Severe acute haemorrhagic liver failure in a neonate with a favourable spontaneous outcome

International Nuclear Information System (INIS)

Cavet, Madeleine; Balu, Marie; Garel, Catherine; Ducou le Pointe, Hubert; Mitanchez, Delphine; Alexandre, Marie; Renolleau, Sylvain; Pariente, Daniele

2008-01-01

Acute liver failure in neonates is rare and is frequently associated with an unfavourable outcome. There is no curative treatment other than liver transplantation. Screening for viral, metabolic, toxic or vascular disease is essential to assess the prognosis and to guide specific treatment. Hepatic haemorrhage in neonates is often associated with bacterial infection, trauma and coagulopathies. We present a unique case of neonatal acute liver failure and multifocal massive haemorrhagic intrahepatic lesions of traumatic origin, documented by US and MRI. The patient made a spontaneous recovery. Clinical, biological and imaging outcome was excellent despite the apparent severity of the initial features. The only possible aetiology was a difficult caesarean delivery for mild fetal macrosomia. (orig.)

Severe acute haemorrhagic liver failure in a neonate with a favourable spontaneous outcome

Energy Technology Data Exchange (ETDEWEB)

Cavet, Madeleine; Balu, Marie; Garel, Catherine; Ducou le Pointe, Hubert [Universite Pierre et Marie Curie Paris VI, Service de Radiologie, Hopital d' enfants Armand-Trousseau, Paris (France); Mitanchez, Delphine; Alexandre, Marie [Universite Pierre et Marie Curie Paris VI, Service de Neonatologie, Hopital d' enfants Armand-Trousseau, Paris (France); Renolleau, Sylvain [Universite Pierre et Marie Curie Paris VI, Service de Reanimation, Hopital d' enfants Armand-Trousseau, Paris (France); Pariente, Daniele [Hopital de Bicetre, Service de Radiologie Pediatrique, Paris (France)

2008-10-15

Acute liver failure in neonates is rare and is frequently associated with an unfavourable outcome. There is no curative treatment other than liver transplantation. Screening for viral, metabolic, toxic or vascular disease is essential to assess the prognosis and to guide specific treatment. Hepatic haemorrhage in neonates is often associated with bacterial infection, trauma and coagulopathies. We present a unique case of neonatal acute liver failure and multifocal massive haemorrhagic intrahepatic lesions of traumatic origin, documented by US and MRI. The patient made a spontaneous recovery. Clinical, biological and imaging outcome was excellent despite the apparent severity of the initial features. The only possible aetiology was a difficult caesarean delivery for mild fetal macrosomia. (orig.)

Favouring Small and Medium Sized Enterprises with Directive 2014/24/EU

OpenAIRE

Trybus, Martin; Andrecka, Marta

2017-01-01

This article argues that the four main measures introduced in the 2014 reform of the Procurement Directives to promote Small andMediumSized Enterprises (SMEs) cannot be classified as measures favouring SMEs. A measure favours SMEs when it compromises the main objectives of competition, non-discrimination and value for money. The discussion covers the regimes on the division of larger contracts into lots, the European Single Procurement Document (ESPD), minimum turnover requirements, and direc...

Less favourable climates constrain demographic strategies in plants.

Science.gov (United States)

Csergő, Anna M; Salguero-Gómez, Roberto; Broennimann, Olivier; Coutts, Shaun R; Guisan, Antoine; Angert, Amy L; Welk, Erik; Stott, Iain; Enquist, Brian J; McGill, Brian; Svenning, Jens-Christian; Violle, Cyrille; Buckley, Yvonne M

2017-08-01

Correlative species distribution models are based on the observed relationship between species' occurrence and macroclimate or other environmental variables. In climates predicted less favourable populations are expected to decline, and in favourable climates they are expected to persist. However, little comparative empirical support exists for a relationship between predicted climate suitability and population performance. We found that the performance of 93 populations of 34 plant species worldwide - as measured by in situ population growth rate, its temporal variation and extinction risk - was not correlated with climate suitability. However, correlations of demographic processes underpinning population performance with climate suitability indicated both resistance and vulnerability pathways of population responses to climate: in less suitable climates, plants experienced greater retrogression (resistance pathway) and greater variability in some demographic rates (vulnerability pathway). While a range of demographic strategies occur within species' climatic niches, demographic strategies are more constrained in climates predicted to be less suitable. © 2017 The Authors. Ecology Letters published by CNRS and John Wiley & Sons Ltd.

Interventions of state in favour of mining industry in EU countries

Energy Technology Data Exchange (ETDEWEB)

Jaroslav Dvoracek; Vladimir Slivka [VSB-Technical University of Ostrava (Czech Republic)

2008-03-15

This contribution is based on a study dealing with the limitation or withdrawal of ownership rights to real estates in favour of the mining industry. All EU countries are included as of the year 2006. The interventions of the state concern ensuring entry to other people's lands to carry out exploration activities and restraining the proprietary rights of landowners in favour of mining, including expropriation. The countries where mining legislation does not cover state interventions are also presented.

Association mapping and favourable QTL alleles for fibre quality ...

Indian Academy of Sciences (India)

Cheng-Guang Dong

A total of 201 markers were polymorphic and generated 394 allele loci, and 403 ... identified as containing favourable allele loci related to fibre quality traits. The identified .... environment. Field management followed respective local practices.

Does the Explanatory Constraint on Practical Reasons favour ...

African Journals Online (AJOL)

Some philosophers, notably Bernard Williams, have argued that the explanatory constraint favours internalism about reasons: for an agent to have a reason to x, it is at least a necessary condition that she would, after ideal deliberation, be motivated to x. Internalism suggests that naturalism about reasons is more plausible ...

Biofuel mandate versus favourable taxation of electric cars. The case of Norway

OpenAIRE

Geir H. Bjertnæs

2013-01-01

This study investigates whether biofuel policies or favourable taxation of electric cars should be employed to satisfy a green house gas emission target connected to private transport within the Norwegian economy. The study shows that implementation of biofuel generates a welfare gain in the presence of the current favourable taxation of electric cars in Norway. Implementation of biofuels, however, generates a welfare loss when the tax rate on purchase of electric cars is increased to the ave...

Everolimus-induced pneumonitis associates with favourable outcome in patients with metastatic renal cell carcinoma

DEFF Research Database (Denmark)

Penttilä, P; Donskov, F; Rautiola, J

2017-01-01

BACKGROUND: Mammalian target of rapamycin inhibitors may induce pneumonitis. We analysed the association of pneumonitis with outcomes in everolimus treated metastatic renal cell carcinoma (mRCC) patients. PATIENTS AND METHODS: Eighty-five mRCC patients received everolimus at Helsinki University...

Geological-uraniferous favourability of South America

International Nuclear Information System (INIS)

Stipanicic, P.N.

1984-01-01

The South American continent includes several metallogenic provinces some of which have excellent uranium possibilities. Basically, two types of lithological complex have contributed to this favourability: the large Precambrian shields covering about 5,500,000 km 2 and the crystalline Hercynian nesocratons with about 300,000 km 2 as source rocks. Only in Argentina and Brazil has continuous uranium exploration in South America been carried out, with moderate budgets, during the last twenty-five years. In the rest of South America the search for uranium has been performed intermittently and with limited resources. However, during recent years interest has increased and more continuous operation has been recorded in some countries (Bolivia, Colombia, Chile, Peru). It can be estimated that only 20% of the favourable areas have been explored fairly intensively in Argentina and Brazil, the two most advanced uraniferous countries. Nevertheless, the uranium possibilities of South America are proved by the resources of 250,000 t U already defined (in Argentina and Brazil) for the category of production cost below US $130/kg U. The speculative uranium potential of the continent was estimated by the International Uranium Resources Evaluation Project as between 770,000 and 1,500,000 t U. Within the South American geostructural framework, five main uraniferous geological areas have been defined on the basis of the geotectonic evolution of the continent, the succession of sedimentary and magmatic processes, and the participation in them of the endogenous and exogenous phases of the uranium geochemical cycle. In this paper the principal uranium metallogenic models occurring in the above five main areas are studied together with the uranium potential of each area. The possibility of uranium recovery from these sources in relation to the respective costs of production is briefly discussed

Favourable environments for uranium occurences in Brazil

International Nuclear Information System (INIS)

Santos, L.C.S. dos

1980-01-01

Based on the present knowledge of Brazilian Precambrian geology, an attempt is made to divide Precambrian rocks into different regions according to their favourability criteria for uranium concentrations. Paleozoic and Mesozoic occurrences are also mentioned. They are mainly associated with large sedimentary basins. Brazilian uranium occurrences can be grouped into the following environments: (1) Metaconglomerates; (2) Metasomatic rocks (associated with albitization); (3) Vein type; (4) Sandstone type and (5) Intrusive alkalic rock. Upper Proterozoicas folding regions related to mobile belts and large Precambrian unconformities are good targets for uranium exploration in Brazil. (Author) [pt

Outcome producing potential influences twelve-month-olds' interpretation of a novel action as goal-directed.

Science.gov (United States)

Biro, Szilvia; Verschoor, Stephan; Coalter, Esther; Leslie, Alan M

2014-11-01

Learning about a novel, goal-directed action is a complex process. It requires identifying the outcome of the action and linking the action to its outcome for later use in new situations to predict the action or to anticipate its outcome. We investigated the hypothesis that linking a novel action to a salient change in the environment is critical for infants to assign a goal to the novel action. We report a study in which we show that 12-month-old infants, who were provided with prior experience with a novel action accompanied with a salient visible outcome in one context, can interpret the same action as goal-directed even in the absence of the outcome in another context. Our control condition shows that prior experience with the action, but without the salient effect, does not lead to goal-directed interpretation of the novel action. We also found that, for the case of 9-month-olds infants, prior experience with the outcome producing potential of the novel action does not facilitate a goal-directed interpretation of the action. However, this failure was possibly due to difficulties with generalizing the learnt association to another context rather than with linking the action to its outcome. Copyright © 2014 Elsevier Inc. All rights reserved.

Guidelines for assessing favourable conservation status of Natura 2000 species and habitat types in Bulgaria

NARCIS (Netherlands)

Zingstra, H.L.; Kovachev, A.; Kitnaes, K.; Tzonev, R.; Dimova, D.; Tzvetkov, P.

2009-01-01

This executive summary describes the methodology for assessing the favourable conservation status of N2000 habitats and species on site level in Bulgaria and gives guidelines for its application. The methodology was developed in the frame of the BBI/Matra project 2006/014 “Favourable Conservation

Will hydrogen be competitive in Europe without tax favours?

International Nuclear Information System (INIS)

Hansen, Anders Chr.

2010-01-01

Hydrogen is one of the alternative transport fuels expected to replace conventional oil based fuels. The paper finds that it is possible for non-fossil-based hydrogen to become the lowest cost fuel without favourable tax treatment. The order of per kilometre cost depends on performance in hydrogen production, the international oil price, and fuel taxes. At low oil prices, the highest per kilometre costs were found for non-fossil power-based hydrogen, the second highest for natural gas-based hydrogen, and the lowest for conventional fuels. At high oil prices, this ranking is reversed and non-fossil power-based hydrogen becomes the most cost competitive fuel. General fuel taxes lower the threshold at which the international oil price reverses this competitiveness order. The highest fuel tax rates applied in Europe lowers this threshold oil price considerably, whereas the lowest fuel taxes may be insufficient to make hydrogen competitive without tax favours. Alternative adjustments of the EU minimum fuel tax rates with a view to energy efficiency and CO 2 -emissions are discussed.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Oman

International Nuclear Information System (INIS)

1977-11-01

The geology of Oman is unlikely to lie favourable for uranium occurrence being mainly of marine sedimentary origin. No exploration for uranium has been reported or is planned. The Speculative Potential is placed in the category of less than 1000 tonnes uranium. (author)

Arterial spin-labelling perfusion MRI and outcome in neonates with hypoxic-ischemic encephalopathy

International Nuclear Information System (INIS)

Vis, Jill B. de; Hendrikse, Jeroen; Petersen, Esben T.; Vries, Linda S. de; Bel, Frank van; Alderliesten, Thomas; Negro, Simona; Groenendaal, Floris; Benders, Manon J.N.L.

2015-01-01

Hyperperfusion may be related to outcome in neonates with hypoxic-ischemic encephalopathy (HIE). The purpose of this study was to evaluate whether arterial spin labelling (ASL) perfusion is associated with outcome in neonates with HIE and to compare the predictive value of ASL MRI to known MRI predictive markers. Twenty-eight neonates diagnosed with HIE and assessed with MR imaging (conventional MRI, diffusion-weighted MRI, MR spectroscopy [MRS], and ASL MRI) were included. Perfusion in the basal ganglia and thalami was measured. Outcome at 9 or 18 months of age was scored as either adverse (death or cerebral palsy) or favourable. The median (range) perfusion in the basal ganglia and thalami (BGT) was 63 (28-108) ml/100 g/min in the neonates with adverse outcome and 28 (12-51) ml/100 g/min in the infants with favourable outcome (p 2 = 0.86, p < 0.001). Higher ASL perfusion values in neonates with HIE are associated with a worse neurodevelopmental outcome. A combination of the MRS and ASL MRI information is the best predictor of outcome. (orig.)

Paraneoplastic pemphigus associated with inflammatory myofibroblastic tumour of the mediastinum: A favourable response to treatment and review of the literature.

Science.gov (United States)

Ghandi, Narges; Ghanadan, Alireza; Azizian, Mohammad-Reza; Hejazi, Pardis; Aghazadeh, Nessa; Tavousi, Parvin; Daneshpazhooh, Maryam

2015-05-01

Paraneoplastic pemphigus (PNP) is an autoimmune blistering disorder that occurs in association with an underlying neoplasm. Inflammatory myofibroblastic tumour (IMT) is a rare low-grade sarcoma of fibroblasts and myofibroblasts associated with inflammatory cells, most commonly occurring in the lung. In this study, a case of PNP associated with IMT of the mediastinum is reported. The patient had a favourable outcome following surgical resection and treatment with a systemic steroid, azathioprine, and i.v. immunoglobulin. The occurrence of PNP with sarcomas, specifically IMT, is noteworthy although it is not well studied in the existing literature. © 2014 The Australasian College of Dermatologists.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Laos

International Nuclear Information System (INIS)

1977-11-01

Laos is a land locked country containing about 3.5 million people living primarily at a subsistence level. Geologically, the country contains a few places that may be marginally favourable for uranium deposits. A uranium potential in the upper half of Category 1 is assigned. (author)

The Factors Associated with Outcomes in Surgically Managed Ruptured Cerebral Aneurysm.

Science.gov (United States)

Chee, Lai Chuang; Siregar, Johari Adnan; Ghani, Abdul Rahman Izani; Idris, Zamzuri; Rahman Mohd, Noor Azman A

2018-02-01

Ruptured cerebral aneurysm is a life-threatening condition that requires urgent medical attention. In Malaysia, a prospective study by the Umum Sarawak Hospital, Neurosurgical Center, in the year 2000-2002 revealed an average of two cases of intracranial aneurysms per month with an operative mortality of 20% and management mortality of 25%. Failure to diagnose, delay in admission to a neurosurgical centre, and lack of facilities could have led to the poor surgical outcome in these patients. The purpose of this study is to identify the factors that significantly predict the outcome of patients undergoing a surgical clipping of ruptured aneurysm in the local population. A single center retrospective study with a review of medical records was performed involving 105 patients, who were surgically treated for ruptured intracranial aneurysms in the Sultanah Aminah Hospital, in Johor Bahru, from July 2011 to January 2016. Information collected was the patient demographic data, Glasgow Coma Scale (GCS) prior to surgery, World Federation of Neurosurgical Societies Scale (WFNS), subarachnoid hemorrhage (SAH) grading system, and timing between SAH ictus and surgery. A good clinical grade was defined as WFNS grade I-III, whereas, WFNS grades IV and V were considered to be poor grades. The outcomes at discharge and six months post surgery were assessed using the modified Rankin's Scale (mRS). The mRS scores of 0 to 2 were grouped into the "favourable" category and mRS scores of 3 to 6 were grouped into the "unfavourable" category. Only cases of proven ruptured aneurysmal SAH involving anterior circulation that underwent surgical clipping were included in the study. The data collected was analysed using the Statistical Package for Social Sciences (SPSS). Univariate and multivariate analyses were performed and a P -value of < 0.05 was considered to be statistically significant. A total of 105 patients were included. The group was comprised of 42.9% male and 57.1% female patients

The scope and applicability of Most-Favoured-Nation (MFN) clause ...

African Journals Online (AJOL)

... 'treatment' in the jurisprudence of the International Centre for Settlement of Investment Disputes (ICSID) with a view of promoting a common vision about the scope and contours of the MFN clause contained in a number of bilateral investment treaties (BITs). Keywords: MFN, BIT, Most-Favoured Nation, investment treaties ...

Hospital Outcomes of Adult Respiratory Tract Infections with Extended-Spectrum B-Lactamase (ESBL) Producing Klebsiella Pneumoniae

Science.gov (United States)

Loh, Li-Cher; Nor Izran Hanim bt Abdul Samad; Rosdara Masayuni bt Mohd Sani; Raman, Sree; Thayaparan, Tarmizi; Kumar, Shalini

2007-01-01

Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalization in Malaysia. To study whether extended-spectrum b-lactamase (ESBL) producing K. pneumoniae was linked to hospital outcomes, we retrospectively studied 441 cases of adult respiratory tract infections with microbial proven K. pneumoniae from an urban-based university teaching hospital between 2003 and 2004. 47 (10.6%) cases had ESBL. Requirement for ventilation and median length of hospital stay, were greater in ‘ESBL’ than in ‘non-ESBL’ group [34% vs. 7.4%, p<0.001; 14 days vs. 5 days, p<0.001 respectively] but not crude hospital mortality rate [21.3% vs. 12.4%, p=0.092]. There was a four-fold increased risk of requiring ventilation [4.61 (2.72–7.85)] when ESBL was present. Our findings support the association of ESBL producing K. pneumoniae with adversed hospital outcomes and reiterate the need for vigilance on the part of treating clinicians. PMID:22993489

Unification of favourable intermediate-, unfavourable intermediate-, and very high-risk stratification criteria for prostate cancer.

Science.gov (United States)

Zumsteg, Zachary S; Zelefsky, Michael J; Woo, Kaitlin M; Spratt, Daniel E; Kollmeier, Marisa A; McBride, Sean; Pei, Xin; Sandler, Howard M; Zhang, Zhigang

2017-11-01

To improve on the existing risk-stratification systems for prostate cancer. This was a retrospective investigation including 2 248 patients undergoing dose-escalated external beam radiotherapy (EBRT) at a single institution. We separated National Comprehensive Cancer Network (NCCN) intermediate-risk prostate cancer into 'favourable' and 'unfavourable' groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), and number of NCCN intermediate-risk factors. Similarly, NCCN high-risk prostate cancer was stratified into 'standard' and 'very high-risk' groups based on primary Gleason pattern, PPBC, number of NCCN high-risk factors, and stage T3b-T4 disease. Patients with unfavourable-intermediate-risk (UIR) prostate cancer had significantly inferior prostate-specific antigen relapse-free survival (PSA-RFS, P prostate cancer-specific mortality (PCSM, P prostate cancer. Similarly, patients with very high-risk (VHR) prostate cancer had significantly worse PSA-RFS (P prostate cancer. Moreover, patients with FIR and low-risk prostate cancer had similar outcomes, as did patients with UIR and SHR prostate cancer. Consequently, we propose the following risk-stratification system: Group 1, low risk and FIR; Group 2, UIR and SHR; and Group 3, VHR. These groups have markedly different outcomes, with 8-year distant metastasis rates of 3%, 9%, and 29% (P < 0.001) for Groups 1, 2, and 3, respectively, and 8-year PCSM of 1%, 4%, and 13% (P < 0.001) after EBRT. This modified stratification system was significantly more accurate than the three-tiered NCCN system currently in clinical use for all outcomes. Modifying the NCCN risk-stratification system to group FIR with low-risk patients and UIR with SHR patients, results in modestly improved prediction of outcomes, potentially allowing better personalisation of therapeutic recommendations. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

The outcome of Mental Health Care Users admitted under Section ...

African Journals Online (AJOL)

The outcome of Mental Health Care Users admitted under Section 40 of the South ... were referred by members of SAPS to the CHBH Emergency Department. ... capacity to identify factors that favour outpatient care (especially substance ...

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Iran

International Nuclear Information System (INIS)

1977-12-01

Iran is on the southern flank of the Alpine-Himalayan mountain system and has within its extensive boundaries rocks ranging from crystalline metamorphics and igneous rocks of Precambrian age to sediments of Tertiary - Pleistocene age, some of which could be considered as potentially favourable for uranium deposits. The search for uranium started about 1959 and in the following years some 40 radioactive anomalies and a small number of uranium occurrences were identified. In 1977 the Atomic Energy Organization of Iran greatly expanded its exploration activities and contracted for 895,000 line kilometres to be flown by three contractors in an aerial spectrometric survey designed to cover almost the two fifths of the whole country. The follow-up of this survey will continue for several years. Purely on the basis of its size (1,648,004 km 2 ), its several favourable host rock areas, its location on the flank of the Alpine-Himalayan system and the relatively small amount of systematic exploration coverage completed to date the Speculative Potential could be placed in the 50,000 - 100,000 tonnes category. (author)

Favourability towards electric utilities jumps 10 per cent in 1997

International Nuclear Information System (INIS)

Anon.

1997-01-01

A recent survey of public opinion has shown that 85 per cent of the public view their electric utility company favourably. This represents a 10 per cent increase over last year. A survey of 4,090 Canadians was conducted which looked at the perceptions of the value of electricity services compared to telephone, natural gas, banking, and home insurance services. The study showed that Canadian electric utility companies are viewed as positively as the telephone companies and almost as favourably as the banks. Some 71 per cent of respondents reported that the value they receive from their electric utility is excellent or good. Lower prices, better customer services and increased research into alternative power sources were among the benefits that Canadians perceive would result from a more competitive electricity sector. Some misgivings about deregulation included a belief that there would be less attention to environmental concerns and more outages. Four per cent of the respondents said they would 'definitely' switch to an alternative supplier of electricity, while 25 per cent said they would 'probably' switch to an alternative supplier of electricity. 2 tabs

Sequential use of human-derived medium supplements favours cardiovascular tissue engineering

NARCIS (Netherlands)

Riem Vis, P.W.; Sluijter, J.P.G.; Soekhradj - Soechit, R.S.; Herwerden, van L.A.; Kluin, J.; Bouten, C.V.C.

2012-01-01

For clinical application of tissue engineering strategies, the use of animal-derived serum in culture medium is not recommended, because it can evoke immune responses in patients. We previously observed that human platelet-lysate (PL) is favourable for cell expansion, but generates weaker tissue as

Determinants of favourable opinions about euthanasia in a sample of French physicians.

Science.gov (United States)

Dany, Lionel; Baumstarck, Karine; Dudoit, Eric; Duffaud, Florence; Auquier, Pascal; Salas, Sébastien

2015-11-05

The question whether euthanasia should be legalised has led to substantial public debate in France. The objective of this study in a sample of French physicians was to establish the potential determinants of a favourable opinion about euthanasia in general and when faced with a specific situation as embodied in the Humbert affair. The study was a cross-sectional survey investigating two different samples of medical doctors: (1) those specialised in palliative care and affiliated to the French Society for Patient Accompaniment and Palliative Care; (2) medical interns (medical doctors in training course) in a French medical university (Marseille). A questionnaire was sent (email) to each voluntary participant including sociodemographics, professional status, mention of believing in God, and opinion about euthanasia (the question was designed to assess the general opinion about euthanasia and the opinion about a specific case, the Vincent Humbert' case (a man who was rendered quadriplegic, blind, and mute after an accident and has requested euthanasia). A total of 413 physicians participated in the research (participation rate: 48.5%). Less than half of the population were favourable to euthanasia in general and almost two-thirds of the population were favourable to Vincent Humbert's request for euthanasia. Based on the multivariate analysis, individuals believing in God and being a medical intern were significant independent factors linked to having a favourable opinion about euthanasia in general and about the Vincent Humbert's request. There is still no study in France on the development of opinion about euthanasia and its impact. The issue goes beyond the strictly professional sphere and involves broader socio-political stakes. These stakes do not necessarily take into account medical practices and experiences or the desires of end-of-life patients. The professional upheaval that the future French legal framework will doubtlessly trigger will require further

Explaining governance outcomes

DEFF Research Database (Denmark)

Fawcett, Paul; Daugbjerg, Carsten

2012-01-01

network analysis school, which has focused on the relationship between processes of interest intermediation and their impact on policy-making outcomes.We examine how each school is underpinned by important epistemological differences between positivist, interpretivist and critical realist approaches.......We argue that these differences complicate and make contestable what would otherwise seem to be an intuitively attractive argument in favour of combining these two schools. In seeking to understand better how these two schools might be combined, we adopt a critical realist approach and make a distinction...

SIMPROVING THE ECONOMIC ACTIVITIES IN THE LESS FAVOURED AREAS OF ROMANIA

Directory of Open Access Journals (Sweden)

Tileaga Cosmin

2011-07-01

Full Text Available This paper deals with finding solutions for improving the economic activities in Romania’s undeveloped areas, which still represent a major problem for this country’s economy. During 1999 and 2009, these areas were considered tax havens, due to some facilities accorded by the Government and the EU (headage compensatory allowances*, tax deductions, non-refundable funds. Many had the opportunity to invest in those regions, but no positive effect was to be seen. Tulcea County (Danube Delta area, coal mine regions, rural areas and the North-East area (Suceava and Botosani county are considered to be Romania’s less favoured areas. * The objective of these schemes is to provide a reasonable level of income for farmers where natural production conditions are least favourable so as to conserve the countryside by the prevention of further depopulation of rural areas. Compensatory allowances are payable to farmers for the keeping of cattle, sheep and goats. (www.europa.eu

Computed tomography and clinical outcome in patients with severe traumatic brain injury.

Science.gov (United States)

Stenberg, Maud; Koskinen, Lars-Owe D; Jonasson, Per; Levi, Richard; Stålnacke, Britt-Marie

2017-01-01

To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI). Initial CT (CT i ) and CT 24 hours post-trauma (CT 24 ) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated. Thirty-seven patients were included. Marshall CT i and CT 24 were significantly correlated with RLAS-R at three months. Rotterdam CT 24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year. Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.

Covering Materials for Anaerobic Digesters Producing Biogas

International Nuclear Information System (INIS)

Itodo, I. N.; Philips, T. K.

2002-01-01

The suitability of foam, concrete and clay soil as covering material on anaerobic digesters producing biogas was investigated using four batch-type digesters of 20 litres volume. The methane yield from the digesters was of the order: foam >control> concrete > clay soil. The digester covered with foam had the highest methane yield, best temperature control and most favourable pH conditions. It is most suitable as cover material on anaerobic digesters

Uranium prospecting and geological favour ability in Uruguay

International Nuclear Information System (INIS)

Goso, H.

1981-01-01

Uranium prospecting carried out in Uruguay since 1976 is described. On the basis of literature available and of an analysis of the large structural units pertinent to Uruguay's geology, the prospecting performed in general in the northeast of the country, and in particular in the districts of Cerro Largo and Las Canas, is described. Some information is presented on uranium favour ability in Uruguay related to sedimentary formations: Devonian (Cerrezuelo Formation) and Gondwana (San Gregorio and Tres Islas Formations), and to the Crystalline formations of the centre and Southwest (1700-2000 m.y.) and of the east and southeast (500-700 m.y.)

Research on interactive genetic-geological models to evaluate favourability for undiscovered uranium resources

International Nuclear Information System (INIS)

Finch, W.I.; Granger, H.C.; Lupe, R.; McCammon, R.B.

1980-01-01

Current methods of evaluating favourability for undiscovered uranium resources are unduly subjective, quite possibly inconsistent and, as a consequence, of questionable reliability. This research is aimed at reducing the subjectivity and increasing the reliability by designing an improved method that depends largely on geological data and their statistical frequency of occurrence. This progress report outlines a genetic approach to modelling the geological factors that controlled uranium mineralization in order to evaluate the favourability for the occurrence of undiscovered uranium deposits of the type modelled. A genetic model is constructed from all the factors that describe the processes, in chronological sequence, that formed uranium deposits thought to have a common origin. The field and laboratory evidence for the processes constitute a geologic-occurrence base that parallels the chronological sequence of events. The genetic model and the geologic-occurrence base are portrayed as two columns of an interactive matrix called the ''genetic-geologic model''. For each column, eight chronological stages are used to describe the overall formation of the uranium deposits. These stages consist of (1) precursor processes; (2) host-rock formation; (3) preparation of host-rock; (4) uranium-source development; (5) transport of uranium; (6) primary uranium deposition; (7) post-deposition modification; and (8) preservation. To apply the genetic-geological model to evaluate favourability, a question is posed that determines the presence or absence of each attribute listed under the geologic-occurrence base. By building a logic circuit of the attributes according to either their essential or non-essential nature, the resultant match between a well-documented control area and the test area may be determined. The degree of match is a measure of favourability for uranium occurrence as hypothesized in the genetic model

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Philippines

International Nuclear Information System (INIS)

1976-12-01

Comparison between the geology of the Philippines and favourable geological environments for uranium in other parts of the world suggests that the Philippine geology is not likely to be favourable for the discovery of uranium. Previous work has been mainly of a reconnaissance type and orientated mainly to checking the existing mining areas for radioactivity. The only occurrence known at the present time is at Larap Mine in the Paracale District of Camarines Norte in Luzon. A magnetite iron ore body operated by Philippines Iron Mines Inc contained certain distinct beds, which, in addition to magnetite also contain copper, molybdenum and iron sulphides and uraninite. It is estimated that 200 short tons U 3 O 8 is contained in 500,000 tons ore grading 0.04% U 3 O 8 at Larap. A number of other largely untested but similar occurrences have also been identified in the Paracale District. A few small occurrences of uranium have recently been identified on the island of Samar. It is suggested that the Speculative Potential of the Philippines may be of the order of 1000 tonnes U 3 O 8 . (author)

Deep brain stimulation for dystonia: patient selection and outcomes

NARCIS (Netherlands)

Speelman, J. D.; Contarino, M. F.; Schuurman, P. R.; Tijssen, M. A. J.; de Bie, R. M. A.

2010-01-01

In a literature survey, 341 patients with primary and 109 with secondary dystonias treated with deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) were identified. In general, the outcomes for primary dystonias were more favourable compared to the secondary forms. For

Deep brain stimulation for dystonia : Patient selection and outcomes

NARCIS (Netherlands)

Speelman, J. D.; Contarino, M. F.; Schuurman, P. R.; Tijssen, M. A. J.; de Bie, R. M. A.

In a literature survey, 341 patients with primary and 109 with secondary dystonias treated with deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) were identified. In general, the outcomes for primary dystonias were more favourable compared to the secondary forms. For

Sexual antagonism and meiotic drive cause stable linkage disequilibrium and favour reduced recombination on the X chromosome.

Science.gov (United States)

Rydzewski, W T; Carioscia, S A; Liévano, G; Lynch, V D; Patten, M M

2016-06-01

Sexual antagonism and meiotic drive are sex-specific evolutionary forces with the potential to shape genomic architecture. Previous theory has found that pairing two sexually antagonistic loci or combining sexual antagonism with meiotic drive at linked autosomal loci augments genetic variation, produces stable linkage disequilibrium (LD) and favours reduced recombination. However, the influence of these two forces has not been examined on the X chromosome, which is thought to be enriched for sexual antagonism and meiotic drive. We investigate the evolution of the X chromosome under both sexual antagonism and meiotic drive with two models: in one, both loci experience sexual antagonism; in the other, we pair a meiotic drive locus with a sexually antagonistic locus. We find that LD arises between the two loci in both models, even when the two loci freely recombine in females and that driving haplotypes will be enriched for male-beneficial alleles, further skewing sex ratios in these populations. We introduce a new measure of LD, Dz', which accounts for population allele frequencies and is appropriate for instances where these are sex specific. Both models demonstrate that natural selection favours modifiers that reduce the recombination rate. These results inform observed patterns of congealment found on driving X chromosomes and have implications for patterns of natural variation and the evolution of recombination rates on the X chromosome. © 2016 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2016 European Society For Evolutionary Biology.

Arterial spin-labelling perfusion MRI and outcome in neonates with hypoxic-ischemic encephalopathy

Energy Technology Data Exchange (ETDEWEB)

Vis, Jill B. de; Hendrikse, Jeroen [University Medical Center Utrecht, Department of Radiology, HP E 01.132, P.O. Box 85500, Utrecht (Netherlands); Petersen, Esben T. [University Medical Center Utrecht, Department of Radiology, HP E 01.132, P.O. Box 85500, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiotherapy, Utrecht (Netherlands); Vries, Linda S. de; Bel, Frank van; Alderliesten, Thomas; Negro, Simona; Groenendaal, Floris; Benders, Manon J.N.L. [Wilhelmina Children' s Hospital/University Medical Center Utrecht, Department of Neonatology, Utrecht (Netherlands)

2015-01-15

Hyperperfusion may be related to outcome in neonates with hypoxic-ischemic encephalopathy (HIE). The purpose of this study was to evaluate whether arterial spin labelling (ASL) perfusion is associated with outcome in neonates with HIE and to compare the predictive value of ASL MRI to known MRI predictive markers. Twenty-eight neonates diagnosed with HIE and assessed with MR imaging (conventional MRI, diffusion-weighted MRI, MR spectroscopy [MRS], and ASL MRI) were included. Perfusion in the basal ganglia and thalami was measured. Outcome at 9 or 18 months of age was scored as either adverse (death or cerebral palsy) or favourable. The median (range) perfusion in the basal ganglia and thalami (BGT) was 63 (28-108) ml/100 g/min in the neonates with adverse outcome and 28 (12-51) ml/100 g/min in the infants with favourable outcome (p < 0.01). The area-under-the-curve was 0.92 for ASL MRI, 0.97 for MRI score, 0.96 for Lac/NAA and 0.92 for ADC in the BGT. The combination of Lac/NAA and ASL MRI results was the best predictor of outcome (r {sup 2} = 0.86, p < 0.001). Higher ASL perfusion values in neonates with HIE are associated with a worse neurodevelopmental outcome. A combination of the MRS and ASL MRI information is the best predictor of outcome. (orig.)

Factors Influencing Visual Outcome after Surgery for Retinal ...

African Journals Online (AJOL)

Dr femi Oderinlo

Three factors favourably affected visual outcome and were of statistical ... These changes are likely to affect the. 10,11 ... within the South Western geopolitical region of Nigeria is one of the ... tamponade (silicon oil or C F gas in a single case), or a combination ..... studies also had similar final anatomic success rates, 90.2%.

A severe genotype with favourable outcome in very long chain acyl-CoA dehydrogenase deficiency

DEFF Research Database (Denmark)

Touma, E H; Rashed, M S; Vianey-Saban, C

2001-01-01

A patient with very long chain acyl-CoA dehydrogenase (VLCAD) deficiency is reported. He had a severe neonatal presentation and cardiomyopathy. He was found to be homozygous for a severe mutation with no residual enzyme activity. Tandem mass spectrometry on dried blood spots revealed increased lo...... chain acylcarnitines. VLCAD enzyme activity was severely decreased to 2% of control levels. Dietary management consisted of skimmed milk supplemented with medium chain triglycerides and L-carnitine. Outcome was good and there was no acute recurrence....

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Indonesia

International Nuclear Information System (INIS)

1977-10-01

Indonesia is a country of south east Asia comprising a large island group extending east-west for over 3000 miles. The geology of Indonesia is fairly well known but is extremely complicated. Successive mountain movements took place around an ancient crustal area. The oldest, of Permian-Triassic age formed northeast Sumatra, northern Java and western Kalimantan. This was followed by the Sumatra orogenesis and finally in Cretaceous and Tertiary times the southern half of Java and the islands as far as New Guinea were formed. Geological studies tend to indicate that the most favourable uranium areas are likely to be in West Sumatra and West Kalimantan. Exploration by the Directorate of Survey and Geology of the National Atomic Energy Agency has been carried out on a small scale since 1961. Exploration concession have been granted to French, German and Japanese organisations. No uranium reserve or resource figures have ever been stated but small occurrences and radioactive anomalies have been found in West and South Sumatra, West and Central Kalimantan and in West Irian. Although the geology of some areas appears to be favourable, little success has attended exploration efforts to date and thus the Speculative Potential is noted as between 1,000 and 10,000 tonnes uranium. (author)

Darwin's Arguments in Favour of Natural Selection and against Special Creationism

Science.gov (United States)

Nola, Robert

2013-01-01

In many places in "The Origin of Species", Darwin compares his own theory of Natural Selection favourably with Special Creationism which comes off as a bad second best. He does this using some version of the argument form known as "Inference to the Best Explanation". The first part of this paper is methodological. It considers Whewell's notion of…

Can corruption favour growth via the composition of government spending?

OpenAIRE

Sugata Ghosh; Andros Gregoriou

2010-01-01

In an endogenous growth model with two public goods, we analytically derive the optimal composition of government spending in the presence of corruption. Although corruption results in a loss of productivity per se, an increase in corruption in the category of public spending that is harmed relatively more by corruption could have a favourable effect on growth, as it would encourage a benevolent government to divert spending towards the public good that is more productive, net of corruption.

Hospital Outcomes of Adult Respiratory Tract Infections with Extended-Spectrum B-Lactamase (ESBL) Producing Klebsiella Pneumoniae

OpenAIRE

Loh, Li-Cher; Nor Izran Hanim bt Abdul Samad,; Rosdara Masayuni bt Mohd Sani,; Raman, Sree; Thayaparan, Tarmizi; Kumar, Shalini

2007-01-01

Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalization in Malaysia. To study whether extended-spectrum b-lactamase (ESBL) producing K. pneumoniae was linked to hospital outcomes, we retrospectively studied 441 cases of adult respiratory tract infections with microbial proven K. pneumoniae from an urban-based university teaching hospital between 2003 and 2004. 47 (10.6%) cases had ESBL. Requirement for ventilation and median length of hospital stay, were great...

Differences in outcome between twins and singletons born very preterm: results from a population-based European cohort

DEFF Research Database (Denmark)

Papiernik, Emile; Zeitlin, Jennifer; Delmas, Dominique

2010-01-01

About 10% of twins are born before 32 weeks of gestation and very preterm birth rates are increasing. Preterm twins tend to have more favourable outcomes than singletons of the same gestational age, but fewer data are available for very preterm infants. This study aims to determine whether outcom...

Four arguments in favour of nuclear power

International Nuclear Information System (INIS)

Pearce, D.

1994-01-01

The first argument in favour of nuclear power is scarcity of energy supplies. In about 40 years time, the world will face shortages of natural gas, oil and uranium. Recoverable reserves of coal are very great, but coal creates the highest environmental damage. A balanced portfolio is the second argument. If all energy sources are potentially scarce, then all energy sources must be developed, subject to environmental impact. This leads to the third argument in support of nuclear power, its expansion would contribute to combating the risk of global warming as indeed would the expansion of renewable sources and other low carbon technologies. Fourthly, nuclear power can make a significant contribution to the control of acidic emissions. While nuclear power is not without its own problems of risk, liability and public acceptance, it has some clear advantages over other fuels. It has, at the very least, to be a substantial part of the transitional phase towards a renewable energy world. (UK)

Employee participation in the private sector in Malaysia: The Applicability of Favourable Conjunctures Model

Directory of Open Access Journals (Sweden)

Balakrishnan Parasuraman

2009-12-01

Full Text Available EP is one crucial aspect of the employment relationship in both private and public organisations in many countries. In 2001, Poole, Lansbury and Wiles developed a model for comparative EP, which they named the Favourable Conjunctures Model. So far, this model has only been applied in developed countries such as the United States of America, United Kingdom, Australia and Europe. There it was applied in order to examine worker participation from the national perspective. No extensive study has been conducted using this model to explain worker participation practices at the company level. In parallel with this aspect, this model also has never been used to explain the nature of EP in the Asian developing countries. This current research will use the Favourable Conjunctures Model to examine the nature of EP in private enterprises based on empirical study carried out in Malaysia. The argument of this paper is that the Favourable Conjunctures Model of Industrial Democracy (Poole et al. 2001 is inadequate to elucidate the characteristics of EP in Malaysia. Based on empirical findings from three private companies in Malaysia, the paper argues that there are many contextual factors that influence the nature of EP in Malaysian private companies that are not taken into account by the model. They are:multi-ethnic (cultural influences, the repressive role of state in the Malaysian industrial relations, the New Economic Policy and industrialisation plan, Islamic working ethics, the influence of a British colonial history, lack of training among non-managerial employees in EP, the impact of foreign direct investment on industrial relations, to identify a few. Based on this study, it is proposed that the present Favourable Conjunctures Model of Industrial Democracy (Poole et al. 2001 be modified based on the contextual factors discussed above. The paper concludes that the western model of EP could not be directly applied in Malaysia without some adjustment of

Rural Diversity and heterogeneity in less-favoured areas: the quest for policy targeting

NARCIS (Netherlands)

Ruben, R.; Pender, J.

2004-01-01

Wide diversity among farmers and fields is a prime characteristic of livelihoods and production systems in less-favoured areas. One-size-fits-all policies can therefore not provide adequate solutions to poverty and degradation problems. Sustainable rural development strategies in these areas need to

Testing the efficacy of downscaling in species distribution modelling: a comparison between MaxEnt and Favourability Function models

Energy Technology Data Exchange (ETDEWEB)

Olivero, J.; Toxopeus, A.G.; Skidmore, A.K.; Real, R.

2016-07-01

Statistical downscaling is used to improve the knowledge of spatial distributions from broad–scale to fine–scale maps with higher potential for conservation planning. We assessed the effectiveness of downscaling in two commonly used species distribution models: Maximum Entropy (MaxEnt) and the Favourability Function (FF). We used atlas data (10 x 10 km) of the fire salamander Salamandra salamandra distribution in southern Spain to derive models at a 1 x 1 km resolution. Downscaled models were assessed using an independent dataset of the species’ distribution at 1 x 1 km. The Favourability model showed better downscaling performance than the MaxEnt model, and the models that were based on linear combinations of environmental variables performed better than models allowing higher flexibility. The Favourability model minimized model overfitting compared to the MaxEnt model. (Author)

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Thailand

International Nuclear Information System (INIS)

1977-08-01

Thailand is a country with an area of 514?000 square kilometres situated in the centre of continental south-east Asia, The geology of Thailand is very varied with sedimentary formations ranging from Cambrian to Quaternary in age and including sandstones, shales, limestones of many varieties. Among the igneous rocks, granites are very important and rhyolites, tuffs diorites, basalts and ultrabasic rocks also exist. Tin is the most important mineral occurrence. Available information on the geology and mineral resources suggests that the country may contain significant resources of radioactive minerals. Favourable potential host types are; 1) uranium and thorium in monazite in beach sands and tin placer deposits; 2) uranium in sandstones, principally in Jurassic sandstones of the Khorat Plateau; 3) uranium in Tertiary lignite deposits; 4) uranium in veins in granites; 5) uranium related to fluorite deposits; 6) uranium in black shales and phosphates. Uranium mineralization in sedimentary rocks at Phu Wieng was discovered in 1970. The area has been radiometrically grid mapped and limited shallow drilling has shown continuity.of the narrow, carbonaceous, conglomeratic sandstone host bed. No uranium reserves or resources can be stated at the present time, but the favourable geology of the Khorat Plateau, the known uranium occurrence and the very small exploration coverage is possibly indicative of a good future potential. The Speculative Potential is estimated to be between 1000 and 10,000 tonnes uranium. (author)

Global warming favours light-coloured insects in Europe

Science.gov (United States)

Zeuss, Dirk; Brandl, Roland; Brändle, Martin; Rahbek, Carsten; Brunzel, Stefan

2014-01-01

Associations between biological traits of animals and climate are well documented by physiological and local-scale studies. However, whether an ecophysiological phenomenon can affect large-scale biogeographical patterns of insects is largely unknown. Insects absorb energy from the sun to become mobile, and their colouration varies depending on the prevailing climate where they live. Here we show, using data of 473 European butterfly and dragonfly species, that dark-coloured insect species are favoured in cooler climates and light-coloured species in warmer climates. By comparing distribution maps of dragonflies from 1988 and 2006, we provide support for a mechanistic link between climate, functional traits and species that affects geographical distributions even at continental scales. Our results constitute a foundation for better forecasting the effect of climate change on many insect groups. PMID:24866819

Two Pregnancies with a Different Outcome in a Patient with Alport Syndrome

Directory of Open Access Journals (Sweden)

Biljana Gerasimovska Kitanovska

2016-07-01

CONCLUSIONS: Pre-pregnancy counselling and frequent controls during pregnancy are necessary for women with Alport syndrome, as well as regular monitoring after delivery. Recent reports are more in favour of good pregnancy and nephrological outcomes in women with Alport syndrome when renal disease is not advanced.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Maldives

International Nuclear Information System (INIS)

1977-11-01

Maldives, an archipelago consisting of between 1,000 and 2,000 islands and atolls in the Indian Ocean contain only 300 square kilometers and is populated by around 130,000 people who are engaged in raising of copra, fruits, taro, and other agricultural products, and in fishing. There is not now and never has been a mining industry except for quarrying of coral road metal. Geologically the coral islands, based on present geological thinking is not a favourable host or source of uranium, and is therefore assigned a zero potential. (author)

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Burma

International Nuclear Information System (INIS)

1977-10-01

There is no information on production of nuclear raw materials in Burma, although there are some uranium occurrences. Hunting Geophysics Ltd has done some aerial prospecting work in the area of Victoria Point in Southern Burma. All the data collected has been plotted on several maps and issued to various Burmese organizations, with a complete report. The follow-up ground exploration was done by a prospecting party headed by Dr Gjelsvik. The Hunting Geophysics' and Dr Gjelsvik reports are not available in the IAEA. The Raw Materials Division in the Union of Burma Atomic Energy Center commenced operations in 1955. The area of Mogok was selected by U Soo Win, the head of the Division, as most favourable for uranium exploration. The region is mountainous, with heavy forest cover. A ground gamma-ray survey was carried out in Mogok Mineral Belt by two geologists accompanied by two assistants, at a spacing of one km. This work showed monazite in all streams over an area of about 150 sq km and has given a detailed studies led to the discovery of some uraninite and pitchblende in the overburden of an old lode. Based, on these first discoveries the Government of Burma requested assistance from the IAEA and an expert was sent there for a period of one year. His field work was mainly limited in the Mogok Mineral Belt, however some reconnaissance field trips were made in other parts of the country. Dr D L Searle concluded that the Mogok area represents a zone of high temperature mineralization but a lower temperature form of uranium mineralization may have developed along the outer edges of the principal high grade zone. He recommended that the area between the Mogok scarp and the Shweli River be systematically traversed. Uranium bearing minerals in Burma are the following: monazite bearing beach sands near Amherst, Tenasserim; monazite placers from near Momeik, Northern Shan States; uraninte crystals from the gem-gravels around Mogok; a radioactive anomaly in syenite at

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Burma

Energy Technology Data Exchange (ETDEWEB)

NONE

1977-10-15

There is no information on production of nuclear raw materials in Burma, although there are some uranium occurrences. Hunting Geophysics Ltd has done some aerial prospecting work in the area of Victoria Point in Southern Burma. All the data collected has been plotted on several maps and issued to various Burmese organizations, with a complete report. The follow-up ground exploration was done by a prospecting party headed by Dr Gjelsvik. The Hunting Geophysics' and Dr Gjelsvik reports are not available in the IAEA. The Raw Materials Division in the Union of Burma Atomic Energy Center commenced operations in 1955. The area of Mogok was selected by U Soo Win, the head of the Division, as most favourable for uranium exploration. The region is mountainous, with heavy forest cover. A ground gamma-ray survey was carried out in Mogok Mineral Belt by two geologists accompanied by two assistants, at a spacing of one km. This work showed monazite in all streams over an area of about 150 sq km and has given a detailed studies led to the discovery of some uraninite and pitchblende in the overburden of an old lode. Based, on these first discoveries the Government of Burma requested assistance from the IAEA and an expert was sent there for a period of one year. His field work was mainly limited in the Mogok Mineral Belt, however some reconnaissance field trips were made in other parts of the country. Dr D L Searle concluded that the Mogok area represents a zone of high temperature mineralization but a lower temperature form of uranium mineralization may have developed along the outer edges of the principal high grade zone. He recommended that the area between the Mogok scarp and the Shweli River be systematically traversed. Uranium bearing minerals in Burma are the following: monazite bearing beach sands near Amherst, Tenasserim; monazite placers from near Momeik, Northern Shan States; uraninte crystals from the gem-gravels around Mogok; a radioactive anomaly in syenite at

Testing the efficacy of downscaling in species distribution modelling: a comparison between MaxEnt and Favourability Function models

Directory of Open Access Journals (Sweden)

Olivero, J.

2016-03-01

Full Text Available Statistical downscaling is used to improve the knowledge of spatial distributions from broad–scale to fine–scale maps with higher potential for conservation planning. We assessed the effectiveness of downscaling in two commonly used species distribution models: Maximum Entropy (MaxEnt and the Favourability Function (FF. We used atlas data (10 x 10 km of the fire salamander Salamandra salamandra distribution in southern Spain to derive models at a 1 x 1 km resolution. Downscaled models were assessed using an independent dataset of the species’ distribution at 1 x 1 km. The Favourability model showed better downscaling performance than the MaxEnt model, and the models that were based on linear combinations of environmental variables performed better than models allowing higher flexibility. The Favourability model minimized model overfitting compared to the MaxEnt model.

Consumer's Fresh Produce Food Safety Practices: Outcomes of a Fresh Produce Safety Education Program

Science.gov (United States)

Scott, Amanda R.; Pope, Paul E.; Thompson, Britta M.

2009-01-01

The Centers for Disease Control and Prevention estimate that there are 76 million cases of foodborne disease annually. Foodborne disease is usually associated with beef, poultry, and seafood. However, there is an increasing number of foodborne disease cases related to fresh produce. Consumers may not associate fresh produce with foodborne disease…

Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

Science.gov (United States)

Broeg-Morvay, Anne; Meisterernst, Julia; Schlager, Markus; Mono, Marie-Luise; El-Koussy, Marwan; Kägi, Georg; Jung, Simon; Sarikaya, Hakan

2016-01-01

Background Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke. Methods We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of favourable clinical outcome and mortality at 3 months between dysphagic patients and those without dysphagia. Results Dysphagia was diagnosed in 118 of 570 (20.7%) patients and persisted in 60 (50.9%) at hospital discharge. Thirty-six (30.5%) patients needed nasogastric tube because of severe dysphagia. Stroke severity rather than infarct location was associated with dysphagia. Dysphagic patients suffered more frequently from pneumonia (23.1% vs. 1.1%, pdysphagia. At 3 months, dysphagic patients less often had a favourable outcome (35.7% vs. 69.7%; pdysphagia to be an independent predictor of discharge destination and institutionalization at 3 months, while severe dysphagia requiring tube placement was strongly associated with mortality. Conclusion Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization. PMID:26863627

The H II galaxy Hubble diagram strongly favours Rh = ct over ΛCDM

Science.gov (United States)

Wei, Jun-Jie; Wu, Xue-Feng; Melia, Fulvio

2016-12-01

We continue to build support for the proposal to use H II galaxies (HIIGx) and giant extragalactic H II regions (GEHR) as standard candles to construct the Hubble diagram at redshifts beyond the current reach of Type Ia supernovae. Using a sample of 25 high-redshift HIIGx, 107 local HIIGx, and 24 GEHR, we confirm that the correlation between the emission-line luminosity and ionized-gas velocity dispersion is a viable luminosity indicator, and use it to test and compare the standard model ΛCDM and the Rh = ct universe by optimizing the parameters in each cosmology using a maximization of the likelihood function. For the flat ΛCDM model, the best fit is obtained with Ω _m= 0.40_{-0.09}^{+0.09}. However, statistical tools, such as the Akaike (AIC), Kullback (KIC) and Bayes (BIC) Information Criteria favour Rh = ct over the standard model with a likelihood of ≈94.8-98.8 per cent versus only ≈1.2-5.2 per cent. For wCDM (the version of ΛCDM with a dark-energy equation of state wde ≡ pde/ρde rather than wde = wΛ = -1), a statistically acceptable fit is realized with Ω _m=0.22_{-0.14}^{+0.16} and w_de= -0.51_{-0.25}^{+0.15} which, however, are not fully consistent with their concordance values. In this case, wCDM has two more free parameters than Rh = ct, and is penalized more heavily by these criteria. We find that Rh = ct is strongly favoured over wCDM with a likelihood of ≈92.9-99.6 per cent versus only 0.4-7.1 per cent. The current HIIGx sample is already large enough for the BIC to rule out ΛCDM/wCDM in favour of Rh = ct at a confidence level approaching 3σ.

Main elements in favour of an immediate decommissioning

International Nuclear Information System (INIS)

Cregut, A.

1985-01-01

After a presentation of the elements to be taken into consideration when undertaking a comparative study of the diverse possible solutions for the future of a shut down nuclear reactor, this outlines the advantages of simultaneously decommissioning and conducting final shut down operations. It is clarified that in a real situation the benefits of demonstration and judgement on the technical solutions adopted are arguments in favour of this approach but that this is only true for the first case. The advantages of this approach in a systematic manner are then developed. In conclusion, the advantages associated with this approach are theoretically beyond question and it should not be rejected a priori. However, if it is a question of taken a decision on the future of a nuclear installation, it is necessary to quantify and compare the advantages and disadvantages of other approaches in order to make the best choice

Dynamic prediction of patient outcomes during ongoing cardiopulmonary resuscitation.

Science.gov (United States)

Kim, Joonghee; Kim, Kyuseok; Callaway, Clifton W; Doh, Kibbeum; Choi, Jungho; Park, Jongdae; Jo, You Hwan; Lee, Jae Hyuk

2017-02-01

The probability of the return of spontaneous circulation (ROSC) and subsequent favourable outcomes changes dynamically during advanced cardiac life support (ACLS). We sought to model these changes using time-to-event analysis in out-of-hospital cardiac arrest (OHCA) patients. Adult (≥18 years old), non-traumatic OHCA patients without prehospital ROSC were included. Utstein variables and initial arterial blood gas measurements were used as predictors. The incidence rate of ROSC during the first 30min of ACLS in the emergency department (ED) was modelled using spline-based parametric survival analysis. Conditional probabilities of subsequent outcomes after ROSC (1-week and 1-month survival and 6-month neurologic recovery) were modelled using multivariable logistic regression. The ROSC and conditional probability models were then combined to estimate the likelihood of achieving ROSC and subsequent outcomes by providing k additional minutes of effort. A total of 727 patients were analyzed. The incidence rate of ROSC increased rapidly until the 10th minute of ED ACLS, and it subsequently decreased. The conditional probabilities of subsequent outcomes after ROSC were also dependent on the duration of resuscitation with odds ratios for 1-week and 1-month survival and neurologic recovery of 0.93 (95% CI: 0.90-0.96, p<0.001), 0.93 (0.88-0.97, p=0.001) and 0.93 (0.87-0.99, p=0.031) per 1-min increase, respectively. Calibration testing of the combined models showed good correlation between mean predicted probability and actual prevalence. The probability of ROSC and favourable subsequent outcomes changed according to a multiphasic pattern over the first 30min of ACLS, and modelling of the dynamic changes was feasible. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Will Hydrogen be Competitive in Europe without Tax-Favours?

DEFF Research Database (Denmark)

Hansen, Anders Chr.

2010-01-01

-fossil power-based hydrogen becomes the most cost competitive fuel. General fuel taxes lower the threshold at which the international oil price reverses this competitiveness order. The highest fuel tax rates applied in Europe lowers this threshold oil price considerably, whereas the lowest fuel taxes may...... production, the international oil price, and fuel taxes. At low oil prices, the highest per kilometre costs were found for non-fossil power-based hydrogen, the second highest for natural gas-based hydrogen, and the lowest for conventional fuels. At high oil prices, this ranking is reversed and non...... be insufficient to make hydrogen competitive without tax favours. Alternative adjustments of the EU minimum fuel tax rates with a view to energy efficiency and CO2-emissions are discussed...

From the noun (hatar 'will, favour, mercy' to the adjective bezajtren 'careless'

Directory of Open Access Journals (Sweden)

Petrović Snežana

2009-01-01

Full Text Available The paper analyzes different forms and meanings of the Turkish loan-word (hatar 'will, favour, mercy' and its lexical family. It also emphasizes the use of the words analyzed in specific phraseological structures and the meanings derived from respective contexts. These are accompanied by parallels from other Balkan languages as well as their Turkish prototypes - whenever they are attested. The paper also offers an etymological explanation of the dialectal adjective bezajtren 'careless'.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: New Caledonia

International Nuclear Information System (INIS)

1977-12-01

New Caledonia is an island and with dependencies totals just over 1900 square kilometers in area and contains an estimated 128,000 people. Its principal products are nickel and chrome, but agricultural products assume considerable importance in addition. Geologically New Caledonia is quite complex, and on the basis of the complexity of geology and the relative intensity of the mineralization of the island as well as apparent favourable host rocks a category 2 - 1,000 - 10,000 tonnes U - (nearer to 1,000 than 10,000) is assigned. (author)

Occurrence of carbapenemase-producing bacteria in coastal recreational waters.

Science.gov (United States)

Montezzi, Lara Feital; Campana, Eloiza Helena; Corrêa, Laís Lisboa; Justo, Livia Helena; Paschoal, Raphael Paiva; da Silva, Isabel Lemos Vieira Dias; Souza, Maria do Carmo Maciel; Drolshagen, Marcia; Picão, Renata Cristina

2015-02-01

The spread of carbapenemase-producing Gram-negative rods is an emerging global problem. Although most infections due to carbapenemase producers are limited to healthcare institutions, reports of the occurrence of clinically relevant carbapenemase producers in sewage and polluted rivers are increasingly frequent. Polluted rivers flowing to oceans may contaminate coastal waters with multidrug-resistant bacteria, potentially threatening the safety of recreational activities in these locations. Here we assessed the occurrence of carbapenemase producers in water from touristic beaches located in Rio de Janeiro, Brazil, showing distinct pollution patterns. The presence of enterobacteria was noted, including the predominantly environmental genus Kluyvera spp., producing either Klebsiella pneumoniae carbapenemase (KPC) or Guyana extended-spectrum (GES)-type carbapenemases and often associated with quinolone resistance determinants. An Aeromonas sp. harbouring blaKPC and qnrS was also observed. These findings strengthen the role of aquatic matrices as reservoirs and vectors of clinically relevant antimicrobial-resistant bacteria, with potential to favour the spread of these resistance threats throughout the community. Copyright © 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Traumatic brain injuries caused by traffic accidents in five European countries: outcome and public health consequences.

Science.gov (United States)

Majdan, Marek; Mauritz, Walter; Wilbacher, Ingrid; Janciak, Ivan; Brazinova, Alexandra; Rusnak, Martin; Leitgeb, Johannes

2013-08-01

Road traffic accidents (RTAs) have been identified by public health organizations as being of major global concern. Traumatic brain injuries (TBIs) are among the most severe injuries and are in a large part caused by RTA. The objective of this article is to analyse the severity and outcome of TBI caused by RTA in different types of road users in five European countries. The demographic, severity and outcome measures of 683 individuals with RTA-related TBI from Austria, Slovakia, Bosnia, Croatia and Macedonia were analysed. Five types of road users (car drivers, car passengers, motorcyclists, bicyclists and pedestrians) were compared using univariate and multivariate statistical methods. Short-term outcome [intensive care unit (ICU) survival] and last available long-term outcome of patients were analysed. In our data set, 44% of TBI were traffic related. The median age of patients was 32.5 years, being the lowest (25 years) in car passengers. The most severe and extensive injuries were reported in pedestrians. Pedestrians had the lowest rate of ICU survival (60%) and favourable long-term outcome (46%). Drivers had the highest ICU survival (73%) and car passengers had the best long-term outcome (59% favourable). No differences in the outcome were found between countries with different economy levels. TBI are significantly associated with RTA and thus, tackling them together could be more effective. The population at highest risk of RTA-related TBI are young males (in our sample median age: 32.5 years). Pedestrians have the most severe TBI with the worst outcome. Both groups should be a priority for public health action.

Correlation of serum KL-6 and CC16 levels with neurodevelopmental outcome in premature infants at 12 months corrected age

Science.gov (United States)

Zhang, Zhiqun; Lu, Hui; Zhu, Yunxia; Xiang, Junhua; Huang, Xianmei

2015-01-01

The aim of this study was to evaluate KL-6 and CC16 levels and their correlation with neurodevelopmental outcome among very low birth weight pre-term infants at 12 months corrected age. This prospective cohort study was performed from 2011 to 2013 by enrolling pre-term neonates of gestational age ≤ 32 weeks and birth weight ≤ 1500 g. Serum KL-6 and CC16 levels were determined 7 days after birth and their correlation with neurodevelopment was evaluated using Gesell Mental Developmental Scales. Of the 86 eligible pre-term infants, 63 completed follow-up, of which 15 had bronchopulmonary dysplasia. At 12 months corrected age, 49 infants had favorable outcomes and 14 infants had poor neurodevelopmental outcome. KL-6 levels were higher and CC16 levels were lower in infants with poor neurodevelopmental outcome compared with those infants who had favourable neurodevelopmental outcome. Serum KL-6 levels less than 90.0 ng/ml and CC16 levels greater than 320.0 pg/ml at 7 days of life were found to be predictive of a favourable outcome at 12 months corrected age. These biological markers could predict neurodevelopmental outcome at 12 months corrected age in very low birth weight premature infants, and help the clinician plan early therapeutic interventions to minimize or avoid poor neurodevelopmental outcome. PMID:25631862

Exogenous cellulases of thermophilic micromycetes. Pt. 1. Selection of producers

Energy Technology Data Exchange (ETDEWEB)

Kvesitadze, G; Kvachadze, L; Aleksidze, T; Chartishvili, D K

1986-01-01

More than 600 micromycetes - representatives of different genera have been investigated for their ability to produce exogenous cellulases. Most of the investigated cultures were found to produce these enzymes, 24 cultures being thermophilic, and 18 thermotolerant. Cellulase or its derivatives proved to be the most favourable carbon source for cellulase secretion. None of the thermophilic cultures studied manifested the ability of exogenous exoglucanase biosynthesis. Using UV-rays as mutagen, a mutant strain A. terreus T-49 has been obtained being characterized by an increased endo-glucanase and cellobiase activity, as compared to the initial strains. The cellulase preparations of thermophilic micromycetes contain one cellulasic component: endo-glucanase, or two: endo-glucanase and cellobiase.

An evolutionary concept of polycystic ovarian disease: does evolution favour reproductive success over survival?

Science.gov (United States)

Gleicher, Norbert; Barad, David

2006-05-01

Polycystic ovarian disease (PCOD) is currently considered as possibly the most frequent cause of female infertility. It is also closely associated with syndrome XX, which, in turn, is closely linked with premature and excessive mortality. Considering these adverse effects on reproductive success and human survival, the evolutionary survival of PCOD, itself considered by many to be a genetically transmitted condition, would, on first glance, appear surprising, since evolution usually discriminates against both of these traits. However, an analysis of some recently reported characteristics of the condition calls for the reconsideration of PCOD as a condition which, from an evolutionary viewpoint, favours decreased reproductive success. Indeed, the reported observations that patients with PCOD will resume spontaneous ovulation with even relatively minor weight loss, and experience later menopause than controls, suggests exactly the opposite. Under an evolutionary concept, PCOD can thus be seen as a 'fertility storage condition' which in fact favours human reproductive success and allows the human species to maintain fertility even during adverse environmental circumstances, such as famines.

Blood pressure targets in type 2 diabetes. Evidence against or in favour of an aggressive approach.

Science.gov (United States)

Mancia, Giuseppe; Grassi, Guido

2018-03-01

When associated with high blood pressure, type 2 diabetes mellitus is characterised by a high risk of adverse cardiovascular (CV) and renal outcomes. However, both can be effectively reduced by antihypertensive treatment. Current guidelines on the treatment of hypertension emphasize the need to effectively treat high blood pressure in diabetic individuals, but their recommendations differ in terms of the optimal target blood pressure value to aim for in order to maximise CV and renal protection. In some guidelines the recommended target blood pressure values are blood pressure values close or even less than 130/80 mmHg are recommended. This paper will discuss the evidence for and against a conservative or more aggressive blood pressure target for treated diabetic hypertensive individuals based on the evidence provided by randomised trials, trial meta-analyses and large observational studies. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90 mmHg, and that values approaching 130/80 mmHg should be recommended. However, evidence in favour of even lower systolic values, i.e. <130 mmHg, is limited and is definitively against a reduction to <120 mmHg.

CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study.

Science.gov (United States)

Pallesen, Lars P; Khomenko, Andrei; Dzialowski, Imanuel; Barlinn, Jessica; Barlinn, Kristian; Zerna, Charlotte; van der Hoeven, Erik Jrj; Algra, Ale; Kapelle, L Jaap; Michel, Patrik; Bodechtel, Ulf; Demchuk, Andrew M; Schonewille, Wouter; Puetz, Volker

2017-02-01

Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56-3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24-0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46-0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39-3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46-1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.

Evaluation of different phenotypic methods for detection of amp c beta-lactamase producing bacteria in clinical isolates

International Nuclear Information System (INIS)

Hassan, A.; Usman, J.; Kalim, F.; Gill, M.M.; Khalid, A.; Iqbal, M.; Ingram, P.

2013-01-01

To compare the sensitivity and specificity of different phenotypic methods for detection of Amp C betalactamase producing bacteria. Study Design: Analytical study. Place and Duration of Study: Department of Microbiology, Army Medical College / National University of Sciences and Technology (NUST), Islamabad, Pakistan, from June 2010 to December 2010. Methodology: A total of 150 clinical isolates were screened for presence of Amp C beta-lactamase by using the cefoxitin disc. The confirmatory methods evaluated were inhibitor based assay (boronic acid), Amp C disc test and Amp C Etest. Three dimensional enzyme extract assay was used as the reference method for determining the sensitivity and specificity. Results: Among the total isolates tested, 62.8% bacteria showed the presence of Amp C beta-lactamase by standard three dimensional enzyme extract assay. Among the three methods compared, boronic acid disk test found out to be highly sensitive (88%) and specific (92%) for the detection of Amp C beta-lactamase producing bacteria. Conclusion: Detection of Amp C production is crucial in order to establish the antibiotic therapy and to attain the favourable clinical outcomes. Implementation of simple tests like boronic acid disk tests in the laboratories will help to alleviate the spread of Amp C beta-lactamase harboring organisms. (author)

A framework for understanding outcomes of integrated care programs for the hospitalized elderly

Directory of Open Access Journals (Sweden)

Jacqueline M. Hartgerink

2013-11-01

Full Text Available Introduction: Integrated care has emerged as a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integrated care delivery. Therefore, we developed a framework to identify the underlying mechanisms of integrated care delivery. We should understand how they operate and interact, so that integrated care programmes can enhance the quality of care and eventually patient outcomes.Theory and methods: Interprofessional collaboration among professionals is considered to be critical in integrated care delivery due to many interdependent work requirements. A review of integrated care components brings to light a distinction between the cognitive and behavioural components of interprofessional collaboration.Results: Effective integrated care programmes combine the interacting components of care delivery. These components affect professionals’ cognitions and behaviour, which in turn affect quality of care. Insight is gained into how these components alter the way care is delivered through mechanisms such as combining individual knowledge and actively seeking new information.Conclusion: We expect that insight into the cognitive and behavioural mechanisms will contribute to the understanding of integrated care programmes. The framework can be used to identify the underlying mechanisms of integrated care responsible for producing favourable outcomes, allowing comparisons across programmes.

Clinical characterisation of Becker muscular dystrophy patients predicts favourable outcome in exon-skipping therapy.

Science.gov (United States)

van den Bergen, J C; Schade van Westrum, S M; Dekker, L; van der Kooi, A J; de Visser, M; Wokke, B H A; Straathof, C S; Hulsker, M A; Aartsma-Rus, A; Verschuuren, J J; Ginjaar, H B

2014-01-01

Duchenne and Becker muscular dystrophy (DMD/BMD) are both caused by mutations in the DMD gene. Out-of-frame mutations in DMD lead to absence of the dystrophin protein, while in-frame BMD mutations cause production of internally deleted dystrophin. Clinically, patients with DMD loose ambulance around the age of 12, need ventilatory support at their late teens and die in their third or fourth decade due to pulmonary or cardiac failure. BMD has a more variable disease course. The disease course of patients with BMD with specific mutations could be very informative to predict the outcome of the exon-skipping therapy, aiming to restore the reading-frame in patients with DMD. Patients with BMD with a mutation equalling a DMD mutation after successful exon skipping were selected from the Dutch Dystrophinopathy Database. Information about disease course was gathered through a standardised questionnaire. Cardiac data were collected from medical correspondence and a previous study on cardiac function in BMD. Forty-eight patients were included, representing 11 different mutations. Median age of patients was 43 years (range 6-67). Nine patients were wheelchair users (26-56 years). Dilated cardiomyopathy was present in 7/36 patients. Only one patient used ventilatory support. Three patients had died at the age of 45, 50 and 76 years, respectively. This study provides mutation specific data on the course of disease in patients with BMD. It shows that the disease course of patients with BMD, with a mutation equalling a 'skipped' DMD mutation is relatively mild. This finding strongly supports the potential benefit of exon skipping in patients with DMD.

Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes

DEFF Research Database (Denmark)

Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Koch, Mette Bjerrum

2015-01-01

OBJECTIVE: The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour of the rehabil...... was -6,789 USD/-5,593 Euro in favour of rehabilitation. CONCLUSION: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs....... of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality...... between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs. METHODS: Patients with first-time implantable cardioverter defibrillator implantation (n = 196...

