Measurement properties of patient-reported outcome measures (PROMs) used in adult patients with chronic kidney disease: a systematic review protocol.

Science.gov (United States)

Aiyegbusi, Olalekan Lee; Kyte, Derek; Cockwell, Paul; Marshall, Tom; Keeley, Thomas; Gheorghe, Adrian; Calvert, Melanie

2016-10-12

Chronic kidney disease (CKD) is associated with symptoms that can significantly reduce the quality of life (QoL) of patients. Patient-reported outcome measures (PROMs) may facilitate the assessment of the impact of disease and treatment on the QoL, from a patient perspective. PROMs can be used in research and routine clinical practice. A systematic review of studies evaluating the measurement properties of PROMs in adults with CKD will be conducted. MEDLINE, EMBASE, PsycINFO and CINAHL Plus will be systematically searched from inception. Hand searching of reference lists and citations of included studies will be carried out. 2 reviewers will independently screen the titles and abstracts of all the studies retrieved during the systematic search to determine their eligibility. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist will be used to appraise the methodological quality of the selected studies following the full-text review. Data on the study population, questionnaire characteristics and measurement properties will be extracted from the selected papers. Finally, a narrative synthesis of extracted data will be undertaken. Ethical permissions are not required for this study as data from published research articles will be used. Findings will be disseminated through publication in a peer-reviewed journal and presented at conferences. This systematic review will provide a comprehensive assessment of the measurement properties of PROMs currently available for use in adult patients with CKD and present evidence which may inform the selection of measures for use in research and clinical practice. CRD42016035554. 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/.

The PU-PROM: A patient-reported outcome measure for peptic ulcer disease.

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Liu, Na; Lv, Jing; Liu, Jinchun; Zhang, Yanbo

2017-12-01

Patient-reported outcome measure (PROM) conceived to enable description of treatment-related effects, from the patient perspective, bring the potential to improve in clinical research, and to provide patients with accurate information. Therefore, the aim of this study was to develop a patient-centred peptic ulcer patient-reported outcome measure (PU-PROM) and evaluate its reliability, validity, differential item functioning (DIF) and feasibility. To develop a conceptual framework and item pool for the PU-PROM, we performed a literature review and consulted other measures created in China and other countries. Beyond that, we interviewed 10 patients with peptic ulcers, and consulted six key experts to ensure that all germane parameters were included. In the first item selection phase, classical test theory and item response theory were used to select and adjust items to shape the preliminary measure completed by 130 patients and 50 controls. In the next phase, the measure was evaluated used the same methods with 492 patients and 124 controls. Finally, we used the same population in the second item reselection to assess the reliability, validity, DIF and feasibility of the final measure. The final peptic ulcer PRO measure comprised four domains (physiology, psychology, society and treatment), with 11 subdomains, and 54 items. The Cronbach's α coefficient of each subdomain for the measure was >0.800. Confirmatory factory analysis indicated that the construct validity fulfilled expectations. Model fit indices, such as RMR, RMSEA, NFI, NNFI, CFI and IFI, showed acceptable fit. The measure showed a good response rate. The peptic ulcer PRO measure had good reliability, validity, DIF and feasibility, and can be used as a clinical research evaluation instrument with patients with peptic ulcers to assess their condition focus on treatment. This measure may also be applied in other health areas, especially in clinical trials of new drugs, and may be helpful in clinical

An independent psychometric evaluation of the PROMS measure of music perception skills

NARCIS (Netherlands)

Kunert, R.; Willems, R.M.; Hagoort, P.

2016-01-01

The Profile of Music Perception Skills (PROMS) is a recently developed measure of perceptual music skills which has been shown to have promising psychometric properties. In this paper we extend the evaluation of its brief version to three kinds of validity using an individual difference approach.

An intronic deletion in the PROM1 gene leads to autosomal recessive cone-rod dystrophy.

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Eidinger, Osnat; Leibu, Rina; Newman, Hadas; Rizel, Leah; Perlman, Ido; Ben-Yosef, Tamar

2015-01-01

To investigate the genetic basis for autosomal recessive cone-rod dystrophy (CRD) in a consanguineous Israeli Jewish family. Patients underwent a detailed ophthalmic evaluation, including eye examination, visual field testing, optical coherence tomography (OCT), and electrophysiological tests, electroretinography (ERG) and visual evoked potential (VEP). Genome-wide homozygosity mapping using a single nucleotide polymorphism (SNP) array was performed to identify homozygous regions shared among two of the affected individuals. Mutation screening of the underlying gene was performed with direct sequencing. In silico and in vitro analyses were used to predict the effect of the identified mutation on splicing. The affected family members are three siblings who have various degrees of progressive visual deterioration, glare, color vision abnormalities, and night vision difficulties. Visual field tests revealed central scotomas of different extension. Cone and rod ERG responses were reduced, with cones more severely affected. Homozygosity mapping revealed several homozygous intervals shared among two of the affected individuals. One included the PROM1 gene. Sequence analysis of the 26 coding exons of PROM1 in one affected individual revealed no mutations in the coding sequence or in intronic splice sites. However, in intron 21, proximate to the intron-exon junction, we observed a homozygous 10 bp deletion between positions -26 and -17 (c.2281-26_-17del). The deletion was linked to a known SNP, c.2281-6C>G. The deletion cosegregated with the disease in the family, and was not detected in public databases or in 101 ethnically-matched control individuals. In silico analysis predicted that this deletion would lead to altered intron 21 splicing. Bioinformatic analysis predicted that a recognition site for the SRSF2 splicing factor is located within the deleted sequence. The in vitro splicing assay demonstrated that c.2281-26_-17del leads to complete exon 22 skipping. A novel

Evaluation and demonstration of commercialization potential of CCSI tools within gPROMS advanced simulation platform

Energy Technology Data Exchange (ETDEWEB)

Lawal, Adekola [Process Systems Enterprise Inc., Cedar Knolls, NJ (United States); Schmal, Pieter [Process Systems Enterprise Inc., Cedar Knolls, NJ (United States); Ramos, Alfredo [Process Systems Enterprise Inc., Cedar Knolls, NJ (United States); Cano, Alejandro [Process Systems Enterprise Inc., Cedar Knolls, NJ (United States); Bhattacharyya, Debangsu [West Virginia Univ., Morgantown, WV (United States); Mebane, David [West Virginia Univ., Morgantown, WV (United States); Sahinidis, Nikolaos [Carnegie Mellon Univ., Pittsburgh, PA (United States); Chowdhury, Ananya [Process Systems Enterprise Inc., Cedar Knolls, NJ (United States); Liu, Xiaohui [Process Systems Enterprise Inc., Cedar Knolls, NJ (United States); Bellinghausen, Stefan [Process Systems Enterprise Inc., Cedar Knolls, NJ (United States)

2017-05-29

PSE, in the first phase of the CCSI commercialization project, set out to identify market opportunities for the CCSI tools combined with existing gPROMS platform capabilities and develop a clear technical plan for the proposed commercialization activities.

Cross-cultural adaptation and measurement properties of generic and cancer-related patient-reported outcome measures (PROMs) for use with cancer patients in Brazil: a systematic review.

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Albach, Carlos Augusto; Wagland, Richard; Hunt, Katherine J

2018-04-01

This systematic review (1) identifies the current generic and cancer-related patient-reported outcome measures (PROMs) that have been cross-culturally adapted to Brazilian Portuguese and applied to cancer patients and (2) critically evaluates their cross-cultural adaptation (CCA) and measurement properties. Seven databases were searched for articles regarding the translation and evaluation of measurement properties of generic and cancer-related PROMs cross-culturally adapted to Brazilian Portuguese that are applied in adult (≥18 years old) cancer patients. The methodological quality of included studies was assessed using the COSMIN checklist. The bibliographic search retrieved 1674 hits, of which seven studies analysing eight instruments were included in this review. Data on the interpretability of scores were poorly reported. Overall, the quality of the CCA process was inconsistent throughout the studies. None of the included studies performed a cross-cultural validation. The evidence concerning the quality of measurement properties is limited by poor or fair methodological quality. Moreover, limited information regarding measurement properties was provided within the included papers. This review aids the selection process of Brazilian Portuguese PROMs for use in cancer patients. After acknowledging the methodological caveats and strengths of each tool, our opinion is that for quality of life and symptoms assessment the adapted FACT-G version and the ESAS could be recommended, respectively. Future research should rely on the already accepted standards of CCA and validation studies.

Proceedings of Patient Reported Outcome Measure’s (PROMs Conference Sheffield 2016: advances in patient reported outcomes research

Directory of Open Access Journals (Sweden)

Tim Croudace

2016-10-01

Full Text Available Table of contents S1 Using computerized adaptive testing Tim Croudace S2 Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policy John Brazier O1 “Am I going to get better?”—Using PROMs to inform patients about the likely benefit of surgery Nils Gutacker, Andrew Street O2 Identifying Patient Reported Outcome Measures for an electronic Personal Health Record Dan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til Wykes O3 Examining the change process over time qualitatively: transformative learning and response shift Nasrin Nasr, Pamela Enderby O4 Developing a PROM to evaluate self-management in diabetes (HASMID: giving patients a voice Jill Carlton, Donna Rowen, Jackie Elliott, John Brazier, Katherine Stevens, Hasan Basarir, Alex Labeit O5 Development of the Primary Care Outcomes Questionnaire (PCOQ Mairead Murphy, Sandra Hollinghurst, Chris Salisbury O6 Developing the PKEX score- a multimodal assessment tool for patients with shoulder problems Dominic Marley, James Wilson, Amy Barrat, Bibhas Roy O7 Applying multiple imputation to multi-item patient reported outcome measures: advantages and disadvantages of imputing at the item, sub-scale or score level Ines Rombach, Órlaith Burke, Crispin Jenkinson, Alastair Gray, Oliver Rivero-Arias O8 Integrating Patient Reported Outcome Measures (PROMs into routine primary care for patients with multimorbidity: a feasibility study Ian Porter, Jaheeda Gangannagaripalli, Charlotte Bramwell, Jose M. Valderas O9 eRAPID: electronic self-report and management of adverse-events for pelvic radiotherapy (RT patients Patricia Holch, Susan Davidson, Jacki Routledge, Ann Henry, Kevin Franks, Alex Gilbert, Kate Absolom & Galina Velikova O10 Patient reported outcomes (PROMs based recommendation in clinical guidance for the management of chronic conditions in the United Kingdom Ian Porter, Jose M.Valderas O11 Cross-sectional and

Proceedings of Patient Reported Outcome Measure’s (PROMs) Conference Oxford 2017: Advances in Patient Reported Outcomes Research

NARCIS (Netherlands)

Velikova, Galina; Valderas, Jose M.; Potter, Caroline; Batchelder, Laurie; A’Court, Christine; Baker, Matthew; Bostock, Jennifer; Coulter, Angela; Fitzpatrick, Ray; Forder, Julien; Fox, Diane; Geneen, Louise; Gibbons, Elizabeth; Jenkinson, Crispin; Jones, Karen; Kelly, Laura; Peters, Michele; Mulhern, Brendan; Labeit, Alexander; Rowen, Donna; Meadows, Keith; Elliott, Jackie; Brazier, John E.; Knowles, Emma; Keetharuth, Anju; Brazier, John E.; Connell, Janice; Carlton, Jill; Buck, Lizzie Taylor; Ricketts, Thomas; Barkham, Michael; Goswami, Pushpendra; Salek, Sam; Ionova, Tatyana; Oliva, Esther; Fielding, Adele K.; Karakantza, Marina; Al-Ismail, Saad; Collins, Graham P.; McConnell, Stewart; Langton, Catherine; Jennings, Daniel M.; Else, Roger; Kell, Jonathan; Ward, Helen; Day, Sophie; Lumley, Elizabeth; Phillips, Patrick; Duncan, Rosie; Buckley-Woods, Helen; Aber, Ahmed; Jones, Gerogina; Michaels, Jonathan; Porter, Ian; Gangannagaripalli, Jaheeda; Davey, Antoinette; Ricci-Cabello, Ignacio; Haywood, Kirstie; Hansen, Stine Thestrup; Valderas, Jose; Roberts, Deb; Gumber, Anil; Podmore, Bélène; Hutchings, Andrew; van der Meulen, Jan; Aggarwal, Ajay; Konan, Sujith; Price, Andrew; Jackson, William; Bottomley, Nick; Philiips, Michael; Knightley-Day, Toby; Beard, David; Gibbons, Elizabeth; Fitzpatrick, Ray; Greenhalgh, Joanne; Gooding, Kate; Gibbons, Elizabeth; Valderas, Chema; Wright, Judy; Dalkin, Sonia; Meads, David; Black, Nick; Fawkes, Carol; Froud, Robert; Carnes, Dawn; Price, Andrew; Cook, Jonathan; Dakin, Helen; Smith, James; Kang, Sujin; Beard, David; Griffiths, Catrin; Guest, Ella; Harcourt, Diana; Murphy, Mairead; Hollinghurst, Sandra; Salisbury, Chris; Carlton, Jill; Elliott, Jackie; Rowen, Donna; Gao, Anqi; Price, Andrew; Beard, David; Lemanska, Agnieszka; Chen, Tao; Dearnaley, David P.; Jena, Rajesh; Sydes, Matthew; Faithfull, Sara; Ades, A. E.; Kounali, Daphne; Lu, Guobing; Rombach, Ines; Gray, Alastair; Jenkinson, Crispin; Rivero-Arias, Oliver; Holch, Patricia; Holmes, Marie; Rodgers, Zoe; Dickinson, Sarah; Clayton, Beverly; Davidson, Susan; Routledge, Jacqui; Glennon, Julia; Henry, Ann M.; Franks, Kevin; Velikova, Galina; Maguire, Roma; McCann, Lisa; Young, Teresa; Armes, Jo; Harris, Jenny; Miaskowski, Christine; Kotronoulas, Grigorios; Miller, Morven; Ream, Emma; Patiraki, Elizabeth; Geiger, Alexander; Berg, Geir V.; Flowerday, Adrian; Donnan, Peter; McCrone, Paul; Apostolidis, Kathi; Fox, Patricia; Furlong, Eileen; Kearney, Nora; Gibbons, Chris; Fischer, Felix; Gibbons, Chris; Coste, Joel; Martinez, Jose Valderas; Rose, Matthias; Leplege, Alain; Shingler, Sarah; Aldhouse, Natalie; Al-Zubeidi, Tamara; Trigg, Andrew; Kitchen, Helen; Davey, Antoinette; Porter, Ian; Green, Colin; Valderas, Jose M.; Coast, Joanna; Smith, Sarah; Hendriks, Jolijn; Black, Nick; Shah, Koonal; Rivero-Arias, Oliver; Ramos-Goni, Juan-Manuel; Kreimeier, Simone; Herdman, Mike; Devlin, Nancy; Finch, Aureliano Paolo; Brazier, John E.; Mukuria, Clara; Zamora, Bernarda; Parkin, David; Feng, Yan; Bateman, Andrew; Herdman, Mike; Devlin, Nancy; Patton, Thomas; Gutacker, Nils; Shah, Koonal

2017-01-01

The proceedings contain 36 papers. The topics discussed include: using patient reported outcome measures (PROMs) in cancer care; validation of the long-term conditions questionnaire (LTCQ) in a diverse sample of health and social care users in England; the national institutes of health

Using Patient-Reported Outcome Measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney disease (PRO-trACK project): a mixed-methods project protocol.

Science.gov (United States)

Aiyegbusi, Olalekan Lee; Kyte, Derek; Cockwell, Paul; Marshall, Tom; Dutton, Mary; Slade, Anita; Marklew, Neil; Price, Gary; Verdi, Rav; Waters, Judi; Sharpe, Keeley; Calvert, Melanie

2017-06-30

Advanced chronic kidney disease (CKD) has a major effect on the quality of life and health status of patients and requires accurate and responsive management. The use of electronic patient-reported outcome measures (ePROMs) could assist patients with advanced pre-dialysis CKD, and the clinicians responsible for their care, by identifying important changes in symptom burden in real time. We report the protocol for 'Using Patient-Reported Outcome measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney Disease' (PRO-trACK) project, which will explore the feasibility and validity of an ePROM system for use in patients with advanced CKD. The project will use a mixed-methods approach in three studies: (1) usability testing of the ePROM system involving up to 30 patients and focusing on acceptability and technical performance/stability; (2) ascertaining the views of patient and clinician stakeholders on the optimal use and administration of the CKD ePROM system-this will involve qualitative face-to-face/telephone interviewing with up to 30 patients or until saturation is achieved, focus groups with up to 15 clinical staff, management and IT team members; (3) psychometric assessment of the system, within a cohort of at least 180 patients with advanced CKD, to establish the measurement properties of the ePROM. This project was approved by the West Midlands Edgbaston Research Ethics Committee (Reference 17/WM/0010) and received Health Research Authority (HRA) approval on 24 February 2017.The findings from this project will be provided to clinicians at the Department of Renal Medicine, Queen Elizabeth Hospitals, Birmingham (QEHB), NHS England, presented at conferences and to the Kidney Patients' Association, British Kidney Patient Association and the British Renal Society. Articles based on the findings will be written and submitted for publication in peer-reviewed journals. © Article author(s) (or their employer

Psychometric validation of the Spanish version of the USS-PROM questionnaire for patients who undergo anterior urethral surgery.

Science.gov (United States)

Puche-Sanz, I; Martín-Way, D; Flores-Martín, J; Expósito-Ruiz, M; Vicente-Prados, J; Nogueras-Ocaña, M; Tinaut-Ranera, J; Cózar-Olmo, J M

2016-06-01

To translate into Spanish and validate the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) questionnaire, assessing its psychometric properties and determining its suitability for clinical use in our community. We also assessed the potential changes in ejaculatory function using the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). A systematic translation of the British version was performed. Patients scheduled for anterior urethral stricture surgery between September 2014 and September 2015 were prospectively included in the study. All patients completed the questionnaire before and after the surgery. We conducted an in-depth psychometric study of the questionnaire. We assessed the responses of a total of 40 patients. The questionnaire showed its validity, presenting an excellent negative correlation between the voiding symptom scores and the maximum flow (r=-0.6, P<.001), and also showed significant improvement in the EQ5D-VAS (visual analogue scale) and the time trade-off. For internal consistency, the Cronbach's alpha was 0.701. For the test-retest reliability, the overall intraclass correlation coefficient (ICC) was 0.974, and the ICC for each item separately ranged from 0.799 to 0.980. We observed significant improvement in all items regarding urinary symptoms and health-related quality of life (P<.001), thereby demonstrating the response capacity to changing the questionnaire. There were no significant changes in the MSHQ-EjD. The Spanish version of the USS-PROM questionnaire is a valid instrument for quantifying changes in voiding symptoms and the health-related quality of life of patients undergoing anterior urethral surgery. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Enhancing rigour in the validation of patient reported outcome measures (PROMs: bridging linguistic and psychometric testing

Directory of Open Access Journals (Sweden)

Roberts Gwerfyl

2012-06-01

Full Text Available Abstract Background A strong consensus exists for a systematic approach to linguistic validation of patient reported outcome measures (PROMs and discrete methods for assessing their psychometric properties. Despite the need for robust evidence of the appropriateness of measures, transition from linguistic to psychometric validation is poorly documented or evidenced. This paper demonstrates the importance of linking linguistic and psychometric testing through a purposeful stage which bridges the gap between translation and large-scale validation. Findings Evidence is drawn from a study to develop a Welsh language version of the Beck Depression Inventory-II (BDI-II and investigate its psychometric properties. The BDI-II was translated into Welsh then administered to Welsh-speaking university students (n = 115 and patients with depression (n = 37 concurrent with the English BDI-II, and alongside other established depression and quality of life measures. A Welsh version of the BDI-II was produced that, on administration, showed conceptual equivalence with the original measure; high internal consistency reliability (Cronbach’s alpha = 0.90; 0.96; item homogeneity; adequate correlation with the English BDI-II (r = 0.96; 0.94 and additional measures; and a two-factor structure with one overriding dimension. Nevertheless, in the student sample, the Welsh version showed a significantly lower overall mean than the English (p = 0.002; and significant differences in six mean item scores. This prompted a review and refinement of the translated measure. Conclusions Exploring potential sources of bias in translated measures represents a critical step in the translation-validation process, which until now has been largely underutilised. This paper offers important findings that inform advanced methods of cross-cultural validation of PROMs.

Proceedings of Patient Reported Outcome Measure?s (PROMs) Conference Sheffield 2016: advances in patient reported outcomes research

OpenAIRE

Croudace, Tim; Brazier, John; Gutacker, Nils; Street, Andrew; Robotham, Dan; Waterman, Samantha; Rose, Diana; Satkunanathan, Safarina; Wykes, Til; Nasr, Nasrin; Enderby, Pamela; Carlton, Jill; Rowen, Donna; Elliott, Jackie; Brazier, John

2016-01-01

Table of contents S1 Using computerized adaptive testing Tim Croudace S2 Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policy John Brazier O1 “Am I going to get better?”—Using PROMs to inform patients about the likely benefit of surgery Nils Gutacker, Andrew Street O2 Identifying Patient Reported Outcome Measures for an electronic Personal Health Record Dan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til W...

The relative proportion of preterm births complicated by premature rupture of membranes in multifetal gestations: a population-based study.

Science.gov (United States)

Pakrashi, Tarita; Defranco, Emily A

2013-01-01

To compare the relative contribution of premature rupture of membranes (PROM) to preterm births in singleton compared with multifetal gestations. A population-based retrospective cohort study of 291,782 nonanomalous live births in the state of Ohio from January 1, 2006, to December 31, 2007, identified through birth certificate data. Frequency of PROM was compared between singleton and multifetal gestations and then stratified by gestational age at birth. Multivariate regression analysis estimated the risk of PROM by plurality in each gestational age group, accounting for influential risk factors. The frequency of PROM increased with increasing plurality of gestation. The relative proportion of preterm birth < 37 weeks complicated by PROM increased with gestational plurality 13.2% singletons, 16.8% twins, 20.0% triplets, 19.6% quadruplets, and 100% for higher-order multiples (p < 0.001). The frequency of PROM increased with earlier gestational age at birth, regardless of plurality. The increased risk of PROM in multifetal gestation persisted even after adjustment for influential concomitant risk factors. The proportion of preterm birth attributable to PROM increases by plurality of gestation, with its most significant contribution in higher-order multiples and at earliest gestational ages when outcomes are the poorest. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

MRC ORACLE Children Study. Long term outcomes following prescription of antibiotics to pregnant women with either spontaneous preterm labour or preterm rupture of the membranes

Directory of Open Access Journals (Sweden)

Salt Alison

2008-04-01

Full Text Available Abstract Background The Medical Research Council (MRC ORACLE trial evaluated the use of co-amoxiclav 375 mg and/or erythromycin 250 mg in women presenting with preterm rupture of membranes (PROM ORACLE I or in spontaneous preterm labour (SPL ORACLE II using a factorial design. The results showed that for women with a singleton baby with PROM the prescription of erythromycin is associated with improvements in short term neonatal outcomes, although co-amoxiclav is associated with prolongation of pregnancy, a significantly higher rate of neonatal necrotising enterocolitis was found in these babies. Prescription of erythromycin is now established practice for women with PROM. For women with SPL antibiotics demonstrated no improvements in short term neonatal outcomes and are not recommended treatment. There is evidence that both these conditions are associated with subclinical infection so perinatal antibiotic administration may reduce the risk of later disabilities, including cerebral palsy, although the risk may be increased through exposure to inflammatory cytokines, so assessment of longer term functional and educational outcomes is appropriate. Methods The MRC ORACLE Children's Study will follow up UK children at age 7 years born to 4809 women with PROM and the 4266 women with SPL enrolled in the earlier ORACLE trials. We will use a parental questionnaire including validated tools to assess disability and behaviour. We will collect the frequency of specific medical conditions: cerebral palsy, epilepsy, respiratory illness including asthma, diabetes, admission to hospital in last year and other diseases, as reported by parents. National standard test results will be collected to assess educational attainment at Key Stage 1 for children in England. Discussion This study is designed to investigate whether or not peripartum antibiotics improve health and disability for children at 7 years of age. Trial registration The ORACLE Trial and Children

MRC ORACLE Children Study. Long term outcomes following prescription of antibiotics to pregnant women with either spontaneous preterm labour or preterm rupture of the membranes.

Science.gov (United States)

Kenyon, Sara; Brocklehurst, Peter; Jones, David; Marlow, Neil; Salt, Alison; Taylor, David

2008-04-24

The Medical Research Council (MRC) ORACLE trial evaluated the use of co-amoxiclav 375 mg and/or erythromycin 250 mg in women presenting with preterm rupture of membranes (PROM) ORACLE I or in spontaneous preterm labour (SPL) ORACLE II using a factorial design. The results showed that for women with a singleton baby with PROM the prescription of erythromycin is associated with improvements in short term neonatal outcomes, although co-amoxiclav is associated with prolongation of pregnancy, a significantly higher rate of neonatal necrotising enterocolitis was found in these babies. Prescription of erythromycin is now established practice for women with PROM. For women with SPL antibiotics demonstrated no improvements in short term neonatal outcomes and are not recommended treatment. There is evidence that both these conditions are associated with subclinical infection so perinatal antibiotic administration may reduce the risk of later disabilities, including cerebral palsy, although the risk may be increased through exposure to inflammatory cytokines, so assessment of longer term functional and educational outcomes is appropriate. The MRC ORACLE Children's Study will follow up UK children at age 7 years born to 4809 women with PROM and the 4266 women with SPL enrolled in the earlier ORACLE trials. We will use a parental questionnaire including validated tools to assess disability and behaviour. We will collect the frequency of specific medical conditions: cerebral palsy, epilepsy, respiratory illness including asthma, diabetes, admission to hospital in last year and other diseases, as reported by parents. National standard test results will be collected to assess educational attainment at Key Stage 1 for children in England. This study is designed to investigate whether or not peripartum antibiotics improve health and disability for children at 7 years of age. The ORACLE Trial and Children Study is registered in the Current Controlled Trials registry. ISCRTN 52995660.

Using patient reported outcome measures in health services: A qualitative study on including people with low literacy skills and learning disabilities

Directory of Open Access Journals (Sweden)

Jahagirdar Deepa

2012-11-01

Full Text Available Abstract Background Patient reported outcome measures (PROMs are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated stakeholder views on the accessibility and use of PROMs to develop suggestions for more inclusive practice. Methods Taking PROMs recommended for chronic obstructive pulmonary disease (COPD as an example, we conducted 8 interviews with people with low literacy skills and/or learning disabilities, and 4 focus groups with 20 health professionals and people with COPD. Discussions covered the format and delivery of PROMs using the EQ-5D and St George Respiratory Questionnaire as prompts. Thematic framework analysis focused on three main themes: Accessibility, Ease of Use, and Contextual factors. Results Accessibility included issues concerning the questionnaire format, and suggestions for improvement included larger font sizes and more white space. Ease of Use included discussion about PROMs’ administration. While health professionals suggested PROMs could be completed in waiting rooms, patients preferred settings with more privacy and where they could access help from people they know. Contextual Factors included other challenges and wider issues associated with completing PROMs. While health professionals highlighted difficulties created by the system in managing patients with low literacy/learning disabilities, patient participants stressed that understanding the purpose of PROMs was important to reduce intimidation. Conclusions Adjusting PROMs’ format, giving an explicit choice of where patients can complete them, and clearly conveying PROMs’ purpose and benefit to patients may help to prevent inequality when using PROMs in health services.

A systematic review of generic multidimensional patient-reported outcome measures for children, part II: evaluation of psychometric performance of English-language versions in a general population.

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Janssens, Astrid; Rogers, Morwenna; Thompson Coon, Jo; Allen, Karen; Green, Colin; Jenkinson, Crispin; Tennant, Alan; Logan, Stuart; Morris, Christopher

2015-03-01

The objectives of this systematic review were 1) to identify studies that assess the psychometric performance of the English-language version of 35 generic multidimensional patient-reported outcome measures (PROMs) for children and young people in general populations and evaluate their quality and 2) to summarize the psychometric properties of each PROM. MEDLINE, EMBASE, and PsycINFO were searched. The methodological quality of the articles was assessed using the COnsensus-based Standards for selection of health Measurement INstruments checklist. For each PROM, extracted evidence of content validity, construct validity, internal consistency, test-retest reliability, proxy reliability, responsiveness, and precision was judged against standardized reference criteria. We found no evidence for 14 PROMs. For the remaining 21 PROMs, 90 studies were identified. The methodological quality of most studies was fair. Quality was generally rated higher in more recent studies. Not reporting how missing data were handled was the most common reason for downgrading the quality. None of the 21 PROMs has had all psychometric properties evaluated; data on construct validity and internal consistency were most frequently reported. Overall, consistent positive findings for at least five psychometric properties were found for Child Health and Illness Profile, Healthy Pathways, KIDSCREEN, and Multi-dimensional Student Life Satisfaction Scale. None of the PROMs had been evaluated for responsiveness to detect change in general populations. Further well-designed studies with transparent reporting of methods and results are required. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Association between maternal urinary chromium and premature rupture of membranes in the Healthy Baby Cohort study in China.

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Huang, Sha; Xia, Wei; Li, Yuanyuan; Zhang, Bin; Zhou, Aifen; Zheng, Tongzhang; Qian, Zhengmin; Huang, Zheng; Lu, Shi; Chen, Zhong; Wang, Youjie; Pan, Xinyun; Huo, Wenqian; Jin, Shuna; Jiang, Yangqian; Xu, Shunqing

2017-11-01

Chromium exposure from increasing industrial releases has become a threat for pregnant women due to the potential health effects on vulnerable embryos. Previous studies have suggested that maternal chromium exposure is associated with adverse birth outcomes, but no epidemiological research has been conducted to examine the relationship between chromium exposure and premature rupture of membranes (PROM). This study aimed at investigating the association of maternal urinary chromium exposure levels with PROM and was performed with 5408 pregnant women recruited from 2012 to 2014 in the city of Wuhan, China. Maternal urinary chromium collected before labor was adjusted with creatinine, and its association with PROM was evaluated using logistic regression. Each one unit increase in the natural logarithm transformed maternal urinary chromium concentration (μg/g creatinine), an odds ratio (OR) of 1.47 [95% confidence interval (CI): 1.36, 1.58] for PROM was observed. Compared to the lowest tertile of maternal urinary chromium, PROM was positively correlated with increased urinary levels of chromium (adjusted OR = 1.42; 95% CI: 1.09, 1.84 for the medium tertile; adjusted OR = 2.77; 95% CI: 2.18, 3.52 for the highest tertile). Additionally, the association of chromium with PROM appeared to be more significant among male infants (adjusted OR = 3.52; 95% CI: 2.51, 4.94 for the highest tertile) than female infants (adjusted OR = 2.16; 95% CI: 1.52, 3.06 for the highest tertile) (p for interaction = 0.05). Our large birth cohort showed an association between maternal urinary chromium levels and PROM, and the association may differ by infant gender. Further studies from different populations are needed to confirm the observed association. Copyright © 2017 Elsevier Ltd. All rights reserved.

Patient-reported outcome measures for patients with cerebral aneurysms acquired via social media: data from a large nationwide sample.

Science.gov (United States)

Chen, Michael; Mangubat, Erwin; Ouyang, Bichun

2016-01-01

With greater survival rates, patient-reported outcome measures (PROMs) among survivors of ruptured cerebral aneurysm should be an increasing concern among neurointerventionalists. Prior studies were limited in scale and generalizability. Our study aims were to (1) evaluate the validity of cerebral aneurysm PROMs obtained from social media; (2) determine the persistence of PROMs over time; and (3) determine what PROMs still exist in those with no physical impairments. By engaging national brain aneurysm support groups and using an online questionnaire modeled after the generic EQ-5D instrument, we asked respondents to classify their health in five dimensions including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression using a 3-point Likert scale. In 2 months we received 604 responses from 46 states in the USA. Our cohort of ruptured aneurysm respondents reported PROMs similar to previously published series. Over time, headache and anxiety improved while depression, level of exercise, and return to work remained unchanged. We found that memory worsened after 2 years. Among those without any physical impairment, rates of 20.6%, 14.9%, 12.6%, and 23% were seen for significant headaches, significant memory loss, significant depression, and sense of life being negatively affected, respectively. Despite this novel study design, we obtained results comparable to prior studies. These results suggest that many patients with ruptured cerebral aneurysms, regardless of whether they are >2 years after the event and/or free of physical impairment, struggle with a poor quality of life. The latency, scale, and low cost of this study design may accelerate future cerebral aneurysm PROM research. 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/

Investigaciones Terapéuticas en la Lepra: Ensayos con “Promín” o “Promanida'”

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J. Ignacio Chala H.

1948-07-01

Full Text Available Con propósitos de observar, comprobar y valorar los resultados del "Promín"  o “Promanida” en la lepra, lo aplicarnos en un grupo de veintisiete enfermos seleccionados con criterio clínico y de investigación terapéutica. Iniciamos el estudio en julio de 1946. Ninguno de estos casos había sido tratado antes con otros medicamentos preconizados contra la enfermedad. Como lo he dicho en varias ocasiones, solamente teniendo esta precaución y seleccionando los pacientes para la investigación, podrá juzgarse científicamente de la eficacia terapéutica que puedan tener en los distintos tipos de lepra, las drogas aconsejadas para tratar esa enfermedad. Prescindimos de aquellos cases en los cuales, por lo avanzado del mal, los organismos no estaban en condiciones de reaccionar favorablemente con ninguna medicación.

Using patient reported outcome measures in health services: A qualitative study on including people with low literacy skills and learning disabilities

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Jahagirdar, D.; Kroll, T.; Ritchie, K.; Wyke, S.

2012-01-01

ABSTRACT: BACKGROUND: Patient reported outcome measures (PROMs) are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated

A PROSPECTIVE STUDY OF FOETOMATERNAL OUTCOME OF THE PATIENT WITH PREMATURE RUPTURE OF MEMBRANES

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Satyaveer Singh

2017-12-01

Full Text Available BACKGROUND Before onset of labour, rupture of membrane is known as Premature rupture of membrane (PROM. PROM is one of the most common complications of pregnancy that has major impact on foetal and maternal outcomes. The aim of the present study was to evaluate the foetomaternal outcome of the patient with premature rupture of membranes, in Department of Obstetrics and Gynaecology, Umaid Hospital, Dr. Sampuranand Medical College, Jodhpur, Rajasthan, India. MATERIALS AND METHODS Randomly 100 cases were studied out during six months of period from Jan. 2016 to June 2016. RESULTS Out of 100 cases it was observed that the mean age of PROM patients was 25 ± 2.59 years with higher incidence in unbooked cases of hospital. Gestational age from 24 weeks to 42 weeks of pregnancy were included in the study. The mode of delivery in 73 patients was vaginal and 27 delivered by LSCS. The implicated risk was found i.e. anaemia (22, UTI (14, lower genital tract infection (8, Cervical stitched (1, malpresentation (5, twin (2 and 48 cases were without any risk factor. CONCLUSION Evaluation of risks of PROM and timely diagnosis is essential to reduce maternal and perinatal morbidity and mortality. Women who experience PROM should be informed that they are at higher risk of a similar complication in a subsequent pregnancy and that early initiation of prenatal care in future pregnancies could reduce the risk of another preterm delivery.

Prospective memory, personality, and individual differences.

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Uttl, Bob; White, Carmela A; Wong Gonzalez, Daniela; McDouall, Joanna; Leonard, Carrie A

2013-01-01

A number of studies investigating the relationship between personality and prospective memory (ProM) have appeared during the last decade. However, a review of these studies reveals little consistency in their findings and conclusions. To clarify the relationship between ProM and personality, we conducted two studies: a meta-analysis of prior research investigating the relationships between ProM and personality, and a study with 378 participants examining the relationships between ProM, personality, verbal intelligence, and retrospective memory. Our review of prior research revealed great variability in the measures used to assess ProM, and in the methodological quality of prior research; these two factors may partially explain inconsistent findings in the literature. Overall, the meta-analysis revealed very weak correlations (rs ranging from 0.09 to 0.10) between ProM and three of the Big Five factors: Openness, Conscientiousness, and Agreeableness. Our experimental study showed that ProM performance was related to individual differences such as verbal intelligence as well as to personality factors and that the relationship between ProM and personality factors depends on the ProM subdomain. In combination, the two studies suggest that ProM performance is relatively weakly related to personality factors and more strongly related to individual differences in cognitive factors.

Genital infections and risk of premature rupture of membranes in Mulago Hospital, Uganda: a case control study.

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Nakubulwa, Sarah; Kaye, Dan K; Bwanga, Freddie; Tumwesigye, Nazarius Mbona; Mirembe, Florence M

2015-10-16

Inflammatory mediators that weaken and cause membrane rupture are released during the course of genital infections among pregnant women. We set out to determine the association of common genital infections (Trichomonas vaginalis, syphilis, Neisseria gonorrhea, Chlamydia trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 and candidiasis) and premature rupture of membranes in Mulago hospital, Uganda. We conducted an unmatched case-control study among women who were in the third trimester of pregnancy at New Mulago hospital, Uganda. The cases had PROM and the controls had intact membranes during latent phase of labour in the labour ward. We used interviewer-administered questionnaires to collect data on socio-demographic characteristics, obstetric and medical history. Laboratory tests were conducted to identify T. vaginalis, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 (HSV-2) and candidiasis. Logistic regression models were used to estimate the odds ratios (OR) and 95% CI of the association between genital infections and PROM. There was an association between PROM and abnormal vaginal discharge (OR = 2.02, 95% CI 1.10-3.70 and AOR = 2.30, 95% CI 1.18-4.47), presence of candidiasis (OR = 0.27, 95% CI 0.14-0.52 and AOR = 0.22, 95% CI 0.10-0.46) and T. vaginalis (OR = 2.98, 95% CI 1.18-7.56 and AOR = 4.22, 95% CI 1.51-11.80). However, there was no association between PROM and presence of C. trachomatis (OR = 2.05, 95% CI 0.37-11.49) and HSV-2 serostatus (OR = 1.15, 95% CI 0.63-2.09). Few or no patients with Bacterial vaginosis, Neisseria gonorrhoea, Group B streptococcus or syphilis were identified among the cases and controls. Co-infection of Trichomoniasis and candidiasis was not associated with PROM (AOR = 1.34, 95% CI 0.16-11.10). Co infection with T. vaginalis and C. trachomatis was associated with PROM (OR = 3.09, 95% CI 1.21-7.84 and AOR = 4.22, 95% CI 1

Patient-reported outcome measures for patients with meniscal tears: a systematic review of measurement properties and evaluation with the COSMIN checklist

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Middleton, Robert; Beard, David J; Price, Andrew J; Hopewell, Sally

2017-01-01

Objective Meniscal tears occur frequently in the population and the most common surgical treatment, arthroscopic partial meniscectomy, is performed in approximately two million cases worldwide each year. The purpose of this systematic review is to summarise and critically appraise the evidence for the use of patient-reported outcome measures (PROMs) in patients with meniscal tears. Design A systematic review was undertaken. Data on reported measurement properties were extracted and the quality of the studies appraised according to Consensus-based Standards for the Selection of Health Measurement Instruments. Data sources A search of MEDLINE, Embase, AMED and PsycINFO, unlimited by language or publication date (last search 20 February 2017). Eligibility criteria for selecting studies Development and validation studies reporting the measurement properties of PROMs in patients with meniscal tears were included. Results 11 studies and 10 PROMs were included. The overall quality of studies was poor. For measurement of symptoms and functional status, there is only very limited evidence supporting the selection of either the Lysholm Knee Scale, International Knee Documentation Committee Subjective Knee Form or the Dutch version of the Knee injury and Osteoarthritis Outcome Score. For measuring health-related quality of life, only limited evidence supports the selection of the Western Ontario Meniscal Evaluation Tool (WOMET). Of all the PROMs evaluated, WOMET has the strongest evidence for content validity. Conclusion For patients with meniscal tears, there is poor quality and incomplete evidence regarding the validity of the currently available PROMs. Further research is required to ensure these PROMs truly reflect the symptoms, function and quality of life of patients with meniscal tears. PROSPERO registration number CRD42017056847. PMID:29030413

How Do We Value Postoperative Recovery?: A Systematic Review of the Measurement Properties of Patient-reported Outcomes After Abdominal Surgery.

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Fiore, Julio F; Figueiredo, Sabrina; Balvardi, Saba; Lee, Lawrence; Nauche, Bénédicte; Landry, Tara; Mayo, Nancy E; Feldman, Liane S

2018-04-01

To appraise the level of evidence supporting the measurement properties of patient-reported outcome measures (PROMs) in the context of postoperative recovery after abdominal surgery. There is growing interest in using PROMs to support value-based care in abdominal surgery; however, to draw valid conclusions regarding patient-reported outcomes data, PROMs with robust measurement properties are required. Eight databases (MEDLINE, EMBASE, Biosis, PsycINFO, The Cochrane Library, CINAHL, Scopus, Web of Science) were searched for studies focused on the measurement properties of PROMs in the context of recovery after abdominal surgery. The methodological quality of individual studies was evaluated using the consensus-based COSMIN checklist. Evidence supporting the measurement properties of each PROM was synthetized according to standardized criteria and compared against the International Society of Quality of Life Research minimum standards for the selection of PROMs for outcomes research. We identified 35 studies evaluating 22 PROMs [12 focused on nonspecific surgical populations (55%), 4 focused on abdominal surgery (18%), and 6 generic PROMs (27%)]. The great majority of the studies (74%) received only poor or fair quality ratings. Measurement properties of PROMs were predominantly supported by limited or unknown evidence. None of the PROMs fulfilled International Society of Quality of Life Research's minimum standards, hindering specific recommendations. There is very limited evidence supporting the measurement properties of existing PROMs used in the context of recovery after abdominal surgery. This precludes the use of these PROMs to support value-based surgical care. Further research is required to bridge this major knowledge gap. International Prospective Register of Systematic Reviews (PROSPERO): CRD42014014349.

HIP AND GLENOHUMERAL PASSIVE RANGE OF MOTION IN COLLEGIATE SOFTBALL PLAYERS

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Plummer, Hillary; Brambeck, Allison

2016-01-01

Background and Purpose Range of motion deficits at the hip and glenohumeral joint (GHJ) may contribute to the incidence of injury in softball players. With injury in softball players on the rise, softball related studies in the literature are important. The purpose of this study was to examine hip and GHJ passive range of motion (PROM) patterns in collegiate softball players. Hypothesis It was hypothesized that the position players would exhibit significantly different PROM patterns than pitchers. Additionally, position players would exhibit significantly different side-to-side differences in PROM for both the hip and GHJ compared to pitchers. Study Design Prospective cohort study. Methods Forty-nine collegiate softball players (19.63 ± 1.15 years; 170.88 ± 8.08 cm; 72.96 ± 19.41 kg) participated. Passive hip and GHJ internal (IR) and external rotation (ER) measures were assessed. Glenohumeral PROM was measured with the participants supine with the arm abducted to 90 °. The measurements were recorded when the scapula began to move or a firm capsular end-feel was achieved. The hip was positioned in 90 ° of flexion and passively rotated until a capsular end-feel was achieved. Total PROM was calculated by taking the sum of IR and ER for both the hip and GHJ. Results No significant side-to-side PROM differences were observed in pitchers, at the GHJ or hip joint. Position players throwing side hip IR was significantly greater than the non-throwing side hip (p = 0.002). The non-throwing side hip had significantly greater ER compared to the throwing side hip (p = 0.002). When examining side-to-side differences at the GHJ, IR was significantly greater in the non-throwing shoulder (p = 0.047). No significant differences in total range of motion of the hip and GHJ were observed. Conclusion In the current study, position players displayed side-to-side differences in hip and GHJ IR PROM while no statistically significant differences were

Measurement properties of patient reported outcome measures for spondyloarthritis: A systematic review.

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Png, Kelly; Kwan, Yu Heng; Leung, Ying Ying; Phang, Jie Kie; Lau, Jia Qi; Lim, Ka Keat; Chew, Eng Hui; Low, Lian Leng; Tan, Chuen Seng; Thumboo, Julian; Fong, Warren; Østbye, Truls

2018-03-21

This systematic review aimed to identify studies investigating measurement properties of patient reported outcome measures (PROMs) for spondyloarthritis (SpA), and to evaluate their methodological quality and level of evidence relating to the measurement properties of PROMs. This systematic review was guided by the preferred reporting items for systematic review and meta-analysis (PRISMA). Articles published before 30 June 2017 were retrieved from PubMed ® , Embase ® , and PsychINFO ® (Ovid). Methodological quality and level of evidence were evaluated according to recommendations from the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). We identified 60 unique PROMs from 125 studies in 39 countries. Twenty-one PROMs were validated for two or more SpA subtypes. The literature examined hypothesis testing (82.4%) most frequently followed by reliability (60.0%). A percentage of 77.7% and 42.7% of studies that assessed PROMs for hypothesis testing and reliability, respectively had "fair" or better methodological quality. Among the PROMs identified, 41.7% were studied in ankylosing spondylitis (AS) only and 23.3% were studied in psoriatic arthritis (PsA) only. The more extensively assessed PROMs included the ankylosing spondylitis quality of life (ASQoL) and bath ankylosing spondylitis functional index (BASFI) for ankylosing spondylitis, and the psoriatic arthritis quality of life questionnaire (VITACORA-19) for psoriatic arthritis. This study identified 60 unique PROMs through a systematic review and synthesized evidence of the measurement properties of the PROMs. There is a lack of validation of PROMs for use across SpA subtypes. Future studies may consider validating PROMs for use across different SpA subtypes. Copyright © 2018 Elsevier Inc. All rights reserved.

Prospective memory, retrospective memory, and individual differences in cognitive abilities, personality, and psychopathology.

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Uttl, Bob; White, Carmela A; Cnudde, Kelsey; Grant, Laura M

2018-01-01

Although individual differences in processing speed, working memory, intelligence, and other cognitive functions were found to explain individual differences in retrospective memory (RetM), much less is known about their relationship with prospective memory (ProM). Moreover, the studies that investigated the relationship between ProM and cognitive functions arrived to contradictory conclusions. The relationship between ProM, personality, and psychopathology is similarly unsettled. Meta-analytic reviews of the relationships of ProM with aging and personality suggest that the contradictory findings may be due to widespread methodological problems plaguing ProM research including the prevalent use of inefficient, unreliable binary measures; widespread ceiling effects; failure to distinguish between various ProM subdomains (e.g., episodic ProM versus vigilance/monitoring); various confounds; and, importantly, small sample sizes, resulting in insufficient statistical power. Accordingly, in a large scale study with nearly 1,200 participants, we investigated the relationship between episodic event-cued ProM, episodic RetM, and fundamental cognitive functions including intelligence, personality, and psychopathology, using reliable continuous measures of episodic event-cued ProM. Our findings show that (a) continuous measures of episodic event-cued ProM were much more reliable than binary measures, (b) episodic event-cued ProM was associated with measures of processing speed, working memory, crystallized and fluid intelligence, as well as RetM, and that such associations were similar for ProM and RetM, (c) personality factors did not improve prediction of neither ProM nor RetM beyond the variance predicted by cognitive ability, (d) symptoms of psychopathology did not improve the prediction of ProM although they slightly improved the prediction of RetM, and (e) participants' sex was not associated with ProM but showed small correlations with RetM. In addition to advancing

The impact of patient-reported outcome measures in clinical practice for pain: a systematic review.

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Holmes, Michelle M; Lewith, George; Newell, David; Field, Jonathan; Bishop, Felicity L

2017-02-01

Patient-reported outcome measures (PROMs) have increasingly been incorporated into clinical practice. Research suggests that PROMs could be viewed as active components of complex interventions and may affect the process and outcome of care. This systematic review examines PROMs in the context of treatment for non-malignant pain. An electronic search on: MEDLINE, EMBASE, PsycINFO, PsycARTICLES, Cochrane Library and Web of Science identified relevant papers (February 2015). The inclusion criteria were: focused on implementing PROMs into clinical practice, adults, and primary data studies. Critical interpretive synthesis was used to synthesise qualitative and quantitative findings into a theoretical argument. Thirteen eligible studies were identified. Synthesis suggested that PROMs may be included in the initial consultation to assess patients and for shared decision-making regarding patient care. During the course of treatment, PROMs can be used to track progress, evaluate treatment, and change the course of care; using PROMs may also influence the therapeutic relationship. Post-treatment, using PROMs might directly influence other outcomes such as pain and patient satisfaction. However, although studies have investigated these areas, evidence is weak and inconclusive. Due to the poor quality, lack of generalisability and heterogeneity of these studies, it is not possible to provide a comprehensive understanding of how PROMs may impact clinical treatment of non-malignant pain. The literature suggests that PROMs enable pain assessment, decision-making, the therapeutic relationship, evaluation of treatment and may influence outcomes. Further research is needed to provide better evidence as to whether PROMs do indeed have any effects on these domains.

Characteristics of children with cerebral palsy in the ORACLE children study.

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Marlow, Neil; Pike, Katie; Bower, Eva; Brocklehurst, Peter; Jones, David; Kenyon, Sara; Kurinczuk, Jennifer J; Taylor, David; Salt, Alison

2012-07-01

We have identified an excess of children with cerebral palsy (CP) born to women who received antibiotic treatment for spontaneous preterm labour (SPL). This nested study investigated the profile of impairment among children with CP in the ORACLE Children Study (OCS), and contrasted outcomes with those in 4Child, a population CP registry. The study group comprised 167 children aged from 7 to 10 years (100 males, 67 females) with CP from the OCS, who were subdivided into a preterm rupture of membranes (PROM) group (87 children) and an SPL group (80 children). The OCS sought follow-up information regarding the health and behaviour of surviving children at 7 years of age in the UK using a parent-report postal questionnaire. Families provided further information to define wider aspects of function and were offered a physiotherapy assessment. The prevalence of CP was higher among children in the OCS than among those in 4Child (standardized morbidity ratios: SPL group, 3.12 [95% confidence interval {CI} 2.47-3.87); PROM group: 1.56 (CI 1.24-1.92)]. The proportion of children with CP born after 32 weeks of gestation was higher in in the SPL group (73%) than in the PROM group (30%); the prevalence of CP was higher in the SPL group than in the PROM group or 4Child. Children with CP in the OCS tended to have similar distributions of neuroimpairment as children in 4Child, but motor impairment and associated vision and hearing problems were found to be less severe. The pattern of CP in both the PROM and the SPL groups was similar, but functional outcomes were milder, compared with children with CP in the general population. However, in these groups the risk of CP was increased independently of gestational age. This is consistent with findings that ongoing inflammatory damage can cause CP. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

Outcomes of different bearings in total hip arthroplasty - implant survival, revision causes, and patient-reported outcome

DEFF Research Database (Denmark)

Varnum, Claus

2017-01-01

ceramic-on-ceramic (CoC) THAs comparing them to those of "standard" metal-on-polyethylene (MoP) THAs. Study II: To compare the six-year revision risk for metal-on-metal (MoM) with that for MoP bearings in cementless stemmed THA, and further to study the revision risk for different designs of stemmed Mo...... for the outcome of THA is the type of bearings. This PhD thesis focuses on the influence of different types of bearings on implant survival, revision causes, PROMs, and noises from THA. The aims of the thesis were: Study I: To examine the revision risk and to investigate the causes of revision of cementless......M THAs and the causes of revision. Study III: To examine the association between CoC, MoM, and MoP bearings and both generic and disease-specific PROMs, and furthermore to examine the incidence and types of noises from the three types of bearings and identify the effect of noises on PROM scores. In study...

What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials.

