledge can inform science, and so that indigenous and traditional peoples can use the tools and methods of science for the benefit of their communities if they choose to do so. Enhancing ways of understanding such connections are critical as the Intergovernmental Panel on Climate Change Fifth Assessment process gets underway.

  14. Observational studies of regions of massive star formation

    Cooper, Heather Danielle Blythe


    Massive stars have a profound influence on their surroundings. However, relatively little is known about their formation. The study of massive star formation is hindered by a lack of observational evidence, primarily due to difficulties observing massive stars at early stages in their development. The Red MSX Source survey (RMS survey) is a valuable tool with which to address these issues. Near-infrared H- and K-band spectra were taken for 247 candidate massive young stellar objects (MYSOs), selected from the RMS survey. 195 (∼80%) of the targets are YSOs, of which 131 are massive YSOs (LBOL>5E3L⊙, M>8 M⊙). This is the largest spectroscopic study of massive YSOs to date. This study covers minimally obscured objects right through to very red, dusty sources. Almost all YSOs show some evidence for emission lines, though there is a wide variety of observed properties, with HI, H2 Fe II, and CO among the most commonly observed lines. Evidence for disks and outflows was frequently seen. Comparisons of Brγ and H2 emission with low mass YSOs suggest that the emission mechanism for these lines is the same for low-, intermediate-, and high-mass YSOs, i.e. high-mass YSOs appear to resemble scaled-up versions of low-mass YSOs. It was found that the YSOs form an evolutionary sequence, based on their spectra, consistent with the existing theoretical models. Type I YSOs have strong H2 emission, no ionized lines, and are redder than the other two subtypes. As such, these are considered to be the youngest sources. The Type III sources are bluest, and therefore considered to be the oldest subtype. They have strong H I lines and fluorescent Fe II 1.6878 μm emission. They may also have weak H2 emission. Type III sources may even be beginning to form a mini-H II region. XSHOOTER data from 10 Herbig Be stars were analysed. The evidence suggests that winds and disks are common among Herbig stars, as they are among their main sequence classical Be star counterparts. Line

  15. [The reporting of observational studies: analysis using the STROBE statement].

    Galera Llorca, Jordi; Lahoz Grillo, Raquel; Roig Loscertales, Francesc


    Deficiencies detected in biomedical studies publication different Guidelines to improve. The objective of the study is to assess the communication of observational studies of Cardiovascular and Metabolism therapeutic area (CVM) published in 6 Spanish journals in 2009 using the STROBE statement. Cross-sectional analysis of articles related to CVM therapeutic area, published during 2009 in 6 Spanish journals applying the 34 items of the STROBE statement. Descriptive analysis of the results for qualitative variables was performed using a frequency analysis. Quantitative variables were analyzed by sample estimates and dispersion. A comparative analysis of journals was performed using ANOVA with a statistical significance of pGaceta Sanitaria and a minimum of 19 (DE±2.8) in Hipertensión. Evaluated papers comply with slightly more than a half items (58%) of the STROBE recommendations. The Methods and Results sections showed more deficiencies.

  16. Palliative care team visits. Qualitative study through participant observation

    María del Mar Alfaya Góngora


    Full Text Available Objectives:To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants.Methods:A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed.Results:The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources.Conclusion:Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources.

  17. An observational study of emergency department intern activities.

    Zhu, Jia Ni; Weiland, Tracey J; Taylor, David M; Dent, Andrew W


    To describe how intern time is spent, and the frequency of activities performed by interns during emergency department (ED) rotations. Prospective observational study of 42 ED interns from three Melbourne city teaching hospitals during 5 months in 2006. Direct observations were made by a single researcher for 390.8 hours, sampling all days of the week and all hours of the day. Proportion of time spent on tasks and number of procedures performed or observed by interns. Direct patient-related tasks accounted for 86.6% of total intern time, including 43.9% spent on liaising and documentation, 17.5% obtaining patient histories, 9.3% on physical examinations, 5.6% on procedures, 4.8% ordering or interpreting investigations, 3.0% on handover and 4.9% on other clinical activities. Intern time spent on non-clinical activities included 4.2% on breaks, 3.7% on downtime, 1.7% on education, and 1.3% on teaching others. Adjusted for an 8-week term, the ED intern would take 253 patient histories, consult more senior ED staff on 683 occasions, perform 237 intravenous cannulations/phlebotomies, 39 arterial punctures, 12 wound repairs and apply 16 plasters. They would perform chest compressions under supervision on seven occasions, observe defibrillation twice and intubation once, but may not see a thoracostomy. The ED exposes interns to a broad range of activities. With the anticipated increase in intern numbers, dilution of the emergency medicine experience may occur, and requirements for supervision may increase. Substitution of ED rotations may deprive interns of a valuable learning experience.

  18. 3-D microphysical model studies of Arctic denitrification: comparison with observations

    S. Davies


    statistical fit to MLS observations. Both adjustments would be required to bring the model into agreement with the MIPAS-B observations. The agreement between the model and observations suggests that a NAT-only denitrification scheme (without ice, which was discounted by previous studies, must now be considered as one mechanism for the observed Arctic denitrification. The timing of onset and the rate of denitrification remain poorly constrained by the available observations.

  19. 3-D microphysical model studies of Arctic denitrification: comparison with observations

    S. Davies


    statistical fit to MLS observations. Both adjustments would be required to bring the model into agreement with the MIPAS-B observations. The agreement between the model and observations suggests that a NAT-only denitrification scheme (without ice, which was discounted by previous studies, must now be considered as one mechanism for the observed Arctic denitrification. The timing of onset and the rate of denitrification remain poorly constrained by the available observations.

  20. An Observational Study of Entrainment Rate in Deep Convection

    Xiaohao Guo


    Full Text Available This study estimates entrainment rate and investigates its relationships with cloud properties in 156 deep convective clouds based on in-situ aircraft observations during the TOGA-COARE (Tropical Ocean Global Atmosphere Coupled Ocean Atmosphere Response Experiment field campaign over the western Pacific. To the authors’ knowledge, this is the first study on the probability density function of entrainment rate, the relationships between entrainment rate and cloud microphysics, and the effects of dry air sources on the calculated entrainment rate in deep convection from an observational perspective. Results show that the probability density function of entrainment rate can be well fitted by lognormal, gamma or Weibull distribution, with coefficients of determination being 0.82, 0.85 and 0.80, respectively. Entrainment tends to reduce temperature, water vapor content and moist static energy in cloud due to evaporative cooling and dilution. Inspection of the relationships between entrainment rate and microphysical properties reveals a negative correlation between volume-mean radius and entrainment rate, suggesting the potential dominance of homogeneous mechanism in the clouds examined. In addition, entrainment rate and environmental water vapor content show similar tendencies of variation with the distance of the assumed environmental air to the cloud edges. Their variation tendencies are non-monotonic due to the relatively short distance between adjacent clouds.

  1. Complete control, direct observation and study of molecular super rotors

    Korobenko, Aleksey; Milner, Valery


    Extremely fast rotating molecules carrying significantly more energy in their rotation than in any other degree of freedom are known as "super rotors". It has been speculated that super rotors may exhibit a number of unique and intriguing properties. Theoretical studies showed that ultrafast molecular rotation may change the character of molecular scattering from solid surfaces, alter molecular trajectories in external fields, make super rotors surprisingly stable against collisions, and lead to the formation of gas vortices. New ways of molecular cooling and selective chemical bond breaking by ultrafast spinning have been proposed. Owing to the fundamental laws of nature, bringing a large number of molecules to fast, directional and synchronous rotation is rather challenging. As a result, only indirect evidence of super rotors has been reported to date. Here we demonstrate the first controlled creation, direct observation and study of molecular super rotors. Using intense laser pulses tailored to produce an ...

  2. Pandemrix™ and narcolepsy: A critical appraisal of the observational studies.

    Verstraeten, Thomas; Cohet, Catherine; Dos Santos, Gaël; Ferreira, Germano Lc; Bollaerts, Kaatje; Bauchau, Vincent; Shinde, Vivek


    A link between Pandemrix™ (AS03-adjuvanted H1N1 pandemic influenza vaccine, GSK Vaccines, Belgium) and narcolepsy was first suspected in 2010 in Sweden and Finland following a number of reports in children and adolescents. Initial scepticism about the reported association faded as additional countries reported similar findings, leading several regulatory authorities to restrict the use of Pandemrix™. The authors acknowledge that currently available data suggest an increased risk of narcolepsy following vaccination with Pandemrix™; however, from an epidemiologist's perspective, significant methodological limitations of the studies have not been fully addressed and raise questions about the reported risk estimates. We review the most important biases and confounders that potentially occurred in 12 European studies of the observed association between Pandemrix™ and narcolepsy, and call for further analyses and debate.

  3. Empirical study of sensor observation services server instances

    Tamayo, Alain; Granell, Carlos; Huerta, Joaquín; 10.1007/978-3-642-19789-5_10


    The number of Sensor Observation Service (SOS) instances available online has been increasing in the last few years. The SOS specification standardises interfaces and data formats for exchanging sensor-related in-formation between information providers and consumers. SOS in conjunction with other specifications in the Sensor Web Enablement initiative, at-tempts to realise the Sensor Web vision, a worldwide system where sensor networks of any kind are interconnected. In this paper we present an empirical study of actual instances of servers implementing SOS. The study focuses mostly in which parts of the specification are more frequently included in real implementations, and how exchanged messages follows the structure defined by XML Schema files. Our findings can be of practical use when implementing servers and clients based on the SOS specification, as they can be optimized for common scenarios.

  4. Study of trace gases in the Martian atmosphere: Groundbased observation using SUBARU/IRCS and development of radiative transfer model for MEX/PFS limb observation

    Aoki, S.; Nakagawa, H.; Kasaba, Y.; Giuranna, M.; Geminale, A.; Sindoni, G.; Sagawa, H.; Mendrok, J.; Kasai, Y.; Formisano, V.


    We observed Martian atmosphere to investigate CH4, H2O, and HDO on 30 November 2011, 4-5 January 2012, and 12 April 2012 using SUBARU/ IRCS. This observation aims to verify CH4 on Mars, constrain its source, and investigate the distribution of H2O/HDO ratio. Our observation covered possible source areas of CH4, i.e. the areas where the extend plumes of CH4 were detected by previous groundbased and MEX/PFS observations [1,2] and the potential mud volcanism areas [3,4]. This paper will show some preliminary results. Vertical profiles of these trace gases are crucial for understanding their chemistry and transportation. Limb observations by MEX/PFS are a powerful tool to retrieve vertical profiles of H2O, CO, and CH4. For this purpose, we adapted the SARTre model, a radiative transfer code which includes multiple scattering for limb geometry observations developed for the terrestrial atmosphere [5], to the Martian atmosphere. In order to validate our model, SARTre model for Martian limb, we first compared of our synthetic spectra in nadir geometry with the result from ARS [6] which has been widely used for previous studies of MEX/PFS nadir-observation. We concluded that the difference between them is small offset (below 3%) in the spectral range between 3000 and 3030 cm-1.

  5. Warfarin and fibrinolysis - a challenging combination: an observational cohort study

    Luurila Harri


    Full Text Available Abstract Background Patients presenting with ST-segment elevation myocardial infarction (STEMI frequently use warfarin. Fibrinolytic agents and warfarin both increase bleeding risk, but only a few studies have been published concerning the bleeding risk of warfarin-prescribed patients receiving fibrinolysis. The objective of this study was to define the prevalence for intracranial haemorrhage (ICH or major bleeding in patients on warfarin treatment receiving pre-hospital fibrinolysis. Methods This was an observational cohort study. Data for this retrospective case series were collected in Helsinki Emergency Medical Service catchment area from 1.1.1997 to 30.6.2010. All warfarin patients with suspected ST-segment elevation myocardial infarction (STEMI, who received pre-hospital fibrinolysis, were included. Bleeding complications were detected from Medical Records and classified as ICH, major or minor bleeding. Results Thirty-six warfarin patients received fibrinolysis during the study period. Fourteen patients had bleeding complications. One (3%, 95% CI 0-15% patient had ICH, six (17%, 95% CI 7-32% had major and seven (19%, 95% CI 9-35% had minor bleeding. The only fatal bleeding occurred in a patient with ICH. Patients' age, fibrinolytic agent used or aspirin use did not predispose to bleeding complications. High International Normalized Ratio (INR seemed to predispose to bleedings with values over 3, but no statistically significant difference was found. Conclusions Bleedings occur frequently in warfarin patients treated with fibrinolysis in the real world setting, but they are rarely fatal.

  6. Mucocutaneous manifestations of acquired hypoparathyroidism: An observational study

    Somenath Sarkar


    Full Text Available Hypoparathyroidism is a disorder of calcium and phosphorus metabolism due to decreased secretion of parathyroid hormone. Hypoparathyroidism can be hereditary and acquired. Acquired hypoparathyroidism usually occurs following neck surgery (thyroid surgery or parathyroid surgery. Along with systemic manifestations, hypoparathyroidism produces some skin manifestations. Lack of study regarding mucocutaneous manifestations of acquired hypoparathyroidism prompted us to undertake this study. To evaluate the mucocutaneous manifestations of acquired hypoparathyroidism. An observational study done in a tertiary care hospital of Kolkata by comprehensive history taking, through clinical examination and relevant laboratory investigations. Twenty-one patients were included in the study. The commonest form of acquired hypoparathyroidism was neck surgery (thyroidectomy and parathyroidectomy operation. Mucocutaneous manifestations were present in 76.19% of patients. The most frequent mucocutaneous manifestation was found in the hairs like the loss of axillary hair (61.9%, loss of pubic hair (52.38%, coarsening of body hair (47.62%, and alopecia areata (9.52%. The nail changes noted were brittle and ridged nail, followed by onycholysis, onychosezia, and onychomedesis. The most common skin features were xerotic skin in 11 patients (52.38%, followed by pellagra-like skin pigmentation, pustular psoriasis and acne form eruption, bullous impetigo, etc. Mucosa was normal in all the cases excepting the one which showed oral candidiasis.

  7. Subsequent pregnancy outcome after previous foetal death

    Nijkamp, J. W.; Korteweg, F. J.; Holm, J. P.; Timmer, A.; Erwich, J. J. H. M.; van Pampus, M. G.


    Objective: A history of foetal death is a risk factor for complications and foetal death in subsequent pregnancies as most previous risk factors remain present and an underlying cause of death may recur. The purpose of this study was to evaluate subsequent pregnancy outcome after foetal death and to

  8. Providers' response to child eating behaviors: A direct observation study.

    Tovar, Alison; Vaughn, Amber E; Fallon, Megan; Hennessy, Erin; Burney, Regan; Østbye, Truls; Ward, Dianne S


    Child care providers play an important role in feeding young children, yet little is known about children's influence on providers' feeding practices. This qualitative study examines provider and child (18 months -4 years) feeding interactions. Trained data collectors observed 200 eating occasions in 48 family child care homes and recorded providers' responses to children's meal and snack time behaviors. Child behaviors initiating provider feeding practices were identified and practices were coded according to higher order constructs identified in a recent feeding practices content map. Analysis examined the most common feeding practices providers used to respond to each child behavior. Providers were predominately female (100%), African-American (75%), and obese (77%) and a third of children were overweight/obese (33%). Commonly observed child behaviors were: verbal and non-verbal refusals, verbal and non-verbal acceptance, being "all done", attempts for praise/attention, and asking for seconds. Children's acceptance of food elicited more autonomy supportive practices vs. coercive controlling. Requests for seconds was the most common behavior, resulting in coercive controlling practices (e.g., insisting child eat certain food or clean plate). Future interventions should train providers on responding to children's behaviors and helping children become more aware of internal satiety and hunger cues.

  9. Critical Observation on Methodologies of Select Doctoral Research Studies

    Dr Indrajit Goswami


    Full Text Available The present article aims to critically observe and interpret the methodological deficiencies as found in randomly selected 14 doctoral theses submitted to two different universities in India. Despite their serious deviation from the expected methodological standards, all those theses were accepted and approved by the universities and scholars concerned conferred with PhD degrees. Undoubtedly, those theses kept in the reference sections at the respective university libraries would potentially misguide and mislead the future researchers. Some of the common technical deficiencies, as have been noticed, include (1 absence of careful thoughts in framing research titles, (ii biased method of data collection, (ii absence of logical explanation in favour of sample size and sample selection process, (iii designing and execution of instrument for data collection, (iv theory formulation in terms of framing of objectives, hypotheses and operational definitions etc. The article attempts to present the critical observations on case-to-case basis so that their conceptual, instrumental and procedural deficiencies and deviations are easily understood by the academicians, researchers and students. The content of this article is divided in to three broad sections. The first section deals with an introduction to quantitative and qualitative research methods and their advantages and limitations. The next section deals with the review of the selected theses followed by conclusion and suggested remedial measures. The objective of this article is purely academic and its scope is limited to enhancement of quality of future research studies in the domains and related fields.

  10. Characterization of ambient aerosols in Mexico City during the MCMA-2003 campaign with Aerosol Mass Spectrometry Part II: overview of the results at the CENICA supersite and comparison to previous studies

    Salcedo, D.; Dzepina, K.; Onasch, T. B.; Canagaratna, M. R.; Jayne, J. T.; Worsnop, D. R.; Gaffney, J. S.; Marley, N. A.; Johnson, K. S.; Zuberi, B.; Molina, L. T.; Molina, M. J.; Shutthanandan, V.; Xie, Y.; Jimenez, J. L.


    An Aerodyne Aerosol Mass Spectrometer (AMS) was deployed at the CENICA Supersite during the Mexico City Metropolitan Area field study from 31 March-4 May 2003. The AMS provides real time information on mass concentration and composition of the non-refractory species in particulate matter less than 1 µm (NR-PM1) with high time and size-resolution. Measurements of Black Carbon (BC) using an aethalometer, and estimated soil concentrations from Proton-Induced X-Ray Emission (PIXE) analysis of impactor substrates are also presented and combined with the AMS in order to include refractory material and estimate the total PM2.5 mass concentration at CENICA during this campaign. In Mexico City, the organic fraction of the estimated PM2.5 at CENICA represents 54.6% of the mass, with the rest consisting of inorganic compounds (mainly ammonium nitrate and sulfate/ammonium salts), BC, and soil. Inorganic compounds represent 27.5% of PM2.5; BC mass concentration is about 11%; while soil represents about 6.9%. The NR species and BC have diurnal cycles that can be qualitatively interpreted as the interplay of direct emissions, photochemical production in the atmosphere followed by condensation and gas-to-particle partitioning, boundary layer dynamics, and/or advection. Bi- and trimodal size distributions are observed for the AMS species, with a small combustion (likely traffic) organic particle mode and an accumulation mode that contains mainly organic and secondary inorganic compounds. The AMS and BC mass concentrations, size distributions, and diurnal cycles are found to be qualitatively similar to those from most previous field measurements in Mexico City.

  11. Nursing diagnoses in patients with chronic venous ulcer: observational study

    Glycia de Almeida Nogueira


    Full Text Available This study aimed to analyze nursing diagnoses in people with chronic venous ulcer. An observational, descriptive, quantitative research conducted in an ambulatory specialized in wound treatment, with a non-probabilistic sample of 20 patients.  Data collection was performed in an institutional form denominated Assessment Protocol for Clients with Tissue Lesions. Diagnoses were established by consensus among four researchers with experience in nursing diagnoses and wound treatments. From data analysis, 16 diagnoses were identified, with 100% of participants presenting: Impaired tissue integrity, Ineffective peripheral tissue perfusion, Risk of infection, Impaired physical mobility and Ineffective health self-control. These diagnoses are found in Safety/Protection, Activity/Rest and Health promotion domains, which from the clinical practice stand point should be priority focuses in nursing intervention and assessment.

  12. Obesity in adolescents with chronic fatigue syndrome: an observational study.

    Norris, T; Hawton, K; Hamilton-Shield, J; Crawley, E


    Identify the prevalence of obesity in patients with chronic fatigue syndrome (CFS) compared with healthy adolescents, and those identified with CFS in a population cohort. Cross-sectional analysis of multiple imputed data. Data from UK paediatric CFS/myalgic encephalomyelitis (CFS/ME) services compared with data collected at two time points in the Avon Longitudinal Study of Parents and Children (ALSPAC). 1685 adolescents who attended a CFS/ME specialist service between 2004 and 2014 and 13 978 adolescents aged approximately 13 years and 16 years participating in the ALSPAC study. Body mass index (BMI) (kg/m(2)), sex-specific and age-specific BMI Z-scores (relative to the International Obesity Task Force cut-offs) and prevalence of obesity (%). Adolescents who had attended specialist CFS/ME services had a higher prevalence of obesity (age 13 years: 9.28%; age 16 years: 16.43%) compared with both adolescents classified as CFS/ME in ALSPAC (age 13 years: 3.72%; age 16 years: 5.46%) and those non-CFS in ALSPAC (age 13 years: 4.18%; age 16 years: 4.46%). The increased odds of obesity in those who attended specialist services (relative to non-CFS in ALSPAC) was apparent at both 13 years (OR: 2.31 (1.54 to 3.48)) and 16 years, with a greater likelihood observed at 16 years (OR: 4.07 (2.04 to 8.11)). We observed an increased prevalence of obesity in adolescents who were affected severely enough to be referred to a specialist CFS/ME service. Further longitudinal research is required in order to identify the temporal relationship between the two conditions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  13. Evidence of clinical competence by simulation, a hermeneutical observational study.

    Lejonqvist, Gun-Britt; Eriksson, Katie; Meretoja, Riitta


    Making the transition from theory to practise easier in nursing education through simulation is widely implemented all over the world, and there is research evidence of the positive effects of simulation. The pre-understanding for this study is based on a definition of clinical competence as encountering, knowing, performing, maturing and developing, and the hypothesis is that these categories should appear in simulated situations. The aim of the study was to explore the forms and expressions of clinical competence in simulated situations and furthermore to explore if and how clinical competence could be developed by simulation. An observational hermeneutic study with a hypothetic-deductive approach was used in 18 simulated situations with 39 bachelor degree nursing students. In the situations, the scenarios, the actors and the plots were described. The story told was "the way from suffering to health" in which three main plots emerged. The first was, doing as performing and knowing, which took the shape of knowing what to do, acting responsibly, using evidence and equipment, appearing confident and feeling comfortable, and sharing work and information with others. The second was, being as encountering the patient, which took the shape of being there for him/her and confirming by listening and answering. The third plot was becoming as maturing and developing which took the shape of learning in co-operation with other students. All the deductive categories, shapes and expressions appeared as dialectic patterns having their negative counterparts. The study showed that clinical competence can be made evident and developed by simulation and that the challenge is in encountering the patient and his/her suffering.

  14. Oral implications of the vegan diet: observational study.

    Laffranchi, L; Zotti, F; Bonetti, S; Dalessandri, D; Fontana, P


    The aim of this study was to investigate oral changes in subjects who have assumed a vegan diet for a long time (at least 18 months), that is to say, a diet completely lacking in meat and animal derivatives. A sample of 15 subjects was analyzed, all from northern Italy and aged 24 to 60 year, composed of 11 men and 4 women who had been following a vegan diet for a minimum of 18 months to a maximum of 20 years. In parallel with the study sample, a control group (15 subjects) with the same criteria of age, sex, and place of origin all following an omnivorous diet was chosen. The sample answered a questionnaire that investigated their eating habits, the frequency with which they eat meals, the main foodstuffs assumed, oral hygiene habits, and any painful symptomatology of the teeth or more general problems in the oral cavity. The sample was then subject to objective examination in which the saliva pH was measured and the teeth were checked for demineralization of the enamel, white spots, and caries (using KaVo DIAGNOdent) with particular attention being paid to the localization of these lesions, and lastly, sounding was carried out to detect any osseous defects and periodontal pockets. The study revealed greater incidence of demineralization and white spots in the vegan subjects compared to the omnivorous ones localized at the neck of the teeth and on the vestibular surfaces of dental elements (with the exception of the lower anterior group). The saliva pH, more acid in the omnivorous patients, ranged between four and six. Changes in oral conditions in both groups of subjects were observed. In order to research into the cause-effect relationship of the vegan diet on the oral cavity effectively, the sample needs to be studied for a longer period of time and the results re-evaluated.

  15. Evaluation of Xerostomia in Different Psychological Disorders: An Observational Study

    Chandrappa, Pramod Redder; Patil, Snehal; Roodmal, Seema Yadav; Kumarswamy, Akshay; Chappi, Mounesh Kumar


    Introduction Psychiatric diseases like anxiety, depression, schizophrenia and bipolar disorders are increasing at an alarming rate. These diseases can affect the quantity and quality of saliva leading to multiple oral diseases. Although many researchers have evaluated xerostomia in general population, its prevalence is not been assessed in patients suffering from different psychological disorders. Aim To investigate the prevalence of xerostomia and to assess the correlation between xerostomia and dryness of lip and mucosa in different psychological disorders. Materials and Methods A cross-sectional observational study was conducted over a period of six months in Department of Psychiatry and Department of Oral Medicine. Patients with anxiety, depression, schizophrenia and bipolar disorder, as diagnosed by an experienced psychiatrist, were given a questionnaire to evaluate the xerostomia. Patients with symptoms of xerostomia were subjected to oral examination by a skilled oral diagnostician to check for dryness of lips and mucosa. One hundred patients from each group of psychiatric diseases were included in the study using a consecutive sampling technique. An equal number of healthy individuals reporting to oral medicine department for routine oral screening were included as control group after initial psychiatric evaluation. Results In this study statistically significant increase in the xerostomia in psychiatric patients was recorded when compared to the control group (p<0.01). Xerostomia was significantly higher in anxiety patients (51%) followed by depression (47%), bipolar disorder (41%), schizophrenia (39%) and control group (27%). The majority of the psychiatric patients had ‘moderate’ to ‘severe’ xerostomia whereas the control group had ‘mild’ xerostomia. Xerostomia was significantly higher in younger age group (18–49 years) than in older age group and females patients had higher xerostomia than male patients. Psychiatric patients had

  16. 2D vs. 3D mammography observer study

    Fernandez, James Reza F.; Hovanessian-Larsen, Linda; Liu, Brent


    Breast cancer is the most common type of non-skin cancer in women. 2D mammography is a screening tool to aid in the early detection of breast cancer, but has diagnostic limitations of overlapping tissues, especially in dense breasts. 3D mammography has the potential to improve detection outcomes by increasing specificity, and a new 3D screening tool with a 3D display for mammography aims to improve performance and efficiency as compared to 2D mammography. An observer study using a mammography phantom was performed to compare traditional 2D mammography with this ne 3D mammography technique. In comparing 3D and 2D mammography there was no difference in calcification detection, and mass detection was better in 2D as compared to 3D. There was a significant decrease in reading time for masses, calcifications, and normals in 3D compared to 2D, however, as well as more favorable confidence levels in reading normal cases. Given the limitations of the mammography phantom used, however, a clearer picture in comparing 3D and 2D mammography may be better acquired with the incorporation of human studies in the future.

  17. Study of the NWC electrons belt observed on DEMETER Satellite

    Li, Xinqiao; Wang, Ping; Wang, Huanyu; Lu, Hong; Zhang, Xuemin; Huang, Jianping; Shi, Feng; Yu, Xiaoxia; Xu, Yanbing; Meng, Xiangcheng; Wang, Hui; Zhao, Xiaoyun; Parrot, M


    We analyzed the data from 2007 to 2008, which is observed by IDP onboard DEMETER satellite, during ten months of NWC working and seven months of NWC shutdown. The characteristic of the space instantaneous electron belts, which come from the influence of the VLF transmitted by NWC, is studied comprehensively. The main distribution region of the NWC electron belts and the flux change are given. We also studied the distribution characteristic of the average energy spectrum in different magnetic shell at the height of DEMETER orbit and the difference of the average energy spectrum of the electrons in the drift loss-cone between day and night. As a result, the powerful power of NWC transmitter and the 19.8 kHz narrow bandwidth VLF emission not only created a momentary electrons enhancement region, which strides 180 degree in them longitude direction and from 1.6 to 1.9 in L value, with the rise of the electrons flux reaching to 3 orders of magnitude mostly, but also induced the enhancement or loss of electrons in ...

  18. Treatment of Crohn's disease with cannabis: an observational study.

    Naftali, Timna; Lev, Lihi Bar; Yablecovitch, Doron; Yablekovitz, Doron; Half, Elisabeth; Konikoff, Fred M


    The marijuana plant cannabis is known to have therapeutic effects, including improvement of inflammatory processes. However, no report of patients using cannabis for Crohn's disease (CD) was ever published. To describe the effects of cannabis use in patients suffering from CD. In this retrospective observational study we examined disease activity, use of medication, need for surgery, and hospitalization before and after cannabis use in 30 patients (26 males) with CD. Disease activity was assessed by the Harvey Bradshaw index for Crohn's disease. Of the 30 patients 21 improved significantly after treatment with cannabis. The average Harvey Bradshaw index improved from 14 +/- 6.7 to 7 +/- 4.7 (P < 0.001). The need for other medication was significantly reduced. Fifteen of the patients had 19 surgeries during an average period of 9 years before cannabis use, but only 2 required surgery during an average period of 3 years of cannabis use. This is the first report of cannabis use in Crohn's disease in humans. The results indicate that cannabis may have a positive effect on disease activity, as reflected by reduction in disease activity index and in the need for other drugs and surgery. Prospective placebo-controlled studies are warranted to fully evaluate the efficacy and side effects of cannabis in CD.

  19. Recognising advancing nursing practice: evidence from two observational studies.

    Wilson-Barnett, J; Barriball, K L; Reynolds, H; Jowett, S; Ryrie, I


    Debates over title, grades and relationships across the profession has tended to dominate the literature in advancing nursing practice. Fewer research projects have attempted to study the activities of nurses who are designated as undertaking advancing nursing roles. One study evaluating Masters courses for Clinical Nursing Practice and a second addressing the impact of the 'Scope of Professional Practice' (United Kingdom Central Council for Nursing, Midwifery & Health Visiting, 1992) document by this team of authors afforded these research opportunities. In this paper empirical data from 'reflective' observation with 19 nurses (including midwives and health visitors) are presented to illustrate the range and type of functions undertaken by a small group of practitioners developing their practice. A number of characteristic features emerged. Assessment of individual and group needs, positive motivation to constantly improve practice, inter-disciplinary and cross agency working for planned change and an ability to identify and prioritize service requirements were recognised in these nurses' roles. Certain personal attributes were seen to be essential for successful role development such as confidence, commitment and problem solving powers combined with a positive working environment and supportive managers.

  20. [Pregnancy-Associated Breast Cancer: An analytical observational study].

    Baulies, Sonia; Cusidó, Maite; Tresserra, Francisco; Rodríguez, Ignacio; Ubeda, Belén; Ara, Carmen; Fábregas, Rafael


    Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum. A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared. The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P < .05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P < .05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively. The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade iii, as well as a delay in diagnosis with a higher rate of advanced stages. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  1. Insulin Pump Failures: Has There Been an Improvement? Update of a Prospective Observational Study.

    Guenego, Agathe; Bouzillé, Guillaume; Breitel, Stéphanie; Esvant, Annabelle; Poirier, Jean-Yves; Bonnet, Fabrice; Guilhem, Isabelle


    Insulin pump failures had been assessed in our center by a prospective observational study from 2001 to 2007. The aim of this study was to update our data since 2008 and to determine whether there exist specific risk factors for insulin pump failures. All insulin pump defects were prospectively collected between 2008 and 2013 in a monocentric cohort of 350 new pumps. Clinical consequences were recorded. Brand and model of pumps and type of defects and patients' characteristics (gender, type of diabetes, age at diabetes diagnosis, age at first pump, pump treatment duration, number of previous pumps, and number of previous pump failures) were tested for possible association with insulin pump failure. Malfunctions occurred in 239 (68%) pumps. The incidence rate was 33/100 pump-years. There were 28 (12%) complete failures, 17 (7%) alarms, 83 (35%) mechanical defects, and 105 (44%) minor defects. Survival curves did not differ according to pump brand and model. Hyperglycemia occurred in 2.9% of cases. In multivariate analysis, only patient age less than 40 years at the initiation of pump therapy was associated with higher risk of malfunction (hazard ratio 1.64; 95% confidence interval 1.19-2.24; P = 0.002). Pump malfunctions remain common with modern pumps. We report less complete failures than in our previous study. This could be because of improvement in quality of pumps or to our strategy of systematic screening and replacement in case of mechanical defects.

  2. Risk factors for suicide behaviors in the observational schizophrenia outpatient health outcomes (SOHO study

    Brugnoli Roberto


    Full Text Available Abstract Background To identify risk factors for suicide using data from a large, 3-year, multinational follow-up study of schizophrenia (SOHO study. Methods Baseline characteristics of 8,871 adult patients with schizophrenia were included in a logistic regression post-hoc analysis comparing patients who attempted and/or committed suicide during the study with those who did not. Results 384 (4.3% patients attempted or committed suicide. Completed suicides were 27 (0.3%. The significant risk factors for suicide behaviors were previous suicidality, depressive symptoms, prolactin-related adverse events, male gender and history of hospitalization for schizophrenia. Conclusions In view of the observational design of the study and the post-hoc nature of the analysis, the identified risk factors should be confirmed by ad-hoc specifically designed studies.

  3. The brain study : Cognition, quality of life and social functioning following preeclampsia; An observational study

    Postma, I. R.; Groen, H.; Easterling, T. R.; Tsigas, E. Z.; Wilson, M. L.; Porcel, J.; Zeeman, G. G.


    Objectives: Previously preeclamptic women may express cognitive difficulties, which have largely been unappreciated or attributed to stresses of a complicated pregnancy. This study aimed to explore the scope of perceived neurocognitive and psychosocial problems as well as quality of life following p

  4. The brain study : Cognition, quality of life and social functioning following preeclampsia; An observational study

    Postma, I. R.; Groen, H.; Easterling, T. R.; Tsigas, E. Z.; Wilson, M. L.; Porcel, J.; Zeeman, G. G.


    Objectives: Previously preeclamptic women may express cognitive difficulties, which have largely been unappreciated or attributed to stresses of a complicated pregnancy. This study aimed to explore the scope of perceived neurocognitive and psychosocial problems as well as quality of life following

  5. Dental injury after conventional direct laryngoscopy: a prospective observational study.

    Mourão, J; Neto, J; Luís, C; Moreno, C; Barbosa, J; Carvalho, J; Tavares, J


    This observational study assessed the frequency and risk factors of dental damage after classic direct laryngoscopy for tracheal intubation in 536 adult patients. The patients' sex, age, height, weight, dental condition, dental mobility, Mallampati class, interincisor gap, thyromental distance, neck circumference, and head and neck extension were recorded. From anaesthesia records, the difficulty of intubation, the number of attempts, type of neuromuscular blocking agent used and duration of anaesthesia were recorded. After anaesthesia, examination revealed that 134 patients (25.0%) had dental damage affecting 162 teeth (147 maxillary; 15 mandibular). Enamel fracture was the commonest injury. In tooth number 21, the interincisor gap (OR 2.5 (95% CI 1.0-5.9)) and in tooth number 22, the number of intubation attempts (OR 5.3 (95% CI 1.3-22.0)) were considered a risk factor for dental injury. Conventional direct laryngoscopy is associated with a strikingly high incidence of dental damage, although specific risk factors remain unclear. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  6. Giant cell arteritis: a multicenter observational study in Brazil

    Alexandre Wagner Silva de Souza


    Full Text Available OBJECTIVE: To describe demographic features, disease manifestations and therapy in patients with giant cell arteritis from referral centers in Brazil. METHODS: A retrospective cohort study was performed on 45 giant cell arteritis patients from three university hospitals in Brazil. Diagnoses were based on the American College of Rheumatology classification criteria for giant cell arteritis or temporal artery biopsy findings. RESULTS: Most patients were Caucasian, and females were slightly more predominant. The frequencies of disease manifestations were as follows: temporal headache in 82.2%, neuro-ophthalmologic manifestations in 68.9%, jaw claudication in 48.9%, systemic symptoms in 44.4%, polymyalgia rheumatica in 35.6% and extra-cranial vessel involvement in 17.8% of cases. Aortic aneurysms were observed in 6.6% of patients. A comparison between patients with biopsy-proven giant cell arteritis and those without temporal artery biopsies did not yield significant differences in disease manifestations. All patients were treated with oral prednisone, and intravenous methylprednisolone was administered to nearly half of the patients. Methotrexate was the most commonly used immunosuppressive agent, and low-dose aspirin was prescribed to the majority of patients. Relapses occurred in 28.9% of patients, and aspirin had a protective effect against relapses. Females had higher prevalences of polymyalgia rheumatica, systemic manifestations and jaw claudication, while permanent visual loss was more prevalent in men. CONCLUSIONS: Most of the clinical features of Brazilian giant cell arteritis patients were similar to those found in other studies, except for the high prevalence of neuro-ophthalmic manifestations and permanent blindness in the Brazilian patients. Aspirin had a protective effect on relapses.

