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  1. Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study.

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    Repping-Wuts, J.W.J.; Uitterhoeve, R.J.; Riel, P.L.C.M. van; Achterberg, T. van

    2008-01-01

    OBJECTIVE: Interest in fatigue research has grown since the finding that fatigue is, besides pain, the symptom most frequently reported by patients with rheumatoid arthritis (RA). The aim of this study was to explore the experience of fatigue from the patients' perspective. METHODS: Twenty-nine

  2. From patients with arthralgia, pre-RA and recently diagnosed RA: What is the current status of understanding RA pathogenesis?

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    M. Molendijk (Marlieke); J.M.W. Hazes (Mieke); E.W. Lubberts (Erik)

    2018-01-01

    textabstractIt is believed that therapy for rheumatoid arthritis (RA) is the most effective and beneficial within a short time frame around RA diagnosis. This insight has caused a shift from research in patients with established RA to patients at risk of developing RA and recently diagnosed

  3. THE IMMUNOLOGICAL CHARACTERISTIC OF RA PATIENTS WITH ANAEMIA

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    A. E. Sizikov

    2014-07-01

    Full Text Available Abstract. The aim of the investigation was to study the immunological characteristics of RA patients with anaemia. Clinical and laboratory data including the percentage of the main lymphocyte subclasses, phagocyte and DTH-effector activity, serum concentration of immunoglobulins, the percentage of cells producing IFNγ and/or IL-4 and percent of monocytes producing TNF. We revealed some significant clinical, laboratory and immunological differences between RA patients and healthy donors and between patients with and without anaemia. Our data demonstrate RA anemic patients to have more severe disorders than patients without anaemia. We also revealed some significant immunological differences between RA patients and healthy donors and between patients with and without anaemia, including percent of cells producing IFNγ and/or IL-4. Our data permit to conclude that RA patients have many different immunological disturbances, more severe in anaemic patients.

  4. Productivity loss due to absenteeism and presenteeism by different instruments in patients with RA and subjects without RA

    NARCIS (Netherlands)

    Braakman-Jansen, Louise Marie Antoinette; Kuper, Ina H.; van de Laar, Mart A F J; Taal, Erik

    2012-01-01

    Objectives. To explore the impact of at-work productivity loss on the total productivity cost by different instruments in patients recently diagnosed with RA and controls without RA. Methods. Cross-sectional data were collected from outpatients with RA between December 2007 and February 2008. The

  5. Pulmonary cryptococcosis in rheumatoid arthritis (RA) patients: Comparison of imaging characteristics among RA, acquired immunodeficiency syndrome, and immunocompetent patients

    International Nuclear Information System (INIS)

    Yanagawa, Noriyo; Sakai, Fumikazu; Takemura, Tamiko; Ishikawa, Satoru; Takaki, Yasunobu; Hishima, Tsunekazu; Kamata, Noriko

    2013-01-01

    Purpose: The imaging characteristics of cryptococcosis in rheumatoid arthritis (RA) patients were analyzed by comparing them with those of acquired immunodeficiency syndrome (AIDS) and immunocompetent patients, and the imaging findings were correlated with pathological findings. Methods: Two radiologists retrospectively compared the computed tomographic (CT) findings of 35 episodes of pulmonary cryptococcosis in 31 patients with 3 kinds of underlying states (10 RA, 12 AIDS, 13 immunocompetent), focusing on the nature, number, and distribution of lesions. The pathological findings of 18 patients (8 RA, 2 AIDS, 8 immunocompetent) were analyzed by two pathologists, and then correlated with imaging findings. Results: The frequencies of consolidation and ground glass attenuation (GGA) were significantly higher, and the frequency of peripheral distribution was significantly lower in the RA group than in the immunocompetent group. Peripheral distribution was less common and generalized distribution was more frequent in the RA group than in the AIDS group. The pathological findings of the AIDS and immunocompetent groups reflected their immune status: There was lack of a granuloma reaction in the AIDS group, and a complete granuloma reaction in the immunocompetent group, while the findings of the RA group varied, including a complete granuloma reaction, a loose granuloma reaction and a hyper-immune reaction. Cases with the last two pathologic findings were symptomatic and showed generalized or central distribution on CT. Conclusion: Cryptococcosis in the RA group showed characteristic radiological and pathological findings compared with the other 2 groups

  6. Pulmonary cryptococcosis in rheumatoid arthritis (RA) patients: Comparison of imaging characteristics among RA, acquired immunodeficiency syndrome, and immunocompetent patients

    Energy Technology Data Exchange (ETDEWEB)

    Yanagawa, Noriyo, E-mail: noriyo_yana@ybb.ne.jp [Departments of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677 (Japan); Sakai, Fumikazu [Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama 350-1298 (Japan); Takemura, Tamiko [Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935 (Japan); Ishikawa, Satoru [Department of Respiratory Medicine, National Hospital Organization Chiba-East-Hospital, 673 Nitona-cho, Chuo-ku, Chiba-shi, Chiba 260-8712 (Japan); Takaki, Yasunobu [Departments of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677 (Japan); Hishima, Tsunekazu [Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677 (Japan); Kamata, Noriko [Departments of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677 (Japan)

    2013-11-01

    Purpose: The imaging characteristics of cryptococcosis in rheumatoid arthritis (RA) patients were analyzed by comparing them with those of acquired immunodeficiency syndrome (AIDS) and immunocompetent patients, and the imaging findings were correlated with pathological findings. Methods: Two radiologists retrospectively compared the computed tomographic (CT) findings of 35 episodes of pulmonary cryptococcosis in 31 patients with 3 kinds of underlying states (10 RA, 12 AIDS, 13 immunocompetent), focusing on the nature, number, and distribution of lesions. The pathological findings of 18 patients (8 RA, 2 AIDS, 8 immunocompetent) were analyzed by two pathologists, and then correlated with imaging findings. Results: The frequencies of consolidation and ground glass attenuation (GGA) were significantly higher, and the frequency of peripheral distribution was significantly lower in the RA group than in the immunocompetent group. Peripheral distribution was less common and generalized distribution was more frequent in the RA group than in the AIDS group. The pathological findings of the AIDS and immunocompetent groups reflected their immune status: There was lack of a granuloma reaction in the AIDS group, and a complete granuloma reaction in the immunocompetent group, while the findings of the RA group varied, including a complete granuloma reaction, a loose granuloma reaction and a hyper-immune reaction. Cases with the last two pathologic findings were symptomatic and showed generalized or central distribution on CT. Conclusion: Cryptococcosis in the RA group showed characteristic radiological and pathological findings compared with the other 2 groups.

  7. Tooth breakage in patients injected with 224Ra

    International Nuclear Information System (INIS)

    Sonnabend, E.; Spiess, H.; Mays, C.W.

    1986-01-01

    Tooth breakage has been common among the 224 Ra patients, especially those injected as teenagers. The fracture of 1 or more teeth was reported by 26% (8/31) of boys and 23% (7/30) of girls injected with 224 Ra at 16-20 years of age. Combining results from all age groups, the incidence of tooth fractures increased significantly with dose (P=0.01). Unlike the normal loss of permanent teeth by periodontal disease, in which the entire tooth is lost, the tooth loss following 224 Ra injection was primarily from tooth resorption near the gum line causing the tooth crowns to break off easily. Eventually the tooth roots may either become incorporated into the jawbone or are resorbed and replaced with bone. These tooth fractures resembled those observed in the U.S. radium dial painters and in dogs injected with bone-seeking α-emitters. (orig.)

  8. [The usefullness of hyaluronate injection in patients with RA].

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    Saito, Seiji

    2003-06-01

    In this seminar, we reported the usefulness of hyaluronate injection in clinical application with patients of RA. In basic research areas, however, the mechanisms responsible for the reported beneficial clinical effects of these treatments remain unclear. There is accumulating experimental evidence to show that the receptors of HA, eg, CD-44, accelerate the inflammation of joint. Administration high molecular weight HA may modulate CD-44 sensitive macromolecular in joint inflammation in part to reduce the activity of proteinases such as MMP-9.

  9. Epidemiological studies of German patients injected with Ra-224

    International Nuclear Information System (INIS)

    Mays, C.W.; Spiess, H.

    1983-01-01

    The health of 898 patients who received repeated injections of short-lived 224 Ra after World War II, mainly for the treatment of tuberculosis and ankylosing spondylitis has been followed. As of 1980, 53 of these patients had developed bone sarcoma vs only 0.2 cases expected naturally. Two patients with bone sarcoma subsequently developed an additional bone sarcoma. No new bone sarcomas have been reported since the end of 1974. For the patients in each category, the tumor rate at every year after 224 Ra injection was calculated by dividing the yearly number of bone sarcomas by the number of patients whose follow-up extended to that year. This corrected for the effects of death and incomplete follow-up. The yearly tumor rates were then summed to obtain the cumulative tumor rate. Dividing by the average skeletal dose in rads yielded the cumulative risk. The cumulative tumor risk was about 200 bone sarcomas/10 6 person rad of average skeletal dose and, with the dosimetric assumptions used, was not statistically different for (a) juveniles vs adults, (b) males vs females, or (c) TB patients vs spondylitic patients

  10. Problems experienced by haemodialysis patients in Greece.

    Science.gov (United States)

    Kaba, E; Bellou, P; Iordanou, P; Andrea, S; Kyritsi, E; Gerogianni, G; Zetta, S; Swigart, V

    Even though Greece has a disproportionate number of haemodialysis stations for the treatment of end-stage renal disease (ESRD), and a rapidly rising number of patients on dialysis, there has been no study of the lived experience of haemodialysis treatment in Greece. ESRD and dialysis drastically impact patients' everyday life, therefore expectations and desires play a major role in adapting to alterations and restrictions. An understanding of these culturally-influenced expectations and desires is essential for the delivery of holistic nursing care. This study aimed to explore how Greek patients receiving long-term haemodialysis perceived their problems and to describe the impact of haemodialysis on their lives. Using a grounded theory approach, 23 patients with ESRD receiving haemodialysis were purposively recruited from two hospital dialysis centres in Athens, Greece. Data were collected during 2006 by personal interviews. Given a distinctive patient experience of haemodialysis, some insight into their common concerns can facilitate provision of healthcare services that adequately meets their needs. By developing an understanding of the experience of renal illness and therapy for a group of people using dialysis, this study was intended as a contribution towards enabling healthcare professionals to provide more effective support to people who are living with this chronic condition.

  11. Impact of socioeconomic gradients within and between countries on health of patients with rheumatoid arthritis (RA): Lessons from QUEST RA

    NARCIS (Netherlands)

    Putrik, Polina; Sokka, Tuulikki; Ramiro, Sofia; Boonen, Annelies

    2012-01-01

    In this chapter, we discuss challenges in collecting data on outcomes of patients who receive usual rheumatology care. We present results of the multinational Quantitative Monitoring of Patients with Rheumatoid Arthritis (QUEST RA) study which is a successful example of quantitative clinical

  12. Serum progranulin irrelated with Breg cell levels, but elevated in RA patients, reflecting high disease activity.

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    Chen, Jiaxi; Li, Shuang; Shi, Jianfeng; Zhang, Lili; Li, Jun; Chen, Shiyong; Wu, Chunlong; Shen, Bo

    2016-03-01

    Soluble progranulin (PGRN) is known to directly regulate regulatory T cells; however, whether PGRN levels are elevated in patients with rheumatoid arthritis and affect the regulatory subsets of B cells remain unknown. In this study, a total of 80 RA patients and 60 healthy controls were studied. Serum progranulin levels were determined using enzyme-linked immune-sorbent assay. A receiver operating characteristic (ROC) curve was used to evaluate the feasibility of serum PGRN as a biomarker for distinguishing patients with RA. CD19(+)CD5(+)GrB(+) B cells were analyzed by flow cytometry in peripheral blood mononuclear cells (PBMCs). Serum progranulin levels in RA patients (median, 59.4 ng/mL) and in RA patients DAS28 > 5.1 (median, 71.98 ng/mL) were much higher than those in normal controls (median, 46.3 ng/mL; P progranulin levels was 0.705 for RA versus normal controls and the area under the ROC curve for progranulin levels in RA patients DAS28 > 5.1 was 0.977 versus normal controls (P progranulin and DAS28, CRP, ESR were all positively correlated in RA patients (P 0.05). Our findings indicated that induction of PGRN expression may play a role in RA immune reaction and PGRN levels could be a useful biomarker in RA inflammatory response, but irrelated with Breg cell levels.

  13. Specificities of anti-neutrophil autoantibodies in patients with rheumatoid arthritis (RA)

    DEFF Research Database (Denmark)

    Brimnes, J; Halberg, P; Jacobsen, Søren

    1997-01-01

    The objective of this study was to characterize antigens recognized by neutrophil-specific autoantibodies from patients with RA. Sera from 62 RA patients were screened by indirect immunofluorescence (IIF). Positive sera were further tested by ELISAs for antibodies against various granule proteins...

  14. Clinical characteristics of RA patients with secondary SS and association with joint damage

    OpenAIRE

    Brown, Lindsay E.; Frits, Michelle L.; Iannaccone, Christine K.; Weinblatt, Michael E.; Shadick, Nancy A.; Liao, Katherine P.

    2014-01-01

    Objectives. Secondary SS (sSS) is a common extra-articular manifestation of RA. There are conflicting data regarding the association of sSS with worse joint damage. This study aims to characterize sSS patients in an RA cohort and study the association between sSS and joint damage.

  15. Physicians Experiencing Intense Emotions While Seeing Their Patients: What Happens?

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    Silva, Joana Vilela Da; Carvalho, Irene

    2016-01-01

    Physicians often deal with emotions arising from both patients and themselves; however, management of intense emotions when they arise in the presence of patients is overlooked in research. The aim of this study is to inspect physicians' intense emotions in this context, how these emotions are displayed, coping strategies used, adjustment behaviors, and the impact of the emotional reactions on the physician-patient relationship. A total of 127 physicians completed a self-report survey, built from a literature review. Participants were recruited in 3 different ways: through a snowball sampling procedure, via institutional e-mails, and in person during service meetings. Fifty-two physicians (43.0%) reported experiencing intense emotions frequently. Although most physicians (88.6%) tried to control their reactions, several reported not controlling themselves. Coping strategies to deal with the emotion at the moment included behavioral and cognitive approaches. Only the type of reaction (but not the emotion's valence, duration, relative control, or coping strategies used) seemed to affect the physician-patient relationship. Choking-up/crying, touching, smiling, and providing support were significantly associated with an immediate positive impact. Withdrawing from the situation, imposing, and defending oneself were associated with a negative impact. Some reactions also had an extended impact into future interactions. Experiencing intense emotions in the presence of patients was frequent among physicians, and the type of reaction affected the clinical relationship. Because many physicians reported experiencing long-lasting emotions, these may have important clinical implications for patients visiting physicians while these emotions last. Further studies are needed to clarify these results.

  16. Opium addiction increases interleukin 1 receptor antagonist (IL-1Ra) in the coronary artery disease patients.

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    Saadat, Habibollah; Ziai, Seyed Ali; Ghanemnia, Maryam; Namazi, Mohammad Hasan; Safi, Morteza; Vakili, Hosein; Dabbagh, Ali; Gholami, Omid

    2012-01-01

    There is evidence that opium addiction has immunosuppressant effects. Coronary artery disease (CAD) is a condition resulted from atherosclerosis which is dependent on the immune response. To evaluate plasma levels of interleukin-6 and interleukin-1Ra in 30 patients with three-vessel coronary artery disease, ejection fraction of more than 35% and to evaluate their changes after prognostic treadmill test in 15 opium addicted and 15 non-addicted patients. The participants underwent prognostic treadmill test and plasma levels of interleukin-6 (IL-6) and interleukin-1Ra (IL-1Ra) were evaluated with ELISA method before, just after and 4 hours after the test. IL-1Ra (2183 pg/ml) tended to decrease over time in the opium addicted group (1372 pg/ml after prognostic treadmill test and 1034 pg/ml 4 hours after that), although such decrease did not reach the statistical significance. IL-1Ra levels were significantly higher in opium addicted than in non addicted patients. Opium addiction had no significant effect on IL-6 changes. Consumption of opium in CAD patients is associated with higher IL-1Ra levels.

  17. Opium addiction increases interleukin 1 receptor antagonist (IL-1Ra in the coronary artery disease patients.

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    Habibollah Saadat

    Full Text Available BACKGROUND: There is evidence that opium addiction has immunosuppressant effects. Coronary artery disease (CAD is a condition resulted from atherosclerosis which is dependent on the immune response. PURPOSE: To evaluate plasma levels of interleukin-6 and interleukin-1Ra in 30 patients with three-vessel coronary artery disease, ejection fraction of more than 35% and to evaluate their changes after prognostic treadmill test in 15 opium addicted and 15 non-addicted patients. METHODS: The participants underwent prognostic treadmill test and plasma levels of interleukin-6 (IL-6 and interleukin-1Ra (IL-1Ra were evaluated with ELISA method before, just after and 4 hours after the test. RESULTS: IL-1Ra (2183 pg/ml tended to decrease over time in the opium addicted group (1372 pg/ml after prognostic treadmill test and 1034 pg/ml 4 hours after that, although such decrease did not reach the statistical significance. IL-1Ra levels were significantly higher in opium addicted than in non addicted patients. Opium addiction had no significant effect on IL-6 changes. CONCLUSION: Consumption of opium in CAD patients is associated with higher IL-1Ra levels.

  18. Perception of environmental sounds by experienced cochlear implant patients

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    Shafiro, Valeriy; Gygi, Brian; Cheng, Min-Yu; Vachhani, Jay; Mulvey, Megan

    2011-01-01

    Objectives Environmental sound perception serves an important ecological function by providing listeners with information about objects and events in their immediate environment. Environmental sounds such as car horns, baby cries or chirping birds can alert listeners to imminent dangers as well as contribute to one's sense of awareness and well being. Perception of environmental sounds as acoustically and semantically complex stimuli, may also involve some factors common to the processing of speech. However, very limited research has investigated the abilities of cochlear implant (CI) patients to identify common environmental sounds, despite patients' general enthusiasm about them. This project (1) investigated the ability of patients with modern-day CIs to perceive environmental sounds, (2) explored associations among speech, environmental sounds and basic auditory abilities, and (3) examined acoustic factors that might be involved in environmental sound perception. Design Seventeen experienced postlingually-deafened CI patients participated in the study. Environmental sound perception was assessed with a large-item test composed of 40 sound sources, each represented by four different tokens. The relationship between speech and environmental sound perception, and the role of working memory and some basic auditory abilities were examined based on patient performance on a battery of speech tests (HINT, CNC, and individual consonant and vowel tests), tests of basic auditory abilities (audiometric thresholds, gap detection, temporal pattern and temporal order for tones tests) and a backward digit recall test. Results The results indicated substantially reduced ability to identify common environmental sounds in CI patients (45.3%). Except for vowels, all speech test scores significantly correlated with the environmental sound test scores: r = 0.73 for HINT in quiet, r = 0.69 for HINT in noise, r = 0.70 for CNC, r = 0.64 for consonants and r = 0.48 for vowels. HINT and

  19. Patient participation during oncological encounters: barriers and facilitators experienced by elderly cancer patients.

    NARCIS (Netherlands)

    Noordman, J.; Driesenaar, J.A.; Henselmans, I.; Heijmans, M.; Verboom, J.; Dulmen, S. van

    2017-01-01

    Objective: To enhance patient participation during (oncological) encounters, this study aims to gain insight into communication barriers and supportive interventions experienced by elderly patients with cancer. Method: A mixed method design, including both quantitative (secondary survey data

  20. Long-term clinical investigation of patients with ankylosing spondylitis treated with /sup 224/Ra

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, E [Universitatsklinik Friedrichsheim, Frankfurt, West Germany; Ruckbeil, C; Wick, R R

    1983-01-01

    Between 1952 and 1980 about 250 patients with ankylosing spondylitis were treated with /sup 224/Ra at the Orthopaedic University Hospital of Frankfurt/M. In 1970, 119 of them were examined and X-rayed as was another group of 40 patients in 1980. The results of those examined could be compared with a group of 40 patients treated without /sup 224/Ra. Patients with /sup 224/Ra demonstrated a long-lasting period of subjective improvement after the treatment, with reduced consumption of antirheumatoid and analgesic drugs, on the average. Blood examinations show inflammatory activities. Nevertheless, the ankylosing spondylitis proceeded. In the final stages of the disease, neither the clinical aspects nor the X-rays showed any specific changes. We observed no case of malignant bone tumor. Of the 169 examined patients, 22 had a total of 32 children after the treatment with /sup 224/Ra. Among these was a set of twins with cerebral palsy and diabetes insipidus renalis. In conclusion, /sup 224/Ra in ankylosing spondylitis is a recommended treatment without higher risk compared to the common therapy with drugs.

  1. Incidence of tumours of the skeleton in 224Ra-treated ankylosing spondylitis patients

    International Nuclear Information System (INIS)

    Wick, R.R.; Goessner, W.

    1983-01-01

    We are following 1426 ankylosing spondylitis (a.sp.) patients treated with 224 Ra and 1556 control patients with a.sp. not treated with any form of ionizing radiation. The average follow-up time of the exposure group is 16 years and the average α-dose to the skeleton is 65 rad, resulting from intravenous injection of 4.8μCi/kg 224 Ra on average within a medium injection span of 12 weeks. Injections normally have been performed once a week, and in some cases also half-weekly with a correspondingly shorter injection span. Since 1970 three cases of malignant tumours in the skeleton have been observed in the exposure group in patients with skeletal α-doses below 90 rad compared with 0.6 expected. (No bone tumour has occurred in the control group.) Two of the three cases observed were tumours of the bone marrow. The incidence of leukaemias in both exposure and control groups is discussed with respect to phenylbutazone treatment and α-radiation from 224 Ra. An effect of 224 Ra on the bone marrow not yet detected in the Spiess series of patients treated with higher amounts of 224 Ra cannot be excluded. (author)

  2. IgG4 Production Against Adalimumab During Long Term Treatment of RA Patients

    NARCIS (Netherlands)

    van Schouwenburg, Pauline A.; Krieckaert, Charlotte L.; Nurmohamed, Michael; Hart, Margreet; Rispens, Theo; Aarden, Lucien; Wouters, Diana; Wolbink, Gerrit Jan

    2012-01-01

    A substantial part of rheumatoid arthritis (RA) patients is chronically treated with adalimumab. Some of these patients produce antibodies against adalimumab, which correlate with lower serum drug levels and reduced clinical response. Long term exposure to antigens may result in antigen specific

  3. PADI4 Haplotypes in Association with RA Mexican Patients, a New Prospect for Antigen Modulation

    Directory of Open Access Journals (Sweden)

    Maria Guadalupe Zavala-Cerna

    2013-01-01

    Full Text Available Peptidyl arginine deiminase IV (PAD 4 is the responsible enzyme for a posttranslational modification called citrullination, originating the antigenic determinant recognized by anti-cyclic citrullinated peptide antibodies (ACPA. Four SNPs (single nucleotide polymorphisms have been described in PADI4 gene to form a susceptibility haplotype for rheumatoid arthritis (RA; nevertheless, results in association studies appear contradictory in different populations. The aim of the study was to analyze if the presence of three SNPs in PADI4 gene susceptibility haplotype (GTG is associated with ACPA positivity in patients with RA. This was a cross-sectional study that included 86 RA patients and 98 healthy controls. Polymorphisms PADI4_89, PADI4_90, and PADI4_92 in the PADI4 gene were genotyped. The susceptibility haplotype (GTG was more frequent in RA patients; interestingly, we found a new haplotype associated with RA with a higher frequency (GTC. There were no associations between polymorphisms and high scores in Spanish HAQ-DI and DAS-28, but we did find an association between RARBIS index and PADI4_89, PADI4_90 polymorphisms. We could not confirm an association between susceptibility haplotype presence and ACPA positivity. Further evidence about proteomic expression of this gene will determine its participation in antigenic generation and autoimmunity.

  4. Factors associated with absenteeism, presenteeism and activity impairment in patients in the first years of RA.

    Science.gov (United States)

    Bansback, Nick; Zhang, Wei; Walsh, David; Kiely, Patrick; Williams, Richard; Guh, Daphne; Anis, Aslam; Young, Adam

    2012-02-01

    To understand the impact of the early years of RA on all aspects of work productivity, and determine how this is related to clinical markers. Previous research on work productivity has examined predominantly early retirement and absenteeism. The impact of reduced work performance (presenteeism) and activity impairment is less well understood in early RA populations. Working patients enrolled in an RA inception cohort were recruited into a nested study. A questionnaire incorporating the Work Productivity and Activity Impairment (WPAI) instrument was administered with a number of clinical outcomes, including the Multidimensional Health Assessment Questionnaire (MD-HAQ) and scales for pain, fatigue and patient assessment of disease patient global assessment (PtGA). Analysis included 150 RA patients, with the mean age at onset being 48 years (s.d. 10 years) and disease duration from symptom onset being 49 months. Patients had relatively mild disease: MD-HAQ (0.6), pain (3.6), PtGA (3.6) and fatigue (4.6). Of the 92% patients working for pay, 19% reported missing work (absenteeism) in the past week due to their health, accounting for 46% of their working time. Even while at work, ∼25% of actual hours was lost due to poor health, while outside work 33% of patients' regular daily activities were prevented. In multivariate analyses, disease severity was associated with the presence of absenteeism, presenteeism and activity impairment. Patients able to self-schedule their work had lower presenteeism and activity impairment. Productivity loss is common in patients in the first years of RA who are in paid work and was associated with work characteristics and adverse clinical outcomes.

  5. Radiation exposure of relatives of patients treated with Ra-223 dichloride

    International Nuclear Information System (INIS)

    Wanke, C.; Szermerski, B.; Solle, A.; Geworski, L.; Kranert, W.T.; Andreeff, M.; TU Dresden

    2015-01-01

    Since November 2013, a radiopharmaceutical containing Ra-223 dichloride as active substance is approved in the European Union for patients with castration resistant prostate cancer with symptomatic bone metastases and no known visceral metastases. Ra-223 (T 1/2 = 11.43 d) decays via a chain of 4 alpha and 2 beta decays. This therapy is presently the only application of an alpha emitter in clinical routine therapy. To show that the exposure of relatives and caregivers of patients treated with Ra-223 dichloride in an outpatient setting does not exceed a value of 1 mSv, the multicenter study ''RAPSODY'' was conducted. As Ra-223 and most of its progeny emit alpha particles, the internal exposure had to be evaluated in particular. Within this study, measurements of the radiation emitted from the patient were performed using standard dose-rate meters. Wipe-tests were taken in the patients' homes to identify significant contaminations and evaluated by liquid scintillation counting. Samples of saliva and sweat were taken and measured using gamma spectrometry. Ra-223 disintegrates to the noble gas Rn-219 and was measured in the exhaled breath from the patients using conventional Radon Monitors. Furthermore, a computational fluid dynamics simulation (CFD) was performed to assess the radioactivity in the air, which could be inhaled by persons close to the patient. Conclusions: The potential exposure of relatives and caregivers by external irradiation and incorporation of radioactivity exhaled or excreted by the patient with saliva or sweat is well below 1 mSv. No objections are seen regarding outpatient treatment. This paper summarizes contents of a poster presented at the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging.

  6. Flexor hallucis longus tendon rupture in RA-patients is associated with MTP 1 damage and pes planus

    NARCIS (Netherlands)

    Baan, H.; Baan, Henriette; Drossaers-Bakker, K.W.; Dubbeldam, Rosemary; Dubbeldam, Rosemary; Buurke, Jaap J.; Nene, A.V.; van de Laar, Mart A F J

    2007-01-01

    Background: To assess the prevalence of and relation between rupture or tenosynovitis of the Flexor Hallucis Longus (FHL) tendon and range of motion, deformities and joint damage of the forefoot in RA patients with foot complaints. Methods: Thirty RA patients with painful feet were analysed, their

  7. Experiencing health care service quality: through patients' eyes.

    Science.gov (United States)

    Schembri, Sharon

    2015-02-01

    The primary aim of the present study was to consider health care service quality from the patients' perspective, specifically through the patient's eyes. A narrative analysis was performed on 300 patient stories. This rigorous analysis of patient stories is designed to identify and describe health care service quality through patients' eyes in an authentic and accurate, experiential manner. The findings show that there are variant and complex ways that patients experience health care service quality. Patient stories offer an authentic view of the complex ways that patients experience health care service quality. Narrative analysis is a useful tool to identify and describe how patients experience health care service quality. Patients experience health care service quality in complex and varying ways.

  8. 224Ra: Risk to bone and haematopoietic tissue in ankylosing spondylitis patients

    International Nuclear Information System (INIS)

    Wick, R.R.; Goessner, W.; Chmelevsky, D.

    1986-01-01

    This follow-up study includes 1501 adult patients, who received repeated intraveneous injections of 224 Ra as a treatment for ankylosing spondylitis (a.sp), and a control group of 1557 a.sp. patients not treated with radioactive drugs or X-rays. The average total injected activity for the patients of the exposure group was 4.8 μCi of 224 Ra per kg body weight; the resulting average skeletal dose of α-rays has been 0.65 Gy. The mean duration of the 224 Ra treatment was 12 weeks with the mode at 10 weeks. At present, the mean follow-up time in the group of exposed patients is 16 years, and three cases of malignant skeletal tumours have been observed in patients with α-doses to the skeleton below 0.9 Gy (the lowest skeletal dose found to be associated with a bone tumour in the high dose group followed by Spiess and Mays). Based on general population statistics the expected number of bone tumours (ICD 170) was 0.4-0.7 . A recent risk estimate from data of Spiess and Mays suggests 5.8 radiation induced bone tumours for the present follow-up time. It is, furthermore, notable that 2 of the 3 observed skeletal tumours are tumours of the bone marrow; in the high dose group of Spiess and Mays there has been only 1 bone marrow tumour among 55 bone tumours. No malignant bone tumours have occurred, until now, in the control group. In the 224 Ra-group and the control group there have been 6 and 5 leukaemias, respectively,. Among the 6 leukaemias in the 224 R group 3 were chronic myeloid leukaemias while among the 5 leukaemias in the control group there was no chronic myeloid leukaemia. (orig.)

  9. The illness trajectory experienced by patients having spine fusion surgery

    DEFF Research Database (Denmark)

    Damsgaard, Janne Brammer; Bastrup, Lene; Norlyk, Annelise

    The illness trajectory of spine fusion patients. A feeling of being (in)visible Background Research shows that being a back patient is associated with great personal cost, and that back patients who undergo so-called spine fusion often experience particularly long and uncoordinated trajectories....... The patients describe a feeling of being mistrusted and thrown around in the system. It is the aim of this study to examine how spine fusion patients experience their illness trajectory and hospitalisation. Methods The study is based on qualitative interviews, and the data analysis is inspired by the French...... system and healthcare professionals are often dismissed as irrelevant. It is also evident that spine fusion patients are denied the opportunity to verbalise what it feels like to, for example, be ”a person in constant pain” or someone who ”holds back” to avoid being an inconvenience. These feelings...

  10. The burden experienced by family caregivers of patients with ...

    African Journals Online (AJOL)

    BACKGROUND: Caring for patients with chronic medical and psychiatric disorders is associated with significant burden. However little is known about the burden experience by caregivers of patients with epilepsy in Nigeria. The objective of this study, therefore, was to assess the level and correlates of burden among ...

  11. Nursing Care For Patients Experiencing Clinical Complications During Haemodialysis

    Directory of Open Access Journals (Sweden)

    Viviane Queiroga Linhares

    2017-02-01

    Full Text Available Introduction: Patients with chronic renal disease treated by haemodialysis experience various changes in their daily lives, which they and their families need to adapt to and cope with. Objective: To analyse the nursing care of patients with chronic renal failure on haemodialysis who experience clinical complications. Method: A descriptive, exploratory study was conducted, using a quantitative approach. Data collection was performed using a sample of 73 patients at the Hemodialysis Center located at city of Patos-PB. The sample comprised 73 patients. Results: 27 (37.0% were female, aged between 20 and 88 years old. It was found that employees are 49.3% of respondents, in consonance to farmers with 31.5%. The most common complications were weakness (76.7%, headache (46.6%, cramp (43.8% and pain (32.9%. Conclusion: The trusting relationship between professionals and patients is paramount, because helps to improve adherence to treatment and, consequently, the reduction of complications; furthermore, educational and preventive actions are facilitated.

  12. Patient Experienced Continuity of Care in the Psychiatric Healthcare System

    DEFF Research Database (Denmark)

    Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne

    2014-01-01

    Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse...... migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry......, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups...

  13. Risk Perceptions in Diabetic Patients Who Have Experienced Adverse Events

    DEFF Research Database (Denmark)

    Sachs, Mikkel Lindskov; Sporrong, Sofia Kälvemark; Colding-Jørgensen, Morten

    2017-01-01

    as part of a benefit-risk assessment. However, the degree of heterogeneity of the patient population is critical for how accurately they can be represented by individuals. OBJECTIVES: This study aims to explore patients' risk perception of rare, serious adverse effects of medicines with regard to blood......, perceptions of the terms rare and serious, and overall levels of risk aversion. A thematic analysis of the interviews, including a consensus discussion, was carried out. RESULTS: Interestingly, respondents rarely made a clear distinction between medicines-induced AEs and complications related to disease...... focused on common and less serious AEs, thus disregarding rare and more serious events. CONCLUSION: The study suggests that experience of AEs, related to either medicines or disease, constitutes an important factor of patient risk perception. We therefore propose that serious adverse experiences should...

  14. Types of vicarious learning experienced by pre-dialysis patients

    OpenAIRE

    McCarthy, Kate; Sturt, Jackie; Adams, Ann

    2015-01-01

    Objective: Haemodialysis and peritoneal dialysis renal replacement treatment options are in clinical equipoise, although the cost of haemodialysis to the National Health Service is £16,411/patient/year greater than peritoneal dialysis. Treatment decision-making takes place during the pre-dialysis year when estimated glomerular filtration rate drops to between 15 and 30 mL/min/1.73 m2. Renal disease can be familial, and the majority of patients have considerable health service experience when ...

  15. Christianity and Resilience as Experienced by Caregivers of Dementia Patients

    Science.gov (United States)

    Lackey, Steven L.

    2014-01-01

    The purpose of this study was to examine the role and relationship of the practice of Christian beliefs and resilience in the context of dementia patient caregivers' lives. The guiding question was "What is the relational nature of the practice of Christian beliefs and resilience in the lived experiences of caregivers of dementia…

  16. Osteoporosis management in older patients who experienced a fracture

    Directory of Open Access Journals (Sweden)

    Oertel MJ

    2016-08-01

    Full Text Available Mark J Oertel,1 Leland Graves,1 Eyad Al-Hihi,2 Vincent Leonardo,3 Christina Hopkins,2 Kristin DeSouza,2 Rajib K Bhattacharya1 1Division of Endocrinology, Metabolism and Genetics, Department of Medicine, 2Department of Internal Medicine, 3Department of Enterprise Analytics, University of Kansas Medical Center, Kansas City, KS, USA Background: Fractures in older patients are common, morbid, and associated with increased risk of subsequent fractures. Inpatient and outpatient management and treatment of fractures can be costly. With more emphasis placed on quality care for Medicare beneficiaries, we studied if patients were receiving proper screening for osteoporosis and treatment after diagnosis of fracture. This study aims to determine if adequate screening and treatment for osteoporosis occurs in the postfracture period.Methods: A retrospective analysis of Medicare beneficiaries aged 67 years or older was gathered from a single institution in both inpatient and outpatient visits. Based on International Classification of Diseases ninth revision codes, primary diagnosis of fractures of neck and trunk, upper limb, and lower limb were obtained in addition to current procedural terminology codes for fracture procedures. We studied patients who had been screened for osteoporosis with a bone mineral study or received osteoporosis treatment after their fracture.Results: Medicare beneficiaries totaling 1,375 patients were determined to have an inclusion fracture between June 1, 2013 and November 30, 2014. At the time of our analysis on December 1, 2014, 1,219 patients were living and included in the analysis. Of these patients, 256 (21.0% either received osteoporosis testing with bone mineral density or received treatment for osteoporosis. On sex breakdown, 208/820 (25.4% females received proper evaluation or treatment of osteoporosis in comparison to 48/399 (12.0% males. This is in comparison to the Centers for Medicare and Medicaid Services’ national

  17. RA Reactor; Reaktor RA

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1989-07-01

    This chapter includes the following: General description of the RA reactor, organization of work, responsibilities of leadership and operators team, regulations concerning operation and behaviour in the reactor building, regulations for performing experiments, regulations and instructions for inserting samples into experimental channels. [Serbo-Croat] Ovo (prvo) poglavlje sadrzi sledece: Opis reaktora RA; semu organizacije rada i rukovodjenja; prava i duznosti direktora i rukovodioca pogona reaktora, propise o rezimu rada i kretanja u zgradi reaktora, propise o izvodjenju eksperimenata, propise o unosenju uzoraka u eksperimentalne kanale reaktora.

  18. RA Reactor; Reaktor RA

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1978-02-15

    In addition to basic characteristics of the RA reactor, organizational scheme and financial incentives, this document covers describes the state of the reactor components after 18 years of operation, problems concerned with obtaining the licence for operation with 80% fuel, problems of spent fuel storage in the storage pool of the reactor building and the need for renewal of reactor equipment, first of all instrumentation. [Serbo-Croat] Pored osnovnih karakeristika reaktora RA, organizacije rada i finansijskih pokazatelja, razmatra se stanje opreme reaktora nakon 18 godina rada, pitanja dozvole za rad sa 80% obogacenim gorivom, problem skladistenja isluzenog goriva u bazenu zgrade reaktora i potreba za obnavljanjem komponenti opreme, pre svega elektronske.

  19. Types of vicarious learning experienced by pre-dialysis patients

    Directory of Open Access Journals (Sweden)

    Kate McCarthy

    2015-04-01

    Full Text Available Objective: Haemodialysis and peritoneal dialysis renal replacement treatment options are in clinical equipoise, although the cost of haemodialysis to the National Health Service is £16,411/patient/year greater than peritoneal dialysis. Treatment decision-making takes place during the pre-dialysis year when estimated glomerular filtration rate drops to between 15 and 30 mL/min/1.73 m2. Renal disease can be familial, and the majority of patients have considerable health service experience when they approach these treatment decisions. Factors affecting patient treatment decisions are currently unknown. The objective of this article is to explore data from a wider study in specific relation to the types of vicarious learning experiences reported by pre-dialysis patients. Methods: A qualitative study utilised unstructured interviews and grounded theory analysis during the participant’s pre-dialysis year. The interview cohort comprised 20 pre-dialysis participants between 24 and 80 years of age. Grounded theory design entailed thematic sampling and analysis, scrutinised by secondary coding and checked with participants. Participants were recruited from routine renal clinics at two local hospitals when their estimated glomerular filtration rate was between 15 and 30 mL/min/1.73 m2. Results: Vicarious learning that contributed to treatment decision-making fell into three main categories: planned vicarious leaning, unplanned vicarious learning and historical vicarious experiences. Conclusion: Exploration and acknowledgement of service users’ prior vicarious learning, by healthcare professionals, is important in understanding its potential influences on individuals’ treatment decision-making. This will enable healthcare professionals to challenge heuristic decisions based on limited information and to encourage analytic thought processes.

  20. Types of vicarious learning experienced by pre-dialysis patients.

    Science.gov (United States)

    McCarthy, Kate; Sturt, Jackie; Adams, Ann

    2015-01-01

    Haemodialysis and peritoneal dialysis renal replacement treatment options are in clinical equipoise, although the cost of haemodialysis to the National Health Service is £16,411/patient/year greater than peritoneal dialysis. Treatment decision-making takes place during the pre-dialysis year when estimated glomerular filtration rate drops to between 15 and 30 mL/min/1.73 m(2). Renal disease can be familial, and the majority of patients have considerable health service experience when they approach these treatment decisions. Factors affecting patient treatment decisions are currently unknown. The objective of this article is to explore data from a wider study in specific relation to the types of vicarious learning experiences reported by pre-dialysis patients. A qualitative study utilised unstructured interviews and grounded theory analysis during the participant's pre-dialysis year. The interview cohort comprised 20 pre-dialysis participants between 24 and 80 years of age. Grounded theory design entailed thematic sampling and analysis, scrutinised by secondary coding and checked with participants. Participants were recruited from routine renal clinics at two local hospitals when their estimated glomerular filtration rate was between 15 and 30 mL/min/1.73 m(2). Vicarious learning that contributed to treatment decision-making fell into three main categories: planned vicarious leaning, unplanned vicarious learning and historical vicarious experiences. Exploration and acknowledgement of service users' prior vicarious learning, by healthcare professionals, is important in understanding its potential influences on individuals' treatment decision-making. This will enable healthcare professionals to challenge heuristic decisions based on limited information and to encourage analytic thought processes.

  1. Economic burden of illness among US patients experiencing fracture nonunion

    Directory of Open Access Journals (Sweden)

    Wu N

    2013-03-01

    Full Text Available Ning Wu,1 Yuan-chi Lee,1 Daniel Segina,2 Hallie Murray,3 Teresa Wilcox,1 Luke Boulanger1 1United BioSource Corporation, Lexington, MA, USA; 2Department of Orthopaedics, Holmes Regional Trauma Center, Melbourne, FL, USA; 3Biomet Spine and Bone Healing Technologies, Parsippany, NJ, USA Objectives: To compare economic outcomes in a real-world study of patients with fracture nonunion receiving non-invasive electrical bone growth stimulation (EBGS, low-intensity pulsed ultrasound stimulation (LIPUS, or other non-stimulation fracture management interventions (No-stim. Methods: Medical and pharmacy claims from a US commercially-insured population were analyzed to select adult patients newly diagnosed with a fracture nonunion between July 2006 and September 2009. The date of initial nonunion diagnosis was set as the index date. Three cohorts were constructed based on the first treatment prescribed post index date: EBGS, LIPUS, or No-stim. Baseline demographics, clinical characteristics, and health care costs 9 months before and 1 year after the index date were assessed. Multivariate regression analyses were performed to compare health care costs between cohorts in the post index period. Results: 11,628 patients (mean age 45.4 years; 45.7% males with a fracture nonunion were identified within the three treatment groups (EBGS: 29.5%, LIPUS: 12.3%, and No-stim: 58.2%. In the post-index period, EBGS patients were significantly less likely to receive fracture-related treatments when compared to the LIPUS (33.6% vs 42.2%, P < 0.01 and the No-stim (33.6% vs 60.3%, P < 0.01 cohorts. Additionally, after adjusting for demographic and clinical characteristics, the EBGS cohort had significantly lower predicted health care-associated costs 1 year post index date when compared to the LIPUS (mean: $21,632 vs $23,964, P < 0.01 and the No-stim (mean: $21,632 vs $23,843, P < 0.01 cohorts. Furthermore, the predicted fracture-related costs (FRC of EBGS patients were also

  2. Emotions related to participation restrictions as experienced by patients with early rheumatoid arthritis: a qualitative interview study (the Swedish TIRA project).

    Science.gov (United States)

    Östlund, Gunnel; Björk, Mathilda; Thyberg, Ingrid; Thyberg, Mikael; Valtersson, Eva; Stenström, Birgitta; Sverker, Annette

    2014-01-01

    Psychological distress is a well-known complication in rheumatoid arthritis (RA), but knowledge regarding emotions and their relationship to participation restrictions is scarce. The objective of the study was to explore emotions related to participation restrictions by patients with early RA. In this study, 48 patients with early RA, aged 20-63 years, were interviewed about participation restrictions using the critical incident technique. Information from transcribed interviews was converted into dilemmas and linked to International Classification of Functioning, Disability, and Health (ICF) participation codes. The emotions described were condensed and categorized. Hopelessness and sadness were described when trying to perform daily activities such as getting up in the mornings and getting dressed, or not being able to perform duties at work. Sadness was experienced in relation to not being able to continue leisure activities or care for children. Examples of fear descriptions were found in relation to deteriorating health and fumble fear, which made the individual withdraw from activities as a result of mistrusting the body. Anger and irritation were described in relation to domestic and employed work but also in social relations where the individual felt unable to continue valued activities. Shame or embarrassment was described when participation restrictions became visible in public. Feelings of grief, aggressiveness, fear, and shame are emotions closely related to participation restrictions in everyday life in early RA. Emotions related to disability need to be addressed both in clinical settings in order to optimize rehabilitative multi-professional interventions and in research to achieve further knowledge.

  3. Experienced continuity of care in patients at risk for depression in primary care

    NARCIS (Netherlands)

    Uijen, Annemarie A.; Schers, Henk J.; Schene, Aart H.; Schellevis, Francois G.; Lucassen, Peter; van den Bosch, Wil J. H. M.

    2014-01-01

    Existing studies about continuity of care focus on patients with a severe mental illness. Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. Explorative study comparing patients at risk

  4. Safety as experienced by patients themselves: a Finnish survey of the most recent period of care.

    Science.gov (United States)

    Sahlström, Merja; Partanen, Pirjo; Turunen, Hannele

    2014-06-01

    We examined patients' experiences of patient safety and participation in promoting safe care during their most recent care period. A survey of patients (N = 175) revealed that treatment, medication, and device safety were mostly experienced as very good or excellent, but responses varied by age and experience. Patients ages 66-75 were most critical of treatment and medication safety. Device safety was rated the worst aspect of safety. Twenty percent of respondents had experienced errors at some time during their care. Patients who had experienced errors and those who were treated at inpatient wards versus a day surgery unit were most critical towards patient participation. Open and transparent error management involving patients is needed to promote treatment, medication, and especially device safety. © 2014 Wiley Periodicals, Inc.

  5. Experienced continuity of care in patients at risk for depression in primary care.

    NARCIS (Netherlands)

    Uijen, A.A.; Schers, H.J.; Schene, A.H.; Schellevis, F.G.; Lucassen, P.; Bosch, W.J.H.M. van den

    2014-01-01

    Background: Existing studies about continuity of care focus on patients with a severe mental illness. Objectives: Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. Methods: Explorative

  6. Stages of change, barriers, benefits, and preferences for exercise in RA patients: a cross-sectional study.

    Science.gov (United States)

    Henchoz, Y; Zufferey, P; So, A

    2013-01-01

    To determine the distribution of exercise stages of change in a rheumatoid arthritis (RA) cohort, and to examine patients' perceptions of exercise benefits, barriers, and their preferences for exercise. One hundred and twenty RA patients who attended the Rheumatology Unit of a University Hospital were asked to participate in the study. Those who agreed were administered a questionnaire to determine their exercise stage of change, their perceived benefits and barriers to exercise, and their preferences for various features of exercise. Eighty-nine (74%) patients were finally included in the analyses. Their mean age was 58.4 years, mean RA duration 10.1 years, and mean disease activity score 2.8. The distribution of exercise stages of change was as follows: precontemplation (n = 30, 34%), contemplation (n = 11, 13%), preparation (n = 5, 6%), action (n = 2, 2%), and maintenance (n = 39, 45%). Compared to patients in the maintenance stage of change, precontemplators exhibited different demographic and functional characteristics and reported less exercise benefits and more barriers to exercise. Most participants preferred exercising alone (40%), at home (29%), at a moderate intensity (64%), with advice provided by a rheumatologist (34%) or a specialist in exercise and RA (34%). Walking was by far the preferred type of exercise, in both the summer (86%) and the winter (51%). Our cohort of patients with RA was essentially distributed across the precontemplation and maintenance exercise stages of change. These subgroups of patients exhibit psychological and functional differences that make their needs different in terms of exercise counselling.

  7. Patient affect experiencing following therapist interventions in short-term dynamic psychotherapy.

    Science.gov (United States)

    Town, Joel M; Hardy, Gillian E; McCullough, Leigh; Stride, Chris

    2012-01-01

    The aim of this research was to examine the relationship between therapist interventions and patient affect responses in Short-Term Dynamic Psychotherapy (STDP). The Affect Experiencing subscale from the Achievement of Therapeutic Objectives Scale (ATOS) was adapted to measure individual immediate affect experiencing (I-AES) responses in relation to therapist interventions coded within the preceding speaking turn, using the Psychotherapy Interaction Coding (PIC) system. A hierarchical linear modelling procedure was used to assess the change in affect experiencing and the relationship between affect experiencing and therapist interventions within and across segments of therapy. Process data was taken from six STDP cases; in total 24 hours of video-taped sessions were examined. Therapist interventions were found to account for a statistically significant amount of variance in immediate affect experiencing. Higher levels of immediate affect experiencing followed the therapist's use of Confrontation, Clarification and Support compared to Questions, Self-disclosure and Information interventions. Therapist Confrontation interventions that attempted to direct pressure towards either the visceral experience of affect or a patient's defences against feelings led to the highest levels of immediate affect experiencing. The type of therapist intervention accounts for a small but significant amount of the variation observed in a patient's immediate emotional arousal. Empirical findings support clinical theory in STDP that suggests strategic verbal responses promote the achievement of this specific therapeutic objective.

  8. RAPID3 scores and hand outcome measurements in RA patients: a preliminary study.

    Science.gov (United States)

    Qorolli, Merita; Hundozi-Hysenaj, Hajrije; Rexhepi, Sylejman; Rehxepi, Blerta; Grazio, Simeon

    2017-06-01

    The Routine Assessment of Patient Index Data 3 (RAPID3) is a patient-reported disease activity measure used to assess physical function, pain, and global health in patients with rheumatoid arthritis (RA) without formal joint counts. Since hand involvement and its decreased function are hallmarks of RA, the aim of our study was to investigate the performance of RAPID3 scores with regard to hand function and to confirm previous findings that the RAPID3 score as a disease activity measure is strongly correlated with the DAS28 score. Sixty-eight consecutive patients with RA (85% female), aged 18-75 years, were included in the study and were recruited during their outpatient visit. Apart from demographic and clinical data, the obtained parameters of interest included RAPID3 scores and assessments of the function of the hand, namely, the signal of functional impairment (SOFI)-hand, grip strength, and pulp-to-palm distance, as well the Health Assessment Questionnaire- Disability Index (HAQ-DI) and DAS28 scores. Pearson's correlation coefficient, Student's t test and linear regression were used in the statistical analysis of the results. The significance was set to p < 0.05. A positive correlation was found between RAPID3 scores and HAQ-DI scores, SOFI-hand scores, and pulp-to-palm distance, and negative correlation was observed between RAPID3 scores and grip strength. The order regarding the strength of correlations between RAPID3 scores and other variables (from the strongest to the weakest) was as follows: HAQ-DI, grip strength, SOFI-hand and pulp-to-palm distance. The hand assessment variables had stronger correlations with RAPID3 scores than with DAS28 scores. Our preliminary study showed that RAPID3 scores were strongly correlated with measurements of the functional ability of the hand, demonstrating that RAPID3 can be used as a measure of disease activity in clinical practice and to characterize hand function. Further studies are needed to confirm this result.

  9. An automatic measure of progression during colonoscopy correlates to patient experienced pain

    DEFF Research Database (Denmark)

    Preisler, Louise; Bulut, Mustafa; Svendsen, Morten Soendergaard

    2018-01-01

    recordings were used for evaluation. We demonstrated a moderate correlation between CoPS and patient experienced pain, Pearson's r = -0.47 (p ... progression. CoPS deliver a numeric score and a graphic map. A high score expresses a rapid and smooth progression. Aims of study were to explore the correlation between CoPS and patient experienced pain and to identity locations associated with pain. METHODS AND MATERIALS: Patients listed for colonoscopy.......61 Passage of the sigmoid colon, right and left flexures were associated with pain for 51%, 33% and 25% of the patients, respectively. CONCLUSION: A moderate correlation between CoPS and patient experienced pain suggest that CoPS measure inserting skills but might also be a measure of a gentle performance...

  10. Automated radiofrequency-based US measurement of common carotid intima-media thickness in RA patients treated with synthetic vs synthetic and biologic DMARDs.

    Science.gov (United States)

    Naredo, Esperanza; Möller, Ingrid; Corrales, Alfonso; Bong, David A; Cobo-Ibáñez, Tatiana; Corominas, Hector; Garcia-Vivar, Ma Luz; Macarrón, Pilar; Navio, Teresa; Richi, Patricia; Iagnocco, Annamaria; Garrido, Jesús; Martínez-Hernández, David

    2013-02-01

    To compare the carotid intima-media thickness (IMT) assessed with automated radiofrequency-based US in RA patients treated with synthetic vs synthetic and biologic DMARDs and controls. Ninety-four RA patients and 94 sex- and age-matched controls were prospectively recruited at seven centres. Cardiovascular (CV) risk factors and co-morbidities, RA characteristics and therapy were recorded. Common carotid artery (CCA)-IMT was assessed in RA patients and controls with automated radiofrequency-based US by the same investigator at each centre. Forty-five (47.9%) RA patients had been treated with synthetic DMARDs and 49 (52.1%) with synthetic and biologic DMARDs. There were no significant differences between the RA patients and controls in demographics, CV co-morbidities and CV disease. There were significantly more smokers among RA patients treated with synthetic and biologic DMARDs (P = 0.036). Disease duration and duration of CS and synthetic DMARD therapy was significantly longer in RA patients treated with synthetic and biologic DMARDs (P radiofrequency-based measurement of CCA-IMT can discriminate between RA patients treated with synthetic DMARDs vs RA patients treated with synthetic and biologic DMARDs.

  11. Gender differences among discrimination & stigma experienced by depressive patients in Pakistan

    OpenAIRE

    Khan, Nashi; Kausar, Rukhsana; Khalid, Adeela; Farooq, Anum

    2015-01-01

    Objective: This study aims to examine Gender Difference in the level of Discrimination and Stigma experienced by people diagnosed with Major Depressive Disorder in Pakistan. It was hypothesized that Women diagnosed with Depression are likely to be experiencing more Discrimination and Internalized Stigma in comparison to Men. Methods: This is a Cross Sectional Study. Thirty eight patients diagnosed with Major Depressive Disorder recruited from different Government Sector Hospitals of Lahore; w...

  12. Association of the TYMS 3G/3G genotype with poor response and GGH 354GG genotype with the bone marrow toxicity of the methotrexate in RA patients.

    Science.gov (United States)

    Jekic, Biljana; Lukovic, Ljiljana; Bunjevacki, Vera; Milic, Vera; Novakovic, Ivana; Damnjanovic, Tatjana; Milasin, Jelena; Popovic, Branka; Maksimovic, Nela; Damjanov, Nemanja; Radunovic, Goran; Kovacevic, Ljiljana; Krajinovic, Maja

    2013-03-01

    Gamma-glutamyl hydrolase (GGH), cyclin D1 (CCND1) and thymidylate synthase (TS) genes encode enzymes that are involved in methotrexate (MTX) action. In a group of 184 RA patients treated with MTX, we have investigated whether selected polymorphisms in these genes modulate MTX efficacy and/or have impact on adverse drug effects (ADEs). The efficacy of the MTX therapy has been estimated using the disease activity score in 28 joints (DAS28-ESR) based on EULAR criteria and relative DAS28 values (rDAS28). All adverse drug events were recorded. Patients were genotyped for selected polymorphisms of the GGH (-354 G > T and 452 C > T), CCND1 (870 A > G) and TYMS (variable number of tandem repeats, VNTR, and G to C substitution of triple repeat, 3R allele) gene. Association studies have been performed between obtained genotypes and the efficacy and toxicity of MTX. According to the EULAR response criteria, 146 RA patients (79.3 %) were classified as responders (good/moderate response) and 38 (20.7 %) as non-responders (poor response). Higher frequency of the TYMS 3 G/3 G genotype has been found among non-responders as compared to individuals with remaining genotypes (p = 0.02). ADEs were recorded in 53 patients. Among those patients eight experienced bone marrow toxicity, all of them carried GGH -354GG genotype (p = 0.003). No other significant association were observed. The 3 G/3 G genotype of the TYMS gene may indicate predisposition of poor response to MTX and GG genotype of GGH -354 T > G polymorphism may have high predictive value for myelosuppression in RA patients.

  13. Differences between novice and experienced caregivers in muscle activity and perceived exertion while repositioning bedridden patients.

    Science.gov (United States)

    Daikoku, Rie; Saito, Yayoi

    2008-11-01

    The aim of this study was to investigate the impact of caregiver knowledge and experience on muscle activity and perceived exertion while repositioning bedridden patients. Subjects were 40- to 65-year-old female caregivers divided into novice and experienced groups. Subjects from both groups performed home-care repositioning techniques on bedridden patients while muscle activity was recorded via electromyogram. Recordings were made from four muscles on the subjects' dominant side: the latissimus dorsi, the biceps brachii, the erector spinae, and the rectus femoris. The subjective burden involved in repositioning was also assessed using the rate of perceived exertion (RPE) and visual analog scales (VAS). Rectus femoris percentage of maximum voluntary contraction (%MVC) values were significantly lower than latissimus dorsi, erector spinae, and biceps brachii values in the novice group. %MVC values from the latissimus dorsi and biceps brachii were significantly higher among the novice group compared to the experienced group. RPE ratings from the novice group were significantly higher than those of the experienced group, and there was a non-significant trend for higher VAS values for the low back, arms, and legs in the novice group compared to the experienced group. Novice caregivers tended to change the patient's position by pulling with the upper limbs without using the lower limbs. In contrast, experienced caregivers exerted less energy by communicating with the patient and utilizing the patient's own movements. They used large, distributed muscle groups that effectively harnessed body mechanics and prevented excess exertion.

  14. The provisional ACR/EULAR definition of remission in RA: a comment on the patient global assessment criterion

    NARCIS (Netherlands)

    Vermeer, M.; Kuper, Hillechina H.; van der Bijl, Arie E.; Baan, H.; Posthumus, Marcel D.; Brus, Herman L.M.; van Riel, Piet L.C.M.; van de Laar, Mart A F J

    2012-01-01

    Objectives. The provisional ACR/European League Against Rheumatism (EULAR) definition of remission in RA requires a score of ≤1 on the patient global assessment (PGA, 0–10 scale). We explored the relation between the PGA criterion and the patient's clinical disease state in an observational dataset.

  15. Changes in hand bone mineral density and the association with the level of disease activity in patients with RA

    NARCIS (Netherlands)

    Dirven, L.; Guler-Yuksel, M.; de Beus, W.M.; Ronday, H.K.; Speyer, I.; Huizinga, T.W.; Dijkmans, B.A.C.; Allaart, C.F.; Lems, W.F.

    2011-01-01

    Objective. To determine if metacarpal bone mineral density (mBMD) gain occurs in patients with rheumatoid arthritis (RA). If mBMD loss is driven by inflammation, we expect to find mBMD gain in patients who are in remission. Methods. mBMD was measured by digital X-ray radiogrammetry in consecutive

  16. The provisional ACR/EULAR definition of remission in RA : a comment on the patient global assessment criterion

    NARCIS (Netherlands)

    Vermeer, Marloes; Kuper, Hillechiena H.; van der Bijl, Arie E.; Baan, Henriette; Posthumus, Marcel D.; Brus, Herman L. M.; van Riel, Piet L. C. M.; van de Laar, Mart A. F. J.

    Objectives. The provisional ACR/European League Against Rheumatism (EULAR) definition of remission in RA requires a score of 41 on the patient global assessment (PGA, 0-10 scale). We explored the relation between the PGA criterion and the patient's clinical disease state in an observational dataset.

  17. Behavioural typologies of experienced benefit of psychomotor therapy in patients with chronic shoulder pain

    DEFF Research Database (Denmark)

    Stamp, Anne Schinkel; Pedersen, Lise Lang; Ingwersen, Kim Gordon

    2018-01-01

    Abstract In this study we aimed to develop a theoretical account of the experienced benefit of psychomotor therapy in addition to treatment as usual in patients with chronic shoulder pain. The qualitative study design was based on a grounded theory approach. Open-ended face-to-face interviews were...... conducted after treatment was completed. We generated data and performed analyses by constant comparative analysis and theoretical sampling that focused on the patients' behavioural characteristics related to the experienced benefit of psychomotor therapy. We conducted 12 interviews, eight of which were...

  18. Stigma Experienced by Parkinson’s Disease Patients: A Descriptive Review of Qualitative Studies

    OpenAIRE

    Maffoni, Marina; Giardini, Anna; Pierobon, Antonia; Ferrazzoli, Davide; Frazzitta, Giuseppe

    2017-01-01

    Parkinson's disease (PD) is a neurodegenerative disease characterized by motor and nonmotor symptoms. Both of them imply a negative impact on Health-Related Quality of Life. A significant one is the stigma experienced by the parkinsonian patients and their caregivers. Moreover, stigma may affect everyday life and patient's subjective and relational perception and it may lead to frustration and isolation. Aim of the present work is to qualitatively describe the stigma of PD patients stemming f...

  19. Stigma experienced by patients with severe mental disorders: A nationwide multicentric study from India.

    Science.gov (United States)

    Grover, Sandeep; Avasthi, Ajit; Singh, Aakanksha; Dan, Amitava; Neogi, Rajarshi; Kaur, Darpan; Lakdawala, Bhavesh; Rozatkar, Abhijit R; Nebhinani, Naresh; Patra, Suravi; Sivashankar, Priya; Subramanyam, Alka A; Tripathi, Adarsh; Gania, Ab Majid; Singh, Gurvinder Pal; Behere, Prakash

    2017-11-01

    This study aimed to evaluate the stigma and its correlates among patients with severe mental disorders. Patients with diagnosis of schizophrenia (N = 707), bipolar disorder (N = 344) and recurrent depressive disorder (N = 352) currently in clinical remission from 14 participating centres were assessed on Internalized Stigma of Mental Illness Scale (ISMIS). Patients with diagnosis of schizophrenia experienced higher level of alienation, sterotype endorsement, discrimination experience and total stigma when compared to patients with bipolar disorder and recurrent depressive disorder. Patients with bipolar disorder experienced higher stigma than those with recurrent depressive disorder in the domain of stigma resistance only. Overall compared to affective disorder groups, higher proportion of patients with schizophrenia reported stigma in all the domains of ISMIS. In general in all the 3 diagnostic groups' stigma was associated with shorter duration of illness, shorter duration of treatment and younger age of onset. To conclude, this study suggests that compared to affective disorder, patients with schizophrenia experience higher self stigma. Higher level of stigma is experienced during the early phase of illness. Stigma intervention programs must focus on patients during the initial phase of illness in order to reduce the negative consequences of stigma. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Patient Education in the Management of Rheumatoid Arthritis (RA)

    Science.gov (United States)

    Brosseau, Lucie; Wells, George A.; Tugwell, Peter; Egan, Mary; Dubouloz, Claire-Jehanne; Welch, Vivian A.; Trafford, Laura; Sredic, Danjiel; Pohran, Kathryn; Smoljanic, Jovana; Vukosavljevic, Ivan; De Angelis, Gino; Loew, Laurianne; McEwan, Jessica; Bell, Mary; Finestone, Hillel M.; Lineker, Sydney; King, Judy; Jelly, Wilma; Casimiro, Lynn; Haines-Wangda, Angela; Russell-Doreleyers, Marion; Laferriere, Lucie; Lambert, Kim

    2012-01-01

    Background and purpose: The objective of this article is to create guidelines for education interventions in the management of patients ([greater than] 18 years old) with rheumatoid arthritis (RA). Methods: The Ottawa Methods Group identified and synthesized evidence from comparative controlled trials using Cochrane Collaboration methods. The…

  1. Value of body mass index in the diagnosis of obesity according to DEXA in well-controlled RA patients.

    Science.gov (United States)

    Tello-Winniczuk, Nina; Vega-Morales, David; García-Hernandez, Pedro A; Esquivel-Valerio, Jorge A; Garza-Elizondo, Mario A; Arana-Guajardo, Ana C

    Rheumatoid arthritis (RA) has an indirect effect on body composition. Body mass index (BMI) is not a valid predictor of body fat in RA patients. To evaluate the accuracy of BMI in identifying obesity diagnosed according to dual energy X-ray absorptiometry (DXA) in well-controlled RA patients. An observational, cross-sectional, descriptive, analytical study. We used 3 different cutoffs for obesity as determined by DXA: >35% total fat, >40% total fat, and >35% central fat mass (central obesity). One hundred one patients were included. We found that 35% total fat corresponded to a BMI of 24kg/m 2 , with a sensitivity of 90% and specificity of 75% (area under the curve [AUC] 0.917); 40% total fat to a BMI of 25kg/m 2 , with a sensitivity of 86% and specificity of 39% (AUC 0.822); and 35% central fat mass to a BMI of 22kg/m 2 , with a sensitivity of 97% and specificity of 84% (AUC 0.951). Obesity according to DXA was underdiagnosed when the classic BMI cutoffs were used in well-controlled RA patients. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  2. Diagnostic delay experienced among gynecological cancer patients: a nationwide survey in Denmark

    DEFF Research Database (Denmark)

    Robinson, Kirstine M; Ottesen, Bent; Christensen, Karl Bang

    2009-01-01

    OBJECTIVE: To examine diagnostic delay among gynecological cancer patients. DESIGN: Nationwide study. SETTING: The cohort comprised all women receiving their first treatment for cervical, endometrial, or ovarian cancer between 1 October 2006 and 1 December 2007 in four of the five centers...... for gynecological cancer surgery in Denmark. SAMPLE: Of the 911 women alive, 648 participated, resulting in a response rate of 71.1%; of these, 30.1% were diagnosed with cervical cancer, 31.0% with endometrial cancer, and 38.9% with ovarian cancer. METHODS: Questionnaire survey. MAIN OUTCOME MEASURES: Diagnostic...... experiencing very long delays. Ovarian cancer patients experienced significantly shorter delays compared with other gynecological cancer patients in all parts of the health care system. CONCLUSIONS: Delays occur in all parts of the diagnostic process, suggesting that a multifaceted approach should be adopted...

  3. Effectiveness of etravirine-based therapy for treatment-experienced HIV-infected patients.

    Science.gov (United States)

    Huerta García, Gloria; Mata-Marín, José Antonio; Domínguez-Hermosillo, Juan Carlos; Chavez-García, Marcelino; Banda-Lara, Marco Issac; Nuñez-Rodríguez, Nohemi; Cruz-Herrera, Javier Enrique; Sandoval-Ramírez, Jorge Luis; Villagómez-Ruiz, Alfredo; Manjarrez-Tellez, Bulmaro; Gaytan-Martínez, Jesús Enrique

    2016-06-30

    Treatment options are limited for HIV-1-infected individuals who have received extensive previous antiretroviral therapy. ETV has shown significant clinical benefits in treatment-experienced HIV-1+ patients with antiretroviral resistance. The aim of this study was to evaluate the effectiveness of ETV plus optimized background regimen in real-life conditions in a cohort of highly HIV-1 antiretroviral-experienced patients. Retrospective cohort of treatment-experienced HIV-1-infected adults with virological failure who started therapy with an ETV-containing regimen. The effectiveness was evaluated using HIV-1 RNA viral load and changes in CD4+ cell count after 48 weeks of treatment. Forty-two patients ≥ 16 years of age were included; 74% were men, and the median age was 45 years (IQR 41-53). All participants had prior non-nucleoside reverse transcriptase inhibitor use (55% nevirapine, 83%, efavirenz, and 28% both). Baseline median HIV-1 RNA viral load was 15,598 copies/mL (IQR 2651-84,175) and CD4+ cell count was 276 cells/mL (IQR 155-436). After 48 weeks of treatment, 90.5% (95% CI 78-96) of patients had HIV-1 RNA viral load treatment to a median of 407 cells/mL (IQR 242-579); p HIV-1 RNA viral load ≥ 100,000 copies/mL (OR 7.6; 95% CI 1.2-44.80; p = 0.025). Our study provides clinically important evidence of the effectiveness and safety of ETV in highly antiretroviral-experienced HIV-1-infected patients.

  4. Correlation between lamivudine plasma concentrations and patient self-reported adherence to antiretroviral treatment in experienced HIV patients

    Directory of Open Access Journals (Sweden)

    Minzi OM

    2011-11-01

    Full Text Available OM Minzi1, V Mugoyela2, LL Gustafsson31Unit of Pharmacology and Therapeutics, 2Department of Medicinal Chemistry, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; 3Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, SwedenBackground: Adherence to antiretroviral treatment (ART is important to achieve treatment success in human immunodeficiency virus (HIV-infected patients. Most HIV clinics apply the patient self-report (PSR method. However, the reliability of this method in experienced HIV patients remains questionable.Purpose: To validate the PSR method for measuring adherence to ART using lamivudine (3TC plasma concentrations in experienced HIV patients.Methods: The study was conducted in Dar Es Salaam and involved 220 patients who were receiving ART services at HIV clinics for more than 12 months. Self-reported adherence information to ART was obtained on the day of HIV clinic visit. The patients were asked to mention the number of doses missed within the past 7 days. In addition, blood samples (2 mL were collected from each patient on the same day. The blood samples were determined for 3TC plasma concentrations. The target 3TC plasma concentration as indicator concentration for adherent patients was determined in 20 patients who took their evening dose of antiretrovirals under supervision. The blood from these patients was drawn 3 hours after drug administration.Results: Complete drug levels of 3TC and self-reported adherence data was obtained in 200 treatment-experienced HIV patients. Lamivudine plasma concentrations obtained in these patients ranged between 0.02–17.36 µg/mL. The mean time from dose administration to blood drawing was 3.1 ± 1.2 hours with coefficient of variation >39%. The mean 3TC plasma concentration obtained in 20 patients who took their antiretroviral dose under supervision was

  5. Gender differences among discrimination & stigma experienced by depressive patients in Pakistan.

    Science.gov (United States)

    Khan, Nashi; Kausar, Rukhsana; Khalid, Adeela; Farooq, Anum

    2015-01-01

    This study aims to examine Gender Difference in the level of Discrimination and Stigma experienced by people diagnosed with Major Depressive Disorder in Pakistan. It was hypothesized that Women diagnosed with Depression are likely to be experiencing more Discrimination and Internalized Stigma in comparison to Men. This is a Cross Sectional Study. Thirty eight patients diagnosed with Major Depressive Disorder recruited from different Government Sector Hospitals of Lahore; were approached after obtaining informed consent. Discrimination and Stigma were measured through Discrimination and Stigma Scale and Internalized Stigma of Mental Illness Inventory respectively. Both Men and Women experience considerably high level of associated Stigma and Discrimination due to their Mental Illness. However, Women in comparison to Men experience significantly greater level of Internalized Stigma especially in domains of Discrimination Experience and Social Withdrawal. The findings of this study highlight the fact that people with Depression can be more benefited with psychological treatment if dealing with Stigma and Discrimination is also addressed in Intervention Plans.

  6. Factors that influence fatigue status in patients with severe rheumatoid arthritis (RA) and good disease outcome following 6 months of TNF inhibitor therapy: a comparative analysis.

    LENUS (Irish Health Repository)

    Minnock, Patricia

    2015-11-01

    The objective of the present study is to determine the factors associated with persistent fatigue in patients with severe rheumatoid arthritis (RA) and good disease response to 6 months of tumour necrosis factor inhibitor therapy. Eligible patients with either persistent (PF) or no fatigue (NF) were compared. Using validated questionnaires and bivariate analysis, this cross-sectional survey explored if clinical characteristics, pain, self-efficacy, sleep and mood\\/depression differed between groups. Patients with PF (PF; NF) (n = 28; 28) reported significantly more overall pain (11.3 ± 9.4 (0-33); 6.9 ± 8.9 (0-33)), more recent and current pain intensity (41.4 ± 26.6 (0-80) 24.4 ± 26.6 (0-100) and depression (11.8 ± 7.5 (1-35); 8.2 ± 6.6 (0-26)), than the NF group. There was no significant difference between groups in self-efficacy and both groups experienced poor sleep quality (Pittsburgh Sleep Quality Index >5). Despite having good disease response, the PF group had significantly higher rheumatoid factor incidence, disease activity score-28, early morning stiffness duration and lower incidence of ever-failing disease-modifying anti-rheumatic drugs than the NF group. These findings enhance the fatigue literature in patients with RA prescribed tumour necrosis factor (TNF) inhibition therapy, identifying the potentially modifiable factors of pain and depression, previously demonstrated to be strongly associated with fatigue in non-biologic populations. In addition, this study highlights the association between persistent fatigue and an on-going state of low disease activity. This infers that more judicious disease management could minimise the symptom burden of pain and depression and consequentially fatigue.