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Kotronoulas, Grigorios; Kearney, Nora; Maguire, Roma; Harrow, Alison; Di Domenico, David; Croy, Suzanne; MacGillivray, Stephen

2014-05-10

The systematic use of patient-reported outcome measures (PROMs) has been advocated as an effective way to standardize cancer practice. Yet, the question of whether PROMs can lead to actual improvements in the quality of patient care remains under debate. This review examined whether inclusion of PROM in routine clinical practice is associated with improvements in patient outcomes, processes of care, and health service outcomes during active anticancer treatment. A systematic review of five electronic databases (Medline, EMBASE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], PsycINFO, and Psychology and Behavioral Sciences Collection [PBSC]) was conducted from database inception to May 2012 to locate randomized and nonrandomized controlled trials of patients receiving active anticancer treatment or supportive care irrespective of type of cancer. Based on prespecified eligibility criteria, we included 26 articles that reported on 24 unique controlled trials. Wide variability in the design and use of interventions delivered, outcomes evaluated, and cancer- and modality-specific context was apparent. Health service outcomes were only scarcely included as end points. Overall, the number of statistically significant findings were limited and PROMs' intervention effect sizes were predominantly small-to-moderate. The routine use of PROMs increases the frequency of discussion of patient outcomes during consultations. In some studies, PROMs are associated with improved symptom control, increased supportive care measures, and patient satisfaction. Additional effort is required to ensure patient adherence, as well as additional support to clinicians who will respond to patient concerns and issues, with clear system guidelines in place to guide their responses. More research is required to support PROM cost-benefit in terms of patient safety, clinician burden, and health services usage.

Development of the measure of ovarian symptoms and treatment concerns: aiming for optimal measurement of patient-reported symptom benefit with chemotherapy for symptomatic ovarian cancer.

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King, Madeleine T; Stockler, Martin R; Butow, Phyllis; O'Connell, Rachel; Voysey, Merryn; Oza, Amit M; Gillies, Kim; Donovan, Heidi S; Mercieca-Bebber, Rebecca; Martyn, Julie; Sjoquist, Katrin; Friedlander, Michael L

2014-06-01

The aim of this study was to determine the optimal patient-reported outcome measure (PROM) for assessing symptom benefit in trials of palliative chemotherapy for women with symptomatic ovarian cancer. Candidate PROMs were EORTC QLQ-C30 plus ovarian-specific QLQ-OV28, Functional Assessment of Cancer Therapy-Ovarian (FACT-O), FACT Ovarian Symptom Index (FOSI), and gynecologic cancer-specific Symptom Representation Questionnaire. Predefined optimality criteria were inclusion of all symptoms necessary for the specified purpose, recall period covering typical length of palliative chemotherapy, numerical item rating scales, and all necessary symptoms included in a single symptom index. Qualitative and quantitative methods were applied to data from stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study to determine the set of necessary symptoms and to objectively assess candidate PROMs against the optimality criteria. Ten necessary symptoms were identified: pain, fatigue, abdominal bloating/discomfort, sleep disturbance, bowel disturbance, nausea and vomiting, shortness of breath, poor appetite, urinary symptoms, and weight changes. Although QLQ-C30 and QLQ-OV28 together cover all these symptoms, they split them into numerous scales, dissipating potential symptom-benefit signal. Conversely, FACT-O does not cover all necessary symptoms and contains many other HRQoL-related items and treatment side effects, diluting potential symptom-benefit signal when summed into scales. Item response scales and composite scoring of all candidate PROMs were suboptimal to our specific purpose. We therefore developed a new PROM, the Measure of Ovarian Symptoms and Treatment (MOST) concerns, to provide optimal measurement for the specified purpose. This article documents the development of the MOST, a new PROM designed to assess patient-reported benefits and burden as end points in clinical trials of palliative chemotherapy for women with symptomatic ovarian cancer. The validity

ROLE OF GENE POLYMORFISM OF PLASMINOGEN ACTIVATOR INGIBITOR TYPE I AS A RISK FACTOR FOR PREMATURE RUPTURE OF MEMBRANE AT TERM PREGNANCY

Directory of Open Access Journals (Sweden)

M. G. Nikolayeva

2013-01-01

Full Text Available The retrospective study was designed to identify association of premature rupture of the fetal membranes (PROM with carrying polymorphisms in genes encoding folate metabolism and hemostasis in 717 women. More than one hundred potential predictors were analyzed including carriage of thrombogenic genes polymorphisms and genes encoding folate metabolism: FV[Arg506Gln], F II [20210 G/A], MTHFR [Ala222Val], (PAI-I[-675 5G/4G]. Study revealed that plasminogen activator ingibitor-1 gene polymorphism increases significantly the risk of premature rupture of the fetal membranes in term pregnancy (PROM: heterozygous plasminogen activator ingibitor-1 gene polymorphism is associated with 3.6-fold (95% CI 2.4–5.4; p < 0.001, homozygous plasminogen activator ingibitor-1 gene polymorphism – with 1.7-fold (95% CI 1.1–2.6; p = 0.01 risk rise of PROM.

Activin A and its regulatory molecules in placenta and fetal membranes of women with preterm premature rupture of the membranes associated with acute chorioamnionitis.

Science.gov (United States)

Torricelli, Michela; Voltolini, Chiara; Novembri, Romina; Bocchi, Caterina; Di Tommaso, Mariarosaria; Severi, Filiberto M; Petraglia, Felice

2012-11-01

LABELED PROBLEM: To investigate regulation of activin A and related molecules in placenta/fetal membranes from preterm premature rupture of membranes (pPROM) associated with acute chorioamnionitis (ACA). Tissues were obtained from women with spontaneous preterm deliveries (PTD), pPROM without ACA, pPROM with ACA. Activin A, follistatin, and nodal and cripto mRNA were measured by RT-PCR. Activin A mRNA was up-regulated in tissues from pPROM, in presence or absence of HCA, respect to PTD and in pPROM with ACA respect to pPROM without ACA. Follistatin mRNA expression did not differ between the groups. In placenta, nodal mRNA showed the same trend of activin A, while cripto was down-regulated in pPROM with ACA than other groups. Nodal and cripto were not expressed by fetal membranes. The study shows the involvement of activin A pathway in pPROM with ACA. Further studies will focus on its role in placental immune functions. © 2012 John Wiley & Sons A/S.

Development and Evaluation of an Implementation Strategy for Collecting Data in a National Registry and the Use of Patient-Reported Outcome Measures in Physical Therapist Practices: Quality Improvement Study.

Science.gov (United States)

Meerhoff, Guus A; van Dulmen, Simone A; Maas, Marjo J M; Heijblom, Karin; Nijhuis-van der Sanden, Maria W G; Van der Wees, Philip J

2017-08-01

In 2013, the Royal Dutch Society for Physical Therapy launched the program "Quality in Motion." This program aims to collect data from electronic health record systems in a registry that is fed back to physical therapists, facilitating quality improvement. The purpose of this study was to describe the development of an implementation strategy for the program and to evaluate the feasibility of building a registry and implementing patient-reported outcome measures (PROMs) in physical therapist practices. A stepwise approach using mixed methods was established in 3 consecutive pilots with 355 physical therapists from 66 practices. Interim results were evaluated using quantitative data from a self-assessment questionnaire and the registry and qualitative data from 21 semistructured interviews with physical therapists. Descriptive statistics and McNemar's symmetry chi-squared test were used to summarize the feasibility of implementing PROMs. PROMs were selected for the 5 most prevalent musculoskeletal conditions in Dutch physical therapist practices. A core component of the implementation strategy was the introduction of knowledge brokers to support physical therapists in establishing the routine use of PROMs in clinical practice and to assist in executing peer assessment workshops. In February 2013, 30.3% of the physical therapist practices delivered 4.4 completed treatment episodes per physical therapist to the registry; this increased to 92.4% in November 2014, delivering 54.1 completed patient episodes per physical therapist. Pre- and posttreatment PROM use increased from 12.2% to 39.5%. It is unclear if the participating physical therapists reflect a representative sample of Dutch therapists. Building a registry and implementing PROMs in physical therapist practices are feasible. The routine use of PROMs needs to increase to ensure valid feedback of outcomes. Using knowledge brokers is promising for implementing the program via peer assessment workshops. © 2017

Antioxidant Vitamin Status in the Serum and Amniotic Fluid of Women with Premature Rupture of the Fetal Membranes.

Science.gov (United States)

Barrett, Bridget M.

The purpose of this study was to examine the status of antioxidant vitamins in women with premature rupture of the fetal membranes. Specimens of blood and amniotic fluid were obtained from 80 pregnant subjects included both smokers and non-smokers during the third trimester. The concentrations of ascorbic acid (ASA), beta -carotene, retinol and alpha -tocopherol in serum and amniotic fluid were determined. The experimental group consisted of those subjects with PROM while the control subjects were those with normal pregnancy. No statistical differences were found between the PROM and control groups in retinol and vitamin E concentrations in amniotic fluid and serum. Serum ASA concentrations of PROM subjects were not different from controls, but the PROM subjects had significantly lower amniotic fluid ASA concentrations. However, in a study with fewer subjects a lower serum ASA concentration in the PROM subjects was observed. The ratio of amniotic fluid ASA concentration to ASA serum concentration was significantly lower in PROM patients than in controls in both studies. This suggests that low levels of ASA in the amniotic fluid, but not in serum is better associated with PROM. A low amniotic fluid concentration of ASA may reflect an inefficient transfer and/or increased fetal utilization. Alterations in ASA concentration in the amniotic fluid may affect the integrity of the chorioamnion leading to PROM. beta -Carotene was not found in the amniotic fluid. Serum beta-carotene levels were significantly lower in the PROM group compared to the control group. Low concentrations of beta-carotene in maternal serum in smokers not only associated with poor maternal outcome (PROM) but also compromised the fetal outcome (decreased birth weight). Maintenance of adequate serum beta-carotene concentration and amniotic fluid ASA in smokers may result in better maternal and fetal outcome. This study demonstrated that nutrition is an important factor in the prevention of PROM.

Využití měr variability pro nominální proměnné ve vícerozměrné statistické analýze

Czech Academy of Sciences Publication Activity Database

Řezanková, Hana; Šulc, Z.; Húsek, Dušan

2016-01-01

Roč. 12, č. 1 (2016), s. 34-43 ISSN 1336-7420 Grant - others:IGA VŠE(CZ) F4/41/2016 Institutional support: RVO:67985807 Keywords : míry variability * nominální proměnné * vícerozměrná analýza * míry závislosti * míry podobnosti * shluková analýza * rozhodovací stromy * hodnocení klasifikace * variability measures * nominal variables * multivariate analysis * dependence measures * similarity measures * cluster analysis * decision trees * classification evaluation Subject RIV: BB - Applied Statistics, Operational Research http://www.ssds.sk/casopis/archiv/2016/fss0116.pdf

An assessment of prospective memory retrieval in women with chronic fatigue syndrome using a virtual-reality environment: an initial study.

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Attree, Elizabeth A; Dancey, Christine P; Pope, Alison L

2009-08-01

People with chronic fatigue syndrome (CFS) have increased rates of depression, anxiety, and illness intrusiveness; they may also suffer from cognitive problems such as retrospective memory (RM) deficits and concentration difficulties that can stem from diminished information-processing capability. We predicted that this diminished capacity may also lead to deficits in other cognitive functions, such as prospective memory (ProM). Event-, time-, and activity-based ProM was assessed in 11 women with CFS and 12 healthy women using a computer-generated virtual environment (VE). RM was assessed using a free-recall test, and subjective assessment of both ProM and RM was assessed by questionnaire. Groups were equivalent in age and measures of IQ. People with CFS performed slightly worse than healthy controls on both the event- and time-based ProM measures, although these were not statistically significant. However, the CFS group performed significantly worse than the healthy controls on both the free recall-task and on subjective assessment of both RM and ProM. Women with CFS do have some subtle decrements in memory, particularly RM. However, it is possible that the decrements found in the present sample would be greater in real life. Further studies utilizing both healthy controls and illness controls are now needed to ascertain how sensitive the VE measure is and to inform the development of tasks in the VE that place progressively increasing demands on working memory capacity.

Diagnostic performance of placental alpha-microglobulin-1 test in women with prolonged pre-labour rupture of membranes.

Science.gov (United States)

Eleje, George Uchenna; Ezugwu, Euzebus Chinonye; Eke, Ahizechukwu Chigoziem; Eleje, Lydia Ijeoma; Ikechebelu, Joseph Ifeanyichukwu; Afiadigwe, Evaristus Anthony; Ezugwu, Frank O; Udigwe, Gerald Okanandu; Okafor, Charles I; Ezeama, Chukwuemeka Okwudili

2016-01-01

To determine diagnostic performance of placental alpha-microglobulin-1 (PAMG-1) test compared to conventional clinical assessment (CCA) in women with prolonged pre-labour rupture of membranes (PROM). A double-blind study of women with symptoms and signs of PROM in Nnamdi Azikiwe University Teaching Hospital, Nnewi and University of Nigeria Teaching Hospital, Enugu, in south-east Nigeria using CCA for PROM and PAMG-1 test was done. Women were included if their symptoms, signs or complaints suggestive of PROM was more than 24 h duration. PROM was diagnosed if two out of three methods from CCA (pooling, positive nitrazine test or ferning) were present. Confirmation of PROM was done after delivery using any two of these clinical criteria: delivery in 48 h to 7 days, evidence of chorioamnionitis, membranes obviously ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. Accuracy, specificity and sensitivity value for CCA were 72.5, 36.8 and 86.0% lower than for PAMG-1 test which were 95.7, 94.1 and 96.2%. In equivocal cases, PAMG-1 was significantly more accurate than CCA (92.3% versus 38.5%; p < 0.001). This study in women with prolonged PROM, confirms that PAMG-1 test has high diagnostic accuracy irrespective of the duration of PROM before clinical evaluation.

Patient Self-Assessed Passive Range of Motion of the Knee Cannot Replace Health Professional Measurements

DEFF Research Database (Denmark)

Borgbjerg, Jens; Madsen, Frank; Odgaard, Anders

2017-01-01

The purpose of this study was to investigate whether patients can accurately self-assess their knee passive range of motion (PROM). A picture-based questionnaire for patient self-assessment of knee PROM was developed and posted to patients. The self-assessed PROM from 58 patients was compared...... (≥ 10-degree flexion contracture). Surgeon- and patient-assessed knee PROM showed a mean difference (95% limits of agreement) of -2.1 degrees (-42.5 to 38.3 degrees) for flexion and -8.1 degrees (-28.8 to 12.7 degrees) for extension. The sensitivity of patient self-assessed PROM in identifying knee...

C-REACTIVE PROTEIN IN PREMATURE RUPTURE OF MEMBRANE WITH RESPECT TO FETOMATERNAL OUTCOME

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Ojaswini Patel

2017-08-01

Full Text Available BACKGROUND The incidence of PROM is about 10% of all pregnancies and 70% of them occur at term. Most of the Indian studies document an incidence of 7-12% for PROM of which 60-70% occurs at term. Rest of the 30-40% is contributed at preterm. The aim of the study is to study the usefulness of maternal CRP measurements in diagnosis of chorioamnionitis, puerperal endometritis, neonatal infectious morbidities and mortalities among patients with PROM ( both term and preterm. MATERIALS AND METHODS This is a hospital-based cross-sectional observational study where 100 premature rupture of membrane cases were diagnosed and observed for fetomaternal outcome by doing routine clinical, biochemical and serum CRP examinations. RESULTS Maximum number of chorioamnionitis (16% has developed when duration of rupture was for more than 36 hrs. PROM patients with latent period of ≥36 hrs had poorer neonatal outcome; i.e. 54.83% neonatal morbidity and 84.61% neonatal mortality were seen when duration of rupture was more than 36 hrs. 47.36% of CRP positive PROM women had developed chorioamnionitis during the course of delivery or postpartum. 49.12% of CRP positive PROM women had developed preterm delivery. CRP positive PROM women had poorer neonatal outcome; i.e. 82.35% neonatal morbidity and mortality has noted in babies delivered from CRP positive mother. CONCLUSION Careful antenatal monitoring, detection and prompt treatment of infection is necessary. Strict aseptic precautions, appropriate therapy, regular antenatal follow up are important features in the prevention and management of PROM. Evaluation of CRP in blood has helped to predict development of chorioamnionitis and preterm delivery following PROM and also perinatal morbidity and mortality.

The role of decision-making ability in HIV/AIDS: impact on prospective memory.

Science.gov (United States)

Coulehan, Kelly; Byrd, Desiree; Arentoft, Alyssa; Monzones, Jennifer; Fuentes, Armando; Fraser, Felicia; Rosario, Ana; Morgello, Susan; Mindt, Monica Rivera

2014-01-01

Prospective memory (ProM), a form of episodic memory related to execution of future intentions, is important for everyday functioning. Among persons living with HIV (PLWH), executive dysfunction is implicated in ProM impairments. However, specific subcomponents of executive functioning involved in ProM deficits remain poorly understood. Unlike more "traditional" neurocognitive (NC) measures of executive functioning associated with dorsolateral prefrontal cortex (i.e., conceptual reasoning, abstraction), those associated with medial orbitofrontal/ventromedial prefrontal (mOF/vmP) cortex (i.e., decision making, inhibitory control, goal-oriented behavior) have yet to be examined in ProM. This study characterized ProM ability in a sample of 89 HIV-seropositive adults and examined the unique role of decision-making ability in ProM. Participants completed a standard NC battery, the Iowa Gambling Task (IGT; a decision-making measure), and the Memory for Intentions Screening Test (MIST; a ProM measure). Correlational analyses revealed that both traditional executive functioning measures and the IGT were associated with ProM. Regression analyses revealed that the IGT significantly predicted ProM, even after accounting for NC measures. Among all NC measures, only executive functioning significantly contributed to ProM. Further examination of mOF/vmP-sensitive executive dysfunction within this population is needed as PLWH may require more tailored treatment recommendations due to specific decision-making difficulties that can impact medication management.

Transparent meta-analysis: does aging spare prospective memory with focal vs. non-focal cues?

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Bob Uttl

Full Text Available BACKGROUND: Prospective memory (ProM is the ability to become aware of a previously-formed plan at the right time and place. For over twenty years, researchers have been debating whether prospective memory declines with aging or whether it is spared by aging and, most recently, whether aging spares prospective memory with focal vs. non-focal cues. Two recent meta-analyses examining these claims did not include all relevant studies and ignored prevalent ceiling effects, age confounds, and did not distinguish between prospective memory subdomains (e.g., ProM proper, vigilance, habitual ProM (see Uttl, 2008, PLoS ONE. The present meta-analysis focuses on the following questions: Does prospective memory decline with aging? Does prospective memory with focal vs. non-focal cues decline with aging? Does the size of age-related declines with focal vs. non-focal cues vary across ProM subdomains? And are age-related declines in ProM smaller than age-related declines in retrospective memory? METHODS AND FINDINGS: A meta-analysis of event-cued ProM using data visualization and modeling, robust count methods, and conventional meta-analysis techniques revealed that first, the size of age-related declines in ProM with both focal and non-focal cues are large. Second, age-related declines in ProM with focal cues are larger in ProM proper and smaller in vigilance. Third, age-related declines in ProM proper with focal cues are as large as age-related declines in recall measures of retrospective memory. CONCLUSIONS: The results are consistent with Craik's (1983 proposal that age-related declines on ProM tasks are generally large, support the distinction between ProM proper vs. vigilance, and directly contradict widespread claims that ProM, with or without focal cues, is spared by aging.

The Cambridge Otology Quality of Life Questionnaire: an otology-specific patient-recorded outcome measure. A paper describing the instrument design and a report of preliminary reliability and validity.

Science.gov (United States)

Martin, T P C; Moualed, D; Paul, A; Ronan, N; Tysome, J R; Donnelly, N P; Cook, R; Axon, P R

2015-04-01

The Cambridge Otology Quality of Life Questionnaire (COQOL) is a patient-recorded outcome measurement (PROM) designed to quantify the quality of life of patients attending otology clinics. Item-reduction model. A systematically designed long-form version (74 items) was tested with patient focus groups before being presented to adult otology patients (n. 137). Preliminary item analysis tested reliability, reducing the COQOL to 24 questions. This was then presented in conjunction with the SF-36 (V1) questionnaire to a total of 203 patients. Subsequently, these were re-presented at T + 3 months, and patients recorded whether they felt their condition had improved, deteriorated or remained the same. Non-responders were contacted by post. A correlation between COQOL scores and patient perception of change was examined to analyse content validity. Teaching hospital and university psychology department. Adult patients attending otology clinics with a wide range of otological conditions. Item reliability measured by item–total correlation, internal consistency and test– retest reliability. Validity measured by correlation between COQOL scores and patient-reported symptom change. Reliability: the COQOL showed excellent internal consistency at both initial presentation (a = 0.90) and 3 months later (a = 0.93). Validity: One-way analysis of variance showed a significant difference between groups reporting change and those reporting no change in quality of life (F(2, 80) = 5.866, P < 0.01). The COQOL is the first otology-specific PROM. Initial studies demonstrate excellent reliability and encouraging preliminary criterion validity: further studies will allow a deeper validation of the instrument.

Vaginal Fluid hCG Levels for Detecting Premature Rupture of Membranes

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T. Artimani

2004-04-01

Full Text Available The aim of this study was to determine whether there is any different in hCG levels of vaginal fluids from normal pregnant women, women with confirmed PROM and with suspected PROM. After irrigating the posterior vaginal fornix with 3 ml of sterile saline and procuring vaginal washing , we measured hCG levels. Samples were analyzed from 38 normal pregnant women , 31 women with confirmed PROM , 28 women with suspected PROM. The mean of vaginal fluid hCG levels of normal pregnant women were 11.2 (0.00-98.6 mIu/ml. That of women with PROM was 140.2 (0.5 , 390.1 and that of women with suspected PROM was 21.5 (0.0 , 143.9. Sensivity was 80%, specility 83% , positive predictive value 73.7% , negative predictive value 88.1% , using a cut-value 20. It was concluded that the hCG level in vaginal fluid is a marker of PROM during third trimester.

The impact of tobacco use on preterm premature rupture of the membranes.

Science.gov (United States)

Andres, Robert L; Zhao, Yuan; Klebanoff, Mark A; Hauth, John C; Caritis, Steve N; Carey, J Christopher; Wapner, Ronald J; Iams, Jay D; Leveno, Kenneth J; Miodovnik, Menachem; Sibai, Baha; Van Dorsten, J Peter; Dombrowski, Mitchell P; O'Sullivan, Mary J; Langer, Oded

2013-03-01

To determine if tobacco use increases the incidence of preterm premature rupture of the membranes (pPROM) or alters perinatal outcomes after pPROM. This is a secondary analysis of the databases of three completed Eunice Kennedy Shriver National Institute of Child Health and Human Development-supported Maternal Fetal Medicine Units Network studies. Self-reported tobacco exposure data was obtained. Its relationship with the incidence of pPROM and associated neonatal outcome measures were assessed. There was no difference in the incidence of pPROM when comparing nonsmokers to those using tobacco. Although a trend was seen between the incidence of pPROM and the amount smoked, this did not reach statistical significance. Among the patients with pPROM, the use of tobacco was not associated with an increase in perinatal morbidity. Our data do not support a significant relationship between tobacco use and pPROM. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Symptoms Reported by Head and Neck Cancer Patients during Radiotherapy and Association with Mucosal Ulceration Site and Size: An Observational Study.

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Anne Margrete Gussgard

Full Text Available Self-reported pain and impairment of oral functions varies markedly and often in spite of extensive oral mucositis (OM. The aim of the current study was to appraise how patient-reported debilitation caused by OM is influenced by the extent and possibly location of the OM lesions.Patients with head and neck cancer undergoing radiotherapy were examined before treatment, twice weekly during 6-7 weeks of therapy, and 3-4 weeks after therapy completion. OM signs of 33 participants were evaluated using the Oral Mucositis Assessment Scale (OMAS, while OM symptoms were recorded using Patient-Reported Oral Mucositis Symptom (PROMS-questionnaires. Changes in OM experience as a function of OM signs was undertaken by comparing the aggregated and individual PROMS scale values at the point of transition of OMAS ulceration scores between 0 to 1, 1 to 2 and 2 to 3, respectively in the nine intra-oral locations designated in the OMAS. ANOVA with pairwise contrasts using the LSD procedure was applied for comparisons of mean changes of PROMS scale values for the participants who experienced an OMAS score of 2 or more during therapy (n=24.Impairment of eating hard foods was more when the OMAS score for ulceration anywhere in the mouth or in the soft palate changed from 1 to 2, compared to between score 0 and 1 (p=.002 and p=.05 or between score 2 and 3 (p=.001 and p=.02. Mouth pain increased more upon transition of OMAS score anywhere in the mouth from 1 to 2 compared to 0 to 1 (p=.05.The relationship between patient-reported impairment of oral function and pain caused by OM ulceration is not linear, but rather curvilinear. Our findings should prompt investigators of future interventional trials to consider using a less severe outcome than maximum OM scores as the primary study outcome.

Readability of Orthopaedic Patient-reported Outcome Measures: Is There a Fundamental Failure to Communicate?

Science.gov (United States)

Perez, Jorge L; Mosher, Zachary A; Watson, Shawna L; Sheppard, Evan D; Brabston, Eugene W; McGwin, Gerald; Ponce, Brent A

2017-08-01

Patient-reported outcome measures (PROMs) are increasingly used to quantify patients' perceptions of functional ability. The American Medical Association and NIH suggest patient materials be written at or below 6th to 8th grade reading levels, respectively, yet one recent study asserts that few PROMs comply with these recommendations, and suggests that the majority of PROMs are written at too high of a reading level for self-administered patient use. Notably, this study was limited in its use of only one readability algorithm, although there is no commonly accepted, standard readability algorithm for healthcare-related materials. Our study, using multiple readability equations and heeding equal weight to each, hopes to yield a broader, all-encompassing estimate of readability, thereby offering a more accurate assessment of the readability of orthopaedic PROMS. (1) What proportion of orthopaedic-related PROMs and orthopaedic-related portions of the NIH Patient Reported Outcomes Measurement Information System (PROMIS ® ) are written at or below the 6th and 8th grade levels? (2) Is there a correlation between the number of questions in the PROM and reading level? (3) Using systematic edits based on guidelines from the Centers for Medicare and Medicaid Services, what proportion of PROMs achieved American Medical Association and NIH-recommended reading levels? Eighty-six (86) independent, orthopaedic and general wellness PROMs, drawn from commonly referenced orthopaedic websites and prior studies, were chosen for analysis. Additionally, owing to their increasing use in orthopaedics, four relevant short forms, and 11 adult, physical health question banks from the PROMIS ® , were included for analysis. All documents were analyzed for reading grade levels using 19 unique readability algorithms. Descriptive statistics were performed using SPSS Version 22.0. The majority of the independent PROMs (64 of 86; 74%) were written at or below the 6th grade level, with 81 of 86

Glioblastoma formation from cell population depleted of Prominin1-expressing cells.

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Kenji Nishide

2009-08-01

Full Text Available Prominin1 (Prom1, also known as CD133 in human has been widely used as a marker for cancer stem cells (CSCs, which self-renew and are tumorigenic, in malignant tumors including glioblastoma multiforme (GBM. However, there is other evidence showing that Prom1-negative cancer cells also form tumors in vivo. Thus it remains controversial whether Prom1 is a bona fide marker for CSCs. To verify if Prom1-expressing cells are essential for tumorigenesis, we established a mouse line, whose Prom1-expressing cells can be eliminated conditionally by a Cre-inducible DTA gene on the Prom1 locus together with a tamoxifen-inducible CreER(TM, and generated glioma-initiating cells (GICs-LD by overexpressing both the SV40 Large T antigen and an oncogenic H-Ras(L61 in neural stem cells of the mouse line. We show here that the tamoxifen-treated GICs-LD (GICs-DTA form tumor-spheres in culture and transplantable GBM in vivo. Thus, our studies demonstrate that Prom1-expressing cells are dispensable for gliomagenesis in this mouse model.

Recalcitrant vulvodynia A clinicopathological study | Sonnedecker ...

African Journals Online (AJOL)

Single patients had the following specific conditions: lichen planus, lichen sclerosus, mature neuroma and chronic candidiasis. The study shows that vulvodynia is a multifactorial problem for which management strategies have evolved over the course of time. Although interferon-a-2b offers much prom.ise for the treatment ...

Measurement of prosocial reasoning among Chinese adolescents.

Science.gov (United States)

Lai, Frank H Y; Siu, Andrew M H; Chan, Chewtyn C H; Shek, Daniel T L

2012-01-01

This study attempted to develop a standardized instrument for assessment of prosocial reasoning in Chinese populations. The Prosocial Reasoning Objective Measure (PROM) was translated, and a two-stage study was conducted to evaluate the psychometric properties of the translated instrument. The content validity, cultural relevance, and reading level of the translated instrument were evaluated by an expert panel. Upon revisions according to the expert opinions, the Chinese PROM demonstrated good content validity, "good-to-very good test-retest" reliability, and internal consistency. However, only partial support to the convergent validity of the Chinese PROM was found. In the first stage of the study (n = 50), the PROM scores had high positive correlations with empathy and negative correlations with personal distress and fantasy. These results were consistent with theoretical expectations, although this is also a concern that empathy had a close-to-unity correlation with PROM score in the small sample study of stage 1. In the second stage of the study (n = 566), the relationship between PROM scores and prosocial behavior appeared to be weak. Results suggest that there were many personal, family, or social factors that were linked to prosocial behavior, and prosocial reasoning might only contribute to a small proportion of variation in prosocial behavior among adolescents.

Measurement of Prosocial Reasoning among Chinese Adolescents

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Frank H. Y. Lai

2012-01-01

Full Text Available This study attempted to develop a standardized instrument for assessment of prosocial reasoning in Chinese populations. The Prosocial Reasoning Objective Measure (PROM was translated, and a two-stage study was conducted to evaluate the psychometric properties of the translated instrument. The content validity, cultural relevance, and reading level of the translated instrument were evaluated by an expert panel. Upon revisions according to the expert opinions, the Chinese PROM demonstrated good content validity, “good-to-very good test-retest” reliability, and internal consistency. However, only partial support to the convergent validity of the Chinese PROM was found. In the first stage of the study (=50, the PROM scores had high positive correlations with empathy and negative correlations with personal distress and fantasy. These results were consistent with theoretical expectations, although this is also a concern that empathy had a close-to-unity correlation with PROM score in the small sample study of stage 1. In the second stage of the study (=566, the relationship between PROM scores and prosocial behavior appeared to be weak. Results suggest that there were many personal, family, or social factors that were linked to prosocial behavior, and prosocial reasoning might only contribute to a small proportion of variation in prosocial behavior among adolescents.

Prospective Memory Deficits in Ecstasy Users: Effects of Longer Ongoing Task Delay Interval

Science.gov (United States)

WEINBORN, MICHAEL; WOODS, STEVEN PAUL; NULSEN, CLAIRE; PARK, KATHERINE

2011-01-01

Ecstasy use has been associated with neurotoxicity and neurocognitive impairment in a variety of domains, including prospective memory (ProM), which involves the delayed execution of a previously encoded intention in response to a specific cue. The present study adopted the multiprocess theory of ProM to evaluate the hypothesis that ecstasy users would evidence differentially impaired ProM on longer versus shorter ongoing task delays. Ecstasy (n = 31) users, high-risk alcohol users (n = 21) and healthy nonusers (n = 31) completed the short (2-min) and long (15-min) delay ProM scales of the Memory for Intentions Screening Test. Results showed a significant group by ProM delay interaction, such that ecstasy users performed comparably to the comparison groups on short-delay trials, but were impaired on long-delay ProM, particularly for time-based cues. Among the ecstasy users, long-delay ProM was positively associated with risky decision-making, but not with retrospective memory or other aspects of executive functions. These findings suggest that ecstasy users may be particularly susceptible to deficits in strategic target monitoring and maintenance of cue-intention pairings over longer ProM delays. Findings are discussed in the context of their potential everyday functioning (e.g., academic, vocational) and treatment implications for ecstasy users. PMID:22047194

The clinical and microbiological correlates of premature rupture of membranes

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Karat C

2006-01-01

Full Text Available Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E . coli , S . aureus , C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM.

The clinical and microbiological correlates of premature rupture of membranes.

Science.gov (United States)

Karat, C; Madhivanan, P; Krupp, K; Poornima, S; Jayanthi, N V; Suguna, J S; Mathai, E

2006-10-01

Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM) is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E. coli, S. aureus, C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM.

High-density cervical ureaplasma urealyticum colonization in pregnant women

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Ranđelović Gordana

2006-01-01

Full Text Available Background/aim: Ureaplasma urealyticum, a common commensal of the female lower genital tract, has been observed as an important opportunistic pathogen during pregnancy. The aims of this study were to determine the degree of cervical colonization with U. urealyticum in pregnant women with risk pregnancy and in pregnant women with normal term delivery and to evaluate the correlation between high-density cervical U. urealyticum colonization and premature rupture of membranes (PROM as well. Methods. This research was conducted on the samples comprising 130 hospitalized pregnant women with threatening preterm delivery and premature rupture of membranes. The control group consisted of 39 pregnant women with term delivery without PROM. In addition to standard bacteriological examination and performing direct immunofluorescence test to detect Chlamydia trachomatis, cervical swabs were also examined for the presence of U. urealyticum and Mycoplasma hominis by commercially available Mycofast Evolution 2 test (International Microbio, France. Results. The number of findings with isolated high-density U. urealyticum in the target group was 69 (53.08%, while in the control group was 14 (35.90%. Premature rupture of membranes (PROM occurred in 43 (33.08% examinees: 29 were pPROM, and 14 were PROM. The finding of U.urealyticum ≥104 was determined in 25 (58.14% pregnant women with rupture, 17 were pPROM, and 8 were PROM. There was statistically significant difference in the finding of high-density U. urealyticum between the pregnant women with PROM and the control group (χ² = 4.06, p < 0.05. U. urealyticum was predominant bacterial species found in 62.79% of isolates in the PROM cases, while in 32.56% it was isolated alone. Among the 49 pregnant women with preterm delivery, pPROM occurred in 29 (59.18% examinees, and in 70.83% of pregnant women with findings of high-density U. urealyticum pPROM was observed. Conclusion. Cervical colonization with U

Photophysical and computational investigation of the intermolecular interactions of pyrene with phenothiazine and promazine

Energy Technology Data Exchange (ETDEWEB)

Güloğlu, Pınar; Acar, Nursel, E-mail: nursel.acar@ege.edu.tr

2016-10-20

Highlights: • Intermolecular interactions of pyrene with phenothiazine/promazine were investigated. • All investigated systems were optimized at ωB97XD/6-31G(d,p) level in gas phase. • The electronic transitions were determined using frontier orbitals. • Both Py–Pheno and Py–Prom are potential candidates for charge transfer systems. - Abstract: The intermolecular interactions between the pyrene (Py) (as acceptor) and phenothiazine (Pheno), promazine (Prom) (as donors) were investigated using UV/Vis absorption and fluorescence spectroscopy. Fluorescence quenching rate constants for Py–Pheno and Py–Prom systems have been calculated approximately 10{sup 10} M{sup −1} s{sup −1}, indicating diffusion controlled processes. A computational investigation has also been carried out in gas phase at ωB97XD/6-31G(d,p) level. Time-dependent density functional theory (TDDFT) was used to calculate the electronic transitions of molecules at B3LYP/6-311++G(d,p) level. Total electronic energies, complexation energies, free energy differences, excitation wavelengths, and HOMO–LUMO energy gaps are discussed in gas phase. Analyses of first excited singlet states have indicated charge transfers transitions between Py and Pheno, Prom through π–π stacking in gas phase at 433 nm and 466 nm, respectively. Due to its charge transfer character, Py–Pheno and Py–Prom systems seem to be appropriate models to investigate and design photosensitive materials.

Feasibility test of a UK-scalable electronic system for regular collection of patient-reported outcome measures and linkage with clinical cancer registry data: The electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system

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Velikova Galina

2011-10-01

Full Text Available Abstract Background Cancer survivors can face significant physical and psychosocial challenges; there is a need to identify and predict which survivors experience what sorts of difficulties. As highlighted in the UK National Cancer Survivorship Initiative, routine post-diagnostic collection of patient reported outcome measures (PROMs is required; to be most informative, PROMs must be linked and analysed with patients' diagnostic and treatment information. We have designed and built a potentially cost-efficient UK-scalable electronic system for collecting PROMs via the internet, at regular post-diagnostic time-points, for linking these data with patients' clinical data in cancer registries, and for electronically managing the associated patient monitoring and communications; the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system. This study aims to test the feasibility of the ePOCS system, by running it for 2 years in two Yorkshire NHS Trusts, and using the Northern and Yorkshire Cancer Registry and Information Service. Methods/Design Non-metastatic breast, colorectal and prostate cancer patients (largest survivor groups, within 6 months post-diagnosis, will be recruited from hospitals in the Yorkshire Cancer Network. Participants will be asked to complete PROMS, assessing a range of health-related quality-of-life outcomes, at three time-points up to 15 months post-diagnosis, and subsequently to provide opinion on the ePOCS system via a feedback questionnaire. Feasibility will be examined primarily in terms of patient recruitment and retention rates, the representativeness of participating patients, the quantity and quality of collected PROMs data, patients' feedback, the success and reliability of the underpinning informatics, and the system running costs. If sufficient data are generated during system testing, these will be analysed to assess the health-related quality-of-life outcomes reported by patients, and to explore

Readability Level of Spanish-Language Patient-Reported Outcome Measures in Audiology and Otolaryngology

Science.gov (United States)

Coco, Laura; Colina, Sonia; Atcherson, Samuel R.

2017-01-01

Purpose The purpose of this study was to examine the readability level of the Spanish versions of several audiology- and otolaryngology-related patient-reported outcome measures (PROMs) and include a readability analysis of 2 translation approaches when available—the published version and a “functionalist” version—using a team-based collaborative approach including community members. Method Readability levels were calculated using the Fry Graph adapted for Spanish, as well as the Fernandez-Huerta and the Spaulding formulae for several commonly used audiology- and otolaryngology-related PROMs. Results Readability calculations agreed with previous studies analyzing audiology-related PROMs in English and demonstrated many Spanish-language PROMs were beyond the 5th grade reading level suggested for health-related materials written for the average population. In addition, the functionalist versions of the PROMs yielded lower grade-level (improved) readability levels than the published versions. Conclusion Our results suggest many of the Spanish-language PROMs evaluated here are beyond the recommended readability levels and may be influenced by the approach to translation. Moreover, improved readability may be possible using a functionalist approach to translation. Future analysis of the suitability of outcome measures and the quality of their translations should move beyond readability and include an evaluation of the individual's comprehension of the written text. PMID:28892821

The accuracy of placental alpha-microglobuline-1 test in diagnosis of premature rupture of the membranes

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Maryam Khooshideh

2015-06-01

Full Text Available Background: Premature rupture of membranes (PROM is a common obstetric issue during pregnancy which might lead to serious fetal or maternal problems. Therefore, an appropriate diagnosis and management of PROM are of significant importance in patients. Objective: The aim of this study was to determine the accuracy of placental alpha microglobuline-1 (PAMG-1 test in PROM diagnosis and compare this diagnostic method with other standard tests in diagnosis of PROM. Materials and Methods: In this prospective diagnostic accuracy study, patients with symptoms of membrane rupture in 16-39 weeks of gestation were involved. Three tests including Fern, Nitrazine and PAMG-1 were performed at the same time. Results: PROM was confirmed in 86 patients out of 100. The sensitivity and specificity were respectively 81.3% and 100% for Fern test, 93% and 92.8% for Nitrazine test, 98.9% and 92.8% for PAMG-1 test. PAMG-1 test showed higher sensitivity (98.9% with p<0.001 and accuracy (98% compared with conventional tests. Although PAMG-1showed a lower positive predictive value (PPV compared to conventional tests such as Fern test (100%, it was shown to be more accurate. Conclusion: The accuracy of PAMG-1 test was superior to both Fern and Nitrazine test in PROM diagnosis.

Measurement properties of the most commonly used Foot- and Ankle-Specific Questionnaires: the FFI, FAOS and FAAM. A systematic review.

Science.gov (United States)

Sierevelt, I N; Zwiers, R; Schats, W; Haverkamp, D; Terwee, C B; Nolte, P A; Kerkhoffs, G M M J

2017-10-12

In the foot and ankle literature, a wide range of patient-reported outcome measures (PROMs) is used, however, consensus as to which PROMs are preferred is lacking. Selection of a PROM is among other reasons, often based on measurement properties without considering the methodological quality of the studies that evaluate these measurement properties. The aim of current study was first to identify the most frequently used foot and ankle-specific PROMs in recent orthopaedic foot and ankle literature, and second to conduct a systematic review to synthesize and critically appraise the measurement properties of these PROMS. Six PubMed indexed journals focussing on foot and ankle research were screened to identify most commonly used foot and ankle-specific PROMs over a 2 year period (2015-2016). Subsequently, a systematic literature search was performed in PubMed, EMBASE, SPORTDiscus and Scopus to identify relevant studies on their measurement properties. Methodological quality assessment was performed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, criteria for good measurement properties were applied, and a level of evidence was determined for the measurement properties of each domain of the questionnaires. The three most frequently reported PROMs were the Foot Function Index (FFI), the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Activity Measure (FAAM). Among 2046 unique citations, 50 studies were included evaluating these PROMs. Evidence to support the measurement properties of the FFI was mainly lacking due to poor methodological quality. More evidence was available for the measurement properties of the FAOS and the FAAM, but overall evidence supporting all measurement properties is not yet sufficient. The best available evidence retrieved in this review showed that the FAOS and the FAAM are promising outcome measures for evaluation of patients with foot and ankle conditions, but their

Prominin-2 expression increases protrusions, decreases caveolae and inhibits Cdc42 dependent fluid phase endocytosis

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Singh, Raman Deep, E-mail: Takhter.Ramandeep@mayo.edu; Schroeder, Andreas S.; Scheffer, Luana; Holicky, Eileen L.; Wheatley, Christine L.; Marks, David L., E-mail: Marks.david@mayo.edu; Pagano, Richard E.

2013-05-10

Highlights: •Prominin-2 expression induced protrusions that co-localized with lipid raft markers. •Prominin-2 expression decreased caveolae, caveolar endocytosis and increased pCav1. •Prominin-2 expression inhibited fluid phase endocytosis by inactivation of Cdc42. •These endocytic effects can be reversed by adding exogenous cholesterol. •Caveolin1 knockdown restored fluid phase endocytosis in Prominin2 expressing cells. -- Abstract: Background: Membrane protrusions play important roles in biological processes such as cell adhesion, wound healing, migration, and sensing of the external environment. Cell protrusions are a subtype of membrane microdomains composed of cholesterol and sphingolipids, and can be disrupted by cholesterol depletion. Prominins are pentaspan membrane proteins that bind cholesterol and localize to plasma membrane (PM) protrusions. Prominin-1 is of great interest as a marker for stem and cancer cells, while Prominin-2 (Prom2) is reportedly restricted to epithelial cells. Aim: To characterize the effects of Prom-2 expression on PM microdomain organization. Methods: Prom2-fluorescent protein was transfected in human skin fibroblasts (HSF) and Chinese hamster ovary (CHO) cells for PM raft and endocytic studies. Caveolae at PM were visualized using transmission electron microscopy. Cdc42 activation was measured and caveolin-1 knockdown was performed using siRNAs. Results: Prom2 expression in HSF and CHO cells caused extensive Prom2-positive protrusions that co-localized with lipid raft markers. Prom2 expression significantly decreased caveolae at the PM, reduced caveolar endocytosis and increased caveolin-1 phosphorylation. Prom2 expression also inhibited Cdc42-dependent fluid phase endocytosis via decreased Cdc42 activation. Effects on endocytosis were reversed by addition of cholesterol. Knockdown of caveolin-1 by siRNA restored Cdc42 dependent fluid phase endocytosis in Prom2-expressing cells. Conclusions: Prom2 protrusions primarily

Measuring outcomes in adult spinal deformity surgery: a systematic review to identify current strengths, weaknesses and gaps in patient-reported outcome measures.

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Faraj, Sayf S A; van Hooff, Miranda L; Holewijn, Roderick M; Polly, David W; Haanstra, Tsjitske M; de Kleuver, Marinus

2017-08-01

Adult spinal deformity (ASD) causes severe disability, reduces overall quality of life, and results in a substantial societal burden of disease. As healthcare is becoming more value based, and to facilitate global benchmarking, it is critical to identify and standardize patient-reported outcome measures (PROMs). This study aims to identify the current strengths, weaknesses, and gaps in PROMs used for ASD. Studies were included following a systematic search in multiple bibliographic databases between 2000 and 2015. PROMs were extracted and linked to the outcome domains of WHO's International Classification of Functioning and Health (ICF) framework. Subsequently, the clinimetric quality of identified PROMs was evaluated. The literature search identified 144 papers that met the inclusion criteria, and nine frequently used PROMs were identified. These covered 29 ICF outcome domains, which could be grouped into three of the four main ICF chapters: body function (n = 7), activity and participation (n = 19), environmental factors (n = 3), and body structure (n = 0). A low quantity (n = 3) of papers was identified that studied the clinimetric quality of PROMs. The Scoliosis Research Society (SRS)-22 has the highest level of clinimetric quality for ASD. Outcome domains related to mobility and pain were well represented. We identified a gap in current outcome measures regarding neurological and pulmonary function. In addition, no outcome domains were measured in the ICF chapter body structure. These results will serve as a foundation for the process of seeking international consensus on a standard set of outcome domains, accompanied PROMs and contributing factors to be used in future clinical trials and spine registries.

Mother-to-child transmission of human immunodeficiency virus (HIV) among HIV-infected pregnant women on highly active anti-retroviral therapy with premature rupture of membranes at term.

Science.gov (United States)

Eleje, George Uchenna; Edokwe, Emeka Stephen; Ikechebelu, Joseph Ifeanyichukwu; Onubogu, Chinyere Ukamaka; Ugochukwu, Ebele Francesca; Okam, Princeston Chukwuemeka; Ibekwe, Adaobi Maryann

2018-01-01

To determine mother-to-child transmission (MTCT) rate and associated risk factors of human immune-deficiency virus (HIV) among HIV-infected pregnant women with term premature rupture of membranes (PROM) in comparison with those without PROM at term. All optimally managed HIV-positive pregnant women of Nnamdi Azikiwe University Teaching Hospital, on highly active anti-retroviral therapy (HAART) who had PROM at term were enrolled. Maternal HIV-1 viral load was not assessed. Follow up was for a minimum of 18 months for evidence of HIV infection. Of the 121 women with PROM at term, 46 (38.0%) were HIV sero-positive, 22/46 (47.8%) of which had their babies followed up till 18 months. The mean latency period was 10.5 ± 5.3 h in PROM group. Apart from duration of PROM (OR = 0.01; 95%CI = 0.00-0.13; p  0.05). Of the 22 (47.8%) babies followed-up in the PROM group and 13 in non-PROM group, none tested positive to HIV, given an MTCT rate of 0%. MTCT rate was 0% following term PROM and in women without PROM. Since maternal HIV-1 viral load was not assessed, we need to be critical while interpreting the findings.

LABOUR TERMINATION AND PERINATAL OUTCOME IN PREGNANT WOMEN WITH PLACENTA ABRUPTION WITH PPROM AND PROM

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Ranko Kutlesic

2007-10-01

Full Text Available Placenta abruption is an obstetric accident which endangers life and health of both mother and embryo. It is one of the most serious obstetric complications, whose incidence ranges from 4.9-12.9 per 1,000 labours, and according to frequency, it represents the second cause of perinatal death. Retrospective analysis included the interval from 1996 to 2005. Total number of labours was analyzed and it was 32358. In addition, the number of labours complicated by placenta abruption was analyzed, and it was 119 or 0.37%. It analyzed the incidence of placenta abruption according to age of pregnancy and the integrity of embryonic membranes. It is established that there is no statistically significant difference in the incidence of placenta abruption appearing in pregnant women, with and without the disruption of embryonic membranes. The age of pregnant women was also analyzed, and it was found out that the pregnant women with placenta abruption and PPROM were 5 years older than those with placenta abruption without PPROM, and that this difference was very significant. Disruption duration was analyzed as well as the time from the first uterus bleeding to labour. The difference between PPROM and PROM duration was statistically significant, as well as the difference in duration between spontaneous and artificial rupture of embryonic membranes. The way of labour termination was analyzed in pregnant women with verified placenta abruption. In 80% of pregnant women, the labour was terminated by Caesarian section, and only 20% by vaginal labour. Also, the perinatal outcome was analyzed, according to Apgar score in the first and fifth minute. Apgar score showed that out of the total number of abruptions, 7 neonatuses was born dead (11.66%, 13 (21.66% was born in good condition (Apgar score>7, 26 (43.33% was marked with 4-7, while 14 (23.33% was in hard asphyxia (Apgar score 1-5.

Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes.

Science.gov (United States)

Lee, Seung Mi; Park, Jeong Woo; Kim, Byoung Jae; Park, Chan-Wook; Park, Joong Shin; Jun, Jong Kwan; Yoon, Bo Hyun

2013-01-01

The objective of this study was to determine whether acute histologic chorioamnionitis is associated with adverse neonatal outcomes in late preterm infants who were born after preterm PROM. The relationship between the presence of acute histologic chorioamnionitis and adverse neonatal outcome was examined in patients with preterm PROM who delivered singleton preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Nonparametric statistics were used for data analysis. The frequency of acute histologic chorioamnionitis was 24% in patients with preterm PROM who delivered preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Newborns born to mothers with histologic chorioamnionitis had significantly higher rates of adverse neonatal outcome (74% vs 51%; p<0.005) than those without histologic chorioamnionitis. This relationship remained significant after adjustment for gestational age at preterm PROM, gestational age at delivery, and exposure to antenatal corticosteroids. The presence of acute histologic chorioamnionitis is associated with adverse neonatal outcome in late preterm infants born to mothers with preterm PROM.

Polimorfisme Gen MMP-9, Ekspresi MMP-9, dan Indeks Apoptosis Sel Serviks pada Kehamilan 21–36 Minggu

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Udin Sabarudin

2011-12-01

Full Text Available Over expression and premature activation of matrix metalloproteinase (MMP can lead to degradation of amnion chorionic membrane which clinically called premature rupture of membrane (PROM. Increasing MMP activity caused by matrix metalloproteinase-9 (MMP-9 gene polymorphism (C-1562T will be followed by apoptosis. This study was aimed to find the differences between MMP-9 expression and cervical apoptotic index (AI and also MMP-9 (C-1562T polymorphism on 21–36 weeks of pregnancy with or without PROM. This was case control study and conducted in Dr. Hasan Sadikin Hospital and Bandung Networking Hospitals (May−November 2009. There were no significant correlation between MMP-9 expression and cervical AI in every variable on both groups. Three cases of PROM were found in mothers below 20 years of age. Women with 28−34 weeks of pregnancy had a greater risk for PROM than 21−28 weeks. Pregnant women with body mass index (BMI 19−26, had risk to have PROM. Only one sample that showed a MMP-9 (C-1562T polymorphism in the premature labor with PROM group. It can be concluded that there are no significant correlation between MMP-9 expression and cervical cells AI on both groups as well as MMP-9 (C-1562T polymorphism which can alter MMP-9 expression.

Early Versus Delayed Passive Range of Motion After Rotator Cuff Repair: A Systematic Review and Meta-analysis.