Evaluation of the Favourable Ecological Impact of the Railway on the Environment

Directory of Open Access Journals (Sweden)

Jasna Golubić

2012-10-01

Full Text Available The railway has advantages over other branches of longdistancetransportation from the ecological, economic, safety,and technological point of view.The paper gives an evaluation of the favourable influenceof railway traffic on the environment reflected in the rationalenergy consumption, significantly reduced need of physicalspace, and reduced air pollution.Having these data in mind, the railway is considered tohave a negligible influence on environmental pollution. However,studying even such small amounts plays a significant rolein the traffic safety and in the lives of people and nature itself

Women Favour Dyadic Relationships, but Men Prefer Clubs: Cross-Cultural Evidence from Social Networking

Science.gov (United States)

David-Barrett, Tamas; Rotkirch, Anna; Carney, James; Behncke Izquierdo, Isabel; Krems, Jaimie A.; Townley, Dylan; McDaniell, Elinor; Byrne-Smith, Anna; Dunbar, Robin I. M.

2015-01-01

The ability to create lasting, trust-based friendships makes it possible for humans to form large and coherent groups. The recent literature on the evolution of sociality and on the network dynamics of human societies suggests that large human groups have a layered structure generated by emotionally supported social relationships. There are also gender differences in adult social style which may involve different trade-offs between the quantity and quality of friendships. Although many have suggested that females tend to focus on intimate relations with a few other females, while males build larger, more hierarchical coalitions, the existence of such gender differences is disputed and data from adults is scarce. Here, we present cross-cultural evidence for gender differences in the preference for close friendships. We use a sample of ∼112,000 profile pictures from nine world regions posted on a popular social networking site to show that, in self-selected displays of social relationships, women favour dyadic relations, whereas men favour larger, all-male cliques. These apparently different solutions to quality-quantity trade-offs suggest a universal and fundamental difference in the function of close friendships for the two sexes. PMID:25775258

Women favour dyadic relationships, but men prefer clubs: cross-cultural evidence from social networking.

Directory of Open Access Journals (Sweden)

Tamas David-Barrett

Full Text Available The ability to create lasting, trust-based friendships makes it possible for humans to form large and coherent groups. The recent literature on the evolution of sociality and on the network dynamics of human societies suggests that large human groups have a layered structure generated by emotionally supported social relationships. There are also gender differences in adult social style which may involve different trade-offs between the quantity and quality of friendships. Although many have suggested that females tend to focus on intimate relations with a few other females, while males build larger, more hierarchical coalitions, the existence of such gender differences is disputed and data from adults is scarce. Here, we present cross-cultural evidence for gender differences in the preference for close friendships. We use a sample of ∼112,000 profile pictures from nine world regions posted on a popular social networking site to show that, in self-selected displays of social relationships, women favour dyadic relations, whereas men favour larger, all-male cliques. These apparently different solutions to quality-quantity trade-offs suggest a universal and fundamental difference in the function of close friendships for the two sexes.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Bangladesh

International Nuclear Information System (INIS)

1978-01-01

With the exception of the exploration activities in relation with the Beach Sand Project along the eastern Bay of Bengal, no systematic exploration for uranium had been done before December 1976, when a radiometric survey was implemented by the IAEA. As a result of this survey high radioactivity up to 450 cps was detected in placer Tipam deposits, The background of the terrain made up by Tertiary sediments is 160 - 170 cps. An anomaly was found in Kalipur Chara area which coincides with concentration of heavy minerals derived from Tipam Sandstones. Another anomaly was found within a horizon of Tipam sandstone crossing Hari River. An isolated outcrop in the riverbed showed a count rate up to 4 times background. During the follow up work it was found that this steeply dipping mineralized band stretches (with interruptions) over a distance of at least 3km along a strike. Samples collected from three different spils showed concentration of uranium 50, 60 and 140 ppm. The mineralized bed varies in thickness from a few cm to 2 m. It consists of alternating altered and unaltered sandstone. Bangladesh and Australian experts have separated monazite, zircon, ilmenite, rutile and magnetite from local sands at Cox's Bazar, 96 km southeast of Dacca. Radioactive mineral content is around 3,1% and exploitation may be feasible. Concerning the present status of exploration the technical assistance mission of the IAEA in the field of uranium exploration in Bangladesh is continuing with the objective to evaluate uranium potential in Chittongong and Sylhet district. Concerning areas favourable for uranium first priority should be given to areas of Hari River and Kalipur Chara where radioactive anomalies were detected. In general the area covered by Tipam Sandstone appears to be favourable for uranium mineralization. The potential for new discoveries in Bangladesh appears to be not too bad. Speculative potential could be in the order of 1-10,000 tons uranium

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Austria

International Nuclear Information System (INIS)

1977-10-01

The Federal Republic of Austria is situated in the southeastern part of Central Europe. The country covers a total area of 83.350 square kilometers, the population amounts to 7.5 million inhabitants. The geographical features of Austria are dominated by the E-W-trending chain of the Alps (approximately 60% of the country). The northeastern part of the country is formed by the nonalpine mountains and hills of the Bohemian Massif. There are a large depression, the basin of Vienna, as well as parts of the Pannonian basin in the eastern part. The main hydrographic features are characterized by the river Danube and its tributaries. With the exception of a small part in the west of the country, the drainage system of which is directed to the river Rhine, all other rivers are drained by the Danube. The elevations in the Alps reach heights of up to 3 800 m. Many of the E-W striking mountain chains are higher than 2000 to 2500 m. Several major N-S trending passes over the mountains are favourable for the transportation systems (railroads, motorroads) - The kind of land use in Austria is mainly determined by the character of the landscape which is made up of mountains and valleys as well as of depressions in the eastern part of the country. In the lowlands, good farmland is available. At lower and at medium elevations, forests and grassland predominate in the Alps. At higher elevations, the Alps are covered with grasslands; a great part of the rocks has no soil cover, another part is covered by perennial snow and ice.The presence of many uranium occurrences in the Permo-Triassic sediments justifies a detailed survey of these strata. Special studies on the lithology and the formation of uranium in these rocks have been made during the last few years. They should be evaluated to point out new favourable prospective areas. The potential of Uranium which is assumed to be found in Austria is 10,000 - 50,000 t U

Differences in outcome between twins and singletons born very preterm: results from a population-based European cohort.

NARCIS (Netherlands)

Papiernik, E.; Zeitlin, J.; Delmas, D.; Blondel, B.; Kunzel, W.; Cuttini, M.; Weber, T.; Petrou, S.; Gortner, L.; Kollee, L.A.A.; Draper, E.S.

2010-01-01

BACKGROUND: About 10% of twins are born before 32 weeks of gestation and very preterm birth rates are increasing. Preterm twins tend to have more favourable outcomes than singletons of the same gestational age, but fewer data are available for very preterm infants. This study aims to determine

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Iraq

International Nuclear Information System (INIS)

1977-11-01

Iraq consists of a lowland trough lying between asymmetrical and very different upland massifs to the east, north and west and continuing southeastwards to the Persian Gulf. The region is one of crustal weakness and subsidence with relatively young plastic sedimentary rocks engulfed in downwarped, ancient, rigid and highly resistant blocks. Exploration in the 1954-55 period found some minor radioactive anomalies and very low uranium contents in limestones and phosphates. The results of an aerial radiometric survey in 1973-74 are not known to IAEA. Iraq has no reported uranium resources but there are several favourable formations which warrant a detailed survey. In view of the size of the country and the small amount of systematic exploration carried out up to the present time, the Speculative Potential is considered to lie in the 1,000 to 10,000 tonnes uranium category. (author)

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Panama

International Nuclear Information System (INIS)

1977-08-01

About 20 percent of Panama has been covered by airborne radiometric surveys, largely in the Azuero-Petaquilia area. Essentially no ground examinations have been made. About one third of the country remains unmapped. Most of the rest has been examined only in rapid reconnaissance largely by the United Nations and oil companies. Detailed mapping has been confined to the Canal Zone. No uranium deposits or prospects of economic interest are known in Panama. There appears to be no information available on present exploration activities for uranium. Panama has no specific legislation relating to nuclear energy. However, all mineral deposits belong to the state, except for salt and similar materials, and are governed by the mineral resources code. There appears to be only one remote possibility for uranium mineralization in Panama, namely, sandstone-type deposits. Marginal marine and fluvial sediments, such as host sandstone-type deposits elsewhere, are most abundant 1n the lower Cenozoic parts of the Azuero and possibly Bocas del Toro basins and are probably absent or poorly developed in the Darien and Central basin. Rocks with even moderate background uranium concentrations to be leached and deposited in such sediments are confined to the silicic and alkaline Intrusive rocks of the La Yeguada Formation 1n western Panama and possibly the Rio Guayabo stock in the Sierra de Maje of eastern Panama. Only the La Yeguada Formation is extensive enough and near enough to a potential sedimentary ore host to be important. Uranium concentrations have not been measured in this unit but its silicic composition, relatively young age (with respect to other volcanic rocks in Panama) and high ash content suggest that it may have relatively high Teachable uranium content. The best areas for exploration for La Yeguada-derived sandstone-type uranium deposits would be in the Pese formation between Santiago and Chitre in the Azuero basin. Possibly favourable sandstone type exploration ground

Favourable environments for the deposition of uranium in the Subandean Belt and the Amazon Plain of Peru

International Nuclear Information System (INIS)

Canepa, L.; Rosado, F.

1981-01-01

The area described is located between the east flank of the eastern Cordillera on the territorial limits with Ecuador, Colombia, Brazil and Bolivia. It covers the morphological areas called sub-Andean zone and Amazon plain. The physiographic characteristics change from west to east. In the eastern Cordillera the morphology is rough, with altitudes of 5000 m. Descending to sub-Andean, it presents a moderate topography with low hills between 1000 and 2500 m. Further east the Amazon plain forms an extensive peneplain with altitudes of 400 m. The stratigraphy of the area includes rocks with ages from the Precambrian (eastern Cordillera) to recent. Outcrops of the Palaeozoic formations are found to the east of the eastern Cordillera. Rocks that belong to the Mesozoic and Cenozoic are extensively distributed in the area, as deposits of continental or deltaic facies. The geological evolution of the area is favourable for the formation of stratiform deposits of uranium. The intensity of the orogenic deformation decreases progressively from west to east. The tendency to low dips favours the conditions of migration and precipitation of uranium. The majority of the geological formations of continental and deltaic origin, as well as igneous bodies of upper Palaeozoic and Tertiary age, have been selected as rocks of good geological uranium favourability, taking into consideration criteria found in other parts of the world. These have been modified to suit local conditions. This area presents similar geological conditions to the eastern side of the Andean Cordillera in Argentina where a number of uranium deposits have been located. (author)

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Israel

International Nuclear Information System (INIS)

1977-12-01

The geology of Israel is relatively simple. Most of the country is underlain by sedimentary rocks of Secondary and Tertiary age. As far as the IAEA is aware no systematic exploration has been done for conventional type uranium deposits. Israel has no uranium deposits, and no high or low-grade uranium ores. However, there are uranium 'sources' which are mainly phosphate rock.Proven phosphate reserves in Israel are estimated at about 220 million tons in five different locations. The average uranium concentration is between 100 and 170 ppm. This makes the uranium content in the proven phosphate reserves of Israel to be about 25,000 tons. Together with the possibility of additional discoveries and on the assumption that the economic conditions for the production of both phosphate and uranium become favourable the Speculative Potential is placed in the 10,000 to 50,000 tonnes uranium category. (author)

The influences of adrenaline dosing frequency and dosage on outcomes of adult in-hospital cardiac arrest: A retrospective cohort study.

Science.gov (United States)

Wang, Chih-Hung; Huang, Chien-Hua; Chang, Wei-Tien; Tsai, Min-Shan; Yu, Ping-Hsun; Wu, Yen-Wen; Hung, Kuan-Yu; Chen, Wen-Jone

2016-06-01

To investigate the influence of dosing frequency and dosage of adrenaline on outcomes of cardiopulmonary resuscitation (CPR). We conducted a retrospective observational study in a single medical centre and included adult patients who had suffered an in-hospital cardiac arrest between 2006 and 2012. We used multivariable logistic regression analysis to evaluate the associations between independent variables and outcomes. Adrenaline average dosing frequency was calculated as the total dosage of adrenaline administered during CPR divided by the duration of CPR. Body weight (BW) was analysed as an interaction term to investigate the effect of adrenaline dosage on outcomes. Favourable neurological outcome was defined as a score of 1 or 2 on the Cerebral Performance Category scale at hospital discharge. We included 896 patients in the analysis. After adjusting for multiple confounding factors, including CPR duration, the results indicated that higher adrenaline dosing frequency was associated with lower rates of survival (odds ratio (OR): 0.05, 95% confidence interval (CI): 0.01-0.23) and favourable neurological outcome at hospital discharge (OR: 0.02, 95% CI: 0.002-0.16). A significant interaction was noted between total adrenaline dosage and BW, which indicated that, with the same adrenaline dosage, the outcomes for patients with BW≥82.5kg would be worse than those for patients with lower BW. Higher adrenaline average dosing frequency may be associated with worse outcomes after CPR. Besides, according to current recommendations, patients with BW above 82.5kg may not receive adequate dose of adrenaline. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

New Technologies and Innovation Capacity - Boosting Economic Transition Processes in the Less Favoured Regions

OpenAIRE

Kati-Jasmin Kosonen

2003-01-01

In the era of knowledge society many regions and local communities/ towns are trying to compete with larger, growing cities over the knowledge and intellectual capital resources. Regional or local knowledge environment has become more important. Building innovation capacity and the institutional capacity as one part of it could be a development tool to some lagging behind-regions, (which are called as less-favoured regions) and quite often do not have universities of their own or successful i...

Employee participation in the private sector in Malaysia: The Applicability of Favourable Conjunctures Model

OpenAIRE

Balakrishnan Parasuraman; Di Kelly; Balan Rathakrishnan

2009-01-01

EP is one crucial aspect of the employment relationship in both private and public organisations in many countries. In 2001, Poole, Lansbury and Wiles developed a model for comparative EP, which they named the Favourable Conjunctures Model. So far, this model has only been applied in developed countries such as the United States of America, United Kingdom, Australia and Europe. There it was applied in order to examine worker participation from the national perspective. No extensive study has ...

Predictors of a favourable outcome in patients with fibromyalgia: results of 1-year follow-up.

Science.gov (United States)

Kim, Ji-Eun; Park, Dong-Jin; Choi, Sung-Eun; Kang, Ji-Hyoun; Yim, Yi-Rang; Lee, Jeong-Won; Lee, Kyung-Eun; Wen, Lihui; Kim, Seong-Kyu; Choe, Jung-Yoon; Lee, Shin-Seok

2016-01-01

To determine the outcomes of Korean patients with fibromyalgia (FM) and to identify prognostic factors associated with improvement at 1-year follow-up. Forty-eight patients with FM were enrolled and examined every 3 months for 1 year. At the time of enrollment, we interviewed all patients using a structured questionnaire that recorded socio-demographic data, current or past FM symptoms, and current use of relevant medications. Tender point counts and scores were assessed by thumb palpation. Patients were asked to complete the Korean versions of the Fibromyalgia Impact Questionnaire (FIQ), the Brief Fatigue Inventory, the SF-36, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Self-Efficacy Scale, and the Social Support Scale. Tender points, FIQ scores, and the use of relevant medications were recorded during one year of follow-up. Of the 48 patients, 32 (66.7%) had improved FIQ scores 1 year after enrollment. Improved patients had higher baseline FIQ scores (68.4±13.9 vs. 48.4±20.8, p=0.001) and STAI-II scores (55.8±10.9 vs. 11.5±11.5, p=0.022). Patients treated with pregabalin were more likely to improve after 1 year, based on the FIQ scores (71.9% vs. 37.5%, p=0.031). On multivariate logistic regression analysis, a higher STAI-II score at the time of enrollment and pregabalin treatment during one year of follow-up were the predictors of improvement. Two-thirds of our Korean FM patients experienced some clinical improvement by 1-year follow-up. A high baseline STAI-II score and treatment with pregabalin were the important predictor of improved FM.

Comparison of Operational Subsidies on Less Favoured Areas in EU Countries

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Jana Lososová

2016-01-01

Full Text Available This article is aimed at an analysis of operational subsidies on the Less Favoured Areas (LFA in the European Union countries. With the help of cluster analysis, the EU countries were divided into groups and, using correlation and regression analyses, the relations between defined indicators were evaluate. The indicators of FADN EU related to the cultivated land area were completed with relative indicators. Some differences were proved in subsidy effectiveness between particular groups of the countries. The amount of operational subsidies only has a positive impact on subsidised costs in the mountain LFAs. Worse productive and climate conditions increase the dependence of the output on subsidies related to cost effectiveness. No dependence of the output share of subsidies and the subsidised costs was proven in all groups.

Outcome after emergency surgery without angiography in patients with intracerebral haemorrhage after aneurysm rupture

DEFF Research Database (Denmark)

Bergdal, Ove; Springborg, Jacob; Hauerberg, John

2009-01-01

BACKGROUND: Patients with large intracerebral haematomas (ICH) from aneurysm rupture often present in a poor clinical condition and have a poor prognosis. Time delay for preoperative angiography might in some cases be unappealing. We evaluated the outcome after immediate haematoma removal...... and aneurysm occlusion without preoperative angiography. METHODS: We retrospectively identified 13 consecutive patients. We recorded clinical data and evaluated mortality and morbidity with the Glasgow Outcome Score (GOS) and Telephone Interview of Cognitive Status (TICS). FINDINGS: At follow up seven...... of thirteen patients had favourable outcome assessed by GOS. Three patients had severe disability and three patients died. None of the survived patients interviewed had impaired cognition. CONCLUSIONS: In patients presented in a critical state with aneurysmal ICH, emergency haematoma removal and aneurysm...

Outcome after prenatal diagnosis of congenital anomalies of the kidney and urinary tract.

Science.gov (United States)

Nef, Samuel; Neuhaus, Thomas J; Spartà, Giuseppina; Weitz, Marcus; Buder, Kathrin; Wisser, Josef; Gobet, Rita; Willi, Ulrich; Laube, Guido F

2016-05-01

Congenital anomalies of the kidney and urinary tract are common findings on fetal ultrasound. The aim of this prospective observational study was to describe outcome and risk factors in 115 patients born 1995-2001. All prenatally diagnosed children were stratified into low- and high-risk group and followed postnatally clinically and by imaging at defined endpoints. Risk factors were evaluated using odds ratios. Neonatal diagnosis included pelvi-ureteric junction obstruction (n = 33), vesicoureteral reflux (n = 27), solitary mild pelvic dilatation (postnatal anteroposterior diameter 5-10 mm; n = 25), and further diagnosis as primary obstructive megaureter, unilateral multicystic dysplastic kidney, renal dysplasia and posterior urethral valves. In 38 children with prenatal isolated hydronephrosis, ultrasound normalized at median age of 1.2 years (range 0.1-9). Surgery was performed in 34 children at median age of 0.4 years (0.1-10.8). Persistent renal anomalies without surgery were present in 43 children and followed in 36 for median time of 16 years (12.2-18). Oligohydramnios and postnatal bilateral anomalies were significantly associated with surgery and impaired renal function. The majority of children had a favourable postnatal outcome, in particular children with prenatally low risk, i.e. isolated uni- or bilateral hydronephrosis. Oligohydramnios and postnatal bilateral anomalies were risk factors for non-favourable outcome. • In congenital anomalies of the kidney and urinary tract significantly poorer outcome is known in patients with bilateral renal hypoplasia or solitary kidney associated with posterior urethral valves. • Other factors as proteinuria and vesicoureteral reflux were associated with a higher risk of progression to chronic renal failure in these patients. What is New: • Unlike other studies giving us above-mentioned information, we included all patients with any kind of prenatally diagnosed congenital anomalies of the kidney

Preliminary Study of Favourable Formations for CO2 Subsurface Storage in Spain

International Nuclear Information System (INIS)

Zapatero, M. A.; Reyes, J. L.; Martinez, R.; Suarez, I.; Arenillas, A.; Perucha, M. A.

2009-01-01

This report is a synthesis of the possibilities of CO 2 storage in the Spanish subsurface. Compilation and analysis of geological information has been carried out, looking at surface and subsurface, in order to make a pre-selection of potential favourable units for CO 2 storage, taking in account that each of this storages needs a confining formation to seal the storage. Before the storage selection, a general description of the great geological units of the Iberian Peninsula is done. Afterwards, borehole logging from petroleum exploration is analysed in these units, formations and areas of interest. The aim is to finally obtain a description of selected units and their possibilities of CO 2 storage. (Author) 17 refs

International Uranium Resources Evaluation Project (IUREP) national favourability studies: People's Republic of China

International Nuclear Information System (INIS)

1977-10-01

China with an area close to 10,000,000 sq km and a fifth of the world's population, has a history of mining and, in fact is quite self sufficient in most of it's needs for the more basic mineral products.However, there is a dearth of knowledge of its resources of uranium. One can however, make the assumption that geologically, there are probably several areas that contain the combination of favourable host rocks and source. The speculative potential of China is estimated to be in Category 5, 100,000 to 500,000 tonnes U. (author)

Producer services, economic geography, and services tradability

NARCIS (Netherlands)

de Vaal, A; van den Berg, M

We investigate how the incorporation of producer services linkages affects the outcome of an economic geography model. We specify the production of manufactures such that a variety of producer services is needed to transform tradable unfinished goods into final consumption goods. We find that

Outcome of schizophrenia: some transcultural observations with particular reference to developing countries.

Science.gov (United States)

Kulhara, P

1994-01-01

The present paper provides a description of data based and methodologically sound studies of outcome of schizophrenia from developing and non-Western countries and compares the results. Major studies reviewed include the 2- and 5-year follow-up of the cohort of the International Pilot Study of Schizophrenia, the patients of the World Health Organization Collaborative Study on the Determinants of Outcome of Severe Mental Disorders, a few Indian studies including the study sponsored by the Indian Council of Medical Research and some studies from Colombia and South-East Asia. The studies are compared in terms of the quality of methodology and the rate of attrition. Although the outcome criteria of these studies are not similar, it is obvious that the outcome of schizophrenia in developing countries is generally more favourable. The reasons for this are far from clear. Research concerning the issues pertaining to better outcome of schizophrenia in developing countries in the context of socio-cultural differences in woefully lacking. This is an area that deserves research attention.

Competitive outcome of Daphnia-Simocephalus experimental microcosms: salinity versus priority effects.

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Cláudia Loureiro

Full Text Available Competition is a major driving force in freshwaters, especially given the cyclic nature and dynamics of pelagic food webs. Competition is especially important in the initial species assortment during colonization and re-colonization events, which depends strongly on the environmental context. Subtle changes, such as saline intrusion, may disrupt competitive relationships and, thus, influence community composition. Bearing this in mind, our objective was to assess whether low salinity levels (using NaCl as a proxy alter the competitive outcome (measured as the rate of population biomass increase of Daphnia-Simocephalus experimental microcosms, taking into account interactions with priority effects (sequential species arrival order. With this approach, we aimed to experimentally demonstrate a putative mechanism of differential species sorting in brackish environments or in freshwaters facing secondary salinization. Experiments considered three salinity levels, regarding NaCl added (0.00, 0.75 and 1.50 g L(-1, crossed with three competition scenarios (no priority, priority of Daphnia over Simocephalus, and vice-versa. At lower NaCl concentrations (0.00 and 0.75 g L(-1, Daphnia was a significantly superior competitor, irrespective of the species inoculation order, suggesting negligible priority effects. However, the strong decrease in Daphnia population growth at 1.50 g L(-1 alleviated the competitive pressure on Simocephalus, causing an inversion of the competitive outcome in favour of Simocephalus. The intensity of this inversion depended on the competition scenario. This salinity-mediated disruption of the competitive outcome demonstrates that subtle environmental changes produce indirect effects in key ecological mechanisms, thus altering community composition, which may lead to serious implications in terms of ecosystem functioning (e.g. lake regime shifts due to reduced grazing and biodiversity.

Co-producing social inclusion: the structure/agency conundrum.

Science.gov (United States)

Clifton, A; Repper, J; Banks, D; Remnant, J

2013-08-01

There is a raft of policy guidelines indicating that mental health nurses should be increasing the social inclusion of mental health service users. Despite this there is no universally accepted definition of social inclusion and there is a dearth of empirical evidence on the successful outcome of increasing inclusion for mental health service users. Recognizing the lack of clarity surrounding the concept we have a produced a social inclusion framework to assist mental health professionals and service users to co-produce social inclusive outcomes. Although we agree that social inclusion can be a positive aspect of recovery, we question the extent to which mental health nurses and service users in co-production can overcome the social, economic and political structures that have created the social exclusion in the first place. An understanding and appreciation of the structure/agency conundrum is required if mental health nurses are to engage with service users in an attempt to co-produce socially inclusive outcomes. © 2012 John Wiley & Sons Ltd.

The most-favoured-nation clause in tax treaties: tool for potential reduction of withholding income tax applicable to Chile and Canada

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Renée Antonieta Villagra Cayamana

2013-07-01

Full Text Available Tax treaties to avoid the double taxation signed by a country have consequences for the future, but they can also modify the terms of treaties that are already in force, in case these contain most-favoured-nation clauses. In this line, taxpayers and companies, particularly, as well as the Tax Administration must be alert, regarding topotential modifications of the terms of the Peruvian tax treaties already in force; mainly about the withholding tax rate applied to royalties in the Convention subscribed with Chile and the withholding tax rates applied to dividends, interests and royalties in the Convention subscribed with Canada, taking into account that both of the mentioned tax treaties contain most-favoured-nation clauses for those kind of income. The Ministry of Economy, as the entity in charge of negotiations of the bilateral conventions, according to Law Decree 25883, has the responsibility of negotiating future treaties with full knowledge that the terms to be included could also cause the effect to decrease the withholding tax rates of the income tax in respect to conventions already in effect, as a consequence of the most-favoured-nation clause they contain.

Facilitating Group Analysis of Two Case Studies Utilising Peer Tutoring: Comparison of Tasks and Outcomes

Science.gov (United States)

Fong, Lin Siew

2016-01-01

Peer-tutoring sessions of two groups of advanced diploma in financial accounting students with mixed proficiency were analysed thoroughly in this study. Numerous studies in peer tutoring have produced favourable results to both tutors and tutees due to the scaffolding process which promotes effective learning. However, there is a lack of studies…

International Uranium Resources Evaluation Project (IUREP) national favourability studies: People's Republic of Mongolia

International Nuclear Information System (INIS)

1977-12-01

Mongolia, a country of 1,525,000 square kilometers, and a population of almost the same number of people is land locked between China and USSR. Historically it's closest ties have been with China, but it is now more closely associated with USSR. Geologically it's complex - most exposed formations are younger than PreCambrian although old exist. Potential for uranium is considered fairly good because the fairly complex geology appears to be favourable both for continental sandstone type deposits and calcretes (less than 50%) and vein type, and other deposits (more than 50$). Considerable effort should be made to obtain additional information related to Mongolian geology. (author)

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Canada

International Nuclear Information System (INIS)

1977-08-01

Exploration for mineral deposits in Canada resulted in the discovery of large uranium deposits, such as at Great. Bear Lake, Northwest Territories (1930), in the Elliot Lake area, Ontario (1949); Beaverlodge, Wollaston Lake Fold Belt and Carswell Structure in Saskatchewan (1946-1975) and many uranium occurrences in the Canadian Shield, in the Orogenic Belts and in the Platforms. Uranium output in Canada since 1942 until and including 1976 amounted to 112,000 tonnes U. Reasonably Assured uranium resources as of 1976 amounted to 167,000 tonnes U (at a price up to $40/lb. U 3 0 8 ) and 15,000 tonnes U (at a price more than $40 up to $60/lb. U 3 O 8 ). Estimated Additional uranium resources as of 1976 amounted to 392,000 tonnes U (at a price up to $40/lb. U-Og) and 264,000 tonnes U (at a price more than $40 up to $60/lb. U 3 0 8 ). Possible further potential beyond the above mentioned classes is tentatively estimated to be in the 6th category according to NEA/IAEA favourability classification. (author)

Seizure outcomes of temporal lobe epilepsy surgery in patients with normal MRI and without specific histopathology.

Science.gov (United States)

Ivanovic, Jugoslav; Larsson, Pål G; Østby, Ylva; Hald, John; Krossnes, Bård K; Fjeld, Jan G; Pripp, Are H; Alfstad, Kristin Å; Egge, Arild; Stanisic, Milo

2017-05-01

Seizure outcome following surgery in pharmacoresistant temporal lobe epilepsy patients with normal magnetic resonance imaging and normal or non-specific histopathology is not sufficiently presented in the literature. In a retrospective design, we reviewed data of 263 patients who had undergone temporal lobe epilepsy surgery and identified 26 (9.9%) who met the inclusion criteria. Seizure outcomes were determined at 2-year follow-up. Potential predictors of Engel class I (satisfactory outcome) were identified by logistic regression analyses. Engel class I outcome was achieved in 61.5% of patients, 50% being completely seizure free (Engel class IA outcome). The strongest predictors of satisfactory outcome were typical ictal seizure semiology (p = 0.048) and localised ictal discharges on scalp EEG (p = 0.036). Surgery might be an effective treatment choice for the majority of these patients, although outcomes are less favourable than in patients with magnetic resonance imaging-defined lesional temporal lobe epilepsy. Typical ictal seizure semiology and localised ictal discharges on scalp EEG were predictors of Engel class I outcome.

Marginal tax rates and tax-favoured pension savings of the self-employed: Evidence from Sweden

OpenAIRE

Selin, Håkan

2009-01-01

In recent years, the study of how individuals respond to policies that aim at promoting pension savings has emerged as a vital area of economic research. This paper adds to this literature by estimating the tax price elasticity of contributions to tax-favoured pension savings accounts on a population of self-employed individuals. I exploit a unique total data base over the Swedish population that covers the years 1999 to 2005. When using instrumental variables I obtain a tax price elasticity ...

Clinical Outcomes Used in Clinical Pharmacy Intervention Studies in Secondary Care

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Lene Juel Kjeldsen

2017-05-01

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

The voice of Holland: Dutch public and patient's opinion favours single-port laparoscopy.

Science.gov (United States)

Fransen, Sofie Af; Broeders, Epm; Stassen, Lps; Bouvy, Nd

2014-07-01

Single-port laparoscopy is prospected as the future of minimal invasive surgery. It is hypothesised to cause less post operative pain, with a shorter hospitalisation period and improved cosmetic results. Population- and patient-based opinion is important for the adaptation of new techniques. This study aimed to assess the opinion and perception of a healthy population and a patient population on single-port laparoscopy compared with conventional laparoscopy. An anonymous 33-item questionnaire, describing conventional and single-port laparoscopy, was given to 101 patients and 104 healthy volunteers. The survey participants (median age 44 years; range 17-82 years) were asked questions about their personal situation and their expectations and perceptions of the two different surgical techniques; conventional multi-port laparoscopy and single-port laparoscopy. A total of 72% of the participants had never heard of single-port laparoscopy before. The most important concern in both groups was the risk of surgical complications. When complication risks remain similar, 80% prefers single-port laparoscopy to conventional laparoscopy. When the risk of complications increases from 1% to 10%, 43% of all participants prefer single-port laparoscopy. A total of 70% of the participants are prepared to receive treatment in another hospital if single-port surgery is not performed in their hometown hospital. The preference for single-port approach was higher in the female population. Although cure and safety remain the main concerns, the population and patients group have a favourable perception of single-port surgery. The impact of public opinion and patient perception towards innovative techniques is undeniable. If the safety of the two different procedures is similar, this study shows a positive attitude of both participant groups in favour of single-port laparoscopy. However, solid scientific proof for the safety and feasibility of this new surgical technique needs to be obtained

Which regional features of Danish agriculture favour the corn bunting in the contemporary farming landscape?

DEFF Research Database (Denmark)

Fox, Anthony David; Heldbjerg, Henning

2008-01-01

Corn buntings Miliaria calandra were abundant throughout arable agricultural landscapes in Europe, but have catastrophically declined since the mid 1970s with changes in farming practice and now give serious conservation cause for concern. Corn buntings declined in Denmark during 1976...... on land use correlation and bird surveillance, these results show an association between mixed farming and favourable conservation status of a species now red-listed throughout much of Europe. Further investigations of habitat use at small spatial scales and throughout the annual cycle are urgently...

EVALUATION OF POSTOPERATIVE VISUAL OUTCOME IN TRAUMATIC CATARACT AND A STUDY OF POSTOPERATIVE COMPLICATIONS IN SUCH CASES

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Shantanu Bhattacharjee

2017-12-01

Full Text Available BACKGROUND Cataract formation is commonly observed as a result of blunt or penetrating ocular injury and constitutes one of major causes of acute or longstanding visual loss. The surgical technique, timing of surgery and postoperative complications have all been considered to be significant factors in determining the final visual outcome. The aim of the present study is to evaluate postoperative visual outcome in a series of patients with traumatic cataract and to assess the postoperative complications conducted at IQ City Medical College, Durgapur, West Bengal. MATERIALS AND METHODS A consecutive series of 45 patients with traumatic cataract were carefully selected from outpatient department between May 2015 and April 2017. All the patients had undergone manual Small Incision Cataract Surgery (SICS with IOL implantation. Postoperative visual outcome and postoperative complications were assessed. RESULTS Corrected Visual Acuity (VA at the end of 6th week in 45 cases ranged between 6/6 and 6/60. Subjective correction with glasses ranged from -2 dioptre spherical to +1.5 dioptre spherical. 25 cases (55.5% had VA 6/6-6/9, 15 cases (33.3% had VA of 6/12 to 6/18, 4 cases (8.9% had VA between 6/24 and 6/36 and 1 case had VA 6/60. The group which had VA between 6/12 and 6/18 was due to the presence of posterior capsular opacification. CONCLUSION The present study reveals most of the traumatic cataract cases had favourable visual outcome. Considering the fact that a good number of paediatric patients were treated in this study, it assumes more significance with the favourable visual outcome that could be achieved, thus preventing deprivation amblyopia and blindness.

Do Refuge Plants Favour Natural Pest Control in Maize Crops?

Science.gov (United States)

Quispe, Reinaldo; Mazón, Marina; Rodríguez-Berrío, Alexander

2017-01-01

The use of non-crop plants to provide the resources that herbivorous crop pests’ natural enemies need is being increasingly incorporated into integrated pest management programs. We evaluated insect functional groups found on three refuges consisting of five different plant species each, planted next to a maize crop in Lima, Peru, to investigate which refuge favoured natural control of herbivores considered as pests of maize in Peru, and which refuge plant traits were more attractive to those desirable enemies. Insects occurring in all the plants, including the maize crop itself, were sampled weekly during the crop growing cycle, from February to June 2011. All individuals collected were identified and classified into three functional groups: herbivores, parasitoids, and predators. Refuges were compared based on their effectiveness in enhancing the populations of predator and parasitoid insects of the crop enemies. Refuges A and B were the most effective, showing the highest richness and abundance of both predators and parasitoids, including several insect species that are reported to attack the main insect pests of maize (Spodoptera frugiperda and Rhopalosiphum maidis), as well as other species that serve as alternative hosts of these natural enemies. PMID:28718835

The Outcomes of Anterior Spinal Fusion for Cervical Compressive Myelopathy—A Retrospective Review

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Tsz-King Suen

2011-12-01

Conclusion: Anterior cervical decompression with bone fusion is a viable surgical option for patients with one level of anterior cervical cord compression, especially for patients with kyphosis or straight canal spine. For patients with two- to three-level involvement, anterior cervical decompression with bone fusion provides good functional result in proper selection of cases. We also identified some prognostic factors (male sex, symptoms less than 1 year, and age less than 70 years in predicting a favourable outcome of anterior spinal fusion for CCM.

Multimodal predictor of neurodevelopmental outcome in newborns with hypoxic-ischaemic encephalopathy.

Science.gov (United States)

Temko, Andriy; Doyle, Orla; Murray, Deirdre; Lightbody, Gordon; Boylan, Geraldine; Marnane, William

2015-08-01

Automated multimodal prediction of outcome in newborns with hypoxic-ischaemic encephalopathy is investigated in this work. Routine clinical measures and 1h EEG and ECG recordings 24h after birth were obtained from 38 newborns with different grades of HIE. Each newborn was reassessed at 24 months to establish their neurodevelopmental outcome. A set of multimodal features is extracted from the clinical, heart rate and EEG measures and is fed into a support vector machine classifier. The performance is reported with the statistically most unbiased leave-one-patient-out performance assessment routine. A subset of informative features, whose rankings are consistent across all patients, is identified. The best performance is obtained using a subset of 9 EEG, 2h and 1 clinical feature, leading to an area under the ROC curve of 87% and accuracy of 84% which compares favourably to the EEG-based clinical outcome prediction, previously reported on the same data. The work presents a promising step towards the use of multimodal data in building an objective decision support tool for clinical prediction of neurodevelopmental outcome in newborns with hypoxic-ischaemic encephalopathy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach.

Science.gov (United States)

Christensen, Leif; Karle, Hans; Nystrup, Jørgen

2007-09-01

An outcome-based approach to medical education compared to a process/content orientation is currently being discussed intensively. In this article, the process and outcome interrelationship in medical education is discussed, with specific emphasis on the relation to the definition of standards in basic medical education. Perceptions of outcome have always been an integrated element of curricular planning. The present debate underlines the need for stronger focus on learning objectives and outcome assessment in many medical schools around the world. The need to maintain an integrated approach of process/content and outcome is underlined in this paper. A worry is expressed about the taxonomy of learning in pure outcome-based medical education, in which student assessment can be a major determinant for the learning process, leaving the control of the medical curriculum to medical examiners. Moreover, curricula which favour reductionism by stating everything in terms of instrumental outcomes or competences, do face a risk of lowering quality and do become a prey for political interference. Standards based on outcome alone rise unclarified problems in relationship to licensure requirements of medical doctors. It is argued that the alleged dichotomy between process/content and outcome seems artificial, and that formulation of standards in medical education must follow a comprehensive line in curricular planning.

Current role and future developments of radiotherapy in early-stage favourable Hodgkin's lymphoma

International Nuclear Information System (INIS)

Eich, H.T.; Mueller, R.P.

2007-01-01

The radiosensibility of Hodgkin's lymphoma (HL) is well established since 1902, when Pusey was one of the first to publish about radiotherapeutical treatment of a HL. In the early years, radiotherapy was the only curative treatment for this systemic disease, but the reports of Kaplan and Rosenberg and Peters in the fifties and seventies showed that irradiation of involved lymph node regions only resulted in high local and distant recurrences. The introduction of linear accelerator based high dose extended field (EF)-radiotherapy by Kaplan in Stanford was a milestone in the evolution of definitive curative radiotherapy strategies. The application of the mantle field for supradiaphragmatic and the inverted Y (with or without including the spleen or splenic pedicle) for infradiaphragmatic disease resulted in a dramatic improvement of survival rates in the early stages I and II (Ann Arbor) from 25-30% in the sixties to 65-80% in the eighties. Kaplan reported about a close relationship between radiation dose and cure rates in the case of definitive radiotherapy. A dose of at least 40 Gy resulted in local recurrences below 5% and is today the standard dose for radiotherapy only outside protocols. Despite complete remission rates after radiotherapy of 90-100%, the overall recurrence rate (including in-field, marginal and distant relapses) was between 20 and 30%. Analysis of the relapses revealed some stage migrating risk factors: large mediastinal mass, extra nodal involvement, number of involved lymph node areas (≥ 3) and high ESR. The possibility of more accurate staging by using new imaging techniques like ultrasonography, CT and MRI as well as PET in the recent years resulted e.g. in the definition of early-favourable, early-unfavourable (intermediate) and high risk stages and more specific, risk adapted treatment strategies. The objective of this article is to show recent achievements and developments in the management of early-stage favourable HL exemplified by

Outcome of decompressive craniectomy (DC) for severe traumatic brain injury (stbi) in adults

International Nuclear Information System (INIS)

Qasmi, S.A.; Ghaffar, A.; Akram, M.

2015-01-01

To evaluate the outcomes of decompressive craniectomy (DC) in adults with severe traumatic brain injury (STBI). Study Design: Observational cross-sectional. Place and Duration of Study: Neurosurgical unit CMH Rawalpindi from July, 2011 to June 2014. Material and Methods: Total of 39 patients who underwent DC for STBI were included in the study. Patients of both sexes and of age range 20 - 48 (32.03 +- 8.01) years were included in the study. The DC was performed within 24 and after 24 hours. Parameters recorded were mortality, neurological outcome / complications like brain herniation, wound dehiscence, cerebrospinal fluid (CSF) leak, contusion expansion, sinking flap syndrome, subdural hygromas and hydrocephalus. Data was analyzed by using SPSS version 17 and descriptive statistics, frequency, rate and percentage was computed for presentation of qualitative outcomes. Results: Favourable neurological outcome was seen in 21 patients (53.85%) where as 6 patients (15.38%) had moderate to severe disability and 3 patients (7.69%) were vegetative respectively. Patients operated within 24 hours and with Glasgow coma scale (GCS) range 6-8 had better outcome. Overall 9 patients (23.08%) did not survive the injury and procedure. Conclusion: As high mortality is associated with STBI, DC is an effective option to lower down the refractory intracranial hypertension with an acceptable surgical outcome. (author)

The present and future of the most favoured inflationary models after Planck 2015

Energy Technology Data Exchange (ETDEWEB)

Escudero, Miguel; Ramírez, Héctor; Boubekeur, Lotfi; Mena, Olga [Instituto de Física Corpuscular (IFIC), CSIC-Universitat de Valencia, Apartado de Correos 22085, E-46071 (Spain); Giusarma, Elena, E-mail: miguel.escudero@ific.uv.es, E-mail: hector.ramirez@ific.uv.es, E-mail: lboubekeur@usfq.edu.ec, E-mail: elena.giusarma@roma1.infn.it, E-mail: olga.mena@ific.uv.es [Physics Department and INFN, Università di Roma ' La Sapienza' , Piazzale Aldo Moro 2, 00185, Rome (Italy)

2016-02-01

The value of the tensor-to-scalar ratio r in the region allowed by the latest Planck 2015 measurements can be associated to a large variety of inflationary models. We discuss here the potential of future Cosmic Microwave Background cosmological observations in disentangling among the possible theoretical scenarios allowed by our analyses of current Planck temperature and polarization data. Rather than focusing only on r, we focus as well on the running of the primordial power spectrum, α{sub s} and the running thereof, β{sub s}. If future cosmological measurements, as those from the COrE mission, confirm the current best-fit value for β{sub s} ∼> 10{sup −2} as the preferred one, it will be possible to rule-out the most favoured inflationary models.

MR imaging of term infants with hypoxic-ischaemic encephalopathy as a predictor of neurodevelopmental outcome and late MRI appearances

International Nuclear Information System (INIS)

Twomey, Eilish; Ryan, Stephanie; Twomey, Anne; Murphy, John; Donoghue, Veronica B.

2010-01-01

detailed neurodevelopmental assessment at 2 years of age, infants were classified into two groups according to whether they had a favourable or unfavourable outcome. Of the 26 infants, 6 infants died before formal assessment at the age of 2 years. A further 5 infants had moderate to severe cerebral palsy in addition to severe cognitive impairment. The remaining 15 infants were categorized in the favourable outcome group. The US appearance performed well in terms of predicting final outcome (P = 0.005). The pattern of ischaemia seen on early MRI was a significant predictor of outcome (P < 0.0001). The BG, BG/W and S scores of the diffusion imaging were significantly associated with outcome (P < 0.0001, P < 0.0001 and P = 0.0005 respectively). DWI was predictive of outcome group (P < 0.0001), as were the early T1- and T2-W sequences (P = 0.002) and cranial US (P = 0.005). Assessment of the PLIC in infants with watershed or atypical patterns of ischaemia was found to be less reliable in predicting outcome. The measured ADC value in the PLIC was significantly reduced in those children who had an unfavourable outcome (P = 0.03). While early MRI performed better than cranial US, the sonography findings were useful. The pattern of ischaemia on early MRI was a good predictor of prognosis. All infants with watershed or atypical patterns had a favourable outcome. The majority of infants with central patterns of ischaemia had an unfavourable outcome and all infants with a diffuse pattern had an unfavourable outcome. DWI was predictive of outcome group, as were early T1- and T2-W sequences and cranial US. (orig.)

MR imaging of term infants with hypoxic-ischaemic encephalopathy as a predictor of neurodevelopmental outcome and late MRI appearances

Energy Technology Data Exchange (ETDEWEB)

Twomey, Eilish; Ryan, Stephanie [Children' s University Hospital, Department of Radiology, Dublin (Ireland); Twomey, Anne; Murphy, John [National Maternity Hospital, Department of Neonatology, Dublin (Ireland); Donoghue, Veronica B. [National Maternity Hospital, Department of Radiology, Dublin (Ireland); Children' s University Hospital, Department of Radiology, Dublin (Ireland)

2010-09-15

detailed neurodevelopmental assessment at 2 years of age, infants were classified into two groups according to whether they had a favourable or unfavourable outcome. Of the 26 infants, 6 infants died before formal assessment at the age of 2 years. A further 5 infants had moderate to severe cerebral palsy in addition to severe cognitive impairment. The remaining 15 infants were categorized in the favourable outcome group. The US appearance performed well in terms of predicting final outcome (P = 0.005). The pattern of ischaemia seen on early MRI was a significant predictor of outcome (P < 0.0001). The BG, BG/W and S scores of the diffusion imaging were significantly associated with outcome (P < 0.0001, P < 0.0001 and P = 0.0005 respectively). DWI was predictive of outcome group (P < 0.0001), as were the early T1- and T2-W sequences (P = 0.002) and cranial US (P = 0.005). Assessment of the PLIC in infants with watershed or atypical patterns of ischaemia was found to be less reliable in predicting outcome. The measured ADC value in the PLIC was significantly reduced in those children who had an unfavourable outcome (P = 0.03). While early MRI performed better than cranial US, the sonography findings were useful. The pattern of ischaemia on early MRI was a good predictor of prognosis. All infants with watershed or atypical patterns had a favourable outcome. The majority of infants with central patterns of ischaemia had an unfavourable outcome and all infants with a diffuse pattern had an unfavourable outcome. DWI was predictive of outcome group, as were early T1- and T2-W sequences and cranial US. (orig.)

Clinical features and outcome analysis of intracranial hydatid cysts

International Nuclear Information System (INIS)

Khan, M.M.; Shah, M.; Ayub, S.; Ahmad, A.; Aman, A.; Shah, M.A.; Rehman, R.U.

2016-01-01

Background: Hydatid cyst of the brain is a serious zoonotic parasitic infection which have profound health consequences if left untreated. The surgical excision of the cysts are rewarding for both the patient the neurosurgeon. Methods: The study was conducted prospectively at Department of Neurosurgery Hayatabad Medical Complex Peshawar from January 2013 to December 2014. Patients with a diagnosis of intracranial hydatid cysts were included, clinical and radiological features recorded, intervention and postoperative outcome were analysed. Results: Eleven patients with a male to female ratio of 1.7:1. Mean age was 12.4 (SD±6.5) years with median GCS on arrival of 10 (SD±2.5). Clinical features were headache (81.8 percentage), vomiting (90.9 percentage), seizures (36.4 percentage), focal deficits (54.5 percentage) and papilloedema (72.7 percentage). The median GCS on discharge was 13 (SD±1.1) while GOS at 1 month follow up was 4 (SD±0.7). The bivariate analysis showed inverse correlation (R2=-0.68; p=0.02) between duration of symptoms and outcome while GCS on admission was positively correlated (rs=0.75; p=0.007) with the outcome. There was no mortality. Conclusion: Despite its rarity the clinical features are non-specific while radiological features help in establishing diagnosis. Earlier diagnosis and prompt intervention is the key to favourable outcome. (author)

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Portugal

International Nuclear Information System (INIS)

1977-10-01

Portugal is situated on the western edge of the Iberian Meseta. At present, its reasonably assured reserves are about 7800 t of U (including 1000 t of U at more than 830/lb U 3 O 8 ) and 850 t of U in estimated additional reserves. This potential is divided between vein deposits and deposits located in the peribatholithic schists or enclaved in granite. Two main districts share these reserves - Beira at the centre of the country and Alto Alentejo in the east, approximately at the same latitude as Lisbon. In spite of the considerable prospecting activities authorized by Portugal in the Meseta area, the subject cannot yet be regarded as exhausted. Additional resources may still be located in the horizontal and vertical extensions of the vein mineralizations or schists from the already known deposits or outside the districts containing such deposits. Moreover, certain post-Palaeozoic sedimentary basins exhibit features favourable for the presence of uranium-bearing deposits and therefore deserve to be taken into consideration. However, there are as yet no examples of economic mineralization in such locations in Portugal. All things considered, we considered it reasonable to place Portugal in category No. 3 of the classiffication adopted by BJREP. (author)

Predation success by a plant-ant indirectly favours the growth and fitness of its host myrmecophyte.

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Alain Dejean

Full Text Available Mutualisms, or interactions between species that lead to net fitness benefits for each species involved, are stable and ubiquitous in nature mostly due to "byproduct benefits" stemming from the intrinsic traits of one partner that generate an indirect and positive outcome for the other. Here we verify if myrmecotrophy (where plants obtain nutrients from the refuse of their associated ants can explain the stability of the tripartite association between the myrmecophyte Hirtella physophora, the ant Allomerus decemarticulatus and an Ascomycota fungus. The plant shelters and provides the ants with extrafloral nectar. The ants protect the plant from herbivores and integrate the fungus into the construction of a trap that they use to capture prey; they also provide the fungus and their host plant with nutrients. During a 9-month field study, we over-provisioned experimental ant colonies with insects, enhancing colony fitness (i.e., more winged females were produced. The rate of partial castration of the host plant, previously demonstrated, was not influenced by the experiment. Experimental plants showed higher δ(15N values (confirming myrmecotrophy, plus enhanced vegetative growth (e.g., more leaves produced increased the possibility of lodging ants in leaf pouches and fitness (i.e., more fruits produced and more flowers that matured into fruit. This study highlights the importance of myrmecotrophy on host plant fitness and the stability of ant-myrmecophyte mutualisms.

Deregulated expression of connective tissue growth factor (CTGF/CCN2) is linked to poor outcome in human cancer.

Science.gov (United States)

Wells, Julia E; Howlett, Meegan; Cole, Catherine H; Kees, Ursula R

2015-08-01

Connective tissue growth factor (CTGF/CCN2) has long been associated with human cancers. The role it plays in these neoplasms is diverse and tumour specific. Recurring patterns in clinical outcome, histological desmoplasia and mechanisms of action have been found. When CTGF is overexpressed compared to low-expressing normal tissue or is underexpressed compared to high-expressing normal tissue, the functional outcome favours tumour survival and disease progression. CTGF acts by altering proliferation, drug resistance, angiogenesis, adhesion and migration contributing to metastasis. The pattern of CTGF expression and tumour response helps to clarify the role of this matricellular protein across a multitude of human cancers. © 2014 UICC.

Does increased salinity influence the competitive outcome of two producer species?

Science.gov (United States)

Venâncio, C; Anselmo, E; Soares, A; Lopes, I

2017-02-01

Within the context of global climate changes, it is expected that low-lying coastal freshwater ecosystems will face seawater intrusion with concomitant increase in salinity levels. Increased salinity may provoke disruption of competitive relationships among freshwater species. However, species may be capable of acclimating to salinity, which, in turn, may influence the resilience of ecosystems. Accordingly, this work aimed at assessing the effects of multigenerational exposure to low levels of salinity in the competitive outcome of two species of green microalgae: Raphidocelis subcapitata and Chlorella vulgaris. To attain this, three specific objectives were delineated: (1) compare the toxicity of natural seawater (SW) and NaCl (as a surrogate of SW) to the two microalgae, (2) determine the capacity of the two microalgae species to acclimate to low salinity levels, and (3) assess the influence of exposure to low salinity levels in the competitive outcome of the two microalgae. Results revealed SW to be slightly less toxic than NaCl for the two microalgae. The EC 25,72 h for growth rate was 4.63 and 10.3 mS cm -1 for R. subcapitata and 6.94 and 15.4 mS cm -1 for C. vulgaris, respectively for NaCl and SW. Both algae were capable of acclimating to low levels of salinity, but C. vulgaris seemed to acclimate faster than R. subcapitata. When exposed in competition, under control conditions, the growth rates of C. vulgaris were lower than those of R. subcapitata. However, C. vulgaris was capable of acquiring competitive advantage equaling or surpassing the growth rate of R. subcapitata with the addition of NaCl or SW, respectively. The multigenerational exposure to low levels of salinity influenced the competitive outcome of the two algae both under control and salinity exposure. These results suggest that long-term exposure to low salinity stress can cause shifts in structure of algae communities and, therefore, should not be neglected since algae are at the basis

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

Science.gov (United States)

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

2014-07-21

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

Centaurs, Pegasus, Sherlock Holmes: Against the Prejudice in Favour of the Real

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Travanini Cristina

2016-12-01

Full Text Available Meinong’s thought has been rediscovered in recent times by analytic philosophy: his object theory has significant consequences in formal ontology, and especially his account of impossible objects has proved itself to be decisive in a wide range of fields, from logic up to ontology of fiction. Rejecting the traditional ‘prejudice in favour of the real’, Meinong investigates what there is not: a peculiar non-existing object is precisely the fictional object, which exemplifies a number of properties (like Sherlock Holmes, who lives in Baker Street and is an outstanding detective without existing in the same way as flesh-and-blood detectives do. Fictional objects are in some sense incomplete objects, whose core of constituent properties is not completely determined. Now, what does it imply to hold that a fictional object may also occur in true statements? We shall deal with the objections raised by Russell and Quine against Meinong’s view, pointing out limits and advantages of both perspectives.

Clinical and economic outcomes in a population-based European cohort of 948 ulcerative colitis and Crohn's disease patients by Markov analysis

DEFF Research Database (Denmark)

Odes, S.; Vardi, H.; Friger, M.

2010-01-01

.66 in CD. Both diseases had similar likelihood of persistent drug-dependency or drug-refractoriness. Surgery was more probable in CD, 0.20, than UC, 0.08. In terms of economic outcomes, surgery was costlier in UC per cycle, but the outlay over 10 years was greater in CD. Drug-refractory UC and CD cases......P>Background Forecasting clinical and economic outcomes in ulcerative colitis (UC) and Crohn's disease (CD) patients is complex, but necessary. Aims To determine: the frequency of treatment-classified clinical states; the probability of transition between states; and the economic outcomes. Methods...... engendered high costs in the cohort. Conclusions Most patients on 5-aminosalicylates, corticosteroids and immunomodulators had favourable clinical and economic outcomes over 10 years. Drug-refractory and surgical patients exhibited greater long-term expenses...

T cells but not NK cells are associated with a favourable outcome for resected colorectal liver metastases

International Nuclear Information System (INIS)

Pugh, Siân A; Harrison, Rebecca J; Primrose, John N; Khakoo, Salim I

2014-01-01

The adaptive immune response to colorectal cancer is important for survival. Less is understood about the role of innate lymphocytes, such as Natural Killer (NK) cells, which are abundant in human liver. Samples of fresh liver (n = 21) and tumour (n = 11) tissue were obtained from patients undergoing surgical resection of colorectal liver metastases. Flow cytometry was used to analyse the presence and phenotype of NK cells, as compared to T cells, in the tumour and liver tissue. Results were correlated with survival. NK cells were poorly recruited to the tumours (distant liver tissue 38.3%, peritumoural liver 34.2%, tumour 12.9%, p = 0.0068). Intrahepatic and intratumoural NK cells were KIR (killer immunoglobulin-like receptor) lo NKG2A hi whereas circulating NK cells were KIR hi NKG2A lo . By contrast T cells represented 65.7% of the tumour infiltrating lymphocytes. Overall survival was 43% at 5 years, with the 5-year survival for individuals with a T cell rich infiltrate being 60% (95% CI 17-93%) and for those with a low T cell infiltrate being 0% (95% CI 0-48%). Conversely individuals with higher levels of NK cells in the tumour had an inferior outcome, although there were insufficient numbers to reach significance (median survivals: NK Hi 1.63 years vs NK Lo 3.92 years). T cells, but not NK cells, are preferentially recruited to colorectal liver metastases. NK cells within colorectal metastases have an intrahepatic and potentially tolerogenic, rather than a peripheral, phenotype. Similar to primary tumours, the magnitude of the T cell infiltrate in colorectal metastases is positively associated with survival

A comparison of two novel antipsychotics in first episode non-affective psychosis: one-year outcome on symptoms, motor side effects and cognition.

Science.gov (United States)

Malla, Ashok; Norman, Ross; Scholten, Derek; Townsend, Laurel; Manchanda, Rahul; Takhar, Jatinder; Haricharan, Raj

2004-12-15

The main objective of this study was to compare 1-year outcome on symptoms, extrapyramidal side effects (EPS) , positive and negative symptoms, and domains of cognition in first episode psychosis (FEP) patients. Drug-naive FEP patients, who were similar on a number of characteristics likely to affect outcome, were treated with only one antipsychotic (risperidone or olanzapine) for at least 1 year and compared at baseline and after 1 year of treatment. Differences in outcome were assessed using an analysis of co-variance with change scores between initial assessment and after 1 year of treatment on levels of psychotic, disorganization and psychomotor poverty symptoms, EPS (parkinsonism, akathesia and dyskineisa) and domains of cognition as the dependent variable, respective baseline scores as covariates, and drug group as the independent variable. While patients in both groups showed substantial improvement, there were no significant differences in the magnitude of change in reality distortion, disorganization and psychomotor poverty symptoms. Trends in change in EPS favouring olanzapine and on some domains of cognition (processing speed and executive functions) favouring risperidone failed to reach statistical significance. The failure to confirm previous claims of greater improvement on either risperidone or olanzapine in patients with a first episode of psychosis may be the result of methodological bias introduced by unequal dosing between the two drugs or the use of chronically ill and treatment-refractory patients in previous studies.

Hepatic transplantation outcomes for carefully selected cirrhotic patients with hepatocellular carcinoma: experience at a small- to medium-volume centre.

LENUS (Irish Health Repository)

Qasim, A

2012-02-01

BACKGROUND: Hepatic transplantation outcomes for cirrhotic patients with hepatocellular carcinoma (HCC) at a small- to medium-volume centre are not fully known due to relative novelty of patient selection criteria. AIM: To determine hepatic transplantation outcomes for HCC at a small- to medium-volume centre. Patients and methods Hepatocellular carcinoma patients were listed for transplantation according to the International Guideline and further categorized as those fulfilling or exceeding Milan or University of San Francisco (UCSF) criteria on explanted liver morphology. Outcomes including mortality, retransplantation, and tumour recurrence rate were analysed. RESULTS: Twenty-six patients had HCC and on explanted liver morphology, Milan and UCSF criteria met 15 and 18 patients, respectively. Patients and graft survival at 3 months, 1 and 5 years were 100, 96, 84, and 88, 84, 77%, respectively. Outcomes favoured Milan criteria but did not reach statistical significance. CONCLUSIONS: Hepatic transplantation for HCC at a small-to medium-volume transplant centre had comparable survival outcomes to high-volume centres.

Genetic favouring of pheomelanin-based pigmentation limits physiological benefits of coloniality in lesser kestrels Falco naumanni.

Science.gov (United States)

Galván, Ismael; Moraleda, Virginia; Otero, Ignacio; Álvarez, Ernesto; Inácio, Ângela

2017-10-01

Pheomelanin contributes to the pigmentation phenotype of animals by producing orange and light brown colours in the integument. However, pheomelanin synthesis in melanocytes requires consumption of glutathione (GSH), the most important intracellular antioxidant. Therefore, a genetic control favouring the production of large amounts of pheomelanin for pigmentation may lead to physiological costs under environmental conditions that promote oxidative stress. We investigated this possibility in the context of breeding coloniality, a reproductive strategy that may affect oxidative stress. We found in lesser kestrel Falco naumanni nestlings that the GSH:GSSG ratio, which decreases with systemic oxidative stress, increased with the size of the colony where they were reared, but the expression in feather melanocytes of five genes involved in pheomelanin synthesis (Slc7a11, Slc45a2, CTNS, MC1R and AGRP) did not vary with colony size. The antioxidant capacity (TEAC) of lesser kestrel nestlings also increased with colony size, but in a manner that depended on Slc7a11 expression and not on the expression of the other genes. Thus, antioxidant capacity increased with colony size only in nestlings least expressing Slc7a11, a gene with a known role in mediating cysteine (a constituent amino acid of GSH) consumption for pheomelanin production. The main predictor of the intensity of pheomelanin-based feather colour was Slc45a2 expression followed in importance by Slc7a11 expression, hence suggesting that the genetic regulation of the pigmentation phenotype mediated by Slc7a11 and a lack of epigenetic lability in this gene limits birds from benefiting from the physiological benefits of coloniality. © 2017 John Wiley & Sons Ltd.

Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam.

Science.gov (United States)

Phuong, N T M; Nhung, N V; Hoa, N B; Thuy, H T; Takarinda, K C; Tayler-Smith, K; Harries, A D

2016-03-21

The programmatic management of drug-resistant tuberculosis (TB) in Viet Nam has been rapidly scaled up since 2009. To document the annual numbers of patients enrolled for multidrug-resistant tuberculosis (MDR-TB) treatment during 2010-2014 and to determine characteristics and treatment outcomes of patients initiating treatment during 2010-2012. A retrospective cohort study using national reports and data from the national electronic data system for drug-resistant TB. The number of patients enrolled annually for MDR-TB treatment increased from 97 in 2010 to 1522 in 2014. The majority of patients were middle-aged men who had pulmonary disease and had failed a retreatment regimen; 77% had received ⩾2 courses of TB treatment. Favourable outcomes (cured and treatment completed) were attained in 73% of patients. Unfavourable outcomes included loss to follow-up (12.5%), death (8%) and failure (6.3%). Having had ⩾2 previous treatment courses and being human immunodeficiency virus-positive were associated with unfavourable outcomes. Increasing numbers of patients are being treated for MDR-TB each year with good treatment outcomes under national programme management in Viet Nam. However, there is a need to increase case detection-currently at 30% of the estimated 5100 MDR-TB cases per year, reduce adverse outcomes and improve monitoring and evaluation.

ISSUES OF INTEGRATION OF SKILLS FAVOURABLE TO HEALTH IN PERSONS WITH DIABETES MELLITUS

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Vida Gudžinskienė

2018-05-01

Full Text Available Diabetes mellitus is not only a medical, but also a public issue. The number of people with diabetes is increasing every year. Diabetes causes complications of diseases. In addition to infertility issues and foot injuries that worsen the health condition, patients develop diabetic retinopathy, diabetic neuropathy, chronic kidney disease, cardiovascular diseases (strokes, ischemic heart diseases, peripheral vascular diseases. Accordingly, training courses for patients and focus on the health of the patients themselves are very important. The object of the research is training of persons with diabetes mellitus and skills favourable to health that help to prevent complications. The aim of the article is to reveal the process of learning of patients with diabetes and the application of skills favourable to health, which help to prevent complications in life. Tasks: 1 determine what kind of training courses are organized in Lithuania for persons with diabetes mellitus; 2 determine what kind of knowledge about health and disease control is provided by medical personnel; 3 reveal what kind of knowledge about health and what skills patients adapt in everyday life. Methods of research: theoretical – analysis of scientific literature, generalization; empirical – questionnaire survey, data analysis was performed by using the SPSS 23.0 program. The t-test was used to compare averages between groups, significant difference was considered to be p < 0,05. Data analysis was performed by applying calculations of non-parametric and parametric criteria. There were 61 patients with diabetes mellitus, aged from 13 to 78 years, who participated in the research. The research sought to reveal what training courses are organized for persons with diabetes mellitus and how patients themselves preserve their health. During the research, participants were questioned about the training courses they have attended; how patients with diabetes mellitus control their disease

[A favourable outcome in yellow nail syndrome: role of respiratory physiotherapy].

Science.gov (United States)

Fournier, C; Just, N; Leroy, S; Wallaert, B

2003-12-01

The yellow nail syndrome is a rare condition that is easily diagnosed but the nail manifestations are poorly understood. A 51 year old patient presented with a chronic cough. The diagnosis was based on the typical appearance of the nails. The patient had bilateral basal bronchiectasis. Daily physiotherapy with bronchial drainage lead to a progressive improvement in the respiratory symptoms without recourse to antibiotics. Surprisingly the abnormalities of the nails disappeared after 2 years treatment. This observation illustrates the possibility of spontaneous resolution of severe nail abnormalities during the course of the yellow nail syndrome.

Clinical and economic outcomes associated with community-acquired intra-abdominal infections caused by extended spectrum beta-lactamase (ESBL) producing bacteria in China.

Science.gov (United States)

Hu, Bijie; Ye, Huifeng; Xu, Yingchun; Ni, Yuxing; Hu, Yunjian; Yu, Yunsong; Huang, Zhenfei; Ma, Larry

2010-06-01

To compare clinical and economic outcomes in patients with community-acquired intra-abdominal infection (IAI) due to extended spectrum beta-lactamase (ESBL) producing (ESBL-positive) bacteria versus non-ESBL-producing (ESBL-negative) bacteria in China. This was a retrospective chart review study of patients hospitalized with community-acquired IAI due to ESBL-positive or ESBL-negative infections caused by Escherichia coli or Klebsiella spp. Data were collected from six hospitals in China that participated in the Study for Monitoring Antibiotic Resistance Trends (SMART) during 2006-2007. Outcomes included clinical response at discharge and following first-line antibiotic, number of antibiotic agents and classes, duration of hospitalization, and overall hospitalization and intravenous antibiotic costs. Of the 85 patients included in the study, 32 (37.6%) had ESBL-positive and 53 (62.4%) had ESBL-negative infections; E. coli was responsible for 77.6% of infections. Infection resolved at discharge in 30 (93.8%) ESBL-positive and 48 (90.6%) ESBL-negative patients (P = NS). Fewer ESBL-positive patients achieved complete response following first-line antibiotics (56.3% versus 83.0%; P = 0.01). ESBL-positive patients required longer antibiotic treatment, more antibiotics, longer hospitalization (24.3 versus 14.6 days; 1.67-fold ratio; P = 0.001), and incurred higher hospitalization costs ( yen24,604 vs. yen13,788; $3604 vs. $2020; 1.78-fold ratio; P < 0.001). Patients with ESBL-positive infection had similar resolution rates at discharge compared to those with ESBL-negative infection, despite poorer first-line antibiotic response. However, ESBL-positive infection led to significantly greater hospitalization cost and intravenous antibiotic cost, and longer hospital stay.

Outcome when adrenaline (epinephrine) was actually given vs. not given - post hoc analysis of a randomized clinical trial.

Science.gov (United States)

Olasveengen, Theresa M; Wik, Lars; Sunde, Kjetil; Steen, Petter A

2012-03-01

IV line insertion and drugs did not affect long-term survival in an out-of-hospital cardiac arrest (OHCA) randomized clinical trial (RCT). In a previous large registry study adrenaline was negatively associated with survival from OHCA. The present post hoc analysis on the RCT data compares outcomes for patients actually receiving adrenaline to those not receiving adrenaline. Patients from a RCT performed May 2003 to April 2008 were included. Three patients from the original intention-to-treat analysis were excluded due to insufficient documentation of adrenaline administration. Quality of cardiopulmonary resuscitation (CPR) and clinical outcomes were compared. Clinical characteristics were similar and CPR quality comparable and within guideline recommendations for 367 patients receiving adrenaline and 481 patients not receiving adrenaline. Odds ratio (OR) for being admitted to hospital, being discharged from hospital and surviving with favourable neurological outcome for the adrenaline vs. no-adrenaline group was 2.5 (CI 1.9, 3.4), 0.5 (CI 0.3, 0.8) and 0.4 (CI 0.2, 0.7), respectively. Ventricular fibrillation, response interval, witnessed arrest, gender, age and endotracheal intubation were confounders in multivariate logistic regression analysis. OR for survival for adrenaline vs. no-adrenaline adjusted for confounders was 0.52 (95% CI: 0.29, 0.92). Receiving adrenaline was associated with improved short-term survival, but decreased survival to hospital discharge and survival with favourable neurological outcome after OHCA. This post hoc survival analysis is in contrast to the previous intention-to-treat analysis of the same data, but agrees with previous non-randomized registry data. This shows limitations of non-randomized or non-intention-to-treat analyses. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Uranium prospecting and geological favour ability in Uruguay; Prospeccion uranifera y favorabilidad geologica en el Uruguay

Energy Technology Data Exchange (ETDEWEB)

Goso, H [Comision Nacional de Energia Atomica, Montevideo (Uruguay)

1981-07-01

Uranium prospecting carried out in Uruguay since 1976 is described. On the basis of literature available and of an analysis of the large structural units pertinent to Uruguay's geology, the prospecting performed in general in the northeast of the country, and in particular in the districts of Cerro Largo and Las Canas, is described. Some information is presented on uranium favour ability in Uruguay related to sedimentary formations: Devonian (Cerrezuelo Formation) and Gondwana (San Gregorio and Tres Islas Formations), and to the Crystalline formations of the centre and Southwest (1700-2000 m.y.) and of the east and southeast (500-700 m.y.)

Attitudes Towards Immigrants, Immigration Policies and Labour Market Outcomes: Comparing Croatia with Hungary and Slovenia

Directory of Open Access Journals (Sweden)

Botrić Valerija

2016-10-01

Full Text Available The paper provides comparative evidence on attitudes towards immigrants, their labour market outcomes and policies in Croatia and two neighbouring countries – Slovenia and Hungary. Three different data sources have been used: the European Social Survey, an ad-hoc Labour Force Survey module for the year 2014, and the MIPEX index. Although immigrants have a disadvantaged position on the Croatian labour market, most analysed indicators do not imply that they are in a worse position than in other European economies. Migrant integration policies related to the labour market are assessed as being relatively favourable for Croatia. Judging by the comparable indicators for the native population in Croatia, immigrants’ adverse labour market outcomes seem to be more related to the unfavourable general economic situation, and particularly by the deep and long recession.