  7. Flexor Hallucis Longus tendon rupture in RA-patients is associated with MTP 1 damage and pes planus

    Directory of Open Access Journals (Sweden)

    Buurke Jaap J

    2007-11-01

    Full Text Available Abstract Background To assess the prevalence of and relation between rupture or tenosynovitis of the Flexor Hallucis Longus (FHL tendon and range of motion, deformities and joint damage of the forefoot in RA patients with foot complaints. Methods Thirty RA patients with painful feet were analysed, their feet were examined clinically for the presence of pes planus and range of motion (ROM, radiographs were scored looking for the presence of forefoot damage, and ultrasound examination was performed, examining the presence of tenosyovitis or rupture of the FHL at the level of the medial malleolus. The correlation between the presence or absence of the FHL and ROM, forefoot damage and pes planus was calculated. Results In 11/60(18% of the feet, a rupture of the FHL was found. This was associated with a limited motion of the MTP1-joint, measured on the JAM (χ2 = 10.4, p = 0.034, a higher prevalence of pes planus (χ2 = 5.77, p = 0.016 and a higher prevalence of erosions proximal at the MTP-1 joint (χ2 = 12.3, p = 0.016, and joint space narrowing of the MTP1 joint (χ2 = 12.7, p = 0.013. Conclusion Rupture of the flexor hallucis longus tendon in RA-patients is associated with limited range of hallux motion, more erosions and joint space narrowing of the MTP-1-joint, as well as with pes planus.

  8. Effectiveness of tipranavir versus darunavir as a salvage therapy in HIV-1 treatment-experienced patients.

    Science.gov (United States)

    Domínguez-Hermosillo, Juan Carlos; Mata-Marin, José Antonio; Herrera-González, Norma Estela; Chávez-García, Marcelino; Huerta-García, Gloria; Nuñez-Rodríguez, Nohemí; García-Gámez, José Gerardo; Jiménez-Romero, Anai; Gaytán-Martínez, Jesús Enrique

    2016-09-30

    Although both tipranavir (TPV) and darunavir (DRV) represent important options for the management of patients with multi-protease inhibitor (PI)-resistant human immunodeficiency virus (HIV), currently there are no studies comparing the effectiveness and safety of these two drugs in the Mexican population. The aim of this study was to compare the effectiveness of TPV versus DRV as a salvage therapy in HIV-1 treatment-experienced patients. This was a comparative, prospective, cohort study. Patients with HIV and triple-class drug resistance evaluated at the Hospital de Infectología "La Raza", National Medical Center, were included. All patients had the protease and retrotranscriptase genotype; resistance mutation interpretation was done using the Stanford database. A total of 35 HIV-1 triple-class drug-resistant patients were analyzed. All of them received tenofovir and raltegravir, 22 received darunavir/ritonavir (DRV/r), and 13 received tipranavir/ritonavir (TPV/r) therapies. The median baseline RNA HIV-1 viral load and CD4+ cell count were 4.34 log (interquartile range [IQR], 4.15-4.72) and 267 cells/mm3 (IQR, 177-320) for the DRV/r group, and 4.14 log (IQR, 3.51-4.85) and 445 cells/mm3 (IQR, 252-558) for the TPV/r group. At week 24 of treatment, 91% of patients receiving DRV/r and 100% of patients receiving TPV/r had an RNA HIV-1 viral load HIV-1 patients who were highly experienced in antiretroviral therapy.

  9. The pillars of well-constructed simulated patient programs: A qualitative study with experienced educators.

    Science.gov (United States)

    Pritchard, Shane A; Blackstock, Felicity C; Keating, Jennifer L; Nestel, Debra

    2017-11-01

    The inclusion of simulated patients (SPs) in health professional education is growing internationally. However, there is limited evidence for best practice in SP methodology. This study investigated how experienced SP educators support SPs in providing SP-based education for health professional students. Experienced SP educators were identified via relevant professional associations, peer-reviewed publications, and peer referral. Semi-structured individual interviews were conducted via telephone. Data were analyzed independently by three researchers using principles of inductive thematic analysis. Four themes were identified that represent the key structural components of SP programs considered by educators seeking to optimize learning for health professional students in SP programs: managing SPs by operationalizing an effective program, selecting SPs by rigorously screening for suitability, preparing SPs by educating for a specific scenario, and directing SPs by leading safe and meaningful interactions. Within these components, subthemes were described, with considerable variation in approaches. Key structural components to SP programs were consistently described by experienced SP educators who operationalize them. A framework has been proposed to assist educators in designing high-quality SP programs that support SPs and learners. Future research is required to evaluate and refine this framework and other evidence-based resources for SP educators.

  10. Perceptions of family members of palliative medicine and hospice patients who experienced music therapy.

    Science.gov (United States)

    Gallagher, Lisa M; Lagman, Ruth; Bates, Debbie; Edsall, Melissa; Eden, Patricia; Janaitis, Jessica; Rybicki, Lisa

    2017-06-01

    Evidence shows that music therapy aids in symptom management and improves quality of life for palliative medicine and hospice patients. The majority of previous studies have addressed patient needs, while only a few addressed the needs of family members. The primary purpose of this study was to understand family members' perceptions of music therapy experienced by a relative in palliative medicine or hospice. Patient self-reported scales and music therapist assessment of change were also investigated. Patients scored their symptoms (pain, anxiety, depression, shortness of breath, and mood) before and after music therapy sessions. One family member present during the session assessed perceived effect on the patient's pain, anxiety, depression, shortness of breath, stress level, restlessness, comfort level, mood, and quality of life. The effect on family member's stress level, quality of life, and mood and helpfulness of the music therapy session for the patient and self were studied. Recommendations about future patient participation in music therapy and qualitative comments were also solicited. Fifty family member/patient dyads participated in the study. Family member perceptions were positive, with 82% of responders indicating improvement for self and patient in stress, mood, and quality of life; 80% rating the session as extremely helpful; and 100% of 49 recommending further music therapy sessions for the patient. Patients reported statistically significant improvement in pain, depression, distress, and mood scores. Family members of patients in palliative medicine and hospice settings reported an immediate positive impact of music therapy on the patient and on themselves. More research needs to be conducted to better understand the benefits of music therapy for family members.

  11. Subtypes of Patients Experiencing Exacerbations of COPD and Associations with Outcomes

    Science.gov (United States)

    Arostegui, Inmaculada; Esteban, Cristobal; García-Gutierrez, Susana; Bare, Marisa; Fernández-de-Larrea, Nerea; Briones, Eduardo; Quintana, José M.

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify

  12. Lived experience of the intensive care unit for patients who experienced delirium.

    Science.gov (United States)

    Whitehorne, Karen; Gaudine, Alice; Meadus, Robert; Solberg, Shirley

    2015-11-01

    Delirium is a common occurrence for patients in the intensive care unit and can have a profound and lasting impact on them. Few studies describe the experience of intensive care patients who have had delirium. To understand the lived experience of intensive care for critically ill patients who experienced delirium. The study participants consisted of 7 men and 3 women, 46 to 70 years old, who had delirium according to the Confusion Assessment Method for the Intensive Care Unit. The van Manen method of hermeneutic phenomenology was used, and data collection entailed audio recorded semistructured interviews. Four themes were detected: "I can't remember," "Wanting to make a connection," "Trying to get it straight," and "Fear and safety concerns." Nurses working in intensive care units need to assess patients for delirium, assess the mental status of patients who have delirium, and help patients and patients' families learn about and deal with the psychological effects of the intensive care unit experience. ©2015 American Association of Critical-Care Nurses.

  13. Tenofovir treatment in an unselected cohort of highly antiretroviral experienced HIV positive patients

    DEFF Research Database (Denmark)

    Lerbaek, A; Kristiansen, Thomas Birk; Katzenstein, TL

    2004-01-01

    Tenofovir treatment in an unselected cohort of highly antiretroviral experienced HIV positive patients.Lerbaek A, Kristiansen TB, Katzenstein TL, Mathiesen L, Gerstoft J, Nielsen C, Larsen K, Nielsen JO, Obel N, Laursen AL, Nielsen SD. Department of Infectious Diseases, Hvidovre Hospital......, HIV-RNA levels and genotypic resistance were determined at baseline and after 3 and 6 months. After initiation of tenofovir treatment, a mean decrease in HIV-RNA for all 34 patients was observed (-0.43 log1o copies/ml (+/- 1.22) and -0.49 log10 copies/ml (+/- 1.36) after 3 and 6 months, respectively......, respectively). After initiation of tenofovir treatment, no significant increases in CD4 count were observed. All new NRTI-associated mutations could be explained by the background treatment. In conclusion, we observed a significant decrease in HIV-RNA only when tenofovir was prescribed, in conjunction...

  14. A Study Of The Effects Of Illness Experienced By Families Of Oral And Oropharyngeal Cancer Patients

    Directory of Open Access Journals (Sweden)

    Bhagyalaxmi A

    2002-01-01

    Full Text Available Research question : What are the various areas and burden a family experiences due to presence of oral and oropharyngeal cancer patient. Objectives: 1. To identify the family burden like financial burden, disruption of routine activities and family leisure etc. 2. To study the severity of family burden experienced by the families of oral and oropharyngeal cancer patients. Study design: Case- control. Setting: Gujarat Cancer and Research Institute (G.C.R.I, Ahmedabad. Participants: 100 cases belonging to the diagnostic categories no. 140-46 of ICD â€"9 and 100 controls belonging to the diagnostic categories other than no. 140-46 of ICD-9 Statistical analysis: Proportions, Chi-square test and Z test. Results: Financial burden was observed in 36% of cases and 43% of controls had burden on the family. Out of 43% respondents reporting any burden, 36(83.72% were identified with severe burden.

  15. RA Reactor

    International Nuclear Information System (INIS)

    1989-01-01

    This chapter includes the following: General description of the RA reactor, organization of work, responsibilities of leadership and operators team, regulations concerning operation and behaviour in the reactor building, regulations for performing experiments, regulations and instructions for inserting samples into experimental channels [sr

  16. Stigma Experienced by Parkinson's Disease Patients: A Descriptive Review of Qualitative Studies.

    Science.gov (United States)

    Maffoni, Marina; Giardini, Anna; Pierobon, Antonia; Ferrazzoli, Davide; Frazzitta, Giuseppe

    2017-01-01

    Parkinson's disease (PD) is a neurodegenerative disease characterized by motor and nonmotor symptoms. Both of them imply a negative impact on Health-Related Quality of Life. A significant one is the stigma experienced by the parkinsonian patients and their caregivers. Moreover, stigma may affect everyday life and patient's subjective and relational perception and it may lead to frustration and isolation. Aim of the present work is to qualitatively describe the stigma of PD patients stemming from literature review, in order to catch the subjective experience and the meaning of the stigma construct. Literature review was performed on PubMed database and Google Scholar (keywords: Parkinson Disease, qualitative, stigma, social problem, isolation, discrimination) and was restricted to qualitative data: 14 articles were identified to be suitable to the aim of the present overview. Results are divided into four core constructs: stigma arising from symptoms, stigma linked to relational and communication problems, social stigma arising from sharing perceptions, and caregiver's stigma. The principal relations to these constructs are deeply analyzed and described subjectively through patients' and caregiver's point of view. The qualitative research may allow a better understanding of a subjective symptom such as stigma in parkinsonian patients from an intercultural and a social point of view.

  17. The Tidal Model as experienced by patients and nurses in a regional forensic unit.

    Science.gov (United States)

    Cook, N R; Phillips, B N; Sadler, D

    2005-10-01

    The Tidal Model has been implemented in Rangipapa, a regional secure mental health forensic unit in New Zealand. A phenomenological study was undertaken to obtain reflective description of the nursing care experience from the perspective's of four Registered Nurses and four Special Patients. Five major themes were identified that appeared to capture the experiences of the participants. The themes show changes to the unit's unique culture and values following implementation of the model. These changes engendered a sense of hope, where nurses felt they were making a difference and patients were able to communicate in their own words their feelings of hope and optimism. Levelling was experienced as an effect emerging from individual and group processes whereby a shift in power enhanced a sense of self and connectedness in their relationships. These interpersonal transactions were noted by the special patients as being positive for their recovery. This enabled effective nurse-patient collaboration expressed simply as working together. The participants reported a feeling of humanity, so that there was a human face to a potentially objectifying forensic setting. Implications arising from this study are that the use of the model enables a synergistic interpersonal process wherein nurses are professionally satisfied and patients are validated in their experience supporting their recovery.

  18. Nursing intervention protocol for adult patients experiencing chronic low back pain

    Directory of Open Access Journals (Sweden)

    Nadia Mohamed Taha

    2015-12-01

    Full Text Available Aim: The aim of this study was to evaluate the effectiveness of a nursing intervention protocol targeting the knowledge and practice of adult patients experiencing low back pain. Design: A quasi-experimental research design. Methods: Pre-post assessment of outcome was used in this study. The study was conducted in the outpatient clinic of the physical therapy department at Zagazig University Hospital and Beni-Suef University Hospital, Egypt. Sample: 40 participants diagnosed with chronic low back pain (lasting for longer than six months. Seven of the 40 dropped out during the follow-up phase for personal or logistical reasons. Tools included sections for demographic characteristics, knowledge and practice assessment; in addition to the Oswestry Disability Index, and Visual Analogue Scale (VAS. Results: The application of an instruction protocol intervention for low back pain was effective in improving patient knowledge and practice, with associated amelioration of the severity of pain and disability among them. The effect was still apparent at the three-month follow-up. Conclusion: It is recommended that the study be replicated using a more robust randomized clinical trial design. Nonetheless, the instruction protocol with the designed booklet may be adopted as an element of the care services offered to patients suffering LBP, given the clear positive effects on patient knowledge, which would undoubtedly help them decide on the most preferential management approach.

  19. Experiencing patient death in clinical practice: nurses' recollections of their earliest memorable patient death.

    Science.gov (United States)

    Anderson, Natalie Elizabeth; Kent, Bridie; Owens, R Glynn

    2015-03-01

    Death and dying are inevitable life encounters, but a nurse's first experience with patient death may pose considerable cognitive, emotional and clinical challenges. This paper reports the findings of the second phase of a study; the first has been reported elsewhere. This phase explored the earliest memorable patient death experiences of New Zealand registered nurses. A purposeful, self-selected sub-sample of a larger study of New Zealand registered nurses, took part in individual face-to-face semi-structured interviews. Interpretative phenomenological analysis was utilised to seek to understand participants' experiences. Thematic analysis was undertaken to identify emerging themes, with participants' own words used as theme headings, where their phrases provided succinct or powerful descriptors. A diverse participant group of twenty, currently practising, New Zealand registered nurses provided rich and detailed descriptions of their earliest memorable experience with patient death. Participants from a variety of training backgrounds described patient deaths, which occurred in a range of settings - some only a few months prior, others - more than thirty years ago. Seven emergent themes, and features of more positive, or negative experiences were identified: Event Significance; Emotional Challenges; Sharing the Experience; Learning; Feeling Unprepared, Responses to Death and Finding Benefits. For participants in this study, there was considerable evidence that their earliest memorable patient death was a significant event. Furthermore, although most participants' experiences were characterised by emphatic or poignant description, there was most often a balance of challenges and rewards. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Patient-experienced burden of treatment in patients suffering from multimorbidity data

    DEFF Research Database (Denmark)

    Rosbach, Michael; Andersen, John Sahl

    2017-01-01

    the multimorbid patients. In studies conducted in the US and Australia the financial burden and the time and travel burden were found most straining to patients with deprived socioeconomic status. The burden of treatment was found to be a complex concept consisting of many different components and factors...... interacting with each other. The size of the burden was associated to the workload of demands (number of conditions, number of medications and health status), the capacity (cognitive, physical and financial resources, educational level, cultural background, age, gender and employment conditions...

  1. Nurses experience of aromatherapy use with dementia patients experiencing disturbed sleep patterns. An action research project.

    Science.gov (United States)

    Johannessen, Berit

    2013-11-01

    The purpose of this study was to gain an insight into nurses' experiences of incorporating aromatherapy into the care of residents suffering from dementia, anxiety and disturbed sleep patterns. Twenty-four residents and twelve nurses from four nursing homes participated in an action research study. The use of lavender augustofolia essential oil diffused nightly was perceived as an effective care modality reducing insomnia and anxiety in this patient cohort. Nurses experienced some negative attitudes among colleagues because they considered aromatherapy as not evidence based. Nurses require greater access to evidence based use of Aromatherapy. Further research is needed to study how smell can enhance dementia care. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. RA Reactor

    International Nuclear Information System (INIS)

    1978-02-01

    In addition to basic characteristics of the RA reactor, organizational scheme and financial incentives, this document covers describes the state of the reactor components after 18 years of operation, problems concerned with obtaining the licence for operation with 80% fuel, problems of spent fuel storage in the storage pool of the reactor building and the need for renewal of reactor equipment, first of all instrumentation [sr

  3. Stigma Experienced by Parkinson’s Disease Patients: A Descriptive Review of Qualitative Studies

    Directory of Open Access Journals (Sweden)

    Marina Maffoni

    2017-01-01

    Full Text Available Parkinson’s disease (PD is a neurodegenerative disease characterized by motor and nonmotor symptoms. Both of them imply a negative impact on Health-Related Quality of Life. A significant one is the stigma experienced by the parkinsonian patients and their caregivers. Moreover, stigma may affect everyday life and patient’s subjective and relational perception and it may lead to frustration and isolation. Aim of the present work is to qualitatively describe the stigma of PD patients stemming from literature review, in order to catch the subjective experience and the meaning of the stigma construct. Literature review was performed on PubMed database and Google Scholar (keywords: Parkinson Disease, qualitative, stigma, social problem, isolation, discrimination and was restricted to qualitative data: 14 articles were identified to be suitable to the aim of the present overview. Results are divided into four core constructs: stigma arising from symptoms, stigma linked to relational and communication problems, social stigma arising from sharing perceptions, and caregiver’s stigma. The principal relations to these constructs are deeply analyzed and described subjectively through patients’ and caregiver’s point of view. The qualitative research may allow a better understanding of a subjective symptom such as stigma in parkinsonian patients from an intercultural and a social point of view.

  4. [Efficacy of dolutegravir in treatment-experienced patients: the SAILING and VIKING trials].

    Science.gov (United States)

    Moreno, Santiago; Berenguer, Juan

    2015-03-01

    Dolutegravir is an HIV integrase inhibitor with a high genetic barrier to resistance and is active against raltegravir- and/or elvitegravir-resistant strains. The clinical development of dolutegravir for HIV infection rescue therapy is based on 3 clinical trials. In the SAILING trial, dolutegravir (5 mg once daily) in combination with 2 other antiretroviral agents was well tolerated and showed greater virological effect than raltegravir (400 mg twice daily) in the treatment of integrase inhibitor-naïve adults with virological failure infected with HIV strains with at least two-class drug resistance. The VIKING studies were designed to evaluate the efficacy of dolutegravir as rescue therapy in treatment-experienced patients infected with HIV strains with resistance mutations to raltegravir and/or elvitegravir. VIKING-1-2 was a dose-ranging phase IIb trial. VIKING-3 was a phase III trial in which dolutegravir (50 mg twice daily) formed part of an optimized regimen and proved safe and effective in this difficult-to-treat group of patients. Dolutegravir is the integrase inhibitor of choice for rescue therapy in multiresistant HIV infection, both in integrase inhibitor-naïve patients and in those previously treated with raltegravir or elvitegravir. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  5. FEELINGS EXPERIENCED BY PATIENTS FACED WITH A FIRST EVENT OF MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    M. L. Botelho

    2015-06-01

    Full Text Available Currently circulatory diseases are the first cause of death in Brazil and worldwide. After the diagnosis of Acute Myocardial Infarction the patient is faced with a new and daunting routine, a fact that constitutes a source of different and ambiguous feelings. In this context nursing has a fundamental role of providing adequate care to these patients. This study aimed at analyzing the feelings experienced by inpatients in a medical treatment unit when faced with Acute Myocardial Infarction (AMI for the first time. This is an exploratory, descriptive study, with a qualitative approach. Seven inpatients participated in the study at diagnosis of first AMI in a medical treatment unit at a public hospital in the municipality of Sinop. Data were collected through semi-structured interviews. The analysis was carried out through the thematic content analysis technique. The study complied with the ethic principles governing research involving human subjects, under Resolution no. 466/2012. The project was submitted to the Research Ethic Committee and approved by Decision 632.272. The categories listed from the accounts were: a expectation of improvement and adoption of measures to promote health; b negative feelings after AMI. Given the above, we concluded that, although the subjects presented positive and negative feelings towards the event, the impact of AMI on patients’ lives must be considered likewise by the health team, especially by the professional since these feelings are generators of anguish and stress

  6. A comparison of pain experienced by patients treated with labial and lingual orthodontic appliances.

    Science.gov (United States)

    Wu, Abby K Y; McGrath, Colman; Wong, Ricky W K; Wiechmann, D; Rabie, A Bakr M

    2010-08-01

    The aim of this prospective longitudinal study was to compare pain experiences among Chinese adult patients treated with labial and lingual orthodontic appliances. Sixty patients, 30 with labial appliances (18 females and 12 males, mean age 20.33 years, SD +/- 4.205) and 30 with lingual appliances (22 females and 8 males, mean age 21.63 years, SD +/- 2.236), rated their overall pain experience on a 100 mm visual analogue scale (VAS) at three time points: 1 week (T(1)), 1 month (T(2)), and 3 months (T(3)) after bracket placement. In addition, on a separate 100 mm VAS, they rated their pain experience at the locations of the tongue, lips, cheeks, gums, face, and jaw at T(1), T(2), and T(3). Changes in pain VAS were conducted using Friedman analysis of variance, area under the curve (AUC) analysis and the data were compared using a t-test. There was no significant difference in global ratings of pain among those treated with labial or lingual appliances (P > 0.05). Among both groups, global ratings of pain decreased over the study period (P appliances reported higher ratings of tongue pain (P appliances reported higher ratings of lip (P appliances rate similarly the level of overall pain they experience during treatment. Ratings of overall pain experienced decreased for both treatment groups with time. However, ratings of pain differed at various sites with respect to the type of orthodontic appliance. These findings have implications in informing patients' treatment decision-making processes regarding labial and lingual appliances and in the management of discomfort associated with different treatment modalities.

  7. Limitations in Activity and Participation experienced by stroke patients : A Qualitative Inquiry

    Directory of Open Access Journals (Sweden)

    A. Rhoda

    2012-12-01

    Full Text Available Stroke affects individuals in a number of ways. The InternationalClassification of Functioning, Disability and Health can be used to conceptualizedisability post stroke. This framework not only identifies the factors as it relatesto disability but also highlights the conceptual factors which impacts on theindividual’s ability to function. Within the framework of the ICF, the aim of thestudy was therefore to explore the activity limitations and participation restrictionsexperienced by patients with a stroke. A qualitative approach was used to interviewa convenient sample of 8 participants who were living in the community. A semistructuredinterview was conducted to obtain the data. The findings reveal that the participants had impairments of bodyfunctions of both the upper and lower limb. They experienced limitations in activities such as caring for themselves andmobility and were restricted in their ability to fulfill roles such work and caring for family. The factors which influencedthe above were personal factors such as impairments and environmental factors such as family and therapy. This studyprovides valuable qualitative information that could be used by health care professionals when providing rehabilitationservices to people with stroke aimed at reintegration back into the community.

  8. Are Janus Kinase Inhibitors Superior over Classic Biologic Agents in RA Patients?

    Directory of Open Access Journals (Sweden)

    Przemyslaw J. Kotyla

    2018-01-01

    Full Text Available The Janus Kinases (JAKs are a family of intracellular tyrosine kinases that provide transmission signals from cytokine, interferons, and many hormones receptors to the nucleus resulting in synthesis of many biologically active compounds and changing cell metabolism and function. That was theoretical background to synthetize the JAK inhibitors (Jakinibs. In recent years a substantial battery of evidence has been collected indicating the potential role of Jakinibs to interact with the specific elements of the immune system, therefore changing the inflammatory response. JAK kinase blockade offers a unique opportunity to block most of the key cytokines enabling the deep interaction into immune system functioning. Following discovery first Jakinibs were intensively studied in various forms of autoimmune diseases, including rheumatoid arthritis, and finally two Jakinibs tofacitinib and Baricitinib have been approved for the treatment of rheumatoid arthritis. Some clinical data indicated that under special circumstances Jakinibs may be even superior to biologics in the treatment of RA; however this suggestion should be verified in large clinical and observational studies.

  9. HIV-1 integrase resistance among antiretroviral treatment naive and experienced patients from Northwestern Poland

    Directory of Open Access Journals (Sweden)

    Parczewski Miłosz

    2012-12-01

    Full Text Available Abstract Background HIV integrase inhibitor use is limited by low genetic barrier to resistance and possible cross-resistance among representatives of this class of antiretrovirals. The aim of this study was to analyse integrase sequence variability among antiretroviral treatment naive and experienced patients with no prior integrase inhibitor (InI exposure and investigate development of the InI drug resistance mutations following the virologic failure of the raltegravir containing regimen. Methods Sequencing of HIV-1 integrase region from plasma samples of 80 integrase treatment naive patients and serial samples from 12 patients with observed virologic failure on raltegravir containing treatment whenever plasma vireamia exceeded >50 copies/ml was performed. Drug resistance mutations were called with Stanford DB database and grouped into major and minor variants. For subtyping bootstrapped phylogenetic analysis was used; Bayesian Monte Carlo Marcov Chain (MCMC model was implemented to infer on the phylogenetic relationships between the serial sequences from patients failing on raltegravir. Results Majority of the integrase region sequences were classified as subtype B; the remaining ones being subtype D, C, G, as well as CRF01_AE , CRF02_AG and CRF13_cpx recombinants. No major integrase drug resistance mutations have been observed in InI-treatment naive patients. In 30 (38.5% cases polymorphic variation with predominance of the E157Q mutation was observed. This mutation was more common among subtype B (26 cases, 54.2% than non-B sequences (5 cases, 16.7%, p=0.00099, OR: 5.91 (95% CI:1.77-22.63]. Other variants included L68V, L74IL, T97A, E138D, V151I, R263K. Among 12 (26.1% raltegravir treated patients treatment failure was observed; major InI drug resistance mutations (G140S, Q148H and N155H, V151I, E92EQ, V151I, G163R were noted in four of these cases (8.3% of the total InI-treated patients. Time to the development of drug resistance ranged

  10. Effectiveness, Safety, and Costs of a Treatment Switch to Dolutegravir Plus Rilpivirine Dual Therapy in Treatment-Experienced HIV Patients.

    Science.gov (United States)

    Revuelta-Herrero, José Luis; Chamorro-de-Vega, Esther; Rodríguez-González, Carmen Guadalupe; Alonso, Roberto; Herranz-Alonso, Ana; Sanjurjo-Sáez, María

    2018-01-01

    Evidence about the use of dolutegravir (DTG) and rilpivirine (RPV) as an antiretroviral therapy (ART) in treatment-experienced patients is scarce. To explore the effectiveness, safety, and costs of switching to a DTG plus RPV regimen in this population. This observational, prospective study included all treatment-experienced patients who switched to DTG plus RPV between November 2014 and July 2016. Patients were excluded if resistance mutations to integrase inhibitors or RPV were found. The effectiveness endpoint was the proportion of patients who achieved virological suppression (viral load [VL] 90% increased from 65.6% to 93.8% ( P = 0.004). The annual per-patient ART costs dropped by €665 ( P = 0.265). Switching to DTG plus RPV seems to be an effective and safe strategy. Significant improvements in patients' adherence and costs were achieved.

  11. Risk of leukaemia following intravenous treatment with {sup 224}Ra - results of a long term follow-up study of ankylosing spondylitis patients; Leukaemierisiko nach intravenoeser {sup 224}Ra-Behandlung - Ergebnisse einer Langzeitstudie an Bechterew-Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Wick, R.R. [GSF - Forschungszentrum fuer Umwelt und Gesundheit Neuherberg GmbH, Oberschleissheim (Germany). Inst. fuer Strahlenbiologie; Chmelevsky, D. [GSF - Forschungszentrum fuer Umwelt und Gesundheit Neuherberg GmbH, Oberschleissheim (Germany). Inst. fuer Strahlenschutz; Goessner, W. [GSF - Forschungszentrum fuer Umwelt und Gesundheit Neuherberg GmbH, Oberschleissheim (Germany). Inst. fuer Pathologie

    1993-12-31

    In an epidemiological study of the somatic late effects risk following incorporation of a short lived {alpha}-emitter, 1473 ankylosing spondylitis patients treated with repeated intravenous injections of {sup 224}Ra in the years 1948 - 75, have been observed in the GSF. The usual therapeutic plan consisted of a total of 10 - 12 injections of 1.036 MBq (28 {mu}Ci) of {sup 224}Ra each, given at weekly intervals; this would result in an cumulative {alpha}-dose of 0.56 - 0.67 Gy to the marrow-free skeleton of a 70-kg-man (standard man). These patients have been followed together with a control group of ankylosing spondylitis patients not treated with radioactive drugs and/or X-rays. Until May 1993 (mean follow-up time 19.9 yr), 595 patients of the exposure group and 722 patients of the control group have died, causes of death have been ascertained for 578, resp. 668 patients. Among others we observed in the exposure group 10 cases of leukaemia (vs. 2.7 - 2.8 cases expected, p < 0.001) and 6 cases of leukaemia in the control group (vs. 3.3 - 3.5 exp., p = 0.14). Subclassification of the leukaemias shows a clear preference for chronic myeloid leukaemia (CML) in the exposure group (4 cases obs. vs. 0.8 cases exp., p = 0.009), whereas in the control group the observed cases of CML are within the range of expectancy. Similar observations have not been made in another group of patients, now observed by Spiess and co-workers, who have been treated at a higher dose/dose rate range. This increased incidence of leukaemias in our exposure group is in one line with results from animal experiments with bone seeking {alpha}-emitters given at low dose rates. The induction of myeloid leukaemia has been demonstrated in mice down to dose rates of only a few mGy/day also for {sup 239}Pu, an {alpha}-emitter which like {sup 224}Ra deposits preferentially on the bone surface. (orig.) [Deutsch] Im Rahmen einer epidemiologischen Studie zum somatischen Strahlenspaetschadenrisiko nach

  12. Cost-Effectiveness of Dolutegravir in HIV-1 Treatment-Experienced (TE Patients in France.

    Directory of Open Access Journals (Sweden)

    Gilles Pialoux

    Full Text Available To evaluate the cost-effectiveness of a new generation integrase inhibitor (INI, dolutegravir (DTG, in France, in treatment-experienced (TE and INI-naïve HIV-infected adults with at least two classes resistance compared to raltegravir (RAL, by adapting previously published Anti-Retroviral Analysis by Monte Carlo Individual Simulation (ARAMIS model.ARAMIS is a microsimulation Markov model with a lifetime time horizon and a monthly cycle length. Health states are defined as with or without opportunistic infection and death. In the initial cohort, efficacy and safety data were derived from a phase III study comparing DTG to RAL. Antiretroviral treatment algorithms, accounting for patient history, were based on French guidelines and experts opinion. Costs are mainly including treatment costs, routine HIV and opportunistic infection care, and death. Utilities depend on CD4+ cell count and the occurrence of opportunistic infections.The ARAMIS model indicates in the TE population that DTG compared to RAL over a life time is associated with 0.35 additional quality-adjusted life years (QALY; 10.75 versus 10.41 and additional costs of €7,266 (€390,001 versus €382,735. DTG increased costs are mainly related to a 9.1-month increase in life expectancy for DTG compared with RAL, and consequently a longer time spent on ART. The incremental cost-effectiveness ratio (ICER for DTG compared with RAL is €21,048 per QALY gained. About 83% and 14% of total lifetime costs are associated with antiretroviral therapy and routine HIV care respectively. Univariate deterministic sensitivity analyses demonstrate the robustness of the model.DTG is cost-effective in the management of TE INI naive patients in France, from a collective perspective. These results could be explained by the superior efficacy of DTG in this population and its higher genetic barrier to resistance compared to RAL. These data need to be confirmed with longer-term real life data.

  13. Clobazam-Treated Patients with Lennox Gastaut Syndrome Experienced Fewer Seizure-Related Injuries than Placebo Patients During Trail OV-1012

    Science.gov (United States)

    2016-08-19

    severe seizure- related AEs occurred in the placebo group, with three patients experiencing one severe AE each (fall, contusion, or jaw fracture ). In all...only one non–seizure- related injury, and therefore no evidence to suggest that the drug was associated with injuries. The analysis also helps to...Clobazam-treated patients with Lennox-Gastaut syndrome experienced fewer seizure- related injuries than placebo patients during trial OV-1012 *Jouko

  14. Preoperative apolipoprotein CI levels correlate positively with the proinflammatory response in patients experiencing endotoxemia following elective cardiac surgery

    NARCIS (Netherlands)

    Schippers, E.F.; Berbée, J.F.P.; Disseldorp, I.M. van; Versteegh, M.I.M.; Havekes, L.M.; Rensen, P.C.N.; Dissel, J.T. van

    2008-01-01

    Objective: Experimental models show that apolipoprotein CI (apoCI) binds and enhances the inflammatory response to endotoxin. We studied in patients undergoing cardiopulmonary bypass surgery (CPB) and experiencing endotoxemia during reperfusion whether plasma apoCI levels correlate with the

  15. A unique drug distribution process for radium Ra 223 dichloride injection and its implication for product quality, patient privacy, and delineation of professional responsibilities.

    Science.gov (United States)

    Dansereau, Raymond N

    2014-11-01

    On May 15, 2013, Bayer Healthcare Pharmaceuticals announced that it had received marketing approval for the therapeutic radioactive medication radium Ra 223 dichloride injection (Xofigo; Ra 223). The product acquisition and distribution process for hospital-based nuclear pharmacies and nuclear medicine services is unlike any other. The product is distributed as a low-risk compounded sterile preparation through a single compounding nuclear pharmacy located in Denver, Colorado, pursuant to a prescription. This model for drug distribution and delivery to the user institution has implications for product quality, patient privacy, and delineation of professional responsibilities. © The Author(s) 2014.

  16. Clinical validation and applicability of different tipranavir/ritonavir genotypic scores in HIV-1 protease inhibitor-experienced patients.

    Science.gov (United States)

    Saracino, Annalisa; Monno, Laura; Tartaglia, Alessandra; Tinelli, Carmine; Seminari, Elena; Maggiolo, Franco; Bonora, Stefano; Rusconi, Stefano; Micheli, Valeria; Lo Caputo, Sergio; Lazzaroni, Laura; Ferrara, Sergio; Ladisa, Nicoletta; Nasta, Paola; Parruti, Giustino; Bellagamba, Rita; Forbici, Federica; Angarano, Gioacchino

    2009-07-01

    Tipranavir, a non-peptidic protease inhibitor which shows in vitro efficacy against some HIV-1-resistant strains, can be used in salvage therapies for multi-experienced HIV patients due to its peculiar resistance profile including 21 mutations at 16 protease positions according to International AIDS Society (IAS). Other genotypic scores, however, which attribute a different weight to single amino-acid substitutions, have been recently proposed. To validate the clinical utility of four different genotypic scores for selecting tipranavir responders, the baseline resistance pattern of 176 HIV heavily experienced patients was correlated with virological success (HIV-RNA42.5% of patients. With univariate analysis, genotypic scores were all associated with outcome but showed a low accuracy with ROC analysis, with the weighted score (WS) by Scherer et al. demonstrating the best performance with an AUC of 68%. Only 52% of patients classified as susceptible (WSIAS mutations: L33F, I54AMV, Q58E, and non-IAS mutation: N37DES. On the contrary, the use of T20 in T20-naïve patients and the V82AFSI and F53LY non-IAS mutations were associated with virological success. The study suggests that even if the "weighted" scores are able to interpret correctly the antiretroviral resistance profile of multi-experienced patients, it is difficult to individuate a cut-off which can be easily applied to this population for discriminating responders.

  17. The problems experienced by patients with cancer and their needs for palliative care.

    NARCIS (Netherlands)

    Osse, B.H.P.; Vernooy-Dassen, M.J.F.J.; Schade, E.; Grol, R.P.T.M.

    2005-01-01

    OBJECTIVES: To investigate the problems that patients experience and their met- and unmet needs for professional help. This information is necessary to tailor palliative care to patient needs. PATIENTS AND METHODS: Patients (n=94) with disseminated cancer completed a validated checklist with 90

  18. Disclosure behaviour and experienced reactions in patients with HIV versus chronic viral hepatitis or diabetes mellitus in Germany.

    Science.gov (United States)

    Kittner, J M; Brokamp, F; Jäger, B; Wulff, W; Schwandt, B; Jasinski, J; Wedemeyer, H; Schmidt, R E; Schattenberg, J M; Galle, P R; Schuchmann, M

    2013-01-01

    Disclosure is a prerequisite to receive disease-specific social support. However, in the case of a stigmatised disease, it can also lead to discrimination. We aimed to assess disclosure rates of HIV patients and the reactions they encountered in comparison to patients with chronic viral hepatitis or diabetes mellitus and patients' general perception of disease-specific discrimination. We constructed a self-report questionnaire, anonymously assessing the size of the social environment, the persons who had been informed, and the experienced reactions as perceived by the disclosing patients, to be rated on 1-4 point Likert scales. In addition, patients were asked whether they perceive general discrimination in Germany. One hundred and seventy-one patients were asked to participate. Five rejected, thus questionnaires from 83 patients with HIV, 42 patients with chronic viral hepatitis B (n = 9) or C (n = 33), and 41 patients with insulin-dependent diabetes mellitus (type I n = 14, type II n = 27) were analysed. Whereas the size of the social environment did not differ, HIV-infected patients were least likely to disclose their disease (60.7%, SD ± 31.9) to their social environment as compared to patients with chronic viral hepatitis (84.2 ± 23.3%, pdiabetes mellitus (94.4 ± 10.3%, ppatient group, the mean disclosure rate was highest to partners (90.9%), followed by the public environment (65.2%), friends (59.4%) and family members (43.8%). HIV patients experienced supportive reactions after 79.3 ± 26.4% of disclosures, which was the case in 91.4 ± 19.6% and 75.7 ± 36.1% of patients with hepatitis or diabetes mellitus, respectively. 69.5% of HIV patients stated to perceive general discrimination in Germany. We conclude that HIV patients had experienced supportive reactions after the majority of disclosures, but the low rate points out that their information strategy had been very selective. Societal discrimination of HIV patients is still an issue and needs to be

  19. Risk of leukaemia following intravenous treatment with 224Ra - results of a long term follow-up study of ankylosing spondylitis patients

    International Nuclear Information System (INIS)

    Wick, R.R.; Chmelevsky, D.; Goessner, W.

    1993-01-01

    In an epidemiological study of the somatic late effects risk following incorporation of a short lived α-emitter, 1473 ankylosing spondylitis patients treated with repeated intravenous injections of 224 Ra in the years 1948 - 75, have been observed in the GSF. The usual therapeutic plan consisted of a total of 10 - 12 injections of 1.036 MBq (28 μCi) of 224 Ra each, given at weekly intervals; this would result in an cumulative α-dose of 0.56 - 0.67 Gy to the marrow-free skeleton of a 70-kg-man (standard man). These patients have been followed together with a control group of ankylosing spondylitis patients not treated with radioactive drugs and/or X-rays. Until May 1993 (mean follow-up time 19.9 yr), 595 patients of the exposure group and 722 patients of the control group have died, causes of death have been ascertained for 578, resp. 668 patients. Among others we observed in the exposure group 10 cases of leukaemia (vs. 2.7 - 2.8 cases expected, p 239 Pu, an α-emitter which like 224 Ra deposits preferentially on the bone surface. (orig.) [de

  20. Waardenburg Syndrome: An Unusual Indication of Cochlear Implantation Experienced in 11 Patients.

    Science.gov (United States)

    Bayrak, Feda; Çatlı, Tolgahan; Atsal, Görkem; Tokat, Taşkın; Olgun, Levent

    2017-08-01

    The aim of this study was to present the surgical findings of children with Waardenburg syndrome (WS) and investigate speech development after cochlear implantation in this unique group of patients. A retrospective chart review of the patients diagnosed with WS and implanted between 1998 and 2015 was performed. Categories of auditory performance (CAP) test were used to assess the auditory skills of these patients. CAP is a nonlinear hierarchical scale used to rate a child's developing auditory abilities. Preoperative test results and intraoperative surgical findings of these patients have been presented. In total, 1835 cases were implanted a tour institution, and 1210 of these were children. Among these implantees, 11 were diagnosed with WS (0.59% of all implantees). Four of the 11 patients showed incomplete partition type 2bony labyrinth abnormality (Mondini deformity) and all patients showed intraoperative gusher during cochleostomy, which was subsided through routine interventions. No other complications occurred during surgery, and all patients showed satisfactory CAP results in the late postoperative period. Our experiences with cochlear implantation in patients with WS showed that the procedure is safe and effective in this group of patients. Surgeons should be aware of possible labyrinth malformations and intraoperative problems such as gusher in these patients. In long term, auditory performances may exhibit satisfactory results with optimal postoperative educational and supportive measures.

  1. Understanding the Knowledge Gap Experienced by U.S. Safety Net Patients in Teleretinal Screening.

    Science.gov (United States)

    George, Sheba M; Hayes, Erin Moran; Fish, Allison; Daskivich, Lauren Patty; Ogunyemi, Omolola I

    2016-01-01

    Safety-net patients' socioeconomic barriers interact with limited digital and health literacies to produce a "knowledge gap" that impacts the delivery of healthcare via telehealth technologies. Six focus groups (2 African- American and 4 Latino) were conducted with patients who received teleretinal screening in a U.S. urban safety-net setting. Focus groups were analyzed using a modified grounded theory methodology. Findings indicate that patients' knowledge gap is primarily produced at three points during the delivery of care: (1) exacerbation of patients' pre-existing personal barriers in the clinical setting; (2) encounters with technology during screening; and (3) lack of follow up after the visit. This knowledge gap produces confusion, potentially limiting patients' perceptions of care and their ability to manage their own care. It may be ameliorated through delivery of patient education focused on both disease pathology and specific role of telehealth technologies in disease management.

  2. The healthcare utilization and cost of treating patients experiencing inappropriate implantable cardioverter defibrillator shocks: a propensity score study.

    Science.gov (United States)

    Bhavnani, Sanjeev P; Giedrimiene, Dalia; Coleman, Craig I; Guertin, Danette; Azeem, Meena; Kluger, Jeffrey

    2014-10-01

    Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs. We conducted a case-control analysis of ICD patients at a single institution from 1997 to 2010 and who had ≥12 months of post-ICD implant follow-up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year [PY]) of healthcare utilization immediately following IAS to the end of the 12-month follow-up period to the rate in the no-shock group over 12 months of follow-up. We also compared 12-month postimplant treatment (outpatient clinic, emergency room, and hospitalization) costs in both groups. A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no-shock patients (contributing 76 PYs). Cardiovascular (CV)-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (4.0 vs 3.3 and 0.7 vs 0.5, respectively, P = 0.02 for both). CV-related emergency room visitation (0.15 vs 0.08) rates were also numerically higher following an IAS, but did not reach statistical significance (P = 0.26). Patients experiencing an IAS accrued greater treatment costs during the 12 months postimplant compared to no-shock patients ($13,973 ± $46,345 vs $6,790 ± $19,091, P = 0.001). Recipients of IAS utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization results in higher costs of treating IAS

  3. Patients with 47, XXX karyotype who experienced premature ovarian failure (POF): two case reports.

    Science.gov (United States)

    Sugawara, Nobuo; Maeda, Machiko; Manome, Tomomi; Nagai, Rie; Araki, Yasuhisa

    2013-10-01

    Pubertal onset and sexual development are usually normal in 47, XXX individuals; however, we report two cases of premature ovarian failure (POF) in infertile women with trisomy X. Chromosome analysis was conducted with G-banding and fluorescence in situ hybridization using X- and Y-bearing probe. Hormonal administration was primarily Kaufmann's treatment or long-term estradiol treatment, followed by withdrawal bleeding from estrogen and progesterone. Two patients with trisomy X, aged 31 (patient 1) and 27 years (patient 2), were diagnosed with POF due to hypergonadotropic hypogonadism. Their ovaries were small. Patient 1 had a FSH level of 44.6 mIU/ml and patient 2 had a FSH level of 74.6 mIU/ml. In patient 1, with Kaufmann's treatment, the FSH decreased to 13.5 mIU/ml; however, follicle growth did not occur following HMG stimulation. In patient 2, FSH did not decrease despite Kaufmann's treatment; therefore, she was given a GnRH agonist and her FSH level decreased to 7.1 mIU/ml. However, her ovaries never responded to HMG stimulation. We report on two patients with a 47, XXX karyotype who became infertile due to POF. We recommend that when a patient is diagnosed with trisomy X, the possibility of POF must be strongly considered.

  4. The essence and meaning of aesthetics in patient care as experienced by nurses

    DEFF Research Database (Denmark)

    Herholdt-Lomholdt, Sine Maria; Uhrenfeldt, Lisbeth

    2016-01-01

    This systematic review seeks to identify, appraise and synthesize available qualitative studies describing nurses’ experiences of the essence and meaning of the phenomenon ‘‘aesthetics’’ in patient care. The specific purpose of the review is to examine the qualitative literature to describe nurses......’ experiences of the phenomenon ‘‘aesthetics’’ within patient care in healthcare settings. More specifically, from the nurses’ perspectives, the aims are: To describe the essence of aesthetics within patient care. To describe the meaning of aesthetics within patient care. To describe what an aesthetic...

  5. Effectiveness and Risk Factors for Virological Outcome of Raltegravir-Based Therapy for Treatment-Experienced HIV-Infected Patients.

    Science.gov (United States)

    Mata-Marín, José Antonio; Smeke, Ariane Estrella Weiser; Rodriguez, Mariana Rotzinger; Chávez-García, Marcelino; Banda-Lara, Marco Isaac; Rios, Alma Minerva Pérez; Nuñez-Rodríguez, Nohemí; Domínguez-Hermosillo, Juan Carlos; Sánchez, Alberto Chaparro; Juarez-Kasusky, Irene; Herrera, Javier Enrique Cruz; Ramírez, Jorge Luis Sandoval; Gaytán-Martínez, Jesús

    2017-03-01

    We evaluated the effectiveness of a raltegravir (RAL)-containing regimen plus an optimized background regimen in HIV-1 highly treatment-experienced patients. A retrospective cohort, multicentre study was conducted. Adult (>16 years old) HIV treatment-experience patients starting therapy with a RAL-containing regimen were included. Effectiveness was evaluated as the percentage of patients with an undetectable HIV-1 RNA viral load (treatment failure. Of the 107 patients in the cohort, 86% were men, the median age was 45 years [interquartile range (IQR) 40-52] and the median number of previous regimens was six (IQR 4-7). After 48 weeks of treatment, 73% (IQR 63-80%) of patients (n = 78) had a viral load of HIV-1 RNA of 40 years [odds ratio (OR) 5.61; 95% confidence interval (CI) 1.61-18.84; P = 0.006] and use of tenofovir in the regimen (OR 0.16; 95% CI 0.03-0.80; P = 0.026). In this Mexican cohort, RAL achieved high rates of virological suppression and an increase in CD4+ cell count in highly treatment-experienced patients infected with HIV-1. Age >40 years was associated with a good virological outcome, contrary to tenofovir use, which was associated with a poor virological outcome.

  6. Experiencing control

    NARCIS (Netherlands)

    Monaci, G.; Braspenning, R.A.C.; Meerbeek, B.W.; Bingley, P.; Rajagopalan, R.; Triki, M.

    2009-01-01

    This report describes the activities carried out in the first part of the Experiencing Control project (2008-324). The guiding idea of the project is to make control part of the experience, exploring new interaction solutions for complex, engaging interactions with Philips devices in the living

  7. Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification.

    Science.gov (United States)

    Ahmad, Nauman; Zahoor, Abdul; Motowa, Saeed A; Jastaneiah, Saba; Riad, Waleed

    2012-01-01

    Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS). The Student's t-test was used to determine the significance of IOWA score in both groups. Ptopical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively). In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively). Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

  8. Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification

    Directory of Open Access Journals (Sweden)

    Nauman Ahmad

    2012-01-01

    Full Text Available Background: Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Methods: Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS. The Student′s t-test was used to determine the significance of IOWA score in both groups. P<0.05 was considered significant. Results: Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively. In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively. Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Conclusion: Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

  9. Universality of physicians' burnout syndrome as a result of experiencing difficulty in relationship with patients.

    Science.gov (United States)

    Sablik, Zbigniew; Samborska-Sablik, Anna; Drożdż, Jarosław

    2013-06-20

    The aim of our work is to present the universality of burnout syndrome among physicians worldwide and to demonstrate selected aspects of the relationship between patients and doctors as a common factor predisposing to burnout. We looked up 20 original pieces of research from the Medline database published in the last 10 years to determine the prevalence of burnout among doctors in different countries. In all quoted works a remarkable percentage of doctors of interventional and non-interventional specialties suffered burnout. Because it is the relationship with patients that constitutes a key denominator for their work, in the discussion we have exposed an important aspect of it, destructive patient games, described on the basis of transactional analysis. Since universal burnout causes a deterioration of doctors' service, for the optimal good of the patient to survive preservation of the doctor's well-being in the patient-doctor relationship is needed everywhere.

  10. [Accommodation effects of the audiovisual stimulation in the patients experiencing eyestrain with the concomitant disturbances of psychological adaptation].

    Science.gov (United States)

    Shakula, A V; Emel'ianov, G A

    2014-01-01

    The present study was designed to evaluate the effectiveness of audiovisual stimulation on the state of the eye accommodation system in the patients experiencing eyes train with the concomitant disturbances of psychological. It was shown that a course of audiovisual stimulation (seeing a psychorelaxing film accompanied by a proper music) results in positive (5.9-21.9%) dynamics of the objective accommodation parameters and of the subjective status (4.5-33.2%). Taken together, these findings whole allow this method to be regarded as "relaxing preparation" in the integral complex of the measures for the preservation of the professional vision in this group of the patients.

  11. International normalized ratio stability in warfarin-experienced patients with nonvalvular atrial fibrillation.

    Science.gov (United States)

    Nelson, Winnie W; Desai, Sunita; Damaraju, Chandrasekharrao V; Lu, Lang; Fields, Larry E; Wildgoose, Peter; Schein, Jeffery R

    2015-06-01

    Maintaining stable levels of anticoagulation using warfarin therapy is challenging. Few studies have examined the stability of the international normalized ratio (INR) in patients with nonvalvular atrial fibrillation (NVAF) who have had ≥6 months' exposure to warfarin anticoagulation for stroke prevention. Our objective was to describe INR control in NVAF patients who had been receiving warfarin for at least 6 months. Using retrospective patient data from the CoagClinic™ database, we analyzed data from NVAF patients treated with warfarin to assess the quality of INR control and possible predictors of poor INR control. Time within, above, and below the recommended INR range (2.0-3.0) was calculated for patients who had received warfarin for ≥6 months and had three or more INR values. The analysis also assessed INR patterns and resource utilization of patients with an INR >4.0. Logistic regression models were used to determine factors associated with poor INR control. Patients (n = 9433) had an average of 1.6 measurements per 30 days. Mean follow-up time was 544 days. Approximately 39% of INR values were out of range, with 23% of INR values being 3.0. Mean percent time with INR in therapeutic range was 67%; INR 3.0 was 14%. Patients with more than one reading of INR >4.0 (~39%) required an average of one more visit and took 3 weeks to return to an in-range INR. Male sex and age >75 years were predictive of better INR control, whereas a history of heart failure or diabetes were predictive of out-of-range INR values. However, patient characteristics did not predict the likelihood of INR >4.0. Out-of-range INR values remain frequent in patients with NVAF treated with warfarin. Exposure to high INR values was common, resulting in increased resource utilization.

  12. On the role of the amygdala for experiencing fatigue in patients with multiple sclerosis.

    Science.gov (United States)

    Hanken, Katrin; Francis, Yoselin; Kastrup, Andreas; Eling, Paul; Klein, Jan; Hildebrandt, Helmut

    2018-02-01

    Recently, we proposed a model explaining the origin of fatigue in multiple sclerosis (MS) patients. This model assumes that the feeling of fatigue results from inflammation-induced information processing within interoceptive brain areas. To investigate the association between self-reported cognitive fatigue and structural integrity of interoceptive brain areas in MS patients. 95 MS patients and 28 healthy controls participated in this study. All participants underwent diffusion tensor MRI and fractional anisotropy data were calculated for the amygdala, the stria terminalis and the corpus callosum, a non-interoceptive brain area. Based on the cognitive fatigue score of the Fatigue Scale for Motor and Cognition, patients were divided into moderately cognitively fatigued (cognitive fatigue score ≥ 28) and cognitively non-fatigued (cognitive fatigue score < 28) MS patients. Healthy controls were recruited as a third group. Repeated measures analyses of covariance, controlling for age, depression and brain atrophy, were performed to investigate whether the factor Group had a significant effect on the fractional anisotropy data. A significant effect of Group was observed for the amygdala (F = 3.389, p = 0.037). MS patients without cognitive fatigue presented lower values of the amygdala than MS patients with cognitive fatigue and healthy controls. For the stria terminalis and the corpus callosum, no main effect of Group was observed. The structural integrity of the amygdala in non-fatigued MS patients appears to be reduced. According to our model this might indicate that the absence of fatigue in non-fatigued MS patients might result from disturbed inflammation-induced information processing in the amygdala. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Behavioural typologies of experienced benefit of psychomotor therapy in patients with chronic shoulder pain: A grounded theory approach.

    Science.gov (United States)

    Stamp, Anne Schinkel; Pedersen, Lise Lang; Ingwersen, Kim Gordon; Sørensen, Dorthe

    2018-05-01

    In this study we aimed to develop a theoretical account of the experienced benefit of psychomotor therapy in addition to treatment as usual in patients with chronic shoulder pain. The qualitative study design was based on a grounded theory approach. Open-ended face-to-face interviews were conducted after treatment was completed. We generated data and performed analyses by constant comparative analysis and theoretical sampling that focused on the patients' behavioural characteristics related to the experienced benefit of psychomotor therapy. We conducted 12 interviews, eight of which were with men. "Regaining capability" emerged as representative of the pattern of behaviour. Through this pattern, the patients resolved concern about losing capability. Regaining capability involved three behavioural typologies: taking advice, minding the body, and encompassing life changes. The patients' behavioural typologies revealed different levels of life changes. Psychomotor therapy offered the patients in our study new and better ways of coping with their shoulder pain. Copyright © 2018 Department of Physio- and Occupational Therapy, Hospital Lillebaelt - Vejle Hospital. Published by Elsevier Ltd.. All rights reserved.

  14. Tenofovir treatment in an unselected cohort of highly antiretroviral experienced HIV positive patients

    DEFF Research Database (Denmark)

    Lerbaek, Anne; Kristiansen, Thomas B; Katzenstein, Terese L

    2004-01-01

    The aim of the present study was to explore the treatment effect of tenofovir as implemented in clinical practice. Data are presented on 34 patients. 11 patients had tenofovir added to a stable anti-retroviral treatment (ART) and 23 patients had drugs other than tenofovir. CD4 counts, HIV......-RNA levels and genotypic resistance were determined at baseline and after 3 and 6 months. After initiation of tenofovir treatment, a mean decrease in HIV-RNA for all 34 patients was observed (-0.43 log1o copies/ml (+/- 1.22) and -0.49 log10 copies/ml (+/- 1.36) after 3 and 6 months, respectively, (p = 0...... initiation of tenofovir treatment, no significant increases in CD4 count were observed. All new NRTI-associated mutations could be explained by the background treatment. In conclusion, we observed a significant decrease in HIV-RNA only when tenofovir was prescribed, in conjunction with other anti...

  15. Effect of bedside shielding on air-kerma rates around gynecologic intracavitary brachytherapy patients containing 226Ra or 137Cs

    International Nuclear Information System (INIS)

    Papin, P.J.; Ramsey, M.J.; LaFontaine, R.L.; LePage, R.P.

    1990-01-01

    An anthropomorphic phantom was implanted with 226Ra or 137Cs gynecologic intracavitary brachytherapy sources. Air-kerma rate measurements were taken at 10-cm increments along a horizontal plane from the side of the bed at 50 cm, 87 cm, and 136 cm heights above the floor. Five portable lead shields were placed at the head, at the foot and along one side of the bed and readings were taken again at the corresponding heights above, below and behind the shields. The readings were normalized to 100-mg Ra equivalence, and air-kerma rate curves were drawn allowing for the comparison of 226Ra and 137Cs with and without lead shields. The data demonstrated that the air-kerma rates for 137Cs were reduced more than those for 226Ra with the use of the portable lead shields. There was four times the transmission with 226Ra than with 137Cs. The optimal placement was with the lateral bedside shields proximal to the head and foot closest to the bed, with the middle shield overlapping in back. The shields at the head and foot should extend out and overlap the bedside shields. The level of the sources should be positioned near the bottom of the shields. This information will provide the medical health physicist with an estimate of air-kerma rates for both 226Ra and 137Cs with and without shielding for evaluating personnel exposures as well as the effectiveness of current shielding in relation to radiation protection requirements in adjacent rooms or hallways

  16. Protease mutations emerging on darunavir in protease inhibitor-naïve and experienced patients in the UK.

    Science.gov (United States)

    El Bouzidi, Kate; White, Ellen; Mbisa, Jean L; Phillips, Andrew; Mackie, Nicola; Pozniak, Anton; Dunn, David

    2014-01-01

    Darunavir (DRV) is a preferred agent in treatment guidelines for ART-naïve and experienced patients [1]. It is considered to have a high genetic barrier to resistance and 11 resistance-associated mutations (RAMs) are recognized by IAS-USA [2]. These have largely been identified by analyses examining the correlation between baseline genotype and virological response [3]. However, there is little information on RAMs that are directly selected by DRV, outside of short-term clinical trials. We aimed to identify emerging mutations by comparing the genotypes of individuals before and after DRV exposure. The UK HIV Drug Resistance Database was used to identify patients aged over 16 who had received at least 30 days of a DRV-containing regimen. Patients were included if they had a "baseline" resistance test, prior to DRV exposure, and a "repeat" test, either on DRV or within 30 days of stopping this agent. To avoid attributing the effects of other PIs on emerging RAMs to DRV, patients were excluded if they had received another PI for greater than 90 days between the baseline genotype and the start of DRV. The baseline and repeat tests were compared to determine the nature of mutations stratified by PI history. A total of 5623 patients had DRV, of whom 306 met the inclusion criteria. A total of 228 (74.5%) were male, median age at the start of DRV was 42 years (IQR 37-47), and half had subtype B infection. The mode of transmission was homosexual contact for 50%, heterosexual for 38%, and 3% were injection drug users. The median CD4 count at the start of DRV was 257 cells/mm(3) (IQR 94-453). A total of 149 patients (49%) had a history of PI use prior to DRV, and 157 (51%) were PI-naïve. The most common previous PIs were lopinavir, atazanavir, and saquinavir. Baseline DRV RAMs were present in 1 (0.6%) PI-naïve and 20 (13.4%) PI-experienced patients. Mutations emerged under DRV pressure in a further 3 (1.9%) PI-naïve patients, and in 7 (4.7%) PI-experienced patients, 5 of

  17. Clinical and pulmonary functions profiling of patients with chronic obstructive pulmonary disease experiencing frequent acute exacerbations

    Directory of Open Access Journals (Sweden)

    Prem Parkash Gupta

    2018-01-01

    Full Text Available Purpose: The present study aimed at clinical and pulmonary functions profiling of patients with chronic obstructive pulmonary disease (COPD to anticipate future exacerbations. Methods: The study included 80 COPD patients; 40 patients had ≥2 acute exacerbations during preceding 1 year (frequent exacerbation [FECOPD] group and 40 patients had <2 acute exacerbations during preceding 1 year (infrequent exacerbation [I-FECOPD] group. Clinical profile, sputum microbiology, blood gas analysis, spirometric indices, and diffusion capacity (transfer test variables were assessed. Groups' comparison was performed using an independent t-test for numeric scale parameters and Chi-square test for nominal parameters. Pearson's and Spearman's correlation coefficients were derived for numeric scale parameters and numeric nominal parameters, respectively. Multinomial logistic regression analysis was done using SPSS software. Results: FECOPD group contained younger patients than in I-FECOPD group although the difference was not statistically significant. There was no significant difference between two groups regarding smoking pack-years and duration of illness. FECOPD group had significantly more expectoration score and Modified Medical Research Council dyspnea scores. Cough score and wheeze score did not differ significantly between two groups. More patients in FECOPD group (12/40 vs. 4/40 had lower airway bacterial colonization. Arterial blood gas parameters were more deranged in FECOPD group. Spirometric indices (forced expiratory volume during 1st s as well as transfer test (both diffusing capacity for carbon monoxide and transfer coefficient of the lung values were significantly reduced in FECOPD group. Conclusions: The patients in FECOPD group had clinical, spirometric, and transfer test profiling suggestive of a severe COPD phenotype, the recognition will help in predicting future exacerbations and a better management.

  18. Depression and caregiver burden experienced by caregivers of Jordanian patients with stroke.

    Science.gov (United States)

    Kamel, Andaleeb Abu; Bond, A Elaine; Froelicher, Erika Sivarajan

    2012-04-01

    Many stroke survivors will be cared for at home, primarily by their relatives. Providing care to a family member with a chronic disabling disease can be both emotionally and physically distressing for the caregivers. The purpose of this study was to investigate the relationship between patients' characteristics, duration of caregiving, daily caregiving time, caregiver's characteristics, caregiver depression and burden in caregivers of patients with stroke. A cross-sectional design was used with a convenience sample of 116 subjects. The Center of Epidemiologic Studies of Depression and the Caregiver Strain Index were used to identify caregiver depression and burden, respectively. Logistic regression analysis identified the influence of independent variables on caregiver depression and caregiver burden. Caregivers had high scores for depression and burden indices. Caregivers' health, receiving professional home health care and caregivers' burden were related to caregiver depression. Functional disabilities of patients with stroke and depression of caregivers were related to caregiver burden. To decrease caregiver depression and burden, nurses must provide caregivers with instructions for home management of patients with stroke. Development of specialized stroke home health services in Jordan that targets patients with stroke and their caregivers are recommended. © 2012 Blackwell Publishing Asia Pty Ltd.

  19. Psychological assessment of acute schizophrenia patients who experienced seclusion either alone or in combination with restraint.

    Science.gov (United States)

    Eguchi, Rika; Onozuka, Daisuke; Ikeda, Kouji; Kuroda, Kenji; Ieiri, Ichiro; Hagihara, Akihito

    2018-05-01

    Objective Numerous studies on the effects of seclusion and/or restraint in acute psychiatric treatment have reported both positive and negative effects. However, no studies to date have evaluated the effects of seclusion and/or restraint on schizophrenia patients using a rating scale. Thus, to examine the effects of seclusion and/or restraint on schizophrenia patients, we used the Brief Psychiatric Rating Scale and assessed the psychological condition of patients. Methods Factor analysis was conducted to create subscales of Brief Psychiatric Rating Scale, and psychiatric changes were assessed with respect to each subscale using multiple logistic regression analyses. Analyses were performed on three groups (i.e. entire, higher functioning, and lower functioning groups) involving a total of 1559 schizophrenia patients aged 18 to 65 years. Results In the entire and lower functioning groups, seclusion was a significant predictor of improvements related to the "hostility/suspiciousness" subscale. Seclusion combined with restraint was associated with improvements related to the "psychosis/thinking disorder" subscale. In the higher functioning group, there were no significant predictors. Conclusions It is implied that seclusion and/or restraint is related to improved psychiatric symptoms only among patients whose functioning is impaired. To verify the present findings, further studies involving multiple sites and additional psychiatric measures are necessary.

  20. Joint positions matter for ultrasound examination of RA patients-increased power Doppler signal in neutral versus flat position of hands.

    Science.gov (United States)

    Husic, Rusmir; Lackner, Angelika; Stradner, Martin H; Hermann, Josef; Dejaco, Christian

    2017-08-01

    Position of joints might influence the result of US examination in patients with RA. The purpose of this work was to compare grey-scale (GS) and power Doppler (PWD) findings obtained in neutral vs flat position of hands. A cross-sectional study of 42 RA patients with active disease. Two dimensional and 3D sonography of wrists and MCP joints were conducted in two different joint positions: neutral position, which is a slight flexion of the fingers with relaxed extensor muscles; and flat position, where all palm and volar sides of fingers touch the Table. Two dimensional GS synovitis (GSS) and PWD signals were scored semi-quantitatively (0-3). For 3D sonography, the percentage of PWD voxels within a region of interest was calculated. GSS was not quantified using 3D sonography. Compared with neutral position, 2D PWD signals disappeared in 28.3% of joints upon flattening. The median global 2D PWD score (sum of all PWD scores of an individual patient) decreased from 8 to 3 ( P < 0.001), and the global 3D PWD voxel score from 3.8 to 0.9 ( P < 0.001). The reduction of PWD scores was similar in all joints (2D: minus 50%, 3D: minus 66.4-80.1%). Inter- and intrareader agreement of PWD results was good (intraclass correlation coefficient: 0.75-0.82). In RA, a neutral position of the hands is linked to a higher sensitivity of 2D and 3D sonography in detecting PWD signals at wrists and MCP joints, compared with a flat position. Standardization of the scanning procedure is essential for obtaining comparable US results in RA patients in trials and clinical routines. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  1. Power of national economy, disease control and employment status in patients with RA-an analytical multi-site ecological study.

    Science.gov (United States)

    Pieringer, Herwig; Puchner, Rudolf; Pohanka, Erich; Danninger, Kathrin

    2016-02-01

    In rheumatology, sufficient disease control is a central part of the treatment concept. However, modern treatment strategies are associated with a substantial economic burden for health care systems. Ecological studies offer the unique opportunity to analyse differences between groups as well as group level effects. In the present analytical multi-site ecological study, we investigated whether more powerful national economies as measured by the gross domestic product per capita (GDPpc) are associated with better disease control in RA patients as measured by the disease activity score 28 (DAS28). We used aggregated data on RA patients from the recently published COMORA study as well as the World Health Organization database. There was a strong negative correlation between DAS28 and GDPpc (r = -0.815; p = 0.0002). Adjustment for sex, smoking status, disease duration or current employment status did not significantly change this association. There was a strong, negative correlation between DAS28 and age (r = -0.870; p < 0.001) and a strong, positive correlation between GDPpc and age (r = 0.737; p = 0.002). Adjustment for age reduced the regression coefficient (DAS28/GDPpc) to -0.000018 (p = 0.054). There was a negative correlation between DAS28 and current employment status (r = -0.642; p = 0.008) and a positive correlation between GDPpc and employment status (r = 0.722; p = 0.002). In conclusion, there is evidence of an association between disease control and GDPpc. This association is alleviated after adjustment for age. Of note, in countries with higher GDPpc, a higher proportion of RA patients are currently employed. This is true despite the fact that RA patients in countries with higher GDPpc are also older.

  2. Life perceptions of patients receiving palliative care and experiencing psycho-social-spiritual healing.

    Science.gov (United States)

    Li, Lingsheng; Sloan, Danetta H; Mehta, Ambereen K; Willis, Gordon; Weaver, Meaghann S; Berger, Ann C

    2017-07-01

    It is important to identify, from the patients' perspectives, the different factors that contribute toward psycho-social-spiritual healing. This was a qualitative study that took place at a large research center, an underserved clinic, and a community hospital. We used a needs assessment questionnaire and open-ended questions to assess the constituents of psycho-social-spiritual healing: (I) how previous life experiences affected patients' present situations in dealing with their illnesses; (II) barriers to palliative care, and (III) benefits of palliative care. Of a total of 30 participants from 3 different study sites, 24 (80%) were receiving inpatient or outpatient palliative care at a research center. Thirteen (43%) participants were female, 10 (33%) were Black/African American, and 16 (53%) reported being on disability. While the initial shock of the diagnosis made participants feel unprepared for their illnesses, many looked to role models, previous work experiences, and spiritual as well as religious support as sources of strength and coping mechanisms. Barriers to palliative care were identified as either external (lack of proper resources) or internal (symptom barriers and perceived self-limitations). The feeling of "being seen/being heard" was perceived by many participants as the most beneficial aspect of palliative care. The needs assessment questionnaire and open-ended questions presented in this study may be used in clinical settings to better help patients achieve psycho-social-spiritual healing through palliative care and to help clinicians learn about the person behind the patient.

  3. Anxiety and depression after failure of assisted reproductive treatment among patients experiencing infertility.

    Science.gov (United States)

    Maroufizadeh, Saman; Karimi, Elaheh; Vesali, Samira; Omani Samani, Reza

    2015-09-01

    To investigate the impact of the number of previous infertility treatment failures on anxiety and depression. In a cross-sectional study, individuals (men and women, but not couples) aged at least 18 years who had a history of infertility and could read and write in Persian were enrolled at the Royan Institute, Tehran, Iran, between November 1, 2013, and February 28, 2014. Participants provided demographic and infertility information and completed the Persian version of the Hospital Anxiety and Depression Scale (HADS). Overall, 330 patients (122 men, 208 women) were included. Mean scores on the HADS anxiety and depression subscales (HADS-A and HADS-D) were 8.40±4.51 and 5.95±3.54, respectively. In multiple regression analysis, mean HADS-A scores were significantly higher for patients with one treatment failure (9.57±4.58) than for those without a history of treatment (7.79±4.13; P=0.003). HADS-D scores were significantly higher for patients with two failures (6.92±3.69) than for those with no previous treatment (5.59±3.79; P=0.019). Patients with infertility have increased depression and anxiety after infertility treatment failure. Counseling or treatment for these potential psychological effects should be considered after infertility treatment failure. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  4. The therapeutic use of music as experienced by cardiac surgery patients of an intensive care unit

    Directory of Open Access Journals (Sweden)

    Varshika M. Bhana

    2014-04-01

    Full Text Available Patients perceive the intensive care unit (ICU as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants.

  5. Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy

    Directory of Open Access Journals (Sweden)

    Anna Calleja

    2015-01-01

    Full Text Available Background. Right ventricular (RV dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined. Aim. We sought to determine the incidence and prognostic value of RV dysfunction at time of LV defined cardiotoxicity. Methods. We retrospectively identified 30 HER2+ female patients with breast cancer treated with trastuzumab (± anthracycline who developed cardiotoxicity and had a diagnostic quality transthoracic echocardiography. LV ejection fraction (LVEF, RV fractional area change (RV FAC, and peak systolic longitudinal strain (for both LV and RV were measured on echocardiograms at the time of cardiotoxicity and during follow-up. Thirty age balanced precancer therapy and HER2+ breast cancer patients were used as controls. Results. In the 30 patients with cardiotoxicity (mean ± SD age 54 ± 12 years RV FAC was significantly lower (42 ± 7 versus 47 ± 6%, P=0.01 compared to controls. RV dysfunction defined by global longitudinal strain (GLS < −20.3% was seen in 40% (n=12. During follow-up in 16 out of 30 patients (23 ± 15 months, there was persistent LV dysfunction (EF < 55% in 69% (n=11. Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant. Conclusion. RV dysfunction at the time of LV cardiotoxicity is frequent in patients with breast cancer receiving trastuzumab therapy. Despite appropriate management, LV dysfunction persisted in the majority at follow-up. The prognostic value of RV dysfunction at the time of cardiotoxicity warrants further investigation.

  6. Are RA patients from a non-endemic HCV population screened for HCV? A cross-sectional analysis of three different settings.