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Kluczynski, Melissa A; Nayyar, Samir; Marzo, John M; Bisson, Leslie J

2015-08-01

Postoperative rehabilitation has been shown to affect healing of the rotator cuff after surgical repair. However, it is unknown whether an early or delayed rehabilitation protocol is most beneficial for healing. To determine whether early versus delayed passive range of motion (PROM) affects rotator cuff (RC) retear rates after surgery. Systematic review and meta-analysis. A systematic review of the literature published between January 2003 and February 2014 was conducted. Retear rates were compared for early (within 1 week after surgery) versus delayed (3-6 weeks after surgery) PROM using χ(2) or Fisher exact tests as well as relative risks (RR) and 95% CIs. In the first analysis, data from evidence level 1 studies that directly compared early versus delayed PROM were pooled; and in the second analysis, data from level 1 to 4 studies that did not directly compare early versus delayed PROM were pooled. The second analysis was stratified by tear size and repair method. Twenty-eight studies (1729 repairs) were included. The first analysis of level 1 studies did not reveal a significant difference in retear rates for early (13.7%) versus delayed (10.5%) PROM (P = .36; RR = 1.30 [95% CI, 0.74-2.30]). The second analysis revealed that for ≤3 cm tears, the risk of retear was lower for early versus delayed PROM for transosseous (TO) plus single-row anchor (SA) repairs (18.7% vs 28.2%, P = .02; RR = 0.66 [95% CI, 0.47-0.95]). For >5 cm tears, the risk of retear was greater for early versus delayed PROM for double-row anchor (DA) repairs (56.4% vs 20%, P = .002; RR = 2.82 [95% CI, 1.31-6.07]) and for all repair methods combined (52.2% vs 22.6%, P = .01; RR = 2.31 [95% CI, 1.16-4.61]). There were no statistically significant associations for tears measuring 3 cm. Evidence is lacking with regard to the optimal timing of PROM after RC repair; however, this study suggests that tear size may be influential. © 2014 The Author(s).

Prominin-1 Is a Novel Regulator of Autophagy in the Human Retinal Pigment Epithelium

OpenAIRE

Bhattacharya, Sujoy; Yin, Jinggang; Winborn, Christina S.; Zhang, Qiuhua; Yue, Junming; Chaum, Edward

2017-01-01

Purpose Prominin-1 (Prom1) is a transmembrane glycoprotein, which is expressed in stem cell lineages, and has recently been implicated in cancer stem cell survival. Mutations in the Prom1 gene have been shown to disrupt photoreceptor disk morphogenesis and cause an autosomal dominant form of Stargardt-like macular dystrophy (STGD4). Despite the apparent structural role of Prom1 in photoreceptors, its role in other cells of the retina is unknown. The purpose of this study is to investigate the...

Exposure to Ambient Air Pollution and Premature Rupture of Membranes.

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Wallace, Maeve E; Grantz, Katherine L; Liu, Danping; Zhu, Yeyi; Kim, Sung Soo; Mendola, Pauline

2016-06-15

Premature rupture of membranes (PROM) is a major factor that predisposes women to preterm delivery. Results from previous studies have suggested that there are associations between exposure to air pollution and preterm birth, but evidence of a relationship with PROM is sparse. Modified Community Multiscale Air Quality models were used to estimate mean exposures to particulate matter less than 10 µm or less than 2.5 µm in aerodynamic diameter, nitrogen oxides, carbon monoxide, sulfur dioxide, and ozone among 223,375 singleton deliveries in the Air Quality and Reproductive Health Study (2002-2008). We used log-linear models with generalized estimating equations to estimate adjusted relative risks and 95% confidence intervals for PROM per each interquartile-range increase in pollutants across the whole pregnancy, on the day of delivery, and 5 hours before delivery. Whole-pregnancy exposures to carbon monoxide and sulfur dioxide were associated with an increased risk of PROM (for carbon monoxide, relative risk (RR) = 1.09, 95% confidence interval (CI): 1.04, 1.14; for sulfur dioxide, RR = 1.15, 95% CI: 1.06, 1.25) but not preterm PROM. Ozone exposure increased the risk of PROM on the day of delivery (RR = 1.06, 95% CI: 1.02, 1.09) and 1 day prior (RR = 1.04, 95% CI: 1.01, 1.07). In the 5 hours preceding delivery, there were 3%-7% increases in risk associated with exposure to ozone and particulate matter less than 2.5 µm in aerodynamic diameter and inverse associations with exposure to carbon monoxide and nitrogen oxides. Acute and long-term air pollutant exposures merit further study in relation to PROM. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Self-report measures of prospective memory are reliable but not valid.

Science.gov (United States)

Uttl, Bob; Kibreab, Mekale

2011-03-01

Are self-report measures of prospective memory (ProM) reliable and valid? To examine this question, 240 undergraduate student volunteers completed several widely used self-report measures of ProM including the Prospective Memory Questionnaire (PMQ), the Prospective and Retrospective Memory Questionnaire (PRMQ), the Comprehensive Assessment of Prospective Memory (CAPM) questionnaire, self-reports of retrospective memory (RetM), objective measures of ProM and RetM, and measures of involvement in activities and events, memory strategies and aids use, personality and verbal intelligence. The results showed that both convergent and divergent validity of ProM self-reports are poor, even though we assessed ProM using a newly developed, reliable continuous measure. Further analyses showed that a substantial proportion of variability in ProM self-report scores was due to verbal intelligence, personality (conscientiousness, neuroticism), activities and event involvement (busyness), and use of memory strategies and aids. ProM self-reports have adequate reliability, but poor validity and should not be interpreted as reflecting ProM ability. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Added Value of Patient-Reported Outcome Measures in Stroke Clinical Practice.

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Katzan, Irene L; Thompson, Nicolas R; Lapin, Brittany; Uchino, Ken

2017-07-21

There is uncertainty regarding the clinical utility of the data obtained from patient-reported outcome measures (PROMs) for patient care. We evaluated the incremental information obtained by PROMs compared to the clinician-reported modified Rankin Scale (mRS). This was an observational study of 3283 ischemic stroke patients seen in a cerebrovascular clinic from September 14, 2012 to June 16, 2015 who completed the routinely collected PROMs: Stroke Impact Scale-16 (SIS-16), EQ-5D, Patient Health Questionnaire-9, PROMIS Physical Function, and PROMIS fatigue. The amount of variation in the PROMs explained by mRS was determined using r 2 after adjustment for age and level of stroke impairment. The proportion with meaningful change was calculated for patients with ≥2 visits. Concordance with change in the other scales and the ability to discriminate changes in health state as measured by c-statistic was evaluated for mRS versus SIS-16. Correlation between PROMs and mRS was highest for SIS-16 ( r =-0.64, P measures. PROMs provide additional valuable information compared to the mRS alone in stroke patients seen in the ambulatory setting. SIS-16 may have a better ability to identify change than mRS in health status of relevance to the patient. PROMs may be a useful addition to mRS in the assessment of health status in clinical practice. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Patient-reported outcome measures in arthroplasty registries

DEFF Research Database (Denmark)

Rolfson, Ola; Eresian Chenok, Kate; Bohm, Eric

2016-01-01

survey (SF-12) or the similar Veterans RAND 12-item health survey (VR-12). The most common specific PROMs were the Hip disability and Osteoarthritis Outcome Score (HOOS), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Oxford Hip Score (OHS), the Oxford Knee Score (OKS), the Western Ontario...... of PROMs for hip and knee arthroplasty in registries worldwide. The 2 main types of PROMs include generic (general health) PROMs, which provide a measure of general health for any health state, and specific PROMs, which focus on specific symptoms, diseases, organs, body regions, or body functions...... all elective hip or knee arthroplasty patients and 6 registries collected PROMs for sample populations; 1 other registry had planned but had not started collection of PROMs. The most common generic instruments used were the EuroQol 5 dimension health outcome survey (EQ-5D) and the Short Form 12 health...

High-risk human papillomavirus infection is associated with premature rupture of membranes.

Science.gov (United States)

Cho, GeumJoon; Min, Kyung-Jin; Hong, Hye-Ri; Kim, SuhngWook; Hong, Jin-Hwa; Lee, Jae-Kwan; Oh, Min-Jeong; Kim, HaiJoong

2013-09-06

Human papillomavirus (HPV) is known to be more prevalent in spontaneous abortions than in elective terminations of pregnancy. More recently, placental infection with HPV was shown to be associated with spontaneous preterm delivery. However, no study has evaluated the prevalence of HPV infection in pregnant Korean females and its association with adverse pregnancy outcomes. We conducted a cross-sectional study of 311 females who gave birth at Korea University Medical Center. Our sample included 45 preterm deliveries, 50 cases of premature rupture of the membranes (PROM), 21 preeclampsia cases, and 8 gestational diabetes mellitus (GDM) patients. We used the Hybrid Capture II system to detect high-risk (HR)-HPV infection at six weeks postpartum. The prevalence of HR-HPV infection was 14.1%. Women with HR-HPV infection had a higher incidence of PROM than those without HR-HPV. HR-HPV infection was associated with an increased risk of PROM (OR, 2.380; 95% CI, 1.103-5.134). The prevalence of preterm delivery, preeclampsia, or GDM was not different between the two groups. We observed a high prevalence of HR-HPV infection in pregnant women. Moreover, HR-HPV infection was associated with a risk of PROM at term. Further studies are needed to evaluate mechanisms by which HR-HPV infection induces PROM.

[Dutch-language patient-reported outcome measures for foot and ankle injuries; a systematic review].

Science.gov (United States)

Weel, Hanneke; Zwiers, Ruben; Sierevelt, Inger N; Haverkamp, Daniel; van Dijk, C Niek; Kerkhoffs, Gino M M J

2015-01-01

To investigate which valid and reliable patient-reported outcome measures (PROMs) are available for foot and ankle disorders in the Dutch population, and which of these is the most suitable for uniform use. Systematic review. PubMed, Embase and Google Scholar were systematically searched for relevant articles; subsequently two researchers screened first the title and the abstract, and then the full article within a selection of these articles. Studies that described a validation process for foot- and ankle-PROMs in a Dutch population were included. Data on measurement characteristics and translation procedure were extracted, and methodological quality of the studies was assessed using the COSMIN checklist. ('COSMIN' stands for 'Consensus-based standards for the selection of health status measurement instruments'.) Two general foot- and ankle-PROMs in the Dutch language were validated: the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measurement (FAAM); two foot-PROMs: the Manchester Foot Pain and Disability Index (MFPDI) and the 5-point Foot Function Index (FFI-5pt) were also validated. There were also two disorder-specific PROMs available in Dutch: the Victorian Institute of Sports Assessment-Achilles (VISA-A) for Achilles tendinopathies and the Foot Impact Scale for Rheumatoid Arthritis (FIS-RA) for rheumatoid arthritis patients. The FAOS and the FFI-5pt showed the strongest evidence for having good measurement characteristics. Currently, we regard the FAOS as the most appropriate foot- and ankle-PROM for general foot and ankle problems. Further studies of higher methodological quality are, however, required to draw firmer conclusions.

Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes.

Directory of Open Access Journals (Sweden)

Seung Mi Lee

Full Text Available BACKGROUND: The objective of this study was to determine whether acute histologic chorioamnionitis is associated with adverse neonatal outcomes in late preterm infants who were born after preterm PROM. METHODOLOGY/PRINCIPAL FINDINGS: The relationship between the presence of acute histologic chorioamnionitis and adverse neonatal outcome was examined in patients with preterm PROM who delivered singleton preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Nonparametric statistics were used for data analysis. The frequency of acute histologic chorioamnionitis was 24% in patients with preterm PROM who delivered preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Newborns born to mothers with histologic chorioamnionitis had significantly higher rates of adverse neonatal outcome (74% vs 51%; p<0.005 than those without histologic chorioamnionitis. This relationship remained significant after adjustment for gestational age at preterm PROM, gestational age at delivery, and exposure to antenatal corticosteroids. CONCLUSIONS/SIGNIFICANCE: The presence of acute histologic chorioamnionitis is associated with adverse neonatal outcome in late preterm infants born to mothers with preterm PROM.

Durable usage of patient-reported outcome measures in clinical practice to monitor health-related quality of life in head and neck cancer patients.

Science.gov (United States)

Duman-Lubberding, S; van Uden-Kraan, C F; Jansen, F; Witte, B I; Eerenstein, S E J; van Weert, S; de Bree, R; Leemans, C R; Verdonck-de Leeuw, I M

2017-12-01

To investigate the long-term follow-up (5 years) of implementing patient-reported outcome measures (PROMs) in clinical practice to monitor health-related quality of life (HRQOL) in head and neck cancer (HNC) patients. A mixed method design was used. The usage rate of OncoQuest (a touch screen computer system to monitor HRQOL) and the subsequent nurse consultation was calculated among HNC patients who visited the outpatient clinic for regular follow-up, as well as differences between ever users and never users (sociodemographic and clinical characteristics). The content of the nurse consultation was investigated. Reasons for not using (barriers) or using (facilitators) OncoQuest and the nurse consultation were explored from the perspective of HNC patients, and of head and neck surgeons. Usage rate of OncoQuest was 67% and of the nurse consultation 79%. Usage of OncoQuest was significantly related to tumor subsite and tumor stage. Topics most frequently (>40%) discussed during the nurse consultation were global quality of life (97%), head and neck cancer related symptoms (82%), other physical symptoms such as pain (61%), and psychological problems such as anxiety (44%). Several barriers and facilitators to implement PROMs in clinical practice were reported by both patients and head and neck surgeons. Usage of PROMs in clinical practice and a nurse consultation is durable, even 5 years after the introduction. This study contributes to better insight into long-term follow-up of implementation, thereby guiding future research and projects that aim to implement PROMs in clinical practice to monitor HRQOL among (head and neck) cancer patients.

Transabdominal amnioinfusion in preterm premature rupture of membranes.

Science.gov (United States)

Singla, Anshuja; Yadav, Poonam; Vaid, Neelam B; Suneja, Amita; Faridi, Mohammad M A

2010-03-01

To evaluate the effect of transabdominal amnioinfusion on prolongation of pregnancy, and maternal and neonatal outcomes in preterm premature rupture of membranes (pPROM). We conducted a prospective randomized controlled study of women with pPROM during singleton live pregnancy-between 26 and 33+6weeks-whose amniotic fluid index (AFI) was less than the 5th percentile. The study group underwent transabdominal amnioinfusion at admission and then weekly if their AFI fell below the 5th percentile again. The control group received expectant management. The difference in the mean interval from pPROM to delivery between the groups was not statistically significant. Neonatal and maternal outcomes were significantly improved in the study group compared with the control group (fetal distress [10% vs 37%]; early neonatal sepsis [17% vs 63%]; neonatal mortality [17% vs 63%]; spontaneous delivery [83% vs 53%]; and postpartum sepsis [7% vs 33%]). Transabdominal amnioinfusion reduced fetal distress, early neonatal sepsis, and neonatal mortality. In the study group, more participants delivered spontaneously and there were fewer cases of postpartum sepsis, although the pPROM-delivery interval was not increased.

Flexible Design and Operation of Multi-Stage Flash (MSF Desalination Process Subject to Variable Fouling and Variable Freshwater Demand

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Said Alforjani Said

2013-10-01

Full Text Available This work describes how the design and operation parameters of the Multi-Stage Flash (MSF desalination process are optimised when the process is subject to variation in seawater temperature, fouling and freshwater demand throughout the day. A simple polynomial based dynamic seawater temperature and variable freshwater demand correlations are developed based on actual data which are incorporated in the MSF mathematical model using gPROMS models builder 3.0.3. In addition, a fouling model based on stage temperature is considered. The fouling and the effect of noncondensable gases are incorporated into the calculation of overall heat transfer co-efficient for condensers. Finally, an optimisation problem is developed where the total daily operating cost of the MSF process is minimised by optimising the design (no of stages and the operating (seawater rejected flowrate and brine recycle flowrate parameters.

Maternal characteristics and timing of presentation following pre ...

African Journals Online (AJOL)

Background: To examine the influence of maternal characteristics on timing of presentation for intervention following pre-labour rupture of membrane (PROM) at term. Materials and Methods: This was a descriptive study of cases of term PROM with singleton births at the University of Benin Teaching Hospital (UBTH) from ...

The Examination of Patient-Reported Outcomes and Postural Control Measures in Patients With and Without a History of ACL Reconstruction: A Case Control Study.

Science.gov (United States)

Hoch, Johanna M; Sinnott, Cori W; Robinson, Kendall P; Perkins, William O; Hartman, Jonathan W

2018-03-01

There is a lack of literature to support the diagnostic accuracy and cut-off scores of commonly used patient-reported outcome measures (PROMs) and clinician-oriented outcomes such as postural-control assessments (PCAs) when treating post-ACL reconstruction (ACLR) patients. These scores could help tailor treatments, enhance patient-centered care and may identify individuals in need of additional rehabilitation. To determine if differences in 4-PROMs and 3-PCAs exist between post-ACLR and healthy participants, and to determine the diagnostic accuracy and cut-off scores of these outcomes. Case control. Laboratory. A total of 20 post-ACLR and 40 healthy control participants. The participants completed 4-PROMs (the Disablement in the Physically Active Scale [DPA], The Fear-Avoidance Belief Questionnaire [FABQ], the Knee Osteoarthritis Outcomes Score [KOOS] subscales, and the Tampa Scale of Kinesiophobia [TSK-11]) and 3-PCAs (the Balance Error Scoring System [BESS], the modified Star Excursion Balance Test [SEBT], and static balance on an instrumented force plate). Mann-Whitney U tests examined differences between groups. Receiver operating characteristic (ROC) curves were employed to determine sensitivity and specificity. The Area Under the Curve (AUC) was calculated to determine the diagnostic accuracy of each instrument. The Youdin Index was used to determine cut-off scores. Alpha was set a priori at P < 0.05. There were significant differences between groups for all PROMs (P < 0.05). There were no differences in PCAs between groups. The cut-off scores should be interpreted with caution for some instruments, as the scores may not be clinically applicable. Post-ACLR participants have decreased self-reported function and health-related quality of life. The PROMs are capable of discriminating between groups. Clinicians should consider using the cut-off scores in clinical practice. Further use of the instruments to examine detriments after completion of standard

Dimensionality of the Knee Numeric-Entity Evaluation Score (KNEES-ACL)

DEFF Research Database (Denmark)

Comins, J D; Krogsgaard, M R; Kreiner, Svend

2013-01-01

The benefit of anterior cruciate ligament (ACL) reconstruction has been questioned based on patient-reported outcome measures (PROMs). Valid interpretation of such results requires confirmation of the psychometric properties of the PROM. Rasch analysis is the gold standard for validation of PROMs...

A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta

OpenAIRE

Matsuzaki, Satoko; Matsuzaki, Shinya; Ueda, Yutaka; Tanaka, Yusuke; Kakuda, Mamoru; Kanagawa, Takeshi; Kimura, Tadashi

2014-01-01

Objective - Concurrent placenta previa and placenta accreta increase the risk of massive obstetric hemorrhage. Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta), the number and quality of previous studies are limited. We present a case of placenta accreta requiring an induced second-trimester abortion because of premature rupture of the membranes (PROM). Study Design - Case report and review of the literature. Results -...

Patient-Reported Outcome Measures for Use in Clinical Trials and Clinical Practice in Inflammatory Bowel Diseases: A Systematic Review.

Science.gov (United States)

de Jong, Marin J; Huibregtse, Roxanne; Masclee, Ad A M; Jonkers, Daisy M A E; Pierik, Marie J

2018-05-01

Mucosal inflammation must be carefully monitored to improve the long-term outcomes of patients with inflammatory bowel diseases (IBD). Patient-reported outcome measures (PROMs) are used increasingly to monitor disease activity in clinical practice and as endpoints in clinical trials. We performed a systematic review to provide an overview of the available PROMs on IBD activity and to evaluate their diagnostic value. A systematic search of the PubMed, Medline, Cochrane library, and Embase databases using defined keywords, identified 973 articles. These were screened by 2 independent reviewers, and 37 articles on development or validation of PROMs to assess IBD activity were identified for further analysis. Based on the recommendations of the Food and Drug Administration (FDA), the following measurement properties were evaluated: content, construct, and criterion validity; reliability; and responsiveness to change. In addition, data on ease of use in clinical practice were collected. Seventeen articles presenting 20 different PROMs were included the final analysis, although none met all the FDA-recommended criteria. Only 2 PROMs (patient-reported Harvey Bradshaw Index and Simple Clinical Colitis Activity Index scores) reported patient involvement during its development. Only 6 PROMs (patient-reported global assessment, patient assessment of disease activity, mobile health index for Crohn's disease, mobile health index for ulcerative colitis, patient-reported outcome derived from the Mayo score, and the 6-point Mayo score) were validated as markers of IBD activity, using findings from endoscopy as the reference standard; these PROMs identified patients with mucosal inflammation with area under the curve values of 0.63-0.82. The mobile health index for CD and UC scores had the best measurement properties for use in clinical practice and in clinical trials. In a systematic review, we identified more than 20 PROMS that have been developed and tested for their ability to

Measurement properties of the most commonly used Foot- and Ankle-Specific Questionnaires: the FFI, FAOS and FAAM. A systematic review

NARCIS (Netherlands)

Sierevelt, I. N.; Zwiers, R.; Schats, W.; Haverkamp, D.; Terwee, C. B.; Nolte, P. A.; Kerkhoffs, G. M. M. J.

2017-01-01

In the foot and ankle literature, a wide range of patient-reported outcome measures (PROMs) is used, however, consensus as to which PROMs are preferred is lacking. Selection of a PROM is among other reasons, often based on measurement properties without considering the methodological quality of the

Using Patient Reported Outcomes Measures to Promote Integrated Care

Directory of Open Access Journals (Sweden)

Marcel G. M. Olde Rikkert

2018-04-01

Full Text Available Introduction: Patient reported outcome measures (PROMs have been introduced as standardised outcomes, but have not been implemented widely for disease targeted pathways of care, nor for geriatric patients who prefer functional performance and quality of life. Discussion: We describe innovative multipurpose implementation of PROMs as evidenced by two best practices of PROMs application in geriatric and physiotherapy practice. We show that PROMs can show meaningful outcomes in older subjects’ patient journeys, which can at the same time serve individuals and groups of both patients and professionals. Key lesson: PROMs can deliver generic outcomes relevant for older patients, may improve patient-physician relationship, quality of care and prediction of future outcomes in geriatric care, if they are valid, reliable and responsive, but still short and simple. A precondition to make the hard tip from research to practice is that PROMs are carefully positioned in the clinical encounters and in electronic health records.

Event-Based Prospective Memory Is Resistant but Not Immune to Proactive Interference.

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Oates, Joyce M; Peynircioglu, Zehra F

2016-01-01

Recent evidence suggests that proactive interference (PI) does not hurt event-based prospective memory (ProM) the way it does retrospective memory (RetroM) (Oates, Peynircioglu, & Bates, 2015). We investigated this apparent resistance further. Introduction of a distractor task to ensure we were testing ProM rather than vigilance in Experiment 1 and tripling the number of lists to provide more opportunity for PI buildup in Experiment 2 still did not produce performance decrements. However, when the ProM task was combined with a RetroM task in Experiment 3, a comparable buildup and release was observed also in the ProM task. It appears that event based ProM is indeed somewhat resistant to PI, but this resistance can break down when the ProM task comprises the same stimuli as in an embedded RetroM task. We discuss the results using the ideas of cue overload and distinctiveness as well as shared attentional and working memory resources.

Optimum study designs.

Science.gov (United States)

Gu, C; Rao, D C

2001-01-01

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

Manual for procesorienteret musikterapi med personer med BPD

DEFF Research Database (Denmark)

Hannibal, Niels; Pedersen, Inge Nygaard; Bonde, Lars Ole

2012-01-01

Denne artikel introducerer et musikterapeutisk behandlingskoncept kaldet: Procesorienteret Musikterapi (PROM). PROM er et forsøg på at formulere en principiel ramme for musikterapi i psykiatrien, som dels tager udgangspunkt i 17 års klinisk erfaring, dels stiler mod at være ”best practice”. PROM ...

Measuring Patient-Reported Outcomes: Key Metrics in Reconstructive Surgery.

Science.gov (United States)

Voineskos, Sophocles H; Nelson, Jonas A; Klassen, Anne F; Pusic, Andrea L

2018-01-29

Satisfaction and improved quality of life are among the most important outcomes for patients undergoing plastic and reconstructive surgery for a variety of diseases and conditions. Patient-reported outcome measures (PROMs) are essential tools for evaluating the benefits of newly developed surgical techniques. Modern PROMs are being developed with new psychometric approaches, such as Rasch Measurement Theory, and their measurement properties (validity, reliability, responsiveness) are rigorously tested. These advances have resulted in the availability of PROMs that provide clinically meaningful data and effectively measure functional as well as psychosocial outcomes. This article guides the reader through the steps of creating a PROM and highlights the potential research and clinical uses of such instruments. Limitations of PROMs and anticipated future directions in this field are discussed.

Absence of Circadian Rhythms of Preterm Premature Rupture of Membranes and Preterm Placental Abruption

Science.gov (United States)

Luque-Fernandez, Miguel Angel; Ananth, Cande V.; Sanchez, Sixto E.; Qiu, Chun-fang; Hernandez-Diaz, Sonia; Valdimarsdottir, Unnur; Gelaye, Bizu; Williams, Michelle A.

2014-01-01

Purpose Data regarding circadian rhythm in the onset of spontaneous preterm premature rupture of membranes (PROM) and placental abruption (PA) cases are conflicting. We modeled the time of onset of preterm PROM and PA cases and examined if the circadian profiles varied based on the gestational age at delivery. Methods We used parametric and nonparametric methods, including trigonometric regression in the framework of generalized linear models, to test the presence of circadian rhythms in the time of onset of preterm PROM and PA cases, among 395 women who delivered a singleton between 2009 and 2010 in Lima, Peru. Results We found a diurnal circadian pattern, with a morning peak at 07h:32’ (95%CI:05h:46’ – 09h:18’) among moderate preterm PROM cases (P-value<0.001), and some evidence of a diurnal circadian periodicity among PA cases in term infants (P-value=0.067). However, we did not find evidence of circadian rhythms in the time of onset of extremely or very preterm PROM (P-value=0.259) and preterm PA (P-value=0.224). Conclusions The circadian rhythms of the time of onset of preterm PROM and PA cases varied based on gestational weeks at delivery. While circadian rhythms were presented among moderate preterm PROM and term PA cases, there was no evidence of circadian rhythms among preterm PA and very or extremely preterm PROM cases, underlying other mechanisms associated with the time of onset. PMID:25453346

Fetal MRI for prediction of neonatal mortality following preterm premature rupture of the fetal membranes

International Nuclear Information System (INIS)

Messerschmidt, Agnes; Sauer, Alexandra; Pollak, Arnold; Pataraia, Anna; Kasprian, Gregor; Weber, Michael; Prayer, Daniela; Helmer, Hanns; Brugger, Peter C.

2011-01-01

Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)

Fetal MRI for prediction of neonatal mortality following preterm premature rupture of the fetal membranes

Energy Technology Data Exchange (ETDEWEB)

Messerschmidt, Agnes; Sauer, Alexandra; Pollak, Arnold [Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna (Austria); Pataraia, Anna; Kasprian, Gregor; Weber, Michael; Prayer, Daniela [Medical University of Vienna, Department of Radiology, Vienna (Austria); Helmer, Hanns [Medical University of Vienna, Department of Obstetrics and Maternal-Fetal Medicine, Vienna (Austria); Brugger, Peter C. [Medical University of Vienna, Center of Anatomy and Cell Biology, Vienna (Austria)

2011-11-15

Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)

CD133 expression in chemo-resistant Ewing sarcoma cells

Directory of Open Access Journals (Sweden)

Kovar Heinrich

2010-03-01

lines the CD133+ fraction is relatively more drug-resistant, while in others there is no apparent difference between CD133+ and CD133- cells. These studies reveal heterogeneity in PROM1/CD133 expression in ESFT tumors and cell lines and confirm that high levels of PROM1 expression are, in at least some cases, associated with chemo-resistant disease. Further studies are required to elucidate the contribution of PROM1/CD133 expressing cells to therapeutic resistance in a large, prospective cohort of primary ESFT.

Measurement of Prosocial Reasoning among Chinese Adolescents

OpenAIRE

Frank H. Y. Lai; Andrew M. H. Siu; Chewtyn C. H. Chan; Daniel T. L. Shek

2012-01-01

This study attempted to develop a standardized instrument for assessment of prosocial reasoning in Chinese populations. The Prosocial Reasoning Objective Measure (PROM) was translated, and a two-stage study was conducted to evaluate the psychometric properties of the translated instrument. The content validity, cultural relevance, and reading level of the translated instrument were evaluated by an expert panel. Upon revisions according to the expert opinions, the Chinese PROM demonstrated goo...

Transabdominal amnioinfusion in preterm premature rupture of membranes: a randomised controlled trial.

Science.gov (United States)

Tranquilli, Andrea Luigi; Giannubilo, Stefano Raffaele; Bezzeccheri, Valeria; Scagnoli, Caterina

2005-06-01

To evaluate the role of transabdominal amnioinfusion in improving the perinatal outcomes of pregnancies complicated by preterm premature rupture of membranes (pPROM). A randomised controlled trial. A teaching hospital in Italy, obstetric unit. Population Women with singleton pregnancies complicated by pPROM, between 24 + 0 and 32 + 6 weeks of gestation. Patients were randomised 24 hours after admission to our referral hospital, to expectant management with transabdominal amnioinfusion or expectant management only. The effects of transabdominal amnioinfusion on pPROM-delivery interval and on perinatal outcomes. Of the 65 women with pPROM 34 met the inclusion criteria. Seventeen women were assigned to amnioinfusion (the amnioinfusion group) and the other 17 to expectant management. Compared with the control group (median: 8 days; range: 3-14), the pPROM-delivery period was significantly longer in women who underwent amnioinfusion (median: 21 days; range: 15-29) (P amnioinfusion were less likely to deliver within seven days since pPROM (RR: 0.18; range: 0.04-0.69 95% CI) or within two weeks (RR: 0.46; range: 0.21-1.02 95% CI). In the amnioinfusion group the neonatal survival was significantly higher at each gestational age (P amnioinfusion after pPROM resulted in significant prolongation of pregnancy and better neonatal outcomes.

[Premature rupture of fetal membranes: problems and obstetric management].

Science.gov (United States)

Neuhaus, W; Eibach, H W; Ahr, A; Bolte, A

1993-12-01

The treatment of a premature rupture of the foetal membrane (prom) has up to now been a subject of controversy. Depending on the stage of gestation, the prompt birth ensuing as a result of prom, involves the risk of immaturity of the child. Conservative waiting by contrast, exposes mother and child to a potential risk of infection. The retrospective study presented, summarises the strategies for treating prom used at the Cologne University Department of Obstetrics and Gynaecology during the period from 1984 to 1989, and attempts to develop from these data proposals for the treatment of prom. With an increase in latency of over 24 hours between prom and delivery, the maternal and neonatal rate of infection also increased significantly. An effective result of a prophylaxis with antibiotics could only be shown in the reduction of incidence of infection in the mother. An effect on the neonatal rate of infection could not be seen. Inducing prepartually lung-maturity with glucocorticoides or ambroxol resulted in a significant decrease of the RDS-rate in new born children up to the 34th week of gestation. Beyond the 34th week of gestation, this effect could not be found. Whereas after completion of the 37th week of gestation, the preferred treatment used by doctors is allowing the shortest possible time of latency between prom and delivery, the expected pulmonary immaturity before the 34th week of gestation has to be treated by prolonging the pregnancy and inducing pulmonary maturity under antibiotic prophylaxis and at the same time controlling infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of umbilical cord interleukin-6 in preterm infants with premature rupture of membranes and intact membranes

International Nuclear Information System (INIS)

Gharebaghi, Manizheh M.; Peirovifar, A.; Gharebaghi, Parvin M.

2008-01-01

Objective was to compare inflammatory mediators in the cord blood of premature newborn infants with premature rupture of membranes (PROM) and intact membranes. Eighty-nine premature neonates with gestational age of 27-34 weeks that delivered in Ghaem Hospital in Mashhad, Iran from June 2005 to March 2006 were enrolled in a prospective observational study and their umbilical cord plasma was collected at birth. They were allocated into 2 groups (45 patients with PROM and 44 neonates with intact membranes). Interleukin-6 (IL-6) and C-reactive protein (CRP) levels were measured in cord plasma by the enzyme linked immunoassay (ELISA) method. Mean cord plasma IL-6 levels in preterm neonates with PROM was 205.71 pg/ml and in neonates with intact membranes was 33.3 pg/ml for IL-6 (p=0.000). The mean cord blood CRP level in newborns was 10.2 ug/ml, and in those with intact membranes was 1.6 ug/ml and in those with intact membranes was 1.6 ug/ml (p=0.41). Early onset sepsis was more frequent in infants with PROM than premature infants with intact membrane (38% versus 10%, p=0.001). In neonates with PROM, the mean cord blood IL-6 level was significantly higher in septic newborns (414.28 versus 40.44 pg/ml, p=0.000). The premature newborn infants with PROM had increased IL-6 levels in cord blood, which was significantly higher in neonates that developed early onset sepsis. (author)

Perspectives of patients and professionals on the use of patient reported outcome measures in primary care

DEFF Research Database (Denmark)

Porter, Ian; Gangannagaripalli, Jaheeda; Davey, Antoinette

2017-01-01

/or healthcare professional’s perspectives on the clinical utility of using PROMs in clinical practice. Results: 19 studies met the inclusion criteria (4 after 2012), 11 of which were conducted in the UK, reporting on the views of professionals (8), patients (5), and both (7). The majority of studies (12...... communication it was also noted that they undermined the human element of consultations, along with professional intuition and judgement. Burden on GP time was also noted. Conclusions: Patients and professionals highlighted a number of benefits of using PROMs in clinical practice, particularly in terms......A71 Perspectives of patients and professionals on the use of patient-reported outcome measures in primary care: a systematic review of qualitative studies Background: Although the use of patient-reported outcome measures (PROMs) in healthcare settings has increased substantially over recent years...

Raised Vaginal Fluid Fibronectin Level Indicates Premature Rupture of Membrane

Directory of Open Access Journals (Sweden)

Amrita Bhowmik

2012-07-01

Full Text Available Background: Premature rupture of membrane (PROM is one of the common complications of pregnancy that has major impact on fetal and neonatal outcome. It is the commonest clinical event where a normal pregnancy becomes suddenly a high-risk one for mother and fetus or neonate. Objective: The study was undertaken to investigate whether raised fibronectin level in vaginal fluid may indicate premature rupture of membrane. Materials and Methods: This cross sectional study was conducted in the department of Obstetrics and Gynecology in Sir Salimullah Medical College & Mitford Hospital, Dhaka during the period of January 2006 to December 2007. A total of 114 pregnant women with gestational age 28th week up to 40th week were included. Sixty were PROM (Group I and 54 were non-PROM (Group II subjects. Fibronectin in vaginal fluid was measured by an immunochemical reaction by nephelometer. Statistical analysis was done by SPSS version 10.0. Results: The PROM patients had significantly higher concentration of fibronectin (225.77 ± 115.18 ng/mL compared to that in non-PROM subjects (8.04 ± 16.17 ng/mL (p < 0.001. Conclusion: It can be concluded that in cases of unequivocal rupture or intactness of the membranes, the result of the fibronectin test corresponds well with the clinical situation. So fibronectin is a sensitive test for detection of amniotic fluid in the vagina.

Development of a patient-reported outcome measure of recovery after abdominal surgery: a hypothesized conceptual framework.

Science.gov (United States)

Alam, Roshni; Figueiredo, Sabrina M; Balvardi, Saba; Nauche, Bénédicte; Landry, Tara; Lee, Lawrence; Mayo, Nancy E; Feldman, Liane S; Fiore, Julio F

2018-05-17

We initiated a research program to develop a novel patient-reported outcome measure (PROM) to assess postoperative recovery from the perspective of abdominal surgery patients. In light of FDA recommendations, the first stage of our program aimed to, based on previous literature and expert input, develop a hypothesized conceptual framework portraying the health domains that are potentially relevant to the process of recovery after abdominal surgery. This study was conducted in three phases: (1) systematic review to identify PROMs with measurement properties appraised in the context of recovery after abdominal surgery, (2) content analysis to categorize the health domains covered by the PROMs according to the ICF, and (3) two-round Delphi study to gain expert input regarding which of these health domains are relevant to the process of recovery. Participants were experts in perioperative care identified through two major surgical societies (35 invited). The systematic review identified 19 PROMs covering 66 ICF domains. 23 experts (66%) participated in the Delphi process. After Round 2, experts agreed that 22 health domains (8 body functions, 14 activities and participation) are potentially relevant to the process of recovery after abdominal surgery. These domains were organized into a diagram, representing our hypothesized conceptual framework. This hypothesized conceptual framework is an important first step in our research program and will be further refined based on in-depth qualitative interviews with patients. The sound methodological approach used to derive this framework may be valuable for studies aimed to develop PROMs according to FDA standards.

Headache Night

Science.gov (United States)

Maxwell, Lesli A.

2007-01-01

The excesses of the modern prom often require principals to play the roles of police, fashion arbiters, and even parents. In the midst of the 2007 junior and senior prom season, school leaders attest to a mounting list of policies, regulations, and security measures they are enforcing for the year's big social event. Indeed, the prom, a…

Development and validation of a condition-specific diary to measure severity, bothersomeness and impact on daily activities for patients with acute urinary tract infection in primary care

DEFF Research Database (Denmark)

Holm, Anne; Cordoba, Gloria; Siersma, Volkert

2017-01-01

Background: Urinary tract infection (UTI) is a common condition in primary care. Patient-reported outcome measures (PROMs) are crucial in the evaluation of interventions to improve diagnosis, treatment and prognosis of UTI. The aim of this study was to identify an existing condition-specific PROM...... for polytomous items in a cohort of 451 women participating in two studies regarding UTI. Results: No existing PROM fulfilled the inclusion criteria. Content validation resulted in one domain concerning symptom severity (18 items), one concerning bothersomeness (18 items), and one concerning impact on daily...... activities (7 items). Psychometrical validation resulted in four dimensions in each of the first two domains and one dimension in the third domain. Conclusions: Domains were not unidimensional, which meant that we identified dimensions of patient-experienced UTI that differed substantially from those...

MANUAL FOR PROCESORIENTERET MUSIKTERAPI MED PERSONER MED BPD.

Directory of Open Access Journals (Sweden)

Niels Hannibal

2010-12-01

Full Text Available Denne artikel introducerer et musikterapeutisk behandlingskoncept kaldet: Procesorienteret Musikterapi (PROM. PROM er et forsøg på at formulere en principiel ramme for musikterapi i psykiatrien, som dels tager udgangspunkt i 17 års klinisk erfaring, dels stiler mod at være ”best practice”. PROM indeholder beskrivelser af manualens unikke, essentielle men ikke unikke, acceptable og ikke acceptable dele. Den unikke del af PROM skal kunne implementeres til alle målgrupper, mens de øvrige dele af manualen rettes til i forhold til en specifik målgruppe. Denne udgave af PROM er specifikt rettet i mod musikterapi for patienter med personlighedsforstyrrelser. Manualen indgår også som en del af et pilotprojekt, der har til formål at udvikle en protokol for et internationalt RCT projekt med samme målgruppe

Development, content validity, and cross-cultural adaptation of a patient-reported outcome measure for real-time symptom assessment in irritable bowel syndrome.

Science.gov (United States)

Vork, L; Keszthelyi, D; Mujagic, Z; Kruimel, J W; Leue, C; Pontén, I; Törnblom, H; Simrén, M; Albu-Soda, A; Aziz, Q; Corsetti, M; Holvoet, L; Tack, J; Rao, S S; van Os, J; Quetglas, E G; Drossman, D A; Masclee, A A M

2018-03-01

End-of-day questionnaires, which are considered the gold standard for assessing abdominal pain and other gastrointestinal (GI) symptoms in irritable bowel syndrome (IBS), are influenced by recall and ecological bias. The experience sampling method (ESM) is characterized by random and repeated assessments in the natural state and environment of a subject, and herewith overcomes these limitations. This report describes the development of a patient-reported outcome measure (PROM) based on the ESM principle, taking into account content validity and cross-cultural adaptation. Focus group interviews with IBS patients and expert meetings with international experts in the fields of neurogastroenterology & motility and pain were performed in order to select the items for the PROM. Forward-and-back translation and cognitive interviews were performed to adapt the instrument for the use in different countries and to assure on patients' understanding with the final items. Focus group interviews revealed 42 items, categorized into five domains: physical status, defecation, mood and psychological factors, context and environment, and nutrition and drug use. Experts reduced the number of items to 32 and cognitive interviewing after translation resulted in a few slight adjustments regarding linguistic issues, but not regarding content of the items. An ESM-based PROM, suitable for momentary assessment of IBS symptom patterns was developed, taking into account content validity and cross-cultural adaptation. This PROM will be implemented in a specifically designed smartphone application and further validation in a multicenter setting will follow. © 2017 John Wiley & Sons Ltd.

Simulation of a coal-fired power plant using mathematical programming algorithms in order to optimize its efficiency

International Nuclear Information System (INIS)

Tzolakis, G.; Papanikolaou, P.; Kolokotronis, D.; Samaras, N.; Tourlidakis, A.; Tomboulides, A.

2012-01-01

Since most of the world's electric energy production is mainly based on fossil fuels and need for better efficiency of the energy conversion systems is imminent, mathematical programming algorithms were applied for the simulation and optimization of a detailed model of an existing lignite-fired power plant in Kozani, Greece (KARDIA IV). The optimization of its overall thermal efficiency, using as control variables the mass flow rates of the steam turbine extractions and the fuel consumption, was performed with the use of the simulation and optimization software gPROMS. The power plant components' mathematical models were imported in software by the authors and the results showed that further increase to the overall thermal efficiency of the plant can be achieved (a 0.55% absolute increase) through reduction of the HP turbine's and increase of the LP turbine's extractions mass flow rates and the parallel reduction of the fuel consumption by 2.05% which also results to an equivalent reduction of the greenhouse gasses. The setup of the mathematical model and the flexibility of gPROMS, make this software applicable to various power plants. - Highlights: ► Modeling and simulation of the flue gases circuit of a specific plant. ► Designing of modules in gPROMS FO (Foreign Objects). ► Simulation of the complete detailed plant with gPROMS. ► Optimization using a non-linear optimization algorithm of the plant's efficiency.

Aging of intrauterine tissues in spontaneous preterm birth and preterm premature rupture of the membranes: A systematic review of the literature.

Science.gov (United States)

Polettini, J; Dutta, E H; Behnia, F; Saade, G R; Torloni, M R; Menon, R

2015-09-01

Many adverse pregnancy outcomes (APOs), including spontaneous preterm birth (PTB), are associated with placental dysfunction. Recent clinical and experimental evidences suggest that premature aging of the placenta may be involved in these events. Although placental aging is a well-known concept, the mechanisms of aging during normal pregnancy and premature aging in APOs are still unclear. This review was conducted to assess the knowledge on placental aging related biochemical changes leading to placental dysfunction in PTB and/or preterm premature rupture of membranes (pPROM). We performed a systematic review of studies published over the last 50 years in two electronic databases (Pubmed and Embase) on placental aging and PTB or pPROM. The search yielded 554 citations, 30 relevant studies were selected for full-text review and three were included in the review. Only one study reported oxidative stress-related aging and degenerative changes in human placental membranes and telomere length reduction in fetal cells as part of PTB and/or pPROM mechanisms. Similarly, two animal studies reported findings of decidual senescence and referred to PTB mechanisms. Placental and fetal membrane oxidative damage and telomere reduction are linked to premature aging in PTB and pPROM but the risk factors and biomolecular pathways causing this phenomenon are not established in the literature. However, no biomarkers or clinical indicators of premature aging as a pathology of PTB and pPROM have been reported. We document major knowledge gaps and propose several areas for future research to improve our understanding of premature aging linked to placental dysfunction. Copyright © 2015 Elsevier Ltd. All rights reserved.

Patient-reported outcome measures versus inertial performance-based outcome measures: A prospective study in patients undergoing primary total knee arthroplasty.

Science.gov (United States)

Bolink, S A A N; Grimm, B; Heyligers, I C

2015-12-01

Outcome assessment of total knee arthroplasty (TKA) by subjective patient reported outcome measures (PROMs) may not fully capture the functional (dis-)abilities of relevance. Objective performance-based outcome measures could provide distinct information. An ambulant inertial measurement unit (IMU) allows kinematic assessment of physical performance and could potentially be used for routine follow-up. To investigate the responsiveness of IMU measures in patients following TKA and compare outcomes with conventional PROMs. Patients with end stage knee OA (n=20, m/f=7/13; age=67.4 standard deviation 7.7 years) were measured preoperatively and one year postoperatively. IMU measures were derived during gait, sit-stand transfers and block step-up transfers. PROMs were assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS). Responsiveness was calculated by the effect size, correlations were calculated with Spearman's rho correlation coefficient. One year after TKA, patients performed significantly better at gait, sit-to-stand transfers and block step-up transfers. Measures of time and kinematic IMU measures demonstrated significant improvements postoperatively for each performance-based test. The largest improvement was found in block step-up transfers (effect size=0.56-1.20). WOMAC function score and KSS function score demonstrated moderate correlations (Spearman's rho=0.45-0.74) with some of the physical performance-based measures pre- and postoperatively. To characterize the changes in physical function after TKA, PROMs could be supplemented by performance-based measures, assessing function during different activities and allowing kinematic characterization with an ambulant IMU. Copyright © 2015 Elsevier B.V. All rights reserved.

Memory, microprocessor, and ASIC

CERN Document Server

Chen, Wai-Kai

2003-01-01

System Timing. ROM/PROM/EPROM. SRAM. Embedded Memory. Flash Memories. Dynamic Random Access Memory. Low-Power Memory Circuits. Timing and Signal Integrity Analysis. Microprocessor Design Verification. Microprocessor Layout Method. Architecture. ASIC Design. Logic Synthesis for Field Programmable Gate Array (EPGA) Technology. Testability Concepts and DFT. ATPG and BIST. CAD Tools for BIST/DFT and Delay Faults.

Gait characteristics of individuals with multiple sclerosis before and after a 6-month aerobic training program.

Science.gov (United States)

Rodgers, M M; Mulcare, J A; King, D L; Mathews, T; Gupta, S C; Glaser, R M

1999-07-01

Individuals who have multiple sclerosis (MS) typically experience problems with physical activities such as walking, resulting from the combined effects of skeletal muscle weakness, sensory disturbances, spasticity, gait ataxia, and reduction in aerobic capacity. The aim of this study was to determine whether a 6-mo exercise program designed for aerobic conditioning might also affect gait abnormalities in individuals with MS. Subjects included 18 individuals with MS who presented a range of disability. Passive range of motion (PROM) in the lower limbs was measured and gait analyzed before and after exercise conditioning. Three-dimensional kinematics, ground reaction forces (GRF), and electromyographic information were acquired as subjects walked at self-selected velocities. Hip PROM increased following conditioning. Mean walking velocity, cadence, and posterior shear GRF (push-off force) decreased. During walking, maximum ankle dorsiflexion decreased and ankle plantarflexion increased. Total knee flexion/extension range during the walking cycle decreased slightly as did maximum hip extension. Results suggest this 6-mo training program had minimal effect on gait abnormalities.

Development and validation of a patient-reported outcome measure for stroke patients.

Science.gov (United States)

Luo, Yanhong; Yang, Jie; Zhang, Yanbo

2015-05-08

Family support and patient satisfaction with treatment are crucial for aiding in the recovery from stroke. However, current validated stroke-specific questionnaires may not adequately capture the impact of these two variables on patients undergoing clinical trials of new drugs. Therefore, the aim of this study was to develop and evaluate a new stroke patient-reported outcome measure (Stroke-PROM) instrument for capturing more comprehensive effects of stroke on patients participating in clinical trials of new drugs. A conceptual framework and a pool of items for the preliminary Stroke-PROM were generated by consulting the relevant literature and other questionnaires created in China and other countries, and interviewing 20 patients and 4 experts to ensure that all germane parameters were included. During the first item-selection phase, classical test theory and item response theory were applied to an initial scale completed by 133 patients with stroke. During the item-revaluation phase, classical test theory and item response theory were used again, this time with 475 patients with stroke and 104 healthy participants. During the scale assessment phase, confirmatory factor analysis was applied to the final scale of the Stroke-PROM using the same study population as in the second item-selection phase. Reliability, validity, responsiveness and feasibility of the final scale were tested. The final scale of Stroke-PROM contained 46 items describing four domains (physiology, psychology, society and treatment). These four domains were subdivided into 10 subdomains. Cronbach's α coefficients for the four domains ranged from 0.861 to 0.908. Confirmatory factor analysis supported the validity of the final scale, and the model fit index satisfied the criterion. Differences in the Stroke-PROM mean scores were significant between patients with stroke and healthy participants in nine subdomains (P < 0.001), indicating that the scale showed good responsiveness. The Stroke-PROM

Patient Reported Outcome Measure of Spiritual Care as Delivered by Chaplains.

Science.gov (United States)

Snowden, Austyn; Telfer, Iain

2017-01-01

Chaplains are employed by health organizations around the world to support patients in recognizing and addressing their spiritual needs. There is currently no generalizable measure of the impact of these interventions and so the clinical and strategic worth of chaplaincy is difficult to articulate. This article introduces the Scottish PROM, an original five-item patient reported outcome measure constructed specifically to address this gap. It describes the validation process from its conceptual grounding in the spiritual care literature through face and content validity cycles. It shows that the Scottish PROM is internally consistent and unidimensional. Responses to the Scottish PROM show strong convergent validity with responses to the Warwick and Edinburgh Mental Well-Being Scale, a generic well-being scale often used as a proxy for spiritual well-being. In summary, the Scottish PROM is fit for purpose. It measures the outcomes of spiritual care as delivered by chaplains in this study. This novel project introduces an essential and original breakthrough; the possibility of generalizable international chaplaincy research.

UK-based prospective cohort study to anglicise and validate the FACE-Q Skin Cancer Module in patients with facial skin cancer undergoing surgical reconstruction: the PROMISCR (Patient-Reported Outcome Measure in Skin Cancer Reconstruction) study.

Science.gov (United States)

Dobbs, Thomas; Hutchings, Hayley A; Whitaker, Iain S

2017-09-24

Skin cancer is the most common malignancy worldwide, often occurring on the face, where the cosmetic outcome of treatment is paramount. A number of skin cancer-specific patient-reported outcome measures (PROMs) exist, however none adequately consider the difference in type of reconstruction from a patient's point of view. It is the aim of this study to 'anglicise' (to UK English) a recently developed US PROM for facial skin cancer (the FACE-Q Skin Cancer Module) and to validate this UK version of the PROM. The validation will also involve an assessment of the items for relevance to facial reconstruction patients. This will either validate this new measure for the use in clinical care and research of various facial reconstructive options, or provide evidence that a more specific PROM is required. This is a prospective validation study of the FACE-Q Skin Cancer Module in a UK facial skin cancer population with a specific focus on the difference between types of reconstruction. The face and content validity of the FACE-Q questionnaire will initially be assessed by a review process involving patients, skin cancer specialists and methodologists. An assessment of whether questions are relevant and any missing questions will be made. Initial validation will then be carried out by recruiting a cohort of 100 study participants with skin cancer of the face pre-operatively. All eligible patients will be invited to complete the questionnaire preoperatively and postoperatively. Psychometric analysis will be performed to test validity, reliability and responsiveness to change. Subgroup analysis will be performed on patients undergoing different forms of reconstruction postexcision of their skin cancer. This study has been approved by the West Midlands, Edgbaston Research Ethics Committee (Ref 16/WM/0445). All personal data collected will be anonymised and patient-specific data will only be reported in terms of group demographics. Identifiable data collected will include the

The patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF)

DEFF Research Database (Denmark)

Crossley, Kay M; Macri, Erin M; Cowan, Sallie M

2018-01-01

with patellofemoral pain and/or osteoarthritis and 14 health and medical clinicians. Item reduction was performed using data from patellofemoral cohorts (n=138). We used the COnsesus-based Standards for the selection of health Measurements INstruments guidelines to evaluate reliability, validity, responsiveness......BACKGROUND: Patellofemoral pain and osteoarthritis are prevalent and associated with substantial pain and functional impairments. Patient-reported outcome measures (PROMs) are recommended for research and clinical use, but no PROMs are specific for patellofemoral osteoarthritis, and existing PROMs...... for patellofemoral pain have methodological limitations. This study aimed to develop a new subscale of the Knee injury and Osteoarthritis Outcome Score for patellofemoral pain and osteoarthritis (KOOS-PF), and evaluate its measurement properties. METHODS: Items were generated using input from 50 patients...