Early increase in circulating carbonic anhydrase IX during neoadjuvant treatment predicts favourable outcome in locally advanced rectal cancer

International Nuclear Information System (INIS)

Hektoen, Helga Helseth; Flatmark, Kjersti; Andersson, Yvonne; Dueland, Svein; Redalen, Kathrine Røe; Ree, Anne Hansen

2015-01-01

Locally advanced rectal cancer (LARC) comprises heterogeneous tumours with predominant hypoxic components. The hypoxia-inducible metabolic shift causes microenvironmental acidification generated by carbonic anhydrase IX (CAIX) and facilitates metastatic progression, the dominant cause of failure in LARC. Using a commercially available immunoassay, circulating CAIX was assessed in prospectively archived serial serum samples collected during combined-modality neoadjuvant treatment of LARC patients and correlated to histologic tumour response and progression-free survival (PFS). Patients who from their individual baseline level displayed serum CAIX increase above a threshold of 224 pg/ml (with 96 % specificity and 39 % sensitivity) after completion of short-course neoadjuvant chemotherapy (NACT) prior to long-course chemoradiotherapy and definitive surgery had significantly better 5-year PFS (94 %) than patients with below-threshold post-NACT versus baseline alteration (PFS rate of 56 %; p < 0.01). This particular CAIX parameter, ΔNACT, was significantly correlated with histologic ypT0–2 and ypN0 outcome (p < 0.01) and remained an independent PFS predictor in multivariate analysis wherein it was entered as continuous variable (p = 0.04). Our results indicate that low ΔNACT, i.e., a weak increase in serum CAIX level following initial neoadjuvant treatment (in this case two cycles of the Nordic FLOX regimen), might be used as risk-adapted stratification to postoperative therapy or other modes of intensification of the combined-modality protocol in LARC. ClinicalTrials.gov: NCT00278694

Development of site selection criteria for radioactive waste disposal in view of favourable geological settings in Germany

Energy Technology Data Exchange (ETDEWEB)

Baltes, B.; Brewitz, W. [Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) mbH, Cologne (Germany)

2001-07-01

In Germany it is intended to dispose of all types of radioactive waste in deep geological formations. Since the government has doubts regarding the suitability of the Gorleben site, further sites in different host rock formations have to be investigated. This investigation process has to be carried out with respect to technical suitability and safety as well as to public acceptance. A Committee has been established whose mandate is to develop a comprehensible procedure for the selection of sites for radioactive waste disposal in Germany. The Committee developed an iterative procedure which provides, besides the increase of transparency, the necessary flexibility in dealing with assessment results. The method is governed by geo-scientific and social-scientific criteria that are presented in this paper. 7 steps have been identified in the procedure: 1) exclusion of areas with obviously unfavourable conditions, 2) identification of areas with favourable geological settings, 3) exclusion of areas for socio-scientific reasons, 4) identification of regions with favourable conditions and ranking of regions, 5) identification of sites for further identification, 6) above-ground site investigation and ranking of potentially suitable sites, and 7) identification of sites for suitability investigations. The first 3 steps give the remaining areas that meet the minimum requirements. The criteria of the first 3 steps are: extensive vertical movements, active disturbance zones, seismic activity and volcanic activity, as for the 4 last steps criteria are based on geo- and socio- scientific weighing, voluntariness and regional mediation. (A.C.)

Development of site selection criteria for radioactive waste disposal in view of favourable geological settings in Germany

International Nuclear Information System (INIS)

Baltes, B.; Brewitz, W.

2001-01-01

In Germany it is intended to dispose of all types of radioactive waste in deep geological formations. Since the government has doubts regarding the suitability of the Gorleben site, further sites in different host rock formations have to be investigated. This investigation process has to be carried out with respect to technical suitability and safety as well as to public acceptance. A Committee has been established whose mandate is to develop a comprehensible procedure for the selection of sites for radioactive waste disposal in Germany. The Committee developed an iterative procedure which provides, besides the increase of transparency, the necessary flexibility in dealing with assessment results. The method is governed by geo-scientific and social-scientific criteria that are presented in this paper. 7 steps have been identified in the procedure: 1) exclusion of areas with obviously unfavourable conditions, 2) identification of areas with favourable geological settings, 3) exclusion of areas for socio-scientific reasons, 4) identification of regions with favourable conditions and ranking of regions, 5) identification of sites for further identification, 6) above-ground site investigation and ranking of potentially suitable sites, and 7) identification of sites for suitability investigations. The first 3 steps give the remaining areas that meet the minimum requirements. The criteria of the first 3 steps are: extensive vertical movements, active disturbance zones, seismic activity and volcanic activity, as for the 4 last steps criteria are based on geo- and socio- scientific weighing, voluntariness and regional mediation. (A.C.)

Objectives and Outcomes

Energy Technology Data Exchange (ETDEWEB)

Segalman, D.J.

1998-11-30

I have recently become involved in the ABET certification process under the new system - ABET 2000. This system relies heavily on concepts of Total Quality Management (TQM). It encourages each institution to define its objectives in terms of its own mission and then create a coherent program based on it. The prescribed steps in setting up the new system at an engineering institution are: o identification of constituencies G definition of mission. It is expected that the department's mission will be consistent with that of the overall institution, but containing some higher resolution language appropriate to that particular discipline of the engineering profession. o statement of objectives consistent with the mission 3G~~\\vED " enumeration of desired, and preferably measurable, outcomes of the process that would ~ `=. verify satisfaction of the objectives. ~~~ 07 !398 o establish performance standards for each outcome. o creation of appropriate feedback loops to assure that the objectives are still consistent with Q$YT1 the mission, that the outcomes remain consistent with the objectives, and that the curriculum and the teaching result in those outcomes. It is my assertion that once the institution verbalizes a mission, enumerated objectives naturally flow from that mission. (We shall try to demonstrate by example.) Further, if the mission uses the word "engineer", one would expect that word also to appear in at least one of the objectives. The objective of producing engineers of any sort must -by decree - involve the presence of the ABET criteria in the outcomes list. In other words, successful satisfaction of the ABET items a-k are a necessary subset of the measure of success in producing engineers. o We shall produce bachelor level engineers whose training in the core topics of chemical (or electrical, or mechanical) engineering is recognized to be among the best in the nation. o We shall provide an opportunity for our students to gain

Associations between pregnancy-associated glycoproteins and pregnancy outcomes, milk yield, parity, and clinical diseases in high-producing dairy cows.

Science.gov (United States)

Mercadante, P M; Ribeiro, E S; Risco, C; Ealy, A D

2016-04-01

Pregnancy-associated glycoproteins (PAG) are produced by the ruminant placenta and secreted into the maternal circulation throughout pregnancy. The extent to which circulating PAG concentrations predict pregnancy outcomes was examined herein. Also, associations between circulating PAG concentrations and various production parameters and clinical diseases were evaluated. Lactating primiparous and multiparous Holstein cows (n=345) were bred via timed artificial insemination using a standard Ovsynch protocol. Pregnancy was diagnosed by transrectal ultrasonography at d 32, 46, and 74 of gestation. Blood was harvested at d 32 to determine plasma concentrations of PAG and progesterone. Cows pregnant at d 32 that subsequently lost their pregnancy at d 46 and 74 had reduced PAG concentrations. Both artificial insemination service number and parity were associated with plasma PAG concentrations. Concentration of PAG in plasma was greater for cows pregnant from their second or later breeding than those pregnant from the first breeding postpartum, and was increased for primiparous compared with multiparous. In addition, cows with greater milk yield had increased plasma PAG concentrations. No association was detected between body condition score and plasma PAG concentrations. Cows that experienced clinical metritis, metabolic problems, or left displacement abomasum in the early postpartum period preceding breeding had greater plasma PAG concentrations than cows not experiencing these clinical diseases. Also, cows with multiple clinical diseases had increased odds of pregnancy loss when compared with cows not experiencing clinical diseases. Odds ratio testing detected a tendency in the relationship between reduced milk yield and increased pregnancy loss. Collectively, these associations illustrate one feature of the early developing placenta that may predict pregnancy outcomes in dairy cattle. It is unclear if plasma PAG are actively involved with mediating pregnancy outcomes

[Early diagnosis, variety of outcomes and prognosis of juvenile schizophrenia with over-value disorders of the "metaphysical intoxication" type onset (results of a late follow-up study)].

Science.gov (United States)

Tsutsul'kovskaia, M Ia; Izvol'skiĭ, S A; Bol'zho, A G; Kopeĭko, G I

1986-01-01

On the basis of follow-up findings about juvenile schizophrenia first expressed in superworship manifestations according to the type of metaphysical intoxication (98 observations), the authors established that most frequently these cases were characterized by a torpid course of the disease in the framework of slowly progressing juvenile schizophrenia. There was a high rate of favourable outcomes at the level of "clinical recovery" (in 42.5%). Favourable prognostic signs were as follows: the complete nature of the clinical picture of the syndrome, its similarity to pubertal crisis manifestations, the absence in its structure of other positive disturbances and a number of specific features of the premorbid picture. The authors determined the pattern of correlation between the typological characteristics of the state of juvenile metaphysical intoxication and the outcome of the disease, peculiarities of manifestations of this phenomenon at the initial stage of psychotic forms of juvenile schizophrenia, as well as distinctive features of superworship formations according to the type of juvenile metaphysical intoxication observed in the framework of pubertal decompensation in schizoid psychopathies.

Does Indonesian National Health Insurance serve a potential for improving health equity in favour of workers in informal economy?

OpenAIRE

Kartika, Dwintha Maya

2015-01-01

This study examines whether Indonesian national health insurance system promotes health equity in favour of informal economy workers. It first lays out the theoretical justification on the need of social protection, particularly health protection for informal workers. The paper argues that the absence of health protection for vulnerable informal workers in Indonesia has reinforced health inequity between formal and informal workers, thus provides a justification on extending health protection...

Hydrodynamic patterns favouring sea urchin recruitment in coastal areas: A Mediterranean study case.

Science.gov (United States)

Farina, S; Quattrocchi, G; Guala, I; Cucco, A

2018-05-11

In invertebrate fisheries, sea urchin harvesting continues to grow with dramatic consequences for benthic ecosystems. The identification of areas with a marked natural recruitment and the mechanisms regulating it is crucial for the conservation of benthic communities and for planning the sustainable harvesting. This study evaluates the spatial distribution and density of recruits of the edible sea urchin Paracentrotus lividus along the Sinis + Peninsula (Sardinia) and explores its significant relationships with the local oceanographic features. Our results reveal that recruitment is favoured in areas with slow currents and high levels of confinement and trapping of the water masses. Analysis of the residual circulation indicates that the presence of local standing circulation structures promotes the sea urchin recruitment process. Our findings emphasize the importance of managing local sea urchin harvesting as a system of populations with their demographic influence mainly dependent on the most important ecological driver that is the recruitment. Copyright © 2018 Elsevier Ltd. All rights reserved.

Manakins can produce iridescent and bright feather colours without melanosomes.

Science.gov (United States)

Igic, Branislav; D'Alba, Liliana; Shawkey, Matthew D

2016-06-15

Males of many species often use colourful and conspicuous ornaments to attract females. Among these, male manakins (family: Pipridae) provide classic examples of sexual selection favouring the evolution of bright and colourful plumage coloration. The highly iridescent feather colours of birds are most commonly produced by the periodic arrangement of melanin-containing organelles (melanosomes) within barbules. Melanin increases the saturation of iridescent colours seen from optimal viewing angles by absorbing back-scattered light; however, this may reduce the wide-angle brightness of these signals, contributing to a dark background appearance. We examined the nanostructure of four manakin species (Lepidothrix isidorei, L. iris, L. nattereri and L. coeruleocapilla) to identify how they produce their bright plumage colours. Feather barbs of all four species were characterized by dense and fibrous internal spongy matrices that likely increase scattering of light within the barb. The iridescent, yet pale or whitish colours of L. iris and L. nattereri feathers were produced not by periodically arranged melanosomes within barbules, but by periodic matrices of air and β-keratin within barbs. Lepidothrix iris crown feathers were able to produce a dazzling display of colours with small shifts in viewing geometry, likely because of a periodic nanostructure, a flattened barb morphology and disorder at a microstructural level. We hypothesize that iridescent plumage ornaments of male L. iris and L. nattereri are under selection to increase brightness or luminance across wide viewing angles, which may potentially increase their detectability by females during dynamic and fast-paced courtship displays in dim light environments. © 2016. Published by The Company of Biologists Ltd.

Psychosocial group rehabilitation for lonely older people: favourable processes and mediating factors of the intervention leading to alleviated loneliness.

Science.gov (United States)

Savikko, Niina; Routasalo, Pirkko; Tilvis, Reijo; Pitkälä, Kaisu

2010-03-01

Loneliness among community-dwelling older people is a common problem, with serious health consequences. The favourable processes and mediating factors of a psychosocial group rehabilitation intervention in alleviating older people's loneliness were evaluated. Altogether, 117 lonely, home-dwelling individuals (aged ≥75 years) participated in a psychosocial group rehabilitation intervention. The content comprised (i) art and inspiring activities, (ii) group exercise and discussions or (iii) therapeutic writing and group therapy. The psychosocial group rehabilitation intervention was evaluated from the group leaders' diaries and by observing the groups. Experiences of loneliness and social participation were collected by postintervention questionnaires from the participants. Data were analysed using methodological triangulation. Doing things together and sharing experiences with their peers inspired lively discussions, created a feeling of togetherness and led to participants' empowerment and increased self-esteem. The intervention socially activated the participants, and their feelings of loneliness had been alleviated during the intervention. Several common favourable processes and mediating factors were identified in the psychosocial group rehabilitation intervention that led to alleviation of loneliness among older people. Relevance to clinical practice.  The psychosocial group rehabilitation intervention gives nurses an effective tool to support older people's psychosocial resources by activating them and alleviating their loneliness. © 2009 Blackwell Publishing Ltd.

Pulmonary function tests as outcomes for systemic sclerosis interstitial lung disease.

Science.gov (United States)

Caron, Melissa; Hoa, Sabrina; Hudson, Marie; Schwartzman, Kevin; Steele, Russell

2018-06-30

Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in systemic sclerosis (SSc). We performed a systematic review to characterise the use and validation of pulmonary function tests (PFTs) as surrogate markers for systemic sclerosis-associated interstitial lung disease (SSc-ILD) progression.Five electronic databases were searched to identify all relevant studies. Included studies either used at least one PFT measure as a longitudinal outcome for SSc-ILD progression ( i.e. outcome studies) and/or reported at least one classical measure of validity for the PFTs in SSc-ILD ( i.e. validation studies).This systematic review included 169 outcome studies and 50 validation studies. Diffusing capacity of the lung for carbon monoxide ( D LCO ) was cumulatively the most commonly used outcome until 2010 when it was surpassed by forced vital capacity (FVC). FVC (% predicted) was the primary endpoint in 70.4% of studies, compared to 11.3% for % predicted D LCO Only five studies specifically aimed to validate the PFTs: two concluded that D LCO was the best measure of SSc-ILD extent, while the others did not favour any PFT. These studies also showed respectable validity measures for total lung capacity (TLC).Despite the current preference for FVC, available evidence suggests that D LCO and TLC should not yet be discounted as potential surrogate markers for SSc-ILD progression. Copyright ©ERS 2018.

Exploiting ecology in drug pulse sequences in favour of population reduction.

Directory of Open Access Journals (Sweden)

Marianne Bauer

2017-09-01

Full Text Available A deterministic population dynamics model involving birth and death for a two-species system, comprising a wild-type and more resistant species competing via logistic growth, is subjected to two distinct stress environments designed to mimic those that would typically be induced by temporal variation in the concentration of a drug (antibiotic or chemotherapeutic as it permeates through the population and is progressively degraded. Different treatment regimes, involving single or periodical doses, are evaluated in terms of the minimal population size (a measure of the extinction probability, and the population composition (a measure of the selection pressure for resistance or tolerance during the treatment. We show that there exist timescales over which the low-stress regime is as effective as the high-stress regime, due to the competition between the two species. For multiple periodic treatments, competition can ensure that the minimal population size is attained during the first pulse when the high-stress regime is short, which implies that a single short pulse can be more effective than a more protracted regime. Our results suggest that when the duration of the high-stress environment is restricted, a treatment with one or multiple shorter pulses can produce better outcomes than a single long treatment. If ecological competition is to be exploited for treatments, it is crucial to determine these timescales, and estimate for the minimal population threshold that suffices for extinction. These parameters can be quantified by experiment.

Outcomes of critically ill intensive care unit patients treated with fosfomycin for infections due to pandrug-resistant and extensively drug-resistant carbapenemase-producing Gram-negative bacteria.

Science.gov (United States)

Pontikis, Konstantinos; Karaiskos, Ilias; Bastani, Styliani; Dimopoulos, George; Kalogirou, Michalis; Katsiari, Maria; Oikonomou, Angelos; Poulakou, Garyphallia; Roilides, Emmanuel; Giamarellou, Helen

2014-01-01

Fosfomycin is active in vitro against extensively drug-resistant (XDR) and pandrug-resistant (PDR) Pseudomonas aeruginosa and Klebsiella pneumoniae carbapenemase-producing strains; however, the in vivo effectiveness against such pathogens is almost unknown. A multicentre, observational, prospective case-series study was performed in 11 ICUs. All consecutive fosfomycin-treated patients suffering from XDR or PDR fosfomycin-susceptible, microbiologically documented infections were recorded. Clinical and microbiological outcomes were assessed. A safety analysis was performed. In total, 68 patients received fosfomycin during the study period, 48 of whom were considered suitable for effectiveness analysis based on predefined criteria. Bacteraemia and ventilator-associated pneumonia were the main infections. Carbapenemase-producing K. pneumoniae and P. aeruginosa were isolated in 41 and 17 cases, respectively. All isolates exhibited an XDR or PDR profile, being fosfomycin-susceptible by definition. Fosfomycin was administered intravenously at a median dose of 24g/day for a median of 14 days, mainly in combination with colistin or tigecycline. Clinical outcome at Day 14 was successful in 54.2% of patients, whilst failure, indeterminate outcome and superinfection were documented in 33.3%, 6.3% and 6.3%, respectively. All-cause mortality at Day 28 was 37.5%. Bacterial eradication was observed in 56.3% of cases. Fosfomycin resistance developed in three cases. The main adverse event was reversible hypokalaemia. In conclusion, fosfomycin could have a place in the armamentarium against XDR and PDR Gram-negative infections in the critically ill. Resistance development during therapy, which has been a matter of concern in previous studies, did not occur frequently. The necessity of combination with other antibiotics requires further investigation. Copyright © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

New onset status epilepticus in older patients: Clinical characteristics and outcome.

Science.gov (United States)

Malter, M P; Nass, R D; Kaluschke, T; Fink, G R; Burghaus, L; Dohmen, C

2017-10-01

We here evaluated (1) the differential characteristics of status epilepticus (SE) in older (≥60 years) compared to younger adults (18-59 years). In particular, we were interested in (2) the proportion and characteristics of new onset SE in patients with no history of epilepsy (NOSE) in older compared to younger adults, and (3) predictive parameters for clinical outcome in older subjects with NOSE. We performed a monocentric retrospective analysis of all adult patients (≥18years) admitted with SE to our tertiary care centre over a period of 10 years (2006-2015) to evaluate clinical characteristics and short-time outcome at discharge. One-hundred-thirty-five patients with SE were included in the study. Mean age at onset was 64 years (range 21-90), eighty-seven of the patients (64%) were older than 60 years. In 76 patients (56%), SE occurred as NOSE, sixty-seven percent of them were aged ≥60 years. There was no age-dependent predominance for NOSE. NOSE was not a relevant outcome predictor, especially regarding age-related subgroups. Older patients with NOSE had less frequently general tonic clonic SE (GTCSE; p=0.001) and were more often female (p=0.01). Regarding outcome parameters and risk factors in older patients with NOSE, unfavourable outcome was associated with infections during in-hospital treatment (0.04), extended stay in ICU (p=0.001), and generally in hospital (p<0.001). In our cohort, older patients represented the predominant subgroup in patients with SE. Older patients suffered more often from non-convulsive semiology and had a less favourable short-time outcome. NOSE was not a predictive outcome parameter in older patients. Data suggest that avoiding infections should have a priority because higher infection rates were associated with unfavourable outcome. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Producing citizens, reproducing the "French race": immigration, demography, and pronatalism in early twentieth-century France.

Science.gov (United States)

Camiscioli, E

2001-01-01

This essay examines how, in the context of depopulation and mass immigration, members of the French pronatalist movement advanced a policy favouring immigrants from Italy, Spain, and Poland. Because the 'demographic crisis' created a shortage of citizens as well as workers, pronatalists held that foreign workers must also be assimilable, and able to produce French offspring. While the racial difference of colonial subjects was deemed immutable, pronatalists called for the immigration of white foreigners whose less 'modern' condition promoted fecundity, traditionalism, and gender dimorphism. Evidence is drawn from demographic studies, the press of France's largest pronatalist movement, and a pronatalist advisory committee created by the Ministry of Health in 1920.

Stress associated gene expression in blood cells is related to outcome in radiotherapy treated head and neck cancer patients

International Nuclear Information System (INIS)

Bøhn, Siv K; Blomhoff, Rune; Russnes, Kjell M; Sakhi, Amrit K; Thoresen, Magne; Holden, Marit; Moskaug, JanØ; Myhrstad, Mari C; Olstad, Ole K; Smeland, Sigbjørn

2012-01-01

We previously observed that a radiotherapy-induced biochemical response in plasma was associated with favourable outcome in head and neck squamous carcinoma cancer (HNSCC) patients. The aim of the present study was to compare stress associated blood cell gene expression between two sub-groups of HNSCC patients with different biochemical responses to radiotherapy. Out of 87 patients (histologically verified), 10 biochemical ‘responders’ having a high relative increase in plasma oxidative damage and a concomitant decrease in plasma antioxidants during radiotherapy and 10 ‘poor-responders’ were selected for gene-expression analysis and compared using gene set enrichment analysis. There was a significant induction of stress-relevant gene-sets in the responders following radiotherapy compared to the poor-responders. The relevance of the involvement of similar stress associated gene expression for HNSCC cancer and radioresistance was verified using two publicly available data sets of 42 HNSCC cases and 14 controls (GEO GSE6791), and radiation resistant and radiation sensitive HNSCC xenografts (E-GEOD-9716). Radiotherapy induces a systemic stress response, as revealed by induction of stress relevant gene expression in blood cells, which is associated to favourable outcome in a cohort of 87 HNSCC patients. Whether these changes in gene expression reflects a systemic effect or are biomarkers of the tumour micro-environmental status needs further study. Raw data are available at ArrayExpress under accession number E-MEXP-2460

Case report: Actinomycetoma caused by Nocardia aobensis from Lao PDR with favourable outcome after short-term antibiotic treatment.

Directory of Open Access Journals (Sweden)

Inthanomchanh Vongphoumy

2015-04-01

Full Text Available Mycetoma is a neglected, chronic, localized, progressively destructive, granulomatous infection caused either by fungi (eumycetoma or by aerobic actinomycetes (actinomycetoma. It is characterized by a triad of painless subcutaneous mass, multiple sinuses and discharge containing grains. Mycetoma commonly affects young men aged between 20 and 40 years with low socioeconomic status, particularly farmers and herdsmen.A 30 year-old male farmer from an ethnic minority in Phin District, Savannakhet Province, Lao PDR (Laos developed a painless swelling with multiple draining sinuses of his right foot over a period of approximately 3 years. X-ray of the right foot showed osteolysis of tarsals and metatarsals. Aerobic culture of sinus discharge yielded large numbers of Staphylococcus aureus and a slow growing Gram-positive rod. The organism was subsequently identified as Nocardia aobensis by 16S ribosomal RNA gene sequencing. The patient received antimicrobial treatment with amikacin and trimethoprim-sulfamethoxazole according to consensus treatment guidelines. Although slight improvement was noted the patient left the hospital after 14 days and did not take any more antibiotics. Over the following 22 weeks the swelling of his foot subsequently diminished together with healing of discharging sinuses.This is the first published case of Actinomycetoma caused by Nocardia aobensis and the second case of Actinomycetoma from Laos. A treatment course of only 14 days with amikacin and trimethoprim-sulfamethoxazole was apparently sufficient to cure the infection, although long-term treatment up to one year is currently recommended. Treatment trials or prospective descriptions of outcome for actinomycetoma should investigate treatment efficacy for the different members of Actinomycetales, particularly Nocardia spp., with short-term and long-term treatment courses.

Procalcitonin levels in sepsis and its association with clinical outcome in southern India.

Science.gov (United States)

Rebello, Alex; Thabah, Molly Mary; Dutta, Tarun Kumar; Bobby, Zachariah; Harish, B N; Mehalingam, Vadivelan

2017-10-01

Procalcitonin has been found to be a good marker for the diagnosis of sepsis. However, data on procalcitonin levels to predict the clinical outcome in patients with sepsis are limited. The aim of our study was to estimate serum procalcitonin levels in patients with sepsis and to identify its relationship with the clinical outcome. This was a prospective observational study conducted on 112 patients with sepsis admitted to the medical wards and medical intensive care unit of a tertiary care teaching hospital. Serum procalcitonin was measured at baseline before antibiotic administration and on day 5. The clinical outcome studied was death or survival on day 28. Baseline mean serum procalcitonin was highest in patients with septic shock and lowest in patients having sepsis without organ dysfunction. Mean values of procalcitonin at baseline and on day 5 were significantly higher in non-survivors when compared with survivors. There was a significant difference in the change in procalcitonin levels from baseline to day 5 between survivors and non-survivors, with survivors having declining values on day 5 while non-survivors had increasing values from baseline. The baseline APACHE II and SOFA scores also showed a significant correlation with the baseline procalcitonin level. Declining values of procalcitonin therefore indicate a favourable clinical outcome in patients with sepsis.

The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey.

Science.gov (United States)

Van Bogaert, Peter; Kowalski, Christoph; Weeks, Susan Mace; Van Heusden, Danny; Clarke, Sean P

2013-12-01

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community. Cross-sectional survey. Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N=1201) in two independent hospitals and one hospital group with six hospitals in Belgium. Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively. The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with

Early prediction of favourable recovery 6 months after mild traumatic brain injury.

NARCIS (Netherlands)

Stulemeijer, M.; Werf, S.P. van der; Borm, G.F.; Vos, P.E.

2008-01-01

BACKGROUND: Predicting outcome after mild traumatic brain injury (MTBI) is notoriously difficult. Although it is recognised that milder head injuries do not necessarily mean better outcomes, less is known about the factors that do enable early identification of patients who are likely to recover

Surgical outcome analysis of paediatric thoracic and cervical neuroblastoma.

Science.gov (United States)

Parikh, Dakshesh; Short, Melissa; Eshmawy, Mohamed; Brown, Rachel

2012-03-01

To identify factors determining the surgical outcome of primary cervical and thoracic neuroblastoma. Twenty-six children with primary thoracic neuroblastoma presented over the last 14 years were analysed for age, mode of presentation, tumour histopathology, biology and outcome. Primary thoracic neuroblastoma was presented in 16 boys and 10 girls at a median age of 2 years (range 6 weeks-15 years). The International Neuroblastoma Staging System (INSS) classified these as Stage 1 (8), Stage 2 (5), Stage 3 (6) and Stage 4 (7). Computed tomography defined the tumour location at the thoracic inlet (11), cervical (2), cervico-thoracic (3), mid-thorax (9) and thoraco-abdominal (1). Twenty-two children underwent surgery that allowed an adequate exposure and resection. Surgical resection was achieved after initial biopsy and preoperative chemotherapy in 15 children, whereas primary resection was performed in 7 children. Four patients with Stage 4 disease underwent chemotherapy alone after initial biopsy; of which, two died despite chemotherapy. Favourable outcome after surgical resection and long-term survival was seen in 19 (86.4%) of the 22 children. Three had local recurrence (14 to 21 months postoperatively), all with unfavourable histology on initial biopsy. The prognostic factors that determined the outcome were age and INSS stage at presentation. In this series, all patients under 2 years of age are still alive, while mortality was seen in five older children. Thoracic neuroblastoma in children under 2 years of age irrespective of stage and histology of the tumour results in long-term survival.

Do Job Demands of Chinese Manufacturing Employees Predict Positive or Negative Outcomes? A Test of Competing Hypotheses.

Science.gov (United States)

Cheung, Janelle H; Sinclair, Robert R; Shi, Junqi; Wang, Mo

2015-12-01

Karasek's job demands-control (JDC) model posits that job control can buffer against the harmful effects of demands experienced by employees. A large volume of JDC research has obtained support for the main effects of demands and control, but not the interactive effects. Recent research on the challenge-hindrance stressors framework, however, found that work stressors may not always be deleterious, suggesting alternative hypotheses about the effects of demands and control. The present study therefore examined competing hypotheses concerning the effects of job demands on occupational health outcomes. Using a sample of 316 employees in a Chinese manufacturing company, we found that, consistent with the challenge-hindrance framework, production demands were challenge stressors associated with favourable outcomes (i.e. job satisfaction and psychological well-being). In addition, results showed that the interactive role of job control depended on the nature of outcome variables. Future recommendations and implications of findings are discussed. Copyright © 2014 John Wiley & Sons, Ltd.

Paediatric retinal detachment: aetiology, characteristics and outcomes.

Science.gov (United States)

McElnea, Elizabeth; Stephenson, Kirk; Gilmore, Sarah; O'Keefe, Michael; Keegan, David

2018-01-01

To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment. A retrospective review of all those under 16y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded. Twenty-eight eyes of 24 patients, 15 (62.5%) of whom were male and 9 (37.5%) of whom were female, their mean age being 11.6y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14 (50.0%) cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11 (39.3%) cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 logMAR with range 0.0-3.0 logMAR. In 22 of 26 (84.6%) cases which underwent surgical repair the retina was attached at last follow-up. Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.

Development of selective medium for IMP-type carbapenemase-producing Enterobacteriaceae in stool specimens.

Science.gov (United States)

Yamamoto, Norihisa; Kawahara, Ryuji; Akeda, Yukihiro; Shanmugakani, Rathina Kumar; Yoshida, Hisao; Hagiya, Hideharu; Hara, Naohiro; Nishi, Isao; Yukawa, Satomi; Asada, Rumiko; Sasaki, Yumi; Maeda, Kazuhiro; Sakamoto, Noriko; Hamada, Shigeyuki; Tomono, Kazunori

2017-03-24

Identification of carbapenemase-producing Enterobacteriaceae (CPE) in faecal specimens is challenging. This fact is particularly critical because low-level carbapenem-resistant organisms such as IMP-producing CPE are most prevalent in Japan. We developed a modified selective medium more suitable for IMP-type CPE. Fifteen reference CPE strains producing different types of β-lactamases were used to evaluate the commercially available CHROMagar KPC and chromID CARBA as well as the newly prepared MC-ECC medium (CHROMagar ECC supplemented with meropenem, cloxacillin, and ZnSO 4 ) and M-ECC medium (CHROMagar ECC supplemented with meropenem and ZnSO 4 ). A total of 1035 clinical samples were then examined to detect CPE using chromID CARBA and M-ECC medium. All tested strains producing NDM-, KPC-, and OXA-48-carbapenemases were successfully cultured in the media employed. Although most of the IMP-positive strains did not grow in CHROMagar KPC, chromID CARBA, or MC-ECC, all tested strains grew on M-ECC. When faecal samples were applied to the media, M-ECC medium allowed the best growth of IMP-type CPE with a significantly higher sensitivity (99.3%) than that of chromID CARBA (13.9%). M-ECC medium was determined as the most favourable selective medium for the detection of IMP-type CPE as well as other types of CPE.

Near-surface hydrogen depletion of diamond-like carbon films produced by direct ion deposition

Science.gov (United States)

Markwitz, Andreas; Gupta, Prasanth; Mohr, Berit; Hübner, René; Leveneur, Jerome; Zondervan, Albert; Becker, Hans-Werner

2016-03-01

Amorphous atomically flat diamond-like carbon (DLC) coatings were produced by direct ion deposition using a system based on a Penning ion source, butane precursor gas and post acceleration. Hydrogen depth profiles of the DLC coatings were measured with the 15N R-NRA method using the resonant nuclear reaction 1H(15N, αγ)12C (Eres = 6.385 MeV). The films produced at 3.0-10.5 kV acceleration voltage show two main effects. First, compared to average elemental composition of the film, the near-surface region is hydrogen depleted. The increase of the hydrogen concentration by 3% from the near-surface region towards the bulk is attributed to a growth model which favours the formation of sp2 hybridised carbon rich films in the film formation zone. Secondly, the depth at which the maximum hydrogen concentration is measured increases with acceleration voltage and is proportional to the penetration depth of protons produced by the ion source from the precursor gas. The observed effects are explained by a deposition process that takes into account the contributions of ion species, hydrogen effusion and preferential displacement of atoms during direct ion deposition.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: India

International Nuclear Information System (INIS)

1977-08-01

Physiographically India has a total area of 3,268,010 km 2 in three distinct regions. 1. The Peninsular shield in the south with an area of 823,310 km 2 . 2. The Himalayan mountain system with an area of 1,797,200 km 2 . 3. The Indo-Gangetic alluvial plain with an area of 647,500 km 2 . The three presently recognised major uranium provinces in India are: 1. The Singhbhum uranium province; 2. The Rajasthan uranium province, 3. The Madhya Pradesh uranium province. The Atomic Minerals Division of the Department of Atomic Energy has carried out a vigorous exploration programme since 1949 but despite their efforts a great deal of ground has still to be explored. At present, structurally controlled deposits account for most of the uranium resources of India. Uranium occurrences and deposits have been outlined in (1) Vein type deposits (the Singhbhum belt), (2) Conglomerate (Karnataka and Udaipur area, Raiasthan), (3) Sandstones (Madhra Pradesh and Swaliks, Himachal Pradesh, (4) Others such as carbonatites, marine phosphates, etc, (Mussorrie - Sahasradhara In Uttar Pradesh and Chatterpur-Saucur in Madhya Pradesh), (5) By-product Uranium in copper tailings and beach sands. India's total resources are listed as 52,538 tonnes uranium (68,300 short tons U 3 O 8 ) with additional resources from monazite of 12700 tonnes uranium. In view of the wide geological favourability, the many types of occurrences already known and the vast areas of unexplored ground it is estimated that the Speculative Potential may be between 150,000 and 250,000 tonnes uranium which is Category 5. (author)

Neurolinguistic programming: a systematic review of the effects on health outcomes

Science.gov (United States)

Sturt, Jackie; Ali, Saima; Robertson, Wendy; Metcalfe, David; Grove, Amy; Bourne, Claire; Bridle, Chris

2012-01-01

Background Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. Aim To evaluate the effects of NLP on health-related outcomes. Design and setting Systematic review of experimental studies. Method The following data sources were searched: MEDLINE®, PsycINFO, ASSIA, AMED, CINAHL®, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. Results Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4–20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, Peffect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes. PMID:23211179

Forest management strategies for producing wood for energy from conventional forestry systems

Energy Technology Data Exchange (ETDEWEB)

Sabourin, M.; Puttock, G.D. (Silv-Econ Ltd., Newmarket, ON (CA)); Richardson, J. (Forestry Canada, Science and Sustainable Development, Ottowa, ON (CA))

1992-01-01

The report reviews the current developments in forest management planning and practices to integrate the production of biomass for energy along with more conventional forest management goals. Efforts are under way to adapt management practices and silvicultural treatments to biomass production. These begin at the planning stage with the development of management tools and more accurate forest inventory data. They include silvicultural treatments such as shelterwood thinning in mixed wood stands and the interplanting of various tree species with the dual purpose of producing energy wood and conventional forest products. Three systems are available for recovering residues at time of final harvesting. The postharvest recovery of residues area is commonly used in Europe but is generally uneconomic in North America where the harvesting of small stems and integrated harvesting are favoured. (author).

Long-term survival with unfavourable outcome: a qualitative and ethical analysis.

Science.gov (United States)

Honeybul, Stephen; Gillett, Grant R; Ho, Kwok M; Janzen, Courtney; Kruger, Kate

2015-12-01

To assess the issue of 'retrospective consent' among a cohort of patients who had survived with unfavourable outcome and to assess attitudes among next of kin regarding their role as surrogate decision makers. Twenty patients who had survived for at least 3 years with an unfavourable outcome following a decompressive craniectomy for severe traumatic brain injury were assessed with their next of kin. During the course of a semistructured interview, participants were asked whether they would have provided consent if they had known their eventual outcome. They were also asked for general comments regarding all aspects of the clinical journey. Eighteen patients had next of kin who were available for interview. For two patients, there was no longer any family involvement. Of the 20 patients, 13 were able to provide a response and 11 felt that they would have provided consent even if they had known their eventual outcome. Of the 18 next of kin who were able to express an opinion, 10 felt that they would have provided retrospective consent. Many patients appeared to have adapted to a level of disability that competent individuals might deem unacceptable. This does not necessarily mean that such outcomes should be regarded as 'favourable', nor that decompressive craniectomy must be performed for patients with predicted poor outcome. Nevertheless, those burdened with the initial clinical decisions and thereafter the long-term care of these patients may draw some support from the knowledge that unfavourable may not necessarily be unacceptable. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Disconfirmed hedonic expectations produce perceptual contrast, not assimilation.

Science.gov (United States)

Zellner, Debra A; Strickhouser, Dinah; Tornow, Carina E

2004-01-01

In studies of hedonic ratings, contrast is the usual result when expectations about test stimuli are produced through the presentation of context stimuli, whereas assimilation is the usual result when expectations about test stimuli are produced through labeling, advertising, or the relaying of information to the subject about the test stimuli. Both procedures produce expectations that are subsequently violated, but the outcomes are different. The present studies demonstrate that both assimilation and contrast can occur even when expectations are produced by verbal labels and the degree of violation of the expectation is held constant. One factor determining whether assimilation or contrast occurs appears to be the certainty of the expectation. Expectations that convey certainty are produced by methods that lead to social influence on subjects' ratings, producing assimilation. When social influence is not a factor and subjects give judgments influenced only by the perceived hedonic value of the stimulus, contrast is the result.

Study of transverse momenta of charged hadrons produced in ν p andbar vp charged current interactions

Science.gov (United States)

Jones, G. T.; Kennedy, B. W.; Middleton, R. P.; O'Neale, S. W.; Cooper, A. M.; Grant, A.; Klein, H.; Mittendorfer, J.; Morrison, D. R. O.; Parker, A.; Schmid, P.; Wachsmuth, H.; Hamisi, F.; Mobayyen, M. M.; Villalobos-Baillie, O.; Aderholz, M.; Deck, L.; Schmitz, N.; Wittek, W.; Corrigan, G.; Myatt, G.; Radojicic, D.; Retter, M.

1984-06-01

Data from a neutrino and antineutrino hydrogen experiment with BEBC are used to investigate transverse properties of the produced charged hadrons. Measurements are presented on average transverse momenta of charged pions as functions of Feynman- x and the hadronic mass, on the transverse momentum flow within an event and on jet-related quantities. The main features of the data are well described by the LUND model. The data favour a version of the model in which soft gluon effects are included and the primordial transverse momentum of the quarks in the proton is small. Effects from 1st order QCD (hard gluon emission) are negligible.

Depigmented-polymerised allergoids favour regulatory over effector T cells: enhancement by 1α, 25-dihydroxyvitamin D3.

Science.gov (United States)

Urry, Zoe L; Richards, David F; Black, Cheryl; Morales, Maria; Carnés, Jerónimo; Hawrylowicz, Catherine M; Robinson, Douglas S

2014-05-29

Allergen immunotherapy (SIT) is the only treatment for allergic disease capable of modifying disease long term. To reduce the risk of anaphylaxis from SIT, allergen-extracts have been modified by polymerisation with glutaraldehyde to reduce IgE binding. It is suggested that these allergoid extracts also have reduced T cell activity, which could compromise clinical efficacy. Effective SIT is thought to act through regulatory T cells (Tregs) rather than activation of effector T cells. There is no published data on the activity of modified extracts on Tregs. We compared the capacity of modified (depigmented-polymerised) versus unmodified (native) allergen extracts of grass pollen and house dust mite to stimulate proliferation/cytokine production and to modulate Treg/effector T cell frequency in cultures of peripheral blood mononuclear cells (PBMC), from volunteers sensitised to both allergens in vitro. Depigmented-polymerised allergen extracts stimulated less proliferation of PBMC, and reduced effector cell numbers after 7 days in culture than did native extracts. However, the frequency of Foxp3+ Tregs in cultures were similar to those seen with native extract so that ratios of regulatory to effector T cells were significantly increased in cultures stimulated with depigmented-polymerised extracts. Addition of 1α, 25-dihydroxyvitamin D3 further favoured Treg, and reduced effector cytokine production, but not interleukin-10. Depigmented-polymerised allergen extracts appear to favour Treg expansion over activation of effector T cells and this may relate to their demonstrated efficacy and safety in SIT. 1α, 25-dihydroxyvitamin D3 further reduces effector T cell activation by allergen extracts and may be a useful adjuvant for SIT.

Early warning score independently predicts adverse outcome and mortality in patients with acute pancreatitis.

Science.gov (United States)

Jones, Michael J; Neal, Christopher P; Ngu, Wee Sing; Dennison, Ashley R; Garcea, Giuseppe

2017-08-01

The aim of this study was to compare the prognostic value of established scoring systems with early warning scores in a large cohort of patients with acute pancreatitis. In patients presenting with acute pancreatitis, age, sex, American Society of Anaesthesiologists (ASA) grade, Modified Glasgow Score, Ranson criteria, APACHE II scores and early warning score (EWS) were recorded for the first 72 h following admission. These variables were compared between survivors and non-survivors, between patients with mild/moderate and severe pancreatitis (based on the 2012 Atlanta Classification) and between patients with a favourable or adverse outcome. A total of 629 patients were identified. EWS was the best predictor of adverse outcome amongst all of the assessed variables (area under curve (AUC) values 0.81, 0.84 and 0.83 for days 1, 2 and 3, respectively) and was the most accurate predictor of mortality on both days 2 and 3 (AUC values of 0.88 and 0.89, respectively). Multivariable analysis revealed that an EWS ≥2 was independently associated with severity of pancreatitis, adverse outcome and mortality. This study confirms the usefulness of EWS in predicting the outcome of acute pancreatitis. It should become the mainstay of risk stratification in patients with acute pancreatitis.

Microbiological and functional outcomes after open extremity fractures sustained overseas: The experience of a UK level I trauma centre

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B. Ardehali

2018-03-01

Conclusion: Patients with open extremity fractures transferred from overseas present the unique challenge of poly-microbial infection in addition to extensive traumatic wounds. Favourable outcomes can be achieved despite positive microbiological findings on tissue culture with adequate antimicrobial therapy. The decision to salvage the limb and the complexity of reconstruction used should be based on the chance of achieving meaningful functional recovery, mainly determined by the extent of bony injury. The complexity of reconstruction was based on the predicted long-term functionality of the salvaged limb.

The shift of the public opinion to the favour of nuclear energy in Slovenia

International Nuclear Information System (INIS)

Lengar, I.; Nemec, T.

2001-01-01

In late August and early September of 1999, nuclear energy topics occupied a central place in the Slovenian media because of the transport of two new steam generators to the Krsko nuclear power plant, and also due to the protest action of an Austrian Greenpeace group. Before these events, the public opinion in Slovenia was not in favour or nuclear energy and Greenpeace had a good reputation. In September it has lost much credibility because of their clumsy action of protest, and in just one month this caused a shift of public opinion in Slovenia towards support of Slovenia's only nuclear power plant. The Greenpeace protest action occurred during the transport of the two new steam generators to Krsko. By replacement of the old steam generators the operation of the Krsko NPP will be extended until 2023. The transport envoy travelled during the first half of September '99 across a considerable part of Slovene territory, passing by the capital of Ljubljana. (authors)

Public Opinion shifts to the favour of nuclear energy due to steam generator transport

International Nuclear Information System (INIS)

Lengar, I.; Nemec, T.

2000-01-01

In late August and early September of 1999, nuclear energy topics occupied a central place in the Slovenian media because of the transport of two new steam generators to the Krsko nuclear power plant, and also due to the protest action of an Austrian Green peace group. Before these events, the public opinion in Slovenia was not in favour or nuclear energy ;and Green peace had a good reputation. In September it has lost much credibility because of their clumsy :action of protest, and in just one month this caused a shift of public opinion in Slovenia towards support of Slovenian's only nuclear power plant. The Green peace protest action occurred during the transport of the two new steam generators to Krsko. By replacement of the old steam generators the operation of the Krsko NPP will be extended until 2023. The transport envoy travelled during the first half of September '99 across a considerable part of Slovene territory, passing by the capital of Ljubljana. (authors)

Pharmacological manipulation of serotonin receptors during brain embryogenesis favours stress resiliency in female rats

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Gianluca Lavanco

2018-02-01

Full Text Available Manipulations of the serotonin transmission during early development induce long-lasting changes in the serotonergic circuitry throughout the brain. However, little is known on the developmental consequences in the female progeny. Therefore, this study aimed at exploring the behavioural effects of pre- and postnatal stimulation of the serotonergic system by 5-methoxytryptamine in adolescent female rats on behavioural reactivity and anxiety- like phenotype. Our results show that perinatal 5- methoxythyptamine decreased total distance travelled and rearing frequency in the novel enviroment, and increased the preference for the centre of the arena in the open field test. Moreover, perinatal 5-methoxytryptamine increased the percentages of entries and time spent on the open arms of the elevated plus maze, with respect to perinatally vehicle-exposed rats. Thus, perinatal stimulation of serotonin receptors does not impair the functional response to the emotional challenges in female rats, favouring the occurrence of a stress-resilient phenotype.

Why have socio-economic explanations between favoured over ...

African Journals Online (AJOL)

explanations trump cultural ones in the South African HIV aetiological literature? In this article, we explore how three factors (a belief in monogamy as a universal norm, HIV's emergence in a time of the construction of non-racialism, and a simplified understanding of HIV epidemiology) have intersected to produce this bias ...

Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review.

Science.gov (United States)

Bond, G R; Drake, R E; Luciano, A

2015-10-01

Young adults with early psychosis want to pursue normal roles - education and employment. This paper summarises the empirical literature on the effectiveness of early intervention programmes for employment and education outcomes. We conducted a systematic review of employment/education outcomes for early intervention programmes, distinguishing three programme types: (1) those providing supported employment, (2) those providing unspecified vocational services and (3) those without vocational services. We summarised findings for 28 studies. Eleven studies evaluated early intervention programmes providing supported employment. In eight studies that reported employment outcomes separately from education outcomes, the employment rate during follow-up for supported employment patients was 49%, compared with 29% for patients receiving usual services. The two groups did not differ on enrolment in education. In four controlled studies, meta-analysis showed that the employment rate for supported employment participants was significantly higher than for control participants, odds ratio = 3.66 [1.93-6.93], p < 0.0001. Five studies (four descriptive and one quasi-experimental) of early intervention programmes evaluating unspecified vocational services were inconclusive. Twelve studies of early intervention programmes without vocational services were methodologically heterogeneous, using diverse methods for evaluating vocational/educational outcomes and precluding a satisfactory meta-analytic synthesis. Among studies with comparison groups, 7 of 11 (64%) reported significant vocational/education outcomes favouring early intervention over usual services. In early intervention programmes, supported employment moderately increases employment rates but not rates of enrolment in education. These improvements are in addition to the modest effects early programmes alone have on vocational/educational outcomes compared with usual services.

Does cruciate retention primary total knee arthroplasty affect proprioception, strength and clinical outcome?

Science.gov (United States)

Vandekerckhove, Pieter-Jan T K; Parys, Roel; Tampere, Thomas; Linden, Patrick; Van den Daelen, Luc; Verdonk, Peter C

2015-06-01

It remains unclear what the contribution of the PCL is in total knee arthroplasty (TKA). The goal of this study was to investigate the influence of the PCL in TKA in relationship to clinical outcome, strength and proprioception. Two arthroplasty designs were compared: a posterior cruciate-substituting (PS) and a posterior cruciate-retaining (CR) TKA. A retrospective analysis was performed of 27 CR and 18 PS implants with a minimum of 1 year in vivo. Both groups were compared in terms of clinical outcome (range of motion, visual analogue scale for pain, Hospital for Special Surgery Knee Scoring system, Lysholm score and Knee Injury and Osteoarthritis Outcome Score), strength (Biodex System 3 Dynamometer(®)) and proprioception (balance and postural control using the Balance Master system(®)). Each design was also compared to the non-operated contralateral side in terms of strength and proprioception. There were no significant differences between both designs in terms of clinical outcome and strength. In terms of proprioception, only the rhythmic weight test at slow and moderate speed shifting from left to right was significant in favour of the CR design. None of the unilateral stance tests showed any significant difference between both designs. There was no difference in terms of strength and proprioception between the operated side and the non-operated side. Retaining the PCL in TKA does not result in an improved performance in terms of clinical outcome and proprioception and does not show any difference in muscle strength. III.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Nigaragua

International Nuclear Information System (INIS)

1977-08-01

On invitation of the Nicaraguan Government, the U. S. Atomic Energy Commission conducted a reconnaissance for uranium in March, 1953. Operating and abandoned mines, as well as prospects, formations, contacts, dikes and sills enroute to these mines were tested by scintillometer. Reconnaissance included two mineralized areas exposed in windows within the volcanic belt but did not include the schists and granitic intrusions in the north eastern part of the country. No anomalous radioactivity was detected. No uranium occurrences were discovered during the 1953 reconnaissance and no uranium deposits or prospects are indicated on the metallogenetic map of Central America or in the bibliography of Nicaraguan geology. Information is net available on current exploration in Nicaragua. All subsoil mineral resources besides quarry materials belong to the state. In the interest of national defence, uranium, thorium, lithium and their derivatives, along with certain other mineral substances, may be classified as o f temporary strategic interest , and their exploration or exploitation would then be subject to special laws. The Ministry of Economy may establish permanent or temporary national reserves on which mining activities are essentially precluded. Foreign nationals and corporations may acquire mineral concessions although particular regulations may be applicable to such an acquisition. Exploration of any favourable formations has been hindered by volcanic ash cover in western Nicaragua and dense vegetation in the East. Little geologic work has been done on the Paleozoic metamorphic rocks or Todos Santos Formation of the Northern Highlands. These could possibly show some potential for discovery of uranium as might the alaskites near Siuna. The potential resources of Nicaragua are estimated at less than 1,000 tonnes uranium

Aneurysmal subarachnoid hemorrhage: outcome of aneurysm clipping versus coiling in anterior circulation aneurysm

International Nuclear Information System (INIS)

Wadd, I.H.; Haroon, A.; Ansari, S.

2015-01-01

To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm. Study Design: Comparative study. Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013. Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society (WFNS) grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale (mRS) as favourable (mRS =2 ) and unfavourable (mRS > 2). Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 ± 10 years and in group B was 51.00 ± years. Overall, 56 (40%) males, 28 (60%) males in each group; and 84 (60%) females, 42 (60%) in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 (38.6%) patients had no disability (grades 1 and 2), 25 (35.7%) were slightly disabled (grade 3) and 18 (25.7%) had moderate disability (grade 4); whereas in group B, i.e. clipping group 23 (32.9%) patients had no disability (grades 1 and 2), 23 (32.9%) were slightly disabled (grade 3) and 24 (34.3%) had moderate disability (grade 4). At one year follow-up, in group A, favourable outcome was achieved in 56 (80%) of patients compared to 48 (68.6%) in group B; whilst, 14 (20%) patients in group A and 22 (33.1%) in group B showed unfavourable outcome. Although mortality rate was higher in clipping (n=3, 4.3%) as compared to coiling (n=1, 1.4%), but was not statistically

Favourable outcome of posterior decompression and stabilization in lordosis for cervical spondylotic myelopathy: the spinal cord "back shift" concept.

Science.gov (United States)

Denaro, Vincenzo; Longo, Umile Giuseppe; Berton, Alessandra; Salvatore, Giuseppe; Denaro, Luca

2015-11-01

Surgical management of patients with multilevel CSM aims to decompress the spinal cord and restore the normal sagittal alignment. The literature lacks of high level evidences about the best surgical approach. Posterior decompression and stabilization in lordosis allows spinal cord back shift, leading to indirect decompression of the anterior spinal cord. The purpose of this study was to investigate the efficacy of posterior decompression and stabilization in lordosis for multilevel CSM. 36 out of 40 patients were clinically assessed at a mean follow-up of 5, 7 years. Outcome measures included EMS, mJOA Score, NDI and SF-12. Patients were asked whether surgery met their expectations and if they would undergo the same surgery again. Bone graft fusion, instrumental failure and cervical curvature were evaluated. Spinal cord back shift was measured and correlation with EMS and mJOA score recovery rate was analyzed. All scores showed a significative improvement (p 0.05). Ninety percent of patients would undergo the same surgery again. There was no deterioration of the cervical alignment, posterior grafted bones had completely fused and there were no instrument failures. The mean spinal cord back shift was 3.9 mm (range 2.5-4.5 mm). EMS and mJOA recovery rates were significantly correlated with the postoperative posterior cord migration (P lordosis is a valuable procedure for patients affected by multilevel CSM, leading to significant clinical improvement thanks to the spinal cord back shift. Postoperative lordotic alignment of the cervical spine is a key factor for successful treatment.

[Clinico-psychological features of patients with favorable outcomes of slowly-progressive juvenile schizophrenia].

Science.gov (United States)

Tsutsul'kovskaia, M Ia; Bil'zho, A G; Kritskaia, V P; Meleshko, T K

1986-01-01

A follow-up study of patients with favourable outcomes of juvenile slowly progressing schizophrenia at the level of clinical cure (n = 84) revealed a number of clinical characteristics in the pattern of personality changes which correlated with a high level of the patients' social and occupational adaptation. The authors also determined external factors contributing to the achievement and stabilization of the "clinical cure" status. An experimental and psychological examination of these patients revealed finer mechanisms contributing to their social adaptation. These are high motivation of activities, compliance with social norms, a high level of voluntary regulation of activity and self-regulation, as well as the ability to overcome autistic trends in situations of interpersonal activities and cooperation.

Paediatric retinal detachment: aetiology, characteristics and outcomes

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Elizabeth McElnea

2018-02-01

Full Text Available AIM: To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment. METHODS: A retrospective review of all those under 16y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded. RESULTS: Twenty-eight eyes of 24 patients, 15 (62.5% of whom were male and 9 (37.5% of whom were female, their mean age being 11.6y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14 (50.0% cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11 (39.3% cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 logMAR with range 0.0-3.0 logMAR. In 22 of 26 (84.6% cases which underwent surgical repair the retina was attached at last follow-up. CONCLUSION: Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.

Does head CT scan pathology predict outcome after mild traumatic brain injury?

Science.gov (United States)

Lannsjö, M; Backheden, M; Johansson, U; Af Geijerstam, J L; Borg, J

2013-01-01

More evidence is needed to forward our understanding of the key determinants of poor outcome after mild traumatic brain injury (MTBI). A large, prospective, national cohort of patients was studied to analyse the effect of head CT scan pathology on the outcome. One-thousand two-hundred and sixty-two patients with MTBI (Glasgow Coma Scale score 15) at 39 emergency departments completed a study protocol including acute head CT scan examination and follow-up by the Rivermead Post Concussion Symptoms Questionnaire and the Glasgow Outcome Scale Extended (GOSE) at 3 months after MTBI. Binary logistic regression was used for the assessment of prediction ability. In 751 men (60%) and 511 women (40%), with a mean age of 30 years (median 21, range 6-94), we observed relevant or suspect relevant pathologic findings on acute CT scan in 52 patients (4%). Patients aged below 30 years reported better outcome both with respect to symptoms and GOSE as compared to patients in older age groups. Men reported better outcome than women as regards symptoms (OR 0.64, CI 0.49-0.85 for ≥3 symptoms) and global function (OR 0.60, CI 0.39-0.92 for GOSE 1-6). Pathology on acute CT scan examination had no effect on self-reported symptoms or global function at 3 months after MTBI. Female gender and older age predicted a less favourable outcome. The findings support the view that other factors than brain injury deserve attention to minimize long-term complaints after MTBI. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

Radiofrequency vs laser in the management of mild to moderate obstructive sleep apnoea: does the number of treatment sessions matter?

Science.gov (United States)

Atef, Ahmed; Mosleh, Mohammed; Hesham, Mohammed; Fathi, Ahmed; Hassan, Mohammed; Fawzy, Mahmoud

2005-11-01

Obstructive sleep apnea (OSA) is a relatively common and serious problem with many medical and social consequences. Laser and radiofrequency are two recent techniques used to treat OSA and they can be carried out under local anaesthesia, but they need multiple sessions to achieve satisfactory outcome and are associated with better short-term than long-term outcomes. In this work we compare the two modalities as regards the optimal number of treatment sessions needed to achieve a favourable outcome in the short and long term. A total of 150 patients with apnoea hypopnoea index (AHI) between 5 and 30 events per hour, no morbid obesity and retropalatal site of obstruction were included in this prospective study. Patients were randomly and equally divided into two groups, each comprising 75 patients. The first group was treated with bipolar radiofrequency volumetric tissue reduction of the palate (BRVTR) and the second group was treated with laser-assisted uvulopalatoplasty (LAUP). Each group was further subdivided into five subgroups each consisting of 15 patients. The first group received one treatment session, the second received two sessions, the third received three sessions, the fourth received four sessions and the fifth group received five treatment sessions. Evaluation of efficiency of both techniques in treating OSA was assessed objectively by polysomnography. In those treated with BRVTR; at least three sessions were needed to achieve a favourable outcome in OSA in the short and long term. In those treated with LAUP, a single treatment session was enough to achieve a favourable outcome on OSA in the short term, while two sessions were needed to achieve the same long-term outcome. In OSA, fewer treatment sessions are needed with LAUP (one session) than with BRVTR (three sessions) to achieve a favourable outcome. In LAUP more treatment sessions (two) are needed to maintain a longer-term favourable outcome than those needed to achieve short-term favourable

Diagnosis and Outcomes of Appendicitis Complicating Pregnancy in a Tertiary Care Centre-A 10 year Experience

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Vaibhav Londhe

2017-10-01

Full Text Available Introduction: Appendicitis in pregnancy is rare and its diagnosis is a challenge as the clinical presentation may be altered in pregnancy. Early diagnosis of appendicitis is vital for a favourable pregnancy outcome. Aim: To study clinical features, radiological findings, surgical, histopathological and pregnancy outcomes in cases of acute appendicitis complicating pregnancy. Materials and Methods: This retrospective study was conducted in Christian Medical College and Hospital, a Tertiary Care Centre in the Department of Obstetrics and Gynaecology, Tamil Nadu, India. We reviewed the medical records and computerized database of a large tertiary care center between January 2007 and December 2016 years and retrieved 34 cases of appendicitis complicating pregnancy. During this period there were 1,23,938 deliveries in the Department of Obstetrics and Gynaecology and a total of 632 women had undergone appendicectomy, in the Department of Surgery. The details of the demography, clinical presentation, lab investigations, imaging, surgical findings, treatment, pathology and pregnancy outcomes were assessed and collated from case notes. Standard clinical, radiological and laboratory diagnostic criteria were used to establish the diagnosis of appendicitis. Categorical variables were summarised as frequencies and percentages. Quantitative variables were summarised as mean and standard deviation for normally distributed variable or median and IQR for skewed variables. Diagnostic accuracy were given with 95% confidence interval. Results: Mean gestational age at diagnosis was 18 weeks. Mean duration between onset of pain to admission was 1.77±1.08 days. The average MANTRELS score comprising of symptoms, signs and laboratory findings was 5. Ultrasound imaging was done for all cases. Thirty two women underwent surgery. Two women were managed conservatively. Thirty one women had histopathological findings of the appendix. The sensitivity of ultrasound was 87

Comparative analysis of functional food producers' profitability in Serbia: A leader-follower relation

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Draganac Dragana

2016-01-01

Full Text Available The functional food market in Serbia is relatively young and insufficiently explored both from the aspects of producers and consumers, the qualitative aspect and especially from the quantitative aspect. The aim of this paper is to illustrate the results of the comprehensive quantitative financial analysis of profitability which focuses on the example of two companies. The main criterion applied in the selection of companies for the analysis represents the fact that one company is recognizable as a producer of foods with nutritive and health claims and is a leader within that market segment, whereas the other analyzed company mostly produces traditional products and has entered the aforementioned market segment at a later stage. The key idea is to do a comparative analysis of the profitability of these two companies for a four-year period. The profitability ratio analysis and the Du Pont analysis system are used in the paper as well as the analysis of solvency and financial leverage effect. The vertical analysis of income statement is also done in order to reveal the relation between some cost categories and operating revenues. The research results lead to a conclusion that the company that mostly produces functional foods has higher profit margins and rates of return and is therefore in a more favourable position since it can benefit from positive effects of financial leverage to a higher extent. The profitability of the second relevant company is mostly based on the better asset turnover.

Association between organisational and workplace cultures, and patient outcomes: systematic review.

Science.gov (United States)

Braithwaite, Jeffrey; Herkes, Jessica; Ludlow, Kristiana; Testa, Luke; Lamprell, Gina

2017-11-08

Every organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes. A variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts. The articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review. Patient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience. The search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction. Synthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare

Exploring flavour-producing core microbiota in multispecies solid-state fermentation of traditional Chinese vinegar.

Science.gov (United States)

Wang, Zong-Min; Lu, Zhen-Ming; Shi, Jin-Song; Xu, Zheng-Hong

2016-05-31

Multispecies solid-state fermentation (MSSF), a natural fermentation process driven by reproducible microbiota, is an important technique to produce traditional fermented foods. Flavours, skeleton of fermented foods, was mostly produced by microbiota in food ecosystem. However, the association between microbiota and flavours and flavour-producing core microbiota are still poorly understood. Here, acetic acid fermentation (AAF) of Zhenjiang aromatic vinegar was taken as a typical case of MSSF. The structural and functional dynamics of microbiota during AAF process was determined by metagenomics and favour analyses. The dominant bacteria and fungi were identified as Acetobacter, Lactobacillus, Aspergillus, and Alternaria, respectively. Total 88 flavours including 2 sugars, 9 organic acids, 18 amino acids, and 59 volatile flavours were detected during AAF process. O2PLS-based correlation analysis between microbiota succession and flavours dynamics showed bacteria made more contribution to flavour formation than fungi. Seven genera including Acetobacter, Lactobacillus, Enhydrobacter, Lactococcus, Gluconacetobacer, Bacillus and Staphylococcus were determined as functional core microbiota for production of flavours in Zhenjiang aromatic vinegar, based on their dominance and functionality in microbial community. This study provides a perspective for bridging the gap between the phenotype and genotype of ecological system, and advances our understanding of MSSF mechanisms in Zhenjiang aromatic vinegar.

Near-surface hydrogen depletion of diamond-like carbon films produced by direct ion deposition

Energy Technology Data Exchange (ETDEWEB)

Markwitz, Andreas, E-mail: A.Markwitz@gns.cri.nz [GNS Science, Lower Hutt (New Zealand); The MacDiarmid Institute for Advanced Materials and Nanotechnology (New Zealand); Gupta, Prasanth [GNS Science, Lower Hutt (New Zealand); The MacDiarmid Institute for Advanced Materials and Nanotechnology (New Zealand); Mohr, Berit [GNS Science, Lower Hutt (New Zealand); Hübner, René [Institute of Ion Beam Physics and Materials Research, Helmholtz-Zentrum Dresden-Rossendorf (Germany); Leveneur, Jerome; Zondervan, Albert [GNS Science, Lower Hutt (New Zealand); Becker, Hans-Werner [RUBION, Ruhr-University Bochum (Germany)

2016-03-15

Amorphous atomically flat diamond-like carbon (DLC) coatings were produced by direct ion deposition using a system based on a Penning ion source, butane precursor gas and post acceleration. Hydrogen depth profiles of the DLC coatings were measured with the 15N R-NRA method using the resonant nuclear reaction {sup 1}H({sup 15}N, αγ){sup 12}C (E{sub res} = 6.385 MeV). The films produced at 3.0–10.5 kV acceleration voltage show two main effects. First, compared to average elemental composition of the film, the near-surface region is hydrogen depleted. The increase of the hydrogen concentration by 3% from the near-surface region towards the bulk is attributed to a growth model which favours the formation of sp{sup 2} hybridised carbon rich films in the film formation zone. Secondly, the depth at which the maximum hydrogen concentration is measured increases with acceleration voltage and is proportional to the penetration depth of protons produced by the ion source from the precursor gas. The observed effects are explained by a deposition process that takes into account the contributions of ion species, hydrogen effusion and preferential displacement of atoms during direct ion deposition.

Neurolinguistic programming: a systematic review of the effects on health outcomes.

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Sturt, Jackie; Ali, Saima; Robertson, Wendy; Metcalfe, David; Grove, Amy; Bourne, Claire; Bridle, Chris

2012-11-01

Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. To evaluate the effects of NLP on health-related outcomes. Systematic review of experimental studies. The following data sources were searched: MEDLINE, PsycINFO, ASSIA, AMED, CINAHL, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4-20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes.

Individual and group based parenting programmes for improving psychosocial outcomes for teenage parents and their children

Science.gov (United States)

Barlow, Jane; Smailagic, Nadja; Bennett, Cathy; Huband, Nick; Jones, Hannah; Coren, Esther

2014-01-01

Background Parenting programmes are a potentially important means of supporting teenage parents and improving outcomes for their children, and parenting support is a priority across most Western countries. This review updates the previous version published in 2001. Objectives To examine the effectiveness of parenting programmes in improving psychosocial outcomes for teenage parents and developmental outcomes in their children. Search methods We searched to find new studies for this updated review in January 2008 and May 2010 in CENTRAL, MEDLINE, EMBASE, ASSIA, CINAHL, DARE, ERIC, PsycINFO, Sociological Abstracts and Social Science Citation Index. The National Research Register (NRR) was last searched in May 2005 and UK Clinical Research Network Portfolio Database in May 2010. Selection criteria Randomised controlled trials assessing short-term parenting interventions aimed specifically at teenage parents and a control group (no-treatment, waiting list or treatment-as-usual). Data collection and analysis We assessed the risk of bias in each study. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post-intervention scores between the intervention and control groups by the pooled standard deviation. Main results We included eight studies with 513 participants, providing a total of 47 comparisons of outcome between intervention and control conditions. Nineteen comparisons were statistically significant, all favouring the intervention group. We conducted nine meta-analyses using data from four studies in total (each meta-analysis included data from two studies). Four meta-analyses showed statistically significant findings favouring the intervention group for the following outcomes: parent responsiveness to the child post-intervention (SMD −0.91, 95% CI −1.52 to −0.30, P = 0.04); infant responsiveness to mother at follow-up (SMD −0.65, 95% CI −1.25 to −0.06, P = 0.03); and an overall measure of parent

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Sweden

International Nuclear Information System (INIS)

1977-11-01

Sweden, covers an area of approx. 450 000 square kilometers. It has a population of 8 millions. With few exceptions in the northern part the access can be regarded as good. A dense network of motorroads and railroad exists. The results obtained by the exploration works combined with other available geo-information permit a separation of two principal uranium provinces in Sweden. The first one is confined to sediments of Upper Cambrian and Lower Ordovician which appears in Southern Sweden and along the border of the Caledonian mountain range in Central Sweden. The uranium occurrence are stratiform, of blackshale type which occurs in the Peltura zone of Upper Cambrian or they are associated to a phosphatite-bearing unit of Lower Ordovician overlying the Cambrian shale formation. The distribution of uranium in Upper Cambrian rocks is in general dependant on their lithology which itself is related to the paleography. This conditions explain relatively higher uranium content of the shale from Billigen.The potential resources of the province are estimated at about 1 million tonnes uranium. The second uranium province, called Arjeplog-Arvidsjaur, situated immediately south of the Arctic circle, comprises one deposit - Pleutajokk - and a group of more than twenty occurrences of similar characteristics and age (1 700 - 1 800 my.). The results of the past exploration have shown that uranium is present in different types of rocks. Because of the presence of uranium in many of the pegmatites the possibility of the formation of large low grade deposits should be tested. Favourable areas are those regions where the geological conditions are similar to the geology of the Grenville province in Canada or the Damara belt of SW-Africa. Special studies are recommended on this subject

International Uranium Resources Evaluation Project (IUREP) national favourability studies: France

International Nuclear Information System (INIS)

1977-09-01

France, with an area of 550,000 km 2 , has been prospecting its territory for uranium for more than 30 years. The proven uranium reserves in all the ore categories defined by the NEA/lAEA are estimated at around 120,000 tU, of which 25,000 tU have already been mined. About 70% of these reserves are associated with granites, while the bulk of the remainder is located in Permian sediments and the last in Paleogene sediments. The prospecting effort has not been distributed equally over French territory. More than half of it - recent orogens and large basins - have been little or very little prospected. On the other hand, the Hercynian massifs and their Upper Paleozoic mantle have been systematically prospected. Nevertheless, even within the latter there is still room for further exploration: extensions of already known mineralizations both laterally and vertically, conventional mineralizations deep down or under a mantle, types of mineralizations not investigated previously (those associated with acid or intermediate vulcanism, peribatholithic shales, alkaline complexes etc.). Of course, in the areas that have not been so well explored, because they appear less favourable, there are still some possibilities, namely, in the areas of recent orogens, mineralizations associated with antemesozoic cores (same types as above) or directly associated with orogenesis (slightly to moderately metamorphic sandstone-phyllitic formations, certain sedimentary formations etc.). As for the large basins, they are capable of containing mineralizations associated with some of their formations (Paleogene of the Basin of Aquitaine etc), but they may also cover workable uranium deposits. It is possible that, in the not to distant future access may be gained to such ores in particular cases. On this basis it does not seem unreasonable to reckon with the discovering of new resources of an order of magnitude between half and the same as those already found. (author)

Cost-minimization analysis favours intravenous ferric carboxymaltose over ferric sucrose for the ambulatory treatment of severe iron deficiency.

