WorldWideScience

Sample records for providing multiple benefits

  1. Social demand for multiple benefits provided by Aleppo pine forest management in Catalonia, Spain

    DEFF Research Database (Denmark)

    Varela, Elsa; Jacobsen, Jette Bredahl; Mavsar, Robert

    2017-01-01

    This paper estimates the social demand for key benefits provided by Aleppo pine forests in Catalonia that can be enhanced by management. These so-called externalities are the side effects of forest management on citizens’ welfare and can be either positive or negative. The externalities addressed...

  2. Technology-Enhanced Peer Review: Benefits and Implications of Providing Multiple Reviews

    DEFF Research Database (Denmark)

    Papadopoulos, Pantelis M.; Lagkas, Thomas D.; Demetriadis, Stavros N.

    2016-01-01

    This study analyses the impact of self and peer feedback in technology-enhanced peer review settings. The impact of receiving peer comments (“receiver” perspective) is compared to that of reaching own insights by reviewing others’ work (“giver” perspective). In this study, 38 sophomore students...... were randomly assigned in two conditions and engaged in peer review activity facilitated by a web-based learning environment asking them to provide multiple reviews. In the Peer Reviewed (PR) condition students both reviewed peer work and received peer comments for their own work. By contrast......, in the Self Reviewed (SR) condition students provided peer reviews, but did not receive any. Instead, they were asked to perform self reviewing, before proceeding to any revisions of their work. Result showed that the two groups were comparable in all aspects, suggesting that the lack of getting peer reviews...

  3. Technology-Enhanced Peer Review: Benefits and Implications of Providing Multiple Reviews

    DEFF Research Database (Denmark)

    Papadopoulos, Pantelis M.; Lagkas, Thomas D.; Demetriadis, Stavros N.

    2017-01-01

    This study analyses the impact of self and peer feedback in technology-enhanced peer review settings. The impact of receiving peer comments (“receiver” perspective) is compared to that of reaching own insights by reviewing others’ work (“giver” perspective). In this study, 38 sophomore students...... were randomly assigned in two conditions and engaged in peer review activity facilitated by a web-based learning environment asking them to provide multiple reviews. In the Peer Reviewed (PR) condition students both reviewed peer work and received peer comments for their own work. By contrast......, in the Self Reviewed (SR) condition students provided peer reviews, but did not receive any. Instead, they were asked to perform self reviewing, before proceeding to any revisions of their work. Result showed that the two groups were comparable in all aspects, suggesting that the lack of getting peer reviews...

  4. Defining treatment success in rosacea as 'clear' may provide multiple patient benefits: results of a pooled analysis.

    Science.gov (United States)

    Webster, Guy; Schaller, Martin; Tan, Jerry; Jackson, J Mark; Kerrouche, Nabil; Schäfer, Gregor

    2017-08-01

    Rosacea treatment success is usually defined as a score of 1 ('almost clear') or 0 ('clear') on the 5-point Investigator Global Assessment (IGA) scale. To evaluate whether, after successful treatment, 'clear' subjects had better outcomes than 'almost clear' subjects. A pooled analysis was performed on 1366 rosacea subjects from four randomized controlled trials with IGA before and after treatment (ivermectin, metronidazole or vehicle). Assessments included the Dermatology Life Quality Index (DLQI) questionnaire and subject assessment of rosacea improvement. In one trial, patients were followed after the treatment period to measure time to relapse (IGA score ≥2). At end of treatment, more 'clear' than 'almost clear' subjects had a clinically meaningful difference in DLQI (59% vs. 44%; p rosacea (77% vs. 42%; p < .001). The median time to relapse was more than 8 months for 'clear' vs. 3 months for 'almost clear' subjects (p < .0001). Achieving an endpoint of 'clear' (IGA 0) vs. 'almost clear' (IGA 1) is associated with multiple positive patient outcomes, including delayed time to relapse.

  5. Whole-body cryostimulation (cryotherapy) provides benefits for fatigue and functional status in multiple sclerosis patients. A case-control study.

    Science.gov (United States)

    Miller, E; Kostka, J; Włodarczyk, T; Dugué, B

    2016-12-01

    To study the effects of whole-body cryostimulation (WBC) on fatigue and functional status in multiple sclerosis (MS) patients with different levels of fatigue. Two groups of 24 MS patients with fatigue were studied. At the beginning of the study, the first group presented a Fatigue Severity Scale (FSS) score between 38 and 42 (low-fatigue (LF) group), and the second group had an FSS score between 48 and 52 (high-fatigue (HF) group). Both groups were matched for age and sex. All patients were exposed to 10.3-min session of WBC (one exposure per day at -110°C or lower). Functional status was assessed before and after the series of WBC exposures using the Rivermead Motor Assessment (RMA), the Multiple Sclerosis Impact Scale (MSIS-29), and the Expanded Disability Status Scale (EDSS). The RMA was estimated in three sections: gross function (RMA1), leg and trunk (RMA2), and arm (RMA3). MSIS-29 consists of two subscales assessing the physical (MSIS-29-PHYS) and psychological (MSIS-29-PSYCH) status. In both groups, the WBC sessions induced a significant improvement in the functional status and in the feeling of fatigue. However, the changes observed in HF patients were significantly greater than those observed in LF patients, especially in the MSIS-29-PHYS, MSIS-29-PSYCH, RMA1, and RMA3. The changes observed in the EDSS, RMA2, and FSS were similar in both groups. WBC appears to be effective in improving functional status and the feeling of fatigue in patients with MS and especially in those who are the most fatigued. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Assessing the Multiple Benefits of Clean Energy: A Resource for States

    Science.gov (United States)

    Clean energy provides multiple benefits. The Multiple Benefits Guide provides an overview of the environmental, energy system and economic benefits of clean energy, specifically energy efficiency, renewable energy and clean distributed generation, and why it is important to thin...

  7. Family benefits - Obligation to provide information

    CERN Document Server

    HR Department

    2015-01-01

    Pursuant to Article R V 1.38 of the Staff Regulations, members of the personnel are reminded that they are required to inform the Organization in writing, within 30 calendar days, of any change in their family situation (marriage, partnership, birth of a child, etc.) and of the amount of any financial benefit of a similar nature to those provided for in the Staff Regulations (e.g. family allowance, child allowance, infant allowance, non-resident allowance or international indemnity) to which they or a member of their family may be entitled from a source other than CERN.   The procedures to be followed are available in the Admin e-guide: https://admin-eguide.web.cern.ch/en/procedure/change-family-situation Members of the personnel are also reminded that any false declaration or failure to make a declaration with a view to deceiving others or achieving a gain resulting in a loss of funds or reputation for CERN constitutes fraud and may lead to disciplinary action in accordance with Article S ...

  8. Family benefits – Obligation to provide information

    CERN Document Server

    HR department

    2016-01-01

    Pursuant to Article R V 1.38 of the Staff Regulations, members of the personnel are reminded that they are required to inform the Organization in writing, within 30 calendar days, of any change in their family situation (marriage, partnership, birth of a child, etc.) and of the amount of any financial benefit of a similar nature to those stipulated in the Staff Regulations (e.g. family allowance, child allowance, infant allowance, non-resident allowance or international indemnity) to which they or a member of their family may be entitled from a source other than CERN.   The procedures to be followed are available in the admin e-guide: https://admin-eguide.web.cern.ch/en/procedure/change-family-situation Members of the personnel are also reminded that any false declaration or failure to make a declaration with a view to deceiving others or achieving a gain resulting in a loss of funds or reputation for CERN constitutes fraud and may lead to disciplinary action in accordance with Article S VI 2.01 of ...

  9. Family benefits - Obligation to provide information

    CERN Multimedia

    HR Department

    2015-01-01

    Pursuant to Article R V 1.38 of the Staff Regulations, members of the personnel are reminded that they are required to inform the Organization in writing, within 30 calendar days, of any change in their family situation (marriage, partnership, birth of a child, etc.) and of the amount of any financial benefit of a similar nature to those stipulated in the Staff Regulations (e.g. family allowance, child allowance, infant allowance, non-resident allowance or international indemnity) to which they or a member of their family may be entitled from a source other than CERN.   The procedures to be followed are available in the Admin e-guide: https://admin-eguide.web.cern.ch/en/procedure/change-family-situation Members of the personnel are also reminded that any false declaration or failure to make a declaration with a view to deceiving others or achieving a gain resulting in a loss of funds or reputation for CERN constitutes fraud and may lead to disciplinary action in accordance with Article S VI 2.01 of ...

  10. Valuing Multiple Benefits, and the Public Perception of SUDS Ponds

    OpenAIRE

    Joy Jarvie; Scott Arthur; Lindsay Beevers

    2017-01-01

    Understanding how the public perceive and value ponds is fundamental to appreciate the synergy between Sustainable urban Drainage (SUDS) ponds and the multiple benefits they provide. This paper investigates this, through the application of a structured postal and online survey, for a case study area of Edinburgh, in the UK. It compares man-made ponds (including SUDS), and ponds with natural origins. The results from Whole Life Cost show that the benefits (based on Contingent Valuation) exceed...

  11. Valuing Multiple Benefits, and the Public Perception of SUDS Ponds

    Directory of Open Access Journals (Sweden)

    Joy Jarvie

    2017-02-01

    Full Text Available Understanding how the public perceive and value ponds is fundamental to appreciate the synergy between Sustainable urban Drainage (SUDS ponds and the multiple benefits they provide. This paper investigates this, through the application of a structured postal and online survey, for a case study area of Edinburgh, in the UK. It compares man-made ponds (including SUDS, and ponds with natural origins. The results from Whole Life Cost show that the benefits (based on Contingent Valuation exceed the CAPEX and OPEX costs for three of five artificial ponds studied. Benefits from natural (reference ponds exceed the replacement costs for a pond with the same surface area/catchment. This paper highlights the importance of monetising the multiple benefits from ponds.

  12. Conserving critical sites for biodiversity provides disproportionate benefits to people

    DEFF Research Database (Denmark)

    Larsen, Frank Wugt; Turner, Will R.; Brooks, Thomas M.

    2012-01-01

    Protecting natural habitats in priority areas is essential to halt the loss of biodiversity. Yet whether these benefits for biodiversity also yield benefits for human well-being remains controversial. Here we assess the potential human well-being benefits of safeguarding a global network of sites......) benefits to maintenance of human cultural diversity - significantly exceeding those anticipated from randomly selected sites within the same countries and ecoregions. Results suggest that safeguarding sites important for biodiversity conservation provides substantial benefits to human well-being....

  13. Multiplicity-adjusted semiparametric benefiting subgroup identification in clinical trials.

    Science.gov (United States)

    Schnell, Patrick M; Müller, Peter; Tang, Qi; Carlin, Bradley P

    2018-02-01

    Background A recent focus in the health sciences has been the development of personalized medicine, which includes determining the population for which a given treatment is effective. Due to limited data, identifying the true benefiting population is a challenging task. To tackle this difficulty, the credible subgroups approach provides a pair of bounding subgroups for the true benefiting subgroup, constructed so that one is contained by the benefiting subgroup while the other contains the benefiting subgroup with high probability. However, the method has so far only been developed for parametric linear models. Methods In this article, we develop the details required to follow the credible subgroups approach in more realistic settings by considering nonlinear and semiparametric regression models, supported for regulatory science by conditional power simulations. We also present an improved multiple testing approach using a step-down procedure. We evaluate our approach via simulations and apply it to data from four trials of Alzheimer's disease treatments carried out by AbbVie. Results Semiparametric modeling yields credible subgroups that are more robust to violations of linear treatment effect assumptions, and careful choice of the population of interest as well as the step-down multiple testing procedure result in a higher rate of detection of benefiting types of patients. The approach allows us to identify types of patients that benefit from treatment in the Alzheimer's disease trials. Conclusion Attempts to identify benefiting subgroups of patients in clinical trials are often met with skepticism due to a lack of multiplicity control and unrealistically restrictive assumptions. Our proposed approach merges two techniques, credible subgroups, and semiparametric regression, which avoids these problems and makes benefiting subgroup identification practical and reliable.

  14. Conserving Critical Sites for Biodiversity Provides Disproportionate Benefits to People

    Science.gov (United States)

    Larsen, Frank W.; Turner, Will R.; Brooks, Thomas M.

    2012-01-01

    Protecting natural habitats in priority areas is essential to halt the loss of biodiversity. Yet whether these benefits for biodiversity also yield benefits for human well-being remains controversial. Here we assess the potential human well-being benefits of safeguarding a global network of sites identified as top priorities for the conservation of threatened species. Conserving these sites would yield benefits – in terms of a) climate change mitigation through avoidance of CO2 emissions from deforestation; b) freshwater services to downstream human populations; c) retention of option value; and d) benefits to maintenance of human cultural diversity – significantly exceeding those anticipated from randomly selected sites within the same countries and ecoregions. Results suggest that safeguarding sites important for biodiversity conservation provides substantial benefits to human well-being. PMID:22666337

  15. Conserving critical sites for biodiversity provides disproportionate benefits to people.

    Directory of Open Access Journals (Sweden)

    Frank W Larsen

    Full Text Available Protecting natural habitats in priority areas is essential to halt the loss of biodiversity. Yet whether these benefits for biodiversity also yield benefits for human well-being remains controversial. Here we assess the potential human well-being benefits of safeguarding a global network of sites identified as top priorities for the conservation of threatened species. Conserving these sites would yield benefits--in terms of a climate change mitigation through avoidance of CO(2 emissions from deforestation; b freshwater services to downstream human populations; c retention of option value; and d benefits to maintenance of human cultural diversity--significantly exceeding those anticipated from randomly selected sites within the same countries and ecoregions. Results suggest that safeguarding sites important for biodiversity conservation provides substantial benefits to human well-being.

  16. Multiple fitness benefits of polyandry in a cephalopod.

    Science.gov (United States)

    Squires, Zoe E; Wong, Bob B M; Norman, Mark D; Stuart-Fox, Devi

    2012-01-01

    Sex differences in reproductive investment play a crucial role in sexual conflict. One intriguing aspect of sexual conflict is the evolution of female multiple mating (polyandry), particularly in systems where females receive no obvious direct benefits from males, and where mating is highly costly. Here, theory predicts that polyandrous females can increase their reproductive success by taking advantage of the genetic benefits of mating with multiple males. Cephalopods provide a model system for addressing this question, as all species mate multiply. Here we examine differences in reproductive success between monandrous, multiply mated (to the same male) and polyandrous female dumpling squid (Euprymna tasmanica). We mated females in the laboratory with two different males (polyandrous; controlling for mating order), or with a single male (monandrous). To control for mating frequency, we mated monandrous females either once (monandrous 1), or with the same male twice (monandrous 2), and measured reproductive success for each of the three treatments (polyandrous, monandrous 1, monandrous 2). Females mated to two different males produced eggs faster and had larger hatchlings relative to egg mass than females mated once with a single male. The benefits of polyandry demonstrated here are the first, to our knowledge, in any cephalopod. These benefits may outweigh the significant costs associated with mating and help to explain how multiple mating has evolved (or is maintained) in this group.

  17. Multiple fitness benefits of polyandry in a cephalopod.

    Directory of Open Access Journals (Sweden)

    Zoe E Squires

    Full Text Available BACKGROUND: Sex differences in reproductive investment play a crucial role in sexual conflict. One intriguing aspect of sexual conflict is the evolution of female multiple mating (polyandry, particularly in systems where females receive no obvious direct benefits from males, and where mating is highly costly. Here, theory predicts that polyandrous females can increase their reproductive success by taking advantage of the genetic benefits of mating with multiple males. Cephalopods provide a model system for addressing this question, as all species mate multiply. Here we examine differences in reproductive success between monandrous, multiply mated (to the same male and polyandrous female dumpling squid (Euprymna tasmanica. METHODOLOGY/PRINCIPAL FINDINGS: We mated females in the laboratory with two different males (polyandrous; controlling for mating order, or with a single male (monandrous. To control for mating frequency, we mated monandrous females either once (monandrous 1, or with the same male twice (monandrous 2, and measured reproductive success for each of the three treatments (polyandrous, monandrous 1, monandrous 2. Females mated to two different males produced eggs faster and had larger hatchlings relative to egg mass than females mated once with a single male. CONCLUSIONS/SIGNIFICANCE: The benefits of polyandry demonstrated here are the first, to our knowledge, in any cephalopod. These benefits may outweigh the significant costs associated with mating and help to explain how multiple mating has evolved (or is maintained in this group.

  18. Physical activity motivation and benefits in people with multiple sclerosis.

    Science.gov (United States)

    Fasczewski, Kimberly S; Gill, Diane L; Rothberger, Sara M

    2017-03-14

    Multiple sclerosis is a degenerative neurological disease that affects 2.1 million people worldwide. There is no cure, but an expanding body of research supports the positive impact of physical activity and suggests physical activity has benefits for the individual's psychological and physical well-being. Using Self-Determination Theory as a framework, mixed methods with a focus on qualitative interviews were used to explore physical activity motivation and benefits with a sample of highly active people with multiple sclerosis (n = 15). Disability level ranged from not disabled to wheelchair bound with the majority of participants reporting minimal impact from multiple sclerosis. Survey data were collected using a number of open-ended questions along with measures of self-efficacy, self-determined motivation, physical activity, and quality of life. Additionally, eight individuals participated in semistructured telephone interviews focused on (a) motivation and strategies used to maintain physical activity and (b) the benefits and impact of physical activity in their lives. The main findings were consistent with Self-Determination Theory; participants described feelings of accomplishment and competence in both their physical activity and daily life, as well as a sense of independence and autonomy. Similarly, all participants cited benefits, and the main themes were enhanced satisfaction with life and an overall positive outlook on life. Results provide insight into the role of physical activity in a highly active sample and have implications for professionals working in physical activity settings with the multiple sclerosis population. Interventions aimed at increasing long-term physical activity adherence should focus on increasing autonomy and competence for physical activity in the individual and promoting potential increased quality of life outcomes from physical activity participation. Implications for Rehabilitation Multiple sclerosis is a chronic

  19. Benefits and limitations of imaging multiples: Mirror migration

    KAUST Repository

    Hanafy, Sherif M.

    2015-07-01

    The benefits and limitations of imaging multiples are reviewed for mirror migration. Synthetic and field data examples are used to characterize the effectiveness of migrating multiples relative to primary imaging.

  20. Do incentives matter? Providing benefits to families of organ donors.

    Science.gov (United States)

    Bryce, C L; Siminoff, L A; Ubel, P A; Nathan, H; Caplan, A; Arnold, R M

    2005-12-01

    Whether the number of organs available for transplant would be positively or negatively affected by providing benefits to families of organ donors has been debated by policymakers, ethicists and the transplant community at large. We designed a telephone survey to measure public opinion regarding the use of benefits in general and of five types in particular: funeral benefits, charitable contributions, travel/lodging expenses, direct payments and medical expenses. Of the 971 adults who completed the survey (response rate = 69%), all were from Pennsylvania households, 45.6% were registered organ donors, and 51.7% were nonwhite. Although 59% of respondents favored the general idea of incentives, support for specific incentives ranged from 53% (direct payment) to 84% (medical expenses). Among those registered as donors, more nonwhites than whites supported funeral benefits (88% vs. 81%; p = 0.038), direct payment (63% vs. 41%; p donation but would influence the behavior of others. While benefits appear to be favored, their true impact can only be assessed through pilot programs.

  1. Electronic consultation system demonstrates educational benefit for primary care providers.

    Science.gov (United States)

    Kwok, Jonas; Olayiwola, J Nwando; Knox, Margae; Murphy, Elizabeth J; Tuot, Delphine S

    2017-01-01

    Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse

  2. Multiplicity of effects and health benefits of resveratrol

    Directory of Open Access Journals (Sweden)

    Lolita Kuršvietienė

    2016-01-01

    Full Text Available Resveratrol is mainly found in grapes and red wine, also in some plants and fruits, such as peanuts, cranberries, pistachios, blueberries and bilberries. Moreover, nowadays this compound is available as purified preparation and dietary supplement. Resveratrol provides a wide range of benefits, including cardiovascular protective, antiplatelet, antioxidant, anti-inflammatory, blood glucose-lowering and anticancer activities, hence it exhibits a complex mode of action. During the recent years, these properties have been widely studied in animal and human models, both in vitro and in vivo. This paper is intended to present information published during the recent years on the biological activities and multiple effects of resveratrol.

  3. Organically Grown Food Provides Health Benefits to Drosophila melanogaster

    Science.gov (United States)

    Chhabra, Ria; Kolli, Santharam; Bauer, Johannes H.

    2013-01-01

    The “organic food” market is the fastest growing food sector, yet it is unclear whether organically raised food is nutritionally superior to conventionally grown food and whether consuming organic food bestows health benefits. In order to evaluate potential health benefits of organic foods, we used the well-characterized fruit fly Drosophila melanogaster as a model system. Fruit flies were raised on a diets consisting of extracts of either conventionally or organically raised produce (bananas, potatoes, raisins, soy beans). Flies were then subjected to a variety of tests designed to assess overall fly health. Flies raised on diets made from organically grown produce had greater fertility and longevity. On certain food sources, greater activity and greater stress resistance was additionally observed, suggesting that organic food bestows positive effects on fly health. Our data show that Drosophila can be used as a convenient model system to experimentally test potential health effects of dietary components. Using this system, we provide evidence that organically raised food may provide animals with tangible benefits to overall health. PMID:23326371

  4. Organically grown food provides health benefits to Drosophila melanogaster.

    Directory of Open Access Journals (Sweden)

    Ria Chhabra

    Full Text Available The "organic food" market is the fastest growing food sector, yet it is unclear whether organically raised food is nutritionally superior to conventionally grown food and whether consuming organic food bestows health benefits. In order to evaluate potential health benefits of organic foods, we used the well-characterized fruit fly Drosophila melanogaster as a model system. Fruit flies were raised on a diets consisting of extracts of either conventionally or organically raised produce (bananas, potatoes, raisins, soy beans. Flies were then subjected to a variety of tests designed to assess overall fly health. Flies raised on diets made from organically grown produce had greater fertility and longevity. On certain food sources, greater activity and greater stress resistance was additionally observed, suggesting that organic food bestows positive effects on fly health. Our data show that Drosophila can be used as a convenient model system to experimentally test potential health effects of dietary components. Using this system, we provide evidence that organically raised food may provide animals with tangible benefits to overall health.

  5. Organically grown food provides health benefits to Drosophila melanogaster.

    Science.gov (United States)

    Chhabra, Ria; Kolli, Santharam; Bauer, Johannes H

    2013-01-01

    The "organic food" market is the fastest growing food sector, yet it is unclear whether organically raised food is nutritionally superior to conventionally grown food and whether consuming organic food bestows health benefits. In order to evaluate potential health benefits of organic foods, we used the well-characterized fruit fly Drosophila melanogaster as a model system. Fruit flies were raised on a diets consisting of extracts of either conventionally or organically raised produce (bananas, potatoes, raisins, soy beans). Flies were then subjected to a variety of tests designed to assess overall fly health. Flies raised on diets made from organically grown produce had greater fertility and longevity. On certain food sources, greater activity and greater stress resistance was additionally observed, suggesting that organic food bestows positive effects on fly health. Our data show that Drosophila can be used as a convenient model system to experimentally test potential health effects of dietary components. Using this system, we provide evidence that organically raised food may provide animals with tangible benefits to overall health.

  6. Benefits and limitations of imaging multiples: Interferometric and resonant migration

    KAUST Repository

    Guo, Bowen

    2015-07-01

    The benefits and limitations of imaging multiples are reviewed for interferometric migration and resonant migration. Synthetic and field data examples are used to characterize the effectiveness of the methods.

  7. Doses of Nearby Nature Simultaneously Associated with Multiple Health Benefits

    Directory of Open Access Journals (Sweden)

    Daniel T. C. Cox

    2017-02-01

    Full Text Available Exposure to nature provides a wide range of health benefits. A significant proportion of these are delivered close to home, because this offers an immediate and easily accessible opportunity for people to experience nature. However, there is limited information to guide recommendations on its management and appropriate use. We apply a nature dose-response framework to quantify the simultaneous association between exposure to nearby nature and multiple health benefits. We surveyed ca. 1000 respondents in Southern England, UK, to determine relationships between (a nature dose type, that is the frequency and duration (time spent in private green space and intensity (quantity of neighbourhood vegetation cover of nature exposure and (b health outcomes, including mental, physical and social health, physical behaviour and nature orientation. We then modelled dose-response relationships between dose type and self-reported depression. We demonstrate positive relationships between nature dose and mental and social health, increased physical activity and nature orientation. Dose-response analysis showed that lower levels of depression were associated with minimum thresholds of weekly nature dose. Nearby nature is associated with quantifiable health benefits, with potential for lowering the human and financial costs of ill health. Dose-response analysis has the potential to guide minimum and optimum recommendations on the management and use of nearby nature for preventative healthcare.

  8. Doses of Nearby Nature Simultaneously Associated with Multiple Health Benefits.

    Science.gov (United States)

    Cox, Daniel T C; Shanahan, Danielle F; Hudson, Hannah L; Fuller, Richard A; Anderson, Karen; Hancock, Steven; Gaston, Kevin J

    2017-02-09

    Exposure to nature provides a wide range of health benefits. A significant proportion of these are delivered close to home, because this offers an immediate and easily accessible opportunity for people to experience nature. However, there is limited information to guide recommendations on its management and appropriate use. We apply a nature dose-response framework to quantify the simultaneous association between exposure to nearby nature and multiple health benefits. We surveyed ca. 1000 respondents in Southern England, UK, to determine relationships between (a) nature dose type, that is the frequency and duration (time spent in private green space) and intensity (quantity of neighbourhood vegetation cover) of nature exposure and (b) health outcomes, including mental, physical and social health, physical behaviour and nature orientation. We then modelled dose-response relationships between dose type and self-reported depression. We demonstrate positive relationships between nature dose and mental and social health, increased physical activity and nature orientation. Dose-response analysis showed that lower levels of depression were associated with minimum thresholds of weekly nature dose. Nearby nature is associated with quantifiable health benefits, with potential for lowering the human and financial costs of ill health. Dose-response analysis has the potential to guide minimum and optimum recommendations on the management and use of nearby nature for preventative healthcare.

  9. Comparison of benefits provided by different hearing aid technologies.

    Science.gov (United States)

    Walden, B E; Surr, R K; Cord, M T; Edwards, B; Olson, L

    2000-01-01

    The performance of 40 hearing-impaired adults with the GN ReSound digital BZ5 hearing instrument was compared with performance with linear hearing aids with input compression limiting (AGC-I) or two-channel analog wide dynamic range compression (WDRC) instruments. The BZ5 was evaluated with an omnidirectional microphone, dual-microphone directionality, and a noise reduction circuit in combination with dual-microphone directionality. Participants were experienced hearing aid users who were wearing linear AGC-I or analog WDRC instruments at the time of enrolment. Performance was assessed using the Connected Speech Test (CST) presented at several presentation levels and under various conditions of signal degradation and by the Profile of Hearing Aid Benefit (PHAB). Subjective ratings of speech understanding, listening comfort, and sound quality/naturalness were also obtained using 11-point interval scales. Small performance advantages were observed for WDRC over linear AGC-I, although WDRC did not have to be implemented digitally for these performance advantages to be realized. Substantial performance advantages for the dual microphones over the omnidirectional microphone were observed in the CST results in noise, but participants generally did not perceive these large advantages in everyday listening. The noise reduction circuit provided improved listening comfort but little change in speech understanding.

  10. Providing Benefit to Black College Students in Counseling Research.

    Science.gov (United States)

    Thompson, Chalmer E.

    Counseling psychologists are in ideal positions to address issues pertinent to black college students, particularly via empirical research study and advocacy. The first step towards maximizing benefit to black college students is to respond to their need for personal and community-wide intervention. It is necessary to collaborate with the…

  11. Multiple-role dilemmas for military mental health care providers.

    Science.gov (United States)

    Johnson, W Brad; Bacho, Roderick; Heim, Mark; Ralph, John

    2006-04-01

    Military psychologists and psychiatrists frequently face ethical quandaries involving boundary crossings, or extratherapy contact, and multiple relationships. A multiple relationship is defined as necessarily engaging psychotherapy patients in nonclinical roles, such as coworker, superior officer, neighbor, or friend. In contrast to their civilian counterparts, military mental health professionals must often engage patients in many different contexts and roles. In this article, we consider the distinctive features of mental health practice in the military and offer military providers several practice guidelines for avoiding harm to patients in military settings. This article is also designed to enhance sensitivity to multiple-role risks among nonpsychiatric providers.

  12. Factors associated with providing social security benefits for traumatic brain injury resulting from occupational accidents

    Directory of Open Access Journals (Sweden)

    Denismar Borges de Miranda

    2014-03-01

    Full Text Available INTRODUCTION: The Occupational Accident (OA is considered to be an important public health problem in Brazil. Traumatic Brain Injury (TBI is the most common among them. The TBI is associated with high morbidity and mortality rates among workers. OBJECTIVE: To identify factors associated with providing social security benefits for TBI due to occupational accidents according to the specific type of economic activity in Brazil, in 2009. METHODS: This is a cross-sectional study that was conducted with all workers who were part of the General Regime of Social Security (RGPS of Brazil. Secondary data were obtained from the National Information System Benefit, from the Synchronized National Register of the Ministry of Finance and from the General Register of Employed and Unemployed Persons. Data were analyzed using the multiple logistic regression method. RESULTS: We analyzed 2,006 cases of social security benefits for traumatic brain injury due to Occupational Accident. Factors associated with the concession of the benefit according to the economic activity of the Company of the beneficiary were identified. Associations were found with sex, income and the region of the Company. CONCLUSION: Factors associated with the concession of social security benefits by TBI resulting from OA differ depending on the type of economic activity in the study. Understanding these factors may contribute to the planning of preventive policies.

  13. Factors associated with providing social security benefits for traumatic brain injury resulting from occupational accidents.

    Science.gov (United States)

    de Miranda, Denismar Borges; Rego, Rita Franco; Viola, Denise Nunes; Lima, Verônica Maria Cadena; Teixeira, Edriene Barros

    2014-01-01

    The Occupational Accident (OA) is considered to be an important public health problem in Brazil. Traumatic Brain Injury (TBI) is the most common among them. The TBI is associated with high morbidity and mortality rates among workers. To identify factors associated with providing social security benefits for TBI due to occupational accidents according to the specific type of economic activity in Brazil, in 2009. This is a cross-sectional study that was conducted with all workers who were part of the General Regime of Social Security (RGPS) of Brazil. Secondary data were obtained from the National Information System Benefit, from the Synchronized National Register of the Ministry of Finance and from the General Register of Employed and Unemployed Persons. Data were analyzed using the multiple logistic regression method. We analyzed 2,006 cases of social security benefits for traumatic brain injury due to Occupational Accident. Factors associated with the concession of the benefit according to the economic activity of the Company of the beneficiary were identified. Associations were found with sex, income and the region of the Company. Factors associated with the concession of social security benefits by TBI resulting from OA differ depending on the type of economic activity in the study. Understanding these factors may contribute to the planning of preventive policies.

  14. Providing undergraduate science partners for elementary teachers: benefits and challenges.

    Science.gov (United States)

    Goebel, Camille A; Umoja, Aminata; DeHaan, Robert L

    2009-01-01

    Undergraduate college "science partners" provided content knowledge and a supportive atmosphere for K-5 teachers in a university-school professional development partnership program in science instruction. The Elementary Science Education Partners program, a Local Systemic Change initiative supported by the National Science Foundation, was composed of four major elements: 1) a cadre of mentor teachers trained to provide district-wide teacher professional development; 2) a recruitment and training effort to place college students in classrooms as science partners in semester-long partnerships with teachers; 3) a teacher empowerment effort termed "participatory reform"; and 4) an inquiry-based curriculum with a kit distribution and refurbishment center. The main goals of the program were to provide college science students with an intensive teaching experience and to enhance teachers' skills in inquiry-based science instruction. Here, we describe some of the program's successes and challenges, focusing primarily on the impact on the classroom teachers and their science partners. Qualitative analyses of data collected from participants indicate that 1) teachers expressed greater self-confidence about teaching science than before the program and they spent more class time on the subject; and 2) the college students modified deficit-model negative assumptions about the children's science learning abilities to express more mature, positive views.

  15. Smartphone medication adherence apps: potential benefits to patients and providers.

    Science.gov (United States)

    Dayer, Lindsey; Heldenbrand, Seth; Anderson, Paul; Gubbins, Paul O; Martin, Bradley C

    2013-01-01

    To provide an overview of medication adherence, discuss the potential for smartphone medication adherence applications (adherence apps) to improve medication nonadherence, evaluate features of adherence apps across operating systems (OSs), and identify future opportunities and barriers facing adherence apps. Medication nonadherence is a common, complex, and costly problem that contributes to poor treatment outcomes and consumes health care resources. Nonadherence is difficult to measure precisely, and interventions to mitigate it have been largely unsuccessful. Using smartphone adherence apps represents a novel approach to improving adherence. This readily available technology offers many features that can be designed to help patients and health care providers improve medication-taking behavior. Currently available apps were identified from the three main smartphone OSs (Apple, Android, and Blackberry). In addition, desirable features for adherence apps were identified and ranked by perceived importance to user desirability using a three-point rating system: 1, modest; 2, moderate; or 3, high. The 10 highest-rated apps were installed and subjected to user testing to assess app attributes using a standard medication regimen. RESULTS 160 adherence apps were identified and ranked. These apps were most prevalent for the Android OS. Adherence apps with advanced functionality were more prevalent on the Apple iPhone OS. Among all apps, MyMedSchedule, MyMeds, and RxmindMe rated the highest because of their basic medication reminder features coupled with their enhanced levels of functionality. Despite being untested, medication apps represent a possible strategy that pharmacists can recommend to nonadherent patients and incorporate into their practice.

  16. Sodium intake and multiple sclerosis activity and progression in BENEFIT

    DEFF Research Database (Denmark)

    Fitzgerald, Kathryn C; Munger, Kassandra L; Hartung, Hans-Peter

    2017-01-01

    OBJECTIVE: To assess whether a high-salt diet, as measured by urinary sodium concentration, is associated with faster conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) and MS activity and disability. METHODS: BENEFIT was a randomized clinical trial comparing early versus...... sodium levels estimated from the cumulative average of the repeated measures were associated with clinical (conversion to MS, Expanded Disability Status Scale [EDSS]) and magnetic resonance imaging (MRI) outcomes. RESULTS: Average 24-hour urine sodium levels were not associated with conversion...... in T2 lesion volume: -0.11, 95% CI = -0.25 to 0.04; change in EDSS: -0.01, 95% CI = -0.09 to 0.08; relapse rate: HR = 0.78, 95% CI = 0.56-1.07). Results were similar in categorical analyses using quintiles. INTERPRETATION: Our results, based on multiple assessments of urine sodium excretion over 5...

  17. Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines.

    Science.gov (United States)

    Ong, Mei-Sing; Olson, Karen L; Cami, Aurel; Liu, Chunfu; Tian, Fang; Selvam, Nandini; Mandl, Kenneth D

    2016-02-01

    Prescription benzodiazepine overdose continues to cause significant morbidity and mortality in the US. Multiple-provider prescribing, due to either fragmented care or "doctor-shopping," contributes to the problem. To elucidate the effect of provider professional relationships on multiple-provider prescribing of benzodiazepines, using social network analytics. A retrospective analysis of commercial healthcare claims spanning the years 2008 through 2011. Provider patient-sharing networks were modelled using social network analytics. Care team cohesion was measured using care density, defined as the ratio between the total number of patients shared by provider pairs within a patient's care team and the total number of provider pairs in the care team. Relationships within provider pairs were further quantified using a range of network metrics, including the number and proportion of patients or collaborators shared. The relationship between patient-sharing network metrics and the likelihood of multiple prescribing of benzodiazepines. Patients between the ages of 18 and 64 years who received two or more benzodiazepine prescriptions from multiple providers, with overlapping coverage of more than 14 days. A total of 5659 patients and 1448 provider pairs were included in our study. Among these, 1028 patients (18.2 %) received multiple prescriptions of benzodiazepines, involving 445 provider pairs (30.7 %). Patients whose providers rarely shared patients had a higher risk of being prescribed overlapping benzodiazepines; the median care density was 8.1 for patients who were prescribed overlapping benzodiazepines and 10.1 for those who were not (p benzodiazepines. Our findings demonstrate the importance of care team cohesion in addressing multiple-provider prescribing of controlled substances. Furthermore, we illustrate the potential of the provider network as a surveillance tool to detect and prevent adverse events that could arise due to fragmentation of care.

  18. Quantifying the multiple, environmental benefits of reintroducing the Eurasian Beaver

    Science.gov (United States)

    Brazier, Richard; Puttock, Alan; Graham, Hugh; Anderson, Karen; Cunliffe, Andrew; Elliott, Mark

    2016-04-01

    Beavers are ecological engineers with an ability to modify the structure and flow of fluvial systems and create complex wetland environments with dams, ponds and canals. Consequently, beaver activity has potential for river restoration, management and the provision of multiple environmental ecosystem services including biodiversity, flood risk mitigation, water quality and sustainable drinking water provision. With the current debate surrounding the reintroduction of beavers into the United Kingdom, it is critical to monitor the impact of beavers upon the environment. We have developed and implemented a monitoring strategy to quantify the impact of reintroducing the Eurasian Beaver on multiple environmental ecosystem services and river systems at a range of scales. First, the experimental design and preliminary results will be presented from the Mid-Devon Beaver Trial, where a family of beavers has been introduced to a 3 ha enclosure situated upon a first order tributary of the River Tamar. The site was instrumented to monitor the flow rate and quality of water entering and leaving the site. Additionally, the impacts of beavers upon riparian vegetation structure, water/carbon storage were investigated. Preliminary results indicate that beaver activity, particularly the building of ponds and dams, increases water storage within the landscape and moderates the river response to rainfall. Baseflow is enhanced during dry periods and storm flow is attenuated, potentially reducing the risk of flooding downstream. Initial analysis of water quality indicates that water entering the site (running off intensively managed grasslands upslope), has higher suspended sediment loads and nitrate levels, than that leaving the site, after moving through the series of beaver ponds. These results suggest beaver activity may also act as a means by which the negative impact of diffuse water pollution from agriculture can be mitigated thus providing cleaner water in rivers downstream

  19. The Twenty-First Century Multiple Generation Workforce: Overlaps and Differences but Also Challenges and Benefits

    Science.gov (United States)

    Helyer, Ruth; Lee, Dionne

    2012-01-01

    Purpose: The purpose of this paper is to explore the issues around a multiple generational workforce and more specifically, the challenges and benefits for education providers and employers. Design/methodology/approach: Reviewing research papers, analysing academic texts, interrogating market intelligence and contextualising case studies, the…

  20. Semantic distributed resource discovery for multiple resource providers

    NARCIS (Netherlands)

    Pittaras, C.; Ghijsen, M.; Wibisono, A.; Grosso, P.; van der Ham, J.; de Laat, C.

    2012-01-01

    An emerging modus operandi among providers of cloud infrastructures is the one where they share and combine their heterogenous resources to offer end user services tailored to specific scientific and business needs. A challenge to overcome is the discovery of suitable resources among these multiple

  1. Complementary therapy use by persons with multiple sclerosis: benefits and research priorities.

    Science.gov (United States)

    Esmonde, Lisa; Long, Andrew F

    2008-08-01

    People with multiple sclerosis (MS) are commonly actively involved in self-care, with many accessing complementary and alternative medicine (CAM) to help in symptom management. To provide increased insight into benefits from CAM use and service user ideas over research priorities, a two-part study, involving a questionnaire and interactive workshop, was undertaken with attendees at a national Congress of the MS Trust in the UK. The six most used therapies were reflexology, massage, yoga, relaxation and meditation, acupuncture and aromatherapy. Each was rated by a quarter to two-fifths as 'extremely helpful'. Insight into the nature of the therapeutic benefit was provided in user comments. Despite the self-selected nature of the sample, the findings point to potential benefits of a set of CAM therapies in helping people with MS. More research on potential benefits of therapies was called for by participants and on the dynamics of the therapeutic effect.

  2. Fitness consequences of female multiple mating: A direct test of indirect benefits

    Directory of Open Access Journals (Sweden)

    Barbosa Miguel

    2012-09-01

    Full Text Available Abstract Background The observation that females mate multiply when males provide nothing but sperm - which sexual selection theory suggests is unlikely to be limiting - continues to puzzle evolutionary biologists. Here we test the hypothesis that multiple mating is prevalent under such circumstances because it enhances female fitness. We do this by allowing female Trinidadian guppies to mate with either a single male or with multiple males, and then tracking the consequences of these matings across two generations. Results Overall, multiply mated females produced 67% more F2 grand-offspring than singly mated females. These offspring, however, did not grow or mature faster, nor were they larger at birth, than F2 grand-offspring of singly mated females. Our results, however, show that multiple mating yields benefits to females in the form of an increase in the production of F1. The higher fecundity among multiply mated mothers was driven by greater production of sons but not daughters. However, contrary to expectation, individually, the offspring of multiply mated females do not grow at different rates than offspring of singly mated females, nor do any indirect fitness benefits or costs accrue to second-generation offspring. Conclusions The study provides strong evidence that multiple mating is advantageous to females, even when males contribute only sperm. This benefit is achieved through an increase in fecundity in the first generation, rather than through other fitness correlates such as size at birth, growth rate, time to sexual maturation and survival. Considered alongside previous work that female guppies can choose to mate with multiple partners, our results provide compelling evidence that direct fitness benefits underpin these mating decisions.

  3. Minimal residual disease in multiple myeloma: Benefits of flow cytometry.

    Science.gov (United States)

    Galtseva, I V; Davydova, Y O; Kapranov, N M; Julhakyan, H L; Mendeleeva, L P

    2017-10-23

    Over the last 20 years, the approaches to the treatment of multiple myeloma (MM) have changed considerably, which led to an increase in remission rate. Using new diagnostic methods has made it possible to assess the response to treatment more reliably and forecast disease recurrence: allele-specific polymerase chain reaction, new-generation sequencing and multicolor flow cytometry enable minimal residual disease (MRD) detection of with sensitivity of 10(-5) to 10(-6) . MRD assessment with flow cytometry using is a rapidly developing area of research. The goal of multicenter groups that use flow cytometry as a tool to detect MRD in patients with MM is achieving standardization and increasing sensitivity and specificity of this method. This article provides data about the methods used for MRD monitoring and describes the advances in the field of flow cytometry. © 2017 John Wiley & Sons Ltd.

  4. PeerWise provides significant academic benefits to biological science students across diverse learning tasks, but with minimal instructor intervention.

    Science.gov (United States)

    McQueen, H A; Shields, C; Finnegan, D J; Higham, J; Simmen, M W

    2014-01-01

    We demonstrate that student engagement with PeerWise, an online tool that allows students to author and answer multiple-choice questions (MCQs), is associated with enhanced academic performance across diverse assessment types on a second year Genetics course. Benefits were consistent over three course deliveries, with differential benefits bestowed on groups of different prior ability. A rating scheme, to assess the educational quality of students' questions, is presented and demonstrates that our students are able intuitively to make such quality assessments, and that the process of authoring high quality questions alone does not explain the academic benefits. We further test the benefits of providing additional PeerWise support and conclude that PeerWise works efficiently with minimal intervention, and can be reliably assessed using automatically generated PeerWise scores. Copyright © 2014 The International Union of Biochemistry and Molecular Biology.

  5. Convenience of providing employee benefits compared to increase of gross wages

    Directory of Open Access Journals (Sweden)

    Jiří Duda

    2004-01-01

    Full Text Available Using tax allowances when providing contributions for life insurance, pension insurance and food, employers significantly decrease their costs in comparison with the traditional increase of wages of employees (the saves range in several hundreds of crowns per one employee. These benefits are more profitable than increase of wages for employees, as well. The paper analyses and mathematically reasons these financial benefits, and compares advantages of employee benefits and wage increase.A disadvantage for employees is that these financial means (contributions for pension and life insurance can not be immediately used for their needs, and are bound with the negotiated types of insurance. This is, perhaps, also the reason why employees of selected firms preferred wage increase before employee-benefits. The above-mentioned employee benefits can become an important factor of stabilisation of current employees, or acquiring new, needed employees. The paper briefly characterises these employee benefits.

  6. Frugal cannibals: how consuming conspecific tissues can provide conditional benefits to wood frog tadpoles ( Lithobates sylvaticus)

    Science.gov (United States)

    Jefferson, Dale M.; Hobson, Keith A.; Demuth, Brandon S.; Ferrari, Maud C. O.; Chivers, Douglas P.

    2014-04-01

    Tadpoles show considerable behavioral plasticity. When population densities become high, tadpoles often become cannibalistic, likely in response to intense competition. Conspecific tissues are potentially an ideal diet by composition and should greatly improve growth and development. However, the potential release of alarm cues from the tissues of injured conspecifics may act to deter potential cannibals from feeding. We conducted multiple feeding experiments to test the relative effects that a diet of conspecifics has on tadpole growth and development. Results indicate that while conspecific tissues represent a better alternative to starvation and provide some benefits over low-protein diets, such a diet can have detrimental effects to tadpole growth and/or development relative to diets of similar protein content. Additionally, tadpoles raised individually appear to avoid consuming conspecific tissues and may continue to do so until they suffer from the effects of starvation. However, tadpoles readily fed upon conspecific tissues immediately when raised with competitors. These results suggest that cannibalism may occur as a result of competition rather than the specific quality of available diets, unless such diets lead to starvation.

  7. Spreading The Net: The Multiple Benefits Of Energy Efficiency Improvements

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    Improving energy efficiency can deliver a range of benefits to the economy and society. However energy efficiency programmes are often evaluated only on the basis of the energy savings they deliver. As a result, the full value of energy efficiency improvements in both national and global economies may be significantly underestimated. This also means that energy efficiency policy may not be optimised to target the potential of the full range of outcomes possible. Moreover, when the merit of energy efficiency programmes is judged solely on reductions in energy demand, programmes are susceptible to criticisms related to the rebound effect when the energy savings are less than expected due to other welfare gains. There are several reasons why the full range of outcomes from energy efficiency policy is not generally evaluated. First, it is due to the non-market, somewhat intangible, nature of the socioeconomic benefits, which makes them difficult to quantify. Second, the effects due to energy efficiency alone can be complex to isolate and to determine causality. Third, evaluators and policy makers working in the energy efficiency sphere are usually energy professionals, working for an energy agency or ministry, with little experience of how energy efficiency might impact other non-energy sectors. The result is an under-appreciation – and related underinvestment – in energy efficiency, and as a consequence, missed opportunities and benefits. These foregone benefits represent the ‘opportunity cost’ of failing to adequately evaluate and prioritize energy efficiency investments. The objective of this report is to fully outline the array of different benefits from improved energy efficiency and investigate their implications for policy design. By better understanding the different benefits arising from energy efficiency it should be easier for policy makers to prioritise the most significant outcomes, in addition to energy savings, in optimising energy efficiency

  8. 20 CFR 1002.261 - Who is responsible for funding any plan obligation to provide the employee with pension benefits?

    Science.gov (United States)

    2010-04-01

    ... obligation to provide the employee with pension benefits? 1002.261 Section 1002.261 Employees' Benefits... and Benefits Pension Plan Benefits § 1002.261 Who is responsible for funding any plan obligation to provide the employee with pension benefits? With the exception of multiemployer plans, which have separate...

  9. Space-Based Sensor Web for Earth Science Applications: An Integrated Architecture for Providing Societal Benefits

    Science.gov (United States)

    Habib, Shahid; Talabac, Stephen J.

    2004-01-01

    There is a significant interest in the Earth Science research and user remote sensing community to substantially increase the number of useful observations relative to the current frequency of collection. The obvious reason for such a push is to improve the temporal, spectral, and spatial coverage of the area(s) under investigation. However, there is little analysis available in terms of the benefits, costs and the optimal set of sensors needed to make the necessary observations. Classic observing system solutions may no longer be applicable because of their point design philosophy. Instead, a new intelligent data collection system paradigm employing both reactive and proactive measurement strategies with adaptability to the dynamics of the phenomena should be developed. This is a complex problem that should be carefully studied and balanced across various boundaries including: science, modeling, applications, and technology. Modeling plays a crucial role in making useful predictions about naturally occurring or human-induced phenomena In particular, modeling can serve to mitigate the potentially deleterious impacts a phenomenon may have on human life, property, and the economy. This is especially significant when one is interested in learning about the dynamics of, for example, the spread of forest fires, regional to large-scale air quality issues, the spread of the harmful invasive species, or the atmospheric transport of volcanic plumes and ash. This paper identifies and examines these challenging issues and presents architectural alternatives for an integrated sensor web to provide observing scenarios driving the requisite dynamic spatial, spectral, and temporal characteristics to address these key application areas. A special emphasis is placed on the observing systems and its operational aspects in serving the multiple users and stakeholders in providing societal benefits. We also address how such systems will take advantage of technological advancement in

  10. Perspectives on Self-Advocacy: Comparing Perceived Uses, Benefits, and Drawbacks Among Survivors and Providers

    Science.gov (United States)

    Hagan, Teresa; Rosenzweig, Margaret; Zorn, Kristin; van Londen, Josie; Donovan, Heidi

    2017-01-03

    To describe and compare survivors' and providers' views of the uses of and perceived benefits and drawbacks of survivor self-advocacy. A cross-sectional, two-group, mixed-methods survey. Survivors were recruited from local and national registries and advocacy organizations. Providers were recruited from the University of Pittsburgh Medical Center Cancer Center and a regional Oncology Nursing Society chapter. 122 female cancer survivors and 39 providers involved in their direct care. Quantitative survey data were summarized using descriptive statistics, including means and frequencies. Qualitative survey data were collected and analyzed using content analysis techniques, and main themes were counted and summarized. Perceptions of the uses, benefits, and drawbacks of female cancer survivor self-advocacy. Survivors and providers perceived similar but distinct uses of self-advocacy. Survivors and providers generally agreed on the potential benefits of self-advocacy but had different views of the potential drawbacks. Survivors were most concerned with finding and making sense of information, that their questions would not be answered, and having a worse relationship with their provider; providers were concerned with increases in clinic time and difficulties developing treatment plans. Although survivors and providers recognized similar benefits to survivor self-advocacy, they had different views of the uses and drawbacks of female cancer survivor self-advocacy. Attempts to increase self-advocacy among female cancer survivors must address survivors’ and providers’ views and apprehensions about self-advocacy.

  11. 41 CFR 101-28.303 - Benefits provided by customer supply centers.

    Science.gov (United States)

    2010-07-01

    ... customer supply centers. 101-28.303 Section 101-28.303 Public Contracts and Property Management Federal...-STORAGE AND DISTRIBUTION 28.3-Customer Supply Centers § 101-28.303 Benefits provided by customer supply centers. The customer supply centers (CSCs) provide the following: (a) Overall savings to the Federal...

  12. Multiple function benefit - cost comparison of conservation buffer placement strategies

    Science.gov (United States)

    Z. Qiu; M.G. Dosskey

    2012-01-01

    Conservation buffers are considered to be effective practices for repairing impaired streams and restoring multiple ecosystem functions in degraded agricultural watersheds. Six different planning strategies for targeting their placement within watersheds were compared in terms of cost-effectiveness for environmental improvement in the 144 km² Neshanic River...

  13. Benefits of the Multiple Echo Technique for Ultrasonic Thickness Testing

    Energy Technology Data Exchange (ETDEWEB)

    Elder, J.; Vandekamp, R.

    2011-02-10

    Much effort has been put into determining methods to make accurate thickness measurements, especially at elevated temperatures. An accuracy of +/- 0.001 inches is typically noted for commercial ultrasonic thickness gauges and ultrasonic thickness techniques. Codes and standards put limitations on many inspection factors including equipment, calibration tolerance and temperature variations. These factors are important and should be controlled, but unfortunately do not guarantee accurate and repeatable measurements in the field. Most technicians long for a single technique that is best for every situation, unfortunately, there are no 'silver bullets' when it comes to nondestructive testing. This paper will describe and discuss some of the major contributors to measurement error as well as some advantages and limitations of multiple echo techniques and why multiple echo techniques should be more widely utilized for ultrasonic thickness measurements.

  14. Increasing Benefit of Magnetic Resonance Imaging in Multiple Sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Pyhtinen, J.; Karttunen, A.; Tikkakoski, T. [Radiologian Klinikka, Oulu (Finland)

    2006-11-15

    Magnetic resonance imaging (MRI) has emerged as an essential tool of multiple sclerosis (MS) diagnosis and has opened up completely new prospects in MS research and treatment trials. It is a sensitive method that gives direct evidence of tissue pathology and has greatly increased our knowledge of MS. In clinical work, MRI is used to confirm and exclude the diagnosis of MS. The international recommendation is that every suspected MS patient should undergo at least one brain MRI. T2-weighted images are the standard tool in clinical work, and functional imaging methods are mainly used in MS research. The subtypes and the course of the disease cause variation in MRI findings. Here, we present a general overview of MR findings in MS. Brain, magnetic resonance imaging, multiple sclerosis, spinal cord.

  15. The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries.

    Science.gov (United States)

    Yap, M L; Hanna, T P; Shafiq, J; Ferlay, J; Bray, F; Delaney, G P; Barton, M

    2017-02-01

    More than half of all cancer diagnoses worldwide occur in low- and middle-income countries (LMICs) and the incidence is projected to rise substantially within the next 20 years. Radiotherapy is a vital, cost-effective treatment for cancer; yet there is currently a huge deficit in radiotherapy services within these countries. The aim of this study was to estimate the potential outcome benefits if external beam radiotherapy was provided to all patients requiring such treatment in LMICs, according to the current evidence-based guidelines. Projected estimates of these benefits were calculated to 2035, obtained by applying the previously published Collaboration for Cancer Outcomes, Research and Evaluation (CCORE) demand and outcome benefit estimates to cancer incidence and projection data from the GLOBOCAN 2012 data. The estimated optimal radiotherapy utilisation rate for all LMICs was 50%. There were about 4.0 million cancer patients in LMICs who required radiotherapy in 2012. This number is projected to increase by 78% by 2035, a far steeper increase than the 38% increase expected in high-income countries. National radiotherapy benefits varied widely, and were influenced by case mix. The 5 year population local control and survival benefits for all LMICs, if radiotherapy was delivered according to guidelines, were estimated to be 9.6% and 4.4%, respectively, compared with no radiotherapy use. This equates to about 1.3 million patients who would derive a local control benefit in 2035, whereas over 615 000 patients would derive a survival benefit if the demand for radiotherapy in LMICs was met. The potential outcome benefits were found to be higher in LMICs. These results further highlight the urgent need to reduce the gap between the supply of, and demand for, radiotherapy in LMICs. We must attempt to address this 'silent crisis' as a matter of priority and the approach must consider the complex societal challenges unique to LMICs. Copyright © 2016 The Royal College

  16. Multiple Friends with Benefits: An Optimal Mutualist Management Strategy?

    Science.gov (United States)

    Moeller, Holly V; Neubert, Michael G

    2016-01-01

    Most mutualisms in nature involve interactions between multispecies mutualist guilds and multiple partner species. While mechanisms such as niche partitioning can explain part of this diversity, the presence of low-quality partners, which produce relatively low returns on investment compared with other guild members, is not well understood. Here, we consider a novel explanation for this persistence: that low-quality partners are actively maintained by their hosts as part of a growth-maximizing strategy, even in the presence of higher-quality alternatives. We use a model inspired by the interaction between host trees and ectomycorrhizal fungi to demonstrate that when the environment is variable, trees maintain low-quality fungal partners that they would not otherwise maintain in constant environments. This active investment, which emerges as a response to saturating returns on investment in higher-quality partners, could contribute to the maintenance of diversity in multispecies mutualisms.

  17. Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: a qualitative study.

    Science.gov (United States)

    Learmonth, Yvonne C; Adamson, Brynn C; Balto, Julia M; Chiu, Chung-Yi; Molina-Guzman, Isabel; Finlayson, Marcia; Riskin, Barry J; Motl, Robert W

    2017-08-01

    There is growing recognition of the benefits and safety of exercise and its importance in the comprehensive care of persons with multiple sclerosis (MS), yet uptake is low. We explored the needs and wants of patients with MS regarding exercise promotion through healthcare providers. Participants were adults with MS who had mild-or-moderate disability and a range of exercise levels. All participants lived in the Midwest of the United States. Fifty semi-structured interviews were conducted and analysed using thematic analysis. Two themes emerged, namely interactions between patients and healthcare providers and needs and wants of patients. Analysis of participant accounts illustrate that current exercise promotion by healthcare providers does not meet patient needs and wants. The identified needs and wants of persons with MS involved (i) information and knowledge on the benefits of exercise and exercise prescription, (ii) materials to allow home and community exercise and (iii) tools for initiating and maintaining exercise behaviour. Patients with MS frequently interact with healthcare providers and are generally unsatisfied with exercise promotion during interactions. Healthcare providers can address the low uptake of exercise among persons with MS by acting upon the identified unmet needs involving materials, knowledge and behaviour change strategies for exercise. © 2016 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  18. Means of transport and ontological security: do cars provide psycho-social benefits to their users?

    Energy Technology Data Exchange (ETDEWEB)

    Hiscock, Rosemary [St Andrews Univ., School of Geography and Geosciences, St Andrews (United Kingdom); Macintyre, Sally; Ellaway, Anne [MRC, Social and Public Health Sciences Unit, Glasgow (United Kingdom); Kearns, Ade [Glasgow Univ., Dept. of Urban Studies, Glasgow (United Kingdom)

    2002-07-01

    This paper presents some empirical evidence on the psycho-social benefits people seem to derive from their cars based on in-depth interviews with a sample of car owners and non-car owners in the West of Scotland. We suggest that psycho-social benefits of protection, autonomy and prestige may help to explain people's attachment to cars and also why studies have found consistently that car owners are healthier than non-car owners. In our study cars were seen to provide protection from undesirable people events, and a comfortable cocoon (but not as providing protection against accidents). Cars provided autonomy because car use was seen as being more convenient, reliable and providing access to more destinations than public transport. Cars were seen to confer prestige and other socially desirable attributes such as competence, skill and masculinity. We think that it is important for policy makers to consider how to make public transport more attractive by increasing its potential to provide similar sorts of benefits, and to do so by targeting the different needs of various population groups. (Author)

  19. Concurrent remote management of CPE by multiple service providers

    NARCIS (Netherlands)

    Balemans, H.; Smedt, A. de; Hartog, F.T.H. de; Önnegren, J.

    2006-01-01

    Configuration and management of devices in the home is becoming ever more complex for the user. The trend is, therefore, that it will be performed remotely by network and service providers using dedicated configuration servers. The current remote management architectures do not support an

  20. The factors associated with the belief that vegetarian diets provide health benefits.

    Science.gov (United States)

    Lea, Emma; Worsley, Anthony

    2003-01-01

    The aim of this paper is to examine the factors associated with the belief that vegetarian diets provide health benefits. A random population mail survey about food choice was conducted among a sample of 1000 South Australians. An additional (non-random) survey of 106 vegetarians and semi-vegetarians was also conducted, giving a total of 707 participants from both samples. The main predictors of the belief that vegetarian diets provide health benefits for all respondents were found to be the belief that meat is neither healthy nor necessary and frequent searching for information on healthy eating. However, there were differences between vegetarians, non-vegetarians and semi-vegetarians. In particular, health issues were relatively more important for semi-vegetarians and vegetarians, while knowledge and convenience issues were most important for non-vegetarians. The results have important implications for public health. Many South Australians perceive that health benefits are associated with eating a vegetarian diet, which may also apply to plant-based diets in general. However, if non-vegetarians are to obtain some of the health benefits associated with the consumption of a plant-based diet, they require information on the preparation of quick and easy plant- based meals.

  1. Enclosed nests may provide greater thermal than nest predation benefits compared with open nests across latitudes

    Science.gov (United States)

    Martin, Thomas E.; Boyce, Andy J.; Fierro-Calderon, Karolina; Mitchell, Adam E.; Armstad, Connor E.; Mouton, James C.; Bin Soudi, Evertius E.

    2017-01-01

    Nest structure is thought to provide benefits that have fitness consequences for several taxa. Traditionally, reduced nest predation has been considered the primary benefit underlying evolution of nest structure, whereas thermal benefits have been considered a secondary or even non-existent factor. Yet, the relative roles of these factors on nest structures remain largely unexplored.Enclosed nests have a constructed or natural roof connected to sides that allow a restricted opening or tube entrance that provides cover in all directions except the entrance, whereas open nests are cups or platforms that are open above. We show that construction of enclosed nests is more common among songbirds (Passeriformes) in tropical and southern hemisphere regions than in north temperate regions. This geographic pattern may reflect selection from predation risk, under long-standing assumptions that nest predation rates are higher in southern regions and that enclosed nests reduce predation risk compared with open cup nests. We therefore compared nest predation rates between enclosed vs. open nests in 114 songbird species that do not nest in tree holes among five communities of coexisting birds, and for 205 non-hole-nesting species from the literature, across northern temperate, tropical, and southern hemisphere regions.Among coexisting species, enclosed nests had lower nest predation rates than open nests in two south temperate sites, but not in either of two tropical sites or a north temperate site. Nest predation did not differ between nest types at any latitude based on literature data. Among 319 species from both our field studies and the literature, enclosed nests did not show consistent benefits of reduced predation and, in fact, predation was not consistently higher in the tropics, contrary to long-standing perspectives.Thermal benefits of enclosed nests were indicated based on three indirect results. First, species that built enclosed nests were smaller than species using

  2. The Multiple Benefits of Measures to Improve Energy Efficiency

    DEFF Research Database (Denmark)

    Puig, Daniel; Farrell, Timothy Clifford

    Understanding the barriers to, and enablers for, energy efficiency requires targeted information and analysis. This report is a summary of four detailed studies providing new insights on how to promote efficiency in selected priority areas. It complements initiatives such as the so-called energy...... efficiency accelerators, which seek to increase the uptake of selected technologies, as well as the work of many other institutions committed to improving energy efficiency. The modelling estimates and the case studies presented in this report illustrate that, while significant progress has already been...... achieved, the case for accelerating energy efficiency action is strong. Key highlights include: • At the global level, energy efficiency improvements would account for between 2.6 and 3.3 Gt CO2e of the reductions in 2030, equivalent to between 23 and 26 percent of the overall reductions achieved...