    Science.gov (United States)

    Skinner-Taylor, Cassandra Michelle; Erhard-Ramírez, Alejandro; Garza-Elizondo, Mario Alberto; Esquivel-Valerio, Jorge Antonio; Abud-Mendoza, Carlos; Martínez-Martínez, Marco Ulises; Vega-Morales, David; Arana-Guajardo, Ana

    In Mexico, other risk factors are associated with hepatitis C virus (HCV): prior heroin users, living alone, widower, and northern region residence. Rheumatoid arthritis (RA) patients are considered immunosuppressed and HCV testing is recommended before treatment. The aim of the study was to describe the characteristics of HCV testing in RA patients in three different medical care settings in a non-endemic area. A retrospective observational study was performed using medical records from 960 RA patients describing the indications for HCV testing. The test was performed in 28.6% and the HCV overall frequency was 0.36%. Population characteristics were not associated with an increased risk of HCV infection; therefore, anti-HCV positivity was low. The main reason for testing was before starting biological agents. Due to the low pre-test probability, testing for HCV infection should be personalized; i.e., according to disease prevalence in a particular geographical location and the individual risk factors. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  7. Tuberculous meningitis: symptoms, diagnosis and evaluation experienced in 532 patients in a pediatric hospital

    Directory of Open Access Journals (Sweden)

    Napoleón González-Saldaña

    2016-03-01

    Full Text Available Objective: To analyze the procedures to manage tuberculous meningitis (TM employed in a third level hospital. Methods: A descriptive study was carried out on the procedures used to manage TM in 532 children attended at the Infectology Service of National Institute of Pediatrics of Mexico City. Patients included must have analysis of cerebrospinal fluid suggestive of TM and negative for other bacteria among others criteria. Results: The predominant signs observed were fever in 486 patients, apathy in 485, somnolence in 477, headache in 173, seizure crisis in 400 and coma progression in 17. Cerebrospinal fluid showed an average of 199 cells/mL, proteins 170.8 mg. Chest X-ray showed abnormalities in 330 cases and brain tomography revealed basal arachnoiditis in 306 cases. 24 patients died and 414 of them had audition and epileptic sequels. Conclusions: TM has continued to be a serious health problem in developing countries. Delay in diagnosis of this disease is a cause of the increase not only of its morbidity but also its mortality as well as its sequels.

  8. Trends in Decline of Antiretroviral Resistance among ARV-Experienced Patients in the HIV Outpatient Study: 1999–2008

    Directory of Open Access Journals (Sweden)

    Kate Buchacz

    2012-01-01

    Full Text Available Background. Little is known about temporal trends in frequencies of clinically relevant ARV resistance mutations in HIV strains from U.S. patients undergoing genotypic testing (GT in routine HIV care. Methods. We analyzed cumulative frequency of HIV resistance among patients in the HIV Outpatient Study (HOPS who, during 1999–2008 and while prescribed antiretrovirals, underwent GT with plasma HIV RNA >1,000 copies/mL. Exposure ≥4 months to each of three major antiretroviral classes (NRTI, NNRTI and PI was defined as triple-class exposure (TCE. Results. 906 patients contributed 1,570 GT results. The annual frequency of any major resistance mutations decreased during 1999–2008 (88% to 79%, P=0.05. Resistance to PIs decreased among PI-exposed patients (71% to 46%, P=0.010 as exposure to ritonavir-boosted PIs increased (6% to 81%, P<0.001. Non-significant declines were observed in resistance to NRTIs among NRTI-exposed (82% to 67%, and triple-class-resistance among TCE patients (66% to 41%, but not to NNRTIs among NNRTI-exposed. Conclusions. HIV resistance was common but declined in HIV isolates from subgroups of ARV-experienced HOPS patients during 1999–2008. Resistance to PIs among PI-exposed patients decreased, possibly due to increased representation of patients whose only PI exposures were to boosted PIs.

  9. Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure.

    Science.gov (United States)

    Smith, Sonali M; Godfrey, James; Ahn, Kwang Woo; DiGilio, Alyssa; Ahmed, Sairah; Agrawal, Vaibhav; Bachanova, Veronika; Bacher, Ulrike; Bashey, Asad; Bolaños-Meade, Javier; Cairo, Mitchell; Chen, Andy; Chhabra, Saurabh; Copelan, Edward; Dahi, Parastoo B; Aljurf, Mahmoud; Farooq, Umar; Ganguly, Siddhartha; Hertzberg, Mark; Holmberg, Leona; Inwards, David; Kanate, Abraham S; Karmali, Reem; Kenkre, Vaishalee P; Kharfan-Dabaja, Mohamed A; Klein, Andreas; Lazarus, Hillard M; Mei, Matthew; Mussetti, Alberto; Nishihori, Taiga; Ramakrishnan Geethakumari, Praveen; Saad, Ayman; Savani, Bipin N; Schouten, Harry C; Shah, Nirav; Urbano-Ispizua, Alvaro; Vij, Ravi; Vose, Julie; Sureda, Anna; Hamadani, Mehdi

    2018-04-12

    Early treatment failure (ETF) in follicular lymphoma (FL), defined as relapse or progression within 2 years of frontline chemoimmunotherapy, is a newly recognized marker of poor survival and identifies a high-risk group of patients with an expected 5-year overall survival (OS) rate of approximately 50%. Transplantation is an established option for relapsed FL, but its efficacy in this specific ETF FL population has not been previously evaluated. This study compared autologous hematopoietic stem cell transplantation (auto-HCT) with either matched sibling donor (MSD) or matched unrelated donor (MUD) allogeneic hematopoietic cell transplantation (allo-HCT) as the first transplantation approach for patients with ETF FL (age ≥ 18 years) undergoing auto-HCT or allo-HCT between 2002 and 2014. The primary endpoint was OS. The secondary endpoints were progression-free survival, relapse, and nonrelapse mortality (NRM). Four hundred forty FL patients had ETF (auto-HCT, 240; MSD hematopoietic stem cell transplantation [HCT], 105; and MUD HCT, 95). With a median follow-up of 69 to 73 months, the adjusted probability of 5-year OS was significantly higher after auto-HCT (70%) or MSD HCT (73%) versus MUD HCT (49%; P = .0008). The 5-year adjusted probability of NRM was significantly lower for auto-HCT (5%) versus MSD (17%) or MUD HCT (33%; P ETF, undergoing auto-HCT for FL have low NRM and a promising 5-year OS rate (70%). MSD HCT has lower relapse rates than auto-HCT but similar OS. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

  10. The therapeutic use of music as experienced by cardiac surgery patients of an intensive care unit

    Directory of Open Access Journals (Sweden)

    Varshika M. Bhana

    2014-04-01

    Full Text Available Patients perceive the intensive care unit (ICU as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants. Pasiënte se persepsie van die intensiewesorgeenheid (ISE is dat dit ’nstresvolle en angswekkende omgewing is. Die fisiologiese effekte van stres en angs is skadelik en daarom moet dit vermy word in die geval van pasiënte wat hartchirurgie ondergaan. Die doel

  11. 226 Ra in food

    International Nuclear Information System (INIS)

    Toader, M.

    1993-01-01

    Between 1986 and 1992 the author has evaluated natural levels of 226 Ra in some foods representing the major components of the diet in Bucharest population. The estimated daily intake by an adult was 72.5 mBq 226 Ra/day or 65.9 mBq 226 Ra/g.Ca. (Author)

  12. Experiencing variation

    DEFF Research Database (Denmark)

    Kobayashi, Sofie; Berge, Maria; Grout, Brian William Wilson

    2017-01-01

    This study contributes towards a better understanding of learning dynamics in doctoral supervision by analysing how learning opportunities are created in the interaction between supervisors and PhD students, using the notion of experiencing variation as a key to learning. Empirically, we have based...... the study on four video-recorded sessions, with four different PhD students and their supervisors, all from life sciences. Our analysis revealed that learning opportunities in the supervision sessions concerned either the content matter of research (for instance, understanding soil structure......), or the research methods— more specifically how to produce valid results. Our results illustrate how supervisors and PhD students create a space of learning together in their particular discipline by varying critical aspects of their research in their discussions. Situations where more openended research issues...

  13. An evaluation of patients' experienced usability of a diabetes mHealth system using a multi-method approach.

    Science.gov (United States)

    Georgsson, Mattias; Staggers, Nancy

    2016-02-01

    mHealth systems are becoming more common to aid patients in their diabetes self-management, but recent studies indicate a need for thorough evaluation of patients' experienced usability. Current evaluations lack a multi-method design for data collection and structured methods for data analyses. The purpose of this study was to provide a feasibility test of a multi-method approach for both data collection and data analyses for patients' experienced usability of a mHealth system for diabetes type 2 self-management. A random sample of 10 users was selected from a larger clinical trial. Data collection methods included user testing with eight representative tasks and Think Aloud protocol, a semi-structured interview and a questionnaire on patients' experiences using the system. The Framework Analysis (FA) method and Usability Problem Taxonomy (UPT) were used to structure, code and analyze the results. A usability severity rating was assigned after classification. The combined methods resulted in a total of 117 problems condensed into 19 usability issues with an average severity rating of 2.47 or serious. The usability test detected 50% of the initial usability problems, followed by the post-interview at 29%. The usability test found 18 of 19 consolidated usability problems while the questionnaire uncovered one unique issue. Patients experienced most usability problems (8) in the Glucose Readings View when performing complex tasks such as adding, deleting, and exporting glucose measurements. The severity ratings were the highest for the Glucose Diary View, Glucose Readings View, and Blood Pressure View with an average severity rating of 3 (serious). Most of the issues were classified under the artifact component of the UPT and primary categories of Visualness (7) and Manipulation (6). In the UPT task component, most issues were in the primary category Task-mapping (12). Multiple data collection methods yielded a more comprehensive set of usability issues. Usability

  14. Counselling low-back-pain patients in secondary healthcare: a randomised trial addressing experienced workplace barriers and physical activity

    DEFF Research Database (Denmark)

    Jensen, Lone Donbæk; Maribo, Thomas; Schiøttz-Christensen, Berit

    2012-01-01

    OBJECTIVE: To assess if counselling by an occupational physician (OP) addressing experienced workplace barriers and physical activity integrated as a part of low-back pain (LBP) outpatient treatment influences pain, function and sick leave. METHODS: Randomised controlled trial in the secondary...... healthcare sector with 3 months' follow-up. The participants were LBP patients who, independently of sick-leave status, expressed concerns about the ability to maintain their current job. Patients referred for surgery were excluded. The intervention consisted of two counselling sessions conducted by an OP......-form health survey questionnaire in favour of the intervention group was found. The change in pain score was found to be clinically relevant. The risk of sick leave for at least 8 weeks due to LBP was significantly reduced in the intervention group. Two secondary outcomes, Fear Avoidance Beliefs about...

  15. Factors associated with influenza and pneumococcal vaccine uptake among rheumatoid arthritis patients in Denmark invited to participate in a pneumococcal vaccine trial (Immunovax_RA)

    DEFF Research Database (Denmark)

    Nguyen, MTT; Lindegaard, H.; Hendricks, O.

    2017-01-01

    the survey during scheduled follow-up visits. The questionnaire included questions concerning previous influenza and pneumococcal vaccine uptake, attitudes about vaccination, and socio-demographic factors. Factors associated with recalled vaccine uptake were assessed by multivariate logistic regression....... Results: A total of 192 RA patients completed the survey, 134 (70%) of whom were women and 90 (47%) were aged ≥ 65 years. Sixty-seven patients (35%) received conventional disease-modifying anti-rheumatic drugs (cDMARDs) and 125 (65%) combination therapy with biological disease-modifying anti...

  16. Knowledge, attitude and stigma experienced by leprosy patients in tribal concentrated Bastar district of Chhattisgarh, India (2013-2023

    Directory of Open Access Journals (Sweden)

    Swapan Kumar Kolay

    2016-12-01

    Full Text Available Objective: To study leprosy patients in tribal concentrated Bastar district of Chhattisgarh, India in terms of their knowledge, attitudes and the stigma they have experienced. Method: This cross-sectional study included 101 registered Leprosy patients, in a single leprosy treatment centre between April, 2012 - June, 2013. The data collection tool (a pre tested close-ended questionnaire was based on leprosy related socio-demographic variables, knowled geregarding different kinds of problems and issues experienced by the patients/participants. The investigators collected the data in face to face interviews and house hold visit. Results: Overall the majority of the respondents (85.1% were between 16 and 60 years of age. 74.3% were males, 80.2% were married, and 54.5% were literate. The majority (67.3% articulated positive knowledge about transmission of the disease, 75.3% knew that numbness of hands is an early symptom, 88.12% that it is curable, 91.1% had untreated deformities. Experiences reported included disturbed marital relationships (90.1% or social life (94.1%, loss of employment (54.5%, isolation with the sitation to talk to people (29.7%, family members not sharing food (94.1%; being forced to leave the family (54.45%. Health education interventions improved the knowledge of 91.1% of participants. Multi-Bacillary leprosy was higher in newly registered cases with higher disabilities in the hands and feet (60.4%, eyes (29.7%. 9.9% of WHO grade-2 disabilities were due to a delayed diagnosis. 67.5% of the patients/participants with some form of disability had experienced a delay in diagnosis up to 12 months. Conclusion: The study noted that the tribal people were affected by leprosy not only in terms of the physical problems, but also by the stigmatization that affects their social participation. These need to be addressed by the progress of the national leprosyp rogram.Keywords: Leprosy, social stigma, disability grading, India

  17. Experienced dilemmas of everyday life in chronic neuropathic pain patients--results from a critical incident study.

    Science.gov (United States)

    Hensing, Gunnel K E; Sverker, Annette M; Leijon, Göran S

    2007-06-01

    Neuropathic pain is a disabling chronic condition with limited therapeutic options. Few studies have addressed patient's experience and strategies. The aim of this study was to explore dilemmas experienced in order to improve care and rehabilitation. An interview study with 39 patients suffering from neuropathic pain of different origin was performed. We used the critical incident technique to collect data. Questions on occasions when patients had been hindered by or reminded of their neuropathic pain were included, and the self-perceived consequences and management of such occasions. The interviews were transcribed verbatim and analysed qualitatively. A broad range of experiences categorised into dilemmas, disturbances, consequences and managements from most parts of everyday life was identified. The dilemmas were 'housework', 'sitting', 'physical activity', 'personal hygiene', 'sleeping difficulties', 'hypersensitivity to external stimuli', 'social relationships', 'transportation' and 'leisure time'. Disturbances were 'failures', 'inabilities' and 'restrictions'. Consequences were 'increased pain', 'psychological reactions' and 'physical symptoms'. The majority of the patients used activity-oriented strategies to manage their pain such as alternative ways of performing the task, a cognitive approach or simply ignoring the pain. This is one of the first studies presenting detailed data on everyday dilemmas, disturbances and consequences of patients with chronic neuropathic pain. Such information is important in clinical settings to improve care and rehabilitation.

  18. Experiencing time

    CERN Document Server

    Prosser, Simon

    2018-01-01

    Our engagement with time is a ubiquitous feature of our lives. We are aware of time on many scales, from the briefest flicker of change to the way our lives unfold over many years. But to what extent does this encounter reveal the true nature of temporal reality? To the extent that temporal reality is as it seems, how do we come to be aware of it? And to the extent that temporal reality is not as it seems, why does it seem that way? These are the central questions addressed by Simon Prosser in Experiencing Time. These questions take on a particular importance in philosophy for two reasons. Firstly, there is a view concerning the metaphysics of time, known as the B-theory of time, according to which the apparently dynamic quality of change, the special status of the present, and even the passage of time are all illusions. Instead, the world is a four-dimensional space-time block, lacking any of the apparent dynamic features of time. If the B-theory is correct, as the book argues, then it must be explained why ...

  19. Communication challenges experienced by migrants with cancer: A comparison of migrant and English-speaking Australian-born cancer patients.

    Science.gov (United States)

    Hyatt, Amelia; Lipson-Smith, Ruby; Schofield, Penelope; Gough, Karla; Sze, Ming; Aldridge, Lynley; Goldstein, David; Jefford, Michael; Bell, Melanie L; Butow, Phyllis

    2017-10-01

    Understanding the difficulties faced by different migrant groups is vital to address disparities and inform targeted health-care service delivery. Migrant oncology patients experience increased morbidity, mortality and psychological distress, with this tentatively linked to language and communication difficulties. The objective of this exploratory study was to investigate the communication barriers and challenges experienced by Arabic, Greek and Chinese (Mandarin and Cantonese) speaking oncology patients in Australia. This study employed a cross-sectional design using patient-reported outcome survey data from migrant and English-speaking Australian-born patients with cancer. Patients were recruited through oncology clinics and Australian state cancer registries. Data were collected regarding patient clinical and demographic characteristics and health-care and communication experiences. Data from the clinics and registries were combined for analysis. Significant differences were found between migrant groups in demographic characteristics, communication and health-care experiences, and information and care preferences. Chinese patients cited problems with understanding medical information, the Australian health-care system, and communicating with their health-care team. Conversely, Arabic- and Greek-speaking patients reported higher understanding of the health-care system, and less communication difficulties. Our study findings suggest that migrant groups differ from each other in their health communication expectations and requirements. Lower education and health literacy of some groups may play a role in poorer health outcomes. Public health interventions and assistance provided to migrants should be tailored to the specific needs and characteristics of that language or cultural group. Future research directions are discussed. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  20. DELIRIUM RELATED DISTRESS EXPERIENCED BY PATIENTS, CAREGIVERS AND NURSING STAFF IN A MEDICAL INTENSIVE CARE UNIT (ICU

    Directory of Open Access Journals (Sweden)

    Ayush Kumar Jayaswal

    2018-03-01

    Full Text Available BACKGROUND Delirium, a common neuropsychiatric syndrome in intensive care settings is a distressing experience for the patient, caregivers and nursing staff. Research on delirium experience has been scant and unsystematic. We set out to explore the extent of recall of delirium, differential distress it had on patients, caregivers and nursing staff and the extent to which it impacted recognition across the motoric subtypes. MATERIALS AND METHODS A prospective study was carried out on all consecutively admitted patients in the medical ICU of a tertiary care teaching hospital. Patients diagnosed with delirium using Confusion Assessment Method for ICU (CAM-ICU were administered the Richmond Agitation Sedation Scale (RASS for differentiating the motor subtypes (hypoactive, hyperactive, mixed. Distress was assessed using the Delirium Experience Questionnaire (DEQ. RESULTS Of the 88 patients (31.43% who developed delirium, 60.2% recalled their experience. Recall was highest in the hyperactive subtype. 76% of patients, 94.3% of caregivers and 31.8% of nursing staff reported severe levels of distress. Motoric subtypes did not impact on the distress levels experienced by the patients or their caregivers, but influenced it significantly in the nursing staff (highest in hyperactive, least in hypoactive. Identification of delirium by nursing staff (13.4% was significantly influenced by the motor subtypes (highest in hyperactive, least in hypoactive. Linear regression analysis revealed that distress of ICU staff (F=1.36, p=0.018 and not the motoric subtypes (F=1.36, p=0.262 significantly predicted recognition of delirium. CONCLUSIONS Most patients who develop delirium and their caregivers experience high levels of distress. Under-recognition is significantly influenced by the distress it causes the ICU staff than the motor subtype of delirium.

  1. Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.

    Science.gov (United States)

    Druce, Katie L; Jones, Gareth T; Macfarlane, Gary J; Basu, Neil

    2015-06-01

    Pro-inflammatory cytokines such as TNF-α are important in the pathogenesis of fatigue in conditions such as RA. This study aimed to determine whether fatigue improved in a cohort of RA patients with clinically relevant fatigue commencing anti-TNF-α therapy and, if so, to identify predictors of improvement. Participants recruited to a long-term observational cohort study (the British Society for Rheumatology Biologics Register for RA) provided information on fatigue using the 36-item Short Form Health Survey (SF-36) vitality subscale. The prevalence of severe baseline fatigue (SF-36 vitality ≤12.5) was calculated and improvements, considered as (i) absolute values and (ii) improvement from severe to non-severe fatigue (SF-36 vitality >12.5), were examined 6 months subsequently. A comprehensive set of putative predictors of fatigue improvement were evaluated using multivariable logistic regression. In 6835 participants the prevalence of severe baseline fatigue was 38.8%. Of those with severe fatigue, 70% reported clinically relevant improvement and 66% moved to the non-severe fatigue category (i.e. improvers). The mean change for improvers was three times the minimum clinically important difference for improvement (33.0 U). Independent baseline predictors of improvement were female sex [odds ratio (OR) 1.3 (95% CI 1.1, 1.7)], not being unemployed due to ill health [OR 1.5 (95% CI 1.2, 1.7)], low disability [OR 1.2 (95% CI 1.001, 1.5)], seropositivity [OR 1.2 (95% CI 0.98, 1.4)], not using steroids [OR 1.2 (95% CI 1.03, 1.5)], no history of hypertension [OR 1.4 (95% CI 1.1, 1.6)] or depression [OR 1.3 (95% CI 1.1, 1.5)] and good mental health [SF-36 mental health subscale >35; OR 1.4 (95% CI 1.2, 1.7)]. Fatigued RA patients reported substantial improvement in their fatigue after commencing anti-TNF-α therapy. Further, a number of clinical and psychosocial baseline factors identified those most likely to improve, supporting future stratified approaches to RA

  2. Darunavir-based dual therapy of treatment-experienced HIV-infected patients: analysis from a national multicenter database.

    Science.gov (United States)

    Sterrantino, Gaetana; Zaccarelli, Mauro; Di Biagio, Antonio; Biondi, Maria Luisa; Antinori, Andrea; Penco, Giovanni

    2015-06-01

    We assessed the virological response of dual therapy with DRV/r, plus raltegravir, maraviroc or etravirine, in virological failure patients and in virologically suppressed patients collected in the Italian Antiretroviral Resistance Database (ARCA). The primary endpoint was the percentage of patients remaining free of virological failure (confirmed >50 copies/mL or any change in the regimen). Subjects had a resistance test and at least one follow-up visit. Observation was censored at last visit under dual therapy and survival analysis and proportional hazard models were used. Sixty-seven percent of the 221 patients started DRV/r with RAL, 20.4 % with ETV, and 12.2 % with MAR; 31.2 % virological failures were observed. At survival analysis, the overall proportion of failure was 29.2 % at 1 year and 33.8 % at 2 years. The proportion of failure was lower in patients starting with undetectable vs. detectable viral load (13.3 and 25.2 % vs. 37.4 and 38.8 % at 1 and 2 years, respectively, p = 0.001 for both analyses) and in patients treated with DRV 600 BID vs. 800 QD (HR: 0.56, 95 % CI: 0.31-0.99, p HIV-DB HR: 0.53, 95 % CI: 0.32-0.88, p = 0.014; Rega 0.60, 0.40-0.88, p HIV-RNA (3.02, 1.70-5.72, p < 0.001). Among experienced patients, the best candidates for dual-therapy regimens including DRV/r are those with undetectable viral load and higher GSS.

  3. Human oocyte calcium analysis predicts the response to assisted oocyte activation in patients experiencing fertilization failure after ICSI.

    Science.gov (United States)

    Ferrer-Buitrago, M; Dhaenens, L; Lu, Y; Bonte, D; Vanden Meerschaut, F; De Sutter, P; Leybaert, L; Heindryckx, B

    2018-01-10

    Can human oocyte calcium analysis predict fertilization success after assisted oocyte activation (AOA) in patients experiencing fertilization failure after ICSI? ICSI-AOA restores the fertilization rate only in patients displaying abnormal Ca2+ oscillations during human oocyte activation. Patients capable of activating mouse oocytes and who showed abnormal Ca2+ profiles after mouse oocyte Ca2+ analysis (M-OCA), have variable responses to ICSI-AOA. It remains unsettled whether human oocyte Ca2+ analysis (H-OCA) would yield an improved accuracy to predict fertilization success after ICSI-AOA. Sperm activation potential was first evaluated by MOAT. Subsequently, Ca2+ oscillatory patterns were determined with sperm from patients showing moderate to normal activation potential based on the capacity of human sperm to generate Ca2+ responses upon microinjection in mouse and human oocytes. Altogether, this study includes a total of 255 mouse and 122 human oocytes. M-OCA was performed with 16 different sperm samples before undergoing ICSI-AOA treatment. H-OCA was performed for 11 patients who finally underwent ICSI-AOA treatment. The diagnostic accuracy to predict fertilization success was calculated based on the response to ICSI-AOA. Patients experiencing low or total failed fertilization after conventional ICSI were included in the study. All participants showed moderate to high rates of activation after MOAT. Metaphase II (MII) oocytes from B6D2F1 mice were used for M-OCA. Control fertile sperm samples were used to obtain a reference Ca2+ oscillation profile elicited in human oocytes. Donated human oocytes, non-suitable for IVF treatments, were collected and vitrified at MII stage for further analysis by H-OCA. M-OCA and H-OCA predicted the response to ICSI-AOA in 8 out of 11 (73%) patients. Compared to M-OCA, H-OCA detected the presence of sperm activation deficiencies with greater sensitivity (75 vs 100%, respectively). ICSI-AOA never showed benefit to overcome

  4. Suicidality and symptoms of anxiety, irritability, and agitation in patients experiencing manic episodes with depressive symptoms: a naturalistic study

    Directory of Open Access Journals (Sweden)

    Eberhard J

    2016-08-01

    Full Text Available Jonas Eberhard,1 Emmanuelle Weiller2 1Department of Clinical Sciences, Lund University, Lund, Sweden; 2H. Lundbeck A/S, Copenhagen, Denmark Purpose: Patients with a bipolar I disorder (BD-I manic episode meeting the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5, criteria for “with mixed features” have a high incidence of suicide attempts and of anxiety, irritability, and agitation (AIA symptoms. The aim of this analysis was to explore the relationship between suicidality and AIA symptoms in patients with BD-I experiencing mania with depressive symptoms, using data from a previous naturalistic study.Patients and methods: Psychiatrists completed an online questionnaire about their adult patients who had a current BD-I manic episode. Questions covered the DSM-5 “with mixed features” specifier, the severity of AIA symptoms, the frequency and controllability of suicidal ideation, and the number of suicide attempts.Results: Of 1,035 patients with BD-I mania who were included in the analyses, 348 (33.6% met the criteria for the DSM-5 “with mixed features” specifier (three or more depressive symptoms. These patients were further stratified according to the severity of their AIA symptoms: “mild AIA” (zero or one AIA symptom above a severity threshold; 105 patients or “severe AIA” (all three AIA symptoms above a severity threshold; 167 patients. A greater incidence of suicidal ideation was observed in the severe AIA group (71.9% than in the mild AIA group (47.6%. Twice as many patients had easily controlled suicidal ideation than difficult-to-control suicidal ideation in both subgroups. The mean number of suicide attempts was higher in the severe AIA group than in the mild AIA group, during the current episode (0.84 vs 0.34 attempts, respectively; P<0.05 and over the patient’s lifetime (1.56 vs 1.04 attempts, respectively.Conclusion: The high risk of suicide among BD-I mania patients with depressive

  5. Risk Perceptions in Diabetic Patients Who Have Experienced Adverse Events: Implications for Patient Involvement in Regulatory Decisions.

    Science.gov (United States)

    Sachs, Mikkel Lindskov; Sporrong, Sofia Kälvemark; Colding-Jørgensen, Morten; Frokjaer, Sven; Helboe, Per; Jelic, Katarina; Kaae, Susanne

    2017-01-01

    Increasingly, patients are expected to influence decisions previously reserved for regulatory agencies, pharmaceutical companies, and healthcare professionals. Individual patients have previously represented their patient population when rare, serious adverse events (AEs) were weighed as part of a benefit-risk assessment. However, the degree of heterogeneity of the patient population is critical for how accurately they can be represented by individuals. This study aims to explore patients' risk perception of rare, serious adverse effects of medicines with regard to blood glucose-lowering antidiabetics used by the individual patient. Semi-structured interviews were conducted with 18 patients with diabetes with self-perceived serious, but not necessarily rare, AEs (e.g. stroke or valve or bypass surgery). The interviews explored the patients' history of disease, perceptions of the terms rare and serious, and overall levels of risk aversion. A thematic analysis of the interviews, including a consensus discussion, was carried out. Interestingly, respondents rarely made a clear distinction between medicines-induced AEs and complications related to disease progression. Concerns regarding AEs were apparently diverse but were systematically related to the personal experiences of the respondents. Respondents routinely ignored information about possible rare, serious AEs, unless it could be related to personal experience. In the absence of experience, concerns were focused on common and less serious AEs, thus disregarding rare and more serious events. The study suggests that experience of AEs, related to either medicines or disease, constitutes an important factor of patient risk perception. We therefore propose that serious adverse experiences should be added to the traditional panel of socioeconomic factors that are accounted for when patients are invited to give input on regulatory decisions.

  6. Impact of a magnetic resonance imaging-guided treat-to-target strategy on disease activity and progression in patients with rheumatoid arthritis (the IMAGINE-RA trial)

    DEFF Research Database (Denmark)

    Møller-Bisgaard, Signe; Hørslev-Petersen, Kim; Ejbjerg, Bo Jannik

    2015-01-01

    /absence of BME may therefore be clinically beneficial. We present the design of a randomized controlled trial (RCT) aiming to evaluate whether an MRI-guided treatment strategy compared to a conventional treatment strategy in anti-CCP-positive erosive RA is better to prevent progression of erosive joint damage...... swollen joints and treatment with synthetic disease-modifying antirheumatic drugs (DMARDs) will be included. Patients will be randomized to either a treatment strategy based on conventional laboratory and clinical examinations (control group) or a treatment strategy based on conventional laboratory...

  7. Communication difficulties experienced by deaf male patients during their in-hospital stay: findings from a qualitative descriptive study.

    Science.gov (United States)

    Sirch, Linda; Salvador, Linda; Palese, Alvisa

    2017-06-01

    Studies available have described several specific issues affecting healthcare accessibility by deaf people, but to date, no research has reported the experience of deaf patients with in-hospital communication. The aim of the study was to explore the communication experience of deaf patients with regard to their in-hospital stay. A purposeful sample of participants was selected. The data collection process was based on a focus group. The focus groups were conducted in Italian sign language and videorecorded; subsequently, the entire conversation was faithfully transcribed. A qualitative content analysis of the transcription was performed and the findings are reported using the Consolidated Criteria for Reporting Qualitative Research approach. Four themes have emerged: (a) experiencing a common vulnerability: the need for reciprocal understanding and sensitivity, (b) being outside the comfort zone: feeling discriminated against once again, (c) perceiving a lack of consonance between care and needs and (d) developing a sense of progressively disempowerment. The experience of deaf individuals during their in-hospital stay may be critical: they are exposed to protracted communication and interaction with healthcare providers and an environment that is not prepared and designed for these vulnerable patients. Two levels of strategies should be identified, implemented and developed to increase the quality of communication with deaf people during hospitalisation, both at the hospital/health system level and at the healthcare professional/clinical level. © 2016 Nordic College of Caring Science.

  8. Counselling low-back-pain patients in secondary healthcare: a randomised trial addressing experienced workplace barriers and physical activity.

    Science.gov (United States)

    Jensen, Lone Donbæk; Maribo, Thomas; Schiøttz-Christensen, Berit; Madsen, Finn Hjorth; Gonge, Bigitte; Christensen, Michael; Frost, Poul

    2012-01-01

    To assess if counselling by an occupational physician (OP) addressing experienced workplace barriers and physical activity integrated as a part of low-back pain (LBP) outpatient treatment influences pain, function and sick leave. Randomised controlled trial in the secondary healthcare sector with 3 months' follow-up. The participants were LBP patients who, independently of sick-leave status, expressed concerns about the ability to maintain their current job. Patients referred for surgery were excluded. The intervention consisted of two counselling sessions conducted by an OP addressing both workplace barriers and leisure-time physical activity. A workplace visit was performed if required. Pain, function and duration of sick leave due to LBP were primary outcomes. A reduction in bodily pain and improvement in physical function both measured by the 36-item short-form health survey questionnaire in favour of the intervention group was found. The change in pain score was found to be clinically relevant. The risk of sick leave for at least 8 weeks due to LBP was significantly reduced in the intervention group. Two secondary outcomes, Fear Avoidance Beliefs about physical activity and maximum oxygen uptake, supported compliance and adherence to the part of the intervention focusing on enhanced physical activity. Two short counselling sessions by an OP combining advice on meeting workplace barriers and enhancing physical activity had a substantial effect on important prognostic factors for LBP patients with moderate to severe symptoms diagnosed in outpatient rheumatological clinics. Current Controlled Trials ISRCTN13071157.

  9. Collaboration and communication in colorectal cancer care: a qualitative study of the challenges experienced by patients and health care professionals

    Science.gov (United States)

    Kamradt, Martina; Baudendistel, Ines; Längst, Gerda; Kiel, Marion; Eckrich, Felicitas; Winkler, Eva; Szecsenyi, Joachim; Ose, Dominik

    2015-01-01

    Background. Colorectal cancer is becoming a chronic condition. This has significant implications for the delivery of health care and implies the involvement of a range of health care professionals (HCPs) from different settings to ensure the needed quality and continuity of care. Objectives. To explore the challenges that patients and HCPs experience in the course of colorectal cancer care and the perceived consequences caused by these challenges. Methods. Ten semi-structured focus groups were conducted including patients receiving treatment for colorectal cancer, representatives of patient support groups, physicians and other non-physician HCPs from different health care settings. Participants were asked to share their experiences regarding colorectal cancer care. All data were audio- and videotaped, transcribed verbatim and thematically analysed using qualitative content analysis. Results. Patients and HCPs (total N = 47) experienced collaboration and communication as well as exchange of information between HCPs as challenging. Particularly communication and information exchange with GPs appeared to be lacking. The difficulties identified restricted a well-working coordination of care and seemed to cause inappropriate health care. Conclusion. Colorectal cancer care seems to require an effective, well-working collaboration and communication between the different HCPs involved ensuring the best possible care to suit patients’ individual needs. However, the perceived challenges and consequences of our participants seem to restrict the delivery of the needed quality of care. Therefore, it seems crucial (i) to include all HCPs involved, especially the GP, (ii) to support an efficient and standardized exchange of health-related information and (iii) to focus on the patients’ entire pathway of care. PMID:26311705

  10. Nursing students experienced personal inadequacy, vulnerability and transformation during their patient care encounter: A qualitative meta-synthesis.

    Science.gov (United States)

    Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth

    2018-05-01

    To identify, appraise and synthesize the best available evidence exploring nursing students' experiences of professional patient care encounters in a hospital unit. The Joanna Briggs Institute (JBI) guidelines were followed and a meta-synthesis was conducted. Qualitative research articles were considered for inclusion in the review, and JBI's meta-aggregative approach to synthesizing qualitative evidence was followed. An extensive search for relevant literature was undertaken in scientific databases. Data were extracted from the included research articles, and qualitative research findings were pooled using the Qualitative Assessment and Review Instrument. This involved categorization of findings on the basis of similarity of meaning and aggregation of these categories to produce a comprehensive set of synthesized findings. A total of five research articles met the inclusion criteria and were included in the review. The review process resulted in 46 subcategories that were aggregated into 13 categories. The categories generated four synthesized findings: personal existence; personal learning and development; being a professional fellow human; and clinical learning environment. We meta-synthesized that: Nursing students experienced personal inadequacy, vulnerability and a transformation during their patient care encounter. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Exploring caregiver burden experienced by family caregivers of patients with End-Stage Renal Disease in Nigeria

    Directory of Open Access Journals (Sweden)

    Yemisi Okikiade Oyegbile

    Full Text Available Background: Family caregivers in many African countries bear the burden of caregiving alone, with the paucity of research, especially for caregivers of End-Stage Renal Disease patients, having concealed their needs. Aim: To explore the caregiver burden of family caregivers of End-Stage Renal Disease (ESRD patients in South-West Nigeria. Design: Following a complementary mixed method data collection strategy, the quantitative data was collected using the Zarit Burden Interview questionnaire to measure the burden of caregiving. Qualitative data was thereafter obtained through in-depth, individual interviews and was analysed using content analysis. Settings: The three research settings consisted of two state hospitals and one private hospital that provide renal care in South-West Nigeria. Result: The mean burden of caregiving for the sample was 50.18 thus indicating that family caregivers experienced moderate to severe burden, which is high compared to the other studies. The participants’ experiences of caregiving revealed the following categories: total dependence, acceptance of caregiving role, competing responsibilities, financial sacrifice and “not making mistakes”. Conclusion: Understanding the extent of caregiver burden, what constitutes burden to family caregivers in low/middle-income countries, and the difficulties associated with caregiving for care-recipients with ESRD, allows appropriate strategies and interventions to be developed. Keywords: End Stage Renal Disease, Family caregivers, Caregiver burden, Complementary mixed methods, Nigeria

  12. Can baseline ultrasound results help to predict failure to achieve DAS28 remission after 1 year of tight control treatment in early RA patients?

    Science.gov (United States)

    Ten Cate, D F; Jacobs, J W G; Swen, W A A; Hazes, J M W; de Jager, M H; Basoski, N M; Haagsma, C J; Luime, J J; Gerards, A H

    2018-01-30

    At present, there are no prognostic parameters unequivocally predicting treatment failure in early rheumatoid arthritis (RA) patients. We investigated whether baseline ultrasonography (US) findings of joints, when added to baseline clinical, laboratory, and radiographical data, could improve prediction of failure to achieve Disease Activity Score assessing 28 joints (DAS28) remission (baseline. Clinical, laboratory, and radiographical parameters were recorded. Primary analysis was the prediction by logistic regression of the absence of DAS28 remission 12 months after diagnosis and start of therapy. Of 194 patients included, 174 were used for the analysis, with complete data available for 159. In a multivariate model with baseline DAS28 (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.2-2.2), the presence of rheumatoid factor (OR 2.3, 95% CI 1.1-5.1), and type of monitoring strategy (OR 0.2, 95% CI 0.05-0.85), the addition of baseline US results for joints (OR 0.96, 95% CI 0.89-1.04) did not significantly improve the prediction of failure to achieve DAS28 remission (likelihood ratio test, 1.04; p = 0.31). In an early RA population, adding baseline ultrasonography of the hands, wrists, and feet to commonly available baseline characteristics did not improve prediction of failure to achieve DAS28 remission at 12 months. Clinicaltrials.gov, NCT01752309 . Registered on 19 December 2012.

  13. A multi-component patient-handling intervention improves attitudes and behaviors for safe patient handling and reduces aggression experienced by nursing staff

    DEFF Research Database (Denmark)

    Risør, Bettina Wulff; Casper, Sven Dalgas; Andersen, Lars L.

    2017-01-01

    This study evaluated an intervention for patient-handling equipment aimed to improve nursing staffs' use of patient handling equipment and improve their general health, reduce musculoskeletal problems, aggressive episodes, days of absence and work-related accidents. As a controlled before......-after study, questionnaire data were collected at baseline and 12-month follow-up among nursing staff at intervention and control wards at two hospitals. At 12-month follow-up, the intervention group had more positive attitudes towards patient-handling equipment and increased use of specific patient......-handling equipment. In addition, a lower proportion of nursing staff in the intervention group had experienced physically aggressive episodes. No significant change was observed in general health status, musculoskeletal problems, days of absence or work-related accidents. The intervention resulted in more positive...

  14. 224Ra and 226Ra experimentally induced dental changes in rats

    International Nuclear Information System (INIS)

    Reichart, P.A.; Althoff, J.; Eckhardt, W.; Rippel, W.

    1979-01-01

    Sprague-Dawley rats received intragastrically a single dose of 226 Ra or 224 Ra once weekly for 21 weeks. During this period the animals of both groups were thus exposed to comparable doses. After 12 weeks, a shortening of the maxillary incisors was observed, and this progressed during the course of the 55-week experiment. Radiologically, a loss of pulpal transparency and an apical irregular opacity in the maxillary incisors were demonstrable. Histologically, dysplastic changes of the maxillary incisors and multiple resorptions at the cemento-enamel junction of the molars were seen. The observed alterations were more pronounced in the 226 Ra group than in the 224 Ra treated group. The experimentally induced resorptions were comparable to those observed in patients who had incorporated 224 Ra or 226 Ra. Clinical, radiological, histological, γspecrometrical, and autoradiographical findings, as well as dose-estimations, are described. (author)

  15. How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries.

    Science.gov (United States)

    Askling, Johan; Berglind, Niklas; Franzen, Stefan; Frisell, Thomas; Garwood, Christopher; Greenberg, Jeffrey D; Ho, Meilien; Holmqvist, Marie; Horne, Laura; Inoue, Eisuke; Michaud, Kaleb; Nyberg, Fredrik; Pappas, Dimitrios A; Reed, George; Tanaka, Eiichi; Tran, Trung N; Verstappen, Suzanne M M; Yamanaka, Hisashi; Wesby-van Swaay, Eveline; Symmons, Deborah

    2016-10-01

    The overall incidence of cancer in patients with rheumatoid arthritis (RA) is modestly elevated. The extent to which cancer rates in RA vary across clinical cohorts and patient subsets, as defined by disease activity or treatment is less known but critical for understanding the safety of existing and new antirheumatic therapies. We investigated comparability of, and means to harmonise, malignancy rates in five RA registries from four continents. Participating RA registries were Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (several countries) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan). Within each registry, we analysed a main cohort of all patients with RA from January 2000 to last available data, and sensitivity analyses of sub-cohorts defined by disease activity, treatment change, prior comorbidities and restricted by calendar time or follow-up, respectively. Malignancy rates with 95% CIs were estimated, and standardised for age and sex, based on the distributions from a typical RA clinical trial programme population (fostamatinib). There was a high consistency in rates for overall malignancy excluding non-melanoma skin cancer (NMSC), for malignant lymphomas, but not for all skin cancers, across registries, in particular following age/sex standardisation. Standardised rates of overall malignancy excluding NMSC varied from 0.56 to 0.87 per 100 person-years. Within each registry, rates were generally consistent across sensitivity analyses, which differed little from the main analysis. In real-world RA populations, rates of both overall malignancy and of lymphomas are consistent. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. 226Ra, 228Ra and 228Ra/226Ra in surface marine sediment of Malaysia

    International Nuclear Information System (INIS)

    Mei-Wo Yii; Zal Uyun Wan-Mahmood

    2013-01-01

    Surface sediment samples were collected at the West (east coast and west coast of Peninsular Malaysia) and East (Sabah and Sarawak) Malaysia in several expeditions within August 2003 until June 2008 for determining the level of natural radium isotopes. Activity concentrations of 226 Ra and 228 Ra in surface marine sediment at 176 sampling stations were measured. The activity concentrations of both radionuclides in Malaysia (East and West Malaysia) display varied with the range from 9 to 158 Bq/kg dry wt. and 13 to 104 Bq/kg dry wt., respectively. Meanwhile, the ratio distributions of 228 Ra/ 226 Ra were ranged from 0.62 to 3.75. This indicated that the ratios were slightly high at west coast of Peninsular Malaysia compared to other regions (east coast of Peninsular Malaysia, Sabah and Sarawak). The variation of activity concentrations of 226 Ra and 228 Ra and its ratios were also supported by the statistical analyses of one-way ANOVA and t test at 95 % confidence level, whereby there were proved that the measured values were different between the regions. These different were strictly related to their half-life, potential input sources (included their parents, 238 U and 232 Th), parent's characteristic, the geological setting/formation of the study area, environment origin and behavior. (author)

  17. Measuring the radium quartet (228Ra, 226Ra, 224Ra, 223Ra) in seawater samples using gamma spectrometry

    International Nuclear Information System (INIS)

    Beek, P. van; Souhaut, M.; Reyss, J.-L.

    2010-01-01

    Radium isotopes are widely used in marine studies (eg. to trace water masses, to quantify mixing processes or to study submarine groundwater discharge). While 228 Ra and 226 Ra are usually measured using gamma spectrometry, short-lived Ra isotopes ( 224 Ra and 223 Ra) are usually measured using a Radium Delayed Coincidence Counter (RaDeCC). Here we show that the four radium isotopes can be analyzed using gamma spectrometry. We report 226 Ra, 228 Ra, 224 Ra, 223 Ra activities measured using low-background gamma spectrometry in standard samples, in water samples collected in the vicinity of our laboratory (La Palme and Vaccares lagoons, France) but also in seawater samples collected in the plume of the Amazon river, off French Guyana (AMANDES project). The 223 Ra and 224 Ra activities determined in these samples using gamma spectrometry were compared to the activities determined using RaDeCC. Activities determined using the two techniques are in good agreement. Uncertainties associated with the 224 Ra activities are similar for the two techniques. RaDeCC is more sensitive for the detection of low 223 Ra activities. Gamma spectrometry thus constitutes an alternate method for the determination of short-lived Ra isotopes.

  18. The effects of gluten-free diet versus hypocaloric diet among patients with fibromyalgia experiencing gluten sensitivity symptoms: protocol for a pilot, open-label, randomized clinical trial.

    Science.gov (United States)

    Slim, Mahmoud; Molina-Barea, Rocio; Garcia-Leiva, Juan Miguel; Rodríguez-Lopez, Carmen Maria; Morillas-Arques, Piedad; Rico-Villademoros, Fernando; Calandre, Elena P

    2015-01-01

    Fibromyalgia is a chronic musculoskeletal pain syndrome characterized by a broad spectrum of manifestations. Patients with fibromyalgia frequently suffer from manifestations similar to those experienced by patients with gluten-related disorders raising the possibility that some patients with fibromyalgia could suffer from underlying gluten sensitivity. This study aims to assess whether avoiding gluten among patients with fibromyalgia and gluten sensitivity is beneficial. Adult patients with fibromyalgia presenting gluten sensitivity symptoms are randomly allocated to receive gluten-free diet or hypocaloric diet for 24 weeks. The primary outcome measure is the mean change in the number of experienced gluten sensitivity symptoms. Secondary outcome measures include the mean changes in the body mass index, Revised Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, Brief Pain Inventory, Beck Depression Inventory-II, State-Trait Anxiety Inventory, Short-Form Health Survey and Patient Global Impression Scale of Severity. Other secondary outcome measures include the frequency of potential adverse events and the proportion of responders according to the Patient Global Impression Scale of Improvement. Previous studies assessing dietary interventions in fibromyalgia primarily evaluated their effects on the severity and impact of fibromyalgia symptoms and pain. The current study is the first to evaluate the effects of gluten-free diet on the gluten sensitivity symptoms experienced by patients with fibromyalgia. The results of this study will contribute to a better understanding of the potential role of gluten sensitivity in fibromyalgia. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Reporting Misconduct of a Coworker to Protect a Patient: A Comparison between Experienced Nurses and Nursing Students

    Directory of Open Access Journals (Sweden)

    Abraham Mansbach

    2014-01-01

    Full Text Available Purpose. Whistleblowing is the reporting of illegal, immoral, or illegitimate practices to persons or organizations that may affect the action. The current study compares experienced nurses to nursing students regarding their willingness to blow the whistle to protect a patient’s interests. Methods. 165 participants were divided into two groups: 82 undergraduate nursing students and 83 experienced nurses. Participants responded to two vignettes that described a colleague’s and a manager’s misconduct at work. Results. The nursing students perceived the severity of the misconduct significantly lower compared to the experienced nurses. The nursing students also ranked the internal and external whistleblowing indices higher than the nurses, but the differences did not reach statistical significance. For each of the examined internal and external indices, professional experience was found to be significant in multivariate regression analyses. Conclusions. Even though nursing students perceived the severity of the misconduct significantly lower than the experienced nurses, the students demonstrated a greater readiness to blow the whistle, both internally and externally. Recommendations for handling comparable situations are offered.

  20. Influence on cervical MR imaging by fear and anxiety. Comparison of MR image quality between the first time and experienced patient's

    Energy Technology Data Exchange (ETDEWEB)

    Iseki, Tadahiro; Okano, Tamotsu; Kanou, Norio; Tanaka, Kazuharu; Kawasaki, Kouichi [Yujinkai Medical Corp., Yujin Yamazaki Hospital, Hikone, Shiga (Japan); Kawachi, Toshiaki [Ohgaki Municipal Hospital, Gifu (Japan)

    2002-08-01

    MR image quality was hampered by patient's emotion. We compared MR image quality between first time (group A) and experienced patient's (group B), and between male and female. B group score was better than A group score, but no significant difference was observed between these two groups. And female score was better than male in the group A. The score difference between male and female in the group B was small. (author)

  1. Does a family history of RA influence the clinical presentation and treatment response in RA?

    Science.gov (United States)

    Frisell, Thomas; Saevarsdottir, Saedis; Askling, Johan

    2016-06-01

    To assess whether family history of rheumatoid arthritis (RA), among the strongest risk factors for developing RA, also carries information on the clinical presentation and treatment response. The prospective Swedish Rheumatology register was linked to family history of RA, defined as diagnosed RA in any first-degree relative, ascertained through the Swedish Multi-Generation and Patient registers. Clinical presentation was examined among patients with early RA 2000-2011 (symptom onset clinical characteristics, drug survival, European League Against Rheumatism (EULAR) response and change in disease activity at 3 and 6 months was estimated using linear and generalised logistic regression models. Correlation in relatives' response measures was also assessed. Patients with early RA with family history of RA were more often rheumatoid factor positive, but with no other clinically meaningful differences in their clinical presentation. Family history of RA did not predict response to MTX or TNFi, with the possible exception of no versus good EULAR response to TNFi at 6 months (OR=1.4, 95% CI 1.1 to 1.7). Having a relative who discontinued TNFi within a year increased the odds of doing the same (OR=3.7, 95% CI 1.8 to 7.5), although we found no significant familial correlations in change in disease activity measures. Family history of RA did not modify the clinical presentation of RA or predict response to standard treatment with MTX or TNFi. Treatment response, particularly drug survival, may itself be familial. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Drug susceptibility to etravirine and darunavir among Human Immunodeficiency Virus Type 1-derived pseudoviruses in treatment-experienced patients with HIV/AIDS in South Korea.

    Science.gov (United States)

    Kwon, Oh-Kyung; Kim, Sung Soon; Rhee, Jee Eun; Kee, Mee-Kyung; Park, Mina; Oh, Hye-Ri; Choi, Ju-Yeon

    2015-04-09

    In South Korea, about 20 types of antiretroviral drugs are used in the treatment of patients with human immunodeficiency virus/acquired immune deficiency syndrome. Since 2010, raltegravir, etravirine, and darunavir have been spotlighted as new drugs for highly active antiretroviral therapy (HAART)-experienced adults with resistant HIV-1 in South Korea. In this study, we investigated potential susceptibility of pseudoviruses derived from treatment-experienced Korean patients to etravirine vs efavirenz and to darunavir vs amprenavir and indinavir using a modified single-round assay. Pseudoviruses derived from nine treatment-experienced patients infected with HIV-1 were investigated by comparison with the wild-type strain pNL4-3. The 50% inhibitory concentration (IC50) values were calculated and drug susceptibility was compared. The intensity of genotypic drug resistance was classified based on the 'SIR' interpretation of the Stanford data base. Drug susceptibility was generally higher for etravirine and darunavir compared with efavirenz, amprenavir, and indinavir in pseudoviruses derived from treatment-experienced patients. Pseudoviruses derived from patients KRB4025 and KRB8014, who exhibited long-term use of protease inhibitors, showed an outside of tested drug concentration, especially for amprenavir and indinavir. However, they exhibited a lower fold-change in resistance to darunavir. Etravirine and darunavir have been used in HAART since 2010 in South Korea. Therefore, these antiretroviral drugs together with other newly introduced antiretroviral drugs are interesting for the optimal treatment of patients with treatment failure. This study may help to find a more effective HAART in the case of HIV-1 infected patients that have difficulty being treated.

  3. The association of fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatiod arthritis. Results from 34 countries participating in the Quest-RA programme

    NARCIS (Netherlands)

    Grøn, K.L.; Ørnbjerg, L.M.; Hetland, M.L.; Aslam, F.; Khan, N.A.; Jacobs, J.W.G.; Henrohn, D.; Rasker, Johannes J.; Kauppi, M.J.; Lang, H.C.; Mota, L.M.H.; Aggarwal, A.; Yamanaka, H.; Badsha, H.; Gossec, L.; Cutolo, M.; Ferraccioli, G.; Gremese, E.; Bong Lee, E.; Inanc, N.; Direskeneli, H.; Taylor, Peter; Huisman, Marieke; Alten, R.; Pohl, C.; Oyoo, O.; Stropuviene, S.; Drosos, A.A.; Kerzberg, E.; Ancuta, C.; Mofti, A.; Bergman, M.; Detert, J.; Selim, Z.I.; Abda, E.A.; Rexhepi, B.; Sokka, T.

    2014-01-01

    OBJECTIVES: The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA).METHODS: Nine thousands eight hundred

  4. The association of fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the Quest-RA program

    DEFF Research Database (Denmark)

    Grøn, Kathrine Lederballe; Ornbjerg, Lykke Midtbøll; Hetland, Merete Lund

    2014-01-01

    OBJECTIVES: The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA). METHODS: Nine thousands eight hundred...

  5. Determination of 226Ra and 228Ra in gypsum

    International Nuclear Information System (INIS)

    Godoy, J.M.

    1989-01-01

    The content of 226 Ra and 228 Ra in different samples of phosphogypsum and three samples of gypsite were determined by gamma spectroscopy. For 226 Ra the 295, 352 and 609 KeV lines and for 228 Ra the 911 and 969 KeV lines were used. The specific activities values ranged from 0.36 to 22.8 pCi/g for 226 Ra and 0.90 to 10.3 pCi/g for 228 Ra. The contribution of a sypsum roof-covering to the 222 Rn concentration in a room was estimated, based on the highest value reported. (author) [pt

  6. [Development and Evaluation of a Self-Reflection Program for Intensive Care Unit Nurses Who Have Experienced the Death of Pediatric Patients].

    Science.gov (United States)

    Kang, Hyun Ju; Bang, Kyung Sook

    2017-06-01

    This study aims to develop a self-reflection program for nurses who have experienced the death of pediatric patients in the intensive care unit and to evaluate its effectiveness. The self-reflection program was developed by means of the following four steps: establishment of the goal through investigation of an initial request, drawing up the program, preliminary research, and implementation and improvement of the program. The study employed a methodological triangulation to evaluate the effectiveness of the program. Participants were 38 nurses who had experienced the death of pediatric patients (experimental group=15, control group=23); they were recruited using convenience sampling. The self-reflection program was provided over 6 weeks (6 sessions). Data were collected from April to August, 2014 and analyzed using t-tests and content analysis. The quantitative results showed that changes in personal growth (t=-6.33, pself-reflection program developed by this study was effective in helping nurses who had experienced the death of pediatric patients to achieve personal growth through self-reflection, and it was confirmed that the program can be applied in a realistic clinical nursing setting. Furthermore, it can be recommended as an intervention program for clinical nurses. © 2017 Korean Society of Nursing Science

  7. Clinical experience with fixed bimonthly aflibercept dosing in treatment-experienced patients with neovascular age-related macular degeneration

    Directory of Open Access Journals (Sweden)

    Khanani AM

    2015-07-01

    Full Text Available Arshad M Khanani Sierra Eye Associates, Reno, NV, USA Purpose: To evaluate the durability of fixed bimonthly dosing of intravitreal aflibercept for neovascular age-related macular degeneration.Methods: Records of 16 patients were retrospectively reviewed. Patients received three initial 2.0 mg monthly doses of aflibercept then 8-weekly doses according to the product label. Best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] letters, central macular thickness, fluid on optical coherence tomography, and pigment epithelial detachment (PED were measured.Results: Prior to starting aflibercept, 13 patients had subretinal fluid (SRF, five had intraretinal fluid (IRF, four had PED, and baseline visual acuity (VA was 62 approximate ETDRS letters. Following the monthly dosing, seven patients had no improvement or decreased VA, ten patients still had SRF/IRF, and PED had worsened in one patient. At Visit 4, an average of 6.8 weeks after Visit 3, VA had decreased in seven patients, SRF/IRF had increased in 12 patients, and PED had returned in all patients who initially responded. Based on the presence of fluid after the initial monthly injections, 12 patients could not be extended to fixed bimonthly dosing.Conclusion: This case series adds to the growing body of evidence on the need for flexible dosing schedules for the personalized treatment of neovascular age-related macular degeneration. Keywords: age-related macular degeneration, AMD, bimonthly, regimen, aflibercept, case studies, retinal fluid

  8. Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.

    Science.gov (United States)

    van Bruinessen, Inge Renske; van Weel-Baumgarten, Evelyn M; Gouw, Hans; Zijlstra, Josée M; Albada, Akke; van Dulmen, Sandra

    2013-12-01

    This study aims to gain insight into patient-perceived communication barriers and facilitators at different stages after the diagnosis of malignant lymphoma. We have detected patterns to explain when these factors influence communication predominantly. A qualitative approach was applied, derived from the context mapping framework. A total of 28 patients completed a set of assignments about their experiences with provider-patient communication during medical consultations. Subsequently, these patients and nine companions shared their experiences during a semistructured (group) interview, which was recorded on audiotape. The audiotapes and assignments were analysed with MAXQDA software. From the patients' viewpoint, communicating effectively appears to depend on their own attributes (e.g. emotions), the health care professionals' attributes (e.g. attitude) and external factors (e.g. time pressure). Three patient communication states were identified: (i) overwhelmed, passive; (ii) pro-active, self-motivated; and (iii) proficient, empowered. Patients seem to behave differently in the three communication states. This study lists patient-perceived communication barriers and facilitators and identifies three different communication states, which indicate when certain barriers and facilitators are encountered. These findings may support health care professionals to tailor the provision of support and information and remove communication barriers accordingly. Additionally, they provide input for interventions to support patients in effective communication. Copyright © 2013 John Wiley & Sons, Ltd.

  9. Evaluation of Real-World Experience with Tofacitinib Compared with Adalimumab, Etanercept, and Abatacept in RA Patients with 1 Previous Biologic DMARD: Data from a U.S. Administrative Claims Database.

    Science.gov (United States)

    Harnett, James; Gerber, Robert; Gruben, David; Koenig, Andrew S; Chen, Connie

    2016-12-01

    Real-world data comparing tofacitinib with biologic disease-modifying antirheumatic drugs (bDMARDs) are limited. To compare characteristics, treatment patterns, and costs of patients with rheumatoid arthritis (RA) receiving tofacitinib versus the most common bDMARDs (adalimumab [ADA], etanercept [ETN], and abatacept [ABA]) following a single bDMARD in a U.S. administrative claims database. This study was a retrospective cohort analysis of patients aged ≥ 18 years with an RA diagnosis (ICD-9-CM codes 714.0x-714.4x; 714.81) and 1 previous bDMARD filling ≥ 1 tofacitinib or bDMARD claim in the Truven MarketScan Commercial and Medicare Supplemental claims databases (November 1, 2012-October 31, 2014). Monotherapy was defined as absence of conventional synthetic DMARDs within 90 days post-index. Persistence was evaluated using a 60-day gap. Adherence was assessed using proportion of days covered (PDC). RA-related total, pharmacy, and medical costs were evaluated in the 12-month pre- and post-index periods. Treatment patterns and costs were adjusted using linear models including a common set of clinically relevant variables of interest (e.g., previous RA treatments), which were assessed separately using t-tests and chi-squared tests. Overall, 392 patients initiated tofacitinib; 178 patients initiated ADA; 118 patients initiated ETN; and 191 patients initiated ABA. Tofacitinib patients were older versus ADA patients (P = 0.0153) and had a lower proportion of Medicare supplemental patients versus ABA patients (P = 0.0095). Twelve-month pre-index bDMARD use was greater in tofacitinib patients (77.6%) versus bDMARD cohorts (47.6%-59.6%). Tofacitinib patients had greater 12-month pre-index RA-related total costs versus bDMARD cohorts (all P 0.10) proportion of patients were persistent with tofacitinib (42.6%) versus ADA (37.6%), ETN (42.4%), and ABA (43.5%). Mean PDC was 0.55 for tofacitinib versus 0.57 (ADA), 0.59 (ETN), and 0.44 (ABA; P = 0.0003). Adjusted analyses

  10. Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying

    OpenAIRE

    Pino, Marco; Parry, Ruth; Land, Victoria; Faull, Christina; Feathers, Luke; Seymour, Jane

    2016-01-01

    Objective\\ud To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL)\\ud talk. To examine whether the practice of “eliciting and responding to cues”, which has been\\ud widely advocated in the EoL care literature, promotes EoL talk.\\ud Design\\ud Conversation analysis of video- and audio-recorded consultations.\\ud Participants\\ud Unselected terminally ill patients and their companions in consultation with experienced palliative\\ud medicine doctors.\\ud Setting\\ud O...

  11. Prevalence and evolution of low frequency HIV drug resistance mutations detected by ultra deep sequencing in patients experiencing first line antiretroviral therapy failure.

    Science.gov (United States)

    Vandenhende, Marie-Anne; Bellecave, Pantxika; Recordon-Pinson, Patricia; Reigadas, Sandrine; Bidet, Yannick; Bruyand, Mathias; Bonnet, Fabrice; Lazaro, Estibaliz; Neau, Didier; Fleury, Hervé; Dabis, François; Morlat, Philippe; Masquelier, Bernard

    2014-01-01

    Clinical relevance of low-frequency HIV-1 variants carrying drug resistance associated mutations (DRMs) is still unclear. We aimed to study the prevalence of low-frequency DRMs, detected by Ultra-Deep Sequencing (UDS) before antiretroviral therapy (ART) and at virological failure (VF), in HIV-1 infected patients experiencing VF on first-line ART. Twenty-nine ART-naive patients followed up in the ANRS-CO3 Aquitaine Cohort, having initiated ART between 2000 and 2009 and experiencing VF (2 plasma viral loads (VL) >500 copies/ml or one VL >1000 copies/ml) were included. Reverse transcriptase and protease DRMs were identified using Sanger sequencing (SS) and UDS at baseline (before ART initiation) and VF. Additional low-frequency variants with PI-, NNRTI- and NRTI-DRMs were found by UDS at baseline and VF, significantly increasing the number of detected DRMs by 1.35 fold (plow-frequency DRMs modified ARV susceptibility predictions to the prescribed treatment for 1 patient at baseline, in whom low-frequency DRM was found at high frequency at VF, and 6 patients at VF. DRMs found at VF were rarely detected as low-frequency DRMs prior to treatment. The rare low-frequency NNRTI- and NRTI-DRMs detected at baseline that correlated with the prescribed treatment were most often found at high-frequency at VF. Low frequency DRMs detected before ART initiation and at VF in patients experiencing VF on first-line ART can increase the overall burden of resistance to PI, NRTI and NNRTI.

  12. Experienced emotional burden in caregivers: psychometric properties of the Involvement Evaluation Questionnaire in caregivers of brain injured patients

    NARCIS (Netherlands)

    Geurtsen, Gert J.; Meijer, Ron; van Heugten, Caroline M.; Martina, Juan D.; Geurts, Alexander C. H.

    2010-01-01

    To examine the psychometric properties (internal consistency, discriminant validity, and responsiveness) of the Involvement Evaluation Questionnaire for Brain Injury measuring emotional burden in caregivers of patients with chronic acquired brain injury. Inception cohort study. Caregivers of chronic

  13. Experienced emotional burden in caregivers: psychometric properties of the Involvement Evaluation Questionnaire in caregivers of brain injured patients.

    NARCIS (Netherlands)

    Geurtsen, G.J.; Meijer, R.; Heugten, C.M. van; Martina, J.D.; Geurts, A.C.H.

    2010-01-01

    OBJECTIVE: To examine the psychometric properties (internal consistency, discriminant validity, and responsiveness) of the Involvement Evaluation Questionnaire for Brain Injury measuring emotional burden in caregivers of patients with chronic acquired brain injury. DESIGN: Inception cohort study.

  14. Combined Analysis of the Prevalence of drug Resistant Hepatitis B Virus in antiviral therapy Experienced patients in Europe (CAPRE)

    DEFF Research Database (Denmark)

    Hermans, L E; Svicher, V; Pas, S D

    2016-01-01

    BACKGROUND: European guidelines recommend treatment of chronic hepatitis B virus infection (CHB) with the nucleos(t)ide analogs (NAs) entecavir or tenofovir. However, many European CHB patients have been exposed to other NAs, which are associated with therapy failure and resistance. The CAPRE study...... was performed to gain insight in prevalence and characteristics of NA resistance in Europe. METHODS: A survey was performed on genotypic resistance testing results acquired during routine monitoring of CHB patients with detectable serum hepatitis B virus DNA in European tertiary referral centers. RESULTS: Data...... from 1568 patients were included. The majority (73.8%) were exposed to lamivudine monotherapy. Drug-resistant strains were detected in 52.7%. The most frequently encountered primary mutation was M204V/I (48.7%), followed by A181T/V (3.8%) and N236T (2.6%). In patients exposed to entecavir (n = 102...

  15. Lived Experiences of Sex Life Difficulties in Men and Women with Early RA - The Swedish TIRA Project.

    Science.gov (United States)

    Östlund, Gunnel; Björk, Mathilda; Valtersson, Eva; Sverker, Annette

    2015-12-01

    Men and women with rheumatoid arthritis (RA) experience restrictions in everyday life, in spite of the development of new medications. Recent research has described in detail how participation limitations are experienced in everyday life from a patient perspective. However, knowledge of how sex and intimate relationships are affected is still scarce. The aim of the present study was to explore sex life experiences in relation to sexual function and sexual relationships in men and women with early RA. The study formed part of TIRA-2 (the Swedish acronym for the prospective multicentre early arthritis project). The data collection included 45 interviews with 21 men and 24 women, aged 20-63, which were recorded and transcribed verbatim. The critical incident technique was used to collect data, and content analysis to categorize the results. Half the participants stated that RA affected their sex life. The general descriptions formed five categories: sex life and tiredness; sex life and ageing; emotional consequences of impaired sexual function; facilitators of sexual function and sexual relationships; and strain on the sexual relationship. Sex life is affected in early RA, in spite of new effective treatment strategies. New strategies of communication, assessment and self-managing interventions concerning the sex lives of patients with RA need to be implemented by a multidisciplinary healthcare team. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  16. Patient experienced continuity of care in the psychiatric healthcare system-a study including immigrants, refugees and ethnic danes.

    Science.gov (United States)

    Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne; Krasnik, Allan; Norredam, Marie

    2014-09-17

    The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.

  17. Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis

    NARCIS (Netherlands)

    Bruinessen, I.R. van; Weel-Baumgarten, E.M. van; Gouw, H.; Zijlstra, J.M.; Albada, A.; Dulmen, S. van

    2013-01-01

    OBJECTIVE: This study aims to gain insight into patient-perceived communication barriers and facilitators at different stages after the diagnosis of malignant lymphoma. We have detected patterns to explain when these factors influence communication predominantly. METHOD: A qualitative approach was

  18. Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.

    NARCIS (Netherlands)

    Bruinessen, I.R. van; Weel, E.M. van; Gouw, H.; Zijlstra, J.M.; Albada, A.; Dulmen, S. van

    2013-01-01

    Objective: This study aims to gain insight into patient-perceived communication barriers and facilitators at different stages after the diagnosis of malignant lymphoma. We have detected patterns to explain when these factors influence communication predominantly. Method: A qualitative approach was

  19. The role of helplessness as mediator between neurological disability, emotional instability, experienced fatigue and depression in patients with multiple sclerosis.

    NARCIS (Netherlands)

    Werf, S.P. van der; Evers, A.W.M.; Jongen, P.J.H.; Bleijenberg, G.

    2003-01-01

    The aim of this study was to test, in patients with multiple sclerosis (MS), whether the concept of helplessness might improve the understanding of the relationship between disease severity (neurological impairment) and personality characteristics (emotional instability) on one hand, and depressive

  20. Role of baseline HIV-1 DNA level in highly-experienced patients receiving raltegravir, etravirine and darunavir/ritonavir regimen (ANRS139 TRIO trial.

    Directory of Open Access Journals (Sweden)

    Charlotte Charpentier

    Full Text Available OBJECTIVE: In the ANRS 139 TRIO trial, the use of 3 new active drugs (raltegravir, etravirine, and darunavir/ritonavir, resulted in a potent and sustained inhibition of viral replication in multidrug-resistant treatment-experienced patients. The aim of this virological sub-study of the ANRS 139 TRIO trial was to assess: (i the evolution of HIV-1 DNA over the first year; and (ii the association between baseline HIV-1 DNA and virological outcome. METHODS: Among the 103 HIV-1-infected patients included in the ANRS-139 TRIO trial, HIV-1 DNA specimens were available for 92, 84, 88, and 83 patients at Week (W0, W12, W24, and W48, respectively. Quantification of total HIV-1 DNA was performed by using the commercial kit "Generic HIV DNA Cell" (Biocentric, Bandol, France. RESULTS: Baseline median HIV-1 DNA of patients displaying virological success (n= 61, viral blip (n= 20, and virological failure (n = 11 were 2.34 log(10 copies/10(6 PBMC (IQR= 2.15-2.66, 2.42 (IQR = 2.12-2.48, and 2.68 (IQR= 2.46-2.83, respectively. Although not statistically significant, patients exhibiting virological success or viral blip had a tendency to display lower baseline HIV-1 DNA than patients experiencing virological failure (P = 0.06. Median decrease of HIV-1 DNA between baseline and W48 was -0.13 log(10 copies/10(6 PBMC (IQR = -0.34 to +0.10, mainly explained by the evolution from W0 to W4. No more changes were observed in the W4-W48 period. CONCLUSIONS: In highly-experienced multidrug-resistant patients, HIV-1 DNA slightly decreased during the first month and then remained stable during the first year of highly potent antiretroviral regimen. In this population, baseline HIV-1 DNA might help to better predict the virological response and to tailor clinical therapeutic management as more aggressive therapeutic choices in patients with higher baseline HIV-1 DNA.

  1. Patients experiencing statin-induced myalgia exhibit a unique program of skeletal muscle gene expression following statin re-challenge

    OpenAIRE

    Elam, Marshall B.; Majumdar, Gipsy; Mozhui, Khyobeni; Gerling, Ivan C.; Vera, Santiago R.; Fish-Trotter, Hannah; Williams, Robert W.; Childress, Richard D.; Raghow, Rajendra

    2017-01-01

    Statins, the 3-hydroxy-3-methyl-glutaryl (HMG)-CoA reductase inhibitors, are widely prescribed for treatment of hypercholesterolemia. Although statins are generally well tolerated, up to ten percent of statin-treated patients experience myalgia symptoms, defined as muscle pain without elevated creatinine phosphokinase (CPK) levels. Myalgia is the most frequent reason for discontinuation of statin therapy. The mechanisms underlying statin myalgia are not clearly understood. To elucidate change...

  2. Scoring correction for MMPI-2 Hs scale with patients experiencing a traumatic brain injury: a test of measurement invariance.

    Science.gov (United States)

    Alkemade, Nathan; Bowden, Stephen C; Salzman, Louis

    2015-02-01

    It has been suggested that MMPI-2 scoring requires removal of some items when assessing patients after a traumatic brain injury (TBI). Gass (1991. MMPI-2 interpretation and closed head injury: A correction factor. Psychological assessment, 3, 27-31) proposed a correction procedure in line with the hypothesis that MMPI-2 endorsement may be affected by symptoms of TBI. This study assessed the validity of the Gass correction procedure. A sample of patients with a TBI (n = 242), and a random subset of the MMPI-2 normative sample (n = 1,786). The correction procedure implies a failure of measurement invariance across populations. This study examined measurement invariance of one of the MMPI-2 scales (Hs) that includes TBI correction items. A four-factor model of the MMPI-2 Hs items was defined. The factor model was found to meet the criteria for partial measurement invariance. Analysis of the change in sensitivity and specificity values implied by partial measurement invariance failed to indicate significant practical impact of partial invariance. Overall, the results support continued use of all Hs items to assess psychological well-being in patients with TBI. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. A Thematic Literature Review: The Importance of Providing Spiritual Care for End-of-Life Patients Who Have Experienced Transcendence Phenomena.