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Xavier Calvet

Full Text Available OBJECTIVE: Intravenous iron is widely used to treat iron deficiency in day-care units. Ferric carboxymaltose (FCM allows administration of larger iron doses than iron sucrose (IS in each infusion (1000 mg vs. 200 mg. As FCM reduces the number of infusions required but is more expensive, we performed a cost-minimization analysis to compare the cost impact of the two drugs. MATERIALS AND METHODS: The number of infusions and the iron dose of 111 consecutive patients who received intravenous iron at a gastrointestinal diseases day-care unit from 8/2007 to 7/2008 were retrospectively obtained. Costs of intravenous iron drugs were obtained from the Spanish regulatory agencies. The accounting department of the Hospital determined hospital direct and indirect costs for outpatient iron infusion. Non-hospital direct costs were calculated on the basis of patient interviews. In the pharmacoeconomic model, base case mean costs per patient were calculated for administering 1000 mg of iron per infusion using FCM or 200 mg using IS. Sensitivity analysis and Monte Carlo simulation were performed. RESULTS: Under baseline assumptions, the estimated cost of iron infusion per patient and year was €304 for IS and €274 for FCM, a difference of €30 in favour of FCM. Adding non-hospital direct costs to the model increased the difference to €67 (€354 for IS vs. €287 for FCM. A Monte Carlo simulation taking into account non-hospital direct costs favoured the use of FCM in 97% of simulations. CONCLUSION: In this pharmacoeconomic analysis, FCM infusion reduced the costs of iron infusion at a gastrointestinal day-care unit.

Surgical adverse outcomes and patients' evaluation of quality of care: inherent risk or reduced quality of care?

Science.gov (United States)

Marang-van de Mheen, Perla J; van Duijn-Bakker, Nanny; Kievit, Job

2007-12-01

Previous research has shown that sicker patients are less satisfied with their healthcare, but specific effects of adverse health outcomes have not been investigated. The present study aimed to assess whether patients who experience adverse outcomes, in hospital or after discharge, differ in their evaluation of quality of care compared with patients without adverse outcomes. In hospital adverse outcomes were prospectively recorded by surgeons and surgical residents as part of routine care. Four weeks after discharge, patients were interviewed by telephone about the occurrence of post-discharge adverse outcomes, and their overall evaluation of quality of hospital care and specific suggestions for improvements in the healthcare provided. Of 2145 surgical patients admitted to the Leiden University Medical Center in 2003, 1876 (88%) agreed to be interviewed. Overall evaluation was less favourable by patients who experienced post-discharge adverse outcomes only (average 19% lower). These patients were also more often dissatisfied (OR 2.02, 95% CI 1.24 to 3.31) than patients without adverse outcomes, and they more often suggested that improvements were needed in medical care (OR 2.07, 1.45 to 2.95) and that patients were discharged too early (OR 3.26, 1.72 to 6.20). The effect of in hospital adverse outcomes alone was not statistically significant. Patients with both in hospital and post-discharge adverse outcomes also found the quality of care to be lower (on average 33% lower) than patients without adverse outcomes. Post-discharge adverse outcomes negatively influence patients' overall evaluation of quality of care and are perceived as being discharged too early, suggesting that patients need better information at discharge.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Saudi Arabia

International Nuclear Information System (INIS)

1977-09-01

Saudi Arabia occupies most of the Arabian Peninsula and has an area of 872,722 sq miles, or 2,260,350 sq km. The ancient Arabian Shield of igneous and metamorphic rocks comprises most of the western third of the country. The shield contains many extinct volcanoes surrounded by lava beds. Sloping eastwards are the newer sedimentary areas in which rich oil fields are found. In Saudi Arabia oil is paramount and less effort has been put into searching for mineral deposits than in other countries of similar size and geology. Pour aerial radiometric surveys have been undertaken and some of the anomalies discovered in the earlier ones were ground checked by an IAEA expert in 1963-64. Two anomalies warranted more detailed work, these were the Jabal Said anomaly in the Central Shield area and the Al Ghrayyat in Wadi Sawawin about 70 miles from the Jordan border. The Jabal Said anomaly consists of a zone of altered rocks consisting largely of pegmatite and pegmatite granite= Allanite, pyrochlore, cyrtolite, xenotime and monazite are the ore minerals,, The deposit was estimated to have 2.2 million tons of ore grading 0.2 - 0.3 percent Nb 2 O 5 and 0.03 - 0,05% U 3 O 8 . The other occurrence at Al Ghrayyat is similar but with much lower grade uranium content. In view of the huge size of Saudi Arabia, the existence of many geologically favourable rock types and the poor coverage by sophisticated uranium exploration techniques, the Speculative Potential is placed between 10,000 and 50,000 Tonnes uranium. (author)

[Isolation and regeneration of the protoplasts of the streptomycete producers of actinomycins C and X].

Science.gov (United States)

Orlova, T I; Masha, G G; Kliueva, N A

1986-09-01

Protoplasts of S. michiganensis, S. chrysomallus and Streptomyces sp. 26-115, organisms producing actinomycins C and X form in hypertonic salt solution under the action of 3-4,5 mg/ml of lysozyme on the mycelium suspension. For protoplasting, the streptomycetes were grown on the soybean medium in the presence of 0.2-0.8 per cent of glycine. The mycelium of the streptomycete exponential growth phase was more favourable for protoplast formation. Protoplast regeneration was studied on the medium described by Okanishi et al. The quantitative composition of this medium was not optimal for regeneration of protoplasts of the above streptomycetes. The level of their regeneration depended to various extents on concentration of phosphate, magnesium and calcium ions and sucrose in the regeneration medium.

Calculation of climate factors as an additional criteria to determine agriculturally less favoured areas

Directory of Open Access Journals (Sweden)

Tjaša POGAČAR

2016-04-01

Full Text Available Climate factors that are proposed to determine agriculturally less favoured areas (LFA in Slovenia were analyzed for the period 1981–2010. Following the instructions of European Commission prepared by Joint Research Centre (JRC 30-years averages of low air temperatures criteria (the vegetation period duration and sums of effective air temperatures and aridity criteria (aridity index AI have to be calculated. Calculations were additionally done using Slovenian Environment Agency (ARSO method, which is slightly different when determining temperature thresholds. Only hilly areas are below the LFA low air temperatures threshold with the lowest located meteorological station in Rateče. According to aridity criteria no area in Slovenia is below the threshold, so meteorological water balance was also examined. Average water balance in the period 1981–2010 was in most of locations lower than in the period 1971–2000. Climate change impacts are already expressed as trend presence in time series of studied variables, so it is recommended to calculate trends and take them into account or to perform regular iterations of calculations.

Study of transverse momenta of charged hadrons produced in νp and anti νp charged current interactions

International Nuclear Information System (INIS)

Jones, G.T.; Kennedy, B.W.; Middleton, R.P.; O'Neale, S.W.; Cooper, A.M.; Grant, A.; Klein, H.; Mittendorfer, J.; Morrison, D.R.O.; Parker, A.; Schmid, P.; Wachsmuth, H.; Hamisi, F.; Mobayyen, M.M.; Villalobos-Baillie, O.; Aderholz, M.; Deck, L.; Schmitz, N.; Wittek, W.; Corrigan, G.; Myatt, G.; Radiojicic, D.; Retter, M.

1984-01-01

Data from a neutrino and antineutrino hydrogen experiment with BEBC are used to investigate transverse properties of the produced charged hadrons. Measurements are presented on average transverse momenta of charged pions as functions of Feynman-x and the hadronic mass, on the transverse momentum flow within an event and on jet-related quantities. The main features of the data are well described by the LUND model. The data favour a version of the model in which soft gluon effects are included and the primordial transverse momentum of the quarks in the proton is small. Effects from 1st order QCD (hard gluon emission) are negligible. (orig.)

Study of transverse momenta of charged hadrons produced in νp and anti νp charged current interactions

International Nuclear Information System (INIS)

Jones, G.T.; Kennedy, B.W.; Middleton, R.P.; O'Neale, S.W.; Cooper, A.M.; Grant, A.; Klein, H.; Mittendorfer, J.; Morrison, D.R.O.; Parker, A.; Schmid, P.; Wachsmuth, H.; Hamisi, F.; Mobayyen, M.M.; Villalobos-Baillie, O.; Aderholz, M.; Deck, L.; Schmitz, N.; Wittek, W.; Corrigan, G.; Myatt, G.; Radojicic, D.; Retter, M.

1984-05-01

Data from neutrino and antineutrino hydrogen experiment with BEBC are used to investigate transverse properties of the produced charged hadrons. Measurements are presented on average transverse momenta of charged pions as functions of Feynman-x and the hadronic mass, on the transverse momentum flow within an event and on jet-related quantities. The main features of the data are well described by the LUND model. The data favour a version of the model in which soft gluon effects are included and the primordial transverse momentum of the quarks in the proton is small. Effects from 1st order QCD (hard gluon emission) are negligible. (orig.)

The bizzare phenomenon of smokers' paradox in the immediate outcome post acute myocardial infarction: an insight into the Malaysian National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) registry year 2006-2013.

Science.gov (United States)

Venkatason, Padmaa; Salleh, Norsabihin Mohd; Zubairi, Yong; Hafidz, Imran; Ahmad, Wan Azman Wan; Han, Sim Kui; Zuhdi, Ahmad Syadi Mahmood

2016-01-01

'Smoker's paradox' is a controversial phenomenon of an unexpected favourable outcome of smokers post acute myocardial infarction. There are conflicting evidences from the literature so far. We investigate for the existence of this phenomenon in our post acute myocardial infarction patients. We analysed 12,442 active smokers and 10,666 never-smokers diagnosed with STEMI and NSTEMI from the Malaysian National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) year 2006-2013 from 18 hospitals across Malaysia. Comparisons in the baseline characteristics, clinical presentation, in-hospital treatment and short term clinical outcome were made between the two groups. To compare the clinical outcome, an extensive multivariate adjustment was made to estimate the allcause mortality risk ratios for both groups. The active smokers were younger (smokers 53.7 years vs non-smokers 62.3 years P smokers and intravenous thrombolysis was the main reperfusion therapy in both groups. Smokers had a higher rate of in-hsopital coronary revascularisation in NSTEMI group (21.6 % smokers vs 16.7 % non-smokers P non-smokers in the STEMI group. Multivariate adjusted mortality risk ratios showed significantly lower mortality risks of smokers at both in-hospital (RR 0.510 [95 % CI 0.442-0.613]) and 30-day post discharge (RR 0.534 [95 % CI 0.437-0.621]). Smoking seems to be associated with a favourable outcome post myocardial infarction. The phenomenon of 'smoker's paradox' is in fact a reality in our patients population. The definitive explanation for this unexpected protective effect of smoking remains unclear.

Relationship between nurses' practice environments and nursing outcomes in Turkey.

Science.gov (United States)

Topçu, I; Türkmen, E; Badır, A; Göktepe, N; Miral, M; Albayrak, S; Kebapçı, A; Serbest, Ş; Özcan, D

2016-06-01

This study aimed to understand nursing practice environment characteristics in Istanbul-area hospitals in Turkey, the relationship between these characteristics, nurse burnout levels and nurses' intentions to leave work. A well-known relationship exists in many countries between nursing practice environments and nurse burnout and intention to leave work. However, little is known about the relationship between practice environment characteristics and nursing outcomes in Turkey. This cross-sectional study was conducted among 2592 nurses in 20 Ministry of Health and 29 private hospitals in Istanbul, Turkey. A demographic questionnaire, Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory were used for data collection. Almost half of nurses suffered from high-level burnout related to emotional exhaustion and personal accomplishment, and one-third reported depersonalization and the intent to leave their jobs within a year. A poor nursing practice environment was the leading factor, increasing nurses' burnout levels in all subdimensions. Burnout related to emotional exhaustion, personal accomplishment and poor practice environment increased intention to leave. Permanent positions decreased intention. There was a relationship between poor practice environments and nursing outcomes in Turkey. The use of a survey data collection method is a potential study limitation. Quantitative and qualitative methods could be combined to obtain more detailed objective data about nursing practice environments. Poor practice environments, high-level burnout and intention to leave work are significant problems in Istanbul, Turkey. Favourable practice environments and job security should be provided to improve nursing outcomes. Policymakers and nurse managers should be aware of any negative issues regarding nursing practice environments and job security to improve nursing outcomes. © 2016 International Council of Nurses.

Combining protein extraction and anaerobic digestion to produce feed, fuel and fertilizer from green biomass – An organic biorefinery concept

DEFF Research Database (Denmark)

Fernandez, Maria Santamaria; Salces, Beatriz Molinuevo; Lübeck, Mette

Organically grown green biomass (red clover, clover grass) was investigated as a resource for organic feed and organic fertilizer by combination of proteins extraction and anaerobic digestion of the residues. Extraction of proteins from both crops revealed very favourable amino acid composition...... for the use as animal feed. The residual 90% of organic matter, leaving the separation as solid press cake and brown juice was subjected to anaerobic digestion to produce biogas and fertilizer. Methane yields of 220-310 and 430-540 ml CH4/g VS were obtained for press cake and brown juice, respectively...

Prospecting direction and favourable target areas for exploration of large and super-large uranium deposits in China

International Nuclear Information System (INIS)

Liu Xingzhong

1993-01-01

A host of large uranium deposits have been successively discovered abroad by means of geological exploration, metallogenetic model studies and the application of new geophysical and geochemical methods since 1970's. Thorough undertaking geological research relevant to prospecting for super large uranium deposits have attracted great attention of the worldwide geological circle. The important task for the vast numbers of uranium geological workers is to make an afford to discover more numerous large and super large uranium deposits in China. The author comprehensively analyses the regional geological setting and geological metallogenetic conditions for the super large uranium deposits in the world. Comparative studies have been undertaken and the prospecting direction and favourable target areas for the exploration of super large uranium deposits in China have been proposed

Evolutionary conservation advice for despotic populations: habitat heterogeneity favours conflict and reduces productivity in Seychelles magpie robins.

Science.gov (United States)

López-Sepulcre, Andrés; Kokko, Hanna; Norris, Ken

2010-11-22

Individual preferences for good habitat are often thought to have a beneficial stabilizing effect for populations. However, if individuals preferentially compete for better-quality territories, these may become hotspots of conflict. We show that, in an endangered species, this process decreases the productivity of favoured territories to the extent that differences in productivity between territories disappear. Unlike predictions from current demographic theory on site-dependent population regulation (ideal despotic distribution), we show that population productivity is reduced if resources are distributed unevenly in space. Competition for high-quality habitat can thus have detrimental consequences for populations even though it benefits individuals. Manipulating conflict (e.g. by reducing variation in habitat quality) can therefore prove an effective conservation measure in species with strong social or territorial conflict.

Serum magnesium levels and clinical outcome of aneurysmal subarachnoid hemorrhage: a study in 60 patients

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Habibi Z

2008-06-01

Full Text Available Background: Hypomagnesemia is commonly encountered in patients with a wide variety of diseases including subarachnoid hemorrhage (SAH, cardiovascular emergencies, head trauma, migraine attacks, seizure and preeclampsia. It seems to be associated with a poor clinical outcome. This study considers the prevalence and temporal distribution of hypomagnesemia after aneurysmal SAH and its correlation with the severity of SAH, delayed cerebral ischemia (DCI as well as the neurological outcome after a period of three months.Methods: Between 2003 and 2008, 60 patients were admitted to the emergency ward of Imam Khomeini Hospital with acute SAH. Serum magnesium levels were measured during the first 72 hours, days 4-7, and second and third weeks after SAH. The three-month outcome was assessed according to the Glasgow Outcome Scale (GOS. Clinical SAH grading was performed according to the criteria of the World Federation of Neurological Surgeons (WFNS and the patients were allocated to "Good" (GOS = 4, 5 and "Poor" (GOS= 1-3 outcome groups. The prevalence of hypomagnesemia was assessed in both patient groups. Fisher exact test was used to analyze data.Results: Hypomagnesemia occurred in 22% of patients during the first 72 hours after SAH. It was associated with more prevalent DCI (p<0.05, whereas low serum magnesium levels during days 4-7 17% of patients and the second week (22% of patients after SAH were correlated with poor clinical outcome (p<0.05. No correlation was found between first 72 hour-hypomagnesemia and poor clinical outcome at three months.Conclusion: Hypomagnesemia occurs after aneurysmal SAH and it may predict the occurrence of DCI, while low serum magnesium levels during days 4-7 and within the second week of event predict poor clinical outcome at three months. Treatment of this electrolyte disturbance may have a favourable effect on the clinical outcome of patients with aneurysmal SAH.

An early burst of IFN-γ induced by the pre-erythrocytic stage favours Plasmodium yoelii parasitaemia in B6 mice

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Barbier Eliane

2009-06-01

Full Text Available Abstract Background In murine models of malaria, an early proinflammatory response has been associated with the resolution of blood-stage infection. To dissect the protective immune mechanims that allow the control of parasitaemia, the early immune response of C57BL/6 mice induced during a non-lethal plasmodial infection was analysed. Methods Mice were infected with Plasmodium yoelii 265BY sporozoites, the natural invasive form of the parasite, in order to complete its full life cycle. The concentrations of three proinflammatory cytokines in the sera of mice were determined by ELISA at different time points of infection. The contribution of the liver and the spleen to this cytokinic response was evaluated and the cytokine-producing lymphocytes were identified by flow cytometry. The physiological relevance of these results was tested by monitoring parasitaemia in genetically deficient C57BL/6 mice or wild-type mice treated with anti-cytokine neutralizing antibody. Finally, the cytokinic response in sera of mice infected with parasitized-RBCs was analysed. Results The early immune response of C57BL/6 mice to sporozoite-induced malaria is characterized by a peak of IFN-γ in the serum at day 5 of infection and splenic CD4 T lymphocytes are the major producer of this cytokine at this time point. Somewhat unexpected, the parasitaemia is significantly lower in P. yoelii-infected mice in the absence of IFN-γ. More precisely, at early time points of infection, IFN-γ favours parasitaemia, whereas helping to clear efficiently the blood-stage parasites at later time points. Interestingly, the early IFN-γ burst is induced by the pre-erythrocytic stage. Conclusion These results challenge the current view regarding the role of IFN-γ on the control of parasite growth since they show that IFN-γ is not an essential mediator of protection in P. yoelii-infected C57BL/6 mice. Moreover, the mice parasitaemia is more efficiently controlled in the absence of an

Pregnancy outcomes of women with HIV in a district general hospital in the UK.

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Carey, L; Desouza, C; Moorcroft, A; Elgalib, A

2018-03-12

The aim of this study was to describe the obstetrical and virological outcomes in HIV-infected pregnant women who delivered at a district general hospital in south London in the period from 2008 to 2014. Our review identified 137 pregnancies; most (60%, 63/105) of them were unplanned. The commonest mode of delivery was spontaneous vaginal delivery (SVD) (42%, 48/114) followed by emergency Caesarean section (32%, 36/114). Gestational age at delivery was ≥37 weeks in most (84%, 91/106) of the cases. Maternal HIV VL at or closest to delivery was undetectable (1000 copies/mL in 73% (94/129), 90% (116/129) and 6% (8/129) of the pregnancies, respectively. None of the infants were infected with HIV making the rate of MTCT of HIV 0% (zero). Our study shows that favourable virological and obstetrical outcomes of HIV-infected pregnant women are achievable in non-tertiary HIV treatment centres. Impact Statement What is already known on this subject: Prevention of mother-to-child transmission (MTCT) of HIV has been one of the major public health successes in the last decades. This success was evident by the reduction of MTCT of HIV in the UK from 25.6% in the 1993 to only 0.46% in 2011. Furthermore, many reports from individual providers, mainly from tertiary centres, of HIV care in the UK also showed very low rates MTCT of HIV. What the results of this study add: Our study shows that favourable virological and obstetrical outcomes of HIV-infected pregnant women are achievable in non-tertiary HIV treatment centres. The MTCT of HIV rate in our hospital was zero in the period from 2008 to 2014. What the implications are of these findings for clinical practice and/or further research: Staff caring for pregnant HIV positive women in general hospitals and small-to-medium HIV clinics should liaise closely with each other and utilise the skill-mix within their hospital in order to provide a quality care that is similar to what is achieved in large teaching centres; however, a

Differential returns from globalization to women smallholder coffee and food producers in rural Uganda.

Science.gov (United States)

Kanyamurwa, J M; Wamala, S; Baryamutuma, R; Kabwama, E; Loewenson, R

2013-09-01

Globalization-related measures to liberalize trade and stimulate export production were applied in Uganda in the late 1980s, including in the coffee production sector, to revitalize agricultural production, increase incomes to farmers and improve rural food security. To explore the different effects of such measures on the health and dietary outcomes of female coffee and food small holder farmers in Uganda. We gathered evidence through a cross-sectional comparative interview survey of 190 female coffee producers and 191 female food producers in Ntungamo district. The study mostly employed quantitative methods of data collection, targeting the sampled households. We also utilized qualitative data; collected three months after the household survey data had been collected and their analysis had been accomplished. Using qualitative interviews based on an unstructured interview guide, extra qualitative information was collected from key informants at national, district and community levels. This was among other underlying principles to avoid relying on snapshot information earlier collected at household level in order to draw valid and compelling conclusions from the study. We used indicators of production, income, access to food and dietary patterns, women's health and health care. Of the two groups selected from the same area, female coffee producers represented a higher level of integration into liberalised export markets. Document review suggests that, although Uganda's economy grew in the period, the household economic and social gains after the liberalization measures may have been less than expected. In the survey carried out, both food and coffee producers were similarly poor, involved in small-scale production, and of a similar age and education level. Coffee producers had greater land and livestock ownership, greater access to inputs and higher levels of income and used a wider variety of markets than food producers, but they had to work longer hours to obtain

Nulliparity is associated with subtle adverse metabolic outcomes in overweight/obese mothers and their offspring.

Science.gov (United States)

Seneviratne, Sumudu N; Derraik, José G B; Jiang, Yannan; McCowan, Lesley M E; Gusso, Silmara; Biggs, Janene B; Parry, Graham K; Chiavaroli, Valentina; Cutfield, Wayne S; Hofman, Paul L

2017-11-01

We aimed to evaluate metabolic outcomes in overweight/obese nulliparous and multiparous women and their offspring. Seventy-two overweight and obese women who participated in a randomized controlled trial of exercise in pregnancy were included in the study, comparing 18 nulliparous and 54 multiparous women and their singleton offspring. Women were assessed at 19 and 36 weeks of gestation. Fetal growth was measured using standard obstetric ultrasound techniques. Cord blood was collected at birth. Maternal and offspring body composition was assessed using DXA ~2 weeks after delivery. Nulliparous women had higher HbA1c in the third trimester of pregnancy than multiparous women (5.48% vs 5.29%; P=.002) and were more insulin-resistant based on the surrogate marker sex hormone-binding globulin (354 vs 408 nmol/L; P=.047). Nulliparous women also had higher levels of the inflammatory marker tumour necrosis factor-alpha (4.74 vs 3.62 pg/mL; P=.025). At birth, the offspring of nulliparous women were on average 340 g (P=.013) and 0.69 standard deviation scores (P=.026) lighter than those born of multiparous women. Cord blood data showed lower insulin-like growth factor-II (P=.026) and higher IGF binding protein-1 (P=.002) levels in the offspring of nulliparous women. In addition, a less favourable metabolic profile was observed in the offspring of nulliparous women, as indicated by higher triglyceride (P<.001) and interleukin-6 (P=.039) concentrations. Infants born of nulliparous overweight and obese women appear to be exposed to a less favourable metabolic environment in utero, with evidence of subtle adverse metabolic outcomes at birth compared to infants of overweight/obese multiparous women. © 2017 John Wiley & Sons Ltd.

Gain-loss-frame in outcome-interdependence : Does it influence equality or equity considerations?

NARCIS (Netherlands)

deDreu, CKW

1996-01-01

Research suggests that framing outcomes as gains produces stronger concern for distributive justice than framing outcomes as losses. Unfortunately, however, this prior research manipulated own and other's outcomes only (and not own and other's input). Hence, it remained unclear whether framing

German 2020 Energy Transition Index. Favourable trend, but no breakthrough; Energiewende-Index Deutschland 2020. Positive Tendenzen, aber noch keine Trendwende

Energy Technology Data Exchange (ETDEWEB)

Vahlenkamp, Thomas; Frunzetti, Katharina [McKinsey and Company, Duesseldorf (Germany); Peters, Michael [McKinsey and Company, Berlin (Germany)

2015-03-15

Introduced in autumn 2012 and updated twice a year since, the German 2020 Energy Transition Index (EWI) shows its first signs ever of a favourable trend. At last the indicators have got moving, even though one can hardly speak of a breakthrough yet. In spite of the positive trend, especially in regard to electricity consumption and the rate of newly installed offshore wind power capacity, the envisaged goals are still a long way off. This holds particularly for major indicators such as CO{sub 2} emissions and price levels of household and industrial electricity.

Stroke outcomes in Malawi, a country with high prevalence of HIV: a prospective follow-up study.

Directory of Open Access Journals (Sweden)

Terttu Heikinheimo

Full Text Available BACKGROUND: Stroke contributes significantly to disability and mortality in developing countries yet little is known about the determinants of stroke outcomes in such countries. 12% of Malawian adults have HIV/AIDS. It is not known whether having HIV-infection alters the outcome of stroke. The aim of this study was to document the functional outcome and mortality at 1 year of first-ever acute stroke in Malawi. Also to find out if the baseline variables, including HIV-infection, affect the outcome of stroke. METHODS AND FINDINGS: 147 adult patients with first-ever acute stroke were prospectively followed up for 12 months. Conventional risk factors and HIV-infection were assessed at baseline. Stroke severity was evaluated with modified National Institute of Health Stroke Scale (mNIHSS and functional outcome with modified Rankin scale (mRS. Fifty (34% of patients were HIV-seropositive. 53.4% of patients had a poor outcome (severe disability or death, mRS 4-6 at 1 year. Poor outcome was related to stroke severity and female gender but not to presence of HIV-infection. HIV-seropositive patients were younger and had less often common risk factors for stroke. They suffer more often ischemic stroke than HIV-seronegative patients. CONCLUSIONS: Mild stroke and male gender were associated with favourable outcome. HIV-infection is common in stroke patients in Malawi but does not worsen the outcome of stroke. However, it may be a risk factor for ischemic stroke for young people, who do not have the common stroke risk factors. Our results are significant, because stroke outcome in HIV-seropositive patients has not been studied before in a setting such as ours, with very limited resources and a high prevalence of HIV.

Causes of social outcome differences encoded in human brain

NARCIS (Netherlands)

Vostroknutov, A.; Tobler, P.N.; Rustichini, A.

2012-01-01

Rewards may be due to skill, effort and luck, and the social perception of inequality in rewards among individuals may depend on what produced the inequality. Rewards due to skill produce a conflict: higher outcomes of others in this case are considered deserved, and this counters incentives to

Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation

Energy Technology Data Exchange (ETDEWEB)

Klontzas, Michail E. [University Hospital and Department of Radiology, University of Crete, Department of Medical Imaging, Heraklion, Crete (Greece); Imperial College London, Department of Chemical Engineering, London (United Kingdom); Vassalou, Evangelia E.; Karantanas, Apostolos H. [University Hospital and Department of Radiology, University of Crete, Department of Medical Imaging, Heraklion, Crete (Greece)

2017-02-15

Rotator cuff calcific tendinopathy (RCCT) with intraosseous extension is a rare complication of tendinous and peritendinous involvement. The purpose of our study is to evaluate the outcome of ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in patients with intraosseous involvement. From January 2011 to June 2014, patients with a clinical and imaging diagnosis of RCCT were prospectively categorised in two groups based on imaging findings: group A (10 patients) with intraosseous RCCT and group B (control group 35 patients) without osseous involvement. US-PICT followed by subacromial injection was applied to all patients in groups A and B. During a 1-year follow-up, treatment outcome in terms of pain and functional improvement was evaluated at 3 weeks, 3 months, 6 months, and 1 year, with the use of a four-grade scale. The study has been approved by our hospital's ethics committee. Mean improvement scores of group A were significantly lower than those of group B at all time points (p < 0.0001). Improvement of group B was noted mainly within the first 3 months post-treatment (p = 0.016). Outcomes of ultrasound-guided treatment in cases of RCCT with intraosseous extension are significantly less favourable than in purely tendinous or peritendinous disease. (orig.)

Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation

International Nuclear Information System (INIS)

Klontzas, Michail E.; Vassalou, Evangelia E.; Karantanas, Apostolos H.

2017-01-01

Rotator cuff calcific tendinopathy (RCCT) with intraosseous extension is a rare complication of tendinous and peritendinous involvement. The purpose of our study is to evaluate the outcome of ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in patients with intraosseous involvement. From January 2011 to June 2014, patients with a clinical and imaging diagnosis of RCCT were prospectively categorised in two groups based on imaging findings: group A (10 patients) with intraosseous RCCT and group B (control group 35 patients) without osseous involvement. US-PICT followed by subacromial injection was applied to all patients in groups A and B. During a 1-year follow-up, treatment outcome in terms of pain and functional improvement was evaluated at 3 weeks, 3 months, 6 months, and 1 year, with the use of a four-grade scale. The study has been approved by our hospital's ethics committee. Mean improvement scores of group A were significantly lower than those of group B at all time points (p < 0.0001). Improvement of group B was noted mainly within the first 3 months post-treatment (p = 0.016). Outcomes of ultrasound-guided treatment in cases of RCCT with intraosseous extension are significantly less favourable than in purely tendinous or peritendinous disease. (orig.)

Self-reported outcomes of aural rehabilitation for adult hearing aid users in a developing South African context

Directory of Open Access Journals (Sweden)

Elaine Pienaar

2010-12-01

Full Text Available Hearing impairment has far reaching consequences for affected individuals, in terms of quality of life indicators. In a developing South African context the hearing impaired population is faced with limited aural rehabilitation services. This study evaluated self-reported outcomes of aural rehabilitation in a group of adults in the public healthcare sector with a standardized outcomes measurement tool (IOI-HA. Sixty-one respondents participated (44% males; 56% females, with a mean age of 69.7 years. Results revealed that the majority of respondents experienced favourable outcomes in all domains of the inventory comprising of: daily use of hearing aids, benefits provided by hearing aids, residual activity limitation, satisfaction with hearing aids, residual participation restriction, impact of hearing difficulties on others, and changes in quality of life. Statistically significant relationships were obtained between the daily use of hearing aids, the degree of hearing loss, and the type of hearing aids fitted, as well as the benefits received from hearing aids in difficult listening environments (p < 0.05. Despite challenges of developing contexts, the mean scores distribution compared positively to similar reports from developed countries. Outcomes of improved quality of life emphasize the importance of providing affordable hearing aids and services to all hearing impaired individuals in South Africa.

Review of extended producer responsibility: A case study approach.

Science.gov (United States)

Gupt, Yamini; Sahay, Samraj

2015-07-01

Principles of extended producer responsibility have been the core of most of the recent policies and legislation dealing with the end-of-life management of recyclable goods. This article makes an exploratory review of 27 cases of extended producer responsibility from developed and developing economies with and without informal recycling, to ascertain the most important aspect of extended producer responsibility. A comparative analysis of the cases with respect to role of stakeholders in the upstream and downstream stages of the extended producer responsibility has been carried out. Further, the study uses exploratory factor analysis to determine the important aspects of the extended producer responsibility in practice using 13 variables identified from the review. Findings of the comparative analysis reveal that financial responsibility of the producers and separate collecting and recycling agencies contributed significantly to the success of the extended producer responsibility-based environmental policies. Regulatory provisions, take-back responsibility and financial flow come out to be the three most important aspects of the extended producer responsibility. Presence of informal sector had a negative impact on the regulatory provisions. The outcomes of this study could serve as a guideline for designing of effective extended producer responsibility-based policies. © The Author(s) 2015.

Improving Information Technology Curriculum Learning Outcomes

Directory of Open Access Journals (Sweden)

Derrick L Anderson

2017-06-01

The case study research methodology has been selected to conduct the inquiry into this phenomenon. This empirical inquiry facilitates exploration of a contemporary phenomenon in depth within its real-life context using a variety of data sources. The subject of analysis will be two Information Technology classes composed of a combination of second year and third year students; both classes have six students, the same six students. Contribution It is the purpose of this research to show that the use of improved approaches to learning will produce more desirable learning outcomes. Findings The results of this inquiry clearly show that the use of the traditional behaviorist based pedagogic model to achieve college and university IT program learning outcomes is not as effective as a more constructivist based andragogic model. Recommendations Instruction based purely on either of these does a disservice to the typical college and university level learner. The correct approach lies somewhere in between them; the most successful outcome attainment would be the product of incorporating the best of both. Impact on Society Instructional strategies produce learning outcomes; learning outcomes demonstrate what knowledge has been acquired. Acquired knowledge is used by students as they pursue professional careers and other ventures in life. Future Research Learning and teaching approaches are not “one-size-fits-all” propositions; different strategies are appropriate for different circumstances and situations. Additional research should seek to introduce vehicles that will move learners away from one the traditional methodology that has been used throughout much of their educational careers to an approach that is better suited to equip them with the skills necessary to meet the challenges awaiting them in the professional world.

Associations Between Hydration Status, Intravenous Fluid Administration, and Outcomes of Patients Infected With Shiga Toxin-Producing Escherichia coli: A Systematic Review and Meta-analysis.

Science.gov (United States)

Grisaru, Silviu; Xie, Jianling; Samuel, Susan; Hartling, Lisa; Tarr, Phillip I; Schnadower, David; Freedman, Stephen B

2017-01-01

The associations between hydration status, intravenous fluid administration, and outcomes of patients infected with Shiga toxin-producing Escherichia coli (STEC) remain unclear. To determine the relationship between hydration status, the development and severity of hemolytic uremic syndrome (HUS), and adverse outcomes in STEC-infected individuals. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials via the OvidSP platform, PubMed via the National Library of Medicine, CINAHL Plus with full text, Scopus, Web of Science, ClinicalTrials.gov, reference lists, and gray literature were systematically searched. Two reviewers independently identified studies that included patients with hydration status documentation, proven or presumed STEC infection, and some form of HUS that developed. No language restrictions were applied. Two reviewers independently extracted individual study data, including study characteristics, population, and outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale; strength of evidence was adjudicated using the Grading of Recommendations Assessment, Development, and Evaluation method. Meta-analyses were conducted using random-effects models. Development of HUS, complications (ie, oligoanuric renal failure, involvement of the central nervous system, or death), and interventions (ie, renal replacement therapy). Eight studies comprising 1511 patients (all children) met eligibility criteria. Unpublished data were provided by the authors of 7 published reports. The median risk-of-bias score was 7.5 (range, 6-9). No studies evaluated the effect of hydration during STEC infections on the risk for HUS. A hematocrit value greater than 23% as a measure of hydration status at presentation with HUS was associated with the development of oligoanuric HUS (OR, 2.38 [95% CI, 1.30-4.35]; I2 = 2%), renal replacement therapy (OR, 1.90 [95% CI, 1.25-2.90]; I2 = 17%), and death (OR, 5.13 [95% CI, 1.50-17.57]; I2 = 55%). Compared with

Autonomic components of Complex Regional Pain Syndrome (CRPS) are favourably affected by Electrical Twitch-Obtaining Intramuscular Stimulation (ETOIMS): effects on blood pressure and heart rate.

Science.gov (United States)

Chu, Jennifer; Bruyninckx, Frans; Neuhauser, Duncan V

2017-07-01

Favourable pain relief results on evoking autonomous twitches at myofascial trigger points with Electrical Twitch Obtaining Intramuscular Stimulation (ETOIMS). To document autonomic nervous system (ANS) dysfunction in Complex Regional Pain Syndrome (CRPS) from blood pressure (BP) and pulse/heart rate changes with ETOIMS. A patient with persistent pain regularly received serial ETOIMS sessions of 60, 90, 120 or ≥150 min over 24 months. Outcome measures include BP: systolic, diastolic, pulse pressure and pulse/heart rate, pre-session/immediate-post-session summed differences (SDPPP index), and pain reduction. His results were compared with that of two other patients and one normal control. Each individual represented the following maximal elicitable twitch forces (TWF) graded 1-5: maximum TWF2: control subject; maximum TWF3: CRPS patient with suspected ANS dysfunction; and maximum TWF4 and TWF5: two patients with respective slow-fatigue and fast-fatigue twitches who during ETOIMS had autonomous twitching at local and remote myotomes simultaneously from denervation supersensitivity. ETOIMS results between TWFs were compared using one-way analysis of variance test. The patients showed immediate significant pain reduction, BP and pulse/heart rate changes/reduction(s) except for diastolic BP in the TWF5 patient. TWF2 control subject had diastolic BP reduction with ETOIMS but not with rest. Linear regression showed TWF grade to be the most significant variable in pain reduction, more so than the number of treatments, session duration and treatment interval. TWF grade was the most important variable in significantly reducing outcome measures, especially pulse/heart rate. Unlike others, the TWF3 patient had distinctive reductions in SDPPP index. Measuring BP and pulse/heart rate is clinically practical for alerting ANS dysfunction maintained CRPS. SDPPP index (≥26) and pulse/heart rate (≥8) reductions with almost every ETOIMS treatment, plus inability to evoke

An innovative and very promising use of tidal turbines. Tidal turbines can produce twenty per cent of the French electricity. An economic solution can produce 500 GW of tide energy. An innovative use of tidal turbines can produce 10 per cent of the World energy

International Nuclear Information System (INIS)

Lemperiere, F.

2013-01-01

A set of articles outlines and describes the opportunities of energy production associated with the use of tidal turbines. Such a technological principle is very efficient in terms of costs but very few natural sea or river sites present favourable conditions, notably in terms of current speed. A first article addresses the peculiarities of sea tide energy, presents the different concepts and components of a sea tide power plant (tanks or basins, plants), describes the present use of tidal turbines, proposes a new solution (the 'Marelienne'), describes and assesses the integration into the grid and the energy storage, evokes the production gain obtained by pumping and the association with wind turbines, describes the construction mode, discusses the various impacts (visual impact, impacts on the environment, direct and indirect socio-economic impacts), discusses issues related to navigation, presents an example of production, costs and impacts (case of the Bay of Somme), evokes other potential areas in France (about the Chausey island and about the Re island), discusses the world potential, evokes other examples in Europe, in Asia, in America, Africa and Australia), indicates the global cost for the main sites, outlines technical and economic uncertainties. The same aspects and issues can be found in the other articles which outline that tidal turbines can produce twenty per cent of the French electricity, that an economic solution can produce 500 GW of tide energy, and that an innovative use of tidal turbines can produce 10 per cent of the World energy

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Mexico

International Nuclear Information System (INIS)

1977-07-01

Reserves of uranium are located in the north eastern part of Mexico, primarily in the states of Tamaulipas and Chihuahua. Most of the remainder of Mexico's reserves are near the Tamaulipas-Neuvo Leon state border in the Tertiary Frio Formation, where they apparently occur in the types of uranium deposits found in Texas, U.S.A. There are two deposits, La Coma and Buenavista, but nothing has been published on dimensions of the ore bodies. Forty-five miles northeast of Hermosillo, in Sonora state is the Los Amoles district where uranium is found associated with gold and other metals in low-grade deposits on the margins of a Cretaceous batholith. Another occurrence is reported in the mining district of Placer de Guadelupe and Puerto del Aire, about 40-50 km northeast of Chihuahua City, in the state of Chihuahua. Reserves of U 3 O 8 which were published in January 1977 by Nuclear Exchange Corporation of Menlo Park, California, are listed. The government of Mexico has not estimated potential resources. It should be noted that much of Mexico appears favourable for uranium, and only 10 percent has been explored. According to NUEXCO (1977), efforts to find uranium are being increased in an attempt to supply Mexico's nuclear reactor requirements through 1990. Activity is reported to be centered in Tamaulipas and Chihuahua states and to a lesser extent in Nueva Leon, Sonora, Coahuila, and Baja California. Major effort will continue to be placed in Chihuahua state to supply the Penna Bianca mill. Correspondence between favorable geological settings for uranium and the geologic regions of Mexico is reported. Mexico is a country with considerable areas that appear promising for discovery of sandstone, vein, and tuff-related deposits. On the other hand, its potential for Precambrian conglomerate and unconformity-related deposits is limited. Considering these geologic factors, as well as the relatively limited amount of exploration done to date, a guesstimate of speculative

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Spain

International Nuclear Information System (INIS)

1977-10-01

Spain, with an area of 504 748 km''2, occupies a large part of the Iberian Peninsula. At present the country appears to have about 6300 t of reasonably assured uranium reserves and 8500 t of additional estimated reserves (all at less than $30/lb of U 3 O 8 ). Spain has devoted some $33 million to prospecting for uranium since the beginning of such work. Most of the reasonably assured reserves are located in ores impregnating Cambrian schists intersected by Hercynian granites (of so-called 'Iberian type'); a small amount, however, is found in veins in Hercynian granites of the Spanish Meseta. The additional estimated reserves are situated in the peripheral post-Hercynian continental basins of the Meseta. Apart from these classical ores, sub-ores have been identified in Silurian quartzites with low concentrations of uranium associated with refractory minerals, totalling more than 200,000 t of U (at concentrations of a few hundred ppm); there are likewise uranium-bearing Oligocene lignites in the Ebro Basin with some 140,000 t of U. These facts, and also the very wide distribution of uranium in space and time (from the Cambrian to the Miocene!) and the country's favourable geological characteristics, suggest that Spain ought in fact to have large reserves of uranium, a conclusion unfortunately belied by the paucity of the economic reserves identified so far. Two things must be borne in mind, however; firstly, Spain's financial outlay for uranium prospecting up till now represents only a quarter of what has been invested in France, for example, and, secondly, the nature of the mineralised bodies in Spain makes exploration difficult. In conclusion it seems that prospecting both of the Iberian-type deposits in the Meseta region and of the deposits associated with detrital sediments in the peripheral continental basins - especially blind mineralized bodies - should hold out excellent prospects for Spain. Consequently we propose that Spain should be placed at least in

Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy

Energy Technology Data Exchange (ETDEWEB)

Tsogkas, Ioannis; Knauth, Michael; Schregel, Katharina; Behme, Daniel; Psychogios, Marios Nikos [University Medicine Goettingen, Department of Neuroradiology, Goettingen (Germany); Wasser, Katrin; Maier, Ilko; Liman, Jan [University Medicine Goettingen, Department of Neurology, Goettingen (Germany)

2016-11-15

CTP images analyzed with the Alberta stroke program early CT scale (ASPECTS) have been shown to be optimal predictors of clinical outcome. In this study we compared two biomarkers, the cerebral blood volume (CBV)-ASPECTS and the CTA-ASPECTS as predictors of clinical outcome after thrombectomy. Stroke patients with thrombosis of the M1 segment of the middle cerebral artery were included in our study. All patients underwent initial multimodal CT with CTP and CTA on a modern CT scanner. Treatment consisted of full dose intravenous tissue plasminogen activator, when applicable, and mechanical thrombectomy. Three neuroradiologists separately scored CTP and CTA images with the ASPECTS score. Sixty-five patients were included. Median baseline CBV-ASPECTS and CTA-ASPECTS for patients with favourable clinical outcome at follow-up were 8 [interquartile range (IQR) 8-9 and 7-9 respectively]. Patients with poor clinical outcome showed a median baseline CBV-ASPECTS of 6 (IQR 5-8, P < 0.0001) and a median baseline CTA-ASPECTS of 7 (IQR 7-8, P = 0.18). Using CBV-ASPECTS and CTA-ASPECTS raters predicted futile reperfusions in 96 % and 56 % of the cases, respectively. CBV-ASPECTS is a significant predictor of clinical outcome in patients with acute ischemic stroke treated with mechanical thrombectomy. (orig.)

Comparing oncoplastic breast conserving surgery with mastectomy and immediate breast reconstruction: Case-matched patient reported outcomes.

Science.gov (United States)

Kelsall, Jennett E; McCulley, Stephen J; Brock, Lisa; Akerlund, Malin T E; Macmillan, R Douglas

2017-10-01

Oncoplastic breast conserving surgery (OBCS) allows women who may otherwise have mastectomy and immediate reconstruction (MxIR) the choice to conserve their breast yet avoid deformity. We compared the outcome of these options. Two cohorts meeting study criteria were identified from prospectively audited series of women undergoing OBCS or MxIR. After case matching for age, tumour size and date of surgery, stratification by breast size and controlling for radiotherapy; body image scale (BIS) scores of psychosocial function and patient reported outcome measures (PROMs) for breast appearance and return to function were analysed. A total of 567 women (286 treated by OBCS and 281 by MxIR) fulfilled inclusion criteria. Demographics were similar between the two unmatched cohorts, except for radiotherapy, age and tumour size (all p < 0.001). Overall, BIS score (p = 0.002), self-rated breast appearance, return to work and function (all p < 0.001) significantly favoured OBCS. Case-matched women with larger breasts treated by OBCS reported better BIS scores (mean 3.30 vs. 5.37, p = 0.011) and self-rated breast appearance score (p < 0.001) than MxIR, whereas no significant difference was observed for smaller breasts. BIS and appearance favoured OBCS, regardless of whether radiotherapy would have been avoided if treated by MxIR. OBCS offers suitable women the option to avoid MxIR while providing faster recovery. Better psychosocial and self-rated satisfaction with breast appearance is achieved for OBCS in all groups, regardless of the need for radiotherapy, apart from those women with smaller breasts for whom the results are comparable. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Information needs, sources, and decision-making by hatching egg and broiler chicken producers: A qualitative study in Alberta, Canada.

Science.gov (United States)

Anholt, R Michele; Russell, Margaret; Inglis, Tom; Mitevski, Darko; Hall, David

2017-05-01

Understanding the sources and use of information from hatching egg and broiler chicken producers, their constraints, and unmet information needs can help define future research agendas. This report presents the results from a qualitative study using interviews of 11 hatching egg producers and 12 broiler producers in Alberta, Canada. Patterns were reported and described using thematic analysis. Producers recognized that there were numerous sources of information available to them for managing disease in their flocks. Complex disease issues such as early mortality were discussed, but many producers did not believe they had any influence over the outcomes and did not see a benefit from additional information to improve outcomes. Producers described their experience, trust in the information source, and the usefulness of the information for decision-making as necessary for information uptake.

Preoperative patient characteristics and outcomes of total knee arthroplasty in a multiethnic Asian population stratified by ethnicity.

Science.gov (United States)

Jiang, Lei; Bin Abd Razak, Hamid Rahmatullah; Chong, Hwei Chi; Tan, Andrew

2014-02-01

We aim to compare the patient profile and outcomes after TKA between the different racial groups in Singapore. Prospective data were collected from 364 patients who underwent TKA in Singapore General Hospital from January 2006 to May 2010. Patients were stratified according to ethnicity and we compared their preoperative demographic data, Short-Form 36 (SF-36), Oxford Knee (OKS) as well as Knee Society Scores (KSS). Malays were younger (62.0 ± 5.3) at time of surgery (p=0.05) and the body mass index of Chinese (27.9 ± 4.7) was lower than Malay (30.4 ± 5.0) and Indian (31.5 ± 4.5) patients (PMalay (40.3 ± 11.0) and Indian (39.2 ± 9.3) patients had less favourable preoperative OKS than Chinese (35.9 ± 7.8) patients (P<0.05). All 3 ethnic groups achieved statistically significant improvements in outcome measures but did not differ significantly between the ethnicities. Copyright © 2014 Elsevier Inc. All rights reserved.

Do marginal investments made by NHS healthcare commissioners in the UK produce the outcomes they hope to achieve? Observational study.

Science.gov (United States)

O'Cathain, Alicia; Sampson, Fiona; Strong, Mark; Pickin, Mark; Goyder, Elizabeth; Dixon, Simon

2015-11-06

To investigate the effect of targeted marginal annual investments by local healthcare commissioners on the outcomes they expected to achieve with these investments. Controlled before and after study. 152 commissioning organisations (primary care trusts) in England. National surveys of commissioning managers in 2009 and 2010 to identify: the largest marginal investments made in four key conditions/services (diabetes, coronary heart disease, chronic pulmonary airways disease and emergency and urgent care) in 2008/2009 and 2009/2010; the outcomes commissioners expected to achieve with these investments; and the processes commissioners used to develop these investments. Collation of routinely available data on outcomes commissioners expected from these investments over the period 2007/2008 to 2010/2011. 51% (77/152) of commissioners agreed to participate in the survey in 2009 and 60% (91/152) in 2010. Around half reported targeted marginal investments in each condition/service each year. Routine data on many of the outcomes they expected to achieve through these investments were not available. Also, commissioners expected some outcomes to be achieved beyond the time scale of our study. Therefore, only a limited number of outcomes of investments were tested. Outcomes included directly standardised emergency admission rates for the four conditions/services, and the percentage of patients with diabetes with glycated haemoglobin investments reduced emergency admission rates. There was evidence of an improvement in blood glucose management for diabetes for commissioners investing to improve diabetes care but this was compromised by a change in how the outcome was measured in different years. This investment was unlikely to be cost-effective. Commissioners made marginal investments in specific health conditions and services with the aim of improving a wide range of outcomes. There was little evidence of impact on the limited number of outcomes measured. Published by the BMJ

Viewpoint: Central adjudication of myocardial infarction in outcome-driven clinical trials--common patterns in TRITON, RECORD, and PLATO?

Science.gov (United States)

Serebruany, Victor L; Atar, Dan

2012-09-01

Central adjudication in randomised controlled outcome-driven trials represents a traditional approach to maintain data integrity by applying uniformed rules for assessment of clinical events. It was the purpose of this investigation to determine the patterns of myocardial infarction (MI) adjudication in the TRITON, RECORD, and PLATO trials. We were matching centrally-adjudicated MI's (CAMI's) from the official trial publication with the site-reported MI (SRMI's) count from the Food and Drug Administration's secondary analyses for the investigational compounds prasugrel (TRITON), rosiglitazone (RECORD), and ticagrelor (PLATO). CAMI numbers showed a remarkable discrepancy to SRMI's by more than a doubling of the difference: from 72 to 145 events in TRITON favoring prasugrel (from a hazard ratio [HR]=0.76, p=0.08; to a HR=0.76, p<0.001), and from 44 to 89 events in favour of ticagrelor in PLATO (from a HR=0.94, p=0.095; to a HR=0.84, p<0.001). In contrast, in the RECORD trial, the CAMI count was less than the SRMI count (from 24 to 8 events, from a HR=1.42, p=0.93; to a HR=1.14, p=0.96), in this case diminishing cardiovascular hazards in favour of rosiglitazone. In conclusion, central adjudication in the TRITON, the RECORD, and the PLATO trial turned out to have a critical impact on study outcomes. Trial publications should in the future include site-reported major efficacy and safety endpoints to preserve data integrity. The regulatory authorities should consider independent audits when there is a major disagreement between centrally adjudicated and site reported events influencing the results of a major clinical trial.

Primary gastric Hodgkin's lymphoma: favourable outcome following multi-agent chemotherapy without surgical intervention.

LENUS (Irish Health Repository)

Quintyne, K I

2011-02-01

The authors report the case of a 51-year-old man who presented with left-sided abdominal pain and weight loss associated with drenching night sweats. Preliminary blood tests yielded no specific cause for his symptoms, but abdominal ultrasound revealed multiple hepatic lesions and peripancreatic lymphadenopathy. Further imaging, including positron emission tomography (PET)\\/CT, revealed fludeoxyglucose 18F (FDG) avid uptake within lymphadenopathy above and below the diaphragm and also noted gastric thickening. Diagnosis was established with gastric biopsy and revealed gastric Hodgkin\\'s lymphoma. He was started on and tolerated multi-agent chemotherapy. Repeated PET\\/CT and gastric biopsy showed complete metabolic and pathologic response to treatment.

Hashimoto's thyroiditis predicts outcome in intrathyroidal papillary thyroid cancer.

Science.gov (United States)

Marotta, Vincenzo; Sciammarella, Concetta; Chiofalo, Maria Grazia; Gambardella, Claudio; Bellevicine, Claudio; Grasso, Marica; Conzo, Giovanni; Docimo, Giovanni; Botti, Gerardo; Losito, Simona; Troncone, Giancarlo; De Palma, Maurizio; Giacomelli, Laura; Pezzullo, Luciano; Colao, Annamaria; Faggiano, Antongiulio

2017-09-01

Hashimoto's thyroiditis (HT) seems to have favourable prognostic impact on papillary thyroid cancer (PTC), but data were obtained analysing all disease stages. Given that HT-related microenvironment involves solely the thyroid, we aimed to assess the relationship between HT, as detected through pathological assessment, and outcome in intrathyroidal PTC. This was a multicentre, retrospective, observational study including 301 PTC with no evidence of extrathyroidal disease. Primary study endpoint was the rate of clinical remission. Auxiliary endpoint was recurrence-free survival (RFS). HT was detected in 42.5% of the cohort and was associated to female gender, smaller tumour size, lower rate of aggressive PTC variants and less frequent post-surgery radio-iodine administration. HT showed relationship with significantly higher rate of clinical remission ( P  < 0.001, OR 4, 95% CI 1.78-8.94). PTCs with concomitant HT had significantly longer RFS, as compared with non-HT tumours ( P  = 0.004). After adjustment for other parameters affecting disease outcome at univariate analysis (age at diagnosis, histology, tumour size and multifocality), prognostic effect of HT remained significant ( P  = 0.006, OR 3.28, 95% CI 1.39-7.72). To verify whether HT could optimise the identification of PTCs with unfavourable outcome, we assessed the accuracy of 'non-HT status' as negative prognostic marker, demonstrating poor capability of identifying patients not maintaining clinical remission until final follow-up (probability of no clinical remission in PTCs without HT: 21.05%, 95% CI 15.20-27.93). In conclusion, our data show that HT represents an independent prognostic parameter in intrathyroidal PTC, but cannot improve prognostic specificity. © 2017 Society for Endocrinology.

Transvenous permanent pacemaker implantation in dextrocardia: technique, challenges, outcome, and a brief review of literature.

Science.gov (United States)

Shenthar, Jayaprakash; Rai, Maneesh K; Walia, Rohit; Ghanta, Somasekhar; Sreekumar, Praveen; Reddy, Satish S

2014-09-01

Dextrocardia is a rare congenital anomaly. Pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy and associated anomalies. The literature regarding implantation of pacemaker in dextrocardia is scarce. The study involved retrospective analysis of records of patients with dextrocardia who had undergone pacemaker implantation between January 2006 and July 2013 from a single centre. Six patients with dextrocardia (five males and one female) underwent permanent pacemaker implantation (PPI) between January 2006 and July 2013. Of them, three had situs solitus dextrocardia and three situs inversus dextrocardia. All three patients with situs solitus dextrocardia had associated corrected transposition of great arteries. The indication for pacemaker implantation was symptomatic complete atrioventricular (AV) block in four, high-grade AV block in one, and sinus node dysfunction in one patient. A favourable outcome was noted during a mean follow-up of 3.9 years (4 months to 7 years) with one patient needing a pulse generator replacement. Permanent pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy. Use of a technique employing angiography to delineate chamber anatomy and relationship can assist the operator during such difficult PPIs. The medium- and long-term survival after a successful pacemaker implantation in dextrocardia is favourable. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Pregnancy outcome after 1st-trimester inadvertent exposure to barium sulphate as a contrast media for upper gastrointestinal tract radiography.

Science.gov (United States)

Han, B H; Lee, K S; Han, J Y; Choi, J S; Ahn, H K; Ryu, H M; Yang, J H; Han, H W; Nava-Ocampo, A A

2011-10-01

Despite barium being used as a contrast media for decades, the specific assessment of its safety in pregnant women is scarce. We are reporting the favourable pregnancy outcome in women who were inadvertently exposed to barium swallow and associated ionising radiation, early in pregnancy. A control group of age- and gravidity-matched unexposed pregnant women was also included. There were 32 live-born babies in the exposed group and 94 in the control group. Women had undergone diagnostic upper gastrointestinal tract (UGT) fluoroscopic examination at 3.3 ± 1.5 weeks' gestation. Estimated maternal radiation dose secondary to barium swallow varied widely, the maximum dose was estimated to be 2.45 mSv. Similar pregnancy outcomes were observed between the groups. The number of babies born with major malformations was not significantly different (p = 1.0) between cases and controls: one (3.1%) vs three (3.2%), respectively. In conclusion, our small prospective cohort study of women suggests no association between inadvertent exposure to ionising radiation and barium sulphate during fluoroscopic barium swallow and adverse fetal outcomes.

Outcome of Cloward technique in cervical disc prolapse.

Science.gov (United States)

Rehman, Lal; Qayoom Khan, Hina Abdul; Hashim, A Sattar M

2010-11-01

To determine the association of pre-operative assessment of MRI findings, neurological status and symptoms with postoperative Cloward surgical outcome in cervical disc prolapse. Descriptive study. The Neurosurgery Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from May 2008 to May 2009. Patients presenting with neck pain, brachialgia, limb weakness and spasticity were clinically examined for pre-operative neurological status of power, reflexes and sensation. The exclusion criteria were, cervical disc prolapsed patients, planned for smith-Robinson and micro-discectomy, traumatic cervical disc prolapse and cervical spondylosis. Neuroradiological investigations included cervical spine X-rays and MRI. All patients were surgically treated for cervical prolapsed intervertebral disc with anterior cervical discectomy and interbody fusion with Cloward technique. Postoperative neck immobilization was done with cervical collar for 7-8 weeks. Drain was removed on first postoperative day while check plain cervical X-rays were taken on third day. Results were analysed using chi-square test with significance at p cervical disc prolapse were C 5-6 (43.3%) and C 6-7 (23.3%); 26 (86.6%) patients had disc herniation causing thecal effacement with cord compression and 04 (13.3%) patients showed ischemia of cord. Single-level Cloward surgery done in 26 (86.3%) patients while two-level Cloward surgery performed in 04 (13.3%) only. About 83.3% patients improved and 13.3% did not while 01 patient was re-operated. No complications and mortality was related to the surgical procedure. Statistically different variables identified, related to outcome were pre-operative neurological status (p=0.001) and spinal cord involvement on MRI (p=0.001). Cloward technique for cervical disc prolase was simple and safe surgical procedure with favourable results and few complications; 100% fusion occurred after Cloward surgery, even without instrumentation. Outcome was significantly

Long-Term Outcomes in a Family with Nephrogenic Syndrome of Inappropriate Antidiuresis

Directory of Open Access Journals (Sweden)

Yoon Hi Cho

2009-01-01

Full Text Available We report a familial case of the nephrogenic syndrome of inappropriate antidiuresis (NSIAD, including 30-year followup data on two patients. The proband and one maternal uncle presented in their infancy with severe recurrent hyponatremia, and clinical pictures consistent with the syndrome of inappropriate antidiuretic hormone (SIADH in the absence of an elevated ADH level. They were both confirmed to be hemizygous for the R137C mutation on the V2R gene (AVPR2, the same locus of the gain of function mutation demonstrated in the original reports of this condition. The proband's mother was identified as an asymptomatic carrier of this X-linked condition. Our case describes a favourable long-term outcome for NSIAD, in particular, successful treatment with oral urea during the infancy period, and with self-regulated precautions on fluid intake into adult life.

Long-Term Outcomes in a Family with Nephrogenic Syndrome of Inappropriate Antidiuresis

Directory of Open Access Journals (Sweden)

Rosenthal Stephen

2009-12-01

Full Text Available We report a familial case of the nephrogenic syndrome of inappropriate antidiuresis (NSIAD, including 30-year followup data on two patients. The proband and one maternal uncle presented in their infancy with severe recurrent hyponatremia, and clinical pictures consistent with the syndrome of inappropriate antidiuretic hormone (SIADH in the absence of an elevated ADH level. They were both confirmed to be hemizygous for the R137C mutation on the V2R gene (AVPR2, the same locus of the gain of function mutation demonstrated in the original reports of this condition. The proband's mother was identified as an asymptomatic carrier of this X-linked condition. Our case describes a favourable long-term outcome for NSIAD, in particular, successful treatment with oral urea during the infancy period, and with self-regulated precautions on fluid intake into adult life.

Uranium favourability and evaluation in Mongolia (phase II), recent events in uranium resources and production in Mongolia

International Nuclear Information System (INIS)

Batbold, T.

2001-01-01

Uranium exploration in Mongolia covered a period of over 5 decades. The main results of these activities were the discoveries of 6 uranium deposits and about 100 occurrences as well as numerous favourable indications. Sizable resources are found mainly in deposits of the sandstone, volcanic and alkaline intrusive types. Of these, the first two are considered to be of economic importance. Uranium production in Mongolia started in 1989 with the exploitation of volcanic type uranium deposits of the Mongol-Priargun metallogenic province, known as the Dornot Mine. Due to political and economic changes in the country and neighbouring areas of the Russian Federation, this uranium production was terminated in 1995. A new plan to restart production at the Mardai-gol deposits as a joint venture between Mongolia, the Russian Federation and a US company is being considered. (author)

Homeopathic pathogenetic trials produce specific symptoms different from placebo.

Science.gov (United States)

Möllinger, Heribert; Schneider, Rainer; Walach, Harald

2009-04-01

Homeopathy uses information gathered from healthy volunteers taking homeopathic substances (pathogenetic trials) for clinical treatment. It is controversial whether such studies produce symptoms different from those produced by placebo. To test whether homeopathic preparations produce different symptoms than placebo in healthy volunteers. Three armed, double-blind, placebo controlled randomised experimental pathogenetic study in 25 healthy volunteers who took either one of two homeopathic remedies, Natrum muriaticum and Arsenicum album in 30CH or identical placebo. Main outcome parameter was the number of remedy-specific symptoms per group. On average, 6 symptoms typical for Arsenicum album were experienced by participants taking arsenicum album, 5 symptoms typical for Natrum muriaticum by those taking natrum muriaticum, and 11 non-specific symptoms by those in the placebo group. Differences were significant overall (Kruskall Wallis test, p = 0.0002,) and significantly different from placebo (Mann-Whitney test, p = 0.001). Homeopathic remedies produce different symptoms than placebo. Copyright (c) 2009 S. Karger AG, Basel.

Sample size calculations based on a difference in medians for positively skewed outcomes in health care studies

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Aidan G. O’Keeffe

2017-12-01

Full Text Available Abstract Background In healthcare research, outcomes with skewed probability distributions are common. Sample size calculations for such outcomes are typically based on estimates on a transformed scale (e.g. log which may sometimes be difficult to obtain. In contrast, estimates of median and variance on the untransformed scale are generally easier to pre-specify. The aim of this paper is to describe how to calculate a sample size for a two group comparison of interest based on median and untransformed variance estimates for log-normal outcome data. Methods A log-normal distribution for outcome data is assumed and a sample size calculation approach for a two-sample t-test that compares log-transformed outcome data is demonstrated where the change of interest is specified as difference in median values on the untransformed scale. A simulation study is used to compare the method with a non-parametric alternative (Mann-Whitney U test in a variety of scenarios and the method is applied to a real example in neurosurgery. Results The method attained a nominal power value in simulation studies and was favourable in comparison to a Mann-Whitney U test and a two-sample t-test of untransformed outcomes. In addition, the method can be adjusted and used in some situations where the outcome distribution is not strictly log-normal. Conclusions We recommend the use of this sample size calculation approach for outcome data that are expected to be positively skewed and where a two group comparison on a log-transformed scale is planned. An advantage of this method over usual calculations based on estimates on the log-transformed scale is that it allows clinical efficacy to be specified as a difference in medians and requires a variance estimate on the untransformed scale. Such estimates are often easier to obtain and more interpretable than those for log-transformed outcomes.

Ostomy metastasis after pull endoscopic gastrostomy: a unique favorable outcome.

Science.gov (United States)

Fonseca, Jorge; Adriana, Carla; Fróis-Borges, Miguel; Meira, Tânia; Oliveira, Gabriel; Santos, José Carlos

2015-04-01

Head and neck cancer (HNC) patients tend to develop dysphagia. In order to preserve the nutritional support, many undergo endoscopic gastrostomy (PEG). In HNC patients, ostomy metastasis is considered a rare complication of PEG, but there are no reports of successful treatment of these metastatic cancers. We report the case of a 65 years old pharyngeal/laryngeal cancer patient who underwent a PEG before the neck surgery. He was considered to be cured, resumed oral intake and the PEG tube was removed. Ten months after, he returned with a metastasis at the ostomy site. A block resection of the stomach and abdominal wall was performed. Two years after the abdominal surgery, he is free of disease. Although usually considered a rare complication of the endoscopic gastrostomy, ostomy metastasis may be more frequent than usually considered and the present case report demonstrates that these patients may have a favourable outcome. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Does a person selectively recall the good or the bad from their personal past? It depends on the recall target and the person's favourability of self-views.

Science.gov (United States)

Ritchie, Timothy D; Sedikides, Constantine; Skowronski, John J

2017-09-01

In three studies, participants remembered real-life behaviours at Time 1 and attempted to recall them at Time 2. When the recall target was the self, a positivity bias emerged: self-positivity. In Study 3, self-positivity extended to an individual (target) who was liked by the participant, but did it not extend to a disliked target. For this latter target, a negativity bias emerged. For recall targets that were participants' acquaintances, self-positivity in recall was also eliminated in Studies 1 and 3, and a negativity bias in recall emerged in Study 2. Finally, in Study 2 (but not Study 3), the favourability of participants' self-view predicted the magnitude of the self-positivity in self-recall, but it did not predict valence effects in other-recall. Taken together, the results indicate that the link between behaviour valence and recall is moderated by the recall target and the favourability of one's self-view.

Spontaneous subarachnoid haemorrhage and outcome--results from Tan Tock Seng Hospital, Singapore.

Science.gov (United States)

Wong, S H; Yeo, T T; Seow, W T; Tan, K K; Ong, P L

1999-07-01

To ascertain the number of cases of spontaneous (aneurysmal) subarachnoid haemorrhage presenting to Tan Tock Seng Hospital, Singapore, over a one year period, the demographics of the patients involved, their treatment and their eventual outcome. A retrospective study from June 1995 to June 1996. There were 62 patients admitted over this period with an average of 5 patients per month. Their ages ranged from 9 to 85 years with a mean of 54 years. All 62 patients underwent 4-vessel cerebral angiograms. Forty-three patients (69%) underwent clipping of their aneurysms. Twelve patients (19%) had negative angiograms. Four patients (6%) underwent coiling of their aneurysms via interventional neuroradiology techniques. Patients with subarachnoid haemorrhage of Grades 1 to 3 on the WFNS (World Federation of Neurological Surgeons) grading had a favourable outcome (Glasgow Outcome Score of 4 and 5) in 85% of the cases. The overall mortality rate for the operated group (all grades) was 11%. However for the group with good WFNS grading, namely the Grade 1 to 2 groups, there were no deaths. Twenty-four percent of patients developed clinically symptomatic vasospasm. Eighteen percent of patients required ventriculo-peritoneal shunting for hydrocephalus secondary to the subarachnoid haemorrhage. The overall management mortality (operated and non-operated cases) was 14% for proven aneurysmal and angiographically-negative spontaneous subarachnoid haemorrhage. These results are comparable to that of other reputable centers reported in the literature.

Co-expression of HER3 and MUC1 is associated with a favourable prognosis in patients with bladder cancer

DEFF Research Database (Denmark)

Nielsen, Trine O; Borre, Michael; Nexo, Ebba

2015-01-01

OBJECTIVES: To investigate the functional impact of the interaction of MUC1 with the epidermal growth factor receptors HER3 and HER4 in patients with bladder cancer. PATIENTS AND METHODS: Using reverse transcription quantitative polymerase chain reaction, we examined MUC1 expression in 82 bladder...... the prognostic value of MUC1 (P = 0.488). MUC1 expression had no correlation with survival, tumour stage or grade, or to the prognostic value of HER4. CONCLUSIONS: A high MUC1 expression was associated with a favourable prognosis in patients with bladder cancer when the expression of HER3 was also high....... This suggests an involvement of HER3 in MUC1 function in bladder cancer....

Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis.

Science.gov (United States)

Tang, Karen L; Caffrey, Niamh P; Nóbrega, Diego B; Cork, Susan C; Ronksley, Paul E; Barkema, Herman W; Polachek, Alicia J; Ganshorn, Heather; Sharma, Nishan; Kellner, James D; Ghali, William A

2017-11-01

Antibiotic use in human medicine, veterinary medicine, and agriculture has been linked to the rise of antibiotic resistance globally. We did a systematic review and meta-analysis to summarise the effect that interventions to reduce antibiotic use in food-producing animals have on the presence of antibiotic-resistant bacteria in animals and in humans. On July 14, 2016, we searched electronic databases (Agricola, AGRIS, BIOSIS Previews, CAB Abstracts, MEDLINE, Embase, Global Index Medicus, ProQuest Dissertations, Science Citation Index) and the grey literature. The search was updated on Jan 27, 2017. Inclusion criteria were original studies that reported on interventions to reduce antibiotic use in food-producing animals and compared presence of antibiotic-resistant bacteria between intervention and comparator groups in animals or in human beings. We extracted data from included studies and did meta-analyses using random effects models. The main outcome assessed was the risk difference in the proportion of antibiotic-resistant bacteria. A total of 181 studies met inclusion criteria. Of these, 179 (99%) described antibiotic resistance outcomes in animals, and 81 (45%) of these studies were included in the meta-analysis. 21 studies described antibiotic resistance outcomes in humans, and 13 (62%) of these studies were included in the meta-analysis. The pooled absolute risk reduction of the prevalence of antibiotic resistance in animals with interventions that restricted antibiotic use commonly ranged between 10 and 15% (total range 0-39), depending on the antibiotic class, sample type, and bacteria under assessment. Similarly, in the human studies, the pooled prevalence of antibiotic resistance reported was 24% lower in the intervention groups compared with control groups, with a stronger association seen for humans with direct contact with food-producing animals. Interventions that restrict antibiotic use in food-producing animals are associated with a reduction in the

Bacteraemia due to AmpC β-lactamase-producing Escherichia coli in hospitalized cancer patients: risk factors, antibiotic therapy, and outcomes.