  7. External Validation of the HERNIAscore: An Observational Study.

    Cherla, Deepa V; Moses, Maya L; Mueck, Krislynn M; Hannon, Craig; Ko, Tien C; Kao, Lillian S; Liang, Mike K


    The HERNIAscore is a ventral incisional hernia (VIH) risk assessment tool that uses only preoperative variables and predictable intraoperative variables. The aim of this study was to validate and modify, if needed, the HERNIAscore in an external dataset. This was a retrospective observational study of all patients undergoing resection for gastrointestinal malignancy from 2011 through 2015 at a safety-net hospital. The primary end point was clinical postoperative VIH. Patients were stratified into low-risk, medium-risk, and high-risk groups based on HERNIAscore. A revised HERNIAscore was calculated with the addition of earlier abdominal operation as a categorical variable. Cox regression of incisional hernia with stratification by risk class was performed. Incidence rates of clinical VIH formation within each risk class were also calculated. Two hundred and forty-seven patents were enrolled. On Cox regression, in addition to the 3 variables of the HERNIAscore (BMI, COPD, and incision length), earlier abdominal operation was also predictive of VIH. The revised HERNIAscore demonstrated improved predictive accuracy for clinical VIH. Although the original HERNIAscore effectively stratified the risk of an incisional radiographic VIH developing, the revised HERNIAscore provided a statistically significant stratification for both clinical and radiographic VIHs in this patient cohort. We have externally validated and improved the HERNIAscore. The revised HERNIAscore uses BMI, incision length, COPD, and earlier abdominal operation to predict risk of postoperative incisional hernia. Future research should assess methods to prevent incisional hernias in moderate-to-high risk patients. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Ventilation strategies in burn intensive care: A retrospective observational study

    Stefano Palazzo


    Full Text Available Consensus regarding optimal burns intensive care (BICU patient management is lacking. This study aimed to assess whether ventilation strategies, cardiovascular support and sedation in BICU patients have changed over time, and whether this affects outcome. A retrospective observational study comparing two 12-patient BICU cohorts (2005/06 and 2010/11 was undertaken. Demographic and admission characteristics, ventilation parameters, sedation, fluid resuscitation, cardiovascular support and outcome (length of stay, mortality data were collected from patient notes. Data was analysed using T-tests, Fisher's exact and Mann-Whitney U tests. In our study cohort groups were equivalent in demographic and admission parameters. There were equal ventilator-free days in the two cohorts 10 ± 12.7 vs. 13.3 ± 12.2 ventilator free days; P = 0.447. The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort (568 ventilator days/1000 patient BICU days vs. 206 ventilator days/1000 patient BICU days; P = 0.001. The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous (17.8% vs. 26%; P = 0.001 and volume-controlled modes (34.4% vs. 40.8%; P = 0.001. Patients in 2010/11 cohort were more heavily sedated (P = 0.001 with more long-acting sedative drug use (P = 0.001 than the 2005/06 cohort, fluid administration was equivalent. Patient outcome did not vary. Inhalational injury patients were ventilated in volume-controlled (44.5% vs. 28.1%; P = 0.001 and pressure-controlled modes (18.2% vs. 9.5%; P = 0.001 more frequently than those without. Outcome did not vary. This study showed there has been shift away from mechanical ventilation, with increased use of tracheostomy/tracheal tube airway spontaneous ventilation. Inhalation injury patients require more ventilatory support though patient outcomes do not differ. Prospective trials are required to establish which strategies confer benefit.

  9. Fatal poisonings in Oslo: a one-year observational study

    Heyerdahl Fridtjof


    Full Text Available Abstract Background Acute poisonings are common and are treated at different levels of the health care system. Since most fatal poisonings occur outside hospital, these must be included when studying characteristics of such deaths. The pattern of toxic agents differs between fatal and non-fatal poisonings. By including all poisoning episodes, cause-fatality rates can be calculated. Methods Fatal and non-fatal acute poisonings in subjects aged ≥16 years in Oslo (428 198 inhabitants were included consecutively in an observational multi-centre study including the ambulance services, the Oslo Emergency Ward (outpatient clinic, and hospitals, as well as medico-legal autopsies from 1st April 2003 to 31st March 2004. Characteristics of fatal poisonings were examined, and a comparison of toxic agents was made between fatal and non-fatal acute poisoning. Results In Oslo, during the one-year period studied, 103 subjects aged ≥16 years died of acute poisoning. The annual mortality rate was 24 per 100 000. The male-female ratio was 2:1, and the mean age was 44 years (range 19-86 years. In 92 cases (89%, death occurred outside hospital. The main toxic agents were opiates or opioids (65% of cases, followed by ethanol (9%, tricyclic anti-depressants (TCAs (4%, benzodiazepines (4%, and zopiclone (4%. Seventy-one (69% were evaluated as accidental deaths and 32 (31% as suicides. In 70% of all cases, and in 34% of suicides, the deceased was classified as drug or alcohol dependent. When compared with the 2981 non-fatal acute poisonings registered during the study period, the case fatality rate was 3% (95% C.I., 0.03-0.04. Methanol, TCAs, and antihistamines had the highest case fatality rates; 33% (95% C.I., 0.008-0.91, 14% (95% C.I., 0.04-0.33, and 10% (95% C.I., 0.02-0.27, respectively. Conclusions Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental

  10. Induced vaginal birth after previous caesarean section

    Akylbek Tussupkaliyev; Andrey Gayday; Bibigul Karimsakova; Saule Bermagambetova; Lunara Uteniyazova; Guldana Iztleuova; Gulkhanym Kusherbayeva; Meruyert Konakbayeva; Assylzada Merekeyeva; Zamira Imangaliyeva


    Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC) remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administra...

  11. Contribution of amateur observations to Saturn storm studies

    Delcroix, Marc


    Since 2004, Saturn Electrostatic Discharges (SEDs), which are the radio signatures of lightning in Saturn's atmosphere, have been observed by the Cassini Radio and Plasma Wave Science instrument (RPWS). Despite their important time coverage, these observations lack the resolution and positioning given by imaging around visible wavelengths. Amateur observations from Earth have been increasing in quality and coverage since a few years, bringing information on positions, drift rates and shape evolutions of large visible white spots in Saturn's atmosphere. Combining these two complementary sources has brought better analysis of Saturn's storms evolutions.

  12. Pulp polyp - A periapical lesion: Radiographic observational study

    Kandagal V Suresh


    Full Text Available Introduction: Pulp polyp (PP is a chronic hyperplastic condition resulting in formation of granulation tissue and proliferative mass. The radiographic appearance of PP has innumerable presentations. Diagnosing and treatment planning of periapical lesions, heavily relies on the radiographic changes surrounding the root structures. Objective: To evaluate different radiographic periapical changes in clinically detected PP patients. Materials and Methods: Patients reporting to Department of Oral Medicine and Radiology and who were clinically diagnosed with PP by an oral diagnostician were subjected to radiographic examination. Digital intraoral periapical radiographs of 50 patients with PP were taken. Various periapical changes in the digital radiographs were recorded by a skilled oral radiologist. The data obtained was subjected to statistical analysis using SPSS ver 17.0 and P-value was set at <0.05 as significant. Result: Periapical changes like periodontal space widening (PDLW, loss of lamina dura, periapical abscess, periapical granuloma, hypercementosis, condensing osteitis and root resorption were noted. Periodontal space widening was seen in all patients (100%, loss of lamina dura was noted in 72%, periapical rarefying osteitis in 56%, condensing osteitis in 8%, hypercementosis, periapical granuloma, and root resorption were seen in 4% of PP patients. Majority of PP were asymptomatic (66%. Pulp polyp was commonly seen in mandibular first molar followed by mandibular second molar and maxillary first molar. Statistically significant difference was noticed between periapical changes in PP patients (P value <0.0001. All PP patients showed definite periapical changes suggesting it to be a periapical lesion. Conclusion: Pulp polyp is confined to the pulpal portion of the tooth which, may or may not cause changes in periapical region. The results of the present study showed that majority of the PP patients were associated with definite periapical

  13. Epidemiology and risk factors of preeclampsia; an overview of observational studies

    Uzma Shamsi


    Full Text Available Objective: To identify and compile a list of important epidemiological risk factors of preeclampsia among pregnant women from observational studies. Methods: Review of published case control and cohort studies on risk factors of Preeclampsia (PE by literature search from 1976 -2010 was conducted. 108 studies were selected using search engines of PubMed and Google Scholar. Findings: Most of the studies were case control studies. The factors identified most often were women with a previous history of preeclampsia, pre-existing diabetes, multiple (twin pregnancy, nulliparity, family history , raised blood pressure (diastolic ≥ 80 mm Hg at booking, raised body mass index before pregnancy, or increasing maternal age ≥ 40. In some individual studies the risk is also increased with an interval of 10 years or more since a previous pregnancy, autoimmune disease, renal disease and chronic hypertension. Conclusions: These factors and the underlying evidence base can be used to assess risk at booking so that a suitable surveillance routine to detect preeclampsia can be planned for the rest of the pregnancy.

  14. An observational study of glycemic control in canagliflozin treated patients.

    Meckley, L M; Miyasato, G; Kokkotos, F; Bumbaugh, J; Bailey, R A


    To evaluate changes in glycemic control following the initial canagliflozin pharmacy claim in a real-world population. A retrospective cohort analysis of adult patients with type 2 diabetes mellitus (T2DM) was conducted using 2013 medical, pharmacy and laboratory claims from the Inovalon MORE 2 Registry. Patients with T2DM aged ≥18 years with ≥60 days of canagliflozin supply and HbA1c test results within 120 days before and ≥60 days after initial canagliflozin claim (defined as index date) were included. The differences between HbA1c levels pre- and post-index were assessed. Changes pre- and post-index in Healthcare Effectiveness Data and Information Set (HEDIS) glycemic control criteria of HbA1c 9% were evaluated. Subgroup analyses of patients with HbA1c >7% at baseline and patients aged ≥65 were also conducted. Among the 268 patients meeting the study criteria, mean HbA1c pre-index was 8.3% and post-index was 7.6%; the mean reduction in HbA1c pre-post index was 0.7% (95% CI: 0.6%, 0.9%). The proportions of patients meeting the HEDIS glycemic control measures (HbA1c 9%) improved and was significantly different pre- and post-index (all p 7% prior to index (81% of the cohort; mean pre-index HbA1c = 8.8%), HbA1c was reduced by 0.9% (95% CI: 0.8%, 1.1%). The aged ≥65 subgroup consisted of 15% of the cohort, with a pre-index HbA1c of 8.3%. The mean reduction in HbA1c test results pre- and post-canagliflozin index was 0.6% (95% CI: 0.4%, 0.9%). This analysis did not adjust for changes in antihyperglycemic agents during the study period. Patients with T2DM were observed to have improved glycemic control following initial canagliflozin pharmacy claim as measured by HbA1c change and attainment of specific glycemic control criteria.

  15. A single-arm, investigator-initiated study of the efficacy, safety, and tolerability of intravitreal aflibercept injection in subjects with exudative age-related macular degeneration previously treated with ranibizumab or bevacizumab (ASSESS study: 12-month analysis

    Singh RP


    Full Text Available Rishi P Singh, Sunil K Srivastava, Justis P Ehlers, Fabiana Q Silva, Rumneek Bedi, Andrew P Schachat, Peter K Kaiser Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA Summary statement: In subjects with active exudative age-related macular degeneration, treating with a fixed intravitreal aflibercept injection dosing regimen for 12 months demonstrated improved anatomic and vision endpoints from baseline.Purpose: Switching therapies in neovascular age-related macular degeneration (AMD may offer an advantage for some patients. This study evaluates the efficacy of intravitreal aflibercept injection (IAI in subjects previously treated with ranibizumab and/or bevacizumab.Methods: Subjects (n=26 were given monthly 2 mg of IAI for 3 months, followed by 2 mg once in every 2 months for up to 12 months. The mean absolute change from baseline in central subfield thickness (CST measured by optical coherence tomography and the mean change from baseline in best-corrected visual acuity (BCVA early treatment in diabetic retinopathy study (ETDRS letter score were obtained. Additionally, the percentage of subjects who gained or lost ≥15 letters of vision and the percentage of subjects who are 20/40 or better or 20/200 or worse were evaluated.Results: There was a mean decrease in CST of -50.3  µm (P<0.001 and a mean increase in ETDRS BCVA of +9.2 letters (P<0.001. Twenty-seven percent of subjects experienced a  ≥15-letter improvement in visual acuity, and no subject lost ≥3 lines of vision from baseline. Fifty percent of subjects were 20/40 or better, and 11.5% of subjects were 20/200 or worse at month 12.Conclusion: Fixed IAI dosing regimen for 12 months demonstrated improved anatomic and vision endpoints in subjects with active exudative AMD. Keywords: aflibercept, age-related macular degeneration, bevacizumab, ranibizumab, vascular endothelial growth factors

  16. Assessing the completeness of reporting of observational studies in Colombian Journal of Anesthesiology. Cross sectional study

    Bravo-Peña, M. (Mary); Barona-Fong, L. (Luis); Campo-López, J. (Julio); Arroyave, Y. (Yeni); J.A. Calvache (Jose Andres)


    textabstractIntroduction The STROBE statement (Strengthening the Reporting of Observational Studies in Epidemiology), consisting of 22 points, was published in 2007 with the aim of improving the reporting of observational research. Objective To determine the completeness of reporting of observationa

  17. Assessing the completeness of reporting of observational studies in Colombian Journal of Anesthesiology. Cross sectional study

    Bravo-Peña, M. (Mary); Barona-Fong, L. (Luis); Campo-López, J. (Julio); Arroyave, Y. (Yeni); J.A. Calvache (Jose Andres)


    textabstractIntroduction The STROBE statement (Strengthening the Reporting of Observational Studies in Epidemiology), consisting of 22 points, was published in 2007 with the aim of improving the reporting of observational research. Objective To determine the completeness of reporting of observationa

  18. Teachers' and Pupils' Behavior in Large and Small Classes: A Systematic Observation Study of Pupils Aged 10 and 11 Years

    Blatchford, Peter; Bassett, Paul; Brown, Penelope


    The authors examined class size effects on teacher-pupil interactions, pupil engagement, and pupil-pupil interaction. They extended previous research by recognizing the hierarchical nature of observation data and the possible influence of other variables. The study used a time sampling method involving 257 children (aged 10-11 years) in 16 small…

  19. Handover patterns: an observational study of critical care physicians

    Ilan Roy


    Full Text Available Abstract Background Handover (or 'handoff' is the exchange of information between health professionals that accompanies the transfer of patient care. This process can result in adverse events. Handover 'best practices', with emphasis on standardization, have been widely promoted. However, these recommendations are based mostly on expert opinion and research on medical trainees. By examining handover communication of experienced physicians, we aim to inform future research, education and quality improvement. Thus, our objective is to describe handover communication patterns used by attending critical care physicians in an academic centre and to compare them with currently popular, standardized schemes for handover communication. Methods Prospective, observational study using video recording in an academic intensive care unit in Ontario, Canada. Forty individual patient handovers were randomly selected out of 10 end-of-week handover sessions of attending physicians. Two coders independently reviewed handover transcripts documenting elements of three communication schemes: SBAR (Situation, Background, Assessment, Recommendations; SOAP (Subjective, Objective, Assessment, Plan; and a standard medical admission note. Frequency and extent of questions asked by incoming physicians were measured as well. Analysis consisted of descriptive statistics. Results Mean (± standard deviation duration of patient-specific handovers was 2 min 58 sec (± 57 sec. The majority of handovers' content consisted of recent and current patient status. The remainder included physicians' interpretations and advice. Questions posed by the incoming physicians accounted for 5.8% (± 3.9% of the handovers' content. Elements of all three standardized communication schemes appeared repeatedly throughout the handover dialogs with no consistent pattern. For example, blocks of SOAP's Assessment appeared 5.2 (± 3.0 times in patient handovers; they followed Objective blocks in only 45

  20. Synergy of multifrequency studies from observations of NGC6334I

    Seifahrt, Andreas; Beuther, Henrik; Leurini, Silvia; Brogan, Crystal L; Hunter, Todd R; Menten, Karl M; Stecklum, Bringfried; 10.1088/1742-6596/131/1/012030


    We combine multifrequency observations from the millimeter to near infrared wavelengths that demonstrate the spatial distributions of H2, CO, and NH3 emission, which are all manifestations of various shocks driven by outflows of deeply embedded sources in NGC6334I. In addition to the well-known northeast-southwest outflow we detect at least one more outflow in the region by combining observations from APEX, ATCA, SMA, Spitzer and VLT/ISAAC. Potential driving sources will be discussed. NGC6334I exhibits several signs of active star formation and will be a major target for future observatories such as Herschel and ALMA.

  1. Patient preference with respect to QoL and reduction in opioid-induced constipation (OIC) after treatment with prolonged-release (PR) oxycodone/naloxone compared with previous analgesic therapy [PREFER study].

    van Dongen, V C P C; Vanelderen, P J L; Koopmans-Klein, G; van Megen, Y J B; Van Zundert, J; Huygen, F J P M


    The aim of this study was to assess patient preference in terms of quality of life (QoL), analgesia and bowel function for patients with moderate to severe chronic non-malignant pain, when treated with oxycodone PR/naloxone PR compared with the previous WHO-step I and/or WHO-step II analgesic treatment . This was a 3-week open-label phase 3b study conducted in Belgium and the Netherlands, after 3 weeks patients could enter an extension phase. Patient preference with respect to QoL for oxycodone PR/naloxone PR treatment compared with previous WHO-step I and/or WHO-step II analgesics was assessed. A patient was considered a responder with respect to QoL if this assessment was 'better' or 'much better' compared with previous WHO-step I or II analgesics at any time point. Response rate with respect to QoL was 59.2% (95% CI: 51.7-66.8%) for the Full Analysis (FA)-population, for the Per Protocol-population response rate was 71.7% (95% CI: 63.1-80.3%). Explorative analysis showed that response rate with respect to QoL was highest in constipated patients pretreated with WHO-step II analgesics (73.8%). Mean ± SD pain score in the FA-population at start was 74.7 ± 16.6 decreasing to 53.9 ± 24.3 after a median (range) treatment period of 173.5 (31-771) days. For constipated subjects the significant reduction in constipation [improvement of the Bowel Function Index (BFI)], was -24.8 points (95% CI: -17.1 to -32.5). BFI for non-constipated subjects remained well below 28.8. Adverse events with oxycodone PR/naloxone PR treatment were well-known opioid-related adverse events. This study shows that the studied patients previously treated with WHO-step I and/or WHO-step II analgesics prefer treatment with oxycodone PR/naloxone PR with respect to QoL. Moreover, the study shows that treatment with oxycodone PR/naloxone PR significantly reduces OIC in constipated patients and that non-constipated patients do not develop OIC during treatment with oxycodone PR/naloxone PR.

  2. The New Worlds Observer: The Astrophysics Strategic Mission Concept Study


    the target star to its antipodal stars and compute where the telescope should appear among the antipodal stars. The addi- tion of corner-cube...starshade observes an optical beacon on the telescope to find the telescope’s location against antipodal stars for medium alignment. Proc. of SPIE Vol

  3. A study on diffuse source detection by HXMT scanning observation

    Guan, Ju; Wu, Mei; Song, Li-Ming; Huo, Zhuo-Xi


    The Hard X-ray Modulation Telescope (HXMT) is a collimated scan X-ray satellite mainly devoted to a sensitive all-sky survey and pointed observations in 1-250 keV. We expect various diffuse sources to be detected in its scanning observations due to the large rigidity factor of the telescope. Diffuse source detection performance of HXMT scanning observation depends not only on the instrument but also on its data analysis method since images have to be reconstructed from HXMT observed data. In this paper, we introduce a multiscale maximum entropy (MSME) algorithm for HXMT image restoration and propose an improved method, ensemble multiscale maximum entropy (EMSME) method, to alleviate the problem of mode mixing exiting in MSME. Simulation have been performed on the detection of the diffuse source Cen A by HXMT in the all-sky survey mode. The results show that the MSME method is adapted to the deconvolution task of HXMT for diffuse source detection and the improved method could suppress noise and improve the cor...

  4. Observational study of compliance with Queensland bicycle helmet laws.

    Debnath, Ashim Kumar; Haworth, Narelle; Schramm, Amy; Williamson, Amy


    Mandatory bicycle helmet laws have been found to increase helmet wearing rates in Australia and internationally. However, much of the research on factors influencing compliance with the Australian helmet laws is dated or focuses on commuters and city areas only. To address this gap, video recordings of bicycle riders were undertaken at 17 sites across Queensland, Australia, representing a mixture of on- and off-road locations, speed limits and regions. Helmet status was able to be determined for 98% of riders observed. The level of compliance with the laws was very high, with 98.3% of the more than 27,000 riders observed wearing helmets. Riders riding on roads were less compliant than those riding on bicycle paths, but no significant differences were observed between the school-holiday and school-term periods. Among the on-road riders, boys were less compliant than girls and overall children were less compliant than adults. Higher compliance levels were found for group riders, road bike riders, lycra-clad riders, during morning hours, and on 50km/h or lower speed limit roads. While the overall level of compliance was very high, certain subgroups were identified as a possible focus for interventions to further improve the compliance level, for example children (particularly boys) riding mountain bikes away from groups during the afternoon hours on 60km/h roads.

  5. The Efficacy and Safety of Icotinib in Patients with Advanced Non-Small Cell Lung Cancer Previously Treated with Chemotherapy: A Single-Arm, Multi-Center, Prospective Study

    Shi, Yuankai; Zhou, Caicun; Liu, Xiaoqing; Wang, Dong; Song, Yong; Li, Qiang; Feng, Jifeng; Qin, Shukui; Xv, Nong; Zhou, Jianying; Zhang, Li; Hu, Chunhong; Zhang, Shucai; Luo, Rongcheng; Wang, Jie; Tan, Fenlai; Wang, Yinxiang; Ding, Lieming; Sun, Yan


    Background Icotinib is a small molecule targeting epidermal growth factor receptor tyrosine kinase, which shows non-inferior efficacy and better safety comparing to gefitinib in previous phase III trial. The present study was designed to further evaluate the efficacy and safety of icotinib in patients with advanced non-small-cell lung cancer (NSCLC) previously treated with platinum-based chemotherapy. Methods Patients with NSCLC progressing after one or two lines of chemotherapy were enrolled to receive oral icotinib (125mg tablet, three times per day). The primary endpoint was progression-free survival. The secondary endpoints included overall survival, objective response rate, time to progression, quality of life and safety. Results From March 16, 2010 to October 9, 2011, 128 patients from 15 centers nationwide were enrolled, in which 124 patients were available for efficacy evaluation and 127 patients were evaluable for safety. The median progression-free survival and time to progression were 5.0 months (95%CI 2.9–6.6 m) and 5.4 months (95%CI 3.1–7.9 m), respectively. The objective response rate and disease control rate were 25.8% and 67.7% respectively. Median overall survival exceeded 17.6 months (95%CI 14.2 m-NA) according to censored data. Further follow-up of overall survival is ongoing. The most frequent treatment-related adverse events were rash (26%, 33/127), diarrhea (12.6%, 16/127) and elevation of transaminase (15.7%, 20/127). Conclusions In general, this study showed similar efficacy and numerically better safety when compared with that in ICOGEN trial, further confirming the efficacy and safety of icotinib in treating patients with advanced NSCLC previously treated with chemotherapy. Trial Registration NCT02486354 PMID:26599904

  6. Does local endometrial injury in the nontransfer cycle improve the IVF-ET outcome in the subsequent cycle in patients with previous unsuccessful IVF? A randomized controlled pilot study

    Sachin A Narvekar


    Full Text Available Background: Management of repeated implantation failure despite transfer of good-quality embryos still remains a dilemma for ART specialists. Scrapping of endometrium in the nontransfer cycle has been shown to improve the pregnancy rate in the subsequent IVF/ET cycle in recent studies. Aim: The objective of this randomized controlled trial (RCT was to determine whether endometrial injury caused by Pipelle sampling in the nontransfer cycle could improve the probability of pregnancy in the subsequent IVF cycle in patients who had previous failed IVF outcome. Setting: Tertiary assisted conception center. Design: Randomized controlled study. Materials and Methods: 100 eligible patients with previous failed IVF despite transfer of good-quality embryos were randomly allocated to the intervention group and control groups. In the intervention group, Pipelle endometrial sampling was done twice: One in the follicular phase and again in the luteal phase in the cycle preceding the embryo transfer cycle. Outcome Measure: The primary outcome measure was live birth rate. The secondary outcome measures were implantation and clinical pregnancy rates. Results: The live birth rate was significantly higher in the intervention group compared to control group (22.4% and 9.8% P = 0.04. The clinical pregnancy rate in the intervention group was 32.7%, while that in the control group was 13.7%, which was also statistically significant ( P = 0.01. The implantation rate was significantly higher in the intervention group as compared to controls (13.07% vs 7.1% P = 0.04. Conclusions: Endometrial injury in nontransfer cycle improves the live birth rate,clinical pregnancy and implantation rates in the subsequent IVF-ET cycle in patients with previous unsuccessful IVF cycles.

  7. Use of acetaminophen and risk of endometrial cancer: evidence from observational studies

    Ding, Yuan-Yuan; Yao, Peng; Verma, Surya; Han, Zhen-Kai; Hong, Tao; Zhu, Yong-Qiang; Li, Hong-Xi


    Previous meta-analyses suggested that aspirin was associated with reduced risk of endometrial cancer. However, there has been no study comprehensively summarize the evidence of acetaminophen use and risk of endometrial cancer from observational studies. We systematically searched electronic databases (PubMed, EMBASE, Web of Science, and Cochrane Library) for relevant cohort or case-control studies up to February 28, 2017. Two independent authors performed the eligibility evaluation and data extraction. All differences were resolved by discussion. A random-effects model was applied to estimate summary relative risks (RRs) with 95% CIs. All statistical tests were two-sided. Seven observational studies including four prospective cohort studies and three case-control studies with 3874 endometrial cancer cases were included for final analysis. Compared with never use acetaminophen, ever use this drug was not associated with risk of endometrial cancer (summarized RR = 1.02; 95% CI: 0.93−1.13, I2 = 0%). Similar null association was also observed when compared the highest category of frequency/duration with never use acetaminophen (summarized RR = 0.88; 95% CI: 0.70−1.11, I2 = 15.2%). Additionally, the finding was robust in the subgroup analyses stratified by study characteristics and adjustment for potential confounders and risk factors. There was no evidence of publication bias by a visual inspection of a funnel plot and formal statistical tests. In summary, the present meta-analysis reveals no association between acetaminophen use and risk of endometrial cancer. More large scale prospective cohort studies are warranted to confirm our findings and carry out the dose-response analysis of aforementioned association. PMID:28410226

  8. A Case Study of Hogtown Creek: Justification for Field Observations.

    West, Felicia E.

    A case-study model of a field trip to a small creek was made to facilitate the use of field studies as a technique for involving students and teachers in studying the earth as it undergoes change. Methods and techniques of planning are presented which include familiarization with the area by the teacher, the development of goals and objectives,…

  9. Astronomical Observations Astronomy and the Study of Deep Space


    Our Search for knowledge about the universe has been remarkable, heartbreaking, fantastical, and inspiring, and this search is just beginning. Astronomical Observations is part of a 7 book series that takes readers through a virtual time warp of our discovery. From the nascent space programs of the 1960's to today's space tourism and the promise of distant planet colonization, readers will be transfixed. Throughout this journey of the mind, Earth-bound explorers gain keen insight into the celestial phenomena that have fascinated humans for centuries. Thrilling narratives about indefatigable sc

  10. Temporal sequence in observational studies to establish causality

    Luis Carlos Silva Ayçaguer, PhD


    Full Text Available The article includes a brief summary on the scope of the notions of causality and risk and considers some operational difficulties that arise when dealing with problems associated with them. It underscores the vital importance of timing and its link with the most commonly used observational research designs that address causal relationships. The article describes in detail the need to record the order in which the relevant events occur and how to consider this in the analysis. A detailed example of errors that are usually incurred in and their effect is provided.

  11. A Training Study of the Hercules Observer Trainer


    des tâches et des exigences en matière de formation, et a déterminé une solution technique qui a été mise en œuvre dans toute une gamme de contrats ...CAE Professional Services Inc. Call-up 7949-08 under Standing Offer W7711-057949. April 2007 – March 2008. [7] Hercules Observer Trainer System...Development. CAE Professional Services Inc. Call-up 7949-06 under Standing Offer W7711-057949. December 2006 – March 2007. [8] High Performance Visual

  12. Reporting of confounding bias in observational intervention studies: Are we making progress?

    Pouwels, Koen B.; Hak, Eelko


    Background: Previously, poor quality of reporting of confounding in articles on observational medical interventions has been observed in a systematic review. Included articles were published before the STROBE statement and it was suggested that this statement could have a considerable impact on the

  13. Activity in the action observation network enhances emotion regulation during observation of risk-taking: an fMRI study.

    Tamura, Miyuki; Moriguchi, Yoshiya; Higuchi, Shigekazu; Hida, Akiko; Enomoto, Minori; Umezawa, Jun; Mishima, Kazuo


    The results of neuroimaging studies have indicated that viewing emotional stimuli can lead to activity increases in brain regions associated with processing actions. We hypothesized that observation of actions involving the potential for harm (i.e., risk-taking actions) would activate emotion- and pain-related processing. We used functional magnetic resonance imaging to examine the changes in neural activity during the observation of safe and risk-taking actions in 34 healthy participants (14 females, 20 males; mean age: 23·4±3·7 years). Observation of risk-taking actions elicited significantly stronger neural activation in the inferior frontal gyrus, ventromedial prefrontal cortex, superior frontal gyrus/frontal pole, inferior parietal lobule, middle temporal gyrus, middle occipital gyrus, lingual gyrus, cuneus (including the calcarine sulcus), insula, and amygdala, than observation of safe actions. Interestingly, we observed significant activation of affect-related brain areas (ventromedial prefrontal cortex, amygdala, and insula), thought to be implicated in various aspects of emotion regulation during the observation of risk-taking actions. No brain regions exhibited greater activation during observation of safe actions than during observation of risk-taking actions associated with risk. Our results reveal that the risk-related content of the observed actions in the video clips elicited activation of a network of visual input and processing regions, including the action observation network, that appears to encode the meanings of observed actions as well as the reflective or retrospective monitoring of their outcomes. These findings suggest that risk-taking situations may increase cognitive load on the entire action perception system, and may command more attention.

  14. Photometric Observation and Modeling Study of the Asteroid (26) Proserpina

    Bin, Li; Hai-bin, Zhao; Xin, Wang


    We present the new CCD observations on the asteroid (26) Proserpina performed between 2011 December and 2012 February. Based upon the new observations, a synodic rotation period of (13.107 ± 0.002) h is obtained. Using all the light curves available sofar, the rotation vector, rotation period, and the shape model of the asteroid are determined with the convex-hull inversion method. Further more, a bootstrap method is applied to estimating the uncertainties of the rotation parameters. We derive a pair of possible rotation poles for (26) Proserpina, and believe that it has a retrograde rotation. The rotation poles are determined to be λ1 = 90.8° ± 1.4°, β1 = -53.1° ± 3.2°, and λ2 = 259.3° ± 2.2°, β2 = -62.0° ± 2.0°. The sidereal rotation periods corresponding to the two poles are almost the same as (13.109777 ± 3.8 × 10-6) h. And corresponding to this pair of rotation poles, the convex-hull shapes of the asteroid are the mirror images of each other.

  15. Observational study of daytime ionospheric irregularities associated with typhoon

    XIAO SaiGuan; SHI JianKui; ZHANG DongHe; HAO YongQiang; HUANG WeiQuan


    Spread-F is a manifestation of ionospheric irregularities and generally takes place at nighttime.However,it can also be observed seldom at daytime.It is recognized that acoustic gravity waves (AGWs) play an important role in triggering plasma instability which results in spread-F in the ionosphere.The typhoon is a main source of the AGWs.In this paper,two cases of ionospheric daytime spread-F in the period of typhoon were analyzed.One case was on July 29,1988 and the other was on August 01,1989.The results showed the following:1) There were some wave-like disturbances appearing in the HF Doppler records firstly,consequently the Doppler echo traces became scattered,which indicated that the ionospheric spread-F was triggered; 2) the blurred echo traces in the both two cases appeared in the morning (08:30-11:30 Beijing time) and lasted for more than two hours; 3) with the blurred echoes gradually weakening,the traveling ionospheric disturbances (TIDs) still existed and became clearer; 4) the frequency shifts in the two cases were both positive,implying the effective reflecting surface of the radio wave in the ionosphere moved downwards.These results provide good observational evidence for daytime spread-F during the typhoon period in Asian region.

  16. Como novos conhecimentos podem ser construídos a partir dos conhecimentos prévios: um estudo de caso How new knowledge can be constructed from previous knowledge: a case study

    Francimar Martins Teixeira


    Full Text Available O presente artigo trata sobre o estudo de caso de como uma professora utiliza os conhecimentos prévios dos estudantes durante a abordagem de um novo conceito científico. Para tanto, foram realizadas filmagens de aulas de ciências durante a execução de uma sequência didática, a fim de investigar de que maneira os conhecimentos prévios dos estudantes eram tratados em sala de aula ao longo da abordagem do tema. A partir dos resultados encontrados, percebemos nas aulas observadas como a professora lidava com os conhecimentos dos estudantes. Identificamos que houve ocasiões em que ela os considerou e outras em que os desconsiderou. Apesar de ações antagônicas, tanto o fato de considerar quanto de desconsiderar parecem ter em comum a busca de manutenção de foco sob os conceitos, entendidos pela professora, como sendo os que devem ser objeto de atenção dos alunos.This article deals with a case study about how a teacher uses previous knowledge of students to approach a new concept. To this end, sciences classes were filmed during the execution of a didactic sequence, in order to investigate how previous knowledge of the students was treated in the classroom along the approach of the theme. From these results, we saw how the teacher dealt with previous knowledge of their students. We identified that there were occasions when she considered them and others in which she disregarded them. Although they are antagonistic actions, both the facts, to consider or to dismiss, have in common the search for keeping the focus on the concepts, defined by the teacher as those that should be the object of attention for the students.

  17. Adjacent segment degeneration: observations in a goat spinal fusion study

    R.J.W. Hoogendoorn; M.N. Helder; P.I.J.M. Wuisman; R.A. Bank; V. Everts; T.H. Smit


    Study Design. The adjacent discs of 13 goats, originally used in a lumbar spinal fusion model study, were analyzed for symptoms of intervertebral disc degeneration by means of magnetic resonance imaging (MRI), macroscopy, and histology. These goats were followed for 6 months and the results were com

  18. Communication Patterns and Stress in the Preschool: An Observational Study

    Sjödin, Fredrik; Neely, Gregory


    The study included 12 preschool departments, with two teachers in six departments characterised by high levels of stress and burnout and two teachers in six departments characterised by low levels of stress and burnout. A total of 24 females with a mean age of 43.5 years participated in the study. The teachers rated stress, fatigue, work demands…

  19. Immunogenicity, efficacy and safety of Nuwiq(®) (human-cl rhFVIII) in previously untreated patients with severe haemophilia A-Interim results from the NuProtect Study.

    Liesner, R J; Abashidze, M; Aleinikova, O; Altisent, C; Belletrutti, M J; Borel-Derlon, A; Carcao, M; Chambost, H; Chan, A K C; Dubey, L; Ducore, J; Fouzia, N A; Gattens, M; Gruel, Y; Guillet, B; Kavardakova, N; El Khorassani, M; Klukowska, A; Lambert, T; Lohade, S; Sigaud, M; Turea, V; Wu, J K M; Vdovin, V; Pavlova, A; Jansen, M; Belyanskaya, L; Walter, O; Knaub, S; Neufeld, E J


    Nuwiq(®) (Human-cl rhFVIII) is a fourth generation recombinant FVIII, produced in a human cell line, without chemical modification or protein fusion. No inhibitors developed in studies with Nuwiq(®) in 201 previously treated patients with haemophilia A (HA). The immunogenicity, efficacy and safety of Nuwiq(®) in previously untreated patients (PUPs) with severe HA are being assessed in the ongoing NuProtect study. The study, conducted across 38 centres worldwide, is evaluating 110 true PUPs of all ages and ethnicities enrolled for study up to 100 exposure days (EDs) or 5 years maximum. The primary objective is to assess the immunogenicity of Nuwiq(®) (inhibitor activity ≥0.6 BU) using the Nijmegen-modified Bethesda assay at a central laboratory. Data for 66 PUPs with ≥20 EDs from a preplanned interim analysis were analysed. High-titre (HT) inhibitors developed in 8 of 66 patients after a median of 11.5 EDs (range 6-24). Five patients developed low-titre inhibitors (4 transient). The cumulative incidence (95% confidence interval) was 12.8% (4.5%, 21.2%) for HT inhibitors and 20.8% (10.7%, 31.0%) for all inhibitors. During inhibitor-free periods, median annualized bleeding rates during prophylaxis were 0 for spontaneous bleeds and 2.40 for all bleeds. Efficacy was rated as "excellent" or "good" in treating 91.8% of bleeds. Efficacy of surgical prophylaxis was "excellent" or "good" for 8 (89%) procedures and "moderate" for 1 (11%). No tolerability concerns were evident. These interim data show a cumulative incidence of 12.8% for HT inhibitors and convincing efficacy and tolerability in PUPs treated with Nuwiq(®) . © 2017 The Authors. Haemophilia published by John Wiley & Sons Ltd.