    Science.gov (United States)

    Broadhurst, Kathleen; Harrington, Ann

    2016-11-01

    The purpose of this review was to investigate within the literature the link between transcendent phenomena and peaceful death. The objectives were firstly to acknowledge the importance of such experiences and secondly to provide supportive spiritual care to dying patients. Information surrounding the aforementioned concepts is underreported in the literature. The following 4 key themes emerged: spiritual comfort; peaceful, calm death; spiritual transformation; and unfinished business The review established the importance of transcendence phenomena being accepted as spiritual experiences by health care professionals. Nevertheless, health care professionals were found to struggle with providing spiritual care to patients who have experienced them. Such phenomena are not uncommon and frequently result in peaceful death. Additionally, transcendence experiences of dying patients often provide comfort to the bereaved, assisting them in the grieving process. © The Author(s) 2015.

  4. Patients experiencing statin-induced myalgia exhibit a unique program of skeletal muscle gene expression following statin re-challenge.

    Directory of Open Access Journals (Sweden)

    Marshall B Elam

    Full Text Available Statins, the 3-hydroxy-3-methyl-glutaryl (HMG-CoA reductase inhibitors, are widely prescribed for treatment of hypercholesterolemia. Although statins are generally well tolerated, up to ten percent of statin-treated patients experience myalgia symptoms, defined as muscle pain without elevated creatinine phosphokinase (CPK levels. Myalgia is the most frequent reason for discontinuation of statin therapy. The mechanisms underlying statin myalgia are not clearly understood. To elucidate changes in gene expression associated with statin myalgia, we compared profiles of gene expression in skeletal muscle biopsies from patients with statin myalgia who were undergoing statin re-challenge (cases versus those of statin-tolerant controls. A robust separation of case and control cohorts was revealed by Principal Component Analysis of differentially expressed genes (DEGs. To identify putative gene expression and metabolic pathways that may be perturbed in skeletal muscles of patients with statin myalgia, we subjected DEGs to Ingenuity Pathways (IPA and DAVID (Database for Annotation, Visualization and Integrated Discovery analyses. The most prominent pathways altered by statins included cellular stress, apoptosis, cell senescence and DNA repair (TP53, BARD1, Mre11 and RAD51; activation of pro-inflammatory immune response (CXCL12, CST5, POU2F1; protein catabolism, cholesterol biosynthesis, protein prenylation and RAS-GTPase activation (FDFT1, LSS, TP53, UBD, ATF2, H-ras. Based on these data we tentatively conclude that persistent myalgia in response to statins may emanate from cellular stress underpinned by mechanisms of post-inflammatory repair and regeneration. We also posit that this subset of individuals is genetically predisposed to eliciting altered statin metabolism and/or increased end-organ susceptibility that lead to a range of statin-induced myopathies. This mechanistic scenario is further bolstered by the discovery that a number of single

  5. Patients experiencing statin-induced myalgia exhibit a unique program of skeletal muscle gene expression following statin re-challenge.

    Science.gov (United States)

    Elam, Marshall B; Majumdar, Gipsy; Mozhui, Khyobeni; Gerling, Ivan C; Vera, Santiago R; Fish-Trotter, Hannah; Williams, Robert W; Childress, Richard D; Raghow, Rajendra

    2017-01-01

    Statins, the 3-hydroxy-3-methyl-glutaryl (HMG)-CoA reductase inhibitors, are widely prescribed for treatment of hypercholesterolemia. Although statins are generally well tolerated, up to ten percent of statin-treated patients experience myalgia symptoms, defined as muscle pain without elevated creatinine phosphokinase (CPK) levels. Myalgia is the most frequent reason for discontinuation of statin therapy. The mechanisms underlying statin myalgia are not clearly understood. To elucidate changes in gene expression associated with statin myalgia, we compared profiles of gene expression in skeletal muscle biopsies from patients with statin myalgia who were undergoing statin re-challenge (cases) versus those of statin-tolerant controls. A robust separation of case and control cohorts was revealed by Principal Component Analysis of differentially expressed genes (DEGs). To identify putative gene expression and metabolic pathways that may be perturbed in skeletal muscles of patients with statin myalgia, we subjected DEGs to Ingenuity Pathways (IPA) and DAVID (Database for Annotation, Visualization and Integrated Discovery) analyses. The most prominent pathways altered by statins included cellular stress, apoptosis, cell senescence and DNA repair (TP53, BARD1, Mre11 and RAD51); activation of pro-inflammatory immune response (CXCL12, CST5, POU2F1); protein catabolism, cholesterol biosynthesis, protein prenylation and RAS-GTPase activation (FDFT1, LSS, TP53, UBD, ATF2, H-ras). Based on these data we tentatively conclude that persistent myalgia in response to statins may emanate from cellular stress underpinned by mechanisms of post-inflammatory repair and regeneration. We also posit that this subset of individuals is genetically predisposed to eliciting altered statin metabolism and/or increased end-organ susceptibility that lead to a range of statin-induced myopathies. This mechanistic scenario is further bolstered by the discovery that a number of single nucleotide

  6. Patients experiencing statin-induced myalgia exhibit a unique program of skeletal muscle gene expression following statin re-challenge

    Science.gov (United States)

    Majumdar, Gipsy; Mozhui, Khyobeni; Gerling, Ivan C.; Vera, Santiago R.; Fish-Trotter, Hannah; Williams, Robert W.; Childress, Richard D.

    2017-01-01

    Statins, the 3-hydroxy-3-methyl-glutaryl (HMG)-CoA reductase inhibitors, are widely prescribed for treatment of hypercholesterolemia. Although statins are generally well tolerated, up to ten percent of statin-treated patients experience myalgia symptoms, defined as muscle pain without elevated creatinine phosphokinase (CPK) levels. Myalgia is the most frequent reason for discontinuation of statin therapy. The mechanisms underlying statin myalgia are not clearly understood. To elucidate changes in gene expression associated with statin myalgia, we compared profiles of gene expression in skeletal muscle biopsies from patients with statin myalgia who were undergoing statin re-challenge (cases) versus those of statin-tolerant controls. A robust separation of case and control cohorts was revealed by Principal Component Analysis of differentially expressed genes (DEGs). To identify putative gene expression and metabolic pathways that may be perturbed in skeletal muscles of patients with statin myalgia, we subjected DEGs to Ingenuity Pathways (IPA) and DAVID (Database for Annotation, Visualization and Integrated Discovery) analyses. The most prominent pathways altered by statins included cellular stress, apoptosis, cell senescence and DNA repair (TP53, BARD1, Mre11 and RAD51); activation of pro-inflammatory immune response (CXCL12, CST5, POU2F1); protein catabolism, cholesterol biosynthesis, protein prenylation and RAS-GTPase activation (FDFT1, LSS, TP53, UBD, ATF2, H-ras). Based on these data we tentatively conclude that persistent myalgia in response to statins may emanate from cellular stress underpinned by mechanisms of post-inflammatory repair and regeneration. We also posit that this subset of individuals is genetically predisposed to eliciting altered statin metabolism and/or increased end-organ susceptibility that lead to a range of statin-induced myopathies. This mechanistic scenario is further bolstered by the discovery that a number of single nucleotide

  7. Advanced scheduling for zygote intrafallopian transfer is possible via the use of a hormone replacement cycle for patients who have experienced repeated implantation failures.

    Science.gov (United States)

    Nakagawa, Koji; Juen, Hiroyasu; Nishi, Yayoi; Sugiyama, Rie; Motoyama, Hiroshi; Kuribayashi, Yasushi; Inoue, Masato; Akira, Shigeo; Sugiyama, Rikikazu

    2014-11-01

    Zygote intrafallopian transfer (ZIFT) is an effective option for patients who have experienced repeated implantation failures (RIF) in assisted reproductive technology (ART) treatment. However, advance planning for the day of the operation can be problematic. Using a hormone replacement cycle (HRC) makes it possible to plan for the day of ZIFT. In the present study, we evaluated whether HRC-ZIFT is useful for RIF patients who have experienced difficulties obtaining morphologically good embryos in vitro. A total of 55 patients with a history of five or more unsuccessful transfers received HRC-ZIFT between June 2008 and June 2013. The oocyte pick-ups were performed and the oocytes showing two pronuclei (2PN) were cryopreserved. After receiving more than five 2PN oocytes, the operation day was scheduled in advance, and as a consequence, a HRC was started and ZIFT was performed. The clinical outcomes were evaluated. The average age of the patients was 39.3 years, and the previous OPU and ET attempts numbered 7.5 and 6.9, respectively. The number of previously transferred embryos was 11.8, and the number of morphologically good embryos (MGEs) was only 1.2. The number of transferred 2PN oocytes was 6.7, and the subsequent pregnancy rate was 23.6 %. No ectopic or multiple pregnancies were observed, but there were 6 cases of miscarriage. Among RIF patients, in particular those who have difficulty obtaining MGEs in vitro, ZIFT might be a useful option. The HRC allows patients and medical staff to plan for the operation day in advance.

  8. Analysis of the cell infiltrate and expression of matrix metalloproteinases and granzyme B in paired synovial biopsy specimens from the cartilage-pannus junction in patients with RA

    NARCIS (Netherlands)

    Smeets, T. J.; Kraan, M. C.; Galjaard, S.; Youssef, P. P.; Smith, M. D.; Tak, P. P.

    2001-01-01

    Examination of synovial tissue (ST) obtained at surgery because of end stage destructive rheumatoid arthritis (RA) showed that macrophages and fibroblasts are the major cell types at the cartilage-pannus junction (CPJ). This study aimed at defining the cell infiltrate and mediators of joint

  9. Holistic self-care for rehabilitation experienced by thai buddhist trauma patients in areas of political and social unrest.

    Science.gov (United States)

    Songwathana, Praneed; Watanasiriwanich, Wachiraya; Kitrungrote, Luppana

    2013-01-01

    This study describes the meaning and practice of holistic self-care for rehabilitation among Thai Buddhist trauma patients living in areas of political unrest where acts of terrorism occur. Eleven Thai Buddhist trauma patients were selected as specified. The data were collected by in-depth interviews between November 2011 and April 2012, and analyzed using the Van Manen method.Those interviewed described "holistic self-care for rehabilitation" as learning (1) to acquire a new life and (2) to bear the increased demands of care as a chronic disease. Health care responses fell into 3 categories: (1) improving physical self-sufficiency and rehabilitation by increasing muscle strength, pain management, and pressure sores; (2) improving psychological well-being by applying positive thinking, making an effort to live independently, and following a set of religious practices; and (3) finding harmony in life through caution and a willingness to adjust one's lifestyle. Although the participants seemed to adapt well to their new lifestyles, extensive support from health care professionals was necessary. This study promotes better understanding of the holistic health care experiences the survivors of trauma have as a result of an unstable political situation that includes aspects of social unrest and terrorism.

  10. Worries and concerns experienced by nurse specialists during inter-hospital transports of critically ill patients: a critical incident study.

    Science.gov (United States)

    Gustafsson, Marcus; Wennerholm, Sara; Fridlund, Bengt

    2010-06-01

    Inter-hospital patient transports are required around the clock. During these transports it is the responsibility of the accompanying nurse specialists to ensure their patient's safety, while at the same time providing optimal nursing care in an unusual and often stressful situation. The aim of this study was to explore and describe the nurse specialists' cause of worries and concerns (WaC) and how they manage these. An explorative and qualitative design based on the critical incident technique was used. Interviews were conducted with 30 nurse specialists within the fields of anaesthetic, intensive and pre-hospital care in the south of Sweden. WaC felt by the nurse specialists were based on being unable to influence their work situation, or carry out their tasks as expected. Their responses to these unusual situations were resolved by using internal (acquired knowledge and experience) and external resources (consulting colleagues having different competences). A safe working environment improves the possibility to deliver a satisfactory work performance. Shared experiences and communication between colleagues should be encouraged; teamwork should be enhanced by the implementation of local and national training courses, and unambiguous work guidelines should be given. Copyright 2010 Elsevier Ltd. All rights reserved.

  11. Cardiovascular safety of biologic therapies for the treatment of RA.

    Science.gov (United States)

    Greenberg, Jeffrey D; Furer, Victoria; Farkouh, Michael E

    2011-11-15

    Cardiovascular disease represents a major source of extra-articular comorbidity in patients with rheumatoid arthritis (RA). A combination of traditional cardiovascular risk factors and RA-related factors accounts for the excess risk in RA. Among RA-related factors, chronic systemic inflammation has been implicated in the pathogenesis and progression of atherosclerosis. A growing body of evidence--mainly derived from observational databases and registries--suggests that specific RA therapies, including methotrexate and anti-TNF biologic agents, can reduce the risk of future cardiovascular events in patients with RA. The cardiovascular profile of other biologic therapies for the treatment of RA has not been adequately studied, including of investigational drugs that improve systemic inflammation but alter traditional cardiovascular risk factors. In the absence of large clinical trials adequately powered to detect differences in cardiovascular events between biologic drugs in RA, deriving firm conclusions on cardiovascular safety is challenging. Nevertheless, observational research using large registries has emerged as a promising approach to study the cardiovascular risk of emerging RA biologic therapies.

  12. Estuarine geochemistry of 224Ra, 226Ra, and 222Rn

    International Nuclear Information System (INIS)

    Elsinger, R.J.

    1982-01-01

    Desorption from river borne sediments is the most likely source of the excess 226 Ra. Laboratory mixing experiments on Pee Dee River sediments show an increase in 226 Ra desorption with increasing salinities with maximum desorption occurring at or above 20 0 /oo salinity. Desorption and diffusion are the sources for 226 Ra in the estuarine systems. In Winyah Bay the 228 Ra/ 226 Ra activity ratio does not change significantly with salinity, averaging around 1.4, indicating desorption as the major source of 228 Ra. In the Yangtze River the 228 Ra/ 226 Ra activity ratio is constant (approx.1.90) until increasing linearly above 16 0 /oo. A diffusive flux from regeneration by 232 Th decay in shelf sediments is the source of the increase. In Delaware Bay 228 Ra increases faster than 226 Ra in the less than or equal to22 0 /oo water, indicating a source in addition to desorption. The increase can be balanced by a 0.33 dpm/cm 2 -year flux over the upper part of the Bay where fine grained sediments predominate. 224 Ra behavior is controlled by its 3.64 day half-life. In Winyah Bay a flux of around 0.4 dpm/cm 2 -day is necessary to support the standing crop of non-desorbed 224 Ra in the water column. In Delaware Bay the nearly constant 224 Ra in concentration over the 2.5 0 /oo to 12 0 /oo salinity range are maintained by regeneration from 228 Th in the turbidity maximum zones and diffusion from bottom sediments. Water leaving on ebb tide from a salt marsh on Delaware Bay had increases in all three radium isotopes ( 224 Ra > 228 Ra > 226 Ra) compared to water coming in on the flood tide. Excess 222 Rn concentrations in a fresh water section of the Pee Dee River show a decreasing downstream gradient. Using these gradients to determine evasion rates, stagnant film thicknesses range from 21μ to 62μ

  13. Burden Experienced by Family Caregivers of Patients at the End of Life: What do General Practice Teams Offer?

    Science.gov (United States)

    Krug, K; Bölter, R; Ballhausen, R A; Engeser, P; Peters-Klimm, F

    2016-09-01

    The aim of the study: was to determine how far general practice teams are prepared to relieve family caregivers of palliative patients from their caregiving burden, the support they actually offer, and where they identify needs for improvement. Method: Focus groups and interviews on the issues of identification and support of family caregivers were conducted with practice teams (general practitioners, GPs, and medical assistants, MAs) and the results qualitatively analyzed. Results: 21 participants (14 GPs, 7 MAs) from 13 practices identified burdened family caregivers, thereupon offered support and provided contact details to local consultation services. They suggested to family caregivers that they should use their social network to create room for meeting their own needs. Conclusions: Practice teams use a multitude of individualized and unsystematic approaches to support family caregivers. In further studies within the framework of this project, systematic approaches will be identified and tried out. © Georg Thieme Verlag KG Stuttgart · New York.

  14. IL-1Ra: its role in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    M. Cutolo

    2011-09-01

    Full Text Available Interleukin-1 (IL-1 is one of the pivotal cytokines in initiating and driving the processes of rheumatoid arthritis (RA, and the body’s natural response, IL-1 receptor antagonist (IL-1Ra, has been shown conclusively to block its effects. IL-1 mediate several clinical symptoms of the inflammatory reaction (i.e. fever, pain, sleep disturbances. IL-1 is considered a key mediator in RA joint damage because of its greater capacity (greater than TNF of increasing matrix degradation by inducing the production of MMPs and PGE2 in synovial cells, as well by its role as mediator of bone and cartilage destruction. In addition, IL-1 decreases the repair process by suppressing matrix synthesis and shows a strong synergism with TNF in inducing many inflammatory genes at both local and systemic level. The induced endogenous production of IL-1Ra, in presence of the RA synovitis, is too low to contrast the high affinity of IL-1 for the cell receptors. Therefore, IL-1Ra presence should result in very effective prevention of IL-1 signal transduction particularly in the inflammatory site. In laboratory and animal studies inhibition of IL-1 by either antibodies to IL-1 or IL-1Ra proved beneficial to the outcome. IL-1Ra is a member of the IL-1 superfamily. The effects of different DMARDs on IL-1Ra levels in RA patients support the important role that selected anticytokine treatments might exert in the pathophysiology of the disease. However, since anti TNFα therapy it is not effective in all RA patients, nor does it fully control the arthritic process in affected joints of good responders and complete TNF suppression should be avoided, the combined treatment with intermediate doses of TNF and IL-1 blockers, reaching synergistic suppression of arthritis, seems warranted in RA.

  15. Growth retardation in children injected with 224Ra

    International Nuclear Information System (INIS)

    Spiess, H.; Mays, C.W.; Spiess-Paulus, E.

    1986-01-01

    We have obtained the adult heights of 133 patients formerly injected with 224 Ra as juveniles. 224 Ra induced growth retardation was greatest in children injected at young ages and increased with dose. The growth retardation was well represented as a 2% decrease in potential growth post irradiation per 100 rads of calculated average skeletal dose. (orig.)

  16. Multiple Bowen's disease and epithelioid malignant peripheral nerve sheath tumor in a patient who experienced chronic arsenic poisoning

    Directory of Open Access Journals (Sweden)

    Ching-En Chen

    2017-01-01

    Full Text Available The Southwest coastal plain of Taiwan is an endemic area of arsenic contamination. Residents who lived there before the 1970s and who used raw groundwater for drinking have a higher risk of arsenic poisoning. In 1968, Tseng et al. described Blackfoot disease as a peripheral vascular disease caused by chronic exposure to arsenic, thereby introducing the concept of arsenic-induced systemic illness in Taiwan. Multiple Bowen's disease (BD is one of the characteristic consequences of chronic arsenic poisoning and it usually presents as cutaneous carcinoma in situ. Multiple BD can also be associated with squamous cell carcinoma and basal cell carcinoma of the skin, as well as lung, liver, gastrointestinal, and bladder cancers. We encountered a 79-year-old male from Yun-Lin, a county in Southwest Taiwan, who presented with a progressing tumor in his right anterior chest wall. In addition, numerous keratoses and scaly skin lesions were noted on his trunk and extremities, some of which were combined with erosions. The patient was diagnosed with chronic arsenic poisoning with multiple BD and the huge tumor was confirmed as an epithelioid malignant peripheral nerve sheath tumor.

  17. TARGETED INFORMATION ON METHOTREXATE AND LIFTING ALCOHOL RESTRICTIONS IN PATIENTS WITH RA AND PSA IS SAFE AND REDUCES PATIENTS' NEGATIVE BELIEFS

    DEFF Research Database (Denmark)

    Larsen, Janni Lisander; Nordin, Henrik

    Background Research regarding potential interaction between use of Methotrexate (MTX) and alcohol consumption is sparse (1-2, 5). Nevertheless patients traditionally are advised against alcohol intake while on MTX for safety reasons. Furthermore MTX generally is perceived by doctors and patients ...

  18. Inpatient schema therapy for nonresponsive patients with personality pathology: Changes in symptomatic distress, schemas, schema modes, coping styles, experienced parenting styles, and mental well-being.

    Science.gov (United States)

    Schaap, Grietje M; Chakhssi, Farid; Westerhof, Gerben J

    2016-12-01

    This study provides an evaluation of group schema therapy (ST) for inpatient treatment of patients with personality pathology who did not respond to previous psychotherapeutic interventions. Forty-two patients were assessed pre- and posttreatment, and 35 patients were evaluated at follow-up 6 months later. The results showed a dropout rate of 35%. Those who dropped out did not differ from those who completed treatment with regard to demographic and clinical variables; the only exception was that those who dropped out showed a lower prevalence of mood disorders. Furthermore, intention-to-treat analyses showed a significant improvement in maladaptive schemas, schema modes, maladaptive coping styles, mental well-being, and psychological distress after treatment, and these improvements were maintained at follow-up. On the other hand, there was no significant change in experienced parenting style as self-reported by patients. Changes in schemas and schema modes measured from pre- to posttreatment were predictive of general psychological distress at follow-up. Overall, these preliminary findings suggest that positive treatment results can be obtained with group ST-based inpatient treatment for patients who did not respond to previous psychotherapeutic interventions. Moreover, these findings are comparable with treatment results for patients without such a nonresponsive treatment history. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  19. Predictors of weight stigma experienced by middle-older aged, general-practice patients with obesity in disadvantaged areas of Australia: a cross-sectional study.

    Science.gov (United States)

    Spooner, Catherine; Jayasinghe, Upali W; Faruqi, Nighat; Stocks, Nigel; Harris, Mark F

    2018-05-21

    Rates of obesity have increased globally and weight stigma is commonly experienced by people with obesity. Feeling stigmatised because of one's weight can be a barrier to healthy eating, physical activity and to seeking help for weight management. The aim of this study was to identify predictors of perceived weight among middle-older aged patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. As part of a randomised clinical trial in Australia, telephone interviews were conducted with 120 patients from 17 general practices in socioeconomically disadvantaged of Sydney and Adelaide. Patients were aged 40-70 years with a BMI ≥ 30 kg/m 2 . The interviews included questions relating to socio-demographic variables (e.g. gender, language spoken at home), experiences of weight-related discrimination, and the Health Literacy Questionnaire (HLQ). Multi-level logistic regression data analysis was undertaken to examine predictors of recent experiences of weight-related discrimination ("weight stigma"). The multi-level model showed that weight stigma was positively associated with obesity category 2 (BMI = 35 to stigma and gender, age, education or the other HLQ domains examined. Weight stigma disproportionately affected the patients with obesity most in need of support to manage their weight: those with more severe obesity, from non-English speaking backgrounds and who were not in employment. Additionally, those who had experienced weight stigma were less able to actively engage with healthcare providers further compounding their disadvantage. This suggests the need for a more proactive approach to identify weight stigma by healthcare providers. Addressing weight stigma at the individual, system and population levels is recommended. The trial was registered with the Australian Clinical Trials Registry ACTRN126400102162 .

  20. Mental health, fatigue and function are associated with increased risk of disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: an exploratory analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) trial.

    Science.gov (United States)

    Bechman, Katie; Sin, Fang En; Ibrahim, Fowzia; Norton, Sam; Matcham, Faith; Scott, David Lloyd; Cope, Andrew; Galloway, James

    2018-01-01

    Tapering of anti-tumour necrosis factor (TNF) therapy appears feasible, safe and effective in selected patients with rheumatoid arthritis (RA). Depression is highly prevalent in RA and may impact on flare incidence through various mechanisms. This study aims to investigate if psychological states predict flare in patients' dose tapering their anti-TNF therapy. This study is a post-hoc analysis of the Optimizing TNF Tapering in RA trial, a multicentre, randomised, open-label study investigating anti-TNF tapering in RA patients with sustained low disease activity. Patient-reported outcomes (Health Assessment Questionnaire, EuroQol 5-dimension scale, Functional Assessment of Chronic Illness Therapy fatigue scale (FACIT-F), 36-Item Short Form Survey (SF-36)) were collected at baseline. The primary outcome was flare, defined as an increase in 28-joint count Disease Activity Score (DAS28) ≥0.6 and ≥1 swollen joint. Discrete-time survival models were used to identify patient-reported outcomes that predict flare. Ninety-seven patients were randomised to taper their anti-TNF dose by either 33% or 66%. Forty-one patients flared. Higher baseline DAS28 score was associated with flare (adjusted HR 1.96 (95% CI 1.18 to 3.24), p=0.01). Disability (SF-36 physical component score), fatigue (FACIT-F) and mental health (SF-36 mental health subscale (MH)) predicted flare in unadjusted models. In multivariate analyses, only SF-36 MH remained a statistically significant predictor of flare (adjusted HR per 10 units 0.74 (95% CI 0.60 to 0.93), p=0.01). Baseline DAS28 and mental health status are independently associated with flare in patients who taper their anti-TNF therapy. Fatigue and function also associate with flare but the effect disappears when adjusting for confounders. Given these findings, mental health and functional status should be considered in anti-TNF tapering decisions in order to optimise the likelihood of success. EudraCT Number: 2010-020738-24; ISRCTN: 28955701

  1. 226Ra, 228Ra, 223Ra, and 224Ra in coastal waters with application to coastal dynamics and groundwater input

    International Nuclear Information System (INIS)

    Moore, W.S.

    1997-01-01

    Four radium isotopes offer promise in unraveling the complex dynamics of coastal ocean circulation and groundwater input. Each isotope is produced by decay of a thorium parent bound to sediment. The activities of these thorium isotopes and the sediment-water distribution coefficient for radium provide an estimate of the source function of each Ra isotope to the water. In salt marshes that receive little surface water input, Ra activities which exceed coastal ocean values must originate within the marsh. In North Inlet, South Carolina, the activities of 226 Ra exported from the marsh far exceed the activities generated within the marsh. To supply the exported activities, substantial groundwater input is required. In the coastal region itself, 226 Ra activities exceed the amount that can be supplied from rivers. Here also, substantial groundwater input is required. Within the coastal ocean, 223 Ra and 224 Ra may be used to determine mixing rates with offshore waters. Shore-perpendicular profiles of 223 Ra and 224 Ra show consistent trends which may be modeled as eddy diffusion coefficients of 350-540 m 2 s -1 . These coefficients allow an assessment of cross-shelf transport and provide further insight on the importance of groundwater to coastal regions. (author)

  2. Physical functioning in patients with ankylosing spondylitis: comparing approaches of experienced ability with self-reported and objectively measured physical activity.

    Science.gov (United States)

    van Genderen, Simon; van den Borne, Carlie; Geusens, Piet; van der Linden, Sjef; Boonen, Annelies; Plasqui, Guy

    2014-04-01

    Physical functioning can be assessed by different approaches that are characterized by increasing levels of individual appraisal. There is insufficient insight into which approach is the most informative in patients with ankylosing spondylitis (AS) compared with control subjects. The objective of this study was to compare patients with AS and control subjects regarding 3 approaches of functioning: experienced ability to perform activities (Bath Ankylosing Spondylitis Functional Index [BASFI]), self-reported amount of physical activity (PA) (Baecke questionnaire), and the objectively measured amount of PA (triaxial accelerometer). This case-control study included 24 AS patients and 24 control subjects (matched for age, gender, and body mass index). Subjects completed the BASFI and Baecke questionnaire and wore a triaxial accelerometer. Subjects also completed other self-reported measures on disease activity (Bath AS Disease Activity Index), fatigue (Multidimensional Fatigue Inventory), and overall health (EuroQol visual analog scale). Both groups included 14 men (58%), and the mean age was 48 years. Patients scored significantly worse on the BASFI (3.9 vs 0.2) than their healthy peers, whereas PA assessed by Baecke and the accelerometer did not differ between groups. Correlations between approaches of physical functioning were low to moderate. Bath Ankylosing Spondylitis Functional Index was associated with disease activity (r = 0.49) and physical fatigue (0.73) and Baecke with physical and activity related fatigue (r = 0.54 and r = 0.54), but total PA assessed by accelerometer was not associated with any of these experience-based health outcomes. Different approaches of the concept physical functioning in patients with AS provide different information. Compared with matched control subjects, patients with AS report more difficulties but report and objectively perform the same amount of PA.

  3. ‘We experienced a lack of tools for strengthening coping and health in encounters with patients with chronic illness': bridging theory and practice through formative research

    Directory of Open Access Journals (Sweden)

    Kristen Heggdal

    2015-11-01

    promotion. Therefore, health professionals should be encouraged by their leaders to engage in interdisciplinary collaboration with researchers in academia in developing new interventions for improving practice. Researchers who engage in such projects should be prepared to take on long-term collaboration. Implications for practice: •\tThere is a need to develop the field of health promotion for long-term conditions, and especially a need to develop interventions to strengthen individuals' capacity for health, empowerment and recovery •\tAn interdisciplinary project team is an advantage when developing interventions that aim to address the challenges experienced by individuals living with long-term conditions •\tPartnership with patients in the design and testing of new interventions is necessary to maximise the relevance and suitability of the intervention

  4. Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying.

    Science.gov (United States)

    Pino, Marco; Parry, Ruth; Land, Victoria; Faull, Christina; Feathers, Luke; Seymour, Jane

    2016-01-01

    To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of "eliciting and responding to cues", which has been widely advocated in the EoL care literature, promotes EoL talk. Conversation analysis of video- and audio-recorded consultations. Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce-then later further articulate-EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients' talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as "cues" as is common in EoL communication contexts. We examine these limitations and propose "possible EoL considerations" as a descriptively more accurate term. Through communicating-via open elaboration solicitations-in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst

  5. Efficacy of sofosbuvir plus ribavirin with or without peginterferon-alfa in patients with hepatitis C virus genotype 3 infection and treatment-experienced patients with cirrhosis and hepatitis C virus genotype 2 infection.

    Science.gov (United States)

    Foster, Graham R; Pianko, Stephen; Brown, Ashley; Forton, Daniel; Nahass, Ronald G; George, Jacob; Barnes, Eleanor; Brainard, Diana M; Massetto, Benedetta; Lin, Ming; Han, Bin; McHutchison, John G; Subramanian, G Mani; Cooper, Curtis; Agarwal, Kosh

    2015-11-01

    We conducted an open-label, randomized, phase 3 trial to determine the efficacy and safety of sofosbuvir and ribavirin, with and without peginterferon-alfa, in treatment-experienced patients with cirrhosis and hepatitis C virus (HCV) genotype 2 infection and treatment-naïve or treatment-experienced patients with HCV genotype 3 infection. The study was conducted at 80 sites in Europe, North America, Australia, and New Zealand Patients were randomly assigned (1:1:1) to groups given sofosbuvir and ribavirin for 16 weeks (n = 196); sofosbuvir and ribavirin for 24 weeks (n = 199); or sofosbuvir, peginterferon-alfa, and ribavirin for 12 weeks (n = 197). The primary end point was the percentage of patients with HCV RNA <15 IU/mL 12 weeks after stopping therapy (sustained virologic response [SVR12]). From October 2013 until April 2014, we enrolled and treated 592 patients-48 with genotype 2 HCV and compensated cirrhosis who had not achieved SVR with previous treatments and 544 with genotype 3 HCV (279 treatment-naïve and 265 previously treated). Overall, 219 patients (37%) had compensated cirrhosis. The last post-treatment week 12 patient visit was in January 2015. Rates of SVR12 among patients with genotype 2 HCV were 87% and 100%, for those receiving 16 and 24 weeks of sofosbuvir and ribavirin, respectively, and 94% for those receiving sofosbuvir, peginterferon, and ribavirin for 12 weeks. Rates of SVR12 among patients with genotype 3 HCV were 71% and 84% in those receiving 16 and 24 weeks of sofosbuvir and ribavirin, respectively, and 93% in those receiving sofosbuvir, peginterferon, and ribavirin. On-treatment virologic failure occurred in 3 patients with HCV genotype 3a receiving sofosbuvir and ribavirin for 24 weeks. The most common adverse events were fatigue, headache, insomnia, and nausea. Overall, 1% of patients discontinued treatment due to adverse events. Among patients with genotype 3 HCV infection, including a large proportion of treatment-experienced

  6. RA reactor operation and maintenance; Pogon i odrzavanje reaktora RA

    Energy Technology Data Exchange (ETDEWEB)

    Zecevic, V [Institute of Nuclear Sciences Boris Kidric, Reaktor RA, Vinca, Beograd (Serbia and Montenegro)

    1963-02-15

    This volume includes the final report on RA reactor operation and utilization of the experimental facilities in 1962, detailed analysis of the system for heavy water distillation and calibration of the system for measuring the activity of the air.

  7. Dolutegravir in antiretroviral-experienced patients with raltegravir- and/or elvitegravir-resistant HIV-1: 24-week results of the phase III VIKING-3 study.

    Science.gov (United States)

    Castagna, Antonella; Maggiolo, Franco; Penco, Giovanni; Wright, David; Mills, Anthony; Grossberg, Robert; Molina, Jean-Michel; Chas, Julie; Durant, Jacques; Moreno, Santiago; Doroana, Manuela; Ait-Khaled, Mounir; Huang, Jenny; Min, Sherene; Song, Ivy; Vavro, Cindy; Nichols, Garrett; Yeo, Jane M

    2014-08-01

    The pilot phase IIb VIKING study suggested that dolutegravir (DTG), a human immunodeficiency virus (HIV) integrase inhibitor (INI), would be efficacious in INI-resistant patients at the 50 mg twice daily (BID) dose. VIKING-3 is a single-arm, open-label phase III study in which therapy-experienced adults with INI-resistant virus received DTG 50 mg BID while continuing their failing regimen (without raltegravir or elvitegravir) through day 7, after which the regimen was optimized with ≥1 fully active drug and DTG continued. The primary efficacy endpoints were the mean change from baseline in plasma HIV-1 RNA at day 8 and the proportion of subjects with HIV-1 RNA <50 c/mL at week 24. Mean change in HIV-1 RNA at day 8 was -1.43 log10 c/mL, and 69% of subjects achieved <50 c/mL at week 24. Multivariate analyses demonstrated a strong association between baseline DTG susceptibility and response. Response was most reduced in subjects with Q148 + ≥2 resistance-associated mutations. DTG 50 mg BID had a low (3%) discontinuation rate due to adverse events, similar to INI-naive subjects receiving DTG 50 mg once daily. DTG 50 mg BID-based therapy was effective in this highly treatment-experienced population with INI-resistant virus. www.clinicaltrials.gov (NCT01328041) and http://www.gsk-clinicalstudywww.gsk-clinicalstudyregister.com (112574). © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

  8. Dolutegravir in Antiretroviral-Experienced Patients With Raltegravir- and/or Elvitegravir-Resistant HIV-1: 24-Week Results of the Phase III VIKING-3 Study

    Science.gov (United States)

    Castagna, Antonella; Maggiolo, Franco; Penco, Giovanni; Wright, David; Mills, Anthony; Grossberg, Robert; Molina, Jean-Michel; Chas, Julie; Durant, Jacques; Moreno, Santiago; Doroana, Manuela; Ait-Khaled, Mounir; Huang, Jenny; Min, Sherene; Song, Ivy; Vavro, Cindy; Nichols, Garrett; Yeo, Jane M.; Aberg, J.; Akil, B.; Arribas, J. R.; Baril, J.-G.; Blanco Arévalo, J. L.; Blanco Quintana, F.; Blick, G.; Boix Martínez, V.; Bouchaud, O.; Branco, T.; Bredeek, U. F.; Castro Iglesias, M.; Clumeck, N.; Conway, B.; DeJesus, E.; Delassus, J.-L.; De Truchis, P.; Di Perri, G.; Di Pietro, M.; Duggan, J.; Duvivier, C.; Elion, R.; Eron, J.; Fish, D.; Gathe, J.; Haubrich, R.; Henderson, H.; Hicks, C.; Hocqueloux, L.; Hodder, S.; Hsiao, C.-B.; Katlama, C.; Kozal, M.; Kumar, P.; Lalla-Reddy, S.; Lazzarin, A.; Leoncini, F.; Llibre, J. M.; Mansinho, K.; Morlat, P.; Mounzer, K.; Murphy, M.; Newman, C.; Nguyen, T.; Nseir, B.; Philibert, P.; Pialoux, G.; Poizot-Martin, I.; Ramgopal, M.; Richmond, G.; Salmon Ceron, D.; Sax, P.; Scarsella, A.; Sension, M.; Shalit, P.; Sighinolfi, L.; Sloan, L.; Small, C.; Stein, D.; Tashima, K.; Tebas, P.; Torti, C.; Tribble, M.; Troisvallets, D.; Tsoukas, C.; Viciana Fernández, P.; Ward, D.; Wheeler, D.; Wilkin, T.; Yeni, G.-P.; Louise Martin-Carpenter, J.; Uhlenbrauck, Gina

    2014-01-01

    Background. The pilot phase IIb VIKING study suggested that dolutegravir (DTG), a human immunodeficiency virus (HIV) integrase inhibitor (INI), would be efficacious in INI-resistant patients at the 50 mg twice daily (BID) dose. Methods. VIKING-3 is a single-arm, open-label phase III study in which therapy-experienced adults with INI-resistant virus received DTG 50 mg BID while continuing their failing regimen (without raltegravir or elvitegravir) through day 7, after which the regimen was optimized with ≥1 fully active drug and DTG continued. The primary efficacy endpoints were the mean change from baseline in plasma HIV-1 RNA at day 8 and the proportion of subjects with HIV-1 RNA <50 c/mL at week 24. Results. Mean change in HIV-1 RNA at day 8 was −1.43 log10 c/mL, and 69% of subjects achieved <50 c/mL at week 24. Multivariate analyses demonstrated a strong association between baseline DTG susceptibility and response. Response was most reduced in subjects with Q148 + ≥2 resistance-associated mutations. DTG 50 mg BID had a low (3%) discontinuation rate due to adverse events, similar to INI-naive subjects receiving DTG 50 mg once daily. Conclusions. DTG 50 mg BID–based therapy was effective in this highly treatment-experienced population with INI-resistant virus. Clinical Trials Registration. www.clinicaltrials.gov (NCT01328041) and http://www.gsk-clinicalstudywww.gsk-clinicalstudyregister.com (112574). PMID:24446523

  9. RA reactor operation and maintenance

    International Nuclear Information System (INIS)

    Zecevic, V.

    1963-02-01

    This volume includes the final report on RA reactor operation and utilization of the experimental facilities in 1962, detailed analysis of the system for heavy water distillation and calibration of the system for measuring the activity of the air

  10. Tenofovir disoproxil fumarate monotherapy for nucleos(tide analogue-naïve and nucleos(tide analogue-experienced chronic hepatitis B patients

    Directory of Open Access Journals (Sweden)

    Sang Kyung Jung

    2015-03-01

    Full Text Available Background/AimsThis study investigated the antiviral effects of tenofovir disoproxil fumarate (TDF monotherapy in nucleos(tide analogue (NA-naive and NA-experienced chronic hepatitis B (CHB patients.MethodsCHB patients treated with TDF monotherapy (300 mg/day for ≥12 weeks between December 2012 and July 2014 at a single center were retrospectively enrolled. Clinical, biochemical, and virological parameters were assessed every 12 weeks.ResultsIn total, 136 patients (median age 49 years, 96 males, 94 HBeAg positive, and 51 with liver cirrhosis were included. Sixty-two patients were nucleos(tide (NA-naïve, and 74 patients had prior NA therapy (NA-exp group, and 31 patients in the NA-exp group had lamivudine (LAM-resistance (LAM-R group. The baseline serum hepatitis B virus (HBV DNA level was 4.9±2.3 log IU/mL (mean±SD, and was higher in the NA-naïve group than in the NA-exp and LAM-R groups (5.9±2.0 log IU/mL vs 3.9±2.0 log IU/mL vs 4.2±1.7 log IU/mL, P<0.01. The complete virological response (CVR rate at week 48 in the NA-naïve group (71.4% did not differ significantly from those in the NA-exp (71.3% and LAM-R (66.1% groups. In multivariate analysis, baseline serum HBV DNA was the only predictive factor for a CVR at week 48 (hazard ratio, 0.809; 95% confidence interval, 0.729-0.898, while the CVR rate did not differ with the NA experience.ConclusionsTDF monotherapy was effective for CHB treatment irrespective of prior NA treatment or LAM resistance. Baseline serum HBV DNA was the independent predictive factor for a CVR.

  11. Automated measurement of 224Ra and 226Ra in water

    International Nuclear Information System (INIS)

    Dimova, N.; Burnett, W.C.; Horwitz, E.P.; Lane-Smith, D.

    2007-01-01

    We present a new simple approach for automated, non-destructive measurement of the alpha-emitting radium isotopes ( 223 Ra, 224 Ra, and 226 Ra) in water based on the emanation of their respective radon daughters ( 219 Rn, 220 Rn, and 222 Rn). The method combines the high adsorption uptake of MnO 2 Resin for radium (K d =2.4x10 4 ml/g) over a wide pH range with the simplicity of the activity registration using a commercial radon-in-air analyzer (RAD7, DURRIDGE Company, Inc). Radium is first adsorbed onto the MnO 2 Resin by passing a water sample through the resin packed in a gas-tight glass cartridge. The same cartridge is then connected to the radon analyzer via a simple tubing system to circulate air through the resin and a drying system. The efficiency of the proposed system is determined by running standards prepared in the same manner. Our results indicate that the efficiency for 226 Ra is >22% if both 218 Po and 214 Po counts are collected. This is comparable with typical efficiencies for alpha spectrometry but with much less sample preparation. We estimate that an MDA of 0.8 pCi/L for 226 Ra may be obtained with this new approach using a 1 L water sample and less than 4 h of counting

  12. Measuring the radium quartet ({sup 228}Ra, {sup 226}Ra, {sup 224}Ra, {sup 223}Ra) in seawater samples using gamma spectrometry

    Energy Technology Data Exchange (ETDEWEB)

    Beek, P. van, E-mail: vanbeek@legos.obs-mip.f [LEGOS, Laboratoire d' Etudes en Geophysique et Oceanographie Spatiales (CNRS/CNES/IRD/UPS), Observatoire Midi Pyrenees, 14 Avenue Edouard Belin, 31400 Toulouse (France); Souhaut, M. [LEGOS, Laboratoire d' Etudes en Geophysique et Oceanographie Spatiales (CNRS/CNES/IRD/UPS), Observatoire Midi Pyrenees, 14 Avenue Edouard Belin, 31400 Toulouse (France); Reyss, J.-L. [LSCE, Laboratoire des Sciences du Climat et de l' Environnement (CNRS/CEA/UVSQ), Avenue de la Terrasse, 91198 Gif-sur-Yvette (France)

    2010-07-15

    Radium isotopes are widely used in marine studies (eg. to trace water masses, to quantify mixing processes or to study submarine groundwater discharge). While {sup 228}Ra and {sup 226}Ra are usually measured using gamma spectrometry, short-lived Ra isotopes ({sup 224}Ra and {sup 223}Ra) are usually measured using a Radium Delayed Coincidence Counter (RaDeCC). Here we show that the four radium isotopes can be analyzed using gamma spectrometry. We report {sup 226}Ra, {sup 228}Ra, {sup 224}Ra, {sup 223}Ra activities measured using low-background gamma spectrometry in standard samples, in water samples collected in the vicinity of our laboratory (La Palme and Vaccares lagoons, France) but also in seawater samples collected in the plume of the Amazon river, off French Guyana (AMANDES project). The {sup 223}Ra and {sup 224}Ra activities determined in these samples using gamma spectrometry were compared to the activities determined using RaDeCC. Activities determined using the two techniques are in good agreement. Uncertainties associated with the {sup 224}Ra activities are similar for the two techniques. RaDeCC is more sensitive for the detection of low {sup 223}Ra activities. Gamma spectrometry thus constitutes an alternate method for the determination of short-lived Ra isotopes.

  13. Avaliação da expressão de interleucina 1 beta (IL-1β e antagonista do receptor de interleucina 1 (IL-1Ra em pacientes com hanseníase Evaluation of the expression of interleukin 1 beta(IL-1β and interleukin 1 receptor antagonist (IL-1Ra in leprosy patients

    Directory of Open Access Journals (Sweden)

    Rosane Dias Costa

    2008-01-01

    Full Text Available A hanseníase é uma doença infectocontagiosa espectral que acompanha-se por uma série de eventos imunológicos desencadeados pela resposta do hospedeiro frente ao agente etiológico, o Mycobacterium leprae. Evidências sugerem que a indução e manutenção da resposta imune/inflamatória na hanseníase estão vinculadas a interações de múltiplas células e fatores solúveis, particularmente através da ação de citocinas. Nesse estudo, foram mensurados níveis de IL-1β e IL-1Ra de 37 casos novos de hanseníase acompanhados ao longo do tratamento e 30 controles sadios pelo teste ELISA. A coleta de sangue periférico foi realizada em quatro tempos para os casos de hanseníase (pré-tratamento com PQT, 2ª dose, 6ª dose e pós-PQT e em único momento para os controles. Na comparação dos níveis das moléculas de casos no pré-PQT e controles, houve diferença estatisticamente significativa somente para IL-1β. Nossos resultados sugerem a participação dessa citocina no processo imune/inflamatório.Leprosy is an infectious and contagious spectral disease accompanied by a series of immunological events triggered by the host's response to the etiologic agent, Mycobacterium leprae. Evidence suggests that the induction and maintenance of the immune/inflammatory response in leprosy are linked to multiple cell interactions and soluble factors, mainly through the action of cytokines. The ELISA test was used to measure the levels of IL-1β and IL-1Ra in 37 new leprosy patients followed-up during treatment and 30 healthy controls. Peripheral blood was collected four times during the treatment of leprosy patients (MDT pretreatment, 2nd dose, 6th dose and post-MDT, and only once from the controls. The comparison of molecular levels in pre-MDT patients and controls showed a statistically significant difference for IL-1β. The results suggest the participation of this cytokine in the genesis of the immune/inflammatory process.

  14. Regulations for RA reactor operation; Propisi nuklearnog reaktora 'RA'

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1980-09-15

    Regulations for RA reactor operation are written in accordance with the legal regulations defined by the Law about radiation protection and related legal acts, as well as technical standards according to the IAEA recommendations. The contents of this book include: fundamental data about the reactor; legal regulations for reactor operation; organizational scheme for reactor operation; general and detailed instructions for operation, behaviour in the reactor building, performing experiments; operating rules for operation under steady state and accidental conditions. [Serbo-Croat] Propisi o radu nuklearnog reaktora RA pisani su tako da svi zakonski propisi definisani 'Zakonom o zastiti od jonizujuceg zracenja' i pratecim propisima (devet pravilnika) kao i tehnicke norme prema preporukama MAAE budu postovani u punoj meri pri radu reaktora. Sadrzaj ove knjige obuhvata: osnovne podatke o reaktoru; zakonske propise; organizaciju rada reaktora RA; opste propise o rezimu rada, kretanju u zgradi reaktora, izvodjenju eksperimenata; pogonske propise za rad u normalnom rezimu i u slucaju udesa.

  15. The association of fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the Quest-RA program.

    Science.gov (United States)

    Grøn, Kathrine Lederballe; Ornbjerg, Lykke Midtbøll; Hetland, Merete Lund; Aslam, Fawad; Khan, Nasim A; Jacobs, Johannes W G; Henrohn, Dan; Rasker, J J; Kauppi, Markku J; Lang, Hui-Chu; Mota, Licia M H; Aggarwal, Amita; Yamanaka, Hisahi; Badsha, Humeira; Gossec, Laure; Cutolo, Maurizio; Ferraccioli, Gianfranco; Gremese, Elisa; Bong Lee, Eun; Inanc, Nevsun; Direskeneli, Haner; Taylor, Peter; Huisman, Margriet; Alten, Rieke; Pohl, Christoph; Oyoo, Omondi; Stropuviene, Sigita; Drosos, Alexandrosos A; Kerzberg, Eduardo; Ancuta, Codorina; Mofti, Ayman; Bergman, Martin; Detert, Jaqueline; Selim, Zaraa I; Abda, Essam A; Rexhepi, Blerta; Sokka, Tuulikki

    2014-01-01

    The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA). Nine thousands eight hundred seventy-four patients from 34 countries, 16 with high GDP (>24.000 US dollars [USD] per capita) and 18 low-GDP countries (6.6) compared with 23.0% in high-GDP countries (p<0.001). In univariate analysis, fatigue increased with increasing number of comorbidities, disease activity and disability in both high- and low-GDP countries. In multivariate analysis of all countries, these 3 variables explained 29.4% of the variability, whereas GDP was not significant. Fatigue is a widespread problem associated with high comorbidity burden, disease activity and disability regardless of GDP.

  16. A study of a reduction of patient's radiation exposure by using the new ortho screen film system. 3. A study of Kodak InSight EF/RA imaging system

    International Nuclear Information System (INIS)

    Yagi, Hiroshi; Imura, Hiroyoshi; Amano, Masafumi; Kuroda, Tokue; Nishitani, Hiromu.

    1995-01-01

    The developing temperature dependency of Kodak InSight EF/RA Image System (IEF system) was evaluated by measuring characteristic curve, resolution properties and noise RMS. Furthermore, the possibility of the reduction of the patient's exposure without decrease in image quality was evaluated. The physical imaging properties of screen/film systems were affected by the developing temperature. Except the gross fog, other imaging properties of IEF system on developing temperature was small. Especially it was confirmed that the developing temperature dependency of granularity of IEF system was less than those of the other new ortho screen film systems (Konica ES-C medical x-ray film of EX system and Fuji UR-1 medical x-ray film of AD system). Therefore, there is the possibility of the reduction of the patient's exposure by using the higher developing temperature than the traditional situation after due consideration of increasing the gross fog. (author)

  17. [The character of the morphological changes of the mucous membrane of the large intestine and the genetic polymorphism of IL-1RA, IL-1B, IL-4 TNFA in patient with irritable bowel syndrome].

    Science.gov (United States)

    Sarsenbaeva, A S; Ivanova, E L; Burmistrova, A L; Drozdov, I V

    2013-01-01

    The aim of this study was to evaluate the presence or absence of a relationship between the variants of the course of IBS and their association with genetic polymorphisms of genes and intergenic interaction of cytokines. The sample consisted of 81 patients, the diagnosis was verified according to the criteria of the Rome III, were isolated psychopathological, morphological complications, extra-intestinal symptoms. Polymorphism genotyping IL-1Ra, IL-b, IL-4, TNFa performed by PCR. Statistical treatment are a non-parametric analysis of multiple comparisons, hierarchical log-linear analysis. It is found out the relation between the clinical variants with morphological changes of the mucous membrane of the large intestine, the association between gender characteristics of patients with IBS is established and with genetic polymorphisms of cytokines.

  18. Fatigue in rheumatoid arthritis: from patient experience to measurement

    NARCIS (Netherlands)

    Nikolaus, Stephanie

    2012-01-01

    Many patients with rheumatoid arthritis (RA) complain about fatigue. In-depths interviews with patients showed that fatigue is experienced as an annoying symptom that can have far-reaching consequences for daily life. However, not each patient has the same experience of fatigue: emotions,

  19. Health professionals responding to men for safety (HERMES): feasibility of a general practice training intervention to improve the response to male patients who have experienced or perpetrated domestic violence and abuse.

    Science.gov (United States)

    Williamson, Emma; Jones, Sue K; Ferrari, Giulia; Debbonaire, Thangam; Feder, Gene; Hester, Marianne

    2015-05-01

    To evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England. Research suggests that male victims and perpetrators of DVA present to primary care clinicians to seek support for their experiences. We know that the response of primary care clinicians to women patients experiencing DVA improves from training and the establishment of referral pathways to specialist DVA services. The intervention consisted of a 2-h practice-based training. Outcome measures included: a pre-post, self-reported survey of staff practice; disclosures of DVA as documented in medical records pre-post (six months) intervention; semi-structured interviews with clinicians; and practice-level contact data collected by DVA specialist agencies. Results show a significant increase in clinicians' self-reported preparedness to meet the needs of male patients experiencing or perpetrating DVA. There was a small increase in male patients identified within the medical records (6 pre- to 17 post-intervention) but only five of those patients made contact with a specialist DVA agency identified within the referral pathway. The training increased clinicians' confidence in responding to male patients affected by DVA. The increase in recorded identification of DVA male patients experiencing or perpetrating DVA was small and contact of those patients with a specialist DVA support service was negligible. We need to better understand male help seeking in relation to DVA, further develop interventions to increase identification of male patients experiencing or perpetrating DVA behaviours, and facilitate access to support services.

  20. Gene polymorphisms and febrile neutropenia in acute leukemia--no association with IL-4, CCR-5, IL-1RA, but the MBL-2, ACE, and TLR-4 are associated with the disease in Turkish patients: a preliminary study.

    Science.gov (United States)

    Pehlivan, Mustafa; Sahin, Handan Haydaroğlu; Ozdilli, Kurşat; Onay, Hüseyin; Ozcan, Ali; Ozkinay, Ferda; Pehlivan, Sacide

    2014-07-01

    The aim of this study was to investigate the mannose-binding lectin 2 (MBL-2), interleukin (IL)-4, Toll-like receptor 4 (TLR-4), angiotensin converting enzyme (ACE), chemokine receptor 5 (CCR-5), and IL-1 receptor antagonist (RA) gene polymorphisms (GPs) in acute leukemias (ALs) and to evaluate their roles in febrile neutropenia (FN) resulting from chemotherapy. The study included 60 AL patients hospitalized between the period of July 2001 and August 2006. Polymorphisms for the genes ACE(I/D), CCR-5, IL-1RA, MBL-2, TLR-4, and IL-4 were typed by polymerase chain reaction (PCR) and/or PCR-restriction fragment length polymerase. Genotype frequencies for these genes were compared in the patient and control groups. The relationships between the genotypes and the body distribution of infections, pathogens, the duration of neutropenia, and febrile episodes in AL patients were evaluated. No significant differences in either the genotype distribution or the allelic frequencies of TLR-4, IL-4, CCR-5, IL-1RN GPs were observed between patients and healthy controls. The AB/BB genotype (53.3%) in the MBL-2 gene was found to be significantly higher in the AL patients compared with control groups. There were correlations between the presence of MBL-2, TLR-4, and ACE polymorphisms and clinical parameters due to FN. Overall, bacteremia was more common in MBL BB and ACE DD. Gram-positive bacteremia was more common in ACE for ID versus DD genotype. Gram-negative bacteremia was more common for both the MBL-2 AB/BB genotype and TLR-4 AG genotype. Median durations of febrile episodes were significantly shorter in ACE DD and MBL AB/BB. Although TLR-4, ACE, and MBL-2 GPs have been extensively investigated in different clinical pictures, this is the first study to evaluate the role of these polymorphisms in the genetic etiopathogenesis of FN in patients with ALs. As a conclusion, TLR-4, ACE, and MBL-2 genes might play roles in the genetic etiopathogenesis of FN in patients with ALs.

  1. 'Delayed discharges and boarders': a 2-year study of the relationship between patients experiencing delayed discharges from an acute hospital and boarding of admitted patients in a crowded ED.

    Science.gov (United States)

    Mustafa, Farah; Gilligan, Peadar; Obu, Deborah; O'Kelly, Patrick; O'Hea, Eimear; Lloyd, Catherine; Kelada, Sherif; Heffernan, Attracta; Houlihan, Patricia

    2016-09-01

    Many believe that hospital crowding manifesting in the ED with the boarding of admitted patients is a result of significant numbers of acute hospital beds being occupied by patients awaiting discharge to nursing homes, step-down facilities or home with or without additional support. This observational study was performed to establish the actual relationship between boarders in the ED and patients experiencing delayed discharge. Data relating to the number of patients in the ED and their points in their patient pathway were entered into a logbook on a daily basis by the most senior doctor on duty. 630 days of observations of patients boarded in the ED were compared with the number of inpatients with delayed discharges, obtained from the hospital information system, to see if large numbers of inpatients with delayed discharges are associated with crowding in the ED. Two years of data showed an annual ED census of more than 47 000, with a daily mean ED admission rate of 29.85 patients and a daily mean ED boarding figure of 29 patients. A mean of 15.4% of the 823 hospital beds was occupied by patients with delayed discharges, and the hospital ran at, or near, full capacity (99%-105%) all the time. Results obtained highlighted a statistically significant relationship between delayed discharges in the hospital and ED crowding as a result of boarders (p value<0.001, with a regression coefficient of 0.16, 95% CI 0.12 to 0.20). The study also showed that the number of boarders was related to the number of ED admissions in the preceding 24 hours (p=0.036, with a regression coefficient of 0.14, 95% CI 0.05 to 0.28). Delayed hospital discharges significantly contribute to crowding in the ED. Healthcare systems should target timely discharge of inpatients experiencing delayed discharge in an urgent and efficient manner to improve timely access to acute hospital beds for patients requiring emergency admission. Published by the BMJ Publishing Group Limited. For permission

  2. Chemical dosimetry at the RA reactor; Hemijska dozimetrija reaktora RA

    Energy Technology Data Exchange (ETDEWEB)

    Gal, O [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1961-12-15

    This report presents the results of measurements of absorbed doses axial and radial distribution in the vertical experimental channels of the RA reactor. Measurements were done in channels VK-5, VK-7, VK-9 and GF-36. Results were compared to the results of calorimetry measurements and measured neutron flux values performed by other laboratories. Fricke and oxalate dosemeters were used in addition to the cobalt indicators.

  3. Are you experienced?

    DEFF Research Database (Denmark)

    Dahl, Michael Slavensky; Reichstein, Toke

    This paper investigates the relationship between the level of experience of managers and founders, and the likelihood of survival of their new firms. We take advantage of a comprehensive dataset covering the entire Danish labor market from 1980-2000. This is used to trace the activities of top...... ranked members of start-ups prior to their founding, and follow the fate of these firms. More specifically, we compare the survival of spin-offs from surviving parents, spin-offs from exiting parents, and other start-ups. Moreover, we investigate whether firms managed and founded by more experienced....... We also find that spin-offs from parent companies that exit are less likely to survive than either spin-offs from surviving parents or other start-ups. These findings support the theoretical arguments that organizational heritage is important for the survival of new organizations. We found no similar...

  4. Radium isotope (223Ra, 224Ra, 226Ra and 228Ra) distribution near Brazil's largest port, Paranaguá Bay, Brazil

    International Nuclear Information System (INIS)

    Dias, Thais H.; Oliveira, Joselene de; Sanders, Christian J.; Carvalho, Franciane; Sanders, Luciana M.; Machado, Eunice C.; Sá, Fabian

    2016-01-01

    This work investigates the 223 Ra, 224 Ra, 226 Ra and 228 Ra isotope distribution in river, estuarine waters and sediments of the Paranaguá Estuarine Complex (PEC). The stratification of the Ra isotopes along water columns indicate differing natural sources. In sediments, the radium isotope activities was inversely proportional to the particle size. The highest concentrations of 223 Ra, 224 Ra, 226 Ra and 228 Ra in the water column were found in the bottom more saline waters and towards the inner of the estuary. These relatively high concentrations towards the bottom of the estuary may be attributed to the influence of tidally driven groundwater source and desorption from particles at the maximum turbidity zone. The apparent river water ages from the radium isotope ratios, 223 Ra/ 224 Ra and 223 Ra/ 228 Ra, indicate that the principal rivers that flow into the estuary have residence times from between 6 and 11 days. - Highlights: • Radium isotope concentrations were evaluated along a large estuarine system. • The radioactivity level in river, estuary and sediments was within a normal range. • Spatial distributions of site specific radionuclides have differing activities and sources.

  5. RA Reactor applications, Annex A

    International Nuclear Information System (INIS)

    Cupac, S.; Vukadin, Z.

    2000-01-01

    Full text: In 2000 Ra reactor was not operated. New instrumentation is not complete, without it, it is not possible to think about reactor start-up. Since 1985, when reactor operation was forbidden, there are 480 fuel elements left in 48 fuel channels in the reactor core. Heavy water was removed from the reactor core because of the repair of the heavy water pumps in 1986. The old instrumentation was removed. Eleven years after being left to its own destiny, it would be difficult to imagine that anybody would think of reactor restart without examining the state of reactor vessel and other vital reactor components. Maintaining the reactor under existing conditions without final decision about restart or permanent shutdown is destructive for this nuclear facility. The existing state that pertains for more than 10 years would have only one result, destruction of the RA reactor [sr

  6. RA Reactor applications, Annex A

    International Nuclear Information System (INIS)

    Cupac, S.; Vukadin, Z.

    1998-01-01

    Full text: In 1998 Ra reactor was not operated. New instrumentation is not complete, without it, it is not possible to think about reactor start-up. Since 1985, when reactor operation was forbidden, there are 480 fuel elements left in 48 fuel channels in the reactor core. Heavy water was removed from the reactor core because of the repair of the heavy water pumps in 1986. The old instrumentation was removed. Eleven years after being left to its own destiny, it would be difficult to imagine that anybody would think of reactor restart without examining the state of reactor vessel and other vital reactor components. Maintaining the reactor under existing conditions without final decision about restart or permanent shutdown is destructive for this nuclear facility. The existing state that pertains for more than 10 years would have only one result, destruction of the RA reactor [sr

  7. RA Reactor applications, Annex A

    International Nuclear Information System (INIS)

    Cupac, S.; Vukadin, Z.

    1996-01-01

    Full text: In 2000 Ra reactor was not operated. New instrumentation is not complete, without it, it is not possible to think about reactor start-up. Since 1985, when reactor operation was forbidden, there are 480 fuel elements left in 48 fuel channels in the reactor core. Heavy water was removed from the reactor core because of the repair of the heavy water pumps in 1986. The old instrumentation was removed. Eleven years after being left to its own destiny, it would be difficult to imagine that anybody would think of reactor restart without examining the state of reactor vessel and other vital reactor components. Maintaining the reactor under existing conditions without final decision about restart or permanent shutdown is destructive for this nuclear facility. The existing state that pertains for more than 10 years would have only one result, destruction of the RA reactor [sr

  8. 228Ra in monazite processing

    International Nuclear Information System (INIS)

    Paul, A.C.; Pillai, K.C.

    1979-01-01

    The treatment of monazite, adopted by the Indian Rare Earths plant is based on alkali digestion by caustic soda and acid leaching by hydrochloric acid. The paper deals with the distribution of 228 Ra, the daughter product of 232 Th in the effluents and outlines the treatment procedures adopted to reduce its levels. The activity gets distributed into the soluble and insoluble fractions in the effluent depending on its acidic/alkaline nature. The scheme for further deactivation of the effluent was based on lime treatment. It is observed that more than 95% removal of Ra is achievable by the treatment. The procedures leading to the proposed final treatment and disposal of effluent are schematically represented. Some environmental data are presented to show the impact of effluent releases in river, water and sediments. (B.G.W.)

  9. Lightcurve of NEA 1993 RA

    Science.gov (United States)

    Vaduvescu, Ovidiu; Aznar Macias, Amadeo

    2018-01-01

    The near-Earth asteroid (NEA) 1993 RA was observed with the 2.5-m Isaac Newton Telescope (INT) in full Moon conditions for 8h total during three successive nights (2017 Oct 3-6). The composite lightcurve could be fit by a 3-order period P = 5.64 ± 0.01 h with amplitude of 0.13 mag; other solutions are possible.

  10. Regulations for RA reactor operation

    International Nuclear Information System (INIS)

    1980-09-01

    Regulations for RA reactor operation are written in accordance with the legal regulations defined by the Law about radiation protection and related legal acts, as well as technical standards according to the IAEA recommendations. The contents of this book include: fundamental data about the reactor; legal regulations for reactor operation; organizational scheme for reactor operation; general and detailed instructions for operation, behaviour in the reactor building, performing experiments; operating rules for operation under steady state and accidental conditions [sr

  11. RA research nuclear reactor - Annual report 1985; Istrazivacki nuklearni reaktor RA - Izvestaj za 1985. godinu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1985-12-01

    Research reactor RA Annual report for year 1985 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection. [Serbo-Croat] Godisnji izvestaj po projektu 'Istrazivacki nuklearni reaktor RA' za 1985 godinu sastoji se od dva dela: prvi deo obuhvata pogon i odzavanje reaktora RA, a drugi poslove zastite od zracenja na reaktoru RA.

  12. RA Research reactor, Annual report 1986; Istrazivacki nuklearni reaktor RA - Izvestaj za 1986. godinu

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1986-12-01

    Research reactor RA Annual report for year 1985 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection. [Serbo-Croat] Godisnji izvestaj po projektu 'Istrazivacki nuklearni reaktor RA' za 1986 godinu sastoji se od dva dela: prvi deo obuhvata pogon i odzavanje reaktora RA, a drugi poslove zastite od zracenja na reaktoru RA.

  13. Post-stroke infection: a role for IL-1ra?

    Science.gov (United States)

    Tanzi, Pat; Cain, Kevin; Kalil, Angela; Zierath, Dannielle; Savos, Anna; Gee, J Michael; Shibata, Dean; Hadwin, Jessica; Carter, Kelly; Becker, Kyra

    2011-04-01

    Infection is common following stroke and is independently associated with worse outcome. Clinical studies suggest that infections occur more frequently in those individuals with stroke-induced immunologic dysfunction. This study sought to explore the contribution of immunomodulatory cytokines and hormones to lymphocyte function and infection risk. Patients (N = 112) were enrolled as soon as possible after the onset of ischemic stroke. Blood was drawn to assess plasma cortisol, IL-10, IL-1ra, lymphocyte numbers, and lymphocyte function at 72 h after stroke onset; infections were censored through 21 days after stroke onset. Infection occurred in 25% of patients. Stroke severity was the most important predictor of infection risk. Increased plasma cortisol, IL-10, and IL-1ra, as well as decreased lymphocyte numbers, at 72 h after stroke onset were associated with risk of subsequent infection. After controlling for stroke severity, only IL-1ra was independently associated with infection risk, and the degree of risk was consistent throughout the post-stroke period. Infection, but not IL-1ra itself, was associated with worse outcome at 3 months. In this study cohort, increased plasma IL-1ra was independently associated with the risk of post-stroke infection. Further studies are needed to validate this finding, which could have important implications for stroke therapy.

  14. Measurements of neutron flux in the RA reactor; Merenje karakteristika neutronskog fluksa u reaktoru RA

    Energy Technology Data Exchange (ETDEWEB)

    Raisic, N [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1961-12-15

    This report includes the following separate parts: Thermal neutron flux in the experimental channels od RA reactor; Epithermal neutron flux in the experimental channels od RA reactor; Fast neutron flux in the experimental channels od RA reactor; Thermal neutron flux in the thermal column and biological experimental channel; Neutronic measurements in the RA reactor cell; Temperature reactivity coefficient of the RA reactor; design of the device for measuring the activity of wire. [Serbo-Croat] Ovaj izvestaj sadrzi sledece referate: Fluks termalnih neutrona u eksperimentalnim kanalima reaktora RA; Fluks epitermalnih neutrona u eksperimentalnim kanalima reaktora RA; Fluks brzih neutrona u eksperimentalnim kanalima reaktora RA; Fluks termalnih neurona u termalnoj koloni i bioloskom eksperimentalnom kanalu; Neutronska merenja u elementarnoj celiji reaktora RA; Temperaturni koeficijent reaktivnosti reaktora RA; Projekat uredjaja za merenje radioaktivnosti zice.

  15. RA reactor building and installations; Zgrada 'RA' i instalacije

    Energy Technology Data Exchange (ETDEWEB)

    Badrljica, R; Sanovic, V; Skoric, M [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1985-08-15

    RA reactor building is made of reinforced concrete and bricks. It is closed facility with a limited number of controlled openings, doors and windows. The site of the building is 100 m above the sea level, 20 m above the mean Danube level and 8 m above the level of the neighbouring stream Mlaka. The building consists of three parts: central prismatic part, annex - surrounding the central part and the sanitary corridor. The biggest space is the reactor hall. In addition to the detailed description and drawings of the reactor building this documents includes design specifications of: electrical installation, water supply system, sewage system, ventilation and heating, gas and compressed air systems. A separate chapter is devoted to fire protection. Zgrada reaktora RA izgradjena je od armiranog betona i opeke, kao zatvoreni objekat ogranicenog broja kontolisanih otvora, sa ogranicenim brojem vrata i prozora. Plato na kojem je zgrada izgradjena nalazi se na 100 m nadmorske visine, na 20 m iznad srednjeg vodostaja Dunava i 8 m iznad nivoa obliznjeg potoka Mlaka. Zgrada se sastoji iz tri dela: sredisnjeg prizmaticnog dela, aneksa - prstenastog okvira sredisnog dela i sanitarnog propusnika. Pojedinacno najveci prostor zauzima reaktorska hala. Pored detaljnog opisa i plana zgrade, ovaj dokument sadrzi projekat elektricne instalacije, projekat vodovoda i kanalizacije, ventilacije i grejanja, instalacije gasa i komprimovanog vazduha. Posebno poglavlje posveceno je protivpozarnoj zastiti.

  16. Effects of music therapy on self- and experienced stigma in patients on an acute care psychiatric unit: a randomized three group effectiveness study.

    Science.gov (United States)

    Silverman, Michael J

    2013-10-01

    Stigma is a major social barrier that can restrict access to and willingness to seek psychiatric care. Psychiatric consumers may use secrecy and withdrawal in an attempt to cope with stigma. The purpose of this study was to determine the effects of music therapy on self- and experienced stigma in acute care psychiatric inpatients using a randomized design with wait-list control. Participants (N=83) were randomly assigned by cluster to one of three single-session group-based conditions: music therapy, education, or wait-list control. Participants in the music therapy and education conditions completed only posttests while participants in the wait-list control condition completed only pretests. The music therapy condition was a group songwriting intervention wherein participants composed lyrics for "the stigma blues." Results indicated significant differences in measures of discrimination (experienced stigma), disclosure (self-stigma), and total stigma between participants in the music therapy condition and participants in the wait-list control condition. From the results of this randomized controlled investigation, music therapy may be an engaging and effective psychosocial technique to treat stigma. Limitations, suggestions for future research, and implications for clinical practice and psychiatric music therapy research are provided. © 2013.

  17. 'Choosing shoes': a preliminary study into the challenges facing clinicians in assessing footwear for rheumatoid patients

    Science.gov (United States)

    2010-01-01

    Background Footwear has been accepted as a therapeutic intervention for the foot affected by rheumatoid arthritis (RA). Evidence relating to the objective assessment of footwear in patients with RA is limited. The aims of this study were to identify current footwear styles, footwear characteristics, and factors that influence footwear choice experienced by patients with RA. Methods Eighty patients with RA were recruited from rheumatology clinics during the summer months. Clinical characteristics, global function, and foot impairment and disability measures were recorded. Current footwear, footwear characteristics and the factors associated with choice of footwear were identified. Suitability of footwear was recorded using pre-determined criteria for assessing footwear type, based on a previous study of foot pain. Results The patients had longstanding RA with moderate-to severe disability and impairment. The foot and ankle assessment demonstrated a low-arch profile with both forefoot and rearfoot structural deformities. Over 50% of shoes worn by patients were open-type footwear. More than 70% of patients' footwear was defined as being poor. Poor footwear characteristics such as heel rigidity and sole hardness were observed. Patients reported comfort (17%) and fit (14%) as important factors in choosing their own footwear. Only five percent (5%) of patients wore therapeutic footwear. Conclusions The majority of patients with RA wear footwear that has been previously described as poor. Future work needs to aim to define and justify the specific features of footwear that may be of benefit to foot health for people with RA. PMID:20959016

  18. In-depth interviews of patients with primary immunodeficiency who have experienced pump and rapid push subcutaneous infusions of immunoglobulins reveal new insights on their preference and expectations.