Science.gov (United States)

Zhang, Qing; Zhang, Wenfang; Li, Zheng; Bai, Changsen; Li, Ding; Zheng, Shan; Zhang, Peng; Zhang, Sihe

2017-07-01

AmpC β-lactamase-producing Escherichia coli (AmpC-EC) is one of the main antimicrobial resistant pathogens in patients with cancer. A cohort study was performed to evaluate the risk factors, antibiotic therapy, and outcomes of AmpC-EC bacteraemia in hospitalized cancer patients from September 2012 through December 2015. Two hundred forty-eight cases of E. coli bacteraemia were documented in cancer patients, 51 (20.6%) were caused by AmpC-EC and 197 (79.4%) were caused with non-AmpC-EC. Prior exposure to cephalosporins (OR 2.786; 95% CI: 1.094-7.091; P=0.032), carbapenems (OR 2.296; 95% CI: 1.054-5.004; P=0.036), and invasive procedures (OR 4.237; 95% CI: 1.731-10.37; P=0.002) were identified as independent risk factors for AmpC-EC. The time to positivity (TTP) of patients with AmpC-EC bacteraemia tended to be significantly shorter than that of non-AmpC-EC (8.33±2.18h versus 9.48±3.82h; P=0.006), and had a higher 30-day mortality rate in AmpC-EC compared with non-AmpC-EC (25.5% versus 12.2%; P=0.018). Metastasis (OR=2.778, 95% CI: 1.078-7.162; P=0.034), the presence of septic shock (OR=4.983, 95% CI: 1.761-14.10; P=0.002), and organ failure (OR=24.51 95% CI: 9.884-60.81; P<0.001) were independently associated with the overall mortality. The mortality rate showed a gradual increase when appropriate antibiotic therapy (AAT) was delayed more than 48h as determined by the trend test (P<0.001). In conclusion, this study showed that prevalence of AmpC-EC was high in hospitalized cancer patients of our area. Thus, it is necessary to apply appropriate therapeutic approaches and improve outcomes based on the analysis of risk factors for the acquisition of AmpC-EC. Copyright © 2017 Elsevier Inc. All rights reserved.

Emergence of quinolone resistance among extended-spectrum beta-lactamase-producing Enterobacteriaceae in the Central African Republic: genetic characterization

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Frank Thierry

2011-08-01

Full Text Available Abstract Background Cross-resistance to quinolones and beta-lactams is frequent in Enterobacteriaceae, due to the wide use of these antibiotics clinically and in the food industry. Prescription of one of these categories of antibiotic may consequently select for bacteria resistant to both categories. Genetic mechanisms of resistance may be secondary to a chromosomal mutation located in quinolone resistance determining region of DNA gyrase or topoisomerase IV or to a plasmid acquisition. The insertion sequence ISCR1 is often associated with qnr and may favour its dissemination in Gram-negative bacteria. The aim of this study was to determine the genetic mechanism of quinolone resistance among extended-spectrum beta-lactamase-producing Enterobacteriaceae strains in the Central African Republic. Findings Among seventeen ESBL-producing Enterobacteriaceae isolated from urine, pus or stool between January 2003 and October 2005 in the Central African Republic, nine were resistant to ciprofloxacin (seven from community patients and two from hospitalized patients. The ESBL were previously characterized as CTX-M-15 and SHV-12. Susceptibility to nalidixic acid, norfloxacin and ciprofloxacin, and the minimal inhibitory concentrations of these drugs were determined by disc diffusion and agar dilution methods, respectively. The presence of plasmid-borne ISCR1-qnrA region was determined by PCR and amplicons, if any, were sent for sequencing. Quinolone resistance determining region of DNA gyrase gyrA gene was amplified by PCR and then sequenced for mutation characterization. We found that all CTX-M-producing strains were resistant to the tested quinolones. All the isolates had the same nucleotide mutation at codon 83 of gyrA. Two Escherichia coli strains with the highest MICs were shown to harbour an ISCR1-qnrA1 sequence. This genetic association might favour dissemination of resistance to quinolone and perhaps other antibiotics among Enterobacteriaceae

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

Science.gov (United States)

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

2017-11-28

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

Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS).

Science.gov (United States)

Goeggel Simonetti, Barbara; Mono, Marie-Luise; Huynh-Do, Uyen; Michel, Patrik; Odier, Celine; Sztajzel, Roman; Lyrer, Philippe; Engelter, Stefan T; Bonati, Leo; Gensicke, Henrik; Traenka, Christopher; Tettenborn, Barbara; Weder, Bruno; Fischer, Urs; Galimanis, Aekaterini; Jung, Simon; Luedi, Rudolf; De Marchis, Gian Marco; Weck, Anja; Cereda, Carlo W; Baumgartner, Ralf; Bassetti, Claudio L; Mattle, Heinrich P; Nedeltchev, Krassen; Arnold, Marcel

2015-09-01

Ischaemic stroke (IS) in young adults has been increasingly recognized as a serious health condition. Stroke aetiology is different in young adults than in the older population. This study aimed to investigate aetiology and risk factors, and to search for predictors of outcome and recurrence in young IS patients. We conducted a prospective multicentre study of consecutive IS patients aged 16-55 years. Baseline demographic data, risk factors, stroke aetiology including systematic genetic screening for Fabry disease and severity were assessed and related to functional neurological outcome (modified Rankin Scale, mRS), case fatality, employment status, place of residence, and recurrent cerebrovascular events at 3 months. In 624 IS patients (60% men), median age was 46 (IQR 39-51) years and median NIHSS on admission 3 (IQR 1-8). Modifiable vascular risk factors were found in 73%. Stroke aetiology was mostly cardioembolism (32%) and of other defined origin (24%), including cervicocerebral artery dissection (17%). Fabry disease was diagnosed in 2 patients (0.3%). Aetiology remained unknown in 20%. Outcome at 3 months was favourable (mRS 0-1) in 61% and fatal in 2.9%. Stroke severity (p young adults with IS had modifiable vascular risk factors, emphasizing the importance of prevention strategies. Outcome was unfavourable in more than a third of patients and was associated with initial stroke severity and diabetes mellitus. Previous cerebrovascular events predicted recurrent ones.

Long-term neurodevelopmental outcome of monochorionic and matched dichorionic twins.

Directory of Open Access Journals (Sweden)

Karien E A Hack

larger co-twin. CONCLUSIONS: There were no significant differences in occurrence of cerebral palsy as well as neurodevelopmental outcome between MC and DC twins. Outcome of MC twins seems favourable in the absence of TTTS or co-twin death.

Comparative analysis of short - term functional outcomes and quality of life in a prospective series of brachytherapy and Da Vinci robotic prostatectomy

International Nuclear Information System (INIS)

Garcia-Sanchez, Cristina; Roman Martin, Ana A.; Conde-Sanchez, J. Manuel; Congregado-Ruiz, C. Belen; Osman-Garcia, Ignacio; Medina-Lopez, Rafael A.

2017-01-01

Introduction: There is a growing interest in achieving higher survival rates with the lowest morbidity in localized prostate cancer (PC) treatment. Consequently, minimally invasive techniques such as low-dose rate brachytherapy (BT) and robotic-assisted prostatectomy (RALP) have been developed and improved. Comparative analysis of functional outcomes and quality of life in a prospective series of 51BT and 42Da Vinci prostatectomies DV. Materials and Methods: Comparative analysis of functional outcomes and quality of life in a prospective series of 93 patients with low-risk localized PC diagnosed in 2011. 51 patients underwent low-dose rate BT and the other 42 patients RALP. IIEF to assess erectile function, ICIQ to evaluate continence and SF36 test to quality of life wee employed. Results: ICIQ at the first revision shows significant differences which favour the BT group, 79% present with continence or mild incontinence, whereas in the DV group 45% show these positive results. Differences disappear after 6 months, with 45 patients (89%) presenting with continence or mild incontinence in the BT group vs. 30 (71%) in the DV group. 65% of patients are potent in the first revision following BT and 39% following DV. Such differences are not significant and cannot be observed after 6 months. No significant differences were found in the comparative analysis of quality of life. Conclusions: ICIQ after surgery shows significant differences in favour of BT, which disappear after 6 months. Both procedures have a serious impact on erectile function, being even greater in the DV group. Differences between groups disappear after 6 months. (author)

Comparative analysis of short - term functional outcomes and quality of life in a prospective series of brachytherapy and Da Vinci robotic prostatectomy

Energy Technology Data Exchange (ETDEWEB)

Garcia-Sanchez, Cristina; Roman Martin, Ana A.; Conde-Sanchez, J. Manuel; Congregado-Ruiz, C. Belen; Osman-Garcia, Ignacio; Medina-Lopez, Rafael A. [Virgen del Rocio Universitary Hospital, Seville (Spain)

2017-03-15

Introduction: There is a growing interest in achieving higher survival rates with the lowest morbidity in localized prostate cancer (PC) treatment. Consequently, minimally invasive techniques such as low-dose rate brachytherapy (BT) and robotic-assisted prostatectomy (RALP) have been developed and improved. Comparative analysis of functional outcomes and quality of life in a prospective series of 51BT and 42Da Vinci prostatectomies DV. Materials and Methods: Comparative analysis of functional outcomes and quality of life in a prospective series of 93 patients with low-risk localized PC diagnosed in 2011. 51 patients underwent low-dose rate BT and the other 42 patients RALP. IIEF to assess erectile function, ICIQ to evaluate continence and SF36 test to quality of life wee employed. Results: ICIQ at the first revision shows significant differences which favour the BT group, 79% present with continence or mild incontinence, whereas in the DV group 45% show these positive results. Differences disappear after 6 months, with 45 patients (89%) presenting with continence or mild incontinence in the BT group vs. 30 (71%) in the DV group. 65% of patients are potent in the first revision following BT and 39% following DV. Such differences are not significant and cannot be observed after 6 months. No significant differences were found in the comparative analysis of quality of life. Conclusions: ICIQ after surgery shows significant differences in favour of BT, which disappear after 6 months. Both procedures have a serious impact on erectile function, being even greater in the DV group. Differences between groups disappear after 6 months. (author)

e-Learning in Advanced Life Support-What factors influence assessment outcome?

Science.gov (United States)

Thorne, C J; Lockey, A S; Kimani, P K; Bullock, I; Hampshire, S; Begum-Ali, S; Perkins, G D

2017-05-01

To establish variables which are associated with favourable Advanced Life Support (ALS) course assessment outcomes, maximising learning effect. Between 1 January 2013 and 30 June 2014, 8218 individuals participated in a Resuscitation Council (UK) e-learning Advanced Life Support (e-ALS) course. Participants completed 5-8h of online e-learning prior to attending a one day face-to-face course. e-Learning access data were collected through the Learning Management System (LMS). All participants were assessed by a multiple choice questionnaire (MCQ) before and after the face-to-face aspect alongside a practical cardiac arrest simulation (CAS-Test). Participant demographics and assessment outcomes were analysed. The mean post e-learning MCQ score was 83.7 (SD 7.3) and the mean post-course MCQ score was 87.7 (SD 7.9). The first attempt CAS-Test pass rate was 84.6% and overall pass rate 96.6%. Participants with previous ALS experience, ILS experience, or who were a core member of the resuscitation team performed better in the post-course MCQ, CAS-Test and overall assessment. Median time spent on the e-learning was 5.2h (IQR 3.7-7.1). There was a large range in the degree of access to e-learning content. Increased time spent accessing e-learning had no effect on the overall result (OR 0.98, P=0.367) on simulated learning outcome. Clinical experience through membership of cardiac arrest teams and previous ILS or ALS training were independent predictors of performance on the ALS course whilst time spent accessing e-learning materials did not affect course outcomes. This supports the blended approach to e-ALS which allows participants to tailor their e-learning experience to their specific needs. Copyright © 2017 Elsevier B.V. All rights reserved.

Making the Outcomes of the Doha Development Round Favourable for Developing Countries: Reflections on a Feasible Proposal for a Special Safeguard Mechanism

Directory of Open Access Journals (Sweden)

Francis Shasha Matambalya

2010-06-01

Full Text Available In principle, there is consensus among World Trade organisation members (WTO on the need to establish Special Safeguard Mechanisms (SSM for use by developing countries. Building on a survey of literature, empirical studies, and exchange of ideas through participation in the international debate on the subject matter, this paper outlines the architecture of a pro-development SSM. The elaboration is based on ten dimensions: country eligibility, criteria for selection of special products, triggers of safeguard action, precondition for application of safeguard action, geographic coverage, permissible remedies, restrictions on the levels of compensation, time scale, other rules, and treatment of developing countries. Compared to the SSG, it allows trigger levels at lower volumes and higher prices. Also, it differentiates demand increase and import surges, maintains linkages of domestic producers to long-run world market dynamics, and allows the computation of the price trigger on consignment by consignment basis.

Favourable outcomes of a preventive screening and counselling programme for older people in underprivileged areas in the Netherlands: The PRIMUS project

Directory of Open Access Journals (Sweden)

D.J. Annemarie van Dijk

2017-06-01

Full Text Available An aging population is associated with an increased prevalence of diabetes, cardiovascular diseases and depression. Important aspects of programmes targeted at older people are: to reach those at risk, effective screening, optimising advice, and referral to local interventions. We examined the effect of a preventive health consultation (PRIMUS, a multi-behavioural screening programme for persons aged 55–74 years in primary care. In a multi-centre randomised controlled trial, the effects of participating in the PRIMUS intervention were compared to a comparison group receiving personalised summaries and advice by postal mail, both preceded by a health risk assessment via a questionnaire. The intervention consisted of a baseline health risk assessment, followed by a preventive health consultation (after 4 weeks, and a follow-up visit (2 weeks later in the primary care centre. A newly developed web-based computer-tailored programme supported the nurse practitioner during the consultation. Main outcomes measures were awareness of, and compliance with referral advice for changing unhealthy lifestyles. The PRIMUS preventive health consultation was successful in older people at risk for cardio metabolic diseases compared to the comparison group (compliance: RR 1.43; 95% CI 1.12–1.79; p < 0.05. The intervention was less successful in older people at risk for mental health problems. This preventive health consultation for older people resulted in positive changes in unhealthy behaviours by optimising reach, raising awareness, motivating and assisting individuals to change, and referring to local interventions.

Pedagogical Approaches to and Effects of Fundamental Movement Skill Interventions on Health Outcomes: A Systematic Review.

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Tompsett, Claire; Sanders, Ross; Taylor, Caitlin; Cobley, Stephen

2017-09-01

Fundamental movement skills (FMS) are assumed to be the basic prerequisite motor movements underpinning coordination of more integrated and advanced movement capabilities. FMS development and interventions have been associated with several beneficial health outcomes in individual studies. The primary aim of this review was to identify FMS intervention characteristics that could be optimised to attain beneficial outcomes in children and adolescents, while the secondary aim was to update the evidence as to the efficacy of FMS interventions on physiological, psychological and behavioural health outcomes. A systematic search [adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines] was conducted in seven databases. Studies were included if they conducted an FMS intervention and targeted at least one physiological, behavioural or psychological outcome in school-aged children (5-18 years). Twenty-nine studies examining the effect of FMS interventions relative to controls were identified. Specialist-led interventions, taught in conjunction with at-home practice and parent involvement, appeared more efficacious in enhancing FMS proficiency than school physical education alone. Intervention environments encouraging psychological autonomy were likely to enhance perceived and actual competence in FMS alongside physical activity. FMS interventions had little influence on overweight/obesity reduction, strength or flexibility. In 93% of studies, evidence indicated interventions improved FMS motor proficiency. Favourable specific physiological, psychological and behavioural outcomes were also identified across a variety of interventions. With reference to clinical and normative school-age populations, future studies should be directed toward determining validated standard FMS assessments to enable accurate effect estimates, permit intervention comparisons and improve the efficacy of FMS development.

Model-based analysis of costs and outcomes of non-invasive prenatal testing for Down's syndrome using cell free fetal DNA in the UK National Health Service.

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Stephen Morris

Full Text Available Non-invasive prenatal testing (NIPT for Down's syndrome (DS using cell free fetal DNA in maternal blood has the potential to dramatically alter the way prenatal screening and diagnosis is delivered. Before NIPT can be implemented into routine practice, information is required on its costs and benefits. We investigated the costs and outcomes of NIPT for DS as contingent testing and as first-line testing compared with the current DS screening programme in the UK National Health Service.We used a pre-existing model to evaluate the costs and outcomes associated with NIPT compared with the current DS screening programme. The analysis was based on a hypothetical screening population of 10,000 pregnant women. Model inputs were taken from published sources. The main outcome measures were number of DS cases detected, number of procedure-related miscarriages and total cost.At a screening risk cut-off of 1∶150 NIPT as contingent testing detects slightly fewer DS cases, has fewer procedure-related miscarriages, and costs the same as current DS screening (around UK£280,000 at a cost of £500 per NIPT. As first-line testing NIPT detects more DS cases, has fewer procedure-related miscarriages, and is more expensive than current screening at a cost of £50 per NIPT. When NIPT uptake increases, NIPT detects more DS cases with a small increase in procedure-related miscarriages and costs.NIPT is currently available in the private sector in the UK at a price of £400-£900. If the NHS cost was at the lower end of this range then at a screening risk cut-off of 1∶150 NIPT as contingent testing would be cost neutral or cost saving compared with current DS screening. As first-line testing NIPT is likely to produce more favourable outcomes but at greater cost. Further research is needed to evaluate NIPT under real world conditions.

Unintended outcomes evaluation approach: A plausible way to evaluate unintended outcomes of social development programmes.

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Jabeen, Sumera

2018-06-01

Social development programmes are deliberate attempts to bring about change and unintended outcomes can be considered as inherent to any such intervention. There is now a solid consensus among the international evaluation community regarding the need to consider unintended outcomes as a key aspect in any evaluative study. However, this concern often equates to nothing more than false piety. Exiting evaluation theory suffers from overlap of terminology, inadequate categorisation of unintended outcomes and lack of guidance on how to study them. To advance the knowledge of evaluation theory, methods and practice, the author has developed an evaluation approach to study unintended effects using a theory building, testing and refinement process. A comprehensive classification of unintended outcomes on the basis of knowability, value, distribution and temporality helped specify various type of unintended outcomes for programme evaluation. Corresponding to this classification, a three-step evaluation process was proposed including a) outlining programme intentions b) forecasting likely unintended effects c) mapping the anticipated and understanding unanticipated unintended outcomes. This unintended outcomes evaluation approach (UOEA) was then trialled by undertaking a multi-site and multi-method case study of a poverty alleviation programme in Pakistan and refinements were made to the approach.The case study revealed that this programme was producing a number of unintended effects, mostly negative, affecting those already disadvantaged such as the poorest, women and children. The trialling process demonstrated the effectiveness of the UOEA and suggests that this can serve as a useful guide for future evaluation practice. It also provides the discipline of evaluation with an empirically-based reference point for further theoretical developments in the study of unintended outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

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Rosman Johan

2009-01-01

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

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

Science.gov (United States)

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

2009-01-21

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

Indicators of fetal and infant health outcomes

NARCIS (Netherlands)

Buitendijk, Simone; Zeitlin, Jennifer; Cuttini, Marina; Langhoff-Roos, Jens; Bottu, Jean

2003-01-01

OBJECTIVE: To assess the ability of the member states of the European Union to produce the indicators recommended by the PERISTAT project on perinatal health indicators and to provide an overview of fetal and infant health outcomes for these countries according to the information now available.

Explaining wind power planning outcomes: some findings from a study in England and Wales

International Nuclear Information System (INIS)

Toke, Dave

2005-01-01

This paper discusses the factors that influence the outcome of onshore windfarm planning application in England and Wales. Various qualitative and quantitative methods have been employed, including regression analysis. Strong associations have been discovered between the outcome of local authority planning decisions, the opinions of local planning officers, the opinions of parish councils where the proposed windfarms are to be sited and the opinions of landscape protection groups. The attitude of people in the immediate vicinity of proposed windfarms is found to be the most important influence on the decisions made by local authorities. However, the local perception of the economic impact is of crucial importance in forming this judgement, as is the national political environment. The expected attitude of Appeal Inspectors is also important. It is concluded that there is a lot that wind power developers could do to improve the prospects of planning success. This includes engaging in local 'parish council' politics, talking to the closest residents to proposed schemes and encouraging local pro-wind power campaigns. Future projects are likely to be favoured by installing viewing towers at the tops of turbines to encourage visitors and in selling shares in the schemes to local people

A synoptic climatology of derecho producing mesoscale convective systems in the North-Central Plains

Science.gov (United States)

Bentley, Mace L.; Mote, Thomas L.; Byrd, Stephen F.

2000-09-01

Synoptic-scale environments favourable for producing derechos, or widespread convectively induced windstorms, in the North-Central Plains are examined with the goal of providing pattern-recognition/diagnosis techniques. Fifteen derechos were identified across the North-Central Plains region during 1986-1995. The synoptic environment at the initiation, mid-point and decay of each derecho was then evaluated using surface, upper-air and National Center for Atmospheric Research (NCAR)/National Center for Environmental Prediction (NCEP) reanalysis datasets.Results suggest that the synoptic environment is critical in maintaining derecho producing mesoscale convective systems (DMCSs). The synoptic environment in place downstream of the MCS initiation region determines the movement and potential strength of the system. Circulation around surface low pressure increased the instability gradient and maximized leading edge convergence in the initiation region of nearly all events regardless of DMCS location or movement. Other commonalities in the environments of these events include the presence of a weak thermal boundary, high convective instability and a layer of dry low-to-mid-tropospheric air. Of the two corridors sampled, northeastward moving derechos tend to initiate east of synoptic-scale troughs, while southeastward moving derechos form on the northeast periphery of a synoptic-scale ridge. Other differences between these two DMCS events are also discussed.

Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Children: Old Foe, Emerging Threat

Science.gov (United States)

Lukac, Paul J.; Bonomo, Robert A.; Logan, Latania K.

2015-01-01

Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae present an ever-growing burden in the hospital and community settings, across all ages and demographics. Infections due to ESBL-containing pathogens continue to be associated with significant morbidity and mortality worldwide. With widespread empiric broad-spectrum β-lactam use creating selective pressure, and the resultant emergence of stable, rapidly proliferating ESBL-producing clones with continued horizontal gene transfer across genera, addressing this issue remains imperative. Although well characterized in adults, the epidemiology, risk factors, outcomes, therapies, and control measures for ESBL-producing bacteria are less appreciated in children. This analysis provides a brief summary of ESBL-producing Enterobacteriaceae in children, with a focus on recent clinical and molecular data regarding colonization and infection in nonoutbreak settings. PMID:25595742

[Open lateral clavicle resection in acromioclavicular osteoarthritis: favourable results after 1 year].

NARCIS (Netherlands)

Stroet, M.A.J. te; Schreurs, B.W.; Waal Malefijt, M.C. de

2010-01-01

OBJECTIVE: To determine the follow-up outcomes of open lateral clavicle resection 1 year postoperatively in patients with acromioclavicular osteoarthritis. The operation involves resection of a small part of the lateral clavicle. DESIGN: Prospective descriptive. METHOD: Data were collected from all

Empowering Pre-Service Teachers to Produce Ubiquitous Flipped Classes

Directory of Open Access Journals (Sweden)

Soraya García-Sánchez

2017-01-01

Full Text Available This work focuses on technological and educational outcomes that resulted from the production of foreign language educational videos by 90 pre-service instructors enrolled in an official Master’s Degree in Secondary Education programme. This teaching practice, conducted during two consecutive years, was set in a ubiquitous learning environment with the intention of effectively linking digital technology with pedagogy by means of producing flipped classroom units. The findings reveal that these pre-service teachers successfully combined instructional dynamics with digital skills to produce flipped classes adapted to the young generation’s needs. The classroom becomes, therefore, a more participatory learner-centred scenario with a variety of interactive and collaborative activities performed by foreign language students.

STUDY ON SURGICAL SITE INFECTIONS CAUSED BY ESBL PRODUCING GRAM NEGATIVE BACTERIA

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Rambabu

2015-09-01

Full Text Available Surgical site infections have been a major problem, because of the emergence of drug resistant bacteria, in particular B - lactamase producing bacteria. Extended spectrum beta lactamase producing gram negative organisms pose a great challenge in treatment o f SSI present study is aimed at determining multiple drug resistance in gram negative bacteria & to find out ESBL producers, in correlation with treatment outcome. A total of 120 wound infected cases were studied. Staphylococcus aureus was predominant bact erium - 20.Among gram negative bacteria, Pseudomonas species is predominant (14 followed by Escherichia coli (13 , Klebsiella species (12 , Proteus (9 Citrobacter (4 Providencia (2 & Acinetobacter species (2 . Out of 56 gramnegative bacteria isolated, 20 were i dentified as ESBL producers, which was statistically significant. Delay in wound healing correlated with infection by ESBL producers, which alarms the need of abstinence from antibiotic abuse

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

DEFF Research Database (Denmark)

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

2013-01-01

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

Morning versus evening induction of labour for improving outcomes.

Science.gov (United States)

Bakker, Jannet J H; van der Goes, Birgit Y; Pel, Maria; Mol, Ben Willem J; van der Post, Joris A M

2013-02-28

in women with a favourable cervix and/or ruptured membranes with intravenous oxytocin. Because of the different mechanism, we have reported results for these two comparisons separately.In the two trials comparing prostaglandins in the morning versus the evening there were few clinically significant differences between study groups for maternal or neonatal outcomes. One study reported a statistically significant preference by women to start induction of labour with prostaglandins in the morning.In the trial examining induction of labour with intravenous oxytocin, the number of neonatal admissions was statistically significantly increased in the group of women that started induction in the morning. This finding was unexpected, and while the trial authors offered some possible explanations for this, it is important that any future trials examine neonatal outcomes. Taking into account women's preferences that favoured administration of prostaglandins in the morning, we conclude that caregivers should preferably consider administering prostaglandins in the morning.There is no strong evidence that induction of labour with intravenous oxytocin in the evening is more or less effective than induction in the morning. Consideration may be given to start induction of labour with oxytocin in the evening when indicated.

Harmful and favourable ultraviolet conditions for human health over Northern Eurasia

Science.gov (United States)

Chubarova, Nataly; Zhdanova, Ekaterina

2014-05-01

We provide the analysis of the spatial and temporal distribution of ultraviolet (UV) radiation over Northern Eurasia taking into account for both its detrimental (erythema and eye-damage effects) and favourable (vitamin D synthesis) influence on human health. The UV effects on six different skin types are considered in order to cover the variety of skin types of European and Asian inhabitants. To better quantifying the vitamin D irradiance threshold we accounted for an open body fraction S as a function of effective air temperature. The spatial and temporal distribution of UV resources was estimated by radiative transfer (RT) modeling (8 stream DISORT RT code) with 1x 1 degree grid and monthly resolution. For this purpose special datasets of main input geophysical parameters (total ozone content, aerosol characteristics, surface UV albedo, UV cloud modification factor) have been created over the territory of Northern Eurasia, which can be of separate interest for the different multidisciplinary scientific applications over the PEEX domain. The new approaches were used to retrieve aerosol and cloud transmittance from different satellite and re-analysis datasets for calculating the solar UV irradiance at ground. Using model simulations and some experimental data we provide the altitude parameterization for different types of biologically active irradiance in mountainous area taking into account not only for the effects of molecular scattering but for the altitude dependence of aerosol parameters and surface albedo. Based on the new classification of UV resources (Chubarova, Zhdanova, 2013) we show that the distribution of harmful (UV deficiency and UV excess) and favorable UV conditions is regulated by various geophysical parameters (mainly, total ozone, cloudiness and open body fraction) and can significantly deviate from latitudinal dependence. The interactive tool for providing simulations of biologically active irradiance and its attribution to the different

Comparison of Technical and Clinical Outcome of Transjugular Portosystemic Shunt Placement Between a Bare Metal Stent and a PTFE-Stentgraft Device.

Science.gov (United States)

Lauermann, J; Potthoff, A; Mc Cavert, M; Marquardt, S; Vaske, B; Rosenthal, H; von Hahn, T; Wacker, F; Meyer, B C; Rodt, Thomas

2016-04-01

To analyse technical and clinical success of transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension and compare a stent and a stentgraft with regard to clinical and technical outcome and associated costs. 170 patients (56 ± 12 years, 32.9% females) treated with TIPS due to portal hypertension were reviewed. 80 patients received a stent (group 1) and 83 a stentgraft (group 2), and seven interventions were unsuccessful. Technical data, periprocedural imaging, follow-up ultrasound and clinical data were analysed with focus on technical success, patency, clinical outcome and group differences. Cost analysis was performed. Portal hypertension was mainly caused by ethyltoxic liver cirrhosis with ascites as dominant symptom (80%). Technical success was 93.5% with mean portosystemic gradient decrease from 16.1 ± 4.8 to 5.1 ± 2.1 mmHg. No significant differences in technical success and portosystemic gradient decrease between the groups were observed. Kaplan-Meier analysis yielded significant differences in primary patency after 14 days, 6 months and 2 years in favour of the stentgraft. Both groups showed good clinical results without significant difference in 1-year survival and hepatic encephalopathy rate. Costs to establish TIPS and to manage 2-year follow-up with constant patency and clinical success were 8876 € (group 1) and 9394 € (group 2). TIPS is a safe and effective procedure to manage portal hypertension. Stent and stentgraft enabled good technical and clinical results with a low complication rate. Primary patency rates are clearly in favour of the stentgraft, whereas the stent was more cost effective with similar clinical results in both groups.

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

Science.gov (United States)

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

2018-01-01

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

Consumer Preferences for Health and Nonhealth Outcomes of Health Promotion: Results from a Discrete Choice Experiment

NARCIS (Netherlands)

Alayli-Goebbels, A.F.G.; Dellaert, B.G.C.; Knox, S.A.; Ament, A.J.H.A.; Lakerveld, J.; Bot, S.D.M.; Nijpels, G.; Severens, J.L.

2013-01-01

Objective: Health promotion (HP) interventions have outcomes that go beyond health. Such broader nonhealth outcomes are usually neglected in economic evaluation studies. To allow for their consideration, insights are needed into the types of nonhealth outcomes that HP interventions produce and their

Antimicrobial Drug-Resistant Shiga Toxin-Producing Escherichia coli Infections, Michigan, USA.

Science.gov (United States)

Mukherjee, Sanjana; Mosci, Rebekah E; Anderson, Chase M; Snyder, Brian A; Collins, James; Rudrik, James T; Manning, Shannon D

2017-09-01

High frequencies of antimicrobial drug resistance were observed in O157 and non-O157 Shiga toxin-producing E. coli strains recovered from patients in Michigan during 2010-2014. Resistance was more common in non-O157 strains and independently associated with hospitalization, indicating that resistance could contribute to more severe disease outcomes.

Hemispheric surgery for refractory epilepsy in children and adolescents: outcome regarding seizures, motor skills and adaptive function.

Science.gov (United States)

Hamad, Ana Paula; Caboclo, Luís Otávio; Centeno, Ricardo; Costa, Livia Vianez; Ladeia-Frota, Carol; Junior, Henrique Carrete; Gomez, Nicolas Garofalo; Marinho, Murilo; Yacubian, Elza Márcia Targas; Sakamoto, Américo Ceiki

2013-11-01

The aim of the study was to report the seizure outcome, motor skills and adaptive motor functions in a series of children and adolescents who underwent hemispheric surgery, analysing the risk-benefits of surgery. The clinical course, seizure and motor function outcomes of 15 patients who underwent hemispheric surgery were reviewed. The mean age at surgery was 9.5, with 1-9 years follow-up. The underlying pathologies were Rasmussen encephalitis, vascular disorders, and hemimegalencephaly. All the patients presented with severe epilepsy and different degrees of hemiparesis, although motor functionality was preserved in 80% of the patients. At last follow-up, 67% were seizure free, and 20% rarely experienced seizures. Antiepileptic drugs were reduced in 60%, and complete withdrawal from such drugs was successful in 20% of the patients. The motor outcome following the surgery varied between the patients. Despite the motor deficit after surgery, the post-operative motor function showed unchanged for gross motor function in most (60%), while 27% improved. Similar results were obtained for the ability to handle objects in daily life activities. Sixty percent of the children were capable of handling objects, with somewhat reduced coordination and/or motor speed. Pre-surgical motor function continues to play a role in the pre-surgical evaluation process in order to provide a baseline for outcome. Hemispheric surgery, once regarded as a radical intervention and last treatment resource, may become routinely indicated for refractory hemispheric epilepsy in children and adolescents, with oftentime favourable motor outcomes. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Maintained intentional weight loss reduces cardiovascular outcomes

DEFF Research Database (Denmark)

Caterson, I D; Finer, N; Coutinho, W

2012-01-01

Aim: The Sibutramine Cardiovascular OUTcomes trial showed that sibutramine produced greater mean weight loss than placebo but increased cardiovascular morbidity but not mortality. The relationship between 12-month weight loss and subsequent cardiovascular outcomes is explored. Methods: Overweight....../obese subjects (N = 10 744), =55 years with cardiovascular disease and/or type 2 diabetes mellitus, received sibutramine plus weight management during a 6-week Lead-in Period before randomization to continue sibutramine (N = 4906) or to receive placebo (N = 4898). The primary endpoint was the time from...... randomization to first occurrence of a primary outcome event (non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death). Results: For the total population, mean weight change during Lead-in Period (sibutramine) was -2.54 kg. Post-randomization, mean total weight...

Living with strangers: direct benefits favour non-kin cooperation in a communally nesting bird.

Science.gov (United States)

Riehl, Christina

2011-06-07

The greater ani (Crotophaga major), a Neotropical cuckoo, exhibits an unusual breeding system in which several socially monogamous pairs lay eggs in a single nest and contribute care to the communal clutch. Cooperative nesting is costly-females compete for reproduction by ejecting each other's eggs-but the potential direct or indirect fitness benefits that might accrue to group members have not been identified. In this study, I used molecular genotyping to quantify patterns of genetic relatedness and individual reproductive success within social groups in a single colour-banded population. Microsatellite analysis of 122 individuals in 49 groups revealed that group members are not genetic relatives. Group size was strongly correlated with individual reproductive success: solitary pairs were extremely rare and never successful, and nests attended by two pairs were significantly more likely to be depredated than were nests attended by three pairs. Egg loss, a consequence of reproductive competition, was greater in large groups and disproportionately affected females that initiated laying. However, early-laying females compensated for egg losses by laying larger clutches, and female group members switched positions in the laying order across nesting attempts. The greater ani, therefore, appears to be one of the few species in which cooperative breeding among unrelated individuals is favoured by direct, shared benefits that outweigh the substantial costs of reproductive competition.

Chemical composition of chicken meat produced in extensive indoor ...

African Journals Online (AJOL)

Cooled carcasses were dissected into primal cuts. Breast and leg muscle (thigh and drumstick) samples were used for chemical analyses. The obtained results suggested that free range rearing system was more favourable than extensive indoor system, as it resulted in a significantly higher protein content and a lower fat ...

Transsylvian selective amygdalohippocampectomy in children with hippocampal sclerosis: seizure, intellectual and memory outcome.

Science.gov (United States)

Beaton, Anne E; Durnford, Andrew; Heffer-Rahn, Phillip E; Kirkham, Fenella; Griffin, Angela; Gray, William P; Gray, W L S

2012-11-01

This study investigates the efficacy of transylvian selective amygdalohippocampectomy (TS SAH) in children with medically intractable epilepsy due to unilateral hippocampal sclerosis. Post-surgical seizure control, intellectual and memory outcomes are examined. This study reports on pre- and post-surgical clinical data from 10 patients who underwent TS SAH between 2002 and 2010 after 24 months follow-up. Pre- and post-operative change in seizure frequency, AED use, intellect and memory are compared. At 12 months and 24 months post-surgery, 9/10 (90%) and 7/8 (87.5%) patients respectively, were seizure free (Engel I). No patients were classed as Engel III or IV. No significant improvement or decline at a group level was found on measures of intellect or verbal or visual memory. One hundred per cent improved or remained within 1 SD of their pre-operatives score on verbal and perceptual reasoning learning and reasoning measures. Significant improvement was found post-operatively for both immediate and delayed facial memory. Our findings of good post-surgical seizure control and favourable cognitive outcome provides evidence against previous findings that SAH in children may not be effective. Copyright © 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Negative decision outcomes are more common among people with lower decision-making competence: An item-level analysis of the Decision Outcome Inventory (DOI

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Andrew M Parker

2015-04-01

Full Text Available Most behavioral decision research takes place in carefully controlled laboratory settings, and examination of relationships between performance and specific real-world decision outcomes is rare. One prior study shows that people who perform better on hypothetical decision tasks, assessed using the Adult Decision-Making Competence (A-DMC measure, also tend to experience better real-world decision outcomes, as reported on the Decision Outcomes Inventory (DOI. The DOI score reflects avoidance of outcomes that could result from poor decisions, ranging from serious (e.g., bankruptcy to minor (e.g., blisters from sunburn. The present analyses go beyond the initial work, which focused on the overall DOI score, by analyzing the relationships between specific decision outcomes and A-DMC performance. Most outcomes are significantly more likely among people with lower A-DMC scores, even after taking into account two variables expected to produce worse real-world decision outcomes: younger age and lower socio-economic status. We discuss the usefulness of DOI as a measure of successful real-world decision making.

Effects of new ways of working on work hours and work location, health and job-related outcomes.

Science.gov (United States)

Nijp, Hylco H; Beckers, Debby G J; van de Voorde, Karina; Geurts, Sabine A E; Kompier, Michiel A J

2016-01-01

New ways of working (NWW) is a type of work organization that is characterized by temporal and spatial flexibility, often combined with extensive use of information and communication technologies (ICT) and performance-based management. In a three-wave intervention study, we examined the effects of NWW on both the organization of work (changes in control over time and place of work; working hours and work location; and other key job characteristics), and on employees' outcomes (work-nonwork balance; health and well-being; and job-related outcomes). We applied a quasi-experimental design within a large Dutch financial company (N = 2,912). We studied an intervention group (n = 2,391) and made comparisons with a reference group (n = 521). There were three study waves: (i) one/two months before, and (ii) 4 months and (iii) 10 months after implementation of NWW. Repeated measures analyses of covariance (involving 361 participants from the intervention group and 80 participants from the reference group) showed a large and significant shift from hours worked at the office to hours worked at home after implementation of NWW. Accordingly, commuting time was reduced. Employees remained working on week days and during day time. Psychosocial work-characteristics, work-nonwork balance, stress, fatigue, and job-related outcomes remained favourable and largely unaffected, but the health score in the intervention group decreased (medium effect). These findings suggest that the implementation of NWW does not necessarily lead to changes in psychosocial work characteristics, well-being or job-related outcomes.

Dry reforming of coke oven gases over activated carbon to produce syngas for methanol synthesis

Energy Technology Data Exchange (ETDEWEB)

J.M. Bermudez; B. Fidalgo; A. Arenillas; J.A. Menendez [Instituto Nacional del Carbn, Oviedo (Spain)

2010-10-15

The dry reforming of coke oven gases (COG) over an activated carbon used as catalyst has been studied in order to produce a syngas suitable for methanol synthesis. The primary aim of this work was to study the influence of the high amount of hydrogen present in the COG on the process of dry reforming, as well as the influence of other operation conditions, such us temperature and volumetric hourly space velocity (VHSV). It was found that the reverse water gas shift (RWGS) reaction takes place due to the hydrogen present in the COG, and that its influence on the process increases as the temperature decreases. This situation may give rise to the consumption of the hydrogen present in the COG, and the consequent formation of a syngas which is inappropriate for the synthesis of methanol. This reaction can be avoided by working at high temperatures (about 1000{sup o}C) in order to produce a syngas that is suitable for methanol synthesis. It was also found that the RWGS reaction is favoured by an increase in the VHSV. In addition, the active carbon FY5 was proven to be an adequate catalyst for the production of syngas from COG. 25 refs., 7 figs., 2 tabs.

Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort.

Science.gov (United States)

Williams, Tracy A; Lenders, Jacques W M; Mulatero, Paolo; Burrello, Jacopo; Rottenkolber, Marietta; Adolf, Christian; Satoh, Fumitoshi; Amar, Laurence; Quinkler, Marcus; Deinum, Jaap; Beuschlein, Felix; Kitamoto, Kanako K; Pham, Uyen; Morimoto, Ryo; Umakoshi, Hironobu; Prejbisz, Aleksander; Kocjan, Tomaz; Naruse, Mitsuhide; Stowasser, Michael; Nishikawa, Tetsuo; Young, William F; Gomez-Sanchez, Celso E; Funder, John W; Reincke, Martin

2017-09-01

wide variance (range 17-62), and partial clinical success in an additional 334 (47%, range 35-66); complete biochemical success was seen in 656 (94%, 83-100) of 699 patients. Female patients had a higher likelihood of complete clinical success (odds ratio [OR] 2·25, 95% CI 1·40-3·62; p=0·001) and clinical benefit (complete plus partial clinical success; OR 2·89, 1·49-5·59; p=0·002) than male patients. Younger patients had a higher likelihood of complete clinical success (OR 0·95 per extra year, 0·93-0·98; pstudies. The variable baseline clinical characteristics of our international cohort contributed to wide variation in clinical outcomes. Most patients derive clinical benefit from adrenalectomy, with younger patients and female patients more likely to have a favourable surgical outcome. Screening for primary aldosteronism should nonetheless be done in every individual fulfilling US Endocrine Society guideline criteria because biochemical success without clinical success is by itself clinically important and older women and men can also derive post-operative clinical benefit. European Research Council; European Union's Horizon 2020; Else Kröner-Fresenius Stiftung; Netherlands Organisation for Health Research and Development-Medical Sciences; Japanese Ministry of Health, Labour and Welfare; Ministry of Health, Slovenia; US National Institutes of Health; and CONICYT-FONDECYT (Chile). Copyright © 2017 Elsevier Ltd. All rights reserved.

Attending to Objects as Outcomes of Design Research

DEFF Research Database (Denmark)

Jenkins, Tom; Andersen, Kristina; Gaver, William

2016-01-01

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

Analysis of conditions favourable for small vertical axis wind turbines between building passages in urban areas of Sweden

Science.gov (United States)

Awan, Muhammad Rizwan; Riaz, Fahid; Nabi, Zahid

2017-05-01

This paper presents the analysis of installing the vertical axis wind turbines between the building passages on an island in Stockholm, Sweden. Based on the idea of wind speed amplification due to the venture effect in passages, practical measurements were carried out to study the wind profile for a range of passage widths in parallel building passages. Highest increment in wind speed was observed in building passages located on the periphery of sland as wind enters from free field. Wind mapping was performed in the island to choose the most favourable location to install the vertical axis wind turbines (VAWT). Using the annual wind speed data for location and measured amplification factor, energy potential of the street was calculated. This analysis verified that small vertical axis wind turbines can be installed in the passage centre line provided that enough space is provided for traffic and passengers.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Taiwan

International Nuclear Information System (INIS)

1977-12-01

Taiwan is an island of 36,000 sq km located 160 km east of mainland China. Geologically, the oldest rocks are Tertiary, and the only igneous rocks on the island are Quaternary andesites and basalts. Copper, gold, and silver are the only known metallic minerals produced. Uranium occurrences and exploration efforts are unknown. The potential uranium resource of Taiwan is considered a category 1 resource. (author)

Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes

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Thabane Lehana

2009-01-01

Full Text Available Abstract Background There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and women's perceptions of benefits for themselves and their children. Methods A comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of women's experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts. Results A total of 15 documents were included in the meta-synthesis. Women experienced a number of psychosocial processes during treatment that played a role in their recovery and contributed to favourable outcomes. These included: development of a sense of self; development of personal agency; giving and receiving of social support; engagement with program staff; self-disclosure of challenges, feelings, and past experiences; recognizing patterns of destructive behaviour; and goal setting. A final process, the motivating presence of children, sustained women in their recovery journeys. Perceived outcomes included benefits for maternal and child well-being, and enhanced parenting capacity. Conclusion A number of distinct but interconnected processes emerged as being important to women's addiction recovery. Women experienced individual growth and

Clinical characterisation of Becker muscular dystrophy patients predicts favourable outcome in exon-skipping therapy

NARCIS (Netherlands)

van den Bergen, J. C.; Schade van Westrum, S. M.; Dekker, L.; van der Kooi, A. J.; de Visser, M.; Wokke, B. H. A.; Straathof, C. S.; Hulsker, M. A.; Aartsma-Rus, A.; Verschuuren, J. J.; Ginjaar, H. B.

2014-01-01

Objective Duchenne and Becker muscular dystrophy (DMD/BMD) are both caused by mutations in the DMD gene. Out-of-frame mutations in DMD lead to absence of the dystrophin protein, while in-frame BMD mutations cause production of internally deleted dystrophin. Clinically, patients with DMD loose

Food safety standards in the fresh produce supply chain: advantages and disadvantages

NARCIS (Netherlands)

Uyttendaele, M.; Jacxsens, L.; Boxstael, Van S.; Kirezieva, K.; Luning, P.

2015-01-01

Abstract : Food safety standards in the fresh produce supply chain are discussed in view of the outcomes of a European Union Directorates General (EU DG) Research project FP7 Veg-i-Trade ‘Impact of climate change and international trade on the safety of fresh produce’. Various standards are outlined

Extended-spectrum β-lactamase/AmpC- and carbapenemase-producing Enterobacteriaceae in animals: a threat for humans?

Science.gov (United States)

Madec, J-Y; Haenni, M; Nordmann, P; Poirel, L

2017-11-01

There has been a great and long-term concern that extended-spectrum β-lactamase (ESBL)/AmpC- and carbapenemase-producing Enterobacteriaceae occurring in animals may constitute a public-health issue. A large number of factors with complex interrelations contribute to the spread of those bacteria among animals and humans. ESBL/AmpC- or carbapenemase-encoding genes are most often located on mobile genetic elements favouring their dissemination. Some shared reservoirs of ESBL/AmpC or carbapenemase genes, plasmids or clones have been identified and suggest cross-transmissions. Even though exposure to animals is regarded as a risk factor, evidence for a direct transfer of ESBL/AmpC-producing bacteria from animals to humans through close contacts is limited. Nonetheless, the size of the commensal ESBL/AmpC reservoir in non-human sources is dramatically rising. This may constitute an indirect risk to public health by increasing the gene pool from which pathogenic bacteria can pick up ESBL/AmpC/carbapenemase genes. The extent to which food contributes to potential transmission of ESBL/AmpC producers to humans is also not well established. Overall, events leading to the occurrence of ESBL/AmpC- and carbapenemase-encoding genes in animals seem very much multifactorial. The impact of animal reservoirs on human health still remains debatable and unclear; nonetheless, there are some examples of direct links that have been identified. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Developing a Learning Outcome-Based Question Examination Paper Tool for Universiti Putra Malaysia

Science.gov (United States)

Hassan, Sa'adah; Admodisastro, Novia Indriaty; Kamaruddin, Azrina; Baharom, Salmi; Pa, Noraini Che

2016-01-01

Much attention is now given on producing quality graduates. Therefore, outcome-based education (OBE) in teaching and learning is now being implemented in Malaysia at all levels of education especially at higher education institutions. For implementing OBE, the design of curriculum and courses should be based on specified outcomes. Thus, the…

Aligning Learning and Talent Development Performance Outcomes with Organizational Objectives: A Proposed Model

Science.gov (United States)

Ware, Iris

2017-01-01

The value proposition for learning and talent development (LTD) is often challenged due to human resources' inability to demonstrate meaningful outcomes in relation to organizational needs and return-on-investment. The primary role of human resources (HR) and the learning and talent development (LTD) function is to produce meaningful outcomes to…

Machine learning for outcome prediction of acute ischemic stroke post intra-arterial therapy.

Directory of Open Access Journals (Sweden)

Hamed Asadi

Full Text Available INTRODUCTION: Stroke is a major cause of death and disability. Accurately predicting stroke outcome from a set of predictive variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. Logistic regression models allow for the identification and validation of predictive variables. However, advanced machine learning algorithms offer an alternative, in particular, for large-scale multi-institutional data, with the advantage of easily incorporating newly available data to improve prediction performance. Our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute anterior circulation ischaemic stroke. METHOD: We conducted a retrospective study of a prospectively collected database of acute ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB®, and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes. These algorithms were trained, validated and tested using randomly divided data. RESULTS: We included 107 consecutive acute anterior circulation ischaemic stroke patients treated by endovascular technique. Sixty-six were male and the mean age of 65.3. All the available demographic, procedural and clinical factors were included into the models. The final confusion matrix of the neural network, demonstrated an overall congruency of ∼ 80% between the target and output classes, with favourable receiving operative characteristics. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.064 (SD: ± 0.408. DISCUSSION: We showed promising accuracy of outcome prediction, using supervised machine learning algorithms, with potential for incorporation of larger multicenter

Did the price-related reforms in Ghana's cocoa sector favour farmers?

NARCIS (Netherlands)

Quarmine, W.; Haagsma, R.; Huis, van A.; Sakyi-Dawson, O.; Obeng-Ofori, D.; Asante, F.

2014-01-01

It is generally hypothesized in the innovation systems literature that institutions can create production incentives for farmers. This paper examines whether the introduction in 1984 of the Producer Price Review Committee (PPRC) in Ghana's cocoa sector has improved the transmission of world prices

Fight with energy producers is a fight for the euro

International Nuclear Information System (INIS)

Mucka, F.

2006-01-01

The battle between the cabinet and companies producing and distributing energy is not about meeting pre-election promises, i.e. decreasing the profits of companies in favour of consumers. The results of negotiations between the cabinet and companies will have a direct impact on Slovakians chances to adopt the common European currency by the planned deadline. Although in the pre-election period the Smer political party did not consider adoption of the euro in 2009 as a priority, the situation changed in the summer. In July, the Prime Minister supported the idea for the first time. His repeated statements supporting the plan to adhere to the original deadline were a part of his goal to stop the fall of the SKK exchange rate. Of all the Maastricht criteria applicable to Slovakia, the inflation criterion seems to be the most difficult one to meet assuming the cabinet keeps its word and government expenditure does not exceed its income by more than is permitted. It is more difficult to keep inflation below the set level than to meet the budget criterion. If Slovakia wants to join the monetary union on 1 January 2009, as of the end of first quarter 2007 inflation will have to be far lower than the current level. (author)

The equity dimension in evaluations of the quality and outcomes framework: a systematic review.

Science.gov (United States)

Boeckxstaens, Pauline; Smedt, Delphine De; Maeseneer, Jan De; Annemans, Lieven; Willems, Sara

2011-08-31

Pay-for-performance systems raise concerns regarding inequity in health care because providers might select patients for whom targets can easily be reached. This paper aims to describe the evolution of pre-existing (in)equity in health care in the period after the introduction of the Quality and Outcomes Framework (QOF) in the UK and to describe (in)equities in exception reporting. In this evaluation, a theory-based framework conceptualising equity in terms of equal access, equal treatment and equal treatment outcomes for people in equal need is used to guide the work. A systematic MEDLINE and Econlit search identified 317 studies. Of these, 290 were excluded because they were not related to the evaluation of QOF, they lacked an equity dimension in the evaluation, their qualitative research focused on experiences or on the nature of the consultation, or unsuitable methodology was used to pronounce upon equity after the introduction of QOF. None of the publications (n = 27) assessed equity in access to health care. Concerning equity in treatment and (intermediate) treatment outcomes, overall quality scores generally improved. For the majority of the observed indicators, all citizens benefit from this improvement, yet the extent to which different patient groups benefit tends to vary and to be highly dependent on the type and complexity of the indicator(s) under study, the observed patient group(s) and the characteristics of the study. In general, the introduction of QOF was favourable for the aged and for males. Total QOF scores did not seem to vary according to ethnicity. For deprivation, small but significant residual differences were observed after the introduction of QOF favouring less deprived groups. These differences are mainly due to differences at the practice level. The variance in exception reporting according to gender and socio-economic position is low. Although QOF seems not to be socially selective at first glance, this does not mean QOF does not

The equity dimension in evaluations of the quality and outcomes framework: A systematic review

Directory of Open Access Journals (Sweden)

Annemans Lieven

2011-08-01

Full Text Available Abstract Background Pay-for-performance systems raise concerns regarding inequity in health care because providers might select patients for whom targets can easily be reached. This paper aims to describe the evolution of pre-existing (inequity in health care in the period after the introduction of the Quality and Outcomes Framework (QOF in the UK and to describe (inequities in exception reporting. In this evaluation, a theory-based framework conceptualising equity in terms of equal access, equal treatment and equal treatment outcomes for people in equal need is used to guide the work. Methods A systematic MEDLINE and Econlit search identified 317 studies. Of these, 290 were excluded because they were not related to the evaluation of QOF, they lacked an equity dimension in the evaluation, their qualitative research focused on experiences or on the nature of the consultation, or unsuitable methodology was used to pronounce upon equity after the introduction of QOF. Results None of the publications (n = 27 assessed equity in access to health care. Concerning equity in treatment and (intermediate treatment outcomes, overall quality scores generally improved. For the majority of the observed indicators, all citizens benefit from this improvement, yet the extent to which different patient groups benefit tends to vary and to be highly dependent on the type and complexity of the indicator(s under study, the observed patient group(s and the characteristics of the study. In general, the introduction of QOF was favourable for the aged and for males. Total QOF scores did not seem to vary according to ethnicity. For deprivation, small but significant residual differences were observed after the introduction of QOF favouring less deprived groups. These differences are mainly due to differences at the practice level. The variance in exception reporting according to gender and socio-economic position is low. Conclusions Although QOF seems not to be socially

Sheep and Goat Farming in Greece: Implications and Challenges for the Sustainable Development of Less Favoured Areas

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Evangelia N. Sossidou

2013-10-01

Full Text Available Sheep and goat farming is considered to be one of the most dynamic sectors of the rural economy in Greece, both in terms of employment and overall income. The aim of this paper is to review the levels of sustainability in the small ruminant production systems in two Less Favoured Areas of Greece (LFAs: (1 in the mountainous areas of Epirus, and (2 in the island of Lesvos. In this context, the characteristics of the production systems that have significant impact on the sustainable development of rural areas under study are underlined. The sustainability is examined by the ecological, social and economic points of view, supplemented with cultural and regional elements. The ultimate purpose is to conclude with the challenges for the future rural development in LFAs through the sustainable development of sheep and goat farming. Data is based on surveys undertaken by the SEE-ERA.NET PLUS ‘INDI_SHEEP TRADI_CHEESE’ Project and the ARIMNET ‘DoMEsTIc’ Project, still in process.

Outcome of Doctors Attending the European Society for Paediatric Endocrinology Winter Schools 2008-2014.

Science.gov (United States)

Donaldson, Malcolm D C

2017-01-01

Since 1995, the European Society for Paediatric Endocrinology (ESPE) has hosted Winter School (WS), a 5-day interactive meeting of 25 trainees and 7 teachers designed to cover all main endocrine topics. The aim of the present study was to determine subsequent outcome in ex-WS "students." A questionnaire was sent in August 2016 to all ESPE WS participants between 2008 and 2014. Information was requested on job/training status at WS attendance and in 2016, and subsequent involvement with ESPE. Of 174 participants (144 women, 30 men) including 5 attending two WS, 129 (74.5%) responded. At the time of WS/2016 survey 58/3 participants were junior trainees, 38/21 senior trainees, and 33/101 consultants. One hundred and seventeen (90.6%) responders were still involved with endocrinology, 107 (82%) rating WS as having a strong/very strong influence on their careers. Following WS, 80/174 (46%) participants had attended at least one ESPE main meeting, 28 (16%) had been awarded ESPE fellowships, and 34 (19%) had become ESPE members. The great majority of WS participants responding to the questionnaire are still involved with endocrinology and rated WS as influential. This favourable outcome supports the continuing funding of WS and similar educational programmes. © 2017 S. Karger AG, Basel.

Comparison of Technical and Clinical Outcome of Transjugular Portosystemic Shunt Placement Between a Bare Metal Stent and a PTFE-Stentgraft Device

Energy Technology Data Exchange (ETDEWEB)

Lauermann, J., E-mail: jostlauermann@gmail.com [Hannover Medical School, Department of Diagnostic and Interventional Radiology (Germany); Potthoff, A. [Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology (Germany); Mc Cavert, M. [Beaumont Hospital, Department of Diagnostic and Interventional Radiology (Ireland); Marquardt, S. [Hannover Medical School, Department of Diagnostic and Interventional Radiology (Germany); Vaske, B. [Hannover Medical School, Institute of Biometry (Germany); Rosenthal, H. [Hannover Medical School, Department of Diagnostic and Interventional Radiology (Germany); Hahn, T. von [Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology (Germany); Wacker, F.; Meyer, B. C.; Rodt, Thomas, E-mail: rodt.thomas@mh-hannover.de [Hannover Medical School, Department of Diagnostic and Interventional Radiology (Germany)

2016-04-15

PurposeTo analyse technical and clinical success of transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension and compare a stent and a stentgraft with regard to clinical and technical outcome and associated costs.Materials and Methods170 patients (56 ± 12 years, 32.9 % females) treated with TIPS due to portal hypertension were reviewed. 80 patients received a stent (group 1) and 83 a stentgraft (group 2), and seven interventions were unsuccessful. Technical data, periprocedural imaging, follow-up ultrasound and clinical data were analysed with focus on technical success, patency, clinical outcome and group differences. Cost analysis was performed.ResultsPortal hypertension was mainly caused by ethyltoxic liver cirrhosis with ascites as dominant symptom (80 %). Technical success was 93.5 % with mean portosystemic gradient decrease from 16.1 ± 4.8 to 5.1 ± 2.1 mmHg. No significant differences in technical success and portosystemic gradient decrease between the groups were observed. Kaplan–Meier analysis yielded significant differences in primary patency after 14 days, 6 months and 2 years in favour of the stentgraft. Both groups showed good clinical results without significant difference in 1-year survival and hepatic encephalopathy rate. Costs to establish TIPS and to manage 2-year follow-up with constant patency and clinical success were 8876 € (group 1) and 9394 € (group 2).ConclusionTIPS is a safe and effective procedure to manage portal hypertension. Stent and stentgraft enabled good technical and clinical results with a low complication rate. Primary patency rates are clearly in favour of the stentgraft, whereas the stent was more cost effective with similar clinical results in both groups.

Modeling the Offensive-Defensive Interaction and Resulting Outcomes in Basketball.

Directory of Open Access Journals (Sweden)

Leonardo Lamas

Full Text Available We analyzed the interaction between offensive (i.e. space creation dynamics--SCDs and defensive (i.e. space protection dynamics--SPDs actions in six play outcomes (free shot, contested shot, new SCD, reset, foul, and turnover in Spanish professional basketball games.Data consisted of 1548 SCD-SPD-outcome triples obtained from six play-off games. We used Bayesian methods to compute marginal probabilities of six outcomes following five different SCDs. We also computed probabilities of the six outcomes following the 16 most frequent SCD-SPD combinations.The pick action (e.g. pick and roll, pop and pop was the most prevalent SCD (33%. However, this SCD did not produce the highest probability of a free shot (0.235. The highest probability of a free shot followed the SCD without ball (0.409. The pick was performed not only to attempt scoring but also to initiate offenses, as it produced the highest probability leading to a new SCD (0.403. Additionally, the SPD performed influenced the outcome of the SCD. This reinforces the notion that the opposition (offensive-defensive interaction should be considered. To the best of our knowledge, in team sports, this is the first study to successfully model the tactical features involved in offense-defense interactions. Our analyses revealed that the high frequency of occurrence of some SCDs may be justified not only by an associated high probability of free shots but also by the possibility of progressively create more space in the defense (i.e. a new SCD as outcome. In the second case, it evidences offensive strategic features of progressive disruption of the defensive system through the concatenation of subsequent offensive actions.

Modeling the Offensive-Defensive Interaction and Resulting Outcomes in Basketball.

Science.gov (United States)

Lamas, Leonardo; Santana, Felipe; Heiner, Matthew; Ugrinowitsch, Carlos; Fellingham, Gilbert

2015-01-01

We analyzed the interaction between offensive (i.e. space creation dynamics--SCDs) and defensive (i.e. space protection dynamics--SPDs) actions in six play outcomes (free shot, contested shot, new SCD, reset, foul, and turnover) in Spanish professional basketball games. Data consisted of 1548 SCD-SPD-outcome triples obtained from six play-off games. We used Bayesian methods to compute marginal probabilities of six outcomes following five different SCDs. We also computed probabilities of the six outcomes following the 16 most frequent SCD-SPD combinations. The pick action (e.g. pick and roll, pop and pop) was the most prevalent SCD (33%). However, this SCD did not produce the highest probability of a free shot (0.235). The highest probability of a free shot followed the SCD without ball (0.409). The pick was performed not only to attempt scoring but also to initiate offenses, as it produced the highest probability leading to a new SCD (0.403). Additionally, the SPD performed influenced the outcome of the SCD. This reinforces the notion that the opposition (offensive-defensive interaction) should be considered. To the best of our knowledge, in team sports, this is the first study to successfully model the tactical features involved in offense-defense interactions. Our analyses revealed that the high frequency of occurrence of some SCDs may be justified not only by an associated high probability of free shots but also by the possibility of progressively create more space in the defense (i.e. a new SCD as outcome). In the second case, it evidences offensive strategic features of progressive disruption of the defensive system through the concatenation of subsequent offensive actions.

Overexpression of SERBP1 (Plasminogen activator inhibitor 1 RNA binding protein) in human breast cancer is correlated with favourable prognosis

International Nuclear Information System (INIS)

Serce, Nuran Bektas; Knuechel, Ruth; Beckmann, Matthias W; Fasching, Peter A; Dahl, Edgar; Boesl, Andreas; Klaman, Irina; Serényi, Sonja von; Noetzel, Erik; Press, Michael F; Dimmler, Arno; Hartmann, Arndt; Sehouli, Jalid

2012-01-01

Plasminogen activator inhibitor 1 (PAI-1) overexpression is an important prognostic and predictive biomarker in human breast cancer. SERBP1, a protein that is supposed to regulate the stability of PAI-1 mRNA, may play a role in gynaecological cancers as well, since upregulation of SERBP1 was described in ovarian cancer recently. This is the first study to present a systematic characterisation of SERBP1 expression in human breast cancer and normal breast tissue at both the mRNA and the protein level. Using semiquantitative realtime PCR we analysed SERBP1 expression in different normal human tissues (n = 25), and in matched pairs of normal (n = 7) and cancerous breast tissues (n = 7). SERBP1 protein expression was analysed in two independent cohorts on tissue microarrays (TMAs), an initial evaluation set, consisting of 193 breast carcinomas and 48 normal breast tissues, and a second large validation set, consisting of 605 breast carcinomas. In addition, a collection of benign (n = 2) and malignant (n = 6) mammary cell lines as well as breast carcinoma lysates (n = 16) were investigated for SERBP1 expression by Western blot analysis. Furthermore, applying non-radioisotopic in situ hybridisation a subset of normal (n = 10) and cancerous (n = 10) breast tissue specimens from the initial TMA were analysed for SERBP1 mRNA expression. SERBP1 is not differentially expressed in breast carcinoma compared to normal breast tissue, both at the RNA and protein level. However, recurrence-free survival analysis showed a significant correlation (P = 0.008) between abundant SERBP1 expression in breast carcinoma and favourable prognosis. Interestingly, overall survival analysis also displayed a tendency (P = 0.09) towards favourable prognosis when SERBP1 was overexpressed in breast cancer. The RNA-binding protein SERBP1 is abundantly expressed in human breast cancer and may represent a novel breast tumour marker with prognostic significance. Its potential involvement in the

Clinical Course, Radiological Manifestations, and Outcome of Pneumocystis jirovecii Pneumonia in HIV Patients and Renal Transplant Recipients.

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Lukas Ebner

Full Text Available Pneumocystis jirovecii pneumonia (PCP is a frequent opportunistic infection in immunocompromised patients. In literature, presentation and outcome of PCP differs between patients with human immunodeficiency virus (HIV infection and renal transplant recipients (RTRs.We conducted a cross-sectional study of patients with PCP based on the HIV and renal transplant registries at our institution. Radiological and clinical data from all confirmed PCP cases between 2005 and 2012 were compared.Forty patients were included: 16 with HIV and 24 RTRs. Radiologically, HIV patients had significantly more areas of diffuse lung affection (81% HIV vs. 25% RTR; p = 0.02, more ground glass nodules 5-10 mm (69% vs. 4%; p = 80% in both groups. Duration from illness onset to hospital presentation was longer in the HIV patients (median of 18 vs. 10 days (p = 0.02, implying a less fulminant clinical course. Sixty percent of PCP cases in RTRs occurred >12 months after transplantation. Lengths of hospitalization, admission rates to the intensive care unit, and requirements for mechanical ventilation were similar. Outcome in both groups was favourable.While important differences in radiological presentation of PCP between HIV patients and RTRs were found, clinical presentation was similar. PCP only rarely presented with fulminant respiratory symptoms requiring ICU admission, with similar results and outcomes for HIV patients and RTRs. Early diagnosis and treatment is mandatory for clinical success.

Teleophthalmology: improving patient outcomes?

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Sreelatha OK

2016-02-01

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

Students developing representational competence as producers with and of augmented reality in science

DEFF Research Database (Denmark)

Nielsen, Birgitte Lund; Brandt, Harald; Swensen, Hakon

2018-01-01

This research aims to examine how augmented reality (AR) can be used in lower secondary science education. The focus is on outcomes as perceived by students and teachers from 3 rounds of piloting AR-resources, in the third round supporting students as producers of AR. Data sources are teacher...

Exercise interventions for the improvement of falls-related outcomes among older adults with diabetes mellitus: A systematic review and meta-analyses.

Science.gov (United States)

Chapman, Anna; Meyer, Claudia; Renehan, Emma; Hill, Keith D; Browning, Colette J

2017-03-01

Falls as a complication of diabetes mellitus (DM) can have a major impact on the health of older adults. Previous reviews have demonstrated that certain exercise interventions are effective at reducing falls in older people; however, no studies have quantified the effectiveness of exercise interventions on falls-related outcomes among older adults with DM. A systematic search for all years to September 2015 identified available literature. Eligibility criteria included: appropriate exercise intervention/s; assessed falls-related outcomes; older adults with DM. Effect sizes were pooled using a random effects model. Positive effect sizes favoured the intervention. Ten RCTs were eligible for the meta-analyses. Exercise interventions were more effective than the control condition for static balance (0.53, 95% CI: 0.13 to 0.93), lower-limb strength (0.63, 95% CI: 0.09 to 1.18), and gait (0.59, 95% CI: 0.22 to 0.96). No RCTs assessed falls-risk; one RCT reported 12month falls-rate, with no differential treatment effect observed. Exercise interventions can improve certain falls-related outcomes among older adults with DM. Substantial heterogeneity and limited numbers of studies should be considered when interpreting results. Among older adults, where DM burden is increasing, exercise interventions may provide promising approaches to assist the improvement of falls-related outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Happiness and health behaviours in Chilean college students: a cross-sectional survey.

NARCIS (Netherlands)

Piqueras, J.A.; Kuhne, W.; Vera-Villarroel, P.; van Straten, A.; Cuijpers, P.

2011-01-01

Background: Happiness has been associated with a range of favourable health outcomes through two pathways: its relationship with favourable biological responses to stress and with healthy lifestyles and prudent health behaviours. There are a substantial number of cross-cultural studies about

Focusing on outcomes: Making the most of COPD interventions

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Noreen M Clark

2008-10-01

Full Text Available Noreen M Clark1, Julia A Dodge1, Martyn R Partridge2, Fernando J Martinez31Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA; 2Imperial College of Science, Technology and Medicine, London, England, UK; 3Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USAAbstract: A number of excellent intervention studies related to clinical and psychosocial aspects of chronic obstructive pulmonary disease (COPD have been undertaken in the recent past. A range of outcomes have been examined including pulmonary function, health care use, quality of life, anxiety and depression, ambulation, exercise capacity, and self-efficacy. The purpose of this narrative review was to a consider clinical, psychosocial, and educational interventions for people living with COPD in light of the health related outcomes that they have produced, b identify the type of interventions most associated with outcomes, c examine work related to COPD interventions as it has evolved regarding theory and models compared to work in asthma, and d explore implications for future COPD research. Studies reviewed comprised large scale comprehensive reviews including randomized clinical trials and meta-analysis as these forms of investigation engender the greatest confidence in clinicians and health care researchers. Extant research suggests that the most significant improvements in COPD health care utilization have been realized from interventions specifically designed to enhance disease management by patients. A range of interventions have produced modest changes in quality of life. Evidence of impact for other outcomes and for a particular type of intervention is not strong. Research in other chronic diseases, particularly asthma, suggests that interventions grounded in learning theory and models of behavior change can consistently produce desired results for patients and clinicians. Use of a model of self-regulation may

Touch DNA collection versus firearm fingerprinting: comparing evidence production and identification outcomes.

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Nunn, Samuel

2013-05-01

A project by a metropolitan police agency in 2008-2009 had police use touch DNA kits to collect cell samples from seized firearms. To assess outcomes, results of touch DNA swabbing of firearms were compared to fingerprinting firearm evidence. The rationale was that fingerprinting, as the older technology, was the baseline against which to compare touch DNA. But little is known about ways to measure touch DNA productivity compared to fingerprinting. To examine differences between the two requires comparable measurements. Two measures were used: quantity of probative or investigative evidence produced and identification outcomes. When applied to firearms seized within an Indianapolis, IN police district, touch DNA produced a larger volume of evidence than fingerprinting, but identification outcomes for the two methods were equal. Because touch DNA was deployed by police patrol officers, there are implications for firearm forensics and the choice of forensic approaches used by police. © 2013 American Academy of Forensic Sciences.

Organic farming favours insect-pollinated over non-insect pollinated forbs in meadows and wheat fields.