  3. Comparing multiple competing interventions in the absence of randomized trials using clinical risk-benefit analysis

    Directory of Open Access Journals (Sweden)

    Lazo-Langner Alejandro

    2012-01-01

    Full Text Available Abstract Background To demonstrate the use of risk-benefit analysis for comparing multiple competing interventions in the absence of randomized trials, we applied this approach to the evaluation of five anticoagulants to prevent thrombosis in patients undergoing orthopedic surgery. Methods Using a cost-effectiveness approach from a clinical perspective (i.e. risk benefit analysis we compared thromboprophylaxis with warfarin, low molecular weight heparin, unfractionated heparin, fondaparinux or ximelagatran in patients undergoing major orthopedic surgery, with sub-analyses according to surgery type. Proportions and variances of events defining risk (major bleeding and benefit (thrombosis averted were obtained through a meta-analysis and used to define beta distributions. Monte Carlo simulations were conducted and used to calculate incremental risks, benefits, and risk-benefit ratios. Finally, net clinical benefit was calculated for all replications across a range of risk-benefit acceptability thresholds, with a reference range obtained by estimating the case fatality rate - ratio of thrombosis to bleeding. Results The analysis showed that compared to placebo ximelagatran was superior to other options but final results were influenced by type of surgery, since ximelagatran was superior in total knee replacement but not in total hip replacement. Conclusions Using simulation and economic techniques we demonstrate a method that allows comparing multiple competing interventions in the absence of randomized trials with multiple arms by determining the option with the best risk-benefit profile. It can be helpful in clinical decision making since it incorporates risk, benefit, and personal risk acceptance.

  4. Multiple Source Biosimilar Insulin, What's a Provider to Do?

    Science.gov (United States)

    Carter, Alan

    2014-01-01

    In the United States the FDA designates generic products that are bioequivalent as AB substitutable (FDA rating signifying the approved application contains adequate scientific evidence establishing through in vivo and/or in vitro studies the bioequivalence of the product to a selected reference product) and are expected to produce the same therapeutic results as the innovator product. In the case of biological proteins that are similar to already approved innovator biologicals, such as recombinant human insulin, the insulin molecule and accompanying secondary and tertiary structures will differ between manufacturing sources. Even subtle differences between innovator (branded) and alternative "biosimilar" products may produce different therapeutic endpoints. Substitution of a branded insulin with a biosimilar insulin product may result in more, less, or equal therapeutic response making in difficult for the practitioner to assess glycemic control between patient follow-up visits. Significant therapeutic difference is possible, which could result in mild to severe hypoglycemia reaction or hyperglycemia induced tissue damage. Slight molecular changes along with different accompanying proteins, protein fragments, and other naturally occurring contaminants theoretically increase odds of insulin resistance or allergic reaction. Current review of medication product and device quality relies on manufacturer self-oversight and individual reporting of product adverse events after use. While this is usually sufficient for oral medications and many medical devices, critical use products such as sterile products, biosimilar insulin, insulin delivery devices, self-monitoring blood glucose monitoring systems, and test strips require much more vigorous oversight to prevent individual and/or large scale catastrophe. Health care providers should advocate for their patient to have access to affordable, consistent, quality-assured products to effectively and safely manage their

  5. 77 FR 74027 - Certain Integrated Circuit Packages Provided with Multiple Heat-Conducting Paths and Products...

    Science.gov (United States)

    2012-12-12

    ... From the Federal Register Online via the Government Publishing Office INTERNATIONAL TRADE COMMISSION Certain Integrated Circuit Packages Provided with Multiple Heat- Conducting Paths and Products... integrated circuit packages provided with multiple heat-conducting paths and products containing same by...

  6. Spatial Evaluation of Multiple Benefits to Encourage Multi-Functional Design of Sustainable Drainage in Blue-Green Cities

    Directory of Open Access Journals (Sweden)

    Richard Fenner

    2017-12-01

    Full Text Available Urban drainage systems that incorporate elements of green infrastructure (SuDS/GI are central features in Blue-Green and Sponge Cities. Such approaches provide effective control of stormwater management whilst generating a range of other benefits. However these benefits often occur coincidentally and are not developed or maximised in the original design. Of all the benefits that may accrue, the relevant dominant benefits relating to specific locations and socio-environmental circumstances need to be established, so that flood management functions can be co-designed with these wider benefits to ensure both are achieved during system operation. The paper reviews a number of tools which can evaluate the multiple benefits of SuDS/GI interventions in a variety of ways and introduces new concepts of benefit intensity and benefit profile. Examples of how these concepts can be applied is provided in a case study of proposed SuDS/GI assets in the central area of Newcastle; UK. Ways in which SuDS/GI features can be actively extended to develop desired relevant dominant benefits are discussed; e.g., by (i careful consideration of tree and vegetation planting to trap air pollution; (ii extending linear SuDS systems such as swales to enhance urban connectivity of green space; and (iii managing green roofs for the effective attenuation of noise or carbon sequestration. The paper concludes that more pro-active development of multiple benefits is possible through careful co-design to achieve the full extent of urban enhancement SuDS/GI schemes can offer.

  7. Valuing blue carbon: carbon sequestration benefits provided by the marine protected areas in Colombia.

    Science.gov (United States)

    Zarate-Barrera, Tatiana G; Maldonado, Jorge H

    2015-01-01

    Marine protected areas are aimed to protect and conserve key ecosystems for the provision of a number of ecosystem services that are the basis for numerous economic activities. Among the several services that these areas provide, the capacity of sequestering (capturing and storing) organic carbon is a regulating service, provided mainly by mangroves and seagrasses, that gains importance as alternatives for mitigating global warming become a priority in the international agenda. The objective of this study is to value the services associated with the capture and storage of oceanic carbon, known as Blue Carbon, provided by a new network of marine protected areas in Colombia. We approach the monetary value associated to these services through the simulation of a hypothetical market for oceanic carbon. To do that, we construct a benefit function that considers the capacity of mangroves and seagrasses for capturing and storing blue carbon, and simulate scenarios for the variation of key variables such as the market carbon price, the discount rate, the natural rate of loss of the ecosystems, and the expectations about the post-Kyoto negotiations. The results indicate that the expected benefits associated to carbon capture and storage provided by these ecosystems are substantial but highly dependent on the expectations in terms of the negotiations surrounding the extension of the Kyoto Protocol and the dynamics of the carbon credit's demand and supply. We also find that the natural loss rate of these ecosystems does not seem to have a significant effect on the annual value of the benefits. This approach constitutes one of the first attempts to value blue carbon as one of the services provided by conservation.

  8. Valuing blue carbon: carbon sequestration benefits provided by the marine protected areas in Colombia.

    Directory of Open Access Journals (Sweden)

    Tatiana G Zarate-Barrera

    Full Text Available Marine protected areas are aimed to protect and conserve key ecosystems for the provision of a number of ecosystem services that are the basis for numerous economic activities. Among the several services that these areas provide, the capacity of sequestering (capturing and storing organic carbon is a regulating service, provided mainly by mangroves and seagrasses, that gains importance as alternatives for mitigating global warming become a priority in the international agenda. The objective of this study is to value the services associated with the capture and storage of oceanic carbon, known as Blue Carbon, provided by a new network of marine protected areas in Colombia. We approach the monetary value associated to these services through the simulation of a hypothetical market for oceanic carbon. To do that, we construct a benefit function that considers the capacity of mangroves and seagrasses for capturing and storing blue carbon, and simulate scenarios for the variation of key variables such as the market carbon price, the discount rate, the natural rate of loss of the ecosystems, and the expectations about the post-Kyoto negotiations. The results indicate that the expected benefits associated to carbon capture and storage provided by these ecosystems are substantial but highly dependent on the expectations in terms of the negotiations surrounding the extension of the Kyoto Protocol and the dynamics of the carbon credit's demand and supply. We also find that the natural loss rate of these ecosystems does not seem to have a significant effect on the annual value of the benefits. This approach constitutes one of the first attempts to value blue carbon as one of the services provided by conservation.

  9. Benefits, safety, and prescription of exercise in persons with multiple sclerosis.

    Science.gov (United States)

    Motl, Robert W

    2014-12-01

    Exercise represents a behavioral approach for the restoration of function and management of symptoms among persons with multiple sclerosis (MS). The current paper provides a review on the topic of exercise in MS and is separated into four sections. The first section defines exercise and related constructs. The second section summarizes evidence for the benefits of exercise in MS based on literature reviews and meta-analyses. The third section focuses on the safety of exercise in MS based on the reporting of relapses and other adverse events, and the last section describes guidelines for exercise. The paper concludes with a discussion of major limitations with the existing body of research and highlights some of the pressing areas for future research on exercise in MS.

  10. E-health: potential benefits and challenges in providing and accessing sexual health services.

    Science.gov (United States)

    Minichiello, Victor; Rahman, Saifur; Dune, Tinashe; Scott, John; Dowsett, Gary

    2013-08-30

    E-health has become a burgeoning field in which health professionals and health consumers create and seek information. E-health refers to internet-based health care and information delivery and seeks to improve health service locally, regionally and worldwide. E-sexual health presents new opportunities to provide online sexual health services irrespective of gender, age, sexual orientation and location. The paper used the dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) as a guiding principle to discuss potentials of E-health in providing and accessing sexual health services. There are important issues in relation to utilising and providing online sexual health services. For healthcare providers, e-health can act as an opportunity to enhance their clients' sexual health care by facilitating communication with full privacy and confidentiality, reducing administrative costs and improving efficiency and flexibility as well as market sexual health services and products. Sexual health is one of the common health topics which both younger and older people explore on the internet and they increasingly prefer sexual health education to be interactive, non-discriminate and anonymous. This commentary presents and discusses the benefits of e-sexual health and provides recommendations towards addressing some of the emerging challenges. The provision of sexual health services can be enhanced through E-health technology. Doing this can empower consumers to engage with information technology to enhance their sexual health knowledge and quality of life and address some of the stigma associated with diversity in sexualities and sexual health experiences. In addition, e-sexual health may better support and enhance the relationship between consumers and their health care providers across different locations. However, a systematic and focused approach to research and the application of findings in policy and practice is required to ensure that

  11. Co-enrolment of Participants into Multiple Cancer Trials: Benefits and Challenges.

    Science.gov (United States)

    Cafferty, F H; Coyle, C; Rowley, S; Berkman, L; MacKensie, M; Langley, R E

    2017-07-01

    Opportunities to enter patients into more than one clinical trial are not routinely considered in cancer research and experiences with co-enrolment are rarely reported. Potential benefits of allowing appropriate co-enrolment have been identified in other settings but there is a lack of evidence base or guidance to inform these decisions in oncology. Here, we discuss the benefits and challenges associated with co-enrolment based on experiences in the Add-Aspirin trial - a large, multicentre trial recruiting across a number of tumour types, where opportunities to co-enrol patients have been proactively explored and managed. The potential benefits of co-enrolment include: improving recruitment feasibility; increased opportunities for patients to participate in trials; and collection of robust data on combinations of interventions, which will ensure the ongoing relevance of individual trials and provide more cohesive evidence to guide the management of future patients. There are a number of perceived barriers to co-enrolment in terms of scientific, safety and ethical issues, which warrant consideration on a trial-by-trial basis. In many cases, any potential effect on the results of the trials will be negligible - limited by a number of factors, including the overlap in trial cohorts. Participant representatives stress the importance of autonomy to decide about trial enrolment, providing a compelling argument for offering co-enrolment where there are multiple trials that are relevant to a patient and no concerns regarding safety or the integrity of the trials. A number of measures are proposed for managing and monitoring co-enrolment. Ensuring acceptability to (potential) participants is paramount. Opportunities to enter patients into more than one cancer trial should be considered more routinely. Where planned and managed appropriately, co-enrolment can offer a number of benefits in terms of both scientific value and efficiency of study conduct, and will increase the

  12. Self-fill oxygen technology: benefits for patients, healthcare providers and the environment.

    Science.gov (United States)

    Murphie, Phyllis; Hex, Nick; Setters, Jo; Little, Stuart

    2016-06-01

    "Non-delivery" home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers. Provide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

  13. Benefits to the Europa Clipper Mission Provided by the Space Launch System

    Science.gov (United States)

    Creech, Stephen D.; Patel, Keyur

    2013-01-01

    The National Aeronautics and Space Administration's (NASA's) proposed Europa Clipper mission would provide an unprecedented look at the icy Jovian moon, and investigate its environment to determine the possibility that it hosts life. Focused on exploring the water, chemistry, and energy conditions on the moon, the spacecraft would examine Europa's ocean, ice shell, composition and geology by performing 32 low-altitude flybys of Europa from Jupiter orbit over 2.3 years, allowing detailed investigations of globally distributed regions of Europa. In hopes of expediting the scientific program, mission planners at NASA's Jet Propulsion Laboratory are working with the Space Launch System (SLS) program, managed at Marshall Space Flight Center. Designed to be the most powerful launch vehicle ever flown, SLS is making progress toward delivering a new capability for exploration beyond Earth orbit. The SLS rocket will offer an initial low-Earth-orbit lift capability of 70 metric tons (t) beginning with a first launch in 2017 and will then evolve into a 130 t Block 2 version. While the primary focus of the development of the initial version of SLS is on enabling human exploration missions beyond low Earth orbit using the Orion Multi-Purpose Crew Vehicle, the rocket offers unique benefits to robotic planetary exploration missions, thanks to the high characteristic energy it provides. This paper will provide an overview of both the proposed Europa Clipper mission and the Space Launch System vehicle, and explore options provided to the Europa Clipper mission for a launch within a decade by a 70 t version of SLS with a commercially available 5-meter payload fairing, through comparison with a baseline of current Evolved Expendable Launch Vehicle (EELV) capabilities. Compared to that baseline, a mission to the Jovian system could reduce transit times to less than half, or increase mass to more than double, among other benefits. In addition to these primary benefits, the paper will

  14. Perspectives from the frontlines: palliative care providers' expectations of Canada's compassionate care benefit programme.

    Science.gov (United States)

    Giesbrecht, Melissa; Crooks, Valorie A; Williams, Allison

    2010-11-01

    Recognising their valuable role as key informants, this study examines the perspectives of front-line palliative care providers (FLPCP) regarding a social benefit programme in Canada designed to support family caregivers at end-of-life, namely the Compassionate Care Benefit (CCB). The CCB's purpose is to provide income assistance and job security to family caregivers who take temporary leave from employment to care for a dying family member. Contributing to an evaluative study that aims to provide policy-relevant recommendations about the CCB, this analysis draws on semi-structured interviews undertaken in 2007/2008 with FLPCPs (n = 50) from across Canada. Although participants were not explicitly asked during interviews about their expectations of the CCB, thematic content analysis revealed 'expectations' as a key finding. Through participants' discussions of their knowledge of and familiarity with the CCB, specific expectations were identified and grouped into four categories: (1) temporal; (2) financial; (3) informational; and (4) administrative. Findings demonstrate that participants expect the CCB to provide: (1) an adequate length of leave time from work, which is reflective of the uncertain nature of caregiving at end-of-life; (2) adequate financial support; (3) information on the programme to be disseminated to FLPCPs so that they may share it with others; and (4) a simple, clear, and quick application process. FLPCPs hold unique expertise, and ultimately the power to shape uptake of the CCB. As such, their expectations of the CCB contribute valuable knowledge from which relevant policy recommendations can be made to better meet the needs of family caregivers and FLPCPs alike. © 2010 Blackwell Publishing Ltd.

  15. Risks vs benefits of glatiramer acetate: a changing perspective as new therapies emerge for multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Kenneth P Johnson

    2010-04-01

    Full Text Available Kenneth P JohnsonMaryland Center for MS, Baltimore, Maryland, USAAbstract: An understanding of the risks, benefits, and relative value of glatiramer acetate (GA in multiple sclerosis (MS has been evolving based on recently completed head-to-head studies: REGARD (REbif vs Glatiramer Acetate in Relapsing MS Disease; BEYOND (Betaseron Efficacy Yielding Outcomes of a New Dose; and BECOME (BEtaseron vs COpaxone in Multiple Sclerosis with Triple-Dose Gadolinium and 3-Tesla MRI Endpoints. Outcomes in the primary endpoints of these trials showed no significant differences between GA and high-dose beta-interferons (IFNβs. Results of the PreCISe (Early GA Treatment in Delaying Conversion to Clinically Definite Multiple Sclerosis [CDMS] in Subjects Presenting With a Clinically Isolated Syndrome [CIS] trial led to the US Food and Drug Administration approval of GA in patients with a CIS. Furthermore, the ongoing follow-up study to the original pivotal GA trial, now extending beyond 15 years, continues to support the safety of GA. Currently, GA and IFNβs are no longer the only immunomodulators available for MS. Introduction of the monoclonal antibody, natalizumab (Tysabri®; Biogen Idec, Inc., Cambridge, MA, USA provides an alternative immunomodulator for MS and has changed the therapeutic landscape dramatically. However, the rare but serious cases of progressive multifocal leukoencephalopathy that have occurred with natalizumab have raised concerns among clinicians and patients about using this agent and some of the emerging agents. The potential risks and benefits of the emerging therapies (cladribine, alemtuzumab, rituximab, fingolimod, laquinimod, teriflunomide, and dimethyl fumarate based on phase II/III trials, as well as their use for indications other than MS, will be presented. This review provides available data on GA, natalizumab, and the emerging agents to support new developments in our understanding of GA and how its long-standing role as a

  16. Organic foods contain higher levels of certain nutrients, lower levels of pesticides, and may provide health benefits for the consumer.

    Science.gov (United States)

    Crinnion, Walter J

    2010-04-01

    The multi-billion dollar organic food industry is fueled by consumer perception that organic food is healthier (greater nutritional value and fewer toxic chemicals). Studies of the nutrient content in organic foods vary in results due to differences in the ground cover and maturity of the organic farming operation. Nutrient content also varies from farmer to farmer and year to year. However, reviews of multiple studies show that organic varieties do provide significantly greater levels of vitamin C, iron, magnesium, and phosphorus than non-organic varieties of the same foods. While being higher in these nutrients, they are also significantly lower in nitrates and pesticide residues. In addition, with the exception of wheat, oats, and wine, organic foods typically provide greater levels of a number of important antioxidant phytochemicals (anthocyanins, flavonoids, and carotenoids). Although in vitro studies of organic fruits and vegetables consistently demonstrate that organic foods have greater antioxidant activity, are more potent suppressors of the mutagenic action of toxic compounds, and inhibit the proliferation of certain cancer cell lines, in vivo studies of antioxidant activity in humans have failed to demonstrate additional benefit. Clear health benefits from consuming organic dairy products have been demonstrated in regard to allergic dermatitis.

  17. Benefits, Challenges, and Perceptions of the Multiple Article Dissertation Format in Instructional Technology

    Science.gov (United States)

    Thomas, Rebecca Arlene; West, Richard E.; Rich, Peter

    2016-01-01

    This study used survey data to investigate the benefits, challenges, perceptions, and current practices of the multiple article dissertation format in instructional technology. Online surveys were sent to current students, alumni, faculty, and department representatives of instructional technology programs, and data were analysed using qualitative…

  18. Two approaches to incorporate clinical data uncertainty into multiple criteria decision analysis for benefit-risk assessment of medicinal products.

    Science.gov (United States)

    Wen, Shihua; Zhang, Lanju; Yang, Bo

    2014-07-01

    The Problem formulation, Objectives, Alternatives, Consequences, Trade-offs, Uncertainties, Risk attitude, and Linked decisions (PrOACT-URL) framework and multiple criteria decision analysis (MCDA) have been recommended by the European Medicines Agency for structured benefit-risk assessment of medicinal products undergoing regulatory review. The objective of this article was to provide solutions to incorporate the uncertainty from clinical data into the MCDA model when evaluating the overall benefit-risk profiles among different treatment options. Two statistical approaches, the δ-method approach and the Monte-Carlo approach, were proposed to construct the confidence interval of the overall benefit-risk score from the MCDA model as well as other probabilistic measures for comparing the benefit-risk profiles between treatment options. Both approaches can incorporate the correlation structure between clinical parameters (criteria) in the MCDA model and are straightforward to implement. The two proposed approaches were applied to a case study to evaluate the benefit-risk profile of an add-on therapy for rheumatoid arthritis (drug X) relative to placebo. It demonstrated a straightforward way to quantify the impact of the uncertainty from clinical data to the benefit-risk assessment and enabled statistical inference on evaluating the overall benefit-risk profiles among different treatment options. The δ-method approach provides a closed form to quantify the variability of the overall benefit-risk score in the MCDA model, whereas the Monte-Carlo approach is more computationally intensive but can yield its true sampling distribution for statistical inference. The obtained confidence intervals and other probabilistic measures from the two approaches enhance the benefit-risk decision making of medicinal products. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  19. Maize benefits the predatory beetle, Propylea japonica (Thunberg, to provide potential to enhance biological control for aphids in cotton.

    Directory of Open Access Journals (Sweden)

    Fang Ouyang

    Full Text Available BACKGROUND: Biological control provided by natural enemies play an important role in integrated pest management. Generalist insect predators provide an important biological service in the regulation of agricultural insect pests. Our goal is to understand the explicit process of oviposition preference, habitat selection and feeding behavior of predators in farmland ecosystem consisting of multiple crops, which is central to devising and delivering an integrated pest management program. METHODOLOGY: The hypotheses was that maize can serve as habitat for natural enemies and benefits predators to provide potential to enhance biological control for pest insects in cotton. This explicit process of a predatory beetle, Propylea japonica, in agricultural ecosystem composed of cotton and maize were examined by field investigation and stable carbon isotope analysis during 2008-2010. PRINCIPAL FINDING: Field investigation showed that P. japonica adults will search host plants for high prey abundance before laying eggs, indicating indirectly that P. japonica adults prefer to inhabit maize plants and travel to cotton plants to actively prey on aphids. The δ(13C values of adult P. japonica in a dietary shift experiment found that individual beetles were shifting from a C(3- to a C(4-based diet of aphids reared on maize or cotton, respectively, and began to reflect the isotope ratio of their new C(4 resources within one week. Approximately 80-100% of the diet of P. japonica adults in maize originated from a C(3-based resource in June, July and August, while approximately 80% of the diet originated from a C(4-based resource in September. CONCLUSION/SIGNIFICANCE: Results suggest that maize can serve as a habitat or refuge source for the predatory beetle, P. japonica, and benefits predators to provide potential to enhance biological control for insect pests in cotton.

  20. Maize benefits the predatory beetle, Propylea japonica (Thunberg), to provide potential to enhance biological control for aphids in cotton.

    Science.gov (United States)

    Ouyang, Fang; Men, Xingyuan; Yang, Bing; Su, Jianwei; Zhang, Yongsheng; Zhao, Zihua; Ge, Feng

    2012-01-01

    Biological control provided by natural enemies play an important role in integrated pest management. Generalist insect predators provide an important biological service in the regulation of agricultural insect pests. Our goal is to understand the explicit process of oviposition preference, habitat selection and feeding behavior of predators in farmland ecosystem consisting of multiple crops, which is central to devising and delivering an integrated pest management program. The hypotheses was that maize can serve as habitat for natural enemies and benefits predators to provide potential to enhance biological control for pest insects in cotton. This explicit process of a predatory beetle, Propylea japonica, in agricultural ecosystem composed of cotton and maize were examined by field investigation and stable carbon isotope analysis during 2008-2010. Field investigation showed that P. japonica adults will search host plants for high prey abundance before laying eggs, indicating indirectly that P. japonica adults prefer to inhabit maize plants and travel to cotton plants to actively prey on aphids. The δ(13)C values of adult P. japonica in a dietary shift experiment found that individual beetles were shifting from a C(3)- to a C(4)-based diet of aphids reared on maize or cotton, respectively, and began to reflect the isotope ratio of their new C(4) resources within one week. Approximately 80-100% of the diet of P. japonica adults in maize originated from a C(3)-based resource in June, July and August, while approximately 80% of the diet originated from a C(4)-based resource in September. Results suggest that maize can serve as a habitat or refuge source for the predatory beetle, P. japonica, and benefits predators to provide potential to enhance biological control for insect pests in cotton.

  1. Interventions to support risk and benefit understanding of disease-modifying drugs in Multiple Sclerosis patients: A systematic review.

    Science.gov (United States)

    Reen, Gurpreet K; Silber, Eli; Langdon, Dawn W

    2017-06-01

    The present review evaluates interventions that have been designed to improve understanding of the complex risk-benefit profiles of disease-modifying drugs (DMDs) in patients with Multiple Sclerosis (MS). A systematic search conducted using PubMed, Embase, Google Scholar and PsycINFO identified 15 studies. Interventions which provided treatment information were present across a range of study designs. A narrative synthesis was conducted due to heterogeneity of research findings. Interventions providing treatment information ranged from comprehensive education programmes to booklets of a few pages. MS patients favoured the interventions they received. Understanding of overall treatment information and treatment risks specifically, generally improved following interventions. Yet overestimation of treatment benefits persisted. There was no conclusive effect on DMD decisions. No superior intervention was identified. Interventions designed to improve understanding of DMD risk and benefit information are moderately successful. Additional support provided to MS patients beyond routine healthcare can generally improve understanding of the complex risk-benefit profiles of DMDs. Future interventions need to ensure that patients with symptoms that may confound understanding can also benefit from this additional information. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. 77 FR 39735 - Certain Integrated Circuit Packages Provided With Multiple Heat-Conducting Paths and Products...

    Science.gov (United States)

    2012-07-05

    ... Integrated Circuit Packages Provided With Multiple Heat- Conducting Paths and Products Containing Same... within the United States after importation of certain integrated circuit packages provided with multiple... importation, or the sale within the United States after importation of certain integrated circuit packages...

  3. Peerwise Provides Significant Academic Benefits to Biological Science Students across Diverse Learning Tasks, but with Minimal Instructor Intervention

    Science.gov (United States)

    McQueen, H. A.; Shields, C.; Finnegan, D. J.; Higham, J.; Simmen, M. W.

    2014-01-01

    We demonstrate that student engagement with PeerWise, an online tool that allows students to author and answer multiple-choice questions (MCQs), is associated with enhanced academic performance across diverse assessment types on a second year Genetics course. Benefits were consistent over three course deliveries, with differential benefits…

  4. Will Mangrove Reforestation Provide Net Benefits: A Case in Sibunag, Guimaras

    Directory of Open Access Journals (Sweden)

    Cheryl Joy Fernandez

    2005-12-01

    Full Text Available In response to the threats in mangrove resources such as massive fishpond conversion, industrialization,and increased human settlements in coastal areas, the province of Guimaras answered these threats bywidespread mangrove reforestation projects in its coastal communities. These projects were found outto be beneficial, as depicted on large gap on the mangroves overall benefits and the costs of implementationof the mangrove reforestation project. Results of the study show that the present total benefit of mangroveper hectare with sustainable harvesting in the first year is lesser than the costs. However after the firstyear, the net benefits are positive. However, in compliance with Republic Act 7161 (R.A. 7161 thatbanned the cutting/using of all mangrove species, cost-benefit analysis of mangrove reforestation withoutharvesting was also computed. The net benefits exceed the costs from the start of the year up to the 20thyear. Both the scenarios include the Mean WTP equivalent to PhP 142.75, which is the amount peopleare willing to give for the conservation of mangroves. The net present values (net benefits of mangrovereforestation were found positive for both scenarios: with sustainable harvesting and without harvesting.

  5. Risk-benefit assessment of oral phosphodiesterase type 5 inhibitors for treatment of erectile dysfunction: a multiple criteria decision analysis.

    Science.gov (United States)

    Hsu, J C; Tang, D H; Lu, C Y

    2015-04-01

    Erectile dysfunction (ED) is a common male sexual disorder worldwide. Three oral phosphodiesterase type 5 inhibitors (PDE5Is) - sildenafil, tadalafil and vardenafil - are available for treatment of ED. This study quantitatively evaluated the therapeutic efficacy and safety of these medications to assist treatment decision making. We used multiple criteria decision analysis (MCDA) to assess the totality of risk-benefit of PDE5Is. We created two models: (i) the overall model included 'overall improvement in erections' and 'any adverse events' and (ii) the detailed model included 'erectile function domain', 'ability for sexual intercourse', 'duration of erection last', 'serious adverse events', 'headache', 'flushing' and 'dyspepsia'. We calculated a synthetic utility for each drug accounting for all of its benefits and risks. Considering the overall risk-benefit, vardenafil had the highest synthetic utility among three medications; in the order of synthetic utilities: vardenafil (0.568), tadalafil (0.478) and sildenafil (0.437). However, when specific risk and benefit criteria were assessed, tadalafil had the highest synthetic utility (0.602) according to the conjoint evaluation (synthetic utility for vardenafil is 0.491 and sildenafil is 0.442, respectively). The sensitivity analysis based on the uncertainties of weight on risks of any adverse events (including serious adverse events and headache) suggested our results were robust. This study provides a useful approach that comprehensively and systematically assesses and compares the risk-benefit of several treatment alternatives. Our study not only rank treatment alternatives by synthetic utilities based on the risk-benefit balance but also compare specific risk and benefit criteria between these medicines. Our results provide valuable evidence that can guide clinicians and patients in making treatment decisions. © 2014 John Wiley & Sons Ltd.

  6. [Who benefits from stepwise occupational reintegration provided under the statutory pension insurance scheme?].

    Science.gov (United States)

    Bürger, W; Streibelt, M

    2011-06-01

    Stepwise occupational reintegration (SOR) - since law amendments in April 2004 also provided under the German pension insurance scheme (Deutsche Rentenversicherung, DRV) - is an instrument intended to support insurants on sick-leave in reintegrating into work step by step after long-term illness. In 2008, the effectiveness of SOR regarding return to work was affirmed for the first time in a comprehensive study. However, in view of the growing amount of SOR, the question of differential effects of SOR in special subgroups is raised. This paper presents a re-analysis of data collected in the 2008 study. A total of 696 patients after medical rehabilitation were included in the analyses, 348 with SOR provided by the DRV, and a control group of 348 patients without SOR matched on a multitude of different variables using the Propensity Scores. Successful outcome was measured using a combined criterion "Return to work in good health", that is, patients returning to gainful activity and with sick leave of under 6 weeks and no intention to retire within a one-year follow-period after medical rehabilitation. Differentiating criteria are age gender, rehab indication, periods of sick leave in the year before medical rehabilitation, kind of and access to medical rehabilitation. The data indicate especially good results of SOR for patients with mental disorders (OR=2.49), patients who were requested to participate in medical rehabilitation by a health insurance fund because of long-term sick leave (OR=2.71), and patients with longer periods of sick leave before medical rehabilitation (3 to <6 months: OR=2.41, 6 months and more: OR=2.23). In contrast, there are only minimal effects (statistically not significant) of SOR in patients with medical rehabilitation directly after a hospital stay ("Anschlussheilbehandlung"), patients with cardiac or oncological diseases, and in younger (age 19-34) and older patients (age 55-60). In-depth analyses show that SOR success is more marked in

  7. Tree Mortality Undercuts Ability of Tree-Planting Programs to Provide Benefits: Results of a Three-City Study

    Directory of Open Access Journals (Sweden)

    Sarah Widney

    2016-03-01

    Full Text Available Trees provide numerous benefits for urban residents, including reduced energy usage, improved air quality, stormwater management, carbon sequestration, and increased property values. Quantifying these benefits can help justify the costs of planting trees. In this paper, we use i-Tree Streets to quantify the benefits of street trees planted by nonprofits in three U.S. cities (Detroit, Michigan; Indianapolis, Indiana, and Philadelphia, Pennsylvania from 2009 to 2011. We also use both measured and modeled survival and growth rates to “grow” the tree populations 5 and 10 years into the future to project the future benefits of the trees under different survival and growth scenarios. The 4059 re-inventoried trees (2864 of which are living currently provide almost $40,000 (USD in estimated annual benefits ($9–$20/tree depending on the city, the majority (75% of which are increased property values. The trees can be expected to provide increasing annual benefits during the 10 years after planting if the annual survival rate is higher than the 93% annual survival measured during the establishment period. However, our projections show that with continued 93% or lower annual survival, the increase in annual benefits from tree growth will not be able to make up for the loss of benefits as trees die. This means that estimated total annual benefits from a cohort of planted trees will decrease between the 5-year projection and the 10-year projection. The results of this study indicate that without early intervention to ensure survival of planted street trees, tree mortality may be significantly undercutting the ability of tree-planting programs to provide benefits to neighborhood residents.

  8. 5 CFR 537.106 - Conditions and procedures for providing student loan repayment benefits.

    Science.gov (United States)

    2010-01-01

    ... begin making loan payments until the job candidate begins serving in the position. (5) Student loan... verify with the holder of the loan that the employee (or job candidate) has an outstanding student loan... student loan repayment benefits. 537.106 Section 537.106 Administrative Personnel OFFICE OF PERSONNEL...

  9. Technology-Enhanced Peer Review: Benefits and Implications of Providing Multiple Reviews

    Science.gov (United States)

    Papadopoulos, Pantelis M.; Lagkas, Thomas D.; Demetriadis, Stavros N.

    2017-01-01

    This study analyses the impact of self and peer feedback in technology-enhanced peer review settings. The impact of receiving peer comments ("receiver" perspective) is compared to that of reaching own insights by reviewing others' work ("giver" perspective). In this study, 38 sophomore students were randomly assigned in two…

  10. Further limiting bisphenol a in food uses could provide health and economic benefits.

    Science.gov (United States)

    Trasande, Leonardo

    2014-02-01

    There is mounting evidence that bisphenol A (BPA), a chemical used in the production of polycarbonate plastics and the linings of aluminum cans, may have adverse health consequences. The Food and Drug Administration has banned BPA from baby bottles and sippy cups but has deferred further action on other food uses-that is, uses in metal-based food and beverage containers. This article quantifies the potential social costs of childhood obesity and adult coronary heart disease attributable to BPA exposure in the United States in 2008 and models the potential health and economic benefits associated with replacing BPA in all food uses. BPA exposure was estimated to be associated with 12,404 cases of childhood obesity and 33,863 cases of newly incident coronary heart disease, with estimated social costs of $2.98 billion in 2008. Removing BPA from food uses might prevent 6,236 cases of childhood obesity and 22,350 cases of newly incident coronary heart disease per year, with potential annual economic benefits of $1.74 billion (sensitivity analysis: $889 million-$13.8 billion per year). Although more data are needed, these potentially large health and economic benefits could outweigh the costs of using a safer substitute for BPA.

  11. Family Members Providing Home-Based Palliative Care to Older Adults: The Enactment of Multiple Roles

    Science.gov (United States)

    Clemmer, Sarah J.; Ward-Griffin, Catherine; Forbes, Dorothy

    2008-01-01

    Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis…

  12. The Importance of Providing Multiple-Channel Sections in Dredging Activities to Improve Fish Habitat Environments

    Directory of Open Access Journals (Sweden)

    Hung-Pin Chiu

    2016-01-01

    Full Text Available After Typhoon Morakot, dredging engineering was conducted while taking the safety of humans and structures into consideration, but partial stream reaches were formed in the multiple-channel sections in Cishan Stream because of anthropogenic and natural influences. This study mainly explores the distribution of each fish species in both the multiple- and single-channel sections in the Cishan Stream. Parts of the environments did not exhibit significant differences according to a one-way ANOVA comparing the multiple- and single-channel sections, but certain areas of the multiple-channel sections had more diverse habitats. Each fish species was widely distributed by non-metric multidimensional scaling in the multiple-channel sections as compared to those in the single-channel sections. In addition, according to the principal component analysis, each fish species has a preferred environment, and all of them have a wide choice of habitat environments in the multiple-channel sections. Finally, the existence of multiple-channel sections could significantly affect the existence of the fish species under consideration in this study. However, no environmental factors were found to have an influence on fish species in the single-channel sections, with the exception of Rhinogobius nantaiensis. The results show that providing multiple-channel sections in dredging activities could improve fish habitat environments.

  13. Practice development: providing benefits for both managers and older patients with delerium and dementia.

    Science.gov (United States)

    Bezzant, Kim

    2008-03-01

    This article describes the ways in which practice development can aid Nurse Managers to enhance both efficiency and effectiveness, focussing particularly on the care of older people with delerium and dementia. Practitioners caring for this group of patients in acute general hospitals need specialist skills, particularly skills in working with the unusual ('challenging') behaviours that these patients often exhibit. These skills are rarely present at the point of registration but practice development techniques can facilitate the acquisition of appropriate skills with resultant benefits for both patients and organization. The study contains an outline of the ways in which a practice development approach can be delivered and appraised: the theories are outlined, strategies for delivery of the techniques are described and methods of evaluation are suggested. These theories and techniques are being applied in a project in Portsmouth called 'Rise to the Challenge', which has the specific aim of improving the care of people with delerium and dementia in an acute hospital setting. This project is currently running and will be evaluated in the summer of 2008.

  14. A haemovigilance team provides both significant financial and quality benefits in a University Hospital.

    Science.gov (United States)

    Decadt, Ine; Costermans, Els; Van de Poel, Maai; Kesteloot, Katrien; Devos, Timothy

    2017-04-01

    Haemovigilance is the process of surveillance of blood transfusion procedures including unexpected hazards and reactions during the transfusion pathway in both donors and recipients. The haemovigilance team aims to increase blood transfusion safety and to decrease both morbidity and mortality in donors and recipients. The team collects data about transfusion reactions and incidents, instructs the involved health workers and assures the tracing of blood components. The haemovigilance team at the University Hospitals Leuven has played a pioneering role in the development of haemovigilance in Belgium Although the literature about safety and quality improvements by haemovigilance systems is abundant, there are no published data available measuring their financial impact in a hospital. Therefore, we studied the costs and returns of the haemovigilance team at the University Hospitals Leuven. This study has a descriptive explorative design. Research of the current costs and returns of the haemovigilance team were based upon data from the Medical Administration of the hospital. Data were analyzed descriptively. The haemovigilance team of the University Hospitals Leuven is financially viable: the direct costs are covered by the annual financial support of the National Public Health Service. The indirect returns come from two important tasks of the haemovigilance team itself: correction of the electronic registration of administered blood component and improvement of the return of conform preserved blood components to the blood bank. Besides safety and quality improvement, which are obviously their main goals, the haemovigilance team also implies a financial benefit for the hospital. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Transistorized Marx bank pulse circuit provides voltage multiplication with nanosecond rise-time

    Science.gov (United States)

    Jung, E. A.; Lewis, R. N.

    1968-01-01

    Base-triggered avalanche transistor circuit used in a Marx bank pulser configuration provides voltage multiplication with nanosecond rise-time. The avalanche-mode transistors replace conventional spark gaps in the Marx bank. The delay time from an input signal to the output signal to the output is typically 6 nanoseconds.

  16. The Effect of Performance Feedback Provided to Student-Teachers Working with Multiple Disabilities

    Science.gov (United States)

    Safak, Pinar; Yilmaz, Hatice Cansu; Demiryurek, Pinar; Dogus, Mustafa

    2016-01-01

    The aim of the study was to investigate the effect of performance feedback (PF) provided to student teachers working with students with multiple disabilities and visual impairment (MDVI) on their teaching skills. The study group of the research was composed of 11 student teachers attending to the final year of the Teaching Students with Visual…

  17. Rotigotine polyoxazoline conjugate SER-214 provides robust and sustained antiparkinsonian benefit.

    Science.gov (United States)

    Eskow Jaunarajs, Karen L; Standaert, David G; Viegas, Tacey X; Bentley, Michael D; Fang, Zhihao; Dizman, Bekir; Yoon, Kunsang; Weimer, Rebecca; Ravenscroft, Paula; Johnston, Tom H; Hill, Michael P; Brotchie, Jonathan M; Moreadith, Randall W

    2013-10-01

    Currently available dopaminergic drugs such as levodopa and dopamine (DA) receptor agonists impart considerable improvement in Parkinson's disease (PD) motor symptoms but often lead to significant motor complications including "wearing-off" and dyskinesia. Such complications are believed to stem from the pulsatile nature of dopaminergic stimulation with these agents. Continuous dopaminergic drug delivery using polyoxazoline (POZ) polymer conjugation may improve motor symptoms, while avoiding development of side effects. The purposes of the current study are to characterize the in vitro and in vivo pharmacokinetics of POZ conjugation of a U.S. Food and Drug Administration (FDA)-approved DA agonist, rotigotine, and to evaluate their effects in an established rat model of PD. After determination of release profiles of several POZ-conjugated constructs ("fast": SER-212; "moderate": SER-213; and "slow": SER-214) using in vitro hydrolysis, normal male Sprague-Dawley rats were used for determination of the pharmacokinetic profile of both acute and chronic exposure. Finally, a separate group of rats was rendered hemiparkinsonian using intracranial 6-hydroxydopamine (6-OHDA) infusions, treated acutely with POZ-rotigotine, and assessed for rotational behavior and antiparkinsonian benefit using the cylinder test. POZ-rotigotine formulations SER-213 and SER-214 led to substantial pharmacokinetic improvement compared to unconjugated rotigotine. In addition, SER-214 led to antiparkinsonian effects in DA-lesioned rats that persisted up to 5 days posttreatment. Repeated weekly dose administration of SER-214 to normal rats for up to 12 weeks demonstrated highly reproducible pharmacokinetic profiles. The continuous dopaminergic stimulation profile afforded by SER-214 could represent a significant advance in the treatment of PD, with potential to be a viable, once-per-week therapy for PD patients. © 2013 Movement Disorder Society.

  18. Assessing Knowledge and Attitudes of U.S. Healthcare Providers about Benefits and Risks of Consuming Seafood

    Science.gov (United States)

    Hicks, Doris T.; Pivarnik, Lori F.; Richard, Nicole Leydon; Gable, Robert K.; Morrissey, Michael T.

    2013-01-01

    An online needs assessment survey of healthcare providers was developed and implemented to determine knowledge and attitudes about the benefits and risks of consuming seafood along with how this might impact patient/clientele counseling. Only 6 of the 45 knowledge items queried (13%) met the 80% subject mastery or proficiency with a total…

  19. Will electronic personal health records benefit providers and patients in rural America?

    Science.gov (United States)

    Hargreaves, John S

    2010-03-01

    The objective of this study was to educate stakeholders (e.g., providers, patients, insurers, government) in the healthcare industry about electronic personal health records (PHRs) and their potential application in rural America. Extensive research was performed on PHRs through standard literature search, product demonstrations, educational webinars, and fact finding via news releases. Various stakeholders are eager to transform the healthcare industry into the digital age like other industries (i.e., banking, retail). Despite low adoption of PHRs in 2008 (2.7% of U.S. adults), patients are interested in secure messaging and eVisits with their physicians, online appointment scheduling and reminders, and online access to their laboratory and radiology results. Federal agencies (e.g., Health and Human Services, Department of Defense, Veterans Affairs [VA]), popular information technology (IT) vendors (e.g., Google, Microsoft), and large insurers (e.g., Aetna) have energized the industry through pilot programs and new product announcements. It remains to be seen if barriers to adoption, including privacy concerns, lack of interoperability standards and funding, and provider resistance, can be overcome to enable PHRs to become a critical tool in the creation of a more efficient and less costly U.S. healthcare industry. Electronic PHRs hold great promise to enhance access and improve the quality of care provided to patients in rural America. Government, vendors, and insurers should create incentives for providers and patients to implement PHRs. Likewise, patients need to become more aware of PHRs and their ability to improve health outcomes.

  20. Residential immersive life skills programs for youth with disabilities: service providers' perceptions of experiential benefits and key program features.

    Science.gov (United States)

    King, Gillian; McPherson, Amy; Kingsnorth, Shauna; Stewart, Debra; Glencross-Eimantas, Tanya; Gorter, Jan Willem; Jones-Galley, Kimberlea; Morrison, Andrea; Isihi, Ana Maria

    2015-01-01

    The objective was to determine service providers' perceptions of the experiential benefits of residential immersive life skills (RILS) programs for youth with disabilities, along with important program features. Thirty-seven service providers from three RILS programs took part in qualitative interviews. Themes were derived using a phenomenological approach. There were perceived benefits for youth, and also for parents and service providers. Study themes concerned the process of youth empowerment, life-changing experiences for youth and parents, and changed service provider views affecting practice. Youth changes were attributed to the residential group format and afforded opportunities, which included being away from home, navigating public transportation, directing attendant services, and sharing intense learning and social experiences with peers. Youth were seen to experience important personal changes in life skills, self-confidence, self-understandings, and self-advocacy. Perceived benefits for parents included realizations concerning their child's abilities and new hope for the future. Service providers indicated changes in their knowledge, perspectives, and approach to practice. The findings suggest that life skills programs should be intentionally designed to provide challenging experiential opportunities that motivate youth to engage in new life directions by providing new insights, self-realizations, and positive yet realistic views of the future. Service providers indicated the importance of challenging, real-world experiential opportunities that provide youth with disabilities with new insights, self-realizations, and positive yet realistic views of the future. Important experiential opportunities for youth included being away from home, navigating public transportation, directing attendant care, and sharing intense learning and social experiences with peers. The findings provide preliminary qualitative evidence that life skills programs should be

  1. Health care provider perceptions of a query-based health information exchange: barriers and benefits

    Directory of Open Access Journals (Sweden)

    Gary L. Cochran

    2015-06-01

    Full Text Available BackgroundHealth information exchange (HIE systems are implemented nationwide to integrate health information and facilitate communication among providers. The Nebraska Health Information Initiative is a state-wide HIE launched in 2009. Objective The purpose of this study was to conduct a comprehensive assessment of health care providers’ perspectives on a query-based HIE, including barriers to adoption and important functionality for continued utilization. MethodsWe surveyed 5618 Nebraska health care providers in 2013. Reminder letters were sent 30 days after the initial mailing. ResultsA total of 615 questionnaires (11% were completed. Of the 100 current users, 63 (63% indicated satisfaction with HIE. The most common reasons for adoption among current or previous users of an HIE (N = 198 were improvement in patient care (N = 111, 56% as well as receiving (N = 95, 48% and sending information (N = 80, 40% in the referral network. Cost (N = 233, 38% and loss of productivity (N = 220, 36% were indicated as the ‘major barriers’ to adoption by all respondents. Accessing a comprehensive patient medication list was identified as the most important feature of the HIE (N = 422, 69%. ConclusionsThe cost of HIE access and workflow integration are significant concerns of health care providers. Additional resources to assist practices plan the integration of the HIE into a sustainable workflow may be required before widespread adoption occurs. The clinical information sought by providers must also be readily available for continued utilization. Query-based HIEs must ensure that medication history, laboratory results and other desired clinical information be present, or long-term utilization of the HIE is unlikely. 

  2. E-health: potential benefits and challenges in providing and accessing sexual health services

    OpenAIRE

    Minichiello, Victor; Rahman, Saifur; Dune, Tinashe; Scott, John; Dowsett, Gary

    2013-01-01

    Background E-health has become a burgeoning field in which health professionals and health consumers create and seek information. E-health refers to internet-based health care and information delivery and seeks to improve health service locally, regionally and worldwide. E-sexual health presents new opportunities to provide online sexual health services irrespective of gender, age, sexual orientation and location. Discussion The paper used the dimensions of the RE-AIM model (reach, efficacy, ...

  3. Service Providers of the Sharing Economy: Who Joins and Who Benefits?

    OpenAIRE

    Ke, Qing

    2017-01-01

    Many "sharing economy" platforms, such as Uber and Airbnb, have become increasingly popular, providing consumers with more choices and suppliers a chance to make profit. They, however, have also brought about emerging issues regarding regulation, tax obligation, and impact on urban environment, and have generated heated debates from various interest groups. Empirical studies regarding these issues are limited, partly due to the unavailability of relevant data. Here we aim to understand servic...

  4. An court action for payment from the National Health Fund for health benefits provided in emergency – selected practical issues

    Directory of Open Access Journals (Sweden)

    Damian Wąsik

    2015-09-01

    Full Text Available The publication describes the problems of payment seeking by healthcare institutions from the National Health Fund for the so-called “life-saving health benefits”. Issues, which are discussed, include the possibility of health benefits financing in the context of the contract’s limits, the burden of proof to provide the health benefits in emergencies, and the necessary of consult experts on these issues in the context of the conditions of Article 248 § 1 Polish Civil Procedure Code.

  5. Applying Multiple Criteria Decision Analysis to Comparative Benefit-Risk Assessment: Choosing among Statins in Primary Prevention.

    Science.gov (United States)

    Tervonen, Tommi; Naci, Huseyin; van Valkenhoef, Gert; Ades, Anthony E; Angelis, Aris; Hillege, Hans L; Postmus, Douwe

    2015-10-01

    Decision makers in different health care settings need to weigh the benefits and harms of alternative treatment strategies. Such health care decisions include marketing authorization by regulatory agencies, practice guideline formulation by clinical groups, and treatment selection by prescribers and patients in clinical practice. Multiple criteria decision analysis (MCDA) is a family of formal methods that help make explicit the tradeoffs that decision makers accept between the benefit and risk outcomes of different treatment options. Despite the recent interest in MCDA, certain methodological aspects are poorly understood. This paper presents 7 guidelines for applying MCDA in benefit-risk assessment and illustrates their use in the selection of a statin drug for the primary prevention of cardiovascular disease. We provide guidance on the key methodological issues of how to define the decision problem, how to select a set of nonoverlapping evaluation criteria, how to synthesize and summarize the evidence, how to translate relative measures to absolute ones that permit comparisons between the criteria, how to define suitable scale ranges, how to elicit partial preference information from the decision makers, and how to incorporate uncertainty in the analysis. Our example on statins indicates that fluvastatin is likely to be the most preferred drug by our decision maker and that this result is insensitive to the amount of preference information incorporated in the analysis. © The Author(s) 2015.

  6. Two randomized trials provide no consistent evidence for nonmusical cognitive benefits of brief preschool music enrichment.

    Directory of Open Access Journals (Sweden)

    Samuel A Mehr

    Full Text Available Young children regularly engage in musical activities, but the effects of early music education on children's cognitive development are unknown. While some studies have found associations between musical training in childhood and later nonmusical cognitive outcomes, few randomized controlled trials (RCTs have been employed to assess causal effects of music lessons on child cognition and no clear pattern of results has emerged. We conducted two RCTs with preschool children investigating the cognitive effects of a brief series of music classes, as compared to a similar but non-musical form of arts instruction (visual arts classes, Experiment 1 or to a no-treatment control (Experiment 2. Consistent with typical preschool arts enrichment programs, parents attended classes with their children, participating in a variety of developmentally appropriate arts activities. After six weeks of class, we assessed children's skills in four distinct cognitive areas in which older arts-trained students have been reported to excel: spatial-navigational reasoning, visual form analysis, numerical discrimination, and receptive vocabulary. We initially found that children from the music class showed greater spatial-navigational ability than did children from the visual arts class, while children from the visual arts class showed greater visual form analysis ability than children from the music class (Experiment 1. However, a partial replication attempt comparing music training to a no-treatment control failed to confirm these findings (Experiment 2, and the combined results of the two experiments were negative: overall, children provided with music classes performed no better than those with visual arts or no classes on any assessment. Our findings underscore the need for replication in RCTs, and suggest caution in interpreting the positive findings from past studies of cognitive effects of music instruction.

  7. Two Randomized Trials Provide No Consistent Evidence for Nonmusical Cognitive Benefits of Brief Preschool Music Enrichment

    Science.gov (United States)

    Mehr, Samuel A.; Schachner, Adena; Katz, Rachel C.; Spelke, Elizabeth S.

    2013-01-01

    Young children regularly engage in musical activities, but the effects of early music education on children's cognitive development are unknown. While some studies have found associations between musical training in childhood and later nonmusical cognitive outcomes, few randomized controlled trials (RCTs) have been employed to assess causal effects of music lessons on child cognition and no clear pattern of results has emerged. We conducted two RCTs with preschool children investigating the cognitive effects of a brief series of music classes, as compared to a similar but non-musical form of arts instruction (visual arts classes, Experiment 1) or to a no-treatment control (Experiment 2). Consistent with typical preschool arts enrichment programs, parents attended classes with their children, participating in a variety of developmentally appropriate arts activities. After six weeks of class, we assessed children's skills in four distinct cognitive areas in which older arts-trained students have been reported to excel: spatial-navigational reasoning, visual form analysis, numerical discrimination, and receptive vocabulary. We initially found that children from the music class showed greater spatial-navigational ability than did children from the visual arts class, while children from the visual arts class showed greater visual form analysis ability than children from the music class (Experiment 1). However, a partial replication attempt comparing music training to a no-treatment control failed to confirm these findings (Experiment 2), and the combined results of the two experiments were negative: overall, children provided with music classes performed no better than those with visual arts or no classes on any assessment. Our findings underscore the need for replication in RCTs, and suggest caution in interpreting the positive findings from past studies of cognitive effects of music instruction. PMID:24349171

  8. Two randomized trials provide no consistent evidence for nonmusical cognitive benefits of brief preschool music enrichment.

    Science.gov (United States)

    Mehr, Samuel A; Schachner, Adena; Katz, Rachel C; Spelke, Elizabeth S

    2013-01-01

    Young children regularly engage in musical activities, but the effects of early music education on children's cognitive development are unknown. While some studies have found associations between musical training in childhood and later nonmusical cognitive outcomes, few randomized controlled trials (RCTs) have been employed to assess causal effects of music lessons on child cognition and no clear pattern of results has emerged. We conducted two RCTs with preschool children investigating the cognitive effects of a brief series of music classes, as compared to a similar but non-musical form of arts instruction (visual arts classes, Experiment 1) or to a no-treatment control (Experiment 2). Consistent with typical preschool arts enrichment programs, parents attended classes with their children, participating in a variety of developmentally appropriate arts activities. After six weeks of class, we assessed children's skills in four distinct cognitive areas in which older arts-trained students have been reported to excel: spatial-navigational reasoning, visual form analysis, numerical discrimination, and receptive vocabulary. We initially found that children from the music class showed greater spatial-navigational ability than did children from the visual arts class, while children from the visual arts class showed greater visual form analysis ability than children from the music class (Experiment 1). However, a partial replication attempt comparing music training to a no-treatment control failed to confirm these findings (Experiment 2), and the combined results of the two experiments were negative: overall, children provided with music classes performed no better than those with visual arts or no classes on any assessment. Our findings underscore the need for replication in RCTs, and suggest caution in interpreting the positive findings from past studies of cognitive effects of music instruction.

  9. Risk-benefit considerations in the treatment of relapsing-remitting multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Lugaresi A

    2013-06-01

    Full Text Available Alessandra Lugaresi,1 Maria di Ioia,1 Daniela Travaglini,1 Erika Pietrolongo,1 Eugenio Pucci,2 Marco Onofrj11Department of Neuroscience and Imaging, University “G d’Annunzio”, Chieti, 2Operative Unit Neurologia ASUR Marche Area Vasta 3, Macerata, ItalyAbstract: Multiple sclerosis (MS is a chronic demyelinating disease of the central nervous system and mainly affects young adults. Its natural history has changed in recent years with the advent of disease-modifying drugs, which have been available since the early 1990s. The increasing number of first-line and second-line treatment options, together with the variable course of the disease and patient lifestyles and expectations, makes the therapeutic decision a real challenge. The aim of this review is to give a comprehensive overview of the main present and some future drugs for relapsing-remitting MS, including risk-benefit considerations, to enable readers to draw their own conclusions regarding the risk-benefit assessment of personalized treatment strategies, taking into account not only treatment-related but also disease-related risks. We performed a Medline literature search to identify studies on the treatment of MS with risk stratification and risk-benefit considerations. We focused our attention on studies of disease-modifying, immunomodulating, and immunosuppressive drugs, including monoclonal antibodies. Here we offer personal considerations, stemming from long-term experience in the treatment of MS and thorough discussions with other neurologists closely involved in the care of patients with the disease. MS specialists need to know not only the specific risks and benefits of single drugs, but also about drug interactions, either in simultaneous or serial combination therapy, and patient comorbidities, preferences, and fears. This has to be put into perspective, considering also the risks of untreated disease in patients with different clinical and radiological characteristics

  10. Methods for providing decision makers with optimal solutions for multiple objectives that change over time

    CSIR Research Space (South Africa)

    Greeff, M

    2010-09-01

    Full Text Available for providing decision makers with optimal solutions for multiple objectives that change over time M GREEFF CSIR Meraka Institute, PO Box 395, Pretoria, 0001, South Africa Email: mgreeff@csir.co.za – www.csir.co.za IntroductIon decision making... solution, but a set of optimal solutions, called the Pareto optimal front (PoF). When the objectives change over time, the problem is called a dynamic mooP (dmooP). this research focuses on finding the PoF for dmooPs, in order to provide the decision...

  11. To provide care and be cared for in a multiple-bed hospital room.

    Science.gov (United States)

    Persson, Eva; Määttä, Sylvia

    2012-12-01

    To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  12. Patient and provider perspectives on the relationship between multiple morbidity management and disease prevention.

    Science.gov (United States)

    Schoenberg, Nancy E; Tarasenko, Yelena N; Bardach, Shoshana H; Fleming, Steven T

    2015-04-01

    Despite competing demands of multiple morbidity (MM) management and disease prevention, our recent survey of 1,153 Appalachian residents aged 50 to 76 documented that individuals with MM were more likely to obtain colorectal cancer screening (CRCS) than those without MM. Nearly two thirds of respondents obtained CRCS, and the more MM, the greater the likelihood of screening. To gain insight into this relationship, we conducted nine focus groups, six with providers and three with patients. Three main explanations emerged: (a) patients' MM increases providers' vigilance for other health vulnerabilities; (b) having MM increases patients' own vigilance; and (c) patients' vigilance may stem from experiencing more symptoms, having a family history of cancer, and having successfully obtained health care. More frequent contact with health care providers appears to encourage preventive referral, especially in low-income populations that otherwise may not receive such counselling. We highlight participant recommendations to improve MM management and prevention. © The Author(s) 2013.

  13. Electromagnetic treatment to old Alzheimer's mice reverses β-amyloid deposition, modifies cerebral blood flow, and provides selected cognitive benefit.

    Directory of Open Access Journals (Sweden)

    Gary W Arendash

    Full Text Available Few studies have investigated physiologic and cognitive effects of "long-term" electromagnetic field (EMF exposure in humans or animals. Our recent studies have provided initial insight into the long-term impact of adulthood EMF exposure (GSM, pulsed/modulated, 918 MHz, 0.25-1.05 W/kg by showing 6+ months of daily EMF treatment protects against or reverses cognitive impairment in Alzheimer's transgenic (Tg mice, while even having cognitive benefit to normal mice. Mechanistically, EMF-induced cognitive benefits involve suppression of brain β-amyloid (Aβ aggregation/deposition in Tg mice and brain mitochondrial enhancement in both Tg and normal mice. The present study extends this work by showing that daily EMF treatment given to very old (21-27 month Tg mice over a 2-month period reverses their very advanced brain Aβ aggregation/deposition. These very old Tg mice and their normal littermates together showed an increase in general memory function in the Y-maze task, although not in more complex tasks. Measurement of both body and brain temperature at intervals during the 2-month EMF treatment, as well as in a separate group of Tg mice during a 12-day treatment period, revealed no appreciable increases in brain temperature (and no/slight increases in body temperature during EMF "ON" periods. Thus, the neuropathologic/cognitive benefits of EMF treatment occur without brain hyperthermia. Finally, regional cerebral blood flow in cerebral cortex was determined to be reduced in both Tg and normal mice after 2 months of EMF treatment, most probably through cerebrovascular constriction induced by freed/disaggregated Aβ (Tg mice and slight body hyperthermia during "ON" periods. These results demonstrate that long-term EMF treatment can provide general cognitive benefit to very old Alzheimer's Tg mice and normal mice, as well as reversal of advanced Aβ neuropathology in Tg mice without brain heating. Results further underscore the potential for EMF

  14. Deriving Multiple Benefits from Carbon Market-Based Savanna Fire Management: An Australian Example.

    Directory of Open Access Journals (Sweden)

    Jeremy Russell-Smith

    Full Text Available Carbon markets afford potentially useful opportunities for supporting socially and environmentally sustainable land management programs but, to date, have been little applied in globally significant fire-prone savanna settings. While fire is intrinsic to regulating the composition, structure and dynamics of savanna systems, in north Australian savannas frequent and extensive late dry season wildfires incur significant environmental, production and social impacts. Here we assess the potential of market-based savanna burning greenhouse gas emissions abatement and allied carbon biosequestration projects to deliver compatible environmental and broader socio-economic benefits in a highly biodiverse north Australian setting. Drawing on extensive regional ecological knowledge of fire regime effects on fire-vulnerable taxa and communities, we compare three fire regime metrics (seasonal fire frequency, proportion of long-unburnt vegetation, fire patch-size distribution over a 15-year period for three national parks with an indigenously (Aboriginal owned and managed market-based emissions abatement enterprise. Our assessment indicates improved fire management outcomes under the emissions abatement program, and mostly little change or declining outcomes on the parks. We attribute improved outcomes and putative biodiversity benefits under the abatement program to enhanced strategic management made possible by the market-based mitigation arrangement. For these same sites we estimate quanta of carbon credits that could be delivered under realistic enhanced fire management practice, using currently available and developing accredited Australian savanna burning accounting methods. We conclude that, in appropriate situations, market-based savanna burning activities can provide transformative climate change mitigation, ecosystem health, and community benefits in northern Australia, and, despite significant challenges, potentially in other fire-prone savanna

  15. Quantitative measures of walking and strength provide insight into brain corticospinal tract pathology in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Nora E Fritz

    2017-01-01

    Quantitative measures of strength and walking are associated with brain corticospinal tract pathology. The addition of these quantitative measures to basic clinical information explains more of the variance in corticospinal tract fractional anisotropy and magnetization transfer ratio than the basic clinical information alone. Outcome measurement for multiple sclerosis clinical trials has been notoriously challenging; the use of quantitative measures of strength and walking along with tract-specific imaging methods may improve our ability to monitor disease change over time, with intervention, and provide needed guidelines for developing more effective targeted rehabilitation strategies.