Patient-reported outcomes and adult patients' disease experience in the idiopathic inflammatory myopathies. report from the OMERACT 11 Myositis Special Interest Group.

Science.gov (United States)

Alexanderson, Helene; Del Grande, Maria; Bingham, Clifton O; Orbai, Ana-Maria; Sarver, Catherine; Clegg-Smith, Katherine; Lundberg, Ingrid E; Song, Yeong Wook; Christopher-Stine, Lisa

2014-03-01

The newly formed Outcome Measures in Rheumatology (OMERACT) Myositis Special Interest Group (SIG) was established to examine patient-reported outcome measures (PROM) in myositis. At OMERACT 11, a literature review of PROM used in the idiopathic inflammatory myopathies (IIM) and other neuromuscular conditions was presented. The group examined in more detail 2 PROM more extensively evaluated in patients with IIM, the Myositis Activities Profile, and the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire, through the OMERACT filter of truth, discrimination, and feasibility. Preliminary results from a qualitative study of patients with myositis regarding their symptoms were discussed that emphasized the range of symptoms experienced: pain, physical tightness/stiffness, fatigue, disease effect on emotional life and relationships, and treatment-related side effects. Following discussion of these results and following additional discussions since OMERACT 11, a research agenda was developed. The next step in evaluating PROM in IIM will require additional focus groups with a spectrum of patients with different myositis disease phenotypes and manifestations across a range of disease activity, and from multiple international settings. The group will initially focus on dermatomyositis and polymyositis in adults. Qualitative analysis will facilitate the identification of commonalities and divergent patient-relevant aspects of disease, insights that are critical given the heterogeneous manifestations of these diseases. Based on these qualitative studies, existing myositis PROM can be examined to more thoroughly assess content validity, and will be important to identify gaps in domain measurement that will be required to develop a preliminary core set of patient-relevant domains for IIM.

Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions?

Science.gov (United States)

Witjes, Suzanne; van Geenen, Rutger C I; Koenraadt, Koen L M; van der Hart, Cor P; Blankevoort, Leendert; Kerkhoffs, Gino M M J; Kuijer, P Paul F M

2017-02-01

Indications for total and unicondylar knee arthroplasty (KA) have expanded to younger patients, in which Patient-Reported Outcome Measures (PROMs) often show ceiling effects. This might be due to higher expectations. Our aims were to explore expectations of younger patients concerning activities in daily life, work and leisure time after KA and to assess to what extent PROMs meet and evaluate these activities of importance. Focus groups were performed among osteoarthritis (OA) patients leisure time after KA. Additionally, 28 activities of daily life, 17 of work and 27 of leisure time were depicted from seven PROMS, which were rated on importance, frequency and bother. A total score, representing motivation for surgery, was also calculated. Data saturation was reached after six focus groups including 37 patients. Younger OA patients expect to perform better on 16 activities after KA, including high-impact leisure time activities. From the PROMs, daily life and work activities were rated high in both importance and motivation for surgery, but for leisure time activities importance varied highly between patients. All seven PROMs score activities of importance, but no single PROM incorporates all activities rated important. Younger patients expect to perform better on many activities of daily life, work and leisure time after KA, and often at demanding levels. To measure outcomes of younger patients, we suggest using PROMs that include work and leisure time activities besides daily life activities, in which preferably scored activities can be individualized.

Histological evidence of oxidative stress and premature senescence in preterm premature rupture of the human fetal membranes recapitulated in vitro.

Science.gov (United States)

Menon, Ramkumar; Boldogh, Istvan; Hawkins, Hal K; Woodson, Michael; Polettini, Jossimara; Syed, Tariq Ali; Fortunato, Stephen J; Saade, George R; Papaconstantinou, John; Taylor, Robert N

2014-06-01

Preterm prelabor rupture of the membranes (pPROM) may lead to preterm births (PTBs). We investigated premature senescence of fetal membranes in women with pPROM and spontaneous PTB with intact membranes (PTBs, and term births. Term fetal membranes were exposed to cigarette smoke extract to induce oxidative stress. Western blots documented p-p53 and p-p38 MAPK. Transmission electron microscopy assessed cellular morphologic features in clinical and cigarette smoke extract-treated membranes. A total of 80% of pPROM cells and >60% of term cells were positive for all three senescence phenotype markers, and concentrations were higher than in PTBs (P PTBs. Histologic and biochemical resemblance of pPROM and term membranes suggests premature senescence of the membranes is a mechanistic feature in pPROM, and this can be phenocopied in an in vitro model. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Designing satisfaction studies

DEFF Research Database (Denmark)

Kristensen, Kai; Eskildsen, Jacob Kjær

2007-01-01

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

Non-invasively collected amniotic fluid as a source of possible biomarkers for premature rupture of membranes investigated by proteomic approach.

Science.gov (United States)

Consonni, Sara; Mainini, Veronica; Pizzardi, Agnese; Gianazza, Erica; Chinello, Clizia; Locatelli, Anna; Magni, Fulvio

2014-02-01

Preterm delivery is one of the main causes of perinatal morbidity and mortality and it accounts for 75 % of perinatal mortality and more than half of the long-term morbidity. We applied a proteomic approach based on mass spectrometry (MS) for biomarkers discovery of preterm premature rupture of membranes (pPROM) by investigating amniotic fluid (AF) invasively and non-invasively collected. Amniotic fluid was obtained from vagina of women with pPROM (group 1), PROM at term (group 2) and by genetic amniocentesis (group 3). Pre-fractionated AF proteome was analyzed through matrix assisted laser desorption ionization-time of flight (MALDI-TOF) MS. The characterization of proteins/peptides of interest was obtained by high performance liquid chromatography-electrospray tandem MS. Three peptides overexpressed in pPROM and able to discriminate the groups 1 and 2 were detected. One peptide was identified as the fragment Gly452LAVPDGPLGLPPKPro466 of the protein KIAA1522, expressed by fetal brain and liver. This peptide was overexpressed in a patient of the group 3, completely asymptomatic at the time of the amniocentesis, who later developed pPROM. Amniotic fluid invasively and non-invasively collected can be analyzed by MALDI-TOF MS to obtain proteomic profiles. Proteomic analysis identified a peptide with promising diagnostic capability for pPROM.

Visual Design Principles: An Empirical Study of Design Lore

Science.gov (United States)

Kimball, Miles A.

2013-01-01

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

Effect of Ankle Range of Motion (ROM) and Lower-Extremity Muscle Strength on Static Balance Control Ability in Young Adults: A Regression Analysis

Science.gov (United States)

Kim, Seong-Gil

2018-01-01

Background The purpose of this study was to investigate the effect of ankle ROM and lower-extremity muscle strength on static balance control ability in young adults. Material/Methods This study was conducted with 65 young adults, but 10 young adults dropped out during the measurement, so 55 young adults (male: 19, female: 36) completed the study. Postural sway (length and velocity) was measured with eyes open and closed, and ankle ROM (AROM and PROM of dorsiflexion and plantarflexion) and lower-extremity muscle strength (flexor and extensor of hip, knee, and ankle joint) were measured. Pearson correlation coefficient was used to examine the correlation between variables and static balance ability. Simple linear regression analysis and multiple linear regression analysis were used to examine the effect of variables on static balance ability. Results In correlation analysis, plantarflexion ROM (AROM and PROM) and lower-extremity muscle strength (except hip extensor) were significantly correlated with postural sway (pregression analysis, plantar flexion PROM with eyes open significantly influenced sway length (B=0.681) and sway velocity (B=0.011). Conclusions Lower-extremity muscle strength and ankle plantarflexion ROM influenced static balance control ability, with ankle plantarflexion PROM showing the greatest influence. Therefore, both contractile structures and non-contractile structures should be of interest when considering static balance control ability improvement. PMID:29760375

Transabdominal amnioinfusion treatment of severe oligohydramnios in preterm premature rupture of membranes at less than 26 gestational weeks.

Science.gov (United States)

De Santis, Marco; Scavo, Maria; Noia, Giuseppe; Masini, Lucia; Piersigilli, Fiammetta; Romagnoli, Costantino; Caruso, Alessandro

2003-01-01

To evaluate the efficacy of transabdominal amnioinfusion on feto-neonatal and maternal morbidity and feto-neonatal mortality. We studied 71 patients with preterm premature rupture of membranes (pPROM) at amnioinfusion with saline every 7 days in case of persistent oligohydramnios. Latency period pPROM delivery, week of delivery (26.0 vs. 22.4, pamnioinfusion-treated patients, we did not note a higher rate of complications from infection during both pregnancy and puerperium. In the amnioinfusion group, fluid loss within 6 h after infusion is the main variable in predicting pulmonary hypoplasia and neonatal survival. Our data suggest that amnioinfusion seems to be a low fetal and maternal risk technique that modifies the natural history of pPROM, improving fetal intrauterine stay and survival. Copyright 2003 S. Karger AG, Basel

Toward Ensuring Health Equity: Readability and Cultural Equivalence of OMERACT Patient-reported Outcome Measures.

Science.gov (United States)

Petkovic, Jennifer; Epstein, Jonathan; Buchbinder, Rachelle; Welch, Vivian; Rader, Tamara; Lyddiatt, Anne; Clerehan, Rosemary; Christensen, Robin; Boonen, Annelies; Goel, Niti; Maxwell, Lara J; Toupin-April, Karine; De Wit, Maarten; Barton, Jennifer; Flurey, Caroline; Jull, Janet; Barnabe, Cheryl; Sreih, Antoine G; Campbell, Willemina; Pohl, Christoph; Duruöz, Mehmet Tuncay; Singh, Jasvinder A; Tugwell, Peter S; Guillemin, Francis

2015-12-01

The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool, the Evaluative Linguistic Framework for Questionnaires, developed to assess text quality of questionnaires. We also considered a study assessing cross-cultural adaptation with/without back-translation and/or expert committee. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM. Thirty-one OMERACT delegates attended the equity session. Twenty-six participants agreed that PROM should be assessed for comprehensibility and for use of suitable methods (4 abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement for improving translation and adaptation. Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures.

Electronic capture of patient-reported and clinician-reported outcome measures in an elective orthopaedic setting: a retrospective cohort analysis.

Science.gov (United States)

Malhotra, Karan; Buraimoh, Olatunbosun; Thornton, James; Cullen, Nicholas; Singh, Dishan; Goldberg, Andrew J

2016-06-20

To determine whether an entirely electronic system can be used to capture both patient-reported outcomes (electronic Patient-Reported Outcome Measures, ePROMs) as well as clinician-validated diagnostic and complexity data in an elective surgical orthopaedic outpatient setting. To examine patients' experience of this system and factors impacting their experience. Retrospective analysis of prospectively collected data. Single centre series. Outpatient clinics at an elective foot and ankle unit in the UK. All new adult patients attending elective orthopaedic outpatient clinics over a 32-month period. All patients were invited to complete ePROMs prior to attending their outpatient appointment. At their appointment, those patients who had not completed ePROMs were offered the opportunity to complete it on a tablet device with technical support. Matched diagnostic and complexity data were captured by the treating consultant during the appointment. Capture rates of patient-reported and clinician-reported data. All information and technology (IT) failures, language and disability barriers were captured. Patients were asked to rate their experience of using ePROMs. The scoring systems used included EQ-5D-5L, the Manchester-Oxford Foot Questionnaire (MOxFQ) and the Visual Analogue Scale (VAS) pain score. Out of 2534 new patients, 2176 (85.9%) completed ePROMs, of whom 1090 (50.09%) completed ePROMs at home/work prior to their appointment. 31.5% used a mobile (smartphone/tablet) device. Clinician-reported data were captured on 2491 patients (98.3%). The mean patient experience score of using Patient-Reported Outcome Measures (PROMs) was 8.55±1.85 out of 10 and 666 patients (30.61%) left comments. Of patients leaving comments, 214 (32.13%) felt ePROMs did not adequately capture their symptoms and these patients had significantly lower patient experience scores (ptechnology into a service improvement programme. Excellent capture rates of ePROMs and clinician

Raising the profile of pilot and feasibility studies in relation to the development, evaluation and implementation of patient-reported outcome measures.

OpenAIRE

Jones, GL

2017-01-01

This editorial introduces a new special series on the pilot and feasibility testing of patient-reported outcome measures (PROMs) in the on-line open access journal Pilot and Feasibility Studies. Pilot and feasibility studies are typically implemented to address issues of uncertainty before undertaking a larger definitive study such as a randomised controlled trial or large scale survey. This editorial considers the role that such pilot and feasibility testing plays in relation to the developm...

A randomized trial of Foley Bulb for Labor Induction in Premature Rupture of Membranes in Nulliparas (FLIP).

Science.gov (United States)

Amorosa, Jennifer M H; Stone, Joanne; Factor, Stephanie H; Booker, Whitney; Newland, Meredith; Bianco, Angela

2017-09-01

In premature rupture of membranes (PROM), the risk of chorioamnionitis increases with increasing duration of membrane rupture. Decreasing the time from PROM to delivery is associated with lower rates of maternal infection. The American College of Obstetricians and Gynecologists suggests that all women with PROM who do not have a contraindication to vaginal delivery have their labor induced instead of being managed expectantly. Although the use of oxytocin for labor induction has been demonstrated to decrease the time to delivery compared with expectant management, no studies have evaluated the effectiveness of cervical ripening with a Foley bulb to additionally decrease the time to delivery. To determine whether simultaneous use of an intracervical Foley bulb and oxytocin decreases time from induction start to delivery in nulliparous patients with PROM compared with the use of oxytocin alone. A randomized trial was conducted from August 2014 to February 2016 that compared the use of concurrent Foley bulb/oxytocin vs oxytocin alone in nulliparous patients ≥34 weeks' gestational undergoing labor induction for PROM. Our primary outcome was time from induction to delivery. Secondary outcomes were mode of delivery, tachysystole, chorioamnionitis, postpartum hemorrhage, Apgar scores, and admission to the neonatal intensive care unit. A total of 128 women were randomized. Baseline characteristics were similar between groups. We found no difference in induction-to-delivery time between women induced with concurrent Foley bulb/oxytocin vs oxytocin alone (median time 13.0 hours [interquartile 10.7, 16.1] compared with 10.8 hours [interquartile range 7.8, 16.6], respectively, P = .09). There were no significant differences in mode of delivery, rates of postpartum hemorrhage, chorioamnionitis, or epidural use. Both groups had similar rates of tachysystole as well as total oxytocin dose. There were no differences in neonatal birth weight, Apgar scores, cord gases, or

Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales.

Directory of Open Access Journals (Sweden)

Simon S Jameson

Full Text Available Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing; the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs, costs and risk of repeat (revision surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index (9159 linked episodes and competing risks modelling of implant survival (79,775 procedures. Cost of implants and ancillary equipment were obtained from National Health Service procurement data.EQ5D score improvements (at 6 months were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001, when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001 for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003 and resurfacing implants, HR = 3.46, p<0.001, with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524 and highest with cementless implants (£1928 to £4285. Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the

Repository design sensitivity study: Engineering study report

International Nuclear Information System (INIS)

1987-01-01

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

Patient reported outcome measures in male incontinence surgery.

Science.gov (United States)

Tran, M G B; Yip, J; Uveili, K; Biers, S M; Thiruchelvam, N

2014-10-01

Patient reported outcome measures (PROMs) were used to evaluate outcomes of the artificial urinary sphincter (AUS) and the AdVance™ (American Medical Systems, Minnetonka, MN, US) male sling system (AVMS) for the symptomatic management of male stress urinary incontinence. All male patients with stress urinary incontinence referred to our specialist clinic over a two-year period completed the ICIQ-UI SF (International Consultation on Incontinence Questionnaire on Urinary Incontinence Short Form) and the ICIQ-MLUTS LF (International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form) at consultation as well as at subsequent follow-up appointments. The Wilcoxon signed-rank test for non-parametric paired data was used for pre and postoperative comparisons. The chi-squared test was used for categorical variables. Thirty-seven patients (forty surgical cases) completed a preoperative and at least one follow-up questionnaire. There was a statistically significant improvement in PROMs postoperatively, regardless of mode of surgery (p25) had greater improvement with an AUS than with the AVMS (p<0.01). This prospective study shows that completion and collection of PROMs as part of routine clinical practice is achievable and useful in the assessment of male stress incontinence surgery. PROMs are important instruments to assess effectiveness of healthcare intervention and they are useful adjuncts in surgical studies.

Design and Co-design of Project-organized Studies

DEFF Research Database (Denmark)

Nielsen, Jørgen Lerche; Andreasen, Lars Birch

2014-01-01

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

Patient-reported outcome measures in arthroplasty registries

DEFF Research Database (Denmark)

Rolfson, Ola; Bohm, Eric; Franklin, Patricia

2016-01-01

The International Society of Arthroplasty Registries (ISAR) Patient-Reported Outcome Measures (PROMs) Working Group have evaluated and recommended best practices in the selection, administration, and interpretation of PROMs for hip and knee arthroplasty registries. The 2 generic PROMs in common use...... are the Short Form health surveys (SF-36 or SF-12) and EuroQol 5-dimension (EQ-5D). The Working Group recommends that registries should choose specific PROMs that have been appropriately developed with good measurement properties for arthroplasty patients. The Working Group recommend the use of a 1-item pain...... should consider the absolute level of pain, function, and general health status as well as improvement, missing data, approaches to analysis and case-mix adjustment, minimal clinically important difference, and minimal detectable change. The Working Group recommends data collection immediately before...

Effect of Ankle Range of Motion (ROM) and Lower-Extremity Muscle Strength on Static Balance Control Ability in Young Adults: A Regression Analysis.

Science.gov (United States)

Kim, Seong-Gil; Kim, Wan-Soo

2018-05-15

BACKGROUND The purpose of this study was to investigate the effect of ankle ROM and lower-extremity muscle strength on static balance control ability in young adults. MATERIAL AND METHODS This study was conducted with 65 young adults, but 10 young adults dropped out during the measurement, so 55 young adults (male: 19, female: 36) completed the study. Postural sway (length and velocity) was measured with eyes open and closed, and ankle ROM (AROM and PROM of dorsiflexion and plantarflexion) and lower-extremity muscle strength (flexor and extensor of hip, knee, and ankle joint) were measured. Pearson correlation coefficient was used to examine the correlation between variables and static balance ability. Simple linear regression analysis and multiple linear regression analysis were used to examine the effect of variables on static balance ability. RESULTS In correlation analysis, plantarflexion ROM (AROM and PROM) and lower-extremity muscle strength (except hip extensor) were significantly correlated with postural sway (psimple correlation analysis, all variables that passed the correlation analysis procedure had significant influence (plinear regression analysis, plantar flexion PROM with eyes open significantly influenced sway length (B=0.681) and sway velocity (B=0.011). CONCLUSIONS Lower-extremity muscle strength and ankle plantarflexion ROM influenced static balance control ability, with ankle plantarflexion PROM showing the greatest influence. Therefore, both contractile structures and non-contractile structures should be of interest when considering static balance control ability improvement.

A Systematic Review of Measurement Properties of Patient-Reported Outcome Measures Used in Patients Undergoing Total Knee Arthroplasty.

Science.gov (United States)

Gagnier, Joel J; Mullins, Megan; Huang, Hsiaomin; Marinac-Dabic, Danica; Ghambaryan, Anna; Eloff, Benjamin; Mirza, Faisal; Bayona, Manuel

2017-05-01

While clinical research on total knee arthroplasty (TKA) outcomes is prevalent in the literature, studies often have poor methodological and reporting quality. A high-quality patient-reported outcome instrument is reliable, valid, and responsive. Many studies evaluate these properties, but none have done so with a systematic and accepted method. The objectives of this study were to identify patient-reported outcome measures (PROMs) for TKA, and to critically appraise, compare, and summarize their psychometric properties using accepted methods. MEDLINE, EMBASE, SCOPUS, Web of Science, PsycINFO, and SPORTDiscus were systematically searched for articles with the following inclusion criteria: publication before December 2014, English language, non-generic PRO, and evaluation in the TKA population. Methodological quality and evidence of psychometric properties were assessed with the COnsensus-based standards for the selection of health Status Measurement INstruments (COSMIN) checklist and criteria for psychometric evidence proposed by the COSMIN group and Terwee et al. One-hundred fifteen studies on 32 PROMs were included in this review. Only the Work, Osteoarthritis or joint-Replacement Questionnaire, the Oxford Knee Score, and the Western Ontario and McMaster Universities Arthritis Index had 4 or more properties with positive evidence. Most TKA PROMs have limited evidence for their psychometric properties. Although not all the properties were studied, the Work, Osteoarthritis or joint-Replacement Questionnaire, with the highest overall ratings, could be a useful PROM for evaluating patients undergoing TKA. The methods and reporting of this literature can improve by following accepted guidelines. Published by Elsevier Inc.

Early motion and directed exercise (EMADE) versus usual care post ankle fracture fixation: study protocol for a pragmatic randomised controlled trial.

Science.gov (United States)

Matthews, Paul A; Scammell, Brigitte E; Ali, Arfan; Coughlin, Timothy; Nightingale, Jessica; Khan, Tanvir; Ollivere, Ben J

2018-05-31

Following surgical fixation of ankle fractures, the traditional management has included immobilisation for 6 weeks in a below-knee cast. However, this can lead to disuse atrophy of the affected leg and joint stiffness. While early rehabilitation from 2 weeks post surgery is viewed as safe, controversy remains regarding its benefits. We will compare the effectiveness of early motion and directed exercise (EMADE) ankle rehabilitation, against usual care, i.e. 6 weeks' immobilisation in a below-knee cast. We have designed a pragmatic randomised controlled trial (p-RCT) to compare the EMADE intervention against usual care. We will recruit 144 independently living adult participants, absent of tissue-healing comorbidities, who have undergone surgical stabilisation of isolated Weber B ankle fractures. The EMADE intervention consists of a non-weight-bearing progressive home exercise programme, complemented with manual therapy and education. Usual care consists of immobilisation in a non-weight-bearing below-knee cast. The intervention period is between week 2 and week 6 post surgery. The primary outcome is the Olerud and Molander Ankle Score (OMAS) patient-reported outcome measure (PROM) at 12 weeks post surgery. Secondary PROMs include the EQ-5D-5 L questionnaire, return to work and return to driving, with objective outcomes including ankle range of motion. Analysis will be on an intention-to-treat basis. An economic evaluation will be included. The EMADE intervention is a package of care designed to address the detrimental effects of disuse atrophy and joint stiffness. An advantage of the OMAS is the potential of meta-analysis with other designs. Within the economic evaluation, the cost-utility analysis, may be used by commissioners, while the use of patient-relevant outcomes, such as return to work and driving, will ensure that the study remains pertinent to patients and their families. As it is being conducted in the clinical environment, this p-RCT has high external

A review of preference-based measures for the assessment of quality of life in children and adolescents with cerebral palsy.

Science.gov (United States)

Mpundu-Kaambwa, Christine; Chen, Gang; Huynh, Elisabeth; Russo, Remo; Ratcliffe, Julie

2018-03-22

To examine the psychometric properties and suitability for use within the context of cerebral palsy research in children and adolescents of generic preference-based outcome measures (PROMs). Nine electronic databases were searched in this systematic review. The consensus-based standards for the selection of health measurement instruments (COSMIN) checklist were used to measure the psychometric properties of the PROMs. A meta-analysis was used to pool correlation coefficients for convergent validity using the Schmidt-Hunter method. Heterogeneity was assessed using the I-squared statistic (I 2 ). Four preference-based PROMs were identified from eight studies: Health Utilities Index-Mark 2 and 3 (HUI-2 and HUI-3, respectively), the Assessment Quality of Life-4 dimension (AQoL-4D) and the EuroQol-5 dimension 3 level (EQ-5D-3L). Only the HUI system was primarily developed for application with children/adolescents though health-state values for scoring the PROM were elicited from adults. The HUI-3 covered the most relevant constructs though it excludes important modules of health-related quality of life (HRQOL) such as activity limitations and participation restrictions. In terms of psychometric properties, evidence was presented for only five of COSMIN measurement properties: reliability (HUI3), measurement error (HUI-3), content validity (HUI-2 and HUI-3), Hypotheses testing (HUI-3 and AQoL-4D) and criterion validity (HUI-3). No papers reported on internal consistency, structural validity, cross-cultural validity or responsiveness of the preference-based measures in children and adolescents with cerebral palsy. This review highlights the dearth in studies using preference-based PROMs to measure HRQOL associated with cerebral palsy in children and adolescents. The HUI-3 demonstrated the strongest psychometric properties, though it does not cover all dimensions relevant to this population.

Factors affecting planned return to work after trauma: A prospective descriptive qualitative and quantitative study.

Science.gov (United States)

Folkard, S S; Bloomfield, T D; Page, P R J; Wilson, D; Ricketts, D M; Rogers, B A

2016-12-01

The use of patient reported outcome measures (PROMs) in trauma is limited. The aim of this pilot study is to evaluate qualitative responses and factors affecting planned return to work following significant trauma, for which there is currently a poor evidence base. National ethical approval was obtained for routine prospective PROMs data collection, including EQ-5D, between Sept 2013 and March 2015 for trauma patients admitted to the Sussex Major Trauma Centre (n=92). 84 trauma patients disclosed their intended return to work at discharge. Additional open questions asked 'things done well' and 'things to be improved'. EQ-5D responses were valued using the time trade-off method. Statistical analysis between multiple variables was completed by ANOVA, and with categorical categories by Chi squared analysis. Only 18/68 of patients working at admission anticipated returning to work within 14days post-discharge. The injury severity scores (ISS) of those predicting return to work within two weeks and those predicting return to work longer than two weeks were 14.17 and 13.59, respectively. Increased physicality of work showed a trend towards poorer return to work outcomes, although non-significant in Chi-squared test in groups predicting return in less than or greater than two weeks (4.621, p=0.2017ns). No significant difference was demonstrated in the comparative incomes of patients with different estimated return to work outcomes (ANOVA r 2 =0.001, P=0.9590ns). EQ-5D scores were higher in those predicting return to work within two weeks when compared to greater than two weeks. Qualitative thematic content analysis of open responses was possible for 66/92 of respondents. Prominent positive themes were: care, staff, professionalism, and communication. Prominent negative themes were: food, ward response time, and communication. This pilot study highlights the importance of qualitative PROMs analysis in leading patient-driven improvements in trauma care. We provide standard

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

NARCIS (Netherlands)

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

2009-01-01

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

Translating patient reported outcome measures: methodological issues explored using cognitive interviewing with three rheumatoid arthritis measures in six European languages

NARCIS (Netherlands)

Hewlett, Sarah E.; Nicklin, Joanna; Bode, Christina; Carmona, Loretto; Dures, Emma; Engelbrecht, Matthias; Hagel, Sofia; Kirwan, John R.; Molto, Anna; Redondo, Marta; Gossec, Laure

2016-01-01

Objective. Cross-cultural translation of patient-reported outcome measures (PROMs) is a lengthy process, often performed professionally. Cognitive interviewing assesses patient comprehension of PROMs. The objective was to evaluate the usefulness of cognitive interviewing to assess translations and

Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable?

Science.gov (United States)

Krol, R. G.; Bhandari, M.; Goslings, J. C.; Poolman, R. W.; Scholtes, V. A. B.

2018-01-01

Objectives The patient-rated wrist evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are patient-reported outcome measures (PROMs) used for clinical and research purposes. Methodological high-quality clinimetric studies that determine the measurement properties of these PROMs when used in patients with a distal radial fracture are lacking. This study aimed to validate the PRWE and DASH in Dutch patients with a displaced distal radial fracture (DRF). Methods The intraclass correlation coefficient (ICC) was used for test-retest reliability, between PROMs completed twice with a two-week interval at six to eight months after DRF. Internal consistency was determined using Cronbach’s α for the dimensions found in the factor analysis. The measurement error was expressed by the smallest detectable change (SDC). A semi-structured interview was conducted between eight and 12 weeks after DRF to assess the content validity. Results A total of 119 patients (mean age 58 years (sd 15)), 74% female, completed PROMs at a mean time of six months (sd 1) post-fracture. One overall meaningful dimension was found for the PRWE and the DASH. Internal consistency was excellent for both PROMs (Cronbach’s α 0.96 (PRWE) and 0.97 (DASH)). Test-retest reliability was good for the PRWE (ICC 0.87) and excellent for the DASH (ICC 0.91). The SDC was 20 for the PRWE and 14 for the DASH. No floor or ceiling effects were found. The content validity was good for both questionnaires. Conclusion The PRWE and DASH are valid and reliable PROMs in assessing function and disability in Dutch patients with a displaced DRF. However, due to the high SDC, the PRWE and DASH are less useful for individual patients with a distal radial fracture in clinical practice. Cite this article: Y. V. Kleinlugtenbelt, R. G. Krol, M. Bhandari, J. C. Goslings, R. W. Poolman, V. A. B. Scholtes. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and

Outcomes of preterm premature rupture of membranes in twin pregnancies.

Science.gov (United States)

Trentacoste, Stephanie V; Jean-Pierre, Claudel; Baergen, Rebecca; Chasen, Stephen T

2008-08-01

To describe outcomes in twin pregnancies with preterm premature rupture of membranes (PPROM). Dichorionic twin pregnancies complicated by PPROM at premature rupture of membranes (PROM), latency from PROM to delivery, and infection were examined. In 49 twin pregnancies, the median gestational age at PROM was 31 weeks with a median latency between PROM and delivery of 0 days (interquartile range 0-6). Latency intervals of >or=2 and >or=7 days were achieved by 40.8% and 22.4%, respectively. PPROM at or= 2 days (70.6% vs. 25.0%) and >or=7 days (47.1% vs. 9.4%). There was a significant relationship between latency and clinical and histologic signs of infection. After 30 weeks, most twin pregnancies with PPROM delivered within 2 days. Infection appears to be a consequence rather than a cause of PPROM in most cases.

Udvikling og validering af patientrapporterede spørgeskemaer – del 2

DEFF Research Database (Denmark)

Willert, Cecilie Balslev; Hölmich, Lisbet Rosenkrantz; Thorborg, Kristian

2015-01-01

Test Theory and Item Response Theory, psychometric validation and the measurement properties of a PROM. The latter is based on the COSMIN (consensus-based standards for the selection of health measurement instruments) guidelines, which are developed to assist in development and evaluation of PROMs.......Patient-reported outcome measurements (PROMs) are often questionnaires which provide and rate the patient's point of view in the measurement of subjective clinical phenomena such as pain or quality of life. In the second of two articles we describe field-testing, the psychometric theories Classical...

Obstetric and perinatal outcome in induction of labor compared with expectant management for prelabor rupture of the membranes at term

International Nuclear Information System (INIS)

Yaqoob, U.; Mushtaq, R.; Mushtaq, M.

2015-01-01

To compare the management outcome of induction of labor with expectant management in patients with term pre labor rupture of membranes (PROM). Study Design: Randomized controlled trial. Place and Duration of Study: This study was conducted in the department of Obstetrics and Gynaecology; Combined Military Hospital Rawalpindi from 25th July 2010 to 25th January 2011. Methods: A total of 384 patients were selected for this study, which were divided into two groups by lottery method. Patients in group A were induced with tablet prostaglandin E2 and group B patients were managed expectantly for 24 hours. The outcome of mothers and neonates was recorded on a pre-designed proforma. Results: The mean duration between PROM to onset of active labor in group A was significantly less (8.4 ± 2.3 hours) as compared to group B in which it was (9.6±2.1 hours) (p = 0.000). The mean duration between PROM to delivery in group A was significantly less in group A (17.4 ± 2.0) versus group B (22.2 ± 2.0 hours) (p = 0.000). The spontaneous vaginal delivery (SVD) rate was considerably higher (p=0.056) in group A in which 161 (83.8%) patients delivered by SVD and 31 (16.1%) patients by LSCS. In group B, 146 (76.0%) patients delivered by SVD and 46 (23.9%) patients by LSCS. In group A, 8 (4.1%) patients developed chorioamnionitis and 13 (6.7%) patients in group B (p = 0.262). In group A there were 178 (92.7%) neonates with APGAR score of > 5 at 1 minute in contrast to 173 (90.1%) in group B with (p = 0.363). Similarly in group A at 5 minutes, there were 178 (92.7%) neonates with APGAR score of > 7 and 173 (90.1%) in group B (p = 0.460). There were 9 (4.6%) cases of neonatal sepsis in group A, in comparison with 12 (6.2%) patients in group B (p = 0.501). Conclusion: The mean duration of labor in induced patients was less as compared to patients with expectant management. (author)

Development and validation of an instrument to assess the prescribing readiness of medical students in Malaysia.

Science.gov (United States)

Lai, Pauline Siew Mei; Sim, Si Mui; Chua, Siew Siang; Tan, Choo Hock; Ng, Chirk Jenn; Achike, Francis Ifejika; Teng, Cheong Lieng

2015-09-21

Prescribing incompetence is an important factor that contributes to prescribing error, and this is often due to inadequate training during medical schools. We therefore aimed to develop and validate an instrument to assess the prescribing readiness of medical students (PROMS) in Malaysia. The PROMS comprised of 26 items with four domains: undergraduate learning opportunities; hands-on clinical skills practice; information gathering behaviour; and factors affecting the learning of prescribing skills. The first three domains were adapted from an existing questionnaire, while items from the last domain were formulated based on findings from a nominal group discussion. Face and content validity was determined by an expert panel, pilot tested in a class of final year (Year 5) medical students, and assessed using the Flesch reading ease. To assess the reliability of the PROMS, the internal consistency and test-retest (at baseline and 2 weeks later) were assessed using the Wilcoxon Signed Ranks test and Spearman's rho. The discriminative validity of the PROMS was assessed using the Mann-Whitney U-test (to assess if the PROMS could discriminate between final year medical students from a public and a private university). A total of 119 medical students were recruited. Flesch reading ease was 46.9, indicating that the instrument was suitable for use in participants undergoing tertiary education. The overall Cronbach alpha value of the PROMS was 0.695, which was satisfactory. Test-retest showed no difference for 25/26 items, indicating that our instrument was reliable. Responses from the public and private university final year medical students were significantly different in 10/26 items, indicating that the PROMS was able to discriminate between these two groups. Medical students from the private university reported fewer learning opportunities and hands-on practice compared to those from the public university. On the other hand, medical students from the private university

Timing of Histologic Progression from Chorio-Deciduitis to Chorio-Deciduo-Amnionitis in the Setting of Preterm Labor and Preterm Premature Rupture of Membranes with Sterile Amniotic Fluid.

Science.gov (United States)

Park, Chan-Wook; Park, Joong Shin; Norwitz, Errol R; Moon, Kyung Chul; Jun, Jong Kwan; Yoon, Bo Hyun

2015-01-01

Histologic chorio-deciduitis and chorio-deciduo-amnionitis (amnionitis) in extra-placental membranes are known to represent the early and advanced stages of ascending intra-uterine infection. However, there are no data in humans about the time required for chorio-deciduitis to develop and for chorio-deciduitis without amnionitis to progress to chorio-deciduitis with amnionitis, and the effect of prolongation of pregnancy on the development of chorio-deciduitis and amnionitis in patients with preterm labor and intact membranes (PTL) and preterm premature rupture of membranes (preterm-PROM). We examined these issues in this study. The study population consisted of 289 women who delivered preterm (133 cases with PTL, and 156 cases with preterm-PROM) and who had sterile amniotic fluid (AF) defined as a negative AF culture and the absence of inflammation as evidenced by a matrix metalloproteinase-8 (MMP-8) level membranes (i.e., inflammation-free extra-placental membranes, choroi-deciduitis only, and chorio-deciduitis with amnionitis) in patients with PTL and preterm-PROM. Amniocentesis-to-delivery interval was longer in cases of chorio-deciduitis with amnionitis than in cases of chorio-deciduitis only in both PTL (median [interquartile-range (IQR)]; 645.4 [319.5] vs. 113.9 [526.9] hours; P = 0.005) and preterm-PROM (131.3 [135.4] vs. 95.2 [140.5] hours; Pmembranes. Moreover, prolongation of pregnancy is an independent predictor of the development of both chorio-deciduitis and amnionitis in cases of PTL with sterile AF.

The Prevalence Of Sexually Transmitted Infections On Teen Pregnancies And Their Association To Adverse Pregnancy Outcomes.

Science.gov (United States)

Rodriguez Gonzalez, Zaskia M; Leavitt, Karla; Martin, Jose; Benabe, Erika; Romaguera, Josefina; Negrón, Ivette

2015-01-01

Based on our population data, the teen pregnancy rate and the prevalence of sexually transmitted infections (STIs) reported during pregnancy are worrisome. STIs appear to pose a threat to pregnancy outcomes including preterm birth (PTB), neonatal low birth weight (NLBW) and premature rupture of membranes (PROM). The objective of this study is to determine the prevalence of STIs in pregnant teens and the association of this variable to adverse pregnancy outcomes. We performed a cross sectional study to assess the prevalence of STIs among pregnant teens during a 4-year period at our institution. Birth outcomes such as gestational age at delivery, PROM and NLBW were analyzed and compared with adults. In the four years of our study, teen pregnancy rate fluctuated from 21.7% in 2010 to 16.8% in 2013. The rate of STIs for adult and teen pregnancies was similar, 21% and 23%, respectively. Chlamydia was the most common STI (67.3%) for both groups. PTB was more prevalent among adults affected with STIs than teens, 13.8% and 11.5%, respectively. NLBW was similar among teens and adults with STIs. PROM complicated 9.1% of teen pregnancies with STIs, compared to 6.7% in adults. There was no significant correlation between the STIs and adverse pregnancy outcomes on teen pregnancies for our population, except for PROM. This age group is associated with a high-risk sexual behavior and poor adherence to treatment. They would benefit from efforts to prevent unintended pregnancies and infectious diseases.

A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta

Directory of Open Access Journals (Sweden)

Satoko Matsuzaki

2015-04-01

Full Text Available Objective - Concurrent placenta previa and placenta accreta increase the risk of massive obstetric hemorrhage. Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta, the number and quality of previous studies are limited. We present a case of placenta accreta requiring an induced second-trimester abortion because of premature rupture of the membranes (PROM. Study Design - Case report and review of the literature. Results - A 41-year-old female presented at 20 weeks of gestation with placenta previa and PROM. Ultrasonography revealed placenta accreta with multiple placental lacunae. She then developed massive hemorrhaging just prior to a planned termination of pregnancy. We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL. Conclusion - Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage. However, together with our case, the literature suggests that placenta previa complicated with placenta accreta presents a significant risk of hemorrhage both during delivery and intraoperatively. Further reports are needed to evaluate the most appropriate treatment options.

Patient Satisfaction with Collection of Patient-Reported Outcome Measures in Routine Care.

Science.gov (United States)

Recinos, Pablo F; Dunphy, Cheryl J; Thompson, Nicolas; Schuschu, Jesse; Urchek, John L; Katzan, Irene L

2017-02-01

Systematic collection of patient-reported outcome measures (PROMs) during ambulatory clinic visits can enhance communication between patient and provider, and provide the ability to evaluate outcomes of care. Little is known about patient satisfaction of PROM data collection in routine clinical care. To evaluate patient reaction to the routine collection of PROMs in the ambulatory setting. Before all ambulatory clinic visits at our neurological institute, patients electronically complete health status questionnaires. We administered an 8-question patient satisfaction survey to a sample of patients seen across the institute after their clinical visit. Of 343 patients approached, 323 agreed to participate. The majority responded that the questionnaire system was easy to use, was an appropriate length, and benefited their care overall (strongly agree or agree = 92.3%, 87.6%, and 77.3%, respectively). Provider review of the PROMs with the patient during the clinic visit was associated with significantly higher positive responses to all questions, even those regarding logistical aspects of the collection process. There were significant age and race differences in response to perceived benefit: those in the Black/other race category had a markedly lower probability of viewing the process favorably with increasing age. Systematic collection of PROMs via an electronic questionnaire appears to be well accepted by patients. A minority of patients did not feel the questionnaire content applied to their appointment or that the system was a beneficial feature of the clinical practice. The provider can significantly improve the patient's perception of PROM collection and the patient-physician encounter by reviewing the questionnaire results with the patient.

Five-Year Experience of Vitamin E-Diffused Highly Cross-Linked Polyethylene Wear in Total Hip Arthroplasty Assessed by Radiostereometric Analysis

DEFF Research Database (Denmark)

Nebergall, Audrey K; Troelsen, Anders; Rubash, Harry E

2016-01-01

BACKGROUND: Vitamin E-diffused highly cross-linked polyethylene (VEPE) was developed to reduce oxidation without compromising mechanical strength. The purpose of this study was to evaluate VEPE in vivo using radiostereometric analysis (RSA) and patient-reported outcome measures (PROMs). METHODS......: Fifty-one hips were enrolled. Each patient received a VEPE liner, a porous titanium shell, and an uncemented stem with a 32-mm cobalt-chrome femoral head. Tantalum beads were inserted into the VEPE to measure femoral head penetration using RSA. RSA radiographs and PROMs were obtained preoperatively...

No difference in joint awareness after mobile- and fixed-bearing total knee arthroplasty: 3-year follow-up of a randomized controlled trial.

Science.gov (United States)

Schotanus, M G M; Pilot, P; Vos, R; Kort, N P

2017-12-01

To compare the patients ability to forget the artificial knee joint in everyday life who were randomized to be operated for mobile- or fixed-bearing total knee arthroplasty (TKA). This single-center randomized controlled trial evaluated the 3-year follow-up of the cemented mobile- and fixed-bearing TKA from the same brand in a series of 41 patients. Clinical examination was during the pre-, 6-week, 6-month, 1-, 2- and 3-year follow-up containing multiple patient-reported outcome measures (PROMs) including the 12-item Forgotten Joint Score (FJS-12) at 3 years. Effect size was calculated for each PROM at 3-year follow-up to quantify the size of the difference between both bearings. At 3-year follow-up, general linear mixed model analysis showed that there were no significant or clinically relevant differences between the two groups for all outcome measures. Calculated effect sizes were small (awareness was slightly lower in patients operated with the MB TKA with comparable improved clinical outcome and PROMs at 3-year follow-up. Measuring joint awareness with the FJS-12 is useful and provides more stringent information at 3-year follow-up compared to other PROMs and should be the PROM of choice at each follow-up after TKA. Level I, randomized controlled trial.

SHOULDER RANGE OF MOTION, PITCH COUNT, AND INJURIES AMONG INTERSCHOLASTIC FEMALE SOFTBALL PITCHERS: A DESCRIPTIVE STUDY

Science.gov (United States)

Michener, Lori A.; Ellenbecker, Todd S.; Rauh, Mitchell J.

2012-01-01

Background/Purpose: Injury rates for softball players are similar to baseball players yet information regarding risk factors, pitching, and physical characteristics for high school windmill softball pitchers is limited. This information is needed to guide prevention, training, and rehabilitation efforts. The purpose of this study was to report descriptive data regarding the physical characteristics and pitching volume experienced by high school softball pitchers during one academic season. A secondary aim was to track and describe upper extremity injuries suffered by high school softball pitchers throughout the course of the 2009 season. Methods: Twelve uninjured female softball pitchers (13‐18y) from 5 Greenville, South Carolina high schools participated. Prior to the 2009 season, the pitchers' shoulder internal, external, total arc of rotation and horizontal adduction PROM was measured. During the 10‐week season, aggregate pitch counts (pitch volume) and occurrence of upper extremity injury were tracked for each pitcher. Results: Mean preseason internal, external, and total arc of rotation PROM was observed to be similar between the pitchers' dominant and non‐dominant shoulders. The PROM measures of horizontal abduction (HA) appear to demonstrate a side‐to‐side difference with less HA on the dominant arm of the pitchers who were examined. Subjects threw in an average of 10.1 games (±4.9) during the season. Six pitchers threw in 60% or more of the team's games and 3 of 12 pitchers pitched less than 25% of games. Pitchers averaged 61.8 pitches per game (±31.5) and 745.8 (±506.4) per season. Pitch count data did not appear to be different between injured and non‐injured pitchers. Conclusions: Knowledge of pitch volume can be used to prepare windmill softball pitchers for the seasonal stresses, guide establishment of goals when recovering from injury, or assist in training for an upcoming season. Further research is needed to examine larger samples of

A small microprocessor based CAMAC module for testing and monitoring purposes

CERN Document Server

Bouquet, B; Nguyen-Ngoc, Hoan

1981-01-01

Summary form only given, as follows. A small microcomputer, using a Motorola 6800, has been developed. Two printed-board versions have been operating since 1979 in the NA3 experiment, and about 30 other are used for test and small experiments in various laboratories. The computer consists of a 2/25 or 3/25 CAMAC unit, which can be crate controller or branch driver. In normal use, it is connected to SA400 floppy disks and a terminal. Optionally, interfaces to a cassette unit, PROM programmer and three analog outputs can be operated on the same boards. Total memory size is 11 kbytes PROM (22 kbytes with 2716 memories) and 8 kbit RAM. Software on PROM consists of an input-output monitor, with disassembling facility, editor and local assembler, a fast and easy-to-use floppy disk monitor, and an histogram package, in 7 kbytes PROM. Some macro instructions are recognised in the assembler: message printing, CAMAC functions, initialisations and are then very easily performed. (0 refs).

Premature rupture of membranes at term: immediate induction of ...

African Journals Online (AJOL)

Objective: To compare the maternal outcomes of immediate induction of labor with expectant management in women presenting with premature rupture of membranes (PROM) at term. Methods: One hundred and fifty two women with PROM at term were randomized into either immediate induction of labor with oxytocin or ...

An operational decision support framework for monitoring business constraints

NARCIS (Netherlands)

Maggi, F.M.; Montali, M.; Aalst, van der W.M.P.; Lara, de J.; Zisman, A.

2012-01-01

Only recently, process mining techniques emerged that can be used for Operational decision Support (OS), i.e., knowledge extracted from event logs is used to handle running process instances better. In the process mining tool ProM, a generic OS service has been developed that allows ProM to

Exploring the use of tablet computer-based electronic data capture system to assess patient reported measures among patients with chronic kidney disease: a pilot study.

Science.gov (United States)

Wong, Dorothy; Cao, Shen; Ford, Heather; Richardson, Candice; Belenko, Dmitri; Tang, Evan; Ugenti, Luca; Warsmann, Eleanor; Sissons, Amanda; Kulandaivelu, Yalinie; Edwards, Nathaniel; Novak, Marta; Li, Madeline; Mucsi, Istvan

2017-12-06

Collecting patient reported outcome measures (PROMs) via computer-based electronic data capture system may improve feasibility and facilitate implementation in clinical care. We report our initial experience about the acceptability of touch-screen tablet computer-based, self-administered questionnaires among patients with chronic kidney disease (CKD), including stage 5 CKD treated with renal replacement therapies (RRT) (either dialysis or transplant). We enrolled a convenience sample of patients with stage 4 and 5 CKD (including patients on dialysis or after kidney transplant) in a single-centre, cross-sectional pilot study. Participants completed validated questionnaires programmed on an electronic data capture system (DADOS, Techna Inc., Toronto) on tablet computers. The primary objective was to evaluate the acceptability and feasibility of using tablet-based electronic data capture in patients with CKD. Descriptive statistics, Fischer's exact test and multivariable logistic regression models were used for data analysis. One hundred and twenty one patients (55% male, mean age (± SD) of 58 (±14) years, 49% Caucasian) participated in the study. Ninety-two percent of the respondents indicated that the computer tablet was acceptable and 79% of the participants required no or minimal help for completing the questionnaires. Acceptance of tablets was lower among patients 70 years or older (75% vs. 95%; p = 0.011) and with little previous computer experience (81% vs. 96%; p = 0.05). Furthermore, a greater level of assistance was more frequently required by patients who were older (45% vs. 15%; p = 0.009), had lower level of education (33% vs. 14%; p = 0.027), low health literacy (79% vs. 12%; p = 0.027), and little previous experience with computers (52% vs. 10%; p = 0.027). Tablet computer-based electronic data capture to administer PROMs was acceptable and feasible for most respondents and could therefore be used to systematically assess PROMs

Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. ORACLE Collaborative Group.

Science.gov (United States)

Kenyon, S L; Taylor, D J; Tarnow-Mordi, W

2001-03-31

benefits for the neonate, and thus a probable reduction in childhood disability. However, co-amoxiclav cannot be routinely recommended for pPROM because of its association with neonatal necrotising enterocolitis. A follow-up study of childhood development and disability after pPROM is planned.

The Cervical Dystonia Impact Profile (CDIP-58: Can a Rasch developed patient reported outcome measure satisfy traditional psychometric criteria?

Directory of Open Access Journals (Sweden)

Bhatia Kailash P

2008-08-01

Full Text Available Abstract Background The United States Food and Drug Administration (FDA are currently producing guidelines for the scientific adequacy of patient reported outcome measures (PROMs in clinical trials, which will have implications for the selection of scales used in future clinical trials. In this study, we examine how the Cervical Dystonia Impact Profile (CDIP-58, a rigorous Rasch measurement developed neurologic PROM, stands up to traditional psychometric criteria for three reasons: 1 provide traditional psychometric evidence for the CDIP-58 in line with proposed FDA guidelines; 2 enable researchers and clinicians to compare it with existing dystonia PROMs; and 3 help researchers and clinicians bridge the knowledge gap between old and new methods of reliability and validity testing. Methods We evaluated traditional psychometric properties of data quality, scaling assumptions, targeting, reliability and validity in a group of 391 people with CD. The main outcome measures used were the CDIP-58, Medical Outcome Study Short Form-36, the 28-item General Health Questionnaire, and Hospital and Anxiety and Depression Scale. Results A total of 391 people returned completed questionnaires (corrected response rate 87%. Analyses showed: 1 data quality was high (low missing data ≤ 4%, subscale scores could be computed for > 96% of the sample; 2 item groupings passed tests for scaling assumptions; 3 good targeting (except for the Sleep subscale, ceiling effect = 27%; 4 good reliability (Cronbach's alpha ≥ 0.92, test-retest intraclass correlations ≥ 0.83; and 5 validity was supported. Conclusion This study has shown that new psychometric methods can produce a PROM that stands up to traditional criteria and supports the clinical advantages of Rasch analysis.

Does acupuncture used in nulliparous women reduce time from prelabour rupture of membranes at term to active phase of labour? A randomised controlled trial.