  20. Can previous learning alter future plasticity mechanisms?

    Crestani, Ana Paula; Quillfeldt, Jorge Alberto


    The dynamic processes related to mnemonic plasticity have been extensively researched in the last decades. More recently, studies have attracted attention because they show an unusual plasticity mechanism that is independent of the receptor most usually related to first-time learning--that is, memory acquisition-the NMDA receptor. An interesting feature of this type of learning is that a previous experience may cause modifications in the plasticity mechanism of a subsequent learning, suggesting that prior experience in a very similar task triggers a memory acquisition process that does not depend on NMDARs. The intracellular molecular cascades necessary to assist the learning process seem to depend on the activation of hippocampal CP-AMPARs. Moreover, most of these studies were performed on hippocampus-dependent tasks, even though other brain areas, such as the basolateral amygdala, also display NMDAR-independent learning.

  1. A submllimeter observation and study of star-forming regions


    Using the 3-m radio telescope of KOSMA, we mapped 12CO (J = 3-2) lines for three molecular clouds, B35, S146 and TMC-2A. High-velocity molecular outflows are found in all these regions. The physical and dynamical parameters of the outflows are derived, and their shapes and driving sources are analyzed. Contour maps of center velocities show that the large scale systematic gradients exist in the three clouds. These observed motions are best explained by rotation after excluding the cause of outflows. Furthermore, in the core region of TMC-2A there is a velocity gradient in opposite direction from that of the large scale. It may be caused by magnetic braking. Finally, angular velocities of the clouds are calculated, and the effects of rotation against gravity and lowering the star-formation rate are also analyzed.

  2. 77 FR 70176 - Previous Participation Certification


    ... URBAN DEVELOPMENT Previous Participation Certification AGENCY: Office of the Chief Information Officer... digital submission of all data and certifications is available via HUD's secure Internet systems. However...: Previous Participation Certification. OMB Approval Number: 2502-0118. Form Numbers: HUD-2530 ....

  3. Observational study of food safety practices in retail deli departments.

    Lubran, M B; Pouillot, R; Bohm, S; Calvey, E M; Meng, J; Dennis, S


    In order to improve the safety of refrigerated ready-to-eat food products prepared at retail deli departments, a better understanding of current practices in these establishments is needed. Food employees in deli departments at six chain and three independent retail establishments in Maryland and Virginia were observed, using notational analysis, as they prepared deli products for sale. The frequency of contact with objects and deli products before sale, hand washing and glove changing during preparation, and equipment, utensil, and surface cleaning and sanitizing was determined. Compliance with the U.S. Food and Drug Administration's 2005 model Food Code recommendations, which must be adopted by the individual state and local jurisdictions that are responsible for directly regulating retail establishments, was also assessed. Observations indicated there were a large number of actions for which hand washing was recommended at independent and chain stores (273 recommended of 1,098 total actions and 439 recommended of 3,073 total actions, respectively). Moreover, 67% (295 of 439) of the actions for which hand washing was recommended at the chain stores and 86% (235 of 273) of those at the independent stores resulted from employees touching non-food contact surfaces prior to handling ready-to-eat food. Compliance with hand washing recommendations was generally low and varied depending on store type with independent stores exhibiting lower compliance than chain stores (5 instances of compliance for 273 recommended actions and 73 instances of compliance for 439 recommended actions, respectively). Potential risk mitigation measures that may reduce the frequency of hand washing actions needed during ready-to-eat food preparation in retail deli departments are discussed. More research is needed to determine the impact of such measures on food safety.

  4. Propensity score modelling in observational studies using dimension reduction methods.

    Ghosh, Debashis


    Conditional independence assumptions are very important in causal inference modelling as well as in dimension reduction methodologies. These are two very strikingly different statistical literatures, and we study links between the two in this article. The concept of covariate sufficiency plays an important role, and we provide theoretical justification when dimension reduction and partial least squares methods will allow for valid causal inference to be performed. The methods are illustrated with application to a medical study and to simulated data.

  5. Asthma changes at a Pediatric Intensive Care Unit after 10 years: Observational study

    Ayman A Al-Eyadhy


    Full Text Available Objectives: To describe the change in the management, and outcome of children with acute severe asthma (ASA admitted to Pediatric Intensive Care Unit (PICU at tertiary institute, as compared to previously published report in 2003. Methods : This is a retrospective observational study. All consecutive pediatric ASA patients who were admitted to PICU during the study period were included. The data were extracted from PICU database and medical records. The Cohort in this study (2013 Cohort was compared with the Cohort of ASA, which was published in 2003 from the same institution (2003 Cohort. Results: In comparison to previous 2003 Cohort, current Cohort (2013 revealed higher mean age (5.5 vs. 3.6 years; P ≤ 0.001, higher rate of PICU admission (20.3% vs. 3.6%; P ≤ 0.007, less patients who received maintenance inhaled steroids (43.3% vs. 62.4%; P ≤ 0.03, less patients with pH <7.3 (17.9% vs. 42.9%; P ≤ 0.001. There were more patients in 2013 Cohort who received: Inhaled Ipratropium bromide (97% vs. 68%; P ≤ 0.001, intravenous magnesium sulfate (68.2% vs. none, intravenous salbutamol (13.6% vs. 3.6%; P ≤ 0.015, and noninvasive ventilation (NIV (35.8% vs. none while no patients were treated with theophylline (none vs. 62.5%. The median length of stay (LOS was 2 days while mean LOS was half a day longer in the 2013 Cohort. None of our patients required intubation, and there was no mortality. Conclusion: We observed slight shift toward older age, considerably increased the rate of PICU admission, increased utilization of Ipratropium bromide, magnesium sulfate, and NIV as important modalities of treatment.

  6. Smoking habits and benign prostatic hyperplasia: A systematic review and meta-analysis of observational studies.

    Xu, Huan; Fu, Shi; Chen, Yanbo; Chen, Qi; Gu, Meng; Wang, Zhong


    Previous studies have warned against the promoting effects of cigarette smoking on benign prostatic hyperplasia (BPH). In contrast, some have argued that smoking confers a protective effect regarding BPH, while others have observed an aggravated effect. Thus, we performed this meta-analysis to determine whether cigarette use is associated with BPH risk.To identify articles from observational studies of relevance, a search was performed concurrent to March 21, 2016, on PubMed, Web of Science, Cochrane, EBSCO, and EMBASE databases. Random-effect model, according to the heterogeneity, was calculated to reveal the relative risks (RRs) and corresponding 95% confidence intervals (CIs).Eight articles were included in this meta-analysis, representing data for 44,100 subjects, of which 5221 (11.8%) had BPH as defined according to the criteria. Seven reports are concerned with analysis between nonsmokers and ex-smokers, in which no significant difference was observed (RR = 0.99, 95% CI 0.94-1.05). Another meta-analysis of 7 studies indicated an observable trend, but without significant difference between groups of nonsmokers and current smokers (RR = 1.17, 95% CI 0.98-1.41). Between groups of heavy (6 articles; RR = 1.02, 95% CI 0.84-1.24) and light smokers (5 articles; RR = 0.90, 95% CI 0.71-1.15), again no significant difference appears. Finally, we combined individuals as never-smokers and ever-smokers and still found no significant difference between the 2 groups of patients (RR = 1.03, 95% CI 0.92-1.15). Sensitivity analysis was displayed and confirmed the stability of the present results.Combined evidence from observational studies shows no significant association between cigarette smoking and BPH risk, either for ex-smokers or for current smokers. The trend of elevated BPH risk from smoking was observed only in current smokers compared with nonsmokers, while marginal significance was observed in comparing ever-smokers with never-smokers in

  7. Use of a 12 months' self-referral reminder to facilitate uptake of bowel scope (flexible sigmoidoscopy) screening in previous non-responders: a London-based feasibility study

    Kerrison, Robert S; McGregor, Lesley M; Marshall, Sarah; Isitt, John; Counsell, Nicholas; Wardle, Jane; von Wagner, Christian


    Background: In March 2013, NHS England extended its national Bowel Cancer Screening Programme to include ‘one-off' Flexible Sigmoidoscopy screening (NHS Bowel Scope Screening, BSS) for men and women aged 55. With less than one in two people currently taking up the screening test offer, there is a strong public health mandate to develop system-friendly interventions to increase uptake while the programme is rolling out. This study aimed to assess the feasibility of sending a reminder to previous BSS non-responders, 12 months after the initial invitation, with consideration for its potential impact on uptake. Method: This study was conducted in the ethnically diverse London Boroughs of Brent and Harrow, where uptake is below the national average. Between September and November 2014, 160 previous non-responders were randomly selected to receive a reminder of the opportunity to self-refer 12 months after their initial invitation. The reminder included instructions on how to book an appointment, and provided options for the time and day of the appointment and the gender of the endoscopist performing the test. To address barriers to screening, the reminder was sent with a brief locally tailored information leaflet designed specifically for this study. Participants not responding within 4 weeks were sent a follow-up reminder, after which there was no further intervention. Self-referral rates were measured 8 weeks after the delivery of the follow-up reminder and accepted as final. Results: Of the 155 participants who received the 12 months' reminder (returned to sender, n=5), 30 (19.4%) self-referred for an appointment, of which 24 (15.5%) attended and were successfully screened. Attendance rates differed by gender, with significantly more women attending an appointment than men (20.7% vs 8.8%, respectively; OR=2.73, 95% CI=1.02–7.35, P=0.05), but not by area (Brent vs Harrow) or area-level deprivation. Of the 30 people who self-referred for an appointment, 27 (90




    Full Text Available BACKGROUND: Dengue is a major preventable and treatable cause of morbidity and mortality among children and adults that occurs mainly in tropical and subtropical regions. Early diagnosis of dengue is important for provision of specific care which ensures marked reduction in the morbidity of the disease itself. OBJECTIVE: To evaluate hematological changes in serologically proven patients with clinical manifestations of Dengue in Bapuji & Chigateri Hospital, Davangere. METHODS: Clinical, hematological and serological information from Patients diagnosed with dengue infection in Bapuji & Chigateri hospital Davangere from April 2013 -June 2013. RESULTS: 221 cases of classic dengue predominated (90.2%, with mild clinical manifestations lacking complications. The main hematological findings were raised hematocrit (79.6%, lymphocytosis (66% monocytosis (84.6%, basophilia (52.9%, thrombocytopenia (100% and atypical lymphocytes (87%. In dengue hemorrhagic fever, thrombocytopenia was more prolonged and the number of atypical lymphocytes was higher, while the other hematological abnormalities presented daily evolution similar to those in classic dengue. The hematological changes observed in dengue presented according to the clinical course of the disease and its severity

  9. Comparing the incomparable: hemodialysis versus peritoneal dialysis in observational studies.

    Foley, Robert N


    A randomized trial comparing survival in hemodialysis and peritoneal dialysis remains a utopian aspiration. Dialysis is still relatively rare on a population basis, and a natural tension exists between desirability and feasibility in terms of quality of evidence. In practice, it is very difficult to perform prospective comparisons with large groups of contemporary representative subjects, and much of the literature comes from retrospective national registries. This article considers several questions to address when trying to compare the outcomes of peritoneal dialysis and hemodialysis. Prognostic similarity at baseline is a fundamental issue. Traditionally, adjustment for known prognostic factors has been used in an attempt to minimize the bias caused by nonrandom treatment assignment. Propensity scores have been suggested to be superior, and matched-case analysis may also be a useful method for comparison. Other questions include, when, in relation to starting dialysis, to start the observation clock; the definition and handling of switches of dialysis therapy; and the decision to censor at transplantation. Finally, comparisons are complicated by hazards ratios that vary over time, and time-segmented analysis is obligatory. Many types of analytical approaches are needed to begin to appreciate outcome disparities between dialysis therapies.

  10. Ground Observations of Post-Noon Aurora :a Case Study


    The characteristics of the post-noon aurora observed at Antarctic Zhongshan station on June 12, 1999, were discussed and analyzed. In the condition of the magnetic activity is not large(Kp≈l), for post-noon 630. 0 nm emissions, the total fluxes of soft precipitating particles were increasing from 10:50 UT to 13:35 UT and were decreasing from 13 :35 UT to 18 :00 UT in almost monotonous way. Away from noon, the 557. 7 nm emissions increased gradually from 10 :50 UT to 17 :10 UT. The behaviors of the precipitat- ing particles for exciting 630. 0 nm aurora and 557. 7 nm aurora were quite different. The peak intensity of 630. 0 nm and 557. 7 nm emissions appeared at about 13:35 UT and 15:40 UT respectively, the time differ- ence of two peaks is about 2 h. The energy of precipitating electrons remained fairly steady until 15:00 UT when it rose dramatically.

  11. Mathematics for teaching: observations from two case studies

    We report on two case studies in which we investigated mathematics for tea- ching. We were ... matical goals for any lesson taught, and link these with the approach used to teach an idea ..... This opens the question as to whether coin tossing.

  12. Understanding the equatorial ocean : theoretical and observational studies

    Rabitti, A.


    By means of a variety of approaches, the present study points out the challenges in understanding equatorial ocean dynamics (±2.5º). Standard theory, in fact, fails in accurately describing such a big portion of our ocean. This is mainly because at the equator rotation and density stratification com

  13. Diversity of Pneumocystis jirovecii Across Europe: A Multicentre Observational Study

    Alexandre Alanio


    Our study showed the wide population diversity across Europe, with evidence of local clusters of patients harbouring a given genotype. These data suggest a specific association between genotype and underlying disease, with evidence of a different natural history of PCP in HIV patients and renal transplant recipients.

  14. Dietary fatty acids and cardiovascular disease risk in observational studies

    Praagman, Jaike


    Dietary fat is a valuable component of the diet and essential for the human body. Over time it has become clear that certain types of fat(ty acids) are also potentially harmful for our health. For example, we know from intervention studies that saturated fat and trans-fat have unfavourable effects

  15. An Observational Study of Social Behavior in Microcomputer Classrooms.

    Feldmann, Shirley C.; And Others


    This study examined the effects of five variables--student grouping at the computer, keyboarding status, academic discipline, student gender, and gender of partner--on student social behavior, both verbal and affective, in microcomputer classrooms in a public business high school. The effect of these variables on teacher behavior was also…

  16. Obesity, polycystic ovary syndrome and breastfeeding: an observational study.

    Joham, Anju E; Nanayakkara, Natalie; Ranasinha, Sanjeeva; Zoungas, Sophia; Boyle, Jacqueline; Harrison, Cheryce L; Forder, Peta; Loxton, Deborah; Vanky, Eszter; Teede, Helena J


    Polycystic ovary syndrome (PCOS) affects 9-21% of reproductive-age women. The relations between PCOS, body mass index (BMI) and breastfeeding are unclear. Our aim was to examine breastfeeding in women with and without PCOS and the relation with BMI. This is a cross-sectional study set in the general community. Participants are women, aged 31-36 years, from the Australian Longitudinal Study on Women's Health (ALSWH), a large community-based study. Data was analyzed from the first child of respondents to Survey five (2009) reporting at least one live born child. Logistic regression analysis was used to examine factors associated with breastfeeding. The main outcome measures studied were breastfeeding initiation and duration and the main explanatory variables included self-reported PCOS and BMI. Of the 4898 women, 6.5% reported PCOS (95% confidence interval 5.8-7.2%). Median duration of breastfeeding was lower in women reporting PCOS (6 months, range 2-10 months) than in women not reporting PCOS (7 months, range 3-12 months) (p = 0.001). On multivariable regression analysis, there was no association between PCOS and breastfeeding outcomes. However, being overweight or obese was associated with not initiating breastfeeding and with breastfeeding for less than 6 months, after adjusting for confounders. High BMI is negatively associated with breastfeeding, whereas PCOS status per se does not appear to be related to breastfeeding initiation and duration, after adjusting for BMI. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  17. Writing Instruction in First Grade: An Observational Study

    Coker, David L., Jr.; Farley-Ripple, Elizabeth; Jackson, Allison F.; Wen, Huijing; MacArthur, Charles A.; Jennings, Austin S.


    As schools work to meet the ambitious Common Core State Standards in writing in the US, instructional approaches are likely to be examined (National Governors Association Center for Best Practices, Council of Chief State School Officers, 2010). However, there is little research on the current state of instruction. This study was designed to…


    Sivaraman M


    Full Text Available BACKGROUND The epidemiological study of diabetic maculopathy in Indian population for the period of three years duration and study the treatment outcome following laser photocoagulation for various type of diabetic maculopathy. MATERIALS AND METHODS The study was conducted from July 2000 to November 2002 in 96 eyes of 50 patients. Diabetic patients either referred or detected at GOH are taken into study. History regarding onset, duration, family history, drug schedule and dietary habits. Associated systemic factors HT, IHD, renal diseases are recorded. Patients are tested for BCVA using Snellen’s chart, IOP using Goldmann applanation tonometer, slit lamp examination, fundus examination using direct and indirect ophthalmoscope and 90D biomicroscopy. Fundus photography taken using fundus camera. FFA done in all cases. RESULTS 32 patients were above 50 years of age and 18 patients are below 50 years of age. The ratio of male-to-female is 2.85:1 and 92% of patients have bilateral involvement. 28% of patients with maculopathy had diabetes mellitus of 6-10 years duration and 24% of patients had 11-15 years duration. 18.7% cases had clinically significant macular oedema. In FFA study showed 44.8% had focal lesions, 34.4% had diffuse lesions and 28.8% had ischaemic lesions. 76.9% of focal lesions improved with focal photocoagulation and 50% of diffuse lesions improved with grid photocoagulation. CONCLUSION Diabetic maculopathy is the commonest cause of visual loss in patient with diabetic retinopathy. Periodic follow up and examination are necessary to detect the involvement of macula at an earlier stage. Early treatment with photocoagulation can stabilise the visual acuity and prevent visual loss.

  19. [Electronic cigarettes - effects on health. Previous reports].

    Napierała, Marta; Kulza, Maksymilian; Wachowiak, Anna; Jabłecka, Katarzyna; Florek, Ewa


    Currently very popular in the market of tobacco products have gained electronic cigarettes (ang. E-cigarettes). These products are considered to be potentially less harmful in compared to traditional tobacco products. However, current reports indicate that the statements of the producers regarding to the composition of the e- liquids not always are sufficient, and consumers often do not have reliable information on the quality of the product used by them. This paper contain a review of previous reports on the composition of e-cigarettes and their impact on health. Most of the observed health effects was related to symptoms of the respiratory tract, mouth, throat, neurological complications and sensory organs. Particularly hazardous effects of the e-cigarettes were: pneumonia, congestive heart failure, confusion, convulsions, hypotension, aspiration pneumonia, face second-degree burns, blindness, chest pain and rapid heartbeat. In the literature there is no information relating to passive exposure by the aerosols released during e-cigarette smoking. Furthermore, the information regarding to the use of these products in the long term are not also available.

  20. Precision Studies of Observables in $pp \\to W \\to \\ell \

    Alioli, S.; et al.


    This report was prepared in the context of the LPCC "Electroweak Precision Measurements at the LHC WG" and summarizes the activity of a subgroup dedicated to the systematic comparison of public Monte Carlo codes, which describe the Drell-Yan processes at hadron colliders, in particular at the CERN Large Hadron Collider (LHC). This work represents an important step towards the definition of an accurate simulation framework necessary for very high-precision measurements of electroweak (EW) observables such as the $W$ boson mass and the weak mixing angle. All the codes considered in this report share at least next-to-leading-order (NLO) accuracy in the prediction of the total cross sections in an expansion either in the strong or in the EW coupling constant. The NLO fixed-order predictions have been scrutinized at the technical level, using exactly the same inputs, setup and perturbative accuracy, in order to quantify the level of agreement of different implementations of the same calculation. A dedicated comparison, again at the technical level, of three codes that reach next-to-next-to-leading-order (NNLO) accuracy in quantum chromodynamics (QCD) for the total cross section has also been performed. These fixed-order results are a well-defined reference that allows a classification of the impact of higher-order sets of radiative corrections. Several examples of higher-order effects due to the strong or the EW interaction are discussed in this common framework. Also the combination of QCD and EW corrections is discussed, together with the ambiguities that affect the final result, due to the choice of a specific combination recipe.

  1. [Observations of MDPV users: a prospective-retrospective study].

    Andrássy, Gábor; Asztalos, Zoltán; Égerházi, Anikó; Frecska, Ede


    The spreading of "designer drugs" resulted in the appearance of "similar yet different" substances, the chemical structure of which are modified so regularly, which makes their research very difficult. We came across one of these substances, MDPV, while on night duty before it was mentioned in research papers. Our own research explores the changes in drug consumption patterns, especially in MDPV consumption patterns in the past few years, and gives a description of psychiatric and associated symptoms. We compared cases of patients admitted to our ward between Jan 1., 2010 and November 30., 2012 with symptoms of drug consumption and its complications (BNO F15.00-F15.90, F19.00-F19.90). We examined symptoms that required inpatient care at the psychiatry ward. While in 2010 we treated only 3 MDPV users on 6 occasions, 4 Mephedrone users on 6 occasions, and 9 patients using other substances (Speed, Cannabis) on 10 occasions at our ward, in 2011 there were no Mephedrone-related hospitalizations and only 9 patients using other substances (Cannabis, Synthetic Cannabinoid, 5-MeO-AMT, Glue, Metamizole, Ketamine) were treated on 13 occasions. Between Jan 1. 2011. and Nov 30.2012 there were 40 recorded cases related to MDPV-use in the period: forty people were registered on 87 occasions. Nine people receive impatient care after observation on 10 occasions. In all these cases psychotic symptoms were recorded. The constant development of designer drugs requires better administration of the individual cases, symptoms and forms of treatments. Informing doctors about these details also seems necessary. We have found that the behaviours of drug users show a positive correspondence with changing legal environments, which calls for a more sensible drug-related policy.

  2. Study on the Application of Previously Fermented Juice in the Forage Silage%绿汁发酵液在饲草青贮中的应用研究



    绿汁发酵液作为一种天然、无毒的青贮添加剂加工简单,经济环保。本文根据近几年的研究,对绿汁发酵液的制作方法、作用机理以及应用进展等进行了综述。%This paper is about the previously fermented juice(PFJ) which has many advantages such as uncomplicated handing, economy and environmental protection as a natural and poisonless additive. Accord-ing to recent studies, this paper summarized the manufacturing methods, mechanism and application progress of PFJ.

  3. Observational research methods—Cohort studies, cross sectional studies, and case–control studies

    C.J. Mann


    Cohort studies are used to study incidence, causes, and prognosis. Because they measure events in chronological order they can be used to distinguish between cause and effect. Cross sectional studies are used to determine prevalence. They are relatively quick and easy but do not permit distinction between cause and effect. Case controlled studies compare groups retrospectively. They seek to identify possible predictors of outcome and are useful for studying rare diseases or outcomes. They are often used to generate hypotheses that can then be studied via prospective cohort or other studies.

  4. HERschel Observations of Edge-on Spirals (HEROES). III. Dust energy balance study of IC 2531

    Mosenkov, Aleksandr V; Baes, Maarten; Bianchi, Simone; Camps, Peter; De Geyter, Gert; De Looze, Ilse; Fritz, Jacopo; Gentile, Gianfranco; Hughes, Thomas M; Lewis, Fraser; Verstappen, Joris; Verstocken, Sam; Viaene, Sébastien


    We investigate the dust energy balance for the edge-on galaxy IC 2531, one of the seven galaxies in the HEROES sample. We perform a state-of-the-art radiative transfer modelling based, for the first time, on a set of optical and near-infrared galaxy images. We show that taking into account near-infrared imaging in the modelling significantly improves the constraints on the retrieved parameters of the dust content. We confirm the result from previous studies that including a young stellar population in the modelling is important for explaining the observed stellar energy distribution. However, the discrepancy between the observed and modelled thermal emission at far-infrared wavelengths, the so-called dust energy balance problem, is still present: the model underestimates the observed fluxes by a factor of about two. We compare two different dust models, and find that dust parameters and thus the spectral energy distribution in the infrared domain are sensitive to the adopted dust model. In general, the THEMIS...


    LI Zhao-rong; FU Shuang-xi; LI Bao-zi; JIANG Lin


    @@ 1 INTRODUCTION Lightning is a phenomenon of atmospheric electricity with convective storms. Since the 1960's, its characteristics during weather processes of torrential rain, hails and tornadoes have been widely studied and a lot of attempts made to probe into the mechanisms responsible for the formation of lightning[1], giving rise to two theories explaining the lightning genesis, from the points of convection and ice-phase precipitation,respectively.

  6. Primary care capitation payments in the UK. An observational study

    Beerstecher Hendrik J; Rhys Gwion; Morgan Claire L


    Abstract Background In 2004 an allocation formula for primary care services was introduced in England and Wales so practices would receive equitable pay. Modifications were made to this formula to enable local health authorities to pay practices. Similar pay formulae were introduced in Scotland and Northern Ireland, but these are unique to the country and therefore could not be included in this study. Objective To examine the extent to which the Global Sum, and modifications to the original f...


    Mukesh Shanthilal


    Full Text Available INTRODUCTION Colorectal cancer is the third most common cancer which can be detected early by implementation of cancer screening. This has led to decline in colorectal cancer related morbidity and mortality in elderly patients. However, there is increase in the incidence of this cancer in young individuals. This study was undertaken to study the characteristics of young colorectal cancer patients. METHODS AND MATERIALS The study was conducted from 2014 to 2016. All colorectal cancer patients attending the Department of Oncology, who were less than or equal to 50 years of age were included. Patients’ demographic data as well as data regarding the colorectal cancer was collected. The data was entered into MS Excel worksheet and analysed using descriptive statistics. RESULTS This study included 28 patients with a median age of 40 years and equal sex distribution. History of smoking in 85.7% (12/14 and alcohol (moderate consumption in 64% (9/14 was present in male patients. There was no history of alcohol or smoking was present among female patients. However, tobacco chewing habit was present in 28% (4/14 of female patients. History of multiple sexual partners in 14% (4/28 of cases and 78% (22/28 were non-vegetarians. Nearly 85% (24/28 of patients presented with an advanced stage disease. The analysis showed involvement of left side of colon in 50% (14/28, rectum in 39% (11/28 and right side of colon in 11%(3/28. Except for two patients who were in stage - 1, all other patients received chemotherapy. CONCLUSION The incidence of colorectal cancer in young individuals is constantly rising. The reason for this increase is unclear and the relative contributions of genetic versus environmental factors remain relatively unexplored.

  8. Observational Study of Human Electrical Muscle Incapacitation and Cardiac Effects


    notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display...activity have been proposed as the cause of death in a small fraction of these individuals. A study of 212 patient exposures to < 1000 volts found 28...combative individuals. A small fraction of these individuals subsequently die while in confinement. Critics of HEMI use claim these deaths are a direct

  9. Quality of Life after Stapled Hemorrhoidopexy: A Prospective Observational Study

    Pankaj Kumar Garg


    Full Text Available Objective. The objective of the study was to assess the change in quality of life (QOL of patients undergoing stapled hemorrhoidopexy (SH using WHO Quality of Life-BREF (WHOQOL-BREF questionnaire. Methods. The study sample comprised patients with symptomatic II, III, and IV degree hemorrhoids, undergoing SH. The patients were asked to complete WHOQOL-BREF questionnaire before and one month following the surgery. Result. There were 20 patients in the study group. The postoperative pain score measured by visual analogue scale at six hours postoperatively was at 24 hours. The items in the WHOQOL-BREF had high-internal consistency or reliability as shown by high Cronbach's alpha coefficient which was 0.82 and 0.90 for pre- and postoperative questionnaires. There was significant improvement in the overall perception of QOL and health, and in physical and psychological domains. There was modest improvement in environmental domain, while no change was noted in social domain. Conclusion. SH improved the quality of life of patients treated for hemorrhoids.

  10. Observing power blackouts from space - A disaster related study

    Aubrecht, C.; Elvidge, C. D.; Ziskin, D.; Baugh, K. E.; Tuttle, B.; Erwin, E.; Kerle, N.


    In case of emergency disaster managers worldwide require immediate information on affected areas and estimations of the number of affected people. Natural disasters such as earthquakes, hurricanes, tornados, wind and ice storms often involve failures in the electrical power generation system and grid. Near real time identification of power blackouts gives a first impression of the area affected by the event (Elvidge et al. 2007), which can subsequently be linked to population estimations. Power blackouts disrupt societal activities and compound the difficulties associated with search and rescue, clean up, and the provision of food and other supplies following a disastrous event. Locations and spatial extents of power blackouts are key considerations in planning and execution of the primary disaster missions of emergency management organizations. To date only one satellite data source has been used successfully for the detection of power blackouts. Operated by NOAA's National Geophysical Data Center (NGDC) the U.S. Air Force Defense Meteorological Satellite Program (DMSP) Operational Linescan System (OLS) offers a unique capability to observe lights present at the Earth's surface at night. Including a pair of visible and thermal spectral bands and originally designed to detect moonlit clouds, this sensor enables mapping of lights from cities and towns, gas flares and offshore platforms, fires, and heavily lit fishing boats. The low light imaging of the OLS is accomplished using a photomultiplier tube (PMT) which intensifies the visible band signal at night. With 14 orbits collected per day and a 3.000 km swath width, each OLS is capable of collecting a complete set of images of the Earth every 24 hours. NGDC runs the long-term archive for OLS data with the digital version extending back to 1992. OLS data is received by NGDC in near real time (1-2 hours from acquisition) and subscription based services for the near real time data are provided for users all over the

  11. The Reporting of Observational Research Studies in Dermatology Journals A Literature-Based Study

    Langan, Sinead; Schmitt, Jochen; Coenraads, Pieter-Jan; Svensson, Ake; von Elm, Erik; Williams, Hywel


    Objective: To assess the quality of reporting in observational studies in dermatology. Data Sources: Five dermatology journals-the Archives of Dermatology, the British Journal of Dermatology, the Journal of the American Academy of Dermatology, the Journal of Investigative Dermatology, and Acta Derma

  12. The Reporting of Observational Research Studies in Dermatology Journals A Literature-Based Study

    Langan, Sinead; Schmitt, Jochen; Coenraads, Pieter-Jan; Svensson, Ake; von Elm, Erik; Williams, Hywel

    Objective: To assess the quality of reporting in observational studies in dermatology. Data Sources: Five dermatology journals-the Archives of Dermatology, the British Journal of Dermatology, the Journal of the American Academy of Dermatology, the Journal of Investigative Dermatology, and Acta

  13. An observational study of secondary task engagement while driving on urban streets in Iranian Safe Communities.

    Torkamannejad Sabzevari, Javad; Nabipour, Amir Reza; Khanjani, Narges; Molaei Tajkooh, Ali; Sullman, Mark J M


    In Iran the prevalence of traffic injuries and death from vehicle collisions are high. Driver engagement in non-driving-related tasks has been previously identified as an important contributing factor to crashes. Therefore, the objective of the present study was to investigate the prevalence of drivers' engagement in potentially distracting activities in Kashmar, Khalilabad and Bardaskan, which are three Iranian International Safe Communities. Observations took place at 12 randomly selected roadside locations in each city, which were comprised of six main streets and six side streets. In total 7979 drivers were observed. The prevalence rates of potentially distracting activities in Kashmar, Khalilabad and Bardaskan were 24.3%, 26% and 24.9%, respectively. In both Kashmar and Khalilabad the most frequently observed secondary tasks were drivers talking to passengers (10.6% and 11.5%, respectively) followed by mobile phone use (3.4% and 4.0%, respectively). Although in Bardaskan the most commonly observed secondary task was also talking to passengers (12.7%), the second most common was reaching for an object (3.2%). In all three cities younger drivers were significantly more likely to be observed engaged in a secondary task while driving. Furthermore, involvement in secondary tasks while driving was significantly higher amongst females and those driving on a working day. The percentage of drivers identified as potentially distracted in these three Safe Communities was worryingly high. Thus, interventions should be integrated into the WHO Safe Community network in these cities, including: education regarding the risks associated with engaging in secondary activities while driving, law enforcement, tougher legislation, periodic assessment, raising public awareness, as well as attracting political and social support.

  14. 中原地区某村既往有偿献血人群艾滋病发病和死亡规律%Study on AIDS incidence and death in previous paid blood-donated population, central China

    朱新义; 崔兆麟; 黄祚军; 朱伯健; 汪宁


    Objective To study incidence and death among previous paid blood-donated AIDS sufferers.Methods A retrospective cohort study was adopted to study incidence and death of 373 previous paid blood-donated HIV sufferers and its effect factors.Results Previous paid blood-donated HIV infection was serious and the infection rate in blood-donated crowd was 35.87%(373/1040);the mean incubation period of AIDS was 8.87 years(95%CI:8.76-8.99,Kaplan-Meier method):the cumulative incidence of AIDS(10 years)was 92.23%(344/373),and the incidence of total sufferers was 11.64/100 person-year;the cumulative probability of survival of one-year,three-year,five-year AIDS sufferers was separately 94.48% (325/344),85.76%(295/344)and 83.14%(286/344),median survival time was over 5 years;the anti-virotic treatment days(960.29±486.38),infection age(33.39±9.08)disease age(41.98±8.88)had significant effects on AIDS sufferers' survival time/survival rate(x2=61.355,P=0.000;x2=6.555,P=0.010;x2=3.969,P=0.046).Conclusion The survival time of previous paid blood-donated HIV cases was longer,and their survival rate was hisher,remarkably higher than the UNAIDS'research findings.%目的 研究既往有偿献血人群获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)发病和死亡规律.方法 采用回顾性队列研究方法,对373例既往有偿献血感染人类免疫缺陷病毒(human immunodeficiency virus,HIV)者的发病、死亡规律及其影响因素进行研究.结果 既往有偿献血人群HIV感染率为35.87%(373/1040),AIDS平均潜伏期为8.87年(95%CI:8.76~8.99,Kaplan-Meier法);感染后10年累计发病率为92.23%(344/373),总人时发病率为11.64/100人年;艾滋病患者1年、3年、5年累计生存率分别为94.48%(325/344)、85.76%(295/344)和83.14%(286/344),中位生存时间超过5年;抗病毒治疗天数[(960.29±486.38)d]、感染年龄[(33.39±9.08)岁]和发病年龄[(41.98±8.88)岁]对艾滋病患者生存时间

  15. Concussion symptoms in youth motocross riders: a prospective, observational study.

    Luo, T David; Clarke, Michelle J; Zimmerman, Amy K; Quinn, Michael; Daniels, David J; McIntosh, Amy L


    Action motorsports, including motocross, have been gaining popularity among children and adolescents, raising concerns for increased risk of concussions in participating youth. The authors undertook this study to test the following hypotheses: 1) that there is a high rate of concussion symptoms associated with a number of preventable or adjustable risk factors, and 2) that a high percentage of these symptoms are not be reported to adults and medical personnel. The authors identified all motocross riders under the age of 18 at a regional racetrack during the riding season between May and October 2010. The participants completed questionnaires pertaining to demographic characteristics and variables associated with motocross. The questionnaire results were compared with the incidence of self-reported concussion symptoms. Two hundred two riders were identified who met the criteria for participation in the study, and 139 of them completed the study questionnaire. Of these 139 riders, 67 (48%) reported at least 1 concussion symptom during the season. The majority of riders (98%) reported "always" wearing a helmet, and 72% received professional help with fitting of their helmets. Proper helmet fitting was associated with a 41% decreased risk of concussion symptoms (RR 0.59, 95% CI 0.44-0.81, p motocross participation. Sponsor support conferred a relative risk for concussion symptoms of 1.48 (95% CI 1.05-2.08, p = 0.02). Nearly half of all motocross competitors under the age of 18 reported concussion symptoms. Preventive measures are necessary to limit the negative impact from concussions. The risk of concussive injury can be decreased for pediatric motocross riders if they receive professional help with proper helmet fitting and through implementation of stricter guidelines regarding sponsorship.