  16. Does an extra kidney-ureter-bladder radiograph taken in the upright position during routine intravenous urography provide diagnostic benefit?

    Science.gov (United States)

    Gürel, Kamil; Gürel, Safiye; Kalfaoğlu, Melike; Yilmaz, Ozlem; Metin, Ahmet

    2008-12-01

    The aim of this prospective study was to assess the diagnostic benefit of taking a kidney-ureter-bladder (KUB) radiograph in an upright position during routine intravenous urography (IVU). Between February 2005 and September 2007, 170 consecutive patients were included in the study. A basal IVU exam consisted of pre-contrast supine KUB, post-contrast supine KUB at the 7th and 15th minutes, and supine pelvic radiographs with full bladder and post-voiding. When needed, additional compression and/or oblique radiographs were taken. In this study, for all patients, a post-contrast 15th minute upright KUB radiograph was added to IVU. Two consecutive radiographs taken at the 15th minute postcontrast in supine and upright positions were evaluated by consensus of 2 radiologists. Primary benefits were improved filling and emptying of the collecting system, and secondary benefits were nephroptosis and ascertaining diagnosis of phlebolith. Of 170 patients, 337 kidneys and collecting systems (n = 168 right; n = 169 left) were examined. Improved filling, emptying of the collecting system, nephroptosis, ascertaining diagnosis of phleboliths were detected with the rates of 12.5%, 44.2%, 8.3%, and 3.2%, respectively. Improved filling was significant in the presence of hydronephrosis (P IVU (P < 0.05) on either side. Upright KUB radiographs provide supplementary data about urine flow in terms of improved filling and emptying of the collecting system.

  17. Does manual therapy provide additional benefit to breathing retraining in the management of dysfunctional breathing? A randomised controlled trial.

    Science.gov (United States)

    Jones, Mandy; Troup, Fiona; Nugus, John; Roughton, Michael; Hodson, Margaret; Rayner, Charlotte; Bowen, Frances; Pryor, Jennifer

    2015-01-01

    Dysfunctional breathing (DB) is associated with an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study sought to investigate whether MT produces additional benefit when compared with breathing retraining alone in patients with DB. Sixty subjects with primary DB were randomised into either breathing retraining (standard treatment; n = 30) or breathing retraining plus MT (intervention; n = 30) group. Both the groups received standardised respiratory physiotherapy, which included: DB education, breathing retraining, home regimen, and audio disc. Intervention group subjects additionally received MT following further assessment. Data from 57 subjects were analysed. At baseline, standard treatment group subjects were statistically younger (41.7 + 13.5 versus 50.8 + 13.0 years; p = 0.001) with higher Nijmegen scores (38.6 + 9.5 versus 31.5 + 6.9; p = 0.001). However, no significant difference was found between the groups for primary outcome Nijmegen score (95% CI (-1.1, 6.6) p = 0.162), or any secondary outcomes (Hospital Anxiety & Depression Score, spirometry or exercise tolerance). Breathing retraining is currently the mainstay of treatment for patients with DB. The results of this study suggest MT provides no additional benefit in this patient group. Dysfunctional breathing (DB) is associated with significant patient morbidity but often goes unrecognised, leading to prolonged investigation and significant use of health care resources. Breathing retraining remains the primary management of this condition. However, physiotherapists are also using manual therapy (MT) as an adjunctive treatment for patients with DB. However, the results of this study suggest that MT provides no further benefit and cannot be recommended in

  18. Integrating multiple benefits in market-based climate mitigation schemes: The case of the Climate, Community and Biodiversity certification scheme

    NARCIS (Netherlands)

    Melo Vasquez, I.; Turnhout, E.; Arts, B.J.M.

    2014-01-01

    This paper analyses the Climate, Community and Biodiversity (CCB) certification scheme with a particular focus on its aim to deliver multiple benefits and contribute not only to climate mitigation but also to biodiversity conservation and socio-economic development. To that end, the articles

  19. Criterion 6: Maintenance and enhancement of long-term multiple socioeconomic benefits to meet the needs of societies

    Science.gov (United States)

    Stephen R. Shifley; Francisco X. Aguilar; Nianfu Song; Susan I. Stewart; David J. Nowak; Dale D. Gormanson; W. Keith Moser; Sherri Wormstead; Eric J. Greenfield

    2012-01-01

    Forests provide an array of products and services that maintain and enhance benefits to our society and economy. Benefits derived from forests may be categorized into wood products, nontimber products and services, and ecosystem services. The value and volume of these products and services indicate the importance of forests for a wide variety of uses.Tracking values,...

  20. How to combine multiple techniques to provide reliable in-situ time series for climate applications

    Science.gov (United States)

    Valladeau, G.; Soudarin, L.; Gravelle, M.

    2012-12-01

    Tide gauge measurements, as observations dedicated to climate applications, require a rigorous quality control since measurements are highly sensitive to biases or drifts in datasets. One major part of the error related to the assessment of Sea Surface Height at tide gauge location originates in vertical movements. Indeed, many studies have for instance demonstrated the need for tide gauges to be corrected for land motion when compared with altimeter data. The combination of multiple techniques (altimeter, in-situ and geodetic data) is a way of providing relevant tide gauge time series for end-users and climate applications such as the contribution of ice-sheet mass balance to the global sea-level. In this way, DORIS (Doppler Orbitography and Radiopositioning Integrated by Satellite) as well as GNSS (Global Navigation Satellite System) are considered as complementary techniques. They determine the crustal motion at a cm (or better) and mm/yr accuracy for the positions and velocities respectively. As the DORIS network was deployed by a geodetic institution, great care was taken when selecting the geographical location of the tracking stations to co-locate them with other space geodetic techniques (VLBI, SLR and GNSS), but also with tide gauges. Hence, as on May 2012, 22 DORIS stations are within 10 km from a tide gauge, including 8 within 500m. Ties between the DORIS antennas and the nearby tide gauge are also available when the measurement is possible. This study focuses on the example of the Thule tide gauge for which measurements are compared to the different techniques previously described. First, the comparison to both DORIS and GNSS data provides relevant information about the strong crustal movement North of Greenland. Then the use of altimeter data confirms results deduced from geodetic stations and give a larger view on the behavior of land motion around the Thule tide gauge. Therefore, the combination of multiple techniques is used to provide reliable tide

  1. Multiple genetic interaction experiments provide complementary information useful for gene function prediction.

    Directory of Open Access Journals (Sweden)

    Magali Michaut

    Full Text Available Genetic interactions help map biological processes and their functional relationships. A genetic interaction is defined as a deviation from the expected phenotype when combining multiple genetic mutations. In Saccharomyces cerevisiae, most genetic interactions are measured under a single phenotype - growth rate in standard laboratory conditions. Recently genetic interactions have been collected under different phenotypic readouts and experimental conditions. How different are these networks and what can we learn from their differences? We conducted a systematic analysis of quantitative genetic interaction networks in yeast performed under different experimental conditions. We find that networks obtained using different phenotypic readouts, in different conditions and from different laboratories overlap less than expected and provide significant unique information. To exploit this information, we develop a novel method to combine individual genetic interaction data sets and show that the resulting network improves gene function prediction performance, demonstrating that individual networks provide complementary information. Our results support the notion that using diverse phenotypic readouts and experimental conditions will substantially increase the amount of gene function information produced by genetic interaction screens.

  2. Meeting multiple demands: Water transaction opportunities for environmental benefits promoting adaptation to climate change

    Science.gov (United States)

    McCoy, Amy

    2015-04-01

    In arid regions, the challenge of balancing water use among a diversity of sectors expands in lock step with conditions of water stress that are exacerbated by climate variability, prolonged drought, and growing water-use demands. The elusiveness of achieving a sustainable balance under conditions of environmental change in the southwestern United States is evidenced by reductions in both overall water availability and freshwater ecosystem health, as well as by recent projections of shortages on the Colorado River within the next five years. The water sustainability challenge in this region, as well as drylands throughout the world, can therefore be viewed through the lens of water stress, a condition wherein demands on land and water -- including the needs of freshwater ecosystems -- exceed reliable supplies, and the full range of water needs cannot be met without tradeoffs across multiple uses. Water stress influences not only ecosystems, but a region's economy, land management, quality of life, and cultural heritage -- each of which requires water to thrive. With respect to promoting successful adaptation to climate change, achieving full water sustainability would allow for water to be successfully divided among water users -- including municipalities, agriculture, and freshwater ecosystems -- at a level that meets the goals of water users and the governing body. Over the last ten to fifteen years, the use of transactional approaches in the western U.S., Mexico, and Australia has proven to be a viable management tool for achieving stream flow and shallow aquifer restoration. By broad definition, environmental water transactions are an equitable and adaptable tool that brings diverse stakeholders to the table to facilitate a fair-market exchange of rights to use water in a manner that benefits both water users and the environment. This talk will present a basic framework of necessary stakeholder engagement, hydrologic conditions, enabling laws and policies

  3. Multiple kisspeptin receptors in early osteichthyans provide new insights into the evolution of this receptor family.

    Directory of Open Access Journals (Sweden)

    Jérémy Pasquier

    Full Text Available Deorphanization of GPR54 receptor a decade ago led to the characterization of the kisspeptin receptor (Kissr in mammals and the discovery of its major role in the brain control of reproduction. While a single gene encodes for Kissr in eutherian mammals including human, other vertebrates present a variable number of Kissr genes, from none in birds, one or two in teleosts, to three in an amphibian, xenopus. In order to get more insight into the evolution of Kissr gene family, we investigated the presence of Kissr in osteichthyans of key-phylogenetical positions: the coelacanth, a representative of early sarcopterygians, the spotted gar, a non-teleost actinopterygian, and the European eel, a member of an early group of teleosts (elopomorphs. We report the occurrence of three Kissr for the first time in a teleost, the eel. As measured by quantitative RT-PCR, the three eel Kissr were differentially expressed in the brain-pituitary-gonadal axis, and differentially regulated in experimentally matured eels, as compared to prepubertal controls. Subfunctionalisation, as shown by these differences in tissue distribution and regulation, may have represented significant evolutionary constraints for the conservation of multiple Kissr paralogs in this species. Furthermore, we identified four Kissr in both coelacanth and spotted gar genomes, providing the first evidence for the presence of four Kissr in vertebrates. Phylogenetic and syntenic analyses supported the existence of four Kissr paralogs in osteichthyans and allowed to propose a clarified nomenclature of Kissr (Kissr-1 to -4 based on these paralogs. Syntenic analysis suggested that the four Kissr paralogs arose through the two rounds of whole genome duplication (1R and 2R in early vertebrates, followed by multiple gene loss events in the actinopterygian and sarcopterygian lineages. Due to gene loss there was no impact of the teleost-specific whole genome duplication (3R on the number of Kissr paralogs

  4. A qualitative study: potential benefits and challenges of traditional healers in providing aspects of palliative care in rural South Africa.

    Science.gov (United States)

    Campbell, L M; Amin, N N

    2014-01-01

    This article draws on selected palliative care providers' views and experiences to reflect on the potential benefits and possible challenges of involving traditional healers in palliative care in rural areas of South Africa. There is increasing consensus that palliative care should be offered by a range of professional and non-professional healthcare givers. Including non-professionals such as traditional healers in a palliative care team may strengthen care provisioning as they have intimate knowledge of patients' local culture and spiritual beliefs. Employing the qualitative method of photo-elicitation, one-on-one discussions about the photographs taken by participants were conducted. The participants - 4 palliative care nurses and 17 home-based care workers - were purposively selected to provide in-depth information about their experiences as palliative caregivers in rural homes. Healthcare workers' experiences revealed that the patients they cared for valued traditional rituals connected to illness, dying, death and bereavement. Participants suggested that traditional healers should be included in palliative care training programs as they could offer appropriate psychological, cultural and spiritual care. A challenge identified by participants was the potential of traditional healers to foster a false sense of longevity in patients facing death. The importance of recognising the value of traditional practices in palliative care should not be underrated in rural South Africa. Traditional healers could enhance palliative care services as they have deep, insider knowledge of patients' spiritual needs and awareness of cultural practices relating to illness, death, dying and bereavement. Incorporating traditional healers into healthcare services where there are differences in the worldviews of healthcare providers and patients, and a sensitivity to mediate cultural differences between caregivers and patients, could have the benefit of providing appropriate care in

  5. A soluble form of Siglec-9 provides an antitumor benefit against mammary tumor cells expressing MUC1 in transgenic mice

    Energy Technology Data Exchange (ETDEWEB)

    Tomioka, Yukiko, E-mail: ytomi@muses.tottori-u.ac.jp [Division of Disease Model Innovation, Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815 (Japan); Avian Zoonosis Research Center, Faculty of Agriculture, Tottori University, Tottori 680-8553 (Japan); Morimatsu, Masami, E-mail: mmorimat@vetmed.hokudai.ac.jp [Division of Disease Model Innovation, Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815 (Japan); Laboratory of Laboratory Animal Science and Medicine, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo 060-0818 (Japan); Nishijima, Ken-ichi, E-mail: nishijma@nubio.nagoya-u.ac.jp [Department of Biotechnology, Graduate School of Engineering, Nagoya University, Nagoya 464-8603 (Japan); Usui, Tatsufumi, E-mail: usutatsu@muses.tottori-u.ac.jp [Avian Zoonosis Research Center, Faculty of Agriculture, Tottori University, Tottori 680-8553 (Japan); Yamamoto, Sayo, E-mail: ysayo@anim.med.kyushu-u.ac.jp [Center of Biomedical Research, Research Center for Human Disease Modeling, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582 (Japan); Suyama, Haruka, E-mail: sharuka@anim.med.kyushu-u.ac.jp [Center of Biomedical Research, Research Center for Human Disease Modeling, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582 (Japan); Ozaki, Kinuyo, E-mail: k-ozaki@anim.med.kyushu-u.ac.jp [Center of Biomedical Research, Research Center for Human Disease Modeling, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582 (Japan); Ito, Toshihiro, E-mail: toshiito@muses.tottori-u.ac.jp [Avian Zoonosis Research Center, Faculty of Agriculture, Tottori University, Tottori 680-8553 (Japan); and others

    2014-07-18

    Highlights: • Tumor-associated antigen MUC1 binds to Siglec-9. • Soluble Siglec-9 reduced proliferation of MUC1-positive tumor in transgenic mice. • Soluble Siglec-9 and MUC1 on tumor cells were colocalized in transgenic mice. • MUC1 expression on tumor cells were reduced in soluble Siglec-9 transgenic mice. - Abstract: Tumor-associated MUC1 binds to Siglec-9, which is expected to mediate tumor cell growth and negative immunomodulation. We hypothesized that a soluble form of Siglec-9 (sSiglec-9) competitively inhibits a binding of MUC1 to its receptor molecules like human Siglec-9, leading to provide antitumor benefit against MUC1-expressing tumor, and generated transgenic mouse lines expressing sSiglec-9 (sSiglec-9 Tg). When mammary tumor cells expressing MUC1 were intraperitoneally transplanted into sSiglec-9 Tg, tumor proliferation was slower with the lower histological malignancy as compared with non-transgenic mice. The sSiglec-9 was detected in the ascites caused by the tumor in the sSiglec-9 Tg, and sSiglec-9 and MUC1 were often colocalized on surfaces of the tumor cells. PCNA immunohistochemistry also revealed the reduced proliferation of the tumor cells in sSiglec-9 Tg. In sSiglec-9 Tg with remarkable suppression of tumor proliferation, MUC1 expressions were tend to be reduced. In the ascites of sSiglec-9 Tg bearing the tumor, T cells were uniformly infiltrated, whereas aggregations of degenerative T cells were often observed in the non-transgenic mice. These results suggest that sSiglec-9 has an antitumor benefit against MUC1-expressing tumor in the transgenic mice, which may avoid the negative immunomodulation and/or suppress tumor-associated MUC1 downstream signal transduction, and subsequent tumor proliferation.

  6. Clinical benefits to vestibular rehabilitation in multiple sclerosis. Report of 4 cases.

    Science.gov (United States)

    Zeigelboim, Bianca; Liberalesso, Paulo; Jurkiewicz, Ari; Klagenberg, Karlin

    2010-01-01

    Balance difficulties are common among multiple sclerosis patients. To evaluate the effectiveness of the Cawthorne and Cooksey protocol of vestibular rehabilitation (VR) exercises in reducing the physical, functional and emotional impact of multiple sclerosis among individuals who complained of vertigo. Four patients with remittent-recurrent multiple sclerosis underwent an interview, otorhinolaryngological and vestibular evaluation, VR exercises and the Dizziness Handicap Inventory pre- and post-intervention. There was significant improvement in the physical, functional and emotional aspects of the DHI after the completion of the VR. The VR exercises appeared useful in reducing subjective complaints of the study participants.

  7. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices

    Science.gov (United States)

    Eshrati, Babak; Asl, Rahim Taghizadeh; Dell, Colleen Anne; Afshar, Parviz; Millson, Peggy Margaret E; Kamali, Mohammad; Weekes, John

    2008-01-01

    Background Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM) and prisoners' risky HIV-related behaviors was examined. Results Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices. PMID:18541032

  8. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices

    Directory of Open Access Journals (Sweden)

    Millson Peggy

    2008-06-01

    Full Text Available Abstract Background Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM and prisoners' risky HIV-related behaviors was examined. Results Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices.

  9. Parafoveal preview benefit in reading is not cumulative across multiple saccades.

    Science.gov (United States)

    McDonald, Scott A

    2005-06-01

    Two empirical predictions can be generated from recent parallel processing models of eye movement control in reading concerning the phenomenon of parafoveal preview benefit. These predictions derive from the assumption that lexical activation accumulates across more than one saccade. A large corpus of eye movement data was used to determine whether parafoveal preview benefit of a target word is modulated by (1) its distance from the penultimate fixation, and (2) the amount of time it spends in the 'perceptual span'. There was an unexpected inverse relationship between first fixation duration and distance: fixations were longer the closer the penultimate fixation was to the target word, and a positive relationship between fixation duration and time: fixations were longer the greater the summed durations of the ultimate and penultimate fixations. These findings represent a challenge for computational models of eye movements in reading.

  10. The Benefits and Problems of Multiple-Intelligence-Based Instruction: A Case Study in Turkey

    Science.gov (United States)

    Bumen, Nilay T.

    2007-01-01

    Multiple-intelligence (MI) theory was developed by Dr. Howard Gardner, and it defines intelligence through a spectrum of content areas, including verbal-linguistic, mathematical-logical, interpersonal, intrapersonal, visual-spatial, bodily-kinesthetic, musical-rhythmic, and naturalistic. The application of MI theory has been found to lead to…

  11. No association of multiple sclerosis activity and progression with EBV or tobacco use in BENEFIT

    NARCIS (Netherlands)

    Munger, K.L.; Fitzgerald, K.C.; Freedman, M.S.; Hartung, H.P.; Miller, D. H.; Montalban, X.; Edan, G.; Barkhof, F.; Suarez, G.; Radue, E.W.; Sandbrink, R.; Kappos, L.; Pohl, C.; Ascherio, A.

    2015-01-01

    Objective: To evaluate whether Epstein-Barr virus (EBV) immunoglobulin G (IgG) antibody levels or tobacco use were associated with conversion to multiple sclerosis (MS) or MS progression/activity in patients presenting with clinically isolated syndrome (CIS). Methods: In this prospective,

  12. Using State-Wide Multiple Measures for School Leadership and Management: Costs Incurred vs. Benefits Gained

    Science.gov (United States)

    Hentschke, Guilbert; Wohlstetter, Priscilla; Hirman, Jennifer; Zeehandelaar, Dara

    2011-01-01

    In this article, we examine the utility and value of multiple measures of school performance for school leaders and managers. The research was conducted within the context of the state of California through an investigation of how operators, managers and authorisers of autonomous "charter" (publicly financed but privately operated)…

  13. Supporting children when providing services to families experiencing multiple problems : Perspectives and evidence on programmes

    NARCIS (Netherlands)

    Knorth, Erik J.; Knot-Dickscheit, Jana; Thoburn, June

    2015-01-01

    Recently, there has been growing interest amongst researchers, practitioners and policy-makers in approaches to understanding and ways of helping parents, children and the communities in which they live to respond to ‘families experiencing multiple problems’ (FEMPs). There is a strong need for

  14. Cognitive behavioural therapy: what benefits can it offer people with Multiple Sclerosis?

    OpenAIRE

    Dennison, Laura; Moss-Morris, Rona

    2010-01-01

    Cognitive-behavioral therapy (CBT) originated as a treatment for emotional disorders. However, it is increasingly used to help people with chronic illnesses manage symptoms and improve psychosocial outcomes, such as depression and quality of life. In this article, we focus on uses of CBT in patients with multiple sclerosis, an incurable neurological disease that causes potentially debilitating symptoms and poses numerous challenges to psychological well-being. We examine the rationale for usi...

  15. Oral and craniofacial manifestations of multiple sclerosis: implications for the oral health care provider.

    Science.gov (United States)

    Zhang, G-Q; Meng, Y

    2015-12-01

    Multiple sclerosis is a complex neurological condition affecting sensory and motor nerve transmission. Its progression and symptoms are unpredictable and vary from person to person as well as over time. Symptoms of orofacial pain, trigeminal neuralgia, spasticity, spasms, tremor, fatigue, depression and progressive disability, impact on the individual's ability to maintain oral health, cope with dental treatment and access dental services. Also, many of the medications used in the symptomatic management of the condition have the potential to cause dry mouth and associated oral disease. There is no cure for multiple sclerosis, and treatment focuses on prevention of disability and maintenance of quality of life. The oral health care team plays an essential role in ensuring that oral health impacts positively on general health. This review highlights the epidemiology, etiology, pathophysiology, diagnosis, oral and craniofacial manifestations and their management, and oral health care considerations in patients with MS.

  16. Multiple benefits and values of trees in urban landscapes in two small towns in northern South Africa

    NARCIS (Netherlands)

    Shackleton, S.; Chinyimba, A.; Hebinck, P.G.M.; Shackleton, C.; Kaoma, H.

    2015-01-01

    Cities and towns can be conceptualised as complex social-ecological systems or landscapes that are composed of different spatial elements. Trees in urban landscapes provide a variety of tangible and intangible benefits (ecosystem services) that may be valued differently across diverse households and

  17. Multiple Problem-Solving Strategies Provide Insight into Students' Understanding of Open-Ended Linear Programming Problems

    Science.gov (United States)

    Sole, Marla A.

    2016-01-01

    Open-ended questions that can be solved using different strategies help students learn and integrate content, and provide teachers with greater insights into students' unique capabilities and levels of understanding. This article provides a problem that was modified to allow for multiple approaches. Students tended to employ high-powered, complex,…

  18. Experiences in simulating and testing coordinated voltage control provided by multiple wind power plants

    Energy Technology Data Exchange (ETDEWEB)

    Arlaban, T.; Alonso, O.; Ortiz, D. [Acciona Windpower S.A. (Spain); Peiro, J.; Rivas, R. [Red Electrica de Espana SAU (Spain); Quinonez-Varela, G.; Lorenzo, P. [Acciona Energia S.A. (Spain)

    2011-07-01

    This document presents some field tests performed in a transmission system node in order to check the adequacy of voltage control performance by multiple wind power plants, with an overall capacity of 395 MW. It briefly explains the Spanish TSO motivation towards new voltage control requirements and the necessity of performing such tests in order to set the most convenient voltage control parameters and to verify the stable operation. It presents how different the voltage control capability between modern wind turbines (DFIG) and older ones (SCIG) specifically retrofitted for voltage control is. (orig.)

  19. CHILDREN WITH MULTIPLE CONGENITAL DEFECTS: WHAT ARE THE LIMITS BETWEEN THERAPEUTIC OBSTINACY AND THE TREATMENT OF UNCERTAIN BENEFIT?

    Science.gov (United States)

    Pastura, Patricia Souza Valle Cardoso; Land, Marcelo Gerardin Poirot

    2017-01-01

    ABSTRACT Objective: Therapeutic approach of children with multiple malformations poses many dilemmas, making it difficult to build a line between the treatment of uncertain benefit and therapeutic obstinacy. The aim of this paper was to highlight possible sources of uncertainty in the decision-making process, for this group of children. Case description: An 11-month-old boy, born with multiple birth defects and abandoned by his parents, has never been discharged home. He has complex congenital heart disease, main left bronchus stenosis and imperforate anus. He is under technological support and has gone through many surgical procedures. The complete correction of the cardiac defect seems unlikely, and every attempt to wean the ventilator has failed. Comments: The first two main sources of uncertainty in the management of children with multiple birth defects are related to an uncertain prognosis. There is a lack of empirical data, due to the multiple possibilities of anatomic or functional organ involvement, with few similar cases described. Prognosis is also unpredictable for neuro-developmental evolution, as well as the capacity for the development and regeneration of other organs. Another source of uncertainty is how to qualify the present and future life as worth living, by weighing the costs and benefits. The fourth source of uncertainty is who has the decision: physicians or parents? Finally, if a treatment is defined futile then, how to limit support? No single framework exists to help these delicate decision-making processes. We propose, then, that physicians should be committed to develop their own perception skills in order to understand patient’s manifestations of needs and family values. PMID:28977304

  20. CHILDREN WITH MULTIPLE CONGENITAL DEFECTS: WHAT ARE THE LIMITS BETWEEN THERAPEUTIC OBSTINACY AND THE TREATMENT OF UNCERTAIN BENEFIT?

    Science.gov (United States)

    Pastura, Patricia Souza Valle Cardoso; Land, Marcelo Gerardin Poirot

    2017-01-01

    Therapeutic approach of children with multiple malformations poses many dilemmas, making it difficult to build a line between the treatment of uncertain benefit and therapeutic obstinacy. The aim of this paper was to highlight possible sources of uncertainty in the decision-making process, for this group of children. An 11-month-old boy, born with multiple birth defects and abandoned by his parents, has never been discharged home. He has complex congenital heart disease, main left bronchus stenosis and imperforate anus. He is under technological support and has gone through many surgical procedures. The complete correction of the cardiac defect seems unlikely, and every attempt to wean the ventilator has failed. The first two main sources of uncertainty in the management of children with multiple birth defects are related to an uncertain prognosis. There is a lack of empirical data, due to the multiple possibilities of anatomic or functional organ involvement, with few similar cases described. Prognosis is also unpredictable for neuro-developmental evolution, as well as the capacity for the development and regeneration of other organs. Another source of uncertainty is how to qualify the present and future life as worth living, by weighing the costs and benefits. The fourth source of uncertainty is who has the decision: physicians or parents? Finally, if a treatment is defined futile then, how to limit support? No single framework exists to help these delicate decision-making processes. We propose, then, that physicians should be committed to develop their own perception skills in order to understand patient's manifestations of needs and family values.

  1. Aerobic exercise in people with multiple sclerosis: its feasibility and secondary benefits.

    Science.gov (United States)

    Swank, Chad; Thompson, Mary; Medley, Ann

    2013-01-01

    The aims of this study were to explore the feasibility of structured aerobic exercise followed by a period of unstructured physical activity and determine the impact of such exercise on cognition, mood, and quality of life in people with multiple sclerosis (MS). A convenience sample of 9 individuals with relapsing-remitting MS performed 30 minutes of aerobic exercise (upper- and lower-extremity ergometry and treadmill ambulation) twice weekly for 8 weeks, followed by 3 months of unstructured physical activity. Eight participants completed the intervention and posttest; 6 returned for the 3-month follow-up. Cardiovascular fitness, cognition, mood (measured with the Beck Depression Inventory-II; BDI-II), and quality of life (measured with the Multiple Sclerosis Quality of Life-54; MSQOL-54) were assessed. Participants completed 27.9 minutes of exercise per session, with an 85.1% attendance rate. Evaluation using the Wilcoxon signed rank test revealed no deleterious effects and improved results on the BDI-II and MSQOL-54 mental subscale. Analysis of change scores using the one-sample t test revealed that the BDI-II and MSQOL-54 were changed from zero after structured exercise, but only the BDI-II maintained improvement after unstructured physical activity. Further analysis of BDI-II subscales revealed that improvement occurred only in the Somato-Affective subscale. In this study, program feasibility was demonstrated in several ways. There were no declines in cognitive function over the 5-month period. Despite unchanged cognitive function, participants may value the improved mood enough to continue both the structured and unstructured physical activity. The role of unstructured physical activity in concert with periodic structured exercise programs merits further investigation.

  2. Structure of the physical therapy benefit in a typical Blue Cross Blue Shield preferred provider organization plan available in the individual insurance market in 2011.

    Science.gov (United States)

    Sandstrom, Robert W; Lehman, Jedd; Hahn, Lee; Ballard, Andrew

    2013-10-01

    The Affordable Care Act of 2010 establishes American Health Benefit Exchanges. The benefit design of insurance plans in state health insurance exchanges will be based on the structure of existing small-employer-sponsored plans. The purpose of this study was to describe the structure of the physical therapy benefit in a typical Blue Cross Blue Shield (BCBS) preferred provider organization (PPO) health insurance plan available in the individual insurance market in 2011. A cross-sectional survey design was used. The physical therapy benefit within 39 BCBS PPO plans in 2011 was studied for a standard consumer with a standard budget. First, whether physical therapy was a benefit in the plan was determined. If so, then the structure of the benefit was described in terms of whether the physical therapy benefit was a stand-alone benefit or part of a combined-discipline benefit and whether a visit or financial limit was placed on the physical therapy benefit. Physical therapy was included in all BCBS plans that were studied. Ninety-three percent of plans combined physical therapy with other disciplines. Two thirds of plans placed a limit on the number of visits covered. The results of the study are limited to 1 standard consumer, 1 association of insurance companies, 1 form of insurance (a PPO), and 1 PPO plan in each of the 39 states that were studied. Physical therapy is a covered benefit in a typical BCBS PPO health insurance plan. Physical therapy most often is combined with other therapy disciplines, and the number of covered visits is limited in two thirds of plans.

  3. Does Manual Therapy Provide Additional Benefit To Breathing Retraining In The Management Of Dysfunctional Breathing? A Randomised Controlled Trial

    OpenAIRE

    Jones, MO; Troup, F; Nugus, J; Roughton, M; Hodson, ME; Rayner, C.; Bowen, F; Pryor, J

    2015-01-01

    Purpose: Dysfunctional breathing (DB) is associated with an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study sought to investigate whether MT produces additional benefit when compared with breathing retraining alone in patients with DB. Methods: Sixty subjects with primary...

  4. Projecting cumulative benefits of multiple river restoration projects: an example from the Sacramento-San Joaquin River system in California

    Science.gov (United States)

    Kondolf, G. Mathias; Angermeier, Paul L.; Cummins, Kenneth; Dunne, Thomas; Healey, Michael; Kimmerer, Wim; Moyle, Peter B.; Murphy, Dennis; Patten, Duncan; Railsback, Steve F.; Reed, Denise J.; Spies, Robert B.; Twiss, Robert

    2008-01-01

    Despite increasingly large investments, the potential ecological effects of river restoration programs are still small compared to the degree of human alterations to physical and ecological function. Thus, it is rarely possible to “restore” pre-disturbance conditions; rather restoration programs (even large, well-funded ones) will nearly always involve multiple small projects, each of which can make some modest change to selected ecosystem processes and habitats. At present, such projects are typically selected based on their attributes as individual projects (e.g., consistency with programmatic goals of the funders, scientific soundness, and acceptance by local communities), and ease of implementation. Projects are rarely prioritized (at least explicitly) based on how they will cumulatively affect ecosystem function over coming decades. Such projections require an understanding of the form of the restoration response curve, or at least that we assume some plausible relations and estimate cumulative effects based thereon. Drawing on our experience with the CALFED Bay-Delta Ecosystem Restoration Program in California, we consider potential cumulative system-wide benefits of a restoration activity extensively implemented in the region: isolating/filling abandoned floodplain gravel pits captured by rivers to reduce predation of outmigrating juvenile salmon by exotic warmwater species inhabiting the pits. We present a simple spreadsheet model to show how different assumptions about gravel pit bathymetry and predator behavior would affect the cumulative benefits of multiple pit-filling and isolation projects, and how these insights could help managers prioritize which pits to fill.

  5. Multiple representations and free-body diagrams: Do students benefit from using them?

    Science.gov (United States)

    Rosengrant, David R.

    2007-12-01

    Introductory physics students have difficulties understanding concepts and solving problems. When they solve problems, they use surface features of the problems to find an equation to calculate a numerical answer often not understanding the physics in the problem. How do we help students approach problem solving in an expert manner? A possible answer is to help them learn to represent knowledge in multiple ways and then use these different representations for conceptual understanding and problem solving. This solution follows from research in cognitive science and in physics education. However, there are no studies in physics that investigate whether students who learn to use multiple representations are in fact better problem solvers. This study focuses on one specific representation used in physics--a free body diagram. A free-body diagram is a graphical representation of forces exerted on an object of interest by other objects. I used the free-body diagram to investigate five main questions: (1) If students are in a course where they consistently use free body diagrams to construct and test concepts in mechanics, electricity and magnetism and to solve problems in class and in homework, will they draw free-body diagrams on their own when solving exam problems? (2) Are students who use free-body diagrams to solve problems more successful then those who do not? (3) Why do students draw free-body diagrams when solving problems? (4) Are students consistent in constructing diagrams for different concepts in physics and are they consistent in the quality of their diagrams? (5) What are possible relationships between features of a problem and how likely a student will draw a free body diagram to help them solve the problem? I utilized a mixed-methods approach to answer these questions. Questions 1, 2, 4 and 5 required a quantitative approach while question 3 required a qualitative approach, a case study. When I completed my study, I found that if students are in an

  6. A CASE STUDY IN DOCUMENTATION PRODUCTION AS LEARNING TOOLS BENEFITTING MULTIPLE STAKEHOLDERS

    Directory of Open Access Journals (Sweden)

    T. J. Truesdale

    2017-08-01

    Full Text Available The Fondation Strutt Foundation has taken on the conservation planning of the Strutt House as part of a P3 collaborative effort with the National Capital Commission (NCC. This paper will address three of the primary documents/data sets (documentary methodologies being used on/for the Strutt House project. The Strutt House is a Recognized Federal Heritage Building and a significant example of Canadian modernist architecture. Stakeholder is a term often used in Architectural Projects reflecting an economic interest in success of the project. In conservation projects the stakeholder generally reflects social, cultural and/or economic interests in a given project. The Strutt House project has benefitted from stakeholders that have all been interested in the above, as well as the education of our future conservationists. The Strutt house was purchased from the architect’s daughter in 2010, and as part of the acquisition, a Heritage Structure Report was commissioned and produced by PTAH Consultants Inc., Architects. The report forms the first of the primary referenced documents of this paper, including: a comprehensive photographic record of existing conditions; and, a building simulation model of the house ‘as designed/built’. This HSR and the accompanying data/documents have been adopted as the basis of an evolving document in the development of the Conservation Plan including: additional heritage surveys and technologies; traditional drawings, photographic and video records; and, a series of workshops on the structural stabilization efforts, thermography scans, and smoke/blow-door (air pressure testing. In 2016, Pierre Jouan, a Master’s thesis student from KU Leuvan, working with the Carleton University CIMS lab under the direction of Professor Mario Santana, and the FSF completed a 3-D scanning and photogrammetry workshop on the Strutt House and created a building information model (BIM model from the collected data. The three primary

  7. a Case Study in Documentation Production as Learning Tools Benefitting Multiple Stakeholders

    Science.gov (United States)

    Truesdale, T. J.; Hierlihy, B.; Jouan, P.

    2017-08-01

    The Fondation Strutt Foundation has taken on the conservation planning of the Strutt House as part of a P3 collaborative effort with the National Capital Commission (NCC). This paper will address three of the primary documents/data sets (documentary methodologies) being used on/for the Strutt House project. The Strutt House is a Recognized Federal Heritage Building and a significant example of Canadian modernist architecture. Stakeholder is a term often used in Architectural Projects reflecting an economic interest in success of the project. In conservation projects the stakeholder generally reflects social, cultural and/or economic interests in a given project. The Strutt House project has benefitted from stakeholders that have all been interested in the above, as well as the education of our future conservationists. The Strutt house was purchased from the architect's daughter in 2010, and as part of the acquisition, a Heritage Structure Report was commissioned and produced by PTAH Consultants Inc., Architects. The report forms the first of the primary referenced documents of this paper, including: a comprehensive photographic record of existing conditions; and, a building simulation model of the house `as designed/built'. This HSR and the accompanying data/documents have been adopted as the basis of an evolving document in the development of the Conservation Plan including: additional heritage surveys and technologies; traditional drawings, photographic and video records; and, a series of workshops on the structural stabilization efforts, thermography scans, and smoke/blow-door (air pressure) testing. In 2016, Pierre Jouan, a Master's thesis student from KU Leuvan, working with the Carleton University CIMS lab under the direction of Professor Mario Santana, and the FSF completed a 3-D scanning and photogrammetry workshop on the Strutt House and created a building information model (BIM model) from the collected data. The three primary documentation processes

  8. The Economic and Social Benefits and the Barriers of Providing People with Disabilities Accessible Clean Water and Sanitation

    Directory of Open Access Journals (Sweden)

    Gregor Wolbring

    2012-11-01

    Full Text Available Resolution A/HRC/RES/16/2 adopted by the UN Human Rights Council on 8 April 2011 declared access to safe drinking water and sanitation a human right. However many people around the globe including people with disabilities do not have access to safe drinking water, hygiene or sanitation facilities. Inaccessibility of clean water sources, hygiene and sanitation facilities negatively impacts among others health, education, the ability to work, and the ability to partake in social activities. This paper looks at the benefits of, and access barriers to, clean water and sanitation for people with disabilities.

  9. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations.

    Science.gov (United States)

    Halabchi, Farzin; Alizadeh, Zahra; Sahraian, Mohammad Ali; Abolhasani, Maryam

    2017-09-16

    Multiple sclerosis (MS) can result in significant mental and physical symptoms, specially muscle weakness, abnormal walking mechanics, balance problems, spasticity, fatigue, cognitive impairment and depression. Patients with MS frequently decrease physical activity due to the fear from worsening the symptoms and this can result in reconditioning. Physicians now believe that regular exercise training is a potential solution for limiting the reconditioning process and achieving an optimal level of patient activities, functions and many physical and mental symptoms without any concern about triggering the onset or exacerbation of disease symptoms or relapse. Appropriate exercise can cause noteworthy and important improvements in different areas of cardio respiratory fitness (Aerobic fitness), muscle strength, flexibility, balance, fatigue, cognition, quality of life and respiratory function in MS patients. Aerobic exercise training with low to moderate intensity can result in the improvement of aerobic fitness and reduction of fatigue in MS patients affected by mild or moderate disability. MS patients can positively adapt to resistance training which may result in improved fatigue and ambulation. Flexibility exercises such as stretching the muscles may diminish spasticity and prevent future painful contractions. Balance exercises have beneficial effects on fall rates and better balance. Some general guidelines exist for exercise recommendation in the MS population. The individualized exercise program should be designed to address a patient's chief complaint, improve strength, endurance, balance, coordination, fatigue and so on. An exercise staircase model has been proposed for exercise prescription and progression for a broad spectrum of MS patients. Exercise should be considered as a safe and effective means of rehabilitation in MS patients. Existing evidence shows that a supervised and individualized exercise program may improve fitness, functional capacity and

  10. Multi-slice echo-planar spectroscopic MR imaging provides both global and local metabolite measures in multiple sclerosis

    DEFF Research Database (Denmark)

    Mathiesen, Henrik Kahr; Tscherning, Thomas; Sorensen, Per Soelberg

    2005-01-01

    MR spectroscopy (MRS) provides information about neuronal loss or dysfunction by measuring decreases in N-acetyl aspartate (NAA), a metabolite widely believed to be a marker of neuronal viability. In multiple sclerosis (MS), whole-brain NAA (WBNAA) has been suggested as a marker of disease progre...

  11. Understanding the positive benefit:risk profile of alemtuzumab in relapsing multiple sclerosis: perspectives from the Alemtuzumab Clinical Development Program

    Directory of Open Access Journals (Sweden)

    Havrdova E

    2017-10-01

    Full Text Available Eva Havrdova,1 Jeffrey A Cohen,2 Dana Horakova,1 Ivana Kovarova,1 Eva Meluzinova3 1Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic; 2Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; 3Department of Neurology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic Abstract: The introduction of high-efficacy therapies for relapsing–remitting multiple sclerosis has driven re-evaluation of treatment goals and benefit:risk considerations in treatment choice. In the alemtuzumab Phase II and III clinical trials, patients treated with alemtuzumab 12 mg versus subcutaneous interferon beta-1a demonstrated significantly reduced annualized relapse rates and improved magnetic resonance imaging outcomes, and were significantly more likely to achieve no evidence of disease activity and reduction in brain volume loss. In two of the studies, alemtuzumab-treated patients had a significantly reduced risk of 6-month confirmed disease worsening, compared with subcutaneous interferon beta-1a. Benefits were maintained throughout 5 years, with a majority of patients receiving no alemtuzumab retreatment or other disease-modifying therapy. Trial results support alemtuzumab’s manageable, consistent safety profile in relapsing–remitting multiple sclerosis. Infusion-associated reactions, the most frequent adverse events (AEs, can be minimized by corticosteroid pretreatment, monitoring, and symptomatic management. Other AEs include infections and autoimmune events. Oral anti-herpes prophylaxis should be initiated on the first day of each alemtuzumab treatment course and continued according to local guidelines. Overall cancer risk was lower in the alemtuzumab clinical trials than in a reference population; however, continuing surveillance will determine if alemtuzumab may be associated with

  12. Machine Learning Takes on Health Care: Leonard D'Avolio's Cyft Employs Big Data to Benefit Patients and Providers.

    Science.gov (United States)

    Mertz, Leslie

    2018-01-01

    When Leonard D'Avolio (Figure 1) was working on his Ph.D. degree in biomedical informatics, he saw the power of machine learning in transforming multiple industries; health care, however, was not among them. "The reason that Amazon, Netflix, and Google have transformed their industries is because they have embedded learning throughout every aspect of what they do. If we could prove that is possible in health care too, I thought we would have the potential to have a huge impact," he says.

  13. Novel Control Strategy for Multiple Run-of-the-River Hydro Power Plants to Provide Grid Ancillary Services

    Energy Technology Data Exchange (ETDEWEB)

    Mohanpurkar, Manish; Luo, Yusheng; Hovsapian, Rob; Muljadi, Eduard; Gevorgian, Vahan; Koritarov, Vladimir

    2017-05-01

    Electricity generated by Hydropower Plants (HPPs) contributes a considerable portion of bulk electricity generation and delivers it with a low carbon footprint. In fact, HPP electricity generation provides the largest share from renewable energy resources, which includes solar and wind energy. The increasing penetration of wind and solar penetration leads to a lowered inertia in the grid and hence poses stability challenges. In recent years, breakthrough in energy storage technologies have demonstrated the economic and technical feasibility of extensive deployments in power grids. Multiple ROR HPPs if integrated with scalable, multi time-step energy storage so that the total output can be controlled. Although, the size of a single energy storage is far smaller than that of a typical reservoir, cohesively managing multiple sets of energy storage distributed in different locations is proposed. The ratings of storages and multiple ROR HPPs approximately equals the rating of a large, conventional HPP. The challenges associated with the system architecture and operation are described. Energy storage technologies such as supercapacitors, flywheels, batteries etc. can function as a dispatchable synthetic reservoir with a scalable size of energy storage will be integrated. Supercapacitors, flywheels, and battery are chosen to provide fast, medium, and slow responses to support grid requirements. Various dynamic and transient power grid conditions are simulated and performances of integrated ROR HPPs with energy storage is provided. The end goal of this research is to investigate the inertial equivalence of a large, conventional HPP with a unique set of multiple ROR HPPs and optimally rated energy storage systems.

  14. Improved power-law estimates from multiple samples provided by millennium climate simulations

    Science.gov (United States)

    Henriksson, S. V.; Räisänen, P.; Silen, J.; Järvinen, H.; Laaksonen, A.

    2015-02-01

    Using the long annual mean temperature time series provided by millennium Earth System Model simulations and a method of discrete Fourier transform with varying starting point and length of time window together with averaging, we get good fits to power laws between two characteristic oscillatory timescales of the model climate: multidecadal (50-80 years) and El Nino (3-6 years) timescales. For global mean temperature, we fit β ˜ 0.35 in a relation S( f) ˜ f - β in a simulation without external climate forcing and β over 0.7 in a simulation with external forcing included. The power law is found both with and without external forcing despite the forcings, e.g. the volcanic forcing, not showing similar behaviour, indicating a nonlinear temperature response to time-varying forcing. We also fit a power law with β ˜ 8 to the narrow frequency range between El Nino frequencies (up to 1/(3.2 years)) and the Nyquist frequency (1/(2 years)). Also, monthly mean temperature time series are considered and a decent power-law fit for frequencies above 1/year is obtained. Regional variability in best-fit β is explored, and the impact of choosing the frequency range on the result is illustrated. When all resolved frequencies are used, land areas seem to have lower βs than ocean areas on average, but when fits are restricted to frequencies below 1/(6 years), this difference disappears, while regional differences still remain. Results compare well with measurements both for global mean temperature and for the central England temperature record.

  15. Multiple Source Biosimilar Insulin, What’s a Provider to Do?

    Science.gov (United States)

    2014-01-01

    In the United States the FDA designates generic products that are bioequivalent as AB substitutable (FDA rating signifying the approved application contains adequate scientific evidence establishing through in vivo and/or in vitro studies the bioequivalence of the product to a selected reference product) and are expected to produce the same therapeutic results as the innovator product. In the case of biological proteins that are similar to already approved innovator biologicals, such as recombinant human insulin, the insulin molecule and accompanying secondary and tertiary structures will differ between manufacturing sources. Even subtle differences between innovator (branded) and alternative “biosimilar” products may produce different therapeutic endpoints. Substitution of a branded insulin with a biosimilar insulin product may result in more, less, or equal therapeutic response making in difficult for the practitioner to assess glycemic control between patient follow-up visits. Significant therapeutic difference is possible, which could result in mild to severe hypoglycemia reaction or hyperglycemia induced tissue damage. Slight molecular changes along with different accompanying proteins, protein fragments, and other naturally occurring contaminants theoretically increase odds of insulin resistance or allergic reaction. Current review of medication product and device quality relies on manufacturer self-oversight and individual reporting of product adverse events after use. While this is usually sufficient for oral medications and many medical devices, critical use products such as sterile products, biosimilar insulin, insulin delivery devices, self-monitoring blood glucose monitoring systems, and test strips require much more vigorous oversight to prevent individual and/or large scale catastrophe. Health care providers should advocate for their patient to have access to affordable, consistent, quality-assured products to effectively and safely manage their

  16. The Endosymbiont Arsenophonus Provides a General Benefit to Soybean Aphid (Hemiptera: Aphididae) Regardless of Host Plant Resistance (Rag).

    Science.gov (United States)

    Wulff, Jason A; White, Jennifer A

    2015-06-01

    Soybean aphid, Aphis glycines Matsumura (Hemiptera: Aphididae), invokes substantial chemical treatment and economic cost in North America. Resistant soybean genotypes hold promise as a low-impact control methodology, but soybean aphid "biotypes" capable of development on resistant soy cast doubt on the durability of soy resistance. We hypothesized that variation in soybean aphid ability to colonize resistant soy is partially attributable to a bacterial symbiont of soybean aphid, Arsenophonus. We used microinjection to manipulate Arsenophonus infection in both virulent and avirulent aphid biotypes, resulting in five pairs of infected versus uninfected isolines. These isolines were subjected to various population growth rate assays on resistant Rag versus susceptible soybean. We found that aphid virulence on Rag soybean was not dependent on Arsenophonus: virulent aphid biotypes performed well on Rag soybean, and avirulent aphid biotypes performed poorly on Rag soybean, regardless of whether Arsenophonus was present or not. However, we did find that Arsenophonus-infected clones on average performed significantly better than their paired uninfected isolines. This pattern was not consistently evident on every date for every clone, either in the population assays nor when we compared lifetime fecundity of individual aphids in a separate experiment. Nevertheless, this overall benefit for infected aphids may be sufficient to explain the high frequency of Arsenophonus infection in soybean aphids. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. 137Cs Inter-Plant Concentration Ratios Provide a Predictive Tool for Coral Atolls with Distinct Benefits Over Transfer Factors

    Energy Technology Data Exchange (ETDEWEB)

    Robison, W L; Hamilton, T F; Bogen, K; Corado, C L; Kehl, S R

    2007-07-17

    Inter-plant concentration ratios (IPCR), [Bq g{sup -1} {sup 137}Cs in coral atoll tree food-crops/Bq g{sup -1} {sup 137}Cs in leaves of native plant species whose roots share a common soil volume], can replace transfer factors (TF) to predict {sup 137}Cs concentration in tree food-crops in a contaminated area with an aged source term. The IPCR strategy has significant benefits relative to TF strategy for such purposes in the atoll ecosystem. IPCR strategy applied to specific assessments takes advantage of the fact tree roots naturally integrate 137Cs over large volumes of soil. Root absorption of {sup 137}Cs replaces large-scale, expensive soil sampling schemes to reduce variability in {sup 137}Cs concentration due to inhomogeneous radionuclide distribution. IPCR [drinking-coconut meat (DCM)/Scaevola (SCA) and Tournefortia (TOU) leaves (native trees growing on all atoll islands)] are log normally distributed (LND) with geometric standard deviation (GSD) = 1.85. TF for DCM from Enewetak, Eneu, Rongelap and Bikini Atolls are LND with GSD's of 3.5, 3.0, 2.7, and 2.1, respectively. TF GSD for Rongelap copra coconut meat is 2.5. IPCR of Pandanus fruit to SCA and TOU leaves are LND with GSD = 1.7 while TF GSD is 2.1. Because IPCR variability is much lower than TF variability, relative sampling error of an IPCR field sample mean is up 6- to 10-fold lower than that of a TF sample mean if sample sizes are small (10 to 20). Other IPCR advantages are that plant leaf samples are collected and processed in far less time with much less effort and cost than soil samples.

  18. State Design and Use of Medicaid 1915(c) Waivers and Related Benefits to Provide Services to Children and Youth With Autism Spectrum Disorder.

    Science.gov (United States)

    Miller, Nancy A; Merryman, M Beth; Eskow, Karen Goldrich; Chasson, Gregory S

    2016-07-01

    Medicaid is the most significant source of funding for medical services for individuals with autism spectrum disorder (ASD). We surveyed state Medicaid directors or their designees regarding their use of autism specific 1915(c) waivers and other Medicaid benefits to provide services to children and youth with ASD, with a response rate of 84%. Ten states used autism-specific waivers to provide services. These waivers varied in the number of children served, eligibility criteria and services provided, among other characteristics. Issues related to the number of children to serve and the specific services to provide were perceived to be the most difficult waiver design issues, while provider geographic distribution, capacity and expertise were perceived to be the most difficult implementation concerns. States used a variety of additional Medicaid state plan services (e.g., the optional rehabilitation benefit) and 1915(c) waivers (e.g., a more general waiver serving individuals with intellectual and developmental disabilities) to provide services to children and youth with ASD. Thus, continuing to examine the adequacy and effectiveness of state use of a range of Medicaid benefits, including autism-specific 1915(c) waivers is critical. Expanding the evidence base for intervention effectiveness is important as well.

  19. Primary palliative care clinic pilot project demonstrates benefits of a nurse practitioner-directed clinic providing primary and palliative care.

    Science.gov (United States)

    Owens, Darrell; Eby, Kerry; Burson, Sean; Green, Meghan; McGoodwin, Wendy; Isaac, Margaret

    2012-01-01

    The purpose of the Primary Palliative Care Pilot Project was to determine if patients with a life-limiting illness who receive their primary care and palliative care from a consistent provider via a nurse practitioner (NP)-founded and-directed Primary Palliative Care Clinic at a public hospital would have improved symptom management and decreased emergency department utilization over time. All patients followed in the Harborview Primary Palliative Care Clinic from January to March 2010. The results of this project demonstrate that patients with a life-limiting illness who receive their primary care and palliative care in an NP-founded and -directed Primary Palliative Care Clinic have decreased utilization of the emergency department, and some experience improvement in symptom assessment scores. Palliative care providers and administrators should explore opportunities to expand outpatient palliative care clinics with an emphasis on primary care and continuity of care. NPs by experience and education are ideally suited to manage both primary and palliative care needs for people at the end of life. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  20. Assessing the Benefits Provided by SWOT Data Towards Estimating Reservoir Residence Time in the Mekong River Basin

    Science.gov (United States)

    Bonnema, M.; Hossain, F.

    2016-12-01

    The Mekong River Basin is undergoing rapid hydropower development. Nine dams are planned on the main stem of the Mekong and many more on its extensive tributaries. Understanding the effects that current and future dams have on the river system and water cycle as a whole is vital for the millions of people living in the basin. reservoir residence time, the amount of time water spends stored in a reservoir, is a key parameter in investigating these impacts. The forthcoming Surface Water and Ocean Topography (SWOT) mission is poised to provide an unprecedented amount of surface water observations. SWOT, when augmented by current satellite missions, will provide the necessary information to estimate the residence time of reservoirs across the entire basin in a more comprehensive way than ever before. In this study, we first combine observations from current satellite missions (altimetry, spectral imaging, precipitation) to estimate the residence times of existing reservoirs. We then use this information to project how future reservoirs will increase the residence time of the river system. Next, we explore how SWOT observations can be used to improve residence time estimation by examining the accuracy of reservoir surface area and elevation observations as well as the accuracy of river discharge observations.

  1. Citrus fruits as a treasure trove of active natural metabolites that potentially provide benefits for human health.

    Science.gov (United States)

    Lv, Xinmiao; Zhao, Siyu; Ning, Zhangchi; Zeng, Honglian; Shu, Yisong; Tao, Ou; Xiao, Cheng; Lu, Cheng; Liu, Yuanyan

    2015-01-01

    Citrus fruits, which are cultivated worldwide, have been recognized as some of the most high-consumption fruits in terms of energy, nutrients and health supplements. What is more, a number of these fruits have been used as traditional medicinal herbs to cure diseases in several Asian countries. Numerous studies have focused on Citrus secondary metabolites as well as bioactivities and have been intended to develop new chemotherapeutic or complementary medicine in recent decades. Citrus-derived secondary metabolites, including flavonoids, alkaloids, limonoids, coumarins, carotenoids, phenolic acids and essential oils, are of vital importance to human health due to their active properties. These characteristics include anti-oxidative, anti-inflammatory, anti-cancer, as well as cardiovascular protective effects, neuroprotective effects, etc. This review summarizes the global distribution and taxonomy, numerous secondary metabolites and bioactivities of Citrus fruits to provide a reference for further study. Flavonoids as characteristic bioactive metabolites in Citrus fruits are mainly introduced.

  2. Speech Perception in Noise in Normally Hearing Children: Does Binaural Frequency Modulated Fitting Provide More Benefit than Monaural Frequency Modulated Fitting?

    Science.gov (United States)

    Mukari, Siti Zamratol-Mai Sarah; Umat, Cila; Razak, Ummu Athiyah Abdul

    2011-07-01

    The aim of the present study was to compare the benefit of monaural versus binaural ear-level frequency modulated (FM) fitting on speech perception in noise in children with normal hearing. Reception threshold for sentences (RTS) was measured in no-FM, monaural FM, and binaural FM conditions in 22 normally developing children with bilateral normal hearing, aged 8 to 9 years old. Data were gathered using the Pediatric Malay Hearing in Noise Test (P-MyHINT) with speech presented from front and multi-talker babble presented from 90°, 180°, 270° azimuths in a sound treated booth. The results revealed that the use of either monaural or binaural ear level FM receivers provided significantly better mean RTSs than the no-FM condition (Pbinaural FM did not produce a significantly greater benefit in mean RTS than monaural fitting. The benefit of binaural over monaural FM varies across individuals; while binaural fitting provided better RTSs in about 50% of study subjects, there were those in whom binaural fitting resulted in either deterioration or no additional improvement compared to monaural FM fitting. The present study suggests that the use of monaural ear-level FM receivers in children with normal hearing might provide similar benefit as binaural use. Individual subjects' variations of binaural FM benefit over monaural FM suggests that the decision to employ monaural or binaural fitting should be individualized. It should be noted however, that the current study recruits typically developing normal hearing children. Future studies involving normal hearing children with high risk of having difficulty listening in noise is indicated to see if similar findings are obtained.

  3. Benefits of Whole-Body Vibration with an Oscillating Platform for People with Multiple Sclerosis: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Sebastião David Santos-Filho

    2012-01-01

    Full Text Available The objective of this work was to investigate the effects of whole-body vibration on people with multiple sclerosis (MS. PubMed, CINAHL and Scopus databases were systematically searched for studies on the use of whole-body vibration (WBV exercise in people with MS. These searches were supplemented with material identified in the references and in the authors’ personal files. A qualitative analysis was performed to summarize the findings. Five studies with a total of seventy-one subjects were identified. All of these studies had small numbers of subjects (3–25, and two of the studies had no control groups. Some investigations have shown significant improvements of the muscle strength, of the functional mobility, and of the timed get up and go test in patients with MS. The number of publications found in the databanks searched is small, and in general, they have limitations in the design of protocols with a weakness to the interpretation of the findings. However, the analysis of the findings in these studies permits to conclude that some papers indicate that WBV exercises could benefit patients with MS. In addition, we suggest further larger scale investigations with controlled parameters and well-designed protocols into the effects of WBV exercises in people with MS.

  4. Novel Control Strategy for Multiple Run-of-the-River Hydro Power Plants to Provide Grid Ancillary Services

    Energy Technology Data Exchange (ETDEWEB)

    Mohanpurkar, Manish; Luo, Yusheng; Hovsapian, Rob; Muljadi, Eduard; Gevorgian, Vahan; Koritarov, Vladimir

    2017-07-12

    Hydropower plant (HPP) generation comprises a considerable portion of bulk electricity generation and is delivered with a low-carbon footprint. In fact, HPP electricity generation provides the largest share from renewable energy resources, which include wind and solar. Increasing penetration levels of wind and solar lead to a lower inertia on the electric grid, which poses stability challenges. In recent years, breakthroughs in energy storage technologies have demonstrated the economic and technical feasibility of extensive deployments of renewable energy resources on electric grids. If integrated with scalable, multi-time-step energy storage so that the total output can be controlled, multiple run-of-the-river (ROR) HPPs can be deployed. Although the size of a single energy storage system is much smaller than that of a typical reservoir, the ratings of storages and multiple ROR HPPs approximately equal the rating of a large, conventional HPP. This paper proposes cohesively managing multiple sets of energy storage systems distributed in different locations. This paper also describes the challenges associated with ROR HPP system architecture and operation.

  5. Impacts of a new insurance benefit with capitated provider payment on healthcare utilization, expenditure and quality of medication prescribing in China.

    Science.gov (United States)

    Sun, Jing; Zhang, Xiaotian; Zhang, Zou; Wagner, Anita K; Ross-Degnan, Dennis; Hogerzeil, Hans V

    2016-02-01

    To assess a new Chinese insurance benefit with capitated provider payment for common diseases in outpatients. Longitudinal health insurance claims data, health administrative data and primary care facility data were used to assess trajectories in outpatient visits, inpatient admissions, expenditure per common disease outpatient (CD/OP) visit and prescribing indicators over time. We conducted segmented regression analyses of interrupted time series data to measure changes in level and trend overtime, and cross-sectional comparisons against external standards. The number of total outpatient visits at 46 primary care facilities (on the CD/OP benefit as of July 2012) increased by 46 895 visits/month (P = 0.004, 95% CI: 15 795-77 994); the average number of CD/OP visits reached 1.84/year/enrollee in 2012; monthly inpatient admissions dropped from 6.4 (2009) to 4.3 (2012) per 1000 enrollees; the median total expenditure per CD/OP visit dropped by CNY 15.40 (P = 0.16, 95% CI: -36.95~6.15); injectable use dropped by 7.38% (P = 0.03, 95% CI: -14.08%~-0.68%); antibiotic use was not improved. Zhuhai's new CD/OP benefit with capitated provider payment has expanded access to primary care, which may have led to a reduction in expensive specialist inpatient services for CD/OP benefit enrollees. Cost awareness was likely raised, and rapidly growing expenditures were contained. Although having been partially improved, inappropriate prescribing of antibiotics and injectables was still prevalent. More explicit incentives and specific quality of care targets must be incorporated into the capitated provider payment to promote scientifically sound and cost-effective care and treatment. © 2015 John Wiley & Sons Ltd.