    Science.gov (United States)

    Cozon, Grégoire Jacques Noël; Clerson, Pierre; Dokhan, Annaïk; Fardini, Yann; Sala, Taylor Pindi; Crave, Jean-Charles

    2018-01-01

    Patients with primary immunodeficiency (PID) often receive immunoglobulin replacement therapy (IgRT). Physicians and patients have the choice between various methods of administration. For subcutaneous immunoglobulin infusions, patients may use an automated pump (P) or push the plunger of a syringe (rapid push [RP]). P infusions are performed once a week and last around 1 hour. RP decreases the duration of administration, but requires more frequent infusions. Eight out of 30 patients (coming from a single center) who had participated in the cross-over, randomized, open-label trial comparing P and RP participated in a focus group or underwent in-depth interviews. Patients had a long history of home-based subcutaneous immunoglobulin using P. The trial suggested that RP had slightly greater interference on daily life than P, but similar efficacy and better cost-effectiveness. When asked about the delivery method they had preferred, around one-third of patients pointed out RP rather than P. In-depth interviews may reveal unforeseen reasons for patients' preferences. Interviews underlined the complexity of the relationship that the patients maintain with their disease and IgRT. Even if they recognized the genetic nature of the disease and claimed PID was a part of them, patients tried not to be overwhelmed by the disease. IgRT by P was well integrated in patients' routine. By contrast, RP too frequently reminded the patients of their disease. In addition, some patients pointed out the difficulty of pushing the plunger due to the viscosity of the product. Coming back too frequently, RP was not perceived as time saving over a week. Long-lasting use of P could partly explain patients' reasonable reluctance to change to RP. In-depth interviews of PID patients highlighted unforeseen reasons for patients' preference that the physician needs to explore during the shared medical decision-making process.

  19. VELoCiRaPTORS.

    Science.gov (United States)

    Lundgren, J.; Esham, B.; Padalino, S. J.; Sangster, T. C.; Glebov, V.

    2007-11-01

    The Venting and Exhausting of Low Level Air Contaminants in the Rapid Pneumatic Transport of Radioactive Samples (VELoCiRaPTORS) system is constructed to transport radioactive materials quickly and safely at the NIF. A radioactive sample will be placed inside a carrier that is transported via an airflow system produced by controlled differential pressure. Midway through the transportation process, the carrier will be stopped and vented by a powered exhaust blower which will remove radioactive gases within the transport carrier. A Geiger counter will monitor the activity of the exhaust gas to ensure that it is below acceptable levels. If the radiation level is sufficient, the carrier will pass through the remainder of the system, pneumatically braking at the counting station. The complete design will run manually or automatically with control software. Tests were performed using an inactive carrier to determine possible transportation problems. The system underwent many consecutive trials without failure. VELoCiRaPTORS is a prototype of a system that could be installed at both the Laboratory for Laser Energetics at the University of Rochester and the National Ignition Facility at LLNL.

  20. Understanding the digital divide in the clinical setting: the technology knowledge gap experienced by US safety net patients during teleretinal screening.

    Science.gov (United States)

    George, Sheba; Moran, Erin; Fish, Allison; Ogunyemi, Lola

    2013-01-01

    Differential access to everyday technology and healthcare amongst safety net patients is associated with low technological and health literacies, respectively. These low rates of literacy produce a complex patient "knowledge gap" that influences the effectiveness of telehealth technologies. To understand this "knowledge gap", six focus groups (2 African-American and 4 Latino) were conducted with patients who received teleretinal screenings in U.S. urban safety-net settings. Findings indicate that patients' "knowledge gap" is primarily produced at three points: (1) when patients' preexisting personal barriers to care became exacerbated in the clinical setting; (2) through encounters with technology during screening; and (3) in doctor-patient follow-up. This "knowledge gap" can produce confusion and fear, potentially affecting patients' confidence in quality of care and limiting their disease management ability. In rethinking the digital divide to include the consequences of this knowledge gap faced by patients in the clinical setting, we suggest that patient education focus on both their disease and specific telehealth technologies deployed in care delivery.

  1. PERFECTED enhanced recovery (PERFECT-ER) care versus standard acute care for patients admitted to acute settings with hip fracture identified as experiencing confusion: study protocol for a feasibility cluster randomized controlled trial.

    Science.gov (United States)

    Hammond, Simon P; Cross, Jane L; Shepstone, Lee; Backhouse, Tamara; Henderson, Catherine; Poland, Fiona; Sims, Erika; MacLullich, Alasdair; Penhale, Bridget; Howard, Robert; Lambert, Nigel; Varley, Anna; Smith, Toby O; Sahota, Opinder; Donell, Simon; Patel, Martyn; Ballard, Clive; Young, John; Knapp, Martin; Jackson, Stephen; Waring, Justin; Leavey, Nick; Howard, Gregory; Fox, Chris

    2017-12-04

    Health and social care provision for an ageing population is a global priority. Provision for those with dementia and hip fracture has specific and growing importance. Older people who break their hip are recognised as exceptionally vulnerable to experiencing confusion (including but not exclusively, dementia and/or delirium and/or cognitive impairment(s)) before, during or after acute admissions. Older people experiencing hip fracture and confusion risk serious complications, linked to delayed recovery and higher mortality post-operatively. Specific care pathways acknowledging the differences in patient presentation and care needs are proposed to improve clinical and process outcomes. This protocol describes a multi-centre, feasibility, cluster-randomised, controlled trial (CRCT) to be undertaken across ten National Health Service hospital trusts in the UK. The trial will explore the feasibility of undertaking a CRCT comparing the multicomponent PERFECTED enhanced recovery intervention (PERFECT-ER), which acknowledges the differences in care needs of confused older patients experiencing hip fracture, with standard care. The trial will also have an integrated process evaluation to explore how PERFECT-ER is implemented and interacts with the local context. The study will recruit 400 hip fracture patients identified as experiencing confusion and will also recruit "suitable informants" (individuals in regular contact with participants who will complete proxy measures). We will also recruit NHS professionals for the process evaluation. This mixed methods design will produce data to inform a definitive evaluation of the intervention via a large-scale pragmatic randomised controlled trial (RCT). The trial will provide a preliminary estimate of potential efficacy of PERFECT-ER versus standard care; assess service delivery variation, inform primary and secondary outcome selection, generate estimates of recruitment and retention rates, data collection difficulties, and

  2. Efficacy and safety of darunavir-ritonavir compared with that of lopinavir-ritonavir at 48 weeks in treatment-experienced, HIV-infected patients in TITAN: a randomised controlled phase III trial

    DEFF Research Database (Denmark)

    Madruga, José Valdez; Berger, Daniel; McMurchie, Marilyn

    2007-01-01

    BACKGROUND: The protease inhibitor darunavir has been shown to be efficacious in highly treatment-experienced patients with HIV infection, but needs to be assessed in patients with a broader range of treatment experience. We did a randomised, controlled, phase III trial (TITAN) to compare 48-week....... The primary endpoint was non-inferiority (95% CI lower limit for the difference in treatment response -12% or greater) for HIV RNA of less than 400 copies per mL in plasma at week 48 (per-protocol analysis). TITAN (TMC114-C214) is registered with ClinicalTrials.gov, number NCT00110877. FINDINGS: Of 595...

  3. Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

    NARCIS (Netherlands)

    Platten, Michael; Kisten, Yogan; Kälvesten, Johan; Arnaud, Laurent; Forslind, Kristina; van Vollenhoven, Ronald

    2017-01-01

    To study fully automated digital joint space width (JSW) and bone mineral density (BMD) in relation to a conventional radiographic scoring method in early rheumatoid arthritis (eRA). Radiographs scored by the modified Sharp van der Heijde score (SHS) in patients with eRA were acquired from the

  4. Research nuclear reactor RA - Annual Report 1989

    International Nuclear Information System (INIS)

    Sotic, O.

    1989-12-01

    Annual report concerning the project 'RA research nuclear reactor' for 1989, financed by the Serbian ministry of science is divided into two parts. First part is concerned with RA reactor operation and maintenance, which is the task of the Division for reactor engineering of the Institute for multidisciplinary studies and RA reactor engineering. Second part deals with radiation protection activities at the RA reactor which is the responsibility of the Institute for radiation protection. Scientific council of the Institute for multidisciplinary studies and RA reactor engineering has stated that this report describes adequately the activity and tasks fulfilled at the RA reactor in 1989. The scope and the quality of the work done were considered successful both concerning the maintenance and reconstruction, as well as radiation protection activities [sr

  5. RA Research nuclear reactor - Annual report 1987

    International Nuclear Information System (INIS)

    1987-12-01

    Annual report concerning the project 'RA research nuclear reactor' for 1987, financed by the Serbian ministry of science is divided into two parts. First part is concerned with RA reactor operation and maintenance, which is the task of the Division for reactor engineering of the Institute for multidisciplinary studies and RA reactor engineering. Second part deals with radiation protection activities at the RA reactor which is the responsibility of the Institute for radiation protection. Scientific council of the Institute for multidisciplinary studies and RA reactor engineering has stated that this report describes adequately the activity and tasks fulfilled at the RA reactor in 1989. The scope and the quality of the work done were considered successful both concerning the maintenance and reconstruction, as well as radiation protection activities [sr

  6. RA Research reactor, Annual report 1988

    International Nuclear Information System (INIS)

    Sotic, O.

    1988-12-01

    Annual report concerning the project 'RA research nuclear reactor' for 1989, financed by the Serbian ministry of science is divided into two parts. First part is concerned with RA reactor operation and maintenance, which is the task of the Division for reactor engineering of the Institute for multidisciplinary studies and RA reactor engineering. Second part deals with radiation protection activities at the RA reactor which is the responsibility of the Institute for radiation protection. Scientific council of the Institute for multidisciplinary studies and RA reactor engineering has stated that this report describes adequately the activity and tasks fulfilled at the RA reactor in 1989. The scope and the quality of the work done were considered successful both concerning the maintenance and reconstruction, as well as radiation protection activities [sr

  7. Ledipasvir/sofosbuvir for treatment of hepatitis C virus in sofosbuvir-experienced, NS5A treatment-naïve patients: Findings from two randomized trials.

    Science.gov (United States)

    Tam, Edward; Luetkemeyer, Anne F; Mantry, Parvez S; Satapathy, Sanjaya K; Ghali, Peter; Kang, Minhee; Haubrich, Richard; Shen, Xianlin; Ni, Liyun; Camus, Gregory; Copans, Amanda; Rossaro, Lorenzo; Guyer, Bill; Brown, Robert S

    2018-06-01

    We report data from two similarly designed studies that evaluated the efficacy, safety, and optimal duration of ledipasvir/sofosbuvir (LDV/SOF) ± ribavirin (RBV) for retreatment of chronic hepatitis C virus (HCV) in individuals who failed to achieve sustained virological response (SVR) with prior SOF-based, non-NS5A inhibitor-containing regimens. The RESCUE study enrolled HCV mono-infected adults with genotype (GT) 1 or 4. Non-cirrhotic participants were randomized to 12 weeks of LDV/SOF or LDV/SOF + RBV. Compensated cirrhotic participants were randomized to LDV/SOF + RBV (12 weeks) or LDV/SOF (24 weeks). The AIDS Clinical Trials Group A5348 study randomized genotype 1 adults with HCV/HIV co-infection to LDV/SOF + RBV (12 weeks) or LDV/SOF (24 weeks). Both studies used SVR at 12 weeks post-treatment (SVR12) as the primary endpoint. In the RESCUE study, 82 participants were randomized and treated, and all completed treatment. Overall, SVR12 was 88% (72/82); 81-100% in non-cirrhotic participants treated with LDV/SOF or LDV/SOF + RBV for 12 weeks and 80-92% in cirrhotic participants treated with LDV/SOF + RBV for 12 weeks or LDV/SOF for 24 weeks. Adverse events (AEs), mostly mild-to-moderate in severity, were experienced by 78% of participants, with headache and fatigue most frequently reported. One serious AE, not related to treatment, was observed. No premature discontinuations of study drug, or deaths occurred. In the A5348 study, seven participants were randomized (cirrhotic n = 1; GT1a n = 5) and all attained SVR12, with no serious AEs or premature discontinuations. In this SOF-experienced, NS5A inhibitor-naïve population, which included participants with cirrhosis or HCV/HIV co-infection, high SVR12 rates were achieved. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Dual Therapy Treatment Strategies for the Management of Patients Infected with HIV: A Systematic Review of Current Evidence in ARV-Naive or ARV-Experienced, Virologically Suppressed Patients.

    Science.gov (United States)

    Baril, Jean-Guy; Angel, Jonathan B; Gill, M John; Gathe, Joseph; Cahn, Pedro; van Wyk, Jean; Walmsley, Sharon

    2016-01-01

    We reviewed the current literature regarding antiretroviral (ARV)-sparing therapy strategies to determine whether these novel regimens can be considered appropriate alternatives to standard regimens for the initial treatment of ARV-naive patients or as switch therapy for those patients with virologically suppressed HIV infection. A search for studies related to HIV dual therapy published from January 2000 through April 2014 was performed using Biosis, Derwent Drug File, Embase, International Pharmaceutical Abstracts, Medline, Pascal, SciSearch, and TOXNET databases; seven major trial registries, and the abstracts of major conferences. Using predetermined criteria for inclusion, an expert review committee critically reviewed and qualitatively evaluated all identified trials for efficacy and safety results and potential limitations. Sixteen studies of dual therapy regimens were critiqued for the ARV-naive population. Studies of a protease inhibitor/ritonavir in combination with the integrase inhibitor raltegravir or the nucleoside reverse transcriptase inhibitor lamivudine provided the most definitive evidence supporting a role for dual therapy. In particular, lopinavir/ritonavir or darunavir/ritonavir combined with raltegravir and lopinavir/ritonavir combined with lamivudine demonstrated noninferiority to standard of care triple therapy after 48 weeks of treatment. Thirteen trials were critiqued in ARV-experienced, virologically suppressed patients. The virologic efficacy outcomes were mixed. Although overall data regarding toxicity are limited, when compared with standard triple therapy, certain dual therapy regimens may offer advantages in renal function, bone mineral density, and limb fat changes; however, some dual combinations may elevate lipid or bilirubin levels. The potential benefits of dual therapy regimens include reduced toxicity, improved tolerability and adherence, and reduced cost. Although the data reviewed here provide valuable insights into the

  9. Dual Therapy Treatment Strategies for the Management of Patients Infected with HIV: A Systematic Review of Current Evidence in ARV-Naive or ARV-Experienced, Virologically Suppressed Patients.

    Directory of Open Access Journals (Sweden)

    Jean-Guy Baril

    Full Text Available We reviewed the current literature regarding antiretroviral (ARV-sparing therapy strategies to determine whether these novel regimens can be considered appropriate alternatives to standard regimens for the initial treatment of ARV-naive patients or as switch therapy for those patients with virologically suppressed HIV infection.A search for studies related to HIV dual therapy published from January 2000 through April 2014 was performed using Biosis, Derwent Drug File, Embase, International Pharmaceutical Abstracts, Medline, Pascal, SciSearch, and TOXNET databases; seven major trial registries, and the abstracts of major conferences. Using predetermined criteria for inclusion, an expert review committee critically reviewed and qualitatively evaluated all identified trials for efficacy and safety results and potential limitations.Sixteen studies of dual therapy regimens were critiqued for the ARV-naive population. Studies of a protease inhibitor/ritonavir in combination with the integrase inhibitor raltegravir or the nucleoside reverse transcriptase inhibitor lamivudine provided the most definitive evidence supporting a role for dual therapy. In particular, lopinavir/ritonavir or darunavir/ritonavir combined with raltegravir and lopinavir/ritonavir combined with lamivudine demonstrated noninferiority to standard of care triple therapy after 48 weeks of treatment. Thirteen trials were critiqued in ARV-experienced, virologically suppressed patients. The virologic efficacy outcomes were mixed. Although overall data regarding toxicity are limited, when compared with standard triple therapy, certain dual therapy regimens may offer advantages in renal function, bone mineral density, and limb fat changes; however, some dual combinations may elevate lipid or bilirubin levels.The potential benefits of dual therapy regimens include reduced toxicity, improved tolerability and adherence, and reduced cost. Although the data reviewed here provide valuable

  10. Hepatitis C viral evolution in genotype 1 treatment-naïve and treatment-experienced patients receiving telaprevir-based therapy in clinical trials.

    Directory of Open Access Journals (Sweden)

    Tara L Kieffer

    Full Text Available In patients with genotype 1 chronic hepatitis C infection, telaprevir (TVR in combination with peginterferon and ribavirin (PR significantly increased sustained virologic response (SVR rates compared with PR alone. However, genotypic changes could be observed in TVR-treated patients who did not achieve an SVR.Population sequence analysis of the NS3•4A region was performed in patients who did not achieve SVR with TVR-based treatment.Resistant variants were observed after treatment with a telaprevir-based regimen in 12% of treatment-naïve patients (ADVANCE; T12PR arm, 6% of prior relapsers, 24% of prior partial responders, and 51% of prior null responder patients (REALIZE, T12PR48 arms. NS3 protease variants V36M, R155K, and V36M+R155K emerged frequently in patients with genotype 1a and V36A, T54A, and A156S/T in patients with genotype 1b. Lower-level resistance to telaprevir was conferred by V36A/M, T54A/S, R155K/T, and A156S variants; and higher-level resistance to telaprevir was conferred by A156T and V36M+R155K variants. Virologic failure during telaprevir treatment was more common in patients with genotype 1a and in prior PR nonresponder patients and was associated with higher-level telaprevir-resistant variants. Relapse was usually associated with wild-type or lower-level resistant variants. After treatment, viral populations were wild-type with a median time of 10 months for genotype 1a and 3 weeks for genotype 1b patients.A consistent, subtype-dependent resistance profile was observed in patients who did not achieve an SVR with telaprevir-based treatment. The primary role of TVR is to inhibit wild-type virus and variants with lower-levels of resistance to telaprevir. The complementary role of PR is to clear any remaining telaprevir-resistant variants, especially higher-level telaprevir-resistant variants. Resistant variants are detectable in most patients who fail to achieve SVR, but their levels decline over time after treatment.

  11. In-depth interviews of patients with primary immunodeficiency who have experienced pump and rapid push subcutaneous infusions of immunoglobulins reveal new insights on their preference and expectations

    Directory of Open Access Journals (Sweden)

    Cozon GJN

    2018-03-01

    Full Text Available Grégoire Jacques Noël Cozon,1 Pierre Clerson,2 Annaïk Dokhan,3 Yann Fardini,2 Taylor Pindi Sala,4 Jean-Charles Crave4 1Department of Clinical Immunology and Rheumatology, Edouard Herriot Hospital, Lyon, France; 2Soladis Clinical Studies, Roubaix, France; 3KPL, Paris, France; 4Octapharma France, Boulogne, France Purpose: Patients with primary immunodeficiency (PID often receive immunoglobulin replacement therapy (IgRT. Physicians and patients have the choice between various methods of administration. For subcutaneous immunoglobulin infusions, patients may use an automated pump (P or push the plunger of a syringe (rapid push [RP]. P infusions are performed once a week and last around 1 hour. RP decreases the duration of administration, but requires more frequent infusions.Patients and methods: Eight out of 30 patients (coming from a single center who had participated in the cross-over, randomized, open-label trial comparing P and RP participated in a focus group or underwent in-depth interviews. Patients had a long history of home-based subcutaneous immunoglobulin using P. The trial suggested that RP had slightly greater interference on daily life than P, but similar efficacy and better cost-effectiveness. When asked about the delivery method they had preferred, around one-third of patients pointed out RP rather than P. In-depth interviews may reveal unforeseen reasons for patients’ preferences. Results: Interviews underlined the complexity of the relationship that the patients maintain with their disease and IgRT. Even if they recognized the genetic nature of the disease and claimed PID was a part of them, patients tried not to be overwhelmed by the disease. IgRT by P was well integrated in patients’ routine. By contrast, RP too frequently reminded the patients of their disease. In addition, some patients pointed out the difficulty of pushing the plunger due to the viscosity of the product. Coming back too frequently, RP was not perceived

  12. LCA versus RA - an introduction

    DEFF Research Database (Denmark)

    Olsen, Stig Irving

    2000-01-01

    Risk Assessment (RA) of chemicals is an environmental management tool used to assess the risk of specific chemicals, which are harmful to man or the environment under certain circumstances of use or in certain environmental recipients. Life Cycle Assessment (LCA) or environmental assessment...... of Industrial Products) developed in Denmark (Wenzel et al., 1997), respectively. The interactions between the two tools can be viewed from two different angles: 1. As a general reflection of how the tools supplement each other in the total environmental effort. 2. As an assessment of coincidences...... on Principles and Methods for Hazard and Risk Assessment)focuses on an assessment of the toxicological and ecotoxicological risks, the focus of this article's comparison of assessment principles, data requirements etc. will be on the assessment of toxicity and ecotoxicity in EDIP's impact assessment methodology...

  13. RA radiological characterization database application

    International Nuclear Information System (INIS)

    Steljic, M.M; Ljubenov, V.Lj. . E-mail address of corresponding author: milijanas@vin.bg.ac.yu; Steljic, M.M.)

    2005-01-01

    Radiological characterization of the RA research reactor is one of the main activities in the first two years of the reactor decommissioning project. The raw characterization data from direct measurements or laboratory analyses (defined within the existing sampling and measurement programme) have to be interpreted, organized and summarized in order to prepare the final characterization survey report. This report should be made so that the radiological condition of the entire site is completely and accurately shown with the radiological condition of the components clearly depicted. This paper presents an electronic database application, designed as a serviceable and efficient tool for characterization data storage, review and analysis, as well as for the reports generation. Relational database model was designed and the application is made by using Microsoft Access 2002 (SP1), a 32-bit RDBMS for the desktop and client/server database applications that run under Windows XP. (author)

  14. Optimum RA reactor fuelling scheme

    International Nuclear Information System (INIS)

    Strugar, P.; Nikolic, V.

    1965-10-01

    Ideal reactor refueling scheme can be achieved only by continuous fuel elements movement in the core, which is not possible, and thus approximations are applied. One of the possible approximations is discontinuous movement of fuel elements groups in radial direction. This enables higher burnup especially if axial exchange is possible. Analysis of refueling schemes in the RA reactor core and schemes with mixing the fresh and used fuel elements show that 30% higher burnup can be achieved by applying mixing, and even 40% if reactivity due to decrease in experimental space is taken into account. Up to now, mean burnup of 4400 MWd/t has been achieved, and the proposed fueling scheme with reduction of experimental space could achieve mean burnup of 6300 MWd/t which means about 25 Mwd/t per fuel channel [sr

  15. RA Reactor applications, Annex A

    International Nuclear Information System (INIS)

    Martinc, R.; Cupac, S.; Stanic, A.

    1990-01-01

    RA reactor was not operated during the past five years due to the renewal and reconstruction of the reactor systems, which in underway. In the period from 1986-1990, reactor was operated only 144 MWh in 1986, for the need of testing the reactor systems and possibility of irradiating 125 I. Reactor will not be operated in 1991 because of the exchange of complete instrumentation which is planned to be finished by the end of 1991. It is expected to start operation in May 1992. That is why this annex includes the plan of reactor operation for period of nine months starting from from the moment of start-up. It is planned to operate the reactor at 0.02 MW power first three months, to increase the power gradually and reach 3.5 MW after 8 months of operation. It is foreseen to operate the reactor at 4.7 MW from the tenth month on [sr

  16. Virologic response to tipranavir-ritonavir or darunavir-ritonavir based regimens in antiretroviral therapy experienced HIV-1 patients: a meta-analysis and meta-regression of randomized controlled clinical trials.

    Directory of Open Access Journals (Sweden)

    Asres Berhan

    Full Text Available The development of tipranavir and darunavir, second generation non-peptidic HIV protease inhibitors, with marked improved resistance profiles, has opened a new perspective on the treatment of antiretroviral therapy (ART experienced HIV patients with poor viral load control. The aim of this study was to determine the virologic response in ART experienced patients to tipranavir-ritonavir and darunavir-ritonavir based regimens.A computer based literature search was conducted in the databases of HINARI (Health InterNetwork Access to Research Initiative, Medline and Cochrane library. Meta-analysis was performed by including randomized controlled studies that were conducted in ART experienced patients with plasma viral load above 1,000 copies HIV RNA/ml. The odds ratios and 95% confidence intervals (CI for viral loads of <50 copies and <400 copies HIV RNA/ml at the end of the intervention were determined by the random effects model. Meta-regression, sensitivity analysis and funnel plots were done. The number of HIV-1 patients who were on either a tipranavir-ritonavir or darunavir-ritonavir based regimen and achieved viral load less than 50 copies HIV RNA/ml was significantly higher (overall OR = 3.4; 95% CI, 2.61-4.52 than the number of HIV-1 patients who were on investigator selected boosted comparator HIV-1 protease inhibitors (CPIs-ritonavir. Similarly, the number of patients with viral load less than 400 copies HIV RNA/ml was significantly higher in either the tipranavir-ritonavir or darunavir-ritonavir based regimen treated group (overall OR = 3.0; 95% CI, 2.15-4.11. Meta-regression showed that the viral load reduction was independent of baseline viral load, baseline CD4 count and duration of tipranavir-ritonavir or darunavir-ritonavir based regimen.Tipranavir and darunavir based regimens were more effective in patients who were ART experienced and had poor viral load control. Further studies are required to determine their consistent

  17. Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain.

    Science.gov (United States)

    Rawshani, Nina; Rawshani, Araz; Gelang, Carita; Herlitz, Johan; Bång, Angela; Andersson, Jan-Otto; Gellerstedt, Martin

    2017-12-01

    In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality). The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG. In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; pECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. The impact of pre-injury anticoagulation therapy in the older adult patient experiencing a traumatic brain injury: A systematic review.

    Science.gov (United States)

    Smith, Karen; Weeks, Susan

    2012-01-01

    The objective of this systematic review is to synthesize the best available evidence on the impact of pre-injury anticoagulation therapy in the older adult patient who experiences a traumatic brain injury. Trauma in the elderly remains one of the most challenging problems for healthcare providers in the 21 century. The most recent United States (U.S.) census estimates that by the year 2020 more than 52 million Americans will be age 65 years or older, and one million of those will live to be over 100 years of age. In the older adult population, classified as age 65 years or greater, the two leading causes of injury were reported as motor vehicle crashes (MVC) and falls. We have become increasingly aware of the unique physiologic changes in this population that make them more susceptible to succumb to traumatic injuries than their younger counterparts. This is especially true in the anticoagulated patient with a traumatic brain injury.Traumatic brain injury (TBI) is defined as an injury occurring when an external force traumatizes the brain. It may also be known as an intracranial or head injury. TBI is classified depending on the mechanism of injury (blunt or penetrating), severity, and location of the assault. Damage to the brain, skull, and/or scalp transpires. TBI is the leading cause of death and disability in the U.S, and persons of all ages, races, ethnicities, and incomes are affected. In the past five to ten years, trauma services have recorded an increase in major trauma admissions of patients age 65 years and older. In review of the literature to date, it is recognized that outcomes following moderate to severe TBI in older adults are poor, with high rates of significant disability and mortality reported. A recent Australian study reported that 28% of older adults died in the hospital following a TBI and in Finland adults aged 75 years and older had the highest rates of TBI related hospitalizations and death. According to a systematic review of European

  19. Distribution of 226Ra and 228Ra in drinking water and dose assessment

    International Nuclear Information System (INIS)

    Ajay Kumar; Sugandhi, S.; Usha, N.; Rupali, K.; Gurg, R.P.

    2002-01-01

    The radioactivity concentrations of 226 Ra and 228 Ra have been analysed in 123 drinking water samples received from different regions of India. The maximum concentrations of 226 Ra and 228 Ra in drinking water are 8 mBq/l and 11.5 mBq/l respectively. The higher doses due to intake of 228 Ra through drinking water suggests that 228 Ra should also be measured in the assessment of ingestion dose to the population. The estimated committed effective doses range from 0.082 to 2.45 μSv/year and from 1.53 to 8.81 μSv/year for the ingestion of 226 Ra and 228 Ra respectively. (author)

  20. Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mortality.

    Science.gov (United States)

    Studnek, Jonathan R; Infinger, Allison; Wilson, Hadley; Niess, Gary; Jackson, Patrick; Swanson, Doug

    2018-03-29

    The impact on mortality due to prompt recognition of ST-segment Elevation Myocardial Infarction (STEMI) patients by EMS has not been well described. The objective of this study was to describe the association between the time interval, 9-1-1 call to percutaneous intervention (PCI), and mortality at one year. This retrospective analysis included patients that were transported by EMS as a "code STEMI" and underwent PCI.  Total time from 9-1-1 call to PCI was calculated for each patient and was the independent variable of interest. Each patient's mortality status at one year was the outcome variable, collected by querying medical records and the national death index. Confounding variables were abstracted from hospital records. Logistic regression was conducted to determine the likelihood of survival given differences in time to PCI. A total of 550 patients were included in the analyses of which 68% were male with an average age 59.8 (SD 12.8). Mean reperfusion time was 81.8 min (SD 20.0) and was significantly lower in patients alive at one year (80.8 min, SD 19.7) vs. deceased at one year (93.9 min, SD 19.6), respectively. Odds of survival at one year decreased by 3% (OR 0.97; 95% CI 0.96-0.99) for every one minute increase in time to PCI. This relationship practically represents a 30% increase in mortality for every 10 minute delay from 9-1-1 call to PCI. The model produced suggests that a linear relationship exists between time to PCI and mortality in the prehospital environment with the probability of survival decreasing significantly as time to PCI increases.

  1. Efficacy and tolerability of buccal buprenorphine in opioid-experienced patients with moderate to severe chronic low back pain: results of a phase 3, enriched enrollment, randomized withdrawal study.

    Science.gov (United States)

    Gimbel, Joseph; Spierings, Egilius L H; Katz, Nathaniel; Xiang, Qinfang; Tzanis, Evan; Finn, Andrew

    2016-11-01

    A buccal film of buprenorphine (BBUP) was evaluated for safety and efficacy in a multicenter, double-blind, placebo-controlled, enriched-enrollment, randomized-withdrawal study in opioid-experienced patients (30 to ≤160 mg/d morphine sulfate equivalent) with moderate to severe chronic low back pain taking around-the-clock opioid analgesics. Patients' opioid doses were tapered to ≤30 mg morphine sulfate equivalent before open-label titration with BBUP (range, 150-900 μg every 12 hours). Patients who responded (received adequate analgesia that was generally well tolerated for 14 days) were randomized to receive buprenorphine (n = 254) or placebo (n = 257) buccal film. The primary efficacy variable was the change from baseline to week 12 of double-blind treatment in mean average daily pain-intensity scores using a rating scale of 0 (no pain) to 10 (worst pain imaginable). In the intent-to-treat population, mean pain scores were 6.7 after opioid taper and declined to 2.8 after the BBUP titration period. After randomization, mean pain scores were lower in the BBUP group than in the placebo group; the difference between groups in the mean change from baseline to week 12 was -0.98 (95% CI, -1.32 to -0.64; P opioid-experienced patients taking around-the-clock opioid treatment for chronic low back pain.

  2. The Impact of Experiencing Adverse Drug Reactions on the Patient's Quality of Life : A Retrospective Cross-Sectional Study in the Netherlands

    NARCIS (Netherlands)

    Rolfes, Leàn; van Hunsel, Florence; Taxis, Katja; van Puijenbroek, Eugène

    INTRODUCTION: There is little information as to what extent adverse drug reactions (ADRs) influence patients' health-related quality of life (HR-QOL). From a pharmacovigilance perspective, capturing and making the best use of this information remains a challenge. The Netherlands Pharmacovigilance

  3. The functional magnetic resonance imaging (fMRI) procedure as experienced by healthy participants and stroke patients – A pilot study

    International Nuclear Information System (INIS)

    Szameitat, André J; Shen, Shan; Sterr, Annette

    2009-01-01

    An important aspect in functional imaging research employing magnetic resonance imaging (MRI) is how participants perceive the MRI scanning itself. For instance, the knowledge of how (un)comfortable MRI scanning is perceived may help institutional review boards (IRBs) or ethics committees to decide on the approval of a study, or researchers to design their experiments. We provide empirical data from our lab gained from 70 neurologically healthy mainly student subjects and from 22 mainly elderly patients suffering from motor deficits after brain damage. All participants took part in various basic research fMRI studies using a 3T MRI scanner. Directly after the scanning, all participants completed a questionnaire assessing their experience with the fMRI procedure. 87.2% of the healthy subjects and 77.3% of the patients rated the MRI procedure as acceptable to comfortable. In healthy subjects, males found the procedure more comfortable, while the opposite was true for patients. 12.1% of healthy subjects considered scanning durations between 30 and 60 min as too long, while no patient considered their 30 min scanning interval as too long. 93.4% of the healthy subjects would like to participate in an fMRI study again, with a significantly lower rate for the subjects who considered the scanning as too long. Further factors, such as inclusion of a diffusion tensor imaging (DTI) scan, age, and study duration had no effect on the questionnaire responses. Of the few negative comments, the main issues were noise, the restriction to keep still for the whole time, and occasional feelings of dizziness. MRI scanning in the basic research setting is an acceptable procedure for elderly and patient participants as well as young healthy subjects

  4. Determination of ''226Ra by Alpha Spectrometry by Using ''225Ra as Yield Tracer

    International Nuclear Information System (INIS)

    Crespo, M. T.; Oller, O.

    1999-01-01

    A method for the determination of low-level ''226 Ra in environmental and geological samples by alpha spectrometry is described. The method is based on the use of ''225 Ra from ''229 Th as yield tracer and has been developed to analyze U, Th and Ra in the same sample. (Author) 12 refs

  5. Phosphoproteome and Transcriptome of RA-Responsive and RA-Resistant Breast Cancer Cell Lines.

    Directory of Open Access Journals (Sweden)

    Marilyn Carrier

    Full Text Available Retinoic acid (RA, the main active vitamin A metabolite, controls multiple biological processes such as cell proliferation and differentiation through genomic programs and kinase cascades activation. Due to these properties, RA has proven anti-cancer capacity. Several breast cancer cells respond to the antiproliferative effects of RA, while others are RA-resistant. However, the overall signaling and transcriptional pathways that are altered in such cells have not been elucidated. Here, in a large-scale analysis of the phosphoproteins and in a genome-wide analysis of the RA-regulated genes, we compared two human breast cancer cell lines, a RA-responsive one, the MCF7 cell line, and a RA-resistant one, the BT474 cell line, which depicts several alterations of the "kinome". Using high-resolution nano-LC-LTQ-Orbitrap mass spectrometry associated to phosphopeptide enrichment, we found that several proteins involved in signaling and in transcription, are differentially phosphorylated before and after RA addition. The paradigm of these proteins is the RA receptor α (RARα, which was phosphorylated in MCF7 cells but not in BT474 cells after RA addition. The panel of the RA-regulated genes was also different. Overall our results indicate that RA resistance might correlate with the deregulation of the phosphoproteome with consequences on gene expression.

  6. Operators retraining in RA-1

    International Nuclear Information System (INIS)

    Pereira, R; Daoud, A

    2012-01-01

    The nuclear activity in Argentina has its foundational milestone in the creation of the Comision Nacional de EnergIa Atomica in 1950. Achievements since then, linked to the area of nuclear reactors and nuclear fuel materials, fuel cycle facilities and the applications of nuclear technology in medicine, industry, agriculture, food preservation, environmental studies and many others, have relied on personnel trained in this specific technology in both professional and technical level. This training has been done in most cases in the exclusive scope of CNEA. Eventually CNEA has been linked with the University to ensure that personnel training concerned to work done in the nuclear field had guarantees of formality and excellence. The creation of the Instituto de Tecnologia Nuclear Dan Beninson that, under an agreement with the Universidad Nacional de General San Martin, has set up an enabling environment for the training of professionals and university technicians to serve with the multiple and growing use of this technology. On the other hand the Institute has been issuing, along with its careers, specialized courses that, in some cases, have been requested by CNEA's nuclear installations and companies related to the nuclear sector. In particular, the Specialization in Nuclear Reactors and its Fuel Cycle (ERCC) and the Courses of Introduction to Nuclear Technology-Complementary training for Installations Personnel Class I (CI-CC), this last, recognized by the ARN as a requirement for applying to the individual licensing examination, providing work experience in the RA-1 reactor among which we can find commissioning, control rods calibration by various methods and calculations of reactivity. With this practical framework developed in the RA-1 and the academic support provided by the Instituto de Tecnologia Nuclear Dan Beninson it was developed a training program for nuclear reactors operators. Let us stress that this research reactor has been forming generations

  7. The Effects of a Gluten-free Diet Versus a Hypocaloric Diet Among Patients With Fibromyalgia Experiencing Gluten Sensitivity-like Symptoms: A Pilot, Open-Label Randomized Clinical Trial.

    Science.gov (United States)

    Slim, Mahmoud; Calandre, Elena P; Garcia-Leiva, Juan M; Rico-Villademoros, Fernando; Molina-Barea, Rocio; Rodriguez-Lopez, Carmen M; Morillas-Arques, Piedad

    2017-07-01

    Patients with fibromyalgia frequently present with symptoms similar to those experienced by patients with gluten-related disorders, raising the possibility that a subgroup of these patients could be experiencing underlying gluten sensitivity. This study aimed to evaluate the effects of a gluten-free diet (GFD) compared with a hypocaloric diet (HCD) among patients with fibromyalgia. Adult patients diagnosed with fibromyalgia were randomly allocated to receive a GFD or a HCD over a 24-week period. The primary outcome measure was the change in the number of gluten sensitivity symptoms. The following secondary outcomes were evaluated: body mass index, Revised Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, Brief Pain Inventory, Beck Depression Inventory-II, State-Trait Anxiety Inventory, Short-Form Health Survey, Patient Global Impression Scale of Severity, Patient Global Impression Scale of Improvement, and adverse events. Seventy-five subjects were randomly allocated to receive either a GFD (n=35) or an HCD (n=40). The least squares mean change in the total number of gluten sensitivity symptoms from baseline did not differ significantly between the GFD and HCD groups (-2.44±0.40 for the GFD; -2.10±0.37 for the HCD; P=0.343). Similarly, the 2 dietary interventions did not differ in any of the remaining measured secondary outcomes. Both dietary interventions were well tolerated. Both dietary interventions were associated with similar beneficial outcomes in reducing gluten sensitivity symptoms and other secondary outcomes. However, despite its specificity, GFD was not superior to HCD in reducing the number of gluten sensitivity symptoms or secondary outcomes.

  8. Prevalence and factors associated with darunavir resistance mutations in multi-experienced HIV-1-infected patients failing other protease inhibitors in a referral teaching center in Brazil

    Directory of Open Access Journals (Sweden)

    Jose E Vidal

    Full Text Available Information about resistance profile of darunavir (DRV is scarce in Brazil. Our objectives were to estimate the prevalence of DRV resistance mutations in patients failing protease inhibitors (PI and to identify factors associated with having more DRV resistance mutations. All HIV-infected patients failing PI-based regimens with genotyping performed between 2007 and 2008 in a referral teaching center in São Paulo, Brazil, were included. DRV-specific resistance mutations listed by December 2008 IAS-USA panel update were considered. Two Poisson regression models were constructed to assess factors related to the presence of more DRV resistance mutations. A total of 171 HIV-infected patients with available genotyping were included. The number of patients with lopinavir, saquinavir, and amprenavir used in previous regimen were 130 (76%, 83 (49%, and 35 (20%, respectively. The prevalence of major DRV resistance mutations was 50V: 5%; 54M: 1%; 76V: 4%; 84V: 15%. For minor mutations, the rates were 11I: 3%; 32I: 7%; 33F: 23%; 47V: 6%; 54L: 6%; 74P: 3%; 89V: 6%. Only 11 (6% of the genotypes had > 3 DRV resistance mutations. In the clinical model, time of HIV infection of > 10 years and use of amprenavir were independently associated with having more DRV resistance mutations. In the genotyping-based model, only total number of PI resistance mutations was associated with our outcome. In conclusion, the prevalence of DRV mutations was low. Time of HIV infection, use of amprenavir and total number of PI resistance mutations were associated with having more DRV mutations.

  9.  Risk of discontinuation of nevirapine due to toxicities in antiretroviral naive and experienced HIV-infected patients with high and low CD4 counts

    DEFF Research Database (Denmark)

    Mocroft, A; Staszewski, S; Weber, R

    2007-01-01

    AND METHODS: 1,571 EuroSIDA patients started NVPc after 1/1/1999, with CD4+ T-cell counts and viral load measured in the 6 months before starting treatment, and were stratified into four groups based on CD4+ T-cell counts at initiation of NVPc (high [H], > 400/mm3 or > 250/mm3 for male or female, respectively...

  10. Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health

    Science.gov (United States)

    2012-01-01

    Purpose Aims of this study were to identify aspects of functioning and health relevant to patients with vertigo expressed by ICF categories and to explore the potential of the ICF to describe the patient perspective in vertigo. Methods We conducted a series of qualitative semi-structured face-to-face interviews using a descriptive approach. Data was analyzed using the meaning condensation procedure and then linked to categories of the International Classification of Functioning, Disability and Health (ICF). Results From May to July 2010 12 interviews were carried out until saturation was reached. Four hundred and seventy-one single concepts were extracted which were linked to 142 different ICF categories. 40 of those belonged to the component body functions, 62 to the component activity and participation, and 40 to the component environmental factors. Besides the most prominent aspect “dizziness” most participants reported problems within “Emotional functions (b152), problems related to mobility and carrying out the daily routine. Almost all participants reported “Immediate family (e310)” as a relevant modifying environmental factor. Conclusions From the patients’ perspective, vertigo has impact on multifaceted aspects of functioning and disability, mainly body functions and activities and participation. Modifying contextual factors have to be taken into account to cover the complex interaction between the health condition of vertigo on the individuals’ daily life. The results of this study will contribute to developing standards for the measurement of functioning, disability and health relevant for patients suffering from vertigo. PMID:22738067

  11. Impact of HIV-1 reverse transcriptase polymorphism F214L on virological response to thymidine analogue based regimens in ART-naïve and experienced patients

    DEFF Research Database (Denmark)

    Silberstein, F; Cozzi-Lepri, A; Ruiz, L

    2007-01-01

    BACKGROUND: A negative association between the polymorphism F214L and type 1 thymidine analogue (TA) mutations (TAMs) has been observed. However, the virological response to TAs according to the detection of F214L has not been evaluated. METHODS: We studied 590 patients from EuroSIDA who started ...... were observed in patients with M41L/T215Y and mixed TAM profiles detected before the initiation of cART. CONCLUSIONS: This study provides evidence that the detection of polymorphism F214L is associated with a favorable virological response to TA-based cART.......BACKGROUND: A negative association between the polymorphism F214L and type 1 thymidine analogue (TA) mutations (TAMs) has been observed. However, the virological response to TAs according to the detection of F214L has not been evaluated. METHODS: We studied 590 patients from EuroSIDA who started TA...... therapy for the first time as part of potent combination antiretroviral therapy (cART) and who were tested for genotypic resistance within the past 6 months. End points were median reduction in the week 24 viral load and time to virological failure (2 consecutive VL measurements >400 copies/mL after...

  12. Socio-demographic characteristics and challenges experienced by disabled patients living with HIV/AIDS in a tertiary hospital in Ibadan, Nigeria.

    Science.gov (United States)

    Olowookere, S A; Adewole, I F

    2012-09-01

    HIV/AIDS is highly prevalent in sub-Saharan Africa and few studies had looked at physically and mentally challenged people living with HIV/AIDS (PLHIV) in this environment. This study aimed to describe the socio-demographic characteristics and challenges faced by these patients attending University College Hospital, Ibadan. A descriptive cross-sectional study design was done. A semi-structured interviewer administered questionnaire was administered to consecutive disabled PLHIV over a period of six months. Data obtained were analyzed using descriptive and inferential statistics. A total of ninety-nine patients were seen during the study period. The mean age of these patients was 39.9 +/- 9.4 years (range 23-60 years). There were 30 (30.3%) males and 69 (69.7%) females. Twenty-four percent had no formal education while 12% had tertiary education. All respondents had suffered stigmatization/discrimination while most were poor. Eighty-seven percent had AIDS at presentation. Musculoskeletal impairments (46.5%), hearing loss (16.2%) and visual impairment (31.3%) were the commonest disability. Over twenty-three percent had prior history of road traffic accident as the cause of disability. Physically and mentally challenged people living with HIV/AIDS are poor and highly stigmatized. They require special assistance to cope and need economic empowerment to reduce their poverty level.

  13. High rate of virologic suppression with darunavir/ritonavir plus optimized background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    José Ernesto Vidal

    Full Text Available OBJECTIVES: To assess the virologic and immunological response of darunavir/ritonavir plus optimized background therapy in highly antiretroviral-experienced HIV-infected patients in Brazil. METHODS: Prospective cohort study carried out in a tertiary center in Sao Paulo, Brazil. Three-class antiretroviral-experienced patients with confirmed virologic failure began darunavir/ritonavir plus optimized background therapy (nucleoside/tide reverse transcriptase inhibitors ± raltegravir ± enfuvirtide ± maraviroc after performing a genotypic resistance assay. Clinical evaluation and laboratory tests were collected at baseline and at weeks 12, 24, and 48. Multivariate analysis was performed to identify predictors of virologic response at 48 weeks. RESULTS: Ninety-two patients were included. The median of darunavir resistant mutation was 1 (range 0-6. The median genotypic sensitivity score in the optimized background therapy was 2 (interquartile range 1-2. At week 48, 83% (95% CI: 75-90% had an HIV RNA level 100 000 copies/mL was inversely associated with virologic success at week 48 (HR: 0.22, 95% CI: 0.06-0.85, p = 0.028. CONCLUSIONS: Darunavir/ritonavir plus optimized background therapy was a highly effective salvage regimen under clinical routine conditions in a referral center in Brazil, which is similar to the reported in high-income countries.

  14. High rate of virologic suppression with darunavir/ritonavir plus optimized background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    José Ernesto Vidal

    2013-02-01

    Full Text Available OBJECTIVES: To assess the virologic and immunological response of darunavir/ritonavir plus optimized background therapy in highly antiretroviral-experienced HIV-infected patients in Brazil. METHODS: Prospective cohort study carried out in a tertiary center in Sao Paulo, Brazil. Three-class antiretroviral-experienced patients with confirmed virologic failure began darunavir/ritonavir plus optimized background therapy (nucleoside/tide reverse transcriptase inhibitors ± raltegravir ± enfuvirtide ± maraviroc after performing a genotypic resistance assay. Clinical evaluation and laboratory tests were collected at baseline and at weeks 12, 24, and 48. Multivariate analysis was performed to identify predictors of virologic response at 48 weeks. RESULTS: Ninety-two patients were included. The median of darunavir resistant mutation was 1 (range 0-6. The median genotypic sensitivity score in the optimized background therapy was 2 (interquartile range 1-2. At week 48, 83% (95% CI: 75-90% had an HIV RNA level 100 000 copies/mL was inversely associated with virologic success at week 48 (HR: 0.22, 95% CI: 0.06-0.85, p = 0.028. CONCLUSIONS: Darunavir/ritonavir plus optimized background therapy was a highly effective salvage regimen under clinical routine conditions in a referral center in Brazil, which is similar to the reported in high-income countries.

  15. Determination of 226Ra and 228Ra in surface seawater around Sagami bay and its vicinity

    International Nuclear Information System (INIS)

    Nakano-Ohta, T.; Kubota, T.; Mahara, Y.; Yoshikawa, M.; Sato, J.

    2006-01-01

    Activity ratios of 228 Ra/ 226 Ra in surface seawaters were observed at 5 ports of Izu-Oshima, Ajiro port of Sagami bay and Umizuri park of Tokyo bay. The 228 Ra/ 226 Ra activity ratio in surface seawaters were from 0.2 to 0.7 for Izu-Oshima, from 0.2 to 0.7 for Ajiro port and from 0.6 to 0.8 for Tokyo bay. The activity ratio in surface seawaters of Izu-Oshima and Atami of Sagami bay showed lower in spring and highly in autumn, while narrow variation pattern was observed in Umizuri park of Tokyo bay. The observed variation patterns of 228 Ra/ 226 Ra in surface seawaters at Izu-oshima, Ajiro park and Umizuri park may be reflected by difference of contribution from amount of seawater far off coast with low 228 Ra concentration. (author)

  16. Preparation of 227Ac/223Ra by neutron irradiation of 226Ra

    International Nuclear Information System (INIS)

    Ekaterina Kukleva; Jan Kozempel; Martin Vlk; Petra Micolova; Dusan Vopalka

    2015-01-01

    Radium-223 is a prospective alpha-emitter for targeted radionuclide therapy. Although 223 Ra is formed naturally by the decay of 235 U, for practical reasons its preparation involves neutron irradiation of 226 Ra. The β - decay of the 227 Ra (T ½ = 43 min) produced via 226 Ra(n,γ) 227 Ra reaction leads to 227 Ac, a mother nuclide of 227 Th and subsequently 223 Ra. Radium target material is generally available in multigram quantities from historical stock. The main aim of this study was to experimentally as well as theoretically evaluate and verify the available literature data on production of 227 Ac/ 223 Ra. According to the data obtained from the γ-spectra, the approximate yield values were determined and effective cross section value for the 227 Ac production was calculated to 14 ± 4 b. (author)

  17. Eating behavior style predicts craving and anxiety experienced in food-related virtual environments by patients with eating disorders and healthy controls.

    Science.gov (United States)

    Ferrer-Garcia, Marta; Pla-Sanjuanelo, Joana; Dakanalis, Antonios; Vilalta-Abella, Ferran; Riva, Giuseppe; Fernandez-Aranda, Fernando; Sánchez, Isabel; Ribas-Sabaté, Joan; Andreu-Gracia, Alexis; Escandón-Nagel, Neli; Gomez-Tricio, Osane; Tena, Virginia; Gutiérrez-Maldonado, José

    2017-10-01

    Eating behavior style (emotional, restrictive, or external) has been proposed as an explanation for the differences in response to food-related cues between people who overeat and those who do not, and has been also considered a target for the treatment of eating disorders (EDs) characterized by lack of control over eating and weight-related (overweight/obesity) conditions. The aim of this study was to analyze the relationship between eating behavior style and psychophysiological responses (self-reported food craving and anxiety) to food-related virtual reality (VR) environments in outpatients with bulimia nervosa (BN) and binge eating disorder (BED) and to compare them with healthy participants. Fifty-eight outpatients and 135 healthy participants were exposed to palatable foods in four experimental everyday real-life VR environments (kitchen, dining room, bedroom and café). During exposure, cue-elicited food craving and anxiety were assessed. Participants also completed standardized instruments for the study purposes. ED patients reported significantly higher levels of craving and anxiety when exposed to the virtual food than healthy controls. Eating behavior styles showed strong associations with cue-elicited food craving and anxiety. In the healthy group, external eating was the only predictor of cue-elicited craving and anxiety. In participants with BN and BED, external and emotional eating were the best predictors of cue-elicited craving and anxiety, respectively. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Gag mutations strongly contribute to HIV-1 resistance to protease inhibitors in highly drug-experienced patients besides compensating for fitness loss.

    Directory of Open Access Journals (Sweden)

    Elisabeth Dam

    2009-03-01

    Full Text Available Human immunodeficiency virus type 1 (HIV-1 resistance to protease inhibitors (PI results from mutations in the viral protease (PR that reduce PI binding but also decrease viral replicative capacity (RC. Additional mutations compensating for the RC loss subsequently accumulate within PR and in Gag substrate cleavage sites. We examined the respective contribution of mutations in PR and Gag to PI resistance and RC and their interdependence using a panel of HIV-1 molecular clones carrying different sequences from six patients who had failed multiple lines of treatment. Mutations in Gag strongly and directly contributed to PI resistance besides compensating for fitness loss. This effect was essentially carried by the C-terminal region of Gag (containing NC-SP2-p6 with little or no contribution from MA, CA, and SP1. The effect of Gag on resistance depended on the presence of cleavage site mutations A431V or I437V in NC-SP2-p6 and correlated with processing of the NC/SP2 cleavage site. By contrast, reverting the A431V or I437V mutation in these highly evolved sequences had little effect on RC. Mutations in the NC-SP2-p6 region of Gag can be dually selected as compensatory and as direct PI resistance mutations, with cleavage at the NC-SP2 site behaving as a rate-limiting step in PI resistance. Further compensatory mutations render viral RC independent of the A431V or I437V mutations while their effect on resistance persists.

  19. Radiation protection at reactors RA and RB

    International Nuclear Information System (INIS)

    Ninkovic, M.

    2003-02-01

    Radiation protection activities at the RA and RB reactors are imposed by the existing legal regulations and international recommendations in this field. This annual report contains five parts which cover the following topics: Radiation safety, dosimetry control and technical radiation protection at reactors RA and RB; Handling of radioactive waste, actions and decontamination; Control of the environment (surroundings of RA and RB reactors) and meteorological measurements; Control of internal contamination and internal exposure; Health control od personnel exposed to radiation. Personnel as well as financial data are part of this report

  20. SF Treg cells transcribing high levels of Bcl-2 and microRNA-21 demonstrate limited apoptosis in RA

    NARCIS (Netherlands)

    van der Geest, Kornelis S. M.; Smigielska, Katarzyna; Park, Ji-Ah; Abdulahad, Wayel H.; Kim, Hye-Won; Kroesen, Bart-Jan; van den Berg, Anke; Boots, Annemieke M. H.; Lee, Eun-Bong; Brouwer, Elisabeth

    Objective. The aim of this study was to investigate the turnover of Treg cells in the SF of RA patients. Methods. Treg cells were enumerated in peripheral blood and SF of RA patients and analysed by flow cytometry for expression of the proliferation marker Ki-67 and binding of the apoptosis marker

  1. Reproduction of the RA reactor fuel element fabrication; Reprodukcija izrade gorivnog elementa za reaktor RA

    Energy Technology Data Exchange (ETDEWEB)

    Novakovic, M [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1961-12-15

    This document includes the following nine reports: Final report on task 08/12 - testing the Ra reactor fuel element; design concept for fabrication of RA reactor fuel element; investigation of the microstructure of the Ra reactor fuel element; Final report on task 08/13 producing binary alloys with Al, Mo, Zr, Nb and B additions; fabrication of U-Al alloy; final report on tasks 08/14 and 08/16; final report on task 08/32 diffusion bond between the fuel and the cladding of the Ra reactor fuel element; Final report on task 08/33, fabrication of the RA reactor fuel element cladding; and final report on task 08/36, diffusion of solid state metals. Ovaj rad sadrzi devet priloga: 1. Zavrsni izvestaj o podzadatku 08/12, ispitivanje elementa goriva reaktora RA; 2. Koncepcija izrade gorivnog elementa reaktora RA; 3. Ispitivanje mikrostrukture gorivnog elementa reaktora RA; 4. Zavrsni izvestaj o podzadatku 08/13, dobijanje binarnih legura urana sa legirajucim komponentama Al, Mo, Zr, Nb i B; 5. Dobijanje legure U-Al; 6. Zavrsni izvestaj o podzadacima 08/14 i 08/16; 7. Zavrsni izvestaj o podzadatku 08/32, difuziona veza goriva i kosuljice gorivnog elementa reaktora RA; 8. Zavrsni izvestaj o podzadatku 08/33, izrada kosuljice gorivnog elementa reaktora RA; 9. Zavrsni izvestaj o podzadatku 08/36, difuzija kod metala u cvrstom stanju.

  2. The decay scheme of 229Ra

    International Nuclear Information System (INIS)

    Yang, W.F.; Yuan, S.G.; Fang, K.M.; Shen, S.F.; Mou, W.T.; Zhang, X.Q.; Li, Z.Q.

    1997-01-01

    By bombarding the natural thorium targets with 14 MeV neutrons, 229 Ra was produced through the reaction 232 Th(n,α) 229 Ra. The radium activities were separated from the irradiated targets by coprecipitation with the BaCl 2 . A total of 18 new weak γ rays with energies of 14.5, 15.6, 18.8, 21.8, 22.5, 44.0, 47.5, 55.0, 63.0, 69.6, 93.6, 94.1, 98.5, 102.2, 104.5, 106.1, 161.1, and 171.5 keV which could be assigned to the decay of 229 Ra were observed in the isolated radium fractions employing high resolution HPGe detectors and γ(X)-γ coincidence methods. A decay scheme of 229 Ra based on these observations is proposed. (orig.). With 2 figs

  3. Understanding Rheumatoid Arthritis (RA): Treatment and Causes

    Science.gov (United States)

    ... this page please turn JavaScript on. Feature: Understanding Rheumatoid Arthritis (RA) Treatment and Causes Past Issues / Summer 2014 Table of Contents How Is Rheumatoid Arthritis Treated? Doctors have many ways to treat this ...

  4. RA Construction KC, LLC Information Sheet

    Science.gov (United States)

    RA Construction KC, LLC (the Company) is located in Gladstone, Missouri. The settlement involves renovation activities conducted at a property constructed prior to 1978, located in Kansas City, Missouri.

  5. RA Research nuclear reactor Part 1, RA Reactor operation and maintenance in 1987; Istrazivacki nuklearni reaktor RA Deo 1 - Pogon i odrzavanje nuklearnog reaktora RA u 1987. godini

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O; Martinc, R; Cupac, S; Sulem, B; Badrljica, R; Majstorovic, D; Sanovic, V [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1987-12-15

    RA research reacto was not operated due to the prohibition issued in 1984 by the Government of Serbia. Three major tasks were finished in order to fulfill the licensing regulations about safety of nuclear facilities which is the condition for obtaining permanent operation licence. These projects involved construction of the emergency cooling system, reconstruction of the existing special ventilation system, and renewal of the system for electric power supply of the reactor systems. Renewal of the RA reactor instrumentation system was initiated. Design project was done by the Russian Atomenergoeksport, and is foreseen to be completed by the end of 1988. The RA reactor safety report was finished in 1987. This annual report includes 8 annexes concerning reactor operation, activities of services and financial issues, and three special annexes: report on testing the emergency cooling system, report on renewal of the RA reactor and design specifications for reactor renewal and reconstruction. [Serbo-Croat] Reaktor RA nije radio usled zabrane Izvsnog veca Skupstine Srbije od 27. avgusta 1984. U cilju povecanja pouzdanosti rada reaktora a da bi se udovoljilo zakonskim propisima sto je uslov za dobijanje stalne dozvole za rad realizovana su tri velika zahvata na reaktoru RA. Ovi zahvati obuhvatili su izgradnju sistema za hladjenje jezgra reaktora u slucaju nuzde, rekonstukciju postojeceg sistema specijalne ventilacije i rekonstrukciju sistema napajanja elektricnom energijom neophodnih potrosaca reaktora RA. Zapoceti su radovi na modernizaciji intrumentacije reaktora RA, projekat je izradjen u sovjetskoj organizaciji Atomenergoeksport, a trebalo bi da se realizuje do kraja 1989. godine. U cilju povecanja prostora za skladistenje ozracenog nuklearnog goriva i njegovog efikasnijeg koriscenja, izradjen je su projekti za rekonstrukciju postojecih uredjaja za rukovanje gorivom, povecanje smestajnog kapaciteta i preciscavanje vode u bazenima za odlezavanje. Realizaija ovih

  6. Determination of sup 226 Ra and sup 228 Ra in gypsum

    Energy Technology Data Exchange (ETDEWEB)

    Godoy, J M [Instituto de Radioprotecao e Dosimetria, Rio de Janeiro, RJ (Brazil)

    1989-01-01

    The content of {sup 226}Ra and {sup 228}Ra in different samples of phosphogypsum and three samples of gypsite were determined by gamma spectroscopy. For {sup 226}Ra the 295, 352 and 609 KeV lines and for {sup 228}Ra the 911 and 969 KeV lines were used. The specific activities values ranged from 0.36 to 22.8 pCi/g for {sup 226}Ra and 0.90 to 10.3 pCi/g for {sup 228}Ra. The contribution of a sypsum roof-covering to the {sup 222}Rn concentration in a room was estimated, based on the highest value reported. (author).

  7. Distribution and flux of 226Ra and 228Ra in the Amazon River estuary

    International Nuclear Information System (INIS)

    Key, R.M.; Sarmiento, J.L.; Stallard, R.F.; Moore, W.S.

    1985-01-01

    Measurements of 226 Ra and 228 Ra in the Amazon River estuary show that desorption from riverborne suspended particulate matter in the estuary increases the riverine flux of both isotopes to the ocean by a factor of approximately 5 over the flux attributable to radium dissolved in the river water alone. The total Amazon flux supplies approximately 0.20% of the 226 Ra and approximately 2.6% of the 228 Ra standing crops in the near-surface Atlantic (0-200 m). Diffusive flux from estuarine and shelf sediments and desorption from resuspended sediments in the region of the estuary approximately double the estuarine 226 Ra concentration and quadruple the estuarine 228 Ra concentration above that caused by the dissolved and desorbed river components alone

  8. Brief history of /sup 224/Ra usage in radiotherapy and radiobiology

    Energy Technology Data Exchange (ETDEWEB)

    Schales, F [Gesellschaft fuer Strahlen- und Umweltforschung m.b.H., Neuherberg (Germany, F.R.)

    1978-07-01

    Attempts were made a short time after its discovery to introduce /sup 224/Ra in therapy. Besides its external application in dermatology the treatment of rheumatic diseases seemed to be promising. From 1944-1952 about 2000 patients, most of them with tuberculosis or ankylosing spondylitis were treated in a German hospital with repeated intravenous injections of Peteosthor, a combination containing /sup 224/Ra with traces of platinum and eosin, totalling about 4000 ..mu..Ci/sup 224/Ra. Different lesions were observed which were suspected to be due to irradiation. The treatment has nevertheless continued. A group of 1500 additional patients, exclusively adults, has received rather low amounts (250-300 ..mu..Ci) of /sup 224/Ra and are now under study. Based on linear hypothetical dose-effect relationships in this group an osteosarcoma incidence of 3-5 per 1000 patients could be expected during the first 20 years following average skeletal doses of 56 rad. In experiments started in 1965 in Neuherberg, Germany, the acute and late effects of /sup 224/Ra and /sup 227/Th in rats and mice are investigated. Similar experiments are under way in Czechoslovakia. In Salt Lake City, Utah, in connection with studies on boneseeking radioisotopes using dogs, a pilot study on /sup 224/Ra was started in 1963. Together with studies of Ra and Th toxicity a mock dial paint containing /sup 224/Ra and /sup 234/Th was developed. As /sup 224/Ra is a /sup 232/Th decay product, it might play a certain role in the Thorotrast problem.

  9. RA Research reactor, Annual report 1988; Istrazivacki nuklearni reaktor RA - Izvestaj za 1988. godinu

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1988-12-15

    Annual report concerning the project 'RA research nuclear reactor' for 1989, financed by the Serbian ministry of science is divided into two parts. First part is concerned with RA reactor operation and maintenance, which is the task of the Division for reactor engineering of the Institute for multidisciplinary studies and RA reactor engineering. Second part deals with radiation protection activities at the RA reactor which is the responsibility of the Institute for radiation protection. Scientific council of the Institute for multidisciplinary studies and RA reactor engineering has stated that this report describes adequately the activity and tasks fulfilled at the RA reactor in 1989. The scope and the quality of the work done were considered successful both concerning the maintenance and reconstruction, as well as radiation protection activities. [Serbo-Croat] Godisnji izvestaj po projektu 'Istrazivacki nuklearni reaktor RA' za 1989. godinu, koji finansira republicka zajednica za nauku SR Srbije po ugovoru br. 3705/1 sastoji se iz dva dela. Prvi deo obuhvata pogon i odrzavanje nuklearnog reaktora RA, sto predstavlja obavezu Odeljenja za reaktorski inzenjering u sastavu OOUR Instituta za multidisciplinarna istrazivanja i inzenjering RA. Drugi deo obuhvata poslove zastite od zracenja na reaktoru RA, sto predstavlja obavezu OOUR Instituta za zastitu od zracenja 'Zastita'. Naucno vece Instituta za multidisciplinarna istrazivanja i inzenjering RA ocenilo je da sadrzina ovog izvestaja odgovara izvrsenim poslovima na reaktoru RA u 1989. godini. Pozitivno se ocenjuje obim i kvalitet izvrsenih radova kako u pogledu odrzavanja i rekonstrukcije reaktora, tako i u pogledu poslova zastite od zracenja izvrsenih kod njega.

  10. Research nuclear reactor RA - Annual Report 1989; Istrazivacki nuklearni reaktor RA - Izvestaj za 1989. godinu

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1989-12-15

    Annual report concerning the project 'RA research nuclear reactor' for 1989, financed by the Serbian ministry of science is divided into two parts. First part is concerned with RA reactor operation and maintenance, which is the task of the Division for reactor engineering of the Institute for multidisciplinary studies and RA reactor engineering. Second part deals with radiation protection activities at the RA reactor which is the responsibility of the Institute for radiation protection. Scientific council of the Institute for multidisciplinary studies and RA reactor engineering has stated that this report describes adequately the activity and tasks fulfilled at the RA reactor in 1989. The scope and the quality of the work done were considered successful both concerning the maintenance and reconstruction, as well as radiation protection activities. [Serbo-Croat] Godisnji izvestaj po projektu 'Istrazivacki nuklearni reaktor RA' za 1989. godinu, koji finansira republicka zajednica za nauku SR Srbije po ugovoru br. 3705/1 sastoji se iz dva dela. Prvi deo obuhvata pogon i odrzavanje nuklearnog reaktora RA, sto predstavlja obavezu Odeljenja za reaktorski inzenjering u sastavu OOUR Instituta za multidisciplinarna istrazivanja i inzenjering RA. Drugi deo obuhvata poslove zastite od zracenja na reaktoru RA, sto predstavlja obavezu OOUR Instituta za zastitu od zracenja 'Zastita'. Naucno vece Instituta za multidisciplinarna istrazivanja i inzenjering RA ocenilo je da sadrzina ovog izvestaja odgovara izvrsenim poslovima na reaktoru RA u 1989. godini. Pozitivno se ocenjuje obim i kvalitet izvrsenih radova kako u pogledu odrzavanja i rekonstrukcije reaktora, tako i u pogledu poslova zastite od zracenja izvrsenih kod njega.

  11. Radiochemical determination and separation or total radium, 226Ra and 224Ra

    International Nuclear Information System (INIS)

    Suarez, J. A.; Gonzalez, J. A.; Pablo, M. A. de

    1987-01-01

    Radiochemical purification and separation of radium has been carried out and the determination of total radium solubilized in aqueous samples has been studied assuming that all the alpha emitters of the sample have their origin in the 226Ra and elements of its desintegration chain. Also, the activities of 22Ra and 226 Ra have been evaluated separately doing a measurement after the chemical separation of the radium and another one 10 days after. (Author) 9 refs

  12. Ba(Ra)SO4 species flotation for decontamination of Ra(II) residual solution

    International Nuclear Information System (INIS)

    Stoica, Ligia; Catuneanu, Rodica; Filip, Gheorghe

    1993-01-01

    The paper presents the results of the research performed on Ra(II) separation from complex composition solutions in a HCO 3 - /CO 3 2- buffer system by Ba(Ra)SO 4 precipitation followed by flotation. The collector selection was done by electrokinetic potential determinations. The optimum concentrations of precipitation-flocculation reagents were established on the basis of the experimental data obtained for synthetic solutions having the same Ra(II) activity, namely 20 pCi/l. (authors)

  13. Cost-effectiveness analysis of dolutegravir plus backbone compared with raltegravir plus backbone, darunavir+ritonavir plus backbone and efavirenz/tenofovir/emtricitabine in treatment naïve and experienced HIV-positive patients

    Directory of Open Access Journals (Sweden)

    Restelli U

    2017-06-01

    Full Text Available Umberto Restelli,1,2 Giuliano Rizzardini,3,4 Andrea Antinori,5 Adriano Lazzarin,6 Marzia Bonfanti,1 Paolo Bonfanti,7 Davide Croce1,2 1Centre for Research on Health Economics, Social and Health Care Management, LIUC – Università Cattaneo, Castellanza, Varese, Italy; 2School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 3First and Second Divisions of Infectious Diseases, “Luigi Sacco” Hospital, Milan, Italy; 4School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 5National Institute for Infectious Diseases “L Spallanzani”, Rome, 6Department of Infectious Diseases, San Raffaele Scientific Institute, 7Department of Infectious and Tropical Diseases, A Manzoni Hospital, Lecco, Italy Background: In January 2014, the European Medicines Agency issued a marketing authorization for dolutegravir (DTG, a second-generation integrase strand transfer inhibitor for HIV treatment. The study aimed at determining the incremental cost-effectiveness ratio (ICER of the use of DTG+backbone compared with raltegravir (RAL+backbone, darunavir (DRV+ritonavir(r+backbone and efavirenz/tenofovir/emtricitabine (EFV/TDF/FTC in HIV-positive treatment-naïve patients and compared with RAL+backbone in treatment-experienced patients, from the Italian National Health Service’s point of view.Materials and methods: A published Monte Carlo Individual Simulation Model (ARAMIS-DTG model was used to perform the analysis. Patients pass through mutually exclusive health states (defined in terms of diagnosis of HIV with or without opportunistic infections [OIs] and cardiovascular disease [CVD] and successive lines of therapy. The model considers costs (2014 and quality of life per monthly cycle in a lifetime horizon. Costs and quality-adjusted life years (QALYs are dependent on OI, CVD, AIDS events, adverse events and antiretroviral therapies.Results: In

  14. Determination of 226Ra and 224Ra in drinking waters by liquid scintillation counting

    International Nuclear Information System (INIS)

    Manjon, G.; Vioque, I.; Moreno, H.; Garcia-Tenorio, R.; Garcia-Leon, M.

    1997-01-01

    A method for the determination of Ra-isotopes in water samples has been developed. Ra is coprecipitated with Ba as sulphate. The precipitate is then dissolved with EDTA and counted with a liquid scintillation system after mixing with a scintillation cocktail. The study of the temporal evolution of the separated activity gives the isotopic composition of the sample, i.e. the 224 Ra and 226 Ra contribution to the total activity. The method has been applied to some Spanish drinking waters. (author)

  15. Dative experiencer predicates in Hungarian

    NARCIS (Netherlands)

    Rákosi, G.

    2006-01-01

    Dative experiencer predicates in Hungarian investigates the argument structure and the syntax of appeal to- and important-type predicates in Hungarian. Couched in terms of Reinhart’s (2000, 2002) Theta System, the thesis presents arguments for the need to resort to the lexicon in setting up

  16. Assessment of 226Ra, 228Ra and 40K contents in the Egyptian bottled natural water

    International Nuclear Information System (INIS)

    El-Afifi, E.M.; Hilal, M.A.; Khalifa, S.M.; Aly, H.F.

    2004-01-01

    The activity concentrations of 2 26Ra, 2 28Ra and 4 0 and k in different brands of the bottled egyptian natural water of different origins obtained from four regions, have been analyzed nondestructively by gamma- ray spectrometry. The study covers nine brands of natural water commonly used mainly for drinking in egypt. The results showed, concentrations up to 184, 156 and 1700 mBq I - 1 for 2 26Ra, 2 28Ra and 4 0K, respectively, in one brand of the natural water from water from Siwa oasis. Whereas, lower activity concentrations of 2 26Ra and 2 28Ra were found in one brand of these natural waters from El sadat region. The activity concentration of 4 0K was found to be in the background range in the brands from El sadat, kafr El arbein and beilbeis regions. The committed effective doses reached 1.9 x 10 - 2 m Sy Y - 1 for ingestion of 2 26Ra and 2 28Ra for one liter per day, respectively, which are lower than the standard permissible limit by the WHO and IAEA. However, it is recommended to moderate drinking of bottled natural water to avoid the accumulation effect of radioactive nuclides especially radium

  17. Techniques for precise mapping of 226Ra and 228Ra in the ocean

    International Nuclear Information System (INIS)

    Moore, W.S.; Key, R.M.; Sarmiento, J.L.