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Batáry, Péter; Sutcliffe, Laura; Dormann, Carsten F; Tscharntke, Teja

2013-01-01

The aim of this study was to determine the relative effects of landscape-scale management intensity, local management intensity and edge effect on diversity patterns of insect-pollinated vs. non-insect pollinated forbs in meadows and wheat fields. Nine landscapes were selected differing in percent intensively used agricultural area (IAA), each with a pair of organic and conventional winter wheat fields and a pair of organic and conventional meadows. Within fields, forbs were surveyed at the edge and in the interior. Both diversity and cover of forbs were positively affected by organic management in meadows and wheat fields. This effect, however, differed significantly between pollination types for species richness in both agroecosystem types (i.e. wheat fields and meadows) and for cover in meadows. Thus, we show for the first time in a comprehensive analysis that insect-pollinated plants benefit more from organic management than non-insect pollinated plants regardless of agroecosystem type and landscape complexity. These benefits were more pronounced in meadows than wheat fields. Finally, the community composition of insect-pollinated and non-insect-pollinated forbs differed considerably between management types. In summary, our findings in both agroecosystem types indicate that organic management generally supports a higher species richness and cover of insect-pollinated plants, which is likely to be favourable for the density and diversity of bees and other pollinators.

Organic Farming Favours Insect-Pollinated over Non-Insect Pollinated Forbs in Meadows and Wheat Fields

Science.gov (United States)

Batáry, Péter; Sutcliffe, Laura; Dormann, Carsten F.; Tscharntke, Teja

2013-01-01

The aim of this study was to determine the relative effects of landscape-scale management intensity, local management intensity and edge effect on diversity patterns of insect-pollinated vs. non-insect pollinated forbs in meadows and wheat fields. Nine landscapes were selected differing in percent intensively used agricultural area (IAA), each with a pair of organic and conventional winter wheat fields and a pair of organic and conventional meadows. Within fields, forbs were surveyed at the edge and in the interior. Both diversity and cover of forbs were positively affected by organic management in meadows and wheat fields. This effect, however, differed significantly between pollination types for species richness in both agroecosystem types (i.e. wheat fields and meadows) and for cover in meadows. Thus, we show for the first time in a comprehensive analysis that insect-pollinated plants benefit more from organic management than non-insect pollinated plants regardless of agroecosystem type and landscape complexity. These benefits were more pronounced in meadows than wheat fields. Finally, the community composition of insect-pollinated and non-insect-pollinated forbs differed considerably between management types. In summary, our findings in both agroecosystem types indicate that organic management generally supports a higher species richness and cover of insect-pollinated plants, which is likely to be favourable for the density and diversity of bees and other pollinators. PMID:23382979

P3-10: Crossmodal Perceptual Grouping Modulates Subjective Causality between Action and Outcome

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Takahiro Kawabe

2012-10-01

Full Text Available Agents have to determine which external events their action has causally produced. A sensation of causal relation between action and outcome is called subjective causality. Subjective causality has been linked to the comparator model. This model assumes that the brain compares an internal prediction for action outcome with an actual sensory outcome, distinguishing between self and externally produced outcomes depending on spatiotemporal congruency. However, recent studies have expressed some doubt about the idea that subjective causality arises depending solely on the spatiotemporal congruency, suggesting instead that other perceptual/cognitive factors play a critical role in determining subjective causality. We hypothesized that crossmodal grouping between action and outcome contributed to subjective causality. Crossmodal temporal grouping is an essential factor for crossmodal simultaneity judgments with ungrouped crossmodal signals likely to be judged as non-simultaneous. We predicted that subjective causality would decrease when an agent's action was not temporally grouped with action outcome. In the experiment, observers were asked to press a key in order to trigger a display change with some temporal delay. To disrupt temporal grouping between action and outcome, a task-irrelevant visual flash or tone was sometimes presented synchronously with the button press and/or the display change. Subjective causality was decreased when the flash or the tone was coincided with the button press. This demonstrates that perceptual grouping has a key role in determination of subjective causality, a result that is not accounted for by the standard comparator model.

Single Fraction Stereotactic Ablative Body Radiotherapy for Oligometastasis: Outcomes from 132 Consecutive Patients.

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Gandhidasan, S; Ball, D; Kron, T; Bressel, M; Shaw, M; Chu, J; Chander, S; Wheeler, G; Plumridge, N; Chesson, B; David, S; Siva, S

2018-03-01

Stereotactic ablative body radiotherapy (SABR) is currently used to treat oligometastases, but the optimum dose/fractionation schedule is unknown. In this study, we evaluated outcomes after single fraction SABR in patients with oligometastatic disease. Single institutional retrospective review of patients treated with single fraction SABR for one to three oligometastases between 2010 and 2015. The primary outcome was freedom from widespread disease defined as distant recurrence not amenable to surgery or SABR; or recurrence with four or more metastases. In total, 186 treatments were delivered in 132 patients. The two most common target sites were lung (51%) and bone (40%). The most frequent single fraction prescription dose was 26 Gy (47%). The most common primary malignancy was genitourinary (n = 46 patients). Freedom from widespread disease was 75% at 1 year (95% confidence interval 67-83%) and 52% at 2 years (95% confidence interval 42-63%). Freedom from local progression at 1 year was 90% (95% confidence interval 85-95%) and at 2 years was 84% (95% confidence interval 77-91%). A compression fracture of the lumbar vertebra was the only grade 3+ treatment-related toxicity. Single fraction SABR is associated with a high rate of freedom from widespread disease, favourable local control and low toxicity comparable with historic multi-fraction SABR reports. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

First attempt to assess the viability of bluefin tuna spawning events in offshore cages located in an a priori favourable larval habitat

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Patricia Reglero

2013-10-01

Full Text Available Most of the Atlantic bluefin tuna caught by the purse-seine fleet in the Mediterranean Sea are transferred alive into transport cages and towed to coastal facilities where they are fattened. This major fishery is targeting aggregations of reproductive bluefin tuna that continue spawning within the transport cages. Our study is the first attempt to assess the viability of the spawning events within transport cages placed offshore in a priori favourable locations for larval survival. The study was conducted in June 2010 in the Balearic Sea, a main spawning area for bluefin tuna in the Mediterranean. The location of two transport cages, one with wild and one with captive tuna, coincide with the situation of the chlorophyll front using satellite imagery as a proxy for the salinity front between resident surface waters and those of recent Atlantic origin. The results showed that bluefin tuna eggs were spawned almost every day within the two cages but few or no larvae were found. The expected larval densities estimated after applying mortality curves to the daily egg densities observed in the cages were higher than the sampled larval densities. The trajectories of the eggs after hatching estimated from a particle tracking model based on observed geostrophic currents and a drifter deployed adjacent to the cage suggest that larvae were likely to be caught close to the cages within the sampling dates. Spawning events in captive tuna in transport cages may hatch into larvae though they may experience higher mortality rates than expected in natural populations. The causes of the larval mortality are further discussed in the text. Such studies should be repeated in other spawning areas in the Mediterranean if spawning in cages located offshore in areas favourable a priori for larval survival is likely to be considered a management measurement to minimize the impact of purse-seine fishing on tuna.

Improved Outcomes with Intensity Modulated Radiation Therapy Combined with Temozolomide for Newly Diagnosed Glioblastoma Multiforme

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Noel J. Aherne

2014-01-01

Full Text Available Purpose. Glioblastoma multiforme (GBM is optimally treated by maximal debulking followed by combined chemoradiation. Intensity modulated radiation therapy (IMRT is gaining widespread acceptance in other tumour sites, although evidence to support its use over three-dimensional conformal radiation therapy (3DCRT in the treatment of gliomas is currently lacking. We examined the survival outcomes for patients with GBM treated with IMRT and Temozolomide. Methods and Materials. In all, 31 patients with GBM were treated with IMRT and 23 of these received chemoradiation with Temozolomide. We correlated survival outcomes with patient functional status, extent of surgery, radiation dose, and use of chemotherapy. Results. Median survival for all patients was 11.3 months, with a median survival of 7.2 months for patients receiving 40.05 Gray (Gy and a median survival of 17.4 months for patients receiving 60 Gy. Conclusions. We report one of the few series of IMRT in patients with GBM. In our group, median survival for those receiving 60 Gy with Temozolomide compared favourably to the combined therapy arm of the largest randomised trial of chemoradiation versus radiation to date (17.4 months versus 14.6 months. We propose that IMRT should be considered as an alternative to 3DCRT for patients with GBM.

Improved outcomes with intensity modulated radiation therapy combined with temozolomide for newly diagnosed glioblastoma multiforme.

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Aherne, Noel J; Benjamin, Linus C; Horsley, Patrick J; Silva, Thomaz; Wilcox, Shea; Amalaseelan, Julan; Dwyer, Patrick; Tahir, Abdul M R; Hill, Jacques; Last, Andrew; Hansen, Carmen; McLachlan, Craig S; Lee, Yvonne L; McKay, Michael J; Shakespeare, Thomas P

2014-01-01

Purpose. Glioblastoma multiforme (GBM) is optimally treated by maximal debulking followed by combined chemoradiation. Intensity modulated radiation therapy (IMRT) is gaining widespread acceptance in other tumour sites, although evidence to support its use over three-dimensional conformal radiation therapy (3DCRT) in the treatment of gliomas is currently lacking. We examined the survival outcomes for patients with GBM treated with IMRT and Temozolomide. Methods and Materials. In all, 31 patients with GBM were treated with IMRT and 23 of these received chemoradiation with Temozolomide. We correlated survival outcomes with patient functional status, extent of surgery, radiation dose, and use of chemotherapy. Results. Median survival for all patients was 11.3 months, with a median survival of 7.2 months for patients receiving 40.05 Gray (Gy) and a median survival of 17.4 months for patients receiving 60 Gy. Conclusions. We report one of the few series of IMRT in patients with GBM. In our group, median survival for those receiving 60 Gy with Temozolomide compared favourably to the combined therapy arm of the largest randomised trial of chemoradiation versus radiation to date (17.4 months versus 14.6 months). We propose that IMRT should be considered as an alternative to 3DCRT for patients with GBM.

Diversity and natural functions of antibiotics produced by beneficial and plant pathogenic bacteria.

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Raaijmakers, Jos M; Mazzola, Mark

2012-01-01

Soil- and plant-associated environments harbor numerous bacteria that produce antibiotic metabolites with specific or broad-spectrum activities against coexisting microorganisms. The function and ecological importance of antibiotics have long been assumed to yield a survival advantage to the producing bacteria in the highly competitive but resource-limited soil environments through direct suppression. Although specific antibiotics may enhance producer persistence when challenged by competitors or predators in soil habitats, at subinhibitory concentrations antibiotics exhibit a diversity of other roles in the life history of the producing bacteria. Many processes modulated by antibiotics may be inherently critical to the producing bacterium, such as the acquisition of substrates or initiation of developmental changes that will ensure survival under stressful conditions. Antibiotics may also have roles in more complex interactions, including in virulence on host plants or in shaping the outcomes of multitrophic interactions. The innate functions of antibiotics to producing bacteria in their native ecosystem are just beginning to emerge, but current knowledge already reveals a breadth of activities well beyond the historical perspective of antibiotics as weaponry in microbial conflicts.

Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer.

Science.gov (United States)

Hartwig, W; Gluth, A; Hinz, U; Koliogiannis, D; Strobel, O; Hackert, T; Werner, J; Büchler, M W

2016-11-01

In the recent International Study Group of Pancreatic Surgery (ISGPS) consensus on extended pancreatectomy, several issues on perioperative outcome and long-term survival remained unclear. Robust data on outcomes are sparse. The present study aimed to assess the outcome of extended pancreatectomy for borderline resectable and locally advanced pancreatic cancer. A consecutive series of patients with primary pancreatic adenocarcinoma undergoing extended pancreatectomies, as defined by the new ISGPS consensus, were compared with patients who had a standard pancreatectomy. Univariable and multivariable analysis was performed to identify risk factors for perioperative mortality and characteristics associated with survival. Long-term outcome was assessed by means of Kaplan-Meier analysis. The 611 patients who had an extended pancreatectomy had significantly greater surgical morbidity than the 1217 patients who underwent a standard resection (42·7 versus 34·2 per cent respectively), and higher 30-day mortality (4·3 versus 1·8 per cent) and in-hospital mortality (7·5 versus 3·6 per cent) rates. Operating time of 300 min or more, extended total pancreatectomy, and ASA fitness grade of III or IV were associated with increased in-hospital mortality in multivariable analysis, whereas resections involving the colon, portal vein or arteries were not. Median survival and 5-year overall survival rate were reduced in patients having extended pancreatectomy compared with those undergoing a standard resection (16·1 versus 23·6 months, and 11·3 versus 20·6 per cent, respectively). Older age, G3/4 tumours, two or more positive lymph nodes, macroscopic positive resection margins, duration of surgery of 420 min or above, and blood loss of 1000 ml or more were independently associated with decreased overall survival. Extended resections are associated with increased perioperative morbidity and mortality, particularly when extended total pancreatectomy is performed. Favourable

Clinical long-term outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in infants.

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Schleihauf, Julia; Cleuziou, Julie; Pabst von Ohain, Jelena; Meierhofer, Christian; Stern, Heiko; Shehu, Nerejda; Mkrtchyan, Naira; Kaltenecker, Emanuel; Kühn, Andreas; Nagdyman, Nicole; Hager, Alfred; Seidel, Heide; Lange, Rüdiger; Ewert, Peter; Wolf, Cordula M

2018-03-01

Surgical septal myectomy is performed to relieve left ventricular outflow tract narrowing in severe drug-refractory obstructive hypertrophic cardiomyopathy. The objective of this study was to assess the perioperative and long-term clinical outcome of this procedure performed during infancy. Clinical, transthoracic echocardiographic, electrocardiographic, 24-h Holter, cardiopulmonary exercise test and genetic data were extracted by medical record review. A subset of patients underwent additional prospective detailed clinical evaluation including cardiac magnetic resonance imaging with contrast. Surgery was performed in 23 paediatric patients between 1978 and 2015 at the German Heart Centre Munich. Twelve patients had undergone surgery during infancy (≤ 1 year) (Group A), 11 between 1 and 18 years of age (Group B). The underlying genetic diagnosis was Noonan syndrome spectrum and non-syndromic hypertrophic cardiomyopathy. As compared to Group B, patients in Group A showed more concomitant cardiac procedures and received more homologous transfusions. One perioperative death occurred in Group A, and none in Group B. Two patients in Group A but no patient in Group B required redo septal myectomy. The long-term clinical outcome was similar between the 2 groups. One patient in Group B required cardioverter-defibrillator/pacemaker implantation for higher degree atrioventricular block and none in Group A. There was no evidence of differences in myocardial fibrosis between groups on long-term follow-up magnetic resonance imaging. Surgical septal myectomy can be performed safely during infancy with favourable perioperative and long-term clinical outcome but with a trend towards a higher reoperation rate later in life. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Pathogenic mechanisms linking periodontal diseases with adverse pregnancy outcomes.

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Cetin, I; Pileri, P; Villa, A; Calabrese, S; Ottolenghi, L; Abati, S

2012-06-01

In the last 2 decades, a large proportion of studies have focused on the relationship between maternal periodontal disease and poor obstetric outcomes. The aim of the present review is to summarize the current knowledge about human studies on the pathogenetic mechanisms linking periodontal diseases with adverse pregnancy outcomes. A search of the medical literature was conducted using NIH (National Institute of Health) Pubmed through April 2011. Articles were identified with the Medical Subject Heading (MeSH) and free text terms "small for gestational age (SGA)," "preeclampsia," "preterm labor," and "periodontal disease." Experimental human studies have shown that periodontal pathogens may disseminate toward placental and fetal tissues accompanied by an increase in inflammatory mediators in the placenta. As such, new inflammatory reactions within the placental tissues of the pregnant woman may occur, the physiological levels of prostaglandin E(2) (PGE(2)) and tumor necrosis factor-α (TNF-α) in the amniotic fluid may increase and eventually lead to premature delivery. Although many data from clinical trials suggest that periodontal disease may increase the adverse pregnancy outcome, the exact pathogenetic mechanism involved remains controversial. The findings explain the potential link between periodontal infections and adverse pregnancy outcomes. First, periodontal bacteria can directly cause infections both of the uteroplacenta and the fetus; second, systemic inflammatory changes induced by periodontal diseases can activate responses at the maternal-fetal interface. Of note, associative studies have produced different results in different population groups and no conclusive evidence has still been produced for the potential role of preventive periodontal care to reduce the risk factors of preterm birth.

Calculation of X-ray emission produced by a quasi-monoenergetic electron distribution

International Nuclear Information System (INIS)

Fanaei, M.; Sadighi-Bonabi, R.

2010-01-01

Complete text of publication follows. By using an intense ultrafast laser interaction with plasma, generation of accelerated relativistic electrons with quasi monoenergetic spectrum has been possible. Analytic expressions for spectra and emission efficiencies of x-rays bremsstrahlung and characteristic line emission produced by a quasi-monoenergetic electron distribution from several targets are investigated. In this work, a Gaussian profile is assumed for the quasi-monoenergetic electron spectrum. The produced x-ray radiations are compared with the previous achieved results for a Maxwellian electron profile. These results and achievements are discussed in detail. Also, the outcomes can be evaluated with the experimental and simulated results.

How well does early-career investigators' cardiovascular outcomes research training align with funded outcomes research?

Science.gov (United States)

Crowley, Matthew J; Al-Khatib, Sana M; Wang, Tracy Y; Khazanie, Prateeti; Kressin, Nancy R; Krumholz, Harlan M; Kiefe, Catarina I; Wells, Barbara L; O'Brien, Sean M; Peterson, Eric D; Sanders, Gillian D

2018-02-01

Outcomes research training programs should prepare trainees to successfully compete for research funding. We examined how early-career investigators' prior and desired training aligns with recently funded cardiovascular (CV) outcomes research. We (1) reviewed literature to identify 13 core competency areas in CV outcomes research; (2) surveyed early-career investigators to understand their prior and desired training in each competency area; (3) examined recently funded grants commonly pursued by early-career outcomes researchers to ascertain available funding in competency areas; and (4) analyzed alignment between investigator training and funded research in each competency area. We evaluated 185 survey responses from early-career investigators (response rate 28%) and 521 funded grants from 2010 to 2014. Respondents' prior training aligned with funded grants in the areas of clinical epidemiology, observational research, randomized controlled trials, and implementation/dissemination research. Funding in community-engaged research and health informatics was more common than prior training in these areas. Respondents' prior training in biostatistics and systematic review was more common than funded grants focusing on these specific areas. Respondents' desired training aligned similarly with funded grants, with some exceptions; for example, desired training in health economics/cost-effectiveness research was more common than funded grants in these areas. Restricting to CV grants (n=132) and National Heart, Lung, and Blood Institute-funded grants (n=170) produced similar results. Identifying mismatch between funded grants in outcomes research and early-career investigators' prior/desired training may help efforts to harmonize investigator interests, training, and funding. Our findings suggest a need for further consideration of how to best prepare early-career investigators for funding success. Copyright © 2017. Published by Elsevier Inc.

Associations between blood glucose level and outcomes of adult in-hospital cardiac arrest: a retrospective cohort study.

Science.gov (United States)

Wang, Chih-Hung; Huang, Chien-Hua; Chang, Wei-Tien; Tsai, Min-Shan; Yu, Ping-Hsun; Wu, Yen-Wen; Chen, Wen-Jone

2016-08-24

We intended to analyse the associations between blood glucose (BG) level and clinical outcomes of in-hospital cardiac arrest (IHCA). We conducted a retrospective observational study in a single medical centre and evaluated patients who experienced IHCA between 2006 and 2014. We used multivariable logistic regression analysis to study associations between independent variables and outcomes. We calculated the mean BG level for each patient by averaging the maximum and minimum BG levels in the first 24 h after arrest, and we used mean BG level for our final analysis. We included a total of 402 patients. Of these, 157 patients (39.1 %) had diabetes mellitus (DM). The average mean BG level was 209.9 mg/dL (11.7 mmol/L). For DM patients, a mean BG level between 183 and 307 mg/dL (10.2-17.1 mmol/L) was significantly associated with favourable neurological outcome (odds ratio [OR] 2.71, 95 % confidence interval [CI] 1.18-6.20; p value = 0.02); a mean BG level between 147 and 317 mg/dL (8.2-17.6 mmol/L) was significantly associated with survival to hospital discharge (OR 2.38, 95 % CI 1.26-4.53; p value = 0.008). For non-DM patients, a mean BG level between 143 and 268 mg/dL (7.9-14.9 mmol/L) was significantly associated with survival to hospital discharge (OR 2.93, 95 % CI 1.62-5.40; p value level in the first 24 h after cardiac arrest was associated with neurological outcome for IHCA patients with DM. For neurological and survival outcomes, the optimal BG range may be higher for patients with DM than for patients without DM.

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

Science.gov (United States)

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

1980-07-01

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

Returns on investment in electricity producing photovoltaic systems under de-escalating feed-in tariffs. The case of Greece

International Nuclear Information System (INIS)

Danchev, Svetoslav; Maniatis, George; Tsakanikas, Aggelos

2010-01-01

Under the threat of ballooning energy bills, the Greek legal framework supporting the electricity producing photovoltaic systems (PVS) changed in January 2009 from a fixed to a de-escalating feed-in tariff schedule. In this paper we investigate the internal rate of return (IRR) on investing in PVS under the new regulatory environment. We find that the new scheme favours strongly the early entry in the market. Unless there is a significant decrease in the equipment cost over the next decade, entering the market from 2015 onwards will be prohibitive. The bias of the current policy design towards early entry in a rapidly developing set of technologies entails the risk of a lock-up with sub-optimal technological option. This outlines the importance for policy design of linking the rate of feed-in-tariff de-escalation to more realistic expectations regarding the technology learning curve. (author)

Consequences of corporal punishment among African Americans: the importance of context and outcome.

Science.gov (United States)

Simons, Leslie Gordon; Simons, Ronald L; Su, Xiaoli

2013-08-01

Corporal punishment is a controversial practice used by the majority of American parents and is especially prevalent among African Americans. Research regarding its consequences has produced mixed results although it is clear that there is a need for considering the context within which corporal punishment is administered. To assess the impact of spanking, we employed an expanded parenting typology that includes corporal punishment. Longitudinal self-report data from a sample of 683 African American youth (54% female) were utilized to evaluate the relative impact of the resulting eight parenting styles on three outcomes: conduct problems, depressive symptoms, and school engagement. Results from Negative Binomial Regression Models indicate that the effect of corporal punishment depends upon the constellation of parenting behaviors within which it is embedded and upon the type of outcome being considered. While it is never the case that there is any added benefit of adding corporal punishment, it is also the case that using corporal punishment is not always associated with poor outcomes. Overall, however, our findings show that parenting styles that include corporal punishment do not produce outcomes as positive as those associated with authoritative parenting.

Plant Hormone Salicylic Acid Produced by a Malaria Parasite Controls Host Immunity and Cerebral Malaria Outcome.

Directory of Open Access Journals (Sweden)

Ryuma Matsubara

Full Text Available The apicomplexan parasite Toxoplasma gondii produces the plant hormone abscisic acid, but it is unclear if phytohormones are produced by the malaria parasite Plasmodium spp., the most important parasite of this phylum. Here, we report detection of salicylic acid, an immune-related phytohormone of land plants, in P. berghei ANKA and T. gondii cell lysates. However, addition of salicylic acid to P. falciparum and T. gondii culture had no effect. We transfected P. falciparum 3D7 with the nahG gene, which encodes a salicylic acid-degrading enzyme isolated from plant-infecting Pseudomonas sp., and established a salicylic acid-deficient mutant. The mutant had a significantly decreased concentration of parasite-synthesized prostaglandin E2, which potentially modulates host immunity as an adaptive evolution of Plasmodium spp. To investigate the function of salicylic acid and prostaglandin E2 on host immunity, we established P. berghei ANKA mutants expressing nahG. C57BL/6 mice infected with nahG transfectants developed enhanced cerebral malaria, as assessed by Evans blue leakage and brain histological observation. The nahG-transfectant also significantly increased the mortality rate of mice. Prostaglandin E2 reduced the brain symptoms by induction of T helper-2 cytokines. As expected, T helper-1 cytokines including interferon-γ and interleukin-2 were significantly elevated by infection with the nahG transfectant. Thus, salicylic acid of Plasmodium spp. may be a new pathogenic factor of this threatening parasite and may modulate immune function via parasite-produced prostaglandin E2.

Outcome and prognostic factors in breast sarcoma: A multicenter study from the rare cancer network

International Nuclear Information System (INIS)

Bousquet, Guilhem; Confavreux, Cyril; Magne, Nicolas; Tunon de Lara, Christine; Poortmans, Philip; Senkus, Elzbieta; Lafontan, Brigitte de; Bolla, Michel; Largillier, Remy; Lagneau, Edouard; Kadish, Sidney; Lemanski, Claire; Ozsahin, Mahmut; Belkacemi, Yazid

2007-01-01

Background and purpose: Breast sarcoma (BS) is a rare tumour. While surgical resection is the primary treatment, the role of radiation therapy (RT) and chemotherapy remains unclear. This study aimed at defining prognostic factors and treatment strategies. Materials and methods: Data from 103 patients treated between 1976 and 2002 were collected. The median age was 55 years (range: 13-86); the median histological tumour size was 4.45 cm (range: 0.8-22). There were 42 angiosarcomas. Surgery consisted of wide excision in 34 cases, and total mastectomy in 69 cases. A total dose of 50 Gy in 25 fractions was delivered in 50 patients. At the completion of treatment, 89 patients had no residual tumour. Results: After a median follow-up of 64 months, 56 patients developed recurrent disease: 38 presented a local relapse and 37 developed distant metastases. The 5-year disease-free survival (DFS) and overall survival (OS) were 44% (95% confidence interval [CI], 39-49%) and 55% (95% CI, 50-60%), respectively. In multivariate analysis, favourable prognostic factors for better local control were: no residual tumour after treatment, no cellular pleomorphism, and histology other than angiosarcoma. For DFS, the five favourable prognostic factors were non-menopausal status, no residual tumour after treatment, non-angiosarcoma histology, absence of tumour necrosis, and grade 1-2 histology. Conclusion: While angiosarcoma has the worst prognosis, the outcome of the other types of sarcomas may be worsened by residual tumour after loco-regional treatment and high grade histology, a classical prognostic factor of the other soft tissue sarcomas. During surgical procedure axillary dissection is not mandatory

Outcome of limbic encephalitis with VGKC-complex antibodies: relation to antigenic specificity.

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Malter, M P; Frisch, C; Schoene-Bake, J C; Helmstaedter, C; Wandinger, K P; Stoecker, W; Urbach, H; Surges, R; Elger, C E; Vincent, A V; Bien, C G

2014-09-01

In limbic encephalitis (LE) with antibodies (Abs) to the voltage-gated potassium channel complex (VGKC), the Abs are mainly directed to the VGKC-complex proteins, leucine-rich, glioma inactivated 1 protein (LGI1) or contactin-associated protein-like 2 (CASPR-2) or neither. Here, we relate the outcomes of VGKC-LE patients to the presence of Abs to LGI1, CASPR-2 or neither antigen (LGI1/CASPR-2-Ab(-)). Clinical, neuropsychology and MRI data were obtained from patient records for all LE patients from the Bonn Epilepsy Centre positive for VGKC-Abs by radioimmunoprecipitation assay between 2002 and 2011. Eighteen VGKC-LE patients were identified: nine patients (50 %) had LGI1-Abs, three (16 %) had CASPR-2-Abs; and six (33 %) were negative for both LGI1- and CASPR-2-Abs. At first assessment, the groups did not differ clinically or radiologically, but faciobrachial dystonic seizures were only observed in two LGI1-Ab(+) patients. All patients received monthly intravenous methylprednisolone (MP) pulses. At the most recent follow up (median 26 months), thirteen (72 %) were seizure-free, and seizure-freedom rates did not differ between the Ab groups. Hippocampal atrophy had developed in 7/9 LGI1-Ab(+) patients, but in none of the CASPR-2-Ab(+) or LGI/CASPR-2-Ab(-) patients (p = 0.003). While all subgroups improved, memory scores only normalized in six patients (33 %) and LGI1-Ab(+) patients were left with significantly poorer memory than the other two subgroups. Most VGKC-LE patients become seizure-free with pulsed monthly MP, but memory outcome is less favourable. Hippocampal atrophy and poor memory recovery is common in patients with LGI1-Abs and suggests permanent functional damage. More intense immunotherapies could improve outcomes in LGI1-Ab(+)-LE.

A Systematic Review of Animal-Assisted Therapy on Psychosocial Outcomes in People with Intellectual Disability.

Science.gov (United States)

Maber-Aleksandrowicz, Sarah; Avent, Cerian; Hassiotis, Angela

2016-01-01

The aim of the study was to review the literature on animal assisted therapy (AAT) in people with intellectual disabilities (ID) measuring psychosocial outcomes (behavioural, social, cognitive and emotional). Quantitative studies were found through a systematic search that identified studies using AAT in people with ID and measuring psychosocial outcomes (behavioural, cognitive, emotional and social). The quality of studies was assessed using a standardised tool and rated as strong, moderate or weak. Only published articles from peer-reviewed journals were included. No language or age restrictions were applied. Over half of the included studies were identified outside standard database searches (e.g. hand searching reference lists from included articles, references from AAT websites and using Google Scholar and a Grey Literature Database). Ten studies were included in the final review; two were rated as moderate quality and eight were rated as weak quality. Overall there was a positive improvement reported from studies for all psychosocial outcomes (with some cognitive, behavioural, social, emotional components reaching statistical significance p ≤ 0.01). Despite having no age restrictions, the included studies had participants that were mainly children and adolescents, in particular favouring male participants, which may limit generalisation. More rigorous methodology is required to improve the quality of future studies including in the main multicentre randomised designs and improved reporting according to CONSORT criteria. Further research should expand to include adults with ID and specific disorders such as challenging behaviour or mental illness. Copyright © 2015 Elsevier Ltd. All rights reserved.

Resurgence of Acanthamoeba keratitis in Auckland, New Zealand: a 7-year review of presentation and outcomes.

Science.gov (United States)

Patel, Dipika V; Rayner, Sandra; McGhee, Charles N J

2010-01-01

To investigate the presentation, clinical characteristics and outcomes of Acanthamoeba keratitis (AK) in Auckland, New Zealand over a 7-year period. Retrospective analysis of all cases of AK treated by the tertiary corneal service at Auckland City Hospital/ University of Auckland Department of Ophthalmology (August 2001 to May 2008). Data were collected regarding age, gender, contact lens history, presenting signs and symptoms, diagnosis at first presentation, time to final diagnosis, identifiable risk factors, presenting and final visual acuity, results of microbiological testing, medical treatment, surgical interventions, recurrence of disease and length of follow up. All photographs and in vivo confocal microscopy images were reviewed. Twenty-five eyes of 25 patients were identified with a diagnosis of AK (mean age 40 +/- 13 years). Ninety-six per cent were contact lens wearers. Mean time to diagnosis was 41 +/- 49 days (range 0-181 days, median 21 days). Fourteen patients (56%) had been treated with topical corticosteroids prior to the diagnosis. Early diagnosis of AK (New Zealand in the current decade. This study highlights the fundamental importance of early diagnosis and appropriate management in ensuring favourable outcomes. Practitioners should maintain a clinical suspicion of AK, especially as 96% of the subjects in this study were contact lens wearers.

Russian ElectroKhimPribor integrated plant - producer and supplier of enriched stable isotopes

International Nuclear Information System (INIS)

Tatarinov, A.N.; Polyakov, L.A.

1997-01-01

Russian ElectroKhimPribor Integrated Plant, as well as ORNL, is a leading production which manufactures and supplied to the world market such specific products as stable isotopes. More than 200 isotopes of 44 elements can be obtained at its electromagnetic separator. Changes being underway for a few last years in Russia affected production and distribution of stable isotopes. There arose a necessity in a new approach to handling work in this field so as to create favourable conditions for both producers and customers. As a result, positive changes in calutron operation at ElectroKhimPribor has been reached; quality management system covering all stages of production has been set up; large and attractive stock of isotopes has been created; prospective scientific isotope-based developments are taken into account when planning separation F campaigns; executing the contracts is guaranteed; business philosophy has been changed to meet maximum of customer needs. For more than forty years ElectroKhimPribor have had no claim from customers as to quality of products or implementing contracts. Supplying enriched stable isotopes virtually to all the world's leading customers, ElectroKhimPribor cooperates successfully with Canadian company Trace Science since 1996

Outcome after intensive reinduction therapy and allogeneic stem cell transplant in paediatric relapsed acute myeloid leukaemia

DEFF Research Database (Denmark)

Karlsson, Lene; Forestier, Erik; Hasle, Henrik

2017-01-01

Given that 30-40% of children with acute myeloid leukaemia (AML) relapse after primary therapy it is important to define prognostic factors and identify optimal therapy. From 1993 to 2012, 543 children from the Nordic countries were treated according to two consecutive protocols: 208 children...... relapsed. The influence of disease characteristics, first line treatment, relapse therapy and duration of first remission on outcome was analysed. Second complete remission (CR2) was achieved in 146 (70%) patients. Estimated 5-year overall survival (OS5y ) was 39 ± 4% for the whole group and 43 ± 4......, no allogeneic stem cell transplantation (SCT) in first remission and core binding factor AML were independent favourable prognostic factors for survival. For the 128 children (124 in CR2) that received SCT as consolidation therapy after relapse, OS5y was 61 ± 5%. Four of 19 children (21%) survived without...

Favourable effect of TNF-alpha inhibitor (infliximab) on Blau syndrome in monozygotic twins with a de novo CARD15 mutation

DEFF Research Database (Denmark)

Milman, Nils; Andersen, Claus B; Hansen, Annette

2006-01-01

Blau syndrome is a hereditary granulomatous disease caused by mutations in the CARD15 gene that is diagnosed in children of young age with exanthema/erythema, arthritis/periarthritis and/or uveitis. We report two cases of Blau syndrome in Danish Caucasian monozygotic male twins, exhibiting...... a heterozygous de novo R334W mutation in codon 334 of CARD15. The patients were initially diagnosed as having sarcoidosis. In both twins, symptoms (exanthema, arthritis/periarthritis) started at 1 year of age, and were followed by uveitis at 7-10 years of age. There was no involvement of the lungs or other...... quality of life. At follow up at 20 years of age (after 2-5 years of infliximab treatment) the twins had an almost normal physical appearance and a normal psychomotoric development, indicating a favourable short-term prognosis of the disease. Blau syndrome has pathologic, clinical and therapeutic features...

THE FORM OF THE COOKING VESSEL AND THE ENERGETIC EFFICIENCY OF COOKING

Directory of Open Access Journals (Sweden)

PAUL KRÄMER

2009-09-01

Full Text Available The present paper examines the contribution of the form of the cooking vessel to the heat transfer efficiency of the stove/pot system. A rounded (convex pot bottom increases the surface available for heat transfer and, hence, heat transfer efficiency. We suggest that combustion-efficient stoves combined with rounded-bottom vessels compare favourably to the same stoves in combination with flat-bottom stoves. Clay pots with a rounded bottom correspond to African traditions. Nowadays metal pots with rounded bottoms are locally produced in some areas. Implications of pot forms for the outcome of Water Boiling Tests are also discussed.

Melanoma patients with unknown primary site or nodal recurrence after initial diagnosis have a favourable survival compared to those with synchronous lymph node metastasis and primary tumour.

Directory of Open Access Journals (Sweden)

Benjamin Weide

Full Text Available BACKGROUND: A direct comparison of prognosis between patients with regional lymph node metastases (LNM detected synchronously with the primary melanoma (primary LNM, patients who developed their first LNM subsequently (secondary LNM and those with initial LNM in melanoma with unknown primary site (MUP is missing thus far. PATIENTS AND METHODS: Survival of 498 patients was calculated from the time point of the first macroscopic LNM using Kaplan Meier and multivariate Cox hazard regression analysis. RESULTS: Patients with secondary LNM (HR = 0.67; p = 0.009 and those with initial LNM in MUP (HR = 0.45; p = 0.008 had a better prognosis compared to patients with primary LNM (median survival time 52 and 65 vs. 24 months, respectively. A high number of involved nodes, the presence of in-transit/satellite metastases and male gender had an additional independent unfavourable effect. CONCLUSIONS: Survival of patients with LNM in MUP and with secondary LNM is similar and considerably more favourable compared to those with primary LNM. This difference needs to be considered during patient counselling and for stratification purposes in clinical trials. The assumption of an immune privilege of patients with MUP which is responsible for rejection of the primary melanoma, and results in a favourable prognosis is not supported by our data.

Rice husk ash with high carbon content proves favourable for soil stabilization

NARCIS (Netherlands)

Pham, P.V.; van der Star, WRL; van Paassen, L.A.; Ye, G.

2015-01-01

Rice husk ash is a promising pozzolanic material produced from rice husk burning and has significant potential a sustainable replacement for cement in construction and ground improvement applications. In this study the effect of burning conditions on the ash reactivity and its potential for soil

Overcoming the tyranny of distance: An audit of process and outcomes from a pilot telehealth spinal assessment clinic.

Science.gov (United States)

Beard, Matthew; Orlando, Joseph F; Kumar, Saravana

2017-09-01

Introduction There is consistent evidence to indicate people living in rural and remote regions have limited access to healthcare and poorer health outcomes. One way to address this inequity is through innovative models of care such as telehealth. The aim of this pilot trial was to determine the feasibility, appropriateness and access to a telehealth clinic. In this pilot trial, the telehealth clinic outcomes are compared with the outreach clinic. Both models of care are commonly utilised means of providing healthcare to meet the needs of people living in rural and remote regions. Methods A prospective audit was conducted on a Spinal Assessment Clinic Telehealth pilot trial for patients with spinal disorders requiring non-urgent surgical consultation. Data were recorded from all consultations managed using videoconferencing technology between the Royal Adelaide Hospital and Port Augusta Community Health Service, South Australia between September 2013 and January 2014. Outcomes included analysis of process, service activity, clinical actions, safety and costs. Data were compared to a previous spinal assessment outreach clinic in the same area between August and December 2012. Results There were 25 consultations with 22 patients over the five-month telehealth pilot trial. Spinal disorders were predominantly of the lumbar region (88%); the majority of initial consultations (64%) were discharged to the general practitioner. There were three requests for further imaging, five for minor interventions and three for other specialist/surgical consultation. Patient follow-up post telehealth pilot trial revealed no adverse outcomes. The total cost of AUD$11,187 demonstrated a 23% reduction in favour of the spinal assessment telehealth pilot trial, with the greatest savings in travel costs. Discussion The telehealth model of care demonstrated the efficient management of patients with spinal disorders in rural regions requiring non-urgent surgical consultation at low costs with

Do time of birth, unit volume, and staff seniority affect neonatal outcome in deliveries at ≥34+0 weeks of gestation?

Science.gov (United States)

Reif, P; Pichler, G; Griesbacher, A; Lehner, G; Schöll, W; Lang, U; Hofmann, H; Ulrich, D

2018-06-01

We investigated whether time of birth, unit volume, and staff seniority affect neonatal outcome in neonates born at ≥34 +0 weeks of gestation. Population-based prospective cohort study. Ten public hospitals in the Austrian province of Styria. A total of 87 065 neonates delivered in the period 2004-2015. Based on short-term outcome data, generalised linear mixed models were used to calculate the risk for adverse and severely adverse neonatal outcomes according to time of birth, unit volume, and staff seniority. Neonatal composite adverse and severely adverse outcome measures. The odds ratio for severely adverse events during the night-time (22:01-07:29 hours) compared with the daytime (07:30-15:00 hours) was 1.35 (95% confidence interval, 95% CI 1.13-1.61). There were no significant differences in neonatal outcome comparing weekdays and weekends, and comparing office hours and shifts. Units with 500-1000 deliveries per year had the lowest risk for adverse events. Adverse and severely adverse neonatal outcomes were least common for midwife-guided deliveries, and became more frequent with the level of experience of the doctors attending the delivery. With increasing pregnancy risks, senior staff attending delivery and delivering in a tertiary centre reduce the odds ratio for adverse events. Different times of delivery were associated with increased adverse neonatal outcomes. The management of uncomplicated deliveries by less experienced staff showed no negative impact on perinatal outcome. In contrast, riskier pregnancies delivered by senior staff in a tertiary centre favour a better outcome. Achieving a better balance in the total number of labour ward staff during the day and the night appears to be a greater priority than increasing the continuous presence of senior obstetrical staff on the labour ward during the out-of-hours period. Deliveries during night time lead to a greater number of neonates experiencing severely adverse events. © 2017 Royal College of

Schools, Skills and Economic Development: Education Policies, Student Learning and Socioeconomic Outcomes in Developing Countries. Bulletin.

Science.gov (United States)

Glewwe, Paul

This paper reviews recent research on the determinants of educational outcomes and the impact of those outcomes on other socioeconomic phenomena. It investigates the relationship between education and economic growth and development in emerging countries. The paper addresses school policies that are most cost-effective in producing students with…

Outcome of poor response paediatric AML using early SCT.

Science.gov (United States)

Wareham, Neval E; Heilmann, Carsten; Abrahamsson, Jonas; Forestier, Erik; Gustafsson, Britt; Ha, Shau-Yin; Heldrup, Jesper; Jahnukainen, Kirsi; Jónsson, Ólafur G; Lausen, Birgitte; Palle, Josefine; Zeller, Bernward; Hasle, Henrik

2013-03-01

Children with poor response acute myeloid leukaemia (AML) generally have a very poor outcome. Allogeneic stem cell transplantation (SCT) is often recommended for these children but the benefit is unclear. The aim of this study was to investigate survival for poor response AML patients treated with SCT. Treatment was given according to the NOPHO-AML 2004 protocol. All patients received AIET (Cytarabine, Idarubicin, Etoposide, Thioguanine) and AM (Cytarabine, Mitoxantrone) as induction. We included poor response defined as > 15% blasts on day 15 after AIET (n = 17) or > 5% blasts after AM (n = 14, refractory disease). Poor response patients received intensively timed induction and proceeded to SCT when a donor was available. Thirty-one of 267 evaluable patients (12%) had a poor response. SCT was performed in 25; using matched unrelated donors in 13, matched sibling donors in 6, cord blood donor in 4, and haploidentical donor in two. The median follow-up for the 31 poor responding patients was 2.6 years (range 0.4 - 8.1 years) and 3-year probability of survival 70% (95% CI 59-77%). The poor responders in the NOPHO-AML 2004 protocol had a favourable prognosis treated with time-intensive induction followed by SCT. © 2012 John Wiley & Sons A/S.

Maintained intentional weight loss reduces cardiovascular outcomes: results from the Sibutramine Cardiovascular OUTcomes (SCOUT) trial.

Science.gov (United States)

Caterson, I D; Finer, N; Coutinho, W; Van Gaal, L F; Maggioni, A P; Torp-Pedersen, C; Sharma, A M; Legler, U F; Shepherd, G M; Rode, R A; Perdok, R J; Renz, C L; James, W P T

2012-06-01

The Sibutramine Cardiovascular OUTcomes trial showed that sibutramine produced greater mean weight loss than placebo but increased cardiovascular morbidity but not mortality. The relationship between 12-month weight loss and subsequent cardiovascular outcomes is explored. Overweight/obese subjects (N = 10 744), ≥55 years with cardiovascular disease and/or type 2 diabetes mellitus, received sibutramine plus weight management during a 6-week Lead-in Period before randomization to continue sibutramine (N = 4906) or to receive placebo (N = 4898). The primary endpoint was the time from randomization to first occurrence of a primary outcome event (non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death). For the total population, mean weight change during Lead-in Period (sibutramine) was -2.54 kg. Post-randomization, mean total weight change to Month 12 was -4.18 kg (sibutramine) or -1.87 kg (placebo). Degree of weight loss during Lead-in Period or through Month 12 was associated with a progressive reduction in risk for the total population in primary outcome events and cardiovascular mortality over the 5-year assessment. Although more events occurred in the randomized sibutramine group, on an average, a modest weight loss of approximately 3 kg achieved in the Lead-in Period appeared to offset this increased event rate. Moderate weight loss (3-10 kg) reduced cardiovascular deaths in those with severe, moderate or mild cardiovascular disease. Modest weight loss over short-term (6 weeks) and longer-term (6-12 months) periods is associated with reduction in subsequent cardiovascular mortality for the following 4-5 years even in those with pre-existing cardiovascular disease. While the sibutramine group experienced more primary outcome events than the placebo group, greater weight loss reduced overall risk of these occurring in both groups. © 2011 Blackwell Publishing Ltd.

Resource-based learning strategies: implications for students and institutions

Directory of Open Access Journals (Sweden)

Malcolm Ryan

1996-12-01

Full Text Available In its strategic plan, the University of Greenwich envisages a significant shift to resource-based learning (RBL. Enterprise in Higher Education (EHE has funded five pilot RBL projects during the past year, including one in introductory economics. The project was managed by three lecturers in the School of Social Sciences, supported by an Academic Development Officer. Learning outcomes were completely revised, and a range of assessment strategies, including computer-based tests, was identified. A resources guide was produced which identified the materials and activities that would enable students to achieve the learning outcomes. A number of innovations were adopted, including: • computer-based curriculum delivery, assessment, and student evaluation of the course; • an open approach to assessment; • abolishing lectures in favour of a diverse range of teaching and learning activities.

SRTR center-specific reporting tools: Posttransplant outcomes.

Science.gov (United States)

Dickinson, D M; Shearon, T H; O'Keefe, J; Wong, H-H; Berg, C L; Rosendale, J D; Delmonico, F L; Webb, R L; Wolfe, R A

2006-01-01

Measuring and monitoring performance--be it waiting list and posttransplant outcomes by a transplant center, or organ donation success by an organ procurement organization and its partnering hospitals--is an important component of ensuring good care for people with end-stage organ failure. Many parties have an interest in examining these outcomes, from patients and their families to payers such as insurance companies or the Centers for Medicare and Medicaid Services; from primary caregivers providing patient counseling to government agencies charged with protecting patients. The Scientific Registry of Transplant Recipients produces regular, public reports on the performance of transplant centers and organ procurement organizations. This article explains the statistical tools used to prepare these reports, with a focus on graft survival and patient survival rates of transplant centers--especially the methods used to fairly and usefully compare outcomes of centers that serve different populations. The article concludes with a practical application of these statistics--their use in screening transplant center performance to identify centers that may need remedial action by the OPTN/UNOS Membership and Professional Standards Committee.

Predicting optimal outcomes in cognitive therapy or interpersonal psychotherapy for depressed individuals using the personalized advantage index approach

NARCIS (Netherlands)

Huibers, M.J.H.; Cohen, Z.D.; Lemmens, L.H.J.M.; Arntz, A.; Peeters, F.P.M.L.; Cuijpers, P.; DeRubeis, R.J.

2015-01-01

Introduction: Although psychotherapies for depression produce equivalent outcomes, individual patients respond differently to different therapies. Predictors of outcome have been identified in the context of randomized trials, but this information has not been used to predict which treatment works

Predicting optimal outcomes in cognitive therapy or interpersonal psychotherapy for depressed individuals using the personalized advantage index approach

NARCIS (Netherlands)

Huibers, M.J.H.; Cohen, Z.D.; Lemmens, L.H.J.M.; Arntz, A.; Peeters, F.P.M.L.; Cuijpers, P.; DeRubeis, R.J.

2015-01-01

Introduction Although psychotherapies for depression produce equivalent outcomes, individual patients respond differently to different therapies. Predictors of outcome have been identified in the context of randomized trials, but this information has not been used to predict which treatment works

The frequency and outcome of uveitis in patients with newly diagnosed juvenile idiopathic arthritis in two 4-year cohorts from 1990-1993 and 2000-2003.

Science.gov (United States)

Kotaniemi, Kaisu; Sihto-Kauppi, Kristiina; Salomaa, Pirjo; Säilä, Hanna; Ristolainen, Leena; Kauppi, Markku

2014-01-01

To retrospectively compare the frequency and outcome of uveitis between two cohorts of patients with newly-onset juvenile idiopathic arthritis (JIA) separated by a 10 year interval. The diagnosis of JIA was made in 239 patients in 1990-1993 and in 240 patients in 2000-2003 by paediatric rheumatologists at the Rheumatism Foundation Hospital, Heinola, Finland. An ophthalmologist examined all the patients regularly and diagnosed uveitis. The demographics of the patients, type of JIA, frequency, medical treatment and outcome of uveitis were documented. The main outcome measures were the frequency and outcome of uveitis, the number of complications and the best corrected visual acuity (BCVA), need of corticosteroids and other immunosuppressive treatment. The frequency of uveitis was higher (25% vs. 18%) in the earlier cohort. The visual outcome was ≥0.5 in all JIA-uveitis patients except one in the earlier cohort. Complications were fewer (21% vs. 35%) and uveitis was milder according to the Standardisation of Uveitis Nomenclature (SUN) criteria in the later cohort. Remission of uveitis (33% vs. 42%) and arthritis (20% vs. 23%) in JIA-uveitis patients was similar in both cohorts after a follow-up of 6.6 and 5.9 years, respectively. Systemic corticosteroids were more commonly used (25% vs. 7%) in JIA-uveitis patients of the earlier cohort but the use of methotrexate was equal in both cohorts (65% vs. 67%). In this study with early and aggressive treatment and close monitoring the outcome of JIA-uveitis patients was favourable and visual loss was avoided in most cases.

Professionals' positive perceptions of fathers are associated with more favourable attitudes towards including them in family interventions.

Science.gov (United States)

de Montigny, Francine; Gervais, Christine; Meunier, Sophie; Dubeau, Diane

2017-12-01

This Université du Québec en Outaouais study examined professionals' attitudes towards fathers, their perceived self-efficacy when working with them and their perceptions of the importance of including fathers in family interventions. Professionals in Québec, Canada, working in childcare fields such as education, social services, health, community services and management answered a self-report questionnaire between 2013 and 2015. The 296 respondents (90% females) had a mean age of 39 (20-65), were from urban, semi-urban and rural settings and provided services to families with children up to five years of age. Social service professionals perceived fathers more negatively than did other professionals. Even though male professionals perceived fathers more negatively, they felt more confident working with them than did their female counterparts. Positive perceptions of fathers were associated with more favourable attitudes towards including them in family interventions, and this association was mediated by the professionals' perceptions of their own self-efficacy. The most negative attitudes were reported by social service professionals. Male professionals viewed fathers more negatively but were more confident working with them than were female colleagues. Improving professionals' perceptions of fathers could help to promote their inclusion in family interventions. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Risk strata-based therapy and outcome in stage Ib-IIa carcinoma cervix: single-centre ten-year experience.

Science.gov (United States)

Kundargi, Rajshekar S; Guruprasad, B; Rathod, Praveen Shankar; Shakuntala, Pn; Shobha, K; Pallavi, Vr; Uma Devi, K; Bafna, Ud

2013-01-01

To review the outcome of stage (Ib, IIa), cervical cancer patients were primarily treated with radical hysterectomy and risk-based postoperative therapy. Between January 2001 and December 2011, 601 cases underwent surgery followed by tailored therapy. Patients were classified into low risk (pelvic lymph node negative, tumour less than 4 cm, no evidence of lympho-vascular invasion, less than one-third of thickness of surgical stoma involved), intermediate risk (positive lympho-vascular space invasion, tumour size more than 4 cm, and deep invasion of cervical stroma), and high risk (pelvic lymph node involved, positive parametrial, or vaginal margins) groups. Postoperative adju-vant therapy in the form of radiotherapy alone to those with intermediate risk and chemo-radiotherapy to those with high risk was given to patients. The median follow-up was 60 months. The majority of patients had intermediate risk. The overall event-free survival (EFS) at five years was 74.37%, with EFS of 86.5% in those from the low-risk group, 73% in those from the intermediate-risk group, and 64% in those from the high-risk group. In conclusion, risk strata-based adjuvant postoperative therapy is able to provide a favourable outcome in patients with stage Ib-IIa cervical cancer with a nearly 11% improvement in survival compared with historical control.

Long-term outcomes of pars plana vitrectomy without internal limiting membrane peeling for optic disc pit maculopathy.

Science.gov (United States)

Avci, R; Yilmaz, S; Inan, U U; Kaderli, B; Kurt, M; Yalcinbayir, O; Yildiz, M; Yucel, A

2013-12-01

To evaluate the results of surgical treatment of maculopathy secondary to congenital optic pit anomaly with pars plana vitrectomy (PPV), endolaser to the temporal edge of the optic disc and C3F8 tamponade without internal limiting membrane (ILM) peeling. Thirteen eyes of 12 patients with serous macular detachment and/or macular retinoschisis secondary to congenital optic disc pit (ODP) were included in the study. All eyes underwent PPV, posterior hyaloid removal, endolaser photocoagulation on the temporal margin of the optic disc and 12% C3F8 gas tamponade. Anatomic success and functional outcome determined retrospectively by optical coherence tomography and measurement of best corrected visual acuity (BCVA), respectively were the main outcome parameters. Two lines or more improvement in BCVA was obtained in 11 eyes and 6 of these eyes had 20/40 or better BCVA at the final visit. Subretinal or intraretinal fluid was completely resorbed postoperatively in 12 eyes but a little intraretinal fluid persisted in one eye at the 16-month follow-up. Better visual improvement was observed in patients treated by earlier surgical intervention. PPV, C3F8 gas tamponade and endolaser to the optic disc margin without ILM peeling may yield favourable results in the treatment of ODP maculopathy.

A Combination of Outcome and Process Feedback Enhances Performance in Simulations of Child Sexual Abuse Interviews Using Avatars

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Francesco Pompedda

2017-09-01

Full Text Available Simulated interviews in alleged child sexual abuse (CSA cases with computer-generated avatars paired with feedback improve interview quality. In the current study, we aimed to understand better the effect of different types of feedback in this context. Feedback was divided into feedback regarding conclusions about what happened to the avatar (outcome feedback and feedback regarding the appropriateness of question-types used by the interviewer (process feedback. Forty-eight participants each interviewed four different avatars. Participants were divided into four groups (no feedback, outcome feedback, process feedback, and a combination of both feedback types. Compared to the control group, interview quality was generally improved in all the feedback groups on all outcome variables included. Combined feedback produced the strongest effect on increasing recommended questions and correct conclusions. For relevant and neutral details elicited by the interviewers, no statistically significant differences were found between feedback types. For wrong details, the combination of feedback produced the strongest effect, but this did not differ from the other two feedback groups. Nevertheless, process feedback produced a better result compared to outcome feedback. The present study replicated previous findings regarding the effect of feedback in improving interview quality, and provided new knowledge on feedback characteristics that maximize training effects. A combination of process and outcome feedback showed the strongest effect in enhancing training in simulated CSA interviews. Further research is, however, needed.

Focal cortical dysplasias: surgical outcome in 67 patients in relation to histological subtypes and dual pathology.

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Fauser, Susanne; Schulze-Bonhage, Andreas; Honegger, Juergen; Carmona, Hans; Huppertz, Hans-Juergen; Pantazis, Georgios; Rona, Sabine; Bast, Thomas; Strobl, Karl; Steinhoff, Bernhard J; Korinthenberg, Rudolf; Rating, Dietz; Volk, Benedikt; Zentner, Josef

2004-11-01

The purpose of this study was to assess whether the histological subtype of focal cortical dysplasia and dual pathology affect surgical outcome in patients with medically intractable epilepsy due to focal cortical dysplasia (FCD). We retrospectively analysed the outcome of 67 patients from 2 to 66 years of age at follow-up periods of 6 to 48 months after epilepsy surgery. Histological subtypes were classified according to Palmini and included a few cases with mild histological abnormalities corresponding to the definition of mild malformations of cortical development. The seizure outcome was classified according to Engel and evaluated at the last follow-up visit as well as at follow-up periods of 12 and 24 months after surgery. The outcome in patients with FCD and additional hippocampal pathology (dual pathology) was analysed separately. Distribution of histological subtypes differed in temporal and extratemporal localization, with a significantly higher extratemporal prevalence of FCD type 2. There was a tendency towards better postsurgical outcome related to the last follow-up visit in patients with more subtle abnormalities classified as mild malformations of cortical development (mMCD) (63% Engel Ia), FCD type 1a (67% Engel Ia) and FCD type 1b (55% Engel Ia) compared with patients with FCD type 2a (43% Engel Ia) and FCD type 2b (Taylor type) (50% Engel Ia). Considering the outcome at follow-up periods over 12 and 24 months, complete seizure-freedom was achieved significantly more often in patients with FCD type 1 and mMCD than with FCD type 2, and seizure reduction by less than 75% (Engel IV) occurred in more patients with FCD type 2a compared with the other subgroups. This tendency was seen in the whole patient group and in the extratemporal subgroup. Patients with dual pathology almost always had temporal lobe epilepsy; the outcome in this patient group was generally favourable (66% complete seizure-freedom at the last follow-up visit). The outcome remained

Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistulae treatment

International Nuclear Information System (INIS)

Sherif, Camillo; Gruber, Andreas; Bavinzski, Gerhard; Standhardt, Harald; Widhalm, Georg; Knosp, Engelbert; Gibson, Daniel; Richling, Bernd

2008-01-01

The optimal treatment of spinal dural arteriovenous fistulae (SDAVF) remains controversial and long-term follow-up data, especially data from multidisciplinary treatment, are rarely available. Thus, long-term outcomes following a multidisciplinary approach to the treatment of SDAVF were investigated. The investigation included 26 patients with SDAVF treated at the authors' department over a 15-year period including a follow-up of more than 2 years. The treatment strategy when occlusion of the draining vein could be achieved was to embolize the fistula with Histoacryl, with surgery reserved for those patients unsuitable for embolization. Posttreatment angiography followed by MRI was performed in all patients. Clinical follow-up was performed using the gait and micturition Aminoff-Logue scale scores and the modified Rankin scale score. Embolization was performed in 19 patients (73.1%), and direct surgery in 7 patients (26.9%). Follow-up angiography (at a mean of 21.7 months) showed occlusion of the SDAVF in 24 patients (92.3%). Of the 19 embolized patients, 2 (10.5%) developed recurrence secondary to insufficient occlusion of the SDAVF draining vein, and one of these two patients underwent re-embolization and one re-operation. No negative effects of SDAVF recurrence on the final clinical outcome were identified in either patient. MRI after angiography (at a mean of 91.5 months) demonstrated occlusion of all SDAVFs. After a mean clinical follow-up of 103.4 months there was a statistically significant improvement in both the modified Rankin scale score and the Aminoff-Logue gait scale score (P < 0.05). The present multidisciplinary study showed for the first time that embolization leads to stable neuroradiological results and favourable clinical outcomes even for very long follow-up times of more than 100 months. Microsurgery remains the treatment of choice when safe embolization of the draining vein cannot be achieved. (orig.)

Outcomes in controlled and comparative studies on non-healing wounds: recommendations to improve the quality of evidence in wound management

DEFF Research Database (Denmark)

Gottrup, F; Apelqvist, J; Price, P

2010-01-01

was to produce recommendations on clinical data collection in wound care. This document, produced by the group and disseminated by JWC, identifies criteria for producing rigorous outcomes in both randomised controlled trials and clinical studies, and describes how to ensure studies are consistent...

A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs.

Science.gov (United States)

Chung, Kyu Sung; Ha, Jeong Ku; Ra, Ho Jong; Kim, Jin Goo

2016-05-01

Although interest in medial meniscus posterior root tear (MMPRT) repair has increased, few case series have been reported. This meta-analysis aimed to examine the clinical and radiological effects of MMPRT repair by pooling pre- and post-operative data from case-series reports. A literature search was performed using MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE databases. Pre- and post-operative data were pooled to investigate the effects of MMPRT repair, including the Lysholm score improvement, meniscal extrusion (mm) reduction, progression of the Kellgren-Lawrence (K-L) grade, and cartilage status according to the Outerbridge classification. Treatment effects included paired standardized mean differences (difference in the pre- and post-operative mean outcomes divided by the standard deviation) for the Lysholm score and meniscal extrusion, as well as the pooled event rates of progression of K-L grade and cartilage status. As treatment effects, the Lysholm score increased by as much as 3.675 (P meniscus extrusion was not reduced (n.s.). The overall pooled event rates of progression of K-L grade and cartilage status were 10.6 and 17.3 % (P meniscus extrusion was not reduced. Considering the occurrence of progression of K-L grade and cartilage status, it did not prevent the progression of arthrosis completely. Based on these results, repair results in favourable outcomes for MMPRT. Meta-analysis, Level IV.

Effect of Boron on Microstructure and Microhardness Properties of Mo-Si-B Based Coatings Produced Via TIG Process

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Islak S.

2016-09-01

Full Text Available In this study, Mo-Si-B based coatings were produced using tungsten inert gas (TIG process on the medium carbon steel because the physical, chemical, and mechanical properties of these alloys are particularly favourable for high-temperature structural applications. It is aimed to investigate of microstructure and microhardness properties of Mo-Si-B based coatings. Optical microscopy (OM, X-ray diffraction (XRD and scanning electron microscopy (SEM were used to characterize the microstructures of Mo-Si-B based coatings. The XRD results showed that microstructure of Mo–Si–B coating consists of α-Mo, α-Fe, Mo2B, Mo3Si and Mo5SiB2 phases. It was reported that the grains in the microstructure were finer with increasing amounts of boron which caused to occur phase precipitations in the grain boundary. Besides, the average microhardness of coatings changed between 735 HV0.3 and 1140 HV0.3 depending on boron content.

Circulating Irisin Concentrations Are Associated with a Favourable Lipid Profile in the General Population.

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Simon Oelmann

Full Text Available Irisin is a myokine, which is mainly inversely associated with the risk for non-communicable diseases. Irisin improves cellular energy metabolism by uncoupling the mitochondrial respiratory chain resulting in increased energy expenditure using lipids. To date potential associations between irisin concentration and lipid profile are poorly understood. Therefore, this investigation aimed to evaluate potential associations between irisin and lipid levels in the general population.Data of 430 men and 537 women from the population-based Study of Health in Pomerania (SHIP-TREND with available irisin and lipid concentrations were used. Analyses of variance, linear and logistic regression models adjusted for age, HBA1c, waist circumference, physical activity, smoking, alcohol consumption, systolic blood pressure, ALAT were calculated.We detected significantly inverse associations between irisin and circulating levels of total [beta coefficient 0.21 (standard error 0.08, p = 0.01], low-density cholesterol [-0.16 (0.07, p = 0.03] and triglycerides [-0.17 (0.08, p = 0.02] for men. Females without lipid lowering medication had an inverse association between irisin and total cholesterol [-0.12 (0.06, p = 0.05]. Further, male subjects with irisin concentrations in the third tertile had an increased odds for elevated low-density cholesterol [odds ratio 1.96 (95% confidence interval 1.07-3.48, p = 0.03 and triglyceride [1.95 (1.09-3.47, p = 0.02] levels, even after exclusion of subjects with lipid lowering medication. In addition, our data revealed an annual rhythm of serum irisin levels with peak levels arise in winter and summer months.This is the first investigation to report a significant association between circulating irisin and a favourable lipid profile in the general population. This may infer that higher irisin concentrations are associated with a reduced risk for non-communicable diseases.

My Therapist is a Student? The Impact of Therapist Experience and Client Severity on Cognitive Behavioural Therapy Outcomes for People with Anxiety Disorders.

Science.gov (United States)

Mason, Liam; Grey, Nick; Veale, David

2016-03-01

Allocation of trainee therapist cases is often performed based on intuition and clinical circumstances, with lack of empirical evidence on the role of severity of presenting problem. This has the potential to be anxiety-provoking for supervisors, trainees and service users themselves. To determine how therapist experience interacts with symptom severity in predicting client outcomes. An intention-to-treat analysis of annual outcome data for primary and secondary care clients seen by a specialist anxiety disorders service. 196 clients were stratified into mild, moderate and baseline severe symptoms of anxiety (GAD-7) and depression (PHQ-9). We measured percentage change on these measures, as well as number of sessions and therapy dropout. We also examined rates of reliable and clinically significant change on disorder-specific measures. We hypothesized that qualified therapists would achieve better outcomes than trainees, particularly for severe presentations. Overall, outcomes were comparable between trainee and qualified therapists on all measures, and trainees additionally utilized fewer therapy sessions. There was however an interaction between anxiety severity (GAD-7) and therapist group, such that severely anxious clients achieved greater symptom improvement with qualified as compared to trainee therapists. Further, for trainee but not qualified therapists, baseline anxiety was negatively associated with rate of reliable and clinically significant change on disorder-specific measures. These findings indicate generally favourable outcomes for trainee therapists delivering manualized treatments for anxiety disorders. They additionally suggest that trainee therapists may benefit from additional support when working with clients that present with severe anxiety.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: New Hebrides

International Nuclear Information System (INIS)

1977-12-01

The New Hebrides consists of about 70 islands in the Southwest Pacific Ocean. The 12 largest, and main islands are volcanic cones with a few marine sediments. A manganese mining industry is presently producing but there has been no known activity in uranium exploration or mining. The area of the New Hebrides is nearly 15,000 square kilometers, and the principal industries are centered around agriculture and fishing. The uranium potential is estimated in category 1 (less than 1,000 tonnes U) (author)

Types of tectonic structures, sedimentary volcanogenetic formations of a mantle, favourable processes for exogenetic and polygenetic uranium deposits formation

International Nuclear Information System (INIS)

Danchev, V.I.; Komarnitskij, G.M.; Levin, V.N.; Shumlyanskij, V.A.

1985-01-01

Factors, affecting mineralization processes are considered. Characteristic features of uranium-bearing provinces are as follows: the presence of crust of continental type; deep-seated tectonic structures-rises and saggings, roofs, gneiss domes, rift zones and transform fractures; specialization for uranium of sedimentary and magmatic formations; the presence of manifestation regions of deep thermal and gaseous flow, etc. In uranium-bearing provinces territories favourable for the manifestation of different types of uranium mineralization: metamorphogenetic, polygenetic and exogenetic ones, are singled out. Different epochs of uranium ore formation are established. In sedimentary masses tectonic regime and climate are of special importance, and for epigenetic deposits, formed with an aid of underground waters-hydrogeological conditions. In the limits of the main structural elements of the Earth crust and geotectonic structures of higher orders the following types of sedimentary and volcanic formations can be singled out: 1-formations with exogenous uranium mineralization; 2-formations, accumulated in the epochs of epigenous ore formation; 3-formations fav ourable for epigenous uranium deposit formation; 4-formations unfavourable for the formation and localization of uranium mineralization

Use and non-use values as motivational construct dimensions for farm animal welfare: impacts on the economic outcome for the farm.

Science.gov (United States)

Hansson, H; Lagerkvist, C J; Azar, G

2018-01-24

This study explored how farmers' motivation in terms of use values and/or non-use values to work with farm animal welfare are associated with the economic outcome for the farm. Use values in farm animal welfare refer to economic value derived from productivity and profitability considerations. Non-use values in farm animal welfare refer to economic value derived from good animal welfare, irrespective of the use the farmer derives from the animal, currently or in the future. The analysis was based on detailed information about the income statements of a sample of Swedish dairy farmers, obtained from the Swedish Farm Economic Survey, complemented with survey information about their perceived use and non-use values in farm animal welfare. The findings suggest that farm economic outcome is significantly associated with motivation in terms of use values, but not so much with motivation in terms of non-use values. This is interesting from a policy point of view, because it indicates that farmers with different approaches to farm animal welfare may experience different economic outcomes for their farms. Findings can, for instance, be used to strengthen farmers' engagement in various private quality assurance standards, which generally focus on values of non-use type, by pointing to that realisation of such values will not impair the economic outcome of the farms. Moreover, findings also suggest that farmers' economic incentives for engagement in such standards may need to be further strengthened in order to become more attractive, as findings point to that a focus on non-use values generally is not associated with more favourable economic outcomes.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Malaysia

International Nuclear Information System (INIS)

1977-12-01

Malaysia is a country of 330,000 square kilometers and a population of 11.9 million. The country is divided into two parts 640 kilometers apart. West Malaysia consists of the Malay Peninsula, and East Malaysia of the provinces of Sarawak and Sabah, formerly North Borneo. The country is the world's leading producer of tin and rubber. Geologic descriptions in detail are difficult to find although maps are available. Uranium exploration, chiefly by the Malaysian Geological Survey, has been carried out without discovery of commercial quantities. Based on possible recovery of uranium from deeply weathered granites on the Malay Peninsula, and possible discoveries in East Malaysia, a uranium potential of 1,000 to 10,000 tonnes U (category 2) is assigned. (author)

Late outcome of a controlled trial of enalapril treatment in progressive chronic renal failure. Hard end-points and influence of proteinuria

DEFF Research Database (Denmark)

Kamper, A L; Strandgaard, S; Leyssac, P P

1995-01-01

An earlier controlled trial showed that over an average of 26 months, enalapril slowed the progression of chronic renal failure. Following completion of the trial, the patients continued to receive antihypertensive treatment according to ordinary clinical criteria. All but four patients...... end-stage renal failure (ESRF) (P renal outcome groups. In all patients, baseline Calb and CIgG were negatively correlated with the rate of change in GFR during the controlled trial (r = -0.37, P .... In the original enalapril group, 12 of the 35 patients (34%) were alive without renal replacement therapy versus five of the 35 patients (14%) in the control group. This difference of 20% in favour of having been in the enalapril group in the original trial was significant (P = 0.05; 95% confidence limits 0...

ICU Telemedicine Program Financial Outcomes.

Science.gov (United States)

Lilly, Craig M; Motzkus, Christine; Rincon, Teresa; Cody, Shawn E; Landry, Karen; Irwin, Richard S

2017-02-01

ICU telemedicine improves access to high-quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following ICU telemedicine implementation and after the addition of logistic center function has not been published to our knowledge. Primary data were collected for consecutive adult patients of a single academic medical center. We compared clinical and financial outcomes across three groups that differed regarding telemedicine support: a group without ICU telemedicine support (pre-ICU intervention group), a group with ICU telemedicine support (ICU telemedicine group), and an ICU telemedicine group with added logistic center functions and support for quality-care standardization (logistic center group). The primary outcome was annual direct contribution margin defined as aggregated annual case revenue minus annual case direct costs (including operating costs of ICU telemedicine and its related programs). All monetary values were adjusted to 2015 US dollars using Producer Price Index for Health-Care Facilities. Annual case volume increased from 4,752 (pre-ICU telemedicine) to 5,735 (ICU telemedicine) and 6,581 (logistic center). The annual direct contribution margin improved from $7,921,584 (pre-ICU telemedicine) to $37,668,512 (ICU telemedicine) to $60,586,397 (logistic center) due to increased case volume, higher case revenue relative to direct costs, and shorter length of stay. The ability of properly modified ICU telemedicine programs to increase case volume and access to high-quality critical care with improved annual direct contribution margins suggests that there is a financial argument to encourage the wider adoption of ICU telemedicine. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Three-dimensional neural cultures produce networks that mimic native brain activity.