  6. Risks, Benefits, and Importance of Collecting Sexual Orientation and Gender Identity Data in Healthcare Settings: A Multi-Method Analysis of Patient and Provider Perspectives.

    Science.gov (United States)

    Maragh-Bass, Allysha C; Torain, Maya; Adler, Rachel; Schneider, Eric; Ranjit, Anju; Kodadek, Lisa M; Shields, Ryan; German, Danielle; Snyder, Claire; Peterson, Susan; Schuur, Jeremiah; Lau, Brandyn; Haider, Adil H

    2017-04-01

    Research suggests that LGBT populations experience barriers to healthcare. Organizations such as the Institute of Medicine recommend routine documentation of sexual orientation (SO) and gender identity (GI) in healthcare, to reduce LGBT disparities. We explore patient views regarding the importance of SO/GI collection, and patient and provider views on risks and benefits of routine SO/GI collection in various settings. We surveyed LGBT/non-LGBT patients and providers on their views on SO/GI collection. Weighted data were analyzed with descriptive statistics; content analysis was conducted with open-ended responses. One-half of the 1516 patients and 60% of 429 providers were female; 64% of patients and 71% of providers were White. Eighty percent of providers felt that collecting SO data would offend patients, whereas only 11% of patients reported that they would be offended. Patients rated it as more important for primary care providers to know the SO of all patients compared with emergency department (ED) providers knowing the SO of all patients (41.3% vs. 31.6%; P discrimination risk most frequently (49.7%; N = 781), whereas provider comments cited patient discomfort/offense most frequently (54.5%; N = 433). Patients see the importance of SO/GI more in primary care than ED settings. However, many LGBT patients seek ED care due to factors including uninsurance; therefore, the ED may represent an initial point of contact for SO/GI collection. Therefore, patient-centered approaches to collecting SO/GI are needed. Patients and providers differed in perceived risks and benefits to routine SO/GI collection. Provider training in LGBT health may address patients' bias/discrimination concerns, and ultimately reduce LGBT health disparities.

  7. Capturing the multiple benefits associated with nature-based solutions: lessons from natural flood management project in the Cotswolds, UK

    Science.gov (United States)

    Short, Chrisopher; Clarke, Lucy; Uttley, Chris; Smith, Brian

    2017-04-01

    co-management and suggest how this type of framework is suitable for a range of nature-based solutions across Europe. However, the challenge remains of capturing the multiple-benefits that such projects offer as these are often missed through conventional approaches such as cost-benefit analysis and some reflections on this will also be presented along with a potential way forward.

  8. Switching to Multiple Daily Insulin Injections in Children and Adolescents with Type 1 Diabetes: Revisiting Benefits from Oman

    Directory of Open Access Journals (Sweden)

    SW Sharef

    2015-03-01

    Full Text Available Objectives: Optimal glycemic control is an important goal in the management of type 1 diabetes mellitus (T1DM. Although the use of multiple daily injections (MDI is a common regimen worldwide, its use is not yet universal in many countries. Our aim was to evaluate the effects of switching from a twice daily (BID to a MDI insulin regimen in children and adolescents with T1DM in order to revisit its benefits in the Omani population. Methods: We conducted a retrospective cohort study of children and adolescents with T1DM at Sultan Qaboos University Hospital, Muscat, Oman, between January 2007 and June 2013. Patients using the BID regimen for more than six months who were then switched to MDI were included in the analysis. We compared glycated hemoglobin levels (HbA1c before and after the regimen change. Results: Fifty-three children were eligible for the study. Ten patients were excluded for various reasons. The remaining 43 patients were 58% male and 42% female, with a mean age of 9.4±3.7 years. There was significant decrease in the overall mean HbA1c level from baseline (10.0 compared to three months after switching to MDI (9.5; p=0.023. Nevertheless, the improvement was not significant in the subsequent follow-up visits at six and nine months. The reduction in HbA1c values was observed mainly in children five to 11 years. Conclusions: Switching from a BID to MDI insulin regimen has favorable effects on the overall control of T1DM in children and adolescents, as assessed by HbA1c levels. In addition, this regimen has been proved to be safe and well tolerated by patients.

  9. Benefits and challenges of using the cohort multiple randomised controlled trial design for testing an intervention for depression.

    Science.gov (United States)

    Viksveen, Petter; Relton, Clare; Nicholl, Jon

    2017-07-06

    Trials which test the effectiveness of interventions compared with the status quo frequently encounter challenges. The cohort multiple randomised controlled trial (cmRCT) design is an innovative approach to the design and conduct of pragmatic trials which seeks to address some of these challenges. In this article, we report our experiences with the first completed randomised controlled trial (RCT) using the cmRCT design. This trial-the Depression in South Yorkshire (DEPSY) trial-involved comparison of treatment as usual (TAU) with TAU plus the offer of an intervention for people with self-reported long-term moderate to severe depression. In the trial, we used an existing large population-based cohort: the Yorkshire Health Study. We discuss our experiences with recruitment, attrition, crossover, data analysis, generalisability of results, and cost. The main challenges in using the cmRCT design were the high crossover to the control group and the lower questionnaire response rate among patients who refused the offer of treatment. However, the design did help facilitate efficient and complete recruitment of the trial population as well as analysable data that were generalisable to the population of interest. Attrition rates were also smaller than those reported in other depression trials. This first completed full trial using the cmRCT design testing an intervention for self-reported depression was associated with a number of important benefits. Further research is required to compare the acceptability and cost effectiveness of standard pragmatic RCT design with the cmRCT design. ISRCTN registry: ISRCTN02484593 . Registered on 7 Jan 2013.

  10. Spirituality and positive psychology go hand in hand: an investigation of multiple empirically derived profiles and related protective benefits.

    Science.gov (United States)

    Barton, Yakov A; Miller, Lisa

    2015-06-01

    We investigate the relationship between personal spirituality and positive psychology traits as potentially presented in multiple profiles, rather than monolithically across a full sample. A sample of 3966 adolescents and emerging adults (aged 18-25, mean = 20.19, SD = 2.08) and 2014 older adults (aged 26-82, mean = 38.41, SD = 11.26) completed a survey assessing daily spiritual experiences (relationship with a Higher Power and sense of a sacred world), forgiveness, gratitude, optimism, grit, and meaning. To assess the relative protective benefits of potential profiles, we also assessed the level of depressive symptoms and frequency of substance use (tobacco, marijuana, alcohol, and heavy alcohol use). Latent class analysis (LCA) was used to examine common subgroupings of study participants across report on personal spirituality and positive psychology scales in each age cohort, with potential difference between latent classes then tested in level of depressive symptoms and degree of substance use. LCA determined a four-class and a three-class best-fitting models for the younger and older cohorts, respectively. Level of personal spirituality and level of positive psychology traits were found to coincide in 83 % of adolescents and emerging adults and in 71 % of older adults, suggesting personal spirituality and positive psychology traits go hand in hand. A minority subgroup of "virtuous humanists" showed high levels of positive psychology traits but low levels of personal spirituality, across both age cohorts. Whereas level of depression was found to be inversely associated with positive psychology traits and personal spirituality, uniquely personal spirituality was protective against degree of substance use across both age cohorts. Overall interpretation of the study findings suggests that personal spirituality may be foundational to positive psychology traits in the majority of people.

  11. Multiple benefits of manure: the key to maintenance of soil fertility and restoration of depleted sandy soils on African smallholder farms

    NARCIS (Netherlands)

    Zingore, S.; Delve, R.J.; Nyamangara, J.; Giller, K.E.

    2008-01-01

    Manure is a key nutrient resource on smallholder farms in the tropics, especially on poorly buffered sandy soils, due to its multiple benefits for soil fertility. Farmers preferentially apply manure to fields closest to homesteads (homefields), which are more fertile than fields further away

  12. MP2RAGE provides new clinically-compatible correlates of mild cognitive deficits in relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Simioni, Samanta; Amarù, Fabio; Bonnier, Guillaume; Kober, Tobias; Rotzinger, David; Du Pasquier, Renaud; Schluep, Myriam; Meuli, Reto; Sbarbati, Andrea; Thiran, Jean-Philippe; Krueger, Gunnar; Granziera, Cristina

    2014-08-01

    Despite that cognitive impairment is a known early feature present in multiple sclerosis (MS) patients, the biological substrate of cognitive deficits in MS remains elusive. In this study, we assessed whether T1 relaxometry, as obtained in clinically acceptable scan times by the recent Magnetization Prepared 2 Rapid Acquisition Gradient Echoes (MP2RAGE) sequence, may help identifying the structural correlate of cognitive deficits in relapsing-remitting MS patients (RRMS). Twenty-nine healthy controls (HC) and forty-nine RRMS patients underwent high-resolution 3T magnetic resonance imaging to obtain optimal cortical lesion (CL) and white matter lesion (WML) count/volume and T1 relaxation times. T1 z scores were then obtained between T1 relaxation times in lesion and the corresponding HC tissue. Patient cognitive performance was tested using the Brief Repeatable Battery of Neuro-psychological Tests. Multivariate analysis was applied to assess the contribution of MRI variables (T1 z scores, lesion count/volume) to cognition in patients and Bonferroni correction was applied for multiple comparison. T1 z scores were higher in WML (p memory; (2) T1 z scores in CL-I (β = 0.3; p = 0.03) were independent determinants of long-term memory storage, and (3) lesion volume did not significantly influenced cognitive performances in patients. Our study supports evidence that T1 relaxometry from MP2RAGE provides information about microstructural properties in CL and WML and improves correlation with cognition in RRMS patients, compared to conventional measures of disease burden.

  13. The route of HIV escape from immune response targeting multiple sites is determined by the cost-benefit tradeoff of escape mutations.

    Science.gov (United States)

    Batorsky, Rebecca; Sergeev, Rinat A; Rouzine, Igor M

    2014-10-01

    Cytotoxic T lymphocytes (CTL) are a major factor in the control of HIV replication. CTL arise in acute infection, causing escape mutations to spread rapidly through the population of infected cells. As a result, the virus develops partial resistance to the immune response. The factors controlling the order of mutating epitope sites are currently unknown and would provide a valuable tool for predicting conserved epitopes. In this work, we adapt a well-established mathematical model of HIV evolution under dynamical selection pressure from multiple CTL clones to include partial impairment of CTL recognition, [Formula: see text], as well as cost to viral replication, [Formula: see text]. The process of escape is described in terms of the cost-benefit tradeoff of escape mutations and predicts a trajectory in the cost-benefit plane connecting sequentially escaped sites, which moves from high recognition loss/low fitness cost to low recognition loss/high fitness cost and has a larger slope for early escapes than for late escapes. The slope of the trajectory offers an interpretation of positive correlation between fitness costs and HLA binding impairment to HLA-A molecules and a protective subset of HLA-B molecules that was observed for clinically relevant escape mutations in the Pol gene. We estimate the value of [Formula: see text] from published experimental studies to be in the range (0.01-0.86) and show that the assumption of complete recognition loss ([Formula: see text]) leads to an overestimate of mutation cost. Our analysis offers a consistent interpretation of the commonly observed pattern of escape, in which several escape mutations are observed transiently in an epitope. This non-nested pattern is a combined effect of temporal changes in selection pressure and partial recognition loss. We conclude that partial recognition loss is as important as fitness loss for predicting the order of escapes and, ultimately, for predicting conserved epitopes that can be

  14. Spearfishing regulation benefits artisanal fisheries: the ReGS indicator and its application to a multiple-use Mediterranean marine protected area.

    Directory of Open Access Journals (Sweden)

    Delphine Rocklin

    Full Text Available The development of fishing efficiency coupled with an increase of fishing effort led to the overexploitation of numerous natural marine resources. In addition to this commercial pressure, the impact of recreational activities on fish assemblages remains barely known. Here we examined the impact of spearfishing limitation on resources in a marine protected area (MPA and the benefit it provides for the local artisanal fishery through the use of a novel indicator. We analysed trends in the fish assemblage composition using artisanal fisheries data collected in the Bonifacio Strait Natural Reserve (BSNR, a Mediterranean MPA where the spearfishing activity has been forbidden over 15% of its area. Fish species were pooled into three response groups according to their target level by spearfishing. We developed the new flexible ReGS indicator reflecting shifts in species assemblages according to the relative abundance of each response group facing external pressure. The catch per unit effort (CPUE increased by ca. 60% in the BSNR between 2000 and 2007, while the MPA was established in 1999. The gain of CPUE strongly depended on the considered response group: for the highly targeted group, the CPUE doubled while the CPUE of the untargeted group increased by only 15.5%. The ReGS value significantly increased from 0.31 to 0.45 (on a scale between 0 and 1 in the general perimeter of this MPA while it has reached a threshold of 0.43, considered as a reference point, in the area protected from spearfishing since 1982. Our results demonstrated that limiting recreational fishing by appropriate zoning in multiple-use MPAs represents a real benefit for artisanal fisheries. More generally we showed how our new indicator may reveal a wide range of impacts on coastal ecosystems such as global change or habitat degradation.

  15. [Duties of institutions and heads of health care centers in the area of infection control, information, assessment, registration and financing of benefits provided to TB patients].

    Science.gov (United States)

    Zielonka, Tadeusz M

    2015-01-01

    The Act on preventing and counteracting infections and infectious diseases in humans effective in Poland requires the heads of health care outlets and institutions to counteract spreading of TB in units under their management. They are, by all means, responsible for monitoring infections in their respective units, including development, implementation and monitoring of the implementation of procedures into practice, aiming at limiting the dissemination of TB in hospitals and outpatient clinics. Medical service unit managers are also responsible for providing members of their staff with means of individual protection against infection with Mycobacterium tuberculosis bacillus. Their duties also include reporting all of the recognized TB cases in their respective units. TB is an infectious diseases included in the occupational disease list. Assessment of TB as an occupational disease is the responsibility of provincial TB prevention clinics. The Act also provides principles of financing of individual benefits available for the insured TB patients as well as those not insured.

  16. Applying Multiple Criteria Decision Analysis to Comparative Benefit-Risk Assessment : Choosing among Statins in Primary Prevention

    NARCIS (Netherlands)

    Tervonen, Tommi; Naci, Huseyin; van Valkenhoef, Gert; Ades, Anthony E.; Angelis, Aris; Hillege, Hans L.; Postmus, Douwe

    2015-01-01

    Decision makers in different health care settings need to weigh the benefits and harms of alternative treatment strategies. Such health care decisions include marketing authorization by regulatory agencies, practice guideline formulation by clinical groups, and treatment selection by prescribers and

  17. External muscle heating during warm-up does not provide added performance benefit above external heating in the recovery period alone.

    Science.gov (United States)

    Faulkner, Steve H; Ferguson, Richard A; Hodder, Simon G; Havenith, George

    2013-11-01

    Having previously shown the use of passive external heating between warm-up completion and sprint cycling to have had a positive effect on muscle temperature (T m) and maximal sprint performance, we sought to determine whether adding passive heating during active warm up was of further benefit. Ten trained male cyclists completed a standardised 15 min sprint based warm-up on a cycle ergometer, followed by 30 min passive recovery before completing a 30 s maximal sprint test. Warm up was completed either with or without additional external passive heating. During recovery, external passive leg heating was used in both standard warm-up (CONHOT) and heated warm-up (HOTHOT) conditions, for control, a standard tracksuit was worn (CON). T m declined exponentially during CON, CONHOT and HOTHOT reduced the exponential decline during recovery. Peak (11.1 %, 1561 ± 258 W and 1542 ± 223 W), relative (10.6 % 21.0 ± 2.2 W kg(-1) and 20.9 ± 1.8 W kg(-1)) and mean (4.1 %, 734 ± 126 W and 729 ± 125 W) power were all improved with CONHOT and HOTHOT, respectively compared to CON (1,397 ± 239 W; 18.9 ± 3.0 W kg(-1) and 701 ± 109 W). There was no additional benefit of HOTHOT on T m or sprint performance compared to CONHOT. External heating during an active warm up does not provide additional physiological or performance benefit. As noted previously, external heating is capable of reducing the rate of decline in T m after an active warm-up, improving subsequent sprint cycling performance.

  18. Novel VEGF decoy receptor fusion protein conbercept targeting multiple VEGF isoforms provide remarkable anti-angiogenesis effect in vivo.

    Directory of Open Access Journals (Sweden)

    Qin Wang

    Full Text Available VEGF family factors are known to be the principal stimulators of abnormal angiogenesis, which play a fundamental role in tumor and various ocular diseases. Inhibition of VEGF is widely applied in antiangiogenic therapy. Conbercept is a novel decoy receptor protein constructed by fusing VEGF receptor 1 and VEGF receptor 2 extracellular domains with the Fc region of human immunoglobulin. In this study, we systematically evaluated the binding affinity of conbercept with VEGF isoforms and PlGF by using anti-VEGF antibody (Avastin as reference. BIACORE and ELISA assay results indicated that conbercept could bind different VEGF-A isoforms with higher affinity than reference. Furthermore, conbercept could also bind VEGF-B and PlGF, whereas Avastin showed no binding. Oxygen-induced retinopathy model showed that conbercept could inhibit the formation of neovasularizations. In tumor-bearing nude mice, conbercept could also suppress tumor growth very effectively in vivo. Overall, our study have demonstrated that conbercept could bind with high affinity to multiple VEGF isoforms and consequently provide remarkable anti-angiogenic effect, suggesting the possibility to treat angiogenesis-related diseases such as cancer and wet AMD etc.

  19. Multidimensional cost-benefit analysis to guide evidence-based environmental enrichment: providing bedding and foraging substrate to pen-housed monkeys.

    Science.gov (United States)

    Bennett, Allyson J; Corcoran, Christopher A; Hardy, Vickie A; Miller, Leslie R; Pierre, Peter J

    2010-09-01

    Refinement of animal care and housing is an important shared goal-and challenge-of the team of research, veterinary, and animal care personnel charged with ensuring the wellbeing of laboratory animals. This study addresses 2 issues central to decision-making and implementation of environmental enhancement: methods for useful and comprehensive cost analysis and evaluation of engineering, husbandry, and facilities considerations. The study was undertaken to analyze the feasibility and cost of providing wood shavings as a floor cover for pen-housed monkeys. The beneficial effects of bedding for the welfare of laboratory-housed animals have long been validated. Our study illustrates a workable team-based procedure for comprehensive cost analysis of an important environmental enhancement and demonstrates that the animal welfare benefit is accompanied by decreased husbandry costs. An engineering solution to the potential challenge that wood shavings pose in terms of clogging water pipes was successful. Another successful outcome was the reduction in water (estimated at 192,000 gal annually) and chemicals used to clean housing areas. Emphasis on rigorous evaluation and objective measures of cost and benefit, as well as inclusion of the many factors and teams involved in animal research, holds strong potential for building a better foundation from which to contribute effective changes and improvements in laboratory animal welfare. Taken together, the findings of this study demonstrate that team-based, integrative, and scientific evaluation of environmental enhancement is an effective approach to guide selection of strategies with maximal potential for improving animal welfare.

  20. Research Ethics Committees and the Benefits of Involving People with Profound and Multiple Learning Disabilities in Research

    Science.gov (United States)

    Boxall, Kathy; Ralph, Sue

    2011-01-01

    Although there is increasing interest in service user involvement in research, such involvement rarely extends to people with profound and multiple learning disabilities. New developments in visual methodologies offer the potential for people with profound and multiple learning disabilities to be included in research. At the same time, however,…

  1. Economic Benefits of Green Infrastructure in Lancaster PA

    Science.gov (United States)

    This document outlines technical assistance for demonstrating how accounting for the multiple benefits of green infrastructure can provide a more complete assessment of infrastructure and community investments.

  2. The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction.

    Science.gov (United States)

    Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O'Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

    2017-01-01

    Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.

  3. Which walking capacity tests to use in multiple sclerosis? A multicentre study providing the basis for a core set.

    Science.gov (United States)

    Gijbels, Domien; Dalgas, Ulrik; Romberg, Anders; de Groot, Vincent; Bethoux, Francois; Vaney, Claude; Gebara, Benoit; Medina, Carme Santoyo; Maamâgi, Heigo; Rasova, Kamila; de Noordhout, Benoit Maertens; Knuts, Kathy; Feys, Peter

    2012-03-01

    Many different walking capacity test formats are being used. It is unclear whether walking speed, obtained from short tests, and walking distance, obtained from long tests, provide different clinical information. To determine the differential effect of various short and long walk test formats on gait velocity, and the actual relationship between walking speed and walking distance in multiple sclerosis (MS) patients with diverse ambulation status. A cross-sectional multicentre study design was applied. Ambulatory MS patients (Expanded Disability Status Scale (EDSS) 0-6.5; n = 189) were tested at 11 sites. Short tests consisted of the Timed 25-Foot Walk (static start, fastest speed) and 10-Metre Walk Test (dynamic start, usual and fastest speed). Long tests consisted of the 2- and 6-Minute Walk Tests (fastest speed). Subjects were divided into mild (EDSS 0-4; n = 99) or moderate (EDSS 4.5-6.5; n = 79) disability subgroups. In both subgroups, the start protocol, instructed pace and length of test led to significantly different gait velocities. Fastest walking speed and 6-Minute walking distance showed the strongest correlation (R (2) = 0.78 in mild and R (2) = 0.81 in moderate MS; p tests' relative estimation errors for 6-Minute walking distance were 8-12% in mildly and 15-16% in moderately affected subjects. Based on the 2-Minute Walk Test, estimation errors significantly reduced to approximately 5% in both subgroups. A single short test format at fastest speed accurately describes an MS patient's general walking capacity. For intervention studies, a long test is to be considered. We propose the Timed 25-Foot Walk and 2-Minute Walk Test as standards. Further research on responsiveness is needed.

  4. The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

    Science.gov (United States)

    Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O’Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

    2017-01-01

    Background Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Conclusion Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment. PMID:28053511

  5. Multidimensional Cost–Benefit Analysis to Guide Evidence-Based Environmental Enrichment: Providing Bedding and Foraging Substrate to Pen-Housed Monkeys

    Science.gov (United States)

    Bennett, Allyson J; Corcoran, Christopher A; Hardy, Vickie A; Miller, Leslie R; Pierre, Peter J

    2010-01-01

    Refinement of animal care and housing is an important shared goal—and challenge—of the team of research, veterinary, and animal care personnel charged with ensuring the wellbeing of laboratory animals. This study addresses 2 issues central to decision-making and implementation of environmental enhancement: methods for useful and comprehensive cost analysis and evaluation of engineering, husbandry, and facilities considerations. The study was undertaken to analyze the feasibility and cost of providing wood shavings as a floor cover for pen-housed monkeys. The beneficial effects of bedding for the welfare of laboratory-housed animals have long been validated. Our study illustrates a workable team-based procedure for comprehensive cost analysis of an important environmental enhancement and demonstrates that the animal welfare benefit is accompanied by decreased husbandry costs. An engineering solution to the potential challenge that wood shavings pose in terms of clogging water pipes was successful. Another successful outcome was the reduction in water (estimated at 192,000 gal annually) and chemicals used to clean housing areas. Emphasis on rigorous evaluation and objective measures of cost and benefit, as well as inclusion of the many factors and teams involved in animal research, holds strong potential for building a better foundation from which to contribute effective changes and improvements in laboratory animal welfare. Taken together, the findings of this study demonstrate that team-based, integrative, and scientific evaluation of environmental enhancement is an effective approach to guide selection of strategies with maximal potential for improving animal welfare. PMID:20858357

  6. Experiences with provider and parental attitudes and practices regarding the administration of multiple injections during infant vaccination visits: lessons for vaccine introduction.

    Science.gov (United States)

    Wallace, Aaron S; Mantel, Carsten; Mayers, Gill; Mansoor, Osman; Gindler, Jacqueline S; Hyde, Terri B

    2014-09-15

    An increasing proportion of childhood immunization visits include administration of multiple injections. Future introduction of vaccines to protect against multiple diseases will further increase the number of injections at routine immunization childhood visits, particularly in developing countries that are still scaling up introductions. Parental and healthcare provider attitudes toward multiple injections may affect acceptance of recommended vaccines, and understanding these attitudes may help to inform critical decisions about vaccine introduction. We conducted a systematic review of the literature to examine factors underlying reported parental and healthcare provider concerns and practices related to administration of multiple injections during childhood vaccination visits. Forty-four articles were identified; 42 (95%) were from high income countries, including 27 (61%) from the USA. Providers and parents report concerns about multiple injections, which tend to increase with increasing numbers of injections. Common parental and provider concerns included apprehension about the pain experienced by the child, worry about potential side effects, and uncertainty about vaccine effectiveness. Multiple studies reported that a positive provider recommendation to the parent and a high level of concern about the severity of the target disease were significantly associated with parental acceptance of all injections. Providers often significantly overestimated parental concerns about multiple injections. Providers may play a critical role in the decision for a child to receive all recommended injections. Their overestimation of parental concerns may lead them to postpone recommended vaccinations, which may result in extra visits and delayed vaccination. More research is needed on interventions to overcome provider and parental concern about multiple injections, particularly in developing countries. Published by Elsevier Ltd.

  7. Multiple Recurrences in Aggressive Forms of Dupuytren?s Disease?Can Patients Benefit from Repeated Selective Fasciectomy?

    OpenAIRE

    K?nneker, S?ren; Broelsch, G. Felix; Krezdorn, Nicco; Dastagir, Khaled; Kuhbier, J?rn W.; Paprottka, Felix J.; Peter M Vogt

    2017-01-01

    Background: In Dupuytren?s disease (DD), limited fasciectomy is the mainstay of surgical therapy in patients at risk of contractures and disease recurrences. New minimally invasive treatments such as injection of collagenase clostridium histolyticum have evolved as a common tool for the preliminary treatment of Dupuytren?s contractures. However, recurrences and their therapy remain controversial. In this study, we evaluate the benefit of repeated limited fasciectomy in patients with aggressiv...

  8. Dual Blockade of HER-2 Provides a Greater Magnitude of Benefit in Patients With Hormone-Negative Versus Hormone-Positive Breast Cancer.

    Science.gov (United States)

    Abramovitz, Mark; Williams, Casey; Loibl, Sibylle; Leyland-Jones, Brian

    2016-12-01

    The dual small molecule tyrosine kinase inhibitor lapatinib blocks both human epidermal growth factor receptor (HER-1) and human epidermal growth factor receptor 2 (HER-2) tyrosine kinase activity by binding reversibly to the ATP-binding site of the receptor's intracellular domain. Lapatinib, in combination with capecitabine, has been approved in 2007 for the treatment of patients with advanced HER-2 + breast cancer upon progressive disease following standard chemotherapy. Approval was also extended to the treatment of postmenopausal women with advanced hormone receptor (HR)-positive and HER-2-positive breast cancer in 2010. More recently, clinical trials that have investigated the efficacy of dual HER-2 blockade in both the metastatic and neoadjuvant breast cancer settings. For example, in 2013 the European Medicines Agency approved the combination of lapatinib and trastuzumab in HER-2 + /HR - patients. We review the efficacy results from dual HER-2 blockade studies and present new post hoc analysis efficacy data according to HR status. We show that dual blockade of HER-2 appears to provide a greater magnitude of benefit in the HR - versus the HR + subgroup of patients. Finally, we examine the potential of molecularly subtyping HER-2 + tumors using the PAM50 test as a predictor of response to treatment with the combination of trastuzumab and lapatinib. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Estimating the Costs and Benefits of Providing Free Public Transit Passes to Students in Los Angeles County: Lessons Learned in Applying a Health Lens to Decision-Making

    Directory of Open Access Journals (Sweden)

    Lauren N. Gase

    2014-10-01

    Full Text Available In spite of increased focus by public health to engage and work with non-health sector partners to improve the health of the general as well as special populations, only a paucity of studies have described and disseminated emerging lessons and promising practices that can be used to undertake this work. This article describes the process used to conduct a Health Impact Assessment of a proposal to provide free public transportation passes to students in Los Angeles County. This illustrative case example describes opportunities and challenges encountered in working with an array of cross-sector partners and highlights four important lessons learned: (1 the benefits and challenges associated with broad conceptualization of public issues; (2 the need for more comprehensive, longitudinal data systems and dynamic simulation models to inform decision-making; (3 the importance of having a comprehensive policy assessment strategy that considers health impacts as well as costs and feasibility; and (4 the need for additional efforts to delineate the interconnectivity between health and other agency priorities. As public health advances cross-sector work in the community, further development of these priorities will help advance meaningful collaboration among all partners.

  10. [Analysis of state costs of the social security benefits provided to the insured presenting with lung cancer and pulmonary diseases caused by external factors].

    Science.gov (United States)

    Kuklińska-Janiak, Dorota

    2013-12-01

    Lung cancer and pneumoconioses constitute two serious problems of contemporary medicine and a public health system. To analyze the costs associated with social security benefits provided to the insured presenting with lung cancer and pulmonary diseases (including pneumoconioses) caused by external factors. The analysis was based on the data obtained from the Department of Statistics and Actuarial Forecasts of the Social Insurance Institution (SlI) in Warsaw. Structural diversity of the costs of the separate benefits available within the national health insurance system has been considered. Based on the data available in Poland costs associated with the incidence of lung cancer and pneumoconiosis were assessed taking into account sex and age of the insured as well as the administrative division of Poland. Additionally, mortality rates from the selected pulmonary diseases were analyzed. Costs of the pensions paid to the insured presenting with lung cancer amount to 81.11% of the total social security costs associated with these diseases, while the sick leave money paid to the insured lung cancer patients equal to 15.5% of the total costs. In the insured women, costs of the pensions paid due to occupational pulmonary diseases (predominantly pneumoconioses) constitute 41.1% and in the insured men--11.5% of the total 'occupational' pensions. Although the maximal incidence of lung cancer occurs in both men and women above their retirement ages the costs of the work incapacity pensions paid to lung cancer patients still exceed 81% of the total social security costs associated with these diseases. In the insured women, the cost of pensions paid due to occupational pulmonary diseases, most of which are pneumoconioses, ranks first among the costs of 'occupational' pensions received by these subjects, while in the insured men the respective cost ranks third (after injuries plus intoxications and cardiovascular diseases) among their 'occupational' pensions. Moreover, the

  11. Design of oral agents for the management of multiple sclerosis: benefit and risk assessment for dimethyl fumarate

    Directory of Open Access Journals (Sweden)

    Nicholas JA

    2014-07-01

    Full Text Available Jacqueline Ann Nicholas,1 Aaron Lee Boster,1 Jaime Imitola,1,2 Colleen O’Connell,1 Michael Karl Racke1,21Department of Neurology and Multiple Sclerosis Center, 2Department of Neuroscience, The Ohio State University, Columbus, OH, USAAbstract: Dimethyl fumarate (DMF is the most recent oral disease-modifying therapy approved by the US Food and Drug Administration and is indicated for the treatment of relapsing forms of multiple sclerosis (MS. Prior to approval for use in MS, DMF and its active metabolite, monomethyl fumarate, had been used for decades as two of the fumaric acid esters in Fumaderm®, a medication used in Europe for the treatment of psoriasis. The unique mechanism of action of DMF remains under evaluation; however, it has been shown to act through multiple pathways leading to shifts away from the Th1 proinflammatory response to the less inflammatory Th2 response. Preliminary data suggest that DMF may induce neuroprotective effects in central nervous system white matter, although further studies are needed to demonstrate these effects on inflammatory demyelination. The DMF Phase III clinical trials demonstrated its efficacy with regard to a reduction in the annualized relapse rate and reductions in new or enlarging T2 lesions and numbers of gadolinium-enhancing lesions on magnetic resonance imaging. DMF has a well-defined safety profile, given the experience with its use in the treatment of psoriasis, and more recently from the DMF clinical trials program and post-marketing era for treatment of MS. The safety profile and oral mode of administration of DMF place it as an attractive first-line therapy option for the treatment of relapsing forms of MS. Long-term observational studies will be needed to determine the effects of DMF on progression of disability in MS.Keywords: multiple sclerosis, dimethyl fumarate, disease-modifying therapy, Nrf2 pathway, quality of life

  12. Hospital readmission after multiple major operative procedures among patients with employer provided health insurance.

    Science.gov (United States)

    Kim, Yuhree; Gani, Faiz; Canner, Joseph K; Margonis, Georgios A; Makary, Martin A; Schneider, Eric B; Pawlik, Timothy M

    2016-07-01

    Most studies report data only on readmission within 30 days of discharge from the same hospital following a single procedure. We sought to define the incidence of early versus late hospital readmission among patients undergoing multiple major operative procedures. Patients were identified using the MarketScan database from 2010-2012. Multivariable logistic regression analysis was performed to identify factors associated with early (≤30 days) versus late readmission (31-90 days) among patients who underwent multiple operative procedures. A total of 194,111 patients were identified of whom 63.2% (n = 122,660) underwent an abdominal procedure (esophagectomy, pancreatectomy, hepatectomy, colectomy, lung resection, and gastrectomy), while the remaining 71,451 (36.8%) patients underwent a cardiovascular procedure (repair of abdominal aortic aneurysm, coronary-artery bypass grafting, carotid endarterectomy, and mitral/aortic valve replacement). A total of 3,444 patients underwent >1 simultaneous procedure (abdominal: 885, 0.7%; cardiovascular: 2,559, 3.6%). The overall incidence of 90-day readmission was 15.6% (n = 30,309); 9.6% of patients were readmitted early, while 6.0% of patients were readmitted late. Readmission was higher among patients undergoing multiple procedures (21.8% vs 15.5%; P 15% of patients being readmitted within 90 days of index discharge. Compared with patients undergoing a single operative procedure, patients undergoing multiple operative procedures demonstrated an increased risk for readmission within 90 days of discharge and were more likely to be readmitted within 30 days of index discharge. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Hypothesizing that a Pro-Dopaminergic Regulator (KB220z(™) Liquid Variant) can Induce "Dopamine Homeostasis" and Provide Adjunctive Detoxification Benefits in Opiate/Opioid Dependence.

    Science.gov (United States)

    Blum, Kenneth; Whitney, Debra; Fried, Lye; Febo, Marcelo; Waite, Roger L; Braverman, Eric R; Dushaj, Kristina; Li, Mona; Giordano, John; Demetrovics, Zsolt; Badgaiyan, Rajendra D

    2016-01-01

    In order to explore the initiation of detoxification of addictive patients to opiates/opioids (along with some other anti-withdrawal agents), we developed a protocol to be utilized in treatment centers particularly with heavily dependent opiate/opioid subjects. Out of 17 subjects, only three received Buprenorphine/Naloxone (Bup/nx) along with KB220Z. In this pilot, we first used a dose of KB220Z of 2 oz twice daily before meals along with clonidine and benzodiazepines and other anti-nausea and sleep aids including Gabapentin. The dose of KB220Z was maintained for 6 days in five individuals. In a second scenario, we utilized a higher dose of 4 oz every 6 hours, over a 6-day period. The higher dose was employed in another 12 patients. It is noteworthy that only 3 people have relapsed utilizing these two protocols during the first two weeks of the study, allowing for the remaining 82% to be maintained on KB220Z. The patients have been maintained without any additional Bup/nx for a minimum of 120 days and in one subject, 214 days. We are in the process of testing this hypothesis in multiple treatment centers across the United Sates utilizing data from the Clinical opiate Withdrawal Scale (COWS) pre and post KB220Z. We are in the process of testing this hypothesis in multiple treatment centers across the United Sates. While this does not constitute an acceptable controlled experiment, it does provide some preliminary evidence that agrees with an earlier study. Moreover, because of the utilization of standard detoxifying agents in this detoxification protocol, we cannot make any inference to KB220Z's effects. However, out of 17 subjects, only three required Bup/nx suggesting an interesting finding. If further confirmed in larger studies, the utilization for opiate/opioid detoxification may provide a novel way to eliminate the need for addictive opioids during withdrawal and detoxification. This paradigm shift may translate to a reduction in utilizing powerful and

  14. Assessing climate change impacts, benefits of mitigation, and uncertainties on major global forest regions under multiple socioeconomic and emissions scenarios

    Science.gov (United States)

    Kim, John B.; Monier, Erwan; Sohngen, Brent; Pitts, G. Stephen; Drapek, Ray; McFarland, James; Ohrel, Sara; Cole, Jefferson

    2017-04-01

    We analyze a set of simulations to assess the impact of climate change on global forests where MC2 dynamic global vegetation model (DGVM) was run with climate simulations from the MIT Integrated Global System Model-Community Atmosphere Model (IGSM-CAM) modeling framework. The core study relies on an ensemble of climate simulations under two emissions scenarios: a business-as-usual reference scenario (REF) analogous to the IPCC RCP8.5 scenario, and a greenhouse gas mitigation scenario, called POL3.7, which is in between the IPCC RCP2.6 and RCP4.5 scenarios, and is consistent with a 2 °C global mean warming from pre-industrial by 2100. Evaluating the outcomes of both climate change scenarios in the MC2 model shows that the carbon stocks of most forests around the world increased, with the greatest gains in tropical forest regions. Temperate forest regions are projected to see strong increases in productivity offset by carbon loss to fire. The greatest cost of mitigation in terms of effects on forest carbon stocks are projected to be borne by regions in the southern hemisphere. We compare three sources of uncertainty in climate change impacts on the world’s forests: emissions scenarios, the global system climate response (i.e. climate sensitivity), and natural variability. The role of natural variability on changes in forest carbon and net primary productivity (NPP) is small, but it is substantial for impacts of wildfire. Forest productivity under the REF scenario benefits substantially from the CO2 fertilization effect and that higher warming alone does not necessarily increase global forest carbon levels. Our analysis underlines why using an ensemble of climate simulations is necessary to derive robust estimates of the benefits of greenhouse gas mitigation. It also demonstrates that constraining estimates of climate sensitivity and advancing our understanding of CO2 fertilization effects may considerably reduce the range of projections.

  15. Calcium and cholecalciferol supplementation provides no added benefit to nutritional counseling to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL).

    Science.gov (United States)

    Kaste, S C; Qi, A; Smith, K; Surprise, H; Lovorn, E; Boyett, J; Ferry, R J; Relling, M V; Shurtleff, S A; Pui, C H; Carbone, L; Hudson, M M; Ness, K K

    2014-05-01

    We sought to improve lumbar spine bone mineral density (LS-BMD) in long-term survivors of childhood acute lymphoblastic leukemia (ALL) using calcium and cholecalciferol supplementation. This double-blind, placebo-controlled trial randomized 275 participants (median age, 17 [9-36.1] years) with age- and gender-specific LS-BMD Z-scores <0 to receive nutritional counseling with supplementation of 1,000 mg/day calcium and 800 International Unit cholecalciferol or placebo for 2 years. The primary outcome was change in LS-BMD assessed by quantitative computerized tomography (QCT) at 24 months. Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes. Pre-randomization LS-BMD below the mean was associated with male gender (P = 0.0024), White race (P = 0.0003), lower body mass index (P < 0.0001), and cumulative glucocorticoid doses of ≥ 5,000 mg (P = 0.0012). One hundred eighty-eight (68%) participants completed the study; 77% adhered to the intervention. Mean LS-BMD change did not differ between survivors randomized to supplements (0.33 ± 0.57) or placebo (0.28 ± 0.56). Participants aged 9-13 years and those 22-35 years had the greatest mean increases in LS-BMD (0.50 ± 0.66 and 0.37 ± 0.23, respectively). Vitamin D insufficiency (serum 25[OH]D <30 ng/ml) found in 296 (75%), was not associated with LS-BMD outcomes (P = 0.78). Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL (93% of whom had LS-BMD Z-scores above the mean at study entry). © 2014 Wiley Periodicals, Inc.

  16. Non-elastic taping, but not elastic taping, provides benefits for patients with knee osteoarthritis: systemic review and meta-analysis.

    Science.gov (United States)

    Ouyang, Jin-Han; Chang, Kwang-Hwa; Hsu, Wen-Yen; Cho, Yen-Ting; Liou, Tsan-Hon; Lin, Yen-Nung

    2017-06-01

    To determine whether therapeutic taping, which includes elastic (Kinesio tape) and non-elastic (Leukotape) taping, is superior to control taping in improving pain and functions for patients with knee arthritis. To understand whether both elastic and non-elastic taping are beneficial. We searched the PubMed and Scopus databases from their earliest record to 31 May 2017 for randomized controlled and cross-over studies that used taping to treat knee osteoarthritis. We extracted the mean differences and SD between baseline and posttreatment for selected outcomes measured in the experimental and control groups for subsequent meta-analyses. In total, 11 studies were included in the review. Of which, five Leukotaping and five Kinesio taping studies involving 379 participants were used in the meta-analysis. PEDro scores of the Leukotaping and Kinesio taping studies were 4.2 and 7.8, respectively. Overall, therapeutic taping exhibited significantly greater pain reduction than control taping with a significant weighted mean difference of 12.8 mm on a 0- to 100-mm visual analogue scale. Compared to control taping, Leukotaping produced a significant weighted mean difference of 11.6 mm regarding pain with a large effect size of 0.89 and I(2) = 0%, while Kinesio taping produced a non-significant weighted mean difference of 12.1 mm and I(2) = 93%. Leukotaping also exhibited a large and significant standard mean difference of 0.82, while Kinesio taping exhibited a non-significant standard mean difference of 1.34 regarding climbing stairs and stepping. Therapeutic taping seemed to be superior to control taping in pain control for knee osteoarthritis. Non-elastic taping, but not elastic taping, provides benefits in pain reduction and functional performance.

  17. Managing the critical zone to obtain and sustain multiple benefits from working landscapes: The value of partnerships between LTAR and NSF CZO networks

    Science.gov (United States)

    Lohse, K. A.; Seyfried, M. S.; Pierson, F. B.

    2015-12-01

    The Critical Zone Observatories add value to earth system science and society by addressing research gaps to understand the critical zone, the surface skin of the earth that extends from the top of the tree canopy to the lower limits of the groundwater. The Critical Zone (CZ) sustains life on earth and provides food, shelter, forage, and fuel and other services to human well-being. This Zone is also where most of human activities take place and thus subject to change and degradation. Managing the critical zone to obtain and sustain these services will require initiatives, policies and incentives that maintain and enhance this zone. The Critical Zone Observatories are seeking to address major gaps in understanding how earth surface evolves over time and how it will respond to future changes. Many of these gaps in our understanding occur at the interface between disciplines, across space and deep time scales, and multiple dimensions. For example, the Reynolds Creek CZO seeks to understand the role of soil environmental variables such as soil moisture and depth that vary across complex terrain in governing soil carbon storage and turnover in a semi-arid environment. For this reason, soil samples are being collected to depth of bedrock. Other networks and agencies such as the new LTAR and NEON are quantifying soil carbon at more shallow depths that will likely capture the variability in near surface soil carbon that is more sensitive to management and climate changes but may underestimate the total stores of carbon on the landscape. The CZOs also provide a platform to conduct interdisciplinary to transdisciplinary science by integrating across geological, soil, hydrologic, ecological, and social sciences to understand the critical zone. The emergence of the CZO Network and the LTAR network brings the opportunity to standardize methods and test hypotheses and ask questions across broad environmental conditions and gradients that could not be achieved with single

  18. Quantitative analysis of oyster larval proteome provides new insights into the effects of multiple climate change stressors

    KAUST Repository

    Dineshram, Ramadoss

    2016-03-19

    The metamorphosis of planktonic larvae of the Pacific oyster (Crassostrea gigas) underpins their complex life-history strategy by switching on the molecular machinery required for sessile life and building calcite shells. Metamorphosis becomes a survival bottleneck, which will be pressured by different anthropogenically induced climate change-related variables. Therefore, it is important to understand how metamorphosing larvae interact with emerging climate change stressors. To predict how larvae might be affected in a future ocean, we examined changes in the proteome of metamorphosing larvae under multiple stressors: decreased pH (pH 7.4), increased temperature (30 °C), and reduced salinity (15 psu). Quantitative protein expression profiling using iTRAQ-LC-MS/MS identified more than 1300 proteins. Decreased pH had a negative effect on metamorphosis by down-regulating several proteins involved in energy production, metabolism, and protein synthesis. However, warming switched on these down-regulated pathways at pH 7.4. Under multiple stressors, cell signaling, energy production, growth, and developmental pathways were up-regulated, although metamorphosis was still reduced. Despite the lack of lethal effects, significant physiological responses to both individual and interacting climate change related stressors were observed at proteome level. The metamorphosing larvae of the C. gigas population in the Yellow Sea appear to have adequate phenotypic plasticity at the proteome level to survive in future coastal oceans, but with developmental and physiological costs. © 2016 John Wiley & Sons Ltd.

  19. Healthy older observers show equivalent perceptual-cognitive training benefits to young adults for multiple object tracking

    Directory of Open Access Journals (Sweden)

    Isabelle eLegault

    2013-06-01

    Full Text Available The capacity to process complex dynamic scenes is of critical importance in real life. For instance, travelling through a crowd while avoiding collisions and maintaining orientation and good motor control requires fluent and continuous perceptual-cognitive processing. It is well documented that effects of healthy aging can influence perceptual-cognitive processes (Faubert, 2002 and that the efficiency of such processes can improve with training even for older adults (Richards et al., 2006. Here we assess the capacity of older observers to learn complex dynamic visual scenes by using the 3D-multiple object tracking speed threshold protocol (Faubert & Sidebottom, 2012. Results show that this capacity is significantly affected by healthy aging but that perceptual-cognitive training can significantly reduce age-related effects in older individuals, who show an identical learning function to younger healthy adults. Data support the notion that plasticity in healthy older persons is maintained for processing complex dynamic scenes.

  20. [A homeless, uninsured illegal alien suffering from psychosis and multiple fractures: providing efficient care to such patients].

    Science.gov (United States)

    van Mill, Josine G; van Laere, Igor R A L; Deunk, Jaap; Nauta, Klaas-Jan

    2015-01-01

    We present the case of a 37-year-old psychotic, homeless man from Albania, who sustained multiple fractures after jumping from a third-floor window. The patient was uninsured and did not consent to transfer to a hospital in Albania because of paranoid delusions. Eventually he was hospitalised for nearly 30 weeks in hospital and a nursing home. Various factors of this complex case are considered, such as the co-morbidity of somatic and psychiatric symptoms, the absence of family support and the financial regulations that apply to uninsured patients. Doctors who are presented with similar complex cases are advised to organise frequent multidisciplinary evaluations with all health care workers involved. We encourage searching for creative interventions which serve both the best interests of the individual patient, and - where possible - also minimize the total cost of health care to society.

  1. Improving Outcomes and Resource Use in Multiple Sclerosis: What are the Benefits Associated With an Early Treatment Strategy With Fingolimod?

    Directory of Open Access Journals (Sweden)

    João Carrasco

    2016-07-01

    Full Text Available Objective: This analysis aims to estimate the cost-effectiveness of early treatment versus delayed treatment with fingolimod 0.5 mg/day in patients with relapsing-remitting multiple sclerosis. Study Type: Economic evaluation of health technologies Local: Portugal Population: Multiple sclerosis patients (MS receiving treatment with fingolimod or interferon beta followed by fingolimod Methodology: A Microsoft Excel-based model was developed to estimate costs and health outcomes associated to two treatment strategies in MS: 1 early treatment with fingolimod -patients received treatment with 0.5 mg/day oral fingolimod continuously for 54 months; and 2 delayed treatment with fingolimod - patients received 12 months treatment with interferon beta-1a (IFN-β1a followed by an additional 42 months of treatment with fingolimod (total of 54 months. The model estimates the total number of relapses associated with the different treatment strategies, the total treatment costs and the cost per relapse avoided. Effectiveness data was derived from the annualized relapse rate of TRANSFORMS and its extension phase. Health care resource use and local clinical practice was estimated based in local experts’ opinion. The study adopted the hospital perspective and only direct medical costs were included. The analysis considered a time horizon of 54 months, and costs and outcomes were discounted at a yearly rate of 5%. Final results are presented as incremental cost-effectiveness ratio. One-way sensitivity analysis was conducted on key inputs to assess their impact on final incremental cost-effectiveness ratio. Results: For a hypothetical cohort of 100 patient’s early treatment with fingolimod was more effective in avoiding relapses when compared to delayed treatment, less 44 relapses (64.10 relapses versus 103.35 for 100 patients after 54 months. Early treatment was associated with incremental costs (€562,165 for 100 patients after 54 months. The incremental cost

  2. Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks

    Directory of Open Access Journals (Sweden)

    Raed Alroughani

    2016-01-01

    Full Text Available The burden of multiple sclerosis (MS in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs, which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-β appears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation.

  3. Maintenance and enhancement of long-term multiple socioeconomic benefits to meet the needs of societies. Criterion 6.

    Science.gov (United States)

    Ken Skog; James Howard; Susan Alexander; Ken Cordell; Marla Emery; Evan Mercer; Shela Mou; Kristen Magis; Maureen. McDonough

    2011-01-01

    This report provides a comprehensive picture of current conditions and trends in our Nation's forests, its forest industries, and its forest communities. Although the first five criteria are centered in the environmental sphere of sustainability (with the exception of Criterion 2, which clearly overlaps the economic sphere), Criterion 6 is centered firmly in the...

  4. Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections.

    Science.gov (United States)

    Holmes-Walker, Deborah Jane; Gunton, Jenny E; Hawthorne, Wayne; Payk, Marlene; Anderson, Patricia; Donath, Susan; Loudovaris, Tom; Ward, Glenn M; Kay, Thomas Wh; OʼConnell, Philip J

    2017-06-01

    The aim was to compare efficacy of multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) and islet transplantation to reduce hypoglycemia and glycemic variability in type 1 diabetes subjects with severe hypoglycemia. This was a within-subject, paired comparison of MDI and CSII and CSII with 12 months postislet transplantation in 10 type 1 diabetes subjects referred with severe hypoglycemia, suitable for islet transplantation. Individuals were assessed with HbA1c, Edmonton Hypoglycemia Score (HYPOscore), continuous glucose monitoring (CGM) and in 8 subjects measurements of glucose variability using standard deviation of glucose (SD glucose) from CGM and continuous overlapping net glycemic action using a 4 hour interval (CONGA4). After changing from MDI to CSII before transplantation, 10 subjects reduced median HYPOscore from 2028 to 1085 (P transplantation, there were significant reductions in all baseline parameters versus CSII, respectively, HbA1c (6.4% cf 8.2%), median HYPOscore (0 cf 1085), mean glucose (7.1 cf 8.6 mmol L), SD glucose (1.7 cf 3.2 mmol/L), and CONGA4 (1.6 cf 3.0). In subjects with severe hypoglycemia suitable for islet transplantation, CSII decreased hypoglycemia frequency and glycemic variability compared with MDI whereas islet transplantation resolved hypoglycemia and further improved glycemic variability regardless of insulin independence.

  5. Seasonal patterns in δ(2) H values of multiple tissues from Andean birds provide insights into elevational migration.

    Science.gov (United States)

    Villegas, Mariana; Newsome, Seth D; Blake, John G

    2016-12-01

    Elevational migration is a widespread phenomenon in tropical avifauna but it is difficult to identify using traditional approaches. Hydrogen isotope (δ(2) H) values of precipitation decrease with elevation so δ(2) H analysis of multiple bird tissues with different isotopic incorporation rates may be a reliable method for characterizing seasonal elevational migration. Here we compare δ(2) H values in metabolically inert (feathers and claws) and metabolically active (whole blood) tissues to examine whether an upslope migration occurs prior to the breeding season in the Yungas Manakin (Chiroxiphia boliviana). We compare results from C. boliviana with data from a known elevational migrant, the Streak-necked Flycatcher (Mionectes striaticollis). Opposite to our expectations, tissue δ(2) H values increased over time, largely reflecting seasonal patterns in precipitation δ(2) H rather than elevational effects; linear mixed-effects models with strongest support included ordinal date, tissue type, and elevation. This seasonal increase in precipitation δ(2) H is a general phenomenon in both tropical and temperate mountain ranges. We use these data to propose a hypothetical framework that predicts different patterns in tissue δ(2) H values collected in different seasons from residents and elevational migrants. This framework can serve as a reference for future studies that assess elevational migration in birds and other animals. © 2016 by the Ecological Society of America.

  6. Which walking capacity tests to use in multiple sclerosis? A multicentre study providing the basis for a core set

    NARCIS (Netherlands)

    Gijbels, D.; Dalgas, U.; Romberg, A.; de Groot, V.; Bethoux, F.; Vaney, C.; Gebara, B.; Santoyo, C.; Maamagi, H.; Rasova, K.; de Maertens, N.B.; Knuts, K.; Feys, P.

    2012-01-01

    Background: Many different walking capacity test formats are being used. It is unclear whether walking speed, obtained from short tests, and walking distance, obtained from long tests, provide different clinical information. Objectives: To determine the differential effect of various short and long

  7. Corporate e-Learning: Justification for Implementation and Evaluation of Benefits. A Study Examining the Views of Training Managers and Training Providers

    Science.gov (United States)

    Newton, Robert; Doonga, Nitin

    2007-01-01

    This study examines the experience and perceptions of training managers and training suppliers with respect to provision of e-training to corporate clients--a rapidly growing area of commercial activity. In particular the study explores the justification for implementing e-training and the consequent benefits which are anticipated by training…

  8. Mosasauroid phylogeny under multiple phylogenetic methods provides new insights on the evolution of aquatic adaptations in the group.

    Directory of Open Access Journals (Sweden)

    Tiago R Simões

    Full Text Available Mosasauroids were a successful lineage of squamate reptiles (lizards and snakes that radiated during the Late Cretaceous (95-66 million years ago. They can be considered one of the few lineages in the evolutionary history of tetrapods to have acquired a fully aquatic lifestyle, similarly to whales, ichthyosaurs and plesiosaurs. Despite a long history of research on this group, their phylogenetic relationships have only been tested so far using traditional (unweighted maximum parsimony. However, hypotheses of mosasauroid relationships and the recently proposed multiple origins of aquatically adapted pelvic and pedal features in this group can be more thoroughly tested by methods that take into account variation in branch lengths and evolutionary rates. In this study, we present the first mosasauroid phylogenetic analysis performed under different analytical methods, including maximum likelihood, Bayesian inference, and implied weighting maximum parsimony. The results indicate a lack of congruence in the topological position of halisaurines and Dallasaurus. Additionally, the genus Prognathodon is paraphyletic under all hypotheses. Interestingly, a number of traditional mosasauroid clades become weakly supported, or unresolved, under Bayesian analyses. The reduced resolutions in some consensus trees create ambiguities concerning the evolution of fully aquatic pelvic/pedal conditions under many analyses. However, when enough resolution was obtained, reversals of the pelvic/pedal conditions were favoured by parsimony and likelihood ancestral state reconstructions instead of independent origins of aquatic features in mosasauroids. It is concluded that most of the observed discrepancies among the results can be associated with different analytical procedures, but also due to limited postcranial data on halisaurines, yaguarasaurines and Dallasaurus.

  9. Large-scale GWAS identifies multiple loci for hand grip strength providing biological insights into muscular fitness

    DEFF Research Database (Denmark)

    Willems, Sara M; Wright, Daniel J.; Day, Felix R

    2017-01-01

    Hand grip strength is a widely used proxy of muscular fitness, a marker of frailty, and predictor of a range of morbidities and all-cause mortality. To investigate the genetic determinants of variation in grip strength, we perform a large-scale genetic discovery analysis in a combined sample of 195...... with involvement of psychomotor impairment (PEX14, LRPPRC and KANSL1). Mendelian randomization analyses are consistent with a causal effect of higher genetically predicted grip strength on lower fracture risk. In conclusion, our findings provide new biological insight into the mechanistic underpinnings of grip...

  10. A comparison of the aided performance and benefit provided by a linear and a two-channel wide dynamic range compression hearing aid.

    Science.gov (United States)

    Humes, L E; Christensen, L; Thomas, T; Bess, F H; Hedley-Williams, A; Bentler, R

    1999-02-01

    The aided performance and benefit achieved with linear and two-channel wide dynamic range compression (WDRC) in-the-canal (ITC) hearing aids were established in 55 individuals. Study participants had been wearing either linear or adaptive-frequency-response (Bass Increase at Low Levels, BILL) ITC hearing aids for approximately one year before participation in this study. Outcome measures included aided performance and objective benefit in quiet and noise at a variety of speech levels (50, 60, and 75 dB SPL), at various levels of babble background (quiet, signal-to-babble ratios of +5 and +10 dB), and for various types of test materials (monosyllabic words and sentences in connected speech). Several subjective measures of aided performance (sound-quality judgments and magnitude estimates of listening effort) and relative benefit (improvement in listening effort and the Hearing Aid Performance Inventory, HAPI) were also obtained. Finally, self-report measures of hearing-aid use were also obtained using daily logs. Participants completed all outcome measures for the linear ITC hearing aids first, following 2 months of usage, and then repeated all outcome measures for the WDRC instruments after a subsequent 2-month period of use. In general, although both types of hearing aids demonstrated significant benefit, the results indicated that the WDRC instruments were superior to the linear devices for many of the outcome measures. This tended to be the case most frequently when low speech levels were used. Many of the performance differences between devices most likely can be ascribed to differences in gain, and prescriptive approaches (DSL[i/o] vs. NAL-R), for the fixed volume control testing performed in this study.

  11. The two faces of L-DOPA: benefits and adverse side effects in the treatment of Encephalitis lethargica, Parkinson's disease, multiple sclerosis and amyotrophic lateral sclerosis.

    Science.gov (United States)

    Foster, Harold D; Hoffer, Abram

    2004-01-01

    Parkinson's disease, encephalitis lethargica, multiple sclerosis and amyotrophic lateral sclerosis patients all display two distinct types of symptoms. Some of these are due directly to a deficiency of dopamine and are quickly reduced by laevodihydroxyphenylalanine (L-DOPA). The second set, however, are the result of neurological damage caused by metabolites of dopamine, which include dopachrome and other chrome indoles that are both hallucinogenic and neurotoxic. If this hypothesis is correct, three corollaries follow. Patients of all four disorders should display excessive oxidative stress, natural methyl acceptors should delay development and elevated antioxidant supplementation, given with L-DOPA, ought to prolong the "honeymoon" period in which the benefits of the drug out weigh its subsequent disadvantages. A literature review suggests that all three corollaries are probably correct.

  12. Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions.

    Science.gov (United States)

    Brenk-Franz, Katja; Strauß, Bernhard; Tiesler, Fabian; Fleischhauer, Christian; Schneider, Nico; Gensichen, Jochen

    2017-06-01

    The conceptual model of attachment theory has been applied to understand the predispositions of patients in medical care and the patient-provider relationship. In patients with chronic conditions insecure attachment was connected to poorer self-management. The patient-provider relationship is associated with a range of health related outcomes and self-management skills. We determined whether the quality of the patient-provider relationship mediates the link between adult attachment and self-management among primary care patients with multiple chronic diseases. 209 patients with a minimum of three chronic diseases (including type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 from eight general practices were included in the APRICARE cohort study. Adult attachment was measured via self-report (ECR-RD), self-management skills by the FERUS and the patient-provider relationship by the PRA-D. The health status and chronicity were assessed by the GP. Multiple mediation analyses were used to examine whether aspects of the patient-provider relationship (communication, information, affectivity) are a mediators of associations between adult attachment and self-management. The analysis revealed that the quality of the patient-provider relationship mediated the effect of attachment on self-management in patients with multiple chronic conditions. Particularly the quality of communication and information over the course of treatment has a significant mediating influence. A personalized, attachment-related approach that promotes active patient-provider communication and gives information about the treatment to the patient may improve self-management skills in patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Romidepsin for the treatment of relapsed/refractory peripheral T cell lymphoma: prolonged stable disease provides clinical benefits for patients in the pivotal trial

    Directory of Open Access Journals (Sweden)

    Francine Foss

    2016-03-01

    Full Text Available Abstract Background Achievement of durable responses in patients with relapsed/refractory peripheral T cell lymphoma (PTCL is challenging with current therapies, and there are few data regarding the potential benefits of continuing treatment in patients with the best response of stable disease (SD. Histone deacetylase inhibitors are a novel class of drugs with activity in T cell malignancies. Romidepsin was approved by the US Food and Drug Administration for the treatment of relapsed/refractory PTCL based on a pivotal trial demonstrating an objective response rate of 25 % (33/130, including 15 % with confirmed/unconfirmed complete response and a median duration of response of 28 months. Our objective was to further study the clinical benefits of romidepsin in patients that had the best response of SD. Methods Patients with PTCL relapsed/refractory to ≥1 prior therapy were treated with the approved dose of 14 mg/m2 romidepsin on days 1, 8, and 15 of six 28-day cycles; patients with SD or response after cycle 6 were allowed to continue on study until progression. By protocol amendment, patients treated for ≥12 cycles could receive maintenance dosing twice per cycle; after cycle 24, dosing could be further reduced to once per cycle in those who had received maintenance dosing for ≥6 months. Results Of the 32 patients (25 % with the best response of SD, 22 had SD for ≥90 days (SD90; cycle 4 response assessment. The longest SD was >3 years in a patient who received maintenance dosing of 14 mg/m2 on days 1 and 15 beginning in cycle 13. Patients with the best response of SD90 or partial response achieved similar overall and progression-free survival. Prolonged dosing of romidepsin was well tolerated. Conclusions We concluded that patients who achieve SD may consider continuing treatment because the clinical benefits of romidepsin may extend beyond objective responses. Trial registration NCT00426764

  14. [Added diagnostic benefit of 16-row whole-body spiral CT in patients with multiple trauma differentiated by region and injury severity according to the ATLS concept].