    1985-01-01

    Improvements in the analyses of 226 Ra and 228 Ra in seawater made possible by better extraction and processing techniques reduce significantly the errors associated with these measurements. These improvements and the extensive sampling for Ra isotopes conducted on the TTO North Atlantic Study should enable us to use the distribution of 228 Ra to study mixing processes on a 3-15 year time scale in both the upper and deep North Atlantic. The 228 Ra profiles already analyzed show a closer resemblance to GEOSECS tritium data than to TTO tritium data in the upper ocean. This is because the transient tracer tritium was responding on a 10-year time scale during GEOSECS and a 20-year time scale during TTO. The steady state tracer 228 Ra should always respond on a time scale of 8 years. Thus the 228 Ra data obtained on TTO should provide a means to extend the features of the GEOSECS tritium field to the regions of the TTO study. The 226 Ra data are of high enough quality to identify features associated with different water masses. Changes in the positions of the deep-water masses since the GEOSECS cruise are revealed by the 226 Radata

  18. Use of nuclear recoil for separating 228Ra, 224Ra, and 233Pa from colloidal thorium

    International Nuclear Information System (INIS)

    Beydon, J.; Gratot, I.

    1968-01-01

    By using α-recoil it is possible to separate by dialysis the α disintegration products (224 Ra; 228 Ra) of thorium from colloidal thorium hydroxide.The use of n, γ recoil allows the separation of 233 Pa produced by the neutron irradiation of thorium, on condition that the colloidal thorium hydroxide is irradiated in the presence of a dispersing. (author) [fr

  19. IL-1Ra (recombinant human IL-1 receptor antagonist in the treatment of rheumatoid arthritis: the efficacy

    Directory of Open Access Journals (Sweden)

    L. Cozzi

    2011-09-01

    Full Text Available Interleukin 1 receptor antagonist (IL-1Ra is a naturally occurring IL-1 inhibitor, acting as a “receptor antagonist”, which blocks IL-1 mediated signal transduction. In 1990 IL-1Ra was cloned and later on, a large numbers of studies led to disclosure of the crucial importance of the imbalance between IL-1 and IL-1Ra in the pathogenesis of rheumatoid arthritis (RA. In 1991, almost 8 years after the initial isolation of IL-1, recombinant IL-1Ra (IL-1ra, Kineret was introduced in clinical trials involving patients with RA. Between 2001 and 2002 IL-1ra was approved by the US Food and Drug Administration and by the European Agency for the Evaluation of the Medicinal Products and in 2003 it was registered in Italy, too. In RA recombinant IL-1ra has been evaluated in 5 randomized, placebo-controlled clinical trials involving more than 2900 patients. Two of the trials involved the use of IL-1ra as monotherapy versus placebo and two trials in combination with methotrexate (MTX; the last trial explored the use of a fixed 100 mg/day IL-1ra dosage in a RA patient population including a wide array of co-morbid conditions as well as concomitant medications. The studies confirmed both the efficacy and the safety of IL-1ra in patients with active and severe RA. 43% of patients receiving 150 mg/day IL-1ra achieved a 20% response according to the American College of Rheumatology criteria (ACR20, compared to 27% in the placebo group. In the MTX combination therapy study, 42% of the patients receiving 1 mg/Kg/day of IL-1ra achieved an ACR20, 24% an ACR50 and 10% an ACR70. In each study, significant improvements in the Health Assessment Questionnaire scores (HAQ were observed. There were rapid gains in the number of days at work or domestic activity in the treated patients, and the increases in productivity were dose related. At early 24 weeks, there was significant reduction of both the score for progression of joint space narrowing (JSN and the Total modified

  20. Discrimination and abuse experienced by general internists in Canada.

    Science.gov (United States)

    Cook, D J; Griffith, L E; Cohen, M; Guyatt, G H; O'Brien, B

    1995-10-01

    To identify the frequency of psychological and emotional abuse, gender discrimination, verbal sexual harassment, physical sexual harassment, physical assault, and homophobia experienced by general internists. Cross-sectional survey. Canadian general internal medicine practices. The overall response rate was 70.6% (984/1,393); the 501 respondents who classified themselves as general internists were studied. Three-fourths of the internists experienced psychological and emotional abuse at the hands of patients, and 38% of the women and 26% of the men experienced physical assault by patients. The majority of the female internists experienced gender discrimination by patients (67%) and by physician peers (56%). Forty-five percent of the women experienced verbal sexual harassment by patients, and 22% experienced physical sexual harassment by patients. The male internists experienced verbal sexual harassment from nurses slightly more often than the female internists did (19% vs 13%, p > 0.05). Verbal sexual harassment by male colleagues was reported by 35% of the female internists, and physical sexual harassment was reported by 11%. Approximately 40% of general internists reported homophobic remarks by both health care team members and patients. Abuse, discrimination, and homophobia are prevalent in the internal medicine workplace. A direct, progressive, multidisciplinary approach is necessary to label and address these problems.

  1. A new determination method of 226Ra, 224Ra, and 228Th in water

    International Nuclear Information System (INIS)

    Horiuchi, Kimiko; Murakami, Yukio.

    1981-01-01

    A new method for the determination of 226 Ra, 224 Ra and 228 Th in water samples is described. It consists of extraction of 222 Rn and 220 Rn into a scintillator-toluene solution in equilibrium with 226 Ra and 224 Ra and the application of integral counting techniques with a liquid scintillation counter. One liter water sample, weakly acidified with hydrochloric acid, is transferred to a glass bottle, and vigorously bubbled with a stream of nitrogen to expel any radon or thoron in the water sample. Twenty five ml of the scintillator-toluene solution is added to the bottle (time is recorded). The bottle is stoppered with a Teflon stopper and kept at an upside-down position for a given period of time (usually 4 -- 16 days) to allow radon and thoron in partial equilibrium with their parent nuclides. Then, the sample system is vigorously shaken for 2 m and the organic layer is gently transferred to a counting vial through a specially devised transferring tube which is connected to the bottle. The initial counting time is set at 4 h after the separation of organic layer. The measurements are repeated 3 times each immediately and after 106 h from the initial counting time. From these results, the integral counting rates of radon and thoron at the initial counting time are easily obtained. The activities of 226 Ra, 224 Ra and 228 Th in the water sample are calculated from these integral counting rates by the proposed formulas. Some data on the 226 Ra and 224 Ra contents of mineral springs are presented. The lowest detection limits for 226 Ra and 224 Ra were 1.10 x 10 -12 and 1.47 x 10 -9 Ci, respectively. The present method is rapid, easy and accurate and eliminates a time-consuming sealing of the sample in Curie bottle and tedious procedure to transfer the sample gas through a vacuum system to the detector. (author)

  2. A Dual Key-Based Activation Scheme for Secure LoRaWAN

    Directory of Open Access Journals (Sweden)

    Jaehyu Kim

    2017-01-01

    Full Text Available With the advent of the Internet of Things (IoT era, we are experiencing rapid technological progress. Billions of devices are connected to each other, and our homes, cities, hospitals, and schools are getting smarter and smarter. However, to realize the IoT, several challenging issues such as connecting resource-constrained devices to the Internet must be resolved. Recently introduced Low Power Wide Area Network (LPWAN technologies have been devised to resolve this issue. Among many LPWAN candidates, the Long Range (LoRa is one of the most promising technologies. The Long Range Wide Area Network (LoRaWAN is a communication protocol for LoRa that provides basic security mechanisms. However, some security loopholes exist in LoRaWAN’s key update and session key generation. In this paper, we propose a dual key-based activation scheme for LoRaWAN. It resolves the problem of key updates not being fully supported. In addition, our scheme facilitates each layer in generating its own session key directly, which ensures the independence of all layers. Real-world experimental results compared with the original scheme show that the proposed scheme is totally feasible in terms of delay and battery consumption.

  3. Research nuclear reactor RA, Annual Report 2001

    International Nuclear Information System (INIS)

    Sotic, O.

    2002-01-01

    During 2001, activities at the RA research nuclear reactor in were performed according to the Contract about financing of the RA reactor for the period January-December 2001, signed by the Ministry of Science, technology and development of the Republic of Serbia. RA reactor was not operated since shutdown in August 1984. Although, the most of the planned reconstruction activities were finished until 1991, the most important, which was concerned with exchange of the reactor instrumentation, financed by the IAEA, was interrupted due to international sanctions imposed on the country. Since 1992, all the renewal and reconstruction activities were ceased. Continuous aging and degradation of the equipment and facilities demand decision making about the future status of the Ra reactor. Until this decision is made it is an obligation to maintain control and maintenance of ventilation system, power supply, internal transportation system, spent fuel storage, hot cells, electronic fuel surveillance system, and part of the stationary dosimetry system. In 2001, apart from the mentioned activities, actions were undertaken related to maintenance of the reactor building and installations. The most important tasks fulfilled were: protection of the roof of the ventilation system building, purchase and installing the fire protection system and twelve new battery cells in the reactor building. There were no actions concerned with improvement of the conditions for intermediate spent fuel storage. With the support of IAEA, actions were initiated for possible transport of the spent fuel tu Russia. At the end of 2001, preparations were started for possible future decommissioning of the RA reactor. After, renewal of the membership of our country in the IAEA, the Government of Yugoslavia has declared its attitude about the intention of RA reactor decommissioning at the General Conference in September 2001 [sr

  4. Measurements of neutron flux in the RA reactor

    International Nuclear Information System (INIS)

    Raisic, N.

    1961-12-01

    This report includes the following separate parts: Thermal neutron flux in the experimental channels od RA reactor; Epithermal neutron flux in the experimental channels od RA reactor; Fast neutron flux in the experimental channels od RA reactor; Thermal neutron flux in the thermal column and biological experimental channel; Neutronic measurements in the RA reactor cell; Temperature reactivity coefficient of the RA reactor; design of the device for measuring the activity of wire [sr

  5. The Impact of Quality Assurance Initiatives and Workplace Policies and Procedures on HIV/AIDS-Related Stigma Experienced by Patients and Nurses in Regions with High Prevalence of HIV/AIDS.

    Science.gov (United States)

    Hewko, Sarah J; Cummings, Greta G; Pietrosanu, Matthew; Edwards, Nancy

    2018-02-23

    Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-assessed individual nurse practices, to nurse-reported HIV/AIDS-stigma practices toward patients living with HIV/AIDS and nurses in health care settings. Our sample of survey respondents (n = 1157) included managers (n = 392) and registered/enrolled nurses (n = 765) from 29 facilities in 4 countries (South Africa, Uganda, Jamaica, Kenya). This is one of the first studies in LMIC countries to use hierarchical linear modeling to examine the contributions of organizational and individual factors to HIV/AIDS stigma. Based on our results, we argue that organizational interventions explicitly targeting HIV/AIDS stigma are required to reduce the incidence, prevalence and morbidity of HIV/AIDS.

  6. RA-0 reactor. New neutronic calculations

    International Nuclear Information System (INIS)

    Rumis, D.; Leszczynski, F.

    1990-01-01

    An updating of the neutronic calculations performed at the RA-0 reactor, located at the Natural, Physical and Exact Sciences Faculty of Cordoba National University, are herein described. The techniques used for the calculation of a reactor like the RA-0 allows prediction in detail of the flux behaviour in the core's interior and in the reflector, which will be helpful for experiments design. In particular, the use of WIMSD4 code to make calculations on the reactor implies a novelty in the possible applications of this code to solve the problems that arise in practice. (Author) [es

  7. ICMPv6 RA Flooding Vulnerability Research

    Directory of Open Access Journals (Sweden)

    Linas Jočys

    2016-06-01

    Full Text Available ICMPv6 is the newest version of internet control message protocol, whose main purpose is to send error message indicating packet processing failure. It is know that ICMPv6 is technologically vulnerable. One of those vulnerabilities is the ICMPv6 RA flooding vulnerability, which can lead to systems in Local Area Network slow down or full stop. This paper will discuss Windows (XP, 7, 8.1 and Linux Ubuntu 14 operating systems resistance to RA flooding attack research and countermeasures to minimize this vulnerability.

  8. Ethical Conflicts Experienced by Medical Students

    Directory of Open Access Journals (Sweden)

    Márcia Mendes Menezes

    Full Text Available ABSTRACT The current study aimed to identify and analyze the prevalence of ethical conflicts experienced by medical students. This study is a cross-sectional and analytical research that was conducted in a public school in the state of Minas Gerais, Brazil. The instrument used for the data collection was a self-administered questionnaire. The data collected were presented in absolute and percentage values. For the analytical statistical treatment of the data, the level of significance was considered p <0.05. The outcome variables were: Experiences of ethical conflicts in interpersonal relations within the medical course and Ethical conduct in health care. The identification of the prevalence of ethical conflicts in the undergraduate program adopted the perspective of different interpersonal relations (academic-teaching, academic-academic, academic-employee, academic-patient, teacher-teacher, teacher-patient, teacher-employee and employee-patient. (Importance of identifying themselves to the health services user and requesting consent to perform the physical examination, assistance without the supervision of the teacher, issuance of health documents without the signature of the professional responsible and use of social networks to share data Of patient. It was verified the association of the outcome variables with sex, year of graduation and course evaluation. A total of 281 undergraduate students enrolled in all undergraduate courses in Medicine of both sexes, with a predominance of female (52.7%. The students reported having experienced conflicting situations in interpersonal relations with teachers (59.6%, provided assistance without proper supervision of a teacher (62.6%, reported having issued health documents without the accompaniment of teachers (18, 5%. The highest frequency was observed among those enrolled in the most advanced years of the undergraduate program (p <0.05. The use of social networks for the purpose of sharing patient

  9. Cost-effectiveness of elbasvir/grazoprevir use in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and chronic kidney disease in the United States.

    Science.gov (United States)

    Elbasha, E; Greaves, W; Roth, D; Nwankwo, C

    2017-04-01

    Among patients with chronic kidney disease (CKD) in the United States, HCV infection causes significant morbidity and mortality and results in substantial healthcare costs. A once-daily oral regimen of elbasvir/grazoprevir (EBR/GZR) for 12 weeks was found to be a safe and efficacious treatment for HCV in patients with CKD. We evaluated the cost-effectiveness of EBR/GZR in treatment-naïve and treatment-experienced CKD patients compared with no treatment (NoTx) and pegylated interferon plus ribavirin (peg-IFN/RBV) using a computer-based model of the natural history of chronic HCV genotype 1 infection, CKD and liver disease. Data on baseline characteristics of the simulated patients were obtained from NHANES, 2000-2010. Model inputs were estimated from published studies. Cost of treatment with EBR/GZR and peg-INF/RBV were based on wholesale acquisition cost. All costs were from a third-party payer perspective and were expressed in 2015 U.S. dollars. We estimated lifetime incidence of liver-related complications, liver transplantation, kidney transplantation, end-stage live disease mortality and end-stage renal disease mortality; lifetime quality-adjusted life years (QALY); and incremental cost-utility ratios (ICUR). The model predicted that EBR/GZR will significantly reduce the incidence of liver-related complications and prolong life in patients with chronic HCV genotype 1 infection and CKD compared with NoTx or use of peg-IFN/RBV. EBR/GZR-based regimens resulted in higher average remaining QALYs and higher costs (11.5716, $191 242) compared with NoTx (8.9199, $156 236) or peg-INF/RBV (10.2857, $186 701). Peg-IFN/RBV is not cost-effective, and the ICUR of EBR/GZR compared with NoTx was $13 200/QALY. Treatment of a patient on haemodialysis with EBR/GZR resulted in a higher ICUR ($217 000/QALY). Assuming a threshold of $100 000 per QALY gained for cost-effectiveness, use of elbasvir/grazoprevir to treat an average patient with CKD can be considered cost

  10. Determination of 226 Ra and 228 Ra in mineral spring waters of the Aguas da Prata region

    International Nuclear Information System (INIS)

    Oliveira, J. de.

    1993-01-01

    Concentration levels of 226 Ra and 228 Ra have been analysed in most of the mineral spring waters available in the Aguas da Prata region. The 226 Ra and 228 Ra were determined by coprecipitation with barium sulphate. The 226 Ra was determined by gross alpha counting of the Ba(Ra)SO 4 precipitate. The determination of 228 Ra was done by measuring the gross beta activity of the same precipitate. Both measurements were carried out in a low background gas flow proportional counter. Dose calculations were performed in order to evaluate the relative importance of such radionuclides to the radiation exposure due to the ingestion of these waters. Based upon measured concentrations, committed effective doses up to 5.5 x 10 -1 mSv/y and 1.0 x 10 -2 mSv/y were observed for 226 Ra and 228 Ra, respectively. These results show that 226 Ra is the main contributor to radiation exposure. (author)

  11. A Fair Adaptive Data Rate Algorithm for LoRaWAN

    OpenAIRE

    Abdelfadeel, Khaled Q.; Cionca, Victor; Pesch, Dirk

    2018-01-01

    LoRaWAN exhibits several characteristics that can lead to an unfair distribution of the Data Extracted Rate (DER) among nodes. Firstly, the capture effect leads to a strong signal suppressing a weaker signal at the gateway and secondly, the spreading codes used are not perfectly orthogonal, causing packet loss if an interfering signal is strong enough. In these conditions, nodes experiencing higher attenuation are less likely to see their packets received correctly. We develop FADR, a Fair Ad...

  12. Fine structures in 14C emission of 223Ra and 224Ra

    International Nuclear Information System (INIS)

    Hourani, E.; Rosier, L.; Berrier-Ronsin, G.; Elayi, A.; Mueller, A.C.; Rappenecker, G.; Rotbard, G.; Renou, G.; Liebe, A.; Stab, L.

    1991-01-01

    The measurement of the energy spectrum of 14 C nuclei emitted in the spontaneous radioactivity from 223 Ra and 224 Ra has been carried out, using thin and intense sources (480 MBq for 223 Ra and 3550 MBq for 224 Ra). The sources were obtained by implanting mass-separated beams from ISOLDE (CERN) into Al and vitreous C catchers. The measurement was performed with the supraconducting solenoidal spectrometer SOLENO installed at Orsay. The discovery, of a fine structure in the energy spectrum of 14 C emission from 223 Ra, which is analogous to the one known for α emission, is confirmed. Only 13% of the branching ratio in 14 C decay leads to the ground state of the residual nucleus, while 8l% to the first excited state. For 14 C emission of 224 Ra, a lower limit of 2 for the hindrance factor has been measured for the transition to the first excited state in the residual nucleus. Also, a precise identification in Z with a E·ΔE telescope has been performed for the radiation from the 223 Ra source. (author) 22 refs., 11 figs., 1 tab

  13. Especial Skills in Experienced Archers.

    Science.gov (United States)

    Nabavinik, Mahdi; Abaszadeh, Ali; Mehranmanesh, Mehrab; Rosenbaum, David A

    2017-09-05

    Especial skills are skills that are distinctive by virtue of massive practice within the narrow contexts in which they are expressed. In the first demonstration of especial skills, Keetch, Schmidt, Lee, and Young (2005) showed that experienced basketball players are better at shooting baskets from the foul line, where they had massive amounts of practice, than would expected from their success at other locations closer to or farther from the basket. Similar results were obtained for baseball throwing. The authors asked whether especial skills hold in archery, a sport requiring less movement. If the emergence of especial skills depends on large-scale movement, one would expect archery to escape so-called especialism. But if the emergence of especial skills reflects a more general tendency for highly specific learning, experienced archers should show especial skills. The authors obtained evidence consistent with the latter prediction. The expert archers did much better at their most highly practiced distance than would be expected by looking at the overall function relating shooting score to distance. We offer a mathematical model to account for this result. The findings attest to the generality of the especial skills phenomenon.

  14. Ethical problems experienced by oncology nurses.

    Science.gov (United States)

    da Luz, Kely Regina; Vargas, Mara Ambrosina de Oliveira; Schmidtt, Pablo Henrique; Barlem, Edison Luiz Devos; Tomaschewski-Barlem, Jamila Geri; da Rosa, Luciana Martins

    2015-01-01

    To know the ethical problems experienced by oncology nurses. Descriptive and exploratory study with a qualitative approach, performed in inpatient units and in chemotherapy out-patients units that provide assistance to oncological patients in two capitals in the South region of Brazil. Eighteen nurses participated in this study, selected by snowball sampling type. For data collection, semi-structured interviews were carried out, which were recorded and transcribed, and then analyzed by thematic analysis. Two categories were established: when informing or not becomes a dilemma - showing the main difficulties related to oncological treatment information regarding health staff, health system, and infrastructure; to invest or not - dilemmas related to finitude - showing situations of dilemmas related to pain and confrontation with finitude. For the effective confrontation of the ethical problems experienced by oncology nurses to occur, it is important to invest in the training of these professionals, preparing them in an ethical and human way to act as lawyers of the patient with cancer, in a context of dilemmas related mainly to the possibility of finitude.

  15. Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database

    DEFF Research Database (Denmark)

    Sokka, T; Kautiainen, H; Pincus, T

    2009-01-01

    OBJECTIVE: To analyse associations between the clinical status of patients with rheumatoid arthritis (RA) and the gross domestic product (GDP) of their resident country. METHODS: The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical....... CONCLUSIONS: The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in "low GDP" than...

  16. Developing a Construct to Evaluate Flares in Rheumatoid Arthritis: A Conceptual Report of the OMERACT RA Flare Definition Working Group

    DEFF Research Database (Denmark)

    Alten, Rieke; Choy, Ernest H; Christensen, Robin

    2011-01-01

    Rheumatoid arthritis (RA) patients and healthcare professionals (HCP) recognize that episodic worsening disease activity, often described as a "flare," is a common feature of RA that can contribute to impaired function and disability. However, there is no standard definition to enable measurement...... of its intensity and impact. The conceptual framework of the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Definition Working Group includes an anchoring statement, developed at OMERACT 9 in 2008: "flare in RA" is defined as worsening of signs and symptoms of sufficient intensity....... The conceptual framework of flare takes into account validated approaches to measurement in RA: (1) various disease activity indices (e.g., Disease Activity Score, Clinical Disease Activity Index, Simplified Disease Activity Index); (2) use of patient-reported outcomes (PRO); and (3) characterization...

  17. RA research reactor - properties and experimental capabilities

    International Nuclear Information System (INIS)

    Milosevic, M.; Martinc, R.

    1978-01-01

    The brief survey of the Reactor RA exploitation experience, as well as the reactor equipment state, after 18 years of operation is presented. The results of efforts spent on reactor characteristics improvement in order to ensure safe and reliable reactor operation for next 15-20 years, are described [sr

  18. Waste Management During RA Reactor Decommissioning

    International Nuclear Information System (INIS)

    Markovic, M.; Avramovic, I.

    2008-01-01

    The objective of radioactive waste management during the RA reactor decommissioning is to deal with radioactive waste in a manner that protects human health and the environment now and in the future. The estimation of waste quantities to be expected during decommissioning is a very important step in the initial planning. (author)

  19. Chôra : Creation and Pathology

    DEFF Research Database (Denmark)

    Isar, Nicoletta

    2009-01-01

    Plato's dialogue the Timaeus describes not only the making of the cosmos (order), but also the condition of what is not order, neither for the human body nor for the universe. What is disorder in cosmogonic terms it is disease for the human body. Timaeus applies to the concept chôra in discussing...

  20. Regulations and instructions for RA reactor operation

    International Nuclear Information System (INIS)

    1989-01-01

    This regulatory guide consists of following 4 chapters: Description of the RA reactor, organization scheme, regulations for performing experiments; Regulations for staff on duty; Instructions for operating the vacuum systems, heavy water and helium systems; and evacuation in case of accident [sr

  1. Status of RA3 conversion studies

    International Nuclear Information System (INIS)

    Testoni, J.

    1983-01-01

    Studies carried out at CNEA in Argentina for the conversion of the RA3 3.5 MW reactor to LEU fuel dealt with neutronic, thermal hydraulic, safety analysis, as well as fuel manufacture. Some of the results for the neutronic studies are reported

  2. Impact of rituximab on patient-reported outcomes in patients with rheumatoid arthritis from the US Corrona Registry.

    Science.gov (United States)

    Harrold, Leslie R; John, Ani; Best, Jennie; Zlotnick, Steve; Karki, Chitra; Li, YouFu; Greenberg, Jeffrey D; Kremer, Joel M

    2017-09-01

    To evaluate the impact of rituximab on patient-reported outcomes (PROs) in a US-based observational cohort of patients with rheumatoid arthritis (RA). Patients with active RA, prior exposure to ≥1 tumor necrosis factor inhibitor (TNFi) and who newly initiated rituximab were identified. Changes in PROs were assessed 1 year after rituximab initiation. PRO measures included Clinical Disease Activity Index (CDAI); patient global disease activity, pain and fatigue (visual analog score; 0-100); morning stiffness (hours); modified Health Assessment Questionnaire (mHAQ; 0-3); and EuroQoL EQ-5D. Of the 667 patients who newly initiated rituximab, baseline PRO and clinical measures indicated that patients were substantially impacted by their RA disease and quality of life; 54% of patients had high disease activity. One year after rituximab initiation, 49.0, 47.1, 49.8, and 23.2% of patients reported clinically meaningful improvements in patient global, pain, fatigue, and mHAQ, respectively. Morning stiffness and EuroQol EQ-5D domains improved in 48 and 19-32% of patients, respectively. These real-world registry data demonstrated that patients with long-standing, refractory RA experienced improvements in PROs 1 year after initiating rituximab.

  3. Research nuclear reactor RA - Annual Report 1991

    International Nuclear Information System (INIS)

    Sotic, O.

    1992-01-01

    Activities related to revitalisation of the RA reactor stared in 1986, were continued in 1991. A number of interventions on the reactor components were finished that are supposed to enable continuous and reliable operation. The last, and at the same time largest action, related to exchange of complete reactor instrumentation is underway, but it is behind the schedule in 1991 because the delivery of components from USSR is late. Production of this instruments is financed by the IAEA according to the contract signed in December 1988 with Russian Atomenergoexport. According to this contract, it has been planned that the RA reactor instrumentation should be delivered to the Vinca Institute by the end of 1990. Only 56% of the instrumentation was delivered until September 1991. Since then any delivery of components to Yugoslavia was stopped because of the temporary embargo imposed by the IAEA. In 1991 most of the existing RA reactor instrumentation was dismantled, only the part needed for basic measurements when reactor is not operated, was maintained. Construction of some support elements is almost finished by the local staff. The Institute has undertaken this activity in order to speed up the ending of the project. If all the planned instrumentation would not arrive until the end of March 1992, it would not be possible to start the RA reactor testing operation in the first part of 1993, as previously planned. In 1991, 53 staff members took part in the activities during 1991, which is considered sufficient for maintenance and repair conditions. Research reactor RA Annual report for year 1991 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection [sr

  4. Research nuclear reactor RA - Annual Report 1994

    International Nuclear Information System (INIS)

    Sotic, O.

    1994-12-01

    Activities related to revitalisation of the RA reactor stared in 1986, were continued in 1991. A number of interventions on the reactor components were finished that are supposed to enable continuous and reliable operation. The last, and at the same time largest action, related to exchange of complete reactor instrumentation is underway, but it is behind the schedule in 1991 because the delivery of components from USSR is late. Production of this instruments is financed by the IAEA according to the contract signed in December 1988 with Russian Atomenergoexport. According to this contract, it has been planned that the RA reactor instrumentation should be delivered to the Vinca Institute by the end of 1990. Only 56% of the instrumentation was delivered until September 1991. Since then any delivery of components to Yugoslavia was stopped because of the temporary embargo imposed by the IAEA. In 1991 most of the existing RA reactor instrumentation was dismantled, only the part needed for basic measurements when reactor is not operated, was maintained. Activities related to improvement of Russian project were continued in 1994. Control and maintenance of the reactor components was done regularly and efficiently. Extensive repair of the secondary coolant loop is almost finished and will be completed in the first part of 1995 according to existing legal procedures and IAEA recommendations. Fuel inspection by the IAEA safeguards inspectors was done on a monthly basis. There have been on the average 47 employees at the RA reactor which is considered sufficient for maintenance and repair conditions. Research reactor RA Annual report for year 1991 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection [sr

  5. Therapy palliative with 223Ra without special radiation protection measures?

    International Nuclear Information System (INIS)

    Just, Guenther; Petzold, Juergen

    2015-01-01

    For nearly 2 years now as a therapy of the castration resistant prostata carcinoma a nuclide therapy with 223 Ra-Dichloride (trade-mark Xofigo) is applied. Xofigo is applied by a medical specialist for nuclear medicine altogether 6 times in a monthly distance. The activity used in each case is according to the body weight (50 kBq/kg BW). This therapy is licensed by the supervisory authorities of the German federal countries as an ambulant therapy. Special radiation protection measures are only required when exceeding a given number of 17 patients per year as incorparation measurements.

  6. Experiencing Security in Interaction Design

    DEFF Research Database (Denmark)

    Mathiasen, Niels Raabjerg; Bødker, Susanne

    2011-01-01

    Security is experienced differently in different contexts. This paper argues that in everyday situations, users base their security decisions on a mix of prior experiences. When approaching security and interaction design from an experience approach, tools that help bring out such relevant...... experiences for design are needed. This paper reports on how Prompted exploration workshops and Acting out security were developed to target such experiences when iteratively designing a mobile digital signature solution in a participatory design process. We discuss how these tools helped the design process...... and illustrate how the tangibility of such tools matters. We further demonstrate how the approach grants access to non-trivial insights into people's security experience. We point out how the specific context is essential for exploring the space between experience and expectations, and we illustrate how people...

  7. Interoceptive awareness in experienced meditators.

    Science.gov (United States)

    Khalsa, Sahib S; Rudrauf, David; Damasio, Antonio R; Davidson, Richard J; Lutz, Antoine; Tranel, Daniel

    2008-07-01

    Attention to internal body sensations is practiced in most meditation traditions. Many traditions state that this practice results in increased awareness of internal body sensations, but scientific studies evaluating this claim are lacking. We predicted that experienced meditators would display performance superior to that of nonmeditators on heartbeat detection, a standard noninvasive measure of resting interoceptive awareness. We compared two groups of meditators (Tibetan Buddhist and Kundalini) to an age- and body mass index-matched group of nonmeditators. Contrary to our prediction, we found no evidence that meditators were superior to nonmeditators in the heartbeat detection task, across several sessions and respiratory modulation conditions. Compared to nonmeditators, however, meditators consistently rated their interoceptive performance as superior and the difficulty of the task as easier. These results provide evidence against the notion that practicing attention to internal body sensations, a core feature of meditation, enhances the ability to sense the heartbeat at rest.

  8. Customer-experienced rapid prototyping

    Science.gov (United States)

    Zhang, Lijuan; Zhang, Fu; Li, Anbo

    2008-12-01

    In order to describe accurately and comprehend quickly the perfect GIS requirements, this article will integrate the ideas of QFD (Quality Function Deployment) and UML (Unified Modeling Language), and analyze the deficiency of prototype development model, and will propose the idea of the Customer-Experienced Rapid Prototyping (CE-RP) and describe in detail the process and framework of the CE-RP, from the angle of the characteristics of Modern-GIS. The CE-RP is mainly composed of Customer Tool-Sets (CTS), Developer Tool-Sets (DTS) and Barrier-Free Semantic Interpreter (BF-SI) and performed by two roles of customer and developer. The main purpose of the CE-RP is to produce the unified and authorized requirements data models between customer and software developer.

  9. VALUE OF RHEUMATIC PATIENTS' AWARENESS OF HAVING INFECTIOUS COMORBIDITIES

    Directory of Open Access Journals (Sweden)

    Rimma Mikhailovna Balabanova

    2010-01-01

    Results. The patients with RD frequently reported to have nasopharyngeal infection. The latter was accompanied by an exacerbation of articular syndrome in more than half of the patients with RD. The rate of pneumonias experienced by patients with systemic lupus erythematosus (SLE (10/55 engages our attention. Urogenital tract infections (mainly cystitis and pyelonephritis are more typical of patients with rheumatic arthritis (RA and those with osteoarthrosis (OA, respectively. The clinical manifestations of herpes simplex virus type 1 (HSV-1 recurred most frequently in patients with SLE and those with OA and less in patients with RA. The percentage of HSV-1 recurrences was high in the medical staff. Conclusion. The findings suggest that it is necessary to thoroughly collect medical history data especially in patients who need aggressive immunosuppressive therapy as activation of latent infection makes management of these patients difficult

  10. Distinct kinetics in the frequency of peripheral CD4+ T cells in patients with ulcerative colitis experiencing a flare during treatment with mesalazine or with a herbal preparation of myrrh, chamomile, and coffee charcoal.

    Directory of Open Access Journals (Sweden)

    Jost Langhorst

    increase was seen (CD4+CD25med pre-flare/flare p = 0.0461; CD4+CD25high baseline/flare p = 0.0269 and pre-flare/flare p = 0.0032. In contrast, no changes in the expression of Foxp3 cells were detected within the subsets of CD4+CD25high regulatory T cells. Of note, no alterations were detected in the suppressive capability of CD4+CD25high regulatory T cells isolated from the peripheral blood of healthy donors, from patients in remission, or from patients with clinical flare. CONCLUSIONS: In patients with UC experiencing acute flare, the CD4+ T compartment demonstrates a distinctly different pattern during treatment with myrrh, chamomile extract, and coffee charcoal than during treatment with mesalazine. These findings suggest an active repopulation of regulatory T cells during active disease. TRIAL REGISTRATION: EU Clinical Trials Register 2007-007928-18/DE.

  11. RA Research nuclear reactor Part 1, RA Reactor operation and maintenance in 1987

    International Nuclear Information System (INIS)

    Sotic, O.; Martinc, R.; Cupac, S.; Sulem, B.; Badrljica, R.; Majstorovic, D.; Sanovic, V.

    1987-01-01

    RA research reacto was not operated due to the prohibition issued in 1984 by the Government of Serbia. Three major tasks were finished in order to fulfill the licensing regulations about safety of nuclear facilities which is the condition for obtaining permanent operation licence. These projects involved construction of the emergency cooling system, reconstruction of the existing special ventilation system, and renewal of the system for electric power supply of the reactor systems. Renewal of the RA reactor instrumentation system was initiated. Design project was done by the Russian Atomenergoeksport, and is foreseen to be completed by the end of 1988. The RA reactor safety report was finished in 1987. This annual report includes 8 annexes concerning reactor operation, activities of services and financial issues, and three special annexes: report on testing the emergency cooling system, report on renewal of the RA reactor and design specifications for reactor renewal and reconstruction [sr

  12. Measurements of neutron flux in the RA reactor; Merenje karakteristika neutronskog fluksa u reaktoru RA

    Energy Technology Data Exchange (ETDEWEB)

    Raisic, N [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1961-12-15

    This report includes results of the following measurements performed at the RA reactor: thermal neutron flux in the experimental channels, epithermal and fast neutron flux, neutron flux in the biological shield, neutron flux distribution in the reactor cell.

  13. Randomized Phase III Trial of Trastuzumab Plus Capecitabine With or Without Pertuzumab in Patients With Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer Who Experienced Disease Progression During or After Trastuzumab-Based Therapy.

    Science.gov (United States)

    Urruticoechea, Ander; Rizwanullah, Mohammed; Im, Seock-Ah; Ruiz, Antonio Carlos Sánchez; Láng, István; Tomasello, Gianluca; Douthwaite, Hannah; Badovinac Crnjevic, Tanja; Heeson, Sarah; Eng-Wong, Jennifer; Muñoz, Montserrat

    2017-09-10

    Purpose To assess the efficacy and safety of trastuzumab plus capecitabine with or without pertuzumab in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer who experienced disease progression during or after trastuzumab-based therapy and received a prior taxane. Patients and Methods Patients were randomly assigned to arm A: trastuzumab 8 mg/kg → 6 mg/kg once every 3 weeks plus capecitabine 1,250 mg/m 2 twice a day (2 weeks on, 1 week off, every 3 weeks); or arm B: pertuzumab 840 mg → 420 mg once every 3 weeks plus trastuzumab at the same dose and schedule as arm A plus capecitabine 1,000 mg/m 2 on the same schedule as arm A. The primary end point was independent review facility-assessed progression-free survival (IRF PFS). Secondary end points included overall survival (OS) and safety. Hierarchical testing procedures were used to control type I error for statistical testing of IRF PFS, OS, and objective response rate. Results Randomly assigned (intent-to-treat) populations were 224 and 228 patients in arms A and B, respectively. Median IRF PFS at 28.6 and 25.3 months' median follow-up was 9.0 v 11.1 months (hazard ratio, 0.82; 95% CI, 0.65 to 1.02; P = .0731) and interim OS was 28.1 v 36.1 months (hazard ratio, 0.68; 95% CI, 0.51 to 0.90). The most common adverse events (all grades; incidence of ≥ 10% in either arm and ≥ 5% difference between arms) were hand-foot syndrome, nausea, and neutropenia in arm A, and diarrhea, rash, and nasopharyngitis in arm B. Conclusion The addition of pertuzumab to trastuzumab and capecitabine did not significantly improve IRF PFS. An 8-month increase in median OS to 36.1 months with pertuzumab was observed. Statistical significance for OS cannot be claimed because of the hierarchical testing of OS after the primary PFS end point; however, the magnitude of OS difference is in keeping with prior experience of pertuzumab in metastatic breast cancer. No new safety signals were identified.

  14. 228Ra and 226Ra measurement on a BaSO4 co-precipitation source

    International Nuclear Information System (INIS)

    Medley, Peter; Martin, Paul; Bollhöfer, Andreas; Parry, David

    2015-01-01

    One of the most commonly-used methods for determination of 226 Ra, particularly in water samples, utilises co-precipitation of Ra with BaSO 4 , followed by microfiltration to produce a source for alpha counting. This paper describes two extensions to BaSO 4 co-precipitation methods which enable determination of 228 Ra using the same source. The adaptations presented here do not introduce any contaminants that will affect the separation of radium or alpha counting for 226 Ra, and can be used for re-analysis of already existing sources prepared by BaSO 4 co-precipitation. The first adaptation uses detection of 228 Ac on the source by gamma spectrometry. The detection efficiency is high, allowing analysis of water samples at sufficiently low activity to be suitable in testing for compliance with drinking water quality standards. As 228 Ac grows in quickly, taking less than 2 days to reach equilibrium with the 228 Ra parent, this can also be useful in radiological emergency response situations. The second adaptation incorporates a method for the digestion of BaSO 4 sources, allowing separation of thorium and subsequent determination of 228 Th activity. Although ingrowth periods for 228 Th can be lengthy, very low detection limits for 228 Ra can be achieved with this technique. - Highlights: • We developed two methods for 228 Ra measurement on Ba(Ra)SO 4 co-precipitation sources. • Measurement by gamma spectrometry using the daughter 228 Ac is rapid. • Detection limits are suitable for assessment of drinking water quality. • The second approach uses alpha spectrometry on a separated Th fraction. • This is more sensitive than gamma spectrometry after an ingrowth period greater than about 1 month

  15. Radiation protection at the RA Reactor in 1998, RA reactor annual report, Part -2

    International Nuclear Information System (INIS)

    Ninkovic, M.; Pavlovic, R.; Mandic, M.; Pavlovic, S.; Grsic, Z.

    1998-01-01

    Radiation protection tasks which enable safe operation of the RA reactor, and are defined according the the legal regulations and IAEA safety recommendations are sorted into four categories in this report: (1) Control of the working environment, dosimetry at the RA reactor; (2) Radioactivity control in the vicinity of the reactor and meteorology measurements; (3) Collecting and treatment of fluid effluents; and (4) radioactive wastes, decontamination and actions. Each of the category is described as a separate annex of this report [sr

  16. RA Research nuclear reactor, Part II: radiation protection at the RA reactor in 1987

    International Nuclear Information System (INIS)

    Ninkovic, M.; Ajdacic, N.; Zaric, M.; Vukovic, Z.

    1987-01-01

    Radiation protection tasks which enable safe operation of the RA reactor, and are defined according the the legal regulations and IAEA safety recommendations are sorted into four categories in this report: (1) Control of the working environment, dosimetry at the RA reactor and radiation protection; (2) Radioactivity control in the vicinity of the reactor and meteorology measurements; (3) Decontamination and relevant actions, collecting and treatment of fluid effluents; and and solid radioactive wastes [sr

  17. Radiation protection at the RA Reactor in 1988, Part -2, RA reactor annual report

    International Nuclear Information System (INIS)

    Ninkovic, M.; Ajdacic, N.; Zaric, M.; Vukovic, Z.

    1988-01-01

    Radiation protection tasks which enable safe operation of the RA reactor, and are defined according the the legal regulations and IAEA safety recommendations are sorted into four categories in this report: (1) Control of the working environment, dosimetry at the RA reactor and radiation protection; (2) Radioactivity control in the vicinity of the reactor and meteorology measurements; (3) Decontamination and relevant actions, collecting and treatment of fluid effluents; and and solid radioactive wastes [sr

  18. Problems experienced by people with arthritis when using a computer.

    Science.gov (United States)

    Baker, Nancy A; Rogers, Joan C; Rubinstein, Elaine N; Allaire, Saralynn H; Wasko, Mary Chester

    2009-05-15

    To describe the prevalence of computer use problems experienced by a sample of people with arthritis, and to determine differences in the magnitude of these problems among people with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). Subjects were recruited from the Arthritis Network Disease Registry and asked to complete a survey, the Computer Problems Survey, which was developed for this study. Descriptive statistics were calculated for the total sample and the 3 diagnostic subgroups. Ordinal regressions were used to determine differences between the diagnostic subgroups with respect to each equipment item while controlling for confounding demographic variables. A total of 359 respondents completed a survey. Of the 315 respondents who reported using a computer, 84% reported a problem with computer use attributed to their underlying disorder, and approximately 77% reported some discomfort related to computer use. Equipment items most likely to account for problems and discomfort were the chair, keyboard, mouse, and monitor. Of the 3 subgroups, significantly more respondents with FM reported more severe discomfort, more problems, and greater limitations related to computer use than those with RA or OA for all 4 equipment items. Computer use is significantly affected by arthritis. This could limit the ability of a person with arthritis to participate in work and home activities. Further study is warranted to delineate disease-related limitations and develop interventions to reduce them.

  19. Simultaneous determination of Ra-226, Ra-228 and Pb-210 using a successive coprecipitations techniques

    International Nuclear Information System (INIS)

    Vilhena Schayer Sabino, C. de; Kastner, S.M.S.; Amaral, A.M.

    1990-01-01

    Several techniques for determination of Ra-226, Ra228 and Pb-210. were developed and used in routine at CDTN in the laboratories of radiochemistry. The matrixes were: water and industrial wastes. Some problems of these techniques were the time spent for analyses and chemical separations, interferents, among others. Now-a-days the method in routine developed here is the one of successive coprecipitations, followed α and β countings of the Ra-226 and Ra-228 daughters. This method is based on coprecipitation, purification of barium radium sulfate with EDTA in acetic solution. Lead is dissolved, radium remains precipitated and suffers a new purification and the time for growing of their daughters is waited to be performed the simultaneous α and β countings for Ra-226 and Ra-228 determination. Pb-210 is analyzed in the floating of the first purification with a carrier of bismuth, and the time for Bi-210 growing is waited. Then it is precipitated as hydroxid, purified as phosphate and the β counting of Bi-210 is done. (author) [pt

  20. 226Ra, 228Ra and 40K in scales formed in boilers of industrial installations

    International Nuclear Information System (INIS)

    Poggi, Claudia M. Braga; Farias, Emerson Emiliano G. de; Hazin, Clovis A.; Gazineu, Maria Helena P.; Universidade Catolica de Pernambuco

    2011-01-01

    Many industrial processes involve the production of steam in boilers, which is sent through pipes to machines and other equipment used in different sectors of the installations. The water commonly used in these processes is groundwater, which generally has high concentrations of calcium and magnesium salts, that can co-precipitate with naturally occurring radioactive elements such as 226 Ra and 228 Ra creating radioactive scales, which are deposited in pipes, thus decreasing the efficiency of steam production. In addition, 40 K that is present in all soils and rocks with a concentration of about 0.012% of natural potassium can also be concentrated in these scales. No data was found in literature relating to radionuclides present in the scales formed on boilers in general. In this context, the purpose of this work was to determine concentrations of 226 Ra, 228 Ra and 40 K, in scales generated inside boilers from different industries in the cities of Caruaru, Paulista and Goiana, Pernambuco. Determination of the radionuclides concentration was performed by gamma spectrometry with an HPGe detector, calculating their specific activities. Activity concentrations of 226 Ra were in the range of -1 and 228 Ra activity concentrations varied from 1 . Activity concentrations of 40 K were in the range of -1 . All these activity concentrations were lower than the limits established by the Brazilian Nuclear Energy Commission of for this type of matrix. (author)

  1. A study on applying Ra needle interstitial brachytherapy for oral cancer

    International Nuclear Information System (INIS)

    Yoshida, Shunichi; Komiya, Yoshiaki; Uchida, Ikuhiro; Tashiro, Kazuyoshi

    1999-01-01

    To investigate applicability of Ra needle interstitial brachytherapy, 93 cases of oral squamous carcinoma were examined. The patients underwent Ra needle interstitial brachytherapy as thorough therapy in our hospital. The criteria of applying Ra needle interstitial brachytherapy was diameter of within 5 cm and depth within 2 cm of tumor size. Ra needle interstitial brachytherapy was applied to 82 cases of tongue, 10 cases of oral floor and one case of lower lip carcinomas. The local control rate was 92.5%, and secondary neck metastasis was 32.3% in all cases applied Ra needle interstitial brachytherapy. The results were not bad compared with surgical treatment. However, the 5-year cumulative survival rate was 64.9%, which was not good enough at the result to obtain a good local control rate and secondary neck metastasis rate. The result was relative to low treatment result of local recurrence cases with Ra needle interstitial brachytherapy. To improve the result, it is important to distinguish local recurrence from radioinduced ulcer, and to start early secondary treatment. The cases in which cervical lymph node metastasis was found as the first examination underwent neck dessection after Ra needle interstitial brachytherapy. The 5-year cumulative survival rate was 83.3% in N1 cases and 40.6% in N2 cases, and the result of N2 cases was poorer than N1 cases with a significant difference. The results indicate that a needle having a diameter of within 5 cm, depth of within 2 cm and less than N1 can be applied during Ra needle interstitial brachytherapy for complete cure of cancer. (author)

  2. Intravenous injection of Ra-224 as a treatment in Morbus Paget

    International Nuclear Information System (INIS)

    Koch, W.

    1976-01-01

    Between 1956 and 1973, 21 patients with histologically verified Morbus Paget were treated at the author's hospital with low dosage 224 Ra. In none of these patients an immediate or late impairment of the hematogenic or parenchymal organs was observed. (MG) [de

  3. Factors affecting {sup 223}Ra therapy: clinical experience after 532 cycles from a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Etchebehere, Elba C. [The University of Texas MD Anderson Cancer Center, Department of Nuclear Medicine, Houston, TX (United States); Campinas State University (Unicamp), Department of Nuclear Medicine, Campinas (Brazil); Milton, Denai R. [The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX (United States); Araujo, John C. [The University of Texas MD Anderson Cancer Center, Department of Genitourinary Medical Oncology, Houston, TX (United States); Swanston, Nancy M.; Macapinlac, Homer A.; Rohren, Eric M. [The University of Texas MD Anderson Cancer Center, Department of Nuclear Medicine, Houston, TX (United States)

    2016-01-15

    The aim of this study was to identify baseline features that predict outcome in {sup 223}Ra therapy. We retrospectively reviewed 110 patients with metastatic castration-resistant prostate cancer treated with {sup 223}Ra. End points were overall survival (OS), progression-free survival (PFS), bone event-free survival (BeFS), and bone marrow failure (BMF). The following parameters were evaluated prior to the first {sup 223}Ra cycle: serum levels of hemoglobin (Hb), prostate-specific antigen (PSA), alkaline phosphatase (ALP), Eastern Cooperative Oncology Group (ECOG) status, pain score, use of chemotherapy, and external beam radiation therapy (EBRT). During/after {sup 223}Ra we evaluated: the total number of radium cycles (Ra{sub Tot}), the PSA doubling time (PSA{sub DT}), and the use of chemotherapy, EBRT, abiraterone, and enzalutamide. A significant reduction of ALP (p < 0.001) and pain score (p = 0.041) occurred throughout the {sup 223} Ra cycles. The risk of progression was associated with declining ECOG status [hazard ratio (HR) = 3.79; p < 0.001] and decrease in PSA{sub DT} (HR = 8.22; p < 0.001). Ra{sub Tot}, ALP, initial ECOG status, initial pain score, and use of abiraterone were associated with OS (p ≤ 0.008), PFS (p ≤ 0.003), and BeFS (p ≤ 0.020). Ra{sub Tot}, ALP, initial ECOG status, and initial pain score were significantly associated with BMF (p ≤ 0.001) as well as Hb (p < 0.001) and EBRT (p = 0.009). On multivariable analysis, only Ra{sub Tot} and abiraterone remained significantly associated with OS (p < 0.001; p = 0.033, respectively), PFS (p < 0.001; p = 0.041, respectively), and BeFS (p < 0.001; p = 0.019, respectively). Additionally, Ra{sub Tot} (p = 0.027) and EBRT (p = 0.013) remained significantly associated with BMF. Concomitant use of abiraterone and {sup 223}Ra seems to have a beneficial effect, while the EBRT may increase the risk of BMF. (orig.)

  4. Preparation of 227Ac by neutron irradiation of 226Ra

    International Nuclear Information System (INIS)

    Kukleva, E.; Kozempel, J.; Vlk, M.; Micolova, P.; Vopalka, D.

    2015-01-01

    Radium-223 is prospective alpha-emitting therapeutic radionuclide for targeted radionuclide therapy. Although 223 Ra is formed naturally by the decay of 235 U, for practical reasons its preparation involves neutron irradiation of 226 Ra. The α-decay of the 227 Ra (T 12 = 43 min.) produced via 226 Ra(n,γ) 227 Ra reaction leads to 227 Ac, a mother nuclide of 227 Th and 223 Ra subsequently. Irradiation target radium material is generally available in multi-gram quantities from historical stock. Main aim of this study was to experimentally and theoretically evaluate and verify available literature data on production of 223 Ra. According to data obtained from γ-spectra, the approximate yield values were determined and effective cross-section for the 223 Ra production was calculated. (authors)

  5. Skeletal dosimetry of injected 226RA in young adult beagles

    International Nuclear Information System (INIS)

    Lloyd, R.D.; Mays, C.W.; Atherton, D.R.

    1986-01-01

    Revised equations are presented for the skeletal dose to young adult beagles from 226 Ra injection. For 0.1 kg of skel/kg body and given 1 μCi 226 Ra/kg with 210 Pb/ 226 Ra = 0.05, the average skeletal dose in rad at 6 yr is 226 Ra = 1200, 222 Rn -> 214 Po = 1050, injected 210 Pb = 56 and 210 Pb from Rn decay in bone = 22. For a Pb/Ra ratio = 0.4, dose from injected 210 Pb is about 20% of that from 226 Ra -> 214 Po. A similar but not numerically indentical relationship obtains for ingested 226 Ra, so the dose from 210 Pb should be included in any study of 226 Ra effects. (orig.)

  6. Etanercept overcomes P-glycoprotein-induced drug resistance in lymphocytes of patients with intractable rheumatoid arthritis.

    Science.gov (United States)

    Tsujimura, Shizuyo; Saito, Kazuyoshi; Nakayamada, Shingo; Tanaka, Yoshiya

    2010-04-01

    P-glycoprotein (P-gp) on activated lymphocytes is an adenosine triphosphate (ATP)-binding cassette transporter that causes drug resistance by exclusion of intracellular drugs in patients with active rheumatoid arthritis (RA). However, infliximab with methotrexate (MTX) can overcome P-gp-mediated drug resistance. We encounter patients who cannot continue infliximab or MTX. Here we tested how etanercept affected P-gp-mediated drug resistance in such intractable RA patients. Peripheral lymphocytes of 11 RA patients (3 switched from infliximab and 8 who could not be treated with MTX) were analyzed for P-gp expression by flow cytometry and for drug exclusion using radioisotope-labeled dexamethasone. Activated lymphocytes of RA patients overexpressed P-gp and coexpressed CD69. Incubation of these lymphocytes with dexamethasone in vitro reduced intracellular dexamethasone levels. Two-week etanercept therapy significantly reduced P-gp expression and eliminated such P-gp- and CD69-high-expressing subgroup. The reduction in P-gp resulted in recovery of intracellular dexamethasone levels in lymphocytes and improvement of disease activity, thus allowing tapering of corticosteroids. None of the patients experienced any severe adverse effects. Etanercept is useful for overcoming P-gp-mediated treatment resistance in intractable RA patients who have to discontinue infliximab or are intolerant to MTX.

  7. 226Ra and 228Ra in ground water of the Cambrian-Ordovician Aquifer System in northern Illinois

    International Nuclear Information System (INIS)

    Gilkeson, R.H.; Holtzman, R.B.

    1982-01-01

    Over a large region of Illinois, ground water of the Cambrian-Ordovician Aquifer System exceeds the US EPA drinking water standard of 5 pCi/L for the combined concentration of 226 Ra and 228 Ra. 226 Ra concentrations range from 226 Ra is the geochemistry of uranium in the ground-water flow system, while the 228 Ra activity in ground water which ranges from 232 Th-bearing minerals in the aquifer strata. The comparison of recent analyses to historical data gathered over the last 20 years indicates that, with few exceptions, 226 Ra and 228 Ra activities in ground water have remained constant. The combined concentrations of the two nuclides in ground water of the aquifer system ranged from 226 Ra concentrations were high (greater than or equal to 10 pCi/L), those of 228 Ra were low (less than or equal to 2 pCi/L), but, with few exceptions, in regions where 228 Ra concentrations were high, those of 226 Ra were also high. The range of values raises questions concerning the validity of the US EPA regulation which requires analysis for 228 Ra only when the concentration of 226 Ra exceeds 3.0 pCi/L

  8. Experiencing sexuality after intestinal stoma

    Directory of Open Access Journals (Sweden)

    Maria Angela Boccara de Paula

    2012-06-01

    Full Text Available OBJECTIVE: Identify the Social Representations (SR of ostomized people in terms of sexuality after the stoma. METHODS: An exploratory, descriptive, qualitative study using the Social Representation Theory with 15 ostomized people (8 females, mean age of 57.9 years, between August and September 2005. Data obtained from transcribed interviews were submitted to content analysis, resulting in the thematic unit "Giving new meaning to sexuality" and subthemes. RESULTS: The study demonstrated that the intestinal stoma interferes in the sexuality experience, showing that the meanings attributed to this experience are based on individual life stories, quality of personal relationships established in practice and perception of sexuality, despite the stoma. CONCLUSIONS: The Social Representations, in terms of experiencing sexuality after the stoma, are based on meanings attributed to the body, associated with daily life and present in the social imaginary. It is influenced by other factors, such as physiological changes resulting from the surgery and the fact of having or not a partner. Care taken during sexual practices provide greater security and comfort in moments of intimacy, resembling the closest to what ostomized people experienced before the stoma. The self-irrigation technique associated or not with the use of artificial occluder, has been attested by its users as a positive element that makes a difference in sexual practice after the stoma. The support to ostomized people should be comprehensive, not limited to technical care and disease, which are important, but not sufficient. The interdisciplinary health team should consider all aspects of the person, seeking a real meeting between subjects.OBJETIVO: Identificar as Representações Sociais (RS da pessoa estomizada intestinal sobre vivência da sexualidade após confecção do estoma. MÉTODOS: Estudo exploratório, descritivo, qualitativo do ponto de vista do referencial da Representa

  9. Determination of 226Ra by alpha spectrometry of liquid scintillation

    International Nuclear Information System (INIS)

    Nobrega, A.W.; Sachett, I.A.; Hespanhol, E.C.B.

    1987-01-01

    The determination of 226 Ra in environmental samples using alpha spectrometry in liquid scintilation is studied. The Radon 1-2 emanation method and 226 Ra separation process of other radionuclides alpha emissors are analyzed. The use of 226 Ra coprecipitation with barium sulphate is evaluated. (M.J.C.) [pt

  10. Drug immunogenicity in patients with inflammatory arthritis and secondary failure to tumour necrosis factor inhibitor therapies: the REASON study.

    Science.gov (United States)

    Balsa, Alejandro; Sanmarti, Raimon; Rosas, José; Martin, Victor; Cabez, Ana; Gómez, Susana; Montoro, María

    2018-04-01

    The aims were to evaluate the prevalence of anti-drug antibodies (ADA) in patients with RA or SpA experiencing secondary failure to anti-TNF therapy and to correlate ADA presence with anti-TNF concentration and clinical response. This was a cross-sectional, observational study of patients with active RA or SpA experiencing secondary failure to etanercept (ETN), infliximab (INF) or adalimumab (ADL). Concomitant non-biologic DMARDs were permitted. Serum anti-TNF and ADA levels were measured with two-site ELISA. Among 570 evaluable patients, those with RA (n = 276) were mostly female (80 vs 39%), older (56 vs 48 years), received concomitant DMARDs (83 vs 47%) and had maintained good clinical disease control for longer (202 vs 170 weeks) compared with patients with SpA (n = 294). ADA were found in 114/570 (20.0%) patients; 51/188 (27.1%) against INF and 63/217 (29.0%) against ADL; none against ETN. Of these 114 patients, 92 (81%) had no detectable serum drug concentrations. Proportionately more patients with SpA (31.3%) had anti-INF antibodies than those with RA (21.1%; P = 0.014). A significantly lower proportion of patients receiving concomitant DMARDs (16.5%) developed ADA than those on monotherapy (26.4%; P reasons for secondary treatment failure, but not the only one. Further investigations are needed to determine other causes of anti-TNF failure.

  11. Research nuclear reactor RA - Annual Report 1997; Istrazivacki nuklearni reaktor RA - Izvestaj za 1997. godinu

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O [Vinca Institute of Nuclear Sciences, Beograd (Serbia and Montenegro)

    1997-12-01

    RA reactor is not in operation since 1984, activities related to revitalisation of the RA reactor started in 1986. The planned actions related to renewal of the reactor components were finished except for the most important action, related to exchange of complete reactor instrumentation which was delayed. Only 80% of the instrumentation was delivered until September 1991. Since then any delivery of components to Yugoslavia was stopped because of the sanctions imposed to our country. The existing RA reactor instrumentation was dismantled. Control and maintenance of the reactor components was done regularly and efficiently. Fuel inspection by the IAEA safeguards inspectors was done on a monthly basis. There have been on the average 42 employees at the RA reactor which is considered sufficient for maintenance and repair conditions. The problem of financing the reactor activities and maintenance remains unsolved. Research reactor RA Annual report for year 1997 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection. [Serbo-Croat] Reaktor RA nije u pogonu od 1984, aktivnosti na revitalizaciji, rekostrukciji i modernizaciji reaktorski sistema zapocete su 1986. godine. Okoncan je niz zahvata na opremi postrojenja kojima ce se u narednom periodu omoguciti kontinualan i pouzdan rad ovog reaktora. Poslednji, i ujedno najveci zahvat, koji se odnosi na zamenu celokupne instrumentacije kasni zbog zastoja u isporuci opreme koja se izradjuje u Sovjetskom savezu. Do septembra 1991. godine isporuceno svega 80% od predvidjene kolicine. Od tada je svaka isporuka obustavljena, a razlog je privremena zabrana na sve isporuke opreme za Jugoslaviju usled sankcija uvedenih od strane organizacije Ujedinjenih nacija. Demontirana je postojeca instrumentacija. Kontrola i odrzavanje celopkupne opreme postrojenja, kao i remontni radovi izvrsavani su redovno i efikasno. Kontrola goriva od strane safeguard inspektora MAAE obavljana

  12. Long-Term Outcomes in Puerto Ricans with Rheumatoid Arthritis (RA) Receiving Early Treatment with Disease-Modifying Anti-Rheumatic Drugs using the American College of Rheumatology Definition of Early RA.

    Science.gov (United States)

    Varela-Rosario, Noemí; Arroyo-Ávila, Mariangelí; Fred-Jiménez, Ruth M; Díaz-Correa, Leyda M; Pérez-Ríos, Naydi; Rodríguez, Noelia; Ríos, Grissel; Vilá, Luis M

    2017-01-01

    Early treatment of rheumatoid arthritis (RA) results in better long-term outcomes. However, the optimal therapeutic window has not been clearly established. To determine the clinical outcome of Puerto Ricans with RA receiving early treatment with conventional and/or biologic disease-modifying anti-rheumatic drugs (DMARDs) based on the American College of Rheumatology (ACR) definition of early RA. A cross-sectional study was performed in a cohort of Puerto Ricans with RA. Demographic features, clinical manifestations, disease activity, functional status, and pharmacotherapy were determined. Early treatment was defined as the initiation of DMARDs (conventional and/or biologic) in less than 6 months from the onset of symptoms attributable to RA. Patients who received early (disease duration was 14.9 years and 337 (87.0%) patients were women. One hundred and twenty one (31.3%) patients received early treatment. In the multivariate analysis adjusted for age and sex, early treatment was associated with better functional status, lower probability of joint deformities, intra-articular injections and joint replacement surgeries, and lower scores in the physician's assessments of global health, functional impairment and physical damage of patients. Using the ACR definition of early RA, this group of patients treated with DMARDs within 6 months of disease had better long-term outcomes with less physical damage and functional impairment.

  13. Migration of 226 Ra, 228 Ra, 210 Pb, U and Th from phosphogypsum

    International Nuclear Information System (INIS)

    Silva, Nivaldo Carlos da; Cipriani, Moacir; Taddei, Maria Helena T.

    2002-01-01

    The physico-chemical availability of radioactive elements ( 210 Pb, 226 Ra, 228 Ra, Th and U) in Brazilian phosphogypsum was investigated in a large scale leaching experiment carried out in lysimeters, using phosphogypsum samples (approximately 1.2 tons) from two phosphoric acid industries. Lysimeters were built using cylindrical concrete containers with 0.9 m inner diameter and 2 m depth. The bottom of the lysimeter was filled with a 10 cm layer of gravel covered with geomembrane sheet. Under this layer a pipe was designed to drain the percolated water. Three lysimeters were filled with phosphogypsum from each industry and a mixture of both. As percolated water comes exclusively from the rain, sample was collected daily when available. Samples were then pooled weekly, carefully prepared and submitted to radiochemical analysis. Radiochemical characterization of phosphogypsum and percolated water was performed by radiochemical separation followed by gross alpha and beta counting ( 226 Ra, 228 Ra and 210 Pb) and UV-Vis spectrophotometry with Arsenazo III (U and Th). This experiment was carried out from 12/01/1999 to 01/22/2001, with a precipitation of 2,732 mm. It was observed that approximately 40% (534 L) of the rain fall percolated through the lysimeter 1. The analysis of 22 samples of percolated water from lysimeter 1 showed mean radionuclides activities of 70±30 mBqL -1 , 70±50 mBqL -1 , 100±60 mBqL -1 and 110±55 mBqL -1 for U, 226 Ra, 228 Ra and 210 Pb, respectively. Thorium activities were below detection limit. (author)

  14. Dificuldades vivenciadas pela equipe multiprofissional na unidade de terapia intensiva Dificultades vividas por el grupo de atención al paciente en la unidad de tratamiento intensivo Difficulties experienced by the patient care team at the intensive care unit

    Directory of Open Access Journals (Sweden)

    Maria Abadia Leite

    2005-04-01

    debe promover discusiones y reflexionar sobre los aspectos técnico-científicos y éticos de la atención, tanto a los pacientes en estado crítico como de la familia de los pacientes, ante una mejor calidad de la atención y de las relaciones interpersonales.This interpretative case study aimed to identify the difficulties experienced by the patient care team while working at the Intensive Care Unit. Data were collected through participant observation and semistructured interviews with doctors, nurses and nurse's aides. Two major categories emerged from the data analysis: Care delivery in intensive care - "it is difficult to deal with death and inform the patient's family" and care delivery in intensive care - "the lack of material resources and the difficulty to work in a team". The difficulties are related to the contact with family members, dealing with death and the lack of material resources, and particularly with the relation between team members. Therefore, teams need to promote opportunities and discussions to reflect on the technical, scientific and ethic aspects of care for critical patients as well as family members, with a view to better care quality and interpersonal relations.

  15. Instructions for RA reactor decontamination - Annex 10; Prilog 10 - Uputstvo za dekontaminaciju Reaktora RA

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1963-12-15

    Instructions for RA reactor decontamination includes: action plan for decontamination of the heavy water system by 7% water solution of H{sub 3}PO{sub 4} + 2% CrO{sub 3} acid; description of the preparatory work including calculation of the pipes volume and installation of special pipes; detailed instructions for decontamination procedure. [Serbo-Croat] Uputstvo za dekontaminaciju Reaktora RA sadrzi: plan operacija za dekontaminaciju sistema teske vode 7% vodenim rastvorom kiseline H{sub 3}PO{sub 4} + 2% CrO{sub 3}; opis pripremnih radova ukljucujuci proracun zapremine covovoda i montiranje posebnih cevovoda; detaljno uputstvo za izvodjenje operacija pri dekontaminaciji.

  16. Radiation protection at the RA Reactor in 1993, RA research reactor, Part

    International Nuclear Information System (INIS)

    Ninkovic, M.; Pavlovic, R.; Mandic, M.; Sipka, V.; Grsic, Z.

    1993-01-01

    Radiation protection tasks which enable safe operation of the RA reactor, and are defined according the the legal regulations and IAEA safety recommendations are sorted into four categories in this report: (1) Control of the working environment, dosimetry and radiation protection at the RA reactor; (2) decontamination, collecting and treatment of fluid effluents and solid wastes; (3) Radioactivity control in the vicinity of the reactor and (4)meteorology measurements; (3). Each of the category is described as a separate annex of this report [sr

  17. Ra-226 bioaccumulation and growth indices in fish.

    Science.gov (United States)

    Shi, Xiaopei; Smith, Richard; Seymour, Colin; Mothersill, Carmel

    2017-06-01

    To determine the accumulated activity of Ra-226 in fathead minnows fed with environmentally relevant levels of Ra-226 for 5 months in water at 20 °C, and to evaluate the influence of this level of Ra-226 on the growth of fathead minnows. Fathead minnows were fed with fish food containing 10-10,000 mBq/g Ra-226 for 5 months. At the end of the experiment, the fish were sacrificed, flash frozen in liquid nitrogen and kept at -20 °C. Longitudinal sections of 40 μm thickness were cut at the middle of the fish body using a cryostat. The activity of Ra-226 in each section was determined using autoradiography with a nuclear track detector CR-39. According to the weight and the width of the fish, the activity of Ra-226 in the whole fish body could be estimated. In addition, the length and the weight of the fish were measured and the condition factor was calculated to evaluate the growth and fitness of the fish. There is a positive but non-linear relationship between the accumulated activity of Ra-226 in fish body and the concentration of Ra-226 in fish food. The highest activity of Ra-226 accumulated in fish body was found from fish fed with 10,000 mBq/g Ra-226 food. This was calculated as 256.4 ± 49.1 mBq/g, p fish fed with food containing lower concentration of Ra-226 (up to 1000 mBq/g), the bioaccumulation of Ra-226 in the body saturated. The Ra-226 concentration factor (CF) for fish was inversely proportional to the Ra-226 activity in food, and the highest CF value was 2.489, obtained from the lowest dietary Ra-226 activity (10 mBq/g). In addition, condition factors (K) of fish in all Ra-226-treated groups were significantly lower than those of the controls. The results show that the bioaccumulation of Ra-226 in fish is not simply related to the dietary Ra-226 activity, and has a saturation value when the dietary activity is low. In addition, the environmental level of Ra-226 in the fish food has a small adverse effect on the growth and fitness of fathead

  18. Research nuclear reactor RA - Annual Report 1991; Istrazivacki nuklearni reaktor RA - Izvestaj za 1991. godinu

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1992-01-01

    Activities related to revitalisation of the RA reactor stared in 1986, were continued in 1991. A number of interventions on the reactor components were finished that are supposed to enable continuous and reliable operation. The last, and at the same time largest action, related to exchange of complete reactor instrumentation is underway, but it is behind the schedule in 1991 because the delivery of components from USSR is late. Production of this instruments is financed by the IAEA according to the contract signed in December 1988 with Russian Atomenergoexport. According to this contract, it has been planned that the RA reactor instrumentation should be delivered to the Vinca Institute by the end of 1990. Only 56% of the instrumentation was delivered until September 1991. Since then any delivery of components to Yugoslavia was stopped because of the temporary embargo imposed by the IAEA. In 1991 most of the existing RA reactor instrumentation was dismantled, only the part needed for basic measurements when reactor is not operated, was maintained. Construction of some support elements is almost finished by the local staff. The Institute has undertaken this activity in order to speed up the ending of the project. If all the planned instrumentation would not arrive until the end of March 1992, it would not be possible to start the RA reactor testing operation in the first part of 1993, as previously planned. In 1991, 53 staff members took part in the activities during 1991, which is considered sufficient for maintenance and repair conditions. Research reactor RA Annual report for year 1991 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection. [Serbo-Croat] U 1991. godini nastavljeni su poslovi na revitalizaciji reaktora RA, zapocetoj 1986. godine. Okoncan je niz zahvata na opremi postrojenja kojima ce se u narednom periodu omoguciti kontinualan i pouzdan rad ovog reaktora. Poslednji, i ujedno najveci

  19. Translocator protein as an imaging marker of macrophage and stromal activation in RA pannus.

    Science.gov (United States)

    Narayan, Nehal; Owen, David; Mandhair, Harpreet; Smyth, Erica; Carlucci, Francesco; Saleem, Azeem; Gunn, Roger; Rabiner, Eugenii Ilan A; Wells, Lisa; Dakin, Stephanie; Sabokbar, Afsie; Taylor, Peter

    2018-01-04

    Positron Emission Tomography (PET) radioligands targeted to Translocator protein (TSPO), offer a highly sensitive and specific means of imaging joint inflammation in rheumatoid arthritis (RA). Through high expression of TSPO on activated macrophages, TSPO PET has been widely reported in several studies of RA as a means of imaging synovial macrophages in vivo. However, this premise does not take into account the ubiquitous expression of TSPO. This study aimed to investigate TSPO expression in major cellular constituents of RA pannus; monocytes, macrophages, fibroblast-like synoviocytes (FLS) and CD4+ T lymphocytes, to more accurately interpret TSPO PET signal from RA synovium. Methods: 3 RA patients and 3 healthy volunteers underwent PET both knees using the TSPO radioligand 11 C-PBR28. Through synovial tissue 3H-PBR28 autoradiography and immunostaining of 6 RA patients and 6 healthy volunteers, cellular expression of TSPO in synovial tissue was evaluated. TSPO mRNA expression and 3H-PBR28 radioligand binding was assessed using in vitro monocytes, macrophages, FLS and CD4+ T-lymphocytes. Results: 11 C-PBR28 PET signal was significantly higher in RA compared to healthy joints (average SUV 0.82± 0.12 compared to 0.03± 0.004 respectively, p<0.01). Further, 3H-PBR28 specific binding in synovial tissue was approximately 10-fold higher in RA compared to healthy controls. Immunofluorescence revealed TSPO expression on macrophages, FLS and CD4+ T cells. In vitro study demonstrated highest TSPO mRNA expression and 3H-PBR28 specific binding, in activated FLS, non-activated and activated 'M2' reparative macrophages, with least TSPO expression in activated and non-activated CD4+ T lymphocytes. Conclusion: This study is the first evaluation of cellular TSPO expression in synovium, finding highest TSPO expression and PBR28 binding on activated synovial FLS and M2 phenotype macrophages. TSPO targeted PET may therefore have unique sensitivity to detect FLS and macrophage

  20. Ra-226 concentrations in the Lower Weser region in the vicinity of a pollution source

    International Nuclear Information System (INIS)

    Lauer, R.