Science.gov (United States)

Bourke, Justin L; Quigley, Anita F; Duchi, Serena; O'Connell, Cathal D; Crook, Jeremy M; Wallace, Gordon G; Cook, Mark J; Kapsa, Robert M I

2018-02-01

Development of brain function is critically dependent on neuronal networks organized through three dimensions. Culture of central nervous system neurons has traditionally been limited to two dimensions, restricting growth patterns and network formation to a single plane. Here, with the use of multichannel extracellular microelectrode arrays, we demonstrate that neurons cultured in a true three-dimensional environment recapitulate native neuronal network formation and produce functional outcomes more akin to in vivo neuronal network activity. Copyright © 2017 John Wiley & Sons, Ltd.

Educating the engineers of 2020: An outcomes-based typology of engineering undergraduates

Science.gov (United States)

Knight, David B.

Members of government and industry have called for greater emphasis within U.S. colleges and universities on producing engineers who can enter and advance a more competitive, globally connected workforce. Looking toward this future, engineers will need to exhibit strong analytical skills as in the past, but they also will need to be proficient in a cadre of new abilities to compete. This study examines, in combination, an array of knowledge and skills aligned with the National Academy of Engineering's "engineer of 2020." The study has two major goals. The first is to develop a typology of engineering students based on the learning outcomes associated with the engineer of E2020. The second is to understand the educational experiences that distinguish these groups of students who resemble, more or less, the engineer of 2020. This approach acknowledges that engineering graduates need a complex skill set to succeed in the new global economy; it is the combination of skills associated with the engineer of 2020, not the individual skills in isolation, which will ensure graduates can respond to workforce needs of the future. To date, research on student outcomes has studied learning outcomes independent of one another rather than investigating student learning holistically. The study uses student data from the Prototype to production: Processes and conditions for preparing the Engineer of 2020 study, sponsored by the National Science Foundation (NSF EEC-0550608). Engineering students from a nationally representative sample of engineering programs in the United States answered a survey that collected information on their pre-college academic preparation and sociodemographic characteristics, their curricular and co-curricular experiences in their engineering programs, and their self-ratings of their engineering-related competencies. Only data on engineering students in their senior year (n=2,422) were utilized in analyses. Analyses were conducted in multiple phases for each

Common Dermatoses in Patients with Obsessive Compulsive Disorders

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Mircea Tampa

2015-10-01

Full Text Available Obsessive-compulsive disorder is a chronic, debilitating syndrome, consisting of intrusive thoughts- which are experienced as inappropriate by the patient and are producing anxiety- and compulsions, defined as repetitive behaviours produced to reduce anxiety. While patients with obsessive-compulsive disorder typically have xerosis, eczema or lichen simplex chronicus, as a result of frequent washing or rubbing their skin, several other disorders which are included in the group of factitious disorders have also been associated with obsessive-compulsive disorder. A close collaboration between the dermatologist and the psychiatrist is therefore mandatory in order to achieve favourable outcomes for these patients. The aim of the article is to present the most frequent dermatological disorders associated with obsessive-compulsive disorder and to look over some of the rare ones.

Dissecting the determinants of depressive disorders outcome: an in depth analysis of two clinical cases

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Oasi Osmano

2007-02-01

Full Text Available Abstract Clinicians face everyday the complexity of depression. Available pharmacotherapies and psychotherapies improve patients suffering in a large part of subjects, however up to half of patients do not respond to treatment. Clinicians may forecast to a good extent if a given patient will respond or not, based on a number of data and sensations that emerge from face to face assessment. Conversely, clinical predictors of non response emerging from literature are largely unsatisfactory. Here we try to fill this gap, suggesting a comprehensive assessment of patients that may overcome the limitation of standardized assessments and detecting the factors that plausibly contribute to so marked differences in depressive disorders outcome. For this aim we present and discuss two clinical cases. Mr. A was an industrial manager who came to psychiatric evaluation with a severe depressive episode. His employment was demanding and the depressive episode undermined his capacity to manage it. Based on standardized assessment, Mr. A condition appeared severe and potentially dramatic. Mrs. B was a housewife who came to psychiatric evaluation with a moderate depressive episode. Literature predictors would suggest Mrs. B state as associated with a more favourable outcome. However the clinician impression was not converging with the standardized assessment and in fact the outcome will reverse the prediction based on the initial formal standard evaluation. Although the present report is based on two clinical cases and no generalizability is possible, a more detailed analysis of personality, temperament, defense mechanisms, self esteem, intelligence and social adjustment may allow to formalize the clinical impressions used by clinicians for biologic and pharmacologic studies.

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Sri Lanka

International Nuclear Information System (INIS)

1977-10-01

Sri Lanka is essentially a detached portion of the Deccan Plateau of south India and like it, is underlain almost everywhere by hard old Precambrian rocks. Prior to 1940 there was no systematic organised geological survey work on the island. Between 1957 and 1962 a partial aerial survey and field traverses were conducted in a search for radio- active minerals. Since then a modest programme has continued. Thorianite was first discovered in placer deposits in 1903 and prospecting has found many other refractory radioactive minerals probably derived from the weathering of pegmatites. Monazite is found as an important constituent of beach placer deposits and it is estimated to have an average content of 8-10%ThO 2 and 0.3 - 0.5% U 3 O 8 . Up to 1000 tons monazite per year could be produced from the beach sand industry. Sri Lanka has had very little systematic exploration for uranium and as it is largely composed of Precambrian rocks it deserves closer attention. On the other hand it is part of a thorium rich province and there is a body of technical opinion that believes that thorium rich provinces are unlikely to contain significant uranium deposits. For these reasons it is estimated that the Speculative Potential may be within the range of 1000 to 10,000 tonnes uranium. In addition it maybe possible to produce up to 5 tonnes uranium and 100 tonnes thorium from the beach sand industry on an annual basis. (author)

Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit

Directory of Open Access Journals (Sweden)

Beishuizen Albertus

2011-05-01

Full Text Available Abstract Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU. Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52% of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index 2 and a positive fluid balance (> 4,683 mL were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery.

SPECT with technetium-99m-HMPAO in relation to late cognitive outcome after surgery for ruptured cerebral aneurysms

International Nuclear Information System (INIS)

Saeveland, H.; Uski, T.; Brandt, L.; Sjoeholm, H.; Sonesson, B.

1996-01-01

Fifteen patients with a good neurological outcome after aneurysmal SAH and surgery were collected prospectively. Six months after surgery neurological examination and a SPECT study for evaluation of the three dimensional CBF distribution as well as an extensive neuropsychological test were performed. In all patients with pathological SPECT findings the location of the reduced regional CBF correlated with the location of the ruptured aneurysm and/or side of surgical approach. The volume of the brain tissue with reduced rCBF showed a great variety, from 9-112 cm 3 (mean: 33 cm 3 ). Similarly, the maximum flow reduction in the affected areas also varied considerably from 17-95 % (mean: 39 %). In general, the neuropsychological functioning of the patients post SAH was favourable. Seven individuals had a presumably normal neuropsychological appearance with respect to estimates of premorbid levels of functioning. Another four patients were slightly impaired and the remaining four were moderately affected. Only in five cases did the location of SPECT pathology and the site of neuropsychological impairment appear to coincide, whereas this was not the case in the remaining 10 patients. In general, the extent of SPECT pathology did not differ in the three neuropsychological outcome groups (normal, slight and moderate disability). (author)

Management of gallbladder dyskinesia: patient outcomes following positive 99mtechnetium (Tc)-labelled hepatic iminodiacetic acid (HIDA) scintigraphy with cholecystokinin (CCK) provocation and laparoscopic cholecystectomy

International Nuclear Information System (INIS)

Dave, R.V.; Pathak, S.; Cockbain, A.J.; Lodge, J.P.; Smith, A.M.; Chowdhury, F.U.; Toogood, G.J.

2015-01-01

Aims: To evaluate clinical outcomes in patients with typical biliary pain, normal ultrasonic findings, and a positive 99m technetium (Tc)-labelled hepatic iminodiacetic acid analogue (HIDA) scintigraphy with cholecystokinin (CCK) provocation indicating gallbladder dyskinesia, as per Rome III criteria, undergoing laparoscopic cholecystectomy (LC). Methods and materials: Consecutive patients undergoing LC for gallbladder dyskinesia were identified retrospectively. They were followed up by telephone interview and review of the electronic case records to assess symptom resolution. Results: One hundred consecutive patients (median age 44; 80% female) with abnormal gallbladder ejection fraction (GB-EF <35%) were followed up for a median of 12 months (range 2–80 months). Following LC, 84% reported symptomatic improvement and 52% had no residual pain. Twelve percent had persisting preoperative-type pain of either unchanged or worsening severity. Neither pathological features of chronic cholecystitis (87% of 92 incidences when histology available) nor reproduction of pain on CCK injection were significantly predictive of symptom outcome or pain relief post-LC. Conclusion: In one of the largest outcome series of gallbladder dyskinesia patients in the UK with a positive provocation HIDA scintigraphy examination and LC, the present study shows that the test is a useful functional diagnostic tool in the management of patients with typical biliary pain and normal ultrasound, with favourable outcomes following surgery. - Highlights: • Gallbladder dyskinesia (GD) is a challenging condition to diagnose and treat. • This study evaluated clinical outcomes following laparoscopic cholecystectomy (LC). • There was sustained symptomatic benefit in >80% following surgery. • Pre-operative counselling before LC is important

Physiotherapy-led arthroplasty review clinic: a preliminary outcomes analysis.

Science.gov (United States)

Large, Kate E; Page, Carolyn J; Brock, Kim; Dowsey, Michelle M; Choong, Peter F M

2014-11-01

With the rising demand for Orthopaedics in the healthcare sector, service delivery innovations need to be explored to accommodate the increasing workload. Senior Musculoskeletal Physiotherapists have the specialised skills in the assessment of musculoskeletal conditions to determine the impact of surgery on patient outcomes. The aim of the present study was to compare outcomes between a physiotherapy-led arthroplasty review clinic (PT clinic) and the traditional model of orthopaedic surgeon review (OS clinic) after hip and knee replacement. This study was a retrospective case-controlled audit using a comprehensive database. Twenty-four patients who had a hip arthroplasty and 52 patients who had a knee arthroplasty were reviewed solely by the PT clinic at 3, 6 and 12 months after surgical reviews. These patients were matched 1:2 against patients seen only by the OS clinic. The outcome measures included International Knee Score (IKS), Harris Hip Score (HHS) and the Short Form (SF)-12. There were no significant differences in HHS or SF-12 scores for patients after hip arthroplasty. Significant differences for knee arthroplasty were observed favouring the PT clinic; IKS, PT clinic 147.6 (37.07), OS clinic 135.4 (35.68), P≤0.01, and physical component of the SF-12, PT clinic 41.98 (10.45), OS clinic 37.20 (10.44), Pphysiotherapy-led arthroplasty review clinic appears to be a safe and effective service alternative to reviews conducted by orthopaedic surgeons. WHAT IS KNOWN ABOUT THE TOPIC?: Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability and the burden of the disease is rapidly increasing. Joint arthroplasty surgery is the mainstay of treatment for people with end-stage OA; it is a high-cost, high-volume procedure that dominates surgical wait lists around Australia. Long-term follow up is encouraged by the Arthroplasty Society of Australia and endorsed by the Australian Orthopaedics Association, but it is acknowledged that it is impossible

Striatal Activity and Reward Relativity: Neural Signals Encoding Dynamic Outcome Valuation.

Science.gov (United States)

Webber, Emily S; Mankin, David E; Cromwell, Howard C

2016-01-01

The striatum is a key brain region involved in reward processing. Striatal activity has been linked to encoding reward magnitude and integrating diverse reward outcome information. Recent work has supported the involvement of striatum in the valuation of outcomes. The present work extends this idea by examining striatal activity during dynamic shifts in value that include different levels and directions of magnitude disparity. A novel task was used to produce diverse relative reward effects on a chain of instrumental action. Rats ( Rattus norvegicus ) were trained to respond to cues associated with specific outcomes varying by food pellet magnitude. Animals were exposed to single-outcome sessions followed by mixed-outcome sessions, and neural activity was compared among identical outcome trials from the different behavioral contexts. Results recording striatal activity show that neural responses to different task elements reflect incentive contrast as well as other relative effects that involve generalization between outcomes or possible influences of outcome variety. The activity that was most prevalent was linked to food consumption and post-food consumption periods. Relative encoding was sensitive to magnitude disparity. A within-session analysis showed strong contrast effects that were dependent upon the outcome received in the immediately preceding trial. Significantly higher numbers of responses were found in ventral striatum linked to relative outcome effects. Our results support the idea that relative value can incorporate diverse relationships, including comparisons from specific individual outcomes to general behavioral contexts. The striatum contains these diverse relative processes, possibly enabling both a higher information yield concerning value shifts and a greater behavioral flexibility.

Different impact of intermediate and unfavourable cytogenetics at the time of diagnosis on outcome of de novo AML after allo-SCT: a long-term retrospective analysis from a single institution.

Science.gov (United States)

Nahi, H; Remberger, M; Machaczka, M; Ungerstedt, J; Mattson, J; Ringden, O; Le-Blanc, Katarina; Ljungman, P; Hägglund, H

2012-12-01

Karyotype of myeloblasts at the time of AML diagnosis has been shown to be prognostic significant for pre-remission outcome and outcome after allo-SCT, but the latter requires further studies. We conducted a retrospective analysis of the impact of intermediate and unfavourable cytogenetics at the time of primary diagnosis on outcome after allo-SCT in de novo AML. The study included 169 patients who underwent allo-SCT at Karolinska University Hospital between 1980 and 2010. Intermediate and unfavourable cytogenetics were found in 129 (76%) and 40 patients (24%), respectively. Myeloablative and reduced-intensity conditioning were given to 120 (71%) and 49 (29%) patients, respectively. Allo-SCT was performed in CR1 in 122 patients (72%). TRM was 16% in both cytogenetics groups. Relapse occurred in 29% patients with intermediate and in 45% patients with unfavourable cytogenetics (P=0.01). The probabilities of 5-year OS for patients with intermediate and unfavourable cytogenetics were 60 and 43%, respectively (P=0.02). Multivariate analysis revealed intermediate cytogenetics, chronic GVHD, and recipient CMV-negative serostatus as variables associated with favourable OS. Our study showed that outcome after allo-SCT in de novo AML differs depending on cytogenetic risk-group; however its position in post-remission therapy of eligible AML patients is not threatened.

Reconstructed Ancestral Enzymes Impose a Fitness Cost upon Modern Bacteria Despite Exhibiting Favourable Biochemical Properties.

Science.gov (United States)

Hobbs, Joanne K; Prentice, Erica J; Groussin, Mathieu; Arcus, Vickery L

2015-10-01

Ancestral sequence reconstruction has been widely used to study historical enzyme evolution, both from biochemical and cellular perspectives. Two properties of reconstructed ancestral proteins/enzymes are commonly reported--high thermostability and high catalytic activity--compared with their contemporaries. Increased protein stability is associated with lower aggregation rates, higher soluble protein abundance and a greater capacity to evolve, and therefore, these proteins could be considered "superior" to their contemporary counterparts. In this study, we investigate the relationship between the favourable in vitro biochemical properties of reconstructed ancestral enzymes and the organismal fitness they confer in vivo. We have previously reconstructed several ancestors of the enzyme LeuB, which is essential for leucine biosynthesis. Our initial fitness experiments revealed that overexpression of ANC4, a reconstructed LeuB that exhibits high stability and activity, was only able to partially rescue the growth of a ΔleuB strain, and that a strain complemented with this enzyme was outcompeted by strains carrying one of its descendants. When we expanded our study to include five reconstructed LeuBs and one contemporary, we found that neither in vitro protein stability nor the catalytic rate was correlated with fitness. Instead, fitness showed a strong, negative correlation with estimated evolutionary age (based on phylogenetic relationships). Our findings suggest that, for reconstructed ancestral enzymes, superior in vitro properties do not translate into organismal fitness in vivo. The molecular basis of the relationship between fitness and the inferred age of ancestral LeuB enzymes is unknown, but may be related to the reconstruction process. We also hypothesise that the ancestral enzymes may be incompatible with the other, contemporary enzymes of the metabolic network.

Multi-criteria analysis of innovation policies in favour of solar mobility in France by 2030

International Nuclear Information System (INIS)

Popiolek, Nathalie; Thais, Françoise

2016-01-01

As part of France's political intentions to reduce CO_2 emissions in building and transport, this work offers an analysis from the perspective of a public authority on the various innovation policies for the deployment of electric vehicles powered by solar photovoltaic electricity (PV) by the year 2030. This innovation involves enhancing the synergy between buildings and mobility by associating positive energy houses with electric vehicles. The vehicle battery, charged primarily using PV electricity, could also provide a way of storing intermittent solar-generated electricity for later use. The aim of this article is to implement a decision-making model for public administration which can select the best innovation policies based on a number of criteria reflecting their major goals in terms of policies relating to energy, economics, social cohesion and “factor 4″ (to reduce greenhouse gas emissions by a factor of 4 by 2050 compared with 1990 levels). The methodology developed herein has been applied to a concrete case, with some resulting recommendations which may be of use for the public authorities: simultaneously combine research in favour of solar mobility technologies and apply a relatively high carbon tax. Such recommendations are mitigated by the choice of the data set and the methodological shortcomings. - Highlights: • Public Policies are examined in order to deploy solar mobility in France by 2030. • A multi-criteria decision making model is implemented to select the best policies. • For each policy, 8 criteria are evaluated compared to the business as usual policy. • Assumptions about decision-making environment are combined to define future scenarios. • The best policies are the R&D support on technologies with a high carbon tax.

International prospective observational study of upper gastrointestinal haemorrhage: Does weekend admission affect outcome?

DEFF Research Database (Denmark)

Murray, Iain A.; Dalton, Harry R.; Stanley, Adrian J.

2017-01-01

Introduction Out of hours admissions have higher mortality for many conditions but upper gastrointestinal haemorrhage studies have produced variable outcomes. Methods Prospective study of 12 months consecutive admissions of upper gastrointestinal haemorrhage from four international high volume...

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

Directory of Open Access Journals (Sweden)

Gibson EJ

2018-03-01

Full Text Available EJ Gibson,1 N Begum,1 I Koblbauer,1 G Dranitsaris,2 D Liew,3 P McEwan,4 AA Tahami Monfared,5,6 Y Yuan,7 A Juarez-Garcia,7 D Tyas,8 M Lees9 1Wickenstones Ltd, Didcot, UK; 2Augmentium Pharma Consulting Inc, Toronto, ON, Canada; 3Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, VIC, Australia; 4Health Economics and Outcomes Research Ltd, Cardiff, UK; 5Bristol-Myers Squibb Canada, Saint-Laurent, QC Canada; 6Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; 7Bristol-Myers Squibb, Princeton, NJ, USA; 8Bristol-Myers Squibb, Uxbridge, UK; 9Bristol-Myers Squibb, Rueil-Malmaison, France Background: Economic models in oncology are commonly based on the three-state partitioned survival model (PSM distinguishing between progression-free and progressive states. However, the heterogeneity of responses observed in immuno-oncology (I-O suggests that new approaches may be appropriate to reflect disease dynamics meaningfully. Materials and methods: This study explored the impact of incorporating immune-specific health states into economic models of I-O therapy. Two variants of the PSM and a Markov model were populated with data from one clinical trial in metastatic melanoma patients. Short-term modeled outcomes were benchmarked to the clinical trial data and a lifetime model horizon provided estimates of life years and quality adjusted life years (QALYs. Results: The PSM-based models produced short-term outcomes closely matching the trial outcomes. Adding health states generated increased QALYs while providing a more granular representation of outcomes for decision making. The Markov model gave the greatest level of detail on outcomes but gave short-term results which diverged from those of the trial (overstating year 1 progression-free survival by around 60%. Conclusion: Increased sophistication in the representation of disease dynamics in economic models

Motivational profiles of slovenian high school students and their academic performance outcomes.

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Vrtačnik, Margareta; Juriševič, Mojca; Savec, Vesna Ferk

2010-09-01

Self-determination theory defines motivation as a multidimensional concept, with autonomous and controlled motivation as central factors of broader distinctions. Previous research has proven that academic achievements are positively correlated with autonomous motivation. Students from 10 Slovenian grammar schools were involved in empirical study, in which a cluster analysis revealed two motivational profiles: a low quantity motivation group (low controlled and autonomous motivation) and a good quality motivation group (high autonomous and low or average controlled motivation). Statistically significant differences between the two identified motivational profiles were found for students' general as well as chemistry performance in three grades of schooling. Furthermore, a good quality motivation group is also more in favour of autonomy-supportive teaching methods used in chemistry classes. Examination of students' opinions about important chemistry topics, and on the other hand, unimportant ones, and not connected with life, reveals that the basic reason for distinction might lie in the chemistry teacher's approach used while presenting these topics. Some chemistry teachers are not using an autonomy-supportive way of teaching which would contribute to better teaching outcomes; therefore a need for further research on Slovenian chemistry teachers' motivation and their teaching approaches was recognized.

Negative mood reverses devaluation of goal-directed drug-seeking favouring an incentive learning account of drug dependence.

Science.gov (United States)

Hogarth, Lee; He, Zhimin; Chase, Henry W; Wills, Andy J; Troisi, Joseph; Leventhal, Adam M; Mathew, Amanda R; Hitsman, Brian

2015-09-01

Two theories explain how negative mood primes smoking behaviour. The stimulus-response (S-R) account argues that in the negative mood state, smoking is experienced as more reinforcing, establishing a direct (automatic) association between the negative mood state and smoking behaviour. By contrast, the incentive learning account argues that in the negative mood state smoking is expected to be more reinforcing, which integrates with instrumental knowledge of the response required to produce that outcome. One differential prediction is that whereas the incentive learning account anticipates that negative mood induction could augment a novel tobacco-seeking response in an extinction test, the S-R account could not explain this effect because the extinction test prevents S-R learning by omitting experience of the reinforcer. To test this, overnight-deprived daily smokers (n = 44) acquired two instrumental responses for tobacco and chocolate points, respectively, before smoking to satiety. Half then received negative mood induction to raise the expected value of tobacco, opposing satiety, whilst the remainder received positive mood induction. Finally, a choice between tobacco and chocolate was measured in extinction to test whether negative mood could augment tobacco choice, opposing satiety, in the absence of direct experience of tobacco reinforcement. Negative mood induction not only abolished the devaluation of tobacco choice, but participants with a significant increase in negative mood increased their tobacco choice in extinction, despite satiety. These findings suggest that negative mood augments drug-seeking by raising the expected value of the drug through incentive learning, rather than through automatic S-R control.

Comparison of outcomes following uncemented hemiarthroplasty and dynamic hip screw in the treatment of displaced subcapital hip fractures in patients aged greater than 70 years.

LENUS (Irish Health Repository)

El-Abed, Kaldoun

2012-02-03

As health care costs increase, evaluating treatment methods in femoral neck fractures to determine the most effective treatment paradigm will become increasingly important. The current study compared two methods of treatment in similar cohorts of displaced femoral neck fractures. One hundred and twenty two patients were randomly assigned to two groups: In Group A, 62 patients were treated with a hemiarthroplasty. In group B, 60 patients were treated with dynamic screw fixation. Patients were evaluated at a minimum 3 year follow-up. Using the Matta functional hip score, 42% of group A and 70% of group B had good to excellent results. This difference was significant (p = 0.004). A significant agreement between physician assessment using the Matta score, and patient perception of outcome using the SF-36 scale was demonstrated (r = 0.64). No statistical difference between groups for revision surgery existed. Both physician based and patient based outcome scores favour retention and internal fixation of the femoral head in this cohort of patients at a short-term follow-up.

Effect of Payment Model on Patient Outcomes in Outpatient Physical Therapy.

Science.gov (United States)

Charles, Derek; Boyd, Sylvester; Heckert, Logan; Lake, Austin; Petersen, Kevin

2018-01-01

Although the literature has well recognized the effectiveness of physical therapy for treating musculoskeletal injuries, reimbursement is evolving towards value-based or alternative payment models and away from procedure orientated, fee-for-service in the outpatient setting. Alternative models include cased-based clinics, pay-for-performance, out-of-network services, accountable care organizations, and concierge practices. There is the possibility that alternative payment models could produce different and even superior patient outcomes. Physical therapists should be alert to this possibility, and research is warranted in this area to conclude if outcomes in patient care are related to method of reimbursement.

Patient-reported outcome measures for chronic obstructive pulmonary disease : the exclusion of people with low literacy skills and learning disabilities

NARCIS (Netherlands)

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

2013-01-01

BACKGROUND: Patient-reported outcome measures (PROMs) are intended to reflect outcomes relevant to patients. They are increasingly used for healthcare quality improvement. To produce valid measures, patients should be involved in the development process but it is unclear whether this usually

Arthroscopic Resection of The Distal Clavicle With Concomitant Subacromial Decompression: A Case Series

Directory of Open Access Journals (Sweden)

HZ Chan

2014-07-01

Full Text Available Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders. Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS and University of California Los Angeles Score (UCLA.

Ertapenem susceptibility of extended spectrum beta-lactamase-producing organisms

Directory of Open Access Journals (Sweden)

Selby Edward B

2007-06-01

Full Text Available Abstract Background Infections caused by multiply drug resistant organisms such as extended spectrum beta-lactamase (ESBL-producing Escherichia coli and Klebsiella pneumoniae are increasing. Carbapenems (imipenem and meropenem are the antibiotics commonly used to treat these agents. There is limited clinical data regarding the efficacy of the newest carbapenem, ertapenem, against these organisms. Ertapenem susceptibility of ESBL-producing E. coli and K. pneumoniae clinical isolates were evaluated and compared to imipenem to determine if imipenem susceptibility could be used as a surrogate for ertapenem susceptibility. Methods 100 ESBL isolates (n = 34 E. coli and n = 66 K. pneumoniae collected from 2005–2006 clinical specimens at WRAMC were identified and tested for susceptibility by Vitek Legacy [bioMerieux, Durham, NC]. Ertapenem susceptibility was performed via epsilometer test (E-test [AB Biodisk, Solna, Sweden]. Results 100% of ESBL isolates tested were susceptible to ertapenem. 100% of the same isolates were also susceptible to imipenem. Conclusion These results, based on 100% susceptibility, suggest that ertapenem may be an alternative to other carbapenems for the treatment of infections caused by ESBL-producing E. coli and K. pneumoniae. Clinical outcomes studies are needed to determine if ertapenem is effective for the treatment of infection caused by these organisms. However, due to lack of resistant isolates, we are unable to conclude whether imipenem susceptibility accurately predicts ertapenem susceptibility.

Juvenile myasthenia gravis in Norway: Clinical characteristics, treatment, and long-term outcome in a nationwide population-based cohort.

Science.gov (United States)

Popperud, T H; Boldingh, M I; Rasmussen, M; Kerty, E

2017-09-01

This study aimed to characterize juvenile myasthenia gravis in a national population-based cohort in Norway, and to evaluate long-term outcome and potential differences correlated with prepubertal versus postpubertal disease onset. Patients with onset of myasthenia gravis aged ≤18 years were identified through multiple strategies. Retrospective clinical data were collected by means of medical charts. All patients had an updated clinical examination. Cases were divided into prepubertal and postpubertal onset using age 12 years as the cut off. In total, 75 patients were identified of whom 63 were included in the study: 21 in the prepubertal and 42 in the postpubertal onset group. There was a female preponderance in both groups. In total, 59% presented with ocular symptoms, but the great majority of patients in both groups generalized during the two first years of the disease. Myasthenic crisis was more frequent in the prepubertal onset group. All patients were initially treated with pyridostigmine, 26 with steroids, and 17 with other immunosuppressive treatment. The postpubertal cases were more often treated with immunosuppressive therapy. Fifty patients (79%) underwent thymectomy. The general outcome was favourable: 57% became asymptomatic and only four subjects failed to attain clinical improvement. One-third had at least one additional autoimmune disease. Despite frequent symptom generalization and a subgroup of prepubertal onset with severe disease, the long-term outcome was good, especially in the thymectomized prepubertal onset group. Polyautoimmunity occurred in both groups in one-third. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Stable, fertile, high polyhydroxyalkanoate producing plants and methods of producing them

Energy Technology Data Exchange (ETDEWEB)

Bohmert-Tatarev, Karen; McAvoy, Susan; Peoples, Oliver P.; Snell, Kristi D.

2015-08-04

Transgenic plants that produce high levels of polyhydroxybutyrate and methods of producing them are provided. In a preferred embodiment the transgenic plants are produced using plastid transformation technologies and utilize genes which are codon optimized. Stably transformed plants able to produce greater than 10% dwt PHS in tissues are also provided.

From favours to entitlements: community voice and action and health service quality in Zambia.

Science.gov (United States)

Schaaf, Marta; Topp, Stephanie M; Ngulube, Moses

2017-07-01

Social accountability is increasingly invoked as a way of improving health services. This article presents a theory-driven qualitative study of the context, mechanisms and outcomes of a social accountability program, Citizen Voice and Action (CVA), implemented by World Vision (WV) in Zambia. Primary data were collected between November 2013 and January 2014. It included in-depth interviews and focus group discussions with program stakeholders. Secondary data were used iteratively-to inform the process for primary data collection, to guide primary data analysis and to contextualize findings from the primary data. CVA positively impacted the state, society, state-society relations and development coordination at the local level. Specifically, sustained improvements in some aspects of health system responsiveness, empowered citizens, the improved provision of public goods (health services) and increased consensus on development issues appeared to flow from CVA. The central challenge described by interviewees and FGD participants was the inability of CVA to address problems that required central level input. The mechanisms that generated these outcomes included productive state-society communication, enhanced trust, and state-society co-production of priorities and the provision of services. These mechanisms were activated in the context of existing structures for state-society interaction, willing political leaders, buy-in by traditional leaders, and WV's strong reputation and access to resources. Prospective observational research in multiple contexts would shed more light on the context, mechanisms and outcomes of CVA programs. In addition to findings that are intuitive and well supported in the literature we identified new areas that are promising areas for future research. These include (1) the context of organizational reputation by the organization(s) spearheading social accountability efforts; (2) the potential relationship between social accountability efforts

Recommendations for a uniform assessment of publication bias related to funding source

NARCIS (Netherlands)

Lent, M. van; Overbeke, J.; Out, H.J.

2013-01-01

BACKGROUND: Numerous studies on publication bias in clinical drug research have been undertaken, particularly on the association between sponsorship and favourable outcomes. However, no standardized methodology for the classification of outcomes and sponsorship has been described. Dissimilarities

Inulin-type fructan degradation capacity of Clostridium cluster IV and XIVa butyrate-producing colon bacteria and their associated metabolic outcomes.

Science.gov (United States)

Moens, F; De Vuyst, L

2017-05-30

Four selected butyrate-producing colon bacterial strains belonging to Clostridium cluster IV (Butyricicoccus pullicaecorum DSM 23266 T and Faecalibacterium prausnitzii DSM 17677 T ) and XIVa (Eubacterium hallii DSM 17630 and Eubacterium rectale CIP 105953 T ) were studied as to their capacity to degrade inulin-type fructans and concomitant metabolite production. Cultivation of these strains was performed in bottles and fermentors containing a modified medium for colon bacteria, including acetate, supplemented with either fructose, oligofructose, or inulin as the sole energy source. Inulin-type fructan degradation was not a general characteristic among these strains. B. pullicaecorum DSM 23266 T and E. hallii DSM 17630 could only ferment fructose and did not degrade oligofructose or inulin. E. rectale CIP 105953 T and F. prausnitzii DSM 17677 T fermented fructose and could degrade both oligofructose and inulin. All chain length fractions of oligofructose were degraded simultaneously (both strains) and both long and short chain length fractions of inulin were degraded either simultaneously (E. rectale CIP 105953 T ) or consecutively (F. prausnitzii DSM 17677 T ), indicating an extracellular polymer degradation mechanism. B. pullicaecorum DSM 23266 T and E. hallii DSM 17630 produced high concentrations of butyrate, CO 2 , and H 2 from fructose. E. rectale CIP 105953 T produced lactate, butyrate, CO 2 , and H 2 , from fructose, oligofructose, and inulin, whereas F. prausnitzii DSM 17677 T produced butyrate, formate, CO 2 , and traces of lactate from fructose, oligofructose, and inulin. Based on carbon recovery and theoretical metabolite production calculations, an adapted stoichiometrically balanced metabolic pathway for butyrate, formate, lactate, CO 2 , and H 2 production by members of both Clostridium cluster IV and XIVa butyrate-producing bacteria was constructed.

Clinical profile and outcome of critically ill pregnant females with H1N1 influenza

Directory of Open Access Journals (Sweden)

Minal Shastri

2016-12-01

Full Text Available Background Record based review of the 2009 H1N1 Influenza pandemic suggests that pregnant women are at higher risk for hospitalization and death due to H1N1 Influenza. Aims To study the clinical profile and outcome of critically ill pregnant females admitted in intensive care unit (ICU with real-time recombinant polymerase chain reaction (rRT-PCR proven positive H1N1 cases. Methods A retrospective record-review based study was conducted at Sir SayajiRao General Hospital (SSGH and Medical College, Vadodara on data of confirmed rRT-PCR H1N1 pregnant females admitted during the pandemics of 2010and 2015. Demographics, clinical profile and laboratory investigations were recorded and outcomes (survived or expired were analysed. Results There were a total of 20 H1N1 positive pregnant females requiring ICU admission. With equal demographic distribution among rural and urban population, cough and fever were the most common presenting complaints. 65 per cent were in third trimester, the subgroup which also had the highest mortality. Mean days from onset until presentation was 5.05 days. 12 (60 per cent patients’ required invasive mode of ventilation and all died. Average hospital stay was 7 days. Foetus had favourable outcome in patients who recovered from H1N1 acute illness. Conclusion Pregnant females in our study had 60 per cent mortality. Thus, awareness, early diagnosis and treatment should be provided to them. Guidelines, policy changes and government protocols are required specifically for pregnant females with H1N1 Influenza A infection. Our study was an observational study and comparisons with non-pregnant females were not done, conclusions applicable to entire pregnant population was not derived.

Cell Cycle Inhibitors and Outcome after Radiotherapy in Bladder Cancer Patients

International Nuclear Information System (INIS)

Roetterud, Ranveig; Pettersen, Erik O.; Berner, Aasmund; Holm, Ruth; Olsen, Dag Rune; Fossaa, Sophie D.

2002-01-01

The aim of this study was to correlate the expression of cell cycle inhibitors with outcome of patients with muscle-invasive bladder cancer treated with preoperative radiotherapy (46 Gy/4-5 weeks or 20 Gy/1 week) and cystectomy. Patients with pT3b (n=42) or pT0 (n=17) were included in the study. Expression of p16INK4a and p27KIP1 was assessed immunohistochemically in pre-radiotherapy biopsies and cystectomy specimens. Previously reported results of p21CIP1 expression were also included. No difference in pretreatment protein expression was found between patients with pT0 and pT3b. Expression of p21CIP1 and p27KIP1 was lower in cystectomy specimens than in pretreatment biopsies. None of the proteins showed significant impact on survival when analysed separately. However, patients with tumours showing > 50% expression of p16INK4a, p21CIP1, or p27KIP1 displayed poorer cancer-specific survival rates compared with the remaining patients (p=0.025). This effect was more pronounced in patients receiving 46 Gy than in those receiving 20 Gy. In conclusion, low expression of cell cycle inhibitors is related to favourable survival after precystectomy radiotherapy

Achievements in mental health outcome measurement in Australia: Reflections on progress made by the Australian Mental Health Outcomes and Classification Network (AMHOCN)

Science.gov (United States)

2012-01-01

Background Australia’s National Mental Health Strategy has emphasised the quality, effectiveness and efficiency of services, and has promoted the collection of outcomes and casemix data as a means of monitoring these. All public sector mental health services across Australia now routinely report outcomes and casemix data. Since late-2003, the Australian Mental Health Outcomes and Classification Network (AMHOCN) has received, processed, analysed and reported on outcome data at a national level, and played a training and service development role. This paper documents the history of AMHOCN’s activities and achievements, with a view to providing lessons for others embarking on similar exercises. Method We conducted a desktop review of relevant documents to summarise the history of AMHOCN. Results AMHOCN has operated within a framework that has provided an overarching structure to guide its activities but has been flexible enough to allow it to respond to changing priorities. With no precedents to draw upon, it has undertaken activities in an iterative fashion with an element of ‘trial and error’. It has taken a multi-pronged approach to ensuring that data are of high quality: developing innovative technical solutions; fostering ‘information literacy’; maximising the clinical utility of data at a local level; and producing reports that are meaningful to a range of audiences. Conclusion AMHOCN’s efforts have contributed to routine outcome measurement gaining a firm foothold in Australia’s public sector mental health services. PMID:22640939

Achievements in mental health outcome measurement in Australia: Reflections on progress made by the Australian Mental Health Outcomes and Classification Network (AMHOCN

Directory of Open Access Journals (Sweden)

Burgess Philip

2012-05-01

Full Text Available Abstract Background Australia’s National Mental Health Strategy has emphasised the quality, effectiveness and efficiency of services, and has promoted the collection of outcomes and casemix data as a means of monitoring these. All public sector mental health services across Australia now routinely report outcomes and casemix data. Since late-2003, the Australian Mental Health Outcomes and Classification Network (AMHOCN has received, processed, analysed and reported on outcome data at a national level, and played a training and service development role. This paper documents the history of AMHOCN’s activities and achievements, with a view to providing lessons for others embarking on similar exercises. Method We conducted a desktop review of relevant documents to summarise the history of AMHOCN. Results AMHOCN has operated within a framework that has provided an overarching structure to guide its activities but has been flexible enough to allow it to respond to changing priorities. With no precedents to draw upon, it has undertaken activities in an iterative fashion with an element of ‘trial and error’. It has taken a multi-pronged approach to ensuring that data are of high quality: developing innovative technical solutions; fostering ‘information literacy’; maximising the clinical utility of data at a local level; and producing reports that are meaningful to a range of audiences. Conclusion AMHOCN’s efforts have contributed to routine outcome measurement gaining a firm foothold in Australia’s public sector mental health services.

Clinical and microbiological characteristics of OXA-23- and OXA-143-producing Acinetobacter baumannii in ICU patients at a teaching hospital, Brazil

Directory of Open Access Journals (Sweden)

Francelli Cordeiro Neves

2016-11-01

Conclusions: In this study, clonally unrelated OXA-123- and OXA-143-producing A. baumannii strains in ICU patients were strongly correlated to colonization with infected patients being associated with a poor outcome.

Post-fire environments are favourable for plant functioning of seeder and resprouter Mediterranean shrubs, even under drought.

Science.gov (United States)

Parra, Antonio; Moreno, José M

2017-05-01

Understanding how drought affects seeder and resprouter plants during post-fire regeneration is important for the anticipation of Mediterranean vegetation vulnerability in a context of increasing drought and fire caused by climate change. A Mediterranean shrubland was subjected to various drought treatments (including 45% rainfall reduction, 7 months drought yr -1 ), before and after experimental burning, by means of a rainout-shelter system with an irrigation facility. Predawn shoot water potential (Ψ pd ), relative growth rate (RGR), specific leaf area (SLA) and bulk leaf carbon isotopic composition (δ 13 C) were monitored in the main woody species during the first 3 yr after fire. Cistus ladanifer seedlings showed higher Ψ pd , RGR and SLA, and lower δ 13 C, than unburned plants during the first two post-fire years. Seedlings under drought maintained relatively high Ψ pd , but suffered a decrease in Ψ pd and RGR, and an increase in δ 13 C, relative to control treatments. Erica arborea, E. scoparia and Phillyrea angustifolia resprouts had higher Ψ pd and RGR than unburned plants during the first post-fire year. Resprouters were largely unaffected by drought. Overall, despite marked differences between the two functional groups, post-fire environments were favourable for plant functioning of both seeder and resprouter shrubs, even under the most severe drought conditions implemented. © 2017 The Authors. New Phytologist © 2017 New Phytologist Trust.

Mediation Analysis with Survival Outcomes: Accelerated Failure Time vs. Proportional Hazards Models.

Science.gov (United States)

Gelfand, Lois A; MacKinnon, David P; DeRubeis, Robert J; Baraldi, Amanda N

2016-01-01

Survival time is an important type of outcome variable in treatment research. Currently, limited guidance is available regarding performing mediation analyses with survival outcomes, which generally do not have normally distributed errors, and contain unobserved (censored) events. We present considerations for choosing an approach, using a comparison of semi-parametric proportional hazards (PH) and fully parametric accelerated failure time (AFT) approaches for illustration. We compare PH and AFT models and procedures in their integration into mediation models and review their ability to produce coefficients that estimate causal effects. Using simulation studies modeling Weibull-distributed survival times, we compare statistical properties of mediation analyses incorporating PH and AFT approaches (employing SAS procedures PHREG and LIFEREG, respectively) under varied data conditions, some including censoring. A simulated data set illustrates the findings. AFT models integrate more easily than PH models into mediation models. Furthermore, mediation analyses incorporating LIFEREG produce coefficients that can estimate causal effects, and demonstrate superior statistical properties. Censoring introduces bias in the coefficient estimate representing the treatment effect on outcome-underestimation in LIFEREG, and overestimation in PHREG. With LIFEREG, this bias can be addressed using an alternative estimate obtained from combining other coefficients, whereas this is not possible with PHREG. When Weibull assumptions are not violated, there are compelling advantages to using LIFEREG over PHREG for mediation analyses involving survival-time outcomes. Irrespective of the procedures used, the interpretation of coefficients, effects of censoring on coefficient estimates, and statistical properties should be taken into account when reporting results.

Mediation Analysis with Survival Outcomes: Accelerated Failure Time Versus Proportional Hazards Models

Directory of Open Access Journals (Sweden)

Lois A Gelfand

2016-03-01

Full Text Available Objective: Survival time is an important type of outcome variable in treatment research. Currently, limited guidance is available regarding performing mediation analyses with survival outcomes, which generally do not have normally distributed errors, and contain unobserved (censored events. We present considerations for choosing an approach, using a comparison of semi-parametric proportional hazards (PH and fully parametric accelerated failure time (AFT approaches for illustration.Method: We compare PH and AFT models and procedures in their integration into mediation models and review their ability to produce coefficients that estimate causal effects. Using simulation studies modeling Weibull-distributed survival times, we compare statistical properties of mediation analyses incorporating PH and AFT approaches (employing SAS procedures PHREG and LIFEREG, respectively under varied data conditions, some including censoring. A simulated data set illustrates the findings.Results: AFT models integrate more easily than PH models into mediation models. Furthermore, mediation analyses incorporating LIFEREG produce coefficients that can estimate causal effects, and demonstrate superior statistical properties. Censoring introduces bias in the coefficient estimate representing the treatment effect on outcome – underestimation in LIFEREG, and overestimation in PHREG. With LIFEREG, this bias can be addressed using an alternative estimate obtained from combining other coefficients, whereas this is not possible with PHREG.Conclusions: When Weibull assumptions are not violated, there are compelling advantages to using LIFEREG over PHREG for mediation analyses involving survival-time outcomes. Irrespective of the procedures used, the interpretation of coefficients, effects of censoring on coefficient estimates, and statistical properties should be taken into account when reporting results.

Predictors of discontinuation of antipsychotic medication and subsequent outcomes in the European First Episode Schizophrenia Trial (EUFEST).

Science.gov (United States)

Landolt, Karin; Rössler, Wulf; Ajdacic-Gross, Vladeta; Derks, Eske M; Libiger, Jan; Kahn, René S; Fleischhacker, W Wolfgang

2016-04-01

This study had two aims: to describe patients suffering from first-episode schizophrenia who had stopped taking any antipsychotic medication, and to gain information on the predictors of successful discontinuation. We investigated data from the European First Episode Schizophrenia Trial (EUFEST). From the 325 patients included, 15.7% discontinued all antipsychotic medication. In a first analysis, clinical and sociodemographical predictors of discontinuing any antipsychotic medication were identified, using Cox regression. In the second analysis, logistic regression was used to determine variables associated with those patients who had stopped taking antipsychotic medication and had a favourable outcome, i.e., successful discontinuation. A good outcome was defined as a) having had no relapse within the whole observation period (80.6%), and b) having had no relapse and symptomatic remission at 12-month-follow-up (37.2%). Cox regression revealed that a higher proportion of patients from Western European countries and Israel stopped antipsychotic medication than from Central and Eastern European countries, that relapse was associated with discontinuation, and that discontinuers had lower compliance and higher quality of life. Predictors of successful discontinuation differed with the outcome definition used. Using definition b), successful discontinuers had a better baseline prognosis and better baseline social integration. Using definition a), successful discontinuers more often were from Western European countries. Region and clinical factors were associated with discontinuation. Prognosis and social integration played an important role in predicting successful discontinuation. As this study had several limitations, for example the observational design regarding discontinuation, further studies are needed to identify predictors of successful discontinuation. Copyright © 2016 Elsevier B.V. All rights reserved.

Characterization of novel W alloys produced by HIP

International Nuclear Information System (INIS)

Monge, M.A.; Auger, M.A.; Leguey, T.; Ortega, Y.; Bolzoni, L.; Gordo, E.; Pareja, R.

2009-01-01

W and W alloys containing 0.5 wt% Y 2 O 3 , x wt% Ti and (x wt% Ti + 0.5 wt% Y 2 O 3 ) have been prepared, x = 2 or 4. Elemental powders were blended or ball milled, canned, degassed and finally consolidated by a two-stage HIP process under a pressure of 195 MPa. It is found that Ti addition favours the densification attaining a fully dense material. XRD, SEM and EDX analyses of the material with Ti addition reveal the formation of a microstructure consisting of tungsten particles embedded in a W-Ti matrix. The microhardness of these materials increased noticeably with the titanium content.

Therapist adherence is associated with outcome in cognitive–behavioral therapy for bulimia nervosa

DEFF Research Database (Denmark)

Folke, Sofie; Daniel, Sarah Ingrid Franksdatter; Gondan, Matthias

2017-01-01

Studies of therapist adherence in relation to treatment outcome have produced mixed results. The aim of the present study was to investigate change in therapist adherence to cognitive–behavioral therapy (CBT) for bulimia nervosa over time, and to investigate the relationship between adherence...... and client outcome in early, middle, and late phases of treatment. Thirty-six clients received the focused form of “enhanced” CBT (CBT-E) for bulimia nervosa. Trained observers rated audiotapes of 92 full-length therapy sessions from early (Session 3), middle (Session 11), and late phases (Session 20...

Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia.

Science.gov (United States)

Jennings, Natasha; O'Reilly, Gerard; Lee, Geraldine; Cameron, Peter; Free, Belinda; Bailey, Michael

2008-04-01

The aim of this study was to evaluate the impact of the introduction of Emergency Nurse Practitioner Candidates (ENPC) on waiting times and length of stay of patients presenting to a major urban Emergency Department (ED) in Melbourne, Australia. As part of a Victorian state funded initiative to improve patient outcomes, the role of the Emergency Nurse Practitioner has been developed. The integration and implementation of this role, is not only new to the Alfred Emergency and Trauma Centre but to EDs in Melbourne, Australia, with aims of providing holistic and comprehensive care for patients. A retrospective case series of all patients with common ED diagnostic subgroups were included. The ENPC group (n = 572) included all patients managed by the ENPC and the Traditional Model (TM) group (n = 2584) included all patients managed by the traditional medical ED model of care. Outcome measures included waiting times and length of stay. Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. The overall median waiting time for emergency patients to be seen by the ENPC was less than for the TM group [median (IQR): ENPC 12 (5.5-28) minutes; TM 31 (11.5-76) minutes (Wilcoxon p times for ENPC shifts vs. non-ENPC shifts revealed significant differences [median (IQR): ENPC rostered 24 (9-52) minutes; ENPC not rostered 33 (13-80.5) minutes (Wilcoxon p Melbourne, Australia were associated with significantly reduced waiting times and length of stay for emergency patients. Emergency Nurse Practitioners should be considered as a potential long term strategy to manage increased service demands on EDs. Relevance to clinical practice. This study is the first in Australia with a significant sample size to vigorously compare ENPC waiting times and length of stay outcomes with the TM model of care in the ED. The study suggests that ENPCs can have a favourable impact on patient outcomes with regard to waiting times and length

Do school-based interventions focusing on physical activity, fitness, or fundamental movement skill competency produce a sustained impact in these outcomes in children and adolescents? A systematic review of follow-up studies.

Science.gov (United States)

Lai, Samuel K; Costigan, Sarah A; Morgan, Philip J; Lubans, David R; Stodden, David F; Salmon, Jo; Barnett, Lisa M

2014-01-01

The aim of this systematic review was to determine whether typically developing children and adolescents (aged 3-18 years) who have participated in school-based interventions have sustained outcomes in PA, fitness, and/or FMS. A systematic search of six electronic databases (CINAHL® Plus with Full Text, Ovid MEDLINE®, SPORTDiscus™, Scopus, PsycINFO® and ERIC) was conducted from 1995 to 26 July 2012. Included studies were school-based studies (including randomized controlled trials, longitudinal cohort, quasi-experimental, and experimental) that had a positive effect at post intervention in at least one variable and had a follow-up PA, fitness, or FMS assessment at least 6 months after the post-intervention assessment. Risk of bias assessment was guided by the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" statement. The search identified 14 articles, and some studies addressed multiple outcomes: 13 articles assessed PA; three assessed fitness; and two assessed FMS. No study in this review met four key methodological criteria that have been shown to influence results, i.e., clarity on the randomization process, assessor blinding, analyzing participants in their original groups, and retaining sufficient participants through the entire study. Three-quarters (ten of 13) of the studies addressing PA, reported PA behavior change maintenance. The length of follow-up ranged from 6 months to 20 years, and the degree of PA difference reported was between 3 and 14 min per day. Only one of the three studies assessing fitness reported a sustained impact, whilst both studies that assessed FMS reported maintenance of effects. It is likely that PA is a sustainable outcome from interventions in children and adolescents, and there is reasonable evidence that interventions of longer than 1 year and interventions that utilize a theoretical model or framework are effective in producing this sustained impact. It would seem probable that FMS are a sustainable

Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome

OpenAIRE

Allen, Laura B.; White, Kamila S.; Barlow, David H.; Shear, M. Katherine; Gorman, Jack M.; Woods, Scott W.

2009-01-01

Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disor...

The association between collateral status, recanalization and long term outcome in stroke patients treated with stent retrievers - Are there indications not to perform thrombectomy based on CT angiography?

Science.gov (United States)

Nordmeyer, Hannes; Webering, Nadine; Chapot, Rene; Hadisurya, Jeffrie; Heddier, Markus; Stracke, Paul; Berger, Klaus; Isenmann, Stefan; Weber, Ralph

2017-06-01

To investigate the association between baseline pial collateral status on computed tomography angiography (CTA) with recanalization and functional outcome in patients with acute anterior circulation stroke treated with stent retriever thrombectomy. Retrospective analysis of 87 patients from a prospective thrombectomy registry. Collateral status on CTA source images was categorized into good, moderate, and poor with the Tan and Miteff scores by two-blinded readers. Association between CTA collateral status and successful recanalization was investigated with univariate regression analysis. Multivariate logistic regression was used to analyse the association between collateral score and favourable clinical outcome (mRS 0-2) and death at follow-up. Mean age was 72.5 years and baseline median NIHSS score was 15. Patients with poor collaterals on Tan score had a significant higher mortality compared with moderate or good collaterals during a mean follow-up period of 5.2 months (85.7% vs. 30.6% vs. 25.7%, Pcollateral score could be assessed only in 65 of the 87 patients and the Tan collateral score had a higher interrater reliability. Poor collaterals on CTA were associated with a very high rate of fatal outcome in anterior circulation stroke patients despite a high rate of successful recanalization with stent retrievers. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Extended producer responsibility for consumer waste: the gap between economic theory and implementation.

Science.gov (United States)

Dubois, Maarten

2012-09-01

Although economic theory supports the use of extended producer responsibility (EPR) to stimulate prevention and recycling of waste, EPR systems implemented in Europe are often criticized as a result of weak incentives for prevention and green product design. Using a stylized economic model, this article evaluates the efficiency of European EPR systems. The model reveals that the introduction of static collection targets creates a gap between theory and implementation. Static targets lead to inefficient market outcomes and weak incentives for prevention and green product design. The minimum collection targets should be complemented with a tax on producers for the non-collected waste fraction. Because such a tax internalizes the cost of waste disposal, more efficient price signals will lead to better incentives for waste management in a complex and dynamic market.

Spontaneous perforation of bile duct, clinical presentation, laboratory work up, treatment and outcome

International Nuclear Information System (INIS)

Malik, H.S.; Cheema, H.A.; Fayyaz, Z.; Hashmi, M.A.

2016-01-01

Spontaneous perforation of bile duct (SPBD) is a rare and often misdiagnosed entity. Though rare, it is the second most common surgical cause of jaundice in infants, after biliary atresia. This study was planned to determine the clinical presentation, study different diagnostic modalities, treatment and outcome of patients with spontaneous perforation of bile duct. Methods: This descriptive case series, comprising 22 patients with spontaneous perforation of bile duct over a period of 24 months. Clinical presentation, biochemical abnormalities, imaging details, treatment options and outcome were studied. Results: Total 22 patients (12 Males and 10 Females) between ages of 1.5-36 months were studied. Associated anatomical defects included choledochal cyst in 7 (31.8%) while acquired biliary atresia in 1 (4.5%). Elevated liver enzymes (ALT and AST) were present in 16 patients (72.7%) and 5 (22.7%) had bilirubin above 3 mg/dl. Coagulopathy was seen in 8 (36.6%) patients. Abdominal USG showed presence of ascites in all 22 (100%), hydrocele in 2 (9.0%), inguinal hernia in 1 (4.5%), choledochal cyst in 7 (31.8%) and atretic gall bladder suggestive of acquired biliary atresia in one (4.5%) patient. HIDA scan was diagnostic in all 17 (77.27%) in which it was performed. MRCP was done in 3 (13.6%) patients. Mortality frequency was 3/22 (13.6%); one died of post-surgical sepsis second one was cirrhotic at time of presentation and didnot make It. Two were lost to follow up one which died at home while we lost contact with fourth patient. Conclusion: Spontaneous perforation of bile duct can present and should be suspected as an important cause of neonatal biliary ascites or peritonitis. Most patients can be managed with intravenous antibiotics, percutaneous drainage and t-tube insertion while patients with choledochal cysts required cholecystectomy with roux en y choledochjejunostomy. Timely recognition and intervention is associated with favourable outcome. (author)

Does a pre-treatment diagnostic interview affect the outcome of internet-based self-help for social anxiety disorder? a randomized controlled trial.

Science.gov (United States)

Boettcher, Johanna; Berger, Thomas; Renneberg, Babette

2012-10-01

Numerous studies suggest that Internet-based self-help treatments are effective in treating anxiety disorders. Trials evaluating such interventions differ in their screening procedures and in the amount of clinician contact in the diagnostic assessment phase. The present study evaluates the impact of a pre-treatment diagnostic interview on the outcome of an Internet-based treatment for Social Anxiety Disorder (SAD). One hundred and nine participants seeking treatment for SAD were randomized to either an interview-group (IG, N = 53) or to a non-interview group (NIG, N = 56). All participants took part in the same 10-week cognitive-behavioural unguided self-help programme. Before receiving access to the programme, participants of the IG underwent a structured diagnostic interview. Participants of the NIG started directly with the programme. Participants in both groups showed significant and substantial improvement on social anxiety measures from pre- to post-assessment (d IG = 1.30-1.63; d NIG = 1.00-1.28) and from pre- to 4-month follow-up assessment (d IG = 1.38-1.87; d NIG = 1.10-1.21). Significant between-groups effects in favour of the IG were found on secondary outcome measures of depression and general distress (d = 0.18-0.42). These findings suggest that Internet-based self-help is effective in treating SAD, whether or not a diagnostic interview is involved. However, the pre-treatment interview seems to facilitate change on secondary outcomes such as depression and general distress.

CCT`s in a deregulated environment: A producer`s perspective

Energy Technology Data Exchange (ETDEWEB)

Edmonds, R.F. Jr.; Fayssoux, J.O. [Duke Power Co., Charlotte, NC (United States)

1997-12-31

The US electric industry will be deregulated (or substantially re-regulated) within 5 years. Several states, including California, Rhode Island, and New Hampshire, already have passed legislation to introduce competition into the electric markets before the year 2000. As this trend sweeps across the country, the resulting competitive market for generation will reward the lowest cost producers and force high cost producers out of the market. As a result, at least in the short run, it may be very difficult for new power plants employing Clean Coal Technologies (CCTs) to compete. This paper discusses a producer`s perspective of the new competitive market, and suggests several short and long term strategies and niches for CCTs.

Dendritic Cell Activity Driven by Recombinant Mycobacterium bovis BCG Producing Human IL-18, in Healthy BCG Vaccinated Adults.

Science.gov (United States)

Szpakowski, Piotr; Biet, Franck; Locht, Camille; Paszkiewicz, Małgorzata; Rudnicka, Wiesława; Druszczyńska, Magdalena; Allain, Fabrice; Fol, Marek; Pestel, Joël; Kowalewicz-Kulbat, Magdalena

2015-01-01

Tuberculosis remains an enormous global burden, despite wide vaccination coverage with the Bacillus Calmette-Guérin (BCG), the only vaccine available against this disease, indicating that BCG-driven immunity is insufficient to protect the human population against tuberculosis. In this study we constructed recombinant BCG producing human IL-18 (rBCGhIL-18) and investigated whether human IL-18 produced by rBCGhIL-18 modulates DC functions and enhances Th1 responses to mycobacterial antigens in humans. We found that the costimulatory CD86 and CD80 molecules were significantly upregulated on rBCGhIL-18-infected DCs, whereas the stimulation of DCs with nonrecombinant BCG was less effective. In contrast, both BCG strains decreased the DC-SIGN expression on human DCs. The rBCGhIL-18 increased IL-23, IL-10, and IP-10 production by DCs to a greater extent than nonrecombinant BCG. In a coculture system of CD4(+) T cells and loaded DCs, rBCGhIL-18 favoured strong IFN-γ but also IL-10 production by naive T cells but not by memory T cells. This was much less the case for nonrecombinant BCG. Thus the expression of IL-18 by recombinant BCG increases IL-23, IP-10, and IL-10 expression by human DCs and enhances their ability to induce IFN-γ and IL-10 expression by naive T cells, without affecting the maturation phenotype of the DCs.

Dendritic Cell Activity Driven by Recombinant Mycobacterium bovis BCG Producing Human IL-18, in Healthy BCG Vaccinated Adults

Directory of Open Access Journals (Sweden)

Piotr Szpakowski

2015-01-01

Full Text Available Tuberculosis remains an enormous global burden, despite wide vaccination coverage with the Bacillus Calmette-Guérin (BCG, the only vaccine available against this disease, indicating that BCG-driven immunity is insufficient to protect the human population against tuberculosis. In this study we constructed recombinant BCG producing human IL-18 (rBCGhIL-18 and investigated whether human IL-18 produced by rBCGhIL-18 modulates DC functions and enhances Th1 responses to mycobacterial antigens in humans. We found that the costimulatory CD86 and CD80 molecules were significantly upregulated on rBCGhIL-18-infected DCs, whereas the stimulation of DCs with nonrecombinant BCG was less effective. In contrast, both BCG strains decreased the DC-SIGN expression on human DCs. The rBCGhIL-18 increased IL-23, IL-10, and IP-10 production by DCs to a greater extent than nonrecombinant BCG. In a coculture system of CD4+ T cells and loaded DCs, rBCGhIL-18 favoured strong IFN-γ but also IL-10 production by naive T cells but not by memory T cells. This was much less the case for nonrecombinant BCG. Thus the expression of IL-18 by recombinant BCG increases IL-23, IP-10, and IL-10 expression by human DCs and enhances their ability to induce IFN-γ and IL-10 expression by naive T cells, without affecting the maturation phenotype of the DCs.

The theory of music, mood and movement to improve health outcomes.

Science.gov (United States)

Murrock, Carolyn J; Higgins, Patricia A

2009-10-01

This paper presents a discussion of the development of a middle-range nursing theory of the effects of music on physical activity and improved health outcomes. Due to the high rate of physical inactivity and the associated negative health outcomes worldwide, nurses need new evidence-based theories and interventions to increase physical activity. The theory of music, mood and movement (MMM) was developed from physical activity guidelines and music theory using the principles of statement and theory synthesis. The concepts of music, physical activity and health outcomes were searched using the CINAHL, MEDLINE, ProQuest Nursing and Allied Health Source, PsycINFO and Cochrane Library databases covering the years 1975-2008. The theory of MMM was synthesized by combining the psychological and physiological responses of music to increase physical activity and improve health outcomes. It proposes that music alters mood, is a cue for movement, and makes physical activity more enjoyable leading to improved health outcomes of weight, blood pressure, blood sugar and cardiovascular risk factor management, and improved quality of life. As it was developed from the physical activity guidelines, the middle-range theory is prescriptive, produces testable hypotheses, and can guide nursing research and practice. The middle-range theory needs to be tested to determine its usefulness for nurses to develop physical activity programmes to improve health outcomes across various cultures.

Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project

Directory of Open Access Journals (Sweden)

Thomas Susie

2008-12-01

Full Text Available Abstract Background The aim of this project was primarily to assess the feasibility of individual exercise programs for older hospitalised patients at risk of functional decline, and secondarily to evaluate impact on discharge outcomes. Methods Design: Cohort service improvement project Setting: 500 bed acute metropolitan hospital Subjects: Patients aged 70 and older admitted to Flinders Medical Centre under the general medical, aged care and respiratory units from June to November 2006, at intermediate or high risk of functional decline, and able to commence exercise within 48 hours of admission Intervention: Functional Maintenance Program (FMP; an individually tailored exercise program to maintain functional mobility, prescribed and progressed by a physiotherapist, and supervised by an Allied Health Assistant (AHA, provided in addition to usual physiotherapy care Outcome measures: Feasibility (number of admissions suitable, commencing and complying with FMP. Impact (length of hospital stay (LOS, Aged Care Assessment Team (ACAT referrals and approvals, hospital readmissions within 28 days, and functional mobility (Elderly Mobility Scale Data Analysis: Descriptive and logistic regression analysis Results Of 1021 admissions of patients aged 70 or older to general medical, aged care and respiratory units, 22% (n = 220 were identified within 48 hours as suitable for FMP: 196 (89% commenced FMP within 48 hours of admission (FMP patients; 24 (11% received usual physiotherapy (usual care patients. Feasibility of individually tailored exercise programs for older medical patients was supported by high uptake (89%, low withdrawal (17% shown by those who commenced FMP, and good compliance with exercise sessions (70%. Logistic regression analysis showed a statistically significant decreased likelihood of referral for nursing home admission (OR = 0.228, 95% CI 0.088–0.587 and decreased likelihood of approval for admission to residential care (OR = 0

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Vietnam

International Nuclear Information System (INIS)

1977-11-01

The Chaine Annamatique represents the last of the three orogenic episodes that shook Indochina and forms most of Vietnam's boundary with Laos, In south Vietnam the mountains which have a north-south trend are formed of granites, gneisses and mica schists and are inseparable from the anti-hercynian formations. Iron ore, gold, lead, copper, tin, wolfraun, bismuth and molybdenium minerals are found. Plans had been made in 1960 to prospect for uranium but no information is available on whether that work was ever done. The only evidence of occurrences of nuclear raw materials is that titaniferous sands occur in several coastal regions and that uranium was once listed as having been produced in Forth Vietnam. Although the geology of Vietnam is not very conducive to the formation and preservation of uranium deposits it is possible that because of the granite terrain and presence of other metalliferous minerals, the Speculative Potential should be stated as in category 2 i.e. from 1,000 to 10,000 tonnes uranium. (author)

The serological screening of deceased tissue donors within the English Blood Service for infectious agents--a review of current outcomes and a more effective strategy for the future.

Science.gov (United States)

Kitchen, A D; Gillan, H L

2010-04-01

The overall effectiveness of the NHSBT screening programme for infectious agents in deceased tissue donors is examined and evaluated in terms of current outcomes and how to improve upon these outcomes. The screening results and any subsequent confirmatory results from a total of 1659 samples from NHSBT deceased donors referred to NTMRL for screening for infectious agents were included in the analysis. Overall 1566/1659 (94.4%) of the samples were screen negative. A total of 93 were repeat reactive on screening for one or more of the mandatory markers screened for, of which only 12 (13%) were subsequently confirmed to be positive on confirmatory testing. The majority of the repeat reactive samples were demonstrating non-specific reactivity with the screening assays in use. Overall, the NHSBT screening programme for infectious agents in deceased tissue donors is very effective with a relatively low overall loss of donors because of non-specific reactivity. However, unnecessary loss of tissue products is not acceptable, and although this programme compares favourably with the outcomes of other such programmes, the confirmatory results obtained demonstrate both the need and the potential for improving the outcomes. This is particularly important as one donor may donate more than one product, and can be achieved very easily with a change to the screening algorithm followed, using the confirmatory data obtained to support and validate this change. CONTENTS SUMMARY: Critical analysis of the NHSBT screening programme for infectious agents in deceased tissue donors and a strategy involving the design and use of a different screening algorithm to improve these outcomes.

Prenatal management and perinatal outcome in giant placental chorioangioma complicated with hydrops fetalis, fetal anemia and maternal mirror syndrome

Directory of Open Access Journals (Sweden)

García-Díaz Lutgardo

2012-07-01

Full Text Available Abstract Background Giant placental chorioangiomas have been associated with a number of severe fetal complications and high perinatal mortality. Case presentation We report a case of giant chorioangioma with fetal hydrops, additionally complicated by severe anemia, mild cardiomegaly with hyperdinamic heart circulation and maternal mirror syndrome. Intrauterine blood transfusion and amniodrainage was performed at 29 weeks. Worsening of the fetal and maternal condition prompted us to proceed with delivery at 29 + 5 weeks. The newborn died 3 hours later due to pulmonary hypoplasia and hemodynamic failure. Maternal course was favourable, mirror syndrome resolved in the second day and the patient was discharged four days following delivery. Conclusions In the case described here, fetal condition got worse despite of the anemia correction and amniodrainage. Our outcome raises the issue whether additional intrauterine clinical intervention, as intersticial laser, should have been performed to stop further deterioration of the fetal condition when progressive severe hydrops develops.

Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems

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Alba Luz Rodríguez-Acelas

Full Text Available Objective.Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults. Methods. Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms. Results. Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop. Conclusion. This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.

Patient outcomes for the chronically critically ill: special care unit versus intensive care unit.

Science.gov (United States)

Rudy, E B; Daly, B J; Douglas, S; Montenegro, H D; Song, R; Dyer, M A

1995-01-01

The purpose of this study was to compare the effects of a low-technology environment of care and a nurse case management case delivery system (special care unit, SCU) with the traditional high-technology environment (ICU) and primary nursing care delivery system on the patient outcomes of length of stay, mortality, readmission, complications, satisfaction, and cost. A sample of 220 chronically critically ill patients were randomly assigned to either the SCU (n = 145) or the ICU (n = 75). Few significant differences were found between the two groups in length of stay, mortality, or complications. However, the findings showed significant cost savings in the SCU group in the charges accrued during the study period and in the charges and costs to produce a survivor. The average total cost of delivering care was $5,000 less per patient in the SCU than in the traditional ICU. In addition, the cost to produce a survivor was $19,000 less in the SCU. Results from this 4-year clinical trial demonstrate that nurse case managers in a SCU setting can produce patient outcomes equal to or better than those in the traditional ICU care environment for long-term critically ill patients.

The neural basis of risky choice with affective outcomes.

Directory of Open Access Journals (Sweden)

Renata S Suter

Full Text Available Both normative and many descriptive theories of decision making under risk are based on the notion that outcomes are weighted by their probability, with subsequent maximization of the (subjective expected outcome. Numerous investigations from psychology, economics, and neuroscience have produced evidence consistent with this notion. However, this research has typically investigated choices involving relatively affect-poor, monetary outcomes. We compared choice in relatively affect-poor, monetary lottery problems with choice in relatively affect-rich medical decision problems. Computational modeling of behavioral data and model-based neuroimaging analyses provide converging evidence for substantial differences in the respective decision mechanisms. Relative to affect-poor choices, affect-rich choices yielded a more strongly curved probability weighting function of cumulative prospect theory, thus signaling that the psychological impact of probabilities is strongly diminished for affect-rich outcomes. Examining task-dependent brain activation, we identified a region-by-condition interaction indicating qualitative differences of activation between affect-rich and affect-poor choices. Moreover, brain activation in regions that were more active during affect-poor choices (e.g., the supramarginal gyrus correlated with individual trial-by-trial decision weights, indicating that these regions reflect processing of probabilities. Formal reverse inference Neurosynth meta-analyses suggested that whereas affect-poor choices seem to be based on brain mechanisms for calculative processes, affect-rich choices are driven by the representation of outcomes' emotional value and autobiographical memories associated with them. These results provide evidence that the traditional notion of expectation maximization may not apply in the context of outcomes laden with affective responses, and that understanding the brain mechanisms of decision making requires the domain

The neural basis of risky choice with affective outcomes.