    Science.gov (United States)

    Maurer, M H; Knopke, S; Schröder, R J

    2008-12-01

    To determine the added diagnostic benefit of using MS-CT in multiple trauma patients differentiated by severity of injury and affected body region. A retrospective analysis was performed of the 16-row whole-body spiral CT findings in 275 multiple trauma patients (73 % men, 27 % women; age 39.6 +/- 18.9 years) with regard to additional findings and new findings obtained with CT compared to the findings obtained by conventional projection radiography and abdominal ultrasound in the emergency room. The additional and new findings were differentiated by body region (head, face, chest, pelvis, abdomen, spine) and the degree of severity according to the three classes of injuries distinguished by the ATLS concept (class 1: simple injury, class 2: potentially life threatening, class 3: immediately life threatening). A total of 921 additional findings (= findings potentially relevant for further diagnosis and therapy in addition to the findings obtained by conventional radiography or ultrasound) were obtained by MS-CT in all patients. The distribution by number of patients and body region was as follows: 22 neck, 76 face, 125 chest, 112 abdomen, 50 pelvis, and 91 spine. Most additional findings were categorized as potentially life threatening (ATLS class 2). In addition, there were 439 completely new findings, involving the head in 128 patients (mostly ATLS class 3), the face in 18, the chest in 47, the abdomen in 26, and the spine in 9 patients. Most new findings involving the face, abdomen, and spine were ATLS class 2 injuries. Compared with conventional radiography and ultrasound in the emergency room, 16-row whole-body spiral CT yields numerous additional and new findings in different body regions in patients with multiple traumas. New findings primarily involved the head, and the additional findings involved the chest, pelvis, and spine. Most findings obtained with CT were potentially life threatening (ATLS class 2).

  15. A moderately low phosphate intake may provide health benefits analogous to those conferred by UV light - a further advantage of vegan diets.

    Science.gov (United States)

    McCarty, M F

    2003-01-01

    Although exposure to ultraviolet light is often viewed as pathogenic owing to its role in the genesis of skin cancer and skin aging, there is growing epidemiological evidence that such exposure may decrease risk for a number of more serious cancers, may have a favorable impact on blood pressure and vascular health, and may help to prevent certain autoimmune disorders - in addition to its well-known influence on bone density. Most likely, these health benefits are reflective of improved vitamin D status. Increased synthesis or intake of vitamin D can be expected to down-regulate parathyroid hormone (PTH), and to increase autocrine synthesis of its active metabolite calcitriol in certain tissues; these effects, in turn, may impact cancer risk, vascular health, immune regulation, and bone density through a variety of mechanisms. Presumably, a truly adequate supplemental intake of vitamin D - manyfold higher than the grossly inadequate current RDA - could replicate the benefits of optimal UV exposure, without however damaging the skin. Diets moderately low in bioavailable phosphate - like many vegan diets - might be expected to have a complementary impact on disease risks, inasmuch as serum phosphate suppresses renal calcitriol synthesis while up-regulating that of PTH. A proviso is that the impact of dietary phosphorus on bone health is more equivocal than that of vitamin D. Increased intakes of calcium, on the other hand, down-regulate the production of both PTH and calcitriol - the latter effect may explain why the impact of dietary calcium on cancer risk (excepting colon cancer), hypertension, and autoimmunity is not clearly positive. An overview suggests that a vegan diet supplemented with high-dose vitamin D should increase both systemic and autocrine calcitriol production while suppressing PTH secretion, and thus should represent a highly effective way to achieve the wide-ranging health protection conferred by optimal UV exposure.

  16. Pomegranate extract and exercise provide additive benefits on improvement of immune function by inhibiting inflammation and oxidative stress in high-fat-diet-induced obesity in rats.

    Science.gov (United States)

    Zhao, Fei; Pang, Wentao; Zhang, Ziyi; Zhao, Jialong; Wang, Xin; Liu, Ye; Wang, Xun; Feng, Zhihui; Zhang, Yong; Sun, Wenyan; Liu, Jiankang

    2016-06-01

    Obesity is reported to be associated with immune dysfunction and a state of low-grade, chronic inflammation. Either pomegranate extract (PomE) or exercise (Ex) has been shown to have antiobesity, anti-inflammatory and antioxidant effects. Nevertheless, no study has addressed the additive benefits of PomE and Ex on the restoration of obesity-induced immune defects. The present work aims to study the effect of PomE and Ex as a combined intervention on immune function and the underlying mechanism involved in inflammation and oxidative stress in rats with high-fat-diet (HFD)-induced obesity. Our results demonstrate that the combination of PomE and Ex showed additive benefits on inhibition of HFD-induced body weight increase and improvement of HFD-induced immune dysfunction, including (a) attenuating the abnormality of histomorphology of the spleen, (b) increasing the ratio of the CD4+:CD8+ T cell subpopulations in splenocytes and peripheral blood mononuclear cells (PBMC), (c) inhibition of apoptosis in splenocytes and PBMC, (d) normalizing peritoneal macrophage phenotypes and (e) restoring immunomodulating factors in serum. We also find that immune dysfunction in HFD-fed rats was associated with increased inflammatory cytokine secretion and oxidative stress biomarkers, and that the combination of PomE and Ex effectively inhibited the inflammatory response and decreased oxidative damage. The effect of PomE and Ex as a combined intervention is greater than the effect of either PomE or Ex alone, showing that PomE and Ex may be additively effective in improving immune function in HFD-fed rats by inhibiting inflammation and decreasing oxidative stress. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers.

    Science.gov (United States)

    Ancker, Jessica S; Witteman, Holly O; Hafeez, Baria; Provencher, Thierry; Van de Graaf, Mary; Wei, Esther

    2015-06-04

    A critical problem for patients with chronic conditions who see multiple health care providers is incomplete or inaccurate information, which can contribute to lack of care coordination, low quality of care, and medical errors. As part of a larger project on applications of consumer health information technology (HIT) and barriers to its use, we conducted a semistructured interview study with patients with multiple chronic conditions (MCC) with the objective of exploring their role in managing their personal health information. Semistructured interviews were conducted with patients and providers. Patients were eligible if they had multiple chronic conditions and were in regular care with one of two medical organizations in New York City; health care providers were eligible if they had experience caring for patients with multiple chronic conditions. Analysis was conducted from a grounded theory perspective, and recruitment was concluded when saturation was achieved. A total of 22 patients and 7 providers were interviewed; patients had an average of 3.5 (SD 1.5) chronic conditions and reported having regular relationships with an average of 5 providers. Four major themes arose: (1) Responsibility for managing medical information: some patients perceived information management and sharing as the responsibility of health care providers; others—particularly those who had had bad experiences in the past—took primary responsibility for information sharing; (2) What information should be shared: although privacy concerns did influence some patients' perceptions of sharing of medical data, decisions about what to share were also heavily influenced by their understanding of health and disease and by the degree to which they understood the health care system; (3) Methods and tools varied: those patients who did take an active role in managing their records used a variety of electronic tools, paper tools, and memory; and (4) Information management as invisible work

  18. A Knowledge-Modeling Approach to Integrate Multiple Clinical Practice Guidelines to Provide Evidence-Based Clinical Decision Support for Managing Comorbid Conditions.

    Science.gov (United States)

    Abidi, Samina

    2017-10-26

    Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS.

  19. Kinesio Taping Does Not Provide Additional Benefits in Patients With Chronic Low Back Pain Who Receive Exercise and Manual Therapy: A Randomized Controlled Trial.

    Science.gov (United States)

    Added, Marco Aurélio Nemitalla; Costa, Leonardo Oliveira Pena; de Freitas, Diego Galace; Fukuda, Thiago Yukio; Monteiro, Renan Lima; Salomão, Evelyn Cassia; de Medeiros, Flávia Cordeiro; Costa, Lucíola da Cunha Menezes

    2016-07-01

    Study Design Randomized controlled trial. Background Many clinical practice guidelines endorse both manual therapy and exercise as effective treatment options for patients with low back pain. To optimize the effects of the treatments recommended by the guidelines, a new intervention known as Kinesio Taping is being widely used in these patients. Objectives To determine the effectiveness of Kinesio Taping in patients with chronic nonspecific low back pain when added to a physical therapy program consisting of exercise and manual therapy. Methods One hundred forty-eight patients with chronic nonspecific low back pain were randomly allocated to receive 10 (twice weekly) sessions of physical therapy, consisting of exercise and manual therapy, or the same treatment with the addition of Kinesio Taping applied to the lower back. The primary outcomes were pain intensity and disability (5 weeks after randomization) and the secondary outcomes were pain intensity, disability (3 months and 6 months after randomization), global perceived effect, and satisfaction with care (5 weeks after treatment). Data were collected by a blinded assessor. Results No between-group differences were observed in the primary outcomes of pain intensity (mean difference, -0.01 points; 95% confidence interval [CI]: -0.88, 0.85) or disability (mean difference, 1.14 points; 95% CI: -0.85, 3.13) at 5 weeks' follow-up. In addition, no between-group differences were observed for any of the other outcomes evaluated, except for disability 6 months after randomization (mean difference, 2.01 points; 95% CI: 0.03, 4.00) in favor of the control group. Conclusion Patients who received a physical therapy program consisting of exercise and manual therapy did not get additional benefit from the use of Kinesio Taping. Level of Evidence Therapy, level 1b. Prospectively registered May 28, 2013 at www.ClinicalTrials.gov (NCT01866332). J Orthop Sports Phys Ther 2016;46(7):506-513. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6590.

  20. Commander’s Emergency Response Program in Laghman Province Provided Some Benefits, but Oversight Weaknesses and Sustainment Concerns Led to Questionable Outcomes and Potential Waste

    Science.gov (United States)

    2011-01-27

    project also provides furniture , a generator, and solar panels. The facility was constructed using a standard Ministry of Education design , according...attacks from the community against the Afghan National Security Forces or coalition forces, and the village elders have signed a contract agreeing to...is leased from a village elder . The saffron bulbs harvested under the project will be split equally among the ADT, landowner, and a local cooperative

  1. The benefit of meeting a stranger: experiences with emotional support provided by nurses among Danish-born and migrant cancer patients.

    Science.gov (United States)

    Kristiansen, M; Tjørnhøj-Thomsen, T; Krasnik, A

    2010-07-01

    Research among cancer patients has shown that emotional support in informal relationships may be difficult to access because of a fear or lack of knowledge about cancer. Consequently, formal relationships with healthcare professionals may be important sources of support. This study explores needs for and experiences with emotional support provided by nurses as well as prerequisites for the provision of support among Danish-born and migrant cancer patients. We conducted narrative interviews with 18 adult Danish-born and migrant cancer patients. Patients were recruited from a variety of places in a purposive strategic sampling process. Analysis was inspired by phenomenological methods and Simmel's theoretical concept of "the stranger". Both Danish-born and migrant patients perceived the support delivered by healthcare professionals as available, empathic and valuable. Prerequisites for providing emotional support were 1) setting aside time for the patient to feel safe and able to verbalise emotional concerns, 2) continuity in relationships with healthcare professionals, and 3) nurses' ability to understand the patient's emotional reactions without creating additional distress. Being positioned as a stranger to the patient gives nurses a unique position from which to provide emotional support during cancer treatment. Thus, formal relationships with healthcare professionals are of great importance for many cancer patients.

  2. A computational modelling approach combined with cellular electrophysiology data provides insights into the therapeutic benefit of targeting the late Na+ current

    Science.gov (United States)

    Yang, Pei-Chi; Song, Yejia; Giles, Wayne R; Horvath, Balazs; Chen-Izu, Ye; Belardinelli, Luiz; Rajamani, Sridharan; Clancy, Colleen E

    2015-01-01

    Selective inhibition of the slowly inactivating or late Na+ current (INaL) in patients with inherited or acquired arrhythmia syndrome may confer therapeutic benefit by reducing the incidence of triggers for arrhythmia and suppressing one component of arrhythmia-promoting cardiac substrates (e.g. prolonged refractoriness and spatiotemporal dispersion of action potential duration). Recently, a novel compound that preferentially and potently reduces INaL, GS-458967 (IC50 for block of INaL = 130 nm) has been studied. Experimental measurements of the effects of GS-458967 on endogenous INaL in guinea pig ventricular myocytes demonstrate a robust concentration-dependent reduction in action potential duration (APD). Using experimental data to calibrate INaL and the rapidly activating delayed rectifier K+ current, IKr, in the Faber–Rudy computationally based model of the guinea pig ventricular action potential, we simulated effects of GS-458967 on guinea pig ventricular APD. GS-458967 (0.1 μm) caused a 28.67% block of INaL and 12.57% APD shortening in experiments, while the model predicted 10.06% APD shortening with 29.33% block of INaL. An additional effect of INaL block is to reduce the time during which the membrane potential is in a high resistance state (i.e. the action potential plateau). To test the hypothesis that targeted block of INaL would make ventricular myocytes less susceptible to small electrical perturbations, we used the computational model to test the degree of APD prolongation induced by small electrical perturbations in normal cells and in cells with simulated long QT syndrome. The model predicted a substantial dose-dependent reduction in sensitivity to small electrical perturbations as evidenced by action potential duration at 90% repolarization variability in the presence of GS-458967-induced INaL block. This effect was especially potent in the ‘disease setting’ of inherited long QT syndrome. Using a combined experimental and theoretical

  3. Benefits and Limitations of Text Messages to Stimulate Higher Learning Among Community Providers: Participants' Views of an mHealth Intervention to Support Continuing Medical Education in Vietnam.

    Science.gov (United States)

    Sabin, Lora L; Larson Williams, Anna; Le, Bao Ngoc; Herman, Augusta R; Viet Nguyen, Ha; Albanese, Rebecca R; Xiong, Wenjun; Shobiye, Hezekiah Oa; Halim, Nafisa; Tran, Lien Thi Ngoc; McNabb, Marion; Hoang, Hai; Falconer, Ariel; Nguyen, Tam Thi Thanh; Gill, Christopher J

    2017-06-27

    A randomized controlled trial was conducted in 2015 to evaluate a mobile continuing medical education (mCME) intervention that provided daily text messages to community-based physicians' assistants (CBPAs) in Thai Nguyen Province, Vietnam. Although the intervention failed to improve medical knowledge over a 6-month period, a companion qualitative study provided insights on the views and experiences of intervention participants. We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) among participants randomized to receive text messages containing either simple medical facts or quiz questions. Trained interviewers collected data immediately following the conclusion of the trial in December 2015. Using semi-structured question guides, respondents were queried on their views of the intervention, positive and negative, and perceived impacts of the intervention. During analysis, after learning that the intervention had failed to increase knowledge among participants, we also examined reasons for lack of improvement in medical knowledge. All analyses were performed in NVivo using a thematic approach. A total of 70 CBPAs engaged in one of 8 FGDs or an IDI. One-half were men; average age among all respondents was 40 years. Most (81%) practiced in rural settings and most (51%) focused on general medicine. The mean length of work experience was 3 years. All respondents made positive comments about the intervention; convenience, relevance, and quick feedback (quiz format) were praised. Downsides encompassed lack of depth of information, weak interaction, technology challenges, and challenging/irrelevant messages. Respondents described perceived impacts encompassing increased motivation, knowledge, collegial discussions, Internet use to search for more information, and clinical skills. Overall, they expressed a desire for the intervention to continue and recommended expansion to other medical professionals. Overreliance on the text messages, lack of

  4. Medicaid Benefits

    Science.gov (United States)

    ... Policy and Program Topics Alternative Benefit Plan Coverage Autism Services Behavioral Health Services Dental Care Early and Periodic Screening, Diagnostic, and Treatment Hospice Benefits List of Medicaid Benefits ...

  5. Transferring the financial risks of pharmaceutical benefits from a large health care provider in Argentina to a consortium of pharmaceutical companies

    Directory of Open Access Journals (Sweden)

    Cervellino Juan C.

    2003-01-01

    Full Text Available OBJECTIVE: The National Institute of Social Services for Retirees and Pensioners (NISSRP is a nationwide health care financing agency and service provider in Argentina. Among its services, the NISSRP provides outpatient drug coverage to more than 3.3 million beneficiaries, mainly senior citizens and disabled persons. In 1997, to help cope with its rising costs, the NISSRP agreed to transfer the risk for the cost of outpatient medications and cancer-treatment drugs to a consortium of pharmaceutical companies in exchange for a fixed monthly payment. The objective of this study was to determine the impact that this new approach had on three things: (1 the level of expenditures for the medicines that were included in the agreement, (2 the pattern of nonrational prescribing for NISSRP beneficiaries, and (3 this pattern's relationship with macroeconomic variables and the pattern of prescribing for Argentina as a whole. METHODS: We compared outpatient-medicine consumption in 1999 with consumption before the agreement went into effect. RESULTS: The actual amount that NISSRP beneficiaries spent out-of-pocket climbed from US$ 336.13 million in 1996 to US$ 473.36 million in 1999, an increase of almost 41%. The nominal amount "spent" by the NISSRP in 1999 was US$ 601.11 million, versus a real amount of US$ 374.75 million in 1996, an "increase" of 60% (that increase for the NISSRP was only theoretical since the agreement specified the fixed monthly amount that the NISSRP would have to pay to the pharmaceutical consortium. In contrast with the increased real spending by NISSRP beneficiaries, Argentina's economy remained stable over the assessed period, with the consumer price index even falling by 0.8%. We found high levels of nonrational drug use in the NISSRP system in both 1996 and 1999, indicating a serious ongoing problem. CONCLUSIONS: An agreement with pharmaceutical companies, like the one we have described, might add an element of financial

  6. A peptide prime-DNA boost immunization protocol provides significant benefits as a new generation Aβ42 DNA vaccine for Alzheimer disease.

    Science.gov (United States)

    Lambracht-Washington, Doris; Qu, Bao-xi; Fu, Min; Anderson, Larry D; Eagar, Todd N; Stüve, Olaf; Rosenberg, Roger N

    2013-01-15

    Immunotherapy has the potential to provide a possible treatment therapy to prevent or delay Alzheimer disease. In a clinical trial (AN1792) in which patients received this immunotherapy and received active Aβ1-42 peptide immunizations, treatment was stopped when 6% of patients showed signs of meningoencephalitis. Follow up on these patients led to the conclusion that the antibody response was beneficial in removing Aβ1-42 from brain but an accompanying inflammatory Th1 T cell response was harmful. As a safe alternative treatment targeting the same self protein, Aβ1-42, in brain, we and others are working on a DNA Aβ1-42 immunization protocol as the immune response to DNA immunizations differs in many aspects from immunizations with peptide antigens. Because the immune response to DNA vaccination has different kinetics and has a significantly lower antibody production, we evaluated two different prime boost regimens, Aβ1-42 DNA prime/Aβ1-42 peptide boost and Aβ1-42 peptide prime/Aβ1-42 DNA boost for their effectiveness in antibody production and possible side effects due to inflammatory T cell responses. While both boost regimes significantly enhanced the specific antibody production with comparable antibody concentrations, the absence of the Aβ1-42 T cell response (no proliferation and no cytokine production) is consistent with our previous findings using this DNA Aβ1-42 trimer immunization and greatly enhances the safety aspect for possible clinical use. Copyright © 2012 Elsevier B.V. All rights reserved.

  7. Residents at the University of Maryland Medical System provide insight to learning infrapubic approach for IPP surgery: relative benefits but novel challenges exposed in first 15 cases.

    Science.gov (United States)

    Kramer, Andrew; Chason, Judd

    2010-03-01

    Emphasis should be placed on assessing resident education. At our institution, the trans-scrotal (TS) approach for inflatable penile prosthesis (IPP) surgery has been widely taught, with infrapubic (IP) approach recently introduced. Feedback and trends on learning a new implant technique is assessed. Aim. The aim is to understand the advantages and pitfalls of a surgical approach through residents in training. This will provide insight into resident education for teaching physicians and a framework for understanding how to teach the two approaches. The outcomes measured will be the residents' reflection on the ease of different steps of the infrapubic procedure upon finishing 15 sequential cases as well as feeling about the end result and time it took to complete the operation. Two senior residents with experience of over 100 TS implants recorded impressions on their first 15 infrapubic IPP cases via questionnaire. IPP was compared with TS with regard to reservoir, cylinder, pump placement, surgical exposure, and resident involvement. Scores of 1-5 were given, with 1 implying harder or more difficult, 3 the same, and 5 better or easier. Proximal dilatation and cylinder placement remained superior for the IP approach, but distal cylinder placement posed major challenges for the IP surgery. Pump placement was more difficult and remained so for the IP approach, yet reservoir placement was similar. Residents' sense of involvement was superior early on for the IP procedure. Operating room time improved steadily for the IP approach and ultimately was faster than implants placed trans-scrotally. The IP approach is quickly learned by residents. Resident placement with the IP approach offers no advantage for the experienced resident. Pump placement and distal dilatation began and remain challenging. Location of corporotomy is the most challenging component and dictates difficulty of dilatation. Residents gain early confidence with the IP approach.

  8. Evaluation of LAGE-1 and NY-ESO-1 expression in multiple myeloma patients to explore possible benefits of their homology for immunotherapy.

    Science.gov (United States)

    de Carvalho, Fabricio; Vettore, Andre L; Inaoka, Riguel J; Karia, Bruno; Andrade, Valéria C C; Gnjatic, Sacha; Jungbluth, Achim A; Colleoni, Gisele W B

    2011-01-20

    Due to the high homology between the LAGE-1 and NY-ESO-1 proteins, we hypothesized that an anti-NY-ESO-1 vaccine might elicit LAGE-1 immunity and hence may be effective in multiple myeloma (MM) patients with LAGE-1-positive/NY-ESO-1-negative tumors. Therefore, we set out to evaluate LAGE-1 and NY-ESO-1 mRNA and protein expression in MM patients in a bid to evaluate possible benefits of their homology for immunotherapy. LAGE-1 (a and b isoforms) and NY-ESO-1 mRNA expression was studied in 18 normal tissues and 50 bone marrow MM samples by RT-PCR. LAGE-1 and NY-ESO-1 protein expression was analyzed by immunohistochemistry (IHC) in 27 MM specimens using mAbs 219-510-23 and E978. Spontaneous serological immune response against both antigens was analyzed by ELISA in sera from 33 MM patients. LAGE-1 (a and b isoforms) was positive in 42% and NY-ESO-1 in 26% of the MM samples analyzed by RT-PCR. Both genes were found to be expressed in 18% of the cases, while at least one of the genes was found to be expressed in 50% of the cases. In LAGE-1 positive samples, 81% were positive for LAGE-1a and 19% were positive for both LAGE-1a and -1b. LAGE-1 and NY-ESO-1 protein expression could only be detected in two cases by IHC and there was a clear strong spontaneous antibody response to LAGE-1 and NY-ESO-1 in only one MM patient. In conclusion, LAGE-1a and NY-ESO-1 homology cannot be easily exploited in an anti-NY-ESO-1 vaccine given the low frequency of protein expression detected by IHC or serum analysis.

  9. Analysis of the benefits of designing and implementing a virtual didactic model of multiple choice exam and problem-solving heuristic report, for first year engineering students

    CERN Document Server

    Bennun, Leonardo

    2015-01-01

    Improvements in performance and approval obtained by first year engineering students from University of Concepcion, Chile, were studied, once a virtual didactic model of multiple-choice exam, was implemented. This virtual learning resource was implemented in the Web ARCO platform and allows training, by facing test models comparable in both time and difficulty to those that they will have to solve during the course. It also provides a feedback mechanism for both: 1) The students, since they can verify the level of their knowledge. Once they have finished the simulations, they can access a complete problem-solving heuristic report of each problem; 2) The teachers, since they can obtain information about the habits of the students in their strategies of preparation; and they also can diagnose the weaknesses of the students prior to the exam. This study indicates how this kind of preparation generates substantial improvements on the approval rates by allowing the students: 1) A more structured and oriented syste...

  10. An Analytical Method for Deriving Reservoir Operation Curves to Maximize Social Benefits from Multiple Uses of Water in the Willamette River Basin

    Science.gov (United States)

    Moore, K. M.; Jaeger, W. K.; Jones, J. A.

    2013-12-01

    A central characteristic of large river basins in the western US is the spatial and temporal disjunction between the supply of and demand for water. Water sources are typically concentrated in forested mountain regions distant from municipal and agricultural water users, while precipitation is super-abundant in winter and deficient in summer. To cope with these disparities, systems of reservoirs have been constructed throughout the West. These reservoir systems are managed to serve two main competing purposes: to control flooding during winter and spring, and to store spring runoff and deliver it to populated, agricultural valleys during the summer. The reservoirs also provide additional benefits, including recreation, hydropower and instream flows for stream ecology. Since the storage capacity of the reservoirs cannot be used for both flood control and storage at the same time, these uses are traded-off during spring, as the most important, or dominant use of the reservoir, shifts from buffering floods to storing water for summer use. This tradeoff is expressed in the operations rule curve, which specifies the maximum level to which a reservoir can be filled throughout the year, apart from real-time flood operations. These rule curves were often established at the time a reservoir was built. However, climate change and human impacts may be altering the timing and amplitude of flood events and water scarcity is expected to intensify with anticipated changes in climate, land cover and population. These changes imply that reservoir management using current rule curves may not match future societal values for the diverse uses of water from reservoirs. Despite a broad literature on mathematical optimization for reservoir operation, these methods are not often used because they 1) simplify the hydrologic system, raising doubts about the real-world applicability of the solutions, 2) exhibit perfect foresight and assume stationarity, whereas reservoir operators face

  11. The 3 A's of the access process to long-term care for elderly: providers experiences in a multiple case study in the Netherlands.

    Science.gov (United States)

    Schipper, Lisette; Luijkx, Katrien; Meijboom, Bert; Schols, Jos

    2015-01-01

    The access process is an important step in the care provision to independently living elderly. Still, little attention has been given to the process of access to long-term care for older clients. Access can be described by three dimensions: availability, affordability and acceptability (three A's). In this paper we address the following question: How do care providers take the three dimensions of access into account for the access process to their care and related service provision to independently living elderly? To answer this question we performed a qualitative study. We used data gathered in a multiple case study in the Netherlands. This study provides insight in the way long-term care organizations organize their access process. Not all dimensions were equally present or acknowledged by the case organizations. The dimension acceptability seems an important dimension in the access process, as shown by the efforts done in building a relationship with their clients, mainly through a strong personal relationship between client and care advisor. In that respect it is remarkable that the case organizations do not structurally evaluate their access process. Availability is compromised by practical issues and organizational choices. Affordability hardly seems an issue. Further research can reveal the underlying factors that influence the three A dimensions. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Combined gene/cell therapies provide long-term and pervasive rescue of multiple pathological symptoms in a murine model of globoid cell leukodystrophy

    Science.gov (United States)

    Ricca, Alessandra; Rufo, Nicole; Ungari, Silvia; Morena, Francesco; Martino, Sabata; Kulik, Wilem; Alberizzi, Valeria; Bolino, Alessandra; Bianchi, Francesca; Del Carro, Ubaldo; Biffi, Alessandra; Gritti, Angela

    2015-01-01

    Globoid cell leukodystrophy (GLD) is a lysosomal storage disease caused by deficient activity of β-galactocerebrosidase (GALC). The infantile forms manifest with rapid and progressive central and peripheral demyelination, which represent a major hurdle for any treatment approach. We demonstrate here that neonatal lentiviral vector-mediated intracerebral gene therapy (IC GT) or transplantation of GALC-overexpressing neural stem cells (NSC) synergize with bone marrow transplant (BMT) providing dramatic extension of lifespan and global clinical–pathological rescue in a relevant GLD murine model. We show that timely and long-lasting delivery of functional GALC in affected tissues ensured by the exclusive complementary mode of action of the treatments underlies the outstanding benefit. In particular, the contribution of neural stem cell transplantation and IC GT during the early asymptomatic stage of the disease is instrumental to enhance long-term advantage upon BMT. We clarify the input of central nervous system, peripheral nervous system and periphery to the disease, and the relative contribution of treatments to the final therapeutic outcome, with important implications for treatment strategies to be tried in human patients. This study gives proof-of-concept of efficacy, tolerability and clinical relevance of the combined gene/cell therapies proposed here, which may constitute a feasible and effective therapeutic opportunity for children affected by GLD. PMID:25749991

  13. Do Patients with Multiple Sclerosis Derive More Benefit from Robot-Assisted Gait Training Compared with Conventional Walking Therapy on Motor Function? A Meta-analysis

    Directory of Open Access Journals (Sweden)

    Xiao Xie

    2017-06-01

    Full Text Available ObjectiveTo determine whether robot-assisted gait training (RAGT is more effective in improving mobility, endurance, gait performance, and balance in patients with multiple sclerosis (MS compared with conventional walking rehabilitation treatment (CWT.Data sourcesSources included the Cochrane Library, PubMed, Embase, and Science Direct databases.Review methodAll possible articles were retrieved by two independent investigators and relevant articles were gathered. Studies on adult patients (older than 19 years old suffering from MS were included, regardless the subtype of MS diagnosis. Finally, we identified seven studies that comprised 205 patients with MS.ResultsWe identified seven studies comprising 205 patients with MS in our meta-analysis. The pooled mean difference (MD for the six-minute walk test (6MWT was 14.25 [95% confidence interval (CI 3.19 to 25.32, Z = 2.53, P = 0.01, I2 = 54%], which indicates that RAGT is superior to CWT on improving endurance. No significant improvement on using RAGT was found regarding the Berg Balance Scale (MD = −0.59, 95% CI: −2.7 to 1.52, Z = 0.55, P = 0.58, I2 = 51%, 10-meter walk test [standard mean difference (SMD = 0.03, 95% CI: −0.26 to 0.31, Z = 0.18, P = 0.86, I2 = 48%] timed up and go (TUG test (MD = −1.04, 95% CI: −8.68 to 6.60, Z = 0.27, P = 0.79, or stride length (SMD = 0.36, 95% CI: −0.13 to 0.85, Z = 0.73, P = 0.15.ConclusionWe can conclude that RAGT can bring more benefits on improving 6MWT among MS patients, but it is not enough to make a clinically significance conclusion. Considering the limitation of our study, it takes reservations about recommending all MS patients to take RAGT as primary rehabilitation intervention. Unless patients with progressive MS can take conventional rehabilitation in early time, RAGT would be a suitable substitute.

  14. Healthcare provider relational quality is associated with better self-management and less treatment burden in people with multiple chronic conditions

    Directory of Open Access Journals (Sweden)

    Eton DT

    2017-09-01

    Full Text Available David T Eton,1,2 Jennifer L Ridgeway,1,2 Mark Linzer,3 Deborah H Boehm,4 Elizabeth A Rogers,5 Kathleen J Yost,1,2 Lila J Finney Rutten,1,2 Jennifer L St Sauver,1,2 Sara Poplau,4 Roger T Anderson6 1Department of Health Sciences Research, 2Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 3Division of General Internal Medicine, Hennepin County Medical Center, 4Minneapolis Medical Research Foundation, 5Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, 6Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA Purpose: Having multiple chronic conditions (MCCs can lead to appreciable treatment and self-management burden. Healthcare provider relational quality (HPRQ – the communicative and interpersonal skill of the provider – may mitigate treatment burden and promote self-management. The objectives of this study were to 1 identify the associations between HPRQ, treatment burden, and psychosocial outcomes in adults with MCCs, and 2 determine if certain indicators of HPRQ are more strongly associated than others with these outcomes.Patients and methods: This is a cross-sectional survey study of 332 people with MCCs. Patients completed a 7-item measure of HPRQ and measures of treatment and self-management burden, chronic condition distress, self-efficacy, provider satisfaction, medication adherence, and physical and mental health. Associations between HPRQ, treatment burden, and psychosocial outcomes were determined using correlational analyses and independent samples t-tests, which were repeated in item-level analyses to explore which indicators of HPRQ were most strongly associated with the outcomes.Results: Most respondents (69% were diagnosed with ≥3 chronic conditions. Better HPRQ was found to be associated with less treatment and self-management burden and better psychosocial outcomes (P<0

  15. Analysis of the CD8+T cell anti-HIV activity in heterologous cell co-cultures reveals the benefit of multiple HLA class I matches.

    Science.gov (United States)

    Killian, M Scott; Teque, Fernando; Sudhagoni, Ramu

    2018-02-01

    CD8 + T lymphocytes can reduce the production of human immunodeficiency virus 1 (HIV-1) by CD4 + T cells by cytotoxic and non-cytotoxic mechanisms. To investigate the involvement of human leukocyte antigen (HLA) class I compatibility in anti-HIV responses, we co-cultured primary CD8 + T cells, isolated from the peripheral blood of HIV-1-infected individuals, with panels of autologous and heterologous acutely HIV-1-infected primary CD4 + T cells. Altogether, CD8 + T cell anti-HIV activity was evaluated in more than 200 co-cultures. Marked heterogeneity in HIV-1 replication levels was observed among the co-cultures sharing a common CD8 + T cell source. The co-cultures that exhibited greater than 50% reduction in HIV production were found to have significantly increased numbers of matching HLA class I alleles (Yates chi-square = 54.21; p T cells from HIV controllers and asymptomatic viremic individuals, matching HLA-B and/or HLA-C alleles were more predictive of strong anti-HIV activity than matching HLA-A alleles. Overall, HLA class I genotype matches were more closely associated with CD8 + T cell anti-HIV activity than supertype pairings. Antibodies against HLA class I and CD3 reduced the CD8 + T cell anti-HIV activity. Stimulated CD8 + T cells exhibited increased anti-HIV activity and reduced dependency on HLA compatibility. These findings provide evidence that the maximal suppression of HIV replication by CD8 + T cells requires the recognition of multiple epitopes. These studies provide insight for HIV vaccine development, and the analytic approach can be useful for the functional characterization of HLA class I alleles and tentative HLA class I supertypes.

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

    Science.gov (United States)

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

    2015-02-27

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

  17. Reabilitação vestibular: utilidade clínica em pacientes com esclerose múltipla Vestibular rehabilitation: clinical benefits to patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Bianca Simone Zeigelboim

    2010-01-01

    Full Text Available O objetivo desse estudo foi analisar a eficácia do exercício de reabilitação vestibular em dois casos de esclerose múltipla remitente-recorrente. Ambos os casos foram encaminhados do Hospital de Clínicas para o Laboratório de Otoneurologia de uma instituição de ensino e foram submetidos aos seguintes procedimentos: anamnese, inspeção otológica, avaliação vestibular e aplicação do Dizziness Handicap Inventory pré e pós reabilitação vestibular utilizando-se o protocolo de Cawthorne e Cooksey. No primeiro caso, gênero feminino, 35 anos, tempo de doença de seis anos, referiu tontura há três anos, de intensidade moderada de ocorrência frequente, cefaléia, quedas, desvio de marcha à direita e sensação de desmaio (sic. Apresentou no exame labiríntico, síndrome vestibular periférica deficitária bilateral. No segundo caso, gênero feminino, 49 anos, tempo de doença de dois anos, referiu desvio de marcha à direita, dificuldade e/ou dor ao movimento do pescoço, formigamento de extremidade e alteração vocal. Apresentou no exame labiríntico, síndrome vestibular periférica deficitária à direita. Houve melhora significativa em ambos os casos dos aspectos físico, funcional e emocional do Dizziness Handicap Inventory após a realização da reabilitação vestibular. O protocolo utilizado promoveu melhora na qualidade de vida e auxiliou no processo de compensação vestibular.The aim of the present study was to analyze the effectiveness of vestibular rehabilitation exercises in two cases of remittent-recurrent multiple sclerosis. Both cases were referred from the Clinics Hospital to the Laboratory of Otoneurology of the same institution and were submitted to the following procedures: anamnesis, otological inspection, vestibular evaluation, and application of the Dizziness Handicap Inventory before and after vestibular rehabilitation using the Cawthorne and Cooksey protocol. The first case was a 35-year-old female

  18. A qualitative systematic review of service user and service provider perspectives on the acceptability, relative benefits, and potential harms of art therapy for people with non-psychotic mental health disorders.

    Science.gov (United States)

    Scope, Alison; Uttley, Lesley; Sutton, Anthea

    2017-03-01

    This systematic review aimed to synthesize qualitative evidence relating to user and service provider perspective on the acceptability and relative benefits and potential harms of art therapy for people with non-psychotic mental disorders. A comprehensive literature search was conducted in 13 major bibliographic databases from May to July 2013. A qualitative evidence synthesis was conducted using thematic framework synthesis. The searches identified 10,270 citations from which 12 studies were included. Ten studies included data from 183 service users, and two studies included data from 16 service providers. The evidence demonstrated that art therapy was an acceptable treatment. The benefits associated with art therapy included the following: the development of relationships with the therapist and other group members; understanding the self/own illness/the future; gaining perspective; distraction; personal achievement; expression; relaxation; and empowerment. Small numbers of patients reported varying reasons for not wanting to take part, and some highlighted potentially negative effects of art therapy which included the evoking of feelings which could not be resolved. The findings suggest that for the majority of respondents art therapy was an acceptable intervention, although this was not the case for all respondents. Therefore, attention should be focussed on both identifying those who are most likely to benefit from art therapy and ensuring any potential harms are minimized. The findings provide evidence to commissioners and providers of mental health services about the value of future art therapy services. Art therapy was reported to be an acceptable treatment for the majority of respondents. Art therapy may not be a preferred treatment option for a small number of patients, emphasizing the importance of considering patient preference in choice of treatment, and selection of the most suitable patients for art therapy. Consideration should be made of adjustments

  19. Forgotten but Not Gone: Retro-Cue Costs and Benefits in a Double-Cueing Paradigm Suggest Multiple States in Visual Short-Term Memory

    Science.gov (United States)

    van Moorselaar, Dirk; Olivers, Christian N. L.; Theeuwes, Jan; Lamme, Victor A. F.; Sligte, Ilja G.

    2015-01-01

    Visual short-term memory (VSTM) performance is enhanced when the to-be-tested item is cued after encoding. This so-called retro-cue benefit is typically accompanied by a cost for the noncued items, suggesting that information is lost from VSTM upon presentation of a retrospective cue. Here we assessed whether noncued items can be restored to VSTM…

  20. Forgotten but not gone: retro-cue cost and benefits in a double-cueing paradigm suggest multiple states in visual short-term memory

    NARCIS (Netherlands)

    van Moorselaar, D.; Olivers, C.N.L.; Theeuwes, J.; Lamme, V.A.F.; Sligte, I.G.

    2015-01-01

    Visual short-term memory (VSTM) performance is enhanced when the to-be-tested item is cued after encoding. This so-called retro-cue benefit is typically accompanied by a cost for the noncued items, suggesting that information is lost from VSTM upon presentation of a retrospective cue. Here we

  1. BenefitClaimWebServiceBean/BenefitClaimWebService

    Data.gov (United States)

    Department of Veterans Affairs — A formal or informal request for a type of monetary or non-monetary benefit. This service provides benefit claims and benefit claim special issues data, allows the...

  2. Core benefits

    National Research Council Canada - National Science Library

    Keith, Brian W

    2010-01-01

    This SPEC Kit explores the core employment benefits of retirement, and life, health, and other insurance -benefits that are typically decided by the parent institution and often have significant governmental regulation...

  3. Improved multiple-locus variable-number tandem-repeat assay for Staphylococcus aureus genotyping, providing a highly informative technique together with strong phylogenetic value

    NARCIS (Netherlands)

    Pourcel, Christine; Hormigos, Katia; Onteniente, Lucie; Sakwinska, Olga; Deurenberg, Ruud H; Vergnaud, Gilles

    2009-01-01

    We describe an improved multiple-locus variable-number tandem-repeat (VNTR) analysis (MLVA) scheme for genotyping Staphylococcus aureus. We compare its performance to those of multilocus sequence typing (MLST) and spa typing in a survey of 309 strains. This collection includes 87 epidemic

  4. Veterans Benefits: Burial Benefits and National Cemeteries

    Science.gov (United States)

    2010-10-18

    hospital, nursing home, or domiciliary care facility; and (2) a plot allowance for a veteran eligible for burial in a national cemetery who is not... domiciliary care . The VA was permitted to enter into contracts to provide the burial and funeral services for veterans who died in VA facilities...Veterans Affairs (VA) provides a range of benefits and services to veterans who meet certain eligibility rules; benefits include hospital and medical care

  5. Fresh groundwater for Wajir – ex-ante assessment of uncertain benefits for multiple stakeholders in a water supply project in Northern Kenya

    Directory of Open Access Journals (Sweden)

    Eike eLuedeling

    2015-03-01

    Full Text Available Decision-making in development rarely considers uncertainty in project benefits and costs and the risk of project failure. Lack of appropriate tools for ex-ante analysis under conditions of data scarcity constrains the ability of decision-makers to anticipate project outcomes. Business analysis techniques can help in such situations, but they have rarely been applied in development contexts. We use the principles of Applied Information Economics to develop a decision model for a water supply intervention.In the proposed Habaswein-Wajir Water Supply Project in Northern Kenya, water is to be extracted from a major aquifer near Habaswein and piped to the city of Wajir. A team of eight experts developed a model including all costs, benefits and risks considered important for project success. After estimation training, these experts expressed their uncertainty for about 100 variables in the model with probability distributions. We used Monte Carlo simulation to project decision outcomes, and Partial Least Squares regression to identify critical uncertainties affecting the decision.The project was found to be risky for most stakeholders, mainly due to the risk of political interference caused by water supply concerns in Habaswein and due to unclear profitability of the water supply business. Uncertainties about how to value decreasing infant mortality and reduction in water-borne disease incidence were also critical. The greatest hydrological risk was salt water intrusion into the aquifer. Careful well design, inclusive project planning and benefit sharing could raise the chance of project success.The analysis improved understanding of the decision by all stakeholders, some of which changed their opinions on the pipeline, requested more measurements, or proposed alternative water supply options. Decision analysis can help clarify decision uncertainties and outcome expectations and thereby improve decision-making processes, especially in data

  6. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial

    DEFF Research Database (Denmark)

    Kappos, Ludwig; Freedman, Mark S; Polman, Chris H

    2009-01-01

    BACKGROUND: The Betaferon/Betaseron in newly emerging multiple sclerosis for initial treatment (BENEFIT) trial investigated the effect of treatment with interferon beta-1b after a clinically isolated syndrome. The 5-year active treatment extension compares the effects of early and delayed treatment...... beta-1b 250 microg (n=292; early treatment) or placebo (n=176; delayed treatment) subcutaneously every other day for 2 years, or until diagnosis of CDMS. All patients were then eligible to enter a prospectively planned follow-up phase with open-label interferon beta-1b up to a maximum of 5 years after...... randomisation. Patients and study personnel remained unaware of initial treatment allocation throughout the study. Primary endpoints were time to CDMS, time to confirmed disability progression measured with the expanded disability status scale, and the functional assessment of multiple sclerosis trial outcomes...

  7. Pain in patients with multiple sclerosis: a complex assessment including quantitative and qualitative measurements provides for a disease-related biopsychosocial pain model

    Directory of Open Access Journals (Sweden)

    Michalski D

    2011-08-01

    Full Text Available Dominik Michalski1,*, Stefanie Liebig1,*, Eva Thomae1,2, Andreas Hinz3, Florian Then Bergh1,21Department of Neurology, 2Translational Centre for Regenerative Medicine (TRM, 3Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany *These authors contributed equallyBackground: Pain of various causes is a common phenomenon in patients with Multiple Sclerosis (MS. A biopsychosocial perspective has proven a useful theoretical construct in other chronic pain conditions and was also started in MS. To support such an approach, we aimed to investigate pain in MS with special emphasis on separating quantitative and qualitative aspects, and its interrelation to behavioral and physical aspects.Materials and methods: Pain intensity (NRS and quality (SES were measured in 38 consecutive outpatients with MS (mean age, 42.0 ± 11.5 years, 82% women. Pain-related behavior (FSR, health care utilization, bodily complaints (GBB-24 and fatigue (WEIMuS were assessed by questionnaires, and MS-related neurological impairment by a standardized neurological examination (EDSS.Results: Mean pain intensity was 4.0 (range, 0–10 and mean EDSS 3.7 (range, 0–8 in the overall sample. Currently present pain was reported by 81.6% of all patients. Disease duration and EDSS did not differ between patients with and without pain and were not correlated to quality or intensity of pain. Patients with pain had significantly higher scores of musculoskeletal complaints, but equal scores of exhaustion, gastrointestinal and cardiovascular complaints. Pain intensity correlated only with physical aspects, whereas quality of pain was additionally associated with increased avoidance, resignation and cognitive fatigue.Conclusion: As in other conditions, pain in MS must be assessed in a multidimensional way. Further research should be devoted to adapt existing models to a MS-specific model of pain.Keywords: pain intensity, quality of pain, pain

  8. Can Universal SEL Programs Benefit Universally? Effects of the Positive Action Program on Multiple Trajectories of Social-Emotional and Misconduct Behaviors.

    Science.gov (United States)

    Duncan, Robert; Washburn, Isaac J; Lewis, Kendra M; Bavarian, Niloofar; DuBois, David L; Acock, Alan C; Vuchinich, Samuel; Flay, Brian R

    2017-02-01

    Behavioral trajectories during middle childhood are predictive of consequential outcomes later in life (e.g., substance abuse, violence). Social and emotional learning (SEL) programs are designed to promote trajectories that reflect both growth in positive behaviors and inhibited development of negative behaviors. The current study used growth mixture models to examine effects of the Positive Action (PA) program on behavioral trajectories of social-emotional and character development (SECD) and misconduct using data from a cluster-randomized trial that involved 14 schools and a sample of predominately low-income, urban youth followed from 3rd through 8th grade. For SECD, findings indicated that PA was similarly effective at improving trajectories within latent classes characterized as "high/declining" and "low/stable". Favorable program effects were likewise evident to a comparable degree for misconduct across observed latent classes that reflected "low/rising" and "high/rising" trajectories. These findings suggest that PA and perhaps other school-based universal SEL programs have the potential to yield comparable benefits across subgroups of youth with differing trajectories of positive and negative behaviors, making them promising strategies for achieving the intended goal of school-wide improvements in student outcomes.

  9. Does self monitoring of blood glucose as opposed to urinalysis provide additional benefit in patients newly diagnosed with type 2 diabetes receiving structured education? The DESMOND SMBG randomised controlled trial protocol

    Science.gov (United States)

    2012-01-01

    Background The benefit of self-monitoring of blood glucose (SMBG) in people with type 2 diabetes on diet or oral agents other than sulphonylureas remains uncertain. Trials of interventions incorporating education about self-monitoring of blood glucose have reported mixed results. A recent systematic review concluded that SMBG was not cost-effective. However, what was unclear was whether a cheaper method of self-monitoring (such as urine glucose monitoring) could produce comparable benefit and patient acceptability for less cost. Methods/Design The DESMOND SMBG trial is comparing two monitoring strategies (blood glucose monitoring and urine testing) over 18 months when incorporated into a comprehensive self-management structured education programme. It is a multi-site cluster randomised controlled trial, conducted across 8 sites (7 primary care trusts) in England, UK involving individuals with newly diagnosed Type 2 diabetes. The trial has 80% power to demonstrate equivalence in mean HbA1c (the primary end-point) at 18 months of within ± 0.5% assuming 20% drop out and 20% non-consent. Secondary end-points include blood pressure, lipids, body weight and psychosocial measures as well as a qualitative sub-study. Practices were randomised to one of two arms: participants attend a DESMOND programme incorporating a module on self-monitoring of either urine or blood glucose. The programme is delivered by accredited educators who received specific training about equipoise. Biomedical data are collected and psychosocial scales completed at baseline, and 6, 12, and 18 months post programme. Qualitative research with participants and educators will explore views and experiences of the trial and preferences for methods of monitoring. Discussion The DESMOND SMBG trial is designed to provide evidence to inform the debate about the value of self-monitoring of blood glucose in people with newly diagnosed type 2 diabetes. Strengths include a setting in primary care, a cluster

  10. Engaging Others in Recognizing the Benefits of Physical Activity

    Science.gov (United States)

    Wilson-Graham, Dianne

    2007-01-01

    Recent research that examines the relationship between physical activity and academic performance provides physical educators with multiple opportunities to engage others in recognizing the benefits of physical activity and high quality physical education programs. Local schools and community provide the greatest opportunity to educate and…

  11. In Psycho-Spiritual Integrative Therapy for Women with Primary Breast Cancer, What Factors Account for the Benefits? Insights from a Multiple Case Analysis

    Directory of Open Access Journals (Sweden)

    John Rettger

    2015-05-01

    Full Text Available This study sought to understand the context in which Psycho-Spiritual Integrative Therapy (PSIT, a group intervention, promotes varying degrees of spiritual growth and quality of life change in breast cancer survivors. A secondary aim was to explore the relationship between spiritual well-being (SWB and Quality of Life (QL in PSIT participants. A qualitative, multiple case analysis was undertaken to examine the experiences of two participants with the highest change scores on the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale-Expanded Version (FACIT-Sp-Ex and two participants with among the lowest change scores on this measure. The participant factors thought to contribute to SWB and QL changes included utilization of metacognitive psychological skills and spiritual/religious frameworks, while PSIT factors included application of PSIT core intervention components, cognitive restructuring, group dynamics, and the role of the facilitator. The nature and extent of participant use of spiritual practices appeared to shape the relationship between SWB and OL. The findings suggest directions for future research to investigate potential moderators and mediators of treatment efficacy of PSIT specifically, as well as other psycho-spiritual interventions for cancer survivors more generally.

  12. Smoke and mirrors: Limited value of relative risk reductions for assessing the benefits of disease-modifying therapies for multiple sclerosis.

    Science.gov (United States)

    Zakaria, Magd

    2015-05-01

    A reduction in relapse rate is the main primary outcome in most clinical trials in patients with multiple sclerosis (MS), with the effect of a treatment commonly expressed as relative risk reduction for this outcome. Physicians often assume that a drug with a higher relative risk reduction demonstrated in one trial is more effective than a drug with a lower relative risk reduction in another, and may pass this idea on to younger physicians and to patients. The use of the relative risk reduction as a measure of drug efficacy can be misleading, as it depends on the nature of the population studied: a treatment effect characterized by a lower relative risk reduction may be more clinically meaningful than one with a higher relative risk reduction. This concept is especially important with regard to clinical trials in patients with MS, where relapse rates in placebo groups have been declining in recent decades. Direct, head-to-head comparisons are the only way to compare the efficacy of the different treatments for MS. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Effect of Providing Multiple Micronutrients in Powder through Primary Healthcare on Anemia in Young Brazilian Children: A Multicentre Pragmatic Controlled Trial.

    Science.gov (United States)

    Cardoso, Marly A; Augusto, Rosangela A; Bortolini, Gisele A; Oliveira, Cristieli S M; Tietzman, Daniela C; Sequeira, Leopoldina A S; Hadler, Maria Claret C M; Peixoto, Maria do Rosario G; Muniz, Pascoal T; Vitolo, Márcia R; Lira, Pedro I C; Jaime, Patrícia C

    2016-01-01

    Multiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce. A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment. In CG, the prevalence of anemia [hemoglobin (Hb) 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol micronutrient status among young Brazilian children. Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b.

  14. Multiple mid-Atlantic field experiments show no economic benefit to fungicide application when fungal disease is absent in winter wheat.

    Science.gov (United States)

    Weisz, Randy; Cowger, Christina; Ambrose, Gaylon; Gardner, Andrew

    2011-03-01

    Strobilurin fungicides produce intensified greening and delayed senescence in plants, and have been claimed to enhance yields of field crops in the absence of disease. To help evaluate this claim, available publicly sponsored tests of fungicides on soft red winter wheat in Virginia and North Carolina (n = 42) were analyzed for the period 1994 to 2010. All tests were replicated and had a randomized complete block, split-plot, or split-block design. Each test included 1 to 32 cultivars and one to five fungicides (two strobilurins, one triazole, and two strobilurin-triazole mixtures). There was a total of 311 test-cultivar-fungicide treatment comparisons, where a comparison was the reported yield difference between sprayed and unsprayed treatments of a given cultivar in a given test. Parameters used to calculate the economic benefit or loss associated with fungicide application included a grain price range of $73.49 to 257.21 Mg(-1) ($2 to 7 bu(-1)), a total fungicide application cost of $24.71 to 74.13 ha(-1) ($10 to 30 acre(-1)), and a 0.14 to 0.21 Mg ha(-1) (2.3 to 3.4 bu acre(-1)) loss in yield from driving over wheat during application (with a sprayer 27.4 or 18.3 m [90 or 60 feet] wide, respectively). The yield increase needed to pay for a fungicide application at each combination of cost and price was calculated, and the cumulative probability function for the fungicide yield-response data was modeled. The model was used to predict the probability of achieving a break-even yield, and the probabilities were graphed against each cost-price combination. Tests were categorized as "no-disease" or "diseased" based on reports of the researchers rating the tests. Subsets of the data were analyzed to assess the profitability of the triazole fungicide and the strobilurin-containing fungicides separately in no-disease versus diseased experiments. From the results, it was concluded that, with routine fungicide application based solely on wheat growth stage, total fungicide

  15. Non-invasive imaging provides spatiotemporal information on disease progression and response to therapy in a murine model of multiple myeloma.

    Directory of Open Access Journals (Sweden)

    Simone S Riedel

    Full Text Available BACKGROUND: Multiple myeloma (MM is a B-cell malignancy, where malignant plasma cells clonally expand in the bone marrow of older people, causing significant morbidity and mortality. Typical clinical symptoms include increased serum calcium levels, renal insufficiency, anemia, and bone lesions. With standard therapies, MM remains incurable; therefore, the development of new drugs or immune cell-based therapies is desirable. To advance the goal of finding a more effective treatment for MM, we aimed to develop a reliable preclinical MM mouse model applying sensitive and reproducible methods for monitoring of tumor growth and metastasis in response to therapy. MATERIAL AND METHODS: A mouse model was created by intravenously injecting bone marrow-homing mouse myeloma cells (MOPC-315.BM that expressed luciferase into BALB/c wild type mice. The luciferase in the myeloma cells allowed in vivo tracking before and after melphalan treatment with bioluminescence imaging (BLI. Homing of MOPC-315.BM luciferase+ myeloma cells to specific tissues was examined by flow cytometry. Idiotype-specific myeloma protein serum levels were measured by ELISA. In vivo measurements were validated with histopathology. RESULTS: Strong bone marrow tropism and subsequent dissemination of MOPC-315.BM luciferase(+ cells in vivo closely mimicked the human disease. In vivo BLI and later histopathological analysis revealed that 12 days of melphalan treatment slowed tumor progression and reduced MM dissemination compared to untreated controls. MOPC-315.BM luciferase(+ cells expressed CXCR4 and high levels of CD44 and α4β1 in vitro which could explain the strong bone marrow tropism. The results showed that MOPC-315.BM cells dynamically regulated homing receptor expression and depended on interactions with surrounding cells. CONCLUSIONS: This study described a novel MM mouse model that facilitated convenient, reliable, and sensitive tracking of myeloma cells with whole body BLI in

  16. Effect of Providing Multiple Micronutrients in Powder through Primary Healthcare on Anemia in Young Brazilian Children: A Multicentre Pragmatic Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Marly A Cardoso

    Full Text Available Multiple micronutrients in powder (MNP are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency are scarce.A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG of children aged 10- to 14 months (n = 521 was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG of infants aged 6- to 8 months (n = 462 was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment.In CG, the prevalence of anemia [hemoglobin (Hb 8.3 mg/L, and vitamin A deficiency (VAD, serum retinol < 0.70μmol/L were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI = 0.63 (0.45, 0.88 and 0.45 (0.29, 0.69, respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children.MNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children.Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b.

  17. Finger Multiplication

    Science.gov (United States)

    Simanihuruk, Mudin

    2011-01-01

    Multiplication facts are difficult to teach. Therefore many researchers have put a great deal of effort into finding multiplication strategies. Sherin and Fuson (2005) provided a good survey paper on the multiplication strategies research area. Kolpas (2002), Rendtorff (1908), Dabell (2001), Musser (1966) and Markarian (2009) proposed the finger…

  18. Self-reported changes in quality of life among people with multiple sclerosis who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners

    DEFF Research Database (Denmark)

    Bjerre, Liv; Henningsen, Inge Biehl; Skovgaard, Lasse

    2011-01-01

    . Materials and methods: A pre- and post-test evaluation design including an intervention group and a comparison group was employed in this study. 142 people with MS were analysed in the intervention group and 142 in the comparison group. Each person in the intervention group was treated with combined......Lwas found within the areas of emotional well-being and thinking/fatigue. Conclusion: The results indicate that collaboration between healthcare providers andCAMpractitioners can improve treatment outcomes regarding some of the psychological aspects of QoL over a period of 18 months for people with MS....

  19. Adding multiple micronutrient powders to a homestead food production programme yields marginally significant benefit on anaemia reduction among young children in Nepal.

    Science.gov (United States)

    Osei, Akoto K; Pandey, Pooja; Spiro, David; Adhikari, Debendra; Haselow, Nancy; De Morais, Caroline; Davis, Dale

    2015-12-01

    Anaemia affects 46% of preschool-aged children in Nepal. A cluster-randomised study was conducted in rural Nepal to test whether providing micronutrient powders (MNP) in addition to enhanced homestead food production (EHFP) programme, consisting of home gardens, poultry and nutrition education, could lead to a higher reduction in anaemia compared with providing only EHFP. This sub-study enrolled 335 children aged 6-9 months into one of three groups: (1) EHFP + MNP; (2) EHFP; or (3) control. The EHFP + MNP group received 60 sachets of MNP for flexible consumption at the start and 6 months later for a total supplementation period of 11 months. The MNP contained 15 micronutrients including iron (10 mg encapsulated ferrous fumarate). Haemoglobin and anthropometry were measured at baseline and post-MNP supplementation. Mean ± SE haemoglobin concentration increased significantly in all groups, with a slightly higher but non-significant increase in the EHFP + MNP and EHFP compared with control (difference-in-differences: 4.1 g L(-1) for EHFP + MNP vs. control; 3.6 g L(-1) for EHFP vs. control; 0.5 g L(-1) for EHFP + MNP vs. EHFP). Anaemia decreased at a slightly higher magnitude in the EHFP + MNP [51.5 percentage points (PP)] than the EHFP (48.6 PP) and control (39.6 PP), with adjusted odds ratios (95% CI) at post-supplementation of 0.52 (0.25-1.12) for EHFP + MNP and 0.69 (0.35-1.36) for EHFP, compared with control. There was no impact on child growth. Combining EHFP and MNP programmes yielded a marginally significant reduction in anaemia among children. © 2015 John Wiley & Sons Ltd.

  20. A retrospective analysis of 3954 patients in phase 2/3 trials of bortezomib for the treatment of multiple myeloma: towards providing a benchmark for the cardiac safety profile of proteasome inhibition in multiple myeloma.

    Science.gov (United States)

    Laubach, Jacob P; Moslehi, Javid J; Francis, Sanjeev A; San Miguel, Jesús F; Sonneveld, Pieter; Orlowski, Robert Z; Moreau, Philippe; Rosiñol, Laura; Faber, Edward A; Voorhees, Peter; Mateos, Maria-Victoria; Marquez, Loreta; Feng, Huaibao; Desai, Avinash; van de Velde, Helgi; Elliott, Jennifer; Shi, Hongliang; Dow, Edward; Jobanputra, Nishith; Esseltine, Dixie-Lee; Niculescu, Liviu; Anderson, Kenneth C; Lonial, Sagar; Richardson, Paul G

    2017-08-01

    This retrospective analysis aimed to establish the overall cardiac safety profile of bortezomib using patient-level data from one phase 2 and seven phase 3 studies in previously untreated and relapsed/refractory multiple myeloma (MM). Seven clinically relevant primary [congestive heart failure (CHF), arrhythmias, ischaemic heart disease (IHD), cardiac death] and secondary (hypertension, dyspnoea, oedema) cardiac endpoints were defined based on MedDRA v16.0 preferred terms. 2509 bortezomib-treated patients and 1445 patients in non-bortezomib-based control arms were included. The incidence of grade ≥3 CHF was 1·3-4·0% in studies in relapsed/refractory MM and 1·2-4·7% in previously untreated MM (2·0-7·6% all grades), with no significant differences between bortezomib- and non-bortezomib-based arms in comparative studies. Incidences of arrhythmias (1·3-5·9% grade ≥2; 0·6-4·1% grade ≥3), IHD (1·2-2·9% all grades; 0·4-2·7% grade ≥3) and cardiac death (0-1·4%) were low, with no differences between bortezomib-based and non-bortezomib-based arms. Higher rates of oedema (mostly grade 1/2) were seen in bortezomib-based versus non-bortezomib-based arms in one study and a pooled transplant study analysis. Logistic regression analyses of comparative studies showed no impact on cardiac risk with bortezomib-based versus non-bortezomib-based treatment. Bortezomib-based treatment was associated with low incidences of cardiac events. © 2017 John Wiley & Sons Ltd.