Science.gov (United States)

Selmer-Olsen, Tone; Lydersen, Stian; Mørkved, Siv

2007-01-01

To assess if acupuncture influences the onset of labour and the need for induction after prelabour rupture of membranes (PROM) in nulliparous women. Further, to investigate a possible effect of acupuncture on the woman's wellbeing. In a randomised controlled trial (RCT), 106 nulliparous women with PROM were allocated to an acupuncture group (AG) or a control group (CG). The outcome measures were time from PROM to onset of active phase of labour, and rate of inductions if labour was absent after 2 days. The women's self-reported wellbeing was registered on a Visual Analogue Scale (VAS). There was no statistically significant difference between the 2 groups regarding time from PROM to active phase (median times in AG versus CG: 15 versus 20.5 h, p=0.34). Additionally, there was no difference between the 2 groups in the need for induction. We found no significant differences in self-reported wellbeing, but the women receiving acupuncture considered their treatment to be more positive than the controls (p=0.003). No adverse effects were reported. Acupuncture treatment used in nulliparas after PROM showed no significant effect in reducing time to active labour or in reducing rate of inductions. There was no change in wellbeing as a result of acupuncture, but it was considered positive to receive this kind of treatment while waiting for labour to begin.

Obstetrical Complications in Women with Endometriosis: A Cohort Study in Japan.

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Takashi Harada

Full Text Available Endometriosis, which occurs in approximately 10% of women of reproductive age, is defined as the presence of endometrial tissue outside the uterus. Women with endometriosis are more likely to have difficulty conceiving and tend to receive infertility treatment, including assisted reproductive technology (ART therapy. There has not yet been a prospective cohort study examining the effects of endometriosis on pregnancy outcome in pregnant Japanese women.This was a prospective cohort study of the incidence of obstetrical complications in women with endometriosis using data of the Japan Environment & Children's Study (JECS. Included in this study were 9,186 pregnant women in the JECS with or without a history of endometriosis who gave birth or stillbirth or whose pregnancy was terminated with abortion between February and December 2011.The effects of endometriosis on pregnancy outcome.Of the 9,186 pregnant women in the JECS, 4,119 (44.8% had obstetrical complications; 330 participants reported a diagnosis of endometriosis before pregnancy, and these women were at higher risk for complications of pregnancy than those without a history of endometriosis (odds ratio (OR = 1.50; 95% confidence interval (CI 1.20 to 1.87. Logistic regression analyses showed that the adjusted OR for obstetrical complications of pregnant women who conceived naturally and had a history of endometriosis was 1.45 (CI 1.11 to 1.90. Among pregnant women with endometriosis, the ORs of preterm premature rupture of the membranes (PROM and placenta previa were significantly higher compared with women never diagnosed with endometriosis who conceived naturally or conceived after infertility treatment, except for ART therapy (OR 2.14, CI 1.03-4.45 and OR 3.37, CI 1.32-8.65.This study showed that endometriosis significantly increased the incidence of preterm PROM and placenta previa after adjusting for confounding of the data by ART therapy.

Correlates of vaginal colonization with group B streptococci among pregnant women

Directory of Open Access Journals (Sweden)

Tsering Chomu Dechen

2010-01-01

Full Text Available Background: A study of genital colonization by group B streptococcus (GBS was conducted in pregnant women in their third trimester, which is a known risk factor of morbidity and mortality among newborns. Aims: The present study was undertaken to study the prevalence and the correlates of vaginal colonization by GBS among pregnant women. Setting and Design: This observational cross-sectional study was conducted during September 2002 to March 2004 on 524 pregnant women. Materials and Methods: Three high vaginal swabs were obtained from all the pregnant women admitted at term and in preterm labor. Two swabs were used for aerobic culture and the third one for gram staining. The first set of swabs was cultured on 5% Sheep blood agar plates. The second set of swabs were inoculated into Todd-Hewitt broth and then subcultured in 5% Sheep blood agar plates. The main outcome measures were the presence of GBS infection in comparison to the age group, gravida, gestational age, premature rupture of membrane (PROM, preterm labor and association with febrile spells of the present pregnancy. Results: The culture positivity rate of GBS was 4.77% and coexistent organisms isolated were Candida species (36%, Staphylococcus aureus (8% and Enterococcus species (8%. Culture positivity in the age group of 18-25 years was 5.71%, of which 5.74% were in their first pregnancy. The correlation between age group and gravida with GBS culture positivity was statistically insignificant. The culture positivity in <36 weeks of gestational age was 6.93%. This relation was statistically significant. Twenty-eight percent developed PROM. Sixty-four percent of culture positives had preterm labor. Conclusion: GBS infection among pregnant women was significantly correlated with the gestational age, PROM and preterm labor. In pregnancy GBS colonization causes asymptomatic bacteriuria or UTI. It is a well known cause of puerperal infections with amnionitis,endometritis and sepsis being

What is the optimal time point to assess patient-reported recovery after hip and knee replacement? A systematic review and analysis of routinely reported outcome data from the English patient-reported outcome measures programme.

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Browne, John Patrick; Bastaki, Hamad; Dawson, Jill

2013-07-30

It is unclear if there is a clinically important improvement in the six to 12-month recovery period after hip and knee replacement. This is an obvious gap in the evidence required by patients undergoing these procedures. It is also an issue for the English PROMs (Patient-Reported Outcome Measures) Programme which uses 6-month outcome data to compare the results of hospitals that perform hip and knee replacements. A systematic review of studies reporting the Oxford Hip Score (OHS) or Oxford Knee Score (OKS) at 12 months after surgery was performed. This was compared with six-month outcome data collected for 60, 160 patients within the English PROMs programme. A minimally important difference of one standard error of the measurement, equivalent to 2.7 for the OHS and 2.1 for the OKS, was adopted. Six studies reported OHS data for 10 different groups containing 8,308 patients in total. In eight groups the change scores reported were at least 2.7 points higher than the six-month change observed in the PROMs programme (20.2 points). Nine studies reported OKS data for 13 different groups containing 4,369 patients in total. In eight groups the change scores reported were at least 2.1 points higher than the six-month change observed in the PROMs programme (15.0 points). There is some evidence from this systematic review that clinically important improvement in the Oxford hip and knee scores occurs in the six to 12 month recovery period. This trend is more apparent for hip than knee replacement. Therefore we recommend that the English Department of Health study the impact on hospital comparisons of using 12- rather than six-month outcome data.

Reliability and validity study on the Hungarian versions of the oswestry disability index and the Quebec back pain disability scale.

Science.gov (United States)

Valasek, Tamás; Varga, Peter Paul; Szövérfi, Zsolt; Kümin, Michelle; Fairbank, Jeremy; Lazary, Aron

2013-05-01

Patient-reported outcome measurements (PROMs) are widely used in spine care. The development of reliable and valid National versions of spine-related disability questionnaires is strongly recommended from both the clinical and scientific points-of-view. The aims of this study were to adapt and validate the Oswestry Disability Index (ODI) and the Quebec back pain disability scale (QDS) for use with the Hungarian language. After translating and culturally adapting the ODI and QDS, 133 patients with lumbar degenerative spinal disorder filled in the questionnaire booklet twice within 2 weeks. Subjects completed the Hungarian versions of the two PROMs as well as the WHOQoL-BREF validated as a general life quality questionnaire and Visual Analogue Scale of pain. Internal consistency, reliability and construct validity of the questionnaires were determined, as were the standard error of measurement (SEM) and minimal detectable change (MDC) scores. The Hungarian ODI consisted of one factor that showed good internal consistency (Cronbach-α 0.890). The QDS showed a four-factor structure with Cronbach-α values between 0.788 and 0.917. No significant floor or ceiling effects were observed. The test-retest analysis showed excellent reliability of the Hungarian ODI and QDS. The intraclass correlation coefficients (ICC) were 0.927 and 0.923, respectively. SEM values of 4.8 and 5.2 resulted in a MDC of 13 and 14 points in the Hungarian ODI and QDS, respectively. The correlation coefficient (r) between pain and ODI was 0.680 (p 0.4, p disability measured by the Hungarian ODI and QDS was significantly higher in the surgical subgroup than in non-surgically treated patients (p < 0.001). Translation and cultural adaptation of the ODI and QDS were successful. Hungarian versions of the ODI and QDS proved to be reliable, valid PROMs confirming that they can be used in future clinical and scientific work with Hungarian-speaking spine patients.

Outcomes of Pregnancies Complicated by Preterm Premature Rupture of Membranes Between 20 and 24 Weeks of Gestation.

Science.gov (United States)

Kibel, Mia; Asztalos, Elizabeth; Barrett, Jon; Dunn, Michael S; Tward, Carly; Pittini, Alex; Melamed, Nir

2016-08-01

To assess the natural history and contemporary outcomes in pregnancies complicated by previable preterm premature rupture of membranes (PROM). Retrospective study of all women with a singleton or twin pregnancy admitted to a single tertiary referral center who experienced preterm PROM between 20 and 23 6/7 weeks of gestation during 2004-2014 and underwent expectant management. Women electing termination of pregnancy and pregnancies complicated by major fetal anomalies were excluded. Severe neonatal morbidity was defined as a composite of bronchopulmonary dysplasia, severe neurologic injury, or severe retinopathy of prematurity. Long-term follow-up to a corrected age of 18-21 months was available for the majority of surviving neonates. Of the 140 neonates born to women with previable preterm PROM during the study period, 104 were eligible for the study. Overall 51 (49.0%, 95% confidence interval [CI] 39.4-58.6%) newborns survived to discharge, of whom 24 (47.1%, 95% CI 33.4-60.8%) experienced severe neonatal morbidity. The overall rate of long-term morbidity among surviving neonates was 23.3% (95% CI 11.7-34.9%) and was significantly higher among neonates who previously experienced severe neonatal morbidity compared with those who did not (39.1% compared with 10.0%, P=.04). The only two factors that were significantly associated with overall survival and survival without severe neonatal morbidity were gestational age at preterm PROM of 22 weeks or greater (adjusted odds ratio [OR] 12.2, 95% CI 3.3-44.8 and adjusted OR 4.8, 95% CI 1.2-19.3, respectively) and a latency period of greater than 7 days (adjusted OR 10.1, 95% CI 3.2-31.6, and adjusted OR 6.7, 95% CI 2.2-21.0, respectively). Expectant management was associated with maternal risks including placental abruption (17.3%, 95% CI 10.0-24.6%) and sepsis (4.8%, 95% CI 0.7-8.9%). Expectant management in pregnancies complicated by previable preterm PROM between 20 and 23 6/7 weeks of gestation is associated with an

Neonatal and infant outcomes in twin gestations with preterm premature rupture of membranes at 24-31 weeks of gestation.

Science.gov (United States)

Mendez-Figueroa, Hector; Dahlke, Joshua D; Viteri, Oscar A; Chauhan, Suneet P; Rouse, Dwight J; Sibai, Baha M; Blackwell, Sean C

2014-08-01

To describe the perinatal and infant and early childhood morbidity associated with preterm premature rupture of membranes (PROM) in a cohort of twin pregnancies evaluated prospectively with neonatal follow-up to 2 years of age. This was a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy. Inclusion criteria were twin gestation with preterm PROM diagnosed between 24 0/7 and 31 6/7 weeks of gestation and planned expectant management. Latency (time from membrane rupture to delivery) and perinatal outcomes were evaluated by gestational age at membrane rupture. Long-term neonatal outcomes were also analyzed. Among 151 women who met inclusion criteria, the median gestational age at preterm PROM was 28.1 weeks (range 24.1-31.6 weeks). Approximately one-third of women achieved a latency of at least 1 week. Gestational age at preterm PROM (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.63-0.90 for each week after 24 weeks of gestation) and cervical dilation at admission (OR 0.66, 95% CI 0.49-0.90 for each centimeter of dilation) were inversely associated with a latency period of at least 1 week. There were no stillbirths (95% CI 0-1%), but the rate of neonatal mortality was 90 per 1,000 newborns (95% CI 57-112) with a 7.3% cerebral palsy rate among survivors (95% CI 4.4-10.3%). In twin pregnancies, preterm PROM from 24 to 31 weeks of gestation is associated with a neonatal mortality rate of 9.0% and an overall cerebral palsy rate of 7.3%. A longer latency period is associated with less advanced cervical dilation and later gestational age at PROM. LEVEL OF EVIEDENCE: II.

Inter-provider comparison of patient-reported outcomes: developing an adjustment to account for differences in patient case mix.

Science.gov (United States)

Nuttall, David; Parkin, David; Devlin, Nancy

2015-01-01

This paper describes the development of a methodology for the case-mix adjustment of patient-reported outcome measures (PROMs) data permitting the comparison of outcomes between providers on a like-for-like basis. Statistical models that take account of provider-specific effects form the basis of the proposed case-mix adjustment methodology. Indirect standardisation provides a transparent means of case mix adjusting the PROMs data, which are updated on a monthly basis. Recently published PROMs data for patients undergoing unilateral knee replacement are used to estimate empirical models and to demonstrate the application of the proposed case-mix adjustment methodology in practice. The results are illustrative and are used to highlight a number of theoretical and empirical issues that warrant further exploration. For example, because of differences between PROMs instruments, case-mix adjustment methodologies may require instrument-specific approaches. A number of key assumptions are made in estimating the empirical models, which could be open to challenge. The covariates of post-operative health status could be expanded, and alternative econometric methods could be employed. © 2013 Crown copyright.

The importance of patient-reported outcome measures in reconstructive urology.

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Jackson, Matthew J; N'Dow, James; Pickard, Rob

2010-11-01

Patient-reported outcome measures (PROMs) are now recognised as the most appropriate instruments to assess the effectiveness of healthcare interventions from the patient's perspective. The purpose of this review was to identify recent publications describing the use of PROMs following reconstructive urological surgery. A wide systematic search identified only three original articles published in the last 2 years that prospectively assessed effectiveness using a patient-completed condition-specific or generic health-related quality of life (HRQoL) instrument. These publications illustrate the need to administer PROMs at a postoperative interval relevant to the anticipated recovery phase of individual procedures. They also highlight the difference in responsiveness of generic HRQoL instruments to symptomatic improvement between straightforward conditions such as pelviureteric junction obstruction and complex multidimensional conditions such as meningomyelocele. PROMs uptake and awareness is increasing in reconstructive urology but more work is required to demonstrate the effectiveness of surgical procedures for patients and healthcare funders alike. Healthcare policy-makers now rely on these measures to determine whether specific treatments are worth financing and to compare outcomes between institutions.

Immediate combined effect of gastrocnemius stretching and sustained talocrural joint mobilization in individuals with limited ankle dorsiflexion: A randomized controlled trial.

Science.gov (United States)

Kang, Min-Hyeok; Oh, Jae-Seop; Kwon, Oh-Yun; Weon, Jong-Hyuk; An, Duk-Hyun; Yoo, Won-Gyu

2015-12-01

Although gastrocnemius stretching and talocrural joint mobilization have been suggested as effective interventions to address limited ankle dorsiflexion passive range of motion (DF PROM), the effects of a combination of the two interventions have not been identified. The aim of the present study was to compare the effects of gastrocnemius stretching combined with joint mobilization and gastrocnemius stretching alone. A randomized controlled trial. In total, 24 individuals with limited ankle DF PROM were randomized to undergo gastrocnemius stretching combined with joint mobilization (12 feet in 12 individuals) or gastrocnemius stretching alone (12 feet in 12 individuals) for 5 min. Ankle kinematics during gait (time to heel-off and ankle DF before heel-off), ankle DF PROM, posterior talar glide, and displacement of the myotendinous junction (MTJ) of the gastrocnemius were assessed before and after the interventions. The groups were compared using two-way repeated measures analysis of variance. Greater increases in the time to heel-off and ankle DF before heel-off during gait and posterior talar glide were observed in the stretching combined with joint mobilization group versus the stretching alone group. Ankle DF PROM and displacement of the MTJ of the gastrocnemius were increased significantly after the interventions in both groups, with no significant difference between them. These findings suggest that gastrocnemius stretching with joint mobilization needs to be considered to improve ankle kinematics during gait. Copyright © 2015 Elsevier Ltd. All rights reserved.

Residential proximity to major roads and obstetrical complications.

Science.gov (United States)

Yorifuji, Takashi; Naruse, Hiroo; Kashima, Saori; Murakoshi, Takeshi; Doi, Hiroyuki

2015-03-01

Exposure to air pollution is linked with an increased risk of preterm births. To provide further evidence on this relationship, we evaluated the association between proximity to major roads--as an index for air pollution exposure--and various obstetrical complications. Data were extracted from a database maintained by the perinatal hospital in Shizuoka, Japan. We restricted the analysis to mothers with singleton pregnancies of more than 22 weeks of gestation from 1997 to 2012 (n=19,077). Using the geocoded residential information, each mother was assigned proximity to major roads. We then estimated multivariate adjusted odds ratios and their 95% confidence intervals (CIs) for the effects of proximity to major roads on various obstetrical complications (preeclampsia, gestational diabetes mellitus, placenta abruption, placenta previa, preterm premature rupture of membrane (pPROM), preterm labor, and preterm births). We found positive associations of proximity to major roads with preeclampsia and pPROM. Living within 200 m increased the odds of preeclampsia by 1.3 times (95% CI, 1.0-1.8) and pPROM by 1.6 times (95% CI, 1.1-2.2). Furthermore, living within 200 m increased the odds of preterm births by 1.4 fold (95% CI, 1.2-1.7). Exposure to traffic-related air pollution increased the risk of preeclampsia and pPROM in this study. We propose a mechanism responsible for the association between air pollution and preterm births. Copyright © 2014 Elsevier B.V. All rights reserved.

Periodontal disease and some adverse perinatal outcomes in a cohort of low risk pregnant women

Directory of Open Access Journals (Sweden)

Cecatti Jose G

2010-11-01

Full Text Available Abstract Objective To evaluate the association of periodontal disease (PD in pregnancy with some adverse perinatal outcomes. Method This cohort study included 327 pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. The rates of preterm birth (PTB, low birth weight (LBW, small for gestational age (SGA neonates and prelabor rupture of membranes (PROM were evaluated using Risk Ratios (95%CI and Population Attributable Risk Fractions. Results PD was associated with a higher risk of PTB (RRadj. 3.47 95%CI 1.62-7.43, LBW (RRadj. 2.93 95%CI 1.36-6.34 and PROM (RRadj. 2.48 95%CI 1.35-4.56, but not with SGA neonates (RR 2.38 95%CI 0.93 - 6.10. Conclusions PD was a risk factor for PT, LBW and PROM among Brazilian low risk pregnant women.

Isolation of Persicaria minor sesquiterpene synthase promoter and its deletions for transgenic Arabidopsis thaliana

Science.gov (United States)

Omar, Aimi Farehah; Ismail, Ismanizan

2016-11-01

Sesquiterpene synthase (SS) catalyzes the formation of sesquiterpenes from farnesyl diphosphate (FDP) via carbocation intermediates. In this study, the promoter region of sesquiterpene synthase was isolated from Persicaria minor to identify possible cis-acting elements in the promoter. The full-length PmSS promoter of P. minor is 1824-bp sequences. The sequence was analyzed and several putative cis-acting regulatory elements were identified. Three cis-acting regulatory elements were selected for deletion analysis which are cis-acting element involved in wound responsiveness (WUN), cis - acting element involved in defense and stress responsiveness (TC) and cis-acting element involved in ABA responsiveness (ABRE). Series of deletions were conducted to assess the promoter activity producing three truncated fragments promoter; Prom 2 1606-bp, Prom 3 1144- bp, and Prom 4 921-bp. The full-length promoter and its deletion series were cloned into the pBGWFS7 vector which contain β-glucuronidase (GUS) gene and green fluorescent protein (GFP) as the reporter gene. All constructs were successfully transformed into Arabidopsis thaliana based on PCR of positive BASTA resistance plants.

Study designs may influence results

DEFF Research Database (Denmark)

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

2017-01-01

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

SPFC bus design studies

Energy Technology Data Exchange (ETDEWEB)

Potter, L.; Reinkingh, J.

1999-07-01

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

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

DEFF Research Database (Denmark)

Özkil, Ali Gürcan

2017-01-01

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

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

Science.gov (United States)

Papantonopoulos, Sotiris

2004-11-01

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

On the Relationship Between Musicianship and Contralateral Suppression of Transient-Evoked Otoacoustic Emissions.

Science.gov (United States)

Stuart, Andrew; Daughtrey, Emma R

2016-04-01

The medial olivocochlear (MOC) efferent reflex that modulates outer hair cell function has been shown to be more robust in musicians versus nonmusicians as evidenced in greater contralateral suppression of transient-evoked otoacoustic emissions (TEOAEs). All previous research comparing musical ability and MOC efferent strength has defined musicianship dichotomously (i.e., high-level music students or professional classical musicians versus nonmusicians). The objective of the study was to further explore contralateral suppression of TEOAEs among adults with a full spectrum of musicianship ranging from no history of musicianship to professional musicians. Musicianship was defined by both self-report and with an objective test to quantify individual differences in perceptual music skills. A single-factor between-subjects and correlational research designs were employed. Forty-five normal-hearing young adults participated. Participants completed a questionnaire concerning their music experience and completed the Brief Profile of Music Perception Skills (PROMS) to quantify perceptual musical skills across multiple musical domains (i.e., accent, melody, tempo, and tuning). TEOAEs were evaluated with 60 dB peak equivalent sound pressure level click stimuli with and without a contralateral 65 dB sound pressure level white noise suppressor. TEOAE suppression was expressed in two ways, absolute TEOAE suppression in dB and a normalized index of TEOAE suppression (i.e., percentage of suppression). Participants who considered themselves musicians scored significantly higher on all subscales and total Brief PROMS score (p 0.05). There were no statistically significant correlations or linear predictive relationships between subscale or total Brief PROMS scores with absolute and percentage of TEOAE suppression (p > 0.05). The findings do not support the notion of a graded enhancement of MOC efferent suppression among adults with varied degrees of musicianship from nonmusicians to

A systematic review of measurement properties of patient reported outcome measures in psoriatic arthritis: A GRAPPA-OMERACT initiative.

Science.gov (United States)

Højgaard, Pil; Klokker, Louise; Orbai, Ana-Maria; Holmsted, Kim; Bartels, Else M; Leung, Ying Ying; Goel, Niti; de Wit, Maarten; Gladman, Dafna D; Mease, Philip; Dreyer, Lene; Kristensen, Lars E; FitzGerald, Oliver; Tillett, William; Gossec, Laure; Helliwell, Philip; Strand, Vibeke; Ogdie, Alexis; Terwee, Caroline B; Christensen, Robin

2018-04-01

An updated psoriatic arthritis (PsA) core outcome set (COS) for randomized controlled trials (RCTs) was endorsed at the Outcome Measures in Rheumatology (OMERACT) meeting in 2016. To synthesize the evidence on measurement properties of patient reported outcome measures (PROMs) for PsA and thereby contribute to development of a PsA core outcome measurement set (COMS) as described by the OMERACT Filter 2.0. A systematic literature search was performed in EMBASE, MEDLINE and PsycINFO on Jan 1, 2017 to identify full-text articles with an aim of assessing the measurement properties of PROMs in PsA. Two independent reviewers rated the quality of studies using the COnsensus based standards for the Selection of health Measurement INstruments (COSMIN) checklist, and performed a qualitative evidence synthesis. Fifty-five studies were included in the systematic review. Forty-four instruments and a total of 89 scales were analyzed. PROMs measuring COS domains with at least fair quality evidence for good validity and reliability (and no evidence for poor properties) included the Stockerau Activity Score for PsA (German), Psoriasis Symptom Inventory, visual analogue scale for Patient Global, 36 Item Short Form Health Survey Physical Function subscale, Health Assessment Questionnaire Disability Index, Bath Ankylosing Spondylitis Functional Index, PsA Impact of Disease questionnaire, PsA Quality of Life questionnaire, VITACORA-19, Functional Assessment of Chronic Illness Therapy Fatigue scale and Social Role Participation Questionnaire. At least one PROM with some evidence for aspects of validity and reliability was available for six of the eight mandatory domains of the PsA COS. Copyright © 2018 Elsevier Inc. All rights reserved.

Risk Factors for Intraventricular Hemorrhage in Preterm Infants Born at 34 Weeks of Gestation or Less Following Preterm Premature Rupture of Membranes.

Science.gov (United States)

Lu, Hongyan; Wang, Qiuxia; Lu, Junyin; Zhang, Qiang; Kumar, Pravesh

2016-04-01

The objective of this study is to identify possible perinatal risk factors related to intraventricular hemorrhage (IVH) in preterm infants born at 34 weeks of gestation or less following preterm premature rupture of membranes (pPROM). A total of 292 preterm infants born at 34 weeks of gestation or less following pPROM were enrolled in the study, while 155 newborns with incomplete data, especially those that lack histological examination of the placenta, maternal details, and neonatal characteristics, have been further excluded. Finally, data of 137 preterm infants were included in the analysis. All infants underwent ultrasonographic screening for IVH. Thirty-three infants with IVH were considered as cases and 104 infants without IVH were considered as controls. The association between risk factors and IVH was evaluated by univariate and multivariate logistic regression analyses. The incidence of IVH in preterm infants born at 34 weeks of gestation or less following pPROM was 24.1%, while the incidence of maternal chorioamnionitis was 43.8%. By univariate analysis, gestational age, birth weight, asphyxia resuscitation, maternal chorioamnionitis, fetal distress, amniotic fluid index, and latency of the rupture of membranes to birth were found to be significantly different between the 2 groups. By logistic regression analysis, lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis were found to be independent risk factors for IVH. Lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis are independent risk factors for IVH in preterm infants born at 34 weeks of gestation or less following pPROM. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

FFAG Designs for the International Design Study for the Neutrino Factory

Energy Technology Data Exchange (ETDEWEB)

Berg, J.S.; Machida, S.

2009-05-04

The International Design Study for the Neutrino Factory (IDS-NF) aims to produce a design report for a neutrino factory. One component of that design is a linear nonscaling fixed-field alternating gradient accelerator (FFAG) that will accelerate to the final energy of 25 GeV. An FFAG is used to reduce the machine cost by maximizing the number of passes made through the RF cavities. We present some design options for this FFAG, individually optimized for cost. We study the addition of nonlinear magnets to the lattice to improve the performance of the lattice and consider the negative effects of doing so.

FED/INTOR reactor design studies

International Nuclear Information System (INIS)

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

1982-03-01

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

What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register.

Science.gov (United States)

Svedbo Engström, Maria; Leksell, Janeth; Johansson, Unn-Britt; Gudbjörnsdottir, Soffia

2016-03-24

There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. Semistructured qualitative interviews analysed using content analysis. Hospital-based outpatient clinics and primary healthcare clinics in Sweden. 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). Swedish adults (≥ 18 years) living with type 1 DM or type 2 DM (duration ≥ 5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme 'To live a good life with diabetes' constituting the two main categories 'How I feel and how things are going with my diabetes' and 'Support from diabetes care in managing diabetes' including five different categories. Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR. 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/

Hand-related physical function in rheumatic hand conditions

DEFF Research Database (Denmark)

Klokker, Louise; Terwee, Caroline B; Wæhrens, Eva Ejlersen

2016-01-01

as well as those items from the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) item bank that are relevant to patients with rheumatic hand conditions. Selection will be based on consensus among reviewers. Content validity of selected items will be established......INTRODUCTION: There is no consensus about what constitutes the most appropriate patient-reported outcome measurement (PROM) instrument for measuring physical function in patients with rheumatic hand conditions. Existing instruments lack psychometric testing and vary in feasibility...... and their psychometric qualities. We aim to develop a PROM instrument to assess hand-related physical function in rheumatic hand conditions. METHODS AND ANALYSIS: We will perform a systematic search to identify existing PROMs to rheumatic hand conditions, and select items relevant for hand-related physical function...

Hand-related physical function in rheumatic hand conditions

DEFF Research Database (Denmark)

Klokker, Louise; Terwee, Caroline; Wæhrens, Eva Elisabet Ejlersen

2016-01-01

INTRODUCTION: There is no consensus about what constitutes the most appropriate patient-reported outcome measurement (PROM) instrument for measuring physical function in patients with rheumatic hand conditions. Existing instruments lack psychometric testing and vary in feasibility...... and their psychometric qualities. We aim to develop a PROM instrument to assess hand-related physical function in rheumatic hand conditions. METHODS AND ANALYSIS: We will perform a systematic search to identify existing PROMs to rheumatic hand conditions, and select items relevant for hand-related physical function...... as well as those items from the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) item bank that are relevant to patients with rheumatic hand conditions. Selection will be based on consensus among reviewers. Content validity of selected items will be established...

Trends in preterm birth: singleton and multiple pregnancies in the Netherlands, 2000-2007.

Science.gov (United States)

Schaaf, J M; Mol, B W J; Abu-Hanna, A; Ravelli, A C J

2011-09-01

Several studies have reported increasing trends in preterm birth in developed countries, mainly attributable to an increase in medically indicated preterm births. Our aim was to describe trends in preterm birth among singleton and multiple pregnancies in the Netherlands. Prospective cohort study. Nationwide study. We studied 1,451,246 pregnant women from 2000 to 2007. We assessed trends in preterm birth. We subdivided preterm birth into spontaneous preterm birth after premature prelabour rupture of membranes (pPROM), medically indicated preterm birth and spontaneous preterm birth without pPROM. We performed analyses separately for singletons and multiples. The primary outcome was preterm birth, defined as birth before 37 weeks of gestation, with very preterm birth (birth was 7.7% and the risk of very preterm birth was 1.3%. In singleton pregnancies, the preterm birth risk decreased significantly from 6.4% to 6.0% (P birth without pPROM (3.6-3.1%, P birth risk increased significantly (47.3-47.7%, P = 0.047), mainly as a result of medically indicated preterm birth, which increased from 15.0% to 17.9% (P birth risk in singleton pregnancies decreased significantly over the years. The trend of increasing preterm birth risk reported in other countries was only observed in (medically indicated) preterm birth in multiple pregnancies. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Outcomes important to burns patients during scar management and how they compare to the concepts captured in burn-specific patient reported outcome measures.

Science.gov (United States)

Jones, Laura L; Calvert, Melanie; Moiemen, Naiem; Deeks, Jonathan J; Bishop, Jonathan; Kinghorn, Philip; Mathers, Jonathan

2017-12-01

Pressure garment therapy (PGT) is an established treatment for the prevention and treatment of hypertrophic scarring; however, there is limited evidence for its effectiveness. Burn survivors often experience multiple issues many of which are not adequately captured in current PGT trial measures. To assess the effectiveness of PGT it is important to understand what outcomes matter to patients and to consider whether patient-reported outcome measures (PROMs) can be used to ascertain the effect of treatments on patients' health-related quality of life. This study aimed to (a) understand the priorities and perspectives of adult burns patients and the parents of burns patients who have experienced PGT via in-depth qualitative data, and (b) compare these with the concepts captured within burn-specific PROMs. We undertook 40 semi-structured interviews with adults and parents of paediatric and adolescent burns patients who had experienced PGT to explore their priorities and perspectives on scar management. Interviews were audio-recorded, transcribed and thematically analysed. The outcomes interpreted within the interview data were then mapped against the concepts captured within burn-specific PROMs currently in the literature. Eight core outcome domains were identified as important to adult patients and parents: (1) scar characteristics and appearance, (2) movement and function, (3) scar sensation, (4) psychological distress, adjustments and a sense of normality, (5) body image and confidence, (6) engagement in activities, (7) impact on relationships, and (8) treatment burden. The outcome domains presented reflect a complex holistic patient experience of scar management and treatments such as PGT. Some currently available PROMs do capture the concepts described here, although none assess psychological adjustments and attainment of a sense of normality following burn injury. The routine use of PROMs that represent patient experience and their relative contribution to trial

On the Modern History of Passive Solar Architecture

DEFF Research Database (Denmark)

Marsh, Rob

2017-01-01

This article examines the paradox of passive solar architecture within the Nordic context of Denmark, Norway and Sweden. Regulative developments to reduce space heating demand since the 1970s oil crisis are explored, highlighting architectural responses and the rise in prom-inence of passive solar...... design. An empirical study of passive solar housing schemes docu-ments architectural strategy, energy savings and extensive problems with overheating. A theo-retical study examines how passive solar was seen as advantageous when viewed with the 1985-2005 space heating paradigm, but actually resulted...... of Nordic modernism meant that passive solar architecture became the de-facto visual, aesthetic and functional expression of environmental design at that time. The article concludes by explor-ing the implications of the environmental paradigm for the architectural profession. By positing the architectural...

United States Air Force Summer Research Program 1991. Summer Faculty Research Program (SFRP) Reports. Volume 5B. Wright Laboratory

Science.gov (United States)

1992-01-09

Design, Addison-Wesley, 1989. 28. Thompson, Peter M., Pro&m CC Version 4 Tutorial and User’s Guide. STI, November, 1988. 29. Bacon, BJ., Schmidt, D.K...6rd USG: pp -C Tre .ser ernv~rr..e--= i e _-es=--. zec --re. ENVI t-e tase .Be- -- Cvi-onmert ;cr cer’er,?’ L-e v..tr mscros tl%:t ar-iv’ec %t the prog

Outcome of Induction and Associated Factors among Term and Post

African Journals Online (AJOL)

GB

354 records ... The purpose of this study was to analyze outcome of induction with ... (PROM), post-term pregnancy, maternal medical ... restriction, iso-immunization), preeclampsia, and .... provides services for approximately 9000 inpatient.

Neonatal survival after prolonged preterm premature rupture of membranes before 24 weeks of gestation.

Science.gov (United States)

Brumbaugh, Jane E; Colaizy, Tarah T; Nuangchamnong, Nina; O'Brien, Emily A; Fleener, Diedre K; Rijhsinghani, Asha; Klein, Jonathan M

2014-11-01

To evaluate neonatal survival after prolonged preterm premature rupture of membranes (PROM) in the era of antenatal corticosteroids, surfactant, and inhaled nitric oxide. A single-center retrospective cohort study of neonates born from 2002-2011 after prolonged (1 week or more) preterm (less than 24 weeks of gestation) rupture of membranes was performed. The primary outcome was survival to discharge. Neonates whose membranes ruptured less than 24 hours before delivery (n=116) were matched (2:1) on gestational age at birth, sex, and antenatal corticosteroid exposure with neonates whose membranes ruptured 1 week or more before delivery (n=58). Analysis used conditional logistic regression for categorical data and Wilcoxon signed rank test for continuous data. The prolonged preterm PROM exposed and unexposed cohorts had survival rates of 90% and 95%, respectively, although underpowered to assess the statistical significance (P=.313). Exposed neonates were more likely have pulmonary hypoplasia (26/58 exposed, 1/114 unexposed, Prupture (20.4 weeks exposed, 22.3 weeks unexposed, P=.189), length of rupture (3.7 weeks exposed, 6.4 weeks unexposed, P=.717), and lowest maximal vertical pocket before 24 weeks of gestation (0 cm exposed, 1.4 cm unexposed, P=.114) did not discriminate between survivors and nonsurvivors after exposure to prolonged preterm PROM. With antenatal steroid exposure and aggressive pulmonary management, survival to discharge after prolonged preterm PROM was 90%. Pulmonary morbidities were common. Of note, the data were limited to women who remained pregnant 1 week or longer after rupture of membranes.

Techniques for Conducting Effective Concept Design and Design-to-Cost Trade Studies

Science.gov (United States)

Di Pietro, David A.

2015-01-01

Concept design plays a central role in project success as its product effectively locks the majority of system life cycle cost. Such extraordinary leverage presents a business case for conducting concept design in a credible fashion, particularly for first-of-a-kind systems that advance the state of the art and that have high design uncertainty. A key challenge, however, is to know when credible design convergence has been achieved in such systems. Using a space system example, this paper characterizes the level of convergence needed for concept design in the context of technical and programmatic resource margins available in preliminary design and highlights the importance of design and cost evaluation learning curves in determining credible convergence. It also provides techniques for selecting trade study cases that promote objective concept evaluation, help reveal unknowns, and expedite convergence within the trade space and conveys general practices for conducting effective concept design-to-cost studies.

Some design aspects of transuranic field studies

International Nuclear Information System (INIS)

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

1977-01-01

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

Antibioticoprofilaxia com ampicilina na rotura prematura das membranas: estudo randomizado e duplo cego Ampicillin prophylaxis in premature rupture of membranes: randomized and double-blind study

Directory of Open Access Journals (Sweden)

José Elias Soares da Rocha

1999-06-01

avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM, and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients received ampicillin and the control group (60 patients received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index, and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes, bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.

Designing a Language Study.

Science.gov (United States)

Brown, James Dean

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

Can patient-reported measurements of pain be used to improve cancer pain management? A systematic review and meta-analysis.

Science.gov (United States)

Adam, Rosalind; Burton, Christopher D; Bond, Christine M; de Bruin, Marijn; Murchie, Peter

2017-12-01

Cancer pain is a distressing and complex experience. It is feasible that the systematic collection and feedback of patient-reported outcome measurements (PROMs) relating to pain could enhance cancer pain management. We aimed to conduct a systematic review of interventions in which patient-reported pain data were collected and fed back to patients and/or professionals in order to improve cancer pain control. MEDLINE, EMBASE and CINAHL databases were searched for randomised and non-randomised controlled trials in which patient-reported data were collected and fed back with the intention of improving pain management by adult patients or professionals. We conducted a narrative synthesis. We also conducted a meta-analysis of studies reporting pain intensity. 29 reports from 22 trials of 20 interventions were included. PROM measures were used to alert physicians to poorly controlled pain, to target pain education and to link treatment to management algorithms. Few interventions were underpinned by explicit behavioural theories. Interventions were inconsistently applied or infrequently led to changes in treatment. Narrative synthesis suggested that feedback of PROM data tended to increase discussions between patients and professionals about pain and/or symptoms overall. Meta-analysis of 12 studies showed a reduction in average pain intensity in intervention group participants compared with controls (mean difference=-0.59 (95% CI -0.87 to -0.30)). Interventions that assess and feedback cancer pain data to patients and/or professionals have so far led to modest reductions in cancer pain intensity. Suggestions are given to inform and enhance future PROM feedback interventions. 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/.

Predictive value of vaginal IL-6 and TNFα bedside tests repeated until delivery for the prediction of maternal-fetal infection in cases of premature rupture of membranes.

Science.gov (United States)

Kayem, Gilles; Batteux, Frederic; Girard, Noémie; Schmitz, Thomas; Willaime, Marion; Maillard, Francoise; Jarreau, Pierre Henri; Goffinet, Francois

2017-04-01

Examine the predictive value for maternal-fetal infection of routine bedside tests detecting the proinflammatory cytokines, TNFα and IL-6, in the vaginal secretions of women with premature rupture of the membranes (PROM). This prospective two-center cohort study included all women hospitalized for PROM over a 2-year period. A bedside test assessed IL-6 and TNFα in vaginal secretions. Both centers routinely tested CRP and leukocytes, assaying both in maternal serum, and analyzed vaginal bacterial flora; all samples were repeated twice weekly until delivery. The study included 689 women. In cases of preterm PROM (PPROM) before 37 weeks (n=184), a vaginal sample positive for one or more bacteria was the only marker associated with early neonatal infection (OR 5.6, 95%CI; 2.0-15.7). Its sensitivity was 82% (95%CI; 62-94) and its specificity 56% (95%CI; 47-65). All positive markers of infection were associated with the occurrence of chorioamnionitis. In cases of PROM from 37 weeks onward (n=505), only CRP >5mg/dL was associated with early neonatal infection (OR=8.3, 95%CI; 1.1-65.4) or clinical chorioamnionitis (OR=6.8, 95%CI; 1.5-30.0). The sensitivity of CRP >5mg/dL was 91% (95%CI; 59-100) and its specificity 45% (95%CI; 40-51) for predicting early neonatal infection, and 89% (95%CI; 65-99) and 46% (95%CI; 41-51), respectively, for predicting clinical chorioamnionitis. The association of vaginal cytokines with maternal-fetal infection is weak and thus prevents their use as a good predictor of maternal-fetal infection. CRP and vaginal samples may be useful for identifying a group of women at low risk of infection. Copyright © 2017 Elsevier B.V. All rights reserved.

Influence of the mental health status on a new measure of objective functional impairment in lumbar degenerative disc disease.

Science.gov (United States)

Stienen, Martin N; Smoll, Nicolas R; Joswig, Holger; Snagowski, Jan; Corniola, Marco V; Schaller, Karl; Hildebrandt, Gerhard; Gautschi, Oliver P

2017-06-01

The Timed Up and Go (TUG) test has recently been proposed as a simple and standardized measure for objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). The study aimed to explore the relationship between a patient's mental health status and both patient-reported outcome measures (PROMs) and TUG test results. This is a prospective institutional review board-approved two-center study. The sample was composed of 375 consecutive patients scheduled for lumbar spine surgery and a healthy cohort of 110 control subjects. Patients and control subjects were assessed with the TUG test and a comprehensive panel of subjective PROMs of pain intensity (visual analog scale [VAS]), functional impairment (Roland-Morris Disability Index [RMDI]), Oswestry Disability Index [ODI]), as well as health-related quality of life (hrQoL; Euro-Qol [EQ]-5D). Standardized age- and sex-adjusted TUG test T-scores were calculated. The dependent variable was the short-form (SF)-12 mental component summary (MCS) quartiles, and the independent variables were the TUG T-scores and PROMs. Direct and adjusted analyses of covariance were performed to estimate the interaction between the SF-12 MCS quartiles and the independent variables. In patients, there was a significant decrease in the subjective PROMs, notably the VAS back pain (p=.001) and VAS leg pain (p=.035), as well as significant increase in the RMDI (pmental hrQoL on subjective measures of pain, functional impairment, and hrQoL that might lead to bias when evaluating patients with lumbar DDD who suffer from reduced mental hrQoL. The TUG test appears to be a stable instrument and especially helpful in the evaluation of patients with lumbar DDD and mental health problems. Copyright © 2016 Elsevier Inc. All rights reserved.

Exploratory Shaft Facility design basis study report

International Nuclear Information System (INIS)

Langstaff, A.L.

1987-01-01

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

Premature rupture of the membranes at term: time to reevaluate the management.

Science.gov (United States)

Sadeh-Mestechkin, Dana; Samara, Nivin; Wiser, Amir; Markovitch, Ofer; Shechter-Maor, Gil; Biron-Shental, Tal

2016-11-01

To compare maternal and neonatal outcomes in induced vs. expectant management of term PROM. This retrospective study included patients with term PROM. A total of 325 were enrolled: 213 managed expectantly and 112 induced at admission and matched according to gestational age. Expectant management group patients were allowed to defer labour induction up to 48 h. Primary outcome measures were maternal or foetal signs of infection (chorioamnionitis, early neonatal sepsis or postpartum endometritis) and prolonged maternal hospitalization. Secondary outcome was caesarean delivery rate. All group characteristics were comparable except that expectant management included more nulliparous women. Women managed expectantly had a higher rate of prolonged hospitalization [15 (7 %) vs. 2 (1.8 %); P = 0.043] as an indication of maternal complications, compared to induction management. They also had a higher rate of caesarean delivery [34 (16.4 %) vs. 8 (7.1 %), respectively; P = 0.024]. Adjustment for parity did not change the results. Early neonatal outcomes were similar between groups. Expectant management increases the likelihood of caesarean delivery and prolonged maternal hospitalization. This should be considered when advising patients with term PROM regarding labour induction.

Relief of knee flexion contracture and gait improvement following adaptive training for an assist device in a transtibial amputee: A case study.

Science.gov (United States)

Kim, Sol-Bi; Ko, Chang-Yong; Son, Jinho; Kang, Sungjae; Ryu, Jeicheong; Mun, Museong

2017-01-01

Management of a knee contracture is important for regaining gait ability in transtibial amputees. However, there has been little study of prosthesis training for enhancing mobility and improving range of motion in cases of restricted knee extension. This study aimed to evaluate the effects of adaptive training for an assist device (ATAD) for a transtibial amputee with a knee flexion contracture (KFC). A male transtibial amputee with KFC performed 4 months of ATAD with a multidisciplinary team. During the ATAD, the passive range of motion (PROM) in the knee, amputee mobility predictor (AMP) assessment, center of pressure (COP) on a force plate-equipped treadmill, gait features determined by three-dimensional motion analysis, and Short-Form 36 Item Health Survey (SF-36) scores were evaluated. Following ATAD, PROM showed immediate improvement (135.6 ± 2.4° at baseline, 142.5 ± 1.7° at Step 1, 152.1 ± 1.8° at Step 2, 165.8 ± 1.9° at Step 3, and 166.0 ± 1.4° at Step 4); this was followed by an enhanced COP. Gradually, gait features also improved. Additionally, the AMP score (5 at baseline to 29 at Step 4) and K-level (K0 at baseline to K3 at Step 4) increased after ATAD. Along with these improvements, the SF-36 score also improved. ATAD could be beneficial for transtibial amputees by relieving knee contractures and improving gait.

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

OpenAIRE

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

2017-01-01

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

Design study on advanced nuclear fuel recycle system. Conceptual design study of recycle system using molten salt

International Nuclear Information System (INIS)

Kasai, Y.; Kakehi, I.; Moro, T.; Higashi, T.; Tobe, K.; Kawamura, F.; Yonezawa, S.; Yoshiuji, T.

1998-10-01

Advanced recycle system engineering group of OEC (Oarai Engineering Center) has being carried out a design study of the advanced nuclear fuel recycle system using molten salt (electro-metallurgical process). This system is aiming for improvements of fuel cycle economy and reduction of environmental burden (MA recycles, Minimum of radioactive waste disposal), and also improvement of safety and nuclear non-proliferation. This report describes results of the design study that has been continued since December 1996. (1) A design concept of the advanced nuclear fuel recycle system, that is a module type recycles system of pyrochemical reprocessing and fuel re-fabrication was studied. The module system has advantage in balance of Pu recycle where modules are constructed in coincidence with the construction plan of nuclear power plants, and also has flexibility for technology progress. A demonstration system, minimum size of the above module, was studies. This system has capacity of 10 tHM/y and is able to demonstrate recycle technology of MOX fuel, metal fuel and nitride fuel. (2) Each process of the system, which are pyrochemical electrorefining system, cathode processor, de-cladding system, waste disposal system, etc., were studied. In this study, capacity of an electrorefiner was discussed, and vitrification experiment of molten salt using lead-boric acid glass was conducted. (3) A hot cell system and material handling system of the demonstration system was studied. A robot driven by linear motor was studied for the handling system, and an arrangement plan of the cell system was made. Criticality analysis in the cell system and investigation of material accountancy system of the recycle plant were also made. This design study will be continued in coincidence with design study of reactor and fuel, aiming to establish the concept of FBR recycle system. (author)

Fast Initialization of Bubble-Memory Systems

Science.gov (United States)

Looney, K. T.; Nichols, C. D.; Hayes, P. J.

1986-01-01

Improved scheme several orders of magnitude faster than normal initialization scheme. State-of-the-art commercial bubble-memory device used. Hardware interface designed connects controlling microprocessor to bubblememory circuitry. System software written to exercise various functions of bubble-memory system in comparison made between normal and fast techniques. Future implementations of approach utilize E2PROM (electrically-erasable programable read-only memory) to provide greater system flexibility. Fastinitialization technique applicable to all bubble-memory devices.

Design studies of Tokamak power reactor in JAERI

International Nuclear Information System (INIS)

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

1985-01-01

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

The household contact study design for genetic epidemiological studies of infectious diseases

Directory of Open Access Journals (Sweden)

Catherine eStein

2013-04-01

Full Text Available Most genetic epidemiological study designs fall into one of two categories: family-based and population-based (case-control. However, recent advances in statistical genetics call for study designs that combine these two approaches. We describe the household contact study design as we have applied it in our several years of study of the epidemiology of tuberculosis. Though we highlight its applicability for genetic epidemiological studies of infectious diseases, there are many facets of this design that are appealing for modern genetic studies, including the simultaneous enrollment of related and unrelated individuals, closely and distantly related individuals, collection of extensive epidemiologic and phenotypic data, and evaluation of effects of shared environment and gene by environment interaction. These study design characteristics are particularly appealing for current sequencing studies.

American Intervention in Russia, 1917-1918: A Study in Political-Military Relationships.

Science.gov (United States)

1987-06-05

The problems of directing and managing the American War effort from Washington as well as participation in the Allied coalition was consuming more...intervention until June of 1918. He managed to support Wilson in his resolve and gave him added strength to resist tremendous Allied pressure regarding...personality at work a well &a the inability of knowledeable subordinates to gain access to hLm 1 Prom January to March, 1918. the Allies continuod to proe

Infusing Technology Driven Design Thinking in Industrial Design Education: A Case Study

Science.gov (United States)

Mubin, Omar; Novoa, Mauricio; Al Mahmud, Abdullah

2017-01-01

Purpose: This paper narrates a case study on design thinking-based education work in an industrial design honours program. Student projects were developed in a multi-disciplinary setting across a Computing and Engineering faculty that allowed promoting technologically and user-driven innovation strategies. Design/methodology/approach: A renewed…

Argonne Tau-charm factory collider design study

International Nuclear Information System (INIS)

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

1995-01-01

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

Mirror Advanced Reactor Study interim design report

Energy Technology Data Exchange (ETDEWEB)

1983-04-01

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

Mirror Advanced Reactor Study interim design report

International Nuclear Information System (INIS)

1983-04-01

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

Short fetal leukocyte telomere length and preterm prelabor rupture of the membranes.

Directory of Open Access Journals (Sweden)

Ramkumar Menon

Full Text Available BACKGROUND: Rupture of the fetal membranes is a common harbinger of imminent labor and delivery. Telomere shortening is a surrogate for oxidative stress (OS and senescence. Fetal leukocyte and placental membrane DNA telomere lengths were evaluated to determine their association with preterm prelabor rupture of the membranes (pPROM or spontaneous preterm births with intact membranes (PTB, compared to term birth. METHODS: Telomere lengths were quantified in cord blood leukocytes (n = 133 from three major groups: 1 pPROM (n = 28, 2 PTB (n = 69 and 3 uncomplicated full term births (controls, n = 35, using real-time quantitative PCR. Placental membrane specimens (n = 18 were used to correlate fetal leukocyte and placental telomere lengths. Telomere length differences among the groups were analyzed by ANOVA. Pearson correlation coefficients determined relationships between leukocyte and placental membrane telomere lengths. RESULTS: In pregnancies with intact membranes, fetal leukocyte telomere length was inversely proportional to gestational age. The mean telomere length decreased as gestation progressed, with the shortest at term. pPROM had telomere lengths (9962 ± 3124 bp that were significantly shorter than gestational age-matched PTB (11546 ± 4348 bp, p = 0.04, but comparable to term births (9011 ± 2497 bp, p = 0.31. Secondary analyses revealed no effects of race (African American vs. Caucasian or intraamniotic infection on telomere length. A strong Pearson's correlation was noted between fetal leukocyte and placental membrane telomere lengths (ρ = 0.77; p<0.01. CONCLUSIONS: Fetal leukocyte telomere length is reduced in pPROM compared to PTB but is similar to term births. pPROM represents a placental membrane disease likely mediated by OS-induced senescence.

Shear wave sonoelastography in infants with congenital muscular torticollis.