Science.gov (United States)

Suter, Renata S; Pachur, Thorsten; Hertwig, Ralph; Endestad, Tor; Biele, Guido

2015-01-01

Both normative and many descriptive theories of decision making under risk are based on the notion that outcomes are weighted by their probability, with subsequent maximization of the (subjective) expected outcome. Numerous investigations from psychology, economics, and neuroscience have produced evidence consistent with this notion. However, this research has typically investigated choices involving relatively affect-poor, monetary outcomes. We compared choice in relatively affect-poor, monetary lottery problems with choice in relatively affect-rich medical decision problems. Computational modeling of behavioral data and model-based neuroimaging analyses provide converging evidence for substantial differences in the respective decision mechanisms. Relative to affect-poor choices, affect-rich choices yielded a more strongly curved probability weighting function of cumulative prospect theory, thus signaling that the psychological impact of probabilities is strongly diminished for affect-rich outcomes. Examining task-dependent brain activation, we identified a region-by-condition interaction indicating qualitative differences of activation between affect-rich and affect-poor choices. Moreover, brain activation in regions that were more active during affect-poor choices (e.g., the supramarginal gyrus) correlated with individual trial-by-trial decision weights, indicating that these regions reflect processing of probabilities. Formal reverse inference Neurosynth meta-analyses suggested that whereas affect-poor choices seem to be based on brain mechanisms for calculative processes, affect-rich choices are driven by the representation of outcomes' emotional value and autobiographical memories associated with them. These results provide evidence that the traditional notion of expectation maximization may not apply in the context of outcomes laden with affective responses, and that understanding the brain mechanisms of decision making requires the domain of the decision to

A critical review of simulation-based mastery learning with translational outcomes.

Science.gov (United States)

McGaghie, William C; Issenberg, Saul B; Barsuk, Jeffrey H; Wayne, Diane B

2014-04-01

This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes in terms of improved patient care practices, better patient outcomes and collateral effects. Secondly, we briefly address implementation science and its importance in the dissemination of innovations in medical education and health care. This is a qualitative synthesis of SBML with translational (T) science research reports spanning a period of 7 years (2006-2013). We use the 'critical review' approach proposed by Norman and Eva to synthesise findings from 23 medical education studies that employ the mastery learning model and measure downstream translational outcomes. Research in SBML in medical education has addressed a range of interpersonal and technical skills. Measured outcomes have been achieved in educational laboratories (T1), and as improved patient care practices (T2), patient outcomes (T3) and collateral effects (T4). Simulation-based mastery learning in medical education can produce downstream results. Such results derive from integrated education and health services research programmes that are thematic, sustained and cumulative. The new discipline of implementation science holds promise to explain why medical education innovations are adopted slowly and how to accelerate innovation dissemination. © 2014 John Wiley & Sons Ltd.

A retrospective review of visual outcome and complications in the treatment of retinoblastoma.

LENUS (Irish Health Repository)

O'Doherty, M

2005-01-01

The aim of this study was to look at the visual outcome and treatment complications of children diagnosed with Retinoblastoma during the years 1985-2003 inclusive. A retrospective review of all patients records was performed. Patient characteristics, treatment methods and complications were recorded. Twenty eight children presented to Temple street Hospital between 1985-2003. Six of these infants had bilateral tumours. The mean age at presentation was 23.7 months. Sixty-nine percent presented with Leucocoria, of these 33% also had a squint. The mean duration of symptoms was only known in 58% and this figure was approximately 19.8 months. Enucleation was performed in 24 eyes of 24 patients. Three patients required adjuvant chemotherapy post enucleation. Two eyes was treated with external beam radiation and one eye with plaque radiotherapy. One eye (second eye) was treated with systemic chemotherapy and radiation. Five eyes of three patients were treated with systemic chemotherapy followed by adjuvant Argon laser, cryotherapy and diode laser to each eye.The complications of each treatment group was recorded. The visual outcome in the salvaged eyes was favourable. There were no deaths recorded. Though chemotherapy with adjuvant local treatments provide adequate treatment for early tumours, enucleation still plays a major role in the treatment of Retinoblastoma. The total eye salvage rate in this study was 29% with an enucleation rate of 90% in unilateral cases and 33% in bilateral cases. Sixty-six percent of bilateral eyes affected were salvaged. Seventy-one percent of tumours were diagnosed after a parent noticed a gross abnormality of the eye. This highlights the possible need for screening for retinoblastoma in the infant population.

Characterisation of ashes produced by co-combustion of recovered fuels and peat

Energy Technology Data Exchange (ETDEWEB)

Frankenhaeuser, M.; Zevenhoven, R. [Borealis Polymers Oy, Porvoo (Finland); Skrifvars, B.J. [Aabo Akademi, Turku (Finland); Orjala, M. [VTT Energy, Espoo (Finland); Peltola, K. [Foster Wheeler Energy (Finland)

1996-12-01

Source separation of combustible materials from household or municipal solid waste yields a raw material for the production of Packaging Derived Fuel (PDF). This fuel can substitute the traditional fuels in heat and power generation and is also called recycled fuel. Co-combustion of these types of fuels with coal has been studied in several LIEKKI-projects and the results have been both technically and environmentally favourable. (author)

Neuroscience Intermediate-Level Care Units Staffed by Intensivists: Clinical Outcomes and Cost Analysis.

Science.gov (United States)

Kyeremanteng, Kwadwo; Hendin, Ariel; Bhardwaj, Kalpana; Thavorn, Kednapa; Neilipovitz, Dave; Kubelik, Dalibour; D'Egidio, Gianni; Stotts, Grant; Rosenberg, Erin

2017-01-01

With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units. This retrospective study assessed clinical and cost-related outcomes in an intermediate-level neurosciences acute care unit (NACU) before and after the addition of an intensivist to the unit's care team. Starting in October 2011, an intensivist-led model was adopted in a 16-bed NACU unit, including daytime coverage by a dedicated intensivist. Data were obtained from all patients admitted 1 year prior to and 2 years after this intervention. Primary outcomes were LOS and hospital costs. Safety outcomes included mortality and readmissions. Descriptive and analytic statistics were calculated. Individual and total patient costs were calculated based on per-day NACU and ward cost estimates and significance measured using bootstrapping. A total of 2931 patients were included over the study period. Patients were on average 59.5 years and 53% male. The most common reasons for admission were central nervous system (CNS) tumor (27.6%), ischemic stroke (27%), and subarachnoid hemorrhage (11%). Following the introduction of an intensivist, there was a significant reduction in NACU and hospital LOS, by 1 day and 3 days, respectively. There were no differences in readmissions or mortality. Adding an intensivist produced an individual cost savings of US$963 in NACU and US$2687 per patient total hospital stay. An intensivist-led model of intermediate-level neurointensive care staffed by intensivists is safe, decreases LOS, and produces cost savings in a system increasingly strained to provide quality

Treatment of oilfield produced water using Fe/C micro-electrolysis assisted by zero-valent copper and zero-valent aluminium.

Science.gov (United States)

Zhang, Qi

2015-01-01

In this study, the Fe/Cu/C and Fe/Al/C inner micro-electrolysis systems were used to treat actual oilfield produced water to evaluate the feasibility of the technology. Effects of reaction time, pH value, the dosage of metals and activated carbon, and Fe:C mass ratio on the treatment efficiency of wastewater were studied. The results showed that the optimum conditions were reaction time 120 min, initial solution pH 4.0, Fe dosage 13.3 g/L, activated carbon dosage 6.7 g/L, Cu dosage 2.0 g/L or Al dosage 1.0 g/L. Under the optimum conditions, the removal efficiencies of chemical oxygen demand (COD) were 39.3%, 49.7% and 52.6% in the Fe/C, Fe/Cu/C and Fe/Al/C processes, respectively. Meanwhile, the ratio of five-day biochemical oxygen demand to COD was raised from 0.18 to above 0.35, which created favourable conditions for the subsequent biological treatment. All these led to an easy maintenance and low operational cost.

Blended learning versus traditional teaching-learning-setting: Evaluation of cognitive and affective learning outcomes for the inter-professional field of occupational medicine and prevention / Blended Learning versus traditionelles Lehr-Lernsetting: Evaluierung von kognitiven und affektiven Lernergebnissen für das interprofessionelle Arbeitsfeld Arbeitsmedizin und Prävention

Directory of Open Access Journals (Sweden)

Eckler Ursula

2017-11-01

Full Text Available Blended learning is characterised as a combination of face-to-face teaching and e-learning in terms of knowledge transfer, students’ learning activities and reduced presence at the teaching facility. The present cohort study investigated long-term effects of blended learning regarding cognitive outcomes as well as self-indicated estimates of immediate learning effects on the affective domain in the inter-professional field of occupational medicine. Physiotherapy students (bachelor degree at FH Campus Wien – University of Applied Sciences completed the course Occupational Medicine/Prevention either in a traditional teaching-learning setting entirely taught face-to-face (control-group, n=94, or with a blended learning model (intervention-group, n=93. Long-term effects (1.5 year follow-up on the cognitive learning outcomes were assessed according to four levels of Bloom’s learning objectives. In addition, students estimated potential benefits resulting from blended learning based on four Krathwohl’s learning objectives for the affective domain by means of a six-option Likert scale (n=282. Concerning cognitive outcomes, significant results favouring both groups were found with effect sizes from small to medium. The traditional teaching-learning setting resulted in significantly better results in the upmost aspired learning objective (analysis at the long-term (p<0,01; r=-0,33. In contrast, the intervention group resulted in significantly better long-term results on learning objective levels 1 (knowledge and 2 (understanding (p=0,01; r=-0,20 and, p=0,02; r=-0,17, respectively. Hence, no general recommendation favouring either the classical setting or blending learning can be drawn regarding the cognitive domain. However, students’ self-indications on the affective domain give preference to blended learning, particularly if inter-professional teamwork is a course objective.

Current Issues and Situation of Producer Responsibility in Waste Management in Indonesia

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Antonius Priyo Nugroho Sulami

2017-11-01

Full Text Available Producer responsibility for wastes has been encouraged in Indonesia since 2008. The Ministry of Environment of the Republic of Indonesia also promoted the reduce, reuse, and recycle (3R concept using the community-based approach of waste banks integrated with the extended producer responsibility (EPR concept. However, related research and implementation are still limited. This study aims to identify the challenges of fulfilling producer responsibility in waste management and determine whether the integration concept could generate outcomes expected from the EPR concept. A semi-structured interview survey of several stakeholders from the government, industrial, and waste management sectors was conducted and the data generated was used to simulate an integration scheme using a system dynamics approach. Secondary data and information from Bandung municipality were used as input for the simulation. The interview survey found that the concerns and issues of fulfilling producer responsibility in waste management include lack of awareness, unavailability of clear guidelines, and the limited capacity of the current recycling sector. The results of the simulation suggested that if the integration scheme is applied, each business entity might bear the responsibility of IDR 29.4 million per year and 14.7 tons of waste per year for the scope of four sectors and IDR 34.1 million per year and 17 tons of waste per year for the scope of two sectors.

Characterization of novel W alloys produced by HIP

Energy Technology Data Exchange (ETDEWEB)

Monge, M.A. [Departamento de Fisica, Universidad Carlos III de Madrid, 28911 Leganes (Spain)], E-mail: mmonge@fis.uc3m.es; Auger, M.A.; Leguey, T.; Ortega, Y. [Departamento de Fisica, Universidad Carlos III de Madrid, 28911 Leganes (Spain); Bolzoni, L.; Gordo, E. [Departamento de Ciencias de Materiales, Universidad Carlos III de Madrid, 28911 Leganes (Spain); Pareja, R. [Departamento de Fisica, Universidad Carlos III de Madrid, 28911 Leganes (Spain)

2009-04-30

W and W alloys containing 0.5 wt% Y{sub 2}O{sub 3}, x wt% Ti and (x wt% Ti + 0.5 wt% Y{sub 2}O{sub 3}) have been prepared, x = 2 or 4. Elemental powders were blended or ball milled, canned, degassed and finally consolidated by a two-stage HIP process under a pressure of 195 MPa. It is found that Ti addition favours the densification attaining a fully dense material. XRD, SEM and EDX analyses of the material with Ti addition reveal the formation of a microstructure consisting of tungsten particles embedded in a W-Ti matrix. The microhardness of these materials increased noticeably with the titanium content.

The closure of European nuclear power plants: a commercial opportunity for the gas-producing countries

International Nuclear Information System (INIS)

Pauwels, J-P.; Swartenbroekx, C.

2000-01-01

The planned closure of nuclear power plants in Sweden, Germany, Belgium, Spain and the Netherlands and their hypothetical closure in the United Kingdom and Switzerland - two countries where this question remains open - will require their replacement by other types of production capacity, mainly gas turbine combined-cycle power stations (GTCCs). The increase in efficiency of GTCCs and the lower carbon content of natural gas favour the use of gas for electricity generation over coal. However, carbon dioxide emissions are unavoidable and, in the context of the Kyoto Protocol, supplementary measures must be taken to compensate, where possible, for the resulting increases in emissions. The replacement of nuclear plants with a 35-40 year lifetime by up-to-date GTCCs will require some 62 billion cubic metres per year of natural gas, resulting in an emissions increase of about 130 million tonnes per year of CO 2 . The replacement of polluting coal-fired and oil-fired plants by GTCCs will reduce CO 2 emissions, but will also require some extra 42 bcm/y of natural gas, at an (unrealistic) high cost. In short, gas-producing countries will benefit from the market breakthrough of their 'clean' fuel, thanks to the GTCCs, and gas demand will be reinforced by the abandonment of nuclear power. (author)

Application of a marketing concept to patient-centered care: co-producing health with heart failure patients.

Science.gov (United States)

Leone, Robert P; Walker, Charles A; Curry, Linda Cox; Agee, Elizabeth J

2012-04-03

Increasing numbers of patients are being treated for heart failure each year. One out of four of the heart failure patients who receives care in a hospital is readmitted to the hospital within 30 days of discharge. Effective discharge instruction is critical to prevent these patient readmissions. Co-production is a marketing concept whereby the customer is a partner in the delivery of a good or service. For example, a patient and nurse may partner to co-produce a patient-centered health regimen to improve patient outcomes. In this article we review the cost of treating heart failure patients and current strategies to decrease hospital readmissions for these patients along with the role of the nurse and the concept of co-producing health as related to heart failure patients. Next we describe our study assessing the degree to which discharge processes were co-produced on two hospital units having a preponderance of heart failure patients, and present our findings indicating minimal evidence of co-production. A discussion of our findings, along with clinical implications of these findings, recommendations for change, and suggestions for future research are offered. We conclude that standardized discharge plans lead to a mindset of 'one size fits all,' a mindset inconsistent with the recent call for patient-centered care. We offer co-production as a patient-centered strategy for customizing discharge teaching and improving health outcomes for heart failure patients.

Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: two-year Valve Academic Research Consortium-2 outcomes.

Science.gov (United States)

Chew, Nicholas; Hon, Jimmy Kim Fatt; Yip, Wei Luen James; Chan, Siew Pang; Poh, Kian-Keong; Kong, William Kok-Fai; Teoh, Kristine Leok Kheng; Yeo, Tiong Cheng; Tan, Huay Cheem; Tay, Edgar Lik Wui

2017-09-01

Transcatheter aortic valve implantation (TAVI) is an effective treatment for high-risk or inoperative patients with severe aortic stenosis. Given the unique characteristics of Asian populations, questions regarding mid-term outcomes in Asians undergoing TAVI have yet to be addressed. We evaluated the two-year clinical outcomes of TAVI in an Asian population using Valve Academic Research Consortium-2 definitions. This prospective study recruited 59 patients from a major academic medical centre in Singapore. The main outcomes were two-year survival rates, peri-procedural complications, symptom improvement, valvular function and assessment of learning curve. Mean age was 76.8 years (61.0% male), mean body surface area 1.6 m 2 and mean logistic EuroSCORE 18.7%. Survival was 93.2%, 86.0% and 79.1% at 30 days, one year and two years, respectively. At 30 days post TAVI, the rate of stroke was 1.7%, life-threatening bleeding 5.1%, acute kidney injury 25.0%, major vascular complication 5.1%, and new permanent pacemaker implantation 6.8%. 29.3% of TAVI patients were rehospitalised (47.1% cardiovascular-related) within one year. These composite outcomes were measured: device success (93.2%); early safety (79.7%); clinical efficacy (66.1%); and time-related valve safety (84.7%). Univariate analysis found these predictors of two-year all-cause mortality: logistic EuroSCORE (hazard ratio [HR] 1.07; p < 0.001); baseline estimated glomerular filtration rate (HR 0.97; p = 0.048); and acute kidney injury (HR 5.33; p = 0.022). Multivariate analysis identified non-transfemoral TAVI as a predictor of cardiovascular-related two-year mortality (HR 14.64; p = 0.008). Despite the unique clinical differences in Asian populations, this registry demonstrated favourable mid-term clinical and safety outcomes in Asians undergoing TAVI. Copyright: © Singapore Medical Association

Heterosis may result in selection favouring the products of long-distance pollen dispersal in Eucalyptus.

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João Costa E Silva

Full Text Available Using native trees from near the northern and southern extremities of the relatively continuous eastern distribution of Eucalyptus globulus in Tasmania, we compared the progenies derived from natural open-pollination (OP with those generated from within-region and long-distance outcrossing. Controlled outcrossing amongst eight parents - with four parents from each of the northern and southern regions - was undertaken using a diallel mating scheme. The progeny were planted in two field trials located within the species native range in southern Tasmania, and their survival and diameter growth were monitored over a 13-year-period. The survival and growth performances of all controlled cross types exceeded those of the OP progenies, consistent with inbreeding depression due to a combination of selfing and bi-parental inbreeding. The poorer survival of the northern regional (♀N♂N outcrosses compared with the local southern regional outcrosses (♀S♂S indicated differential selection against the former. Despite this mal-adaptation of the non-local ♀N♂N crosses at both southern sites, the survival of the inter-regional hybrids (♀N♂S and ♀S♂N was never significantly different from that of the local ♀S♂S crosses. Significant site-dependent heterosis was detected for the growth of the surviving long-distance hybrids. This was expressed as mid-parent heterosis, particularly at the more northern planting site. Heterosis increased with age, while the difference between the regional ♀N♂N and ♀S♂S crosses remained insignificant at any age at either site. Nevertheless, the results for growth suggest that the fitness of individuals derived from long-distance crossing may be better at the more northern of the planting sites. Our results demonstrate the potential for early-age assessments of pollen dispersal to underestimate realised gene flow, with local inbreeding under natural open-pollination resulting in selection favouring the

EFFECT OF CEREBROPROTEIN HYDROLYSATE WITH CITICOLINE VERSUS CITICOLINE ALONE IN THE INITIAL MANAGEMENT OF HEAD INJURY AND ITS CLINICAL OUTCOME “A PROSPECTIVE RANDOMISED COMPARATIVE STUDY”

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Varadaraju D. N

2017-06-01

Full Text Available BACKGROUND Traumatic brain injury is an important cause of morbidity. It also represents the most frequent reason for neurological illness after headache. Compared with other types of brain insult, traumatic brain injury produces more diffuse injury causing more cognitive and neuropsychiatric disturbances. Various drugs have been used in an attempt to improve the clinical outcome, citicoline and Cerebrolysin hydrolysate have been used to improve the clinical outcome in traumatic brain injury. The evidence thus far has been conflicting with reports in favour and against the use of these drugs in the clinical benefit of the patients with traumatic brain injury. We attempt to determine the benefits and advantages of using these drugs in the management of traumatic brain injury. MATERIALS AND METHODS This is a prospective study comprising 60 patients of head injury admitted in the Department of Neurosurgery at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. The purpose of the current study is to evaluate the effect of cerebroprotein hydrolysate with citicoline compared to citicoline alone in the initial management of head injury and its clinical outcome and to assess the improvement. RESULTS Sixty patients with head injury were recruited and divided into group A and group B randomly. The mean age was 43.5 years with 43 male patients and 17 female patients. The GCS at admission of 27 patients was mild head injury and of 33 patients was moderate head injury. Group A had 13 patients with mild head injury and 17 patients with moderate head injury. Group B had 14 patients with mild and 16 patients with moderate head injury at the time of admission. The GCS was assessed at 1 week and 3 weeks. On assessing the patients at 1 week, group A had 14 patients with mild head injury and 16 patients with moderate head injury, whereas group B had 14 patients with mild and 16 patients with moderate head injury. The extended Glasgow Outcome Scale

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

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Jensen Rikke K

2011-08-01

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

Outcome analysis of liver stiffness by ARFI (acoustic radiation force impulse) elastometry in patients with chronic viral hepatitis B and C

International Nuclear Information System (INIS)

Goertz, R.S.; Sturm, J.; Zopf, S.; Wildner, D.; Neurath, M.F.; Strobel, D.

2014-01-01

Aim: To evaluate the association between liver stiffness measured by acoustic radiation force impulse (ARFI) elastometry and the outcome of antiviral treatment in patients with chronic viral hepatitis B and C. Materials and methods: Thirty-eight patients with chronic viral hepatitis B (n = 16) or hepatitis C (n = 22) underwent liver biopsy and ARFI elastometry of the right hepatic lobe. A follow-up assessment using ARFI was performed a mean of 2.3 years after the baseline evaluation. The patients with favourable outcome were classified in group S and those receiving no treatment, showing no response to treatment, or experiencing a relapse were classified in group N. Results: The 38 patients had an initial mean ARFI value of 1.56 ± 0.62 m/s as compared with 1.54 ± 0.64 m/s in the follow-up evaluation. Group S showed a significant decline in ARFI values (1.55 ± 0.60 m/s versus 1.34 ± 0.47 m/s; p < 0.05) and included 16 (64%) patients with lower shear wave velocities at follow-up. In group N, liver stiffness values showed a slight but not significant increase (1.57 ± 0.70 m/s versus 1.93 ± 0.77 m/s). Conclusion: Changes in liver stiffness during antiviral therapy can be assessed by ARFI reflecting response or no response. ARFI elastometry is an additional, useful tool for the follow-up assessment of treatment outcome in patients with chronic viral hepatitis B or C infection

Economic and quality-of-life outcomes in head and neck cancer

International Nuclear Information System (INIS)

Harrison, Louis B.

1996-01-01

Head and neck cancer offers a special and unique challenge to physicians and patients. Treatment of cancers in this part of the body, especially surgical resection, can cause profound changes in quality-of-life. The patient's ability to work, earn a living, articulate speech, communicate, have social interaction, and live a normal life, can be affected in a major way. Therefore, physicians and patients must look beyond the obvious oncologic outcomes of locoregional control, distant metastasis free survival, and overall survival. These outcomes must be assessed along with detailed, quality-of-life and economic outcomes, in order to properly manage patients. It is also mandatory that patients have a clear understanding of all their treatment options, and the implications of these options on cancer control and quality-of-life. This panel will focus on the available methods to assess quality-of-life and economic outcomes in head and neck cancer management. It will also highlight areas where new oncologic strategies are utilized which emphasize organ and function preservation. This latter area is an important aspect of modern clinical research and practice. In particular, management of cancers of the tongue, larynx, and hypopharynx offer special opportunities. Resection of these organs can produce debilitating functional outcomes. New multidisciplinary approaches to treat patients while avoiding primary resection have been developed. The oncologic and quality-of-life/economic outcomes will be assessed for these organ preserving strategies

Emergence of extended-spectrum β-lactamase producing Enterobacter spp. in patients with bacteremia in a tertiary hospital in southern Brazil.

Science.gov (United States)

Nogueira, Keite da Silva; Paganini, Maria Cristina; Conte, Andréia; Cogo, Laura Lúcia; Taborda de Messias Reason, Iara; da Silva, Márcio José; Dalla-Costa, Libera Maria

2014-02-01

Extended-spectrum β-lactamases (ESBLs) are increasingly prevalent in Enterobacter spp., posing a challenge to the treatment of infections caused by this microorganism. The purpose of this retrospective study was to evaluate the prevalence, risk factors, and clinical outcomes of inpatients with bacteremia caused by ESBL and non ESBL-producing Enterobacter spp. in a tertiary hospital over the period 2004-2008. The presence of blaCTX-M, blaTEM, blaSHV, and blaPER genes was detected by polymerase chain reaction (PCR) and nucleotide sequence analysis. Genetic similarity between strains was defined by pulsed-field gel electrophoresis (PFGE). Enterobacter spp. was identified in 205 of 4907 of the patients who had positive blood cultures during hospitalization. Of those cases, 41 (20%) were ESBL-producing Enterobacter spp. Nosocomial pneumonia was the main source of bacteremia caused by ESBL-producing Enterobacter spp. The presence of this microorganism was associated with longer hospital stays. The ESBL genes detected were: CTX-M-2 (23), CTX-M-59 (10), CTX-M-15 (1), SHV-12 (5), and PER-2 (2). While Enterobacter aerogenes strains showed mainly a clonal profile, Enterobacter cloacae strains were polyclonal. Although no difference in clinical outcomes was observed between patients with infections by ESBL-producing and non-ESBL-producing strains, the detection of ESBL in Enterobacter spp. resulted in the change of antimicrobials in 75% of cases, having important implications in the decision-making regarding adequate antimicrobial therapy. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Modeling Outcomes with Floor or Ceiling Effects: An Introduction to the Tobit Model

Science.gov (United States)

McBee, Matthew

2010-01-01

In gifted education research, it is common for outcome variables to exhibit strong floor or ceiling effects due to insufficient range of measurement of many instruments when used with gifted populations. Common statistical methods (e.g., analysis of variance, linear regression) produce biased estimates when such effects are present. In practice,…

Is voluntary certification of tropical agricultural commodities achieving sustainability goals for small-scale producers? A review of the evidence

Science.gov (United States)

DeFries, Ruth S.; Fanzo, Jessica; Mondal, Pinki; Remans, Roseline; Wood, Stephen A.

2017-03-01

Over the last several decades, voluntary certification programs have become a key approach to promote sustainable supply chains for agricultural commodities. These programs provide premiums and other benefits to producers for adhering to environmental and labor practices established by the certifying entities. Following the principles of Cochrane Reviews used in health sciences, we assess evidence to evaluate whether voluntary certification of tropical agricultural commodities (bananas, cocoa, coffee, oil palm, and tea) has achieved environmental benefits and improved economic and social outcomes for small-scale producers at the level of the farm household. We reviewed over 2600 papers in the peer-review literature and identified 24 cases of unique combinations of study area, certification program, and commodity in 16 papers that rigorously analyzed differences between treatment (certified households) and control groups (uncertified households) for a wide range of response variables. Based on analysis of 347 response variables reported in these papers, we conclude that certification is associated on average with positive outcomes for 34% of response variables, no significant difference for 58% of variables, and negative outcomes for 8% of variables. No significant differences were observed for different categories of responses (environmental, economic and social) or for different commodities (banana, coffee and tea), except negative outcomes were significantly less for environmental than other outcome categories (p = 0.01). Most cases (20 out of 24) investigated coffee certification and response variables were inconsistent across cases, indicating the paucity of studies to conduct a conclusive meta-analysis. The somewhat positive results indicate that voluntary certification programs can sometimes play a role in meeting sustainable development goals and do not support the view that such programs are merely greenwashing. However, results also indicate that

Bioactive metabolite production by Streptomyces albolongus in favourable environment

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Myn Uddin

2013-06-01

Full Text Available Objectives: Demand for new antibiotic is rising up due to continuous resistance risk against conventional antibiotic.This attempt was taken to find out a novel antimicrobial metabolite.Methods: Chili field antagonistic actinomycetes Streptomyces albolongus was isolated and tested for optimum antimicrobialmetabolite production. Primary screening was done by selective media and antibiotic assay was done by agarcup plate method. Fermented product was recovered by separating funnel using suitable solvent.Results: Maximum antimicrobial metabolite production was found at temperature 35°C and pH 9.0 and on 6th day ofincubation. The medium consisting of corn steep liquor (0.2%, glucose (1.0%, NaCl (0.5%, K2HPO4 (0.1% was screenedout as suitable medium for maximum antimicrobial production. Sucrose was found as the best carbon source amongfour sources. The antimicrobial metabolite was found to be stable at pH and temperature up to 11.0 and 100°C respectively.The active agent was best extracted with chloroform. The antimicrobial spectrum of the metabolite was wideand shows activity against Shigella dysenteriae (AE14612, Shigella sonnei (CRL, ICDDR, B, Salmonella typhi (AE14296,Vibrio cholerae (AE14748, Pseudomonas aeruginosa (CRL, ICDDR, B, Bacillus cereus (BTCC19, Staphylococcus aureus(ATCC6538, Bacillus subtilis (BTTC17 and Bacillus megaterium (BTTC18.Conclusions: The findings of antibacterial activity of S. albolongus against several species of human pathogens includingboth Gram-positive and Gram-negative bacteria indicated that our produced material might be an alternative antimicrobialsubstance to control human diseases. J Microbiol Infect Dis 2013; 3(2: 75-82Key words: Streptomyces albolongus, antimicrobial metabolite, optimum production, antimicrobial spectrum

Cooperative Networks: Altruism, Group Solidarity, Reciprocity, and Sanctioning in Ugandan Producer Organizations.

Science.gov (United States)

Baldassarri, Delia

2015-09-01

Repeated interaction and social networks are commonly considered viable solutions to collective action problems. This article identifies and systematically measures four general mechanisms--that is, generalized altruism, group solidarity, reciprocity, and the threat of sanctioning--and tests which of them brings about cooperation in the context of Ugandan producer organizations. Using an innovative methodological framework that combines "lab-in-the-field" experiments with survey interviews and complete social networks data, the article goes beyond the assessment of a relationship between social networks and collective outcomes to study the mechanisms that favor cooperative behavior. The article first establishes a positive relationship between position in the network structure and propensity to cooperate in the producer organization and then uses farmers' behavior in dictator and public goods games to test different mechanisms that may account for such a relationship. Results show that cooperation is induced by patterns of reciprocity that emerge through repeated interaction rather than other-regarding preferences like altruism or group solidarity.

The role of contextual associations in producing the partial reinforcement acquisition deficit.

Science.gov (United States)

Miguez, Gonzalo; Witnauer, James E; Miller, Ralph R

2012-01-01

Three conditioned suppression experiments with rats as subjects assessed the contributions of the conditioned stimulus (CS)-context and context-unconditioned stimulus (US) associations to the degraded stimulus control by the CS that is observed following partial reinforcement relative to continuous reinforcement training. In Experiment 1, posttraining associative deflation (i.e., extinction) of the training context after partial reinforcement restored responding to a level comparable to the one produced by continuous reinforcement. In Experiment 2, posttraining associative inflation of the context (achieved by administering unsignaled outcome presentations in the context) enhanced the detrimental effect of partial reinforcement. Experiment 3 found that the training context must be an effective competitor to produce the partial reinforcement acquisition deficit. When the context was down-modulated, the target regained behavioral control thereby demonstrating higher-order retrospective revaluation. The results are discussed in terms of retrospective revaluation, and are used to contrast the predictions of a performance-focused model with those of an acquisition-focused model. (c) 2012 APA, all rights reserved.

The Millennium Villages Project: a retrospective, observational, endline evaluation

Directory of Open Access Journals (Sweden)

Shira Mitchell, PhD

2018-05-01

Full Text Available Summary: Background: The Millennium Villages Project (MVP was a 10 year, multisector, rural development project, initiated in 2005, operating across ten sites in ten sub-Saharan African countries to achieve the Millennium Development Goals (MDGs. In this study, we aimed to estimate the project's impact, target attainment, and on-site spending. Methods: In this endline evaluation of the MVP, we retrospectively selected comparison villages that best matched the project villages on possible confounding variables. Cross-sectional survey data on 40 outcomes of interest were collected from both the project and the comparison villages in 2015. Using these data, as well as on-site spending data collected during the project, we estimated project impacts as differences in outcomes between the project and comparison villages; target attainment as differences between project outcomes and prespecified targets; and on-site spending as expenditures reported by communities, donors, governments, and the project. Spending data were not collected in the comparison villages. Findings: Averaged across the ten project sites, we found that impact estimates for 30 of 40 outcomes were significant (95% uncertainty intervals [UIs] for these outcomes excluded zero and favoured the project villages. In particular, substantial effects were seen in agriculture and health, in which some outcomes were roughly one SD better in the project villages than in the comparison villages. The project was estimated to have no significant impact on the consumption-based measures of poverty, but a significant favourable impact on an index of asset ownership. Impacts on nutrition and education outcomes were often inconclusive (95% UIs included zero. Averaging across outcomes within categories, the project had significant favourable impacts on agriculture, nutrition, education, child health, maternal health, HIV and malaria, and water and sanitation. A third of the targets were met in the

Short-term course and outcome of acute and transient psychotic disorders: Differences from other types of psychosis with acute onset.

Science.gov (United States)

Castagnini, Augusto C; Munk-Jørgensen, Povl; Bertelsen, Aksel

2016-02-01

The category of 'acute and transient psychotic disorders' (ATPDs) appeared in the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10), but its distinctive features remain uncertain. To examine the course and outcome of ATPDs, pointing out differences from other types of psychosis. A one-year follow-up investigation of patients enrolled at the former World Health Organization (WHO) Centre for Research and Training in Mental Health in Aarhus (Denmark) for the WHO collaborative study on acute psychoses. Of 91 patients aged 15-60 years presenting with acute psychosis, 47 (51.6%) were diagnosed with ATPD, and it occurred more commonly in females; yet, the other acute psychoses featured mainly mood disorders and affected equally both genders. After 1 year, the ATPD diagnosis did not change in 28 cases (59.6%); the remaining developed either affective psychoses (27.7%), or schizophrenia and schizoaffective disorder (12.8%). Nearly, all patients with unchanged diagnosis of ATPD enjoyed full recovery, while those with other types of acute psychosis had significantly higher rates of recurrence or incomplete remission. Duration of illness within 4 weeks and stressful events in the 3 months before symptom onset predicted 1-year favourable clinical outcome for acute psychoses. Although ATPDs fared better over the short-term than other acute psychoses, their diagnostic stability is relatively low. © The Author(s) 2015.

Dominance of IMP-4-Producing Enterobacter cloacae among Carbapenemase-Producing Enterobacteriaceae in Australia

Science.gov (United States)

Townell, Nicola; Nimmo, Graeme R.; George, Narelle M.; Robson, Jennifer; Vohra, Renu; Davis, Louise; Heney, Claire; Paterson, David L.

2015-01-01

The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) has been increasing worldwide. blaIMP has been reported to be the predominant carbapenemase-encoding gene within Enterobacteriaceae in Australia. However, there are limited data currently available on CPE from Queensland, Australia. A total of 58 CPE isolates were isolated between July 2009 and March 2014 from Queensland hospitals. The clonality of isolates was determined by Diversilab repetitive sequence-based PCR. The isolates were investigated for the resistance mechanisms carbapenemase, extended-spectrum β-lactamase, and AmpC β-lactamase and for aminoglycoside resistance and plasmid-mediated quinolone resistance genes by PCR. The plasmid types associated with carbapenemase-encoding genes were characterized. The majority of the CPE were Enterobacter cloacae (n = 29). The majority of Queensland CPE isolates were IMP producers and comprised 11 species (n = 48). Nine NDM-producing Enterobacteriaceae were identified. One NDM-producing Klebsiella pneumoniae isolate coproduced OXA-48. One K. pneumoniae isolate was an OXA-181 producer. The incidence of IMP producers increased significantly in 2013. blaIMP-4 was found in all IMP-producing isolates. blaTEM, qnrB, and aacA4 were common among IMP-4 producers. The HI2 (67%) and L/M (21%) replicons were associated with blaIMP-4. All HI2 plasmids were of sequence type 1 (ST1). All but one of the NDM producers possessed blaCTX-M-15. The 16S rRNA methylase genes found among NDM producers were armA, rmtB, rmtC, and rmtF. The substantial increase in the prevalence of CPE in Queensland has been associated mainly with the emergence E. cloacae strains possessing HI2 plasmids carrying blaIMP-4 over the past 2 years. The importation of NDM producers and/or OXA-48-like producers in patients also contributed to the increased emergence of CPE. PMID:25918153

Outcome of endoscopic transsphenoidal surgery in combination with somatostatin analogues in patients with growth hormone producing pituitary adenoma.

Science.gov (United States)

Zhou, Tao; Wang, Fuyu; Meng, Xianghui; Ba, Jianmin; Wei, Shaobo; Xu, Bainan

2014-11-01

To determine the efficacy of endoscopic surgery in combination with long-acting somatostatin analogues (SSAs) in treating patients with growth hormone (GH)-secreting pituitary tumor. We performed retrospective analysis of 133 patients with GH producing pituitary adenoma who underwent pure endoscopic transsphenoidal surgery in our center from January 2007 to July 2012. Patients were followed up for a range of 3-48 months. The radiological remission, biochemical remission and complication were evaluated. A total of 110 (82.7%) patients achieved radiological complete resection, 11 (8.2%) subtotal resection, and 12 (9.0%) partial resection. Eighty-eight (66.2%) patients showed nadir GH level less than 1 ng/mL after oral glucose administration. No mortality or severe disability was observed during follow up. Preoperative long-acting SSA successfully improved left ventricle ejection fraction (LVEF) and blood glucose in three patients who subsequently underwent success operation. Long-acting SSA (20 mg every 30 days) achieved biochemical remission in 19 out 23 (82.6%) patients who showed persistent high GH level after surgery. Endoscopic transsphenoidal surgery can biochemically cure the majority of GH producing pituitary adenoma. Post-operative use of SSA can improve biochemical remission.

Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment for Multidrug-Resistant Tuberculosis in Mumbai, India

Science.gov (United States)

Isaakidis, Petros; Paryani, Roma; Khan, Samsuddin; Mansoor, Homa; Manglani, Mamta; Valiyakath, Asmaa; Saranchuk, Peter; Furin, Jennifer

2013-01-01

Background Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10–19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India. Methods A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation. Results The median age was 16 (IQR 14–18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8–250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens. Conclusions Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial

Poor outcomes in a cohort of HIV-infected adolescents undergoing treatment for multidrug-resistant tuberculosis in Mumbai, India.

Directory of Open Access Journals (Sweden)

Petros Isaakidis

Full Text Available BACKGROUND: Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF project in Mumbai, India. METHODS: A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation. RESULTS: The median age was 16 (IQR 14-18 years and 54% were female. Five (46% adolescents had pulmonary TB (PTB, two (18% extrapulmonary disease (EPTB and four (36% had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5. By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5% patients: one was cured and three were still on treatment with negative culture results. Seven patients (64% had poor outcomes: four (36.5% died and three (27% defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100% on-treatment experienced adverse events (AEs: two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens. CONCLUSIONS: Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial

Poor outcomes in a cohort of HIV-infected adolescents undergoing treatment for multidrug-resistant tuberculosis in Mumbai, India.

Science.gov (United States)

Isaakidis, Petros; Paryani, Roma; Khan, Samsuddin; Mansoor, Homa; Manglani, Mamta; Valiyakath, Asmaa; Saranchuk, Peter; Furin, Jennifer

2013-01-01

Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India. A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation. The median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens. Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents

Mobility into favourable jobs

NARCIS (Netherlands)

Maurice Gesthuizen; Jaco Dagevos

2005-01-01

Original title: Arbeidsmobiliteit in goede banen. Hundreds of thousands of employees change jobs each year. Why do they do this, and what benefits do they derive from it? Many employees are not in the right jobs. Job dissatisfaction is found to be a key reason for labour mobility. These

Producing charcoal from wastes

Energy Technology Data Exchange (ETDEWEB)

Pogorelov, V.A.

1983-01-01

Experimental works to use wood wastes for producing charcoal are examined, which are being conducted in the Sverdlovsk assembly and adjustment administration of Soyuzorglestekhmontazh. A wasteless prototype installation for producing fine charcoal is described, along with its subsequent briqueting, which is made on the basis of units which are series produced by the factories of the country. The installation includes subassemblies for preparing and drying the raw material and for producing the charcoal briquets. In the opinion of specialists, the charcoal produced from the wastes may be effectively used in ferrous and nonferrous metallurgy and in the production of pipes.

Misunderstanding publication bias: editors are not blameless after all [v1; ref status: indexed, http://f1000r.es/YvAwwD

Directory of Open Access Journals (Sweden)

Stephen Senn

2012-12-01

Full Text Available In analysing whether there is an editorial bias in favour of positive studies, researchers have made implicit assumptions that are implausible. In particular, to justify the conclusion that there is no bias because observed editorial acceptance rates do not favour positive studies, the assumption that the decision to submit an article is based solely on quality would be required. If, on the other hand, submission were based on perceived probability of acceptance, negative and positive studies would not differ in terms of acceptance rates, but in terms of quality. It is shown, using a simple graphical model, how similar underlying situations as regards the relationship between quality and probability of acceptance on the one hand and study outcome (positive or negative and probability of acceptance on the other could produce dramatically different results depending on the behaviour of authors. Furthermore, there is, in fact, some evidence that submitted negative studies are, on average, of higher quality than positive ones. This calls into question the standard interpretation of the studies examining editorial bias. It would appear that despite similar probabilities of acceptance for negative and positive studies, editors could be discriminating against negative studies.

Prognostic indicators of outcomes in patients with lung metastases from differentiated thyroid carcinoma during long-term follow-up.

Science.gov (United States)

Sohn, Seo Young; Kim, Hye In; Kim, Young Nam; Kim, Tae Hyuk; Kim, Sun Wook; Chung, Jae Hoon

2018-02-01

Distant metastases, although uncommon, represent maximum disease-related mortality in differentiated thyroid carcinoma (DTC). Lungs are the most frequent sites of metastases. We aimed to evaluate long-term outcomes and identify prognostic factors in metastatic DTC limited to the lungs. This retrospective study included 89 patients with DTC and metastases limited to the lungs, who were treated between 1996 and 2012 at Samsung Medical Center. Progression-free survival (PFS) and cancer-specific survival (CSS) rates were evaluated according to clinicopathologic factors. Cox regression analysis was used to identify independent factors associated with structural progressive disease (PD) and cancer-specific death. With a median follow-up of 84 months, the 5- and 10-year CSS rates were 78% and 73%, respectively. Older age at diagnosis (≥55 years), radioactive iodine (RAI) nonavidity, preoperative or late diagnosis of metastasis and macro-nodular metastasis (≥1 cm) were predictive of decreased PFS and CSS. Multivariate analysis identified older age (P = .002), RAI nonavidity (P = .045) and preoperative (P = .030) or late diagnosis (P = .026) as independent predictors of structural PD. RAI avidity was also independent predictor of cancer-specific death (P = .025). Patients with DTC and metastatic disease limited to the lungs had favourable long-term outcomes. Age, RAI avidity and timing of metastasis were found to be major factors for predicting prognosis. © 2017 John Wiley & Sons Ltd.

[A critical assessment of the relation between the food industry and health research].

Science.gov (United States)

León Mengíbar, Josep; Pastor-Valero, María; Hernández Aguado, Ildefonso

To describe the influence of the food industry in health research, observing how funding influences health outcomes and the quality of the studies. We performed a systematic review in MEDLINE, Cochrane Library Plus and Scopus using the MESH "Food Industry", "Food-Processing Industry", "Biomedical Research", "Research Support as Topic", and the keywords "Industry Sponsorship" and "Funding Source". The quality was assessed using the PRISMA guidelines. We revised 1,506 articles and 10 were included; two reviewed the relationship between funding-outcomes and quality-outcomes; six focused on the funding-outcomes relationship; and the other two focused on methodological quality. Six showed that funding from the food industry resulted in more favourable outcomes for their products. No differences in quality were found in relation to the funding source, but those which did not declare their funding had a worse quality. Studies funded by the food industry showed favourable results for their products. However, this fact did not affect the quality of the studies. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Drunk, Powerful, and in the Dark: How General Processes of Disinhibition Produce Both Prosocial and Antisocial Behavior.

Science.gov (United States)

Hirsh, Jacob B; Galinsky, Adam D; Zhong, Chen-Bo

2011-09-01

Social power, alcohol intoxication, and anonymity all have strong influences on human cognition and behavior. However, the social consequences of each of these conditions can be diverse, sometimes producing prosocial outcomes and other times enabling antisocial behavior. We present a general model of disinhibition to explain how these seemingly contradictory effects emerge from a single underlying mechanism: The decreased salience of competing response options prevents activation of the Behavioral Inhibition System (BIS). As a result, the most salient response in any given situation is expressed, regardless of whether it has prosocial or antisocial consequences. We review three distinct routes through which power, alcohol intoxication, and anonymity reduce the salience of competing response options, namely, through Behavioral Approach System (BAS) activation, cognitive depletion, and reduced social desirability concerns. We further discuss how these states can both reveal and shape the person. Overall, our approach allows for multiple domain-specific models to be unified within a common conceptual framework that explains how both situational and dispositional factors can influence the expression of disinhibited behavior, producing both prosocial and antisocial outcomes. © Association for Psychological Science 2011.

The impact of organizational culture on the outcome of hospital care: after the implementation of person-centred care.

Science.gov (United States)

J Alharbi, Tariq Saleem; Olsson, Lars-Eric; Ekman, Inger; Carlström, Eric

2014-02-01

To measure the effect of organizational culture on health outcomes of patients 3 months after discharge. a quantitative study using Organizational Values Questionnaire (OVQ) and a health-related quality of life instrument (EQ-5D). A total of 117 nurses, 69% response rate, and 220 patients answered the OVQ and EQ-5D, respectively. The regression analysis showed that; 16% (R(2) = 0.02) of a decreased health status, 22% (R(2) = 0.05) of pain/discomfort and 13% (R(2) = 0.02) of mobility problems could be attributed to the combination of open system (OS) and Human Relations (HR) cultural dimensions, i.e., an organizational culture being dominated by flexibility. The results from the present study tentatively indicated an association between an organizational culture and patients' health related quality of life 3 months after discharge. Even if the current understanding of organizational culture, which is dominated by flexibility, is considered favourable when implementing a new health care model, our results showed that it could be hindering instead of helping the new health care model in achieving its objectives.

Favourable outcome in a patient bitten by a rabid bat infected with the European bat lyssavirus-1.

Science.gov (United States)

Van Gucht, S; Verlinde, R; Colyn, J; Vanderpas, J; Vanhoof, R; Roels, S; Francart, A; Brochier, B; Suin, V

2013-01-01

The classic rabies virus (genotype 1) has been eliminated in Western Europe, but related lyssaviruses still circulate in local bats. In August 2010, a Belgian photographer was bitten upon provocation of a disoriented Eptesicus serotinus bat in Spain. The bat was infected with European bat lyssavirus-1 (genotype 5). The isolate proved highly neurovirulent in mice. The patient had received preventive rabies immunisations years before the incident and received two boosters with the HDCV rabies vaccine afterwards. Available vaccines are based on the classic rabies virus, which is significantly divergent from the European bat lyssavirus-1. Fortunately, the patient's serological immune response demonstrated satisfactory neutralisation of the 2010 EBLV-1 isolate, using an intracerebral challenge model in mice. Most likely, the patient's life was saved thanks to vaccination with the classic rabies vaccine, which proved sufficiently protective against European bat lyssavirus-1. This case highlights the need for preventive rabies vaccination in people, who come in contact with bats and to seek medical council after a scratch or bite from a bat.

Implications of market integration for cardiovascular and metabolic health among an indigenous Amazonian Ecuadorian population.

Science.gov (United States)

Liebert, Melissa A; Snodgrass, J Josh; Madimenos, Felicia C; Cepon, Tara J; Blackwell, Aaron D; Sugiyama, Lawrence S

2013-05-01

Market integration (MI), the suite of social and cultural changes that occur with economic development, has been associated with negative health outcomes such as cardiovascular disease; however, key questions remain about how this transition manifests at the local level. The present paper investigates the effects of MI on health among Shuar, an indigenous lowland Ecuadorian population, with the goal of better understanding the mechanisms responsible for this health transition. This study examines associations between measures of MI and several dimensions of cardiovascular and metabolic health (fasting glucose, lipids [LDL, HDL and total cholesterol; triglycerides] and blood pressure) among 348 adults. Overall, Shuar males and females have relatively favourable cardiovascular and metabolic health. Shuar who live closer to town have higher total (p market foods (r = 0.140; p = 0.045) and ownership of consumer products (r = 0.184; p = 0.029). This study provides evidence that MI among Shuar is not a uniformly negative process but instead produces complex cardiovascular and metabolic health outcomes.

The Neural Basis of Risky Choice with Affective Outcomes

Science.gov (United States)

Suter, Renata S.; Pachur, Thorsten; Hertwig, Ralph; Endestad, Tor; Biele, Guido

2015-01-01

Both normative and many descriptive theories of decision making under risk are based on the notion that outcomes are weighted by their probability, with subsequent maximization of the (subjective) expected outcome. Numerous investigations from psychology, economics, and neuroscience have produced evidence consistent with this notion. However, this research has typically investigated choices involving relatively affect-poor, monetary outcomes. We compared choice in relatively affect-poor, monetary lottery problems with choice in relatively affect-rich medical decision problems. Computational modeling of behavioral data and model-based neuroimaging analyses provide converging evidence for substantial differences in the respective decision mechanisms. Relative to affect-poor choices, affect-rich choices yielded a more strongly curved probability weighting function of cumulative prospect theory, thus signaling that the psychological impact of probabilities is strongly diminished for affect-rich outcomes. Examining task-dependent brain activation, we identified a region-by-condition interaction indicating qualitative differences of activation between affect-rich and affect-poor choices. Moreover, brain activation in regions that were more active during affect-poor choices (e.g., the supramarginal gyrus) correlated with individual trial-by-trial decision weights, indicating that these regions reflect processing of probabilities. Formal reverse inference Neurosynth meta-analyses suggested that whereas affect-poor choices seem to be based on brain mechanisms for calculative processes, affect-rich choices are driven by the representation of outcomes’ emotional value and autobiographical memories associated with them. These results provide evidence that the traditional notion of expectation maximization may not apply in the context of outcomes laden with affective responses, and that understanding the brain mechanisms of decision making requires the domain of the decision

Consumers and Producers

NARCIS (Netherlands)

E. Maira (Elisa)

2018-01-01

markdownabstractIn the last few decades, advances in information and communication technology have dramatically changed the way consumers and producers interact in the marketplace. The Internet and social media have torn down the information barrier between producers and consumers, leading to

Imputation by the mean score should be avoided when validating a Patient Reported Outcomes questionnaire by a Rasch model in presence of informative missing data

LENUS (Irish Health Repository)

Hardouin, Jean-Benoit

2011-07-14

Abstract Background Nowadays, more and more clinical scales consisting in responses given by the patients to some items (Patient Reported Outcomes - PRO), are validated with models based on Item Response Theory, and more specifically, with a Rasch model. In the validation sample, presence of missing data is frequent. The aim of this paper is to compare sixteen methods for handling the missing data (mainly based on simple imputation) in the context of psychometric validation of PRO by a Rasch model. The main indexes used for validation by a Rasch model are compared. Methods A simulation study was performed allowing to consider several cases, notably the possibility for the missing values to be informative or not and the rate of missing data. Results Several imputations methods produce bias on psychometrical indexes (generally, the imputation methods artificially improve the psychometric qualities of the scale). In particular, this is the case with the method based on the Personal Mean Score (PMS) which is the most commonly used imputation method in practice. Conclusions Several imputation methods should be avoided, in particular PMS imputation. From a general point of view, it is important to use an imputation method that considers both the ability of the patient (measured for example by his\\/her score), and the difficulty of the item (measured for example by its rate of favourable responses). Another recommendation is to always consider the addition of a random process in the imputation method, because such a process allows reducing the bias. Last, the analysis realized without imputation of the missing data (available case analyses) is an interesting alternative to the simple imputation in this context.

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

Science.gov (United States)

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

2016-09-01

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

Biologically produced sulfur

NARCIS (Netherlands)

Kleinjan, W.E.; Keizer, de A.; Janssen, A.J.H.

2003-01-01

Sulfur compound oxidizing bacteria produce sulfur as an intermediate in the oxidation of hydrogen sulfide to sulfate. Sulfur produced by these microorganisms can be stored in sulfur globules, located either inside or outside the cell. Excreted sulfur globules are colloidal particles which are

Calcium carbonate formation on mica supported extracellular polymeric substance produced by Rhodococcus opacus

Energy Technology Data Exchange (ETDEWEB)

Szcześ, Aleksandra, E-mail: aszczes@poczta.umcs.lublin.pl [Department of Physical Chemistry – Interfacial Phenomena, Faculty of Chemistry, Maria Curie-Skłodowska University, Lublin 20-031 (Poland); Czemierska, Magdalena; Jarosz-Wilkołazka, Anna [Department of Biochemistry, Maria Curie-Skłodowska University, Lublin 20-031 (Poland)

2016-10-15

Extracellular polymeric substance (EPS) extracted from Rhodococcus opacus bacterial strain was used as a matrix for calcium carbonate precipitation using the vapour diffusion method. The total exopolymer and water-soluble exopolymer fraction of different concentrations were spread on the mica surface by the spin-coating method. The obtained layers were characterized using the atomic force microscopy measurement and XPS analysis. The effects of polymer concentration, initial pH of calcium chloride solution and precipitation time on the obtained crystals properties were investigated. Raman spectroscopy and scanning electron microscopy were used to characterize the precipitated minerals. It was found that the type of precipitated CaCO{sub 3} polymorph and the crystal size depend on the kind of EPS fraction. The obtained results indicates that the water soluble fraction favours vaterite dissolution and calcite growth, whereas the total EPS stabilizes vaterite and this effect is stronger at basic pH. It seems to be due to different contents of the functional group of EPS fractions. - Highlights: • CaCO{sub 3} crystal size and polymorph can be controlled by EPS substance obtained from R. opacus. • The water soluble fraction favours vaterite dissolution and calcite growth. • The total EPS stabilizes vaterite. • This effect is stronger at basic pH.

Calcium carbonate formation on mica supported extracellular polymeric substance produced by Rhodococcus opacus

International Nuclear Information System (INIS)

Szcześ, Aleksandra; Czemierska, Magdalena; Jarosz-Wilkołazka, Anna

2016-01-01

Extracellular polymeric substance (EPS) extracted from Rhodococcus opacus bacterial strain was used as a matrix for calcium carbonate precipitation using the vapour diffusion method. The total exopolymer and water-soluble exopolymer fraction of different concentrations were spread on the mica surface by the spin-coating method. The obtained layers were characterized using the atomic force microscopy measurement and XPS analysis. The effects of polymer concentration, initial pH of calcium chloride solution and precipitation time on the obtained crystals properties were investigated. Raman spectroscopy and scanning electron microscopy were used to characterize the precipitated minerals. It was found that the type of precipitated CaCO 3 polymorph and the crystal size depend on the kind of EPS fraction. The obtained results indicates that the water soluble fraction favours vaterite dissolution and calcite growth, whereas the total EPS stabilizes vaterite and this effect is stronger at basic pH. It seems to be due to different contents of the functional group of EPS fractions. - Highlights: • CaCO 3 crystal size and polymorph can be controlled by EPS substance obtained from R. opacus. • The water soluble fraction favours vaterite dissolution and calcite growth. • The total EPS stabilizes vaterite. • This effect is stronger at basic pH.

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

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Slawomir Czachowski

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

Outcome prediction in gastroschisis - The gastroschisis prognostic score (GPS) revisited.

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Puligandla, Pramod S; Baird, Robert; Skarsgard, Eric D; Emil, Sherif; Laberge, Jean-Martin

2017-05-01

The GPS enables risk stratification for gastroschisis and helps discriminate low from high morbidity groups. The purpose of this study was to revalidate GPS's characterization of a high morbidity group and to quantify relationships between the GPS and outcomes. With REB approval, complete survivor data from a national gastroschisis registry was collected. GPS bowel injury scoring was revalidated excluding the initial inception/validation cohorts (>2011). Length of stay (LOS), 1st enteral feed days (dFPO), TPN days (dTPN), and aggregate complications (COMP) were compared between low and high morbidity risk groups. Mathematical relationships between outcomes and integer increases in GPS were explored using the entire cohort (2005-present). Median (range) LOS, dPO, and dTPN for the entire cohort (n=849) was 36 (26,62), 13 (9,18), and 27 (20,46) days, respectively. High-risk patients (GPS≥2; n=80) experienced significantly worse outcomes than low risk patients (n=263). Each integer increase in GPS was associated with increases in LOS and dTPN by 16.9 and 12.7days, respectively (pGPS effectively discriminates low from high morbidity risk groups. Within the high risk group, integer increases in GPS produce quantitatively differentiated outcomes which may guide initial counseling and resource allocation. IIb. Copyright © 2017 Elsevier Inc. All rights reserved.

Cue-elicited food seeking is eliminated with aversive outcomes following outcome devaluation.

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Eder, Andreas B; Dignath, David

2016-01-01

In outcome-selective Pavlovian-to-instrumental transfer (PIT), stimuli that are predictive of specific outcomes prime instrumental responses that are associated with these outcomes. Previous human studies yielded mixed evidence in respect to whether the PIT effect is affected by a posttraining devaluation of an outcome, with the PIT effect being preserved after a devaluation of a primary reinforcer (food, drugs) but not following the devaluation of a secondary reinforcer (money). The present research examined whether outcome-selective transfer is eliminated when the devaluation of a primary (liquid) reinforcer is strong and aversive. Experiment 1 confirmed these expectations following a devaluation with bad tasting Tween 20. However, outcome-selective transfer was still observed when the earned (devalued) outcome was not consumed immediately after each test (Experiment 2). These results suggest that the capacity of a Pavlovian cue to motivate a specific response is affected by the incentive value of the shared outcome only when the devaluation yields an aversive outcome that is consumed immediately.

Scaled-up manufacturing of recombinant antibodies produced by plant cells in a 200-L orbitally-shaken disposable bioreactor

NARCIS (Netherlands)

Raven, N.; Rasche, F.; Kuehn, C.; Anderlei, T.; Klöckner, W.; Schuster, F.; Henquet, M.G.L.; Bosch, H.J.; Büchs, J.; Fischer, R.; Schillberg, S.

2015-01-01

Tobacco BY-2 cells have emerged as a promising platform for the manufacture of biopharmaceutical proteins, offering efficient protein secretion, favourable growth characteristics and cultivation in containment under a controlled environment. The cultivation of BY-2 cells in disposable bioreactors is

The effect of electronic medical record adoption on outcomes in US hospitals

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Lee Jinhyung

2013-02-01

Full Text Available Abstract Background The electronic medical record (EMR is one of the most promising components of health information technology. However, the overall impact of EMR adoption on outcomes at US hospitals remains unknown. This study examined the relationship between basic EMR adoption and 30-day rehospitalization, 30-day mortality, inpatient mortality and length of stay. Methods Our overall approach was to compare outcomes for the two years before and two years after the year of EMR adoption, at 708 acute-care hospitals in the US from 2000 to 2007. We looked at the effect of EMR on outcomes using two methods. First, we compared the outcomes by quarter for the period before and after EMR adoption among hospitals that adopted EMR. Second, we compared hospitals that adopted EMR to those that did not, before and after EMR adoption, using a generalized linear model. Results Hospitals adopting EMR experienced 0.11 (95% CI: -0.218 to −0.002 days’ shorter length of stay and 0.182 percent lower 30-day mortality, but a 0.19 (95% CI: 0.0006 to 0.0033 percent increase in 30-day rehospitalization in the two years after EMR adoption. The association of EMR adoption with outcomes also varied by type of admission (medical vs. surgical. Conclusions Previous studies using observational data from large samples of hospitals have produced conflicting results. However, using different methods, we found a small but statistically significant association of EMR adoption with outcomes of hospitalization.

Activity Performance Management Framework Based on Outcome Based Budgeting Malaysian Nuclear Agency

International Nuclear Information System (INIS)

Aisya Raihan Abdul Kadir; Mohd Azmi Sidid Omar; Noriah Jamal

2015-01-01

The implementation of the Outcome Based Budgeting (OBB) in the planning and implementation of national development and public spending will emphasize the impact and effectiveness of programs and activities in line with the policies and objectives of the four pillars in the National Transformation programme, which is 1 Malaysia: People First, Performance Now, Government Transformation Programme (GTP), Economic Transformation Programme (ETP) and Malaysia Five Year Development Plan. OBB effective implementation at the ministry level was implemented by the Ministry OBB Implementation Committee (OIC) and Program Performance Management Committee (PPMC). At the agency it will be implemented by the Performance Management Committee Activities (APMC). OBB involve strategic implementation cycle consisting of four main processes, namely, outcome-based planning, budgeting, monitoring, evaluation, and reporting performance. OBB will be fully implemented in 2016 to replace the Modified Budgeting System (MBS). Performance Management Framework Activity (APMF) is based on outcome-based planning has been developed using methodologies such as ProLL Model (Logic and Linkages Programme), Problem Tree Analysis (PTA), Top-down approach, SMART principle, Framework Approach and rigour test. By applying this methodology several Activity Performance Management Framework (APMF) has been produced which consists of 3 output, 6 KPI output, 3 outcome and 8 KPI outcome in line with the direction and outcome of programme level and ministries level. APMF was planned at the beginning of each year and reporting of the performance on a quarterly basis through My Results application. (author)

Fresh produce consumption and the association between frequency of food shopping, car access, and distance to supermarkets

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Gustat, Jeanette; O'Malley, Keelia; Luckett, Brian G.; Johnson, Carolyn C.

2015-01-01

Background Fresh fruit and vegetables are important components of a healthy diet. Distance to a supermarket has been associated with the ability to access fresh produce. Methods A randomly sampled telephone survey was conducted with the main shopper for 3000 households in New Orleans, Louisiana in 2011. Individuals were asked where and how often they shopped for groceries, frequency of consumption of a variety of foods, and whether they had access to a car. Bivariate models assessed the relationship between four outcomes: car access, distance to the store patronized by the respondent, number of monthly shopping trips, and daily servings of produce. Structural equation modeling (SEM) was used to distinguish direct and indirect effects. Results In bivariate models, car access was positively associated with number of shopping trips and produce consumption while distance was inversely associated with shopping trips. In SEM models, produce consumption was not associated with car access or distance, but to the number of monthly shopping trips. Conclusion The frequency of shopping is associated with car access but a further distance deters it. Access to stores closer to the shopper may promote more frequent shopping and consumption of produce. PMID:26844049

Effect of socioeconomic status disparity on child language and neural outcome: how early is early?

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Hurt, Hallam; Betancourt, Laura M

2016-01-01

It is not news that poverty adversely affects child outcome. The literature is replete with reports of deleterious effects on developmental outcome, cognitive function, and school performance in children and youth. Causative factors include poor nutrition, exposure to toxins, inadequate parenting, lack of cognitive stimulation, unstable social support, genetics, and toxic environments. Less is known regarding how early in life adverse effects may be detected. This review proposes to elucidate "how early is early" through discussion of seminal articles related to the effect of socioeconomic status on language outcome and a discussion of the emerging literature on effects of socioeconomic status disparity on brain structure in very young children. Given the young ages at which such outcomes are detected, the critical need for early targeted interventions for our youngest is underscored. Further, the fiscal reasonableness of initiating quality interventions supports these initiatives. As early life adversity produces lasting and deleterious effects on developmental outcome and brain structure, increased focus on programs and policies directed to reducing the impact of socioeconomic disparities is essential.

Relating quality of life to Glasgow outcome scale health states.

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Kosty, Jennifer; Macyszyn, Luke; Lai, Kevin; McCroskery, James; Park, Hae-Ran; Stein, Sherman C

2012-05-01

There has recently been a call for the adoption of comparative effectiveness research (CER) and related research approaches for studying traumatic brain injury (TBI). These methods allow researchers to compare the effectiveness of different therapies in producing patient-oriented outcomes of interest. Heretofore, the only measures by which to compare such therapies have been mortality and rate of poor outcome. Better comparisons can be made if parametric, preference-based quality-of-life (QOL) values are available for intermediate outcomes, such as those described by the Glasgow Outcome Scale Extended (GOSE). Our objective was therefore to determine QOL for the health states described by the GOSE. We interviewed community members at least 18 years of age using the standard gamble method to assess QOL for descriptions of GOSE scores of 2-7 derived from the structured interview. Linear regression analysis was also performed to assess the effect of age, gender, and years of education on QOL. One hundred and one participants between the ages of 18 and 83 were interviewed (mean age 40 ± 19 years), including 55 men and 46 women. Functional impairment and QOL showed a strong inverse relationship, as assessed by both linear regression and the Spearman rank order coefficient. No consistent effect or age, gender, or years of education was seen. As expected, QOL decreased with functional outcome as described by the GOSE. The results of this study will provide the groundwork for future groups seeking to apply CER methods to clinical studies of TBI.

Polymer producing palladium complexes of unidentate phosphines in the methoxycarbonylation of ethene.

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Smith, Graeme; Vautravers, Nicolas R; Cole-Hamilton, David J

2009-02-07

A wide range of unidentate phosphines have been studied as ligands for the palladium-catalysed methoxycarbonylation of ethene in the presence of methanesulfonic acid using methanol as the solvent. At high phosphine to Pd ratios, methyl propanoate is formed at a low rate. However, at P-Pd ratios of 4 : 1, some unidentate phosphines promote the formation of polyketone with moderate rates. Analysis of all the phosphines shows that good electron donating power, combined with small size, favours polyketone formation.

Quality of rearing practices as predictor of short-term outcome in adolescent anorexia nervosa.

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Castro, J; Toro, J; Cruz, M

2000-01-01

Studies of family relationships in anorexia nervosa have produced conflicting results. Some authors claim that family factors are related to short-term outcomes. Perceived rearing practices, as measured by the EMBU (Egna Minnen Betraffande Uppfostran: 'My memories of Upbringing') were examined in a sample (N = 158) of adolescents with anorexia nervosa and compared with the perceptions of adolescents (N = 159) from the general population. A further comparison was made between the groups of patients with good and bad short-term outcomes. Logistic regression analysis was performed to evaluate the predictive value of different variables on short-term outcome. Overall, small differences were observed in the perceptions of rearing practices as expressed by the controls and the anorexic patients. Patients with bad short-term outcome perceived more rejection and control-overprotection from both parents than those with good outcome. In the logistic regression analysis only Rejection from father and the EAT (Eating Attitudes Test) total score gave independent prediction of treatment response. Taken as a whole, these results do not support the idea of altered rearing practices in anorexic patients, at least in young patients with a short evolution of the disease. Perceived rearing practices, especially 'rejection', appear to have an appreciable effect on the short-term outcome.

Management and outcome of stage 3 neuroblastoma

Science.gov (United States)

Modak, Shakeel; Kushner, Brian H.; LaQuaglia, Michael P.; Kramer, Kim; Cheung, Nai-Kong V.

2013-01-01

Purpose The management of patients with International Neuroblastoma Staging System (INSS) stage 3 neuroblastoma (NB) is not consistent worldwide. We describe a single centre approach at Memorial Sloan-Kettering Cancer Centre (MSKCC) from 1991 to 2007 that minimizes therapy except for those patients with MYCN-amplified NB. Methods In this retrospective analysis of 69 patients, tumour MYCN was not amplified in 53 and amplified in 16. Event-free survival (EFS) and overall survival (OS) were determined by Kaplan–Meier analysis. Results Fourteen patients with non-MYCN-amplified tumours were treated with surgery alone (group A) and the remaining 39 (group B) with surgery following chemotherapy that was initiated and administered at non-MSKCC institutions. Chemotherapy was discontinued after surgery in 38/39 of the latter. The 10-year EFS and OS for all patients with MYCN-non-amplified NB were 74.9 ± 16.9% and 92.6 ± 5.5%, respectively. There was no difference in OS between groups A and B (p = 0.2; 10-year OS for groups A and B was 84.6 ± 14% and 97.1 ± 2.9%, respectively). Patients with MYCN-amplified disease (group C) underwent dose-intensive induction, tumour resection and local radiotherapy: 13 achieved complete or very good partial remission, and 10 received myeloablative chemotherapy. 11/16 patients also received 3F8-based immunotherapy: 10 remain free of disease. The 10-year EFS and OS for patients with MYCN-amplified neuroblastoma treated with immunotherapy were both 90.9 ± 8.7%. Conclusion Patients with MYCN-non-amplified stage 3 NB can be successfully treated with surgery without the need for radiotherapy or continuation of chemotherapy. Combination of dose-intensive chemotherapy, surgery, radiotherapy and immunotherapy was associated with a favourable outcome for most patients with MYCN-amplified stage 3 NB. PMID:18996003

Charles Robert Darwin (to the 200th Birthday and the 150th Anniversary of the publication of the book «On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life»

Directory of Open Access Journals (Sweden)

Vagin Yu. V.

2009-10-01

Full Text Available Charles Robert Darwin (to the 200th Birthday and the 150th Anniversary of the publication of the book «On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life»

International Uranium Resources Evaluation Project (IUREP) national favourability studies: Papua New Guinea

International Nuclear Information System (INIS)

1977-08-01

prospective rocks. The Permian or Triassic granite and Triassic acidic volcanics are possible source rocks for uranium in the Mesozoic sediments, although the uranium levels are unknown. Granitic rocks of similar age, exposed in the western part of Irian Jaya (Rirdshead) are accompanied by radiometric anomalies and are known to contain monazite, allanite, xenotime, zircon, and thorite. Miocene and younger intrusions - principally diorite, tonalite, and granodiorite - in the central range, contain up to 4 ppm U and 16 ppm Th, while Tertiary intrusives in New Britain and the Solomon Islands contain less than 2.5 ppm U and 7 ppm Th. Quaternary volcanics in New Britain and on islands off the North New Guinea coast have low levels of U and Th similar to those of the Tertiary intrusives in the area. Some of the tertiary limestone deposits in Papua New Guinea could be potential host rocks to uranium. The most favourable rock unit is Miocene basinal limestone on the platform; it consists of argillaceous micrite and biomicrite, and calcareous mudstone, and is a source and (locally) a reservoir rock of petroleum. Apart, from the inherent difficulties of exploration of a remote region an added problem is the difficulty of airborne surveying in areas of rugged topography and terrain covered by dense forest. In lowland areas there are the additional problems of permanent water cover, leaching of the surface rocks, and heavy soil cover