  1. Socioeconomic benefits

    African Journals Online (AJOL)

    User

    Coffea Arabica is extensively cultivated by households under a variety of shade trees in southwestern Ethiopia. The main purpose of this study was to assess the overall farmers' perception on the benefits of shade trees in coffee production systems in southwestern part of Ethiopia. Semistructured questionnaires were ...

  2. A Determination of the Benefits Derived by the Air Force from Providing Air Force Officers in the Logistics Field with Graduate Degrees in the Business Area from Civilian Graduate Institutions.

    Science.gov (United States)

    Chamberlin, Brian; Smith, Richard A.

    This thesis is concerned with what benefits the Air Force receives from sending logistics officers to civilian graduate institutions (CID). Additionally, the authors wanted to find how CID graduates fare as compared with graduates of the Graduate Logistics Management (GL). Three samples gathered were for CID graduates, the non-degree group…

  3. Addition of Rice Bran Arabinoxylan to Curcumin Therapy May Be of Benefit to Patients With Early-Stage B-Cell Lymphoid Malignancies (Monoclonal Gammopathy of Undetermined Significance, Smoldering Multiple Myeloma, or Stage 0/1 Chronic Lymphocytic Leukemia)

    Science.gov (United States)

    Golombick, Terry; Diamond, Terrence H.; Manoharan, Arumugam; Ramakrishna, Rajeev

    2016-01-01

    Hypothesis. Prior studies on patients with early B-cell lymphoid malignancies suggest that early intervention with curcumin may lead to delay in progressive disease and prolonged survival. These patients are characterized by increased susceptibility to infections. Rice bran arabinoxylan (Ribraxx) has been shown to have immunostimulatory, anti-inflammatory, and proapoptotic effects. We postulated that addition of Ribraxx to curcumin therapy may be of benefit. Study design. Monoclonal gammopathy of undetermined significance (MGUS)/smoldering multiple myeloma (SMM) or stage 0/1 chronic lymphocytic leukemia (CLL) patients who had been on oral curcumin therapy for a period of 6 months or more were administered both curcumin (as Curcuforte) and Ribraxx. Methods. Ten MGUS/SMM patients and 10 patients with stage 0/1 CLL were administered 6 g of curcumin and 2 g Ribraxx daily. Blood samples were collected at baseline and at 2-month intervals for a period of 6 months, and various markers were monitored. MGUS/SMM patients included full blood count (FBC); paraprotein; free light chains/ratio; C-reactive protein (CRP)and erythrocyte sedimentation rate (ESR); B2 microglobulin and immunological markers. Markers monitored for stage 0/1 CLL were FBC, CRP and ESR, and immunological markers. Results. Of 10 MGUS/SMM patients,5 (50%) were neutropenic at baseline, and the Curcuforte/Ribraxx combination therapy showed an increased neutrophil count, varying between 10% and 90% among 8 of the 10 (80%) MGUS/SMM patients. An additional benefit of the combination therapy was the potent effect in reducing the raised ESR in 4 (44%) of the MGUS/SMM patients. Conclusion. Addition of Ribraxx to curcumin therapy may be of benefit to patients with early-stage B-cell lymphoid malignancies. PMID:27154182

  4. An Explanation for the Use of Arrays to Promote the Understanding of Mental Strategies for Multiplication

    Science.gov (United States)

    Day, Lorraine; Hurrell, Derek

    2015-01-01

    Lorraine Day and Derek Hurrell provide a convincing argument for using arrays to promote students' understandings of mental computation strategies for multiplication. They also provide a range of different examples that illustrate the benefits of arrays in the primary classroom.

  5. University Benefits Survey. Part I (All Benefits Excluding Pensions).

    Science.gov (United States)

    University of Western Ontario, London.

    Results of a 1986 survey of benefits, excluding pensions, for 17 Ontario, Canada, universities are presented. Information is provided on the following areas: whether the university self- administers insurance plans, communication of benefits, proposed changes in benefits, provision of accidental death and dismemberment insurance, maternity leave…

  6. University Benefits Survey. Part 1 (All Benefits Excluding Pensions).

    Science.gov (United States)

    University of Western Ontario, London.

    Results of a 1983 survey of benefits, excluding pensions, for 17 Ontario, Canada, universities are presented. Information is provided on the following areas: whether the university self-administers insurance plans, communication of benefits, proposed changes in benefits, provision of life and dismemberment insurance, maternity leave policy,…

  7. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  8. Quantitative analysis of oyster larval proteome provides new insights into the effects of multiple climate change stressors, supplement to: Dineshram, R; Chandramouli, K; Ko, W K Ginger; Zhang, Huoming; Qian, Pei Yuan; Ravasi, Timothy; Thiyagarajan, Vengatesen (2016): Quantitative analysis of oyster larval proteome provides new insights into the effects of multiple climate change stressors. Global Change Biology, 22(6), 2054-2068

    KAUST Repository

    Dineshram, R

    2016-01-01

    The metamorphosis of planktonic larvae of the Pacific oyster (Crassostrea gigas) underpins their complex life-history strategy by switching on the molecular machinery required for sessile life and building calcite shells. Metamorphosis becomes a survival bottleneck, which will be pressured by different anthropogenically induced climate change-related variables. Therefore, it is important to understand how metamorphosing larvae interact with emerging climate change stressors. To predict how larvae might be affected in a future ocean, we examined changes in the proteome of metamorphosing larvae under multiple stressors: decreased pH (pH 7.4), increased temperature (30 °C), and reduced salinity (15 psu). Quantitative protein expression profiling using iTRAQ-LC-MS/MS identified more than 1300 proteins. Decreased pH had a negative effect on metamorphosis by down-regulating several proteins involved in energy production, metabolism, and protein synthesis. However, warming switched on these down-regulated pathways at pH 7.4. Under multiple stressors, cell signaling, energy production, growth, and developmental pathways were up-regulated, although metamorphosis was still reduced. Despite the lack of lethal effects, significant physiological responses to both individual and interacting climate change related stressors were observed at proteome level. The metamorphosing larvae of the C. gigas population in the Yellow Sea appear to have adequate phenotypic plasticity at the proteome level to survive in future coastal oceans, but with developmental and physiological costs.

  9. Using the International Classification of Functioning, Disability, and Health Model to Gain Perspective of the Benefits of Yoga in Stroke, Multiple Sclerosis, and Children to Inform Practice for Children with Cerebral Palsy: A Meta-Analysis.

    Science.gov (United States)

    Veneri, Diana; Gannotti, Mary; Bertucco, Matteo; Fournier Hillman, Sarah E

    2018-02-06

    Research pertaining to yoga and children with cerebral palsy (CP) is negligible. The primary purpose of this study was to determine the domains of the International Classification of Functioning, Disability, and Health (ICF) model and levels of evidence for yoga and adults with stroke and multiple sclerosis (MS), and children. A secondary purpose was to decide whether any inferences could be made for children with CP. This study included a meta-analysis. A systematic review was performed of yoga and said populations. Outcome measures were categorized according to the ICF model domains of body structures and function, activity, and quality of life. Effect sizes (ESs) were calculated by using Cohen's d. Since there were few commonalities among outcome measures and reporting of outcomes within and among diagnostic groups, direct comparisons of ESs were difficult. Hence, we chose to evaluate the impact of yoga as compared with the control group or other physical exercise by using a General Linear Mixed Model. There were 5 yoga studies with stroke, 15 with MS, and 12 with children. Studies with children used outcomes related to body structure and function, whereas those with stroke and MS used outcomes across all three domains of the ICF. ESs varied from negligible to medium for stroke, from negligible to large for MS and children. The findings of this meta-analysis indicate that yoga is no better or worse than other exercise modalities as a treatment intervention for adults with stroke and MS, and children. Group yoga classes are typically social environments that can contribute to increased physical progress and feelings that contribute to quality of life, which may benefit individuals with CP. More research on yoga and particularly in children and adults with CP would yield valuable information for creating effective and safe yoga programs with a rich array of benefits.

  10. Benefit sharing in health research

    African Journals Online (AJOL)

    2015-08-02

    Aug 2, 2015 ... [7,9] The guideline's MTA template provides for the 'fair and equitable sharing of benefits' derived ... exposure which could assist in safeguarding the women's rights to any benefits that may accrue from ..... biological resources in developing countries: Benefit sharing without undue inducement (in press).

  11. Allergen-specific immunotherapy provides immediate, long-term and preventive clinical effects in children and adults: the effects of immunotherapy can be categorised by level of benefit -the centenary of allergen specific subcutaneous immunotherapy

    Directory of Open Access Journals (Sweden)

    Jacobsen Lars

    2012-04-01

    Full Text Available Abstract Allergen Specific Immunotherapy (SIT for respiratory allergic diseases is able to significantly improve symptoms as well as reduce the need for symptomatic medication, but SIT also has the capacity for long-term clinical effects and plays a protective role against the development of further allergies and symptoms. The treatment acts on basic immunological mechanisms, and has the potential to change the pathological allergic immune response. In this paper we discuss some of the most important achievements in the documentation of the benefits of immunotherapy, over the last 2 decades, which have marked a period of extensive research on the clinical effects and immunological background of the mechanisms involved. The outcome of immunotherapy is described as different levels of benefit from early reduction in symptoms over progressive clinical effects during treatment to long-term effects after discontinuation of the treatment and prevention of asthma. The efficacy of SIT increases the longer it is continued and immunological changes lead to potential long-term benefits. SIT alone and not the symptomatic treatment nor other avoidance measures has so far been documented as the therapy with long-term or preventive potential. The allergic condition is driven by a subset of T-helper lymphocytes (Th2, which are characterised by the production of cytokines like IL-4, and IL-5. Immunological changes following SIT lead to potential curative effects. One mechanism whereby immunotherapy suppresses the allergic response is through increased production of IgG4 antibodies. Induction of specific IgG4 is able to influence the allergic response in different ways and is related to immunological effector mechanisms, also responsible for the reduced late phase hyperreactivity and ongoing allergic inflammation. SIT is the only treatment which interferes with the basic pathophysiological mechanisms of the allergic disease, thereby creating the potential for

  12. Who benefits?

    DEFF Research Database (Denmark)

    Hjorth, Frederik Georg

    2016-01-01

    Cross-border welfare rights for citizens of European Union member states are intensely contested, yet there is limited research into voter opposition to such rights, sometimes denoted ‘welfare chauvinism’. We highlight an overlooked aspect in scholarly work: the role of stereotypes about...... beneficiaries of cross-border welfare. We present results from an original large-scale survey experiment (N=2525) among Swedish voters, randomizing exposure to cues about recipients' country of origin and family size. Consistent with a model emphasizing the role of stereotypes, respondents react to cues about...... recipient identity. These effects are strongest among respondents high in ethnic prejudice and economic conservatism. The findings imply that stereotypes about who benefits from cross-border welfare rights condition public support for those rights....

  13. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections.

    Science.gov (United States)

    Creaney, Leon; Wallace, Andrew; Curtis, Mark; Connell, David

    2011-09-01

    Growth factor technologies are increasingly used to enhance healing in musculoskeletal injuries, particularly in sports medicine. Two such products; platelet-rich plasma (PRP) and autologous blood, have a growing body of supporting evidence. No previous trial has directly compared the efficacy of these two methods. Growth factor administration improves tissue regeneration in patients who have failed to respond to conservative therapy. A prospective, double-blind, randomised trial. Elbow tendinopathy patients who had failed conservative physical therapy were divided into two patient groups: PRP injection (N=80) and autologous blood injection (ABI) (N=70). Each patient received two injections at 0 and 1 month. Patient-related tennis elbow evaluation (PRTEE) was recorded by a blinded investigator at 0, 1, 3 and 6 months. The main outcome measure was PRTEE, a validated composite outcome for pain, activities of daily living and physical function, utilising a 0-100 scale. At 6 months the authors observed a 66% success rate in the PRP group versus 72% in the ABI group, p=NS. There was a higher rate of conversion to surgery in the ABI group (20%) versus the PRP group (10%). In patients who are resistant to first-line physical therapy such as eccentric loading, ABI or PRP injections are useful second-line therapies to improve clinical outcomes. In this study, up to seven out of 10 additional patients in this difficult to treat cohort benefit from a surgery-sparing intervention.

  14. Sequential and simultaneous multiple explanation

    Directory of Open Access Journals (Sweden)

    Robert Litchfield

    2007-02-01

    Full Text Available This paper reports two experiments comparing variants of multiple explanation applied in the early stages of a judgment task (a case involving employee theft where participants are not given a menu of response options. Because prior research has focused on situations where response options are provided to judges, we identify relevant dependent variables that an intervention might affect when such options are not given. We use these variables to build a causal model of intervention that illustrates both the intended effects of multiple explanation and some potentially competing processes that it may trigger. Although multiple explanation clearly conveys some benefits (e.g., willingness to delay action to engage in information search, increased detail, quality and confidence in alternative explanations in the present experiments, we also found evidence that it may initiate or enhance processes that attenuate its advantages (e.g., feelings that one does not need more data if one has multiple good explanations.

  15. The provision of a cane provides greater benefit to community-dwelling people after stroke with a baseline walking speed between 0.4 and 0.8 metres/second: an experimental study.

    Science.gov (United States)

    Nascimento, Lucas R; Ada, Louise; Teixeira-Salmela, Luci F

    2016-12-01

    To investigate the effect of the provision of a cane on walking ability in ambulatory people with chronic stroke. Experimental study. Clinics within the community. Twenty-four people on average 6 years after a stroke, who were not regular users of walking sticks. Participants were categorized as slow (0.8 metres/second) on the basis of their baseline walking ability. Walking with and without a cane. Walking ability was measured using the 10-m Walk Test and reported as speed (metres/second), step length (metres), and cadence (steps/minute). Overall, the provision of a cane produced no significant change in speed (0.05 metres/second, 95% CI -0.01 to 0.11) or cadence (-3 steps/minute; 95% CI -8 to 3), but a small increase in step length (0.04 metres, 95% CI 0.03 to 0.06). For the intermediate walkers, the cane increased speed by 0.18 metres/second (95% CI 0.11 to 0.24), step length by 0.07 metres (95% CI 0.05 to 0.09), but not cadence. The provision of a cane to the intermediate walkers also produced 0.27 metres/second (95% CI 0.18 to 0.36) more increase in speed compared with the fast walkers, and 0.12 metres/second (95% CI 0.03 to 0.21) more increase compared with the slow walkers. The provision of a cane produced most benefit to a subgroup of intermediate walkers in a group of community-dwelling people with chronic stroke whose walking had stabilized, without detriment to quality of walking. Copyright © 2016. Published by Elsevier Ltd.

  16. Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality

    DEFF Research Database (Denmark)

    Smith, Emily R; Shankar, Anuraj H; Wu, Lee S-F

    2017-01-01

    . Multiple micronutrient supplements also had a greater effect on preterm births among underweight pregnant women (BMI ... to multiple micronutrient supplements also provided greater overall benefits. Studies should now aim to elucidate the mechanisms accounting for differences in the effect of antenatal multiple micronutrient supplements on infant health by maternal nutrition status and sex. FUNDING: None....

  17. Identifying patients who may benefit from adaptive radiotherapy : Does the literature on anatomic and dosimetric changes in head and neck organs at risk during radiotherapy provide information to help?

    NARCIS (Netherlands)

    Brouwer, Charlotte L.; Steenbakkers, Roe J. H. M.; Langendijk, Johannes A.; Sijtsema, Nanna M.

    In the last decade, many efforts have been made to characterize anatomic changes of head and neck organs at risk (OARS) and the dosimetric consequences during radiotherapy. This review was undertaken to provide an overview of the magnitude and frequency of these effects, and to investigate whether

  18. Improving anxiety regulation in patients with breast cancer at the beginning of the survivorship period: a randomized clinical trial comparing the benefits of single-component and multiple-component group interventions.

    Science.gov (United States)

    Merckaert, Isabelle; Lewis, Florence; Delevallez, France; Herman, Sophie; Caillier, Marie; Delvaux, Nicole; Libert, Yves; Liénard, Aurore; Nogaret, Jean-Marie; Ogez, David; Scalliet, Pierre; Slachmuylder, Jean-Louis; Van Houtte, Paul; Razavi, Darius

    2017-08-01

    To compare in a multicenter randomized controlled trial the benefits in terms of anxiety regulation of a 15-session single-component group intervention (SGI) based on support with those of a 15-session multiple-component structured manualized group intervention (MGI) combining support with cognitive-behavioral and hypnosis components. Patients with nonmetastatic breast cancer were randomly assigned at the beginning of the survivorship period to the SGI (n = 83) or MGI (n = 87). Anxiety regulation was assessed, before and after group interventions, through an anxiety regulation task designed to assess their ability to regulate anxiety psychologically (anxiety levels) and physiologically (heart rates). Questionnaires were used to assess psychological distress, everyday anxiety regulation, and fear of recurrence. Group allocation was computer generated and concealed till baseline completion. Compared with patients in the SGI group (n = 77), patients attending the MGI group (n = 82) showed significantly reduced anxiety after a self-relaxation exercise (P = .006) and after exposure to anxiety triggers (P = .013) and reduced heart rates at different time points throughout the task (P = .001 to P = .047). The MGI participants also reported better everyday anxiety regulation (P = .005), greater use of fear of recurrence-related coping strategies (P = .022), and greater reduction in fear of recurrence-related psychological distress (P = .017) compared with the SGI group. This study shows that an MGI combining support with cognitive-behavioral techniques and hypnosis is more effective than an SGI based only on support in improving anxiety regulation in patients with breast cancer. Copyright © 2016 John Wiley & Sons, Ltd.

  19. Exploring Antecedents of Relationship Benefits

    OpenAIRE

    Shuxia Ren; Mingli Zhang

    2013-01-01

    This study introduces data mining technology into the framework of the antecedents of relationship benefits based self-service environment which is broadly used in relational marketing research. The findings show that the relationship benefits dimensions are confidence and special treatment benefits and their antecedents dimensions are perceived control, efficiency and convenience through the use of web self-service technology, namely web self-service attributes. The results not only provide ...

  20. Combined oral contraceptives: health benefits beyond contraception.

    Science.gov (United States)

    Caserta, D; Ralli, E; Matteucci, E; Bordi, G; Mallozzi, M; Moscarini, M

    2014-09-01

    It has been recognized for over 50 years that combined oral contraceptives (COCs) are also capable of offering health benefits beyond contraception through the treatment and prevention of several gynaecological and medical disorders. During the last years a constant attention was given to the adverse effects of COCs, whereas their non-contraceptive benefits were underestimated. To date, most women are still unaware of the therapeutic uses of hormonal contraceptives, while on the contrary there is an extensive and constantly increasing of these non-contraceptive health benefits. This review summarizes the conditions of special interest for physicians, including dysmenorrhoea, menorrhagia, hyperandrogenism (acne, hirsutism, polycystic ovary syndrome), functional ovarian cysts, endometriosis, premenstrual syndrome, myomas, pelvic inflammatory disease, bone mineral density, benign breast disease and endometrial/ovarian and colorectal cancer. The benefits of COCs in rheumatoid arthritis, multiple sclerosis, menstrual migraine and in perimenopause have also been treated for more comprehensive information. Using COCs specifically for non-contraceptive indications is still outside the product licence in the majority of cases. We strongly believe that these aspects are not of minor relevance and they deserve a special consideration by health providers and by the mass media, which have the main responsibility in the diffusion of scientific information. Thus, counseling and education are necessary to help women make well-informed health-care decisions and it is also crucial to increase awareness among general practitioners and gynaecologists.

  1. 78 FR 76574 - Burial Benefits

    Science.gov (United States)

    2013-12-18

    ... World War II veterans, Congress' clear motivation was to make burial benefits ``easier to administer, i... definition of ``burial.'' Under the proposed rule, the definition would be placed at the beginning of the... Deceased Veterans for Whom VA May Provide Burial Benefits Under the definition in 38 U.S.C. 101(2), a...

  2. Kidneys from donors after cardiac death provide survival benefit

    NARCIS (Netherlands)

    M.G. Snoeijs (Maarten); D.E. Schaubel (Douglas); R. Hené (Ronald); A.J. Hoitsma (Andries); M.M. Idu (Mirza); J.N.M. IJzermans (Jan); R.J. Ploeg (Rutger); J. Ringers (Jan); M.H. Christiaans (Maarten); W.A. Buurman (Wim); L.W.E. van Heurn (Ernest)

    2010-01-01

    textabstractThe continuing shortage of kidneys for transplantation requires major efforts to expand the donor pool. Donation after cardiac death (DCD) increases the number of available kidneys, but it is unknown whether patients who receive a DCD kidney live longer than patients who remain on

  3. Kidneys from Donors after Cardiac Death Provide Survival Benefit

    NARCIS (Netherlands)

    Snoeijs, Maarten G.; Schaubel, Douglas E.; Hene, Ronald; Hoitsma, Andries J.; Idu, Mirza M.; Ijzermans, Jan N.; Ploeg, Rutger J.; Ringers, Jan; Christiaans, Maarten H.; Buurman, Wim A.; van Heurn, L. W. Ernest

    The continuing shortage of kidneys for transplantation requires major efforts to expand the donor pool. Donation after cardiac death (DCD) increases the number of available kidneys, but it is unknown whether patients who receive a DCD kidney live longer than patients who remain on dialysis and wait

  4. Kidneys from donors after cardiac death provide survival benefit.

    NARCIS (Netherlands)

    Snoeijs, M.G.; Schaubel, D.E.; Hene, R.; Hoitsma, A.J.; Idu, M.M.; Ijzermans, J.N.M.; Ploeg, R.J.; Ringers, J.; Christiaans, M.H.; Buurman, W.A.; Heurn, L.W.E. van

    2010-01-01

    The continuing shortage of kidneys for transplantation requires major efforts to expand the donor pool. Donation after cardiac death (DCD) increases the number of available kidneys, but it is unknown whether patients who receive a DCD kidney live longer than patients who remain on dialysis and wait

  5. Kidneys from donors after cardiac death provide survival benefit

    NARCIS (Netherlands)

    Snoeijs, Maarten G.; Schaubel, Douglas E.; Hené, Ronald; Hoitsma, Andries J.; Idu, Mirza M.; Ijzermans, Jan N.; Ploeg, Rutger J.; Ringers, Jan; Christiaans, Maarten H.; Buurman, Wim A.; van Heurn, L. W. Ernest

    2010-01-01

    The continuing shortage of kidneys for transplantation requires major efforts to expand the donor pool. Donation after cardiac death (DCD) increases the number of available kidneys, but it is unknown whether patients who receive a DCD kidney live longer than patients who remain on dialysis and wait

  6. Ethyl Pyruvate Provides Therapeutic Benefits to Resuscitation Fluids

    Science.gov (United States)

    2009-02-01

    Dentistry of New Jersey Newark, NJ 07101 REPORT DATE: February 2009 TYPE OF REPORT: Final PREPARED FOR: U.S. Army...PERFORMING ORGANIZATION REPORT NUMBER University of Medicine and Dentistry of New Jersey...pleiotropic cytokine and therapeutic target. Annu Rev Med, 1994. 45: p. 491-503. 7. Xu, J., et al., Trauma and hemorrhage-induced acute hepatic insulin

  7. Specialized Summer Camps: Provide Benefits for Children and Families Alike

    Science.gov (United States)

    Neff, John M.

    2009-01-01

    The arrival of summer signals a season of endless days of swimming, fishing, summer camps, and other outdoor activities. For children with chronic or terminal illnesses, it can be difficult to participate in many of these activities as well as challenging for parents to find summer camps that not only engage their children, but also offer the…

  8. 7 CFR 274.2 - Providing benefits to participants.

    Science.gov (United States)

    2010-01-01

    ....2 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE... households comprised of elderly or disabled members which have difficulty reaching issuance offices, and... tribal organization that exercises governmental jurisdiction over a reservation, the State agency shall...

  9. Benefits of dietary fiber in clinical nutrition.

    Science.gov (United States)

    Klosterbuer, Abby; Roughead, Zamzam Fariba; Slavin, Joanne

    2011-10-01

    Dietary fiber is widely recognized as an important part of a healthy diet and is a common addition to enteral nutrition (EN) formulas. Fiber sources differ in characteristics such as solubility, fermentability, and viscosity, and it is now well known that different types of fiber exert varying physiological effects in the body. Clinical studies suggest fiber can exert a wide range of benefits in areas such as bowel function, gut health, immunity, blood glucose control, and serum lipid levels. Although early clinical nutrition products contained fiber from a single source, it is now thought that blends of fiber from multiple sources more closely resemble a regular diet and may provide a greater range of benefits for the patient. Current recommendations support the use of dietary fiber in clinical nutrition when no contraindications exist, but little information exists about which types and combinations of fibers provide the relevant benefit in certain patient populations. This article summarizes the different types of fiber commonly added to EN products and reviews the current literature on the use of fiber blends in clinical nutrition.

  10. Benefício fornecido pelo uso de aparelhos de amplificação sonora individual em idosos de um programa de saude auditiva de Porto Velho - RO Benefit provided by the use of individual amplification device in older adults from a hearing health program in Porto Velho-RO

    Directory of Open Access Journals (Sweden)

    Claudilena Cristine Costa Rodrigues

    2013-01-01

    severe sensorineural hearing loss. The benefit was evaluated by the Abbreviated Profile of Hearing Aid Benefit - APHAB questionnaire under conditions of with and without hearing aids which was applied at the moment of adaptation and three months later. For analysis of the responses were considered the following subscales: Ease of communication, environmental noise, reverberant noise and sound aversion. The provided benefit was evaluated according to the degree of hearing loss by each subject. RESULTS: it was verified benefit in the subscales: ease of communication, environmental noise and reverberant noise, and these results demonstrated a statistically significant difference. With regard to the relation between the benefit to the degree of loss, it was found, among subjects with symmetrical hearing loss, greater benefit in those ones with sensorineural moderate hearing loss. However, it was not possible to verify the relation between the degree of loss and the provided benefit among individuals with different degrees of hearing loss. CONCLUSION: there was a reduction of hearing difficulties through the use of sound amplification in favorable environments, as well as in reverberant and high noise level ones.

  11. Multiple Pregnancy

    Science.gov (United States)

    ... multiple pregnancy affect fetal growth? Are tests for genetic disorders as accurate in multiple pregnancies? How can multiple pregnancy affect delivery? Can multiple pregnancy affect my risk of postpartum depression? Can I breastfeed if I have multiples? Glossary ...

  12. T₂ mapping provides multiple approaches for the characterization of muscle involvement in neuromuscular diseases: a cross-sectional study of lower leg muscles in 5-15-year-old boys with Duchenne muscular dystrophy.

    Science.gov (United States)

    Arpan, Ishu; Forbes, Sean C; Lott, Donovan J; Senesac, Claudia R; Daniels, Michael J; Triplett, William T; Deol, Jasjit K; Sweeney, H Lee; Walter, Glenn A; Vandenborne, Krista

    2013-03-01

    Skeletal muscles of children with Duchenne muscular dystrophy (DMD) show enhanced susceptibility to damage and progressive lipid infiltration, which contribute to an increase in the MR proton transverse relaxation time (T₂). Therefore, the examination of T₂ changes in individual muscles may be useful for the monitoring of disease progression in DMD. In this study, we used the mean T₂, percentage of elevated pixels and T₂ heterogeneity to assess changes in the composition of dystrophic muscles. In addition, we used fat saturation to distinguish T₂ changes caused by edema and inflammation from fat infiltration in muscles. Thirty subjects with DMD and 15 age-matched controls underwent T₂ -weighted imaging of their lower leg using a 3-T MR system. T₂ maps were developed and four lower leg muscles were manually traced (soleus, medial gastrocnemius, peroneal and tibialis anterior). The mean T₂ of the traced regions of interest, width of the T₂ histograms and percentage of elevated pixels were calculated. We found that, even in young children with DMD, lower leg muscles showed elevated mean T₂, were more heterogeneous and had a greater percentage of elevated pixels than in controls. T₂ measures decreased with fat saturation, but were still higher (P < 0.05) in dystrophic muscles than in controls. Further, T₂ measures showed positive correlations with timed functional tests (r = 0.23-0.79). The elevated T₂ measures with and without fat saturation at all ages of DMD examined (5-15 years) compared with unaffected controls indicate that the dystrophic muscles have increased regions of damage, edema and fat infiltration. This study shows that T₂ mapping provides multiple approaches that can be used effectively to characterize muscle tissue in children with DMD, even in the early stages of the disease. Therefore, T₂ mapping may prove to be clinically useful in the monitoring of muscle changes caused by the disease process or by therapeutic

  13. Family-centredness of professionals who support people with profound intellectual and multiple disabilities: validation of the Dutch 'Measure of Processes of Care for Service Providers' (MPOC-SP-PIMD).

    Science.gov (United States)

    Jansen, Suzanne L G; van der Putten, Annette A J; Post, Wendy J; Vlaskamp, Carla

    2014-07-01

    A Dutch version of the 'Measure of Processes of Care for Service Providers' (MPOC-SP) was developed to determine the extent to which professionals apply the principles of family-centred care in the rehabilitation of children with physical disabilities. However, no data were available on the reliability and construct validity of this instrument when it comes to supporting people with profound intellectual and multiple disabilities (PIMD). This study aimed to validate an adapted version of the Dutch MPOC-SP for assessing the family-centred behaviours of professionals who support this group (MPOC-SP-PIMD). A total of 105 professionals took part in the study. A Mokken scale analysis was conducted to determine whether the instrument satisfied the assumptions of both monotone homogeneity and double monotonicity. Loevinger's scalability coefficient (H) was used for the scalability of the entire scale and of each item separately. Rho was calculated as a measure of the internal consistency of the scales. The analyses resulted in two scales: a nine-item scale interpreted as 'Showing Interpersonal Sensitivity', with H=.39 and rho=.76, and a seven-item scale interpreted as 'Treating People Respectfully', with H=.49 and rho=.78. A validated version of the MPOC-SP-PIMD, suitable for supporting people with PIMD, consists of a subset of two scales from the original Dutch MPOC-SP. This instrument can be used to compare the family-centredness of professionals with parent's expectations and views. This information can be used in practice to match the support to the needs of the parents and family of the child with PIMD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Multiple sclerosis; Multiple Sklerose

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Kuehn, A.L.; Backens, M.; Papanagiotou, P. [Universitaet des Saarlandes, Abteilung fuer Diagnostische und Interventionelle Neuroradiologie, Radiologische Klinik, Homburg/Saar (Germany); Shariat, K. [Universitaet des Saarlandes, Klinik fuer Neurochirurgie, Homburg/Saar (Germany); Kostopoulos, P. [Universitaet des Saarlandes, Klinik fuer Neurologie, Homburg/Saar (Germany)

    2008-06-15

    Multiple sclerosis is the most common chronic inflammatory disease of myelin with interspersed lesions in the white matter of the central nervous system. Magnetic resonance imaging (MRI) plays a key role in the diagnosis and monitoring of white matter diseases. This article focuses on key findings in multiple sclerosis as detected by MRI. (orig.) [German] Die Multiple Sklerose (MS) ist die haeufigste chronisch-entzuendliche Erkrankung des Myelins mit eingesprengten Laesionen im Bereich der weissen Substanz des zentralen Nervensystems. Die Magnetresonanztomographie (MRT) hat bei der Diagnosestellung und Verlaufskontrolle eine Schluesselrolle. Dieser Artikel befasst sich mit Hauptcharakteristika der MR-Bildbebung. (orig.)

  15. Benefits and Risks Associated with Landscapes

    Science.gov (United States)

    To fully reap the benefits that lawns and landscapes can provide our urban and suburban communities, these green spaces must be well-maintained. The landscaping initiative helps manage the benefits and risks associated with lawn care.

  16. Electronics Environmental Benefits Calculator

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Electronics Environmental Benefits Calculator (EEBC) was developed to assist organizations in estimating the environmental benefits of greening their purchase,...

  17. Economic benefit assignment in environmental cost allocation

    OpenAIRE

    Collins C. Ngwakwe

    2013-01-01

    This paper aims to suggest a model to reward a dirty product which has the potential to offer sales promotion services to other clean products in a multiple product firm. The paper suggests a model economic benefit assignment (eba) for apportionment of direct waste costs where a polluting product offers a sales promotion benefit to other clean products of the same company, which proposes that benefiting products should be assigned a proportion of the direct waste cost of the polluting product...

  18. Making benefit transfers work

    DEFF Research Database (Denmark)

    Bateman, I. J.; Brouwer, R.; Ferrini, S.

    2011-01-01

    We develop and test guidance principles for benefits transfers. These argue that when transferring across relatively similar sites, simple mean value transfers are to be preferred but that when sites are relatively dissimilar then value function transfers will yield lower errors. The paper also...... provides guidance on the appropriate specification of transferable value functions arguing that these should be developed from theoretical rather than ad-hoc statistical principles. These principles are tested via a common format valuation study of water quality improvements across five countries. Results...

  19. Making benefit transfers work

    DEFF Research Database (Denmark)

    Bateman, I.J.; Brouwer, R.; Ferrini, S.

    We develop and test guidance principles for benefits transfers. These argue that when transferring across relatively similar sites, simple mean value transfers are to be preferred but that when sites are relatively dissimilar then value function transfers will yield lower errors. The paper also...... provides guidance on the appropriate specification of transferable value functions arguing that these should be developed from theoretical rather than ad-hoc statistical principles. These principles are tested via a common format valuation study of water quality improvements across five countries. Results...

  20. Validation of sick leave measures: self-reported sick leave and sickness benefit data from a Danish national register compared to multiple workplace-registered sick leave spells in a Danish municipality.

    Science.gov (United States)

    Stapelfeldt, Christina Malmose; Jensen, Chris; Andersen, Niels Trolle; Fleten, Nils; Nielsen, Claus Vinther

    2012-08-15

    Previous validation studies of sick leave measures have focused on self-reports. Register-based sick leave data are considered to be valid; however methodological problems may be associated with such data. A Danish national register on sickness benefit (DREAM) has been widely used in sick leave research. On the basis of sick leave records from 3,554 and 2,311 eldercare workers in 14 different workplaces, the aim of this study was to: 1) validate registered sickness benefit data from DREAM against workplace-registered sick leave spells of at least 15 days; 2) validate self-reported sick leave days during one year against workplace-registered sick leave. Agreement between workplace-registered sick leave and DREAM-registered sickness benefit was reported as sensitivities, specificities and positive predictive values. A receiver-operating characteristic curve and a Bland-Altman plot were used to study the concordance with sick leave duration of the first spell. By means of an analysis of agreement between self-reported and workplace-registered sick leave sensitivity and specificity was calculated. Ninety-five percent confidence intervals (95% CI) were used. The probability that registered DREAM data on sickness benefit agrees with workplace-registered sick leave of at least 15 days was 96.7% (95% CI: 95.6-97.6). Specificity was close to 100% (95% CI: 98.3-100). The registered DREAM data on sickness benefit overestimated the duration of sick leave spells by an average of 1.4 (SD: 3.9) weeks. Separate analysis on pregnancy-related sick leave revealed a maximum sensitivity of 20% (95% CI: 4.3-48.1).The sensitivity of self-reporting at least one or at least 56 sick leave day/s was 94.5 (95% CI: 93.4 - 95.5) % and 58.5 (95% CI: 51.1 - 65.6) % respectively. The corresponding specificities were 85.3 (95% CI: 81.4 - 88.6) % and 98.9 (95% CI: 98.3 - 99.3) %. The DREAM register offered valid measures of sick leave spells of at least 15 days among eldercare employees. Pregnancy

  1. Multiple sclerosis - New treatment modalities

    Directory of Open Access Journals (Sweden)

    Rocco Totaro

    2015-01-01

    Full Text Available Ever since the introduction of the first disease modifying therapies, the concept of multiple sclerosis treatment algorithms developed ceaselessly. The increasing number of available drugs is paralleled by impelling issue of ensuring the most appropriate treatment to the right patient at the right time. The purpose of this review is to describe novel agents recently approved for multiple sclerosis treatment, namely teriflunomide, alemtuzumab and dimethylfumarate, focusing on mechanism of action, efficacy data in experimental setting, safety and tolerability. The place in therapy of newer treatment implies careful balancing of risk-benefit profile as well as accurate patient selection. Hence the widening of therapeutic arsenal provides greater opportunity for personalized therapy but also entails a complex trade-off between efficacy, tolerability, safety and eventually patient preference.

  2. Motivation and benefits of implementation and certification ...

    African Journals Online (AJOL)

    This paper aims to provide a contribution to the research related to the motivation and benefits associated to the quality management systems. The selection of the motives and benefits were validated through statistical analysis and the relationship between expected and perceived benefits was discussed. Keywords: Quality ...

  3. USCIS Applications for Immigration Benefits and Naturalization Monthly Statistical Reports

    Data.gov (United States)

    Department of Homeland Security — The 'Application for Immigration Benefits' monthly charts provide data on applications and petitions received by USCIS for immigration benefits. The report exclude...

  4. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial

    DEFF Research Database (Denmark)

    Kappos, Ludwig; Freedman, Mark S; Polman, Chris H

    2009-01-01

    with interferon beta-1b on time to clinically definite multiple sclerosis (CDMS) and other disease outcomes, including disability progression. METHODS: Patients with a first event suggestive of multiple sclerosis and a minimum of two clinically silent lesions in MRI were randomly assigned to receive interferon...... beta-1b 250 microg (n=292; early treatment) or placebo (n=176; delayed treatment) subcutaneously every other day for 2 years, or until diagnosis of CDMS. All patients were then eligible to enter a prospectively planned follow-up phase with open-label interferon beta-1b up to a maximum of 5 years after....... No significant differences in other disability related outcomes were recorded. Frequency and severity of adverse events remained within the established safety and tolerability profile of interferon beta-1b. INTERPRETATION: Effects on the rate of conversion to CDMS and the favourable long-term safety...

  5. Employee benefits or wage increase?

    Directory of Open Access Journals (Sweden)

    Jiří Duda

    2011-01-01

    Full Text Available The paper comes from a survey done during the years 2007–2009. It focused on employee satisfaction with the provision of employee benefits. The research included 21 companies, 7 companies were from the engineering sector, 7 companies from the food industry, 3 companies represented the budgetary sphere, 3 companies the services sector and one company operates in pharmaceutical industry.The questionnaire survey consisted of 14 questions, including 5 identification-questions. The paper presents results of the questions on dealing with employees’ awareness of employee benefits and on choosing between employees’ preferences of wage increase or increase in value of benefits provided.Employees are informed about all options of providing employee benefits. Only in 3 cases employees stated dissatisfaction with information. This answer was related with the responses to the second monitored question. Employees of these companies preferred pay increases before benefits’ increases. There was no effect of gender of the respondents, neither the influence of the sector of operation, in the preference of increases in wages or in benefits. Exceptions were the employees of companies operating in the financial sector, who preferred employee benefits before a wage increase. It was found that employees of companies who participated in research in 2009, preferred wage increases before the extension of employee benefits, although the value of the net wage increase is lower than the monetary value of benefits increase.The paper is a part of solution of the research plan MSM 6215648904 The Czech economy in the process of integration and globalization, and the development of agricultural sector and the sector of services under the new conditions of the integrated European market.

  6. Health benefit modelling and optimization of vehicular pollution control strategies

    Science.gov (United States)

    Sonawane, Nayan V.; Patil, Rashmi S.; Sethi, Virendra

    2012-12-01

    This study asserts that the evaluation of pollution reduction strategies should be approached on the basis of health benefits. The framework presented could be used for decision making on the basis of cost effectiveness when the strategies are applied concurrently. Several vehicular pollution control strategies have been proposed in literature for effective management of urban air pollution. The effectiveness of these strategies has been mostly studied as a one at a time approach on the basis of change in pollution concentration. The adequacy and practicality of such an approach is studied in the present work. Also, the assessment of respective benefits of these strategies has been carried out when they are implemented simultaneously. An integrated model has been developed which can be used as a tool for optimal prioritization of various pollution management strategies. The model estimates health benefits associated with specific control strategies. ISC-AERMOD View has been used to provide the cause-effect relation between control options and change in ambient air quality. BenMAP, developed by U.S. EPA, has been applied for estimation of health and economic benefits associated with various management strategies. Valuation of health benefits has been done for impact indicators of premature mortality, hospital admissions and respiratory syndrome. An optimization model has been developed to maximize overall social benefits with determination of optimized percentage implementations for multiple strategies. The model has been applied for sub-urban region of Mumbai city for vehicular sector. Several control scenarios have been considered like revised emission standards, electric, CNG, LPG and hybrid vehicles. Reduction in concentration and resultant health benefits for the pollutants CO, NOx and particulate matter are estimated for different control scenarios. Finally, an optimization model has been applied to determine optimized percentage implementation of specific

  7. Benefits of Java

    Science.gov (United States)

    ... Women Home Health Wellness Preventing Illness Benefits of Java Print Email Benefits of Coffee Reviewed by Taylor ... is a calcium-rich alternative. So how much java is too much? It's wise to stick to ...

  8. Characteristics of individuals receiving disability benefits in the Netherlands and predictors of leaving the disability benefit scheme: a retrospective cohort study with five-year follow-up.

    Science.gov (United States)

    Louwerse, Ilse; Huysmans, Maaike A; van Rijssen, H Jolanda; van der Beek, Allard J; Anema, Johannes R

    2018-01-18

    Today, work disability is one of the greatest social and labour market challenges for policy makers in most OECD countries, where on average, about 6% of the working-age population relies on disability benefits. Understanding of factors associated with long-term work disability may be helpful to identify groups of individuals at risk for disability benefit entitlement or continuing eligibility, and to develop effective interventions for these groups. The purpose of this study is to provide insight into the main diagnoses of workers who qualify for disability benefits and how these diagnoses differ in age, gender and education. Using a five-year follow-up, we examined the duration of disability benefits and how durations differ among individuals with various characteristics. We performed a cohort study of 31,733 individuals receiving disability benefits from the Dutch Social Security Institute (SSI) with a five-year follow-up. Data were collected from SSI databases. Information about disorders was assessed by an insurance physician upon benefit application. These data were used to test for significant relationships among socio-demographics, main diagnoses and comorbidity, and disability benefit entitlement and continuing eligibility. Mental disorders were the most frequent diagnosis for individuals claiming work disability. Diagnoses differed among age groups and education categories. Mental disorders were the main diagnosis for work disability for younger and more highly educated individuals, and physical disorders (generally musculoskeletal, cardiovascular and cancer) were the main diagnosis for older and less educated individuals. In 82% of the claims, the duration of disability benefit was five years or more after approval. Outflow was lowest for individuals with (multiple) mental disorders and those with comorbidity of mental and physical disorders, and highest for individuals with (multiple) physical disorders. The main diagnosis for persons entitled to

  9. PESTICIDES: BENEFITS AND HAZARDS

    Directory of Open Access Journals (Sweden)

    Ivan Maksymiv

    2015-05-01

    Full Text Available Pesticides are an integral part of modern life used to prevent growth of unwanted living  organisms. Despite the fact that scientific statements coming from many toxicological works provide indication on the low risk of the pesticides and their residues, the community especially last years is deeply concerned about massive application of pesticides in diverse fields. Therefore evaluation of hazard risks particularly in long term perspective is very important. In the fact there are at least two clearly different approaches for evaluation of pesticide using: the first one is defined as an objective or probabilistic risk assessment, while the second one is the potential economic and agriculture benefits. Therefore, in this review the author has considered scientifically based assessment of positive and negative effects of pesticide application and discusses possible approaches to find balance between them.

  10. NASA Technology Benefits Orthotics

    Science.gov (United States)

    Myers, Neill; Shadoan, Michael

    1998-01-01

    Engineers at NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama have designed a knee brace to aid in the rehabilitation of medical patients. The device, called the Selectively Lockable Knee Brace, was designed for knee injury and stroke patients but may potentially serve in many more patient applications. Individuals with sports related injuries, spinal cord injuries and birth defects, such as spina bifida, may also benefit from the device. The Selectively Lockable Knee Brace is designed to provide secure support to the patient when weight is applied to the leg; however; when the leg is not supporting weight, the device allows free motion of the knee joint. Braces currently on the market lock the knee in a rigid, straight or bent position, or by manually pulling a pin, allow continuous free joint motion.

  11. Neutron Multiplicity Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Frame, Katherine Chiyoko [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-06-28

    Neutron multiplicity measurements are widely used for nondestructive assay (NDA) of special nuclear material (SNM). When combined with isotopic composition information, neutron multiplicity analysis can be used to estimate the spontaneous fission rate and leakage multiplication of SNM. When combined with isotopic information, the total mass of fissile material can also be determined. This presentation provides an overview of this technique.

  12. Exercise and multiple sclerosis.

    Science.gov (United States)

    White, Lesley J; Dressendorfer, Rudolph H

    2004-01-01

    The pathophysiology of multiple sclerosis (MS) is characterised by fatigue, motor weakness, spasticity, poor balance, heat sensitivity and mental depression. Also, MS symptoms may lead to physical inactivity associated with the development of secondary diseases. Persons with MS are thus challenged by their disability when attempting to pursue an active lifestyle compatible with health-related fitness. Although exercise prescription is gaining favour as a therapeutic strategy to minimise the loss of functional capacity in chronic diseases, it remains under-utilised as an intervention strategy in the MS population. However, a growing number of studies indicate that exercise in patients with mild-to-moderate MS provides similar fitness and psychological benefits as it does in healthy controls. We reviewed numerous studies describing the responses of selected MS patients to acute and chronic exercise compared with healthy controls. All training studies reported positive outcomes that outweighed potential adverse effects of the exercise intervention. Based on our review, this article highlights the role of exercise prescription in the multidisciplinary approach to MS disease management for improving and maintaining functional capacity. Despite the often unpredictable clinical course of MS, exercise programmes designed to increase cardiorespiratory fitness, muscle strength and mobility provide benefits that enhance lifestyle activity and quality of life while reducing risk of secondary disorders. Recommendations for the evaluation of cardiorespiratory fitness, muscle performance and flexibility are presented as well as basic guidelines for individualised exercise testing and training in MS. Special considerations for exercise, including medical management concerns, programme modifications and supervision, in the MS population are discussed.

  13. Parenting Multiples

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Parenting Multiples KidsHealth / For Parents / Parenting Multiples What's in ... your ability to take care of your babies. Parenting Issues With Multiples It may be difficult to ...

  14. The Benefits of Watching Television.

    Science.gov (United States)

    Levinson, Paul

    The unfounded and sometimes absurd attacks on television have tended to obscure many of the medium's obvious personal, social, and aesthetic benefits. It is easy to watch, and if its content does not always provide viewers with much to think about, television does not ask much of them either: they may eat, sleep, and unwind in front of it,…

  15. The cardiovascular benefits of dark chocolate.

    Science.gov (United States)

    Kerimi, Asimina; Williamson, Gary

    2015-08-01

    Dark chocolate contains many biologically active components, such as catechins, procyanidins and theobromine from cocoa, together with added sucrose and lipids. All of these can directly or indirectly affect the cardiovascular system by multiple mechanisms. Intervention studies on healthy and metabolically-dysfunctional volunteers have suggested that cocoa improves blood pressure, platelet aggregation and endothelial function. The effect of chocolate is more convoluted since the sucrose and lipid may transiently and negatively impact on endothelial function, partly through insulin signalling and nitric oxide bioavailability. However, few studies have attempted to dissect out the role of the individual components and have not explored their possible interactions. For intervention studies, the situation is complex since suitable placebos are often not available, and some benefits may only be observed in individuals showing mild metabolic dysfunction. For chocolate, the effects of some of the components, such as sugar and epicatechin on FMD, may oppose each other, or alternatively in some cases may act together, such as theobromine and epicatechin. Although clearly cocoa provides some cardiovascular benefits according to many human intervention studies, the exact components, their interactions and molecular mechanisms are still under debate. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. 20 CFR 617.4 - Benefit information to workers.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Benefit information to workers. 617.4 Section... ASSISTANCE FOR WORKERS UNDER THE TRADE ACT OF 1974 General § 617.4 Benefit information to workers. (a) Providing information to workers. State agencies shall provide full information to workers about the benefit...

  17. Information Portal Costs and Benefits

    Directory of Open Access Journals (Sweden)

    Lorena BATAGAN

    2006-01-01

    Full Text Available All transformations of our society are the product of the large use of Information and Communications Technologies (ICT and Internet. ICT are technologies which facilitate communication, processing, and transmission of information by electronic means. It is very important to use the new technologies to the correct value because this determinate an increase of global benefits. Portal provides a consistent way to select, evaluate, prioritize and plan the right information. In research we point the important costs and benefits for an informational portal. The portal for local administrative determinate for citizens the access to information of interest and on the other hand make easier for employer to manage the documents.

  18. Multiple Perspectives / Multiple Readings

    Directory of Open Access Journals (Sweden)

    Simon Biggs

    2005-01-01

    Full Text Available People experience things from their own physical point of view. What they see is usually a function of where they are and what physical attitude they adopt relative to the subject. With augmented vision (periscopes, mirrors, remote cameras, etc we are able to see things from places where we are not present. With time-shifting technologies, such as the video recorder, we can also see things from the past; a time and a place we may never have visited.In recent artistic work I have been exploring the implications of digital technology, interactivity and internet connectivity that allow people to not so much space/time-shift their visual experience of things but rather see what happens when everybody is simultaneously able to see what everybody else can see. This is extrapolated through the remote networking of sites that are actual installation spaces; where the physical movements of viewers in the space generate multiple perspectives, linked to other similar sites at remote locations or to other viewers entering the shared data-space through a web based version of the work.This text explores the processes involved in such a practice and reflects on related questions regarding the non-singularity of being and the sense of self as linked to time and place.

  19. Transit Benefit Program Data -

    Data.gov (United States)

    Department of Transportation — This data set contains information about any US government agency participating in the transit benefits program, funding agreements, individual participating Federal...

  20. Empowering University Students Through Online Multiple Choice Questions

    OpenAIRE

    Bolat, Elvira; Dogan, H.; Biggins, David; Dupac, Mihai; Crowley, Emma J.

    2016-01-01

    The benefit of using online multiple choice questions (MCQs) to test knowledge acquisition, provide reassurance to learners that required knowledge has be understood and as a tool to detect knowledge deficits or misunderstanding have long been understood. Moving the MCQ online provides an opportunity to widen access, measure participation and interaction and to test the use of theories such as gamification in raising engagement by students. Aim of this paper is to describe how Bournemouth Uni...

  1. Multiple density layered insulator

    Science.gov (United States)

    Alger, Terry W.

    1994-01-01

    A multiple density layered insulator for use with a laser is disclosed wh provides at least two different insulation materials for a laser discharge tube, where the two insulation materials have different thermoconductivities. The multiple layer insulation materials provide for improved thermoconductivity capability for improved laser operation.

  2. Ontario Universities Benefits Survey, 1987-88. Part I: Benefits Excluding Pensions.

    Science.gov (United States)

    University of Western Ontario, London.

    Results of the 1987-1988 survey of benefits, excluding pensions, for 17 Ontario, Canada, universities are presented. Information is provided on the following areas: administration and insurance plans, communication of benefits, proposed changes in benefits, provision of life and dismemberment insurance, maternity leave policy, Ontario health…

  3. "Cuz They Care about the People Who Goes There": The Multiple Roles of a Community-Based Youth Center in Providing "Youth (Comm)Unity" for Low-Income Chinese American Youth

    Science.gov (United States)

    Wong, Nga-Wing Anjela

    2010-01-01

    This article will explore the role of "CYC," a community-based youth center, in providing a sense of what I call "Youth (Comm)Unity" for Chinese American youth from low-income immigrant families. While CYC combines the youths' home and school worlds, it is also distinct from these worlds by forming a new and hybrid culture/space. In doing so, I…

  4. Generalized internal multiple imaging

    KAUST Repository

    Zuberi, Mohammad Akbar Hosain

    2014-12-04

    Various examples are provided for generalized internal multiple imaging (GIMI). In one example, among others, a method includes generating a higher order internal multiple image using a background Green\\'s function and rendering the higher order internal multiple image for presentation. In another example, a system includes a computing device and a generalized internal multiple imaging (GIMI) application executable in the computing device. The GIMI application includes logic that generates a higher order internal multiple image using a background Green\\'s function and logic that renders the higher order internal multiple image for display on a display device. In another example, a non-transitory computer readable medium has a program executable by processing circuitry that generates a higher order internal multiple image using a background Green\\'s function and renders the higher order internal multiple image for display on a display device.

  5. A framework for organizing and selecting quantitative approaches for benefit-harm assessment

    Directory of Open Access Journals (Sweden)

    Puhan Milo A

    2012-11-01

    Full Text Available Abstract Background Several quantitative approaches for benefit-harm assessment of health care interventions exist but it is unclear how the approaches differ. Our aim was to review existing quantitative approaches for benefit-harm assessment and to develop an organizing framework that clarifies differences and aids selection of quantitative approaches for a particular benefit-harm assessment. Methods We performed a review of the literature to identify quantitative approaches for benefit-harm assessment. Our team, consisting of clinicians, epidemiologists, and statisticians, discussed the approaches and identified their key characteristics. We developed a framework that helps investigators select quantitative approaches for benefit-harm assessment that are appropriate for a particular decisionmaking context. Results Our framework for selecting quantitative approaches requires a concise definition of the treatment comparison and population of interest, identification of key benefit and harm outcomes, and determination of the need for a measure that puts all outcomes on a single scale (which we call a benefit and harm comparison metric. We identified 16 quantitative approaches for benefit-harm assessment. These approaches can be categorized into those that consider single or multiple key benefit and harm outcomes, and those that use a benefit-harm comparison metric or not. Most approaches use aggregate data and can be used in the context of single studies or systematic reviews. Although the majority of approaches provides a benefit and harm comparison metric, only four approaches provide measures of uncertainty around the benefit and harm comparison metric (such as a 95 percent confidence interval. None of the approaches considers the actual joint distribution of benefit and harm outcomes, but one approach considers competing risks when calculating profile-specific event rates. Nine approaches explicitly allow incorporating patient preferences

  6. The failure of community benefit.

    Science.gov (United States)

    Colombo, John D

    2005-01-01

    Though proponents of tax exemption for health care providers continue to extol the virtues of the community-benefit test, Part II of this article illustrates that the train pretty much has already left the station on this front. Both the federal government and the states increasingly look to uncompensated care as the touchstone of exemption for health care providers. To a great extent, this transition back to a "relief of the poor" standard for exemption is the result of the inherent lack of precision in community benefit standards, along with the general trend of empirical evidence that nonprofit health care providers behave similarly to their for-profit counterparts. Faced with this situation, federal and state policymakers naturally have focused on charity care as the one quantifiable behavioral difference to justify exemption. Nevertheless, some empirical evidence suggests that nonprofits may engage in socially desirable behavior other than simply free care for the poor, and the arguments that a mixed ownership system provides the best overall health care model cannot be dismissed out of hand. Thus, despite my past criticisms of the community benefit formulation, I have come to the view that we should seriously consider the options available beyond complete repeal of the community benefit test or a return to a strict charity-care exemption standard. I continue to believe that we should demand a fairly high level of "accountability" from exemption, however, and that exemption should have some direct causal connection to whatever socially-desirable behavior we are seeking. While one option along these lines is to adopt Nina Crimm's approach of rewarding specific behaviors through a deduction or credit system, using "enhancing access" as a test of exemption may provide the best combination of flexibility and verifiable behavioral differences to support continued exemption for health care providers.

  7. Wellbeing or welfare benefits

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Kristiansen, Maria; Nørredam, Marie Louise

    2016-01-01

    This debate article debunks the myth that migrants are driven primarily by the size of the welfare benefits in the host country, when they decide where to migrate to. We show that instead of welfare benefits, migrants are driven by a desire for safety, wellbeing, social networks and opportunities...

  8. Institution-wide peer mentoring: Benefits for mentors

    Directory of Open Access Journals (Sweden)

    Susan Beltman

    2012-08-01

    Full Text Available Extensive research has shown the benefits of mentoring, including peer mentoring, for higher education students, especially in their first year. However, few studies have focussed exclusively on the outcomes for the mentors themselves. This paper reports the findings of data gathered over three years about a university-wide peer mentoring program. Benefits identified by 858 mentors were coded inductively and four major categories emerged: altruistic, cognitive, social and personal growth. The findings have implications for the promotion of mentor programs to administrators and to prospective mentors. The study provides evidence that university-wide peer mentoring programs offer multiple positive outcomes for the mentors involved, and potentially for higher education institutions administering and supporting such programs. 

  9. Human benefits of animal interventions for zoonosis control.

    Science.gov (United States)

    Zinsstag, Jakob; Schelling, Esther; Roth, Felix; Bonfoh, Bassirou; de Savigny, Don; Tanner, Marcel

    2007-04-01

    Although industrialized countries have been able to contain recent outbreaks of zoonotic diseases, many resource-limited and transitioning countries have not been able to react adequately. The key for controlling zoonoses such as rabies, echinococcosis, and brucellosis is to focus on the animal reservoir. In this respect, ministries of health question whether the public health sector really benefits from interventions for livestock. Cross-sectoral assessments of interventions such as mass vaccination for brucellosis in Mongolia or vaccination of dogs for rabies in Chad consider human and animal health sectors from a societal economic perspective. Combining the total societal benefits, the intervention in the animal sector saves money and provides the economic argument, which opens new approaches for the control of zoonoses in resource-limited countries through contributions from multiple sectors.

  10. [Multiple apheresis].

    Science.gov (United States)

    Coffe, C

    2007-05-01

    Multiple apheresis makes it possible to obtain at least two labile blood components from a single donor using a cell separator. It can be either multicomponent apheresis leading to the preparation of at least two different blood component types or red blood cell apheresis providing two identical red blood cell concentrates. These techniques available in addition to whole blood donation, are modifying collection strategies in many Etablissements Français du Sang and will contribute to improve stock logistics in the future. In areas with insufficient stock, these procedures will help achieve blood component self-sufficiency. The author first describes the principle underlying different--current or future--techniques as well as their advantages and drawbacks. He finally addresses the potential impact of these processes on the evolution of blood collection and the advantages to be gained.

  11. Multiple Sclerosis

    Science.gov (United States)

    Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin ... healthy cells in your body by mistake. Multiple sclerosis affects women more than men. It often begins ...

  12. Artefactual multiplicity

    DEFF Research Database (Denmark)

    Bjørn, Pernille; Hertzum, Morten

    2011-01-01

    Whiteboards are highly important to the work in emergency departments (EDs). As a collaborative technology ED whiteboards are usually placed in the dynamic centre of the ED, and all ED staff will approach the whiteboard regularly to organize their individual yet interdependent work. Currently, di...... this characteristic of heterogeneous artefacts; namely artefactual multiplicity. Artefactual multiplicity identifies not only the multiple functions of heterogeneous artefacts but also the intricate relations between these multiple functionalities....

  13. Supraglottoplasty for Laryngomalacia: Who Will Benefit?

    Directory of Open Access Journals (Sweden)

    Azida Zainal

    2011-04-01

    Conclusion: Supraglottoplasty remains an effective method to treat severe laryngomalacia. Patients who will benefit most are those with severe laryngomalacia that is uncomplicated by neurological conditions or multiple medical problems. In our institution, early extubation is the norm, and a significant number of patients can be nursed in the normal wards and be discharged within 48 hours of the procedure.

  14. Comparing Top-down and Bottom-up Estimates of Methane Emissions across Multiple U.S. Basins Provides Insights into National Oil and Gas Emissions and Mitigation Strategies

    Science.gov (United States)

    Hamburg, S.; Alvarez, R.; Lyon, D. R.; Zavala-Araiza, D.

    2016-12-01

    Several recent studies quantified regional methane emissions in U.S. oil and gas (O&G) basins using top-down approaches such as airborne mass balance measurements. These studies apportioned total methane emissions to O&G based on hydrocarbon ratios or subtracting bottom-up estimates of other sources. In most studies, top-down estimates of O&G methane emissions exceeded bottom-up emission inventories. An exception is the Barnett Shale Coordinated Campaign, which found agreement between aircraft mass balance estimates and a custom emission inventory. Reconciliation of Barnett Shale O&G emissions depended on two key features: 1) matching the spatial domains of top-down and bottom-up estimates, and 2) accounting for fat-tail sources in site-level emission factors. We construct spatially explicit custom emission inventories for domains with top-down O&G emission estimates in eight major U.S. oil and gas production basins using a variety of data sources including a spatially-allocated U.S. EPA Greenhouse Gas Inventory, the EPA Greenhouse Gas Reporting Program, state emission inventories, and recently published measurement studies. A comparison of top-down and our bottom-up estimates of O&G emissions constrains the gap between these approaches and elucidates regional variability in production-normalized loss rates. A comparison of component-level and site-level emission estimates of production sites in the Barnett Shale region - where comprehensive activity data and emissions estimates are available - indicates that abnormal process conditions contribute about 20% of regional O&G emissions. Combining these two analyses provides insights into the relative importance of different equipment, processes, and malfunctions to emissions in each basin. These data allow us to estimate the U.S. O&G supply chain loss rate, recommend mitigation strategies to reduce emissions from existing infrastructure, and discuss how a similar approach can be applied internationally.

  15. Risks and Benefits of Consumption of Great Lakes Fish

    Science.gov (United States)

    Bhavsar, Satyendra P.; Bowerman, William; Boysen, Eric; Clark, Milton; Diamond, Miriam; Mergler, Donna; Pantazopoulos, Peter; Schantz, Susan; Carpenter, David O.