  16. An observational study on extraperitoneal caesarean section in present era

    Sudhanshu Sekhara Nanda


    Full Text Available Background: This study was designed to find out the maternal and perinatal outcome in cases of extraperitoneal caesarean section. Total 100 women undergoing extraperitoneal cesarean section were included in the study. Methods: A detailed history taking, examination done and intra and post-operative parameters as per protocols were noted. Results: Success rate of extra peritoneal CS was 79.63%, Time taken from incision to delivery was and #8804;5 minutes in 60% cases, time taken from incision to closure was between 31-45 min in 67% cases, blood loss and #8804;500 ml in 58% cases, return of bowel function between 5-8 hours in 52%, mobilization within 24 hours in 52%, neonatal one minute APGAR score and #8805;7 in 90.91%. Conclusions: Extraperitoneal cesarean section can be applied as a surgical form of infection prophylaxis. Since it possesses a rational basis for the avoidance of serious post-operative pelvic infectious complications, this operation deserves reconsideration in the modern era. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 724-727

  17. Change in neck circumference after shoulder arthroscopy: An observational study

    Shrividya Chellam


    Full Text Available Background and Aims: Shoulder arthroscopy requires fluid irrigation, which causes soft-tissue oedema around chest, neck, and arm intraoperatively, leading to postoperative airway complications. We decided to study the incidence of increase in the neck circumference in shoulder arthroscopy and its effects on the airway. Methods: We studied 32 cases of shoulder arthroscopies over a period of 1-year, performed under general anaesthesia with interscalene block. The neck circumference of patients before and after the procedure was measured along with other parameters. The endotracheal tube cuff was deflated at the end of surgery to determine air leak around the tube. The negative leak test suggested airway oedema. Results: Thirty out of 32 patients showed positive air leak test. The average change in neck circumference was 1.17 ± 1.16 cm and all could be extubated uneventfully. Two showed negative leak test with an increase in neck circumference by 4.5 and 6.4 cm and were not extubated. Multiple regression analysis for risk factors showed intraoperative hypertension as a single predictor for an increase in neck circumference. Conclusion: Change in the neck circumference beyond 4 cm may suggest airway compromise and below 4 cm, airway compromise is unlikely even in the presence of extensive soft-tissue oedema around the shoulder, upper arm and chest.


    Sidharth Kapoor


    Full Text Available BACKGROUND Snakes are the most feared and the most worshipped living creatures on the earth. Snakes are called venomous when envenomation or human fatalities after their bite are known. Snakebite is an acute medical emergency faced by temperate and tropical regions with heavy rainfall and humid climate. The specific therapy for snakebite in India is still polyvalent ASV and clinical practice ASV is not recommended until the victim of snakebite presents either with the evidence of bite by a poisonous snake such as definite fang marks, swelling or pain at the bite site or with clinical or laboratory evidence of envenomation such as local and systemic bleeding. In some cases, institution of ASV may also be initiated on the identification of offending snake brought by the patient or attendants, but most of these are subjective matters and subject to fallacies. Also, that out of polyvalent and monovalent ASV available, since it is monovalent ASV, which is desirable due to its less side effects and more effectiveness, but its use warrants the identification of snake, which is practically not possible in every case and/or on the objective evidence of peripheral neurological signs and symptoms and haematological alterations, which may not be dependable in many cases. MATERIALS AND METHODS Snake envenomation is in fact a multifactorial stress phenomenon, which produces altered physiological states including death and one of the consequences of the stress phenomenon is generation of several lysosomal enzymes and formation of free radicals. Extensive data search on Medline has failed to show study of this type in any part of the world, so this study being taken up as a preliminary attempt to evaluate the pattern of enzymatic changes in snake envenomation. RESULTS The patients included in the study were be those coming to the Emergency Department of Government Medical College, Jammu, bitten by poisonous snakes during the period May 2003 to April 2004. The

  19. Evaluation of the Quality of Reporting of Observational Studies in Otorhinolaryngology - Based on the STROBE Statement

    Hendriksma, Martine; Joosten, Michiel H M A; Peters, Jeroen P M; Grolman, Wilko; Stegeman, Inge


    BACKGROUND: Observational studies are the most frequently published studies in literature. When randomized controlled trials cannot be conducted because of ethical or practical considerations, an observational study design is the first choice. The STROBE Statement (STrengthening the Reporting of

  20. Evaluation of the Quality of Reporting of Observational Studies in Otorhinolaryngology - Based on the STROBE Statement

    Hendriksma, Martine; Joosten, Michiel H M A; Peters, Jeroen P M; Grolman, Wilko; Stegeman, Inge


    BACKGROUND: Observational studies are the most frequently published studies in literature. When randomized controlled trials cannot be conducted because of ethical or practical considerations, an observational study design is the first choice. The STROBE Statement (STrengthening the Reporting of OBs

  1. The advances in airglow study and observation by the ground-based airglow observation network over China

    Xu, Jiyao; Li, Qinzeng; Yuan, Wei; Liu, Xiao; Liu, Weijun; Sun, Longchang


    Ground-based airglow observation networks over China used to study airglow have been established, which contains 15 stations. Some new results were obtained using the networks. For OH airglow observations, firstly, an unusual outbreak of Concentric Gravity Wave (CGW) events were observed by the first no-gap network nearly every night during the first half of August 2013. Combination of the ground imager network with satellites provides multilevel observations of the CGWs from the troposphere to the mesopause region. Secondly, three-year OH airglow images (2012-2014) from Qujing (25.6°N, 103.7°E) were used to study how orographic features of the Tibetan Plateau (TP) affect the geographical distributions of gravity wave (GW) sources. We find the orographic forcings have a significant impact on the gravity wave propagation features. Thirdly, ground-based observations of the OH (9-4, 8-3, 6-2, 5-1, 3-0) band airglow over Xinglong (40°2N, 117°4E) in northern China from 2012 to 2014 are used to calculate rotational temperatures. By comparing the ground-based OH rotational temperature with SABER's observations, five Einstein coefficient datasets are evaluated. We find rotational temperatures determined using any of the available Einstein coefficient datasets have systematic errors. We have obtained a set of optimal Einstein coefficients ratios for rotational temperature derivation using three years data from ground-based OH spectra and SABER temperatures. For the OI 630.0 nm airglow observations, we used three-year (2011-2013) observations of thermospheric winds (at 250 km) by Fabry-Perot interferometers at Xinglong to study the climatology of atmospheric planetary wave-type oscillations (PWTOs) with periods of 4-19 days. We found these PWTOs occur more frequently in the months from May to October. They are consistent with the summertime preference of middle-latitude ionospheric electron density oscillations noted in other studies. By using an all-sky airglow imager


    Narendra Kumar Narahari


    Full Text Available Pneumomediastinum is an uncommon condition which is defined by the presence of air in the mediastinum. It may result from a number of causes, but at times the underlying aetiology remains obscure. The present study aims to review the clinical and imaging features in patients who presented with pneumomediastinum alone or in association with other findings in order to establish the aetiological diagnosis. We report here, a series of cases with pneumomediastinum of various unusual aetiologies and also the clinical profile, predisposing factors and outcome of these patients along with the associated complications. METHODS We retrospectively reviewed the records of all patients who presented to the respiratory unit of our hospital with the diagnosis of pneumomediastinum over a period of 2 years from 2013-2015. The cases of pneumomediastinum resulting from trauma and iatrogenic causes were excluded from the study. RESULTS A total of six patients (4 males and 2 females with pneumomediastinum were identified during the study period after applying the exclusion criteria. The most common presenting symptom in these cases was shortness of breath followed by dry cough, chest pain and fever. Subcutaneous emphysema and Hamman sign was identified in one patient each. Of the six cases, preexisting lung disease was identified in 3 patients and these included connective tissue disease related interstitial lung disease in two cases and combined pulmonary fibrosis and emphysema in one case. In the remaining three cases, the causes of pneumomediastinum were Pneumocystis carinii pneumonia (PCP in HIV positive patient, pulmonary tuberculosis in another and spontaneous oesophageal perforation in the third. Coexisting pneumothorax was present in 3 out of 6 cases. The mean duration of hospital stay in these six patients was 8 days. No recurrence of pneumomediastinum was seen in any of the six patients during six months of followup. CONCLUSIONS Pneumomediastinum is a

  3. Can headache impair intellectual abilities in children? An observational study

    Esposito M


    Full Text Available Maria Esposito,1 Antonio Pascotto,1 Beatrice Gallai,3 Lucia Parisi,2 Michele Roccella,2 Rosa Marotta,4 Serena Marianna Lavano,4 Antonella Gritti,5 Giovanni Mazzotta,6 Marco Carotenuto11Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Second University of Naples, Naples, 2Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, 3Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, 4Department of Psychiatry, “Magna Graecia” University of Catanzaro, Catanzaro, 5Suor Orsola Benincasa University, Napoli, 6Unit of Child and Adolescent Neuropsychiatry, Azienda Sanitaria Locale 4, Terni, ItalyBackground: The purpose of this study was to assess the cognitive functioning of children affected by headache, pinpointing the differences in intelligence style between subjects affected by migraine without aura and subjects with tension-type headache.Methods: The study population consisted of 147 children (mean age 10.82 ± 2.17 years with headache, recruited from the Headache Center for Developmental Age, Child and Adolescent Neuropsychiatry Clinic, Second University of Naples. Cognitive profiling was performed using Weschler Intelligence Scale for Children Third Edition throughout the sample. According to the International Classification of Headache Disorders II criteria for pediatric age, subjects were divided into a migraine without aura group (n = 75; 43 boys, 32 girls and a tension-type headache group (n = 72; 49 boys, 23 girls. The results were compared with the findings obtained from a sample of 137 healthy control subjects recruited from schools in the Campania region, matched for age and gender.Results: No difference in full intelligence quotient was found between the groups, but the children with tension-type headache had a lower verbal intelligence quotient and a higher performance intelligence quotient than the healthy controls and children with migraine. Factor

  4. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study

    Nematy Mohsen


    Full Text Available Abstract Background Previous research has shown that Ramadan fasting has beneficial effects on cardiovascular risk factors, however there are controversies. In the present study, the effect of Ramadan fasting on cardiovascular risk factors has been investigated. Method This is a prospective observational study that was carried out in a group of patients with at least one cardiovascular risk factor (including history of documented previous history of either coronary artery disease (CAD, metabolic syndrome or cerebro-vascular disease in past 10 y. Eighty two volunteers including 38 male and 44 female, aged 29–70 y, mean 54.0 ± 10 y, with a previous history of either coronary artery disease, metabolic syndrome or cerebro-vascular disease were recruited. Subjects attended the metabolic unit after at least 10 h fasting, before and after Ramadan who were been fasting for at least 10 days. A fasting blood sample was obtained, blood pressure was measured and body mass index (BMI was calculated. Lipids profile, fasting blood sugar (FBS and insulin, homocysteine (hcy, high-sensitivity C-reactive protein (hs-CRP and complete blood count (CBC were analyzed on all blood samples. Results A significant improvement in 10 years coronary heart disease risk (based on Framingham risk score was found (13.0 ± 8 before Ramadan and 10.8 ±7 after Ramadan, P 0.001, t test.There was a significant higher HDL-c, WBC, RBC and platelet count (PLT, and lower plasma cholesterol, triglycerides, LDL-c, VLDL-c, systolic blood pressure, body mass index and waist circumference after Ramadan (P 0.05, t test. The changes in FBS, insulin,Homeostasis Model Assessment Insulin Resistance (HOMA-IR, hcy, hs-CRP and diastolic blood pressure before and after Ramadan were not significant (P >0.05, t test. Conclusions This study shows a significant improvement in 10 years coronary heart disease risk score and other cardiovascular risk factors such as lipids profile

  5. Skin features in myotonic dystrophy type 1: an observational study.

    Campanati, A; Giannoni, M; Buratti, L; Cagnetti, C; Giuliodori, K; Ganzetti, G; Silvestrini, M; Provinciali, L; Offidani, A


    Poor data regarding skin involvement in Myotonic Dystrophy, also named Dystrophia Myotonica type 1, have been reported. This study aimed to investigate the prevalence and types of skin disorders in adult patients with Myotonic Dystrophy type 1. Fifty-five patients and one hundred age- and sex-matched healthy subjects were referred to a trained dermatologist for a complete skin examination to check for potential cutaneous hallmarks of disease. No difference in prevalence of preneoplastic, neoplastic, and cutaneous lesions was detected between the two groups. Among morphofunctional, proliferative and inflammatory lesions, focal hyperhidrosis (p Myotonic Dystrophy type 1 significant differences according to sex were found for: early androgenic alopecia, twisted hair and seborrheic dermatitis, whose prevalence was higher in males (p Myotonic Dystrophy type 1. On the other hand, an increased prevalence of morphofunctional, inflammatory, and proliferative diseases involving adnexal structures seems to characterize adult patients with Myotonic Dystrophy type 1.

  6. UFOs in the LHC: Observations, studies and extrapolations

    Baer, T; Cerutti, F; Ferrari, A; Garrel, N; Goddard, B; Holzer, EB; Jackson, S; Lechner, A; Mertens, V; Misiowiec, M; Nebot del Busto, E; Nordt, A; Uythoven, J; Vlachoudis, V; Wenninger, J; Zamantzas, C; Zimmermann, F; Fuster, N


    Unidentified falling objects (UFOs) are potentially a major luminosity limitation for nominal LHC operation. They are presumably micrometer sized dust particles which lead to fast beam losses when they interact with the beam. With large-scale increases and optimizations of the beam loss monitor (BLM) thresholds, their impact on LHC availability was mitigated from mid 2011 onwards. For higher beam energy and lower magnet quench limits, the problem is expected to be considerably worse, though. In 2011/12, the diagnostics for UFO events were significantly improved: dedicated experiments and measurements in the LHC and in the laboratory were made and complemented by FLUKA simulations and theoretical studies. The state of knowledge, extrapolations for nominal LHC operation and mitigation strategies are presented

  7. [Using consumer panels in public health observational studies].

    Matilla-Santander, Nuria; Fu, Marcela; Ballbè, Montse; Lidón-Moyano, Cristina; Martín-Sánchez, Juan Carlos; Fernández, Esteve; Martínez-Sánchez, José M

    Consumer panels are a market research method useful for gathering information about low-frequency or difficult-access customers. The objective of this field-note is to explain our experience using this method in a cross-sectional public health study on the use of electronic cigarettes. After taking into account other non-probabilistic sampling techniques to obtain a huge sample of electronic-cigarette users (n=600), in the end we decided to use consumer panels (recruiters) because of the relative short duration of the field work and the high representativeness of the sample. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Fluoroquinolone resistance during 2000–2005 : An observational study

    Sheehan Paul


    Full Text Available Abstract Background Moxifloxacin is a respiratory fluoroquinolone with a community acquired pneumonia indication. Unlike other fluoroquinolones used in our healthcare system, moxifloxacin's urinary excretion is low and thus we hypothesized that increased use of moxifloxacin is associated with an increase in fluoroquinolone resistance amongst gram negative uropathogens. Methods All antibiograms for Gram negative bacteria were obtained for 2000 to 2005. The defined daily dose (DDD for each fluoroquinolone was computed according to World Health Organization criteria. To account for fluctuation in patient volume, DDD/1000 bed days was computed for each year of study. Association between DDD/1000 bed days for each fluoroquinolone and the susceptibility of Gram negative bacteria to ciprofloxacin was assessed using Pearson's Correlation Coefficient, r. Results During the study period, there were 48,261 antibiograms, 347,931 DDD of fluoroquinolones, and 1,943,338 bed days. Use of fluoroquinolones among inpatients decreased from 237.2 DDD/1000 bed days in 2000 to 115.2 DDD/1000 bed days in 2005. With the exception of Enterobacter aerogenes, moxifloxacin use was negatively correlated with sensitivity among all 13 Gram negative species evaluated (r = -0.07 to -0.97. When the sensitivities of all Gram negative organisms were aggregated, all fluoroquinolones except moxifloxacin were associated with increased sensitivity (r = 0.486 to 1.000 while moxifloxacin was associated with decreased sensitivity (r = -0.464. Conclusion Moxifloxacin, while indicated for empiric treatment of community acquired pneumonia, may have important negative influence on local antibiotic sensitivities amongst Gram negative organisms. This effect was not shared by other commonly used members of the fluoroquinolone class.

  9. A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates.

    Echlin, Paul Sean; Tator, Charles H; Cusimano, Michael D; Cantu, Robert C; Taunton, Jack E; Upshur, Ross E G; Hall, Craig R; Johnson, Andrew M; Forwell, Lorie A; Skopelja, Elaine N


    The objective of this study was to measure the incidence of concussion (scaled relative to number of athlete exposures) and recurrent concussion within 2 teams of fourth-tier junior ice hockey players (16-21 years old) during 1 regular season. A prospective cohort study called the Hockey Concussion Education Project was conducted during 1 junior ice hockey regular season (2009-2010) involving 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years, range 16-21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete baseline SCAT2 and ImPACT testing. If the protocol was not followed, the postinjury test results of a player without true baseline test results would be compared against previously established age and gender group normative levels. Each regular season game was observed by a qualified physician and at least 1 other neutral nonphysician observer. Players who suffered a suspected concussion were evaluated at the game. If a concussion diagnosis was made, the player was subsequently examined in the physician's office for a full clinical evaluation and the SCAT2 and ImPACT were repeated. Based on these evaluations, players were counseled on the decision of when to return to play. Athlete exposure was defined as 1 game played by 1 athlete. Twenty-one concussions occurred during the 52 physician-observed games (incidence 21.5 concussions per 1000 athlete exposures). Five players experienced repeat concussions. No concussions were reported during practice sessions. A concussion was diagnosed by the physician in 19 (36.5%) of the 52 observed games. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a

  10. Temperature variability during delirium in ICU patients: an observational study.

    Arendina W van der Kooi

    Full Text Available INTRODUCTION: Delirium is an acute disturbance of consciousness and cognition. It is a common disorder in the intensive care unit (ICU and associated with impaired long-term outcome. Despite its frequency and impact, delirium is poorly recognized by ICU-physicians and -nurses using delirium screening tools. A completely new approach to detect delirium is to use monitoring of physiological alterations. Temperature variability, a measure for temperature regulation, could be an interesting component to monitor delirium, but whether temperature regulation is different during ICU delirium has not yet been investigated. The aim of this study was to investigate whether ICU delirium is related to temperature variability. Furthermore, we investigated whether ICU delirium is related to absolute body temperature. METHODS: We included patients who experienced both delirium and delirium free days during ICU stay, based on the Confusion Assessment method for the ICU conducted by a research- physician or -nurse, in combination with inspection of medical records. We excluded patients with conditions affecting thermal regulation or therapies affecting body temperature. Daily temperature variability was determined by computing the mean absolute second derivative of the temperature signal. Temperature variability (primary outcome and absolute body temperature (secondary outcome were compared between delirium- and non-delirium days with a linear mixed model and adjusted for daily mean Richmond Agitation and Sedation Scale scores and daily maximum Sequential Organ Failure Assessment scores. RESULTS: Temperature variability was increased during delirium-days compared to days without delirium (β(unadjusted=0.007, 95% confidence interval (CI=0.004 to 0.011, p<0.001. Adjustment for confounders did not alter this result (β(adjusted=0.005, 95% CI=0.002 to 0.008, p<0.001. Delirium was not associated with absolute body temperature (β(unadjusted=-0.03, 95% CI=-0.17 to 0

  11. Adverse effect profile of trichlormethiazide: a retrospective observational study

    Nishida Yayoi


    Full Text Available Abstract Background Trichlormethiazide, a thiazide diuretic, was introduced in 1960 and remains one of the most frequently used diuretics for treating hypertension in Japan. While numerous clinical trials have indicated important side effects of thiazides, e.g., adverse effects on electrolytes and uric acid, very few data exist on serum electrolyte levels in patients with trichlormethiazide treatment. We performed a retrospective cohort study to assess the adverse effects of trichlormethiazide, focusing on serum electrolyte and uric acid levels. Methods We used data from the Clinical Data Warehouse of Nihon University School of Medicine obtained between Nov 1, 2004 and July 31, 2010, to identify cohorts of new trichlormethiazide users (n = 99 for 1 mg, n = 61 for 2 mg daily dosage and an equal number of non-users (control. We used propensity-score matching to adjust for differences between users and control for each dosage, and compared serum chemical data including serum sodium, potassium, uric acid, creatinine and urea nitrogen. The mean exposure of trichlormethiazide of 1 mg and 2 mg users was 58 days and 64 days, respectively. Results The mean age was 66 years, and 55% of trichlormethiazide users of the 1 mg dose were female. In trichlormethiazide users of the 2 mg dose, the mean age was 68 years, and 43% of users were female. There were no statistically significant differences in all covariates (age, sex, comorbid diseases, past drugs, and current antihypertensive drugs between trichlormethiazide users and controls for both doses. In trichlormethiazide users of the 2 mg dose, the reduction of serum potassium level and the elevation of serum uric acid level were significant compared with control, whereas changes of mean serum sodium, creatinine and urea nitrogen levels were not significant. In trichlormethiazide users of the 1 mg dose, all tests showed no statistically significant change from baseline to during the exposure period in

  12. Phase I/II study of docetaxel combined with resminostat, an oral hydroxamic acid HDAC inhibitor, for advanced non-small cell lung cancer in patients previously treated with platinum-based chemotherapy.

    Tambo, Yuichi; Hosomi, Yukio; Sakai, Hiroshi; Nogami, Naoyuki; Atagi, Shinji; Sasaki, Yasutsuna; Kato, Terufumi; Takahashi, Toshiaki; Seto, Takashi; Maemondo, Makoto; Nokihara, Hiroshi; Koyama, Ryo; Nakagawa, Kazuhiko; Kawaguchi, Tomoya; Okamura, Yuta; Nakamura, Osamu; Nishio, Makoto; Tamura, Tomohide


    Objectives To determine the recommended dose and efficacy/safety of docetaxel combined with resminostat (DR) in non-small cell lung cancer (NSCLC) patients with previous platinum-based chemotherapy. Materials and Methods A multicenter, open-label, phase I/II study was performed in Japanese patients with stage IIIB/IV or recurrent NSCLC and prior platinum-based chemotherapy. The recommended phase II dose was determined using a standard 3 + 3 dose design in phase I part. Resminostat was escalated from 400 to 600 mg/day and docetaxel fixed at 75 mg/m(2). In phase II part, the patients were randomly assigned to docetaxel alone (75 mg/m(2)) or DR therapy. Docetaxel was administered on day 1 and resminostat on days 1-5 in the DR group. Treatment was repeated every 21 days until progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). Results A total of 117 patients (phase I part, 9; phase II part, 108) were enrolled. There was no dose-limiting toxicity in phase I part; the recommended dose for resminostat was 600 mg/day with 75 mg/m(2) of docetaxel. In phase II part, median PFS (95% confidence interval [CI]) was 4.2 (2.8-5.7) months with docetaxel group and 4.1 (1.5-5.4) months with DR group (hazard ratio [HR]: 1.354, 95% CI: 0.835-2.195; p = 0.209). Grade ≥ 3 adverse events significantly more common with DR group than docetaxel group were leukopenia, febrile neutropenia, thrombocytopenia, and anorexia. Conclusion In Japanese NSCLC patients previously treated with platinum-based chemotherapy, DR therapy did not improve PFS compared with docetaxel alone and increased toxicity.

  13. An observational study of alemtuzumab following fingolimod for multiple sclerosis

    Willis, Mark; Pearson, Owen; Illes, Zsolt; Sejbaek, Tobias; Nielsen, Christian; Duddy, Martin; Petheram, Kate; van Munster, Caspar; Killestein, Joep; Malmeström, Clas; Tallantyre, Emma


    Objective: To describe a series of patients with relapsing multiple sclerosis (MS) who experienced significant and unexpected disease activity within the first 12 months after switching from fingolimod to alemtuzumab. Methods: Patients with relapsing MS treated sequentially with fingolimod then alemtuzumab who experienced significant subsequent disease activity were identified by personal communication with 6 different European neuroscience centers. Results: Nine patients were identified. Median disease duration to alemtuzumab treatment was 94 (39–215) months and follow-up from time of first alemtuzumab cycle 20 (14–21) months. Following first alemtuzumab infusion cycle, 8 patients were identified by at least 1 clinical relapse and radiologic disease activity and 1 by significant radiologic disease activity alone. Conclusions: We acknowledge the potential for ascertainment bias; however, these cases may illustrate an important cause of reduced efficacy of alemtuzumab in a vulnerable group of patients with MS most in need of disease control. We suggest that significant and unexpected subsequent disease activity after alemtuzumab induction results from prolonged sequestration of autoreactive lymphocytes following fingolimod withdrawal, allowing these cells to be concealed from the usual biological effect of alemtuzumab. Subsequent lymphocyte egress then provokes disease reactivation. Further animal studies and clinical trials are required to confirm these phenomena and in the meantime careful consideration should be given to mode of action of individual therapies and sequential treatment effects in MS when designing personalized treatment regimens. PMID:28101520

  14. Purification of human parathyroid hormone: recent studies and further observations.

    Keutmann, H T; Hendy, G N; Boehnert, M; O'Riordan, J L; Potts, J T


    During the isolation of human parathyroid hormone there is an extensive loss of immuno-assayble hormone over the successive extraction steps, due in part to the presence of fragments that are soluble in 4% trichloroacetic acid. These fragments are derived from both the amino- and carboxyl-terminal regions of the hormone. The hormonal fractions precipitated with trichloroacetic acid were further purified by gel filtration and ion-exchange chromatography. At the final ion-exchange purification step, some preparations of the hormone eluted in multiple fractions. When the various components were characterized separately by immunoassay, amino acid composition, enzymic cleavage and partial sequence analysis, they were found to be closely comparable, although the most acidic fraction contained a blocked terminal amino group. Extraction of a number of batches of tissue permitted revision of the amino acid composition of human parathyroid hormone. Biosynthetic studies with labelled amino acids confirmed the absence of tyrosine and the presence of phenylalanine and threonine and localized these residues to definite regions of the molecule.

  15. Seizures in Preterm Neonates: A Multicenter Observational Cohort Study.

    Glass, Hannah C; Shellhaas, Renée A; Tsuchida, Tammy N; Chang, Taeun; Wusthoff, Courtney J; Chu, Catherine J; Cilio, M Roberta; Bonifacio, Sonia L; Massey, Shavonne L; Abend, Nicholas S; Soul, Janet S


    The purpose of this study was to characterize seizures among preterm neonates enrolled in the Neonatal Seizure Registry, a prospective cohort of consecutive neonates with seizures at seven pediatric centers that follow the American Clinical Neurophysiology Society's neonatal electroencephalography monitoring guideline. Of 611 enrolled neonates with seizures, 92 (15%) were born preterm. Seizure characteristics were evaluated by gestational age at birth for extremely preterm (preterm (28 to preterm (32 to preterm neonates. Hypothermia therapy was utilized in 15 moderate to late preterm subjects with encephalopathy. The presence of subclinical seizures, monotherapy treatment failure, and distribution of seizure burden (including status epilepticus) was similar in preterm and term neonates. However, exclusively subclinical seizures occurred more often in preterm than term neonates (24% vs 14%). Phenobarbital was the most common initial medication for all gestational age groups, and failure to respond to an initial loading dose was 63% in both preterm and term neonates. Mortality was similar among the three preterm gestational age groups; however, preterm mortality was more than twice that of term infants (35% vs 15%). Subclinical seizures were more common and mortality was higher for preterm than term neonates. These data underscore the importance of electroencephalographic monitoring and the potential for improved management in preterm neonates. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Metaphors among titles of medical publications: an observational study

    Philippa Mungra


    Full Text Available In this study, we attempted to determine the frequency and types of metaphors in a corpus of titles from a single medical journal collected over one year. The frequency of metaphor tokens (4.6% was highest among editorials and other opinion articles and consisted predominantly of primary metaphors, which require explanation using a visual, cultural or other physical vehicle. When the metaphor was used only in the title and not in the body of the text, as was common in letters to the editor or in editorials, the metaphor may constitute a para-textual device used for engaging the reader. Other metaphors among research article titles were present not only in the title, but also used repeatedly in the body of the text. Among these research articles, metaphors were frequently used to endow the focus words of the metaphor with a precise and meaningful significance which, when used repeatedly in the text, may constitute a mechanism by which sub-technical language or internal jargon may arise. Being syntactically simple but endowed with a high communicative import, titles as a text type may help improve academic literacy, among beginners.

  17. Quality of Parent-Adolescent Conversations About Sex and Adolescent Sexual Behavior: An Observational Study.

    Rogers, Adam A; Ha, Thao; Stormshak, Elizabeth A; Dishion, Thomas J


    Studies suggest that the quality of parent-adolescent communication about sex uniquely predicts adolescent sexual behavior. Previous studies have relied predominantly on self-report data. Observational methods, which are not susceptible to self-report biases, may be useful in examining the associations between the quality of parent-adolescent communication about sex and adolescent sexual behavior more objectively. With a sample of adolescents (N = 55, 58% male, 44% white, Mage = 15.8) and their parents, we used hierarchical logistic regression analyses to examine the associations between the observed quality of parent-adolescent communication about dating and sex and the likelihood of adolescents' sexual intercourse. The quality of parent-adolescent communication about dating and sex predicted sexual behavior. Specifically, lecturing was associated with a higher likelihood of adolescents having had sexual intercourse. The quality of parent-adolescent communication about sex is a unique correlate of adolescent sexual behavior and warrants further investigation. Thus, it serves as a potential target of preventive interventions that aim to foster adolescent sexual health behaviors. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  18. Prevention of congenital Chagas disease by Benznidazole treatment in reproductive-age women. An observational study.

    Álvarez, María G; Vigliano, Carlos; Lococo, Bruno; Bertocchi, Graciela; Viotti, Rodolfo


    Since the decline in new cases of infection by insect/vector, congenital Chagas disease has become more relevant in the transmission of Chagas disease. Treatment with benznidazole significantly reduces the parasitemia, which constitutes an important factor linked to vertical transmission. The objective of this study was to evaluate whether treatment with benznidazole previously administered to women of childbearing age can prevent or reduce the incidence of new cases of congenital Chagas disease. An historical cohort study that included all women in reproductive age (15-45 years) assisted in our center was designed. We included 67 mothers with chronic Chagas disease; 35 women had not been treated prior to pregnancy, 15 had been treated prior to pregnancy and 17 gave birth prior and after treatment with benznidazole. Eight mothers gave birth to 16 children with congenital Chagas disease (8/67, 12%). The prevalence of congenital Chagas was 16/114 (14%) children born to untreated mothers and 0/42 (0%) children born to benznidazole- treated mothers, p=0.01. No significant differences were observed in clinical, serologic, epidemiological or socioeconomic baseline variables between mothers with and without children born with congenital Chagas. A 32% conversion rate to negative serology was observed in benznidazole-treated women after long-term follow up. Antiparasitic treatment administered to women in reproductive age can prevent the occurrence of congenital Chagas disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Induced vaginal birth after previous caesarean section

    Akylbek Tussupkaliyev


    Full Text Available Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administration of E1 prostaglandin (Misoprostol, and intravenous infusion of Oxytocin-Richter. The assessment of rediness of parturient canals was conducted by Bishop’s score; the labour course was assessed by a partogram. The effectiveness of labour induction techniques was assessed by the number of administered doses, the time of onset of regular labour, the course of labour and the postpartum period and the presence of complications, and the course of the early neonatal period, which implied the assessment of the child’s condition, described in the newborn development record. The foetus was assessed by medical ultrasound and antenatal and intranatal cardiotocography (CTG. Obtained results were analysed with SAS statistical processing software. Results The overall percentage of successful births with intravaginal administration of Misoprostol was 93 per cent (83 of cases. This percentage was higher than in the amniotomy group (relative risk (RR 11.7 and was similar to the oxytocin group (RR 0.83. Amniotomy was effective in 54 per cent (39 of cases, when it induced regular labour. Intravenous oxytocin infusion was effective in 94 per cent (89 of cases. This percentage was higher than that with amniotomy (RR 12.5. Conclusions The success of vaginal delivery after previous Caesarean section can be achieved in almost 70 per cent of cases. At that, labour induction does not decrease this indicator and remains within population boundaries.

  20. Aortic replacement in aorto-occlusive disease: an observational study

    Winter Richard K


    Full Text Available Abstract Background For many patients with aorto-occlusive disease, where stent deployment is not possible, surgery remains the only treatment option available. The aim of this study was to assess the results of aortic reconstruction surgery performed in patients with critical ischaemia. Methods All patients with critical ischaemia undergoing surgery during 1991–2004 were identified from a prospectively maintained database. Mortality data was verified against death certificate data. Demographic and clinical data were obtained from the clinical notes and the radiology database. Disease was classified as: type I – limited to aorta and common iliac arteries; type II – external iliac disease and type III combined aortic, iliac and infra-inguinal disease. Results 86 patients underwent aortic replacement surgery all of whom had critical ischaemia consisting of: type I (n = 16; type II (n = 37 and type III (n = 33. The 30-day mortality rate was 10.4%, the one-year patient survival was 80%, and the 1-year graft survival was 80%. At 2 years the actual patient survival was 73% and no additional graft losses were identified. All patients surviving 30 days reported excellent symptomatic relief. Early, complications occurred in 6 (7% patients: thrombosis within diseased superficial femoral arteries (n = 4; haemorrhage and subsequent death (n = 2. Ten (14% late complications (> 12 months occurred in the 69 surviving patients and included: anastomotic stenosis (n = 3; graft thrombosis (n = 4, graft infection (n = 3. Four patients developed claudication as a result of more distal disease in the presence of a patent graft, and 1 patient who continued smoking required an amputation for progressive distal disease. Conclusion Aortic reconstruction for patients with extensive aorto-occlussive disease provides long-standing symptomatic relief for the majority of patients. After the first year, there is continued patient attrition due to co

  1. Primary care capitation payments in the UK. An observational study

    Beerstecher Hendrik J


    Full Text Available Abstract Background In 2004 an allocation formula for primary care services was introduced in England and Wales so practices would receive equitable pay. Modifications were made to this formula to enable local health authorities to pay practices. Similar pay formulae were introduced in Scotland and Northern Ireland, but these are unique to the country and therefore could not be included in this study. Objective To examine the extent to which the Global Sum, and modifications to the original formula, determine practice funding. Methods The allocation formula determines basic practice income, the Global Sum. We compared practice Global Sum entitlements using the original and the modified allocation formula calculations. Practices receive an income supplement if Global Sum payments were below historic income in 2004. We examined current overall funding levels to estimate what the effect will be when the income supplements are removed. Results Virtually every Welsh and English practice (97% received income supplements in 2004. Without the modifications to the formula only 72% of Welsh practices would have needed supplements. No appreciable change would have occurred in England. The formula modifications increased the Global Sum for 99.5% of English practices, while it reduced entitlement for every Welsh practice. In 2008 Welsh practices received approximately £6.15 (9% less funding per patient per year than an identical English practice. This deficit will increase to 11.2% when the Minimum Practice Income Guarantee is abolished. Conclusions Identical practices in different UK countries do not receive equitable pay. The pay method disadvantages Wales where the population is older and has higher health needs.

  2. Endotoxin Elimination in Patients with Septic Shock: An Observation Study.

    Adamik, Barbara; Zielinski, Stanislaw; Smiechowicz, Jakub; Kübler, Andrzej


    To evaluate the effectiveness of endotoxin elimination with an adsorption column in patients with septic shock and endotoxemia. The elimination therapy was guided by a new bedside method of measuring endotoxin activity (EA). Intensive care unit (ICU) patients with septic shock and suspected Gram-negative infection were consecutively added to the study group within the first 24 h. Endotoxin elimination was performed using hemoperfusion with the Alteco LPS Adsorber. The primary endpoint was improvement in organ function within the first 24 h of treatment. A secondary objective was to assess the usefulness of a new method of measuring EA to help guide endotoxin elimination therapy. Out of 64 patients 18 had a high baseline EA [0.70 EA units (0.66-0.77)]. Those patients had endotoxin elimination treatment in addition to conventional medical therapy. At 24 h after endotoxin elimination, the EA had decreased to 0.56 EA units (0.43-0.77), (p = 0.005); MAP increased from 69 (62-80) to 80 mm Hg (68-88), (p = 0.002), and noradrenaline use decreased from 0.28 (0.15-0.80) to 0.1 μg/kg/min (0.00-0.70) at the same time (p = 0.04). The SOFA score had decreased from 11 (9-15) to 9 (7-14) points 24 h after endotoxin elimination (p = 0.01) with a median delta SOFA -2 points. Endotoxin elimination did not have a significant effect on the ICU length of stay or ICU mortality. Effective endotoxin elimination resulted in a significant improvement in hemodynamic parameters and of organ function. The application of the EA assay was useful for the bedside monitoring of endotoxemia in critically ill ICU patients.

  3. Surgery of intracranial aneurysms previously treated endovascularly.

    Tirakotai, Wuttipong; Sure, Ulrich; Yin, Yuhua; Benes, Ludwig; Schulte, Dirk Michael; Bien, Siegfried; Bertalanffy, Helmut


    To perform a retrospective study on the patients who underwent aneurysmal surgery following endovascular treatment. We performed a retrospective study on eight patients who underwent aneurysmal surgery following endovascular treatment (-attempts) with gugliemi detachable coils (GDCs). The indications for surgery, surgical techniques and clinical outcomes were analyzed. The indications for surgical treatment after GDC coiling of aneurysm were classified into three groups. First group: surgery of incompletely coiled aneurysms (n=4). Second group: surgery of mass effect on the neural structures due to coil compaction or rebleeding (n=2). Third group: surgery of vascular complications after endovascular procedure due to parent artery occlusion or thrombus propagation from aneurysm (n=2). Aneurysm obliterations could be performed in all cases confirmed by postoperative angiography. Six patients had an excellent outcome and returned to their profession. Patient's visual acuity was improved. One individual experienced right hemiparesis (grade IV/V) and hemihypesthesia. Microsurgical clipping is rarely necessary for previously coiled aneurysms. Surgical treatment is uncommonly required when an acute complication arises during endovascular treatment, or when there is a dynamic change of a residual aneurysm configuration over time that is considered to be insecure.