    1981-01-01

    Near Nordenham at the lower Weser Ra-containing waste water is discharged from a fertilizer factory. The measurements are restricted to Ra-analysis and the Ra in fish, sediment, and river water samples (Ra-226). (DG) [de

  1. Durable efficacy of enfuvirtide over 48 weeks in heavily treatment-experienced HIV-1-infected patients in the T-20 versus optimized background regimen only 1 and 2 clinical trials

    NARCIS (Netherlands)

    Nelson, Mark; Arastéh, Keikawus; Clotet, Bonaventura; Cooper, David A.; Henry, Keith; Katlama, Christine; Lalezari, Jacob P.; Lazzarin, Adriano; Montaner, Julio S. G.; O'Hearn, Mary; Piliero, Peter J.; Reynes, Jacques; Trottier, Benoit; Walmsley, Sharon L.; Cohen, Calvin; Eron, Joseph J.; Kuritzkes, Daniel R.; Lange, Joep; Stellbrink, Hans-Jürgen; Delfraissy, Jean-François; Buss, Neil E.; Donatacci, Lucille; Wat, Cynthia; Smiley, Lynn; Wilkinson, Martin; Valentine, Adeline; Guimaraes, Denise; DeMasi, Ralph; Chung, Jain; Salgo, Miklos P.

    2005-01-01

    The T-20 Versus Optimized Background Regimen Only (TORO) 1 and TORO 2 clinical trials are open-label, controlled, parallel-group, phase 3 studies comparing enfuvirtide plus an optimized background (OB) of antiretrovirals (n = 661) with OB alone (n = 334) in treatment-experienced HIV-1-infected

  2. Experienced and anticipated discrimination against people with schizophrenia

    Directory of Open Access Journals (Sweden)

    Milačić-Vidojević Ivona

    2011-01-01

    Full Text Available Aim of this research was to describe the nature, direction and severity of anticipated and experienced discrimination reported by people with schizophrenia. We applied interview to 50 patients with diagnosis of schizophrenia in two psychiatric hospitals in Belgrade. Discrimination was measured with discrimination and stigma scale (DISC which produce 3 subscores, positive experienced discrimination, negative experienced discrimination and anticipated discrimination. The same scale was used in cross-cultural research in 27 european countries. Results have shown that participants from Serbia do not recognize discrimination in all areas of life equally. The discrimination recognized is more frequentlly negative then positive and is associated with existentially important realms of life. Due to anticipated discrimination participants in our study prevent themselves from looking for a close relationship. Anticipated discrimination could not be predicted on the grounds of experienced, positive or negative discrimination.

  3. Design of fuel element for RA10

    International Nuclear Information System (INIS)

    Estevez, Esteban A.; Markiewicz, Mario; Gerding, Roberto

    2012-01-01

    The RA-10 reactor is an open pool multipurpose reactor. It is intended for radioisotopes production, fuel irradiation and use of neutron beam experiments. The nominal configuration core consists of 19 fuel elements (FE) and 6 in-core irradiation positions. With regard to the FE, although both conceptual design and manufacturing technology are similar to the already developed and qualified by CNEA (MTR fuel flat plate), the conditions imposed by the new reactor on FE's are more demanding that previous supplies. Here it should be mentioned the magnitude of the hydrodynamic forces acting on the FE caused by coolant flow through the core (upward) and mainly by the high coolant velocity between fuel plates (greater than 5 times than those currently in operation). Moreover, the high power density results in higher heat flux in fuel plates and greater temperature gradient. As a result of these increased demands present during irradiation, and in order to maintain a high level of reliability, it is necessary carry out some modifications in the mechanical design of the FE (with respect to the so-called ECBE design or s tandard ) . Design verification is performed through analytical and code calculations, and hydrodynamic tests on a full-scale prototype. This article describes the design of the FE for RA 10 reactor, with special emphasis on those aspects that represent innovations in the traditional design (ECBE). It also presents the functional requirements, design criteria and design limits established according to the reactor operational states (author)

  4. High-Speed RaPToRS

    Science.gov (United States)

    Henchen, Robert; Esham, Benjamin; Becker, William; Pogozelski, Edward; Padalino, Stephen; Sangster, Thomas; Glebov, Vladimir

    2008-11-01

    The High-Speed Rapid Pneumatic Transport of Radioactive Samples (HS-RaPToRS) system, designed to quickly and safely move radioactive materials, was assembled and tested at the Mercury facility of the Naval Research Laboratory (NRL) in Washington D.C. A sample, which is placed inside a four-inch-diameter carrier, is activated before being transported through a PVC tube via airflow. The carrier travels from the reaction chamber to the end station where it pneumatically brakes prior to the gate. A magnetic latch releases the gate when the carrier arrives and comes to rest. The airflow, optical carrier-monitoring devices, and end gate are controlled manually or automatically with LabView software. The installation and testing of the RaPToRS system at NRL was successfully completed with transport times of less than 3 seconds. The speed of the carrier averaged 16 m/s. Prospective facilities for similar systems include the Laboratory for Laser Energetics and the National Ignition Facility.

  5. Alpha-particle doses to human organs and tissues from internally-deposited 226Ra and 228Ra

    International Nuclear Information System (INIS)

    Keane, A.T.; Schlenker, R.A.

    1981-01-01

    Estimation of radiation doses to the soft tissues from internally-deposited 226 Ra and 228 Ra is relevant to an investigation of soft-tissue malignancies in radium-exposed persons being conducted at the Center for Human Radiobiology. Alpha-particle doses in a 50-year period following a single injection of 226 Ra or 228 Ra are presented for 31 soft tissues and organs of the adult human. The dose estimates were derived from the ICRP alkaline earth model fitted to data on retention of 226 Ra in soft tissues and bone, combined with reported ratios of 226 Ra to Ca in soft tissue and bone at natural levels and the distribution of Ca in the tissues of Reference Man (ICRP23). The median of the 31 organ and tissue doses from the α-particles of 226 Ra itself is 0.08 rad per injected μCi. An additional average dose of 0.01 rad per μCi 226 Ra daughter products produced in soft tissue or transferred from bone to soft tissue. Soft-tissue doses from α-particles of the 228 Ra decay series are about six times those from 226 Ra α-particles for equal injected activities of 228 Ra and 226 Ra, with the assumption that 228 Ra daughter products do not transfer from the organ in which they are produced. The 50-year dose to the red marrow of bone from α-particles originating in bone is 0.55 rad per μCi 226 Ra injected and 1.0 rad per μCi 228 Ra injected. For ingestion by dial painters of luminous compound containg 226 Ra or 228 Ra with a daughter-to-parent activity ratio of 0.5, the dose to the mucosal alyer of the lower large intestine from α-particles originating in the gut contents is about 0.1 rad per μCi systemic intake of 226 Ra or 228 Ra

  6. Soft-tissue effects following /sup 224/Ra injections into humans

    Energy Technology Data Exchange (ETDEWEB)

    Spiess, H; Gerspach, A [Muenchen Univ. (Germany, F.R.). Kinderklinik; Mays, C W

    1978-07-01

    Following the Second World War, repeated intravenous injections of /sup 224/Ra were given to German children and adults for the intended treatment of tuberculosis, ankylosing spondylitis and a few other diseases. We have ascertained the health status of 204 juveniles and 612 adults for whom both dosage and injection span are known. /sup 224/Ra is known as a skeletal-seeker, and has induced malignant bone sarcomas, benign exostoses, tooth breakage, and growth retardation. But because of its short 3.62-day half-life, /sup 224/Ra also decays to an appreciable extent in soft tissues, as do the injected atoms of its decay products. Evidence is presented suggesting that some, but certainly not all, of the observed cases of soft-tissue neoplasms, kidney diseases, liver cirrhosis, and cataracts may be related to the /sup 224/Ra therapy. Of particular interest are the 8 cases of cataracts reported at 14-46 years of age (33 yr average) among the 204 patients injected with /sup 224/Ra as juveniles. Due to the rarity of naturally-occurring cataracts at young ages, perhaps all of these 8 cases can be regarded as induced.

  7. IoT devices and applications based on LoRa/LoRaWAN

    CSIR Research Space (South Africa)

    Khutsoane, Oratile C

    2017-10-01

    Full Text Available such as smart water management systems. However, they require high energy-efficient sensor nodes that are able to communicate across long distance. This motivates the development of many Low-Power Wide Area Networks (LPWAN) technologies, such as LoRa, to fulfill...

  8. Research nuclear reactor RA - Annual report 1992; Istrazivacki nuklearni reaktor RA - Izvestaj za 1992. godinu

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1992-12-01

    Research reactor RA Annual report for year 1992 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection. First part includes 8 annexes describing reactor operation, activities of services for maintenance of reactor components and instrumentation, financial report and staffing. Second annex B is a paper by Z. Vukadin 'Recurrence formulas for evaluating expansion series of depletion functions' published in 'Kerntechnik' 56, (1991) No.6 (INIS record no. 23024136. Second part of the report is devoted to radiation protection issues and contains 4 annexes with data about radiation control of the working environment and reactor environment, description of decontamination activities, collection of radioactive wastes, and meteorology data. [Serbo-Croat] Godisnji izvestaj o radu nuklearnog reaktora RA za 1992. godinu sastoji se od dva dela: prvi deo obuhvata pogon i odzavanje reaktora RA, a drugi poslove zastite od zracenja na reaktoru RA. Prvi deo sadrzi 8 priloga, koji opisuju rad reaktora i poslove sluzbi za odrzavanje opreme i komponenti, finansijski izvestaj, kadrovsku strukturu osoblja reaktora. Drugi prilog (B) je rad Z. Vukadina 'Recurrence formulas for evaluating expansion series of depletion functions' objavljen u casopisu Kerntechnik, 1991. Drugi deo izvestaja o poslovima zastite od zracenja sadrzi 4 priloga sa podacima radijacione kontrole radne sredine i okoline reaktora, opis poslova dekontaminacije i sakupljanja radioaktivnih materija, kao i meteoroloske podatke.

  9. RA-0 reactor. New neutronic calculations; Reactor RA-0. Nuevos calculos neutronicos

    Energy Technology Data Exchange (ETDEWEB)

    Rumis, D; Leszczynski, F

    1991-12-31

    An updating of the neutronic calculations performed at the RA-0 reactor, located at the Natural, Physical and Exact Sciences Faculty of Cordoba National University, are herein described. The techniques used for the calculation of a reactor like the RA-0 allows prediction in detail of the flux behaviour in the core`s interior and in the reflector, which will be helpful for experiments design. In particular, the use of WIMSD4 code to make calculations on the reactor implies a novelty in the possible applications of this code to solve the problems that arise in practice. (Author). [Espanol] En este trabajo se actualizan los calculos neutronicos realizados para el reactor RA-0, instalado en la Facultad de Ciencias Exactas, Fisicas y Naturales de la Universidad Nacional de Cordoba. Se describen los calculos realizados hasta la fecha y los resultados obtenidos. Las tecnicas incorporadas al calculo de un reactor como el RA-0 permiten predecir en detalle el comportamiento del flujo en el interior del nucleo y en el reflector, lo que sera una importante ayuda en el diseno de experimentos. En particular, el empleo del codigo WIMSD4 para calculos del reactor completo constituye una novedad en las posibles aplicaciones de ese codigo para resolver problemas que se presentan en la practica. (Autor).

  10. The genetics of rheumatoid arthritis: risk and protection in different stages of the evolution of RA

    Science.gov (United States)

    Yarwood, Annie; Huizinga, Tom W. J.

    2016-01-01

    There is now a general consensus that RA has a spectrum of disease stages that can begin many years before the onset of clinical symptoms. It is widely thought that understanding the complex interplay between genetics and environment, and their role in pathogenesis, is essential in gaining further insight into the mechanisms that drive disease development and progression. More than 100 genetic susceptibility loci have now been identified for RA through studies that have focused on patients with established RA compared with healthy controls. Studying the early preclinical phases of disease will provide valuable insights into the biological events that precede disease and could potentially identify biomarkers to predict disease onset and future therapeutic targets. In this review we will cover recent advances in the knowledge of genetic and environmental risk factors and speculate on how these factors may influence the transition from one stage of disease to another. PMID:25239882

  11. Research nuclear reactor RA - Annual Report 1996; Istrazivacki nuklearni reaktor RA - Izvestaj za 1996. godinu

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1996-12-01

    Activities related to revitalisation of the RA reactor started in 1986, were continued in 1996. All the planned actions related to renewal of the reactor components were finished. The last, and at the same time most important action, related to exchange of complete reactor instrumentation is underway, delayed. The delivery of components from USSR is late. Production of this instruments is financed by the IAEA according to the contract signed in December 1988 with Russian Atomenergoexport. According to this contract, it has been planned that the RA reactor instrumentation should be delivered to the Vinca Institute by the end of 1990. Only 80% of the instrumentation was delivered until September 1991. Since then any delivery of components to Yugoslavia was stopped because of the temporary embargo imposed by the IAEA. The existing RA reactor instrumentation was dismantled. Control and maintenance of the reactor components was done regularly and efficiently. Fuel inspection by the IAEA safeguards inspectors was done on a monthly basis. There have been on the average 43 employees at the RA reactor which is considered sufficient for maintenance and repair conditions. The problem of financing the reactor activities and maintenance remains unsolved. Research reactor RA Annual report for year 1996 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection. [Serbo-Croat] U toku 1996. godine nastavljeni su poslovi na revitalizaciji reaktora RA, zapocetoj 1986. godine. Okoncan je niz zahvata na opremi postrojenja kojima ce se u narednom periodu omoguciti kontinualan i pouzdan rad ovog reaktora. Poslednji, i ujedno najveci zahvat, koji se odnosi na zamenu celokupne instrumentacije kasni zbog zastoja u isporuci opreme koja se izradjuje u Sovjetskom savezu. Izradu ove opreme finansira Medjunarodna agencija za atomsku energiju kroz ugovor sklopljen decembra 1988. godine sa moskovskom firmom Atomenergoexport. Prema tom

  12. Behavior and distribution of 226Ra and 228Ra in the east coast of Peninsular Malaysia marine environment

    International Nuclear Information System (INIS)

    Nurrul Assyikeen Mohd Jaffary; Zal Uyun Wan Mahmood; Zaharudin Ahmad; Yii, Mei Wo; Kamarozaman Ishak

    2010-01-01

    The present distributions of 226 Ra, 228 Ra and activity ratios of 228 Ra/ 226 Ra covering the east coast of Peninsular Malaysia were studied. Sediment core samples were collected at 10 identified stations with the thickness of water column between 14 - 72 m depth during the cruise conducted in 2008. Activity concentrations of 226 Ra and 228 Ra in sediment cores of the studied area were in the range of 18.95 ±4.25 Bq/ kg to 46.48 ± 6.41 Bq/ kg dry wt. and 35.50 ± 7.50 Bq/ kg to 77.10 ±11.37 Bq/ kg dry wt., respectively. Meanwhile, the calculated activity ratios of 228 Ra/ 226 Ra were varied mostly 1.48 to 2.24. The finding showed that there has relationships between 226 Ra, 228 Ra and oceanographic parameters which are can be attributed for better understanding of its transport processes and behavior in the east coast of Peninsular Malaysia marine environment. (author)

  13. Dosimetry of {sup 223}Ra-chloride: dose to normal organs and tissues

    Energy Technology Data Exchange (ETDEWEB)

    Lassmann, Michael [University of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Nosske, Dietmar [Federal Office for Radiation Protection (BfS), Department of Radiation and Health, Oberschleissheim (Germany)

    2013-02-15

    {sup 223}Ra-Chloride (also called Alpharadin {sup registered}) targets bone metastases with short range alpha particles. In recent years several clinical trials have been carried out showing, in particular, the safety and efficacy of palliation of painful bone metastases in patients with castration-resistant prostate cancer using {sup 223}Ra-chloride. The purpose of this work was to provide a comprehensive dosimetric calculation of organ doses after intravenous administration of {sup 223}Ra-chloride according to the present International Commission on Radiological Protection (ICRP) model for radium. Absorbed doses were calculated for 25 organs or tissues. Bone endosteum and red bone marrow show the highest dose coefficients followed by liver, colon and intestines. After a treatment schedule of six intravenous injections with 0.05 MBq/kg of {sup 223}Ra-chloride each, corresponding to 21 MBq for a 70 kg patient, the absorbed alpha dose to the bone endosteal cells is about 16 Gy and the corresponding absorbed dose to the red bone marrow is approximately 1.5 Gy. The comprehensive list of dose coefficients presented in this work will assist in comparing and evaluating organ doses from various therapy modalities used in nuclear medicine and will provide a base for further development of patient-specific dosimetry. (orig.)

  14. Research nuclear reactor RA - Annual Report 1994; Istrazivacki nuklearni reaktor RA - Izvestaj za 1994. godinu

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1994-12-01

    Activities related to revitalisation of the RA reactor stared in 1986, were continued in 1991. A number of interventions on the reactor components were finished that are supposed to enable continuous and reliable operation. The last, and at the same time largest action, related to exchange of complete reactor instrumentation is underway, but it is behind the schedule in 1991 because the delivery of components from USSR is late. Production of this instruments is financed by the IAEA according to the contract signed in December 1988 with Russian Atomenergoexport. According to this contract, it has been planned that the RA reactor instrumentation should be delivered to the Vinca Institute by the end of 1990. Only 56% of the instrumentation was delivered until September 1991. Since then any delivery of components to Yugoslavia was stopped because of the temporary embargo imposed by the IAEA. In 1991 most of the existing RA reactor instrumentation was dismantled, only the part needed for basic measurements when reactor is not operated, was maintained. Activities related to improvement of Russian project were continued in 1994. Control and maintenance of the reactor components was done regularly and efficiently. Extensive repair of the secondary coolant loop is almost finished and will be completed in the first part of 1995 according to existing legal procedures and IAEA recommendations. Fuel inspection by the IAEA safeguards inspectors was done on a monthly basis. There have been on the average 47 employees at the RA reactor which is considered sufficient for maintenance and repair conditions. Research reactor RA Annual report for year 1991 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection. [Serbo-Croat] U 1994. godini nastavljeni su poslovi na revitalizaciji reaktora RA, zapocetoj 1986. godine. Okoncan je niz zahvata na opremi postrojenja kojima ce se u narednom periodu omoguciti kontinualan i

  15. Experienced job autonomy among maternity care professionals in The Netherlands.

    Science.gov (United States)

    Perdok, Hilde; Cronie, Doug; van der Speld, Cecile; van Dillen, Jeroen; de Jonge, Ank; Rijnders, Marlies; de Graaf, Irene; Schellevis, François G; Verhoeven, Corine J

    2017-11-01

    High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care system and whether they expect a new system of integrated maternity care to affect their experienced job autonomy. A cross-sectional survey. The Leiden Quality of Work Life Questionnaire was used to assess experienced job autonomy among maternity care professionals. Data were collected in the Netherlands in 2015. 799 professionals participated of whom 362 were primary care midwives, 240 obstetricians, 93 clinical midwives and 104 obstetric nurses. The mean score for experienced job autonomy was highest for primary care midwives, followed by obstetricians, clinical midwives and obstetric nurses. Primary care midwives scored highest in expecting to lose their job autonomy in an integrated care system. There are significant differences in experienced job autonomy between maternity care professionals. When changing the maternity care system it will be a challenge to maintain a high level of experienced job autonomy for professionals. A decrease in job autonomy could lead to a reduction in job related wellbeing and in satisfaction with care among pregnant women. Copyright © 2017. Published by Elsevier Ltd.

  16. Radon emanometric technique for 226Ra estimation

    International Nuclear Information System (INIS)

    Mandakini Maharana; Sengupta, D.; Eappen, K.P.

    2010-01-01

    Studies on natural background radiation show that the major contribution of radiation dose received by population is through inhalation pathway vis-a-vis contribution from radon ( 222 Rn) gas. The immediate parent of radon being radium ( 226 Ra), it is imperative that radium content is measured in the various matrices that are present in the environment. Among the various methods available for the measurement of radium, gamma spectrometry and radiochemical method are the two extensively used measurement methods. In comparison with these two methods, the radon emanometric technique, described here, is a simple and convenient method. The paper gives details of sample processing, radon bubbler, Lucas cell and the methodology used in the emanometric method. Comparison of emanometric method with gamma spectrometry has also undertaken and the results for a few soil samples are given. The results show a fairly good agreement among the two methods. (author)

  17. Research nuclear reactor RA - Annual report 1992

    International Nuclear Information System (INIS)

    Sotic, O.

    1992-12-01

    Research reactor RA Annual report for year 1992 is divided into two main parts to cover: (1) operation and maintenance and (2) activities related to radiation protection. First part includes 8 annexes describing reactor operation, activities of services for maintenance of reactor components and instrumentation, financial report and staffing. Second annex B is a paper by Z. Vukadin 'Recurrence formulas for evaluating expansion series of depletion functions' published in 'Kerntechnik' 56, (1991) No.6 (INIS record no. 23024136. Second part of the report is devoted to radiation protection issues and contains 4 annexes with data about radiation control of the working environment and reactor environment, description of decontamination activities, collection of radioactive wastes, and meteorology data [sr

  18. RA research reactor - potentials and prospective

    International Nuclear Information System (INIS)

    Sotic, O.

    1984-01-01

    Since December 1959, the RA reactor was operated successfully, except for a few shorter periods needed for maintenance and a four longer shutdown periods caused by decrease in the heavy water quality. Accordingly, reconstruction of some reactor systems was started at the beginning of this decad, as well as increase of its experimental potential which would enable its efficient reliable operation in the future period. Reconstruction is concerned with emergency core cooling system, special ventilation system, and modernization of the reactor instrumentation. Improvement of the experimental potential is related to modifications of the neutron scattering instruments. Development of methods for isotope production is described as well. Design of the reactor experimental loop with external cooling system will be of significant importance in improvement of reactor potential in the future

  19. Measurements of multipolarities in 225Ra

    International Nuclear Information System (INIS)

    Andersen, E.; Nyboe, K.; Thorsteinsen, T.F.; Gietz, H.; Kaffrell, N.; Mattsson, S.; Nyman, G.

    1989-01-01

    Multipolarities of 45 transitions in 225 Ra have been established by investigating the radiations associated with the β - decay of 225 Fr. The study includes β - , e - and γ-singles spectra, e - γ- and γγ-coincidence measurements. The conversion electrons were measured with a mini-orange electron spectrometer, and the γ-spectra with Ge detectors. The multipolarities obtained from the measured conversion coefficients support the assignments of spin-parity doublets thus giving evidence for a stable octupole deformation of this nucleus. The negative parity of the 394.2 keV level established in the present work indicates that this level is a candidate for the parity-doublet partner of the 5/2 + state at 236.3 keV. (orig.)

  20. RaPToRS Sample Delivery System

    Science.gov (United States)

    Henchen, Robert; Shibata, Kye; Krieger, Michael; Pogozelski, Edward; Padalino, Stephen; Glebov, Vladimir; Sangster, Craig

    2010-11-01

    At various labs (NIF, LLE, NRL), activated material samples are used to measure reaction properties. The Rapid Pneumatic Transport of Radioactive Samples (RaPToRS) system quickly and safely moves these radioactive samples through a closed PVC tube via airflow. The carrier travels from the reaction chamber to the control and analysis station, pneumatically braking at the outlet. A reversible multiplexer routes samples from various locations near the shot chamber to the analysis station. Also, the multiplexer allows users to remotely load unactivated samples without manually approaching the reaction chamber. All elements of the system (pneumatic drivers, flow control valves, optical position sensors, multiplexers, Geiger counters, and release gates at the analysis station) can be controlled manually or automatically using a custom LabVIEW interface. A prototype is currently operating at NRL in Washington DC. Prospective facilities for Raptors systems include LLE and NIF.

  1. Disassembling and modification of RA-3

    International Nuclear Information System (INIS)

    Tarizzo, R.D.

    1990-01-01

    The objective of this paper is to describe the partial disassembling and modification of RA-3, called the Modernization Project. It comprises all the technical and administrative steps directly related with this task. The improvement of RA-3 is a result of the lack of 90% enriched uranium obliging a change over to 20% enriched uranium. This brought about design modifications both in fuel elements and the reactor. The presentation of documents for the licensing authority as well as are detailed separately. The modernization project was divided in 25 tasks: 1) changing fuel element support table, 2) changing heat exchanger, 3) repairing of cooling towers, 4) repairing of primary circuit valves, 5) repairing of irradiation channels, 6) construction of a new sampler, 7) changing tangential channel, 8) cleaning and disassembling of reactor (inside), 9) changing continuous demineralizer (ion exchange column), 10) detection of failure in fuel elements, 11) modification of nuclear instrumentation, 12) modification of conventional instrumentation, 13) modification of electrical system, 14) changing telemanipulators, 15) construction of mechanism bridge, 16) changing a primary circuit valve when the heat exchanger is changed too, 17) painting ground floor, hall floor, and pump room floor with epoxy resin levelling, 18) installation of fire alarm system, 19) radioactive liquid discharge, 20) modification of secondary circuit (This task involves: a) installation of a third secondary pump, b) extension of this piping, c) installation of two 12 inch valves to the present cooling towers pools independent, d) installation of filtering system), 21) optimization hot water bed, 22) changing detector support table, 23) removal, decontamination and reinstallation of shielding, 25) changing pneumatic system

  2. Influence of relativistic effects on hydrolysis of Ra2+

    International Nuclear Information System (INIS)

    Zielinska, B.; Bilewicz, A.

    2005-01-01

    Using 224 Ra radiotracer the first hydrolysis constant (pK 1h ) of Ra 2+ cations has been determined. The pK 1h value of Ra 2+ was compared with the pK 1h values of other Group 2 cations. It has been shown that the electrostatic hydrolysis model based on assumption that pK 1h is a linear function of reciprocal ionic radii (1/r i ) does not describe well the hydrolysis of Group 2 metal cations. The reason of higher Ra 2+ hydrolysis as expected is the influence of relativistic effects on bonding 7s and 7p 1/2 orbitals. (author)

  3. Research on background neutron of 226Ra γ source

    International Nuclear Information System (INIS)

    Ji Changsong

    1996-01-01

    This work studies the background neutron emission of 226 Ra γ source: the mechanism of resulting in background neutron is studied; a thesis that the (α, n) type reaction on Radium carriers Cl or Br is the main source of creating background neutron emission of 226 Ra γ source has been proposed and certificated; a proposal of substitution of Cl carrier by Br in radium source produced in China in order to reduce background neutron emission is put forward. A result to reduce the background neutron from 96.4 neutrons/4πsmgRa to 6.1 neutrons/4πsmgRa is obtained

  4. Modeling the Energy Performance of LoRaWAN

    OpenAIRE

    Casals, Lluís; Mir, Bernat; Vidal, Rafael; Gomez, Carles

    2017-01-01

    LoRaWAN is a flagship Low-Power Wide Area Network (LPWAN) technology that has highly attracted much attention from the community in recent years. Many LoRaWAN end-devices, such as sensors or actuators, are expected not to be powered by the electricity grid; therefore, it is crucial to investigate the energy consumption of LoRaWAN. However, published works have only focused on this topic to a limited extent. In this paper, we present analytical models that allow the characterization of LoRaWAN...

  5. RA Reactor operation and maintenance (I-IX), Part IV, Task 3.08/04, Refurbishment of the RA reactor; Pogon i odrzavanje reaktora RA (I-IX), IV Deo, Zadatak 3.08/04 Remont reaktora RA

    Energy Technology Data Exchange (ETDEWEB)

    Zecevic, V [Institute of Nuclear Sciences Boris Kidric, Reaktor RA, Vinca, Beograd (Serbia and Montenegro)

    1963-12-15

    This volume contains reports describing maintenance and repair work of the RA reactor instrumentation, equipment of the reactor dosimetry control system, and equipment for regulation and control systems.

  6. Back to Bentham? Explorations of Experienced Utility

    NARCIS (Netherlands)

    D. Kahneman (Daniel); P.P. Wakker (Peter); R.K. Sarin (Rakesh)

    1997-01-01

    textabstractTwo core meanings of “utility” are distinguished. “Decision utility” is the weight of an outcome in a decision. “Experienced utility” is hedonic quality, as in Bentham’s usage. Experienced utility can be reported in real time (instant utility), or in retrospective evaluations of past

  7. Experienced discrimination amongst European old citizens

    NARCIS (Netherlands)

    van den Heuvel, Wim J. A.; van Santvoort, Marc M.

    2011-01-01

    This study analyses the experienced age discrimination of old European citizens and the factors related to this discrimination. Differences in experienced discrimination between old citizens of different European countries are explored. Data from the 2008 ESS survey are used. Old age is defined as

  8. Experienced General Music Teachers' Instructional Decision Making

    Science.gov (United States)

    Johnson, Daniel C.; Matthews, Wendy K.

    2017-01-01

    The purpose of this descriptive study was to explore experienced general music teachers' decision-making processes. Participants included seven experienced, American general music teachers who contributed their views during two phases of data collection: (1) responses to three classroom scenarios; and (2) in-depth, semi-structured, follow-up…

  9. Concentration of natural radionuclides (40K, 228Ra and 226Ra) in vegetables and fruits collected around Kudankulam, South India

    International Nuclear Information System (INIS)

    Mahiban Ross, E.; Feroz Khan, M.; Lenin Raj, Y.; Godwin Wesley, S.; Kumar, M.; Sundar Rajan, P.

    2007-01-01

    Baseline activity concentration of the natural radio nuclides 40 K, 228 Ra and 226 Ra in vegetables and fruits was determined around Kudankulam. In many of the samples, 228 Ra and 226 Ra was below minimum detection limit. 40 K was found to be more in leafy vegetables followed by pods, tubers and fleshy fruits. The highest accumulator among the matrices was the leafy vegetables with the geometric mean of 189.47 Bq.kg -1 fresh for vegetables and fruits with the geometric mean of 128.95 Bq.kg -1 fresh. 228 Ra activity in vegetables and fruits ranged from 0.074 to 1.153 and 0.074 to 0.131 Bq.kg -l fresh respectively. 226 Ra in vegetables and fruits ranged from BDL to 0.07 and BDL-.044 Bq.kg -l fresh respectively. 40 K in vegetables and fruits followed a log normal distribution. (author)

  10. Experienced job autonomy among maternity care professionals in The Netherlands

    NARCIS (Netherlands)

    Perdok, H.; Cronie, D.; Speld, C. van der; Dillen, J. van; Jonge, A . de; Rijnders, M.; Graaf, I. de; Schellevis, F.G.; Verhoeven, C.J.

    2017-01-01

    OBJECTIVE: High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care

  11. Experienced job autonomy among maternity care professionals in The Netherlands

    NARCIS (Netherlands)

    Perdok, Hilde; Cronie, Doug; van der Speld, Cecile; van Dillen, Jeroen; de Jonge, Ank; Rijnders, Marlies; de Graaf, Irene; Schellevis, François G.; Verhoeven, Corine J.

    2017-01-01

    Objective: High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care

  12. Experienced job autonomy among maternity care professionals in The Netherlands

    NARCIS (Netherlands)

    Perdok, H.; Cronie, D.; Speld, C. van der; Dillen, J. van; Jonge, A. de; Rijnders, M.; Graaf, I. de; Schellevis, F.G.; Verhoeven, G.

    2017-01-01

    Objective High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care

  13. Experienced job autonomy among maternity care professionals in The Netherlands.

    NARCIS (Netherlands)

    Perdok, H.; Cronie, D.; Speld, C. van der; Dillen, J. van; Jonge, A. de; Rijnders, M.; Graaf, J. de; Schellevis, F.; Verhoeven, C.

    2017-01-01

    Objective: High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care

  14. The potential of {sup 223}Ra and {sup 18}F-fluoride imaging to predict bone lesion response to treatment with {sup 223}Ra-dichloride in castration-resistant prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Murray, Iain; Chittenden, Sarah J.; Denis-Bacelar, Ana M.; Flux, Glenn D. [Royal Marsden NHS Foundation Trust, Joint Department of Physics, Sutton, Surrey (United Kingdom); The Institute of Cancer Research, London (United Kingdom); Hindorf, Cecilia [Royal Marsden NHS Foundation Trust, Joint Department of Physics, Sutton, Surrey (United Kingdom); The Institute of Cancer Research, London (United Kingdom); Skaane University Hospital, Department of Radiation Physics, Lund (Sweden); Parker, Christopher C. [Royal Marsden NHS Foundation Trust, Department of Urology, Sutton (United Kingdom); Chua, Sue [Royal Marsden NHS Foundation Trust, Department of Nuclear Medicine, Sutton (United Kingdom)

    2017-10-15

    The aims of this study were to calculate bone lesion absorbed doses resulting from a weight-based administration of {sup 223}Ra-dichloride, to assess the relationship between those doses and corresponding {sup 18}F-fluoride uptake and to assess the potential of quantitative {sup 18}F-fluoride imaging to predict response to treatment. Five patients received two intravenous injections of {sup 223}Ra-dichloride, 6 weeks apart, at 110 kBq/kg whole-body weight. The biodistribution of {sup 223}Ra in metastatic lesions as a function of time after administration as well as associated lesion dosimetry were determined from serial {sup 223}Ra scans. PET/CT imaging using {sup 18}F-fluoride was performed prior to the first treatment (baseline), and at week 6 immediately before the second treatment and at week 12 after baseline. Absorbed doses to metastatic bone lesions ranged from 0.6 Gy to 44.1 Gy. For individual patients, there was an average factor difference of 5.3 (range 2.5-11.0) between the maximum and minimum lesion dose. A relationship between lesion-absorbed doses and serial changes in {sup 18}F-fluoride uptake was demonstrated (r{sup 2} = 0.52). A log-linear relationship was demonstrated (r{sup 2} = 0.77) between baseline measurements of {sup 18}F-fluoride uptake prior to {sup 223}Ra-dichloride therapy and changes in uptake 12 weeks after the first cycle of therapy. Correlations were also observed between both {sup 223}Ra and {sup 18}F-fluoride uptake in lesions (r = 0.75) as well as between {sup 223}Ra absorbed dose and {sup 18}F-fluoride uptake (r = 0.96). There is both inter-patient and intra-patient heterogeneity of absorbed dose estimates to metastatic lesions. A relationship between {sup 223}Ra lesion absorbed dose and subsequent lesion response was observed. Analysis of this small group of patients suggests that baseline uptake of {sup 18}F-fluoride in bone metastases is significantly correlated with corresponding uptake of {sup 223}Ra, the associated {sup 223

  15. RA Research nuclear reactor - Annual report 1987; Istrazivacki nuklearni reaktor RA - Izvestaj o radu za 1987. godinu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1987-12-15

    Annual report concerning the project 'RA research nuclear reactor' for 1987, financed by the Serbian ministry of science is divided into two parts. First part is concerned with RA reactor operation and maintenance, which is the task of the Division for reactor engineering of the Institute for multidisciplinary studies and RA reactor engineering. Second part deals with radiation protection activities at the RA reactor which is the responsibility of the Institute for radiation protection. Scientific council of the Institute for multidisciplinary studies and RA reactor engineering has stated that this report describes adequately the activity and tasks fulfilled at the RA reactor in 1989. The scope and the quality of the work done were considered successful both concerning the maintenance and reconstruction, as well as radiation protection activities. [Serbo-Croat] Godisnji izvestaj po projektu 'Istrazivacki nuklearni reaktor RA' za 1987. godinu, koji finansira republicka zajednica za nauku SR Srbije po ugovoru br. 3509/1 sastoji se iz dva dela. Prvi deo obuhvata pogon i odrzavanje nuklearnog reaktora RA, sto predstavlja obavezu Odeljenja za reaktorski inzenjering u sastavu OOUR Instituta za multidisciplinarna istrazivanja i inzenjering RA. Drugi deo obuhvata poslove zastite od zracenja na reaktoru RA, sto predstavlja obavezu OOUR Instituta za zastitu od zracenja 'Zastita'. Naucno vece Instituta za multidisciplinarna istrazivanja i inzenjjring RA ocenilo je da sadrzina ovog izvestaja odgovara izvrsenim poslovima na reaktoru RA u 1989. godini. Pozitivno se ocenjuje obim i kvalitet izvrsenih radova kako u pogledu odrzavanja i rekonstrukcije reaktora, tako i u pogledu poslova zastite od zracenja izvrsenih kod njega.

  16. Transfer of 226Ra, 228Ra, 210Pb and 210Po in aquatic organisms and food chain

    International Nuclear Information System (INIS)

    Yang Xiaotong; Weng Detong; Chen Wenyin; Chen Xiuyun; Chen Jixi; Zhao Shimin

    1998-01-01

    Objective: To find out the transfer regularities of 226 Ra, 228 Ra, 210 Pb and 210 Po, which are natural radionuclides in the aquatic organisms and food chain. Methods: Large amount of breed of representative aquatic products and their living waters and sediments were collected and treated according to routine experimental procedures. The contents of 226 Ra, 228 Ra, 210 Pb and 210 Po were detected in each sample. Measured data were analyzed statistically and pairwise comparisons were made to determine the differences between groups. Results: 226 Ra, 228 Ra and 210 Pb were mainly deposited in the bones (or shells), their concentration factors (CF) ranged from 10 2 to 10 3 ; the CF ranged only from 10 0 to 10 2 in the flesh. 210 Po was mainly deposited in the soft tissues, CF ranged from 10 2 to 10 4 ; especially in the stomachs and intestines of fishes, the value reached 10 4 . The cooking process did not impinge significantly on the transfer of 226 Ra, 228 Ra and 210 Pb in the food chain (P>0.05), but did significantly influence the transfer of 210 Po, especially in the freshwater fishes and shrimps. Paired comparison test of the activities between raw flesh and cooked flesh showed very significant difference (P 226 Ra, 228 Ra, 210 Pb and 210 Po. Even though the bones (or shells) of aquatic organisms contained relatively higher levels of 226 Ra, 228 Ra and 210 Pb, the cooking process does not significantly increase the radioactive contents in the foodstuffs. However, the cooking process does significantly influence the transfer of 210 Po. It does significantly increase the content of 210 Po in foodstuffs

  17. Doses from 222Rn, 226Ra, and 228Ra in groundwater from Guarani aquifer, South America.

    Science.gov (United States)

    Bonotto, D M

    2004-01-01

    Groundwater samples were analysed for 222Rn, 226Ra, and 228Ra in Guarani aquifer spreading around 1 million km2 within four countries in South America, and it was found that their activity concentrations are lognormally distributed. Population-weighted average activity concentration for these radionuclides allowed to estimate a value either slightly higher (0.13 mSv/year) than 0.1 mSv for the total effective dose or two times higher (0.21 mSv/year) than this limit, depending on the choice of the dose conversion factor. Such calculation adds useful information for the appropriate management of this transboundary aquifer that is socially and economically very important to about 15 million inhabitants living in Brazil, Argentina, Uruguay and Paraguay.

  18. Doses from 222Rn, 226Ra, and 228Ra in groundwater from Guarani aquifer, South America

    International Nuclear Information System (INIS)

    Bonotto, D.M.

    2004-01-01

    Groundwater samples were analysed for 222 Rn, 226 Ra, and 228 Ra in Guarani aquifer spreading around 1 million km 2 within four countries in South America, and it was found that their activity concentrations are lognormally distributed. Population-weighted average activity concentration for these radionuclides allowed to estimate a value either slightly higher (0.13 mSv/year) than 0.1 mSv for the total effective dose or two times higher (0.21 mSv/year) than this limit, depending on the choice of the dose conversion factor. Such calculation adds useful information for the appropriate management of this transboundary aquifer that is socially and economically very important to about 15 million inhabitants living in Brazil, Argentina, Uruguay and Paraguay

  19. Separation of Ra/Ca by ion exchange; Separacion de Ra/Ca por intercambio ionico

    Energy Technology Data Exchange (ETDEWEB)

    Iturbe, J L; Jimenez R, M; Flores M, J

    1991-04-15

    The radium and the calcium belong to the same group in the periodic classification and as consequence both they present very similar chemical properties, that makes difficult its separation. Both elements are also frequently associate in the nature, the calcium is very abundant, the radium is not it and for that reason it is indispensable its separation to analyze to this last one. The alpha spectroscopy is very appropriate to analyze to the {sup 226} Ra, however to achieve a good resolution of the spectra, the samples should contain small quantities of calcium. The purposes of this work were to know the chromatographic behavior of the alkaline-earthy cations: calcium, barium and radium and to apply these knowledge to the separation of the {sup 226} Ra and its analysis by means of alpha spectroscopy. (Author)

  20. RA Research reactor, Part 1, Operation and maintenance of the RA nuclear reactor for 1986

    International Nuclear Information System (INIS)

    Sotic, O.; Martinc, R.; Cupac, S.; Sulem, B.; Badrljica, R.; Majstorovic, D.; Sanovic, V.

    1986-01-01

    In order to enable future reliable operation of the RA reactor, according to new licensing regulations, three major tasks started in 1984 were fulfilled: building of the new emergency system, reconstruction of the existing ventilation system, and reconstruction of the power supply system. Simultaneously in 1985/1986 renewal of the instrumentation and reconstruction of the system for handling and storage of the spent fuel in the reactor building have started. Design projects for these tasks are almost finished and the reconstruction of both systems is expected to be finished until 1988 and mid 1989 respectively. RA reactor Safety report was finished according to the recommendations of the IAEA. Investments in 1986 were used for 8000 kg of heavy water, maintenance of reactor systems and supply of new components, reconstruction of reactor systems. This report includes 8 annexes concerning reactor operation, activities of services and financial issues [sr

  1. Diagrams about RA reactor operation, Annex 7; Prilog 7 - Rad reaktora RA po godinama - dijagrami

    Energy Technology Data Exchange (ETDEWEB)

    Martinc, R [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1976-01-15

    This Annex 7 includes diagrams about RA reactor operation (MWh) from 1960-1975; mean values of reactor power per day and month in 1975, and percent of utilisation of experimental space during 1975. [Serbo-Croat] Ovaj prilog sadrzi dijagrame o radu reaktora (MWh) po godinama (1960-1975); srednje vrednosti dnevne snage reaktora u 1975. godini; rad reakrora (MWh) po mesecima u 1975; procenat iskoriscenja eksperimentalnog prostora u 1975. godini.

  2. RA Reactor operation and maintenance (I-IX), Part IV, Task 3.08/04, Refurbishment of the RA reactor

    International Nuclear Information System (INIS)

    Zecevic, V.

    1963-12-01

    This volume contains reports describing maintenance and repair work of the RA reactor instrumentation, equipment of the reactor dosimetry control system, and equipment for regulation and control systems

  3. Determination of the four natural Ra isotopes in thermal waters by gamma-ray spectrometry

    International Nuclear Information System (INIS)

    Condomines, M.; Rihs, S.; Lloret, E.; Seidel, J.L.

    2010-01-01

    Our method for the simultaneous determination of the four natural Ra isotopes ( 226 Ra, 228 Ra, 224 Ra and 223 Ra) in thermal waters involves a separation of Ra on a selective filter (3 M EMPORE TM Radium Rad disk), and a single counting using a broad-energy HPGe detector (BE Ge manufactured by CANBERRA TM ). The calculation of 223 Ra and 228 Ra activities requires interference and cascade summing corrections. The 226 Ra activities in CO 2 -rich thermal waters of the Lodeve Basin (South of France) range from 530 to 2240 mBq/l. The low ( 228 Ra/ 226 Ra) activity ratios (0.19-0.29) suggest that Ra is mostly derived from the aquifer carbonates. The short-lived 224 Ra and 223 Ra are probably added to the water through recoil or desorption processes from Th-enriched coatings on the fracture walls.

  4. A multicenter, primary-care-based, open-label study to assess the success of converting opioid-experienced patients with chronic moderate-to-severe pain to morphine sulfate and naltrexone hydrochloride extended-release capsules using a standardized conversion guide.

    Science.gov (United States)

    Setnik, Beatrice; Roland, Carl L; Sommerville, Kenneth W; Pixton, Glenn C; Berke, Robert; Calkins, Anne; Goli, Veeraindar

    2015-01-01

    To evaluate the conversion of opioid-experienced patients with chronic moderate-to-severe pain to extended-release morphine sulfate with sequestered naltrexone hydrochloride (MSN) using a standardized conversion guide. This open-label, single-arm study was conducted in 157 primary care centers in the United States. A total of 684 opioid-experienced adults with chronic moderate-to-severe pain were converted to oral administration of MSN from transdermal fentanyl and oral formulations of hydrocodone, hydromorphone, methadone, oxycodone, oxymorphone, and other morphine products using a standardized conversion guide. The primary endpoint was the percentage of patients achieving a stable MSN dose within a 6-week titration phase. Secondary endpoints included duration of time to stable dose, number of titration steps, safety and efficacy measures, and investigator assessment of conversion guide utility. Of the 684 patients, 51.3% were converted to a stable dose of MSN (95% confidence interval: 47.5%, 55.1%). The mean (standard deviation) number of days to stable dose was 20 (8.94), and number of titration steps to stable dose was 2.4 (1.37). The majority of adverse events were mild/moderate and consistent with opioid therapy. Mean pain scores at stable dose decreased from baseline. Investigators were generally satisfied with the conversion guide and, in 94% of cases, reported they would use it again. Conversion to MSN treatment using the standardized MSN conversion guide was an attainable goal in approximately half of the population of opioid-experienced patients with chronic moderate-to-severe pain. Investigators found the guide to be a useful tool to assist conversion of opioid-experienced patients to MSN.

  5. Determination of 226Ra and 224Ra in sediments samples by liquid scintillation counting

    International Nuclear Information System (INIS)

    Villa, M.; Moreno, H.P.; Manjon, G.

    2005-01-01

    An experimental procedure has been developed for a rapid determination of the activity concentration of 226 Ra and 224 Ra in sediments by liquid scintillation counting. The importance of the method lies in its application to the measurement of sediments where the Ra-isotopes activity concentration has been increased due to an anthropomorphic enhancement based on releases of naturally occurring radioactive material (NORM). A sample pre-treatment, including a digestion with aqua regia and a precipitation of hydroxides, was applied to samples before the radium extraction, which was made by co-precipitation with barium. Measurements were done in a low background scintillation spectrometer Quantulus 1220, which can separate and detect simultaneously α and β particles. Additionally, some improvements are suggested for a better α and β interference correction of the results. The obtaining of radiochemical yields is also improved using 133 Ba as tracer, which decays by emission of conversion electrons and γ-rays; the wide range of radiochemical yields obtained confirms the need of this analyses. The procedure has been applied to the measurement of riverbed sediments from an estuary in the south-west of Spain, affected in the past by direct and indirect phosphogypsum discharges

  6. RA Research nuclear reactor, Part I - RA nuclear reactor operation, maintenance and utilization in 1983

    International Nuclear Information System (INIS)

    Sotic, O.; Martinc, R.; Kozomara-Maic, S.; Cupac, S.; Raickovic, N.; Radivojevic, J.; Badrljica, R.; Majstorovic, D.; Sanovic, V.

    1983-12-01

    After regular shutdown in November 1982, inspection of the fuel elements from the RA reactor core which was done from December 1982 - February 1983 has shown that there are deposits of aluminium oxides on the surface of the fuel cladding. After restart The RA reactor was operated at power levels from 1.8 - 2 MW, with 80% enriched uranium dioxide fuel elements. It was found that there was no corrosion of the fuel element cladding and that it was not possible to find the cause of surface deposition on the cladding surfaces without further operation. It was decided to purify the heavy water permanently during operation and to increase the heavy water flow by operating two pumps. This procedure was adopted in order to decrease the possibility of corrosion. The Safety committee of the Institute has approved this procedure for operating the RA reactor in 1983. The core was made of 80% enriched fuel, critical experiments were done until June 1983, and after that the operation was continued at power levels up to 2 MW [sr

  7. Gender, body mass index and rheumatoid arthritis disease activity: results from the QUEST-RA Study.

    Science.gov (United States)

    Jawaheer, D; Olsen, J; Lahiff, M; Forsberg, S; Lähteenmäki, J; da Silveira, I G; Rocha, F A; Magalhães Laurindo, I M; Henrique da Mota, L M; Drosos, A A; Murphy, E; Sheehy, C; Quirke, E; Cutolo, M; Rexhepi, S; Dadoniene, J; Verstappen, S M M; Sokka, T

    2010-01-01

    To investigate whether body mass index (BMI), as a proxy for body fat, influences rheumatoid arthritis (RA) disease activity in a gender-specific manner. Consecutive patients with RA were enrolled from 25 countries into the QUEST-RA program between 2005 and 2008. Clinical and demographic data were collected by treating rheumatologists and by patient self-report. Distributions of Disease Activity Scores (DAS28), BMI, age, and disease duration were assessed for each country and for the entire dataset; mean values between genders were compared using Student's t-tests. An association between BMI and DAS28 was investigated using linear regression, adjusting for age, disease duration and country. A total of 5,161 RA patients (4,082 women and 1,079 men) were included in the analyses. Overall, women were younger, had longer disease duration, and higher DAS28 scores than men, but BMI was similar between genders. The mean DAS28 scores increased with increasing BMI from normal to overweight and obese, among women, whereas the opposite trend was observed among men. Regression results showed BMI (continuous or categorical) to be associated with DAS28. Compared to the normal BMI range, being obese was associated with a larger difference in mean DAS28 (0.23, 95% CI: 0.11, 0.34) than being overweight (0.12, 95% CI: 0.03, 0.21); being underweight was not associated with disease activity. These associations were more pronounced among women, and were not explained by any single component of the DAS28. BMI appears to be associated with RA disease activity in women, but not in men.

  8. RAPIDARC (RA) in the uterine cervical cancer; dosimetric gain vs 3D-Crt

    International Nuclear Information System (INIS)

    Ramirez, J.; Garcia, B.; Quispe, K.; Gonzales, A.; Marquina, J.

    2014-08-01

    This work aims to quantitatively assess RAPIDARC (RA) treatments versus three dimensional-Conformal Radiation Therapy with field to field technique (3D-Crt-Fin F). 11 patients with cervical cancer treated at our institution radically or adjuvant clinical stages I-III B were evaluated. The prescribed dose was 50 Gy (2 Gy / Fr). The RA plans consisted of two isocentric complete arcs and conformational plans of 4 isocentric fields (previous, subsequent, right side and left side) with 3D-Crt-Fin F technique; both cases carried out ??in the Eclipse version 10 planner with calculation algorithm analytical anisotropic algorithm (AAA) and volumetric optimization software (for VMAT plans). Homogeneity indices (Hi), conformity indices (CI) Sigma indices (S-Index), monitor units (MU) and the time required for each treatment were compared. The mean age was 52 years (32-65) of the 11 patients 9 were clinical stages I-II B. The Hi varied from 0.052 for RA to 0.163 for 3D-Crt-Fin F (p = 0.009), and the CI between 1.005 and 1.35 (p = 0.26), the S-index from 1.2 to 3.7 (p = 0.001) and the H-index of 1.08 to 1.15 (p = 0.24). All dose limits in risk organs were met with a significant difference in the RA plans versus 3D-Crt-Fin F. In patients with cervical cancer the treatment plans quality with the indices aforementioned seems to be better with the RA technique, being observed a significant reduction of radiation to surrounding organs. (author)

  9. Measurements at the RA Reactor related to the VISA-2 project - Part 1, Start-up of the RA reactor and measurement of new RA reactor core parameters

    International Nuclear Information System (INIS)

    Markovic, H.

    1962-07-01

    The objective of the measurements was determining the neutron flux in the RA reactor core. Since the number of fuel channels is increased from 56 to 68 within the VISA-2 project, it was necessary to attain criticality of the RA reactor and measure the neutron flux properties. The 'program of RA reactor start-up' has been prepared separately and it is included in this report. Measurements were divided in two phases. First phase was measuring of the neutron flux after the criticality was achieved but at zero power. During phase two measurements were repeated at several power levels, at equilibrium xenon poisoning. This report includes experimental data of flux distributions and absolute values of the thermal and fast neutron flux in the RA reactor experimental channels and values of cadmium ratio for determining the neutron epithermal flux. Data related to calibration of regulatory rods for cold un poisoned core are included [sr

  10. RA Research reactor, Annual report 1971

    International Nuclear Information System (INIS)

    Milosevic, D. et al.

    1971-12-01

    During 1971, the RA Reactor was operated at nominal power of 6.5 MW for 190 days, and 50 days at lower power levels. Total production mounted to 31606 MWh which is 5.3% higher than planned, and the highest annual level since the reactor started operation. Reactor was used for irradiation and experiments according to the demand of 425 users, of which 370 from the Institute and 55 external users. This report contains detailed data about reactor power and experiments performed in 1971. Discrepancies from the action plan, meaning higher production was achieved in June and December due to special demand of the users. Total number of interruptions was lower than during all the previous years, and were caused mainly due to power cuts during reactor operation. There was no longer interruption caused by failures of the equipment. There was only on scram shutdown during this year caused by a false signal of the reactor control instrumentation. Shorter interruptions resulted from breaking of connectors in the technical water pipe system caused by soil sliding near the pumping station on the Danube. Total personnel exposure dose was lower than during previous years. There was no accident nor any event that could be called accidental. Decontamination od surfaces was less than during previous years. It was concluded that the successful operation in 1971 resulted from efficient work during past years. But, some of the activities were interrupted due to undefined policy concerned with operation of the RA reactor and financial issues. This involves study of the possibility to use highly enriched fuel that would increase the useful neutron flux and the reactor compatibility with similar reactors for the future ten years. Another project that has been interrupted is construction of the emergency core cooling system which is important for the reactor safety. Financial problems have influenced not only the reactor operation but the number of employees, which could cause negative

  11. 226Ra determination in phosphogypsum by alpha-particle spectrometry

    International Nuclear Information System (INIS)

    Aguado, J.L.; Bolivar, J.P.; Garcia-Tenorio, R.

    1999-01-01

    A radiochemical method for 226 Ra determination by alpha-particle spectrometry in environmental samples has been developed in our laboratory. The method has been validated by measurements in samples with known concentrations of this radionuclide and it has been applied in studies related to 226 Ra behaviour in phosphogypsum (the main by-product of producing phosphoric acid from phosphate rocks). (author)

  12. Rheumatoid Arthritis (RA) associated interstitial lung disease (ILD).

    LENUS (Irish Health Repository)

    O'Dwyer, David N

    2013-10-01

    Rheumatoid Arthritis (RA) is the most common Connective Tissue Disease (CTD) and represents an increasing burden on global health resources. Interstitial lung disease (ILD) has been recognised as a complication of RA but its potential for mortality and morbidity has arguably been under appreciated for decades. New studies have underscored a significant lifetime risk of ILD development in RA. Contemporary work has identified an increased risk of mortality associated with the Usual Interstitial Pneumonia (UIP) pattern which shares similarity with the most devastating of the interstitial pulmonary diseases, namely Idiopathic Pulmonary Fibrosis (IPF). In this paper, we discuss recent studies highlighting the associated increase in mortality in RA-UIP. We explore associations between radiological and histopathological features of RA-ILD and the prognostic implications of same. We emphasise the need for translational research in this area given the growing burden of RA-ILD. We highlight the importance of the respiratory physician as a key stakeholder in the multidisciplinary management of this disorder. RA-ILD focused research offers the opportunity to identify early asymptomatic disease and define the natural history of this extra articular manifestation. This may provide a unique opportunity to define key regulatory fibrotic events driving progressive disease. We also discuss some of the more challenging and novel aspects of therapy for RA-ILD.

  13. 226Ra concentrations in some Illinois well waters

    International Nuclear Information System (INIS)

    Holtzman, R.B.; Gilkeson, R.H.

    1982-01-01

    226 Ra concentrations are reported for the waters from deep wells in 43 communities in Illinois. The concentrations range from 0.08 to 20.6 pCi/L. The effectiveness of additives (nitric acid or EDTA) in keeping the 226 Ra in solution in the samples is discussed

  14. RA Reactor operation and maintenance (I-IX), Part I

    International Nuclear Information System (INIS)

    Zecevic, V.

    1963-12-01

    The report on RA reactor operation and maintenance for year 1963 is divided in six tasks. This volume contains the introductory report, and three tasks of the final report, namely reactor exploitation, reactivity changes of the RA reactor before repair, planning of refuelling

  15. The study of 226Ra concentration in Teheran's pasteurized milk

    International Nuclear Information System (INIS)

    Khademi, B.; Sekhavat, A.; Movahed Shari'atpanahi, J.

    1975-01-01

    A study of 226 88 Ra concentration in pasteurized milk distributed in Tehran during 1970-72 was accomplished. The Ash resulting from the milk was 4.5 to 5.5 gr., which might be due to poor nourishment of the animals. These results are compared with the Ra concentration in France and Puerto Rico

  16. Psychological stress in rheumatoid arthritis patients: a comparative Polish-German study: summary of the current conceptualization of the role of stress in rheumatoid arthritis.

    Science.gov (United States)

    Bugajska, J; Brzosko, M; Jedryka-Góral, A; Głuszko, P; Zołnierczyk-Zreda, D; Sagan, A; Konarska, M; Rell-Bakalarska, M; Pazdur, J; Zeidler, H; Rihl, M

    2010-02-01

    Cultural differences in experiencing individual stress in rheumatoid arthritis (RA) patients might be observed. The aim of the study was to assess quality of life and psychological stress (distress) in RA patients, and to evaluate socio-demographic and disease specific variables predicting stress of patients. The study covered 300 Polish and 137 German RA patients. SF-36v2 scale was used to evaluate the patients' health. Psychological stress was defined as the feeling of "social isolation" and "being a burden" as demanding help in everyday activities. In both countries, the mental and physical health of patients deteriorated and about 50% of patients required support in everyday activities. 95% of Polish and 62% of German patients felt rejected from social activities. For the psychological stress perceived, functional capacity class 3 and male gender were shown to be predictive in Polish patients and living in a small town - in German patients. In the Polish group, the tertiary/bachelor level of education was linked with lower distress level. RA has a serious impact on the mental health owing to a great disease burden. Awareness of impact of the disease on quality of life and psychological stress of patients should be considered in routine clinical practice. Copyright 2009 Elsevier B.V. All rights reserved.

  17. Reproduction of the RA reactor fuel element fabrication

    International Nuclear Information System (INIS)

    Novakovic, M.

    1961-12-01

    This document includes the following nine reports: Final report on task 08/12 - testing the Ra reactor fuel element; design concept for fabrication of RA reactor fuel element; investigation of the microstructure of the Ra reactor fuel element; Final report on task 08/13 producing binary alloys with Al, Mo, Zr, Nb and B additions; fabrication of U-Al alloy; final report on tasks 08/14 and 08/16; final report on task 08/32 diffusion bond between the fuel and the cladding of the Ra reactor fuel element; Final report on task 08/33, fabrication of the RA reactor fuel element cladding; and final report on task 08/36, diffusion of solid state metals [sr

  18. Recovery of Ra-223 from natural thorium irradiated by protons

    Energy Technology Data Exchange (ETDEWEB)

    Vasiliev, Aleksandr N.; Ostapenko, Valentina S. [Lomonosov Moscow State Univ. (Russian Federation); Russian Academy of Sciences, Moscow-Troitsk (Russian Federation). Inst. for Nuclear Research; Lapshina, Elena V.; Ermolaev, Stanislav V.; Zhuikov, Boris L. [Russian Academy of Sciences, Moscow-Troitsk (Russian Federation). Inst. for Nuclear Research; Danilov, Sergey S. [Lomonosov Moscow State Univ. (Russian Federation); Kalmykov, Stepan N. [Lomonosov Moscow State Univ. (Russian Federation); National Research Center ' Kurchatov Institute' (NRC ' Kurchatov Institute' ), Moscow (Russian Federation)

    2016-11-01

    Irradiation of natural thorium with medium-energy protons is considered to be a prospective approach to large-scale production of {sup 225}Ac and {sup 223}Ra. In addition to the earlier-developed method of {sup 225}Ac isolation, the present work focuses on the simultaneous recovery of {sup 223}Ra from the same thorium target. Radiochemical procedure is based on liquid-liquid extraction, cation exchange and extraction chromatography. The procedure provides separation of radium from spallation and fission products generated in the thorium target. High chemical yield (85-90%) and radionuclide purity of {sup 223}Ra (> 99.8% except {sup 224}Ra and {sup 225}Ra isotopes) have been achieved.

  19. Back to Bentham? Explorations of Experienced Utility

    OpenAIRE

    Kahneman, Daniel; Wakker, Peter; Sarin, Rakesh

    1997-01-01

    textabstractTwo core meanings of “utility” are distinguished. “Decision utility” is the weight of an outcome in a decision. “Experienced utility” is hedonic quality, as in Bentham’s usage. Experienced utility can be reported in real time (instant utility), or in retrospective evaluations of past episodes (remembered utility). Psychological research has documented systematic errors in retrospective evaluations, which can induce a preference for dominated options. We propose a formal normative ...

  20. Significance of determination of serum cytidine deaminase (CD) levels for diagnosis of active rheumatoid arthritis (RA)

    International Nuclear Information System (INIS)

    Xiao Chuangqing; Jang Xiaogong; He Yunnan

    2005-01-01

    Objective: To determine the clinical value of measurement of serum cytidine deaminase (CD) levels in patients with active rheumatoid arthritis (RA). Methods: Serum levels of CD were detected with spectrophotometry, in 33 patients with active RA and 60 controls. The erythrocyte sedimentation rate (ESR) and CRP content were also determined in both groups. Results: The ser- um CD contents in patients with active RA(14.80 ± 2.11U/ml) were significantly higher than those in controls(4.86±1.86 U/ml,P<0.01). The CRP contents (51.46 ± 20.43mg/L) and ESR readings(85.03 ± 27.6mm/h) in the patients were also significantly higher than those in the controls(3.40 ± 2.21mg/L and 13.04 ± 4.89mm/h respectively, all P<0.01). In the patients, the serum CD contents were linearly positively correlated with the ESR contents and CRP readings (r=0.6324 and 0.8013 respectively, P <0.01). Conclusion: Serum CD is an early biochemical marker for diagnosis of active rheumatoid arthritis and is also of prognostic value. (authors)

  1. High 3-year golimumab survival in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis: real world data from 328 patients.

    Science.gov (United States)

    Thomas, Konstantinos; Flouri, Irini; Repa, Argiro; Fragiadaki, Kalliopi; Sfikakis, Petros P; Koutsianas, Christos; Kaltsonoudis, Evripidis; Voulgari, Paraskevi V; Drosos, Alexandros A; Petrikkou, Evangelia; Sidiropoulos, Prodromos; Vassilopoulos, Dimitrios

    2018-01-01

    Our primary objective was to study the long-term survival on drug (SOD) of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) treated with golimumab (GLM) in real life settings. This was a retrospective, observational study of all patients treated with GLM in 4 Academic Centres in Greece during a 4-year period (09/2010-06/2014). SOD was analysed using Kaplan-Meier survival analysis, while Cox regression analysis estimating hazard ratios (HRs) for different baseline variables associated with drug discontinuation was performed for each disease. 328 patients (RA: 166, PsA: 82, AS: 80) were included. The estimated SOD at 2 and 3 years was 68% and 62% overall and was better for AS (79% and 76%) compared to RA (69% and 60%, p=0.067) and PsA (58% and 53%, p=0.001) patients; no difference was noted between RA and PsA patients (p=0.204). There was no difference in SOD between biologic-naïve and experienced nor between non-biologic co-treated or GLM monotherapy treated patients. Seropositivity (rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies) was associated with a lower risk for GLM discontinuation by multivariate analysis (HR=0.5, 95% CI=0.0.25-1.1, p=0.05) in RA patients. During 606 patient-years of follow-up, 11 (3.3%) patients discontinued GLM due to adverse events (AE), accounting for 11% of treatment discontinuations. The rates of serious AEs and serious infections were 2.3 and 1.0/100-patient-years, respectively. In this real-life study, GLM showed a high 3-year SOD in patients with inflammatory arthritides with a low rate of discontinuation due to AEs.

  2. 226Ra and 228Ra in scale and sludge samples and their correlation with the chemical composition.

    Science.gov (United States)

    Godoy, José Marcus; da Cruz, Rosana Petinatti

    2003-01-01

    In order to contribute to a future waste management policy related to the presence of technologically enhanced natural occurring radioactive material (TENORM) in the Brazilian petroleum industry, the present work presents the chemical composition and the (226)Ra and (228)Ra content of sludge and scales generated during the offshore E and P petroleum activities in the Campos Basin, the primary offshore oil production region in Brazil. The (226)Ra and (228)Ra content on 36 sludge and scales samples were determined by gamma-spectrometry. Based on X-ray diffractometry results, a chemical analysis schema for these samples was developed. The results have shown that scales are 75% barium and strontium sulfates, with a mean (226)Ra and (228)Ra content of 106 kBq kg(-1) and 78 kBq kg(-1), respectively. On the other hand, sludge samples have a much more complex chemical composition than the scales. The (226)Ra and (228)Ra content in sludge also varies much more than the content observed in the scales samples and ranged from 0.36 to 367 kBq kg(-1) and 0.25 to 343 kBq kg(-1), respectively.

  3. RA Reactor operation and maintenance (I-IX), Part I; Pogon i odrzavanje reaktora RA (I-IX), I Deo

    Energy Technology Data Exchange (ETDEWEB)

    Zecevic, V [Institute of Nuclear Sciences Boris Kidric, Reaktor RA, Vinca, Beograd (Serbia and Montenegro)

    1963-12-15

    The report on RA reactor operation and maintenance for year 1963 is divided in six tasks. This volume contains the introductory report, and three tasks of the final report, namely reactor exploitation, reactivity changes of the RA reactor before repair, planning of refuelling.

  4. RA Reactor operation and maintenance (I-IX), part VII, Task 3.08/04, Refurbishment of the RA reactor

    International Nuclear Information System (INIS)

    Zecevic, V.

    1963-12-01

    This volume covers the following reports concerned with the maintenance and repair work of the RA reactor: repair of the technical water system; maintenance of the transportation equipment; vacuuming and drying during refurbishment; repair and decontamination of the distillation device; and the report on participation of the operational dosimetry division in the RA reactor refurbishment activities

  5. SU-F-J-08: Quantitative SPECT Imaging of Ra-223 in a Phantom

    Energy Technology Data Exchange (ETDEWEB)

    Yue, J; Hobbs, R; Sgouros, G; Frey, E [Johns Hopkins University Baltimore, MD (United States)

    2016-06-15

    Purpose: Ra-223 therapy of prostate cancer bone metastases is being used to treat patients routinely. However, the absorbed dose distribution at the macroscopic and microscopic scales remains elusive, due to the inability to image the small activities injected. Accurate activity quantification through imaging is essential to calculate the absorbed dose in organs and sub-units in radiopharmaceutical therapy, enabling personalized absorbed dose-based treatment planning methodologies and more effective and optimal treatments. Methods: A 22 cm diameter by 20 cm long cylindrical phantom, containing a 3.52 cm diameter sphere, was used. A total of 2.01 MBq of Ra-223 was placed in the phantom with 177.6 kBq in the sphere. Images were acquired on a dual-head Siemens Symbia T16 gamma camera using three 20% full-width energy windows and centered at 84, 154, and 269 keV (120 projections, 360° rotation, 45 s per view). We have implemented reconstruction of Ra-223 SPECT projections using OS-EM (up to 20 iterations of 10 subsets) with compensation for attenuation using CT-based attenuation maps, collimator-detector response (CDR) (including septal penetration, scatter and Pb x-ray modeling), and scatter in the patient using the effective source scatter estimation (ESSE) method. The CDR functions and scatter kernels required for ESSE were computed using the SIMIND MC simulation code. All Ra-223 photon emissions as well as gamma rays from the daughters Rn-219 and Bi-211 were modeled. Results: The sensitivity of the camera in the three combined windows was 107.3 cps/MBq. The visual quality of the SPECT images was reasonably good and the activity in the sphere was 27% smaller than the true activity. This underestimation is likely due to partial volume effect. Conclusion: Absolute quantitative Ra-223 SPECT imaging is achievable with careful attention to compensate for image degrading factors and system calibration.

  6. Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study.

    Science.gov (United States)

    Sokka, Tuulikki; Toloza, Sergio; Cutolo, Maurizio; Kautiainen, Hannu; Makinen, Heidi; Gogus, Feride; Skakic, Vlado; Badsha, Humeira; Peets, Tõnu; Baranauskaite, Asta; Géher, Pál; Ujfalussy, Ilona; Skopouli, Fotini N; Mavrommati, Maria; Alten, Rieke; Pohl, Christof; Sibilia, Jean; Stancati, Andrea; Salaffi, Fausto; Romanowski, Wojciech; Zarowny-Wierzbinska, Danuta; Henrohn, Dan; Bresnihan, Barry; Minnock, Patricia; Knudsen, Lene Surland; Jacobs, Johannes Wg; Calvo-Alen, Jaime; Lazovskis, Juris; Pinheiro, Geraldo da Rocha Castelar; Karateev, Dmitry; Andersone, Daina; Rexhepi, Sylejman; Yazici, Yusuf; Pincus, Theodore

    2009-01-01

    Gender as a predictor of outcomes of rheumatoid arthritis (RA) has evoked considerable interest over the decades. Historically, there is no consensus whether RA is worse in females or males. Recent reports suggest that females are less likely than males to achieve remission. Therefore, we aimed to study possible associations of gender and disease activity, disease characteristics, and treatments of RA in a large multinational cross-sectional cohort of patients with RA called Quantitative Standard Monitoring of Patients with RA (QUEST-RA). The cohort includes clinical and questionnaire data from patients who were seen in usual care, including 6,004 patients at 70 sites in 25 countries as of April 2008. Gender differences were analyzed for American College of Rheumatology Core Data Set measures of disease activity, DAS28 (disease activity score using 28 joint counts), fatigue, the presence of rheumatoid factor, nodules and erosions, and the current use of prednisone, methotrexate, and biologic agents. Women had poorer scores than men in all Core Data Set measures. The mean values for females and males were swollen joint count-28 (SJC28) of 4.5 versus 3.8, tender joint count-28 of 6.9 versus 5.4, erythrocyte sedimentation rate of 30 versus 26, Health Assessment Questionnaire of 1.1 versus 0.8, visual analog scales for physician global estimate of 3.0 versus 2.5, pain of 4.3 versus 3.6, patient global status of 4.2 versus 3.7, DAS28 of 4.3 versus 3.8, and fatigue of 4.6 versus 3.7 (P < 0.001). However, effect sizes were small-medium and smallest (0.13) for SJC28. Among patients who had no or minimal disease activity (0 to 1) on SJC28, women had statistically significantly higher mean values compared with men in all other disease activity measures (P < 0.001) and met DAS28 remission less often than men. Rheumatoid factor was equally prevalent among genders. Men had nodules more often than women. Women had erosions more often than men, but the statistical significance

  7. Preparation and labelling hydroxyapatite with 223Ra and 99mTc

    International Nuclear Information System (INIS)

    Malkova, E.; Micolova, P.; Vlk, M.; Kozempel, J.; Rabyk, M.

    2015-01-01

    The aim of this study was the preparation, studies and investigation of novel nanoparticles suitable for targeted delivery of 223 Ra and 99 mTc. Preliminary experiments were focused on the synthesis of hydroxyapatite nanoparticles (HANPs) and their affinity to 223 Ra and 99m Tc. Technetium-99m ( 99 mTc, T 1 /2 = 6.0 h) is the most commonly used medical radionuclide for diagnostic procedures. Radium-223 is the first -emitting radionuclide approved for targeted radionuclide therapy. The physical half-life of 223 Ra of 11.4 days is providing sufficient time for the synthesis, distribution and administration of the radiopharmaceutical to patients. HANPs labelling yields with 223 Ra were 95 - 100 % and with 99m Tc were 93 - 94 % depending on the reaction conditions. HANPs were studied on FT-IR (Fourier transform infrared spectroscopy), XRPD (X-Ray Powder Diffraction), DLS (Dynamic Light Scattering), and the sizes of nanoparticles were studied at temperatures 80, 120 and 200 grad C. (authors)

  8. [Professional Development Processes of Trainee and Experienced Psychotherapists in Turkey].