    2011-01-01

    Background: Beneficial effects of fish consumption on early cognitive development and cardiovascular health have been attributed to the omega-3 fatty acids in fish and fish oils, but toxic chemicals in fish may adversely affect these health outcomes. Risk–benefit assessments of fish consumption have frequently focused on methylmercury and omega-3 fatty acids, not persistent pollutants such as polychlorinated biphenyls, and none have evaluated Great Lakes fish consumption. Objectives: The risks and benefits of fish consumption have been established primarily for marine fish. Here, we examine whether sufficient data are available to evaluate the risks and benefits of eating freshwater fish from the Great Lakes. Methods: We used a scoping review to integrate information from multiple state, provincial, and federal agency sources regarding the contaminants and omega-3 fatty acids in Great Lakes fish and fish consumers, consumption rates and fish consumption advisories, and health effects of contaminants and omega-3 fatty acids. Data synthesis: Great Lakes fish contain persistent contaminants—many of which have documented adverse health effects —that accumulate in humans consuming them. In contrast, data are sparse on omega-3 fatty acids in the fish and their consumers. Moreover, few studies have documented the social and cultural benefits of Great Lakes fish consumption, particularly for subsistence fishers and native communities. At this time, federal and state/provincial governments provide fish consumption advisories based solely on risk. Conclusions: Our knowledge of Great Lakes fish has critical gaps, particularly regarding the benefits of consumption. A risk–benefit analysis requires more information than is currently available on the concentration of omega-3 fatty acids in Great Lakes fish and their absorption by fish eaters in addition to more information on the social, cultural, and health consequences of changes in the amount of fish consumed. PMID

  16. Health benefits of dietary fiber

    OpenAIRE

    Anderson, JW; Baird, P.; Davis, RH; Ferreri, S.; Knudtson, M.; Koraym, A; Waters, V; Williams, CL

    2009-01-01

    Dietary fiber intake provides many health benefits. However, average fiber intakes for US children and adults are less than half of the recommended levels. Individuals with high intakes of dietary fiber appear to be at significantly lower risk for developing coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal diseases. Increasing fiber intake lowers blood pressure and serum cholesterol levels. Increased intake of soluble fiber improves glycemia and in...

  17. Multiplicity Counting

    Energy Technology Data Exchange (ETDEWEB)

    Geist, William H. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-12-01

    This set of slides begins by giving background and a review of neutron counting; three attributes of a verification item are discussed: 240Pueff mass; α, the ratio of (α,n) neutrons to spontaneous fission neutrons; and leakage multiplication. It then takes up neutron detector systems – theory & concepts (coincidence counting, moderation, die-away time); detector systems – some important details (deadtime, corrections); introduction to multiplicity counting; multiplicity electronics and example distributions; singles, doubles, and triples from measured multiplicity distributions; and the point model: multiplicity mathematics.

  18. Benefits of Breastfeeding

    Medline Plus

    Full Text Available A project of the U.S. Department of Health and Human Services Office on Women's Health Skip Navigation ... to breastfeed Secrets to breastfeeding success The benefits of breastfeeding Breastfeeding 411 ...

  19. Benefits of Breastfeeding

    Medline Plus

    Full Text Available ... size | Print | Skip left navigation It's Only Natural Planning ahead Breastfeeding and baby basics Making breastfeeding work ... Enter email address Submit Home > It's Only Natural > Planning ahead The benefits of breastfeeding YouTube embed video: ...

  20. Benefits of Breastfeeding

    Medline Plus

    Full Text Available ... Only Natural > Planning ahead The benefits of breastfeeding YouTube embed video: YouTube embed video: https://www.youtube-nocookie.com/embed/DpVp07lgDsI Learn the unique ways ...

  1. Benefits of Java

    Science.gov (United States)

    ... For Men For Women For Seniors Benefits of Java Published September 29, 2014 Print Email Reviewed by ... your coffee even more beneficial. So how much java is too much? Both Dubost and Salge Blake ...

  2. Benefits of Breastfeeding

    Medline Plus

    Full Text Available ... Only Natural email updates. Enter email address Submit Home > It's Only Natural > Planning ahead The benefits of breastfeeding YouTube embed video: YouTube embed video: https://www. ...

  3. Unemployment Benefit Exhaustion

    DEFF Research Database (Denmark)

    Filges, Trine; Pico Geerdsen, Lars; Knudsen, Anne-Sofie Due

    2015-01-01

    This systematic review studied the impact of exhaustion of unemployment benefits on the exit rate out of unemployment and into employment prior to benefit exhaustion or shortly thereafter. Method: We followed Campbell Collaboration guidelines to prepare this review, and ultimately located 12...... studies for final analysis and interpretation. Twelve studies could be included in the data synthesis. Results: We found clear evidence that the prospect of exhaustion of benefits results in a significantly increased incentive for finding work. Discussion: The theoretical suggestion that the prospect...... of exhaustion of benefits results in an increased incentive for finding work has been confirmed empirically by measures from seven different European countries, the United States, and Canada. The results are robust in the sense that sensitivity analyses evidenced no appreciable changes in the results. We found...

  4. Addition of Rice Bran Arabinoxylan to Curcumin Therapy May Be of Benefit to Patients With Early-Stage B-Cell Lymphoid Malignancies (Monoclonal Gammopathy of Undetermined Significance, Smoldering Multiple Myeloma, or Stage 0/1 Chronic Lymphocytic Leukemia): A Preliminary Clinical Study.

    Science.gov (United States)

    Golombick, Terry; Diamond, Terrence H; Manoharan, Arumugam; Ramakrishna, Rajeev

    2016-06-01

    Hypothesis Prior studies on patients with early B-cell lymphoid malignancies suggest that early intervention with curcumin may lead to delay in progressive disease and prolonged survival. These patients are characterized by increased susceptibility to infections. Rice bran arabinoxylan (Ribraxx) has been shown to have immunostimulatory, anti-inflammatory, and proapoptotic effects. We postulated that addition of Ribraxx to curcumin therapy may be of benefit. Study design Monoclonal gammopathy of undetermined significance (MGUS)/smoldering multiple myeloma (SMM) or stage 0/1 chronic lymphocytic leukemia (CLL) patients who had been on oral curcumin therapy for a period of 6 months or more were administered both curcumin (as Curcuforte) and Ribraxx. Methods Ten MGUS/SMM patients and 10 patients with stage 0/1 CLL were administered 6 g of curcumin and 2 g Ribraxx daily. Blood samples were collected at baseline and at 2-month intervals for a period of 6 months, and various markers were monitored. MGUS/SMM patients included full blood count (FBC); paraprotein; free light chains/ratio; C-reactive protein (CRP)and erythrocyte sedimentation rate (ESR); B2 microglobulin and immunological markers. Markers monitored for stage 0/1 CLL were FBC, CRP and ESR, and immunological markers. Results Of 10 MGUS/SMM patients,5 (50%) were neutropenic at baseline, and the Curcuforte/Ribraxx combination therapy showed an increased neutrophil count, varying between 10% and 90% among 8 of the 10 (80%) MGUS/SMM patients. An additional benefit of the combination therapy was the potent effect in reducing the raised ESR in 4 (44%) of the MGUS/SMM patients. Conclusion Addition of Ribraxx to curcumin therapy may be of benefit to patients with early-stage B-cell lymphoid malignancies. © The Author(s) 2016.

  5. Benefits for handicapped children

    CERN Document Server

    2003-01-01

    The introduction of long-term care benefits within the CERN Health Insurance Scheme requires the coordination of the benefits foreseen for handicapped children. Measures were adopted by the Management following the recommendation made by the Standing Concertation Committee on 26 March 2003. A document clarifying these measures is available on the Web at the following address: http://humanresources.web.cern.ch/humanresources/external/soc/Social_affairs/social_affairs.asp Social Affairs Service 74201

  6. MULTIPLE OBJECTS

    Directory of Open Access Journals (Sweden)

    A. A. Bosov

    2015-04-01

    Full Text Available Purpose. The development of complicated techniques of production and management processes, information systems, computer science, applied objects of systems theory and others requires improvement of mathematical methods, new approaches for researches of application systems. And the variety and diversity of subject systems makes necessary the development of a model that generalizes the classical sets and their development – sets of sets. Multiple objects unlike sets are constructed by multiple structures and represented by the structure and content. The aim of the work is the analysis of multiple structures, generating multiple objects, the further development of operations on these objects in application systems. Methodology. To achieve the objectives of the researches, the structure of multiple objects represents as constructive trio, consisting of media, signatures and axiomatic. Multiple object is determined by the structure and content, as well as represented by hybrid superposition, composed of sets, multi-sets, ordered sets (lists and heterogeneous sets (sequences, corteges. Findings. In this paper we study the properties and characteristics of the components of hybrid multiple objects of complex systems, proposed assessments of their complexity, shown the rules of internal and external operations on objects of implementation. We introduce the relation of arbitrary order over multiple objects, we define the description of functions and display on objects of multiple structures. Originality.In this paper we consider the development of multiple structures, generating multiple objects.Practical value. The transition from the abstract to the subject of multiple structures requires the transformation of the system and multiple objects. Transformation involves three successive stages: specification (binding to the domain, interpretation (multiple sites and particularization (goals. The proposed describe systems approach based on hybrid sets

  7. International Space Station Benefits for Humanity

    Science.gov (United States)

    Thumm, Tracy L.; Robinson, Julie A.; Buckley, Nicole; Johnson-Green, Perry; Kamigaichi, Shigeki; Karabadzhak, George; Nakamura, Tai; Sabbagh, Jean; Sorokin, Igor; Zell, Martin

    2012-01-01

    The ISS partnership has seen a substantial increase in research accomplished, crew efforts devoted to research, and results of ongoing research and technology development. The ISS laboratory is providing a unique environment for research and international collaboration that benefits humankind. Benefits come from the engineering development, the international partnership, and from the research results. Benefits can be of three different types: scientific discovery, applications to life on Earth, and applications to future exploration. Working across all ISS partners, we identified key themes where the activities on the ISS improve the lives of people on Earth--not only within the partner nations, but also in other nations of the world. Three major themes of benefits to life on earth emerged from our review: benefits to human health, education, and Earth observation and disaster response. Other themes are growing as use of the ISS continues. Benefits to human health range from advancements in surgical technology, improved telemedicine, and new treatments for disease. Earth observations from the ISS provide a wide range of observations that include: marine vessel tracking, disaster monitoring and climate change. The ISS participates in a number of educational activities aimed to inspire students of all ages to learn about science, technology, engineering and mathematics. To date over 63 countries have directly participated in some aspect of ISS research or education. In summarizing these benefits and accomplishments, ISS partners are also identifying ways to further extend the benefits to people in developing countries for the benefits of humankind.

  8. International Space Station Research Benefits for Humanity

    Science.gov (United States)

    Thumm, Tracy; Robinson, Julie A.; Johnson-Green, Perry; Buckley, Nicole; Karabadzhak, George; Nakamura, Tai; Kamigaichi, Shigeki; Sorokin, Igor V.; Zell, Martin; Fuglesang, Christer; hide

    2012-01-01

    The ISS partnership has seen a substantial increase in research accomplished, crew efforts devoted to research, and results of ongoing research and technology development. The ISS laboratory is providing a unique environment for research and international collaboration that benefits humankind. Benefits come from the engineering development, the international partnership, and from the research results. Benefits can be of three different types: scientific discovery, applications to life on Earth, and applications to future exploration. Working across all ISS partners, we identified key themes where the activities on the ISS improve the lives of people on Earth -- not only within the partner nations, but also in other nations of the world. Three major themes of benefits to life on earth emerged from our review: benefits to human health, education, and Earth observation and disaster response. Other themes are growing as use of the ISS continues. Benefits to human health range from advancements in surgical technology, improved telemedicine, and new treatments for disease. Earth observations from the ISS provide a wide range of observations that include: marine vessel tracking, disaster monitoring and climate change. The ISS participates in a number of educational activities aimed to inspire students of all ages to learn about science, technology, engineering and mathematics. To date over 63 countries have directly participated in some aspect of ISS research or education. In summarizing these benefits and accomplishments, ISS partners are also identifying ways to further extend the benefits to people in developing countries for the benefits of humankind.

  9. Applying Multiple Intelligences

    Science.gov (United States)

    Christodoulou, Joanna A.

    2009-01-01

    The ideas of multiple intelligences introduced by Howard Gardner of Harvard University more than 25 years ago have taken form in many ways, both in schools and in other sometimes-surprising settings. The silver anniversary of Gardner's learning theory provides an opportunity to reflect on the ways multiple intelligences theory has taken form and…

  10. How Managers Can Benefit from Multiple Perspectives on Design Management

    DEFF Research Database (Denmark)

    Gasparin, Marta; Christiansen, John K.

    Operations management should be more concerned with the relationship to design and how the interplay between design processes and operations can be managed. The design of products and services has huge implications on operations in different ways: Design can increase the value of products......; influence and lead to innovation of manufacturing processes; implications for the supply chain processes and has implications on the life cycle of products and sustainability issues. To fully exploit the opportunities, we claim that it's useful for managers to be aware of the different ways that design...

  11. Maximizing Benefits through Simultaneous Compliance with Multiple Process Models

    Science.gov (United States)

    2011-05-01

    www.abridge-tech.com Example Reference Models CMMI-DEV CMMI-SVC CMMI-ACQ ISO 15504 ISO 9000 AS 9100 ISO 20000 Si Si ITIL x gma Malcolm Baldrige Slide #: 4...and safety Slide #: 6 rbechtold@abridge-tech.comAbridge Technology Abridge Technology www.abridge-tech.com Example Reference Models ITIL

  12. Ancillary Services Provided from DER

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, J.B.

    2005-12-21

    Distributed energy resources (DER) are quickly making their way to industry primarily as backup generation. They are effective at starting and then producing full-load power within a few seconds. The distribution system is aging and transmission system development has not kept up with the growth in load and generation. The nation's transmission system is stressed with heavy power flows over long distances, and many areas are experiencing problems in providing the power quality needed to satisfy customers. Thus, a new market for DER is beginning to emerge. DER can alleviate the burden on the distribution system by providing ancillary services while providing a cost adjustment for the DER owner. This report describes 10 types of ancillary services that distributed generation (DG) can provide to the distribution system. Of these 10 services the feasibility, control strategy, effectiveness, and cost benefits are all analyzed as in the context of a future utility-power market. In this market, services will be provided at a local level that will benefit the customer, the distribution utility, and the transmission company.

  13. Looking beyond borders: integrating best practices in benefit-risk analysis into the field of food and nutrition.

    Science.gov (United States)

    Tijhuis, M J; Pohjola, M V; Gunnlaugsdóttir, H; Kalogeras, N; Leino, O; Luteijn, J M; Magnússon, S H; Odekerken-Schröder, G; Poto, M; Tuomisto, J T; Ueland, O; White, B C; Holm, F; Verhagen, H

    2012-01-01

    An integrated benefit-risk analysis aims to give guidance in decision situations where benefits do not clearly prevail over risks, and explicit weighing of benefits and risks is thus indicated. The BEPRARIBEAN project aims to advance benefit-risk analysis in the area of food and nutrition by learning from other fields. This paper constitutes the final stage of the project, in which commonalities and differences in benefit-risk analysis are identified between the Food and Nutrition field and other fields, namely Medicines, Food Microbiology, Environmental Health, Economics and Marketing-Finance, and Consumer Perception. From this, ways forward are characterized for benefit-risk analysis in Food and Nutrition. Integrated benefit-risk analysis in Food and Nutrition may advance in the following ways: Increased engagement and communication between assessors, managers, and stakeholders; more pragmatic problem-oriented framing of assessment; accepting some risk; pre- and post-market analysis; explicit communication of the assessment purpose, input and output; more human (dose-response) data and more efficient use of human data; segmenting populations based on physiology; explicit consideration of value judgments in assessment; integration of multiple benefits and risks from multiple domains; explicit recognition of the impact of consumer beliefs, opinions, views, perceptions, and attitudes on behaviour; and segmenting populations based on behaviour; the opportunities proposed here do not provide ultimate solutions; rather, they define a collection of issues to be taken account of in developing methods, tools, practices and policies, as well as refining the regulatory context, for benefit-risk analysis in Food and Nutrition and other fields. Thus, these opportunities will now need to be explored further and incorporated into benefit-risk practice and policy. If accepted, incorporation of these opportunities will also involve a paradigm shift in Food and Nutrition benefit

  14. Accelerating time to benefit

    DEFF Research Database (Denmark)

    Svejvig, Per; Geraldi, Joana; Grex, Sara

    Despite the ubiquitous pressure for speed, our approaches to accelerate projects remain constrained to the old-fashioned understanding of the project as a vehicle to deliver products and services, not value. This article explores an attempt to accelerate time to benefit. We describe and deconstruct...... of the time. Although all cases valued speed and speed to benefit, and implemented most practices proposed by the methodology, only three of the five projects were more successful in decreasing time to speed. Based on a multi-case study comparison between these five different projects and their respective...... the implementation of a large intervention undertaken in five project-based organizations in Denmark – the Project Half Double where the same project methodology has been applied in five projects, each of them in five distinct organizations in Denmark, as a bold attempt to realize double the benefit in half...

  15. Deserving social benefits?

    DEFF Research Database (Denmark)

    Esmark, Anders; Richardt Schoop, Sarah

    2017-01-01

    welfare reforms involving reductions of social benefits in Denmark in 2005 and 2013, the article analyses the frames used by politicians supporting and opposing reform, as well as the frames used by the media. The article shows, first, that political reforms reducing social benefits are followed......The article contributes to the growing literature on framing of deservingness as an alternative to ‘blame avoidance’ strategies in the politics of welfare retrenchment. In particular, the article focuses on the interplay between political framing and media framing. Based on an analysis of two major...... by increased framing of recipients as undeserving. The article finds a strong correlation between the political objective of reducing benefits and the reliance on frames that position recipients as undeserving. Second, the article shows that media framing remains significantly different from political framing...

  16. Cofee consumption benefits

    Directory of Open Access Journals (Sweden)

    Jaime Bonilla Medina

    2017-12-01

    Full Text Available The central point of this reflection around two recent studies on the association between coffee consumption and mortality. The studies point to the benefit of coffee intake in the mortality reduction. In Colombia, despite the loss of prestige gained as a land of drug trafficking and illicit crops, it is our concern to enhance the beverage that characterizes us in order to recover our good name in the international context. It is important to be attentive to the evidence that is emerging about the benefits of our national drink.

  17. Health Benefits of Fiber Fermentation.

    Science.gov (United States)

    Dahl, Wendy J; Agro, Nicole C; Eliasson, Åsa M; Mialki, Kaley L; Olivera, Joseph D; Rusch, Carley T; Young, Carly N

    2017-02-01

    Although fiber is well recognized for its effect on laxation, increasing evidence supports the role of fiber in the prevention and treatment of chronic disease. The aim of this review is to provide an overview of the health benefits of fiber and its fermentation, and describe how the products of fermentation may influence disease risk and treatment. Higher fiber intakes are associated with decreased risk of cardiovascular disease, type 2 diabetes, and some forms of cancer. Fiber may also have a role in lowering blood pressure and in preventing obesity by limiting weight gain. Fiber is effective in managing blood glucose in type 2 diabetes, useful for weight loss, and may provide therapeutic adjunctive roles in kidney and liver disease. In addition, higher fiber diets are not contraindicated in inflammatory bowel disease or irritable bowel syndrome and may provide some benefit. Common to the associations with disease reduction is fermentation of fiber and its potential to modulate microbiota and its activities and inflammation, specifically the production of anti-inflammatory short chain fatty acids, primarily from saccharolytic fermentation, versus the deleterious products of proteolytic activity. Because fiber intake is inversely associated with all-cause mortality, mechanisms by which fiber may reduce chronic disease risk and provide therapeutic benefit to those with chronic disease need further elucidation and large, randomized controlled trials are needed to confirm causality.Teaching Points• Strong evidence supports the association between higher fiber diets and reduced risk of cardiovascular disease, type 2 diabetes, and some forms of cancer.• Higher fiber intakes are associated with lower body weight and body mass index, and some types of fiber may facilitate weight loss.• Fiber is recommended as an adjunctive medical nutritional therapy for type 2 diabetes, chronic kidney disease, and certain liver diseases.• Fermentation and the resulting shifts in

  18. Community benefits from offshore renewables: The relationship between different understandings of impact, community, and benefit

    DEFF Research Database (Denmark)

    Rudolph, David Philipp; Haggett, Claire; Aitken, Mhairi

    2018-01-01

    This paper presents the findings of a research project evaluating community benefit models for offshore renewables. We identify and analyse UK and international case studies of different forms of community benefit, and provide evidence of how such benefits are delivered. In particular we consider...... the key relationship between the identification of communities, perception of impact, and the apportionment of benefits. In doing so, we develop a range of different definitions of ‘community’, ‘benefit’, and ‘impact’ when considering community benefits. We propose that the way in which community, benefit......, and impact are understood is crucial in determining whether or how benefits should be apportioned and delivered; and that these definitions are closely connected to each other. We develop a new series of typologies as a way to understand this. Finally, we assess different mechanisms and schemes of community...

  19. Multiple Sclerosis and Vitamin D

    Science.gov (United States)

    ... Editors David C. Spencer, MD Steven Karceski, MD Multiple sclerosis and vitamin D Andrew J. Solomon, MD WHAT ... caused by improper immune responses (autoimmune diseases), including multiple sclerosis (MS). A recent Patient Page in Neurology provided ...

  20. 5 CFR 890.910 - Provider information.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Provider information. 890.910 Section 890.910 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS..., and FEHB Benefit Payments § 890.910 Provider information. The hospital provider information used to...

  1. The Benefits of Latin?

    Science.gov (United States)

    Holliday, Lisa R.

    2012-01-01

    Classicists have long claimed that the study of Latin has benefits that exceed knowledge of the language itself, and in the current economic times, these claims are made with urgency. Indeed, many contend that Latin improves English grammar and writing skills, cognitive abilities, and develops transferable skills necessary for success in the…

  2. Benefits at risk

    DEFF Research Database (Denmark)

    Lassen, Jesper; Sandøe, Peter

    2007-01-01

    Herbicide resistant GM plants have been promoted as a tool in the development of more environment-friendly agriculture. The environmental benefits here, however, depend not only on farmer's acceptance of GM crops as such, but also on their willingness to use herbicides in accordance with altered...

  3. PENSION FUND BENEFITS SERVICE

    CERN Multimedia

    Benefits Service

    2002-01-01

    Please note that from now on, our offices (5-1-030) will be opened to members and beneficiaries on Tuesday, Wednesday and Thursday from 10 to 12 a.m. and from 3 to 5 p.m. We are otherwise available but by appointment only. Benefits Service (tel. 79194 / 72738)

  4. PENSION FUND BENEFITS SERVICE

    CERN Multimedia

    Benefits Service

    2002-01-01

    Please note that from now on, our offices will be opened to members and beneficiaries on Tuesday, Wednesday and Thursday from 10 to 12 a.m. and from 3 to 5 p.m. We are otherwise available but by appointment only. Benefits Service 5-1-030 tel. 79194 / 72738

  5. Benefits of Breastfeeding

    Medline Plus

    Full Text Available ... Health Skip Navigation En Español Skip top navigation Home A-Z Health Topics Printables and Shareables Blog ... Only Natural email updates. Enter email address Submit Home > It's Only Natural > Planning ahead The benefits of ...

  6. Benefits of Breastfeeding

    Medline Plus

    Full Text Available ... address Submit Home > It's Only Natural > Planning ahead The benefits of breastfeeding YouTube embed video: YouTube embed ... https://www.youtube-nocookie.com/embed/DpVp07lgDsI Learn the unique ways that breast milk can impact your ...

  7. Benefits of Breastfeeding

    Medline Plus

    Full Text Available ... eating well Overcoming challenges Addressing breastfeeding myths Finding support Fitting it into your life My breastfeeding story Partner resources Subscribe to It's Only Natural email updates. Enter email address Submit Home > It's Only Natural > Planning ahead The benefits of ...

  8. Benefits of investing in ecosystem restoration.

    Science.gov (United States)

    DE Groot, Rudolf S; Blignaut, James; VAN DER Ploeg, Sander; Aronson, James; Elmqvist, Thomas; Farley, Joshua

    2013-12-01

    Measures aimed at conservation or restoration of ecosystems are often seen as net-cost projects by governments and businesses because they are based on incomplete and often faulty cost-benefit analyses. After screening over 200 studies, we examined the costs (94 studies) and benefits (225 studies) of ecosystem restoration projects that had sufficient reliable data in 9 different biomes ranging from coral reefs to tropical forests. Costs included capital investment and maintenance of the restoration project, and benefits were based on the monetary value of the total bundle of ecosystem services provided by the restored ecosystem. Assuming restoration is always imperfect and benefits attain only 75% of the maximum value of the reference systems over 20 years, we calculated the net present value at the social discount rates of 2% and 8%. We also conducted 2 threshold cum sensitivity analyses. Benefit-cost ratios ranged from about 0.05:1 (coral reefs and coastal systems, worst-case scenario) to as much as 35:1 (grasslands, best-case scenario). Our results provide only partial estimates of benefits at one point in time and reflect the lower limit of the welfare benefits of ecosystem restoration because both scarcity of and demand for ecosystem services is increasing and new benefits of natural ecosystems and biological diversity are being discovered. Nonetheless, when accounting for even the incomplete range of known benefits through the use of static estimates that fail to capture rising values, the majority of the restoration projects we analyzed provided net benefits and should be considered not only as profitable but also as high-yielding investments. Beneficios de Invertir en la Restauración de Ecosistemas. © 2013 Society for Conservation Biology.

  9. Social media for patients: benefits and drawbacks.

    Science.gov (United States)

    De Martino, Ivan; D'Apolito, Rocco; McLawhorn, Alexander S; Fehring, Keith A; Sculco, Peter K; Gasparini, Giorgio

    2017-03-01

    Social media is increasingly utilized by patients to educate themselves on a disease process and to find hospital, physicians, and physician networks most capable of treating their condition. However, little is known about quality of the content of the multiple online platforms patients have to communicate with other potential patients and their potential benefits and drawbacks. Patients are not passive consumers of health information anymore but are playing an active role in the delivery of health services through an online environment. The control and the regulation of the sources of information are very difficult. The overall quality of the information was poor. Bad or misleading information can be detrimental for patients as well as influence their confidence on physicians and their mutual relationship. Orthopedic surgeons and hospital networks must be aware of these online patient portals as they provide important feedback on the patient opinion and experience that can have a major impact on future patient volume, patient opinion, and perceived quality of care.

  10. Social Security and Medicare Benefits

    Data.gov (United States)

    Social Security Administration — Cash benefits and rehabilitation benefits paid in each year from the Old-Age and Survivors Insurance, and Disability Insurance Trust Funds, and benefits paid from...

  11. Prevention of intrauterine growth retardation by multiple micronutrient supplements during pregnancy in Burkina Faso

    NARCIS (Netherlands)

    Roberfroid, D.A.G.

    2012-01-01

    This is the story of an idea. This is the account of its journey from birth to the delivery of new hypotheses. Reproduction, birth, but also death, are indeed at the heart of this research in which we assessed, in Burkina Faso, the health benefits of providing pregnant women with multiple

  12. Potential explanations for control group benefit.

    Science.gov (United States)

    Nichols, Linda O; Martindale-Adams, Jennifer L; Burns, Robert; Graney, Marshall J; Zuber, Jeffrey K; Kennedy, Sarah E

    2012-10-01

    Estimating effectiveness of clinical interventions depends on detecting differences between the responses of intervention and control groups. The outcome, intervention, and moderating factors all may influence the between group change. The absence of a clinically or statistically meaningful difference may also result from control group improvement due to nonspecific factors such as participants' perception of attention, positive regard, expectations, desire to please, and therapeutic alliance with the care provider. We examined perceived benefit and sources of benefit for control caregivers who participated in the CONNECT randomized controlled trial of a dementia caregiving intervention. After the final scheduled data collection in CONNECT, control group participants were asked whether they believed they benefited from study participation. Those who reported benefit were asked to describe the benefit received. Data were analyzed qualitatively. Of 60 available control caregivers, 82% reported a perceived benefit from study participation in five areas: getting information about dementia and caregiving; having someone to talk to and feeling supported; receiving understanding and validation of feelings; knowledge that others were in similar situations; and perceived appreciation of own abilities. Control caregivers who reported benefit were less burdened and depressed and spent less time on duty at baseline than those who did not report benefit. From caregivers' responses, we have identified the assessment battery, both content and time spent in data collection, as a possible mechanism of action for benefit. Study limitations include the better baseline characteristics of the control caregivers who reported benefit, the sample size of benefit control caregivers, the possibility of perceptions of benefit being a function of social desirability, and the lack of a similar question about benefit being asked of intervention caregivers. These findings suggest that the

  13. Simultaneous comparisons of treatments at multiple time points

    DEFF Research Database (Denmark)

    Pallmann, Philip; Pretorius, Mias; Ritz, Christian

    2017-01-01

    hypotheses as well as a global test decision. We compare via simulation the powers of multiple contrast tests based on a joint model and multiple marginal models, respectively, and quantify the benefit of incorporating longitudinal correlation, i.e. the advantage over Bonferroni. Practical application.......e. occasion-specific models. Upon parameter and covariance estimation with either modeling approach, we employ a variant of multiple contrast tests that acknowledges correlation between time points and test statistics. This method provides simultaneous confidence intervals and adjusted p-values for elementary......We discuss several aspects of multiple inference in longitudinal settings, focusing on many-to-one and all-pairwise comparisons of (a) treatment groups simultaneously at several points in time, or (b) time points simultaneously for several treatments. We assume a continuous endpoint...

  14. Multiple homicides.

    Science.gov (United States)

    Copeland, A R

    1989-09-01

    A study of multiple homicides or multiple deaths involving a solitary incident of violence by another individual was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during 1983-1987. A total of 107 multiple homicides were studied: 88 double, 17 triple, one quadruple, and one quintuple. The 236 victims were analyzed regarding age, race, sex, cause of death, toxicologic data, perpetrator, locale of the incident, and reason for the incident. This article compares this type of slaying with other types of homicide including those perpetrated by serial killers. Suggestions for future research in this field are offered.

  15. Creating Multiple Processes from Multiple Intelligences.

    Science.gov (United States)

    Wolffe, Robert; Robinson, Helja; Grant, Jean Marie

    1998-01-01

    Howard Gardner's multiple-intelligences theory stresses that all humans possess the various intelligences (linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, interpersonal, intrapersonal, and naturalist) to differing degrees, and most people can attain adequate competency levels. This article provides a sample checklist for…

  16. 'Strategic approach' can reveal benefits.

    Science.gov (United States)

    Baillie, Jonathan

    2011-01-01

    Speaking at last October's Healthcare Estates 2010 conference in Manchester, Peter Haggarty, assistant director, Health Facilities Scotland, outlined some of the key steps and priorities for large healthcare providers seeking to establish and implement an effective asset management strategy, focusing particularly on work ongoing in this area in the Scottish public health service. While any radical change to a large healthcare organisation's existing asset management practices could be "challenging", both for the organisation itself, and for its staff, with "sufficient planning, persistence, and support", such changes could, he told delegates, often result in "unanticipated benefits". HEJ editor Jonathan Baillie reports.

  17. Electronic health records: eliciting behavioral health providers' beliefs.

    Science.gov (United States)

    Shank, Nancy; Willborn, Elizabeth; Pytlikzillig, Lisa; Noel, Harmonijoie

    2012-04-01

    Interviews with 32 community behavioral health providers elicited perceived benefits and barriers of using electronic health records. Themes identified were (a) quality of care, (b) privacy and security, and (c) delivery of services. Benefits to quality of care were mentioned by 100% of the providers, and barriers by 59% of providers. Barriers involving privacy and security concerns were mentioned by 100% of providers, and benefits by 22%. Barriers to delivery of services were mentioned by 97% of providers, and benefits by 66%. Most providers (81%) expressed overall positive support for electronic behavioral health records.

  18. Added diagnostic benefit of 16-row whole-body spiral CT in patients with multiple trauma differentiated by region and injury severity according to the ATLS {sup registered} concept; Diagnostischer Zugewinn der 16-Zeilen-Ganzkoerper-Spiral-CT bei polytraumatisierten Patienten differenziert nach Koerperregion und Verletzungsschwere gemaess ATLS {sup registered} -Konzept

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, M.H.; Knopke, S.; Schroeder, R.J. [Klinik fuer diagnostische und interventionelle Radiologie, Charite-Universitaetsmedizin Berlin (Germany)

    2008-12-15

    Purpose: to determine the added diagnostic benefit of using MS-CT in multiple trauma patients differentiated by severity of injury and affected body region. Materials and methods: a retrospective analysis was performed of the 16-row whole-body spiral CT findings in 275 multiple trauma patients (73% men, 27% women; age 39.6 {+-} 18.9 years) with regard to additional findings and new findings obtained with CT compared to the findings obtained by conventional projection radiography and abdominal ultrasound in the emergency room. The additional and new findings were differentiated by body region (head, face, chest, pelvis, abdomen, spine) and the degree of severity according to the three classes of injuries distinguished by the ATLS {sup registered} concept (class 1: simple injury, class 2: potentially life threatening, class 3: immediately life threatening). Results: a total of 921 additional findings (= findings potentially relevant for further diagnosis and therapy in addition to the findings obtained by conventional radiography or ultrasound) were obtained by MS-CT in all patients. The distribution by number of patients and body region was as follows: 22 neck, 76 face, 125 chest, 112 abdomen, 50 pelvis, and 91 spine. Most additional findings were categorized as potentially life threatening (ATLS class 2). In addition, there were 439 completely new findings, involving the head in 128 patients (mostly ATLS class 3), the face in 18, the chest in 47, the abdomen in 26, and the spine in 9 patients. Most new findings involving the face, abdomen, and spine were ATLS class 2 injuries. (orig.)

  19. Multiple myeloma.

    LENUS (Irish Health Repository)

    Collins, Conor D

    2012-02-01

    Advances in the imaging and treatment of multiple myeloma have occurred over the past decade. This article summarises the current status and highlights how an understanding of both is necessary for optimum management.

  20. Multiple Sclerosis

    Science.gov (United States)

    ... SEARCH Definition Treatment Prognosis Clinical Trials Organizations Publications Definition An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the ...

  1. Multiple sclerosis

    Science.gov (United States)

    ... Bradley's Neurology in Clinical Practice . 7th ed. Philadelphia, PA: Elsevier; 2016:chap 80. Heine M, van de Port I, Rietberg MB, van Wegen EE, Kwakkel G. Exercise therapy for fatigue in multiple ...

  2. Tai chi chuan: mind-body practice or exercise intervention? Studying the benefit for cancer survivors.

    Science.gov (United States)

    Mansky, Patrick; Sannes, Tim; Wallerstedt, Dawn; Ge, Adeline; Ryan, Mary; Johnson, Laura Lee; Chesney, Margaret; Gerber, Lynn

    2006-09-01

    Tai chi chuan (TCC) has been used as a mind-body practice in Asian culture for centuries to improve wellness and reduce stress and has recently received attention by researchers as an exercise intervention. A review of the English literature on research in TCC published from 1989 to 2006 identified 20 prospective, randomized, controlled clinical trials in a number of populations, including elderly participants (7 studies), patients with cardiovascular complications (3 studies), patients with chronic disease (6 studies), and patients who might gain psychological benefit from TCC practice (2 studies). However, only the studies of TCC in the elderly and 2 studies of TCC for cardiovascular disease had adequate designs and size to allow conclusions about the efficacy of TCC. Most (11 studies) were small and provided limited information on the benefit of TCC in the settings tested. There is growing awareness that cancer survivors represent a population with multiple needs related to physical deconditioning, cardiovascular disease risk, and psychological stress. TCC as an intervention may provide benefit to cancer survivors in these multiple areas of need based on its characteristics of combining aspects of meditation and aerobic exercise. However, little research has been conducted to date to determine the benefit of TCC in this population. We propose a model to study the unique characteristics of TCC compared to physical exercise that may highlight characteristic features of this mind-body intervention in cancer survivors.

  3. Atomic Bomb Health Benefits

    OpenAIRE

    Luckey, T. D.

    2008-01-01

    Media reports of deaths and devastation produced by atomic bombs convinced people around the world that all ionizing radiation is harmful. This concentrated attention on fear of miniscule doses of radiation. Soon the linear no threshold (LNT) paradigm was converted into laws. Scientifically valid information about the health benefits from low dose irradiation was ignored. Here are studies which show increased health in Japanese survivors of atomic bombs. Parameters include decreased mutation,...

  4. Harnessing natural ventilation benefits.

    Science.gov (United States)

    O'Leary, John

    2013-04-01

    Making sure that a healthcare establishment has a good supply of clean fresh air is an important factor in keeping patients, staff, and visitors, free from the negative effects of CO2 and other contaminants. John O'Leary of Trend Controls, a major international supplier of building energy management solutions (BEMS), examines the growing use of natural ventilation, and the health, energy-saving, and financial benefits, that it offers.

  5. Emotional Disorders in People with Multiple Sclerosis

    Science.gov (United States)

    ... guideline was endorsed by the American Association of Neuroscience Nurses, the Consortium of Multiple Sclerosis Centers, and the International Organization of Multiple Sclerosis Nurses. This statement is provided ...

  6. Therapy Provider Phase Information

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Therapy Provider Phase Information dataset is a tool for providers to search by their National Provider Identifier (NPI) number to determine their phase for...

  7. Managing bay and estuarine ecosystems for multiple services

    Science.gov (United States)

    Needles, Lisa A.; Lester, Sarah E.; Ambrose, Richard; Andren, Anders; Beyeler, Marc; Connor, Michael S.; Eckman, James E.; Costa-Pierce, Barry A.; Gaines, Steven D.; Lafferty, Kevin D.; Lenihan, Junter S.; Parrish, Julia; Peterson, Mark S.; Scaroni, Amy E.; Weis, Judith S.; Wendt, Dean E.

    2013-01-01

    Managers are moving from a model of managing individual sectors, human activities, or ecosystem services to an ecosystem-based management (EBM) approach which attempts to balance the range of services provided by ecosystems. Applying EBM is often difficult due to inherent tradeoffs in managing for different services. This challenge particularly holds for estuarine systems, which have been heavily altered in most regions and are often subject to intense management interventions. Estuarine managers can often choose among a range of management tactics to enhance a particular service; although some management actions will result in strong tradeoffs, others may enhance multiple services simultaneously. Management of estuarine ecosystems could be improved by distinguishing between optimal management actions for enhancing multiple services and those that have severe tradeoffs. This requires a framework that evaluates tradeoff scenarios and identifies management actions likely to benefit multiple services. We created a management action-services matrix as a first step towards assessing tradeoffs and providing managers with a decision support tool. We found that management actions that restored or enhanced natural vegetation (e.g., salt marsh and mangroves) and some shellfish (particularly oysters and oyster reef habitat) benefited multiple services. In contrast, management actions such as desalination, salt pond creation, sand mining, and large container shipping had large net negative effects on several of the other services considered in the matrix. Our framework provides resource managers a simple way to inform EBM decisions and can also be used as a first step in more sophisticated approaches that model service delivery.

  8. Benefits of being biased!

    Indian Academy of Sciences (India)

    Administrator

    The genetic code is degenerate: most amino acids are coded by multiple codons. However, it is known that certain ... tems, under certain conditions, it is possible to empirically demonstrate the effects of codon bias at the ... ing the metabolic costs incurred in terms of nonfunctional/ misfunctional proteins. Hence, codon bias ...

  9. Probiotics, immunomodulation, and health benefits.

    Science.gov (United States)

    Gill, Harsharn; Prasad, Jaya

    2008-01-01

    Probiotics are defined as live microorganisms that, when administered in adequate amount, confer a health benefit on the host. Amongst the many benefits associated with the consumption of probiotics, modulation of the immune system has received the most attention. Several animal and human studies have provided unequivocal evidence that specific strains of probiotics are able to stimulate as well as regulate several aspects of natural and acquired immune responses. There is also evidence that intake of probiotics is effective in the prevention and/or management of acute gastroenteritis and rotavirus diarrhoea, antibiotic-associated diarrhoea and intestinal inflammatory disorders such as Crohn's disease and pouchitis, and paediatric atopic disorders. The efficacy of probiotics against bacterial infections and immunological disorders such as adult asthma, cancers, diabetes, and arthritis in humans remains to be proven. Also, major gaps exist in our knowledge about the mechanisms by which probiotics modulate immune function. Optimum dose, frequency and duration of treatment required for different conditions in different population groups also remains to be determined. Different probiotic strains vary in their ability to modulate the immune system and therefore efficacy of each strain needs to be carefully demonstrated through rigorously designed (randomised, double-blind, placebo-controlled) studies. This chapter provides an over view of the immunomodulatory effects of probiotics in health and disease, and discusses possible mechanisms through which probiotics mediate their disparate effects.

  10. Multiple myeloma.

    Science.gov (United States)

    Kumar, Shaji K; Rajkumar, Vincent; Kyle, Robert A; van Duin, Mark; Sonneveld, Pieter; Mateos, María-Victoria; Gay, Francesca; Anderson, Kenneth C

    2017-07-20

    Multiple myeloma is a malignancy of terminally differentiated plasma cells, and patients typically present with bone marrow infiltration of clonal plasma cells and monoclonal protein in the serum and/or urine. The diagnosis of multiple myeloma is made when clear end-organ damage attributable to the plasma cell proliferative disorder or when findings that suggest a high likelihood of their development are present. Distinguishing symptomatic multiple myeloma that requires treatment from the precursor stages of monoclonal gammopathy of undetermined significance and smouldering multiple myeloma is important, as observation is the standard for those conditions. Much progress has been made over the past decade in the understanding of disease biology and individualized treatment approaches. Several new classes of drugs, such as proteasome inhibitors and immunomodulatory drugs, have joined the traditional armamentarium (corticosteroids, alkylating agents and anthracyclines) and, along with high-dose therapy and autologous haemopoietic stem cell transplantation, have led to deeper and durable clinical responses. Indeed, an increasing proportion of patients are achieving lasting remissions, raising the possibility of cure for this disease. Success will probably depend on using combinations of effective agents and treating patients in the early stages of disease, such as patients with smouldering multiple myeloma.

  11. Disentangling the benefits of sex.

    Science.gov (United States)

    Roze, Denis

    2012-01-01

    Understanding the evolutionary advantage of sexual reproduction remains one of the most fundamental questions in evolutionary biology. Most of the current hypotheses rely on the fact that sex increases genetic variation, thereby enhancing the efficiency of natural selection; an important body of theoretical work has defined the conditions under which sex can be favoured through this effect. Over the last decade, experimental evolution in model organisms has provided evidence that sex indeed allows faster rates of adaptation. A new study on facultatively sexual rotifers shows that increased rates of sex can be favoured during adaptation to new environmental conditions and explores the cause of this effect. The results provide support for the idea that the benefits of increasing genetic variation may compensate for the short-term costs of sexual reproduction.

  12. Multiple paternity in reptiles: patterns and processes.

    Science.gov (United States)

    Uller, Tobias; Olsson, Mats

    2008-06-01

    The evolution of female promiscuity poses an intriguing problem as benefits of mating with multiple males often have to arise via indirect, genetic, effects. Studies on birds have documented that multiple paternity is common in natural populations but strong evidence for selection via female benefits is lacking. In an attempt to evaluate the evidence more broadly, we review studies of multiple paternity in natural populations of all major groups of nonavian reptiles. Multiple paternity has been documented in all species investigated so far and commonly exists in over 50% of clutches, with particularly high levels in snakes and lizards. Marine turtles and lizards with prolonged pair-bonding have relatively low levels of multiple paternity but levels are nevertheless higher than in many vertebrates with parental care. There is no evidence that high levels of polyandry are driven by direct benefits to females and the evidence that multiple paternity arises from indirect genetic benefits is weak. Instead, we argue that the most parsimonious explanation for patterns of multiple paternity is that it represents the combined effect of mate-encounter frequency and conflict over mating rates between males and females driven by large male benefits and relatively small female costs, with only weak selection via indirect benefits. A crucial step for researchers is to move from correlative approaches to experimental tests of assumptions and predictions of theory under natural settings, using a combination of molecular techniques and behavioural observations.

  13. Niacinamide leave-on formulation provides long-lasting protection against bacteria in vivo.

    Science.gov (United States)

    Mathapathi, Mruthyunjaya Swamy; Mallemalla, Prathyusha; Vora, Shilpa; Iyer, Vidula; Tiwari, Jyoti Kumar; Chakrabortty, Amit; Majumdar, Amitabha

    2017-09-01

    Antimicrobial peptides (AMPs) form a part of the skin's innate immune system. Their primary activity is to provide antimicrobial benefits and hence protect from infections. AMPs that are present on human skin include psoriasin (S100A7), RNase 7, lysozyme, LL-37 and defensins. Niacinamide is a well-known cosmetic ingredient that has been used traditionally for multiple skin benefits. Recent data indicate that niacinamide treatment can boost AMPs in human gut epithelial cells and in neutrophils. Treatment with niacinamide in mice also provided protection from skin infections by enhancing AMPs. In this article, we find that treatment with niacinamide formulation provides long-lasting protection against bacteria, potentially through the activation of an AMP response. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Nature’s Benefit Mapping User Guide

    Science.gov (United States)

    Purpose Nature’s benefit mapping provides a way to quickly get an idea of where the beneficial aspects of ecosystems can be found. When trying to communicate the value of natural areas to policy makers, members of a community, or another group, it can help to provide an int...

  15. Diagrams Benefit Symbolic Problem-Solving

    Science.gov (United States)

    Chu, Junyi; Rittle-Johnson, Bethany; Fyfe, Emily R.

    2017-01-01

    Background: The format of a mathematics problem often influences students' problem-solving performance. For example, providing diagrams in conjunction with story problems can benefit students' understanding, choice of strategy, and accuracy on story problems. However, it remains unclear whether providing diagrams in conjunction with symbolic…

  16. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, Egon; Stenager, E N; Knudsen, Lone

    1994-01-01

    In a cross-sectional study of 117 randomly selected patients (52 men, 65 women) with definite multiple sclerosis, it was found that 76 percent were married or cohabitant, 8 percent divorced. Social contacts remained unchanged for 70 percent, but outgoing social contacts were reduced for 45 percent......, need for structural changes in home and need for pension became greater with increasing physical handicap. No significant differences between gender were found. It is concluded that patients and relatives are under increased social strain, when multiple sclerosis progresses to a moderate handicap...

  17. Oral treatment for multiple sclerosis

    NARCIS (Netherlands)

    Killestein, J.; Rudick, R.A.; Polman, C.H.

    2011-01-01

    Background: The armamentarium for the treatment of relapsing-remitting multiple sclerosis (RRMS) is increasing rapidly. Several oral treatments have shown benefit and will generate much interest because of the convenience of such administration. However, availability of convenient oral drugs will

  18. Analytical models quantify the military benefit of collaborative search

    Science.gov (United States)

    Friedman, Melvin H.; Du Bosq, Todd W.; Flug, Eric A.

    2010-04-01

    Analytical Model 1 describes how long it takes the first observer to find a target when multiple observers search a field of regard using imagery provided by a single sensor. This model, developed using probability concepts, suggests considerable benefits accrue from collaborative search: when P is near one and with ten observers the mean detection time (in reduced time) is reduced by almost an order of magnitude when compared to that of a single observer. To get the instant of detection in clock time we add the delay time td to the reduced time. Empirical fits for td and are also given in the paper. Model 1 was verified/validated by computer simulation and perception experiments. Here ten observers searched sixty computer generated fields of regard (each one was 60 x 20 degrees) for a single military vehicle. Analytical Model 2 describes how the probability of target acquisition increases with the number of observers. The results of Model 2 suggest that probability of target acquisition increases considerably when multiple observers independently search a field of regard. Model 2 was verified by simulation but not by perception experiment. Models 1 and 2 are pertinent to development of search strategies with multiple observers and are expected to find use in wargaming for evaluating the efficacy of networked imaging sensors.

  19. Enstore with Chimera namespace provider

    Energy Technology Data Exchange (ETDEWEB)

    Litvintsev, Dmitry [Fermilab; Moibenko, Alexander [Fermilab; Oleynik, Gene [Fermilab; Zalokar, Michael [Fermilab

    2012-01-01

    Enstore is a mass storage system developed by Fermilab that provides distributed access and management of data stored on tapes. It uses a namespace service, PNFS, developed by DESY to provide a filesystem-like view of the stored data. PNFS is a legacy product and is being replaced by a new implementation, called Chimera, which is also developed by DESY. Chimera offers multiple advantages over PNFS in terms of performance and functionality. The Enstore client component, encp, has been modified to work with Chimera, as well as with any other namespace provider. We performed high load end-to-end acceptance test of Enstore with the Chimera namespace. This paper describes the modifications to Enstore, the test procedure and the results of the acceptance testing.

  20. Climate Action Benefits: Health

    Science.gov (United States)

    This page provides background on the relationship between human health and climate change and describes what the CIRA Health analyses cover. It provides links to the subsectors Air Quality, Extreme Temperature, Labor, and Water Quality.

  1. Climate Action Benefits: Electricity

    Science.gov (United States)

    This page provides background on the relationship between electricity and climate change and describes what the CIRA Electricity analyses cover. It provides links to the subsectors Electricity Demand and Electricity Supply.

  2. Education System Benefits of U.S. Metric Conversion.

    Science.gov (United States)

    Phelps, Richard P.

    1996-01-01

    U.S. metric conversion efforts are reviewed as they have affected education. Education system benefits and costs are estimated for three possible system conversion plans. The soft-conversion-to-metric plan, which drops all inch-pound instruction, appears to provide the largest net benefits. The primary benefit is in class time saved. (SLD)

  3. Potential benefits of satiety to the consumer: scientific considerations

    NARCIS (Netherlands)

    Hetherington, M.M.; Cunningham, K.; Dye, L.; Gibson, E.L.; Gregersen, N.T.; Halford, J.C.G.; Lawton, C.L.; Lluch, A.; Mela, D.J.; Trijp, van J.C.M.

    2013-01-01

    Foods and dietary patterns that enhance satiety may provide benefit to consumers. The aim of the present review was to describe, consider and evaluate research on potential benefits of enhanced satiety. The proposal that enhanced satiety could only benefit consumers by a direct effect on food intake

  4. Ecosystem services provided by waterbirds.

    Science.gov (United States)

    Green, Andy J; Elmberg, Johan

    2014-02-01

    Ecosystem services are ecosystem processes that directly or indirectly benefit human well-being. There has been much recent literature identifying different services and the communities and species that provide them. This is a vital first step towards management and maintenance of these services. In this review, we specifically address the waterbirds, which play key functional roles in many aquatic ecosystems, including as predators, herbivores and vectors of seeds, invertebrates and nutrients, although these roles have often been overlooked. Waterbirds can maintain the diversity of other organisms, control pests, be effective bioindicators of ecological conditions, and act as sentinels of potential disease outbreaks. They also provide important provisioning (meat, feathers, eggs, etc.) and cultural services to both indigenous and westernized societies. We identify key gaps in the understanding of ecosystem services provided by waterbirds and areas for future research required to clarify their functional role in ecosystems and the services they provide. We consider how the economic value of these services could be calculated, giving some examples. Such valuation will provide powerful arguments for waterbird conservation. © 2013 The Authors. Biological Reviews © 2013 Cambridge Philosophical Society.

  5. Multiple sclerosis

    OpenAIRE

    Nicholas, Richard; Rashid, Waqar

    2012-01-01

    Multiple sclerosis is characterised by central nervous system lesions causing neurological dysfunction and other problems, such as fatigue, pain, depression, and anxiety. Early disease is usually relapsing and remitting, but most people develop secondary-progressive disease over time. No treatment has been shown to affect long-term outcome.Irreversible disability can occur, but life expectancy is generally not affected.

  6. Multiple Intelligences.

    Science.gov (United States)

    Laughlin, Janet

    1999-01-01

    Details the characteristics of Howard Gardner's seven multiple intelligences (MI): linguistic, logical-mathematical, bodily-kinesthetic, spatial, musical, interpersonal, and intrapersonal. Discusses the implications of MI for instruction. Explores how students can study using their preferred learning style - visual, auditory, and physical study…

  7. Multiple Leiomyoma

    Directory of Open Access Journals (Sweden)

    Nath Sarkar Jyotirindra

    1999-01-01

    Full Text Available A case of multiple cutaneous lelomyomas is reported for its uncommon occurrence. This cases was associated with osseous and soft tissue hamartoma of right thumb, lipoma on left side of chest and back, hoarseness of voice and lower motor neurone disorder in limbs.

  8. Multiple Sclerosis.

    Science.gov (United States)

    Plummer, Nancy; Michael, Nancy, Ed.

    This module on multiple sclerosis is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then…

  9. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1988-01-01

    Forty-two (12%) of a total of 366 patients with multiple sclerosis (MS) had psychiatric admissions. Of these, 34 (81%) had their first psychiatric admission in conjunction with or after the onset of MS. Classification by psychiatric diagnosis showed that there was a significant positive correlation...

  10. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1994-01-01

    In a cross-sectional study of 94 patients (42 males, 52 females) with definite multiple sclerosis (MS) in the age range 25-55 years, the correlation of neuropsychological tests with the ability to read TV-subtitles and with the use of sedatives is examined. A logistic regression analysis reveals...

  11. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    In a cross-sectional investigation of 116 patients with multiple sclerosis, the social and sparetime activities of the patient were assessed by both patient and his/her family. The assessments were correlated to physical disability which showed that particularly those who were moderately disabled...

  12. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1990-01-01

    An investigation on the correlation between ability to read TV subtitles and the duration of visual evoked potential (VEP) latency in 14 patients with definite multiple sclerosis (MS), indicated that VEP latency in patients unable to read the TV subtitles was significantly delayed in comparison...

  13. [Smoldering multiple myeloma].

    Science.gov (United States)

    Fouquet, G; Guidez, S; Herbaux, C; Demarquette, H; Leleu, X

    2014-04-01

    Smoldering multiple myeloma (SMM) is an asymptomatic plasma cell neoplasia, characterized by monoclonal plasma cell proliferation in the absence of end-organ damage, but with a high risk of progression to multiple myeloma. It has therefore to be distinguished from monoclonal gammapathy of undetermined significance (MGUS), which has a much lower risk of progression, but also from multiple myeloma, which remains an incurable disease and requires a specific treatment. The critical question in the management of SMM is whether an early therapeutic strategy could help delaying the progression to multiple myeloma, in order to lower the risk of serious complications related to this progression, or even to cure the disease. This early treatment could not be proposed to all SMM patients, who are indeed asymptomatic, and in whom the risk of toxicity could make it difficult to justify the potential benefit obtained. The challenge is to target early at diagnosis SMM patients with a high risk of progression, using available routine tests sufficiently reliable to warrant the therapeutic sanction which relies on it. Today however, apart from randomized studies, recommendations are to maintain therapeutic abstention in SMM patients. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  14. Rapid Assessment of Ecosystem Service Co-Benefits of Biodiversity Priority Areas in Madagascar.

    Directory of Open Access Journals (Sweden)

    Rachel A Neugarten

    Full Text Available The importance of ecosystems for supporting human well-being is increasingly recognized by both the conservation and development sectors. Our ability to conserve ecosystems that people rely on is often limited by a lack of spatially explicit data on the location and distribution of ecosystem services (ES, the benefits provided by nature to people. Thus there is a need to map ES to guide conservation investments, to ensure these co-benefits are maintained. To target conservation investments most effectively, ES assessments must be rigorous enough to support conservation planning, rapid enough to respond to decision-making timelines, and often must rely on existing data. We developed a framework for rapid spatial assessment of ES that relies on expert and stakeholder consultation, available data, and spatial analyses in order to rapidly identify sites providing multiple benefits. We applied the framework in Madagascar, a country with globally significant biodiversity and a high level of human dependence on ecosystems. Our objective was to identify the ES co-benefits of biodiversity priority areas in order to guide the investment strategy of a global conservation fund. We assessed key provisioning (fisheries, hunting and non-timber forest products, and water for domestic use, agriculture, and hydropower, regulating (climate mitigation, flood risk reduction and coastal protection, and cultural (nature tourism ES. We also conducted multi-criteria analyses to identify sites providing multiple benefits. While our approach has limitations, including the reliance on proximity-based indicators for several ES, the results were useful for targeting conservation investments by the Critical Ecosystem Partnership Fund (CEPF. Because our approach relies on available data, standardized methods for linking ES provision to ES use, and expert validation, it has the potential to quickly guide conservation planning and investment decisions in other data-poor regions.

  15. Rapid Assessment of Ecosystem Service Co-Benefits of Biodiversity Priority Areas in Madagascar

    Science.gov (United States)

    Andriamaro, Luciano; Cano, Carlos Andres; Grantham, Hedley S.; Hole, David; Juhn, Daniel; McKinnon, Madeleine; Rasolohery, Andriambolantsoa; Steininger, Marc; Wright, Timothy Max

    2016-01-01

    The importance of ecosystems for supporting human well-being is increasingly recognized by both the conservation and development sectors. Our ability to conserve ecosystems that people rely on is often limited by a lack of spatially explicit data on the location and distribution of ecosystem services (ES), the benefits provided by nature to people. Thus there is a need to map ES to guide conservation investments, to ensure these co-benefits are maintained. To target conservation investments most effectively, ES assessments must be rigorous enough to support conservation planning, rapid enough to respond to decision-making timelines, and often must rely on existing data. We developed a framework for rapid spatial assessment of ES that relies on expert and stakeholder consultation, available data, and spatial analyses in order to rapidly identify sites providing multiple benefits. We applied the framework in Madagascar, a country with globally significant biodiversity and a high level of human dependence on ecosystems. Our objective was to identify the ES co-benefits of biodiversity priority areas in order to guide the investment strategy of a global conservation fund. We assessed key provisioning (fisheries, hunting and non-timber forest products, and water for domestic use, agriculture, and hydropower), regulating (climate mitigation, flood risk reduction and coastal protection), and cultural (nature tourism) ES. We also conducted multi-criteria analyses to identify sites providing multiple benefits. While our approach has limitations, including the reliance on proximity-based indicators for several ES, the results were useful for targeting conservation investments by the Critical Ecosystem Partnership Fund (CEPF). Because our approach relies on available data, standardized methods for linking ES provision to ES use, and expert validation, it has the potential to quickly guide conservation planning and investment decisions in other data-poor regions. PMID:28006005

  16. Collaborative Outbound Taxi Metering for Environmental Benefits Project

    Data.gov (United States)

    National Aeronautics and Space Administration — This proposal addresses the concept of Collaborative Outbound Taxi Metering (COTM), which provides environmental benefits without sacrificing throughput. In current...

  17. Twitter for travel medicine providers.

    Science.gov (United States)

    Mills, Deborah J; Kohl, Sarah E

    2016-03-01

    Travel medicine practitioners, perhaps more so than medical practitioners working in other areas of medicine, require a constant flow of information to stay up-to-date, and provide best practice information and care to their patients. Many travel medicine providers are unaware of the popularity and potential of the Twitter platform. Twitter use among our travellers, as well as by physicians and health providers, is growing exponentially. There is a rapidly expanding body of published literature on this information tool. This review provides a brief overview of the ways Twitter is being used by health practitioners, the advantages that are peculiar to Twitter as a platform of social media, and how the interested practitioner can get started. Some key points about the dark side of Twitter are highlighted, as well as the potential benefits of using Twitter as a way to disseminate accurate medical information to the public. This article will help readers develop an increased understanding of Twitter as a tool for extracting useful facts and insights from the ever increasing volume of health information. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  18. The benefits of convergence.

    Science.gov (United States)

    Chang, Gee-Kung; Cheng, Lin

    2016-03-06

    A multi-tier radio access network (RAN) combining the strength of fibre-optic and radio access technologies employing adaptive microwave photonics interfaces and radio-over-fibre (RoF) techniques is envisioned for future heterogeneous wireless communications. All-band radio spectrum from 0.1 to 100 GHz will be used to deliver wireless services with high capacity, high link speed and low latency. The multi-tier RAN will improve the cell-edge performance in an integrated heterogeneous environment enabled by fibre-wireless integration and networking for mobile fronthaul/backhaul, resource sharing and all-layer centralization of multiple standards with different frequency bands and modulation formats. In essence, this is a 'no-more-cells' architecture in which carrier aggregation among multiple frequency bands can be easily achieved with seamless handover between cells. In this way, current and future mobile network standards such as 4G and 5G can coexist with optimized and continuous cell coverage using multi-tier RoF regardless of the underlying network topology or protocol. In terms of users' experience, the future-proof approach achieves the goals of system capacity, link speed, latency and continuous heterogeneous cell coverage while overcoming the bandwidth crunch in next-generation communication networks. © 2016 The Author(s).

  19. Preferred provider organizations.

    Science.gov (United States)

    Davy, J D

    1984-05-01

    The 1980s has marked the beginning of a new alternative health care delivery system: the preferred provider organization ( PPO ). This system has developed from the health maintenance organization model and is predominant in California and Colorado. A PPO is a group of providers, usually hospitals and doctors, who agree to provide health care to subscribers for a negotiated fee that is usually discounted. Preferred provider organizations are subject to peer review and strict use controls in exchange for a consistent volume of patients and speedy turnaround on claims payments. This article describes the factors leading to the development of PPOs and the implications for occupational therapy.

  20. Multiple sclerosis

    OpenAIRE

    Nylander, Alyssa; Hafler, David A.