  4. Cost-effectiveness of recurrence risk guided care versus care as usual in women who suffered from early-onset preeclampsia including HELLP syndrome in their previous pregnancy (the PreCare study

    de Wit-Zuurendonk Laura D


    Full Text Available Abstract Background Preeclampsia and HELLP syndrome may have serious consequences for both mother and fetus. Women who have suffered from preeclampsia or the HELLP syndrome, have an increased risk of developing preeclampsia in a subsequent pregnancy. However, most women will develop no or only minor complications. In this study, we intend to determine cost-effectiveness of recurrence risk guided care versus care as usual in pregnant women with a history of early-onset preeclampsia. Methods/design We developed a prediction model to estimate the individual risk of recurrence of early-onset preeclampsia and the HELLP syndrome. In a before-after study, pregnant women with preeclampsia or HELLP syndrome in their previous pregnancy receiving care as usual (before introduction of the prediction model will be compared with women receiving recurrence risk guided care (after introduction of the prediction model. Eligible and pregnant women will be recruited at six university hospitals and seven large non-university tertiary referral hospitals in the Netherlands. The primary outcome measure is the recurrence of early-onset preeclampsia or HELLP syndrome in women allocated to the regular monitoring group. For the economic evaluation, a modelling approach will be used. Costs and effects of recurrence risk guided care with those of care as usual will be compared by means of a decision model. Two incremental cost-effectiveness ratios will be calculated: 1 cost per Quality Adjusted Life Year (mother unit of analysis and 2 cost per live born child (child unit of analysis. Discussion This is, to our knowledge, the first study that evaluates prospectively the efficacy of a multivariable prediction rule for recurrent hypertensive disease in pregnancy. Results of this study could either be integrated into the current guideline on Hypertensive Disorders in Pregnancy, or be used to develop a new guideline.

  5. Rates of induced abortion in Denmark according to age, previous births and previous abortions

    Marie-Louise H. Hansen


    Full Text Available Background: Whereas the effects of various socio-demographic determinants on a woman's risk of having an abortion are relatively well-documented, less attention has been given to the effect of previous abortions and births. Objective: To study the effect of previous abortions and births on Danish women's risk of an abortion, in addition to a number of demographic and personal characteristics. Data and methods: From the Fertility of Women and Couples Dataset we obtained data on the number of live births and induced abortions by year (1981-2001, age (16-39, county of residence and marital status. Logistic regression analysis was used to estimate the influence of the explanatory variables on the probability of having an abortion in a relevant year. Main findings and conclusion: A woman's risk of having an abortion increases with the number of previous births and previous abortions. Some interactions were was found in the way a woman's risk of abortion varies with calendar year, age and parity. The risk of an abortion for women with no children decreases while the risk of an abortion for women with children increases over time. Furthermore, the risk of an abortion decreases with age, but relatively more so for women with children compared to childless women. Trends for teenagers are discussed in a separate section.

  6. Nutritional status and clinical outcome of children on continuous renal replacement therapy: a prospective observational study

    Castillo Ana


    Full Text Available Abstract Background No studies on continuous renal replacement therapy (CRRT have analyzed nutritional status in children. The objective of this study was to assess the association between mortality and nutritional status of children receiving CRRT. Methods Prospective observational study to analyze the nutritional status of children receiving CRRT and its association with mortality. The variables recorded were age, weight, sex, diagnosis, albumin, creatinine, urea, uric acid, severity of illness scores, CRRT-related complications, duration of admission to the pediatric intensive care unit, and mortality. Results The sample comprised 174 critically ill children on CRRT. The median weight of the patients was 10 kg, 35% were under percentile (P 3, and 56% had a weight/P50 ratio of less than 0.85. Only two patients were above P95. The mean age for patients under P3 was significantly lower than that of the other patients (p = 0.03. The incidence of weight under P3 was greater in younger children (p = 0.007 and in cardiac patients and in those who had previous chronic renal insufficiency (p = 0.047. The mortality analysis did not include patients with pre-existing renal disease. Mortality was 38.9%. Mortality for patients with weight P3 (51% vs 33%; p = 0.037. In the univariate and multivariate logistic regression analyses, the only factor associated with mortality was protein-energy wasting (malnutrition (OR, 2.11; 95% CI, 1.067-4.173; p = 0.032. Conclusions The frequency of protein-energy wasting in children who require CRRT is high, and the frequency of obesity is low. Protein-energy wasting is more frequent in children with previous end-stage renal disease and heart disease. Underweight children present a higher mortality rate than patients with normal body weight.

  7. The association of DNA Repair with breast cancer risk in women. A comparative observational study

    Matta Jaime


    Full Text Available Abstract Background Previous studies have found a link between a low DNA repair capacity (DRC level and increased cancer risk. Our aim was to assess the statistical association of DRC level and breast cancer (BC using a case–control epidemiological study in a Hispanic community. Methods We conducted a comparative observational study to assess the validity of DRC in detecting BC in 824 women throughout Puerto Rico. Over a 6-year period, we compared 285 women newly diagnosed with BC to 539 without BC. DRC levels were measured in lymphocytes by means of a host-cell reactivation assay. We assessed the sensitivity, specificity, and association using the receiver operating characteristic curve analysis. Multiple logistic regression-adjusted odds ratios were estimated with 95% confidence level to measure the strength of the association of DRC and BC after adjusting for all confounders simultaneously. Results Compared to women without cancer, women with BC showed an average decrease of 60% in their DRC levels (p p Conclusions Our results support the usefulness of DRC level as a measure of BC risk. Additional studies in other populations are needed to further verify its usefulness.

  8. Improved staff procedure skills lead to improved managment skills: an observational study in an educational setting.

    Rüter, Anders; Vikstrom, Tore


    Good staff procedure skills in a management group during incidents and disasters are believed to be a prerequisite for good management of the situation. However, this has not been demonstrated scientifically. Templates for evaluation results from performance indicators during simulation exercises have previously been tested. The aim of this study was to demonstrate the possibility that these indicators can be used as a tool for studying the relationship between good management skills and good staff procedure skills. Good and structured work (staff procedure skills) in a hospital management group during simulation exercises in disaster medicine is related to good and timely decisions (good management skills). Results from 29 consecutive simulation exercises in which staff procedure skills and management skills were evaluated using quantitative measurements were included. The statistical analysis method used was simple linear regression with staff procedure skills as the response variable and management skills as the predictor variable. An overall significant relationship was identified between staff procedure skills and management skills (p(2)0.05). This study suggests that there is a relationship between staff procedure skills and management skills in the educational setting used. Future studies are needed to demonstrate if this also can be observed during actual incidents.

  9. Measurement errors in polymerase chain reaction are a confounding factor for a correct interpretation of 5-HTTLPR polymorphism effects on lifelong premature ejaculation: a critical analysis of a previously published meta-analysis of six studies.

    Paddy K C Janssen

    Full Text Available OBJECTIVE: To analyze a recently published meta-analysis of six studies on 5-HTTLPR polymorphism and lifelong premature ejaculation (PE. METHODS: Calculation of fraction observed and expected genotype frequencies and Hardy Weinberg equilibrium (HWE of cases and controls. LL,SL and SS genotype frequencies of patients were subtracted from genotype frequencies of an ideal population (LL25%, SL50%, SS25%, p = 1 for HWE. Analysis of PCRs of six studies and re-analysis of the analysis and Odds ratios (ORs reported in the recently published meta-analysis. RESULTS: Three studies deviated from HWE in patients and one study deviated from HWE in controls. In three studies in-HWE the mean deviation of genotype frequencies from a theoretical population not-deviating from HWE was small: LL(1.7%, SL(-2.3%, SS(0.6%. In three studies not-in-HWE the mean deviation of genotype frequencies was high: LL(-3.3%, SL(-18.5% and SS(21.8% with very low percentage SL genotype concurrent with very high percentage SS genotype. The most serious PCR deviations were reported in the three not-in-HWE studies. The three in-HWE studies had normal OR. In contrast, the three not-in-HWE studies had a low OR. CONCLUSIONS: In three studies not-in-HWE and with very low OR, inadequate PCR analysis and/or inadequate interpretation of its gel electrophoresis resulted in very low SL and a resulting shift to very high SS genotype frequency outcome. Consequently, PCRs of these three studies are not reliable. Failure to note the inadequacy of PCR tests makes such PCRs a confounding factor in clinical interpretation of genetic studies. Currently, a meta-analysis can only be performed on three studies-in-HWE. However, based on the three studies-in-HWE with OR of about 1 there is not any indication that in men with lifelong PE the frequency of LL,SL and SS genotype deviates from the general male population and/or that the SL or SS genotype is in any way associated with lifelong PE.

  10. Poor quality of reporting confounding bias in observational intervention studies : a systematic review

    Groenwold, Rolf H H; Van Deursen, Anna M M; Hoes, Arno W; Hak, Eelko


    PURPOSE: To systematically review observational studies on medical interventions to determine the quality of reporting of confounding. METHODS: Articles on observational studies on medical interventions in five general medical journals and five epidemiological journals published between January 2004

  11. Poor quality of reporting confounding bias in observational intervention studies : a systematic review

    Groenwold, Rolf H H; Van Deursen, Anna M M; Hoes, Arno W; Hak, Eelko


    PURPOSE: To systematically review observational studies on medical interventions to determine the quality of reporting of confounding. METHODS: Articles on observational studies on medical interventions in five general medical journals and five epidemiological journals published between January 2004

  12. Accretion dynamics and disk evolution in NGC 2264: a study based on the Corot photometric observations

    Alencar, S H P; Guimaraes, M M; McGinnis, P T; Gameiro, J F; Bouvier, J; Aigrain, S; Flaccomio, E; Favata, F


    The young cluster NGC 2264 was observed with the Corot satellite for 23 days uninterruptedly in March 2008 with unprecedent photometric accuracy. We present here the first results of the analysis of the accreting population. We intended to look for possible light curve variability of the same nature as that observed in the classical T Tauri star AA Tau, which was attributed to a magnetically controlled inner disk warp, which is directly associated with the interaction between the stellar magnetic field and the inner disk region. We analysed the Corot light curves of 83 previously known classical T Tauri stars that belong to NGC 2264 and classified them according to their morphology. We also studied the Corot light curve morphology as a function of a Spitzer-based classification of the star-disk systems. The classification derived on the basis of the Corot light curve morphology agrees very well with the Spitzer IRAC-based classification of the systems. The percentage of AA Tau-like light curves decreases as t...

  13. A school-based program implemented by community providers previously trained for the prevention of eating and weight-related problems in secondary-school adolescents: the MABIC study protocol.

    Sánchez-Carracedo, David; López-Guimerà, Gemma; Fauquet, Jordi; Barrada, Juan Ramón; Pàmias, Montserrat; Puntí, Joaquim; Querol, Mireia; Trepat, Esther


    The prevention of eating disorders and disordered eating are increasingly recognized as public health priorities. Challenges in this field included moving from efficacy to effectiveness and developing an integrated approach to the prevention of a broad spectrum of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. The main aim of this effectiveness trial protocol is to test whether this program has effects when incorporating an integrated approach to prevention and when previously-trained community providers implement the intervention. The research design involved a multi-center non-randomized controlled trial with baseline, post and 1-year follow-up measures. Six schools from the city of Sabadell (close to Barcelona) participated in the intervention group, and eleven schools from four towns neighboring Sabadell participated in the control group. A total of 174 girls and 180 boys in the intervention group, and 484 girls and 490 boys in the control group were registered in class lists prior to baseline. A total of 18 community providers, secondary-school class tutors, nurses from the Catalan Government's Health and School Program, and health promotion technicians from Sabadell City Council were trained and delivered the program. Shared risk factors of eating and weight-related problems were assessed as main measures. It will be vital for progress in disordered eating prevention to conduct effectiveness trials, which test whether interventions are effective when delivered by community providers under ecologically valid conditions, as opposed to tightly controlled research trials. The MABIC project will provide new contributions in this transition from efficacy

  14. 机采血小板检测前过程质量控制的研究%A study on quality control of previous process of apheresis platelets detection

    杨图深; 朱业华; 陈亦明


    目的:探讨机采血小板检测前过程的质量控制。方法留取机采单份血小板、机采双份血小板样本各100份,以1∶1、1∶3及1∶7稀释度进行稀释,采用全自动血液细胞计数仪检测血小板计数。另采集机采血小板样本100份,室温下静置0、30、60、90、120 min ,以1∶3稀释后,检测其血小板计数。结果机采单份或双份血小板样本以1∶1与1∶3稀释后检测血小板计数的差异及1∶3与1∶7稀释后检测的差异均有统计学意义( P<0.05)。静置0、30 min检测的血小板计数与静置60、90、120 min的检测值的差异有统计学意义(P<0.05)。结论机采血小板检测前过程的质量控制对采集后的血小板计数十分重要。%Objective To study the quality control of previous process of apheresis platelets detection .Methods Single and double apheresis platelets each of 100 samples were collected and were diluted 1∶1 ,1∶3 and 1∶7 .Aautomatic Blood Cell Count-er was employed to detect the platelet count .Another 100 samples of apheresis platelets were collected and stand at room tempera-ture for 0 ,30 ,60 ,90 ,120 min ,After 1∶3 dilution ,the platelet counts were detected .Results Differences of platelet counts be-tween 1∶1 and 1∶3 dilution ,1∶3 and 1∶7 dilution of single or double apheresis platelets showed statistically significant differ-ences(P<0 .05) .Differences of platelet counts between standing for 0 ,30 min and standing for 60 ,90 ,120 min were found statis-tically significant(P<0 .05) .Conclusion Quality control of previous process of apheresis platelets detection is very important for platelet count after collection .

  15. Sebacinales everywhere: previously overlooked ubiquitous fungal endophytes.

    Weiss, Michael; Sýkorová, Zuzana; Garnica, Sigisfredo; Riess, Kai; Martos, Florent; Krause, Cornelia; Oberwinkler, Franz; Bauer, Robert; Redecker, Dirk


    Inconspicuous basidiomycetes from the order Sebacinales are known to be involved in a puzzling variety of mutualistic plant-fungal symbioses (mycorrhizae), which presumably involve transport of mineral nutrients. Recently a few members of this fungal order not fitting this definition and commonly referred to as 'endophytes' have raised considerable interest by their ability to enhance plant growth and to increase resistance of their host plants against abiotic stress factors and fungal pathogens. Using DNA-based detection and electron microscopy, we show that Sebacinales are not only extremely versatile in their mycorrhizal associations, but are also almost universally present as symptomless endophytes. They occurred in field specimens of bryophytes, pteridophytes and all families of herbaceous angiosperms we investigated, including liverworts, wheat, maize, and the non-mycorrhizal model plant Arabidopsis thaliana. They were present in all habitats we studied on four continents. We even detected these fungi in herbarium specimens originating from pioneering field trips to North Africa in the 1830s/40s. No geographical or host patterns were detected. Our data suggest that the multitude of mycorrhizal interactions in Sebacinales may have arisen from an ancestral endophytic habit by specialization. Considering their proven beneficial influence on plant growth and their ubiquity, endophytic Sebacinales may be a previously unrecognized universal hidden force in plant ecosystems.

  16. Sebacinales everywhere: previously overlooked ubiquitous fungal endophytes.

    Michael Weiss

    Full Text Available Inconspicuous basidiomycetes from the order Sebacinales are known to be involved in a puzzling variety of mutualistic plant-fungal symbioses (mycorrhizae, which presumably involve transport of mineral nutrients. Recently a few members of this fungal order not fitting this definition and commonly referred to as 'endophytes' have raised considerable interest by their ability to enhance plant growth and to increase resistance of their host plants against abiotic stress factors and fungal pathogens. Using DNA-based detection and electron microscopy, we show that Sebacinales are not only extremely versatile in their mycorrhizal associations, but are also almost universally present as symptomless endophytes. They occurred in field specimens of bryophytes, pteridophytes and all families of herbaceous angiosperms we investigated, including liverworts, wheat, maize, and the non-mycorrhizal model plant Arabidopsis thaliana. They were present in all habitats we studied on four continents. We even detected these fungi in herbarium specimens originating from pioneering field trips to North Africa in the 1830s/40s. No geographical or host patterns were detected. Our data suggest that the multitude of mycorrhizal interactions in Sebacinales may have arisen from an ancestral endophytic habit by specialization. Considering their proven beneficial influence on plant growth and their ubiquity, endophytic Sebacinales may be a previously unrecognized universal hidden force in plant ecosystems.

  17. A previously undescribed pathway for pyrimidine catabolism.

    Loh, Kevin D; Gyaneshwar, Prasad; Markenscoff Papadimitriou, Eirene; Fong, Rebecca; Kim, Kwang-Seo; Parales, Rebecca; Zhou, Zhongrui; Inwood, William; Kustu, Sydney


    The b1012 operon of Escherichia coli K-12, which is composed of seven unidentified ORFs, is one of the most highly expressed operons under control of nitrogen regulatory protein C. Examination of strains with lesions in this operon on Biolog Phenotype MicroArray (PM3) plates and subsequent growth tests indicated that they failed to use uridine or uracil as the sole nitrogen source and that the parental strain could use them at room temperature but not at 37 degrees C. A strain carrying an ntrB(Con) mutation, which elevates transcription of genes under nitrogen regulatory protein C control, could also grow on thymidine as the sole nitrogen source, whereas strains with lesions in the b1012 operon could not. Growth-yield experiments indicated that both nitrogens of uridine and thymidine were available. Studies with [(14)C]uridine indicated that a three-carbon waste product from the pyrimidine ring was excreted. After trimethylsilylation and gas chromatography, the waste product was identified by mass spectrometry as 3-hydroxypropionic acid. In agreement with this finding, 2-methyl-3-hydroxypropionic acid was released from thymidine. Both the number of available nitrogens and the waste products distinguished the pathway encoded by the b1012 operon from pyrimidine catabolic pathways described previously. We propose that the genes of this operon be named rutA-G for pyrimidine utilization. The product of the divergently transcribed gene, b1013, is a tetracycline repressor family regulator that controls transcription of the b1012 operon negatively.


    S. Yu. Martsevich


    Full Text Available Aim. To evaluate drug therapy received by patients who had survived acute myocardial infarction (AMI in the framework of the AMI register (the “LIS” study and estimate this therapy influence on long-term outcomes of the disease. Material and methods. The total of 961 patients of 1133 enrolled in the “LIS” study , were discharged from hospital. 191 patients had died during follow-up. 632 patients (who had survived and consented to visit out-patient clinic underwent repeated examination (median of follow-up 1.6 [1.0; 2.4] years. Data about treatment before and during AMI were received from patient’s charts; data about treatment after AMI were obtained from out-patient medical records. Results. Before reference AMI only a small number of the patients received the main drug groups (antiplatelet agents, β-blockers, ACE inhibitors, statins, at that ACE inhibitors were prescribed more often than the others. Use of β-blockers and ACE inhibitors before reference AMI significantly improved long-term life prognosis [relative risk (RR 0.70 and 0.66, respectively]. Rate of the main drug groups prescribed in hospital was rather high with the exception of thrombolytics (less than 10%. Thrombolytics, β-blockers and antiplatelet agents prescribed in hospital significantly improved long-term life prognosis of patients (RR 0.42, 0.65 and 0.58 respectively. At the second visit (according to data of out-patient medical records rate of antiplatelet agents, ACE inhibitors, β-blockers and statins prescription exceeded 60%. Conclusion. Very low prevalence of adequate drug therapy preceding AMI determines high mortality rate among survived acute stage of myocardial infarction patients in long-term period.


    S. Yu. Martsevich


    Full Text Available Aim. To evaluate drug therapy received by patients who had survived acute myocardial infarction (AMI in the framework of the AMI register (the “LIS” study and estimate this therapy influence on long-term outcomes of the disease. Material and methods. The total of 961 patients of 1133 enrolled in the “LIS” study , were discharged from hospital. 191 patients had died during follow-up. 632 patients (who had survived and consented to visit out-patient clinic underwent repeated examination (median of follow-up 1.6 [1.0; 2.4] years. Data about treatment before and during AMI were received from patient’s charts; data about treatment after AMI were obtained from out-patient medical records. Results. Before reference AMI only a small number of the patients received the main drug groups (antiplatelet agents, β-blockers, ACE inhibitors, statins, at that ACE inhibitors were prescribed more often than the others. Use of β-blockers and ACE inhibitors before reference AMI significantly improved long-term life prognosis [relative risk (RR 0.70 and 0.66, respectively]. Rate of the main drug groups prescribed in hospital was rather high with the exception of thrombolytics (less than 10%. Thrombolytics, β-blockers and antiplatelet agents prescribed in hospital significantly improved long-term life prognosis of patients (RR 0.42, 0.65 and 0.58 respectively. At the second visit (according to data of out-patient medical records rate of antiplatelet agents, ACE inhibitors, β-blockers and statins prescription exceeded 60%. Conclusion. Very low prevalence of adequate drug therapy preceding AMI determines high mortality rate among survived acute stage of myocardial infarction patients in long-term period.

  20. The Asthma Mobile Health Study, a large-scale clinical observational study using ResearchKit.

    Chan, Yu-Feng Yvonne; Wang, Pei; Rogers, Linda; Tignor, Nicole; Zweig, Micol; Hershman, Steven G; Genes, Nicholas; Scott, Erick R; Krock, Eric; Badgeley, Marcus; Edgar, Ron; Violante, Samantha; Wright, Rosalind; Powell, Charles A; Dudley, Joel T; Schadt, Eric E


    The feasibility of using mobile health applications to conduct observational clinical studies requires rigorous validation. Here, we report initial findings from the Asthma Mobile Health Study, a research study, including recruitment, consent, and enrollment, conducted entirely remotely by smartphone. We achieved secure bidirectional data flow between investigators and 7,593 participants from across the United States, including many with severe asthma. Our platform enabled prospective collection of longitudinal, multidimensional data (e.g., surveys, devices, geolocation, and air quality) in a subset of users over the 6-month study period. Consistent trending and correlation of interrelated variables support the quality of data obtained via this method. We detected increased reporting of asthma symptoms in regions affected by heat, pollen, and wildfires. Potential challenges with this technology include selection bias, low retention rates, reporting bias, and data security. These issues require attention to realize the full potential of mobile platforms in research and patient care.

  1. The Southern Argentina Agile Meteor Radar (SAAMER): Platform for comprehensive meteor radar observations and studies

    Janches, D.; Hormaechea, J.; Pifko, S.; Hocking, W.; Fritts, D.; Brunini, C.; Close, S.; Michell, R.; Samara, M.


    The Southern Argentina Agile Meteor Radar (SAAMER) is a new generation system deployed in Rio Grande, Tierra del Fuego, Argentina (53^oS) in May 2008 (Janches et al., 2013,2014). SAAMER transmits 10 times more power than regular meteor radars, and uses a newly developed transmitting array, which focuses power upward instead of the traditional single-antenna-all-sky configuration. The system is configured such that the transmitter array can also be utilized as a receiver. The new design greatly increases the sensitivity of the radar enabling the detection of large numbers of particles at low zenith angles. The more concentrated transmitted power enables additional meteor studies besides those typical of these systems based on the detection of specular reflections, such as routine detections of head echoes and non-specular trails, previously only possible with High Power and Large Aperture radars (Janches et al., 2014). In August 2010, SAAMER was upgraded to a system capable to determine meteoroid orbital parameters. This was achieved by adding two remote receiving stations approximately 10 km away from the main site in near perpendicular directions (Pifko et al., 2014). The upgrade significantly expands the science that is achieved with this new radar enabling us to study the orbital properties of the interplanetary dust environment. Because of the unique geographical location, the SAAMER allows for additional inter-hemispheric comparison with measurements from Canadian Meteor Orbit Radar, which is geographically conjugate. Initial surveys show, for example, that SAAMER observes a very strong contribution of the South Toroidal Sporadic meteor source (Pifko et al., 2014), of which limited observational data is available. In addition, SAAMER offers similar unique capabilities for meteor showers and streams studies given the range of ecliptic latitudes that the system enables to survey (Janches et al., 2013). It can effectively observe radiants from the ecliptic south

  2. Observational study of safety and efficacy of varenicline for smoking cessation among Filipino smokers.

    Park, Peter W; Casiano, Errol M; Escoto, Laarni; Claveria, Angelica M


    Varenicline, an α4β2 receptor nicotinic receptor partial agonist, is known to be an effective aid for smoking cessation. To date, few observational studies of varenicline have been conducted. This prospective, non-interventional, post-marketing surveillance study (NCT00794365) was designed to monitor the efficacy and safety of varenicline for 12 weeks in Filipino smokers who were motivated to quit. This study was conducted between July 2, 2008, and November 23, 2009, in 70 centers throughout the Philippines. Participants were adult smokers who were prescribed varenicline (0.5 mg orally once daily, days 1 to 3; 0.5 mg twice daily, days 4 to 7; 1 mg twice daily for the remainder of a 12-week treatment period) for the first time. Participants made five clinic visits (weeks 0, 1, 4, 8, and 12). Adverse events (AEs) were recorded at each clinic visit and up to 28 days after administration of the last study treatment. Seven-day point prevalence of smoking cessation was measured at weeks 4, 8, and 12. A total of 330 participants were enrolled into the study, of whom 251 (76.1%) completed the study. At the end of week 12, 57.6% (95% confidence interval, 52.0, 63.0) of participants had been abstinent for the previous 7 days. The most frequently reported AEs were headache (5.5%), dizziness (3.9%), and nausea (3.6%). Ten participants (3.0%) permanently discontinued varenicline treatment due to AEs, and 13 (3.9%) reduced their varenicline dose or discontinued treatment temporarily due to AEs. There were no reports of any serious AEs, deaths, suicidal ideation, or behavior. The results of this study in adult Filipino smokers prescribed varenicline for the first time during routine clinical practice demonstrate that varenicline was well tolerated and efficacious as an aid for smoking cessation.

  3. First Light Observations from the International Study of Astronomy Reasoning (ISTAR) Database

    Tatge, Coty B.; Slater, Stephanie; Slater, Timothy F.; Bretones, Paulo S.; McKinnon, David; Schleigh, Sharon


    During the period between Fall 2014 and Summer 2015, the International Astronomical Union reorganized its structure to include the IAU Working Group on Theory and Methods in Astronomy Education. The initial goals of that working group are 1) promoting Astronomy Education Research (AER) by adopting the international collaboration model used by astronomy researchers, 2) fostering international astronomy education and AER capacity through the development of networks, training and shared resources, and 3) improving astronomy education by describing research based approaches to the teaching and learning of astronomy. In support of those efforts, the working group began a collaboration with the Center for Astronomy & Physics Education Research to develop the International Study of Astronomy Reasoning (ISTAR) Database, an online, searchable research tool, intended to catalog, characterize, and provide access to all known astronomy education research production, world-wide. Beginning in the Summer of 2015, a test of ISTAR's functionality began with a survey of a previously uncatalogued set of test objects: U.S.-based doctoral dissertations and masters. This target population was selected for its familiarity to the ISTAR developers, and for its small expected sample size (50-75 objects). First light observations indicated that the sample exceeded 300 dissertation objects. These objects were characterized across multiple variables, including: year of production, document source, type of resource, empirical methodology, context, informal setting type, research construct, type of research subject, scientific content, language, and nation of production. These initial observations provide motivation to extend this project to observe masters levels thesis, which are anticipated to be ten times more numerous as doctoral dissertations, other peer-reviewed contributions, contributions from the larger international community.

  4. Learning Curves Among All Patients Undergoing Transcatheter Aortic Valve Implantation in Germany: A Retrospective Observational Study.

    Kaier, Klaus; Reinecke, Holger; Schmoor, Claudia; Frankenstein, Lutz; Vach, Werner; Hehn, Philip; Zirlik, Andreas; Bode, Christoph; Zehender, Manfred; Reinöhl, Jochen


    Transcatheter aortic valve implantation (TAVI) is a rapidly evolving technique for therapy of aortic stenosis. Previous studies report learning curves with respect to in-hospital mortality and clinical complications. We aim to determine whether observed improvements of in-hospital outcomes after TAVI are the result of improvements in procedures or due to a change in the patient population, and whether improvements differ between the transfemoral (TF) and the transapical (TA) approach. Data was analyzed using risk-adjusted regression analyses in order to track the development of clinical outcomes of all isolated TAVI procedures performed in Germany from 2008 to 2013 (N=32.436) in all German hospitals performing TAVI. Measurements include in-hospital mortality, stroke, bleeding, and mechanical ventilation. Unadjusted mortality rates decrease over time for both TA-TAVI and TF-TAVI. Reductions in mortality were smaller for TA-TAVI than for TF-TAVI. These trends could also be observed for risk-adjusted (standardized) mortality rates, indicating that time trends and differences between TA-TAVI (around 7% in 2013) and TF-TAVI (around 4% in 2013) cannot be explained by changes in the risk factor composition of the patient populations. Bleeding complications decreased for both access routes. Both unadjusted and standardized bleeding rates were substantially higher for TA-TAVI. In addition, TA-TAVI procedures were associated with an increased likelihood of requiring >48h of mechanical ventilation. Observed improvements in TAVI-related in-hospital mortality are not due to a change in patient population. The results indicate the superiority of a TF-first approach. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  5. The reporting of statistics in medical educational studies: an observational study

    Desbiens Norman A


    Full Text Available Abstract Background There is confusion in the medical literature as to whether statistics should be reported in survey studies that query an entire population, as is often done in educational studies. Our objective was to determine how often statistical tests have been reported in such articles in two prominent journals that publish these types of studies. Methods For this observational study, we used electronic searching to identify all survey studies published in Academic Medicine and the Journal of General Internal Medicine in which an entire population was studied. We tallied whether inferential statistics were used and whether p-values were reported. Results Eighty-four articles were found: 62 in Academic Medicine and 22 in the Journal of General Internal Medicine. Overall, 38 (45% of the articles reported or stated that they calculated statistics: 35% in Academic Medicine and 73% in the Journal of General Internal Medicine. Conclusion Educational enumeration surveys frequently report statistical tests. Until a better case can be made for doing so, a simple rule can be proffered to researchers. When studying an entire population (e.g., all program directors, all deans, and all medical schools for factual information, do not perform statistical tests. Reporting percentages is sufficient and proper.

  6. "Radiative Closure Studies for Clear Skies During the ARM 2003 Aerosol Intensive Observation Period"

    J. J. Michalsky, G. P. Anderson, J. Barnard, J. Delamere, C. Gueymard, S. Kato, P. Kiedron, A. McComiskey, and P. Ricchiazzi


    The Department of Energy's Atmospheric Radiation Measurement (ARM) program sponsored a large intensive observation period (IOP) to study aerosol during the month of May 2003 around the Southern Great Plains (SGP) Climate Research Facility (CRF) in north central Oklahoma. Redundant measurements of aerosol optical properties were made using different techniques at the surface as well as in vertical profile with sensors aboard two aircraft. One of the principal motivations for this experiment was to resolve the disagreement between models and measurements of diffuse horizontal broadband shortwave irradiance at the surface, especially for modest aerosol loading. This paper focuses on using the redundant aerosol and radiation measurements during this IOP to compare direct beam and diffuse horizontal broadband shortwave irradiance measurements and models at the surface for a wide range of aerosol cases that occurred during 30 clear-sky periods on 13 days of May 2003. Models and measurements are compared over a large range of solar-zenith angles. Six different models are used to assess the relative agreement among them and the measurements. Better agreement than previously achieved appears to be the result of better specification of input parameters and better measurements of irradiances than in prior studies. Biases between modeled and measured direct irradiances are less than 1%, and biases between modeled and measured diffuse irradiances are less than 2%.

  7. Observational Study on the Occurrence of Muscle Spindles in Human Digastric and Mylohyoideus Muscles

    Daniele Saverino


    Full Text Available Although the occurrence of muscle spindles (MS is quite high in most skeletal muscles of humans, few MS, or even absence, have been reported in digastric and mylohyoideus muscles. Even if this condition is generally accepted and quoted in many papers and books, observational studies are scarce and based on histological sections of a low number of specimens. The aim of the present study is to confirm previous data, assessing MS number in a sample of digastric and mylohyoideus muscles. We investigated 11 digastric and 6 mylohyoideus muscles from 13 donors. Muscle samples were embedded in paraffin wax, cross-sectioned in a rostrocaudal direction, and stained using haematoxylin-eosin. A mean of 5.1 ± 1.1 (range 3–7 MS was found in digastric muscles and mean of 0.5 ± 0.8 (range 0–2 in mylohyoideus muscles. A significant difference (P<0.001 was found with the control sample, confirming the correctness of the histological procedure. Our results support general belief that the absolute number of spindles is sparse in digastric and mylohyoideus muscles. External forces, such as food resistance during chewing or gravity, do not counteract jaw-opening muscles. It is conceivable that this condition gives them a limited proprioceptive importance and a reduced need for having specific receptors as MS.

  8. Observational study of Arctium lappa in the treatment of acne vulgaris.

    Miglani, Anjali; Manchanda, Raj K


    Arctium lappa (Lappa) is used in traditional Western and Chinese medicine for acne. It is mentioned in homeopathic literature for acne, but its effect has not previously been evaluated. To determine the effectiveness of homeopathic medicine Lappa in treatment of acne vulgaris. An uncontrolled observational interventional study was conducted on human subjects who fulfilled the inclusion criteria and gave written informed consent. Lappa was prescribed in potencies starting from 6c rising to 1M as required, over a period of 6 months. Objective assessment was change in acne lesion counts supplemented with Global Acne Grading System (GAGS) and subjective assessment by using Acne-Specific Quality of Life questionnaire (Acne-QoL). Out of 34 human subjects, 32 completed the follow-up. Statistical significant results were seen in lesion counts, GAGS and Acne-QoL score (p value Lappa has shown positive effects in the treatment of acne especially of inflammatory type. Further controlled, randomized studies with larger sample size are desirable. Trial is registered at Identifier: NCT01040390. Copyright © 2013 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  9. Study of subaqueous melting of Store Glacier, West Greenland using ocean observations and numerical simulations

    Xu, Y.; Rignot, E. J.; Menemenlis, D.; van den Broeke, M. R.


    Ice discharge from the Greenland Ice Sheet is mainly through tidewater glaciers that terminate in the ocean and melt in contact with ocean waters. Subaqueous melting at the calving front is a direct mechanism for mass loss and a potential trigger for glacier acceleration. We present an analysis of oceanographic data collected in the fjord of Store Glacier, West Greenland during August 2010 and 2012. Using these data, we calculate the subaqueous melt rates. Independently, we employ the Massachusetts Institute of Technology general circulation model (MITgcm), modified to include melting at the calving front and outflow of subglacial water to model the ice melt rates of Store Glacier. Previous 2-D sensitivity studies showed that the subaqueous melt rate reaches several meters per day during the summer, increases non-linearly with subglacial runoff and linearly with ocean thermal forcing, and ceases when subglacial discharge is off during winter. We present new 3-D simulations at very high resolution, with measured oceanic temperature/salinity as boundary conditions, and subglacial runoff from the University of Utrecht's Regional Atmospheric Climate Model outputs on different years and seasons. We compare the ocean observations and numerical simulations and discuss the seasonal and inter-annual variations of subaqueous melting. This study helps evaluate the impact of the ocean on the subaqueous melting of Greenland tidewater glaciers and in turn on glacier mass balance. This work was carried out at University of California, Irvine and at the Jet Propulsion Laboratory under contract with NASA Cryosphere Science Program.

  10. Dynamic Measurement of Hemodynamic Parameters and Cardiac Preload in Adults with Dengue: A Prospective Observational Study.

    Vipa Thanachartwet

    Full Text Available Few previous studies have monitored hemodynamic parameters to determine the physiological process of dengue or examined inferior vena cava (IVC parameters to assess cardiac preload during the clinical phase of dengue. From January 2013 to July 2015, we prospectively studied 162 hospitalized adults with confirmed dengue viral infection using non-invasive cardiac output monitoring and bedside ultrasonography to determine changes in hemodynamic and IVC parameters and identify the types of circulatory shock that occur in patients with dengue. Of 162 patients with dengue, 17 (10.5% experienced dengue shock and 145 (89.5% did not. In patients with shock, the mean arterial pressure was significantly lower on day 6 after fever onset (P = 0.045 and the pulse pressure was significantly lower between days 4 and 7 (P50% between days 4 and 5 (P<0.05. Hypovolemic shock was observed in 9 (52.9% patients and cardiogenic shock in 8 (47.1%, with a median (interquartile range time to shock onset of 6.0 (5.0-6.5 days after fever onset, which was the median day of defervescence. Intravascular hypovolemia occurred before defervescence, whereas myocardial dysfunction occurred on the day of defervescence until 2 weeks after fever onset. Hypovolemic shock and cardiogenic shock each occurred in approximately half of the patients with dengue shock. Therefore, dynamic measures to estimate changes in hemodynamic parameters and preload should be monitored to ensure adequate fluid therapy among patients with dengue, particularly patients with dengue shock.