Science.gov (United States)

Park, Gi Young; Kwon, Dong Rak; Kwon, Dae Gil

2018-02-01

Congenital muscular torticollis (CMT) is characterized by shortening or excessive contraction of the sternocleidomastoid muscle (SCM). The main purpose of this study was to evaluate the feasibility of quantifying SCM stiffness using acoustic radiation force impulse (ARFI) sonoelastography in infants with CMT. Twenty infants with an SCM thickness greater than 10 mm with or without involvement of the entire SCM length (limitation of neck rotation passive range of motion [PROM]: group 1S >30°, group 1M = 15°-30°) and 12 infants with an SCM thickness smaller than 10 mm with or without involvement of any part of SCM (group 2) were included. The SCM thickness was measured using real time B-mode ultrasound, and the local SCM shear wave velocity (SWV) and subcutaneous fat layer using ARFI sonoelastography. The neck rotation PROM was significantly greater in group 1S (36.5° ± 5.3°) than in group 1M (18.8° ± 4.9°; P SCM in the affected side (2.96 ± 0.99 m/s) was significantly higher than that in the unaffected side (1.50 ± 0.30 m/s; P SCM was significantly higher in group 1S than in group 1M. There was significant correlation between the degree of PROM deficit of neck rotation and the SWV of the affected SCM (r = .75; P SCM in relationship to the limitation of neck rotation PROM in infants with CMT, if there was no difference in SCM thickness among infants.

The Oxford Participation and Activities Questionnaire: study protocol.

Science.gov (United States)

Morley, David; Dummett, Sarah; Kelly, Laura; Dawson, Jill; Fitzpatrick, Ray; Jenkinson, Crispin

2013-01-01

With an ageing population and increasing demands on health and social care services, there is growing importance attached to the management of long-term conditions, including maximizing the cost-effectiveness of treatments. In line with this, there is increasing emphasis on the need to keep people both active and participating in daily life. Consequently, it is essential that well developed and validated instruments that can meaningfully assess levels of participation and activity are widely available. Current measures, however, are largely focused on disability and rehabilitation, and there is no measure of activity or participation for generic use that fully meets the standards set by regulatory bodies such as the US Food and Drug Administration. Here we detail a protocol for the development and validation of a new patient-reported outcome measure (PROM) for assessment of participation and activity in people experiencing a variety of health conditions, ie, the Oxford Participation and Activities Questionnaire (Ox-PAQ). The stages incorporated in its development are entirely in line with current regulations and represent best practice in the development of PROMs. Development of the Ox-PAQ is theoretically grounded in the World Health Organization International Classification of Functioning, Disability, and Health. The project incorporates a new strategy of engaging with stakeholders from the outset in an attempt to identify those characteristics of PROMs considered most important to a range of potential users. Items will be generated through interviews with patients from a range of conditions. Pretesting of the instrument will be via cognitive interviews and focus groups. A postal survey will be conducted, with data subject to factor and Rasch analysis in order to identify appropriate dimensions and redundant items. Reliability will be assessed by Cronbach's alpha and item-total correlations. A second, large-scale postal survey will follow, with the Ox-PAQ being

Comparison of induced labour pattern in women with premature rupture of membranes at term and those with intact membranes

Directory of Open Access Journals (Sweden)

J A Osaikhuwuomwan

2011-01-01

Conclusion: The finding of a significant shorter latent period, requirement for less oxytocin dose and overall shorter duration of stimulated labour cases with PROM compared to induction of labour for those with intact membranes suggest that PROM may be a means of labour initiation by some parturients and thus implies that these two groups of paturients are different obstetric entities and should therefore be treated as such in their labour management and research consideration.

Argonne Tau-charm Factory collider design study

International Nuclear Information System (INIS)

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

1996-01-01

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

Designing for Nomadic Play: A case study of participatory design with children

DEFF Research Database (Denmark)

Brynskov, Martin; Christensen, Bent Guldbjerg; Ludvigsen, Martin

This poster presents the results from an empirical probe study trying to engage children creatively in the design process of systems and artifacts that support nomadic life-style. Based on observational studies and interviews with children of different ages (5-15 years), we conducted a participat......This poster presents the results from an empirical probe study trying to engage children creatively in the design process of systems and artifacts that support nomadic life-style. Based on observational studies and interviews with children of different ages (5-15 years), we conducted...... a participatory design workshop cycle where children were encouraged to envision and virtually play with not-yet-invented future technology. Findings include qualitative characterizations of children’s activities (e.g. ‘play’ culture, use of digital media, age and gender differences, relation to space...

NEONATAL COMPLICATIONS OF PREMATURE RUPTURE OF MEMBRANES

Directory of Open Access Journals (Sweden)

F. Nili AA. Shams Ansari

2003-07-01

Full Text Available Premature rupture of membranes (PROM is one of the most common complications of pregnancy that has a major impact on neonatal outcomes. With respect to racial, nutritional and cultural differences between developed and developing countries, this study was conducted to detect the prevalence of neonatal complications following PROM and the role of the duration of rupture of membranes in producing morbidities and mortalities in these neonates in our hospital. Among 2357 pregnant women, we found 163 (6.91% cases of premature rupture of the fetal membranes in Tehran Vali-e-Asr Hospital during April 2001 to April 2002. Route of delivery was cesarean section in 65.6% of women. Urinary tract infection occured in 1.8%, maternal leukocytosis and fever in 20.2% and 5.5%, chorioamnionitis in 6.1%, fetal tachycardia in 1.2% and olygohydramnios in 4.9%. Gestational age in 138 (86% of neonates was less than 37 completed weeks. Thirty five infants (21.47% had respiratory distress syndrome and 33 (20.245% had clinical sepsis. Pneumonia in 6 (3.7% and skeletal deformity in 7 (4.294% were seen. Rupture of membrane of more than 24 hours duration occurred in 71 (43.6% of the patients. Comparison of morbidities between two groups of neonates and their mothers according to the duration of PROM (less and more than 24 hours showed significant differences in NICU admission, olygohydramnios, maternal fever, leukocytosis and chorioamnionitis rates (p24 hr of PROM with an odds ratio of 2.68 and 2.73, respectively. Positive blood and eye cultures were detected in 16 cases during 72 hours of age. Staphylococcus species, klebsiella, E.coli and streptococcus were the predominant organisms among positive blood cultures. Mortality was seen in 18 (11% of neonates because of respiratory failure, disseminated intravascular coagulation, septic shock, and a single case of congenital toxoplasmosis. In this study, the prevalence of prematurity, sepsis and prolonged rupture of membrane

Vliv motorických schopností a antropometrických měr na úspěšnost v závodech u 11 a 12letých hráček tenisu The influence of tennis motor abilities and anthropometric measures on the competition successfulness of 11 and 12 year-old female tennis players

Directory of Open Access Journals (Sweden)

Tjaša Filipčič

2005-02-01

Full Text Available Soubor 75 mladých hráček tenisu ve věku 11 a 12 let byl zahrnut do výzkumného projektu s cílem zjistit vliv vybraných antropometrických údajů a tenisových motorických dovedností na úspěšnost v soutěžích mladých tenisových hráčů. Vybrané tenisové motorické proměnné zahrnují: sílu svalů paží a ramen, sílu nohou, opakovanou sílu trupu, rychlost pohybu, rychlost střídavého pohybu rukou, ohebnost zad, hbitost a koordinaci ruka – oko. Výsledky regresní analýzy antropometrických měr odhalují statisticky významné spojení s kritérii proměnných (0,36. Skupina predikčních proměnných může vysvětlit 13% rozdílnost kritérií proměnných. To stejné se aplikuje na tenisové motorické proměnné, u kterých je důležitá hodnota poněkud bližší, dosahuje 0,64, zatímco systém prediktorů vysvětluje 41% rozdílnost kritérií proměnných. Tři proměnné z antropometrických měr (obvod lýtka, tělesná váha, břišní kožní řasa vysvětlují kritérium proměnné se statistickou významností. Mezi již výše zmíněné tenisové motorické proměnné patří běh na 2 400 metrů, který se používá pro měření vytrvalosti v běhu, a běh na 5 metrů, který se používá pro meření rychlosti pohybu. A sample of 75 young female tennis players, aged 11 and 12, was included in a research project aimed at establishing the influence of selected anthropometric measures and tennis motor abilities on the competition successfulness of young tennis players. The selected tennis motor variables include: the muscular power of arms and shoulders, elastic power of the legs, repetitive strength of the trunk, speed of movement, speed of alternative movements with the arm, flexibility of the back, agility, and hand-eye coordination. The results of regression analysis of anthropometric measures reveal a statistically significant connection with the criterion variable (0.36. The system of

Cryostat design case studies, principles and engineering

CERN Document Server

2016-01-01

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

Designs for mechanical circulatory support device studies.

Science.gov (United States)

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

2007-02-01

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

Alternative Design Study Report: WindPACT Advanced Wind Turbine Drive Train Designs Study; November 1, 2000 -- February 28, 2002

Energy Technology Data Exchange (ETDEWEB)

Poore, R.; Lettenmaier, T.

2003-08-01

This report presents the Phase I results of the National Renewable Energy Laboratory's (NREL's) WindPACT (Wind Partnership for Advanced Component Technologies) Advanced Wind Turbine Drive Train Designs Study. Global Energy Concepts, LLC performed this work under a subcontract with NREL. The purpose of the WindPACT project is to identify technology improvements that will enable the cost of energy (COE) from wind turbines to be reduced. Other parts of the WindPACT project have examined blade and logistics scaling, balance-of-station costs, and rotor design. This study was designed to investigate innovative drive train designs.

280 GHz Gyro-BWO design study: Final report

International Nuclear Information System (INIS)

1988-07-01

This report summarizes the results of a design study of a 280 GHz Gyro-BWO tunable source. The purpose of this study is to identify and propose viable design alternatives for any significant technological risk associated with building an operational BWO system. The tunable Gyro-BWO system will have three major components: a Gyro-BWO microwave tube, a superconducting magnet, and a power supply/modulator. The design tasks for this study in order of decreasing importance are: design and specification of the superconducting magnet; preliminary design and layout of a Gyro-BWO microwave tube; and specification for the power supply/modulator. 2 refs., 4 figs

A 13-Bits wilkinson analog-digital converter for NIM acquisition system

International Nuclear Information System (INIS)

Acosta Toledo, R.; Osorio Deliz, J.; Arista Romeu, E.; Fernandez, J.

1994-01-01

A new 13-bits Wilkinson analog-digital converter is described. The aim of this work is to describe the circuits of sample and hold, memory condensator loading and releasing PROM based control memory logic, zero level detection and correction. The converter is designed for the digital measurement of the peak amplitudes of pulses with statistical or periodical time distribution. The analog-digital converter may be used in spectrometric systems, multi-channel analysers or any similar PC based system

Schematic representation of case study research designs.

Science.gov (United States)

Rosenberg, John P; Yates, Patsy M

2007-11-01

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

Nuclear-Powered GPS Spacecraft Design Study

Energy Technology Data Exchange (ETDEWEB)

Raab, Bernard

1977-05-01

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

Mobile Variable Depth Sampling System Design Study

International Nuclear Information System (INIS)

BOGER, R.M.

2000-01-01

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

Mobile Variable Depth Sampling System Design Study

Energy Technology Data Exchange (ETDEWEB)

BOGER, R.M.

2000-08-25

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

A systematic review of measurement properties of patient reported outcome measures in psoriatic arthritis

DEFF Research Database (Denmark)

Højgaard, Pil; Klokker, Louise; Orbai, Ana Maria

2018-01-01

Background: An updated psoriatic arthritis (PsA) core outcome set (COS) for randomized controlled trials (RCTs) was endorsed at the Outcome Measures in Rheumatology (OMERACT) meeting in 2016. Objectives: To synthesize the evidence on measurement properties of patient reported outcome measures...... (PROMs) for PsA and thereby contribute to development of a PsA core outcome measurement set (COMS) as described by the OMERACT Filter 2.0. Methods: A systematic literature search was performed in EMBASE, MEDLINE and PsycINFO on Jan 1, 2017 to identify full-text articles with an aim of assessing...... the measurement properties of PROMs in PsA. Two independent reviewers rated the quality of studies using the COnsensus based standards for the Selection of health Measurement INstruments (COSMIN) checklist, and performed a qualitative evidence synthesis. Results: Fifty-five studies were included in the systematic...

Design Study for A Low-Cost LH2 Turbopump

Science.gov (United States)

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

2000-01-01

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

[Clinical evaluation of flomoxef in the treatment of chorioamnionitis and changes in the fetal fibronectin level in vaginal secretion].

Science.gov (United States)

Chimura, T; Hirayama, T; Oda, T; Saitou, N; Morisaki, N

1993-02-01

Flomoxef (FMOX) was administered as an initial treatment for chorioamnionitis complicating possible spontaneous abortion or premature delivery and preterm PROM (premature rupture of the membranes), and the clinical effectiveness of the drug, and the usefulness of fetal fibronectin (FFN) as a diagnostic marker of premature delivery were evaluated. 1. Clinical effects of drip infusion of FMOX (2-4 g/day) with and without tocolysis for the treatment of chorioamnionitis were evaluated in 43 patients with possible spontaneous abortion or premature delivery and those with preterm PROM (n = 43). Changes in the FFN level in the vaginal secretion were also studied in 11 patients. 2. It was possible to prevent premature delivery in 7 (26.9%) of 26 patients, and the latent period of preterm PROM was longer than 8 days in 6 (46.2%) of 13 patients. 3. The FFN level decreased slightly in patients for whom FMOX was effective, and the outcome was satisfactory in those whose FFN levels were less than 200 ng/ml. However, the outcome was poor in those whose FFN levels were higher than 1,000 ng/ml. These findings suggest that changes in the FFN level in the vaginal secretion reflect the clinical course of chorioamnionitis as do changes in CRP.

Toll receptor 4 Asp299Gly polymorphism and its association with preterm birth and premature rupture of membranes in a South American population.

Science.gov (United States)

Rey, G; Skowronek, F; Alciaturi, J; Alonso, J; Bertoni, B; Sapiro, R

2008-09-01

Preterm birth (PTB) is a worldwide health problem and remains the leading cause of perinatal morbidity and mortality. Systemic and local intrauterine infections have been implicated in the pathogenesis of preterm labor and delivery. Common pathways between PTB, premature rupture of ovular membranes (PROM) and altered molecular routes of inflammation have been proposed. There is evidence to support a genetic component in these conditions. Lipopolysaccharide (LPS), a component of the cell wall of Gram-negative bacteria, is thought to play a key role in eliciting an inflammatory response. LPS is recognized by proteins of the innate immune system, including Toll-like receptor 4 (TLR4). Individuals from some European countries carrying the variant alleles resulting in an amino acid substitution (Asp299Gly) are at increased risk of Gram-negative infections and premature birth. The objective of this study was to determine if preterm newborns have different allele frequency of the Asp299Gly TLR4 variant from healthy term neonates in Uruguay. The impact of PROM was also examined. There was an increase in the risk for fetuses carrying the Asp299Gly substitution in TLR4 of being severely premature (<33 weeks) and to present PROM at the same time.

Microbial load of umbilical cord blood Ureaplasma species and Mycoplasma hominis in preterm prelabor rupture of membranes.

Science.gov (United States)

Kacerovsky, Marian; Pliskova, Lenka; Menon, Ramkumar; Kutova, Radka; Musilova, Ivana; Maly, Jan; Andrys, Ctirad

2014-11-01

To evaluate Ureaplasma species and M. hominis DNA in the umbilical cord blood and its correlation with its microbial load in the amniotic fluid, as a measure of microbial burden in fetal inflammatory response and neonatal outcome in pregnancies complicated by preterm prelabor rupture of membranes (pPROM). A retrospective study of 158 women with singleton pregnancies complicated by pPROM between 24(0/7) and 36(6/7) weeks was conducted. Amniotic fluid was obtained from all women by transabdominal amniocentesis, and umbilical cord blood was obtained by venipuncture from umbilical cords immediately after the delivery of the neonates. The Ureaplasma species and M. hominis DNA was quantitated using absolute quantification techniques. Ureaplasma species and M. hominis DNA was identified in 9% of the umbilical cord blood samples. No correlation between the amniotic fluid and umbilical cord blood microbial load was observed. The presence of Ureaplasma species and M. hominis DNA in the umbilical cord blood had no impact on short-term neonatal morbidity. A high microbial load of genital mycoplasma Ureaplasma species DNA in the umbilical cord in pregnancies complicated by pPROM is not associated with a high fetal inflammatory response and is therefore not associated with serious neonatal morbidity.

Improving Navy Recruiting with the New Planned Resource Optimization Model With Experimental Design (PROM-WED)

Science.gov (United States)

2017-03-01

GUI graphical user interface HumRRO Human Resources Research Organization JPM Job Performance Measurement/Enlistment Standards LRP loan repayment... management system… for all appropriated funding” (Tomasini, n.d.). The DOD’s strategy, force structure, and allocation of resources are all delineated...Alexandria, Va. Human Resources Research Organization. Microsoft Excel, Version 15.0.4849.1003 [Computer software] (2013). Redmond, WA: Microsoft

Prom Health and Safety Tips

Science.gov (United States)

... cost is an issue, look for alternatives to spending a lot of money. Expensive doesn't necessarily mean better. Plan ahead for safety Tell family members or a trusted adult what your plans are ahead of time. Make an agreement with friends to check on ...

Paired split-plot designs of multireader multicase studies.

Science.gov (United States)

Chen, Weijie; Gong, Qi; Gallas, Brandon D

2018-07-01

The widely used multireader multicase ROC study design for comparing imaging modalities is the fully crossed (FC) design: every reader reads every case of both modalities. We investigate paired split-plot (PSP) designs that may allow for reduced cost and increased flexibility compared with the FC design. In the PSP design, case images from two modalities are read by the same readers, thereby the readings are paired across modalities. However, within each modality, not every reader reads every case. Instead, both the readers and the cases are partitioned into a fixed number of groups and each group of readers reads its own group of cases-a split-plot design. Using a [Formula: see text]-statistic based variance analysis for AUC (i.e., area under the ROC curve), we show analytically that precision can be gained by the PSP design as compared with the FC design with the same number of readers and readings. Equivalently, we show that the PSP design can achieve the same statistical power as the FC design with a reduced number of readings. The trade-off for the increased precision in the PSP design is the cost of collecting a larger number of truth-verified patient cases than the FC design. This means that one can trade-off between different sources of cost and choose a least burdensome design. We provide a validation study to show the iMRMC software can be reliably used for analyzing data from both FC and PSP designs. Finally, we demonstrate the advantages of the PSP design with a reader study comparing full-field digital mammography with screen-film mammography.

Determination the bacterial etiologies for sepsis in premature newborns admitted in neonatal intensive care unit

Directory of Open Access Journals (Sweden)

Nastaran Khosravi

2017-02-01

Full Text Available Background: Bacterial sepsis is a main cause of mortality and morbidity especially in preterm newborns. The aim of this study was to search the bacterial etiologies of neonatal sepsis in NICU admitted preterm neonates. Methods: A descriptive cross-sectional study had done in NICU of Ali Asghar Hospital, Tehran, Iran from March 2007 to March 2009. Seventy septicemic preterm newborns (<37 weeks were studied. At admission day, for blood culture, 1-2 ml of venous blood was drawn after swabbing the venipuncture site with alcohol. After centrifugation of blood samples, deposits were cultured on sheep blood agar and incubated in a candle jar at 37 °C for 48 h and followed by subcultured. Isolates were identified using standard techniques (Nima pouyesh, Iran. Type of isolated bacterial organisms determined. Its correlation with gestational age, birth weight, premature rupture of membranes (PROM and other variables determined we used the nonparametric two independent sample test, Mann-Whitney U test. Chi-square values (CI 95%, P< 0.05 were calculated for all categorical variables. P-value less than 0.05 considered statistically significant. Results: Of 70 studied septicemic preterm cases, 17 (10.6% cases had positive blood culture. Overall gram-negative organisms were more frequent than gram-positive organisms, Klebsiella (K. pneumoniae, Escherichia (E. coli and Staphylococcus (S. aureus organisms were the 3 common causes of bacterial sepsis in studied cases. Early onset sepsis produced by K. pneumonia (40%, E. coli (20% and S. aureus (20%. K. pneumonia, E. coli, S. aureus had equal incidence in late onset sepsis (26.8%. K. pneumonia was more frequent in early onset sepsis (P= 0.05, and in low birth weight (< 1500 g neonates (P= 0.005, and PROM (P= 0.05. Conclusion: Three causes for sepsis in premature newborns were determined: K. pneumonia, E. coli and S. aureus, it is so important for initial antibiotic treatment in admission day. Low birth weight

Controlled air incinerator conceptual design study

International Nuclear Information System (INIS)

1982-01-01

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

Vertical ground reaction forces in patients after calcaneal trauma surgery.

Science.gov (United States)

van Hoeve, S; Verbruggen, J; Willems, P; Meijer, K; Poeze, M

2017-10-01

Vertical ground reaction forces (VGRFs) are altered in patients after foot trauma. It is not known if this correlates with ankle kinematics. The aim of this study was to analyze VGRFs in patients after calcaneal trauma and correlate them to patient-reported outcome measures (PROMs), radiographic findings and kinematic analysis, using a multi-segment foot model. In addition, we determined the predictive value of VGRFs to identify patients with altered foot kinematics. Thirteen patients (13 feet) with displaced intra-articular calcaneal fractures, were included an average of two years after trauma surgery. PROMs, radiographic findings on postoperative computed tomography scans, gait analysis using the Oxford foot model and VGRFs were analysed during gait. Results were compared with those of 11 healthy subjects (20 feet). Speed was equal in both groups, with healthy subjects walking at self-selected slow speed (0.94±0.18m/s) and patients after surgery walking at self-selected normal speed (0.94±0.29m/s). ROC curves were used to determine the predictive value. Patients after calcaneal surgery showed a lower minimum force during midstance (p=0.004) and a lower maximum force during toe-off (p=0.011). This parameter correlated significantly with the range of motion in the sagittal plane during the push-off phase (r 0.523, p=0.002), as well as with PROMs and with postoperative residual step-off (r 0.423, p=0.016). Combining these two parameters yielded a cut-off value of 193% (ppush-off correlated significantly with PROMs, range of motion in the sagittal plane during push-off and radiographic postoperative residual step-off in the posterior facet of the calcaneal bone. VGRFs are a valuable screening tool for identifying patients with altered gait patterns. Copyright © 2017 Elsevier B.V. All rights reserved.

User Design: A Case Study on Corporate Change

Science.gov (United States)

Pastore, Raymond S.; Carr-Chellman, Alison A.; Lohmann, Neal

2011-01-01

The purpose of this study was to examine the effects of implementing user design strategies within the corporate culture. Using a case study design approach, this article explores the change process within a "Fortune" 100 company in which users were given significant decision-making powers. The main focus is on the unique nature of user design in…

A study on the development of an infographic designer questionnaire and designer opinions

Directory of Open Access Journals (Sweden)

Yıldırım Serkan

2016-01-01

Full Text Available Technological developments and changes in how learning is understood have not only changed learning environments, but also how educational materials are developed. Infographics, one of the materials that are becoming increasingly more popular in learning environments, have nowadays become quite commonplace. Demonstrating the understanding of those who design such instructional materials is important with respect to the organisation of learning processes. In this study, we devised a questionnaire that aims to demonstrate the understanding infographic designers have of infographic design. A total of 94 students from the Department of Computer and Instructional Technologies Education of the Kazım Karabekir Faculty of Education took part in this study conducted during the fall semester of the 2013–2014 academic year. The participants were given a questionnaire consisting of 41 items that enquired about the readers’ views regarding infographic design. The collected data were assessed using Principal Component Analysis. Based on the analysis results, a questionnaire form consisting of 27 items and 8 factors (Understanding of Design, Design Process, Copyrights, Introduction, Readability, Sharing, References, Development was developed.

Conceptual study of advanced PWR core design

International Nuclear Information System (INIS)

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

1997-09-01

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

Conceptual study of advanced PWR core design

Energy Technology Data Exchange (ETDEWEB)

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

1997-09-01

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

Class 1 devices case studies in medical devices design

CERN Document Server

Ogrodnik, Peter J

2014-01-01

The Case Studies in Medical Devices Design series consists of practical, applied case studies relating to medical device design in industry. These titles complement Ogrodnik's Medical Device Design and will assist engineers with applying the theory in practice. The case studies presented directly relate to Class I, Class IIa, Class IIb and Class III medical devices. Designers and companies who wish to extend their knowledge in a specific discipline related to their respective class of operation will find any or all of these titles a great addition to their library. Class 1 Devices is a companion text to Medical Devices Design: Innovation from Concept to Market. The intention of this book, and its sister books in the series, is to support the concepts presented in Medical Devices Design through case studies. In the context of this book the case studies consider Class I (EU) and 510(k) exempt (FDA) . This book covers classifications, the conceptual and embodiment phase, plus design from idea to PDS. These title...

Electric-powered passenger vehicle design study program. Task 1. Tradeoff studies

Energy Technology Data Exchange (ETDEWEB)

Rowlett, B.H.

1976-09-16

Using the baseline vehicle and power system design established previously to meet the performance goals of the program, three power system computer simulation programs were prepared for the basic vehicle tradeoff studies. These programs simulate the performance of the power system and vehicle over different types of driving conditions such as maximum power acceleration, deceleration, city driving cycles, and hill climbing, and permit accurate determination of the benefits of the unique hybrid power system, the total energy required for the suburban city driving cycle, and the extremes of the operating envelopes of the components so that component design options can be defined and studied. Component design tradeoff studies were conducted, including sensitivity studies to show the criticality of the various losses and unknowns in the analytical models. Also, preliminary vehicle layout studies were performed to determine the best locations of the power system and the batteries. Three basic design options are identified for further study. Economic studies were initiated using analytical models to establish the complete vehicle weight and cost breakdowns. Preliminary reliability and safety studies were completed, and maintainability and safety certification criteria established. The detailed analysis of the power system has verified the feasibility of the system and of the performance expectations. Also, the feasibility of energy recovery from regenerative braking has been confirmed. The sensitivity analysis of the power system shows that sufficient margin for unknown design variables is provided. The preliminary economic analysis indicates that the most difficult objective of the study will be the selection of the cost and weight relationships which are required to achieve the overall cost objectives.

Engineering study for ISSTRS design concept

Energy Technology Data Exchange (ETDEWEB)

Hertzel, J.S.

1997-01-31

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

Is the surgical outcome for lumbar disc herniation related to the duration of symptoms?

DEFF Research Database (Denmark)

Støttrup, Christian; Ernst, Carsten; Clemmensen, Dorte

included in a Single-Center Study. Data were prospectively collected in DaneSpine, the Danish National Spine Register. The patient reported outcome measures (PROM) EQ5D, SF36, ODI, VAS-leg and -back were correlated with duration of symptoms. Findings / Results: 832 patients were included in the study...

Preterm labor and preterm premature rupture of membranes have a different pattern in the involved compartments of acute histologoic chorioamnionitis and/or funisitis: Patho-physiologic implication related to different clinical manifestations.

Science.gov (United States)

Park, Chan-Wook; Park, Joong Shin; Moon, Kyung Chul; Jun, Jong Kwan; Yoon, Bo Hyun

2016-06-01

It is unknown whether histo-topographic findings about the involved compartments (i.e., choriodecidua, amnion, chorionic-plate) of acute-histologic chorioamnionitis (acute-HCA) and/or funisitis according to the presence or absence of intra-amniotic inflammation (IAI) and/or fetal inflammatory response syndrome (FIRS) are different between preterm labor and intact membranes (PTL) and preterm premature rupture of membranes (preterm-PROM). The involved compartments of acute-HCA and/or funisitis were examined in 161 singleton preterm-births ( 0.1). However, IAI(+)/FIRS(+) group had a significantly higher rate of inflammation in each compartment than IAI(+)/FIRS(-) group in both PTL and preterm-PROM (each-for P < 0.05). We first demonstrated that PTL and preterm-PROM had a different pattern in the involved compartments of acute-HCA and/or funisitis in the IAI(-)/FIRS(--) group and in the change of involved compartments from IAI(-)/FIRS(-) to IAI(+)/FIRS(-). © 2016 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

Parametric design study of tandem mirror fusion reactors

International Nuclear Information System (INIS)

Carlson, G.A.

1977-01-01

The parametric design study of the tandem mirror reactor (TMR) is described. The results of this study illustrate the variation of reactor characteristics with changes in the independent design parameters, reveal the set of design parameters which minimizes the cost of the reactor, and show the sensitivity of the optimized design to physics and technological uncertainties. The total direct capital cost of an optimized 1000 MWe TMR is estimated to be $1300/kWe. The direct capital cost of a 2000 MWe plant is less than $1000/kWe

Design study on sodium-cooled large-scale reactor

International Nuclear Information System (INIS)

Shimakawa, Yoshio; Nibe, Nobuaki; Hori, Toru

2002-05-01

In Phase 1 of the 'Feasibility Study on Commercialized Fast Reactor Cycle Systems (F/S)', an advanced loop type reactor has been selected as a promising concept of sodium-cooled large-scale reactor, which has a possibility to fulfill the design requirements of the F/S. In Phase 2 of the F/S, it is planed to precede a preliminary conceptual design of a sodium-cooled large-scale reactor based on the design of the advanced loop type reactor. Through the design study, it is intended to construct such a plant concept that can show its attraction and competitiveness as a commercialized reactor. This report summarizes the results of the design study on the sodium-cooled large-scale reactor performed in JFY2001, which is the first year of Phase 2. In the JFY2001 design study, a plant concept has been constructed based on the design of the advanced loop type reactor, and fundamental specifications of main systems and components have been set. Furthermore, critical subjects related to safety, structural integrity, thermal hydraulics, operability, maintainability and economy have been examined and evaluated. As a result of this study, the plant concept of the sodium-cooled large-scale reactor has been constructed, which has a prospect to satisfy the economic goal (construction cost: less than 200,000yens/kWe, etc.) and has a prospect to solve the critical subjects. From now on, reflecting the results of elemental experiments, the preliminary conceptual design of this plant will be preceded toward the selection for narrowing down candidate concepts at the end of Phase 2. (author)

Flight Path Recovery System (FPRS) design study

International Nuclear Information System (INIS)

1978-09-01

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

Flight Path Recovery System (FPRS) design study

Energy Technology Data Exchange (ETDEWEB)

1978-09-01

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

Empirical studies of design software: Implications for software engineering environments

Science.gov (United States)

Krasner, Herb

1988-01-01

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

The Oxford Participation and Activities Questionnaire: study protocol

Directory of Open Access Journals (Sweden)

Morley D

2013-12-01

Full Text Available David Morley, Sarah Dummett, Laura Kelly, Jill Dawson, Ray Fitzpatrick, Crispin JenkinsonNuffield Department of Population Health, University of Oxford, Oxford, UKBackground: With an ageing population and increasing demands on health and social care services, there is growing importance attached to the management of long-term conditions, including maximizing the cost-effectiveness of treatments. In line with this, there is increasing emphasis on the need to keep people both active and participating in daily life. Consequently, it is essential that well developed and validated instruments that can meaningfully assess levels of participation and activity are widely available. Current measures, however, are largely focused on disability and rehabilitation, and there is no measure of activity or participation for generic use that fully meets the standards set by regulatory bodies such as the US Food and Drug Administration. Here we detail a protocol for the development and validation of a new patient-reported outcome measure (PROM for assessment of participation and activity in people experiencing a variety of health conditions, ie, the Oxford Participation and Activities Questionnaire (Ox-PAQ. The stages incorporated in its development are entirely in line with current regulations and represent best practice in the development of PROMs.Methods: Development of the Ox-PAQ is theoretically grounded in the World Health Organization International Classification of Functioning, Disability, and Health. The project incorporates a new strategy of engaging with stakeholders from the outset in an attempt to identify those characteristics of PROMs considered most important to a range of potential users. Items will be generated through interviews with patients from a range of conditions. Pretesting of the instrument will be via cognitive interviews and focus groups. A postal survey will be conducted, with data subject to factor and Rasch analysis in order to

Design vs. Content: A Study of Adolescent Girls' Website Design Preferences

Science.gov (United States)

Agosto, Denise E.

2004-01-01

This study considered the utility of gender schema theory in examining girls' website design preferences. It built on a previous study which identified eight website evaluation criteria related to biological sex: collaboration, social connectivity, flexibility, motility, contextuality, personal identification, inclusion, and graphic/multimedia…

Design study of laser fusion rocket

International Nuclear Information System (INIS)

Nakashima, Hideki; Shoyama, Hidetoshi; Kanda, Yukinori

1991-01-01

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

Core design and fuel management studies

International Nuclear Information System (INIS)

Min, Byung Joo; Chan, P.

1997-06-01

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

Transitioning from Marketing-Oriented Design to User-Oriented Design: A Case Study

Science.gov (United States)

Laster, Shari; Stitz, Tammy; Bove, Frank J.; Wise, Casey

2011-01-01

The transition to a new architecture and design for an academic library Web site does not always proceed smoothly. In this case study, a library at a large research university hired an outside Web development contractor to create a new architecture and design for the university's Web site using dotCMS, an open-source content management system. The…

Assessing participation in the ACL injured population: Selecting a patient reported outcome measure on the basis of measurement properties.

Science.gov (United States)

Letchford, Robert; Sparkes, Valerie; van Deursen, Robert W M

2015-06-01

A return to pre injury activity participation remains a common but often elusive goal following ACL injury. Investigations to improve our understanding of participation restrictions are limited by inconsistent use of insufficiently investigated measurement tools. The aim of this study was to follow the consensus based standards for the selection of health measurement instruments (COSMIN) guideline to provide a comparative evaluation of four patient reported outcomes (PROMs) on the basis of measurement properties. This will inform recommendations for measuring participation of ACL injured subjects, particularly in the United Kingdom (UK) National Health Service (NHS). Thirteen criteria were compiled from the COSMIN guideline. These included reliability, measurement error, content validity, construct validity, responsiveness and interpretability. Data from 51 subjects collected as part of a longitudinal observational study of recovery over the first year following ACLR was used in the analysis. Of the thirteen criteria, the required standard was met in 11 for Tegner, 11 for International Knee Documentation Committee (IKDC), 6 for Cincinnati Sports Activity Scale (CSAS) and 6 for Marx. The two weaknesses identified for the Tegner are more easily compensated for during interpretation than those in the IKDC; for this reason the Tegner is the recommended PROM. The Tegner activity rating scale performed consistently well in respect of all measurement properties in this sample, with clear benefits over the other PROMs. The measurement properties presented should be used to inform implementation and interpretation of this outcome measure in clinical practice and research. Level II prospective study. Copyright © 2015 Elsevier B.V. All rights reserved.

Design Evolution Study - Aging Options

International Nuclear Information System (INIS)

McDaniel, P.

2002-01-01

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

INEL design studies in support of the Westinghouse EPRI small plant study

International Nuclear Information System (INIS)

Burtt, J.D.; Kullberg, C.M.

1986-03-01

In support of the design effort of a Westinghouse EPRI small plant study, several analyses were performed at the Idaho National Engineering Laboratory. An analysis was performed to study fuel behavior under conditions of a limiting flow coastdown transient. Depressurization capabilities for the reactor coolant system were studied. The post-accident heat removal for the current containment design was studied. The results of all three studies are reported. 31 figs

Automated simulation and study of spatial-structural design processes

NARCIS (Netherlands)

Davila Delgado, J.M.; Hofmeyer, H.; Stouffs, R.; Sariyildiz, S.

2013-01-01

A so-called "Design Process Investigation toolbox" (DPI toolbox), has been developed. It is a set of computational tools that simulate spatial-structural design processes. Its objectives are to study spatial-structural design processes and to support the involved actors. Two case-studies are

Distribution Network Design--literature study based

OpenAIRE

LI, ANG

2012-01-01

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

External cephalic version in premature rupture of membranes: a systematic review.

Science.gov (United States)

Quist-Nelson, Johanna; Landers, Kathryn; McCurdy, Rebekah; Berghella, Vincenzo

2017-09-01

External cephalic version (ECV) increases the likelihood of a vaginal delivery in patients with breech presentation. Our objective was to determine the rate of cephalic vaginal delivery in women undergoing ECV after PROM. We performed a systematic review of all case reports, case series and clinical trials of patients undergoing an ECV after PROM ≥ 24 weeks. Maternal demographics and outcome data were obtained. The primary outcome was rate of cephalic vaginal delivery. Statistical analysis was performed for continuous outcomes by calculating mean and standard deviations for appropriate variables. The systematic review yielded six papers with 13 case reports and no clinical trials of ECV after PROM. The rate of success to cephalic presentation was 46.1% (six of 13 cases), with a subsequent vaginal delivery rate of 23.1% (three of 13 cases). The rate of umbilical cord prolapse was 33.3% (two of six cases). ECV after PROM has been reported in 13 cases in the literature. For the cases reported, 46.1% of ECV were successful in turning to cephalic position, but only 23.1% resulted in a vaginal delivery. There was a 33.3% incidence of umbilical cord prolapse. Given the high rate of umbilical cord prolapse, it would be imperative to offer an ECV in the setting of PROM only at an institution that has the ability to perform the indicated emergent cesarean delivery and only after appropriate counseling.

Interim report on the tandem mirror hybrid design study

International Nuclear Information System (INIS)

Moir, R.W.

1979-01-01

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

Use of the WOMAC questionnaire in Mumbai and the challenges of translation and cross cultural adaptation.

Science.gov (United States)

Gogtay, N J; Thatte, U M; Dasgupta, B; Deshpande, S

2013-01-01

Patient-reported outcome measures (PROMs) are disease specific questionnaires that are being increasingly used in clinical practice and research. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), is a widely used PROM in patients with hip or knee osteoarthritis. A validated WOMAC was used by us, and significant challenges were faced in administering it as several questions did not have a cultural connect. Functionally equivalent items in the Indian context had then to be used to complete the score. With greater emphasis today on the use of patient-reported outcome measures, and with data from multi-centric studies being pooled, cross-cultural adaptation becomes very important if the pooled data are to be really relevant. In India, with several languages being spoken, and a significant proportion of the population being illiterate, the physician and/ or the impartial witness must provide considerable explanation without attempting to influence the response. The key to the effective and correct use of PROMs thus lies not just in translation, but also in a stepwise validation of the questionnaire, and modification in the context of the country where it is used. Scores like WOMAC are often primary efficacy endpoints in clinical trials; are gaining greater importance to support label claims; have ethical implications, and directly impact regulatory decision making and thus, eventually, evidence-based practice.

Design study of 'HIBLIC-I' reactor cavity

International Nuclear Information System (INIS)

Fujiie, Y.

1984-01-01

A preliminary conceptual design of a reactor cavity for HIBLIC-1, a heavy ion fusion reactor system, was carried out. Design efforts have been concentrated mainly on the feasibility study of the physical scenario adopted and also on the system integration of the structures and components into a compact reactor cavity. The design features of the reactor are a compact reactor cavity, maximum coolant temperature up to 500 deg C, the protection of the sacrificial wall and cavity wall from radiation, the protection of the sacrificial wall from the pressure transient due to rapid heating, the selection of a ferritic steel HT-9 as the structural material and impurity control, and tritium breeding and recovery. The purpose of this paper is to describe the outline of the reactor cavity design of HIBLIC-1. The objectives of the preliminary conceptual design were to propose the idea and concept in order to constitute the physical scenario without contradiction and to find out the critical and fundamental problems to be studied in future. The cavity configuration and dynamics, tritium breeding and radiation damage, the behavior of a structural material in liquid lithium and tritium recovery are reported. (Kako, I.)

Extrap conceptual fusion reactor design study

International Nuclear Information System (INIS)

Eninger, J.E; Lehnert, B.

1987-12-01

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

Design study of underground facility of the Underground Research Laboratory

International Nuclear Information System (INIS)

Hibiya, Keisuke; Akiyoshi, Kenji; Ishizuka, Mineo; Anezaki, Susumu

1998-03-01

Geoscientific research program to study deep geological environment has been performed by Power Reactor and Nuclear Fuel Development Corporation (PNC). This research is supported by 'Long-Term Program for Research, Development and Utilization of Nuclear Energy'. An Underground Research Laboratory is planned to be constructed at Shoma-sama Hora in the research area belonging to PNC. A wide range of geoscientific research and development activities which have been previously studied at the Tono Area is planned in the laboratory. The Underground Research Laboratory is consisted of Surface Laboratory and Underground Research Facility located from the surface down to depth between several hundreds and 1,000 meters. Based on the results of design study in last year, the design study performed in this year is to investigate the followings in advance of studies for basic design and practical design: concept, design procedure, design flow and total layout. As a study for the concept of the underground facility, items required for the facility are investigated and factors to design the primary form of the underground facility are extracted. Continuously, design methods for the vault and the underground facility are summarized. Furthermore, design procedures of the extracted factors are summarized and total layout is studied considering the results to be obtained from the laboratory. (author)

Study on integrated design and analysis platform of NPP

International Nuclear Information System (INIS)

Lu Dongsen; Gao Zuying; Zhou Zhiwei

2001-01-01

Many calculation software have been developed to nuclear system's design and safety analysis, such as structure design software, fuel design and manage software, thermal hydraulic analysis software, severe accident simulation software, etc. This study integrates those software to a platform, develops visual modeling tool for Retran, NGFM90. And in this platform, a distribution calculation method is also provided for couple calculation between different software. The study will improve the design and analysis of NPP

Inertial Fusion Energy reactor design studies: Prometheus-L, Prometheus-H

International Nuclear Information System (INIS)

Waganer, L.M.; Driemeyer, D.E.; Lee, V.D.

1992-03-01

This report contains a review of design studies for inertial confinement reactors. The first of three volumes briefly discusses the following: Introduction; Key objectives, requirements, and assumptions; Systems modeling and trade studies; Prometheus-L reactor plant design overview; Prometheus-H reactor plant design overview; Key technical issues and R ampersand D requirements; Comparison of IFE designs; and study conclusions

Self-patching firmware program

International Nuclear Information System (INIS)

Stanchi, L.

1976-12-01

A method of branching to an auxiliary program without any hardware or software modification at the time the auxiliary program will be written is described. Suitable statements in the main program are already prepared to accept a future program that will be written in machine language. The main program is stored as firmware in PROM memory, while the auxiliary program is loaded into RAM memory. The method is described for the Intel 8080 microprocessor, but can be generalized for any microprocessor or minicomputer that uses ROMs or PROMs. 1 figure, 2 tables

Do Patient-Reported Outcome Measures describe functioning in patients with low back pain, using the Brief International Classification of Functioning, Disability and Health Core Set as a reference?

DEFF Research Database (Denmark)

Ibsen, Charlotte; Schiøttz-Christensen, Berit; Melchiorsen, Hanne

2016-01-01

OBJECTIVE: To link the items in the Patient-Reported Outcome Measures (PROMs): Roland Morris Disability Questionnaire, Short Form 36 (SF-36) and pain scores, to the Brief International Classification of Functioning, Disability and Health (ICF) Core Set for low back pain, and to examine the extent...... Set (34%). A weak correlation was found between the patients' responses and the clinician's assessment. CONCLUSION: The selected PROMs do not cover the prototypical spectrum of problems encountered in patients with low back pain as defined by the Brief ICF Core Set. The clinical assessment of patients...

Design thinking for website optimization. A case study

DEFF Research Database (Denmark)

Somoza Sanchez, Vella Veronica; Andersen, Frederik; Schneider-Kamp, Peter

This paper presents results from a pilot study, which is part of a larger research project where we study the process innovation of website optimization as a service through the use of big data. Over a process of design thinking we investigate which type of website design best addresses the needs...... for observing the users in their native environment. Furthermore, we use the method of Digital Anthropology to complete the loop between the human-centric designs and the possibilities offered by the analysis of big data....

RF quadrupole beam dynamics design studies

International Nuclear Information System (INIS)

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

1979-01-01

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

Danish Hip Arthroscopy Registry (DHAR)

DEFF Research Database (Denmark)

Lund, Bent; Mygind-Klavsen, Bjarne; Grønbech Nielsen, Torsten

2017-01-01

The Danish Hip Arthroscopy Registry (DHAR) was initiated in January 2012 as a web-based prospective registry. The purpose of this study was to evaluate and report the first registry based outcome data of a national population with radiological and clinical femoroacetabular impingement (FAI......) undergoing hip arthroscopic treatment. Our primary hypothesis was that patients undergoing hip arthroscopy would improve significantly in pain, quality of life and sports related outcome measurements in Patient Related Outcome Measures (PROM). Peri-operative data and Patient Reported Outcome Measures (PROM......-5 D demonstrated improvement after 1 and 2 years from 0.66 pre-op to 0.78 at 2 years. HSAS improved significantly from 2.5 to 3.3. Pain score data demonstrated improvement in NRS-rest 39 to 17 and NRS Walk 49 to 22 at follow-up. We conclude that patients with FAI undergoing hip arthroscopy...

Measurement properties of patient-reported outcome measures (PROMS) in Patellofemoral Pain Syndrome: a systematic review.

Science.gov (United States)

Green, Andrew; Liles, Clive; Rushton, Alison; Kyte, Derek G

2014-12-01

This systematic review investigated the measurement properties of disease-specific patient-reported outcome measures used in Patellofemoral Pain Syndrome. Two independent reviewers conducted a systematic search of key databases (MEDLINE, EMBASE, AMED, CINHAL+ and the Cochrane Library from inception to August 2013) to identify relevant studies. A third reviewer mediated in the event of disagreement. Methodological quality was evaluated using the validated COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) tool. Data synthesis across studies determined the level of evidence for each patient-reported outcome measure. The search strategy returned 2177 citations. Following the eligibility review phase, seven studies, evaluating twelve different patient-reported outcome measures, met inclusion criteria. A 'moderate' level of evidence supported the structural validity of several measures: the Flandry Questionnaire, Anterior Knee Pain Scale, Functional Index Questionnaire, Eng and Pierrynowski Questionnaire and Visual Analogue Scales for 'usual' and 'worst' pain. In addition, there was a 'Limited' level of evidence supporting the test-retest reliability and validity (cross-cultural, hypothesis testing) of the Persian version of the Anterior Knee Pain Scale. Other measurement properties were evaluated with poor methodological quality, and many properties were not evaluated in any of the included papers. Current disease-specific outcome measures for Patellofemoral Pain Syndrome require further investigation. Future studies should evaluate all important measurement properties, utilising an appropriate framework such as COSMIN to guide study design, to facilitate optimal methodological quality. Copyright © 2014 Elsevier Ltd. All rights reserved.

ACSYNT inner loop flight control design study

Science.gov (United States)

Bortins, Richard; Sorensen, John A.

1993-01-01

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

Interior Design Supports Art Education: A Case Study

Science.gov (United States)

Clemons, Stephanie A.

2006-01-01

Interior design, as a field of study, is a rapidly growing area of interest--particularly for teenagers in the United States. Part of this interest stems from the proliferation of design-related reality shows available through television media. Some art educators and curriculum specialists in the nation perceive the study of interior spaces as a…

Good, better, best? A comprehensive comparison of healthcare providers' performance: An application to physiotherapy practices in primary care.

Science.gov (United States)

Steenhuis, Sander; Groeneweg, Niels; Koolman, Xander; Portrait, France

2017-12-01

Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers' performance. The aim of this paper is to describe the feasibility of assessing and comparing the performances of providers using a comprehensive set of quality and cost data. We had access to unique and extensive datasets containing individual data on PROMs, PREMs and costs of physiotherapy practices in Dutch primary care. We merged these datasets at the patient-level and compared the performances of these practices using case-mix corrected linear regression models. Several significant differences in performance were detected between practices. These results can be used by both physiotherapists, to improve treatment given, and insurers to support their purchasing decisions. The study demonstrates that it is feasible to compare the performance of providers using PROMs and PREMs. However, it would take an extra effort to increase usefulness and it remains unclear under which conditions this effort is cost-effective. Healthcare providers need to be aware of the added value of registering outcomes to improve their quality. Insurers need to facilitate this by designing value-based contracts with the right incentives. Only then can payment methods contribute to value-based healthcare and increase value for patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Menstrual questionnaires for clinical and research use.

Science.gov (United States)

Matteson, Kristen A

2017-04-01

Patient-reported outcome measures (PROMs) have the potential to be extremely valuable in the clinical care delivery for women who report heavy menstrual bleeding (HMB). Increasingly, studies on HMB have incorporated PROMs to evaluate the impact of bleeding on quality of life. These measures have included semiquantitative charts and pictograms, questionnaires to assess symptoms and impact on quality of life, and health-related quality of life questionnaires. Recent systematic reviews have highlighted inconsistency of outcome measurement across studies on HMB as a challenge limiting the interpretability of the body of literature and the ability to generate consensus on the relative effectiveness of treatment options. Consequently, research initiatives and international collaborations are working to harmonize outcome measurement. Harmonizing the use of questionnaires in research and clinical care has the potential to improve patient-centered care delivery for women with HMB and improve the generation of patient-focused evidence-based guidelines for the evaluation and treatment of HMB. Copyright © 2016. Published by Elsevier Ltd.

Design Fixation and Cooperative Learning in Elementary Engineering Design Project: A Case Study

Science.gov (United States)

Luo, Yi

2015-01-01

This paper presents a case study examining 3rd, 4th and 5th graders' design fixation and cooperative learning in an engineering design project. A mixed methods instrument, the Cooperative Learning Observation Protocol (CLOP), was adapted to record frequency and class observation on cooperative learning engagement through detailed field notes.…

Design Fixation and Cooperative Learning in Elementary Engineering Design Project: A Case Study

Directory of Open Access Journals (Sweden)

Yi Luo

2015-09-01

Full Text Available This paper presents a case study examining 3rd, 4th and 5th graders’ design fixation and cooperative learning in an engineering design project. A mixed methods instrument, the Cooperative Learning Observation Protocol (CLOP, was adapted to record frequency and class observation on cooperative learning engagement through detailed field notes. Students’ design journals and reflections were also analyzed for an inductive qualitative analysis. The findings indicate three major themes of design fixation: 1 fixation on common features of things; 2 fixation on popular teenage culture; 3 fixation on the first design idea. In the cooperative learning process of elementary engineering design project, although pupils had demonstrated some abilities to solve concrete problems in a logical fashion, the participants encountered a number of obstacles in the group. Dominance, social loafing, and other problems occurring in the group process might have offset certain benefits of cooperative learning. Implications of the findings are also discussed.

Design fixation and cooperative learning in elementary engineering design project: A case study

Directory of Open Access Journals (Sweden)

Yi Luo

2015-09-01

Full Text Available This paper presents a case study examining 3rd, 4th and 5th graders’ design fixation and cooperative learning in an engineering design project. A mixed methods instrument, the Cooperative Learning Observation Protocol (CLOP, was adapted to record frequency and class observation on cooperative learning engagement through detailed field notes. Students’ design journals and reflections were also analyzed for an inductive qualitative analysis. The findings indicate three major themes of design fixation: 1 fixation on common features of things; 2 fixation on popular teenage culture; 3 fixation on the first design idea. In the cooperative learning process of elementary engineering design project, although pupils had demonstrated some abilities to solve concrete problems in a logical fashion, the participants encountered a number of obstacles in the group. Dominance, social loafing, and other problems occurring in the group process might have offset certain benefits of cooperative learning. Implications of the findings are also discussed.

Design tradeoff studies and sensitivity analysis. Appendix B

Energy Technology Data Exchange (ETDEWEB)

1979-05-25

The results of the design trade-off studies and the sensitivity analysis of Phase I of the Near Term Hybrid Vehicle (NTHV) Program are presented. The effects of variations in the design of the vehicle body, propulsion systems, and other components on vehicle power, weight, cost, and fuel economy and an optimized hybrid vehicle design are discussed. (LCL)

[Saarland Growth Study: sampling design].

Science.gov (United States)

Danker-Hopfe, H; Zabransky, S

2000-01-01

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

Safety design study of fast breeder reactors in Japan

International Nuclear Information System (INIS)

Miura, M.; Inagaki, T.