    2012-01-01

    Multiple sclerosis (MS) is a multifocal demyelinating disease with progressive neurodegeneration caused by an autoimmune response to self-antigens in a genetically susceptible individual. While the formation and persistence of meningeal lymphoid follicles suggest persistence of antigens to drive the continuing inflammatory and humoral response, the identity of an antigen or infectious agent leading to the oligoclonal expansion of B and T cells is unknown. In this review we examine new paradig...

  1. Multiple Sclerosis

    OpenAIRE

    Gaby, Alan

    2013-01-01

    Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system. Common manifestations include paresthesias, diplopia, loss of vision, numbness or weakness of the limbs, bowel or bladder dysfunction, spasticity, ataxia, fatigue, and mental changes. Four main patterns of MS are recognized: relapsing remitting, primary progressive, secondary progressive, and progressive relapsing. The cause of MS is unknown, although it appears to be an autoimmune disease. M...

  2. Landfill Gas Energy Benefits Calculator

    Science.gov (United States)

    This page contains the LFG Energy Benefits Calculator to estimate direct, avoided, and total greenhouse gas reductions, as well as environmental and energy benefits, for a landfill gas energy project.

  3. Smoldering Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Minjie Gao

    2015-01-01

    Full Text Available Smoldering multiple myeloma (SMM is an asymptomatic precursor stage of multiple myeloma (MM characterized by clonal bone marrow plasma cells (BMPC ≥ 10% and/or M protein level ≥ 30 g/L in the absence of end organ damage. It represents an intermediate stage between monoclonal gammopathy of undetermined significance (MGUS and symptomatic MM. The risk of progression to symptomatic MM is not uniform, and several parameters have been reported to predict the risk of progression. These include the level of M protein and the percentage of BMPC, the proportion of immunophenotypically aberrant plasma cells, and the presence of immunoparesis, free light-chain (FLC ratio, peripheral blood plasma cells (PBPC, pattern of serum M protein evolution, abnormal magnetic resonance imaging (MRI, cytogenetic abnormalities, IgA isotype, and Bence Jones proteinuria. So far treatment is still not recommended for SMM, because several trials suggested that patients with SMM do not benefit from early treatment. However, the Mateos et al. trial showed a survival benefit after early treatment with lenalidomide plus dexamethasone in patients with high-risk SMM. This trial has prompted a reevaluation of early treatment in an asymptomatic patient population.

  4. Joint audits - benefit or burden?

    DEFF Research Database (Denmark)

    Holm, Claus; Thinggaard, Frank

    In this paper we examine whether there are perceived and observed benefits or burdens from using two audit firms instead of one. In 2005 the mandatory joint audit requirement was abolished in Denmark. This provides a unique setting for studying the consequences and implications of going from...... a joint audit regime to a single auditor/voluntary joint audit regime. The dataset used in this paper has been collected for the full population of non-financial Danish companies listed on the Copenhagen Stock Exchange (CSE) in the years 2004 and 2005. We find that a majority of firms perceive joint...... audits to be a net burden. Furthermore, based on DeAngelo's (1981) initial audit pricing model and legislators' claim that joint audits are an unnecessary economic burden to the companies we predict and find discounts (of around 25%) in audit fees in companies that change to single audits. The primary...

  5. A Robust Two-Phase Pumped Loop With Multiple Evaporators and Multiple Radiators Project

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA's future spacecraft require advanced thermal management technologies to provide effective cooling for multiple instruments and reject heat through multiple...

  6. Building Service Provider Capabilities

    DEFF Research Database (Denmark)

    Brandl, Kristin; Jaura, Manya; Ørberg Jensen, Peter D.

    In this paper we study whether and how the interaction between clients and the service providers contributes to the development of capabilities in service provider firms. In situations where such a contribution occurs, we analyze how different types of activities in the production process...

  7. Providing free autopoweroff plugs

    DEFF Research Database (Denmark)

    Jensen, Carsten Lynge; Hansen, Lars Gårn; Fjordbak, Troels

    2012-01-01

    Experimental evidence of the effect of providing households with cheap energy saving technology is sparse. We present results from a field experiment in which autopoweroff plugs were provided free of charge to randomly selected households. We use propensity score matching to find treatment effects...

  8. Corporate benefits of CSR activities

    Directory of Open Access Journals (Sweden)

    Maja Żychlewicz

    2014-11-01

    Full Text Available The main aim of the paper is to present the benefits that a company may derive from socially responsible activities. The paper lists various definitions of CSR that indicate the expected benefits stemming from its use. Both in theory and in practice, there is observed the need for strategic connection between the CSR concept and its real-life benefits.

  9. Role of oral teriflunomide in the management of multiple sclerosis.

    Science.gov (United States)

    Tanasescu, Radu; Evangelou, Nikos; Constantinescu, Cris S

    2013-01-01

    The landscape of the treatment of relapsing-remitting multiple sclerosis is changing fast. Several oral treatments have shown benefit and generate much interest because of the convenience of their administration. Two oral compounds, fingolimod and teriflunomide, have been approved in relapsing-remitting multiple sclerosis, while others have completed Phase III trials and are awaiting review for registration. Teriflunomide is a pyrimidine synthesis inhibitor with selective immunomodulatory and immunosuppressive properties that have shown consistent efficacy in clinical trials, and a good safety profile. This paper provides an overview of the mechanisms of action and efficacy and safety results from clinical trials with this drug. The role of teriflunomide in the treatment of relapsing-remitting multiple sclerosis is discussed.

  10. 20 CFR 1002.260 - What pension benefit plans are covered under USERRA?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What pension benefit plans are covered under... REEMPLOYMENT RIGHTS ACT OF 1994 Reemployment Rights and Benefits Pension Plan Benefits § 1002.260 What pension...) defines an employee pension benefit plan as a plan that provides retirement income to employees, or defers...

  11. Cardiovascular benefits of exercise

    Directory of Open Access Journals (Sweden)

    Agarwal SK

    2012-06-01

    Full Text Available Shashi K AgarwalMedical Director, Agarwal Health Center, NJ, USAAbstract: Regular physical activity during leisure time has been shown to be associated with better health outcomes. The American Heart Association, the Centers for Disease Control and Prevention and the American College of Sports Medicine all recommend regular physical activity of moderate intensity for the prevention and complementary treatment of several diseases. The therapeutic role of exercise in maintaining good health and treating diseases is not new. The benefits of physical activity date back to Susruta, a 600 BC physician in India, who prescribed exercise to patients. Hippocrates (460–377 BC wrote “in order to remain healthy, the entire day should be devoted exclusively to ways and means of increasing one's strength and staying healthy, and the best way to do so is through physical exercise.” Plato (427–347 BC referred to medicine as a sister art to physical exercise while the noted ancient Greek physician Galen (129–217 AD penned several essays on aerobic fitness and strengthening muscles. This article briefly reviews the beneficial effects of physical activity on cardiovascular diseases.Keywords: exercise, cardiovascular disease, lifestyle changes, physical activity, good health

  12. Benzodiazepines: risks and benefits. A reconsideration.

    Science.gov (United States)

    Baldwin, David S; Aitchison, Katherine; Bateson, Alan; Curran, H Valerie; Davies, Simon; Leonard, Brian; Nutt, David J; Stephens, David N; Wilson, Sue

    2013-11-01

    Over the last decade there have been further developments in our knowledge of the risks and benefits of benzodiazepines, and of the risks and benefits of alternatives to benzodiazepines. Representatives drawn from the Psychopharmacology Special Interest Group of the Royal College of Psychiatrists and the British Association for Psychopharmacology together examined these developments, and have provided this joint statement with recommendations for clinical practice. The working group was mindful of widespread concerns about benzodiazepines and related anxiolytic and hypnotic drugs. The group believes that whenever benzodiazepines are prescribed, the potential for dependence or other harmful effects must be considered. However, the group also believes that the risks of dependence associated with long-term use should be balanced against the benefits that in many cases follow from the short or intermittent use of benzodiazepines and the risk of the underlying conditions for which treatment is being provided.

  13. Med Diet 4.0: the Mediterranean diet with four sustainable benefits.

    Science.gov (United States)

    Dernini, S; Berry, E M; Serra-Majem, L; La Vecchia, C; Capone, R; Medina, F X; Aranceta-Bartrina, J; Belahsen, R; Burlingame, B; Calabrese, G; Corella, D; Donini, L M; Lairon, D; Meybeck, A; Pekcan, A G; Piscopo, S; Yngve, A; Trichopoulou, A

    2017-05-01

    To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns. A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined. The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet. By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.

  14. Spin multiplicities

    Energy Technology Data Exchange (ETDEWEB)

    Curtright, T.L., E-mail: curtright@miami.edu [Department of Physics, University of Miami, Coral Gables, FL 33124-8046 (United States); Van Kortryk, T.S., E-mail: vankortryk@gmail.com [Department of Physics, University of Miami, Coral Gables, FL 33124-8046 (United States); High Energy Physics Division, Argonne National Laboratory, Argonne, IL 60439-4815 (United States); Zachos, C.K., E-mail: zachos@anl.gov [Department of Physics, University of Miami, Coral Gables, FL 33124-8046 (United States); High Energy Physics Division, Argonne National Laboratory, Argonne, IL 60439-4815 (United States)

    2017-02-05

    The number of times spin s appears in the Kronecker product of n spin j representations is computed, and the large n asymptotic behavior of the result is obtained. Applications are briefly sketched. - Highlights: • We give a self-contained derivation of the spin multiplicities that occur in n-fold tensor products of spin-j representations. • We make use of group characters, properties of special functions, and asymptotic analysis of integrals. • We emphasize patterns that arise when comparing different values of j, and asymptotic behavior for large n. • Our methods and results should be useful for various statistical and quantum information theory calculations.

  15. 20 CFR 220.104 - Multiple impairments.

    Science.gov (United States)

    2010-04-01

    ... DISABILITY Evaluation of Disability § 220.104 Multiple impairments. To determine whether the claimant's physical or mental impairment or impairments are of a sufficient medical severity that such impairment or... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Multiple impairments. 220.104 Section 220.104...

  16. 20 CFR 416.923 - Multiple impairments.

    Science.gov (United States)

    2010-04-01

    ... DISABLED Determining Disability and Blindness Evaluation of Disability § 416.923 Multiple impairments. In determining whether your physical or mental impairment or impairments are of a sufficient medical severity... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Multiple impairments. 416.923 Section 416.923...

  17. Tremor in multiple sclerosis

    NARCIS (Netherlands)

    Koch, Marcus; Mostert, Jop; Heersema, Dorothea; De Keyser, Jacques

    Tremor is estimated to occur in about 25 to 60 percent of patients with multiple sclerosis (MS). This symptom, which can be severely disabling and embarrassing for patients, is difficult to manage. Isoniazid in high doses, carbamazepine, propranolol and gluthetimide have been reported to provide

  18. Multiple Primary Cancer Monograph

    Science.gov (United States)

    To identify groups of cancer survivors that are at increased risk for multiple primary cancers, investigators led an effort to provide the first comprehensive population-based analysis of the risk of subsequent cancer in the U.S., resulting in a monograph.

  19. Barriers and benefits to using mobile health technology after operation: A qualitative study.

    Science.gov (United States)

    Abelson, Jonathan S; Kaufman, Elinore; Symer, Matthew; Peters, Alexander; Charlson, Mary; Yeo, Heather

    2017-09-01

    Recently, mobile health technology has emerged as a promising avenue for improving physician-patient communication and patient outcomes. The objective of our study was to determine the public's perception of barriers and benefits to using mobile health technology technologies to enhance recovery after operation. We used the Empire State Poll to ask 2 open-ended questions to 800 participants assessing their perceptions of benefits and barriers to use mobile health technology after operation. All responses were coded independently, and any discrepancies were resolved by consensus. We used grounded theory to allow themes to arise from the codes. Interrater reliability was calculated using Cohen's Kappa. Participants identified a range of possible barriers to using mobile health technology apps after operation including: protecting personal health information, technology effectiveness and failure, preference for face-to-face interaction with their surgeon, level of effort required, and ability of the older adults to navigate mobile health technology. Participants identified multiple possible benefits including: better monitoring, improved communication with their surgeon, minimizing follow-up visits, improved convenience, and increased patient knowledge. In the study, 15% of all respondents stated there were no barriers whereas 6% stated there were no benefits. Participants were receptive to the many potential benefits of this technology to enhance not only their relationships with providers and the convenience of access, but also their health outcomes. We must address participants concerns about data security and their fears of losing a personal relationship with their doctor. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. External Benefit Evaluation of Renewable Energy Power in China for Sustainability

    Directory of Open Access Journals (Sweden)

    Huiru Zhao

    2015-04-01

    Full Text Available China’s renewable energy power has developed rapidly in recent years. Evaluating the external benefits of renewable energy power can provide a reference for the Chinese government to set diverse development goals and to implement differentiated supporting policies for different renewable energy power types, which can promote their sustainable development. In this paper, a hybrid MCDM method was applied to evaluate the external benefits of China’s renewable energy power. Firstly, the impacts of renewable energy power accessing the power grid for multiple stakeholders in the electric power system were analyzed. Secondly, the external benefit evaluation index system for renewable energy power was built from the economic, social and environmental factors, based on the concept of sustainability. Then, the basic theory of the hybrid MCDM method employed in this paper was introduced in two parts: the superiority linguistic ratings and entropy weighting method for index weight determination and the fuzzy grey relation analysis for ranking alternatives. Finally, the external benefits of wind power, solar PV power and biomass power were evaluated. Taking a regional electric power system as an example, the results show that PV power has the greatest external benefit, followed by wind power and biomass power. Therefore, more policies supporting PV power should be put in place to promote the harmonious and sustainable development of the whole renewable energy power industry.

  1. Separate spheres and indirect benefits

    Directory of Open Access Journals (Sweden)

    Brock Dan W

    2003-02-01

    Full Text Available Abstract On any plausible account of the basis for health care resource prioritization, the benefits and costs of different alternative resource uses are relevant considerations in the prioritization process. Consequentialists hold that the maximization of benefits with available resources is the only relevant consideration. Non-consequentialists do not reject the relevance of consequences of benefits and costs, but insist that other considerations, and in particular the distribution of benefits and costs, are morally important as well. Whatever one's particular account of morally justified standards for the prioritization of different health interventions, we must be able to measure those interventions' benefits and costs. There are many theoretical and practical difficulties in that measurement, such as how to weigh extending life against improving health and quality of life as well as how different quality of life improvements should be valued, but they are not my concern here. This paper addresses two related issues in assessing benefits and costs for health resource prioritization. First, should benefits be restricted only to health benefits, or include as well other non health benefits such as economic benefits to employers from reducing the lost work time due to illness of their employees? I shall call this the Separate Spheres problem. Second, should only the direct benefits, such as extending life or reducing disability, and direct costs, such as costs of medical personnel and supplies, of health interventions be counted, or should other indirect benefits and costs be counted as well? I shall call this the Indirect Benefits problem. These two issues can have great importance for a ranking of different health interventions by either a cost/benefit or cost effectiveness analysis (CEA standard.

  2. Health benefits revised.

    Science.gov (United States)

    McCormack, T

    1998-01-01

    The State Children's Health Insurance Program (SCHIP) provides $24 billion for States to use in providing health coverage to needy children and the States have some flexibility in developing their own programs. Some States have raised Medicaid income eligibility levels and others have purchased private insurance for eligible children. The private insurance provision can lead to whole family coverage being purchased, extending coverage to many HIV-positive parents. Provisions of last year's welfare reform bill dropped many children from health coverage by tightening the definition of disability or by making their parents ineligible because of immigration status. The Specified Low Income Medicaid Beneficiary (SLIMB) program and the economic issues in providing private coverage are described.

  3. USGEO National Earth Observation Assessment Methods for Evaluating the Relative Contributions of Earth Observing Systems to Societal Benefit

    Science.gov (United States)

    Gallo, J.; Stryker, T.

    2015-12-01

    The second National Civil Earth Observation Assessment identifies the inputs and relative contributions of the portfolio of observing systems currently relied upon by Federal agencies to meet key Earth observing objectives. The Assessment employs a hierarchical value-tree framework that traces the pathways through which Earth observing systems contribute value across 13 societal benefit areas, utilizing multiple levels to provide logical traceability. This presentation describes the methods used to construct societal benefit area value-trees that include key objectives and the information products, services, and research derived from Earth observations that help satisfy them. It describes the methods for weighting nodes at multiple levels of each value-tree and the expert elicitation process for assessing the relative contributions of Earth observing systems to the development of information products, services, and research. The methodology employed in the Assessment is especially useful at assessing the interdependence and relative contributions of multiple Earth observing systems on the development of blended information products and tracing information pathways from direct observations through intermediate products, such as models, to end-products used to improve decision-making. This presentation will highlight case study examples from the 13 societal benefit areas (agriculture and forestry, biodiversity, climate, disasters, ecosystems, energy and mineral resources, human health, ocean and costal resources, space weather, transportation, water resources weather, and reference measurements) to demonstrate tractability from Earth observing systems, through information products and research that satisfy key objectives, to societal benefit.

  4. Perceptions of Community Benefits from Two Wild and Scenic Rivers

    Science.gov (United States)

    Smith, Jordan W.; Moore, Roger L.

    2011-05-01

    Wild and Scenic Rivers provide a host of psychological, social, ecological, and economic benefits to local communities. In this study, we use data collected from recreational users of two Wild and Scenic Rivers to examine perceptions of the benefits provided by the rivers to local communities. Our purposes are (1) to determine if similar perceptions of community benefits exist across the two rivers, (2) to determine if individuals' proximity to the rivers are related to the benefits they perceive, (3) to determine if individuals' prior recreation experience on the river is related to variations in perceived benefits, (4) to determine if users' sociodemographic characteristics are related to perceived community benefits, and (5) to determine if the influence of these characteristics on perceived community benefits is similar across the two resource areas. Perceived benefits were found to be analogous across both rivers as individuals consistently ranked ecological/affective benefits as well as tangible benefits similarly. Recreationists living further from the river ranked ecological and affective benefits as significantly less important than those individuals living closer to the river. Women perceived the community benefits produced by the resource areas to be significantly more important when compared to men. Significant relationships were also found between perceived benefits and recreationists' previous use of the river, their age, and their level of education. With the exception of resource proximity and prior use history, the effects of user characteristics on perceived community benefits were not statistically different across the two rivers. These findings imply similar patterns of perceived community benefits exist across distinct resource areas and that the relationships between user characteristics and perceived benefits are also similar across the study rivers.

  5. Homework in Physical Education: Benefits and Implementation

    Science.gov (United States)

    Novak, Benjamin Edward; Lynott, Francis John, III.

    2015-01-01

    This article identifies homework as an underutilized strategy in physical education. It reviews the benefits associated with the use of homework in the physical education setting, and provides guidelines for the effective implementation of this strategy. The guidelines include practical application examples and define structured active homework…

  6. Health aspects of caffeine: benefits and risks.

    Science.gov (United States)

    Ruxton, C

    This article examines the benefits and risks associated with caffeinated foods and drinks, taking an evidence-based approach to identify appropriate daily caffeine limits. Suggestions are provided on how to structure dietary advice for different patient groups including children, individuals with hypertension, renal patients, athletes and older adults.

  7. Identifying and explicating variation among friends with benefits relationships.

    Science.gov (United States)

    Mongeau, Paul A; Knight, Kendra; Williams, Jade; Eden, Jennifer; Shaw, Christina

    2013-01-01

    This two-study report identifies and validates a typology containing seven types of "friends with benefits relationships" (FWBRs). Study 1 asked heterosexual students to define the term FWBR and to describe their experience with the relationship type. Qualitative analysis of these data identified seven types of FWBRs (true friends, network opportunism, just sex, three types of transition in [successful, failed, and unintentional], and transition out). Study 2 quantitatively differentiates these relationship types in the amount of nonsexual interaction, strength of the friendship at the first sexual interaction, and history of romantic relationships with the FWBR partner (before the FWBR, after it, or both). Results from both studies clearly suggest that FWBRs represent a diverse set of relationship formulations where both the benefits (i.e., repeated sexual contact) and the friends (i.e., relationship between partners) vary widely. In many cases, FWBRs represent a desire for, or an attempt at, shifting the relationship from friends to a romantic partnership. Other implications are discussed, as are limitations and directions for future research. The diverse nature of FWBRs provides challenges for researchers that likely require multiple methods and theoretical frames.

  8. Accessibility of MOOCs: Understanding the Provider Perspective

    Science.gov (United States)

    Iniesto, Francisco; McAndrew, Patrick; Minocha, Shailey; Coughlan, Tim

    2016-01-01

    Massive Online Open Courses (MOOCs) have become an accepted way to make learning opportunities available at large scale and with low cost to the learner. However, only if these are made accessible will they be able to offer flexibility of learning and benefits to all, irrespective of disability. Experience in providing accessible online learning…

  9. Functional improvement with digital prosthesis use after multiple digit amputations.

    Science.gov (United States)

    Lifchez, Scott D; Marchant-Hanson, Judith; Matloub, Hani S; Sanger, James R; Dzwierzynski, William W; Nguyen, Hanh H

    2005-07-01

    Patients who sustain traumatic amputation of multiple fingers suffer both a functional and psychologic loss. Previous studies of prosthesis use for finger amputees have focused primarily on the psychologic benefits. Clinically our group noticed a functional improvement on hand function tests when patients with multiple digit amputations used a prosthesis. Given the expense of multiple finger prostheses we sought to determine if they led to a consistent functional improvement in these patients. Ten consecutive patients performed a battery of hand function tests and rated their ability to perform a variety of activities of daily living both with and without their prosthesis using the Disabilities of the Arm, Shoulder, and Hand questionnaire. Our results show a significant improvement in 3-finger-pinch strength and grip strength and a trend of improvement of tip-pinch, lateral-pinch, and grip strength in dynamometer positions 1, 2, 3, and 4 in these patients when tested with and without their prostheses. Function in activities of daily living, as assessed by the Disabilities of the Arm, Shoulder, and Hand questionnaire, was improved globally with prosthesis use. In addition, significant improvement was noted in several specific activities including opening a jar, writing, and turning a key, among others. These results show that prosthesis use provides a functional benefit to these patients in multiple activities.

  10. Medicare Hospice Benefits

    Science.gov (United States)

    ... to pay. Medicare Advantage Plan (Part C) —A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with ... plan —Generally, a plan offered by a private company that ... organizations are special types of Medicare health plans that can be offered ...

  11. [Oral treatments in multiple sclerosis].

    Science.gov (United States)

    Meca-Lallana, José Eustasio; Hernández-Clares, Rocío; Carreón-Guarnizo, Ester

    2014-12-01

    The development of new disease-modifying drugs (DMD) in relapsing-remitting multiple sclerosis (RRMS), which share the common denominator of oral administration, considerably improves patient expectations in terms of effectiveness, tolerability and treatment adherence compared with currently available drugs. However, the common route of administration of these drugs does not mean that they are equivalent, since the heading of "oral route" encompasses drugs with distinct indications and mechanisms of action, as well as heterogeneous results in terms of efficacy and safety, allowing treatment to be personalized according to the each patient' s characteristics. Currently, four oral DMD are available or in an advanced stage of clinical development: fingolimod, teriflunomide, dimethyl fumarate and laquinimod. In pivotal trials versus placebo, these molecules reduced the annualized rate of exacerbations versus placebo by 54%, 31%, 53% and 23%, respectively, the risk of progression of disability by 31%, 30%, 38% and 36%, and the number of active lesions showing contrast uptake on magnetic resonance imaging by 82%, 80%, 90% and 37%, respectively. Based on the risk/benefit ratio, fingolimod is indicated in patients with suboptimal response to initial DMD or in severe rapidly progressing RRMS, while the remaining drugs can be used as first-line options. Clinical experience with these treatments will provide new data on safety and effectiveness, which will be determinant when establishing therapeutic algorithms. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  12. Providing care for an elderly parent: interactions among siblings?

    Science.gov (United States)

    Fontaine, Roméo; Gramain, Agnès; Wittwer, Jérôme

    2009-09-01

    This article is focused on children providing and financing long-term care for their elderly parent. The aim of this work is to highlight the interactions that may take place among siblings when deciding whether or not to become a caregiver. We look at families with two children using data from the Survey of Health, Ageing and Retirement in Europe; our sample contains 314 dependent elderly and their 628 adult children. In order to identify the interactions between siblings, we have specified a two-person discrete game model. To estimate this model, without invoking the 'coherency' condition, we have added an endogenous selection rule to solve the incompleteness problem arising from multiplicity or absence of equilibrium. Our empirical results suggest that the three classical effects identified by Manski could potentially explain the observed correlation between the siblings' caregiving behaviour. Correlated effects alone appear to be weak. Contextual interactions and endogenous interactions reveal cross-effects. The asymmetric character of the endogenous interactions is our most striking result. The younger child's involvement appears to increase the net benefit of caregiving for the elder one, whereas the elder child's involvement decreases the net benefit of caregiving for the younger child. Copyright (c) 2009 John Wiley & Sons, Ltd.

  13. The benefits of human-companion animal interaction: a review.

    Science.gov (United States)

    Barker, Sandra B; Wolen, Aaron R

    2008-01-01

    This article provides a review of research published since 1980 on the benefits of human-companion animal interaction. Studies focusing on the benefits of pet ownership are presented first, followed by research on the benefits of interacting with companion animals that are not owned by the subject (animal-assisted activities). While most of the published studies are descriptive and have been conducted with convenience samples, a promising number of controlled studies support the health benefits of interacting with companion animals. Future research employing more rigorous designs and systematically building upon a clearly defined line of inquiry is needed to advance our knowledge of the benefits of human-companion animal interaction.

  14. 20 CFR 404.1662 - What support we will provide.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What support we will provide. 404.1662 Section 404.1662 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... support we will provide. Performance support may include, but is not limited to, any or all of the...

  15. 20 CFR 416.1062 - What support we will provide.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What support we will provide. 416.1062 Section 416.1062 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE... What support we will provide. Performance support may include, but is not limited to, any or all of the...

  16. Provider of Services File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it...

  17. The Provident Principal.

    Science.gov (United States)

    McCall, John R.

    This monograph offers leadership approaches for school principals. Discussion applies the business leadership theory of Warren Bennis and Burt Nanus to the role of the principal. Each of the booklet's three parts concludes with discussion questions. Part 1, "Visions and Values for the Provident Principal," demonstrates the importance of…

  18. What HERA may provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes [DESY, Hamburg (Germany); De Roeck, Albert [CERN, Genf (Switzerland); Bartles, Jochen [Univ. Hamburg (DE). Institut fuer Theoretische Physik II] (and others)

    2008-09-15

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. (orig.)

  19. care Providers in Ibadan

    African Journals Online (AJOL)

    Three hundred and eighty six respondents (77.7%) were aware of intermittent preventive treatment (IPT). Awareness ... Key Words: malaria in pregnancy, intermittent preventive treatment, malaria control, health care providers. Department of Obstetrics .... Auxiliary nurses do not have formal training prior to employment.

  20. Health systems ownership: can regulation preserve community benefits?

    Science.gov (United States)

    Pauly, M V

    1996-01-01

    This article addresses two questions. What determines the amount of community benefit a nonprofit firm will provide? What would be the expected effect of legal rules requiring nonprofit firms to provide more community benefit than they would otherwise have chosen? The amount of community benefit provided, it is argued, depends on the desires of the donors who endow the nonprofit firm with its equity capital and control its corporate board. The effect of a law requiring the provision of community benefit depends on the degree of competition in the local market. In competitive markets, such a rule is like a hidden tax. In markets in which nonprofit firms have market power, it may divert resources from types of benefit valued highly by the board toward activities valued highly by the political process. The definition of community benefit and the future of nonprofit hospitals are also discussed.

  1. The Benefits of Graded Reading

    Directory of Open Access Journals (Sweden)

    Mustafa Albay

    2017-06-01

    Full Text Available Doing large amounts of extensive reading at suitable levels of understanding is a productive tool to increase reading rate, vocabulary, motivation, attitude and general language proficiency. The amount of vocabulary and grammar learners has determines their language proficiency. Extensive reading enables learners to attain competencies in language skills. Graded readers are essential materials for doing extensive reading. They are particularly designed to enable learners practice reading skills and provide an opportunity to reinforce known vocabulary. Through multiple exposures learners become familiar with grammatical structures and vocabulary. Moreover, learners experience how they function in texts and they are motivated to use the vocabulary and structures they have learnt in their communication. Graded readers motivate learners, help them gain reading fluency, enhance their vocabulary and grammar knowledge development. This article defines extensive reading, emphasizes its contributions to language proficiency development and finally stresses out the role of grader readers in language learning.

  2. Predicting Anthracycline Benefit

    DEFF Research Database (Denmark)

    Bartlett, John M S; McConkey, Christopher C; Munro, Alison F

    2015-01-01

    PURPOSE: Evidence supporting the clinical utility of predictive biomarkers of anthracycline activity is weak, with a recent meta-analysis failing to provide strong evidence for either HER2 or TOP2A. Having previously shown that duplication of chromosome 17 pericentromeric alpha satellite as measu......PURPOSE: Evidence supporting the clinical utility of predictive biomarkers of anthracycline activity is weak, with a recent meta-analysis failing to provide strong evidence for either HER2 or TOP2A. Having previously shown that duplication of chromosome 17 pericentromeric alpha satellite...... not affect HER2-to-CEP17 ratios but necessitated different definitions for CEP17 duplication: > 1.86 observed copies per cell for BR9601, NEAT, Belgian, and DBCG89D trials and > 2.25 for the MA.5 trial. RESULTS: Fluorescent in situ hybridization data were available in 89.3% (HER2), 83.9% (CEP17), and 80...

  3. Internet Medline providers.

    Science.gov (United States)

    Vine, D L; Coady, T R

    1998-01-01

    Each database in this review has features that will appeal to some users. Each provides a credible interface to information available within the Medline database. The major differences are pricing and interface design. In this context, features that cost more and might seem trivial to the occasional searcher may actually save time and money when used by the professional. Internet Grateful Med is free, but Ms. Coady and I agree the availability of only three ANDable search fields is a major functional limitation. PubMed is also free but much more powerful. The command line interface that permits very sophisticated searches requires a commitment that casual users will find intimidating. Ms. Coady did not believe the feedback currently provided during a search was sufficient for sustained professional use. Paper Chase and Knowledge Finder are mature, modestly priced Medline search services. Paper Chase provides a menu-driven interface that is very easy to use, yet permits the user to search virtually all of Medline's data fields. Knowledge Finder emphasizes the use of natural language queries but fully supports more traditional search strategies. The impact of the tradeoff between fuzzy and Boolean strategies offered by Knowledge Finder is unclear and beyond the scope of this review. Additional software must be downloaded to use all of Knowledge Finders' features. Other providers required no software beyond the basic Internet browser, and this requirement prevented Ms. Coady from evaluating Knowledge Finder. Ovid and Silver Platter offer well-designed interfaces that simplify the construction of complex queries. These are clearly services designed for professional users. While pricing eliminates these for casual use, it should be emphasized that Medline citation access is only a portion of the service provided by these high-end vendors. Finally, we should comment that each of the vendors and government-sponsored services provided prompt and useful feedback to e

  4. Subjective benefits of energy storing prostheses.

    Science.gov (United States)

    Alaranta, H; Lempinen, V M; Haavisto, E; Pohjolainen, T; Hurri, H

    1994-08-01

    The energy storing (ES) prosthesis has been used in the Prosthetic Foundation's workshop since 1987. Subjective responses from 168 amputees (141 trans-tibial and 27 trans-femoral) fitted with the ES prosthesis were analysed. Ratings were generally favourable in comparison with those for conventional prostheses. The most pronounced advantages of the new prosthesis as shown by the ratings were in walking uphill or swift walking. The younger amputees had more benefit than the older ones. High body weight decreased the benefit of the ES prosthesis. The ES prosthesis does not seem to provide any major advantage for the less active amputee whose movements are mainly indoors.

  5. The road to treating smoldering multiple myeloma.

    Science.gov (United States)

    Korde, Neha; Mailankody, Sham; Landgren, Ola

    2014-09-01

    The management of smoldering multiple myeloma (SMM) has been a challenge to clinicians, ever since the condition was first characterized in 1980. While the risk of progression to symptomatic myeloma is greater for SMM (10% per year) compared to MGUS (1% per year), several SMM patients remain asymptomatic for years without evidence of disease progression. Early clinical trials focusing on early treatment of SMM have been equivocal with no clear benefit. However, the last decade has seen a greater understanding of the pathogenesis of plasma cell disorders, including SMM, and development of better therapeutics. A recent randomized trial has provided evidence of clinical benefit with early treatment of high-risk SMM. In this review, we summarize issues related to the early treatment of SMM including risk stratification and possible outcomes with therapy initiation. In the context of reviewing recent clinical trial data supporting early treatment, we define challenges faced by clinicians and provide future directions to the road to treating SMM. Published by Elsevier Inc.

  6. Providing plastic zone extrusion

    Science.gov (United States)

    Manchiraju, Venkata Kiran; Feng, Zhili; David, Stan A.; Yu, Zhenzhen

    2017-04-11

    Plastic zone extrusion may be provided. First, a compressor may generate frictional heat in stock to place the stock in a plastic zone of the stock. Then, a conveyer may receive the stock in its plastic zone from the compressor and transport the stock in its plastic zone from the compressor. Next, a die may receive the stock in its plastic zone from the conveyer and extrude the stock to form a wire.

  7. Core Benefits of Network Participation

    OpenAIRE

    Kheiri Pileh Roud, Ensieh

    2015-01-01

    This study deals with the core benefits of network participation from the maritime companies’ perspective. It mainly focuses on the area of innovation, network qualities and absorptive capacities. A single case study has been conducted to address two research questions; 1) what are the core benefits of network participation for a maritime company? 2) Which qualities of network events influence the benefits for the participants? The main findings show that, the networks are valuable communi...

  8. "We're Almost Guests in Their Clinical Care": Inpatient Provider Attitudes Toward Chronic Disease Management.

    Science.gov (United States)

    Blecker, Saul; Meisel, Talia; Dickson, Victoria Vaughan; Shelley, Donna; Horwitz, Leora I

    2017-03-01

    Many hospitalized patients have at least 1 chronic disease that is not optimally controlled. The purpose of this study was to explore inpatient provider attitudes about chronic disease management and, in particular, barriers and facilitators of chronic disease management in the hospital. We conducted a qualitative study of semi-structured interviews of 31 inpatient providers from an academic medical center. We interviewed attending physicians, resident physicians, physician assistants, and nurse practitioners from various specialties about attitudes, experiences with, and barriers and facilitators towards chronic disease management in the hospital. Qualitative data were analyzed using constant comparative analysis. Providers perceived that hospitalizations offer an opportunity to improve chronic disease management, as patients are evaluated by a new care team and observed in a controlled environment. Providers perceived clinical benefits to in-hospital chronic care, including improvements in readmission and length of stay, but expressed concerns for risks related to adverse events and distraction from the acute problem. Barriers included provider lack of comfort with managing chronic diseases, poor communication between inpatient and outpatient providers, and hospital-system focus on patient discharge. A strong relationship with the outpatient provider and involvement of specialists were facilitators of inpatient chronic disease management. Providers perceived benefits to in-hospital chronic disease management for both processes of care and clinical outcomes. Efforts to increase inpatient chronic disease management will need to overcome barriers in multiple domains. Journal of Hospital Medicine 2017;12:162-167.

  9. Financial risk management of pharmacy benefits.

    Science.gov (United States)

    Saikami, D

    1997-10-01

    Financial risk management of pharmacy benefits in integrated health systems is explained. A managed care organization should assume financial risk for pharmacy benefits only if it can manage the risk. Horizontally integrated organizations often do not have much control over the management of drug utilization and costs. Vertically integrated organizations have the greatest ability to manage pharmacy financial risk; virtual integration may also be compatible. Contracts can be established in which the provider is incentivized or placed at partial or full risk. The main concerns that health plans have with respect to pharmacy capitation are formulary management and the question of who should receive rebates from manufacturers. The components needed to managed pharmacy financial risk depend on the type of contract negotiated. Health-system pharmacists are uniquely positioned to take advantage of opportunities opening up through pharmacy risk contracting. Functions most organizations must provide when assuming pharmacy financial risk can be divided into internal and external categories. Internally performed functions include formulary management, clinical pharmacy services and utilization management, and utilization reports for physicians. Functions that can be outsourced include claims processing and administration, provider- and customer support services, and rebates. Organizations that integrate the pharmacy benefit across the health care continuum will be more effective in controlling costs and improving outcomes than organizations that handle this benefit as separate from others. Patient care should not focus on payment mechanisms and unit costs but on developing superior processes and systems that improve health care.

  10. The Benefits of High Intensity Functional Training (HIFT) Fitness Programs for Military Personnel

    Science.gov (United States)

    Haddock, Christopher K.; Poston, Walker S.C.; Heinrich, Katie M.; Jahnke, Sara A.; Jitnarin, Nattinee

    2016-01-01

    High intensity functional training (HIFT) programs are designed to address multiple fitness domains, potentially providing improved physical and mental readiness in a changing operational environment. Programs consistent with HIFT principals such as CrossFit, SEALFIT and the US Marine Corps’ High Intensity Tactical Training (HITT) program are increasingly popular among military personnel. This article reviews the practical, health, body composition, and military fitness implications of HIFT exercise programs. We conclude that, given the unique benefits of HIFT, the military should consider evaluating whether these programs should be the standard for military fitness training. PMID:27849484

  11. Providing Compassion through Flow

    Directory of Open Access Journals (Sweden)

    Lydia Royeen

    2015-07-01

    Full Text Available Meg Kral, MS, OTR/L, CLT, is the cover artist for the Summer 2015 issue of The Open Journal of Occupational Therapy. Her untitled piece of art is an oil painting and is a re-creation of a photograph taken while on vacation. Meg is currently supervisor of outpatient services at Rush University Medical Center. She is lymphedema certified and has a specific interest in breast cancer lymphedema. Art and occupational therapy serve similar purposes for Meg: both provide a sense of flow. She values the outcomes, whether it is a piece of art or improved functional status

  12. Providing Contraception to Adolescents.

    Science.gov (United States)

    Raidoo, Shandhini; Kaneshiro, Bliss

    2015-12-01

    Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Ysla S. Catalina & Providence

    OpenAIRE

    Diazgranados, Carlos Nicolás; Torres Carreño, Guillermo Andrés; Castell, Edmon; Moreno, Santiago; Ramirez, Natalia

    2010-01-01

    Esta Hoja de Mano pertenece a la exposición temporal "Ysla S. Catalina & Providence". Contiene un resumen histórico de las Islas de Santa Catalina y Providencia en los idiomas inglés y español y un mapa del siglo VI que lo hace más didáctico apoyado por figuras recortables. Esta muestra hace parte del proyecto IDA y VUELTA del Sistema de Patrimonio Cultural y Museos SPM que gestiona la descentralización del patrimonio cultural de la Universidad Nacional de Colombia a otras ciudades del pa...

  14. Providing better indoor environmental quality brings economicbenefits

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William; Seppanen, Olli

    2007-06-01

    This paper summarizes the current scientific evidence that improved indoor environmental quality can improve work performance and health. The review indicates that work and school work performance is affected by indoor temperature and ventilation rate. Pollutant source removal can sometimes improve work performance. Based on formal statistical analyses of existing research results, quantitative relationships are provided for the linkages of work performance with indoor temperature and outdoor air ventilation rate. The review also indicates that improved health and related financial savings are obtainable from reduced indoor tobacco smoking, prevention and remediation of building dampness, and increased ventilation. Example cost-benefit analyses indicate that many measures to improve indoor temperature control and increase ventilation rates will be highly cost effective, with benefit-cost ratios as high as 80 and annual economic benefits as high as $700 per person.

  15. Alemtuzumab for the treatment of multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Willis MD

    2015-03-01

    Full Text Available Mark D Willis, Neil P Robertson Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK Abstract: Alemtuzumab is an anti-CD52 monoclonal antibody, recently approved for the treatment of active, relapsing multiple sclerosis (MS. Administration of alemtuzumab causes a rapid and dramatic reduction in circulating lymphocytes, with a predictable subsequent pattern of immune reconstitution. Although the precise mode of action remains unclear, treatment results in a marked reduction in annualized relapse rates, slowing of disability progression compared with an active comparator, and may even cause disability reversal. Although conferring clear clinical benefits, alemtuzumab carries a significant long-term risk of autoimmune disease (AID, which has a particular predilection for the thyroid gland, although a wide range of other disorders have also been reported. However, risks of AID can usually be anticipated and treated successfully, provided rigorous monitoring and surveillance protocols are followed by clinicians and patients alike. Despite its immunosuppressive mechanism of action serious infections are rare and malignancies commonly associated with immunodeficiency have not been observed to date. Alemtuzumab’s unique mode of administration, as well as it’s durability of effect, provides an important addition to currently available therapeutic interventions for MS, and in particular is a valuable treatment option in recent onset and highly active relapsing disease. Keywords: multiple sclerosis, alemtuzumab, autoimmune disease

  16. Do multiple micronutrient interventions improve child health, growth, and development?

    Science.gov (United States)

    Ramakrishnan, Usha; Goldenberg, Tamar; Allen, Lindsay H

    2011-11-01

    Micronutrient deficiencies are common and often co-occur in many developing countries. Several studies have examined the benefits of providing multiple micronutrient (MMN) interventions during pregnancy and childhood, but the implications for programs remain unclear. The key objective of this review is to summarize what is known about the efficacy of MMN interventions during early childhood on functional outcomes, namely, child health, survival, growth, and development, to guide policy and identify gaps for future research. We identified review articles including meta-analyses and intervention studies that evaluated the benefits of MMN interventions (3 or more micronutrients) in children (child morbidity, anemia, and growth. Two studies found no effects on child mortality. The findings for respiratory illness and diarrhea are mixed, although suggestive of benefit when provided as fortified foods. There is evidence from several controlled trials (>25) and 2 meta-analyses that MMN interventions improve hemoglobin concentrations and reduce anemia, but the effects were small compared to providing only iron or iron with folic acid. Two recent meta-analyses and several intervention trials also indicated that MMN interventions improve linear growth compared to providing a placebo or single nutrients. Much less is known about the effects on MMN interventions during early childhood on motor and mental development. In summary, MMN interventions may result in improved outcomes for children in settings where micronutrient deficiencies are widespread.

  17. Benefits for People with Disabilities

    Science.gov (United States)

    ... about whether or not you meet Social Security's definition of disability . Use the Benefits Eligibility Screening Tool to find out which programs may be able to pay you benefits. If your application has recently been denied, the Internet Appeal is a starting point to request a ...

  18. Who Benefits from Pension Enhancements?

    Science.gov (United States)

    Koedel, Cory; Ni, Shawn; Podgursky, Michael

    2014-01-01

    During the late 1990s public pension funds across the United States accrued large actuarial surpluses. The seemingly flush conditions of the pension funds led legislators in most states to substantially improve retirement benefits for public workers, including teachers. In this study we examine the benefit enhancements to the teacher pension…

  19. Complexity of Risks and Benefits

    National Research Council Canada - National Science Library

    Elasy, Tom A

    2011-01-01

    ... was simultaneously earning her Masters in Business Administration degree, I likened the benefits of health care (with glucose control, those benefits include reductions in microvascular complications) to a "top-line" evaluation. It is essential, however, to have a "bottom-line" evaluation as well. Bottom-line evaluations would involve subtracting the c...

  20. When Measurement Benefits the Measured

    Science.gov (United States)

    2014-04-23

    late 33% state that rework is at least 25% of their budget 2014 IT Leadership Survey - Blueprint Software Systems Inc. 5 When Measurement Benefits...People as machines. Frederick Taylor Peter Drucker 21 When Measurement Benefits the Measured Kasunic & Nichols, April 23, 2014 © 2014 Carnegie

  1. Challenges in evaluating influenza vaccine effectiveness and the mortality benefits controversy.

    Science.gov (United States)

    Nichol, Kristin L

    2009-10-23

    Randomized, controlled trials are the gold standard study design. However, ethical constraints and practical considerations may necessitate other types of studies for evaluating influenza vaccine effectiveness in the elderly--a high priority group for annual vaccination in many countries. Observational studies therefore comprise the bulk of the vaccine effectiveness evidence in older persons, but these types of studies can be susceptible to selection bias and residual confounding. All observational studies should utilize strategies to minimize the impact of bias and confounding. Recent studies questioning the plausibility of reported mortality benefits among vaccinated elderly persons may themselves be based on assumptions that are susceptible to important limitations and multiple biases. Future studies that incorporate prospectively collected information on functional status, life expectancy, and other types of data may provide additional insights into these concerns. At present, even after taking into account the potential for residual bias and confounding, most studies confirm the benefits of vaccination among the elderly for reducing hospitalization and death.

  2. Multiple Intelligences for Differentiated Learning

    Science.gov (United States)

    Williams, R. Bruce

    2007-01-01

    There is an intricate literacy to Gardner's multiple intelligences theory that unlocks key entry points for differentiated learning. Using a well-articulated framework, rich with graphic representations, Williams provides a comprehensive discussion of multiple intelligences. He moves the teacher and students from curiosity, to confidence, to…

  3. Folklore and the Multiple Intelligences.

    Science.gov (United States)

    Koehnecke, Dianne Swenson

    1995-01-01

    Explores using Howard Gardner's multiple intelligences for folklore analysis. States that when listening to folktales, linguistic intelligence was used, as opposed to drawing pictures of the stories, which used spatial intelligence. Provides some ideas on how to bring folklore studies and the use of multiple intelligences into the classroom. (PA)

  4. Reverse time migration of multiples for OBS data

    KAUST Repository

    Zhang, Dongliang

    2014-08-05

    Reverse time migration of multiples (RTMM) is applied to OBS data with sparse receiver spacing. RTMM for OBS data unlike a marine streamer acquisition is implemented in the common receiver gathers (CRG) and provides a wider and denser illumination for each CRG than the conventional RTM of primaries. Hence, while the the conventional RTM image contains strong aliasing artifacts due to a sparser receiver interval, the RTMM image suffers from this artifacts less. This benefit of RTMM is demonstrated with numerical test on the Marmousi model for sparsely sampled OBS data.

  5. An Overview on SDN Architectures with Multiple Controllers

    Directory of Open Access Journals (Sweden)

    Othmane Blial

    2016-01-01

    Full Text Available Software-defined networking offers several benefits for networking by separating the control plane from the data plane. However, networks’ scalability, reliability, and availability remain as a big issue. Accordingly, multicontroller architectures are important for SDN-enabled networks. This paper gives a comprehensive overview of SDN multicontroller architectures. It presents SDN and its main instantiation OpenFlow. Then, it explains in detail the differences between multiple types of multicontroller architectures, like the distribution method and the communication system. Furthermore, it provides already implemented and under research examples of multicontroller architectures by describing their design, their communication process, and their performance results.

  6. Polyphenol metabolism provides a screening tool for beneficial effects of Onobrychis viciifolia (sainfoin).

    Science.gov (United States)

    Thill, Jana; Regos, Ionela; Farag, Mohamed A; Ahmad, Asma F; Kusek, Justyna; Castro, Ana; Schlangen, Karin; Carbonero, Christine Hayot; Gadjev, Ilya Z; Smith, Lydia M J; Halbwirth, Heidi; Treutter, Dieter; Stich, Karl

    2012-10-01

    Onobrychis viciifolia (sainfoin) is a traditional fodder legume showing multiple benefits for the environment, animal health and productivity but weaker agronomic performance in comparison to other legumes. Benefits can be mainly ascribed to the presence of polyphenols. The polyphenol metabolism in O. viciifolia was studied at the level of gene expression, enzyme activity, polyphenol accumulation and antioxidant activity. A screening of 37 accessions regarding each of these characters showed a huge variability between individual samples. Principal component analysis revealed that flavonols and flavan 3-ols are the most relevant variables for discrimination of the accessions. The determination of the activities of dihydroflavonol 4-reductase and flavonol synthase provides a suitable screening tool for the estimation of the ratio of flavonols to flavan 3-ols and can be used for the selection of samples from those varieties that have a specific optimal ratio of these compounds for further breeding. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Enhancing CIDOC-CRM and compatible models with the concept of multiple interpretation

    Science.gov (United States)

    Van Ruymbeke, M.; Hallot, P.; Billen, R.

    2017-08-01

    Modelling cultural heritage and archaeological objects is used as much for management as for research purposes. To ensure the sustainable benefit of digital data, models benefit from taking the data specificities of historical and archaeological domains into account. Starting from a conceptual model tailored to storing these specificities, we present, in this paper, an extended mapping to CIDOC-CRM and its compatible models. Offering an ideal framework to structure and highlight the best modelling practices, these ontologies are essentially dedicated to storing semantic data which provides information about cultural heritage objects. Based on this standard, our proposal focuses on multiple interpretation and sequential reality.

  8. Productivity benefits of industrial energy efficiency measures

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Laitner, John A.; Michael, Ruth; Finman, Hodayah

    2004-08-30

    We review the relationship between energy efficiency improvement measures and productivity in industry. We review over 70 industrial case studies from widely available published databases, followed by an analysis of the representation of productivity benefits in energy modeling. We propose a method to include productivity benefits in the economic assessment of the potential for energy efficiency improvement. The case-study review suggests that energy efficiency investments can provide a significant boost to overall productivity within industry. If this relationship holds, the description of energy-efficient technologies as opportunities for larger productivity improvements has significant implications for conventional economic assessments. The paper explores the implications this change in perspective on the evaluation of energy-efficient technologies for a study of the iron and steel industry in the US. This examination shows that including productivity benefits explicitly in the modeling parameters would double the cost-effective potential for energy efficiency improvement, compared to an analysis excluding those benefits. We provide suggestions for future research in this important area.

  9. Quantitative evidence for the benefits of Moving the Goalposts, a Sport for Development project in rural Kenya.

    Science.gov (United States)

    Woodcock, Alison; Cronin, Órla; Forde, Sarah

    2012-08-01

    Sport for Development has many reported benefits, but quantitative evidence of the impact of these interventions in Low Income Countries remains sparse. A new monitoring and evaluation toolkit was used in a cross-sectional survey at Moving the Goalposts (MTG), a football project aiming to empower young Kenyan women. We wished to determine empirically whether increased membership duration brought increased benefits. MTG selected and translated toolkit items consistent with the organisation's strategic aims. We collected 333 completed questionnaires at 15 sites. Psychometric validation revealed some reliable scales; remaining items were scored separately. Scores were sensitive to differences between members defined by sociodemographic and site characteristics. Bivariate and multiple regression analyses showed that increased membership duration brought increasing benefits across several domains (perceived lifeskills; social life; insights about HIV/AIDS; outcomes related to female empowerment). Improved leadership skills were mainly age-related. Members attending more established sites experienced greater benefits, but members at more and less accessible sites benefitted similarly. Positive thoughts and feelings were related not to membership duration, but to how long a site had been operating. This indicates the importance of creating a positive culture over time. This cross-sectional study provides quantitative evidence for the benefits of Sport for Development initiatives. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. What HERA May Provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes; /DESY; De Roeck, Albert; /CERN; Bartels, Jochen; /Hamburg U., Inst. Theor. Phys. II; Behnke, Olaf; Blumlein, Johannes; /DESY; Brodsky, Stanley; /SLAC /Durham U., IPPP; Cooper-Sarkar, Amanda; /Oxford U.; Deak, Michal; /DESY; Devenish, Robin; /Oxford U.; Diehl, Markus; /DESY; Gehrmann, Thomas; /Zurich U.; Grindhammer, Guenter; /Munich, Max Planck Inst.; Gustafson, Gosta; /CERN /Lund U., Dept. Theor. Phys.; Khoze, Valery; /Durham U., IPPP; Knutsson, Albert; /DESY; Klein, Max; /Liverpool U.; Krauss, Frank; /Durham U., IPPP; Kutak, Krzysztof; /DESY; Laenen, Eric; /NIKHEF, Amsterdam; Lonnblad, Leif; /Lund U., Dept. Theor. Phys.; Motyka, Leszek; /Hamburg U., Inst. Theor. Phys. II /Birmingham U. /Southern Methodist U. /DESY /Piemonte Orientale U., Novara /CERN /Paris, LPTHE /Hamburg U. /Penn State U.

    2011-11-10

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. The HERA accelerator and the HERA experiments H1, HERMES and ZEUS stopped running in the end of June 2007. This was after 15 years of very successful operation since the first collisions in 1992. A total luminosity of {approx} 500 pb{sup -1} has been accumulated by each of the collider experiments H1 and ZEUS. During the years the increasingly better understood and upgraded detectors and HERA accelerator have contributed significantly to this success. The physics program remains in full swing and plenty of new results were presented at DIS08 which are approaching the anticipated final precision, fulfilling and exceeding the physics plans and the previsions of the upgrade program. Most of the analyses presented at DIS08 were still based on the so called HERA I data sample, i.e. data taken until 2000, before the shutdown for the luminosity upgrade. This sample has an integrated luminosity of {approx} 100 pb{sup -1}, and the four times larger statistics sample from HERA II is still in the process of being analyzed.

  11. Core Multiplication in Childhood

    Science.gov (United States)

    McCrink, Koleen; Spelke, Elizabeth S.

    2011-01-01

    A dedicated, non-symbolic, system yielding imprecise representations of large quantities (Approximate Number System, or ANS) has been shown to support arithmetic calculations of addition and subtraction. In the present study, 5–7-year-old children without formal schooling in multiplication and division were given a task requiring a scalar transformation of large approximate numerosities, presented as arrays of objects. In different conditions, the required calculation was doubling, quadrupling, or increasing by a fractional factor (2.5). In all conditions, participants were able to represent the outcome of the transformation at above-chance levels, even on the earliest training trials. Their performance could not be explained by processes of repeated addition, and it showed the critical ratio signature of the ANS. These findings provide evidence for an untrained, intuitive process of calculating multiplicative numerical relationships, providing a further foundation for formal arithmetic instruction. PMID:20537618

  12. Potential benefits of satiety to the consumer: scientific considerations.

    Science.gov (United States)

    Hetherington, M M; Cunningham, K; Dye, L; Gibson, E L; Gregersen, N T; Halford, J C G; Lawton, C L; Lluch, A; Mela, D J; Van Trijp, H C M

    2013-06-01

    Foods and dietary patterns that enhance satiety may provide benefit to consumers. The aim of the present review was to describe, consider and evaluate research on potential benefits of enhanced satiety. The proposal that enhanced satiety could only benefit consumers by a direct effect on food intake should be rejected. Instead, it is proposed that there is a variety of routes through which enhanced satiety could (indirectly) benefit dietary control or weight-management goals. The review highlights specific potential benefits of satiety, including: providing appetite control strategies for consumers generally and for those who are highly responsive to food cues; offering pleasure and satisfaction associated with low-energy/healthier versions of foods without feeling 'deprived'; reducing dysphoric mood associated with hunger especially during energy restriction; and improved compliance with healthy eating or weight-management efforts. There is convincing evidence of short-term satiety benefits, but only probable evidence for longer-term benefits to hunger management, possible evidence of benefits to mood and cognition, inadequate evidence that satiety enhancement can promote weight loss, and no evidence on which consumers would benefit most from satiety enhancement. The appetite-reducing effects of specific foods or diets will be much more subtle than those of pharmaceutical compounds in managing hunger; nevertheless, the experience of pharmacology in producing weight loss via effects on appetite suggests that there is potential benefit of satiety enhancement from foods incorporated into the diet to the consumer.

  13. Benefit adequacy among elderly Social Security retired-worker beneficiaries and the SSI federal benefit rate.

    Science.gov (United States)

    Rupp, Kalman; Strand, Alexander; Davies, Paul; Sears, Jim

    2007-01-01

    Both target effectiveness and administrative simplicity are desirable properties in the design of minimum benefit packages for public retirement programs. The federal benefit rate (FBR) of the Supplemental Security Income (SSI) program has been proposed by some analysts as a potentially attractive basis of establishing a new minimum benefit for Social Security on both of these grounds. This type of proposal is related to a broader array of minimum benefit proposals that would establish a Social Security benefit floor based on the poverty rate. In contrast to Social Security, the SSI program is means tested, including both an income and asset screen and also a categorical eligibility screen (the requirement to qualify as aged or disabled). The SSI FBR provides an inflation-adjusted, guaranteed income floor for aged and disabled people with low assets. The FBR has been perceived by proponents as a minimal measure of Social Security benefit adequacy because it represents a subpoverty income level for a family of one or two depending on marital status. For this same reason it has been seen as a target-effective tool of designing a minimum Social Security benefit. An FBR-based minimum benefit has also been viewed as administratively simple to implement; the benefit can be calculated from Social Security administrative records using a completely automated electronic process. Therefore-in contrast to the SSI program itself-an FBR-based minimum benefit would incur virtually no ongoing administrative costs, would not require a separate application for a means-tested program, and would avoid the perception of welfare stigma. While these ideas have been discussed in the literature and among policymakers in the United States over the years, and similar proposals have been considered or implemented in several foreign countries, there have been no previous analyses measuring the size of the potentially affected beneficiary population. Nor has there been any systematic assessment

  14. Vaccine safety evaluation: Practical aspects in assessing benefits and risks.

    Science.gov (United States)

    Di Pasquale, Alberta; Bonanni, Paolo; Garçon, Nathalie; Stanberry, Lawrence R; El-Hodhod, Mostafa; Tavares Da Silva, Fernanda

    2016-12-20

    Vaccines are different from most medicines in that they are administered to large and mostly healthy populations including infants and children, so there is a low tolerance for potential risks or side-effects. In addition, the long-term benefits of immunisation in reducing or eliminating infectious diseases may induce complacency due to the absence of cases. However, as demonstrated in recent measles outbreaks in Europe and United States, reappearance of the disease occurs as soon as vaccine coverage falls. Unfounded vaccine scares such as those associating the combined measles-mumps-rubella vaccine with autism, and whole-cell pertussis vaccines with encephalopathy, can also have massive impacts, resulting in reduced vaccine uptake and disease resurgence. The safety assessment of vaccines is exhaustive and continuous; beginning with non-clinical evaluation of their individual components in terms of purity, stability and sterility, continuing throughout the clinical development phase and entire duration of use of the vaccine; including post-approval. The breadth and depth of safety assessments conducted at multiple levels by a range of independent organizations increases confidence in the rigour with which any potential risks or side-effects are investigated and managed. Industry, regulatory agencies, academia, the medical community and the general public all play a role in monitoring vaccine safety. Within these stakeholder groups, the healthcare professional and vaccine provider have key roles in the prevention, identification, investigation and management of adverse events following immunisation (AEFI). Guidelines and algorithms aid in determining whether AEFI may have been caused by the vaccine, or whether it is coincidental to it. Healthcare providers are encouraged to rigorously investigate AEFIs and to report them via local reporting processes. The ultimate objective for all parties is to ensure vaccines have a favourable benefit-risk profile. Copyright

  15. Do conditional benefits reduce equilibrium unemployment?

    NARCIS (Netherlands)

    van der Ploeg, F.

    2006-01-01

    Although unconditional unemployment benefits destroy jobs in competitive and noncompetitive labor markets, conditional benefits can spur job growth in noncompetitive labor markets. Unconditional benefits reduce the penalty of shirking and misconduct, while conditional benefits increase this penalty.

  16. Benefits of Dance Education in the Middle School Setting

    Science.gov (United States)

    Cook, Wrenn

    2005-01-01

    The author talks about the benefits of dance education in the middle school setting. The author describes a scene in a dance classroom where all students can be successful, for within the confines of the space, a broad spectrum of learning preferences are addressed and multiple intelligences are acknowledged and validated. The author stresses that…

  17. Comprehensive Benefit Platforms to Simplify Complex HR Processes

    Science.gov (United States)

    Ehrsam, Hank

    2012-01-01

    Paying for employee turnover costs, data storage, and multiple layers of benefits can be difficult for fiscally constrained institutions, especially as budget cuts and finance-limiting legislation abound in school districts across the country. Many traditional paper-based systems have been replaced with automated, software-based services, helping…

  18. SHARING TOURISM BENEFITS WITH THE LOCAL COMMUNITY: A ...

    African Journals Online (AJOL)

    Osondu

    2012-03-12

    Mar 12, 2012 ... benefit local people, but the extent to which a particular business has developed its schemes ..... village, are clear enough to make this research ... the area have involved local communities in their business. Data Collection. Data for this study was collected in June –. August 2008 through a multiple-method.

  19. Farmers' awareness and perceived benefits of agro-ecological ...

    African Journals Online (AJOL)

    Wellington

    2013-07-17

    Jul 17, 2013 ... African Journal of Biotechnology ... survey from different agro-ecological zones and banana production systems. ... motivated to apply AEI practices perceived to offer multiple benefits: .... increasing productivity through use of improved varieties ... potential for the creation of environmental conditions less.

  20. Creating raptor benefits from powerline problems

    Science.gov (United States)

    Kochert, Michael N.; Olendorff, R.R.

    1999-01-01

    Powerlines benefit raptors by providing enhanced nesting and roosting sites. However, they also can kill raptors by electrocution and raptors can interfere with power transmission. The electrocution problem has been reduced by correcting existing lethal lines and implementing electrocution safe designs for new lines. Remedial actions include pole modifications, perch management and insulation of wires and hardware. New line designs provide for proper insulation and adequate spacing of conductors and grounded hardware. Nesting platforms can reduce power transmission problems and enhance the benefits of nesting on powerlines. A combination of perch deterrents and insulator shields is a positive, cost-effective approach to managing bird contamination that allows birds to continue roosting on the towers.