  11. Pregnancy outcome in patients with antiphospholipid syndrome after cerebral ischaemic events: an observational study.

    Fischer-Betz, R; Specker, C; Brinks, R; Schneider, M


    Among the most prominent features associated with antiphospholipid syndrome (APS) are cerebral ischaemic events (CVE). Pregnancy with APS increases the risk of thrombosis, including CVE. This study was undertaken to assess the risk of obstetric complications and recurrence of CVE during pregnancy in women with APS and previous CVE. We prospectively observed 23 pregnancies in 20 women (median age 31 years) with primary (n = 8) or secondary APS (n = 12). Eight patients had transient ischaemic attacks (TIA) and 12 had stroke before pregnancy. All patients received aspirin 100 mg daily in combination with low molecular weight heparin (LMWH) during their pregnancies. The live birth rate was 91.3% (n = 21). Obstetrical complications consisted mainly of preeclampsia (n = 8, 34.8%) and preterm delivery (n = 9, 42.9%). The risk for preeclampsia increased in patients who were positive for multiple antiphospholipid antibodies (aPL) (odds ratio (OR) 3.06 (95% confidence interval (CI) 1.01-9.32)) per positive aPL test (i.e anticardiolipin antibody, anti-ß2-glycoprotein I antibody, lupus anticoagulant) (p 0.049). Three patients experienced recurrent CVE in the context of pregnancy (one during pregnancy, two in the postpartum period). We found an increased, but not significant, risk of a new episode of cerebral ischaemia in patients with pregnancies complicated by preeclampsia (two out of the eight preeclampsia (p 0.15). Despite treatment, there is a significant risk for pregnancy complications in APS patients with previous CVE. Especially in the context of preeclampsia, anticoagulation should be given rigorously to prevent recurrence of CVE.

  12. Freeze-fracture studies of photoreceptor membranes: new observations bearing upon the distribution of cholesterol.

    Andrews, L D; Cohen, A I


    We performed electron microscopy of replicas from freeze-fractured retinas exposed during or after fixation to the cholesterol-binding antibiotic, filipin. We observed characteristic filipin-induced perturbations throughout the disk and plasma membranes of retinal rod outer segments of various species. It is evident that a prolonged exposure to filipin in fixative enhances rather than reduces presumptive cholesterol detection in the vertebrate photoreceptor cell. In agreement with the pattern seen in our previous study (Andrews, L.D., and A. I. Cohen, 1979, J. Cell Biol., 81:215-228), filipin-binding in membranes exhibiting particle-free patches seemed largely confined to these patches. Favorably fractured photoreceptors exhibited marked filipin-binding in apical inner segment plasma membrane topologically confluent with and proximate to the outer segment plasma membrane, which was comparatively free of filipin binding. A possible boundary between these differing membrane domains was suggested in a number of replicas exhibiting lower filipin binding to the apical plasma membrane of the inner segment in the area surrounding the cilium. This area contains a structure (Andrews, L. D., 1982, Freeze-fracture studies of vertebrate photoreceptors, In Structure of the Eye, J. G. Hollyfield and E. Acosta Vidrio, editors, Elsevier/North-Holland, New York, 11-23) that resembles the active zones of the nerve terminals for the frog neuromuscular junction. These observations lead us to hypothesize that these structures may function to direct vesicle fusion to occur near them, in a domain of membrane more closely resembling outer than inner segment plasma membrane. The above evidence supports the views that (a) all disk membranes contain cholesterol, but the particle-free patches present in some disks trap cholesterol from contiguous particulate membrane regions; (b) contiguous inner and outer segment membranes may greatly differ in cholesterol content; and (c) the suggested

  13. Primary care screening for peripheral arterial disease: a cross-sectional observational study

    Davies, Jane H; Richards, Jonathan; Conway, Kevin; Kenkre, Joyce E; Lewis, Jane EA; Mark Williams, E


    Background Early identification of peripheral arterial disease (PAD) and subsequent instigation of risk modification strategies could minimise disease progression and reduce overall risk of cardiovascular (CV) mortality. However, the feasibility and value of primary care PAD screening is uncertain. Aim This study (the PIPETTE study — Peripheral arterial disease In Primary carE: Targeted screening and subsequenT managEment) aimed to determine the value of a proposed primary care PAD screening strategy. Outcomes assessed were: prevalence of PAD and agreement of ankle– brachial index (ABI)-defined PAD (ABI ≤0.9) with QRISK®2-defined high CV risk (≥20). Design and setting A cross-sectional observational study was undertaken in a large general practice in Merthyr Tydfil, Wales. Method In total, 1101 individuals with ≥2 pre-identified CV risk factors but no known CV disease or diabetes were invited to participate. Participants underwent ABI measurement and QRISK2 assessment, and completed Edinburgh Claudication Questionnaires. Results A total of 368 people participated in the study (participation rate: 33%). Prevalence of PAD was 3% (n = 12). The number needed to screen (NNS) to detect one new case of PAD was 31. Refining the study population to those aged ≥50 years with a smoking history reduced the NNS to 14, while still identifying 100% of PAD cases. Of participants with PAD, 33% reported severe lifestyle-limiting symptoms of intermittent claudication that warranted subsequent endovascular intervention, yet had not previously presented to their GP. The QRISK2 score predicted high CV risk in 92% of participants with PAD. Conclusion The low PAD yield and the fact that QRISK2 was largely comparable to the ABI in predicting high CV risk suggests that routine PAD screening may be unwarranted. Instead, strategies to improve public awareness of PAD are needed. PMID:28126882

  14. Whole-Genome Sequences of Mycobacterium tuberculosis TB282 and TB284, a Widespread and a Unique Strain, Respectively, Identified in a Previous Study of Tuberculosis Transmission in Central Los Angeles, California, USA

    Yang, Zhenhua


    ABSTRACT We report here the genome sequences of two Mycobacterium tuberculosis clinical isolates previously identified in central Los Angeles, CA, in the 1990s using a PacBio platform. Isolate TB282 represents a large-cluster strain that caused 27% of the tuberculosis cases, while TB284 represents a strain that caused disease in only one patient. PMID:28082486




    Full Text Available OBJECTIVE: The aim of the study was to see the fetomaternal outcome of pregnancy with previous cesarean section. METHODS: This study was conducted in the department of OBGYN, BARC Hospital, Mumbai from October 2011 to September 2012, a period of one year. All the pregnant women with previous one cesarean section attending ANC clinic for confinement were included in the study group after giving consent. RESULTS: Out of total75 cases, a total of 23 patients (30.67% were given trial of labor. Out of 23 patients given trial of labor, 12 patients (52.17% had successful VBAC. Commonest indication for unsuccessful trial of labor undergoing repeat cesarean section was non-progress of labor (54.55% and failed IOL (36.67%. Out of 12 patients who had successful VBAC, 3 patients (25% had complication like episiotomy hematoma, perineal tear and cervical tear. No patients had major complications. In present study no baby had apgar score <7 at 1min and 5 min in VBAC group and elective LSCS group. CONCLUSION: The current study concludes that women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counseling for trial of labor and proper antepartum and intrapartum monitoring of patients, are key to reducing the cesarean section rates. The antepartum, intrapartum and postpartum complications are more in repeat cesarean section cases. There is no doubt that a trial of labor is a relatively safe procedure, but it is not risk free. Therefore, patient evaluation prior to TOLAC, careful observation throughout labor in a well-equipped unit with around the clock services for emergency surgery and availability of expertise is the backbone for successful VBAC.

  16. Randomized Phase II Study of R-CHOP With or Without Bortezomib in Previously Untreated Patients With Non-Germinal Center B-Cell-Like Diffuse Large B-Cell Lymphoma.

    Leonard, John P; Kolibaba, Kathryn S; Reeves, James A; Tulpule, Anil; Flinn, Ian W; Kolevska, Tatjana; Robles, Robert; Flowers, Christopher R; Collins, Robert; DiBella, Nicholas J; Papish, Steven W; Venugopal, Parameswaran; Horodner, Andrew; Tabatabai, Amir; Hajdenberg, Julio; Park, Jaehong; Neuwirth, Rachel; Mulligan, George; Suryanarayan, Kaveri; Esseltine, Dixie-Lee; de Vos, Sven


    Purpose To evaluate the impact of the addition of bortezomib to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) on outcomes in previously untreated patients with non-germinal center B-cell-like (non-GCB) diffuse large B-cell lymphoma (DLBCL). Patients and Methods After real-time determination of non-GCB DLBCL using the Hans immunohistochemistry algorithm, 206 patients were randomly assigned (1:1; stratified by International Prognostic Index [IPI] score) to six 21-day cycles of standard R-CHOP alone or R-CHOP plus bortezomib 1.3 mg/m(2) intravenously on days 1 and 4 (VR-CHOP). The primary end point, progression-free survival (PFS), was evaluated in 183 patients with centrally confirmed non-GCB DLBCL who received one or more doses of study drug (91 R-CHOP, 92 VR-CHOP). Results After a median follow-up of 34 months, with 25% (R-CHOP) and 18% (VR-CHOP) of patients having had PFS events, the hazard ratio (HR) for PFS was 0.73 (90% CI, 0.43 to 1.24) with VR-CHOP ( P = .611). Two-year PFS rates were 77.6% with R-CHOP and 82.0% with VR-CHOP; they were 65.1% versus 72.4% in patients with high-intermediate/high IPI (HR, 0.67; 90% CI, 0.34 to 1.29), and 90.0% versus 88.9% (HR, 0.85; 90% CI, 0.35 to 2.10) in patients with low/low-intermediate IPI. Overall response rate with R-CHOP and VR-CHOP was 98% and 96%, respectively. The overall survival HR was 0.75 (90% CI, 0.38 to 1.45); 2-year survival rates were 88.4% and 93.0%, respectively. In the safety population (100 R-CHOP and 101 VR-CHOP patients), grade ≥ 3 adverse events included neutropenia (53% v 49%), thrombocytopenia (13% v 29%), anemia (7% v 15%), leukopenia (26% v 25%), and neuropathy (1% v 5%). Conclusion Outcomes for newly diagnosed, prospectively enrolled patients with non-GCB DLBCL were more favorable than expected with R-CHOP and were not significantly improved by adding bortezomib.

  17. Study of Application for Excursion Observation Method in Primary School 2nd Grade Social Studies

    Ahmet Ali GAZEL


    Full Text Available This study aims to investigate how field trips are conducted at 2nd grade of primary schools as a part of social studies course. Data for this research is compiled from 143 permanent Social Studies teachers working throughout 2011–2012 Education Year in the primary schools of central Kütahya and its districts. Data is compiled by using descriptive search model. In the research, after taking expert opinions, a measuring tool developed by the researcher is used. Data obtained from the research were transferred to computer, and analyses were made. In the analysis of the data, frequency and percentage values have been used to determine the distribution. Also a single factor variance analysis and t-test for independent samples have been used to determine the significance of difference between the variables. As a result of the research, it has been realized that insufficient importance is given to field trip method in Social Studies lessons. Most of the teachers using this method apply it in spring months. Teachers usually make use of field trips independent from unit/topic to increase the students’ motivation, and they generally use verbal expression in the class after tours. The biggest difficulty teachers encounter while using tour-observation method is the students’ undisciplined behavior.

  18. Study of Observer Variability in Modern Display Colorimetry: Comparison of CIE 2006 Model and 10° Standard Observer

    Sarkar, Abhijit; Blondé, Laurent; Le Callet, Patrick; Autrusseau, Florent; Stauder, Jürgen; Morvan, Patrick


    International audience; This paper compares CIE 2006 model predictions and the 1964 10° standard colorimetric observer with the average observer data from three distinct subgroups of 47 Stiles-Burch observers formed on the basis of observer ages. For two of these subgroups, the long-wave sensitive (x-) color matching functions obtained from the CIE06 model did not accurately predict the intra-group average observer functions. In terms of display color perception, the prediction error is refle...

  19. The chimeric peptide [Lys(-2)-Arg(-1)]-sarafotoxin-S6b, composed of the endothelin pro-sequence and sarafotoxin, retains the salt-bridge staple between Arg(-1) and Asp8 previously observed in [Lys(-2)-Arg(-1)]-endothelin. Implications of this salt-bridge in the contractile activity and the oxidative folding reaction.

    Aumelas, A; Chiche, L; Kubo, S; Chino, N; Watanabe, T X; Kobayashi, Y


    The chimeric peptide [Lys(-2)-Arg(-1)]-sarafotoxin-S6b (KR-SRTb) designed from the Lys-2-Arg-1 dipeptide of the endothelin pro-sequence and the sarafotoxin-S6b sequence was synthesized. Its contractile activity was found to be decreased markedly when compared with that of the parent SRTb. In contrast, the extension by the Lys-Arg dipeptide was found to increase the formation of the native disulfide isomer (82/18 versus 96/4) when the reaction was carried out in the presence of redox reagents. The solution structure of KR-SRTb was determined by NMR as a function of pH. In the carboxylic acid state, the structure consists of the cystine-stabilized alpha-helical motif, with the alpha-helical part spanning residues 9-15, and of an unstructured C-terminal tail. In the carboxylate state, the structure is characterized by a salt-bridge between Arg(-1) and Asp8, which we identified previously in the [Lys(-2)-Arg(-1)]-endothelin-1 peptide (KR-ET-1). The fact that this salt-bridge is commonly observed in KR-SRTb and KR-ET-1, despite the 33% sequence difference between the corresponding parental peptides, highlights the remarkable adaptability of the Lys-Arg extension for the formation of a special salt-bridge. As a consequence, this salt-bridge, which does not depend on either the 4-7 sequence of the loop or the C-terminal sequence, appears to be particularly well suited to improve the stability of the cystine-stabilized alpha-helical motif. Therefore, because of its high yield in the native disulfide arrangement and its high permissiveness for sequence mutation in the 4-7 loop, such a stabilized cystine-stabilized alpha-helical motif could be a valuable scaffold for the presentation of a library of constrained short peptides.

  20. Van Allen Probes observations of unusually low frequency whistler mode waves observed in association with moderate magnetic storms: Statistical study.

    Cattell, C A; Breneman, A W; Thaller, S A; Wygant, J R; Kletzing, C A; Kurth, W S


    We show the first evidence for locally excited chorus at frequencies below 0.1 fce (electron cyclotron frequency) in the outer radiation belt. A statistical study of chorus during geomagnetic storms observed by the Van Allen Probes found that frequencies are often dramatically lower than expected. The frequency at peak power suddenly stops tracking the equatorial 0.5 fce and f/fce decreases rapidly, often to frequencies well below 0.1 fce (in situ and mapped to equator). These very low frequency waves are observed both when the satellites are close to the equatorial plane and at higher magnetic latitudes. Poynting flux is consistent with generation at the equator. Wave amplitudes can be up to 20 to 40 mV/m and 2 to 4 nT. We conclude that conditions during moderate to large storms can excite unusually low frequency chorus, which is resonant with more energetic electrons than typical chorus, with critical implications for understanding radiation belt evolution.

  1. Effectiveness of Vildagliptin in Clinical Practice: Pooled Analysis of Three Korean Observational Studies (the VICTORY Study

    Sunghwan Suh


    Full Text Available The present observational study aimed to evaluate the clinical effectiveness of vildagliptin with metformin in Korean patients with type 2 diabetes mellitus (T2DM. Data were pooled from the vildagliptin postmarketing survey (PMS, the vildagliptin/metformin fixed drug combination (DC PMS, and a retrospective observational study of vildagliptin/metformin (fixed DC or free DC. The effectiveness endpoint was the proportion of patients who achieved a glycemic target (HbA1c of ≤7.0% at 24 weeks. In total, 4303 patients were included in the analysis; of these, 2087 patients were eligible. The mean patient age was 56.99 ± 11.25 years. Overall, 58.94% patients achieved an HbA1c target of ≤7.0% at 24 weeks. The glycemic target achievement rate was significantly greater in patients with baseline HbA1c < 7.5% versus ≥7.5% (84.64% versus 43.97%, receiving care at the hospital versus clinic (67.95% versus 52.33%, and receiving vildagliptin/metformin fixed DC versus free DC (70.69% versus 55.42%. Multivariate logistic regression analysis indicated that disease duration (P<0.0001, baseline HbA1c (P<0.0001, and DC type (P=0.0103 had significant effects on drug effectiveness. Vildagliptin plus metformin appeared as an effective treatment option for patients with T2DM in clinical practice settings in Korea.

  2. Interferon Beta-1a (AVONEX® as a Treatment Option for Untreated Patients with Multiple Sclerosis (AXIOM: A Prospective, Observational Study

    Christoph Kleinschnitz


    Full Text Available The efficacy and safety of first-line disease-modifying therapies (DMT for relapsing-remitting multiple sclerosis (RRMS has been demonstrated in pivotal, randomized trials, but these studies do not reflect the routine care setting where treatment gaps or switches are common. The Avonex as Treatment Option for Untreated MS Patients (AXIOM trial assessed the efficacy of newly-initiated intramuscular interferon beta-1a (IM IFNb-1a after a treatment-free interval, with particular consideration of the previous course of disease and therapy. The AXIOM trial was an open, 12-month, observational, non-interventional study with a retrospective and a prospective part conducted in Germany. RRMS patients with a treatment-free interval of at least three months were included and treated with IFNb-1a for up to 12 months. Relapse rate, disability progression, injection-related parameters and quality of life observed during the prospective part were compared with retrospectively-collected data. Two hundred and thirty five RRMS patients participated in AXIOM. The mean relapse rate decreased from 1.1 in the three months before baseline to 0.2 per quarter during the twelve-month observational period; the Multiple Sclerosis Functional Composite score improved during twelve months of IM IFNb-1a treatment, while the Expanded Disability Status Scale score did not change over the course of this study. Compared to previous DMTs (IM IFNb-1a, subcutaneous IFNb-1a (SC IFNb-1a, SC IFNb-1b, glatiramer acetate, the patients experienced less injection site reactions and flu-like symptoms, with a stated improved quality of life. IM IFNb-1a was effective and well accepted in RRMS patients with no or discontinued previous therapy. These results from the routine care setting may inform optimization of DMT treatment in RRMS, but need confirmation in further studies.


    Kala Bahuleyan Santha


    Full Text Available BACKGROUND Missed miscarriage is one of the common cases encountered by the practicing obstetricians all over the world. Diagnosis is made early due to increased use of ultrasound. Medical management is as effective as surgical management, but many still resort to surgical management due to concerns about adherence of products to uterine wall. This may result in complications like perforation, infection, cervical injury and may affect future fertility. Mifepristone followed by misoprostol is well accepted in medical abortion. Misoprostol alone is as efficient as the combination in missed miscarriage. In India, studies with misoprostol alone are limited. Hence, this study was conducted to evaluate the outcome of medical management in patients with first trimester miscarriage with misoprostol alone. MATERIALS AND METHODS After approval of Institutional Review Board, a total of 100 women with first trimester miscarriage were recruited for the study after satisfying inclusion and exclusion criteria. After necessary investigations and consent, they were treated with 800 micrograms of vaginal misoprostol followed by 600 micrograms after 3 hours. Main outcome measured was successful resolution without surgical intervention. Secondary outcomes measured were the induction delivery interval, incidence of pain, excess vaginal bleeding, infection, pyrexia and other gastrointestinal side effects. RESULTS Complete expulsion occurred in 89% patients and surgical evacuation needed in 11%. Mean induction delivery interval was 6- 12 hours. Incidence of complete expulsion was more among primigravida than multigravida. In multi, complete expulsion was observed in patients with previous normal delivery than caesarean. Majority of patients had bleeding for less than 7 days. None of them had major side effects like sepsis or heavy bleeding. Minor side effects were fever, nausea, diarrhoea and abdominal pain. CONCLUSION Medical management with misoprostol is efficient

  4. Observational Study of Morphological Changes in Medium-mass Evolved Stars

    Chong, Sze-Ning


    Medium-mass (or intermediate-mass) stars refer to main sequence stars with masses ranging from 0.4 to 8 solar masses. These stars are believed to finally evolve into the central stars of planetary nebulae (PNe) and white dwarfs. One of the fascinating aspects of PNe is their diverse morphology. To understand the mechanisms of the morphological changes from spherical circumstellar envelopes (CSEs) of asymptotic giant branch (AGB) stars to those forming highly diversified PNe, it is necessary to investigate the true three-dimensional (3D) morphology of PNe from two-dimensional images, and the short transition phase in-between the two phases should also be explored. "Water Fountain" (WF) sources belong to transition phase objects; they are AGB or post-AGB stars with collimated jets traced by high velocity water maser emissions in their CSEs. This thesis comprises of four chapters. The results can be divided into two major parts. Chapter 1 is the introduction on the related fields with brief reviews of previous observational studies on PNe and the rapidly evolving transition phase objects. Basic theories necessary for understanding the next chapters were also described, including those explaining the commonly observed Hα emission in PNe, the formation of multipolar PNe, the maser emission and the role of shock in circumstellar materials. The first major part of the results, about the morphological classification of multipolar PNe, is presented in Chapter 2. At the beginning of the chapter, the problems on the previous classification methods were pointed out. Then a three-lobed model was introduced. By changing the combination of the orientations of the three pairs of lobes, simulations using the model produced statistical results in classification and quantified the errors of misidentification. Assuming that all PNe observed have the true structure of three lobes, due to projection effect, only 49% of them would be correctly classified. 46% and 5% of them would be

  5. Influence of the physico-chemical process as previous treatment to the electrocoagulation. Study with leachate of a landfill; Influencia del proceso fisicoquimico como tratamiento previo a la electrocoagulacion. Estudio con lixiviados de un relleno

    Mercado Martinez, I. D.; Reyes Avila, D.


    This article has as purpose to show the influence of the method physico-chemical as previous process to the novel technique of electrocoagulation, presenting as a new alternative to depurate wastewaters. to obtain it, was done tests measuring the very parameters to leachates so much affluent as effluent from treatment plant of the Sanitary Landfill La Esmeralda, situated near to the Manizales city(Colombia), and so much before as later to apply this electrochemical technology, looking for this way to compare the obtained removals. (Author)

  6. Risk Factors Associated With Salmonella in Laying Hen Farms: Systematic Review of Observational Studies.

    Denagamage, Thomas; Jayarao, Bhushan; Patterson, Paul; Wallner-Pendleton, Eva; Kariyawasam, Subhashinie


    Salmonella contamination of laying hen flocks and shell eggs is associated with various management and environmental factors. Foodborne outbreaks of human salmonellosis have been traced back to consumption of Salmonella-contaminated shell eggs. In the present study, a systematic literature review was conducted to identify and provide an evidence-based overview of potential risk factors of Salmonella contamination of laying hens, layer premises, and shell eggs. This systematic literature search was conducted using AGRICOLA, CAB Abstracts, and PubMed databases. Observational studies that identified risk factors for Salmonella contamination of layer flocks and shell eggs were selected, and best evidence was synthesized to summarize the results. Altogether, 13 cross-sectional studies and four longitudinal studies published in English were included in the review. Evidence scores were assigned based on the study design and quality of the study to grade the evidence level. The strength of association of a risk factor was determined according to the odds ratios. In this systematic review, the presence of previous Salmonella infection, absence of cleaning and disinfection, presence of rodents, induced molting, larger flock size (>30,000 hens), multiage management, cage housing systems, in-line egg processing, rearing pullets on the floor, pests with access to feed prior to movement to the feed trough, visitors allowed in the layer houses, and trucks near farms and air inlets were identified as the risk factors associated with Salmonella contamination of laying hen premises, whereas high level of manure contamination, middle and late phase of production, high degree of egg-handling equipment contamination, flock size of >30,000, and egg production rate of >96% were identified as the risk factors associated with Salmonella contamination of shell eggs. These risk factors demonstrated strong to moderate evidence of association with Salmonella contamination of laying hens and

  7. Intravenous Immunoglobulin Therapy in Pediatric Narcolepsy: A Nonrandomized, Open-Label, Controlled, Longitudinal Observational Study

    Lecendreux, Michel; Berthier, Johanna; Corny, Jennifer; Bourdon, Olivier; Dossier, Claire; Delclaux, Christophe


    Study Objectives: Previous case reports of intravenous immunoglobulins (IVIg) in pediatric narcolepsy have shown contradictory results. Methods: This was a nonrandomized, open-label, controlled, longitudinal observational study of IVIg use in pediatric narcolepsy with retrospective data collection from medical files obtained from a single pediatric national reference center for the treatment of narcolepsy in France. Of 56 consecutively referred patients with narcolepsy, 24 received IVIg (3 infusions administered at 1-mo intervals) in addition to standard care (psychostimulants and/or anticataplectic agents), and 32 continued on standard care alone (controls). Results: For two patients in each group, medical files were unavailable. Of the 22 IVIg patients, all had cerebrospinal fluid (CSF) hypocretin ≤ 110 pg/mL and were HLA-DQB1*06:02 positive. Of the 30 control patients, 29 were HLA-DQB1*06:02 positive and of those with available CSF measurements, all 12 had hypocretin ≤ 110 pg/mL. Compared with control patients, IVIg patients had shorter disease duration, shorter latency to sleep onset, and more had received H1N1 vaccination. Mean (standard deviation) follow-up length was 2.4 (1.1) y in the IVIg group and 3.9 (1.7) y in controls. In multivariate-adjusted linear mixed-effects analyses of change from baseline in Ullanlinna Narcolepsy Scale (UNS) scores, high baseline UNS, but not IVIg treatment, was associated with a reduction in narcolepsy symptoms. On time-to-event analysis, among patients with high baseline UNS scores, control patients achieved a UNS score narcolepsy symptoms were not significantly reduced by IVIg. However, in patients with high baseline symptoms, a subset of IVIg-treated patients achieved remission more rapidly than control patients. Commentary: A commentary on this article appears in this issue on page 363. Citation: Lecendreux M, Berthier J, Corny J, Bourdon O, Dossier C, Delclaux C. Intravenous immunoglobulin therapy in pediatric

  8. ACTRIS aerosol vertical profile data and observations: potentiality and first examples of integrated studies with models

    Mona, Lucia; Benedetti, Angela; D'Amico, Giuseppe; Myhre, Cathrine Lund; Schulz, Michael; Wandinger, Ulla; Laj, Paolo; Pappalardo, Gelsomina


    . The potentiality of the new EARLINET data products and first examples of integrated studies with models will be presented at the conference. Acknowledgments: ACTRIS2 Research Infrastructure Project is funded by the European Union's Horizon 2020 research and innovation programme under the grant agreement n. 654169 and previously under FP7 grant agreement n. 262254.

  9. Adaptive list sequential sampling method for population-based observational studies


    Background In population-based observational studies, non-participation and delayed response to the invitation to participate are complications that often arise during the recruitment of a sample. When both are not properly dealt with, the composition of the sample can be different from the desired composition. Inviting too many individuals or too few individuals from a particular subgroup could lead to unnecessary costs or decreased precision. Another problem is that there is frequently no or only partial information available about the willingness to participate. In this situation, we cannot adjust the recruitment procedure for non-participation before the recruitment period starts. Methods We have developed an adaptive list sequential sampling method that can deal with unknown participation probabilities and delayed responses to the invitation to participate in the study. In a sequential way, we evaluate whether we should invite a person from the population or not. During this evaluation, we correct for the fact that this person could decline to participate using an estimated participation probability. We use the information from all previously invited persons to estimate the participation probabilities for the non-evaluated individuals. Results The simulations showed that the adaptive list sequential sampling method can be used to estimate the participation probability during the recruitment period, and that it can successfully recruit a sample with a specific composition. Conclusions The adaptive list sequential sampling method can successfully recruit a sample with a specific desired composition when we have partial or no information about the willingness to participate before we start the recruitment period and when individuals may have a delayed response to the invitation. PMID:24965316

  10. Adaptive list sequential sampling method for population-based observational studies.

    Hof, Michel H; Ravelli, Anita C J; Zwinderman, Aeilko H


    In population-based observational studies, non-participation and delayed response to the invitation to participate are complications that often arise during the recruitment of a sample. When both are not properly dealt with, the composition of the sample can be different from the desired composition. Inviting too many individuals or too few individuals from a particular subgroup could lead to unnecessary costs or decreased precision. Another problem is that there is frequently no or only partial information available about the willingness to participate. In this situation, we cannot adjust the recruitment procedure for non-participation before the recruitment period starts. We have developed an adaptive list sequential sampling method that can deal with unknown participation probabilities and delayed responses to the invitation to participate in the study. In a sequential way, we evaluate whether we should invite a person from the population or not. During this evaluation, we correct for the fact that this person could decline to participate using an estimated participation probability. We use the information from all previously invited persons to estimate the participation probabilities for the non-evaluated individuals. The simulations showed that the adaptive list sequential sampling method can be used to estimate the participation probability during the recruitment period, and that it can successfully recruit a sample with a specific composition. The adaptive list sequential sampling method can successfully recruit a sample with a specific desired composition when we have partial or no information about the willingness to participate before we start the recruitment period and when individuals may have a delayed response to the invitation.

  11. Observed Prevalence of Congenital Heart Defects From a Surveillance Study in China

    Zhang, Yali; Riehle-Colarusso, Tiffany; Correa, Adolfo; Li, Song; Feng, Xinheng; Gindler, Jacqueline; Lin, Hui; Webb, Catherine; Li, Wei; Trines, Jean; Berry, Robert J.; Yeung, Lorraine; Luo, Ying; Jiang, Meifang; Chen, Hua; Sun, Xiamei; Li, Zhu


    Objectives The purpose of this study was to estimate the prevalence of major and minor congenital heart defects among fetuses and neonates using sonography in a general population of 4 areas surrounding Shanghai, China. Methods Pregnant women were recruited between April 2004 and December 2005 in Jiaxing City, Suzhou City, Changshu County, and Haining County. All participants could have 3 sonographic examinations performed by specially trained physicians regardless of medical indication: a fetal sonographic screen and fetal echocardiography between 20 and 28 weeks’ gestation and neonatal echocardiography. Diagnoses of congenital heart defects were made on the basis of review of all available scans by an international group of experts in pediatric cardiology. Prevalence rates were calculated per 1000 births. Results Among 4006 scanned fetuses and neonates, there were 75 congenital heart defects, including 12 major defects. The observed prevalence for all congenital heart defects was 18.7 (95% confidence interval, 14.8–23.5) per 1000 births, and the prevalence for major defects was 3.0 (95% confidence interval, 1.6–5.2) per 1000 births. The most common defects were ventricular septal defects (n = 47 [62.7%]), atrial septal defects (n = 14 [18.7%]), tetralogy of Fallot (n = 4 [5.3%]), and hypoplastic left heart syndrome (n = 3 [4.0%]). Conclusions The prevalence of all congenital heart defects in the 4 areas of China studied was higher than that reported in other countries, with ventricular septal defects being the most frequent defects. Our data likely reflect a better estimate of the total prevalence of congenital heart defects in China than reported previously. PMID:21705732

  12. Twelve previously unknown phage genera are ubiquitous in global oceans.

    Holmfeldt, Karin; Solonenko, Natalie; Shah, Manesh; Corrier, Kristen; Riemann, Lasse; Verberkmoes, Nathan C; Sullivan, Matthew B


    Viruses are fundamental to ecosystems ranging from oceans to humans, yet our ability to study them is bottlenecked by the lack of ecologically relevant isolates, resulting in "unknowns" dominating culture-independent surveys. Here we present genomes from 31 phages infecting multiple strains of the aquatic bacterium Cellulophaga baltica (Bacteroidetes) to provide data for an underrepresented and environmentally abundant bacterial lineage. Comparative genomics delineated 12 phage groups that (i) each represent a new genus, and (ii) represent one novel and four well-known viral families. This diversity contrasts the few well-studied marine phage systems, but parallels the diversity of phages infecting human-associated bacteria. Although all 12 Cellulophaga phages represent new genera, the podoviruses and icosahedral, nontailed ssDNA phages were exceptional, with genomes up to twice as large as those previously observed for each phage type. Structural novelty was also substantial, requiring experimental phage proteomics to identify 83% of the structural proteins. The presence of uncommon nucleotide metabolism genes in four genera likely underscores the importance of scavenging nutrient-rich molecules as previously seen for phages in marine environments. Metagenomic recruitment analyses suggest that these particular Cellulophaga phages are rare and may represent a first glimpse into the phage side of the rare biosphere. However, these analyses also revealed that these phage genera are widespread, occurring in 94% of 137 investigated metagenomes. Together, this diverse and novel collection of phages identifies a small but ubiquitous fraction of unknown marine viral diversity and provides numerous environmentally relevant phage-host systems for experimental hypothesis testing.

  13. The contribution of observational studies to the knowledge of drug effectiveness in heart failure

    Dobre, Daniela; van Veldhuisen, Dirk J.; deJongste, Mike J. L.; van Sonderen, Eric; Klungel, Olaf H.; Sanderman, Robbert; Ranchor, Adelita V.; Haaijer-Ruskamp, Flora M.


    Randomized controlled trials (RCTs) are the golden standard for the assessment of drug efficacy. Little is known about the add-on value of observational studies in heart failure (HF). We aimed to assess the contribution of observational studies to actual knowledge regarding the effectiveness of angi

  14. Adverse drug reaction profile of nanoparticle versus conventional formulation of paclitaxel: An observational study

    Ballari Brahmachari


    Conclusions : Despite its ADR profile being statistically comparable to conventional paclitaxel, this observational study suggests that Nanoxel tolerability could be better, considering that a significantly higher dose was employed. This hypothesis needs confirmation through an interventional study.

  15. Observational studies on the near-infrared unidentified emission bands in galactic H II regions

    Mori, Tamami I.; Onaka, Takashi; Sakon, Itsuki; Ohsawa, Ryou; Bell, Aaron C. [Department of Astronomy, Graduate School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan); Ishihara, Daisuke [Graduate School of Science, Nagoya University, Chikusa-ku, Nagoya 464-8602 (Japan); Shimonishi, Takashi, E-mail: [Department of Earth and Planetary Sciences, Graduate School of Science, Kobe University, 1-1 Rokkodai-cho, Nada Kobe 657-8501 Japan (Japan)


    Using a large collection of near-infrared spectra (2.5-5.4 μm) of Galactic H II regions and H II region-like objects, we perform a systematic investigation of astronomical polycyclic aromatic hydrocarbon (PAH) features. Thirty-six objects were observed using the infrared camera on board the AKARI satellite as a part of a director's time program. In addition to the well known 3.3-3.6 μm features, most spectra show a relatively weak emission feature at 5.22 μm with sufficient signal-to-noise ratios, which we identify as the PAH 5.25 μm band (previously reported). By careful analysis, we find good correlations between the 5.25 μm band and both the aromatic hydrocarbon feature at 3.3 μm and the aliphatic hydrocarbon features at around 3.4-3.6 μm. The present results give us convincing evidence that the astronomical 5.25 μm band is associated with C-H vibrations, as suggested by previous studies, and show its potential to probe the PAH size distribution. The analysis also shows that the aliphatic-to-aromatic ratio of I {sub 3.4-3.6} {sub μm}/I {sub 3.3} {sub μm} decreases against the ratio of the 3.7 μm continuum intensity to the 3.3 μm band, I {sub cont,} {sub 3.7} {sub μm}/I {sub 3.3} {sub μm}, which is an indicator of the ionization fraction of PAHs. The midinfrared color of I {sub 9} {sub μm}/I {sub 18} {sub μm} also declines steeply against the ratio of the hydrogen recombination line Brα at 4.05 μm to the 3.3 μm band, I {sub Brα}/I {sub 3.3} {sub μm}. These facts indicate possible dust processing inside or at the boundary of ionized gas.

  16. Study of Tectonic Tremor in Depth: Triggering Stress Observation and Model of the Triggering Mechanism

    Wang, Tien-Huei

    Non-volcanic tremor (NVT) has been discovered in recent years due to advances in seismic instruments and increased density of seismic networks. The NVT is a special kind of seismic signal indicative of the physical conditions and the failure mechanism on the source on the fault where NVT occurs. The detection methods used and the sensitivity of them relies on the density, distance and instrumentation of the station network available. How accurately the tremor is identified in different regions varies greatly among different studies. Therefore, there has not been study that rigorously documents tectonic tremors in different regions under limited methods and data. Meanwhile, many incidences of NVTs are observed during or after small but significant strain change induced by teleseismic, regional or local earthquake. The understanding of the triggering mechanisms critical for tremor remains unclear. In addition, characteristics of the triggering of NVT in different regions are rarely compared because of the short time frame after the discovery of the triggered NVTs. We first explore tectonic tremor based on observations to learn about its triggering, frequency of occurrence, location and spectral characteristics. Then, we numerically model the triggering of instability on the estimated tremor-source, under assumptions fine-tuned according to previous studies (Thomas et al., 2009; Miyazawa et al., 2005; Hill, 2008; Ito, 2009; Rubinstein et al., 2007; Peng and Chao, 2008). The onset of the slip reveals that how and when the external loading triggers tremor. It also holds the information to the background stress conditions under which tremor source starts with. We observe and detect tremor in two regions: Anza and Cholame, along San Jacinto Fault (SJF) and San Andreas Fault (SAF) respectively. These two sections of the faults, relative to general fault zone on which general earthquakes occur, are considered transition zones where slip of slow rates occurs. Slip events

  17. Books average previous decade of economic misery.

    R Alexander Bentley

    Full Text Available For the 20(th century since the Depression, we find a strong correlation between a 'literary misery index' derived from English language books and a moving average of the previous decade of the annual U.S. economic misery index, which is the sum of inflation and unemployment rates. We find a peak in the goodness of fit at 11 years for the moving average. The fit between the two misery indices holds when using different techniques to measure the literary misery index, and this fit is significantly better than other possible correlations with different emotion indices. To check the robustness of the results, we also analysed books written in German language and obtained very similar correlations with the German economic misery index. The results suggest that millions of books published every year average the authors' shared economic experiences over the past decade.