1992-01-01

This paper reports on two fast breeder reactor (FBR) concepts, the tank type and the loop type, that have been studied as possible reactor designs to be used for a demonstration FBR (DFBR). The basic principle fo the DFBR design is to ensure plant safety through a defense-in-depth methodology. Improvements in the seismic and thermal stress designs have been attempted for both reactor concepts. The system design study strives to maximize the reliability of the safety-related systems and to rationalize commercialization of the plant

Structural Design Feasibility Study for the Global Climate Experiment

Energy Technology Data Exchange (ETDEWEB)

Lewin,K.F.; Nagy, J.

2008-12-01

Neon, Inc. is proposing to establish a Global Change Experiment (GCE) Facility to increase our understanding of how ecological systems differ in their vulnerability to changes in climate and other relevant global change drivers, as well as provide the mechanistic basis for forecasting ecological change in the future. The experimental design was initially envisioned to consist of two complementary components; (A) a multi-factor experiment manipulating CO{sub 2}, temperature and water availability and (B) a water balance experiment. As the design analysis and cost estimates progressed, it became clear that (1) the technical difficulties of obtaining tight temperature control and maintaining elevated atmospheric carbon dioxide levels within an enclosure were greater than had been expected and (2) the envisioned study would not fit into the expected budget envelope if this was done in a partially or completely enclosed structure. After discussions between NEON management, the GCE science team, and Keith Lewin, NEON, Inc. requested Keith Lewin to expand the scope of this design study to include open-field exposure systems. In order to develop the GCE design to the point where it can be presented within a proposal for funding, a feasibility study of climate manipulation structures must be conducted to determine design approaches and rough cost estimates, and to identify advantages and disadvantages of these approaches including the associated experimental artifacts. NEON, Inc requested this design study in order to develop concepts for the climate manipulation structures to support the NEON Global Climate Experiment. This study summarizes the design concepts considered for constructing and operating the GCE Facility and their associated construction, maintenance and operations costs. Comparisons and comments about experimental artifacts, construction challenges and operational uncertainties are provided to assist in selecting the final facility design. The overall goal

Sustainable Design Approach: A case study of BIM use

Directory of Open Access Journals (Sweden)

Abdelhameed Wael

2017-01-01

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

An INTEL 8080 microprocessor development system

International Nuclear Information System (INIS)

Horne, P.J.

1977-01-01

The INTEL 8080 has become one of the two most widely used microprocessors at CERN, the other being the MOTOROLA 6800. Even thouth this is the case, there have been, to date, only rudimentary facilities available for aiding the development of application programs for this microprocessor. An ideal development system is one which has a sophisticated editing and filing system, an assembler/compiler, and access to the microprocessor application. In many instances access to a PROM programmer is also required, as the application may utilize only PROMs for program storage. With these thoughts in mind, an INTEL 8080 microprocessor development system was implemented in the Proton Synchrotron (PS) Division. This system utilizes a PDP 11/45 as the editing and file-handling machine, and an MSC 8/MOD 80 microcomputer for assembling, PROM programming and debugging user programs at run time. The two machines are linked by an existing CAMAC crate system which will also provide the means of access to microprocessor applications in CAMAC and the interface of the development system to any other application. (Auth.)

Experimental design of a waste glass study

International Nuclear Information System (INIS)

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

1995-04-01

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

Systematic literature review of patient-reported outcome measures used in assessment and measurement of sleep disorders in chronic obstructive pulmonary disease.

Science.gov (United States)

Garrow, Adam P; Yorke, Janelle; Khan, Naimat; Vestbo, Jørgen; Singh, Dave; Tyson, Sarah

2015-01-01

Sleep problems are common in patients with chronic obstructive pulmonary disease (COPD), but the validity of patient-reported outcome measures (PROMs) that measure sleep dysfunction has not been evaluated. We have reviewed the literature to identify disease-specific and non-disease-specific sleep PROMs that have been validated for use in COPD patients. The review also examined the psychometric properties of identified sleep outcome measures and extracted point and variability estimates of sleep instruments used in COPD studies. The online EMBASE, MEDLINE, PsycINFO, and SCOPUS databases for all years to May 2014 were used to source articles for the review. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Criteria from the Medical Outcomes Trust Scientific Advisory Committee guidelines were used to evaluate the psychometric properties of all sleep PROMs identified. One COPD-specific and six non-COPD-specific sleep outcome measures were identified and 44 papers met the review selection criteria. We only identified one instrument, the COPD and Asthma Sleep Impact Scale, which was developed specifically for use in COPD populations. Ninety percent of the identified studies used one of two non-disease-specific sleep scales, ie, the Pittsburgh Sleep Quality Index and/or the Epworth Sleep Scale, although neither has been tested for reliability or validity in people with COPD. The results highlight a need for existing non-disease-specific instruments to be validated in COPD populations and also a need for new disease-specific measures to assess the impact of sleep problems in COPD.

Survey of methods of facial palsy documentation in use by members of the Sir Charles Bell Society.

Science.gov (United States)

Fattah, Adel Y; Gavilan, Javier; Hadlock, Tessa A; Marcus, Jeffrey R; Marres, Henri; Nduka, Charles; Slattery, William H; Snyder-Warwick, Alison K

2014-10-01

Facial palsy manifests a broad array of deficits affecting function, form, and psychological well-being. Assessment scales were introduced to standardize and document the features of facial palsy and to facilitate the exchange of information and comparison of outcomes. The aim of this study was to determine which assessment methodologies are currently employed by those involved in the care of patients with facial palsy as a first step toward the development of consensus on the appropriate assessments for this patient population. Online questionnaire. The Sir Charles Bell Society, a group of professionals dedicated to the care of patients with facial palsy, were surveyed to determine the scales used to document facial nerve function, patient reported outcome measures (PROM), and photographic documentation. Fifty-five percent of the membership responded (n = 83). Grading scales were used by 95%, most commonly the House-Brackmann and Sunnybrook scales. PROMs were used by 58%, typically the Facial Clinimetric Evaluation scale or Facial Disability Index. All used photographic recordings, but variability existed among the facial expressions used. Videography was performed by 82%, and mostly involved the same views as still photography; it was also used to document spontaneous movement and speech. Three-dimensional imaging was employed by 18% of respondents. There exists significant heterogeneity in assessments among clinicians, which impedes straightforward comparisons of outcomes following recovery and intervention. Widespread adoption of structured assessments, including scales, PROMs, photography, and videography, will facilitate communication and comparison among those who study the effects of interventions on this population. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Preliminary Systems Design Study assessment report

International Nuclear Information System (INIS)

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

1992-01-01

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

Overview of Fusion-Fission Hybrid Reactor Design Study in China

International Nuclear Information System (INIS)

Huang Jinhua; Feng Kaiming; Deng Baiquan; Deng, P.Zh.; Zhang Guoshu; Hu Gang; He Kaihui; Wu Yican; Qiu Lijian; Huang Qunying; Xiao Bingjia; Liu Xiaoping; Chen Yixue; Kong, M.H.

2002-01-01

The motivation for developing fusion-fission hybrid reactors is discussed in the context of electricity power requirements by 2050 in China. A detailed conceptual design of the Fusion Experimental Breeder (FEB) was developed from 1986-1995. The FEB has a subignited tokamak fusion core with a major radius of 4.0 m, a fusion power of 145 MW, and a fusion energy gain Q of 3. Based on this, an engineering outline design study of the FEB, FEB-E, has been performed. This design study is a transition from conceptual to engineering design in this research. The main results beyond that given in the detailed conceptual design are included in this paper, namely, the design studies of the blanket, divertor, test blanket, and tritium and environment issues. In-depth analyses have been performed to support the design. Studies of related advanced concepts such as the waste transmutation blanket concept and the spherical tokamak core concept are also presented

A study of aerobic bacterial pathogens associated with vaginitis in reproductive age group women (15-45 years) and their sensitivity pattern

OpenAIRE

Sangeetha K. T.; Saroj Golia; Vasudha C. L.

2015-01-01

Background: Aerobic vaginitis (AV) is caused by a displacement of the healthy vaginal Lactobacillus species with aerobic pathogens such as Enterococcus faecalis, Escherichia coli and Staphylococcus aureus that triggers a localized vaginal inflammatory immune response. AV if it is not diagnosed and treated early, especially during pregnancy can place the health of both the mother and the foetus at risk as it is associated with preterm birth, premature rupture of membranes (PROM) and chorioamni...

Computer electronics made simple computerbooks

CERN Document Server

Bourdillon, J F B

1975-01-01

Computer Electronics: Made Simple Computerbooks presents the basics of computer electronics and explains how a microprocessor works. Various types of PROMs, static RAMs, dynamic RAMs, floppy disks, and hard disks are considered, along with microprocessor support devices made by Intel, Motorola and Zilog. Bit slice logic and some AMD bit slice products are also described. Comprised of 14 chapters, this book begins with an introduction to the fundamentals of hardware design, followed by a discussion on the basic building blocks of hardware (NAND, NOR, AND, OR, NOT, XOR); tools and equipment that

Seal design alternatives study

International Nuclear Information System (INIS)

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

1993-06-01

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

Complexity Metrics for Workflow Nets

DEFF Research Database (Denmark)

Lassen, Kristian Bisgaard; van der Aalst, Wil M.P.

2009-01-01

analysts have difficulties grasping the dynamics implied by a process model. Recent empirical studies show that people make numerous errors when modeling complex business processes, e.g., about 20 percent of the EPCs in the SAP reference model have design flaws resulting in potential deadlocks, livelocks......, etc. It seems obvious that the complexity of the model contributes to design errors and a lack of understanding. It is not easy to measure complexity, however. This paper presents three complexity metrics that have been implemented in the process analysis tool ProM. The metrics are defined...... for a subclass of Petri nets named Workflow nets, but the results can easily be applied to other languages. To demonstrate the applicability of these metrics, we have applied our approach and tool to 262 relatively complex Protos models made in the context of various student projects. This allows us to validate...

Lessons Learned from Applying Design Thinking in a NASA Rapid Design Study in Aeronautics

Science.gov (United States)

McGowan, Anna-Maria; Bakula, Casey; Castner, Raymond

2017-01-01

In late 2015, NASA's Aeronautics Research Mission Directorate (ARMD) funded an experiment in rapid design and rapid teaming to explore new approaches to solving challenging design problems in aeronautics in an effort to cultivate and foster innovation. This report summarizes several lessons learned from the rapid design portion of the study. This effort entailed learning and applying design thinking, a human-centered design approach, to complete the conceptual design for an open-ended design challenge within six months. The design challenge focused on creating a capability to advance experimental testing of autonomous aeronautics systems, an area of great interest to NASA, the US government as a whole, and an entire ecosystem of users and developers around the globe. A team of nine civil servant researchers from three of NASA's aeronautics field centers with backgrounds in several disciplines was assembled and rapidly trained in design thinking under the guidance of the innovation and design firm IDEO. The design thinking process, while used extensively outside the aerospace industry, is less common and even counter to many practices within the aerospace industry. In this report, several contrasts between common aerospace research and development practices and design thinking are discussed, drawing upon the lessons learned from the NASA rapid design study. The lessons discussed included working towards a design solution without a set of detailed design requirements, which may not be practical or even feasible for management to ascertain for complex, challenging problems. This approach allowed for the possibility of redesigning the original problem statement to better meet the needs of the users. Another lesson learned was to approach problems holistically from the perspective of the needs of individuals that may be affected by advances in topic area instead of purely from a technological feasibility viewpoint. The interdisciplinary nature of the design team also

Powersail High Power Propulsion System Design Study

Science.gov (United States)

Gulczinski, Frank S., III

2000-11-01

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

Mining student capstone projects with FRASR and ProM

NARCIS (Netherlands)

Poncin, W.; Serebrenik, A.; Brand, van den M.G.J.

2011-01-01

Capstone projects are commonly carried out at the end of an undergraduate program of study in software engineering or computer science. While traditionally such projects solely focussed on the software product to be developed, in more recent work importance of the development process has been

Conceptual design study of Fusion Experimental Reactor (FY87FER)

International Nuclear Information System (INIS)

1988-05-01

The design study of Fusion Experimental Reactor(FER) which has been proposed to be the next step fusion device has been conducted by JAERI Reactor System Laboratory since 1982 and by FER design team since 1984. This is the final report of the FER design team program and describes the results obtained in FY1987 (partially in FY1986) activities. The contents of this report consist of the reference design which is based on the guideline in FY1986 by the Subcomitees set up in Nuclear Fusion Council of Atomic Energy Commission of Japan, the Low-Physics-Risk reactor design for achieving physics mission more reliably and the system study of FER design candidates including above two designs. (author)

The Potential of Adaptive Design in Animal Studies

Directory of Open Access Journals (Sweden)

Arshad Majid

2015-10-01

Full Text Available Clinical trials are the backbone of medical research, and are often the last step in the development of new therapies for use in patients. Prior to human testing, however, preclinical studies using animal subjects are usually performed in order to provide initial data on the safety and effectiveness of prospective treatments. These studies can be costly and time consuming, and may also raise concerns about the ethical treatment of animals when potentially harmful procedures are involved. Adaptive design is a process by which the methods used in a study may be altered while it is being conducted in response to preliminary data or other new information. Adaptive design has been shown to be useful in reducing the time and costs associated with clinical trials, and may provide similar benefits in preclinical animal studies. The purpose of this review is to summarize various aspects of adaptive design and evaluate its potential for use in preclinical research.

The Potential of Adaptive Design in Animal Studies.

Science.gov (United States)

Majid, Arshad; Bae, Ok-Nam; Redgrave, Jessica; Teare, Dawn; Ali, Ali; Zemke, Daniel

2015-10-12

Clinical trials are the backbone of medical research, and are often the last step in the development of new therapies for use in patients. Prior to human testing, however, preclinical studies using animal subjects are usually performed in order to provide initial data on the safety and effectiveness of prospective treatments. These studies can be costly and time consuming, and may also raise concerns about the ethical treatment of animals when potentially harmful procedures are involved. Adaptive design is a process by which the methods used in a study may be altered while it is being conducted in response to preliminary data or other new information. Adaptive design has been shown to be useful in reducing the time and costs associated with clinical trials, and may provide similar benefits in preclinical animal studies. The purpose of this review is to summarize various aspects of adaptive design and evaluate its potential for use in preclinical research.

Assessing musical abilities objectively: construction and validation of the profile of music perception skills.

Directory of Open Access Journals (Sweden)

Lily N C Law

Full Text Available A common approach for determining musical competence is to rely on information about individuals' extent of musical training, but relying on musicianship status fails to identify musically untrained individuals with musical skill, as well as those who, despite extensive musical training, may not be as skilled. To counteract this limitation, we developed a new test battery (Profile of Music Perception Skills; PROMS that measures perceptual musical skills across multiple domains: tonal (melody, pitch, qualitative (timbre, tuning, temporal (rhythm, rhythm-to-melody, accent, tempo, and dynamic (loudness. The PROMS has satisfactory psychometric properties for the composite score (internal consistency and test-retest r>.85 and fair to good coefficients for the individual subtests (.56 to.85. Convergent validity was established with the relevant dimensions of Gordon's Advanced Measures of Music Audiation and Musical Aptitude Profile (melody, rhythm, tempo, the Musical Ear Test (rhythm, and sample instrumental sounds (timbre. Criterion validity was evidenced by consistently sizeable and significant relationships between test performance and external musical proficiency indicators in all three studies (.38 to.62, p<.05 to p<.01. An absence of correlations between test scores and a nonmusical auditory discrimination task supports the battery's discriminant validity (-.05, ns. The interrelationships among the various subtests could be accounted for by two higher order factors, sequential and sensory music processing. A brief version of the full PROMS is introduced as a time-efficient approximation of the full version of the battery.

Clinical value of polymerase chain reaction in detecting group B streptococcus during labor.

Science.gov (United States)

Koppes, Dorothea Maria; Vriends, Antonius Arnoldus Cornelis Maria; van Rijn, Michiel; van Heesewijk, Antonine Dimphne

2017-06-01

To reduce the intrapartum use of antibiotics in women with prolonged rupture of the membranes (PROM) by restriction of antibiotics to women who are colonized with group B streptococci (GBS), as identified with the Cepheid Gene Xpert polymerase chain reaction (PCR) for detecting GBS. We conducted a randomized controlled trial among full-term delivering women with PROM. Fifty-four women were enrolled, based on a power calculation with a significance level of 5% and a power of 95%. Twenty-seven women received the standard treatment (rectovaginal swab [RVS] for bacterial culture and antibiotics). For another 27 women PCR was performed on the RVS and antibiotics were used only when the PCR was positive. The primary outcome was reduction in antibiotic use, defined as the percentage of women who received antibiotics during labor. 54 Women were enrolled in the study between 1 May and 18 November 2014. There were no significant differences in baseline characteristics. In total, 10 of the 54 women were GBS positive (18.5%). Of those 10 women, three were identified on bacterial culture and seven on PCR. In the bacterial culture group all the women received antibiotics. In the PCR group 10 women (37%) received antibiotics (P = 0.002). Two false-positive PCR tests were identified. There were no false-negative PCR tests. Real-time identification of GBS on PCR reduces the intrapartum use of antibiotics in women with PROM. © 2017 Japan Society of Obstetrics and Gynecology.

Research designs and making causal inferences from health care studies.

Science.gov (United States)

Flannelly, Kevin J; Jankowski, Katherine R B

2014-01-01

This article summarizes the major types of research designs used in healthcare research, including experimental, quasi-experimental, and observational studies. Observational studies are divided into survey studies (descriptive and correlational studies), case-studies and analytic studies, the last of which are commonly used in epidemiology: case-control, retrospective cohort, and prospective cohort studies. Similarities and differences among the research designs are described and the relative strength of evidence they provide is discussed. Emphasis is placed on five criteria for drawing causal inferences that are derived from the writings of the philosopher John Stuart Mill, especially his methods or canons. The application of the criteria to experimentation is explained. Particular attention is given to the degree to which different designs meet the five criteria for making causal inferences. Examples of specific studies that have used various designs in chaplaincy research are provided.

Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic.

Science.gov (United States)

Moura, Lidia M V R; Schwamm, Eli; Moura Junior, Valdery; Seitz, Michael P; Hsu, John; Cole, Andrew J; Schwamm, Lee H

2016-12-06

To determine whether patients could self-report physical and mental health assessments in the waiting room and whether these assessments would be associated with modified Rankin Scale (mRS) and Quality of Life in Epilepsy (QOLIE-10) scores. We offered iPad-based surveys to consecutive adult neurology patients at check-in to collect patient-reported outcome measures (PROMs). We collected demographic and clinical data on 6,075 patients through survey or administrative claims and PROMs from participating patients. We compared demographic characteristics of participants and nonparticipants and tested associations between physical and mental health scores and mRS and QOLIE-10. Of 6,075 patients seen by neurologists during the study period, 2,992 (49.3%) participated in the survey. Compared to nonparticipating patients, participating patients more often were privately insured (53.5% vs 42.7%, p neurology (nonsubspecialty) clinics (53.1% vs 46.6%, p Neurology.

A comparative study of two shovel designs.

Science.gov (United States)

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

1993-10-01

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

Green Diesel from Hydrotreated Vegetable Oil Process Design Study

NARCIS (Netherlands)

Hilbers, T.J.; Sprakel, Lisette Maria Johanna; van den Enk, L.B.J.; Zaalberg, B.; van den Berg, Henderikus; van der Ham, Aloysius G.J.

2015-01-01

A systematic approach was applied to study the process of hydrotreating vegetable oils. During the three phases of conceptual, detailed, and final design, unit operations were designed and sized. Modeling of the process was performed with UniSim Design®. Producing green diesel and jet fuel from

Proměny Corporate Social Responsibility

OpenAIRE

Knížová, Kristýna

2014-01-01

In 1953, Howard R. Bowen gave rise to the debate on social responsibility, and since then it has become very widespread. The concept of Corporate Social Responsibility gained a lot of forms during the second half of the twentieth century and from the university campuses got into practice and also into the Czech Republic. On the background of changing theoretical approaches toward CSR we can see changes of business environment - especially in the change of the conceptualization of the enterpri...

DU-AGG pilot plant design study

International Nuclear Information System (INIS)

Lessing, P.A.; Gillman, H.

1996-07-01

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

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

OpenAIRE

Marshall, R; Page, T

2016-01-01

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

A framework for studying teacher learning by design

NARCIS (Netherlands)

Voogt, Joke; McKenney, Susan; Janssen, Fred; Berry, Amanda; Kicken, Wendy; Coenders, Fer

2012-01-01

Voogt, J., McKenney, S., Janssen, F., Berry, A., Kicken, W., & Coenders, F. (2012, 2-6 July). A framework for studying teacher learning by design. Paper presentation at the Teachers as Designers of Technology Enhanced Learning pre-conference workshop in conjunction with the ISLS annual meeting,

Preliminary 2D design study for A ampersand PCT

International Nuclear Information System (INIS)

Keto, E.; Azevedo, S.; Roberson, P.

1995-03-01

Lawrence Livermore National Laboratory is currently designing and constructing a tomographic scanner to obtain the most accurate possible assays of radioactivity in barrels of nuclear waste in a limited amount of time. This study demonstrates a method to explore different designs using laboratory experiments and numerical simulations. In particular, we examine the trade-off between spatial resolution and signal-to-noise. The simulations are conducted in two dimensions as a preliminary study for three dimensional imaging. We find that the optimal design is entirely dependent on the expected source sizes and activities. For nuclear waste barrels, preliminary results indicate that collimators with widths of 1 to 3 inch and aspect ratios of 5:1 to 10:1 should perform well. This type of study will be repeated in 3D in more detail to optimize the final design

Interactive design computation : A case study on quantum design paradigm

NARCIS (Netherlands)

Feng, H.

2013-01-01

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

Scaffolding Preservice Teachers' WebQuest Design: A Qualitative Study

Science.gov (United States)

Wang, Feng; Hannafin, Michael J.

2009-01-01

This study examined how participating preservice teachers reported their perceptions and use of different scaffolds provided to support their WebQuest design. Sixteen preservice teachers participated in a succession of course activities designed to guide WebQuest design and development. Results indicated that while participants followed, adapted,…

Fusion reactor design studies

International Nuclear Information System (INIS)

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

1990-01-01

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

Research Design in the study of the European Neighbourhood Policy

DEFF Research Database (Denmark)

Exadaktylos, Theofanis; Lynggaard, Kennet

2017-01-01

This chapter deals with the pitfalls and pathways of research design aimed at the study of the European Neighbourhood Policy (ENP) and maps out the literature on questions of knowledge ambition, research ontology and epistemology, and choices of approaches to the research object. We include...... a review of traditional research designs in ENP research, through a systematic meta-analysis of a selection of the most-cited articles on the ENP. Inspired by earlier work on awareness of research design in EU studies, ENP research is categorised according to typical choices of research design in the form...... of dichotomous trade-offs. The chapter then discusses how individual contributions to this volume deal with research design challenges of the past and present innovative ways of studying the revised ENP....

Incomplete by Design: A Study of a Design-in-Use Approach to Systems Implementation

DEFF Research Database (Denmark)

Torkilsheyggi, Arnvør Martinsdóttir á; Hertzum, Morten

2017-01-01

In complex work settings the design of a system, including the associated work practices, must be completed in use to derive full benefit from the system. We investigate the introduction of an electronic whiteboard throughout a hospital in which management substituted a local design-in-use process......, driven by super users, for a centrally organized implementation process. The aim of this study is to investigate the design-in-use approach to systems implementation with respect to the tension that ensued between hospital management’s expectations to the process and the goals pursued in the individual...

Rhetorical Design Studies: The Art of Making Design Choices Explicit

DEFF Research Database (Denmark)

Halstrøm, Per L.

2017-01-01

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

[Strengthening the methodology of study designs in scientific researches].

Science.gov (United States)

Ren, Ze-qin

2010-06-01

Many problems in study designs have affected the validity of scientific researches seriously. We must understand the methodology of research, especially clinical epidemiology and biostatistics, and recognize the urgency in selection and implement of right study design. Thereafter we can promote the research capability and improve the overall quality of scientific researches.

Parametric study for design of thermal sleeves

International Nuclear Information System (INIS)

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

1985-01-01

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

Design study on sodium cooled large-scale reactor

International Nuclear Information System (INIS)

Murakami, Tsutomu; Hishida, Masahiko; Kisohara, Naoyuki

2004-07-01

In Phase 1 of the 'Feasibility Studies on Commercialized Fast Reactor Cycle Systems (F/S)', an advanced loop type reactor has been selected as a promising concept of sodium-cooled large-scale reactor, which has a possibility to fulfill the design requirements of the F/S. In Phase 2, design improvement for further cost reduction of establishment of the plant concept has been performed. This report summarizes the results of the design study on the sodium-cooled large-scale reactor performed in JFY2003, which is the third year of Phase 2. In the JFY2003 design study, critical subjects related to safety, structural integrity and thermal hydraulics which found in the last fiscal year has been examined and the plant concept has been modified. Furthermore, fundamental specifications of main systems and components have been set and economy has been evaluated. In addition, as the interim evaluation of the candidate concept of the FBR fuel cycle is to be conducted, cost effectiveness and achievability for the development goal were evaluated and the data of the three large-scale reactor candidate concepts were prepared. As a results of this study, the plant concept of the sodium-cooled large-scale reactor has been constructed, which has a prospect to satisfy the economic goal (construction cost: less than 200,000 yens/kWe, etc.) and has a prospect to solve the critical subjects. From now on, reflecting the results of elemental experiments, the preliminary conceptual design of this plant will be preceded toward the selection for narrowing down candidate concepts at the end of Phase 2. (author)

What Does It Take to Be a Successful Graphic Designer: A Phenomenological Study on Graphic Design Curriculum

Science.gov (United States)

Beller, Shannon

2017-01-01

This study examined the phenomenon of what it takes to be a successful graphic designer. With an identity crisis in graphic design education, design curriculum is faced with uncertainties. With the diversity of programs and degrees in graphic design, the competencies and skills developed among the various programs reflect different purposes, thus…

Conceptual design study of fusion experimental reactor (FY86 FER)

International Nuclear Information System (INIS)

Miki, Nobuharu; Iida, Fumio; Suzuki, Shohei; Wachi, Yoshihiro; Toyoda, Katsuyoshi; Hashizume, Takashi; Konno, Masayuki.

1987-09-01

This report summarizes the FER magnet design which was conducted last year (1986). Main objective of the new FER design is to have better cost performance of the machine. The physics assumptions are reviewed to reduce risks. Optimization of the physics design and improvements of the engineering design have been done without changing missions of the device. After a preliminary investigation for the optimization and improvements, six FER concepts have been developed to establish the improved design point, and have been studied in more detail. In the magnet design, the improvements of superconducting magnet design were mainly investigated to reduce the reactor size. A normal conductor was studied as an alternative option for appling to the special poloidal field coils that were located on the interior to the toroidal field coils. Some improvements were made on the superconducting magnet design. Based on the preliminary investigation, the magnet design specifications have been modified somewhat. The conceptual design of the magnet system components have been done for the candidate FER concepts. (author)

Study, design and manufacture eddy current probes for industry applications

International Nuclear Information System (INIS)

Nguyen Phuc; Nguyen Van Thuy; Vuong Binh Duong; Do Minh Duc; Trinh Dinh Truong; Tran Trong Duc; Do Tung Khanh; Dang Quang Trung

2016-01-01

This study is based on the studying, designing and manufacturing of eddy current probes for industry applications. The main tasks of this study include: i) Describes the overview and classification of eddy current probes (which can be classified into three categories based on the mode of operation: absolute eddy current probe, differential eddy current probe and reflect eddy current probe); ii) Describes the three methods of probe designing and manufacturing (including experimental, analytical and numerical designs); iii) Describes the designing and manufacturing of eddy current probes for industry applications, which based on experimental and analytical methods. Based on this study, we have successfully manufactured some current probes (including absolute eddy current probe, differential eddy current probe and reflect eddy current probe) for surface and tube inspections. (author)

HTS Insert Magnet Design Study

CERN Document Server

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

2011-01-01

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

Study on Design Optimization of Centrifugal Compressors Considering Efficiency and Weight

International Nuclear Information System (INIS)

Lee, Younghwan; Kang, Shinhyoung; Ha, Kyunggu

2015-01-01

Various centrifugal compressors are currently used extensively in industrial fields, where the design requirements are more complicated. This makes it more difficult to determine the optimal design point of a centrifugal compressor. Traditionally, the efficiency is an important factor for optimization. In this study, the weight of the compressor was also considered. The aim of this study was to present the design tendency considering the stage efficiency and weight. In addition, this study suggested possibility of a selection of compressor design objectives at an early design stage based on the optimization results. Only a vaneless diffuser was considered in this case. The Kriging method was used with sample points from 1D design program data. The optimal points were determined in a substitute design space.

Study on Design Optimization of Centrifugal Compressors Considering Efficiency and Weight

Energy Technology Data Exchange (ETDEWEB)

Lee, Younghwan; Kang, Shinhyoung [Seoul National University, Seoul (Korea, Republic of); Ha, Kyunggu [Hyundai Motor Group, Ulsan (Korea, Republic of)

2015-04-15

Various centrifugal compressors are currently used extensively in industrial fields, where the design requirements are more complicated. This makes it more difficult to determine the optimal design point of a centrifugal compressor. Traditionally, the efficiency is an important factor for optimization. In this study, the weight of the compressor was also considered. The aim of this study was to present the design tendency considering the stage efficiency and weight. In addition, this study suggested possibility of a selection of compressor design objectives at an early design stage based on the optimization results. Only a vaneless diffuser was considered in this case. The Kriging method was used with sample points from 1D design program data. The optimal points were determined in a substitute design space.

Children as Educational Computer Game Designers: An Exploratory Study

Science.gov (United States)

Baytak, Ahmet; Land, Susan M.; Smith, Brian K.

2011-01-01

This study investigated how children designed computer games as artifacts that reflected their understanding of nutrition. Ten 5th grade students were asked to design computer games with the software "Game Maker" for the purpose of teaching 1st graders about nutrition. The results from the case study show that students were able to…

An Empirical Study on Design Partner Selection in Green Product Collaboration Design

Directory of Open Access Journals (Sweden)

Aijun Liu

2018-01-01

Full Text Available Green production has become an important issue in PCD (Product Collaboration Design for almost every enterprise, and will determine the sustainability of enterprises in the long term. The choice of design partner is a necessary condition in order to achieve green production. For the uncertain, fuzzy, and dynamic information such as unknown indices and weights, fuzzy semantics, and dynamic time factors in GPCD (Green Product Collaboration Design, a two-stage dynamic hybrid MADM (Multi-Attribute Decision Making approach based on fuzzy DEMATEL (Decision-Making and Trial Evaluation Laboratory, fuzzy KMA (Karnik–Mendel Algorithm, and fuzzy VIKOR (VlseKriterjumska Optimizacija I Kompromisno Resenje was proposed. In the first stage, fuzzy DEMATEL was used to determine the evaluation indices. Then, in the second stage, to accurately depict the dynamic information generated by the different phases of a product design, the dynamic evaluation method based on fuzzy theories was employed, and the weights of the indices were calculated by fuzzy KMA, then sorted by fuzzy VIKOR. Finally, a case study and a comparative analysis wre provided to illustrate the effectiveness of the proposed approach.

Conceptual design study for the demonstration reactor of JSFR. (3) Safety design and evaluation

International Nuclear Information System (INIS)

Tani, Akihiro; Shimakawa, Yoshio; Kubo, Shigenobu; Fujimura, Ken; Yamano, Hidemasa

2011-01-01

This paper describes the result of conceptual safety design and evaluation for the demonstration plant of Japan sodium-cooled fast reactor (JSFR), which was preliminarily conducted for providing information necessary to decide the plant specification for further design study. The plant major specifications except for output power and safety design concept are almost the same as those of the commercial JSFR. A set of safety evaluation for typical design basis events (DBEs) is mainly focused here, which was conducted for the 750 MWe design. Safety analyses for DBEs evaluation were performed on the basis of conservative assumptions using a one-dimensional flow network code with point kinetics. For representative DBEs, transient over power type events and loss of flow type events were analyzed. The long-term loss-of-offsite power event was also calculated to evaluate the natural circulation decay heat removal system. All analytical results showed to meet tentative safety criteria, thus it was confirmed that the safety design concept of JSFR is feasible against DBEs. (author)

Tile-based rigidization surface parametric design study

Science.gov (United States)

Giner Munoz, Laura; Luntz, Jonathan; Brei, Diann; Kim, Wonhee

2018-03-01

Inflatable technologies have proven useful in consumer goods as well as in more recent applications including civil structures, aerospace, medical, and robotics. However, inflatable technologies are typically lacking in their ability to provide rigid structural support. Particle jamming improves upon this by providing structures which are normally flexible and moldable but become rigid when air is removed. Because these are based on an airtight bladder filled with loose particles, they always occupy the full volume of its rigid state, even when not rigidized. More recent developments in layer jamming have created thin, compact rigidizing surfaces replacing the loose volume of particles with thinly layered surface materials. Work in this area has been applied to several specific applications with positive results but have not generally provided the broader understanding of the rigidization performance as a function of design parameters required for directly adapting layer rigidization technology to other applications. This paper presents a parametric design study of a new layer jamming vacuum rigidization architecture: tile-based vacuum rigidization. This form of rigidization is based on layers of tiles contained within a thin vacuum bladder which can be bent, rolled, or otherwise compactly stowed, but when deployed flat, can be vacuumed and form a large, flat, rigid plate capable of supporting large forces both localized and distributed over the surface. The general architecture and operation detailing rigidization and compliance mechanisms is introduced. To quantitatively characterize the rigidization behavior, prototypes rigidization surfaces are fabricated and an experimental technique is developed based on a 3-point bending test. Performance evaluation metrics are developed to describe the stiffness, load-bearing capacity, and internal slippage of tested prototypes. A set of experimental parametric studies are performed to better understand the impact of

HYFIRE II: fusion/high-temperature electrolysis conceptual-design study. Annual report

International Nuclear Information System (INIS)

Fillo, J.A.

1983-08-01

As in the previous HYFIRE design study, the current study focuses on coupling a Tokamak fusion reactor with a high-temperature blanket to a High-Temperature Electrolyzer (HTE) process to produce hydrogen and oxygen. Scaling of the STARFIRE reactor to allow a blanket power to 6000 MW(th) is also assumed. The primary difference between the two studies is the maximum inlet steam temperature to the electrolyzer. This temperature is decreased from approx. 1300 0 to approx. 1150 0 C, which is closer to the maximum projected temperature of the Westinghouse fuel cell design. The process flow conditions change but the basic design philosophy and approaches to process design remain the same as before. Westinghouse assisted in the study in the areas of systems design integration, plasma engineering, balance-of-plant design, and electrolyzer technology

Hydrodynamic studies in designing of fluidized bed system

International Nuclear Information System (INIS)

Mohamad Puad Abu; Muhd Noor Muhd Yunus; Syed Nasaruddin Syed Idris

2002-01-01

Fluidized bed process have been used mostly in the petroleum and paper industries, and for processing nuclear wastes, spent cook liquor, wood chips, and sewage sludge disposal. Even at MINT some of the equipment available used this principal. Before we use or purchase this equipment, it is very grateful if we could understand how the system has been designed. The hydrodynamic fluidization studies is very important in designing of fluidized bed system especially in determining the minimum fluidizing velocity, terminal velocity, flexibility of operation, slugging condition, bubble size and velocity, and transport disengaging height. They can be determined either by calculation or experimentation. This paper will highlight the hydrodynamic study that need to be performed in designing of fluidized bed system so that its can be used appropriately. (Author)

Design study of plant system for the fusion experimental reactor (FER)

International Nuclear Information System (INIS)

Iida, Hiromasa; Kuroda, Hideo; Yamada, Masao; Suzuki, Tatsushi; Honda, Tsutomu; Ohmura, Hiroshi; Itoh, Shinichi.

1986-11-01

This report describes design study results of the FER plant system. The purpose of this study is to have an image of the FER plant system as a whole by designing major auxiliary systems, reactor building and maintenance and radwaste desposal systems. The major auxiliary systems include tritium, cooling, evacuation and fueling systems. For these each systems, flowdiagrams are studied and designs of devices and pipings are conducted. In the reactor building design, layout of the above auxiliary systems in the building is studied with careful zoning concept by the radiation level. Structural integrity of the reactor building is also studied including seismic analysis. In the design of the maintenance and radwaste system flowdiagram of failed reactor components is developed and transfer vehicles and buildings are designed. Finally assuming JAERI Naka site as the reactor site layout of the whole FER plant system is developed. (author)

A foundational observation method for studying design situations

DEFF Research Database (Denmark)

Cash, Philip; Hicks, Ben; Culley, Steve

2015-01-01

Observational studies of designers play an important role in engineering design research, yet there is currently no accepted standard approach for comparing, combining, or contrasting studies. Consequentially, reuse, reanalysis, replication, and aggregation of data are limited and the potential...... that covers capture, coding, and analysis. The capture step defines overall and situational context as well as multiple capture streams, generating a broad data-set that can be examined from multiple perspectives. The coding step employs a multi-level approach that seeks to minimise workload while describing...

Interim Design Report for the International Design Study for a Neutrino Factory

International Nuclear Information System (INIS)

Choubey, S.; Gandhi, R.; Goswami, S.; Berg, J.S.; Fernow, R.; Gallardo, J.C.; Gupta, R.; Kirk, H.; Simos, N.; Souchlas, N.; Ellis, M.

2011-01-01

The starting point for the International Design Study for the Neutrino Factory (the IDS-NF) was the output of the earlier International Scoping Study for a future Neutrino Factory and super-beam facility (the ISS). The accelerator facility described in section 2 incorporates the improvements that have been derived from the substantial amount of work carried out within the Accelerator Working Group. Highlights of these improvements include: (1) Initial concepts for the implementation of the proton driver at each of the three example sites, CERN, FNAL, and RAL; (2) Detailed studies of the energy deposition in the target area; (3) A reduction in the length of the muon beam phase-rotation and bunching systems; (4) Detailed analyses of the impact of the risk that stray magnetic field in the accelerating cavities in the ionization cooling channel will reduce the maximum operating gradient. Several alternative ionization-cooling lattices have been developed as fallback options to mitigate this technical risk; (5) Studies of particle loss in the muon front-end and the development of strategies to mitigate the deleterious effects of such losses; (6) The development of more complete designs for the muon linac and re-circulating linacs; (7) The development of a design for the muon FFAG that incorporates insertions for injection and extraction; and (8) Detailed studies of diagnostics in the decay ring. Other sub-systems have undergone a more 'incremental' evolution; an indication that the design of the Neutrino Factory has achieved a degree of maturity. The design of the neutrino detectors described in section 3 has been optimized and the Detector Working Group has made substantial improvements to the simulation and analysis of the Magnetized Iron Neutrino Detector (MIND) resulting in an improvement in the overall neutrino-detection efficiency and a reduction in the neutrino-energy threshold. In addition, initial consideration of the engineering of the MIND has generated a

Long-Term Survival Prediction for Coronary Artery Bypass Grafting: Validation of the ASCERT Model Compared With The Society of Thoracic Surgeons Predicted Risk of Mortality.

Science.gov (United States)

Lancaster, Timothy S; Schill, Matthew R; Greenberg, Jason W; Ruaengsri, Chawannuch; Schuessler, Richard B; Lawton, Jennifer S; Maniar, Hersh S; Pasque, Michael K; Moon, Marc R; Damiano, Ralph J; Melby, Spencer J

2018-05-01

The recently developed American College of Cardiology Foundation-Society of Thoracic Surgeons (STS) Collaboration on the Comparative Effectiveness of Revascularization Strategy (ASCERT) Long-Term Survival Probability Calculator is a valuable addition to existing short-term risk-prediction tools for cardiac surgical procedures but has yet to be externally validated. Institutional data of 654 patients aged 65 years or older undergoing isolated coronary artery bypass grafting between 2005 and 2010 were reviewed. Predicted survival probabilities were calculated using the ASCERT model. Survival data were collected using the Social Security Death Index and institutional medical records. Model calibration and discrimination were assessed for the overall sample and for risk-stratified subgroups based on (1) ASCERT 7-year survival probability and (2) the predicted risk of mortality (PROM) from the STS Short-Term Risk Calculator. Logistic regression analysis was performed to evaluate additional perioperative variables contributing to death. Overall survival was 92.1% (569 of 597) at 1 year and 50.5% (164 of 325) at 7 years. Calibration assessment found no significant differences between predicted and actual survival curves for the overall sample or for the risk-stratified subgroups, whether stratified by predicted 7-year survival or by PROM. Discriminative performance was comparable between the ASCERT and PROM models for 7-year survival prediction (p validated for prediction of long-term survival after coronary artery bypass grafting in all risk groups. The widely used STS PROM performed comparably as a predictor of long-term survival. Both tools provide important information for preoperative decision making and patient counseling about potential outcomes after coronary artery bypass grafting. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

[Prediction of the latency period by cervical ultrasonography in premature rupture of the membranes before term].

Science.gov (United States)

Gabriel, R; Morille, C; Drieux, L; Bige, V; Leymarie, F; Quereux, C

2002-11-01

To assess the value of ultrasonographic measurement of cervical length for predicting the duration of the latency period from admission to delivery in women with preterm premature rupture of the membranes (PROM). Prospective study in 88 women with preterm PROM before 34 weeks of amenorrhea. The median gestational age at admission was of 30.1 weeks. The clinical management included: no digital examination of the uterine cervix, antenatal corticosteroids, antibiotics (amoxicillin & clavulanic acid) for 7 days, and hoding back until 34 weeks. Cervical length at admission was determined with transvaginal ultrasonography. The duration of the latency period was studied in relation with cervical length, serum C-reactive protein (CRP) level and white blood cell (WBC) count at admission. The median latency period was longer in women with a cervical length > or = 25 mm (10 vs 5 days; p = 0.04), but this was not associated with a significant increase in birth weight. The median latency period was also longer in women with CRP < 20 mg/l (10 vs 3 days; p < 0.001) and this was associated with a significant increase in birth weight (1716 +/- 549 vs 1201 +/- 485 g; p < 0.01). Moreover, increased CRP levels were more frequent in women with a cervical length < 25 mm, and cervical length was no more predictive of the duration of the latency period in the subgroup of women with CRP < 20 mg/l and WBC < 20,000 cells/mm3. In women with preterm PROM, the latency period from admission to delivery is shorter when cervical length is < 25 mm. However, the clinical value of transvaginal ultrasonography is limited in comparison with serum CRP.

Preliminary neutronics design studies for a 400 MWt STAR-LM

International Nuclear Information System (INIS)

Aliberti, G.; Yang, W. S.; Stillman, J. A.; Hill, R. N.

2004-01-01

Neutronics design studies for a 400 MWt high temperature fast reactor are being performed, utilizing lead coolant, transuranic (TRU) nitride fuel, and HT-9 structural material. Under the main design constraints of long fuel lifetime, natural convection heat transport, semi-autonomous control, and small unit size, parametric studies were performed to maximize the discharge burnup and minimize the burnup reactivity swing. Based on the results of these parametric studies, two point designs were developed for a single-batch once-through fuel cycle; one is a 15 full power year cycle design with core volume of 9.5 cubic meters, and the other is a 12 full power year cycle design with core volume of 7.4 cubic meters. For these two point designs, fuel cycle analyses and reactivity feedback coefficients calculations were performed. The 9.5 cubic meter design achieved an average discharge burnup of 83 MWd/kg with a maximum reactivity change over the lifetime of 0.6%. The peak fast fluence was well within the fast fluence limit of HT9, and both average and peak power densities were well below the estimated limit for natural circulation. The performances of the 7.4 cubic meter design were slightly inferior to this design. To enhance the passive safety characteristics, however, further design improvements need to be made to reduce the coolant density coefficient and to increase the radial expansion coefficient. (authors)

Hardness variability in commercial technologies

International Nuclear Information System (INIS)

Shaneyfelt, M.R.; Winokur, P.S.; Meisenheimer, T.L.; Sexton, F.W.; Roeske, S.B.; Knoll, M.G.

1994-01-01

The radiation hardness of commercial Floating Gate 256K E 2 PROMs from a single diffusion lot was observed to vary between 5 to 25 krad(Si) when irradiated at a low dose rate of 64 mrad(Si)/s. Additional variations in E 2 PROM hardness were found to depend on bias condition and failure mode (i.e., inability to read or write the memory), as well as the foundry at which the part was manufactured. This variability is related to system requirements, and it is shown that hardness level and variability affect the allowable mode of operation for E 2 PROMs in space applications. The radiation hardness of commercial 1-Mbit CMOS SRAMs from Micron, Hitachi, and Sony irradiated at 147 rad(Si)/s was approximately 12, 13, and 19 krad(Si), respectively. These failure levels appear to be related to increases in leakage current during irradiation. Hardness of SRAMs from each manufacturer varied by less than 20%, but differences between manufacturers are significant. The Qualified Manufacturer's List approach to radiation hardness assurance is suggested as a way to reduce variability and to improve the hardness level of commercial technologies

ORACLE--antibiotics for preterm prelabour rupture of the membranes: short-term and long-term outcomes.

Science.gov (United States)

Kenyon, S; Taylor, D J; Tarnow-Mordi, W O

2002-01-01

Preterm prelabour rupture of the foetal membranes (pPROM) is the most common antecedent of preterm birth and can lead to death, neonatal disease and long-term disability. Previous small trials of antibiotics for pPROM suggested some health benefits for the neonate, but the results were inconclusive. A large, randomized, multicentre trial was undertaken to try to resolve this issue. In total, 4826 women with pPROM were randomized to one of four treatments: 325 mg co-amoxiclav plus 250 mg erythromycin, co-amoxiclav plus erythromycin placebo, erythromycin plus co-amoxiclav placebo, or co-amoxiclav placebo plus erythromycin placebo, four times daily for 10 d or until delivery. The primary outcome measure was a composite of neonatal death, chronic lung disease or major cerebral abnormality on ultrasonography before discharge from hospital. The analysis was undertaken by intention to treat. Indications of short-term respiratory function, chronic lung disease and major neonatal cerebral abnormality were reduced with the prescription of erythromycin. In contrast, the use of co-amoxiclav was associated with a significant increase in the occurrence of neonatal necrotizing enterocolitis. Prophylactic antibiotics can play a role in preterm prelabour rupture of the membranes in reducing infant morbidity.

High performance APCS conceptual design and evaluation scoping study

International Nuclear Information System (INIS)

Soelberg, N.; Liekhus, K.; Chambers, A.; Anderson, G.

1998-02-01

This Air Pollution Control System (APCS) Conceptual Design and Evaluation study was conducted to evaluate a high-performance (APC) system for minimizing air emissions from mixed waste thermal treatment systems. Seven variations of high-performance APCS designs were conceptualized using several design objectives. One of the system designs was selected for detailed process simulation using ASPEN PLUS to determine material and energy balances and evaluate performance. Installed system capital costs were also estimated. Sensitivity studies were conducted to evaluate the incremental cost and benefit of added carbon adsorber beds for mercury control, specific catalytic reduction for NO x control, and offgas retention tanks for holding the offgas until sample analysis is conducted to verify that the offgas meets emission limits. Results show that the high-performance dry-wet APCS can easily meet all expected emission limits except for possibly mercury. The capability to achieve high levels of mercury control (potentially necessary for thermally treating some DOE mixed streams) could not be validated using current performance data for mercury control technologies. The engineering approach and ASPEN PLUS modeling tool developed and used in this study identified APC equipment and system performance, size, cost, and other issues that are not yet resolved. These issues need to be addressed in feasibility studies and conceptual designs for new facilities or for determining how to modify existing facilities to meet expected emission limits. The ASPEN PLUS process simulation with current and refined input assumptions and calculations can be used to provide system performance information for decision-making, identifying best options, estimating costs, reducing the potential for emission violations, providing information needed for waste flow analysis, incorporating new APCS technologies in existing designs, or performing facility design and permitting activities

Quantitative methods for studying design protocols

CERN Document Server

Kan, Jeff WT

2017-01-01

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

Do different types of bearings and noise from total hip arthroplasty influence hip-related pain, function, and quality of life postoperatively?

DEFF Research Database (Denmark)

Varnum, Claus; Pedersen, Alma B; Kjærsgaard-Andersen, Per

2016-01-01

with metal-on-metal (MoM) THAs to scores from patients with metal-on-polyethylene (MoP) THAs, and to determine the influence of THA-related noise on PROM scores. Patients and methods - We conducted a nationwide cross-sectional questionnaire survey in a cohort of patients identified from the Danish Hip......, and 12% with MoP THAs reported noise from their hip. For the 3 types of bearings, PROM scores from patients with a noisy THA were statistically significantly worse than those from patients with a silent MoP THA. The exception was noisy CoC and MoM THAs, which had the same mean UCLA activity score...

Measuring Quality and Outcomes in Sports Medicine.

Science.gov (United States)

Ruzbarsky, Joseph J; Marom, Niv; Marx, Robert G

2018-07-01

Patient-reported outcome measures (PROMs) are objective metrics critical to evaluating outcomes throughout orthopedic surgery. New instruments continue to emerge, increasing the breadth of information required for those intending to use these measures for research or clinical care. Although earlier metrics were developed using the principles of classic test theory, newer instruments constructed using item response theory are amenable to computer-adaptive testing and may change the way these instruments are administered. This article aims to define the psychometric properties that are important to understand when using all PROMs and to review the most widely used instruments in sports medicine. Copyright © 2018 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

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

2018-04-24

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

BWID System Design Study

International Nuclear Information System (INIS)

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

1991-01-01

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

Improving Creativity Training: A Study of Designer Skills

DEFF Research Database (Denmark)

Valgeirsdóttir, Dagný; Onarheim, Balder; Li-Ying, Jason

2016-01-01

and Cross2001]. Establishing that creativity is important for design and innovation implies that identifying ways of improving creativity is a relevant research area within design studies. Creativity is a basic human skill and multiple studies have been published showing that creativity is a skill that can...... be directed at the individual level by enhancing individual creativity skills, but also improvement at the team level, rendering it important to first improve the understanding of both these levels of creativity in the design process.There are multiple ways to train creativity, although currently most...... optimal way of training creativity is through a combination of (1) educating individuals about creativity, thereby building a solid theoretical understanding, and (2) providing them with a real world case where they are trained in the use of creative tools and processes[Scott et al. 2004]. The latter...

Amnioinfusion in labor induction of term pregnancies with premature rupture of the membranes and low amniotic fluid.

Science.gov (United States)

Miño, M; Puertas, A; Herruzo, A J; Miranda, J A

1998-05-01

To analyze the utility of prophylactic amnioinfusion in term pregnancies with PROM and a low amniotic fluid index during labor induction. Forty-two women with amnioinfusion and 42 in a control group with amniotic fluid index (AFI) below 10 cm when admitted to labor induction were studied. All patients had electronic fetal heart rate and intrauterine pressure continuous monitoring. Amnioinfusion of normal saline (37 degrees C) was realized in the study group, using a continuous perfusion pump at 600 ml/h for 1 h, after which the AFI was again recorded; if this was amnioinfusion. Both groups were similar in age, primiparity, gestational age, initial AFI, interval from rupture of membranes until delivery and length of labor. The amnioinfusion of 600 ml in 1 h significantly increased the AFI (an increase of 7.2 +/- 3.9 vs. a decrease of 1.1 +/- 1.6, P amnioinfusion group, there was a significantly lower rate of cesarean deliveries (0 vs. 6, P amnioinfusion improves neonatal metabolic state when used in labor induction of term pregnancies with PROM and a low amniotic fluid index.

Evaluating and comparing imaging techniques: a review and classification of study designs

International Nuclear Information System (INIS)

Freedman, L.S.