    Science.gov (United States)

    Bilican, F Işıl; Soygüt, Gonca

    2015-01-01

    This study explored professional characteristics of psychotherapists in Turkey, examined the changes in their professional developmental processes, and compared the professional characteristics of the trainees and experienced therapists. The participants were 88 psychotherapists, including trainee (N=37) and experienced (N=51) psychotherapists in Turkey. They completed the Development of Psychotherapists International Study-Common Core Questionnaire (DPCCQ), developed by the Collaborative Research Network. The participants identified with the cognitive theoretical orientation most often. 30% of the participants had more than two salient orientations. The most prevalent therapy modality was individual, followed by couples, family, and group psychotherapy. Ongoing supervision rate was 44%. Trainees scored lower on effectiveness in engaging patients in a working alliance, feeling natural while working with patients, effectiveness in communicating their understanding and concern to their patients, and feeling confident in their role as a therapist. Experienced therapists made changes in the therapeutic contract and invited collaboration from families more compared to the trainees. 63% of the variance in Healing Involvement was explained by Overall Career Development, Currently Experienced Growth, being influenced by the humanistic approach, and the impact of the main therapeutic environment; 26% of the variance in Stressful Involvement was explained by the length of official supervision received and having control over the length of therapy sessions. Therapists were more cognitively oriented, less eclectic, and had less supervision compared to their international counterparts. Experienced therapists were more flexible, natural, and confident than the trainees. Supervision, a supportive work environment, the humanistic approach, and investing in career development were essential to providing a healing experience.

  9. 226Ra and 228Ra activities associated with agricultural drainage ponds and wetland ponds in the Kankakee Watershed, Illinois-Indiana, USA

    International Nuclear Information System (INIS)

    Sidle, W.C.; Shanklin, D.; Lee, P.Y.; Roose, D.L.

    2001-01-01

    Background radioactivity is elevated in many agricultural drainage ponds and also constructed wetland ponds in the Kankakee watershed. During 1995-1999, gross-α and -β activities were measured up to 455 and 1650 mBq L -1 , respectively. 226 Ra and 228 Ra averaged 139 and 192 mBq L -1 in controlled drainage ponds compared to 53 and 58 mBq L -1 for 226 Ra and 228 Ra, respectively, in native wetland ponds. Analyses of applied ammonium phosphate fertilizers near both native and controlled ponds indicate comparable 226 Ra/ 228 Ra and 228 Ra/ 232 Th activity ratios with only the surface waters in the controlled ponds. For example, 226 Ra/ 228 Ra activity ratios in controlled ponds ranged from 0.79 to 0.91 and group with a local fertilizer batch containing FL phosphate compounds with 226 Ra/ 228 Ra activity ratios of 0.83-1.04. Local soils of the Kankakee watershed have 226 Ra/ 228 Ra activity ratios of 0.54-0.70. Calculated Ra fluxes of waters, in drainage ditches associated with these controlled ponds, for 226 Ra ranged from 0.77 to 9.00 mBq cm -2 d -1 and for 228 Ra ranged from 1.22 to 8.43 mBq cm -2 d -1 . Ra activity gradients were measured beneath these controlled ponds both in agricultural landscapes and in constructed wetlands, all being associated with drainage ditches. Ra had infiltrated to the local water table but was below regulatory maximum contaminant limits. Still, measurable Ra activity was measured downgradient of even the constructed wetlands in the Kankakee watershed, suggesting that the attenuation of Ra was low. However, no Ra excess was observed in the riparian zone or the Kankakee River downgradient of the native wetland ponds

  10. RA reactor exploitation, task 3.08/01; Zadatak 3.08/01 - Eksploatacija reaktora RA

    Energy Technology Data Exchange (ETDEWEB)

    Zecevic, V [Institute of Nuclear Sciences Boris Kidric, Reaktor RA, Vinca, Beograd (Serbia and Montenegro)

    1963-12-15

    During 1963 the RA reactor was operated for 1852 hours at mean power of 5.7 MW (total power production was 10716 MWh). Reactor was used for irradiation according to the demand of 356 users, and 15 experiments. The reason for decreased operation in comparison with the previous year was repair of all the reactor equipment and decontamination of the heavy water system. This report contains detailed data about reactor power, reactivity changes and fuel burnup. Mean monthly usage of the reactor experimental channels as well as samples which were irradiated are part of this report.

  11. RA research reactor - properties and experimental capabilities; Istrazivacki reaktor RA - Tehnicke karakteristike i eksploatacione mogucnosti

    Energy Technology Data Exchange (ETDEWEB)

    Milosevic, M; Martinc, R [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1978-05-15

    The brief survey of the Reactor RA exploitation experience, as well as the reactor equipment state, after 18 years of operation is presented. The results of efforts spent on reactor characteristics improvement in order to ensure safe and reliable reactor operation for next 15-20 years, are described. Prikazani su fragmenti iz eksploatacije reaktora kao i stanje opreme, posle 18 godina rada. Na kraju je dat prikaz sta je preduzeto i sta se preduzima da se poboljsaju karakteristike i poveca sigurnost i bezbednost rada za sledecih 15-20 godina.

  12. Measurement of neutrons in the RA reactor cell; Merenje neutrona u elementarnoj celiji reaktora RA

    Energy Technology Data Exchange (ETDEWEB)

    Raisic, N; Bosevski, T [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1961-12-15

    A special experimental device was constructed for measuring the neutron flux distribution in the RA reactor cell. This device simulated the reactor cell in order to avoid disturbance in the reactor core. It was made of an aluminium cylindrical vessel having outer diameter same as the vertical experimental channel and contained three fuel slugs. Hole was made in through the center of the fuel slugs and a copper wire was placed in the hole for measuring the thermal neutron flux distribution. It was placed in the experimental channel VK-5 in the location of highest neutron flux. Handling of samples for irradiation was quite simple.

  13. Seasonal variations in 228Ra/226Ra ratio within coastal waters of the Sea of Japan: implications for water circulation patterns in coastal areas

    International Nuclear Information System (INIS)

    Inoue, M.; Tanaka, K.; Watanabe, S.; Kofuji, H.; Yamamoto, M.; Komura, K.

    2006-01-01

    In this study, low-background γ-spectrometry was used to determine the 228 Ra/ 226 Ra ratio of 131 coastal water samples from various environments around Honshu Island, Japan (mainly around Noto Peninsula) at 1-3 month intervals from April 2003 until September 2005. Spatial variation in 228 Ra/ 226 Ra ratios was also assessed by analyzing 34 coastal water samples from five areas within the Sea of Japan during May and June 2004. The 228 Ra/ 226 Ra ratio of coastal water from all sites around Noto Peninsula shows seasonal variation, with minimum values during summer ( 228 Ra/ 226 Ra = 0.7) and maximum values during autumn-winter ( 228 Ra/ 226 Ra = 1.7-2). This seasonal variation is similar to that recorded for coastal water between Tsushima Strait and Noto Peninsula. The measured lateral variation in 228 Ra/ 226 Ra ratios within coastal water between Tsushima Strait and Noto Peninsula is only minor (0.5-0.7; May-June 2004). Coastal waters from two other sites (Pacific shore and Tsugaru Strait, north Honshu) show no clear seasonal variation in 228 Ra/ 226 Ra ratio. These measured variations in 228 Ra/ 226 Ra ratio, especially the temporal variations, have important implications for seasonal changes in patterns of coastal water circulation within the Sea of Japan

  14. Hydroxyapatite particles as carriers for "2"2"3Ra

    International Nuclear Information System (INIS)

    Vasiliev, A.N.

    2017-01-01

    Systematic investigation of optimal conditions for preparation and in vitro stability of HAP particles labeled with "2"2"3Ra, that could be considered as promising candidates for targeted α-therapy, has been carried out. Two different approaches to HAP labelling were tested: sorption of Ra"2"+ on pre-synthesized HAP-particles and incorporation of Ra"2"+ into the structure of HAP during its synthesis. Two textural forms of HAP particles were used-nanoparticles and particles with the diameter of 350 ± 20 μm. Kinetics of "2"2"3Ra sorption on HAP of different particle size and desorption in 0.9 % NaCl solution were studied. The influence of solution acidity and solid to liquid phase ratio on sorption of Ra was evaluated and the sorption yield up to 98 % was achieved. It was found that the optimal conditions for the sorption included synthesis of HAP nanoparticles in the presence of "2"2"3Ra at pH values of 4-7 followed by annealing at 900 deg C. In this case subsequent cumulative desorption of Ra was <5 % of initial activity. (author)

  15. Modeling the Energy Performance of LoRaWAN.

    Science.gov (United States)

    Casals, Lluís; Mir, Bernat; Vidal, Rafael; Gomez, Carles

    2017-10-16

    LoRaWAN is a flagship Low-Power Wide Area Network (LPWAN) technology that has highly attracted much attention from the community in recent years. Many LoRaWAN end-devices, such as sensors or actuators, are expected not to be powered by the electricity grid; therefore, it is crucial to investigate the energy consumption of LoRaWAN. However, published works have only focused on this topic to a limited extent. In this paper, we present analytical models that allow the characterization of LoRaWAN end-device current consumption, lifetime and energy cost of data delivery. The models, which have been derived based on measurements on a currently prevalent LoRaWAN hardware platform, allow us to quantify the impact of relevant physical and Medium Access Control (MAC) layer LoRaWAN parameters and mechanisms, as well as Bit Error Rate (BER) and collisions, on energy performance. Among others, evaluation results show that an appropriately configured LoRaWAN end-device platform powered by a battery of 2400 mAh can achieve a 1-year lifetime while sending one message every 5 min, and an asymptotic theoretical lifetime of 6 years for infrequent communication.

  16. Modeling the Energy Performance of LoRaWAN

    Directory of Open Access Journals (Sweden)

    Lluís Casals

    2017-10-01

    Full Text Available LoRaWAN is a flagship Low-Power Wide Area Network (LPWAN technology that has highly attracted much attention from the community in recent years. Many LoRaWAN end-devices, such as sensors or actuators, are expected not to be powered by the electricity grid; therefore, it is crucial to investigate the energy consumption of LoRaWAN. However, published works have only focused on this topic to a limited extent. In this paper, we present analytical models that allow the characterization of LoRaWAN end-device current consumption, lifetime and energy cost of data delivery. The models, which have been derived based on measurements on a currently prevalent LoRaWAN hardware platform, allow us to quantify the impact of relevant physical and Medium Access Control (MAC layer LoRaWAN parameters and mechanisms, as well as Bit Error Rate (BER and collisions, on energy performance. Among others, evaluation results show that an appropriately configured LoRaWAN end-device platform powered by a battery of 2400 mAh can achieve a 1-year lifetime while sending one message every 5 min, and an asymptotic theoretical lifetime of 6 years for infrequent communication.

  17. Behavior of 226Ra in the Mississippi River mixing zone

    Science.gov (United States)

    Moore, Daniel G.; Scott, Martha R.

    1986-12-01

    The behavior of 226Ra in the Mississippi River mixing zone is strongly nonconservative and includes desorption similar to that reported for the Hudson, Pee Dee, and Amazon rivers. However, dissolved and desorbed 226Ra concentrations in the Mississippi are 2 to 5 times greater than in the other rivers at the same salinity. Radium concentrations vary inversely with the water discharge rate. The 226Ra desorption maximum occurs at a salinity of 5.0, much lower than the 18 to 28 salinity values for the maxima of the other three rivers. High concentrations of dissolved 226Ra (up to 82 dpm per 100 L) and the low salinity values for the desorption maximum in the Mississippi River result from three major factors. Suspended sediments include a large fraction of montmorillonite, which gives the sediment a high cation exchange capacity, 0.54 meq/g. The average suspended sediment load is large, about 510 mg/L, and contains 1.9 dpm/g desorbable 226Ra. The dissolved 226Ra river water end-member (9.6 dpm per 100 L) is higher than in surface seawater. The annual contribution of 226Ra to the ocean from the Mississippi River is 3.7 × 1014 dpm/yr, based on data from three cruises. Evidence of flux of 226Ra from estuarine and shelf sediments is common in vertical profile sampling of the deltaic waters but is not reflected in calculations made with an "apparent" river water Ra value extrapolated to zero salinity.

  18. Mitigating Inter-Network Interference in LoRa Networks

    OpenAIRE

    Voigt, Thiemo; Bor, Martin; Roedig, Utz; Alonso, Juan

    2017-01-01

    Long Range (LoRa) is a popular technology used to construct Low-Power Wide-Area Network (LPWAN) networks. Given the popularity of LoRa it is likely that multiple independent LoRa networks are deployed in close proximity. In this situation, neighbouring networks interfere and methods have to be found to combat this interference. In this paper we investigate the use of directional antennae and the use of multiple base stations as methods of dealing with inter-network interference. Directional a...

  19. Discontinuation of Biologic Therapy in Rheumatoid Arthritis: Analysis from the Corrona RA Registry.

    Science.gov (United States)

    Strand, Vibeke; Miller, Paul; Williams, Setareh A; Saunders, Katherine; Grant, Shannon; Kremer, Joel

    2017-12-01

    Despite the availability of multiple effective therapies, discontinuation/switching of treatment is common for many patients with rheumatoid arthritis (RA). This study was designed to examine initiation of biologic disease-modifying anti-rheumatic drugs (bDMARDs) within the Consortium of Rheumatology Researchers of North America (Corrona) RA Registry, and characterize reasons for discontinuation. Inclusion criteria were: Corrona-registered adults (≥18 years) with RA (2002-2011); age of RA onset: ≥16 years; ≥6 months' follow-up after initiation of first/subsequent bDMARD. Patients receiving both tumor necrosis factor antagonists and non-TNF antagonists were included. Treatment discontinuation was defined as first report of stopping initial therapy or initiation of new bDMARD at/between visits, using a follow-up physician questionnaire. Overall, 6209 patients met inclusion criteria and 80.7% received TNF antagonists. Median time to discontinuation/change of therapy was 25.1 months (26.5 months with TNF antagonists vs. 20.5 months with non-TNF antagonists; log-rank p < 0.0001); 82.2, 67.3, and 51.1% of patients remained on therapy at 6, 12, and 24 months, respectively. Reasons for discontinuation were captured for 49.2% of patients, including: loss of efficacy (35.8%); physician preference (27.8%); safety (20.1%); patient preference (17.9%); and no access to treatment (9.0%). Baseline factors with greatest correlation to discontinuation were modified Health Assessment Questionnaire scores, patient-reported anxiety/depression, initiation of bDMARD treatment in 2007-2010 versus 2002-2003, and Clinical Disease Activity Index scores. Almost one-third of patients in the US discontinue currently available bDMARD therapies for RA by 12 months and almost half by 24 months, most commonly due to loss of efficacy. Corrona LLC and MedImmune.

  20. RA research reactor, Part 1, Operation and maintenance of the RA nuclear reactor for 1985

    International Nuclear Information System (INIS)

    Sotic, O.; Martinc, R.; Cupac, S.; Sulem, B.; Badrljica, R.; Majstorovic, D.; Sanovic, V.

    1985-01-01

    According to the plan, RA reactor was to be in operation in mid September 1985. But, since the building of the emergency cooling system, nor the reconstruction of the existing special ventilation system were not finished until the end of August reactor was not operated during 1985. During the previous four years reactor operation was limited by the temporary operating license issued by the Committee of Serbian ministry for health and social care, which was cancelled in August 1984. The reason was the non existing emergency cooling system and lack of appropriate filters in the special ventilation system. This temporary license has limited the reactor power to 2 MW from 1981-1984. Control and maintenance of the reactor instrumentation and tools was done regularly but dependent on the availability of the spare parts. In order to enable future reliable operation of the RA reactor, according to new licensing regulations, during 1984, three major tasks have started: building of the new emergency system, reconstruction of the existing ventilation system, and renewal of the reactor instrumentation. IAEA has approved the amount of 1,300,000 US dollars for the renewal of the instrumentation [sr

  1. Effects of interleukin-1 receptor antagonist (IL-1Ra) gene 86 bp VNTR polymorphism on recurrent pregnancy loss: a case-control study.

    Science.gov (United States)

    Hajizadeh, Yasamin Sayed; Emami, Elina; Nottagh, Marina; Amini, Zahra; Maroufi, Nazila Fathi; Azimian, Saba Haj; Isazadeh, Alireza

    2017-05-26

    Objective Recurrent pregnancy loss (RPL) is a heterogeneous disease which is defined as two or more consecutive fetal losses during early pregnancy. Interleukin-1 receptor antagonist (IL-1Ra) is a anti-inflammatory cytokine, which inhibits IL-1 activity by binding to its receptors. The aim of this study was to investigate the association between RPL and IL-1Ra intron 2 polymorphism (86 bp VNTR) in Iranian women. Materials and methods In this case control study, genetic polymorphism was studied in 140 RPL patients and 140 healthy women as controls. Genomic DNA was extracted from the blood samples and polymorphism analysis was performed using the polymerase chain reaction (PCR) method. Finally, the data obtained were analyzed by statistical software. Results We found an increased frequency of the IL-1Ra 1/1 genotype in the case group compared to the control group. Whereas, the frequency of IL-1Ra genotype 1/2 was higher in control group than in the case group. However, we did not observe an association between IL-1Ra 86 bp VNTR polymorphism in intron 2 and RPL patients (p > 0.05). Conclusion IL-1Ra VNTR polymorphism may not be a genetic factor for RPL. However, investigation of IL-1Ra polymorphism was recommended in other populations and patients with recurrent pregnancy loss.

  2. Concentrations and activity ratios of 228Ra and 226Ra in surface seawater along the Pacific coast of Japan

    International Nuclear Information System (INIS)

    Ohta, T.; Mahara, Y.; Kubota, T.; Sato, J.; Gamo, T.

    2011-01-01

    We measured the 228 Ra/ 226 Ra activity ratios in surface seawater along the Pacific coast of Japan at five ports around the island of Izu-Oshima (n = 29), at Atami in Sagami Bay (n = 13), and at Umizuri Park in Tokyo Bay (n = 14). We also conducted these measurements along a transect from the open Pacific Ocean across the Kuroshio to the mouth of Tokyo Bay (n = 7). The activity ratios decreased with increasing salinity of the sampling sites. The 228 Ra/ 226 Ra activity ratios in surface seawater along the coast gradually decreased after at the end of autumn and were lowest in winter and the beginning of spring. The surface salinity along the coast decreased from summer into autumn and increased from winter to the beginning of spring. The activity ratios decreased with the increase of salinity. The variation in activity ratios at the three coastal sites is possibly caused by differing contributions of surface seawater from the Kuroshio and surrounding open ocean. The different patterns and ranges of variation in the 228 Ra/ 226 Ra activity ratios in surface seawater at Izu-Oshima, Atami, and Umizuri Park may reflect both the amount of water from the Kuroshio and vicinity, and the local bathymetry, because continental shelf sediment is the source of Ra isotopes in surface seawater. (orig.)

  3. Problems experienced by older people when opening medicine packaging.

    Science.gov (United States)

    Philbert, Daphne; Notenboom, Kim; Bouvy, Marcel L; van Geffen, Erica C G

    2014-06-01

    Medicine packages can cause problems in daily practice, especially among older people. This study aimed to investigate the prevalence of problems experienced by older people when opening medicine packaging and to investigate how patients manage these problems. A convenience sample of 30 community pharmacies participated in this study. They selected a systematic sample of 30 patients over 65 years old with a recent omeprazole prescription, and a questionnaire was administered by telephone for at least 10 patients per pharmacy. A total of 317 patients completed the questionnaire. They received their omeprazole in a bottle (n = 179, 56.5%), push-through blister pack (n = 102, 32.2%) or peel-off blister pack (n = 36, 11.4%). Some 28.4% of all patients experienced one or more problems with opening their omeprazole packaging; most problems occurred with peel-off blisters (n = 24, 66.7% of all respondents using peel-off blisters), followed by push-through blisters (n = 34, 33.3%) and finally bottles (n = 32, 17.9%). The risk of experiencing problems with peel-off blisters and push-through blisters was higher [relative risk 3.7 (95% confidence interval 2.5-5.5) and 1.9 (1.2-2.8), respectively] than the risk of experiencing problems with opening bottles. Two-thirds of respondents reported management strategies for their problems. Most were found for problems opening bottles (n = 24, 75%), followed by push-through blisters (n = 24, 70.6%) and peel-off blisters (n = 14, 58.3%). One in four patients over 65 experienced difficulties opening their omeprazole packaging and not all of them reported a management strategy for their problems. Manufacturers are advised to pay more attention to the user-friendliness of product packaging. In addition, it is important that pharmacy staff clearly instruct patients on how to open their medicine packaging, or assist them in choosing the most appropriate packaging. © 2013 Royal Pharmaceutical Society.

  4. Development of a liquid scintillation method for in vitro determination of 226Ra and 228 Ra in bioassay samples

    International Nuclear Information System (INIS)

    Fernandes, Paulo Cesar P.; Sousa, Wanderson O.; Juliao, Ligia M.Q.C.; Dantas, Bernardo M.

    2011-01-01

    Radium isotopes are dispersed in the environment according to their physicochemical characteristics. The intake of 226 Ra and 228 Ra in humans can occur by inhalation and ingestion and the risk of internal exposure are related to their long half-lives, characteristics of the emission and biokinetics of the isotopes in the human body. The goal of this work is to develop a methodology for the analysis of 226 Ra and 228 Ra in excreta samples (urine and feces), using liquid scintillation technique. Excreta samples were provided by non-exposed humans for the purpose of standardizing the methodology and the establishment of a background level of radium excretion. Radium isotopes were concentrated and separated from the constituents of the sample by co-precipitation with barium sulphate. The precipitate of Ba(Ra)SO 4 was filtrated and weighted for the determination of the chemical yield. The filter containing the precipitate was transferred to a scintillation vial. In the scintillation vial, 8 mL of water, 8 mL of Instagel XF and 4 mL of UltimaGold were added, forming a gel suspension, after stirring the solution. The 226 Ra and 228 Ra activities were determined 21 days after the precipitation of samples. The samples were counted in a liquid scintillation spectrometer. The technique presented adequate sensitivity and reproducibility for the analysis of urine and feces. The activities of 226 Ra and 228 Ra in excreta samples provide useful information for the identification of the main route of intake and for the assessment of the internal exposure of occupationally exposed workers and inhabitants of high background areas. (author)

  5. Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study.

    Directory of Open Access Journals (Sweden)

    Piero Ruscitti

    Full Text Available Several studies showed the close relationship between Rheumatoid Arthritis (RA and cerebro-cardiovascular events (CVEs and subclinical atherosclerosis. In this study, we investigated the occurrence of CVEs and subclinical atherosclerosis during the course of RA and we evaluated the possible role of both traditional cardiovascular (CV and disease related risk factors to predict the occurrence of new CVEs and the onset of subclinical atherosclerosis.We designed a single centre, bias-adjusted, prospective, observational study to investigate, in a homogeneous subset of RA patients, the occurrence of new onset of CVEs and subclinical atherosclerosis. Statistical analyses were performed to evaluate the role of traditional CV and disease-related risk factors to predict the occurrence of new CVEs and subclinical atherosclerosis.We enrolled 347 RA patients prospectively followed for 12 months. An increased percentage of patients experienced CVEs, developed subclinical atherosclerosis and was affected by systemic arterial hypertension (SAH, type 2 diabetes mellitus and metabolic syndrome (MS, at the end of follow up. Our analysis showed that the insurgence of both SAH and MS, during the follow up, the older age, the CVE familiarity and the lack of clinical response, were associated with a significantly increased risk to experience CVEs and to develop subclinical atherosclerosis.Our study quantifies the increased expected risk for CVEs in a cohort of RA patients prospectively followed for 1 year. The occurrence of both new CVEs and subclinical atherosclerosis in RA patients may be explained by inflammatory burden as well as traditional CV risk factors.

  6. Ra: The Sun for Science and Humanity

    Science.gov (United States)

    1996-01-01

    To guide the development of the Ra Strategic Framework, we defined scientific and applications objectives. For our primary areas of scientific interest, we choose the corona, the solar wind, the Sun's effect on the Earth, and solar theory and model development. For secondary areas of scientific interest, we selected sunspots, the solar constant, the Sun's gravitational field, helioseismology and the galactic cosmic rays. We stress the importance of stereoscopic imaging, observations at high spatial, spectral, and temporal resolutions, as well as of long duration measurements. Further exploration of the Sun's polar regions is also important, as shown already by the Ulysses mission. From an applications perspective, we adopted three broad objectives that would derive complementary inputs for the Strategic Framework. These were to identify and investigate: possible application spin-offs from science missions, possible solar-terrestrial missions dedicated to a particular application, and possible future applications that require technology development. The Sun can be viewed as both a source of resources and of threats. Our principal applications focus was that of threat mitigation, by examining ways to improve solar threat monitoring and early warning systems. We compared these objectives to the mission objectives of past, current, and planned international solar missions. Past missions (1962-1980) seem to have been focused on improvement of scientific knowledge, using multiple instrument spacecraft. A ten year gap followed this period, during which the results from previous missions were analyzed and solar study programmes were prepared in international organizations. Current missions (1990-1996) focus on particular topics such as the corona, solar flares, and coronal mass ejections. In planned missions, Sun/Earth interactions and environmental effects of solar activity are becoming more important. The corona is the centre of interest of almost all planned missions

  7. RA Research reactor, Annual report 1969

    International Nuclear Information System (INIS)

    Milosevic, D. et al.

    1969-12-01

    During 1969, the RA Reactor was operated at nominal power of 6.5 MW for 200 days, and 15 days at lower power levels. Total production mounted to 31131 MWh which is 3.77% higher than planned. Reactor was used for irradiation and experiments according to the demand of 463 users from the Institute and 63 external users. This report contains detailed data about reactor power and experiments performed in 1969. It is concluded that the reactor operated successfully according to the plan. If there had been no problems with power supply during last three months and Danube low water level in September and October the past year would have been the most successful up to now. The number od scram shutdowns was not higher than during past two years in spite of the difficulties in the last quarter. There were three incidents which caused higher personnel exposure during operation. One, was the destruction of the canner with silver (because the time spent in the core was too long) which caused the surface contamination of the platform, the background radiation was 10 to 100 times higher than regular. The other two cases were caused by failure of the device for handling the fuel slugs in the fuel channels during refuelling. Reactor refuelling was done four times during 1969, and 499 fresh fuel slugs were used. Refuelling applied the approach of 'mixing' the fresh fuel slugs with the 'old' fuel slugs in the fuel channel. Decontamination of surfaces was on the same level as previously in spite of the problems with silver. Since two staff members have left, the present number od employees is now the minimum needed for reactor operation and maintenance. It is stated that the operation of components and equipment is on sufficiently high level after ten years of reactor operation. The action plan for 1970 is made according to the same principles as in previous four years but the planned production is decreased to 25000 MWh, because control of important components is needed after ten

  8. Safety shutdowns and failures of the RA reactor equipment; Sigurnosna zaustavljanja i kvarovi opreme na reaktoru RA

    Energy Technology Data Exchange (ETDEWEB)

    Mitrovic, S [Institut za nuklearne nauke ' Boris Kidric' , Vinca, Belgrade (Yugoslavia)

    1966-07-01

    This report is an attempt of statistical analysis of the failures occurred during RA reactor operation. A list of failures occurred on the RA equipment during 1965 is included. Failures were related to the following systems: dosimetry system (22%), safety and control system (7%), heavy water system (2%), technical water (4%), helium system (2%), measuring instruments (30%), transport, ventilation, power supply systems (32%). A review of safety shutdowns from 1962 to 1966 is included as well, as a comparison with three similar reactors. Although the number of events used for statistical analysis was not adequate, it has been concluded that RA reactor operation was stable and reliable.

  9. The rapid mode of calcium uptake into heart mitochondria (RaM): comparison to RaM in liver mitochondria.

    Science.gov (United States)

    Buntinas, L; Gunter, K K; Sparagna, G C; Gunter, T E

    2001-04-02

    A mechanism of Ca(2+) uptake, capable of sequestering significant amounts of Ca(2+) from cytosolic Ca(2+) pulses, has previously been identified in liver mitochondria. This mechanism, the Rapid Mode of Ca(2+) uptake (RaM), was shown to sequester Ca(2+) very rapidly at the beginning of each pulse in a sequence [Sparagna et al. (1995) J. Biol. Chem. 270, 27510-27515]. The existence and properties of RaM in heart mitochondria, however, are unknown and are the basis for this study. We show that RaM functions in heart mitochondria with some of the characteristics of RaM in liver, but its activation and inhibition are quite different. It is feasible that these differences represent different physiological adaptations in these two tissues. In both tissues, RaM is highly conductive at the beginning of a Ca(2+) pulse, but is inhibited by the rising [Ca(2+)] of the pulse itself. In heart mitochondria, the time required at low [Ca(2+)] to reestablish high Ca(2+) conductivity via RaM i.e. the 'resetting time' of RaM is much longer than in liver. RaM in liver mitochondria is strongly activated by spermine, activated by ATP or GTP and unaffected by ADP and AMP. In heart, RaM is activated much less strongly by spermine and unaffected by ATP or GTP. RaM in heart is strongly inhibited by AMP and has a biphasic response to ADP; it is activated at low concentrations and inhibited at high concentrations. Finally, an hypothesis consistent with the data and characteristics of liver and heart is presented to explain how RaM may function to control the rate of oxidative phosphorylation in each tissue. Under this hypothesis, RaM functions to create a brief, high free Ca(2+) concentration inside mitochondria which may activate intramitochondrial metabolic reactions with relatively small amounts of Ca(2+) uptake. This hypothesis is consistent with the view that intramitochondrial [Ca(2+)] may be used to control the rate of ADP phosphorylation in such a way as to minimize the probability of

  10. Seasonal changes in submarine groundwater discharge to coastal salt ponds estimated using 226Ra and 228Ra as tracers

    Science.gov (United States)

    Hougham, A.L.; Moran, S.B.; Masterson, J.P.; Kelly, R.P.

    2008-01-01

    Submarine groundwater discharge (SGD) to coastal southern Rhode Island was estimated from measurements of the naturally-occurring radioisotopes 226Ra (t1/2 = 1600??y) and 228Ra (t1/2 = 5.75??y). Surface water and porewater samples were collected quarterly in Winnapaug, Quonochontaug, Ninigret, Green Hill, and Pt. Judith-Potter Ponds, as well as nearly monthly in the surface water of Rhode Island Sound, from January 2002 to August 2003; additional porewater samples were collected in August 2005. Surface water activities ranged from 12-83??dpm 100??L- 1 (60??dpm = 1??Bq) and 21-256??dpm 100??L- 1 for 226Ra and 228Ra, respectively. Porewater 226Ra activities ranged from 16-736??dpm 100??L- 1 (2002-2003) and 95-815??dpm 100??L- 1 (2005), while porewater 228Ra activities ranged from 23-1265??dpm 100??L- 1. Combining these data with a simple box model provided average 226Ra-based submarine groundwater fluxes ranging from 11-159??L m- 2 d- 1 and average 228Ra-derived fluxes of 15-259??L m- 2 d- 1. Seasonal changes in Ra-derived SGD were apparent in all ponds as well as between ponds, with SGD values of 30-472??L m- 2 d- 1 (Winnapaug Pond), 6-20??L m- 2 d- 1 (Quonochontaug Pond), 36-273??L m- 2 d- 1 (Ninigret Pond), 29-76??L m- 2 d- 1 (Green Hill Pond), and 19-83??L m- 2 d- 1 (Pt. Judith-Potter Pond). These Ra-derived fluxes are up to two orders of magnitude higher than results predicted by a numerical model of groundwater flow, estimates of aquifer recharge for the study period, and values published in previous Ra-based SGD studies in Rhode Island. This disparity may result from differences in the type of flow (recirculated seawater versus fresh groundwater) determined using each technique, as well as variability in porewater Ra activity. ?? 2007 Elsevier B.V. All rights reserved.

  11. High Ra, high Pr convection with viscosity gradients

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. High Ra, high Pr convection with viscosity gradients. Weak upward flow through mesh. Top fluid more viscous. Unstable layer Instability Convection.

  12. The distribution of 226Ra in the Atlantic Ocean

    International Nuclear Information System (INIS)

    Broecker, W.S.; Goddard, J.; Sarmiento, J.L.

    1976-01-01

    Based on results obtained during the GEOSECS program the primary features of the distribution of 226 Ra in the Atlantic Ocean can be defined. Outside the Antarctic no significant variation has been found in the 226 Ra content of surface waters. Eighty samples yield an average of 7.4 dpm/100 kg (normalized to a salinity of 35.00%). Deep waters in the central Atlantic have 226 Ra contents several dpm/100 kg higher than expected from the mixing of Antarctic Bottom Water (21.3 dpm/100 kg) and basal North Atlantic Deep Water (10.3 dpm/100 kg). These excesses correlate well with deficiencies in O 2 and excesses in SiO 2 . The intermediate water 226 Ra maximum in the South Atlantic is associated with the inflow of low-oxygen Circumpolar Intermediate Water beneath the Antarctic Intermediate Water. (Auth.)

  13. Tehnikaromud saab peagi tasuta ära anda / Urmas Tooming

    Index Scriptorium Estoniae

    Tooming, Urmas

    2005-01-01

    13. augustist saab vana elektroonikat tasuta ära anda. MTÜ Eesti Elektroonikaromu on juba loonud selleks üle Eesti 44 kogumispunkti, EES-Ringlus ühingus endale konkurenti ei näe. Lisa: Vana tehnika

  14. 226Ra adsorption on active coals from waste waters

    International Nuclear Information System (INIS)

    Panturu, E.; Georgescu, D.P.; Serban, N.; Filip, D.; Radulescu, R.

    2000-01-01

    During the mining and extraction of uranium, the principle means of protection measurement is to prevent uranium and its products diffusing into the environment. The main carriers of radioactive elements in the environment are air and water. Therefore, reduction of the pollution at a uranium mine can be achieved by the treatment of waste waters contaminated with 226 Ra Radium contaminated waste waters represent a major biological risk. This paper presents the results of the study of the sorption of 226 Ra on active coal mechanisme and the influence of the physical and chemical characteristics of fluid. The 226 Ra removal from the residue pond water at the uranium ore processing plant was studied using eight types of indigenous active coals. The experimental results for each type of active coal and their effect on removal of 226 Ra from waste waters are presented in this paper. (author)

  15. Radiosensitivity and thermoresistance of rat RA-2 rhabdomyosarcoma cells

    International Nuclear Information System (INIS)

    Fedorova, E.V.; Trusova, V.D.; Vakhtin, Yu.B.

    1990-01-01

    The data obtained show that clonogenic RA-2T cells are 2-3 times more thermoresistant than clonogenic cells of the original thermosensitive RA-2T strain as estimated by D 0 value upon heating up to 43-45 deg C. After X-irradiation of rat rhabdomyosarcoma, a decrease in the capacity of forming pulmonary colonies is more pronounced in cells of the thermosensitive RA-2 strain cells than in those of the thermoresistant strain RA-2T (D 0 =1.6 Gy and D 0 =2.4 Gy, respectively). In all appearance, within one and the same tumor cell population, the hereditarily thermoresistant cells are more radioresistant than the thermosensitive ones

  16. RA reactor operation and maintenance in 1992, Part 1

    International Nuclear Information System (INIS)

    Sotic, O.; Cupac, S.; Sulem, B.; Zivotic, Z.; Majstorovic, D.; Tanaskovic, M.

    1992-01-01

    During 1992 Ra reactor was not in operation. All the activities were fulfilled according to the previously adopted plan. Basic activities were concerned with revitalisation of the RA reactor and maintenance of reactor components. All the reactor personnel was busy with reconstruction and renewal of the existing reactor systems and building of the new systems, maintenance of the reactor devices. Part of the staff was trained for relevant tasks and maintenance of reactor systems [sr

  17. 226Ra bioavailability of plants at urgeirica uranium mill tailings

    International Nuclear Information System (INIS)

    Madruga, M.J.; Brogueira, A.

    2002-01-01

    Large amounts of solid wastes (tailings) resulting from the exploitation and treatment of uranium ore at the Urgeirica mine (north of Portugal) have been accumulated in dams (tailing ponds). To reduce the dispersion of natural radionuclides into the environment some dams were revegetated with eucalyptus (Eucalyptus globolus) and pines (Pinus pinea). Besides, some shrubs (Cytisus s.p.) are growing at some of the dams. The objective of this study is to determine the 226 Ra bioavailability from uranium mill tailings through the quantification of the total and available fraction of radium in the solid wastes and to estimate its transfer to the plants growing on the tailing piles. Plants and solid waste samples were randomly collected at dams. Activity concentration of 226 Ra in plants (aerial part and roots) and solid wastes were measured by gamma spectrometry. The exchangeable fraction of radium in solid wastes was quantified using one single step extraction with 1 mol dm -3 ammonium acetate (pH=7) or 1 mol dm -3 calcium chloride solutions. The results obtained for the 226 Ra uptake by plants show that 226 Ra concentration ratios for eucalyptus and pines decrease at low 226 Ra concentration in the solid wastes and appear relatively constant at higher radium concentrations. For shrubs, the concentration ratios increase at higher 226 Ra solid waste concentrations approaching a saturation value. Percentage values of 16.0±8.3 and 12.9±8.9, for the fraction of radium extracted from the solid wastes, using 1 mol dm -3 ammonium acetate or calcium chloride solutions respectively, were obtained. The 226 Ra concentration ratios determined on the basis of exchangeable radium are one order of magnitude higher than those based on total radium. It can be concluded that, within the standard error values, more consistent 226 Ra concentration ratios were obtained when calculated on the basis of available radium than when total radium was considered, for all the dams. (author)

  18. RA Research nuclear reactor, Part II - radiation protection at the RA nuclear reactor in 1984; Istrazivacki nuklearni reaktor RA - Deo II - zastita od zracenja kod nuklearnog reaktora RA u 1984. godini

    Energy Technology Data Exchange (ETDEWEB)

    Ninkovic, M; Ajdacic, N; Zaric, M; Vukovic, Z [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Yugoslavia)

    1984-12-15

    Radon protection tasks which enable safe operation of the RA reactor, and are defined according the the legal regulations and IAEA safety recommendations are sorted into four categories in this report: (1) Control of the working environment, dosimetry at the RA reactor; (2) Radioactivity control in the vicinity of the reactor and meteorology measurements; (3) Collecting and treatment of fluid effluents; and (4) radioactive wastes, decontamination and actions. Each category is described as a separate annex of this report.

  19. On the octupole deformation in Ra-Th region

    International Nuclear Information System (INIS)

    Rozmej, P.; Boening, K.; Sobiczewski, A.

    1986-03-01

    The problem of the existence of a stable octupole deformation in Ra-Th region has been reinvestigated using a Nilsson single-particle potential with a newly fitted set of parameters, which reproduce the spins of the ground states of odd-A nuclei. In the energy surfaces, calculated for 222 Ra and 222 Th, the octupole deformed minima, separated by the barriers of 150 KeV and 210 keV, respectively, have been obtained. (orig.)

  20. Radioactive decay of 223Ra by 14C emission

    International Nuclear Information System (INIS)

    Yashita, S.; Gregorich, K.; Ghiorso, A.

    1985-01-01

    Recently H.J. Rose and G.A. Jones at the University of Oxford reported the very difficult observation of an exotic radioactive decay mode in 233 Ra, its spontaneous disintegration by the emission of 14 C particles. The authors have confirmed their somewhat surprising discovery by an independent method. Within the present experimental accuracy the magnetic rigidity, energy and branching ratio support the assignment of 14 C emission from 223 Ra as proposed by the Oxford experiment

  1. Kinetic parameters of the RB and RA reactors

    Energy Technology Data Exchange (ETDEWEB)

    Petrovic, M; Obradovic, D [Institute of nuclear sciences Boris Kidric, Vinca, Beograd (Yugoslavia)

    1965-12-15

    In the paper the expressions for transfer functions of the zero power reactors, as well as power reactors of the RA reactor type are given, based on the space independent model. The modulation method for reactor transfer function measurements is explained. The results of the measurement and interpretation are given. The measurement were done on the RB and RA reactors in 'Boris Kidrich' Institute for Nuclear Sciences in Vincha (author)

  2. Communications programme for the RA nuclear reactor decommission

    International Nuclear Information System (INIS)

    Milanovic, S.; Antic, D.

    2002-01-01

    During the decommissioning of the RA research nuclear reactor at the VINCA Institute of Nuclear Sciences, an adequate number of radiation and contamination surveys should be conduced to assure radiological safety of the workers, the public and the environment. Public would like to know more about the nuclear and radiological safety. The communications programme defines the ways to informing the public, its representatives and the information media about the health and safety aspects of the activities during the RA nuclear reactor decommission. (author)

  3. Ecological Understanding 1: Ways of Experiencing Photosynthesis.

    Science.gov (United States)

    Carlsson, Britta

    2002-01-01

    Investigates 10 student teachers' understanding of the different ways in which the function of the ecosystem could be experienced. Explores the functional aspects of the ecosystem using a system approach. Concludes that the idea of transformation is crucial to more complex ways of understanding photosynthesis. (Contains 62 references.) (Author/YDS)

  4. Experienced teachers' informal learning from classroom teaching

    NARCIS (Netherlands)

    Hoekstra, A.; Beijaard, D.; Brekelmans, M.; Korthagen, F.

    2007-01-01

    The purpose of this paper is to explore how experienced teachers learn informally, and more specifically, how they learn through the activities they undertake when teaching classes. Regarding these activities we studied four aspects: behaviour, cognition, motivation and emotion. During one year,

  5. Preparing Experienced Elementary Teachers as Mathematics Specialists

    Science.gov (United States)

    Nickerson, Susan D.

    2010-01-01

    High quality teaching is critical to student learning, yet takes considerable time to develop in particular content areas. Students in high-poverty, urban settings are less likely to encounter experienced and trained teachers. Administrators from a large school district and university mathematics education faculty partnered and attempted to…

  6. Novice and experienced teachers’ views on professionalism

    NARCIS (Netherlands)

    Okas, Anne; van der Schaaf, Marieke; Krull, Edgar

    2014-01-01

    This article discusses teachers’ practical knowledge and beliefs of their profession based on reflective writings of twenty Estonian teachers.Ten novice and ten experienced teachers participated in the study. They put together their professional portfolios, which among other documents included

  7. On value differences experienced by sector switchers

    NARCIS (Netherlands)

    de Graaf, G.; van der Wal, Z.

    2008-01-01

    This article examines experienced differences in values between employees in the public and private sector. To elucidate them, the authors interviewed 30 employees of the public sector previously employed in the private sector and 30 employees of the private sector previously employed in the public

  8. Experienced Teachers' Informal Learning from Classroom Teaching

    Science.gov (United States)

    Hoekstra, Annemarieke; Beijaard, Douwe; Brekelmans, Mieke; Korthagen, Fred

    2007-01-01

    The purpose of this paper is to explore how experienced teachers learn informally, and more specifically, how they learn through the activities they undertake when teaching classes. Regarding these activities we studied four aspects: behaviour, cognition, motivation and emotion. During one year, data were collected through observations of and…

  9. Experienced discrimination in home mortgage lending

    DEFF Research Database (Denmark)

    Secchi, Davide; Seri, Raffaello

    2017-01-01

    This article proposes a framework for the analysis of experienced discrimination in home mortgages. It addresses the problem of home mortgage lending discrimination in one of the richest areas of northern Italy. Employees of a local hospital were interviewed to study their perception (or experien...

  10. A multicenter, primary-care-based, open-label study to assess the success of converting opioid-experienced patients with chronic moderate-to-severe pain to morphine sulfate and naltrexone hydrochloride extended-release capsules using a standardized conversion guide

    Directory of Open Access Journals (Sweden)

    Setnik B

    2015-07-01

    Full Text Available Beatrice Setnik,1 Carl L Roland,1 Kenneth W Sommerville,1,2 Glenn C Pixton,1 Robert Berke,3,4 Anne Calkins,5 Veeraindar Goli1,2 1Pfizer Inc, 2Duke University Medical Center, Durham, NC, USA; 3Family Health Medical Services PLLC, Mayville, 4Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, 5New York Spine & Wellness Center, Syracuse, NY, USA Objective: To evaluate the conversion of opioid-experienced patients with chronic moderate-to-severe pain to extended-release morphine sulfate with sequestered naltrexone hydrochloride (MSN using a standardized conversion guide. Methods: This open-label, single-arm study was conducted in 157 primary care centers in the United States. A total of 684 opioid-experienced adults with chronic moderate-to-severe pain were converted to oral administration of MSN from transdermal fentanyl and oral formulations of hydrocodone, hydromorphone, methadone, oxycodone, oxymorphone, and other morphine products using a standardized conversion guide. The primary endpoint was the percentage of patients achieving a stable MSN dose within a 6-week titration phase. Secondary endpoints included duration of time to stable dose, number of titration steps, safety and efficacy measures, and investigator assessment of conversion guide utility. Results: Of the 684 patients, 51.3% were converted to a stable dose of MSN (95% confidence interval: 47.5%, 55.1%. The mean (standard deviation number of days to stable dose was 20 (8.94, and number of titration steps to stable dose was 2.4 (1.37. The majority of adverse events were mild/moderate and consistent with opioid therapy. Mean pain scores at stable dose decreased from baseline. Investigators were generally satisfied with the conversion guide and, in 94% of cases, reported they would use it again. Conclusion: Conversion to MSN treatment using the standardized MSN conversion guide was an attainable goal in approximately half of the population of

  11. ANTI-HETEROGENEOUS NUCLEAR RIBONUCLEOPROTEIN B1 (ANTI-RA33 ANTIBODIES IN RHEUMATOID ARTHRITIS AND SYSTEMIC SCLEROSIS

    Directory of Open Access Journals (Sweden)

    P. A. Kuznetsova

    2017-01-01

    Full Text Available Anti-heterogeneous nuclear ribonucleoprotein (RNP autoantibodies (AAbs are encountered in many autoimmune rheumatic diseases (ARDs. The potential diagnostic value of the RA33 AAb complex consisting of RNP A2 and alternative domains of the splicing proteins RNP B1 and RNP B2 is now of interest to rheumatologists. Subjects and methods. The authors studied the frequency of anti-RNP B1 AAbs in 300 patients with systemic ARDs, including those with rheumatoid arthritis (RA, ankylosing spondylitis (AS, systemic lupus erythematosus (SLE, systemic sclerosis (SSc, and Sjö gren's syndrome (SS and in 53 people without ARDs, who constituted a control group. Serum anti-RNP B1 AAbs were assessed by enzyme immunoassay. Results and discussion. The frequency of anti-RNP B1 AAbs in patients with ARDs was much higher than that in the control group: 170/300 (56.6% and 8/53 (13% patients, respectively. Anti-RNP B1 AAbs were detected in 78.5% (113/144 of the patients with RA; 40.3% (23/57 of those with AS, in 67.5% (27/40 of those with SSc, in 36.4% (16/44 of those with SLE, and in 13.3% (2/15 of those with SS. The diagnostic sensitivity of the marker for RA was 78.5%, its diagnostic specificity was 84.9%; the likelihood ratio of positive and negative results was 5.24 and 0.24, respectively. In the patients with RA, the level of anti-RNP B1 AAbs significantly correlated with that of C-reactive protein and erythrocyte sedimentation rate, while in those with SSc the detection of anti-RNP B1 AAbs was related to the rigidity of the vascular wall and the presence of hypertension. The frequency of anti-RNP B1 AAbs among the RA patients seronegative for rheumatoid factor and anti-cyclic citrullinated peptide antibodies was 15.4%. Conclusion. Anti-RNP B1 AAs are a useful laboratory marker (with the upper limit of the normal range being 3.3 U/ml, but are of limited value in the diagnosis of RA. Anti-RNP B1 AAbs may be regarded as an additional diagnostic marker for RA.

  12. Effective 226Ra-content of some Hungarian building materials

    International Nuclear Information System (INIS)

    Toth, A.; Feher, I.

    1976-01-01

    The aim of the work was to analyse the effective 226 Ra content of building- and back filling materials used in Hungary. The quantity of radon was determined by ionization chambers connected to vibrating-reed electrometers, as well as by a scintillation radon counter. The radon measuring instruments were calibrated by known 222 Rn quantities given off from standard RaCl 2 solutions. The overall uncertainty of the data obtained is estimated as being 25%. The minimum measurable effective 226 Ra concentration due to a 10 4 g building material source is calculated as 16 fCi/g for the ionization chambers and 8 fCi/g for the scintillation counter. 68 building material samples and 11 backfill (concrete made by fly-ashes) samples have been studied and it has been found, that the effective 226 Ra contents of the tested building materials are 2 to 9 times greater than those found in the Soviet Union though none exceeds the recommended 600 fCi/g level. Among the back filling materials made with fly-ash the maximum 226 Ra content was 3300 fCi/g. The effective 226 Ra content measurements are well suited for a priori radon escape qualification of building materials. (K.A.)

  13. Argonne-Utah studies of 224Ra endosteal surface dosimetry

    International Nuclear Information System (INIS)

    Schlenker, R.A.; Smith, J.M.

    1984-01-01

    The activities of 212 Pb relative to 224 Ra and of 222 Rn relative to 226 Ra were measured in bone surface deposits 24 h after radium injection into beagles. The fractional retention of 220 Rn atoms was measured in vitro with hydrated and dehydrated bone samples to determine the effect of water content on the escape of radon from bone surfaces. The experimental data suggest that substantial 224 Ra daughter product disequilibrium exists in bone surface deposits. Estimates for the lower and upper limits on the fractional retention of 220 Rn in vivo are 0.05 and 0.25, respectively. The average bone surface activity of 212 Pb relative to 224 Ra ranged from 0.34 to 0.71 for four dogs, with the majority of the values toward the low end of the range. Only a small portion of the deposited 212 Pb came from lead in the injection solution despite near equilibrium between 224 Ra and its daughters at the time of injection. The retention data indicate that the endosteal tissue dose rate in the dogs at one day was actually one-third to about one-half that which would be calculated assuming equilibrium of 224 Ra daughter products in bone surface deposits. 11 references, 2 figures, 7 tables

  14. Argonne-Utah studies of 224Ra endosteal surface dosimetry

    International Nuclear Information System (INIS)

    Schlenker, R.A.; Smith, J.M.

    1985-01-01

    The activities of 212 Pb relative to 224 Ra and of 222 Rn relative to 226 Ra were measured in bone surface deposits 24 h after injection of radium into beagles. The fractional retention of 220 Rn atoms was measured in vitro with hydrated and dehydrated bone samples to determine the effect of water content on the escape of radon from bone surfaces. The experimental data suggest that substantial 224 Ra daughter-product disequilibrium exists in bone surface deposits. Estimates for the lower and upper limits on the fractional retention of 220 Rn in vivo are 0.05 and 0.25, respectively. The average bone surface activity of 212 Pb relative to 224 Ra ranged from 0.34 to 0.71 for four dogs, with the majority of the values toward the lower end of the range. Only a small portion of the deposited 212 Pb came from lead in the injection solution despite near equilibrium between 224 Ra and its daughters at the time of injection. The retention data indicate that the endosteal tissue dose rate in the dogs at one day was actually one-third to about one-half that which would be calculated assuming equilibrium of 224 Ra daughter products in bone surface deposits. 11 references, 2 figures, 7 tables

  15. 226Ra chronology of a coastal marine sediment

    International Nuclear Information System (INIS)

    Koide, M.; Bruland, K.; Goldberg, E.D.

    1976-01-01

    Unsupported 226 Ra (tsub (1/2) = 1620 years) in marine sediments can provide a basis for measuring rates of accumulation of the order of centimeters per thousand years. The excess radium apparently enters the sediments incorporated in phytoplankton. The sensitivity of the method depends upon the initial value of the unsupported 226 Ra and of the value of 230 Th, a parent of 226 Ra, in the sedimentary components. 226 Ra dating was applied to a sediment taken from the slope of the San Clemente Basin in the Southern California coastal region. Rates of sedimentation over two half-lives of the nuclide were found to be either 5.2 or 5.3 cm/1000 years depending upon which of two models for the geochronology is used. One model assumes that the 230 Th brings to the deposit an amount of 226 Ra in equilibrium with it. The other is based upon the growth of the 226 Ra from the 230 Th in the sedimentary components. 238+239 Pu and 210 Pb levels in the upper strata indicated sedimentation rates of the order of 100-500 cm/1000 years, i.e. much faster accumulations. It is suggested that these derived rates are spurious and reflect bioturbative activities of surface-living organisms. (Auth.)

  16. 210Pb and 226Ra distributions in the circumpolar waters

    International Nuclear Information System (INIS)

    Chung, Y.

    1981-01-01

    210 Pb and 226 Ra profiles have been measured at five GEOSECS stations in the Circumpolar region. These profiles show that 226 Ra is quite uniformly distributed throughout the Circumpolar region, with slightly lower activities in surface waters, while 210 Pb varies with depth as well as location or area. There is a subsurface 210 Pb maximum which matches the oxygen minimum in depth and roughly correlates with the temperature and salinity maxima. This 210 Pb maximum has its highest concentrations in the Atlantic sector and appears to originate near the South Sandwich Islands northeast of the Weddell Sea. Concentrations in this maximum decrease toward the Indian Ocean sector and then become fairly constant along the easterly Circumpolar Current. Relative to 226 Ra, the activity of 210 Pb is deficient in the entire water column of the Circumpolar waters. The deficiency increases from the depth of the 210 Pb maximum toward the bottom, and the 210 Pb/ 226 Ra activity ratio is lowest in the Antarctic Bottom Water, indicating a rapid removal of Pb by particulate scavenging in the bottom layer and/or a short mean residence time of the Antarctic Bottom Water in the Circumpolar region. 226 Ra is essentially linearly correlated with silica and barium in the Circumpolar waters. However, close examination of the vertical profiles reveals that Ba and Si are more variable than 226 Ra in this region. (orig.)

  17. Argonne-Utah studies of 224Ra endosteal surface dosimetry

    International Nuclear Information System (INIS)

    Schlenker, R.A.; Smith, J.M.

    1986-01-01

    The activities of 212 Pb relative to 224 Ra and of 222 Rn relative to 226 Ra were measured in bone surface deposits 24 h after radium injection into beagles. The fractional retention of 220 Rn atoms was measured in vitro with hydrated and dehydrated bone samples to determine the effect of water content on the escape of radon from bone surfaces. The experimental data suggest that substantial 224 Ra daughter product disequilibrium exists in bone surface deposits. Estimates for the lower and upper limits on the fractional retention of 220 Rn in vivo are 0.05 and 0.25, respectively. The average bone surface activity of 212 Pb relative to 224 Ra ranged from 0.34 to 0.71 for four dogs, with the majority of the values toward the low end of the range. Only a small portion of the deposited 212 Pb came from lead in the injection solution despite near equilibrium between 224 Ra and its daughters at the time of injection. The retention data indicate that the endosteal tissue dose rate in the dogs at one day was actually one-third to about one-half that which would be calculated assuming equilibrium of 224 Ra daughter products in bone surface deposits. (orig.)

  18. Assessing Medication Adherence in Patients with Rheumatoid Arthritis (RA)

    Science.gov (United States)

    2017-04-26

    35.4) 53 (64.6) Vrrywtilk Weak Moder; lte Strona VerySlronl • Fisher’. 1txllC1 test • MMAS8 and CQR19 taking and dosing group assignments were...eported meaSlle 01 medICation adherence Med Care 1966.2467_74 Morl6ky DE. OJMalteo MR Improving the measurement of ult.,epor1ed medICation nonadherence

  19. Operation and maintenance of the RA reactor; Pogon i odrzavanje reaktora RA

    Energy Technology Data Exchange (ETDEWEB)

    Petrovic, M; Zecevic, V [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1961-12-15

    During 1961 the RA reactor was used for irradiation of samples for 258 users ( from which 188 from the Institute) and for 34 experiments, this means productions of 5958 MWh. The production was almost four times bigger than during previous year due to the demand of the Laboratories of the Institute. Burnup of the fuel from the first batch was about 30%. This means that the operation time could be much higher. Number of safety shut-downs was 11. The reasons were related to electrical faults, 9 occurrences, failure of the instrument for reactor period measurement, once, and failure of the pump once. This report covers state and operation data of the reactor components, control instruments, devices for reactor protection, dosimetry, heavy water system, helium system, mechanical and electrical equipment. Problems related to training of the staff and lack of personnel are mentioned as well.

  20. Temperature reactivity coefficient of the RA reactor; Temperaturni koeficijenat reaktivnosti reaktora RA

    Energy Technology Data Exchange (ETDEWEB)

    Raisic, N; Strugar, P; Dobrosavljevic, N [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1961-12-15

    Temperature reactivity coefficient of the RA reactor was determined as follows. Stabilization of moderator temperature and graphite reflector was achieved in the reactor operated at power levels of 20, 100, 500, 1000, 3000 and 5000 kW. Temperature change of the moderator was achieved by changing the water flow rate in the secondary cooling system. The fuel temperature was changed simultaneously. During the measurement at each power level the temperature change was between 30 - 50 deg C. Changing the position of the automated regulator is registered during moderator temperature change, and these changes were used for determining the total reactivity change by using the calibration curves for the automated regulator. In the measured temperature range the the reactivity change was linear and it was possible to determine the total temperature coefficient.

  1. Guayaquil au temps du choléra

    Directory of Open Access Journals (Sweden)

    1996-01-01

    Full Text Available L’épidémie de choléra survenue en 1991 en Équateur a frappé certaines villes et régions plus que d’autres sur la Côte. Guayaquil, la première ville du pays par le nombre de ses habitants (1 600 000 habitants, a connu le record de cas. L’analyse de la répartition des malades hospitalisés dans la ville montre que les quartiers pauvres, récents et, de surcroît, bâtis sur les eaux polluées du delta ne sont pas les plus frappés alors que la zone centrale taudifiée a concentré un nombre de cas élevé. Les pratiques sociales sont-elles davantage responsables de cette situation que les facteurs pourtant très contraignants ici de l’environnement ? GUAYAQUIL EN LOS TIEMPOS DEL CÓLERA. La epidemia del cólera, ocurrida en 1991 en Ecuador, ha golpeado mucho más algunas ciudades y regiones de la Costa. Guayaquil, la primera ciudad del país con 1 600 000 habitantes, ha conocido un número de casos record. El análisis de la distribución de los enfermos hospitalizados en la ciudad revela que los barrios pobres, recientes y además construidos sobre las aguas contaminadas del delta no son los más afectados por esta epidemia en relación con la parte central tugurizada. Las prácticas sociales tal vez tienen más responsabilidad en esta situación que las condiciones particularmente difíciles del medio ambiente. GUAYAQUIL DURING THE CHOLERA. The cholera epidemic, which occured in 1991, impacted some cities and regions of the coast much more than others. Guayaquil, inhabitants Ecuador's largest city with a population of some 1, 6000 000 inhabitants, experienced a record number of cases. An analysis of the sick hospitalized in this city reveals that the poor urban sections, which were built recently and moreover were constructed upon the contaminated waters of the delta, were not the most affected by this epidemic, particularly when compared to the congested central part of the city. This suggests that social practices were more

  2. Using 226Ra/228Ra disequilibrium to determine the residence half-lives of radium in vegetation compartments

    International Nuclear Information System (INIS)

    Baeza, A.; Barandica, J.; Paniagua, J.M.; Rufo, M.; Sterling, A.

    1999-01-01

    The concentrations of 226 Ra and 228 Ra were studied in different vegetation compartments and in available and non-available soil fractions in a Mediterranean scrubland ecosystem. A high percentage of the plant samples showed an apparent discrimination in favour of 226 Ra over 228 Ra. A linear compartmental model was applied to the soil-plant system. It allowed us to explain why these discrimination coefficients differed from unity, to obtain the residence half-lives of radium in the different compartments, to estimate the age of the plants, and to simulate the temporal evolution of the radioactive concentrations in each compartment. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

  3. RA reactor operation and maintenance in 1992, Part 1; Deo 1 - Pogon i odrzavanje nuklearnog reaktoro RA u 1992. Godini

    Energy Technology Data Exchange (ETDEWEB)

    Sotic, O; Cupac, S; Sulem, B; Zivotic, Z; Majstorovic, D; Tanaskovic, M [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1992-12-01

    During 1992 Ra reactor was not in operation. All the activities were fulfilled according to the previously adopted plan. Basic activities were concerned with revitalisation of the RA reactor and maintenance of reactor components. All the reactor personnel was busy with reconstruction and renewal of the existing reactor systems and building of the new systems, maintenance of the reactor devices. Part of the staff was trained for relevant tasks and maintenance of reactor systems. [Serbo-Croat] U toku 1992 godine poslovi u okviru projekta 'Istrazivacki nuklearni reaktor RA' obavljani su u skladu sa programom i planom rada. Osnovne aktivnosti na kojima je radjeno odnosile su se na revitalizaciju reaktora RA, kao i na odrzavanje opreme. U ovom periodu reaktor nije bio u pogonu. Svo osoblje je bilo angazovano na poslovima rekonstrukcije i modernizacije postojecih i dogradnje novih reaktorskih sistema, na odrzavanju opreme a deo tehnickog osoblja je bio obucavan za vrsenje odgovarajucih poslova u pogonu i odrzavanju opreme.

  4. O pensamento desenvolvimentista de Raúl Prebisch Raúl Prebisch's thought on development

    Directory of Open Access Journals (Sweden)

    Joaquim Miguel Couto

    2007-04-01

    Full Text Available As idéias do economista argentino Raúl Prebisch (1901-1986 sempre estiveram voltadas para a ação. As dificuldades encontradas diante de problemas concretos (durante a crise dos anos 1930, tornaram Prebisch um homem prático. Assim, suas teorias sobre a substituição de importações, o sistema centro-periferia e a criação de um mercado comum latino-americano, possuíam um grande sentido de influenciar a realidade. A única exceção coube a sua "Teoria da Transformação", construída no último decênio de sua vida. Nesta, Prebisch se afasta da realidade e teoriza sobre a criação de um novo sistema econômico, através de uma síntese entre socialismo e liberalismo.The Argentinean economist Raúl Prebisch’s (1901-1986 ideas were always gone back to the action. Difficulties facing concrete problems made him a pragmatic man. Thus, his theories about import substitution, core-periphery system and the creation of a common Latin-American market, were embodied in a great purpose of influencing the reality. The only exception was the "Theory of Transformation", which was built in the last decade of this life. There, Prebisch moves off practical matters and speculates about the creation of a new economic system, through a synthesis of socialism and liberalism.

  5. RA reactor kinetic parameters - Progress report; Kineticki parametri reaktora RA - Izvestaj o napredovanju -

    Energy Technology Data Exchange (ETDEWEB)

    Petrovic, M; Obradovic, D; Jevtovic, V; Velickovic, Lj [Institute of nuclear sciences Boris Kidric, Vinca, Beograd (Yugoslavia)

    1965-11-15

    The objective of nuclear reactor kinetics study is to analyze the stability of reactor operation in practice. The obtained parameters should define the needed properties of automatic control system relevant for the stability of the designed reactor system. Refining the analytical models is done by using the analysis and interpretation of experimental data. Results of measured the reactor response obtained by using the reactor oscillator ROB-1 are explained by using the space independent model of the zero power reactor, by power reactor model with one feedback circuit, and by a complex model. It was assumed that the perturbations of the system are small and that linearized kinetic equations could be used. Linearized kinetic equation of the reactor system are transformed into the frequency region in order to analyze the measured values directly. The objective of this paper is to measure the RA reactor kinetics parameters, and analyze the stability of reactor operation at power levels high than nominal. Istrazivanja u oblasti kinetike nuklearnih reaktora imaju za cilj da dovedu analizu stabilnosti rada reaktora na nivo 'radne tehnologije'. Dobijeni pararametri treba da specificiraju potrebne karakteristike sistema automatske kontrole za odgovarajucu stabilnost projektovanog reaktorskog sistema. Doterivanjem analitickih modela do takvog nivoa da se zapazeni fenomeni mogu anailitcki predvideti ide preko analize i interpretacije eksperimentalnih podataka. Eksperimentalni rezultati merenja odziva reaktora, izvedeni reaktorskim oscilatorom ROB-1, interpretirani su na osnovu prostorno nezavisnog modela za reaktor nulte snage, modelom reaktora snage sa jednim kolom povratne sprege, kao i kompleksnim modelom. U ovom radu se poslo od toga da su perturbacije parametara sistema male, pa se mogu upotrebiti linearizovane kineticke jednacine. Linearizovane kineticke jednacine reaktorskog sistema transformirane su u frekventno podrucje s ciljem direktne analize mernih rezultata

  6. Bioavailability of radionuclides 226Ra, 228Ra and 210Pb present in the brazilian phosphate fertilizers and phosphogypsum

    International Nuclear Information System (INIS)

    Russo, Ana Carolina

    2013-01-01

    Phosphogypsum, also called gypsum, by-product of the phosphate fertilizer industry, can be used as soil conditioner since it provides improvements in the soil-plant system. However, this by-product concentrates radionuclides of the U and Th series, present in the phosphate rock used as raw material, which can impact the environment. In order to study the bioavailability of radionuclides, samples of phosphogypsum and phosphate fertilizers (monoammonium phosphate and triple superphosphate) were analyzed. The concentration of 226 Ra, 228 Ra and 210 Pb were determined by gamma spectrometry. The samples were leached with a mild EDTA solution and the radionuclides present in the final solution were determined by total alpha and beta counting on a gas flow proportional counter. The percentage of extraction varied from 1.6% to 1.7% for 210 Pb, from 0.5% to 1.4% for 226 Ra and from 0.1% to 1.0% for the 228 Ra in phosphogypsum samples. The low percentage of extraction obtained for the radionuclides can be partly explained by the low solubility of phosphogypsum, which ranged from 7.7% to 16%. For the monoammonium phosphate samples the percentage of extraction were less than 26% for 226 Ra, less than 10% for '2 28 Ra and less than 10% for 210 Pb. In spite of the high solubility of 77% of monoammonium phosphate in the EDTA solution, low concentrations of radionuclides were observed in the leached solution. For the triple superphosphate samples, the percentage of extraction was 2.3% for 226 Ra, 1.2% for 228 Ra and 11.3% for 210 Pb. In spite of the high solubility of 66% of triple superphosphate in the EDTA solution, low concentrations of radionuclides were observed in the leached solution. (author)

  7. Late excretion rates of 226Ra and 210Pb following occupational or iatrogenic exposure. I. 226Ra

    International Nuclear Information System (INIS)

    Holtzman, R.B.; Sha, J.Y.; Markun, F.

    1982-01-01

    The urinary and fecal excretion rates of 226 Ra have been determined for 53 subjects who had been exposed to 226 Ra; 25 had been radium dial painters, 16 were iatrogenic (medical) cases and 12 were former radium chemists. The mean coefficient of elimination, CE (fraction of body content excreted annually), was significantly lower for the medical cases than for dial painters. The mean ratio of urinary-to-fecal excretion rates was 3.0 +- 0.7%

  8. Therapy palliative with {sup 2}23Ra without special radiation protection measures?; Palliative Therapie mit {sup 223}Ra ohne besondere Strahlenschutzmassnahmen?

    Energy Technology Data Exchange (ETDEWEB)

    Just, Guenther [Forschungsbuero Radonbalneologie (FRB), Grosspoesna (Germany); Petzold, Juergen

    2015-07-01

    For nearly 2 years now as a therapy of the castration resistant prostata carcinoma a nuclide therapy with {sup 223}Ra-Dichloride (trade-mark Xofigo) is applied. Xofigo is applied by a medical specialist for nuclear medicine altogether 6 times in a monthly distance. The activity used in each case is according to the body weight (50 kBq/kg BW). This therapy is licensed by the supervisory authorities of the German federal countries as an ambulant therapy. Special radiation protection measures are only required when exceeding a given number of 17 patients per year as incorparation measurements.

  9. Systematic review and network meta-analysis of combination and monotherapy treatments in disease-modifying antirheumatic drug-experienced patients with rheumatoid arthritis: analysis of American College of Rheumatology criteria scores 20, 50, and 70

    Science.gov (United States)

    Orme, Michelle E; MacGilchrist, Katherine S; Mitchell, Stephen; Spurden, Dean; Bird, Alex

    2012-01-01

    Background Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritis patients with suboptimal response or intolerance to conventional DMARDs. The objective of this systematic review and meta-analysis was to compare the relative efficacy of EU-licensed bDMARD combination therapy or monotherapy for patients intolerant of or contraindicated to continued methotrexate. Methods Comprehensive, structured literature searches were conducted in Medline, Embase, and the Cochrane Library, as well as hand-searching of conference proceedings and reference lists. Phase II or III randomized controlled trials reporting American College of Rheumatology (ACR) criteria scores of 20, 50, and 70 between 12 and 30 weeks’ follow-up and enrolling adult patients meeting ACR classification criteria for rheumatoid arthritis previously treated with and with an inadequate response to conventional DMARDs were eligible. To estimate the relative efficacy of treatments whilst preserving the randomized comparisons within each trial, a Bayesian network meta-analysis was conducted in WinBUGS using fixed and random-effects, logit-link models fitted to the binomial ACR 20/50/70 trial data. Results The systematic review identified 10,625 citations, and after a review of 2450 full-text papers, there were 29 and 14 eligible studies for the combination and monotherapy meta-analyses, respectively. In the combination analysis, all licensed bDMARD combinations had significantly higher odds of ACR 20/50/70 compared to DMARDs alone, except for the rituximab comparison, which did not reach significance for the ACR 70 outcome (based on the 95% credible interval). The etanercept combination was significantly better than the tumor necrosis factor-α inhibitors adalimumab and infliximab in improving ACR 20/50/70 outcomes, with no significant differences between the etanercept combination and certolizumab pegol or tocilizumab. Licensed-dose etanercept, adalimumab

  10. Att vara "container" för patienten : En studie om hur sjukhuskuratorer upplever att de påverkas av det patientnära arbetet

    OpenAIRE

    Eriksson, Oskar; Holmstedt, Markus

    2015-01-01

    Sjukhuskuratorer har samtal med patienter som lider till exempel av depression, ångest eller andra besvär orsakade av psykosociala faktorer så som stress, livskriser eller alkohol. I denna studie ställdes frågan vilka effekter det patientnära arbetet kan ha för sjukhuskuratorn. Syftet var att utifrån ett emotionsteoretiskt perspektiv undersöka hur sjukhuskuratorer upplever att de påverkas av det patientnära arbetet. I studien ställdes frågan vad sjukhuskuratorer upplever att det patientnära a...

  11. Clinical and subclinical neuropsychiatric abnormalities in rheumatoid arthritis patients

    Directory of Open Access Journals (Sweden)

    Eman M Khedr

    2015-01-01

    Conclusion Cognitive impairment, depression, anxiety and peripheral neuropathy are common in RA patients. Early diagnosis and management of neuropsychiatric disorders in RA patients may greatly improve the patients′ health-related quality of life.

  12. Deprivation as un-experienced harm?

    DEFF Research Database (Denmark)

    Keerus, Külli; Gjerris, Mickey; Röcklinsberg, Helena

    2017-01-01

    Tom Regan encapsulated his principle of harm as a prima facie direct duty not to harm experiencing subjects of a life. However, his consideration of harm as deprivation, one example of which is loss of freedom, can easily be interpreted as a harm, which may not be experienced by its subject....... This creates a gap between Regan’s criterion for moral status and his account of what our duties are. However, in comparison with three basic paradigms of welfare known in nonhuman animal welfare science, Regan’s understanding coheres with a modified version of a feelings-based paradigm: not only the immediate...... feelings of satisfaction, but also future opportunities to have such feelings, must be taken into account. Such an interpretation is compatible with Regan’s understanding of harm as deprivation. The potential source of confusion, however, lies in Regan’s own possible argumentative mistakes....

  13. Operation and maintenance of the RA reactor, RA Research reactor. Annual report 1976; Pogon i odrzavanje reaktora RA, Izvestaj o radu u 1976. godini

    Energy Technology Data Exchange (ETDEWEB)

    Martinc, R [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1976-12-15

    During 1976 the Ra reactor was operating for about 30% shorter period than usual. The reason were extraordinary repair activities within regular and investment maintenance as well as repair of failures caused by neglected maintenance during previous 6 years. Delay was caused by unavailability of fuel (2% enriched fuel elements are spent) and the new 80% enriched fuel demanded experimental and theoretical analyses before being introduced into the core. Safety analyses concerned with using 80% enriched fuel both experimental and the