  18. Obinutuzumab for previously untreated chronic lymphocytic leukemia.

    Abraham, Jame; Stegner, Mark


    Obinutuzumab was approved by the Food and Drug Administration in late 2013 for use in combination with chlorambucil for the treatment of patients with previously untreated chronic lymphocytic leukemia (CLL). The approval was based on results of an open-label phase 3 trial that showed improved progression-free survival (PFS) with the combination of obinutuzumab plus chlorambucil compared with chlorambucil alone. Obinutuzumab is a monoclonal antibody that targets CD20 antigen expressed on the surface of pre B- and mature B-lymphocytes. After binding to CD20, obinutuzumab mediates B-cell lysis by engaging immune effector cells, directly activating intracellular death signaling pathways, and activating the complement cascade. Immune effector cell activities include antibody-dependent cellular cytotoxicity and antibody-dependent cellular phagocytosis.

  19. Books average previous decade of economic misery.

    Bentley, R Alexander; Acerbi, Alberto; Ormerod, Paul; Lampos, Vasileios


    For the 20(th) century since the Depression, we find a strong correlation between a 'literary misery index' derived from English language books and a moving average of the previous decade of the annual U.S. economic misery index, which is the sum of inflation and unemployment rates. We find a peak in the goodness of fit at 11 years for the moving average. The fit between the two misery indices holds when using different techniques to measure the literary misery index, and this fit is significantly better than other possible correlations with different emotion indices. To check the robustness of the results, we also analysed books written in German language and obtained very similar correlations with the German economic misery index. The results suggest that millions of books published every year average the authors' shared economic experiences over the past decade.

  20. Comparison of balance assessment modalities in emergency department elders: a pilot cross-sectional observational study

    Karaman Rowan


    Full Text Available Abstract Background More than one-third of US adults 65 and over fall every year. These falls may cause serious injury including substantial long-term morbidity (due declines in activities of daily living and death. The emergency department (ED visit represents an opportunity for identifying high risk elders and potentially instituting falls-related interventions. The unique characteristic of the ED environment and patient population necessitate that risk-assessment modalities be validated in this specific setting. In order to better identify elders at risk of falls, we examined the relationship between patient-provided history of falling and two testing modalities (a balance plate system and the timed up-and-go [TUG] test in elder emergency department (ED patients. Methods We conducted a cross-sectional observational study of patients ≥ 60 years old being discharged from the ED. Patient history of falls in the past week, month, 6 months, and year was obtained. Balance plate center of pressure excursion (COP measurements and TUG testing times were recorded. COP was recorded under four conditions: normal stability eyes open (NSEO and closed (NSEC, and perturbed stability eyes open and closed. Correlation between TUG and COP scores was measured. Univariate logistic regression was used to identify the relationship between patient-provided falls history and the two testing modalities. Proportions, likelihood ratios, and receiver-operating-characteristic (ROC curves for prediction of previous falls were reported. Results Fifty-three subjects were enrolled, 11% had fallen in the previous week and 42% in the previous year. There was no correlation between TUG and any balance plate measurements. In logistic regression, neither testing modality was associated with prior history of falls (p > 0.05 for all time periods. Balance plate NSEO and NSEC testing cutoffs could be identified which were 83% sensitive and had a negative likelihood ratio (LR- of 0

  1. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE: explanation and elaboration.

    Jan P Vandenbroucke


    Full Text Available Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site ( should be helpful resources to improve reporting of observational research.

  2. Quality-of-life and performance status results from the phase III RAINBOW study of ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated gastric or gastroesophageal junction adenocarcinoma†

    Al-Batran, S.-E.; Van Cutsem, E.; Oh, S. C.; Bodoky, G.; Shimada, Y.; Hironaka, S.; Sugimoto, N.; Lipatov, O. N.; Kim, T.-Y.; Cunningham, D.; Rougier, P.; Muro, K.; Liepa, A. M.; Chandrawansa, K.; Emig, M.; Ohtsu, A.; Wilke, H.


    Background The phase III RAINBOW trial demonstrated that the addition of ramucirumab to paclitaxel improved overall survival, progression-free survival, and tumor response rate in fluoropyrimidine–platinum previously treated patients with advanced gastric/gastroesophageal junction (GEJ) adenocarcinoma. Here, we present results from quality-of-life (QoL) and performance status (PS) analyses. Patients and methods Patients with Eastern Cooperative Oncology Group PS of 0/1 were randomized to receive ramucirumab (8 mg/kg i.v.) or placebo on days 1 and 15 of a 4-week cycle, with both arms receiving paclitaxel (80 mg/m2) on days 1, 8, and 15. Patient-reported outcomes were assessed with the QoL/health status questionnaires EORTC QLQ-C30 and EQ-5D at baseline and 6-week intervals. PS was assessed at baseline and day 1 of every cycle. Time to deterioration (TtD) in each QLQ-C30 scale was defined as randomization to first worsening of ≥10 points (on 100-point scale) and TtD in PS was defined as first worsening to ≥2. Hazard ratios (HRs) for treatment effect were estimated using stratified Cox proportional hazards models. Results Of the 665 patients randomized, 650 (98%) provided baseline QLQ-C30 and EQ-5D data, and 560 (84%) also provided data from ≥1 postbaseline time point. Baseline scores for both instruments were similar between arms. Of the 15 QLQ-C30 scales, 14 had HR < 1, indicating similar or longer TtD in QoL for ramucirumab + paclitaxel. Treatment with ramucirumab + paclitaxel was also associated with a delay in TtD in PS to ≥2 (HR = 0.798, P = 0.0941). Alternate definitions of PS deterioration yielded similar results: PS ≥ 3 (HR = 0.656, P = 0.0508), deterioration by ≥1 PS level (HR = 0.802, P = 0.0444), and deterioration by ≥2 PS levels (HR = 0.608, P = 0.0063). EQ-5D scores were comparable between treatment arms, stable during treatment, and worsened at discontinuation. Conclusion In patients with previously treated advanced gastric

  3. Extensive X-ray variability studies of NGC 7314 using long XMM-Newton observations

    Emmanoulopoulos, D.; McHardy, I. M.; Vaughan, S.; Papadakis, I. E.


    We present a detailed X-ray variability study of the low-mass active galactic nuclei (AGN) NGC 7314 using the two newly obtained XMM-Newton observations (140 and 130 ks), together with two archival data sets of shorter duration (45 and 84 ks). The relationship between the X-ray variability characteristics and other physical source properties (such as the black hole mass) are still relatively poorly defined, especially for low-mass AGN. We perform a new, fully analytical, power spectral density (PSD) model analysis method, which will be described in detail in a forthcoming paper, that takes into consideration the spectral distortions, caused by red-noise leak. We find that the PSD in the 0.5-10 keV energy range, can be represented by a bending power law with a bend around 6.7 × 10-5 Hz, having a slope of 0.51 and 1.99 below and above the bend, respectively. Adding our bend time-scale estimate, to an already published ensemble of estimates from several AGN, supports the idea that the bend time-scale depends linearly only on the black hole mass and not on the bolometric luminosity. Moreover, we find that as the energy range increases, the PSD normalization increases and there is a hint that simultaneously the high-frequency slope becomes steeper. Finally, the X-ray time-lag spectrum of NGC 7314 shows some very weak signatures of relativistic reflection, and the energy resolved time-lag spectrum, for frequencies around 3 × 10-4 Hz, shows no signatures of X-ray reverberation. We show that the previous claim about ks time delays in this source, is simply an artefact induced by the minuscule number of points entering during the time-lag estimation in the low-frequency part of the time-lag spectrum (i.e. below 10-4 Hz).

  4. Assessing preoperative anxiety using a questionnaire and clinical rating: a prospective observational study.

    Laufenberg-Feldmann, Rita; Kappis, Bernd


    Preoperative anxiety and need for information can be detected during preoperative consultation via structured and standardised screening by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire. To identify the prevalence of preoperative anxiety and need for information, with regard to influencing factors such as age, sex, previous operation and grade of surgery, and to examine the level of agreement between patients' self-rating and physicians' ratings. Prospective observational study. Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany. Two hundred seventeen patients scheduled for elective surgery. The patients completed questionnaires prior to the interaction with the anaesthesiologist. Physicians were blinded to the patients' ratings and provided their subjective ratings about patients' anxiety and need for information immediately after seeing the patient. Degree of anxiety and need for information, agreement of patients' self-reports and physician's rating. 18.9% of patients were classified as 'anxiety cases' (31.8% in women and 10.6% in men). The grade of the intended surgery but no other investigated factor was related to patients' anxiety. Age (older patients) was correlated with information requirement (r = 0.21, P = 0.002). Analysis of agreement showed only weak correlations between patients' self-reports and physicians' ratings, demonstrated in low weighted Kappa-coefficients (0.12 to 0.32). The APAIS is a useful instrument to assess the level of patients' preoperative anxiety and the need for information. Given the relationship between preoperative anxiety and postoperative outcome, it seems justified to incorporate this approach into the preoperative consultation. German Clinical Trials Register DRKS00003084.

  5. Generalizability and decision studies to inform observational and experimental research in classroom settings.

    Bottema-Beutel, Kristen; Lloyd, Blair; Carter, Erik W; Asmus, Jennifer M


    Attaining reliable estimates of observational measures can be challenging in school and classroom settings, as behavior can be influenced by multiple contextual factors. Generalizability (G) studies can enable researchers to estimate the reliability of observational data, and decision (D) studies can inform how many observation sessions are necessary to achieve a criterion level of reliability. We conducted G and D studies using observational data from a randomized control trial focusing on social and academic participation of students with severe disabilities in inclusive secondary classrooms. Results highlight the importance of anchoring observational decisions to reliability estimates from existing or pilot data sets. We outline steps for conducting G and D studies and address options when reliability estimates are lower than desired.

  6. Observational study of the role of magnetic fields in star formation

    Hakobian, Nicholas Szandor

    emission with emission of other tracer molecules. We determined that CN is a good high density tracer which correlates well with other tracers such as HCO+ and HCN. From this, we concluded that these regions can be observed at high resolution and long integration times with an instrument capable of performing CN Zeeman measurements, when such an interferometer array becomes available. A study was additionally performed to apply the Li & Houde method of estimating magnetic field strengths from linewidth differences of ion and neutral molecular species. We were unable to replicate the previously published results; however, there were several differences in the datasets that may contribute to the non-detection of this effect. Several possible reasons for this discrepancy were determined, and further investigation may be able to determine whether this analysis technique holds significant merit.

  7. Repeat Targeted Prostate Biopsy under Guidance of Multiparametric MRI-Correlated Real-Time Contrast-Enhanced Ultrasound for Patients with Previous Negative Biopsy and Elevated Prostate-Specific Antigen: A Prospective Study

    Jang, Dong Ryul; Jung, Dae Chul; Oh, Young Taik; Noh, Songmi; Han, Kyunghwa; Kim, Kiwook; Rha, Koon-Ho; Choi, Young Deuk; Hong, Sung Joon


    Objectives To prospectively determine whether multi-parametric MRI (mpMRI) - contrast-enhanced ultrasound (CEUS) correlated, imaging-guided target biopsy (TB) method could improve the detection of prostate cancer in re-biopsy setting of patients with prior negative biopsy. Methods From 2012 to 2014, a total of 42 Korean men with a negative result from previous systematic biopsy (SB) and elevated prostate-specific antigen underwent 3T mpMRI and real-time CEUS guided TB. Target lesions were determined by fusion of mpMRI and CEUS. Subsequently, 12-core SB was performed by a different radiologist. We compared core-based cancer detection rates (CaDR) using the generalized linear mixed model (GLIMMIX) for each biopsy method. Results Core-based CaDR was higher in TB (17.92%, 38 of 212 cores) than in SB (6.15%, 31 of 504 cores) (p biopsy of patients with prior negative biopsy can improve CaDR based on the number of cores taken. PMID:26083348

  8. AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury

    Mason, Suzanne; Kuczawski, Maxine; Teare, M Dawn; Stevenson, Matt; Goodacre, Steve; Ramlakhan, Shammi; Morris, Francis; Rothwell, Joanne


    Objectives Management of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome. Design Multicentre, observational study using routine patient records. Setting 33 emergency departments in England and Scotland. Participants 3566 adults (aged ≥16 years) who had suffered blunt head injury and were currently taking warfarin. Main outcome measures Primary outcome measure was rate of adverse outcome defined as death or neurosurgery following initial injury, clinically significant CT scan finding or reattendance with related complication within 10 weeks of initial hospital attendance. Secondary objectives included identifying risk factors for adverse outcome using univariable and multivariable analyses. Results Clinical data available for 3534/3566 patients (99.1%), median age 79 years; mean initial international normalised ratio (INR) 2.67 (SD 1.34); 81.2% Glasgow Coma Scale (GCS) 15: 59.8% received a CT scan with significant head injury-related finding in 5.4% (n=208); 0.5% underwent neurosurgery; 1.2% patients suffered a head injury-related death. Overall adverse outcome rate was 5.9% (95% CI 5.2% to 6.7%). Patients with GCS=15 and no associated symptoms had lowest risk of adverse outcome (risk 2.7%; 95% CI 2.1 to 3.6). Patients with GCS=15 multivariable analysis (using imputation) found risk of adverse outcome to increase when reporting at least one associated symptom: vomiting (relative risk (RR) 1.8; 95% CI 1.0 to 3.4), amnesia (RR 3.5; 95% CI 2.1 to 5.7), headache (RR 1.3; 95% CI 0.8 to 2.2), loss of consciousness (RR 1.75; 95% CI 1.0 to 3.0). INR measurement did not predict adverse outcome in patients with GCS=15 (RR 1.1; 95% CI 1.0 to 1.2). Conclusions In alert warfarinised patients following head injury, the presence of symptoms is associated with greater risk of adverse outcome. Those with GCS=15

  9. Early rehabilitation for severe acquired brain injury in intensive care unit: multicenter observational study.

    Bartolo, Michelangelo; Bargellesi, Stefano; Castioni, Carlo A; Bonaiuti, Donatella; Antenucci, Roberto; Benedetti, Angelo; Capuzzo, Valeria; Gamna, Federica; Radeschi, Giulio; Citerio, Giuseppe; Colombo, Carolina; Del Casale, Laura; Recubini, Elena; Toska, Saimir; Zanello, Marco; D'Aurizio, Carlo; Spina, Tullio; Del Gaudio, Alredo; Di Rienzo, Filomena; Intiso, Domenico; Dallocchio, Giulia; Felisatti, Giovanna; Lavezzi, Susanna; Zoppellari, Roberto; Gariboldi, Valentina; Lorini, Luca; Melizza, Giovanni; Molinero, Guido; Mandalà, Giorgio; Pignataro, Amedeo; Montis, Andrea; Napoleone, Alessandro; Pilia, Felicita; Pisu, Marina; Semerjian, Monica; Pagliaro, Giuseppina; Nardin, Lorella; Scarponi, Federico; Zampolini, Mauro; Zava, Raffaele; Massetti, Maria A; Piccolini, Carlo; Aloj, Fulvio; Antonelli, Sergio; Zucchella, Chiara


    The increased survival after a severe acquired brain injury (sABI) raise the problem of making most effective the treatments in Intensive Care Unit (ICU)/Neurointensive Care Unit (NICU), also integrating rehabilitation care. Despite previous studies reported that early mobilization in ICU was effective in preventing complications and reducing hospital stay, few studies addressed the rehabilitative management of sABI patients in ICU/NICU. To collect clinical and functional data about the early rehabilitative management of sABI patients during ICU/NICU stay. Prospective, observational, multicenter study. Fourteen facilities supplied by intensive neurorehabilitation units and ICU/NICUs. Consecutive sABI patients admitted to ICU/NICU. Patients were evaluated at admission and then every 3-5 days. Clinical, functional and rehabilitative data, including Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), The Rancho Los Amigos Levels of Cognitive Functioning Scale (LCF), Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome scale (GOS) and Functional Independence Measure (FIM) were collected. One hundred and two patients (F/M 44/58) were enrolled. The mean duration of ICU stay was 24.7±13.9 days and the first rehabilitative evaluation occurred after 8.7±8.8 days. Regular postural changes and multijoint mobilization were prescribed in 63.7% and 64.7% cases, respectively. The mean session duration was 38±11.5 minutes. Swallowing evaluation was performed in 14.7% patients, psychological support was provided to 12.7% of patients' caregivers, while 17.6% received a psycho-educational intervention, and 28.4% were involved in interdisciplinary team meetings. The main discharge destinations were Severe Acquired Brain Injury rehabilitation units for 43.7%, intensive neurorehabilitation units for 20.7%. Data showed that early rehabilitation was not diffusely performed in sABI subjects in ICU/NICU and rehabilitative interventions were variable; one-third of subjects were

  10. Study of Vertical Movements of the European Crust Using Tide Gauge and Gnss Observations

    Tretyak Kornyliy


    Full Text Available This research is devoted to the study of vertical movements of the European crust on the basis of two independent methods, namely tide gauge and GNSS observations results. The description and classification of factors affecting sea level change has been made. The precision with which the movement of the earth's crust according to the results of tide gauge observations can be explored has been calculated . A methodology to identify the duration of tide gauge observations required for studies of vertical movements of the earth 's crust has been presented. Approximation of tide gauge time series with the help of Fourier series has been implemented, the need for long-term observations in certain areas has been explained. The diagram of the velocities of the vertical movements of the European crust on the basis of the tide gauge data and GNSS observations has been built and the anomalous areas where the observations do not coincide have been identified.

  11. Previous gastric bypass surgery complicating total thyroidectomy.

    Alfonso, Bianca; Jacobson, Adam S; Alon, Eran E; Via, Michael A


    Hypocalcemia is a well-known complication of total thyroidectomy. Patients who have previously undergone gastric bypass surgery may be at increased risk of hypocalcemia due to gastrointestinal malabsorption, secondary hyperparathyroidism, and an underlying vitamin D deficiency. We present the case of a 58-year-old woman who underwent a total thyroidectomy for the follicular variant of papillary thyroid carcinoma. Her history included Roux-en-Y gastric bypass surgery. Following the thyroid surgery, she developed postoperative hypocalcemia that required large doses of oral calcium carbonate (7.5 g/day), oral calcitriol (up to 4 μg/day), intravenous calcium gluconate (2.0 g/day), calcium citrate (2.0 g/day), and ergocalciferol (50,000 IU/day). Her serum calcium levels remained normal on this regimen after hospital discharge despite persistent hypoparathyroidism. Bariatric surgery patients who undergo thyroid surgery require aggressive supplementation to maintain normal serum calcium levels. Preoperative supplementation with calcium and vitamin D is strongly recommended.

  12. Observational Studies on Evaluating the Safety and Adverse Effects of Traditional Chinese Medicine

    Jung-Nein Lai; Jin-Ling Tang; Jung-Der Wang


    Background. This study aims to share our experiences when carrying out observational studies of traditional Chinese medicine (TCM). Methods. We have proactively monitored the safety profiles of Duhuo Jisheng Tang (DJT), Suan Zao Ren Tang (SZRT), and TMN-1. A list of adverse events (AEs), complete blood counts, and liver and kidney function tests were obtained from the participants during their scheduled hospital visits. Retrospective observational studies were conducted based on the reimburse...

  13. Evaluation of the Quality of Reporting of Observational Studies in Otorhinolaryngology - Based on the STROBE Statement.

    Hendriksma, Martine; Joosten, Michiel H M A; Peters, Jeroen P M; Grolman, Wilko; Stegeman, Inge


    Observational studies are the most frequently published studies in literature. When randomized controlled trials cannot be conducted because of ethical or practical considerations, an observational study design is the first choice. The STROBE Statement (STrengthening the Reporting of OBservational studies in Epidemiology) was developed to provide guidance on how to adequately report observational studies. The objectives were 1) to evaluate the quality of reporting of observational studies of otorhinolaryngologic literature using the STROBE Statement checklist, 2) to compare the quality of reporting of observational studies in the top 5 Ear, Nose, Throat (ENT) journals versus the top 5 general medical journals and 3) to formulate recommendations to improve adequate reporting of observational research in otorhinolaryngologic literature. The top 5 general medical journals and top 5 otorhinolaryngologic journals were selected based on their ISI Web of Knowledge impact factors. On August 3rd, 2015, we performed a PubMed search using different filters to retrieve observational articles from these journals. Studies were selected from 2010 to 2014 for the general medical journals and from 2015 for the ENT journals. We assessed all STROBE items to examine how many items were reported adequately for each journal type. The articles in the top 5 general medical journals (n = 11) reported a mean of 69.2% (95% confidence interval (CI): 65.8%-72.7%; median 70.6%), whereas the top 5 ENT journals (n = 29) reported a mean of 51.4% (95% CI: 47.7%-55.0%; median 50.0%). The two journal types reported STROBE items significantly different (p articles can considerably enhance. The quality of reporting was better in general medical journals compared to ENT journals. To improve the quality of reporting of observational studies, we recommend authors and editors to endorse and actively implement the STROBE Statement.

  14. Raw data from orientation studies in crystalline rock areas of the southeastern United States. [Maps, tables of field data and analytical data for sections of North and South Carolina and Georgia, previously reported sites of uranium mineralization

    Price, V.


    Raw data are presented on orientation studies conducted in crystalline rock areas of the Southeast which were chosen because of published references to uranium mineralization. Preliminary data for four orientation study areas are included. These areas are Lamar County, Georgia; Oconee County, South Carolina; Brush Creek, North Carolina; and North Harper, North Carolina. Sample locality maps, tables of field data, and tables of analytical data are included for each study area. (JGB)

  15. Efficacy and safety of a recombinant factor IX (Bax326) in previously treated patients with severe or moderately severe haemophilia B undergoing surgical or other invasive procedures: a prospective, open-label, uncontrolled, multicentre, phase III study.

    Windyga, J; Lissitchkov, T; Stasyshyn, O; Mamonov, V; Ghandehari, H; Chapman, M; Fritsch, S; Wong, W-Y; Pavlova, B G; Abbuehl, B E


    Haemostatic management of haemophilia B patients undergoing surgery is critical to patient safety. The aim of this ongoing prospective trial was to investigate the haemostatic efficacy and safety of a recombinant factor IX (rFIX) (Bax326) in previously treated subjects (12-65 years, without history of FIX inhibitors) with severe or moderately severe haemophilia B, undergoing surgical, dental or other invasive procedures. Haemostatic efficacy was assessed according to a predefined scale. Blood loss was compared to the average and maximum blood loss predicted preoperatively. Haemostatic FIX levels were achieved peri- and postoperatively in 100% of subjects (n = 14). Haemostasis was 'excellent' intraoperatively in all patients and postoperatively in those without a drain, and 'excellent' or 'good' at the time of drain removal and day of discharge in those with a drain employed. Following the initial dose, the mean FIX activity level rose from 6.55% to 107.58% for major surgeries and from 3.60% to 81.4% for minor surgeries. Actual vs. predicted blood loss matched predicted intraoperative blood loss but was equal to or higher than (but less than 150%) the maximum predicted postoperative blood loss reflecting the severity of procedure and FIX requirements. There were no related adverse events, severe allergic reactions or thrombotic events. There was no evidence that BAX326 increased the risk of inhibitor or binding antibody development to FIX. BAX326 was safe and effective for peri-operative management of 14 subjects with severe and moderately severe haemophilia B.

  16. Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials.

    Anglemyer, Andrew; Horvath, Hacsi T; Bero, Lisa


    Researchers and organizations often use evidence from randomized controlled trials (RCTs) to determine the efficacy of a treatment or intervention under ideal conditions. Studies of observational designs are often used to measure the effectiveness of an intervention in 'real world' scenarios. Numerous study designs and modifications of existing designs, including both randomized and observational, are used for comparative effectiveness research in an attempt to give an unbiased estimate of whether one treatment is more effective or safer than another for a particular population.A systematic analysis of study design features, risk of bias, parameter interpretation, and effect size for all types of randomized and non-experimental observational studies is needed to identify specific differences in design types and potential biases. This review summarizes the results of methodological reviews that compare the outcomes of observational studies with randomized trials addressing the same question, as well as methodological reviews that compare the outcomes of different types of observational studies. To assess the impact of study design (including RCTs versus observational study designs) on the effect measures estimated.To explore methodological variables that might explain any differences identified.To identify gaps in the existing research comparing study designs. We searched seven electronic databases, from January 1990 to December 2013.Along with MeSH terms and relevant keywords, we used the sensitivity-specificity balanced version of a validated strategy to identify reviews in PubMed, augmented with one term ("review" in article titles) so that it better targeted narrative reviews. No language restrictions were applied. We examined systematic reviews that were designed as methodological reviews to compare quantitative effect size estimates measuring efficacy or effectiveness of interventions tested in trials with those tested in observational studies

  17. Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies

    Brorson, S.; Bagger, J.; Sylvest, A.;


    on the classification of displaced four-part fractures according to the Neer system. Published and unpublished data from five observer studies were reviewed. Observers agreed less on displaced four-part fractures than on the overall Neer classification. Mean kappa values for interobserver agreement ranged from 0...

  18. Wind‐gust parametrizations at heights relevant for wind energy: a study based on mast observations

    Suomi, I.; Vihma, T.; Gryning, Sven-Erik;


    gustiness conditions were studied using observations from two coastal/archipelago weather masts in the Gulf of Finland (northern Europe) with observation heights between 30 and 143 m. Only moderate and strong wind cases were addressed. Both masts were located over relatively flat terrain but the local...

  19. An Observational Analysis of Coaching Behaviors for Career Development Event Teams: A Mixed Methods Study

    Ball, Anna L.; Bowling, Amanda M.; Sharpless, Justin D.


    School Based Agricultural Education (SBAE) teachers can use coaching behaviors, along with their agricultural content knowledge to help their Career Development Event (CDE) teams succeed. This mixed methods, collective case study observed three SBAE teachers preparing multiple CDEs throughout the CDE season. The teachers observed had a previous…

  20. Work-site musculoskeletal pain risk estimates by trained observers - a prospective cohort study

    Coenen, P.; Kingma, I.; Boot, C.R.L.; Douwes, M.; Bongers, P.M.; Dieën, J.H. van


    Work-related musculoskeletal pain (MSP) risk assessments by trained observers are often used in ergonomic practice; however, the validity may be questionable. We investigated the predictive value of work-site MSP risk estimates in a prospective cohort study of 1745 workers. Trained observers estimat

  1. Skin lesions in children admitted to the paediatric intensive care unit: an observational study

    Sillevis Smitt, J.H.; van Woensel, J.B.M.; Bos, A.P.


    We analysed, by a prospective observational study over a 3-year period, the frequency and character of dermatological symptoms and diseases in children admitted to a tertiary general paediatric intensive care unit (PICU) of a university hospital. Skin problems were observed in 42 of 1,800 children

  2. Work-site musculoskeletal pain risk estimates by trained observers - a prospective cohort study

    Coenen, P.; Kingma, I.; Boot, C.R.L.; Douwes, M.; Bongers, P.M.; Dieën, J.H. van


    Work-related musculoskeletal pain (MSP) risk assessments by trained observers are often used in ergonomic practice; however, the validity may be questionable. We investigated the predictive value of work-site MSP risk estimates in a prospective cohort study of 1745 workers. Trained observers

  3. Detailed Study of the Internal Structure of a Red-giant Star Observed with Kepler

    Di Mauro, M. P.; Ventura, R.; Cardini, D.;


    We study the internal structure and evolutionary state of KIC 4351319, a red-giant star observed with the Kepler satellite. The use of 25 individual oscillation frequencies, together with the accurate atmospheric data provided by ground-based spectroscopic observations, allowed us to estimate the...

  4. Combining HVSR microtremor observations with the SPAC method for site resonance study of the Tamar Valley in Launceston (Tasmania, Australia)

    Claprood, M.; Asten, M. W.; Kristek, J.


    The presence of the deep and narrow Tamar Valley in the City of Launceston (Tasmania, Australia), in-filled with soft sediments above hard dolerite bedrock, induces a complex pattern of resonance across the city. Horizontal to vertical spectrum ratio (HVSR) microtremor observations are combined with 1-D shear wave velocity (SWV) profiles evaluated from spatially averaged coherency spectra (SPAC) observations of the vertical component of the microtremor wavefield to complete a site resonance study in a valley environment such as the Tamar Valley. Using the methodology developed in a previous paper, 1-D SWV profiles are interpreted from observed coherency spectra (axial-COH) above the deepest point of the Tamar Valley, using pairs of sensors spatially separated parallel to the valley axis. The 1-D SWV profiles interpreted at five sites suggest the depth to bedrock interface varies from approximately z= 25 m north of the city, to z= 250 m above the deepest point of the valley. Numerical simulations of the propagation of surface waves in a 2-D model representation of the Tamar Valley compare well with HVSR observations recorded on two profiles transverse to the valley axis. HVSR observations can identify the in-plane shear (SV) frequency of resonance above the deepest part of the valley on two separate profiles transverse to the valley axis. By computing the ellipticity curves from the preferred SWV profiles interpreted by the SPAC method, the antiplane shear (SH) modes of resonance expected to develop in the Tamar Valley are identified; modes which HVSR observations alone fail to locate with precision. HVSR observations suggest a complex mix of 1-D and 2-D patterns of resonance develops across the valley. The results from this paper suggest that HVSR microtremor observations can be combined with SPAC microtremor method to characterize the geology and the pattern of resonance in a 2-D narrow structure such as the Tamar Valley.

  5. Crisis-related observations in competition: a case study in basketball.

    Bar-Eli, M; Sachs, S; Tenenbaum, G; Pie, J S; Falk, B


    This study presents a unique observational approach to basketball, based on the theory of psychological performance crisis in competition. The approach used takes into account the responses of a player' s actions to significant social factors such as team-mates, spectators, the coach and the referees. The contribution of this approach beyond traditional observational techniques is discussed. In our investigation, a single case design was used, in which a professional basketball player was observed during 10 home and 3 away games of the regular season. The relations between the observations and the crisis concept are discussed in detail. In addition, some relevant methodological and applied aspects are presented.

  6. Aerodynamics simulation studies on the observation head placed on a board of the unmanned aerial vehicle

    Krzysztofik Izabela


    Full Text Available An important element of UAV equipment are observation heads. Observation head is multisensor optoelectronic system. It includes TV camera and infrared camera, safe for the eye rangefinder and laser pointer and a navigation system GPS. Image stability is provided by electro-mechanical gyro stability system. Optoelectronic head are designed for use in systems of detection, identification and observation of ground and air targets and in daylight and at night. In this paper simulation studies of the air masses flow around the observation head placed on the UAV deck, for different speeds of UAV movement were conducted. The results of numerical research were presented in a graphical form.

  7. Aerodynamics simulation studies on the observation head placed on a board of the unmanned aerial vehicle

    Krzysztofik, Izabela; Blasiak, Slawomir


    An important element of UAV equipment are observation heads. Observation head is multisensor optoelectronic system. It includes TV camera and infrared camera, safe for the eye rangefinder and laser pointer and a navigation system GPS. Image stability is provided by electro-mechanical gyro stability system. Optoelectronic head are designed for use in systems of detection, identification and observation of ground and air targets and in daylight and at night. In this paper simulation studies of the air masses flow around the observation head placed on the UAV deck, for different speeds of UAV movement were conducted. The results of numerical research were presented in a graphical form.

  8. Empowerment perceptions of educational managers from previously ...

    Erna Kinsey

    A literature study, including an internet-based search, and empirical ... provided and educational policy implications highlighted for implementation of empowerment ... of educational managers themselves; empowerment of teachers and staff, ...

  9. Composite sampling a novel method to accomplish observational economy in environmental studies

    Patil, Ganapati P; Taillie, Charles


    This monograph provides a comprehensive statistical account of composite sampling as an ingenious environmental sampling method to help accomplish observational economy in a variety of environmental and ecological studies.

  10. COGNOS : Care for People With Cognitive Dysfunction A National Observational Study

    Mets, Tony; De Deyn, Peter P.; Pals, Philippe; De Lepeleire, Jan; Vandewoude, Maurits; Ventura, Manfredi; Ivanoiu, Adrian; Albert, Adelin; Seghers, An-Katrien


    Care plans are intended to improve the independence and functioning of patients with cognitive dysfunction and support the caregivers involved. They are an integral part of the Belgian reimbursement procedure for cholinesterase inhibitors. This nationwide, multicenter, observational study examined t

  11. Coronary revascularization in ischemic heart disease: lessons from observational studies and randomized clinical trials

    N.F. Mercado (Nestor)


    textabstractThis thesis presents an overview of clinical trials and observational studies on coronary revascularization and evaluates the results obtained with revascularization in different subsets of patients treated with percutaneous coronary intervention or coronary artery bypass graft surgery.

  12. Aspirin might reduce the incidence of pancreatic cancer: A meta-analysis of observational studies

    Zhang, Yan-Peng; Wan, You-Dong; Sun, Yu-Ling; Li, Jian; Zhu, Rong-Tao


    .... We searched PubMed and Embase for observational (cohort or case-control) studies examining the consumption of aspirin and other NSAIDs and the incidence of or mortality rates associated with pancreatic cancer...

  13. Observational study of patients switched to the fixed travoprost 0.004%/timolol 0.5% combination in Croatia.

    Mandic, Z; Novak-Lauš, K; Bojic, L; Popovic-Suic, S; Maricic-Došen, V; Pelcic, G; Dobutovic, D; Biuk, D; Kovacic, Z; Pavan, J


    The purpose of this study was to assess both the benefits of a 3-month travoprost 0.004%/timolol 0.5%fixed combination (trav/tim) regimen in comparison with previous medications for the control of intraocular pressure (IOP) and the tolerability of these drug regimens in glaucoma patients. An observational, non-interventional, open-label study of 406 eyes with primary open angle glaucoma and ocular hypertension was thus undertaken. One drop of trav/tim fixed combination was administered in the evening for 3 months. Patients were divided into five groups according to previous drug regimens: timolol 0.5% monotherapy; betaxolol 0.5% monotherapy; latanoprost 0.005% monotherapy; travoprost 0.004% monotherapy; and dorzolamide 2%/timolol 0.5% fixed combination. Upon medication substitution, the trav/tim fixed combination provided better IOP control and tolerability in all five patient groups. At the 3-month follow up, the mean IOP changes from previous therapy were as follows: 5.2 ± 2.7 mmHg (20.8% change) in timolol 0.5% group; 5.7 ± 2.2 mmHg (22.5% change) in betaxolol 0.5% group; 3.8 ± 2.6 mmHg (24.5% change) in latanoprost 0.005% group; 4.4 ± 2.8 mmHg (20% change) in travoprost 0.004% group; and 3.4 ± 4.1 mmHg (14.5% change) in dorzolamide 2%/timolol 0.5% fixed combination group. The difference between baseline and trav/tim combination patient satisfaction at the 3-month follow-up was significant. Thus, the trav/tim fixed combination provided better IOP control and tolerability than previous mono- or polytherapies. Copyright 2010 Prous Science, S.A.U. or its licensors. All rights reserved.

  14. Studies of Arctic Tropospheric Ozone Depletion Events Through Buoy-Borne Observations and Laboratory Studies

    Halfacre, John W.

    The photochemically-induced destruction of ground-level Arctic ozone in the Arctic occurs at the onset of spring, in concert with polar sunrise. Solar radiation is believed to stimulate a series of reactions that cause the production and release of molecular halogens from frozen, salty surfaces, though this mechanism is not yet well understood. The subsequent photolysis of molecular halogens produces reactive halogen atoms that remove ozone from the atmosphere in these so-called "Ozone Depletion Events" (ODEs). Given that much of the Arctic region is sunlit, meteorologically stable, and covered by saline ice and snow, it is expected that ODEs could be a phenomenon that occurs across the entire Arctic region. Indeed, an ever-growing body of evidence from coastal sites indicates that Arctic air masses devoid of O3 most often pass over sea ice-covered regions before arriving at an observation site, suggesting ODE chemistry occurs upwind over the frozen Arctic Ocean. However, outside of coastal observations, there exist very few long-term observations from the Arctic Ocean from which quantitative assessments of basic ODE characteristics can be made. This work presents the interpretation of ODEs through unique chemical and meteorological observations from several ice-tethered buoys deployed around the Arctic Ocean. These observations include detection of ozone, bromine monoxide, and measurements of temperature, relative humidity, atmospheric pressure, wind speed, and wind direction. To assess whether the O-Buoys were observing locally based depletion chemistry or the transport of ozone-poor air masses, periods of ozone decay were interpreted based on current understanding of ozone depletion kinetics, which are believed to follow a pseudo-first order rate law. In addition, the spatial extents of ODEs were estimated using air mass trajectory modeling to assess whether they are a localized or synoptic phenomenon. Results indicate that current understanding of the



    Objective: To (I) describe anthropometric and body-size measurements in the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) population at baseline and (2) examine potential secular trends in the prevalence of obesity in young black and white girls by comparing NGHS baseline

  16. Twelve-week efficacy and safety study of mometasone furoate/formoterol 200/10 microg and 400/10 microg combination treatments in patients with persistent asthma previously receiving high-dose inhaled corticosteroids

    Weinstein, Steven F; Corren, Jonathan; Murphy, Kevin;


    A significant unmet medical need exists in patients with uncontrolled asthma. The purpose of this study was to evaluate the efficacy and safety of mometasone furoate/formoterol (MF/F) 400/10 microg versus MF 400 microg administered twice-daily (b.i.d.) via metered-dose inhaler in patients...