1987-01-01

The design of studies to evaluate and compare imaging techniques are reviewed. Thirteen principles for the design of studies of diagnostic accuracy are given. Because of the 'independence principle' these studies are not able directly to evaluate the contribution of a technique to clinical management. For the latter, the 'clinical value' study design is recommended. A classification of study designs is proposed in parallel with the standard classification of clinical trials. Studies of diagnostic accuracy are analogous to Phase II, whereas studies evaluating the contribution to clinical management correspond to the Phase III category. Currently the majority of published studies employ the Phase II design. More emphasis on Phase III studies is required. (author)

Remarks about the prognosis in case of antenatal diagnosis of gastroschisis.

Science.gov (United States)

Poulain, P; Milon, J; Frémont, B; Proudhon, J F; Odent, S; Babut, J M; Le Marec, B; Grall, J Y; Giraud, J R

1994-05-18

We report our experience of 15 cases of gastroschisis which occurred between 1981 and 1993. All but one were diagnosed antenatally by ultrasound between 16 and 32 weeks of pregnancy. We made a termination of the pregnancy in 3 cases, for multiple malformations in 2 cases and one case of very early premature rupture of the membranes (PROM). When checked (11 cases), the karyotype was normal. We made a cesarean section in 11 cases: the indication was a complication for 6 (fetal distress, PROM, polyhydramnios, large dilatation of the gut). We noted growth retardation in 7 newborns and prematurity in 5/12 (mean gestational age of 36.8 weeks). The preoperative study of the gut noted 5 cases with intestinal damage and one case of complete necrosis of the gut. The global prognosis is not as good as usual, with a perinatal mortality of 41.6% (5/12). We discuss this latter point and examine the literature.

Design study on metal fuel FBR cores

International Nuclear Information System (INIS)

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

1991-01-01

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

Design study of electrical power supply system for tokamak fusion power reactor

International Nuclear Information System (INIS)

1977-01-01

Design study of the electrical power supply system for a 2000MWt Tokamak-type fusion reactor has been carried out. The purposes are to reveal and study problems in the system, leading to a plan of the research and development. Performed were study of the electrical power supply system and design of superconducting inductive energy storages and power switches. In study of the system, specification and capability of various power supplies for the fusion power reactor and design of the total system with its components were investigated. For the superconducting inductive energy storages, material choice, design calculation, and structural design were conducted, giving the size, weight and performance. For thyristor switches, circuit design in the parallel / series connection of element valves and cooling design were studied, providing the size and weight. (auth.)

Modular Stellarator Reactor conceptual design study

International Nuclear Information System (INIS)

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

1983-01-01

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

Modular stellarator reactor conceptual design study

International Nuclear Information System (INIS)

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

1983-01-01

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

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

Science.gov (United States)

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

2013-10-01

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

Interim Design Report for the International Design Study for a Neutrino Factory

Energy Technology Data Exchange (ETDEWEB)

Choubey, S.; Gandhi, R.; Goswami, S.; /Harish-Chandra Res. Inst.; Berg, J.S.; Fernow, R.; Gallardo, J.C.; Gupta, R.; Kirk, H.; Simos, N.; Souchlas, N.; /Brookhaven; Ellis, M.; /Brunel U. /CERN /Durham U., IPPP /Fermilab /Geneva U. /Glasgow U. /Heidelberg, Max Planck Inst. /Imperial Coll., London /Jefferson Lab /Saha Inst.

2011-10-01

The starting point for the International Design Study for the Neutrino Factory (the IDS-NF) was the output of the earlier International Scoping Study for a future Neutrino Factory and super-beam facility (the ISS). The accelerator facility described in section 2 incorporates the improvements that have been derived from the substantial amount of work carried out within the Accelerator Working Group. Highlights of these improvements include: (1) Initial concepts for the implementation of the proton driver at each of the three example sites, CERN, FNAL, and RAL; (2) Detailed studies of the energy deposition in the target area; (3) A reduction in the length of the muon beam phase-rotation and bunching systems; (4) Detailed analyses of the impact of the risk that stray magnetic field in the accelerating cavities in the ionization cooling channel will reduce the maximum operating gradient. Several alternative ionization-cooling lattices have been developed as fallback options to mitigate this technical risk; (5) Studies of particle loss in the muon front-end and the development of strategies to mitigate the deleterious effects of such losses; (6) The development of more complete designs for the muon linac and re-circulating linacs; (7) The development of a design for the muon FFAG that incorporates insertions for injection and extraction; and (8) Detailed studies of diagnostics in the decay ring. Other sub-systems have undergone a more 'incremental' evolution; an indication that the design of the Neutrino Factory has achieved a degree of maturity. The design of the neutrino detectors described in section 3 has been optimized and the Detector Working Group has made substantial improvements to the simulation and analysis of the Magnetized Iron Neutrino Detector (MIND) resulting in an improvement in the overall neutrino-detection efficiency and a reduction in the neutrino-energy threshold. In addition, initial consideration of the engineering of the MIND has

Initial trade and design studies for the fusion engineering device

International Nuclear Information System (INIS)

Flanagan, C.A.; Steiner, D.; Smith, G.E.

1981-06-01

The Magnetic Fusion Energy Engineering Act of 1980 calls for the operation of a Fusion Engineering Device (FED) by 1990. It is the intent of the Act that the FED, in combination with other testing facilities, will establish the engineering feasibility of magnetic fusion energy. The Fusion Engineering Design Center (FEDC), under the guidance of a Technical Management Board (TMB), initiated a program of trade and design studies in October 1980 to support the selection of the FED concept. This document presents the results of these initial trade and design studies. Based on these results, a baseline configuration has been identified and the Design Center effort for the remainder of the fiscal year will be devoted to the development of a self-consistent FED design description

Preliminary design study of a steady state tokamak device

International Nuclear Information System (INIS)

Miya, Naoyuki; Nakajima, Shinji; Ushigusa, Kenkichi; and athors)

1992-09-01

Preliminary design study has been made for a steady tokamak with the plasma current of 10MA, as the next to the JT-60U experimental programs. The goal of the research program is the integrated study of steady state, high-power physics and technology. Present candidate design is to use superconducting TF and PF magnet systems and long pulse operation of 100's-1000's of sec with non inductive current drive mainly by 500keV negative ion beam injection of 60MW. Low activation material such as titanium alloy is chosen for the water tank type vacuum vessel, which is also the nuclear shield for the superconducting coils. The present preliminary design study shows that the device can meet the existing JT-60U facility capability. (author)

The effects of intra-articular glucocorticoids and exercise on pain and synovitis assessed on static and dynamic magnetic resonance imaging in knee osteoarthritis

DEFF Research Database (Denmark)

Riis, R G C; Henriksen, M; Klokker, L

2017-01-01

) investigate if any of the changes in patient reported outcome measures (PROMs) were associated with changes in MRI-measures of synovitis. DESIGN: We performed a randomized, double-blinded, placebo-controlled clinical trial evaluating the effects of intra-articular corticosteroid vs placebo injections given......-articular corticosteroids over intra-articular saline when combined with an exercise program for reduction of synovitis in KOA. The improvement in pain and function following the intervention with intra-articular corticosteroids/saline and exercise could not be explained by a decrease in synovitis on MRI indicating other...... pain causing/relieving mechanisms in KOA....

Flexible Architecture for FPGAs in Embedded Systems

Science.gov (United States)

Clark, Duane I.; Lim, Chester N.

2012-01-01

Commonly, field-programmable gate arrays (FPGAs) being developed in cPCI embedded systems include the bus interface in the FPGA. This complicates the development because the interface is complicated and requires a lot of development time and FPGA resources. In addition, flight qualification requires a substantial amount of time be devoted to just this interface. Another complication of putting the cPCI interface into the FPGA being developed is that configuration information loaded into the device by the cPCI microprocessor is lost when a new bit file is loaded, requiring cumbersome operations to return the system to an operational state. Finally, SRAM-based FPGAs are typically programmed via specialized cables and software, with programming files being loaded either directly into the FPGA, or into PROM devices. This can be cumbersome when doing FPGA development in an embedded environment, and does not have an easy path to flight. Currently, FPGAs used in space applications are usually programmed via multiple space-qualified PROM devices that are physically large and require extra circuitry (typically including a separate one-time programmable FPGA) to enable them to be used for this application. This technology adds a cPCI interface device with a simple, flexible, high-performance backend interface supporting multiple backend FPGAs. It includes a mechanism for programming the FPGAs directly via the microprocessor in the embedded system, eliminating specialized hardware, software, and PROM devices and their associated circuitry. It has a direct path to flight, and no extra hardware and minimal software are required to support reprogramming in flight. The device added is currently a small FPGA, but an advantage of this technology is that the design of the device does not change, regardless of the application in which it is being used. This means that it needs to be qualified for flight only once, and is suitable for one-time programmable devices or an application

Scenario for concurrent conceptual assembly line design: A case study

Science.gov (United States)

Mas, F.; Ríos, J.; Menéndez, J. L.

2012-04-01

The decision to design and build a new aircraft is preceded by years of research and study. Different disciplines work together throughout the lifecycle to ensure not only a complete functional definition of the product, but also a complete industrialization, a marketing plan, a maintenance plan, etc. This case study focuses on the conceptual design phase. During this phase, the design solutions that will meet the functional and industrial requirements are defined, i.e.: the basic requirements of industrialization. During this phase, several alternatives are studied, and the most attractive in terms of performance and cost requirements is selected. As a result of the study of these alternatives, it is possible to define an early conceptual design of the assembly line and its basic parameters. The plant needs, long cycle jigs & tools or industrial means and human resources with the necessary skills can be determined in advance.

Study on advanced structural design for commercialized fast breeder reactors

International Nuclear Information System (INIS)

Morishita, Masaki; Aoto, Kazumi; Kasahara, Naoto; Asayama, Tai

2002-01-01

Japan Nuclear Cycle Development Institute (JNC) and Japan Atomic Power Company (JAPC) launched joint research programs on structural design and three-dimensional seismic isolation technologies, as part of the supporting R and D activities for the feasibility studies on commercialized fast breeder reactor cycle systems. A research project by JAPC under the auspices of the Ministry of Economy, Trade, and Industry (METI) with technical support by JNC is included in this joint study. This report contains the results of the research on the structural design technology. The research scope was identified as (1) System Based Code for Integrity, (2) FDS (FBR Design Standard), and (3) Standardization of new material, and the results of this year's studies are summarized as follows. (1) System Based Code for Integrity. Requirements that a structural design standard must fulfill for enhanced reliability and economy were clarified. Based on this, the authors began to develop the system-based code for integrity. A structural reliability based design approach was proposed as a basic concept for an integrated evaluation of structural integrity. A system consisting of a supreme code and partial codes was proposed. Technologies and engineering tools that are necessary to materialize this code were clarified and research and development was begun. (2) FDS(FBR Design Standard). A rational design approach against thermal loads was proposed. Applicable area of inelastic analysis methods was investigated to develop inelastic analysis guide. A new design system which realizes feedback from structural to thermal hydraulic designs was proposed with a total analysis method of thermal hydraulic and mechanical behaviors. (3) Standardization of new material. Current status of development of high-chromium ferritic steels was investigated. Those steels have excellent high temperature strength and thermal properties. The authors proposed material specifications to apply those steels to structures

Study on advanced structural design for commercialized fast breeder reactors

Energy Technology Data Exchange (ETDEWEB)

Morishita, Masaki; Aoto, Kazumi; Kasahara, Naoto; Asayama, Tai [Japan Nuclear Cycle Development Inst., Oarai, Ibaraki (Japan). Oarai Engineering Center; Sagayama, Yutaka; Dozaki, Koji; Tanaka, Yoshihiko [Japan Atomic Power Co., Research and Development Department, Tokyo (Japan)

2002-01-01

Japan Nuclear Cycle Development Institute (JNC) and Japan Atomic Power Company (JAPC) launched joint research programs on structural design and three-dimensional seismic isolation technologies, as part of the supporting R and D activities for the feasibility studies on commercialized fast breeder reactor cycle systems. A research project by JAPC under the auspices of the Ministry of Economy, Trade, and Industry (METI) with technical support by JNC is included in this joint study. This report contains the results of the research on the structural design technology. The research scope was identified as (1) System Based Code for Integrity, (2) FDS (FBR Design Standard), and (3) Standardization of new material, and the results of this year's studies are summarized as follows. (1) System Based Code for Integrity. Requirements that a structural design standard must fulfill for enhanced reliability and economy were clarified. Based on this, the authors began to develop the system-based code for integrity. A structural reliability based design approach was proposed as a basic concept for an integrated evaluation of structural integrity. A system consisting of a supreme code and partial codes was proposed. Technologies and engineering tools that are necessary to materialize this code were clarified and research and development was begun. (2) FDS(FBR Design Standard). A rational design approach against thermal loads was proposed. Applicable area of inelastic analysis methods was investigated to develop inelastic analysis guide. A new design system which realizes feedback from structural to thermal hydraulic designs was proposed with a total analysis method of thermal hydraulic and mechanical behaviors. (3) Standardization of new material. Current status of development of high-chromium ferritic steels was investigated. Those steels have excellent high temperature strength and thermal properties. The authors proposed material specifications to apply those steels to

osDesign: An R Package for the Analysis, Evaluation, and Design of Two-Phase and Case-Control Studies

Directory of Open Access Journals (Sweden)

Sebastien Haneuse

2011-08-01

Full Text Available The two-phase design has recently received attention in the statistical literature as an extension to the traditional case-control study for settings where a predictor of interest is rare or subject to missclassification. Despite a thorough methodological treatment and the potential for substantial efficiency gains, the two-phase design has not been widely adopted. This may be due, in part, to a lack of general-purpose, readily-available software. The osDesign package for R provides a suite of functions for analyzing data from a two-phase and/or case-control design, as well as evaluating operating characteristics, including bias, efficiency and power. The evaluation is simulation-based, permitting flexible application of the package to a broad range of scientific settings. Using lung cancer mortality data from Ohio, the package is illustrated with a detailed case-study in which two statistical goals are considered: (i the evaluation of small-sample operating characteristics for two-phase and case-control designs and (ii the planning and design of a future two-phase study.

Fusion reactor design studies: standard accounts for cost estimates

International Nuclear Information System (INIS)

Schulte, S.C.; Willke, T.L.; Young, J.R.

1978-05-01

The fusion reactor design studies--standard accounts for cost estimates provides a common format from which to assess the economic character of magnetically confined fusion reactor design concepts. The format will aid designers in the preparation of design concept costs estimates and also provide policymakers with a tool to assist in appraising which design concept may be economically promising. The format sets forth a categorization and accounting procedure to be used when estimating fusion reactor busbar energy cost that can be easily and consistently applied. Reasons for developing the procedure, explanations of the procedure, justifications for assumptions made in the procedure, and the applicability of the procedure are described in this document. Adherence to the format when evaluating prospective fusion reactor design concepts will result in the identification of the more promising design concepts thus enabling the fusion power alternatives with better economic potential to be quickly and efficiently developed

Should English healthcare providers be penalised for failing to collect patient-reported outcome measures? A retrospective analysis.

Science.gov (United States)

Gutacker, Nils; Street, Andrew; Gomes, Manuel; Bojke, Chris

2015-08-01

The best practice tariff for hip and knee replacement in the English National Health Service (NHS) rewards providers based on improvements in patient-reported outcome measures (PROMs) collected before and after surgery. Providers only receive a bonus if at least 50% of their patients complete the preoperative questionnaire. We determined how many providers failed to meet this threshold prior to the policy introduction and assessed longitudinal stability of participation rates. Retrospective observational study using data from Hospital Episode Statistics and the national PROM programme from April 2009 to March 2012. We calculated participation rates based on either (a) all PROM records or (b) only those that could be linked to inpatient records; constructed confidence intervals around rates to account for sampling variation; applied precision weighting to allow for volume; and applied risk adjustment. NHS hospitals and private providers in England. NHS patients undergoing elective unilateral hip and knee replacement surgery. Number of providers with participation rates statistically significantly below 50%. Crude rates identified many providers that failed to achieve the 50% threshold but there were substantially fewer after adjusting for uncertainty and precision. While important, risk adjustment required restricting the analysis to linked data. Year-on-year correlation between provider participation rates was moderate. Participation rates have improved over time and only a small number of providers now fall below the threshold, but administering preoperative questionnaires remains problematic in some providers. We recommend that participation rates are based on linked data and take into account sampling variation. © The Royal Society of Medicine.

The changes in Doppler indices of fetal ductus venosus and umbilical artery after amnioinfusion for women with preterm premature rupture of membranes before 26 weeks' gestation.

Science.gov (United States)

Hsu, Te-Yao; Hsu, Jenn-Jeih; Fu, Hung-Chun; Ou, Chia-Yu; Tsai, Chih-Chang; Cheng, Bi-Hua; Fang, Fu-Min; Kao, Hui-Fen; Yang, Chun-Yuh; Tsai, Wen Lin; Sung, Chuen Chu; Tsai, Men-Yi

2009-09-01

To investigate the changes in Doppler indices of the fetal ductus venosus (DV) and umbilical artery (UMA) after amnioinfusion in pregnant women with preterm premature rupture of membranes (pPROM). Pregnancies with pPROM and severe oligohydramnios cause sequelae in newborns and mothers. This cross-sectional study included a group of 25 patients with pPROM before 26 weeks' gestation. Color Doppler imaging was used to measure the impedance index and quantitative blood flow in the DV and systolic/diastolic ratio (S/D) of the UMA before and 30 minutes after the end of amnioinfusion. The following velocity parameters were measured: (1) DV peak systolic velocity; (2) DV time-averaged velocity; (3) DV maximum forward velocity during atrial contraction; (4) DV S/D; (5) DV pulsatility index (PI); (6) DV Pourcelots resistance index (RI); (7) fetal heart rate; and (8) UMA S/D. Twenty-one of the 25 patients underwent a total of 27 amnioinfusions. The mean PI and RI of the DV, and S/D of the DV and UMA decreased significantly after amnioinfusion (PI, 0.75 +/- 0.24 vs. 0.60 +/- 0.18, p = 0.009; RI, 0.60 +/- 0.15 vs. 0.50 +/- 0.13; DV S/D, 3.07 +/- 1.81 vs. 2.13 +/- 0.66, p = 0.008; UMA S/D, 3.58 +/- 0.87 vs. 2.88 +/- 0.62, p = 0.001). Amnioinfusion increases the space for the fetuses and reduces the impedance of the fetoplacental circulation. Improvements in DV and UMA flow may benefit fetuses suffering severe oligohydramnios in mid-pregnancy.

77 FR 9946 - Draft Guidance for Industry on Drug Interaction Studies-Study Design, Data Analysis, Implications...

Science.gov (United States)

2012-02-21

... industry entitled ``Drug Interaction Studies--Study Design, Data Analysis, Implications for Dosing, and... data analysis in the context of identifying potential drug interactions. The guidance also addresses... Studies--Study Design, Data Analysis, and Implications for Dosing and Labeling.'' Comments were received...

Design study on sodium-cooled middle-scale modular reactor

International Nuclear Information System (INIS)

Shimakawa, Yoshio; Nibe, Nobuaki; Hori, Toru

2002-05-01

In Phase 1 of the 'Feasibility Study on Commercialized Fast Reactor Cycle Systems (F/S)', an advanced loop type reactor has been selected as a promising concept of sodium-cooled middle-scale modular reactor, which has a possibility to fulfill the design requirements of the F/S. In Phase 2 of the F/S, it is planed to precede a preliminary conceptual design of a sodium-cooled middle-scale modular reactor based on the design of the advanced loop type reactor. Through the design study, it is intended to construct such a plant concept that can show its attraction and competitiveness as a commercialized reactor. This report summarizes the results of the design study on the sodium-cooled middle-scale modular reactor performed in JFY2001, which is the first year of Phase 2. As the construction cost of the sodium-cooled middle-scale modular reactor, which has been constructed in Phase 1, was about 10% higher than that of the sodium-cooled large-scale reactor, a new concept of the middle-scale modular reactor, which is expected to be equal to the large-scale reactor from a viewpoint of economic competitiveness, has been re-constructed based on the design of the advanced loop type reactor. After that, fundamental specifications of main systems and components for the new concept have been set, and critical subjects related to safety, structural integrity, thermal hydraulics, operability, maintainability and economy have been examined and evaluated. As a result of this study, the plant concept of the sodium-cooled middle-scale modular reactor has been constructed, which has a prospect to satisfy the economic goal (construction cost: less than 200,000 yens/kWe, etc.) and has a prospect to solve the critical subjects. From now on, reflecting the results of elemental experiments, the preliminary conceptual design of this plant will be preceded toward the selection for narrowing down candidate concepts at the end of Phase 2. (author)

Feasibility study on floating nuclear power plant (2). Safety design study of FNPP. Contract research

Energy Technology Data Exchange (ETDEWEB)

Yabuuchi, Noriaki; Shimazaki, Junya; Ochiai, Masaaki [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment; Takahashi, Masao [Niigata Engineering Co. Ltd., Tokyo (Japan); Nakazawa, Toshio [Japan Atomic Energy Research Inst., Oarai, Ibaraki (Japan). Oarai Research Establishment; Sato, Kazuo [Ishikawajima-Harima Heavy Industries Co. Ltd., Tokyo (Japan)

2001-02-01

In the previous report of 'Conceptual Design Study of FNPP (Floating Nuclear Power Plant)', a design study on a concept for FNPP, which is sited off the sea coast on the open sea with water depth of 20m and it is moored on protected sea by the breakwater was conducted and the floating platform guarded by the breakwater was found to be stable enough to install the nuclear power plant from analysis simulating the movement of the platform due to sea wave or wind. In this report, studies on a basic safety design concept of the FNPP, setting natural phenomena for design condition, required safety functions and a review on dynamic analysis of the large floating structure are presented. The studies revealed that the stability of the floating platform is an essential issue for the FNPP soundness, and the design base natural phenomena such as S1 and S2-class storm including S1 and S2-class earthquake should be considered in evaluation of the stability of the floating platform, and it is one of key technical subjects how to set the magnitude of these storm in application of design evaluation on each FNPP case. (J.P.N.)

Complexity in Design-Driven Innovation: A Case Study of Knowledge Transfer Flow in Subsea Seismic Sensor Technology and Design Education

Science.gov (United States)

Pavel, Nenad; Berg, Arild

2015-01-01

To the extent previously claimed, concept exploration is not the key to product innovation. However, companies that are design-focused are twice as innovative as those that are not. To study design-driven innovation and its occurrence in design education, two case studies are conducted. The first is an example of design practice which includes…

Progress in design study on reduced-moderation water reactors

Energy Technology Data Exchange (ETDEWEB)

Okubo, Tsutomu; Kugo, Teruhiko; Shimada, Shoichiro; Shirakawa, Toshihisa; Iwamura, Takamichi [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment; Takeda, Renzo [Hitachi Ltd., Tokyo (Japan); Yokoyama, Tsugio [Toshiba Corp., Kawasaki, Kanagawa (Japan); Hibi, Koki [Mitsubishi Heavy Industries Ltd., Tokyo (Japan); Wada, Shigeyuki [Japan Atomic Power Co., Tokyo (Japan)

2000-06-01

The Reduced-Moderation Water Reactor (RMWR) is a next generation water-cooled reactor which aims at effective utilization of uranium resource, high burn-up and long operation cycle, and plutonium multi-recycle. These characteristics can be achieved by the high conversion ratio from {sup 238}U to {sup 239}Pu resulted from the higher neutron energy spectrum in comparison to conventional light water reactors. Considering the extension of LWR utilization, Japan Atomic Energy Research Institute (JAERI) started the research on it in 1997 and then started a collaboration in the conceptual design study with the Japan Atomic Power Company (JAPC) in 1998, under technical cooperation with three Japanese reactor vendors. In the core design study of the RMWR, negative void reactivity coefficient is required from a viewpoint of safety as well as establishing hard neutron spectrum. In order to achieve the above trade-off characteristics simultaneously, several basic core design ideas should be combined, such as a tight-lattice fuel assembly, a flat core, a blanket effect, a streaming effect and so on. Up to now, five core concepts have been created for the RMWR as follows: a high conversion BWR type core with high void fraction and super-flat core, a long operation cycle BWR type core using void tube assembly, a high conversion BWR type core without blankets, a high conversion PWR type core using heavy water as a coolant, and a PWR type core for plutonium multi-recycle using seed-blanket type fuel assemblies. Detailed feasibility studies for the RMWR have been continued on core design study. The present report summarizes the recent progress in the design study for the RMWR. (author)

Outline and Status of the FCC-ee Design Study

CERN Document Server

Zimmermann, Frank

2015-01-01

The Update of the European Strategy for Particle Physics in 2013 [1] declared as its second highest priority that “…to propose an ambitious post-LHC accelerator project….., CERN should undertake design studies for accelerator projects in a global context,…with emphasis on proton-proton and electron-positron high-energy frontier machines…”. In response to this request, the global Future Circular Collider (FCC) study is designing a 100-TeV proton collider (FCC-hh) in a new ~100 km tunnel near Geneva, a high-luminosity electron-positron collider (FCC-ee) as a potential intermediate step, and a lepton-hadron option (FCC-he). The FCC study comprises accelerators, technology, infrastructure, detector, physics, concepts for worldwide data services, international governance models, and implementation scenarios. The FCC study is mandated to deliver a Conceptual Design Report and preliminary cost estimate by the time of the next European Strategy Update expected for 2019. As of July 2015, 58 institutes from...

Designing Web-Based Educative Curriculum Materials for the Social Studies

Science.gov (United States)

Callahan, Cory; Saye, John; Brush, Thomas

2013-01-01

This paper reports on a design experiment of web-based curriculum materials explicitly created to help social studies teachers develop their professional teaching knowledge. Web-based social studies curriculum reform efforts, human-centered interface design, and investigations into educative curriculum materials are reviewed, as well as…

Studying Design Engineers Use Of Information Systems

DEFF Research Database (Denmark)

Restrepo-Giraldo, John Dairo

2006-01-01

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

A Design Study for Standard Nanofluid Coolants

International Nuclear Information System (INIS)

Bang, In Cheol; Heo, Gyun Young

2007-01-01

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

Inertial Fusion Energy reactor design studies: Prometheus-L, Prometheus-H

International Nuclear Information System (INIS)

Waganer, L.M.; Driemeyer, D.E.; Lee, V.D.

1992-03-01

This report contains a review of design studies for Inertial Confinement reactor. This second of three volumes discussions is some detail the following: Objectives, requirements, and assumptions; rationale for design option selection; key technical issues and R ampersand D requirements; and conceptual design selection and description

Design studies for the Positron Factory

International Nuclear Information System (INIS)

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

1996-01-01

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

Muon System Design Studies for Detectors at CLIC

CERN Document Server

van der Kraaij, E

2011-01-01

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

Neutronic design studies for an unattended, low power reactor

International Nuclear Information System (INIS)

Palmer, R.G.; Durkee, J.W. Jr.

1986-01-01

The Los Alamos National Laboratory is involved in the design and demonstrations of a small, long-lived nuclear heat and electric power source for potential applications at remote sites where alternate fossil energy systems would not be cost effective. This paper describes the neutronic design analysis that was performed to arrive at two conceptual designs, one using thermoelectric conversion, the other using an organic Rankine cycle. To meet the design objectives and constraints a number of scoping and optimization studies were carried out. The results of calculations of control worths, temperature coefficients of reactivity and fuel depletion effects are reported

Architecture and Urban Studies to offer overseas design course

OpenAIRE

Chadwick, Heather Riley

2006-01-01

Virginia Tech's College of Architecture and Urban Studies invites professional architects and designers to participate in the 11th annual International Architecture and Design Continuing Education Course in Italy to be held in May. The deadline to register for this course is Saturday, April 15.

AFB/open cycle gas turbine conceptual design study

Science.gov (United States)

Dickinson, T. W.; Tashjian, R.

1983-09-01

Applications of coal fired atmospheric fluidized bed gas turbine systems in industrial cogeneration are identified. Based on site-specific conceptual designs, the potential benefits of the AFB/gas turbine system were compared with an atmospheric fluidized design steam boiler/steam turbine system. The application of these cogeneration systems at four industrial plant sites is reviewed. A performance and benefit analysis was made along with a study of the representativeness of the sites both in regard to their own industry and compared to industry as a whole. A site was selected for the conceptual design, which included detailed site definition, AFB/gas turbine and AFB/steam turbine cogeneration system designs, detailed cost estimates, and comparative performance and benefit analysis. Market and benefit analyses identified the potential market penetration for the cogeneration technologies and quantified the potential benefits.

Design Study for Pulsed Proton Beam Generation

Directory of Open Access Journals (Sweden)

Han-Sung Kim

2016-02-01

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

Communicating Qualitative Research Study Designs to Research Ethics Review Boards

Science.gov (United States)

Ells, Carolyn

2011-01-01

Researchers using qualitative methodologies appear to be particularly prone to having their study designs called into question by research ethics or funding agency review committees. In this paper, the author considers the issue of communicating qualitative research study designs in the context of institutional research ethics review and offers…

Cultural study in design : In search of a meaningful approach

NARCIS (Netherlands)

van Boeijen, A.G.C.

2014-01-01

Does the Circuit of Culture help design students to do a cultural study that is meaningful for their design project? Indeed, it provides a good view on the phenomenon culture, its complexity and how contemporary cultures can be studied, providing an overview and structure of the processes that

Nippon Storm Study design

Directory of Open Access Journals (Sweden)

Takashi Kurita

2012-10-01

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

Study on Product Innovative Design Process Driven by Ideal Solution

Science.gov (United States)

Zhang, Fuying; Lu, Ximei; Wang, Ping; Liu, Hui

Product innovative design in companies today relies heavily on individual members’ experience and creative ideation as well as their skills of integrating creativity and innovation tools with design methods agilely. Creative ideation and inventive ideas generation are two crucial stages in product innovative design process. Ideal solution is the desire final ideas for given problem, and the striving reaching target for product design. In this paper, a product innovative design process driven by ideal solution is proposed. This design process encourages designers to overcome their psychological inertia, to foster creativity in a systematic way for acquiring breakthrough creative and innovative solutions in a reducing sphere of solution-seeking, and results in effective product innovative design rapidly. A case study example is also presented to illustrate the effectiveness of the proposed design process.

Reverse design and characteristic study of multi-range HMCVT

Science.gov (United States)

Zhu, Zhen; Chen, Long; Zeng, Falin

2017-09-01

The reduction of fuel consumption and increase of transmission efficiency is one of the key problems of the agricultural machinery. Many promising technologies such as hydromechanical continuously variable transmissions (HMCVT) are the focus of research and investments, but there is little technical documentation that describes the design principle and presents the design parameters. This paper presents the design idea and characteristic study of HMCVT, in order to find out the suitable scheme for the big horsepower tractors. Analyzed the kinematics and dynamics of a large horsepower tractor, according to the characteristic parameters, a hydro-mechanical continuously variable transmission has been designed. Compared with the experimental curves and theoretical curves of the stepless speed regulation of transmission, the experimental result illustrates the rationality of the design scheme.

Conceptual design study on inertial confinement reactor ''SENRI-II''

International Nuclear Information System (INIS)

Nakamura, N.; Ouura, H.

1983-01-01

Design features of a laser fusion reactor concept SENRI-II are reviewed and discussed. A conceptual design study of the ICF reactor SENRI-II (an advanced design of SENRI-I) has been carried out over 2 years in the Research Committee of ICF Reactors, Institute of Laser Engineering, Osaka University. While the ICF reactor SENRI-I utilized a magnetic field to guide and control an inner liquid lithium flow, SENRI-II is designed to use porous metal as the liquid lithium flow guide. In the design of SENRI-II, a metal porous lithium blanket serves as the protection of a wall against fusion products and as wall per se. Because of the separation of these two functions, a high power density can be attained

A study on the fusion reactor - A study on the design feature of fusion reactor divertor

Energy Technology Data Exchange (ETDEWEB)

Lee, Kyung Jin [Chosun University, Kwangju (Korea, Republic of); Paek, Won Pil; Jang, Soon Hong [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of); Sim, Young Jae [Kyungsang University, Jinju (Korea, Republic of)

1996-09-01

The contents and scope of the project can be summarized as, - study on the trend of divertor design - study on characteristics of coolant materials - study on characteristics of divertor materials - study on the thermal analysis method of divertor design. 36 refs., 12 tabs., 16 figs. (author)

Preliminary design study of a large scale graphite oxidation loop

International Nuclear Information System (INIS)

Epel, L.G.; Majeski, S.J.; Schweitzer, D.G.; Sheehan, T.V.

1979-08-01

A preliminary design study of a large scale graphite oxidation loop was performed in order to assess feasibility and to estimate capital costs. The nominal design operates at 50 atmospheres helium and 1800 F with a graphite specimen 30 inches long and 10 inches in diameter. It was determined that a simple single walled design was not practical at this time because of a lack of commercially available thick walled high temperature alloys. Two alternative concepts, at reduced operating pressure, were investigated. Both were found to be readily fabricable to operate at 1800 F and capital cost estimates for these are included. A design concept, which is outside the scope of this study, was briefly considered

Use of a Multivector Mandibular Distractor for Treatment of Pediatric Proximal Interphalangeal Joint Pilon Fractures: A Case-Based Review.

Science.gov (United States)

Pedreira, Rachel; Cho, Brian H; Geer, Angela; DeJesus, Ramon A

2018-04-01

The difficulties in surgical treatment of pilon fractures of the finger include fragment reconstitution and posthealing stiffness. In adults, external fixation with traction and early active range of motion (AROM)/passive range of motion (PROM) during healing is considered necessary for avoiding joint stiffness and attaining realignment. The authors present a unique approach to pediatric pilon fractures that uses open reduction and multivector external fixation with delayed AROM/PROM. Initial immobilization and significant traction allowed for joint realignment and prevented noncompliance with staged distraction. The authors believe this immobilization leads to a superior outcome because, unlike adults, children tend to avoid stiffness and a larger distraction force allowed for sufficient joint realignment to regain range of motion (ROM). A right-handed 13-year-old boy sustained a right ring finger fracture and presented 12 days later. Radiographs revealed a comminuted Salter-Harris 4 fracture of the middle phalanx. The patient underwent open reduction and placement of multivector external fixation using a pediatric mandibular distractor/fixator. Significant traction was applied to distract the finger to length. Hardware was removed 6 weeks postoperatively and AROM was initiated after splinting. The patient started PROM 8 weeks postoperatively. Strengthening was initiated 2 weeks later. ROM improved and rehabilitation was continued. The patient exhibited nearly equal grip strength 12 weeks postoperatively. At 14 months follow-up, radiographs showed complete healing and joint realignment. There was no deformity or pain and finger length was restored. Management of pediatric pilon fractures is rarely described and presents unique considerations. Early-stage traction and immobilization using a multivector mandibular fixator/distractor is suitable in a child because noncompliance is avoided and there is a decreased risk for stiffness. Combining early immobilization

Development and psychometric properties of the client's assessment of treatment scale for supported accommodation (CAT-SA).

Science.gov (United States)

Sandhu, Sima; Killaspy, Helen; Krotofil, Joanna; McPherson, Peter; Harrison, Isobel; Dowling, Sarah; Arbuthnott, Maurice; Curtis, Sarah; King, Michael; Leavey, Gerard; Shepherd, Geoff; Priebe, Stefan

2016-02-25

Patient-Reported Outcome Measures (PROMs) are important for evaluating mental health services. Yet, no specific PROM exists for the large and diverse mental health supported accommodation sector. We aimed to produce and validate a PROM specifically for supported accommodation services, by adapting the Client's Assessment of Treatment Scale (CAT) and assessing its psychometric properties in a large sample. Focus groups with service users in the three main types of mental health supported accommodation services in the United Kingdom (residential care, supported housing and floating outreach) were conducted to adapt the contents of the original CAT items and assess the acceptability of the modified scale (CAT-SA). The CAT-SA was then administered in a survey to service users across England. Internal consistency was assessed using Cronbach's alpha. Convergent validity was tested through correlations with subjective quality of life and satisfaction with accommodation, as measured by the Manchester Short Assessment of Quality of Life (MANSA). All seven original items of the CAT were regarded as relevant to appraisals of mental health supported accommodation services, with only slight modifications to the wording required. In the survey, data were obtained from 618 clients. The internal consistency of the CAT-SA items was 0.89. Mean CAT-SA scores were correlated with the specific accommodation item on the MANSA (r s  = 0.37, p ˂ .001). The content of the CAT-SA has relevance to service users living in mental health supported accommodation. The findings from our large survey show that the CAT-SA is acceptable across different types of supported accommodation and suggest good psychometric properties. The CAT-SA appears a valid and easy to use PROM for service users in mental health supported accommodation services.

Conceptual design study of fusion experimental reactor (FER)

International Nuclear Information System (INIS)

1986-11-01

Since 1980 the design study has been conducted at JAERI for the Fusion Experimental Reactor (FER) which has been proposed to be the next machine to JT-60 in the Japanese long term program of fusion reactor development. During two years from 1984 to 1985 FER concept was reviewed and redesigned. This report is the summary of the results obtained in the review and redesign activities in 1984 and 85. In the first year FER concept was discussed again and its frame work was reestablished. According to the new frame work the major reactor components of FER were designed. In the second year the whole plant system design including plant layout plan was conducted as well as the more detailed design analysis of the reactor conponents. The newly established frame for FER design is as follows: 1) Plasma : Self-ignition. 2) Operation scenario : Quasi-steady state operation with long burn pulse. 3) Neutron fluence on the first wall : 0.3 MWY/M 2 . 4) Blanket : Non-tritium breeding blanket with test modules for breeding blanket development. 5) Magnets : Superconducting Magnets. (author)

Study on advanced structural design for commercialized fast breeder reactors

International Nuclear Information System (INIS)

Morishita, Masaki; Aoto, Kazumi; Kasahara, Naoto; Asayama, Tai

2003-05-01

Japan Nuclear Cycle Development Institute (JNC) and Japan Atomic Power Company (JAPC) launched joint research programs on structural design and three-dimensional seismic isolation technologies, as part of the supporting R and D activities for the feasibility studies on commercialized fast breeder reactor cycle systems. A research project by JAPC under the auspices of the Ministry of Economy, Trade, and Industry (METI) with technical support by JNC is included in this joint study. This report contains the results of the research on the structural design technology. The research scope was identified as (1) FDS (FBR Design Standard), (2) Standardization of new material, and (3) System Based Code for Integrity, and the results of this year's studies are summarized as follows. (1) FDS (FBR Design Standard). R and D policy of Phase II study considering to the newest needs demanded for structural design were clarified, and R and D items were settled concretely. As for failure criteria, preliminary ratcheting-fatigue tests were conducted with rational methods, and Negligible Creep curves that settle creep designing region rationally were expanded their applying condition. R and D policy and items of guideline for inelastic analysis were clarified, and analyzing methodologies were studied. Summering up exemplification of thermal load prediction methodologies were progressed. To predict thermal striping loads, advanced frequency response function of thermal stress, and fatigue evaluation methodology were studied. (2) Standardization of new material. As for candidate 12-chromium stainless steel (added tungsten, non-added tungsten), that is expected to improve strength of components of commercialized FR, short and medium-term material tests, and creep-fatigue tests at small strain range were conducted. As for above candidate steel, TIG (Tungsten Inert Gas) welding method was recommended. Requirements to standardize new materials and index to select new materials were studied

Learning design thinking online : studying students' learning experience in shared virtual reality

OpenAIRE

Lau, Kung Wong

2010-01-01

Learning Design Thinking Online: Studying Students' Learning Experience in Shared Virtual Reality My study attempts to deepen understanding about the learning experiences of design students in undertaking design-thinking exercises in a shared virtual reality. This study has identified the areas of an appropriate pedagogy for E-Learning and the use of a shared virtual environment for students in tertiary design education. Specific questions arising ji"Om this research are: (1...

Study of the reactor relevance of the NET design concept

International Nuclear Information System (INIS)

Reynolds, P.; Worraker, W.J.

1987-08-01

The objective of the study was to explore the reactor relevance of NET, i.e. whether the technologies and design principles proposed for NET can be directly extrapolated to a demonstration power reactor (DEMO). The main areas of study were those near to the plasma, namely the divertor, first wall and tritium breeding blanket. Other aspects which were investigated were tritium permeation and recovery, reactor maintenance, afterheat and effects of disruptions. The principal results of the study are briefly presented; the details of the work are given in fourteen appendices. These appendices were selected for INIS and indexed separately. The overall conclusion of the study is that the NET design is only partly relevant to the design requirements of a DEMO reactor. (U.K.)

Design study of SMES system using high temperature superconductors

International Nuclear Information System (INIS)

Yoshihara, T.; Masuda, M.; Shintomi, T.; Hasegawa, J.

1988-01-01

Various studies of high Tc superconductors are being energetically pursued all over the world, since IBM Zurich Research Laboratory reported on the superconducting oxide. A new design using a high Tc superconductor is under study for 5000 MWh, on the assumption that it is available like conventional superconductors. Problems related to the Tc SMES system, mainly thermal insulation, refrigeration system, stability of superconductors, etc., are considered. Some design examples of high Tc SMES system are proposed

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway.

Science.gov (United States)

Abola, Ramon E; Bennett-Guerrero, Elliott; Kent, Michael L; Feldman, Liane S; Fiore, Julio F; Shaw, Andrew D; Thacker, Julie K M; Gan, Tong J; Miller, Timothy E; Hedrick, Traci L; McEvoy, Matthew D; Mythen, Michael G; Bergamaschi, Roberto; Gupta, Ruchir; Holubar, Stefan D; Senagore, Anthony J; Wischmeyer, Paul E; Carli, Franco; Evans, David C; Guilbert, Sarah; Kozar, Rosemary; Pryor, Aurora; Thiele, Robert H; Everett, Sotiria; Grocott, Mike

2017-12-29

Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using

Acting like a physicist: Student approach study to experimental design

Science.gov (United States)

Karelina, Anna; Etkina, Eugenia

2007-12-01

National studies of science education have unanimously concluded that preparing our students for the demands of the 21st century workplace is one of the major goals. This paper describes a study of student activities in introductory college physics labs, which were designed to help students acquire abilities that are valuable in the workplace. In these labs [called Investigative Science Learning Environment (ISLE) labs], students design their own experiments. Our previous studies have shown that students in these labs acquire scientific abilities such as the ability to design an experiment to solve a problem, the ability to collect and analyze data, the ability to evaluate assumptions and uncertainties, and the ability to communicate. These studies mostly concentrated on analyzing students’ writing, evaluated by specially designed scientific ability rubrics. Recently, we started to study whether the ISLE labs make students not only write like scientists but also engage in discussions and act like scientists while doing the labs. For example, do students plan an experiment, validate assumptions, evaluate results, and revise the experiment if necessary? A brief report of some of our findings that came from monitoring students’ activity during ISLE and nondesign labs was presented in the Physics Education Research Conference Proceedings. We found differences in student behavior and discussions that indicated that ISLE labs do in fact encourage a scientistlike approach to experimental design and promote high-quality discussions. This paper presents a full description of the study.

Acting like a physicist: Student approach study to experimental design

Directory of Open Access Journals (Sweden)

Anna Karelina

2007-10-01

Full Text Available National studies of science education have unanimously concluded that preparing our students for the demands of the 21st century workplace is one of the major goals. This paper describes a study of student activities in introductory college physics labs, which were designed to help students acquire abilities that are valuable in the workplace. In these labs [called Investigative Science Learning Environment (ISLE labs], students design their own experiments. Our previous studies have shown that students in these labs acquire scientific abilities such as the ability to design an experiment to solve a problem, the ability to collect and analyze data, the ability to evaluate assumptions and uncertainties, and the ability to communicate. These studies mostly concentrated on analyzing students’ writing, evaluated by specially designed scientific ability rubrics. Recently, we started to study whether the ISLE labs make students not only write like scientists but also engage in discussions and act like scientists while doing the labs. For example, do students plan an experiment, validate assumptions, evaluate results, and revise the experiment if necessary? A brief report of some of our findings that came from monitoring students’ activity during ISLE and nondesign labs was presented in the Physics Education Research Conference Proceedings. We found differences in student behavior and discussions that indicated that ISLE labs do in fact encourage a scientistlike approach to experimental design and promote high-quality discussions. This paper presents a full description of the study.

Managing multi-architect collaborative design: case study of design competition for Ground Zero in New York

NARCIS (Netherlands)

Sebastian, R.

2006-01-01

This paper presents a part of the PhD research by the author that responds to the need of an innovative approach to manage collaborative design in the conceptual design phase of a multi-architect building project. The research studied recent multi-architect building projects in the Netherlands,

Feasibility design study. Land-based OTEC plants. Final report

Energy Technology Data Exchange (ETDEWEB)

Brewer, J. H.; Minor, J.; Jacobs, R.

1979-01-01

The purpose of this study has been to determine the feasibility of installing 10 MWe (MegaWatt-electric) and 40 MWe land-based OTEC demonstration power plants at two specific sites: Keahole Point on the western shore of the island of Hawaii; and Punta Tuna, on the southeast coast of the main island of Puerto Rico. In addition, the study has included development of design parameters, schedules and budgets for the design, construction and operation of these plants. Seawater systems (intake and discharge pipes) were to be sized so that flow losses were equivalent to those expected with a platform-based OTEC power plant. The power module (components and general arrangement was established based on the TRW design. Results are presented in detail. (WHK)

Academic Primer Series: Five Key Papers about Study Designs in Medical Education.

Science.gov (United States)

Gottlieb, Michael; Chan, Teresa M; Fredette, Jenna; Messman, Anne; Robinson, Daniel W; Cooney, Robert; Boysen-Osborn, Megan; Sherbino, Jonathan

2017-06-01

A proper understanding of study design is essential to creating successful studies. This is also important when reading or peer reviewing publications. In this article, we aimed to identify and summarize key papers that would be helpful for faculty members interested in learning more about study design in medical education research. The online discussions of the 2016-2017 Academic Life in Emergency Medicine Faculty Incubator program included a robust and vigorous discussion about education study design, which highlighted a number of papers on that topic. We augmented this list of papers with further suggestions by expert mentors. Via this process, we created a list of 29 papers in total on the topic of medical education study design. After gathering these papers, our authorship group engaged in a modified Delphi approach to build consensus on the papers that were most valuable for the understanding of proper study design in medical education. We selected the top five most highly rated papers on the topic domain of study design as determined by our study group. We subsequently summarized these papers with respect to their relevance to junior faculty members and to faculty developers. This article summarizes five key papers addressing study design in medical education with discussions and applications for junior faculty members and faculty developers. These papers provide a basis upon which junior faculty members might build for developing and analyzing studies.

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

Science.gov (United States)

Berges, Idoia; Bermúdez, Jesus; Illarramendi, Arantza

2018-02-01

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

Thermodynamic Studies for Drug Design and Screening

Science.gov (United States)

Garbett, Nichola C.; Chaires, Jonathan B.

2012-01-01

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

Thermodynamic studies for drug design and screening.

Science.gov (United States)

Garbett, Nichola C; Chaires, Jonathan B

2012-04-01

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

Japanese studies on sodium fires, design and testing

International Nuclear Information System (INIS)

Mitsutsuka, N.; Yoshida, N.

1983-01-01

Considerations of sodium fires are very important for the design and licensing of LMFBRs. Continuing effort has been made in the study of sodium fires and their consequences since the beginning of the Japanese fast breeder reactor development program. Recent effort is mainly focussed on studies related to Monju, especially on the design and testing of primary cell liners against large sodium spills. Experimental and analytical studies on sodium fires, water release from concrete and sodium concrete reactions are conducted as a part of this study. Some extinguishing agents are also tested against sodium fires. In addition, considerable effort is being made in the development of detection systems for the small sodium leaks before a pipe rupture. This paper briefly summarizes the Japanese status of these sodium fire related activities conducted by Fast Breeder Reactor Development Project of the Power Reactor and Nuclear Fuel Development Corporation (PNC)

A study of ergonomics factors in washbasin design.

Science.gov (United States)

Aksoy, O; Ertürk, Z; Oztürk, K; Saltik, H; Ward, J S

1977-06-01

A 4-week UNESCO-sponsored mission to the Department of Architecture, Karadeniz Technical University in Eastern Turkey, gave an opportunity to apply ergonomics techniques to some aspects of that country's domestic washbasin design. The study was intended to provide experience in questionnaire design and administration, in the application of psycho-physical methods, and to highlight the importance of determining user characteristics and preferences with regard to the built environment. A field study elicited information on dimensions and positioning of existing wash-basins and ancillary equipment and the opinions of users as to the suitability of these features in relation to the activities performed. A laboratory study, using an adjustable rig permitting variation in the heights of basin, taps and mirror/shelf, followed. The data obtained on preferred heights of these items led to the conclusions that basin height should be increased to between 95 and 100 cm to satisfy the majority of users; tap height above the basin should be reduced to about 11 cm; the shelf and lower edge of a mirror sited above the basin should be 136 cm above the floor; and a clear space of 110 cm should be available between the front of the basin and a wall or other obstruction. Suggestions on other design aspects of the bathroom, resulting from the study, are discussed.

Embracing Wicked Problems: The Turn to Design in Composition Studies

Science.gov (United States)

Marback, Richard

2009-01-01

Recent appeal to the concept of design in composition studies benefits teaching writing in digital media. Yet the concept of design has not been developed enough to fully benefit composition instruction. This article develops an understanding of design as a matter of resolving wicked problems and makes a case for the advantages of this…

Mortality Risk After Transcatheter Aortic Valve Implantation: Analysis of the Predictive Accuracy of the Transcatheter Valve Therapy Registry Risk Assessment Model.

Science.gov (United States)

Codner, Pablo; Malick, Waqas; Kouz, Remi; Patel, Amisha; Chen, Cheng-Han; Terre, Juan; Landes, Uri; Vahl, Torsten Peter; George, Isaac; Nazif, Tamim; Kirtane, Ajay J; Khalique, Omar K; Hahn, Rebecca T; Leon, Martin B; Kodali, Susheel

2018-05-08

Risk assessment tools currently used to predict mortality in transcatheter aortic valve implantation (TAVI) were designed for patients undergoing cardiac surgery. We aim to assess the accuracy of the TAVI dedicated American College of Cardiology / Transcatheter Valve Therapies (ACC/TVT) risk score in predicting mortality outcomes. Consecutive patients (n=1038) undergoing TAVI at a single institution from 2014 to 2016 were included. The ACC/TVT registry mortality risk score, the Society of Thoracic Surgeons - Patient Reported Outcomes (STS-PROM) score and the EuroSCORE II were calculated for all patients. In hospital and 30-day all-cause mortality rates were 1.3% and 2.9%, respectively. The ACC/TVT risk stratification tool scored higher for patients who died in-hospital than in those who survived the index hospitalization (6.4 ± 4.6 vs. 3.5 ± 1.6, p = 0.03; respectively). The ACC/TVT score showed a high level of discrimination, C-index for in-hospital mortality 0.74, 95% CI [0.59 - 0.88]. There were no significant differences between the performance of the ACC/TVT registry risk score, the EuroSCORE II and the STS-PROM for in hospital and 30-day mortality rates. The ACC/TVT registry risk model is a dedicated tool to aid in the prediction of in-hospital mortality risk after TAVI.

The Danish Alzheimer Intervention Study: Rationale, Study Design and Baseline Characteristics of the Cohort

DEFF Research Database (Denmark)

Waldemar, G.; Waldorff, F.B.; Buss, D.V.

2011-01-01

There is a lack of appropriately designed trials investigating the efficacy of psychosocial interventions for patients with mild dementia and their family caregivers. This paper reports the rationale and design of the Danish Alzheimer Disease Intervention Study and baseline characteristics...

An overview of the HIE-ISOLDE Design Study