    Objective: To (I) describe anthropometric and body-size measurements in the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) population at baseline and (2) examine potential secular trends in the prevalence of obesity in young black and white girls by comparing NGHS baseline

  18. Association Between the Mediterranean Diet and Cancer Risk: A Review of Observational Studies

    Verberne, L.D.M.; Bach-Faig, A.; Buckland, G.; Serra-Majem, L.


    The aim of this article was to summarize the evidence concerning the association between Mediterranean dietary pattern and cancer risk in observational epidemiological studies. All the studies that met the following criteria were reviewed: human cohort and case-control studies that examined the effe

  19. Sensitivity studies of spin cut-off models on fission fragment observables

    Thulliez L.


    Full Text Available A fission fragment de-excitation code, FIFRELIN, is being developed at CEA Cadarache. It allows probing the characteristics of the prompt emitted particles, neutrons and gammas, during the de-excitation process of fully accelerated fission fragments. The knowledge of the initial states of the fragments is important to accurately reproduce the fission fragment observables. In this paper a sensitivity study of various spin cut-off models, completely defining the initial fission fragment angular momentum distribution has been performed. This study shows that the choice of the model has a significant impact on gamma observables such as spectrum and multiplicity and almost none on the neutron observables.

  20. Disagreements in meta-analyses using outcomes measured on continuous or rating scales: observer agreement study

    Tendal, Britta; Higgins, Julian P T; Jüni, Peter


    OBJECTIVE: To study the inter-observer variation related to extraction of continuous and numerical rating scale data from trial reports for use in meta-analyses. DESIGN: Observer agreement study. DATA SOURCES: A random sample of 10 Cochrane reviews that presented a result as a standardised mean...... difference (SMD), the protocols for the reviews and the trial reports (n=45) were retrieved. DATA EXTRACTION: Five experienced methodologists and five PhD students independently extracted data from the trial reports for calculation of the first SMD result in each review. The observers did not have access...

  1. Milky Way Past Was More Turbulent Than Previously Known


    Results of 1001 observing nights shed new light on our Galaxy [1] Summary A team of astronomers from Denmark, Switzerland and Sweden [2] has achieved a major breakthrough in our understanding of the Milky Way, the galaxy in which we live. After more than 1,000 nights of observations spread over 15 years, they have determined the spatial motions of more than 14,000 solar-like stars residing in the neighbourhood of the Sun. For the first time, the changing dynamics of the Milky Way since its birth can now be studied in detail and with a stellar sample sufficiently large to allow a sound analysis. The astronomers find that our home galaxy has led a much more turbulent and chaotic life than previously assumed. PR Photo 10a/04: Distribution on the sky of the observed stars. PR Photo 10b/04: Stars in the solar neigbourhood and the Milky Way galaxy (artist's view). PR Video Clip 04/04: The motions of the observed stars during the past 250 million years. Unknown history Home is the place we know best. But not so in the Milky Way - the galaxy in which we live. Our knowledge of our nearest stellar neighbours has long been seriously incomplete and - worse - skewed by prejudice concerning their behaviour. Stars were generally selected for observation because they were thought to be "interesting" in some sense, not because they were typical. This has resulted in a biased view of the evolution of our Galaxy. The Milky Way started out just after the Big Bang as one or more diffuse blobs of gas of almost pure hydrogen and helium. With time, it assembled into the flattened spiral galaxy which we inhabit today. Meanwhile, generation after generation of stars were formed, including our Sun some 4,700 million years ago. But how did all this really happen? Was it a rapid process? Was it violent or calm? When were all the heavier elements formed? How did the Milky Way change its composition and shape with time? Answers to these and many other questions are 'hot' topics for the

  2. Impacts of Previous Winter Kuroshio SSTA on Summer Rainfall in China

    LI Zhongxian; SUN Zhaobo; NI Donghong; ZENG Gang


    The relationship of Kuroshio sea surface temperature anomaly (SSTA) in the previous winter and summer rainfall in China was analyzed based on observational studies and numerical simulations. Observational results indicate that there is a close relation between Kuroshio SSTA and precipitation in China. When Kuroshio SSTA is positive, the western Pacific subtropical high will be stronger and extend farther westward in the following summer, with Asian summer monsoon weaker and the frontal precipitation further southward. As a result, summer precipitation increases (decreases) in the mid-lower reaches of the Yangtze River (in North and Northeast China), and vice versa. Conclusions drawn by NCAR-CCM3 testify the observational results.

  3. [Registration of observational studies: it is time to comply with the Declaration of Helsinki requirement].

    Dal-Ré, Rafael; Delgado, Miguel; Bolumar, Francisco


    Publication bias is a serious deficiency in the current system of disseminating the results of human research studies. Clinical investigators know that, from an ethical standpoint, they should prospectively register clinical trials in a public registry before starting them. In addition, it is believed that this approach will help to reduce publication bias. However, most studies conducted in humans are observational rather than experimental. It is estimated that less than 2% out of 2 million concluded or ongoing observational studies have been registered. The 2013 revision of the Declaration of Helsinki requires registration of any type of research study involving humans or identifiable samples or data. It is proposed that funding agencies, such as the Fondo de Investigaciones Sanitarias, as well as private companies, require preregistration of observational studies before providing funding. It is also proposed that Research Ethics Committees which, following Spanish regulation, have been using the Declaration as the framework for assessing the ethics of clinical trials with medicines since 1990, should follow the same provisions for the assessment of health-related observational studies: therefore, they should require prospective registration of studies before granting their final approval. This would allow observational study investigators to be educated in complying with an ethical requirement recently introduced in the most important ethical code for research involving humans. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  4. Study on the Effects of Diverting Water into Upper Burnt Pocket, Navigation Pool Number 18, Illinois and A Field Test of the Regression Simulation Model Previously Developed on Navigation Pool Number 8.


    concentrations generally accepted as levels which, when combined with specific morphological , hydrological ani climatic factors, can lead to excessive...River Basin Commission from The River Studies Center, Univ. Wisconsin-La Crosse. 114 pp. Simons, D. B. 1979. River and canal morphology . Chapter 5 in...subintegerrima (Vahi) Fern. PHYTOLACCACEAE Phytolacca americana L. Pokeweed PLATANACEAE Platanus occidentalis L. Sycamore POACEAE Leersia oryzoides (L.) Sw

  5. Twelve-week efficacy and safety study of mometasone furoate/formoterol 200/10 microg and 400/10 microg combination treatments in patients with persistent asthma previously receiving high-dose inhaled corticosteroids

    Weinstein, Steven F; Corren, Jonathan; Murphy, Kevin


    with asthma uncontrolled on high-dose inhaled corticosteroids (ICS). In a 12-week, randomized, multicenter, double-blind, parallel-group study, patients (>or=12 years of age) were randomized to MF/F 200/10 microg, MF/F 400/10 microg, or MF 400 microg, b.i.d. after a 2- to 3-week open-label run in with MF 400...

  6. The OptiMUM-study: EMDR therapy in pregnant women with posttraumatic stress disorder after previous childbirth and pregnant women with fear of childbirth: design of a multicentre randomized controlled trial

    Baas, M. A. M.; Stramrood, C. A. I.; Dijksman, L. M.; de Jongh, A.; van Pampus, M. G.


    ABSTRACT Background: Approximately 3% of women develop posttraumatic stress disorder (PTSD) after giving birth, and 7.5% of pregnant women show a pathological fear of childbirth (FoC). FoC or childbirth-related PTSD during (a subsequent) pregnancy can lead to a request for an elective caesarean section as well as adverse obstetrical and neonatal outcomes. For PTSD in general, and several subtypes of specific phobia, eye movement desensitization and reprocessing (EMDR) therapy has been proven effective, but little is known about the effects of applying EMDR during pregnancy. Objective: To describe the protocol of the OptiMUM-study. The main aim of the study is to determine whether EMDR therapy is an effective and safe treatment for pregnant women with childbirth-related PTSD or FoC. In addition, the cost-effectiveness of this approach will be analysed. Method: The single-blind OptiMUM-study consists of two two-armed randomized controlled trials (RCTs) with overlapping design. In several hospitals and community midwifery practices in Amsterdam, the Netherlands, all eligible pregnant women with a gestational age between eight and 20 weeks will be administered the Wijma delivery expectations questionnaire (WDEQ) to asses FoC. Multiparous women will also receive the PTSD checklist for DSM-5 (PCL-5) to screen for possible PTSD. The clinician administered PTSD scale (CAPS-5) will be used for assessing PTSD according to DSM-5 in women scoring above the PCL-5 cut-off value. Fifty women with childbirth-related PTSD and 120 women with FoC will be randomly allocated to either EMDR therapy carried out by a psychologist or care-as-usual. Women currently undergoing psychological treatment or women younger than 18 years will not be included. Primary outcome measures are severity of childbirth-related PTSD or FoC symptoms. Secondary outcomes are percentage of PTSD diagnoses, percentage caesarean sections, subjective childbirth experience, obstetrical and neonatal complications

  7. Improving visual observation skills through the arts to aid radiographic interpretation in veterinary practice: A pilot study.

    Beck, Cathy; Gaunt, Heather; Chiavaroli, Neville


    Radiographic interpretation is a perceptual and cognitive skill. Recently core veterinary radiology textbooks have focused on the cognitive (i.e., the clinical aspects of radiographic interpretation) rather than the features of visual observation that improve identification of abnormalities. As a result, the skill of visual observation is underemphasized and thus often underdeveloped by trainees. The study of the arts in medical education has been used to train and improve visual observation and empathy. The use of the arts to improve visual observation skills in Veterinary Science has not been previously described. Objectives of this pilot study were to adapt the existing Visual Arts in Health Education Program for medical and dental students at the University of Melbourne, Australia to third year Doctor of Veterinary Medicine students and evaluate their perceptions regarding the program's effects on visual observation skills and confidence with respect to radiographic interpretation. This adaptation took the form of a single seminar given to third year Doctor of Veterinary Medicine students. Following the seminar, students reported an improved approach to radiographic interpretation and felt they had gained skills which would assist them throughout their career. In the year following the seminar, written reports of the students who attended the seminar were compared with reports from a matched cohort of students who did not attend the seminar. This demonstrated increased identification of abnormalities and greater description of the abnormalities identified. Findings indicated that explicit training in visual observation may be a valuable adjunct to the radiology training of Doctor of Veterinary Medicine students. © 2017 American College of Veterinary Radiology.

  8. Time to pregnancy after a previous miscarriage in subfertile couples

    T. Cox; J.W. van der Steeg; P. Steures; P.G.A. Hompes; F. van der Veen; M.J.C. Eijkemans; J.H. Schagen van Leeuwen; C. Renckens; P.M.M. Bossuyt; B.W.J. Mol


    Objective: To assess the time to spontaneous ongoing pregnancy after a previous miscarriage in subfertile couples. Design: A prospective cohort study. Setting: The study was conducted in 38 fertility centers in the Netherlands. Patient(s): Subfertile couples who miscarried after completing their bas

  9. Analysis of Previous Studies on African Nobel Prize Winner Wole Soyinka in China%非裔诺贝尔文学奖得主沃勒·索因卡在中国的研究

    江玉娇; 盛钰


    作为首位黑人诺贝尔文学奖得主,沃勒·索因卡(1934-)在其作品中融入了古老的神话、悠久的传统以及欧洲文化的文学遗产。为了深入考察和分析索因卡在中国的研究现状,文章首先梳理索因卡作品在中国的译介和引入,然后将其文学作品按照诗歌、小说、戏剧3个题材在中国的研究现状进行综述,以期探讨国内在接受非洲异质文化时的规律与特征;最后,反思目前对该作家的研究中尚存的缺失与不足,并指出今后发展的研究方向和设想,希望以此为推进国内非洲本土文学和文化研究提供借鉴。%As the first Nobel Prize winner in Africa,Wole Soyinka integrates his works with ancient Afri-can myths,a long tradition and the literary heritages of European cultures. In order to make an in-depth re-view and analysis of studies of Wole Soyinka in China,this paper,firstly,analyzes the introduction and trans-lations of his works,and then,makes a review of the present researches of his poems,novels and dramas re-spectively so as to find out the rules of how Chinese scholars have accepted the heterogeneous African cultures. At last,this paper analyzes the problems in the study of Soyinka and points out new directions and perspectives of further studies in the hope of providing reference for promoting the domestic studies on African literature and culture.

  10. The predictive effect of fear-avoidance beliefs on low back pain among newly qualified health care workers with and without previous low back pain: a prospective cohort study

    Jensen, Jette Nygaard; Albertsen, Karen; Borg, Vilhelm;


    Health care workers have a high prevalence of low back pain (LBP). Although physical exposures in the working environment are linked to an increased risk of LBP, it has been suggested that individual coping strategies, for example fear-avoidance beliefs, could also be important in the development...... and maintenance of LBP. Accordingly, the main objective of this study was to examine (1) the association between physical work load and LBP, (2) the predictive effect of fear-avoidance beliefs on the development of LBP, and (3) the moderating effect of fear-avoidance beliefs on the association between physical...

  11. Uterine rupture without previous caesarean delivery

    Thisted, Dorthe L. A.; H. Mortensen, Laust; Krebs, Lone


    .3/100,000 deliveries. Multiparity (RR 8.99 (95% CI 1.86-43.29)), induction of labour (RR 3.26 (95% CI 1.24-8.57)), epidural analgesia (RR 10.78 (95% CI 4.25-27.39)), and augmentation by oxytocin (RR 9.50 (95% CI 3.15-28.63)) were associated with uterine rupture. Induction of labour was not significantly related...... to uterine rupture when adjusted for parity, epidural analgesia and augmentation by oxytocin. CONCLUSION: Although uterine rupture is rare, its association with epidural analgesia and augmentation of labour with oxytocin in multipara should be considered. Thus, vigilance should be exercised when labour...... is obstructed and there is need for epidural analgesia and/or augmentation by oxytocin in multiparous women. Due to the rare occurrence of uterine rupture caution should be exerted when interpreting the findings of this study....


    Bellad Girija


    Full Text Available BACKGROUND Carefully selected cases of Vaginal Birth after Caesarean Section (VBAC is safe and successful. Even though options of elective caesarean section or a trial of labour are given to women with prior caesarean section, the risk is always present. In successful VBACs, morbidity is less compared to repeat caesarean section. That is why this study is conducted to determine the outcome of pregnancy in women with previous CS. OBJECTIVES 1. To evaluate the clinical course of labour in cases with previous caesarean section. 2. To study the perinatal outcome in cases with previous caesarean section either by vaginal delivery or repeat Caesarean section. 3. To study maternal morbidity in these cases. METHOD A retrospective analysis of medical records of 250 women with a previous caesarean section, who delivered in BIMS Hospital between May 2015 and July 2015 was carried out. Women with recurrent indications for caesarean section and those having nonrecurrent indications with any complicating factors in present pregnancy and women with previous two caesarean sections were not given trial for vaginal delivery. Those women with previous section for the non-recurrent indications were given trial for vaginal delivery. STATISTICAL ANALYSIS Was done by Chi-square test. RESULT In 250 cases, 132 cases were given trial for vaginal delivery. In these, vaginal delivery was 61.3% and repeat section was 38%. There is an association between maternal morbidity and type of delivery. Birth weight was associated with the type of delivery. There is no association between neonatal outcome and type of delivery. CONCLUSION In carefully selected patients, appropriate timing and close supervision, trial of vaginal delivery in previous one caesarean section is safe and successful. Individual approach seems to be the best.

  13. Two-stage replication of previous genome-wide association studies of AS3MT-CNNM2-NT5C2 gene cluster region in a large schizophrenia case-control sample from Han Chinese population.

    Guan, Fanglin; Zhang, Tianxiao; Li, Lu; Fu, Dongke; Lin, Huali; Chen, Gang; Chen, Teng


    Schizophrenia is a devastating psychiatric condition with high heritability. Replicating the specific genetic variants that increase susceptibility to schizophrenia in different populations is critical to better understand schizophrenia. CNNM2 and NT5C2 are genes recently identified as susceptibility genes for schizophrenia in Europeans, but the exact mechanism by which these genes confer risk for schizophrenia remains unknown. In this study, we examined the potential for genetic susceptibility to schizophrenia of a three-gene cluster region, AS3MT-CNNM2-NT5C2. We implemented a two-stage strategy to conduct association analyses of the targeted regions with schizophrenia. A total of 8218 individuals were recruited, and 45 pre-selected single nucleotide polymorphisms (SNPs) were genotyped. Both single-marker and haplotype-based analyses were conducted in addition to imputation analysis to increase the coverage of our genetic markers. Two SNPs, rs11191419 (OR=1.24, P=7.28×10(-5)) and rs11191514 (OR=1.24, P=0.0003), with significant independent effects were identified. These results were supported by the data from both the discovery and validation stages. Further haplotype and imputation analyses also validated these results, and bioinformatics analyses indicated that CALHM1, which is located approximately 630kb away from CNNM2, might be a susceptible gene for schizophrenia. Our results provide further support that AS3MT, CNNM2 and CALHM1 are involved with the etiology and pathogenesis of schizophrenia, suggesting these genes are potential targets of interest for the improvement of disease management and the development of novel pharmacological strategies.

  14. A multicenter, open-label, randomized phase II controlled study of rh-endostatin (Endostar) in combination with chemotherapy in previously untreated extensive-stage small-cell lung cancer.

    Lu, Shun; Li, Lu; Luo, Yi; Zhang, Li; Wu, Gang; Chen, Zhiwei; Huang, Cheng; Guo, Shuliang; Zhang, Yiping; Song, Xiangqun; Yu, Yongfeng; Zhou, Caicun; Li, Wei; Liao, Meilin; Li, Baolan; Xu, Liyan; Chen, Ping; Hu, Chunhong; Hu, Chengping


    Based on promising efficacy in a single-arm study, a randomized phase II trial was designed to compare the efficacy and safety of adding rh-endostatin (Endostar) to first-line standard etoposide and carboplatin (EC) chemotherapy for treatment of extensive-stage small-cell lung cancer. One hundred forty Chinese patients with pathologically confirmed, extensive-stage small-cell lung cancer were randomly assigned to EC alone or rh-endostatin + EC for 4-6 cycles, followed by single-agent rh-endostatin until progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). The secondary endpoints included overall survival, Objective response rate (ORR), and quality of life. Median PFS was 6.4 months with rh-endostatin + EC (n = 69) and 5.9 months with EC (n = 69) (hazard ratio 0.8 [95% confidence interval 0.6-1.1]). PFS was significantly higher with rh-endostatin + EC than with EC (hazard ratio 0.4 [0.2-0.9; p = 0.020]) in female. Median overall survival was similar in both groups (12.1 versus 12.4 months, respectively [p = 0.82]). ORR was higher in the rh-endostatin + EC group (75.4%) than in the EC group (66.7%) (p = 0.348). The efficacy of rh-endostatin + EC relative to that of EC was reflected by greater improvements in patient-assessed quality of life scores after 4 and 6 weeks of treatment. There was no difference between each regimen in the incidence of nonhematological or Grade III-IV hematological toxicities. Addition of rh-endostatin to EC for the treatment of extensive-stage small-cell lung cancer had an acceptable toxicity profile, but did not improve overall survival, PFS, and ORR.

  15. Endoscopic Third Ventriculostomy in Previously Shunted Children

    Eva Brichtova


    Full Text Available Endoscopic third ventriculostomy (ETV is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%. There were two serious complications (4.7%—one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.

  16. Spectroscopic Studies of Extremely Metal-Poor Stars with Subaru/HDS:I. Observational Data

    Honda, S; Ando, H; Izumiura, H; Kajino, T; Kambe, E; Kawanomoto, S; Noguchi, K; Okita, K; Sadakane, K; Sato, B; Takada-Hidai, M; Takeda, Y; Watanabe, E; Beers, T C; Norris, J E; Ryan, S G


    We have obtained high-resolution (R $\\simeq$ 50,000 or 90,000), high-quality (S/N $\\ga$ 100) spectra of 22 very metal-poor stars ([Fe/H] $\\la$ -2.5) with the High Dispersion Spectrograph fabricated for the 8.2m Subaru Telescope. The spectra cover the wavelength range from 3500 to 5100 {\\AA}; equivalent widths are measured for isolated lines of numerous elemental species, including the $\\alpha$ elements, the iron-peak elements, and the light and heavy neutron-capture elements. Errors in the measurements and comparisons with previous studies are discussed. These data will be used to perform detailed abundance analyses in the following papers of this series. Radial velocities are also reported, and are compared with previous studies. At least one moderately r-process-enhanced metal-poor star, HD 186478, exhibits evidence of a small-amplitude radial velocity variation, confirming the binary status noted previously. During the course of this initial program, we have discovered a new moderately r-process-enhanced, ...

  17. Body Characteristics, Dietary Protein and Body Weight Regulation. Reconciling Conflicting Results from Intervention and Observational Studies?

    Ankarfeldt, Mikkel Z; Angquist, Lars; Stocks, Tanja;


    between greater protein intake and weight gain. In both types of studies the results are based on average weight changes, and show considerable diversity in both directions. This study investigates whether the discrepancy in the evidence could be due to recruitment of overweight and obese individuals......: This modified observational study, minimized the differences between the RCT and observational data with regard to dietary intake, participant characteristics and statistical analysis. Compared with low protein diet the high protein diet was associated with better weight maintenance when individuals...

  18. Do transfusions cause necrotizing enterocolitis? The complementary role of randomized trials and observational studies.

    Kirpalani, Haresh; Zupancic, John A F


    A systematic review and a meta-analysis of the published literature on the association between transfusions in newborns and the occurrence of transfusion-associated necrotizing enterocolitis were performed. We discuss the differences between findings in randomized trials, and the results of observational studies that first explored this putative link. We suggest the following framework: where observational studies play a hypothesis generating- role for therapies and harm, and randomized studies allow an acid test of that hypothesis. It is acknowledged that not all questions can be subject to a randomized evaluation, but argued that this particular association is amenable to such a test. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Using direct clinical observation to assess the quality of cesarean delivery in Afghanistan: an exploratory study.

    Evans, Cherrie Lynn; Kim, Young Mi; Yari, Khalid; Ansari, Nasratullah; Tappis, Hannah


    As part of a National Emergency Obstetric and Newborn Care (EmONC) Needs Assessment, a special study was undertaken in July 2010 to examine the quality of cesarean deliveries in Afghanistan and examine the utility of direct clinical observation as an assessment method in low-resource settings. This cross-sectional assessment of the quality of cesareans at 14 facilities in Afghanistan included a survey of surgeons regarding their routine cesarean practices, direct observation of 29 cesarean deliveries and comparison of observations with facility records for 34 additional cesareans conducted during the 3 days prior to the observation period at each facility. For both observed cases and record reviews, we assessed time intervals between specified points of care-arrival to the ward, first evaluation, detection of a complication, decision for cesarean, incision, and birth. All time intervals with the exception of "decision to skin incision" were longer in the record reviews than in observed cases. Prior cesarean was the most common primary indication for all cases. All mothers in both groups observed survived through one hour postpartum. Among newborns there were two stillbirths (7%) in observed births and seven (21%) record reviews. Although our sample is too small to show statistical significance, the difference is noteworthy. In six of the reviewed cesareans resulting in stillbirth, a fetal heart rate was recorded in the operating theater, although four were recorded as macerated. For the two fresh stillbirths, the cesarean surgeries were recorded as scheduled and not urgent. Direct observation of cesarean deliveries enabled us to assess a number of preoperative, postoperative, and intraoperative procedures that are often not described in medical records in low resource settings. Comparison of observations with findings from provider interviews and facility records allowed us to infer whether observed practices were typical of providers and facilities and detect

  20. An Optimal Observing System Study for the Kuroshio Extension using Particle Filters

    Kramer, Werner; van Leeuwen, Peter Jan; Pierieni, Stefano; Dijkstra, Henk


    The Kuroshio Extension - the eastward-flowing free jet formed when the warm waters of the Kuroshio separate from the Japanese coast - reveals bimodal behavior. It changes from an elongated, energetic meandering jet into a weaker, unstable jet with a reduced zonal penetration. Many of its characteristics, e.g. the decadal period and the more stable character of the elongated state, are also observed in a reduced-gravity ocean model of the northern Pacific basin with a schematic Japanese coastline driven by a constant double-gyre wind field. The success of this idealized model suggests that intrinsic nonlinear mechanisms play a major role in determining the meander pattern of the mean flow. The low complexity of the model makes it ideal to perform an observing system study. Here, we take a new approach by using particle filters to assimilate observations into the model. An ensemble of model states is integrated over time from an initial distribution. The first approach is to pick one run as the synthetic truth. Observations are produced from this synthetic truth with an additional observation error. The particle filter technique adjusts the weight of each ensemble run - each particle - according to the observation value and the error distribution. From the ensemble and its weight distribution the expectation and probability distribution of the state vector can be computed. As the ensemble itself is not altered by the filter, different sets of observations, e.g. with different geometrical configurations, locations and/or time resolutions, can be analyzed a posteriori. The particle filter analyses allows us to identify which observations have a large impact on reconstructing the true state of Kuroshio Extension. More precisely, which observations contribute to a (local) reduction in the entropy of the ensemble. In a way each observation is then linked to an area of influence, which permits for determining the flow of information. We will present results where

  1. Mechanisms of virologic failure in previously untreated HIV-infected patients from a trial of induction-maintenance therapy. Trilège (Agence Nationale de Recherches sur le SIDA 072) Study Team).

    Descamps, D; Flandre, P; Calvez, V; Peytavin, G; Meiffredy, V; Collin, G; Delaugerre, C; Robert-Delmas, S; Bazin, B; Aboulker, J P; Pialoux, G; Raffi, F; Brun-Vézinet, F


    In the Trilège trial, following induction with a zidovudine, lamivudine, and indinavir regimen, human immunodeficiency virus (HIV) replication was less suppressed by 2-drug maintenance therapy than by triple-drug therapy. To identify mechanisms of virologic failure in the 3 arms of the Trilège trial. Case-control study conducted from February to October 1998. Three urban hospitals in Paris, France. Fifty-eight case patients with virologic failure (HIV RNA rebound to >500 copies/mL in 2 consecutive samples) randomized to 3 therapy groups: triple drug (zidovudine, lamivudine, and indinavir), 8; zidovudine-lamivudine, 29; and zidovudine-indinavir, 21; the case patients were randomly matched with 58 control patients with sustained viral suppression. At virologic failure (S1 sample) and 6 weeks later (S2 sample), assessment of protease and reverse transcriptase gene mutations, plasma indinavir level, and degree of viral load rebound; pill count during induction and maintenance periods. Only 1 primary resistance mutation, M184V, was detected in S1 plasma samples from 4 of 6 patients in the triple-drug and in all 22 in the zidovudine-lamivudine therapy groups and in S2 plasma samples from 3 of 6 in the triple-drug and 20 of 21 in the zidovudine-lamivudine groups. Of controls, M184V was detected in 11 of 13 S1 plasma samples and in 10 of 11 S2 plasma samples. Indinavir levels were undetectable in all S1 samples but 2 in 7 triple-drug cases tested and in the expected range in 11 of 18 S1 and 5 of 12 S2 zidovudine-indinavir case plasma samples tested. Maintenance adherence rates were lower for cases vs controls for zidovudine (P = .05) and indinavir (P = .05). Low indinavir levels, lower adherence rates for zidovudine (P = .04) and lamivudine (P = .03), and rebound to near-baseline values suggested adherence as cause of early failure for 4 of 8 triple-drug cases. In the zidovudine-lamivudine arm, for which case and control adherence rates did not differ significantly (P

  2. A preliminary study for spatial representiveness of flux observation at ChinaFLUX sites


    <正>The results of eddy covariance observation system could represent the physical process at certain area of the surface. Thus point-to-area representativeness was of primary interest in flux observation. This research presents a preliminary study for flux observation at ChinaFLUX sites by the use of observation data and Flux Source Area Model (FSAM). Results show that the footprint expands and is further away from flux tower when atmosphere becomes more stable, the observation height increases, or the surfaces become smoother. This suggests that the area represented by the flux observation becomes larger. The distances from the reference point to the maximum point Smax and the minimum point x1 of source weight function (Dmax and Dmin, respectively) can be influenced by atmosphere stability which becomes longer when atmosphere is more stable. For more rough surfaces and lower observation point Dmax and Dmin become shorter. This research gives the footprint at level P=90% at ChinaFLUX sites at different atmosphere stability. The preliminary results of spatial representiveness at ChinaFLUX sites were given based on the dominant wind direction and footprint response to various factors. The study also provides some theoretical basis for data quality control and evaluating data uncertainty.

  3. Using and Experiencing the Academic Library: A Multisite Observational Study of Space and Place

    May, Francine; Swabey, Alice


    This study examines how students are using academic library spaces and the role these spaces are playing in the campus community. Data were collected on five campuses (two community colleges, two undergraduate universities, and one technical institute) via observational seating sweeps and questionnaires. The study found remarkably similar usage…

  4. A Comparative Study of Observed Score Approaches and Purification Procedures for Detecting Differential Item Functioning.

    Kwak, Nohoon; Davenport, Ernest C., Jr.; Davison, Mark L.

    The purposes of this study were to introduce the iterative purification procedure and to compare this with the two-step purification procedure, to compare false positive error rates and the power of five observed score approaches and to identify factors affecting power and false positive rates in each method. This study used 2,400 data sets that…

  5. The comparison of two analgesic regimes after ambulatory surgery: an observational study

    Worp, F. van der; Stapel, J.T.; Lako, S.J.; Hendriks, J.C.M.; Vissers, K.C.P.; Steegers, M.A.H.


    INTRODUCTION: Over the past 15 years, the number of ambulatory surgical procedures worldwide has increased continuously. Studies show that 30% to 40% of the patients experience moderate-to-severe pain in the first 48 hours. The objective of this observational study is to compare the percentage of

  6. The comparison of two analgesic regimes after ambulatory surgery: an observational study

    Worp, F. van der; Stapel, J.T.; Lako, S.J.; Hendriks, J.C.M.; Vissers, K.C.P.; Steegers, M.A.H.


    INTRODUCTION: Over the past 15 years, the number of ambulatory surgical procedures worldwide has increased continuously. Studies show that 30% to 40% of the patients experience moderate-to-severe pain in the first 48 hours. The objective of this observational study is to compare the percentage of mo

  7. Dietary patterns are associated with disease risk among participants in the women's health initiative observational study

    Coronary heart disease (CHD) is the leading cause of death in women. A nested case-control study tested whether dietary patterns predicted CHD events among 1224 participants in the Women’s Health Initiative-Observational Study (WHI-OS) with centrally confirmed CHD, fatal or nonfatal myocardial infar...

  8. The effect of maternal ketanserin use on the circulation of the neonate : a prospective, observational study

    Schaafstra, Liselotte; van Roon, Eric N.; Morssink, Leonard P.; de Vries, Nathalie K. S.

    Objective: High ketanserin levels are found in the umbilical cord after maternal treatment. However, the effect on the circulation of the neonate has never been investigated. Study design: A prospective, observational study was performed at the neonate ward at the Medical Centre Leeuwarden, The

  9. Coagulation Profile Dynamics in Pediatric Patients with Cushing Syndrome: A Prospective, Observational Comparative Study

    Birdwell, L. (Leah); M.B. Lodish (Maya Beth); Tirosh, A. (Amit); P. Chittiboina (Prashant); M. Keil (Mark); Lyssikatos, C. (Charlampos); Belyavskaya, E. (Elena); R.A. Feelders (Richard); C.A. Stratakis (Constantine)


    textabstractObjective To evaluate the association between Cushing syndrome and hypercoagulability in children. Study design A prospective, observational study was performed of 54 patients with Cushing syndrome, 15.1 ± 3.9 years, treated at the National Institutes of Health Clinical Center.

  10. The comparison of two analgesic regimes after ambulatory surgery: an observational study

    Worp, F. van der; Stapel, J.T.; Lako, S.J.; Hendriks, J.C.M.; Vissers, K.C.P.; Steegers, M.A.H.


    INTRODUCTION: Over the past 15 years, the number of ambulatory surgical procedures worldwide has increased continuously. Studies show that 30% to 40% of the patients experience moderate-to-severe pain in the first 48 hours. The objective of this observational study is to compare the percentage of mo

  11. Reading Instruction for Students with Learning Disabilities: An Observation Study Synthesis (1980-2014)

    Walker, Melodee A.; Stevens, Elizabeth A.


    This article synthesizes observation studies investigating reading instruction for students with learning disabilities (LD) in Grades K-12. A systematic search of the literature between 1980 and 2014 resulted in the identification of 25 studies. In addition to replicating and extending E. A. Swanson's synthesis, the research questions of studies…

  12. Shared care with task delegation to nurses for type 2 diabetes : prospective observational study

    Ubink-Veltmaat, L.J.; Bilo, HJG; Groenier, KH; Rischen, RO; Meyboom-de Jong, B

    Background: To study the effects of two different structured shared care interventions, tailored to local needs and resources, in an unselected patient population with type 2 diabetes mellitus. Methods: A three-year prospective observational study of two interventions and standard care. The

  13. The use of community pharmacies in North West England: an observational study.

    Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J


    There are few studies of community pharmacy footfall and activity in the existing literature, especially by direct observation. To describe the characteristics of counter interactions between pharmacy staff and customers. Structured observation of all interactions between pharmacy staff and customers across the weekly opening hours of five pharmacies diverse in location and ownership. Three-quarters (76%) of observed interactions were associated with prescriptions, but a significant minority accessed cognitive services. Dispensing was the primary activity across the diverse range of pharmacies. Reasons for visits are diversifying into advice and services, particularly among younger users. © 2016 Royal Pharmaceutical Society.

  14. Simulation study on heterogeneous variance adjustment for observations with different measurement error variance

    Pitkänen, Timo; Mäntysaari, Esa A; Nielsen, Ulrik Sander


    of variance correction is developed for the same observations. As automated milking systems are becoming more popular the current evaluation model needs to be enhanced to account for the different measurement error variances of observations from automated milking systems. In this simulation study different...... models and different approaches to account for heterogeneous variance when observations have different measurement error variances were investigated. Based on the results we propose to upgrade the currently applied models and to calibrate the heterogeneous variance adjustment method to yield same genetic...

  15. Studies of circumstellar shells in AGB stars by multifrequency (sub)mm-VLBI observations of maser emission

    Colomer, F.; Desmurs, J. F.; Bujarrabal, V.; Baudry, A.; de Vicente, P.; Soria-Ruiz, R.; Alcolea, J.; Diaz-Pulido, A.; Gómez, M.


    VLBI observations of maser emission are a basic tool to study the circumstellar envelopes (CSEs) around evolved stars, mainly around AGB and post-AGB stars. The maser lines of water and silicon monoxide are particularly intense. They provide us with high spatial resolution data on the very inner CSEs around AGB stars, including the pulsating layers previous to grain formation and outer regions where the fast expansion characteristic of such envelopes is already present. The analysis of the pumping mechanism of SiO masers and of the physical conditions in the emitting clumps requires accurate maps of the various lines, which show different excitation requirements. A large observational effort is being done to obtain (quasi-)simultaneous multiline data at the highest spatial resolution, using VLBI techniques, which makes possible to compare the relative distribution of the maser lines. We present the state-of-the-art in the field, and discuss preliminary results of SiO masers observed with the Global Millimeter VLBI Array (GMVA) which provide a new view into the physics of these AGB envelopes. The participation of ALMA in these VLBI arrays will boost the study of these masers, at higher frequencies.

  16. Seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar: an observational study.

    Mahfoud, Ziyad R; Cheema, Sohaila; Alrouh, Hekmat; Al-Thani, Mohammed Hamad; Al-Thani, Al Anoud Mohammed; Mamtani, Ravinder


    In Qatar traffic injuries and fatalities are of serious concern. Mobile phone use whilst driving has been associated with increased risk of vehicular collisions and injuries. Seat belt use has been demonstrated to save lives and reduce the severity of road traffic injuries. Whereas previously published studies may have looked at all front passengers, this study aims to obtain reliable estimates of the prevalence of seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar. Additionally, we aim to investigate the association of these behaviors with other variables namely gender, time of the day and type of vehicle.